Dental X-Ray Mounting and Viewing

This assignment focuses on the proper procedures for mounting and viewing dental x-rays. It outlines the steps involved in placing x-ray film into opaque mounts, labeling them with patient information and date, and using a viewbox for safe and effective viewing under controlled lighting conditions. The document also emphasizes the importance of radiation safety awareness and best practices.

Radiography Case Study
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Radiography case study
Student's Name:
Instructor's Name:
Date:

Radiography Case Study
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Radiography case study
Case study 1:
Several interventions in dentistry are guided by fluoroscopic instrumentation and
equipment1. Radiological dentistry interventions are some of the most commonly used
procedures in the recent times. Additionally, they have several benefits in the solution to the
disease condition. However, they are known to cause alarming concerns in terms of
deterministic effects of acute or chronic nature in the patient due to exposure to harmful
radiation.
1. Detail to the patient the reason why you provide the lead apron with a thyroid collar
for her to use during radiation exposure.
I shall inform the patient that the leaded apron is essential for her to reduce exposure
of ionizing radiation to vital organs of the body. It just not only protects the organ, but also
reduces the total body dose of exposure. In addition, I will explain to the patient that thyroid
collar has been provided along with lead apron as the thyroid may be exposed to radiation
even after wearing lead apron. It provides protection to all areas at risk in the front and back.
The need for using thyroid collar during radiation exposure has also become a necessity
because of the increased in rate of thyroid cancer. Thyroid is the main site that is at risk of
radiation induced cancer in patient and as x-rays is mostly performed during diagnostic
testing, protecting the thyroid gland is a strategy to reduce thyroid cancer risk. The Radiation
Protection guideline also recommends providing thyroid shielding to patient when thyroid is
1 Aerab-Sheibani, H., Safi, M., Namazi, M.H., et al. (2014). Radiation safety
awareness and practice among Iranian cardiology and radiology residents/fellows.
Anadolu KardiyolDerg, 14, 310–1

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in line with the primary beam of the x-rays. It significantly reduces radiation dose during x-
ray examination2. Thyroid collar is an effective protective device to reduce all forms of risk
and her that the leaded apron provides protection for the gonads, whilst the collar for the
thyroid is essential as the organs that have to be particularly offered protection include the
thyroid, gonads, and breast. I shall explain to the patient that radiation interventions can
induce stochastic effects such as cancer and genetic mutations, or even impairment in fertility
and cataract as deterministic effects if the apron is not used. However, I will explain to her
that the radiographic intervention provides extensive support in her treatment and with the
precaution of wearing the apron and collar, it is possible to avoid the adverse effects of
radiation along with obtaining the complete advantage of the intervention3. The patient has to
be told that the calculated risk to benefit ratio in her case indicates that the benefits are higher
than the risk involved. Additionally, the hospital is certified to undertake the radiographic
intervention owing to the appropriate equipment used. She needs to be informed that the
limitation of the dosage is determined according to her specific condition and case. In adults
and children, it is essential to provide thyroid collar and leaded apron. The primary reason for
this is that the thyroid gland and the gonads have the highest sensitivity to the risk of
development of tumours of both malignant or benign nature.
2. Explain to the patient why you and the operator leave the room for every patient
during the exposure of radiation.
2 Sinnott, Bridget, Elaine Ron, and Arthur B. Schneider. "Exposing the thyroid to radiation: a
review of its current extent, risks, and implications." Endocrine reviews 31, no. 5 (2010):
756-773.
3 Safi, M., Aera-Sheibani, H., Namazi, M.H., Vakili, H., & Saadat, H. (2014).
Academic training in radiation safety awareness and practice among Iranian
residents/fellows. Heart Asia, 6(1), 137–141.

