X-ray in Dentistry: Who Can Indicate and Who Can Perform?
X-ray is an integral and important part of dental diagnostics. However, since it is also a source of ionizing radiation, its use is subject to legislative regulations that govern it.
Current Legislation at a Glance
The conditions for using X-ray devices in dentistry are currently regulated by Act No. 263/2016 Coll., the Atomic Act (hereinafter AZ), effective since January 1, 2017, and related implementing decrees.
AZ introduced the new term 'registration,' meaning that to use sources of X-ray radiation in dentistry, registration with the State Office for Nuclear Safety (SÚJB) is required. This registration necessity applies to all types of X-ray devices – intraoral, panoramic, cephalometric, or CBCT (cone beam computed tomography). It is also necessary for the workplace to have a person or persons responsible for the registrant's radiation protection. This person must be physically present during the patient imaging and have confirmation that they have completed a 6-hour educational course. Therefore, it is not possible to perform X-ray examinations without the presence of this person at the workplace. Similarly, it is not possible to perform an X-ray examination without proper indication.
It is necessary to note that even if the X-ray is performed at the request of the X-rayed person and is not covered by health insurance, the provider performing this examination is still obliged to ensure proper indication and the presence of a person responsible for the registrant's radiation protection.
Who Can Indicate a Dental X-ray?
The answer is simple – only a dentist with completed education, based on a prior examination and assessment of the patient's condition.
A situation, which unfortunately is quite common in some workplaces, where an X-ray is taken before the doctor even sees the patient for the first time, is illegal. On the other hand, it is entirely acceptable for a properly indicated examination to be conducted at a different time than the doctor's examination (e.g., planned before the next visit or during a separate visit to the workplace performing the X-ray for the dentist – this applies mainly to orthopantomography /OPG/, tele-X-ray /TLR/, and CBCT).
Who Can Perform X-ray Examinations in Dentistry?
The examination can be performed by either a doctor or an authorized person with medical education. These persons can be nurses, radiological technicians, or dental hygienists. Conversely, someone without a medical background should never perform the examination.
Under What Conditions Can a Dental Hygienist Perform X-ray Examinations?
As of July 1, 2022, a dental hygienist (DH) can perform the practical part of the exposure using a dental X-ray device, which means the actual imaging and all related supportive activities, including handling radiological equipment. However, the X-ray examination must always be indicated by a dentist. DH cannot indicate, justify, evaluate the quality of, or clinically assess the X-ray exposure.
When a dental hygienist conducts the X-ray imaging, it must be under the professional supervision of a dentist. An X-ray examination carried out by a DH based on their own decision would not be properly indicated or justified, thus constituting illegal medical exposure of the patient with all the associated consequences under radiation protection regulations.
(norg)
Sources:
1. Slavík J. A dental hygienist can perform X-ray imaging based on a dentist's indication but must not evaluate the images clinically. LKS 2022; 32 (7–8): S122.
2. Jursíková E., Vostřáková M. Use of dental X-rays and registration requirements. LKS 2019; 29 (3): S42–S43.
3. Radiation Protection. SÚJB. Available at: https://sujb.gov.cz/radiacni-ochrana
4. Act No. 263/2016 Coll., Atomic Act. Available at: www.zakonyprolidi.cz/cs/2016-263
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