Bạn đang đọc cuốn sách này chủ yếu là vì tôi may mắn. Sự hiểu biết sâu sắc về cách hình ảnh CBCT được tạo ra đòi hỏi sự hiểu biết về lý thuyết phát hiện dấu hiệu, xử lý tín hiệu và hình ảnh kỹ thuật số và một nền tảng toán học khá vững chắc. Có rất nhiều cuốn sách đi sâu vào các chi tiết kỹ thuật và toán học này nhưng lại thiếu các ứng dụng lâm sàng và các vấn đề về cảm nhận và diễn giải. Có một cơ sở học thuật rộng rãi và sâu sắc trong việc đo lường nhận thức hầu hết được thực hiện bởi các nhà tâm lý học thực nghiệm được đào tạo. Nội dung công việc này tập trung chủ yếu vào nhận thức và quá trình diễn giải với các hình ảnh hoặc hình ảnh chụp Xquang tĩnh mạch quanh vùng (PA) và không trình bày chi tiết các vấn đề về tạo hình ảnh hoặc các vấn đề lâm sàng. Có một số sách xuất sắc về chụp X quang, một số sách dành riêng cho chụp X quang nội nha và gần đây là một số văn bản về CBCT. Nội dung công việc này tập trung vào giải phẫu lâm sàng và giảng dạy dựa trên trường hợp của chụp X quang PA được mở rộng sang lĩnh vực hình ảnh nâng cao của CBCT, nhưng nó thiếu các chi tiết kỹ thuật và diễn giải liên quan đến việc triển khai lâm sàng CBCT trong thực hành tư nhân. Nhiều năm trước, những người đóng góp của tôi (GC, RS) và tôi đã thấy các vấn đề trong việc mở rộng hiểu biết về chụp X quang chiếu PA sang hình ảnh nâng cao. Không có tài liệu tham khảo nào bắt đầu lấy CBCT làm trọng tâm và phát triển một khuôn khổ để hiểu rõ hơn về sự khác biệt hoàn toàn của hình ảnh CBCT so với chụp X quang chiếu PA, chưa kể đến các vấn đề tiếp theo trong nhận thức hình ảnh, nhận thức và ra quyết định và CBCT làm thay đổi căn bản việc thực hành nội nha như thế nào. Cuốn sách này là nỗ lực của chúng tôi để thu hẹp khoảng cách đó. Cơ sở của quá trình tái thiết chắc chắn là mang nặng tính toán học. Tuy nhiên, vẻ đẹp của chụp cắt lớp vi tính và những gì những hình ảnh này thực sự đại diện, không thể hiểu được nếu không có kiến thức về tạo tia X, tương tác photonvật chất, cũng như các khái niệm và bước xử lý tín hiệu cơ bản. Những phần khó này trong văn bản được hỗ trợ bởi vô số hình ảnh minh họa cho thấy ba bước quan trọng của phép chiếu lùi được lọc theo cách phi toán học. Hai phần bổ sung trong chương 2 và 5 được dành riêng cho các hiện vật hình ảnh. Vẻ đẹp, trong mắt người xem, đòi hỏi một cuộc điều tra về các vấn đề cảm nhận và nhận thức xung quanh việc giải thích hình ảnh. Hình ảnh là một phần cốt lõi của thông tin mà bác sĩ lâm sàng sử dụng để chẩn đoán, lập kế hoạch điều trị, điều trị và đánh giá kết quả điều trị. Một yêu cầu quan trọng sau đó là nhận thức và hiểu những gì hình ảnh chỉ ra trong quá trình diễn giải. Vai trò của tri giác và nhận thức và ngôn ngữ của quá trình diễn giải chưa được nghiên cứu kỹ trong nội nha như trong y học, và sự hiểu biết này dẫn đến một số kết luận đáng ngạc nhiên, phản trực giác. Với hình ảnh nâng cao, việc nhận thức những vấn đề này càng trở nên quan trọng hơn vì chúng làm màu — hoặc vết — diễn giải. Phần vui nhộn này có nhiều câu đố vui về mắt và trí não mà chúng tôi hy vọng sẽ là một phần của động cơ tinh thần chạy ẩn khi bác sĩ lâm sàng điều hướng thông qua quá trình diễn giải và đưa ra quyết định sau đó. Chẩn đoán hình ảnh đã, đang và sẽ tiếp tục là công nghệ trung tâm đằng sau việc ra quyết định và đánh giá kết quả trong nội nha. Có rất nhiều bài báo học thuật và các chương sách giáo khoa về việc ra quyết định dựa trên kinh nghiệm học, các phương pháp hay nhất và trình bày trường hợp khiến ngay cả các bác sĩ lâm sàng có kinh nghiệm cũng không có một khung hướng dẫn thống nhất. Hình ảnh nâng cao kiểm tra các phương pháp tiếp cận kế thừa này đối với việc ra quyết định và đánh giá kết quả mà chúng tôi tin rằng đã khiến chuyên môn của chúng tôi đi chệch hướng. Vì vậy, tôi đã may mắn gặp đúng người vào đúng thời điểm trong cuộc hành trình của mình để cung cấp cho tôi nền tảng toán học, lập trình và tâm lý học thực nghiệm để kết hợp toán học cơ bản với nhau, những gì đã học được về quá trình diễn giải và một khuôn khổ cho ra quyết định mà chúng tôi tin rằng làm cơ sở cho việc sử dụng tinh vi thiết bị thiết yếu này trong thực hành lâm sàng hiện đại của chuyên khoa của chúng tôi.
John A Khademi, DDS, MS Advanced CBCT for Endodontics: Technical Considerations, Perception, and Decision-Making Contributions by Gary B Carr, DDS Richard S Schwartz, DDS Michael Trudeau, DDS www.pdflobby.com Advanced CBCT for Endodontics: Technical Considerations, Perception, and Decision-Making www.pdflobby.com www.pdflobby.com Advanced CBCT for Endodontics: Technical Considerations, Perception, and Decision-Making John A Khademi, DDS, MS Private Practice Limited to Endodontics Durango, Colorado With contributions by Gary B Carr, DDS Private Practice Limited to Endodontics San Diego, California Richard S Schwartz, DDS Private Practice Limited to Endodontics San Antonio, Texas Michael Trudeau, DDS Private Practice Limited to Endodontics