OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals of Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
Clin Oral Investig. 2018 May;22(4):1783-1793. doi: 10.1007/s00784-017-2274-0. Epub 2017 Nov 29.
The objective of the study was to compare estimates of pediatric cumulative exposure and lifetime attributable risk (LAR) of radiation-induced cancer from dental radiology between cleft palate (CP) subjects and age- and gender-matched controls (non-CP), with and without orthodontic treatment.
The radiation exposure frequency of CP subjects and non-CP controls with and without orthodontic treatment was compared for two-dimensional radiography (intra-oral, panoramic and cephalometric radiography), computed tomography (CT), and cone-beam CT (CBCT) using cumulative radiation dose as an estimate. From this dose estimate, the age- and gender-dependent risk for radiation-induced stochastic effects was calculated for each patient group.
CP patients received more radiographic examinations than non-CP controls, with the exception of intra-oral radiographs. The cumulative dose to CP patients was considerably higher (1963 μSv at the age of 20 years) than non-CP patients with (597 μSv) and without (383 μSv) orthodontic treatment, primarily due to the higher frequency of CT scanning. Accordingly, CP patients had a three to five times higher LAR than non-CP patients.
This study suggests a significantly higher lifetime radiation exposure to CP patients than non-CP controls from dental radiographic procedures. Diagnostic benefits from the use of CT and CBCT in children must be justified and appropriate dose optimization strategies implemented.
The present study indicates the need for proper justification and optimization of pediatric exposures in dentistry, with a special focus on high-risk groups.
本研究旨在比较伴有和不伴有正畸治疗的腭裂（CP）患者与年龄和性别匹配的对照组（非 CP）患者的牙科放射学累积辐射暴露和终生归因风险（LAR）估计值，以评估儿童辐射诱导癌症的风险。
通过累积辐射剂量评估，比较 CP 患者和非 CP 对照组患者（伴有和不伴有正畸治疗）的二维放射学（口腔内、全景和头颅侧位放射摄影）、计算机断层扫描（CT）和锥形束 CT（CBCT）的辐射暴露频率。根据该剂量估计值，计算了每个患者组的年龄和性别依赖性辐射诱导随机效应风险。
CP 患者接受的影像学检查次数多于非 CP 对照组，除口腔内 X 光片外。CP 患者的累积剂量明显高于非 CP 患者（CP 患者 20 岁时为 1963 μSv，非 CP 患者伴有正畸治疗时为 597 μSv，不伴有正畸治疗时为 383 μSv），这主要是由于 CT 扫描的频率较高。因此，CP 患者的 LAR 比非 CP 患者高 3 到 5 倍。
本研究表明，CP 患者在牙科放射学检查中的终生辐射暴露明显高于非 CP 对照组。在儿童中使用 CT 和 CBCT 必须有明确的诊断益处，并应实施适当的剂量优化策略。
本研究表明，需要在牙科领域对儿科的辐射暴露进行适当的正当性和优化，特别关注高风险群体。
