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Background:
Review

Cone Beam Computed Tomography in Oral Cancer: A Scoping Review

by
Muhammad Aiman Mohd Nizar
1 and
Syed Nabil
2,*
1
Department of Craniofacial Diagnostic and Biosciences, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
2
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(11), 1378; https://doi.org/10.3390/diagnostics15111378
Submission received: 13 May 2025 / Revised: 27 May 2025 / Accepted: 28 May 2025 / Published: 29 May 2025
(This article belongs to the Special Issue Application of Diagnostic Tools for Dentistry and Maxillofacial Surgery)
Browse Figure
Versions Notes

Abstract

:
Objectives: The present scoping review aims to explore and provide an overview of the current applications of cone beam computed tomography (CBCT) in the management of oral cancer. Methods: This study was conducted in accordance with the JBI Guidance for Scoping Reviews and reported following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic search was performed across the following databases: PubMed, OVID, Scopus, Web of Science, and the Cochrane Library to answer the research question: “What are the current applications of CBCT in the perioperative management of patients with oral cancer?”. Results: A total of 52 studies met the inclusion criteria. Four major areas of CBCT application in oral cancer were identified: radiotherapy planning and monitoring (25 studies), assessment of bone invasion (16 studies), intraoperative surgical guidance (6 studies), and evaluation of treatment-related complications (5 studies). These findings highlight the diverse but focused use of CBCT across different stages of oral cancer management. Conclusions: CBCT is increasingly utilized in the perioperative management of oral cancer, with its application in radiotherapy planning and assessment being the most well-established. However, other uses, such as for surgical navigation and complication assessment, are still emerging, with promising evidence. Further research is needed to expand and validate these applications.

1. Introduction

Cone beam computed tomography (CBCT) is an extraoral radiographic scanner designed to produce a three-dimensional image of the maxillofacial bones. It was first introduced at the end of the 20th century mainly for dental implant planning and surgery [1]. Since then, there has been an exponential increase in the adoption of this technology [2]. This is mainly because of its advantages such as its ability to obtain detailed volumetric rendering, its compact size, low radiation dose, rapid image acquisition, and more recently low cost [3]. There are also disadvantages, however, especially when compared to conventional CT, which include the presence of more image artefacts that affect the image quality and also reduced contrast resolution [3].
A recent estimate puts oral cancer, mostly squamous cell carcinomas, as the 16th most common malignant neoplasm, with an incidence of 355,000 cases per year [4]. Oral cancer is often diagnosed at an advanced stage, which affects its prognosis. The delay in diagnosis can be due to a delay of seeking medical care by the patient, a delay in achieving diagnosis, or a delay in initiating treatment following diagnosis [5]. Surgery is still the primary mode of treatment, with radiotherapy and chemotherapy usually used as an adjunct in a more advanced disease [6]. The prognosis of oral cancer is generally better for early-stage oral cancer, with advanced stages, especially cases of nodal involvement, meaning lower rates of survival [7].
While CBCT was initially primarily used for implant planning, its application has now expanded to include more indications. It is now commonly used to obtain images of the dento-maxillofacial region for a variety of indications, including orthodontics, endodontics, periodontics, jaw pathology, paranasal sinuses, maxillofacial trauma, temporomandibular joints, and airway assessment [8,9]. While the use of CBCT in benign pathology in the dento-maxillofacial region is quite established, there is still a lack of discussion on its application in oral malignancies [10,11,12]. In this context, this scoping review aimed to map and summarize the literature data on the application of CBCT in the perioperative management of oral cancers.

2. Materials and Methods

2.1. Protocol and Registration

This study was conducted following the JBI Guidance for Scoping Reviews [13] recommendations and the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The review protocol was registered in the OSF database under the number [osf.io/gwvf6].

2.2. Research Question

Based on the PCC principle—population: patients with oral cancer; concept: the application of CBCT; context: perioperative period of care—the research question for this review is as follows: “What are the current applications of CBCT in the perioperative management of patients with oral cancer?”

2.3. Identification of Relevant Studies

Searches were performed in MEDLINE using the PubMed and OVID search engines. Databases such as Web of Science, Scopus, and the Cochrane Library were also utilized in this study. The search strategy was created using MeSH terms, DeCS/MeSH terms, Emtree terms, and other free terms, combined using the Boolean operators “OR” and “AND” (Supplementary Table S1). The electronic search was last updated on 17 March 2025. Manual searches were also performed in reference lists of articles undergoing full-text assessment in the 2nd stage.

2.4. Study Selection

Studies were assessed with the pre-defined inclusion and exclusion criteria detailed in Table 1. The retrieved papers were exported to Rayyan® reference manager (https://www.rayyan.ai, accessed on 10 March 2025), and duplicates were removed by the program and manually. The selection process was conducted in two stages. In the first stage, the two authors (M.A.M.N. and S.N.) independently examined titles and abstracts of all identified articles from the electronic search and selected articles relevant to the topic. In the second stage, the full text of the articles selected in the first stage was retrieved, and the two authors independently applied the inclusion/exclusion criteria. Disagreements at both stages were resolved through discussion and a consensus decision between the authors. The reasons for study exclusion in stage 2 of the process was recorded.

2.5. Data Extraction

Data were extracted by the first author (M.A.M.N.) from the full text of the accepted articles. When there was ambiguity or unclear information, a discussion between the authors was conducted. If the issue remained unresolved or data were missing, it was recorded as missing data. The accuracy of the extracted data was verified by the second author (S.N.). The data were recorded using a standardized sheet in Microsoft® Excel. Among the selected papers, the following data were extracted: a. publication information (such as year of publication, type of study design, citation received, etc.) and b. the exact application of CBCT. The obtained data were presented descriptively and categorized in tables according to the application of CBCT in oral cancer. Citation data were based on the citations received from the Scopus databases up to 30 April 2025.

3. Results

A total of 1447 titles/abstracts were identified and screened. There were 367 articles identified from PubMed, 312 articles from OVID, 203 from Web of Science, 531 from Scopus, and 34 from the Cochrane Library (Figure 1). After duplicate removal using the Rayyan® reference manager and manually, a total of 783 articles remained. Title and abstract screening of these 783 articles eventually resulted in the exclusion of 609 articles for not being related to the topic. The inclusion and exclusion criteria were then applied to the remaining 174 articles, with two additional articles identified through hand-searching. A total of 124 articles were excluded for not meeting the predefined criteria. The reasons for exclusion were recorded (Supplementary Table S2). In the end, 52 articles were included in this review (Table 2). From the 52 articles included, four general applications of CBCT in oral cancer can be identified. These are its use in radiation treatment, bone invasion assessment, intraoperative surgical guidance, and in assessing complications from the treatment of oral cancer.

3.1. Imaging in Radiotherapy Treatment

This review found that this CBCT application in oral cancer had the most publications, with 24 articles (Table 3). Among the uses of CBCT in oral cancer radiation therapy are verifying patient positioning and assessing tumour changes during the course of treatment. Most of the studies being published on this topic are observational studies, either case–control, prospective, or retrospective studies. The majority of the articles were published within the past 5 years, with the earliest publication on this application being in 2009. Overall, there were 264 citations received for all the articles on this topic, giving a citation rate of 11 citations per article for this application.

3.2. Bone Invasion Assessment

Bone invasion assessment is another indication of the use of CBCT in oral cancer. Overall, there are a total of 16 articles on the topic (Table 4). The majority of the use of CBCT is for the assessment of bone invasion in the mandible specifically (n = 11), some assessed bone invasions in both jaws (n = 4), while only one article used CBCT specifically for maxillary bone invasion. The majority of the studies were observational, but there were also three systematic reviews on this topic. Besides having articles with higher levels of evidence, this CBCT application also received the highest citation rate compared to other applications, with 21 citations per article. The first article on this topic, published in 2009, compared CBCT with orthopantomograms (OPGs) in detecting mandibular invasion. Subsequently, more studies were comparing CBCT with other imaging modalities such as conventional CT scans, magnetic resonance imaging (MRI), and single-photon emission CT (SPECT).

