Dentomaxillofacial Radiology (2007) 36, 443-450
© 2007 British Institute of Radiology
doi: 10.1259/dmfr/82631203
Undergraduate dental education in dental and maxillofacial radiology
IADMFR Education Standards Committee*
Department of Diagnostics and Radiology, Faculty of Dentistry, University of the Western cape, Tygerberg, South Africa
*Correspondence to: Dr ME Parker, Secretary General, IADMFR, Department of Diagnostics and Radiology, Faculty of Dentistry, University of the Western Cape, Private Bag X1, Tygerberg 7505, Republic of South Africa;
E-mail: meparker{at}uwc.ac.za
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Abstract
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This is an official document of the International Association of Dentomaxillofacial Radiology (IADMFR) that provides guidelines for programs in dental and maxillofacial radiology education for undergraduate dental students. The standards are intended as a program development aid.
Keywords: dental education; dentomaxillofacial radiology; curriculum; guidelines
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Background
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The first International Association of Dentomaxillofacial Radiology (IADMFR) Ad Hoc Committee on Education Standards was appointed at the 7th International Congress of Dentomaxillofacial Radiology (ICDMFR), London, UK, in 1985. That Committee was tasked with drafting guidelines for undergraduate instruction in dentomaxillofacial radiology. The members of the original committee were Drs Axel Ruprecht (Chairperson), Laetitia M Brocklebank, C-O Henrikson, Neill Serman and NJD Smith. This Committee made a preliminary report to the IADMFR Board of Directors during the 8th ICDMFR, San Antonio, TX, in 1988, and submitted a final report to the 9th ICDMFR, Budapest, Hungary, in 1991, with a related workshop also held at that time. The workshop discussions were summarized in the winter 1991–1992 issue of the IADMFR Newsletter. A report was also distributed during the 10th ICDMFR, Seoul, South Korea, in 1994. The Committee on Education Standards was re-established at the General Assembly of the 10th ICDMFR, Seoul, South Korea, in 1994. As incoming IADMFR President, Dr Allan G Farman appointed Dr Madeline Rohlin as chairperson of the Committee and tasked the Committee to report to the 11th ICDMFR, Louisville, KY, in 1997.
During the General Assembly at the 14th ICDMFR, Florianopolis, Brazil, in 2003, Dr Neill Serman was appointed Chairman of the IADMFR Ad Hoc Education Standards Committee. The Committee charge was to update the IADMFR standards for undergraduate dental education in dental and maxillofacial radiology. The Committee was charged with presenting its report to the General Assembly Meeting of the 15th ICDMFR, Cape Town, South Africa, in 2005. At that time the report was returned to the Committee for amendment. An amended version was submitted to the IADMFR Committee on Dental Education Standards and the Board of Directors and Council in November 2006. This version was distributed to the Executive Committee of the IADMFR in February 2007. The final draft, presented here, incorporates comments from Executive Committee members and the Board of Directors and was presented to the Executive Committee of the IADMFR for approval at its biannual Board of Directors meeting, and was subsequently approved by the General assembly at the 16th ICDMFR, Beijing, China, in 2007.
The goal of the revised project was to produce a document providing contemporary guidelines for programs in dental and maxillofacial radiology education for undergraduate dental students. The standards are intended as a program development aid.
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Introduction
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It is now widely accepted that dental practitioners and dental radiography operators should not carry out a diagnostic X-ray exposure without having received adequate training.1–3 Dental practitioners and dental radiography operators should complete training, including theoretical knowledge and practical experience, in:- radiation production, radiation protection and statutory obligations relating to ionizing radiation as are relevant to their functions as a practitioner or operator; and
- diagnostic radiology as relevant to the specific area of practice.
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Educational basis
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Historically, educational standards in undergraduate dental and maxillofacial radiology have been developed using a curricula model, providing guidelines that reflect specific topic content or "core curriculum".3–8 Educationally this model is being replaced by competency-based education (CBE). Other terms used for this are evidence-based education (EBE), outcomes-based education (OBE) and values-based curriculum (VBC). In dental education this model has been adopted by national authorities including the United States9,10 and the United Kingdom.11 Recent economic events related to the expansion of the European Union and their associated directives have also led to convergence towards comparable and acceptable standards of dental education and competence for European countries.12–15 These are contemporary approaches to instruction that focus on the outcome of the education, rather than the process or content of the education.
