Uso de protector tiroideo en tomografía computarizada de haz cónico: revisión narrativa

Autores/as

  • Andrea Carrasco M. MSc Oral and Maxilofacial Health Sciences. Specialist in Oral and Maxillofacial Radiology. Professor in the Department of Stomatology and in the Oral and Maxillofacial Radiology. Specialization Program, Faculty of Dentistry, University of Talca, Talca, Chile. Autor/a https://orcid.org/0009-0005-0434-8404
  • Lucía Barba R. MSc Oral and Maxillofacial Radiology, Specialist in Oral and Maxillofacial Radiology. Professor in the Department of Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Costa Rica, San José, Costa Rica. Autor/a https://orcid.org/0000-0003-1457-7209
  • Alejandro Hidalgo R. PhD in Oral Radiology, Specialist in Oral and Maxillofacial Radiology. Professor in the Department of Stomatology and Director of the Oral and Maxillofacial Radiology Specialization Program, Faculty of Dentistry, University of Talca, Talca, Chile. Autor/a https://orcid.org/0000-0001-9341-9529

DOI:

https://doi.org/10.15517/ijds.2025.65020

Palabras clave:

Protección radiológica; Tomografía computarizada de haz cónico; Guía; Radiación ionizante; Glándula tiroides; Radiografía dental; Dosis de radiación.

Resumen

El objetivo de la presente revisión narrativa fue analizar la evidencia y recomendaciones internacionales sobre el uso de protector tiroideo (PT) en exámenes con tomografía computarizada de haz cónico (TCHC).  La búsqueda se realizó en tres bases de datos electrónicas (PubMed, Scopus y Web of Science) en idioma inglés desde el año 2010 en adelante. Esta búsqueda incluyó artículos que contuvieran recomendaciones o beneficios del uso de PT en TCHC, así como aquellos que desaconsejaran su uso. La búsqueda complementaria se basó en la revisión de guías, recomendaciones o artículos de organismos internacionales y de revistas de referencia mundial, publicados en su página oficial de internet.  De los 23 artículos revisados, 19 indican que el uso del PT en TCHC reduce las dosis de radiación ionizante en los pacientes o recomiendan su uso en estos exámenes, ya que proporciona un beneficio al paciente. Sin embargo, algunos artículos señalan casos específicos en los que no se aconseja su uso. Por otro lado, dos artículos, del Instituto Británico de Radiología y la Agencia de Seguridad Sanitaria del Reino Unido no recomiendan el uso del PT en exámenes con TCHC, excepto en casos específicos. Finalmente, dos artículos, ambos de la Asociación Dental Americana, se oponen al uso de PT en todos los exámenes radiográficos maxilofaciales, incluyendo TCHC. No existe consenso entre los artículos revisados con respecto a las recomendaciones o beneficios del uso de PT en exámenes con TCHC. Sin embargo, la mayoría de los artículos reportan una reducción en las dosis de radiación o bien recomiendan su uso. En algunos casos, el uso de PT puede disminuir la calidad de la imagen, lo que representa un desafío para el operador al momento de decidir su aplicación en estos exámenes.

Referencias

Arai Y., Tammisalo E., Iwai K., Hashimoto K., Shinoda K. Development of a compact computed tomographic apparatus for dental use. Dentomaxillofac Radiol. 1999; 28 (4): 245-8. DOI: https://doi.org/10.1038/sj.dmfr.4600448

Mozzo P., Procacci C., Tacconi A., Martini P.T., Andreis I.A. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998; 8 (9): 1558-64. DOI: https://doi.org/10.1007/s003300050586

Scarfe W.C., Farman A.G. What is cone-beam CT and how does it work? Dent Clin North Am. 2008; 52 (4): 707-30, v. DOI: https://doi.org/10.1016/j.cden.2008.05.005

Ludlow J.B., Timothy R., Walker C., Hunter R., Benavides E., Samuelson D.B., et al. Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol. 2015; 44 (1): 20140197. DOI: https://doi.org/10.1259/dmfr.20140197

European Commission. European guidelines on radiation protection in dental radiology: the safe use of radiographs in dental practice. Publications Office. 2004 [Accessed 06 March 2025]. Available from: https://op.europa.eu/en/publication-detail/-/publication/ea20b522-883e-11e5-b8b7-01aa75ed71a1

European Commission. Evidence-based guidelines on cone beam CT for dental and maxillofacial radiology. Office for Official Publications of the European Communities. Radiation Protection 172. 2012 [Accessed 06 March 2025]. Available from: http://ec.europa.eu/energy/nuclear/radiation_protection/doc/publication/172.pdf

