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Factors influencing the effective dose associated with CBCT: a systematic review

  • Wilana da Silva Moura
  • Kelly Chiqueto
  • Gustavo Menezes Pithon
  • Leniana Santos Neves
  • Renata Castro
  • José Fernando Castanha Henriques
Original Article
  • 6 Downloads

Abstract

Introduction

Due to potential impact of the effects of ionizing radiation used in medical and dental examinations on public health in recent years, many studies are being conducted to quantify the radiation dose values, evaluate scanners, and indicate factors that could influence or reduce radiation doses.

Objectives

This study aimed to evaluate, by a systematic review, the factors that influence the effective radiation dose associated with cone beam computed tomography and respective effects, and compared the effective dose of different cone beam computed tomography (CBCT) scanners with similar exposure parameters.

Materials and methods

A search was conducted on five databases from 2007 to 2015.

Results

The search identified 741 abstracts, among which 44 eligible articles were retrieved in full text. Twenty-three studies met the inclusion criteria and were included. Additional copper filter was evaluated in one study, patient size in 2 studies, region of interest in 1 study, use of a thyroid shield in 2 studies, scan angle in 3 studies, exposure time in 10 studies, FOV diameter in 17 studies, FOV height in 17 studies, kV in 16 studies, mA in 18 studies, mAs in 13 studies, voxel in 8 studies, and resolution in 3 studies. When similar exposure parameters were evaluated, it was observed that CBCT scanner with lower effective dose was Kodak® 9000C 3D (mean 21.2 μSv) in selected studies.

Conclusions

Thirteen factors were related to changes in the effective dose emitted by different scanners. More studies are needed to identify the image quality requirements in addition to measure the radiation.

Clinical relevance

Studies that give more information for professionals who request and interpret the exams and for technicians who perform 3D images about effective radiation dose associated with CBCT are necessary.