Suffolk, Virginia Berlin, Barcelona, Chicago, Istanbul, London, Milan, Moscow, New Delhi, Paris, Prague, Sao Paulo, Seoul, Singapore, Tokyo, Warsaw www.pdflobby.com Library of Congress Cataloging-in-Publication Data Names: Khademi, John A., author Title: Advanced CBCT for endodontics : technical considerations, perception, and decision-making / John Khademi Other titles: Advanced cone beam computed tomography for endodontics Description: Hanover Park, IL : Quintessence Publishing Co, Inc, [2017] | Includes bibliographical references and index Identifiers: LCCN 2017006605 (print) | LCCN 2017008473 (ebook) | ISBN 9780867157208 (hardcover) | ISBN 9780867157598 (ebook) Subjects: | MESH: Diagnosis, Oral | Cone-Beam Computed Tomography methods | Endodontics methods Classification: LCC RK309 (print) | LCC RK309 (ebook) | NLM WN 230 | DDC 617.6/07572 dc23 LC record available at https://lccn.loc.gov/2017006605 97% © 2017 Quintessence Publishing Co, Inc Quintessence Publishing Co, Inc 4350 Chandler Drive Hanover Park, IL 60133 www.quintpub.com All rights reserved This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher Editor: Leah Huffman Design: Ted Pereda Production: Kaye Clemens Printed in China www.pdflobby.com Contents Dedication vi Preface vii Acknowledgments viii CHAPTER Introduction CHAPTER Technical Considerations with Cone Beam Imaging 13 CHAPTER Perception and Cognition 103 CHAPTER Decision-Making in Radiology 175 CHAPTER Implementing CBCT in Endodontic Practice 207 Bibliography 315 Index 339 A Google Group is set up for conversation and comments regarding the concepts in this book Registration is free and open to all interested clinicians: cbctinendo@GoogleGroups.com www.pdflobby.com Dedication To my dearest Camille, who stood by my side through this process To my father, who always encouraged me, and to three other fathers, Drs Jack Preston, Paul Rhodes, and Eric Herbranson, who took me under their wings To my wonderful chairsides, Ana, Amelia, and Ashlee, and the best group of restorative dentists and specialists whom I get to work with every day And finally, to all those who have come before me whose helping hand was extended and whose shoulders I have stood upon, and to those who will come after me who may stand upon mine It is my hope that this inspires the next generation of teachers and that they will a better job than I have As E T Jaynes writes: But it required a few years before I perceived what a science teacher’s job really is The goal should be, not to implant in the student’s mind every fact that the teacher knows now; but rather to implant a way of thinking that will enable the student, in the future, to learn in one year what the teacher learned in two years Only in that way can we continue to advance from one generation to the next vi www.pdflobby.com Preface You are reading this book primarily because of my good luck A deep understanding of how CBCT images are generated requires an understanding of signaldetection theory, signal processing, and digital imaging and a fairly solid mathematical background There are many books that dive into these technical and mathematical details but are lacking in the clinical applications and perceptual and interpretive issues There is a wide and deep academic evidential base in perception metrology mostly performed by trained experimental psychologists This body of work is focused largely on perception and the interpretive process with static periapical (PA) projection radiographs or images and does not detail the issues with image generation or the clinical issues There are several excellent books on radiography, some books specific to endodontic radiography, and more recently some texts on CBCT This body of work focuses on the clinical anatomy and case-based teaching of PA radiography extended to the advanced imaging domain of CBCT, but it is missing the technical and interpretive details that pertain to the clinical deployment of CBCT in private practice Years ago my contributors (GC, RS) and I saw issues with extending the understanding of PA projection radiography to advanced imaging There was no reference material that started with the CBCT as the focus and developed a framework for a better understanding of how radically different CBCT images are from PA projection radiography, not to mention the ensuing issues in image perception, cognition, and decision-making and how CBCT fundamentally changes endodontic practice This book is our attempt to close that gap The basis of the reconstruction process is, undoubtedly, heavily mathematical However, the beauty of computed tomography, and what these images actually represent, cannot be understood without knowledge of x-ray generation, photon-matter interaction, as well as fundamental signalprocessing concepts and steps These difficult sections in the text are supported by a tremendous number of illustrations