Importance Of Lead Apron With Thyroid Collar For Radiation Protection In Dentistry

The Reason for Providing Lead Apron with Thyroid Collar During Radiation Exposure

Questions:

1. Detail to the patient the reason why you provide the lead apron with a thyroid collar for her to use during radiation exposure.

2. Explain to the patient why you and the operator leave the room for every patient during the exposure of radiation.

3. How you applied safe work practices; handled, processed, and disposed of the radiographic films?

4. How you mounted and filed the films and digital images that you processed?

Several interventions in dentistry are guided by fluoroscopic instrumentation and equipment[1]. Radiological dentistry interventions are some of the most commonly used procedures in the recent times. Additionally, they have several benefits in the solution to the disease condition. However, they are known to cause alarming concerns in terms of deterministic effects of acute or chronic nature in the patient due to exposure to harmful radiation.

I shall inform the patient that the leaded apron is essential for her to reduce exposure of ionizing radiation to vital organs of the body. It just not only protects the organ, but also reduces the total body dose of exposure. In addition, I will explain to the patient that thyroid collar has been provided along with lead apron as the thyroid may be exposed to radiation even after wearing lead apron. It provides protection to all areas at risk in the front and back. The need for using thyroid collar during radiation exposure has also become a necessity because of the increased in rate of thyroid cancer. Thyroid is the main site that is at risk of radiation induced cancer in patient and as x-rays is mostly performed during diagnostic testing, protecting the thyroid gland is a strategy to reduce thyroid cancer risk.  The Radiation Protection guideline also recommends providing thyroid shielding to patient when thyroid is in line with the primary beam of the x-rays. It significantly reduces radiation dose during x-ray examination[2]. Thyroid collar is an effective protective device to reduce all forms of risk and her that the leaded apron provides protection for the gonads, whilst the collar for the thyroid is essential as the organs that have to be particularly offered protection include the thyroid, gonads, and breast. I shall explain to the patient that radiation interventions can induce stochastic effects such as cancer and genetic mutations, or even impairment in fertility and cataract as deterministic effects if the apron is not used. However, I will explain to her that the radiographic intervention provides extensive support in her treatment and with the precaution of wearing the apron and collar, it is possible to avoid the adverse effects of radiation along with obtaining the complete advantage of the intervention[3]. The patient has to be told that the calculated risk to benefit ratio in her case indicates that the benefits are higher than the risk involved. Additionally, the hospital is certified to undertake the radiographic intervention owing to the appropriate equipment used. She needs to be informed that the limitation of the dosage is determined according to her specific condition and case. In adults and children, it is essential to provide thyroid collar and leaded apron. The primary reason for this is that the thyroid gland and the gonads have the highest sensitivity to the risk of development of tumours of both malignant or benign nature.

Benefits of Using Thyroid Collar and Leaded Apron

If the patient asks why I and the operator leave the room during the exposure of radiation, then I would explain to the patient that leaving the room is a necessary precaution for them to protect them from exposure to radiation. I would explain to the patient that leaving the room is important for operator because they conduct large number of radiation for patients throughout the day and apart from the patient, they do not wear any protective clothes like apron or collar. Hence, to prevent themselves from adverse exposure to radiation, leaving the room or standing behind a barrier is a necessary step for them. This saves them from workplace hazards and any safety concerns. The guidelines for safe operation of x-ray equipment and radiographic procedures also mention that the person whose presence is not required must be asked to leave the room until the exposure is complete. If leaving the room is not possible, then it is a responsibility for operator to position the person as far away as possible. In addition, both the patient and operator must use protective barriers like lead aprons[4].

However, the above response may make the patient apprehensive and fearful about the dose of radiation they receive. I would address patient’s worry by stating that we have given thyroid collar and apron to the patient to protect them from harmful radiation. Lead apron and thyroid collar is one of the process of shielding, which reduces the radiation dose. Using lead as a method of shielding is one of the common procedure. Lead aprons are about 0.25-0.5 mm thick which attenuates about more than 90% of the radiation[5]. I would also explain that they would get radiation for very short period which reduces the possibility of taking high dose of radiation. Hence, this response would be an appropriate step to convince patient that they the radiation dose they are receiving in the radiation room is not harmful for them.

The boy with the knocked mouth required manual processing cycle. While employing manual processing, it is necessary to take many safety precautions during handling, processing and disposing of the radiographic films.  I applied safe work practices by checking the temperature of developer and fixer. The optimum temperature for the developer is 65- F to 750 F and the temperature in this range was maintained by adjusting the water tap so that correct temperature is achieved.  The safe handling of radiograph was maintained by removing the exposed using safe light illumination only. Correct lighting was checked by avoid fluorescent light emission and using red lighting. Red illumination prevents films from fogging[6]. Safe light condition is also necessary while transferring the film from developer to the wash tank. After removing the film from the developer solution, it was placed in circulating water of the rinsing tank.  The films was first placed in fixer solution for 5 seconds and then placed in running water for 10 minutes. The films was then dried in moderately warm air.

Why Operator Leave the Room During Exposure of Radiation

Sustainable method of disposal is also needed for the radioactive film. The film has to be disposed as hazardous waste off-site or in the hospital in the presence of a silver recovery unit[7]. The other two patients required digital transferring imaging. It is the process that employs digital X-ray sensors for producing enhanced computer image of teeth and gums. There are limited safety requirements in this process as staffs do not need an enclosed space to develop the film and everything is generated by means of digital sensors[8].

