Ionizing Radiation Protection
Policy Acknowledgement
Dental Assisting Program
The Indian Hills Community College Dental Assisting Program uses ionizing radiation as part of its educational
program. Certain precautions must be taken to protect the health of both student and patient volunteers to be
consistent with current health guidelines.
1. Patients must present a signed Dentist’s Authorization Form prescribing needed radiographs from the
patient’s dentist of record. A completed Health History Form and a Patient Volunteer Form must be
provided to IHCC by the patient.
2. Persons must NOT have had bitewing exposures within the past 12 months to qualify for a bitewing series.
One retake is allowed. There are NO retakes allowed on children.
3. Persons must NOT have had a Panelipse exposure OR Full-Mouth Survey within the past 3 years to have
either of these surveys repeated. 4 retakes are allowed for the FMS. A Panelipse cannot be retaken.
4. Women of child-bearing age must inform the dental assisting student if they are pregnant or suspect they
may be pregnant.
5. ALL PATIENTS RECEIVING RADIOGRAPHIC EXPOSURE MUST WEAR A LEAD APRON WITH THYROID
COLLAR (unless a Panoramic exposure is being done)
6. All students participating in DEA312 and DEA321 MUST wear a dosimeter. Lack of your dosimeter will
prevent you from participation in radiology lab class and clinical days.
7. All students participating in DEA312 and DEA321 will create their account in myLDR.com and print o and
sign their quarterly radiation report to be given to the Program Director.
I have read and I understand the 3 Radiation Policies of Indian Hills Community College Dental Assisting Program;
Safety, Protection, and Patient Selection. As either a patient volunteer or as a student/operator, my signature
below signifies my compliance with these policies.
Name:
Signature: Date:
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