PHYSICAL SURVEY MANUAL DENTAL X-RAY © U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service \ PHYSICAL SURVEY MANUAL DENTAL X-RAY prepared under the direction of Ray W. Alcox, D.D.S. X-RAY SECTION MEDICAL and OCCUPATIONAL RADIATION PROGRAM 2 REVISED EDITION APRIL 1967 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Bureau of Disease Prevention and Environmental Control National Center for Radiological Health Rockville, Maryland — 20852 ) CAT. FOR PUBLIC HEALTH CONTENTS Page INTRODUCTION- = = = = = = = = mm mmm mmm mmm m mmm mmm ms afm 1 THE SURVEY FORM- = = = = = = = = = = = = mmm mmm meme mmm mem meo 9 SURVEY PROCEDURE =- cc cmcc mmm mcm c ccm meme mmcc mcm mmm mm 4 The Survey Kit= = = = = cm cc cee eee e meme meme meme m mmm 5 Initial Procedure ---=-=-=-=-- cc ccc cccecccceccccceeceee ee 6 Interview Procedure -----==c ccc ccc c ccc ccc cee e eee m em 9 Item 1 - Name and Location of Dentist and Dental Practice ------ 9 Item 2 - State, County, City Identification = === ==---cocc-coao- 9 Item 3 - Dentist, Card Identification= === === ccc ccc cman 9 Item 4 - Number of X-ray Units ==--=-cccmmccc cece eae a 9 Item 5 - X-ray Identification Number === === ccc ccc ccc cea n 9 Item 6 - Number of Persons Operating This Unit == ===-==-=cc---- 10 Item 7 - Number of Office Personnel --------cceccoocaoonoo- 10 Item 8 - Type of Dental Practice -======mccmcmmcocmeeaaaano- 10 Item 10 - Pointer CONE == === =e cc mc cmc c emcee meme mmm 11 Item 23 - Protective Barriers =-=----ccccmem ccm ccc ceeana- 11 Item 24 - Lead Aprons ==---=-- ec mc mcmcc cece ccm e mmm mmm 11 Item 25 - Personnel Monitoring =---=-=--cccmccaoeooooo- 12 Item 26 - Workload--==-=-c emcee cmc c meme e meme meme mmm 13 Item 27 - Film Used -=-= == cc ccm m cme e cme e eee m emo = 14 Item 28 - Darkroom Procedures =-=-====c coc mc oma annana- 14 Physical Survey ProceduresS--=-==- mc ccc mmm mcm meme meme m mmm 17 Item 9 - Equipment Identification- === =-c ccc ceca coooooooon 17 Item 11 - Field Diameter (before modification) === === ==ceec-a- 18 (after modification) = === ==---o-ccoo-- 19 Item 13 - Roentgen Output (before modification)- = - == == =ccc-u-- 19 (after modification)- == --=--==--c----- 28 Item 12 - Filtration (before modification) = === = = = ccc ccc ceca 24 (after modification) = === === =cccccoaaaoon 28 Item 22 - Tubehead Leakage--=== =o cc ccc mcmc ccc c emcee mm 26 Item 14 - Is X-ray Unit Operable at Least 6 Feet from Tubehead --- 30 Item 19 - Timer--=---c-ccccecccmcmcmmcc eee meme. ——.—- 30 Item 20 - X-ray Unit Grounded - == === == cc ccc ccm c mee mem = 31 Item 21 - Stability of Tubehead === === cc ccc cc mcm m emcee 39 Scatter Radiation Demonstration Procedures-------=------c------ 33 Item 29 - Occupational Exposure: Scatter Radiation------------ 33 Anterior Upper Periapical Exposure ----=-------- 34 Right and Left Bitewing Exposure ---------=----- 36 Consultation= = === ccc ccm ccm cmc ccc cce cca a mm 37 iii Ne» CZo FOREWORD The National Center for Radiological Health has primary responsibility within the Public Health Service for programs concerned with protecting the public against undue exposure to ionizing radiation, and with obtaining the maximum benefit from beneficial usage of radiation producing machines and materials. To accomplish these ends the Center main- tains nationwide surveillance to determine levels of human radiation exposure from all sources; conducts research on the effects of radiation on man, and means for reducing both exposures and adverse effects; and works with official agencies and other organizations to make the most effective use of radiation—particularly in medicine and dentistry. The use of X-rays is recognized as being an essential part of modern dental health practice, and the importance of the diagnostic use of X-rays to the provision of quality dental care cannot be overestimated. In light of our present knowledge of the potentially harmful effects from the use of X-radiation, it is necessary to balance the benefits from the use of diagnostic radiography against the risk from exposure to radiation. The increasing numbers and kinds of radiation sources make it imperative that the public’s exposure to radiation be kept to a minimum consistent with diagnostic necessity. This manual has been prepared by the X-ray Section staff of the National Center for Radi- ological Health, under the direction of Dr. Ray W. Alcox. Fa 0, (~~ James G. Terrill, Jr. Director National Center for Radiological Health J ya 1v ACKNOWLEDGEMENT This manual was prepared by members of the X-ray Section, National Center for Radio- logical Health. Many individuals have contributed to the preparation and review of the ma- terial, and it is impossible to enumerate here all of those persons who were of assistance. However, we would especially like to acknowledge the contribution of the following individ- uals who participated in the preparation of this manual while assigned to the Section: Victor L. Chesser, D.M.D. William C. Klein, D.D.S. Mrs. Dorothy H. Mitchell Paul St. Miklossy We also wish to acknowledge the cooperation and assistance we have received from the manufacturers and suppliers of dental X-ray equipment, film badge services, dental X-ray film, lead aprons, protective barriers, and protective barrier materials, in the assembly of material for this manual. We particularly appreciate the assistance of the following manufacturers who provided tech- nical information and photographs of their products: The General Electric Company North American Philips Company, Inc. Ritter Company, Inc. Weber Dental Manufacturing Company X-ray Manufacturing Corporation of America Siemens America, Inc. Yo pW he N48 Ray W. Alcox, D.D.S. X-ray Section Medical and Occupational Radiation Program National Center for Radiological Health INTRODUCTION This manual has been prepared to assist State and local health agencies in develop- ment of their dental radiological health program activities by setting forth a stand- ard physical radiation protection survey method. The manual consists of two parts: (1) an illustrated step-by-step description of an office inspection visit based upon the use of PHS Form 3657, and (2) an appendix of reference materials related to dental radiological health. The appendix is intended as a handy reference for the surveyor and other persons with an interest in dental radiological health. The goal of good dental radiological health is to ensure the efficient use of X-ray, i.e. to obtain a maximum of diagnostic information with a minimum of radiation exposure. The judicious expenditure of radiation makes it possible to obtain more and better diagnostic radiographs with less exposure to patients. By adhering to the recommendations of the American Academy of Oral Roentgenology or the National Committee on Radiation Protection, it is possible to reduce unnecessary radiation exposure to a minimum and still obtain satisfactory diagnostic dental films. In fact, if the dental X-ray machine is properly corrected, and recommended exposure and development techniques are followed, the result will be dental films of better diag- nostic quality. Maintenance of a good relationship with private practitioners is essential if the health department is to perform its mission effectively. It is expected that the survey teams will maintain a friendly but professional and business-like attitude at all times while surveying a dental office. The surveyors are present as guests in the dental office and represent the State or local health department. This is an excellent opportunity for the survey team to impress upon the doctor that he is receiving a service from his health agency. This manual assumes that two persons comprise a survey team. This has proved to be the optimum number and minimizes the inconvenience to the dental practi- tioner. The time involved for each office surveyed varies with different teams and the experience of the surveyors, but usually approximates 20 minutes. The use of two-man teams makes it possible to share the physical chores of carrying heavy survey equipment and to vary the duties of each survey team member so as to re- lieve the monotony of doing a repetitious job. This does not mean to imply that these procedures cannot be carried out by only one person, or by three or more persons, but such arrangements have proved to be inefficient. An exception is the inclusion of the third or fourth person for train- ing purposes when new survey teams are being formed. THE SURVEY FORM The present design of the Physical Survey Form (PHS-3657, Rev. 5-61) is a result of a series of evolutionary changes brought about through a number of studies. As knowledge of radiological health advanced, the form was modified and refined to its present state. When first using the Physical Survey Form, the new surveyor may feel the items are not arranged conveniently and should be rearranged so that interview questions would be in -one section and actual measurement data in another section. His first impression is one of needless turning of pages, but with experience this ceases to be a problem. The basic format was designed to satisfy the varied needs of many different State and local health agencies, since they donot seek to accomplish the same purpose or obtain the same information when conducting a physical survey. One health depart- ment may be primarily concerned with registration of dental X-ray equipment, another may wish to do a complete survey and conduct a corrective and educational program simultaneously. Consequently, the form is arranged for use in many situations. The first half of page one is designed to secure the necessary information for registration purposes. The bottom half can be used to secure basic information about beam diameter, filtration and Roentgen output. Page two proceeds into more detailed information about equipment and starts into the area of technique. Page three is designed for use in educational efforts and provides a visible demonstra- tion of scatter radiation to personnel operating dental X-ray equipment. Page four was designed for determination of inherent filtration of X-ray equipment by cap/on- cap/off technique. There is presently sufficient information about the inherent filtration of dental X-ray units so that visual inspection is adequate. For this reason, page four is not in general use at present, although some health depart- ments may still use it for training or other purposes. In order to utilize the advantages of modern data processing equipment, the form is designed for use with IBM cards, permitting the rapid tabulation of findings. This makes possible the accumulation and cross-correlation of statistical informa- tion on a State and/or nationwide basis. The time-lag between the actual physical survey and reporting of the findings is reduced because large masses of informa- tion can be handled rapidly. The IBM card is limited to 80 items of information on each card, so the form requires one card for each page. Certain standard codes exist, and these are used when possible, particularly in the identification portion of each card. These codes are taken from published IBM Standard Codes--IBM Standard State Code, IBM Standard County Code and IBM Standard City Code. The State or local health depart- ment will assign each surveyor a code number which will be entered as item 18. For further standardized coding within the radiological health field, it has been agreed to use the following codings, when applicable. A - Not stated B - Unknown C - Not applicable O - No or None -92- It is important to leave no blank spaces. All spaces must be filled in, The "key punch operators', who transfer the information from the Physical Survey Form to the IBM cards, know nothing about dentistry or the physical survey of dental x-ray equipment, therefore, cannot be expected to fill in blanks with proper coding. Remember, uniform and complete coding is a must. These "key punch operators" work on many different tabulations and are trained to punch what is recorded. If they encounter blank spaces, it can cause errors which may invalidate important information. Some of the more commonly made mistakes and portions of the form which cause difficulty are: 1. Failure to fill in all the blank spaces. It is permissible, when a series of boxes are all to be scored with zeros, to mark the first box with a zero and draw a line through the rest, indicating they are also zeros. 2. Failure to vecovd time survey began and time suvvey ended. If an office has more than one X-ray machine, the time recorded for each survey should be entered separately. 3. Calculated average exposuve time perv film. This is calculated only if the dentist uses different exposure times for different areas of the mouth. If he uses the same exposure time, item 26C is the same as item 26B. SURVEY PROCEDURE (Step-by-Step) Advance arrangements to survey the dental office should be made by the State or local health department or the survey team before the actual visit. If the dentist or dental assistant is available, have that person operate the unit during the survey procedures. If this is not feasible, it is strongly recommended that verbal consent to operate the equipment be obtained. The actual survey in a dental office is best accomplished if the survey team divides the work. One team member should take the clipboard and blank survey form and secure the interview material from the dentist or the dental assistant. The other team member does the actual survey of the dental X-ray equipment and reports the findings verbally to the recorder. THE SURVEY KIT The survey kit contains the following equipment items, arranged as shown in the picture. 1) Samsonite case 12) tools (thumb screw, penlight, 2) ionization rate meter - binder clips, 6' tape measure, ""Cutie-Pie" round and needle nose pliers, 3) 1 roll masking tape 3 bit screwdriver set, knife, 4) support bars dental shears, wrenches) 5) medical fluorescent strips 13) Victoreen Condenser R-Meter: 6) elevator type tripod 1-filter thickness key, 7) leaded protective apron 2- 25R ionization chambers, 8) dental fluorescent screen with 1- 10R ionization chamber, lead backing 1-0.25R ionization chamber, 9) tripod table top 1-15.6mm. x 3" Al chamber cap, 10) ionization chamber holder 1-lead plate 11) stop watch Not illustrated is a plastic jug, which when filled with water, has proved to be a convenient and effective phantom head. 13 12 11 10 9 INITIAL PROCEDURE It is usually advisable to record the name and address of the dentist whose office is to be surveyed before calling on him. The survey team is neatly dressed The members of the survey team in- and has a business-like attitude. troduce themselves to the doctor and/or his assistant and explain that they are representatives of the health depart- ment and have arrived to survey the doctor's X-ray equipment. If the doctor is busy it may be neces- sary to wait until the dental operating room is available. If the dental assist- ant is not needed to assist the dentist, the recorder asks if she can supply some of the information needed. In this way it may be possible to secure the information and not take any more of the doctor's time than is necessary. When the doctor is available, the members of the team have the assist- ant introduce them or they introduce themselves. The physical surveyor requests permission to operate the X-ray machine. It is important to get the dentist's permission to opevate his X-vay machine in case something should go wrong while suv - veying it. If the dental X-ray tube were to burn out during the survey proce- dures, it is possible the surveyor could be held personally liable if he did not have prior permission. The recorder interviews the doctor to secure the remaining information needed. As soon as permission is received, the surveyor begins to set up his equipment. The surveyor proceeds with the physical inspection. For his own protection, and also to demonstrate his respectfor X-rays to the dentist, the surveyor always makes certain that he wears the lead apron and film badge during the actual survey pro- cedures. (Handbook 76, U.S. Department of Commerce, National of Standards, Page 10, Section 5.6.D, has guidelines to follow in regard to placement of film badge.) INTERVIEW PROCEDURE The recorder proceeds to obtain the necessary items of information while the other member of the team carries out the physical survey procedures. Before the survey appointment, lie should have completed items 1, 2, 3, and 18. Note the time survey begins and enter in item 15. l. A. NAME OF USER(S) INSTALLATION ADDRESS C. PHONE NUMBER D. CITY E. COUNTY E STATE G. NAME OF SURVEYOR Item 1 supplies registration and iden- tification information and all the information necessary to complete items 2 and 3. Item 2 is coded for use with IBM processing, using the IBM Standard State, County, and City Codes. Enter the appropriate State code in boxes 1 and 2; county code in boxes 3, 4, and 5; and the city code in boxes 6, 7, and 8. Item 3 and the IBM card identification. is for dentist identification If the State or local health department assigns a code number for each dentist, it is entered in boxes 9, 10, 11, 12, and 13. Boxes 14 and 15 are used to identify which IBM card this page represents. If all three pages of the survey form are to be used, this page will be recorded as 113 sds - page 1 of 3 pages. The second page will appear as | 2 | 3 2.STATE, COUNTY, CITY 3. DENTIST, CARD IDENTIFICATION 9 10 11 12 13 14 10 - page 2 of 3 w 1s pages, etc. The first 13 boxes on each page will be identical. Total X-ray Units 4. TOTAL XRAY UNITS AT INSTALLATION Item 4 indicates the total number of 16 dental X-ray units in the office. The number is recorded as item 4. X-ray Unit Identification Number If there is more than one dental X-ray unit in the office, the recorder assigns a number to each of them so that at this in- stallation they can be referred to as X-ray Units #1, #2, #3, etc. Each X-ray unit requives a Sepavate Physical Suvvey Form. Enter the number of each X-ray unit being surveyed, on separate forms, as item 5. 