Radiation Protection

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology
RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

L 22: Optimization of Protection in Dental Radiology
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International Atomic Energy Agency
Introduction
Dental radiology makes use of specific types
of equipment, needed for different purposes. Frequent exposures though each with low dose involve a risk for the practitioner and for the patient Background: general principles of x-ray diagnostic imaging
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22: Optimization of Protection in Dental Radiology
Topics
Dental X-ray equipment Radiation protection in dental

radiology
Quality control for dental

equipment
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Overview
To be able to apply the principle of

radiation protection to dental radiology system including design and Quality Control.
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Part 22: Optimization of protection in dental radiology

Topic 1: Dental x-ray equipment
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Types of units
Intra-Oral units
Standard dental tube uses an intra-oral image receptor has extra-oral x-ray tube Panoramic (OPG) Cephalometric ( Ceph)
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Intra-Oral Dental X-Ray Equipment
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Modern Dental X-Ray Unit
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Panoramic X-Ray Equipment
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Cephalometric X-Ray Equipment
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X-Ray Tube
stationary Anode avoid overheating tube duty cycle:
typical: 1:30 intaroral 1:10 OPG 420 mAs/hr intraoral
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Tube Head
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Generator Circuit
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Generators & Pre-Heat

Medium frequency - stable waveform Single phase (SP) - pulsed Pre-Heat: separate circuit for heating
filament Single Phase units without a pre-heat circuit initial pulses of variable kV
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Collimator
1. Lead Collimator with central hole
2. Spacer Tube
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Applicator Cones
Good
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Bad
Bad
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Cephalometric Holder
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Intra-Oral Dental X-Ray Equipment (technical data)

Exposure time
Tube Focal spot size
from 60 ms to 2.5 s
Min. 50 kV, ~7mA 1 mm
Inherent filtration
Focus-skin distance Irradiated field
~2 mm Al equivalent
20 cm 28 cm2 with round section, 6 cm diameter collimator
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Panoramic X-Ray Equipment (technical data)
Focal spot kV mA Exposure time
0.5 mm 60 - 80 kV in 2 kV steps 4 - 10 mA steps 4, 5, 6, 8, 10 12 s (standard projections) 0.16 - 3.2 s (cephalometric projections)
Flat panoramic cassette 15x30 cm (Lanex Regular screens))
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Image Receptors in Dental Radiology

Intraoral Radiology Small films (2 x 3 or 3 x 4 cm) in light-tight envelopes (no screen) Digital intraoral sensors - compared with category E film, the radiation dose is reduced by 60%. Panoramic Radiology and Cephalometry Film-screen combination Digital sensors - compared with filmscreen sensitivity class 200, the radiation dose is reduced by 50-70%.
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Dental Radiology Film Types

Sensitivity class D Very good spatial resolution Typical delivered dose: about 0.5 mGy Typical exposure times: 0.3 - 0.7 s Sensitivity class E Good spatial resolution Typical delivered dose: about 0.25 mGy Typical exposure times: 0.1 - 0.3 s
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Part 22: Optimization of Protection in Dental Radiology

Topic 2: Radiation Protection in Dental Radiology
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Radiation Protection in Dental Radiology

Facts
Very frequent examination (about 25% of all the radiological examinations) Delivered doses may differ of a factor 2 or 3. (entrance doses between 0.5 and 150 mGy)
Image Quality often very low

Organs at risk: parathyroid, thyroid, larynx, parotid glands
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Technical hints to reduce patient doses Quality Control of Film Processing
Keep under control time and temperature of the developing process. Do not use oxydized chemicals
Do not adjust development time by viewing the film

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RP in Dental Radiology
Technical hints to reduce patient doses Privilege the use of sensitive films Sensitivity class D Very good spatial resolution Typical delivered dose: about 0.5 mGy Typical exposure times: 0.3 - 0.7 s Sensitivity class E Good spatial resolution Typical delivered dose: about 0.25 mGy Typical exposure times: 0.1 - 0.3 s
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Technical hints to reduce patient doses Lead apron and collar

Useful when the path of primary beam intercepts the protected organs (downward bite-twin projection).
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Panoramic examination
Image quality not as good as in intra-oral
films
Important global information
Relatively low dose

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(one panoramic examination 35 intra-oral films)

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Part 22: Optimization of Protection in Dental Radiology

Topic 3: Quality Control for Dental Equipment
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Why Dental QC ?
Widespread use of dental units Lack of QC history on most units Dental practitioners working in the primary
health care sector do not have the continuous medical physics support available in a hospital-based diagnostic imaging department
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What Tests ?
Collimation
Dose Evaluation
Kilovoltage (kVp)
Leakage Radiation
Exposure Time
Half Value Layer
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Quality Control for Dental Equipment

The recommended tests are consequently divided into: those simple tests which can be performed by dental practice staff those more complex tests which can be carried out by medical physicists.
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Tests which can be performed by dental practice staff
Physical parameter Image Quality Tolerances 10% reference values Frequency Quarterly
Developer temperature and condition of processing solutions

Processing
Specified by the film manufacturer
Every time processing solutions are used
Base+Fog: >0.2 OD Speed and Contrast >0.15 OD about baseline
Every time processing solutions are changed
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Tests performed by medical physicists
Physical parameter Tube voltage Tolerances >50 kV and error <10% Frequency 3 yearly
Beam size/collimation <60 mm diameter 3 yearly (intra-oral) <150 x 10 mm at cassette (panoramic) Dose at cone tip 50 kV: <5.0 mGy 70 kV: <2.5 mGy (E speed film) <75 mGy mm 1-3 yearly
Dose-width product for panoramic film
1-3 yearly
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Dental QC Methods
Unit
Intra-Oral Receptors (I/O) Test Method
as for Radiology QC
Cephalometric (Ceph) Panoramic (OPG )

