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Taking the Pledge to Image Gently

Posted on Wednesday, August 20, 2014

When it comes to radiation, one size does not fit all. Radiographs should not be ordered routinely, but rather prescribed based upon professional judgment of an individual patient’s needs. This requires taking a history and performing a clinical evaluation before prescribing and taking radiographs.

Once it has been decided that radiographs are indicated based upon an appropriate individualized evaluation, they should be performed optimally, using the fastest available detectors. This may include E and F speed film or digital sensors set to adequately low settings for intraoral radiographs as well as extraoral projections and cone-beam computed tomography. If a radiograph or radiographic volume is needed for diagnostic purposes, it should be exposed to achieve diagnostic quality.

These rules apply to all patients, but it is especially important to minimize unnecessary doses of ionizing radiation in children, because tissue turnover is more rapid in children than adults, making them several times more susceptible to damage from ionizing radiation. Furthermore, children have a greater life expectancy, making the likelihood that changes occurring from radiation doses during their lifetime will be greater than for older individuals. While the risks may be relatively small, in light of these considerations, the FDA has designated X-radiation a known carcinogen. Therefore, dental professionals should strive to minimize that risk by not exposing patients unless it is diagnostically necessary to the point that its benefits outweigh the risks.

To draw attention to the need to “image gently” for children, the Alliance for Radiation Safety in Pediatric Imaging was initiated by the Society for Pediatric Radiology in 2006. It now has 80 sponsoring organizations worldwide, including 10 from dentistry. Dental member organizations include the American Dental Association, American Dental Education Association, American Academy of Oral and Maxillofacial Radiology, American Academy of Oral and Maxillofacial Pathology, American Academy of Pediatric Dentistry, American Academy of Periodontology, American Association of Endodontists, American Association of Oral and Maxillofacial Surgeons, Canadian Association of Oral and Maxillofacial Radiology, and the European Academy of Dentomaxillofacial Radiology. Additional dental organizations are welcome to join the alliance at no cost. Further, individual practitioners are urged to take the pledge to “Image Gently,” which is also the name of a campaign slated for a September rollout.

The “Image Gently” website can be accessed at This site provides resources for professionals and for parents, who can access it to “take the pledge.” It has a section specifically designated to dentistry.

In addition, the Alliance for Radiation Safety in Pediatric Imaging, along with 10 member dental professional societies, is launching a campaign titled “Image Gently in Dentistry” September 24 to 27, 2014, in conjunction with the Annual Session of the American Academy of Oral and Maxillofacial Radiology, in Orlando, Florida, with Marilyn Goske, MD, as Alliance Chair. More information on that initiative is available at

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