Abstract
The purpose of this study was to review and compare the properties of all the available cone beam CT (CBCT) devices offered on the market, while focusing especially on Europe. In this study, we included all the different commonly used CBCT devices currently available on the European market. Information about the properties of each device was obtained from the manufacturers’ official available data, which was later confirmed by their representatives in cases where it was necessary. The main features of a total of 47 CBCT devices that are currently marketed by 20 companies were presented, compared and discussed in this study. All these CBCT devices differ in specific properties according to the companies that produce them. The summarized technical data from a large number of CBCT devices currently on the market offer a wide range of imaging possibilities in the oral and maxillofacial region.
Keywords: radiology, three-dimensional imaging, cone beam computed tomography, tomography scanners
Introduction
Until recently, oral and maxillofacial radiology was based on two-dimensional (2D) imaging, such as intraoral and panoramic radiographs. Owing to the complex anatomy in the oral and maxillofacial region, a shift from 2D to three-dimensional (3D) imaging evolved.
Although dental CT and, specifically, multislice CT (MSCT) have provided much useful information in the investigation of oral and maxillofacial pathology, the possibly higher radiation dose is a currently discussed disadvantage of this technique. Moreover, MSCT requires considerable space and is expensive, and therefore is used relatively rarely for oral and maxillofacial pathology compared with conventional radiographs.
More recently, an imaging technique called cone beam CT (CBCT) has been developed. CBCT devices perform not as a substitute for MSCT, but, rather, as a complement to MSCTs in the oral and maxillofacial region. CBCT technology provides excellent imaging frequently, but not always, at reduced radiation doses, and at a lower cost than MSCT.1,2
The technique used in CBCT has been applied in medical imaging since 1982.3 In the dental field, CBCT applications range from implant planning, pain diagnosis and periodontitis as well as ectopic and impacted teeth, facial fractures, temporomandibular joint disorders and orthodontics to oral and maxillofacial surgery, including image-guided surgery.4–7
Since its introduction, the continuous development of CBCT has led to a high number of different CBCT devices. In 2005, 4 main CBCT devices were reported in the literature,8 while, in July 2008, 16 companies were producing 23 of these devices.
Over the last several years, CBCT began to have applications in general radiology, particularly in otolaryngological, musculoskeletal, breast, respiratory and cardiac imaging.9–13 CBCT has also been used in spinal surgery.14
Manufacturers strongly advertise their own CBCT devices but do not offer the same extensive view of the technical properties of these devices to practitioners as that which is typically offered for MSCT.
This technical note was written to provide a comparative overview of information about the currently available CBCT devices and their properties.
Materials and methods
The medical literature about the properties of available CBCT devices used in maxillofacial applications was reviewed. A PubMed search (National Library of Medicine, National Center for Biotechnology Information, new PubMed system) was conducted, and there were no recent studies found that described and compared the properties of all CBCT devices currently available on the market.
Subsequently, all the CBCT devices that were most frequently sold in the period 2005–2012 in Europe have been included in this study.
Information about each CBCT device was first collected from official web sites and from the company’s official available data. Most of the missing or incomplete data were completed and verified at the International Dental Show in Cologne, Germany, in 2009 and in 2011, at the European Congress of Radiology in Vienna, Austria, in 2011, as well as at the European Congress of DentoMaxilloFacial Radiology in Leipzig, Germany, in 2012. E-mails were sent to each official representative of the companies for validation of the information about the properties of each CBCT device.
The variety of information that was collected about all these devices can be seen in Table 1.
Table 1.
Properties for the cone beam CT devices that were included in this study
| Properties | Measurements units | Remarks |
| Manufacturer | Trade name, company, country | |
| Costs | Euro | Suggested price |
| Dimensions | m kg−1 | Size and weight |
| Field of view CT height | cm | Some devices allow stitching |
| Field of view CT diameter | cm | Some devices allow stitching |
| Detector type | Type | |
| Greyscale depth | Bit | Maximum |
| Voxel size | mm | Minimum size |
| Tube potential | kV | Range from ... to ... |
| Tube current | mA | Range from ... to ... |
| Focal spot | mm | Size from ... to ... |
| Rotation angle | ° | |
| Patient positioning | Supine/seated/standing | |
| Panoramic separate detector | Yes/no | To obtain panoramic images |
| Cephalometric separate detector | Yes/no | To obtain cephalometric images |
| Pre-installed software | Name | |
| Scan time | s | Movement of tube |
| Reconstruction time | s | Probably dependent on PC |
| Pulsed beam | Yes/no | |
| Images acquired during scan | Number | |
| Effective exposition time | s | Radiation time |
| Effective radiation dosea | μSv | As provided by manufacturer |
PC, personal computer.
