Physical and Engineering Sciences in Medicine

https://doi.org/10.1007/s13246-021-00985-5

SCIENTIFIC PAPER

Evaluation of radiation exposure to operators of portable hand‑held

dental X‑ray units
Justin Leadbeatter1 · Jennifer Diffey1

Received: 12 October 2020 / Accepted: 18 February 2021

© Crown 2021

Abstract
The use of hand-held dental X-ray units is increasing within Australia since their portability is advantageous in applications
such as aged care. However, proximity of the operator to the X-ray unit raises radiation safety concerns. The aim of this
study was to evaluate operator radiation exposure and methods of dose reduction for the Rextar X camera-style hand-held
dental X-ray unit. Leakage and scattered radiation were measured using a solid state detector. Scatter was generated using
a Perspex head phantom. Measurements of scattered radiation dose as a function of distance were made with and without a
lead acrylic scatter shield (0.6 mm Pb equivalence at 100 kVp) attached to the X-ray unit. Without the scatter shield, doses
to the operator from a single adult maxillary molar X-ray exposure were 0.69, 0.78 and 0.47 µGy at the left hand, right hand
and eyes respectively. With the scatter shield attached, doses were reduced to 0.25, 0.12 and 0.15 µGy respectively, corre-
sponding to a dose reduction of 64, 85 and 68%. The contribution from leakage radiation was insignificant in comparison.
It is highly unlikely that an operator would reach occupational dose limits when using the Rextar X hand-held dental X-ray
unit, even without the scatter shield in place. Nevertheless, it is strongly recommended that the scatter shield is attached to
keep operator doses as low as reasonably achievable. Use of the scatter shield additionally ensures compliance with the Aus-
tralian legislative requirement for a protective barrier and is considered a preferable alternative to X-ray protective clothing.

Keywords Hand-held dental X-ray · Intra-oral X-ray · Radiation safety · Occupational radiation exposure · Radiation dose
limits · Scattered radiation

Introduction
The portability of hand-held dental intra-oral X-ray units
makes them valuable in a number of applications. Their use
within the military, forensics and disaster recovery fields is
well-established [1–6]. Within Australia, they are increas-
ingly being used in aged care facilities, operating theatres
and schools, with a New South Wales (NSW) Health Pri-
mary School Mobile Dental Program being launched in 2019
[7].
International guidelines on the safe use of hand-held
dental X-ray equipment exist [8–11], though their recom-
mendations have not yet been adopted within Australian/
New Zealand Standards™ [12] and regulatory requirements
* Jennifer Diffey
jennifer.diffey@health.nsw.gov.au
1
Department of Medical Physics, Hunter New England
Imaging, John Hunter Hospital, New Lambton Heights,
NSW, Australia
[13, 14]. The Australian documents were written prior to the
introduction of hand-held units, with the Australian/New
Zealand Standard™ for Dento-Maxillofacial X-ray Equip-
ment [12] stating that the exposure switch shall be arranged
so that the X-ray equipment can be operated at a distance of
at least 2 m from the X-ray tube and the patient, a condition
that would not be possible on a hand-held unit. Regulatory
requirements have the caveat that if it is not possible to be
more than 2 m from the X-ray tube during exposure, the
operator must be behind a protective barrier [13, 14], with
the barrier being a structural shield, protective screen or
X-ray protective apron [14].
Although hand-held dental X-ray units that comply with
state regulatory requirements [13] are not prohibited within
NSW, concerns have been expressed about the potential for
increased radiation exposure to the operator. It would be pru-
dent to only permit the use of hand-held dental X-ray units
that present no additional risk to the operator, patient or third
party, compared with using fixed intra-oral X-ray equipment
[9]. Given the proximity of the operator to the X-ray tube, it

