dental hygiene radiation safety manual

Updated 9-29-11/rsc Last Updated 01/12 sgp

Austin Community College Department of Dental Hygiene

Dental Radiography Operating and Safety Procedures

Purpose of this Document: The Purpose of this document is to meet in part the requirements of the Texas Administrative Code, Texas Department of State Health Services as it pertains to the use of dental radiation. Implementing the following procedures will minimize radiation exposure to patients, employees, and students. The certificate of registration, #R28393, for the dental x-ray equipment located at the Eastview Campus, 8101 Webberville Road, Austin, Texas 78702, Building 8000, Department of Dental Hygiene is posted in room 8142. Original College documents are located with the office of Environmental Health Safety & Insurance, ACC Service Center, located at 9101 Tuscany Way, Austin, Texas 78754.

1. Radiation Safety Officer:

Gary Wright, DDS – Professor and Consulting Dentist Department of Dental Hygiene 512-223-5717 – office 512-963-1369 – mobile email – [email protected] The Radiation Safety Officer is responsible for insuring the proper functioning of the departmental radiography equipment including intraoral and panoramic x-ray machines and automatic film and digital image processing machines, and informing departmental personnel of their proper use. All inquiries regarding departmental procedures, equipment or safety issues must be directed to the Radiation Safety Officer as soon as is possible.

2. Personnel Allowed to Operate Departmental Radiographic Equipment:

Only Texas licensed/credentialed dental personnel or students who have enrolled in and passed Dental Radiography DHYG 1304 are allowed to operate the departmental radiographic equipment to make x-ray exposures of patients. Students currently enrolled in DHYG 1304 or Dental Radiology DNTA 1005 are only allowed to use the departmental radiographic equipment under the direct supervision of a credentialed faculty member and may only make x-ray exposures to manikins, not human subjects.

3. Location of Operating and Safety Procedures Documents:

The operating manuals for the departmental radiographic equipment, including intraoral and panoramic x-ray machines and automatic film and digital image processing machines, are located in the darkroom, room 8142.1 Copies of this document are located in 8142 with the Clinic reference documents such as the OSHA Manual, HIPAA Manual, and the Clinic Manual and are readily accessible by students, faculty, and staff. Additionally a copy of this document is located with the College Radiation Safety Program document adjacent to the registration document posted on the bulletin boards in 8142.

ACC Dental Hygiene Clinic Manual Section 7 - Radiology

Last Reviewed 01/12 (SGP) of 26

mailto:[email protected]


4. Radiation Protection Guidelines

ALL X-ray Equipment Operators will follow the following procedures:

A. ONLY the x-ray equipment operator and the Patient are permitted in the operatory

during radiographic procedures. (Children of adult patients must remain outside in the reception area.)

B. A thyroid Collar and protective apron of/or equivalent to the FDA requirements of

0.3mm lead is to be used on EACH patient. For panoramic radiography, the protective apron will be positioned so that it will not interfere with the diagnostic value of the radiograph. Thyroid collars are NOT used for panoramic radiography.

C. The operator of the x-ray equipment will stand in a safe area during each

radiographic exposure. Safe areas include: 1) standing 6 feet away NOT in a direct line with the x-ray beam, 2) behind an appropriate barrier, or 3) outside the room.

D. X-ray equipment operators WILL NOT hold films in a patient's mouth during a

radiographic exposure. If it is ever necessary to hold films in a patient's mouth, the parent, guardian, or personal representative of the individual should be asked to hold the film.

E. X-ray equipment operators WILL NOT hold or stabilize the X-ray tubehead during a

radiographic exposure. F. X-ray equipment operators WILL NOT stand in a direct line with the central ray.

5. Infection Control Guidelines for Dental Radiology

A. Accepted clinic attire shall be worn at all times. In general, the only personal

protective equipment [PPE] that MUST be worn during a radiographic procedure are gloves. Typically when a patient/client is radiographed, there is minimal risk of aerosol contamination or body fluid spatter during the procedure[s]; thus it is not usually necessary to wear a face mask/shield, eye protection or waterproof protective outer clothing. It is appropriate to use PPE if the patient has a respiratory infection or might be a severe gagger. Under most clinical radiographic situations the "universal precautions" utilized will involve the use of gloves, proper handling of the contaminated materials & instruments, AND the appropriate decontamination of surfaces & instruments exposed to saliva.

Reference: Principles of Dental Imaging 2nd Ed., Langland, Langlais, Preece, Lippincott

Williams & Wilkins, p.70, 2002, ISDN 0-7817-2965-3. 49

B. The Clinician is NOT to assume that the operatory has been cleaned and disinfected by the previous person. Before bringing patient into operatory, prepare the room as follows: a. Clean and disinfect all surfaces you plan to touch, including: the chair and counter

surfaces. b. Cover the control panel, exposure switch (if hand held), and counter surface, yoke,

tubehead, BID (positioning indicating device) with plastic wrap, or other suitable barrier material.

