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RADIOLOGY CLINIC MANUAL

Table of Contents: I. II. III. IV. V. VI. VII. VIII. IX. X. Introduction . . . . . . . . . . . . . . . . . . Page 1 Objectives. . . . . . . . . . . . . . . . . . . Page 1 Professional Appearance . . . . . . . . . . Page 1 Criteria for Radiographic Exposure of Dental Patients . . . . . . . . . . . . . . . . Page 2 Operators of X-ray Machines . . . . . . . . . Page 3 Clinic Procedures . . . . . . . . . . . . . . Pages 3, 4 & 5 Infection Control . . . . . . . . . . . . . . . Pages 5, 6 & 7 Panoramic Film Instructions . . . . . . . . . Pages 7 & 8 Grading. . . . . . . . . . . . . . . . . . . . . Pages 8 & 9 Radiology Clinic Faculty/Staff . . . . . . . . Page 9

Online slide presentation: Radiology Clinic Orientation

http://dent.osu.edu/radiology/radclinic.ppt

RADIOLOGY CLINIC MANUAL

I.

Introduction The purpose of this manual is to answer any questions that may arise concerning the student's activities in Radiology. Students are expected to follow the guidelines presented in the various sections in order to expedite optimal patient care with a minimum of wasted time and effort. This manual covers the entire range of clinical activities in Radiology.

II.

Objectives A. B. C. D. E. F. G. The student will be able to answer questions regarding radiation exposure. The student will be able to perform a brief oral examination and order appropriate films in consultation with instructor. The student will use good technique in taking the necessary films and identify technique errors. The student will follow accepted radiation safety guidelines and infection control procedures. The student will be able to properly process films and identify any processing errors. The student will be able to identify normal radiographic anatomy on both intraoral and panoramic films. The student will be able to identify caries, periodontal involvement and pathology on both intraoral and panoramic films.

III.

Professional Appearance In keeping with the general clinic manual, students working in the Radiology Clinic should be clean, well-groomed, and wear clean clothing at all times. A surgical gown is to be worn. These guidelines apply to anyone seeing patients in the Radiology Clinic. Failure to comply may result in dismissal from the clinic. Any future guidelines that may be developed regarding proper clinical attire will be adopted by the Radiology Clinic.

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Criteria for Radiographic Exposure of Dental Patients A. Following an oral examination, only those films considered necessary for a proper diagnosis will be ordered. The need for radiographs should be based on Guidelines for Prescribing Dental Radiographs (Kodak Pub. No. N-80A), developed by a panel of the leading dental organizations. Under no circumstances will the need for, or the extent of, a radiographic examination be based on arbitrarily established conditions (e.g., check-out bitewings) or on specific time frames. The lead apron and thyroid collar will be used on all patients for intraoral films. The lead apron only (no thyroid collar) is used for extraoral films. All radiographic exposures are to be recorded in the patient's clinic folder. Retake-radiographs are not to be taken for the sole purpose of having technically acceptable or perfect radiographs, providing that the areas are covered at diagnostically acceptable levels on other radiographs. Students are expected to seek help from an instructor if they are having any problems getting the appropriate films. This does not affect the grade the student receives for that patient unless it is determined that the student should have been able to complete the exposure without assistance. The pregnant patient should be exposed to x-rays only for the information that is diagnostically required for planned treatment during pregnancy. The need for films and the number taken will be determined by the instructor. Recent films taken by an outside dentist should be requested for evaluation prior to ordering new films. Based on the areas covered and the diagnostic value of these films, additional radiographs may be indicated. The re-exposure of a patient to obtain duplicate radiographic information for third party or teaching purposes is contrary to radiation health and is prohibited. Page 3

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V.

Operators of X-ray Machines A. B. C. Students will be permitted to use x-ray equipment only under the supervision of the faculty or staff. No student, faculty or staff member shall be in the x-ray cubicle during radiographic exposure of a patient. The operator must stand behind the barrier provided for each cubicle; the operator must observe the patient through the leaded glass window during the exposure of each film.

VI.

Clinic Procedures A. Students on Screening Detail 1. Report to the X-ray Clinic after the panoramic film has been ordered by the Screening Faculty. Check in with the receptionist at the desk and fill out a Clinical Evaluation Form (purple sheet). The information includes your name and class rank, patients name and ID #, date, and film(s) to be taken. The receptionist will provide the panoramic cassette. Take the evaluation form with you. Check with a faculty member to see which panoramic unit to use. Place cassette in unit and then enter the patients name (last name first) and ID# into the panoramic imprinter. After cleaning hands and putting on gloves, place a bitestick cover on the bitestick. Bring patient into the cubicle. Have them remove jewelry, glasses, dentures, etc., and then place the lead apron. Position patient (see section VIII on page 7) and complete exposure. After removing the cassette and imprinting the patient information, take the cassette to the darkroom for film processing, which will be done by the technician. The film will be ready in 3 minutes. It is usually best to wait on the film and then review it with an instructor before returning to the Screening Clinic.