Keywords

Tomography Radiation exposure measurement Radiation dosage 

Notes

Funding

The work was supported by the researchers themselves.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA (1998) A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol 8:1558–1564CrossRefPubMedGoogle Scholar
  2. 2.
    Garib DG, Raymundo R Jr, Raymundo MV, Raymundo DV, Ferreira SN (2007) Cone beam computed tomography (CBCT): understandind this new imaging diagnostic method with promissing application in orthodontics. Rev Dent Press Ortodon Ortop Facial 12:139–156CrossRefGoogle Scholar
  3. 3.
    De Vos W, Casselman J, Swennen G (2009) Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature. Int J Oral Maxillofac Surg 38:609–625CrossRefPubMedGoogle Scholar
  4. 4.
    Swennen GR, Mollemans W, De Clercq C, Abeloos J, Lamoral P, Lippens F et al (2009) A cone-beam computed tomography triple scan procedure to obtain a three-dimensional augmented virtual skull model appropriate for orthognathic surgery planning. J Craniofac Surg 20:297–307CrossRefPubMedGoogle Scholar
  5. 5.
    Lorenzoni DC, Bolognese AM, Garib DG, Guedes FR, Sant’Anna EF (2012) Cone-beam computed tomography and radiographs in dentistry: aspects related to radiation dose. Int J Dent 2012:813768.  https://doi.org/10.1155/2012/813768 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Craft AW, Parker L, Berrington de González A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Garcia Silva MA, Wolf U, Heinicke F, Grundler K, Visser H, Hirsch E (2008) Effective dosages for recording Veraviewepocs dental panoramic images: analog film, digital, and panoramic scout for CBCT. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:571–577CrossRefPubMedGoogle Scholar
  8. 8.
    Hirsch E, Wolf U, Heinicke F, Silva MA (2008) Dosimetry of the cone beam computed tomography Veraviewepocs 3D compared with the 3D Accuitomo in different fields of view. Dentomaxillofac Radiol 37:268–273CrossRefPubMedGoogle Scholar
  9. 9.
    Ludlow JB, Ivanovic M (2008) Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:106–114CrossRefPubMedGoogle Scholar
  10. 10.
    Palomo JM, Rao PS, Hans MG (2008) Influence of CBCT exposure conditions on radiation dose. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:773–782CrossRefPubMedGoogle Scholar
  11. 11.
    Silva MA, Wolf U, Heinicke F, Bumann A, Visser H, Hirsch E (2008) Cone-beam computed tomography for routine orthodontic treatment planning: a radiation dose evaluation. Am J Orthod Dentofac Orthop 133:640 e641–640 e645CrossRefGoogle Scholar
  12. 12.
    Loubele M, Bogaerts R, Van Dijck E, Pauwels R, Vanheusden S, Suetens P et al (2009) Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol 71:461–468CrossRefPubMedGoogle Scholar
  13. 13.
    Okano T, Harata Y, Sugihara Y, Sakaino R, Tsuchida R, Iwai K, Seki K, Araki K (2009) Absorbed and effective doses from cone beam volumetric imaging for implant planning. Dentomaxillofac Radiol 38:79–85CrossRefPubMedGoogle Scholar
  14. 14.
    Roberts JA, Drage NA, Davies J, Thomas DW (2009) Effective dose from cone beam CT examinations in dentistry. Br J Radiol 82:35–40CrossRefPubMedGoogle Scholar
  15. 15.
    Suomalainen A, Kiljunen T, Kaser Y, Peltola J, Kortesniemi M (2009) Dosimetry and image quality of four dental cone beam computed tomography scanners compared with multislice computed tomography scanners. Dentomaxillofac Radiol 38:367–378CrossRefPubMedGoogle Scholar
  16. 16.
    Jadu F, Yaffe MJ, Lam EW (2010) A comparative study of the effective radiation doses from cone beam computed tomography and plain radiography for sialography. Dentomaxillofac Radiol 39:257–263CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Qu XM, Li G, Ludlow JB, Zhang ZY, Ma XC (2010) Effective radiation dose of ProMax 3D cone-beam computerized tomography scanner with different dental protocols. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:770–776CrossRefPubMedGoogle Scholar
  18. 18.
