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Features / July 26, 2016

Lights, camera, action: how to excel at radiography

by Guy Hiscott

Maurice Fitzgerald explains what makes good radiography and how to get the perfect image

Why is good radiography so important?
Dental radiography is an essential part of everything we do in modern dentistry, from assisting in an accurate diagnosis to implementing and delivering the desired patient outcome. Current high-quality dentistry requires high-quality radiography.

Maurice case study
Figure 1: An example of a bad radiograph

What do you see as the most common mistake a dentist can make in radiography?
The most common mistake that is made in radiography is failure to get the best possible image in a given situation. There will be times, where perhaps because of patient compliance, that it just isn’t possible to get a high-quality image, but generally it is. It’s all about sticking to basic principles and systems.

How did you come to have an interest in radiology?
I graduated from University College Cork in 1989 and completed my postgraduate training at University College London in 2000 while working in general practice. My interest in radiology came from just wanting to get better at dentistry in general. It is such an integral part of everything we do every day in the dental surgery.

There will be times where it just isn’t possible to get a high-quality image, but generally it is. It’s all about sticking to basic principles and systems

How can dentists produce more accurate and predictable X-rays?
The vast majority of images taken in dentistry are intraoral. Film/sensor holders with beam aiming devices are essential in order to get a geometrically accurate image. Rinn is one such system.

Selection of the correct exposure setting for that given situation and size of patient is the next important factor. With digital systems, you’re home and dry at this stage. However, with film, ensuring that your chemical processing is well maintained is essential. This is where the diagnostic quality of the image is typically lost with film unless great care is taken with the management of the chemicals.

Auditing your images intermittently against the benchmark and ideal images keeps image quality standards high and consistent. Image quality tends to decline gradually rather than deteriorate overnight in a practice, so checking yourself using an internal audit will help keep you on top of things and identify problems early.

How do you see radiography improving in the years to come?
I see the whole area of dental radiography becoming 3D, both intraorally and extra-orally. The cone beams that are out there at present have limited applications in general practice because of issues with patient dose, field-of-view sizes, and resolution. I believe this will all change; high-quality 3D images being used in general practice is inevitable. It would have the potential for greatly improved diagnoses and patient care outcomes.

High-quality 3D images being used in general practice is inevitable

In your experience, what technology/equipment is better for patient protection against radiation etc?
This question is all about patient safety and care. I believe all dentists should feel confident in telling their patients that dental radiographs are safe but used selectively to manage their care and get the best possible health outcomes for them.

The best equipment/technology available to a dentist is knowledge. Know what you are doing, understand and apply the ALARA (as low as reasonably achievable) principle and get an excellent image almost every time using positioning aids and beam aiming devices. This might all sound basic but it ensures that the best radiograph, with the least dose, is achieved first time, every time for most patients.

If dentists want to improve their radiography skills, what advice would you offer?
The best way to improve radiography skills is firstly to identify areas that need improvement. There are a vast amount of resources available online, so really, just read, watch and apply.

Dentaltown and other online resources are a great port of call for everyday solutions to everyday problems in general practice. As well as, of course, attending postgraduate education on radiology, which is not only mandatory but an essential opportunity to discuss your concerns with your colleagues. By getting better at radiography, the quality of every other aspect of your dental practice improves, so it’s worth investing time and effort in the subject.

What not to do

Figure 1 highlights some of the radiographic errors that are avoidable with phosphor plates. The plate is scratched and bent, and should be replaced. Positioning errors are present and could have been avoided by using a holder with a beam aiming device. The strange appearance of the incisors is down to a failure to clear the previous image from the plate prior to re-use. A protocol should always be in place regarding the handling of plates to eliminate the risk of this error

Maurice Fitzgerald is a native of Mallow, Co Cork. He graduated from University College Cork in 1989 and holds a masters degree in dental radiology from the University of London. He works in private practice in Sligo.

What are your top tips for good dental radiography? Share your tips in the comments below