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Xray > Xray - Week 12 PP > Flashcards

Xray - Week 12 PP Flashcards

1
Q

Imaging of Patients with Special Needs

A

Not all imaging techniques can be successfully performed on all patients.
Sometimes imaging techniques must be modified to accommodate patients with
special needs.

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2
Q

Patients with a Gag Reflex

A

Also referred to as the pharyngeal reflex, caused by the stimulation of the sensitive tissues of the
soft palate region.

Usually caused by stimulating the
* Soft Palate
* Lateral 1/3 of the tongue

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3
Q

A person’s gag reflex can be triggered by
either;

A

Psychogenic Stimuli
◦ originating in the mind
- thinking about it - watching a gross movie, etc.

Tactile Stimuli
◦ Originating from touch
- touching the tongue, soft palate

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4
Q

Patient Preparation

A

It is important that the operator conveys a
confident attitude, as well as patience and
understanding.

Before starting:
* Thoroughly explain the procedure to the patient - will only be 15 minutes, they can do it!
* Limit the amount of time the receptor is in the mouth - work quick!
* Sequence exposures starting with the least likely to elicit a gag reflex first (anterior)
* Do not slide the sensor along the palate - if you touch with your finger first, where you are going to put the sensor.. this may help them!
* Rub finger along the area where the sensor will be placed to prepare the patient prior to placement

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5
Q

Gag Reflex Management - Tips & Tricks

A
  • NEVER suggest gagging
  • DO reassure the patient
  • Suggest wriggling their toes (distract them) - works well with children!
  • Focus on deep breathing
  • Give the patient a glass of ice water to drink - numbs the mouth a bit
  • Place table salt on the tip of the patient’s tongue (confuses the sensory nerve endings)
  • Use topical anesthetic spray - if desperate! must be approved by doctor
  • Have patient push on pressure point - inbetween thumb and index
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6
Q

Pediatric Patient

A

Pediatric dentistry involves the diagnosis and treatment of dental diseases in children.
* Dental images are useful for
* Detecting lesions
* Observing conditions of the teeth and bones
* Diagnosing tooth decay
* Evaluating trauma
* Evaluating growth and development

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7
Q

For Pediatric Patients - The dental radiographer must be aware of:

A

*Tooth eruption sequences (and dates) - could flag if they don’t have a a specifc tooth by typical date
* Patient and equipment preparations
* Prescribing of dental images - not DAs job, but could flag if needed for dentist
* Recommended techniques
* Types of examinations
* Digital sensor issues
* Patient management

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8
Q

Prescribing Dental Radiographs

A

The number and type of dental images depends on the individual needs of the child including the number of teeth present, the age of the child and the child’s ability to cooperate during the
procedure

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9
Q

Pediatric Patient Management

A
  • Be confident
  • Be patient
  • “Show and tell” - show them everything, let them touch it if they want
    ◦ Explain procedure using words they will understand
  • Reassure the patient
    ◦ A frightened child is not a cooperative one
  • Request assistance from the parent
  • Postpone the examination:
    ◦ Breaking up the appointment will allow the child to become familiar - first appointment.. only show them the equipment, 2nd appointment.. take the xrays
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10
Q

Infant: Treatment Method

A
  1. Child sits or lies on parent’s lap
    * Both child and parent wear a lead apron
  2. Childs head cradled against the parent
  3. The parents left arm and hand encompass the child and restrain the child’s hands
  4. The parent’s right hand supports the head
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11
Q

Edentulous Patient

A

An edentulous patient, or patient without teeth, requires dental imaging to:
* Detect the presence of root tips, impacted teeth or lesions (cysts, tumors)
* Identify objects embedded in bone
* Establish the position of normal anatomic landmarks
* Observe the quantity and quality of bone that is present

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12
Q

Edentulous Patients - Images

A

Panoramic Examination
◦ The most common way of evaluating the edentulous jaw

Periapical Examination
◦ Used if a panoramic machine is not available
◦ May be used as a follow-up to the panoramic examination

Occlusal - Periapical Examination
◦ Combination of occlusal and periapical projections

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13
Q

Cotton Rolls for Edentulous Patients

A

Put a cotton roll on each side of the bite block to create space

If missing only a few teeth, you can put the cotton roll in place of the missing teeth

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14
Q

Partially Edentulous Patients

A

Partial dentures must be removed
* Stabilize film packet or film holder
◦ Option #1: Place a cotton roll in edentulous areas.
◦ Option #2: Place a 2x2 gauze in edentulous areas

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15
Q

Endodontic Procedures

A

Endodontic treatment involves removal of the dental pulp (nerve tissue) from the pulp chamber and canals within the tooth
Dental x-rays are indispensable during root canal treatment.
◦ Essential for diagnosing pulp problems
◦ Used to evaluate the tooth before, during and after treatment

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16
Q

Endodontic Positioning Devices & Technique

A

During the root canal procedure the pulp canals
must be accurately measured without distortion.
The paralleling technique is strongly
recommended.

