Adams School of Dentistry: Standard Regarding Use of Ionizing Radiation

Title

Adams School of Dentistry: Standard Regarding Use of Ionizing Radiation

I. Introduction

A. Purpose

The purpose of this Standard is to set forth the minimum requirements for the use of ionizing radiation at the UNC Adams School of Dentistry.

B. Scope of Applicability

This Standard applies to all School of Dentistry personnel and students who may use radiographic equipment.

II. Standard

A. Physical Facilities

1. All existing radiographic equipment and facilities must meet all regulations specified and/or recommended by the Federal Radiation Control for Health and Safety Act of 1968, NCRP Report No. 177 (Radiation Protection in Dentistry and Oral & Maxillofacial Imaging), the ADA recommendations on acceptable radiographic practices (The use of dental radiographs. Update and recommendations. JADA 2006; 137:1304-1312) and the North Carolina Regulations For Protection against Radiation, November 1, 2007.
2. All purchasing considerations of radiology-related equipment must be communicated to the Radiation Safety Officer of the Adams School of Dentistry to ensure compliance with State regulations and with school policies as well as to optimize quality and consistency.
3. Radiographic facilities must be designed to maximize student, operator, and patient protection from unnecessary exposure to ionizing radiation.
4. Digital imaging equipment (photo-stimulable phosphor (PSP) and solid-state receptors, scanners, monitors, etc.) must be monitored on a regular basis to promote consistency in image quality.

B. Radiation Safety (General)

1. Radiographic equipment and technical procedures must be in compliance with State and Federal radiation safety standards, rules and regulations.
2. Technical procedures will be utilized according to the ALARA-principle (As Low As Reasonably Achievable) in order to limit the radiation exposure to a level that is sufficient to obtain adequate radiographic information for patient diagnosis, treatment planning and follow-up.
3. Techniques to minimize unnecessary patient exposure during intraoral radiographic examinations must be used, including long position indicating devices (PIDs), digital receptors, and rectangular collimators. Receptor-holding and beam aiming devices must be used when possible to optimize image quality and minimize the need for  patient re-exposure. Lead, or lead equivalent, lap aprons and thyroid shielding must be used per NC regulatory requirements.
4. Only qualified and authorized persons must expose patients to ionizing radiation, including DDS, RDH, DA, and RT’s. Students who have achieved radiographic pre-clinical competence will be allowed to image patients under faculty supervision.
5. Personnel radiation monitoring should be offered to those individuals who frequently make radiographic exposures or supervise radiography students and to those who request a monitoring device. Personnel radiation monitoring is not required by N.C. regulations governing dental radiation exposures.
6. Personal monitoring dosimeters must be offered for declared pregnant personnel who may be occupationally exposed.

C. Radiation Safety (Handheld X-ray Sources)

1. Operators of handheld x-ray  sources must complete the ASOD required operator safety training before making any patient radiographic exposures.
2. Rectangular collimation must be used with handheld devices whenever possible.
3. The operator of a U.S. Food and Drug Administration (FDA)-cleared handheld x-ray source adhering to published recommendations for safe use must not be required to wear a personal radiation protective garment.
4. If recommended protocols for safe use of handheld x-ray sources are expected to be compromised, the operator of the device must be required to wear a personal radiation protective garment.
5. When portable or handheld x-ray sources are used, all individuals in the area other than the patient and operator must be protected as members of the public.
6. Operators of handheld x-ray sources must have the physical ability to hold the device in place for multiple exposures. Otherwise, a conventional stationary x-ray source must be used.
7. Operators must store a handheld x-ray source so that it is not accessible to members of the public when not in use.

D. Instructional/teaching support for clinical activities

1. Supporting clinical staff must be knowledgeable and skillful in oral radiography procedures and the safe use of ionizing radiation.
2. Radiology faculty must possess appropriate training in oral and maxillofacial radiology.
3. Students must be closely supervised by faculty or staff during all clinical radiographic procedures conducted on patients, except in the case of competency exams. Exposures must be made only after faculty authorization. Reimaging of patients must be authorized and supervised by an attending supervisor or radiology clinical staff.
4. If possible, a student/faculty ratio of 5:1 or less should be maintained in radiology acquisition clinics, with a maximum 6:1 ratio allowed.

E. Institutional obligations to the patient

1. Technique factors for radiographic exposure must be appropriate for the age and size of the patient.
2. Retake of a radiograph is conducted only when additional diagnostic information is needed. Patients must not be subjected to unnecessary re-exposures to improve image quality without a diagnostic benefit.
3. Patients must not be subjected to administrative radiographic examinations prior to initial screening and consultation.
4. Radiographic images must be made available to private practitioners or other appropriate professionals when so requested by patients.
5. Radiographic images must be limited to the minimum number needed to obtain information required for diagnosis and treatment planning and should be prescribed following the ADA/FDA guidelines for prescribing dental radiographs.
6. Additional persons, whether members of the patient’s family or party, must not be subjected to radiation exposure.
7. Patients may refuse a clinician’s recommendation for a radiographic examination. In the case of refusal, patients must be required to complete and submit the ASOD “Diagnostic Imaging Informed Refusal Form”.

F. Institutional obligations to the student

1. Students must be taught to critically assess the need for diagnostic radiographic information and to evaluate the risks and benefits to the patient before ordering the radiographs.
2. Students should be well prepared to assume the challenge of clinical dental radiography and must receive appropriate guidance from faculty and staff.
3. Technical competence in radiographic procedures must be achieved on mannequins prior to clinical assignment; students should be taught to recognize clinical situations that may require a compromise of established technical criteria.
4. Students must not expose radiographs on each other for practice unless clinically indicated.
5. Students must not be allowed to retake a clinical radiograph without the authorization of a faculty member or supervising attending. Direct supervision by faculty or staff during reimaging procedures is required.
6. Students must achieve radiologic competence and should be prepared to demonstrate appropriate concern in selecting equipment and following procedures to minimize radiation exposure to patients.

Ordering of Radiographs Standard

The purpose of this section is to provide a guide to the clinician in prescribing radiographic images. Radiographic images must be prescribed only in cases when the information cannot be obtained otherwise.

General Guidelines

1. Radiographic images must be prescribed by faculty members and/or graduate students holding the D.D.S./D.M.D. degree and who are licensed to practice dentistry within the UNC Adams School of Dentistry according to North Carolina State law.
2. Radiographic images must be ordered only after an appropriate clinical examination and patient interview have been completed in order to establish the necessity for radiographic images and to determine which radiographic examination will most effectively contribute to an accurate diagnosis. An exception is only permitted if (1) ordered radiographs represent a minimum requirement for diagnosis and treatment planning and (2) the exception is approved by radiology.
3. The frequency and type of radiographic images that are taken to aid in routine maintenance of a patient’s dental health varies and the decision must be made based on individual patient needs.

Note: For more specific guidelines refer to the ADA/FDA “Guidelines for prescribing dental radiographs”.

III. Contact Information