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Benavides E, Bhula A, Gohel A, Lurie AG, Mallya SM, Ramesh A, Tyndall DA. Patient shielding during dentomaxillofacial radiography: Recommendations from the American Academy of Oral and Maxillofacial Radiology. J Am Dent Assoc 2023; 154:826-835.e2. [PMID: 37530694 DOI: 10.1016/j.adaj.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The American Academy of Oral and Maxillofacial Radiology established an ad hoc committee to draft evidence-based recommendations and clinical guidance for the application of patient contact shielding during dentomaxillofacial imaging. TYPES OF STUDIES REVIEWED The committee reviewed monographs and reports from radiation protection organizations and studies that reported radiation dose to gonads, breasts, and thyroid gland from dentomaxillofacial imaging. RESULTS Considering the absence of radiation-induced heritable effects in humans and the negligible dose to the gonads and fetus from dentomaxillofacial imaging, the committee recommends discontinuing shielding of the gonads, pelvic structures, and fetuses during all dentomaxillofacial radiographic imaging procedures. On the basis of radiation doses from contemporaneous maxillofacial imaging, the committee considered that the risks from thyroid cancer are negligible and recommends that thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging. PRACTICAL IMPLICATIONS This position statement informs and educates the reader on evolving radiation protection practices and provides simple, unequivocal guidance to dental personnel to implement these guidelines. State and local authorities should be contacted to update regulations to reflect these recommendations.
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Khafaji M, Albadawi GH. Assessment of Scattered Dose to the Eye in Dentistry: A Systematic Review. Cureus 2023; 15:e43113. [PMID: 37560052 PMCID: PMC10407597 DOI: 10.7759/cureus.43113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/11/2023] Open
Abstract
Cone-beam computed tomography (CBCT) is a tool for dental imaging of impactions, maxillofacial discrepancies, facial trauma, and tumors. In addition, It is used in treatment planning for dental implants, orthognathic surgery, and general maxillofacial surgery. There are no standardized methods for utilizing CBCT dosimetry, and there is no consensus among dental and medical physics health professionals regarding dental CBCT imaging procedures. The eyes and thyroid glands are radiosensitive organs that lie outside the primary beam but receive a significant amount of radiation due to scattered radiation. This study aimed to assess the dose to eye lens in patients imaged using CBCT. This review aims to evaluate the scattered doses to the eye from CBCT among adult patients seeking dental treatment. The search included published articles in the Web of Science, PubMed (MeSH and Web PubMed), Medline, and Google Scholar databases using the appropriate keywords from January 2010 to July 2022. The inclusion criteria were based on the method of dose measurement (phantom studies using Optically stimulated luminescence (OSL) and Thermoluminescent dosimeter (TLD), language, and type of protocol used. A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flow chart. Out of 653 articles identified, 5 met the inclusion criteria. The results show that the scattered radiation dose ranged between 0.103 mSv and 8.3 mSv. This variation exists due to the difference in the field of vision (FOV), phantom exposure, dosimeters used, degree of rotation in the protocol, and finally, the scanner used. The scattered dose to the eye from CBCT is higher than the background radiation, with huge variability in the range of the dose measured. Clear guidelines for utilizing CBCT should be implemented, and dose reference levels should be established for benchmarking and optimization in practice.
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Affiliation(s)
- Mawya Khafaji
- Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Kweon DC. Radiation exposure in cone beam CT measured using a MOSFET and RPLGD dosimeter and Monte Carlo simulation in phantom. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023:XST230026. [PMID: 37248944 DOI: 10.3233/xst-230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Due to the wide application of the cone beam computed tomography (CBCT) in clinical practice, it is important to assess radiation dose of CBCT more accurately and efficiently in different clinical applications. OBJECTIVE This study aims to calculate effective and absorbed doses in CBCT measured in an anthropomorphic phantom using computer-based Monte Carlo (PCXMC) software, and to conduct comparative evaluations of MOSFET (metal- oxide- semiconductor field-effect transistor) and radiophotoluminescence glass dosimeters (RPLGD). METHODS Effective and absorbed organ doses are compared with those obtained using MOSFET and RPLGD dosimetry in an anthropomorphic phantom given the same exposure settings. Effective and absorbed organ doses from CBCT during scout and main projections are calculated using PCXMC and PCXMCRotation software, respectively. RESULTS The mean effective dose from CBCT calculated using PCXMC software is 233.8μSv, while the doses calculated using dosimetry (MOSFET and RPLGD) are 266.67μSv and 268.78μSv, respectively. The X-ray source variation is 0.79%. The prescription limits based on the Friedman test for MOSFET and RPLGD pre-points (i.e., in an analytical analysis of diagnostic names in CBCT) are not statistically significant. The calculated correlation coefficient between MOSFET- and RPLGD-derived absorbed dose values with respect to a field of view CBCT parameter of 17×13.5 mm is r = 0.8623. CONCLUSIONS The study demonstrates that the PCXMC software may be used as an alternative to MOSFET and RPLGD dosimetry for effective and absorbed organ dose estimation in CBCT conducted with a large FOV in an anthropomorphic phantom.
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Affiliation(s)
- Dae Cheol Kweon
- Department of Radiological Science, Shinhan University, Uijeongbu, Republic of Korea
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Chauhan D, Ahmad HS, Singh S, Albayar A, Patel A, Welch WC, Yoon JW. A Prospective Cohort Study of Radiation Exposure to a Spine Surgeon's Exposed Body Parts During Utilization of Intraoperative Radiation-based Imaging. Clin Spine Surg 2023; 36:90-95. [PMID: 36959180 DOI: 10.1097/bsd.0000000000001450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/25/2023] [Indexed: 03/25/2023]
Abstract
STUDY DESIGN Prospective cohort study. SUMMARY OF BACKGROUND DATA C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. Although a surgeon's chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. OBJECTIVE In this study, we compare differences in intraoperative radiation exposure across the protected and unprotected regions of a surgeon's body. METHODS Sixty-five consecutive spine surgeries were performed by a single spine-focused neurosurgeon over 9 months. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated. RESULTS During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (P = 0.0020), demonstrating a shielding protective effect. The surgeon's dominant hand was exposed to 329 mrem whereas the eyes were exposed to 152.5 mrem of radiation. Compared with the surgeon's protected abdominal area, the hands (P = 0.0002) and eyes (P = 0.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career. CONCLUSIONS Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared with protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiologic Protection for the extremities (50,000 mrem/y) and the eyes (15,000 mrem/y), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one's career.
