The HARP Act requires owners of x-ray equipment to appoint a person as a radiation safety officer (RPO). In a dental facility, only one dentist can act as an RPO. Dental hygienists and dental assistants are not allowed to perform dental CT scans. I once heard a doctor tell a patient that people are more exposed to radiation from their color televisions than dental X-rays. While this is an analogy a patient can understand, the accuracy of this statement is questionable. What the doctor tried to make is that we receive radiation from many different environmental sources, not just dental X-rays. Only persons who meet the qualifications set out in the HARP Act and its regulations may have x-rays. Radiology training requirements for dental office staff are often different from those for medical staff who take medical X-rays and are less stringent. Training requirements for dental office staff are usually found in state dental practice laws or dental practice regulations. The risk of occupational exposure in dental facilities is much lower than in hospitals and doctors` offices. According to NCRP5, the occupational exposure limit is 50 mSv in one year, although the lifetime occupational dose is limited to 10 times a person`s age.
The NCRP concludes that occupational exposure of dental personnel should not exceed these limits, except for issues related to plant design, diagnostic equipment performance, or operating procedures. For pregnant dental staff, the radiation exposure limit is 0.5 mSv per month (see section below).6 As an example, let`s say Joe Blow is coming to his prevention appointment today. His last injections were taken three years ago, and he did not request X-rays during his last visit seven months ago. He chews tobacco and has had several carious lesions in the past. Knowing his history of X-ray rejection, a hygienist might feel intimidated if he even broaches the subject. I hear the hygienist express the need for x-rays: “Mr. Blow, it has been three years since we took X-rays on you. Is it okay if we have them today? Joe notices the shyness with which the hygienist asks and boldly announces, “No, no X-rays! I remember a patient who consistently refused to allow X-rays. During a particular preventive visit, the doctor asked to see his X-rays. When I told him that Mrs. XXX had asked not to take it, he looked at her and said, “Really? What is it? As the patient responded, he put his hand in his back pocket, pulled out a handkerchief, and began tying it around his eyes like a blindfold. Then he reached out and said, “Dianne, give me the mirror,” as if he were doing the exam blindfolded! The patient started laughing, but she understood when he told her that treatment without X-rays was like asking her to work blindfolded.
Then she said, “OK, OK, I understand what`s important,” and I took her films. Legal risks – Many offices have a policy stating that if a patient refuses to have the necessary X-rays, they will be released from practice. While this practice may seem rather rigid and even harsh, it might be the smartest policy from a legal perspective. Even if you ask a patient to sign a form in which they voluntarily refuse X-rays, no patient can agree that the dentist is negligent. If an X-ray is not taken when it is necessary for proper diagnosis and a serious dental problem occurs later, the doctor could become entangled in a legal disorder. The only staff members who can expose patients to dental CT scans are qualified medical radiation technologists registered with the College of Medical Radiation Technologists of Ontario and acting under the supervision of a qualified local prescribing dentist. Portable devices that facilitate imaging when patients are sedated or anesthetized were approved by the FDA in July 2005. The FDA advises dentists19 to use legally marketed products for this purpose and to verify that they are properly labeled to indicate that this is the case. Studies on legally marketed equipment have shown that radiation exposure is within safe limits19, 20 and even significantly lower than that of wall systems (0.28 mSv versus 7.86 mSv). Studies have concluded that no additional shielding is required.20 The dentist acting as an RPO in the dental facility should ensure that only qualified individuals take dental x-rays. The ADA, in cooperation with the United States. The Food and Drug Administration (FDA) has developed recommendations for dental X-rays that complement the dentist`s professional assessment of the best use of diagnostic imaging.2 X-rays can help the dentist evaluate and definitively diagnose many oral conditions and conditions.
However, the dentist must weigh the benefits of dental X-rays against the risk of exposing a patient to X-rays, the effects of which accumulate over time from multiple sources. The dentist who is familiar with the patient`s medical history and susceptibility to oral disease is in the best position to make this judgment. For this reason, the recommendations are intended to serve as a resource for the practitioner and are not intended to constitute standards of care, requirements or regulations. An XRIS inspector can visit any dental facility to inspect surgeries, review records, and perform tests to determine HARP compliance. By law, inspectors can enter and inspect dental facilities at any reasonable time without an appointment. Inspectors can provide dentists with a one-week window for office inspection visits. The ADA encourages dentists and patients to discuss dental treatment recommendations, including the need for X-rays, to make informed decisions together. In a dental office, only a dentist has the authority to prescribe dental X-rays. It is important for the physician to engage in discussions about X-rays.
The doctor may say, “I understand your concerns about X-rays. But please understand my position that without X-rays, I can`t give you the care you deserve. Prepare to receive x-rays at your next visit. If the patient refuses again at the next visit, the doctor may decide to release him from the office. The HARP Act requires every dental office to establish a photographic quality assurance (QA) program. Photographic quality assurance is a program of activities designed to ensure that diagnostic imaging is performed with the maximum benefit to the patient with minimal risk. The program requires dentists to perform acceptance testing on all new and used X-ray machines.