advicesheet

radiationindentistry A11
advicesheet
radiationindentistry

contents page
Appointments 3

General requirements 4
Notify the HSE 4
Risk assessment 4
Training 4
Radiation Protection File 4

Patient Protection 4
Referral 4
Justification 4
Medico-legal exposures 5
Lead aprons and thyroid collars 5
Female patients of child-bearing age 5
Optimisation (ALARP) 5
Excessive exposure of patients 5
Quality assurance 5

Equipment 6
Controlled area 6
Dosemeters 6
Maintenance and testing 6
Intra-oral radiography 6
Extra-oral radiography 7
Digital detectors 7
Film processing 7

Radiation Protection File 7

Local rules 7
Written procedures for patient protection 8

Quality Assurance Programme 9

Image quality 9
Patient dose and x-ray equipment 9
Darkroom, films and processing 10
Training 10
QA audits 10

Coin Test 11
bda advice sheet A11 Radiation in dentistry
3

Dental radiographs are one of the

most frequently undertaken
radiological exposures in the UK.
Although the dose delivered to
individual patients is small, the
collective dose is significant because
of the large numbers of radiographs
taken. This advice sheet summarises
your obligations under current
legislation and good working
practice. More information about
your requirements is contained in
Guidance notes for dental practitioners
on the safe use of x-ray equipment
published by the National
Radiological Protection Board and
the Department of Health in June
2001.

The Ionising Radiations Regulations

1999 (IRR99) are concerned
principally with the protection of
workers and patients, including the
equipment aspects of patient
protection. The Ionising Radiation A radiation protection supervisor ● processing films
(Medical Exposure) Regulations 2000 must be appointed by the legal
(IRMER) impose significant new person to implement the Local Rules. ● evaluation of radiographic quality
requirements for patient protection. The RPS can be an appropriately
These Regulations together with good trained dentist or PCD. ● exposing test objects as part of
working practice encourage dentists to the QA programme.
eliminate exposures that have no merit ‘Patients A referrer is a dentist who refers
and optimise all justified exposures. patients for radiographs to an Any single radiograph could involve
are IRMER practitioner. A PCD cannot a number of different operators
Clinical governance is the linchpin
of the delivery of high quality health
exposed act as a referrer. In practice, the
referrer and IRMER practitioner will
performing the various tasks.

care. Compliance with IRR99 and only to be the same person. The distinction A dentist could therefore be the
IRMER will help minimise risks from
ionising radiation for both patients
radiation is important, however, where a
patient is referred to another dentist,
referrer, the IRMER practitioner
and an operator. Many dental nurses
and health care workers. The aim is to doses that practice or hospital for a radiograph. or other PCDs will also undertake
make sure that patients are exposed
only to radiation doses that are as low
are as low An IRMER practitioner is a dentist
some of the tasks of an operator.
All operators must be adequately
as reasonably practicable and as who takes responsibility for trained to undertake their
consistent with the intended clinical
outcome.
reasonably justifying an individual medical
exposure to ensure that the benefit
individual duties.

practicable’ to the patient from the diagnostic A radiation protection adviser must

Appointments
information outweighs the detriment be appointed in writing to provide
of the exposure (see page 4). advice on complying with legal
obligations including the periodic
The Regulations introduce some An operator is any person who examination and testing of all
new terminology to describe the carries out all or part of the practical radiation equipment, the risk
various responsibilities of those aspects associated with a assessment, contingency plans, staff
involved with taking radiographs radiographic examination including: training and the quality assurance
within the practice. programme. The person or
● patient identification organisation that provides routine
The legal person is responsible for radiation surveys would normally
implementing the requirements of ● positioning the film, the patient, act as the practice RPA. If appointed
the legislation and good working the x-ray tube head on an ongoing basis, advice from
practice. In general dental practice, the RPA is always available and the
the legal person would normally be ● setting the exposure parameters continuity of advice is assured. It is
the practice owner. Practices with possible, however, to appoint the
several dentists in partnership will ● pressing the exposure button to RPA on a temporary basis to obtain
have to decide who takes on this role. initiate the exposure specific advice.