C. Operators MUST wash hands before donning gloves.




D. Gloves shall be worn at all times. E. Supplies and film shall be kept on the covered work surface. Several cotton rolls

should be removed from the container and made available, as needed. A paper cup should be used to receive the exposed films after they have been dried using a paper towel.

F. When exposures are completed, leave the operatory CLEAN and NEAT:

1) Remove and properly dispose of all plastic wrap. 2) Dispose of all other supplies by placing them in a suitable trash receptacle. 3) Remove gloves, wash your hands. 4) Clean and disinfect all contaminated surfaces, which were not covered with

plastic wrap. (Note: DO NOT USE A SPRAY DELIVERY OF DISINFECTANT ON THE CONTROL PANEL OF the X-RAY UNIT)

5) Turn x-ray unit off and position the tubehead against the wall/within the cabinet. 6) Lead apron is cleaned and hung up 7) Remove & dispose of gloves BEFORE leaving the x-ray operatory.

6. Infection control continues in the darkroom area:

A. Don new gloves after entering the darkroom, or before using the daylight loader of the automatic processor. Strip films from packets with gloved hands. Open film packet with gloved hands over a CLEAN paper cup. Allow the "clean" film to fall into the cup without touching the film with either the film packet or your gloved hands.

B. Lay contaminated film packets on a paper towel, or throw them directly into the trash

receptacle. Contaminated film packets shall never be laid directly on the film processor or touched with ungloved hands.

C. Once all films are removed from their packets and in the clean cup. Remove gloves

and insert films into the processor using ungloved hands. Films should be handled as little as possible, preferably by the edges.

D. After all films are in the processor, wash and dry hands.

E. Handle processed radiographs with clean hands only, no gloves.

7. Panoramic Radiography There is no need to wrap anything in this room except to use the barrier on the chin rest with a single use or autoclavable bite block. If a bite-block barrier is used, the patient can remove the barrier once the exposure is completed. Wipe down the patient positioning area and handles of the panoramic unit before and after making the exposure, using gloved hands and appropriate disinfecting solution.




8. Dental Radiography Value and Attitude Statements:

A. Operation of X-ray Equipment.

During the operation of x-ray units and film processors, the clinician is to actively monitor the functions of the equipment they are using and report any malfunctions or deviations from "normal" expectations to the appropriate responsible person. Assume personal responsibility for properly setting x-ray equipment to produce a diagnostic image with lowest exposure to the patient.

B. Intraoral Radiographic Techniques.

While exposing radiographs, actively monitor patient verbal and non-verbal reactions to film placement and take appropriate steps to maintain patient comfort and still assure appropriate diagnostic quality, OR seek appropriate assistance from supervising faculty. Incorporate personal compliance with principles of the ALARA concept (as low/minimal radiation as reasonably achievable) and asepsis during the exposure of patients. Appreciate the role and use of quality radiographs in the diagnosis and treatment of each patient. Accept personal responsibility for complying with all appropriate Federal, State, and Local regulations concerning the safe operation of x-ray equipment. Accept personal responsibility for personal, patient, and staff safety while operating x-ray equipment.

C. Radiographic Quality Assurance.

Accept personal responsibility for providing radiographs of high diagnostic value by differentiating between acceptable radiographs and unacceptable radiographs by recognizing and correcting technique and/or processing errors without having to be told to do so. Accept responsibility for evaluating whether or not a retake is required to meet minimum diagnostic criteria. Be willing to assume responsibility for improving, or suggesting improvements, in radiographic quality assurance procedures when existing procedures do not provide a consistent quality diagnostic radiograph.

D. Communication Skills. Assume personal responsibility for appropriately addressing any questions the patient might have related to the radiographic procedures being performed, issues of radiation safety, and biological risk associated with the procedure being performed. Demonstrate a willingness to help the patient understand importance of dental radiographic procedures in their overall treatment.




Communication Skills. continued: Respond with appropriate empathy/sympathy to patient fears and appropriately communicate using lay terms.

E. Leadership. Accept personal responsibility for job performance, and maintaining knowledge and skills appropriate to the standard of care for their profession. Appreciate the importance of evaluating job related performance on a continuing basis and demonstrate the behaviors of a "life-long learner." Model professional leadership qualities and skills.

F. Radiation Biology and Safety.

Take personal responsibility for applying radiographic selection criteria appropriate for each patient when requesting approval of diagnostic radiographs. Accept responsibility for effectively communicating potential radiation risks and benefits for selected radiographic procedures to patients and colleagues at a level understandable to each constituent group.

9. Equipment Maintenance and Assessments An equipment maintenance calendar and related logs for the film processors in addition to the dark room light leak tests are located in the Dark Room 8142.1. Repair of the x-ray equipment is provided by certified technicians of a dental service company like Patterson Dental.

10. The Radiology Section of the Department of Dental Hygiene Clinic Manual includes the following:

• decision matrix for determining the need for dental x-rays; • definition of clinical competence in dental radiology; • documentation principles; • x-ray evaluation for acceptable images; • management of traditional film and digital formats; • essential principles of the complete full mouth series.



