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

  • Head and Neck
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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).

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Abbreviations

μGy:

Microgray

2D:

Two-dimensional

3D:

Three-dimensional

CBCT:

Cone beam computed tomography

CLI:

Central lower incisors

CUI:

Central upper incisors

CV:

Coefficient of variance

ED:

Effective dose

ET:

Extrathoracic tissue

FOV:

Field of view

LAR:

Life attributable risk

LJ:

Lower jaw

mAs:

Milli ampere second product

MC:

Monte Carlo

MDCT:

Multi-detector computed tomography

PL:

Lower premolar

PU:

Upper premolar

RBM:

Red bone marrow

SAD:

Source to axis of rotation distance

SDD:

Source to detector distance

Sv:

Sievert

TCM:

Tube current modulation

TLD:

Thermoluminescent dosimeter

ULJ:

Upper and lower jaw

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Acknowledgements

This work was supported by the European 415 Atomic Energy Community’s Seventh Framework Programme FP7/ 416 2007–2011 under grant agreement No. 604984 (OPERRA: Open 417 Project for the European Radiation Research Area) and by the research fund of KU Leuven (OT/13/109).

Funding

This work was supported by the European 415 Atomic Energy Community’s Seventh Framework Programme FP7/ 416 2007–2011 under grant agreement No. 604984 (OPERRA: Open 417 Project for the European Radiation Research Area) and by the research fund of KU Leuven (OT/13/109).

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Author notes

  1. Andreas Stratis and Hilde Bosmans equally contributed to this work.

Authors and Affiliations

  1. Katholieke Universiteit Leuven, Department of Imaging and Pathology, OMFS-IMPATH Research Group, Campus St. Rafael, Kapucijnenvoer 33, Leuven, 3000, Belgium

    Andreas Stratis & Reinhilde Jacobs

  2. University Hospitals of Leuven, Department of Radiology, Herestraat 49, Leuven, 3000, Belgium

    Andreas Stratis, Guozhi Zhang, Ria Bogaerts & Hilde Bosmans

Authors
  1. Andreas Stratis
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  2. Guozhi Zhang
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  3. Reinhilde Jacobs
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  4. Ria Bogaerts
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  5. Hilde Bosmans
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Corresponding author

Correspondence to Andreas Stratis.

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Guarantor

The scientific guarantor is Prof. Dr. Ir. Hilde Bosmans (hilde.bosmans@uzleuven.be).

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study; this study was based on blind CT image datasets, not on patients themselves.

Ethical approval

YES: Commissie Medische Ethiek van de Universitaire Ziekenhuizen KU Leuven, B322201525196.

Methodology

• Retrospective

• Experimental

• Multicentre study

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Stratis, A., Zhang, G., Jacobs, R. et al. The growing concern of radiation dose in paediatric dental and maxillofacial CBCT: an easy guide for daily practice. Eur Radiol 29, 7009–7018 (2019). https://doi.org/10.1007/s00330-019-06287-5

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  • DOI: https://doi.org/10.1007/s00330-019-06287-5

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