© BDA June 2003

4 Radiation in dentistry bda advice sheet A11

General setting exposure parameters - the principles of radiation

requirements
and/or positioning the film, the protection
patient and the tube head: - statutory requirements
dental nurses undertaking these - quality assurance
Notify HSE duties should possess a Certificate - selection criteria (IRMER
in Dental Radiography and practitioners only).
The Health and Safety Executive hygienists and therapists should
must be informed of the use of have received an equivalent level Radiation Protection File
ionising radiation at the practice. of training. Operators must
If you have already done this under update their knowledge at least Your Radiation Protection File
the previous legislation, there is no every five years. should hold as much information as
need to do so again. HSE should be possible about the procedures in
re-informed if there is a change in As an interim measure, dental place to ensure radiation protection
ownership of the practice or if the nurses who were competently within the practice. It will include
practice relocates. undertaking radiography prior local rules and written procedures
to 13 May 2000 and had only for patient protection to provide a
Risk assessment received the 'core of knowledge' working framework for the practice.
training, may continue to take See page 7 for more information on
A risk assessment should be carried radiographs until 12 May 2005, what should be included in your
out, with the help of your RPA, to by which time they should have Radiation Protection File
identify the precautions necessary to obtained the Certificate in

Patient
restrict the exposure of those Dental Radiography. The legal
involved with taking radiographs person must record all the

protection
and patients. If five or more training and relevant experience
employees are involved in taking or of dental nurses using this
processing radiographs, the risk ‘An up to interim measure.
assessment must be recorded date record Referral
(although it is good practice to ● Other operators whose duties
record the findings of the risk of training include film processing and If you decide to refer a patient to
assessment if there are fewer than
five employees).
must be quality assurance should
preferably possess the Certificate
another dentist or to a hospital for a
radiograph, you must provide
maintained’ in Dental Nursing or NVQ sufficient clinical information to
Your risk assessment should be equivalent. Failing this, they enable the person taking the
reviewed at least every five years and must have received adequate and radiograph to decide whether the
more frequently if there are changes documented training for the exposure is justified. As a minimum,
to working methods or new types of tasks that they undertake, which this information should include:
equipment are used in the practice. may be provided in-house.
Changes in legislation may also ● unique identification of the
require a risk assessment review. Dental nurses who 'press the patient
button' may only do so in the
Training presence of the operator who ● clinical information to justify
physically sets up the patient for the requested exposure
The legal person must ensure that a radiograph. They must have
every IRMER practitioner and received appropriate training, ● unique identification of the
operator has received adequate and which should be documented. referrer
appropriate training and undertakes
continuing education. An up to date ● Non-clinical staff may carry out ● if relevant, information
record of training must be some of the more straightforward on pregnancy.
maintained and be available for operator duties (patient
inspection. Female employees identification, for example) and You should establish guidelines for
involved in radiography must be be aware of the need to avoid referring patients for radiographs,
made aware of the risk to a foetus unnecessary personal exposure. which should be kept in your
should they become pregnant. Radiation Protection File.
● Appropriate training courses
● IRMER practitioners (dentists) for IRMER practitioners and Justification
should attend formal courses on operators would cover:
radiation protection as part of - the principles of radiation physics Before taking a radiograph you must
their five-yearly recertification - risks of ionising radiation assess whether an individual
cycle, providing at least five - radiation doses in dental exposure is justified - the benefit
hours of verifiable CPD. radiography should outweigh the detriment of
- factors affecting doses in dental the exposure. The radiograph would
● Operators whose duties include radiography normally provide new information.

