Occupational radiation monitoring devices are the best means to ensure personnel compliance with radiation safety practices and to track occupational exposure. The use of personnel monitoring devices is a recommended practice and, in some states, is mandated by law. Several companies offer dosimetry monitoring services that include provision of the devices and periodic printed reports. Typical devices include film badges, thermoluminescence dosimeters, and optically stimulated luminescence (OSL) dosimeters. An occupational exposure monitoring report provides detailed information regarding occupational exposure received by tracked personnel. Figure 2 provides a sample dosimetry report.
Figure 2: Sample Dosimetry Report
C/kg = coulomb/kilogram; R = roentgen; Gy = gray; rad = radiation absorbed dose; Sv= sievert; rem = roentgen equivalent man; Bq = becquerel; Ci = curie. Note . From Radiation Emergency Medical Management. (2016). Radiation units and conversions. Retrieved from https://www.remm. nlm.gov/radmeasurement.htm. radiographs have been established by the American Dental Association (ADA) (Johnson, et al., 2021), the U.S. Public Health Service, and the U.S. Food and Drug Administration (FDA). First promulgated in 1987, these recommendations were revised in 2004 and again in 2012 (FDA, 2016). The dentist is responsible for justifying the radiographic examination to ensure that the benefit of the radiographs outweighs the risk. This process includes a review of the patient’s health history, completion of a clinical examination, application of the recommendations for prescribing dental radiographs, and adherence to the ALARA principle to minimize patient exposure (Lurie and Kantor, 2020). The recommendations are subject to clinical judgment and may not apply to every patient. Indicators that the dentist may use to determine the need for radiographs include the presence of caries, periodontal disease, pain or trauma, previous restorations, eruption discrepancies, or missing teeth. The recommendations are organized by the type of patient encounter, patient age, and developmental stage. Table 7 summarizes the updated primary recommendations provided in the ADA document.
Patient protection Protecting patients from excessive radiation exposure is vital. Every effort should be made to keep the radiation dose to all individuals as low as possible; all unnecessary radiation should be avoided. The ALARA principle recognizes that no matter how small the dose, some biologic effect may occur. Methods to reduce radiation exposure to the patient and adhere to the ALARA principle include the use of established guidelines for prescribing radiographs, filtration, collimation, lead aprons and thyroid collars, fast image receptors, beam alignment devices, and quality assurance practices to minimize retakes, as well as periodic inspection of equipment. Selection criteria Radiographs should be prescribed only when a high probability exists that the radiographic examination will provide information that will affect the treatment or prognosis of the patient. In other words, rather than routinely exposing every patient on an annual basis, clinicians should determine the frequency and type of radiographic examination based on the oral condition of the patient and the dentist’s estimate of the patient’s disease susceptibility. Joint recommendations for prescribing dental
Table 7: Recommendations for Prescribing Dental Radiographs a
Adolescent: Permanent Dentition
Type of Patient Encounter
Child: Primary Dentition Individualized exam – selected PAS or occlusals if indicated; BWS if contacts closed. BWS at 6- to 12- month intervals if contacts closed. BWS at 12- to 24- month intervals if contacts closed. Clinical judgment for need & type of images; may include selected PAS and/or BWS as indicated.
Child: Mixed Dentition
Adult: Dentate or Partially Dentate Adult: Edentulous
New patient
Individualized exam – BWS & panoramic or BWS & selected PAS. BWS at 6- to 12-month intervals if contacts closed. BWS at 12- to 24-month intervals if contacts closed. Clinical judgment for need & type of images; may include selected PAS and/or BWS as indicated.
Individualized exam – BWS & panoramic or BWS & selected PAS; FM when indicated. BWS at 6- to 12- month intervals if contacts closed. BWS at 18- to 36- month intervals. Clinical judgment for need & type of images; may include selected PAS and/or BWS as indicated.
Individualized exam – BWS & panoramic or BWS & selected PAS; FM when indicated.
Individualized exam based on clinical signs & symptoms.
Recall patient with clinical caries or increased caries risk Recall patient with no clinical caries or low caries risk Recall patient with periodontal disease
BWS at 6- to 18- month intervals.
NA.
BWS at 24- to 36- month intervals.
NA.
Clinical judgment for need & type of images; may include selected PAS and/or BWS as indicated.
NA.
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