Dentomaxillofacial Radiology (2020) 50, 20200225

© 2021 The Authors. Published by the British Institute of Radiology

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REVIEW ARTICLE
A review of dental cone-­beam CT dose conversion coefficients
Eugene Mah, 1,2E Russell Ritenour and 2Hai Yao
1,2

1
Department of Radiology & Radiologic Imaging, Medical University of South Carolina, Charleston, SC, USA; 2Department of
Bioengineering, Clemson University, Clemson-­MUSC Bioengineering Program, Charleston, SC, USA

Objective: The purpose of this study was to review the literature to examine the usage and
magnitude of effective dose conversion factors (DCE) for dental cone beam CT (CBCT) scan-
ners.
Methods: A PubMed literature search for publications relating to radiation dosimetry in
dental radiography was performed. Papers were included if they reported DCE, or reported
ICRP 103 effective dose and dose-­area product. 71 papers relating to dental CBCT dosimetry
were found, of which eight reported effective dose conversion factors or provided enough
information to calculate dose conversion factors. Scanner model, effective dose, dose-­area
product, tube voltage, field of view size and DCE were extracted from the papers for analysis.
Results: DCE values ranged from 0.035 to 0.31 µSv/mGy-­cm2 with a mean of 0.129 µSv/
mGy-­cm2 (SD = 0.056). When categorized into small (<100 cm2), medium (100–225 cm2) and
large (>225 cm2) fields of view (FOV), linear fits to the effective dose and dose-­area product
yielded slopes of 0.129, 0.111 and 0.074 µSv/mGy-­cm2 for small, medium and large FOVs
respectively.
Conclusion: The range of reported DCE values and spread with respect to field of view cate-
gory suggests that DCE values that depend on FOV would provide more accurate effective
dose estimates. Tube voltage was found to be a smaller factor in determining DCE. Reasonable
values for DCE taking into account FOV size were obtained. There is considerable room for
more work to be done to examine the behaviour of DCE with changes to patient age and dental
CBCT imaging parameters.
Dentomaxillofacial Radiology (2020) 50, 20200225. doi: 10.1259/dmfr.20200225

Cite this article as: Mah E, Ritenour ER, Yao H. A review of dental cone-­beam CT dose
conversion coefficients. Dentomaxillofac Radiol 2020; 50: 20200225.

Keywords: Cone beam computed tomography; Effective dose; Conversion factors; Radiation
dosimetry

Introduction

Dental cone-­beam CT (CBCT) has been available as a the entire head or small enough to image an individual
dental imaging modality since the late 1990s.1 Modern tooth. Some scanners have an integrated chair or table
dental CBCT scanners are based on flat panel detectors for the patient to sit or lay on, while others require the
and offer the potential for multi modality imaging (2D patient to stand.
panoramic and cephalometric imaging in addition to 3D There have been a number of studies investigating
CBCT imaging). Dental CBCT scanners are available the radiation doses to patients from dental CBCT scans
in a wide variety of gantry geometries, scan technique since the modality was introduced. The majority of
options, detector sizes and fields of view.2 Some units these studies have used thermoluminescent (TLD) or
operate at a single fixed X-­ray tube voltage while others optically stimulated (OSL) dosimeters with an anthro-
offer a range of selectable X-­ray techniques. Multiple pomorphic phantom to measure organ absorbed doses
field sizes are often available allowing scans to cover and effective doses from CBCT studies. More recent
studies have used Monte-­Carlo simulations to calcu-
Correspondence to: Eugene Mah, E-mail: ​maheug@​musc.​edu late effective doses for some dental CBCT scans with
Received 15 May 2020; revised 05 October 2020; accepted 20 October 2020 some studies also using TLD, OSL or radiochromic
 Dental cone beam CT dose conversion coefficients
Mah et al 2 of 9

