radiation risk C D A J O U R N A L , V O L 4 9 , Nº 5
Effective and Safe Use of X-Rays: Understanding the Risks for Decision-Making Sanjay M. Mallya, BDS, MDS, PhD
abstract Background: X-radiation is part of the dentist’s diagnostic armamentarium and is used to make radiologic images for diagnosis and treatment planning. However, the hazards of X-radiation — in particular, its potential to induce cancer — have concerned health care providers and patients. Application of diagnostic imaging is based on the premise that the benefits will vastly outweigh the risks. Results: The first part of this article discusses increasing imaging effectiveness with proper patient selection — a critical and frequently overlooked step toward maximizing diagnostic benefit. The second part provides a basic understanding of the risks from diagnostic X-radiation, including typical doses from maxillofacial radiologic procedures and the magnitude of associated radiation-related risks. Practical applications: This article provides approaches for the dentist to communicate radiation risks to their patients in lay terms. It also highlights recent developments of importance to dental practice — developing changes to practices of gonadal and fetal shielding during diagnostic imaging. Key words: Evidence-based imaging, radiation risk, radiation safety
AUTHOR Sanjay M. Mallya, BDS, MDS, PhD, is an associate professor and the chair of oral and maxillofacial radiology at the University of California, Los Angeles, School of Dentistry. He has authored numerous scientific manuscripts and book chapters on oral radiology, periodontology, endodontology and implantology. He is the editor of “White and Pharoah’s Oral Radiology”
and is a past president of the American Academy of Oral and Maxillofacial Radiology. Dr. Mallya is a diplomate of the American Board of Oral and Maxillofacial Radiology and serves on the board for the Intersocietal Accreditation Commission. Conflict of Interest Disclosure: None reported.
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-rays have sufficient energy to ionize biologic molecules and possibly cause damage that is manifested as disease. Nevertheless, despite its potentially hazardous effects, X-ray-based imaging continues to be an essential tool for diagnosis and treatment planning in health care, including dentistry. For example, asymptomatic patients are screened to detect incipient caries lesions using bitewing radiography. Alternatively, a patient with a periapical abscess may be imaged using intraoral periapical
imaging. In another clinical scenario, cone beam computed tomography (CBCT) may be prescribed to evaluate the relationship between an impacted mandibular third molar and the inferior alveolar canal. Although the specific diagnostic objective in each scenario is unique, the principles that guide the decision to make radiologic images are the same. The first principle addresses the effectiveness of imaging and is based on the tenet that radiologic examination will likely provide information relevant to diagnosis and treatment planning. M AY 2 0 2 1
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