Survey of dental radiological practice in Turkey

Attitudes and practices of radiation protection among Jordanian dental radiography practitioners

INTRODUCTION

Varying radiation protection practices have been documented in the literature. This study aims to evaluate the attitudes and practices of dental radiography practitioners towards radiation protection in Jordan, as no data currently explores their understanding and practices in this area.

METHODS

The survey involved 192 dental radiography practitioners. A cross-sectional, self-administered questionnaire containing 43 questions covered socio-demographic data, practices towards radiation protection, and attitudes.

RESULTS

The majority of participants were less than 40 years old (87.5 %), with 66.7 % working in private clinics and 53.6 % based in the capital city of Jordan. Nearly a quarter (26.5 %) of the practitioners used an X-ray tube voltage of 65-70 kVp; however, 14.6 % were unaware of the X-ray tube voltage used in their machines. Additionally, almost one quarter of the participants never or rarely used light beam positioning aids and available positioning guides in panoramic radiography practice. Only 33.3 % of practitioners consistently used lead aprons, with the main reasons for non-use being the weight of the apron or its unavailability. About 81 % of participants believed in spreading awareness about radiation protection and applying this knowledge in their daily practices.

CONCLUSIONS

The study found that the practitioners' practices were satisfactory to some extent, supported by a positive attitude towards radiation protection. The participants understand the importance of increasing their awareness and knowledge of radiation protection practices.

IMPLICATIONS FOR PRACTICE

The findings of this study highlight the need to improve radiation protection practices among dental radiography practitioners in Jordan by introducing standard dose protocols, supporting the transition to digital systems, establishing diagnostic reference levels, and encouraging the use of equipment over staff holding practices, and raising awareness about radiation safety.

Assessing the Adherence to Safety Protocol Among Personnel Working in the Dental Radiology Department: A Qualitative Cross-Sectional Study

BACKGROUND

Implementing recommended radiation safety protocols in the radiology departments is crucial for the safety of the working personnel, patients, and environment. Similarly, adherence and continuous monitoring are essential, and few studies have been conducted in dental radiology settings regarding the occupational safety of employees. Hence, the present study was carried out to assess the knowledge and adherence of personnel to safety protocol in the dental radiology department.

MATERIALS AND METHODS

The questionnaire-based study was conducted in a dental institute involving the relevant staff and students, consisting of 25 participants including radiographers (a technician, faculty, and postgraduates) and auxiliary staff. The 14-element questionnaire with questions on radiation exposure, hazards, safety protocols, protective devices, and infrastructure was given to study participants, and data was obtained.

RESULTS

Overall, the responses to the questionnaire were favorable in terms of awareness or knowledge of participants about radiation protection and protection devices. Notably, 71.4 % (15) of the participants agreed that they consistently wear PPDs, and 86.5% (18) agreed that the radiology operatory is well-equipped concerning radiation safety measures. On the whole, the responses to the questionnaire were encouraging from the auxiliary staff in terms of radiation protection awareness.

CONCLUSION

The perception of study participants provides valuable insight to enhance the adherence to radiation safety protocol in the institutes. The study demonstrated that most participants revealed adequate knowledge of radiation exposure hazards, the need for personnel protection, and adherence to radiation safety protocol. This study would serve as the pilot project and may provide a platform for further multicenter studies to be carried out.

Exposure and protection protocols of dentomaxillofacial imaging applied by paediatric dentists in Europe

OBJECTIVES

Evaluate exposure and protection practices regarding dentomaxillofacial imaging among pediatric dentists in Europe and determine the effect of different clinician specific characteristics on their implementation.

METHODS

A cross-sectional study involving an electronic questionnaire addressed to paediatric dentists, participating in a seminar on dental radiology organized by the European Academy of Paediatric Dentistry. Participants were asked to respond to questions regarding dentomaxillofacial imaging in terms of applied radiation dose, adoption of radiation protection techniques, and different patterns of radiographic studying and exchange between patients and colleagues. Data analysis was performed and distribution of responses was tested using chi-square and Fisher's exact tests.

RESULTS

A total of 151 paediatric dentists, 119 females and 32 males, with a mean chronological age of 42.8 years (s.e. 11.3 years), successfully completed the questionnaire (response rate = 82%). Regardless of the type of radiograph, majority of respondents (68%), reported that they perform the radiographs themselves, while 21% reported that they refer the patients. Half of the respondents (51%), indicated requesting a small (localized) field of view (FOV) when referring for a cone beam computed tomography (CBCT) with only a small proportion (11%) reporting a large (maxillofacial) FOV. Thyroid collars and optimizing exposure settings were the most commonly reported patient protection measures used. Lastly, paediatric dentists have adopted the latest technological capacities for the study of dental images.

CONCLUSIONS

Dentomaxillofacial imaging protection and exposure protocols used are common among paediatric dentists with none of their specific characteristics having a significant effect.

Knowledge, attitude, and behavior of Turkish dentists about radiation protection and radiation safety

OBJECTIVES

Dentists use dental imaging methods frequently in the diagnosis and treatment of dental diseases. This study aimed to determine dentists' knowledge, attitudes, and behaviors about radiation protection during dental imaging procedures.