CBE incorporates not only curriculum but also student learning experiences and evaluation methods from documents that describe the knowledge, skills and values that a student must possess to graduate. These documents include descriptions of all competencies/abilities that a graduating practitioner must consistently perform accurately and efficiently. Programs preparing new dental graduates must also include consideration of the cognitive (foundation knowledge), the affective (values associated with professional responsibility) and psychomotor (pre-clinical and clinical) dimensions. These abilities may be expressed through competency statements or learning outcomes. Other terms used for this are core competencies, key skills, baseline competencies, or instructional blueprints.
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Competency statements
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Preamble
The organization of the following competency statements for undergraduate education in dental and maxillofacial radiology are based on principles and concepts developed in the United States, United Kingdom and Europe. Appendix A provides specific competency statements and is structured from the general to the more specific for every section. They are interdisciplinary in nature and involve an understanding of the educational hierarchy of domains, major competencies and supporting competencies. Appendix B provides specific curricula content topics.
The outline of each statement is as follows:
- Domain
- 1.1. Major competency
- 1.1.1. Supporting competency
- 1.1.1.1. Foundation ability
Although numerous hierarchies have been published,9–15 the committee adopted the following domain framework as being the most applicable to education in DMFR:
- Clinical domain
- Communication domain
- Professionalism domain
- Management domain
Domains
Domains represent the broad categories of professional activities and concerns that occur in the general practice of dental and maxillofacial radiology within dental practice. The concept of domains is to encourage an eventual structure and process in the undergraduate curriculum that is more interdisciplinary and less sectional.
Major competencies
Major competencies within each domain are identified as relating to that domain's activity or concern. A major competency is the ability to perform or provide a particular but complex task or service. The complexity of this service suggests that multiple and more specific abilities are required to support the performance of this major competency.
Supporting competencies
Supporting competencies are more specific abilities and could be considered as subdivisions of a major competency. The achievement of a major competency requires the acquisition and demonstration of all supporting competencies related to that particular service or task. A supporting competency is less complex than a major competency; however, it requires more specific abilities that are termed foundation abilities.
Foundation abilities
Foundation ability is the product of didactic and laboratory instruction that imparts information and experiences that are prerequisite for satisfactory attainment of supporting competencies. Foundation ability encompasses knowledge, skill and attitudes. Foundation knowledge is the ability to use information and correctly answer specific questions (e.g. in an examination). Foundation skills are the ability to follow rules in specific situations to produce acceptable results in a standardized situation (e.g. a radiographic procedure on a mannequin). Foundation attitudes are positive intellectual and behavioural actions (e.g. radiographic interpretation according to patients' needs and not the student's need). The inclusion of any foundation ability in the curriculum should be based on its direct support of one or more of the major and supporting competencies.
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Terminology
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The wording of each competency is important because it provides direction as to the level of inclusion (reflects the importance of a particular requirement), level of knowledge (reflects the detail required within the foundation knowledge) and level of skill (competency in foundation skill). The following provides operational definitions of terms used within each of the three levels used to describe compliance within the competency statements.
Level of inclusion
- Must/shall: indicate requirements that are an essential, mandatory or indispensable item.
- Should: implies that compliance with the requirement is highly desirable.
- May/could: implies freedom or liberty to follow a suggested alternative to the requirement.
Levels of knowledge
- In-depth: a thorough knowledge of concepts and theories for the purpose of critical analysis and the synthesis of more complete understanding.
- Understanding: adequate knowledge with the ability to apply.
- Familiarity: a simplified knowledge for the purpose of orientation and recognition of general principles.
Levels of skill
- Proficient: the level of skill beyond competency. It is that level of skill acquired through advanced training or the level of skill attained when a particular activity is accomplished with repeated quality and a more efficient utilization of time.
- Competent: the level of skill displaying special ability or knowledge derived from training and experience.
- Exposed: the level of skill attained by observation of or participation in a particular activity.
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Facilities and resources
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Facilities
The institution(s) or place(s) of training should have access to sufficient facilities to allow students to gain both qualitative and quantitative experience in dentomaxillofacial radiography.
Clinical experiences
Practical instruction must be undertaken by students to obtain experience in the radiographic techniques carried out with X-ray equipment normally available to dental practitioners, to a level such that they are able to comply with current guidelines, rules and regulations. The institution(s) should have access to a range of modern X-ray and other imaging equipment to allow the competencies to be fully met.
Human resources
The implementation of these competencies is dependent on the appointment of an adequate number of properly trained and certified oral and maxillofacial radiologists, at least one of whom should be Board/College certified in the relevant special discipline, where possible.