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Page 4 B. Students taking films on non-screening patients

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Enter the films to be taken in the front of the patient's chart and have the clinical instructor sign in the appropriate space. Report to the desk person in the Radiology Clinic with patient's chart. Fill out evaluation form and receive films, film bag and any necessary bitewing or paralleling instruments. Proceed to designated cubicle (Instructor will tell you which cubicle to use). Seat patient, adjust headrest and place lead apron/thyroid collar. Empty the films and instruments out of their plastic bags onto the tray. Open the film bag and set it up on the counter behind or beside the tray. Have patient remove any intraoral appliances and glasses. After cleaning hands, using antiseptic hand gel (preferable) or washing with soap and water, and putting on gloves, assemble the bitewing and/or paralleling instrument(s) and proceed with taking the films. Unless the instructor indicates otherwise, each film should be checked by the instructor before exposure to minimize errors. Dry the films thoroughly before placing in the film bag. This should be done immediately after each exposure. Unexposed films and instruments should never be placed directly on the counter. Always keep them on the tray to maintain sterility. In addition, anything dropped on the floor should be left there until you are finished with the patient. Obtain replacements from the desk person as needed, making sure you remove gloves and rinse your hands before leaving the cubicle. After completing the intraoral radiographs and placing the last film in the bag, remove all plastic from the x-ray machine and exposure switch. Disassemble the paralleling instrument(s). Remove gloves, clean hands (gel), and take the lead apron off the patient. Advise the patient to have a seat in the waiting area. If a panoramic film is needed, instruct the patient to remove earrings, necklace, etc., while they are waiting. Remove and discard head-rest cover. Using a surface disinfectant, wipe down any areas contacted that were not covered by plastic.

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Take instruments and tray to Cubicle F. Place instruments in sink and place tray on counter. Take the films back to the darkroom for processing by the x-ray technician. Place the grade sheet in the back room next to the viewboxes (unless you are taking a panoramic film; see next section). If a panoramic film is needed, the film will be given to you by the desk person when you come out of the darkroom. You will need the purple evaluation form in order to enter the patients ID# in the panoramic film imprinter. Proceed to take the film following the instructions in Section VIII on page 7. After completing the exposure, the patient returns to the waiting area while you clean the panoramic equipment. After imprinting the patient information on the film, take the panoramic cassette back to the darkroom technician. You may remain in the X-ray Clinic until the films are ready to be evaluated if you are only taking a few films and need them before you can proceed with treatment. Otherwise, it is preferable that you take the patient back to the clinic and start other procedures. You should return to the Radiology Clinic after at least 15 minutes to get the films. A faculty member will review the films with you to identify pathology and technique errors.

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VII.

Infection Control Infection control procedures are intended to eliminate cross-contamination from patient-to-patient and patient-to-operator. They are to be used for ANY patient seen in the X-ray Clinic. These procedures are important and they must be strictly followed. 1. Before seating patient, make sure the tubehead, exposure switch and headrest are covered with plastic. A rubber band should be placed over the PID to help keep the plastic out of the way when positioning the tubehead. (This will usually be done by the faculty before you are assigned a cubicle). A tray covered with plastic will be used on the counter top. Instruments and films will be placed on this tray. If any of the equipment is not covered, and is touched by the student with contaminated gloves, it will serve as a possible source of cross-contamination for subsequent patients. Seat patient, adjust head rest and place lead apron/thyroid collar. No gloves are needed for these steps.

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Page 6 3. After emptying films and instruments on the tray, prepare for taking films by: a. b. c. 4. 5. 6. Setting up paper bag on counter top (not on tray) so you are able to drop films in without touching bag. Cleaning hands using alcohol gel or washing hands and putting on gloves. Assembling bitewing and/or paralleling instruments.

Proceed to take films. Each film must be thoroughly dried off with a paper towel after exposure. You must not touch any of the following items after you have put on your gloves: 1. Charts or grade forms, 2. Pens or pencils (unless wrapped in plastic), 3. X-ray film bag and 4. Lead apron. In effect, this limits you to touching only the film, film holders, x-ray equipment and paper towel. If for some reason you must check the chart, need to readjust the headrest or lead apron, or need to get additional films or cotton rolls, you should remove old gloves, rinse, and reglove when ready to proceed. After the last film is taken, dried, and placed in the film bag, remove the plastic bag from the tubehead and the plastic sleeve from the exposure switch. Disassemble the instrument(s) and dispose of the paper towel and any other disposble items on tray. Now you are ready to remove your gloves, clean your hands, and take the lead apron off the patient. Then direct the patient to the desk if they are done or to a seat in the waiting area if they need a panoramic film. The headrest cover may now be removed (no gloves needed).Take the instruments and tray to Cubicle F. You should never leave the cubicle with gloves on. Always remove the gloves and immediately clean your hands. You can take new gloves with you into the darkroom if you are processing your own films. If you touched any part of the x-ray equipment that was not covered by plastic, you must spray-wipe-spray these areas down with a surface disinfectant. This should be done before you take the

