Dental radiography – general patient considerations including control of infection
General guidelines on patient care
• For intraoral radiography the patient should be positioned comfortably in the dental chair, ideally with the occlusal plane horizontal and parallel to the floor. For most projections the head should be supported against the chair to minimize unwanted movement. This upright positioning is assumed in subsequent chapters when describing radiographic techniques. However, some clinicians elect to X-ray their patients in the supine position along with most other dental surgery procedures. All techniques need to be modified accordingly, but it can sometimes be more difficult to assess angulations and achieve accurate alignment of film and tubehead with the patient lying down.
• For extraoral views the patient should be reassured about the large, possibly frightening or unfriendly-looking equipment, before being positioned within the machine. This is of particular importance with children.
• The procedure should be explained to the patients in terms they can understand, including warning them not to move during the investigation.
• Spectacles, dentures or orthodontic appliances should be removed. Jewellery including earrings may also need to be removed for certain projections.
• A protective lead thyroid collar, if deemed appropriate for the investigation being carried out, should be placed on the patient (see Ch. 7).
• The exposure factors on the control panel should be selected before positioning the intraoral image receptor and X-ray tubehead, in order to reduce the time of any discomfort associated with the investigation.
• Intraoral image receptor should be positioned carefully to avoid trauma to the soft tissues taking particular care where tissues curve, e.g. the anterior hard palate, lingual to the mandibular incisor teeth and distolingual to the mandibular molars.
• The radiographic investigation should be carried out as accurately and as quickly as possible, to avoid having to retake the radiograph and to lessen patient discomfort.
• The patient should always be watched throughout the exposure to check that he/she has obeyed instructions and has not moved.
Specific requirements when X-raying children and patients with disabilities
These two groups of patients can present particular problems during radiography, including:
As a result of these difficulties, the following additional guidelines should be considered:
• Only radiographic investigations appropriate to the limitations imposed by the patient’s age, cooperation or disability should be attempted.
• Select intraoral image receptor of appropriate size, modifying standard techniques as necessary.
• Utilize assistant(s) to help hold the image receptor and/or steady and reassure the patient. This can be accomplished by using an accompanying relative, rather than repeatedly using a member of staff.
NOTE: Radiation protection regulations usually require that during an exposure a designated controlled area or exclusion zone must exist around the X-ray set and theoretically only the patient is allowed in this area (see Ch. 7). Therefore, if assistance is needed and this requirement cannot be fulfilled, a radiation protection adviser (RPA) or a medical physics expert must advise on the appropriate protective measures for the assistant.