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Affiliation(s)
- Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Hamzian N, Asadian S, Zarghani H. A Study of Radiation Protection Standards Compliance in Hospital Radiographic Departments in Iran. J Biomed Phys Eng 2022; 12:513-520. [PMID: 36313405 PMCID: PMC9589086 DOI: 10.31661/jbpe.v0i0.2108-1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
Background The X-ray is a critical diagnostic and therapeutic tool with harmful effects. The International Commission on Radiological Protection (ICRP) has some recommendations regarding applying radiation protection principles. Objective This study aimed to determine the standards of the typical radiation protection in radiographic departments of hospitals in Iran. Material and Methods In this cross-sectional descriptive study, the usual radiation protection standards in places, such as the physical environment of the control and waiting rooms, radiographic devices, the physical space of the darkroom, and shielding facilities, were investigated using a checklist in Iran. A total of 84 hospitals in 51 cities throughout Iran were randomly selected, and the checklists were distributed to the radiation protection officers. In hospitals with multiple radiography rooms, the radiation protection officers were asked to complete the checklist about the room with the highest workload as a baseline to evaluate their facilities. Finally, the authors reviewed all checklists. Results In radiology departments in control and waiting rooms, the mean of radiation protection was 71.9%. Pregnancy and radiation warning signs and labels were present in 96.1% of the parameters, while gonad shielding protocols were not presented. Conclusion The principles of observed radiation protection were unsatisfactory, and it is recommended that surveillance be conducted at frequent intervals.
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Affiliation(s)
- Nima Hamzian
- PhD, Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeed Asadian
- BSc, Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Hassan Zarghani
- PhD, Cardiovascular Diseases Research Center, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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Vogiatzi T, Menz R, Verna C, Bornstein MM, Dagassan-Berndt D. Effect of field of view (FOV) positioning and shielding on radiation dose in paediatric CBCT. Dentomaxillofac Radiol 2022; 51:20210316. [PMID: 35762346 PMCID: PMC10043625 DOI: 10.1259/dmfr.20210316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of two different large field of view (FOV) positions in the vertical dimension and shielding (thyroid collar and eyeglasses) on the effective dose and the local doses of various sites of the craniofacial complex. METHODS Organ doses and effective doses were calculated based on the measured doses using 27 pairs of thermoluminescent dosemeters in a paediatric tissue-equivalent of a 10-year-old anthropomorphic phantom. The large FOV of the 3D Accuitomo F170 CBCT scanner was used to image parts of the craniofacial complex. Six protocols were performed: (A) cranial position without shielding; (B) cranial position with shielding; (C) caudal position without shielding; (D) caudal position with shielding, (E) similar to C with 3600 rotation and (F) similar to D with 360° rotation. Measurements were obtained in duplicate, and the relative δ value (%) was applied to compare the average doses between the protocols. RESULTS Changing the FOV position from cranial to caudal without using shielding resulted in an increase of the effective dose of 18.8%. Use of shielding in the caudal position reduced the dose by 31.6%. Local absorbed dose of the thyroid had the most relevant impact on calculation of the effective dose, followed by oesophagus, bone marrow and bone surfaces, especially when comparing the different protocols. CONCLUSIONS Application of shielding devices for thyroid in combination with a most caudal positioning of FOV led to the lowest local absorbed doses as well as the effective dose in a child phantom model.
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Affiliation(s)
- Theodosia Vogiatzi
- Department of Oral Health and Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Roman Menz
- Division of Radiological Physics, Department of Radiology, University of Basel, Basel, Switzerland
| | - Carlalberta Verna
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Michael M. Bornstein
- Department of Oral Health and Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography with small and medium fields of view. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:245-253. [PMID: 35534405 DOI: 10.1016/j.oooo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography (CBCT) with small and medium fields of view (FOVs). STUDY DESIGN Six CBCT protocols were investigated by exposing an adult anthropomorphic male phantom head without and with thyroid shielding, using 4 small (4 × 5 cm) and 2 medium (10 × 6 cm) FOVs. Twenty metal oxide semiconductor field-effect transistor dosimeters were placed in the phantom head to measure absorbed doses and calculate equivalent doses at 11 sites. Effective doses were calculated based on the tissue weighting factors in International Commission on Radiological Protection Publication 103. The data were analyzed using the independent samples t test. RESULTS Thyroid gland shielding led to significant equivalent dose reductions in many tissues for all protocols. Equivalent dose reductions to the thyroid were significant in all 6 protocols (P ≤ .037). Significant reduction depended on the FOV and ranged between 24.5% and 42.6% for the thyroid gland and 4.9% and 34.5% for other tissues and organs. Effective doses were significantly lower in all protocols (P ≤ .016). CONCLUSIONS Thyroid gland shielding protects the thyroid gland and other organs and should be utilized with all CBCT examinations where feasible.
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Organ dose and radiogenic risk in dental cone-beam computed tomography examinations. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Geist JR. This far but no farther: elimination of protective radiation shielding for dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:347-349. [DOI: 10.1016/j.oooo.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/30/2023]
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Ting S, Attaia D, Johnson KB, Kossa SS, Friedland B, Allareddy V, Masoud MI. Can modifying shielding, field of view, and exposure settings make the effective dose of a cone-beam computed tomography comparable to traditional radiographs used for orthodontic diagnosis? Angle Orthod 2020; 90:655-664. [PMID: 33378479 DOI: 10.2319/072819-496.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyze the effect of changes in exposure settings, field of view (FOV), and shielding on radiation to an adult and child phantom from cone-beam computed tomography (CBCT) imaging compared to panoramic and lateral cephalometric radiographs. MATERIALS AND METHODS The effective dose to an adult and child anthropomorphic phantom by the CS 9300 using various scan protocols was recorded. Absorbed radiation was measured with optically stimulated luminescence dosimeters and effective dose calculated using 2007 International Commission on Radiological Protection tissue weighting factors. Scan protocols included different FOVs, voxel sizes, and standard versus low-dose protocols. Radiation shielding was used when it did not interfere with FOV. Panoramic and lateral cephalometric radiographs were taken with the Orthophos SL. RESULTS Even with shielding, smaller FOVs, and increased voxel sizes, the effective dose of standard CBCT scans was higher than panoramic and lateral cephalometric radiographs. A shielded limited FOV standard scan combined with a lateral cephalometric radiograph resulted in a lower dose (P < .001) than a full FOV standard scan. Low-dose shielded scans resulted in significant dose reductions to the adult (P < .05) and child (P < .001) phantoms compared to the respective panoramic and lateral cephalometric radiographs combined. Image quality analysis was not possible with radiation equivalent phantoms. CONCLUSIONS Unlike standard CBCTs, shielded low-dose CBCT protocols in the CS 9300 have lower effective doses than conventional radiographs for adult and child phantoms. If high resolution and cranial base visualization are necessary, combining a shielded LFOV standard exposure with a cephalometric radiograph is recommended.
