Radiation dose and risk assessment in pediatric dental CBCT: DAP-based evaluation and implications for radiation protection.

Pediatric patients are more sensitive to ionising radiation, making radiation protection a critical concern in dental cone-beam computed tomography (CBCT). This study aimed to assess organ and effective doses and associated radiation risk in pediatric imaging, to validate the PCXMC-20Rotation Monte Carlo code against optically stimulated luminescence dosimeters (OSLDs), and to evaluate dose-area product (DAP) as an indicator for effective dose (E) and risk of exposure-induced cancer death (REID). Age-specific 5 and 10 year-old head-and-neck phantoms were manufactured by three-dimensional (3D) printing and embedded with seventeen OSLDs each. The phantoms were scanned on a CS 9000 system in panoramic mode at both ages and in 3D maxillary and mandibular CBCT mode at 10 years. DAP was recorded with a VacuDAP metre and used in PCXMC-20Rotation to calculate organ doses,E, and REID. In panoramic mode, differences inEbetween PCXMC and OSLD were -4.7% (5 year) and -10.7% (10 year), and organ dose rankings were generally similar. PCXMC overestimated oral mucosa dose in 3D mandibular imaging, where totalEwas approximately 3-5 times higher than in panoramic mode. DAP correlated strongly withE(R2= 0.971-0.987) and with REID (R2= 0.967-0.986); the highest REID (8.1 × 10-6) was predicted for 10 year-old girls undergoing 3D mandibular CBCT. PCXMC estimatedEwithin ±15% of OSLD measurements for both panoramic and 3D modes. DAP may serve as a practical indicator ofEand REID in pediatric CBCT. From a radiation protection perspective, the findings support the use of child-specific exposure settings and DAP monitoring as approaches to minimise unnecessary radiation exposure, particularly in female pediatric patients.