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Radiation hygiene and practice in dentistry: state regulation of dental X rays
REPORTS OF COUNCILS AND BUREAUS
Radiation hygiene and practice in dentistry: state regulation of dental X rays
Council on Legislation Council on Dental Research Council on Dental Materials and Devices
At the present time, it is estimated that approxi mately 95,000 X-ray units are in use in dental of fices in the United States. Different states have different regulations concerning these units when one considers for example, equipment standards, structural shielding, or operating procedures. To keep the profession informed concerning state legislation in the radiation area, the Councils on Legislation, on Dental Research, and on Dental Materials and Devices have prepared a summary of state regulations concerning the use of dental X rays. One of the principal objectives of this sum mary is to encourage dentists to cooperate in the administration of state radiation protection laws. Data on the 50 states, the District of Columbia, and Puerto Rico are arranged alphabetically in
the first part of the summary, with general infor mation given regarding state administering agen cies, requirements of inspection, and record main tenance. Equipment standards, structural shielding standards, operating procedures, and other specific dental regulations are coded to refer to the foot notes which form the second part of the summary. Approximately 60 percent of the states have adopted mandatory regulations regarding the use of radiation in dentistry whereas over 90 percent either require registration of dental X-ray units or have general radiation codes. The dentist should direct questions regarding specific state regulations to the state dental associ ation or the dental officer in the state health de partment. 107
STATE
SPECIFIC LEGISLATION
GENERAL REGULATIONS FOR RADIATION DENTISTRY ADMINISTERING MAND. RECOM. AGENCY CODES yes
yes
State Board of Health
yes
yes
yes
Arizona Atomic Energy Commission
ARKANSAS
yes
yes
yes
State Health Department
CALIFORNIA
yes
yes
yes
State Department of Health
COLORADO
yes
yes
yes
State Department of Public Health
CONNECTICUT
yes
yes
yes
State Department of Health
DELAWARE
no
yes
yes
DISTRICT OF COLUMBIA
no
no
FLORIDA
yes
yes
GEORGIA
yes
yes
HAWAII
yes
yes
no
IDAHO
yes
yes
yes
ILLINOIS
yes
yes
yes
INDIANA
yes
yes
no
IOWA
no
no
KANSAS
yes
yes
yes
KENTUCKY
yes
yes
yes
LOUISIANA
yes
yes
yes
MAINE
yes
yes
yes
MARYLAND
yes
yes
yes
MASSACHUSETTS
yes
yes
no
MICHIGAN
yes
yes
yes
MINNESOTA
yes
yes
MISSISSIPPI
yes
yes
ALABAMA
yes
ALASKA
no
ARIZONA
yes
yes
yes
yes
*
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
State Board of Health Department of Public Health State Board Health
yes
Department of Public Health State Department of Health State Board of Health Department of Public Health State Board of Health
Division of Radiation Control Department of Health and Welfare State Board of Health and Mental Hygiene Department of Public Health Department of Public Health State Board of Health State Board of Health
voluntary program yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
State Department of Health State Department of Health
yes yes
RECORD DENTIST ON MAINTENANCE BY USERS ADVISORY BOARD INSPECTION
yes
v
no
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes yes yes
yes
yes yes
yes
STRUCTURAL EQUIPMENT STANDARDS
STANDARDS
OPERATING PROCEDURES
a, b, c
a, b, c, d, e
d, e, i, j,
a, b, c, d, e, f, g, h, i, 1, m
a, b, c, d, e, g
d, e, i, j,
a, b, c, e, f, g, h, i
a, b, c, d, e
d, e, i, j
a, b, c, e, f, g, h, i
a, b, c, d, e, f. g
a, i, j
a, b, c, 6, f, g- h, i, j, r
a, b, c, e, f, g, b, i, j
a, b, c, d, e, g
a, b, c, d, i, m
a, b, c, d, e, f, g, h
a, b, c, e, f, g, b, i
a, b, c, d, e
d
a, b, c, d, ç, f, g- h, i, j
s h ie l d in g
OTHER SPECIFIC DENTAL REGULATIONS a, i
REFERENCE TO NATIONAL BUREAU OF STANDARDS HANDBOOK #76 yes
STATE ALABAMA ALASKA
a, b, c, f, g, h, k, q a, b, c, f. g. h, k a, b, c, f, g, h,
a, b, c, d, e, f, g, h, i, j, k
yes
a, b, c, d
yes ARKANSAS yes yes (all handbooks of NBS) yes (regulations include mandatory items only)
a, b, d, e, f, g, h, o (reference to NBS#76)
j- k
a, b, c, d, e, g
COLORADO
CONNECTICUT
a, e
j. k, 1
DISTRICT OF COLUMBIA FLORIDA
regulations s till being considered
a, b, f, g, h, 1, m, n a, b, f, g, 1, m
CALIFORNIA
DELAWARE yes
a, b, c, d, e, f, g, h, k, m, n. o, q
ARIZONA
a, b, c, d
i
a, b, c, d, e, g
d, f, g, h, i
GEORGIA Handbook #61 (all handbooks of NBS) (all handbooks of NBS) yes
HAWAII IDAHO ILLINOIS
yest IOWA a, b, c, d, e, f, g, h, i, j a, b, c, d, e, f, g, h a, b, c, d, e, f, g, h, i, j a, b, c, d, e, f, g ,h , i- j a, b, c, f, g, h, i, i. 0
a, b, c, e, f, g, h, i b, m
a, b, c, d, e
a, c, d
a, b, c, d, e, g
i, j
a, b, c, e, f, g, h, i
a, b, c, d
a, c, d, i, j
a, b, e, f, g, h, i, m
a, b, c, d, e, g
a
a, b, e, f, g, h, i
a, b, c, d, e
a, cT ï ï T Ï Ï T
yes
KANSAS KENTUCKY
yes
yes (all handbooks of NBS)
MAINE
MARYLAND MASSACHUSETTS
a, b, f, g, h, j, P. q
a, b
a, c, d, e, g, h
k a, d, e, g
a, b, c, d, e, f, g, h, i, j, k
b, c, e, f, k, 1, m
a, b, c, d, e, h, j
(all handbooks of NBS) (miscellaneous handbooks of NBS)
MICHIGAN MINNESOTA
a, c, d, e, g, h yes
MISSISSIPPI
STATE
SPECIFIC LEGISLATION
GENERAL REGULATIONS FOR RADIATION DENTISTRY ADMINISTERING CODES MAND. RECOM. AGENCY
MISSOURI
yes
yes
yes
MONTANA
yes
no
no
NEBRASKA
yes
yes
NEVADA
yes
yes
yes
NEW HAMPSHIRE
yes
yes
yes
NEW JERSEY
yes
yes
yes
yes
yes
no
yes
yes
yes
yes
yes
yes
yes
NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO
yes
OKLAHOMA
yes
yes
OREGON
yes
yes
yes
PENNSYLVANIA
yes
yes
yes
PUERTO RICO
yes
yes
*t
yes
yes
no
RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA
yes
yes
Division of Health of Missouri of Department of Public Health „and Welfare State Board of Health Department of Health Depßrtment of Health Department of Health and Welfare, Division of Public Health - Radiation Control Agency Department of Health Department of Public Health New York Depart ment of Health State Board of Health State Department of Health Department of Health
yes
State Department of Health State Board of Health Department of Health Department of Health and Labor Department of Health
DENTIST ON ADVISORY BOARD
RECORD MAINTENANCE BY USERS INSPECTION
yes
yes
yes
yes
yes
yes yes
yes
yes
yes
yes
yes yes
yes
no
yes
yes
yes
yes
no
no
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes II
yes
yes
yes
no yes
. yes
TENNESSEE
yes
yes
yes
TEXAS
yes
yes
yes
UTAH
yes
yes
yes§
VERMONT
yes
VIRGINIA
yes
yes
WASHINGTON
yes
yes
yes
WEST VIRGINIA
no
no
yes
WISCONSIN
yes
yes
WYOMING
no
no
yes
State Department of Health Department of Public Health State Department of Health Department of Health State Board of Health State Health Department Department of Health State Board of Health Division of Health
no
EQUIPMENT STANDARDS
STRUCTURAL SHIELDING STANDARDS
a, b, d, e, f, g, h, k
OPERATING PROCEDURES
OTHER SPECIFIC DENTAL REGULATIONS
g
i, j
a, b, c, d, e
None
g
i b, c, d, i
REFERENCE TO NATIONAL BUREAU OF STANDARDS HANDBOOK #76 (all handbooks NBS).
i. 1 a, b, d, e, f, g, h
a, b, c
a, b, o a, b, c, d, e, f, g, h i. j, k
a, b, c, e, f. g> h, i
a, b, c, d, e
a, b, c, d, e, f, g, h, o
b, m
a, b, c, d, e, g
a, b, c, d, e, g
a, b, c, d, e, f, g, h, i, j, k
a, b
NEW HAMPSHIRE
NEW JERSEY Handbook #69
a, c, d
yes
Regulations have been proposed - awaiting action no
NEBRASKA NEVADA
yes a, b, c, d, e, g
MISSOURI
MONTANA yes
yes
i a, b, d, e, g, h
STATE
no
no
None
c, d, e, f, i, j, k d, e, f,
a, b, c
a, b, c, d, e,g
a, c, d
c, d, e, f, i, j, k, m, p, q
a, b, c, e, f, g. h, i, j, m
yes voluntary basis only not legal basis
NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA
a, g. a, g, a, g. n,
b, h, b, h b, h, o,
c, d, e, g, i a, b, c, d, e, f. g
a, b, c, d, e, g, i, j
yes (all handbooks of NBS) yes
OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA
a, g, a, g,
b, h, b, h,
c, d, e, f, i, j, k, c, d, e, f, i, n, o
yes
m
a, c, d, e, h
a, c, d, i, j TENNESSEE yes
yes
yes
no
(handbooks of NBS) ■(handbooks of NBS)
TEXAS UTAH VERMONT VIRGINIA
a, b, c, d, e, f, g. h, j, k
3,
b, c, e, f, g, h, i
a, b, c, d, e
a, c, d, i, j
NBS 76
NBS 76
no
no
a, b, c, d, e f, g, h, q
a, c
a, b, c, d, e, g, k
a, i
Handbook #76 (handbook of NBS) (handbooks of NBS)
WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
* Consists of individuals possessing education and scientific training in one or more of the following fields: radiology, pathology, medicine, other healing arts, radiation or health physics, or related sciences, with specialization in ionizing radiation, t A ll recommendations of National Committee on Radiation Protection and Measurements and the Federal Radiation Council, t Regulations in progress. § Regulations are mandatory where dentist has one or more employees — not mandatory for dentist working alone. II By Bureau of Industrial Hygiene Department of Health.
EQUIPMENT STANDARDS: (a) The tube housing shall be of diagnostic type. (b) Diaphragms or cones shall be used for collimating the useful beam and shall provide the same degree of protection as the housing. The dia meter of the useful beam at the cone tip shall not be more than three (3) inches, (sometimes 2.75” ) (c) A cone or spacer frame shall provide a target-to-skin distance of not less than seven (7) inches with apparatus operating above fifty (50) kvp or four (4) inches with apparatus operating at fifty (50) kvp or below. (d) For equipment operating up to seventy (70) kvp, the total filtration permanently in the useful beam shall be equivalent to at least 1.5 mm of aluminum. This requirement may be assumed to have been met if the half-value layer is not less than 1.5 mm,aluminum at normal operating voltages. (60 kvp - Pennsylvania) (e) For equipment operating above seventy (70) kvp, the total filtration permanently in the useful beam shall be equivalent to at least 2.5 mm.of aluminum. This requirement may be assumed to have been met if the half-value layer is not less than 2.5 mm.aluminum at the normal operating voltages. (60 kvp - Pennsylvania) (f) A device shall be provided to terminate the exposure after a preset time or exposure. (g) The exposure control switch shall be of the dead-man type. (h) Each installation shall be provided with a protective barrier for the operator or shall be so arranged that the operator can stand at least six (6) feet from the patient and well away from the useful beam. (5 feet - Pennsylvania) (i)
(j)
The Department may waive compliance with the specific requirements . . . by an existing machine or installation if: (a) Such compliance would require replacement or substantial modification of the machine or installation and (b) The registrant demonstrates to the Department’ s satisfaction achievement through other means ofradiation protection equivalent to required by these regulations.
that
No person shall make, sell, lease, transfer, lend or install X-ray or fluoroscopic equipment or the supplies used in connection with such equip ment unless such supplies and equipment, when properly placed in operation or properly used, w ill meet the requirements (of this regulation). This includes responsibility for the delivery of cones or collimators, filters, adequate timers and fluoroscopic shutters (where applicable).
(k) No registrant shall operate or permit the operation of X-ray equipment unless the equipment and installation meet the requirements (of this part). (I) A cone should be used for all routine exposures. In some cases the cone must be removed for special technics (e. g. temporomandibular-joint exposures) where a skin dose of 25 rads or more may be obtained during a single exposure (at 65 kvp for 60 milliampere-seconds with 1.5 mm. aluminum total filtration). The regular cone should be reinstalled immediately after completion of such exposures. (m) For equipment operating at and below 65 kvp, the total filtration permanently in the useful beam should be equivalent to at least 1.5 mm.of aluminum. For equipment operating above 65 kvp, the total filtration permanently in the useful beam should be equivalent to atleast 2.5 mm.of aluminum (or 2.0 mm). (n) The installation should be arranged so that the useful beam is directed away from occupied areas as much as possible. (o) The total filtration permanently in the useful beam shall be equivalent to not less than 2.0 mm.of aluminum. This requirement may be assumed to have been met if the half-value layer is not less, than 2.0 mm of aluminum when the unit is operated at normal voltage. (p) The filte r permanently in the useful beam shall be equal to at least the equivalent of 2 mm of aluminum. layer is approximately 1.4 mm,at 65 kilovolts.
With this filtration,
(q) In multiple installations, consideration shall be given to the possible exposure from all sources. (r)
2.0 mm of aluminum filtration for those X-ray machines operating up to 70 kvp.
STRUCTURAL SHIELDING STANDARDS: (a) Dental rooms containing X-ray machines shall be provided with primary barriers for all areas struck by the useful beam. (b) When dental X-ray units are installed, the rooms adjacent w ill be adequately protected.
thealuminumhalf-value
(c) Note: In most cases structural materials or ordinary walls suffice as a protective barrier without addition of special shielding material. (d) A ll wall, floor and ceiling areas that, because of restrictions in the orientation of the useful beam, cannot be struck by the useful beam shall be provided with secondary barriers. (e) Lead barriers shall be mounted in such against mechanical damage.
9 manner that
they w ill not sag or cold-flow because of their own weight. They shall be protected
(f) Joints between different kinds of protective materials shall be so designed that the overall protection of the barrier is not impaired. (g) Joints at the floor and ceiling shall be so designed that the overall protection is not impaired. (h) Windows, window frames, doors, and door frames shall have the same lead equivalent as that required of the adjacent wall. (i)
Holes in protective barriers shall be covered so that overall attenuation is not impaired.