5 X-RAY UNIT IDENTIFICATION NUMBER 17 -9- Number of Persons Operating This Unit [6.NUMBER OF PERSONS OPERATING THIS UNIT 18 Any person who normally takes X-rays, or assists when X-rays are being taken, is included in this total. For instance, if a dental assistant operates the timer for the doctor while he is using the X-ray equipment, she is included in the total number of persons operating the equipment. On the other hand, if the receptionist, for example, never helps when X-rays are being taken, she is not to be included. Enter total as item 6. Number of Office Personnel 7. NUMBER OF OFFICE PERSONNEL A. FULL TIME DENTISTS 19 This item includes all those who work in the office and are connected with 8. PART TIME DENTISTS the practice of dentistry, such as hy- n gienists, assistants, bookkeepers, re- C. OTHER FULL TIME PERSONNEL ceptionists, laboratory technicians, etc. a Enter as item 7. 0. OTHER PART TIME PERSONNEL 22 Type of Practice The type of practice refers to dental specialties. A dental specialist is one who has had special training and limits his practice entirely to this area. Many dentists emphasize certain areas of dental work, such as children's dentistry or prosthetics, but also do general dentistry. They are considered general practitioners and are recorded as such. Only dentists who have limited their practice to their specialty are recorded as specialists. The various dental specialties are: Oral surgery - that branch of dentistry that deals with the surgical treatment of diseases and injuries of the mouth, teeth, and adjacent tis- sues. Orthodontia - that branch of dentistry which deals with the prevention and correction of irregularities of the teeth and malocclusion. Pedodontia - that branch of dentistry which deals with the teeth and mouth conditions of children. Periodontia - that branch of dentistry dealing with the study and treatment of periodontal diseases. Prosthodontia - that branch of dentistry which deals with the design and fabrication of dental appliances and substitutes, such as crown, bridges, artificial dentures, etc. Other, the specialities of Endodontics, Oral Pathology, and dental X-ray installa- tions located in clinics, hospitals, military installations, etc., are recorded as other. Record your findings as Item 8. 8. TYPE OF PRACTICE 1. oceneraL 4. PEDODONTIC 7. MORE THAN ONE TYPE 2. ORAL SURGERY _ _ 5. PERIODONTIC 9. OTHER (SPECIFY) 3. ORTHODONTIC = 6. PROSTHODONTIC 23 X-ray unit identification, field diameter, filtration, Roentgen output, and other items of information secured by the physical surveyor are recorded whenever circum- stances permit. It is usually possible to record these items of information as they are obtained or they can be copied later from notes made by the physical surveyor. -10 - Pointer Cone This item refers to the plastic aiming device attached to the tubehead. Most X-ray units have a short pointed cone. All cones which establish a target-face distance of eight inches or less are classed as short cones. 1 2 The above illustration shows some of the commonly encountered cones. The cone at the far left is one found on many later model General Electric X-ray units. Some surveyors tend to record this as a long pointer cone, but since this cone actually establishes an 8" target-face distance, it is classed as a short cone. Record cone type as item 10. 10.POINTER CONE 0. NONE 2. SHORT OPEN 4. LONG OPEN 1. SHORT POINTED 3. LONG POINTED 9. OTHER(SPECIFY) 43 Protective Barriers Protective barriers can greatly reduce the occupational exposure of working personnel and the dentist or his assistant should be consulted as to their presence. If a barrier is present, inquire to what extent it is used. If the dentist uses other materials, such as the structural components of his office, as a protective barrier, enter this information as ''other' with a notation on type of material so used. (Dlustrations of common types of protective barriers are included in the appendix.) Enter this information as Item 23. 23.PROTECTIVE BARRIERS 1. FIXED WITH LEAD WINDOW 4. MOBILE WITH NO LEAD WINDOW 0. IONE 2. FIXED WITH NO LEAD WINDOW 5. PRESENT BUT NOT IN USE 3. MOBILE WITH LEAD WINDOW 9. OTHER (SPECIFY) yi Lead Aprons Protective leaded aprons are generally recommended for patients, expecially chil- dren and young women in the reproductive ages. Certain States have laws requiring a dentist to use such a protective device on their patients, while others only recom- mend it. Your position on this subject is determined by your State or local health -11 - department's policy. An apron of .25 mm. lead equivalent is adequate for patient protection for nearly all dental X-ray procedures. Such protective aprons are usually rubber or plastic materials impregnated with finely powdered lead. The shape varies widely, ranging from an apron which completely covers the patient's torso to a 12" square lap apron laid over the gonadal area. Protective apron requirements for operating personnel are determined by workload and the physical layout of the office. In some situations it may not be possible for operating personnel to utilize available shielding or to move far enough away from the tubehead for adequate protection. In such an instance, the use of a protective apron by the operator is indicated. Record your findings as item 24. (Illustrations of some of the lead aprons available are included in the appendix.) 24 LEAD APRONS 1. OPERATOR ONLY 3. BOTH OPERATOR AND PATIENT C NONE 2. PATIENT ONLY 4. PRESENT BUT NOT IN USE Personnel Monitoring Personnel monitoring concerns the use of radiation monitoring devices by the dentist and/or his personnel to determine if they are receiving excessive radiation exposure. The form of such monitoring devices varies widely. In the order that they appear in the survey form, they are briefly described as follows: Film Badge. This consists of a holder into which a special film packet is inserted. Generally, the holder has a clip which enables the user to fasten it to his clothing while he is working. Film badge service is sold on a contract basis by companies which specialize in such services. The films are supplied by the company and must be returned for processing. After processing, the company reads the film and reports the findings to the dentist by mail. This is an accurate and economical method of measuring exposure to the dental personnel and provides a permanent record of exposure. Pocket Chamber. This is a device about the size of a fountain pen which can be carried in the user's pocket. A separate charger-reader is required in order to use this device which can be read by the practitioner in his office. (This is basically the same instrument as the Victoreen R-Meter which is used to determine X-ray unit output.) Its principal advantage is its relatively low cost as compared to the dosimeter. Pocket Dosimeter. This is a self-reading device, also about the size of a fountain pen. A separate charger is required. The principal advantage is that it can be held up to a light source and read at any time. The chief disadvantage lies in the fact it is relatively expensive. Dental Film. Quite often a dentist will tape a penny or a paper clip on a dental film and carry it in his pocket for a time if he thinks he might be exposed to radiation. After a time he will process and examine it. If the metal object shows on the processed film, the individual has received radiation exposure, but -12 - the amount is unknown. Negative findings by such a method are generally unreliable because of variations in film speed and processing. Positive find- ings indicate a need for more accurate personnel monitoring methods and better radiation hygiene practices. (Ilustrations of film badges, pocket chambers, and dosimeters are included in the appendix.) Items 25B and 25C are self-explanatory. Report your findings as item 25. "25. PERSONNEL MONITORING A. TYPE 0. NONE 2. POCKET CHAMBER 4. DENTAL FILM 76 1. FILM BADGE 3. POCKET DOSIMETER 9. OTHER (SPECIFY) B. TIME 0. NONE 2. WAS USED WITHIN TiE PAST 12 MOS _ — 1. CURRENTLY BEING USED 3. WAS USED OVER ONE YEAR AsO C. RESULTS 1. UNDETERMINED 3. 25 TO 100 mr/wk ____ 0. NONE 2. BELOW 25 mr/wk _ 4. ABOV: 1CO mr/wk —_— . _— —_— 5 The National Committee on Radiation Protection (NCRP) has recommended that the exposure of one who is occupationally exposed to X-ray radiation should not exceed 100 mR per week. In view of present knowledge, this amount is not expected to cause any detectable bodily injury during his lifetime. (For more detailed information on the maximum permissible doses recommended by the National Committee on Radia- tion Protection refer to the National Bureau of Standards Handbooks 59 and 76.) Workload Information for items 26A and 26B is obtained by asking the dentist or his assistant. Quite often the dentist will be unable to supply accurate information in this area. The information sought is for an average workweek. If the dentist is uncertain as to the X-ray workload, a clue may be provided by asking how often he has to re- order X-ray film or how long a package of film lasts him. Regular periapical films are supplied in gross quantity packages (usually 150 instead of 144) and bitewing films are supplied in packages of 25. From this information it may be possible to estimate the workload. Another approach is to ask how many fullmouth surveys (usually 14 films, but may vary from 10-22), how many bitewing exposures (2 or 4 films may be used), and how many single exposures he takes in a specified time period. Item 26C is calculated by multiplying the average exposure time for the upper first molar by .7 (7/10). This is done only if the dentist uses a diffevent exposure time for the diffevent aveas of the mouth, Usual dental X-ray practice requires slightly longer exposure times in the molar area than in the anterior because of the greater mass and density of the tissues present. However, some dentists do not vary their exposure times with the area being X-rayed. If they do not vary their exposure times, enter the same information in item 26C as appears in item 26B. The usual milliamperage and kilovoltage at which the dentist operates is recorded as items 26D and 26F, respectively. It is necessary to ask the dentist if he adjusts his machine to certain dial readings, or if he uses it as it is set. If he does not adjust the equipment, the readings are recorded as indicated from the dial settings. -13 - If the machine does not have dials that supply this information, enter the kVp and mA figures listed in the Dental X-ray Units - General Information chart, which is included in the appendix. Item 26E is the product of the average number of films per week (26A), times the usual milliamperage (26D), times the average calculated exposure time per film (26C). Items 26C and 26E may be calculated and recorded after leaving the office. 26.WORKLOAD A. ESTIMATED NUMBER OF FILMS PER WEEK ON THIS UNIT 22 30 31 B. AVERAGE EXPOSURE TIME PER FILM OF UPPER FIRST MOLAR 32 33 34 C. CALCULATED AVERAGE EXPOSURE TIME PER FILM (in seconds) (AVG. EXP. = UP. MOLAR X .7) 35 36 7 D. USUAL MILLIAMPERES E. MILLIAMPERE -SECONDS PER WEEK F. USUAL KILOVOLTAGE Film Used Determination of the brand of film used is obtained by asking the dentist or his assistant and examining a film packet, if one is available. Dentists will sometimes use the same film for periapical exposures that they use for bitewing exposures. To do this, the use of a gummed tab or a paper loop is necessary. If the dentist uses only one film for both kinds of exposures, enter the same information in both items 27A and 27B. 27 FILM USED A. BITEWING MANJFACTJRER TYPE OR CODE 3 47 B. PERIAPICAL MANUY ACTVRER TYPE OR CODE LIST OTHER FILMS UNDER REMARKS 48 49 Generally, the type or code number of the X-ray film is found on the end of the packet. (A complete list of dental X-ray films and illustrations, showing the loca- tion of their code numbers, is included in the appendix.) Darkroom Procedures Item 28 requires a combination of interviewing and observation to complete. The brand of developer used is obtained from the label on the bottle, if possible, and is recorded as item 28A. Most manufacturers market only one developer for dental X-ray film; but a few, notably General Electric, market more than one type, which necessitates specifying the type in this instance. -14 - 28. DARKROOM PROCEDURES A DEVELOPER USED B. USUAL DEVELOPMENT TIME (in minutes) 52 53 C. USUAL TEMPERATURE OF DEVELOPER (in degrees fahrenheit) 54 55 D. THERMOMETER IN DARKROOM 1. YES 3. NO DARKROGM 0. 10 2. THERMOSTATIC CONTROL 3 ine E. USUAL CHANGE OF DEVELOPER (in weeks) 57 58 F. IS DARKROOM LIGHT TIGHT 0. NO 59 Item 28B, Usual Development Time, is recorded as reported by the dentist, unless he states that he '’sight'’ develops his films. ''Sight'' developing is a process by which the development is observed under a safelight. When the latent image appears to have reached the proper stage of development, the film is rinsed and cleared in the fixing bath. This method, although highly subjective and apt to produce incon- sistent results, is quite widely used. If the dentist or his assistant ’'sight!’ develop their films, record it as 9.9. Item 28C, Usual Temperature of Developer, is recorded as the dentist reports it. Quite often the temperature of the developer will be approximately room tempera- ture, which is usually 680 - 720, This may be reported as the temperature used. If the dentist has no thermometer or doesnotuseone, record item 28C as 99. Fre- quently, if "sight" developing is reported, the dentist will not use a thermometer. If he uses a thermometer in his tanks, report his estimation of usual tank tempera- ture as the temperature of developer. Item 28E, Usual Change of Developer, is reported as number of weeks between changes. Often the dentist is not aware of how often he changes or cleans his de- veloping tanks. Here again, his record of purchases may be a convenient way of establishing the time interval. If you are unable to determine the time interval, and the dentist reports that he changes when the solutions get weak or dirty report it as 99. Occasionally you may find a situation in which he reports that he does not change his tanks, but adds replenisher whennecessary. This is most likely to occur at a very busy installation where a large volume of radiographs are processed. Item 28F, Is Darkroom Light Tight, is subjective and will vary widely among surveyors. To check this item, step into the darkroom and close the door tightly. It may be well to tell the dentist or his assistant beforehand what you are going to do, since the darkroom is often alsousedfor storage. Wait a few moments for your eyes to adapt themselves and then look for light leaks.If you can readily detect light leaks around the door, window, or anywhere else, the room is not light tight. -15 - Record your findings as item 28F. A surprisingly high percentage of darkrooms will not be light tight. Ultrafast dental film, which is recommended as one of the best means of reducing unnecessary radiation exposure, is also very sensitive to light, much more than the slow or intermediate speed dental X-ray film. For this reason, a good darkroom becomes very important if the dentist is to use ultra- fast film successfully. If you should observe a faulty darkroom and have an opportunity to bring it diplo- matically to the dentist's attention, do so. You will be doing him a favor. A few words of explanation about the importance of a good darkroom and good darkroom technique in obtaining satisfactory dental radiographs may be a lot of help to a den- tist who has been having difficulty. -16 - PHYSICAL SURVEY PROCEDURES Equipment Identification Either the interviewer or the surveyor may obtain the make, model, and serial number and record them in item 9. Generally it is easier for the surveyor to get this information and read it to the interviewer. This information is located on the machine in different places, depending upon the make and model of the equip- ment. (The appendix contains information about the location of serial and model numbers on different X-ray units.) 