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.
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Acknowledgements
We thank Prof Johan Aps, (Univ Western Australia, Division Oral Diagnostic & Surgical Sciences, Perth, WA, Australia) for feedback on construction of the search strategy and feedback on the preliminary manuscript. Dr Ellen de Schepper, (Biostatistics Unit, Department of Public Health, Ghent University, Ghent) for the work on the statistical analysis.
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This study did receive partial funding from the EAPD, providing the licence to the reviewing software used for study selection. A small part of the financing was utilised for the purchase of necessary literature.
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JWGVA is the guarantor, JWGVA, SR and NP drafted the protocol. JWGVA and NP developed the search strategy with feedback from all authors. JWGVA and SR performed the selection of the articles. JWGVA and SR performed data extraction. JWGVA and SR performed the quality assessment. All authors read, provided feedback and approved the final manuscript.
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The authors declare no conflict of interest. Ghent University (UGent) is the Sponsor of this study. The EAPD and UGent are not involved in any other aspect of the project, such as the design of the project’s protocol and analysis plan, the collection, analyses and interpretation of the study results. This manuscript is one of the four systematic reviews that form the base for the renewal of the ‘EAPD guidelines for use of radiographs in children’ (Espelid et al. 2003). The policy document distracted from this review is a policy document on clinical practice and future research on the topic and is published open access on the EAPD website (http://www.eapd.eu/index.php/policies-and-guidelines). The protocol and preliminary results of this study were communicated on the 11th EAPD interim seminar (3–4 May 2019) to representatives of organisations in paediatric dentistry.
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Van Acker, J.W.G., Pauwels, N.S., Cauwels, R.G.E.C. et al. Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review. Eur Arch Paediatr Dent 21, 463–508 (2020). https://doi.org/10.1007/s40368-020-00544-8
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DOI: https://doi.org/10.1007/s40368-020-00544-8