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Attaia D, Ting S, Johnson B, Masoud MI, Friedland B, Abu El Fotouh M, Abu el Sadat S. Dose reduction in head and neck organs through shielding and application of different scanning parameters in cone beam computed tomography: an effective dose study using an adult male anthropomorphic phantom. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:101-109. [DOI: 10.1016/j.oooo.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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Mutalik S, Tadinada A, Molina MR, Sinisterra A, Lurie A. Effective doses of dental cone beam computed tomography: effect of 360-degree versus 180-degree rotation angles. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:433-446. [PMID: 32616450 DOI: 10.1016/j.oooo.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aims of this study were to compare radiation absorbed dose (AD) and effective dose (ED) to tissues from cone beam computed tomography (CBCT) scans with 360-degree versus 180-degree rotations with use of different fields of view (FOV), to compare EDs calculated from measured ADs versus dose area product (DAP) values, and to compare doses to the lens of the eye (LOE) from different scan parameters. STUDY DESIGN ADs for each protocol were measured in tissues, including the LOE, by using an anthropometric phantom. EDs were calculated on the basis of dosimetry (EDm) and DAP values (EDd). Dose differences were determined with analysis of variance (ANOVA). RESULTS ADs and EDs were substantially lower for 180-degree rotation scans compared with 360-degree rotation scans (P < .01). Remainder tissues had the greatest effect on effective dose for most FOVs. Doses were generally lower with small FOVs compared with large FOVs. Most EDm values were lower than EDd values in large FOVs but higher in small FOVs. Differences in EDm and EDd were variable and unpredictable. LOE doses were smaller with the 180-degree scans and smaller FOVs. CONCLUSIONS Radiation doses were generally lower with 180-degree rotation scans and smaller FOVs. These parameters should be used for CBCT acquisitions, whenever possible, and should be made available in all units.
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Affiliation(s)
- Sunil Mutalik
- Sessional Faculty, University of Manitoba, Gerald Niznick College of Dentistry, Winnipeg, MB, Canada
| | - Aditya Tadinada
- Section of Oral & Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Marco R Molina
- Department of Diagnostic Imaging, University of Connecticut School of Medicine, Farmigton, Connecticut, USA
| | - Andrés Sinisterra
- Section of Oral and Maxillofacial Radiology, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Alan Lurie
- Section of Oral & Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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Soares MR, Santos WS, Neves LP, Perini AP, Batista WO, Maia AF, Belinato W, Caldas LV. The use of personal protection equipment for the absorbed doses of eye lens and thyroid gland in CBCT exams using Monte Carlo. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Castillo JC, Gianneschi G, Azer D, Manosudprasit A, Haghi A, Bansal N, Allareddy V, Masoud MI. The relationship between 3D dentofacial photogrammetry measurements and traditional cephalometric measurements. Angle Orthod 2019; 89:275-283. [PMID: 30779676 DOI: 10.2319/120317-825.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To determine the relationship between traditional cephalometric measurements and corresponding nonradiographic three-dimensional (3D) photogrammetry measurements. MATERIALS AND METHODS This was a cross-sectional study of 20 orthodontic patients (10 male and 10 female) who received lateral cephalometric radiographs and 3D dentofacial photogrammetric records with each subject serving as his or her own control for a total sample size of 40 images (20 per method). A 3D analysis that resembled a traditional cephalometric analysis was established using the eyes and natural head orientation as substitutes for the cranial base. Pearson correlation coefficients and multivariable linear regression plots were calculated to evaluate the relationship between the photogrammetry measurements and the cephalometric measurements. RESULTS The ANB angle, mandibular plane angle, lower anterior face height, upper incisor angle to SN, upper incisor angle to NA, and all measurements of lower incisor position and inclination had strong positive Pearson correlation coefficients with the corresponding 3D photogrammetry measurements ( P < .004). Statistically significant regression plots demonstrated that cephalometric relationships between the jaws and incisor orientation can be predicted from corresponding 3D photogrammetry measurements. CONCLUSIONS 3D photogrammetry measurements relating the jaws to each other and incisor orientation has a strong positive correlation with corresponding traditional cephalometric measurements and can serve as cephalometric predictors. Capturing the eyes using 3D photogrammetry can obviate the need to expose the cranial base and allow limiting the radiographic field to the area of interest.