film-­based dosimetry to validate the simulation results. be produced for commonly performed radiographic
Depending on the scanner, scan protocol and field of procedures.11,12
view, effective doses can range from a few tens of µSv Using an appropriate DCE value, effective dose for a
to several hundreds of µSv.3,4 The general tendency has study can be estimated using Equation 1
been to report dental CBCT effective doses stratified by
field of view (FOV) size, either by FOV height, or FOV ‍ E = DCEE × PKA‍ (Equation 1)
diameter. In general, the larger the FOV, the higher
A review of the current literature was undertaken to
the effective doses with median effective doses ranging
from under 100 µSv for the smallest FOVs (<10 cm) investigate the use and magnitude of effective dose
to just over 1000 µSv for the largest FOVs (>15 cm).4–8 conversion factors being reported for dental CBCT
The range of published effective doses is quite large scanners.
and determining an effective dose for an arbitrary scan
protocol is difficult using the currently published data.
Methods and materials
Effective dose
Effective dose is a radiation protection quantity often A literature search was performed using PubMed
used to compare radiation doses for different imaging to search the MEDLINE database for published
procedures or between different types of imaging literature on radiation dosimetry for dental CBCT
modalities. The computation of effective dose is a machines. The search terms selected, “dental radi-
weighted sum of the absorbed dose to a defined list of ography radiation dosimetry”, were intentionally
tissues and is measured in units of Sievert (Sv). The broad to capture as many results as possible. This was
weighting factors used take into account the effect of expressed in Pubmed as (“radiography, dental”[MeSH
different types of radiation on tissue, and the sensitivity Terms] OR (“radiography”[All Fields] AND
of different tissues to radiation. The effective dose calcu- “dental”[All Fields]) OR “dental radiography”[All
lation, tissues used and weighting factors are defined in Fields] OR (“dental”[All Fields] AND “radiogra-
ICRP Report 103.9 phy”[All Fields])) AND (“radiometry”[MeSH Terms]
Of the tissues used in the ICRP 103 effective dose OR “radiometry”[All Fields] OR (“radiation”[All
calculation, the following are exposed to either the
Fields] AND “dosimetry”[All Fields]) OR “radiation
direct beam or scatter radiation during dental CBCT
dosimetry”[All Fields]).
scans: salivary glands, thyroid, brain, bone surface and
Required selection criteria for papers were scanner
oral mucosa (remainder tissue).
Kerma area product (sometimes referred to as dose-­ model and dose conversion factors (DCE). Optional
area product) is a measurable radiation quantity that selection criteria for papers were ICRP 103 effective
is generally interpreted as the total amount of radi- dose (E), kerma area product (PKA), tube voltage, or
ation directed at a point. The air kerma area product field of view size. Papers that reported effective dose
(PKA) is defined as the air kerma emitted by the X-­ray and PKA but not DCE were included, but papers that
tube integrated over the area of the X-­ray beam. A only reported either effective dose or PKA but not DCE
common method for measuring PKA is to use a dose-­ were excluded. Papers that reported only ICRP60
area product (DAP) meter, which is simply an ionization effective doses were also excluded.
chamber, placed at exit port of the collimator assembly. Of the 1618 results returned by the Pubmed search
The ionization chamber integrates the total air kerma as of April 2020, approximately 71 papers were
emitted by the tube during the exposure. retrieved that directly related to dental CBCT dosim-
etry. Eight of these papers met the inclusion criteria
and gave DCE or provided sufficient information
Dose conversion factors
The concept of an effective dose conversion factor (DCE) (effective dose and PKA) to calculate a DCE. Scanner
has been in use in diagnostic radiology for many years.10 model, tube voltage, effective dose, PKA, DCE and field
DCE values allow an easily measured quantity such as of view size were extracted from the papers when avail-
kerma area product (PKA) or entrance surface dose to able. Some papers reported both ICRP 60 and ICRP
be converted to an effective dose value for combinations 103 effective doses but most of the more recent papers
of X-­ray tube voltage, filtration/half value layer, X-­ray reported ICRP 103 effective doses. ICRP 103 added
field size and anatomical region exposed. Since organ some additional tissues and modified tissue weighting
and tissue doses used in the effective dose calculation factors from those published in ICRP 60.13 Only ICRP
can be difficult to measure, a common method to obtain 103 effective doses were used in the analysis here.
DCE values is through Monte Carlo simulations. Monte Data obtained from the papers were analysed to see
Carlo simulations using mathematical or voxel-­based if any trends in the response of DCE with changes in
phantoms makes obtaining organ/tissue absorbed doses tube voltage or field of view could be identified. Data
under different X-­ray beam conditions fairly easy, so analysis was performed using R v3.6.4 (https://www.​
DCE tables such as those published by Hart et al can r-​project.​org/).14

