Clear 3D Imaging is proud to bring innovative 3D Imaging technology to your practice! 
Overview This technology utilizes intermittent bursts of radiation only milliseconds in length during the image acquisition.  Other systems deliver a constant stream of radiation and the same amount of radiation, whether scanning a 300 pound adult or a small child. 
In conjunction with the patented Safe Beam™ technology, when compared to other CBCT systems, NewTom VGi has a wider range with which it adjusts the x-ray power and quantity (kV=110 and mA=1-20).  As a result, patient exposure is tailored and image contrasts remains consistent regardless of size. CBCT exhibits clear advantages over conventional radiographic methods, including controlled magnification, lack of superimposition, and absence of geometric distortion, convenient multiplanar and 3D displays.  These advances offer improved structure visualization and diagnostic efficacy.  Cone Beam Computed Tomography (CBCT) provides a lower dose, lower cost alternative to conventional CT that promises to revolutionize the practice of Oral and Maxillofacial Radiology. CBCT has been used in an expanding number of applications involving the disciplines of Endodontics, Oral Surgery, Oral Medicine, Periodontology, Restorative Dentistry, and Orthodontics. Risks and Responsibilities
CT scans, like conventional X-Rays, expose the patient to radiation. The amount of radiation the patient will be exposed to by the CT scan used by Clear 3D Imaging is the equivalent to the exposure you would get from approximately 3-5 days in the sun. An alternative to CT scans is conventional X-Rays.  While many anatomical structures may be evident from the scan, Clear 3D Imaging is not qualified to diagnose conditions that are present on the scan.  A review by a certified Radiologist is available upon request for an additional fee. 
Technical factors for standard full FOV exposure of RANDO phanto













Clear 3D Imaging will provide the equipment necessary to perform the CT scans described above.  In addition, a qualified technician will be provided to perform the scan under the direction and supervision of the Client/ Dentist. 
The Client/Dentist will determine the type of scan to be performed and will communicate that to Clear 3D Imaging by completing a Prescription Form.  In addition, the Client/Dentist is responsible for determining the patient’s eligibility for being scanned considering any contraindications that may exist for this type of procedure.  
Ordering a Scan
Any doctor wishing to have a CBCT scan performed on a patient, should submit a request online at www.Clear3DImaging.com or email at Info@Clear3DImaging.com. 
Upon receipt of your request, a representative will contact your office regarding scheduling.   The scan will be performed by a qualified Clear 3D Technician onsite at your facility.  
The Client/Dentist will specify whether a Full or Limited Scan is desired.  There are considerations for each.  A full scan will expose the patient to slightly more radiation than a limited scan, but provides the benefit of possible future use in viewing visible structures without having to order another scan for the patient.  Since more anatomical structure will be visible in this type of scan, a report from a Radiologist is recommended when ordering a full scan. 
A limited scan will only show the desired focus area.  The Client/Dentist will specify the requested field of view on the prescription when ordering the scan. 
The patient scan will be provided to you in digital format with the software required to view the image. 
Operating Instructions
Operating instructions for the NewTom VGi are included with this agreement and should be reviewed and maintained by the Client/Dentist. 

Fees
The price per patient scan is $375, which is billed directly to the Client/Dentist.  This cost may be passed along to the patient and/or filed with dental/medical insurance. 
Radiographer readings are available for an additional fee of $75 
A billing statement will be generated every 30 days for scans performed during the current billing cycle. Overdue accounts will be subject to 1.5% interest or formal collection action as the account becomes overdue. All fees associated with collection efforts will be the responsibility of the client. 
I have reviewed this agreement in its entirety and agree to the terms and conditions represented herein. _______________________________                                              __________________________ Client/Dentist Printed Name                                                    Practice Name- if applicable ________________________________                                            __________________________ Client/Dentist Signature                                                                       Date _______________________________ NC Dental License #