The concept for our recent session was simple: an oral and maxillofacial radiologist opens a CBCT, starts at the top of the volume, and reads it all the way through, narrating what she sees as she goes.
As you watch Dr. Dania Tamimi do it, you start to see how much experience is actually packed into those roughly 25 minutes. She has been reading scans for over two decades, authored textbooks, and educates around the world, so the experience shows up in small, useful ways. For example, why she refuses to look at the chief complaint first and even leaves the teeth alone until everything else is done.
This is vital, as there’s a well-known name within radiology for what happens when the eye goes straight to the indication: satisfaction of search error. It’s the tendency of one’s brain to check out once it finds the answer to the question it walked in with. Practically speaking, if you take out third molars all day, your eyes might go to the third molars. If you live in TMJ, you look at the TMJs.
Among those who responded during the webinar, the vast majority expressed (in this judgement-free zone), that teeth, airway, sinuses, spine, or the site that brought the patient in were the most common places they’d looked first. Only a couple individuals mentioned having a systematic search pattern.
The search pattern
Dr. Tamimi illustrates the search pattern she and many other oral and maxillofacial radiologists use. Black things come first, meaning the air-filled spaces: sinuses, nasal cavity, nasopharynx, and airway. Then she moves to the white things: cervical spine, skull base, and jaws. The gray areas follow, where soft-tissue interfaces and calcifications live. She saves the teeth for the end, counting them right to left the way a dentist would. The reason for the scan comes after all of that. This is vital to ensure that nothing in the volume is missed.
The case she reads makes her point for her. The scan was taken for orthodontics, with the patient wanting their smile fixed. As she works through the volume, she connects the appearance of the condyles to the patient's mandibular position, narrowed airway, long soft palate, and forward head posture. The scan reveals a much larger story, and all of it matters for treatment planning.
“Anatomy is king”
Throughout the session, Dr. Tamimi reminds us that, “Anatomy is king… Your eyes will only see what your mind knows.”
When we asked how comfortable people felt interpreting beyond the reason for the scan, nearly half of those who responded said they would rather have a radiologist review it. Whether you want to strengthen your own method or have an OMR review the entire volume, seeing how an expert approaches the scan is a great place to start.
The session runs under 30 minutes and is available on demand. Sign up and watch it here.