UNIT 3 - guidelines for the prescription of dental x-rays

Historical context

Who discovered X-rays? and when

Röetgen in 1895

Historical context

What ability of X-rays was discovered?

Their ability to penetrate human tissues.

Historical context

How was the radiographic image traditionally produced?

X-rays passed through the patient and interacted with a photographic emulsion on film.

Historical context

What is gradually replacing radiographic film?

Various digital sensors.

Historical context

Where is the image created with digital sensors?

On a computer.

Historical context

What type of image receptor is radiographic film?

An analogue image receptor.

Historical context

What does radiographic film consist of?

A photosensitive film.

Historical context

What is required to obtain a radiograph from radiographic film?

Chemical processing.

Historical context

What type of image receptor is a PSP plate?

An indirect digital image receptor.

Historical context

What does a PSP plate do with radiographic information?

It stores radiographic information.

Historical context

What must be done to a PSP plate to generate the digital image?

It needs to be scanned.

Historical context

What type of image receptor is a digital sensor?

A direct digital image receptor.

Historical context

What does a digital sensor convert X-rays into?

A visible image.

Historical context

How quickly does a digital sensor produce the visible image?

Almost immediately.

Historical context

What does a digital sensor not require?

Processing or scanning.

Decision making

What do most patients require in dental practice?

Some type of radiographic examination as part of the care process.

Decision making

What is the role of radiographic images in diagnosis?

They are an essential complementary tool for diagnosis.

Decision making

How are radiographic images used in treatment planning?

they are an essential complementary tool for treatment planning and follow up

Decision making

What can radiographic images be used to evaluate after treatment?

Outcomes and postoperative follow-up.

Decision making

What must the indication for a radiographic examination always be?

Justified.

Decision making

What should support the necessity of taking a radiograph?

A prior medical history and clinical examination.

Decision making

Why does radiography involve a biological risk?

Because radiographic examinations use ionising radiation.

Decision making

How is the biological risk from radiographic examinations described?

low

Decision making

When should radiographs be prescribed?

When the expected benefit to the patient outweighs the risk associated with exposure.

Radiation protection - nuclear safety council (CSN)

What is radiological protection?

A multidisciplinary activity of a scientific and technical nature.

Radiation protection - nuclear safety council (CSN)

What is the aim of radiological protection?

Protecting people and the environment.

Radiation protection - nuclear safety council (CSN)

What does radiological protection protect people and the environment against?

The harmful effects that may result from exposure to ionising radiation.

Radiation protection - nuclear safety council (CSN)

What type of activity is radiological protection?

A multidisciplinary activity of a scientific and technical nature.

Justification - nuclear safety council (CSN)

What must any practice involving exposure to ionising radiation provide?

A benefit to society.

Justification - nuclear safety council (CSN)

What must be considered when exposing people to ionising radiation?

The negative effects and possible alternatives.

Justification - nuclear safety council (CSN)

What does the justification process determine?

Whether or not medical exposure will take place.

Justification - nuclear safety council (CSN)

What is the aim of justification?

To avoid unnecessary radiological procedures.

Justification - nuclear safety council (CSN)

What would unnecessary radiological procedures expose the patient to?

Ionising radiation and its potential risks.

(International atomic energy agency - IAEA)

Justification - nuclear safety council (CSN)

When should a radiographic examination only be performed?

When there is a clear clinical indication.

Justification - nuclear safety council (CSN)

What should the information obtained from a radiographic examination be able to influence?

Diagnosis, treatment plan or patient follow-up.

Justification - nuclear safety council (CSN)

What should the prescription of a radiograph be based on?

The medical history, clinical examination and individual diagnostic needs.

Justification - nuclear safety council (CSN)

What should be avoided when prescribing radiographic examinations?

Systematic performance of examinations without a specific indication.

Optimization

What does ALARA stand for?

As Low As Reasonably Achievable.

Optimization

What does the ALARA principle require for radiation exposures?

They must be maintained at levels as low as reasonably achievable.

Optimization

what factors are considered when applying ALARA?

Social and economic factors.

Optimization

What does the ALARA principle establish about exposure to ionising radiation?

Exposure should be kept as low as reasonably achievable.

Optimization

What must not be compromised when reducing radiation exposure?

The diagnostic quality of the image.

Optimization

What does ALARA mean for each radiographic examination in Dentistry?

It should only be performed when clinically justified.

Optimization

What should be optimised to reduce the radiation dose to the patient?

All factors that allow the radiation dose to the patient to be reduced.

Optimization

When should radiographs be requested?

After an appropriate medical history and clinical examination.

Optimization

What should the medical history and clinical examination establish?

A genuine diagnostic need for the examination.

Optimization

When should the radiographic examination be performed?

When it provides additional information that may modify the diagnosis, treatment plan or patient follow-up.

Optimization

What should be selected for each clinical situation?

The most appropriate radiographic technique.

Optimization

What should the selected radiographic technique provide?

The necessary diagnostic information with the lowest possible radiation exposure.

Optimization

What should happen to the irradiated field?

It should be limited exclusively to the region of interest.

Optimization

Why should the irradiated field be limited to the region of interest?

To avoid exposure of tissues that do not provide clinically relevant information.

