Journal of Radiological Protection

ACCEPTED MANUSCRIPT

Measurement of scattered and transmitted X-rays from intra-oral and

panoramic dental X-ray equipment
To cite this article before publication: John Richard Holroyd et al 2018 J. Radiol. Prot. in press https://doi.org/10.1088/1361-6498/aabce3

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Page 1 of 12 AUTHOR SUBMITTED MANUSCRIPT - JRP-101143.R2

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3 Measurement of Scattered and Transmitted X-rays from Intra-Oral and Panoramic Dental
4 X-ray Equipment
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6 John Holroyd
7
8 Public Health England, Chilton, Didcot, OX11 0RQ

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10 Abstract
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12 Objectives: To quantify the levels of transmitted radiation arising from the use of intra-oral dental
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X-ray equipment and scattered radiation arising from the use of both intra-oral and panoramic X-

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15 ray equipment.
16 Methods: Levels of scattered radiation were measured at 1 m from a phantom, using an 1800 cc
17 ion chamber. Transmitted radiation was measured using both:
18 i) a phantom and Dose Area Product (DAP) meter,
19 ii) a patient and an 1800 cc ion chamber.
20

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Results: For intra-oral radiography the patient study gave a maximum transmission of 1.80%
21
22 (range 0.04% to 1.80%, mean 0.26%) and the phantom study gave a maximum transmission of
23 6% (range 2% to 6%, mean 5%). The maximum scattered radiation, per unit DAP, was 5.5 nGy
24 (mGy cm2)-1 at 70 kVp and a distance of 1 m. For panoramic radiography the maximum scattered
25 radiation was 9.3 nGy (mGy cm2)-1 at 80 kVp and a distance of 1 m.
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Conclusions: Typical doses from scattered and transmitted radiation in modern dental practice
have been measured and values are presented to enable the calculation of adequate protection
measures for dental radiography rooms.
30 Advances in knowledge: Previous studies have used a phantom and measured radiation doses
31 at 1 m from the phantom to determine the radiation dose transmitted through a patient, whereas
32 this study uses both patient and phantom measurements together with a large area dose meter,
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33 positioned to capture the entire X-ray beam, to ensure more realistic dose measurements can be
34 made.
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36
37 1. Introduction
38
39 The use of X-rays for diagnosis in dental practice is a common procedure. As with other uses of
40 ionising radiation, the employer is required to ensure that suitable protection from radiation is
41 provided for staff and for members of the public. The Guidance Notes for Dental Practitioners on
42 the safe use of X-rays (hereafter referred to as the ‘Dental GNs’) provide practical advice for the
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employer on the provision of suitable and sufficient radiation protection measures (NRPB, 2001).
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Protection from X-rays can be provided in three ways: by restricting the radiographic workload
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46 (eg. the number of exposures taken and the exposure factors selected), by using suitable
47 shielding materials to attenuate X-rays or by maintaining a safe distance from the X-ray source.
48 The Dental GNs recommended that for a workload of up to 100 intra-oral X-rays or 50 panoramic
49 X-rays per week, a ‘controlled area1’ should be designated within the primary beam until it has
50 been sufficiently attenuated by distance or shielding and within 1.5 m of an X-ray tube and the
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patient, in any direction. The Dental GNs go on to say that since the beam is not always fully
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attenuated by the patient, ‘it should be considered as extending beyond the patient until it has
54 been intercepted by primary protective shielding, eg a brick wall’. This simplification could lead
55 to unnecessary shielding being installed. The validity of assuming no attenuation by the patient is
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1 As defined in the Ionising Radiations Regulations 1999, an area where ‘special procedures’ are required to
restrict exposure. Outside the controlled area, it can be assumed that no special procedures or additional
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protection measures are required.
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3 tested in this study. The aim of this study was to carry out measurements to quantify the levels of
4 transmitted radiation arising from the use of intra-oral dental X-ray equipment and scattered
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radiation arising from the use of both intra-oral and panoramic X-ray equipment. For panoramic
7 X-ray sets, the primary X-ray beam can be assumed to be fully intercepted by the image receptor
8 and does not contribute to public or occupational exposure.

