WRITTEN RADIATION SAFETY PLAN

October 2011

WRITTEN RADIATION SAFETY PLAN

TABLE OF CONTENTS

RADIATION SAFETY OFFICER 1

LOCATION AND RETENTION OF DOCUMENTS 3

PERSONNEL TRAINING POLICY 5

TECHNIQUE CHART 7

WRITTEN RADIATION SAFETY PLAN 8

PROTECTION OF PERSONS IN ROOM 9

MINIMUM EXPOSURE STANDARDS 11

INTRAORAL IMAGE RECEPTOR 12

PATIENT PREGNANCY POLICY 13

MOBILE/PORTABLE EXMAS 13

OPERATOR LOCATION 14

DECLARED EMPLOYEE PREGNANCY 16

MONITORING OF OCCUPATIONAL DOSE 17

REPORTING INCIDENTS/EXPOSURES 21

PRACTICE SPECIFIC PROTOCOLS

Table of Contents

Required Use of PPE 1

Appropriate Use of Dosimeter 2

Material Safety Data Sheets 3

Infection Control Protocols 4

Sample Protocols

Film Storage and Processing

Gendex 765CD Intraoral X-ray

Trophy CCX Digital

Planmeca Intra

Orthomantomography Panorex OP100 Orthoceph

Air Techniques Proverta 70

Note: This section of the Written Radiation Protection Safety Program contains:

• Procedures to minimize exposures to blood, OPIM or chemicals.

• Procedures for operating specific equipment.

• Office specific policies and procedures.

These serve as instructions and guidelines for employees and must be followed as outlined.

Sample protocols are provided as examples. Replace the samples with protocols specific to

instrumentation in use and remove the samples. Use the samples only if they are accurate for your

practice.

January 2012 ©2008 by Total Medical Compliance

1

RADIATION SAFETY OFFICER

The Written Radiation Safety Plan polices, and procedures are reviewed by the Safety

Officer and updated annually and when changes are made:

Name Date Signature

The Radiation Safety Officer (RSO) as required in .0203(b)(2) for our practice is:

Name Date Signature

If the primary Radiation Safety Officer for the practice is located at another office, the

contact for this office/satellite is:

Name Date Signature

The RSO responsibilities include industry monitoring, office performance, daily

duties and equipment safety. The RSO will:

• Monitor radiation safety for our office.

• Report on radiation safety issues and take action to correct the issues.

• Maintain awareness of the radiation safety legislation and keep abreast of the trends in

radiation safety.

The RSO duties on an ongoing basis are to:

• Ensure all personnel are properly trained before operating equipment and on an annual basis

as needed.

• Ensure all personnel utilize appropriate PPE as outlined in the Hazard Assessment

Certification.

• Monitor the safety of the x-ray equipment, premises and protective equipment and devices to

identify that relevant radiation safety standards are in compliance. (for example, compliance

may be affected by damage to, or modification of, the x-ray equipment or premises)


2

• Maintain records of all x-ray equipment and the locations at which it is installed

• Identify ways to minimize radiation doses

• Advise staff on safe working practices

• Ensure regulatory requirements are met for personal monitoring badges for new and existing

employees, devices are properly calibrated, and appropriate reports are maintained and

available for review.

• Investigate radiation incidents.

The RSO will keep management informed:

• Provide reports on radiation incidents and action taken or recommendations for

improvements

• Notify management of any action that needs to be taken to achieve compliance with this plan

or relevant Radiation Safety Standard.

• Provide written assurance that the plan has been reviewed annually as outlined below.

Annually the RSO will ensure completion of the following actions and report the

action to management:

• The equipment inventory list is accurate and all equipment has been accounted for.

• The State registration is current and appropriate. All changes must be reported to the State

immediately.

• All users of the x-ray equipment have been trained and necessary licensure or certifications

are current.

• All maintenance and operational checks have been completed within the stated timeframes

and recorded, and any relevant problems have been appropriately rectified.

• Recommendations for improvement.

The Radiation Safety Officer for the practice has been trained in:

Fundamentals of Radiation Safety

Characteristics of gamma radiation

Hazards of x-ray exposure

Units of radiation dose

Levels of radiation from sources

Methods of controlling radiation dose

Use of personnel monitoring device


3

Location and Retention of Required Documents

Employees can locate the following documents for inspection and review in the

following locations:

The Radiation for Dental Manual is located: __________________________________________

The following documents are located in the Equipment and Facility section:

Plan Reviews [.0603(a)(2)(A)] [.0603(b)]

Letter of Acknowledgement [.0603(a)(2)(A)] [.0603(b)]

Current Notice of Registration [.0603(a)(2)(A)] [.0209]

Post installation Survey as required for dental units utilizing cephalometric equipment, dental

CT, tomography, and i-CAT. Survey is also required when taking radiographs in an open bay

if stated in the Letter of Acknowledgement or during an inspection by the State.

[.0603(a)(2)(B)] [.0603(c)]

FDA 2579 Report of Assembly Form [.0115]

The location of the following documents is listed:

NC Regulation Book [.102(a)(1)] (2002 edition): ____________________________

Notice to Employees [.102(c)]: In the State Regulations tab in this manual and posted in

__________________________________of this facility.

Written Safety Procedures[.0603(a)(1)(D)]: Radiation Safety Program section of this manual

Review of Written Procedures [.1603(c)] [.1636(a)(2)]: Page 1 of Radiation Safety Program


4

Records Retention

Retention schedules are set to consider legal requirements and business requirements.

Record Type Retention Policy

Employee Training

Records

For duration of employment

Patient X-rays Same time as all patient medical records.

In the case of practice ceasing business,

state laws will be followed.

Dosimeter reports Forever

Surveys Latest report will be retained as long as

equipment is in service +5 years

Equipment Maintenance &

Repair Records

Retain for the life of the equipment

Approvals to acquire/

relocate equipment

Permanent

Operational Checklists 6 years

Incident Reports Life of the equipment

Equipment Inventory Permanent

Equipment Registration Most current

Plan Reviews Latest for each piece of equipment used

Letter of

Acknowledgement

Permanent

Post Installation Survey Latest for each piece of equipment

FDA Form 2579 Report of

Assembly

Life of equipment

Notice of Registration Most current for life of equipment


5

PERSONNEL TRAINING POLICY

Certification Requirements-NC

Only individuals certified or otherwise recognized by the State of NC may operate x-ray

equipment.

All RDH, DDS & DMDs are qualified as per current licensure.

A certified dental assistant (one who successfully completes the DANB exam) may take

radiographs without further examination.

Dental assistant who can show evidence of satisfactory performance on an equivalency

examination, recognized by the Board of Dental Examiners, based on seven hours of

instruction in the production and use of dental x rays and an educational program of not

less than seven hours in clinical dental radiology.

Operation of x-ray equipment in this practice must be authorized by the Radiation Safety Officer.

As outlined in [.0603(a)(1)(B))] training must occur PRIOR to operation of equipment.

The following sections of the Radiation Manual must be read by personnel prior to operation of

x-ray equipment:

Introduction

Written Radiation Safety Plan

State Regulations and Guidance

Quality Control Plans

Supplemental Materials

o Infection Control Procedures

o Recycling Plans

Employees Authorized to Operate Equipment

A list of employees authorized to operate the x-ray equipment is located in the training

section of the manual. These employees have met the certification requirements for x-ray

safety training and have been trained on the policies and procedures of this practice.

No one under the age of 18 will be allowed to be involved with radiation services.

Exceptions will be handled by the RSO.


6

Annual Training

Upon hire, all employees will be trained on the policies and equipment of this office. Refresher

training will be conducted at least annually, if the office is remodeled or relocates radiation

equipment or moves to a new facility.

Documentation on training will be maintained for the duration of employment in the training

section of the manual.

A copy of this policy is located in the training section of the manual.


7

TECHNIQUE CHART

The Technique Chart required by [.0603(a)(1)(C)] provides information on all routine

examinations performed by the system and must be used to set up for each routine exam. The

chart gives the mAs or (mAand time) and kVp that must be used for: bitewing, anterior PA,

posterior PA, occlusal, panoramic and cephalometric examinations.

Technique charts are unique to the machine and must be changed when new equipment is

introduced. The technique factors to be used during an exposure should be set before the exposure

begins unless the exposure is automatic by preset buttons.

Types of technique charts utilized – Select ALL that apply

Our wall mounted control has automatic settings that are calculated when the patient size

(large adult, medium adult, small child pictographs) button is activated therefore we do not

have a chart for each patient size.

Instruction to SHIELD EVERY PATIENT will be displayed at the control panel

If settings are being changed, contact your supervisor because a technique

chart will be required.

There is separate chart information for each technique that relates to patient size, kVp, mA,

mAs or exposure time.

The dental unit has a set kV and mA. The technique chart states the time of exposure to be

used in these cases.

Other (Explain) _____________________________________________________

_______________________________________________________________

The information in the chart is provided to help minimize the exposure to the employee and

patient during the examinations to comply with ALARA (the minimum necessary to accomplish

the desired result). The technique is unique to the machine regardless of the operator. The

operator must follow the guidelines on the Technique Chart for each machine at all times.

The chart is posted near the control panel of each x-ray machine, near the control where the

technique is adjusted. Employees must be familiar with the chart and its utilization prior to

operating the equipment. If the Technique Chart is not seen or some recommendation is not

understood, ask the RSO or supervisor before proceeding with the examination.


8

WRITTEN RADIATION PROTECTION SAFETY PROGRAM

The Dental Radiation manual is located _________________________________ and made

available at all times to operators as required by [.0603(a)(1)(D)]. The safe work practices

included are policies of this office and/or are required by regulation.

ALARA is a radiation safety principle for minimizing radiation doses by employing all

reasonable methods. ALARA is not only a sound safety principle, but is required by law for

radiation safety programs.

The following practices contained in this manual will ensure all x-ray equipment operators will

keep their exposures as well as, ancillary staff and patients As Low As Reasonably Achievable

(ALARA).

Maximum Annual Occupation Dose Limits:

5 rems (.05 Sv)), total effective dose to whole body.

15 rems (0.15 Sv) eye dose equivalent to the lens of the eye.

50 rems (0.50 Sv) total organ dose equivalent.

50 rems (0.50 Sv) shallow dose equivalent to skin or any extremity

All equipment operators will take reasonable steps to ensure the radiation dose received by any

person, employee, patient or others is as low as reasonably achievable (ALARA).

Key concepts to minimize radiation exposure include:

1. Shorter exposure times to lower the radiation dose

2. Increasing distance from the source of radiation

3. Shielding such as lead aprons and barriers, to reduce actual exposure.

This Plan is reviewed at initial hire, on an annual basis, and if there is a change to activities or

procedures.


9

PROTECTION OF PERSONS IN ROOM DURING EXPOSURE

Presence during exposures:

Based on [.0603(a)(1)(E)] it is the policy of this office that without approval of the RSO, no one

is allowed in the room with the patient during a radiographic exposure. When holding is required

the policy is to use the parent/caregiver whenever possible. If professional staff and ancillary

personnel are required for the procedure then the listed safety measures are used.

Lead Shielding

Lead aprons or non-lead equivalent required by [.0603(a)(1)(F)] are provided and should be

worn by all patients when x-rays are taken.

Thyroid collars will be used, whenever practicable, with all patients but especially

children.

Lead shielding:

Will be inspected before each use for any cracks or damage and if detected the RSO will

be notified.

Will be stored unfolded to help prevent cracking.

Aprons are located:

In the hygiene operatory (ies)

In the dental exam rooms

In the close vicinity of the pan/ceph unit

In every room that houses an x-ray unit

Other _____________________________________________________________

Safety Measures for Professional Staff and Ancillary Support for Holding Patients

and/or Film During Exposure [.0603(a)(1)(E)(i)&(ii)].

No one individual will be used routinely to hold patients or film.

When holding patients, personal monitoring badges are utilized and will be worn at the

collar outside the apron. [.0603(a)(1)(J)][.1614].

Professional staff and ancillary personnel will be protected from the direct scatter

radiation by protective aprons or whole body protective barriers of not less than 0.25 mm

lead equivalent.

Individuals will be positioned so that no part of the body including the extremities which

is not protected by 0.5 mm lead equivalent will be exposed to the useful beam.

Forceps or a film holder will be used for holding film. [.0603(a)(1)(H)(i)].


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Non-occupationally exposed staff will not be utilized for holding of patients or films. [.0603(a)(1)(E)(i)(ii)&(iv)].

Safety Measures When Others are Permitted in the Room:

Whenever possible, an adult accompanying the patient will be used for holding. This must be

approved by the RSO. Information on the holder must be recorded in the patient file.

The following instructions will be provided to the human holder [.0603(a)(1)(H)(ii)&(iii)]:

If a parent or another person is required to hold the patient, they must be at least 18 years

old and must not be pregnant. [.0603(a)(1)(H)(iv)].

Wear a 0.25 mm lead apron.

Stand as far as possible from the useful beam. Under no circumstances must any person

other than the patient be exposed to the direct beam.

Ordering of Radiographic Exams

X-rays including retakes of patients may be taken only upon the order of the dentist as identified

in [.0603(a)(1)(G)(ii)].


11

MINIMUM EXPOSURE STANDARDS

Minimum Necessary Exposure is the Standard

This practice uses equipment and procedures in all cases to reduce patient and employee exposure

to the minimum necessary.

The radiation exposure time to the patient will be the minimum exposure required to produce

images of valuable diagnostic quality. Exposure techniques listed on Technique Charts or

preprogramed on certain units must not be adjusted to compensate for inadequate film processing.

In order to meet the requirements set forth in [.0603(a)(1)(I)] the following procedures/equipment

is utilized to minimize radiation exposure to patients and personnel:

Film speed is the fastest speed consistent with the diagnostic objective of the exam. Film

must be “E” speed or faster. [.0603(a)(1)(I)(i]

For non-digital panoramic or cephalometric machines, screen and film combinations are

the fastest speed consistent with the diagnostic objective of the exam. Film must be “E”

speed or faster. [.0603(a)(1)(I)(i]

For digital units, the exposure index will be monitored to ensure it is within the range for a

particular body part x-rayed as established by the equipment manufacturer.

[.0603(a)(1)(I)(ii)]

Other: ___________________________________________________________

_________________________________________________________________

_________________________________________________________________

All employees will report conditions to the RSO that compromise the concept of minimum

exposure. Examples would be:

• Slower film than necessary is being used when a better speed is possible.

• Equipment operating conditions that require extra exposure time to accomplish the task due

to a malfunction or less than maximum operating performance.


12

INTRAORAL IMAGE RECEPTOR SAFETY

Intraoral images are not performed in this practice.

The following information on Intraoral Image Receptor Safety applies to this office.

Radiographic systems designed for use with an intraoral image receptor will be provided with

means to limit the x-ray beam such that:

• If the source-skin distance (SSD) is 18 centimeters or more, the x-ray field at the SSD will be

containable in a circle having a diameter of no more than 7 centimeters (2.75 inches); and

• If the SSD is less than 18 centimeters, the x-ray field at the SSD will be containable in a

circle having a diameter of no more than six centimeters (2.4 inches).

Automatic Protection Equipment on Machines

X-Ray machines are equipped with devices to limit the radiation exposure to patients and

employees. These devices include filters that reduce unnecessary low-energy radiation from the

primary beam (PBL- positive beam limiting) and collimators which restrict the size of the x-ray

beam.

No operator is to alter, remove, or tamper with these devices. Any interference in these

protective measures could lead to needless radiation exposure to patients and/or employees.

X-Ray Beam Restriction & Alignment

Use the cone provided on the x-ray machine.

Never take a patient x-ray without a cone on the tube head.

Shielded, lead lined, cylinder, open-ended cones will replace short, black plastic cones.

Measurements have shown a scatter reduction to the patient of up to 75 percent by

changing to the shielded cone.

The beam size may not be larger than the image receptor on stand-alone cephlametric

equipment.

Tube Housing

The tube housing must not drift or move during any exposure as this could result in radiation

exposure to unintended areas. No one is allowed, under any circumstances, to hold the tube

housing or support housing during any exposure.

If a problem exists with the stability of the support arm, notify the RSO and suspend use of the

equipment immediately. There is the possibility of electric shock from improper grounding if the

machine is hand-held.

Place a sign on the equipment that it is OUT OF ORDER to ensure no other person will attempt

to use the equipment until it has been evaluated or repaired.


13

PATIENT PREGNANCY POLICY

A number of studies have suggested that the embryo/fetus may be more sensitive to ionizing

radiation than adults. This is especially true for the first trimester of gestation.

In order to ensure the safety of the pregnant patient this practice will:

Post signs prominently instructing patients to inform the technologist if they are pregnant

or might be pregnant.

Question female patients about the possibility of pregnancy prior to radiation exposure

being sensitive to the privacy rights and feelings of the patient.

If the patient is pregnant or thinks they may be pregnant notify the doctor.

The x-ray procedure will be delayed until the end of the pregnancy if possible.

If necessary to proceed or if the patient chooses to proceed, shield the patient with a 0.5 mm

lead apron or double shield with the regular aprons.

Obtain a signed waiver from the patient if the decision is made to proceed with the x-ray.

MOBILE/PORTABLE EXAMS

Mobile or portable exams are not performed in this practice.

The following information on mobile devices applies to this office.

Use of Mobile or Portable Machines is used only for examinations where it is

impractical for medical reasons to transfer the patient to a stationary radiographic

installation. [.0603(a)(1)(I)(iii)]

During the exposure using a mobile or portable x-ray device the x-ray machine operator:

1. Must be positioned so that his/her exposure to scatter radiation is as low as reasonably

achievable (ALARA) (e.g. 6 feet or more away)

2. Should never be in line with the direct beam.

3. Any person must be able to leave the room unless it is an Operating Room and then all

personnel must be badged and shielded. [.0603(a)(1)(E)(iii)]


14

OPERATOR LOCATION WHILE TAKING THE X-RAY

The employee must not be in the room or subject to scatter radiation due to their position.

Additionally the employee taking the x-ray must be able to control the area so that others will not

be exposed to scatter radiation during the process.

This practice performs the following radiographic studies which requires visual

contact of the patient

Panorex

Cephalometric

CT

Tomography

i-CAT

Visual contact as required in [.0604(b)(1)(C)] is maintained through:

Use of a window of lead equivalent glass.

Use of a mirror system.

Location of operator as required in [.0607(e)(2)(A)].

The operator is required to be in the protected area where the exposure switch is permanently

mounted.

The protected area(s) is located:

________________________________________________________________________

Visual Indicators and Audible Signal [.0607(e)(3)].

The exposure switch of our x-ray system provides a means to terminate an exposure at

any time if the exposure exceeds the devices set time +/- 15%. The switch is located in

the protected area.

Employees must remain in the protected area where access to the switch is possible

during an exposure. When the exposure has been completed the employee will:

o Hear an audible signal

o See the indication that the exposure is complete.

Each operator will see the visual indicator and hear the audible signal before leaving the

protected area following an exposure.


15

In order to keep exposures as low as reasonably achievable (ALARA) as outlined in

[.1603(b)], employees and this practice will protect themselves, and the patient by:

Operator standing behind the protective barrier.

Visually control the area. The operator will verify hallways and other areas are clear in

order to protect others from scatter radiation.

All appropriate doors are closed and appropriate shields are used during x-ray operation

as documented in the operating procedures and Plan Review.

Cone positioning is adjusted to ensure that no beam is aimed at a non-shielded area.

