5.6.5 - Procedures for Radiographic Exposures for the Operator

All exposed radiographic images must be made according to the following guidelines. Any technical deviations must be approved by the attending dental faculty or trained staff. 

1. A clinical examination must be performed first to determine if radiographs are needed or not. Based on clinical judgment and the patient’s history, the provider decides what radiographs (type and number) are needed.
2. Providers must ask the patient if any radiographs were taken outside OUCOD. If yes, ask the patient to provide any details they can remember such as the date taken, what type, and how many. 
3. For pre-doc clinics, radiographs from outside practices can be emailed to radiology at CODRADIOLOGY@OUHSC.EDU.
4. Patients can request an outside practice to email the radiographs to OUCOD on this email. Radiology staff cannot make this request. Radiology staff can only upload images that are digitally received on this email. It would be best if radiographs were received before the day of the appointment.
5. If any radiographs are found to be undiagnostic, retakes can be done based on the clinical judgment of the provider/faculty.
6. To minimize risks associated with radiation exposure, use the fastest imaging system appropriate for the diagnostic need. At OUCOD, digital image receptors of varied sizes are used. 
7. Periapical and bitewing radiographic images are acquired with circular or rectangular collimation that limits the beam to a diameter of 2.75 inches or less at the patient's face. Use open-ended, shielded beam-indicating devices (BID) only. 
8. Ensure that the target-to-skin distance for intraoral radiography is no less than 8 inches. Long BID length is preferred. 
9. Use image receptor holding devices during standard intraoral techniques. Digital retention of intraoral image receptors is not recommended. 
10. Protective body aprons and thyroid shields are currently optional for all intraoral radiographic imaging.
11. Operators using hand-held devices must wear protective aprons.
12. Operators should not hold patients or image receptors during the radiograph exposures. If assistance is required for children or disabled patients, an adult member of the patient's family or other non-radiation staff may help. If the need arises, the operator must wear a protective apron when stabilizing the patient or image receptor and stay out of the primary X-ray beam. 
13. The operator should not stabilize or hold the tube head of a wall-mounted or mobile x-ray unit on wheels by hand during exposures. During each exposure, the operator should stand out of the primary beam and stand behind an adequate protective barrier that permits patient observation and communication. The tube head must not vibrate or drift during exposure. 
14. For fixed wall-mounted tube heads, the exposure button must be located behind the barrier or at a safe distance. Operators must apply continuous pressure on the exposure button throughout the exposure time until the exposure cycle has been completed. 
15. Portable mobile X-ray generators and hand-held devices such as Nomad must be used with proper precautions.
16. Fixed wall-mounted X-ray generators shall have a posted list of “average” exposure factors that are appropriate for the views taken with that machine. Professional judgment must be used if an adjustment is needed.
17. All x-ray generators must meet federal requirements for collimation and filtration: Total filtration of x-ray machines should not be less than 1.5 mm aluminum equivalent at 70 kVp or less and not less than 2.5 mm on machines operating above 70 kVp.  Collimation: beam diameter of 2.75 inches or less at the patient's face.
18. If a malfunction is detected in an x-ray generating unit, do not use the unit unless the necessary corrections have been made and the equipment recalibrated. Report the malfunction to the Division Head of Oral Diagnosis and Radiology. 
19. For extraoral radiography, restrict radiographic images to the area in question and with the beam collimated equal to or smaller than the size of the image receptor. Use the fastest extraoral digital image receptors appropriate for the diagnostic need.
20. The number of radiographs needed for a patient will vary depending on the type of encounter, various clinical situations, history, risk factors, available radiographs, etc. Please review the ADA/FDA guidelines for prescribing dental radiographs.  
21. There is no such practice as taking radiograph(s) every 6 months or every year on a patient. This is incorrect practice. Taking radiographs before any clinical examination is also an incorrect practice.
22. All radiation exposures for each patient must be included in the patient's record.
23. Current ADA / FDA guidelines for prescribing dental radiographs can found at: https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/selection-patients-dental-radiographic-examinations
24. Evidence for discontinuing radiographic shielding: https://jada.ada.org/article/S0002-8177(23)00391-4/fulltext
    As you will note, the Position Statement makes two recommendations:
    1. Discontinuing shielding of the gonads, pelvic structures, and fetuses during all dentomaxillofacial radiographic imaging procedures
    2. Thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging