Midterm (Chs. 7, 8, 10, 11, 17, 18)

Question 1

Which of these is NOT a component of dental x-ray film?

a. Protective layer
b. Base
c. Phosphor crystals
d. Emulsion

Answer 1

c. Phosphor crystals

The components of dental x-ray film are the base, the adhesive layer, the emulsion, and the protective layer. Silver halide crystals make up part of the emulsion.

Question 2

Which of these is NOT a component of the dental x-ray film packet?

a. Black paper wrapping
b. One or two films
c. Moisture-resistant outer wrapping
d. Aluminum foil

Answer 2

d. Aluminum foil

Lead foil is placed at the back of the film packet to absorb scatter radiation.

Question 3

Each of the following statements regarding dental x-ray film speed is true EXCEPT one. Which one is the EXCEPTION?

a. E-speed film is the fastest film speed currently available.
b. Film speed is printed on the back side of each individual film packet.
c. Trademark names like “Super” or “Ultra” are not film speeds.
d. Film speeds slower than D are no longer used.

Answer 3

a. E-speed film is the fastest film speed currently available.

F-speed film is the fastest film speed currently available.

Question 4

Which of the following radiographs gets its name from the Greek word that means around and the Latin word for apex that refers to the root tip?

a. Bitewing
b. Periapical
c. Occlusal
d. Panoramic

Answer 4

b. Periapical

Peri is from the Greek word for “around” and apex is Latin referring to the root tip. The periapical radiograph images the entire tooth including the root tip.

Question 5

Which of these intraoral dental films is 2.25 inches × 3 inches?

a. Size #1
b. Size #2
c. Size #3
d. Size #4

Answer 5

d. Size #4

Size #4 films are the largest intraoral dental x-ray films. Size #4 is used to expose occlusal radiographs on adult patients.

Question 6

Each of the following statements regarding duplication of radiographs is correct EXCEPT one. Which one is the EXCEPTION?

a. The emulsion side of duplicating film contains an antihalation coating.
b. The solarized emulsion records the copy of the image.
c. The emulsion side of duplicating film is placed against the original radiograph.
d. The antihalation coating prevents back-scattered light from re-exposing the film.

Answer 6

a. The emulsion side of duplicating film contains an antihalation coating.

The nonemulsion side of duplicating film contains an antihalation coating.

Question 7

Which of the following statements regarding extraoral film is FALSE?

a. It is used outside the mouth.
b. It comes individually wrapped in protective paper.
c. It is called a “screen film.”
d. It uses intensifying screens.

Answer 7

b. It comes individually wrapped in protective paper.

Intraoral films come individually wrapped in protective paper.

Extraoral films come packaged in a box of 25, 50, or 100.

Question 8

Which of the following statements regarding film storage and protection is FALSE?

a. It is light-sensitive.
b. It has a shelf life.
c. It is affected by high heat and humidity.
d. It should be stored in the darkroom.

Answer 8

d. It should be stored in the darkroom.

Radiographic film is sensitive to a number of factors, including those found in the darkroom such as heat, humidity, and chemical fumes.

Question 9

Extraoral film is used for ALL of the following projections EXCEPT one. Which one is this EXCEPTION?

a. Lateral jaw radiographs
b. Occlusal radiographs
c. Cephalometric radiographs
d. Panoramic radiographs

Answer 9

b. Occlusal radiographs

Occlusal radiographs use intraoral film.

Question 10

Each of the following statements is true EXCEPT one. Which one is the EXCEPTION?

a. During exposure, the x-rays strike and ionize all silver halide crystals on the film.
b. The invisible image on an x-ray film is called the “latent image.”
c. The function of the gelatin in film emulsion is to keep the silver halide crystals evenly suspended over the base.
d. Silver halide in the emulsion is primarily silver bromide.

Answer 10

a. During exposure, the x-rays strike and ionize all silver halide crystals on the film.

Some, but not all, of the silver halide crystals are ionized. Metal restorations absorb x-ray energy and prevent the radiation from reaching the film. Denser tissues such as enamel and bone absorb x-ray energy and prevent much more of it from reaching the film than less dense structures such as dentin or pulp.

Question 11

Dental film has a polyester base for the purpose of:

a. increasing the contrast and image quality.
b. providing support for the emulsion.
c. producing the latent (invisible) image.
d. preventing scatter radiation from exposing the film.

Answer 11

b. providing support for the emulsion.

The purpose of the film base is to provide support for the fragile emulsion and to provide strength for handling.

Question 12

Which portion of the dental film retains the latent image?

a. The protective layer
b. The gelatin
c. The silver halide crystals
d. The adhesive

Answer 12

c. The silver halide crystals

Silver halide crystals are sensitive to radiation. It is the silver halide crystals that, when exposed to x-rays, retain the latent image.

Question 13

Which structure is most likely to absorb or stop more of the x-rays from reaching the film?

a. The enamel
b. The bone
c. The pulp
d. The soft tissue (cheek)

Answer 13

a. The enamel

The varying thicknesses of the objects in the path of the beam will allow more or less radiation to pass through and reach the film emulsion. Because it is a dense structure, enamel will absorb or stop more x-rays from reaching the film than the other structures listed.

Question 14

Which of these protects the film from white-light exposure?

a. Antihalation coating
b. Solarized emulsion
c. Lead foil
d. Black paper

Answer 14

d. Black paper

Black paper wrapping surrounds the film inside the packet to protect it from light.

Question 15

The purpose of the embossed dot on the film packet is to:

a. identify which side of the film contains the emulsion.
b. determine if the film packet contains one or two films.
c. distinguish the patient’s right from left on the developed radiographs
d. locate the edge of the packet that should be positioned toward the apices.

Answer 15

c. distinguish the patient’s right from left on the developed radiographs.

The embossed dot will be used after the film is processed to aid in identifying the image as either the patient’s right or left side.

