HLTDEN023: Portfolio and Critique of Diagnostic Standard Dental Image Assessment Solutions

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Subject Name : Science and Maths

During the Work Placement, Did you Observe the Student?

1. Produce and critique thirty (30) diagnostic standard dental radiographic de-identified images in a simulated workplace environment, including:

a. At least twenty (20) images must be intraoral radiographic de-identified images taken on a minimum of ten (10) ten different people, demonstrating skills in periapical (PA) and bitewings (BW) (Note these images and critiques are to be uploaded in portfolio document)

b. Ten (10) images must be extraoral radiographic de-identified images taken on a minimum of ten (10) different people (Note these images and critiques are to be uploaded in portfolio document)

Each of the tasks should be completed and ‘ticked off’ when the supervisor agrees the student has satisfactorily demonstrated the relevant skills for the described practical tasks and/or behaviours. Performance can be broken down into the following:

Satisfactory (Y):

Indicates that the student is able to complete the procedure/task/skill effectively and without any cues from the Supervisor, and they are able to discuss the theory as it relates to the practical situation. In ticking a student as satisfactory the Supervisor is declaring that they are confident that the student is able to perform the procedure to an industry standard and in keeping with the assessment instruction without supervision/guidance.

Not Yet Satisfactory (N):

Indicates the student is not yet able to complete the skills/procedure/task effectively to an organisational standard and in keeping with the assessment instruction. In this instance, give the student feedback and opportunities to further practice and implement the task. Do not tick the task as Satisfactory and make sure to re-attempt this item after the student has had more time to practice and implement your feedback and guidance.

During the Task, you Observed the Student

2. Implemented and maintained radiation safety measures for the patient, the practitioner and others throughout the procedure, including through the use of personal wearable radiation monitoring devices that measure radiation exposure levels, for example:

The oral health practitioner must only take radiographs when clinically necessary
The oral health practitioner must select the most appropriate technique and equipment
The oral health practitioner must know how to use equipment in a safe and effective way
The oral health practitioner must ensure X-ray equipment is maintained in good condition
The oral health practitioner must carefully maintain a patient’s radiographic records; this is important in monitoring the patient’s maximum permissible dose (MPD) of radiation
The oral health practitioner must comply with all requirements in laws and codes of practice
The oral health practitioner must use lead protection on patients and on themselves, where this is required (e.g. lead apron, drapes, thyroid collar, etc. – X-rays cannot penetrate lead)
The oral health practitioner must locate X-ray units in appropriate areas (e.g. in consultation rooms), and ensure these have correct structural shielding (e.g. lead-lined barriers) in place
The oral health practitioner must ensure they and other staff maintain a safe distance from the source of the radiation (e.g. by ensuring they leave the room when X-rays are taken)
The oral health practitioner must ensure that staff who are pregnant are not exposed to X-rays

3. Correctly position the patient according to the radiographic receptor unit used, for example depending on the type of X-ray you are taking:

Periapical projections
Bitewing projections
Occlusal projections

4. Ensured that communication with the patient was maintained after positioning, for example:

Continue to explain verbally to the patient about what they should do (e.g. “Bite down hard”)
Use sign language to communicate with the patient (e.g. thumbs up indicates ‘OK’)
Ensure the patient remains visible throughout the procedure, as outlined in a later section
Observe the patient to see if they attempt to communicate using body language (e.g. grunting or grimacing might indicate that they ae experiencing discomfort or distress)

5. Selected the exposure variables on the dental radiographic unit for the intraoral or extraoral image according to manufacturers’ instructions, procedure and patient requirements, for example:

The tube voltage, measured in kilovolts
The tube amperage, measured in milliamps; also consider the tube length
The radiation dose, measured in millisieverts (outlined in the following section)
The exposure time, usually measured in seconds

6. Select the radiographic technique for the intraoral or extraoral image prescribed by the dental practitioner, for the oral structure under investigation, for example:

Intraoral X-rays
Periapical
Bitewing
Occlusal

7. Positioned the receptor and adjusted the settings according to the prescribed request and patient’s requirements, for example check:

That it is positioned correctly in/against the mouth, for the type of X-ray that is to be taken
That it is positioned correctly in relation to the X-ray unit delivering the X-rays
That it is unlikely to move, immediately prior to or while the X-ray is being taken
That it is bearable for the patient – note: X-ray receptors often need to be place deep in the patient’s mouth, and are not comfortable, but they also should not cause unbearable pain

8. Selected and used locating devices or guides to apply the correct horizontal and vertical planes for the radiograph, for example tools that can help you to apply the correct horizontal and/or vertical planes for the radiograph. When required, use accessories according to manufacturers’ instructions, for example:

X-ray receptors; these are outlined in greater detail in a previous section
Immobilisation equipment – used to help a person remain still for the X-ray

9. Operated the intraoral radiographic equipment according to manufacturers’ instructions and legislative requirements for the safe use of radiation, for example safely.

10. Ensured that the patient remains visible throughout the procedure to observe positioning and safety precautions and expose the X-ray, for example, take the X-ray image, by delivering the radiation dose to the patient and to the receptor.

11. Carefully remove the exposed intraoral dental radiographic receptor from the mouth, for example, remove the exposed radiographic receptor carefully from their mouth by asking the patient to open wide, and lift the receptor gently out of their mouth. Placed it on a tray, ready for processing.

12. Separated the receptor and barrier sleeve, when required, following the manufacturer’s instructions. Dispose of the barrier sleeve carefully in the correct waste.

13. Confirm that the digital image was displayed correctly in the correct orientation in the patient file.

Taking Into Consideration

Orientation of bitewings – curve of spee
Upper periapical images oriented with crowns pointing down and roots up
Lower periapical images oriented with crowns pointing up and roots down

14. Ensured that the image was attached to the correct patient file, for example scanned into the correct patient in practice management software so it is stored in the patient’s electronic file.

15. Correctly processed and viewed the image, for example through: