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Radiation Use Policy
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file)
The following policy has been developed in the interest
of establishing a consistent standard concerning the use of ionizing radiation
within the School of Dentistry. This radiation use policy complies with the
Federal Radiation Control for Health and Safety Act of 1969, the
Consumer-Patient Radiation Health and Safety Act of 1981 and the Rules and
Regulations for X-rays of the Georgia Department of Human Resources. The primary
goal of this policy is to assure the safe effective use of ionizing radiation
and to minimize the potential risk from adverse biological effects to patients,
students, faculty, and staff.
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Deliberate exposure of an individual to dental radiographic procedures
for training or demonstration purposes shall not be permitted unless there is a
documented diagnostic need for the exposure by a member of the Medical College
of Georgia School of Dentistry faculty.
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No operator (faculty, student or dental auxiliary) shall hold the film in
place for the patient during the exposure. The use of film holding devices, bite
tabs, or other positioning devices should be used to position the film during
exposure.
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The operator must stand at least 1.8 meters (6 feet) from the patient and
behind the barrier provided for each x-ray exposure cubicle in the School of
Dentistry. The operator shall be positioned outside the path of the useful beam
and be able to directly observe the patient during each exposure.
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The tube housing, the cone, or the position indicating device must never
be hand held during the exposure. If equipment is not stable, report the
problem to the radiation protection supervisor for the School of Dentistry, and
use another unit.
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Radiographic machines designed for use with an intraoral image receptor
shall limit the source-to-skin distance to not less than 18 centimeters (7
inches).
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Only shielded open-end position indicating devices will be used in order
to minimize scatter radiation.
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When a cylindrically collimated x-ray machine is being used, the circular
beam shall be limited to no larger than 7.0 centimeters (2.75 inches) at the end
of the cylinder. When rectangular collimation is used, the useful beam at the
end of the collimator shall not have a diagonal measurement of greater than 7.0
centimeters (2.75 inches).
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Only film of ANSI (ASA) speed group rating of "D" or faster shall be
used. "F" speed film or Digital Receptors are preferred.
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Each dental x-ray machine shall contain filtration of 2 mm of aluminum
equivalent if operated at less than 70 kilovolt peak (kVp), and 2.5 mm of
aluminum equivalent if operating at 70 kVp or above.
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Leaded aprons will be used on all x-ray patients of the Medical College
of Georgia School of Dentistry as an additional precaution to prevent
unnecessary scatter radiation exposure to the body of the patient. Thyroid
shields shall be used in all situations, except when diagnostic
information will be lost by their use (panoramic and some extraoral radiographic
procedures).
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Periodic radiation protection surveys and inspections will be made by the
radiation safety officer, Medical College of Georgia. All recommendations by the
radiation safety officer concerning collimation, filtration (HVL), beam
alignment, roentgen output, radiation leakage, etc., will be implemented
immediately.
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All operators will follow prescribed exposure techniques. Appropriate
exposure procedures and values will be mounted on the wall of each x-ray
exposure cubicle. Instructions for processing x-ray film will be displayed in
each darkroom or processing area. Films will be processed using time-temperature
processing procedures when using manual processing or automatic film processing
equipment. If radiographic density is inappropriate (film is not diagnostic),
the exposure technique and the processing procedure will be evaluated and
corrected immediately by the faculty dentist or supervising staff member on
duty.
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As a general policy, all newly admitted patients to the School of
Dentistry must have adequate oral and maxillofacial radiographic examinations to
assist in diagnosis prior to treatment in the school's clinics. In all
situations, the need for radiographs shall be determined by using high-yield
selection criteria as the basis of professional judgment. The following shall be
adhered to in regards to criteria for exposure:
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All radiographs shall be prescribed in writing by a licensed dentist.
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Radiographs ordered on a routine basis or for screening purposes will not
be permitted.
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A radiographic examination shall not be ordered before the patient's
medical and dental history has been reviewed and an initial extraoral and
intraoral evaluation has been completed.