Use of lead aprons and thyroid collars when possible on patients for all exposures.

Appropriate construction of the walls, floor and ceiling areas exposed to the useful beam

in accordance with regulatory requirements to provide appropriate protection to all

employees taking x-rays.

All equipment is maintained in good operating order. Maintenance and calibration

records are stored behind the Equipment and Facility tab for the lifetime of the

equipment.

Other ____________________________________________________________

_________________________________________________________________

_________________________________________________________________

Additional measures taken in order to ensure that members of the general public do

not receive a total effective dose that exceeds 0.1 rem (1mSv) in a year as outlined in

[.1611(a)(1)] and that the dose in any unrestricted area of this practice will not

exceed 0.002 rem (0.02 mSv) in any hour [.1611(a)(2)] :

No member of the general public is allowed in controlled areas.

As outlined in [.1604(a)(1)] the Maximum Annual Occupation Dose Limits:

5 rems (.05 Sv)), total effective dose to whole body.

15 rems (0.15 Sv) eye dose equivalent to the lens of the eye.

50 rems (0.50 Sv) total organ does equivalent.

50 rems (0.50 Sv) shallow dose equivalent to skin or any extremity


16

VOLUNTARY DECLARED EMPLOYEE PREGNANCY POLICY

For the declared pregnant worker, this practice has the responsibility to take appropriate action to

ensure the dose to a fetus due to occupational exposure [.1610]:

Does not exceed 0.5 rem (5 mSv or 500 millirems) during the entire pregnancy

Does not exceed more than 0.5 mSv in any month

The dose to the fetus is measured as the sum of:

The deep-dose equivalent to the declared pregnant woman and

The dose to the embryo from radionuclides in the embryo and radionuclides in the

pregnant woman.

Verbal notification is not an acceptable form of notification. Declaration of pregnancy must be

submitted in writing and must include the following information:

Pregnant employee’s name.

Estimated due date or date of conception.

The date the declaration was signed.

Upon receipt of written notification of pregnancy the following apply:

Fetal Badging:

The use of a fetal badge is required at any time the potential for radiation exposure

exists. The badge will be worn at waist level of the pregnant worker.

Declared pregnant worker:

This practice has performed baseline testing which has documented workers are not

likely to receive, in one year, in excess of 10 percent of the annual limits which is

0.05 rem (.5mSv) therefore personal badging is not required.

The use of a personal badge at any time there is the likelihood the pregnant women

would receive a deep dose equivalent in excess of 0.1 rem (1mSv) as required in

[.1614(1)(c)] is required.

Information will be provided to the employee on the dangers of fetal exposure to

radiation, as well as techniques and procedures to minimize exposure to the fetus.

Job reassignment or other actions depending on the potential for exposure may be

considered. The employee may also request reassignment of duties if desired.

Exposure history will be reviewed.

Record Keeping [.1640(f)]

The practice will maintain the employee declaration of pregnancy records of dose to an

embryo/fetus with the records if indicated of dose to the declared pregnant woman for 30 years

past the last date of employment or until the practice license or registration is terminated by The

North Carolina Department of Health and Human Services, Radiation Protection Section,

whichever is longer.


17

MONITORING OF OCCUPATIONAL DOSE

Radiation Monitoring for Employees

Personnel monitoring devices to monitor radiation dose are required for workers using dental x-

ray machines if an employee is likely to receive 10 percent of the annual limit allowed by

regulation. If previous baseline radiation monitoring records show that it is unlikely that a person

will receive a dose of this amount, then ongoing personal monitoring is not necessary except in

outlined situations.

For the safety of employees and to meet regulations outlined in [.1614], this office

will provide personal monitoring badges for workers as outlined below:

Personal monitoring badging is not required. This practice has performed baseline testing

which has documented workers are not likely to receive, in one year, in excess of 10

percent of the annual limits which is 0.05 rem (.5mSv).

This practice will perform baseline testing to document workers are not likely to receive, in

one year, in excess of 10 percent of the annual limits which is 0.05 rem (.5mSv).

• All employees will wear the badges for ________________________ (time) even

when operating only digital equipment.

Badges will be required for an additional ______________________(time) period if new

equipment is installed or if the office layout is changed.

Any employee required to hold patients must wear a badge.

Any employee must wear a badge if instructed to do so by the RSO.

Other _________________________________________________________

Personal Monitoring Devices Placement and Recommendations:

Follow manufacturer’s guidelines for use.

Whole body monitoring devices are placed at the neck level or upper torso. If a protective

apron is worn the monitoring device is placed at collar level outside of the protective

apron.

Fetal monitoring devices are placed at the waist and always on the outside of any

protective apron.

Badges are issued to a specific employee and record the personal exposure of that

employee. Do not share your badge with another employee it will distort both records.

Remove badge when receiving personal radiographic studies.

Changing of Personal Monitoring Badges

The schedule for badge changing is set by the RSO.

Badges will be changed: _____________ (must be at least every 3 months).

This practice will change badges on the first working day of the month.


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If any employee in the practice reaches the maximum annual allowed dose of 5 mSv, then

all workers will change badges monthly until the cause for the high reading has been

resolved.

Fetal monitoring badges will be changed on a monthly basis.

Notify the RSO if badge is lost or misplaced.

Storage of Personal Monitoring Badges

Store in a safe place, at work away from sources of radiation and heat.

Do not store badge clipped to lab coat or jacket as someone could accidentally pick up

your badge or it could fall off of the jacket and become lost, or laundered accidentally.

Storage location for this office: __________________________________________

Control badge monitoring – A control personal monitoring device must be stored in an area

where only background radiation will be measured. The control badge will not be used for area

monitoring or assigned to a person.

Storage location for this office: ____________________________________________.

The monitoring badge service provider is ___________________________________.

The provider is accredited by the National Voluntary Laboratory Accreditation Program

(NVLAP) of the National Institute of Standards and Technology (NIST).

When the defined issuing period has passed, all badges, including the control, must be returned to

the service provider for measurement. Any badges that have not been issued, or if issued have not

been worn, must also be returned to the service provider.

Report of Individual Monitoring Results

Individual reports of dose levels reported by the dosimeter will be reviewed by the RSO and with

employees on a quarterly basis when badging is in process. These reports will be retained in the

employees file and are available for review by the employee upon request. The employee will

initial each report to acknowledge the review process.

Reports of Excessive Radiation Exposure

In this practice the RSO will investigate if a report is received that indicates any employee badge

has a reading that exceeds the following ALARA investigational limits.

Quarterly Investigational Limits for Monthly Wear Dates

125 mRem for whole body badges

30 mRem for fetal badges


19

Each employee must be aware of their own accumulated dose as registered on their badge.

Accumulated exposure, even from a prior employer, must be considered in the overall exposure

limit.

If at any time the employee for any reason (accident, etc.) believes they have received an

exposure that exceeds the limit the employee must notify the RSO immediately.

Reassignment of duties may be necessary if dose limits are met or exceeded for any reason.

Prior Records for Occupational Dose for New Worker [.1638(a)(1)&(2)],

This practice has performed baseline testing which has documented workers are not

likely to receive, in one year, in excess of 10 percent of the annual limits which is 0.05

rem (.5mSv).

This practice will attempt to obtain previous occupational dose history for the current year

from the previous employer(s) on all new employees and will attempt to obtain the

records of lifetime cumulative occupational radiation dose.

This practice will accept any of the following:

• Signed statement from the individual, or from the individual's most recent employer

for work involving radiation exposure, that discloses the nature and the amount of

any occupational dose that the individual may have received during the current

year;

• Accept, as the record of lifetime cumulative radiation dose, an up-to-date agency

form for recording occupational radiation dose history, or equivalent, signed by the

individual and counter-signed by an appropriate official of the most recent

employer for work involving radiation exposure, or the individual's current

employer if the individual is not employed by this practice (example – staffing

service).

• Reports of the individual's dose equivalent(s) obtained by telephone, telegram,

electronic media, or letter from the most recent employer for work involving

radiation exposure, or the individual's current employer if the individual is not

employed by this practice (example – staffing service). This practice will request a

written verification of the dose data if the authenticity of the transmitted report

cannot be established.

Working for Multiple Employers

It is the employee’s responsibility to provide dose information to each employer from the other

place of employment. Employees working for multiple employers with the possibility of radiation

exposure should talk with the RSO about the best method of ensuring the total radiation dose is

recorded.


20

Information in Personnel and Exposure Records: Records will be maintained for 30 years past the last date of employment or until the

practice license or registration is terminated by The North Carolina Department of Health

and Human Services, Radiation Protection Section, whichever is longer

[.1640(a)(1)&(g)] and will include:

Full name, sex and date of birth.

Home address.

The date of commencement of employment and the last date of employment.

Description of work performed by the employee.

Details of the types of ionizing radiation to which the employee may have been exposed

in the course of their employment.

Details must be provided of any radiation accidents in which the employee has been

involved or by which they may have been affected.

Details of the personal monitoring badge worn by the employee. This may include the

type of monitor, where on the body the monitor was worn and the name of the monitoring

service provider.

Radiation exposure dose results for the employee.

Radiation exposure dose for the fetus.

Radiation Exposure Records for Departing Employees

This practice will provide the following:

A copy of their radiation exposure records. This will include all annual dose records

and any subsequent periodic reports received after the employee has ceased

employment if available.

An additional copy of the radiation exposure records will be provided to the new

employer if requested by the employee. These records are required to be given to a

new employer so that an assessment can be made of possible future doses that can be received to keep an employee under their annual limit.

21


REPORTING RADIATION INCIDENTS AND EXPOSURES IN NC

A radiation incident is an incident adversely affecting, or likely to adversely affect, the health or

safety of any person because of the emission of radiation and must be reported to the RSO. The

most likely radiation incident at this practice is an actual or suspected malfunction of the x-ray

equipment.

In this case of equipment malfunction, the following procedure must be observed:

The user must switch off the x-ray unit as quickly as possible at the main supply.