(j)
A ll wall, ceiling, and floor areas shall be equivalent to or provided with applicable protective barriers as permanent parts of the building or equipment in accordance with the recommended criteria of the National Committee on Radiation Protection as outlined in the current National Bureau of Standards Handbook.
(k)
(The Director) may require the user to provide protective barriers to reduce stray and/or
leakage radiation.
(I)
The (State Board) may require submission of plans and specifications on the design and determining possible radiation hazards.
(m)
Permanent structural shielding and/or protective barriers shall be used as necessary toinsure that no personotherthan thepatient being X rayed receives a dose in excess of the lim it specified (in these RAD regulations).
shielding for radiationsourcesfor thepurposeof
OPERATING PROCEDURES: (a) Neither the dentist nor his assistant shall be permitted to hold patients or films during exposure, nor shall any individual be regularly used for this service. (b) During each exposure, the operator shall stand at least six (6) feet from the patient or behind a protective barrier. (c) Only the patient shall be in the useful beam. (d) Neither the tube housing nor the pointer cone shall be hand-held during exposure. (e) Fluoroscopy shall not be used in dental examinations. (f)
Each patient undergoing dental radiography shall be draped with a protective apron of not less than 0.25 mm lead-equivalent to cover the gonadal area.
(g) Personnel monitoring equipment shall be used as required by (these RAD regulations). (h) Whenever possible, fast film shall be used for diagnostic work. (i). The gonads of children and persons who have not passed the reproductive age shall beprotected from the useful beam either by the use of shielding (0.5 mm. Pb equivalent) collimation or special gonad shields when this w ill not impair the value of the examination. (j)
A protective leaded apron shall be worn.
(k) Protective leaded apron is recommended but not required.
OTHER SPECIFIC DENTAL REGULATIONS: (a) The registrant shall assure that all X-ray equipment under his jurisdiction is operated only by individuals adequately instructed in safe oper ating procedures and competent in safe use of the equipment. (b) The registrant shall make available to each individual operating X-ray equipment under his jurisdiction a copy of the current recommendations of the National Committee on Radiation Protection pertaining to X rays, such as National Bureau of Standards Handbook 76. (c) The registrant shall provide to the individuals operating X-ray equipment under his jurisdiction safety rules, including any restrictions of the operating technic required for the safe operation of the particular X-ray apparatus, and require that the operators demonstrate fam iliarity with these rules. (d) The registrant shall be responsible for assuring that all requirements (of this part) are met. (e) He (the registrant) shall insure beyond reasonable doubt that no radioactive material (including that in patients, animals, and equipment) is al lowed to leave the jurisdiction of the radiation user under circumstances that may subject other persons to radiation in amounts in excess of those indicated . . . in these regulations.
(f) (The Director) may require the user to provide protective clothing suitable to work carried on in each radiation installation. (g) There shall be a responsible person in charge of radiation protection in each radiation installation. He shall be cognizant of the radiation hazards associated with the use of radiation equipment or material and when necessary obtain the services of a qualified engineering and/or radiation expert to furnish such information as is necessary for the safe handling and use of such equipment or material. He shall be respon sible for providing the necessary instructions regarding radiation hazards and safe working practices to all employees using or handling radioactive substances or radiation producing machines. (h) (The Director) may require the user of any new or altered radiation installation to prepare plans and specifications of the proposed installation and submit them to the Department for review and approval prior to starting construction or operation. (i)
Each user shall maintain records showing the radiation exposures of all individuals for whom personnel monitoring is required in accordance with these ("R AD ” ) regulations. Such records shall be kept . . . in accordance with the instructions contained in that form or on clear and legible records containing all the information . . .
(j)
Records of individual radiation exposure which must be maintained . . . shall be preserved until five years after the effective date of this regu lation, or until a date five years after termination of the individual's employment or association with the user, whichever is later. Records which must be maintained pursuant to this regulation may be maintained in the form of microfilms.
(k) No X-ray apparatus or other radiographic sources shall be left unattended without locking the apparatus itself, or the room or building in some manner which w ill prevent its use by unauthorized persons. (I)
Any person possessing or using a source of ionizing radiation shall furnish to each employee, for whom personnel monitoring is required, a copy of such employees personal exposure record annually, at any time such employee has received excessive exposure, and upon termination of employment.
(m) If a dentist would use radioisotopes he is no longer a registrant but a licensee and must comply with all the requirements of a specific licensee as under (e).
Supplement to List of Certified Dental Materials
Council on Dental Materials and Devices
Eugenol Type, respectively, and have been added to the List. CERTIFIED DENTAL MERCURIES ADA Specification no. 6, second revision
Since publication of the most recent List o f Certi fied Dental Materials, revised to November 1, 1966, and published in the February, 1967, issue of t h e j o u r n a l (JADA 74:471) the following changes have been made in the List. Additions: The following materials conform to the American Dental Association Specification no. 6 for Dental Mercury and Specification no. 16 for Dental Impression Paste— Zinc Oxide114 ■ JADA, Vol. 76, Jan. 1968
Dental Mercury Triple Distilled
Advanced Laboratory Associates, Inc. CERTIFIED DENTAL IMPRESSION PASTE—ZINC OXIDEEUGENOLTYPE ADA Specification no. 16, Type II, Soft
Multi-Form Dual Purpose Impression Paste
Surgident, Ltd.
Radiation hygiene and practice in dentistry: state regulation of dental X rays
Council on Legislation Council on Dental Research Council on Dental Materials and Devices
At the present time, it is estimated that approxi mately 95,000 X-ray units are in use in dental of fices in the United States. Different states have different regulations concerning these units when one considers for example, equipment standards, structural shielding, or operating procedures. To keep the profession informed concerning state legislation in the radiation area, the Councils on Legislation, on Dental Research, and on Dental Materials and Devices have prepared a summary of state regulations concerning the use of dental X rays. One of the principal objectives of this sum mary is to encourage dentists to cooperate in the administration of state radiation protection laws. Data on the 50 states, the District of Columbia, and Puerto Rico are arranged alphabetically in
the first part of the summary, with general infor mation given regarding state administering agen cies, requirements of inspection, and record main tenance. Equipment standards, structural shielding standards, operating procedures, and other specific dental regulations are coded to refer to the foot notes which form the second part of the summary. Approximately 60 percent of the states have adopted mandatory regulations regarding the use of radiation in dentistry whereas over 90 percent either require registration of dental X-ray units or have general radiation codes. The dentist should direct questions regarding specific state regulations to the state dental associ ation or the dental officer in the state health de partment. 107
STATE
SPECIFIC LEGISLATION
GENERAL REGULATIONS FOR RADIATION DENTISTRY ADMINISTERING MAND. RECOM. AGENCY CODES yes
yes
State Board of Health
yes
yes
yes
Arizona Atomic Energy Commission
ARKANSAS
yes
yes
yes
State Health Department
CALIFORNIA
yes
yes
yes
State Department of Health
COLORADO
yes
yes
yes
State Department of Public Health
CONNECTICUT
yes
yes
yes
State Department of Health
DELAWARE
no
yes
yes
DISTRICT OF COLUMBIA
no
no
FLORIDA
yes
yes
GEORGIA
yes
yes
HAWAII
yes
yes
no
IDAHO
yes
yes
yes
ILLINOIS
yes
yes
yes
INDIANA
yes
yes
no
IOWA
no
no
KANSAS
yes
yes
yes
KENTUCKY
yes
yes
yes
LOUISIANA
yes
yes
yes
MAINE
yes
yes
yes
MARYLAND
yes
yes
yes
MASSACHUSETTS
yes
yes
no
MICHIGAN
yes
yes
yes
MINNESOTA
yes
yes
MISSISSIPPI
yes
yes
ALABAMA
yes
ALASKA
no
ARIZONA
yes
yes
yes
yes
*
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
State Board of Health Department of Public Health State Board Health
yes
Department of Public Health State Department of Health State Board of Health Department of Public Health State Board of Health
Division of Radiation Control Department of Health and Welfare State Board of Health and Mental Hygiene Department of Public Health Department of Public Health State Board of Health State Board of Health
voluntary program yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
State Department of Health State Department of Health
yes yes
RECORD DENTIST ON MAINTENANCE BY USERS ADVISORY BOARD INSPECTION
yes
v
no
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes yes yes
yes
yes yes
yes
STRUCTURAL EQUIPMENT STANDARDS
STANDARDS
OPERATING PROCEDURES
a, b, c
a, b, c, d, e
d, e, i, j,
a, b, c, d, e, f, g, h, i, 1, m
a, b, c, d, e, g
d, e, i, j,
a, b, c, e, f, g, h, i
a, b, c, d, e
d, e, i, j
a, b, c, e, f, g, h, i
a, b, c, d, e, f. g
a, i, j
a, b, c, 6, f, g- h, i, j, r
a, b, c, e, f, g, b, i, j
a, b, c, d, e, g
a, b, c, d, i, m
a, b, c, d, e, f, g, h
a, b, c, e, f, g, b, i
a, b, c, d, e
d
a, b, c, d, ç, f, g- h, i, j
s h ie l d in g
OTHER SPECIFIC DENTAL REGULATIONS a, i
REFERENCE TO NATIONAL BUREAU OF STANDARDS HANDBOOK #76 yes
STATE ALABAMA ALASKA
a, b, c, f, g, h, k, q a, b, c, f. g. h, k a, b, c, f, g, h,
a, b, c, d, e, f, g, h, i, j, k
yes
a, b, c, d
yes ARKANSAS yes yes (all handbooks of NBS) yes (regulations include mandatory items only)
a, b, d, e, f, g, h, o (reference to NBS#76)
j- k
a, b, c, d, e, g
COLORADO
CONNECTICUT
a, e
j. k, 1
DISTRICT OF COLUMBIA FLORIDA
regulations s till being considered
a, b, f, g, h, 1, m, n a, b, f, g, 1, m
CALIFORNIA
DELAWARE yes
a, b, c, d, e, f, g, h, k, m, n. o, q
ARIZONA
a, b, c, d
i
a, b, c, d, e, g
d, f, g, h, i
GEORGIA Handbook #61 (all handbooks of NBS) (all handbooks of NBS) yes
