RADIATION PROTECTION

CONTENTS
 INTRODUCTION
 SOURCE OF RADIATION
 EXPOSURE & DOSE RADIOGRAPHY
 METHODS OF RADIATION PROTECTION
Protection for the patient.
Protection for the operator.
Protection of environment.
Protection of the department
 QUALITY ASSURANCE
INTRODUCTION:
Dentists must be prepared to intelligently
discuss with patients the benefits and possible
hazards involve with use of x rays and to describe
the steps taken to reduce the hazard.
This lecture considers of source of
exposure, estimates of risk from dental
radiography, and means to minimize exposure
from dental examinations.
 SOURCES OF RADIATION
 EXPOSURE & DOSE RADIOGRAPHY
 METHODS OF RADIATION PROTECTION
 QUALITY ASSURANCE
 ASPESIS
 SOURCES OF RADIATION
 EXPOSURE & DOSE RADIOGRAPHY
 METHODS OF RADIATION PROTECTION
 QUALITY ASSURANCE
 ASPESIS
 SOURCES OF RADIATION:

NATURAL (83%) ARTIFICAL (17%)

EXTERNAL INTERNAL MEDICAL CONSUMER

(16%) (67%) PRODUCTS OTHER
COSMIC RADON X-RAY OCCUPATIONAL
TERRESTRIAL OTHER NUCLEAR NUCLEAR FUEL
MEDICINE MISCELLENOUOS
A) Natural radiation / Background radiation:
 Largest contributor

 From external & internal sources

i) External Sources:
 From cosmic & terrestrial radiation, both of which
originate from the environment
 Contribute about 16% to the radiation exposure
ii) Internal sources:
are radionuclides that are taken up from the
external environment by inhalation & ingestion.
a) Radon: A decay product in the uranium series, is
estimated to be responsible for approximately 55% of
the radiation exposure.
 Is the largest single contributor to natural radiation
(2.0 mSv).
 The ubiquitous noble gas radon( radon-222) is
transported in the water & air that enter our homes &
buildings & by itself does little harm.
b) Other internal sources:
 The second largest source
(11%) of natural radiation
results from the ingestion
of food & water that contain
radionuclides.
 SOURCES OF RADIATION:

NATURAL (83%) ARTIFICAL (17%)

EXTERNAL INTERNAL MEDICAL CONSUMER

PRODUCTS OTHER
COSMIC RADON X-RAY OCCUPATIONAL
TERRESTRIAL OTHER NUCLEAR MISCALLEONUS
MEDICINE
B) Artificial radiation:
Human beings, with all their technologic
advances, have contributed a number of sources of
radiation to the environment.
May be categorized into 3 major groups:
 Medical diagnosis & treatment
 Consumer & industrial products and
 Other minor sources
In total contributes an average annual E of
about 0.6 mSv or 17% of the annual radiation
exposure.
i) Medical Diagnosis & Treatment:

 Diagnostic X-ray exposure is the

largest contributor, with an
average annual E of about 0.39 mSv.
 But the contribution made by oral radiology have been
excluded from this calculated total, because dental
examinations are responsible for an average annual E of
less than the negligible individual dose (0.001 mSv).
 Dental X-ray examinations are responsible for only
2.5% of the average annual E resulting from X-ray
diagnosis & 0.3% of the total average annual E.
ii) Consumer & industrial products & sources:
Only a minor contributor to the average annual E
( 3%), but is the most interesting & includes unsuspected
sources. Includes,
 Domestic Water supply ( 10-60 microSv)
 Combustible fuels ( 1-6 microSv)
 Dental porcelain (0.1 microSv)
 Television recievers( <10 microSv)
 Pocket watches (1-5 x 10-2 microSv)
 Smoke alarms (< 1 x 10-2 microSv)
 Airport inspection systems (< 1 x 10-2 microSv)
In total contributes to 0.10 mSv to the
average annual E
 SOURCES OF RADIATION
 EXPOSURE & DOSE RADIOGRAPHY
 METHODS OF RADIATION PROTECTION
 QUALITY ASSURANCE
 ASPESIS
The means of protection can be divided into:
A) Protection for the patient.
B) Protection for the operator.
C) Protection of environment.
D) Protection of the department
A) PROTECTION FOR THE PATIENT:
i) PATIENT SELECTION
ii) CONDUCT OF THE EXAMINATION
 Choice of equipment
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
 Choice of technique
a) Bisecting angle technique
b) Paralleling technique
 Operation of the technique
a) Kilovoltage
b) Milliampere-seconds
 Processing
 Interpretation of the radiographic image
A) PROTECTION FOR THE PATIENT:
i) PATIENT SELECTION:

 Dentists should exercise professional judgment when

prescribing diagnostic radiographs for dental patients.

 Diagnostic radiography should be used only after

clinical examination, consideration of the patient's
history and consideration of both the dental and the
general health needs of the patients.

 A radiographic examination is necessary when the

history & clinical examination have not provided
enough information for complete evaluation of a
patient’s condition & formulation of an appropriate
treatment plan.
The general guidelines for radiographs are:
 Make radiographs only after a clinical examination

 Order only those radiographs that directly benefit the

patient in terms of diagnosis/treatment plan.

 Use the least amount of radiation exposure necessary to

generate an acceptable view of the imaged area.
A) PROTECTION FOR THE PATIENT:
i) PATIENT SELECTION
ii) CONDUCT OF THE EXAMINATION
ii) CONDUCT OF THE EXAMINATION:
When the decision has been made that a
radiographic examination is justified (patient selection),
the way in which the examination is conducted greatly
influences patient exposure to X radiation.
 Choice of equipment:
 Choice of technique
 Operation of equipment:
 Processing and
 Interpretation of the radiographic image.
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
a) Selection of the image receptor:
The basis for selecting film types, film-intensifying screens
combinations & other image receptors is to obtain
the maximum sensitivity (speed) consistent with the
image quality required for the diagnostic task.
Intraoral Image receptors:
 Currently intraoral image films available in three
speed groups
 Speed D
 Speed E and
 Speed F
 Speed group F is almost twice as fast as film D and E
 Faster films are desirable to reduce the radiation
exposure.
 Multiple studies have found that F speed film has the
same density, contrast and image quality as D and E
speed.
 F speed film can be used as routine dental radiographic
examination without sacrificing diagnostic information.
 Current digital sensors provides equal or greater dose
savings than F speed films.
Intensifying Screens:
 Use the rare earth elements

gadolinium and lanthanum.

 These rare earth phosphors emit

on interaction with x rays

green light
 Compared with the older calcium tungstate screens,
rare earth screens
decrease patient exposure by as much as
 55% in panoramic and cephalometric radiography.
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
Focal spot-to-film distance:
 The combination of proper collimation and extended
source-patient distance (focal spot-to-film distance) will
reduce the amount of radiation to the patient.
 Two standard focal spot-to-film distances (FSFDs)
have evolved over the years for use in intraoral
radiography,
a) one 20cm (8 inches) and
b) the other 41cm (16 inches).
 When the x-ray tube is operated above 50kVp, each of
these distances satisfies the federal regulation.
 Use of an FSFD longer distance results in a 32%
reduction in exposed tissue volume. This is because at
the greater distance, the x-ray beam is less divergent
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
C) X-ray beam collimation
Is the restriction of the of the beam & is usually done
with a collimator placed within the tube head.

 It refers to the control of size & shape of the X-ray

beam
 The tissue area (and volume) exposed to the primary x-
ray beam should not exceed the minimum coverage
consistent with meeting diagnostic requirements and
clinical feasibility.
 Different types used are
 Circular
 Tubular
 Rectangular and
 Slit
 Since a rectangular collimator decrease the
radiation dose compared with others.
 Radiographic equipment should provide
rectangular for periapical and bitewing
radiographs.
 Film holders with rectangular collimators may be used
with round PIDs ; these holders reduce patient
exposure to the same degree as rectangular PIDs.
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
Filtration:
 is the absorption of the
long wavelength, less
penetrating X-rays of the
polychromatic X-ray beam
by passage of the beam
through a sheet of material
called FILTER.
 Filtration preferentially
removes the soft, low
energy, long wavelength
X-rays from the beam.
 The x-ray beam emitted from the radiographic tube
consists of not only high-energy x-ray photons, but also
many photons with relatively lower energy
 Low-energy photons, which have little penetrating
power, are undesirable and are absorbed mainly by the
patient (increasing the patient's dose) and without
contributing to the formation of the radiographic image
(no increased benefit)
 The purpose of filtration is to remove these low-energy
X-ray photons selectively from the x-ray beam. This
results in decreased patient exposure with no loss of
radiologic information
Filter materials:
 Are to remove the unwanted low-energy radiation as
efficiently as possible whilst having the smallest
possible effect in the wanted higher energy photons.

