Dental Radiography: Principles, Techniques, And Legal Requirements

Legal Requirements for Ionising Radiation

Describe about the Dental Radiography for Principles and Techniques.

Outline the legal requirements for ionising radiation

As per dental nursing studies and practices the two most essential legal requirements that are followed in United kingdoms for using ionising radiation are: -

Ionising radiation regulations 1999

These Ionising radiation regulations 1999 (IRR99), ensures the limit of medical exposure to radiations like x-rays, UV rays etc. The regulations are applicable to major regions of the UK including England, Wales and Scotland. The main aim is to minimise the risk of radiation exposure of employees. The employee falling under this category are dentists practising x-ray, other staff members and dental nurses. Hygienists.

Ionising radiation (medical exposure) regulations 2000

This Ionising Radiation (Medical Exposure) Regulations IR(ME)R, 2000 ensures that any dental practice undergoing x-ray examination excludes any possible risk to harm to patient undergoing medical radiation exposure. Therefore, this regulation works to protect patient involved in dental processes (Whaites and Drage, 2013).

Explain the role of dental personnel when using ionising radiation in the dental environment

The dental personnel has to play four different duty holder role while using ionising radiation in the dental environment

Employer or legal person

The dental personnel need to manage or carry out or engage other employees that have to perform radiation exposure. The employer provides frameworks regarding professional, ethical and legal obligations that other professionals or duty holders need to follow

The basic role is to ensure duty process, written documentation, training records, establish dose constraints, and other management responsibilities of radiation exposure process.

Referrer

The referrer is the healthcare worker that refers individuals or persons to dental exposure practitioner. The referrer needs to supply all the required information regarding radiation exposure process and scenario that involves medical data of patient developed by initial assessment before medical exposure. This assessment data contains all information for the proper exposure process. the referrer role is to perform this assessment. Further, referrer needs to manage clinical diagnosis, x-ray requirements, radiation dose indications and many more functions as per referral criteria provided by the employer (White and Pharoah, 2014).

Practitioner

The major role of the dental practitioner is to perform individual dental exposure process. The practitioner needs to follow the employer’s procedures, instruction, referrer information, ensure proper exposure and carry out their duty as per legal regulations.

Operator

This medical professional needs to carry out practical processes of radiation exposure except for the role of the practitioner (Rout and Brown, 2012).

Role of Dental Personnel when Using Ionising Radiation

Identify the hazards associated with ionising radiation

The following are some of the most prominent hazards related to ionising radiation exposure in dental care

• The ionising radiation leads to ionisation of small atoms like DNA, chromosomes and other genetic materials of the body that can result in mutation and genetic defects
• Dental ionising radiation risk for meningioma and other different types of cancers
• If the ionising radiation dose is not managed then there is high risk of tumour development in the body
• The organs like brain, thyroid glands and salivary glands have high risk of damage due to ionising radiations
• They can also affect hairs, skin and fertility conditions in individual (Sabarudin and Tiau, 2013)

Explain organisational practices and policies relating to ionising radiations and the taking of dental images

Some of the most workable practices and policies that regulate radiation exposure are: -

Local rules

The local rules are fundamental organisational working instructions or guidelines that restrict and control the radiation exposure process. These local rules implement the professional designations, roles and responsibilities to each and every healthcare professional. The local rules determine and manage controlled area, ionisation equipment’s, working guidelines, equipment management policy, dose limit for patient and hazardous conditions (Altintas et al. 2013).

Quality control systems

The quality control system ensures proper quality process with controlled procedures. This quality assurance system in the organisation involves proper written documentation, monitoring of equipment’s, darkroom, audit and training of staff. There are quality assurance programmes implemented to ensure betterment of radiographic image quality. The image and film quality undergo daily investigation in this system.

Staff training records

The staff’s training records are maintained to detect errors related to teaching in bisecting angle technique, paralleling technique, orthopantomogram (OPG) and Dental Panoramic Tomogram (DPT). The written records for all these training processes are essential to confirm effective dental radiation procedure in healthcare organisation (Jacobs and Van Steenberghe, 2012).

Explain the uses of

Intra Oral radiographs

Bitewing

The bitewing x-rays are intraoral radiographs that help to view back teeth, alveolar bone height relating it with cementoenamel junctions. This imaging process helps to detect interdental caries as well as recurrent caries occurring in restorations. Therefore, decay in the back tooth is detectable through this imaging process.

