BRITISH SOCIETY OF DENTAL AND MAXILLOFACIAL
RADIOLOGY
CORE CURRICULUM IN
DENTAL RADIOGRAPHY FOR DENTAL CARE PROFESSIONALS
2008
INTRODUCTION
Regulation 11 paragraph 1 of the Ionising Radiation (Medical
Exposure) Regulations 2000 (IRMER)1 states that no practitioner
or operator shall carry out a medical or dental exposure
or any practical aspect without having been adequately trained. The
requirements for adequate training are set out in Schedule 2 of the
Regulations. The Schedule states that operators
shall have completed training, including theoretical knowledge and practical
experience in:
i)
Radiation production, radiation protection and statutory
obligations relating to ionising radiations, as are relevant to their functions
as practitioner or operator; and
ii)
Diagnostic radiology as relevant to their specific area of
practice.
This core curriculum for DCPs, acting as
operators involved with the radiography of patients, is based on the core
curriculum for dental students and is intended to meet the requirements for
adequate training in those subjects specified in Schedule 2 of IR(ME)R 2000,
which are indicated by an asterisk (*) in the text that follows. Implementation of this core curriculum into
the course will also fulfil the requirements of ‘Developing the Dental Team, Curricula
Frameworks for Registrable Qualifications for Professionals Complementary to
Dentistry’.2
It is 4 years since
the ‘Core curriculum in dental radiography for dental nurses’ was produced, and
it was felt by BSDMFR council at the April 2008 meeting that there had been
sufficient developments to warrant
further revision.
THEORETICAL
INSTRUCTION
Radiation Physics
Electromagnetic spectrum
Background radiation - natural and man-made
*Production of X-rays
Relationship of energy, frequency and
wavelength
*Properties of
radiation
*Attenuation of ionising radiation and factors
affecting attenuation
*Scattering and absorption
*Biological effects of radiation
*Risks/benefits of radiation
*Dose optimisation
*Dosimetry- absorbed dose, dose equivalent,
effective dose and their units
*Factors affecting radiation dose
*Image quality versus radiation dose
Radiation Protection
*General radiation protection including the
ICRP principles of radiation protection
*Use of radiation protection devices
-
patient
-
personal
*Procedures for untoward incidents involving
overexposure to ionising radiation
*Pregnancy and potential pregnancy
*Infants and children
*Justification of the individual exposure
including selection criteria
*Patient identification and consent
*Use of existing appropriate radiological
information
*Alternative techniques
*Clinical evaluation of outcome
*Medico-legal issues
*Regulations
*Local rules and procedures
*Individual responsibilities relating to
medical exposures
*Responsibility for radiation safety
*Routine inspection and testing of equipment
*Notification of faults and Health Department
hazard warnings
*Clinical audit
Apparatus and equipment
X-ray equipment – intra-oral and extra-oral
X-ray tube - cathode, anode, focal spot size
and vacuum
Heat production and how it is dispersed
Basic components of the dental x-ray set
Timers
Applied potential (kV), tube current (mA) and
exposure setting (mAs) - how change affects X-ray quality and quantity
Films and processing
Film types - direct action and indirect
action/screen film
Intensifying screens
Black and white final image production -
effect of exposure
Emphasis on processing - chemistry, wet and
automatic processing and film faults
Darkroom - design and safelights
Digital imaging
Principles of digital image production
Intra-oral and extra-oral systems using:
·
Solid state detectors
·
Photostimulable phosphor plates
Digital image faults and Quality Assurance
Data storage and retrieval, and data
protection
PRACTICAL INSTRUCTION
DCPs should obtain practical experience in
those radiographic techniques normally available in dental practice, to a level
such that they are able to comply with current legislation.
Principles of imaging
Geometric requirements for image production
Importance of quality of image - effects of
distortion
Use and limitation of radiography as a
diagnostic aid
Film handling
Storage - protection from heat, damp and
radiation
*Conventional film processing
Film fault identification
Filing and retrieval
Information exchange
Digital Imaging
Care of digital imaging receptors
Identification of digital image faults
Image storage and data protection
Techniques
DCPs should know the
*Fundamentals of radiological techniques used in dentistry and be able to select
and use the correct equipment
Intra-oral techniques (using
conventional and digital systems)
Bitewings
Periapical views - paralleling technique and
bisected angle technique
Image receptor holders and secondary
collimation
Endodontic radiography
Occlusal radiography
Extra-oral techniques (using conventional and digital systems)
Oblique lateral views of the jaws
Panoramic radiography (dental panoramic
tomography)
Cephalometry
Quality assurance for
conventional and digital imaging systems
*Quality assurance and quality control
The use of the three-point quality rating
scale for radiographs3
Care of patients
Children
Special care patients
Infection control
Communication of risks to patients
RADIOLOGY
Principles and practice of interpretation
Viewing conditions
Nature and limitations of the radiographic
image
Critical assessment of radiographic quality
*Fundamentals of radiological anatomy
Normal anatomy of the teeth and jaws as
depicted on intra-oral and extra-oral radiographs
Identification of common dental pathology such as
Caries
Periapical disease
Periodontal disease
Time required
This course could be covered using lectures,
practical radiography and seminars.
Other teaching styles may also be used such as computer-aided and problem-based
learning. The main objective of the
course is that upon completion dental nurses should be competent to undertake
dental radiography to a level and standard required for general practice. It is suggested that a total of 40 hours is
normally sufficient to cover the course but this is not prescriptive since the
number of hours taught is not as important as the quality of the teaching
received.
A log should be kept by the candidates to
record their clinical experience of taking dental radiographs. This log should
record the number and types of radiographs taken, the quality rating and
identification of any film faults. Although there is no specific quota for the
number of views taken, as a recommendation a suggested minimum would be:
10
panoramic radiographs
30
intra oral views
Practical experience in bisected angle
technique periapicals, occlusal views, oblique laterals and cephalometric views
will be dependent upon the practice. Theoretical instruction in these
techniques is essential. However, it is desirable that as broad a range of
practical experience as possible is obtained, as an understanding of all
techniques will be required for the examination. Dental practices and course organisers are
encouraged to make local arrangements to facilitate obtaining practical
experience.
Examination
For DCPs where dental radiography forms part
of the curriculum, it is considered essential that this curriculum is formally
assessed within the examination structure of the individual dental schools, and
that each major area is identifiable.
This will ensure that the registrable qualification is evidence of
‘adequate training’ as required under IR(ME)R 20001,. For dental nurses, it is highly desirable
that they sit a formal national NEBDN examination at the completion of this
course. The national NEBDN certificate would then be acceptable as 'Proof of
Training' in dental radiography.
REFERENCES
1. The Ionising Radiation (Medical Examination)
Regulations 2000. SI 2000 Number 1059
2. General Dental Council. Developing the Dental
Team. Curricula Frameworks for Registrable
Qualifications for Professionals Complementary to Dentistry (PCDs) 2004
3. National Radiological Protection
Board/Department of Health ‘Guidance Notes for Dental Practitioners on the Safe
Use of X-ray Equipment’. Chilton: NRPB 2001. (http://www.hpa.org.uk/radiation/publications/misc_publications/dental_guidance_notes.pdf)
ACKNOWLEDGEMENT
This document was approved by the Council of
the British Society of Dental and Maxillofacial Radiology at its meeting in
September 2008. Council wishes to acknowledge warmly the contribution of Mr
Nicholas Drage, Consultant Oral and Maxillofacial Radiologist,
Further copies of this document can be
obtained from Mrs Jennifer Lavery, NEBDN, 110 London Road, Fleetwood,
Lancashire FY7 6EU