Interviewer: Thank you, Dr. Liakh, for speaking with us today. To start, can you tell us what drew you into the field of oral and maxillofacial radiology?
Dr. Liakh: Thanks for having me. My journey actually began in general dentistry. I trained at ECU School of Dental Medicine, then completed an AEGD at a VA Medical Center. Early on in practice, I kept seeing the same scenario: a 2-D image looked fine, but when a more advanced scan was taken, everything changed—the diagnosis, the treatment plan, sometimes even the outcome. That moment of transitioning from “we’re not sure” to “we know” really hooked me. That’s when I knew I wanted to become an oral radiologist—someone who helps the clinician and patient move from uncertainty to clarity.
Interviewer: At your practice, you emphasize “a second set of eyes.” Why is that so important in today’s dental world?
Dr. Liakh: There are two main reasons. First, patients often appreciate reassurance from a third party before proceeding with treatment. Second, radiologist input is essential for responsible risk management. With full-volume CBCT data and clinicians focused on treatment, involving a radiologist helps ensure important findings are not overlooked. We designed IDR to make this second set of eyes accessible and secure online. In many ways, it functions as dental radiology reporting online, giving clinicians specialist input without disrupting their daily workflow.
Interviewer: Could you walk us through how you approach reading a CBCT scan? What’s your process?
Dr. Liakh: Absolutely. I follow a consistent routine for every interpretation and never skip steps. My advice to clinicians is to develop a structured review process and adhere to it. Consistency maintains accuracy and focus.
I also recommend reviewing images in a quiet room with dim lighting, as this helps detect subtle contrast differences that might otherwise be missed.
Regardless of the field of view, I begin with a global overview, systematically reviewing all planes to identify any obvious or critical findings. This initial pass often reveals issues outside the primary area of interest.
Next, I conduct a structured, whole-volume review. I start with the cervical spine, the middle cranial fossa, the upper airway, and the oropharynx, then examine the jaws and teeth. I conclude with the specific region of interest, such as an implant site or localized area.
I use checklists and a fixed reading order to avoid focusing on a single finding and missing others. A disciplined, repeatable process ensures accurate and comprehensive interpretations.
Interviewer: That’s wonderfully systematic. In your view, which types of cases yield the greatest impact from radiology interpretation?
Dr. Liakh: Implant planning is the first area, as anatomical details are critical. Failure to identify the position of the neurovascular canal, cortical boundaries, or sinus borders can lead to nerve injury or sinus complications. In implant planning, precision is essential.
Next is endodontic decision-making, which involves evaluating apical pathology, hidden or atypical canals, resorption, or post-surgical healing. A thorough radiology interpretation can significantly alter the treatment plan.
Finally, incidental findings are important. Many CBCT scans are performed for a specific purpose but often reveal additional issues that impact patient care or treatment timing. Radiologists help identify these findings that may be overlooked when clinicians focus on the primary concern.
Interviewer: Many dentists might assume that if they just scroll through a CBCT, that counts as interpretation. Is that a misconception?
Dr. Liakh: Absolutely. That is a common misconception. Simply scrolling through a CBCT is not equivalent to interpreting it.
A proper interpretation requires evaluating the entire volume, including all relevant structures, spaces, and regions of interest, while considering the clinical presentation and medical history. Omitting any of these steps can create blind spots.
It is similar to flipping through a book and assuming you have read the story; you will miss the context, details, and often the most important information.
Interviewer: Why did you build IDR? What gap in the marketplace were you trying to fill?
Dr. Liakh: My goal was to provide busy practices with a trusted radiologist who is easily accessible. The platform offers easy uploads, clear and timely reports, and direct communication with me, all within a secure system.
Interviewer: Could you sum up IDR’s mission for busy general dentists?
Dr. Liakh: Our mission is to enhance diagnostic accuracy and improve patient outcomes by providing clear and systematic interpretations of dental imaging.
Interviewer: What’s your case mix like?
Dr. Liakh: Most of my work involves medium field-of-view CBCT scans, typically submitted for comprehensive pathology review. I also handle a variety of endodontic and pathology evaluations, which I find rewarding as they often prompt changes in treatment decisions.
I also frequently provide airway analyses and TMJ assessments. Occasionally, I interpret panoramic images, which are usually submitted as supporting studies with CBCT scans.
Interviewer: What are some of the most common findings you see in your CBCT interpretations, especially in implant and pathology cases?