HAWAII IDAHO ILLINOIS
yest IOWA a, b, c, d, e, f, g, h, i, j a, b, c, d, e, f, g, h a, b, c, d, e, f, g, h, i, j a, b, c, d, e, f, g ,h , i- j a, b, c, f, g, h, i, i. 0
a, b, c, e, f, g, h, i b, m
a, b, c, d, e
a, c, d
a, b, c, d, e, g
i, j
a, b, c, e, f, g, h, i
a, b, c, d
a, c, d, i, j
a, b, e, f, g, h, i, m
a, b, c, d, e, g
a
a, b, e, f, g, h, i
a, b, c, d, e
a, cT ï ï T Ï Ï T
yes
KANSAS KENTUCKY
yes
yes (all handbooks of NBS)
MAINE
MARYLAND MASSACHUSETTS
a, b, f, g, h, j, P. q
a, b
a, c, d, e, g, h
k a, d, e, g
a, b, c, d, e, f, g, h, i, j, k
b, c, e, f, k, 1, m
a, b, c, d, e, h, j
(all handbooks of NBS) (miscellaneous handbooks of NBS)
MICHIGAN MINNESOTA
a, c, d, e, g, h yes
MISSISSIPPI
STATE
SPECIFIC LEGISLATION
GENERAL REGULATIONS FOR RADIATION DENTISTRY ADMINISTERING CODES MAND. RECOM. AGENCY
MISSOURI
yes
yes
yes
MONTANA
yes
no
no
NEBRASKA
yes
yes
NEVADA
yes
yes
yes
NEW HAMPSHIRE
yes
yes
yes
NEW JERSEY
yes
yes
yes
yes
yes
no
yes
yes
yes
yes
yes
yes
yes
NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO
yes
OKLAHOMA
yes
yes
OREGON
yes
yes
yes
PENNSYLVANIA
yes
yes
yes
PUERTO RICO
yes
yes
*t
yes
yes
no
RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA
yes
yes
Division of Health of Missouri of Department of Public Health „and Welfare State Board of Health Department of Health Depßrtment of Health Department of Health and Welfare, Division of Public Health - Radiation Control Agency Department of Health Department of Public Health New York Depart ment of Health State Board of Health State Department of Health Department of Health
yes
State Department of Health State Board of Health Department of Health Department of Health and Labor Department of Health
DENTIST ON ADVISORY BOARD
RECORD MAINTENANCE BY USERS INSPECTION
yes
yes
yes
yes
yes
yes yes
yes
yes
yes
yes
yes yes
yes
no
yes
yes
yes
yes
no
no
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes II
yes
yes
yes
no yes
. yes
TENNESSEE
yes
yes
yes
TEXAS
yes
yes
yes
UTAH
yes
yes
yes§
VERMONT
yes
VIRGINIA
yes
yes
WASHINGTON
yes
yes
yes
WEST VIRGINIA
no
no
yes
WISCONSIN
yes
yes
WYOMING
no
no
yes
State Department of Health Department of Public Health State Department of Health Department of Health State Board of Health State Health Department Department of Health State Board of Health Division of Health
no
EQUIPMENT STANDARDS
STRUCTURAL SHIELDING STANDARDS
a, b, d, e, f, g, h, k
OPERATING PROCEDURES
OTHER SPECIFIC DENTAL REGULATIONS
g
i, j
a, b, c, d, e
None
g
i b, c, d, i
REFERENCE TO NATIONAL BUREAU OF STANDARDS HANDBOOK #76 (all handbooks NBS).
i. 1 a, b, d, e, f, g, h
a, b, c
a, b, o a, b, c, d, e, f, g, h i. j, k
a, b, c, e, f. g> h, i
a, b, c, d, e
a, b, c, d, e, f, g, h, o
b, m
a, b, c, d, e, g
a, b, c, d, e, g
a, b, c, d, e, f, g, h, i, j, k
a, b
NEW HAMPSHIRE
NEW JERSEY Handbook #69
a, c, d
yes
Regulations have been proposed - awaiting action no
NEBRASKA NEVADA
yes a, b, c, d, e, g
MISSOURI
MONTANA yes
yes
i a, b, d, e, g, h
STATE
no
no
None
c, d, e, f, i, j, k d, e, f,
a, b, c
a, b, c, d, e,g
a, c, d
c, d, e, f, i, j, k, m, p, q
a, b, c, e, f, g. h, i, j, m
yes voluntary basis only not legal basis
NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA
a, g. a, g, a, g. n,
b, h, b, h b, h, o,
c, d, e, g, i a, b, c, d, e, f. g
a, b, c, d, e, g, i, j
yes (all handbooks of NBS) yes
OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA
a, g, a, g,
b, h, b, h,
c, d, e, f, i, j, k, c, d, e, f, i, n, o
yes
m
a, c, d, e, h
a, c, d, i, j TENNESSEE yes
yes
yes
no
(handbooks of NBS) ■(handbooks of NBS)
TEXAS UTAH VERMONT VIRGINIA
a, b, c, d, e, f, g. h, j, k
3,
b, c, e, f, g, h, i
a, b, c, d, e
a, c, d, i, j
NBS 76
NBS 76
no
no
a, b, c, d, e f, g, h, q
a, c
a, b, c, d, e, g, k
a, i
Handbook #76 (handbook of NBS) (handbooks of NBS)
WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
* Consists of individuals possessing education and scientific training in one or more of the following fields: radiology, pathology, medicine, other healing arts, radiation or health physics, or related sciences, with specialization in ionizing radiation, t A ll recommendations of National Committee on Radiation Protection and Measurements and the Federal Radiation Council, t Regulations in progress. § Regulations are mandatory where dentist has one or more employees — not mandatory for dentist working alone. II By Bureau of Industrial Hygiene Department of Health.