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 Physical and Engineering Sciences in Medicine

is necessary for equipment to be constructed with adequate (Posdion Co. Ltd) and ultimately determine its suitability for
shielding to reduce effective and equivalent doses from both use within NSW and Australia.
leakage and backscattered radiation to acceptable levels.
Good practice dictates that doses should firstly be
restricted by the use of engineering controls and design fea- Methods
tures. Only once these have been applied should considera-
tion be given to systems of work and the use of personal Technical specifications of the Rextar X portable
protective equipment (PPE) [15]. For the model of unit eval- hand‑held dental X‑ray unit
uated in this study, the Rextar X (Posdion Co. Ltd), the prin-
cipal design feature that limits radiation exposure to patients The Rextar X (Posdion Co. Ltd) has a camera-style design
and staff is an attachable cone of length 140 mm. This and is held by the operator on at least one side of the unit,
ensures compliance with the regulatory requirements that with the exposure button located on the front (Fig. 1).
the minimum focus to skin distance is not less than 200 mm Technical specifications were taken from manufacturer’s
and that the maximum dimension of the useful beam at documentation and verified by local quality control meas-
the open end of the cone is not more than 60 mm [12–14]. urements in accordance with established test protocols [13,
The unit can be purchased with a number of optional dose 20], noting that verification of mA and focal spot size are
reduction features, but these are not supplied as standard. not required (Table 1). The unit used in this study had a pre-
These include a tripod to mount the unit and a detachable programmed exposure time of 0.36 s for an adult maxillary
exposure switch on a cable; this feature is employed within molar examination using a digital photostimulable phosphor
the NSW Health Primary School Mobile Dental Program (PSP) image receptor, therefore delivering an exposure of
to ensure that staff are able to remain 2 m from the X-ray 70 kVp and 0.72 mAs and giving a measured entrance skin
tube (personal correspondence with Co-ordinator of NSW air kerma of 1.1 mGy.
Health Primary School Mobile Dental Program). However,
the use of a tripod negates the benefits associated with port- Determination of lead equivalence of scatter shield
ability, which may be essential, or at least desirable in other
applications. The other available option is a scatter shield, The scatter shield, which may be optionally purchased for
which is an annulus of lead acrylic that attaches to the end the Rextar X unit, is an annulus of lead acrylic that attaches
of the cone. PPE, if required, could potentially include X-ray to the end of the cone and has an outer diameter of 155 mm
protective clothing such as a gown, thyroid shield, gloves (Fig. 2).
and lead glasses. The lead equivalence was not marked, so was determined
There are two basic design types of hand-held dental in accordance with the method in the Australian/New Zea-
X-ray units. The first is described as a pistol-style [8] or a land Standard™ for Protective devices against diagnostic
handle and trigger device [10]; the second is a camera-style medical X-radiation [21]. This involved using a specially
device [8, 10]. For equipment that is well constructed with made jig to ensure narrow beam geometry. Testing was
suitable design features such as backscatter shields, studies
have shown that annual effective doses to operators of hand-
held models is comparable to, or lower than, doses to opera-
tors of wall-mounted units [1, 8] and below occupational
dose limits [1–4, 8, 10, 16, 17]. It should be noted that the
majority of these studies were conducted using a pistol-style
device [1–4, 16, 17], with authors stressing the requirement
to evaluate each model individually since results could differ
significantly based on variations in design characteristics.
This is sound advice, given that one model purchased from
the online marketplace was found to contain such inadequate
lead shielding that it placed the operator at risk of exceeding
statutory dose limits and even incurring radiation-induced
tissue reactions [8, 18]. Within the UK, a medical devices
alert was issued [18] and warnings were made in the main-
stream media [19].
The aim of this study was to evaluate operator radiation
exposure and methods of dose reduction for one particu- Fig. 1  The Rextar X portable hand-held dental X-ray unit, shown
lar camera-style hand-held dental X-ray unit, the Rextar X with 140 mm cone and lead acrylic scatter shield attached

