Patient Radiation Safety and Protection

Recommendations for Safety and Protection

Prior to any radiographic examination, the dentist should obtain the patient’s medical/dental history, conduct a clinical examination, and acquire and review previous radiographic images, particularly CBCT scans.¹ CBCT examinations should not be routine nor be used for screening purposes.³ Clinicians should base any imaging decision on the patient’s history, clinical findings, disease risk assessments, and the presence of specific clinical conditions and other clinical signs and symptoms that may impact the patient’s oral health.¹ Radiographic imaging should serve as an adjunct to the clinical examination in the diagnosis, effective treatment planning, and management of the patient with confirmed or suspected dental disease, pathosis, injury or other pertinent indicators.¹

The dentist should prescribe dental radiographic imaging and CBCT scans only when there is an expectation that the diagnostic yield will enhance patient safety, benefit patient care, or substantially improve the clinical outcomes.² The clinical prescription of radiographic imaging as well as CBCT should be justified by professional judgement based on established contemporary selection and recall criteria to ensure the benefit of the radiographic examination outweighs the radiation risk.³¹ In addition, the radiographic equipment used to image the patient must be configured to optimize imaging and dosimetric performance with regard to the age and size of the individual.^9,24,32,33 The intended goal is to optimize patient treatment while limiting radiation exposure.

Pediatric patients should be given special consideration when radiographic imaging is used, regardless of modality. As previously discussed, children and young adults are more susceptible to the effects of ionizing radiation exposure. The dentist must justify any prescribed radiographic examination with consideration given to the age and size of the patient, developmental status in terms of tooth eruption and clinical tooth spacing, careful patient positioning, and application of dose-reduction measures to keep the dose as low as possible.^{3,9,15,19,24,32-37} Exposure of the thyroid to the x-ray beam is of particular concern and requires application of dose reduction measures including rectangular collimation, and careful patient positioning.^25,35

Although patient shielding has been recommended in the past, thyroid collars and abdominal/ gonadal shielding are no longer recommended during diagnostic intraoral, panoramic, cephalometric, and CBCT imaging and should be discontinued³⁸ These devices do not protect against internal scatter radiation and can produce artifacts by blocking the primary beam, leading to retakes.^23,25,38 Patient radiation dose can be effectively minimized through the use of rectangular collimation, proper patient positioning, and application of dose reduction measures.^24,38