*snap a ray

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17
Q

Patients with Disabilities

A

A disability is defined as a physical or mental impairment that substantially limits
one or more of an individual’s major life activities
The radiographer must be prepared to modify imaging techniques to accommodate the patient

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18
Q

Vision Impairment Patient Management

A
  • Talk with clear instructions
  • Explain everything that you will be doing
  • Let the patient feel the film and the holder
  • Inform the patient if you leave the area
  • Never gesture to another person in the patient’s presence
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19
Q

Mobility Impairment

A

Wheelchair Options
* Take the radiographs with the patient in the wheelchair
* Transfer patient to dental chair
* Ask for the assistance of the caretaker
Film holding
* If patient cannot support film, ask caretaker to assist in film holding
* Caretaker must wear a lead apron with a thyroid collar
* Instruct caretaker on how to hold the film

20
Q

Hearing Impairment

A

The dental radiographer should ask the patient how they prefer to communicate
* A caregiver may interpret
* Use gestures or sign language
* Use assistive technology
* Use written instructions
Some patients can read lips, ensure to face the patient and speak clearly and slowly

21
Q

Developmental Disabilities

A

A developmental disability is a substantial impairment of mental or physical functioning
that occurs before the age of 22 and is of indefinite duration.
* Autism
* Cerebral palsy
* Down Syndrome
A person with developmental disabilities mayhave problems with coordination or comprehension that can make obtaining intraoral images difficult.

22
Q

Developmental Disabilities Helpful Hints

A
  • Treat the patient as you would like to be treated
  • Do not ask personal questions about their disability
  • Think before you speak
  • Ask before assisting a person with a disability
  • Always talk directly to your patient
23
Q

Legal Considerations

A

Risk Management
Involves following policies and procedures that reduce the chance that a malpractice lawsuit will be brought against the dentist.

These include:
Informed consent
Patient records
Confidentiality
Liability issues
Patient education

24
Q

Informed Consent

A

Patients must give informed consent prior to any xrays being taken. In order to give proper
informed consent the patient must be provided with the following information:
* Risks and benefits of radipgraphic procedures
* Person who will be exposing the xray
* Number and type of radiographs being taken
* Consequences of not having radiographs
* Alternative diagnostic aids that may provide the same information

25
Q

Liability

A

Even though dental assistants work under the supervision of a dentist, they can still be held
legally liable for their own actions.
There have been cases where the dentist and dental assistant have both been sued for the
actions of the dental assistant.
This is why as a registered dental assistant in Alberta you must carry your own personal
malpractice insurance

26
Q

Patient Records

A

Both conventional and digital xrays are considered a legal record. The chart must accurately reflect all aspects of patient care and documentation of radiographs must include the
following:
Informed consent
Number and type of radiographs (including retakes)
Rationale for requiring radiographs (ex. patient has pain, routine check-up)
Diagnostic interpretation
*re-takes are also documented as well as the reason why a re-take was required

27
Q

Patient Refusal

A

Patients may from time to time refuse to have xrays taken. This can make an accurate
diagnosis and treatment planning difficult.
Every effort should be made to educate the patient about the importance of dental
radiographs.
*no document can be signed releasing the dentist from liability if the patient refuses
radiographs. Legally a patient cannot consent to negligent care.
Ultimately it is up to the dentist if they will proceed with negligent care

28
Q

Patient Education

A

As dental assistants we need to be sensitive to a patients concern about radiation exposure
during xrays. The patient usually feels more comfortable confiding in the dental assistant
than the dentist about these fears.
You should be able to explain the importance of dental radiographs in disease detection and
treatment planning as well as regulations regarding xray equipment, maintenance and monitoring.

29
Q

Quality Assurance

A

A Quality Assurance Program ensures the highest quality images with the least amount of
radiation risk to patients and personnel.
Quality assurance includes:
* Regular equipment testing
* quality control tests
* Scheduled maintenance and record keeping

30
Q

Safety Code 30

A

Is a national government code that sets out the standards for xray requirements that must be followed in a dental office.

Dental radiography is one of the most
valuable tools used in dental health care. It is
used in the diagnosis of physical conditions
that would otherwise be difficult to identify,
as well as to assist in the planning of
treatment (Government of Canada, Safety Code 30 2022)

31
Q

4 Aspects of Dental Radiation Safety

A

There are four main aspects of radiation protection to be considered in dental radiography:
1. Patients should not be subjected to unnecessary radiographic imaging procedures. This means that the procedures are ordered with justification, and when the diagnostic information
cannot be obtained otherwise.
2. When a radiographic imaging procedure is required, it is essential that the patient be protected from excessive radiation exposure during the procedure by ensuring that only
the minimum radiation dose is applied to obtain the diagnostic information required.
3. It is necessary that personnel within the facility be protected from excessive exposure to radiation during the course of their work.
4. Personnel and the general public in the vicinity of such facilities require adequate protection from stray radiation.

