is not moving during the exam, which would require repeat imaging due to motion. These units are considered safe if the backscatter shield remains in place and the operator has been properly trained. Handheld x-ray units represent a practical, efficient and modern solution in today’s dental practices.


Stephanie Patrick, BS, RT (R)(M) (QM) is a Qualified Expert and travels throughout Missouri performing radiation safety inspections for various types of sites including dental. She has been in the radiologic sciences with experience in radiation physics


and safety for more than 30 years and enjoys providing educational radiology information to facilities. Contact her at stephpatrickh3@gmail.com. Images are the property of the author except where noted.


REFERENCES


1. National Council on Radiation Protection and Measurements. (2019, Dec 19). Radiation Protection in Dentistry and Oral & Maxillofacial Imaging: Recom-


mendations of the National Council on Radiation Protection and Measurements. NCRP Report No. 177.


2. Missouri Department of Health and Senior Services, Bureau of Diagnostic Services, Missouri Radiation Control Program. (2025, Jul 8). Usage of handheld dental x-ray units in the State of Missouri. https:// health.mo.gov/safety/radprotection/pdf/usage-of- hand-held-xray-units.pdf


3. Dental Imaging Technologies. (2025, Mar 10). Every- thing You Need to Know About the Dexis Nomad Pro 2. Video. https://dexis.com/en-us/dexis-nomad-pro-2, https://www.youtube.com/watch?v=81tJfI48iyk


4. Dental Imaging Technologies. (2025, Mar 10). Safely Using your Dexis Nomad Pro 2. Video and training manual. https://dexis.com/en-us/dexis-nomad-pro-2


5. Digi-Doc.com. (2019, Oct 14). Digital Doc XTG Hand-Held Xray Training. Video and training manual. https://digi-doc.com/xtg-handheld-xray/


6. VatechAmerica.com (2023, Oct 27). Vatech EZRay Air Portable. Video and training manual. https://vatecha- merica.com/products/ezray-air


7. Journal of the American Dental Association. (2023, September) Patient shielding during dentomaxil- lofacial radiography: Recommendations from the American Academy of Oral and Maxillofacial Radiol- ogy. Volume 154, Issue 9. Benavides, E., Bhula, A., Gohel, A., et al. https://jada.ada.org/article/S0002- 8177(23)00391-4/fulltext


8. ADA.org. (2024, Feb 1). ADA Releases Updated Recommendations to Enhance Radiography Safety in Dentistry. https://www.ada.org/about/press- releases/ada-releases-updated-recommendations-to- enhance-radiography-safety-in-dentistry


9. Missouri Department of Health and Senior Services, Bureau of Diagnostic Services, Missouri Radiation Control Program. (2015, Aug). Guidance for dental fa- cilities, radiation badges and shielding. https://health. mo.gov/safety/radprotection/pdf/Guidance-for-Den- tal-Facilities-Radiation-badges-and-shielding.pdf


10. OSHA Review Incorporated. (2018, Feb 28). X-ray Dosimetry Monitoring in a Dental Office. https://os- hareview.com/2018/02/x-ray-dosimetry-monitoring- in-a-dental-office/


11. Journal of the American Dental Association. (2024, Apr 25) Optimizing Radiation Safety in Dentistry. Volume 155, Issue 4. Benavides, E., Krecioch, J., Con- nolly, R., et al. https://jada.ada.org/article/S0002- 8177(23)00734-1/fulltext


12. RDHMag.com (2019, Aug 1). Handheld vs conven- tional wall-mounted x-ray units. Rothmund, Windy, MSDH, RDH. https://www.rdhmag.com/patient- care/article/14068492/handheld-vs-conventional- wall-mounted-x-ray-units


Radiation Shielding Questions Continue Answered by STEPHANIE PATRICK


QUESTION: In the Winter 2023 Focus, the article “To Shield or Not to Shield?” states the Missouri Radiation Control Program (MRCP) adheres to the recommendations of the National Council on Radiation Protection and Measurements (NCRP) and cited the most recent NCRP publication (Report No. 177), which states that aprons are to be discontinued but thyroid shields are to be utilized. However, the American Academy of Oral & Maxillofacial Radiology (AAOMR) recommends both apron and thyroid shielding be discontinued. I’m seek- ing clarification on the current Missouri guidelines and recommendations.


The MRCP follows the recommendations of the NCRP. Due to this known conflict in recommendations by two national groups, I have repeatedly checked with the NCRP for updates, but there are no additional clari- fications published yet. In my most recent contact with them, they stated they have a draft of updated recommendations in place, but it is in review and not published. Accord- ing to their website, the NCRP has formed a committee to review the current patient shielding recommendations in all areas of radiology, including dental, which could be


why it’s taking so long to finalize. The com- mentary information is currently out for re- view by experts and then must be approved by the council before publishing. There was no date provided for the expected publica- tion at this time, but you can read more here: bit.ly/3KbLq8h. Access the referenced Focus article here: bit.ly/4gpJWDw.


QUESTION: Our team wants to ensure we are following the best practices for tracking our annual radiation levels in compliance with state and federal safety guidelines. Specifically, 1) What is the recommended process and frequency for monitoring annual occupational radia- tion exposure in a dental setting? 2) Are there any state-recommended or approved vendors for personal dosimeter services? Currently we use Instadose but have found communication barriers in understand- ing our report/deep dose reading/annual allowed limits. 3) Does Missouri offer any free local programs for radiation exposure testing and monitoring?


1) Most offices (if they choose to have monitoring badges) replace them quarterly. That is personally what our medical physics company does, and I survey a lot of dental units along with veterinary offices, hospi-


tals and fluoroscopy units, which are much higher radiation output. 2) The state doesn’t recommend any vendors, but popular ones are Landauer, Mirion and ThermoScientific. Those are probably the most popular do- simetry companies in the industry, but there are many other choices. 3) There are no free programs for testing that I am aware of.


When a QE inspects your pano or CBCT unit, a scatter survey is usually taken in the surrounding areas in addition to measur- ing the exposure parameters of the x-ray unit. For wall-mounted intraoral units, the operator is out of the room. For handheld units, the operator is shielded with the circular backscatter shield if the unit is being used properly. Dental exposure is quite low compared to general radiography. Go to bit.ly/3K8Hcyj to download the American College of Radiology’s radiation dose refer- ence chart. General guidelines for radiation badge monitoring from the MRCP are here: bit.ly/4n1UH1i. Some dental facilities are monitoring their exposure, and many are not. If you are likely to be exposed to 100 mrem per year, badging is recommended. If you have a pregnant worker, you can also purchase a dosimetry badge for that staff member for the gestation, and their badge is turned in monthly.


ISSUE 3 | FALL 2025 | focus 27


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36