Upright Cone Beam Computed Tomography (UCBCT) at The Hauser Neck Center

What is Upright Cone Beam Computed Tomography? Upright cone beam computed tomography (UCBCT) is a radiographic imaging method that allows accurate, three-dimensional imaging of the bony structures of the head (cranium), neck (cervical spine), and facial bones; joints in these areas; as well as the dentoalveolar (teeth/gum) structures, nasal/oral-pharyngeal airway, and neurovascular structures and canals.

3D images help clearly identify and assess the degree of structural causes of a patient’s symptoms.

The name cone beam comes from the divergent, cone-shaped x-ray that is produced from the scanner. As the scanner rotates 180-360 degrees around the defined anatomical area of interest, hundreds of these tiny cone beam x-rays are taken and the computer then processes this into a 3-dimensional image.

How much radiation does UCBCT emit? UCBCT is different than conventional CT scanning which is performed by image slices that are then put together. Therefore, UCBCT only uses 10% of the radiation dosage compared to traditional CT scans. Each UCBCT scan emits approximately the same amount of background radiation that a person would get normally from just living on planet earth for 3 to 48 days.

What is Upright CBCT used for? Cone beam technology has been used in orthopedic imaging for visualizing bones, joints, muscles, fat, tendons, ligaments, and cartilage. It provides a three-dimensional (3-D) reconstruction of individual cervical vertebrae and their relationship to one another. It has many applications that pertain to head and neck pathologies and is being used in dentistry, particularly, endodontics, periodontics, orthodontics, forensic dentistry (tooth or gum disease), and implant dentistry, as well as upper cervical chiropractic and orthopedics.

Lateral view clearly shows styloid.

UCBCT can be used to identify density of bone, fractures, skeletal maturation, bone density, cervical fusion assessments, cervical and temporomandibular joint instabilities, bony alignment, styloid pathologies, paranasal sinuses, sleep apnea (narrowed airway spaces), blood vessel and brain tissue (intracranial) calcifications, semicircular canal (temporal bone) dehiscence, otosclerosis, hearing loss (structures in the inner ear and middle ear can be seen), cervical osteoarthritis, joint swelling, TMJ syndrome, craniocervical instability, facial and cervical soft tissue densities, congenital (developmental) anomalies, empty sella syndrome, and other brain pathologies.

Right and left atlantostyloid intervals can be measured.

What are the advantages of UCBCT? The advantages of UCBCT scanning compared to most radiographic imaging techniques include the following:

1. Can be performed with the patient in standing or sitting positions.
2. Can scan in different head and neck position(s), such as oblique/rotational.
3. Can be performed in the actual head/neck position that causes the greatest number of symptoms, such as looking at a cell phone or turning head right or left.
4. Provides extremely high dimensional accuracy at only about 2% magnification.
5. Provides 3-D vs 2-D images.
6. Can perform a full scan in about 1 minute.
7. Can perform multiple scans in minutes.
8. Can visualize hard-to-find images of craniocervical and cervical instabilities and other pathologies.
9. Can compare 3-dimensional bony alignment in multiple neck and head positions.
10. Can visualize instability of the occipito-atlanto joint (C0-C1) and TMJs.
11. Emits low amounts of radiation (10%) compared to conventional CT scans.

Seated or standing views can be taken, and the patient is not confined to a small tube.

How is UCBCT performed at Caring Medical? While in the desired upright position, the scanner moves around the patient’s head, which is stabilized with a chin holder to prevent motion artifact. The machine travels around the patient’s head for a minute or less, depending on what test(s) are ordered. The patient is not in a claustrophobic tube or laying down, just sitting or standing in a room with the scanner around their head.

Patients can be placed in rotational or other symptomatic head and neck positions.

The series of images then can produce projection images that can be seen in all three orthogonal planes (axial, sagittal, and coronal).

