X ray imaging is used extensively in dentistry to diagnose symptoms, plan and monitor treatments and to follow up pathoses. This Safety Report provides guidance on meeting the requirements for radiation protection and safety in uses of ionizing radiation in dentistry established in IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards. It includes guidelines for the justification and appropriateness of medical exposure, and the optimization of radiation protection and safety for patients, carers and dental staff, with detail on considerations relevant for children and pregnant women. Quality assurance, dosimetry and the operation of dental radiological equipment are also discussed. This publication is intended for dental practitioners, referring medical practitioners, medical radiation technologists and other dental health professionals, as well as medical physicists, radiation protection experts, manufacturers and regulators.

• 1. INTRODUCTION
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. IMAGING MODALITIES AND TECHNIQUES USED IN DENTAL RADIOLOGY
  • 2.1. Intraoral radiography
    • 2.1.1. Dental X ray units
    • 2.1.2. Intraoral image receptors
    • 2.1.3. Bitewing radiography
    • 2.1.4. Periapical radiography
    • 2.1.5. Occlusal radiography
  • 2.2. Panoramic radiography
  • 2.3. Cephalometric radiography
    • 2.3.1. Lateral cephalometric radiography
    • 2.3.2. Posteroanterior cephalometric radiography
  • 2.4. Cone beam computed tomography
    • 2.4.1. Image acquisition
    • 2.4.2. Image reconstruction
    • 2.4.3. Image visualization
  • 2.5. Conventional multidetector computed tomography
• 3. FRAMEWORK FOR RADIATION PROTECTION IN DENTAL RADIOLOGY
  • 3.1. Radiation risk
  • 3.2. Radiation dose
    • 3.2.1. Fundamental dose quantities
    • 3.2.2. Specific quantities for patient dose estimation
  • 3.3. Basic principles of radiation protection
    • 3.3.1. Justification
    • 3.3.2. Optimization
    • 3.3.3. Dose limits
  • 3.4. Roles and responsibilities for radiation protection
    • 3.4.1. Government
    • 3.4.2. Health authority
    • 3.4.3. Regulatory body
    • 3.4.4. Professional bodies
    • 3.4.5. Medical radiation facility
    • 3.4.6. Suppliers of equipment and software, maintenance and servicing organizations
    • 3.4.7. Patients
    • 3.4.8. Management system for radiation protection and safety
  • 3.5. Education and training
    • 3.5.1. Referring medical practitioners
    • 3.5.2. Radiological medical practitioners
    • 3.5.3. Medical radiation technologists
    • 3.5.4. Medical physicists
    • 3.5.5. Suppliers, installation, maintenance and servicing personnel
    • 3.5.6. Considerations for dental radiology
  • 3.6. Quality assurance and quality audit
    • 3.6.1. Quality assurance
    • 3.6.2. Quality audits
• 4. JUSTIFICATION AND IMAGING GUIDELINES
  • 4.1. General approaches for justification in dental radiography
  • 4.2. Justification in two dimensional dental radiography
    • 4.2.1. Intraoral radiography
    • 4.2.2. Panoramic radiography
    • 4.2.3. Cephalometric radiography
    • 4.2.4. Other extraoral projection radiography
  • 4.3. Justification in three dimensional dental imaging
  • 4.4. Justification in paediatric patients
  • 4.5. Justification in pregnant patients
  • 4.6. Guidelines on the use of imaging in dentistry
  • 4.7. Justification of medical exposure for carers and comforters
• 5. OPTIMIZATION OF RADIATION PROTECTION OF INDIVIDUALS UNDERGOING MEDICAL EXPOSURE
  • 5.1. Equipment selection
    • 5.1.1. General considerations
    • 5.1.2. Intraoral radiography
    • 5.1.3. Panoramic and cephalometric radiography
    • 5.1.4. Cone beam computed tomography
    • 5.1.5. Image viewing conditions
  • 5.2. Quality control
    • 5.2.1. Basic principles
    • 5.2.2. Quality control in intraoral radiography
    • 5.2.3. Quality control in extraoral radiography (including panoramic radiography)
    • 5.2.4. Quality control in cone beam computed tomography
    • 5.2.5. Acceptance testing and quality control of protective apparel
  • 5.3. Patient dosimetry and diagnostic reference levels
    • 5.3.1. Establishment and use of diagnostic reference levels
    • 5.3.2. Diagnostic reference levels in dental radiography
  • 5.4. Procedural aspects
    • 5.4.1. General recommendations and considerations
    • 5.4.2. Intraoral radiography
    • 5.4.3. Panoramic radiography
    • 5.4.4. Cephalometric radiography
    • 5.4.5. Cone beam computed tomography
  • 5.5. Paediatric patients
    • 5.5.1. General considerations
    • 5.5.2. Specific considerations for dental radiography
  • 5.6. Pregnant patients
  • 5.7. Carers and comforters and volunteers in biomedical research
    • 5.7.1. Dose constraints
    • 5.7.2. Optimization of protection
  • 5.8. Unintended and accidental medical exposures
• 6. OCCUPATIONAL AND PUBLIC PROTECTION
  • 6.1. Dose limits
  • 6.2. Classification of areas
    • 6.2.1. Controlled areas
    • 6.2.2. Supervised areas
  • 6.3. Design of X ray room
  • 6.4. Protection for adjacent areas
  • 6.5. Local rules and procedures
    • 6.5.1. General considerations
    • 6.5.2. Dental facilities with intraoral and panoramic equipment
    • 6.5.3. Dental facilities with cone beam computed tomography equipment
  • 6.6. Individual monitoring and assessment of occupational exposure
• Appendix I RADIATION DOSE QUANTITIES APPLICABLE TO DENTAL RADIOLOGY
• Appendix II EDUCATION AND TRAINING OBJECTIVES APPLICABLE TO DENTISTRY
• REFERENCES
• Annex CLINICAL INDICATIONS FOR DENTAL RADIOLOGICAL IMAGING
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW