Checklists aren’t just for beginners—they’re essential for experienced practitioners too. In fact, they might matter more as expertise grows, when the temptation to skip steps can creep in. I learned this lesson during my residency, thankfully under supervision, when a missed detail could’ve slipped by without someone double-checking my work. That stuck with me.
Below is my checklist for cone-beam CT (CBCT) interpretation. It’s not a report template—every item doesn’t need to be documented—but a guide to ensure I review key structures, account for critical anatomy, and catch anything significant. This isn’t exhaustive; no list could cover every possible finding in a volume. It’s a starting point to methodically assess the scan. That said, a checklist alone isn’t enough—scrolling through the entire dataset, slice by slice in each anatomical plane, is just as vital. Combining both approaches is a safeguard, like wearing a belt and suspenders, to minimize oversights.
This list will likely evolve, and I’d welcome any feedback or suggestions to refine it. Please email us if you would like a pdf copy of my most up-to-date checklist!
Tony Mecham
CBCT Interpretation Checklist
General
- Assess overall bone density and trabecular pattern for generalized or localized abnormalities.
- Evaluate cortical plates for density, thickness, uniformity, and continuity.
- Check symmetry in hard and soft tissues.
- Look for irregular calcifications, foreign bodies, or swelling.
- Confirm expected anatomy and normal variations, noting anything unusual.
Skull
- Verify normal, patent foramina.
- Confirm auditory canal patency.
- Examine cochlea and semicircular canals.
- Assess ossicles.
- Evaluate sella turcica and clinoid processes.
Orbits
- Inspect orbital walls.
- Check fissures and canals.
Brain
- Look for calcifications within brain parenchyma and along skull surfaces.
Spine
- Note osteophytes or fusion.
- Assess cortication, erosion, and alignment.
- Examine internal vertebral structure.
- Identify abnormal calcifications.
Nasal Cavity
- Confirm osteomeatal complex is patent and normal.
- Verify patent airspace.
- Note septal deviation (a common finding).
- Assess conchae and meati for normal appearance.
Maxilla
- Examine nasopalatine canal.
- Check greater and lesser palatine canals.
- Assess pterygopalatine fossa.
- Evaluate pterygoid process and plates (part of the sphenoid, but included here for convenience).
Mandible
- Trace mandibular canals.
- Inspect mandibular fossae.
- Note lingual tori and genial tubercles.
- Identify nutrient canals.
Sinuses
- Review frontal, ethmoidal, maxillary, sphenoidal, and mastoid air cells.
- Check for mucosal thickening, continuous/uniform borders, septae, opacification, or calcifications.
Salivary Glands
- Assess size.
- Look for calcifications.
Airway
- Confirm patency and symmetry.
- Note any notably narrow cross-sectional areas.
Dentition
- Ensure each tooth appears normal.
- Identify impacted or malpositioned teeth.
- Check for dental hypodensities.
- Differentiate artifacts (e.g., beam hardening, streaking from metal or gutta-percha) from true findings.
- Verify periodontal ligament (PDL) and lamina dura are intact and uniform.
- Assess for apical hypodensities.
Occlusion
- Note if in maximum intercuspation or separated by a bite stick.
- Identify premature contacts or cross-bites.
TMJ
- Evaluate condylar cortication (present, uniform, thick/sclerotic).
- Assess condyle size and shape (e.g., flattening, remodeling).
- Look for erosion, subcortical cysts, or osteophytes.
- Check joint space size, uniformity, and condyle position in the fossa.
- Examine articular fossa.