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Dental Radiography Safety

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1. Dental Radiography Safety By Aggie Barlow, CHP, MS, MBA 2. Goal <ul><li>The goal of dental radiography is to obtain…
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  • 1. Dental Radiography Safety By Aggie Barlow, CHP, MS, MBA
  • 2. Goal <ul><li>The goal of dental radiography is to obtain </li></ul><ul><li>useful diagnostic information while keeping </li></ul><ul><li>radiation exposure to the patient and dental </li></ul><ul><li>staff to a minimum. </li></ul>
  • 3. Digital Radiography in Dentistry <ul><li>Digital radiography was introduced in </li></ul><ul><li>Dentistry in 1987. The technology has been </li></ul><ul><li>gaining in acceptance, and in 2005 more than </li></ul><ul><li>22% of dentists were using digital </li></ul><ul><li>radiography. 1 </li></ul>
  • 4. Radiation Source <ul><li>A conventional x-ray tube is the source of </li></ul><ul><li>X-radiation in most digital systems. </li></ul><ul><li>Digital radiography requires 50-80% less </li></ul><ul><li>radiation exposure in order to achieve an </li></ul><ul><li>image compared to film systems. 2 </li></ul>
  • 5. Other Advantages <ul><li>No film, no darkroom and no chemicals are needed. </li></ul><ul><li>No lead foil waste is generated. </li></ul><ul><li>Digital radiography has superior gray scale </li></ul><ul><li>resolution compared to conventional film. </li></ul><ul><li>Digital images can be magnified. </li></ul><ul><li>With the direct method, images appear immediately </li></ul><ul><li>on the computer monitor. </li></ul><ul><li>There is ease of information transfer to other dentists </li></ul><ul><li>or insurance companies. </li></ul>
  • 6. MA Radiation Control Program Safety Regulations <ul><li>MA Regulations prohibit the deliberate </li></ul><ul><li>exposure of an individual for training, </li></ul><ul><li>demonstration or other non-healing arts </li></ul><ul><li>purposes. </li></ul>
  • 7. Ordering Dental Radiographs <ul><li>Examinations must only be performed on direct </li></ul><ul><li>prescription of a dentist, physician or other </li></ul><ul><li>legally authorized provider. Dental radiographs </li></ul><ul><li>must only be performed by Dentists or other </li></ul><ul><li>legally qualified and credentialed personnel. </li></ul>
  • 8. Operator Location <ul><li>The operator of the dental unit must stand at </li></ul><ul><li>least six feet from the useful beam or behind </li></ul><ul><li>a protective barrier. [Stand at an angle of from 90 to </li></ul><ul><li>135 degrees from the central ray. Do NOT stand in </li></ul><ul><li>the path of the primary x-ray beam.] </li></ul><ul><li>If a protective barrier is used, it must have a viewing </li></ul><ul><li>window to allow the operator to see the patient. </li></ul>
  • 9. Personnel Radiation Badges <ul><li>MA Regulations state that individuals who </li></ul><ul><li>operate only dental radiographic systems </li></ul><ul><li>are exempt from the radiation badge </li></ul><ul><li>requirements. </li></ul>
  • 10. X-ray Tube Housing <ul><li>The tube housing must not drift from its set position during an </li></ul><ul><li>exposure. The tube housing must not be hand-held during an </li></ul><ul><li>exposure by the operator or the patient due to leakage radiation </li></ul><ul><li>through the tube housing. </li></ul><ul><li>If you note problems with the tube housing, immediately </li></ul><ul><li>report this to your supervisor so that any instability of the </li></ul><ul><li>suspension arm can be corrected. </li></ul>
  • 11. Required Distances <ul><li>If the dental unit can operate above 50 kVp, </li></ul><ul><li>the source to skin distance must be at least </li></ul><ul><li>18 cm [7 inches]. </li></ul><ul><li>The x-ray field must be limited to a circle </li></ul><ul><li>having a diameter of no more than 7 cm [~3 in]. </li></ul><ul><li>An open-ended beam indicating device must be used. </li></ul>
  • 12. Panoramic Units <ul><li>The beam must be limited to the imaging slit in </li></ul><ul><li>the transverse axis and shall not exceed a total </li></ul><ul><li>of 0.5 inches larger than the imaging slit in the </li></ul><ul><li>vertical axis. </li></ul>
