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In order to assure that Dental Cone Beam CTs are being used safely and effectively, almost all states require that the Dental Cone Beam equipment have a mechanism to confirm it is operating properly year after year in a dental office.  This process can be confusing for a dental office because what’s required can vary between states, and the process can vary between manufacturers.  In fact, some first-time cone beam users may not be aware there is a requirement.

Typically, this procedure is generally referred to as “QA”, which is short for Quality Assurance.  For dental cone beam systems, this QA procedure across all manufacturers utilizes a tool referred to as the Quality Assurance, or QA, phantom.

To shed some light on this topic, we wanted to provide answers to some commonly asked questions about keeping your system compliant.

What is the QA phantom used for?

The QA phantom is a component that is scanned by the dental cone beam CT, and the resulting scan of this phantom is evaluated in specific ways.  If this evaluation passes a specific set of metrics, it serves as an indication that the cone beam CT is operating correctly.  This process is typically a core piece of the quality assurance, or QA, process.

Where do I get it?

Most commonly, this will come from the manufacturer of the cone beam.  However, there are independent companies that also provide dental cone beam CT phantoms.

Are they all the same?

No.  While there are many similarities, each one typically has its own unique characteristics.  It’s also important to know that each phantom provider has a unique process to use it, including what measurements to take.  

What does it look like?

While they are all different, they are typically cylindrical and made of a clear resin material.  They will typically also have different layers and some specific items embedded in them.  Here are a few examples:

I have a technician who services my office and my unit. Does my staff really need to know how to use this phantom?

It depends.  Some states require the office to perform the QA tests periodically (using the phantom), and sometimes an inspector will want to see evidence that this has been happening.  As an aside, performing this check is typically not that hard, and can be done fairly quickly.

How do I use the phantom?

This procedure on how to use it will come from the manufacturer, and the procedure is most commonly detailed in the User’s Manual.  While phantoms vary, there are some similarities.  Typically, it involves placing the phantom in the field of the view of the unit and taking a scan.  Then the QA process involves performing a number of simple measurements on the resulting image using the software.

These measurements will be looking at spatial accuracy, noise levels, contrast resolution, slice thickness and other parameters.  

I have a Dental Cone Beam and I don’t know where my QA phantom is.

You are not alone.  This is unfortunately an all too common occurrence as sometimes these items get lost in the office over time.  It’s highly recommended to designate a place to store this (and other maintenance accessories for the cone beam) and then inform the entire staff of this location. 

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I Place Implants, and I Outsource My CBCTs.  Would I See Higher Acceptance If I Absorbed the Initial CBCT Cost?

For most dental implant cases, one of the first steps is to perform an initial CBCT scan.  For those offices that do not have a CBCT in their office, this scan has a direct cost.  Depending on where the patient is scanned, the scanning facility may charge as little as $150 or as much as $300.  Charges for radiologist reviews may increase this charge further.

To cover this cost, most offices simply have the patient arrange the scan with the scanning facility, which the patient pays for directly out of pocket.  In many cases, they may tell the patient this cost will be “included” if they decide to move forward with the implant treatment.  This is a reasonable way to make sure the cost is covered.  Furthermore, many doctors see it as a valuable indicator to determine how committed the patient is to the treatment. 

However, some offices take the perspective that this initial CBCT payment may be serving as a hurdle that prevents many patients from even considering the procedure.  These offices take a different approach, and remove this barrier by agreeing to absorb this cost – independent of whether the patient decides to move forward with the full treatment plan.

With all the dental offices that utilized our digital imaging solutions, we have found that the latter approach is less common.  However, if done well, we have seen it be very effective in bringing implant treatment to more patients than would consider it otherwise.  One of the biggest benefits of this approach is that the CBCT arms the dental professional with a really powerful graphic to make the case to the patient how the treatment plan will improve their life.  These dental professionals prefer to remove barriers because once they have the cone beam scan, the patients can see the value for themselves.

However, this approach does come with risk.  It would be foolish and irresponsible to encourage patients to have CT scans performed when they will not accept the treatment.  So how is an office to decide the right strategy?

For those that are considering taking this approach, our recommendation is to run an experiment. 

As with any good experiment, it’s important to test the variable you are focused on and keep all other variables the same.  In this case, if you pick a reasonable time period — perhaps 3 months — then simply compare case acceptance during this period when patients are told that the initial scan is no charge to the acceptance rate when patient is told they will play for their scans.

Once this data is captured, it’s simple math.  The key datapoint is to evaluate how many more cases get accepted – and whether this additional income pays for the added costs of paying for scans on patients that do not move forward.  In this case, we will assume that in the standard operating procedure, the true cost does not change for patients that move forward with treatment – because in those cases the costs were absorbed in the broader treatment price.  

Here’s an example.  Let’s say that under normal operation (patient pays for their initial scan), the acceptance rate is 60%.  Let’s say that for this office that does implants, but not an enormous volume, they traditionally did 3 per month.

They then perform an experiment for 3 months, in which they offer to absorb the initial scan.  Let’s say that at the end of the three months, they find that they had 11 cases move forward on 15 recommendations, or an acceptance of 72%.

An increased acceptance is a good thing, but is this approach worthwhile?  We can’t be sure until we compare income vs. costs.

Let’s assume the cost of that initial scan is $300 and the incremental income for the implant case is $2000.  If we typically present the treatment to 15 patients in every 3 month period, then according to our experiment, changing our approach would result in about two additional cases every three months.   This means that:

Additional Cost:

Scans paid for patients that do not pursue treatment: 4

Cost per scan:  $300

Total Additional Cost:  $1200

Additional Income:

Additional Cases: 2

Income per case: $2000

Total Additional Income:  $4000

In this example, (assuming no other factors), it would be worth changing the policy to not charge the patients for that initial scan.

Of course, as with any calculation, the analysis is only as good as the inputs.  In addition, it should never be done in a vacuum without considering other soft factors.  For instance, perhaps there are other indicators that experience of the staff influence decisions about probability for case acceptance.  However, hopefully this provides on frameworks to decide if this approach makes sense for your practice. 

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The old saying “May you live in interesting times” never seems to get the old, and halfway through 2022, it’s as applicable as ever.    

Anyone who reads the paper is aware of the fears of inflation.  In June, the US Dept of Labor released their Consumer Price Index Report, and confirmed that the Consumer Price Index rose 9.1% in the trailing 12 months, which is that largest increase since 1981. 

However, more relevant to dental professionals, the index for Dental services increased 1.9% in June, the largest monthly change for those services “ever recorded” since the U.S. Bureau of Labor Statistics began tracking such numbers in 1995, according to the ADA.

This is mainly driven by price increases on materials and paying more to staff.

According to the ADA, a poll in November 2021 showed that personal protective equipment has drastically increased in price with more than half of dentists polled indicating that the price of surgical masks had at least doubled, and nearly 50% indicating that gloves had at least tripled in price.

In addition, “Eight out of 10 dentists reported issuing pay raises for their dental hygienists and dental assistants within the past year, which is reflective of a competitive job market across many industries, including health care,” said ADA President Cesar R. Sabates, D.D.S. 

As with many industries, the dental industry is also feeling the double-whammy of supply chain constraints along with higher competition for labor.  The goal for every dental office is to stay observant on these trends so that they can make the best decisions to navigate their practice through a changing landscape.

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