The other two cases included digital radiography. Digital radiography has to be practiced with utmost safety in protocol. The exposure of the patient to the radiation must be as low as reasonably achievable (ALARA). In the routine of dental procedures, several intra-oral protocols are being carried out in the recent times by digital radipgraphy[9]. The equipment of the digital processing must be compatible with the unit of X-ray scanning. The X-ray radiographs are required to be stored in a taut container protected from humidity, heat, and contamination by chemical substances. The film processing and equipment are governed by regulations of the government and the health sector on the hospital usage of the digital radiography equipment. For digital radiography equipment, the receptors of digital units are essential. The sensors in the units must be examined and replaced for wearing and scratches. The stability of the head of the tube section has to be ascertained and fixed accordingly. The stability is checked at different angulations and vibrations or drift offset is corrected. The dosage is recommended according to the health policies by grouping the patient into the categories for treatment. The individual doses are determined according to the patient need and condition. The operators need to be aware of the health recommendations set by the International commission on radiation protection and the Centre for devices and radiological health. The radiographic images are best formed in the adequate dark room. The dark room is configured with the elimination of leaking of light and the installation of the appropriate safelight.

The mount chosen was opaque to avoid light refraction. Hands were kept clean along with wearing clean, soft gloves to avoid scratches on the image. The opaque mount has unique slots for the placement of the film. The placement was made according to the regulation of the dental health facility i.e. with the dot embossed on the film facing the viewer. The view of the dentition had left to right hand directionality. The mount was labelled with relevant and identifiable patient information. The date of mounting was specified in the label.

The film was viewed with the help of a viewbox. The viewbox has adequate and uniform lighting. The light may be varied in intensity accordingly. The viewing was carried out in the dark room with safelight for correctness and to avoid distraction.

References

Aerab-Sheibani, H., Safi, M., Namazi, M.H., et al. (2014).  Radiation safety awareness and practice among Iranian cardiology and radiology residents/fellows.  Anadolu KardiyolDerg, 14, 310–1

Hyun, S. J., Kim, K. J., Jahng, T. A., & Kim, H. J. (2016). Efficiency of lead aprons in blocking radiation− how protective are they?. Heliyon, 2(5), e00117.

Madhavan, A., Sankaran, S. & Balasubramani, S. (2015). Radiographic waste management -an overlooked necessity.  World Journal of Pharmaceutical Research, 4, 2050-2058.

Safi, M., Aera-Sheibani, H., Namazi, M.H., Vakili, H., & Saadat, H. (2014).  Academic training in radiation safety awareness and practice among Iranian residents/fellows.  Heart Asia, 6(1), 137–141.

Sinnott, Bridget, Elaine Ron, and Arthur B. Schneider. "Exposing the thyroid to radiation: a review of its current extent, risks, and implications." Endocrine reviews 31, no. 5 (2010): 756-773.

Srinivasan, D., Than, K. D., Wang, A. C., La Marca, F., Wang, P. I., Schermerhorn, T. C., & Park, P. (2014). Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World neurosurgery, 82(6), 1337-1343.

Taguchi, Yasunori, Yukinobu Sakata, Ryusuke Hirai, Kyoka Sugiura, Tomoyuki Takeguchi, Shinichiro Mori, and Fumi Maruyama. "Apparatus, method, and program for processing medical image, and radiotherapy apparatus." U.S. Patent 9,919,164, issued March 20, 2018.

Williamson, G.F. (2014).  Digital radiography in dentistry.  J PracHyg, 13, 25-32.

Winand, C., Shetty, A., Senior, A., Ganatra, S., De Luca Canto, G., Alsufyani, N., ... & Pachêco-Pereira, C. (2016). Digital imaging capability for caries detection: a meta-analysis. JDR Clinical & Translational Research, 1(2), 112-121

[1] Aerab-Sheibani, H., Safi, M., Namazi, M.H., et al. (2014).  Radiation safety awareness and practice among Iranian cardiology and radiology residents/fellows.  Anadolu KardiyolDerg, 14, 310–1

[2] Sinnott, Bridget, Elaine Ron, and Arthur B. Schneider. "Exposing the thyroid to radiation: a review of its current extent, risks, and implications." Endocrine reviews 31, no. 5 (2010): 756-773.

[3] Safi, M., Aera-Sheibani, H., Namazi, M.H., Vakili, H., & Saadat, H. (2014).  Academic training in radiation safety awareness and practice among Iranian residents/fellows.  Heart Asia, 6(1), 137–141.

[4] Srinivasan, D., Than, K. D., Wang, A. C., La Marca, F., Wang, P. I., Schermerhorn, T. C., & Park, P. (2014). Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World neurosurgery, 82(6), 1337-1343.

[5] Hyun, S. J., Kim, K. J., Jahng, T. A., & Kim, H. J. (2016). Efficiency of lead aprons in blocking radiation− how protective are they?. Heliyon, 2(5), e00117.

[6] Taguchi, Yasunori, Yukinobu Sakata, Ryusuke Hirai, Kyoka Sugiura, Tomoyuki Takeguchi, Shinichiro Mori, and Fumi Maruyama. "Apparatus, method, and program for processing medical image, and radiotherapy apparatus." U.S. Patent 9,919,164, issued March 20, 2018.

[7] Madhavan, A., Sankaran, S. & Balasubramani, S. (2015). Radiographic waste management -an overlooked necessity.  World Journal of Pharmaceutical Research, 4, 2050-2058.

[8] Winand, C., Shetty, A., Senior, A., Ganatra, S., De Luca Canto, G., Alsufyani, N., ... & Pachêco-Pereira, C. (2016). Digital imaging capability for caries detection: a meta-analysis. JDR Clinical & Translational Research, 1(2), 112-121.

[9] Williamson, G.F. (2014).  Digital radiography in dentistry.  J PracHyg, 13, 25-32.