3.3. Intraoperative Surgical Guidance

There were only six articles that described the application of CBCT for surgical treatment of oral cancer (Table 5). Four of the six articles described its use in assisting the resection of the tumour during surgery. The other two articles used CBCT for sentinel lymph node identification and for intraoperative imaging during minimally invasive cancer surgery. Half of the articles were laboratory experimental studies, while the remaining three were observation clinical studies. The first article on this topic was published in 2014, and the last was published in 2021. The citation rate is the lowest compared to the other applications, with 10 citations/article.

3.4. Complication Assessment

CBCT has also been used for the assessment of complications related to oral cancer treatment. We identified five articles of this application (Table 6). The complications that were assessed included osteoradionecrosis, xerostomia, malnutrition, and temporomandibular joint resorption. The study design of the included articles on this application was either prospective or retrospective observational studies. Collectively, the articles on this topic had 19 citations per article. The first article on complication assessment was published in 2009, but in the past 5 years only one further article was related to the oral cancer treatment complication assessment.

4. Discussion

CBCT was initially developed for the dento-maxillofacial region, mainly for the planning of dental implants [1]. Prior to CBCT, implant planning was performed two-dimensionally with OPG, which inherently had some limitations due to distortion and magnification and furthermore provided no information on the horizontal bone volume. This inaccuracy was eliminated with the use of CBCT for implant planning, which has now become the “standard of care”, changing the entire landscape of implant treatment in terms of precision and safety [67]. This shift in practice can also be seen in other clinical situations; for example, the most common indication for the use of CBCT in children and adolescents is the assessment of impacted teeth for orthodontics [68]. Endodontics has also seen the assessment of surgical cases with CBCT as the gold standard [69]. Seeing how CBCT has changed a multitude of clinical practices in the dento-maxillofacial region, some adoption or adaptation of CBCT can also be expected in oral cancer management.
This scoping review provides a comprehensive exploration of the applications of CBCT in the management of oral cancer. We identified four general applications of CBCT related to oral cancer. The application with the most publications regarding CBCT use is in radiation therapy. CBCT was incorporated into the linear accelerator (LINAC) in the mid-2000s [70]. This advancement enabled the development of image-guided radiation therapy (IGRT), and the use of CBCT has since become standard practice in modern radiotherapy. It enables quick and convenient imaging during treatment sessions, ensuring precise radiation delivery. The other three applications of CBCT in oral cancer, however, are not as well established. The use of CBCT in detecting bone invasion in oral cancer has been widely discussed in the literature, as reflected by its relatively high citation rate. Most studies evaluate CBCT in comparison with other imaging modalities, highlighting its potential advantages. The remaining two applications of CBCT in oral cancer involve enhancing surgical precision—particularly in achieving predictable surgical margins—and assessing treatment-related complications. Both of these applications are currently in the exploratory stage and require further clinical validation.
CBCT is now widely used in radiation therapy for head and neck cancers, including oral cancers. Prior to the use of CBCT, electronic portal imaging devices (EPIDs) were used for verifying patient setup and field placement. However, they provide limited anatomical detail due to the mostly two-dimensional image. The turn of the century marked the initial application of CBCT in radiation therapy, laying the groundwork for its eventual integration into image-guided treatment workflows [71]. The majority of radiotherapy centres in developed and even developing nations are now equipped with CBCT for rescanning and replanning [72,73]. During radiotherapy, some changes in tumour volume and patient body weight can occur, potentially leading to either overdosage or underdosage of radiation to the target area or surrounding healthy tissues. The use of daily or weekly CBCT enables adaptive radiation therapy (ART), which allows for real-time adjustments to the treatment plan [74]. With ART, radiation delivery can be modified throughout the treatment process, ensuring that the most effective dose reaches the tumour while minimizing exposure to healthy tissues, thereby reducing side effects [74]. It therefore enables tumour delineation, target volume assessment, and detection of inter-fraction setup errors during the treatment phase [25,31,36]. Any dose discrepancies or deviations from the planned doses would give the opportunity for dose recalculation or plan revision [16,23,28]. CBCT can also serve as an essential evaluation tool for assessing the efficacy of immobilization devices [21,34,38]. Overall, the use of CBCT in delivering radiation therapy contributes to greater uniformity in treatment outcomes by balancing technical precision with individualized patient anatomy and tumour characteristics, making it an essential tool in radiotherapy treatment.
CBCT has also been extensively investigated for its application in detecting bone invasion in oral cancer cases. Based on a systematic review conducted in 2018, CBCT was identified as the best imaging modality for detecting bone invasion, compared to other imaging modalities [48]. Other studies have found that CBCT’s diagnostic accuracy in detecting bone invasion is comparable to that of conventional CT scans or MRI [45,47] although its performance is observed to be observer-dependent [53]. In comparison to SPECT, multislice CT, MRI, and conventional CT scans, CBCT exhibits superior sensitivity for detecting bone invasion [54,55]. However, its specificity is considerably lower than that of multislice CT, MRI, and CT [54,55]. Despite its superior accuracy and sensitivity among various imaging techniques, CBCT lacks a soft-tissue window, limiting its utility in assessing soft-tissue involvement, nerve invasion, and tumour staging. Therefore, it is recommended to use CBCT in conjunction with MRI or CT for comprehensive evaluation [44,45]. A conundrum remains in establishing CBCT as a standard practice in oral cancer management. Even if CBCT demonstrates superior sensitivity in detecting bone invasion compared to MRI or conventional CT scans, its routine use may not be justified when patients already undergo MRI or CT as part of initial staging. Unless there is ambiguity regarding bone involvement on the initial imaging, CBCT may be best reserved as an adjunct or confirmatory tool in cases where diagnostic clarity is required. Thus, in our view, CBCT serves better as an adjunct to already established imaging modalities, primarily because MRI or conventional CT—performed as part of routine staging—can often provide similar information. However, if the intent of using CBCT is to replace the OPG, which is routinely required to assess dental conditions prior to radiation therapy, then its use may be warranted as an essential imaging modality in such cases. The decision to use CBCT must also consider the radiation exposure it entails; even though it delivers a lower dose than conventional CT, it still exposes patients to more radiation than panoramic radiography (OPG) and non-radiating modalities such as MRI. Overall, although the capability of CBCT in detecting bone invasion has been demonstrated, it remains a secondary imaging modality reserved for selected cases, given that standard staging imaging—such as MRI or conventional CT—also possesses comparable diagnostic capability in identifying bone involvement.
The use of CBCT for intraoperative imaging in maxillofacial surgery is quite common, especially in cases of orbito-zygomatico-maxillary complex fracture treatment [75]. The implementation of intraoperative CBCT therefore presents several promising strategies to enhance the outcomes of oral cancer surgery. One of the applications of CBCT is assisting the determination of surgical margins to enable more precise resection of tumour boundaries [57,58,60,61]. Ivashchenko et al., for example, suggested the use of CBCT for margin verification immediately after resection [58]. Steybe et al. meanwhile used CBCT for identification of the planned tumour resection that had been marked with a liquid fiducial marker [60]. Polfliet et al. and Weijs et al. utilized CBCT to construct patient-specific resection templates which were used as a guide for resection of the tumour [57,61]. In all these descriptions, it is clear that the use of CBCT involved the need for jawbone resection, highlighting its limitation in soft-tissue delineation for cancer surgery. Besides assisting in obtaining optimum surgical margin, there were also non-clinical laboratory studies assessing the feasibility of applying CBCT in the identification of sentinel lymph nodes and for surgical navigation system application [56,59]. Although these two applications have not yet been translated into clinical practice, there is significant potential to expand the utilization of CBCT in oral cancer surgery.
CBCT has been utilized as a valuable tool in managing surgical and radiation-therapy-related complications following oral cancer treatment. Two of the described uses of CBCT in this aspect are related to osteoradionecrosis (ORN). Brauner et al. used CBCT images and overlaid them with the radiation planning CT images to identify the most suitable sites for implant placement by determining areas of the jaw that had received less radiation [65]. This approach enables the selection of optimal implant sites, thereby avoiding high-dose irradiated regions and ultimately reducing the risk of ORN, thus improving the chances of successful implant placement [65]. In cases where there is a risk for ORN, CBCT has been suggested to be used to monitor the bone healing process following tooth extraction [62]. The low radiation dose provided by CBCT, coupled with its ability to deliver reliable and accurate volumetric assessments, makes it an invaluable tool for monitoring bone healing [62]. In relation to radiotherapy-related complications, prediction of complications, namely xerostomia and malnutrition, can be made using CBCT images obtained during radiotherapy treatment [64,66]. Changes in parotid gland density, as detected through CBCT, have been shown to be associated with the development of long-term xerostomia [64]. CBCT during treatment assessing oral cavity, oropharynx, and oesophagus changes alongside clinical parameters and dose distribution can be used to identify patients who need nutrition supplementation via a feeding tube [66]. In the surgical treatment, CBCT, in combination with MRI, was used to assess TMJ morphology following mandibulotomy, allowing assessment of both the functional and morphological changes [63]. Progress in this application of CBCT has, however, been stagnant, with only a single publication in the past five years supporting this perspective.
The obvious limitation of this review is the omission of CBCT usage in reconstructive surgery of the jaw. CBCT has also emerged as an imaging modality for surgical planning in reconstructing jawbone defects. This application is already well established but was not included, considering the focus of this review was on oral cancers. Most of the articles describing CBCT planned reconstructive surgery are for the reconstruction of the bony defect of the jawbones, i.e., maxilla or the mandible [57,76]. These articles did not delineate cases of oral cancer, osteoradionecrosis, or benign jaw tumours and focused on how CBCT is used in the reconstruction; therefore, they did not meet the predefined criteria to be included in this review. However, a systematic review of computer-assisted surgery (CAS) for mandibular reconstruction found that CBCT is still less commonly used compared to conventional CT scans in computer-assisted surgical planning for jaw reconstruction [77]. It is, however, one of the viable applications of CBCT in oral cancer, specifically in cases needing jawbone reconstruction.