The user must take precautions to prevent the use of the x-ray unit by:

1. Posting a sign which states that the x-ray unit must not be used.

2. Removing the key to the x-ray unit or taking other appropriate action.

The x-ray unit must not be used until it has been repaired (and if necessary compliance

tested) and the possession licensee authorizes its use.

The RSO must determine the radiation dose to each person involved in the incident.

Overexposure Incidents

If a patient may have received radiation in excess of the normal x-ray or a member of the general

public may have received radiation in excess of the dose limits, notify the RSO immediately. This

office is required to report to the State Radiation Protection area any individual exposure in

excess of the limit set by regulation. The timeframe for reporting of overexposures by this

practice depends on the exposure the patient received.

Records Retention

Unless otherwise indicated, all reports will be retained for 3 years.

The following incidents will be reported by the RSO immediately as outlined in

[.1646]:

Any event involving a source of radiation possessed by this practice that may have caused or

threatens to cause any of the following conditions:

An individual to receive:

o a total effective dose equivalent of 25 rems (0.25 Sv) or more

o an eye dose equivalent of 75 rems (0.75 Sv) or more

o a shallow-dose equivalent to the skin or extremities of 250 rads (2.5 Gy) or more

Loss of one working week or more of the operation of any facilities affected

Damage to property in excess of $200,000.

Reports required immediately should be called to:

The Division of Radiation Protection

(919) 571-4141

8:00 a.m. to 5:30 p.m. on workdays

22


The following incidents must be reported by the RSO within 24 hours as required in

[.1646]:

Any event involving a source of radiation possessed by this practice that may have caused or

threatens to cause any of the following conditions:

An individual to receive, in a period of 24 hours

o a total effective dose equivalent exceeding five rems (0.05 Sv)

o an eye dose equivalent exceeding 15 rems (0.15 Sv)

o a shallow-dose equivalent to the skin or extremities exceeding 50 rems (0.5 Sv);

Loss of one day or more of the operation of any facilities affected

Damage to property in excess of $2,000

Reports required within 24 hours should be called to:

The Division of Radiation Protection

(919) 571-4141

8:00 a.m. to 5:30 p.m. on workdays

A written report will be submitted by the RSO within 30 days as required in [.1647]

for the following incidents:

Any incidents which were reported by phone immediately or within a 24 hour timeframe

as required by [.1646]

For the dose limits that exceed:

o Occupational dose limit for adults [.1604], and minors[.1609]

o Limits for an embryo/fetus[.1610)]

o Limits for a patient or general public[.1611]

o The ALARA constraints for air emissions[.1603]

The report using the Radiation and Exposure Report form will outline the extent of exposure of

the individual to radiation and will include the following [.1647(b)]:

Estimates of each individual's dose.

Levels of radiation involved.

Cause of the elevated exposures, dose rates, or concentrations.

Corrective steps taken or planned to ensure against a recurrence, including the schedule

for achieving conformance with applicable limits as outlined in ALARA.

For each occupationally overexposed individual, the report as required by [.1647(c)] will be

prepared so that the following information is stated in a separate and detachable part of the

report and will include

Name

Social security account number

Date of birth

With respect to the limit for the embryo/fetus, the identifying information shall be that of

the declared pregnant woman.

23


A copy of the completed report will be provided as directed in [.1647(d)] and [.0111] to:

The North Carolina Department of Health and Human Services

Radiation Protection Section

1645 Mail Service Center

Raleigh, North Carolina 27699-1645

Or delivered to the agency at its office located at:

3825 Barrett Drive

Raleigh, North Carolina 27609-7221

The practice will provide a report to the exposed individual no later than when the report is

provided to The North Carolina Department of Health and Human Services, Radiation Protection

Section as required in [.1647(e)]

Radiation exposure reports will be maintained for 30 years past event date or until the practice

license or registration is terminated by The North Carolina Department of Health and Human

Services, Radiation Protection Section, whichever is longer.

PRACTICE SPECIFIC PROTOCOLS

Table of Contents

Required Use of PPE 1

Appropriate Use of Dosimeter 2

Material Safety Data Sheets 3

Infection Control Protocols 4

Sample Protocols

Film Storage and Processing

Gendex 765CD Intraoral X-ray

Trophy CCX Digital

Planmeca Intra

Orthomantomography Panorex OP100 Orthoceph

Air Techniques Proverta 70

Note: This section of the Written Radiation Protection Safety Program contains:

• Procedures to minimize exposures to blood, OPIM or chemicals.

• Procedures for operating specific equipment.

• Office specific policies and procedures.

These serve as instructions and guidelines for employees and must be followed as outlined.

Sample protocols are provided as examples. Replace the samples with protocols specific to

instrumentation in use and remove the samples. Use the samples only if they are accurate for your

practice.

1

REQUIRED USE OF PERSONAL PROTECTIVE EQUIPMENT

Personal protective equipment (PPE) such as gloves, eye protection, masks and gowns are used

by this office for infection control purposes.

As part of new employee and annual training, the appropriate use of PPE, is reviewed with all

employees involved in radiology services.

Training includes:

Indication for use of PPE

Appropriate donning and doffing of PPE

Appropriate disposal of PPE

The appropriate PPE for use with each procedure is indicated on:

The Hazard Assessment Certification which is located at the end of this section.

Other (Indicate where the information is recorded and located)

_______________________________________________________________

2

APPROPRIATE USE OF DOSIMETER

The following are reminders of the appropriate use of the dosimeter. The RSO will provide clear

instruction when dosimeters are to be utilized outside of the following situations:

Baseline monitoring of radiation exposure in the practice

Declared pregnancy

When holding patient/film during exposure

• DO WEAR IT when working. It has no value in your locker or purse.

• DO TURN IT IN on time. Time gaps make analysis more difficult, less accurate and reduces

legal and historical value of the reports.

• DO PLACE the control dosimeter in a radiation-safe area; the dose to the control is subtracted

from each dosimeter and needs to be accurate.

• DO REPORT LOST OR DAMAGED dosimeters immediately. Prevent damage by not

leaving your dosimeter in areas of high temperature such as your dashboard or in the clothes

dryer.

• DON’T WEAR IT when you are receiving x-rays for your own health care.

• DON’T WEAR IT away from the workplace. Leave your dosimeter in the same place every

day when you leave the office so you know where it is.

• DON’T WEAR IT under your apron unless you are wearing two dosimeters, one at the neck

level outside the apron and one under the apron. This applies to pregnant workers.

• DON’T PLACE a dosimeter in an area for testing of stray radiation. Additional dosimeters

can be assigned for testing.

• DON’T SHARE dosimeters. An average total for a shared dosimeter is meaningless to each

individual.

• DON’T TAMPER with your dosimeter or anyone else’s. The reports are legal documents and

are regarded as real exposures received.

3

MATERIAL SAFETY DATA SHEETS This practice recognized the employees “right to know” about chemicals in which they may come

in contact with during the performance of their work responsibilities.

As part of new employee orientation, on an annual basis, and when new chemicals are added

employees are trained on appropriate use, spill response, and appropriate disposal of chemical

utilized in the X-ray process.

Employees will follow manufacturers recommendation for use of all chemicals associated with

the X-ray process.

Material Safety Data Sheets (MSDS) are available at all times to employees.

MSDS are accessed via the internet at _________________________________________

In the event internet access is unavailable employees may find the needed MSDS by

________________________________________________________________________

MSDS are available in hard copy form in ______________________________________

4

INFECTION CONTROL PROTOCOLS

Preparation before taking x-rays

Utilize appropriate PPE as outlined in the Hazard Assessment

Protect radiography equipment (radiograph tube head and control panel) with surface

barriers that are changed after each patient.

Aseptically dispense film to be used into a clean disposable container and transport to the

treatment area.

Protect the patient by using a lead apron with a thyroid collar even when performing

digital studies.

Panoramic/Extraoral x-rays

Wash hands.

Handle extraoral cassettes with ungloved hands.

The bite holder required on some panoramic x-ray units (or any intraoral film holder)

should be autoclaved if possible.

Disposable or barrier protected bite holders may be used instead. If a barrier is used have

the patient remove the barrier and place it in the trash.

Decontaminate bite holder based on manufacturer’s recommendation.

Digital Studies

Utilize barrier device as listed by equipment manufacturer to reduce gross contamination.

Clean and disinfect device with EPA approved hospital disinfectant as outlined by

manufacturer.

Taking x-rays:

Wear gloves when taking intraoral radiographs. Use eyewear, mask and gowns if spatter

is likely.

Stay behind the lead shield.

Dry the film with disposable gauze or paper towel to remove blood or excess saliva.

Place film in a disposable container, such as a plastic or paper cup.

Using Film-Holders

Use film-holders that have been autoclaved or sterilized with a cold sterilant if they

cannot take the heat of an autoclave.

Assemble the film-holder for specific region to be viewed/exposed.

Insert the correct film size and insert into block with ‘dot in the slot.’

Position the film-holder in the mouth.

Use cotton roll as needed for comfort of patient.

Slide aiming ring down the indicator rod to near the skin surface.

Align BID/PID flat against the aiming ring.

Select correct exposure settings on machine and make the exposure.

Gently remove the film-holder.

Place exposed film in a place where it will not be accidently mistaken for unexposed

films.

5

After completing the x-rays:

If film barrier pouches are used, remove the film packets from the pouch and allow them

to drop into a clean container for transport to the developing area. Take care to avoid

contamination of the outside packet and container. If barrier pouches are not used,

transport the film to the developing without further handling in the patient area.

Remove and discard contaminated barriers. Discard other contaminated disposable items.

Remove and discard gloves and wash hands.

After each patient, clean and disinfect any equipment, not protected by barriers, that was

touched by gloved hands or contaminated film packets. Use an EPA-registered

disinfectant.

