Dental X-Ray Safety Training - PowerPoint Presentation

1. Dental X-Ray Safety TrainingRadiation Safety ProgramSafety, Health, Environment & Risk Management (SHERM)713-500-5840

2. THE SHERM MISSIONSafety, Health, Environment and Risk Management’s (SHERM) mission is to work in conjunction with the UTHSC-H community to ensure that education, research, and health care services activities take place in conditions that are optimally safe and healthy for all student, faculty, staff, visitors, surrounding community and the general public. Put simply, we exist to help people go home as healthy and safe as they arrived.

3. OutlineFundamentals of radiationHow x-rays are producedAnnual background exposureHow to minimize your radiation exposureInstructions for the radiation monitoring programPotential biological effects from radiation exposureOperating and Safety ProceduresAccess to applicable dental radiation regulationsRadiation Safety contact information

4. What is radiation?Emission of energy in the form of particles (e.g. beta) or waves (e.g. x-rays)“Ionizing” radiation has enough energy to remove an orbital electron and produce ions.

5. Radiation SpectrumRadioMicrowaveInfrared VisibleUltraviolet X-rayGamma Ray10310-210-5.5 x 10-610-810-1010-12Wavelength (meters)Electromagnetic radiation travels through space in the form of waves. Waves of all types have an associated wavelength and frequency. Radio waves have the longest while gamma rays have the shortest wavelength.

6. Wilhelm Roentgen Discovers X-raysNovember 8, 1895While studying cathode ray tubes, he noticed that the fluorescence occurred in a cathode ray tube even when shielded from outside lightDiscovery instantly revolutionized physics and medicine

7. X-Ray TubeTungsten Target

8. X-ray Tube AnatomyX-rays are produced by energy conversion when a fast moving stream of electrons is suddenly slowed down in the target (e.g. tungsten) anode of the x-ray tube.

9. Natural and Manmade “Background” RadiationNational Annual Average Exposure is 625 mremNote: Medical procedures are not occupational but exposures as a patient.

10. RadonLargest contributor to background radiation in the U.S. Noble gasnot readily incorporated into tissuesdeposited to the lungs via nuclides attaching to aerosols in the airSeeps into basements and foundations of homes and buildingslocation, building materials, and soil determine radon exposure

11. X-ray OutputThe dose to the patient may change by varying the parameters of the x-ray machine such as:Total exposure timeTube current (mAs) {Controls the # of x-rays}Kilovolt peak (kVp)Beam shapingCollimation

12. Minimize Exposures byCombining the use ofLeast TimeGreatest distanceAppropriate shieldingIn order to maintain doses = As Low As Reasonably Achievable

13. ALARA TechniquesMinimize the time spent in unshielded environments while the x-ray beam is onAvoid anyone beyond the patient being in the area while x-ray beam is onStand at least 6 feet away from the dental x-ray machineStanding 6ft away verses 1 ft away reduces the exposure by 1/36

14. X-rays are easily shielded by a layer of dense material, like lead.Exam room walls may be shielded to protect the public areas.Protective aprons, leaded walls and leaded glass barriers in diagnostic radiology often block most (~90% - 99%) of the radiation.TissuePlexiglasThinLeadThickLeadALARA Techniques

15. Protective EquipmentPersonnel Protective ApparelLead aprons, gloves, thyroid shieldsVisual and tactile examination of leaded aprons is required annually

16. Occupational Exposure Any worker who receives radiation exposure while performing a job or task.The worker is required to wear dosimetry if their job tasks produce high enough exposures that they are “likely” to exceed 10% of the occupational dose limits.

17. Annual Radiation Exposure LimitsOccupationally Exposed Worker: rem mrem Whole body 5 5000Eye 15 15,000Shallow 50 50,000Minor 0.5 500Pregnant Worker 0.5* 500* *in 9 monthsGeneral Public: 100 mrem/year or 2 mrem/hour

18. Dental X-ray Regulations for Monitoring Occupational Exposures25 TAC §289.232(d)(6) – No individual monitoring shall be required for personnel operating only dental radiation machines for dental diagnostic purposesUTHSC-H, EH&S will monitor dental x-ray operators who request dosimetry.Quarterly change out is typical at UTHSC-H for personnel operating dental x-ray machines

19. How to Obtain a Badge… Fill out form (RS-03) available online or by contacting Radiation Safety Programhttp://www.uth.tmc.edu/safety/radsafety/rs03.htm

20. http://www.uth.tmc.edu/safety/radsafety

21. Proper Badge LocationsWear any specially assigned abdomen badge at the waist under any protective apron At the collar&outside any lead apron

