Last week I wrote a bit about a September JADA article on the use of lead aprons when exposing dental radiographs. After reading that article and fielding several questions from colleagues, I sent a note to the Maryland Department of Environment (MDE), Radiologic Health Section, to inquire about the current regulations on x-ray shielding and the JADA article. 

The current Code of Maryland Regulations (COMAR 26.12.01.01) is interpreted by the MDE as "Lead aprons should be used on patients to protect them from scatter radiation."

My note asked if the department will be considering any changes to its current regulations based on the evidence presented in a study by the American Academy of Oral and Maxillofacial Radiology (AAOMR). The entire AAOMR study results and clinical implications state:

Results. Considering the absence of radiation-induced heritable effects in humans and the negligible dose to the gonads and fetus from dentomaxillofacial imaging, the committee recommends discontinuing shielding of the gonads, pelvic structures, and fetuses during all dentomaxillofacial radiographic imaging procedures. On the basis of radiation doses from contemporaneous maxillofacial imaging, the committee considered that the risks from thyroid cancer are negligible and recommends that thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging.

Practical Implications. This position statement informs and educates the reader on evolving radiation protection practices and provides simple, unequivocal guidance to dental personnel to implement these guidelines. State and local authorities should be contacted to update regulations to reflect these recommendations.

I promptly heard back from the department:

“Thank you for bringing this article to our attention.  We are in the process of reviewing what the article has brought to light.  We will be reaching out to the Conference of Radiation Control Program Directors and to the Maryland Radiation Control Advisory Board for additional guidance.  I ask that you give us some time to confer with our counterparts.  We also would very much like to work with you on this issue to ensure that we have the best practices in place for public health and safety.”  

They also included several colleagues to ensure that everyone knew of the new AAOMR recommendations. I am appreciative of the department’s quick response and desire to work with us.

However, until we hear additional guidance from the state officials, we should stay within Maryland law and continue the use of patient x-ray shielding under current "ALARA" (As Low As Reasonably Achievable) principles. 

P.s. Please don’t forget to complete the forms on the MSDA website about any denied claims or concerns regarding dental benefits. These are critical to our continued work on dental insurance and other dental benefits. In addition, if you aren’t submitting any complaints to the Maryland Insurance Administration (MIA), please begin to do so at this link. The MIA needs to have a record of all insurer concerns and complaints, even the benefits they don’t oversee, so those can be reported to the legislature.