9. X-RAY UNIT A. MANUFACTURER MODEL ra B. TUBE SERIAL NUMBER 26 27 28 29 30 31 32 33 34 C. CONSOLE SERIAL NUMBER 35 36 37 38 39 40 41 42 The most common loca- tion of serial numbers is on the side or back of the console and is often dif- ficult to read. -17 - Most units have the tube serial number on the tube housing under the pointer cone. If it is under the pointer cone, removal of the cone is necessary. It may be advisable to wait and se- cure this information when the cone is removed to check for filtration and collima- tion. Field Diameter The surveyor prepares to determine the beam size by setting the fluorescent screen on the bracket table (only if free of dental instruments and medicants) or on the tripod table top, whichever is more convenient. The tube head is aligned perpendicularly and centered on the fluorescent screen (note the lead backing). If possible the blinds should be closed and the operatory darkened for easier reading of the fluores- cent screen. -18 - The machine is turned on and an exposure of approximately two or three seconds is made while the surveyor, standing well away, reads the diameter of the fluorescent area on the screen. (The illustration shows a beam diameter of 3-1/2".) He notes the beam diameter and reports it to the recorder or makes a separate record on scratch paper until such time as the recorder is available. This information is recorded indecimal form as item 11A. II.LFIELD DIAMETER AT END OF POINTER A. BEFORE MODIFICATION CONE (inches) B. AFTER MODIFICATION 47 48 49 Roentgen Output The surveyor next prepares to determine the Roentgen output of the X-ray equipment. The case containing the Victoreen Condenser R-Meter is removed from the kit and opened. -19 - The charger-reader is removed, the cord connected to a convenient 110-115 v. electrical outlet and the plastic plug in the charger-reader opening removed. (The plug keeps dirt particles out of the charger-reader which affects the accuracy of the readings. The plug should be kept in position when the device is not in use.) A 25 R chamber is selected and the plastic cap removed. The 25 R chamber base is removed and the chamber inserted into the charger- reader. A one-quarter twist of the cham- ber will engage the chamber and lock it firmly in place. - 920 - The chamber is charged by mov- ing the adjustment on the left side back to charge position. Check to see if the scale indica- tor is on zero. If not, hold the charge adjustment on charge and adjust the instrument to zero by manipulating the zero set. As soon as the zero is adjusted, release both charge and zevo set controls. Remove the chamber and insert it into its base. Carve should be taken not to touch the end of the chamber because this contact may discharge the chamber. -21 - Place the ionization chamber holder on the bracket table or the tripod platform and install the chamber in one of the holes. -22 - Position the tubehead so that the top of the pointer cone just touches the plastic tip of the chamber andis directed horizontally away fromoc- cupied areas. The X-ray machine is turned on and the chamber ex- posed. The amount of total exposure time necessary is variable and sufficient exposure must be made so that the reading obtained is near the center of the scale of the Condenser R-Meter. This is necessary since readings are more accurate in the center area of the scale and are quite variable at either end. Generally speaking, it is best to break up the exposure into several shorter ex- posures with a time interval between to protect the tube from overheating and to avoid any danger of burning out the tube. With a 65 kVp machine two three-second exposures are often satisfactory. [tis inadvisable to operate a dental X-ray machine for longer than thvee seconds at any one intevval, With higher kVp machines, two two-second exposures will probably suffice while low kVp machines (45-50) may require three three-second exposures. In any event, the total exposure time is determined by the total amount of radiation necessary to give mid-range readings on the charger-reader. Before reading the chamber check the charger-reader to see if the scale indicator is on zero. Adjust to zero if necessary. Remove the chamber from the holder, re- move the base, and re-insert the chamber into the charger-reader. Care should be taken to avoid rough handling. Take the reading, being careful to read the correct scale for the chamber used. The scale used is determined by the capacity of the chamber, which for dental equipment is the 25 R chamber. The correct reading in the sketch below is 13, assuming it is obtained from a 25 R chamber. Oo SO 100 150 200 250 o S 10 15 20 25 A A A A A A V Vv 4 : V VV Vv oO 20 40 60 80 100 ROENTGENS (The sketch shows the scales as seen through the eyepiece of the charger-reader.) - 93 - The reading observed is the Roentgen output for a specified number of seconds. To calculate the true Roentgen output per second, divide the number observed on the scale by the total number of seconds of exposure (e.g., a reading of 13 Roentgens was obtained with two three-second exposures: 13 R/6 sec = 2.16 R/sec). This number can be calculated and recorded in the appropriate squares (item 13A) at a later time. I13.ROENTGEN OUTPUT AT END OF POINTER CONE IN r/sec. A. BEFORE MODIFICATION 56 51 58 B. AFTER MODIFICATION 59 60 61 Filtration The next step is to check the X-ray unit for total filtration. Total filtration is the sum of inherent filtration and added filtration. Inherent filtration is the absorption of the X-ray beam caused by the glass wall of the tube, the oil or air surrounding the tube, and the tubehead seal. Added filtration is that filtration placed in the primary beam to absorb the low-energy or "soft" X-rays which do not contribute to the radiograph. A difference does exist in the recommendations made by National Bureau of Standards Handbook 76 and the American Academy of Oral Roentgenology. Depend- ing upon which recommendations the health department adopts for its standards, a late model X-ray unit could meet State or local standards without modification. The approximate inherent filtration in millimeters of aluminum equivalent for a particular make or model is obtained by referring to the Dental X-ray Units - General Information chart, which is included in the appendix. This chart also rec- ommends the amount of additional filtration needed. The recommendations are based on a total of 2 mm. aluminum for machines operated at 70 kVp or below and 2.5 mm. aluminum for machines operated above 70 kVp. These standards may vary slightly from those adopted by your health agency but it should be borne in mind that the recommended standards are to be considered as minimum standards. In any event, the cone of the machine should be removed, if possible. Care should be taken not to damage the cone by dropping it or stripping the threads. With the pointer cone removed, it is generally possible to see if filters and collimators are present and to determine if factory installed filtration has been removed or modi- fied. - 924 - Remove the pointer cone. Note the tube serial number if there is one recorded in this loca- tion. At this time, it is possible to determine if the filtration and collimation have been modi- fied. If there is no additional filtration, record the inherent filtration from the chart, Den- tal X-ray Units - General In- formation, in the appendix. Add any additional filtration present to the inherent filtra- tion indicated by the chart. Enter these findings as item 12A. 12. TOTAL FILTRATION OF PRIMARY BEAM (mm Al equiv.) A. BEFORE MODIFICATION 50 51 52 B. AFTER MODIFICATION 53 54 SS - 95 = Tubehead Leakage While the pointer cone is removed, check for tubehead leakage. Leakage radiation is any radiation coming from within the tubehead housing except the useful beam. National Bureau of Standards Handbook 76 states that the diagnostic type protective tube housing is an "X-ray tube housing so constructed that the leakage radiation at a distance of one meter from the target cannot exceed 100 mR in one hour when the tube is operated at any of its specified ratings." The rating of a tube may be specified in terms of ''continuous operation’ or in terms of individual exposures with a duty cycle. As dental X-ray units are used to make individual exposures, the duty cycle for such exposures must be considered. The X-ray tube duty cycle refers to the period of activation per unit of time that an X-ray tube can be ener- gized without damage to the tube. In other words, the X-ray tube can be operated only a limited number of seconds in each minute without exceeding its safe limits. Exceeding this safe limit may result in "burning out" the tube. In view of this fact, a reading in excess of 100 mR/hr on the Nucor rate meter does not necessarily mean that the X-ray unit fails to meet the leakage requirement because the machine cannot be operated continuously for one hour. Most dental X-ray machines have a duty cycle rating of the order of six seconds for each minute or a duty cycle conversion factor of 1/10. This duty cycle conversion factor multiplied by the rate meter reading gives the actual exposure dose rate from leakage radiation at one meter. If this resultant figure exceeds 100 mR/hr, the X-ray unit does not meet the leakage radiation requirements. A table of duty cycle ratings, conversion factors, and a sample calculation is included in the appendix. (Most dental X-ray machines meet the leakage radiation requirements.) Place the lead plate over the X-ray tube head port and secure it in place with masking tape. (A small bag of lead shot may be used instead of the lead plate.) - 96 - Point the tube head away from the surveyor and any occupied areas, and activate the machine. (CAUTION: Do not exceed the duty cycle limitation during this proce- dure.) While the machine is operating, make a slow sweep with the Nucor rate meter, around the back and sides of the tubehead, ap- proximately one meter (39'") away from the housing. Ob- serve the rate meter while doing this. In particular, check the ends of the tube where the tubehead pivots, since this is one of the most likely areas for the tubehead housing to leak. Since the response time of these rate meters is rather slow, if an area is found where deflection of the needle increases, it is wise to reread this area without moving the meter during a 2-3 second exposure. Careful consideration should be given to the limitations imposed by the X-ray tube duty cycle before you report that leakage radiation exceeds recommended standards. Your findings are reported as item 22. Q. NO 1. YES 22.TUBE HOUSING RADIATION LEAKAGE WITHIN RECOMMENDED STANDARDS 23 - 97 - Modification of Filtration and Collimation If, after visual observation and reference to the Dental X-ray Units - General Infor- mation chart, it isdetermined that additional filtration is required, the correct amount of filtration may be installed with the knowledge and consent of the dentist. (His right to accept or reject the installa- tion is dependent upon the State laws pertaining to the subject.) The PHS supplies filters in .5 mm. thicknesses of alumi- num. Filtersare placed closer to the X-ray tube than collimators to reduce scatter radiation to the patient. In some units, additional filtration is installed and secured by a spring clip as shown above, or is held in place by the pointer cone. In other units, it is necessary to use utility wax or masking tape to retain the filters and collimators. Record total filtration after modification, as item 12B. If no modification is made, enter the same figure in item 12B as appears in item 12A. 12. TOTAL FILTRATION OF PRIMARY BEAM (mm Al equiv.) A. BEFORE MODIFICATION 50 51 52 B. AFTER MODIFICATION 53 S54 3S Collimation of the beam diam- eter to the recommended 2.75" (or 3", as the case may be) reduces unnecessary radiation exposure by limiting the beam to the area of diagnostic concern. If the beam diameter measure- ments were excessive, the sur- veyor may install a suitable collimator or replace an exist- ing collimator with one which has the proper aperture. As with the filters, the consent of the dentist should be secured before installation. (The PHS supplies collimators for the five most commonly used dental X-ray units but only for short pointer cones. Refer to appendix for a method to calculate aperture sizes of collimators for long cones and other units.) - 98 - Replace the pointer cone. If a new collimator has been inserted, recheck the beam diameter with the fluorescent screen to be certain that the beam is the correct size (2.75") and properly centered, as illustrated below. Enter the modified beam di- ameter as item 11B. If the beam diameter is within rec- ommended limits or cannot be modified, enter the infor- mation recorded in item 11A in item 11B. A. BEFORE MODIFICATION II.LFIELD DIAMETER AT END OF POINTER CONE (inches) B. AFTER MODIFICATION 47 48 49 If additional filtration is in- serted, determine the new Roentgen output and record as item 13B. If no filtration is added, enter the figures re- corded in item 13A in item 13B. A. BEFORE MODIFICATION I3.ROENTGEN OUTPUT AT END OF POINTER CONE IN r/sec. B. AFTER MODIFICATION 56 51 38 59 60 61 -929 - Is X-ray Unit Operable at Least 6 Feet from Tubehead For item 14, the point to be determined is whether the operator can stand at least six feet away from the tubehead while operating the equipment, assuming that the tubehead is positioned around the headrest of the chair. The findings are entered as item 14. 14.1S X-RAY UNIT OPERABLE AT LEAST 6 FEET FROM TUBE HEAD 0. NO 1. YES 62 Timer Mechanical and electronic timers are, in general, easily distinguished. Invariably the control setting for electronic timers is located on the console. (The exception to this is the older X-ray machine that has been modified by installation of an electronic timer.) The electronic timer control is calibrated to read in fractions of a second and is adjustable for settings as low as 1/30 or 1/60 of a second. The hand control to activate the X-ray machine consists of a button switch which must be held down until the timer completes the preset exposure time. Most electronic timers automatically reset themselves after the completion of the pre-set exposure or any part thereof. In order to determine whether or not the timer terminates the exposure, observe the milliamperage in- dicator (for both electronic and mechani- cal timers) while you hold the button down at the end of the timing cycle. The milliamper- age indicator operates only | gop when the machine is activated. | : At present, there is no con- venient means of checking the accuracy of electronic timers when surveying dental X-ray equipment in the dental office. For electronic timers, item 19C, box 20, is recorded as C - Not applicable. Also, elec- tronic timers cannot be op- erated without simultaneously energizing the tube. TG Il 3 | | ‘! -30 - 19. TIMER A TY G. NONE B. TERMINATES EXPOSURE 0. NO C. STOPWATCH CHECK TIMER SETTING 1. MECHANICAL 2. ELECTRICAL OR ELECTRONIC 18 1. YES B. UNKNOWN 19 STOPWATCH READING DIFFERENCE 20 & 4 Mechanical timers consist of a hand-held clockwork mech- anism with a dial setting calibrated in seconds and a control button to activate the timer. With some mechanical timers, it is necessary to turn the setting indicator past a certain point in order to cock the clockwork mechanism, and then turn back to the desired time setting. The button must be held firmly throughout the exposure in order to complete the pre- set exposure time. If a dental X-ray machine has no milli- amperage indicator, observe the fluorescent screen to deter- mine if the timer terminates the exposure. This can be done while measuring beam diameter.) Generally speaking, older mechanical timers are not consist- ently accurate at time intervals of less than one second. The stopwatch check is performed by turning off the machine and setting the timer to its maximum indicated time interval. Start the timer and the stopwatch simultaneously, holding one in each hand, and trip the stopwatch again when the timer snaps off. This procedure sometimes requires a little practice since it is necessary to keep the timer button depressed and to release the stopwatch button while the timer is operating. Record the times and note the difference as item 19C. (This method will only detect gross inaccuracies, severe inaccuracies may affect the calculated Roentgen output values.) X-ray Unit Grounded It is desirable to have X-ray units properly grounded to eliminate any shock hazard to pa- tients and dental personnel. Checking to see if the X-ray unit is grounded has proved to be undeterminable in many cases. The presence of a three-prong plug does not prove anything since most X-ray units come so equipped. The presence of a three-hole female wall receptacle does not necessarily mean that the outlet is properly grounded since these are very easily installed without proper grounding. Most den- tists do not know for certain if the outlet has been properly grounded. Unless there is definite visible evidence of proper grounding, or you have a means for checking electrical grounds, it is advisable to record item 20 as B - Unknown. 20. X-RAY UNIT GROUNDED 0. NO 1. YES B. UNKNOWN 21 -31 - Stability of Tubehead Tubehead stability refers to the ability of the tube- head to maintain a desired position without moving. An unstable tubehead that drifts or changes position while X-rays are being taken can be responsible for many retakes because of blurred radiographs. Such retakes constitute un- necessary radiation ex- posure to patients and den- tal personnel. Also, dental personnel operating the equipment may be tempted to hold the tubehead to prevent it from drifting during the exposure, which would result in their receiving unnecessary radiation. Tubehead stability is checked by extending the tubehead and seeing if it will stay in place without drifting. This should be done in positions that may be encountered during X-ray procedures. (CAU- TION: Some of the mobile X-ray equipment will tip if the tube head is fully extended to one side or the other.) If the tubehead will not hold its position with reasonable stability, it is considered not adequate, Record your findings as item 21. 