Níveis de referência em diagnóstico por imagem na radiologia odontológica

Abstract

Dental radiology is the specialty that applies exploratory imaging methods for diagnosis, monitoring and documentation of the oral and maxillofacial complex and associated structures. The imaging examinations included modalities exams that use ionizing radiation, as panoramic and cephalometric radiographs. Due to the biological effects of radiation, it is necessary to apply radiological protection tools. The ICRP (International Commission on Radiation Protection) uses Diagnostic Reference Levels (DRL) as an auxiliary tool in optimizing radiation protection in medical and dental exposures of patients in diagnostic imaging. Currently, ANVISA has not published the DRLs for dental exams in Brazil. In this work, the implementation of DRLs in dental radiology was reviewed through established international standards and documents, raising the typical value in a health unit and, based on this survey (6877 exams), proposed the local DRL for the city of Curitiba for panoramic, temporomandibular joint (TMJ) and cephalometric radiographs.The local DRL and the typical value were obtained through the averages of the 50th and 75th percentile values of each equipment, respectively.The established local DRL for panoramic radiographs in adult patients was 81 mGy.cm² and the typical value was 70.8 mGy.cm². For pediatric patients aged 2 to 5 years and 7 to 10 years, the DRL were 33.8 mGy.cm² and 45.8 mGy.cm²; the typical values were 28.2 mGy.cm² and 37.8 mGy.cm² for panoramic radiography. Finally, the local DRL and typical value defined for patients aged 10 to 17 years were 67.4 mGy.cm² and 57.2 mGy.cm², respectively. The local DRL established for cephalometric radiographs in lateral norm in adult patients was 6.6 mGy.cm² and the calculated typical value was 5.4 mGy.cm². For posteroanterior cephalometric radiographs in adult patients, the local DRL and typical value were 11.4 mGy.cm² and 9.1 mGy.cm,², respectively. The local DRL and the typical value calculated for the TMJ radiographs was 37.4 mGy.cm² for both. Comparing the results obtained with other locations and countries, it was verified that the DRL surveyed agree with the DRL established in regions with a history of implementation in dental radiology, such as the United Kingdom, demonstrating that the procedures in the researched sector are optimized. To ensure optimization, it is suggested to update the data in 5 years, following the ICRP recommendation, and emphasize the importance and need for the implementation of DRL in dental radiology in Brazil, as well as their inclusion and updates in the regulations in force in the country.