Apron Shielding Not Needed

Why the AAOMR No Longer Recommends Leaded Aprons for Dental Imaging

For decades, the use of leaded aprons has been standard practice in dental radiology. Patients expect it. Clinicians feel reassured by it. But with advances in radiologic science and imaging technology, longstanding traditions are being re-examined.

In a move that may surprise many dental professionals, the American Academy of Oral and Maxillofacial Radiology (AAOMR) no longer recommends the routine use of leaded aprons during dental x-ray / cone-beam computed tomography (CBCT) and other dental radiographic procedures. This shift reflects a growing consensus in medical physics and radiation safety communities worldwide.

So, what’s changed? And why?

1. Lead Aprons Don't Significantly Reduce Radiation Risk in Head and Neck Imaging

CBCT scans are highly collimated and focused on a small region, usually the head and neck. The radiation is localized, and modern machines emit low doses compared to medical CT scans.

Most of the critical organs affected by dental x-ray / CBCT scan are in the field of view (e.g., salivary glands, thyroid, lenses of the eyes). A lead apron over the chest or abdomen does not shield these areas.

Key Point: The effective dose reduction offered by lead aprons in dental imaging is minimal, often less than 1%.

2. Lead Shields May Interfere With Automatic Exposure Controls

In some digital systems, lead shielding may trigger automatic exposure compensation, unintentionally increasing radiation output. This defeats the purpose of shielding and can actually result in higher doses to the patient.

3. Scatter Radiation to the Rest of the Body Is Negligible

The amount of scatter radiation from dental imaging that reaches the torso or reproductive organs is extremely low, often comparable to a few hours of background radiation from natural sources.

As a result, shielding the torso does little to reduce risk further, especially when other protective measures are in place, such as:

• Proper patient positioning

• Use of the smallest appropriate field of view (FOV)

• Adherence to ALARA (As Low As Reasonably Achievable) principles

4. The Focus Has Shifted to Justified Imaging and Dose Optimization

The AAOMR and related organizations (such as AAPM, NCRP, and the Image Gently Alliance) now emphasize a three-pronged approach to radiation safety:

• Justification: Take radiographs only when clinically necessary

• Optimization: Use the lowest possible dose for the diagnostic task, with reduced radiation dosage techniques such as digital radiography and the use of collimators

• Limitation: Minimize unnecessary exposure by following best practices

In this context, routine lead apron use becomes less relevant—or even counterproductive—when it distracts from more meaningful protective strategies.

5. Modern Guidelines Are Evidence-Based and Evolving

The AAOMR’s position reflects the best available scientific evidence and aligns with international recommendations from:

• American Association of Physicists in Medicine (AAPM)

• National Council on Radiation Protection & Measurements (NCRP)

• British Institute of Radiology (BIR)

• European Commission Dental Guidelines

Final Thoughts

The discontinuation of routine lead apron use in dental radiography and CBCT imaging is not about cutting corners; it's about following evidence-based dentistry. By focusing on justified imaging, precise technique, and modern equipment, we can protect patients more effectively than ever before.

The AAOMR’s updated recommendation reminds us that good radiology isn’t about what we’ve always done—it’s about what works best for our patients today.

References

1. AAOMR Statement on Lead Aprons (2021)

   • Title: Leaded Aprons in Dental Imaging: An AAOMR Position Statement

   • Source: American Academy of Oral and Maxillofacial Radiology (AAOMR)

   • Link: Patient shielding during dentomaxillofacial radiography - The Journal of the American Dental Association

2. AAPM Position Statement

   • Title: AAPM Position Statement on the Use of Patient Gonadal and Fetal Shielding (PP 32-A)

   • Organization: American Association of Physicists in Medicine

   • Link: https://www.aapm.org/org/policies/details.asp?id=468&type=PP

3. Image Gently Alliance – “Pause and Pulse” Campaign

   • Focus: Promotes optimization in pediatric CBCT without routine use of shielding.

   • Link: https://www.imagegently.org

4. NCRP Report No. 177 (2019)

   • Title: Radiation Protection in Dentistry and Oral & Maxillofacial Imaging

   • Publisher: National Council on Radiation Protection and Measurements

   • Summary: Emphasizes justification, dose optimization, and modern radiological protection practices over routine shielding.

5. European Guidelines on Radiation Protection in Dental Radiology (2004)

   • EUR 16262 EN

   • Recommendation: Prefer thyroid shielding when it does not interfere with imaging; minimal role for lead aprons in CBCT.

   • Link: https://ec.europa.eu/energy/sites/ener/files/documents/162_en.pdf

6. BIR Statement (2020) – British Institute of Radiology

   • Title: Patient Shielding in Diagnostic Radiology: A Position Statement

   • Link: https://www.bir.org.uk/media/414334/final_patient_shielding_statement.pdf

For additional information, please visit the AAOMR webpage.

Source: www.aaomr.org