Dentaltown July 2013 - (Page 26)
second opinion
column
» Radiation Minimization
– “Are We There Yet?”
by Dale A. Miles, BA, DDS, MS, FRCD(C)
Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what
to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow
dental professionals to share their opinions on various topics, providing you with a “second opinion.” Perhaps some of
these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. – Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine
If you’ve been on a long trip with kids you’ve
probably heard the question many times – Are we
there yet? It’s easy to answer if you are driving the
family car, not so easy in the dental practice when
the patient asks you “Why do I need these X-rays?”
or “Are these X-rays safe?” Hopefully this brief discussion of current concepts and guidelines, updated
recently, jointly by the AAOMR and ADA, will give
you the information necessary to take the final steps
to minimize all of your patients’ X-ray burden successfully and easily as well as answer their questions.
What Have We Done Well?
Manufacturers and clinicians have continued
the move to faster image receptors. We’ve gone from
D-speed film to F-speed film with conventional
film-based imaging. Many offices have adopted
PIDs (position indicating devices), largely because
their staff members who take radiographs have been
trained this way in dental schools and in dental auxiliary programs. The use of the PIDs with any type
image receptor facilitates the correct placement of
the receptor and greatly reduces retakes – a significant factor for increased patient dose. Every retake
increases the X-radiation burden to the patient by
100 percent for that area.
Dental offices using conventional film are more
routinely using the leaded aprons and thyroid collars
for their film-based imaging procedures. With the new
NCRP #145 report,1 dental offices that switch to
become totally digital for their X-ray procedures do not
actually have to use a leaded apron except on females
who are pregnant or might be pregnant. Use of the
1.
leaded apron for procedures where the apron might
interfere with the diagnostic information (panoramic
and cone beam imaging) is unnecessary according to
the new NCRP guidelines. However, if the patient asks
for a leaded apron, one should be provided.
These current guidelines have both “should” and
“shall” statements, and the “shall” statements are considered mandatory. Thus, the use of the thyroid collar on all children is mandatory, independent of the
type of image receptor – conventional film, phosphor
plates or solid-state detectors (sensors).
Only about 45 percent of North American dentists have adopted solid-state, digital imaging receptors. These clinicians and their offices should be
commended for using fast image receptors.
Manufacturers have also helped the profession
minimize radiation to the patient. We now have
contemporary X-ray generators that are DC
(direct current) with state-of-the-art timers to
accurately match the very fast exposure times for
solid-state detectors. And, of course, all of the
companies who make or resell solid-state systems
should be commended for helping the profession
advance the radiation-minimization cause.
Institutionally, dental schools and dental auxiliary programs continue to adopt faster image receptors when economically feasible. Dental auxiliary
schools teach long cone, rectangular collimation
technique and rectangular collimation devices.
Unfortunately no one is using them in their offices.
After graduation, dentists, assistants and dental
hygienists all abandon rectangular collimation. The
main reason being, “I can’t possibly hit the image
Radiation Protection in Dentistry: Recommendations of the National Council on Radiation Protection and Measurements, report #145; December, 2003.
continued on page 28
26
JULY 2013 » dentaltown.com
http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown July 2013
Dentaltown.com Highlights
Howard Speaks: Quit Rambling On
Professional Courtesy: New Patients with Baggage
Second Opinion: Radiation Minimization – “Are We There Yet?”
Is Anyone Really Cementing e.max with RMGI?
Please Critique My “Breakaway” Office Design
Surely People Don’t Die from Tooth Decay?
Townie Choice Awards Preview: Dentistry’s Official Gear Guide
Corporate Profile: Gendex
What’s On Your Tray? Endodontics
Product Profile: Synergy
Do-it-Yourself Finance, Part VIII: It’s Retirement Time! How Do I Get My Money?
Dental Education by Circuit Training
Everyday Dentistry with CAD/CAM and Lithium Disilicate
Ad Index
Maximizing Anterior Design for Predictable Results in a Six-unit Anterior Makeover
In This Issue: Dental Hygiene Diagnosis
Perio Reports
Continuing Education Periodontal Probes: An Overview of History, Evolution and Clinical Technique
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