    Ludlow JB (2011) A manufacturer’s role in reducing the dose of cone beam computed tomography examinations: effect of beam filtration. Dentomaxillofac Radiol 40:115–122CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Davies J, Johnson B, Drage N (2012) Effective doses from cone beam CT investigation of the jaws. Dentomaxillofac Radiol 41:30–36CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Grunheid T, Kolbeck Schieck JR, Pliska BT, Ahmad M, Larson BE (2012) Dosimetry of a cone-beam computed tomography machine compared with a digital x-ray machine in orthodontic imaging. Am J Orthod Dentofac Orthop 141:436–443CrossRefGoogle Scholar
  21. 21.
    Jeong DK, Lee SC, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC (2012) Comparison of effective dose for imaging of mandible between multi-detector CT and cone-beam CT. Imaging Sci Dent 42:65–70CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Pauwels R, Beinsberger J, Collaert B, Theodorakou C, Rogers J, Walker A, Cockmartin L, Bosmans H, Jacobs R, Bogaerts R, Horner K, SEDENTEXCT Project Consortium (2012) Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol 81:267–271CrossRefPubMedGoogle Scholar
  23. 23.
    Qu X, Li G, Zhang Z, Ma X (2012) Thyroid shields for radiation dose reduction during cone beam computed tomography scanning for different oral and maxillofacial regions. Eur J Radiol 81:e376–e380CrossRefPubMedGoogle Scholar
  24. 24.
    Qu XM, Li G, Sanderink GC, Zhang ZY, Ma XC (2012) Dose reduction of cone beam CT scanning for the entire oral and maxillofacial regions with thyroid collars. Dentomaxillofac Radiol 41:373–378CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sezgin Ö, Kayipmaz S, Yasar D, Yilmaz A, Ozturk M (2012) Comparative dosimetry of dental cone beam computed tomography, panoramic radiography, and multislice computed tomography. Oral Radiol 28:32–37CrossRefGoogle Scholar
  26. 26.
    Theodorakou C, Walker A, Horner K, Pauwels R, Bogaerts R, Jacobs R (2012) Estimation of paediatric organ and effective doses from dental cone beam CT using anthropomorphic phantoms. Br J Radiol 85:153–160CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lukat TD, Wong JC, Lam EW (2013) Small field of view cone beam CT temporomandibular joint imaging dosimetry. Dentomaxillofac Radiol 42:20130082CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Rottke D, Patzelt S, Poxleitner P, Schulze D (2013) Effective dose span of ten different cone beam CT devices. Dentomaxillofac Radiol 42:20120417CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Schilling R, Geibel MA (2013) Assessment of the effective doses from two dental cone beam CT devices. Dentomaxillofac Radiol 42:20120273CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ludlow JB, Walker C (2013) Assessment of phantom dosimetry and image quality of i-CAT FLX cone-beam computed tomography. Am J Orthod Dentofac Orthop 144:802–817CrossRefGoogle Scholar
  31. 31.
    PRISMA. Reporting guideline for systematic reviews and metaanalyses; 2009. Available at: http://www.prisma-statement.org/statement.htm. Accessed on June 24, 2015.
  32. 32.
    Grec RH, Janson G, Branco NC, Moura-Grec PG, Patel MP, Castanha Henriques JF (2013) Intraoral distalizer effects with conventional and skeletal anchorage: a meta-analysis. Am J Orthod Dentofac Orthop 143:602–615CrossRefGoogle Scholar
  33. 33.
    Chen Y, Kyung HM, Zhao WT, Yu WJ (2009) Critical factors for the success of orthodontic mini-implants: a systematic review. Am J Orthod Dentofac Orthop 135:284–291CrossRefGoogle Scholar
  34. 34.
    Batista EL Jr, Moreira CC, Batista FC, de Oliveira RR, Pereira KK (2012) Altered passive eruption diagnosis and treatment: a cone beam computed tomography-based reappraisal of the condition. J Clin Periodontol 39:1089–1096CrossRefPubMedGoogle Scholar
  35. 35.
    Koivisto J, Kiljunen T, Tapiovaara M, Wolff J, Kortesniemi M (2012) Assessment of radiation exposure in dental cone-beam computerized tomography with the use of metal-oxide semiconductor field-effect transistor (MOSFET) dosimeters and Monte Carlo simulations. Oral Surg Oral Med Oral Pathol Oral Radiol 114:393–400CrossRefPubMedGoogle Scholar
  36. 36.
