Dentists' Responsibilities

CBCT scan referrals: what needs to be included

A CBCT scan (Cone Beam Computed Tomography) is a 3D imaging technique used throughout dentistry to produce detailed images of teeth, bones, and surrounding structures. To prescribe, order, take, interpret and report on CBCT scans, the dentists or specialist must be authorized by the RCDSO.

There are two main instances where a referral can occur involving CBCT scans:

1. When a dentist refers a patient to a prescribing (CT authorized) dentist to have the CBCT scan acquired.

  • In this instance, the “referring” dentist identifies the potential need for CBCT scan.
  • They refer the patient to a prescribing dentist to acquire the scan. The prescribing dentist is required to determine if the CBCT scan is clinically justified.
  • The referring dentist does not need to have CT authorization because they are not performing any of the restricted acts – prescribing, ordering, taking, interpreting or reporting on the CBCT scan.

2. When a CT authorized dentist prescribes and acquires CBCT scans but then refers the scan to an oral radiologist or another CT authorized dentist for interpretation and reporting.

Let’s look more closely at the responsibilities involved in each of the two referrals.

When a dentist refers a patient to a prescribing dentist for a CBCT scan

The College’s Standard of Practice - Dental CT Scanners (“Standard of Practice”) states that referrals made by the referring dentist must include sufficient clinical information to enable the prescribing dentist to determine whether a CBCT scan is clinically justified. The Standard also outlines the following details that must be provided by the referring dentist:

  • the patient’s name, address and date of birth;
  • the referring dentist’s name, as well as the names of any other dentists who are to receive copies of the report;
  • the type of dental CT scan requested for the patient, including any special instructions;
  • pertinent clinical information, such as case history, provisional diagnosis and/or proposed treatment;
  • copies or a written report of any recent radiographs and/or other images that have been taken of the patient in the area of clinical interest (when taken).

It is the prescribing dentist’s responsibility to ensure they have the appropriate referral information. If a patient is referred without appropriate referral information, the Standard of Practice requires the prescribing dentist to contact the referring dentist for clarification. This signifies the importance of a proper referral for patient safety and effective treatment planning.

Copies or a written report of any recent radiographs or other relevant images of the patient—specifically in the area of clinical interest—must be included with the referral. For example, additional periapical or panoramic radiograph acquired by the referring dentist can help the prescribing dentist determine the appropriate field of view, accurately position the CBCT scan, correlate findings across images, and assess whether CBCT imaging is clinically necessary.

If these details are not properly communicated to the prescribing dentist, it may result in inappropriate or unnecessary imaging.

When a dentist refers a CBCT scan to an oral radiologist or a different CT authorized dentist for interpretation and reporting

Unlike the initial referral to acquire a CBCT scan, the Standard of Practice does not specify what information must accompany a CBCT scan when it is sent to an oral radiologist or reporting dentist for interpretation. Typically, only the CBCT volume is provided, without any accompanying 2D imaging. The oral radiologists may advise the treating clinician to “correlate with imaging,” meaning they should review any available previous imaging or obtain new ones if none are recent or accessible when reviewing the CT report.

Key takeaway

If the referring dentist is unsure what to include, either when referring a patient to a CT authorized dentist to acquire a CBCT scan or when referring a CBCT scan to a CT authorized dentist/oral radiologist for interpretation and reporting, best practice is to ask the CT authorized dentist or oral radiologist to confirm what they need. This ensures that all critical clinical details are communicated.