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Influence of a Commercial Lead Apron on Patient Skin Dose Delivered During Oral and Maxillofacial Examinations under Cone Beam Computed Tomography (CBCT)

Schulze, Ralf Kurt Willy; Sazgar, Mahssa; Karle, Heiko; de las Heras Gala, Hugo*

doi: 10.1097/HP.0000000000000676

The purpose of this paper is to investigate the impact of a commercial lead apron on patient skin dose delivered during maxillofacial CBCT in five critical regions by means of solid-state-dosimetry. Five anatomical regions (thyroid gland, left and right breast, gonads, back of the phantom torso) in an adult female anthropomorphic phantom were selected for dose measurement by means of the highly sensitive solid-state dosimeter QUART didoSVM. Ten repeated single exposures were assessed for each patient body region for a total of five commercial CBCT devices with and without a lead apron present. Shielded and non-shielded exposures were compared under the paired Wilcoxon test, with absolute and relative differences computed. Reproducibility was expressed as the coefficient of variation (CV) between the 10 repeated assessments. The highest doses observed at skin level were found at the thyroid (mean shielded ± SD: 450.5 ± 346.7 μGy; non-shielded: 339.2 ± 348.8 μGy, p = 0.4922). Shielding resulted in a highly significant (p < 0.001) 93% dose reduction in skin dose in the female breast region with a mean non-shielded dose of approximately 35 μGy. Dose reduction was also significantly lower for the back-region (mean: −65%, p < 0.0001) as well as for the gonad-region (mean: −98%, p < 0.0001) in the shielded situation. Reproducibility was inversely correlated to skin dose (Rspearman = −0.748, p < 0.0001) with a mean CV of 10.45% (SD: 24.53 %). Skin dose in the thyroid region of the simulated patient was relatively high and not influenced by the lead apron, which did not shield this region. Dose reduction by means of a commercial lead apron was significant in all other regions, particularly in the region of the female breast.

*University Medical Center of the Johannes Gutenberg-University Mainz.

Authors Schulze, Sazgar, and Karle declare no conflict of interest. Author de las Heras Gala declares that he is employed with the company QUART GmbH (Zorneding, Germany) providing and selling the high-sensitivity dosimeter used for this study. The measurements, however, were entirely performed by M. Sazgar and thus were not influenced by de las Heras Gala at any time. No other conflicts of interest were involved with this work.

For correspondence contact: Ralf Kurt Willy Schulze, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany, or email at

(Manuscript accepted 13 February 2017)

© 2017 by the Health Physics Society