showing the three critical steps of filtered back-projection in a nonmathematical way An additional two sections in chapters and are dedicated to imaging artifacts Beauty, being in the eye of the beholder, requires an investigation into the perceptual and cognitive issues surrounding image interpretation Imaging forms a core portion of the information a clinician uses to diagnose, treatment plan, treat, and evaluate treatment outcomes An important requirement then is to perceive and understand what the image indicates during the interpretive process The roles of perception and cognition and the language of the interpretive process have not been as well studied in endodontics as they have been in medicine, and this understanding leads to some surprising, counterintuitive conclusions With advanced imaging, it becomes even more important to be aware of these issues because they color—or stain—the interpretation This fun section has many eye- and brain-teasers that we hope will be part of the mental engine running in the background as the clinician navigates through the interpretive process and ensuing decision-making Imaging has been, and will continue to be, a central technology behind decision-making and outcomes assessment in endodontics There are many scholarly articles and textbook chapters on decisionmaking that are based on heuristics, best practices, and case presentations that leave even experienced clinicians without a unifying, guiding framework Advanced imaging tests these legacy approaches to decision-making and outcomes assessment that we believe have led our specialty astray So I was lucky to have bumped into the right people at the right time along my journey to give me the mathematical, programming, and experimental psychology background to piece together the underlying mathematics, what has been learned about the interpretive process, and a framework for decision-making that we believe underlies sophisticated use of this essential device in state-ofthe-art clinical practice of our specialty vii www.pdflobby.com Acknowledgments As I look back, there are individuals who were key inflection points in my academic and clinical life, the first being Bill Kapelle, whom I simply partnered up with by chance in sophomore organic chemistry Bill, a natural-born teacher, got a year ahead of me and gained an appointment in Professor V Ara Apkarian’s physical chemistry laboratory at the University of California Irvine I followed a year later It was there that I gained a little insight into how scientists work and think, and I was grateful that I got into dental school, seeing as I wasn’t that smart, struggling with Bill’s help in graduate quantum mechanics and diffeq It was with Professor Apkarian that I got my unusual programming and mathematical background At the University of California San Francisco I met Professor T L Green, and later at Baylor, Professor Jesse Bullard, who would later help me get into the University of Iowa with Department Chair Professor Richard Walton I had written some software for digital subtraction radiology and joined the Radiological Society of North America in dental school, and digital radiology and PACS were coming of age, so doing my master’s on digital imaging was a natural fit as an endodontic resident Iowa had a world-class perception metrology laboratory in the medical school with Professors Kevin Berbaum and Paul Chang, and Professor Walton gave me incredible latitude to pursue work in this domain outside of the dental school I went to see Professor Chang about doing a project patterned after the work I had seen done in dentistry and learned that we had been doing it backward Professor Chang gave me a paper he had just written on Bayesian analysis that changed everything I would become a Bayesian and would never look at the academic evidential base—or anything—in the same way I finished at Iowa, nearly practiced with Dr Steve Buchanan—a natural Bayesian in Santa Barbara—but instead joined Dr Eric Herbranson in San Francisco I practiced with Eric, another natural Bayesian, for half a dozen years and then moved to Colorado Eric and Steve are responsible for the clinician I am today, just as Professors Apkarian, Berbaum, and Chang are responsible for my scientific background I joined The Digital Office (TDO) shortly after relocating and through the TDO chat forum developed a close relationship with Drs Gary Carr and Richard Schwartz, often throwing bombs at the academic evidential base but still remaining relatively quiet about the details of what I had learned at Iowa a decade earlier I was known to have expertise in imaging, but the time was not right to talk about these details CBCT imaging blew onto the scene in 2009, and Gary spoke about it at the TDO meeting Now the time was right—Gary and Rick listened, and so their journeys began In the coming years, we delved into the details