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Physical and Engineering Sciences in Medicine
Table 1  Technical specifications Specification
for the Rextar X portable hand-
held dental X-ray unit Tube potential (kVp)—fixed
Tube current (mA)—fixed
Exposure time (seconds)—variable
Focal spot size (mm)
Total filtration (mm Al)
Focus to skin distance with cone (mm)
Beam diameter (mm)
Comparison of nominal and measured values, where applicable
Fig. 2  Lead acrylic scatter shield that affixes to the cone of the Rextar
X dental X-ray unit
carried out on a general radiographic X-ray unit using expo-
sure factors of 96 kVp and 20 mAs. The beam was tightly
collimated and filtered using 0.1 mm Cu and 1 mm Al, to
achieve the standardized radiation quality of 0.25 mm Cu
at 100 kV [21]. A distance of 150 cm was set between the
X-ray tube focal spot and a solid state technology Unfors Xi
R/F detector (Raysafe™). A calibration curve was gener-
ated by measuring unattenuated air kerma and transmitted
air kerma through high purity lead of known thicknesses
(Puratronic® 99.998% from Alfa Aesar, Thermo Fisher Sci-
entific). A polynomial equation was fitted to the calibration
curve and used to derive the lead equivalence of the scatter
shield, based on the transmitted air kerma measurement.
Evaluation of radiation exposure to the operator
There are two potential sources of radiation exposure to the
operator: leakage and scatter.
Nominal value Measured value
70 67.8
2.0 n/a
0.01–1.30 0.362 s (0.360 s set)
0.4 n/a
1.5 HVL 2.1 mm Al at 70 kVp
205 205
60 60
Fig. 3  Experimental set up used for generating scattered radiation.
The Rextar X unit, shown here with cone attached (but without scat-
ter shield), is positioned in contact with a CTDI head phantom
Leakage from the X-ray unit was measured using a solid
state technology Unfors Xi Survey Detector (Raysafe™),
selected for its precision of 0.001 µGy and measurement
uncertainty of 0.3 µGy/h. The cone was removed from the
unit and the X-rays were directed into a sheet of lead to
ensure that backscattered radiation was minimised, since it
was not possible to close the collimator. The Survey Detec-
tor was positioned in contact with each of the six surfaces
of the X-ray unit (front, back, top, bottom and sides) and
exposures of 70 kVp, 0.72 mAs were made. The integral
dose from each exposure was recorded and corrected to a
measurement in mGy/h at 1 m, averaged over 100 ­cm2, tak-
ing into account the tube duty cycle.
Scattered radiation was also measured using the Unfors
Xi Survey Detector (Raysafe™), again selected for its sensi-
tivity. The cone was attached to the unit, to replicate clinical
conditions. X-ray exposures of 70 kVp and 0.72 mAs were
made with the cone in contact with a Computed Tomog-
raphy Dose Index (CTDI) head phantom (Fig. 3). This is
a Perspex cylinder with a diameter of 16 cm and height
of 15 cm. This methodology was selected to simulate the
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scatter from a patient’s head during a typical adult maxillary
molar examination.
The following scatter measurements were performed both
with and without the scatter shield attached to the end of the
cone. Firstly, the Survey Detector was positioned at loca-
tions corresponding to where the operator would put each
hand while holding the unit to make an exposure. Secondly,
scatter dose profiles were obtained. The Survey Detector
