Dental portable X-ray

The use of handheld portable X-ray devices for intraoral radiography is increasing. This development introduces new challenges for staff and patient safety, for which new or revised risk assessments need to be undertaken and taken into account before use. Major problems could be: difficulties with the use of rectangular collimation with beam targeting devices, more complex adjustment of exposure settings to the X-ray receptor used (e.g. longer exposure times), movements due to unit weight, operator and third-party protection, and use in uncontrolled environments. These issues may result in a violation of the “as low as reasonably achievable” principle of ALARA by increasing (re)exposures compared to other available intraoral X-ray devices. The use of portable X-ray handheld devices should therefore only be considered after careful and documented evaluation (which could be carried out on the basis of medical physics support), when there is evidence that handheld operation has advantages over traditional modalities and when no new risks to operators and/or third parties are caused. The use of portable X-ray handheld devices is expected to be very exceptional, and only in justified situations.

This document refers to a non-standard form of dental X-ray equipment that is battery-powered, portable and designed for use during exposure when held in the operator’s hands. While some equipment of this type can also be attached to a tripod or other support and operated at a distance using either an exposure button on a cable attachment or a cable-free control, this position statement focuses on the alleged use of the devices, since the devices are designed to be used “handheld.” The term “handheld portable X-ray device” is used throughout this document.

Handheld portable X-ray dental devices are used for intraoral x-rays in dentistry. The current portable X-ray handheld devices resemble a photographic camera or are designed with a “shotgun.” The devices are used to replace wall-mounted or semi-mobile X-ray devices (on a tripod or mobile support) and differ in two main features:

• The handheld portable X-ray devices are held by the operator during the patient’s exposure so that the operator can’t stand back and therefore dedicated means of radiation protection (scattering) are required.
• Typically, new handheld devices have lower output dose rates (set by current, waveform, filtration and cone length) than traditional wall-mounted direct current units.