Abstract
Introduction: Dental X-rays are one of the most frequent medical exposures to ionizing radiation. The use of
ionizing radiation is associated with a probable risk of triggering adverse biological effects and possible damage to the patient’s health. To prevent patients from receiving unnecessarily high doses during these exposures, the International Commission on Radiological Protection recommends the use of diagnostic reference levels as an effective tool to help optimize radiological protection for patients. Objective: To estimate diagnostic reference levels in intraoral and panoramic dental radiography in the city of Bogotá, D.C. Methodology: In 68 periapical dental radiography equipment and 23 panoramic radiography equipment, the radiographic exposure parameters of the equipment and image quality were evaluated. The dosimetric magnitudes of incident air kerma (Ka,i) in intraoral equipment for the radiography of a maxillary molar of an adult and the air kerma-area product (PKA) in panoramic radiography equipment in a standard adult examination were estimated. Results: The third quartile of the incident air kerma distribution for intraoral radiography was 3,3 mGy and the air kerma-area product for panoramic radiography was 103,9 mGy·cm2. In the frequency distribution of incident air kerma for intraoral radiography, the highest percentage of equipment was in the range of 2,0–3,0 mGy, and in the frequency distribution of the air kermaarea product for equipment of panoramic radiography, the highest percentage of the equipment was in the range of 60 to 80 mGy cm2 . Discussion: The institutions considered to establish the diagnostic reference levels in this study had an adequate quality of the image evaluated with a dental phantom, but the variations in radiation doses between institutions indicate the need to implement tools that contribute to the optimization of the practices. Conclusions: It is recommended to use the values of the diagnostic reference levels found in this research to optimize radiological protection in dental radiological exposures, and it is expected that this study will serve as a basis for further research in other cities of the country.
References
Nations Scientific Committee on the Effects of Atomic Radiation U. Source and Effects of Ionizing Radiation Nations Scientific Committee on the Effects of Atomic Radiation UNSCEAR 2000 Report to the General Assembly, with Scientific Annexes [Internet]. Vol. 1: Sources. 200AD. New York: UNSCEAR; 2000. 659 p. doi: https://doi.org/10.18356/49c437f9-en
Wilches Visbal JH, Castillo Pedraza MC, Khoury HJ. Protección Radiológica en Radiología Dental. CES Odontol [Internet]. 2021 [citado 2023 abril 26]; 34(1): 52-67. doi: https://doi.org/10.21615/cesodon.34.1.6
Horner K, Rushton V, Tsiklakis K, Hisrchmann PN. European guidelines on radiation protection in dental radiology; the safe use of radiographs in dental practice. European Commission, Directorate-General for Energy and Transport [Internet]. Copenhagen: European Comission; 2004. Available from: https://www.researchgate.net/publication/254767872_European_guidelines_on_radiation_protection_in_dental_radiology_the_safe_use_of_radiographs_in_dental_practice_European_Commission_Directorate-General_for_Energy_and_Transport
Ubeda C, Nocetti D, Aragón M, Aragón G, Aragón D, Medina O. Niveles de Referencia para Diagnóstico en Procedimientos Radiológicos Dentales: Una Guía Práctica. Int J Odontostomat [Internet]. 2020; 14(4): 610-616. doi: http://dx.doi.org/10.4067/S0718-381X2020000400610
The International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection. Ann IRCP [Internet]. 2007; 37(2-4). Available from: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_37_2-4
The International Commission on Radiological Protection. Ethical Foundations of the System of Radiological Protection. Ann IRCP [Internet]. 2018; 47(1). Available from: https://www.icrp.org/publication.asp?id=ICRP%20Publication%20138
Shore RE, Beck HL, Boice JD, Caffrey EA, Davis S, Grogan HA, et al. Implications of recent epidemiologic studies for the linear nonthreshold model and radiation protection. J Radiol Prot [Internet]. 2018; 38(3): 217-1233. doi: https://doi.org/10.1088/1361-6498/aad348
Serra HA, Ramírez MC, Véliz HJ, Salas MI, Pérez AJ, Vera MF, et al. Valores típicos de dosis para tomografía computada de cerebro en pacientes adultos. Rev Chil Radiol [Internet]. 2020 [citado 2023 abril 26]; 26(1): 25-31. doi: http://dx.doi.org/10.4067/S0717-93082020000100025
Amaya Ríos E, Muñoz Arango E. Determinación de los niveles de referencia de dosis (DRL) para diagnóstico de baja y media complejidad en Servicios Especiales de Salud Hospital Universitario de Caldas de Colombia (SES-HUC). Rev. Investig. Apl. Nucl [Internet]. 2021; 5: 84-98. doi: https://doi.org/10.32685/2590-7468/invapnuclear.5.2021.604
The International Commission on Radiological Protection. Radiological Protection and Safety in Medicine. Ann IRCP [Internet]. 1996; 26(2). Available from: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_37_2-4