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Memon A, Rogers I, Paudyal P, Sundin J. Dental X-Rays and the Risk of Thyroid Cancer and Meningioma: A Systematic Review and Meta-Analysis of Current Epidemiological Evidence. Thyroid 2019; 29:1572-1593. [PMID: 31502516 DOI: 10.1089/thy.2019.0105] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Exposure to moderate-to-high doses of ionizing radiation is the only established environmental risk factor for thyroid cancer and brain and central nervous system tumors. Considering the high lifetime prevalence and frequency of exposure to dental X-rays, the most common source of diagnostic radiation exposure in the general population, even a small associated increase in cancer risk would be of considerable public health importance. With the objective to inform clinical practice and guidelines, we synthesized the current epidemiological evidence on the association between dental X-rays and the risk of thyroid cancer, meningioma, and other cancers of the head and neck region. Methods: The Medline, Embase, and Web of Science databases were searched to identify eligible studies. Summary odds ratio/relative risk estimates and confidence intervals were extracted, and pooled risk ratios (RRs) for each cancer were calculated using random effects meta-analysis. Results: The literature search identified 5537 publications; of these, 26 studies including 10,868 cancer patients were included in the synthesis. The random effects meta-analyses, based on seven studies of thyroid cancer (six case/control, one cohort) and eight studies of meningioma (all case/control), showed that multiple (or repeated) exposures to dental X-rays were significantly associated with an increased risk of thyroid cancer (pooled RR = 1.87 [95% confidence interval, CI 1.11-3.15]) and meningioma (pooled RR = 1.53 [CI 1.26-1.85]). There was no association with glioma, and there were too few studies of other cancers of the head and neck region to conduct a meaningful meta-analysis. Conclusions: Based on a meta-analysis of retrospective case/control studies, these findings provide some support to the hypothesis that multiple (or repeated) exposures to dental X-rays may be associated with an increased risk of thyroid cancer and meningioma. These studies did not include individual organ doses and ages at exposure, and are subject to recall bias and other limitations. Furthermore, the thyroid exposure has decreased dramatically over time from the use of thyroid shields and improved technology/equipment. Prospective studies, based on dental X-ray records and patient follow-up, are needed to test the hypothesis further and clarify the possible cancer risk associated with dental radiography, as although the risk at the individual level, particularly with improved technology/equipment, is likely to be very low, the proportion of the population exposed is high. Considering that about one-third of the general population in developed countries is routinely exposed to one or more dental X-rays per year, these findings manifest the need to reduce diagnostic radiation exposure as much as possible.
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Affiliation(s)
- Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Priyamvada Paudyal
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Josefin Sundin
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
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Dorey S, Gray L, Tootell A, Higgins R, Al-Islam S, Baxter H, Dixon P, Hogg P. Radiation protection value to the operator from augmented reality smart glasses in interventional fluoroscopy procedures using phantoms. Radiography (Lond) 2019; 25:301-307. [DOI: 10.1016/j.radi.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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Pauwels R, Horner K, Vassileva J, Rehani MM. Thyroid shielding in cone beam computed tomography: recommendations towards appropriate use. Dentomaxillofac Radiol 2019; 48:20190014. [PMID: 31237774 DOI: 10.1259/dmfr.20190014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objective of this paper is to provide recommendations towards the appropriate use of thyroid shielding in dental cone beam CT (CBCT). Based on current evidence of thyroid radiosensitivity, dosimetric data in the presence and absence of shielding, and a depiction of potential adverse effects of thyroid shielding, a concise set of recommendations was prepared. According to current risk models, thyroid sensitivity is particularly high at a young age, and much higher for females. In the literature, involving adult male, female and paediatric reference phantoms, the use of a tightly fitted thyroid collar with a lead-equivalent thickness of at least 0.25 mm has consistently shown a significant reduction (average: 45.9%) of the equivalent dose to the thyroid. It can therefore be recommended that thyroid shielding should be routinely used for children undergoing CBCT scanning and is recommended for adults up to the age of 50. The increase of the X-ray tube current from automatic exposure control systems due to thyroid shielding can be avoided by placing the shielding collar after acquiring the scout images. Should real-time tube current modulation be implemented in dental CBCT imaging in the future, perspectives regarding the appropriate use of shielding may change according to current trends in CT. In view of the manifestation of metal artefacts, shielding is best avoided if radiological evaluation of tissues below the lower border of the mandible is needed.
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Affiliation(s)
- Ruben Pauwels
- Mechanical Engineering Department, KU Leuven, Leuven, Belgium.,Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
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Shanbhag VKL. Cone-Beam Computed Tomography in Orthodontics. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2019. [DOI: 10.1177/0301574219861789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vagish Kumar L Shanbhag
- Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Yenepoya (Deemed to be University) University Road, Deralakatte Mangaluru, Karnataka, India
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Ghanbarnezhad Farshi R, Mesbahi A, Johari M, Kara Ü, Gharehaghaji N. Dosimetry of Critical Organs in Maxillofacial Imaging with Cone-beam Computed Tomography. J Biomed Phys Eng 2019; 9:51-60. [PMID: 30881934 PMCID: PMC6409370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/21/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND While the benefits of cone-beam computed tomography (CBCT) are well known in maxillofacial imaging, the use of this modality is not risk-free. OBJECTIVE The aim of this study was to evaluate the exposure doses received by patients during maxillofacial imaging with CBCT. METHODS Entrance surface dose (ESD) was measured by using thermoluminescent dosimeters (TLDs) attached to the eyes lids, parotid glands and thyroid of 64 patients in two imaging centers (A and B). Phantom dosimetry was performed by a cylindrical poly-methyl methacrylate (PMMA) head-size phantom and an ionization chamber for different exposure parameters. NewTom VGi and Planmeca Promax 3D CBCT scanners were used at centers A and B, respectively. RESULTS The mean ESD of the eyes, parotid glands and thyroid were 2.57, 2.33 and 0.28 mGy in center A, 0.35, 2.11 and 0.37 mGy in center B, respectively. ESD of the eyes revealed a significant difference in two centers; in center B, it was 86.4% lower than center A. In the phantom dosimetry, the measured doses of NewTom VGi were 2.63 and 2.08 mGy, respectively by changing field of view (FOV) size from 8×8 cm2 (height × diameter) to 6×6 cm2. For Planmeca Promax 3D, it ranged from 0.98 to 3.24 mGy depending on exposure parameters. CONCLUSION There is a wide range of radiation doses dependent on the units, patients and selected scan parameters. Inappropriate selection of exposure settings, especially FOV size, can seriously increase patient dose.