The software program then allows the reconstruction of the images to give a three-dimensional image that allows an almost limitless possibility of important measurements including the following:

• Multiple at the craniocervical junction, including odontoid process and McGregor, Chamberlain, Fischgold diagastric and/or McRae lines; atlanto-dens interval (ADI), basion dental interval, basio axial interval, and others.
• Spinal canal volume at each vertebral segment.
• 3-D spatial arrangements between cervical vertebrae, facial bones, and the cranium and cervical vertebrae.
• Cervical vertebral bony and joint subluxations in the various planes.
• Neuroforaminal dimensions.
• Degree of upper and lower cervical instabilities and in what plane.
• Upper airway spaces (helpful in sleep apnea.).
• Orthospinology (and other upper cervical) measurements (for upper cervical adjusting.)
• The distance between facet joints to show gapping or swelling.
• Atlantostyloid interval (ASI) – distance between the styloid bone and atlas.
• The displacement of the atlas in 3 dimensions.
• C6-atlas interval (C6AI) – distance between the posterior C6 vertebral body and anterior arch of atlas (C1). (Shows how far forward the top of cervical vertebrae is compared to lower segments)
• Styloid bones. Elongated styloids can compress the carotid sheath and its contents from the front.
• Temporomandibular joint subluxations in various positions.

How is UCBCT used at Caring Medical Florida’s Hauser Neck Center?

Identification of the underlying cause of symptoms: The forces on the human neck, especially in the upper cervical spine can involve hundreds of thousands of pounds of force each day as the average person is in forward head posture for an average of 5-6 hours per day looking at cell phones, tablets, and computer screens.

The face-down lifestyle effects: Research done at The Hauser Neck Center and other medical centers have documented that changes in cervical spine structure, especially a breakdown of the cervical facet joints and subsequently the normal optimum cervical lordotic curve, a condition called cervical dysstructure, can lead to dire consequences to the human brain and body’s autonomic and central nervous systems, as all nerve tracts and fluid flow into and out of the brain through the neck.

Unfortunately, the face-down-forward-head-posture that most of us are in throughout the day puts incredible stresses on not only the ligaments of neck, leading to bone spur formation through the cervical spine, but also in the stylohyoid and atlanto-occipital ligaments. These long-term stresses cause calcification of the stylohyoid ligament leading to an elongated styloid and calcification of the atlanto-occipital ligament leading to formation of a ponticulus posticus or what is known as Kimmerle’s anomaly.

Elongated styloid processes: An elongated styloid can compress the carotid sheath, especially closing off the jugular veins leading to intracranial hypertension, as well as various cranial nerves, while a ponticulus posticus, usually along with upper cervical instability, can compress the vertebral artery and/or C1 nerve root. As these ligament calcifications are no longer considered “rare” but commonplace, we needed an in-house method to accurately access them and more definitively recommend solutions for patients’ symptoms.

UCBCT scans can determine the length of the styloid bone, its distance from the atlas (atlantostyloid interval), and other cervical vertebrae, its angle in 3-D space in the neutral and upright positions. This information is used by our team to how to best change the cervical curve and alignment. In rare instances, the styloid bone must be surgically removed because of its thickness, length, and compression of vital nerves and blood vessels in the neck. The team at the Hauser Neck Center, however, has never referred a patient for surgical removal of a ponticulus posticus.

The process of improving the alignment, cervical curve, and spine stability is termed Neck Reconstruction Therapy. UCBCT provides a 3-D picture of the cervical spine and its relation to the cranium, especially whether atlas misalignments/subluxations or displacements are diminishing foramen magnum space. The information gleaned from the UCBCT in the various neck positions, combined with the digital motion analysis or fluoroscopic x-ray images while moving, and the neck vitals, including optic nerve sheath, vagus and internal jugular vein diameters, give a comprehensive accurate picture of not only cervical vertebral alignments, relationships between vertebrae and the cranium, but also insights into the potential pathological effects on the human brain, spinal cord, cranial nerves, central and autonomic nervous system, vagus nerves, cervical nerve roots and cervical plexus and the consequences of such on the human body.

The study of how upright posture or human movement affects body health and disease is known as Dynamic Structural Medicine. UCBCT is a key diagnostic component of this.

UCBCT structural abnormalities reveal an indication of the severity of the cervical dysstructure and instability, but also help determine the course of treatment and prognosis. UCBCT measurements are objective and help assess not only the diagnoses causing pathology, but the severity of the structural problems. This assists the Caring Medical team in knowing what to do for our patients, as well as how frequently, and how gently or aggressively to treat. The UCBCT is also used to document progression on improvement with scans being performed at the beginning and end of the treatment course, and at times, mid-treatment.

Caring Medical is excited to bring this technology to our patients to even better diagnose and treat them, helping them achieve normal, healthy, and active lives.

• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.