was placed in line with the back surface of the unit, at the
intersection with the focal spot indicator on the top of the
unit. This point was classed as the origin (Fig. 3). A dose
profile in the horizontal direction was generated by measur-
ing the scattered radiation dose at 3 cm increments to the left
and right of the origin (Fig. 4). The same method was used
to create a dose profile in the vertical direction, collecting
data in the upward and downward directions. The profiles
extend 30 cm from the origin in each of the four directions.
The measurement made 30 cm above the origin gives an
approximation of the scattered radiation dose to the eyes of
the operator.
Fig. 4  Experimental set up used for measuring scattered radiation
to create dose profiles in the horizontal direction. In this image, the
Unfors Xi Survey Detector is positioned 15 cm to the right of the ori-
gin
Table 2  Radiation dose to the Location Operator’s radiation dose per exposure (µGy)
operator for a single maxillary
molar X-ray exposure, without Without shield
and with scatter shield attached
Left hand 0.687
Right hand 0.784
Eyes 0.474
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Physical and Engineering Sciences in Medicine
Results
Leakage radiation, corrected for tube duty cycle, ranged
from 0.001 to 0.01 mGy/h at 1 m from the tube focus. The
minimum measurement was made at the back surface of
the Rextar X unit, which faces directly towards the opera-
tor’s body and the maximum measurement was made at the
left surface, which is the side closest to the focal spot. Note
that the minimum measurement for a single exposure was
below the threshold of measurement of the Unfors Xi Survey
Detector, so was assumed to be 0.001 µGy for the purposes
of calculating the dose rate at 1 m.
The scatter shield had a measured lead equivalence of
0.59 mm Pb at 100 kVp. Radiation dose at the location of
the operator’s hands and approximate location of the opera-
tor’s eyes are shown in Table 2 for measurements made with
and without the scatter shield, for a single maxillary molar
exposure of 70 kVp and 0.72 mAs. The effect of the scat-
ter shield was significant, reducing doses by 64%, 85% and
68% for the left hand, right hand and eyes, respectively. Note
that measurements of radiation dose include the contribution
from both scattered and leakage radiation.
Figures 5 and 6 show the scattered radiation dose pro-
files in the horizontal and vertical directions, respectively
for measurements made with and without the scatter shield
attached.
Discussion
Dose limits and constraints
Statutory dose limits for occupationally exposed persons and
members of the public in NSW [22] and Australia [23] are
adopted from the International Commission of Radiological
Protection [24]. The dose limits applicable to oral health
practitioners within NSW is open to interpretation since
there is no requirement to issue a personal monitoring device
to those working in dentistry; this implies that oral health
practitioners are not expected to receive exposures greater
than the recommended threshold dose for individual moni-
toring of 1 mSv per year [22, 25] and the member of the pub-
lic dose limits should apply. However, a more conservative
Dose reduction by
scatter shield (%)
With shield Contribution from
leakage
0.250 0.024 64
0.116 0.012 85
0.153 < 0.001 68
Physical and Engineering Sciences in Medicine

