Radiation exposure to children in intraoral dental radiology

Parents' perspective towards dental radiography for children

Background/purpose

Radiographs provide critical information on developmental and eruption problems, detection of interface caries, pulpal and periapical pathologies in clinical examination. This study aimed to evaluate parents' knowledge, attitudes and behaviors towards dental radiographs.

Materials and methods

A cross-sectional study was conducted on the parents of 396 children who visited to the Pediatric Dentistry clinics. All participants were asked to answer a total of 26 questions. A questionnaire was developed to assess participants' attitudue, behavior and knowledge toward pediatric dental radiographies and provided information on their demographic characteristics. The number of positive attitudes and correct answers was scored based on items asked to the participants. In order to analyze the effect of demographic data on the obtained scores, a multivariate linear regression model was created. The significance level was accepted as 0.05 in all analyzes.

Results

Children's dental radiography experience affects parents' attitude score towards dental radiographs (t = 4.375, P < 0.001). Parents' level of knowledge about dental radiography has a positive effect on their attitudes (t = 5.510, P = 0.005). The education level of the parents and the frequency of visits to the dentist have a significant effect on the knowledge level of the parents about dental radiography (P < 0.05). When the correlation between knowledge and attitude scores is analyzed, it is observed that there is a statistically significant, weak and positive correlation between the two variables (r = 0.34, P < 0.001).

Conclusion

In conclusion, parents who did not had dental radiographs before have a more negative attitude towards dental radiographs than those who have had dental radiographs.

Assessment of Regional Pediatric Diagnostic Reference Levels for Panoramic Radiography Using Dose Area Product

AIM

The current work aims to calculate dose area product (DAP) and to determine regional diagnostic reference level (DRL) for pediatric panoramic radiography in Tamil Nadu.

MATERIALS AND METHODS

In this study, DAP was calculated after finding the product of air kerma on the detector side of scanner with the corresponding exposed area. The obtained DAP values were further analyzed, and DRL was calculated using Microsoft Excel. The study was carried out with routine pediatric exposure parameters.

RESULTS

The obtained mean, range, and third quartile values for pediatric panoramic radiography are found to be 65 mGycm2, 11-148 mGycm2, and 82 mGycm2, respectively. The proposed DRL is comparable with the other countries' DRL.

CONCLUSION

Based on the results of the present study, it was observed that there exists a wide difference in mean doses among the panoramic scanners. The variation in radiation doses between the clinics/hospitals and similar scanners suggests a large potential for optimization of panoramic procedures.

Korean dentists' perceptions and attitudes regarding radiation safety and protection

OBJECTIVES

To investigate dentists' perceptions and attitudes regarding radiation safety in dental practices in Korea.

METHODS

207 dentists participated in this study. An anonymous survey was conducted regarding the following areas: years of practice, characteristics of the radiography equipment, knowledge of diagnostic reference levels, prescription of dental radiographs, use of radiation protection procedures and participation in the radiation safety program. Data were evaluated according to frequency distribution; the χ test; and Fisher's exact test, which was used to investigate statistical significances (p < 0.05) between those with less than 10 years of experience in practice vs those with 10 years of experience or more.

RESULTS

Approximately 83% of the dentists who responded to our survey participated in the radiation safety program, but only 58% were satisfied with it. There were statistically significant differences in the installation of X-ray units, learning pathway of diagnostic reference levels, prescription of dental radiography for new adult patients, use of personnel radiation monitoring systems and participation in the radiation safety program between those with less than 10 years of experience in practice vs those with 10 years of experience or more (p < 0.05).

CONCLUSIONS

Dentists with less than 10 years of experience were less attentive to radiation protection procedures. Therefore, taking both the duration of experience of dentists and the installed X-ray equipment into consideration, continuous and efficient education for both dental workers and patients regarding radiation safety and protection is recommended.

Diagnostic reference levels for panoramic and lateral cephalometric radiography of Korean children

Pediatric patients are considered to be more radiosensitive than adults; thus, radiation dose evaluations based on radiologic examinations are particularly important in this population. However, no national diagnostic reference levels (DRLs) are available for pediatric patients in the Republic of Korea. Therefore, the aim of this study was to determine the usage of panoramic and cephalometric radiography under the National Health Insurance (NHI) scheme and to investigate the current DRLs for child panoramic and lateral cephalometric radiography using dose area product (DAP). DAP values were obtained for standard child exposure settings used routinely by dentists. Analysis was performed on data obtained from 28 panoramic and 20 cephalometric x-ray units for the DAP investigation. DRLs for child panoramic and cephalometric radiography were found to be 95.9 mGy cm and 121.3 mGy cm, respectively. These DRLs are higher than those recommended in the UK and Germany, which indicates that further effort is required to reduce pediatric doses in the Republic of Korea.

Quality assurance in digital dental imaging: a systematic review

OBJECTIVES

Doses induced by individual dental examinations are low. However, dental radiography accounts for nearly one third of the total number of radiological examinations in the European Union. Therefore, special attention is needed with regard to radiation protection. In order to lower patient doses, the staff performing dental examinations must have competence in imaging as well as in radiation protection issues. This paper presents a systematic review about the core competencies needed by the healthcare staff in performing digital dental radiological imaging quality assurance.

MATERIALS AND METHODS

The following databases were searched: Pubmed, Cinahl, Pro Quest and IEEXplore digital library. Also volumes of some dental imaging journals and doctoral theses of the Finnish universities educating dentists were searched. The search was performed using both MeSH terms and keywords using the option 'search all text'. The original keywords were: dental imaging, digital, x-ray, panoramic, quality, assurance, competence, competency, skills, knowledge, radiographer, radiologist technician, dentist, oral hygienist, radiation protection and their Finnish synonyms.

RESULTS

Core competencies needed by the healthcare staff performing digital dental radiological imaging quality assurance described in the selected studies were: management of dental imaging equipment, competence in image quality and factors associated with it, dose optimization and quality assurance.

CONCLUSIONS

In the future there will be higher doses in dental imaging due to increasing use of CBCT and digital imaging. The staff performing dental imaging must have competence in dental imaging quality assurance issues found in this review. They also have to practice ethical radiation safety culture in clinical practice.

Oblique lateral radiographs and bitewings; estimation of organ doses in head and neck region with Monte Carlo calculations

OBJECTIVES

When bitewing radiographs are not possible (e.g. patients with special needs), oblique lateral radiographs may offer an alternative. The aims of this study were to assess the impact of horizontal projection angulation, focus-to-skin distance, exposure time and age of the patient on the equivalent radiation dose of several organs in the head and neck region by means of personal computer X-ray Monte Carlo (PCXMC) calculations and to assess the dose obtained from conventional bitewing radiographs.

METHODS

PCXMC v. 2.0 software (STUK(®), Helsinki, Finland) was used to estimate the equivalent radiation doses and the total effective dose. Three exposure times, five age categories, two focus-to-skin distances and eight horizontal geometric angulations were assumed. The organs involved were the thyroid gland, oesophagus, salivary glands, bone marrow, oral mucosa, skull, cervical spine and skin. A similar calculation was also performed for bitewings taken with a rectangular collimator. Results and conclusion Bitewings taken with rectangular collimation decrease the radiation burden of the patient to 50%, compared with circular collimation. In the oblique lateral radiographs, focus-to-skin distance, patient's age and beam collimation had a significant impact on the equivalent doses measured in this study. Exposure time had a significant impact on the equivalent doses of the salivary glands, oral mucosa, skull and skin. Horizontal angulations had a significant impact on the equivalent doses of the thyroid gland, bone marrow, oral mucosa, skull and cervical spine. The total effective radiation dose was significantly influenced by all parameters investigated in this study.

Parental knowledge and attitudes towards dental radiography for children

BACKGROUND

Radiographs are an essential part of most clinical dental examinations and diagnoses. The aim of the study was to assess the knowledge and attitudes of parents towards dental radiographs for their children.

METHODS

A 21-item questionnaire, covering parental level of radiation knowledge and socio-demographics was applied. Sliding scales were used to assess attitude towards dental radiographs.

RESULTS

There were 1467 questionnaires distributed between five primary schools in the Perth (Western Australia) metropolitan area, with 309 surveys (21%) returned for collection. Most parents displayed a low level of knowledge, but had a positive attitude towards dental radiographs. Parents with children who have previously had dental radiographs perceived dental radiographs as 'good', 'useful' and 'pleasant'. A higher level of education and parents with children who have previously had radiographs were significantly associated with a higher level of knowledge about dental radiography. Parents who had higher scores on questions assessing radiation knowledge were more likely to perceive dental radiographs as 'safe' and 'beneficial'.

CONCLUSIONS

Most parents have a positive attitude towards dental radiographs on their children. However, the majority of parents lack knowledge regarding dental radiography, especially regarding the risks involved.

Dose area product measurement for diagnostic reference levels and analysis of patient dose in dental radiography

In this study, diagnostic reference levels (DRLs) were suggested and patient doses were analysed through the dose-area product value in dental radiography. In intraoral radiography, at three sites, i.e. molar, premolar and incisor on the maxilla and acquired third quartile values: 55.5, 46 and 36.5 mGy cm(2), respectively, were measured. In panoramic, cephalometric and cone beam computed tomography, the values were 120.3, 146 and 3203 mGy cm(2) (16 × 18 cm), respectively. It has been shown that, in intraoral radiography, the patient dose changes proportionally to the value of mA s, but the change in extraoral radiography in response to mA s could not be confirmed. The authors could confirm, however, the difference in dose according to the manufacturer in all dental radiography examinations, except for panoramic radiography. Depending on the size of hospital, there were some differences in patient dose in intraoral radiography, but no difference in patient dose in extraoral radiography.

