Diagnostic reference levels for dental cone-beam computed tomography: current state and way forward

Area of Science:

• Medical Physics
• Radiology
• Dental Imaging

Background:

• Diagnostic Reference Levels (DRLs) are essential for radiation protection in medical imaging.
• Implementing DRLs for dental Cone Beam Computed Tomography (CBCT) presents challenges due to international variability.
• Existing DRLs lack standardization in methodologies and reporting practices.

Purpose of the Study:

• To provide a comprehensive overview of current DRLs for dental CBCT across multiple countries.
• To identify and analyze the variability in DRLs based on field of view and clinical application.
• To highlight challenges and propose recommendations for harmonizing DRLs globally.

Main Methods:

• A survey was conducted among members of the Dental Imaging Special Interest Group of the European Federation of Organizations for Medical Physics.
• Data collection focused on official DRL documentation and peer-reviewed publications from 33 countries.
• DRLs were analyzed using classification schemes based on Field of View (FOV) dimensions and clinical application.

Main Results:

• Official DRLs were identified in 11 countries, with significant variations in values and methodologies.
• DRLs ranged from 200 mGy·cm² (single jaw quadrant) to 1150 mGy·cm² (paranasal sinuses) based on clinical application.
• FOV-based DRLs varied from 500 mGy·cm² (≤25 cm²) to 1960 mGy·cm² (>100 cm²).
• The United Kingdom was the only country with pediatric-specific DRLs.

Conclusions:

• There is substantial variability in dental CBCT DRLs internationally, complicating comparisons and radiation safety efforts.
• Harmonization of DRLs is essential for improving radiation safety and optimizing CBCT practices worldwide.
• International collaboration, standardized dose metrics, and enhanced training are critical for evidence-based DRL implementation.