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10 2. Literature review
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12 The first task of this study was to review the available literature on public and occupational
13 exposure. A summary is presented in this section. The search was restricted to the previous 20

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14 years prior to 2017.
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16 2.1. Intra-oral radiography
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2.1.1. Transmitted radiation
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A search of the literature has identified one publication (Worrall et al., 2012) and one conference
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22 presentation (Berkhout, 2012) on the subject of transmitted radiation through the patient.
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24 Berkhout’s results indicate transmissions of 24%, 33% and 39%, for three different radiographic
25 views, with the highest transmission for a bitewing radiograph. A DXTTR III phantom (Dentsply
26 Rinn; USA) was used to simulate a patient and the transmitted doses were measured using an
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Unfors survey meter (Unfors RaySafe AB; Sweden). Worrall et al (2012) proposed a maximum
value of 0.03% of the patient entrance surface dose at 1 m from the patient for a lateral
radiograph. A solid anthropomorphic head phantom was used to simulate a patient. The patient
30
31
entrance dose was measured using an Unfors Xi solid state detector (Unfors RaySafe AB;
32 Sweden) and the dose at 1 m was measured using a Radcal 1800 cc ionisation chamber
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33 (Radcal; USA). Assuming a 20 cm focus to end of collimator distance and applying the inverse
34 square law, then a dose of 1 mGy at 20 cm would reduce to a dose of 0.03 mGy at 1.2 m. 0.03%
35 of 1 mGy is 0.0003 mGy, which implies a 1.08% transmission. The specific phantom used is
36 unknown.
37
38 The transmission values obtained in these two studies are different by a factor of 36 for similar
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radiographic procedures (bitewing radiograph vs. lateral radiograph). One possible explanation
40
41 for this is that dosemeters of different sizes were used for the two studies. The smaller
42 dosemeter gave the higher transmission value. As the measured beam is likely to be non-
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uniform, due to the different attenuation through different parts of the phantom, it is possible that
44 the smaller detector was positioned to record the highest dose measurement, whereas with the
45 larger detector the dose was averaged over the volume of the detector, giving a lower dose.
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47 Due to the non-uniformity of the X-ray beam transmitted through the patient it would be
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preferable to use a detector which can measure the complete dose profile of the transmitted
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50 radiation.
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52 2.1.2. Scattered radiation

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54 Two papers were identified that considered scattered radiation. One paper considered scattered
55 radiation for a number of radiographic views with the patient in a supine position. The results
56 show a dose of up to 0.1 µGy at 1 m from the patient (Kuroyanagi et al, 1998). Worrall et al
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57 (2012) reported a worst case scatter value of 5 µGy (Gy cm2)-1 at 1 m from the patient. For a
58 typical X-ray set with a patient entrance dose of 1.7 mGy and a 60 mm circular collimator, the
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3 dose area product would be 0.048 Gy cm 2. Using Worrall’s method would give a dose of 0.24
4 µGy at 1 m from the patient, which is reasonably consistent with the results of Kuroyanagi et al.
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6 2.2. Panoramic radiography
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8 Two reports were identified which considered the levels of scattered radiation from panoramic X-

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ray sets. Information was also obtained from a number of manufacturers’ user manuals where
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11 data on scattered radiation was included. A summary of the results is presented in Table 1. In
12 order to directly compare results that were presented using different dose units, the assumptions
13 that 1 milliRoentgen = 8.7 µSv and 1 Sv (equivalent dose) = 1 Gy have been made.

