# Evaluation of Operator and Patient Doses after Irradiation with Handheld X-ray Devices
## 4 Discussion  
Radiological assessments play a pivotal role in the diagnostic and therapeutic decision-making processes within both the dental and medical fields. While the implications of protracted exposure to low-dose radiation remain a topic of ongoing research, emerging evidence suggests that the associated risks may be more pronounced than previously anticipated [11]. In the realm of clinical dentistry, radiographs are indispensable, forming an integral component of the daily diagnostic arsenal. Traditionally, dental X-ray machines have been either stationary (wall or floor mounted) or mobile (tripod based). However, advancements in technology have paved the way for the inception of handheld, portable, and rechargeable X-ray devices. Initially, these devices found application in sectors such as military medicine, dentistry, and humanitarian outreach. Subsequently, their utility extended to diverse fields like archaeology, forensic dentistry, veterinary sciences, and criminal forensics in disaster zones. A salient advantage of these handheld devices lies in their capacity to facilitate radiographic evaluations for patients with restricted mobility or those under general anesthesia, scenarios where traditional fixed or mobile X-ray units might be impracticable [2, 5]. Typically, these devices are engineered to be held aloft, parallel to the ground, and at arm's length from the user. However, their advent has ushered in a slew of queries pertaining to radiation safety, particularly concerning the operator's exposure. Conventional stationary or mobile X-ray units necessitate that operators adhere to stringent safety protocols, which include maintaining a prescribed distance from the device and avoiding direct manual contact. Such protocols, ubiquitously termed being within the \"controlled area\", are universally recognized and practiced, including within our jurisdiction. The primary intent behind these guidelines is to mitigate unwarranted radiation exposure to both operators and the broader public. Notably, the central apprehension surrounding handheld X-ray devices centers on the potential for undue radiation exposure to the operator [12]. Handheld X-ray devices, being directly operated by practitioners, challenge the conventional paradigm of the \"controlled area\". To address this, manufacturers have incorporated shielding into the device's design. Furthermore, select models are fortified with an acrylic shield imbued with lead, designed to counter backscatter radiation. \begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline  & \multicolumn{3}{c}{**NOMAD Pro 2 TM**} & \multicolumn{3}{c}{**Rextar X**} & \multicolumn{3}{c}{**Diox 602**} \\ \hline  & **C** & **P** & **R** & **C** & **P** & **R** & **C** & **P** & **R** \\ \hline R. hand & 54.23 & 36.8 & 36.18 & 89.7 & 92.62 & 93.25 & 62.94 & 67.43 & 58.67 \\ \hline L. hand & 67.31 & 55.87 & 14.26 & 25.31 & 18.16 & 11.49 & 70.23 & 73.5 & 59.91 \\ \hline R. eye & 64.43 & 62.08 & 26.74 & 28.44 & 65.21 & 54.98 & 20.64 & 21.07 & 48.61 \\ \hline L. eye & 59.34 & 55.11 & 26.64 & 14.26 & 26.66 & 28.12 & 53.18 & 31.37 & 23.03 \\ \hline Thyroid & 62.85 & 41.83 & 41.96 & 41.98 & 36.05 & 59.31 & 26.05 & 18.78 & 24.28 \\ \hline Gonads & 54.05 & 34.46 & 32.80 & 40.03 & 30.84 & 62.89 & 31.98 & 47.03 & 40.11 \\ \hline \hline \end{tabular}  
* C: conventional, P: phosphor, R: RVG.  
\end{table} 
Table 6: Reduced dose rates when protective measures are used for all regions (%). \begin{table}
\begin{tabular}{c c c c} \hline \hline  & **NOMAD Pro 2 TM** & **Rextar X** & **Diox 602** \\ \hline P & 22.38 & 36.55 & 60.64 \\ \hline R & 77.45 & 60.09 & 72.58 \\ \hline P: phosphor, R: RVG.  
\end{table} 
Table 7: Reduced dose rates of phosphor plate and digital system compared to conventional system (%). The existing literature pertaining to handheld portable X-ray devices indicates that when assessing the effective dose directly, both the patient and the operator are exposed to radiation levels beneath the recommended thresholds [12].