5. Conclusions

In conclusion, CBCT has shown promise as a valuable tool in the management of oral cancer, specifically in radiation treatment planning, evaluation of bone invasion, intraoperative navigation, and post-treatment complications. The current body of evidence is still evolving, particularly in its application for surgical guidance and complication assessment, with most studies being small-scale and heterogeneous. Its advantages, including low radiation exposure and cost-effectiveness, make it particularly suitable for repeated imaging and longitudinal monitoring. Nevertheless, imaging modalities such as MRI and conventional CT remain essential for a comprehensive evaluation, especially when assessing soft-tissue involvement.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/diagnostics15111378/s1. Table S1: Search strategies for online databases. Table S2: Excluded articles based on inclusion and exclusion criteria.

Author Contributions

Conceptualization, S.N.; methodology, S.N.; formal analysis, S.N. and M.A.M.N.; investigation, S.N. and M.A.M.N.; data curation, M.A.M.N.; writing—original draft preparation, M.A.M.N.; writing—review and editing, S.N.; supervision, S.N. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The original contributions presented in this study are included in the article/Supplementary Materials. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
CBCTCone beam computed tomography
OPGOrthopantomogram
MRIMagnetic resonance imaging
TMJTemporomandibular joint
CTComputed tomography
IGRTImage-guided radiation therapy
SPECTSingle-photon emission CT
ARTAdaptive radiation therapy
LINACLinear accelerator
EPIDsElectronic portal imaging devices
CASComputer-assisted surgery
ORNOsteoradionecrosis

