Dr. Michael Bornstein is a Clinical Professor in Oral Maxillofacial Radiology and Associate Dean for Research and Innovation at the University of Hong Kong. He has followed the ongoing evolution of low dose CBCT imaging closely, encourages all clinicians to increase their use of dose limitation measures, and states that patient doses will only continue to get lower going forward.
Dr. Bornstein is one of the leading CBCT imaging experts in the dental community. He was also one of the speakers at Planmeca’s stand at IDS 2019 in Cologne, Germany, with a presentation entitled Low dose CBCT protocols in dental medicine and their impact on daily clinical practice. It covered the changes and paradigm shifts that have taken place in the field of dental 3D imaging, with a particular emphasis on low dose protocols.
Cone beam computed tomography – or CBCT – is an imaging technique that has been a game-changer in dentistry over the last decades. It has allowed clinicians to easily acquire three-dimensional images that have a significantly higher diagnostic value than traditional 2D images.
However, this improvement is not one completely without downsides as the additional dimension comes at the cost of higher effective patient doses. Their exact biological effects have been hard and sometimes even impossible to measure, but potential harm from radiation dose levels still should not be ignored.
Although the risks of CBCT imaging are very small to individuals, they are still significant when examined in the context of large population bases. Dr. Bornstein states that 6 to 8 patients per million are at risk of getting cancer that is related to dental imaging in their lifetime. This is why ways to reduce patient doses without losing diagnostic image quality are considered so valuable.
Over the past five years, there has been an ongoing shift in the minds of radiologists from ALARA to ALADA – from capturing images that are As Low As Reasonably Achievable to As Low As Diagnostically Acceptable.
You could even say that finding an optimal balance between image quality and dose is at the core of modern dental imaging. Dr. Bornstein’s own research has indicated that images can be diagnosed as intended also when using ultra low dose imaging protocols.
From low to ultra low
The Planmeca Ultra Low Dose imaging protocol has been leading the way in patient dose minimisation over the last five years. According to research done by John Barrett Ludlow and Juha Koivisto a few years back, a mean dose reduction of 77% can be achieved using it as part of CBCT imaging. This figure is set to improve further with Planmeca’s R&D team steadily working towards new technological breakthroughs.
Dr. Bornstein views low dose imaging not only as a mere technological question but also one intricately related to usability. “We all talk about digital workflows, but they are not always that easy to implement. That is why they need to be straightforward and intuitive. I think it is safe to say that our smartphones, for example, would have never become so popular if they would be very difficult to use.”
It was always possible to manually adjust the dose levels of various X-ray units, but this was just not that easy. Various manufacturers have also struggled to maintain a diagnostically acceptable image quality at lower doses.
In turn, deploying Planmeca Ultra Low Dose is as easy as pressing a button. It can be used with any resolution or volume size, as the protocol does not rely on taking fewer frames or using a smaller rotational angle to lower the patient dose.
“Planmeca was one of the first to come up with a pre-set modality that makes it very easy to apply dose limitation measures. By doing this, they were also leading the path for many others.”
The broad field of radiology
Dr. Bornstein went to dental school at the University of Basel in his native country of Switzerland and then proceeded his studies to become an oral surgeon. Working as a dentist further expanded his interests and led him to the world of oral maxillofacial radiology and diagnostic imaging.
He quickly noticed that radiology is a quite extensive discipline that encompasses not only 2D and 3D X-ray imaging but also ultrasound and magnetic resonance imaging in some countries.
“Radiology is a broad and challenging field. Because it is so technically-driven, it is also very innovative. I think these factors together have kept me so interested and enthusiastic about it,” Dr. Bornstein elaborates.
Although he now resides in Asia, IDS still holds a special significance for Dr. Bornstein – as is the case for countless other dental professionals worldwide. In fact, he has witnessed the international atmosphere significantly strengthen at the exhibition over the years.
“Being from Switzerland, IDS has always been on my agenda, although I don’t go every time. In contrast to many other fairs and exhibitions, it seems to still be growing, and has become more and more international,” Dr. Bornstein comments.
“20 years ago, IDS was still very European and German-centric. Now, I think it has become much more of a global village for dentistry.”
No limit to how low doses can go
Although significant strides have already been made in lowering patient doses to levels unimaginable in previous decades, Dr. Bornstein still sees much room for improvement ahead.
“I would say there is no limit really to how much lower doses can go. 10 years ago, nobody would have even said that ultra low dose imaging would provide reasonable image quality, so I hope this shift will continue,” he says.
“Maybe in 10 or 20 years the term low dose will not even be applied anymore, because all 3D imaging will be low dose. Maybe the low doses we talk about today are the regular doses of the future.”
Originally from Basel, Switzerland, Dr. Michael Bornstein is an oral surgeon turned radiology expert. He headed the Section of Dental Radiology and Stomatology at the University of Bern from 2007 to 2014. Currently, Dr. Bornstein holds the position of Clinical Professor in Oral Maxillofacial Radiology and is Associate Dean for Research and Innovation at the University of Hong Kong’s Faculty of Dentistry. His key fields of research include dental CBCT imaging, stomatology, GBR procedures, and dental implants. During his academic career, he has thus far published over 140 original articles and also authored numerous case reports, review articles, and book chapters.