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15 There is a factor of 7 between the highest and lowest values. Each machine is different and will
16 have a different beam size and range of exposure factors, meaning a wide range of scattered
17 radiation levels can be expected. None of these reports gave an indication of patient dose (eg. by
18
providing air kerma or dose area product measurements); therefore the exposure settings used
19
20 may significantly differ from those used in clinical practice. There was also no estimation of

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21 measurement error in these publications.
22
23 Reference X-ray set Exposure settings Maximum Maximum value
24 value at 1 m at 1 m
25 (µGy) (µGy/100mAs)
26 1 Kodak 9000 80 kVp, 150 mAs 2.3 1.5
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2
3
4
Vatech Pax Duo
Sirona Orthophos DS
Planmeca Proline EC
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70 kVp, 121.5 mAs
90 kVp, 169 mAs
64 kVp, 128.1 mAs
0.35
1.9
0.6
0.3
1.1
0.5
30 5 Gendex DP-700 90 kVp, 208 mAs 0.93 0.4
31 6 Carestream CS 8100 76 kVp, 142.8 mAs 1 0.7
32 Table 1 Summary of panoramic scattered doses reported in the literature.1: Carestream Health, Inc, 2008,
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33 2: ProPhysics Innovations, Inc, nd, 3: Neuwirtha and Hefnera, 2008, 4: Gijbels et al, 2005, 5: Gendex
34 Dental Systems, 2013, 6: Carestream Health, Inc, 2012.
35
36 3. Method
37
38 3.1. Transmitted radiation
39
40 Two methods were used to evaluate the transmitted radiation dose. One method used an
41 anthropomorphic phantom and a second method evaluated the dose transmitted through
42 patients.
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44 3.1.1. Phantom study

45
46 A phantom used as a teaching aid for radiography (DXTTR III; Dentsply Rinn, USA) was set up
47 by a qualified radiographer. A phosphor plate was positioned in the phantom’s mouth and the X-
48
ray tube aligned for the radiographic procedure. A dose area product (DAP) meter (VacuDAP
49
50 compact; VacuTec, Germany) was positioned on the opposite side of the phantom to the X-ray
51 tube, to measure the transmitted radiation dose. This instrument was selected as it allows the
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52 complete primary X-ray beam to be captured. The DAP meter was calibrated traceable to a
53 national standard and has a measurement accuracy of +/- 25% as quoted by the manufacturer.
54 As the X-ray beam will be non-uniform following transmission through the phantom, this allowed
55
an accurate dose measurement to be made. Measurements were repeated with and without the
56
phantom in place to determine the attenuation of the phantom. Some additional measurements
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58 were made to mimic poor positioning technique, to see what effect this had on the measured
59 transmitted doses. A limited number of measurements were also made using a real skull
60 encased in plastic to see whether a different phantom changed the transmitted dose.
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Figure 1 The experimental setup for measuring transmission through a phantom
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24 3.1.2. Patient study
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All patients at a private dental practice who had been selected by a dentist for an intra-oral
radiograph during a two week period were included in the study. Patient consent was not
required for this study. The patient was positioned in the dental chair and the X-ray set aligned by
30 the dentist. The X-ray set operated at 60 kVp (measured to be 58.1 kVp) with a circular collimator
31 (the exit beam size measured to be 62 mm in diameter) and 2 mm Al filtration. A qualified dental
32 radiographer positioned the detector on the opposite side of the patient at a distance of 1 m from
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33 the end of the X-ray set director cone. The type of radiograph, gender of the patient and the
34 measured dose were recorded and compared to the dose with no patient in the X-ray beam. The
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dose was measured using a large 1800cc ion chamber (10X5-1800; Radcal, USA) connected to
37 a dosemeter (9010; Radcal, USA). The dosemeter was calibrated traceable to a national
38 standard and has a measurement accuracy of +/-4% as quoted by the manufacturer. The DAP
39 meter, as used in the phantom study, positioned next to the head (Figure 1) was not used in this
40 patient study as this could be uncomfortable for the patient.
41
42 3.2. Scattered radiation
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44 Measurements of scattered radiation were made using the Radcal 1800cc ion chamber and
45 dosemeter. The ion chamber was positioned at various points around a phantom at a distance of
46
1 m from the centre of the phantom. Measurements were made at the height of the phantom and
47
48 for intra-oral exposures, with the X-ray beam directed horizontally as for a bitewing radiograph.
49 The positions of the measurements are shown in Figures 2, 3 and 4.
50
51 3.2.1. Scattered radiation from intra-oral radiography
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53 Intra-oral exposures were made using a Planmeca Pro-X X-ray set (Planmeca Oy, Finland).
54 Exposures were made at two operating potentials, 60 kVp and 70 kVp, and using two collimators,
55 a rectangular collimator measured to be 35 mm x 45 mm and a circular collimator with a diameter
56 of 60 mm. A skull encased in a plastic housing was used to simulate a patient’s head. The
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phantom was positioned on a stand and the X-ray set positioned to capture a bitewing
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59 radiograph.
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12 Front
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14 1m 3
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16 X-ray tube
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23 4 5
24 1
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Figure 2 Locations of measurements for the intra-oral X-ray set