Periapical

This imaging process helps to view the complete teeth from crown to root at one time but can capture only one or two teeth each time. Basically, it captures anterior and posterior teeth to detect pain in that specific tooth. The condition of pain is easily detected through this process because it captures teeth and surrounding bones. This imaging is useful in endodontic therapy and hypodontia testing process.

Occlusal

This imaging process is useful to detect skeletal or pathologic anatomy of palate floor or mouth floor because this film is larger than other intraoral radiographs. This imaging is helpful to detect placement and development of tooth in children. Further, it is also useful to detect sialoith in Stenson’s duct (Iannucci and Howerton, 2016).

Hazards Associated with Ionising Radiation

Extraoral radiographs

Lateral oblique

This imaging is useful to detect mandibular projection, premolar-molar region, mandible inferior border and mandible protruded head position.

Cephalostats

This imaging process is helpful to view entire head side looking tooth in relation with jaw and individual profile. This is used professionally for teeth realignment approach.

Dental pantomographs (DPT), Orthopantomogram (OPG)

This imaging is useful to detect impacted and emerging teeth as well as detect tumours in this zone by visualising entire mouth area (Khedmat et al. 2012).

Evaluate the reasons for using digital radiography

The digital radiography considered being the most contemporary form of radiographic imaging is preferred because it directly transfers the image to computer generating print in the minute of seconds. This imaging is also workable to detect the minutest changes viable through oral examination. Further, digital radiography uses less ionising radiations than traditional x-rays (Altintas et al. 2013).  

Explain the purpose of intensifying screens in dental radiography

The main purpose of intensified screens in dental radiography is to produce fluoresce (emit light) image of the tooth. The lightning image is the blue or green visualisation of bone (Kim et al. 2012).

Explain methods for processing radiographs

The processing radiograph involves a variety of steps to convert the invisible latent image to a visible one. There are different types of methods involved in this process that is described below: -

Manual

The manual method involves five steps to process the image that is development, rinsing, fixing, washing and drying. In the development phase, chemical developer is used to exposing silver halide crystal into black silver as well as softens film emulsion. Further, rinsing involves dilution of the developer by water and removal of alkali activator. The third phase of fixing involves the use of fixer (chemical) for fixing the image and hardens the film emulsion. Lastly, washing is done for removal of excess chemicals and drying is done by air drying at room temperature in the dark room (Choi et al. 2012).

Automatic

Easier than the manual process, the automatic process is much simpler, time-saving and efficient. The darkroom is prepared and locked where the automatic process occurs. The overhead white light is turned off and safelight is turned on to start the process. The intraoral films are unwrapping over clean working surface one at a time and the extraoral films are removed from the cassette. Both the films are handled from the edge. The unwrapped film is inserted in processor film feed slot and allowed for 4-6 minutes waiting period for automated process to occur. Lastly, put the film in recovery slot and retrieve the radiographs prepared automatically (Lachowski et al. 2013).

Organisational Practices and Policies Relating to Ionising Radiations and the Taking of Dental Images

Digital (direct, indirect)

The digital radiography involves use of direct and indirect method

Indirect images

These are captured by digital cameras or involving scanning to digitalising and capturing process. In this method imaging plates (PSP) are used to convert an invisible image to visible one using wireless image receptors. The image is stored in form of stored energy until scanner stimulated laser that develops an image on computer screen.

Direct images

In this method, image is directly transferred from sensor to the computer. The ionising radiations strike the scintillator that produces a light creating electrical signal. This electric signal is further transferred to the computer that creates an image on the computer screen (Iannucci and Howerton, 2016).

Explain the purpose of using safelights during processing of radiographs

The safelight while working with radiographs provides illumination specifically for the visible spectrum to which the photographic material is insensitive completely (Lachowski et al. 2013).

Describe faults that may occur when taking and processing radiographs

The basic faults are: -

• Underexposed images due to insufficient exposure and development time
• Overexposed image due to over radiation exposure, development time and overuse fo development solution.
• Blurred image due to patient movement or dislocation while taking radiographs
• Partial images developed due to the defect in developing a solution, contact of one film with another and central ray improper alignment.
• Distorted image due to bending of film packet
• Fogged film due to light exposure in storage, use of heat, chemical fumes and defective safelight
• Stained and bleached image due to defects in chemicals
• No image occurs when no current is processed at the time of exposure (Dhillon et al. 2012).