International Commission on Radiological Protection publication no. 103 was used to calculate the radiation dose.15
After gathering the information about the properties of each CBCT device, a database sheet was developed to present these properties and to facilitate the comparison across devices.
Results
There were 20 manufacturers offering a total of 47 devices (2.4 units per manufacturer) produced in 7 different countries (Japan, Korea, Finland, USA, France, Italy, Germany). Japan had the highest production number, with 12 different devices followed by Korea, Finland, USA, France and Italy. Germany had the lowest number (three devices) among these countries. Asahi Roentgen and Vatech are the companies that produced the most varieties of CBCT devices (Table 2).
Table 2.
The properties of cone beam CT devices
| Trade name | Manufacturer | Costs (€) | Size (m) H × W × D | Weight (kg) | Greyscale (bit) | Voxel size (mm) | FOV CT height (cm) | FOV CT DM (cm) | Detector CT | Tube potential (kV) | Tube current (mA) | Focal spot (mm) |
| AUGE® ZIO CM | Asahi Roentgen JAP | N/A | 2.23 × 1.90 × 1.30 | 338 | 12 | 0.100–0.155 | 5.1–7.1 | 5.1–7.9 | CsI flat panel | 60–95 | 2–12 | 0.5 |
| AUGE × ZIO CM | Asahi Roentgen JAP | N/A | 2.23 × 1.90 × 1.30 | 338 | 12 | 0.100–0.155 | 5.1–7.1 | 5.1–7.9 | CsI flat panel | 60–95 | 2–12 | 0.5 |
| AUGE ZIO maxim | Asahi Roentgen JAP | N/A | 2.23 × 1.90 × 1.30 | 348 | 12 | 0.100–0.155 | 5.1–7.1 | 5.1–7.9 | CsI flat panel | 60–95 | 2–12 | 0.5 |
| AUGE × ZIO maxim | Asahi Roentgen JAP | N/A | 2.23 × 1.90 × 1.30 | 348 | 12 | 0.100–0.155 | 5.1–7.1 | 5.1–7.9 | CsI flat panel | 60–95 | 2–12 | 0.5 |
| Alioth® CM | Asahi Roentgen JAP | N/A | 2.30 × 2.10 × 1.54 | 314 | 8–14 | 0.100–0.155 | 5.1–7.1 | 5.1–7.9 | CsI flat panel | 60–100 | 1–12 | 0.5 |
| Alphard®-3030 | Asahi Roentgen JAP | N/A | N/A | 480 | N/A | 0.1–0.3 | 5.1–17.9 | 5.1–20.0 | Flat-panel detector | 60–110 | 2–15 | 0.6 |
| Alphard-2520 | Asahi Roentgen JAP | N/A | N/A | 480 | N/A | 0.10–0.33 | 5.1–11.9 | 5.1–16.9 | Flat-panel detector | 60–110 | 2–15 | 0.6 |
| Volux® 21 | Genoray KOR | N/A | 1.60 × 0.85 × 1.44 | 250 | N/A | 0.10–0.28 | 9.2 | 14 | CMOS flat panel + CCD detector | 60–110 | 5–7 | 0.5–1.5 |
| Volux 21 C | Genoray KOR | N/A | 1.60 × 2.11 × 1.44 | 300 | N/A | 0.10–0.28 | 9.2 | 14 | CMOS flat panel + CCD detector | 60–110 | 5–7 | 0.5–1.5 |
| WhiteFox® | De Götzen IT | 160 000 | 2.48 × 1.58 × 1.89 | 275 | 16 | 0.1–0.5 | 6–17 | 6–20 | Amorphous silicon flat panel | 105 | 6–9 | 0.5 |
| Gendex® GXCB-500 | Gendex USA/Imaging Sciences internet | 90 000 | 1.80 × 1.22 × 1.34 | 200 | 14 | 0.125–0.400 | 8 | 8–14 | Amorphous silicon flat panel | 90–120 | 3–8 | 0.5 |