30 3.2.2. Scattered radiation from panoramic radiography

31
32 Panoramic exposures were made using a Planmeca PM2002EC X-ray set (Planmeca Oy,
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33 Finland). Exposure settings of 70 kVp and 80 kVp, 10 mA and 18 seconds were used for the
34 exposures, with a standard 15 cm x 30 cm film loaded in a cassette. A Computed Tomography
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Dose Index (CTDI) head phantom (St Georges NHS Trust, London) was used to simulate a
37 patient’s head.
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47 0.5 m 1m
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C B
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52 E
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60 Figure 3 Locations of measurements for the first panoramic X-ray set
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3 A second set of exposures was conducted on a Vatech Pax-i X-ray set (Vatech, Sutton, UK).
4 This allowed access to three sides of the X-ray unit. The same experimental set up was used
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with exposure settings of 70 kVp and 80 kVp, 10 mA and 10.1 seconds selected. This system
7 utilises a direct digital imaging receptor rather than film.
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Figure 4 Locations of measurements for the second panoramic X-ray set

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31 4. Results
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4.1. Transmitted radiation
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36 4.1.1. Phantom study
37
38 Measurements were made for four standard radiographic views using two operating potentials
39 and two collimators. The operating potential was measured to be within +/- 0.5 kV of the set
40 value using a calibrated Unfors Xi solid state detector (Unfors RaySafe AB; Sweden) with an
41 uncertainty of +/-2%. The circular collimator had a diameter of 59 mm and the rectangular
42 collimator had dimensions of 32 mm x 42 mm.
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3 Operating 1st DAP 2nd DAP Average Unattenuated
4 potential reading reading DAP DAP Transmission
5 Radiograph (kVp) Collimator (µGy.m2) (µGy.m2) (µGy.m2) (µGy.m2) (%)
6
7 Bitewing 60 Rectangular 0.11 0.11 0.11 2.83 4%
8 Bitewing 60 Circular 0.30 0.30 0.30 5.58 5%

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9 Bitewing 70 Rectangular 0.22 0.18 0.20 3.90 5%
10
Bitewing 70 Circular 0.49 0.50 0.50 7.65 6%
11
12 Upper molar 60 Rectangular 0.11 0.10 0.11 2.83 4%
13 Upper molar 60 Circular 0.23 0.22 0.23 5.58 4%

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14 Upper molar 70 Rectangular 0.19 0.19 0.19 3.90 5%
15
16 Upper molar 70 Circular 0.41 0.40 0.41 7.65 5%
17 Lower molar 60 Rectangular 0.10 0.11 0.11 2.83 4%
18 Lower molar 60 Circular 0.25 0.24 0.25 5.58 4%
19
Lower molar 70 Rectangular 0.20 0.19 0.20 3.90 5%
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21 Lower molar 70 Circular 0.45 0.44 0.45 7.65 6%
22 Upper canine 60 Rectangular 0.06 0.06 0.06 2.83 2%
23 Upper canine 60 Circular 0.26 0.26 0.26 5.58 5%
24
25 Upper canine 70 Rectangular 0.12 0.13 0.13 3.90 3%
26 Upper canine 70 Circular 0.42 0.42 0.42 7.65 5%
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29 1st DAP
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Table 2 Results of intra-oral transmitted doses for the phantom study

