VOMIT stands for Victims Of Modern Imaging Technology which was first described in an article in the British Medical Journal in 2003 (Volume 3. 26) by Richard Hayward, a Consultant Neurosurgeon from GOSH.
The concept of VOMIT can be applied to CBCT in dentistry where incidental findings of pathology and disease occur while imaging someone using enhanced modern technology to try to find something else. Example: assessing someone for residual height beneath a sinus prior to implant placement and finding an enlarged and thickened sinus membrane. What should you do with this? How should you refer? How should you consider the potential outcome for the patient?
The difficulty for VOMIT is that can cause more pathology than it solves. Take the above patient for example: refer to ENT > no obvious cause for thickened membrane which appears to be abnormally thickened > patient undergoes investigation using endoscopic surgery > patient suffers a complication as a result of surgery despite no pathology being present or worse, a hospital acquired infection.
The flip side to that is not reporting the thickened membrane, the patient does not have a tumour diagnosed early and therefore dies to more aggressive disease. A very, very difficult circle to square.
In CBCT reporting in the UK (in fact around the world) we could really do with a structure that is nailed on by ethical and honest clinicians as to how to effectively report these cases and which lines of responsibility to take. Any of us who are interested in this are setting up our own pathways and networks but this has to apply as much as possible across the board for every single patient. Perhaps the flipside of VOMIT in dentistry is faeces (this is not an acronym, it’s a suggestion of something crap) repeatedly i’m receiving scans from other practices and other dentists that are clearly unreported and hand written on with a marker. The field of view is too great and the reason for taking the scan was to get money from the referral to pass it on. This is utterly unacceptable. Please can we speak to the guys who are producing scans on this basis and tell them to stop? They’re not helping the profession or indeed the reputation of the profession as a whole by acting in such a crass, commercial and unethical fashion.
For anybody involved in CBCT, it’s time to choose VOMIT or faeces. VOMIT is quality and consideration of every scan and every outcome, trying to limit the impact on patients and looking at things in a philosophical and ethical way. Faeces is crap.
Blog Post Number: 970