Put away reusable items such as film-holding devices and lead apron.

Transport film to the developing area with ungloved hands.

Developing film:

Use barriers to protect equipment or clean and disinfect surfaces that become

contaminated.

To process film without barrier pouches:

o Don gloves.

o Open each film and drop it out of its wrapping onto a flat surface covered by a

paper towel. Discard lead foil into container for recycling.

o After opening all of the exposed film, dispose of container and packets.

o Remove and disposed of contaminated gloves. Wash hands.

o Place the film into the processor slot or film holder for developing.

When an automatic film processor with daylight loader is used, contamination of the

fabric shield is likely a problem. There is no practical way to disinfect this material. The

following procedures will prevent contamination.

o With clean, ungloved hands, open the lid. Place a paper towel, paper cup and

powder-free gloves inside the loader’s compartment.

o Place the container with the film next to the cup.

o Place ungloved hands through the light shield and don gloves. Unwrap the film

packet and drop the film onto paper towel or processor film feed slot.

o Place the film wrapping into the second cup. Remove gloves, turn them inside

out and place them into the cup.

o Place the film in the chute for processing handling only by the edges.

o Remove hands from the loader and wash hands.

o Lift the lid and dispose of the paper cups and waste.

FILM STORAGE AND PROCESSING This section does not apply to facilities with digital imaging and no “wet chemistry” processing

capability or Endodontic facilities that use “hot” chemistry at the chairside.

Manufacturer’s instructions for processing and storing film are located in the Equipment and

Facility section of this manual for reference.

Film Storage Unexposed x-ray film must be stored in accordance with the manufacturer’s instructions. The

manufacturer of our film is __________________________________.

Store daily use supply of film in a container in each operatory or

_____________________________________________________________.

Larger quantities, more than a month’s supply, are stored

______________________________________________________________.

Film is stored in light-tight containers with shielding to prevent fogging of

undeveloped film from stray radiation. If boxes are lead-lined be sure the lead has

been treated.

Do not store in untreated lead-lined boxes. Some older wooden boxes, usually the

size of a shoebox, used untreated lead. The FDA recommends discontinuing their use

immediately.

The area of storage is not near excessive heat of any type or excessive humidity.

Film may be frozen for up to two years usually (check the manufacturer’s

instructions.) Thaw at room temperature at least 24 hours before using.

The film container is not stored where chemical contamination might occur.

Film processing chemicals are stored in a manner to protect the film.

The film storage area is far enough away from the X-Ray unit to protect it from

ionizing radiation. (Do not store in the direct beam of the x-ray tube) and is protected

by ______________________________________________.

Do not use expired film. Remove expired film and check with the Safety Officer for recycling or disposal instructions.

Film Processing Tips

Chemicals: • The manufacturer of the processing fluid is

____________________________________________________.

• Test processing fluid before use by: ____________________________________ as specified

in the manufacturer’s instructions.

• Replace processing fluid every __________________________________________ as

specified in the manufacturer’s instructions.

• Processing fluid should not be used past the expiration date on the container.

• Do not use premix chemistry that is more than 30 days old.

• Do not allow processing fluid to freeze.

Lighting: • Lighting in the film processing area should be retained at:

• Filter type on the safe light ___________________

• Bulb wattage in the safe light _________________

• Distance from work surface for mounting of safe light _____________ feet.

• If you see leaks around the door or other openings in the darkroom notify the RSO.

The person responsible for replacing the fluid (chemistry) and cleaning the processor:

Name Date Name Date

Film Processing – Manual

Processing tanks are mechanically rigid and corrosion resistant.

The temperature of the solution is adequate will be verified using a non Mercury

thermometer.

Temperature guides will be followed as indicated by the film manufacturer’s chart

located in the Equipment section of the manual and ______________________.

Temperatures must be between 60F and 80F (16C to 27C)

The recommended developing time for that temperature as shown on the time-

temperature developing charts will be utilized.

The temperature will be checked at the beginning of the day and throughout the day each

time film is developed.

Sight developing of radiographs is not acceptable for processing films.

Caution:

o When film holders and pan cassettes are used it is important that each be marked

so it is identifiable by the exposure operator if it is possible for a 2nd film

cassette to be placed in developer or fixer at the same time. Failure to mark them

could result in removing the wrong one and possibly ruining both.

Film Processing – Automatic

The temperature of the developer will be verified to ensure it is at the level recommended

by the manufacturer.

The temperature will be checked at the beginning of the day and throughout the day. The

temperature should be at ___________.

The accuracy of the automatic temperature control will be verified periodically.

Automatic developers monitor and adjust the temperature only and do not monitor the

chemistry condition.

Clean-up or blank films will be run daily or more often as specified by the manufacturer.

Processor will be maintained according to the instructions in the manufacturer’s

operation manual. The manufacturer’s manual is located in the Manufacturer’s section of

the Radiation Manual or ____________________________________.

Film Processing Records

Records of the weekly processor testing will not be retained, but the weekly films will be

retained until the chemistry is changed and the process begins again.

The processor chemistry change and darkroom maintenance log sheet will be posted in

the film processing area.

GENDEX 765DC INTRAORAL X-RAY

1. Switch the power switch to the “On” position. The Ready indicator lamp on the front of the

control panel will light.

2. Select or verify that the unit is set for either film or digital imaging. The indicator light should

be lit next to the appropriate graphic icon. Press the button between the two icons to toggle to

the correct selection.

3. Select or verify that the system is set for the appropriate patient selection (i.e. an adult or

child). Press the button between the two icons to toggle to the correct selection. The

technique factors to be used during an exposure should be set before the exposure begins

except when the exposure is automatic. In this case note the settings.

4. Press the selector button in the center of the control to toggle the indicator lamp until it lights

next to the tooth (or bitewing) symbol for the area that you wish to x-ray.

Note: The exposure time defaults (the times displayed when the system is initially turned on)

can be modified per the instructions in the Configuring Control Settings.

Setting exposure times and types before placement of film holders in the patient’s mouth

increases the chances of a better exposure. The least amount of time the film is in the mouth,

the better the odds the patient will not move to blur your image.

5. Position the tubehead to the patient using standard accepted positioning procedures.

Note: Care should be taken to not place fingers in areas where they may be potentially

pinched during the movement of the arm. Also, be careful to not have the tubehead hit the

wall after returning the arm to the storage position. Restrict the beam to the area of clinical

interest. The beam should not be larger than the image receptor. The method used for

restricting the beam is collimation or _________________________________.

6. Prior to making the exposure, verify or modify the time settings as necessary using the

secondary tubehead controls. Note: The unit is supplied with an 8” (20cm) cone. An optional

longer 12” (30cm) cone can be used to sharpen the image as when the paralleling technique is

used. A rectangular cone is available as an option to reduce the x-ray field size to that of the

film and reduce the radiation to the patient. Each cone must have a separate technique chart.

Notify your supervisor or the RSO if it is not available.

7. Optional coil-cord exposure switch is not allowed in North Carolina or South Carolina. If the

equipment comes with this option it must be disconnected even though you do not use it.

TROPHY CCX DIGITAL

1. Switch the power switch to the “On” position. The switch is on the control panel. The

power indicator light will come on.

2. Verify that the unit is set for film. The film speed indicator should be 1. Adjust as

necessary.


child) and tooth or bite wings. Press the button to make this selection.

4. The exposure time defaults can be modified to accommodate a large adult if necessary.

Always consult the dentist before changing the exposures. You will adjust this exposure

time by increasing the film speed selector number.

5. Drape the patient with a lead apron.

6. Place the phosphorus plate in the XCP device and position it in the patient’s mouth.

7. Position the tubehead to the patient using standard accepted positioning procedures. Note:

Care should be taken to not place fingers in areas where they may be potentially pinched

during the movement of the arm. Also, be careful to not have the tubehead hit the wall

after returning the arm to the storage position. Restrict the beam to the area of clinical

interest.

8. Step outside room to the control panel. Press the exposure buttons on the left and right

simultaneously. Watch the exposure move to o. You will hear a beep and see the X-ray

indicator light showing the x-ray was completed. Release the buttons. The machine will

automatically stop when the proper exposure time has passed. However if you release the

buttons early you will see the operator error light and hear a beeping noise.

9. Retrieve the plate form the patient’ mouth.

10. Turn the machine off.

PLANMECA INTRA

1. Turn the equipment on. The switch is in the patient room. Switch is on the base where the

arm is attached to the wall.

2. Go to the control panel and verify that the ready indicator light is lit.

3. Verify the unit is set on Plate mode. Plate mode will show P in the Exposure time

display.


child).

5. Select the appropriate X-ray area. You may have to press the button multiple times to get

to the proper area (upper, lower, etc.).

6. Drape the patient with a lead apron.

7. Place the phosphorus plate in the XCP device and position it in the patient’s mouth.

8. Position the tubehead to the patient using standard accepted positioning procedures. Note:

Care should be taken to not place fingers in areas where they may be potentially pinched

during the movement of the arm. Also, be careful to not have the tubehead hit the wall

after returning the arm to the storage position. Restrict the beam to the area of clinical

interest.

9. Return to the control panel. Press the buttons in the middle and the one on the left side to

activate the X-Ray. The Exposure warning indicator light will flash and you will hear a

beep during the exposure. Both will stop on completion. If you press only one button the

equipment will not activate.

10. Retrieve the plate form the patient’ mouth.

11. Turn the machine off.

ORTHOMANTOMOGRAPH PANOREX OP100 ORTHOCEPH

1. Turn the equipment on. The switch is under the base.

2. To set the unit to manual mode first press the down key once to move the flashing light

from standard panoramic to the AEC (A) position. Then press the right over key once to

move the flashing light to Manual (M) position.

3. At this time the light over the juvenile of the programmed exposure should be lit. To

change the program exposure first press the down key two times until the flashing light is

over the patient size symbol.

