Answer to Question #5706 Submitted to "Ask the Experts"

Q

I am a practicing full-time endodontist (root canal dental specialist) and am also licensed to provide moderate IV sedation for my patients during their procedures. We normally take two to three periapical x rays during a root canal to measure the length of the root(s) and verify that the entire root canal(s) is properly filled before completing the case. Retakes are often also needed, if I miss the image "shot." In a nonsedation case, the patients typically hold the x-ray film or digital sensor with their finger or hand while my staff and I leave the room and step behind the leaded wall and push the exposure button. We then return back into the treatment room to continue on with the procedure.

The problem with sedation cases is that although the patients are not unconscious, they can be very heavily sedated to the point that they cannot comprehend nor hold the x-ray device for the necessary check x rays during treatment. I then have to hold the sensor for the patient with my hand or fingers and expose my fingers, arm, and body to the accumulated scatter radiation. Do you have any suggestions as to the type of apron that I would need to wear? Various Web sites display aprons, gloves, eyeware, etc., that an operator could use, but I see no protection for the wrist, forearm, etc. What about the x-ray unit itself? Is there a backscatter device that can be attached to the x-ray machine itself? What do I need?

Endodontics with moderate IV sedation is a relatively "new field" and there are very few offices/doctors providing both services, therefore there is very little information out there and it is anecdotal in nature.

A

Radiation safety in dental facilities is regulated by the state you are in, and there may be requirements that prohibit you from being in the room during the x-ray exposure. Recommendations in National Council on Radiation Protection and Measurements (NCRP) Report No. 145 also have the operator outside the room. NCRP No. 145 also indicates that occupationally exposed personnel (that is, dentists and their staff) shall not hold the patient or image receptor (film or digital receptors).

Based on state regulations and national recommendations, you have two clear options: (1) have a family member (or person who comes with the patient) hold the image receptor or (2) develop or locate a device to hold the image receptor during exposure. If you have a family member hold an image receptor (or if a conscious patient holds an image receptor), he/she should be holding the image receptor with something such as a pair of forceps, so that no part of his/her body (that is, the fingers or hands) is in the primary x-ray beam. Anyone in the room who is holding an image receptor for a patient should also be given a lead apron and should be screened as to whether or not he/she is over 18 years of age or pregnant.

Ken "Duke" Lovins, CHP

References
National Council on Radiation Protection and Measurements. Radiation protection in dentistry. NCRP Report No. 145; 2003.

Ruter, Douglas, DDS, personal communication.