1 RADIOLOGY CLINIC MANUAL

Table of Contents:

I. Introduction . . . . . . . . . . . . . . . . . . Page 1

II. Objectives. . . . . . . . . . . . . . . . . . . Page 1

III. Professional Appearance . . . . . . . . . . Page 1

IV. Criteria for Radiographic Exposure of

Dental Patients . . . . . . . . . . . . . . . . Page 2

V. Operators of X-ray Machines . . . . . . . . . Page 3

VI. Clinic Procedures . . . . . . . . . . . . . . Pages 3, 4 & 5

VII. Infection Control . . . . . . . . . . . . . . . Pages 5, 6 & 7

VIII. Panoramic Film Instructions . . . . . . . . . Pages 7 & 8

IX. Grading. . . . . . . . . . . . . . . . . . . . . Pages 9

X. Radiology Clinic Faculty/Staff . . . . . . . . Page 10

Online slide presentation: Radiology Clinic Orientation

http://dent.osu.edu/radiology/radclinic.ppt
 RADIOLOGY CLINIC MANUAL

I. Introduction

The purpose of this manual is to answer any questions that may arise concerning
the student's activities in Radiology. Students are expected to follow the
guidelines presented in the various sections in order to expedite optimal patient
care with a minimum of wasted time and effort. This manual covers the entire
range of clinical activities in Radiology.

II. Objectives

A. The student will be able to answer questions regarding radiation exposure.

B. The student will be able to perform a brief oral examination and order
appropriate films in consultation with instructor.
C. The student will use good technique in taking the necessary films and
identify technique errors.
D. The student will follow accepted radiation safety guidelines and infection
control procedures.
E. The student will be able to properly process films and identify any
processing errors.
F. The student will be able to identify normal radiographic anatomy on both
intraoral and panoramic films.
G. The student will be able to identify caries, periodontal involvement and
pathology on both intraoral and panoramic films.

III. Professional Appearance

In keeping with the general clinic manual, students working in the Radiology
Clinic should be clean, well-groomed, and wear clean clothing at all times. A
surgical gown is to be worn. These guidelines apply to anyone seeing patients in
the Radiology Clinic. Failure to comply may result in dismissal from the clinic.

Any future guidelines that may be developed regarding proper clinical attire will
be adopted by the Radiology Clinic.

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IV. Criteria for Radiographic Exposure of Dental Patients

A. Following an oral examination, only those films considered necessary

for a proper diagnosis will be ordered. The need for radiographs should
be based on “Guidelines for Prescribing Dental Radiographs” (Kodak
Pub. No. N-80A), developed by a panel of the leading dental
organizations.

B. Under no circumstances will the need for, or the extent of, a radiographic
examination be based on arbitrarily established conditions (e.g., check-out
bitewings) or on specific time frames.

C. The lead apron and thyroid collar will be used on all patients for
intraoral films. The lead apron only (no thyroid collar) is used for extraoral
films.

D. All radiographic exposures are to be recorded in the patient's clinic

folder. Retake-radiographs are not to be taken for the sole purpose of
having technically acceptable or perfect radiographs, providing that the
areas are covered at diagnostically acceptable levels on other
radiographs.

E. Students are expected to seek help from an instructor if they are having
any problems getting the appropriate films. This does not affect the grade
the student receives for that patient unless it is determined that the
student should have been able to complete the exposure without
assistance.

F. The pregnant patient should be exposed to x-rays only for the

information that is diagnostically required for planned treatment
during pregnancy. The need for films and the number taken will be
determined by the instructor.

G. Recent films taken by an outside dentist should be requested for

evaluation prior to ordering new films. Based on the areas covered and
the diagnostic value of these films, additional radiographs may be
indicated.

H. The re-exposure of a patient to obtain duplicate radiographic information

for third party or teaching purposes is contrary to radiation health and is
prohibited.

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V. Operators of X-ray Machines

A. Students will be permitted to use x-ray equipment only under the

supervision of the faculty or staff.

B. No student, faculty or staff member shall be in the x-ray cubicle

during radiographic exposure of a patient.

C. The operator must stand behind the barrier provided for each cubicle;
the operator must observe the patient through the leaded glass
window during the exposure of each film.

VI. Clinic Procedures

A. Students on Screening Detail

1. Report to the X-ray Clinic after the panoramic film has been
ordered by the Screening Faculty. Check in with the receptionist
at the desk and fill out a Clinical Evaluation Form (purple sheet).
The information includes your name and class rank, patient’s name
and ID #, date, and film(s) to be taken. The receptionist will provide
the panoramic cassette. Take the evaluation form with you.

2. Check with a faculty member to see which panoramic unit to use.

Place cassette in unit and then enter the patient’s name (last name
first) and ID# into the panoramic imprinter. After cleaning hands,
place a bitestick cover on the bitestick.

3. Bring patient into the cubicle. Have them remove jewelry, glasses,
dentures, etc., and then place the lead apron. Position patient (see
section VIII on page 7) and complete exposure.

4. After removing the cassette and imprinting the patient information,

take the cassette to the darkroom for film processing, which will be
done by the technician.