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Results wide rectangular cone beam) and the applicability of

the calculated DCE values to dental CBCT geometries
From the eight papers used for this review, 2010 was and scan parameters is unknown.
the publication year of the earliest paper found from Ernst et al performed TLD-­based dosimetry as well
which DCE could be calculated. Publication year of as Monte Carlo simulations.19 Their results reported
the other papers were 2013 (1), 2014 (2), 2017 (1) and good agreement in organ/tissue doses between the
2018 (3). Four papers reported DCE values in their TLD measurements and Monte Carlo simulations,
results.15–18 One of these papers provided only DCE. but they did not calculate DCE values. DCE calculated
Four other papers provided effective dose and PKA from their data ranged from 0.116 to 0.120 µSv/mGy-­
from which DCE values were calculated.19–22 A total of cm2 based on their TLD measurements and 0.111–
78 DCE measurements were obtained, covering a range 0.128 µSv/mGy-­cm2 based on their Monte Carlo
of field sizes and imaging modes for nine different simulations.
dental CBCT scanners (Table 1). For the majority Kralik et al used Monte Carlo simulations and DAP
of the papers, effective dose estimates were obtained measurements, but only DCE values were provided in
using TLD, OSL, or radiochromic film with an their paper.16 Their simulations investigated full and
anthropomorphic head phantom. Dose-­area product half rotation scans for different FOVs for a single
in most papers was measured using an external dose-­ dental CBCT scanner. The DCE values they obtained
area product meter. Several of the papers reviewed ranged from 0.19 to 0.23 µSv/mGy-­cm2 for half rota-
also used Monte Carlo simulations to obtain effective tion scans and 0.23–0.31 µSv/mGy-­cm2 for full rota-
dose estimates.16,17,19,21,22 tion scans. These were the highest DCE values reported
The effective doses presented by Vassileva et al were out of all of the papers reviewed. Their linear fits to
calculated using Monte Carlo simulations (PCXMC, effective dose and DAP values gave DCE values of 0.21
STUK, Finland) modelling a single scanner and three µSv/mGy-­cm2 for the half rotation scans and 0.25 µSv/
imaging protocols (standard adult, low dose adult, mGy-­cm2 for the full rotation scans.
paediatric).22 DCE calculated from effective dose and Kadesjö et al looked at effective doses for both dental
PKA values provided in the paper was 0.085 µSv/mGy-­ CBCT and 2D dental imaging for small FOV scans
cm2 for all three protocols. Only 12 projections at using a paediatric head phantom (10 year old).20 Two
30 degree intervals. As a result, it is possible that effec- scanners were investigated using TLD and radiochromic
tive doses were underestimated somewhat. film-­based dosimetry. DCE values calculated based on
Monte Carlo simulations were used by Morant their effective dose and DAP values ranged from 0.154
et al to obtain sex-­averaged effective dose results.17 to 0.173 µSv/mGy-­cm2. These were slightly higher than
Their simulations made use of the voxel-­based ICRP other values published, but consistent with expectations
anatomical male and female reference phantoms and for the paediatric age range.
modelled a specific scanner. Multiple fields of view as Kim, Han, et al performed TLD studies to vali-
well as full and half rotation scans were simulated. date Monte Carlo simulations using PCXMCRotation
DCE values ranged from 0.10 to 0.14 µSv/mGy-­cm2 for (STUK, Finland).21 Three FOVs for a single dental
the full rotation scans and 0.10–0.16 µSv/mGy-­cm2 for CBCT scanner were investigated. Their DCE values
the half rotation scans. Using a linear fit to their effec- ranged from 0.049 to 0.083 µSv/mGy-­ cm2 for their
tive dose and dose-­area product measurements, they Monte Carlo simulations and 0.061–0.102 µSv/mGy-­
derived a DCE value of 0.130 µSv/mGy-­cm2 which was cm2 for their TLD results. These values were comparable
consistent with the DCE values calculated from the to the other study by Kim et al on the same brand dental
individual measurements. CBCT scanner.15
TLD-­ based dosimetry and DAP measurements The mean effective dose from the publications that
were used by Kim et al to obtain DCE values for a reported it was 124.9 µSv (SD = 97 µSv) with a median
single dental CBCT scanner at four FOV modes and value of 101 µSv and an inter quartile range (IQR) of
two preset exposure settings (adult, low dose).15 The 126.7 µSv (n = 68). The mean reported PKA was 1310
scanner operated at a fixed tube voltage so the low mGy-­cm2 (SD = 1211 mGy-­cm2) with a median value
dose mode used a lower X-­ray tube current. Scans were of 956 mGy-­cm2 (IQR = 1498.5 mGy-­cm2, n = 68). The
also performed at the maxilla and mandible levels as mean DCE was 0.128 µSv/mGy-­cm2 (SD = 0.056 µSv/
permitted by each FOV mode. DCE values obtained by mGy-­cm2) with a median of 0.128 µSv/mGy-­cm2 (IQR
them ranged from 0.034 to 0.15 µSv/mGy-­cm2. = 0.058 µSv/mGy-­cm2, n = 78).
Shin et al used calculated DCE values based on an DCE values appear to be poorly correlated with
empirical formula derived for dental panoramic radi- X-­ray beam area or FOV, with a very slight trend
ography to get effective doses.18,23 Their DCE values of toward decreasing DCE with increasing field of view
0.128 and 0.142 µSv/mGy-­cm2 were consistent with area (Figure 1). A common practice in dental CBCT
those published by Morant et al. Dental panoramic dosimetry publications has been to categorize dose
radiography uses a very different beam geometry than results by field of view height or diameter. Typical field
dental CBCT does although (narrow fan beam versus of view categories were small (height/diameter ≤10 cm),