References

  1. Mozzo, P.; Procacci, C.; Tacconi, A.; Martini, P.T.; Andreis, I.A. A new volumetric CT machine for dental imaging based on the cone-beam technique: Preliminary results. Eur. Radiol. 1998, 8, 1558–1564. [Google Scholar] [CrossRef] [PubMed]
  2. Lam, M.; Critchley, S.; Zhang, A.; Monsour, P. Current trends in the adoption and education of cone beam computed tomography and panoramic radiography machines across Australia. Dentomaxillofac. Radiol. 2021, 50, 20200380. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  3. Scarfe, W.C.; Farman, A.G. What is cone-beam CT and how does it work? Dent. Clin. N. Am. 2008, 52, 707–730. [Google Scholar] [CrossRef] [PubMed]
  4. Bray, F.; Ferlay, J.; Soerjomataram, I.; Siegel, R.L.; Torre, L.A.; Jemal, A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2018, 68, 394–424. [Google Scholar] [CrossRef]
  5. Güneri, P.; Epstein, J.B. Late stage diagnosis of oral cancer: Components and possible solutions. Oral Oncol. 2014, 50, 1131–1136. [Google Scholar] [CrossRef] [PubMed]
  6. Köhler, H.F.; Mehanna, H.; Shah, J.P.; Sanabria, A.; Fagan, J.; Kuriakose, M.A.; Rene Leemans, C.; O’Sullivan, B.; Krishnan, S.; Kowalski, L.P. Comparison of different guidelines for oral cancer. Eur. Arch. Otorhinolaryngol. 2021, 278, 2961–2973. [Google Scholar] [CrossRef] [PubMed]
  7. Zanoni, D.K.; Montero, P.H.; Migliacci, J.C.; Shah, J.P.; Wong, R.J.; Ganly, I.; Patel, S.G. Survival outcomes after treatment of cancer of the oral cavity (1985–2015). Oral Oncol. 2019, 90, 115–121. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  8. Nasseh, I.; Al-Rawi, W. Cone Beam Computed Tomography. Dent. Clin. N. Am. 2018, 62, 361–391. [Google Scholar] [CrossRef] [PubMed]
  9. Kamburoğlu, K. Use of dentomaxillofacial cone beam computed tomography in dentistry. World J. Radiol. 2015, 7, 128–130. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  10. Scarfe, W.C.; Toghyani, S.; Azevedo, B. Imaging of Benign Odontogenic Lesions. Radiol. Clin. N. Am. 2018, 56, 45–62. [Google Scholar] [CrossRef] [PubMed]
  11. Luo, J.; You, M.; Zheng, G.; Xu, L. Cone beam computed tomography signs of desmoplastic ameloblastoma: Review of 7 cases. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2014, 118, e126–e133. [Google Scholar] [CrossRef] [PubMed]
  12. Treister, N.S.; Friedland, B.; Woo, S.B. Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2010, 109, 753–764. [Google Scholar] [CrossRef] [PubMed]
  13. Peters, M.D.J.; Marnie, C.; Tricco, A.C.; Pollock, D.; Munn, Z.; Alexander, L.; McInerney, P.; Godfrey, C.M.; Khalil, H. Updated methodological guidance for the conduct of scoping reviews. JBI Evid. Synth. 2020, 18, 2119–2126. [Google Scholar] [CrossRef] [PubMed]
  14. Lip and Oral Cavity Cancer Treatment (PDQ®). Available online: https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq (accessed on 5 March 2024).
  15. Cheung, J.; Aubry, J.F.; Yom, S.S.; Gottschalk, A.R.; Celi, J.C.; Pouliot, J. Dose Recalculation and the Dose-Guided Radiation Therapy (DGRT) Process Using Megavoltage Cone-Beam CT. Int. J. Radiat. Oncol. Biol. Phys. 2009, 74, 583–592. [Google Scholar] [CrossRef]
  16. Den, R.B.; Doemer, A.; Kubicek, G.; Bednarz, G.; Galvin, J.M.; Keane, W.M.; Xiao, Y.; Machtay, M. Daily image guidance with cone-beam computed tomography for head-and-neck cancer intensity-modulated radiotherapy: A prospective study. Int. J. Radiat. Oncol. Biol. Phys. 2010, 76, 1353–1359. [Google Scholar] [CrossRef]
  17. Yan, D.; Liang, J. Expected treatment dose construction and adaptive inverse planning optimization: Implementation for offline head and neck cancer adaptive radiotherapy. Med. Phys. 2013, 40, 021719. [Google Scholar] [CrossRef]
  18. Hermans, B.C.M.; Persoon, L.C.G.G.; Podesta, M.; Hoebers, F.J.P.; Verhaegen, F.; Troost, E.G.C. Weekly kilovoltage cone-beam computed tomography for detection of dose discrepancies during (chemo)radiotherapy for head and neck cancer. Acta Oncol. 2015, 54, 1483–1489. [Google Scholar] [CrossRef]
  19. Hvid, C.A.; Elstrøm, U.V.; Jensen, K.; Alber, M.; Grau, C. Accuracy of software-assisted contour propagation from planning CT to cone beam CT in head and neck radiotherapy. Acta Oncol. 2016, 55, 1324–1330. [Google Scholar] [CrossRef]
  20. Hofmaier, J.; Haehnle, J.; Kurz, C.; Landry, G.; Maihoefer, C.; Schüttrumpf, L.; Süss, P.; Teichert, K.; Söhn, M.; Spahr, N.; et al. Multi-criterial patient positioning based on dose recalculation on scatter-corrected CBCT images. Radiother. Oncol. 2017, 125, 464–469. [Google Scholar] [CrossRef]
  21. Norfadilah, M.N.; Ahmad, R.; Heng, S.P.; Lam, K.S.; Radzi, A.; John, L.S.H. Immobilisation precision in VMAT for oral cancer patients. J. Phys. Conf. Ser. 2017, 851, 012025. [Google Scholar] [CrossRef]
  22. Brivio, D.; Hu, Y.D.; Margalit, D.N.; Zygmanski, P. Selection of head and neck cancer patients for adaptive replanning of radiation treatment using kV-CBCT. Biomed. Phys. Eng. Express 2018, 4, 055009. [Google Scholar] [CrossRef]
  23. McCulloch, M.M.; Lee, C.; Rosen, B.S.; Kamp, J.D.; Lockhart, C.M.; Lee, J.Y.; Polan, D.F.; Hawkins, P.G.; Anderson, C.J.R.; Heukelom, J.; et al. Predictive Models to Determine Clinically Relevant Deviations in Delivered Dose for Head and Neck Cancer. Pract. Radiat. Oncol. 2019, 9, e422–e431. [Google Scholar] [CrossRef] [PubMed]
  24. Wei, W.; Ioannides, P.J.; Sehgal, V.; Daroui, P. Quantifying the impact of optical surface guidance in the treatment of cancers of the head and neck. J. Appl. Clin. Med. Phys. 2020, 21, 73–82. [Google Scholar] [CrossRef]
  25. Hague, C.; Aznar, M.; Dong, L.; Fotouhi-Ghiam, A.; Lee, L.W.; Li, T.; Lin, A.; Lowe, M.; Lukens, J.N.; McPartlin, A.; et al. Inter-fraction robustness of intensity-modulated proton therapy in the post-operative treatment of oropharyngeal and oral cavity squamous cell carcinomas. Br. J. Radiol. 2020, 93, 20190638. [Google Scholar] [CrossRef]
  26. Figen, M.; Çolpan Öksüz, D.; Duman, E.; Prestwich, R.; Dyker, K.; Cardale, K.; Ramasamy, S.; Murray, P.; Şen, M. Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice. Front. Oncol. 2020, 10, 579917. [Google Scholar] [CrossRef]
  27. Morgan, H.E.; Wang, K.; Dohopolski, M.; Liang, X.; Folkert, M.R.; Sher, D.J.; Wang, J. Exploratory ensemble interpretable model for predicting local failure in head and neck cancer: The additive benefit of CT and intra-treatment cone-beam computed tomography features. Quant. Imaging Med. Surg. 2021, 11, 4781–4796. [Google Scholar] [CrossRef]
  28. De Ornelas, M.; Xu, Y.; Padgett, K.; Schmidt, R.M.; Butkus, M.; Diwanji, T.; Luciani, G.; Lambiase, J.; Samuels, S.; Samuels, M.; et al. CBCT-Based Adaptive Assessment Workflow for Intensity Modulated Proton Therapy for Head and Neck Cancer. Int. J. Part. Ther. 2021, 7, 29–41. [Google Scholar] [CrossRef]
  29. Kanehira, T.; van Kranen, S.; Jansen, T.; Hamming-Vrieze, O.; Al-Mamgani, A.; Sonke, J.J. Comparisons of normal tissue complication probability models derived from planned and delivered dose for head and neck cancer patients. Radiother. Oncol. 2021, 164, 209–215. [Google Scholar] [CrossRef]
  30. Shinde, P.; Jadhav, A.; Gupta, K.K.; Dhoble, S. Quantification Of 6D Inter-Fraction Tumour Localisation Errors in Tongue And Prostate Cancer Using Daily Kv-CBCT For 1000 OMRT And VMAT Treatment Fractions. Radiat. Prot. Dosim. 2022, 198, 1265–1281. [Google Scholar] [CrossRef]
  31. Rachi, T.; Ariji, T.; Takahashi, S. Development of Machine-Learning Prediction Programs for Delivering Adaptive Radiation Therapy with Tumor Geometry and Body Shape Changes in Head and Neck Volumetric Modulated Arc Therapy. Adv. Radiat. Oncol. 2023, 8, 101172. [Google Scholar] [CrossRef]
  32. All, S.; Zhong, X.; Choi, B.; Kim, J.S.; Zhuang, T.; Avkshtol, V.; Sher, D.; Lin, M.H.; Moon, D.H. In Silico Analysis of Adjuvant Head and Neck Online Adaptive Radiation Therapy. Adv. Radiat. Oncol. 2023, 9, 101319. [Google Scholar] [CrossRef] [PubMed]