METHODS

Dentists from two major dental health centres in İzmir province were asked to participate in this study. The participants replied to a questionnaire that consisted of questions on the use of radiographic devices, knowledge on the radiation protection of patients and staff, and attitudes and behaviors regarding radiation protection. The questionnaire also included questions about the socio-demographic characteristics of the participants. Descriptive statistics of data were performed using the SPSS software program.

RESULTS

Sixty-six dentists participated in the survey. The mean knowledge score of dentists on dental imaging, radiation, and radiation protection was 8.3 ± 2.6 out of 17, while the mean attitude and behavior score was 8.3 ± 2.1 out of 27.97% of the participants stated that medical imaging technicians should carry out imaging procedures. The use of rectangular collimators was 9.1%, and using E/F film was 56.3% among dentists. 23.3% of participants stated that they applied the bisecting angle technique during dental imaging, 23.8% stated that they wear a lead apron during imaging, and 37.8% stated that they always used thyroid shields on the patients. In addition, 37.2% of the dentists stated that the patient holds the film during preapical radiography, and 81.5% used the same imaging parameters for adult and pediatric patients. 62% of dentists stated that they question the pregnancy of female patients before imaging.

CONCLUSION

Findings of the study suggest that the knowledge of dentists about dental imaging procedures and radiation protection needs to be improved. The implementation and the follow-up of quality training programs in accordance with the standards set by the national authority will be of great importance.

Accuracy of computer-aided image analysis in the diagnosis of odontogenic cysts: A systematic review

Background

This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing odontogenic cysts.

Material and Methods

A systematic review was conducted according to the PRISMA statements and considering eleven databases, including the grey literature. Protocol was registered in PROSPERO (CRD 42020189349). The PECO strategy was used to define the eligibility criteria and only studies involving diagnostic accuracy were included. Their risk of bias was investigated using the Joanna Briggs Institute Critical Appraisal tool.

Results

Out of 437 identified citations, five papers, published between 2006 and 2019, fulfilled the criteria and were included in this systematic review. A total of 5,264 images from 508 lesions, classified as radicular cyst, odontogenic keratocyst, lateral periodontal cyst, glandular odontogenic cyst, or dentigerous cyst, were analyzed. All selected articles scored low risk of bias. In three studies, the best performances were achieved when the two subtypes of odontogenic keratocysts (solitary or syndromic) were pooled together, the case-wise analysis showing a success rate of 100% for odontogenic keratocysts and radicular cysts, in one of them. In two studies, the dentigerous cyst was associated with the majority of misclassifications, and its omission from the dataset improved significantly the classification rates.

Conclusions

The overall evaluation showed all studies presented high accuracy rates of computer-aided systems in classifying odontogenic cysts in digital images of histological tissue sections. However, due to the heterogeneity of the studies, a meta-analysis evaluating the outcomes of interest was not performed and a pragmatic recommendation about their use is not possible.

Key words:Computer-assisted diagnosis, computer-assisted image analysis, computer-assisted image processing, odontogenic cysts, keratocysts, radicular cysts.

A Questionnaire of Digital Radiography and CBCT Use and Knowledge among Lithuanian Dentists

Objectives

Digital radiography is an increasingly used technology in Lithuania. However, there is no published information about using cone-beam computed tomography. The aims of this cross-sectional study performed in Lithuania were (1) to obtain information about the prevalence and accessibility of digital radiography and cone-beam computed tomography usage, and (2) to estimate dental practitioners’ knowledge about this diagnostic method and their need for education.

Material and Methods

Questionnaires consisting of 31 questions were distributed during the 2019 International Dentist Congress in Lithuania.

Results

This study analyses the data obtained from 248 respondents. Most of the clinicians use digital radiographic methods in their practice. The institutions usually have a digital dental X-ray machine, less often a digital panoramic X-ray machine, and least often a cone-beam computed tomography (CBCT) unit. Most dental practitioners performed 1 to 10 CBCT scans per month for adult patients and the most frequent reason for its use was implantation planning. Of the practitioners, 81.7% would like to improve their CBCT knowledge and skills.

Conclusions

The number of digital X-ray machines has increased throughout the last decade. Lithuanian dental practitioners do not excessively use cone-beam computed tomography. Some concerns were raised regarding respondents’ knowledge about exposure factors and this diagnostic method’s performance for paediatric patients. Additional training should be provided to Lithuanian dental specialists.

Awareness and practice of 2D and 3D diagnostic imaging among dentists in Hong Kong

Aims To investigate the awareness and practice of 2D and 3D diagnostic imaging, including respective equipment, specifications, number of images acquired, indications for CBCT scans, preference between 2D and 3D imaging, and the confidence in acquiring and interpreting radiographic images among dentists in Hong Kong.Materials and methods A citywide survey was performed with an online questionnaire that was sent via the local dental association to registered dentists in Hong Kong. The anonymous survey focused on: their dental background; number, type and age of their intra-oral, panoramic devices; CBCT indications, field-of-view and consideration of low-dose protocols; and their confidence in taking and interpreting these images.Results From the feedback collected, 65% of dentists used digital intra-oral systems. Around 70% of respondents who perform CBCTs utilised low-dose protocols to reduce radiation dose. Age and years of practising dentistry were significant influencing factors in determining dentists' utilisation of low-dose protocols for CBCT devices. Male dentists and dentists with higher qualifications generally reported being more confident in taking and interpreting CBCT images. Dentists who were older and had more years of practising dentistry were generally more confident in interpreting CBCT images.Conclusion Only half of the dentists feel confident in taking and interpreting CBCT images, and there seems to be a limited knowledge of radiation dose-related risks. Therefore, continuous professional education should specifically focus on the potential of digital imaging and training in CBCT modalities, radiation dose protection and image interpretation.

