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PROTECTION FOR
DENTAL RADIOGRAPHY
PREPARED BY
DR. NITIN SHARMA
Postgraduate Student
Dept. Of Oral Medicine & Radiology
Introduction
Licensed dentists play an important role in maintaining
radiation exposures of patients and staff as low as reasonably
achievable (ALARA). Greater numbers of intra-oral
radiographs are being requested and a wide range of other
dental radiographic examinations (panoramic, cephalometric)
are being performed on a routine basis with the addition of
advanced imaging modalities (CBCT). Individuals who operate
dental X-ray equipment must have a basic knowledge of the
inherent health risks associated with radiation and must have
demonstrated familiarity with basic rules of radiation safety.
To facilitate issuance of licence, AERB has launched an egovernance application e-LORA(e-Licensing of Radiation
Applications).
2.
Dental personnel must not expose any individual to the useful beam
for training or demonstration purposes
In areas or rooms where X-ray equipment is used, post a sign (that
may include the radiation symbol) stating: CAUTION X-RAYS
B. Collimating Device
Tube Operating
Potential (kV)
Minimum Total
Filteration
Below 50
0.5
50 to 70
1.5
71 and above
2.5
(Aluminum-equivalent is defined as
a substance equivalent to aluminium
in its ability to absorb preferentially
less penetrating radiation.)
D. Exposure Cord
The exposure switch must be permanently fixed in a safe shielded
location or must be long enough to permit the operator to make
exposures while positioned at least six feet from the patient.
Patient Protection
All individuals unnecessary to the dental radiographic examination
leave the X-ray room prior to making an exposure.
Anyone who is in the X-ray room at the
time of exposure must be behind a protective
barrier or they can wear protective apron.
The apron should be preferably 0.5 mm of
lead or lead-equivalent but not less than 0.25
mm of lead or lead-equivalent thickness.
The reduction in exposure resulting from placing 0.25 mm leadequivalent apron material in a primary X-ray beam of 100 kVp would
only be 60% as compared to 0.50 mm lead-equivalent apron that will
attenuate the beam by 85%.
Speed Group
D
D
E
E/F
F
C. Digital Receptors
Digital receptors include rigid wired or wireless sensors such as the
charged-coupled device (CCD) and the complementary metal oxide
semiconductor (CMOS) and photostimulable phosphor plate (PSP) or
storage phosphor plate (SPP) receptors.
It is estimated that digital radiography reduces patient radiation dose
by 75% compared with D speed film, 50% compared with E speed film
and approximately 40% compared with F speed film.
Digital receptors cannot be sterilized so the clinician must use
careful disinfection and barrier coverage techniques to avoid crosscontamination of the receptor.
D. Intensifying Screens
With regard to film-based extraoral radiography, rare earth
intensifying screen phosphors are recommended to reduce radiation
exposure.
Rare earth elements like lanthanum and gadolinium have replaced
calcium tungstate crystals in intensifying screens.
When rare earth screens are combined with green light sensitive
film, exposure can be reduced approximately 55% for panoramic and
cephalometric radiographs.
COLLIMATION
Four dental films are placed on a sheet of paper, crossed with edge
of cone crossing the middle of film. The outline of cone end and films
are marked on the paper.
Radiopaque objects such as paper clips, coins, pins or nails are
placed on the film inside the X-ray beam and films are exposed with
one half of the exposure time used for an anterior radiograph.
Radiographs are processed and relocated in their original position on
the paper using the image of the different radiopaque objects.
DARKROOM
Safelight requires checking of the following:
Types of filter : Type of filter which should be compatible with
the colour sensitivity of film used, i.e. blue, green, ultraviolet.
Condition of filter : Scratched filter should be replaced.
Watt of bulb : It should be not more than 25 W.
Distance from work area : The distance from the work surface
should not be more than 4 ft.
Coin test/penny test
Place the coin on the film, turn on the safelight
and leave for approximately 15 min. Process the
film in the normal way. Fogging of the film due to
safelight will then be obvious when compared to
the clear area protected by the coin.
X-RAY FILM
Take an unexposed film from newly opened box and process it in
freshly prepared solution. The film is then viewed.
Fresh film : It appears clearer with blue tint which means film is
properly stored and protected.
Fogged film : It appears fogged, meaning that film has expired,
improperly stored or exposed to radiation.
PROCESSING
Developer Strength
The solution must reached optimum temperature of 20C for manual
processing and 28C for automatic processing.
Step-wedge film :
Step-wedge film is a device with small, graduated increase in the
thickness of its material.
Step wedge can be made in dental office by following
method :
Tape six pieces of lead foil from the film packets on
the end of tongue blade.
The first two pieces should be 1 in. long, second two
pieces in. long and third two pieces should be in.
long.
Tape these foil pieces in three steps, with one step
having six layers, second having four layers, and third
having two layers.
Cut the excess foil from the side and tape the foil
layer to the tongue blade.
Step-wedge radiograph
Take a radiograph of step wedge using known
exposure factors.
Process the film in fresh solution and produce
a standard reference film with level of
increasing density.
Repeat using the same exposure factor every
day as the solution becomes depleted.
Compare it every day with standard reference
step wedge film to determine objectively any
decrease in blackening of the processed film
which would indicate deterioration of the
developer.
Fixer Strength
To monitor fixing following tests are carried out:
Preparation of film : Unwrap one film and immediately place it in
the fixer solution. Check the time taken for clearing.
Fast clearing : If the film clears in 2 min, the fixer is of adequate
strength.
Slow clearing : If the film is not completely cleared after 2 min,
then fixer strength is not adequate.
periodontal
or
endodontic
Dental radiographic examinations are not without risk. Xradiation has the potential to damage tissue through
either the indirect effect or direct effect of radiation.
The biologic effects of radiation are cumulative and every
effort must be taken to keep radiation exposures as low
as reasonably achievable. A variety of radiation safety and
protection measures can be employed to reduce exposure
to dental patients and minimize occupational exposure.