  33. Sharma, G.; Razeghi Kondelaji, M.H.; Sharma, G.P.; Hansen, C.; Parchur, A.K.; Shafiee, S.; Jagtap, J.M.; Fish, B.; Bergom, C.; Paulson, E.; et al. X-ray and MR Contrast Bearing Nanoparticles Enhance the Therapeutic Response of Image-Guided Radiation Therapy for Oral Cancer. Technol. Cancer Res. Treat. 2023, 22, 15330338231189593. [Google Scholar] [CrossRef] [PubMed]
  34. Jung, S.; Kim, B.; Lee, S.Y.; Chang, W.I.; Son, J.; Park, J.M.; Choi, C.H.; Lee, J.H.; Wu, H.G.; Kim, J.I.; et al. Novel tongue-positioning device to reduce tongue motions during radiation therapy for head and neck cancer: Geometric and dosimetric evaluation. PLoS ONE 2023, 18, e0291712. [Google Scholar] [CrossRef]
  35. Bobić, M.; Lalonde, A.; Nesteruk, K.P.; Lee, H.; Nenoff, L.; Gorissen, B.L.; Bertolet, A.; Busse, P.M.; Chan, A.W.; Winey, B.A.; et al. Large anatomical changes in head-and-neck cancers—A dosimetric comparison of online and offline adaptive proton therapy. Clin. Transl. Radiat. Oncol. 2023, 40, 100625. [Google Scholar] [CrossRef] [PubMed]
  36. Jain, V.; Soni, T.P.; Singh, D.K.; Patni, N.; Jakhotia, N.; Gupta, A.K.; Gupta, T.C.; Singhal, H. A prospective study to assess and quantify the setup errors with cone-beam computed tomography in head-and-neck cancer image-guided radiotherapy treatment. J. Cancer Res. Ther. 2022, 19, 783–787. [Google Scholar] [CrossRef]
  37. Håkansson, K.; Giannoulis, E.; Lindegaard, A.; Friborg, J.; Vogelius, I. CBCT-based online adaptive radiotherapy for head and neck cancer—Dosimetric evaluation of first clinical experience. Acta Oncol. 2023, 62, 1369–1374. [Google Scholar] [CrossRef]
  38. Mail, N.; Alshamrani, K.M.; Lodhi, R.N.; Khawandanh, E.; Saleem, A.; Khan, B.; Alghamdi, M.; Nadershah, M.; Althaqafy, M.S.; Subahi, A.; et al. Evaluation of positioning accuracy in head-and-neck cancer treatment: A cone beam computed tomography assessment of three immobilization devices with volumetric modulated arc therapy. J. Biol. Methods 2024, 11, e99010025. [Google Scholar] [CrossRef]
  39. Blumenfeld, P.; Arbit, E.; Den, R.; Salhab, A.; Falick Michaeli, T.; Wygoda, M.; Hillman, Y.; Pfeffer, R.M.; Fang, M.; Misrati, Y.; et al. Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer. Radiat. Oncol. 2024, 19, 43. [Google Scholar] [CrossRef]
  40. Momin, M.A.; Okochi, K.; Watanabe, H.; Imaizumi, A.; Omura, K.; Amagasa, T.; Okada, N.; Ohbayashi, N.; Kurabayashi, T. Diagnostic accuracy of cone-beam CT in the assessment of mandibular invasion of lower gingival carcinoma: Comparison with conventional panoramic radiography. Eur. J. Radiol. 2009, 72, 75–81. [Google Scholar] [CrossRef]
  41. Hendrikx, A.W.; Maal, T.; Dieleman, F.; Van Cann, E.M.; Merkx, M.A. Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: Results of the preliminary study. Int. J. Oral Maxillofac. Surg. 2010, 39, 436–439. [Google Scholar] [CrossRef]
  42. Dreiseidler, T.; Alarabi, N.; Ritter, L.; Rothamel, D.; Scheer, M.; Zöller, J.E.; Mischkowski, R.A. A comparison of multislice computerized tomography, cone-beam computerized tomography, and single photon emission computerized tomography for the assessment of bone invasion by oral malignancies. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2011, 112, 367–374. [Google Scholar] [CrossRef] [PubMed]
  43. Uribe, S.; Rojas, L.; Rosas, C. Accuracy of imaging methods for detection of bone tissue invasion in patients with oral squamous cell carcinoma. Dentomaxillofac. Radiol. 2013, 42, 20120346. [Google Scholar] [CrossRef] [PubMed]
  44. Hakim, S.G.; Wieker, H.; Trenkle, T.; Sieg, P.; Konitzer, J.; Holl-Ulrich, K.; Jacobsen, H.C. Imaging of mandible invasion by oral squamous cell carcinoma using computed tomography, cone-beam computed tomography and bone scintigraphy with SPECT. Clin. Oral Investig. 2014, 18, 961–967. [Google Scholar] [CrossRef]
  45. Linz, C.; Müller-Richter, U.D.; Buck, A.K.; Mottok, A.; Ritter, C.; Schneider, P.; Metzen, D.; Heuschmann, P.; Malzahn, U.; Kübler, A.C.; et al. Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer. J. Oral Maxillofac. Surg. 2015, 44, 8–15. [Google Scholar] [CrossRef]
  46. Czerwonka, L.; Bissada, E.; Goldstein, D.P.; Wood, R.E.; Lam, E.W.; Yu, E.; Lazinski, D.; Irish, J.C. High-resolution cone-beam computed tomography for assessment of bone invasion in oral cancer: Comparison with conventional computed tomography. Head Neck 2017, 39, 2016–2020. [Google Scholar] [CrossRef]
  47. Bombeccari, G.P.; Candotto, V.; Gianni, A.B.; Carinci, F.; Spadari, F. Accuracy of the Cone Beam Computed Tomography in the Detection of Bone Invasion in Patients with Oral Cancer: A Systematic Review. Eurasian J. Med. 2019, 51, 298–306. [Google Scholar] [CrossRef]
  48. Qiao, X.; Liu, W.; Cao, Y.; Miao, C.; Yang, W.; Su, N.; Ye, L.; Li, L.; Li, C. Performance of different imaging techniques in the diagnosis of head and neck cancer mandibular invasion: A systematic review and meta-analysis. Oral Oncol. 2018, 86, 150–164. [Google Scholar] [CrossRef]
  49. Shree, S.; Ramesh, K.; Sadaksharam, J. CBCT-based active contour segmentation of bone invasion in oral squamous cell carcinoma—A preliminary retrospective study. J. Ind. Acad. Oral Med. Radiol. 2020, 32, 140. [Google Scholar] [CrossRef]
  50. Abhinaya, L.M.; Arvind, M.; Rajendran, D. Evaluation of Osseous Changes in Oral Carcinoma—2D Vs 3D Imaging. Int. J. Cur. Res. Rev. 2020, 12, S95–S100. [Google Scholar] [CrossRef]
  51. Wang, Z.; Zhang, S.; Pu, Y.; Wang, Y.; Lin, Z.; Wang, Z. Accuracy of cone-beam computed tomography for the evaluation of mandible invasion by oral squamous cell carcinoma. BMC Oral Health 2021, 21, 226. [Google Scholar] [CrossRef]
  52. Shenoy, P.; Archana, P.; Chatra, L.; Veena, K.; Prabhu, R.V.; Shetty, P. Evaluation of Patterns of Mandibular Bone Invasion in CBCT of Patients with Oral Squamous Cell Carcinoma. J. Ind. Acad. Oral Med. Radiol. 2022, 34, 300–303. [Google Scholar] [CrossRef]
  53. Slieker, F.J.B.; Van Gemert, J.T.M.; Seydani, M.G.; Farsai, S.; Breimer, G.E.; Forouzanfar, T.; de Bree, R.; Rosenberg, A.J.W.P.; Van Cann, E.M. Value of cone beam computed tomography for detecting bone invasion in squamous cell carcinoma of the maxilla. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2022, 134, 102–109. [Google Scholar] [CrossRef] [PubMed]
  54. Straub, A.; Linz, C.; Lapa, C.; Hartmann, S.; Kübler, A.C.; Müller-Richter, U.D.A.; Faber, J.; Bley, T.; Brumberg, J.; Kertels, O.; et al. Performance of cone-beam computed tomography (CBCT) in comparison to conventional computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone invasion in oral squamous cell cancer (OSCC): A prospective study. BMC Oral Health 2024, 24, 341. [Google Scholar] [CrossRef]
  55. Neal, T.W.; Wahidi, J.; Williams, F.C.; Schlieve, T.; Donepudi, J.; Kim, R.Y. The utility of cone-beam computed tomography and multislice computed tomography scan for the evaluation of invasion versus erosion by mandibular squamous cell carcinoma as viewed on medical PACS. Proc. Bayl. Univ. Med. Cent. 2024, 37, 396–400. [Google Scholar] [CrossRef]
  56. Daly, M.J.; Muhanna, N.; Chan, H.; Wilson, B.C.; Irish, J.C.; Jaffray, D.A. A surgical navigation system for non-contact diffuse optical tomography and intraoperative cone-beam CT. Proc. SPIE 2014, 8937, 893703. [Google Scholar] [CrossRef]
  57. Weijs, W.L.; Coppen, C.; Schreurs, R.; Vreeken, R.D.; Verhulst, A.C.; Merkx, M.A.; Bergé, S.J.; Maal, T.J. Accuracy of virtually 3D planned resection templates in mandibular reconstruction. J. Craniomaxillofac. Surg. 2016, 44, 1828–1832. [Google Scholar] [CrossRef]
  58. Ivashchenko, O.; Pouw, B.; de Witt, J.K.; Koudounarakis, E.; Nijkamp, J.; van Veen, R.L.P.; Ruers, T.J.M.; Karakullukcu, B.M. Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography. Br. J. Oral Maxillofac. Surg. 2019, 57, 174–181. [Google Scholar] [CrossRef]