The use of radiographic imaging technologies by general dentists in Ontario, Canada

OBJECTIVE

The aim of this study was to determine the prevalence of 2-dimensional and 3-dimensional digital imaging technologies, the methods used by general dentists to limit patient exposure to ionizing radiation, and the impact of dentists' education on imaging technologies and patient dose-reducing techniques.

STUDY DESIGN

A cross-sectional, web-based survey of all general dentists in Ontario was conducted.

RESULTS

Responses from 1332 (14.7%) of the 9052 registered general dentists in Ontario were included in the analysis. Approximately 89% reported using digital intraoral technology, 81.1% reported owning panoramic imaging systems, 71.2% reported making referrals for cone beam computed tomography (CBCT), and 9.5% reported including CBCT in their practices. CBCT was most commonly used for dental implant treatment planning (85.8%), followed by endodontics (45.4%), evaluation of pathology (39.6%), and surgical assessment for impacted teeth or difficult extractions (36.8%). Approximately 32.7% used only collimators with a long focal point-receptor distance and 8% used only rectangular collimation; 86.9% reported using a thyroid collar when imaging patients. Differences in educational backgrounds correlated with differences in the use of imaging and dose-reducing techniques.

CONCLUSIONS

There is widespread adoption of digital imaging technologies by general dentists in Ontario, including CBCT. Greater implementation of long and/or rectangular collimation could markedly reduce the ionizing radiation dose to patients. Changes in dental education curricula and continuing education course offerings may address these issues.

Simulation of three intraoral radiographic techniques in pediatric dental patients: subjective comfort assessment using the VAS and Wong-Baker FACES Pain Raiting Scale

BACKGROUND

Perception of pain associated with intraoral radiography in pediatric patients was evaluated through statistical comparisons of data obtained using the Wong-Baker FACES Pain Raiting Scale (WBFPRS) and visual analog scale (VAS) scoring.

METHODS

A total of 75 pediatric patients aged 6-12 years were included in this study. Simulations of each of three radiological methods (analog films, CCD sensor and phosphorus plates) were performed on 25 pediatric patients. Following the simulations, the meaning of each facial expression on the WBFPRS and the numbers on the VAS were explained to each child. For the comparison between groups, the homogeneity of the variances was tested with Levene's test; because the variances were not homogeneous, Welch's test was used. Tamhane's T2 test was used because the homogeneity assumption was not provided to determine the source of the difference between the groups.

RESULTS

When the conventional method was compared to the PSPL (photostimulable phosphor luminescence) method, no significant differences were noted in either the WBFPRS or VAS results (p >0.05). The results obtained from both of the scales were significantly different between the conventional method and the CCD sensor method (p < 0.05). When the PSPL and CCD sensors were compared, a significant difference was observed for the WBFPRS (p < 0.05). It was found the highest level of pain scores when used the CCD sensor method than the analog film and PSPL methods (p < 0.05).

CONCLUSIONS

It is expected that digital radiographic techniques will be improved in the future and that their disadvantages will be eliminated, resulting in imaging devices that are more comfortable for pediatric patients.

Accuracy of computer-assisted image analysis in the diagnosis of maxillofacial radiolucent lesions: A systematic review and meta-analysis

OBJECTIVES

This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing maxillofacial radiolucent lesions.

METHODS

A systematic review was conducted according to the statements of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols and considering 10 databases, including the gray literature. Protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018089945). The population, intervention, comparison and outcome strategy was used to define the eligibility criteria and only diagnostic test studies were included. Their risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal tool. Random-effects model meta-analysis was performed and heterogeneity among the included studies was estimated using the I² statistic. The grade of recommendation, assessment, development, and evaluation (GRADE) tool assessed the quality of evidence and strength of recommendation across included studies.

RESULTS

Out of 715 identified citations, four papers, published between 2009 and 2017, fulfilled the criteria and were included in this systematic review. A total of 191 lesions, classified as periapical granuloma and cyst, dentigerous cyst or keratocystic odontogenic tumor, were analyzed. All selected articles scored low risk of bias. The pooled accuracy estimation, regardless of the classification method used, was 88.75% (95% CI = 85.19-92.30). Heterogeneity test reached moderate values (I² = 57.89%). According to the GRADE tool, the analyzed outcome was classified as having low level of certainty.

CONCLUSIONS

The overall evaluation showed all studies presented high accuracy rates of computer-aided diagnosis systems in classifying radiolucent maxillofacial lesions compared to histopathological biopsy. However, due to the moderate heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of computer-assisted analysis is not possible.