2nd DAP Average Unattenuated

30 reading reading DAP DAP Transmission
31 Measurement condition collimator (µGy.m2) (µGy.m2) (µGy.m2) (µGy.m2) (%)
32 Poor positioning Circular 1.42 1.45 1.44 7.65 19%
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33 Real skull phantom Circular 0.43 0.43 0.43 7.65 6%
34
35 Real skull phantom Rectangular 0.07 0.06 0.07 3.90 2%
Table 3 Additional measurements for a bitewing radiograph at 70 kVp, simulating a poor patient set up
36
and using a real head skull
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38 4.1.2. Patient study
39
40 Measurements were made for a total of 42 radiographs and the results are presented in Table 4.
41
There was no apparent difference between male and female patients or the type of radiograph
42
43 being taken. The average transmission was 0.27% with a range of 0.04% to 1.80%. Overall, the
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44 measured transmission was lower than that determined from the phantom study, with a wider
45 variation of transmission values. This is considered to be due to the difficulty of positioning the X-
46 ray detector to measure the maximum transmitted dose.
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3 Radiograph Patient gender % Transmitted Radiograph Patient gender %
4 Transmitted
5 PA (37) M 0.13 PA M 0.04
6
7 PA (37) M 0.11 BWL M 0.04
8 PA (37) M 0.24 BW F 0.25

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9 PA (37) M 1.08 PA (17) F 0.39
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PA (47) M 0.20 PA (25) M 0.13
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12 PA (15) F 0.14 PA (36) F 0.16
13 PA (15) F 0.10 PA (25) F 0.25

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14 PA (16) F 0.50 PA (25) F 0.33
15
16 BWL M 0.17 PA (25) F 0.17
17 BWL M 0.58 PA (25) F 0.27
18 BWR M 0.17 PA (25) F 0.22
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PA (26) M 0.07 PA (36) F 0.10

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21 PA (26) M 0.07 PA (36) F 0.06
22 BWR F 0.76 PA (36) F 0.11
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BWR F 0.20 PA (38) M 1.80
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25 PA (16) F 0.11 PA (38) M 0.25
26 PA (16) F 0.10 PA (38) M 0.23
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BWR
BWR
F
F
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0.57
0.11
BWR
BWR
M
M
0.18
0.24
30 BWR M 0.06 BWL M 0.17
31 PA M 0.04 BWL M 0.11
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BWL M 0.04 BWR F 0.25
33
34 Table 4 Measurements made during the patient study of transmitted doses. The types of radiographs are:
BW = bitewing, BWR = right bitewing, BWL = left bitewing, PA(X) = periapical (where X indicates the tooth
35 imaged).
36
37 4.2. Scattered radiation
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39
4.2.1. Scattered radiation from intra-oral radiography
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Table 5 shows the intra-oral scatter measurements. Exposures were made with a 300 mm focus
42
43 to end of collimator distance and using tube current settings of 6 mA. For the 60 kVp exposures
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44 an exposure time of 0.63 seconds was used giving an entrance dose of 1.86 mGy. An exposure
45 time of 0.50 seconds was selected at 70 kVp to give a similar entrance dose of 1.98 mGy. The
46 entrance doses were measured using the Unfors Xi solid state detector with an uncertainty of +/-
47 5% and the operating potential was measured to be within +/- 0.5 kV of the set value.
48
49 Measurement position
50 1 2 3 4 5 6 7
(see Fig 2)
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Collimator kVp Measured dose at each measurement position (nGy)