  59. Muhanna, N.; Chan, H.H.L.; Douglas, C.M.; Daly, M.J.; Jaidka, A.; Eu, D.; Bernstein, J.; Townson, J.L.; Irish, J.C. Sentinel lymph node mapping using ICG fluorescence and cone beam CT—A feasibility study in a rabbit model of oral cancer. BMC Med. Imaging 2020, 20, 106. [Google Scholar] [CrossRef]
  60. Steybe, D.; Russe, M.F.; Ludwig, U.; Sprave, T.; Vach, K.; Semper-Hogg, W.; Schmelzeisen, R.; Voss, P.J.; Poxleitner, P. Intraoperative marking of the tumour resection surface for improved radiation therapy planning in head and neck cancer: Preclinical evaluation of a novel liquid fiducial marker. Dentomaxillofac. Radiol. 2021, 50, 20200290. [Google Scholar] [CrossRef]
  61. Polfliet, M.; Hendriks, M.S.; Guyader, J.M.; Ten Hove, I.; Mast, H.; Vandemeulebroucke, J.; van der Lugt, A.; Wolvius, E.B.; Klein, S. Registration of magnetic resonance and computed tomography images in patients with oral squamous cell carcinoma for three-dimensional virtual planning of mandibular resection and reconstruction. Int. J. Oral Maxillofac. Surg. 2021, 50, 1386–1393. [Google Scholar] [CrossRef]
  62. Agbaje, J.O.; Jacobs, R.; Michiels, K.; Abu-Ta’a, M.; van Steenberghe, D. Bone healing after dental extractions in irradiated patients: A pilot study on a novel technique for volume assessment of healing tooth sockets. Clin. Oral Investig. 2009, 13, 257–261. [Google Scholar] [CrossRef] [PubMed]
  63. Al-Saleh, M.A.; Punithakumar, K.; Lagravere, M.; Boulanger, P.; Jaremko, J.L.; Wolfaardt, J.; Major, P.W.; Seikaly, H. Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy. J. Otolaryngol. Head Neck Surg. 2017, 46, 8. [Google Scholar] [CrossRef] [PubMed]
  64. Rosen, B.S.; Hawkins, P.G.; Polan, D.F.; Balter, J.M.; Brock, K.K.; Kamp, J.D.; Lockhart, C.M.; Eisbruch, A.; Mierzwa, M.L.; Ten Haken, R.K.; et al. Early Changes in Serial CBCT-Measured Parotid Gland Biomarkers Predict Chronic Xerostomia After Head and Neck Radiation Therapy. Int. J. Radiat. Oncol. Biol. Phys. 2018, 102, 1319–1329. [Google Scholar] [CrossRef] [PubMed]
  65. Brauner, E.; Musio, D.; Mezi, S.; Ciolfi, A.; Maghella, F.; Cassoni, A.; De Angelis, F.; Guarino, G.; Romeo, U.; Tenore, G.; et al. Implant placement in oral squamous cells carcinoma patients treated with chemoradiotherapy: “Sapienza Head and Neck Unit” clinical recommendations. Eur. Rev. Med. Pharmacol. Sci. 2019, 23, 9923–9930. [Google Scholar] [CrossRef]
  66. Dohopolski, M.; Wang, K.; Morgan, H.; Sher, D.; Wang, J. Use of deep learning to predict the need for aggressive nutritional supplementation during head and neck radiotherapy. Radiother. Oncol. 2022, 171, 129–138. [Google Scholar] [CrossRef]
  67. Tyndall, D.A.; Price, J.B.; Tetradis, S.; Ganz, S.D.; Hildebolt, C.; Scarfe, W.C. American Academy of Oral and Maxillofacial Radiology. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2012, 113, 817–826. [Google Scholar] [CrossRef]
  68. Hidalgo-Rivas, J.A.; Theodorakou, C.; Carmichael, F.; Murray, B.; Payne, M.; Horner, K. Use of cone beam CT in children and young people in three United Kingdom dental hospitals. Int. J. Paediatr. Dent. 2014, 24, 336–348. [Google Scholar] [CrossRef]
  69. Peters, C.I.; Peters, O.A. CBCT: The New Standard of Care?—American Association of Endodontists. American Association of Endodontists. Available online: https://www.aae.org/specialty/cbct-new-standard-care/ (accessed on 8 May 2025).
  70. van Herk, M.; Jaffray, D.; Betgen, A.; Remeijer, P.; Sonke, J.; Smitsmans, M.; Zijp, L.; Lebesque, J. First clinical experience with cone-beam CT guided radiation therapy; evaluation of dose and geometric accuracy. Int. J. Radiat. Oncol. Biol. Phys. 2004, 60, S196. [Google Scholar] [CrossRef]
  71. Jaffray, D.A.; Siewerdsen, J.H. Cone-beam computed tomography with a flat-panel imager: Initial performance characterization. Med. Phys. 2000, 27, 1311–1323. [Google Scholar] [CrossRef]
  72. Yap, L.M.; Jamalludin, Z.; Ng, A.H.; Ung, N.M. A multi-center survey on adaptive radiation therapy for head and neck cancer in Malaysia. Phys. Eng. Sci. Med. 2023, 46, 1331–1340. [Google Scholar] [CrossRef]
  73. Lee, V.S.; SchettIno, G.; Nisbet, A. UK adaptive radiotherapy practices for head and neck cancer patients. BJR Open 2020, 2, 20200051. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  74. Dohopolski, M.; Choi, B.; Meng, B.; Visak, J.; Zhong, X.; Kim, J.S.; Inam, E.; Avkshtol, V.; Moon, D.H.; Sher, D.J.; et al. Dosimetric Impact of Simulated Daily Adaptive Radiotherapy with Significantly Reduced Setup Margins in the Definitive Treatment of Head and Neck Cancer. Int. J. Radiat. Oncol. Biol. Phys. 2022, 114, e590. [Google Scholar] [CrossRef]
  75. Assouline, S.L.; Meyer, C.; Weber, E.; Chatelain, B.; Barrabe, A.; Sigaux, N.; Louvrier, A. How useful is intraoperative cone beam computed tomography in maxillofacial surgery? An overview of the current literature. Int. J. Oral Maxillofac. Surg. 2021, 50, 198–204. [Google Scholar] [CrossRef]
  76. Schepers, R.H.; Kraeima, J.; Vissink, A.; Lahoda, L.U.; Roodenburg, J.L.; Reintsema, H.; Raghoebar, G.M.; Witjes, M.J. Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction. J. Craniomaxillofac Surg. 2016, 44, 392–399. [Google Scholar] [CrossRef]
  77. Van Baar, G.J.C.; Forouzanfar, T.; Liberton, N.P.T.J.; Winters, H.A.H.; Leusink, F.K.J. Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review. Oral Oncol. 2018, 84, 52–60. [Google Scholar] [CrossRef]
Diagnostics 15 01378 g001
Figure 1. Flowchart summarizing the selection process of papers with a PRISMA-ScR flow diagram.
Figure 1. Flowchart summarizing the selection process of papers with a PRISMA-ScR flow diagram.
Diagnostics 15 01378 g001
Table 1. Inclusion and exclusion criteria.
Table 1. Inclusion and exclusion criteria.
Inclusion criteria
a.
Any primary or secondary studies on the application of CBCT in oral cancer patients.
b.
Only malignant growth from the lips or oral cavity (tongue, buccal mucosa, floor of mouth, upper and lower gingiva, retromolar trigone, and hard palate) [14].
c.
Articles published after the year 1998 (i.e., after 1st publication on CBCT for the dento-maxillofacial region).
d.
Article in the English language.
Exclusion criteria
a.
Conference abstracts, letters, author’s personal opinions, book chapters, case reports, and editorials.
b.
Other head and neck cancers such as those of the glottis, larynx, hypopharynx, nasopharynx, ethmoid, nose, paranasal sinuses, or salivary glands are excluded.
c.
Full text unavailable.
Table 2. Summary of utilization of CBCT in oral cancer.
Table 2. Summary of utilization of CBCT in oral cancer.
IndicationNumber of ArticlesHighest Level of EvidenceCitation Received (up to April 2025)Citation per ArticleDate of First Publication on TopicPublications Number Since 2020
Imaging in radiation treatment25Case–control483 citations19.3200916
Bone invasion assessment16Systematic review334 citations20.920097
Intraoperative surgical guidance6Prospective observational study60 citations1020143
Complication assessment5Prospective observational study96 citations19.220091
Table 3. Summary of studies regarding the use of CBCT during radiation treatment.
Table 3. Summary of studies regarding the use of CBCT during radiation treatment.
AuthorTitleYearStudy DesignObjective of StudyCitations
Cheung et al. [15]Dose recalculation and the Dose-Guided Radiation Therapy (DGRT) process using megavoltage cone-beam CT2009PSTo demonstrate the process of performing dose recalculation on megavoltage CBCT images41
Den et al. [16]Daily Image Guidance With Cone-Beam Computed Tomography for Head-and-Neck Cancer Intensity-Modulated Radiotherapy: A Prospective Study2010PSTo report on the use of daily kilovoltage CBCT to evaluate the inter-fraction and residual error motion of patients undergoing intensity-modulated radiotherapy for head and neck cancer219
Yan et al. [17]Expected treatment dose construction and adaptive inverse planning optimization: Implementation for offline head and neck cancer adaptive radiotherapy2013RSTo evaluate expected treatment dose for adaptive inverse planning optimization and evaluate it on head and neck cancer adaptive treatment modification using daily CBCT images23
