A couple of weeks ago I saw some short notes about new radiation safety instructions from the Swedish Radiation Protection Institute in the Journal of the Swedish Dental Association. I became curious it was nothing written in the Journal about the contents, only stated where these new regulations could be found in Internet.

Therefore I made a visit to the Institute's homepage (www.ssi.se) and will this time refer some matters from this visit. These new recommendations are also accepted by EU.

As I have written about before, Dental Radiology is today a fast speeding subject with above all the digital era coming up. But also in radiation protection new things are happening all the time. For example is a faster film produced all the time, which is a benefit for the patient with a decreasing radiation dose. Also newer x-ray units with for example smaller collimators contribute to this decreasing dose to our patients. 

However, even if we today use very small doses to our patients (see my earlier report called "More about radiation physics matters") it is important to remember the ALARA principle that has been proclaimed by ICRP (the International Commission of Radiological Protection). Which says that we always should use "As Low As Reasonable Achievable" radiation.

These trains of thoughts are behind the new recommendations and also the quality checking that we dentists shall carry out at least yearly in our country. 

I will start today to describe some things from the first of these safety instructions (SSI FS 2000:1). The instructions are written for all kinds of medical and dental clinics with radiographic units, but I will stress the matters that are important for a general dental practitioner.

Regarding justification and optimizing of a x-ray exam

Some general obligations for medical and dental work with ionizing radiation are described. It is stated that if we want to take radiographs of our patient, we must weight the pros of having a diagnosis later on with the cons of receiving radiation for the patient. There must be a net gain or benefit for the patient. 

When it has been decided to make a x-ray exam, this one shall be optimized regarding its extent and dose.

Regarding the competence of the staff

It is also necessary that all staff involved in the exam have enough theoretical and practical experience to perform a safe exam from a radiation safety viewpoint. And if a new equipment or a new method is implemented, the staff should have an education and training for this.

Regarding a radiographic organization plan

In a clinic it should always be one person being responsible for the clinic´s radiographic units and for the examinations. He should be assisted by a radiation organization adapted to the nature of the Clinic's activities. The responsible certified dentist, shall have elaborated a radiation safety organization plan, which should be documented. If the certified dentist has several clinics, there should be a radiation safety committee, which regularly keeps their minutes from meetings.

Regarding quality assurance

There should also be a manual in quality assurance regarding radiation safety. This one should for example describe when technical checkups should be made of the equipment.

Regarding pregnant women

The following is stated

If a female patient is pregnant or a pregnancy cannot be excluded, a special attention shall be paid to the child during medical radiographing. Nothing is said about taking dental radiographs and this is probably since we know that in principle no radiation at all will reach the uterus if we take a regular FMS (full mouth survey) with the usual safety steps.

Next time I will continue with more recommendations from the Swedish Radiation Protection Institute!

Leif Kullman