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Affiliation(s)
- R Ghanbarnezhad Farshi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Mesbahi
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Johari
- Department of Oral & Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ü Kara
- Vocational School of Health Services, Suleyman Demirel University, Isparta, Turkey
| | - N Gharehaghaji
- Radiology Department, Paramedical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Finn SC, Silver MT, Canary B, Kantarci A, Allareddy V, Katebi N, Masoud MI. A modified Steiner's analysis that does not require radiographic exposure of the cranial base. Orthod Craniofac Res 2018; 22:1-8. [PMID: 30365248 DOI: 10.1111/ocr.12250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To correlate traditional Steiner's skeletal and dental measurements to similar measurements that use the eyes and natural head position as references instead of the cranial base. SETTING AND SAMPLE One hundred and fifty-two lateral cephalometric radiographs (66 female and 86 male) from the Harvard Forsyth twin sample were included in the study based on record availability. MATERIAL AND METHODS This was an observational study in which all cephalometric radiographs were traced and analysed using Steiner's cephalometric analysis. Each cephalogram was then altered to perform a similar analysis that uses the maximum convexity of the cornea together with natural head position as references instead of the cranial base. A Pearson product-moment correlation coefficient was measured to determine the correlation between the conventional Steiner's analysis measurements and the novel measurements relying on the eyes and natural head position. RESULTS Steiner's cephalometric measurements of the jaws to each other, the divergency and the orientation of the incisors had a strong positive correlation with their counterparts that relied on true horizontal and/or the eyes (P < 0.001). CONCLUSION The eyes and true horizontal can be used as alternatives to the cranial base when diagnosing the relationship between the jaws and the position and orientation of the teeth. Since the eyes and natural head position are identifiable without ionizing radiation, future research should focus on the use of radiographic exposures limited to the upper and lower jaws for orthodontic diagnosis and outcome assessment.
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Affiliation(s)
- Stephanie C Finn
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts.,Private Practice, Boston, Massachusetts
| | - Mathew T Silver
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts.,Private Practice, Boston, Massachusetts
| | - Benjamin Canary
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts
| | | | | | - Negin Katebi
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Mohamed I Masoud
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts
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22
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Rottke D, Dreger J, Sawada K, Honda K, Schulze D. Comparison of manual and dose reduction modes of a MORITA R100 CBCT. Dentomaxillofac Radiol 2018; 48:20180009. [PMID: 30182744 DOI: 10.1259/dmfr.20180009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE: To compare effective dose differences when acquiring (1) dose reduction mode and (2) manual mode in a MORITA R100 CBCT. METHODS: 24 exposure protocols with different technique factors were performed in both the dose reduction mode and the manual mode in a Veraviewepocs 3D R100 cone beam CT device. 48 TLD were placed in a RANDO head phantom at 24 different sites. Effective doses were calculated according to the formalism published in the 103rd ICRP report. RESULTS: Effective doses for the dose reduction mode protocols ranged from 14 to 156 µSv [mean = 57 µSv, standard deviation (SD) = 37 µSv], whereas effective doses for the manual mode protocols ranged from 22 to 267 µSv (mean = 94 µSv, SD = 65 µSv). Thus, across all protocols, the dose reduction mode leads to a drop of the effective dose by 38 % (SD = 6 %). CONCLUSIONS: The estimated effective doses are significantly lower if dose reduction protocols are acquired.
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Affiliation(s)
- Dennis Rottke
- 1 Digital Diagnostic Center , Freiburg im Breisgau , Germany.,2 Department of Odontology, Oral and Maxillofacial Radiology, Faculty of Medicine, Umeå University , Umeå , Sweden
| | - Julia Dreger
- 1 Digital Diagnostic Center , Freiburg im Breisgau , Germany
| | - Kunihiko Sawada
- 3 Department of Radiology, Nihon University School of Dentistry , Tokyo , Japan
| | - Kazuya Honda
- 3 Department of Radiology, Nihon University School of Dentistry , Tokyo , Japan
| | - Dirk Schulze
- 1 Digital Diagnostic Center , Freiburg im Breisgau , Germany
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23
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Panmekiate S, Rungwittayathon P, Suptaweeponboon W, Tangtraitham N, Pauwels R. Optimization of exposure parameters in dental cone beam computed tomography using a 3-step approach. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:545-552. [PMID: 30237039 DOI: 10.1016/j.oooo.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/17/2018] [Accepted: 08/13/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to find the optimal balance among tube voltage (kV), tube current (mA), and exposure time (s) in cone beam computed tomography (CBCT). STUDY DESIGN Three human hemimandibles were scanned by using the 3D Accuitomo 170 scanner (J. Morita, Kyoto, Japan). First, 3 combinations of kilovolt (kV) and milliampere (mA) were used at a constant radiation dose. Seven observers evaluated the images; the kV of the highest-scoring scan was considered optimal. Second, the lowest acceptable mA for visualizing different anatomic structures was determined. Finally, the samples were scanned by using 3 combinations of tube current and exposure time; the observers determined the combination with the highest image quality. RESULTS At a constant radiation dose, the highest available voltage (i.e., 90 kV) resulted in the highest image quality in terms of general impression, sharpness, noise, and artefacts. Depending on the anatomic structure, mA reductions of 20% to 40% compared with the default setting were possible. Fast-scan protocols showed equal or slightly better image quality compared with the standard-scan mode. CONCLUSIONS For the CBCT model used in this study, optimization implies the use of the highest kV along with the shortest exposure time and a task-specific mA. The proposed stepwise optimization approach could be applied to any CBCT unit, preferably during commissioning.
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Affiliation(s)
- Soontra Panmekiate
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Peera Rungwittayathon
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Wijuck Suptaweeponboon
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattarus Tangtraitham
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Mechanical Engineering Department, Catholic University of Leuven, Leuven, Belgium.
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24
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What is the underestimation of radiation dose to the pediatric thyroid gland from contrast enhanced CT, if contrast medium uptake is not taken into account? Phys Med 2018; 49:95-98. [DOI: 10.1016/j.ejmp.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
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25
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Gad K, Ellabban M, Sciubba J. Utility of Transfacial Dental Ultrasonography in Evaluation of Cystic Jaw Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:635-644. [PMID: 28877358 DOI: 10.1002/jum.14374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Plain radiography has been widely used in dentistry. Because of the variability of the quality of equipment, radiographic technique, accuracy of interpretation, and radiation risk to the patients, the field is ripe for the introduction of other newer diagnostic modalities. In this report, we demonstrate the utility of ultrasonography in the diagnostic workup of cystic or cystlike lesions of the jaw. METHODS We used a transfacial ultrasonographic scanning approach to examine 32 patients with clinical or radiographic presentation of a jaw cyst. Computed tomography and histopathologic analysis were used as the reference standards to confirm the findings. RESULTS Ultrasonography could establish the presence or absence of a lesion, erosion of the buccal cortical plate, and identification of associated soft tissue involvement in all cases (sensitivity and specificity, 100% and 100%, respectively; area under the receiver operating characteristic curve, 1.0; P < .001). CONCLUSIONS Our observations revealed the usefulness of ultrasonography and demonstrated its potential value when introduced as a routine office-based imaging method for dentistry.
