Methods to Reduce

Radiation Exposure
 Guideline Principles for Radiation
Protection
• Justification- The dentist should identify situations where the benefit
to a patient from diagnostic exposure likely exceeds the risk of harm.

• Optimization- the dentist should use every reasonable means to

reduce unnecessary exposure to their patients , their staff, and
themselves.

ALARA- As Low As Reasonably Achievable

• Dose Limitation-This principle applies to dentist and their staff who
are exposed occupationally but not to patients because there are no
dose limits for individuals exposed for diagnostic purposes.
 Patient Protection
• Patient Selection Criteria- radiographic screening for the
purpose of detecting disease before clinical examination should not
be performed. A through clinical examination consideration of
patient history, review of any prior radiograph, caries risk assessment,
and consideration of both dental and the general health needs of the
patient sould preecede radiographic examination(ADA 2012).
ADA Patient selection Criteria
 Film and Digital Imaging
Good radiologic practice includes use of the fastest image receptor compatible
with the diagnostic task (F-speed film or digital) (ADA 2012).
 Intensifying Screens and Films
Rare-earth intensifying screens are recommended combined with high-
speed film of 400 or greater (ADA 2006).
 Source-to-Skin Distance

• Use of long source-to-skin

distances of 40 cm, rather than
short distances of 20 cm,
decreases exposure by 10 to 25 %.
Distances between 20 cm and 40
cm are appropriate, but the longer
distances are optimal (ADA 2006).
 Rectangular Collimation
• Since a rectangular collimator
decreases the radiation dose by
up to five-fold as compared with
a circular one, radiographic
equipment should provide
rectangular collimation for
exposure of periapical and
bitewing radiographs (ADA
2012).
Filtration
Federal regulations in the United States require the total filtration in the
path of a dental x-ray beam to be equal to the equivalent of 1.5 mm of
aluminum for a machine operating at 50 to 70 kVp and 2.5 mm of
aluminum for machines operating at higher voltages.

Protective Aprons and Thyroid Collars

 Film and Sensor Holder
Film holders that align the film precisely with the collimated beam are
recommended for periapical and bitewing radiographs (ADA 2006).
Kilovoltage :The optimal operating potential of
dental x-ray units is between 60 and 70 kVp (ADA
2012).

Milliampere-Seconds : The operator should set the

amperage and time settings for exposure of dental radiographs of
optimal quality (ADA 2006).
 Film Processing
• All film should be processed following the film and processer
manufacturer recommendations. Poor processing technique,
including sight-developing, most often results in underdeveloped
films, forcing the x-ray operator to increase the dose to compensate,
resulting in patient and personnel being exposed to unnecessary
radiation (ADA 2012).

• Use automatic film processing machines to reduce human errors.

 Personnel Protection
• Operators of radiographic equipment should use barrier
protection when possible, and barriers should contain a
leaded glass window to enable the operator to view the
patient during exposure. When shielding is not possible,
the operator should stand at least two meters from the
tube head and out of the path of the primary beam (ADA
2006).

• Primary barriers such as walls or mobile lead barriers provide the most effective
method to protect the operator from primary and scattered radiation. The
exposure switch should be located behind this barrier. The barrier should have a
leaded window and allow the operator to maintain visual and verbal contact with
the patient during the exposure.
 Position-And-Distance Rule
The operator should stand at least 6 feet (2 m) from the patient, at an
angle of 90 to 135 degrees to the central ray of the x-ray beam
 Handheld Radiographic Personnel Monitoring Devices
Devices
The ADA recommends that workers who may receive
an annual dose greater than 1 mSv should wear
personal dosimeters to monitor their exposure levels.
Pregnant dental personnel operating x-ray equipment
should use personal dosimeters, regardless of
anticipated exposure levels (ADA 2012).
OSLD

A backscatter shield is incorporated into the device at

the end of the collimator ring and provides a zone
where scattered radiation is negligible.
 Recomended Dose Limit
NCRP ICRP
Occupational Exposure
Annual 50 mSv/year 20 mSv, averaged over defined 5-year periods
effective dose
Cumulative 10 mSv × age 100 mSv in 5 years and should not exceed 50 mSv in any
effective dose single year
Annual
equivalent
dose:
Lens of eye Absorbed dose of 50 20 mSv, averaged over defined 5-year periods, and
mGy exposure in any single year should not exceed 50 mSv
Skin 500 mSv 500 mSv
Hands
and feet
Pregnant 0.5 mSv/month to 1 mSv to the embryo/fetus after declaration of
workers embryo-fetus pregnancy
Public Exposure
Annual 1 mSv (continuous
effective dose or frequent 1 mSv
exposure)
5 mSv (infrequent
exposure)
Annual
equivalent
dose in:
Lens of eye 15 mSv 15 mSv
Skin 50 mSv 50 mSv
 Quality Assurance
• Quality assurance protocols for the x-ray machine, imaging receptor,
film processing, dark room, and patient shielding should be developed
and implemented for each dental health care setting (ADA 2012).

• Quality assurance is defined as a program for periodic assessment of

the performance of all parts of the radiologic procedure. It is intended
to ensure that a dental office consistently produces high-quality images
with minimum exposure to patients and personnel.