Fig. 5  Scattered radiation dose profiles in the horizontal direction, with and without the scatter shield attached. Negative values on the x-axis
indicate measurements of scatter in the left direction and positive values indicate measurements of scatter in the right direction

Fig. 6  Scattered radiation dose profiles in the vertical direction, with and without the scatter shield attached. Negative values on the x-axis indi-
cate measurements of scatter in the downward direction and positive values indicate measurements of scatter in the upward direction

and perhaps appropriate strategy would be to apply a dose
constraint to ensure that their radiation exposure is no more
than that which would be received if they were using fixed
intra-oral X-ray equipment. This is in line with the prin-
ciple of optimisation, in particular that doses are kept as
low as reasonably achievable (ALARA). For the purposes
of this study, we have chosen to apply the constraints pro-
posed by Public Health England, of 0.25 mSv and 10 mSv
for annual effective dose and annual equivalent dose to the
hands, respectively [8]. A dose constraint of 0.25 mSv for

13

annual equivalent dose to the eyes was also applied, on the
basis that the statutory limits for effective dose and equiva-
lent dose to the lens of the eye are numerically equal for
occupationally exposed persons [22, 23].
Leakage radiation
The measured leakage radiation complies with the relevant
standards and regulatory requirements [12–14], which state
that the X-ray tube must be enclosed in a housing in such
a manner that the air kerma from radiation leakage meas-
ured at a distance of 1 m from the focus of that tube, aver-
aged over an area not larger than 100 ­cm2, does not exceed
0.25 mGy/h for intra-oral X-ray apparatus.
The leakage radiation from the Rextar X unit was 25 to
250 times lower than the regulatory limit and was below the
threshold of measurement of the Unfors Xi Survey Detec-
tor at the back surface of the unit, which is the direction in
which the operator would be standing. This demonstrates
that the “leaded double-shield” (terminology used by Pos-
dion Co. Ltd) is a design feature which substantially restricts
radiation exposure.
With the scatter shield in place, leakage contributes about
10% to the total radiation dose received by the operator’s
hands but represents a negligible portion of the operator’s
total eye dose, where the main source of their exposure is
considered to be backscattered radiation.
Scattered radiation
The scatter shield has a measured lead equivalence of
0.59 mm Pb and diameter of 15.5 cm. It therefore complies
with the Food and Drug Administration requirements of
being at least 0.25 mm lead equivalent, 15.2 cm in diameter
and positioned no further than 1 cm from the end of the
cone so that backscattered radiation is sufficiently blocked
[11, 26].
The scattered radiation dose profiles in both the horizon-
tal and vertical directions (Figs. 5 and 6, respectively) show
a region of near zero radiation dose (< 0.01 µGy) for meas-
urements made with and without the scatter shield in place.
This region coincides approximately with the dimensions
of the unit and is due to the leaded double-shield within
the unit itself (self-shielding). The scatter dose profiles are
asymmetric because the origin has been defined as being in
line with the focal spot, which is not located in the middle
of the Rextar X unit, but is closer to the top of the unit and
operator’s left hand side.
At distances greater than about 15 cm from the focal spot,
the profiles without a scatter shield show that measured radi-
ation dose decreases with increasing distance from the phan-
tom, whereas the profiles with a scatter shield show a plateau
in measured radiation dose up to about 20 cm from the focal
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Physical and Engineering Sciences in Medicine
spot and then a very slight increase. This is due to two com-
peting factors. Distance from the phantom will decrease the
amount of scatter being measured (inverse square law), but
at greater distances more scatter can pass around the edges
of the shield.
Beyond the region of self-shielding from the unit, the
scatter profiles indicate that the radiation dose to the opera-
tor is much higher when the unit is used without a scatter
shield, compared to with the scatter shield in place. Specifi-
cally, the dose is a factor of 2.7 and 6.8 times higher to the
left and right hands, respectively when the scatter shield
is not used. Using the scatter shield dramatically reduces
these hand doses by 64% (left) and 85% (right). The position
of the eyes relative to the X-ray unit will vary for differ-
ent operators and clinical situations, but a typical position
is 30 cm above the focal spot. At this position, the scatter
shield reduces the eye dose by 68% from 0.474 to 0.153 µGy
per exposure.
Our results are in good agreement with those of Cho and
Han [5], who found that the radiation dose to the opera-
tor’s hands is reduced by 68–77% when a scatter shield is
attached to a camera-style device, noting that this was a
different model (DX3000, Dexcowin) with a shorter cone