of what I had learned, the broad and deep academic evidential base in medicine that I stumbled into through working with Professors Berbaum and Chang When it came time for Rick and Dr Venkat Canakapalli to write a book on best practices in endodontics, Gary, Rick, and I began the task It quickly became clear that this wasn’t a chapter, but three, and then it became clear that this wasn’t going to make it in three chapters either With the help of my editor, Leah Huffman, it became the book you have in front of you All of these people who had a part in my life led to the unusual background that I have, which enabled a particular understanding of the material required to write this book In chemistry, we talk about a rate-limiting step This book would not have happened without the support and faith in my message of my boss at Saint Louis University, Professor John Hatton viii www.pdflobby.com CHAPTER Introduction The physical world is a cunning, deceitful character, full of lies, or worse, half-truths It is not to be trusted at any time, nor at any cost The brain is a flawed detective with a loaded die for a compass, working on lousy pay with fuzzy data, and a strict, sometimes literal, deadline But over eons of evolutionary time, the brain has always had one crucial advantage: it knows that the physical world has to play by certain rules, rules that are ultimately derived from the laws of physics Armed with this singular insight, the brain tests and retests, millisecond by millisecond, multiple competing hypotheses about what in the world might have produced the evidence of its own eyes, ruthlessly casting aside red herrings and fallguys one by one, by one, until there is only a single suspect who does not have a rock-solid alibi: and that is the one chosen by the brain, that is what we see — Stone (Vision and Brain, 2012) Much like the physical world, cone beam computed tomography (CBCT) has to play by certain rules, rules that are ultimately derived from the laws of physics It is a beautiful instrument but can be cunning, deceitful, and full of lies (or worse, half-truths) When can we trust it? How much can we trust it? And at what cost? Why We Wrote This Book The purpose of this book is twofold First, we wish to address cone beam imaging in endodontics from both technical and theoretical perspectives We will examine how it differs from periapical (PA) projection radiography by developing a more sophisticated understanding of how the image is acquired, processed, and reconstructed prior to it being viewed and interpreted Each of these phases in cone beam technology has its own important parameters that could fill an entire chapter Therefore, the chapters in this book will provide the practicing clinician a background for understanding how CBCT volumes are reconstructed from the projection data that are typically observed as the examination is performed Second, we will introduce vital perceptual and cognitive issues related to image interpretation and important considerations in the related academic field of perception metrology (how perception is measured) These issues affect diagnosis, treatment planning, decision-making, and how treatment outcomes are assessed The chapters on these topics are heavily referenced for the reader interested in further study of this important area www.pdflobby.com Bibliography Oppenheimer DM, Tenenbaum JB, Krynski TR Categorization as causal explanation: Discounting and augmenting in a Bayesian framework In: Ross BH (ed) The Psychology of Learning and Motivation, vol 58 Waltham, MA: Academic Press, 2013:203–232 Orne MT Demand characteristics and the concept of quasi-controls In: Rosenthal R, Rosnow RL (eds) Artifacts in Behavioral Research New York: Academic Press, 1969 Orne MT On the social psychology of the psychological experiment: With particular reference to demand characteristics and their implications Am Psychol 1962;17:776–783 Orrison WW, Nord TE, Kinard RE, Juhl JH The language of certainty: Proper terminology for the ending of the radiologic report AJR Am J Roentgenol 1985;145:1093–1095 Orstavik D Time-course and risk analyses of the development and healing of chronic apical periodontitis in man Int Endod J 1996;29:150–155 Orstavik D, Kerekes K, Eriksen HM The periapical index: A scoring system for radiographic assessment of apical periodontitis Endod Dent Traumatol 1986;2:20–34 Osler W, Bean RB, Bean WB Sir William Osler: Aphorisms from His Bedside Teachings and Writings New York: Schuman, 1950 Osman M An evaluation of dual-process theories of reasoning Psychon Bull Rev 2004;11:988–1010 Papafragou A, Hulbert J, Trueswell J Does language guide event perception? 