© BDA June 2003

bda advice sheet A11 Radiation in dentistry
5

In deciding to take a radiograph, you 'nothing abnormal diagnosed'. If the type of radiograph required
should take account of: means that the pelvic area might be
- previous radiographs Lead aprons and thyroid collars irradiated (the vertex occlusal
- the reason for taking the projection, for example) and the
radiograph In dentistry, there is no justification patient is or might be pregnant, you
- diagnostic benefit to the patient for the routine use of lead aprons should consider whether the radiograph
- the radiation risk where modern equipment and can be deferred until after delivery. If
- alternative techniques that might techniques ensure there is minimal you decide to take the radiograph,
achieve the same purpose. scatter towards the trunk of the the foetal dose must be kept to a
body. Furthermore, they do not minimum and a lead apron used.
The booklet Selection Criteria for protect against radiation scattered
Dental Radiography published internally within the body. Lead Excessive exposure of patients
by the Faculty of General Dental aprons only provide some protection
Practitioners (UK) and Guidelines for for the vertex occlusal projection Where a patient has received an
the use of radiographs and and should be used only if the exposure that is 'much greater than
orthodontics published by the British patient is, or may be, pregnant. intended', the legal person should
Orthodontic Society (2001) are consult an RPA without delay. 'Much
useful references for assessing Lead aprons should be provided for greater than intended' is suggested as
whether an exposure is justified. a member of staff or other person being 20 times the intended dose.
who assists a handicapped patient
Every decision to take a radiograph or child during radiography. The Where the cause of overexposure is
should be recorded in the patient's assisting person should not be due to a malfunction or defect in
notes. It should be clear who carried pregnant. The lead apron should equipment, the local Health and
out the clinical examination and have a lead equivalence of not less Safety Executive should be notified.
who authorised the radiograph. ‘Each than 0.25mm and, when not in use, Where the cause is the result of
radiograph should be stored over a suitable clinical or operator error, the IRMER
Medico-legal exposures hanger, not folded. The lead apron Inspectorate should be notified.
must be should be visually inspected annually.
You should consider the need for subject to a The detailed investigation will aim
and usefulness of radiographs Thyroid collars should be used in to establish what happened, identify
requested for medico-legal and other clinical those few cases where the thyroid the failure, decide on remedial
third-party purposes when assessing evaluation’ may be in the primary beam. action to minimise the chance of a
whether they are justified - there is similar failure and estimate the doses
often no direct health benefit to the Female patients of involved. The legal person must keep
patient. You should obtain the child-bearing age this report for 50 years.
patient's written consent before
undertaking these radiographs. It is not usually necessary to ask a Quality assurance
patient if she is pregnant before you
Optimisation (ALARP) take a dental radiograph because the Quality assurance programmes must
pelvic area is not usually irradiated be in place to ensure consistently
For every radiograph, the dose from and the dose involved is very small. accurate diagnostic information and
the exposure should be kept as low as You should explain that the risks to keeping radiation doses to the patients
reasonably practicable (ALARP) for the foetus are negligible and give as low as reasonably practicable.
the intended diagnostic purpose. the patient the option of delaying Page 9 gives more information on
Written guideline exposure settings the radiograph. developing your own QA programme.
must be in place for every type of
radiograph that can be taken at the
practice. These should be kept close
to the x-ray equipment; a copy can
also be kept in the Radiation
Protection File.

Each radiograph must be subject to a

clinical evaluation, which is recorded
in the patient's notes. The clinical
evaluation must provide enough
information to be audited at a later
date and might include the charting
of caries and findings relevant to the
patient's management or prognosis.
In the case of a pre-extraction
radiograph, it may be sufficient to
record either 'root form simple' or

© BDA June 2003

6 Radiation in dentistry bda advice sheet A11

Equipment
Controlled area

You should define a controlled area

around the dental x-ray equipment
and, with the exception of the
patient, prevent anyone entering
this area when radiographs are
being taken. Your RPA will help you
to define your controlled area,
which will normally be within 1.5m
of the x-ray tube and the patient
and within the primary x-ray beam
until it has been sufficiently
attenuated by distance or shielding.
The controlled area should not
normally extend beyond the x-ray
room or surgery.