21. STABILITY OF TUBE HEAD J. ADEQUATE 1. NOT ADEQUATE 22 - 32 - SCATTER RADIATION DEMONSTRATION PROCEDURES 29. OCCUPATIONAL EXPOSURE; SCATTER RADIATION The third page of the survey form is best completed by the physical surveyor and the interviewer working together. This procedure is designed primarily as an educational demonstration to the dentist and his personnel in order to assist them in reducing any unnecessary radiation exposure. The demonstration is essentially a matter of taking rate meter readings of scatter radiation at the positions in which the dentist and/or his assistant normally stand, using three of the most commonly used dental X-ray exposures. If the exposure to the dentist or his personnel is measurable or more than a very slight amount, the survey team demonstrates how to reduce their exposure. This is done by effective utilization of existing structural features of the office or by increasing the distance from the source of radiation. A phantom is filled with water and placed on the backrest of the dental chair. The headrest is adjusted to support the phantom at the approximate height and angula- tion of a seated patient's head. (Since the human body is approximately 90% water, the phantom full of water results in a similar scatter radiation pattern.) In order to standardize the recording of positions and distances, the patient's head (the phantom) is envisioned as the center of a clock, facing 12 o'clock. The illustration at the left shows this concept diagrammatically. Even if the chair is normally rotated in relation to the cus- pidor, the direction of the patient's head is the indicator which determines the 12 o'clock position. The three dental exposures which are used for demonstration purposes are (I) right bitewing exposure, (II) anterior upper periapical exposure, and (III) left bitewing exposure. - 33 - Anterior Upper Periapical Exposure The correct positioning for the up- per anterior periapical exposure is with the tubehead directed down- ward at an angle of approximately 45° and aimed at the center of the phantom, i.e., from 12 o'clock toward 6 o'clock. If the dentist is readily available, it is advisable to ask him to position the tube- head. Spe ¥ © After positioning the tubehead J = { " for this exposure, the survey team asks the dentist where he and his assistant normally stand during this exposure. The physi- cal surveyor, wearing the lead apron, measures the scatter ra- diation in the dentist's position. The recorder notes the direction, distance, and mR/hr at this posi- tion. The surveyor repeats the procedure standing in the assist- ant's position. The recorder en- ters the findings under '""At Nor- mal Operating Position in item 29-11. IL ANTERIOR UPPER PERIAPICAL EXPOSURE DIRECTION DISTANCE mr /hr mr /hr C. DENTIST 38 39 40 41 42 43 44 45 46 47 0. ASSISTANT 48 49 50 51 52 53 54 55 56 57 Throughout this procedure it is advisable to invite the dental personnel to observe the indicator needle during the scatter radiation measurements. (Consideration must be given to the duty cycle of the X-ray tube and to the response time of the rate meter during these procedures. In most instances, two- or three-second exposures are adequate to satisfy both requirements.) - 34 - Readings are obtained for the dentist's new position and the reduction demonstrated to him. The illustration at the right shows an appropriate lower reading when taken at the new position. This visual observa- tion of the reduction in scatter readings between the old and new positions is a highly effective educational technique. It is advisable to explain briefly the significance of the various scale settings on the rate meter to the dentist and his staff. The scale settings are essentially a sensitivity range selection. Care should be taken to point out that if the scale setting is on any other setting than xl (times one), the dial reading must be multiplied by the scale setting to obtain the correct reading. - 35 =~ The surveyor then selects new locations which offer improved protection and takes scatter radiation readings. The new positions are determined by the physical layout of the office and may include such changes as stepping behind an available wall, increasing the distance from the tubehead, standing in a different location, or utilizng a protective barrier. A number of readings may be required to find new locations which will best reduce unnecessary radia- tion exposure. The demonstration of the reduction in exposure is repeated at the assistant's position and recorded un- der "At New Position" in item 29-II. Right and Left Bitewing Exposures The picture below shows the phantom and the tubehead properly positioned for a right bitewing exposure. The right and left bitewing exposure positions have similar tubehead positioning from opposite sides of the patient. The tubehead is angled downward approximately 8° and directed slightly backward--from 2 o'clock toward 8 o'clock for the right bitewing and from 10 o'clock toward 4 o'clock for the left bitewing. Following the procedures used for the upper anterior periapical exposure, scatter radiation is determined for a left bitewing exposure at the dentist and dental assistant positions. Enter findings as item 29-1. 29. OCCUPATIONAL EXPOSURE; SCATTER RADIATION (REFER TO DIAGRAM BELOW). AT NORMAL OPERATING POSITION AT NEW POSTION I LEFT BITEWING EXPOSURE DIRECTION DISTANCE mr /hr mr /hr A. DENTIST B. ASSISTANT 28 29 30 31 32 33 34 35 36 37 - 36 - The tubehead is placed in position for a right bitewing exposure. The same proce- dure is repeated as before, and the findings entered un- der "At Normal Operating Position" in item 29-III. II RIGHT BITEWING EXPOSURE AT NORMAL OPERATING POSITION AT NEW POSTION DIRECTION DISTANCE /hx. — E. DENTIST 58 59 60 61 62 63 64 65 66 67 F ASSISTANT 68 69 70 71 72 73 74 75 76 77 New recommended positions are determined, readings ob- tained and demonstrated, and these findings entered under "At New Position" initems 29-1 and 29-III. If the dentist's tech- niques and operating proce- dures are such that no modifi- cations are necessary, enter C-Not applicable, in the "At New Position" column in item 29. If the dental assistant does not participate in the taking of X-rays, rows B, D, and F are entered as C. Consultation After completing the scatter radiation demonstration, be prepared to spend a few minutes talking with the dentist or his assistant. If they exhibit interest, try to answer their questions insofar as you are qualified, or suggest a source that can aid him. A good dental X-ray survey consists of more than installing filters and collimators and filling out a survey form; it involves educating the dentist and his staff to good radiation hygiene practices. So if the opportunity presents itself, be - 37 - prepared to spend a few minutes in an educational effort. You will find that it will make surveying dental X-ray equipment much more interesting. If you feel that further consultation is to be recommended, enter as item 17, IT. FURTHER CONSULTATION RECOMMENDED 0. NO 1. YES (SEE REMARKS) 69 Try to have a supply of educational literature with you for distribution. We suggest that you leave a copy of Radiation Protection for Dentist and Patient (Public Health Service Publication No. 885) at each office. is H When the equipment is packed and you are ready to leave, be sure to thank the dentist and his personnel for their time and interest. Note the time and date the survey was completed, and enter as items 15 and 16. 15. TIME | | SURVEY BEGAN SURVEY ENDED DIFFERENCE IN MINUTES 63 64 I6 DATE OF SURVEY (MONTH /DAY /YEAR) 65 66 67 68 After the survey is completed, the survey form should be coded in accordance with the Coding and Punching Instructions. All boxes must be filled in with the proper numbers ov coding. It is important that this be done as soon as possible. Almost invariably a busy survey team will find they have neglected to record some obvious items of information. If the forms are coded soon after the survey was performed, it is usually possible to remember unrecorded information or, if necessary, to obtain it by other means. This is particularly true of survey teams in the field that may be moving from town to town or from area to area. - 38 - APPENDIX X-Ray Equipment X-Ray Film Film Badge Service Calculations Protective Accessories Sample Form Punching and Coding -0F - UNCOLLIMATED BEAM: 4.0" at tip of pointer cone 5.0" at mid-saggital plane Area covered by beam: at tip of pointer cone 12.56 sq. in. at mid-saggital plane 19.61 sq. in. - Iv - COLLIMATED BEAM: 2.75" at tip of pointer cone 3.50" at mid-saggital plane Area covered by beam: at tip of pointer cone 5.93 sq. in. at mid-saggital plane 9.61 sq. in. At the mid-saggital plane the collimated beam represents a 49.0% reduction of area exposed by the uncollimated beam. § General Information Manufacturers Illustrations Electronic Timers uL 03 9SEBaJqdUT 03 ITqETTeAE J30BdS yx asnoyduT)SaM JI0J ‘W'Y'X AQ PIJINIOBINUEBHN xx quaudinbe TBjUSDP 9anjoeJnuew JB3JUOT ON 4 === 8 00°23 or €9 Ggcel (pesay-paso1d) 05gz-N (sqng-uado) TeSJIaATUN ST Gz2°'9 0L"0 or S9 xx2SNOY3UTISOM g'0 S°L oL'T or 09 VE-TQW ® VZ-aW ‘our Leaxagoad 0°'T L 00°T »Ley-zusan SI iad 060 or <9 2S6T P,3uU0dSIq (peay-pasord) cI --- 0S°0 (eqny-uado) *I9UOSTYH 0'% 9 0S°0 ST 06 Y xSxoLa ‘um So 9 00°32 ZT 2L 3x9udsoT 19H --- v 00°2 L 0S JUSPOT 3H SUSU TS === ¥ 00°2 L [UY - 0961 aos) OD T3JON === ¥ 00°32 g Sy 0 XTT1EeI0 0'T v 00°T S Sv 6S6T - 8¥61 d%V sdr1Tud So *%x%xG °C 00°2 St 06 06 oT g°9 00°23 ST 09 LC6T - 6E6T ge dz I SI g'¢ SLO ST oL VER VE dl W'H¥'X == L 062 ST 06 HZ T 0'T S29 0G6°I ST 06 06 S 1 L 08°0 ST oL UIT ¥9 S'T S%'9 060 oT <9 6°VLL 9S I9Q9M 8¢LG09 ‘ON TeTJIdS MOTSQ TY UMW G° Tx === 8 06°32 ST 00T - S961 00T-dD Gg'0 8 0G°T or oL - G96T SL-3D === 8 SG Cx ST 06 - 6S6T II-06-39 S'0 8 061 [1] 8 oL - 6G6T IT-0L-8D 0°1 8 0G8°T ST 06 8G61 - GG6T 06-490 go 8 0G6°T oT oL 8G6T - GG61 0L-d9 S'0 8 0% 1 ot G9 $G6T - €E61 q-Xad 0'T 8 06°0 or eg £661 - £261 Xad J030TA OTJ309TH TEJLdUd) m= L 08°32 ST SL - 9961 SL == L GS'2 ST 06 - 2961 D So L S0°2 ST 06 2961 - 6G61 a So L S0°2 ST 06 6S6T - 9G6T I G1 L 08°0 SI oL 9S6T - 0S61 a ST L 060 oT <9 0G6T - €€6T dq ST L 060 ot £9 £661 - 1261 Vv d933TY ‘UWoO ay (*ut) suo) *ATnbs TY um UOT3BJIITTH Jo dig UOT3BeJI}TTd eu day sanjoeJnuey ano ) (tua) TV 03 3odg juaJayul Jurjey umurXen Jo 83eq repon I9IN3OBINUEN D3ppPy Teooq aqewrxoaddy NOILVIWHOJNI TVHINID - SLINA AvY-X TVINEA - 43 - OOO TYPICAL DENTAL X-RAY CIRCUIT Basic elements of a self-rectified circuit for the generation of X-ray (AR (3) (1) T AMMETER CLT FILAMENT TRANSFORMER X-RAY TUBE A.C. (9) 10{POWER SUPPLY SWITCH MILLIAMMETER RHEOSTAT (2) HIGH VOLTAGE TRANSFORMER 4) (6) VOLTMETER i) AUTO 4X TRANSFORMER 9H (5) A.C. pik POWER po (9) T0i5uppLy pind SWITCH ash pik py HH AUTO TRANSF — CONTROL SWITCH OR TIMER O JX (8) COMPENSATOR ——i CONTROL» — 1 —— Filament transformer to supply heating current to the filament of the X-ray tube. A rheostat for controlling the filament current. An ammeter for indicating the filament current (usually omitted in modern apparatus). A transformer to supply necessary voltage for electron acceleration (high voltage transformer). An autotransformer for controlling the accelerating voltage. A line voltage compensating control indicating voltmeter. A milliammeter for indicating tube current. A switch for initiating and terminating the X-ray exposure. A line switch for disconnecting the entire apparatus from its power supply. - 44 - MANUFACTURERS OF DENTAL X-RAY EQUIPMENT (Addresses given where known) Presently making equipment General Electric Company, 4855 Electric Avenue, Milwaukee, Wisconsin. North American Philips Co., Inc., Norelco Medical and Dental Division, 100 East 42nd Street, New York, New York 10017 Profexray, Inc., Maywood, Illinois. Ritter Company, Inc., Rochester 3, New York. Siemens America Inc., Dental Division, 10-39 44th Drive, Long Island City 1, New York. Universal, 1138 North Western Avenue, Chicago, Illinois. XRM, Community Drive, Great Neck, New York 11021. Weber, 2206 13th, N.E., Canton, Ohio No longer making dental X-ray equipment Adams A. S. Aloe Company, Continental Pace Maker MX-F-8435, 1831 Olive, St. Louis, Missouri. Edwards Englen H. G. Fischer, 9451 West Belmont Avenue, Franklin Park, Illinois. Grenz-Ray Humphrey International Liebel Flarsheim Co., 111 Amity Road, Cincinnati, Ohio. Mattern G. M. McFedrier Meyer, Chicago, Illinois. Pengelly Philberg Picker X-ray Corporation, Waite Manufacturing Division, Inc., Cleveland, Ohio Pony Professional Equipment Company Standard, 1933 North Burling, Chicago, Illinois Thomas Plaster Company X-Cell-Ray Waite and Bartlett Wappler Westinghouse, 2521 Wilkens Avenue, Baltimore, Maryland. - 45 - MAKE MANUFACTURER: MODELS FILTRATION & COLLIMATION General Electric General Electric Company 4855 Electric Avenue, Milwaukee 1, Wisconsin The General Electric Company has produced essentially five different series of dental X-ray models. The first one they marketed was the Victor-CDX model, which was engineered and marketed by the Victor Company, beginning in 1923. General Electric purchased the Victor Company and continued the Victor CDX unit until 1933. At that time they produced the G. E. CDX Model E X-ray unit, which was marketed until 1954. Since 1955, the General Electric Company has marketed two dental X-ray units—a 70 kV unit and a 90 kV unit—and in 1965 added a 100 kV unit to their line of dental X-ray models. The Victor CDX models manufactured from 1923 to 1933 came equipped with an open-end cast-iron cone, which restricted the primary beam of radiation to a 4-%" diameter circle at a distance of 8" from the focal spot. The inherent filtration of the Victor CDX unit was 0.6 to 0.9 mm. aluminum equivalent. Additional filtration was not supplied at the time of manufac- ture, but can be installed by taping one or more 0.5 mm. Al discs over the small aperture of the cast-iron cone. Order Part No. 1005341 P1 to obtain the 0.5 mm. Al discs. The CDX Model E unit has a total inherent filtration equivalent to 1.0 to 1.4 mm. aluminum. Additional filtration was not originally supplied with the CDX-E units but is now available in 0.5 mm. Al discs which may be ordered by requesting Part No. T4007A. These discs can be retained in place by the three screws which hold the lead diaphragm in position. The GE-70 and 70 II units come equipped with a pointed plastic cone (Catalog No. 2001444G2), which provides an 8' distance from the focal spot to cone tip. An integral part of this cone is a lead diaphragm with a 3/4' aperture which restricts the primary beam of radiationtoa 3''diameter at cone tip distance. An optional transparent open-end cone (Catalog No. E63044) is available and provides a 16" distance from the focal spot to the end of the cone. This cone contains a lead diaphragm with a 3/8" aperture which restricts the primary beam of radiation to a 3" diameter at a distance of 16" from the focal spot. On the 70 kV units there is a built-in filtration equivalent to 1.5 mm. aluminum. Additional 0.5 mm. Al filters (Part No. 1005341P1) are available and are easily installed by means of a retaining ring (Part No. 508AZ5691). The GE-73 unit comes equipped with an open plastic cone (E6304D) which provides an 8'" distance from the focal spot to - 46 - the end of cone. An integral part of this cone is a lead diaphragm that restricts the primary beam of radiation to a 2 3/4" diameter at the end of the cone. A scatter guard is also built into this open cone for further patient and operator protection. Optional transparent open cones with scatter guard and lead diaphragms (that restrict the primary beam to 2 3/4" at cone end) are available. They provide either a 12" or 16" focal spot to end of cone distance. (Catalog No. E6304E for the 12" cone and E6304F for the 16' cone.) The Model GE-73 has built-in filtration: equivalent to 1.5mm. Al. (two 0.5 mm. Al filters are also supplied with each unit if additional filtration is required.) G.E. 90 units come equipped with a pointed plastic cone (Part No. 2001444G2), which provides an 8' distance from the focal spot to cone tip. This cone has a built-in lead diaphragm with a 3/4" aperture which restricts the primary beam of radiation to a 3" diameter at cone tip distance. As was the case with the 70 kV unit, the 90 kV unit has available an optional long cone, which provides a 3'" diameter beam of radiation at a distance of 16". Older G.E. 90 units have a built-in filtration of 1.5 mm. alu- minum equivalent. Two additional 0.5 mm. Al. filters (Part No. 1005341P1) are initially supplied with each unit and are easily secured with a retaining ring (Part No. 508A256P1). On the G.E. 90-II units there is a built-in filtration equivalent of 2.55 mm. Al. It is noteworthy, also, that recently General Electric has taken further steps to reduce the primary beam diameter at cone tip distance. New units have a primary beam diameter at cone tip of 2-3/4" or less. All G.E. 90-II units below Serial No. 605738 have built-in filtration of 1.5 mm. aluminum equivalent. They were manu- factured to comply with recommendations of Bureau of Stand- ards Handbook 60, the predecessor of Handbook 76. Since 1955, G.E. has provided two 0.5 mm. aluminum filters in a plastic bag with each 90 kV unit shipped. One of these should be added, to bring units below serial No. 605738 into compliance with Handbook 76. The GE-100 unit comes equipped with an open plastic cone (E6304D) which provides an 8' distance from the focal spot to the end of cone. An integral part of this cone is a lead dia- phragm that restricts the primary beam of radiationto a 2 3/4" diameter at the end of the cone. A scatter guard is also built into this open cone for further patient and operator protection. - 47 - LOCATION OF TUBE NO. CONSOLE SERIAL NO. Optional transparent open cones with scatter guard and lead diaphragms (that restrict the primary beam to 2 3/4'" at cone end) are available. They provide either a 12" or 16" focal spot to end of cone distance. (Catalog Number E6304E for the 12" cone and E6304F for the 16" cone.) The Model GE-100 has built in filtration equivalent to 2.5 mm. Al. (two 0.5 mm. Al filters are supplied with each unit if additional filtration is required.) The tube serial numbers on the Victor CDX units and the CDX Model E units are on a table pasted to the inside cover of the stabilizer housing of the tubehead. The stabilizer part number is TO0346A. This part is held in place by one screw and can easily be removed. If the paper tag is illegible or absent, the serial number can be obtained from the Bakelite cover plate that seals the oil in the tubehead. This number is more diffi- cult to find because it requires the removal of the head cover (TO307A). Removal is accomplished by taking out a screw at each of the four corners of the cover plate. (We do not recom- mend this procedure because of the possibility of damage to the oil seals.) The tubehead serial numbers on the later 70 kV units and the 90 kV units are easily viewed on a plate attached to the outside top surface of the tubehead housing. The Victor CDX and G.E. CDX Model E units have their con- sole serial numbers on a metal plate that is easily visible at the bottom center of the console control box. (The G.E, 90-1I has a metal plate on the left side of the console near the on-off switch.) The G.E. 70-II unit has the serial number on the right side near the bottom of the console. - 48 - GENERAL Should it become necessary to obtain the tubehead serial INFORMATION : number of the CDX or CDX Model E units, the illustration below may be helpful. General Electric is currently producing a remote control Model 90 kV unit in addition to the composite 70-1II and 90-II models. The remote control model allows the operator to have his console mounted out of the room where the tubehead is located. (Turn to the section on photographs of X-ray units in order to view the various General Electric models manufactured.) 