4. Now press side arrow keys to select the appropriate size ( child, juvenile, adult, large

adult)

5. Bring the patient to the machine.

6. Drape the patient.

7. Position patient appropriately.

8. On the side panel, lower right, press the down button. This will position the plate.

9. Step into the hall and push exposure button and hold. Watch your patient in the mirror.

10. Have the patient release the bite block.

AIR TECHNIQUES PROVERTA 70

1. Switch the power to the “On” position. The time in seconds will appear on the front of

the control panel.

2. Select or verify that the unit is set for either film or digital imaging. The indicator light

should be lit next to the appropriate graphic icon. Press the button between the two icons

to toggle to the correct selection.

3. Select or verify that the system is set for the appropriate patient selection (i.e. adult or

child). Press the button between the two icons to toggle to the correct selection. The

technique factors to be used during an exposure should be set before the exposure except

when the exposure is automatic. In this case note the settings.

4. Press the selector button in the center of the control to toggle the indicator lamp until it

lights next to the tooth (or bitewing) symbol for the area you wish to X-ray.

Note: The exposure time defaults (the times displayed when the system is initially turned

on) can be modified per the instructions in the Configuring Control Settings.

Setting exposure times and types before placement of film holders in the patient’s mouth

increases the chances of a better exposure. The least amount of time the film is in the

mouth, the better the odds the patient will not move to blur the image.

5. Position the tubehead to the patient using standard accepted positioning procedures.

Take care to not place fingers in areas where they may be pinched during the movement

of the arm. Also be careful to not have the tubehead hit the wall after returning the arm

to the storage position. Restrict the beam to the area of clinical interest.

6. Prior to making the exposure, verify or modify the time settings as necessary using the

secondary tubehead controls.

7. Optional coil-cord exposure switch is not allowed in North Carolina. If the equipment

comes with this option it must be disconnected even though you do not use it.

1

DOCUMENTATION REQUIREMENTS

Shielding Design/Plan Review - Prior to construction of structural modifications, the

floor plans and equipment arrangement of all installations utilizing x-rays for diagnostic

or therapeutic purposes must be reviewed by a qualified expert. The practice will submit

the recommendations to The North Carolina Department of Environment and Natural

Resources, Division of Radiation Protection. [.0603(a)(2)(A)] [.0306(b)]

Letter of Acknowledgement - Written acknowledgement of receipt by North Carolina

Department of Environment and Natural Resources, Division of Radiation Protection

received PRIOR to installation, of any facility and shielding design.

State Registration Forms – Required by the "North Carolina Regulations for Protection

Against Radiation" rules .0203, each registrant will complete proper application to

register radiation machines and facilities within 30 days following initial operation of that

facility and each radiation machine. The registration of the first radiation machine at a

facility constitutes registration of the facility itself.

Application: Registration: Radiation Machines: Facilities

Application: Registration of Service

Post Installation Survey – Required for dental units utilizing cephalometric equipment

or taking radiographs in an open bay which must be performed within 30 days following

the initial operation of each radiation machine. This survey must be performed by a

person approved through The North Carolina Department of Environment and Natural

Resources, Division of Radiation Protection [.0603(a)(2)(B)] [.0603(c)]

Current Notice of Registration – Most current registration as outlined in

[.0603(a)(2)(A)] The registrant shall notify the North Carolina Department of

Environment and Natural Resources, Division of Radiation Protection in writing when

any change will render the information contained in the application for registration or

notice of registration no longer accurate. [.0209].

Maintenance and Calibration Reports - Each registrant will keep records of

maintenance or modifications which affect the useful beam, along with the names of

persons performing the service. [.0603(a)(2)(C)]

Inventory - Listing of all X-ray, development and support equipment essential to the

operation of X-ray units.

FDA Form 2579 - Report of Assembly - Manufacturers of diagnostic x-ray systems

intended for human use are required to file reports of assembly upon installation of a

certifiable system or component(s). The report of assembly represents the assemblers

certification that the system or component(s) are of the type called for by the Standard

(i.e., certified), have been assembled according to the instructions provided by the

manufacturer, and meets the requirements of the applicable Federal standards contained

in 21 CFR 1020.30 through 1020.33. Reports must be filed with FDA's Center for

Devices and Radiological Health (CDRH) within 15 days of completion of the assembly.

Copies must also be provided to State agencies and the purchaser.

QUALITY CONTROL

Table of Contents

QUALITY ASSURANCE PLAN FOR FILM RADIOLOGY

OPERATIONAL CHECKLISTS 1

VENDOR QUALITY ASSURANCE TESTING 3

QUARTERLY CHECKLIST – FILM 4

DAILY CONSISTENCY TESTING 6

PROCESSOR CHEMISTRY TEST 7

DARKROOM QC – SCREEN-FILM UNITS 10

SCREEN FILM UNITS

INTRAORAL

QUALITY ASSURANCE PLAN FOR DIGITAL RADIOLOGY

OPERATIONAL CHECKLISTS 13

VENDOR QUALITY ASSURANCE TESTING 15

QUARTERLY CHECKLIST – DIGITAL 16

LEAD APRONS 18

RETAKES AND REPEATS 19

Revised October 2011 1

QUALITY ASSURANCE PLAN FOR FILM RADIOGRAPHY

Operational Checklists

Forms are available in the Forms section of the manual to use for recording routine

operational checks. Indicate the QC functions performed by this office

Daily

Confirm the processing and intraoral x-ray unit is operating in a consistent

manner every day. Check the quality of a test film (e.g. first clinical image of the

day) by comparing it with a reference radiograph. (Consistency Test).

Run blank or clean-up films.

Verify temperature of processing chemicals each morning.

Check developer, rinse and fixer levels.

Clean processor feed tray and counter tops.

Clean darkroom.

Ensure visual and audible indication of exposure is functional.

Monthly

Perform a retake/reject analysis to determine the reason for the retake or reject

(which may include problems with the film, developing process, the X-ray unit

or the user).

Check processing box for light leaks.

Clean the viewboxes with glass cleaner. Replace bulbs and tubes.

Check the condition of personal protective equipment.

Technique Charts - exposure factors for specific examinations are readily

available.

Processor maintenance procedures are displayed in a prominent location

adjacent to the film processor.

Instructions for mixing chemicals and processing films are available.

Time/temperature chart, a timer and a thermometer are available for manual

processing.

Radiation Caution signs are properly displayed.

Visibly inspect lead aprons and shields for rips or tears.


Quarterly or Every Six month

X-ray equipment warning signs are displayed on each control panel and are in

good condition.

Film is within the expiration date specified by the manufacturer.

X-ray film is stored in accordance with this plan.

Oldest x-ray film is used first.

Verify accuracy of the information on the technique charts.

Cephalometric BLD insert in place.

Panoramic tube and film holder working properly.

Cables and wires meet OSHA requirements and are not in direct beam.

Cassettes stored properly.

Equipment allows employees to be shielded properly – Exposure switch

placement and patient can be viewed (except intra-oral).

Cone secured.

Film artifacts not present on processed film.

Control panel without operational issues.

Annual

Notice to Employees Poster is current and displayed.

Radiation Plan has been reviewed, updated and signed.

Employees have been trained and documentation of training recorded.

All operators have the appropriate and current certification/training.

Review incident reports for the year to determine if a trend exists and to define

any additional corrective action is needed to avoid future incidents.

Check lead aprons and shields to ensure adequate protection is provided. Aprons

must be x-rayed to detect problems. Suppliers can check aprons when inspecting

equipment.


Equipment Quality Assurance Testing to be conducted by vendors:

Adherence to the approved shielding plan, if applicable.

Half-value layer, exposure reproducibility.

mA/mAs linearity.

Integrity of pass through interlocks.

kVp accuracy.

Timer reproducibility and accuracy.

X-ray beam size.

Proper indication of multiple tubes on units so equipped.

Minimum source to skin distance.

Patient exposure at skin entrance (bitewing and/or periapicals).

Mechanical support of tubehead.

Visual and audible indication of exposure.

Exposure reproducibility.


QUARTERLY CHECKLIST ITEMS – Film Radiography

Each of the items below should pass the visual check or corrective action should be

taken. Use the Quarterly Inspection Record form to note any action taken.

Some of the items on the visual checklist are operator convenience features. However,

many of the items are essential for patient safety and high quality diagnostic images. It

may be necessary to add additional items to the list that are specific to particular

equipment or procedures. These should be included on the checklist and in each

evaluation.

1. Cephalometric beam limiting device (BLD) insert in place and used. Determine if the

unit has built-in collimation or if manual beam limiting devices are being used. Assure

that the collimators are functioning correctly and smoothly. Determine that manual

beam limiting devices are sufficient for blocking the beam. Assure that collimators or

beam limiting devices are being utilized correctly for the area being radiographed.

2. Panoramic tube and film holder motion smoothness. Determine that during motion the

tube and film holder moves smoothly without catches or interruptions.

3. Cone or cylinder secured to tube. Visually inspect the connection between the tube

and the cone or cylinder. Determine the connection is secure and stable. Could cause

retakes. Operators may not support tube in any way.

4. Tube or generator oil leakage. Visually inspect areas around tubes and generators for

oil or abnormal collections of dust attaching to oil leaks. Equipment problems and a

risk of slips.

5. Condition of cables and wires. All cables and wires should be inspected for frayed

coverings, kinks, and should be free from catching on other objects. Must meet OSHA

standards for safety. Cords should be outside of area. X-ray can damage cords.

6. Film artifacts. Examine exposed processed films closely to determine if artifacts are

visible. Density variations, small specks from dust particles, fingerprints, water marks,

and other artifacts should not be visible.

7. Cassettes and screens condition. Cassettes and screens should be cleaned regularly.

Check screen condition for dust particles, scratches, and areas of discoloration. Assure

screens are properly fitted and attached to cassettes (if applicable). Check cassette

latches to make sure they are functioning properly and are not broken. Cassettes and

screens should be replaced if necessary.