Hermans et al. [18]Weekly kilovoltage cone-beam computed tomography for detection of dose discrepancies during (chemo)radiotherapy for head and neck cancer2015RSTo evaluate discrepancies between planned and actually delivered radiation doses in head and neck patients and identify predictive factors using weekly CBCT images9
Hvid et al. [19]Accuracy of software-assisted contour propagation from planning CT to cone beam CT in head and neck radiotherapy2016RSTo determine the accuracy of automated contours compared to manually corrected contours using daily CBCT images23
Hofmaier et al. [20]Multi-criterial patient positioning based on dose recalculation on scatter-corrected CBCT images2017RSTo evaluate the feasibility and potential advantages of dose-guided patient positioning based on dose recalculation on scatter-corrected CBCT images19
Norfadilah et al. [21]Immobilisation precision in VMAT for oral cancer patients2017PSTo evaluate the positioning reproducibility of immobilization devices during oral cancer radiotherapy by using CBCT images2
Brivio et al. [22]Selection of head and neck cancer patients for adaptive re-planning of radiation treatment using kV-CBCT2018RSTo develop a CBCT-based method for the selection of head and neck cancer patients that may require adaptive re-planning5
McCulloch et al. [23]Predictive Models to Determine Clinically Relevant Deviations in Delivered Dose for Head and Neck Cancer2019RSTo develop a predictive model based on the radiation delivered dose deviations assessed by CBCT17
Wei et al. [24]Quantifying the impact of optical surface guidance in the treatment of cancers of the head and neck2020RSTo assess the setup accuracy and time for surface-guided radiation therapy using CBCT to verify patient positioning10
Hague et al. [25]Inter-fraction robustness of intensity-modulated proton therapy in the post-operative treatment of oropharyngeal and oral cavity squamous cell carcinomas2020RSTo evaluate the robustness of an inter-fraction multifield optimized with the use of CBCT in regard to radiation clinical target volume coverage15
Figen et al. [26]Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Re-planning in Routine Practice2020RSTo evaluate the rate of re-planning and determine the factors for a re-plan by assessing anatomical changes with CBCT32
Morgan et al. [27]Exploratory ensemble interpretable model for predicting local failure in head and neck cancer: the additive benefit of CT and intra-treatment cone-beam computed tomography features2021CCSTo analyse local failure in head and neck cancer using images from CT and CBCT to develop a model for predicting local failure16
De Ornelas et al. [28]CBCT-Based Adaptive Assessment Workflow for Intensity Modulated Proton Therapy for Head and Neck Cancer2021RSTo explore CBCT use in calculating the proton dose for adaptive radiotherapy in intensity-modulated proton therapy for head and neck cancer15
Kanehira et al. [29]Comparisons of normal tissue complication probability models derived from planned and delivered dose for head and neck cancer patients2021RSTo compare planned radiation dosage with the delivered dose as estimated from daily CBCT images2
Shinde et al. [30]Quantification of 6D inter-fraction tumour localisation errors in tongue and prostate cancer using daily KV-CBCT for 1000 IMRT and VMAT treatment fractions2022RSTo evaluate the use of CBCT in minimizing tumour localization errors0
Rachi et al. [31]Development of Machine-Learning Prediction Programs for Delivering Adaptive Radiation Therapy With Tumor Geometry and Body Shape Changes in Head and Neck Volumetric Modulated Arc Therapy2023RSTo use CBCT to identify objective indicators for cases needing adaptive radiation therapy and develop machine-learning prediction programs1
All et al. [32]In Silico Analysis of Adjuvant Head and Neck Online Adaptive Radiation Therapy2024PSTo evaluate the benefits of single versus weekly adaptive radiation therapy in head and neck cancer by assessing planning target volume changes using CBCT0
Sharma et al. [33]X-ray and MR Contrast Bearing Nanoparticles Enhance the Therapeutic Response of Image-Guided Radiation Therapy for Oral Cancer2023ASTo demonstrate the use of theranostic nanoparticles in image-guided radiation therapy planning, utilizing CBCT for tumour delineation and radiation beam arrangement4
Jung et al. [34]Novel tongue-positioning device to reduce tongue motions during radiation therapy for head and neck cancer: Geometric and dosimetric evaluation2023PSTo verify the position of the tongue during radiation therapy for oral cancer0
Bobic et al. [35]Large anatomical changes in head-and-neck cancers—A dosimetric comparison of online and offline adaptive proton therapy2023RSTo evaluate an online adaptive workflow intensity-modulated proton therapy versus full offline re-planning with CBCT used to assess anatomical changes17
Jain et al. [36]A prospective study to assess and quantify the setup errors with cone-beam computed tomography in head-and-neck cancer image-guided radiotherapy treatment2023PSTo assess and quantify the setup errors with CBCT in head and neck cancer image-guided radiotherapy treatment3
Håkansson et al. [37]CBCT-based online adaptive radiotherapy for head and neck cancer-dosimetric evaluation of first clinical experience2023PSTo assess the dosimetric difference between the daily adapted plans and the original plan with daily CBCT5
Mail et al. [38]Evaluation of positioning accuracy in head-and-neck cancer treatment: A cone beam computed tomography assessment of three immobilization devices with volumetric modulated arc therapy2024RSTo assess the precision and repeatability of the daily patient positioning for three immobilization devices used for patients undergoing radiation using CBCT0
Blumenfeld et al. [39]Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer2024PSTo evaluate the initial clinical experience of daily adaptive radiotherapy for patients with head and neck cancer using an online adaptive platform with intelligence-assisted workflows with daily CBCT5
PS: prospective observational study; RS: retrospective observational study; CCS: case–control study; AS: animal study.
Table 4. Summary of studies regarding the use of CBCT in bone invasion assessment.
Table 4. Summary of studies regarding the use of CBCT in bone invasion assessment.
AuthorsTitleYearStudy DesignObjective of StudyCitations
Momin et al. [40]Diagnostic accuracy of cone-beam CT in the assessment of mandibular invasion of lower gingival carcinoma: Comparison with conventional panoramic radiography2009RSTo compare the diagnostic accuracy of CBCT versus panoramic radiography in assessing mandibular invasion by oral cancer47
Hendrikx et al. [41]Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study.2010RSTo compare the diagnostic value of CBCT in assessing mandibular invasion by oral cancer with panoramic radiography, MRI, and histological examination59
Dreiseidler et al. [42]A comparison of multislice computerized tomography, cone-beam computerized tomography, and single photon emission computerized tomography for the assessment of bone invasion by oral malignancies2011PSTo compare the performance of CBCT with conventional CT and SPECT in the detection of bone invasion from oral cancer41
Uribe et al. [43]Accuracy of imaging methods for detection of bone tissue invasion in patients with oral squamous cell carcinoma2013SRTo examine the available evidence on the diagnostic accuracy of imaging methods for the detection of mandibular bone tissue invasion by squamous cell carcinoma71
Hakim et al. [44]Imaging of mandible invasion by oral squamous cell carcinoma using computed tomography, cone-beam computed tomography and bone scintigraphy with SPECT2014CCSTo compare the performances in detecting bone invasion of the mandible in oral cancer between CT, CBCT, and bone scintigraphy with SPECT28
