Rationalization of radiation dose

Yuri Nejaim, Karla de Faria Vasconcelos, Gina D Roque-Torres, Abraham Meneses-López, Frab Norberto Bóscolo, Francisco Haiter-Neto

Article ID: 1714
Vol 2, Issue 1, 2019

VIEWS - 626 (Abstract) 565 (PDF)


Currently there is a great acceptance in medicine and dentistry that clinical practice should be “evidence-based” as much as possible. That is why multiple works have been published aimed at decreasing radiation doses in the different types of imaging modalities used in dentistry, since the greater effect of radiation, especially in children, forces us to take necessary measures to rationalize its use, especially with Cone Beam computed tomography (CBCT), the method that provides the highest doses in dentistry. This review was written using such an approach with the purpose of rationalizing the radiation dose in our patients. In order to formulate recommendations that contribute to the optimization of the use of ionizing radiation in dentistry, the SEDENTEXCT project team compiled and analyzed relevant publications in the literature, guidelines that have demonstrated their efficiency in the past, thus helping to see with different perspectives the dose received by patients, and with this, it is recommended taking into account this document so as to prescribe more adequately the complementary examinations that we use on a daily basis.


Ionizing Radiation; Radiobiology; Radiation Dose-response Relationship

Full Text:



1. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 2008; 106(1): 106–114.

2. Environmental Health Directorate, Health Canada. Radiation protection in dentistry—Recommended safety procedures for the use of dental X-ray equipment—Safety code 30 [Internet]. Ontario: Environmental Health Directorate; 1999. Available from: http://www.hc-sc.gc.ca/ewh-semt/pubs/radiation/99ehd-dhm177/index-eng.php.

3. SEDENTEXCT project. Radiation protection [Internet]. Luxembourg: European Commission; 2012. Available from: http://www.seden-texct.eu/files/radiation_protection_172.pdf.

4. American Dental Association. Dental radiographic examinations: Recommendations for patient selection and limiting radiation exposure. Washington D.C.: Department Of Health and Human Services Public Health Service Food and Drug Administration; 2004.

5. White SC, Heslop EW, Hollender LG, et al. Parameters of radiologic care: An official report of the American Academy of Oral and Maxillofacial Radiology. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 2001; 91(5): 498–511.

6. White SC. Assessment of radiation risk from dental radiography. Dentomaxillofacial Radiology 1992; 21(3): 118–126.

7. Hirsch E, Wolf U, Heinicke F, et al. Dosimetry of the cone beam computed tomography Veraviewepocs 3D compared with the 3D Accuitomo in different fields of view. Dentomaxillofacial Radiology 2008; 37(5): 268–273.

8. Brooks SL. CBCT Dosimetry: Orthodontic considerations. Seminars in Orthodontics 2009; 15(1): 14–18.

9. Okano T, Harata Y, Sugihara Y, et al. Absorbed and effective doses from cone beam volumetric imaging for implant planning. Dentomaxillofacial Radiology 2009; 38(2): 79–85.

10. Garcia-Silva MA, Wolf U, Heinicke F, et al. Effective dosages for recording Veraviewepocs dental panoramic images: Analog film, digital, and panoramic scout for CBCT. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 2008; 106(4): 571–577.

11. Palomo JM, Rao PS, Hans MG. Influence of CBCT exposure conditions on radiation dose. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 2008; 105(6): 773–782.

12. Garcia-Silva MA, Wolf U, Heinicke F, et al. Cone-beam computed tomography for routine orthodontic treatment planning: A radiation dose evaluation. American Journal of Orthodontics and Dentofacial Orthopedics 2008; 133(5): 640–645.

13. Loubele M, Jacobs R, Maes F, et al. Radiation dose vs. image quality for low-dose CT protocols of the head for maxillofacial surgery and oral implant planning. Radiation Protection Dosimetry 2005; 117(1–3): 211–216.

14. Faccioli N, Barillari M, Guariglia S, et al. Radiation dose saving through the use of Cone-Beam CT in hearing-impaired patients. Radiologia Medica 2009; 114(8): 1308–1318.

15. Suomalainen A, Kiljunen T, Kaser Y, et al. Dosimetry and image quality of four dental cone beam computed tomography scanners compared with multislice computed tomography scanners. Dentomaxillofacial Radiology 2009; 38(6): 367–378.

16. Longstreth WT, Dennis LK, McGuire VM, et al. Epidemiology of intracranial meningioma. Cancer 1993; 72(3): 639–648.

17. Preston-Martin S, White SC. Brain and salivary gland tumors related to prior dental radiography: Implications for current practice. Journal of the American Dental Association 1990; 120(2): 151–158.

18. Hallquist A, Hardell L, Degerman A, et al. Medical diagnostic and therapeutic ionizing radiation and the risk for thyroid cancer: A case-control study. European Journal of Cancer Prevention 1994; 3(3): 259–267.

19. Memon A, Godward S, Williams D, et al. Dental X-rays and the risk of thyroid cancer: A case-control study. Acta Oncologica 2010; 49(4): 447–453.

20. Valentin J (editor). The 2007 recommendations of the international commission on radiological protection [Internet]. Stockholm: The International Commission on Radiological Protection/Elsevier; 2007. Available from: http://www.icrp.org/docs/ICRP_Publication_103-Annals_of_the_ICRP_37(2-4)-Free_extract.pdf.

21. De Vos W, Casselman J, Swennen GR. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: A systematic review of the literature. International Journal of Oral and Maxillofacial Surgery 2009; 38(6): 609–625.