8. Film storage. Determine that film is stored in a cool, dry place, and is protected from

exposure to stray radiation. Assure that film boxes that have been opened are stored in

a light-tight container. Determine that film being stored has not expired; check the

expiration dates.

9. Loaded cassette storage. Determine that loaded cassettes are stored in an area that is

properly shielded from radiation to prevent exposure. They should be stored off the

ground and kept free from dust.


10. Control panel indicators. Assure all control panel switches, lights, and meters are

functioning correctly.

11. Technique chart. Make sure technique charts are available, current, and appropriate for

all procedures normally performed.

12. Equipment allows operators to remain behind barriers during X-rays as required.

Patient view ability. Check for the availability of a method to permit continuous

observation of the patients during the x-ray exposures, except with intraoral films.

Exposure switch placement. Assure the exposure switches are mounted or

exposure switch cables are long enough that operators are not exposed to

unnecessary levels of scatter radiation during x-rays.


QC - DAILY CONSISTENCY TESTING

A reference radiograph is an image that exhibits the desired qualities of contrast,

density and sharpness. Radiographs should be compared to the reference radiograph.

Changes in appearance may indicate problems with equipment, exposure or processing.

The reference radiograph should last for the life of the processor.

Establish a reference radiograph for daily comparison use. Be sure to use new solutions

of developing films to establish the reference radiograph.

1. Place the Dental Radiographic Normalizing and Monitoring Device on a flat

surface and insert unexposed intraoral film under the copper square.

2. Center the cone on the copper square and touching device.

3. Use posterior bitewing technique factors and expose the film.

4. Process the film as normal.

5. Insert the dried test film into the film slot on the test tool. Slide the test film until

one of the density steps match the test film density.

6. If the test film is above or below the mid-density steps (Steps 3-5), adjust the x-

ray timer settings and repeat the steps to establish the reference radiograph.

7. Record the technique factors used and the density setting matched by the film.

Conduct a daily test prior to the first patient x-ray and record the results on the daily QC

form. The daily test should be within one step of the first test film.

Resolving Problems

If problems are encountered, refer to the troubleshooting guide for the device. If

problems persist call the service engineer for the equipment.

If you are using extraoral screen-film and are doing daily sensitometry to monitor the

film processor, it may not be necessary to complete the daily consistency test. This

process is recommended by the Conference of Radiation Control Program Directors,

Inc. (CRCPD) www.crcpd.org.

http://www.crcpd.org/


QC – PROCESSOR CHEMISTRY TEST METHOD

Processor Chemistry Test Method

Test processor chemistry activity at least once a week using a density comparison

technique, such as the Dental Radiographic Quality Control Device (Crabtree)®* or a

density step wedge such as the 76-025-4000 Dental Aluminum Step Wedge from

Cardinal Health/Nuclear Associates**.

The DRQCD ® is a density comparison tool that is constructed with a copper strip to

create a density on a dental intra oral film. The film is inserted into the pocket on the

device behind the copper plate and exposed to a typical bitewing x-ray technique.

Create a "master" film when the chemistry is fresh.

A new "master" is created each time the chemistry is changed. This master is used

to compare with the weekly test film.

Insert the processed "master" into the slot above the density comparison scale and

identify the "step" closest to the film density by pulling or pushing the slide back

and forth.

Once you find the matching density, label the "master" with that number (usually

3, 4,or 5).

The subsequent processed image is compared to the density scale to determine

whether there are changes in the density or contrast due to changes in the

chemistry when compared to the "master". Lighter films could indicate developer

that is getting exhausted and needs to be changed or replenished or could indicate

that the developer temperature is low.

By testing at least once per week, you may be able to extend the chemistry change

time and save resources by not changing as frequently.

You may find that the automatic replenishment system (if the unit has one) is not

functioning properly and you need to hand replenish the developer or adjust the

replenishment rate.

Films that are cloudy may indicate that the fixer solution has become

contaminated and needs to be changed or replenished or that the wash water is not

turned on.

If the difference between the "master" film created when the chemistry was fresh

and the weekly comparison film is one step or more when comparing the same

step, the chemistry needs to be changed or replenished before patient films are

processed.

DO NOT CHANGE THE TECHNIQUE TO MAKE THE TEST FILM

MATCH THE MASTER! If you use the new technique on patients, all you

are doing is increasing the radiation exposure. Find out what the problem

with the processor is before processing patient films.


Large film processors (ceph and pan)

If a large film processor is used for ceph or pan films, the 11 step aluminum

wedge, such as the Cardinal Health/Nuclear Associates Model 76-025-4000, may

be used with a flat cassette such as a cephalometric cassette. If the cassette has a

screen block for the nasal bones, be sure to place the wedge on the portion of the

cassette where the screen is not blocked.

If only a curved cassette or flexible film holder for a pan unit is available, the test

cannot be performed and you will have to rely on the processor manufacturer

instruction for frequency of chemistry changes.

If a flat cassette is available, expose the wedge on the cassette to a technique of

about 70 kV at about one second or 60 pulses. This can be done with the cassette

in the ceph frame by taping the wedge to the cassette. This should produce a film

that shows all 11 steps on the wedge. The darker steps (thinner portion of the

wedge) may be difficult to discern.

Label the first film on fresh chemistry as the "master" and retain this film.

Compare all other films to the "master".

If the density difference between the "master" and the test film is more than one

step, change the chemistry or replenish the chemistry if the temperature is correct.

The test film should be exposed using the same x-ray machine and same

technique each time. This will provide more consistent results and prevent

unnecessary chemistry changes.

Hand processing

• Proper processing time is critical with hand tanks and a timer is needed in the

darkroom.

• A stem-type thermometer should be in the developer tank to monitor the temperature.

Mercury thermometers must never be used in film processors.

• Process the film for the length of time required by the developer temperature.

• A time/temperature chart should be posted in the darkroom.

Alternative Methods

Alternative test methods, such as anatomical phantoms, may be used for consistency

testing so long as they are capable of producing images of sufficient contrast variation to

tell when the chemistry needs attention.

Step wedges may also be hand-made by using dental lead foil from film packets. Stagger

a group of four lead foils to create steps of different thicknesses to create a wedge shape.

*A Dental Radiographic Quality Control Device© (Crabtree) device is a tool used to

compare the density of dental films exposed using the device to a standard film strip

which comes with the device. A copper plate in the device creates a density when the

film is exposed to x-ray. The films taken at various times of the month can be compared

to see if the chemistry is becoming exhausted and needs to be replaced.

Other density comparison devices, such as an aluminum step wedge, may be used as

well. The wedge is placed on the film and exposed to the same technique from the same

tube head each time. The films are processed and compared with the master film created


when the processor chemistry is first replaced. The master film is stored and used for the

weekly comparison. A master film needs to be made each time the chemistry is changed.

Contact your supplier for more information.

Mention of a device, product or service does not constitute an endorsement of a product

or manufacturer. It serves only as a representation of the types of devices, products or

services which are available.


QC - DARKROOM

General Housekeeping

Clean processor feed tray and counter top.

Mop the floor of the darkroom, clean counters and cabinets to remove any dust.

Clean film hangers.

Developer Temperature Control

Manual Processing:

Measure the developer temperature daily with a non-mercury

thermometer.

Compare the temperature with the time-temperature for the equipment.

Replenish the fluid following the manufacturer’s guidelines for manual

processing and replace rinse water.

Automatic Processing

Measure the temperature to confirm it is within the range established by

the manufacturer and that the display is accurate.

If completing the daily consistency of film test, daily temperature

measurement may not be necessary.

Minimize Darkroom Fog – Screen-Film Units

A suggested standard by CRCPD is an optical density increase of 0.05 or less which

should be conducted with each type of film used on a semiannual or annual basis.

Supplies Needed:

Manila file folder

Watch

Densitometer

Attenuation block (aluminum step wedge, phantom, acrylic block) to create a

medium optical density of about 1.0 on the film.

Procedure:

1. Load a cassette with film and place on a flat surface.

2. Center the attenuation block and expose the film using an x-ray technique that

will result in an optical density of about 1.0 after the film is processed.

3. With the safelights on, place the exposed film on the work area in the darkroom.

Cover half the film with opaque material, bisecting the latent image parallel to the

long axis of the film.

4. Leave exposed film on the counter for 2 minutes, then process as usual.


5. While waiting 2 minutes for darkroom fog test, look for any sources of extraneous

light. Any light leaks identified should be repaired as soon as possible.

6. Inspect the processed film. If there is no discernible delineation between the

shielded and unshielded sides of the film, there is no fog problem.

7. If a line is evident, measure the optical densities of both sides of the line with the

densitometer. If the density difference is greater than 0.05, corrective action

should be taken.

Corrective Action if Necessary

Repeat the test with the safelight off.

If the results remain the same, the problem may be caused by a light leak or

extraneous light.

If the fog level disappears, the fog was due to the safelight and remedial action

must be taken to correct the problem.

Possible sources of fog

Safelight filters (old or compromised)

Safelight housing

Safelight too close to work area

Light bulb of incorrect wattage or type

Ancillary indicator lights on processor

Timers

Radios

Fluorescent light afterglow

Light leaks

Suspended ceilings

Any place there is a hole cut in the wall

Excessive ambient light through the tinted viewing windows of daylight loading

systems

Minimize Darkroom Fog – Intraoral (without densitometer)

The goal is to maintain no visible difference in density between the shielded and

unshielded sides of the fog test film. With no defined density differences present the use

of a densitometer is unnecessary.

Conduct this test semiannually, for each type of film used, after bulb or filter replacement

and after changing or adding types of film.

Supplies Needed:

Manila file folder

Watch

Attenuation block (aluminum step wedge, phantom, acrylic block) to create a

medium optical density of about 1.0 on the film.


Procedure:

1. Expose the film so that the background density will produce a medium optical

density.