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films back to the darkroom. Page 7 10. The soiled disposable items (gloves, clinasept barriers, film packets, paper towels, etc.) are not considered as infectious (regulated) medical waste. These items may be placed in the regular trash receptacle. If you take a panoramic film, you must wipe down any parts of the machine with which the patient had contact. Gauze pads with surface disinfectant are provided in the panoramic room.

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VIII.

Panoramic Film Instructions A. Instruct the patient to remove all jewelry, dentures, glasses, bobby pins, hearing aids, etc., from the head and neck region. Coats should also be removed. (The patient should be doing this while you are loading the film). Load the cassette in the machine as indicated. The arrow on the back of the cassette should point upward and face away from the patient. (Check with the instructor if you are not sure how this is done). With gloves on, place a plastic cover on bitestick. Use cotton pliers to get cover out of container. Place lead apron on patient with short side in back. Make sure the apron does not cover the back of the neck or rest too high on the sides of the neck. Position the patient as follows: 1. 2. 3. 4. Chin on chin rest (Raise bitestick so that patient can get chin in position). Incisors in notch of bitestick. (Align ridges over notch for edentulous patient or use special edentulous positioner). Make sure the back is straight. Advise patient to hold onto the handles and step forward until they feel they are leaning back. Align the Frankfort Plane parallel to the floor using light lines as guide. Make sure the midsagittal plane is centered, again using the light line.

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Make sure light line at side of mouth passes through maxillary canine. Make focal trough adjustments as needed. Page 8 Move head positioner into contact with forehead and tighten the lateral head positioners until snug against the head. Lower cassette holder to confirm shoulder clearance. Tell patient to hold tongue against the palate during the exposure. Inform the patient about machine movement and the need to hold still for the twenty seconds it takes for the machine to rotate.

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Complete the exposure. Do not release the exposure switch until the machine has come to a complete stop. Open the lateral head positioners, advise the patient to carefully step out of the machine, and send the patient back to the desk. Remove and discard the plastic bitestick cover. Remove the cassette and wipe down the unit with disinfecting solution. Place the cassette in the imprinter to label film. Take the cassette back to the darkroom technician for processing.

Grading A. Students are assigned patients on a random basis when they are on Screening Detail. They are expected to take the necessary films on each assigned patient. Each student must see at least four patients during a given quarter to receive a grade. (Dent 747-Aut; Dent 748-Win; Dent 749-Spr; all 1- hr. courses). Films are reviewed with the student before leaving the Radiology Clinic. A numerical grade (0-4) is given for each patient. The number of minor errors (not requiring retakes) and major errors (requiring retakes) are computed for each patient and a grade is assigned. The number of films taken is also considered in assigning the grade. (See Radiographic Technique Evaluation Form, page 10). No grades are given during Summer Quarter. The grading scale for the final grade is as follows: 1. A: 3.50 - 4.00

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B: 3.00 - 3.49 C: 2.40 - 2.99 D: 1.80 - 2.39 E: below 1.80 Page 9

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A Radiographic Exercise is required during Summer Quarter. This exercise involves the bisecting-angle technique, radiographic interpretation of intraoral and panoramic films, recognition of technique errors, the buccal object rule and film mounting. This exercise must be completed before a grade can be assigned for Autumn Quarter (Dent 747). If for some reason a student receives less than three technique grades during the quarter, an incomplete will be given. As soon as a sufficient number of patients have been seen the following quarter, a grade will be assigned. There is no penalty associated with the incomplete; the final grade will not be affected. Anyone receiving an E for the quarter will be required to complete remedial work assigned by Dr. Jaynes. Students are encouraged to check with the instructors regarding their grades and ask questions if there is any confusion about how the grade was determined. If there are specific problems with a grade or with an instructor, the student should contact Dr. Jaynes.

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X.

Radiology Clinic Faculty/Staff A. Radiology Clinic Director Dr. Robert M. Jaynes B. Radiology Clinic Faculty Ms. Constance Kuntupis Dr. Eliana Sanchez Ms. Brenda Kennedy Ms. Denise Kissell C. Radiology Clinic Staff Ms. Kathleen Marquard Ms. Debbi Pack Ms. Luckisha Townsend Room 1117 Room 1117 Room 1117 292-0874 292-0874 292-0874 Room 3039-D Room 3040 Room 3040 Room 3001K 292-5264 292-2994 688-3579 292-8410 Room 3001L 688-3374

Revised 8/15/09