Non-conventional dental X-ray operations
The correct utilisation of cone beam computed tomography (CBCT) equipment requires special expertise. Special attention must be paid to the patient’s radiation protection when using CBCT equipment.
The use of cone beam computed tomography (CBCT) equipment is always subject to a safety licence. The licence application is submitted to the Radiation and Nuclear Safety Authority in writing before the start of operations. For more information about licence procedures, read the Safety Licence page and Guide ST 3.1.
The use of portable intraoral X-ray equipment is always subject to a safety licence. The report enclosed with the licence application must specify why portable intraoral X-ray equipment is especially suitable for the use of radiation for which the licence is being applied. The number of examinations conducted with the device must also be reported along with a description of the radiation shielding of the X-ray machine operators.
If the intraoral X-ray equipment or panoramic tomography X-ray unit is intended for non-conventional use at dental practices, a safety licence is required for the use of the equipment. Other purposes of use may include the non-dental imaging of suspected fractures in the head region, screening imaging or scientific research conducted on patients.
The following documentation must be enclosed with the safety licence application:
- technical specifications of the X-ray equipment
- floor plan of the place of use of the X-ray equipment; preferably detail drawings in paper size A4 (or A3)
- certificate of the qualifications of the person proposed for radiation safety officer
- extract from the trade register, if the licence application is submitted by a company, co-operative or other community.
An application must be submitted to change the safety licence if the X-ray equipment, its place of use, owner or radiation safety officer changes. Reports regarding the change must be enclosed with the application.
The radiation safety of the practices is the responsibility of the radiation safety officer, who must have qualifications approved by the Radiation and Nuclear Safety Authority. The qualification requirements are presented in Guide ST 1.4.
Who can serve as the physician responsible for a cone beam computed tomography (CBCT) procedure?
The correct utilisation of cone beam computed tomography (CBCT) equipment requires special expertise. Procedures done using CBCT equipment cause significantly more radiation exposure to the patient than conventional dental X-ray examinations.
Specialists in radiology and dental radiology have the special expertise required for using CBCT equipment and interpreting CBCT images. They may serve as physicians responsible for CBCT procedures because CBCT examinations are an essential part of the specialisation training.
Other specialist physicians and dental specialists also have the opportunity to attain the necessary qualifications for functioning as physicians responsible for CBCT procedures or performing CBCT imaging within their special field. The qualifications can be attained by completing special supplementary training on CBCT examinations.
The universities that are responsible for the basic training of dentists organise examinations for dentists regarding CBCT imaging and determine the studied material (the scope of which is 5 ECTS credits). Completing the examination entitles a dentist to serve as a physician responsible for an activity and perform CBCT imaging in accordance with Guide ST 3.1, item 3.2.
However, the supplementary training does not include instruction on interpreting the images. If the physician in charge of a procedure is a dentist or physician who has completed the CBCT supplementary training, that person must have the opportunity to obtain image interpretation services from an external specialist in radiology or dental radiology in cases that require special expertise.
During the safety licence process, STUK requires a report certifying that those physicians in charge of procedures who are not specialists in radiology or dental radiology have completed the supplementary CBCT training and that the imaging chain includes a specialist in radiology or dental radiology. On the other hand, clinical audits should also determine that radiology specialists are used in situations that require special expertise.
CBCT imaging may also be performed by a specially trained nurse
A person trained as radiology nurse may perform CBCT imaging independently in accordance with a referral from a physician. A dental hygienist or dental nurse may perform CBCT imaging if he/she has completed the supplementary training on CBCT imaging referred to in Guide ST 3.1, item 3.2.
The supplementary CBCT training for nurses is organised by universities of applied sciences, particularly Helsinki Metropolia University of Applied Sciences in the first phase. The scope of the training is 10 ECTS credits and it includes the training, written examination and a demonstration of skills in the CBCT imaging of a patient. The examination and demonstration of skill included in the training must be completed at a university of applied sciences that organises radiology nurse training.