Give reasons for faults when taking and processing radiographs

Operator error

The operator can lead to processing errors like insufficient exposure, movement of equipment, insufficient exposure time and improper management of exposure rays.

Processing

The errors in processing method can also lead to faulty images. Some of the common radiographic processing errors are insufficient chemical exposure, the abnormal temperature of developing solution (too cold or warm), contact of films with each other, exposure to heat or sunlight, improper staining and incomplete washing and drying process.

Equipment

• X-ray machine

The reasons for faults in x-ray machinery are soft error due to the hindrance of rays, an artefact in the perception or representation of information, refractive error due to improper focusing of light.

• Automatic film processors

The reasons for automatic film processor errors are low or high solution temperature, exhausted developer, excess replenishment, leakage of light, chemical leakage, contamination, fixing errors, and defective safelight.

Storage of materials

The improper storage of chemicals and equipment’s also leads to radiographic errors because chemicals show a reaction with heat and light (Jacobs and Van Steenberghe, 2012).

Explain how chemicals should be handled, stored and disposed of in a safe manner

• The chemicals of radiograph should be kept segregated, handled in dry areas and holding them with care
• Always wash hands with cleanser after using the radiograph chemicals
• The chemicals should not be stored on the floor
• The chemical waste is segregated as hazardous and normal waste where the hazardous waste is stored, handled and released as per legal perspectives (Kullman and Al Sane, 2012).

Explain how to manage a spillage of processing solutions

The spillages of processing solutions are basically chemicals that are handled with proper care. Firstly, to manage these spills seal off the area and assemble equipment’s to deal with spills. The personal protective equipment’s (PPE) like eye protector, gloves, and chemical resistance apron are used to clean the spills. The chemical waste is further disposed of using appropriate disposal equipment like sealed container or plastic bag (White and Pharoah, 2014).

Uses of Intraoral Radiographs

Explain the procedure for managing equipment failure

X-ray machine

The process for managing equipment failure involves troubleshooting and quality assurance testing followed by detecting faults and maintaining logbooks, simple tools for quality assurance and troubleshooting process. Further, the equipment repairing is initiated to overcome defects.

Automatic film processor

For managing automatic film processor the immediate requirement is to inspect the visible errors and notify the repair service provider. It is required to take the switch off the equipment, shut power down, turn off the water supply and allow repairing system (Rad et al. 2013).

Explain importance of rotating x-ray film stock

The rotating x-ray film stock is essential in retaining information for the longer duration of time to protect individual rights, evidence for claim process and also for other reasons like health monitoring and management (White and Pharoah, 2014).

Explain the protocol for storing

X-ray films

The x-ray films should be packed in sealed packages away from heat and light. The x-ray film is then stored in cool and dry place having temperature range 10 degree to 24 degree. The humidity is maintained between 30 and 50% with the use of sling psychrometer. Any radiation source near the storage zone and store the x-ray films like books in a library.

Digital images

The digital images can be stored in specials software where they are quick and easy to view. For hardcopy storage, the digital images are stored in form of leaves in the library with proper temperature, humidity and cleanliness are required like x-ray film.

Processing solutions

The processing solutions should be stored in the cool and dry place where no exposure to sunlight, heat, water or light is possible. These processing solutions are not stored in the floor but are kept in shelves or cupboards.

Radiographs

The radiographs are stored where the dirt, physical deterioration and contamination are not possible. The radiographs are allowed with residual thiosulfate testing to detect the rate of reaction and contamination. Further, they are stored below the upper limits of humidity (60%), temperature (38 degrees) and pressure to avoid stain generation, cracking and damages (Udupa et al. 2013).

Explain why film stock that has deteriorated should not be used

The deteriorated film stock persist errors that can transmit incorrect information, therefore, the damaged film stock should not be used in medical processes.

Explain the methods of mounting radiographs

Method – 1

In this method, the radiographs are mounted with maxillary teeth apices in the upward direction and mandibular teeth in the downward direction. This method is used to determine the anatomy of teeth and surrounding tissues.

Uses of Extraoral Radiographs

Method -2

In this method, radiograph is positioned as per the patient’s position while taking the film. If the mesial is to the right than the film position right side of patient and if mesial is in left then left side profile of the patient is visualised to determine the tissue anatomy (White and Pharoah, 2014).