Investigation of radiation-protection knowledge, attitudes, and practices of North Queensland dentists

AIM

Queensland has current radiation-protection guidelines; however, with the absence of data exploring compliance and implementation, the efficacy is unknown. The aim of the present study was to investigate the knowledge and attitudes on radiation protection among private North Queensland (NQ) dentists.

METHODS

A quantitative methodology was employed in an observational and descriptive study using questionnaires for data collection.

RESULTS

Of the 154 questionnaires distributed, 63 were completed and returned. The respondents' knowledge concerning the technical details of their equipment was limited, with 31.5% and 47% not knowing the tube voltage and current utilized for their machines, respectively. In total, 23.8% of dentists had limited knowledge about the speed of the conventional film they used, 90.5% of respondents agreed that the role of imaging in dentistry is important, and 75.8% dentists reported the thyroid as the most important organ to protect during dental radiography. Their knowledge regarding position-distance rule was reasonably adequate; 80.3% of the dental practices appeared to follow the Australian Radiation Protection and Nuclear Safety Agency guidelines, 95.2% preferred taking radiographs if it was only urgent, and 69.8% identified a need for spreading awareness regarding radiation protection.

CONCLUSIONS

An opportunity and need for further continuing education was identified among NQ dentists to ensure safety of patients.

Pathogenesis, Clinical Features, Diagnosis, and Management of Radiation Hazards in Dentistry

Introduction

With the advent of newer radiographic diagnostic procedures of the maxillofacial region, there is a drastic increase in the use of Ionizing radiation which further leads to increased chance of radiation hazards among the patients and the health care workers. In addition to the diagnostic information extracted, the radiation exposure carries the potential to induce carcinogenesis in the exposed individual. However, the amount of Radiation exposure in dentistry is significantly low but it is still harmful owing to the requirement of repeated radiographic examination during the dental treatment. Therefore, to ensure minimum and inevitable exposure during dental treatment, it is necessary to follow principles of radiation protection and safety.

Recommendations

Several studies in the literature have revealed that the attitude and knowledge of the dental professionals regarding radiation safety is not up to the mark. Henceforth, there is a necessity of implementing certain basic guidelines regarding radiation safety and protection. Further state dental councils must advocate new and interesting methods of education regarding the same and should introduce strict rules and penalties for this spectrum of field.

Conclusion

This present short commentary is to familiarize the dental practitioner regarding the methods to minimize the risk of the radiation hazards. Further this article will also educate the dental practitioners regarding the pathogenesis of Radiation effects during Radiation therapy of head and neck region along with pertinent management protocols.

Knowledge, Attitude And Practice Of Radiation Exposure Protection For Pediatric Patients Among Undergraduate Dental Students

Radiography in dentistry is commonly used in modern dental health care. It acts as a diagnostic tool in identifying the physical condition of the patients. However the use of dental radiography should be carefully managed since it can cause some side effects toward normal cells and tissues especially in growing children. To assess the knowledge, attitude and practice of undergraduate dental students on radiation exposure protection for pedodontic patients. A self-administered questionnaire consists of 13 questions with both ‘yes’,’no’ and multiple choice pattern was prepared to obtain information about knowledge, attitude and practice on radiation exposure protection for pedodontic patients.A total of 100 dental students were chosen as the participants. The questionnaires were assessed by manual survey. The use of dental radiograph has bee significantly enhanced over the years for better diagnosis and treatment planning .Tough the application of has been increased, there is an increased risk for unwanted exposure for both patient and operator also. In this current study, conducted among third year and final year dental students, we observed that the students are able to take proper radiograph with unnecessary retakes with years of study and practice. To conclude, it can be noted that the final year dental students were much more knowledgeable in using radiograph judicially compared to the other group of participants which belong to third year dental students. However, in terms of practise both third year and final year dental students irrespective of year of study do not follow radiation protection measures even though they were aware of it.

Digital dental radiology in Belgium: a nationwide survey

OBJECTIVES

The aim of this study is to analyse the use of digital dental radiology in Belgium, by focussing on the use of extraoral and intraoral radiographic techniques, digitalisation and image communication.

METHODS

A nationwide survey has been performed amongst Belgian general dentists and dental specialists. Questionnaires were distributed digitally via mailings lists and manually on multiple refresher courses and congresses throughout the country. The overall response rate was 30%.

RESULTS

Overall, 94% of the respondents had access to an intraoral radiographic unit, 76% had access to a panoramic unit, 21% has an attached cephalometric arm. One in five Belgian dentists also seem to have direct access to a cone beam CT. 90% of all intraoral radiography unit worked with digital detectors, while this was 91% for panoramic units (with or without cephalometrics). In 70% of the cases, general dental practitioners with a digital intraoral unit used a storage phosphor plate while in 30% of the cases they used sensor technology (charge-coupled device or complementary metal-oxide-semiconductor). The most common method for professional image transfer appeared to be email. Finally, 16% of all respondents used a calibrated monitor for image analysis.

CONCLUSIONS

The survey indicates that 90% of the respondents, Belgian dentists, make use of digital image techniques. For sharing images, general dental practitioners mainly use methods such as printout and e-mail. The usage of calibrated monitors, however, is not well established yet.

Dentists' use of digital radiographic techniques: Part I - intraoral X-ray: a questionnaire study of Swedish dentists

OBJECTIVE

The present study aims to gain knowledge about the dentist's use and choice of digital intraoral imaging methods.

MATERIALS AND METHODS

A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the type of X-ray technique used, problems experienced with digital radiography, and reasons for choosing digital technology, and about indications, clinic size and type of service. Response rate was 53%.

RESULTS

Ninety-eight percent of the dentists had made the transition to digital radiography; only 2% used film technique, and solid-state detector (SSD) was the most used digital technique. More years in service decreases the likelihood of applying individual indications for performing a full mouth examination. More retakes were done with SSDs compared to storage phosphor plates. Reasons for choosing digital techniques were that work was easier and communication with the patients improved. However, dentists also experienced problems with digital techniques, such as exposure and projection errors and inadequate image quality. The Swedish Radiation Safety Authority states that all radiological examinations should be justified, something not always followed.

CONCLUSIONS

This study showed that 98% of the respondents, Swedish dentists within the Swedish Dental Society, used digital techniques, and the most used was the solid-state technique.

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.

Attitude and awareness of general dental practitioners toward radiation hazards and safety

AIM AND OBJECTIVE

The aim and objective is to evaluate the level of awareness and attitude about radiation hazards and safety practices among general dental practitioners in Trivandrum District, Kerala, India.

MATERIALS AND METHODS

A questionnaire-based cross-sectional study was conducted among 300 general dental practitioners in Trivandrum District, Kerala, India. Postanswering the questions, a handout regarding radiation safety and related preventive measures was distributed to encourage radiation understanding and protection.

STATISTICAL ANALYSIS

Statistical analysis were done by assessing the results using Chi-square statistical test, t-test, and other software (Microsoft excel + SPSS 20.0 trail version).

RESULTS

Among 300 general practitioners (247 females and 53 males), 80.3% of the practitioners were found to have a separate section for radiographic examination in their clinics. Intraoral radiographic machines were found to be the most commonly (63.3%) used radiographic equipment while osteoprotegerin was the least (2%). Regarding the practitioner's safety measures, only 11.7% of them were following all the necessary steps while 6.7% clinicians were not using any safety measure in their clinic, and with respect to patient safety, only 9.7% of practitioners were following the protocol.

CONCLUSION

The level of awareness of practitioners regarding radiation hazards and safety was found to be acceptable. However, implementation of their knowledge with respect to patient and personnel safety was found wanting. Insisting that they follow the protocols and take necessary safety measures by means of continuing medical education programs, pamphlets, articles, and workshops is strongly recommended.

Occupational radiation procedures and doses in South Korean dentists

OBJECTIVES

Dentistry is among the occupations involving chronic exposure to ionizing radiation. Although several cohort studies on medical radiation workers have been conducted in some countries, only a few epidemiological studies on dentists have been performed to examine occupational radiation exposure worldwide. The aim of this study was to investigate occupational characteristics and radiation exposures in South Korean dentists.

METHODS

A total of 658 dentists were surveyed from April 2012 to May 2013, and survey data were linked with dosimetry data from the National Dose Registry. Multiple linear regression analysis was used to identify the relationship between demographic or occupational factors and individual radiation doses.

RESULTS

Of the dentists sampled, 78% were men, 51% were younger than age 40, and 61% began employment after 2000. The most frequent procedures performed by dentists were panoramic radiography, followed by intraoral and portable dental radiography. Male dentists were more frequently involved in radiation procedures, and a higher proportion of male than female dentists wore a lead apron for diagnostic radiology. The average annual effective dose was 0.18 mSv for male and 0.13 mSv for female dentists. Female dentists working in provincial areas had significantly higher average annual and cumulative effective doses than those in metropolitan areas. The cumulative effective doses were significantly greater for older dentists, those who entered the field in the 1990s, and those with longer employment duration.

CONCLUSIONS

Our findings provided detailed information on work practices, number of procedures performed on a weekly basis, and occupational radiation doses, which enabled in-depth evaluation of occupational radiation exposure and work status among dentists.

Oral Radiology Safety Standards Adopted by the General Dentists Practicing in National Capital Region (NCR)

INTRODUCTION

With advancement in diagnostic techniques, the utilization of radiologic examination has risen to many folds in the last two decades. Ionizing radiations from the radiographic examination carry the potential for harm by inducing carcino-genesis in addition to the diagnostic information extracted. Radiation doses utilized in the course of dental treatment might be low for individual examinations but patients are exposed to repeated examinations very often and many people are exposed during the course of dental care. Therefore, principles of radiation protection and safety are necessary for the dentists to follow to ensure minimum and inevitable exposure.

AIM

The aim of this study was to investigate the knowledge and behaviour of general dentists practicing in the National Capital Region (NCR) regarding radiation safety during oral radiographic procedures.

MATERIALS AND METHODS

The study was a questionnaire based cross-sectional study. A total of 500 general dentists were contacted to participate in the study. The target population entailed of general dentists practicing in the National Capital Region. Data was computed and tabulated in Microsoft excel sheet and statistical analysis was performed with the help of SPSS version 21.0.