Question 16

Which of the following indicates the correct placement of an intraoral film?

a. The back side faces the buccal surfaces of the teeth and away from the source of radiation.
b. The back side faces the lingual surfaces of the teeth and is facing the source of radiation.
c. The tube side faces the buccal surfaces of the teeth and faces the source of radiation
d. The tube side faces the lingual surfaces of the teeth and faces the source of radiation.

Answer 16

d. The tube side faces the lingual surfaces of the teeth and faces the source of radiation.

In intraoral radiography, the tube side of the film faces the source of radiation. When placing the film intraorally, the tube side will face the lingual surfaces of the teeth of interest.

Question 17

Each of the following affects film speed EXCEPT one. Which one is the EXCEPTION?

a. Emulsion thickness
b. Crystal size
c. Film packet size
d. Special dyes

Answer 17

c. Film packet size

The factors that determine film speed are the size of the silver halide crystals within the emulsion, the thickness of the emulsion, and the addition of special radiosensitive dyes by the film manufacturer.

Question 18

Graininess of a radiographic image results from:

a. large silver halide crystals.
b. the addition of radiosensitive dyes.
c. a decrease in film speed
d. film packets that contain two films.

Answer 18

a. large silver halide crystals.

The larger crystals used in high-speed (fast) film result in a certain amount of graininess that reduces the sharpness of the radiographic image. It has been determined that this slight loss of image sharpness does not interfere with diagnosis and is tolerated because of the reduction in patient radiation exposure.

Question 19

Which of the following is NOT an intraoral projection?

a. Periapical
b. Occlusal
c. Panoramic
d. Bitewing

Answer 19

c. Panoramic

The panoramic radiograph requires an extraoral technique.

Question 20

Which film size is ideal for positioning a periapical radiograph in the narrow canine region on an adult patient?

a. Size #0
b. Size #1
c. Size #2
d. Size #3

Answer 20

b. Size #1

In adults, the use of the narrow size #1 film is normally limited to exposing radiographs of the anterior teeth. Although it images only two or three teeth, this film is ideal for areas where the oral cavity is narrow.

Question 21

Film used for dental radiography is very similar to photographic film.

True

False

Answer 21

True

Dental radiographic films are photographic films that have been adapted in size, emulsion, film speed, and packaging to customize them for dental use.

Question 22

Intraoral films are designed for use outside the oral cavity.

True

False

Answer 22

False

Extraoral films are designed for use outside the oral cavity.

Question 23

Dental x-ray film is surrounded by a sheet of white paper inside the film packet.

True or False

Answer 23

False

Film is wrapped in black paper because black is light-protective of the film.

Question 24

Film packets may contain one or two films.

True

False

Answer 24

True

If a packet contains two films, a duplicate radiograph is produced without any increase in radiation exposure to the patient.

Question 25

The tab for **opening** the **film packet** is on the tube **side** of the **packet**. True False

Answer 25

**False** The **tab** for opening the film packet is on the **back side** of the packet.

Question 26

During **periapical** radiograph film packet placement, the **embossed dot** should be positioned **toward the apices** of the teeth. True False

Answer 26

**False** ## Footnote The **embossed dot should be positioned away from the area of interest**, which, on periapical radiographs, is the apices of the teeth. For these images, the embossed dot should be placed toward the occlusal portion of the tooth.

Question 27

**Bitewing** radiographs image the **entire tooth,** from **crown to root tip**. True False

Answer 27

**False** ## Footnote Bitewing films are used to examine the crowns of the maxillary and mandibular teeth on one film. Periapical radiographs are used to make a detailed examination of the entire tooth from crown to apex.

Question 28

**Pedodontic** films are usually size #**2 films.** True False

Answer 28

**False** Size **#0 or size #1 films** are most often used as **pedodontics films**. Their smaller size is well designed for use with **children.**

Question 29

The **radiation exposure** needed for **extraoral film** projections is **higher** than that needed for **intraoral** projections. True Fasle

Answer 29

**False** The light emitted by the **intensifying screens** permits a **significant reduction** in the amount of **radiation** needed to produce an **extraoral** radiograph.

Question 30

The **same film type** used for **exposing dental radiographs** can be used to **duplicate them**. True False

Answer 30

False ## Footnote Duplicating film is similar to dental x-ray film but is a **single -emulsion** film. It is exposed

Question 31

A **fast speed film requires** **more radiation** exposure to record a diagnostic image. True False

Answer 31

**False** ## Footnote A fast speed film requires less radiation exposure to record a diagnostic image.

Question 32

The **latent image** is an image that is **slow in its formation**, especially when using **slow-speed film**. True False

Answer 32

False ## Footnote **The latent image is an invisible pattern of stored energy produced when the film is exposed to x-rays.**

Question 33

The purpose of the **lead foil** in the film packet is to **absorb back-scattered** x-rays to **reduce film fog**. True False

Answer 33

**True** ## Footnote A sheet of lead foil is located in the back of the film packet, behind the film. The purpose of the lead foil backing is to **absorb scattered radiation**.

Question 34

Dental film emulsion is about 90 to 99% **silver bromide** and 1 to 10% **silver iodide**. True False

Answer 34

**True** ## Footnote Dental film emulsion is about 90 to 99 percent silver bromide and 1 to 10 percent silver iodide.

Question 35

The appearance of **clear/white or radiopaque** structures on the radiograph is a result of the **_developer step_** during **film processing.** True False

Answer 35

**False** The appearance of **clear/white or radiopaque structures** on the radiograph is a result of the **_fixer step_** during film processing.

