Dentist Kunal Shah ponders PROPACS, GDPR, and asks: “X-ray reporting – Are you protected?”
CBCT scans are crucial for treatment planning in dental implant therapy. To ensure the process of taking and reading CBCT scans is compliant with regulations, you must consider who is the referrer, who is the operator and who is the practitioner. The referrer requests the CBCT scan, the operator acquires the image and the practitioner is responsible for justifying the need for a CBCT and reporting on it.
In some cases, one dentist could be all three, while in others, there will be multiple professionals involved. This is crucial, as one of the steps may be outside the remit of a dentist.
The first two stages present few problems – so long as the dentist is sufficiently trained and informed to know when a CBCT scan is needed, their request/referral is supported. With regards to implant treatment, for example, the dentist needs the X-ray to acquire clinical information necessary to plan treatment accurately. Similarly, if you have the competence to physically use the CBCT equipment and take the scan, then you’ll face no problems as the operator.
However, complications arise when the dentist is the practitioner, as they are responsible for justifying and reporting on the scan produced. Because radiology is not necessarily the dentist’s speciality, it is easy to see how things might be missed. The danger here is that most dentists typically go into tunnel-vision mode when reading the scans – other than checking for generalised issues, we often only examine the specific area of concern in any detail.
For example, when treatment planning a dental implant in the lower arch, most oral surgeons will concentrate on the anatomy of the bottom arch and may therefore miss an abnormality in the upper arch. While this might not affect the implant treatment at that time, the practitioner is still responsible for reporting on everything that can be seen in the radiograph. This might include reporting on TMJ features, regardless of whether this affects implant treatment.
There might also be the risk of missing any abnormalities that fall outside the remit of a dentist and are better diagnosed by a general medical professional. For example, thrombosis can be detected on a radiograph. This is a completely medical condition and not one that a dentist would be expected to find. However, if a dentist has taken on responsibility for reporting on an x-ray, they would be held accountable for identifying the symptoms of thrombosis, as well as any dental concerns.
Similarly, osteopenia/osteoporosis can be detected on a radiograph and this is not something that even a highly experienced dentist would diagnose. The regulations are designed to ensure the patient receives all the relevant information that can be gleaned from their X-ray, maximising the usefulness of their radiation exposure and allowing them to act on it accordingly.
Benefits of working with a specialist
Reporting by a specialist radiologist eliminates the risk of missing anything from an x-ray. They will automatically look at everything presented on the image and deliver a full report on any detectable anomaly. They will also have training and experience within the general medical field, meaning they can identify and report on any issues beyond the expertise of a dentist.
As the dentist, you may not need all this information to plan your implant – or any other type of dentistry for that matter – but it is still important to ensure that there are no underlying issues that could affect treatment. It is equally as relevant when considering longevity of dental treatment.
If an issue arose several years after an implant was placed and it turned out that the problem could have been found early in the original X-rays, the dentist would be responsible and could face legal consequences. As such, delegating the role of reporting on a radiograph to an expert provides the practitioner with medico-legal protection.
This was why I became involved with the PROPACS system from Pro Diagnostics UK. It provides detailed reports by specialist radiologists, with which I have worked with the team to ensure they are as systematic and clear as possible. I simply take the radiograph and send it securely to the experts for review.
Another benefit of the system is that it aids compliance with GDPR – this is a huge issue for dentists right now so anything that helps compliance is more than welcome! Ultimately, it provides me with confidence that I will be protected against any issues that might arise in the future.
In addition, by working with an expert radiologist I know I am delivering the best possible service to my patients. By combining two different specialities, my patients have complete confidence they are receiving the most appropriate treatment – now and into the future.