attached. Cho and Han [5] used an anthropomorphic head
phantom to generate scatter, as opposed to a Perspex CTDI
phantom, and dose was measured using a 1,800 cc ionisation
chamber, as opposed to a solid state detector. Studies using
a pistol-style device found that the scatter shield reduced
operator dose by approximately 70–90%, depending on the
type of dosimeter and its location [4, 16, 17]. Despite some
differences in methodology, the results from our study and
others [4, 5, 16, 17] clearly demonstrate the effectiveness
of a backscatter shield in reducing operator radiation dose.
Estimates of annual operator radiation dose
At present, the maximum workload in the NSW Health
Primary School Mobile Dental Program is estimated to be
3000 X-ray exposures per year (personal correspondence
with Co-Ordinator of NSW Health Primary School Mobile
Dental Program). The potential annual radiation doses to
the operator’s eyes and hands based on this workload are
summarised in Table 3.
It is unlikely that a user would ever exceed the proposed
constraint for annual equivalent dose to the hands of 10 mSv
per year. Our findings are in broad agreement with those
of Gray et al. [1] based on their review of 116 personnel
dosimetry reports for extremity (finger) dose measured
using optically stimulated luminesence (OSL) dosimeters.
95% of the readings were below the threshold of the OSL
monitoring device, but for the remaining 5%, the average
monthly finger dose was 21 uSv, which agrees well with our
measurement of 25 uSv per month (right hand, scatter shield
Physical and Engineering Sciences in Medicine
Table 3  Potential annual equivalent doses to operator’s hands and
eyes for an estimated workload of 3000 X-ray exposures per year
Location Operator’s estimated annual equivalent
dose (mSv)
Without shield With shield
Left hand 2.1 0.8
Right hand 2.4 0.3
Eyes 1.4 0.5
attached), although it is unclear how workload compares.
There are some significant differences in study design in
terms of the dosimeters used (OSL [1] compared to solid
state technology detector) and the X-ray device (pistol-style
[1] compared to camera-style). Nevertheless, our study and
multiple others [1–4, 16, 17] support the finding that hand
dose presents no concern and the use of PPE, such as lead
gloves, is unwarranted.
The annual equivalent dose to the eyes could exceed the
proposed dose constraint of 0.25 mSv per year for a user
with a high workload, although it is inconceivable that it
would ever exceed the member of the public dose limit of
15 mSv per year [22, 23]. Oral health practitioners in the
School Mobile Dental Program make exposures with the
dental X-ray unit mounted on a tripod, but if they were to use
the equipment as a hand-held device, the proposed dose con-
straint of 0.25 mSv would be exceeded in approximately 530
exposures without the scatter shield or 1500 with the scatter
shield. However, over 30,000 exposures would be required
to exceed the member of public dose limit, even without the
scatter shield in place. Other studies have shown that eye
dose is extremely low [2, 4, 16, 17], with Danforth et al.
[2] even finding that the cumulative eye dose was below the
threshold of measurement of a thermoluminescent dosimeter
(TLD) when 915 X-ray exposures were made using a pistol-
style device with scatter shield attached [2]. These findings
indicate that PPE, such as lead glasses, is not required.
Additional considerations for patient care
Although the aim of this study was to evaluate radiation
exposure to the operator of portable hand-held dental X-ray
units, it is vital that such equipment should only be pur-
chased and used if it additionally meets requirements relat-
ing to patient care. This includes both diagnostic imaging
capabilities and radiation protection. As per previous com-
ments made in the context of operators, hand-held dental
X-ray equipment should perform to the same standard as
fixed dental intra-oral X-ray equipment.
Studies have shown that image quality is acceptable for a
number of pistol-style and camera-style devices [3, 8]. How-
ever, one consideration is that hand-held dental X-ray units
have a lower output dose rate than their fixed counterparts,
owing to a lower tube current: 2 mA for the Rextar X unit
compared to typically 7 mA for most fixed units. As a result,
exposure times are expected to be longer to deliver sufficient
mAs to ensure adequate image quality (signal to noise ratio).
Longer exposure times are associated with an increased risk
of image blur and the potential for repeat exposures due to
patient motion or even operator movement. For this reason,
the European Academy of DentoMaxilloFacial Radiology
(EADMFR) recommends that exposure times exceeding
1 s must never be used [9] and the Conference of Radia-
tion Control Program Directors (CRCPD) stresses that high
speed image receptors should be used to reduce exposure
time [10]. Although it is possible to set 1.3 s on the Rextar
X unit, a locally established technique chart indicates that
the maximum exposure time required is 0.7 s for the adult
occlusal bitewing examination using a digital PSP image
receptor. This would be reduced to 0.34 s if using a digital