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If the patient asks why I and the operator leave the room during the exposure of
radiation, then I would explain to the patient that leaving the room is a necessary precaution
for them to protect them from exposure to radiation. I would explain to the patient that
leaving the room is important for operator because they conduct large number of radiation for
patients throughout the day and apart from the patient, they do not wear any protective
clothes like apron or collar. Hence, to prevent themselves from adverse exposure to radiation,
leaving the room or standing behind a barrier is a necessary step for them. This saves them
from workplace hazards and any safety concerns. The guidelines for safe operation of x-ray
equipment and radiographic procedures also mention that the person whose presence is not
required must be asked to leave the room until the exposure is complete. If leaving the room
is not possible, then it is a responsibility for operator to position the person as far away as
possible. In addition, both the patient and operator must use protective barriers like lead
aprons4.
However, the above response may make the patient apprehensive and fearful about
the dose of radiation they receive. I would address patient’s worry by stating that we have
given thyroid collar and apron to the patient to protect them from harmful radiation. Lead
apron and thyroid collar is one of the process of shielding, which reduces the radiation dose.
Using lead as a method of shielding is one of the common procedure. Lead aprons are about
0.25-0.5 mm thick which attenuates about more than 90% of the radiation5. I would also
4 Srinivasan, D., Than, K. D., Wang, A. C., La Marca, F., Wang, P. I., Schermerhorn, T. C.,
& Park, P. (2014). Radiation safety and spine surgery: systematic review of exposure limits
and methods to minimize radiation exposure. World neurosurgery, 82(6), 1337-1343.
5 Hyun, S. J., Kim, K. J., Jahng, T. A., & Kim, H. J. (2016). Efficiency of lead aprons in
blocking radiation− how protective are they?. Heliyon, 2(5), e00117.

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explain that they would get radiation for very short period which reduces the possibility of
taking high dose of radiation. Hence, this response would be an appropriate step to convince
patient that they the radiation dose they are receiving in the radiation room is not harmful for
them.
Case study 2:
1. How you applied safe work practices; handled, processed, and disposed of the
radiographic films
The boy with the knocked mouth required manual processing cycle. While employing manual
processing, it is necessary to take many safety precautions during handling, processing and
disposing of the radiographic films. I applied safe work practices by checking the
temperature of developer and fixer. The optimum temperature for the developer is 65- F to
750 F and the temperature in this range was maintained by adjusting the water tap so that
correct temperature is achieved. The safe handling of radiograph was maintained by
removing the exposed using safe light illumination only. Correct lighting was checked by
avoid fluorescent light emission and using red lighting. Red illumination prevents films from
fogging6. Safe light condition is also necessary while transferring the film from developer to
the wash tank. After removing the film from the developer solution, it was placed in
circulating water of the rinsing tank. The films was first placed in fixer solution for 5
seconds and then placed in running water for 10 minutes. The films was then dried in
moderately warm air.
Sustainable method of disposal is also needed for the radioactive film. The film has to
be disposed as hazardous waste off-site or in the hospital in the presence of a silver recovery
6 Taguchi, Yasunori, Yukinobu Sakata, Ryusuke Hirai, Kyoka Sugiura, Tomoyuki Takeguchi, Shinichiro Mori,
and Fumi Maruyama. "Apparatus, method, and program for processing medical image, and radiotherapy
apparatus." U.S. Patent 9,919,164, issued March 20, 2018.