3000 0)o T03308 55-213 — Fh T0226— y|| —-703288 34-207 13-1027 yp ® 99-3 T03304A 55-212 2 / To3308 1104 PUP Sjieq JOLBIX] — PRA aqn| 3 73ACKW — LINN AVY¥-X TVLIN3IQ XAaO TUBE HEAD (EXTERIOR PARTS) AND FORK - 49 - MAKE : MANUFACTURER: MODELS FILTRATION & COLLIMATION LOCATION OF TUBE NO CONSOLE SERIAL NO. Philips Oralix These dental units are manufactured in Holland and merchan- dised in the United States by: North American Philips Co., Inc. Norelco Medical and Dental Division 100 East 42nd Street, New York, New York. 10017 There are two kilovoltage ranges on these units; earlier models are 45 kV and more recent ones are 50 kV units. Oralix dental units come equipped with a rather unique colli- mating device. On the older units in the 45 kV range, the collimator provides a choice of two aperture sizes. This device is a rectangular metal plate in which are cut two cir- cular apertures. Filters are press-fitted into the apertures. Stamped in the metal collimator beside each aperture is a suggested film size for that particular aperture. This type of collimator slides horizontally into a slitinthe pointer cone. By reversing the metal plate, the operator has a choice of the two sizes. The new 50 kV models have a turret type of collimating device with four apertures in it. By rotating this device, the operator has a choice of four aperture sizes. The field dimensions of the apertures are: Focus-to-Film Diameter Aperture Beam Angle Distance at Film #1 240 4h" an #2 260 5" un #3 320 ral 4" #4 380 9g" 6" The inherent filtration on the Oralix Models Aand B is 1.0 mm. of aluminum; Models C and D have inherent filtration of 2.0 mm. of aluminum. Filter diaphragms are available from the manu- facturer. For Models A and B. No. 93446 will bring the total filtration to 2.0 mm aluminum; No. 93448 will bring the total filtration to 1.5 mm. of aluminum. For Models C and D .5 mm. aluminum discs are available, if additional filtrationis desired. Oralix 45 kV units and some early 50 kV units had the tube number placed at the attachment of the handle to the tubehead housing. On some models the tube number is affixed at some position along the bracket arm. More currently manufactured 50 kV models (including the Super 50kV model) have the number behind the pointer cone on a metal circular ring. On early models this identifying number was located on a plate at the bottom center of the console control box housing. Later models have the console number on the top surface of the bracket arm. (Turn to the section on photographs of X-ray units in order to view the various Philips models manufactured.) - 50 - MAKE MANUFACTURER: MODELS FILTRATION & COLLIMATION LOCATION OF TUBE NO. LOCATION OF CONSOLE NO. Ritter Ritter Company, Inc. Rochester 3, New York Since 1921, the Ritter Company has manufactured seven different dental X-ray models. Models A, B,D, E, F, G(1and 2) and H, have the console and tubehead attached, so that these models are one composite unit. The Model G-3 is a remote control model allowing the tubehead to be mounted in one area and the console in another. Additional filters, in thicknesses of 0.5 mm. aluminum, may be obtained from the factory as follows: Model A - P-13045, 0.5 mm. aluminum Models B and D - P-13045, 0.5 mm. aluminum Models E, F, and G - 3129-6-2, 0.5 mm. aluminum disc retaining ring (to retain added filters order P-16150 retainer) Before September 1959, an additional 1.0 mm. aluminum disc was included with each Model E X-ray unit shipped from the factory. After September 1959, an additional 0.5 mm. aluminum disc was included with Models E, F and G. In order to limit the primary beam to 3 inches at an 8 inch target to film distance on Models B and D, order Z-29 colli- mator. No such collimator is available for Model A. Models E and F leave the factory with an effective 3 inch beam diameter. Models G and H leave the factory with an effective 2 5/8 inch beam diameter. On Models B and D, a maximum of 2 mm's of the aluminum discs and the Z-29 lead collimator can be as- sembled into the standard cone without need of a retainer. On Models E, F, and G, one disc can be retained by a snap ring, which is standard on all E, F, and G models. Model A -inside the tube, underneath the filament on the cathode. Models Band D-on a plate located on the back of the tubehead housing. Models E, F, G,-on a plate which is on the underside of the yoke and H that holds the tubehead. Model A -inside the console cabinet so that to view it, one must open the door on the side of the console. Model B -on the kV selector dial on top of the console. Model D -beside the timer button hanger. Models E, F, G -on the bottom surface of the console. (1 and 2)and H Model G-3 -on lower right side of control console. - 51 - GENERAL INFORMATION For Models B and D with serial numberslower than 8D-6545, a split-second timer is available from the factory. This timer has a range from 1/8 to 8 seconds. It has a reversible, manual, reset dial available that allows for correction shouldit ever be over-set, With this timer it is impossible to make an exposure before setting the dial. A period for pre-heating the filament is automatically provided when the timer switch is pressed. With this timer, faster film can be employed, thereby reducing primary radiation to the patient and secondary radiation to the operator. To order this timer, (Part #438-G-18), specify the model and serial number of the unit. [tf is not available for models othev than B and D. (Turn to the section on photographs of X-ray units in order to view the various Ritter models manufactured.) - 52 - MAKE MANUFACTURER: MODELS FILTRATION & COLLIMATION LOCATION OF TUBE NO. LOCATION OF CONSOLE NO. Siemens Siemens, Reiniger Werke, A. G.; Erlangen, Germany. Marketed in the United States by: Siemens America, Inc. Dental Division 10-39 44th Drive Long Island City 1, New York Essentially, there are only two Siemens dental X-ray models. One is referred to as the Heliodent; the other as the Helio- sphere. The Heliodent unit is a 50 kV, 7 mA unit. These models can be attached to several different makes of dental operating units, so that the Heliodent model has varying designs, de- pending on how the unit is to be attached. The units are designed to be mounted in the following ways: Unit mounted for Sirona C, D, F, and G units. Unit mounted for S. S.”White, Master, and Selector units, Unit mounted for Ritter, Weber, and other units. Wall mounted with board. Mobile unit. DN — nok Ww The Heliosphere 2'' Model operates in the 60-72 kV range. Its mA capabilities are 10-12 mA. It was engineered for 220 volt, 50 cycle a.c. power supply. To our knowledge it is not marketed in the United States. It is manufactured in two designs: 1. Mobile mounted unit. 2. Wall mounted unit. Heliodent units currently being manufactured have an inherent : filtration of 2 mm. of Al. The manufacturer makes the follow- ing statement with regard to collimation: "The radiation beam is confined by a diaphragm at the tip of the cone to a diameter of 5.8 cm (2-5/16'"), con- forming to State and Federal requirements." The tubehead serial numbers on Heliodent units can be located : on a metal ring behind the pointer cone. The console serial number is located on the top surface of the : bracket arm on the wall mounted units. The mobile unit has this number near the base of the main column. (Turn to the section on photographs of X-ray units in order to view the various Siemens models manufactured.) - 53 - MAKE MANUFACTURER: MODELS FILTRATION & COLLIMATION LOCATION OF TUBE NO. LOCATION OF CONSOLE NO. Weber Weber Dental Manufacturing Company 2206 Thirteenth Street N.E. Canton 5, Ohio The Weber Dental Manufacturing Company has manufactured some 31 different dental X-ray ms, beginning with the #1 series and progressing through .ue new Ultron 90 kV unit. Currently all dental X-ray units, whether 70 kV or 90 kV, are equipped with 2.5 mm. of total filtration and the following statement is enclosed with each unit shipped from the factory: "To comply with requirements of many States, this Weber Oil Immersed X-ray Head has a total filtration (inherent plus added) equal to 2.5 mm. of aluminum permanently installed. With the addition of the cone pointer, this X-ray Head has a total minimum filtration of 3.0 mm. of alumi- num. Also installed in this Head is a lead washer that limits the beam to 3" atan 8''focal point. All requirements of ADA, Bureau of Standards Handbook 60, various State agencies and all presently known agencies, have been in- corporated in this Weber Oil Immersed X-ray Tube Head." Older models may require additional filtration. The following collimator and filter kits may be obtained from the factory: XR-8818 G - three aluminum filters of 0.5 mm. thickness each. XR-8077 - one lead washer. XR-8137 - one snap ring for holding these discs in place. Tube serial numbers are located on a metal ring behind the pointer cone. (On some models it may be necessary to remove the metal plate on the tubehead housing in order to see the number.) The tube number of the new #90 series is on the outside of the tubehead housing; on the old #4 models, it is inside the tube under the filament on the cathode. Console serial number plates are not consistent as to location. They are usually located on the back of the console. (Some consoles open and it is necessary to open the door in order to see the serial plate.) The three models in the #5 series have the number affixed to the tubehead bracket arm where it attaches to the console; the models in the #6 series have it on the front of the console control box housing; and on the new models, it is on the back of the console. - 54 - GENERAL INFORMATION Weber Dental Manufacturing Company produced X-ray units in Models #1, #2, and #3, which most likely will never be seen during a survey due to their early vintage. It is difficult to state, with accuracy, the focal spot end-of-pointer-cone distance on the various models. Since the National Bureau of Standards recommendation of 7 inch target-skin distance in Handbook 76 was made, the Weber Dental Manufacturing Com- pany has made a Bakelite spacer which enables their X-ray units to have a 7 inch target-skin distance. This spacer was not used on early models, therefore, may notbe found on some units, If it is not found, the target-skindistance is 6.25 inches. The spacer may be obtained from the factory for old Weber units and is listed as Part Number X-R-1843, ''ring nut''. (Turn to the section on photographs of X-ray units in order to view the various Weber models manufactured.) - 55 - MAKE MANUFACTURER: MODELS FILTRATION & COLLIMATION XRM XRM is an abbreviation for X-ray Manufacturing Corporation of America. The S. S. White Company purchased the X-ray Manufacturing Corporation on March 28, 1958. Dental X-ray units manufac- tured for S. S. White Company bear the trade name XRM. X-ray Manufacturing Corporation of America Community Drive Great Neck, New York 11021 XRM has produced some 15 different dental X-ray models, including panoramic, cephalometric, and split models. Models 2A, 3A, 1B, 2B, and 3B were produced from approximately the year 1939 to 1957. Models 2B and 3B were 60 kV, 15mA units; 2A, 3A, and 1B were 70 kV,15 mA units. Since 1957 XRM has produced composite models 70S, 70P, 90S, and 90P; split models 70W and 90W; cephalometric models OR90S and OR90P; and the panoramic unit which is called '""Panorex'. XRM man- ufactured a 70 kV cephalometric X-ray unit before 1956. When many of the earlier XRM models were produced, no recommendations were existant concerning filtration and colli- mation. For that reason, XRM produced its early models with a 0.75 mm. equivalent filtration. Subsequent to the National Bureau of Standards recommendations in 1955, XRM wrote a letter to the customers listed in their files, stating that an additional 1.25 mm. of Al filter was available. As a result, many thousands of filters were supplied to XRM customers. As an aid to the identification of specific amounts of filtrations, the following statements may be noteworthy: If, upon removal of the pointer cone, a concave piece of aluminum is observed to be permanently mounted behind the brass ving, that unit has only 0.75 mm. Al equivalent inherent filtration. If the unit has 1.25 mm. of loose aluminum filter in front of the brass ving, then it has been modified to the correct amount of filtration as advocated by the National Bureau of Standards. During repairs to any older tubeheads sent back to the XRM factory, 2.5 mm. Al was installed permanently behind the brass ring. These units canbe differentiated from the 0.75 mm. equivalent units by the fact that when the factory installed the 2.5 mm. equivalent, they used a flat, vathev than a concave, filter behind the brass ving. Since 1956, every tubehead shipped from the factory was shipped with 2.5 mm. inherent filtration permanently installed. - 56 - LOCATION OF TUBE NO. LOCATION OF CONSOLE NO. GENERAL INFORMATION With regard to collimation, XRM units formerly had a 5.5" target-skin distance when the standard short pointer cone was utilized. The beam diameter with the earlier units was within 3" when the original pointer cone was used. This gives a target-tip-of-cone distance of 5.5". Currently, XRM is producing a pointer cone which produces a target-tip-of-cone distance of 7". This was begun as a result of the NBS recom- mendation that the target-skin distance must be 7' for units operating at 50 kV or above. The 7" pointer cone is provided with a collimator which has an aperture diameter of 3/4". A long cone is also available which will provide an effective beam diameter at the skin which is within 3". The long cone aperture has an inside measured diameter of 7/16". The cones just described can be obtained from the factory without a specified part number. However, size of the aperture diameter must be specified, and preference must be stated for either long or short cone. XRM has maintained a consistent position for placing tubehead serial numbers. They can be found stamped into the brass ring behind the pointer cone. Two numbers are presenton the brass ring; the shorter one, or the number with an alphabetical letter in it, is the tube number; the other is the transformer number. Console numbers are usually on the right side of the console, by the "off-on'" switch. However, there are units which bear this number plate on the left side. In 1956 the first 90 kV unit was produced. A 70 kV unit was available in the same console. These units came equipped with the first split-second timers manufactured by XRM. The 90 kV unit's timer was a 1/30 second impulse timer. The 70 kv unit's timer was a synchronous, automatic reset timer calibrated from 1/4 second to seven seconds. In 1959 XRM produced their first split model design. They currently market several split model console designs. Up to five tubeheads can be operated from one console on the split models. (Turn to the section on photographs of X-ray units in order to view the various XRM models.) - 57 - GENERAL ELECTRIC DENTAL X-RAY EQUIPMENT VICTOR CDX GE CDX-E GE CDX-E Wall Model KV -53 Wall Model KV - 65 MA -10 KV - 65 MA - 10 FSD - 8" MA - 10 FSD - 8" FSD - 8" GE 70-11 - GE CDX-E Slimline Model GE 90-II Floor Model Mobile Model KV - 65 1 KV - 90 MA - 10 YD 8 MA - 15 FSD - 8" sg. FSD - 8" GE-100 Stationary X-Ray Unit KV - 100 MA - 15 FSD - 8" GE-"73 X-Ray Unit Kv - 170 MA - 10 FSD - 8" GE 90-11 Remote Control Console and Tubhead Kv - 90 MA - 15 FSD - 8" GE-100 Remote Control X-Ray Unit with compact control and wall support for tubehead. Kv - 100 MA - 15 FSD - 8" - 59 - PHILIPS ORALIX DENTAL X-RAY EQUIPMENT 45 Series YL 4 a ME ARR PO MOBILE + TYPE FLOOR MOUNTED KV - 45 KV -45 MA - 5 MA - 5 FSD - 4" FSD - 4" CUSPIDOR MOUNTED UNIT MOUNTED KV -45 KV - 45 MA - 5 MA - 5 FSD - 4" FSD - 4" - 60 - Philips Oralix Super 50 Series UNIT MOUNTED KV -50 MA - 7 FSD - 4" SPLIT MODEL COMPOSITE MODEL KV -50 Kv -50 MA - 7 MA - 7 FSD - 4" FSD - 4" The controls are on the bracket arm - 61 - RITTER DENTAL X-RAY EQUIPMENT RITTER A RITTER B RITTER D Mobile Model Mobile Model Mobile Model KV - 63 KV - 65 Kv -170 MA -10 MA - 10 MA - 15 FSD - 17" FSD - 1" FSD - TT" RITTER F FSD - 17" Mobile Model KV - 90 RITTER E MA - 15 Floor Model FSD - TT" Kv - 90 MA - 15 FSD - 7" - 62 - SIEMENS DENTAL X-RAY EQUIPMENT SIEMENS Heliosphere Floor Mounted Unit KV - 72 MA - 12 SIEMENS Heliodent FSD - 4" : = Wall Mounted Unit SIEMENS Heliodent KV - 50 i i MA - 7 Mobile Unit FSD an Kv - 50 MA - 7 FSD - 4" SIEMENS ORTHOPANTOMOGRAPH Console Tubehead and Head Positioning Device with Cassette WEBER DENTAL X-RAY EQUIPMENT WEBER 4 WEBER 5 Mobile Unit Navy Unit KV - 65 KV - 65 MA -10 MA -10 FSD - ? FSD - 6.25" WEBER 5 WEBER 5 Floor Unit Mobile Unit KV - 65 KV - 65 MA -10 MA -10 FSD - 6.25" FSD - 6.25" - 64 - WEBER 6 WEBER 6 Mobile Unit Wall Unit Kv - 65 KV - 65 MA -10 MA -10 FSD - 6.25" FSD - 6.25" WEBER 6 Mobile Unit KV -65 MA -10 FSD - 6.25" - 65 - WEBER 6 Wall Unit KV -65 MA -10 FSD - 6.25" CD) Ny WEBER 6A Wall Unit KV - 65 MA -10 FSD - 6.25" WEBER 6A WEBER 6B Mobile Unit Wall Unit KV - 65 KV - 65 MA -10 MA -10 FSD - 6.25" FSD - 6.25" fro) \ ) i} Wl | J | D oo / WEBER 6R Wall Unit KV -170 MA -15 FSD - 7" - 66 - WEBER 7 Mobile Unit KV -65 MA -10 FSD - 6.25" WEBER 6R Wall Unit Kv -170 MA -15 FSD - 7" WEBER 7 Mobile Unit KV - 65 MA -10 FSD - 6.25" WEBER 7A Mobile Unit Kv - MA - FSD - 65 10 6.25" WEBER 7 Mobile Unit KV - 65 MA - 10 FSD - 6.25" WEBER 7A Mobile Unit KV -65 MA - 10 FSD - 6.25" - 67 - WEBER 7 Mobile Unit KV - 65 MA - 10 FSD - 6.25" WEBER 9 Mobile