Question 36

**Intraoral film emulsion** is composed of **gelatin** and **silver halide crystals.** True False

Answer 36

**True** ## Footnote The emulsion is composed of gelatin in which crystals of silver halide salts are suspended.

Question 37

The **white, unprinted side** of an **intraoral film** packet is the **backside**. True False

Answer 37

**False** The white, unprinted side of an intraoral film packet is the **front side**. **White to the light!\***

Question 38

A **pedodontic film (kids)** is any film used to radiograph a child’s teeth. True False

Answer 38

**False** The term “**pedodontic film**” is usually given to the **smaller sized intraoral film packets**. All sizes of intraoral films, small and large, may be used to expose radiographs on child patients. The term “pedodontic” is usually given to the **smaller size #0 and size #1 films**.

Question 39

**Duplicating film** gets **lighter the longer** the **exposure to light.** True False

Answer 39

**True** ## Footnote The **solarized emulsion** of duplicating film is **different than x-ray film** emulsion in that the image produced in response to light exposure gets darker with less light exposure and **lighter with more light exposure.**

Question 40

**Film** should be **stored** in its **original packaging** in an area **shielded from radiation.** True False

Answer 40

**True** ## Footnote Stray radiation, not intended for primary exposure, can fog film. Film should be stored in its original packaging in an area shielded from radiation. Individual film packets should also be kept in a shielded area.

Question 41

Which of these is **NOT** part of the **developer solution**? a. Reducing agent b. Clearing agent c. Activator d. Restrainer

Answer 41

b. **Clearing agent (fixing)** ## Footnote The four chemicals in the developer include: developing (**reducing**) agents, preservative, activator (**alkalizer**), and **restraine**r. A **clearing (fixing**) agent is a component of **fixer.**

Question 42

Which of the following statements regarding **developer chemistry is FALSE**? a. Sodium sulfite slows down the oxidation rate. b. Sodium carbonate provides the alkaline medium. c. Potassium bromide restrains development of unexposed silver halide crystals. d. Potassium alum _swells the gelatin._

Answer 42

d. **Potassium alum swells the gelatin.** **The activator (sodium carbonate) in developer softens and swells the gelatin**, allowing more of the exposed silver halide crystals to come into contact with the developing agents. **Potassium alum is a component of fixer that shrinks and hardens the gelatin.**

Question 43

Each of the following statements is **true** regarding the **darkroom** EXCEPT one. Which one is the **EXCEPTION**? a. It should be located near where radiographs will be exposed. b. It should be well ventilated. c. It should have adequate space to _store unexposed film_. d. It should be equipped with safe lighting.

Answer 43

c. **It should have adequate space to store unexposed film.** Although storing unused film in the darkroom may seem convenient, it is not recommended. **Unexposed film is sensitive to heat, humidity, and chemicals, all of which may be increased in the darkroom.**

Question 44

Which of these is **NOT** a component of **fixer**? a. Sodium thiosulfate b. Preservative c. Activator d. Acidifier

Answer 44

c. **Activator** ## Footnote An activator (sodium carbonate) is found in the developer. **_Fixer:_** **Acidifier** **fixing agent (sodium Thiosulfate)** **Preservative** **hardening agent**

Question 45

Each of the following statements regarding **darkroom safe lighting** is true **EXCEPT one**. Which one is the EXCEPTION? a. Walls should be painted black. b. You should allow longer wavelength **red-orange light** to pass through the safelight filter. c. Shorter wavelength **blue-green light** is removed by the safelight filter d. **Four feet** is the minimum distance between the safelight and the countertop.

Answer 45

a. **Walls should be painted black.** ## Footnote If the darkroom is sealed light-tight, there is no need for darkly painted walls.

Question 46

Which of the following statements regarding **manual film processing is FALSE?** a. A visual inspection of the image will determine the length of time the film stays in the developer. b. A film holder clip is used to transport films to and from each of the processing solutions. c. The optimum temperature for manual processing is **68 degrees** Fahrenheit. d. Cleansing powders should not be used to clean processing tank inserts.

Answer 46

a. **A visual inspection of the image will determine the length of time the film stays in the developer.** An accurate and **audible timer** should be used in **manual processing** to indicate **how long the film stays in the developer, the fixer, and the wash water**, and to alert the radiographer to remove the films from each of the solutions.

Question 47

Each of the following statements regarding **automatic film processing is correct** EXCEPT one. Which one is the **EXCEPTION**? a. It requires diligent care for optimal performance. b. Chemical solutions are **heated** to **_match_** the **temperature** used in manual processing. c. If processor rollers are not kept clean, films can emerge streaked. d. It uses a roller transport system to move the film through the processing cycle.

Answer 47

b. **Chemical solutions are heated to match the temperature used in manual processing.** The chemistry in automatic processors is **heated to temperatures *_highe_*r than those used in manual processing**—as high as 125 degrees F in some units.

Question 48

Which of the following statements regarding **automatic processors** is **FALSE**? a. Depending on the workload, cleaning must be done approximately every **6 months**. b. The roller assembly should be cleaned in warm running water with special cleansers. c. Chemistry should be replenished or changed as necessary. d. Roller transports squeeze excess solution from film surfaces.

Answer 48

a. **Depending on the workload, cleaning must be done approximately every 6 months.** Depending on the workload, automatic processors **require daily, weekly, or monthly cleaning.**

Question 49

Which of the following statements regarding **rapid processing** of dental radiographs is **FALSE**? a. It can be accomplished in 30 seconds with special, fast-acting chemicals. b. It provides **archival**, **permanent quality** radiographs. c. Four cups are set up inside the box containing developer, rinse water, fixer, and wash water. d. A light-tight countertop box contains two openings that allow light-tight access of the radiographer’s hands.

