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Dental practice owners who operate radiography equipment must follow radiation safety regulations. But too many don’t understand their compliance obligations. The solution is to call in an accredited consulting radiation expert. By Shane Conroy
Many dentists and dental technicians use radiation-emitting X-ray devices multiple times per day. While the low-dose units typically present little risk to patients, practice owners have a duty of care to ensure their staff are not exposed to unnecessary radiation.
There are a range of state- and territory-based radiation safety regulations that dental practices must adhere to, but too many are letting their compliance responsibilities slide.
“There is clearly a lack of information about radiation safety and compliance,” says Makenzie Harris, founder and consulting radiation expert (CRE) at Sydney-based radiation safety specialists, Gamma Tech. “Dentists go out and get their radiation user license, but they do seem to have a lack of knowledge about equipment upkeep and compliance.”
Harris thinks the confusion probably stems from the complex state-based regulatory systems that apply different radiation compliance standards between states and territories.
“In NSW, the Environment Protection Authority (EPA) oversees radiation compliance in the dental industry, but there are different regulatory bodies in each state and territory,” he explains.
The Australian Dental Association (ADA) points dentists to the Code of Practice and Safety Guide for Radiation Protection in Dentistry published by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) as the go-to national guide for radiation safety.
ARPANSA makes it clear that the responsibility for radiation protection lies with the person in control of the practice using the dental X-ray equipment. That person, says APPANSA, must ensure that “the use of dental X-ray equipment constitutes minimal risks to patients, operators and other staff in the practice as well as to persons who are in or near the premises where the dental X-ray equipment is installed”.
Harris says dental practices can fulfill that obligation with assistance from a CRE who is accredited in your state or territory.
Harris is a Sydney-based CRE accredited by the NSW EPA. His company, Gamma Tech, provides compliance testing and certification on radiation-emitting dental equipment. These include intraoral X-ray, panoramic X-ray (OPG), cephalometry, and cone beam computed tomography (CBCT) units.
Harris explains that while regulations do differ between states and territories, dentists generally need to ensure all radiology equipment is serviced annually by the manufacturer’s service engineers, and compliance tested (once every five years in NSW) by an accredited CRE.
“Units should also be compliance tested following installation, relocation, and major repairs involving a tubehead replacement,” Harris adds. “We’ll come in to ensure that there is no leakage from the tubehead, no damage has occurred to the unit, and it is still operating within the legal tolerances.”
The scatter effect
Radiography equipment can deteriorate over time, which may cause fluctuations in the dosage output.
“These units typically emit low radiation doses, so when the units are in sound working order, the risk isn’t really to the patient,” Harris says. “However, given the frequency of examinations, it’s more a case of ensuring that the dental staff and everyone else in the practice isn’t exposed to unnecessary radiation.”
Ensuring the unit is in good working order is only part of your radiation safety responsibilities. You also need to consider protecting technicians with appropriate shielding, which may even include installing lead lining on walls surrounding radiography equipment.
“The main risk isn’t the radiation coming from the tubehead, it’s the radiation coming from the scatter,” Harris explains. “Most of the X-ray photons pass through the patient as the scan is taken. However, some of the rays hit the hard and soft tissues of the patient, and scatter radiation in different directions perpendicular to the beam. As rotating units go around the head, that scatter becomes a curve that expands outwards.”
Harris says the radiation scatter generally dissipates to a negligible dose over a distance of about two metres. An accredited CRE can advise where shielding may need to be placed and where lead lining on walls may be required to protect people in adjoining rooms who might come within two metres of the unit.
“It may sound a little scary, but a CRE can help you understand your obligations,” says Harris. “At Gamma Tech, for example, we manage the process for you. We’ll provide all the advice you need, remind you when your compliance testing needs to be done, and come in after hours so there’s no disruption to your practice.”
Calling in the CREs
If you’ve let the compliance certification lapse on any of your equipment, now is the time to call in a CRE—particularly if your practice is in NSW. Last year, the NSW EPA introduced ‘Radiation Standard 6: Compliance requirements for ionising radiation apparatus used in diagnostic imaging’.
Harris says that while this new standard tightens compliance testing requirements, the details of the regulation are more of concern to CREs than dentists. “Standard 6 doesn’t really change much for the dental practice. It has added more parameters we need to test for, particularly for CBCT units. But, again, as long as the dentist works with an accredited CRE, there’s nothing really for them to worry about.”
Harris adds that retiring or outgoing dentists should remember to transfer equipment on their radiation management license to the license of the new practice owner. “Dentists often forget to do that,” he says. “You also need to update your license if you’re disposing of any X-ray equipment.
“But I think the main message for dentists here is that all you really need is a good relationship with an accredited CRE. They’ll be across all the technical compliance testing details, and most will be happy to advise on anything you need to do to ensure you’re meeting the compliance regulations in your state or territory.”