R ADIOLOGY C HAPTER 5, 25

P ATIENT P ROTECTION Dentist prescribes – first step in limiting exposure of radiation Lead aprons w/thyroid collar Limiting the number of films Fast film Proper technique: Exposing Developing

P ATIENT P ROTECTION Proper equipment: Tube head Collimator PID XCP – film holding devices

T UBE HEAD – FILTRATION -T WO TYPES PG. 52 Inherent Filtration – primary beam passes through the glass window of the x-ray tube, oil, and tube head seal. Added Filtration – refers to the placement of aluminum disks in the path of the x-ray beam between the collimator and the tube head.

C OLLIMATION Collimation – used to restrict the size and shape of the x-ray beam and to reduce patient exposure. PID Cone – no longer used Round, lead-lined available in 8” & 16” Rectangular, lead-lined available in 8” and 16”

D URING E XPOSURE Use lead shield w/thyroid collar during pt exposure to intra oral – not recommended for extra-oral films (pano, ceph.). Place shield over patients lap to protect the reproductive and blood forming tissues. Never fold lead shield, this will break the lead and you will have leakage.

F ILM SPEED We use Kodak Insight, F speed, currently this is the fastest film available. Before F speed there was E speed. E speed is 50% faster than D, F speed is 30% faster than E and 60% faster than D.

F ILM H OLDING D EVICES Film holding devices (XCP) Effective - reduces patients exposure by stabilizing film, preventing movement less re-takes, exposing patient to less radiation. All re-takes must be avoided. DANB only allows three re-takes on your live patient. ALARA

ALARA As low as reasonably achievable Patient education: done while you work Before starting Before exposure – individual need During exposure – safety precautions After – development & retakes

BEFORE EXPOSURE Be prepared, confident & in charge After seating patient: Have women remove lipstick Check for appliances – partials, dentures, retainers, piercings Have pt remove glasses When taking extra oral (panos, cephs, etc.) pt must remove necklaces, earrings, lip rings, le braes, tongue studs, etc.

S HIELDING R ECOMMENDATIONS Protect pt. with lead shield Protective barriers that absorb the primary beam, such as the wall. Double thick drywall is the most common.

A FTER E XPOSURE Proper film handling and processing are just as important for patient protection as the exposure process. Make sure not too touch film in the middle, you can leave finger prints. We will discuss film errors at a later time. Check your solution levels, run a cleaning film through

O PERATOR S AFETY The dental radiographer must avoid the primary beam, NEVER HOLD A FILM IN PLACE FOR YOUR PATIENT AND NEVER HOLD THE TUBE HEAD. Must stand at least 6 feet from x-ray tube head. Radiation travels in a straight line- you must be positioned perpendicular to primary beam, degree angle to the beam.

E QUIPMENT M ONITORING Check for leakage, this can be done by the use of a film device that can obtained through the state health department or from manufacturers of dental x-ray equipment. Film Badges-always wear at waist level, returned to service company. NEVER WEAR BADGE OUTSIDE OR RADIOGRAPHER IS UNDERGOING X-RAY EXPOSURE.

M AXIMUM P ERMISSIBLE D OSE Occupational exposed person –REM Is 5.0 per year Occupational pregnant woman is 0.1 per year. Non-occupational exposed persons- RAD Is 0.1 rem/year

P ATIENT M ANAGEMENT Operator attitude Patient and equipment preparations Exposure sequencing Start with the anterior, then pre-molar and molar films last. Even start with mandibular first. Film placement and technique Avoid the palate and demonstrate film placement with your finger while verbally explaning to patient. Know some helpful hints for preventing gag reflex

P ATIENTS WITH SPECIAL NEEDS Gag reflex-soft palate and the lateral posterior third of the tongue. Before gag reflex is initiated two reactions occur: Cessation of respiration and contraction of the muscles in the throat and abdomen.

P ATIENT M ANAGEMENT -EXTREME GAG Never suggest gagging, don’t ask are you a gagger? Or do you gag? Reassure the patient, suggest breathing, remind them to breath Distract patient-please raise your feet off the chair. Give patient a drink of cold water, salt, or use topical anesthetic spray.

P ATIENTS WITH D ISABILITIES -P HYSICAL Vision, speak clearly and explain in detail before doing. Hearing-may ask caregiver to interpret or write instructions on a piece of paper or if they read lips face them and speak clearly and slowly. Mobility-you may offer to help place them in the chair, or they may have stay in wheelchair. Caregiver may hold the film in place for patient while wearing lead apron and specific instructions.

D EVELOPMENTAL DISABILITIES Example-autism, cerebral palsy, epilepsy, mental disabilities. If patient can not tolerate intra-oral films they must not be taken, can use extra oral films. Always speak directly to the patient, not the caregiver only.

P ATIENTS WITH S PECIFIC DENTAL NEEDS Pediatric-children-preparation is the same as an adult, except reduce exposure, kVp, mA, and time, and film size is what ???????? Bitewings are the same in placement, and paralleling for PA’s, (PA’s bisecting technique is preferred because the small size of the mouth precludes the placement of a film beyond the apical region of the teeth.) (chapter 17 & 18)

P ATIENT M ANAGEMENT FOR P EDO Be confident Show and Tell Reassure them Demonstrate behavior Request assistance (help), you can ask the parent or accompanying adult to hold the film. Postpone examination

E NDODONTIC P ATIENT During a root canal several films may be taken of the same tooth. Paralleling technique should be used to avoid distortion Endo holding devices to hold film, hemostat, or plastic rinn.

E DENTULOUS P ATIENTS We still have to take x-rays on edentulous patients. Why? Detect presence of root tips, lesions, cysts, impacted teeth. Establish normal anatomic landmarks, observe quantity and quality of bone. Most common is the panoramic. If panoramic is not an option then 14 PA’s are taken. Size 2 & Paraelleling tech. or w/ occlusal films as well.

M IXED OCCLUSAL Would consist of a total of six films. One Max. topographic occlusal projection (4), one mandibular cross- sectional occlusal projection (4) and four standard molar PA’s (2). Remember cotton rolls to help stabilize the size (2) films. As with the panoramic film, if an object is identified on an occlusal film, a periapical film of that specific area should be exposed.