 Tin, copper & aluminum are the other filter

materials.

 The use of these materials in combination with

aluminum filtration may reduce patient exposure by
20% to 80% compared with conventional aluminum
filtration alone, which attenuates few high-energy
photons. However, exposure reduction achieved with
rare earth filtration has costs.
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
Use of position indicating devices: the position
indicating device (PID) or cone appears to be as an
extension of the X-ray tube head & is used to direct
the X-ray beam.

There are 3 basic types:

a) Conical
b) Rectangular
c) Round
a) Conical: The conical PID appears as a closed,
pointed, plastic cone. When X-rays exit from the
pointed cone, they penetrate the plastic & produce
scatter radiation.
It is no longer used in dentistry. Instead, open-ended and
lead-lined rectangular/round PID’s are used that do
not scatter radiation.
B) Rectangular & Round PID’s:
Both rectangular & round PID’s are commonly availabale
in 3 lengths:
i) Short ( 8 inches)
ii) Medium ( 12 inches)
iii) Long (16 inches)
The long PID is preferred, because less divergence of
the X-ray beam occurs. Of these types, the rectangular
PID is most effective in reducing patient exposure.
 These help to minimize the volume of tissue
irradiated in intra oral radiography. It is necessary to
increase the target film distance by using longer
position indicating devices to direct the X-ray beam.
 As a result the diagnostic quality of the image is
markedly improved & significantly smaller doses of
radiation are delivered to the head & neck. This is due
to the reduction of the beam divergence &
concomitant reduction of the scattered radiation.
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
f) Film holding devices:
Film holder is a device used to hold & align
intraoral X-ray film in the mouth. These offer
protection to the patient because:
 Their use often reduces the frequency of retakes, as the
film can be positioned more accurately in the patient’s
mouth.
 The possibility of misaligning the X-ray tube & partially
missing the film (cone cut) is also reduced.
 Some of the holders also collimate the beam to the size
of the film being used, which further reduces patient
exposure
 The exposure to the patient’s fingers is also reduced, as
the patient does not have to hold the film.
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
g) Timers: the timers on the X-ray
machine should be electronic.
Mechanic timers are imprecise
when used for the short exposures
needed in modern dental radiography.
Mechanical timers are also
not recommended for exposures less than 1 second.
 The timer on the machine should have a “dead-man”
control, which shuts the machine off immediately
regardless of timer resetting unless a finger/foot
pressure is held continuously on the timer switch
throughout the desired exposure
 Dental X-ray machine timers generally automatically
reset once the exposure has been terminated. Care
should be taken that they are not capable of initiating
another exposure until the switch is pressed again.
 Also, it should not make an exposure if the timer is set
to zero or off position.
 The X-ray timer should be accurate (it should deliver
the time exposure for which it is set) & reporducible (it
should repeatedly deliver the same time interval at a
given setting)
 Choice of equipment:
a) Selection of the image receptor
b) Focal spot to film distance
c) X-ray beam collimation
d) Filtration
e) Use of position indicating devices
f) Film holding devices
g) Timers
h) Protective barriers
h) Protective barriers:
In dental radiography mainly includes
i) Leaded Aprons
ii) Leaded Thyroid Shield
iii)Use of film holders with facial shields
i) Leaded Aprons :
A leaded apron is
made of 0.25 mm lead or
lead-equivalent materials &
placed over the patient’s body
to protect the reproductive organs
& other radiosensitive tissues from scatter radiation
 Lead has been found to be the best shield for the
protection against diagnostic x-rays.
 It has the highest atomic number of any element that
is nonradioactive.
 Although scatter radiation to the
patient's abdomen is extremely low,
leaded aprons should be used to
minimize patient's exposure to
radiation.

