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      Cone-beam computed tomography: Time to move from ALARA to ALADA

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          Abstract

          Cone-beam computed tomography (CBCT) is routinely recommended for dental diagnosis and treatment planning. CBCT exposes patients to less radiation than does conventional CT. Still, lack of proper education among dentists and specialists is resulting in improper referral for CBCT. In addition, aiming to generate high-quality images, operators may increase the radiation dose, which can expose the patient to unnecessary risk. This letter advocates appropriate radiation dosing during CBCT to the benefit of both patients and dentists, and supports moving from the concept of "as low as reasonably achievable" (ALARA) to "as low as diagnostically acceptable" (ALADA).

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          Most cited references8

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          Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature.

          This study reviewed the literature on cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial (OMF) region. A PUBMED search (National Library of Medicine, NCBI; revised 1 December 2007) from 1998 to December 2007 was conducted. This search revealed 375 papers, which were screened in detail. 176 papers were clinically relevant and were analyzed in detail. CBCT is used in OMF surgery and orthodontics for numerous clinical applications, particularly for its low cost, easy accessibility and low radiation compared with multi-slice computerized tomography. The results of this systematic review show that there is a lack of evidence-based data on the radiation dose for CBCT imaging. Terminology and technical device properties and settings were not consistent in the literature. An attempt was made to provide a minimal set of CBCT device-related parameters for dedicated OMF scanners as a guideline for future studies.
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            Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology.

            This study compares 2 measures of effective dose, E(1990) and E(2007), for 8 dentoalveolar and maxillofacial cone-beam computerized tomography (CBCT) units and a 64-slice multidetector CT (MDCT) unit. Average tissue-absorbed dose, equivalent dose, and effective dose were calculated using thermoluminescent dosimeter chips in a radiation analog dosimetry phantom. Effective doses were derived using 1990 and the superseding 2007 International Commission on Radiological Protection (ICRP) recommendations. Large-field of view (FOV) CBCT E(2007) ranged from 68 to 1,073 microSv. Medium-FOV CBCT E(2007) ranged from 69 to 560 microSv, whereas a similar-FOV MDCT produced 860 microSv. The E(2007) calculations were 23% to 224% greater than E(1990). The 2007 recommendations of the ICRP, which include salivary glands, extrathoracic region, and oral mucosa in the calculation of effective dose, result in an upward reassessment of fatal cancer risk from oral and maxillofacial radiographic examinations. Dental CBCT can be recommended as a dose-sparing technique in comparison with alternative medical CT scans for common oral and maxillofacial radiographic imaging tasks.
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              Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units.

              This article analyses dose measurement and effective dose estimation of dental CBCT examinations. Challenges to accurate calculation of dose are discussed and the use of dose-height product (DHP) as an alternative to dose-area product (DAP) is explored.
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                Author and article information

                Journal
                Imaging Sci Dent
                Imaging Sci Dent
                ISD
                Imaging Science in Dentistry
                Korean Academy of Oral and Maxillofacial Radiology
                2233-7822
                2233-7830
                December 2015
                17 December 2015
                : 45
                : 4
                : 263-265
                Affiliations
                [1 ]Department of Oral Medicine and Radiology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, India.
                [2 ]Department of Conservative Dentistry and Endodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, India.
                Author notes
                Correspondence to: Dr. Prashant P. Jaju. Department of Oral Medicine and Radiology, Rishiraj College of Dental Sciences and Research Centre, Near Raja Bhoj International Airport, Gandhinagar, Bhopal, India. Tel) 91-975-209-3011, Fax) 91-755-264-6524, docprashant_jaju@ 123456yahoo.com
                Article
                10.5624/isd.2015.45.4.263
                4697012
                26730375
                d03f1807-856e-4158-a0ff-885f50d2d6f8
                Copyright © 2015 by Korean Academy of Oral and Maxillofacial Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 June 2015
                : 29 June 2015
                : 18 July 2015
                Categories
                Pictorial Essay

                Dentistry
                radiation, cone-beam computed tomography,dental implants
                Dentistry
                radiation, cone-beam computed tomography, dental implants

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