RESULTS

The total response rate recovered was 70.6% and the respondents comprised of 59% and 41% males & females respectively. Only 64.8% of the general dentists contemplated thyroid to be the most important organ for radiation protection. Only 28.8% of the general dentists followed the position & distance rule appropriately.

CONCLUSION

The results showed that the knowledge and behaviour of the general dentists and the practices adopted by them regarding radiation safety is not satisfactory. To ensure the following of basic and necessary guidelines for radiation safety and protection, strict rules with penalties should be implemented by the state councils and new and interesting methods of education for this spectrum of the field should be introduced.

Intensive care nurses' knowledge of radiation safety and their behaviors towards portable radiological examinations

Background:

Radiological examinations for patients who are hospitalized at intensive care units are usually performed using portable radiography devices. However they may require knowledge and safety precautions of nurses.

Objectives:

The aim of the study was to investigate ICU nurses’ knowledge of radiation safety and their behaviors towards portable radiological examinations.

Materials and Methods:

In total, 44 intensive care nurses were recruited for this cross-sectional descriptive study using census sampling during April and May 2014. The study setting was at intensive care units of Shahid Beheshti Hospital of Kashan, Iran. An eleven-item questionnaire and a five-item checklist were used for evaluating nurses’ radiation protection knowledge and behaviors, respectively. An expert panel consisting of ten nursing and radiology faculty members confirmed the content validity of the questionnaire and the checklist. Moreover, a Geiger-Müller counter was used for measuring ionizing radiation during portable radiological examinations. Study data were analyzed using the SPSS software version 13.0. Mean, standard deviation, frequency and one-sample t test were used for description of the data. The level of significance was set at below 0.05.

Results:

The mean of participants’ radiation protection knowledge was 4.77 ± 1.38. The most prevalent radiation protection behavior of nurses was leaving the intensive care unit during portable radiological examinations. Only 6.8% of nurses stayed at the nursing station during radiological examinations. The highest dose of radiation was 0.11 micro Sievert per hour (μSv/h), which was much lower than the highest permitted level of radiation exposure i.e. 0.25 μSv/h.

Conclusions:

Portable radiological examinations did not expose healthcare providers to high doses of ionizing radiation. Nurses’ radiation protection knowledge was limited and hence, they require in-service education programs.

Insights into the state of radiation protection among a subpopulation of Indian dental practitioners

PURPOSE

Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed.

MATERIALS AND METHODS

All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondent's age, gender, education, and type and duration of practice was collected.

RESULTS

Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54±2.54, 59.39±7.01, and 5.80±3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice.

CONCLUSION

Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines.

Attitude of the Korean dentists towards radiation safety and selection criteria

Purpose

X-ray exposure should be clinically justified and each exposure should be expected to give patients benefits. Since dental radiographic examination is one of the most frequent radiological procedures, radiation hazard becomes an important public health concern. The purpose of this study was to investigate the attitude of Korean dentists about radiation safety and use of criteria for selecting the frequency and type of radiographic examinations.

Materials and Methods

The study included 267 Korean dentists. Five questions related to radiation safety were asked of each of them. These questions were about factors associated with radiation protection of patients and operators including the use of radiographic selection criteria for intraoral radiographic procedures.

Results

The frequency of prescription of routine radiographic examination (an example is a panoramic radiograph for screening process for occult disease) was 34.1%, while that of selective radiography was 64.0%. Dentists' discussion of radiation risk and benefit with patients was infrequent. More than half of the operators held the image receptor by themselves during intraoral radiographic examinations. Lead apron/thyroid collars for patient protection were used by fewer than 22% of dental offices. Rectangular collimation was utilized by fewer than 15% of dental offices.

Conclusion

The majority of Korean dentists in the study did not practice radiation protection procedures which would be required to minimize exposure to unnecessary radiation for patients and dental professionals. Mandatory continuing professional education in radiation safety and development of Korean radiographic selection criteria is recommended.

Questionnaire surveys of dentists on radiology

OBJECTIVES

Survey by questionnaire is a widely used research method in dental radiology. A major concern in reviews of questionnaires is non-response. The objectives of this study were to review questionnaire studies in dental radiology with regard to potential survey errors and to develop recommendations to assist future researchers.

METHODS

A literature search with the software search package PubMed was used to obtain internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. A search of the English language peer-reviewed literature was conducted of all published studies, with no restriction on date. The search strategy found articles with dates from 1983 to 2010. The medical subject heading terms used were "questionnaire", "dental radiology" and "dental radiography". The reference sections of articles retrieved by this method were hand-searched in order to identify further relevant papers. Reviews, commentaries and relevant studies from the wider literature were also included.

RESULTS

53 questionnaire studies were identified in the dental literature that concerned dental radiography and included a report of response rate. These were all published between 1983 and 2010. In total, 87 articles are referred to in this review, including the 53 dental radiology studies. Other cited articles include reviews, commentaries and examples of studies outside dental radiology where they are germane to the arguments presented.

CONCLUSIONS

Non-response is only one of four broad areas of error to which questionnaire surveys are subject. This review considers coverage, sampling and measurement, as well as non-response. Recommendations are made to assist future research that uses questionnaire surveys.

