Staying safe in a safer environment

The lower radiation output is among the regularly touted benefits of digital radiography, but the safety benefits for both patient and clinician do not yet make this technology foolproof and risk free.

Whether using digital or film-based radiography, the routine for taking dental x-rays is pretty well established. The patient is given a protective apron, the sensor or film is placed, the x-ray is aimed, the clinician leaves the room and the image is captured. So it should follow that with greater adoption of digital radiographs, radiation exposure in dental offices should be on the decline, but according to Paul Maurer, President of radiation badge provider IC Care, that is not the case.

“We have seen a gradual increase in dose throughout the digital era. It’s something that’s really horrible,” he said.

Safer, but not safe

Much like a game of Telephone where a phrase gets distorted as it’s passed from person to person, Maurer said the idea of digital radiography as a safer technology can sometimes be misconstrued to the point where it is thought of as a “safe” technology instead. Because of the lower doses, some clinicians may be shooting more images than are actually necessary, he added. This means more exposure for the patient, and more risk to the clinician as well.

While the typical occupational radiation dose is just 3 to 4 millirems a month, Maurer said he’s seen instances where clinicians have been exposed to extremely high doses due to misuse of the technology. In one case after switching to digital radiography a woman began regularly taking four to five images per patient while standing in the room with the x-ray unit and her monthly reading shot up to more than 5,000 millirems.

“I would expect that Homer Simpson, doing his job the way he does it, would get 5,000 a year, but this gal got 5,000 in one month,” he said.

Exposure such as that is the extreme, but it underscores the importance of properly and safely using all technologies that involve radiation risks. The principle of ALARA, or As Low As Reasonably Achievable, should always be the basic guideline for exposing patients and staff to radiation and Maurer said the technology should only be used when there are clear benefits from the information it provides.

Typically this means a patient is only occasionally exposed to radiation, but when it comes to the clinicians there are numerous instances each day when the technology may be called for and thus more regular exposure could be common. The extent of this exposure can be monitored via a dosimeter badge, and now the information those monitors provide can be put to use faster and more effectively.

“It’s not OK to say my machine doesn’t deliver as much radiation so I don’t need to be cautious,” he said. “It’s the combination of the machine and how you operate the machine. The only way to know if that combination is correct and the only way to get those two things as low as reasonably achievable is by using badges.”

Instant results

Last summer Quantum Products launched Instadose™, a dosimeter that provides instant radiation exposure data when its USB plug is connected to a computer with Internet access. Quantum Products President Sander Perle said the instant access to exposure results is a huge improvement over traditional dosimeter badge monitoring where the badges must be sent back to their source for processing and results may not be known for up to three months after possible radiation exposure.

“If you read it once a week you are going to identify if there is any issue,” added Quantum Products Vice President of Sales Lou Biacchi.

Relying on direct ion storage technology, the Instadose badge is actually more sensitive to radiation and thus can track and report exposure to lower doses of radiation than traditional badges. If everything is done correctly during a typical dental x-ray even the Instadose badge should not show any exposure, but Biacchi said a clinician could use the system to check right away if he or she felt anything went wrong during a radiographic procedure.

IC Care distributes the Instadose dosimeters from Quantum Products and is marketing service with the devices under the name RAD-Badge™. Maurer said the instant results are a great way to make the radiation monitoring process a more interactive and involved experience for clinicians. Badging employees and tracking exposure can also reduce some office liability, he added.

“Now you have control. Now there’s greater compliance,” he said. “We think the industry is going to accept this better than they do with standard badges.”

Perle, Biacchi and Maurer all agreed on one specific area where the speed of the results and the ability to instantly pull up personal reports of radiation exposure from a specific time period can be extremely valuable in a dental practice. Many of the people snapping dental x-rays are women of childbearing age and if they are pregnant, they might not learn this until a month or more after conception. With Instadose this clinician could pull up a report to see exactly how much or little radiation exposure has been experienced since the start of that pregnancy.

Optimizing procedures

Another advantage of instant results and easy to track exposures during specific periods of time is the ability to use the data to optimize the safety of procedures in a practice. While a single, safely performed x-ray might not create a measurable reading, Maurer said a clinician could track different exposure levels by spending a day or a week performing one x-ray protocol and then comparing those results with the same period of time spent with a different protocol.

“You’ll know what the difference is, therefore you will inherently develop a much safer operating procedure,” he said while noting that exposure decreases exponentially the further a clinician can be from the radiation source.

With the different color options available for the Instadose, it is easier for clinicians to make sure they are wearing the badge they have been assigned. However, the badges themselves know what online account they are connected to, and because those accounts are password protected, it is difficult for exposure results to be assigned to the wrong clinician. However, Biacchi said data could be reassigned to a different clinician in an event where someone does accidentally wear the wrong badge for a day or a week.

Another use for the instant results from USB badges could be putting patients’ minds at ease. It’s possible for a practice to order a badge and have it assigned for use by patients with a reading taken at every appointment to show the patients how low the radiation levels they have been exposed to really are. However, Biacchi said if a practice were to do this, it would need to find a good place on the patient to clip the badge, and have a good way of quickly teaching a patient how to understand the Instadose results.

“You could put this on the patient to give them a sense they didn’t get much of a dose, but you would have to educate them on what the numbers mean,” he said.

While that may be taking the technology a step beyond its original purpose, optimizing procedures for clinician safety and tracking the impact of technologies involving radiation exposure on the clinicians using those systems does provide benefits for the patients as well. The instant results mean malfunctioning machines can be discovered more quickly and clinicians can be more comfortable with the piece of mind from having the data accessible whenever they want to check it.

“If the practitioner is doing what’s best for the them, they’re probably doing what’s best for the patient,” Maurer said.

Noah Levine is a senior editor for DPR. Contact him at nlevine@advanstar.com.