Pauwels R., Horner K., Vassileva J., Rehani M.M. Thyroid shielding in cone beam computed tomography: recommendations towards appropriate use. Dentomaxillofac Radiol. 2019; 48 (7): 20190014. DOI: https://doi.org/10.1259/dmfr.20190014

Terashima S., Sano J., Osanai M., Toshima K., Ohuchi K., Hosokawa Y. Monte Carlo simulations of organ and effective doses and dose-length product for dental cone-beam CT. Oral Radiol. 2024; 40 (1): 37-48. DOI: https://doi.org/10.1007/s11282-023-00705-7

Hidalgo A., Davies J., Horner K., Theodorakou C. Effectiveness of thyroid gland shielding in dental CBCT using a paediatric anthropomorphic phantom. Dentomaxillofac Radiol. 2015; 44 (3): 20140285. DOI: https://doi.org/10.1259/dmfr.20140285

International Commission on Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103 2007 [Accessed 06 March 2025]. Available from: https://www.icrp.org/docs/icrp_publication_103-annals_of_the_icrp_37(2-4)-free_extract.pdf

National Research Council of the National Academies. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2 Washington, DC: The National Academies Press; 2006 [Accessed 06 March 2025]. Available from: https://nap.nationalacademies.org/catalog/11340/health-risks-from-exposure-to-low-levels-of-ionizing-radiation

Ludlow J.B., Walker C. Assessment of phantom dosimetry and image quality of i-CAT FLX cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2013; 144 (6): 802-17. DOI: https://doi.org/10.1016/j.ajodo.2013.07.013

Jaju P.P., Jaju S.P. Cone-beam computed tomography: Time to move from ALARA to ALADA. Imaging Sci Dent. 2015; 45 (4): 263-5. DOI: https://doi.org/10.5624/isd.2015.45.4.263

Oenning A.C., Jacobs R., Pauwels R., Stratis A., Hedesiu M., Salmon B., et al. Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol. 2018; 48 (3): 308-16. DOI: https://doi.org/10.1007/s00247-017-4012-9

Hidalgo-Rivas J.A., Theodorakou C., Carmichael F., Murray B., Payne M., Horner K. Use of cone beam CT in children and young people in three United Kingdom dental hospitals. Int J Paediatr Dent. 2014; 24 (5): 336-48. DOI: https://doi.org/10.1111/ipd.12076

Benavides E., Bhula A., Gohel A., Lurie A.G., Mallya S.M., Ramesh A., et al. Patient shielding during dentomaxillofacial radiography: Recommendations from the American Academy of Oral and Maxillofacial Radiology. J Am Dent Assoc. 2023; 154 (9): 826-35.e2. DOI: https://doi.org/10.1016/j.adaj.2023.06.015

Benavides E., Krecioch J.R., Connolly R.T., Allareddy T., Buchanan A., Spelic D., et al. Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations. J Am Dent Assoc. 2024; 155 (4): 280-93.e4. DOI: https://doi.org/10.1016/j.adaj.2023.12.002

Cascante-Sequeira D., Barba Ramírez L., Ruiz-Imbert A. The use of thyroid shielding and lead apron in dentistry. Position Statement from the Costa Rican Academy of Oral and Maxillofacial Radiology. Odovtos-Int J Dent Sc. 2024; 26 (3): 10-9. DOI: https://doi.org/10.15517/ijds.2024.60558

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. Eur J Radiol. 2012; 81 (3): e376-80. DOI: https://doi.org/10.1016/j.ejrad.2011.11.048

International Atomic Energy Agency. Radiation protection in dental radiology, safety reports series No. 108. Vienna. 2022 [Accessed 06 March 2025]. Available from: https://www.iaea.org/publications/14720/radiation-protection-in-dental-radiology

British Institute of Radiology. Guidance on using shielding on patients for diagnostic radiology applications. 2020 [Accessed 05 October 2024]. Available from: www.bir.org.uk

National Council on Radiation Protection and Measurements. Radiation protection in dentistry and oral & maxillofacial imaging: recommendations of the National Council on Radiation Protection and Measurements. NCRP Report No. 177: National Council on Radiation Protection and Measurements; 2019 [Accessed 06 March 2025]. Available from: https://ncrponline.org/shop/reports/report-no-177/

Schneider A.B., Kaplan M.M., Mihailescu D.V. Thyroid Collars in Dental Radiology: 2021 Update. Thyroid. 2021; 31 (9): 1291-6. DOI: https://doi.org/10.1089/thy.2021.0087

