The need for national diagnostic reference levels: Entrance surface dose measurement in intraoral radiography

Background: Intraoral radiographies are the most frequent X-ray examinations in humans. According to International Commission on Radiation Protection (ICRP) recommendations, the selection of a diagnostic reference level (DRL) should be specific to a country or region. Critica l organs such as thyroid gland are exposed to X-rays in intraoral radiography and these exposures should be kept as low as reasonably achievable. To assist the development of DRLs for intraoral radiography, a National Radiation Protection Department-sponsored pilot study was carried out. Materials and Methods: Thermoluminescent dosimetry (TLD) is widely acknowledged to be the recommended method for measuring entrance surface doses (ESD). In this study, ESD was measured using LiF thermoluminescent dosimeters (TLD-100) on the skin (either mandibular or maxillary arcs) of 40 patients. Three TLD chips were placed on the skin of each patient. The doses were averaged for each radiography and mean ESD of all patients calculated. Results: The mean ± SD entrance surface dose at the center of the beam on the patients' skin in intraoral radiography was 1.173 ± 0.606 mGy (ranged from 0.01 to 0.40 mGy). The mean ESD for male and female patients were 1.380 ± 0.823, and 1.004 ± 0.258 respectively. No statistically significant difference was found between these means. Despite its necessity, in national level, there is no published data on the diagnostic reference levels for intraoral radiography. However, the results obtained in this study are lower than those reported by investigators in other countries. Conclusion: In IR Iran, due to lack of large scale studies, no diagnostic reference levels have been set for X-ray diagnostic procedures. Due to lack of national diagnostic reference levels, it is not possible to clarify whether in intraoral radiographies any dose reduction techniques are needed. We intend to perform similar nationwide studies to set the diagnostic reference level for intraoral radiography. Iran . J. Radiat. Res., 2004 2 (3): 127-133