Cone-beam computed tomography: Time to move from ALARA to ALADA

Abstract

Cone-beam computed tomography (CBCT) is routinely recommended for dental diagnosis and treatment planning. CBCT exposes patients to less radiation than does conventional CT. Still, lack of proper education among dentists and specialists is resulting in improper referral for CBCT. In addition, aiming to generate high-quality images, operators may increase the radiation dose, which can expose the patient to unnecessary risk. This letter advocates appropriate radiation dosing during CBCT to the benefit of both patients and dentists, and supports moving from the concept of "as low as reasonably achievable" (ALARA) to "as low as diagnostically acceptable" (ALADA).

The Use of Cone‐Beam Computed Tomography in Management of Patients Requiring Dental Implants: An American Academy of Periodontology Best Evidence Review

“…Nonetheless, published estimated risks usually represent averages for both sexes at all ages, even though risks for females are higher than those for males 10 . Therefore, creating awareness of the important responsibilities regarding patient safety when using this powerful resource becomes pivotal to providing proper justification and optimization of CBCT exposures 1,4,11‐27 …”

The effect of varying cone beam computed tomography image resolution and field-of-view centralization on effective radiation dose

“…Finally, the “ALADA” concept must be applied to every patient regardless of the type of imaging required. This approach, as per the NCRP’s recommendation in 2014,12 aims to reduce unnecessary high resolution imaging associated with greater radiation in favor of diagnostic images that may be of lower quality but associated with less radiation 10,23. Therefore, Further studies need to be carried out on the quality of the resulting images while varying the technical factors so that proper protocols can be established for the various CBCT indications that take into consideration not only the radiation risk but also the quality of the image.…”

The effect of different exposure parameters on proximal caries detection using the Kodak 9000 3D CBCT system

“…According to Jaju & Jaju 10 , a reduction on tube current is a practical way to reduce radiation dose, but any reduction on tube current should be carefully considered, as this reduction can cause noise increase on the final image, what can reflect on diagnostic accuracy.…”

“…According to SEDENTEXCT 22 , an intraoral radiographic image has less than 1.5 µSv effective dose, while a small Field of View (FOV) CBCT acquisition varies from 11 to 674 µSv. It is important to emphasize the ALADA principle, and the chosen protocol should be adapted to each specific usage 10 . The permitted variation on kV and mA in Kodak 9000 3D system can interfere considerably on image quality when detecting proximal caries lesions.…”

“…However, at the same time, kV and mA alternatives parameters can reduce image quality when compared to the images achieved using higher dosage parameters 9 . An agreement between accepted exposure and image quality needs to be established, using as guidance the ALADA principle: ""as low as diagnostically acceptable" 10 .…”