Radiation Protection in Dental Radiology

By IAEA

X ray imaging is used extensively in dentistry to diagnose symptoms, plan and monitor treatments and to follow up pathoses. This Safety Report provides guidance on meeting the requirements for radiation protection and safety in uses of ionizing radiation in dentistry established in IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards. It includes guidelines for the justification and appropriateness of medical exposure, and the optimization of radiation protection and safety for patients, carers and dental staff, with detail on considerations relevant for children and pregnant women. Quality assurance, dosimetry and the operation of dental radiological equipment are also discussed. This publication is intended for dental practitioners, referring medical practitioners, medical radiation technologists and other dental health professionals, as well as medical physicists, radiation protection experts, manufacturers and regulators.

• Language: English
• Publisher: International Atomic Energy Agency
• Release date: May 16, 2022
• ISBN: 9789201386212

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RADIATION PROTECTION

IN DENTAL RADIOLOGY

SAFETY REPORTS SERIES No. 108

RADIATION PROTECTION

IN DENTAL RADIOLOGY

ENDORSED BY THE

FDI WORLD DENTAL FEDERATION, IMAGE GENTLY ALLIANCE,

INTERNATIONAL ASSOCIATION OF

DENTOMAXILLOFACIAL RADIOLOGY AND

INTERNATIONAL ORGANIZATION FOR MEDICAL PHYSICS

INTERNATIONAL ATOMIC ENERGY AGENCY

VIENNA, 2022

COPYRIGHT NOTICE

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© IAEA, 2022

Printed by the IAEA in Austria

May 2022

STI/PUB/1972

IAEA Library Cataloguing in Publication Data

Names: International Atomic Energy Agency.

Title: Radiation protection in dental radiology / International Atomic Energy Agency.

Description: Vienna : International Atomic Energy Agency, 2022. | Series: safety reports series, ISSN 1020–6450 ; no. 108 | Includes bibliographical references.

Identifiers: IAEAL 22-01475 | ISBN 978-92-0-138421-8 (paperback : alk. paper) | ISBN 978-92-0-138521-5 (pdf) | ISBN 978-92-0-138621-2 (epub)

Subjects: LCSH: Radiation — Safety measures. | Teeth — Radiography. | Medical physics.

Classification: UDC 614.876:616.314 | STI/PUB/1972

FOREWORD

IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, establishes basic requirements for radiation protection and safety in medical exposures. IAEA Safety Standards Series No. SSG-46 , Radiation Protection and Safety in Medical Uses of Ionizing Radiation, provides recommendations and guidance on fulfilling the requirements of GSR Part 3 with respect to medical uses of ionizing radiation, including dentistry. However, SSG-46 does not provide detailed guidelines specific to different modalities and techniques used in dental radiology.

Dentistry is an independent health care specialty and dental X ray equipment can be used in a variety of settings. Often dentists undertake X ray procedures for patients on the basis of their own clinical assessments. Therefore, dentists have a responsibility to justify medical exposure and optimize radiation protection for patients, and need specific and detailed guidelines. The available international guidelines for radiation protection in dental radiology are either outdated or only partly cover existing dental techniques, such as the use of cone beam computed tomography.

Participants in an IAEA meeting of experts held in February 2016 in Vienna, including representatives of leading international organizations and professional societies, concluded that there was a need for guidance on the justification and appropriateness of dental radiology imaging and the optimization of radiation protection and safety for patients, staff and the public, including details on safety aspects of dental facilities and equipment. The meeting participants requested that the IAEA consider leading the development of such a publication and approaching the international organizations represented at the meeting of experts to contribute to the development of this publication and endorse it.

The purpose of this Safety Report is to provide guidance on meeting the requirements for radiation protection and safety in the use of ionizing radiation in dentistry established in GSR Part 3. This guidance is intended for those using X rays to examine dental, maxillofacial and adjacent structures, including dental practitioners, referring medical practitioners, medical radiation technologists and other dental health professionals, as well as medical physicists, radiation protection experts and manufacturers of dental imaging equipment. Regulatory bodies may also use it for reviewing applications for the authorization and inspection of dental radiology facilities. This Safety Report is expected to be of use to experts participating in IAEA missions to advise on implementation of the requirements established in GSR Part 3 for the practice of dental radiology.

This Safety Report has been endorsed by the FDI World Dental Federation, the Image Gently Alliance, the International Association of DentoMaxilloFacial Radiology and the International Organization for Medical Physics.

