Aspectos Éticos de la Protección Radiológica en Procedimientos de Radiología Dental

RESUMEN: Se sabe de los beneficios que la radiología dental ha significado para mejorar la calidad de vida de las personas en todo el mundo, sin embargo, también conocemos los riesgos asociados a su uso. Para disminuir estos riegos, diferentes organizaciones a nivel internacional han desarrollado un SISTEMA DE PROTECCIÓN RADIOLÓGICA (SRP) basado en los principios de: Justificación, optimización y limitación de dosis, los cuales a su vez han evolucionado en base al desarrollo de la ciencia, los valores éticos, y la experiencia acumulada en la práctica cotidiana de los profesionales de la protección radiológica. Al revisar la normativa que regula el uso de las radiaciones ionizantes en Chile, analizamos que no se tienen en cuenta los aspectos o valores éticos al momento de hablar y aplicar el SPR en procedimientos de radiología dental. Por todo lo anterior, el objetivo del presente trabajo de revisión narrativa fue elaborar un nuevo documento de consulta para los odontólogos, que contenga de manera resumida y con definiciones precisas, los principales aspectos a tener en cuenta a la hora de comprender como funciona el SPR y los valores éticos que lo fundamentan, ayudando de esta manera a resolver objetivamente los juicios de valor que se pueden presentar durante la solicitud, ejecución e interpretación de los procedimientos de radiología dental.

ABSTRACT: The benefits of dental radiology that improve the quality of life of populations worldwide have been well established. However, the risks associated with its use are also known. With these risks in mind, various international organizations have developed a Radiological Protection System (RPS) based on the principles of: Justification, optimization and dose limitation, which in turn have evolved based on science, values ethics, and the experience accumulated during the daily practice by radiation protection professionals. While reviewing the standards that regulate the use of ionizing radiation in Chile, we observed that ethical aspects or values are not taken into account when applying the RPS in dental radiology procedures. In light of these findings, the objective of this narrative review was to develop a new consultation procedure for dentists, which contains the main aspects to consider when understanding how SPR works, in a summarized precise form, as well as the supporting ethical values. Thereby helping to resolve the value judgments that may arise during the performance and interpretation of dental radiology procedures.

Protección Radiológica en Radiología Dental / Proteção Radiologica em Radiologia Dentária / Radiation Protection in Dental Radiology

Resumen El uso de rayos X juega un papel esencial en el diagnóstico y planificación de tratamientos dentales. Los avances tecnológicos de los equipos de rayos X han contribuido al mayor uso de este tipo de radiación en la práctica odontológica. Aunque la exposición a la radiación es baja en estos procedimientos, todavía existe un riesgo que debe reducirse al mínimo necesario a fin de obtener una imagen adecuada para el diagnóstico y a la vez evitar efectos nocivos para el paciente y el personal involucrado. Debido al alto y creciente número de radiografías dentales, el hecho de que niños y adolescentes sean el foco de la mayoría de estas, la subestimación de la cantidad de exámenes radiológicos reportados y la supuesta baja conciencia de estudiantes y profesionales de la odontología sobre los peligros del uso indiscriminado de los rayos X, es necesario adoptar medidas de protección radiológica para mitigar los efectos biológicos radioinducidos. Este artículo tiene como objetivo revisar los principios básicos de la radioprotección que deben considerarse en la práctica dental, con el fin de garantizar el menor daño posible a trabajadores ocupacionalmente expuestos, pacientes y miembros del público.

Resumo O uso dos raios X desempenha um papel essencial no diagnóstico e planejamento de tratamentos dentários. O avanço tecnológico nos equipamentos de raios-X tem contribuído para o aumento do uso deste tipo de radiação na prática odontológica. Embora a exposição à radiação seja baixa nestes procedimentos, ela representa um risco e deve ser reduzida ao mínimo valor necessário para se obter a imagem adequada para o diagnóstico, evitando efeitos nocivos ao paciente e ao pessoal envolvido. Devido ao elevado e crescente número de radiografias odontológicas, ao fato de crianças e adolescentes serem o foco de grande parte delas, a subestimação do número de exames radiológicos notificados e a suposta baixa conscientização de estudantes e profissionais da odontologia sobre os perigos dos uso indiscriminado de raios-x, é precisa a adoção de medidas de radioproteção para mitigar o risco de efeitos nocivos radioinduzidos. Este artigo tem como objetivo revisar os princípios básicos da radioproteção a serem considerados na prática odontológica, a fim de garantir o menor prejuízo possível para trabalhadores ocupacionalmente expostos, pacientes e membros do público.

