What the EU's New Reference-Level Recommendation Means for Dental X-Rays

Why this matters now

In February 2026 the European Commission adopted a new Recommendation on establishing, reviewing and using diagnostic reference levels (DRLs) for medical radiation exposure, building on the Basic Safety Standards Directive (2013/59/Euratom). A DRL is not a dose limit for an individual patient. It is a benchmark dose for a typical exam on a standard-sized patient group, used to flag when a facility's own doses run unusually high so the equipment and technique can be reviewed. The Recommendation sets out the methodology national authorities should use to build, and periodically re-check, their own DRL systems.

That is relevant to dental practices because a 2025 survey of the Dental Imaging Special Interest Group of the European Federation of Organisations for Medical Physics found that official DRLs for dental cone-beam CT exist in only a handful of the 33 countries it covered, and the figures that do exist vary widely between them. If your national authority has not published dental-specific reference levels yet, a Recommendation like this is exactly the kind of document that gets that process started.

What actually changed

• The Commission's Recommendation gives member states a common methodology for setting up, maintaining and re-evaluating national DRL systems. It does not itself set new dose figures — it sets out how those figures should be built and reviewed.
• The 2025 academic survey found published DRLs for dental CBCT in only nine of the 33 countries surveyed: Finland, Germany, Ireland, Italy, Greece, the UK, Sweden, Switzerland and Estonia. Values ranged from 200 mGy·cm² for imaging a single jaw quadrant in Sweden to 1150 mGy·cm² for paranasal sinus imaging in Finland. The UK was the only country with pediatric-specific dental CBCT values.
• Where dental DRLs do exist, they are set separately by modality, not as one blanket figure. The UK's own National Diagnostic Reference Levels, updated in December 2025, list an adult intraoral mandibular molar radiograph at 1.2 mGy, adult panoramic at 81 mGy·cm², adult lateral cephalometric at 35 mGy·cm², and adult CBCT for a maxillary molar implant at 265 mGy·cm² — each with a separate, lower child figure alongside it.

What this means in the operatory

If your country already publishes dental DRLs, expect the radiation protection adviser or medical physics expert who reviews your equipment to reference the Commission's updated methodology at your next audit. That is a more structured comparison against the national figures, not new numbers overnight.

If your country does not yet have modality-specific dental DRLs — which, going by the 2025 survey, is still the more common situation across Europe — this Recommendation is aimed squarely at closing that gap. It is reasonable to expect national authorities to start that work, which over time means more specific documentation requests at equipment servicing or notified body review, rather than a general instruction to keep doses "as low as reasonably achievable."

Either way, DRLs are set and monitored by a radiation protection adviser or medical physics expert working from the equipment's own dose output data. They are not something a practice sets on its own, and not something a barrier product changes.

What to check

• Ask your radiation protection adviser or medical physics expert whether a national DRL exists for each dental modality you operate. Intraoral, panoramic, cephalometric and CBCT are generally tracked separately, as the UK figures above show.
• If one exists, confirm when your equipment's output was last compared against it, and file that alongside your other quality and MDR records.
• If none exists yet for your country, ask whether local reference values have been set in the meantime — many national DRL systems start from local figures before a national one is published.
• Treat equipment servicing and dose audits as a practical moment to also confirm barrier and positioning-device protocols are current for that specific unit. It is easier to combine both checks into one visit than to schedule two.