Distance learning
Preference for instructors in dental and maxillofacial radiology is that they should have completed a formal postgraduate course in this discipline of no less than 2 years' duration. It is recognized that this is not always feasible. Distance learning resources are available. Examples include:
- King's College, London, UK, distance learning MSc in Dental and Maxillofacial Radiology (http://www.kcl.ac.uk/pgp05/programme/35).
- University of Cardiff, UK, distance learning postgraduate modules (including dental radiology) contributing to a diploma in Postgraduate Dental Studies (http://www.dentpostgradwales.ac.uk/start.htm).
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Time requirement
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This course should be covered using lectures/seminars/computer-aided learning, practical radiography laboratories and clinics. It is suggested that a total of no less than 80 h is normally required to cover the course, but this is not prescriptive since the number of hours taught is not as important as the quality of the teaching received.
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Assessment
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This curriculum should be formally examined within the examination structure of the individual dental school and each major competency should be assessed. This will ensure that the dental degree certificate is evidence of "adequate training" in the safe and effective usage of ionizing radiation, including selection and interpretation of examinations.
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APPENDIX A
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Competency statements for undergraduate dental and maxillofacial radiology
- Clinical domain
1.1. Patient assessment
1.1.1. Assess dental, skeletal and occlusal relationships in the primary, mixed and permanent dentition accurately, and identify conditions which may require treatment or referral
1.1.1.1. Students must have an in-depth knowledge of (a) the normal development of the teeth and jaws, (b) developmental disorders of the teeth and periodontium, (c) developmental disorders of the jaws, facial bones and cranium, and (d) disorders of the temporomandibular joint.
1.1.1.2. Students should have an understanding of the radiographic methods of assessment including skeletal maturation (e.g. hand–wrist analysis) and orthodontic analysis.
1.1.2. Assess hard and soft tissue developmental abnormalities and identify conditions which may require investigation, treatment, or onward referral
1.1.2.1. Students must have an in-depth knowledge of the normal radiographic anatomy of the cranium, jaws, teeth and periodontium.
1.1.2.2. Students must be proficient at the radiological interpretation of hard tissue abnormalities affecting the cranium, jaws, teeth and supporting apparatus including (a) infective disorders, (b) cysts, (c) tumours, (d) fibro-osseous lesions, (e) lesions of bone origin (e.g. giant cell lesions), (f) traumatic disorders, (g) temporomandibular joint disorders and (h) endocrine disorders, haematopoietic disorders and other systemic diseases manifested in the jaws.
1.1.2.3. Students should understand conditions that affect the paranasal sinuses, salivary glands and other soft tissues of the neck.
1.1.2.4. Students should be able to recognize common developmental syndromes involving the maxillofacial region.
1.1.3. Distinguish between alveolar status in health and disease, and identify conditions which may require investigation, treatment or referral
1.1.3.1. Students must have an in-depth knowledge of disorders of the periodontium and dental support apparatus, and their radiological presentation.
1.1.3.2. Students must be proficient at the radiological interpretation of hard tissue abnormalities affecting the periodontium.
1.1.4. Identify the location, extent and activity of caries
1.1.4.1. Students must have an in-depth knowledge of the process of dental caries and its radiological progression and classification.
1.1.4.2. Students must be proficient at the radiological interpretation of dental caries, its classification and different interpretations, such as cervical burnout and Mach band effect.
1.1.5. Distinguish between pulpal health and disease, and identify conditions which may require treatment or onward referral
1.1.5.1. Students must have an in-depth knowledge of the effects of pulpal disease on alveolar bone structure.
1.1.5.2. Students must be proficient at the radiological interpretation of the effects of pulpal disease on the alveolar process.
1.1.6. Prescribe an appropriate and risk-assessed imaging examination that meets the diagnostic needs of the patient
1.1.6.1. Students must have an in-depth knowledge of (a) radiation physics including the electromagnetic spectrum, background radiation, units of measurement, production of radiant energy, properties of radiation and in particular X-radiation, (b) mechanisms of interaction of X-rays with matter including attenuation and scatter, (c) the biological effects of radiation at the atomic, molecular/biochemical, cellular, tissue and organ level, and (d) analyse the risks/benefits of exposure and understand the concept of diagnostic yield related to use of ionizing radiation.
1.1.6.2. Students must also have an in-depth knowledge of (a) patient selection criteria/principles of patient exposure justification and specific regional guidelines, (b) As Low As Reasonably Achievable (ALARA) and dose optimization and (c) indications/contraindications and advantages and disadvantages of specific imaging examinations used in general dental practice (intraoral, panoramic, skull radiography).