Dentists and their staff should

stand well outside this controlled Critical examination by the Intra-oral radiography
area - preferably 2 m or more from installer and a report produced. The
the x-ray tube and the patient and critical examination report will The nominal tube potential for
well out of the direction of the include intra-oral x-ray sets should not be
primary beam. Alternatively, a - a description of the equipment lower than 50 kV. New equipment
protected area can be provided for and where it is installed should operate within the range 60
the operators. - an evaluation of the equipment to 70 kV. Intra-oral sets operating at
location, the equipment's less than 50 kV should be withdrawn
The operator should be able to see warning signals and the from use, as soon as practicable.
the x-ray tube warning light and the exposure control
patient throughout the radiograph - confirmation that sufficient The fastest available films consistent
and also be able to prevent anyone radiation protection and safety with satisfactory diagnostic results
entering the room whilst an features are in place and should be used; ISO speed group E
radiograph is being taken. operating correctly. or faster is preferred. Instant process
films should only be used in specific
Dosemeters Acceptance test to provide baseline essential situations.
values for subsequent routine tests.
As staff will not routinely enter the It uses the results of the critical Rectangular collimation is
controlled area, personal dosemeters examination report and includes recommended for new equipment
are not normally required. It is, measurements to determine whether and should be retro-fitted to existing
however, good practice to provide the equipment is operating within equipment. It should be combined
dosemeters if the weekly workload of agreed performance parameters and with beam-aiming devices and film
an individual exceeds 100 intra-oral assessment of the typical patient holders. The beam size at the end of
or 50 panoramic films, or a pro-rata dose. This test can be combined with the collimator should not exceed 40
combination of each type. The the critical examination. by 50 mm (so does not overlap the
dosemeter wear period may be up dimensions of the standard ISO film
to three months and the results Routine tests to confirm that there size 2 by more than 5 mm at any edge).
should be recorded and discussed have been no significant changes to Ideally, it should be 35 by 45 mm.
periodically with your RPA. The the equipment or its location,
results of any personal monitoring compare the results of technical tests Beam collimators/directors should
should be kept for at least two years. with previous results. These tests be open ended and provide a
should be carried out at least every minimum focus-to-skin distance of
Maintenance and testing three years. Annual testing is 200 mm for equipment operating at
required only in certain 60 kV or greater and 100 mm for
Suppliers and installers of dental circumstances, for example, if equipment operating at below 60 kV.
x-ray equipment are required to previous test procedures have shown
provide adequate information a fault. Film holders should be used for
about its proper use, testing and accurate alignment with the intra-
maintenance. Dental x-ray Representative patient doses tests oral film to reduce patient dose and
equipment must be subject to the should be carried out as part of each improve diagnostic quality. The
following tests: routine test. patient should only hold a dental

© BDA June 2003

bda advice sheet A11 Radiation in dentistry
7

film when it cannot otherwise be kept The sensitivity of the detector stray light.
in position. If a film is to be held by system should be compatible with

Radiation
anyone else, forceps or an alternative the x-ray set for which it is to be
appropriate holder should be used to used. Ideally the x-ray set should