22. Miracle AC, Mukherji SK. Cone beam CT of the head and neck, part 2: Clinical applications. American Journal of Neuroradiology 2009; 30(7): 1285–1292.

23. Kau CH, Richmond S, Palomo JM, Hans MG. Three-dimensional cone beam computerized tomography in orthodontics. Journal of Orthodontics 2005; 32(4): 282–293.

24. Honda K, Larheim TA, Maruhashi K, et al. Osseous abnormalities of the mandibular condyle: Diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material. Dentomaxillofacial Radiology 2006; 35(3): 152–157.

25. Estrela C, Bueno MR, Alencar AHG, et al. Method to evaluate inflammatory root resorption by using cone beam computed tomography. Journal of Endodontics 2009; 35(11): 1491–1497.

26. Patel S, Dawood A, Whaites E, et al. The potential applications of cone beam computed tomography in the management of endodontic problems. International Endodontic Journal 2007; 40(10): 818–830.

27. Balasundaram A, Gurun D, Neely A, et al. Novel CBCT and optical scanner-based implant treatment planning using a stereolithographic surgical guide: A multipronged diagnostic approach. Implant Dentistry 2014; 23(4): 401–406.

28. Hannig C, Dullin C, Hulsmann M, et al. Three-dimensional, non-destructive visualization of vertical root fractures using flat panel volume detector computer tomography: An ex vivo in vitro case report. International Endodontic Journal 2005; 38(12): 904–913.

29. Melo SL, Haiter-Neto F, Correa LR, et al. Comparative diagnostic yield of cone beam CT reconstruction using various software programs on the detection of vertical root fractures. Dentomaxillofacial Radiology 2013; 42(9): 20120459.

30. Nascimento HA, Ramos AC, Neves FS, et al. The ‘Sharpen’ filter improves the radiographic detection of vertical root fractures. International Endodontic Journal 2015; 48(5): 428–434.

31. Hassan B, Metska ME, Ozok AR, et al. Comparison of five cone beam computed tomography systems for the detection of vertical root fractures. Journal of Endodontics 2010; 36(1): 126–129.

32. Da Silveira PF, Vizzotto MB, Liedke GS, et al. Detection of vertical root fractures by conventional radiographic examination and cone beam computed tomography—An in vitro analysis. Dental Traumatology 2013; 29(1): 41–46.

33. Khedmat S, Rouhi N, Drage N, et al. Evaluation of three imaging techniques for the detection of vertical root fractures in the absence and presence of gutta-percha root fillings. International Endodontic Journal 2012; 45(11): 1004–1009.

34. Patel S, Brady E, Wilson R, et al. The detection of vertical root fractures in root filled teeth with periapical radiographs and CBCT scans. International Endodontic Journal 2013; 46(12): 1140–1152.

35. Costa FF, Gaia BF, Umetsubo OS, Cavalcanti MG. Detection of horizontal root fracture with small-volume cone-beam computed tomography in the presence and absence of intracanal metallic post. Journal of Endodontics 2011; 37(10): 1456–1459.

36. Costa FF, Gaia BF, Umetsubo OS, et al. Use of large-volume cone-beam computed tomography in identification and localization of horizontal root fracture in the presence and absence of intracanal metallic post. Journal of Endodontics 2012; 38(6): 856–859.

37. Kajan ZD, Taromsari M. Value of cone beam CT in detection of dental root fractures. Dentomaxillofacial Radiology 2012; 41(1): 3–10.

38. Kamburŏglu K, Kolsuz E, Murat S, et al. Assessment of buccal marginal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode. Dentomaxillofacial Radiology 2013; 42(8): 20130176.

39. De-Azevedo-Vaz SL, Alencar PN, Rovaris K, et al. Enhancement cone beam computed tomography filters improve in vitro periimplant dehiscence detection. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 2013; 116(5): 633–639.

40. De-Azevedo-Vaz SL, Vasconcelos Kde F, Neves FS, et al. Detection of periimplant fenestration and dehiscence with the use of two scan modes and the smallest voxel sizes of a cone-beam computed tomography device. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 2013; 115(1): 121–127.

41. Guerrero ME. State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Clinical Oral Investigations 2006; 10: 1–7.

42. Sancho-Puchades M, Hämmerle CHF, Benic GI. In vitro assessment of artifacts induced by titanium, titanium-zirconium and zirconium dioxide implants in cone-beam computed tomography. Clinical Oral Implants Research 2015; 26(10): 1222–1228.

43. Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. Journal of the Canadian Dental Association 2006; 72(1): 75–80.

44. Cavalcanti M. Tomografi a computadorizada por feixe cônico: Interpretação e diagnóstico para o cirurgião dentista (Portuguese) [Cone-beam computed tomography: Interpretation and diagnosis for the dental surgeon]. 1st ed. São Paulo: Livraria Santos Ltda; 2010.

45. Garib DG, Raymundo R Jr., Raymundo MV, et al. Tomografia computadorizada de feixe cônico (cone beam): Entendimiento este novo método de diagnóstico por imagem com promissora aplicabilidade na Ortodontia (Portuguese) [Cone beam computed tomography: Understanding this new diagnostic imaging method with promising applicability in Orthodontics]. Revista Dental Press de Ortodontia e Ortopedia Facial 2007; 12(2): 139–156.

DOI: http://dx.doi.org/10.24294/irr.v2i1.1714


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License

This site is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.