Requesting and Justifying Radiographs Flashcards
What are the two steps to taking a radiograph?
- Considering whether a radiograph is a useful tool in a particular clinical case
- Deciding that the radiograph is legally justified for that case
What does the referrer do?
requests patient’s radiograph
Entitled by employer to refer patients for exposure
Must be a registered healthcare professional
Responsible for ensuring sufficient clinical information is available to aid justification process
Achieved by taking a history & clinical examination & then highlighting relevant findings
What does the practitioner do?
justifies patient’s radiograph
Entitled by employer to take responsibility for exposure
Must be a registered healthcare professional & adequately trained for the type of radiograph involved
* e.g. a dentist not trained in CBCT (“3d imaging”) cannot justify it
* e.g. a dental therapist is unlikely to have sufficient training in lateral cephalograms
Responsible for undertaking justification process for each exposure
* Will the expected benefits gained from information in the radiograph outweigh the risk of detriment caused by the radiation dose?
Who is a radiographic practitioner?
In radiography, a “practitioner” is a member of staff entitled by the employer to justify radiographs under IRMER17
When doing the two roles as one person, what must you do?
Your records must still state the clinical information considered in the justification - it cannot just be done in your head
What are situations when the roles are done separately?
In Hospital Dental Service if:
you send patients to a radiology department to get their radiographs taken
In General Dental Practice if:
- another healthcare professional takes your patients’ radiographs
- you need to send your patients to another practice which has equipment you don’t have
* e.g. panoramic machine, CBCT machine, occlusal receptors
What are the referrer considerations?
- Is there any previous imaging or an alternative investigation without ionising radiation which could be used instead?
- Have I have provided enough clinical information for someone who has never seen the patient to be able to justify the exposure
- Have I stated a specific
clinical question
What is the clinical question?
The purpose for
why you need the radiograph
for that particular patient
An appropriate healthcare professional (e.g. dentist) should be able to read the referral & immediately know why the radiograph is required
* Cannot be so vague that it would apply to almost anyone
Should not have to “join the dots” themselves
What are the practitioner’s considerations when justifying?
- The availability & findings of previous radiographs
- The specific objectives of the exposure in relation to the history & examination of the patient
- The age of the individual
- The total potential diagnostic benefit to the individual
- The radiation risk associated with the radiographic examination
- The efficacy, benefits & risk of available alternative techniques having the same objective but involving no, or less, exposure to ionising radiation
Is routine radiography acceptable?
There can be no possible justification for the routine radiography of ‘new’ patients without a thorough clinical examination.”
“A history and clinical examination are the only acceptable means for determining if dental disease is suspected, and to help decide which are the most appropriate, and necessary, radiographic views.”
Where is the selection criteria found?
Guidance on when to take radiographs & on which radiograph to choose
* Should be evidence-based where possible
UK guidance available from The Faculty of General Dental Practice
* Available online (with free sign-up)
What is the basic requirement of clinical notes?
Any appropriate healthcare professional should be able to read your notes &clearly see what the purpose of that radiograph was for that specific patient
* e.g. a colleague, the GDC
Needs to be readily obvious but does not need to be excessively descriptive
* Acceptable: “To assess bone levels around 26 due to pocketing”
* This assumes your notes already include the measurements
* Excessive: “To assess bone levels of tooth 26 due to periodontal pocket probing depth of 6mm at mesio-buccal aspect as per periodontal disease management guidelines by the British Periodontal Society”
Can be covered in your referral or radiograph report
Who is responsible for informing patient prior to exposure?
- This is an “operator” (IRMER duty holder) role & is often undertaken by the referrer or practitioner
In Glasgow Dental School, it is the responsibility of the referrer (e.g. the student on
clinic)
Because there is no point in requesting a radiograph (& sending the patient to the Radiology department) if the patient is not willing to consent to it
What are ways to inform the patient?
- Show patient an
information leaflet/poster
& check they understand - Give a brief explanation:
The risks associated with dental radiography are extremely small under normal conditions & the radiograph will help inform your treatment. The radiation dose from two bitewing radiographs or one panoramic radiograph is roughly equivalent to that received during a one hour plane flight.
What are the two settings for panoramic machines in dentistry?
Standard: optimised for skeleton - reduces distortion of jaws & mid face
Orthogonal: optimised for teeth - reduces overlap of teeth
