Protection Measures for Patients

As Low As Diagnostically Acceptable (ALADA)

• Aimed at limiting radiation exposure to patients
• Patient-centric approach vs. ALARA (see Protective Measures for Staff)
• Overall guiding principle: Diagnostic objective (Reason for Study) determines imaging modality and appropriate resolution settings (FOV size, mAs, kVp) specific to each patient

ALADA Principles

• Justify use of radiation before exposing the patient
  • For 2D imaging, see Selection Criteria (pre-CBCT)
  • For CBCT imaging, see Position Statements on the use of CBCT
• Reduce exposure (dose) to patient via optimization of CBCT machine settings / FOV size
  • See Methods to Maximum CBCT Image Quality
  • See FOV Determinations based on Scan Indication
• Reduce exposure (dose) to patient via proper use of Safety Features
  • Intraoral-specific
    • Collimator – Rectangular (vs. Round) Position Indicating Device
      • ** Most effective – 80% reduction in dose compared to Round!
    • Sensors – Digital (vs. film)
    • Aluminum x-ray filters
  • Leaded aprons
    • Highly encouraged but not required – verify with your state regulations
  • Thyroid shielding
    • Highly encourage for children (if not in x-ray beam path to area of interest)
  • Correct exposure settings based on area of interest / size of patient
    • Pediatric patients – use “Child” settings
    • Pediatric patients – see Image Gently campaign for 7 methods to reduce dose to children
  • Ensure capture of area of interest with diagnostic image quality
    • CBCT
      • See Methods to Maximum CBCT Image Quality
    • Panoramic
      • See Panoramic Acquisition Technique
    • Intraoral
      • See Intraoral Radiographs