Establishment of reference levels in dental diagnostics
DOI:
https://doi.org/10.62486/agodonto2025203Keywords:
Diagnostic reference levels, radiological protection, dental radiology, dose optimization, patient safetyAbstract
The initial process for establishing Diagnostic Reference Levels (DRLs) should focus on several key aspects: promoting a culture of safety, training personnel, assigning clear responsibilities, implementing tools and methods for dose assessment, and ensuring adequate regulation and funding by the competent regulatory authority. Although the risk associated with dental radiological examinations is relatively low compared to natural risks, any additional risk, however minimal, is unacceptable if it does not benefit the patient. According to the International Commission on Radiological Protection (ICRP), dose limits and dose constraints are not recommended for individual patients, as they could compromise diagnostic efficacy, causing more harm than benefit. Therefore, it is crucial that dental radiology services implement radiological protection measures by establishing DRLs, in order to maximize the diagnostic benefits while minimizing the risk to the patient. A methodology for establishing DRLs in dental clinical practice is proposed, including justification of appropriate radiological examination, optimization of radiological protection, and correct use of DRL values.
References
Amaya Ríos, E. & Muñoz Arango, E. (2021). Determinación de los niveles de referencia de dosis (DRL) para diagnóstico de baja y media complejidad en Servicios Especiales de Salud Hospital Universitario de Caldas de Colombia (SES-HUC). Rev. Investig. Apl. Nucl. 5, 84-98. doi: 10.32685/2590-7468/invapnuclear.5.2021.604
Beauvais-March, H., Valero, M., Biau, A. & Bourguignon, M. (2003). Niveaux de reference diagnostiques: spécificités de la demarche francaise en radiologie. Radioprotection, 38(2), 187-200.
BRASIL. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Portaria nº453. Diretrizes básicas de proteção radiológica em radiodiagnóstico médico e odontológico. Diário Oficial da União, Brasília, 01 jun. 1998.
BRASIL. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução RDC Nº 330. Diário Oficial da União, Brasília, 20 dez. 2019.
BRASIL. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. INSTRUÇÃO NORMATIVA - IN N° 94. Diário Oficial da União, Brasília, 31 mai. 2021.
BRASIL. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução RDC Nº 611. Diário Oficial da União, Brasília, 9 mar. 2022.
Brando de Arruda, E. M. Níveis de referência em diagnóstico por imagem na radiologia odontológica. Dissertação (Mestrado em Engenharia Biomédica), Universidade Tecnológica Federal do Paraná, 2022.
Digital Imaging and Communications in Medicine (DICOM). Supplement 127: CT Radiation Dose Reporting (Dose SR). DICOM Standards Committee, 2007
EUROPEAN COMISSION. European Guidelines on Radiation Protection in Dental Radiology, Radiation Protection No. 136, Office for Official Publications of the European Communities, Luxemburgo (2004).
Gisone, P. A. & Pérez, M. (2004). La protección radiológica del paciente: marco conceptual, nuevas recomendaciones a nivel internacional. Primera Reunión sobre Protección Radiológica del Paciente. Buenos Aires, Argentina.
Hart, D., Hillier, M. C. & Wall, B. F. (2009). National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. Br. J. Radiol., 82(973), 1-12.
Hart, D., Hillier, M. C. & Shrimpton, P. C. (2012). Doses to Patients from Radiographic and Fluoroscopic X-Ray Imaging Procedures in the UK? 2010 review. Chilton, Health Protection Agency, Centre for Radiation, Chemical and Environmental Hazards, Radiation Protection Division.
Horner, K. & Eiton, K. A. (Eds). Selection Criteria for Dental Radiology, 3rd edn. Faculty of General Dental Practice (UK), London (2018).
International Atomic Energy Agency of Vienna. (2007). Dosimetry in diagnostic radiology: An international code of practice. Technical reports series No. 457 IAEA.
International Atomic Energy Agency of Vienna. (2022). Safety Reports Series No. 108. Radiation Protection in Dental Radiology.
International Commission on Radiation Protection. (1996). Radiological Protection and Safety in Medicine Ann ICRP. ICRP, 73, 26(2).
International Commission on Radiation Protection. (2007). The 2007 Recommendations of the International Commission on Radiological Protection. Ann. ICRP, 37(2-4).
International Commission on Radiation Protection. (2017). Diagnostic Reference Levels in Medical Imaging. Report 135. Ann. ICRP, 46(1).
Martin, C. J., Le Heron, J., Borrás, C., Sookpeng, S. & Ramirez, G. (2013). Approaches to aspects of optimization of protection in diagnostic radiology in six continents. J. Radiol. Prot., 33(4),711-34.
Martínez, H. A., Peña Rodríguez, A., Sevilla Moreno, A. C., Cruz Salazar, E. & Puerto Jiménez, D. N. (2023). Niveles de referencia diagnósticos en equipos de radiografía dental en Bogotá, Colombia. Salud UIS, 55, e23044. doi: 10.18273/saluduis.55.e:23044
Ramos, O. & Villarreal, M. (2013). Disminución de la dosis de radiación en el radiodiagnóstico. Rev Chil Radiol, 19(1), 5-11. doi: 10.4067/S0717-93082013000100003
Serra, H. A., Ramírez, M. C., Véliz, H. J., Salas, M. I., Pérez, A. J., Vera, M. F., et al. (2020). Valores típicos de dosis para tomografía computada de cerebro en pacientes adultos. Rev Chil Radiol, 26(1), 25-31. doi: 10.4067/S0717-93082020000100025
Ubeda, C., Nocetti, D., Aragón, M., Aragón, G., Aragón, D. & Medina, O. (2020). Niveles de Referencia para Diagnóstico en Procedimientos Radiológicos Dentales: Una Guía Práctica. Int J Odontostomat, 14(4), 610-616. doi: 10.4067/S0718-381X2020000400610
United Nations Scientific Committee on the Effects of Atomic Radiations (UNSCEAR). UNSCEAR 2008 Report: Sources and Effects of Ionizing Radiation. Viena, United Nations Scientific Committee on the Effects of Atomic Radiations (UNSCEAR), 2008.
Villarreal Uzcategui, M. A. & La Corte Donato, O. E. (2024). Valores típicos de tomografía computarizada en dos instituciones de la región occidental de Venezuela. Austral J. Imaging, 30(1), 2-9. doi: 10.24875/RCHRAD.23000031
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