Ionizing Radiation Protection Policy
Dental Hygiene Program
Patients selected for the Indian Hills Community College Dental Hygiene Program for radiology exposure must
meet the following criteria:
The Indian Hills Community College Dental Hygiene Program uses ionizing radiation as part of its educational
program. Certain precautions must be taken to protect the health of both student and patient volunteer to be
consistent with current health guidelines.
1. Patients must present a signed “Doctor’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 with out intervention of the clinical instructor.
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. Seven (7) retakes are allowed for the FMS. A Panelipse cannot be
retaken.
4. Women of child-bearing age must inform the dental hygiene student if they are pregnant or suspect they
may be pregnant.
5. All patients receiving radiographic exposures must wear lead a apron with thyroid collar.
6. All students participating in DHY165, 290, and 310 MUST wear a dosimeter. Lack of your dosimeter will
prevent you from participation in Radiology lab and the dental clinic.
I have read and I understand the Radiation Policy of Indian Hills Community College Dental Hygiene Program.
Either as a patient volunteer or as a student, my signature below signifies my compliance with this policy.
Name:
Signature: Date:
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