Protection File
avoid irradiation of the fingers. have an effectively constant
operating potential with the ability
Extra-oral radiography to select sufficiently low exposure
settings to enable the full extent of Your Radiation Protection File
For panoramic and cephalometric available dose savings to be realised. should contain
radiography with manual control, Exposure settings should be reduced - Local Rules, which contain the
a range of tube potential settings to the minimum compatible with working instructions,
should be available, preferably from the diagnostic quality of the image. contingency arrangements and
60 to 90 kV. There should be ‘Dedicated dose investigation level
provision for the selection of a range Warning signals - written procedures for patient
of tube currents so that full advantage viewing protection.
can be taken of the sensitivity of facilities The control panel of the equipment
modern film/screen combinations. should have a light to indicate that Your Radiation Protection File
should be the main power is switched on. A might also contain information
For extra-oral radiography, the
fastest available film and intensifying
available’ warning light should be fitted to give
a clear indication that an exposure is
on the training and information
that each member of the practice
screen combination consistent with taking place and remain illuminated has received and any update
satisfactory diagnostic results should for the duration of the exposure. courses attended. You might
be used; the system speed should be Audible warnings should work in the decide, however, to keep this
at least 400. same way as the visual warning light. information with the individual
personal development folders, in
Panoramic equipment should have Film processing which case you should reference
patient positioning aids and this where relevant.
incorporate the use of light beams Film processing should consistently
to be effective. produce good quality radiographs Your Radiation Protection File
and avoid the need for radiographs should be reviewed regularly to
Field limitation can significantly to be repeated. Where automated ensure that it remains relevant and
reduce patient exposure when processing is used, the processor effective. Keep a log to show how
specific diagnostic information is should be properly cleaned and and when you reviewed or modified
required. New equipment should maintained. With manual it and make sure that everyone
have an automatic selection of beam processing, the temperature of the in the practice is aware of the File
limitation, although manual selection developer should be checked prior and any amendments that are
is acceptable. All primary beam to film processing and the relevant to them.
defining slits should be accurately development time adjusted.
aligned with the receiving slit. Local Rules
Dedicated viewing facilities should
If, with panoramic radiography, the be available so that the full diagnostic The Local Rules must contain at
rotational movement fails to start or information can be obtained from least the following information:
stops before the full arc is covered, the radiographic films. Suitable film
the exposure switch should be masking should be used to optimise ● name of the appointed
released immediately to avoid high, the viewing conditions by cutting out Radiation Protection Adviser
localised exposure of the patient.

A cephalostat should be used in

cephalometric radiography to ensure
precise alignment of x-ray beam, film
cassette and patient. A light beam
diaphragm should be provided so
that the beam can be accurately
collimated to include only the
diagnostically relevant area.

Digital detectors

The digital equipment selected should

offer the sensor sizes that are required
clinically and be available in a range
that compares with dental film.

© BDA June 2003

8 Radiation in dentistry bda advice sheet A11

● the identification and

description of each controlled
area and a summary of the
arrangements for restricting
access

● an appropriate summary of
the working instructions - for
example, the need to stand
outside the controlled area or
behind protective panels

● identification or summary of
any contingency arrangements
- for example, failure of the x-
ray control to stop after a preset
exposure

● the dose investigation level

to decide whether personal
monitoring is needed.

It is recommended that you also

include the following information:

● the legal person (usually the

practice owner or employing
dentist)

● contact details of the RPA Written procedures for

patient protection
● ensuring the probability and
● arrangements for personal magnitude of accidental or
dosimetry (if required) The legal person is required to have unintended doses to patients
written procedures to describe the are reduced so far as reasonably
● arrangements for pregnant staff protocols for patient protection that practicable
are in place. These include:
● reminder to employees of the ● provision for the carrying out of
need to report any problems
with the x-ray equipment or if
‘Ensure ● correct identification of the
patient prior to radiography
clinical audits as appropriate

there has been a case of Local Rules The legal person is also required
overexposure
remain up ● identification of individuals
entitled to act as referrer or
to establish:

● a brief mention that the to date’ IRMER practitioner or operator ● guidelines for referral criteria for
following can be found radiographic examinations
elsewhere in the Radiation ● medico-legal exposures
Protection File: ● written protocols (guideline
- arrangements for the ● making enquiries of female exposure settings) for every type
maintenance and testing patients of child bearing of standard projection for each
of equipment age whether they are or may item of equipment
- the significant findings of the be pregnant
risk assessment ● quality assurance programmes
- staff instruction and training ● ensuring that quality assurance
- review programme to ensure programmes are followed ● diagnostic reference levels
Local Rules remain up to date
- arrangements for investigating ● the assessment of patient dose ● the method for authorising each
and reporting incidents. exposure, to ensure that there is
● the use of diagnostic reference a record that justification has
Model Local Rules can be found in levels taken place.
the BDA's Practice Compendium.
● the carrying out and recording Example protocols for patient
of a clinical evaluation of protection can be found in the
outcome of each exposure BDA's Practice Compendium.