Answer 49

b. **It provides archival, permanent quality radiographs.** Rapid processing produces working films that are **seldom suitable for filing** with the patient’s permanent record. **Short developing and fixing times with minimal washing result in a substandard, nonarchival radiograph.**

Question 50

Which of the following statements regarding **automatic processing** is **correct**? a. _No water_ is required. b. Processing is accomplished under _normal white-light_ conditions. c. The chemistry in automatic processors is heated to _68 degrees F_. d. **Unwrapped film** is fed into the film feed slot on the **outside of the processor.**

Answer 50

d. Unwrapped film is fed into the film feed slot on the outside of the processor. After removal from the film packet or cassette, film is fed into the **film feed slot**. The roller transport system moves the film through the solutions and the film emerges through an opening on the outside of the processor called the “**film recovery slot.**”

Question 51

The purpose of the **developing step** is to: a. remove unexposed silver halide crystals from the film emulsion. b. neutralize the alkalinity prior to the film progressing to the fixer. c. reduce exposed silver halide crystals to black metallic silver. d. prevent the rapid buildup of image contrast.

Answer 51

c. **reduce exposed silver halide crystals to black metallic silver.** The role of the developing step is to **reduce the exposed silver halide crystals** within the film emulsion to black metallic silver.

Question 52

Which ingredient **slows down the oxidation** rate of the **developing solution**? a. Sodium sulfite (preservative) b. Sodium carbonate (activator) c. Potassium bromide (restrainer) d. Hydroquinone (developing agent)

Answer 52

a. **Sodium sulfite (preservative)** The preservative, sodium sulfite**,** protects the developing agents by slowing down the rapid **oxidation rate** of the developer.

Question 53

**Potassium alum** in the fixer serves to: a. neutralize the alkali of the developer. b. act as a preservative. c. clear remaining crystals. d. shrink and harden the emulsion.

Answer 53

d. **shrink and harden the emulsion.** ## Footnote The hardening agent, potassium alum, shrinks and hardens the gelatin emulsion.

Question 54

What wattage is ideal for safe lighting a darkroom for all film types? a. 15 b. 25 c. 40 d. 60

Answer 54

a. **15w** ## Footnote Traditional safelights consist of a 7 1/2 or 15-watt white incandescent light bulb with a safelight filter placed over it.

Question 55

The **advantage** of **manual processing** over **automatic processing** is that there is: a. less hazardous waste production. b. more time required to produce finished radiographs. c. less malfunction of processing equipment. d. less water used.

Answer 55

c. **less malfunction of processing equipment.** An advantage of manual film processing is that it is **reliable and not subject to equipment malfunction.**

Question 56

At a **minimum,** how often should **manual processing solutions be changed**? a. Every week b. Every 2 weeks c. Every 3 weeks d. Every month

Answer 56

d. **Every month** ## Footnote Many chemical manufacturers recommend that processing solutions be changed at least every 4 weeks under “normal” use.

Question 57

The **time required** for the **development** of radiographic film is **determined** by the: a. temperature of the darkroom. b. temperature of the water. c. temperature of the developer. d. temperature of the fixer.

Answer 57

c. **temperature of the developer**. ## Footnote The time required for development of radiographic film is determined by the temperature of the developer.

Question 58

The purpose of the washing step in film processing is to: a. shrink and harden the emulsion. b. remove any residual chemistry remaining on the emulsion. c. neutralize alkaline and/or acidic chemistry. d. reduce the exposed silver halide to metallic silver.

Answer 58

b. **remove any residual chemistry remaining on the emulsion.** ## Footnote After the film is completely fixed, it is washed in running water to remove any remaining traces of the chemicals.

Question 59

During **manual** time-temperature film processing, **after fixing**, the films are to be placed in the **water wash** for: a. 5 minutes. b. 10 minutes. c. 20 minutes. d. time is dependent upon water temperature.

Answer 59

c. **20 minutes.** ## Footnote When the fixing step is complete, the film hanger should be placed in the circulating water for 20 minutes.

Question 60

The **optimum** developing **temperature** for **manual time-temperature** film processing is: a. 58 degrees F. b. 68 degrees F. c. 78 degrees F. d. 88 degrees F.

Answer 60

b. **68 degrees F.** The ideal manual processing temperature is **68 degrees** F (20°C), with a development time of **5 minutes.**

Question 61

Developer contains **hydroquinone** and **elon**. True False

Answer 61

**True** ## Footnote **Hydroquinone** works slowly but steadily to build up **density** and **contrast** in the film. **Elon** works quickly to manifest the **contrast** (gray shades) of the film.

Question 62

**Replenisher** is a **superconcentrated solution** of developer or fixer. True False

Answer 62

**True** **Replenisher is added to the developer or fixer in the appropriate tank to make up for loss of volume during processing and chemical strength through oxidation**. Processing solutions weaken over time and with use, and need the addition of replenisher to maintain solution strength.

Question 63

In addition to a safelight, the **darkroom** should be **equipped with** a **white overhead light**. True False

Answer 63

**True** *An **overhead white light** is needed to provide **illumination** for* ***cleaning and maintenance.***

Question 64

The **darkroom door** should be **locked** when processing film. True False

Answer 64

**True** **Locking the darkroom door during film processing prevents others from inadvertently allowing white light into the darkroom.** In addition, an in-use warning light outside the darkroom indicates when it is not safe to enter.

Question 65

A **thermometer** is mandatory for **archival manual processing**. True False

Answer 65

**True** Floating-type thermometers can be left in the tank and easily picked up for reading.

Question 66

**Reduction** is the **union** of **developer** and **oxygen**. True False

Answer 66

**False** **Oxidation** is the **union** of **developer and oxygen** in the air. Oxidized developer has diminished effectiveness. The tank should remain covered as much as possible to minimize evaporation and oxidation.

Question 67

The **life of processing solutions** can be **extended** by **replenishment**. True False

Answer 67

**True** **Replenishment consists of the removal of a small amount of developer and fixer and replacement with replenisher made for that purpose**. This process takes into account evaporation of developer, exhaustion of developer over time with processing, and carryover of developer into the next compartment.

