Dose reduction in orthodontic lateral cephalography: dosimetric evaluation of a novel cephalographic thyroid protector (CTP) and anatomical cranial collimation (ACC)

Hoogeveen, Reinier; Rottke, D; Stelt, P F van der; Berkhout, Erwin

doi:10.1259/dmfr.20140260

Cited by 13 publications

(6 citation statements)

References 23 publications

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“…When two radiographs yield comparable diagnostic information or contribute equally to the treatment, the technique with the lowest radiation is clearly preferable [ 8 ]. Nowadays, there are also techniques to limit the area of exposure for an LC by covering the cranial base and thyroid gland with protective elements [ 41 ]. These are radiologic aspects that could be additionally elaborated on in a future update of this guideline.…”

Section: Limitations Of the Guideline And Recommendations For Future mentioning

confidence: 99%

Orthodontic radiology: development of a clinical practice guideline

Kapetanović¹,

Oosterkamp²,

Lamberts

et al. 2020

Radiol med

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Objectives Radiographs are considered essential in orthodontics. However, their diagnostic value and indications for use are still uncertain, while exposure to radiation carries health risks. This study aimed to report on the development of a clinical practice guideline on orthodontic radiology. Methods A Guideline Development Taskforce was set up. The GRADE methodology was used for development and the RIGHT Statement for reporting of the guideline. We systematically reviewed articles to address the main clinical question: how different types of radiographs contribute to orthodontic diagnosis, treatment planning and post-treatment outcome evaluation. After a literature search and data extraction, we formulated conclusions and assessed the strength of the evidence according to the GRADE method. Both literature conclusions and the most important considerations, such as patient preferences, organizational matters and expert opinions were taken into account to finally issue recommendations. Results 7 clinical questions focused on orthopantomograms, lateral cephalograms, hand-wrist radiographs, peri-apical radiographs, bitewings, antero-occlusal radiographs, and cone-beam computer tomographic imaging. The literature search lead to 484 unique studies, of which 17 were included in the analysis. The strength of evidence of the conclusions was graded low or very low. We formulated considerations and took them into account when issuing the 13 clinical recommendations to address the clinical questions. Conclusions There was a considerable lack of scientific evidence on this topic. Nonetheless, this guideline provides clinicians with a tool for decision-making regarding radiographic records while enhancing patient radiation protection. More research of higher quality is recommended for a future update.

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Section: Limitations Of the Guideline And Recommendations For Future mentioning

confidence: 99%

Orthodontic radiology: development of a clinical practice guideline

Kapetanović¹,

Oosterkamp²,

Lamberts

et al. 2020

Radiol med

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“…We do not know, however, how much unwanted coverage of the fourth cervical vertebra arises from the magnification factor. New designs of the TS such as modified thyroid protector 26 with a narrow metallic circular part around the neck can be placed mainly on the area of the lobes of the thyroid gland with minimum interference with the area of the cervical spine on the final image. Such a shielding is recommended as a means to visualize the four cervical vertebrae and for radiation protection of the thyroid gland especially in children.…”

Section: Discussionmentioning

confidence: 99%

“…Benefiting retrospective three-dimensional radiographic examinations of children in different age groups is a safe way to localize the thyroid gland in respect to the cervical vertebrae in order to optimize the use of the TS in lateral cephalometric radiography. The use of the modified thyroid protector 26 could also be evaluated, and its use could be optimized with the help of ultrasound examination.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic localization of the thyroid gland for its optimal shielding prior to lateral cephalometric radiography: a pilot study

Esmaeili¹,

Hurmerinta²,

Rice

et al. 2016

Dentomaxillofacial Radiology

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Objectives: Lateral cephalometric radiography is a common radiographic examination technique in children. The exclusion of the thyroid gland from the primary X-ray beam is important especially with children. However, patient treatment might require displaying the four most cranial cervical vertebrae (C1-C4) for the assessment of cervical vertebral maturation. Our aim was to present a safe way to display C1-C4 and exclude the thyroid gland from the X-ray beam during lateral cephalometric radiography. Methods: The thyroid glands of 25, 7-to 12-year-old patients were localized by ultrasound examination and shielded prior to lateral cephalometric radiography. A roentgen-positive mark was taped on the patient's skin at the level of most cranial level of the thyroid gland in the midsagittal plane. After exposure, each lateral cephalometric radiograph (LCR) was analyzed for the visibility of the cervical vertebrae. The distance between the ear post and the highest edge of the thyroid shield (TS) at the lateral part of the neck was measured and compared with the distance between the centre of the radiological external auditory meatus, and a roentgen-positive mark was made on the LCR. Results: 68% of the LCRs displayed C1-C4, and the rest of them displayed C1-C3. In all of the patients, the highest edge of the TS in the lateral parts of the neck was located in a higher position than the actual most cranial level of the thyroid gland. Conclusions: Despite localizing the thyroid gland prior to lateral cephalometric radiography, simultaneous visualization of C1-C4 and exclusion of the thyroid gland from the primary Xray beam during lateral cephalometric radiography might not be completely possible in children because of the design and poor fitness of the TS.

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“…These devices reduce the E of a lateral cephalographic exposure by 58.8% (from 8.5 to 3.5 mSv), which is a reduction of 5.0 mSv reduction per exposure. 17 The combined cost of ACC and CTP was estimated by the manufacturer to be approximately V1000.…”

Section: Methodsmentioning

confidence: 99%

Reducing an already low dental diagnostic X-ray dose: does it make sense? Comparison of three cost-utility analysis methods used to assess two dental dose-reduction measures

Hoogeveen

Sanderink

Stelt

et al. 2015

Dentomaxillofacial Radiology

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Objectives: To find a method that is suitable for providing an objective assessment of the cost effectiveness of a dose-reducing measure used for diagnostic dental X-ray exposures. Methods: Three cost-utility analysis (CUA) methods were evaluated by comparing their assessments of two dose-reduction measures, a rectangular collimator and the combination of two devices that reduce the radiation dose received during orthodontic lateral cephalography. The following CUA methods were used: (1) the alpha value (AV), a monetary valuation of dose reduction used in the nuclear industry; (2) the value of a statistical life for valuation of the reduction in stochastic adverse effects; and (3) the time-for-time method, based on the postulate that risk reduction is effective when the number of years of life gained is more than the years that an average worker must work to earn the costs of the risk-reducing measure. The CUA methods were used to determine the minimum number of uses that was required for the dose-reducing device to be cost effective. The methods were assessed for coherence (are comparable results achieved for comparable countries?) and adaptability (can the method be adjusted for age and gender of specific patient groups?). Results: The performance of the time-for-time method was superior to the other methods. Both types of dose-reduction devices tested were assessed as cost effective after a realistic number of uses with all three methods except low AVs. Conclusions: CUA for the methods of X-ray dose reduction can be performed to determine if investment in low dose reduction is cost effective. The time-for-time method proved to be a coherent and versatile method for performing CUA.

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Dose reduction in orthodontic lateral cephalography: dosimetric evaluation of a novel cephalographic thyroid protector (CTP) and anatomical cranial collimation (ACC)

Cited by 13 publications

References 23 publications

Orthodontic radiology: development of a clinical practice guideline

Orthodontic radiology: development of a clinical practice guideline

Ultrasonographic localization of the thyroid gland for its optimal shielding prior to lateral cephalometric radiography: a pilot study

Reducing an already low dental diagnostic X-ray dose: does it make sense? Comparison of three cost-utility analysis methods used to assess two dental dose-reduction measures

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