2. With the safelights on, remove exposed film from its light tight covering and

place the exposed film on the work area in the darkroom. Cover half the film with

opaque material, bisecting the latent image parallel to the long axis of the film.

For a daylight processor, place film under the tinted viewing window in the glove

box.

3. Leave exposed film on the counter for 2 minutes, then process as usual.

4. While waiting 2 minutes for darkroom fog test, look for any sources of extraneous

light; any light leaks identified should be repaired as soon as possible.

5. Inspect the processed film. If there is no discernible delineation between the

shielded and unshielded sides of the film, there is no fog problem.

6. If a line is evident, repeat the test to determine the source of darkroom fog. A test

film, which shows no delineation between the shielded and unshielded sides, must

be obtained to assure the source of the darkroom fog has been resolved.

Corrective action if Necessary

Repeat the test with the safelight off. If the results remain the same, a light leak or

extraneous light may be the cause of the problem. If the fog level disappears, the fog was

due to the safelight and remedial action must be taken to correct the problem.

Possible sources of fog

Safelight filters (old or compromised)

Safelight housing

Safelight too close to work area

Light bulb of incorrect wattage or type

Ancillary indicator lights on processor

Timers

Radios

Fluorescent light afterglow

Light leaks

Suspended ceilings

Any place there is a hole cut in the wall.

Excessive ambient light through the tinted viewing windows of daylight loading systems


QUALITY ASSURANCE PLAN FOR DIGITAL RADIOGRAPHY

Operational Checklists

Forms are available in the Forms section of the manual to use for recording routine

operational checks. Indicate the QC functions performed by this office.

Daily

Confirm the intraoral x-ray unit is operating in a consistent manner every day.

Check the quality of a test digital image (e.g. first clinical image of the day) by

comparing it with a reference radiograph. (Consistency Test)

Visual and audible indication of exposure is functional

Monthly

Perform a retake/reject analysis to determine the reason for the retake or reject

(which may include problems with the X-ray unit, software or the user)

Inspect the condition of personal protective equipment

Technique Charts – Ensure exposure factors for specific examinations are

readily available

Radiation Caution signs are properly displayed.

Visibly inspect lead aprons and shields for rips or tears.

Quarterly or Every Six month

X-ray equipment warning signs are displayed on each control panel and are in

good condition.

Technique Charts - Verify accuracy of the information on the technique charts.

Cephalometric BLD insert in place

Panoramic tube and sensor holder are working properly.

Cables and wires meet OSHA requirements and are not in direct beam.

Cassettes stored properly.

Equipment allows employees to be shielded properly – Exposure switch

placement and patient can be viewed except intra-oral.

Cone secured.

Control panel without operational issues.

Annual

Notice to Employees Poster is current and displayed

Radiation Plan has been reviewed, updated and signed

Employees have been trained and documentation of training recorded.


Verify all operators have the appropriate and current certification/training.

Review all incident reports for the year to determine if a trend exists and to

define any additional corrective action is needed to avoid future incidents.

Check lead aprons and shields to ensure adequate protection is provided. Aprons

must be x-rayed to detect problems. Suppliers can check aprons when inspecting

equipment.

Document verification of PPE.


Equipment Quality Assurance Testing to be conducted by vendors:

Adherence to the approved shielding plan, if applicable.

Half-value layer, exposure reproducibility.

mA/mAs linearity.

Integrity of pass through interlocks.

kVp accuracy.

Timer reproducibility and accuracy.

Minimum source to skin distance.

X-ray beam size

Proper indication of multiple tubes on units so equipped.

Patient exposure at skin entrance (bitewing and/or periapicals).

Mechanical support of tubehead.

Visual and audible indication of exposure.

Exposure reproducibility.


QUARTERLY CHECKLIST ITEMS – Digital Radiography

Each of the items below should pass the visual check or corrective action should be

taken. Use the Quarterly Inspection Record form to note any action taken.

Some of the items on the visual checklist are operator convenience features. However,

many of the items are essential for patient safety and high quality diagnostic images. It

may be necessary to add additional items to the list that are specific to particular

equipment or procedures. These should be included on the checklist and in each

evaluation.

1. Cephalometric beam limiting device (BLD) insert in place and used. Determine if

the unit has built-in collimation or if manual beam limiting devices are being

used. Assure that the collimators are functioning correctly and smoothly.

Determine that manual beam limiting devices are sufficient for blocking the

beam. Assure that collimators or beam limiting devices are being utilized

correctly for the area being radiographed.

2. Panoramic tube and film holder motion smoothness. Determine that during

motion the tube and film holder moves smoothly without catches or interruptions.

3. Cone or cylinder secured to tube. Visually inspect the connection between the

tube and the cone or cylinder. Determine the connection is secure and stable.

Could cause retakes. Operators may not support tube in any way.

4. Tube or generator oil leakage. Visually inspect areas around tubes and generators

for oil or abnormal collections of dust attaching to oil leaks. Equipment problems

and a risk of slips.

5. Condition of cables and wires. All cables and wires should be inspected for frayed

coverings, kinks, and should be free from catching on other objects. Must meet

OSHA standards for safety. Cords should be outside of area. X-ray can damage

cords.

6. Film artifacts. Examine exposed processed films closely to determine if artifacts

are visible. Density variations and other artifacts should not be visible.

7. Cassettes if being utilized, and screens condition. Cassettes and screens should be

cleaned regularly. Check screen condition for dust particles, scratches, and areas

of discoloration. Assure screens are properly fitted and attached to cassettes (if

applicable). Cassettes and screens should be replaced if necessary.

8. Loaded cassette storage. Determine that loaded cassettes are stored in an area that

is properly shielded from radiation to prevent exposure. They should be stored off

the ground and kept free from dust.

9. Control panel indicators. Assure all control panel switches, lights, and meters are

functioning correctly.

10. Technique chart. Make sure technique charts are available, current, and

appropriate for all procedures normally performed.

11. Equipment allows operators to remain behind barriers during X-rays as required.

o Patient view ability. Check for the availability of a method to permit

continuous observation of the patients during the x-ray exposures, except

with intraoral films.


o Exposure switch placement. Assure the exposure switches are mounted or

exposure switch cables are long enough that operators are not exposed to

unnecessary levels of scatter radiation during x-rays.


LEAD APRONS

Lead aprons must be utilized for all X-ray studies, regardless of whether the study is

digital or film. Thyroid protection should be provided with each exposure, especially

when films are taken on children.

Lead aprons should never be folded as folds can cause cracks in the lead lining. In order

to protect the useful life of the lead apron always hang or lay flat the apron with no folds.

Always inspect the lead apron visually with each use. If any damage is seen discontinue

use of that apron.

Conduct a more thorough examination of the apron annually:

Preferred Method of Inspection – Image Intensified Fluoroscopy Unit

• Lay the apron or other item on the table

• Examine the entire item with the fluoroscope

• Record results on the Annual QC checklist

Alternate Inspection Method – Fluoroscopy not Available

• Inspect closely for irregularities and kinks

• Take a radiograph of suspect areas

• Review film for breaks in the lead lining

• Record results on the Annual QC Checklist

See the Recycling information in the Supplemental Section of the manual if aprons

need to be discarded. Lead is a hazardous waste.


RETAKES and REPEATS

Retakes of x-rays regardless of the reasons are expensive for the practice and result in

unnecessary patient exposure. There is no standard or regulation on the number of repeat

rates that are acceptable but the CRCPD in their Quality Control Recommendations

suggests a best practice of a retake rate no greater than 5 to 7 %.

Maintaining records on retakes will allow a practice to calculate the rates, determine the

reasons and take action to reduce the numbers.

1. Record the number of repeats by category on the Repeat X-ray Log.

2. Determine the total number of repeated films and the total number of films

exposed. The overall repeat rate is the total of repeated films divided by the total

number of films exposed during the test period.

3. By dividing the number of repeats per category by the total number of repeated

films, a facility can calculate the repeat rate per category.

Focus corrective action to those areas causing the most retakes. Films that are too light or

too dark may be due to processing problems, equipment problems that require repair or

re-calibration, issues with software or technique charts may need updating.

HAZARD ASSESSMENT CERTIFICATION - DENTAL

PRACTICE NAME: _______________________________________________ DATE: ___________________________

EVALUATED BY:_________________________________________________POSITION:_______________________

POTENTIAL EXPOSSURE

Biological Mechanical Chemical X-Ray

LASER

PPE

Personal Protective

Equipment

Check

All

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TASKS

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TAC

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EXAM (no A/W syringe) √ √ √ √ √ √

EXAM (with A/W syringe) √ √ √ √ √ √ √ √ √ √

PROPHY √ √ √ √ √ √ √ √ √ √ √ √

X-RAY √ √ √

RESTORATIONS √ √ √ √ √ √ √ √ √ √ √ √

CROWN AND BRIDGE √ √ √ √ √ √ √ √ √ √ √ √

ENDODONTICS √ √ √ √ √ √ √ √ √ √ √ √ √ √

PERIODONTICS √ √ √ √ √ √ √ √ √ √ √

ORAL SURGERY √ √ √ √ √ √ √ √ √ √ √

LAB PROCEDURES √ √ √ √ √ √ √ √ √ √ √ √ √

INJECTIONS √ √ √ √ √ √

INSTRUMENT DECONTAMINATION √ √ √ √ √ √ √ √ √ √ √ √ √

OPERATORY DECONTAMINATION √ √ √ √ √ √ √

WASTE HANDLING √ √ √ √ √ √ √ √ √

CPR √ √ √ √

SCALING √ √ √ √ √ √ √ √ √ √

ORTHODONTICS

NOTE: Please review all categories that pertain to your practice to insure the proper fields are checked.

ECP 551 D (Revised 2/2004)

WRITTEN RADIATION SAFETY PLAN

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Transcript of WRITTEN RADIATION SAFETY PLAN