Panoramic radiology — a postal survey of GDPs

Key Points

• Almost all dentists satisfy guidelines on servicing and radiation survey of panoramic x-ray equipment.

• A substantial proportion of dentists carry out routine panoramic radiography of new adult patients, a practice in conflict with guidelines.

• A substantial proportion of dentists use unqualified staff to take panoramic radiographs, also in conflict with guidelines.

• There are important implications in these findings for educators and those who set clinical standards.

Abstract

Objectives To gather information on the types of panoramic x-ray equipment used in NHS dental practice and whether dentists satisfy the legal requirements for safety, to determine which practice personnel take panoramic radiographs and to assess the prevalence of the practice of 'routine' panoramic radiography among NHS dentists.

Design Postal questionnaire survey of general dental practitioners carried out during 1997 in selected FHSAs in England and Wales.

Results 542 dentists returned the questionnaire, a 73.3% response. Panoramic x-ray equipment ranged in age from 27 years old to new, with 42.2% exceeding 10 years in age. The overwhelming majority of GDPs satisfied the requirement for regular maintenance and surveying of equipment. Almost all dentists (95.9%) performed a history and clinical examination prior to panoramic radiography but 42% practised 'routine screening' of new adult patients. A substantial proportion (36.7%) of dentists used unqualified personnel to take panoramic radiographs.

Conclusions While some aspects of this study give reassurance about the prevalence of good practice, widespread panoramic screening and using unqualified staff to take radiographs causes concern. These findings have implications for educators and for those involved in maintaining clinical standards.

Main

Aspects of panoramic radiography in general dental practice V E Rushton, K Horner, H V Worthington Br Dent J 1999; 186: 342–344

Comment

Compared with medical examinations, doses from dental radiography are very low. On the other hand, it constitutes 25% of all radiographic examinations in the UK, and the risk to the UK population as a whole is therefore not insignificant. Further, the poor diagnostic quality of many panoramic radiographs taken in general dental practices causes concern.¹ This paper examines four aspects of panoramic radiography in general dental practice which have an impact on both risk and image quality. The results require serious consideration. While it is reassuring that almost all who responded had regular radiation protection surveys, do we know how many of them implemented any changes that might be recommended?

The finding that so many practised 'routine screening' has implications if the volume of panoramic radiographs is to be justified. For example, we need to condsider whether they led to a change in the patient's management or prognosis? The age of the machine is probably a less useful means of assessing standards. Rather, we need to know how many practitioners are not using rare earth receptors and have panoramic machines without light beam positioning aids. They may find implementing the recent advice on achievable doses will be a salutary experience.²

The authors highlight serious gaps in training. While some of those who have not attended a POPUMET (Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988) course may have been recent graduates in 1988, their findings reinforce the advice that GDPs should attend a course every 7 years.¹ Radiation protection has been proposed as part of a compulsory core in the GDP's 5-yearly recertification cycle.

There are also justifiable concerns regarding who takes the radiographs. It is a weakness of the present statutory framework that neither the Department of Health nor the Health & Safety Executive appears to consider dental radiography a priority because of the low level of risk. It remains to be seen whether the current revision of the Ionising Radiation Regulations (1988) proposes any effective changes. Meanwhile, a more promising approach is to treat it as an issue of clinical governance. Discussions as to how this concept can be achieved in primary dental care are at a developmental stage. However, records and radiographs are known to be a poweful tool for quality assurance.³ GDPs should seriously consider attending a suitable educational course before embarking on panoramic radiography¹ while the Certificate in Dental Radiography sets the standard for dental nurses.