Work Package 1: Justification and Guideline Development


The theme of this package is “Justification and Guideline development”. The principle of ‘Justification’ is a central pillar of radiation protection, recognised as such by the European Commission through its Directive 97/43 Euratom. Any X-ray exposure should show a net benefit to the patient, weighing the total potential diagnostic benefits it produces against the individual detriment that the exposure might cause. The efficacy, benefits and risk of available alternative techniques having the same objective but involving no or less exposure to X-rays should be taken into account. In dentistry, this issue was addressed specifically by the 2004 European Guidelines on Radiation Protection in Dental Radiology. This document included some evidence-based referral criteria for the common dental radiological procedures, largely derived from a previous document developed in the UK. Unfortunately, these guidelines did not include reference to CBCT. Guidelines on the use of imaging in dental implantology (a common use of CBCT) by the European Association for Osseointegration also omitted any specific reference to CBCT. This lack of referral criteria has been raised as a potential concern with CBCT recently in the United States.

Review of the scientific literature shows, as described above for ‘Diagnostic Accuracy’, an enthusiasm for use of CBCT by individuals based on subjective opinion and small case series. There is a real risk that CBCT will be perceived by dentists as a panacea for all ills, leading to an excessive use analogous to conventional CT being used to conduct ‘whole body health checks’ in the absence of clinical need. Our research ‘fills the gap’ in referral criteria for CBCT in dentistry. Our strategy follows a systematic process of identifying the evidence, assessing its strength and robust guideline setting. Many of the individuals involved in this application have past experience of setting such guidelines.


  1. To perform a systematic review of CBCT based on ‘dose and risk’, ‘diagnostic accuracy’ and ‘quality assurance’.
  2. To develop provisional guidelines to input into Work Package 6.
  3. To incorporate knowledge obtained from the results of SEDENTEXCT study.
  4. To develop definitive referral criteria and guidelines on quality assurance, optimization to input into Work Package 6.