Austin Community CollegeDepartment of Dental Hygiene

Guidelines for Prescribing Dental Radiographsin accordance with US Department of Health and Human Services guidelines

prepared 9-28-04; Revised 01-09 (PS; Dr. Preece; SGP)reference: Essentials of Dental Radiography for Dental Assistants and Hygienists, 7th ed; 2003ISBN 0-13-093231-0

Dentulous Edentulous

New Patient Recall Patient New Patient Recall Patient

FMX or pano not applicable

Presents w/clinical evidence of gen

dental disease or hx of extensive tx

No clinical evidence of gen dental disease or

hx of extensive tx

Clinical Caries or high risk for caries

No clinical caries and no high risk factors for caries

ADULT: FMX

ADULT: Pano + BW's; selected PA's

(as requried)

ADULT: BW's q 12-18 mos

ADULT: BW's q 24-36 mos

ADOLESCENT: PA's or pano to

assess developing 3rd

molars

ADOLESCENT: PA's or pano to assess

developing 3rd molars

ADOLESCENT: BW's q 6-12 mos

or until no carious lesions present; PA's or pano to assess developing 3rd

molars

ADOLESCENT: BW's q 18-36 mos;

PA's or pano to assess developing

3rd molars

ADULT and ADOLESCENT



Austin Community CollegeDepartment of Dental Hygiene

Guidelines for Prescribing Dental Radiographsin accordance with US Department of Health and Human Services guidelines

prepared 9-28-04; Revised 01-09 (PS; Dr. Preece; SGP)reference: Essentials of Dental Radiography for Dental Assistants and Hygienists, 7th ed; 2003ISBN 0-13-093231-0

CHILD

Primary Dentition Mixed Dentition

New Patient Recall New Patient Recall

BW's + pano

High Risk: BW's q 6mos or until

no carious lesions are

evident

Pano + BW's; selected PA's (as

required)

High Risk: BW's q 6mos or until

no carious lesions are

evidentNo High Risk

Factors: BW's q 12-14mos if

proximal surfaces can not be

visualized or probed

No High Risk Factors: BW's q 12-24mos; pano may be needed

to assess development

Definition of Child Categories: 0 - 4 years: BW's or PA's only with evidence of gross caries and if possible 5 - 12 years: (primary and mixed dentitions) Pano & BW's (with selected PA's as required) to assess developing permanent teeth



Dental Radiology This section is intended to provide the dental hygiene student with information regarding the performance of dental radiographic procedures and related policies in the Dental Hygiene Clinic.

DEFINITION OF CLINICAL COMPETENCE IN DENTAL RADIOLOGY

I. Clinical Applications of Basic (Didactic) Knowledge Upon graduation, the effective dental hygienist will be able to apply basic

(didactic) knowledge of dental radiology to clinical procedures by:

A. Routinely reviewing dental and medical histories and by performing a cursory oral examination PRIOR to beginning intraoral radiographic procedures.

B. Carefully performing infection control procedures for each patient and

utilizing appropriate procedures for their own protection. C. Applying at all times, principles for optimizing the radiologic health of the

patient and themselves by: •considering the potential of pregnancy PRIOR to initiating the

radiographic procedure(s). • checking for the availability of a recent CMRS from another dentist. • observing principles of radiologic health. • using the lead apron and thyroid shield when appropriate. D. Employing, during clinical radiographic procedures, basic principles of

radiographic theory and modifying normal procedures as appropriate to the clinical circumstances encountered.

E. Suggesting other radiographic procedures or techniques which may

provide additional diagnostic information about the patient's condition.

II. Radiographic Technique Skills The effective dental hygienist/student will:

A. Choose the most appropriate method for intraoral radiography, but be flexible enough to modify the procedure as the situation requires, e.g., gagging patients, ankylglossia, tori, etc.

B. Have the necessary skills to complete the procedure they are attempting.

Document Date: 02-04 (RSC); Last Review 01-10 (SGP)



II. Radiographic Technique Skills continued:

The effective dental hygienist/student will:

C. Respond rationally to unexpected developments, either by modifying the procedure or by seeking appropriate help and advice. D. Complete the task in a reasonable amount of time.

Time Guidelines to expose process, mount, critique (with 2 retakes if needed) a CMRS: Clinic I: 1 ¼ hr. Clinic II: 45 minutes – 1 hr. Clinic III: 45 minutes or less

E. Perform technical procedures (radiographic technique) and produce good

to excellent quality radiographs. [An ineffective auxiliary will be incapable of maintaining an average score of 80 on any four (4) consecutive CMRS.]

F. Be capable of determining whether or not their radiographs meet minimal

requirements of acceptability and whether or not specific films require retaking.

III. Radiographic Interpretative Skills The effective dental hygienist/student will:

A. Be able to list and recognize appropriate exposure, processing, and film viewing factors necessary for proper radiographic interpretation.

B. Be capable of accurately identifying all normal anatomic structures visible

on intraoral CMRS and panoramic* radiographs. C. Be able to distinguish gross deviations in radiographic form and density

from normal structures on all routine radiographic surveys. * In the case of panoramic radiographic surveys, the auxiliary should also be

able to identify areas of "radiographic artifact" produced by the panoramic procedure and distinguish them from normal anatomic structures.

IV. Relating to the Patient The effective dental hygienist/student will:

A. Monitor the patient's reactions and consider the patient's comfort throughout the radiographic procedure.

B. Exhibit a demeanor that elicits confidence and cooperation from the

patient who will feel free to ask questions and discuss radiographic concerns. The hygienist will respond with sensitivity and patience to any sign of fear or anxiety on the part of the patient.



V. Professional Behavior The effective dental hygienist/student will:

A. Relate well to others and communicate easily in addition to helping create a harmonious working relationship.

B. Seek consultation and advice when appropriate and respect the views of

others. C. Function independently in a clinical situation and complete procedures

properly without constant supervision. D. Be reliable and punctual in keeping clinical appointments and in fulfilling

duty assignments. E. Conduct themselves in a manner appropriate for a professional person.



Prescribing and Obtaining Radiographs

I. Identify patients who meet selection criteria for radiographs: A. Typically the decision for obtaining and the types of radiographs needed will

correspond with the Consulting Dentist’s examination. B. Reasons for radiographing a dental hygiene patient may include but not be

limited to the following: 1. generalized, moderate to severe periodontitis with ≥5 mm pockets. 2. pain associated with dental structures. 3. clinical evidence of caries, missing teeth without a history of extractions,

sinus tracts, large restorations with defective margins and overhangs, fractured teeth, etc.

4. request by patient's regular dentist for CMRS (in writing). 5. patient's radiographs are unavailable from previous dentist. 6. patient's radiographs are more than 2 years old and patient presents with

active disease.

C. Patients WILL NOT be radiographed if there is no justifiable clinical need. The specific reasons for taking radiographs will be justified for each patient individually and the Consulting Dentist will note the rationale in the patient's chart.

Refer to the radiograph prescription decision matrix, “Guidellines for Prescribing Dental Radiographs”, Pages 1 and 2

II. Consulting DDS orders the radiographs and will designate traditional or digital images. A. The Consulting DDS/faculty documents a corresponding entry in the Patient’s

Progress Notes. B. The student will obtain film and sterilized RINN XCP instruments from the

Sterilization Center. C. For digital intraoral radiographs, the student will use their dispensed phosphor

plates or check out the Schick sensor(s) from the Sterilization Center, D. Panoramic film will be obtained from the darkroom supply cabinet, taking all

necessary precautions not to expose the box of films to light. If the patient requests a copy, two films will be placed in the cassette to produce two original panoramic radiographs.

E. For digital panoramic radiographs, the appropriate cassette can be obtained from the darkroom supply cabinet.



Radiation Protection Guidelines Radiology procedures and protection guidelines are to be in accordance with the theory presented in the Dental Radiology Course DHYG 1304. Selected principles are included in this Manual. 1. ONLY the X-ray Equipment Operator and the Patient are permitted in the

Operatory when radiographs are taken. (Children of adult patients must remain outside in the reception area.)

2. Thyroid Collar and Lead Apron will be used on EACH patient, for all intraoral

radiographic procedures, regardless of age. For panoramic radiography, only the lead apron will be used and it will be positioned in such a way so that it will not interfere with the diagnostic value of the radiograph.

3. The Operator of the X-ray equipment will remain the recommended

distance (per manufacturer’s specifications – i.e., at least 6 feet from the tube head) during each radiographic exposure.

4. X-ray Equipment Operators WILL NOT (under any circumstances) hold

films in a patient's mouth during a radiographic exposure. 5. X-ray Equipment Operators WILL NOT hold or stabilize the X-ray tubehead

during a radiographic exposure. If equipment is not stable notify the Clinic Coordinator and move to an x-ray unit that is stable.

6. X-ray Equipment Operators WILL NOT stand in a direct line with the central

ray. 7. Under exceptional circumstances, it may be necessary for someone to hold a

film in a patient’s mouth (never on a mannequin). When these circumstances arise, it will be necessary to consult with and receive permission from the dentist assigned to the clinic. During these special circumstances, the patient’s guardian or parent may be used to assist in holding the film in a patient’s mouth if they are draped with a lead apron. Faculty, Students, and Staff WILL NOT (under any circumstances) be asked to hold film in a patient’s mouth.



Documentation and Radiographic Exposure Record

1. The student will document in the Progress Notes all radiographic exposures, listing exactly the prescribed films that were obtained – i.e., CMRS, 4 vertical BW’s, 2 BW’s, 2 PAX of # 19 and #30-31, etc. 2. Each active dental hygiene patient will have a separate Radiographic Exposure Record in addition to the corresponding documentation in the patient’s Progress Notes. The purpose of the Radiographic Exposure Record is to keep a Departmental log of the patient’s radiographic exposures to date in order to demonstrate attention to issues such as appropriate patient management and when considering calculating the x-ray maximum permissible dose.