Question 68

**Processing chemistry** can be used **indefinitely**. True False

Answer 68

**False** **Processing chemistry** becomes i**neffective** with use and **evaporation.** Over time, there is a breakdown in the integrity of processing chemicals if they are not replenished or changed at recommended intervals.

Question 69

A **disadvantage** of **automatic processing** is the time it takes to produce a finished radiograph. True False

Answer 69

**False** Depending on the unit, films exit the processor in about **5 minutes**, ready for mounting.

Question 70

The **ideal time-temperature for manual processing archival** radiographs is **85 degrees F**. True False

Answer 70

**False** ## Footnote The ideal solution temperature for manual processing of archival dental radiographs in a processing tank is **68 degrees F**. Developer and fixer made especially for rapid processing are heated to 85 degrees F.

Question 71

The developer reducing agent that builds up **gray tones** in the image is **hydroquinone**. True False

Answer 71

**False** gray tones= Elon

Question 72

**Oxidation** is the process during which the **chemicals** of the developing and fixing solutions **combine with oxygen** and **lose their strength**. True False

Answer 72

**True** ## Footnote Weakened chemistry occurs through oxidation of the union of a substance—in this case, the developer and fixer—with the oxygen in the air.

Question 73

**Developer** solution needs **replenishment** more often than **fixer.** True False

Answer 73

**False** **Replenisher**, a superconcentrated solution of developer or fixer, must be **added daily to both solutions,** or as indicated, to compensate for loss of volume or strength from oxidation.

Question 74

The **preservative (sodium sulfite)** is found in **both** the **developer** and **fixer** solutions. True False

Answer 74

**True** The preservative sodium sulfite protects both the developer and the fixer by **slowing down the rate of oxidation.**

Question 75

The **dark portion** of the radiograph is called “**radiolucent**.” True False

Answer 75

**True** **lucent = giving off light** Tissues that are not very dense, such as the pulp chamber of the tooth, allow more radiation to reach the film emulsion, resulting in black (radiolucent) areas on the radiograph.

Question 76

A darkroom is not necessary if the **automatic processor** is equipped with a **daylight loader**. True False

Answer 76

**True** A daylight loader, a **light-shielded compartment** attached to an automatic processor, allows films to be unwrapped in a room with white light.

Question 77

It is safe to read a radiograph under **white-light conditions** after only **2 or 3 minutes** of **_developing_**. True False

Answer 77

**False** A wet reading, under white-light conditions, is safe after **2 or 3 minutes of _fixation._**

Question 78

The **fixer** is responsible for creating the film’s **radiolucent** appearance, and the **developer** is responsible for creating the film’s **radiopaque** appearance. True False

Answer 78

**False** **developer = dark (radiolucent)** **fixer = white (radiopaque)** The **developer** is responsible for creating the film’s **radiolucent** appearance, and the **fixer** is responsible for creating the film’s **radiopaque** appearance.

Question 79

**Developer** and **fixer** chemicals may be obtained in **three forms**: **powder, liquid concentrate**, or **ready-to-use solutions**. True False

Answer 79

**True** ## Footnote Developer and fixer chemicals may be obtained in three forms: powder, liquid concentrate, or ready-to-use solutions.

Question 80

The **developing agent** will only have an effect on the **_exposed_ silver halide crystals** at recommended time-temperature. True False

Answer 80

**True** The developing agent reduces the exposed silver halide crystals to metallic silver but has **no effect on the unexposed crystals** at recommended time–temperatures. This is called “**selective reduction,”** meaning that only the **nonmetallic elements, the halides, are removed,** and the **exposed silver remains.**

Question 81

For **infection** to occur, each of the following conditions must be present EXCEPT one. Which one is the **EXCEPTION**? a. An appropriate portal of entry into the host b. A pathogen c. An acceptable barrier d. A susceptible host

Answer 81

c. **An acceptable barrier** An **acceptable barrier** would **prevent infection** from occurring.

Question 82

Which of these statements is **FALSE**? a. **Microbial aerosols** are **pathogens** present in **blood** that cause disease in humans. b. Asepsis means “freedom from infection.” c. An antiseptic is an agent used on living tissue to kill or reduce numbers of bacteria. d. Contamination is soiling by contact or mixing.

Answer 82

a. **Microbial aerosols are pathogens present in blood that cause disease in humans.** Bloodborne pathogens are pathogens present in blood that cause disease in humans. **Microbial aerosols are suspensions in the air of microorganisms that may cause disease.**

Question 83

Which of the following statements regarding **infection control terminology** is correct? a. A barrier prevents the transmission of infectious microorganisms. b. Microbial aerosols are disease-causing microorganisms present in human blood. c. Sepsis is the absence of septic matter. d. Infection requires an appropriate portal of entry into the host.

Answer 83

a. **A barrier prevents the transmission of infectious microorganisms** **Barriers** are materials that **prevent the transmission of infectious microorganisms**, while **microbial aerosols** are **airborne** suspensions of disease-causing microorganisms. **Sepsis** is the **presence of septic matter.**

Question 84

Each of the following statements regarding **personal protective equipmen**t is correct EXCEPT one. Which one is the EXCEPTION? a. Protective clothing should be laundered _weekly_. b. Protection from aerosols may be achieved through the use of a mask. c. Protective eyewear protects the eye area from aerosols and spatter. d. Hands should be washed before gloving and after removing gloves.

Answer 84

a. **Protective clothing should be laundered weekly.** Protective clothing should be laundered **daily**, or more frequently if soiled or wet. **Protective clothing should be removed before leaving the treatment facility and laundered separately with bleach.**

Question 85

Each of the following types of **protective eyewear is acceptable** for use by the dental radiographer EXCEPT one. Which one is the EXCEPTION? a. Glasses with side shields b. Goggles c. Contact lenses d. Full face shields

Answer 85

c. **Contact lenses (no protection)** Protective eyewear is worn to protect against aerosols and spatter and, to be effective, must cover the sides as well as the front of the eye.