5. The film will be ready in 3 minutes. It is usually best to wait on the

film and then review it with an instructor before returning to the
Screening Clinic.

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B. Students taking films on non-screening patients

1. Enter the films to be taken in the front of the patient's chart and have
the clinical instructor sign in the appropriate space.

2. Report to the desk person in the Radiology Clinic with patient's chart.
Fill out evaluation form and receive films, film bag and any necessary
bitewing or paralleling instruments. Proceed to designated cubicle
(Instructor will tell you which cubicle to use).

3. Seat patient, adjust headrest and place lead apron/thyroid collar.

4. Empty the films and instruments out of their plastic bags onto the tray.
Open the film bag and set it up on the counter behind or beside the
tray.

5. Have patient remove any intraoral appliances and glasses.

6. After cleaning hands, using antiseptic hand gel (preferable) or

washing with soap and water, and putting on gloves, assemble
the bitewing and/or paralleling instrument(s) and proceed with
taking the films. Unless the instructor indicates otherwise, each film
should be checked by the instructor before exposure to minimize
errors. Dry the films thoroughly before placing in the film bag.
This should be done immediately after each exposure.

7. Unexposed films and instruments should never be placed directly on

the counter. Always keep them on the tray to maintain sterility. In
addition, anything dropped on the floor should be left there until you
are finished with the patient. Obtain replacements from the desk
person as needed, making sure you remove gloves and rinse your
hands before leaving the cubicle.

8. After completing the intraoral radiographs and placing the last film in
the bag, remove all plastic from the x-ray machine and exposure
switch. Disassemble the paralleling instrument(s). Remove
gloves, clean hands (gel), and take the lead apron off the patient.
Advise the patient to have a seat in the waiting area. If a panoramic
film is needed, instruct the patient to remove earrings, necklace,
etc., while they are waiting. Remove and discard head-rest cover.
Using a surface disinfectant, wipe down any areas contacted that
were not covered by plastic.

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 9. Take instruments and tray to Cubicle F. Place instruments in sink
and place tray on counter. Take the films back to the darkroom for
processing by the x-ray technician. Place the grade sheet in the
back room next to the viewboxes (unless you are taking a panoramic
film; see next section).

10. If a panoramic film is needed, the film will be given to you by the desk
person when you come out of the darkroom. You will need the purple
evaluation form in order to enter the patient’s ID# in the panoramic
film imprinter. Proceed to take the film following the instructions in
Section VIII on page 7. After completing the exposure, the patient
returns to the waiting area while you clean the panoramic equipment.

11. After imprinting the patient information on the film, take the panoramic
cassette back to the darkroom technician.

12. You may remain in the X-ray Clinic until the films are ready to be
evaluated if you are only taking a few films and need them before you
can proceed with treatment. Otherwise, it is preferable that you take
the patient back to the clinic and start other procedures. You should
return to the Radiology Clinic after at least 15 minutes to get the films.
A faculty member will review the films with you to identify pathology
and technique errors.

VII. Infection Control

Infection control procedures are intended to eliminate cross-contamination from

patient-to-patient and patient-to-operator. They are to be used for ANY patient seen
in the X-ray Clinic. These procedures are important and they must be strictly
followed.

1. Before seating patient, make sure the tubehead, exposure

switch and headrest are covered with plastic. A rubber band
should be placed over the PID to help keep the plastic out of the
way when positioning the tubehead. A tray covered with plastic
will be used on the counter top. All plastic bags, rubber band and
paper towel are supplied on the tray which is placed on the counter in
each cubicle. Instruments and films will be placed on this tray. If anyof
the equipment is not covered, and is touched by the student with
contaminated gloves, it will serve as a possible source of cross-
contamination for subsequent patients.

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2. Seat patient, adjust head rest and place lead apron/thyroid collar.
No gloves are needed for these steps.

3. After emptying films and instruments on the tray, prepare for

taking films by:

a. Setting up paper bag on counter top (not on tray) so you are

able to drop films in without touching bag.

b. Cleaning hands using alcohol gel or washing hands and putting

on gloves.

c. Assembling bitewing and/or paralleling instruments.

4. Proceed to take films.

5. Each film must be thoroughly dried off with a paper towel after
exposure.

6. You must not touch any of the following items after you have put
on your gloves: 1. Charts or grade forms, 2. Pens or pencils
(unless wrapped in plastic), 3. X-ray film bag and 4. Lead apron.
In effect, this limits you to touching only the film, film holders, x-ray
equipment and paper towel. If for some reason you must check the
chart, need to readjust the headrest or lead apron, or need to get
additional films or cotton rolls, you should remove old gloves, rinse,
and reglove when ready to proceed.

7. After the last film is taken, dried, and placed in the film bag,
remove the plastic bag from the tubehead and the plastic sleeve
from the exposure switch. Disassemble the instrument(s) and
dispose of the paper towel and any other disposble items on tray.
Now you are ready to remove your gloves, clean your hands, and
take the lead apron off the patient. Then direct the patient to the desk
if they are done or to a seat in the waiting area if they need a
panoramic film. The headrest cover may now be removed (no gloves
needed).Take the instruments and tray to Cubicle F.

8. You should never leave the cubicle with gloves on. Always remove
the gloves and immediately clean your hands. You can take new
gloves with you into the darkroom if you are processing your own
films.

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 9. If you touched any part of the x-ray equipment that was not covered
by plastic, you must spray-wipe-spray these areas down with a
surface disinfectant. This should be done before you take the films
back to the darkroom.

10. The soiled disposable items (gloves, clinasept barriers, film packets,
paper towels, etc.) are not considered as infectious (regulated)
medical waste. These items may be placed in the regular trash
receptacle.

11. If you take a panoramic film, you must wipe down any parts of the
machine with which the patient had contact. Gauze pads with surface
disinfectant are provided in the panoramic room.

VIII. Panoramic Film Instructions

A. Instruct the patient to remove all jewelry, dentures, glasses, bobby pins,
hearing aids, etc., from the head and neck region. Coats should also be
removed. (The patient should be doing this while you are loading the film).

B. Load the cassette in the machine as indicated. The arrow on the back of
the cassette should point upward and face away from the patient. (Check
with the instructor if you are not sure how this is done).

C. With gloves on, place a plastic cover on bitestick. Use cotton pliers to get
cover out of container.

D. Place lead apron on patient with short side in back. Make sure the apron
does not cover the back of the neck or rest too high on the sides of the
neck.

E. Position the patient as follows:

1. Chin on chin rest (Raise bitestick so that patient can get chin in
position).

2. Incisors in notch of bitestick. (Align ridges over notch for edentulous

patient or use special edentulous positioner).

3. Make sure the back is straight. Advise patient to hold onto the
handles and step forward until they feel they are “leaning back”.

4. Align the Frankfort Plane parallel to the floor using light lines as
guide.

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5. Make sure the midsagittal plane is centered, again using the light
 line.

6. Make sure light line at side of mouth passes through maxillary

canine. Make focal trough adjustments as needed.

7. Move head positioner into contact with forehead and tighten the
lateral head positioners until snug against the head.

8. Lower cassette holder to confirm shoulder clearance.

9. Tell patient to hold tongue against the palate during the exposure.

10. Inform the patient about machine movement and the need to hold
still for the twenty seconds it takes for the machine to rotate.

F. Complete the exposure. Do not release the exposure switch until the
machine has come to a complete stop.

G. Open the lateral head positioners, advise the patient to carefully step out of
the machine, and send the patient back to the desk.

H. Remove and discard the plastic bitestick cover. Remove the cassette and
wipe down the unit with disinfecting solution.

I. Place the cassette in the imprinter to label film.

J. Take the cassette back to the darkroom technician for processing.

IX. Grading

A. Students are assigned patients on a random basis when they are on

Screening Detail. They are expected to take the necessary films on each
assigned patient. Each student must see at least four patients during a given
quarter to receive a grade. (Dent 747-Aut; Dent 748-Win; Dent 749-Spr; all
1- hr. courses).

B. Films are reviewed with the student before leaving the Radiology Clinic. A
numerical grade (0-4) is given for each patient. The number of minor errors
(not requiring retakes) and major errors (requiring retakes) are computed for
each patient and a grade is assigned. The number of films taken is also
considered in assigning the grade. (See “Radiographic Technique Evaluation
Form”, page 10). No grades are given during Summer Quarter.

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C. The grading scale for the final grade is as follows:

 1. A: 3.50 - 4.00
2. B: 3.00 - 3.49
3. C: 2.40 - 2.99
4. D: 1.80 - 2.39
5. E: below 1.80

D. A Radiographic Exercise is required during Summer Quarter. This exercise

involves the bisecting-angle technique, radiographic interpretation of
intraoral and panoramic films, recognition of technique errors, the buccal
object rule and film mounting. This exercise must be completed before a
grade can be assigned.

E. If for some reason a student receives less than three technique grades
during the quarter, an incomplete will be given. As soon as a sufficient
number of patients have been seen the following quarter, a grade will be
assigned. There is no penalty associated with the incomplete; the final grade
will not be affected.

F. Anyone receiving an E for the quarter will be required to complete remedial

work assigned by Dr. Jaynes.

G. Students are encouraged to check with the instructors regarding their grades
and ask questions if there is any confusion about how the grade was
determined. If there are specific problems with a grade or with an instructor,
the student should contact Dr. Jaynes.

X. Radiology Clinic Faculty/Staff

A. Radiology Clinic Director

Dr. Robert M. Jaynes Room 3001L 688-3374

B. Radiology Clinic Faculty

Ms. Constance Kuntupis Room 3039-D 292-5264
Dr. Eliana Sanchez Room 3040 292-2994
Dr. Joan Gibson-Howell Room 3029 292-1235
Ms. Brenda Kennedy Room 3040 688-3579
Ms. Denise Kissell Room 3001K 292-8410

C. Radiology Clinic Staff

Ms. Kathleen Marquard Room 1117 292-0874
Ms. Debbi Pack Room 1117 292-0874
Ms. Luckisha Townsend Room 1117 292-0874

Revised 5/12/08