 Consequently, any dose that can be reduced without

difficulty, great expense, or inconvenience should be
reduced.
 They should be checked against the order for the
proper size and thickness of the apron. This can
often be checked by weighing them or checking their
shielding capabilities.
 Then before use, they should be checked to make
certain that there are no flaws and loss of integrity in
the shielding provided by the apron.
 Lead aprons should be checked fluoroscopically at
least on an annual basis for their shielding integrity.
Some general features of the leaded aprons are as follows:
1. The life expectancy for a lead apron is assumed to be 10
years
2. Defects are assumed to appear in 5 years.
ii) Leaded thyroid collars:
contains a lead or lead-equivalent
material & protects the
radiosensitive thyroid gland
in the neck region & are strongly recommended.
 Thyroid shields reduce the
exposure of this gland by as much as
92% .No difficulty, great expense,
or inconvenience is encountered
with their use; instead, using them
demonstrates a real concern for
the welfare of the patient.
iii) Use of film holders with facial shields:
A) PROTECTION FOR THE PATIENT:
i) PATIENT SELECTION
ii) CONDUCT OF THE EXAMINATION
 Choice of equipment

 Choice of technique

a) Bisecting angle technique

b) Paralleling technique
 Operation of the technique

 Processing

 Interpretation of the radiographic image

Choice of intraoral technique:
 Currently no recommendations or regulations deal
specifically with intraoral radiographic techniques.
Consequently, the choice of technique (bisection of the
angle or paralleling long cone) is left to the practitioner.
 The decision as to which technique is used should be
based on the diagnostic quality of the resultant
radiographs, the efficiency of using radiation, and the
convenience of the technique
 The more efficient the technique, the fewer radiograph
retakes will be required, along with less patient
exposure.
 A study of comparative efficiencies of the bisection
and parallel techniques found that the number of
undiagnostic radiographs was reduced by more than
half when intraoral complete mouth examinations were
made with the paralleling technique.
 If it is assumed that all undiagnostic radiographs are
remade, use of the bisection technique leads to a
significant increase in patient exposure.
 This study used the Rinn XCP instrument for parallel
film placement
A) PROTECTION FOR THE PATIENT:
i) PATIENT SELECTION
ii) CONDUCT OF THE EXAMINATION
 Choice of equipment

 Choice of technique

 Operation of the technique

 Processing

 Interpretation of the radiographic image

PROCESSING THE FILM:
 Film processing should be

performed under the

manufacturer recommended
conditions with proper processing equipment and a
darkroom with safelights.
 Alternatively, an automatic processor with an
appropriate safelight hood may be used.
 A major cause of unnecessary patient
exposure is the deliberate overexposure
of films compensated by underdevelopment
of the film.
 Time-temperature processing, in an adequately
equipped and maintained darkroom, is the best way to
ensure optimal film quality
 For optimizing image quality, care must be exercised in
the selection of processing solutions. To help ensure
optimal image quality, the technician should follow the
film manufacturer's recommendation for processing
solutions, not the solution manufacturer's directions.
A) PROTECTION FOR THE PATIENT:
i) PATIENT SELECTION
ii) CONDUCT OF THE EXAMINATION
 Choice of equipment

 Choice of technique

 Operation of the technique

 Processing

 Interpretation of the radiographic image

INTERPRETATION OF THE IMAGE:
 Radiographic images should be viewed under proper
conditions with an illuminated viewer to obtain
maximum available information
 The quality of viewing equipment can make a
considerable difference in the interpretative results.
VIEWING TECHNICS:

 The way in which a person scans a radiograph with his

eyes is important. The viewer should not allow his
attention to skip from area to area but should scan the
radiograph in a systematic manner in order not to
miss or overlook any area.
 Radiographs are viewed with transillumination. The
human eye sees slight differences in film density much
better when the background or surrounding
illumination is minimal.
 Radiographs are best viewed in a semi darkened
room with light transmitted through the films; all
extraneous light should be eliminated. The human eye
detects differences in illumination in relation to the
overall background illumination
 In addition, radiographs should be studied with the aid
of a magnifying glass to detect even the smallest
change in image density.

 For a density difference between two areas of a

radiograph to be detected, the difference in light
intensity coming from the two areas must be at least 1%
of the amount of background or overall illumination.
The means of protection can be divided into:
A) Protection for the patient.
B) Protection for the operator.
C) Protection for and from the
environment.
THANK YOU