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Table 1 Effective dose, dose area product (PKA) and dose conversion factors (DCE) from published literature
E PKA DCE FOV
Scanner kV (µSv) (mGy-­cm2) (µSv/mGy-­cm2) (cm) Reference
ILUMA Ultra 120 157 1840 0.085 18.5 × 23.4 Vassileva and Stoyanov22
120 94 1100 0.086 18.5 × 23.4
120 46 540 0.085   18.5 × 23.4
 I-­CAT NG 360° 120 66 556 0.119 16 × 13 Morant et al17
120 58 476 0.122 16 × 11
120 53 415 0.128 16 × 10
120 47 361 0.130 16 × 8
120 35 276 0.127 16 × 6 maxilla
120 39 270 0.144 16 × 6 mandible
120 25 181 0.138 16 × 4
120 29 214 0.136   8×8
120 46 443 0.104 23 × 17 full
 I-­CAT NG 180° 120 40 303 0.132 16 × 13
120 36 260 0.138   16 × 11
120 32 226 0.142   16 × 10
120 29 197 0.147   16 × 8
120 22 151 0.146   16 × 6 maxilla
120 24 147 0.163   16 × 6 mandible
120 16 98 0.163   16 × 4
120 18 117 0.154   8×8
120 24 241 0.100   23 × 17 full
Alphard VEGA 80 183.07 3704 0.049 20 × 17.9 Kim et al15
80 123.02 2485 0.049
80 303.66 4499 0.068 15.4 × 15.4
80 163.23 2508 0.065
80 288.48 4499 0.064 15.4 × 15.4
80 158.49 2508 0.063
80 145.85 1910 0.076   10.2 × 10.2
80 68.51 956 0.072
80 184.33 1910 0.096   10.2 × 10.2
80 85.1 956 0.089
80 22.34 644 0.034 5.1 × 5.1
80 20.1 429 0.047
80 25.26 644 0.039   5.1 × 5.1
80 20.2 429 0.047
80 93.67 644 0.146 5.1 × 5.1
80 61.51 429 0.145
Alphard 3030 80 428.3 3349 0.128   20 × 20 Shin et al18
80 255.9 2001 0.128   20 × 20
80 350.7 2743 0.128   15.4 × 15.4
80 210.1 1643 0.128   15.4 × 15.4
80 273.7 2140 0.128   10.2 × 10.2
80 171 1337 0.128   10.2 × 10.2
80 81.46 637.4 0.128   5.1 × 5.1
80 50.77 395.8 0.128   5.1 × 5.1
(Continued)

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Table 1 (Continued)

E PKA DCE FOV

Scanner kV (µSv) (mGy-­cm2) (µSv/mGy-­cm2) (cm) Reference
Rayscan Symphony 90 158 1109 0.142   14.2 × 14.2
90 133.4 937 0.142   14.2 × 14.2
90 160.3 1126 0.142   14.2 × 14.2
90 143.2 1006 0.142   14.2 × 14.2
90 153.9 1081 0.142   14.2 × 14.2
90 146.3 1028 0.142   14.2 × 14.2
90 154.5 1085 0.142   9.7 × 9.7
90 141.9 996.7 0.142   9.7 × 9.7
3D Accuitomo 170 90 48 401 0.120   4×4 Ernst et al19
90 97 818 0.119   8×5
90 250 2160 0.116   14 × 10
90 49 401 0.122   4×4
90 105 818 0.128   8×5
90 240 2160 0.111   14 × 10
Cranex3D × 180° 90 0.180   5×5 Kralik et al16
90 0.230   6.1 × 7.8
90 0.230   7.8 × 7.8
90 0.190   7.8 × 15
90 0.220   13 × 15
Cranex3D × 360° 90 0.190   5×5
90 0.300   6.1 × 7.8
90 0.310   7.8 × 7.8
90 0.230   7.8 × 15
90 0.280   13 × 15
ProMax3D 90 88 510 0.173 4 × 5 (TLD) Kadesjö et al20
NewTom5G 110 172 1080 0.159 6 × 6 (TLD)
NewTom5G 110 166 1080 0.154 6 × 6 (Film)
Alphard VEGA 80 174 3568.1 0.049 20 × 17.9 (MC) Kim et al21
80 289 4336.4 0.067   15.4 × 15.4 (MC)
80 152 1837.8 0.083 10.2 × 10.2 (MC)
80 216 3568.1 0.061   20 × 17.9 (TLD)
80 366 4336.4 0.084   15.4 × 15.4 (TLD)
80 187 1837.8 0.102   10.2 × 10.2 (TLD)

medium (height/diameter between 10 and 15 cm) and

large (height/diameter >15 cm).3–7 Using these divisions,
FOVs were categorized as small (<100 cm2), medium
(100–225 cm2) and large (>225 cm2). Using these group-
ings a much more distinct relationship between DCE and
FOV emerged. The mean DCE for the small, medium
and large FOV were 0.148 (SD = 0.062), 0.137 (SD =
0.046) and 0.084 (SD = 0.028) µSv/mGy-­cm2 respec-
tively (Figure 2). Median and mean effective dose, PKA
and DCE grouped by FOV are listed in Table 2. Using
a two-­sided t-­test, the mean DCE for the small and
medium FOV were not found to be statistically different
(p = 0.44) while the mean DCE for the small – large and
medium – large FOV were statistically different (p <
0.001).
In the small FOV data, there are several outliers on the
Figure 1 Change in dose conversion factor with field of view area. high and low end. On the low end, low DCE (0.034–0.047
The slope of the linear fit line is −1.60 × 10−4 (µSv/mGy-­cm2)/cm2.

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Figure 2 DCE values categorized by small, medium and large FOV areas.

