Intraoral radiology in general dental practices - a comparison of digital and film-based X-ray systems with regard to radiation protection and dose reduction

Purpose: The purpose of this study was to gain insight into the distribution and application of digital intraoral radiographic techniques within general dental practices and to compare these with film-based systems in terms of patient dose reduction.

Materials and methods: 1100 questionnaires were handed out to general dental practitioners. Data was analyzed with respect to the type of system by using descriptive statistics and nonparametric tests, i.e. Kruskal-Wallis, Mann-Whitney and chi-square test (SPSS 20).

Results: 64% of the questioned dentists still use film-based radiology, 23% utilize storage phosphor plate (SPP) systems and 13% use a charge-coupled device (CCD). A strong correlation between the number of dentists working in a practice and the use of digital dental imaging was observed. Almost 3/4 of the film users work with E- or F-speed film. 45% of them refuse to change to a digital system. The use of lead aprons was popular, while only a minority preferred thyroid shields and rectangular collimators. A fourfold reduction of exposure time from D-speed film to CCD systems was observed. Due to detector size and positioning errors, users of CCD systems take significantly more single-tooth radiographs in total. Considering the number of radiographs per patient, there is only a slight tendency towards more X-rays with CCD systems. Up to image generation, digital systems seem to be as or even more difficult to handle than film-based systems, while their handling was favored after radiographic exposure.

Conclusion: Despite a slight increase of radiographs taken with CCD systems, there is a significant dosage reduction. Corresponding to the decrease in exposure time, the patient dose for SPP systems is reduced to one half compared to film. The main issues in CCD technology are positioning errors and the size of the X-ray detectors which are difficult to eliminate. The usage of radiation protection measures still needs to be improved.

Key points: ► Responsible use of digital intraoral radiology results in a significant dose reduction in everyday practice. ► The ALARA principle is only achieved by strict implementation of dose-reducing methods. ► The efforts to use dose-reducing devices must be increased.