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If prior radiographs are available, they should be evaluated by a faculty
member before new radiographs are prescribed. Only those additional views needed
for complete diagnosis and treatment planning should be exposed. The faculty
member will determine if sufficient time has passed, since the patient's last
radiographic examination, to warrant a new examination.
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Radiographs should be made only on patients capable of compliance or
under appropriate sedation.
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Subsequent follow-up (recall) radiographic examinations for School of
Dentistry patients will be based on the diagnostic need of the patient as
determined by the faculty dentist after a thorough health history review and
oral examination of the patient.
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Radiographs obtained for administrative purposes only, including those
for insurance claims or legal proceeding, should not be made.
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Radiographs of patients shall not be made merely for the purpose of
training or demonstration.
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The following shall apply to dental board examination patients:
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Request for radiographs for all board examination patients shall be
signed by a licensed dentist.
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Radiographs should not be made for testing purposes alone. Radiographs
acquired should contribute to the proper diagnosis and treatment of the patient.
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Radiographs made on site for, or as part of, board examinations shall be
made in compliance with the Medical College of Georgia School of Dentistry's
radiation use guidelines.
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The type and number of radiographs needed shall be dictated by the oral
and maxillofacial disease clinically evident or suggested by the history or
other tests.
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Radiographs should not be required at specific time
intervals to document treatment progress for board certification purposes.
Rather, the clinical progress as monitored by the candidate (and his or her
mentor in the case of a student) should be used as a guide to the need for
radiographs.
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Newly admitted adult patients will generally receive a radiographic
examination to determine a base-line for the patient. This may include a
panoramic radiograph, bitewings, selected periapicals, or a series of full mouth
radiographs (FMX).
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Edentulous patients may receive a complete edentulous periapical series,
a panoramic radiograph, or a combination of occlusal and periapical radiographs
as deemed appropriate by the faculty dentist. Nevertheless, edentulous surveys
will usually contain fewer films than a comparable FMX of dentate patients.
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Patients under 12 years of age may receive a complete child periapical
survey and bitewings, a panoramic radiograph with bitewings and selected
periapical views (if indicated), bitewings only, bitewings and selected
periapicals and occlusals, or no radiographs if none are indicated. The complete
child periapical survey will vary depending on the age of the child; however,
all child surveys will contain fewer films than the adult periapical survey.
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he radiation exposure of endodontic patients for pre-operative and
post-operative radiographs will be kept to a minimum level consistent with
clinical requirements. The limits of exposure in each case will be determined by
the professional judgment of the faculty dentist. Where possible, a single
radiograph at each stage of the endodontic procedure will be acquired. Multiple
radiographs from different angles may be acquired on a restricted basis and only
when the information to be gained is considered to significantly enhance the
diagnosis and treatment. When multi-angle projections are required,
documentation of their need will be made in the treatment record by the
supervising faculty.
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Emergency patients will receive only those radiographs needed to
diagnosis and treat the immediate emergency problem.
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The Dental Radiographic Selection Criteria Panel's recommendations shall
be followed in regards to radiographic examination of pregnant patients. Quoting
directly, "Accordingly, there appears to be no rationale to preclude a properly
justified dental radiographic examination because of pregnancy. In some cases,
radiography may be arbitrarily deferred during pregnancy for purely
psychological reasons." Appropriate protective shielding of the patient will always be used.
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Radiation monitoring of operator exposure will include the following:
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All members of the faculty and staff who regularly use x-ray equipment
will wear film badge monitors at all times while at work.
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Records of monthly, quarterly, yearly, and total cumulative exposures
will be kept as a permanent record and will be available for inspection by the
employee.
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These employees should not receive more than 50 mSv (5 rem) each year,
the radiation protection guide value. Quarterly readings above 10 percent of
the radiation protection guide or 1.25 mSv (125 mrem) will be investigated.
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Operators who are pregnant should not be exposed to more than 5 mSv (500
mrem) during the term of their pregnancy.
