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European Radiology
Published in: European Radiology 12/2019

01-12-2019 | Digital Volume Tomography | Head and Neck

The growing concern of radiation dose in paediatric dental and maxillofacial CBCT: an easy guide for daily practice

Authors: Andreas Stratis, Guozhi Zhang, Reinhilde Jacobs, Ria Bogaerts, Hilde Bosmans

Published in: European Radiology | Issue 12/2019

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Abstract

Objectives

To provide an indication-based and scanner-specific radiation dose and risk guide for paediatric patients undergoing dental and maxillofacial cone beam computed tomography (CBCT) examinations.

Methods

Five commercially available scanners were simulated in EGSnrc Monte Carlo (MC) code. Dedicated, in-house built, head and neck voxel models, each consisting of 22 segmented organs, were used in the study. Organ doses and life attributable risk (LAR) for cancer incidence were assessed for males and females, aged 5 to 14 years old, for every clinically available protocol: central upper and lower incisors, upper and lower premolars, upper and lower jaws, cleft palate, temporal bone, sinus, dentomaxillofacial complex, and face and skull imaging. Dose results were normalised to the x-ray tube load (mAs) and logarithmic curves were fit to organ dose and risk versus age data.

Results

Females demonstrated higher LAR values in all cases. A well-established dose decreasing pattern with increasing age-at-exposure was observed. Central upper incisor protocols were those with the lowest risk, contrary to skull protocols which provided the highest LAR values. Salivary glands and oral mucosa were the highest irradiated organs in all cases, followed by extrathoracic tissue (ET) in protocols where the entire nasal cavity was inside the primary field. The dose to thyroid was considerably high for younger patients.

Conclusions

This work provides an extensive dose assessment guide for 5 dental CBCTs, enabling detailed dose assessment for every paediatric patient.

Key Points

• Radiation dose concerns due to the growing use of paediatric dental and maxillofacial CBCT underline the need for justification that should in part be based on radiation exposure in radiology.
• Patient-specific dose calculations based on Monte Carlo simulations and head-neck paediatric voxel models overcome the limitations of conventional thermoluminescent dosimeter (TLD) dosimetry and provide proper guidance for justification of CBCT exposures.
• Monte Carlo simulations with head-neck models reveal an organ dose and radiation risk decreasing pattern with increasing age at exposure, and with decreasing size of the scanning volume of interest (field of view).
Appendix
Available only for authorised users
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Metadata
Title
The growing concern of radiation dose in paediatric dental and maxillofacial CBCT: an easy guide for daily practice
Authors
Andreas Stratis
Guozhi Zhang
Reinhilde Jacobs
Ria Bogaerts
Hilde Bosmans
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06287-5

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