Skip to main content
Top
Published in: European Archives of Paediatric Dentistry 4/2020

01-08-2020 | Digital Volume Tomography | Systematic Review

Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review

Authors: J. W. G. Van Acker, N. S. Pauwels, R. G. E. C. Cauwels, S. Rajasekharan

Published in: European Archives of Paediatric Dentistry | Issue 4/2020

Login to get access

Abstract

Purpose

To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination.

Methods

A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case–control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18 years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed.

Results

Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies.

Conclusion

The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.
Appendix
Available only for authorised users
Literature
go back to reference Alcaraz M, Garcia-Vera MC, Bravo LA, Martinez-Beneyto Y, Armero D, Morant JJ, et al. Collimator with filtration compensator: clinical adaptation to meet European Union recommendation 4F on radiological protection for dental radiography. Dentomaxillofac Radiol. 2009;38(6):413–20. https://doi.org/10.1259/dmfr/15580890.CrossRefPubMed Alcaraz M, Garcia-Vera MC, Bravo LA, Martinez-Beneyto Y, Armero D, Morant JJ, et al. Collimator with filtration compensator: clinical adaptation to meet European Union recommendation 4F on radiological protection for dental radiography. Dentomaxillofac Radiol. 2009;38(6):413–20. https://​doi.​org/​10.​1259/​dmfr/​15580890.CrossRefPubMed
go back to reference Espelid I, Mejare I, Weerheijm K. EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent. 2003;4(1):40–8.PubMed Espelid I, Mejare I, Weerheijm K. EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent. 2003;4(1):40–8.PubMed
go back to reference García Vera MdC. Reducción de dosis en la telerradiografía lateral de cráneo en pediatría: nueva técnica de colimación con filtración compensada. 2006. García Vera MdC. Reducción de dosis en la telerradiografía lateral de cráneo en pediatría: nueva técnica de colimación con filtración compensada. 2006.
go back to reference Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.CrossRefPubMed Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.CrossRefPubMed
go back to reference Gwet K. Kappa statistic is not satisfactory for assessing the extent of agreement between raters. Stat Methods Inter-rater Reliab Assess. 2002;1(6):1–6. Gwet K. Kappa statistic is not satisfactory for assessing the extent of agreement between raters. Stat Methods Inter-rater Reliab Assess. 2002;1(6):1–6.
go back to reference Horner K, Rushton V, Tsiklakis K, Hirschmann PN, van der Stelt PF, Glenny A-M et al. European guidelines on radiation protection in dental radiology; the safe use of radiographs in dental practice. European Commission, Directorate-General for Energy and Transport. Radiation Protection: EU2004 2004. Report No.: 92-984-5958-1. Horner K, Rushton V, Tsiklakis K, Hirschmann PN, van der Stelt PF, Glenny A-M et al. European guidelines on radiation protection in dental radiology; the safe use of radiographs in dental practice. European Commission, Directorate-General for Energy and Transport. Radiation Protection: EU2004 2004. Report No.: 92-984-5958-1.
go back to reference ICRP. The 1990 recommendations of the international commission on radiological protection. ICRP publication 60. Ann ICRP. 1991;21(1–3). ICRP. The 1990 recommendations of the international commission on radiological protection. ICRP publication 60. Ann ICRP. 1991;21(1–3).
go back to reference ICRP. Managing patient dose in digital radiology. ICRP Publication 93. Ann ICRP 2004;34. ICRP. Managing patient dose in digital radiology. ICRP Publication 93. Ann ICRP 2004;34.
go back to reference Johnson KB, Ludlow JB, Mauriello SM, Platin E. Reducing the risk of intraoral radiographic imaging with collimation and thyroid shielding. Gen Dent. 2014;62(4):34–40.PubMed Johnson KB, Ludlow JB, Mauriello SM, Platin E. Reducing the risk of intraoral radiographic imaging with collimation and thyroid shielding. Gen Dent. 2014;62(4):34–40.PubMed
go back to reference Land CE. Estimating cancer risks from low doses of ionizing radiation. Science. 1980;209(4462):1197–203.CrossRefPubMed Land CE. Estimating cancer risks from low doses of ionizing radiation. Science. 1980;209(4462):1197–203.CrossRefPubMed
go back to reference Little MP. Heterogeneity of variation of relative risk by age at exposure in the Japanese atomic bomb survivors. Radiat Environ Biophys. 2009;48(3):253–62.CrossRefPubMed Little MP. Heterogeneity of variation of relative risk by age at exposure in the Japanese atomic bomb survivors. Radiat Environ Biophys. 2009;48(3):253–62.CrossRefPubMed
