Referral Slips

What is DICOM and Viewer?

  • DICOM – A digital CT scan formatted for clinical use.
  • Viewer – A radiology visualization software program for rendering the patients anatomy.  

What is a Image Portfolio?

  • Case specific arrangement of key radiographs, organized into a portfolio layout displaying relevant images.
  • Supports the diagnostic question and any incidental findings.
  • Assists in patient education and conserving doctor and staff time.

What is Beamreaders?

  • A free, HIPAA compliant web portal that allows DDI to upload your patient’s files.
  • Doctor has digital access to patient records.
  • Can share with other dental team members.

DDI Imaging Goals

Study Purpose

When a patient is referred to DDI the referring clinician is encouraged to select a study purpose (ie., the reason for referring).  The list below are typical study purposes.

  1. TMD
  2. Orthodontics
  3. Impaction/ Localization
  4. Pathosis
  5. Implants
  6. Endodontics
  7. Airway
  8. General report

Imaging Goals: 

Each study purpose has unique Imaging goals and proposed punch list of anatomic features that need to be captured during the imaging session and displayed in an imaging portfolio.   The imaging session is tailored to the study purpose and the DDI technologist will select the appropriate field of view, image resolution, patient positioning and selection and assembly of image captures to facilitate diagnosis and treatment planning.  

Temporomandibular Disorders (TMDs):

  1. Reveal the size, shape, quality and spatial relationships of osseous and/ soft tissue TMJ components
  2. Capture appropriate anatomy in order to identify or rule out potential sources of pain by region.
    1. Dentition
    1. Sinuses
    1. Jaws
    1. Spine.
  3. Preliminary Airway Analysis
  4. Assessment of Jaw Growth
  5. Assessment of Occlusion


  1. Assessment of:
    1. Jaw Growth
      1. Maxilla/ mandible Normal growth or recessive
      1. Mandibular plane angle
      1. Gonial angle
      1. Transverse dimensions
    1. Airway
    1. TMJs
    1. Eruption pattern
    1. Ridge dimensions
      1. Labiolingual dimensions
    1. Jaw Symmetry
    1. Occlusion
    1. Dentition
      1. Crowding
  2. Identify or Rule Out
    1. Supernumerary teeth
    1. Impacted Teeth
    1. Pathosis


  1. Determine 3D location of impacted tooth
    1. Crown and root
    1. Orientation
  2. Relative to:
    1. Adjacent teeth
    1. Sinuses/ Nose/ Nerve Canals
  3. Identify or Rule out Pathosis including:
    1. Supernumerary teeth
    1. Odontomas
    1. Cysts
    1. Hyperplastic follicles
    1. Root resorption
    1. Infection
  4. Identify Barriers preventing forced eruption of impacted tooth into place


  1. Lesion location
  2. Lesion size
  3. Lesion shape
  4. Border characteristics
  5. Internal characteristics
  6. Effect on adjacent structures


  1. Dimensions of implant site.
    1. Height
    1. Labiolingual dimensions
    1. Mesiodistal dimensions
  2. Evaluation of Implant site.
    1. Identify or rule out pathosis
    1. Bone quality
  3. Localize Anatomic boundaries including:
    1. Nerve canals
    1. Sinuses/ sinus Septa/ Ostiomeatal unit
    1. Nasal fossae
    1. Canine and submandibular fossae


  1. Pre-RCT evaluation
    1. Identify or rule out periapical or periodontal pathosis
    1. Identify dental anomalies
    1. Identify accessory/ anomalous canals
    1. Identify root fracture
    1. Identify root resorption
    1. Identify pulp calcification/ stones
    1. Determine proximity to and condition of vital structures
  2. Post RCT evaluation
    1. Recurrence/ persistence of inflammatory disease
    1. Root or crown fractures
    1. Access/  Instrumentation/ obturation evaluation
    1. Periodontal condition
    1. Determine proximity to and condition of vital structures


  1. Assess airway anatomy
    1. Nasal fossae
    1. Nasopharynx
    1. Oropharynx
    1. Hypopharynx
    1. Paranasal sinuses
  2. Assess Airway Dimensions
    1. Determine smallest cross sectional area
  3. Nasal Fossae
    1. External nasal valve
    1. Nasal septum Shape
    1. Identify or rule out masses
    1. Turbinate size
    1. Mucosal thickening
    1. Developmental anomalies
  4. Nasopharynx
    1. Encroachments
      1. Inferior turbinates
      1. Adenoids
      1. Masses
    1. Parapharyngeal structures
      1. Torus Tubarius
      1. Fossa of Rosenmuller
  5. Oropharynx.
    1. Encroachments
      1. Tonsils
      1. Tongue
      1. Soft Palate/ Uvula
      1. Masses
      1. Spine
      1. Epiglottis
  6. Paranasal sinuses:
    1. Maxillary
    1. Ethmoid
    1. Sphenoid
    1. Frontal
    1. Sinus drainage
  7. Airway supporting structures
    1. Jaw Size and shape
    1. Cervical spine quality and position
    1. Hyoid bone position
    1. Skull base length and shape
  8. Confirm validity of Study
    1. Head Position
    1. Tongue position
    1. Soft palate position
    1. Epiglottis position
  9. Mobile elements
    1. Tongue size
    1. Soft palate length and thickness


  1. General review of Anatomy
    1. Use report template


        ExaminationEffective Dose
CBCT – small and medium volumes (FOV <10 cm)11-674 μSv (median value: 61 μSv)
CBCT – large volumes (FOV >10 cm)30-1073 μSv (median value: 87 μSv)
Panoramic9-26 μSv
FMX – PSP plates/ F-speed film, rectangular collimation34.6 μSv
FMX – PSP plates/ F-speed film, round collimation170.7 μSv
FMX – D-speed film, round collimation388 μSv
Medical CT280-1410 μSv
Daily background radiation in US8 μSv