1.1.6.3. Students must have an in-depth knowledge of modifications to appropriate imaging selection due to presentation, age, medical history including pregnancy status, as well as dental and radiographic history.
1.1.6.4. Students must have an in-depth knowledge of the appropriate choice of imaging modalities based on patient presentation.
1.2. Patient radiographic examination
1.2.1. Obtain valid informed consent
1.2.1.1. The student must be proficient at verifying implied (as part of overall examination) or obtaining and documenting radiological examination-specific informed consent from the patient/parent/guardian as appropriate.
1.2.2. Apply all appropriate radiation protection measures
1.2.2.1. The student must have an in-depth knowledge of the principles and levels of radiation protection available to both the operator and patient.
1.2.2.2. The student must be proficient in applying all patient and operator radiation protection procedures as determined by national, regional and local regulations.
1.2.3. Perform an accurate radiographic examination and expose, process, assess, report and store the image correctly
1.2.3.1. Students must have an in-depth knowledge of the operation of X-ray apparatus and equipment both in general and specifically in relation to intraoral, skull and panoramic radiography.
1.2.3.2. Students must have an in-depth knowledge of the effect of X-ray apparatus features on radiation dose and image quality.
1.2.3.3. Students must have an in-depth knowledge of the choice of exposure parameters on radiation dose and image quality.
1.2.3.4. Students must have an in-depth knowledge of the characteristics of image detectors in relation to types, selection and handling, and the effect of these on patient exposure and image quality.
1.2.3.5. Students must have an in-depth knowledge of chemical processing, including analogue (film composition, intensifying screen, latent image) and electronic (digital detectors and their different sensor technology).
1.2.3.6. Students must have an in-depth knowledge of appropriate storage, retrieval and display of images including: (a) analogue-viewing conditions, mounts; (b) digital-pixel, voxel, image processing, storage and file format (DICOM).
1.2.3.7. Students must have an in-depth knowledge of the geometric principles of image formation relating to bisecting and parallel intraoral radiography, panoramic and extraoral radiography.
1.2.3.8. Students must be proficient in performing all intraoral radiographic procedures (periapical, bitewing, occlusal) and panoramic radiography including patient preparation, machine preparation, detector positioning, exposure selection, irradiation detector retrieval and patient dismissal.
1.2.3.9. Students must be proficient in the identification and correction of radiographic errors.
1.2.3.10. Students must be proficient in all infection control procedures associated with performing radiographic examinations.
1.2.3.11. Students should be competent in performing cephalometric radiography and exposed to performing other extraoral radiographic projections (posteroanterior (PA), submental vertex (SMV), Waters', Townes', lateral oblique) and hand–wrist radiography.
1.2.3.12. Students must be proficient at organizing, correctly recording and integrating resultant images into the clinical or electronic patient record ("mounting").
1.2.3.13. Students must have an in-depth knowledge of the physical factors affecting interpretation of images (viewing conditions/monitor characteristics).
1.2.3.14. Students may be exposed to advanced imaging modalities including cone beam CT (CBCT).
1.2.3.15. Students must be proficient at technique critique for intraoral, panoramic and skull radiography.
1.2.4. Knowledge of the indications for other diagnostic imaging techniques
1.2.4.1. Students should have an understanding of the appropriate use of advanced imaging modalities including CBCT, helical CT, MRI.
1.2.4.2. Students should have a familiarity with additional advanced imaging including ultrasound, positron emission tomography and image fusion.
1.2.5. Recognise the need for additional diagnostic tests when appropriate and refer to appropriate personnel to acquire an accurate interpretation and record of the results
1.2.5.1. Students must understand the limitations of their foundation abilities and should refer additional imaging and/or interpretation of unexplained imaging findings to specialists with appropriate clinical and specialist expertise.
1.3. Patient diagnosis
1.3.1. Generate a differential diagnosis and treatment/management plan based on evidence through the correct interpretation of radiological findings
1.3.1.1. Students must have an in-depth knowledge of the terms related to imaging presentation of disease processes related to pathology, accurately describe their imaging findings and understand the development and importance of provisional (working) and definitive diagnosis in patient management.
1.3.1.2. Students must be proficient at generating a report of their interpretive findings and developing an appropriate radiological differential diagnosis.