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as for Radiology QC
where possible: immobilise unit remove slit collimator
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Test Equipment
Dosimeter
small & large volume
chambers 2mm wide detector for OPG
kVp meter
measure kVp
average Programmable delay ~100 ms Range: 50 to 120 kV
Timer
triggering at 75%
peak kV
Aluminum filters
4 x 1mm Grade 1100
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Collimation
Expose film or fluorescent screen Measure x-ray field image
Unit Film position Limits of X Ray field
Standard
OPG
End of Cone 60 mm diameter

Slit, in film cassette (2 films) At cassette Equal slit images Vertical image film height 1 % of FFD on all margins
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Ceph
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Collimator Light Intensity

Ceph units: Place external detector 1m from focus Measure illuminance in lux ( lumen/m2) Read each quadrant Limit: >100 lux at 1m
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Dead man Switch

timer at 50 cm from focus set low kV, mA, long time start exposure release switch during exposure
Require exposure cut-out when switch is released. Check exposure time is less than set time
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Kilovoltage
Accuracy: Set kVp meter to ~100 msec delay Observe kVp waveform at 70 kV if poss. Limit: measured kVp within 5% of set value Reproducibility: Take 5 repeat exposures Limit: coefficient of variation 2%
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Dose Evaluation
Skin dose from I/O units: place cone 10 mm from dosimeter set maxillary molar/ bitewing setting
Should be (65-70 kVp):
2-3 mGy for molar view < 5 mGy for any view
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Output Reproducibility (1)

Standard I/O units & Ceph units: Dosimeter position:
I/O units ~10 mm from cone Ceph units: 75 cm from focus
or other recommended distance
Five repeat exposures

Limit: coefficient of variation 5%
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Output Reproducibility (2)

Optional Method for OPG units: Align detector on film cassette slit Measure dose rate Take 5 repeat exposures Limit: coefficient of variation 5%
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Exposure Time Accuracy

Standard I/O units & Ceph units: Set timer to trigger at 75% peak kV Test times in the normal working range
Limit: 10 % error for I/O units 5% error for all other units
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Timer Reproducibility
Standard I/O units & Ceph units
Place timer in beam 5 repeat exposures

Limit: coefficient of variation 5%
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Half Value Layer (HVL)

Standard I/O units: Position cone facing down Place dosimeter at ~ 40 cm from focus Position Al filters near end of cone Measure dose
measure with no added filters with 2,3,4 mm Al added, then again with no filters
Plot on semi-log paper and find HVL

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HVL Set-up
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HVL: Ceph & OPG Units

Position Al filters on collimator
Cephalometric units Position dosimeter at 75 cm from focus OPG Units Position dosimeter on film cassette slit Measure dose rate, dose for fixed exposure time, or dose for full scan NB Test kVp accuracy before measuring HVL
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OPG Quality Control (kVp/HVL measurement)
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HVL- Minimum Values

kVp HVL (mm Al)
Intraoral 1.5 1.5 2.3 2.5 Ceph/OPG 1.8 2.1 2.3 2.5
60 70 80 90
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Leakage Radiation
Cover collimator with 2 mm lead Set large ionization chamber (~180 cc)
or solid state detector at known distance d cm from focus Expose on maximum kVp for 0.5 - 1 sec (but be careful!) Scale up the reading to 1 hour
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Leakage Radiation
Choose the most likely points for

leakage where collimator joins to housing, lateral to
the tube, joints in housing etc.
Normalise measurement to 1 m from

focus with inverse square law:
Dose1m = dosed x (distanced/100)2
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Leakage Measurement
In normal radiography, leakage
measurements are normalised to the maximum continuous rated tube current R:
Leakage = Dose (for P mAs at 100 cm) x (R x 3600/P)
BUT...a dental unit has no continuous operation rating

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Leakage Measurement
Instead we normalize the dose reading

to tube duty cycle:
Leakage Limit at 1 m from focus:

0.25 mGy/hour 1.0 mGy/hour - Standard I/O units - Ceph & OPG units
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Calculation of Leakage
Measured leakage at 100 cm = 2mGy/hr Duty cycle = 1: 20 (i.e. must wait ~ 20 times
the exposure time between exposures to allow tube cooling) Thus actual leakage = 2 / 20 mGy/hr = 0.1 mGy/hr i.e. acceptable
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Quality Control of Film Processing
Keep under control time and

temperature of the developing process.
Do not use oxidized chemicals Regularly check processing with

phantom
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Dental Phantom
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Dental Phantom
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Where to Get More Information

Code of practice for protection of persons against
ionising radiations arising from medical and dental use, DHSS, HMSO, London, 1964 Guidance notes for the protection of persons against ionising radiations arising from medical and dental use, DHSS, HMSO, London, 1988 Radiation protection and quality assurance in dental radiology. Radiation protection 81. European Commission.(1995) CG-89-95-971-ENC
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Summary
General and specific types of x-ray equipment
(and image receptors) are reviewed: (panoramic and cephalometric), with technical data about operating conditions
Although doses are generally low, the high

frequency of examinations requires radiation protection (for the practitioner) in dental radiology
Some tests are detailed for Quality control of

dental equipment.
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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology