RADIOGRAPHY
Relevant legislation to consider:

• The Health and Safety Act 1974
• The Ionising Radiation Regulations 1999
• The Ionising Radiation (Medical Exposure) Regulations 2000

Principles of radiation protection:

• “No practice shall be adopted unless its introduction produces a POSITIVE net BENEFIT”.
• “All exposures shall be kept as low as reasonably practicable (ALARP), taking economic and social factors into account”.
• The dose equivalent to individuals shall not exceed the limits recommended by the ICRP.
• Consider justification, optimisation and limitation.

When record any radiography training, ensure you include:

• Name, role, date and nature of training
• Details of updated courses
• Next date

Diagnostic reference levels:

• Intraoral (adult molar) – 1.7 mGy
• Panoramic (adult) – 93 mGy
• Panoramic (child) – 67 mGy

Image quality assessment:

• Subjective rating
• Results versus targets
• Regular performance tests
• Fault register
• Record actions taken

Why we are at risk:

• Radiation dose to dentists and DCPs
• Primary beam
• Scattered radiation
• Radiation leakage from tube head

Caries:

Periodontal:

• CBCT not indicated ( but if taken for other reasons than check perio bone levels and include in report)
• If pockets 4-5 mm and little or no recession horizontal BWs are recommended
• +/- PAs for selected anterior teeth but only IF this is likely to change management of the patient
• DPT
• If perio- endo lesion – take PA
• Pocket > 6mm vertical BWs supplemented by PAs using paralleling technique

How to describe a lesion:

• Site
• Size
• Shape
• Outline
• Relative radiodensity
• Effect on adjacent structures
• (Time present)

RECORDING KEEPING

1. Keep records for everyone who attends your practice including occasional or emergency patients.
2. Make sure all entries are legible.
3. Make entries in ink.
4. If different people write on the record card, identify the individuals.
5. Always make entries on lines – not in margins or below the ruled area of the card – it may suggest tampering.
6. Do not add entries after the records have been requested. Use a separate sheet to record conversations.
7. Correct errors by neatly deleting a previous entry with a single line – so that it can still be read afterwards. Heavy shading to delete entries can arouse suspicion.
8. Make notes of telephone conversations with patients
9. Record missed appointment or late arrivals.
10. Make a note of post-operative given and any supporting literature.
11. Record elements of communications – for example if a procedure has been explained using computerised animation.
12. Document consent.
13. Record adverse outcomes and confirm that the patient has been informed.
14. Keep copies of referral letters.
15. Keep study casts and radiographs.
16. Keep a record of financial transactions on a separate sheet.
17. Retain clinical photographs and other relevant images.
18. Document diagnoses and treatment options.
19. Maintain confidentiality – do not disclose unless authorised to do so.
20. Retain records in locked and fire-proof filing cabinets.
21. Retain all records for as long as possible.

General Dental