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threshold, 190–191 Action-grounded language, 163 Active learning, 171 Actuarial method, 202 Advanced imaging, 207–208 Affirming the consequent, 181 Affordances, 157 Aggregate bias, 186 ALARA principles, 207, 223, 230 Aliasing, 98f–100f, 98–101 Alignment, 300 Aluminum, 17 Alveolar fractures, 281, 283f Amalgam, 297 American Academy of Oral and Maxillofacial Radiologists, 220–221 American Association of Endodontists, 9, 220–221 Americans with Disabilities Act, 214, 217f Analytical knowledge, 167 Anchoring and adjustment, 185 Apical periodontitis, 9–10, 140, 154, 183 Apical root resorption, 304f, 313 Artifacts beam hardening, 59–74, 60f–74f caries versus, 263, 265f cracks versus, 263, 263f–264f, 293 definition of, 47 description of, 272f metal as cause of, 226, 226f–227f motion, 86f–88f, 86–88 reconstruction, 74–86, 75f–85f reviewing of image for, 259–266, 260f–265f ringing, 3f, 106 scatter, 48–59, 49f–58f slice, 92–98, 93f–97f, 235f summary of, 101 Atomic number, 17f, 18t Attention description of, 127–128 language effects on allocation of, 158 Attentional allocation, 139 Attentional templates definition of, 128 learning and, 132–136 rigidity in, 130, 130f–131f Attenuation calcium density effects on, 18 clinician’s model of, 17f, 17–18 definition of, 14 photon-matter interaction, 14–15 scatter, 18–20 scattered radiation, 18–20 summary of, 22 x-ray production, 14–15 Attenuation profile, 21, 37, 39, 62f Attribute substitution, 185 Availability, 185 B Bacteria, 183 Base-rate fallacy, 184 Bayes’ theorem, 194b Bayesian probability, 189 Beam hardening artifacts, 17, 59–74, 60f–74f Bias aggregate, 186 commission, 186 confirmation, 185, 187 hindsight, 186 omission, 186–187 Biased competition, 136–139, 158 Binary discrimination, 191–195 Binormal model, standard, 195–199 Bone schema, 272f Bottom-up processing, 105, 107–111, 139 C Calcification, 300, 313 Calcium, 17 Calcium hydroxide, 252, 253f–254f, 301 Calcium hydroxyapatite, 18 Campbell-Robson contrast sensitivity functions chart, 98f Carestream 9000, 26, 27f, 29, 88, 215f Caries, 263, 265f Cartesian thinking, 92 Case reports, 268, 269f 339 www.pdflobby.com C Index Casual knowledge, 167 Categorization, 159–162, 203, 232 Category learning, 171 Causal inference, 181 Causal oversimplification, 181 Cementoenamel junction, 298 Checklists, 267 Chromoluminarism, 128 Cingulum, 298f Clinical examination, 222 Clinical history explicit, 143 in image interpretation, 140 influence of, 146, 147f–149f in perception, 139–140, 143 role of, 139–145, 153–154 Closure principle, 118, 119f Cognition categorization in, 159–162 dual-process model of, 168 importance of, 103–104 language and, 159 modeling of, 124 Cognitive dispositions to respond aggregate bias, 186 commission bias, 186–187 confirmation bias, 187 definition of, 186 framing of decisions, 186 gambler’s fallacy, 187 hindsight bias, 186 omission bias, 187 overconfidence, 186 Cognitive framework, 22 Coherent scattering, 14 Commission bias, 186 Common fate principle, 118, 120f Communication, 156 Compton effect, 14 Computers, 219–220 Cones, 112, 113f Confidence interval, 180 Confidence level, 176 Confirmation bias, 185, 187 Conjunction fallacy, 182 Continuity principle, 118, 120f Cornsweet effect, 122f, 153 Cracks artifacts versus, 263, 263f–264f, 293 bone loss pattern associated with, 261f–262f detection of, 260, 261f–265f imaging of, 3f mesial root, 263, 263f Crop tools field-of-view, 247f region of interest, 245f Cross-arch projections, 71f Crosshatching pattern, 7f Curved reconstruction plane, 212f, 234, 234f, 237f D Decision, 176 Decision errors, 205 Decision-making categorization’s role in, 203 clinical history in, 139 clinician-centric, 225 cognitive biases influencing judgment anchoring and adjustment, 185 attribute substitution, 185 availability, 185 representativeness, 184–185 cognitive dispositions to respond See Cognitive dispositions to respond considerations for, 202–204 descriptive, 202 errors in, 204–206 logic See Logic; Logical fallacies overview of, 175–177 prescriptive, 202 probabilistic, 274 satisfaction of search, 205–206 schematic diagram of, 176f summary of, 206 tests and testing binary discrimination, 191–195 conundrum of, 200b overview of, 190–191 receiver operating characteristic analysis, 200–202, 201f–202f standard binormal model, 195–199 Decision theory, 202 Deduction/deductive reasoning description of, 177–179, 183 in frequentist probability, 189 inference versus, 184t Dental materials, 17f, 18t Denying the antecedent, 180–181 Descriptive decision-making, 202 Diagnosis findings associated with, 161 imaging uses in, practice model for, 273–281, 274f–280f sinus findings used in, 280–281 Diagnostic accuracy, 195 Diagnostic errors, 175 Diagnostic reasoning, 175 Disciplined intuition approach, 237–239 Disease, 198, 199b Disease-based classification systems, 160 Disjunction, 182 Distal stimulus, 117, 124 Double-rooted teeth, 305, 305f Dual-arch imaging study, 243, 244f Dual-learning system models, 171 Dual-monitor approach, 218, 218f E Effortful practice description of, 170–171 experience