CMOS (complementary metal–oxide–semiconductor) image
receptor. Film with speed of not less than ‘E’ is still permit-
ted in NSW, but it is believed that most facilities use PSP
image receptors. The potential for operator motion may be
exacerbated when the scatter shield is in place, due to the
additional weight and torque. The mass of the Rextar X unit
is 2.2 kg without the scatter shield and 2.5 kg with the scat-
ter shield. The EADMFR cautions that when the patient is
in the supine position, such as in an operating theatre, there
exists a risk of dropping the unit onto the patient’s head [9].
A second consideration is battery life and its effect on
exposure reproducibility. While repeating some of the
scatter measurements, it was found that a lower battery
charge was resulting in lower scattered radiation detected.
This effect has been observed in a number of different
hand-held dental X-ray units, and can be attributed to a
decrease in tube voltage at low battery charge [27]. This
raises the concern that image quality may degrade as bat-
tery charge reduces in clinical settings [8]. Care was taken
to ensure the Rextar X unit was fully charged for every
measurement in this research. It is advised that hand-held
dental units are charged regularly to avoid the deterioration
of beam quality that is seen at low charge [9].
A final consideration is that the oral health practitioner
should ensure that third parties are not irradiated. Due
to the portability of hand-held X-ray units, they may be
used in places that do not have established radiation safety
procedures, such as an aged care facility. Where an oral
health practitioner is visiting such a location, the EAD-
MFR recommends that they undertake a risk assessment
to identify the most suitable room, avoid directing the unit
at unsuitable barriers and ensure that third parties cannot
inadvertently enter the room and other staff are informed
of X-rays being used [9].
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Conclusion
The Rextar X hand-held portable dental X-ray unit has
been shown to be constructed with adequate shielding
and design features to reduce effective and equivalent
doses from both leakage and scattered radiation to accept-
able levels. Even without the scatter shield in place, it
is unlikely that a single operator would reach an annual
workload that would place them at risk of exceeding statu-
tory occupational dose limits, or even member of the pub-
lic dose limits.
However, in order to ensure compliance with current
Australian legislative requirements [13, 14, 22, 23] and
international best practice guidelines [8–11], it is recom-
mended that the Rextar X unit must routinely have the
scatter shield attached to the end of the cone when used
as a hand-held device (i.e. not mounted on a tripod). This
reduces operator doses by up to 85%, ensures adherence
to the ALARA principle and is preferable to PPE such as
X-ray protective clothing.
Given that hand-held dental X-ray units are not spe-
cifically referenced in current Australian federal [14] and
NSW legislation [13], it is hoped that the results from this
study can be used to inform future revisions of such docu-
ments to provide clear guidance on the safe and consistent
use of such devices across Australia, in a similar manner to
the Suggested State Regulations for Control of Radiation
(SSRCR) used in the US [11].
To the best of our knowledge, this is the only study to
date that has evaluated operator dose using the Rextar X
hand-held portable dental X-ray unit with and without the
scatter shield attached, and one of few studies carried out
on a camera-style device. Other advances in knowledge
include measurements of the lead equivalence of the scat-
ter shield and separate consideration of the dose contribu-
tion from leakage and scattered radiation. The generation
of scatter profiles in multiple directions around the unit
would allow interested parties to calculate doses based
on variations in distance, exposure factors and workload.
As a final note, it is advised that measurements similar
to those in this study are carried out on other makes and
models of hand-held portable dental X-ray units prior to
clinical use, in order to ascertain their compliance with
regulatory requirements for radiation safety.
Acknowledgements The authors would like to acknowledge Karen
Sleishman, Jared Walters and the team at Hunter New England Oral
Health, Newcastle for the loan of the Rextar X unit and providing
valuable advice on clinical applications and practical use. We also
wish to acknowledge Thomas Greig for his advice on study design
and methodology.
13
Physical and Engineering Sciences in Medicine
Declarations of Compliance with Ethical Standards
Funding No funding was received for conducting this study.
Conflicts of interest/competing interests The authors have no relevant
financial or non-financial interests to disclose.
Ethics approval This research did not involve human participants, ani-
mals, their data or biological material. Therefore ethics approval was
not required.
Consent Not applicable.
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