Abstract The use of X-rays plays an essential role in the diagnosis and planning of dental treatments. Technological advances in X-ray equipment have contributed to the increased use of this type of radiation in dental practice. Although radiation exposure is low in these procedures, there is still a risk. The reduction of the risk to the minimum value possible is necessary to obtain an adequate image for the diagnosis and avoiding harmful effects on the patient and the personnel involved. Due to the high and growing number of dental X-rays, the fact that children and adolescents are the focus of most of them, the underestimation of the number of radiological examinations reported and the supposed low awareness of dental students and professionals about the dangers the indiscriminate use of X-rays, it is necessary to adopt radioprotection measures to mitigate the risk of harmful radioinduced effects. This article aims to review the basic principles of radioprotection to be considered in dental radiology, in order to ensure the least possible damage to occupationally exposed workers, patients and public members.

Niveles de Referencia para Diagnóstico Locales en Procedimientos Radiográficos Dentales Periapicales. Primeros valores para Chile

RESUMEN: La información que aportan los procedimientos de radiología dental, tanto en la evaluación, como en el diagnóstico y tratamiento de patologías y/o alteraciones dento maxilofaciales, hace que correspondan al tipo más frecuente de estudio radiológico. Sin embargo, existe un escaso conocimiento en nuestro país respecto de los niveles de dosis que se imparten en dichos procedimientos, haciendo necesaria su determinación para maximizar el beneficio derivado de los mismos y minimizar el riesgo radiológico para los pacientes. El presente estudio determinó el nivel de referencia para diagnóstico (NRD) local en la radiografía periapical de Molar maxilar e Incisivo, para ello se realizaron simulaciones de los procedimientos radiográficos en un maniquí antropomorfo seccional y se determinó el valor de Kerma aire en la superficie de entrada con retrodispersión mediante dosimetría termoluminiscente. Los NRD locales determinados en la radiografía periapical de Molar maxilar fueron 5,6 mGy para adultos y 4,0 mGy para niños; mientras que en la radiografía periapical de Incisivo fue de 9,2 mGy para pacientes adultos y 1,8 mGy para niños. Los resultados obtenidos buscan orientar la ejecución de futuras investigaciones en el área y aportar información del nivel de radiación en estos procedimientos, con lo que se espera promover una cultura de radioprotección y motivar la optimización de las dosis registradas.

ABSTRACT: The information provided by dental radiology procedures, both in evaluation, as well as in the diagnosis and treatment of pathologies and / or dentomaxilofacial alterations, makes them the most frequent type of radiological study. However, there is a meager knowledge in our country regarding dose levels applied in such procedures, making their determination necessary to maximize the benefits and to minimize the radiological risk to patients. The present study determined the local diagnostic reference level (LDRL) for the periapical radiography of the Maxillary molar and Incisive. Simulations of radiographic procedures were performed and the value of air Kerma at the entrance surface with backscattering, was estimated using thermo luminescent dosimetry. The LDRL determined in the maxillary molar periapical radiography was 5.6 mGy for adults and 4.0 mGy for children; while on the incisive periapical radiography it was 9.2 mGy for adult patients and 1.8 mGy for children. The results obtained seek to guide the execution of future research in the area and provide information on the radiation doses delivered in these procedures, which is expected to promote a radiation protection culture and motivate the optimization of the registered doses.

Niveles de Referencia para Diagnóstico en Procedimientos Radiológicos Dentales: Una Guía Práctica / Diagnostic Reference Levels in Dental Radiological Procedures: A Practical Guide

RESUMEN: Las exposiciones médicas con radiación ionizante son actualmente la principal fuente de exposición a la radiación artificial a nivel global, entre ellas, los exámenes dentales corresponden a uno de los más frecuentes. Para prevenir dosis innecesariamente altas a los pacientes durante estas exposiciones, la Comisión Internacional de Protección Radiológica (ICRP) recomienda la utilización de Niveles de Referencia para Diagnóstico (DRLs), como una herramienta efectiva de ayuda a la optimización de la protección radiológica en la exposición médica de pacientes. Dado que la legislación de Chile aún no ha incorporado el uso de los DRLs, el presente trabajo de revisión tuvo como objetivo analizar la publicación N° 135 de la ICRP para generar un documento que sirva de guía para los odontólogos, explicando de manera didáctica y en un lenguaje sencillo, pero técnico, los principales aspectos a tener en cuenta para establecer los DRLs en procedimientos de radiología dental.