Question 86

Each of the following statements regarding the use of **daylight loader attachments** on **automatic processors i**s correct EXCEPT one. Which one is the EXCEPTION? a. The operator must remove the light-filter cover when placing and removing items. b. The advantage of these devices is that time-saving _shortcuts_ are acceptable. c. Clean, dry hands can be slid through light-tight baffles to access the unit. d. The key to infection control is to never slide anything through the baffles except clean, dry hands.

Answer 86

b. **The advantage of these devices is that time-saving shortcuts are acceptable.** Daylight loader attachments actually require an **increase in careful attention** to infection control protocol. The radiographer should be **discouraged from shortcutting procedures** that would pose a health threat for the operator and others using the unit.

Question 87

Each of the following statements regarding the use of **gloves** is correct EXCEPT one. Which one is the EXCEPTION? a. It is acceptable to _wear rings under gloves_. b. Hands must be dried thoroughly before patient treatment gloves are put on. c. Fingernails should be cut short and well-manicured. d. Hands should be washed thoroughly before gloving and after removing gloves.

Answer 87

a. **It is acceptable to wear rings under gloves.** ## Footnote Rings, wristwatches, and other jewelry can harbor microorganisms.

Question 88

Which of the following statements regarding the use of **gloves** is **FALSE**? a. Sterile gloves should be used for surgical procedures. b. Use of plastic over-gloves is acceptable to protect patient treatment gloves. c. Punctured, torn, or cut gloves should be changed immediately. d. Gloves should be washed with soap if treatment must be interrupted.

Answer 88

d. **Gloves should be washed with soap if treatment must be interrupted.** Washing treatment gloves with soap may damage gloves in a way that would allow flow of liquid through undetected holes.

Question 89

Which of the following statements regarding **sterilization** and **disinfection** is **FALSE**? a. Steilization is accomplished by autoclaving or dry heat processes. b. Spores are destroyed during _disinfection_. c. Disinfecting agents are too toxic to be used on living tissues. d. Iodophors are hospital-grade disinfectants and tuberculocidals.

Answer 89

b. **Spores are destroyed during disinfection.** Spores are destroyed during **sterilization**

Question 90

Which of these statements regarding **classification** of **objects used** in **radiographic procedures** is **FALSE**? a. _Critical objects must be sterilized after each use._ b. _Most quality-made image receptor holders are sterilizable or disposable._ c. Semicritical objects are those used to penetrate soft tissue or bone. d. _No critical instruments are used in dental radiography._

Answer 90

c. **Semicritical objects are those used to penetrate soft tissue or bone.** **Semicritical objects** such as an image receptor holder **contact but do not penetrate soft tissue or bone.**

Question 91

Prior to film placement, **preprocedural mouthrinses** are considered: a. antiseptics. b. disinfectants. c. sterilants. d. sanitizers.

Answer 91

a. **antiseptics.** **Antimicrobial mouth rinses** that reduce **the number of microorganisms** the patient might release in the form of aerosols or spatter are **considered antiseptic.**

Question 92

**Infection control procedures** must be applied to each of the following **body fluids EXCEPT one**. Which one is the EXCEPTION? a. Blood b. Mucus c. Sweat d. Saliva

Answer 92

c. **Sweat** ## Footnote Care should be taken to protect persons from pathogens spread via blood or any other body fluid, excretion, or secretion (except sweat).

Question 93

During radiographic procedures, when should hands be washed? a. Before treating the patient b. After treating the patient c. Before putting on gloves d. All of the above

Answer 93

d. **All of the above** ## Footnote Hands should be cleaned thoroughly before and after treating each patient (before gloving and after removing gloves).

Question 94

Which of the following gloves are recommended for cleaning and disinfecting radiographic operatories and equipment? a. Heavy-duty utility gloves b. Plastic overgloves c. Latex treatment gloves d. Vinyl treatment gloves

Answer 94

a. **Heavy-duty utility gloves** ## Footnote Heavy-duty utility gloves are appropriate for cleaning and disinfection.

Question 95

Iodophors, phenolics, and **chlorine-containing** compounds that **do not destroy spores** are classified as: a. high-level disinfectants. b. intermediate-level disinfectants. c. low-level disinfectants.

Answer 95

b. **intermediate-level disinfectants.** Iodophors, phenolics, and chlorine-containing compounds are **chemical germicides** labeled as both hospital-grade **disinfectants** and tuberculocidals. These intermediate-level disinfectants do not destroy spores.

Question 96

**Lead aprons** are classified as __________ objects. a. critical b. semicritical c. noncritical

Answer 96

c. **noncritical** Noncritical instruments and clinical contact surfaces are those devices and surfaces of the treatment area that may **contact intact skin** or **may become contaminated** by microbial aerosols or spatter but **do not come into contact with the mucous membranes.**

Question 97

After patient treatment, **reusable image receptor holding devices** must be: a. sanitized. b. disinfected. c. sterilized. d. washed.

Answer 97

c. **sterilized.** **Semicritical** instruments such as image receptor holders are those that **contact oral mucosa** without penetrating soft tissue or bone. **Semicritical instruments must be sterilized following use.**

Question 98

Which of the following will require adhering to i**nfection control protocol** for a **semicritical object**? a. A lead apron and thyroid collar b. A control panel and timer selector c. A film mount and counter top d. An image receptor holder

Answer 98

d. **An image receptor holder** **Semicritical** instruments such as image receptor holders are those that **contact oral mucosa** without penetrating soft tissue or bone. Semicritical instruments must be sterilized following use.