go back to reference Ludlow JB, Koivisto J. Dosimetry of orthodontic diagnostic FOVs using low dos CBCT protocol. 2015 IADR/AADR/CADR General Session & Exhibition; Boston, USA2015. Ludlow JB, Koivisto J. Dosimetry of orthodontic diagnostic FOVs using low dos CBCT protocol. 2015 IADR/AADR/CADR General Session & Exhibition; Boston, USA2015.
go back to reference Mazonakis M, Damilakis J, Raissaki M, Gourtsoyiannis N. Radiation dose and cancer risk to children undergoing skull radiography. Pediatr Radiol. 2004;34(8):624–9.CrossRefPubMed Mazonakis M, Damilakis J, Raissaki M, Gourtsoyiannis N. Radiation dose and cancer risk to children undergoing skull radiography. Pediatr Radiol. 2004;34(8):624–9.CrossRefPubMed
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009a;151(4):264–9.CrossRefPubMed Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009a;151(4):264–9.CrossRefPubMed
go back to reference Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8(9):1558–64.CrossRefPubMed Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8(9):1558–64.CrossRefPubMed
go back to reference Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. Product ESRC Methods Progr Vers. 2006;1:b92. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. Product ESRC Methods Progr Vers. 2006;1:b92.
go back to reference R Core Team. R: A language and environment for statistical computing. 2013. R Core Team. R: A language and environment for statistical computing. 2013.
go back to reference Robb J. Estimates of radiation detriment in a UK population: National Radiological Protection Board. 1994. Robb J. Estimates of radiation detriment in a UK population: National Radiological Protection Board. 1994.
go back to reference Rush E, Thompson N. Dental radiography technique and equipment: how they influence the radiation dose received at the level of the thyroid gland. Radiography. 2007;13(3):214–20.CrossRef Rush E, Thompson N. Dental radiography technique and equipment: how they influence the radiation dose received at the level of the thyroid gland. Radiography. 2007;13(3):214–20.CrossRef
go back to reference Schmidt K, Velders XL, van Ginkel FC, van der Stelt PF. The use of a thyroid collar for intraoral radiography. Ned Tijdschr Tandheelkd. 1998;105(6):209–12.PubMed Schmidt K, Velders XL, van Ginkel FC, van der Stelt PF. The use of a thyroid collar for intraoral radiography. Ned Tijdschr Tandheelkd. 1998;105(6):209–12.PubMed
go back to reference Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.CrossRefPubMed Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.CrossRefPubMed
go back to reference Stenstrom B, Henrikson CO, Holm B, Richter S. Absorbed doses from intraoral radiography with special emphasis on collimator dimensions. Swed Dent J. 1986;10(1–2):59–71.PubMed Stenstrom B, Henrikson CO, Holm B, Richter S. Absorbed doses from intraoral radiography with special emphasis on collimator dimensions. Swed Dent J. 1986;10(1–2):59–71.PubMed
go back to reference UNSCEAR. Report to the general assmebly. Volume II: scientific Annex B: effects of radiation exposure of children. 2013. UNSCEAR. Report to the general assmebly. Volume II: scientific Annex B: effects of radiation exposure of children. 2013.
go back to reference UNSCEAR. Effects of ionizing radiation (exposure from natural sources of radiation), New York, 1993. 2017. UNSCEAR. Effects of ionizing radiation (exposure from natural sources of radiation), New York, 1993. 2017.
go back to reference Whaites E. Essentials of dental radiography and radiology. 4th ed. London: Churchill Livingstone; 2007. Whaites E. Essentials of dental radiography and radiology. 4th ed. London: Churchill Livingstone; 2007.
go back to reference Yepes JF, Booe MR, Sanders BJ, Jones JE, Ehrlich Y, Ludlow JB, et al. Pediatric phantom dosimetry of Kodak 9000 cone-beam computed tomography. Pediatr Dent. 2017;39(3):229–32.PubMed Yepes JF, Booe MR, Sanders BJ, Jones JE, Ehrlich Y, Ludlow JB, et al. Pediatric phantom dosimetry of Kodak 9000 cone-beam computed tomography. Pediatr Dent. 2017;39(3):229–32.PubMed
Metadata
Title
Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review
Authors
J. W. G. Van Acker
N. S. Pauwels
R. G. E. C. Cauwels
S. Rajasekharan
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Paediatric Dentistry / Issue 4/2020
Print ISSN: 1818-6300
Electronic ISSN: 1996-9805
DOI
https://doi.org/10.1007/s40368-020-00544-8

Other articles of this Issue 4/2020

European Archives of Paediatric Dentistry 4/2020 Go to the issue

Editorial

Editorial