SUMMARY: Currently exposure to ionizing radiation is currently the main source of exposure to artificial radiation worldwide, with dental examinations being one of the most frequent events. In order to prevent exposure of unnecessarily high doses in patients, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective tool to help maximize protection from radiation during medical exposure of patients. Given that the Chilean legislation has not yet incorporated the use of DRLs, the purpose of this study was to analyze publication N° 135 of the ICRP to generate a document, to serve as a guide for dentists, didactically outlining in simple but technical language, the main aspects to consider when establishing DRLs in dental radiology procedures.

Seguridad y Protección Radiológica en Procedimientos Imagenológicos Dentales / Safety and Radiological Protection in Dental Imaging Procedures

RESUMEN: Los procedimientos de imagenología dental son el tipo más frecuente de estudio radiológico y aportan información esencial para apoyar la evaluación, diagnóstico y tratamiento de patologías y/o alteraciones dentomaxilofaciales. La presente revisión narrativa, muestra los procedimientos de radiología dental, define conceptos asociados a la protección radiológica en éstos y entrega una guía con recomendaciones para mejorar la seguridad y protección radiológica del paciente y del operador, en esta clase de procedimientos imagenológicos. Comprender que bajo el actual sistema de protección radiológica, es el Odontólogo quién debe justificar la realización o no de un tipo de procedimiento radiológico, teniendo presente los costos económicos y sobre todo los costos en términos de dosis para el paciente.

ABSTRACT: Dental imaging procedures are the most frequent type of radiological study and provide essential information to support the evaluation, diagnosis and treatment of pathologies and / or dentomaxillofacial alterations. The present narrative review shows dental radiology procedures, defines concepts associated with radiological protection in these and provides a guide with recommendations to improve the safety and radiological protection of the patient and the operator in this kind of imaging procedures. Understanding that under the current system of radiological protection, it is the dentist who must confirm the realization or not, of a type of radiological procedure, keeping in mind the financial costs, and above all, consequences to the patient in terms of dose used in the procedure.

Dental radiology: an adjunctive aid in age estimation

The concept of using radiographic methods for age estimation has kindled so much interest in the field of forensic dentistry in past few decades. Aim and Objectives: To evaluate the different dental radiographic methods for age estimation and their significance in the field of forensic dentistry. Methodology:- 64articles were collected after an extensive literature review. Literature survey of these articles was done.Conclusion:-Radiographic methods play an indispensible role in age estimation specifically in living persons because of their non-invasive and non-destructive nature. This review paper focus on different radiographic methods and new developments available for radiological dental age estimation and their effective aid in identification and crime investigation.

Dental Radiology: An Adjunctive Aid In Age Estimation

The concept of using radiographic methods for age estimation has kindled so much interest in the field of forensic dentistry in past few decades. Aim and Objectives: To evaluate the different dental radiographic methods for age estimation and their significance in the field of forensic dentistry. Methodology:- 64 articles were collected after an extensive literature review. Literature survey of these articles was done. Conclusion:-Radiographic methods play an indispensible role in age estimation specifically in living persons because of their non-invasive and non-desrtructive nature. This review paper focus on different radiographic methods and new developments available for radiological dental age estimation and their effective aid in identification and crime investigation.

Avaliação da utilização de aparelhos de raios-x em consultórios odontológicos em Belo Horizonte, Brasil / Evaluation of the use of x-ray equipment in dental offices in Belo Horizonte, Brazil

Objetivo: Avaliar o conhecimento teórico e a prática radiológica dos cirurgiões dentistas no município de Belo Horizonte. Materiais e Métodos: Foi aplicado questionário para 256 dentistas registrados em Belo Horizonte, selecionados aleatoriamente, enfocando aspectos relacionados ao conhecimento teórico e à prática radiológica na clínica odontológica. Os dados foram analisados por meio de análise de frequência e análise bivariada. Resultados: Dos entrevistados, 53,9% possuíam aparelhos de raios-X. Destes, 19,6% não conheciam o tipo de aparelho que utilizavam. Os profissionais com até 20 anos de formatura apresentaram maior conhecimento sobre as técnicas radiográficas e sobre as medidas de radioproteção e biossegurança, porém mostraram menor conhecimento sobre as características do aparelho que utilizavam. Por outro lado, os profissionais formados há mais de 21 anos demonstraram maior conhecimento sobre a aparelhagem e menor conhecimento em relação às técnicas radiográficas, medidas de radioproteção e biossegurança. A câmara portátil foi o ambiente de processamento mais utilizado. Conclusão: Detectou-se que a prática radiológica apresenta problemas diferenciados, sugerindo a necessidade de melhorias na formação e atualização profissionais.(AU)

