Dental Radiography: Extra Oral & Quality Assurance PDF

College of medicine and health sciences school of dentistry department of dental therapy MODULE TITLE: SCIENCES COMPLEMENTARY TO DENTISTRY UNIT: DENTAL RADIOGRAPHY ASSIGNMENT TOPIC: DISCUSS ABOUT EXTRA-ORAL X-RAYS, QUALITY ASSURANCE &SAFETY IN DENTAL RADIOGRAPH...

College of medicine and health sciences school of dentistry department of dental therapy MODULE TITLE: SCIENCES COMPLEMENTARY TO DENTISTRY UNIT: DENTAL RADIOGRAPHY ASSIGNMENT TOPIC: DISCUSS ABOUT EXTRA-ORAL X-RAYS, QUALITY ASSURANCE &SAFETY IN DENTAL RADIOGRAPHY, DIGITAL VS TRADITIONAL X RAYS.  Group 3 members Names Reg numbers NYABYENDA Paul  222001050 TWIRINGIYIMANA  222001880 Octave  222000967 NDAMUKUNZE Evelyne  222000466 NGIRAMAHIRWE  222001001 Theophile  Introduction Dental x-rays are internal Images of the teeth and jaws. Used to examine and diagnose structures that can’t be seen during a routine checkup like jawbone, teeth roots, nerves. Dental x-rays are divided into two main categories namely; intra-oral and extraoral. With intraoral x-rays, the x-ray film is placed inside the mouth while extraoral x-rays films are placed outside the mouth. Extraoral x-rays provide information to detect impacted teeth, monitor jaw growth and development, and identify potential problems between teeth, jaws and temporomandibular joints (TMJ), or other facial bones.  Types of Extraoral X-rays include: a) Panoramic X-rays. b) Cephalometric X-ray c) Cone beam CT scan Other types Standard CT scan Sialography Panoramic X-ray This type of extraoral X-ray shows the entire mouth on a single X-ray. It shows all teeth on both maxilla and mandibular arcs. The X-ray tube moves around the head, the x-ray film moves in the opposite direction behind your head. It is indicated for kids or patients with bad reflex, assessing the 3rd molar before extraction to check the interference with the nerves as well as the orientation of the roots in case of the impaction. To assess jawbone fractures, tumors and cysts, assessing TMJ.  Cephalometric X-ray With this X-ray the entire side of the head is taken and help to examine teeth in relation to a patient’s jaw and profile. Orthodontists use cephalometric projections to plan their treatments in aligning and straightening teeth.  Cone Beam CT scan It provide three- dimensional images. In dental office is used to identify facial bone problems, such as tumors or fractures Evaluate bone for dental implant placement and difficult tooth extractions to avoid possible complications during and after surgical procedures Assessing the sinuses  Other extraoral X-rays used in dental setting Standard CT scan: It is like Cone beam, but the difference is that here the beam is fan- shaped and uses more radiations (high radiation exposure).  Sialography This is a method of visualizing salivary glands on radiograph. In this technique, the dentist injects a radiopaque contrast material directly into the salivary glands. This material shows up easily on film, allowing dentists to diagnose salivary gland problems, such as blockages or Sjogren's disease. Sialography  Quality assurance in dental radiography WHO defines QA as ‘’An organized effort by the staff operating a facility aims to: To produce radiographs that are of a consistently high standard  Reduce the number of repeat radiographs  To highlight sources of error so that they can be rectified  Reduce costs  Increase efficiency To ensure that radiation doses to patients (and staff) are kept as low as reasonably practicable.  Areas Quality Assurance programme must cover ❖ Image quality ❖ Patient dose and x-ray equipment ❖ Image processing and display equipment ❖ Employers’ procedures required by IRMER a) Quality Image ❖Implement routine quality control tests to evaluate image quality: Tests for resolution, contrast, density, and proper exposure factors( kv, mA,time,distance) ❖Assess number of retakes and identify causes of poor image quality: improper positioning, exposure errors  b) x-ray equipment Aims to ensure doses to patients are kept As Low As Reasonably Practicable with regural equipment evaluation.  It uses 3 main phases of testing i. Critical Examination ii. The Acceptance Test: performed during installation iii. Routine Test  Daily tasks: record all errors  Weekly tasks: review error log  Monthly tasks: examine photostimulable phosphor plates for scratches, inspect aprons for tears.  