Department of Dental Hygiene Radiographic Exposure Record

Patient’s Last Name First Name

The purpose of the Radiographic Exposure Record is to keep a Departmental log of the patient’s radiographic exposures to date. Record the number of all the exposures to include any retake(s).

Indicate whether the image is a traditional (TR) or digital (DI) radiograph exposure.

Image

Type Total #

Images

Faculty

Initials Date TR DI Size 0 Size 1 Size 2 Size 3 Size 4 Pano Sample

00-00-06 8 12 20 SGP

00-00-06 1 1 SGP



Evaluating Your Films: CMRS

Evaluate your radiographs using the criteria employed for the Dental Radiology (preclinical) course. Once you have decided on retakes, ask your faculty member/DDS to verify your conclusions. Take only the retakes requested by the faculty (and submit the related Film Dispensing Form to obtain the additional film needed). MINIMUM ACCEPTABLE CRITERIA FOR A CMRS on a patient consists of being able to see each interproximal space at least once (somewhere) on the CMRS without overlapping. Each root apex should be visible at least once in the series. Retakes will be taken only to the degree that these minimal standards can be achieved. Retakes WILL NOT be taken merely to improve the technical quality of an individual radiograph.



Student name: Date: ACC Dental Hygiene CMRS Self-Evaluation Grade Worksheet

Student name: Date:

ACC Dental Hygiene CMRS Self-Evaluation Grade Worksheet

Evaluate each radiograph taken [Place the appropriate abbreviation in each window - in pencil] A = acceptable = NO ERRORS P = packet placement H = overlapped key interproximal space C = cone cut Bt = bent film B = backward film Pr = processing error V = vertical angulation [foreshortened/elongated] O = other error not listed above R = retake - NOT CLINICALLY ACCEPTABLE

Assessment #1: This set of radiographs meets MINIMUM criteria for clinical acceptability. I.e., each "key" interproximal space is visible at least once WITHOUT overlap on the CMRS and each root apex is visible at least once with at least 2-4mm of bone visible beyond the apex. [Circle the most appropriate answer]

YES NO Score = 5 points [all or nothing]

Patient Name: ____________________________ ReTakes: #2 films _________________ #1 films _________________ Pano ___________________ Other: __________________ Comments:

DDS Signature:

Evaluate each radiograph taken [Place the appropriate abbreviation in each window - in pencil] A = acceptable = NO ERRORS P = packet placement H = overlapped key interproximal space C = cone cut Bt = bent film B = backward film Pr = processing error V = vertical angulation [foreshortened/elongated] O = other error not listed above R = retake - NOT CLINICALLY ACCEPTABLE

Assessment #1: This set of radiographs meets MINIMUM criteria for clinical acceptability. I.e., each "key" interproximal space is visible at least once WITHOUT overlap on the CMRS and each root apex is visible at least once with at least 2-4mm of bone visible beyond the apex. [Circle the most appropriate answer]

YES NO Score = 5 points [all or nothing]

Patient Name: ____________________________ ReTakes: #2 films _________________ #1 films _________________ Pano ___________________ Other: __________________ Comments: DDS Signature:



Student Patient Name Name Date: Student Patient Name Name Date:

Retake films indicated in RED, or (R) Black pencil indicates MINOR error but retake NOT necessary.

Error Identification: B - backward film Bt - bent film C - cone cut D - density H - horizontal angulation = overlap M - movement Mt - mounting error O - other error P - packet placement Pr - processing error Ret = retake taken V - vertical angulation Each retake = -5 pts. Each minor error = -1 to -4 pts. Acceptable retake = +2 pts Mismounted radiograph = -2/film

Evaluation: No. Total P H V C Bt Mt O Retakes Score

Case complexity: (S) = simple (A) = average (C) = complex

Austin Community College Dental Hygiene CMRS Grading Form

Right Left

Molar Premolar

BW's

Retake films indicated in RED, or (R) Black pencil indicates MINOR error but retake NOT necessary.

Error Identification: B - backward film Bt - bent film C - cone cut D - density H - horizontal angulation = overlap M - movement Mt - mounting error O - other error P - packet placement Pr - processing error Ret = retake taken V - vertical angulation Each retake = -5 pts. Each minor error = -1 to -4 pts. Acceptable retake = +2 pts Mismounted radiograph = -2/film

Evaluation: No. Total P H V C Bt Mt O Retakes Score

Case complexity: (S) = simple (A) = average (C) = complex

Austin Community College Dental Hygiene CMRS Grading Form

Right Left

Molar Premolar

BW's



Department of Dental Hygiene Management of Traditional Film Radiographs

GENERAL

• Obtain film from the Sterilization Center o Follow protocol described elsewhere in the Manual, i.e., infection

control, placement of barriers, etc. o You will be provided 2 plastic cups nested inside each other.

The exterior cup is to remain clean and inside cup is used to store the exposed radiographs while awaiting processing.