Dr. Liakh: The most common findings I encounter are the inferior alveolar canal and mandibular incisive canal, especially during implant planning; the retromolar neurovascular canal, often relevant in third molar cases; and early periapical disease, which can be overlooked without a detailed radiology review.
Interviewer: You offer two report types—Screening and Advanced. Can you explain how they differ?
Dr. Liakh: Both reports provide a detailed review of the entire scan. The difference lies in their presentation:
- Screening Report: A concise, text-only overview designed to rule out significant pathology. No measurements or annotated images are included. If further analysis is needed, we may recommend upgrading to an Advanced Report.
- Advanced Report: A comprehensive, image-supported interpretation with measurements, annotated visuals, and decision-focused recommendations. This report is ideal for complex or surgical cases that require detailed analysis.
Interviewer: Are there services you don’t offer?
Dr. Liakh: Yes, there are a few services I do not currently offer, such as cephalometric tracing or surgical guide design, although these may be available in the future. I also do not provide direct second opinions to patients, as my reports are prepared for the treating dentist, who oversees the overall care plan.
Interviewer: What does a case submission look like, from the clinician’s side?
Dr. Liakh: The process is straightforward. Log in to the secure portal, complete a brief intake form with clinical and medical history and the region of interest, upload the zipped DICOM folder, select the service, and submit.
Our standard turnaround time is 2–3 business days, though I typically aim to deliver reports within 2 days. A rush option is available within 12 hours. If I identify an urgent issue, I contact the provider directly before or immediately after finalizing the report.
Interviewer: What kind of information helps you in your diagnosis?
Dr. Liakh: A complete medical history and clear clinical presentation are essential. Information about trauma, radiation therapy, or bisphosphonate use is particularly important when I interpret a case.
For periapical pathology, knowing tooth vitality and patient symptoms is helpful. Additional details such as symptom duration, prior treatment, and supporting images are also valuable.
The clearer the information and clinical question, the more precise and targeted the report will be.
Interviewer: If a clinician needs a revision on the previously submitted case or wants additional views, how does that work?
Dr. Liakh: For a follow-up interpretation, the provider should submit a new request that includes both the new and previous images. If only additional views or clarification are needed, providers can message me directly through the secure portal.
Interviewer: How do you approach quality control and patient safety in CBCT imaging and reporting?
Dr. Liakh: When it comes to quality control in dental radiology, especially with cone beam CT scanners, we follow procedures such as those used in patient dose measurements and ongoing quality checks, similar to what has been reported in initial experiences with systems like the ILUMA Ultra for oral and maxillofacial imaging, according to a 2010 article on quality control and patient dosimetry in dental cone beam CT.
Interviewer: When you see a worrisome diagnosis, how do you handle it with a provider?
Dr. Liakh: If I suspect pathology or recommend a histopathologic evaluation, I always call the provider after submitting the report. I understand how busy clinical days can be, and sometimes reports are reviewed just before seeing a patient. I want to ensure providers are not caught off guard by a critical diagnosis. A quick call helps them understand the concern and prepares them to discuss it with the patient.
Interviewer: What is your standard turnaround time for both initial reports and clarifications?
Dr. Liakh: According to Dental Radiology Solution Services, report turnaround times begin as soon as 4 hours after the radiologist receives the radiologic images or scans. For questions or clarifications, responses are typically provided on the same business day, often within a few hours if available.
Interviewer: Could you share a memorable case—something unexpected that truly changed a treatment plan?
Dr. Liakh: I recently reviewed an implant case where the implant failed to integrate. After evaluating previous images and clarifying the patient’s medical history, I discovered the implant had been placed in bone affected by fibrous dysplasia, a site where osseointegration is not possible.
Unfortunately, the provider had obtained the patient’s physician’s medical clearance to proceed. This case demonstrates how a radiologist’s input can change or even prevent such outcomes. A brief consultation before placement could have saved both the provider and patient time, expense, and disappointment.
Interviewer: And finally—any parting words for our readers?
Dr. Liakh: CBCT scans are powerful diagnostic tools, but their value depends on accurate interpretation. Patients recognize when their care receives extra attention, and a specialist’s review can further strengthen their trust in you.
A fresh perspective can elevate routine care to exceptional care. Having another set of eyes on a scan can clarify findings and provide patients with the reassurance they need to proceed with treatment.
If you have a case you would like reviewed, I would be happy to assist.