| 3D eXam® = N.G. i-CAT | Gendex USA/Imaging Sciences internet | 170 000 | 1.83 × 1.22 × 1.16 | 200 | 14 | 0.125–0.400 | 8–13 | 8–16 | Amorphous silicon flat panel | 90–120 | 3–8 | 0.5 |
| ILUMA® Ultra CBCT LFOV | Imtec Corp. (3 M)/GE Healthcare USA | 190 000 | 2.45 × 2.14 × 1.83 | 350 | 14 | 0.09–0.40 | −14.2 | −21.1 | Amorphous silicon flat panel | 120 | 1–3.8 | 0.3 |
| ILUMA Ultra CBCT SFOV | Imtec Corp. (3 M)/GE Healthcare USA | 165 000 | 2.45 × 2.14 × 1.83 | 350 | 14 | 0.09–0.40 | −9.6 | −10.8 | Amorphous silicon flat panel | 120 | 1–3.8 | 0.3 |
| 3D Accuitomo® 170 | J. Morita JAP | 255 000 | 2.08 × 1.62 × 1.20 | 400 | 14 | 0.08–0.25 | 4–12 | 4–17 | CsI amorphous silicon flat panel | 60–90 | 1–10 | 0.5 |
| 3D Accuitomo 80 | J. Morita JAP | 215 000 | 2.08 × 1.62 × 1.20 | 400 | 13 | 0.125–0.160 | 4–8 | 4–8 | CsI flat panel | 60–90 | 1–10 | 0.5 |
| Veraviewepocs® 3D | J. Morita JAP | 150 000 | 2.36 × 1.02 × 1.33 | 258 | 13 | 0.125 | 4–8 | 4–8 | CsI flat panel | 60–90 | 1–10 | 0.5 |
| Veraviewepocs 3De | J. Morita JAP | 100 000 | 2.36 × 1.02 × 1.33 | 258 | 13 | 0.125 | 4–8 | 4 | CsI flat panel | 60–90 | 1–10 | 0.5 |
| Kodak® 9000C 3D | Carestream FR | 65 000 | 2.38 × 2.14 × 1.60 | 199 | 14 | 0.076 | 3.7 | 5 | CMOS flat panel | 60–90 | 2–15 | 0.5 |
| Kodak 9500 | Carestream FR | 150 000 | 2.38 × 1.42 × 1.73 | 176 | 14 | 0.2–0.3 | 9.0–18.4 | 15.0–20.6 | Amorphous silicon flat panel | 60–90 | 2–15 | 0.7 |
| CS® 9300C | Carestream FR | 129 000 | 2.38 × 2.14 × 1.60 | 199 | 14 | 0.09–0.50 | 5.0–13.5 | 5–17 | CMOS flat panel | 60–90 | 2–15 | 0.7 |
| SkyView® | Myray IT | 120 000 | 1.72 × 1.54 × 2.51 | 360 | 12 | 0.17–0.33 | 7–15 | 7–15 | I.I. + CCD camera | −90 | 1–10 | 0.5–0.6 |
| I-max® Touch 3D | Owandy FR | 69 000 | 2.45 × 1.90 × 1.27 | 150 | 8–16 | 0.15 | 8.3 | 9.3 | Amorphous silicon flat panel | 60–86 | 6–10 | 0.5 |
| Promax® 3Ds | Planmeca FIN | 79 000 | 2.43 × 2.15 × 1.63 | 128 | 15 | 0.1–0.2 | 5–11 | 5–10 | Amorphous silicon flat panel | 54–84 | 1–16 | 0.5 |
| Promax 3D | Planmeca FIN | 135 000 | 2.43 × 2.15 × 1.63 | 128 | 15 | 0.16–0.32 | 5–14 | 4–14 | CMOS CsI flat panel | 50–84 | 0.5–16 | 0.5 |
| Promax 3D Mid | Planmeca FIN | 163 000 | 2.39 × 2.25 × 1.75 | 146 | 15 | 0.1–0.6 | 5–9 | 4–16 | Amorphous silicon flat panel | 54–84 | 1–16 | 0.5 |
| Promax 3D Max | Planmeca FIN | 177 000 | 2.49 × 1.56 × 1.74 | 134 | 15 | 0.1–0.2 | 5.5–17.0 | 5–22 | Amorphous silicon flat panel | 54–84 | 1–16 | 0.5 |
| New Tom® 5G | QR Verona IT | 200 000 | 1.78 × 1.75 × 2.30 | 530 | 14 | 0.075–0.127 | 6–16 | 6–18 | Amorphous silicon flat panel | 110 | 1–20 | 0.3 |
| New Tom Vgi | QR Verona IT | 175 000 | 2.29 × 1.13 × 1.50 | 370 | 14 | 0.075–0.300 | 6–15 | 6–15 | Amorphous silicon flat panel | 110 | 1–20 | 0.3 |