1.3.2. Assess the influence of systemic diseases and other disabilities on the radiological presentation of dental disease
1.3.2.1. Students must have an in-depth knowledge of the interrelationship and association of radiological findings and localized maxillofacial diagnoses to the patients' overall medical condition.
1.4. Treatment planning and patient management
1.4.1. Present and explain the radiological imaging findings to the patient
1.4.1.1. Students must be proficient at communicating their imaging findings to the patient together with their differential diagnoses, and assimilate this knowledge with clinical presentation to provide prognoses and management plan options.
1.4.1.2. Students must be proficient at discussing the appropriateness of additional or alternate imaging options with the patient to establish a definitive diagnosis.
- Communication domain
2.1. Communication with the patient
2.1.1. Increase the patient's understanding and compliance with the radiographic examination procedure
2.1.1.1. The student must be proficient at clearly explaining the rationale for the radiographic imaging procedure and imaging findings and their implications by effective communication skills.
2.2. Communication with the dental team
2.2.1. Prescribe (verbally or in writing) to the dental healthcare team
2.2.1.1. The student must be proficient in interacting with all members of the dental team and peers in practice policies, rules and regulations, health and safety procedures, and appropriate clinical techniques related to radiographic examinations.
2.3. Communication with other professionals
2.3.1. Communicate effectively with other professionals
2.3.1.1. The student must be proficient at interacting and communicating with other health professionals using effective oral and written communication skills to describe the radiological procedure, imaging findings and impression.
- Professionalism domain
3.1. Ethics
3.1.1. Understand and apply the general principles of practice and standards of care in treating patients
3.1.1.1. The student must have an in-depth knowledge of the appropriate standard of care for specific radiographic examinations.
3.1.1.2. The student must be proficient at explaining the sequelae of untoward additional radiation exposure to the patient.
3.1.1.3. The student must treat all patients and staff with respect.
3.1.2. Adhere to appropriate guidelines where necessary
3.1.2.1. The student must have an in-depth knowledge of the mechanisms of quality control to minimize radiation exposure to patient and operator.
3.2. Professionalism
3.2.1. A thorough understanding of the professional responsibility of a dentist within the profession and the community
3.2.1.1. The student must be committed to continuing education of staff and self through regular efforts to update and improve knowledge and skills, and the incorporation of these skills into everyday practice.
3.2.1.2. The student must be committed to impartially evaluating and adopting new radiological techniques and technologies based on scientific evidence and diagnostic yield to improve the quality of care for the patient.
3.2.1.3. Students must be aware of prevailing national guidelines on patient selection criteria and radiation protection.
- Management domain
4.1. Personal and practice organization
4.1.1. Maintenance of clinical records
4.1.1.1. The student must be proficient at the full, accurate and secure documentation of all radiographic exposures and findings, and maintaining clinical records (conventional or electronic), in accordance with recognized standards.
4.1.2. Observance of all regulations
4.1.2.1. Students must have knowledge and understanding of the International Commission on Radiological Protection's recommendations and guidelines.
4.1.2.2. Students must have an understanding of national, regional and local guidelines and regulations associated with performing and supervising clinical radiographic procedures including (a) regulations related to registration, care and routine inspection and maintenance of radiographic equipment, (b) compliance with radiation safety procedures such as personnel radiation monitoring and use of patient protective barriers and (c) occupational health and safety employee dose limits and management considerations.