Optimization

What should be reviewed before indicating a new radiographic examination?

Available previous radiographs.

Optimization

What should be assessed in previous radiographs?

Whether the information they contain is sufficient.

Optimization

Why should previous radiographs be reviewed before a new examination?

To avoid unnecessary exposures.

Dose limitation

What does the principle of dose limitation state?

Radiation doses received by individuals must not exceed the limits established by current legislation.

Dose limitation

Which organisation states the principle of dose limitation?

Nuclear Safety Council (CSN).

Dose limitation

What does absorbed dose measure?

The amount of ionising radiation energy absorbed per unit mass of a material or tissue.

Dose limitation

What is the unit of absorbed dose?

Gray (Gy).

Dose limitation

What does 1 Gy equal?

The absorption of 1 joule of energy per kilogram of matter.

Dose limitation

What does effective dose estimate?

The biological risk associated with exposure to ionising radiation.

Dose limitation

What is effective dose obtained from?

The absorbed dose.

Dose limitation

What does effective dose take into account?

The type of radiation and the different sensitivity of the irradiated organs and tissues.

Dose limitation

What is the unit of effective dose?

Sievert (Sv).

Dose limitation

What does the gray (Gy) quantify?

The energy absorbed by tissues.

Dose limitation

What does the sievert (Sv) reflect?

The potential biological effect of that radiation on the body.

Dose limitation

Which dose is commonly used to assess radiological risk in patients?

Effective dose.

Prescription of dental radiographs

When should radiographic examinations not be prescribed?

When they do not provide a net clinical benefit to the patient.

Prescription of dental radiographs

When should diagnostic usefulness not justify a radiographic examination?

When it does not outweigh the risk associated with exposure to ionising radiation.

Prescription of dental radiographs

What must every radiographic examination have?

Adequate justification.

Prescription of dental radiographs

When should a radiographic examination be performed?

When the information obtained may significantly influence diagnosis, treatment planning or clinical follow-up.

Prescription of dental radiographs

What should precede a radiographic examination?

A complete medical history and clinical examination.

Prescription of dental radiographs

What should the indication for a radiographic examination respond to?

A specific diagnostic need.

Prescription of dental radiographs

What type of radiographs should be avoided?

Routine or unnecessary radiographs that do not provide a direct benefit to the patient.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can previous periodontal or endodontic treatment indicate for radiographic examination?

Evaluation of treatment progress.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can radiographs assess after previous periodontal or endodontic treatment?

Tissue healing and possible complications.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can radiographs verify after previous periodontal or endodontic treatment?

The stability of the results obtained.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can radiographic examination help identify in cases of pain or trauma?

The cause of the clinical condition.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What fractures can radiographic examination detect after pain or trauma?

Dental or bone fractures.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What other findings can radiographs detect after pain or trauma?

Luxations, periapical lesions, foreign bodies or abnormalities not evident during clinical examination.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

When is radiographic examination indicated with a family history of dental anomalies?

When hereditary abnormalities of dental development are suspected.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What dental anomalies can radiographs identify in this situation?

Anomalies in the number, shape, size, position or eruption of teeth.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can postoperative radiographs assess?

The outcome of the intervention and appropriate tissue healing.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can postoperative radiographs detect early?

Possible complications.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What are examples of possible postoperative complications?

Infections, displacement of structures or persistence of lesions.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What does monitoring of mineralisation allow?

Follow-up of the development and maturation of the dentition.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can be assessed when monitoring mineralisation?

The degree of mineralisation and abnormalities in dental development.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What stage can be estimated through monitoring of mineralisation?

The stage of tooth formation.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

Why is radiographic examination fundamental for implant treatment planning?

It allows assessment of bone availability and the relationship with anatomical structures.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What else does radiographic examination assess for implant treatment planning?

The relationship with structures at risk.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can radiographs help select for an implant?

The appropriate implant position, length and diameter.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What is radiographic examination essential for during implant follow-up?

Evaluating osseointegration.

Prescription of dental radiographs

• indications for radiographic examination

• → positive findings in the medical history

What can radiographs detect during implant follow-up?

Possible peri-implant complications.

positive signs and symptoms in the medical history

• evidence of periodontal disease

What can radiographic examination assess in periodontal disease?

Loss of bone support and the pattern of alveolar bone resorption.

positive signs and symptoms in the medical history

• evidence of periodontal disease

What periodontal involvement can radiographs assess?

Furcation involvement.

positive signs and symptoms in the medical history

• evidence of periodontal disease

How do radiographic findings complement the clinical examination in periodontal disease?

They facilitate diagnosis and planning of periodontal treatment.

positive signs and symptoms in the medical history

• deep restorations

What can radiographs assess in deep restorations?

The proximity of the restoration to the pulp.

positive signs and symptoms in the medical history

• deep restorations

What type of caries can radiographs detect around deep restorations?

Secondary caries.

positive signs and symptoms in the medical history

• deep restorations

What tissues can be evaluated with deep restorations?

The condition of the periapical tissues.

positive signs and symptoms in the medical history

• deep restorations

What else can radiographs identify with deep restorations?

Possible complications resulting from restorative treatment.

positive signs and symptoms in the medical history

• Extensive caries

What can radiographs determine about extensive caries?

The depth of the lesion.