The IAEA expresses its appreciation to all those who assisted in the drafting and review of this publication. The IAEA officer responsible for this publication was J. Vassileva of the Division of Radiation, Transport and Waste Safety.

EDITORIAL NOTE

Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use.

This publication does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person.

Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States.

The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries.

The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA.

The IAEA has no responsibility for the persistence or accuracy of URLs for external or third party Internet web sites referred to in this book and does not guarantee that any content on such web sites is, or will remain, accurate or appropriate.

The authoritative versions of the publications are the hard copies issued and available as PDFs on www.iaea.org/publications.To create the versions for e-readers, certain changes have been made, including the movement of some figures and tables.

CONTENTS

1. INTRODUCTION

1.1. Background

1.2. Objective

1.3. Scope

1.4. Structure

2. IMAGING MODALITIES AND TECHNIQUES USED IN DENTAL RADIOLOGY

2.1. Intraoral radiography

2.2. Panoramic radiography

2.3. Cephalometric radiography

2.4. Cone beam computed tomography

2.5. Conventional multidetector computed tomography

3. FRAMEWORK FOR RADIATION PROTECTION IN DENTAL RADIOLOGY

3.1. Radiation risk

3.2. Radiation dose

3.3. Basic principles of radiation protection

3.4. Roles and responsibilities for radiation protection

3.5. Education and training

3.6. Quality assurance and quality audit

4. JUSTIFICATION AND IMAGING GUIDELINES

4.1. General approaches for justification in dental radiography

4.2. Justification in two dimensional dental radiography

4.3. Justification in three dimensional dental imaging

4.4. Justification in paediatric patients

4.5. Justification in pregnant patients

4.6. Guidelines on the use of imaging in dentistry

4.7. Justification of medical exposure for carers and comforters

5. OPTIMIZATION OF RADIATION PROTECTION OF INDIVIDUALS UNDERGOING MEDICAL EXPOSURE

5.1. Equipment selection

5.2. Quality control

5.3. Patient dosimetry and diagnostic reference levels

5.4. Procedural aspects

5.5. Paediatric patients

5.6. Pregnant patients

5.7. Carers and comforters and volunteers in biomedical research

5.8. Unintended and accidental medical exposures

6. OCCUPATIONAL AND PUBLIC PROTECTION

6.1. Dose limits

6.2. Classification of areas

6.3. Design of X ray room

6.4. Protection for adjacent areas

6.5. Local rules and procedures

6.6. Individual monitoring and assessment of occupational exposure

Appendix I: RADIATION DOSE QUANTITIES APPLICABLE TO DENTAL RADIOLOGY

Appendix II: EDUCATION AND TRAINING OBJECTIVES APPLICABLE TO DENTISTRY

REFERENCES

Annex: CLINICAL INDICATIONS FOR DENTAL RADIOLOGICAL IMAGING

ABBREVIATIONS

CONTRIBUTORS TO DRAFTING AND REVIEW

1. INTRODUCTION

1.1. Background

X ray imaging is used extensively in dentistry to diagnose, plan and monitor treatments and to follow up pathoses. According to the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR)¹, approximately 13% of all diagnostic radiological examinations are performed in dentistry globally, with the annual frequency estimated to be 74 dental examinations per 1000 population globally, and 275 per 1000 population in health care level I countries² [1]. A report by the European Commission [2] estimates that dental X ray procedures make up 32% of all plain radiography procedures in Europe, with a mean value of 352 dental procedures per 1000 population per year. The 2014–2015 Nationwide Evaluation of X-Ray Trends survey in the United States of America (USA) [3] estimated that approximately 500 million intraoral radiographs and almost 4 million dental cone beam computed tomography (CBCT) examinations were performed in the USA yearly. These data suggest that globally at least 1.5 billion dental radiographic examinations are performed annually.

The imaging techniques used in dentistry can be categorized as intraoral radiography (i.e. bitewing, periapical and occlusal), panoramic radiography, cephalometric radiography and CBCT, with CBCT being the newest modality and associated with relatively high patient doses. Medical computed tomography (CT) imaging is also needed in some patients. Although the individual doses from dental procedures are small, because of the increasing frequency of dental imaging procedures, particularly of CBCT and CT, their contribution to collective dose is increasing and raises the need for more attention to be paid to radiation protection of patients. An important consideration is that dental radiological procedures are performed more frequently on younger individuals, who