  • 13. Filtration Requirements <ul><li>The amount of filtration required varies with the </li></ul><ul><li>operating range of the x-ray unit. For example: </li></ul><ul><li>For 51 to 70 kVp units* ….. 1.5 mm Al [HVL] </li></ul><ul><li>Units above 70 kVp ….. 2.1 or more Al </li></ul><ul><li>*Note: Settings below 65 kVp are not recommended </li></ul><ul><li>because of higher patient exposure. </li></ul>
  • 14. Technique Charts <ul><li>Written operating procedures and techniques </li></ul><ul><li>must be available to all operators of dental </li></ul><ul><li>units. </li></ul><ul><li>Update each unit’s technique chart regularly. </li></ul>
  • 15. Exposure Indicators <ul><li>Units must have “dead man” type exposure </li></ul><ul><li>switches and indications of when an exposure </li></ul><ul><li>is being made. </li></ul>
  • 16. Thyroid <ul><li>The thyroid gland, especially in children, is </li></ul><ul><li>among the most radiosensitive organs. </li></ul><ul><li>Even with optimum techniques, the primary </li></ul><ul><li>dental beam may pass near or occasionally </li></ul><ul><li>through the gland. A thyroid shield may </li></ul><ul><li>reduce the dose to the gland without interfering </li></ul><ul><li>with obtaining a diagnostic image. </li></ul>
  • 17. Lead aprons and shields <ul><li>Even though the dose from digital radiography is less </li></ul><ul><li>than convention radiography, patients should be </li></ul><ul><li>shielded with lead aprons and thyroid shields. </li></ul><ul><li>These shields should have at least 0.5 mm of lead </li></ul><ul><li>equivalent. </li></ul><ul><li>Do not fold or bend aprons. Hang aprons to </li></ul><ul><li>prevent damage and loss of protective qualities. </li></ul>
  • 18. Protection of others <ul><li>No one but the patient should be in the exam room </li></ul><ul><li>during x-ray exposures. If a person’s presence is </li></ul><ul><li>necessary for the performance of the examination, </li></ul><ul><li>that person must be behind a shield or wearing a lead </li></ul><ul><li>apron. He/she must not be in line with the primary </li></ul><ul><li>beam, and should stand at least six feet from the </li></ul><ul><li>x-ray tube if feasible. He/she must also be at least </li></ul><ul><li>18 years of age and not be pregnant. </li></ul>
  • 19. Collimators <ul><li>Collimators limit the size and shape of the </li></ul><ul><li>useful beam which reaches the patient. </li></ul><ul><li>Rectangular collimators are recommended for </li></ul><ul><li>periapical radiographs as their use significantly </li></ul><ul><li>reduces the area of the patient’s body that </li></ul><ul><li>is exposed to radiation. </li></ul>
  • 20. Cones <ul><li>The ADA discourages the use of short, closed, </li></ul><ul><li>pointed cones because of the increased </li></ul><ul><li>scatter radiation close to the face and adjacent </li></ul><ul><li>areas of the patient’s body. </li></ul>
  • 21. System Speed <ul><li>Faster image receptor systems result in </li></ul><ul><li>decreased radiation exposure to the patient. </li></ul>
  • 22. Notes <ul><li>Dental Products Report (DPR) Radiography: A DPR Survey report. Dental Products Report 2005 , May Accessed at: www.dentalproducts.net/xml/display.asp?file=2976 </li></ul><ul><li>Haring, J., Howarten, L., Dental Radiography Principles and Techniques , 3 rd Edition. </li></ul><ul><li>Philadelphia, Elsevier, 2006, 351-2 </li></ul>
  • 23. Acknowledgement <ul><li>The image of the preferred 90 to 135 degree </li></ul><ul><li>operator location was from: </li></ul><ul><li>Radiation Safety in Dental Radiography </li></ul><ul><li>Eastman Kodak Company, 2004 </li></ul><ul><li>Rochester, NY, Health Imaging Division </li></ul>
  • 24. Additional Suggested Reading <ul><li>Radiation Protection in Dentistry </li></ul><ul><li>NCRP Report #145, Oct. 2004, Bethesda </li></ul>
  • 25. For More Information <ul><li>Contact: </li></ul><ul><li>F.X. Masse Associates at (978) 283-4888 </li></ul><ul><li>or </li></ul><ul><li>Tufts EH&S at (617) 636-3450. </li></ul>
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