Unit KV -65 MA -10 FSD - 6.25" WEBER 9 Wall Unit WEBER 9A KV - 65 Floor Unit MA -10 KV - 65 FSD - 6.25" MA -10 FSD - 6.25" WEBER 9A WEBER 11 Wall Unit Floor Unit KV - 65 Kv -170 MA - 10 MA -15 FSD - 6.25" FSD - 7" - 68 - WEBER 11R Floor Unit KV -170 MA -15 FSD - 7m WEBER 11R WEBER 12R Mobile Unit Floor Unit KV -170 KV -90 MA -15 MA - 15 FSD - 7" FSD - 7" WEBER Ultron Split Model Console & Tubehead KV -90 MA - 15 FSD - 7" - 69 - XRM DENTAL X-RAY EQUIPMENT XRM 2B XRM 3A Wall Model Floor Model KV -60 Kv -170 MA - 15 MA -15 FSD - 5.5" FSD - 5.5" XRM 90P XRM 90S Space Maker Mobile Model KV -90 KV - 90 MA -15 MA -15 FSD - 7" FSD - 7" - 10 - Early XRM 90 kV console with one of the first split-second timers, seen here mounted on column. KV -90 MA -15 FSD - 5.5" XRM SPACEMAKER XRM PANOREX Composite Unit KV -90 KV -90 MA - 10 MA -15 FSD - ? FSD - 17" - 71 - XRM 1964 Split Model Consoles with Tubehead KV -90 MA -15 FSD - 7" Close-up of one of the XRM 90 kV consoles -"2 = SELDOM ENCOUNTERED DENTAL X-RAY UNITS MAKE : Fischer Discontinued manufacturing dental X-ray equipment in 1952. Continues to manufacture X-ray generators for other purposes. MANUFACTURER: H. G. Fischer 9451 W. Belmont Avenue Franklin Park, Illinois LOCATION OF On a plate directly under the pointer cone. TUBE NO. : LOCATION OF On the right side, on a plate beneath the opening through which CONSOLE NO. : the electric cord passes. ar FISCHER-CMDX FISCHER-DX Mobile Unit Wall Mounted KV -65 KV -65 MA -10 MA -10 FSD - ? FSD - ? - "73 - MAKE : International MANUFACTURER: Union Dental Instrument Manufacturing Company Philadelphia, Pennsylvania LOCATION OF Inside the tube beneath the filament on the cathode. TUBE NO. : LOCATION OF On a metal plate on the back of the console. CONSOLE NO. Mobile Mounted KV - 65 MA -10 FSD - ? -74 - MAKE Wm. Meyer MANUFACTURER: Wm. Meyer Corporation Chicago, Illinois LOCATION OF Unknown TUBE NO. : LOCATION OF On back of console. CONSOLE NO. Pe —— Floor Mounted KV - 90 MA -15 FSD - ? Note: This unit can be properly collimated and filtered by adding the PHS (Dental) Fischer Collimator and 1.0 mm. of aluminum. - 75 - MAKE : Picker Picker X-ray Corporation has discontinued manufacturing dental X-ray equipment. : MANUFACTURER: Picker X-ray Corporation Waite Manufacturing Division, Inc. Cleveland, Ohio LOCATION OF On side of the tubehead housing at yoke connection. TUBE NO. : LOCATION OF By the “off-on” switch on the right side of console. CONSOLE NO. Floor Mounted Kv -170 MA -10 FSD - ? - 76 - MAKE : Profexray MANUFACTURER: Profexray Inc. Maywood, Illinois LOCATION OF : On a plate located outside on the tubehead housing. TUBE NO. LOCATION OF : On the back of the console. CONSOLE NO. Wall Mount KV - ? (voltmeter 30-150 v.) MA - 5-20 - 7 - MAKE MANUFACTURER: LOCATION OF TUBE NO. LOCATION OF CONSOLE NO. Universal (Cephalometric Unit) Universal X-ray Products Inc. 1138 North Western Avenue Chicago, Illinois On the front of the tubehead housing. Unknown Tubehead and Head Positioning Device - 178 - MAKE : Westinghouse MANUFACTURER: Westinghouse Electric Corporation 2521 Wilkens Avenue Baltimore, Maryland LOCATION OF : On the brass ring behind the pointer cone. TUBE NO. LOCATION OF : On left side of console housing. CONSOLE NO. Wall Mounted WESTINGHOUSE PANORAMIX KV -60 - 65 Tube MA -10 FSD - 5.5" Normal 70 KV at 1 MA for one second Control 30 - 70 KV 0-1 MAS - 179 - SUPPLIERS OF ELECTRONIC TIMERS Electronic Control Corp. 1573 E. Forest Ave. Detroit 7, Mich. X-ray Manufacturing Corp. of America Lake Success Park, Community Dr. Great Neck, N. Y. SUPPLIERS OF LONG OPEN END TUBES R. Margraf, Fab. 27 Woodhill Drive Willow Grove, Penn, General Electric Company 4855 Electric Avenue Milwaukee, Wisconsin 53201 Ritter Equipment Company P.O. Box 848 Rochester 3, New York Hanau Engineering Co., Inc. 1233 Main St. Buffalo 9, N. Y. Liebel Flarsheim Co. 111 E. Amity Rd. Cincinnati 15, Ohio (CONES) Weber Dental Manufacturing Company 2206 13th Street, N.E. Canton, Ohio 44705 X-Ray Manufacturing Corporation of America Community Drive Great Neck, New York - 80 - General Information Illustrations GENERAL INFORMATION ABOUT AVAILABLE DENTAL X-RAY FILMS DUPONT IFI KODAK MINIMAX ORAGRAPHIC RINN OTHER E. I. DuPont de Nemours and Company make two speeds of film-- DuPont D and Lightning Fast. Code number on the D film includes the letter D, A bitewing film is produced which is indicated by the code letters BW, The Lightning Fast code numbers include the letters LF. International Film Industries Corporation presently makes three speeds of dental film--Intermediate BH, Super speed SBH, and an Ultra-Rapid speed UBH, Eastman Kodak presently makes two speeds of film--Radia-Tized and Ultra-Speed. All Kodak dental film code numbers are preceded by DF followed by a number. Kodak no longer makes '""Regular' and "Super-Speed''. Kodak dental films incorporate a '"Morlite'' feature which allows a higher intensity of light in the darkroom when used with the ML-2 safelight filter. A Wratten 6 B safelight filter is required for Kodak extra-oral films such as Royal Blue, Blue Brand and No-Screen Medical X-ray Film. Kodak markets a 5''x 12" film for use with the XRM Panorex. Minimax Company presently makes two speeds of film--Interme- diate and Extra Fast. The Intermediate speed film is identified by the letter B in its coding. The Extra Fast has the letters EF in its coding. Oragraphic presently makes two speeds of film--Intermediate and Super speed. The Intermediate speed film is identified by OR-1 in its code. The Super speed is identified as OSS-1 in its code. (Until it has been assigned IBM code numbers, Oragraphic will be re- ferred to as 99-other.) Rinn Corporation presently makes three speeds of film. Medium MF, Extra EF, and Super S. The Rinn film code identifications include the code letters MF, EF or S followed by a number or a letter and number code, indicating the film size and number of films per packet. Their bitewing film is identified by a number preceding the code letters. Rinn dental films MF and S incor- porated a ''Pluslight' feature which allows a higher intensity of light in the darkroom when used with the ML-2 safelight filter. (Rinn no longer markets their DC, HF, or SF dental films. The Rinn Super S replaces the Rinn Superfast SFand has the ""Pluslight" feature.) Rinn also manufactures a 5" x 12" film for use with the XRM Panorex. Any other available film not included above will be listed as 99- Other. Other brands of film which may be encountered are: Gavaert, Dentus Rapid: Ilford, Contrast and Standard: Cea, Normal and Rapid. These are generally films of foreign manufac- ture. - 81 - AMERICAN STANDARD SPEED CLASSIFICATIONS FOR INTRA-ORAL DENTAL RADIOGRAPHIC FILM: DIAGNOSTIC GRADE Table XII-a. Dental Roentgenographic Film Speed-Group Ratings (data furnished by the manufacturers) Film brand Speed group Manufacturer or distributor (A.S.A. PH6.1-1961) (In reciprocal roentgens)t Periapical film None --- A (slowest) 1.5-3.0 DuPont "D" E.I. duPont de Nemours & Co. B 3.0-6.0 Kodak Radio-Tized (Morelite) Eastman Kodak Co. IFI BH 1 International Film Industries Minimax Intermediate Minimax Co. Rinn MF Rinn Corp. IFI SBH 1 International Film Industries C 6.0-12,0 Minimax Extra Fast Minimax Co. Rinn EF Rinn Corp. DuPont "LF" E.I. duPont de Nemours & Co. D 12,0-24.0 IFI UBH-1 International Film Industries Kodak Ultra-Speed (Morelite) Eastman Kodak Co. Rinn S.F., S Rinn Corp. None -—— E 24,0-48.0 None --- FP (fastest) 48.0-96.0 Bitewing film DuPont "BW" E.I. duPont de Nemours & Co. B 3.0-6.0 IFI Interproximal Standard International Film Industries Kodak Radio-Tized (Morelite) Eastman Kodak Co. Minimax Intermediate Minimax Co. Rinn MF Rinn Corp. IFI Interproximal Super International Film Industries C 6.0-12.0 Minimax Extra Fast Minimax Co. Rinn EF Rinn Corp. IFI Interproximal Ultra International Film Industries D 12,0-24.0 Kodak Ultra-Speed (Morelite) Eastman Kodak Co. Rinn SF, S Rinn Corp. Occlusal film Kodak Ultra-Speed (Morlite) Eastman Kodak Co. D 12.0-24,0 Rinn SF Rinn Corp. * The method of calculating film speeds has been discussed in JADA 59:472 Sept. 19589. t The upper limit of each speed group range shall be excluded from that range. - 82 - LOCATION OF CODE NUMBER OF THE VARIOUS FILMS KODAK DUPONT ORAGRAPHIC RINN MINIMAX IFI 3 EX Periapical RADIA-TIZED 1 FILM PACKET 150 MORLITE PACKETS peveor serons fp 0 MAL SET GU PONT : i cilia) DENTAL X-RAY FILM E1410 RTH ld 144 PACKETS 1 FiLM EACH EAR DENTAL X-RAY FILMS EXTRA FAST DOUBLE COATED SAFETY BLUE BASE 144 PACKETS CUS Aa J Fn MORLITE by ly m em 10 Occlusal ULTRA-SPEE - PACKETS ETE ULTRA-SPEED Posterior Al 25 1 FILM PACKET 3k MORLIT Periapical Citi = ULTRA-SPE 50 moO PACKETS No. 0 size A115 ULE 1E SH DENTAL X-RAY FILM 150 ONE FILM PACKETS OPEN OTHER END ORAGRAPHIC y AEN 3d 130) 144 PACKETS 1 FILM EACH \Y} ERNE a DENTAL X-RAY FILMS INTERMEDIATE DOUBLE COATED SAFETY BLUE BASE 144 PACKETS EYE ITI ol CURRIE) LIU AAI) - 83 - RC oo TT pErnTmeTen aE sees w= [ER B . ) } : i i’ ) . Bi Bo BE | KR a 5 be lv oo FILM BADGE SERVICE The amount of X-ray radiation that reaches the body of the dentist or of the auxil- iary dental personnel can be measured economically with a film badge. The film badge is worn on the clothing for one or two weeks or for one month and is then returned by mail to the laboratory where it was purchased originally. At the labora- tory, the film in the badge is carefully processed, and its exposure is evaluated. The amount of radiation recorded by the film badge is a measure of the exposure of the wearer. He is notified by mail of the amount of his exposure. Film badges can be obtained on a weekly, biweekly, or monthly basis. Some labora- tories require contracts which state that film badges will be accepted for a mini- mum of 13 consecutive weekly, biweekly, or monthly periods. Other laboratories set no limit on the minimum length of time for which the service is desired. ! Following is a list of commercial companies and organizations known to have a program for film badge monitoring. The list does not necessarily include all organizations which have a film badge program. This does not constitute an en- dorsement or a recommendation of the companies listed. Applied Health Physics, Inc. Nuclear Consultants Corporation Bethel Park Box 6172, Lambert Field Pennsylvania St. Louis, Missouri 63145 Atomic Energy Industrial Nuclear Service Laboratories Laboratory of the Southwest Box 1885 6413 South Main Knoxville 1, Tennessee Houston, Texas Nucleonic Corporation of America Controls for Radiation, Inc. 196 De Graw Street 130 Alewife Brook Parkway Brooklyn 31, New York Cambridge, Massachusetts R. S. Landauer, Jr. and Company Eberline Instrument Corporation 3920 216th Street 805 Early Street Matteson, Illinois Santa Fe, New Mexico Radiation Detection Company Gardray Film Badge Service 385 Logue Avenue P.O. Box 117 Mountain View, California Burlington, Massachusetts St. John X-ray Laboratory Califon New Jersey Health Physics Services, Inc. 1109-13 Low Street Baltimore 2, Maryland Nuclear Chicago Corporation T. M. Gaines Company 333 East Howard Avenue 845 University Avenue Des Plaines, Illinois 60018 Berkeley 10, California sar . H,; Silha, R. E.; Richards, A. G.: Effective Use of X-ray Radiation in Dentistry.O.S., O.M. & O.P.,; Vol. 16: pp. 299- , Mar. . ys sss - 85 - Film Badge Service (continued) Technical Associates Nuclear Instrumentation 140 West Providencia Ave. Burbank, California 91502 Tracerlab A Division of Laboratory for Electronics, Incorporated 1601 Trapelo Road Waltham 54, Massachusetts - 86 - United States Testing Company, Inc. 1415 Park Street Hoboken, N.J. 07030 Westinghouse Radiation Monitor Westinghouse X-ray Department 2519 Wilkens Avenue Baltimore 3, Maryland Conversion to Fast Film Scatter Exposure Collimation with Illustrations Duty Cycle SUGGESTIONS FOR CONVERSION TO ULTRA-FAST TECHNIQUE Because different X-ray units vary considerably in their X-ray output and since individual preferences result in a wide variety of opinions regarding optimum density of radiograms, the exposure times suggested below may be modified some- what in order to achieve the film quality desired. If mAs is the milliampere-second value for the area to be radiographed (see suggested values in Table I), and mA is the new, reduced milliampere setting selected by the operator, exposure times for ultrafast techniques to be used with units having mechanical timers may be calculated using the following formula: mAs m Exposure Time = Table I Suggested mAs Values for use in Preparing a New Technique Chart using Ultra-Fast Film Emulsions with Older 65 kVp X-ray Units Short (8'") Cone Long (16'') Cone Maxillary: Central -------------- 2.5 mAs 10.0 mAs Lateral -------=-=------ 2.0 mAs 7.5 mAs Cuspid---=-=--=--cccu-- 2.0 mAs 7.5 mAs Bicuspid--------=------ 2.5 mAs 10.0 mAs Molar -=-=-c cc cmc eee 3.75 mAs 15.0 mAs Mandibular: Central-------------- 2.0 mAs 7.5 mAs Lateral -------------- 2.0 mAs 7.5 mAs Cuspid-=--=-=-=---=------ 2.0 mAs 7.5 mAs Bicuspid--=-=-===-=-=------ 2.0 mAs 7.5 mAs Molar -=-=====--=-=---- 2.5 mAs 10.0 mAs - 87 - For example, if you use a short (8') cone and 65 kVp, you could choose to set the milliamperes on your unit at 4 mA and use the following exposure times for the various areas (Table 2): *Table 2 Sample Technique Chart (65 kVp, 4 mA) Exposure Time Maxillary: Central---=-cceaeu-a- 1/2 - 3/4 seconds Lateral--=--c ccc ccaa= 1/2 second Cuspid-=-=-====c=cec--- 1/2 second Bicuspid---===-=oc-o-- 1/2 - 3/4 seconds Molar ---=-=-=--o----- 1 second Mandibular: Central-=--=-=---cccececa- 1/2 second Lateral ---=-=-=-==ccccu-- 1/2 second Cuspid-==-cceccaeaa-- 1/2 second Bicuspid-----==-==-=-=---- 1/2 second Molar ----=-==--c-uc--- 3/4 second *These exposure times were calculated using the mAs values given in Table I. If, after setting up a new technique such as just described, the X-ray unit fails to produce consistent film densities at the shorter exposure time settings, try a further reduction in milliampere setting, and increase the exposure time accord- ingly. Users of long cones can convert to the faster film technique in the same manner as described, but must use the mAs values listed in the long (16') cone column of Table I when calculating the exposure times for the technique chart. Ordinarily, units using long cones need only slight reduction of milliamperes to extend the exposure times into an accurate mechanical timer range. In many cases the rec- ommended exposure times given by the film manufacturer may be used directly, without any reduction in milliampere setting. - 88 - RADIATION EXPOSURE TO OPERATOR FROM SCATTER RADIATION The exposure or dose (D) is the product of the intensity of radiation and the exposure time (t), or D = I x t. Since you are concerned only with X-rays, the exposure or dose D will be in Roentgens. You can measure the exposure time in any units (seconds, minutes, hours, etc.) that youdesire. However, for convenience in calculating the exposure, the intensity and time will have to be converted to the same units of time; that is, the intensity of radiation will have tobe in milliroentgens per second, or minute, or hour, depending on the unit in which you prefer to measure your total exposure time. However, for most of the portable radiation survey meters, the units used are milliroentgen/hr, or mR/hr. For the calculations, consider one average case and use these factors. Assume that the operator stands in the same position while taking the radiographs. Consider scatter radiation only at the position of the operator. EXAMPLE: Given--The average working situation of A. 46 = number of dental films exposed per week B. 1.3 seconds (secs) = average exposure time per film C. 1200 mR/hr = intensity of scatter radiation from a phantom or patient, measured at a distance of three feet from the patient, and at a location of 450 from the direction of the X-ray beam during a bitewing exposure using 90 kVp. To find--the radiation exposure to the operator per year. With D = I x t, to solve for D you need both I and t, which were given. All that is needed is to convert to appropriate units. Since I was given in mR/hr, calculate exposure time on the basis of a week. This will be the product of the number of films per week (46) and the average exposure time per week (1.3 seconds). Or, 46 films 1.3 secs _ 59.8 seconds week X film week For simplicity in the following calculations, round off the 59.8 seconds to 60 sec- onds. The problem now is to convert 60 seconds to hours. Since there are 60 sec/min x 60 min/hr, or 3600 sec/hr, a total of 60 seconds is 60/3600 hours, or 1/60 hour. Therefore: D=1t 1200 mR/hr x 1/60 hr/week 20 mR/week Your exposure would be approximately 20 mR/week. If occupationally exposed persons do not receive more that .1 R or 100 mR per week, they will not exceed the limits of exposure recommended by the National Committee on Radiation Protection. For more detailed information on the maximum permissible doses recommended by the National Committee on Radiation Protection, refer to the National Bureau of Standards Handbooks 59 and 76. I 1] - 89 - SAMPLE CALCULATION TO DETERMINE APERTURE SIZE FOR LEAD COLLIMATOR I. Using the chart in the appendix, Dental X-ray Units - General Information, read off the '""Focal Spot to Tip of Cone' distance in inches for the X-ray unit in question. (In this sample calculation a General Electric unit is used.) Example: General Electric Focal Spot to Tip of Cone = 8" II. Next, remove pointer cone and measure as accurately as possible the distance from tip of cone to location where the collimator will be installed (Y). (The side of the collimator nearest the tubehead is used in all measurements.) This distance is then subtracted from ''Focal Spot to Tip of Cone Distance" (A) to give “Focal Spot to Collimator Distance” (B). Example: Cone tip to collimator = 6.00" o's Focal spot to tip of cone (8') minus cone tip to collimator (6') = focal spot to collimator (2') A-Y =B III. The desired beam size at tip of cone (C) is 2.75" in all cases. Example: Beam size = 2.75" IV. The aperture size (X) can now be determined by setting up a ratio of Focal Spot to Tip of Cone _ Beam Size at Tip of Cone Focal Spot to Collimator ~ Aperture size in Collimator Example: 8" 2.75" 8x = 5.5" x= BE x = 0.687" 2" X Focal Spot to Tip of Cone Cone Tip to Collimator Focal Spot to Collimator Beam Size at Tip of Cone Aperture Size in Collimator Xaw > won Equation: ow» I > OQ -90 - INFORMATION ON PUBLIC HEALTH SERVICE FILTER AND COLLIMATOR SETS The Public Health Service supplies filter and collimator sets for the five most commonly encountered dental X-ray machines. Although these are supplied by manufacturer's name, they will not necessarily fit all equipment marketed by that manufacturer. (The Public Health Service collimators do not fit Victor, GE-CDX-E or the Ritter E, F, and G models. The PHS filters do not fit the Ritter E, F, and G models.) The dimensions for these collimators are based upon a 2-3/4" diameter beam at the tip of the short pointer cone. The specifications for the filters and collimators supplied by the Public Health Service are as follows: OUTSIDE APERTURE DIAMETER DIAMETER Ritter 2.6 " 1.55" Weber 1.44" .89" XRM 2.67" .86" GE 1.76" .69" Fischer 2.44" 1.57" Collimators are made of 1/16" thick lead, also known as "four pound lead' because it weighs approximately 4 lbs/sq. ft. Filters are made of 1/2 mm. commercially pure aluminum, #1100 or 2S. -91 - CALCULATION USING DUTY CYCLE CORRECTION FACTOR The duty cycle of an X-ray machine is the amount of time the tube can be operated per unit of time without causing damage to the tube. Dental X-ray machines can be operated only in terms of individual exposures, not in terms of continuous opevation over a long period of time, Since the rate meters currently used in survey work read in terms of mR/hr, the duty cycle of an X-ray machine must be considered. FOR EXAMPLE: If a surveyor checking tubehead leakage were to obtain a rate meter reading of 100 mR/hr at a distance of one meter, this reading might be misleading because the maximum possible continuous exposure time of a dental X-ray unit is far short of an hour. In fact, the average unit cannot be operated in excess of approximately six minutes in one hour. Therefore, it is necessary to calculate the true exposure dose rate from leakage at a distance of one meter, considering the operation limits of the equipment. 