| Orthophos® XG 3D | Sirona Dental Systems GmbH DE | 80 000 | 2.25 × 2.10 × 1.50 | 138 | 12 | 0.1–0.2 | 8 | 8 | CMOS flat panel | 60–90 | 3–16 | 0.5 |
| GALILEOS® Compact | Sirona Dental Systems GmbH DE | 104 900 | 2.25 × 1.60 × 1.60 | 140 | 12 | 0.3 | 12 | 15 | I.I. + CCD camera | 85 | 5–7 | 0.5 |
| GALILEOS Comfort | Sirona Dental Systems GmbH DE | 156 900 | 2.25 × 1.60 × 1.60 | 140 | 12 | 0.15–0.30 | 15 | 15 | I.I. + CCD camera | 85 | 5–7 | 0.5 |
| Orthoceph® OC200 D VT | PaloDEx Group FIN | N/A | 2.25 × 2.00 × 1.24 | 210 | N/A | 0.23 | 6 | 6 | N/A | 57–85 | 2–16 | 0.5 |
| Scanora® 3D | PaloDEx Group FIN | 125 000 | 1.97 × 1.60 × 1.40 | 310 | 12 | 0.133–0.350 | 6.0–7.5 | 6.0–14.5 | CMOS flat panel | 60–90 | 8–15 | 0.5 |
| Cranex® 3D | PaloDEx Group FIN | N/A | 2.41 × 0.97 × 1.41 | 250 | N/A | N/A | 6.1 | 4.1–7.8 | CMOS flat panel | 57–90 | 4–16 | 0.5 |
| PaX®-Flex3D | Vatech KOR | N/A | 2.33 × 1.95 × 1.54 | 400 | 14 | 0.12–0.20 | 5 | 12 | CMOS flat panel | 50–90 | 2–10 | 0.5 |
| PaX-Uni3D (EU)/Suni® 3D (USA) | Vatech KOR | N/A | 2.33 × 1.92 × 1.46 | 400 | 14 | 0.12–0.20 | 8.5–5.0 | 5–12 | CMOS flat panel | 40–90 | 2–10 | 0.5 |
| PaX-Duo3D | Vatech KOR | 129 900 | 2.35 × 1.07 × 1.57 | 400 | 14 | 0.12–0.20 | 5.0–8.5 | 5–12 | CMOS flat panel | 60–90 | 2–10 | 0.5 |
| PaX-Reve3D | Vatech KOR | 219 000 | 2.33 × 2.05 × 1.57 | 400 | 14 | 0.08–0.25 | 5–15 | 5–19 | CMOS flat panel | 40–90 | 2–10 | 0.5 |
| PaX-Zenith3D | Vatech KOR | 194 500 | 1.85 × 1.80 × 2.00 | 400 | 14 | 0.125–0.400 | 5–19 | 5–24 | CMOS flat panel | 50–120 | 4–10 | 0.5 |
| MiniCAT® | Xoran USA | N/A | 1.70 × 1.02 × 0.91 | 204 | 8 | 0.3 | 16 | 12 | N/A | 120 | 7 | N/A |
| xCAT® ENT | Xoran USA | N/A | 1.52 × 1.19 × 0.81 | N/A | 8 | 0.4 | 24 | 14 | N/A | 125 | 6 | N/A |
| PreXion® 3D (EU)/Fine Cube® (USA) | Yoshida JAP | 135 000 | 1.93 × 1.17 × 1.57 | 390 | 14 | 0.10–0.15 | 8 | 8 | CsI flat panel | 90 | 4 | 0.15 |
| Rayscan® Symphony V | Ray Co., Ltd. KOR | N/A | 1.96 × 1.10 × 1.22 | 276 | 16 | 0.19–0.38 | 14.2 | 17.8 | N/A | 60–90 | 4–10 | 0.5 |
| Point® 3D Combi 500S | PointNix Co., Ltd. KOR | N/A | 2.30 × 2.06 × 0.88 | N/A | 12 | 0.236 | 19 | 16 | Amorphous silicon flat panel | 50–90 | 4–16 | 0.5 |
| Dinnova® 3 | Medical System Willmed KOR | N/A | 1.90 × 1.59 × 1.66 | 450 | 14 | 0.15–0.40 | 8–19 | 12–20 | Amorphous silicone flat panel | 50–120 | 4–10 | 0.5 |
| ORTHOPANTOMOGRAPH® OP300 | Instrumentarium Dental FIN | N/A | 2.41 × 0.96 × 2.05 | 250 | 14 | N/A | 6.1 | 4.1–7.8 | CMOS flat panel | 57–90 | 4–16 | 0.5 |
| Trade name | Scan time CT (s) | Reconstruction time (s) | Pulsed beam | Images acquired during scan | Effective exposition time (s) | Rotation angle (°) | Patient position | Panoramic separate detector | Cephalometric separate detector | Pre-installed software | Effective radiation dose ICRP 103 (μSv) |