Hiles P., Gilligan P., Damilakis J., Briers E., Candela-Juan C., Faj D., et al. European consensus on patient contact shielding. Insights Imaging. 2021; 12 (1): 194. DOI: https://doi.org/10.1186/s13244-021-01085-4

American Thyroid Association. Policy statement on thyroid shielding during diagnostic medical and dental radiology 2013 [Accessed 06 March 2025]. Available from: https://www.thyroid.org/wp-content/uploads/statements/ABS1223_policy_statement.pdf

White S.C., Scarfe W.C., Schulze R.K., Lurie A.G., Douglass J.M., Farman A.G., et al. The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118 (3): 257-61. DOI: https://doi.org/10.1016/j.oooo.2014.06.001

United Kingdom Health Security Agency. Guidance on the safe use of dental cone beam CT (computed tomography) equipment. HPA-CRCE-010 2010 [Accessed 06 March 2025]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/340159/HPA-CRCE-010_for_website.pdf

Grüning M., Koivisto J., Mah J., Bumann A. Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography with small and medium fields of view. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022; 134 (2): 245-53. DOI: https://doi.org/10.1016/j.oooo.2022.03.002

Attaia D., Ting S., Johnson B., Masoud M.I., Friedland B., Abu El Fotouh M., 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 Surg Oral Med Oral Pathol Oral Radiol. 2020; 130 (1): 101-9. DOI: https://doi.org/10.1016/j.oooo.2019.11.012

Goren A.D., Prins R.D., Dauer L.T., Quinn B., Al-Najjar A., Faber R.D., et al. Effect of leaded glasses and thyroid shielding on cone beam CT radiation dose in an adult female phantom. Dentomaxillofac Radiol. 2013; 42 (6): 20120260. DOI: https://doi.org/10.1259/dmfr.20120260

Qu X.M., Li G., Sanderink G.C., Zhang Z.Y., Ma X.C. Dose reduction of cone beam CT scanning for the entire oral and maxillofacial regions with thyroid collars. Dentomaxillofac Radiol. 2012; 41 (5): 373-8. DOI: https://doi.org/10.1259/dmfr/30200901

Vogiatzi T., Menz R., Verna C., Bornstein M.M., Dagassan-Berndt D. Effect of field of view (FOV) positioning and shielding on radiation dose in paediatric CBCT. Dentomaxillofac Radiol. 2022; 51 (6): 20210316. DOI: https://doi.org/10.1259/dmfr.20210316

Van Acker J.W.G., Pauwels N.S., Cauwels R.G.E.C., Rajasekharan S. Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review. Eur Arch Paediatr Dent. 2020; 21 (4): 463-508. DOI: https://doi.org/10.1007/s40368-020-00544-8

Tsapaki V. Radiation protection in dental radiology - Recent advances and future directions. Phys Med. 2017; 44: 222-6. DOI: https://doi.org/10.1016/j.ejmp.2017.07.018

Sarıbal G., Canger E.M., Yaray K. Evaluation of the radiation protection effectiveness of a lead-free homopolymer in cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2023; 136 (1): 91-101. DOI: https://doi.org/10.1016/j.oooo.2023.01.011

Chen G., Yin Y., Sun L., Tang Z., Chen J. Monte Carlo simulation study of the effect of thyroid shielding on radiation dose in dental cone beam CT in an adult male phantom. Radiat Prot Dosimetry. 2024. DOI: https://doi.org/10.1093/rpd/ncae206

American Dental Association, US Department of Health and Human Services. Dental radiographic examinations: recommendations for patient selection and limiting radiation exposure. 2012 [Accessed 06 March 2025]. Available from: https://www.ada.org/resources/ada-library/oral-health-topics/x-rays-radiographs

Memon A., Rogers I., Paudyal P., Sundin J. Dental x-rays and the risk of thyroid cancer and meningioma: a systematic review and meta-analysis of current epidemiological evidence. Thyroid. 2019; 29 (11): 1572-93. DOI: https://doi.org/10.1089/thy.2019.0105

International Atomic Energy Agency. Dosimetry in diagnostic radiology: an international code of practice. Vienna. 2007 [Accessed 06 March 2025]. Available from: https://www.iaea.org/publications/7638/dosimetry-in-diagnostic-radiology-an-international-code-of-practice

Fakhoury E., Provencher J.A., Subramaniam R., Finlay D. J. Not all lightweight lead aprons and thyroid shields are alike. J Vasc Surg. 2019; 70 (1): 246-50. DOI: https://doi.org/10.1016/j.jvs.2018.07.055

Publicado

2025-08-27