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Affiliation(s)
- Khaled Gad
- Department of Radiology, Suez Canal University School of Medicine, Ismailia, Egypt
| | - Mohamed Ellabban
- Division of Plastic and Reconstructive Surgery, Suez Canal University School of Medicine, Ismailia, Egypt
| | - James Sciubba
- Department of Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Milton J. Dance Head and Neck Center Greater Baltimore Medical Center, Baltimore, Maryland, USA
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26
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Hayashi T, Arai Y, Chikui T, Hayashi-Sakai S, Honda K, Indo H, Kawai T, Kobayashi K, Murakami S, Nagasawa M, Naitoh M, Nakayama E, Nikkuni Y, Nishiyama H, Shoji N, Suenaga S, Tanaka R. Clinical guidelines for dental cone-beam computed tomography. Oral Radiol 2018; 34:89-104. [PMID: 30484133 DOI: 10.1007/s11282-018-0314-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
Dental cone-beam computed tomography (CBCT) received regulatory approval in Japan in 2000 and has been widely used since being approved for coverage by the National Health Insurance system in 2012. This imaging technique allows dental practitioners to observe and diagnose lesions in the dental hard tissue in three dimensions (3D). When performing routine radiography, the examination must be justified, and optimal protection should be provided according to the ALARA (as low as reasonably achievable) principles laid down by the International Commission on Radiological Protection. Dental CBCT should be performed in such a way that the radiation exposure is minimized and the benefits to the patient are maximized. There is a growing demand for widespread access to cutting-edge health care through Japan's universal health insurance system. However, at the same time, people want our limited human, material, and financial resources to be used efficiently while providing safe health care at the least possible cost to society. Japan's aging population is expected to reach a peak in 2025, when most of the baby boomer generation will be aged 75 years or older. Comprehensive health care networks are needed to overcome these challenges. Against this background, we hope that this text will contribute to the nation's oral health by encouraging efficient use of dental CBCT.
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Affiliation(s)
- Takafumi Hayashi
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan.
| | - Yoshinori Arai
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry, 1-8-13 Surugadai Kand Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Toru Chikui
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Sachiko Hayashi-Sakai
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Kazuya Honda
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry, 1-8-13 Surugadai Kand Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Hiroko Indo
- Division of Oncology, Department of Maxillofacial Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Kaoru Kobayashi
- Department of Oral and Maxillofacial Radiology and Diagnosis, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masako Nagasawa
- Division of Bio-Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Munetaka Naitoh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Eiji Nakayama
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Ishikari-Tobetsu, Hokkaido, 061-0293, Japan
| | - Yutaka Nikkuni
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Hideyoshi Nishiyama
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Noriaki Shoji
- Division of Oral Diagnosis, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Shigeaki Suenaga
- Division of Oncology, Department of Maxillofacial Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Ray Tanaka
- Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, SAR, China
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Tsapaki V. Radiation protection in dental radiology – Recent advances and future directions. Phys Med 2017; 44:222-226. [DOI: 10.1016/j.ejmp.2017.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/21/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022] Open
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Safiullah S, Patel R, Uribe B, Spradling K, Lall C, Zhang L, Okhunov Z, Clayman RV, Landman J. Prevalence of Protective Shielding Utilization for Radiation Dose Reduction in Adult Patients Undergoing Body Scanning Using Computed Tomography. J Endourol 2017; 31:985-990. [PMID: 28719979 DOI: 10.1089/end.2017.0294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Ionizing radiation is implicated in nearly 2% of malignancies in the United States; radiation shields prevent unnecessary radiation exposure during medical imaging. Contemporary radiation shield utilization for adult patients in the United States is poorly defined. Therefore, we evaluated the prevalence of protective shielding utilization in adult patients undergoing CT scans in United States' hospitals. MATERIALS AND METHODS An online survey was sent to established radiology departments randomly selected from the 2015 American Hospital Association Guide. Radiology departments conducting adult CT imaging were eligible; among 370 eligible departments, 215 departments accepted the study participation request. Questions focused on shielding practices during CT imaging of the eyes, thyroid, breasts, and gonads. Prevalence data were stratified per hospital location, size, and type. Main outcomes included overall protective shielding utilization, respondents' belief and knowledge regarding radiation safety, and organ-specific shielding prevalence. RESULTS Sixty-seven of 215 (31%) hospitals completed the survey; 66 (99%) reported familiarity with the ALARA (as low as reasonably achievable) principle and 56 (84%) affirmed their belief that shielding is beneficial. Only 60% of hospitals employed shielding during CT imaging; among these institutions, shielding varied based on CT study: abdominopelvic CT (13, 33%), head CT (33, 83%), or chest CT (30, 75%). CONCLUSIONS Among surveyed hospitals, 40% do not utilize CT shielding despite the majority acknowledging the ALARA principle and agreeing that shielding is a beneficial practice. Failure to address the low prevalence of protective shielding may lead to poor community health due to increased risk of radiation-related cancers.
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Affiliation(s)
- Shoaib Safiullah
- 1 Department of Urology, University of California , Irvine, Orange, California.,2 Division of Urology, University of Missouri , Columbia, Missouri
| | - Roshan Patel
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Brittany Uribe
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kyle Spradling
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Chandana Lall
- 3 Department of Radiology, University of California , Irvine, Orange, California
| | - Lishi Zhang
- 4 Institute for Clinical and Translational Science, University of California , Irvine, Irvine, California
| | - Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Ralph V Clayman
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Jaime Landman
- 1 Department of Urology, University of California , Irvine, Orange, California.,3 Department of Radiology, University of California , Irvine, Orange, California
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Abstract
BACKGROUND The use of radiation protection equipment can reduce the radiation exposure of patients. OBJECTIVES The aim was to show which patient shields should be used for the different types of examination. METHODS The results of multiple studies were compiled and analyzed and recommendations made for the use of patient shields. The absolute dose values and the protective effect were considered. RESULTS Radiological protection should be used in many investigations; particularly in the case of CT investigations, a reasonable dose reduction potential exists due to the higher radiation dose. CONCLUSIONS Based on these recommendations, workflow changes in some types of investigation are expected due to the use of additional patient shields.
