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

Pediatric patients are more sensitive to ionizing 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 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 meter and used in PCXMC-20Rotation to calculate organ doses, E, and REID.In panoramic mode, differences in E between PCXMC and OSLD were -4.7% (5 y) and -10.7% (10 y), and organ-dose rankings were generally similar. PCXMC overestimated oral mucosa dose in 3D mandibular imaging, where total E was approximately 3-5 times higher than in panoramic mode. DAP correlated strongly with E (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 estimated E within ±15% of OSLD measurements for both panoramic and 3D modes. DAP may serve as a practical indicator of E and 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 minimize unnecessary radiation exposure, particularly in female pediatric patients.