PRACTICE PERSPECTIVES


Bringing X-ray to the Chairside: The Portable Imaging Advantage in Dentistry


by STEPHANIE PATRICK, BS,RT(R)(M)(QM) M


any dental offices throughout Missouri have incorporated handheld portable x-ray units into their practices, which


have been on the market in America since 2006. Portable units are an excellent option in a variety of situations: • when wall-mounted units fail and need replacement;


• in new construction where in-wall wir- ing and pass-through cabinetry are not desired;


• for patient loads that are geared toward pediatric, challenging or elderly patients where it is beneficial to have the opera- tor remaining in the room; and,


• for surgical procedures where a quick image is needed.


Additionally, dentists who practice in sites away from the office, such as humanitarian missions or events, find this device an invalu- able tool.


The units’ advantages are that they are lightweight, rechargeable and can be shared between multiple rooms in a practice. How- ever, if the device is dropped or damaged, it must be sent in for repair — and if the office does not have a secondary backup unit, imaging will be halted. Some companies will provide a loaner unit to the practice free of charge. Also, the internal battery must be kept charged, as no radiation exposure will be possible without it; many brands take ap- proximately three hours to charge fully.


DESIGN & SPECIFICATIONS


All handheld units have a leaded acrylic circular backscatter shield located at the end of the cone, typically 0.5 mm lead equivalent, to protect the operator’s hands and body from scattered radiation from the patient.


This backscatter device must remain in place at all times and is usually permanently affixed to the portable unit by the manufacturer.1,2 While many x-ray photons are absorbed by the patient or reach the sensor contribut- ing to the image, some x-rays will interact with the patient’s body, change direction and exit the patient in all directions, resulting in scattered radiation. Handheld devices are also enclosed in lead housing to block leakage radiation from the x-ray tube for the user’s protection. Portable units also can be purchased with an associated tripod or stand and exposure switch, where the operator can leave the room or distance themselves from the imaging equipment. This setup is not typically practiced in the United States.


Technical exposure parameters utilized are similar to those of wall-mounted intraoral units. The kV and mA are fixed, generally ranging from 60-65 kVp and 2-2.5 mA with high-frequency x-ray production generators. The user only needs to select the exposure time, which with digital sensors is quite low; settings between 0.15-0.3 seconds can be used for excellent image quality. Short expo- sure times are always beneficial in any type of intraoral imaging to reduce artifact motion on the image and patient dose. Each type usually offers both child and adult modes with preset techniques to select for specific teeth that are imaged. A full mouth series can be obtained efficiently without delays, as these units cool down fairly quickly between exposures.


Not all handheld units are FDA-approved or authorized for use by the Missouri Radiation Control Program (MRCP) — in fact, multiple units manufactured overseas are considered illegal in Missouri.2


Three of the approved


manufacturers and models most utilized in Missouri will be discussed, with their fea- tures and differences observed.


THE DEXIS UNIT: NOMAD PRO 2


Dexis states that they are the first handheld unit on the market, and in fact, many por- table units are collectively called ‘Nomads’, even though this brand is truly the only Nomad. Aribex, followed by Kavo, manufac- tured this device prior to Dexis. Resembling a hairdryer or power drill, the Nomad Pro 2 is probably the most widely recognized por- table dental x-ray machine on the market (Figure 1).


The unit features a detachable handset that houses the exposure trigger and the rechargeable battery. When purchased new from the vendor, a second handset is included so that a charged handset is always available. It is recommended to switch be- tween the handsets after charging to prolong battery life. Dexis estimates that 300-600 exposures can be made on a fully charged handset.3


These handsets do have a limited


life with regard to being charged, and new handsets will need to be purchased over time — typically every two to three years if 7,200 exposures per year are made.


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