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口腔颌面诊断影像学中的剂量、获益、安全性和风险。

Doses, Benefits, Safety, and Risks in Oral and Maxillofacial Diagnostic Imaging.

机构信息

University of Connecticut School of Dental Medicine, Division of Oral and Maxillofacial Diagnostic Sciences, Section of Oral and Maxillofacial Radiology, 263 Farmington Avenue, Farmington, CT 06030-1605.

出版信息

Health Phys. 2019 Feb;116(2):163-169. doi: 10.1097/HP.0000000000001030.

Abstract

Diagnostic imaging is essential in dentistry. Doses range from low to very low, benefits to patients can be immense, and safe techniques are well known but widely ignored. Doses range from very low with properly executed intraoral, cephalometric, and panoramic imaging to higher than multidetector computed tomography with cone-beam computed tomography. Benefits are substantial: imaged dental disease, often obscured from direct vision by size and anatomy, can pose a mortal threat to the patient. Additionally, imaging is often central in planning complex dental procedures. Safe imaging in dental environments is straightforward; the means for minimizing dose and maximizing diagnostic efficacy have been widely and inexpensively available for decades. Such techniques reduce patient dose by some 80% over traditional techniques but are infrequently used. Digital panoramic equipment reduces doses markedly. For cone-beam computed tomography imaging, selection criteria are critical in defining appropriate fields of view and presets; several publications address this. It is treacherous to discuss risk in oral and maxillofacial radiology. There are more than 330 million dental x-ray examinations annually, the majority being intraoral examinations, with steady increases in panoramic and cone-beam computed tomography. Radiation carcinogenesis from conventional imaging is unlikely, while large field-of-view, high-resolution preset cone-beam computed tomography can be comparable in carcinogenesis risk to craniofacial multidetector computed tomography. Uncertainties in risk estimation from low doses coupled with the huge numbers of dental images taken annually and the rapid growth of cone-beam computed tomography dictate that safe oral and maxillofacial imaging is in the interests of patients, staff, and the public. As low as reasonably achievable (ALARA) practices and linear no-threshold risk modeling continue to be prudent and appropriate.

摘要

诊断影像学在牙科中至关重要。剂量范围从低到非常低,患者获益可能非常大,并且安全技术众所周知但广泛被忽视。剂量范围从通过正确执行口腔内、头颅侧位和全景成像的非常低到高于多排 CT 的锥形束 CT。获益是实质性的:通过成像检测到的常常由于大小和解剖结构而从直接视野中隐藏的牙科疾病可能对患者构成致命威胁。此外,成像在复杂牙科手术的计划中通常是核心。在牙科环境中进行安全成像很简单;几十年来,已经广泛且廉价地提供了用于最小化剂量和最大化诊断效果的手段。这些技术将患者剂量降低约 80%,但很少使用。数字全景设备可显著降低剂量。对于锥形束 CT 成像,选择标准对于定义适当的视野和预设至关重要;有几篇出版物讨论了这一点。在口腔颌面放射学中讨论风险是危险的。每年进行超过 3.3 亿次牙科 X 射线检查,其中大多数是口腔内检查,全景和锥形束 CT 的数量稳步增加。常规成像的辐射致癌风险不太可能,而大视野、高分辨率预设锥形束 CT 的致癌风险可与颅颌面多排 CT 相媲美。低剂量风险估计中的不确定性,加上每年拍摄的大量牙科图像以及锥形束 CT 的快速增长,都表明安全的口腔颌面成像符合患者、工作人员和公众的利益。尽可能低的合理可行(ALARA)实践和线性无阈值风险建模继续是谨慎和适当的。

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