EQUIPMENT STANDARDS: (a) The tube housing shall be of diagnostic type. (b) Diaphragms or cones shall be used for collimating the useful beam and shall provide the same degree of protection as the housing. The dia meter of the useful beam at the cone tip shall not be more than three (3) inches, (sometimes 2.75” ) (c) A cone or spacer frame shall provide a target-to-skin distance of not less than seven (7) inches with apparatus operating above fifty (50) kvp or four (4) inches with apparatus operating at fifty (50) kvp or below. (d) For equipment operating up to seventy (70) kvp, the total filtration permanently in the useful beam shall be equivalent to at least 1.5 mm of aluminum. This requirement may be assumed to have been met if the half-value layer is not less than 1.5 mm,aluminum at normal operating voltages. (60 kvp - Pennsylvania) (e) For equipment operating above seventy (70) kvp, the total filtration permanently in the useful beam shall be equivalent to at least 2.5 mm.of aluminum. This requirement may be assumed to have been met if the half-value layer is not less than 2.5 mm.aluminum at the normal operating voltages. (60 kvp - Pennsylvania) (f) A device shall be provided to terminate the exposure after a preset time or exposure. (g) The exposure control switch shall be of the dead-man type. (h) Each installation shall be provided with a protective barrier for the operator or shall be so arranged that the operator can stand at least six (6) feet from the patient and well away from the useful beam. (5 feet - Pennsylvania) (i)
(j)
The Department may waive compliance with the specific requirements . . . by an existing machine or installation if: (a) Such compliance would require replacement or substantial modification of the machine or installation and (b) The registrant demonstrates to the Department’ s satisfaction achievement through other means ofradiation protection equivalent to required by these regulations.
that
No person shall make, sell, lease, transfer, lend or install X-ray or fluoroscopic equipment or the supplies used in connection with such equip ment unless such supplies and equipment, when properly placed in operation or properly used, w ill meet the requirements (of this regulation). This includes responsibility for the delivery of cones or collimators, filters, adequate timers and fluoroscopic shutters (where applicable).
(k) No registrant shall operate or permit the operation of X-ray equipment unless the equipment and installation meet the requirements (of this part). (I) A cone should be used for all routine exposures. In some cases the cone must be removed for special technics (e. g. temporomandibular-joint exposures) where a skin dose of 25 rads or more may be obtained during a single exposure (at 65 kvp for 60 milliampere-seconds with 1.5 mm. aluminum total filtration). The regular cone should be reinstalled immediately after completion of such exposures. (m) For equipment operating at and below 65 kvp, the total filtration permanently in the useful beam should be equivalent to at least 1.5 mm.of aluminum. For equipment operating above 65 kvp, the total filtration permanently in the useful beam should be equivalent to atleast 2.5 mm.of aluminum (or 2.0 mm). (n) The installation should be arranged so that the useful beam is directed away from occupied areas as much as possible. (o) The total filtration permanently in the useful beam shall be equivalent to not less than 2.0 mm.of aluminum. This requirement may be assumed to have been met if the half-value layer is not less, than 2.0 mm of aluminum when the unit is operated at normal voltage. (p) The filte r permanently in the useful beam shall be equal to at least the equivalent of 2 mm of aluminum. layer is approximately 1.4 mm,at 65 kilovolts.
With this filtration,
(q) In multiple installations, consideration shall be given to the possible exposure from all sources. (r)
2.0 mm of aluminum filtration for those X-ray machines operating up to 70 kvp.
STRUCTURAL SHIELDING STANDARDS: (a) Dental rooms containing X-ray machines shall be provided with primary barriers for all areas struck by the useful beam. (b) When dental X-ray units are installed, the rooms adjacent w ill be adequately protected.
thealuminumhalf-value
(c) Note: In most cases structural materials or ordinary walls suffice as a protective barrier without addition of special shielding material. (d) A ll wall, floor and ceiling areas that, because of restrictions in the orientation of the useful beam, cannot be struck by the useful beam shall be provided with secondary barriers. (e) Lead barriers shall be mounted in such against mechanical damage.
9 manner that
they w ill not sag or cold-flow because of their own weight. They shall be protected
(f) Joints between different kinds of protective materials shall be so designed that the overall protection of the barrier is not impaired. (g) Joints at the floor and ceiling shall be so designed that the overall protection is not impaired. (h) Windows, window frames, doors, and door frames shall have the same lead equivalent as that required of the adjacent wall. (i)
Holes in protective barriers shall be covered so that overall attenuation is not impaired.
(j)
A ll wall, ceiling, and floor areas shall be equivalent to or provided with applicable protective barriers as permanent parts of the building or equipment in accordance with the recommended criteria of the National Committee on Radiation Protection as outlined in the current National Bureau of Standards Handbook.
