An analysis of patient dose received during cone-beam computed tomography in relation to scan settings and imaging indications as seen in a dental institution in order to establish institutional diagnostic reference levels

Abstract

Objectives: To investigate the dose-area product (DAP) of cone-beam computed tomography (CBCT) examinations for different scan settings and imaging indications, and to establish institutional diagnostic reference levels (DRLs) for dose optimization. Methods: A retrospective analysis of the DAP values of 3568 CBCT examinations taken from two different devices at the Prince Philip Dental Hospital, Hong Kong between 2016 and 2021 was performed. Patient- (age, gender, and imaging indication) and imaging-related (CBCT device, field-of-view (FOV), and voxel size) were correlated with the DAPs. The indication-oriented third-quartile DAP values were compared with DRLs from the UK, Finland, and Switzerland. The obtained third-quartile DAPs lower than the national DRLs and those for which no national DRLs have been proposed were used to establish institutional DRLs. Results: In the investigated CBCTs, the DAP value for large FOV scans was significantly lower than medium/small FOVs. CBCTs with a small voxel size exhibited a significantly higher DAP than those with a medium/large voxel size. CBCTs for endodontic, periodontal, orthodontic, or orthognathic evaluation exhibited a significantly higher DAP than other indications. Twelve indication-oriented institutional DRLs were established and five of them were lower than the national DRLs: third molars (229 mGy×cm2), jaw cysts/tumors (410 mGy×cm2), maxillary sinus pathology (520 mGy×cm2), developing dentition (164 mGy×cm2), and periapical lesions (564 mGy×cm2). Conclusions: CBCT examinations for endodontic, periodontal, orthodontic, or orthognathic evaluation may deliver a higher radiation dose to the patient than other imaging tasks. A periodic review of the patient dose from CBCT imaging and establishment of institutional DRLs for specific clinical settings are needed for monitoring patient dose and to optimize indication-oriented scanning protocols.

CBCTs in a Swiss university dental clinic: a retrospective evaluation over 5 years with emphasis on radiation protection criteria

“…In individual cases, the values were significantly higher, for example, if a larger FOV was prepared. However, when comparing the DAP values in our cohort to a recent study conducted by Hung et al on patient doses received during CBCT scans, we observe differences in the median values of the study populations [ 32 ]. Hung et al found a median DAP of 333 mGycm 2 for small FOV (≤ 40 cm 2 ), which is lower than the DAP values in our cohort [ 32 ].…”

A comprehensive review and update on the current state of computer-assisted rehabilitation in implant dentistry

“…22 Regarding CBCT it must be understood that image quality and high image resolution are always associated with higher radiation doses. 23 In guided surgery, the voxel size of 0.2mm 3 is an adequate resolution serving guided surgery with low noise and a moderate radiation burden. Limiting the FOV as much as possible, minimising retakes, and using bespoke exposure parameters are additional measures that serve the purpose of reducing the radiation exposure in guided implant rehabilitation.…”

Personalized dental medicine, artificial intelligence, and their relevance for dentomaxillofacial imaging

“…While several low-dose CBCT protocols have been suggested and applied in practice, the perceived inferior image quality of low-dose scans may hamper their use, with clinicians nevertheless employing standard- or even high-dose scanning mode for certain imaging tasks. 111 In addition, the presence of severe artifacts in CBCT images has been reported as one of the common reasons for re-exposure. 112 Patient motion during scanning and metallic dental restorations are the main sources for the occurrence of movement or metal artifacts in CBCT images.…”