Question 99

Which of the following will benefit the most from using **film packets** with a **protective barrier**? a. Manual processing b. Automatic processing c. Daylight loaders d. Rapid (chairside) processing

Answer 99

c. **Daylight loaders** Although film packets with and without plastic barrier envelopes can be processed in an **automatic processor** with a **daylight loader attachment,** because of the complexity of the **infection protocol** for its use, using **film packets with barriers is recommended.**

Question 100

After aseptically removing the barriers, film packets that were packaged inside barrier envelopes may be processed with clean, dry hands *because* the film packets are not contaminated. a. The first part of the statement is true. The second part of the statement is false. b. The first part of the statement is false. The second part of the statement is true. c. Both parts of the statement are true. d. Both parts of the statement are false.

Answer 100

c. **Both parts of the statement are true.** Plastic barriers protect the film packet from contamination when placed intraorally. **Removing the plastic barrier aseptically allows the radiographer to handle the film packets with clean, dry hands.**

Question 101

A **pathosis** is a **microorganism** capable of **causing disease**. True False

Answer 101

**False** A **pathogen** is a microorganism capable of causing disease. **Pathosis refers to the disease itself.**

Question 102

Using standard precautions, **infection control protocols** are carried out **only** if the patient is **known** to be **infectious**. True False

Answer 102

**False** ## Footnote Some patients do not know or decline to admit their infectious status, putting everyone at risk for acquiring infectious disease. Use of a single standard for all patients assumes everyone is infective and requires the same infection control protocols to be applied to all patients.

Question 103

The **lead apron** should be **_sterilized_** after use. True False

Answer 103

**False** A **lead apron** is a **noncritical** object that does **not contact the mucous membrane** and therefore should be **_disinfected_** after use.

Question 104

**Sterilization** refers to **total destruction of spores** and disease-causing **microorganisms**. True False

Answer 104

**True** Sterilization is accomplished by autoclaving or dry heat processes.

Question 105

The radiographer should use **powdered**, **nonsterile gloves** made of latex or vinyl when placing intraoral radiographs. True False

Answer 105

**False** **Powdered gloves should be avoided, as the powder residue can cause radiographic artifacts.** Sterile gloves would be required for surgical procedures.

Question 106

**Sterilization** is the use of a **chemical or physical** procedure to **reduce** the **pathogens** to an acceptable level on **inanimate objects**. True False

Answer 106

**False** **Disinfection** is the use of a chemical or physical procedure to reduce pathogens. Sterilization is the total destruction of spores and disease-producing microorganisms.

Question 107

**Semicritical** objects must be **sterilized** after use. True False

Answer 107

**True** Semicritical objects touch, but do not penetrate, soft tissue or bone. Most instruments used in dental radiography fall into this category. Using instruments that can be heat sterilized or are disposable are recommended.

Question 108

**Barrier** materials should be placed over **surfaces likely to be contaminated** during radiographic procedures such as the **PID** and **tube head**, **control panel, exposure switch**, and countertops. True False

Answer 108

**True** ## Footnote Surfaces not covered must be cleaned and disinfected after radiographic procedures are completed. Liquid disinfectants may harm electrical connections and the x-ray machine. Disinfecting solutions may not adequately reach irregular surfaces, so barrier wrap is recommended.

Question 109

**Noncritical** objects are those that **do not come into contact with mucous membranes.** True False

Answer 109

**True** Examples include the **lead apron, PID, and the exposure button.** If barrier wrap is not used, noncritical objects may be disinfected with EPA-registered chemicals classified as intermediate-level disinfectants.

Question 110

The radiographer should be able to **aseptically open all film packets** in a **full mouth series** in **2 minutes or less** to **avoid excessive exposure** to safelight. True False

Answer 110

**True** Prolonged exposure to light, even safelight, increases the **risk of fogging the film**.

Question 111

**Protective clothing, mask**, and **eyewear** should be in place **prior** to putting on patient treatment **gloves**. True False

Answer 111

**True** **Protective clothing, mask, and eyewear should all be in place to prepare for handwashing prior to putting on medical examination gloves.**

Question 112

Darkroom counter surfaces **without barrier protection** that have been **touched by gloved hands** must be **_cleaned_**. True False

Answer 112

**False** Darkroom counter surfaces without barrier protection that have been touched by gloved hands must be **_disinfected._**

Question 113

The goal of infection control is the prevention and reduction of disease-causing (pathogenic) microorganisms. True False

Answer 113

**True** ## Footnote The primary purpose of infection control is to prevent the transmission of infectious diseases.

Question 114

**Occupational exposure** refers to an **infection** a patient might be exposed to while **undergoing oral health care treatment.** True False

Answer 114

**False** **Occupational exposure** refers to a worker **(oral health care professional)** coming in contact with blood, saliva, or other infectious material that involves the skin, eye, or mucous membrane.

Question 115

Radiographers should be vaccinated against certain diseases. True False

Answer 115

**True** ## Footnote The Centers for Disease Control and Prevention (CDC) recommends that dental personnel working with blood or blood-contaminated substances be vaccinated for hepatitis B virus (HBV).

Question 116

**Spatter** is the **suspension of microorganisms** that may be capable of causing disease produced during normal breathing and speaking. True False

Answer 116

**False** ## Footnote **Microbial aerosols** are a suspension in air of microorganisms that may be capable of causing disease produced during normal breathing and speaking.

Question 117

Universal precautions have replaced standard precautions. True False

Answer 117

**False** **Universal precautions** are a concept of infection control where the focus is on **blood-borne** pathogens. **The all-inclusive “standard precautions” has replaced the universal precautions** concept.

Question 118

Taking a thorough medical history and performing an oral examination will **not always identify** potential infected patients. True False

Answer 118

**True** ## Footnote It is a fact that some patients are reluctant to admit their infectious condition.

Question 119

The Centers for Disease Control and Prevention (CDC) **does not enforce infection control regulations.** True False

Answer 119

**True** The Centers for Disease Control and Prevention (CDC) does not enforce regulations but is a major influence in the development and **recommendation of guidelines** for preventing disease and controlling infection.