© BDA June 2003

bda advice sheet A11 Radiation in dentistry
9

Rating Quality Basis

Quality
1 Excellent No errors of patient preparation,
assurance in exposure, positioning, processing
or film handling
dental radiology
2 Diagnostically acceptable Some errors of patient preparation,
Quality assurance (QA) is concerned exposure, positioning, processing
with achieving consistently adequate ‘Ensure or film handling but which do not
diagnostic information whilst
controlling radiation doses to the
good detract from the diagnostic utility
of the radiograph
patient to as low as reasonably diagnostic
3 Unacceptable Errors of patient preparation,
practicable. Your QA programme
should be comprehensive but
quality exposure, positioning, processing
inexpensive to operate and maintain. radiographs’ or film handling, which render the
Records will need to be maintained radiograph diagnostically
and checked - an essential feature unacceptable.
of QA.

Someone within the practice should

oversee the implementation of a You should then aim for the following performance targets within three years
QA programme, which for dental of the start of your QA programme. The interim targets are a minimum for
radiology should include image the shorter term.
quality, patient dose and x-ray
equipment, film processing, training
and audits. Rating Percentage of radiographs taken
Target Interim target
Image quality
1 Not less than 70% Not less than 50%
Image quality should be monitored
on a regular basis to ensure good 2 Not greater than 20% Not greater than 40%
diagnostic quality radiographs. A
simple subjective image quality 3 Not greater than 10% Not greater than 10%
rating can be used:

You need to rate the image quality recorded. Your record should include
of the radiographs and compare this the date of the radiograph, why it is
against these targets. It is for you to unacceptable, the cause and the
decide how many radiographs to number of repeat radiographs taken.
assign quality ratings to but the larger This type of assessment can help to
the sample, the more accurately it will identify a range of problems
reflect the image quality of your including the need for equipment
radiographs. You might assign a maintenance, improvements in
rating to the radiograph as it is techniques or improved staff training.
viewed, recording the rating and then
analysing the results. Selecting a Patient dose and x-ray
representative sample from clinical equipment
records at regular intervals to assign
quality ratings would fail to take Patient radiation doses must be
account of rejected (unacceptable) kept as low as reasonably practicable
films and consequently gives and so should be monitored on
inaccurate results. a regular basis. Patient doses can
only be kept to a minimum if the
You should keep a record of each x-ray equipment complies with
analysis of the results together with a recommended standards for
record of any action arising from the equipment performance and
analysis. Corrective action should be diagnostic reference levels (DRL).
taken where the performance targets You should seek advice from your
are not being achieved. RPA for the level of the adopted
DRL. If the representative doses to
Unacceptable ratings should be patients are consistently above the
further assessed and the reason DRL a thorough review must be

© BDA June 2003

10 Radiation in dentistry bda advice sheet A11

undertaken to either improve, or to

justify keeping, the current
techniques.

An equipment log should be

maintained to record the results of
these checks in chronological order.
This log should include details of
routine or special maintenance
of the x-ray equipment.

Day to day checks of the warning

lights and audible alarms, correct
operation of safety devices and
correct position of the counterbalance
for maintaining the position of the
x-ray tube should be undertaken
and periodically (every six months
is suggested) the results of these
checks should be recorded in the
equipment log.

