This document discusses optimization of radiation protection in dental radiology. It describes different types of dental x-ray equipment including intra-oral, panoramic, and cephalometric units. It emphasizes that while individual dental x-ray exposures result in low doses, the frequent nature of exposures poses risks. The document outlines topics to cover which include dental x-ray equipment, radiation protection in dental radiology, and quality control for dental equipment. It provides details on technical specifications and quality control tests that can be performed by dental staff and medical physicists to ensure safe and optimized use of dental radiology equipment.
Brief introduction to the latest innovations that are used at dentistry, where equipment used are fully digitized and computerized, with the differences between using conventional methods and digital equipment in dentistry.
Main equipment to be discussed are dental imaging systems and CAD/CAM systems
Those who administer ionizing radiation must become familiar with the magnitude of exposure encountered in medicine, dentistry and every day life; the possible risks associated with such exposure; and the methods used to affect exposure.
Practitioners should remain informed about safety updates to further improve diagnostic quality of radiographs and decrease radiation exposure.
Brief introduction to the latest innovations that are used at dentistry, where equipment used are fully digitized and computerized, with the differences between using conventional methods and digital equipment in dentistry.
Main equipment to be discussed are dental imaging systems and CAD/CAM systems
Those who administer ionizing radiation must become familiar with the magnitude of exposure encountered in medicine, dentistry and every day life; the possible risks associated with such exposure; and the methods used to affect exposure.
Practitioners should remain informed about safety updates to further improve diagnostic quality of radiographs and decrease radiation exposure.
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2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
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4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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1. IAEA
International Atomic Energy Agency
IAEA Regional Training Course on Radiation
Protection of patients for Radiographers,
Accra, Ghana, 11-15 July 2011
Optimization of Protection in Dental Radiology
2. IAEA 22: Optimization of Protection in Dental Radiology 2
Introduction
• Dental radiology makes use of specific types
of equipment, needed for different purposes.
• Frequent exposures (though each with low
dose) involve a risk for the practitioner and
for the patient
3. IAEA 22: Optimization of Protection in Dental Radiology 3
Dental X-ray equipment
Radiation protection in dental
radiology
Quality control for dental
equipment
Topics
4. IAEA 22: Optimization of Protection in Dental Radiology 4
Dental x-ray equipment: Types of units
• “Intra-Oral” units
• Standard dental tube
• uses an intra-oral image receptor
• has extra-oral x-ray tube
• Panoramic (orthopantomography (OPG))
• Cephalometric ( Ceph)
5. IAEA 22: Optimization of Protection in Dental Radiology 5
Intra-Oral Dental X-Ray Equipment
10. IAEA 22: Optimization of Protection in Dental Radiology 10
Generators & Pre-Heat
• Medium frequency - stable waveform
• Single phase (SP) - pulsed
• Pre-Heat: separate circuit for heating
filament
• Single Phase units without a pre-heat circuit
• initial pulses of variable kV
11. IAEA 22: Optimization of Protection in Dental Radiology 11
Collimator
1. Lead Collimator
with central hole
2. Spacer Tube
12. IAEA 22: Optimization of Protection in Dental Radiology 12
Applicator Cones
Good Bad Bad
14. IAEA 22: Optimization of Protection in Dental Radiology 14
Intra-Oral Dental X-Ray Equipment
(technical data)
Exposure time from 60 ms to 2.5 s
Tube Min. 50 kV, ~7mA
Focal spot size 1 mm
Inherent filtration ~2 mm Al equivalent
Focus-skin distance 20 cm
Irradiated field 28 cm2 with round
section, 6 cm
diameter collimator
15. IAEA 22: Optimization of Protection in Dental Radiology 15
Panoramic X-Ray Equipment
(technical data)
Focal spot 0.5 mm
kV 60 - 80 kV in 2 kV steps
mA 4 - 10 mA steps 4, 5, 6, 8, 10
Exposure time 12 s (standard projections)
0.16 - 3.2 s
(cephalometric projections)
Flat panoramic cassette 15x30 cm (Lanex Regular
screens))
16. IAEA 22: Optimization of Protection in Dental Radiology 16
Image Receptors in Dental Radiology
• Small films (2 x 3 or 3 x 4 cm) in light-tight
envelopes (no screen)
• Digital intraoral sensors - compared with
category E film, the radiation dose is
reduced by 60%.
Intraoral Radiology
Panoramic Radiology and Cephalometry
• Film-screen combination
• Digital sensors - compared with film-
screen sensitivity class 200, the radiation
dose is reduced by 50-70%.