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53 Circular 70 40 137 33 44 149 127 132
54 (60mm Ø) 60 30 108 15 28 119 97 104
55 70 30 82 24 25 74 68 51
Rectangular
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(35x45mm) 23 64 10 16 56 52 36
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57 60
58 Table 5 Results of intra-oral scattered radiation doses. The maximum value is shown in bold.
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5 4.2.2. Scattered radiation from panoramic radiography
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7 Tables 6 and 7 show the panoramic scatter measurements for two different X-ray sets.
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Measurements were made at operating potentials of 70 kVp and 80 kVp. The tube current time

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10 product and dose area product for each setting is shown in the tables. The DAP values were
11 measured at the image receptor position using the VacuDAP compact DAP meter described
12 above.
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14 Measurement position
A B C D E F
15 (see Fig 3)
16 Exposure setting Measured dose at each measurement position (nGy)
17
70 kVp, 180 mAs
18 --- --- --- 449 465 ---
(DAP = 124 mGy cm2)
19
20 80 kVp, 180 mAs

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459 686 294 642 663 291
21 (DAP = 137 mGy cm2)
22 Table 6 Results of the first panoramic scattered radiation dose measurements. The maximum value is
23 shown in bold.
24
25 Measurement position
26
A B C D E F G
(see Fig 4)
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Exposure setting
70 kVp, 101 mAs
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Measured dose at each measurement position (nGy)

185 220 222 569 586 572

(DAP = 81 mGy cm2)
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31 80 kVp, 101 mAs
32
499 348 363 369 902 964 902
(DAP = 104 mGy cm2)
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33 Table 7 Results of the second panoramic scattered radiation dose measurements. The maximum value is
34 shown in bold.
35
36 The first set of results (Table 6) give a maximum of 0.7 µGy (0.4 µGy per 100 mAs) at 1 m from
37 the phantom. The second set of results (Table 7) gives a maximum of 1.0 µGy (1.0 µGy per 100
38 mAs) at 1 m.
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5. Discussion
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44 5.1. Intra-oral radiography

45
46 The results for the intra-oral scatter measurements agree well with other data presented in the
47 literature.
48
49 The maximum transmission values of 1.08% and 39% reported in the literature for intra-oral
50 radiography are very different and would imply very different shielding requirements for rooms
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containing intra-oral X-ray sets. The maximum transmission value of 6% found in this study falls
52
somewhere in the middle of these values. As the method used in this study ensures the entire
53
54 beam is captured by the detector it should represent an average dose to a person. The methods
55 used in other studies will only capture a small part of the X-ray beam and depending on the
56 positioning this could be a part of the beam that is highly or insignificantly attenuated by the
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57 patient, thus giving very different results. This is also apparent from the patient results in this
58 study, which showed a wide range of transmitted doses, making it difficult to use the patient data
59 to draw conclusions on typical transmitted doses.
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3 The measurements made with the phantom consisting of a real human skull encased in a plastic
4 housing showed similar transmission results for the circular collimator and reduced (5% vs 2%)
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transmission for the rectangular collimator. As this phantom has a closed jaw, it would be
7 expected that more radiation would be attenuated than with a real patient suggesting a likely
8 underestimation of the real transmitted dose.

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10 The results obtained with the phantoms showed higher levels of transmission than those
11 obtained with patients. However, given the difficulty with instrument placement for the patient
12 study, it is possible that those results underestimate the true situation. It is also possible that the
13 phantom does not attenuate as much of the X-ray beam as a patient. To provide a conservative

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14
approach it is suggested that the maximum transmission value from both studies is used, which
15
16 is 6%.
17
18 When a poor technique was simulated (cone misaligned with the film holder and cone not close
19 to patient’s cheek) the transmission increased from 6% to 19%. This highlights the need to
20 ensure equipment is positioned correctly, not only to ensure appropriate diagnostic information is