6 seconds in 1 minute = 6 minutes in 1 hour 6/60 of 1 hour = 1/10 = 0.1, the conversion factor. Multiply the rate meter reading (100 mR/hr) by the conversion factor (0.1) to obtain the true amount of leakage occurring within one hour with this particular X-ray unit. 100 mR/hr (rate meter reading) x 0.1 (conversion factor) = 10.0 mR, the amount of actual leakage in a one-hour period from this unit. Handbook 76 allows a diagnostic tubehead leakage not to exceed 100 mR in one hour, The unit in question leaks 10 mR in one hour, or 0.1 of the maximum permissible amount. The average conversion factor for dental X-ray units is one-tenth (0.1). When surveying equipment with the duty cycle unknown, use 0.1 as the conversion factor. This is a conservative average and allows for a safety factor of approximately 2.0. In using the conversion factor given, bear in mind that a specific milliamperage (mA) and kVp were used to calculate the conversion factors. If the mA or kVp is changed, the conversion factor given in the table will not be correct. The ma and kVp ratings used in Table I are, in general, the maximum so that the conversion factor is conservative and allows maximum safety. - 92 - U31eoH (eor1d0oIpey 1961 "320 ‘9SH-%S% :II° *,S8ursnoy aqn] Ae1-X [BIUSQ WOIJ UOIIeIpeY 28BNEIT JO JUSWIINSEI,, BIEQ :woaJ pajuraday *anoy uo ul uoljerpea adeyqea] Jo LA3rjuenb ayy ureiqo ol olde] u0T3091100 2Yy3a Aq 3981e3 9qn3j Oyj WOIJ I23d2W UO JB pIUTWI2IIp 23eI 2S0p 2insodxa ana ay3z ATdII[NN x <0 0 “uIw yoes ‘soos ¢ 0S / (06 12dng) a 001230N 9990°0 ‘uTw Yyoes SOI 7 S9 01 Xd I9YdSTJg 0° 0 ‘UTW yoea °S09S hg 06 St gzt 10°0 ‘urw Yyoea °S23S Z°% 0L ST 411 01°0 ‘uw Yyoea °sSI9S 9 G9 01 11 01°0 ‘utw Yyoea ‘Sd9s Q G9 01 V6 01°0 ‘utw yoea ‘sO3S 9 S9 oT VL 01°0 ‘ulw yoea °SO3S G9 01 L 10°0 ‘urw Yyoea °SO09S 7'Y 0L ST 49 01°0 ‘uTW Yyoea °*SO3S 9 $9 OT 49 01°0 ‘ulw yoea ‘S29 G9 01 v9 01°0 ‘utw Yyoea °sSO3S 9 G9 01 9 199°9M 9990°0 ‘uTuw ydoes 'SO9S v 06 SIT 06 99900 ‘utw Yyoea ‘SO3S 4 0L ST Ve 9990°0 ‘ulw Yyoea ‘SO3S 1 0L ST VC WX 9990 °0 ‘ulw yoea ‘sos Y 001 ST 00T 01°0 ‘ulw Yoea SIS 9 0L 01 el 01°0 ‘uTw Yyoea ‘SIS 9 06 St II-06 %® 06 010 ‘ulw Yyoea ~sO3S 9 0L 01 II-0L ® OL umou uf) G9 01 d-Xao umou uf €S 01 (3T£1S PTO) I039TA a9 SL SI GL jqAeR 090°'0 ‘ulw Yyoea ‘S23S 9°¢ 06 GI 9 090° 0 "uTw Yoed ‘SI3S 9°¢ 06 St d 090° 0 ‘uru yoeo °s939S 9g ¢ 06 St (£an3jua)) 3 C9C0 ‘uTWw Yyoed "sSO9S 9g 0¢L St X-18nd 090°0 ‘uTw Yodoed "SO9S gg 0£-06S 01 4 280T°0 ‘ulw yoea °"sI9s G9 £9 01 \ 1933TY x 1030BJ (uotaeaadQ snonutiuo)) (day) (ew) 1°POW Auedwo) UOTSISAUOD 2124) Aang 238e310A juaxin) SLINN AVY-X TVINIC ¥Od SONILVY HTIOAD ALNd - 93 - Bl Cdl ae Sli Sl SI a Le a is i Aprons and Barriers Barrier Materials Personnel Monitoring Devices eee LEAD APRONS, PROTECTIVE BARRIERS, AND PROTECTIVE BARRIER MATERIALS Following are lists of commercial companies and organizations known to sell lead aprons, protective barriers, and protective barrier materials. The lists do not necessarily include all organizations handling these articles. These lists do not constitute an endorsement or recommendation of the organizations listed. LEAD APRONS AND SHEETING Bar-Ray Products, Inc., 209 25th Street, Brooklyn 32, New York LeadX Protective Aprons Office Personnel Patients’ Aprons Sheeting .25 mm. lead equivalent .50 mm. lead equivalent 1.00 mm. lead equivalent General Electric Company, X-ray Department, 4855 Electric Avenue, Milwaukee, Wisconsin Lead Protective Aprons Office Personnel Patients' Aprons Sheeting .50 mm. lead equivalent Picker X-ray Corporation, 25 South Broadway, White Plains, New York Lead Protective Aprons Office Personnel Patients' Aprons Sheeting .50 mm. lead equivalent 1.00 mm. lead equivalent Buck-X-Ograph, 87 Xograph Avenue, St. Louis, Missouri Buffalo Weaving & Belting Company, 300 Chandler, Buffalo, New York Halsey X-ray Products, Inc., 1425 37th Street, Brooklyn, New York J. Palmero Sales Company, P. O. Box 368, Westport, Connecticut Wolf X-ray Products, Inc., 93 Underhill Avenue, Brooklyn, New York Rinn Corporation, 2929 N. Crawford Avenue, Chicago 41, Illinois - 95 - EXAMPLES OF LEAD APRONS Pictured here are several of the various types of protective lead aprons for patient and office personnel. Aprons are made with a vinyl or rubber that is impregnated with finely powdered lead. The lead equivalent varies from .25 mm. lead equivalent to 1.00 mm, lead equivalent. Coat Apron Bib Apron Strap Apron - 96 - Lead Aprons (continued) - 97 - PROTECTIVE BARRIERS Bar-Ray Products, Inc., 209 25th Street, Brooklyn 32, New York Floor Screen (Shield) 1.5 mm. lead-lined; 8" x 10" lead glass window General Electric Company, X-ray Department, 4855 Electric Avenue, Milwaukee, Wisconsin Floor Screen 1.5 lead-lined; 8'" x 10" lead glass window Picker X-ray Corporation, 25 South Broadway, White Plains, New York Floor Screens 1.5 mm. lead-lined,; 8" x 10" lead glass window Campbell X-ray Transformer Company, 146 Exchange Street, Malden, Massachusetts Rinn Corporation, 2929 N. Crawford Avenue, Chicago 41, Illinois Wolf X-ray Products, Inc., 93 Underhill Avenue, Brooklyn, New York Pivoting Screen (left) Mobile Screen Mobile Screen (right) - 98 - Protective Barriers (continued) Wall Pivoting Screen Wall Pivoting Screen - 99 = PROTECTIVE BARRIER MATERIALS Ameray Corp. Route 46 Kenvil, New Jersey Andel & Co., Inc. 5218 N. Kedzie Avenue Chicago, Illinois Bar-Ray Products, Inc. 209 25th Street Brooklyn 32, New York Division Lead Co. 7742 W. 61st Street Summit, Illinois Duro Metal Spinning Co. 207 Oster Street Glen Olden, Pennsylvania General Electric Co., X-ray Dept. 4855 Electric Avenue Milwaukee, Wisconsin General Lead Construction Corp. 1800 Harrison Avenue Kearney, New Jersey Keleket Division (Laboratory for Electronics, Inc.) Medical X-ray Apparatus 1601 Trapelo Road Waltham, Mass. Keller Products, Inc. 37 Union Manchester, New Hampshire O. G. Kelley & Co. 105 Taylor Street Boston, Massachusetts Maryland Metal Spinning Co. 604 W. Fairmount Avenue Baltimore, Maryland Met-L-Wood Corp. 6755 W. 65th Street Chicago 38, Illinois Picker X-ray Corp. 1273 Mamaroneck Avenue White Plains, New York ” Ray Proof Corp. 843 Canal Street, P.O. Box 1454 Stamford, Connecticut Westinghouse Electric Corp. X-ray Dept, 2519 Wilkins Avenue Baltimore, Maryland Wolf X-ray Products, Inc. 93 Underhill Avenue Brooklyn 38, New York - 100 - PERSONNEL MONITORING DEVICES Film Badges HE Clip-on Badge Wrist Badge JO sg Clip-on Badge in Plastic Cover Clip-on Badge with Plastic Cover Removed OA AO i — ig Back Side of Film Badge - 101 - Film Badges (continued) Wrist Clip-on Ring Opened Dosimeters and Chargers Pocket Chambers and Charger Readers - 102 - Pocket Dosimeter and Charger Pocket Chamber and Charger-Reader Dosimeters Vp / | il 1's] 1" Ig] gpg J 0g Glass Dosimeter Opened Glass Dosimeter Closed Warning Device Chirpy - 103 - Ri 2.STATE, COUNTY, j PHYSICAL RADIATION PROTECTION SURVEY ay Zo l4el2 ed 1 2 3 4 5 6 7 8 OF DENTAL X-RAY EQUIPMENT INSTALLATION 3. DENTIST, CARD ol /olg 13 CARD NO. | IDENTIFICATION 9 10 11 12 13 14 15 L 4. TOTAL XRAY UNITS AT INSTALLATION / 16 5. X-RAY UNIT IDENTIFICATION NUMBER / . 17 » ) wi Or OSES) . 6. NUMBER OF PERSONS OPERATING THIS UNIT ¢ INS TION ADDRESS 18 cCAr/ec 5-432/ 7. NUMBER OF OFFICE PERSONNEL PHONE WONDER A. FULL TIME DENTISTS Z o.(a mma J CITY B. PART TIME DENTIST E. ho Z on $ 20 COUNTY E Zandi na C. OTHER FULL TIME PERSONNEL 2 a STATE 11 oF hilip Saal Coster pe — D. OTHER PART TIME PERSONNEL 22 8 TYPE OF PRACTICE 1. . PEDODONTI . - ET pie enn 5 3. ORTHODONTIC 6. PROSTHODONTIC 23 3. X-RAY UNIT 7. LJ : A. MANUFACTURER z MODEL A 9 Z B. TUBE SERIAL NUMBER 9523250 0|0|718|2 <|5 0 26 27 28 29 30 31 32 33 34 C CONSOLE SERIAL NUMBER _ £ 5 23250 218181213252 35 36 37 38 39 40 41 42 10.POINTER CONE | 0. NONE 2. SHORT OPEN 4. LONG OPEN vv 1. SHORT POINTED 3. LONG POINTED 9. OTHER(SPECIFY) 43 II.LFIELD DIAMETER AT END OF POINTER CONE (inches) 4 rs oO A. BEFORE MODIFICATION S$. 50 44 45 46 B. AFTER MODIFICATION Z. J5 21715 47 48 49 12. TOTAL FILTRATION OF PRIMARY BEAM (mm Al equiv.) 0 5 o A. BEFORE MODIFICATION 0.5 50 51 52 B. AFTER MODIFICATION 2.0 210|0 53 S54 SS I3.ROENTGEN OUTPUT AT END OF iyi CONE IN r/sec. 2 J A. BEFORE MODIFICATION Z 6 7 56 31 58 B. AFTER MODIFICATION /. 2/7 713 59 60 61 [14.18 X-RAY UNIT OPERABLE AT LEAST 6 FEET FROM TUBE HEAD 0 0. NO 1. YES 3 PHS-3657 Row 5-61 Coster 2rd A/eox 15. TIME . [ | | SURVEY BEGAN Z LZ ‘ o/ SURVEY ENDED z 2 :3/ JM DIFFERENCE IN MINUTES 3 0 63 64 16 DATE OF SURVEY record month HnTE DAY YEAR) January 4 /76% and year o|/|¢|¥ 65 66 67 68 IZ FURTHER CONSULTATION RECOMMENDED 0. NO 1. YES (SEE REMARKS) 0 69 18.CODE NUMBER OF SURVEYOR /| 3 13 10 form Budget Bureau No. 63-R711 caro | oenrimcation |/ 1S 101 #412 ¢| #10] 02712 31/17 NO. 2 1 2 3 4 5 7 8 9 10 11 12 13 1 15 16 17 19. TIMER ” A. TYPE one 1. MECHANICAL vv 2. ELECTRICAL OR ELECTRONIC / 18 B. TERMINATES ee 0 0. NO 1. yes B. UNKNOWN __ 19 C. STOPWATCH CHECK Electronic 7rmer fs 2 IMER SETTING STOPWATCH READING DIFFERENCE T 4 Coded “eo ”_ nol 2 Tao 20. X-RAY UNIT GROUNDED 0. NO 1. YES B. UNKNOWN y 4H 21 21. STABILITY OF TUBE HEAD J. ADEQUATE 1. NOT ADEQUATE vv / 22 22. TUBE HOUSING RADIATION LEAKA! WITHIN RECOMMENDED STANDARDS 0. NO ~ 1. YES 0 23 23.PROTECTIVE BARRIERS 1. FIXED WITH LEAD WINDOW 4. MOBILE WITH NO LEAD WINDOW 0. HONE 2. FIXED WITH NO LEAD WINDOW 5S. PRESENT BUT NOT IN USE 4 - 3. MOBILE WITH LEAD WINDOW ______ 9. OTHER (SPECIFY) 24. LEAD APRONS ¢ vou 2 PATIENT MY TT Uo ee = | # “75 25. PERSONNEL MONITORING A. TYPE 3 . 2. POCKET CHAMBER 4. DENTAL FILM SF wit 3. POCKET DOSIMETER = 9. OTHER (SPECIFY) 26 B. TIME 0. NONE ____ 2. WAS USED WITHIN THE PAST12 MOS _ _ 4° Z 1. CURRENTLY BEING USED ___ 3. WAS USED OVER ONE YEAR AGO C. RESULTS 1. UNDETERMINED dl 3. 2570 100 mr/wk ________ / 0. NONE _ 2. BELOW 25 mr/uk 4. ABOV: 100 mr/wk LL bo = 26.WORKLOAD A. ESTIMATED NUMBER OF FILMS PER WEEK ON THIS UNIT “#4 0 4 4 22 30 31 /, B. AVERAGE EXPOSURE TIME PER FILM OF UPPER FIRST MOLAR 2/4 2145 32 33 34 C. CALCULATED AVERAGE EXPOSURE TIME PER FILM (nseconds) J, 24 ¥.7=/.57 |/,4|7 (AVG. EXP. = UP. MOLAR X .7) 35° 36 57 D. USUAL MILLIAMPERES / 0 Jo 38 39 E. MILLIAMPERE -SECONDS PER WEEK [22 o|\7 212 ) 4 41 42 43 F. USUAL KILOVOLTAGE ts é\5 4b 45 27 FILM USED A. BITEWING 217 MANJFACTJRER Dupo nt TYPE OR CODE /5 a D-/ 46 47 8. PERIAR CAL Du pont TYPE OR CODE [50 D-/ AY LIST OTHER FILMS UNDER REMARKS 48 49 | 28. DARKROOM PROCEDURES A DEVELOPER USED O05 wv o wv —- MANUFACTURER GE TYPE Super Mix B. USUAL DEVELOPMENT TIME (in minutes) 5 \ of ~ o C. USUAL TEMPERATURE OF DEVELOPER (in degrees fahrenheit) JO 7 D0. THERMOMETER IN DARKROOM 1. YES 3. NO DARKROGM 0. MO 2. THERMOSTATIC corn pr” E. USUAL CHANGE OF DEVELOPER (in weeks) 3 0 F. IS DARKROOM LIGHT TIGHT 0. NO 1, YES lo Jd oN [2Q [40 w od PHS-3657 Rev 5-61 (Page 2) CARD NO. 3 IDENTIFICATION 3 J #1 ¢ 2 68 o / 0 J / / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 29. OCCUPATIONAL EXPOSURE; SCATTER RADIATION I LEFT BITEWING EXPOSURE (REFER TO DIAGRAM BELOW). AT NORMAL OPERATING POSITION AT NEW POSTION _DIRECTION DISTANCE mr /hr mr /hr A. DENTIST o|\7 / /1 4710] 2 Jlo|2 18 19 20 21 22 23 2% 25 26 27 B. ASSISTANT 0 2 2 / 7 5 0 olol|/ 28 29 30 31 32 33 34 35 36 37 IL ANTERIOR UPPER PERIAPICAL EXPOSURE DIRECTION DISTANCE mr /hr mr /hr C. DENTIST J 2 | / /J16 102 oo |3 38 39 40 41 42 43 44 45 46 47 D. ASSISTANT 02 2 APA ANZ olo|/ 48 49 50 51 52 53 54 55 56 57 II RIGHT BITEWING EXPOSURE DIRECTION DISTANCE Vi Jhb E. DENTIST 0 | 3 / | / 4 7 4 olol|/ 58 59 60 61 62 63 64 65 66 67 F ASSISTANT 0 / [2] / 7 ol o 21 oo 68 69 70 71 72 73 74 75 76 77 ANTERIOR LEFT RIGHT 30. TYPE OF SURVEY INSTRUMENT USED PHS-3657 Rev 5461 (Page 3) 78 NDED CARD NO. 4 IDENTIFICATION 1 2 3 % 5 7 8 9 0 11 iz 13 1 516 7 31. BEAM QUALITY DETERMINATION (cap on/cap orF METHOD) A. KVP FOR THIS EXPOSURE 18 19 B. MA FOR THIS EXPOSURE 20 21 ROENTGENS /SEC C. CHAMBER A CAP OFF TIME IN SECONDS WOMBER OF ROENTCENS 22 23 2 ROENTGENS /SET D. CHAMBER B CAP OFF TIME IN SECONDS NUMBER OF ROENTGENS 25 26 27 ROENTGENS /SEC E. CHAMBER A CAP ON TIME IN SECONDS NUMBER OF ROENTGENS 28 29 30 ROENTGENS /SEC F. CHAMBER B CAP OFF TIME IN SECONDS NUMBER OF ROENTGENS, | 31 32 33 G. RATIO CAP ON / CAP OFF — CHAMBER A 3% 35 36 H. HALF VALUE LAYER CALCULATED 37 38 39 I. TOTAL ALUMINUM EQUIVALENT FILTRATION 40 41 42 31. REMARKS conduclinea Ae SUrve . o / the Nemarks" 1lem /S for He benefil of Lhe State PHS-3657 Rev 5-61 (Page 4) aA TOT Sada des Ad it PHYSICAL RADIATION PROTECTION SURVEY REPORT OF DENTAL X-RAY EQUIPMENT INSTALLATIONS CODING AND PUNCHING INSTRUCTIONS Card Item Column 2. Code Number State 1-2 County 3-5 City 6-8 Card #1 Code 01- 51 001-999 001-999 Remarks From IBM Standard State Code From IBM Standard County Code From IBM Standard City Code 3. Dentist Card Identification Dentist 9-13 00001-99999 Dentist's identification number assigned in consecutive order within the State Card Identification Card 14-15 11 first form First page Card #1 12 second form First page Card #1 22 second form Second page Card #2 13 third fom First page Card #1 23 third form Second page Card #2 33 third form Third page Card #3 14 fourth form First page Card #1 24 fourth form Second page Card #2 34 fourth form Third page Card #3 44 fourth form Fourth page Card #4 4, Number of 16 A - not stated As reported - If zero, then x-ray units 0 - none punch zeroes in columns 1 1 unit 24-62 2 2 units 3 - 3 units 9 - 9 or more units 5. Number assigned 17 A - not stated As reported - assign:d by to this unit 0 - none surveyor 1 - first unit 2 - second unit 3 - third unit 9 - ninth unit - 109 - Card Item Column 6. Number of 18 persons operating this unit Code A - not stated 1 - 1 person 2 - 2 persons 3 - 3 persons 9 - 9 or more persons Remarks As reported 7. Number of Office Personnel A. Full-time 19 Dentists B. Part-time 20 Dentists C. Other full-time 21 personnel D. Other part-time 22 personnel OWN +- OP Cw Hop Own =P WWN- OD» - not stated - 1 dentist - 2 dentists - 3 dentists - 9 or more dentists - not stated - none - 1 dentist - 2 dentists - 3 dentists - 9 or more dentists - not stated - none - 1 person - 2 persons - 3 persons - 9 or more persons - not stated - none - 1 person ~ 2 persons - 3 persons - 9 or more persons As reported As reported As reported As reported 8. Type of 23 practice OWN F WN - not stated - General - Oral Surgery - Orthodontic - Pedodontic - Periodontic - Prosthodontic - more than one type ~ other As reported NOTE: Clinics, hospitals, military installations, etc. will be coded as 9 - 110 = Card Item Column Code Remarks 9. X-ray Unit A. Manufacturer 24-25 AA - not stated As reported - manufacturer and and Model BB - unknown model 01-99 See attachment A B. Tube serial 26-34 AAAAAAAAA - not stated As reported number BBBBBBBBB - unknown 000000001-999999999 C. Console serial 35-42 AAAAAAAA - not stated As reported number BBBBBBBB - unknown 00000001-99999999 10. Pointer cone 43 A - not stated As reported B - unknown 0 - none 1 - Short-pointed 2 - Short-open 3 - Long-pointed 4 - Long-open 9 - Other 11. Field diameter at end of pointer cone (inches) A. Before 44-46 A.AA - not stated As reported to nearest 1/4 Modification B.BB - unknown inch in decimal form 0.00 none 0.25 1/4 inch 0.50 1/2 inch 2.75 2-3/4 inches 9.75 9-3/4 inches B. After 47-49 AAA not stated As reported to nearest 1/4 Modification B.BB unknown inch in decimal form. Code c.cC not applicable CCC if modification is not 0.25 1/4 inch performed during survey. 