    Al-Okshi A, Nilsson M, Petersson A, Wiese M, Lindh C (2013) Using GafChromic film to estimate the effective dose from dental cone beam CT and panoramic radiography. Dentomaxillofac Radiol 42:20120343CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Lofthag-Hansen S, Thilander-Klang A, Ekestubbe A, Helmrot E, Grondahl K (2008) Calculating effective dose on a cone beam computed tomography device: 3D Accuitomo and 3D Accuitomo FPD. Dentomaxillofac Radiol 37:72–79CrossRefPubMedGoogle Scholar
  38. 38.
    Moze G, Seehra J, Fanshawe T, Davies J, McDonald F, Bister D (2013) In vitro comparison of contemporary radiographic imaging techniques for measurement of tooth length: reliability and radiation dose. J Orthod 40:225–233CrossRefPubMedGoogle Scholar
  39. 39.
    Vassileva J, Stoyanov D (2010) Quality control and patient dosimetry in dental cone beam CT. Radiat Prot Dosim 139:310–312CrossRefGoogle Scholar
  40. 40.
    Morant J, Salvadó M, Hernández-Girón I, Casanovas R, Ortega R, Calzado A (2013) Dosimetry of a cone beam CT device for oral and maxillofacial radiology using Monte Carlo techniques and ICRP adult reference computational phantoms. Dentomaxillofac Radiol 42:92555893CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Zhang G, Marshall N, Bogaerts R, Jacobs R, Bosmans H (2013) Monte Carlo modeling for dose assessment in cone beam CT for oral and maxillofacial applications. Med Phys 40:072103CrossRefPubMedGoogle Scholar
  42. 42.
    Chambers D, Bohay R, Kaci L, Barnett R, Battista J (2015) The effective dose of different scanning protocols using the Sirona GALILEOS® comfort CBCT scanner. Dentomaxillofac Radiol 44:20140287CrossRefPubMedGoogle Scholar
  43. 43.
    Carrafiello G, Dizonno M, Colli V, Strocchi S, Pozzi Taubert S, Leonardi A, Giorgianni A, Barresi M, Macchi A, Bracchi E, Conte L, Fugazzola C (2010) Comparative study of jaws with multislice computed tomography and cone-beam computed tomography. Radiol Med 115:600–611CrossRefPubMedGoogle Scholar
  44. 44.
    Gervaise A, Osemont B, Lecocq S, Noel A, Micard E, Felblinger J, Blum A (2012) CT image quality improvement using adaptive iterative dose reduction with wide-volume acquisition on 320-detector CT. Eur Radiol 22:295–301CrossRefPubMedGoogle Scholar
  45. 45.
    Ohman A, Kull L, Andersson J, Flygare L (2008) Radiation doses in examination of lower third molars with computed tomography and conventional radiography. Dentomaxillofac Radiol 37:445–452CrossRefPubMedGoogle Scholar
  46. 46.
    Thongvigitmanee SS, Pongnapang N, Aootaphao S, Yampri P, Srivongsa T, Sirisalee P et al (2013) Radiation dose and accuracy analysis of newly developed cone-beam CT for dental and maxillofacial imaging. Conf Proc IEEE Eng Med Biol Soc 2013:2356–2359PubMedGoogle Scholar
  47. 47.
    Okano T, Matsuo A, Gotoh K, Yokoi M, Hirukawa A, Okumura S, Koyama S (2012) Comparison of absorbed and effective dose from two dental cone beam computed tomography scanners. Nihon Hoshasen Gijutsu Gakkai Zasshi 68:216–225CrossRefPubMedGoogle Scholar
  48. 48.
    Qu XM, Li G, Zhang ZY, Ma XC (2011) Comparative dosimetry of dental cone-beam computed tomography and multi-slice computed tomography for oral and maxillofacial radiology. Zhonghua Kou Qiang Yi Xue Za Zhi 46:595–599PubMedGoogle Scholar
  49. 49.
    Ludlow JB, Timothy R, Walker C, Hunter R, Benavides E, Samuelson DB, Scheske MJ (2015) Effective dose of dental CBCT—a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 44:20140197CrossRefPubMedGoogle Scholar
  50. 50.
    Pauwels R, Zhang G, Theodorakou C, Walker A, Bosmans H, Jacobs R, Bogaerts R, Horner K, The SEDENTEXCT Project Consortium (2014) Effective radiation dose and eye lens dose in dental cone beam CT: effect of field of view and angle of rotation. Br J Radiol 87:20130654CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Soares MR, Batista WO, Antonio Pde L, Caldas LV, Maia AF (2015) Study of effective dose of various protocols in equipment cone beam CT. Appl Radiat Isot 100:21–26CrossRefPubMedGoogle Scholar
  52. 52.