Linz et al. [45]Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer2015RSTo compare the performance of CBCT with OPG radiographs, conventional CT, MRI, and SPECT in the detection of bone invasion from oral cancer26
Czerwonka et al. [46]High-resolution cone-beam computed tomography for assessment of bone invasion in oral cancer: Comparison with conventional computed tomography2017PSTo compare the sensitivity and specificity to detect mandibular invasion with conventional CT among patients with oral cancer12
Bombeccari et al. [47]Accuracy of the Cone Beam Computed Tomography in the Detection of Bone Invasion in Patients with Oral Cancer: A Systematic Review2019SRTo examine the available evidence on the accuracy of CBCT compared with other imaging techniques to detect the degree of invasion of the bone tissue in oral cancer16
Qiao et al. [48]Performance of different imaging techniques in the diagnosis of head and neck cancer mandibular invasion: A systematic review and meta-analysis2018SRTo examine the available evidence on the diagnostic efficacy of the different imaging techniques for mandibular invasion by head and neck cancer18
Shree et al. [49]CBCT-based active contour segmentation of bone invasion in oral squamous cell carcinoma—A preliminary retrospective study2020RSTo compare the volumetric analysis by manual and semiautomatic active contour segmentation in oral cancer with frank mandibular bone invasion0
Abhinaya et al. [50]Evaluation of osseous changes in oral carcinoma-2D versus 3D imaging2020RSTo compare osseous changes using OPG radiographs and CBCT in oral cancer cases0
Wang et al. 2021 [51]Accuracy of cone-beam computed tomography for the evaluation of mandible invasion by oral squamous cell carcinoma2021ELSTo evaluate the accuracy of CBCT to detect mandibular erosion or invasion with spiral CT among patients with oral cancer6
Shenoy et al. [52]Evaluation of patterns of mandibular bone invasion in CBCT of patients with oral squamous cell carcinoma: A descriptive study2022RSTo evaluate the patterns of mandibular invasion of oral cancer in CBCT images0
Slieker et al. [53]Value of cone beam computed tomography for detecting bone invasion in squamous cell carcinoma of the maxilla2022RSTo determine the diagnostic value of CBCT in detecting bone invasion in cancer of the maxilla4
Straub et al. [54]Performance of cone-beam computed tomography (CBCT) in comparison to conventional computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone invasion in oral squamous cell cancer (OSCC): a prospective study2024PSTo compare the ability to detect bone erosion or invasion with conventional CT and MRI among patients with oral cancer5
Neal et al. [55]The utility of cone-beam computed tomography and multislice computed tomography scan for the evaluation of invasion versus erosion by mandibular squamous cell carcinoma as viewed on medical PACS2024RSTo compare the utility for detecting mandibular erosion or invasion with conventional CT among patients with oral cancer1
PS: prospective observational study; RS: retrospective observational study; CCS: case–control study; SR: systematic review; ELS: experimental laboratory study.
Table 5. Summary of studies regarding the use of CBCT for intraoperative surgical guidance.
Table 5. Summary of studies regarding the use of CBCT for intraoperative surgical guidance.
AuthorTitleYearStudy DesignObjective of StudyCitations
Daly et al. [56]A surgical navigation system for non-contact diffuse optical tomography and intraoperative cone-beam CT2014ELSTo assess the feasibility of a non-contact diffuse optical tomography system for multimodal imaging with intraoperative CBCT during minimally invasive cancer surgery5
Weijs et al. [57]Accuracy of virtually 3D planned resection templates in mandibular reconstruction2016PSTo evaluate the accuracy of prefabricated surgical resection templates using CBCT used in mandibular segmental resections37
Ivashchenko et al. [58]Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography2019PSTo assess the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins5
Muhanna et al. [59]Sentinel lymph node mapping using ICG fluorescence and cone beam CT—a feasibility study in a rabbit model of oral cancer2020ASTo assess the technical feasibility of intraoperative indocyanine green (ICG)-based near-infrared (NIR) fluorescence imaging and CBCT for sentinel lymph node identification during head and neck surgery8
Steybe et al. [60]Intraoperative marking of the tumour resection surface for improved radiation therapy planning in head and neck cancer: preclinical evaluation of a novel liquid fiducial marker2020ASTo assess the feasibility of using CBCT as part of intraoperative marking of the tumour resection surface in oral cancer patients3
Polfliet et al. [61]Registration of magnetic resonance and computed tomography images in patients with oral squamous cell carcinoma for three-dimensional virtual planning of mandibular resection and reconstruction2021RSTo evaluate an automated method to perform image registration of MRI and CBCT to be integrated for the virtual planning of mandibular resection margins in oral cancer2
PS: prospective observational study; RS: retrospective observational study; AS: animal study; ELS: experimental laboratory study.
Table 6. Summary of studies regarding the use of CBCT as a tool to assess complications in oral cancers.
Table 6. Summary of studies regarding the use of CBCT as a tool to assess complications in oral cancers.
AuthorTitleYearStudy DesignObjective of StudyCitations
Agbaje et al. [62]Bone healing after dental extractions in irradiated patients: a pilot study on a novel technique for volume assessment of healing tooth sockets2009PSTo assess socket healing following extraction in irradiated jaws22
Al-Saleh et al. [63]Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy2017PSTo assess TMJ morphological changes following mandibulotomy compared to the transoral approach12
Rosen et al. [64]Early Changes in Serial CBCT-Measured Parotid Gland Biomarkers Predict Chronic Xerostomia After Head and Neck Radiation Therapy2018RSTo assess the applicability of serial CBCT images to predict the occurrence of chronic xerostomia47
Brauner et al. [65]Implant placement in oral squamous cells carcinoma patients treated with chemoradiotherapy: “Sapienza Head and Neck Unit” clinical recommendations2019PSTo prevent the occurrence of osteoradionecrosis following dental implant by blending radiation dosimetry planning CT scan with CBCT4
Dohopolski et al. [66]Use of deep learning to predict the need for aggressive nutritional supplementation during head and neck radiotherapy2022RSTo assess the use of CBCT as an adjunct to predict the need for aggressive nutrition supplementation to prevent malnutrition11
PS: prospective observational study; RS: retrospective observational study.
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Mohd Nizar, M.A.; Nabil, S. Cone Beam Computed Tomography in Oral Cancer: A Scoping Review. Diagnostics 2025, 15, 1378. https://doi.org/10.3390/diagnostics15111378

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Mohd Nizar MA, Nabil S. Cone Beam Computed Tomography in Oral Cancer: A Scoping Review. Diagnostics. 2025; 15(11):1378. https://doi.org/10.3390/diagnostics15111378

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Mohd Nizar, Muhammad Aiman, and Syed Nabil. 2025. "Cone Beam Computed Tomography in Oral Cancer: A Scoping Review" Diagnostics 15, no. 11: 1378. https://doi.org/10.3390/diagnostics15111378

APA Style

Mohd Nizar, M. A., & Nabil, S. (2025). Cone Beam Computed Tomography in Oral Cancer: A Scoping Review. Diagnostics, 15(11), 1378. https://doi.org/10.3390/diagnostics15111378

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