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The following policy has been developed in the interest of establishing a consistent
standard concerning the use of ionizing radiation within the Dental College of Georgia.
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.
- 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 licensed faculty dentist of the Augusta University Dental
College of Georgia.
- No operator (faculty, student or dental auxiliary) shall hold the receptor in place
for the patient during the exposure. Digital receptor holding devices, bite tabs,
or other positioning devices should be used to position the digital receptor during
exposure.
- 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 Dental College of Georgia.
The operator shall be positioned outside the path of the useful beam and be able to
directly observe the patient during each exposure.
- 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 Dental College of Georgia, and use another unit.
- Radiographic machines designed for use with an intraoral image receptor shall limit
the source-to-skin distance to not less than 12 inches .
- Only shielded open-end position indicating devices will be used in order to minimize
scatter radiation.
- 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).
- Photostimulable phosphor plates and direct digital sensors shall be used for intra
oral imaging and direct digital sensors for extra oral radiography.
- 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.
- Leaded aprons will be used on all x-ray patients of the Dental College of Georgia
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).
- Periodic radiation protection surveys and inspections will be made by the radiation
safety officer, Augusta University. All recommendations by the radiation safety officer
concerning collimation, filtration (HVL), beam alignment, exposure output, radiation
leakage, etc., will be implemented immediately.
- All operators will follow prescribed exposure techniques that are programmed into
each radiographic equipment unit. If radiographic density is inappropriate (image
is not diagnostic), the exposure technique and the digital processing procedure will
be evaluated and corrected immediately by the faculty dentist or supervising staff
member on duty. If problem persists it should be reported to the radiation safety
officer at DCG.
- As a general policy, all newly admitted patients to the Dental College of Georgia
must have adequate 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:
- All radiographs shall be prescribed in writing by a licensed dentist.
- Radiographs ordered on a routine basis (e.g. case complete examinations) or for screening
purposes will not be permitted.
- A radiographic examination shall not be ordered before the patient's medical and dental
history has been reviewed and an extraoral and intraoral evaluation has been completed.
- 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.
- Radiographs should be made only on patients capable of compliance or under appropriate
sedation.
- Subsequent follow-up (recall) radiographic examinations for Dental College of Georgia
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.
- Radiographs obtained for administrative purposes only, including those for insurance
claims or legal proceeding, should not be made.
- Radiographs of patients shall not be made merely for the purpose of training or demonstration.
- Cone beam computed tomography should be considered as an adjunct to conventional intraoral
and extraoral imaging. As with conventional intraoral and extraoral imaging, CBCT
should only be ordered when the treating dentist has deemed it necessary to complete
diagnosis and treatment planning of the case.
- The following shall apply to dental board examination patients:
- Request for radiographs for all board examination patients shall be signed by a licensed
dentist.
- Radiographs should not be made for testing purposes alone. Radiographs acquired should
contribute to the proper diagnosis and treatment of the patient.
- Radiographs made on site for, or as part of, board examinations shall be made in compliance
with the Dental College of Georgia’s radiation use guidelines.
- 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.
- 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.
- 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).
- Edentulous patients may receive a panoramic radiograph, as deemed appropriate by the
faculty dentist.
- 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, 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 radiographs than
the adult periapical survey.
- The 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.
- Emergency patients will receive only those radiographs needed to diagnosis and treat
the immediate emergency problem.
- 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.
- Radiation monitoring of operator exposure _ need input from EHS
- Occupationally exposed pregnant individuals shall not exceed an equivalent dose to
the fetus of 0.5mSv (50 mrem) equivalent dose per month once their pregnancy has been
declared.
- Documentation of all radiographs and radiation exposures will be maintained in the
patient's electronic 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.
- All radiographs will be electronically processed via axiUm and examined through the
viewing software MiPACS. Each series of radiographs are labeled with patient’s name,
the date and time of exposure, right and left orientation-and the anatomic description.
The radiographs are permanently stored on servers and routinely backed up.
- The Dental College of Georgia will have a Quality Assurance Program designed to produce
radiographs of consistently high quality with minimal exposure. This program will
consist of the following:
- Projection Techniques
- 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.
- There will be direct supervision of all students during their first clinical experiences
in radiology.
- 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 5 or more films
will be directly supervised and instructed by faculty and / or appropriate staff member.
- To minimize retakes, each image is analyzed for accuracy and software tools are utilized
to adjust density and contrast
- Receptor holders and alignment devices will be used to aid students in the correct
alignment of the position indicating device, the image receptor, and the area of interest.
- A radiographic phantom measuring dynamic range, contrast resolution, and spatial resolution
will be used to verify adequate exposure settings and diagnostic quality.
- Computer monitor contrast and spatial resolution will be verified using the MiPACS
SMPTE pattern.
- The x-ray equipment in the Dental College of Georgia 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 Dental College of Georgia 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.
- All receptors will be stored in the respective clinics/ dispensary and distributed
for clinical use each day. Phosphor plates are routinely inspected and damaged ones
will be taken out of circulation and replaced with a new phosphor plate.
- All image processing scanners shall be maintained and operated in such a manner that
insures optimum diagnostic quality of radiographs. In the event of scanner -malfunction
the scanner will be immediately replaced with one in working condition. The biomedical
staff in the school is responsible for proper functioning/ maintenance of the scanners.
Along with the IT staff, the biomedical team periodically inspects the scanners and
updates the imaging software.
- 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:
- The control panel, tube head, 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.
- Operators will wash their hands as they enter the clinic before proceeding with the
radiographic procedures. The operator must wear personal protective -equipment including
closed toe shoes and full sleeve clinical gowns.
- Protective gloves, masks, and eye wear will be worn during intra oral radiography
to minimize risks to the operator and the patient.
- Receptor holders will be sterilized prior to patient use and left unopened until the
procedure begins. Disposable items and supplies will be used whenever practical.
- Supplies and receptors will be kept on a covered work surface. Charts and other types
of forms will be kept away from the work area.
- Each receptor is protected in a plastic sheath to avoid contamination from saliva
or blood. Receptors are wiped with denatured ethyl alcohol before reusing the same
receptor on another patient. If the PSP is accidentally touched with contaminated
gloves then it must be wiped with germicidal disposable wipes
- The operator should remove the contaminated gloves before proceeding to the scanning
room.
- The patient’s electronic record is accessed on a computer attached to the scanner
to electronically process the images. The computer keyboard and mouse should be covered
with plastic wrap and the counter surface adjacent to the scanner should be covered
with a blue napkin. The operator then dons a new pair of gloves and each image is
scanned individually and saved to patient’s electronic record.
- At the completion of the procedure, all touched surfaces (x-ray tube housing, x-ray
arm, counter top, control panel, dental chair, lead apron, keyboard and mouse if used)
will be wiped down with a disinfectant recommended by the Dental College of Georgia
Infection Control Guidelines.
Patient Services
AU Dental College of Georgia
1430 John Wesley Gilbert Drive
Augusta, GA 30912
706-721-7019 office
706-721-6276 fax
