Conference Paper

Radiation exposure and image resolution testing of a low-dose x-ray imaging (LDXI) prototype

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Abstract

Background: Although radiographs are an indispensable diagnostic tool, the increased effective doses of dental imaging are high enough to warrant reconsideration of means to reduce patients' exposure.1 Fluoroscopy uses low mA settings as well as image intensification for dose reduction and dynamic imaging acquisition.2 Objective: This investigation proposed to prove the concept of radiation exposure reduction and dental fluoroscopy feasibility without compromising image quality by testing a low-dose x-ray imaging (LDXI) prototype comprising a 0.2 mA x-ray source and a high quantum efficiency (HQE) intraoral/extraoral sensor and comparing it to standard of care. Materials & Methods: The Environmental Health and Radiation Safety Institutional Department approved this study. Groups 1 and 2 were exposed to the LDXI static and dynamic modes, respectively. Group 3 was exposed to medical fluoroscopy (MF), group 4 to digital/film-based intraoral radiography (DFIR) and group 5 to CBCT scan. Image resolution was measured (lp/mm). Preliminary Results: LDXI at 0.2 seconds would reduce 93.45% dosage as compared to DFIR at 0.2 seconds and allowed 15 seconds dynamic imaging for a conventional root canal. The Mann-Whitney test showed no statistical significance (α =0.01) in radiation exposure (mR) between groups 1 and 3 & 1 and 4 and timing exposure (seconds) between groups 1 and 5 & 2 and 3. Dosimeters for the LDXI operator simulated distance and controls did not register significant dose equivalent (mrem). Resolution test showed LDXI1 > DFIR > LDXI2 > MF > CBCT scan. Future Directions: Lower mA at the x-ray source and HQE image intensification at the sensor level permitted reducing radiation dosage considerably for digital radiography while allowing dynamic fluoroscopy. These principles could be applied to all dental imaging modalities in the near future. Conflict of interest/acknowledgements: Dr. Yang Consultant and Dr. Uzbelger equity interest in Real Time Imaging Technologies, LLC. 1 Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations: the impact of 2007 International Commission on Radiological Protection recommendations regarding dose calculation. J Am Dent Assoc. 2008 Sep;139(9):1237-43. 2 Uzbelger Feldman D, Yang J, Susin C. A Systematic Review for the Uses of Fluoroscopy in Dentistry. Chin J Dent Res. 2010 Jun;13(1):23-29.

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... A 50% reduction in mA would result in a decrease in radiation dose by 50% [1]. Previously, the mA range has not been taken into consideration in any attempt to reduce radiation dose to which dental patients are being exposed [2][3][4][5][6]. The sensitivity of a digital sensor is measured at a constant wavelength in nanometers (nm) on the basis of the detective quantum efficiency (DQE). ...
... Consequently, a lower milliamperes (mA) setting at the X-ray source and the use of front illuminated sensors with microlens or back illuminated sensors at the detector level for an increased QE that reduces the required radiation dose and sensor pixel size without impacting image quality should have a dramatic positive impact on dental radiology and oral diagnosis. The purpose of this investigation was to prove the concept of radiation exposure reduction and dynamic fluoroscopy feasibility in dentistry without compromising image quality by testing a low-dose X-ray imaging (LDXI) prototype comprising a low-dose X-ray source and a high QE front illuminated sensor with microlens and comparing it to standard of care in terms of dose exposure in milligrays (mGy) and image resolution in lines per millimeters (lp/mm) [6]. ...
... Image resolution for the LDXI was measured with a resolution test pattern (Fluke Corp., Cleveland, OH) in lp/mm. An endodontic file size 10 (Dentsply, Maillefer, York, PA) was placed within phantom's tooth number 27 at the radiographic apex for intraoral imaging subjective resolution assessment purposes in which two endodontists and one oral and maxillofacial radiologist from the institution were asked to confirm tooth's working length [6]. Dose exposure measurements and image resolution were calculated for all groups and dosimeters were analyzed. ...
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Objective(s). The major challenge encountered to decrease the milliamperes (mA) level in X-ray imaging systems is the quantum noise phenomena. This investigation evaluated dose exposure and image resolution of a low dose X-ray imaging (LDXI) prototype comprising a low mA X-ray source and a novel microlens-based sensor relative to current imaging technologies. Study Design. A LDXI in static (group 1) and dynamic (group 2) modes was compared to medical fluoroscopy (group 3), digital intraoral radiography (group 4), and CBCT scan (group 5) using a dental phantom. Results. The Mann-Whitney test showed no statistical significance in dose exposure between groups 1 and 3 and 1 and 4 and timing exposure (seconds) between groups 1 and 5 and 2 and 3. Image resolution test showed group 1 > group 4 > group 2 > group 3 > group 5. Conclusions. The LDXI proved the concept for obtaining a high definition image resolution for static and dynamic radiography at lower or similar dose exposure and smaller pixel size, respectively, when compared to current imaging technologies. Lower mA at the X-ray source and high QE at the detector level principles with microlens could be applied to current imaging technologies to considerably reduce dose exposure without compromising image resolution in the near future.
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