Yearly tasks: machines calibrated by health physician, verify digital sensors with phantom  c)Image processing and viewing facilities  Routine checks to ensure darkrooms and processing units remain light tight (checks should be made at least annually and results recorded)  Processors must be regularly serviced and undergo regular cleaning of rollers and chemical tanks  Solutions should be tested to ensure correct strength and changed when necessary  Films should be stored in a cool, dry place and rotated to ensure that older stock is used first.  d)Training All practitioners and operators involved in exposing patients to x-rays must be adequately trained and that Continuing Professional Development is undertaken. These trainings should encompasses the following : Risks to health arising from exposure to dental X-rays. The significant findings of the risk assessment and precautions that need to be taken, the specific requirements of the local rules and contingency plans at their place of work.  Regular audit activities help to create a culture of quality improvement in the delivery e) Audits of imaging services. Safety in dental x-rays In areas or rooms where x-ray equipment is used ,post a sign (that may include the radiation symbol) stating: CAUTION X- RAYS Any one in the x ray room at exposure time must be behind a protective barrier or can wear protective apron preferably 0.5mm of lead.  Lead apron & shielding This approach is targeted to reduce exposure of sensitive tissues to external radiation. These includes thyroid shielding, breast tissue shielding, gonadal shielding, as well as shielding during pregnancy. A specially designed lead-impregnated thyroid collar is used to protect the thyroid gland from excessive/scattering radiations during intraoral x ray exposures. Aprons should be evaluated periodically(at least yearly) for tears and cracks which can allow radiation to penetrate. Lead 0.5mm and 0.25mm are used.  Dose limits have been established for occupationally exposed persons, non-occupationally exposed persons(general public) and occupationally exposed pregnant women. Exposure The maximum permissible levels dose(MPD) is the dose of wholebody radiation that is not expected to produce any significant somatic or genetic effects in a life time.  Digital X-ray A digital X-ray, is a modern type of X-ray that utilizes digital sensors instead of photographic film, as with a traditional X-ray. Two types of receptors are used for digital intraoral radiography a) solid-state sensors of either charge-coupled device CCD or complementary metal oxide semiconductor CMOS, which are used with a wire and b) Photo stimulate Phosphor plates  Cont. Digital X-rays work by using x-ray sensitive plates or sensors. When a patient is exposed to an x-ray beam, the sensor captures the data and converts it into an electric charge. This charge is then processed into a digital image, allowing for high-quality images to be generated and transmitted to a computer screen.  Digital x ray vs traditional x ray Features Traditional x ray Digital x ray Image production Uses film to capture Uses electronic and develop image sensors to capture and display the image Image quality Lower resolution and Higher resolution and contrast contrast Radiation dose Higher radiation Lower radiation exposure to the patient exposure as fewer due to repeated shots shots are required Feature Traditional x rays Digital x rays Almost instant processing Processing time Longer processing time as the film needs to be and display of the image developed Physical storage of film can Digital storage of images is Storage take up space and is prone to easier, takes up less space, damage and can be easily transferred Limited ability to manipulate Image the image after it’s been It can be manipulated and enhanced on a computer manipulation taken after being taken Higher initial costs, but the Cost Lower initial cost, but the cost of film and development cost of maintenance and can add up over time supplies are generally lower over time Requires chemicals for Digital X-rays are more Environmental developing the film, which environmentally friendly as impact can be harmful to the they do not require film or environment chemicals for processing  Conclusion The biologic effects of radiation are cumulative, and every effort must be taken to keep ration exposures as low as reasonably achievable. A variety of radiation safety and protection measures must be employed in dental radiographs to reduce exposure to dental patients and minimize occupational exposure.  References https://www.jmhsci.org/wp-content/uploads/2021/10/BJ MHS450344.pdf#:~:text=A%20clinical%20audit%20is %20a%20systematic%20examination%20or,harm%20to %20patients%20and%20members%20of%20the%20pu blic. https://pocketdentistry.com/9-extraoral-projections-and- anatomy/ https://www.aapm.org/pubs/reports/RPT_175.pdf