17. IAEA 22: Optimization of Protection in Dental Radiology 17
Dental Radiology Film Types
Sensitivity class D
• Very good spatial resolution
• Typical delivered dose: about 0.5 mGy
• Typical exposure times: 0.3 - 0.7 s
Sensitivity class E
• Good spatial resolution
• Typical delivered dose: about 0.25 mGy
• Typical exposure times: 0.1 - 0.3 s
18. IAEA 22: Optimization of Protection in Dental Radiology 18
Facts
Very frequent examination (about 25% of all
the radiological examinations)
Delivered doses may differ of a factor 2 or 3.
(entrance doses between 0.5 and 150 mGy)
Image Quality often very low
Organs at risk: parathyroid, thyroid, larynx,
parotid glands
Radiation Protection in Dental
Radiology
19. IAEA 22: Optimization of Protection in Dental Radiology 19
Keep under control time and temperature
of the developing process.
Do not use oxydized chemicals
Do not adjust development time by
viewing the film
Quality Control of Film Processing
Technical hints to reduce patient
doses
20. IAEA 22: Optimization of Protection in Dental Radiology 20
Lead apron and collar
•Useful when the path of primary beam
intercepts the protected organs
(downward bite-twin projection).
Technical hints to reduce patient doses
21. IAEA 22: Optimization of Protection in Dental Radiology 21
Panoramic examination
• Image quality not as good as in intra-oral
films
• Important global information
• Relatively low dose
(one panoramic examination 35 intra-oral films)
22. IAEA 22: Optimization of Protection in Dental Radiology 22
Why Dental QC ?
• Widespread use of dental units
• Lack of QC history on most units
• Dental practitioners working in the primary
health care sector do not have the
continuous medical physics support
available in a hospital-based diagnostic
imaging department
23. IAEA 22: Optimization of Protection in Dental Radiology 23
What Tests ?
• Collimation
• Dose Evaluation
• Exposure Time
• Half Value Layer
• Kilovoltage (kVp)
• Leakage Radiation
24. IAEA 22: Optimization of Protection in Dental Radiology 24
The recommended tests are
consequently divided into:
those simple tests which can be
performed by dental practice staff
those more complex tests which can
be carried out by medical physicists.
Quality Control for Dental Equipment
25. IAEA 22: Optimization of Protection in Dental Radiology 25
Quality Control for Dental Equipment
Tests which can be performed by
dental practice staff
Physical parameter Tolerances Frequency
Image Quality ±10% reference
values
Quarterly
Developer
temperature and
condition of
processing solutions
Specified by the film
manufacturer
Every time processing
solutions are used
Processing Base+Fog: >0.2 OD
Speed and Contrast
>0.15 OD about
baseline
Every time processing
solutions are changed
26. IAEA 22: Optimization of Protection in Dental Radiology 26
Quality Control for Dental Equipment
Tests performed by medical physicists
Physical parameter Tolerances Frequency
Tube voltage >50 kV and error
<10%
3 yearly
Beam size/collimation <60 mm diameter
(intra-oral)
<150 x 10 mm at
cassette (panoramic)
3 yearly
Dose at cone tip 50 kV: <5.0 mGy
70 kV: <2.5 mGy
(E speed film)
1-3 yearly
Dose-width product
for panoramic film
<75 mGy mm 1-3 yearly
27. IAEA 22: Optimization of Protection in Dental Radiology 27
Dental QC Methods
Unit
Intra-Oral Receptors
(I/O)
Cephalometric
(Ceph)
Panoramic
(OPG )
Test Method
as for Radiology QC
as for Radiology QC
where possible:
• immobilise unit
• remove slit collimator
28. IAEA 22: Optimization of Protection in Dental Radiology 28
“Dead man” Switch
• timer at 50 cm from focus
• set low kV, mA, long time
• start exposure
• release switch during exposure
Require exposure cut-out when switch is released.
Check exposure time is less than set time
29. IAEA 22: Optimization of Protection in Dental Radiology 29
Dose Evaluation
Skin dose from I/O units:
• place cone 10 mm from dosimeter
• set maxillary molar/ bitewing setting
• Should be (65-70 kVp):
2-3 mGy for molar view
< 5 mGy for any view
31. IAEA 22: Optimization of Protection in Dental Radiology 31
• Keep under control time and
temperature of the developing process.
• Do not use oxidized chemicals
• Regularly check processing with
phantom
Quality Control of Film Processing
34. IAEA 22: Optimization of Protection in Dental Radiology 34
Summary
• Although doses are generally low, the high
frequency of examinations requires radiation
protection (for the practitioner) in dental
radiology
• Some tests are detailed for Quality control of
dental equipment.