All radiology equipment in Ontario is regulated by the Ontario Ministry of Health and Long-Term Care through the Healing Arts and Radiation Protection (HARP) Commission and the HARP Act, which was enacted in 1990. Among other things, HARP classifies all CT equipment — including cone-beam CT — into a single category.
In 2005, amid growing concerns about radiation exposure, the Ontario director of x-ray safety requested that the HARP Commission review the health and safety issues related to the ordering
and operation of dental CT scanners in dental offices. In early 2006, the ministry received a letter from the chair of the HARP Commission requesting that a moratorium be placed on the designation of dental CT scanners in dental facilities but not prohibiting the purchase of dental CT systems.
“This is completely ‘cart before the horse.”— Ernest Lam, DMD, PhD, University
In May 2006, the HARP Commission submitted to the health ministry an interim report outlining public safety concerns with the use of this technology in a dental setting. In 2007, the HARP Commission and the Diagnostic Imaging Safety Committee did its own review of cone-beam CT and concluded that only oral and maxillofacial radiologists have the necessary training to order and operate dental CT systems.
“Compared to CT scanners used for body imaging, dental CBCT scanners are relatively simple and use significantly lower radiation doses to produce high-resolution images. Image acquisition is almost completely automated, with a limited number of parameters that can be adjusted,” the committee noted in a 2007 report. “However, if dental CBCT scanners become readily available for use by general dentistry practices, it is possible that this technology will replace panoramic radiology for conventional diagnostic dental examinations. This raises concerns about a potential increase in patient and population exposure to radiation.”
Also of concern “is the current lack of training for general dentists in the interpretation of images generated by dental CBCT scanners,” the committee noted. “Within the dental profession, the specialty of oral and maxillofacial radiology has training in both the application and the interpretation of images produced by dental CBCT scanners.”
Following the committee’s recommendations, the ministry altered the moratorium to allow dentists who are also oral and maxillofacial radiologists to install and utilize cone-beam CT systems, according to David Jensen, media relations coordinator for the ministry of health.
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