22. Declared PregnancyWhen you contact RSP regarding your pregnancy, RSP will schedule a confidential meeting to:Review the risks associated with prenatal exposures and methods to minimize risksReview previous personnel monitoring resultsReview exposure limitsDiscuss the NRC Regulatory Guide 8.13Provide an opportunity for questions Provide additional monitoring if appropriateAssist you in completing the written declaration

23. Declared PregnancyProgram to assess, monitor, define and minimize exposures to the developing fetus. It is the individual’s decision to contact the Radiation Safety Program (RSP) and provide a written declaration of pregnancy for the lower limit to be applied.Limit is  500 mrem per gestation periodWith a recommendation of a 50 mrem limit per month In rare cases, job duties or assignments may be re-evaluated and changed. http://www.nrc.gov/reading-rm/doc-collections/reg-guides/occupational-health/active/8-13/index.html

24. Contact the RSP at 713-500-5840 or CYF G.102 to discuss pregnancy and radiation. We will assist you in completing the shown (RS-14) form.http://www.uth.tmc.edu/safety/radsafety/Pregnant%20Employee's%20Guide%20to%20Radiation.html

25. Radiation Misconceptions. . . . . .Potential Biological Effects?

26. Biological DamageRadiation may…Deposit Energy in BodyCause DNA DamageCreate Ionizations in BodyLeading to Free RadicalsWhich may Lead to Biological DamageRadiation is a weak carcinogen (chronic effect)A dose of 1,000 mrem increases your risk in cancer by ≈ 0.04%Acute effects (e.g. erythema) have a threshold and the dose increases the severity of effect

27. Biological Effects

28. Paperwork, paperwork . . . . . . . . For the protection of patients & workers, there are requirementsFederal regulationsState regulationsUTHSCH Standard Operating Procedures Equipment registrationEquipment CalibrationsHmmm…...

29. DSHS RequirementsRegistration for all machinesIf not digital x-ray unitLog of developing chemical replacementDarkroom tests (stray light)Annual lead apron tests for integrityReceipt/disposal records of equipmentRecord of maintenanceCalibration of machines by Licensed Medical PhysicistReview of Standard Operating ProceduresDocumented trainingPatient log

30. Radiation Control, Texas Department of State Health Services Regulations are available at:http://www.dshs.state.tx.us/radiation/rules.shtm25 Texas Administrative Code (TAC)§289.231 – X-ray Safety (General)§289.203 – Notices to Workers§289.232 – Dental Radiography

31. Dental Regulations

32. General Machine RequirementsImages must have dentist ordersMinimum distance is 6 feet from patient unless standing behind protective barrierTechnique chartExclude unnecessary personnel from areaKeep out of direct beam pathUse shielding prudently (0.25 mm of lead)Minimize retakesOperators must be credentialed

33. If you are pregnant or suspect you are, please inform the technologist BEFORE x-rays are taken.Thank you.Postings for Radiography Rooms

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35. Overexposure Data BackgroundTexas Department of State Health Services’ Radiation Control (DSHS-RC) (formerly known as Texas Depart of Health’s Bureau of Radiation Control (TDH-BRC)) is the designated state agency for issues involving radiation in Texas An essential function of the DSHS-RC is responding to incidents and complaintsRecords of such events have been recorded in text format since 1956This data is much more thorough than any other state or federal government agency, but is not in a format that is analyzablePrevious work performed by Dr. Robert Emery and Dr. Mike Charlton examined, classified, and defined various events that occurred from 1988-1997

36. Quarterly LimitAnnual Whole Body LimitGeneral Public Limit>1.25 rem per 3 month period>5 rem per year>100 mrem per yearDefinition of Overexposure in Texas

37. (n=6,102)Reported Radiation Incidents in Texas, 1956-2000 (n=6,102)

38. Overexposure Incidents in Texas by Total Dose, 1956-2000Only 2% of the overexposures in Texas from 1956 to 2000 have been high enough to see acute clinical effects

39. Near equal prevalence of overexposures in medical and industrial settingsSignificant decreases in overexposure incidentsEarly 80’s, likely related to oil and gas exploration activity in TexasAfter 1994, likely due to change in regulationsWithin the largest category of events in Texas from 1956-2000, the occurrence of non-stochastic events was rare.Initial Overexposure Conclusions

40. Operating & Safety Procedures for Use of Radiation in Dental Branch ClinicsFor current version contact Ms. Adkisson’s officeRadiation Safety Website http://www.uth.tmc.edu/safety/radiation_safety.htmlForms is the repository for standard forms (e.g., dosimetry, training & experience)Policies lists the basic radiation safety policiesManuals – UTHSC-H Radiation Safety ManualRadiation Safety Office Phone Number: 713 500 5840 In an Emergency (call): (713) 500 4357 (HELP)For Assistance or More Information…

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