New European Guidelines for Cone Beam CT

Cone Beam CT technology has developed rapidly over the last few years, and involves more complex imaging technology and higher patient doses than conventional dental x-ray equipment. There is also a lot of diversity in types of Cone Beam scanners on the market. The SENDENTEXCT project was established in 2008 in response to an urgent need for some basic guidance to users of CBCT because of concerns over inappropriate use. This is a collaborative European project, sponsored by the European Commission, established to acquire key information necessary for sound and scientifically based clinical use of Cone Beam Computed Tomography (CBCT) in dental and maxillofacial imaging. The SEDENTEXCT project published evidence based guidelines in 2011; "Radiation protection: Cone Beam CT for Dental and Maxillofacial Radiology". This document makes recommendations on areas such as; referral criteria, quality assurance guidelines, and optimisation strategies, and provides the basis of a useful standard for the use of CBCT in clinical practice.
The UK Health Protection Agency have also published useful guidelines for CBCT including Guidance on the Safe Use of Dental Cone Beam CT Equipment (2010), and Recommendations for the Design of X-ray Facilities and the Quality Assurance of Dental Cone Beam CT (Computed Tomography) Systems. Other European states have also produced guidelines for CBCT, and these have been referenced and incorporated into the SEDENTEXCT document.
The document includes chapters on justification & referral criteria, equipment factors in the reduction of radiation risk to patients, quality standards and quality assurance (including dosimetry and image quality), staff protection, and training. It provides clear guidelines in all of these areas which could provide standards for audit criteria under most of the Dental Council headings in their Criteria For Clinical Audit.
A useful guide to Clinical Audit in Cone Beam CT has been compiled and is available from the downloads section of the website.

New License Conditions Regarding Maintenance in Dental Radiography

The RPII issued a circular in June 2011, noting that annual maintenance of Dental Radiography Equipment is no longer mandatory. The new requirement is that "the licensed items shall be maintained in good working condition and any defects in its performance or in its safe use shall be corrected as soon possible by a suitably qualified and competent person". All irradiating apparatus continues to be subject to a biennial quality assurance assessment undertaken by the appointed RPA.

The Use of Lead Aprons in Dental Radiography

The RPII issued new guidelines on the Use of Lead Aprons in Dentistry which replace guidelines on lead aprons in the Code of Practice for radiological protection in Dentistry . The RPII now only require a dental practice to have a lead apron where the practice undertakes exposures that require staff to hold patients for the duration of the exposure. Staff taking exposures (even if pregnant) are not required to wear lead aprons once they maintain an appropriate distance during exposures or are protected by structural shielding. Thyroid Shields are recommended for patients in certain circumstances. For further advice, contact your RPA.

Personal Dosimetry in Dental Radiography

The RPII issued new guidelines on Dosimetry in Dental Radiography in May 2011. Under these new guidelines, mandatory personal dosimetry is no longer warranted for dental radiology where a risk assessment, performed by the RPA in conjunction with the dentist, indicates that operators (staff or students in third level education) are not expected to receive doses in excess of 1.0 mSv/year. If you are using personal dosimetry and/or you want to determine if it is warranted in your dental practice, you should request your RPA to perform the necessary risk assessment.