Compliance of Iranian dentists with safety standards of oral radiology

OBJECTIVES

Dentists use radiographs in their daily practice. Their knowledge and behaviour towards radiographic examination can affect patients' exposure to radiation. The aim of this study was to survey the knowledge and behaviour of Iranian dentists regarding oral radiology safety standards.

METHODS

1000 questionnaires were given to the participants of the 48th Annual Congress of the Iranian Dental Association, of which 700 were returned. The participants were asked about demographic data, primary knowledge of radiation protection, selection criteria, radiographic equipment and technique, methods of patient and personnel protection and management of radiographic waste. Descriptive analysis of data was performed.

RESULTS

44% of respondents said the initial radiograph they took was of the periapical view of a limited area. 12% preferred the periapical paralleling technique. F-speed film was used by 9% and E-speed film by 62%. Only 2% had digital receptors. Proper exposure time was selected by 26.5%. The use of long and rectangular collimators was 15% and 6%, respectively. 34% occasionally covered their patients with both thyroid shields and lead aprons. 36% used the position and distance rule correctly for their own protection. Proper disposal of the used processing solutions and the lead foils were done by only 1% and 3%, respectively.

CONCLUSIONS

It can be concluded that the majority of dentists in the study group did not select the proper method, material and equipment in order to minimize the exposure of their patient to unnecessary radiation in dental radiography.

Dental students' knowledge and attitudes towards cone beam computed tomography in Turkey

OBJECTIVE

The aim of this study was to evaluate students' knowledge and attitudes regarding cone beam CT (CBCT).

METHODS

A questionnaire consisting of 11 questions was given to 472 dental students (280 pre-graduate and 192 post-graduate) at two institutions located in Ankara, Turkey (Ankara University, Faculty of Dentistry, and Gazi University, Faculty of Dentistry). Differences in responses by institution, education level and sex were statistically assessed with the χ(2) test.

RESULTS

Statistical results showed that only 63.3% of students had heard of CBCT. Of these, 59.9% said they had learned about CBCT in their classes, 31.0% in seminars and 20.9% from the internet; 76.8% felt that CBCT was not given adequate coverage in their courses; 69% thought that CBCT should be taught as part of their clinical education; 91% thought it essential for CBCT to be available at dental faculties; 53.5% believed that the use of CBCT would become more widespread in the near future; and 84.9% wished to use CBCT technology in their future careers.

CONCLUSION

This research suggests that efforts should be made to improve students' knowledge base regarding CBCT and that the dental school curriculum should devote more curriculum time to this promising new technology.

The usage of digital radiography and cone beam computed tomography among Turkish dentists

OBJECTIVES

The aim of this study was to determine the prevalence of the use of digital radiography and report how it was used by Turkish dentists.

METHODS

The survey was based on 383 dentists who were present at the sixteenth International Congress organized by the Turkish Dental Association. A questionnaire which consisted of 19 questions was given to the dentists who participated in the study. Data were assessed according to frequency distribution and the χ(2) test was used to determine the significance of differences between two independent groups.

RESULTS

376 questionnaires were analysed. The mean age of the dentists who participated in the study was 37.14 ± 9.6 years (range: 20-63 years). The distribution of the dentists according to the 7 regions of Turkey were: Marmara 58%, Aegean 13% and Mediterranean 10%, Central Anatolia 8%, Black Sea 7%, Southeastern Anatolia 3%, Eastern Anatolia 1%. 124 dentists (33%) said they did not work with digital radiography. 95 dentists indicated that they did not use digital radiography owing to cost (60%). 252 dentists (67%) said they used digital radiography. 40% of the participants noted that the repetition of periapical radiographs was due to digital radiography. 166 dentists (55.9%) and 79.1% academicians had knowledge about cone beam CT (CBCT).

CONCLUSION

Digital radiography users are increasing in Turkey and levels of knowledge of CBCT and awareness of radiation safety has also increased.

Flemish general dental practitioners' knowledge of dental radiology

The aim of this study was to assess general dental practitioners' knowledge of dental radiography and radiation protection in order to alert the Belgian authorities and dental professional societies. Prior to attending a postgraduate course on intraoral radiology, general dental practitioners in Flanders, Belgium, were asked to fill in a questionnaire regarding the radiological equipment and the techniques they used for intraoral radiography. The availability and type of dental panoramic equipment were also assessed. A total of 374 questionnaires were available for this study. 15% of the attendants used radiographic equipment that was more than 27 years old and 43% reported equipment that operated with a clockwork timer. 32% and 75% respectively had no idea what the kV or mA settings were on their intraoral equipment. 5% were unaware which cone geometry or geometric technique (paralleling or bisecting angle technique) they were using. 81% claimed to be using a short cone technique. 47% did not know what collimation meant, whereas 40% stated that they were using circular collimation. 38% used digital intraoral image detectors (63% were photostimulable storage phosphorplate (PSPP)), but 16% were not sure about the type of sensor they were using (PSPP or solid-state sensors). 61% also had dental panoramic equipment available, 25% of which was digital (10% charge coupled device (CCD) and 15% PSPP). These results clearly indicate the need for continued education on this subject. The latter is an important signal to Belgian authorities and dental professional societies.

