DIAGNOSTIC REFERENCE LEVELS IN DENTAL RADIOLOGY: A SYSTEMATIC REVIEW

Purpose: The purpose of this work was to review published articles in the fi eld of diagnostic reference levels in dental radiology, and to determine which areas have not been covered yet and require further scientifi c studies. The aim was also to determine if there are any dose optimization procedures suggested after DRL establishment. Materials and methods: A systematic review was performed using the Science Direct, PubMed, CINAHL (via EBSCOhost) and Dentistry & Oral Sciences Source (via EBSCOhost) databases, following the Cochrane Network study design guidelines. Articles were analysed and presented by author, year of publication, country of origin, technology (e.g. digital radiography, computed radiography and fi lm-screen), radiographic type (e.g. intraoral, panoramic and CBCT), units of measurement and main conclusions for each study. Results: Thirteen scientifi c articles on dose reference values in dental radiology were evaluated. Full-access articles published between 2001 and 2021 were used, and both reviews and original research articles were included. The studies address the defi nition or analysis of DRLs in intraoral and panoramic dental imaging and in dental CBCT imaging. Many studies report results based on diff erent image-receiving systems (e.g. DR, CR and fi lm-screen). The fi lm-screen system yielded the highest dose values of all three systems. All studies reviewed describe DRLs for the adult population, while only four also describe paediatric DRLs. Conclusion: Most EU countries have not yet set national DRLs for dental radiology. Most studies set or revise DRLs at the national level and compare them with guidelines from literature and from similar studies conducted in other countries. Most of these studies observed DRLs in the adult population. DRLs should also be set in the fi eld of dental CBCT imaging, as the use of this technology is rapidly increasing and the dose levels are incomparably higher than in general dental radiography. Keywords: dental radiography, diagnostic reference levels, intraoral imaging, panoramic dental imaging.