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Affiliation(s)
- M Fiebich
- Institut für Medizinische Physik und Strahlenschutz, Technische Hochschule Mittelhessen, Wiesenstr. 14, 35390, Gießen, Deutschland.
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30
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Are Bismuth Shields Useful in Dentomaxillofacial Radiology Practice for the Protection of Eyes and Thyroid Glands from Ionizing Radiation? IRANIAN JOURNAL OF RADIOLOGY 2017. [DOI: 10.5812/iranjradiol.40723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sung KH, Jung YJ, Kwon SS, Lee GW, Youb Chung C, Lee KM, Cha H, Park MS, Lee K. Performances of a protector against scattered radiation during intraoperative use of a C-arm fluoroscope. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:629-640. [PMID: 27517131 DOI: 10.1088/0952-4746/36/3/629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The scattered radiation protector for mobile x-ray systems, Creative Valuable Protector-2, has been recently developed. However, there have been no studies investigating the effects of this device. We aim to investigate the effects of the scattered radiation protector on the equivalent doses from scattered radiation delivered to radiosensitive organs while simulating spine surgery using a C-arm fluoroscope. Chest and rando phantoms were used to simulate a patient and a surgeon in this study. The equivalent dose from scattered radiation to radiosensitive organs was measured in four different situations according to the use of the scattered radiation protector and the C-arm configuration. To compare the quality of the images with and without the scattered radiation protector, an acryl step phantom with five steps was used, and the contrast resolution of each step was calculated. The equivalent dose from the scattered radiation to the surgeon's eye, thyroid, and gonad decreased significantly by using the scattered radiation protector for both the Posteroanterior (PA) (p < 0.001) and Anteroposterior (AP) (p < 0.001) C-arm configurations. The installation of the scattered radiation protector also reduced the direct radiation dose to the chest phantom. A scattered map showed that scattered radiation doses decreased by approximately 50% for the PA configuration and 75% for the AP configuration by using the scattered radiation protector. Before and after installation of the scattered radiation protector, the contrast resolution of each adjacent step area was 0.025-0.404 and 0.216-0.421. The scattered radiation protector was effective in reducing not only the equivalent dose from scattered radiation to the surgeon's radiosensitive organs, but also the direct radiation dose to the patient. This was all achieved without decreasing the quality of the C-arm fluoroscopic images.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam, Gyeonggi 13620, Korea
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Effective dose comparison between stitched and single FOV in CBCT protocols for complete dental arcade. Radiat Phys Chem Oxf Engl 1993 2015. [DOI: 10.1016/j.radphyschem.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Study of effective dose of various protocols in equipment cone beam CT. Appl Radiat Isot 2015; 100:21-6. [PMID: 25665897 DOI: 10.1016/j.apradiso.2015.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/16/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
This study has the purpose of assessing the radiation absorbed dose in organs/tissues and estimating the effective dose using five different models of Cone Beam Computed Tomography equipment using protocols with similar purpose. For this purpose, 26 thermoluminescent dosimeters were inserted in the position of the organs/tissues of a female anthropomorphic phantom. From the measurements the contribution of wT×HT in the organs and tissues the effective dose were calculated. The measurements have shown the effective dose values within the range 9.3-111.5µSv. The effective dose values by field of view (FOV) size are within the following ranges: 9.3-51.2µSv, 17.6-52.0µSv, and 43.1-111.5µSv for small/located, medium and large FOV respectively. Protocols with same purpose, carried out with different models of equipment, presented significant differences in the values of the equivalent and effective doses. From the point of view of radiological protection, it is not enough to have knowledge about the dimensions of the FOV and the purpose of the examination. It is necessary to assess the dose using the different models of the equipment and protocols available. In this context, this study provides useful information for this assessment.
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Pauwels R, Zhang G, Theodorakou C, Walker A, Bosmans H, Jacobs R, Bogaerts R, Horner K. Effective radiation dose and eye lens dose in dental cone beam CT: effect of field of view and angle of rotation. Br J Radiol 2014; 87:20130654. [PMID: 25189417 DOI: 10.1259/bjr.20130654] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To quantify the effect of field of view (FOV) and angle of rotation on radiation dose in dental cone beam CT (CBCT) and to define a preliminary volume-dose model. METHODS Organ and effective doses were estimated using 148 thermoluminescent dosemeters placed in an anthropomorphic phantom. Dose measurements were undertaken on a 3D Accuitomo 170 dental CBCT unit (J. Morita, Kyoto, Japan) using six FOVs as well as full-rotation (360°) and half-rotation (180°) protocols. RESULTS For the 360° rotation protocols, effective dose ranged between 54 µSv (4 × 4 cm, upper canine) and 303 µSv (17 × 12 cm, maxillofacial). An empirical relationship between FOV dimension and effective dose was derived. The use of a 180° rotation resulted in an average dose reduction of 45% compared with a 360° rotation. Eye lens doses ranged between 95 and 6861 µGy. CONCLUSION Significant dose reduction can be achieved by reducing the FOV size, particularly the FOV height, of CBCT examinations to the actual region of interest. In some cases, a 180° rotation can be preferred, as it has the added value of reducing the scan time. Eye lens doses should be reduced by decreasing the height of the FOV rather than using inferior FOV positioning, as the latter would increase the effective dose considerably. ADVANCES IN KNOWLEDGE The effect of the FOV and rotation angle on the effective dose in dental CBCT was quantified. The dominant effect of FOV height was demonstrated. A preliminary model has been proposed, which could be used to predict effective dose as a function of FOV size and position.