| AUGE ZIO CM | 8.5–17.0 | Depending on PC | No | N/A | N/A | 180/360 | Standing | Yes (FPD) | Yes (CCD) | ADR plus | N/A |
| AUGE × ZIO CM | 8.5–17.0 | Depending on PC | No | N/A | N/A | 180/360 | Standing | Yes (CCD) | Yes (CCD) | ADR plus | N/A |
| AUGE ZIO maxim | 8.5–17.0 | Depending on PC | No | N/A | N/A | 180/360 | Standing | Yes (FPD) | Yes (FPD) | ADR plus | N/A |
| AUGE X ZIO maxim | 8.5–17.0 | Depending on PC | No | N/A | N/A | 180/360 | Standing | Yes (CCD) | Yes (FPD) | ADR plus | N/A |
| Alioth CM | 17 | Depending on PC | No | N/A | N/A | 180/360 | Standing | Yes | Yes | ADR plus | N/A |
| Alphard-3030 | N/A | N/A | N/A | N/A | 17 | N/A | N/A | N/A | N/A | NEO 3D | N/A |
| Alphard-2520 | N/A | N/A | N/A | N/A | 17 | N/A | N/A | N/A | N/A | NEO 3D | N/A |
| Volux 21 | 15.8 | 150 | N/A | N/A | N/A | 360 | Standing | Yes | Yes (CCD) | N/A | N/A |
| Volux 21 C | 15.8 | 150 | N/A | N/A | N/A | 360 | Standing | Yes | Yes (CCD) | N/A | N/A |
| WhiteFox | 18–27 | 30 | N/A | N/A | 6–9 | 360 | Standing/sitting | No | No | WhiteFox control | N/A |
| Gendex GXCB-500 | 8.9–23.0 | 20–95 | N/A | 360 | N/A | 360 | Sitting | No | No | i-CAT Vision, 3dvr | N/A |
| 3D eXam = N.G. i-CAT | 8.5–24.0 | −60 | Yes | 360 | 2.0–7.2 | 360 | Sitting | No | No | i-CAT Vision, 3dvr | 45–8717,18 |
| ILUMA Ultra CBCT LFOV | 7.8–40.0 | 120 | No | 190/360 | N/A | 190/360 | Sitting | No | No | ILUMAVision 3D | 98–49818 |
| ILUMA Ultra CBCT SFOV | 7.8–40.0 | 120 | No | 190/360 | N/A | 190/360 | Sitting | No | No | ILUMAVision 3D | N/A |
| 3D Accuitomo 170 | 5.4–30.0 | −180 | No | 360 | 5.4–30.0 | 360/180 | Sitting | No | No | i-Dixel | N/A |
| 3D Accuitomo 80 | 9.0–17.5 | −180 | No | 360 | 9.0–17.5 | 360/180 | Sitting | No | No | i-Dixel | N/A |
| Veraviewepocs 3D | 9.4 | −180 | No | 194 | 9.4 | 180 | Standing/wheelchair | Yes (CCD) | Yes (CCD) | i-Dixel | 7316 |
| Veraviewepocs 3De | 9.4 | −180 | No | 194 | 9.4 | 180 | Standing/wheelchair | No | Yes (CCD) | i-Dixel | N/A |
| Kodak 9000C 3D | 22 | −60 | Yes | 360 | 11 | 360 | Standing/sitting | Yes (CCD) | Yes (CCD) | Kodak dental imaging | 19–4017 |
| Kodak CS 9300C | 10–20 | −60 | Yes | 180 | 11 | 180 | Standing/sitting | Yes (CCD) | Yes (CCD) | Kodak dental imaging | N/A |
| Kodak 9500 | 24 | 20–120 | Yes | 360 | 10.8 | 360 | Standing | No | No | Kodak dental imaging | 76–26019 |
| SkyView | 10–30 | 30–70 | Yes | 800 (360°) | 6.88 | 190/360 | Lying | No | No | SkyView | 8716 |
| I-max Touch 3D | 20 | −90 | Yes | N/A | 8 | 200 | Standing | Yes (CCD) | Yes (CCD) | QuickVision 4 | N/A |