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21 obtained from the radiograph but also to ensure adequate protection for staff and the public from
22 exposure to X-rays.
23
24 5.2. Panoramic radiography
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The results for the panoramic scatter measurements also agree well with those presented in the
literature. A method to calculate a theoretical panoramic scatter is available (Sutton et al., 2012).
This suggests a maximum scattered dose at 1 m of 4.3 µGy (Gy.cm2)-1 at an operating potential
30 of 70 kVp. Using this method, the maximum scatter value for the first panoramic machine would
31 be 0.53 µGy and for the second panoramic machine would be 0.35 µGy. Compared to the
32 measurements obtained in this study, this represents a significant underestimation for one
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33 machine and so caution should be exercised if using this method.
34
35 5.3. Values recommended for shielding calculations
36
37
5.3.1. Exposure to scattered radiation from intra-oral radiography
38
39
Using the data from Table 5 and adjusting for a patient entrance dose of 1.7 mGy, which is the
40
41 current national diagnostic reference level (NDRL) for an adult mandibular molar radiograph,
42 would give a maximum dose of 0.13 µGy per exposure at 1 m from the patient. This is rounded
43
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up to 0.15 µGy to provide a conservative estimate.

44
45 5.3.2. Exposure to both transmitted and scattered radiation from intra-oral radiography
46
47 Assuming an X-ray set producing a patient entrance dose of 1.7 mGy, as in 5.3.1, with a focus to
48 end of collimator distance of 30 cm and a transmission factor of 6%, this would give a dose of 9.2
49 µGy at 1 m. This is rounded up to 10 µGy.
50
51
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Scattered radiation accounts for less than 10% of the total radiation, therefore, given the
52
conservative assumptions already used, the contribution from scattered radiation can be ignored
53
54 for these calculations.
55
56
5.3.3. Exposure to scattered radiation from panoramic radiography
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57
58
The maximum value of scattered radiation dose at 1 m recorded in Table 7 was 0.96 µGy at 80
59 kVp. If this is adjusted for a DAP of 93 mGy cm2 (the current adult NDRL) this would give a value
60 of 0.86 µGy per exposure at 1 m. For added conservatism this is rounded up to 1 µGy.
Page 11 of 12 AUTHOR SUBMITTED MANUSCRIPT - JRP-101143.R2

1
2
3 5.4. Comparison with current guidance
4
5 With regard to scattered radiation, current guidance (NRPB, 2001) recommends that a controlled
6 area should extend 1.5 metres in all directions from the X-ray tube and patient.
7
8

pt
9
10 5.4.1. Exposure to scattered radiation from intra-oral radiography
11
12 Using the inverse square law, the maximum scattered dose of 0.15 µGy per exposure for a set
13
producing a patient entrance dose of 1.7 mGy would reduce to 0.067 µGy per exposure at a

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14
15 distance of 1.5 m. Based on a workload of 100 exposures per week for 50 weeks of the year a
16 person at the boundary of the controlled area would receive an annual dose of 0.33 mSv
17 (assuming that 1 Gy = 1 Sv). It can be concluded that at 1.5 metres from the X-ray tube head
18 and patient, exposure from scattered radiation would be adequately restricted and hence the
19 results obtained in this study accord with current guidance.
20