µSv/mGy-­cm2) comes from scans performed in the small categories at each tube voltage. Table 4 gives the linear
FOV (D-­mode, 5.1 × 5.1 cm) in the maxillary region.15 fit parameters for DCE as a function of tube voltage for
The low effective dose measured in these scans was likely each FOV category with the intercept constrained to
due to sensitive tissues (salivary glands) not being in the go through the origin. Table 5 gives the mean and stan-
primary beam due to the scan location and small FOV. dard deviation DCE grouped by tube voltage and FOV.
Monte Carlo simulations performed by Kralik et al Two-­sided t-­tests between the small, medium and large
produced the highest DCE values (derived from linear FOVs at each tube voltage suggest the mean DCE are
fits to effective dose and PKA data) out of all the publica- not statistically different at 80 and 90 kV, but are statis-
tions reviewed, and can be seen as the high DCE outliers tically different at 120 kV (p < 0.05).
in the small and medium FOV data.16
An estimate for reasonable DCE values for the small,
medium and large FOV can be obtained by plotting Discussion
the effective dose as a function of PKA (Figure 3) and
obtaining the slope of a linear fit line through the data. The primary purpose for calculating effective doses for
Constraining the fit to go through the origin gives slopes imaging procedures is to facilitate the optimization of
of 0.129, 0.111 and 0.074 µSv/mGy-­cm2 for the small, imaging protocols and compare the risks from different
medium and large FOVs respectively. Data from Kralik
et al were not included because effective dose and PKA
values were not provided..
All of the papers reviewed provided information on
the scan protocols used, which included tube voltage.
Table 3 gives the mean and median of the effective
dose, PKA, and DCE grouped by tube voltage. Figure 4
shows a box plot of DCE grouped by tube voltage.
Figure 5 shows the same data with the addition of FOV

Table 2 Mean (median) effective dose, PKA and DCE grouped by

FOV area
E PKA DCE
FOV (µSv) (mGy-­cm2) (µSv/mGy-­cm2) N
Small 64.2 (48) 515.8 (429) 0.148 (0.143) 31
Medium 125.6 (144.5) 1095.2 (1017) 0.137 (0.131) 28 Figure 3 Effective dose as a function of dose area product. The
Large 204.1 (183.1) 2627 (2508) 0.084 (0.084) 19 slopes for the small, medium and large FOV are 0.129, 0.111 and 0.074
µSv/mGy-­cm2, respectively.

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Table 3 Mean (median) effective dose, PKA and DCE grouped by tube
voltage
E PKA DCE
kVp (µSv) (mGy-­cm2) (µSv/mGy-­cm2) N
80 171.8 (167.1) 2096 (1910) 0.087 (0.080) 30
90 137.9 (143.2) 1042 (1006) 0.175 (0.142) 25
110 169.0 (169.0) 1080 (1080) 0.157 (0.157) 2
120 44.6 (36.0)1 400.6 (270.0) 0.128 (0.132) 21

imaging protocols and modalities. Even although effec-

tive dose is not intended to be used for patient-­specific
dosimetry, it is still sometimes used for that purpose
by incorporating patient-­specific correction factors for
age and patient weight. Thus having a method to easily Figure 5 DCE box plot for different tube voltages and FOV sizes
obtain effective dose estimates is useful. Many dental
CBCT units provide an indication of the kerma-­area
product (PKA) for the selected protocol, so PKA based a decrease in DCE with increasing FOV at a given kV.
DCE values provide an easy way to obtain effective dose This is reflected in the linear fit slopes given in Table 4.
estimates. One area that still requires more investigation is
Figure 1 suggests poor correlation between FOV and dental CBCT radiation dose to the paediatric popula-
DCE. Using previously published conventions of cate- tion. The carcinogenic risks of radiation exposure to the
gorizing dental CBCT doses by small, medium, or large paediatric population is well known. Paediatric patients
FOV gives a somewhat different picture with a more may also be subjected to follow-­up dental CBCT scans
visible trend for lower DCE values as FOV increases. resulting in additional exposure. Of the eight papers
Figure 2 indicates that using DCE values based on FOV reviewed here, only three reported results for paediatric
size would be more appropriate than using a single DCE aged phantoms. Vassileva et al22 included a paediatric
for all dental CBCT scan protocols. Although the mean dental CBCT protocol, but did not mention what age
DCE between the small and medium FOV did not seem PCXMC phantom was used to obtain the effective dose
statistically different, this could be due to the limited value for the paediatric protocol. Since their paediatric
number of data points available. DCE has essentially the same value as the adult DCE
A linear fit to the complete set of effective dose and values, it seems unlikely their paediatric protocol simu-
PKA data results in a slope of 0.083 µSv/mGy-­cm2, which lation used a paediatric phantom. The paediatric proto-
is close to the slope obtained for the large FOV, but cols evaluated by Shin et al appear to be identical to the
lower than that for the small and medium FOVs. This adult protocols except for using a lower tube current
indicates that using a DCE value without taking into (mA) setting. The same DCE values were used to calcu-
account FOV size could significantly underestimate or late effective doses for both the adult and child proto-
overestimate the effective dose. cols on the two dental CBCT machines they evaluated.18
When tube voltage is considered, the behaviour of Intuitively, paediatric DCE values would be expected to
DCE appears to be more complex. Figure 4 suggests be higher than for adults, so their effective doses for the
DCE increases with increasing kV, while Figure 5 implies child protocol are likely to be underestimated. The paper
by Kadesö was the only one to look at effective doses
specifically to paediatric patients, but their work only
looked at small FOV scans.20 Their results and those of
others show that effective doses to paediatric patients
from dental CBCT are higher than for adults.20,24–26 The
DCE values reported by Kadaesjö were in the higher end
of the values in Table 1.
Although a single DCE value can be calculated from
the published effective dose and dose area product

Table 4 Linear fit parameters (DCE = m*kV) for DCE as a function

of kV with the intercept constrained to go through the origin
FOV Slope (m) R2
Small 0.0015 0.85
Medium 0.0014 0.89
Large 0.0009 0.89
Figure 4 DCE box plot for different tube voltages.

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Table 5 DCE mean and standard deviation grouped by tube voltage than a single DCE value applied to all dental CBCT
and FOV imaging.
DCE
kV FOV (µSv/mGy-­cm2) SD N
Conclusion
80 Small 0.089 0.051 8
Medium 0.097 0.022 8 Effective dose conversion factors provide a simple
Large 0.081 0.032 14 method for obtaining effective dose estimates for dental
90 Small 0.184 0.066 13 CBCT from the dose area product that many scanners
Medium 0.167 0.052 12 report. A summary of DCE values found in the current
110 Small 0.157 0.004 2 literature was presented. DCE values range from 0.035
120 Small 0.146 0.013 8 to 0.31 µSv/mGy-­cm2 with a median value of 0.128
Medium 0.132 0.010 8 µSv/mGy-­cm2 (SD = 0.056). FOV size appears to be a
Large 0.092 0.009 5 significant factor affecting DCE with tube voltage being
a smaller factor. Linear fits to effective dose vs PKA for
small, medium and large FOVs gave reasonable DCE
data, the range of DCE values published in the liter- values that can be used to obtain effective dose estimates
ature suggests that a range of DCE values would be that take into account scan FOV. Further investigation
more useful for calculating dental CBCT effective into imaging parameters such as age, field size, tube
dose estimates. It has been shown in the literature that voltage and beam location would be useful to determine
dental CBCT effective doses can change significantly the most significant factors that affect DCE.
depending on field of view size and scan location
due to the location of sensitive organs relative to the Acknowledgements
X-­ray beam.8,16 A single DCE value also does not take
into account patient size or age. Tables that take into This project was supported by National Institutes of
account age, scan location and X-­ray tube technique Health (NIH) grants P20GM121342, T32DE017551,
would provide more accurate effective dose estimates and R01DE021134 to HY.

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