    Ali AS, Fteita D, Kulmala J (2015) Comparison of physical quality assurance between Scanora 3D and 3D Accuitomo 80 dental CT scanners. Libyan J Med 10:28038CrossRefGoogle Scholar
  53. 53.
    Kadesjo N, Benchimol D, Falahat B, Nasstrom K, Shi XQ (2015) Evaluation of the effective dose of cone beam CT and multislice CT for temporomandibular joint examinations at optimized exposure levels. Dentomaxillofac Radiol 44:20150041CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    National Council on Radiation Protection & Measurements (2009) Radiation Protection in Dentistry (Report No. 160). NRCP Publications, BethesdaGoogle Scholar
  55. 55.
    American Academy of Oral and Maxillofacial Radiology (2013) Clinical recommendations regarding use of cone beam computed tomography in orthodontics. Position statement by the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol 116:238–257CrossRefGoogle Scholar
  56. 56.
    Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M (2012) Dental x-rays and risk of meningioma. Cancer 118:4530–4537CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    2007 Recommendations of the International Commission on Radiological Protection. Available at: htpp://www.icrp.org. Accessed April 5, 2015.
  58. 58.
    Thilander-Klang A, Helmrot E (2010) Methods of determining the effective dose in dental radiology. Radiat Prot Dosim 139:306–309CrossRefGoogle Scholar
  59. 59.
    Roberts SK, Weltman MD, Crawford DH, McCaughan GW, Sievert W, Cheng WS et al (2009) Impact of high-dose peginterferon alfa-2A on virological response rates in patients with hepatitis C genotype 1: a randomized controlled trial. Hepatology 50:1045–1055CrossRefPubMedGoogle Scholar
  60. 60.
    Bornstein MM, Scarfe WC, Vaughn VM, Jacobs R (2014) Cone beam computed tomography in implant dentistry: a systematic review focusing on guidelines, indications, and radiation dose risks. Int J Oral Maxillofac Implants 29 Suppl:55–77.  https://doi.org/10.11607/jomi.2014suppl.g1.4 CrossRefPubMedGoogle Scholar
  61. 61.
    Bornstein MM, Horner K, Jacobs R (2017) Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research. Periodontol 2000 73(1):51–72.  https://doi.org/10.1111/prd.12161 CrossRefPubMedGoogle Scholar
  62. 62.
    Hidalgo Rivas JA, Horner K, Thiruvenkatachari B, Davies J, Theodorakou C (2015) Development of a low-dose protocol for cone beam CT examinations of the anterior maxilla in children. Br J Radiol 88(1054):20150559CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Feragalli B, Rampado O, Abate C, Macrì M, Festa F, Stromei F, Caputi S, Guglielmi G (2017) Cone beam computed tomography for dental and maxillofacial imaging: technique improvement and low-dose protocols. Radiol Med 122(8):581–588CrossRefPubMedGoogle Scholar
  64. 64.
    McCollough C, Branham T, Herlihy V, Bhargavan M, Robbins L, Bush K, McNitt-Gray M, Payne JT, Ruckdeschel T, Pfeiffer D, Cody D (2011) Diagnostic reference levels from the ACR CT accreditation program. J Am Coll Radiol 8(11):795–803CrossRefPubMedGoogle Scholar
  65. 65.
    Tonkopi E, Duffy S, Abdolell M, Manos D (2017 May) Diagnostic reference levels and monitoring practice can help reduce patient dose from CT examinations. Am J Roentgenol 208(5):1073–1081CrossRefGoogle Scholar
  66. 66.
    Radiation Protection. Cone Beam CT for dental and maxillofacial radiology. Evidence based guidelines. The SEDENTEXCT project (2008–2011). In May 2012. Available at: http://wwwsedentexcteu/content/guidelines-cbct-dental-and-maxillofacial-radiology

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Wilana da Silva Moura
    • 1
    • 2
  • Kelly Chiqueto
    • 3
    • 4
  • Gustavo Menezes Pithon
    • 3
    • 5
  • Leniana Santos Neves
    • 3
    • 6
  • Renata Castro
    • 3
  • José Fernando Castanha Henriques
    • 1
  1. 1.Department of OrthodonticsBauru Dental SchoolBauruBrazil
  2. 2.TeresinaBrazil
  3. 3.Department of OrthodonticsSão Leopoldo Mandic Institute and Research CenterCampinasBrazil
  4. 4.Porto AlegreBrazil
  5. 5.SalvadorBrazil
  6. 6.Belo HorizonteBrazil

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