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21 5.4.2. Exposure to scattered radiation from panoramic radiography
22
23 Given the dimensions of a panoramic X-ray set, a distance of 1.5 metres from the X-ray tube
24
head and patient will be at least 2 m from the rotational centre as used for the measurements
25
26 presented in section 4.2.2. Using the inverse square law, the maximum scattered dose of 1 µGy
27
28
29
an
per exposure for a set producing a DAP of 93 mGy cm2 would reduce to 0.25 µGy per exposure
at a distance of 2 m. Based on a workload of 50 exposures per week for 50 weeks of the year a
person at the boundary of the controlled area would receive an annual dose of 0.63 mSv
30 (assuming that 1 Gy = 1 Sv). This study indicates that it in some circumstances, exposure from
31 scattered radiation may not be adequately restricted at a distance of 1.5 metres from the X-ray
32
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33
tube.
34
6. Conclusion
35
36
Typical doses to operators and other persons from scattered and transmitted radiation in modern
37
38 dental practice have been measured. The following values are recommended when considering
39 the protection measures required, particularly when calculating shielding requirements for a new
40 dental radiography facility:
41
42 • 0.15 µGy at 1 m from the patient for scattered radiation from an intra-oral set
43
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44
• 10 µGy at 1 m from the patient for transmitted and scattered radiation from an intra-oral
45
46 set
47
48 • 1 µGy at 1 m from the patient for scattered radiation from a panoramic set
49
50 These values are based on patient doses equivalent to the current NDRLs and for intra-oral
51
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radiography using a circular collimator and a 300 mm focus to end of collimator distance. Where
52 specific information is known about the X-ray set (eg, cone length, collimator and dose output),
53
these values can be adjusted accordingly to determine specific shielding requirements for a
54
55 dental surgery.
56
It should be noted, however, that poor technique increases the transmission factor for intra-oral
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57
58 radiography considerably and the value of 10 µGy at 1 m from the patient for transmitted and
59 scattered radiation from an intra-oral set will be an underestimate if the equipment is not
60 positioned correctly.
 AUTHOR SUBMITTED MANUSCRIPT - JRP-101143.R2 Page 12 of 12

1
2
3 References
4
5 Berkhout, E., 2012. Influence of the remnant beam on occupational dose in intraoral radiography.
6
In: EADMFR (European Academy of Dentomaxillofacial Radiologists), 13th European
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8 Congress of Dentomaxillofacial Radiology. Leipzig, Germany, 13-16 June 2012.

pt
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10 Carestream Health, Inc., 2008. Product News KODAK 9000 3D Extraoral Imaging System.
11 France: Carestream Health.
12
13 Carestream Health, Inc., 2012. CS 8100 and CS 8100 Access Safety, Regulatory and Technical

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14 Specifications User Guide. France: Carestream Health.
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16 Gendex Dental Systems, 2013. GXDP-700 Digital Panoramic X-ray System User Manual
17 [207723 Rev 4]. USA: Gendex Dental Systems.
18
19 Gijbels, F., Jacobs, R., Debaveye, D., Bogaerts, R., Verlinden, S. and Sanderink, G., 2005.
20 Dosimetry of digital panoramic imaging. Part II: occupational exposure. Dentomaxillofacial

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Radiology, 34, pp.150–153.
22
23 Kuroyanagi, K., Hayakawa, Y., Fujimofi, H. and Sugiyama, T.,1998. Distribution of scattered
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25
radiation during intraoral radiography with the patient in supine position. Oral Surg Oral Med Oral
26 Pathol Oral Radiol Endod, 85, pp.736-41.
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29 ASSISTANTS.
an
Ministry of Health [New Zealand], n.d. RADIATION PROTECTION for DENTISTS and
Available at:
30 http://www.health.govt.nz/system/files/documents/pages/43.dental_pamphlet.doc [Accessed 3
31 April 2017].
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33 National Radiological Protection Board (NRPB), 2001. Guidance Notes for Dental Practitioners
34 on the Safe Use of X-rays. Oxford: NRPB.
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36 Neuwirtha, J. and Hefnera, A., 2008. Comparison of the local dose of scattered radiation of a
37
special dental phantom and a real human head by using a Digital Volume Tomography (DVT). In:
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39 International Radiation Protection Association (IRPA), 12th Congress of the International
40 Radiation Protection Association (IRPA12). Buenos Aires, Argentina, 19-24 October 2008.
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42 ProPhysics Innovations, Inc., n.d. SCATTER PLOT -Picasso Duo. USA: ProPhysics Innovations,
43 Inc.
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45 Sutton, D.G., Martin, C.J., Williams, J.R. and Peet, D.J., 2012.Radiation Shielding for Diagnostic
46 Radiology. London: British Institute of Radiology.
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48 Worrall, M., McVey, S. and Sutton, D.G., 2012. Proposals for revised factors in intra-oral
49 radiography shielding calculations. J Radiol. Prot., 32, pp.243-249.
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