Reliability of panoramic radiographs for identifying supernumerary teeth in children

OBJECTIVES. To evaluate the reliability of panoramic radiographs (PRs) for identifying supernumerary teeth (ST) and to determine whether the level of dental training of the observer influenced the identification of ST. METHODS. Seventy-five PRs were randomly selected from the patient records and 18 examiners independently rated 25 radiographs each, for specific risk factors as well as for a measure of adequacy. Subsequently, the results were paired with those of the other examiners who assessed the same set of PRs. Descriptive statistics were computed using Fisher's exact test, and kappa statistics were used to assess the inter- and intra-observer reliability. RESULTS. Four hundred and fifty PRs were available for analysis. The overall sensitivity and specificity figures were 50% and 98.3%, whereas the positive and negative predictive values were 90.6% and 83.6%, respectively. The sensitivity figures for Junior House Dental Officers and Postgraduate Paediatric Dental Trainees were 39.2% and 60.8%, whereas the specificity figures were 99.4% and 95% with slight inter-examiner and moderate intra-examiner reliability. CONCLUSIONS. Panoramic radiographs are unreliable for identifying ST, and higher level of dental training is essential for identifying ST.

Effect of tube potential and image receptor on the detection of natural proximal caries in primary teeth

The aim of this study was to assess the detection of proximal caries in primary teeth at three different tube potentials using Ektaspeed films, storage phosphor plates (SPPs), and a charge-coupled device (CCD). Fifty-three extracted human primary molars with natural proximal caries were radiographed with three different imaging modalities--Digora Optime SPP system, RVGui CCD system, and Ektaspeed films--at 50-, 65-, and 70-kV tube potentials. Three observers scored the resultant images for the presence or absence of caries. The definitive diagnosis was determined by stereomicroscopic assessment. The diagnostic accuracy for each imaging modality was expressed as the area under the receiver operating characteristic curves (A(z)). Differences among the A(z) values were assessed using two-way ANOVA and t tests. Kappa was used to measure inter- and intra-observer agreement. Higher accuracy was found for SPPs compared to film and CCD images at all tube potentials. Accuracy was significantly different only at 50-kV tube setting in favor of SPPs (p < 0.05). Inter- and intra-observer agreement was high for all systems. A SPP system can be recommended for dental peadodontic clinics particularly with 50-kV tube potential for the diagnosis of proximal caries since further advantages include the elimination of chemical processing, image enhancement, and a better low-contrast detectability performance.

Conversion coefficients for the estimation of effective doses in intraoral and panoramic dental radiology from dose-area product values

Conversion coefficients for the estimation of effective doses in intraoral and panoramic dental radiology from dose-area product (DAP) values were determined by measuring organ-absorbed doses and the corresponding DAP values. Measurements were performed for all standard intraoral radiological projections and standard panoramic examination at different exposure parameters. Organ-absorbed doses were measured using thermoluminescent detectors and an adult anthropomorphic phantom specially designed for dosimetric study in dental radiology. Different techniques for the calculation of effective doses were evaluated. Conversion coefficients derived from this study range from 0.008 to 0.132 microSv mGy(-1) cm(-2) for intraoral radiography and 0.055 to 0.238 microSv mGy(-1) cm(-2) for panoramic radiography.

Dose-area product measurements in panoramic dental radiology

In this study, dose-area product (DAP) measurements in panoramic dental radiology have been performed in Germany. The results obtained in this study were proposed as diagnostic reference levels (DRLs). A representative number of dental panoramic units, both with digital and conventional image receptors, have been chosen. Common statistical parameters such as mean, standard deviation and 3rd quartile have been calculated. For four different standard programmes, 'large adult', 'adult male', 'adult female' and 'child', the proposed DRLs are 101, 87, 84 and 75 mGy cm(2), respectively. No clear tendency to a generalised dose reduction from the transition to digital techniques has been observed. Effective doses have been calculated from E/DAP conversion factors published in literature. Even though these values differ by a factor of approximately 3, upper limits of 15.8-21.2 microSv for the four different exposure settings were derived from the data.

Radiation exposure and dose evaluation in intraoral dental radiology

In this study, dose area product measurements have been performed to propose diagnostic reference levels (DRLs) in intraoral dental radiology. Measurements were carried out at 60 X-ray units for all types of intraoral examinations performed in clinical routine. The third quartile values calculated range from 26.2 to 87.0 mGy cm(2). The results showed that there exists a large difference between the patient exposures among different dental facilities. It was also observed that dentists working with faster film type or higher tube voltage are not always associated with lower exposure. The study demonstrated the necessity to have the DRLs laid out as guidelines in dental radiology.