Patient risk related to common dental radiographic examinations - The impact of 2007 International Commission on Radiological Protection recommendations regarding dose calculation

Background. In 2007, the International Commission on Radiological Protection (ICRP) revised estimates of the radiosensitivity of tissues including those in the maxillofacial region. The authors conducted a study to reassess patients' risk related to common dental radiographic exposures using the 2007 ICRP recommendations. Methods. The authors used a tissue-equivalent head phantom to measure dose. They calculated effective doses by using both 1990 and revised. 2007 ICRP recommendations. Effective dose is a calculation that takes into consideration the different sensitivities of organs to long-term effects from ionizing radiation. It is the preferred method for comparing doses between different types of exposures. Results. Effective doses (per the 2007 ICRP) in microsieverts were as follows: full-mouth radiographs (FMX) with photo-stimulable phosphor (PSP) storage or F-speed film with rectangular collimation, 34.9 mu Sv; four-image posterior bitewings with PSP or F-speed film with rectangular collimation, 5.0 mu Sv; FMX using PSP or F-speed film with round collimation, 170.7 mu Sv; FMX with D-speed film and round collimation, 388 mu Sv; panoramic Orthophos XG (Sirona Group, Bensheim, Germany) with charge-coupled device (CCD), 14.2 mu Sv; panoramic ProMax (Plannieca, Helknki, Finland) with CCD, 24.3 mu Sv; posteroanterior cephalogram with PSP, 5.1 mu Sv; and lateral cephalograrn with PSP, 5.6 mu Sv. These values are 32 to 422 percent higher than those determined according to the 1990 ICRP guidelines. Conclusions. Although radiographs are an indispensable diagnostic tool, the increased effective doses of common intraoral and extraoral imaging techniques are high enough to warrant reconsideration of means to reduce patients' exposure. Clinical Implications. Clinicians can reduce patients' dose substantively by using digital receptors or F-speed film instead of D-speed film, rectangular collimation instead of round collimation and radiographic selection criteria.