(k)
(The Director) may require the user to provide protective barriers to reduce stray and/or
leakage radiation.
(I)
The (State Board) may require submission of plans and specifications on the design and determining possible radiation hazards.
(m)
Permanent structural shielding and/or protective barriers shall be used as necessary toinsure that no personotherthan thepatient being X rayed receives a dose in excess of the lim it specified (in these RAD regulations).
shielding for radiationsourcesfor thepurposeof
OPERATING PROCEDURES: (a) Neither the dentist nor his assistant shall be permitted to hold patients or films during exposure, nor shall any individual be regularly used for this service. (b) During each exposure, the operator shall stand at least six (6) feet from the patient or behind a protective barrier. (c) Only the patient shall be in the useful beam. (d) Neither the tube housing nor the pointer cone shall be hand-held during exposure. (e) Fluoroscopy shall not be used in dental examinations. (f)
Each patient undergoing dental radiography shall be draped with a protective apron of not less than 0.25 mm lead-equivalent to cover the gonadal area.
(g) Personnel monitoring equipment shall be used as required by (these RAD regulations). (h) Whenever possible, fast film shall be used for diagnostic work. (i). The gonads of children and persons who have not passed the reproductive age shall beprotected from the useful beam either by the use of shielding (0.5 mm. Pb equivalent) collimation or special gonad shields when this w ill not impair the value of the examination. (j)
A protective leaded apron shall be worn.
(k) Protective leaded apron is recommended but not required.
OTHER SPECIFIC DENTAL REGULATIONS: (a) The registrant shall assure that all X-ray equipment under his jurisdiction is operated only by individuals adequately instructed in safe oper ating procedures and competent in safe use of the equipment. (b) The registrant shall make available to each individual operating X-ray equipment under his jurisdiction a copy of the current recommendations of the National Committee on Radiation Protection pertaining to X rays, such as National Bureau of Standards Handbook 76. (c) The registrant shall provide to the individuals operating X-ray equipment under his jurisdiction safety rules, including any restrictions of the operating technic required for the safe operation of the particular X-ray apparatus, and require that the operators demonstrate fam iliarity with these rules. (d) The registrant shall be responsible for assuring that all requirements (of this part) are met. (e) He (the registrant) shall insure beyond reasonable doubt that no radioactive material (including that in patients, animals, and equipment) is al lowed to leave the jurisdiction of the radiation user under circumstances that may subject other persons to radiation in amounts in excess of those indicated . . . in these regulations.
(f) (The Director) may require the user to provide protective clothing suitable to work carried on in each radiation installation. (g) There shall be a responsible person in charge of radiation protection in each radiation installation. He shall be cognizant of the radiation hazards associated with the use of radiation equipment or material and when necessary obtain the services of a qualified engineering and/or radiation expert to furnish such information as is necessary for the safe handling and use of such equipment or material. He shall be respon sible for providing the necessary instructions regarding radiation hazards and safe working practices to all employees using or handling radioactive substances or radiation producing machines. (h) (The Director) may require the user of any new or altered radiation installation to prepare plans and specifications of the proposed installation and submit them to the Department for review and approval prior to starting construction or operation. (i)
Each user shall maintain records showing the radiation exposures of all individuals for whom personnel monitoring is required in accordance with these ("R AD ” ) regulations. Such records shall be kept . . . in accordance with the instructions contained in that form or on clear and legible records containing all the information . . .
(j)
Records of individual radiation exposure which must be maintained . . . shall be preserved until five years after the effective date of this regu lation, or until a date five years after termination of the individual's employment or association with the user, whichever is later. Records which must be maintained pursuant to this regulation may be maintained in the form of microfilms.
(k) No X-ray apparatus or other radiographic sources shall be left unattended without locking the apparatus itself, or the room or building in some manner which w ill prevent its use by unauthorized persons. (I)
Any person possessing or using a source of ionizing radiation shall furnish to each employee, for whom personnel monitoring is required, a copy of such employees personal exposure record annually, at any time such employee has received excessive exposure, and upon termination of employment.
(m) If a dentist would use radioisotopes he is no longer a registrant but a licensee and must comply with all the requirements of a specific licensee as under (e).
Supplement to List of Certified Dental Materials
Council on Dental Materials and Devices
Eugenol Type, respectively, and have been added to the List. CERTIFIED DENTAL MERCURIES ADA Specification no. 6, second revision
Since publication of the most recent List o f Certi fied Dental Materials, revised to November 1, 1966, and published in the February, 1967, issue of t h e j o u r n a l (JADA 74:471) the following changes have been made in the List. Additions: The following materials conform to the American Dental Association Specification no. 6 for Dental Mercury and Specification no. 16 for Dental Impression Paste— Zinc Oxide114 ■ JADA, Vol. 76, Jan. 1968
Dental Mercury Triple Distilled
Advanced Laboratory Associates, Inc. CERTIFIED DENTAL IMPRESSION PASTE—ZINC OXIDEEUGENOLTYPE ADA Specification no. 16, Type II, Soft
Multi-Form Dual Purpose Impression Paste
Surgident, Ltd.