#9 – X-rays

Digital X-rays Using Dexis

To scan a pano on the ScanX using Dexis:
1. Open tooth chart for your patient
2. Click on Image tab & double click on person icon – this opens Dexis program
3. Click radiation symbol – brings up new window that says Pan low and shows your patient name.
4. Click the play button (looks like a triangle) – this turns the patient name green & turns the ScanX buttons green so its ready to scan
5. Place the pano into the Scan X machine.
6. It saves automatically
7. Click close and you will see the pano

To scan a BWX or PA on the ScanX using Dexis:
1. Open tooth chart for your patient
2. Click on Image tab & double click on tooth icon – this opens Dexis program
3. Click radiation symbol – this brings up ScanX images – when green, go ahead & put xrays into the ScanX
4. Place the x-rays in the right part of the mouth & select a tooth number for each – then click “Auto number teeth”
5. These save automatically

Section 1 – Digital X-ray with Phosphor Plates (ScanX by Air Techniques)

To scan an x-ray:

Place x-ray on paper towel
Wear gloves when taking x-rays to the x-ray room
Remove protective covers and take off gloves
Highlight patient in the Dentrix appt book
Click & Open the Bridge Gallery Icon program
Click the air techniques scanx icon. – make sure your patient’s name is correct
For BWX or CMX – Choose intra-oral & choose layout (CMS, BWX, or Single Image)
For Pano – Choose Pano
Click Start
Now – load the x-rays into the Scanner
Once all the x-rays show on screen, click Stop
Click Yellow Arrow to exit program
Click on each x-ray & adjust/rotate image with arrows. Click yellow arrow to exit after adjusting. This will save your images.
Click Auto Arrange icon – this will straighten up your layout (be sure no icons are highlighted)
Enter your patient’s name and close the window
Now you can go to your operatory & pull up the images there!
-Pick up Film by the edges and place blue side up into the eraser

-Put eraser lid down – wait till light turns off, about 20 seconds

-Remove film by the edges & place in packages with “Air Techniques” visible

-Peel off white strip and close – Be Careful! The films scratch easily & are very expensive. Each individual BWX plate costs $25 and the Pano plate costs $800.

Immediately after Processing erase old images from plates in eraser.

Adding a single x-ray to a CMX

Check mark CMS
Click layout, scroll to template.
Click file, Add images
Select the images you want to add.
Take old image out, and drop new image into it’s place.
Rotate image.
Click the “Save” icon before exiting or it WILL NOT save.
To find lost x-rays

Occasionally, you will lose an x-ray that you have scanned. This can happen when the image is still being scanned & you close the ScanX program. It can also happen if the green lights on the scanner are not ready and you close the ScanX program.

To find these x-rays, you need to run a utility in Scan X & put them into the patient named Lost N Found.

Close out all programs.
Double click & open the patient gallery.
Select maintenance.
Click Recover Images. (This takes several minutes, Best to do last thing at the end of the day.)
Importing electronic x-rays

When receiving x-rays electronically, save the images to the desktop or file where you will remember FIRST.
Open patient’s file in Bridge Gallery.
Click Image, drop down to import images.
Select file & click open.
Confirm picture & select OK.
To print a PA from a CMS:

Open patient’s bridge gallery.
Check Mark the CMS.
Select icon “x-ray”. (looks like a PurpleMountain)
Select x-ray you would like to print.
Close remaining CMS.
File, Print.
Quality checklist

x-ray unit maintenance regularly
processors maintenance regularly
film stored corrected
fastest film used
well skilled operator
Adding and subtracting X-rays from CMS

Adding –

Check Mark CMS
Select layout, Scroll down to template.
File Add images.
Select images you wish to add.
Drag out old images, add new images in.
File. SAVE.
Check mark CMS.
Subtracting

Select layout, scroll down to template.
File, remove images.
Select images you wish to remove.
File. SAVE.
To Prevent Losing X-rays when Processing

– After all x-rays are put through, and motor sound stops, let computer rest for 5 to 10 secs. Before starting to arrange images.

– If anything seems unusual during the developing process (Example: Errors popping up, processing stopping too soon) Save images and hit duplicate box. This will put 2 separate boxes of x-rays on screen. Leave them there. Do not delete any for now. Sometimes the computer will delete them on its own.

– Another problem is when arranging, if an x-ray is left at top of screen, x-ray will not save correctly. Never do this.

– If 2 sets of x-rays show up on the screen after processing. Never delete. Computer might do it on it’s own. One image is not real.

– If ever in question on if an x-ray is good or not, try clicking on it and seeing if it blows up or doesn’t change. (Image should increase in size. If x-ray does not get bigger, it is a false image.

To practice arranging x-rays:

Click on any patient tooth chart and click FX link
Click on File and click Select another patient
Choose a fake patient in Dentrix and click Ok
Tag (√) every x-ray, there should be 18
Click on contact sheet icon
Click on organize images freely
Arrange image by click and drag and rotating
Click green arrow one time
Click save contact sheet-click save
Click exit contact sheet

Film X-rays

A. Automatic Processor that uses chemicals

USE CLEAN GLOVES AND SPRAY X-RAY PACKETS WITH DENTAPHENE.

B. Hand Processing use only when automatic processors are down.

The black 3-bath processor is located in the processor room.

If the chemicals are dark, or the processor prompts it, replace the fixer, developer and water. Keep lid shut.

1. Technique
i. Close door
ii. Turn on red safe light
iii. Clamp x ray to hemostat
iv. Dip into developer solution for 40 seconds
v. Rinse up and down for 5 seconds in water
Dip into fixer for 30 seconds
Rinse up and down in water container for 5 seconds
Return to fixer after the doctor is done with it for 10 minutes, rinse for 10 minutes

C. Pano Cassettes
1. Take cassette into darkroom, close and LOCK door.
2. Turn off ALL lights, TOTAL DARKNESS.
3. Open pano cassette and take film out and place it in the processor, close lid and push start button.
4. In the 4th drawer down remove a new film from the box (put lid back on and close drawer) and insert film into the cassette and close the lid until it snaps.
5. Insert cassette back into the pano machine.

D. Pano x rays (Old Machine)
1. Place Pano cassette in daylight loader cover loader with lead apron.
2. Turn on dial timer set for 3.5 – 4 minutes.
3. Open cassette and feed Pano film through machine.
4. When film is in machine take empty cassette and put in bathroom to store.

E. Using the daylight loader in the specialist area

Because they have cloth or rubber sleeves, cuffs, or flaps to allow access to the x-ray processing chamber without allowing light exposure, daylight loaders present additional infection control challenges.
1. With clean, ungloved hands, open the lid of the loader and place paper towel, paper cup, and powder-free gloves inside the loader’s compartment.
2. Place container with contaminated films next to the paper cup.
3. Close the lid and place hands through the sleeves and into the compartment.
4. Put on gloves.
5. Remove one film from the container, and open packet as previously described.
6. Allow film to drop onto paper towel or processor film feed slot.
7. Dispose of film packet contents in empty paper cup.
8. Repeat until all packets have been opened.
9. After opening all packets, remove gloves and place them in the cup.
10. Feed all films into the processor, handling them only by the edges
11. Removes hands from the loader.
12. Wash and dry hands.
13. Lift the lid to the loader compartment and remove all contents.
14. Label film mount or paper envelope.

Maintenance

Clean Pano/Ceph phosphor plates once annually and record in maintenance book.

Signed by _________________ on ___________