Radiation Dose and Image Quality in Various Examinations and Imaging Modes of Dentomaxillofacial Cone Beam Computed Tomography

Document Type : Original Paper


1 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Cone-beam computed tomography is used for specialized imaging of dental and maxillofacial structures. CBCTs capabilities and facilities for dental and maxillofacial imaging have resulted in their increasing clinical use. Although the dose of CBCT tests is low, its widespread use increases the cumulative dose. This study was conducted to evaluate head and neck effective dose and image quality in different organs for various exposure techniques in CBCT imaging.
Material and Methods: This study was performed on various CBCT imaging examinations. Head and neck parts of anthropomorphic male Rando® Alderson Phantom and thermoluminescent dosimeters were used for organ dosimetry. Contrast to noise ratio and signal to noise ratio were evaluated for image quality assessments. For this purpose, the region of the tooth and soft tissue images were randomly used as the basis.
Results: Mean effective dose for face and paranasal sinuses imaging in three modes (  standard, low-dose, ultra-low dose), temporomandibular imaging in two modes(standard & low dose), and dental imaging in implant and endo imaging modes was equal to 382.17, 193.97, 79.96, 262.6, 135.67, 53.93, 682.83, 335.75, 184.18, and 234.57 μSv, respectively.
Signal -to -noise ratio (SNR) for the above-mentioned procedures was equal to 6.04, 5.73, 3.71, 6.3, 6.00, 4.08, 14.2, 12.3, 7.51, and 6.97, respectively.

Conclusion: The present study showed, when low dose and ultra-low-dose modes are chosen, the patient's dose will be severely reduced in most CBCT procedures. Contrast-to-noise ratio (CNR) and SNR will diminish too, but they are sufficient for some diagnostic purposes.


Main Subjects

  1. Farman, A.G. and W.C. Scarfe. The basics of maxillofacial cone-beam computed tomography. in Seminars in Orthodontics. 2009. Elsevier.
  2. Alamri HM, Sadrameli M, Alshalhoob MA, Alshehri MA. Applications of CBCT in dental practice: a review of the literature. General dentistry. 2012 Sep 1;60(5):390-400.
  3. Dawood A, Patel S, Brown J. Cone beam CT in dental practice. British dental journal. 2009 Jul;207(1):23-8.
  4. Loubele M, Bogaerts R, Van Dijck E, Pauwels R, Vanheusden S, Suetens P, et al. Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. European journal of radiology. 2009 Sep 1;71(3):461-8.
  5. White SC, Pharoah MJ. The evolution and application of dental maxillofacial imaging modalities. Dental Clinics of North America. 2008 Oct 1;52(4):689-705.
  6. C Cangul S, Adiguzel O. Cone-beam three-dimensional dental volumetric tomography in dental practice. International Dental Research. 2017 Dec 31;7(3):62-70.
  7. Agrawal JM, Agrawal MS, Nanjannawar LG, Parushetti AD. CBCT in orthodontics: the wave of future. The journal of contemporary dental practice. 2013 Jan 1;14(1):153.
  8. Galicia JC, Kawilarang J, Tawil PZ. Clinical endodontic applications of cone beam-computed tomography in modern dental practice. Open Journal of Stomatology. 2017 Jul 17;7(7):314-26.
  9. Carter JB, Stone JD, Clark RS, Mercer JE. Applications of cone-beam computed tomography in oral and maxillofacial surgery: an overview of published indications and clinical usage in United States academic centers and oral and maxillofacial surgery practices. Journal of Oral and Maxillofacial Surgery. 2016 Apr 1;74(4):668-79.
  10. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2008 Jul 1;106(1):106-14.
  11. Li G. Patient radiation dose and protection from cone-beam computed tomography. Imaging science in dentistry. 2013 Jun 1;43(2):63-9.
  12. Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB. Dosimetry of 3 CBCT devices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G and i-CAT. Dentomaxillofacial radiology. 2006 Jul;35(4):219-26.
  13. Roberts JA, Drage NA, Davies J, Thomas DW. Effective dose from cone beam CT examinations in dentistry. The British journal of radiology. 2009 Jan;82(973):35-40.
  14. Mah JK, Danforth RA, Bumann A, Hatcher D. Radiation absorbed in maxillofacial imaging with a new dental computed tomography device. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2003 Oct 1;96(4):508-13.
  15. Soares MR, Santos WS, Neves LP, Perini AP, Batista WO, Belinato W, et al. Dose estimate for cone beam CT equipment protocols using Monte Carlo simulation in computational adult anthropomorphic phantoms. Radiation Physics and Chemistry. 2019 Feb 1;155:252-9.
  16. Attaia D, Ting S, Johnson B, Masoud MI, Friedland B, El Fotouh MA, et al. Dose reduction in head and neck organs through shielding and application of different scanning parameters in cone beam computed tomography: an effective dose study using an adult male anthropomorphic phantom. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2020 Jul 1;130(1):101-9.
  17. Katz F. Reducing CBCT radiation dose and maintaining image quality for reliable cephalometric measurements–proof of concept (Doctoral dissertation).
  18. Nascimento HA, Andrade ME, Frazão MA, Nascimento EH, Ramos-Perez FM, Freitas DQ. Dosimetry in CBCT with different protocols: emphasis on small FOVs including exams for TMJ. Brazilian Dental Journal. 2017 Jul;28:511-6.
  19. Andrade ME, Khoury HJ, Nascimento Neto JB, Kramer R. Dosimetric evaluation of dental implant planning examinations with cone-beam computed tomography. Radiation protection dosimetry. 2014 Jan 1;158(2):175-80.
  20. Feragalli B, Rampado O, Abate C, Macrì M, Festa F, Stromei F, et al. Cone beam computed tomography for dental and maxillofacial imaging: technique improvement and low-dose protocols. La radiologia medica. 2017 Aug;122(8):581-8.
  21. Qu X, Li G, Zhang Z, Ma X. Thyroid shields for radiation dose reduction during cone beam computed tomography scanning for different oral and maxillofacial regions. European journal of radiology. 2012 Mar 1;81(3):e376-80.
  22. Almuqrin AH, Tamam N, Abdelrazig A, Elnour A, Sulieman A. Organ dose and radiogenic risk in dental cone-beam computed tomography examinations. Radiation Physics and Chemistry. 2020 Nov 1;176:108971.
  23. Pauwels R. Cone beam CT for dental and maxillofacial imaging: dose matters. Radiation protection dosimetry. 2015 Jul 1;165(1-4):156-61.
  24. Brüllmann D, Schulze RK. Spatial resolution in CBCT machines for dental/maxillofacial applications—what do we know today?. Dentomaxillofacial Radiology. 2015 Jan;44(1):20140204.