versus, 173 Electronic dental record, 210 Emergence profiles, 294–295, 295f, 298, 299f, 305 Empirical analysis, 204 Empty space schema, 272f Endodontic platform, 294–297, 296f–297f Endodontic therapy, 9, 140 Errors of commission, 204, 231 decision, 205 in decision-making, 204–206 of omission, 204, 231 recognition, 205 scanning, 204 Euclidean geometry, 92 Exclusion threshold, 190 340 www.pdflobby.com Index Exemplar theory, 159 Experience, 173 Experiential knowledge, 167 Experimental psychologic research, 146 Expert(s) determinants of, 164–167 Dreyfus’s definition of, 169 explicit knowledge of, 167–168 inductive inferential reasoning used by, 166 studies of, 163 summary of, 171–173 tacit knowledge of, 167–168 thinking by, 168–170 Expertise effortful practice in, 170–171 experience and, 173 feedback’s role in, 170–171 human errors and, 170 practice needed to develop, 172–173 summary of, 171–173 Explicit knowledge, 167–168 Eye anatomy of, 113f viewing distance for, 114–115 F Fallacy of the single cause, 181 Fast thinking, 168–170 FDK cone-beam reconstruction, 22 Features, 266 Feedback, 133, 135–136, 170–171 Field-of-view crop tool, 247f Fields of view, 113–115, 138 Figure/ground principle, 118, 120f Final report, 267, 267f Financial considerations, 314 Findings, 266 Fluency, 160 Focused analysis, 238 Forward-reasoning strategy, 167 Fourier transform, 34–41, 35f–40f Fourier-slice theorem, 41–46, 41f–46f Fovea, 112, 113f Foveating, 116 Fractures, 281, 283f–284f Framing of decisions, 186 Frequentist probability, 187–189, 188f–189f G Gambler’s fallacy, 187 Gantry, 26, 29, 30f, 61f Gantry lift, 228f Gaze, 116, 117f Gaze volume, 146 Gestalt Principles, 118f–120f, 118–121, 123f, 238 Global percept, 128, 132, 167, 169 Gold, 17 H Healing, 285, 285f–288f Hedge language, 162b Hemimandible, 48f Heuristics attribute substitution, 185 availability, 185 representativeness, 184–185 Hindsight bias, 186 History See Clinical history I Holistic impression, 169 Human errors, 170 I IF-THEN logic, 178 Illumination, 16 Image interpretation clinical history’s role in, 140 See also Clinical history cognitive factors in attention, 127–128 attentional templates, 128–136 biased competition, 136–139, 158 overview of, 124 perceptual set, 125–127 response bias, 125 contextual considerations, 142 disciplined intuition approach to, 237–239 knowledge needed for, 167 language used in, 266 mistakes in, 3f–7f perception in See Perception prior treatment and, 150–154 reading room for, 218, 218f reports generated from, 266–269, 267f–269f as visual reasoning activity, 104, 159 Image perception bottom-up processing, 105, 107–111 importance of, 103–104 top-down processing, 105–107, 105f–107f, 110–111 Image reconstruction approximate, from cone projections aliasing, 98f–100f, 98–101 artifacts See Artifacts description of, 22 Fourier transform, 34–41, 35f–40f Fourier-slice theorem, 41–46, 41f–46f inverse problems, 22 projection-slice theorem, 41–46, 41f–46f Radon transform of projection data, 26f–33f, 26–34 resolution, 98f–100f, 98–101 sampling, 98f–100f, 98–101 schematic diagram of, 24f–25f sinogram, 29, 31f–32f, 34 summary of, 101 FDK cone-beam, 22 key relationships in, 46f process of, 13 Image sensor, 19f Image-guided access double-rooted teeth, 305, 305f emergence profiles, 294–295, 295f, 298, 299f endodontic platform, 294–297, 296f–297f multiple-rooted teeth, 305–311, 306f–311f portals of navigation, 294–297, 295f, 309f single-rooted teeth, 297f–304f, 297–305 Image-guided instrumentation, 311–313 Image-guided treatment, 294, 310 Imager Americans with Disabilities Act guidelines, 214, 217f competency in use of, 314 components of, 211f cost-effectiveness of, 314 field-of-view, 209 learning curve with, 314 341 www.pdflobby.com I Index patient positioning for, 214, 216f physical space for, 213–214, 215f–217f return-on-investment considerations for, 314 seated positioning, 214 selection of, 209–212, 210f–213f useful life of, 314 Imaging diagnostic uses of, learning curve with, 314 non-diagnostic indications for, 191 purpose of, salient objects in, 139 Imaging plane, 228, 228f–229f Imaging study dual-arch, 243, 244f fees for, 222 incidental findings, 224, 224t informed consent for, 224 large-FOV, 249, 249f legal considerations for, 225–226 optimization techniques for exposure parameters, 230f, 230–231 imaging plane, 228, 228f–229f metal removal, 226, 226f–227f patient preparation for, 222–226 radiation exposure during, 222–223, 223f rationale for, 222 review and reporting of for artifacts, 259–266, 260f–265f disciplined intuition approach, 237–239 for interval change, 257–259, 257f–259f overview of, 231–232 principles of, 233–239 setting up study for, 233–237, 233f–237f screening uses of, 221, 250–252, 251f–252f setting up, 233–237, 233f–237f single-arch, 243 stitched, 243 when to order, 220–222 Imaging-based prompts and cues, 144 Inattentional blindness, 136 