You should also maintain an up-to-

date inventory of each item of x-ray
equipment, which should include:
● changing frequency for individual training logs, for example.
● name of manufacturer processing solutions
QA audits
● model number ● cleaning instructions for
automatic processors. The responsible person should
● serial number or other unique review all the records that are made
identifier As part of your QA programme you as part of the QA programme at
should keep records to demonstrate intervals not exceeding 12 months.
● year of manufacture control of your film stock, changes
of processing solutions and cleaning Clinical audits and/or peer reviews
● year of installation. ‘Monitor of automatic processors. of radiography may include:

Darkroom, films and processing

the After every change of solutions and ● the QA programme and
processing before processing patients' films, you associated records
Darkrooms should remain light
tight and safelights should not
of films’ should monitor the processing of
films by, for example, radiographing ● the justification and
produce film fogging. Checks, for a test object and comparing the authorisation of radiographs
example a ‘coin test’ (see page 11), image with a reference film to detect
should be carried out at least once a variations in processing quality ● the clinical evaluation of
year and the results recorded in a before they affect patient films. radiographs.
log. Desktop processing units
should also be checked for light- Training
tightness and the results recorded.
Those involved with the actual
Inadequate film processing will taking of radiographs (IRMER
compromise the diagnostic practitioners and operators) must
information. The QA standards will have received appropriate training.
be provided by the suppliers of the The QA programme should include
films, processing solutions and a register of all staff involved with
processing equipment and will any aspect of radiology and include
include: the name, responsibility training
received (and date) and training
● film speed, expiry date and review date.
recommended storage
conditions The training register should also
include details of training provided
● processing conditions (times for all staff or make reference to an
and temperatures) alternative source for this information -

© BDA June 2003

bda advice sheet A11 Radiation in dentistry
11

Coin Test
This test is designed to show any problems with fogging of films, which makes films become progressively darker with reduced
detail and poor contrast. It is most likely to occur to films that are sensitive to light, such as cassette films.

Fogging can result from light contamination in a darkroom, daylight in the loading bay of an automatic processor or poor safelights.

Technique
You will need at least six coins and a piece of opaque card, large enough to cover the film completely.

Using the most sensitive type of film used in the practice (for example, a cassette containing a blank film), flash expose it by placing it
several feet from the intra-oral tube and exposing it to a lower incisor exposure setting; exposed film is more sensitive to light than
unexposed film.

For darkrooms:
· turn off all the safelights, remove the pre-exposed film from the cassette and place it on the work surface. Arrange the coins at
intervals across the film and then cover the film with opaque card

· turn the safelights on and move the card to reveal the first coin. Keep the first coin uncovered for 30 seconds and then reveal the
second coin. After a further 30 seconds reveal the third coin and so on until all the coins have been revealed (at 30-second
intervals). When the last coin has been revealed for 30 seconds cover the whole film with the opaque card

· turn off the safelights and process the film in complete darkness.

For automatic processors:

· set up the test in the daylight loading bay of an automatic processor by placing a cassette film or a number of periapical films, pre-
exposed as before, together with a number of coins into the loading area. Cover the whole processor with a dark blanket to
eliminate all light. Unwrap the film/films and lay them along the floor of the loading bay and place the coins at intervals across them.
Cover with opaque card.

· remove the blanket and open the black-out window to reveal the red viewing window (if present). Move the opaque card to
reveal the first coin for 30 seconds, then the second coin for 30 seconds etc. Continue until all the coins have been revealed and
then return the card to cover the whole film / films.

· Cover the processor with the dark blanket and process the film / films in complete darkness.

Interpreting the results:

You can calculate your working time from the coin outlines present on the test film(s). If, for example, there are no coin outlines in
the sections where they were revealed for two minutes or more, no fogging has occurred, so you know you have at least a two-
minute working time available.

If there are outlines of coins revealed for only 30 seconds or one minute, your available working time will be insufficient to prevent
fogging occurring. Safelights should be checked and/or light leakage identified.
 British Dental Association
● 64 Wimpole Street ● London W1G 8YS ● Tel: 020 7563 4563 ● Fax: 020 7487 5232
● E-mail: enquiries@bda-dentistry.org.uk ● © BDA June 2003