Handheld dental X-ray devices: a scoping review of radiation safety and image quality

Handheld dental X-ray devices are increasingly used in diverse clinical and non-clinical settings, raising important considerations regarding radiation safety, diagnostic image quality, and technical performance. This scoping review aimed to map and synthesize the available evidence across these domains. A comprehensive search of Embase, MEDLINE (via PubMed), Cochrane Library, CINAHL, Web of Science, BIOSIS, and LIVIVO was performed from database inception to February 2026. Studies addressing radiation safety, dosimetry, image quality, and technical characteristics of handheld dental X-ray devices were included and synthesized according to PRISMA-ScR guidelines. A total of 308 records were identified, of which 56 studies met the inclusion criteria. The evidence base was methodologically diverse and predominantly comprised dosimetric and experimental studies performed in phantom or laboratory settings, with limited clinical data, and originated mainly from North America, Asia, and Latin America. Most studies focused on radiation safety and operator exposure. Reported operator doses were generally low under recommended conditions but varied depending on device design, shielding, and operator positioning. Patient doses were less frequently reported and were broadly comparable to conventional intraoral radiography. Image quality was generally comparable to conventional systems, although assessment methods varied substantially. Handheld dental X-ray devices can be used safely and provide diagnostically acceptable image quality when appropriate radiation protection measures are applied. However, the predominance of experimental evidence and methodological heterogeneity highlight the need for well-designed clinical studies and standardized evaluation protocols.