| Promax 3Ds | 18 | 30–150 | Yes | 300 | 3–12 | 200 | Standing/sitting | Yes (CCD) | Yes (CCD) | Planmeca Romexis | N/A |
| Promax 3D | 18 | 30–150 | Yes | 300 | 7 | 200 | Standing/sitting | Yes | Yes | Planmeca Romexis | 28–65217,18 |
| Promax 3D Mid | 18–26 | 30 | Yes | 300 | 2.5–12.0 | 200/360 | Standing/sitting | Yes | Yes | Planmeca Romexis | N/A |
| Promax 3D Max | 18–30 | 30–150 | Yes | 300 | 2.5–12.0 | 200/450 | Standing/sitting | No | No | Planmeca Romexis | N/A |
| New Tom 5G | 18–26 | 40 | Yes | 360 | 3.6–5.4 | 360 | Lying | No | No | NNT | N/A |
| New Tom Vgi | 18–26 | 40 | Yes | 360 | 3.6–9.0 | 360 | Sitting/standing/wheelchair | No | No | NNT | 194–26517 |
| Orthophos XG 3D | 14 | 90–270 | Yes | 200 | 3–6 | 200 | Sitting/standing/wheelchair | Yes (CCD) | Yes (CCD) | Galileos Implant, Galaxis, Sidexis | N/A |
| GALILEOS Compact | 14 | 240–300 | Yes | 200 | 2–6 | 200 | Sitting/standing/wheelchair | No | No | Galileos implant, Galaxis, Sidexis | N/A |
| GALILEOS Comfort | 14 | 240–300 | Yes | 200 | 2–6 | 200 | Sitting/standing/wheelchair | No | No | Galileos implant, Galaxis, Sidexis | 70–12818 |
| Orthoceph OC200 D VT | N/A | N/A | N/A | N/A | N/A | 360 | Standing | Yes | Yes | N/A | N/A |
| Scanora 3D | 10–26 | 60–124 | Yes | 450 | 2.25–6.00 | 360 | Sitting | Yes (CCD) | No | OnDemand 3D | 45–6817 |
| Cranex 3D | 10–20 | N/A | N/A | N/A | 2.3–12.6 | 360 | Standing/sitting | Yes (FPD) | Yes (FPD) | OnDemand 3D | N/A |
| Pax-Flex3D | 24 | 5–37 | Yes | 360 | −9 | 240/360 | Standing/wheelchair | Yes (FPD) | Yes (FPD) | EzDent/Ez3D plus | N/A |
| PaX-Uni3D (EU)/Suni 3D (USA) | 8–20 | 30 | Yes | 360 | −9 | 220/360 | Standing/wheelchair | Yes (FPD) | Yes (FPD) | EzDent/Ez3D plus | 4417 |
| PaX-Duo3D | 15–24 | 32–59 | Yes | 360 | −9 | 360 | Standing/wheelchair | Yes (FPD) | No | EzDent/Ez3D Plus | N/A |
| PaX-Reve3D | 15–24 | −60 | Yes | 360 | −9 | 360 | Standing/wheelchair | Yes (FPD) | Yes (FPD) | EzDent/Ez3D Plus | N/A |
| PaX-Zenith3D | 15–24 | 9–51 | Yes | 300–600 | −9 | 360 | Sitting/wheelchair | Yes (FPD) | No | EzDent/Ez3D Plus | N/A |
| MiniCAT | 10–30 | 60 | N/A | N/A | N/A | N/A | Sitting | No | No | N/A | N/A |
| xCAT ENT | N/A | 60 | N/A | N/A | N/A | 360 | Lying | No | No | N/A | N/A |
| PreXion 3D (EU)/Fine Cube (USA) | 8.6–34.0 | −60 | No | 512/1024 | 8.6–34.0 | 360 | Sitting | No | No | Prexion 3D Viewer | 189–38818 |
| Rayscan Symphony V | 20 | N/A | N/A | N/A | N/A | N/A | Sitting | No | No | N/A | N/A |
| Point 3D Combi 500S | 19 | 10–60 | N/A | N/A | N/A | 360 | Standing | Yes | Yes | N/A | N/A |
| Dinnova 3 | 7–24 | −120 | Yes | N/A | N/A | N/A | Sitting/wheelchair | Yes | Yes | N/A | N/A |
| ORTHOPANTOMOGRAPH OP300 | 10–20 | N/A | N/A | N/A | 2.34–12.5 | N/A | Standing | Yes (CMOS) | Yes | Cliniview | N/A |