APPENDIX B
Suggested curriculum content topics
Radiation physics
- Radiant energies
- Electromagnetic spectrum
- Background radiation—natural radiation vs man-made
- Production of radiant energy
- Relationship of energy, frequency and wavelength
- Properties of radiation
- Attenuation—factors affecting attenuation of radiant energy
- Scatter and absorption
- Biological effects of ionizing radiation
- Risks/benefits related to use of ionizing radiation
- Dose optimization
- Absorbed dose, dose equivalent, effective dose and their units
- Factors affecting radiation dose
- Image quality vs radiation dose
Radiation protection
- General radiation protection
- Use of radiation protection devices
- Patient
- Personnel
- Patient identification and consent
- Use of existing appropriate radiological information
- Justification of exposures
- Alternative techniques
- Pregnancy/potential pregnancy
- Infants/children
- Procedures for untoward incidents involving overexposure to ionizing radiation
- Clinical evaluation of outcome
- Medico-legal issues, regulations, local rules and procedures
- Individual responsibilities relating to medical exposures
- Ethical behaviour
- Responsibility for radiation safety
- Routine inspection and testing of equipment
- Notification of faults and hazard warnings
- Clinical audit
- ALARA principle
Apparatus and equipment
- Basic circuitry of stationary anode high-frequency and self-rectified X-ray generators
- X-ray tube—cathode, anode, focal spot size and vacuum
- Heat production and how it is overcome
- Basic components of dental X-ray generators (beam-directing devices, collimation, filtration)
- Timers
- Applied potential (kV), tube current (mA) and exposure setting (mAs)
- Operator selection of X-ray quality and quantity
X-ray detectors (digital)
- Solid state charge-coupled device (CCD), complementary metal oxide semiconductor (CMOS), thin film transistor (TFT)
- Photostimulable phosphor imaging plates—exposure, laser scan processing
- Pixel—dimensions, bit-depth
- Voxel-3D applications
- Image acquisition
- Post-processing
- Archiving
- DICOM
- Image interoperability
X-ray detectors (analogue film)
- Analogue film—direct action and screen/film
- Scintillators—intensifying screens
- Speed—characteristic curve
- Processing—chemistry, manual processing, automatic processing machines
- Darkroom—design and safelights
- Pitfalls/errors
- Mounting and documentation
- Viewing conditions
- Quality assurance
Radiographic techniques
- Intraoral radiography—periapical, bitewing, occlusal, adult dentate, adult edentulous, adolescent, child
- Panoramic radiography
- Skull radiography—PA, SMV, Waters', Townes', lateral oblique
- Hand–wrist
- Tomography—cone beam volumetric imaging, helical CT
- Other modalities—MRI, ultrasound, PET, image fusion, digital subtraction
Radiological interpretation (normal anatomy)
- Principles and practice of interpretation
- Guidelines on making a radiological differential diagnosis
- Reporting on diagnostic images—methods and conventions
- Fundamentals of radiological anatomy
- Teeth and periodontium
- Jaws, facial bones and cranium (including cephalometric points and planes)
- Neck
- Soft tissue shadows and air spaces
- Normal development of teeth and jaws
- Skeletal maturation (e.g. hand–wrist analysis)
Radiological interpretation (pathology)
- Definition of fundamental terms
- Methods of describing radiological lesions
- Development abnormalities
- Disorders of teeth and periodontium
- Infective disorders, caries and periapical infection
- Cysts of jaws
- Tumours of jaws
- Fibro-osseous lesions
- Giant cell lesions
- Metabolic disorders of significance in dental practice
- Trauma including fractures
- Teeth
- Jaws
- Skull
- Disorders of the temporomandibular joints
- Disorders of the salivary glands
- Disorders of the paranasal sinuses
- Soft tissue calcifications
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Acknowledgements
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Special thanks to Dr Allan Farman for his assistance in the initial draft of this document in 2005. Additional thanks to those members of the Board of Directors who provided valuable guidance with the preliminary draft in February 2007.
Education Standards Committee, International Association of Dentomaxillofacial Radiology:
Neill Serman (Chairperson), Professor and Director, Division of Oral Radiology, Columbia University, 630 West 168 Street, New York, NY 10032, USA; E-mail: njs2@columbia.edu
Malcolm Coombs, Head of Oral Surgery, Faculty of Dentistry, Sydney Dental Hospital, 2 Chalmers Street, Surry Hills, NSW 2010, Australia; E-mail: micoombs@hotmail.com
Jimmy Makdissi, Clinical Senior Lecture/Honorary Consultant Oral and Maxillofacial Radiology, Dental Institute, The Royal London Hospital, Whitechapel, London E1 1BB, UK; E-mail: jimmy.makdissi@bartsandthelondon.nhs.uk
Axel Ruprecht (Past Chair), Professor and Director of Oral and Maxillofacial Radiology, Professor of Radiology/Professor of Anatomy and Cell Biology, The University of lowa–DSB, lowa City IA 52242-1001, USA; E-mail: axel-ruprecht@blue.weeg.uiowa.edu
Zuyan Zhang, Department of Oral and Maxillofacial Radiology, Peking University School of Stomatology, Beijing 100081, China; E-mail: zhangzy-bj@vip.sina.com.cn
Steven R Singer (appointed January 2006), Associate Professor and Acting Director, Oral and Maxillofacial Radiology, Columbia University College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA; E-mail: srs2@columbia.edu
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Footnotes
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IADMFR Education Standards Committee: Accepted at the 16th International Congress of Dentomaxillofacial Radiology, Beijing, China, effective 1 July 2007. 
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Abstract
Background