Incidental findings, 224, 224t Incomplete examinations, 89–91 Inductive inferential reasoning, 166 Inference causal, 181 deduction versus, 184t description of, 179, 183 Inferences, 105 Information flow, in bottom-up processing, 107 Information technology, 219–220 Informed consent, 224 “Inner speech,” 156 Instrumentation, image-guided, 311–313 Internal resorption, 312f Interpretive process, 176 Interval change, 257–259, 257f–259f, 285, 285f–288f Inverse Fourier transform, 44 Inverse problems, 22 Inverse Radon transform, 46 Inversion of the conditional, 180 Ionizing radiation exposure, 222–223, 223f Isthmus, 109f K Knowledge, 167–168 L Language action-grounded, 163 categorization in, 160 cognition and, 159 communicative uses of, 156 definition of, 156 description of, 10–11, 141 hedge, 162b hypotheses about, 156 of image interpretation, 266 of imaging findings, 154–163 importance of, 156 meaning conveyed through, 156–157 of perception, 117–118 perception and, 157–158 in reasoning, 159 relativist view of, 154 summary of, 162–163 symbols in, 156 thought and, 156, 162 universalist view of, 154 Large-FOV studies, 249, 249f Learning active, 171 attentional templates and, 132–136 category, 171 effortful practice in, 170–171 feedback’s role in, 170–171 Legal considerations, 225–226 Level of confidence, 176 Likelihood, 189–190 Logic deduction, 177–179 directions of, 177 inference, 179 necessary and sufficient in, 183 summary of, 184 Logical fallacies affirming the consequent, 181 conjunction fallacy, 182 denying the antecedent, 180–181 description of, 179–180 fallacy of the single cause, 181 inversion of the conditional, 180 necessary and sufficient, 183 Lung nodule detection, 133–134, 134f M Mach bands, 21, 21f, 122f Malpractice law, 225 Mandibular molars, 306f–307f Mandibular premolar, 300, 300f Mass density, 17f Material schema, 272f Maxillary incisor, 303f Maxillary molars, 306f–308f Maxillary right central incisor, 276f Medical model, 207–208 Medical radiology, 153–154 Mental models, 10–11, 14, 22, 118 Mesial angulation, 302f Mesiobuccal canal, 254f, 307, 310 Metal, 226, 226f–227f Mineral trioxide aggregate, 303 Models, 10–11 Molars, 306f–307f Motion artifacts, 86f–88f, 86–88 342 www.pdflobby.com Index Multiple-rooted teeth, 278, 305–311, 306f–311f Multitasking, 136 N Necessary, in logic, 183 Noise, 99f Non-endodontic findings, 150 Null hypothesis, 179 Numbers, 159 O Observational evidence, 178 Omission bias, 186–187 Open margins, 125, 135 Operative imaging calcium hydroxide techniques, 252, 253f–254f periapical area evaluations, 255, 255f–256f Ordering-interpreting-intervening clinician model, 140, 155 Outcomes, 9–10 Overconfidence, 186 P PAI See Periapical Index Parafunctional habits, 280 Pathosis, 161 Patient history, 126 Percept, 117 Perception as bottom-up process, 118 changes in, 139 clinical history in, 139–140, 143 components of, 117–118 Gestalt Principles, 118f–120f, 118–121, 123f language and, 117–118, 157–158 process of, 118f–120f, 118–121 summary of, 123–124 temporal organization of, 136–137 visual illusions and, 122, 122f–123f Perception metrology, Perceptual set, 125–127 Perforations, 289 Periapical area, 255, 255f–256f Periapical Index, 10 Periapical radiography, 13 Periapical radiolucencies, 150, 152 Pericervical dentin, 158–159 Perturbation, 231 Photoelectric effect, 14 Photon scattering, 18, 20, 20f Photon-matter interaction, 14–15 Photopic vision, 112 Plane-focused software, 211 Pointillism, 128 Pop-outs, 108 Portal of navigation, 294–297, 295f, 309f Practice, 172–173 Practice model clinical applications of, 270–293 cracked teeth, 293 diagnosis using, 273–281, 274f–280f healing evaluations, 285, 285f–288f interval change evaluations, 285, 285f–288f overview of, 270 perforations, 289 restorability determination, 289–293, 290f–293f revision of existing treatment, 288–289 schemas, 271f–272f, 273 trauma, 281, 281f–284f R Preliminary read, 218 Prescriptive decision-making, 202 Presidential Commission for the Study of Bioethical Issues, 225 Prior probability, 190, 203 Prior treatment, 150–154 Probabilistic decision-making, 274 Probability Bayesian, 189 description of, 140, 178–179, 182 frequentist, 187–189, 188f–189f likelihood versus, 189–190 prior, 190, 203 summary of, 190 Professional judgment, 204 Projection-slice theorem, 41–46, 41f–46f Prolonged dwell time, 1234f Prototype theory, 159 Proximal stimulus, 117, 124 Proximity principle, 118, 118f Pseudo-PA image curved slice used in creation of, 236f, 255f description of, 4f–7f, 233, 242f thick-section, 234, 236f Pseudopan, 233–234 Pulpal floor, 305 P value, 179, 187 R Radiation exposure, 222–223, 223f Radiologic hedge, 162 Radiological Society of North America, 266 Radiolucent findings, 14 Radon space, 41 Radon transform of projection data, 26f–33f, 26–34 Reading room, 218, 218f Reasoning components of, 177 deductive, 177–179, 183 forward-reasoning strategy, 167 