EXPOSING • Assure that the x-ray machine is set for the corresponding traditional film image. • Follow infection control procedures regarding barrier placement, etc. • Place the lead apron with the thyroid collar onto the patient. • Adjust the headrest to support the back of your patient’s head in a stable,

comfortable position. • Ask the patient to remove eyeglasses and any removable dental

appliances. Place appliances in a ziplock bag with water/mouthwash. • Wash hands and put on gloves. • Place paper toweling onto the counter and place your unexposed film

atop of the paper towel. • Expose the films & place them into the nested plastic cups for transport

to the darkroom – being careful not to contaminate the interior of the outside cup.

• De-glove & wash your hands. • Remove lead apron with thyroid collar from the patient. • Take exposed film to darkroom.

PROCESSING

• Place clean paper towels in the bottom of the daylight loader. Set the nested plastic cups and a pair of clean powder-free gloves into the daylight loader atop of the toweling. Put hands through sleeves into the daylight loader. Put on clean powder-free gloves.

• Under the daylight loader conditions, un-nest the second cup from the one containing the patient's radiographs.

• Unwrap films wearing gloves and allow the film(s) to drop into the 2nd "clean" plastic cup. Place the opened film packets on the paper towel. Do not allow the "contaminated" film packet or gloves to touch the clean cup.

• After all films are unwrapped, properly dispose of your gloves and film packets. (De-glove while keeping your hands in the processor sleeves; place the contaminated gloves into the contaminated plastic cup. Place all to the side so that you can access the film for processing.)



• With ungloved hands, remove the film from the clean cup and place them into the processor, taking care to separate duplicate films. Avoid overlapping the films as they are fed into the processor.

• Once all of the films are safely fed into the processor and the red indicator light has stopped flashing, remove your hands from the sleeves. Taking a new paper towel and protecting your hand, pick up the contaminated items (cups, films packets, paper towels, etc) and dispose of them. Wash your hands.

• Once films are out of the automatic processor, place them in a clean cup in preparation for mounting.

• Mount your radiographs using clean dry hands. Be sure to label the mount with your patient's name, date, and “ACC” in the Rx DDS area. Place duplicate films in a coin envelope labeled with your patient’s name, date and type of radiographs (eg, CMRS, PA #2, 4 BWX, 2 Vertical BWX, etc). Any retakes should be placed in a separate coin envelope labeled with patient’s name, date and “retakes”.

rsc 2/2004; updated 1/2009 (PS & SGP); Last Review 01/10 (SGP)



Department of Dental Hygiene Management of Phosphor Plates and Digital Imaging

GENERAL

• Handle Plates with Care o Do not bend o Do not apply pressure to the plate o Take care not to scratch o Take care not to soil/contaminate o Store away from moisture and heat o Protect the plate from direct sunlight and ultraviolet rays

• Perform appropriate infection control and barrier equipment, surfaces, and phosphor plates.

EXPOSING

• Assure that the x-ray machine is set for the corresponding digital image. Use the pre-programmed exposure settings card found on the x-ray exposure switch cord (Table 1 for Phosphor Plates and Table 2 for Schick sensors).

• Follow infection control procedures regarding barrier placement, etc. (Plates should be placed in barrier envelops ahead of clinic time.)

• Place the lead apron with the thyroid collar onto the patient • Don gloves • Select the plate(s) you need from your storage tin • Expose the plates & place them into a plastic cup or paper towel lined tin

for transport to the scanner • De-glove & wash your hands • Take exposed plates to darkroom

rsc 2-2004; updated 1-2010 (RSC & SGP)




Management of Phosphor Imaging Plates: Preparation for Scanning

• You should have delivered your exposed plates to the darkroom in a clean Dixie

cup (like you do with traditional film) or your storage tin • If you delivered your plates free of barriers (e.g., via a transport container) and

contamination free then proceed to the scanning process. Refer to the procedure handout located by the computer.

IF THE PLATES ARE STILL IN CONTAMINATED BARRIERS: • Turn off the under counter task lights & turn down the overhead

lighting to create a dim room. • If the plate eraser top is propped open, close it to prevent it being inadvertently

closed while your are unwrapping your plates (= too much light = loss of the image)

• Place paper toweling atop the counter in front of the trash grommet located adjacent to the scanner

• Place your exposed plates in the Dixie cup/storage tin on the counter next to the toweling.

• Glove with powder-free gloves • Remove each plate barrier envelope, allowing the plate to drop onto the paper

toweling AND not contaminating the plate o Dispose of the contaminated barrier through the trash grommet

Be sure and protect your plates from ambient light (e.g., place them in the storage

tin and place the cover on the tin). From the time you remove the barriers the light, though dim, will begin clearing the image.

o Contaminated plates need to be disinfected per manufacturer’s instruction

• Once all of the plates are barrier-free, dispose of any contaminated items (e.g.,

Dixie cup) and de-glove • Wash your hands and dry them well • For the scanning process, refer to the procedure handout located by the

computer




Procedure for Scanning Phosphor Imaging Plates

• Boot up the computer in the Darkroom (8142.1) • Turn on the AirTechniques Scanner • Launch EagleSoft • Select the patient • Turn off the under counter task lights & turn down the overhead lighting to create a

dim room. • Place the corresponding plate guides onto the scanner

(by plate size for example, size 1 or 2) • Using aseptic technique, remove the barriers from the

Phosphor plates [refer to the separate set of instructions] Be sure and protect your plates from ambient light (e.g., place them in the storage tin

and place the cover on the tin). From the time you remove the barriers the light, though dim, will begin clearing the image.