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Documentation of all radiographs and radiation exposures will be
maintained in the patient's record. The patient's treatment record should
include the date, prescription detailing type and number of radiographs and any
remakes necessary. The number of radiographs acquired should also be entered
into the radiographic log sheet.
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All intraoral radiographs will be mounted and labeled with the patient's
name and date exposed. No loose or unmounted intraoral radiographs will be
stored in the patient's chart. All extraoral radiographs will be labeled with
the patients name, the date exposed, the patient's date of birth and the
right/left side orientation.
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The School of Dentistry will have a Quality Assurance Program designed to
produce radiographs of consistently high quality with minimal exposure. This
program will consist of the following:
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Projection Techniques
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Before students will be allowed to acquire radiographs on a patient, they
will have didactic instruction in oral and maxillofacial radiology plus
laboratory instruction in acquiring radiographs on a mannequin.
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There will be direct supervision of all students during their first
clinical experiences in radiology.
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All radiographs will be reviewed for errors by departmental faculty or
staff immediately after they have been processed. When practical, the patient
will not be dismissed until indicated remakes have been completed. Students who
must remake 4 or more films will be directly supervised and instructed by
faculty and / or appropriate staff member.
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A variable intensity illuminator ("hot light") will be used so that
radiographs with greater density than optimally diagnostic may be viewed without
necessitating a remake.
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Film holders and alignment devices will be used to aid students in the
correct alignment of the position indicating device, the film, and the area of
interest.
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The x-ray equipment in the School of Dentistry will be inspected by
members of the Radiation Safety Office at a frequency that complies with current
federal and state regulations. The results of these tests and any corrective
measures taken will be maintained by the School of Dentistry radiation
supervisor. If during the routine use of any x-ray machine, an error is noted in
its operation, the machine will immediately be put out of service until the
appropriate corrective repairs can be made. Any suspected malfunction should be
reported to the radiation supervisor so that appropriate corrective measures may
be instituted.
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All radiographic film will be stored in a refrigerator according to
manufacturer's instructions, and used according to age sequence. Outdated film
will not be used on patients and will be discarded according to current
environmental regulations.
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All radiograph processing systems shall be maintained and operated in
such a manner that insures optimum diagnostic quality of radiographs. The
following information shall be maintained for each automatic processor or manual
developing system:
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The correct processing time and temperature.
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A description of daily solution evaluation and maintenance activities,
including replenishment, solution change, and cleaning.
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Dates and description of any repairs, upgrades, or relocation of the
processor.
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Charted densities taken from sensitometer images.
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Disposal of radiographic waste shall comply with
current environmental regulations. Specifically, this includes the following:
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Lead foil from intraoral radiographs will be
collected and disposed of through the institutional hazardous waste
management program.
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Fixer, a processing chemical, will be collected
and disposed of through the institutional hazardous waste management
program. This will apply to all processors except those that have silver
recovery units attached to the fixer discharge.
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Radiographic procedures will be completed following institutional
infection control guidelines. All patients will be treated as potentially
infectious and the following will be adhered to:
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Since potentially infectious patients may have no
evidence of a problem, the patient's medical history will be evaluated for
indications of infectious disease.
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Protective gloves, masks, and eye wear will be
worn during film and tube placement and during film processing to minimize
risks to the operator and the patient.
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Operators will wash their hands as they enter the
clinic and after removing their gloves to handle processed radiographs, film
mounts, and records.
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Supplies and film packets will be kept on a
covered work surface. Charts and other types of forms will be kept away from
the work area.
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Film holders will be sterilized prior to patient
use and left unopened until the procedure begins. Disposable items and
supplies will be used whenever practical.
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The control panel, tubehead, exposure button, and
position indicating device will be covered with disposable plastic wrap.
Any other surface likely to be touched during the radiographic examination
will also be covered. At the completion of the procedure, all surfaces will
be wiped down with 0.5 percent sodium hypochlorite or an equivalent
disinfectant.
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