inductive inferential, 166 inferential, 179 language in, 159 Receiver operating characteristic analysis, 200–202, 201f–202f Recognition errors, 205 Reconstruction artifact, 74–86, 75f–85f Referral-based imaging, 267, 268f Region of interest crop tool, 245f Reports, 266–269, 267f–269f Representative, 184 Representativeness, 184–185 Resolution, 98f–100f, 98–101, 112–114 Resorption, 289, 291f–292f Response bias, 125, 127, 152 Restorability determinations, 289–293, 290f–293f Retreatment outcome studies of, 152 risks associated with, 278 Return-on-investment, 314 Review and reporting for artifacts, 259–266, 260f–265f disciplined intuition approach, 237–239 for interval change, 257–259, 257f–259f overview of, 231–232 principles of, 233–239 setting up study for, 233–237, 233f–237f Revision of existing treatment, 288–289 Rigidity, in attentional templates, 130, 130f–131f 343 www.pdflobby.com R Index Ringing artifact, 3f, 106 Rods, 112, 113f Root fractures, 281, 284f Root resorption, 304f S Saccades, 116 Sagittal plane, 243 Sampling, 98f–100f, 98–101 Satisfaction of search, 205–206, 231, 238 Scanning errors, 204 Scatter, 18–20, 48–59, 49f–58f Scattered radiation, 18–20 Schemas, 271f–272f, 273 Scotopic vision, 112 Screening, 221, 250–252, 251f–252f Selection bias, 238 Self-assessment, overconfidence in, 186 Semiotics, 156 Sensitivity, 195–196, 197f, 200, 201f Sensors, 19f Sign, 156 “Significant,” 266 Similarity principle, 118, 119f Simplicity principle, 118, 121f Simultaneous contrast, 122f Single-arch imaging study, 243 Single-rooted teeth, 297f–304f, 297–305 Sinogram, 29, 31f–32f, 34 Sinus, 249f Sinus schema, 272f Skull base, 249f Slice artifacts, 92–98, 93f–97f, 235f Slow thinking, 168–170 Soft tissue schema, 272f Software, 234, 267 SoS See Satisfaction of search Specificity, 195–196, 197f, 200, 201f Staging of disease, 314 Standard binormal model, 195–199 Stimulus salience, 238 Stitched imaging study, 243 Sufficient, in logic, 183 Sure-thing principle, 182b Surrogate endpoint, 10 Symbols, in language, 156 Symmetry/order principle, 118, 120f Symptomatic teeth, 280 System backup, for computers, 220, 220f T Tacit knowledge, 167–168 Taper instruments, 313 Target, 117 Taxicab problem, 191–195, 192f–193f, 194b Temporal organization, 238 Tests and testing binary discrimination, 191–195 conundrum of, 200b overview of, 190–191 standard binormal model, 195–199 Thinking, 168–170 Thought, 156, 162 Titanium, 17 Tooth schema, 272f Top-down processing, 105–107, 105f–107f, 110–111, 139 Transsagittal plane, 240f–241f, 243, 246f Trauma, 281, 281f–284f Treatment completion of, 311 existing, revision of, 288–289 image-guided, 294, 310 Truth, 177 Type I errors, 194, 198, 204 Type II errors, 194, 204 Type III errors, 194 V Validity, 177, 184 Viewing distance, 114–115 Visible white light, 63, 65f Vision basics of, 112, 117 fields of view, 113–115, 138 foveating, 116 photopic, 112 resolution in, 112–114 saccades, 116 scotopic, 112 viewing distance, 114–115 Visual illusions, 122, 122f–123f Visual reasoning activity, 104 Visual system, 104, 112, 126 Volume-focused software, 211 W Wavelength, 17, 17f X X-ray(s) photon matter and, interaction between, 14–15 production of, 14–15 X-ray beam, 16 344 www.pdflobby.com John A Khademi, DDS, MS, received his DDS from the University of California, San Francisco and his certificate in endodontics and MS in digital imaging from the University of Iowa He currently maintains a full-time private practice in Durango, Colorado Previously he was an associate clinical professor in the Department of Maxillofacial Imaging at the University of Southern California, and he is currently an adjunct assistant professor at Saint Louis University Before he entered private practice, he wrote software for laboratory automation, instrument control, and digital imaging He lectures internationally about CBCT, clinical trial design, outcomes, and conventional endodontic technique As a Radiological Society of North America member for over 20 years, Dr Khademi has gained a background in medical radiology that allows him a perspective shared by very few dental professionals CONTENTS Introduction Technical Considerations with Cone Beam Imaging Perception and Cognition Decision-Making in Radiology Implementing CBCT in Endodontic Practice www.pdflobby.com .. .Advanced CBCT for Endodontics: Technical Considerations, Perception, and Decision-Making www.pdflobby.com www.pdflobby.com Advanced CBCT for Endodontics: Technical Considerations, Perception,. .. Khademi, John A., author Title: Advanced CBCT for endodontics : technical considerations, perception, and decision-making / John Khademi Other titles: Advanced cone beam computed tomography for. .. real and what is artifact? ?and allow us to predict what we are likely to be able to detect, or just as important, anticipate what we are unlikely to detect with a CBCT study The CBCT reconstruction