Hart D, Hillier MC, Wall BF. Doses to patients from radiographic and fluoroscopic X-ray imaging procedures in the UK - 2005 review. Health Protection Agency [Internet]. London: HPA; 2007 [cited 2023 Apr 26]. 81 p. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/431134/HPA-RPD-029.pdf
Resolución 482 de 2018. Por la cual se reglamenta el uso de equipos generadores de radiación ionizante, su control de calidad, la prestación de servicios de protección radiológica y se dictan otras disposiciones. Ministerio de Salud y Protección Social [Internet]. Bogotá; MSPS; 2018. [citado 2023 abril 26]. Disponible en: http://normograma.supersalud.gov.co/normograma/docs/resolucion_minsaludps_0482_2018.htm
Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, et al. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Ann ICRP [Internet]. 2017; 46(1): 1-144. doi: https://doi.org/10.1177/0146645317717209
International Atomic Energy Agency of Vienna. Dosimetry in diagnostic radiology: An international code of practice. Technical reports series No. 457 IAEA [Internet]. 2007 [cited 2023 Apr 26]. 359 p. Available from: https://www.iaea.org/publications/7638/dosimetry-in-diagnosticradiology-an-international-code-of-practice
Registro Especial de Prestadores de Servicios de Salud - REPS. Ministerio de Salud y Protección Social [Internet]. 2022 [citado febrero 21 2022]. Disponible en: https://prestadores.minsalud.gov.co/habilitacion/
Acuerdo Regional de Cooperación para la Promoción de la Ciencia y Tecnología Nucleares en América Latina y el Caribe, Organismo Internacional de Energía Atómica. Protocolos de control de calidad en radiodiagnóstico [Internet]. 2001 [citado abril 26 2023]. Disponible en https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/MET/arcal-49-protocolo-cc.pdf?ID=16589
European Union. Diagnostic Reference Levels in Thirty-six European Countries. Part 2/2. Radiation Protection N° 180 [Internet]. Luxembourg: Publications Office of the European Union, 2014 [cited 2023 Apr 26]. 73 p. Available from: http://www.eurosafeimaging.org/wp/wp-content/uploads/2015/05/Radiation-protection-180-part2.pdf
Nocetti D, Ubeda C, Villalobos K. Niveles de referencia para diagnóstico locales en procedimientos radiográficos dentales periapicales. Primeros valores para Chile Local. Int J Odontostomat [Internet]. 2021; 15(1): 196-203. doi: http://dx.doi.org/10.4067/S0718-381X2021000100196
Lubis LE, Bayuadi I, Bayhaqi YA, Ardiansyah F, Setiadi AR, Sugandi RD, et al. Radiation dose from dental radiography in Indonesia: A five-year survey. Radiat Prot Dosimetry [Internet]. 2019 [cited 2023 Apr 26]; 183(3) :347-347. doi: https://doi.org/10.1093/rpd/ncy123
Hodolli G, Kadiri S, Nafezi G, Bahtijari M, Syla N. Diagnostic reference levels at intraoral and dental panoramic examinations. Int J Radiat Res. [Internet]. 2019 [cited 2023 Apr 26]; 17(1): 147-150.
Jose A, Kumar AS, Govindarajan KN, Sharma SD. Assessment of regional diagnostic reference levels in dental radiography in Tamil Nadu. J Med Phys [Internet]. 2022 [cited 2023 Apr 26]; 47(1): 86-92. doi: https://www.doi.org/10.4103/jmp.jmp_119_21
Suliman II, Abdelgadir AH. Patient radiation doses in intraoral and panoramic X-ray examinations in Sudan. Phys Medica [Internet]. 2018; 46: 148-152. doi: https://doi.org/10.1016/j.ejmp.2018.01.017
Alcaraz M, Velasco F, Olivares A, Velasco E, Canteras M. Dose reference levels in Spanish intraoral dental radiology: Stabilisation of the incorporation of digital systems in dental clinical practices. Radiat Prot Dosimetry [Internet]. 2016 [cited 2023 Apr 26]; 172(4): 422-427. doi: https://doi.org/10.1093/rpd/ncv508
Walker C, van der Putten W. Patient dosimetry and a novel approach to establishing Diagnostic Reference Levels in dental radiology. Phys Medica [Internet]. 2012; 28(1): 7-12. doi: http://dx.doi.org/10.1016/j.ejmp.2010.12.003
Han S, Lee B, Shin G, Choi J, Kim J, Park C, et al. Dose area product measurement for diagnostic reference levels and analysis of patient dose in dental radiography. Radiat Prot Dosimetry [Internet]. 2012; 150(4): 523–531. doi: https://doi.org/10.1093/rpd/ncr439
Alcaraz M, Velasco F, Martínez-Beneyto Y, Alcaraz-Saura M, Velasco E, Achel GD, et al. Evolution of diagnostic reference levels in Spanish intraoral radiology. Radiat Prot Dosimetry [Internet]. 2012 [cited 2023 Apr 26]; 151(1): 166-171. doi: https://www.doi.org/10.1093/rpd/ncr467
Hart D, Hillier MC, Wall BF. National reference doses for common radiographic, fluoroscopic and
dental X-ray examinations in the UK. Brit J Radiol. [Internet]. 2009 [cited 2023 Apr 26]; 82(973): 1-12.
doi: https://www.doi.org/10.1259/bjr/12568539
Tierris CE, Yakoumakis EN, Bramis GN, Georgiou E. Dose Area Product reference levels in dental panoramic radiology. Radiat Prot Dosimetry [Internet]. 2004 [cited 2023 Apr 26]; 111(3): 283-287. doi: https://www.doi.org/10.1093/rpd/nch341
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