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unit7. The other two patients required digital transferring imaging. It is the process that
employs digital X-ray sensors for producing enhanced computer image of teeth and gums.
There are limited safety requirements in this process as staffs do not need an enclosed space
to develop the film and everything is generated by means of digital sensors8.
2. How you mounted and filed the films and digital images that you processed.
The other two cases included digital radiography. Digital radiography has to be practiced
with utmost safety in protocol. The exposure of the patient to the radiation must be as low as
reasonably achievable (ALARA). In the routine of dental procedures, several intra-oral
protocols are being carried out in the recent times by digital radipgraphy9. The equipment of
the digital processing must be compatible with the unit of X-ray scanning. The X-ray
radiographs are required to be stored in a taut container protected from humidity, heat, and
contamination by chemical substances. The film processing and equipment are governed by
regulations of the government and the health sector on the hospital usage of the digital
radiography equipment. For digital radiography equipment, the receptors of digital units are
essential. The sensors in the units must be examined and replaced for wearing and scratches.
The stability of the head of the tube section has to be ascertained and fixed accordingly. The
stability is checked at different angulations and vibrations or drift offset is corrected. The
dosage is recommended according to the health policies by grouping the patient into the
categories for treatment. The individual doses are determined according to the patient need
and condition. The operators need to be aware of the health recommendations set by the
7 Madhavan, A., Sankaran, S. & Balasubramani, S. (2015). Radiographic waste management -
an overlooked necessity. World Journal of Pharmaceutical Research, 4, 2050-2058.
8 Winand, C., Shetty, A., Senior, A., Ganatra, S., De Luca Canto, G., Alsufyani, N., ... &
Pachêco-Pereira, C. (2016). Digital imaging capability for caries detection: a meta-
analysis. JDR Clinical & Translational Research, 1(2), 112-121.
9 Williamson, G.F. (2014). Digital radiography in dentistry. J PracHyg, 13, 25-32.

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International commission on radiation protection and the Centre for devices and radiological
health. The radiographic images are best formed in the adequate dark room. The dark room is
configured with the elimination of leaking of light and the installation of the appropriate
safelight.
Mounting the radiograph:
The mount chosen was opaque to avoid light refraction. Hands were kept clean along with
wearing clean, soft gloves to avoid scratches on the image. The opaque mount has unique
slots for the placement of the film. The placement was made according to the regulation of
the dental health facility i.e. with the dot embossed on the film facing the viewer. The view of
the dentition had left to right hand directionality. The mount was labelled with relevant and
identifiable patient information. The date of mounting was specified in the label.
Viewing the film:
The film was viewed with the help of a viewbox. The viewbox has adequate and uniform
lighting. The light may be varied in intensity accordingly. The viewing was carried out in the
dark room with safelight for correctness and to avoid distraction.

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References
Aerab-Sheibani, H., Safi, M., Namazi, M.H., et al. (2014). Radiation safety awareness and
practice among Iranian cardiology and radiology residents/fellows. Anadolu KardiyolDerg,
14, 310–1
Hyun, S. J., Kim, K. J., Jahng, T. A., & Kim, H. J. (2016). Efficiency of lead aprons in
blocking radiation− how protective are they?. Heliyon, 2(5), e00117.
Madhavan, A., Sankaran, S. & Balasubramani, S. (2015). Radiographic waste management -
an overlooked necessity. World Journal of Pharmaceutical Research, 4, 2050-2058.
Safi, M., Aera-Sheibani, H., Namazi, M.H., Vakili, H., & Saadat, H. (2014). Academic
training in radiation safety awareness and practice among Iranian residents/fellows. Heart
Asia, 6(1), 137–141.
Sinnott, Bridget, Elaine Ron, and Arthur B. Schneider. "Exposing the thyroid to radiation: a
review of its current extent, risks, and implications." Endocrine reviews 31, no. 5 (2010):
756-773.
Srinivasan, D., Than, K. D., Wang, A. C., La Marca, F., Wang, P. I., Schermerhorn, T. C., &
Park, P. (2014). Radiation safety and spine surgery: systematic review of exposure limits and
methods to minimize radiation exposure. World neurosurgery, 82(6), 1337-1343.

Radiography Case Study
9
Taguchi, Yasunori, Yukinobu Sakata, Ryusuke Hirai, Kyoka Sugiura, Tomoyuki Takeguchi,
Shinichiro Mori, and Fumi Maruyama. "Apparatus, method, and program for processing
medical image, and radiotherapy apparatus." U.S. Patent 9,919,164, issued March 20, 2018.
Williamson, G.F. (2014). Digital radiography in dentistry. J PracHyg, 13, 25-32.
Winand, C., Shetty, A., Senior, A., Ganatra, S., De Luca Canto, G., Alsufyani, N., ... &
Pachêco-Pereira, C. (2016). Digital imaging capability for caries detection: a meta-
analysis. JDR Clinical & Translational Research, 1(2), 112-121.