Xray - PAN Directive

Question 1

Part 1 - Operatory Preparation

Answer 1

1. Turn on computer and log into Dentrix
2. Turn on the machine.
3. Complete hand hygiene.
4. Don PPE
5. Wipe down panoramic machine X2.
6. Doff PPE
7. Complete hand hygiene.
8. Place barriers on the following:
   a. Exposure button
   b. Control panel
   c. Patient mouthpiece
9. Ensure the machine is in the starting position (if the “R” button is flashing – depress
   this button to return the machine to the start position).
10. Make the DEXIS Program ready for exposure.
    a. Open the patient’s chart
    b. Select the sensor icon
    c. Select the panoramic icon on the tool bar
    d. Select panoramic and start (green area should light up).

Question 2

Part 2 - Patient Engagement

Answer 2

1. Bring your patient to the pan area.
2. Find out what your patient knows about this type of radiograph by asking them “Have
   they ever had this type of radiograph before”.
3. Explain the procedure to the patient (Based on the answer to the above question).
   Ensure the patient understands the following:
   a. This is a radiograph that is used to evaluate larger areas such as your jaw.
   b. This film is taken outside of the mouth.
   c. I will help position you in the equipment.
   d. The equipment will rotate around your head.
   e. You will need to keep still while the machine rotates.

Question 3

Part 3 - Patient Preparation

Answer 3

1. Ask the patient to take off all metallic objects such as glasses and jewelry in the head
   and neck area only, as well as all removable dental prostheses. The tray in front of
   the control mirror is used for depositing items.
2. Place the lead apron on the patient, with the long side draped over the patient’s back.
3. Perform hand hygiene.
4. Don PPE (gloves must be worn).

Question 4

Part 4 - Patient Positioning

Answer 4

1. Select the correct setting for the patient based on the requisition and the stature of the patient:
   a. P1-adult
   b. P10-child
   c. BW1- bitewings
2. Instruct the patient to stand in front of the machine, in front of the control mirror.
3. Using the “up” or “down” arrow key, adjust the height of the unit so that the bite block and the anterior teeth are at the same height.
4. Have the patient grab the handles.
5. Have the patient bite into the indentation of the bite block.
6. Swivel out the mirror.
7. Position the head of the patient in such a way that the occlusal plane is slightly inclined towards anterior (chin is angled up slightly).
8. Switch on the light localizer with key on the control panel. It is used for correct patient positioning. The Frankfort Horizontal plane (FH) horizontal light beam should reflect between the upper edge of the external auditory canal and the lowest point of the infraorbital rim (tragus).
   The height of the FH horizontal light beam can be adjusted with the slider.
   * Fine-tune the head inclination for the FH setting
   * Align the center of the anterior teeth or of the face with the central light line
   * Press key on control Panel to move the forehead support “towards forehead”.
   On touching the patient’s forehead - stop.
   * Close the temple supports by pressing key on the control Panel. On touching the patient’s temples –stop.
9. Swivel the mirror back.
10. Check the FH setting and the central light line again to ensure patient did not move.
11. Have the patient swallow place their tongue against the palate.
12. Instruct patient to breathe through their nose, close their eyes if they would like and hold in position until the machine completes rotating.
13. Stand behind the wall. Check to make use that no one is in the area.
    Call exposing and depress the exposure button, hold the button down until the machine has completely rotated around the patient.

Question 5

Part 5 - Patient Returned to Operatory

Answer 5

1. Doff PPE.
2. Perform hand hygiene as required.
3. Assist the patient with the removal of the lead apron and return any personal items.
4. Return patient to operatory.

Question 6

Part 6 - Completion of Procedure

Answer 6

1. Record kVp and MA (to be placed in the patient’s PARTS Notes).
2. Don PPE and remove barriers
3. Disinfect all contaminated surfaces.
4. Save image to patient file.
5. Log-out of Dentrix.