Korean J Orthod.  2021 May;51(3):189-198. 10.4041/kjod.2021.51.3.189.

Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment

• Jha N
• Kim YJ
• Lee Y
• Lee JY
• Lee WJ
• Sung SJ

• KMID: 2515822
• DOI: http://doi.org/10.4041/kjod.2021.51.3.189

Abstract

Objective
To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults.
Methods
We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1–3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients.
Results
For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period.
Conclusions
The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.

Keyword

Cancer risk; Cone-beam computed tomography; Ionizing radiation; Lifetime fractional ratio

Figure

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  Figure 1 ALARA-Dental software (Kyung Hee University, Seoul, Korea, and Korea Centers for Disease Control and Prevention, Cheongju, Korea)13 for estimating organ doses delivered for the acquisition of dental radiographs, including intraoral radiographs, panoramic radiographs, and cone-beam computed tomography images.

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  Figure 2 Estimation of cancer risk from cone-beam computed tomography for orthodontic purposes using the radiation risk assessment tool (RadRAT version 4.1.1; National Institutes of Health, Bethesda, MD, USA).18

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  Figure 3 Distribution of mean organ doses (mGy) delivered by cone-beam computed tomography performed for orthodontic purposes in children and adults.

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  Figure 4 Mean lifetime fractional ratio (LFR) after a single exposure under maximum and median exposure settings, according to age.

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  Figure 5 Comparison of the mean lifetime fractional ratio (LFR) after a single exposure under maximum exposure settings between male and female patients in different age groups.

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  Figure 6 Comparison of mean lifetime attributable risk (LAR) values after a single exposure under maximum exposure parameters between adults and children, according to the cancer site.

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