CCD, charge-coupled device; CMOS, complementary metal oxide semiconductor; D, depth; DE, Germany; DM, diameter; FIN, Finland; FOV, field of view; FPD, flat-panel detector; FR, France; H, height; ICRP 103, International Commission on Radiological Protection publication no. 103;15 I.I., image intensifier; IT, Italy; JAP, Japan; KOR, Korea; N/A, no information available; PC, personal computer; W, width.
The size of the CBCT devices varied enough to accommodate installation in various locations. The weight of CBCT devices ranged between 128 and 530 kg (Table 2) and referred only to the devices themselves, without separate work units (e.g. computers).
Several CBCT devices offered a range of fields of view (FOVs), while a fixed FOV was provided by other devices. Based on the transverse diameter, the PaX Zenith3D had the largest FOV, and, based on the height, the xCAT ENT had the largest FOV. Of the devices evaluated, 56% provided a small FOV (less than 8 cm), 24% provided a medium FOV (8–15 cm) and 20% provided a large FOV (15–21 cm) (Table 2).
Most companies used flat-panel detectors (FPDs), but the exact technique could not always be verified (MiniCat, Rayscan Symphony V, Orthoceph OC200 D VT and xCAT ENT). Optional detectors for panoramic or cephalometric examination were not considered here. The majority (93%) of detectors were based on FPD technology. Caesium iodide (CsI) was the most often used scintillation material. There were only three devices (GALILEOS Compact, Comfort and MYRAY SkyView) that operated with image intensifier detectors (Table 2).
Tube potential and current were either fixed or could be varied, depending on the CBCT devices (Table 2). Only two devices (3D eXam = N.G. i-CAT and Gendex GXCB-500) operated in a significantly higher range (90–120 kV) than the rest. 57% of the X-ray tubes were operated in the pulsed mode and 29% continuously (Table 2).
Voxel size varied from 0.075 mm to 0.600 mm. Data for greyscales ranged between 8 bits and 16 bits. The majority of CBCT devices (40%) operated with 14 bits. Most CBCT devices (85%) operated with a 0.5 mm focal spot size (Table 2).
The rotation angle varied between 180º and 360°. According to the scanning protocol, 39% operated with different rotation angles, and the remaining 61% were permanently assigned. Most of the devices (66%) operated with a 360° rotation (Table 2).
28% of the devices supported wheelchair access, 67% supported standing patient positioning and 47% sitting patient positioning. In 49%, patient positioning was variable. Only three devices were equipped to offer horizontal patient position (New Tom 5G, SkyView and xCAT ENT) (Table 2).