[Radioprotection in dentistry offices]

In 1998, the Brazilian Ministry of Health established the Guidelines for Protection in Medical and Odontological Radiography, aimed at ensuring the quality of radiological procedures provided to the population as well as radiological protection for the health professionals. The purpose of this study was to verify the current situation in the dental offices with regard to the technical specifications and the adopted protective measures, using a questionnaire including questions about equipments, techniques and radiological protection. The investigated universe consisted of the surgeon dentists of the city of Aracaju using radiographic examination as a routine, resulting in a final sample of 103 professionals. The results showed that a high percentage of these professionals ignore the current norms (64.1%) as well as the technical specifications of their equipment (51.5% ignored the peak kilovoltage and 57.3% the milliamperage of their equipment), besides examining the radiographs visually (67%) As positive behaviors, the paralleling technique was preferred by 62.1% and the lead apron was used by 98.1%. We conclude that, despite the limited knowledge about the Guidelines, some measures are being correctly adopted but that the dentists have to be more aware of the necessary protective measures.

Detection of artificial occlusal caries in a phosphor imaging plate system with two types of LCD monitors versus three different films

The aim of this study was to determine diagnostic performance of a storage phosphor plate system Digora Optime (Soredex, Helsinki, Finland) with two types of LCD monitor in the detection of artificial caries when compared to Ultraspeed (D), Ektaspeed Plus (E), and Insight (F) radiographic films. Seventy extracted human molars-with artificial caries-were radiographed under identical standardized conditions using (1) a storage phosphor plate system Digora (Soredex, Helsinki, Finland), (2) Insight, (3) Ektaspeed Plus, and (4) Ultraspeed (Carestream Health Inc, Rochester, NY). All digital images and radiographs were examined by three observers for the presence or absence of artificial caries using a five-point confidence scale. Digital images were evaluated both on a LCD computer monitor (Philips 170S, Holland) and medical monitor-3 megapixel monochrome display (Me355i2, Totoku, Tokyo)-with brightness and contrast enhancement. Observer responses were evaluated using ROC analysis and other measurements for diagnostic accuracy. Storage phosphor images with medical monitor demonstrated higher mean A (z) values (0.70 +/- 0.08) than digital images with computer monitor and conventional films. Storage phosphor images with medical monitor presented the highest score, 0.97, 0.90, 0.94, for each observer, respectively. Also, true positive observations (0.82) and positive likelihood ratios (2.71) were higher in enhanced storage phosphor images with medical monitor. Caries detection of mechanically created lesions by experienced radiologists is roughly comparable when examining D-speed film images and Digora images on both the computer and medical LCD monitors, and appears to be poorer on E- and F-speed film images.

European survey of dental X-ray equipment

The implementation of an X-ray Quality Assurance (QA) program is a legal requirement in Europe as stipulated in the EU Council Directive 97/43/EURATOM (MED). A review of the literature has identified that European countries are performing some level of QA testing of their dental X-ray equipment, although the type and level to which testing is performed can differ. The European SENTINEL co-ordination action proposed to collate a survey of equipment data for both conventional and digital dental X-ray installations among the SENTINEL partners. The European QA results confirm that systems can be operated below tolerance, and in some cases significantly so, while still in clinical use. This can occur despite servicing of equipment. The results have emphasised the fact that there is a requirement for the medical physics/engineering professions to become more closely involved in the management of dental radiology equipment. This also includes their involvement in the development and delivery of appropriate training courses for dentists and suppliers of dental radiology equipment.

A training syllabus for radiation protection in dental radiology

The EU Council Directive 97/43/EURATOM (MED) states that Member States shall ensure that adequate theoretical and practical training is provided for dental practitioners working with ionising radiation; this also includes the provision of continuing education and training programmes, post-qualification. The area of dental radiology is specifically mentioned in this legally binding document. The Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, is particularly interested in the area of radiation protection training and routinely provides educational courses both at national and international levels. A recent review of their dental radiation protection course was undertaken in conjunction with a number of Principal Dental Surgeons within the Health Service Executive in Ireland. The revised course was delivered to over 200 dental staff members at two separate meetings during 2006. The response from attendees was very positive. It is proposed to extend this course to other dental professionals, working both in the Irish private and public health sectors in the future.

Spanish dental hygienist attitudes to dental radiological protection: assessment of a 1-day pilot course

OBJECTIVES

To determine hygienists' knowledge of and attitudes to X-ray equipment and film processing, and to assess both after a 1-day course.

STUDY POPULATION

One-hundred and four dental hygienists from the south-east of Spain attending a 1-day course in oral radiology.

METHODOLOGY

A questionnaire comprising different sections related with socio-demographic items, X-ray equipment and the processing of dental films was answered before and after a 1-day pilot course on radiation protection.

RESULTS

The response rate was 89.42% (n = 93). Of the participants 94.6% were women, with a mean age of 29.52 (SD 6.861) and 7.20 years of professional experience (SD 5.089). The level of knowledge before the course was 48.28%, which increased to 85.62% after the course (P < 0.001).

CONCLUSIONS

The prescribed standard was reached by <23.65% of those attending the course at the beginning. Although attending the course led to a considerable improvement, it did not always result in a high level of knowledge of basic radiation equipment and processing.