32
Q

Full Explanation of Safety Code 30

A

This Safety Code sets out principles and best
practices to help ensure radiation protection of all
individuals who may be exposed to radiation from
dental X-ray equipment. It provides dental facilities
with the necessary information to achieve the
following principal objectives:
1. to minimize patient exposure to ionizing radiation in
dental radiography, while ensuring the necessary
diagnostic information is obtained;
2. to help ensure optimal protection of personnel operating
dental X-ray equipment; and
3. to help ensure optimal protection of other personnel and
the general public in the vicinity of areas where dental Xray equipment is operated.

33
Q

Responsibilities of Xray Equipment Operators

A

All dental X-ray equipment operators have the
responsibility of carrying out prescribed dental
radiological procedures in a manner which does not
cause any unnecessary exposures to patients,
themselves, other workers and the public in the
facility

34
Q

All dental X-ray equipment operators must:

A
  1. be familiar with, and have access to, the manufacturer’s operator manual for the specific dental X-ray equipment used in the facility;
  2. recognize the radiation hazards associated with their work and take measures to minimize them;
  3. have a thorough understanding of safe working methods and appropriate techniques and procedures, including the appropriate use of personal protective equipment;
  4. strive to eliminate unnecessary radiographic procedures by reducing the number of retakes, and reduce all patient radiation exposures to the lowest practical values while maintaining acceptable diagnostic image quality;
  5. participate fully in the established quality assurance program for the facility, including reporting any change in equipment performance to the Coordinator of the Radiation Protection Program;
  6. if they may receive an annual dose in excess of 1 mSv, as declared by the coordinator of the radiation protection program, monitor their radiation exposures with the use of
    a personal dosimeter, and be aware of their annual occupational dose;
  7. record the patient radiographs in a registry, and maintain records of retakes (See Section C3.2, item M9), and;
  8. understand and comply with the recommendations of this Safety Code.
35
Q

Quality Assurance Requirement

A

All dental facilities must develop and
maintain an effective quality assurance
program. The ultimate goal of a quality
assurance program is to ensure accurate and
timely diagnosis at the minimum dose to the
patient and staff

36
Q

4 steps must be included in quality control procedures

A
  1. Equipment operation
  2. Baseline performance
  3. Reference test image
  4. Result Evaluation and Actions Levels
37
Q

Quality Control - Equipment operation

A

It is essential that the dental X-ray equipment and image processing and display equipment function properly before a quality assurance program is implemented. For CR and DR systems, the imaging system must be properly calibrated with the X-ray systems. This may involve replacement, repair, upgrading or calibration of the equipment.

38
Q

Quality Assurance - Baseline Performance

A

Baseline performance values of X-ray equipment and image processing system must be established after verifying that the equipment functions properly. This baseline performance will be used to diagnose any changes in equipment performance. It is important to keep records of equipment operation data and baseline performance measurements. These records will be needed to diagnose any changes in image quality. Baselines values must be determined when new equipment is introduced into the facility, when there are changes in components which affect image quality and patient dose and also when testing equipment is changed.

39
Q

Quality Assurance - Reference test image

A

To evaluate image quality a reference test image is needed. This reference test image is made by using the X-ray equipment, image processing system and a quality control phantom and will be used for comparison of quality control test images

40
Q

Quality Assurance - Result Evaluation and Action Levels

A

An effective quality control monitoring program includes not only a routine quality control
testing schedule, data recording and record keeping, but also test result evaluation, such as determination of acceptable or unacceptable limits of equipment operation coupled with a list of corrective actions that may be required. A set of limits should beestablished which indicates
a level of operation outside of which the system or the function should be closely monitored but where no immediate action is required. Another set of limits should also be established where immediate remedial action must be taken.

41
Q

Types of Quality Control Tests

A

Traditional Dental film: test each new box for freshness
X-ray Machine: calibrate equipment
PSP : clean and examine for scratches
Safelighting: check for light tightness in darkroom
Automatic processor: follow manufacturer maintenance instructions
Manual processor: replenish and change chemicals

42
Q

XRAY Machine Quality Control

A

Test output of xrays
Test size of focal spot
Test tubehead for stability
Test timer for accuracy
Test milliamperage
Test Kilivoltage

43
Q

Sensor Quality Control - Stepwedge Radiograph

A

A stepwedge is a device that is constructed of layered aluminum steps. When placed on top of
a film and then “exposed” the different steps absorb varying amounts of radiation.

44
Q

Annual Dose Limits for Radiation Workers

A

Whole Body - 20 mSv effective dose per year averaged over a defined 5 year period and 50 mSv in any single year.

Lens of the eye - 20 nSv equivalent dose per year averaged over a defined 5 year period and 50 mSv in any single year

Skin - 500 mSv equivalent dose

Hands & Feet - 500 mSv equivalent dose

45
Q

Annual Dose Limits - Members of the public

A

Whole Body - 1 mSv effective dose
Lens of the eye - 15 mSv equivalent dose
Skin - 50 mSv equivalent dose

Xray (21 decks)

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