Scan time ranged from a minimum of 5.4 to a maximum of 40.0 s. Information on reconstruction time varied greatly, depending on the type of CBCT device. The largest range was specified for the PreXion 3D (8.6–34.0 s) and the smallest for the New Tom 5G (3.6–5.4 s) (Table 2).
The number of projections acquired during a scan ranged from 180 to 1024. Most of the devices (29%) delivered 360 projections per rotation, while 17% of the devices delivered 300 projections (Table 2).
Data about effective radiation doses were only included as far as the measurement procedure was in accordance with the International Commission on Radiological Protection (ICRP publication no. 103).15 Information from companies that was not in accordance with scientific papers has been ignored (Table 2).
Discussion
CBCT is a new technology in the field of oral and maxillofacial imaging and allows 3D visualization of the areas scanned.
CBCT has also been called dental CT, volumetric CT or cone beam volumetric tomography. In the literature, the term CBCT seems to be preferred by most practitioners because it best describes the operation principle.
The implementation of CBCT technology in the maxillofacial and dental field in the 1990s has brought many benefits to imaging techniques. The first CBCT device (NewTom-9000; Quantitative Radiology, Verona, Italy) was described in 1998 by Mozzo et al.20
A multifunctional maxillofacial imaging device (Scanora; Soredex, Helsinki, Finland) in which the film was replaced with an X-ray imaging intensifier (Hamamatsu Photonics, Hamamatsu, Japan) was described by Arai et al.21
Only a small number of original articles were found that presented the properties of CBCT devices. De Vos et al22 and Kau et al23 conducted similar reviews about the properties of CBCT devices, but including far fewer devices.
It was sometimes difficult to acquire sufficient verified information from the manufacturers and hence, in some cases, data are missing about specific properties.
In the literature, CBCT devices are often characterized by their FOV, which represents the region of interest. The FOV may vary from a few centimetres in height and transverse diameter to full head reconstructions. Thus, this parameter is highly associated with radiation dose to the patient.1,24 CBCT devices carry lower radiation doses than MSCTs, but much higher doses than panoramic X-rays.25 Following the as low as reasonably achievable principle, it can be seen as beneficial if the FOV is adjustable, so that it can be downsized to the region of interest whenever possible.
Most CBCT devices are targeted to maxillofacial practitioners, while devices with larger FOVs led to their use outside the oral and maxillofacial region, such as ear and paranasal sinus imaging and for the post-operative assessment of cochlear implantation.26,27 There is one CBCT device (NewTom 5G) that provides free patient positioning, so that even skeletal imaging of various body parts becomes possible.28
X-ray tube potential and tube current are frequently adjustable and must be optimized during use, based on the clinical purpose of the examination. Ideally, medical physicists should be involved to establish adequate protocols. For this, more research is needed to explore the optimum protocol in CBCT technology. In some cases, CBCT devices have a fixed tube potential and current, which limit the options for further optimization. Most devices have presets where tube potential and current automatically change when entering the patient’s weight, height or sex.
Small voxel sizes may be associated with better spatial resolution but, as a result, carry higher radiation doses to the patient.29 Thus, CBCT devices should offer a range of different voxel sizes, so that examinations enable the use of the largest voxel size, while still maintaining acceptable diagnostic accuracy.
Different types of CBCT devices offer the opportunity to perform partial rotations (180° instead of 360°), with a reduction of radiation dose to the patient. There are some studies suggesting that partial rotations can be used while maintaining acceptable diagnostic accuracy and image quality for certain clinical applications on different types of CBCT devices.30 Further research studies should investigate the effect of the number of acquired images on the relationship between radiation dose and image quality.
All these parameters must be established according to the scanning protocol to limit the radiation dose and to maintain the image quality at acceptable evaluation levels.
When comparing radiation doses in the literature, the significant differences between the CBCT devices in our study can be attributed to the use of different scanning protocols, and, therefore, data cannot easily be compared between various studies.
In conclusion, the data from 43 CBCT devices summarized in this technical note shall provide a helpful basis for acquiring further optimizations and enhancements in imaging of the oral and maxillofacial region.
Acknowledgments
AN wishes to thank the European Social Fund within the Operational Programme for Human Resources Development 2007–2013, with the contract code POSDRU 107/1.5/S/78702, for cofinancing this project and for his scholarship.
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