Radiation protection in dental radiology - Recent advances and future directions.

Dental radiology uses X-ray technology to diagnose and design treatment of various clinical problems related to the oral cavity and surrounding tissues. As technology quickly evolves, there are numerous X-ray modalities using different tools in the attempt to best image and treat efficiently these diseases, disorders or other related clinical conditions. The reported numbers of dental X-rays, the fact that these may be under-reported in many countries and because dental X-rays are performed more on younger individuals, whose teeth and dentition are still developing, calls for increased need on radiation protection. The objectives of this paper are to report on the latest technology updates and related radiation protection issues, to present future directions and define gaps. Most of existing radiation protection national and international guidelines are more than a decade old. Update is needed to account for newer technologies such as cone beam computed tomography (CBCT) and digital imaging. Diagnostic Reference Levels (DRLs), a well established method for dose optimization, are not yet defined for CBCT and have to be set for various clinical indications. As far as shielding is concerned, recent data confirm that use of lead apron, even in pregnant patients, or gonadal shielding are not recommended, due to negligible radiation dose reduction. Thyroid lead shielding should be used in case the organ is in or close to the primary beam. Specifically for CBCT, leaded glasses, thyroid collars and collimation (smaller field of view (FOV) especially for paediatric patients) minimize the dose to organs outside the FOV.