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?
- The practitioner is responsible for the justification and authorisation.
- They authorise the request, confirming justification and ensures does are ALARP.
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 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
What is accidental and unintended exposure?
“Accidental exposure”
: exposure received when none was intended
“Unintended expsoure”: exposure received was greater or different to what was intended
What are potential causes in dental school for accidental exposure?
- Different patient imaged because wrong patient details given in referral
- New radiographs obtained but suitable radiographs already available (from GDP or PACS)
- Wrong patient chosen in Radiology department
What are potential causes in dental school for unintended exposure?
- Wrong tooth put in referral
- Wrong type of radiograph requested (referrer error) or carried out (operator error)
- e.g. using a periapical radiograph instead of a true occlusal radiograph (note: not applicable to debatable situations like using a panoramic radiograph instead of full mouth periapical radiographs)
- X-ray tube malfunction
Where are incidents reported?
Healthcare Improvement Scotland, Care Quality Commission (England), etc.
Carried out online within 2 weeks of discovering incident
When are incidents reported in scotland?
- Accidental: every incident
- Unintended: if ≥3mSv (adult) or ≥1mSv (child)
Scotland/Wales/Northern Ireland
