Bitewing X-Rays And Orthopantogram (OPG): Procedure And Safety Precautions

Q1) Explain how you would prepare Mr. White for his x-rays, any safety precautions you take, your choice of x-ray equipment, accessories such as locating devices or guides, and technique for the x-rays including positioning of film or film plate or sensors.

Q2) Explain how you operate the necessary equipment for this exposure.

Q3) Once the image has been produced, you notice it is blurred. How do you prevent blurred images occurring?

Bitewing X-Rays: What They Are and Why They're Done

1. Mr. White was new patient and his initial appointment was for bitewing X-rays. Bitewing X-rays are the most common type of X-rays taken up by the patient during regular dental check-ups. Bitewing X-ray displays the upper and lower premolars and molars in a solitary view. This X-ray is used to discover for decay, detection of infection leading to bone loss and to evaluate severe gum diseases (Nwpgmd.nhs.uk 2019). Mr White was prepared to position properly before taking up the X-ray. He has to be informed in detail about the X-ray and the outcome of the test. He was asked to sit on the chair and to remove any orthodontic appliances ion case he used any; the chair was adjusted with the headrest to support his head while taking up the X-ray. Once he was positioned properly, the operator made sure that lead aprons and the thyroid collar was given to him as a safety precaution.

The major safety precaution taken into consideration was to cover the patient with lead aprons and thyroid collar, which will protect his exposed body parts from radiation including his neck and reproductive organs. The radiation level in bitewing X-ray method is very less when compared to other radiation approach still the safety measures were considered to avoid any future risk (Dianati et al. 2014). Except the operator and the specialist, nobody else was allowed in the X-ray room. Film holders were used so that the patient do not have to hold the film or nay kind of exposure takes place.

For bitewing X-ray, Rinn bitewing instrument was used where patient has to bite a wing, which will be placed on the X-ray film to examine the problem. There are three different types of film, which can be used for this process such as interproximal caries, restorations contours and Crestal bone levels. The film was placed in the instrument. The premolar and molar bitewing film was placed in the second premolars and second molars respectively. It is always recommended to start the process by placing the film first in second premolars, so that the patient is adjusted with the film. Once X-ray is done for both premolars, the operator should move the film to second molars. In case of Mr White, film size of 31*41 mm was used with a longer film packet of size 53*26 mm (Training.gov.au 2019). The film is placed inside the mouth parallel to the crown with the X-ray beam directed in contact with the teeth or over the connection areas, with right angles of the teeth and the film packet. In this method of X-ray film holders are used to eliminate the traditional method of bitewing X-ray were detachable tabs were used instead of film holders. Each bitewing X-ray expose the upper as well as lower part of the teeth with a detail view of the roots and the supportive bone.   

Patient Safety During Bitewing X-Rays

2. X-ray technicians are used to operate and to maintain the X-ray with quality. In order to get supreme quality of X-rays, the technicians are firstly required to manipulate or operate the equipment properly with prior knowledge of the machine (Zenobio et al. 2018). After every X-ray conducted, it is necessary to wash or clean up the equipment to ensure the best quality of the X-ray because the correct calibration of the equipment is necessary to avoid any kind of error. The second most important aspect of maintaining supreme quality of X-ray is the perfect patient alignment. The proper positioning of patient is the only important criteria while taking up the X-ray as the Film needs to be placed correctly with minimum possibility of error. In case of movable x-ray equipment, good ergonomic methods need to be used (Zenobio et al. 2018). Precautions has to be taken while developing the X-ray film too. Different chemicals or compounds with film processing equipment is required for developing X-ray film. The material safety data sheets (MSDS) should be considered in case of using chemicals for developing the X-ray so that the operator know how to exactly function the equipment. Chemical resistant gloves and splash goggles need to be used while functioning with wet chemicals for developing the X-ray.

Once the X-ray has been taken, it is labelled and mounted properly with correct patient information and stored (Claudia et al. 2018). The patient data is entered into the cut tape and labelled in bold. The label is removed through crack and peel backing paper and is adhered to the required X-ray. All the X-ray films must be stored in a vented cab inets or vented storage room in hospitals.

3. An Orthopantogram (OPG) provides a panoramic outlook in a sole film, which includes lower face covering all the teeth of the upper and lower jaw. This method gives an overview of the teeth, which is still not surfaced or erupted. OPG also reveals the problem of jawbone and the joint fixing the jawbone with the head of the patient (Walshaw and Mannion 2018). Radiographic imaging equipment is used in case of OPG, which is operated by the technician. This equipment is operated when the patient is standing and relaxing his face on a trifling shelf. A sterilized mouthpiece is provided to the patient to help him stand steadily and firmly. The accurate and firm positioning of the patient is considered as the most essential criteria for operating the radiographic imaging in OPG. The head and neck of the patient needs to be straight and firm. Three different rays of light is essential for this exposure process, which comprises of mid saggital, canine position and Frankfort (Claudia et al. 2018). Once the patient is positioned properly, the operators starts the procedure by placing the X-ray film in the mouth of the patient with all safety measures and then mount and label the film to analyse the result.

Steps taken to prevent occurrence of blurred images are as follows (Rockenbach, Morosolli and Dias 2018):

• Patient should be positioned properly while taking up the radiography. If the patient was not positioned properly then the X-ray will have a blur image and to overcome that a retake radiography is conducted.
• The size of the image plane or focal trough must be adjusted properly according to the patient to overcome any kind of blur images.
• The latest radiographic machines are fully automated as compared to the older ones hence, the specialist should use the automatic radiographic machine with all the facilities and no prior adjustments.
• The light alignment of the X-ray must be accurate and precise.
• The radiation dosage must be kept in mind while performing the X-ray as for older people the amount of radiation is different from younger people with high-resolution sensors.
• Image enhancement like local equalization, colorization and embossing must be done to obtain a proper and correct X-ray with no errors or blur images.

References:

Claudia, A., Barbu, H.M., Adi, L., Gultekin, A., Reiser, V., Gultekin, P. and Mijiritsky, E., 2018. Relationship between third mandibular molar angulation and distal cervical caries in the second molar. Journal of Craniofacial Surgery, 29(8), pp.2267-2271.

Dianati, M., Zaheri, A., Talari, H.R., Deris, F. and Rezaei, S., 2014. Intensive care nurses’ knowledge of radiation safety and their behaviors towards portable radiological examinations. Nursing and midwifery studies, 3(4).

Nwpgmd.nhs.uk 2019. [online] Nwpgmd.nhs.uk. Available at: https://www.nwpgmd.nhs.uk/dentistry/courses/docs/Bitewing%20Radiography.pdf [Accessed 25 Feb. 2019].

Rockenbach, M.I.B., Morosolli, A.R.C. and Dias, V.S.C., 2018. Periapical radiographic technique errors made with digital sensors. Journal of Pharmaceutical and Biological Sciences.

Training.gov.au 2019. [online] Training.gov.au. Available at: https://training.gov.au/TrainingComponentFiles/HLT07/HLTDA304D_R1.pdf [Accessed 25 Feb. 2019].

Walshaw, E.G. and Mannion, C.J., 2018. A systematic approach. British Dental Journal, 224(8), p.560.

Zenóbio, E.G., Zenóbio, M.A., Azevedo, C.D., Nogueira, M.D.S., Almeida, C.D. and Manzi, F.R., 2018. Assessment of image quality and exposure parameters of an intraoral portable X-rays device. Dentomaxillofacial Radiology, 47(xxxx), p.20180329.