• Using the operatory view, click on the Scanner icon • Choose new exam by type [e.g., 4 BW’s; FMX; Panorex] • Hi-light all of the imaging spaces you need

o For example, for a FMS, click on the upper left space on the screen & then, while holding down the “shift” key select the lower right imaging space, highlighting all 20 spaces.

• Select Acquire by clicking on the yellow colored icon in the upper left menu area of the screen that looks similar to this or use the drop down menu under “Image” then choose “Acquire”

• Click Start • Once the scanner light for the corresponding imaging slot turns GREEN the scanner

is ready for you to insert the corresponding plate o Face the blue/light colored side of the plate toward the scanner drum

(= printed side toward you) Gently yet firmly press the edge of the plate down into the guide until

the plate begins to feed AND the corresponding light turns RED Be sure and insert the plate in the guide slot, not behind it next to the scanner drum.

o For a panorex, plate guides are not needed. Rather you need to wrap the plate with the blue/white side next to the drum & gently yet firmly slide it until the scanner “grabs” and begins feeding the plate without your assistance. Try to line the plate edge parallel with the base of the scanner

• Your images will begin to display on the computer monitor & the corresponding plates will fall into the scanner tray

o You may want to store the plates back in the tin, protected from light, till you are sure all have scanned and saved properly

• Once all of the images have scanned, click on Finish • Click on Save if the system has not already automatically saved the series • Now you are ready to sort your images & place them into the correct area in the

electronic x-ray “mount” • Once you are sure you will not need to re-scan a plate,

clear the plates using the Plate Eraser & re-barrier rsc 10-09; Last Review 01-10 (SGP) ACC Dental Hygiene Clinic Manual

Section 7 - Radiology Last Reviewed 01/12 (SGP)

of 26

01/2009; Last Review 01/10 (SGP) Radiographic Film Exposure and Retake Procedures

1. DDS will order radiographs with dental exam, and will document in progress notes. 2. Student will expose ordered radiographs, process, mount and self-critique technique. Student will also complete Radiographic Exposure Form that stays with patient’s chart; faculty will initial form. 3. The assigned instructor or DDS will review technique and determine if retakes are needed. 4. If retakes are needed, student will expose radiographs and document on patient’s radiographic Exposure Form as well as in progress notes. Faculty will evaluate retakes and initial Rad Exposure form. 5. Student will place films that were not acceptable in a “retake” coin envelope, which will remain in patient chart (until removal by the Clinic Coordinator after chart audit is completed). On envelope, write: Patient Name Date Number of films inside (write the number of exposures, but put all films in the envelope) ‘Retakes’ 6. Student will place the second set of films in a separate coin envelope and label appropriately (include description, eg. CMRS, 2 BWX, etc). 7. DDS will review x-rays with patient. The student will listen carefully to the dentists’ explanation and any related referral with appropriate follow-up. Note: E-F Speed film, double film packets:

• Mount one set • Place second set in labeled coin envelope (see # 5 & 6 above). If patient requests

the second set of radiographs, they be given to the patient or mailed to their dentist. This set should be mounted and documentation entered in the Progress Notes.




Updated August 4, 2009; Last Review 01-10 (SGP)

Procedure for Printing Digital Images from the EagleSoft Patient Management System

• Launch EagleSoft • Select the patient • Using the operatory view, click on the imaging icon [x-rays on the monitor] • Open exams by date • Select the survey you want to print • Turn the printer on • Load plain paper in the tray (to print a “test run”) • For FMX and BWX surveys click file and print all • Select the HP Photosmart 8000 printer from the list of printers • Click on properties • Click on the color tab • Select digital radiographs from the upper dropdown menu • Click OK • Select the landscape paper setting • Click OK

Be sure and let the prints dry completely before touching them or they will SMEAR

• Assess your hardcopy and adjust settings as needed if images need to be improved (e.g., contrast)

• When satisfied with output, then print on the 8.5”X11” photo paper located in the right side overhead cabinet; place the paper shiny-side down on the printer tray

You will need to reset the printer selection and properties each time you print – for each copy – or the system defaults to the HP LaserJet 4200

• To print one very large PA film o Double-click on the image to bring up a larger image on the screen o Then in that window, click on file, then print o Use the same printer settings as described above for the FMX and BWX

• To print a panoramic image o Double-click on the image which will bring up another window o Then use the same printer settings as described above for the FMX and

BWX When you are done printing, exit out of the patient’s file, then exit out of EagleSoft. Please report any low-ink messages provider by the printer during your procedures to the Patient Care Coordinator.



