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Controlling Exposure of Patients

Risks to patients can be controlled by putting in place appropriate procedures. Example Employer’s Procedures for the procedures denoted * can be downloaded via Written Procedures and Protocols.

Put in place guidelines for referral criteria* and make these available to all Referrers (see ‘Selection Criteria for Dental Radiography’ [1] and EP2 Referrals for Dental Examinations example Employer’s Procedure).

If the Referrer and Operator are the same person, ensure that the correct case notes for the patient are available prior to exposure [1].

Ensure that if the Referrer and Operator are not the same person, the patient is asked prior to the exposure to confirm their identity* by stating relevant details such as their name, address and date of birth (see EP4 Patient Identification example Employer’s Procedure).

Ensure that if the Referrer and Practitioner are not the same person, the Referrer provides sufficient information to allow the Practitioner to correctly identify the patient and to decide whether or not the exposure is justified* (see EP3 Justification and Authorisation example Employer’s Procedure).

Ensure that the exposure of the patient to radiation is justified and authorised by a Practitioner before exposure takes place*. For an exposure to be justified, the benefit to the patient must outweigh the risks and the exposure would normally be expected to provide new information to aid the patient’s management or prognosis (see EP3 Justification and Authorisation example Employer’s Procedure).

Ensure that exposures which generally lack any direct clinical benefit to the patient, such as those for employment or insurance purposes, are critically assessed when considering whether or not they are justified*; in these cases it is recommended that the patient’s written consent is obtained prior to the exposure (see EP15 Non-Medical Imaging example Employer’s Procedure).

To comply with IR(ME)R, put in place a written procedure for your practice’s policy on pregnant patients* (see EP5 Pregnancy Enquiries example Employer’s Procedure).

  • In dental practice, the pelvic area is not usually exposed therefore the pregnancy status of the patient is not a contraindication for dental radiographic examination.
  • Although a practice’s policy may be to not make direct enquiries about pregnancy for patients having a dental x-ray, displaying a general poster asking patients to notify the dentist if they are pregnant prior to any type of dental treatment, enables their treatment to be planned appropriately (see example poster in Communication During Examination and Treatment).
  • Information relating to the benefits and risks of an exposure* must be provided to all patients (see EP17 Provision of Information Relating to the Benefits and Risks of an Exposure example Procedure).

If an assisting adult (carer or comforter*) is required for exposures carried out within the practice (e.g. for a child or person with special needs) ensure that guidance and dose constraints are in place (see EP16 Exposure of Carers and Comforters example Employer’s Procedure). The assisting adult must not be a member of staff.

If lead aprons are kept in the practice, store over a hanger (unfolded) and inspect annually.

NB: The only instance where the pelvic area would be irradiated is the vertex occlusal view but as this is not recommended the use of lead aprons for dental patients is not required.

Sources of Information

  1. Selection Criteria for Dental Radiography(2018) Faculty of General Dental Practice (UK)