Guidelines for clinical use of Cone Beam CT: a review
Formålet med denne oversigtsartikel er at identificere guidelines for den kliniske anvendelse af Cone Beam computer-tomografi (CBCT) inden for dento-maxillo-facial radiologi, i særdeleshed beskrivelsen af selektionskriterier: at vurdere, på hvilket grundlag disse er fremlagt, at vurdere kvaliteten af guidelines ved hjælp af en objektiv metode samt at sammenligne deres anbefalinger. Der blev foretaget en litteratursøgning ved hjælp af MEDLINE (Ovid®) fra 1. januar 2000 for at identificere, hvilke skrifter der kunne klassificeres som guidelines for, hvornår CBCT kan anvendes i odontologien. Denne søgning blev suppleret med søgninger på websites, internetbaserede søgemaskiner og håndsøgninger blandt publicerede afhandlinger og information fra personlige kontakter. Der blev foretaget en kvalitetsvurdering af søgeresultaterne efter den såkaldte AGREE II-metode. Desuden blev det undersøgt, hvor de forskellige guidelines var enige og uenige. Der blev identificeret 26 publikationer, som opfyldte inklusionskriterierne. 11 af disse var specielt bestemt til at give tandlæger guidelines og selektionskriterier for den kliniske anvendelse af CBCT. De resterende var en heterogen blanding af publikationer. To af publikationerne havde anvendt en formel evidensbaseret retningslinje for udviklingen af guidelines, og to havde anvendt en konsensusmetode. Kvaliteten af publikationerne blev oftest klassificeret som lav efter AGREE II på grund af manglende beskrivelse af metodologien. Der sås generelt en bred overensstemmelse blandt guidelines for den kliniske brug af CBCT, undtagen for behandlingsplanlægning før implantatbehandling. Det konkluderes i denne oversigt, at processen i udviklingen af guidelines for brugen af CBCT ofte var dårligt beskrevet. Paneler, der varetager udvikling af sådanne guidelines, bør sigte mod at beskrive deres arbejde i overensstemmelse med AGREE II-princippet som en model til at højne standarden og undgå risiko for bias.
Objectives - To identify guidelines on the clinical use of CBCT in dental and maxillofacial radiology, in particular selection criteria, to consider how they were produced, to appraise their quality objectively and to compare their recommendations. Methods - A literature search using MEDLINE (OVID) was undertaken prospectively from 1 January 2000 to identify published material classifiable as “guidelines” pertaining to the use of CBCT in dentistry. This was supplemented by searches on websites, an internet search engine, hand searching of theses and by information from personal contacts. Quality assessment of publications was performed using the AGREE II instrument. Publications were examined for areas of agreement and disagreement. Results - Twenty-six publications were identified, 11 of which were specifically written to give guidelines on the clinical use of CBCT and contained sections on selection criteria. The remainder were a heterogeneous mixture of publications which included guidelines relating to CBCT. Two had used a formal evidence-based approach for guideline development and two used consensus methods. The quality of publications was frequently low as assessed using AGREE II, with many lacking evidence of adequate methodology. There was broad agreement between publications on clinical use, apart from treatment planning in implant dentistry. Conclusions - Reporting of guideline development is often poorly presented. Guideline development panels should aim to perform and report their work using the AGREE II instrument as a template in order to raise standards and avoid the risk of suspicions of bias.