Explain the consequences of incorrectly mounting radiographs

The incorrect mounting radiographs can lead to improper diagnosis and treatment of the wrong tooth. The incorrect mounting can also lead to missing tumours, cavities and other dental defects.

Explain purpose of quality assuring dental radiographs

The quality assuring dental radiographs have a purpose of maintaining image quality, excellent equipment’s, proper training and processing, perfect audit in the dental radiography process to meet the determined standards (Whaites and Drage, 2013).

Explain the recording systems used as part of the quality assurance process

The recording system used as a part of quality assurance process classifies the radiographic films in different categories to check for trends as per date, the cause of deficiency, repeat radiographs number, nature of deficiency etc. (Abesi et al. 2012).

References

Books

Iannucci, J. and Howerton, L.J., 2016. Dental radiography: principles and techniques. Elsevier Health Sciences.

Jacobs, R. and Van Steenberghe, D., 2012. Radiographic planning and assessment of endosseous oral implants. Springer Science & Business Media.

Whaites, E. and Drage, N., 2013. Essentials of dental radiography and radiology. Elsevier Health Sciences.

White, S.C. and Pharoah, M.J., 2014. Oral radiology: principles and interpretation. Elsevier Health Sciences. 

Journals

Abesi, F., Mirshekar, A., Moudi, E., Seyedmajidi, M., Haghanifar, S., Haghighat, N. and Bijani, A., 2012. Diagnostic accuracy of digital and conventional radiography in the detection of non-cavitated approximal dental caries. Iranian Journal of Radiology, 9(1), p.17.

Altintas, S.H., Yildirim, T., Kayipmaz, S. and Usumez, A., 2013. Evaluation of the radiopacity of luting cements by digital radiography. Journal of Prosthodontics, 22(4), pp.282-286.

Choi, B.R., Choi, D.H., Huh, K.H., Yi, W.J., Heo, M.S., Choi, S.C., Bae, K.H. and Lee, S.S., 2012. Clinical image quality evaluation for panoramic radiography in Korean dental clinics. Imaging science in dentistry, 42(3), pp.183-190.

Dhillon, M., Raju, S.M., Verma, S., Tomar, D., Mohan, R.S., Lakhanpal, M. and Krishnamoorthy, B., 2012. Positioning errors and quality assessment in panoramic radiography. Imaging science in dentistry, 42(4), pp.207-212.

Khedmat, S., Rouhi, N., Drage, N., Shokouhinejad, N. and Nekoofar, M.H., 2012. Evaluation of three imaging techniques for the detection of vertical root fractures in the absence and presence of guttaâ€Âpercha root fillings.International endodontic journal, 45(11), pp.1004-1009.

Kim, E.K., Han, W.J., Choi, J.W., Jung, Y.H., Yoon, S.J. and Lee, J.S., 2012. Diagnostic reference levels in intraoral dental radiography in Korea. Imaging science in dentistry, 42(4), pp.237-242.

Kullman, L. and Al Sane, M., 2012. Guidelines for dental radiography immediately after a dentoâ€Âalveolar trauma, a systematic literature review. Dental Traumatology, 28(3), pp.193-199.

Lachowski, K.M., Botta, S.B., Lascala, C.A., Matos, A.B. and Sobral, M.A.P., 2013. Study of the radio-opacity of base and liner dental materials using a digital radiography system. Dentomaxillofacial Radiology, 42(2), p.20120153.

Rad, A.E., Rahim, M.S.M. and Norouzi, A., 2013. Digital dental X-ray image segmentation and feature extraction. Indonesian Journal of Electrical Engineering and Computer Science, 11(6), pp.3109-3114.

Rout, J. and Brown, J., 2012. Ionizing radiation regulations and the dental practitioner: 1. The nature of ionizing radiation and its use in dentistry. Dental update, 39(3), pp.191-2.

Sabarudin, A. and Tiau, Y.J., 2013. Image quality assessment in panoramic dental radiography: a comparative study between conventional and digital systems. Quantitative imaging in medicine and surgery, 3(1), p.43.

Udupa, H., Mah, P., Dove, S.B. and McDavid, W.D., 2013. Evaluation of image quality parameters of representative intraoral digital radiographic systems. Oral surgery, oral medicine, oral pathology and oral radiology,116(6), pp.774-783.