CMRS Table of Essential PrinciplesAs Presented by John W. Preece, DDS, MS

Table by Holly Jackson-Kuhn

ARCH REGION FILM TYPE

BITE BLOCK PACKET PLACEMENT TUBEHEAD ALIGNMENT KEY INTERPROXIMAL

SPACE RADIOGRAPHIC APPEARANCE

Maxillary Central Incisor 1.1 Anterior Centered directly behind the two maxillary central incisors.

Vertical angulation - CR directed perpendicularto long axis of tooth and film.

Horizontal angulation - CR directed between the central incisors.

R&L central incisors (centered) and R&L lateral incisors.

Maxillary Lateral IncisorRight and Left

1.1 Anterior Centered directly behind the maxillary lateral incisor.


Horizontal angulation - CR directed at the center of the lateral incisor (central-lateral incisor contact should be open).

Lateral incisor (centered), central incisor, and canine.

Maxillary CanineRight and Left

1.1 Anterior Centered directly behind the maxillary lateral-canine interproximal space.*Acceptable alternative placement is centered directly behind canine.


Horizontal angulation - CR directed parallel to/or through the lateral-canine interproximal space.

Lateral incisor, canine, 1st premolar with lateral-canine interproximal space open.*Typically there will be overlappingof canine-1st premolar interproximal space.

Maxillary PremolarRight and Left

1.2 Posterior Mesial to include the distal half of the canine, parallel to the lingual surface of the teeth.*Upper edge of film at or across the midline of the palate-buccal cusps in 1st groove of bite block.


Horizontal angulation - CR directed parallel to2nd premolar-1st molar interproximal space.

Distal half of canine, all of 1st and2nd premolars, all of 1st molar, andpart of 2nd molar. The 2nd premolar-1st molar interproximal space shouldbe open.

Maxillary MolarRight and Left

1.2 Posterior Distal to include the entire molar region (3rd molar may/may not be erupted). Film should be positioned parallel to the lingual surface of the teeth.*Upper edge of film will be at or across the midline of the palate. Do not include any of the 1st premolar.


Horizontal angulation - CR directed parallel to1st molar-2nd molar interproximal space.

Typically, half of the 2nd premolar,and entire 1st, 2nd, and 3rd molars(3rd may or may not be erupted).The 1st-2nd molar interproximalspace should be open.

1 of 310/4/2006








Mandibular Central IncisorRight and Left

1.1 Anterior Centered directly behind the two central incisors.


Horizontal angulation - CR directed between thetwo central incisors.

R&L central incisors (centered) andR&L lateral incisors.

Mandibular CanineRight and Left

1.1 Anterior Centered directly behind the canine.


Horizontal angulation - CR directed perpendicularto canine (should open both contacts mesial and distalto canine).

Canine centered, also shows all of the lateral incisor and 1st premolar.

Mandibular PremolarRight and Left

1.2 Posterior Mesial to include the distalhalf of the canine and parallelto the lingual surface of themandibular teeth.


Horizontal angulation - CR directed parallel to the 2nd premolar-1st molar interproximal space.

Distal half of canine, all of 1st and2nd premolars, all of 1st molar, andpart of 2nd molar. The 2nd premolar-1st molar interproximal space shouldbe open.

Mandibular MolarRight and Left

1.2 Posterior Distal to include all of the3rd molar, erupted or not, and parallel to the lingual surfaceof the mandibular teeth.


Horizontal angulation - CR directed parallel to1st molar-2nd molar interproximal space.

Typically all/most of the 1st molar, allof the 2nd, and 3rd molars. Whateverelse gets included on this radiographwill depend on how large the patient'steeth are. Typically, this radiographwill include all of the 2nd molar andmost of the 1st molar.

2 of 310/4/2006








Bitewing PremolarRight and Left

2 Bitewing Seated firmly against the occlusal surface of the mandibular teeth and mesial to include the distal half of the mandibular canine. *The upper, distal edge of the film should be tipped to the lingual before the patient closes, to make sure the upper distal corner of the film slides lingual to the erupted maxillary molar. This will assure an equal distribution of the teeth on both arches. Note: The upper edge of the film will be closer to the midline than the lower edge of the film. Also be sure that the tongue is out from underneath the bottom edge of the film before the patient closes.

Vertical angulation - CR directed perpendicularto the film (typically at +10°with patient's occlusal plane parallel to the floor).

Horizontal angulation - CR directed parallel tomaxillary 2nd premolar-1st molar interproximal space.

Equal portions of both arches.Distal half of mandibular canine, allof 1st and 2nd premolars, 1st molars,and part of 2nd molars. Maxillary2nd premolar-1st molar interproximalspace should be open.

Bitewing MolarRight and Left

2 Bitewing Seated firmly against the occlusal surface of the mandibular teeth distal to include the last erupted tooth in the arch.

Vertical angulation - CR directed perpendicularto the film (typically at +10°with patient's occlusal plane parallel to the floor).

Horizontal angulation - CR directed parallel tothe maxillary 1st-2nd molar interproximal space.

Equal portions of both arches. Theonly critical element is that the entirelast erupted tooth is included. Maxillary1st-2nd molar interproximal spaceshould be open.

3 of 310/4/2006

