Purpose and Technique
50%of exam
Radiation Characteristics
25%of exam
Infection Prevention
25%of exam
Quick Facts
- Exam
- DANB RHS
- Questions
- 75 MCQ
- Time
- 60 min
- Pass
- Scaled 400
- Fee
- $270 / $265
- Format
- CAT
- Scope
- Digital only
- Blueprint
- Mar 12 2025
Object Localization
SLOB = Same Lingual Opposite Buccal
Same = lingualOpposite = buccalTube-shift rule
PA vs Bitewing
Periapical
- Full tooth + apex
- Root pathology
- Single-tooth focus
Bitewing
- Crowns in occlusion
- Interproximal caries
- Crestal bone
Apex vs contacts
Image Picker
- Apex / root pathology→Periapical(PA)
- Interproximal caries→Bitewing(BW)
- Full dentition baseline→FMS(PA + BW)
- Broad arch / sialolith→Occlusal
- Third molars survey→Panoramic(Extraoral)
- Ortho growth planning→Cephalometric
- Implant / 3D anatomy→CBCT
- Paralleling possible→Paralleling(Preferred)
Image Types
- Periapical
- Crown to apexPA
- Bitewing
- Crowns + crestBW
- FMS / FMX
- Full mouth set
- Occlusal
- Broad arch view
- Panoramic
- Both jaws survey
- Cephalometric
- Ortho skull view
- CBCT
- 3D multiplanar
Domain Weights
Technique 50 | Protection 25 | IC 25
Half is techniqueSafety quarterInfection quarter
Paralleling vs Bisecting
Paralleling
- Receptor parallel
- Less distortion
- Preferred when possible
Bisecting
- Ray to bisector
- More vertical error
- Shallow palate option
Preferred vs workaround
Error Fix Picker
- Overlapped contacts→Fix horizontal(Through contacts)
- Teeth too long→Increase vertical(Elongation)
- Teeth too short→Decrease vertical(Foreshortening)
- Clear unexposed edge→Center PID(Cone cut)
- Blurred anatomy→Stabilize patient(Motion)
- Too light / noisy→Increase exposure
- Too dark / washed→Decrease exposure
- Shallow palate / tori→Modify / bisect
Technique Basics
- Paralleling
- Receptor parallel tooth
- Bisecting
- Ray to bisector
- PID
- Aims useful beam
- XCP holder
- Beam alignment device
- SLOB
- Same lingual opposite buccal
- Frankfort plane
- Panoramic head plane
- Central ray
- Beam centerline
- OFD
- Object-receptor distance
Vertical Errors
Long = add angle | Short = reduce
Elongation: increaseForeshorten: decrease
Elongation vs Foreshortening
Elongation
- Teeth look longer
- Insufficient vertical
- Increase angulation
Foreshortening
- Teeth look shorter
- Excessive vertical
- Decrease angulation
Too little vs too much
Image Errors
- Overlap
- Bad horizontal angle
- Elongation
- Too little vertical
- Foreshortening
- Too much vertical
- Cone cut
- Beam missed receptor
- Motion blur
- Patient/tube moved
- Underexposed
- Light / noisy
- Overexposed
- Dark / washed
- Artifact
- Jewelry / piercings
CCD/CMOS vs PSP
CCD / CMOS
- Immediate display
- Wired/wireless sensor
- Barrier only
PSP
- Latent then scan
- Reusable plate
- Scratch-sensitive
Instant vs scanned
Digital Receptors
- CCD
- Solid-state sensor
- CMOS
- Solid-state sensor
- PSP
- Scanned storage plate
- Radiopaque
- Appears light/white
- Radiolucent
- Appears dark
- Density
- Overall blackness
- Contrast
- Gray-scale range
- Sharpness
- Edge detail
Operator Controls
ALARA = Time Distance Shielding
Less timeMore distanceUse barrier
kVp vs mAs
kVp
- Beam quality
- Penetration
- Affects contrast
mAs
- Beam quantity
- Density/exposure
- mA × time
Quality vs quantity
Protection Picker
- Need less patient dose→Collimate + filter
- No barrier available→6 ft + 90-135°
- Track occupational dose→Wear dosimeter
- Avoid retake dose→Correct first exposure
- Patient thyroid concern→Thyroid collar
- Suspected unit leak→Stop + report
Exposure Factors
- kVp
- Beam quality/energy
- mA
- Beam quantity
- Time
- Exposure duration
- mAs
- mA × time
- Filtration
- Removes soft x-rays
- Collimation
- Restricts beam size
- Primary
- Useful tube beam
- Scatter
- Secondary from matter
Somatic vs Genetic
Somatic
- Irradiated person
- Tissue injury risk
- Cancer risk
Genetic
- Reproductive cells
- Future offspring
- Heritable damage
Self vs offspring
Radiation Biology
- Radiosensitive
- Rapid dividing cells
- Radioresistant
- Muscle / nerve
- Latent period
- Delay before effects
- Somatic
- Effects in person
- Genetic
- Heritable cell damage
- Gray (Gy)
- Absorbed dose
- Sievert (Sv)
- Equivalent/effective
- Inverse square
- Intensity ∝ 1/d²
ALARA Protection
- ALARA
- Lowest reasonable dose
- Time
- Minimize near source
- Distance
- Stand ≥6 feet
- Shielding
- Barrier / apron
- Thyroid collar
- Neck scatter shield
- MPD
- 50 mSv/year occupational
- Dosimeter
- Badge / TLD monitor
- Rectangular PID
- Less patient dose
Critical vs Noncritical
Critical / Semi
- Tissue / mucosa
- Sterilize holders
- Heat when possible
Noncritical
- Intact skin / surfaces
- Disinfect
- Barriers first
Sterilize vs disinfect
IC Workflow Picker
- Before patient seated→Barriers on surfaces
- Reusable holder→Heat sterilize(Semi-critical)
- CCD / CMOS sensor→Barrier + disinfect
- After exposure gloves→Remove before keyboard
- Between patients→Disinfect contacts
- PSP after scan→Erase + rebarrier
Standard Precautions
- Hand hygiene
- Before/after contact
- PPE
- Gloves mask eyewear
- Barriers
- Cover contact surfaces
- Cross-contamination
- Dirty to clean spread
- IFU
- Manufacturer instructions
- Clinical contact
- Touched during care
Spaulding Items
- Critical
- Sterilize; penetrates tissue
- Semi-critical
- Heat sterilize holders
- Noncritical
- Disinfect surfaces
- Sensor barrier
- Disposable sleeve
- PSP barrier
- Plate sleeve + erase
- Keyboard barrier
- Cover input devices
Common Traps
Film vs digital
RHS is digital-only ≠ No film/darkroom items
Horizontal vs vertical
Overlap = horizontal ≠ Length = vertical
kVp vs mAs role
kVp = quality ≠ mAs = quantity
Gy vs Sv
Gy = absorbed ≠ Sv = biologic effect
Hold receptor myth
Never hold receptor ≠ Never hold tubehead
Gloves then keyboard
Remove dirty gloves ≠ Then touch computer
Pan vs bitewing caries
BW for contacts ≠ Pan is survey only
Last Minute
- 1.Weights: 50 / 25 / 25
- 2.Digital only since Jul 2022
- 3.75 Q / 60 min / 400
- 4.PA = apex; BW = contacts
- 5.Overlap = horizontal fix
- 6.Long = ↑ vertical; short = ↓
- 7.ALARA: time distance shield
- 8.Stand ≥6 ft at 90-135°
- 9.CCD/CMOS barrier; PSP scan
- 10.Semi-critical holders: sterilize
- 11.Gloves off before keyboard
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