0.50 1/2 inch If no modification is necessary, 2.75 2-3/4 inches code same number as before 9.75 - 9-3/4 inches modification - 111 - Card Item Column Code Remarks 12. Total Filtration of Primary Beam A. Before 50-52 A_AA - not stated As reported to nearest 1/4 modification B.BB - unknown millimeter in Aluminum 0.00 - none equivalent in decimal form 0.25 - 1/4 mm 0.50 - 1/2 mm 1.50 - 1-1/2 mm 9.75 - 9-3/4 mm B. After 53-55 A.AA - not stated As reported to nearest 1/4 modification B.BB - unknown millimeter of Aluminum C.CC - not applicable equivalent in decimal form. 0.25 - 1/4 mm Code CCC if modification is 0.50 - 1/2 mm not performed during survey. 1.50 - 1-1/2 mm If no modification is neces- 9.75 - 9-3/4 mm sary, code same number as before modification. 13. Roentgen Output at end of pointer cone r/sec. A. Before 56-58 A.AA - not stated As calculated from seconds modification B.BB ~- unknown and number of roentgens as 0.00 - none read from integrated meter in 0.01 - 1/100 r/sec 100ths of roentgens per sec. 0.05 - 1/20 r/sec Code AAA if measurement is 0.97 - 97/100 r/sec not made as part of the 1.50 - 1-1/2 r/sec survey 9.99 - 9-99/100 r/sec B. After 59-61 A.AA - not stated As calculated from seconds modification B.BB® - unknown and number of roentgens as C.CC - not applicable read from integrated meter in 0.01 - 1/100 r/sec 100ths of roentgens per sec. 0.05 - 1/20 r/sec Code CCC if modification is 0.97 - 97/100 r/sec not performed during survey. 1.50 - 1-1/2 r/sec Code AAA if measurement is 9.99 - 9-99/100 r/sec not made part of the survey. If no modification is neces- sary, code same number as before modification - 112 = Card Item Column Code Remarks 14. Is X-ray unit 62 A - not stated As reported - Under 6 feet-No operable at least B - unknown 6 feet or more - Yes 6 feet from tube 0 - no * Assume no protective head? 1 - yes barrier in use 15. Time survey 63-64 AA - not stated Code the difference between began and time BB - unknown ending and starting time in survey ended 01 - 1 minute minutes 02 - 2 minutes 99 - 99 minutes 16. Date of Survey 65-68 0361 - Mar. 1961 As reported 0861 - Aug. 1961 1161 - Nov. 1961 1261 - Dec. 1961 1262 - Dec. 1962 0163 - Jan. 1963 1269 - Dec. 1969 17. Further consulta- 69 A - not stated If "yes" it will be explained tion recommended 0 - no under remarks. Code as 1 - yes reported. 18. Code number of 70-71 AA - not stated As assigned Surveyor 01-99 - 113 - PHYSICAL RADIATION PROTECTION SURVEY REPORT OF DENTAL X-RAY EQUIPMENT INSTALLATIONS CODING AND PUNCHING INSTRUCTIONS Card #2 Card Item Column Code Remarks Code Number State 1-2 01-51 From IBM Standard State Code County 3-5 001-999 From IBM Standard County Code City 6-8 001-999 From IBM Standard City Code Dentist 9-13 00001-99999 Dentist's identification identification number assigned in consecu- tive order within the State. Card Identification Card 14-15 11 first form First page Card #1 identification 12 second form First page Card #1 22 second form Second page Card #2 13 third form First page Card #1 23 third form Second page Card #2 33 third form Third page Card #3 14 fourth form First page Card #1 24 fourth form Second page Card #2 34 fourth form Third page Card #3 44 fourth form Fourth page Card #4 Total x-ray units 16 A - not stated As reported at installation 0 - none 1 - 1 unit 2 - 2 units 3 - 3 units 9 - 9 or more units X-ray unit identi- 17 A - not stated As reported - assigned by fication number 0 - none surveyor 1 - first unit 2 - second unit 3 ~ third unit 9 - ninth unit 19. Timer A. Type 18 A - not stated As reported B - unknown 0 - none 1 - mechanical 2 - electrical or electronic -114 - Card Item Column Code Remarks B. Terminates 19 A - not stated As reported exposure B unknown 0 no 1 yes C. Stopwatch 20 A - not stated Difference between timer and check B - unknown stopwatch. As reported to 0 none nearest second either plus 1 1 second or minus. Applies only on 2 2 seconds machines with mechanical 9 9 or more seconds timers. 20. Is x-ray unit 21 A - not stated As reported grounded? B - unknown 0 no 1 yes 21. Stability of 22 A - not stated As reported Tube Head 0 adequate 1 not adequate 22. Tube housing 23 not stated As reported - Code 0 - No. radiation leakage within recommended standards —- ow» unknown no yes If reading at 1 meter exceeds 100 mr in one (1) hour after consideration is given to the limitation imposed by the duty cycle of the tube as determined from the manufac- ture tube rating and cooling charts. As a rule of thumb with dental x-ray units oper- ated at the normal KVP and Ma settings, readings obtained car be divided by ten (10) to determine the leakage at the maximum voltage and current for continuous operation at that voltage. - 115 - Card Item Column Code Remarks 23. Protective 24 A - not stated As reported - regard fixed barrier 0 - none wall as protective barrier 1 - fixed - with lead if distance and material is window adequate, then code as 9. 2 - fixed - with no lead window 3 - mobile - with lead window 4 - mobile - with no lead window 5 - present - but not in use 9 - other 24. Lead apron 25 - not stated As reported - Code 9 if used - none only on children and pregnant - operator only women. patient only - patient and operator - present but not in use - other OF WN +— OP» 1 25. Personnel Monitoring - not stated As reported - if more than - none one means is or has been ~ film badge used, record most recent pocket chamber or most accurate (1, 2, 3) - pocket dosimeter - dental film - other A. Type 26 CEWN- OX 1 B. Time 27 - not stated As reported never - currently being used - used within past 12 months 3 - used over one year ago N— OB 1 C. Results 28 - not stated As reported - none undetermined - below 25 mr/wk ~ 25to 100 mr/wk - above 100 mr/wk FLW — OY 1 - 116 - Card Item Column 26. Workload A. Estimated 29-31 number of films per week on this unit B. Average exposure 32-34 time per film of upper first molar C. Calculated 35-37 average exposure time per film in seconds D. Usual 38-39 milliamperes E. Milliampere- 40-43 seconds per week F. Usual 44-45 kilovoltage oN OOOoOOo Ca o ONHOOOOW» 5 . N Code BBB 000 001 999 BB - 00 - 01 - 02 - 10 - 99 - BBBB 0000 0001 0002 1000 9999 BB - 00 - 01 - 02 - 45 - not stated unknown none 1 film/wk 999 films/wk not stated unknown none 1/100 sec 1/50 sec 1/10 sec 1 sec 2-1/4 sec 9-99/100 sec not stated unknown none 1/100 sec 1/50 sec 1/10 sec 1 sec 2-1/4 sec 9-99/100 sec not stated unknown none 1 ma 2 ma 10 ma 99 ma - not stated - unknown - none - 1 ma-sec/wk - 2 ma-sec/wk - 1000 ma-sec/wk - 9999 ma-sec/wk not stated unknown none 1 kvp 2 kvp 45 kvp 99 kvp - 117 - Remarks As reported for this unit only As reported to nearest 100th of a second in decimal form As reported to nearest 100th of a second in decimal form. Obtained by multiplying average exposure time of upper first molar by correc- tion factor of 7/10 As reported to nearest milliampere As reported. Obtained by multiplying entries in cols. 29-31 by entries in Cols. 38-39 and multiplying that total with entry in cols. 35-37 (no. of films/wk x ma x av. exposure time) As reported to nearest kilovolt Card Item Column Code Remarks 27. Film used A. Bitewing 46-47 See Attachment B As reported - manufacturer and code B. Periapical 48-49 See Attachment B As reported - manufacturer and code 28. Darkroom procedures A. Developer used 50-51 See Attachment C As reported - manufacturer B. Development time 52-53 A.A - not stated As reported to nearest 1/2 0.0 - none minute except for sight 0.5 - 1/2 minute development 1.0 - 1 minute 1.5 - 1-1/2 minutes 9.5 - 9-1/2 minutes 9.9 - Sight C. Temperature of 54-55 AA - not stated As reported - to nearest de- developer 00 - none gree Fahrenheit except for 60 - 60 degrees thermometer not used 61 - 61 degrees 62 - 62 degrees 98 - 98 degrees 99 - thermometer not used D. Thermometer 56 A - not stated As reported Darkroom 0 - none 1 - yes 2 - thermostatic control 3 - no darkroom 4 - present but not in use E. Usual change 57-58 AA - not stated As reported to the nearest of developer 00 - none week for complete change 01 - every week 02 - every 2 weeks 03 - every 3 weeks 97 - every 97 weeks 98 - replenished only 99 - Sight F. Is darkroom 59 - not stated As reported - NOTE: if no light tight = no A B ~ unknown 0 1 - yes darkroom in office, Code B - 118 = PHYSICAL RADIATION PROTECTION SURVEY REPORT OF DENTAL X-RAY EQUIPMENT INSTALLATIONS CODING AND PUNCHING INSTRUCTIONS Card #3 Card Item Column Code Remarks Code State 1-2 01-51 From IBM Standard State Code County 3-5 001-999 From IBM Standard County Code City 6-8 001-999 From IBM Standard City Code Dentist 9-13 00001-99999 Dentist's identification identification number assigned in consecutive order within the State Card Identification Card 14-15 11 first form First page Card #1 identification 12 second form First page Card #1 22 second form Second page Card #2 13 third form First page Card #1 23 third form Second page Card #2 33 third form Third page Card #3 14 fourth form First page Card #1 24 fourth form Second page Card #2 34 fourth form Third page Card #3 44 fourth form Fourth page Card #4 Total x-ray units 16 A - not stated As reported at installation 0 - none 1 1 unit 2 - 2 units 3 - 3 units 9 9 units X-ray unit identi~ 17 not stated As reported - assigned by fication number OCWN +—= Oo» none first unit second unit third unit ninth unit surveyor - 119 - Card Item Column 29. Occupational Exposure Scatter Radiation TEST I: Left Bitewing Exposure A. Dentist Direction 18-19 Distance 20 mr/hr 21-24 New position 25-27 mr/hr . B. Assistant Direction 28-29 Distance 30 mr/hr 31-34 New position 35-37 mr/hr Code 01 - 1 o'clock 02 - 2 o'clock 03 - 3 o'clock etc. 1 - 1 foot or less 2 - 2 feet 3 - 3 feet 9 - 9 feet or more 0001-9999 001-999 0l - 1 o'clock 02 - 2 o'clock 03 - 3 o'clock ete. 1 - 1 foot or less 2 - 2 feet 8 - 8 feet 9 - 9 feet or more 0001-9999 001-999 Remarks As reported - using 12-hour clock around phantom patient As reported to nearest foot within the circle As recorded on survey instrument As recorded on survey instrument As reported - using 12-hour clock around phantom patient As reported to nearest foot within the circle As recorded on survey instrument As recorded on survey instrument TEST II: Anterior Upper Periapical Exposure C. Dentist Direction 38-39 01 - 1 o'clock 02 - 2 o'clock 03 - 3 o'clock ete. -120 - As reported using 12-hour clock around phantom patient Item Distance mr/hr New position mr/hr . Assistant Direction Distance mr/hr New position mr/hr Card Column 40 41-44 45-47 48-49 50 51-54 55-57 Code - 1 foot or less - 2 feet 8 feet - 9 feet or more © oN = I 0001-9999 001-999 01 - 1 o'clock 02 - 2 o'clock 03 - 3 o'clock etc. 1 - 1 foot or less 2 - 2 feet 8 - 8 feet 9 - 9 feet or more 0001-9999 001-999 Remarks As reported to nearest foot within the circle As recorded on survey instrument As recorded on survey instrument As reported using 12-hour clock around phantom patient As reported to nearest foot within the circle As recorded on survey instrument As recorded on survey instrument TEST III: Right Bitewing Exposure E. Dentist Direction Distance mr/hr New position mr/hr 58-59 60 61-64 65-67 01 - 1 o'clock 02 - 2 o'clock 03 - 3 o'clock etc. 1 - 1 foot or less 2 - 2 feet 8 - 8 feet 9 - 9 feet or more 0001-9999 001-999 - 121 - As reported using 12-hour clock around phantom patient As reported to nearest foot within the circle As recorded on survey instrument As recorded on survey instrument Card Item Column Code Remarks F. Assistant Direction 68-69 01 - 1 o'clock As reported using 12-hour 02 - 2 o'clock clock around phantom patient 03 - 3 o'clock etc. Distance 70 1 - 1 foot or less As reported to nearest foot 2 - 2 feet within the circle 8 - 8 feet 9 - 9 feet or more mr/hr 71-74 0001-9999 As recorded on survey instrument New position 75-77 001-999 As recorded on survey mr/hr instrument 30. Type of survey 78 A - not stated As reported instrument used B - unknown 0 - none 1 - rate meter (Nucor) 2 - G.M. survey meter 3 - ionization chamber 9 - other -122 - PHYSICAL RADIATION PROTECTION SURVEY REPORT OF DENTAL X-RAY EQUIPMENT INSTALLATIONS CODING AND PUNCHING INSTRUCTIONS Card #4 Card Item Column Code Remarks Code number State 1-2 01-51 From IBM Standard State Code County 3-5 001-999 From IBM Standard County Code City 6-8 001-999 From IBM Standard City Code Dentist 9-13 00001-99999 Dentist's identification identification number assigned in consecutive order within the State Card Identification Card 14-15 11 first form First page Card #1 identification 12 second form First page Card #1 22 second form Second page Card #2 13 third form First page Card #1 23 third form Second page Card #2 33 third form Third page Card #3 14 fourth form First page Card #1 24 fourth form Second page Card #2 34 fourth form Third page Card #3 44 fourth form Fourth page Card #4 Total x-ray units 16 A - not stated As reported at installation 0 - none 1 = 1 unit 3 3 units 6 6 units 9 - 9 units X-ray unit 17 not stated As reported - assigned by identification number CwWwN+—= Oo» none first unit second unit third unit ninth unit -123 - surveyor 31. Item Card Column Beam Quality determination (Cap ON/Cap OFF method) A. KVP for this exposure B. Ma for this exposure C. Chamber A Cap OFF D. Chamber B Cap OFF E. Chamber A Cap ON F. Chamber B Cap ON 18-19 20-21 22-24 25-27 28-30 31-33 Code BB - 00 - 01 - 02 - 60 - 99 - BB - 00 - 01 - 02 - 15 - .BB .01 .97 .50 - oH OO0OoOWw» oO wi .99 .BB .05 .97 .50 oO O0Oow» .BB .01 .50 .99 Oo oOO0OoOW» .01 .05 .97 .50 OHO OOW» .01 - 99 - .05 - 97 - .BB - not stated unknown none 1 kvp 2 kvp 60 kvp 99 kvp not stated unknown none 1 ma 2 ma 15 ma 99 ma not stated unknown 1/100 r/sec 1/20 r/sec 97/100 r/sec 1-1/2 r/sec 9-99/100 r/sec not stated unknown 1/100 r/sec 1/20 r/sec 97/100 r/sec 1-1/2 r/sec 9-99/100 r/sec not stated unknown 1/100 r/sec 1/20 r/sec 97/100 r/sec 1-1/2 r/sec 9-99/100 r/sec not stated unknown 1/100 r/sec 1/20 r/sec 97/100 r/sec 1-1/2 r/sec 9-99/100 r/sec - 124 - Remarks As recorded by x-ray units instrument in kilovolts As recorded by x-ray units instrument in milliamperes As calculated from seconds and number of roentgens as read from integrated meter in 100ths of roentgens per seconds As calculated from seconds and number of roentgens as read from integrated meter in 100ths of roentgens per second As calculated from seconds and number of roentgens as read from integrated meter in 100ths of roentgens per second As calculated from seconds and number of roentgens as read from integrated meter in 100ths of roentgens per second Card Item Column Code Remarks G. Ratio 34-36 .AAA - not stated As calculated by dividing Cap ON/Cap OFF .BBB - unknown roentgens per second for Chamber A .001 - .001 Chamber A (Cap ON) by .050 - .050 roentgens per second for .100 - .100 Chamber A (Cap OFF) in .500 - .500 1000ths .999 - .999 H. Half Value Layer 37-39 A.AA - not stated As determined by reading Calculated B.BB - unknown value from graph for 0.01 - 0.01 mm established ratio - in 0.50 - 0.50 mm millimeters of aluminum 1.00 - 1.00 mm equivalent 2.50 - 2.50 mm 9.99 - 9.99 mm I. Total Aluminum 40-42 A.AA - not stated As determined by reading Equivalent B.BB - unknown value from graph for Filtration 0.01 - 0.01 mm established half value 0.50 - 0.50 mm layer - in milliamperes 1.00 - 1.00 mm of aluminum equivalent 2.50 - 2.50 mm 9.99 - 9.99 mm - 125 - X-Ray Unit - Manufacturer and Model AA - not stated BB - unknown Attachment A 00 - none Code Manufacturer Model 01 Ritter A 02 Ritter B 03 Ritter Dual -X o4 Ritter E (Century) 05 Ritter F 06 Ritter Model not stated or other 07 Ritter G 08 Ritter H (Mark 175) 15 General Electric Victor (old style) 16 General Electric CDX-E 17 General Electric 70 and 73 18 General Electric 90 19 General Electric Model not stated or other 20 General Electric 0 30 Weber 5 31 Weber 6 32 Weber 6A 33 Weber 6B 34 Weber 6R 35 Weber 7 36 Weber 7A 37 Weber 9 38 Weber 9A 39 Weber 11 uo Weber 11R 41 Weber Raydex (70) 42 Weber Raydex 12R (90) 43 Weber Model not stated or other - 126 - Attachment A Page 2 Code Manufacturer Model 60 X.R.M, 2A 61 X.R.M, 3A 62 X.R.M. 90 63 X.R.M., 70W 64 X.R.M. Panoramic 65 X.R.M. Model not stated or other 70 Philips Oralix 45 71 Philips Oralix 50 72 Philips All models 75 Universal All models 77 Westinghouse All models 79 Fischer All models 80 Liebel Flarsheim All models 82 Meyer All models 84 Wappler All models 85 Grenz-Ray All models 86 Norelco All models 87 Warte and Bartlett All models 88 G.M. McFedrier All models 89 Mattern All models 90 Picker All models 91 Profexray All models 92 Professional Equipment Corp. All models 93 Pony All models 94 Adams All models 95 Pengelly All models 96 X-Cell-Ray All models 97 Siemens All models 99 Other All models -127 = Speed Group Reciprocal r. Attachment B MANUFACTURER AND CODE BY SPEED OF FILM (Item 27, Film Used)* Speed Group Reciprocal r. Speed Group Reciprocal r. Speed Group Reciprocal r. 1.5 - 3.0 3.0 - 6.0 6.0 - 12.0 12.0 - 24.0 A B C D Kodak Wa DF 20 DF-1 yor 70 DF-38 02 -18 21 DF-7 - 71 DF-40 ZS DF 22 DF-37 72 DF-42 23 DF-39 DISCONTINUED 73 DF-48 DISCONTINUED 24 DF-41 yan DF-51 25 DF-43 75 DF-55 726 DF-49 76 DF-57 77 DF-58 DuPont 27 25D-1 78 25LF-1 28 25D-2 79 25LF-2 25 150D-1 80 150LF-1 30 150D-2 81 150LF-2 3T 25BW - Rinn 32 MF-1 52 EF-1 82 SF-1,8-1 33 MF-N-1 53 EF-N-1 83 SF-N-1,8-N-1 34 MF-0-1 5% EF-O-1 84 SF-0-1,5-0-1 35 MF-2 B5 EF-2 85 SF-2,5-2 36 MF-N-2 56 EF-N-2 86 SF-N-2,S-N-2 37 MF-0-2 57 EF-0-2 87 SF-0-2,5-0-2 38 3-MF 58 3-EF 88 3-8F, 3-8 39 2-MF 55 2-rF 89 2-5F,2-8 Minimax 40 BS 60 EFS 17 D 1 BD 61 EFD 72 BT 62 EFT 43 3-B 63 3-EF IE 3B x 6 64 3-FF x 6 45 OB 65 O-EF 6 OB x 3 66 O-EF x 3 IF1 47 BH 67 SBH 68 UBH Other 99 * Underlined figures are codes to be used on machine tabulating cards to identify the specific film by manufacturer and film code. -128 - Attachment C DEVELOPER BY MANUFACTURER (Item 28, Darkroom Procedures - Developer Used) AA - Not stated 00 ~ None 01 - Ace X-ray service 02 - Ansco liquid 03 - DuPont 04 - G.E. 05 - G.E. supermix 06 - Kerr FR 07 - Kodak 08 - Minimax 09 ~ Oneida 10 - Rinn 11 - X.R.M. 99 - Other - 129 - %U. S. GOVERNMENT PRINTING OFFICE : 1966 O - 237-451 Ca i at PUBLIC HEALTH SERVICE PUBLICATION NO. [559 U. C. BERKELEY LIBRARIES COL981L7704