Aim: To evaluate the theoretical and practical radiological knowledge of dentists in the city of Belo Horizonte, Brazil. Materials and methods: A questionnaire was applied to 256 randomly selected, registered dentists in Belo Horizonte, focusing on aspects related to theoretical knowledge and radiologic practice. Data were analyzed using frequency and bivariate analyses. Results: Of the respondents, 53.9% had x-ray equipment. Of these, 19.6% did not know what type of device they used. Professionals who had graduated up to 20 years prior showed a greater knowledge about radiographic techniques, the procedures of radioprotection, and biosafety, but showed less knowledge about the characteristics of the instruments they used. On other hand, trained professionals who had graduated more than 21 years prior, demonstrated greater knowledge about the equipment and less knowledge in relation to radiographic techniques, radioprotection, and biosafety. The portable developing chamber proved to be the most widely used processing environment. Conclusion: It could be observed that radiological practice presents specific problems, suggesting the need for improvements in both professional training and post-graduate studies.(AU)

Radiographic image quality after interruption of the fixing stage to view the image with a viewbox / Qualidade da imagem radiográfica quanto ao tempo de leitura em negatoscópio com interrupção da etapa de fixação

Purpose: To evaluate the quality of radiographic images with regard to the time during which the fixing stage was interrupted to allow a preliminary reading of the image in the viewbox. Methods: Radiographs were taken with 130 Insight periapical films, including a step-wedge and lead plate. The films were distributed into 13 groups according to the time taken for reading in a viewbox: 0 (control), 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140 and 150 s. During processing using the temperature-time method, the films in the experimental groups were removed 5 s after immersion in the fixer, placed against the light of a viewbox for the studied times and then re-immersed in the fixer to complete the fixation process. Base-plus-fog density and the densities of the first and last degree of the step-wedge were measured immediately and after six months to calculate the contrast. Results: There were no significant differences with regard to the base-plus-fog density or the contrast values of the experimental groups when compared with the control group. Conclusion: It was concluded that interrupting the radiograph fixation process to read the image in a viewbox does not interfere with the base-plus-fog density or with the radiographic contrast, even six months after they were taken.

Objetivo: Avaliar a qualidade da imagem radiográfica quanto ao tempo de leitura em negatoscópio com interrupção da etapa fixação. Metodologia: Foram radiografados 130 filmes periapicais Insight com um penetrômetro e placa de chumbo. Os filmes foram distribuídos em 13 grupos de acordo com o tempo de leitura em negatoscópio: 0 (controle), 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140 e 150 s. Durante o processamento pelo método temperatura-tempo, nos grupos experimentais, após 5 s de imersão no fixador, os filmes foram removidos, postos contra a luz de um negatoscópio durante os tempos estudados e imersos no fixador para completar o processo de fixação. Foram mensuradas, imediatamente e após seis meses, as densidades base e velamento e as densidades do primeiro e último degrau do penetrômetro para o cálculo do contraste. Resultados: Não houve diferença significativa em relação aos valores de densidade base e velamento e de contraste das radiografias dos grupos experimentais comparando-os com o grupo controle. Conclusão: Concluiu-se que, durante o processamento das radiografias, os tempos de leitura em negatoscópio não interferiram na densidade base e velamento, nem no contraste radiográfico, mesmo após seis meses de seu arquivamento.

The Creation of Dental Radiology Multimedia Electronic Textbook / 대한구강악안면방사선학회지

PURPOSE: This study was performed to develop the electronic textbook (CD-rom title) about preclinical practice of oral and maxillofacial radiology, using multimedia technology with interactive environment. MATERIALS AND METHODS: After comparing the three authoring methods of multimedia, i.e. programming language, multimedia authoring tool and web authoring tool, we determined the web authoring tool as an authoring method of our electronic textbook. Intel Pentium II 350 MHz IBM-compatible personal computer with 128 Megabyte RAM, Umax Powerlook flatbed scanner with transparency unit, Olympus Camedia 1400L digital camera, ESS 1686 sound card, Sony 8 mm Handycam, PC Vision 97 pro capture board, Namo web editor 3.0, Photoshop 3.0, ThumbNailer, RealPlayer 7 basic and RealProducer G2 were used for creating the text document, diagram, figure, x-ray image, video and sound files. We made use of javascripts for tree menu structure, moving text bar, link button and spread list menu and image map etc.. After creating all files and hyperlinking them, we burned out the CD-rom title with all of the above multimedia data, Netscape communicator and plug in program as a prototype. RESULTS AND CONCLUSIONS: We developed the dental radiology electronic textbook which has 9 chapters and consists of 155 text documents, 26 figures, 150 x-ray image files, 20 video files, 20 sound files and 50 questions with answers. We expect that this CD-rom title can be used at the intranet and internet environments and continuous updates will be performed easily.