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Affiliation(s)
- R Pauwels
- 1 Oral Imaging Center, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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Hidalgo A, Davies J, Horner K, Theodorakou C. Effectiveness of thyroid gland shielding in dental CBCT using a paediatric anthropomorphic phantom. Dentomaxillofac Radiol 2014; 44:20140285. [PMID: 25411710 DOI: 10.1259/dmfr.20140285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of the study is to evaluate the effectiveness of thyroid shielding in dental CBCT examinations using a paediatric anthropomorphic phantom. METHODS An ATOM(®) 706-C anthropomorphic phantom (Computerized Imaging Reference Systems Inc., Norfolk, VA) representing a 10-year-old child was loaded with six thermoluminescent dosemeters positioned at the level of the thyroid gland. Absorbed doses to the thyroid were measured for five commercially available thyroid shields using a large field of view (FOV). RESULTS A statistically significant thyroid gland dose reduction was found using thyroid shielding for paediatric CBCT examinations for a large FOV. In addition, a statistically significant difference in thyroid gland doses was found depending on the position of the thyroid gland. There was little difference in the effectiveness of thyroid shielding when using a lead vs a lead-equivalent thyroid shield. Similar dose reduction was found using 0.25- and 0.50-mm lead-equivalent thyroid shields. CONCLUSIONS Thyroid shields are to be recommended when undertaking large FOV CBCT examinations on young patients.
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Affiliation(s)
- A Hidalgo
- 1 School of Dentistry, University of Manchester, Manchester, UK
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White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, Law CS, Levin MD, Sauer RA, Valachovic RW, Zeller GG, Goske MJ. The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:257-61. [DOI: 10.1016/j.oooo.2014.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/27/2022]
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Matikka H, Virén T. Radiation dose reduction in cone-beam computed tomography of extremities: evaluation of a novel radiation shield. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2014; 34:N57-N63. [PMID: 24894593 DOI: 10.1088/0952-4746/34/2/n57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cone-beam computed tomography (CBCT) is a relatively new technique for imaging of extremities. It provides high-resolution images with lower effective dose compared to conventional CT. However following the ALARA principle, CBCT-imaging protocols and practices must also be optimised to minimize the dose absorbed by the patient as well as personnel. The aim of this study is to evaluate the effect of a novel scanner-attached radiation shield on the dose absorbed by the patient and on the amount of scattered radiation around the scanner.An orthopedic CBCT scanner was applied for comparing the doses with and without the shield during an elbow and a knee scan. A homogeneous 8 cm PMMA phantom with either an anthropomorphic Alderson phantom or a 16 cm PMMA phantom simulated the tissues of a patient. Measurements were made for several scan parameters using calibrated dose meters.The results show that the radiation shield significantly decreased the doses measured on the patient during CBCT scans of the elbow and the knee. The usage of the shield decreased the absorbed doses by up to 95.5%. Also scattered radiation around the gantry decreased notably. The use of the shield is highly recommended, especially for pediatric patients.
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Affiliation(s)
- H Matikka
- Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Lee SY, Min E, Bae J, Chung CY, Lee KM, Kwon SS, Park MS, Lee K. Types and arrangement of thyroid shields to reduce exposure of surgeons to ionizing radiation during intraoperative use of C-arm fluoroscopy. Spine (Phila Pa 1976) 2013; 38:2108-12. [PMID: 23963017 DOI: 10.1097/brs.0b013e3182a8270d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Measurement of radiation dose from C-arm fluoroscopy during a simulated intraoperative use in spine surgery. OBJECTIVE To assess how the radiation dose is affected by changes in the types of thyroid shields used and by the arrangements or ways in which they are worn during the intraoperative use of C-arm fluoroscopy. SUMMARY OF BACKGROUND DATA Although the danger to the thyroid from exposure to radiation is well known, there are no guidelines for the proper use of thyroid shields. METHODS Two photoluminescence dosimeters were used to measure the dose of scattered radiation arriving at the location of the thyroid in a whole-body phantom in the position of the surgeon. On an operating table beside this setup was an anthropomorphic chest phantom representing a patient for which treatment with C-arm fluoroscopy was simulated. Radiation doses were measured using 3 different arrangements of the thyroid shield: worn tightly, worn loosely, and worn loosely with a bismuth masking reagent. The same tests were performed using 2 kinds of thyroid shield: lead and lead-equivalent. RESULTS For the lead-shield group, radiation doses were measured in 3 arrangements; worn tightly, worn loosely, and worn loosely with a bismuth masking reagent, for which the results were 1.91 ± 0.13, 2.35 ± 0.22, and 1.86 ± 0.13 μSv/min, respectively. Wearing the shield tight against the throat and wearing it loose with a bismuth masking reagent led to lower radiation exposure levels than by simply wearing the shield loosely (P ≤ 0.001). For the lead-equivalent shield group, doses were measured for the same 3 arrangements, for which the results were 1.79 ± 0.12, 1.82 ± 0.11, and 1.74 ± 0.12 μSv/min. Lower scattered radiation doses were delivered to the thyroid in the lead-equivalent thyroid shield group compared with the lead thyroid shield group (P ≤ 0.001). The unshielded thyroid group received a radiation dose of 16.32 ± 0.48 μSv/min. CONCLUSION The use of some form of thyroid shield is essential during the use of C-arm fluoroscopy. It was found that the best way to reduce scattered radiation exposure to the thyroid was wearing the thyroid shield tightly or wearing it loosely in combination with a bismuth masking reagent. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Seung Yeol Lee
- *Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea †Department of Radiologic Science, College of Health Science, Korea University, Seoul, Korea; and ‡Biomedical Research Institute, Seoul National University Bundang Hospital, Kyungki, Korea
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Abstract
Diagnostic imaging techniques have evolved with technological advancements - but how far? The objective of this article was to explore the electromagnetic spectrum to find imaging techniques which may deliver diagnostic information of equal, or improved, standing to conventional radiographs and to explore any developments within radiography which may yield improved diagnostic data. A comprehensive literature search was performed using Medline, Web of Knowledge, Science Direct and PubMed Databases. Boolean Operators were used and key-terms included (not exclusively): terahertz, X-ray, ultraviolet, visible, infra-red, magnetic resonance, dental, diagnostic, caries and periodontal. Radiographic techniques are primarily used for diagnostic imaging in dentistry, and continued developments in X-ray imaging include: phase contrast, darkfield and spectral imaging. Other modalities have potential application, for example, terahertz, laser doppler and optical techniques, but require further development. In particular, infra-red imaging has regenerated interest with caries detection in vitro, due to improved quality and accessibility of cameras. Non-ionising imaging techniques, for example, infra-red, are becoming more commensurate with traditional radiographic techniques for caries detection. Nevertheless, X-rays continue to be the leading diagnostic image for dentists, with improved diagnostic potential for lower radiation dose becoming a reality.
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