Question 120

The **lead apron** is considered part of personal protective equipment **(PPE)**. True False

Answer 120

**False** ## Footnote Personal protective equipment, or PPE, includes clothing, masks, eyewear, and gloves worn by dental personnel as a protective barrier "2" to prevent the transmission of infective microorganisms between oral health care practitioners and patients.

Question 121

Each of the following statements regarding dental radiographic equipment regulations is correct **EXCEPT one.** Which one is the EXCEPTION? a. Most states require registration of dental x-ray machines. b. Inspection of dental x-ray machines is usually conducted every 2–4 years. c. Fees are usually collected for inspection of x-ray machines. d. The dentist can perform inspections of dental x-ray machines.

Answer 121

d. **The dentist can perform inspections of dental x-ray machines.** Although the dentist, dental assistant, and dental hygienist **can all perform periodic quality control tests** on the dental x-ray machine, equipment regulations usually specify that inspections be done by a **qualified radiological expert licensed by the state.**

Question 122

a. The Consumer-Patient Radiation Health and Safety Act was designed to protect patients from _unnecessary radiation_. b. The Federal Performance Act of 1974 was designed to protect patients from unnecessary radiation. c. The Consumer-Patient Radiation Health and Safety Act requires that all x-ray equipment manufactured or sold in the United States meet federal performance standards. d. There are no federal laws regarding use of dental x-ray equipment.

Answer 122

a. **The Consumer-Patient Radiation Health and Safety Act was designed to protect patients from unnecessary radiation.** ## Footnote Established in 1981 and updated in 1991, the federal Consumer-Patient Radiation Health and Safety Act established guidelines regarding who can place and expose radiographs.

Question 123

Each of the following statements **regarding risk management** is correct EXCEPT one. Which one is the EXCEPTION? a. An attempt should be made to obtain duplicate copies of a new patient’s radiographs. b. The fastest film speed currently available should be used for all radiographs. c. Unless required by law, personnel monitoring devices should be discouraged. d. All intraoral radiograph exposures should use an image receptor holding device.

Answer 123

c. **Unless required by law, personnel monitoring devices should be discouraged.** ## Footnote Providing all radiographers with a radiation monitoring badge, whether required by law or not, is a good risk-management tool. Monitoring lack of exposure provides the practice with documentation of safe work habits.

Question 124

The federal Consumer-Patient Radiation Health and Safety Act: a. mandated safety requirements for collimation and filtration of equipment. b. provided guidelines and recommended procedures for infection control. c. provided and updates evidence-based selection criteria guidelines. d. established standards for state certification/licensure of radiographic personnel.

Answer 124

d. **established standards for state certification/licensure of radiographic personnel.** ## Footnote The Consumer-Patient Radiation Health and Safety Act established minimum standards for state certification and licensure of personnel who administer radiation in medical and dental radiographic procedures. The intent of the act was to minimize unnecessary exposure to potentially hazardous radiation.

Question 125

Each of the following statements regarding **informed consent** is correct EXCEPT one. Which one is the EXCEPTION? a. Speak to the patient in lay terms about the risks and benefits of exposing radiographs. b. Allow the patient to choose who he/she wants to expose the radiographs. c. Inform the patient about the risks of radiation exposure. d. Inform the patient of the purpose of exposing the radiographs.

Answer 125

b. **Allow the patient to choose who he/she wants to expose the radiographs.** ## Footnote The patient must be informed as to who will be exposing the radiographs, but they do not need to be provided with the option of selecting the radiographer.

Question 126

Each of the following statements regarding **patients who refuse radiographs** is correct EXCEPT one. Which one is the EXCEPTION? a. The dentist must consider whether care can be provided without the radiographs. b. A patient who does not want radiographs _may_ sign a document releasing the dentist from liability. c. Patients may believe radiographs are not necessary or that they will add to treatment costs. d. Patients may be fearful that dental x-ray exposure will be hazardous to their health.

Answer 126

b. **A patient who does not want radiographs may sign a document releasing the dentist from liability.** Such documents are **not valid** because the **patient cannot legally consent to negligent care.**

Question 127

Which of these statements is **FALSE**? a. Professional rules of conduct are called a “code of ethics.” b. Professional ethics define a standard by which all members of a profession are obligated to conform. c. The ethics of a profession help guide the behavior of the health care professional. d. Ethics are laws and regulations pertaining to the behavior of the health care professional.

Answer 127

d. **Ethics are laws and regulations pertaining to the behavior of the health care professional.** ## Footnote **Ethics** is defined as a sense of moral obligation regarding **right and wrong behaviors.** Professional ethics supplement legal guidelines and regulations regarding the behavior of health care professionals.

Question 128

Which of the following is NOT a goal of the dental radiographer? a. Keep retake radiographs under three per patient. b. Perform confidently and with authority. c. Aim for perfection with each radiograph. d. Follow strict protocols to protect oneself during exposures.

Answer 128

a. **Keep retake radiographs under three per patient.** Radiation exposure should be as low as possible. If the patient cannot tolerate film placement, stop and seek assistance or apply an acceptable alternative to avoid any retakes.

Question 129

Which of these statements is **FALSE**? a. Direct supervision means the dentist is in the office when radiographs are being exposed. b. Each state’s dental commission controls the scope of practice for dentists, dental assistants, and dental hygienists. c. State laws governing dental radiographers with on-the-job training vary considerably from state to state. d. Each state has a mandatory state exam or continuing education requirement for dental radiographers.

Answer 129

d. **Each state has a mandatory state exam or continuing education requirement for** **dental radiographers.** Some states without mandatory exams or continuing education requirements **allow uncertified dental assistants** who have received on-the-job training to take radiographs under the **direct supervision of a dentist.**

Question 130

Which of these statements regarding **risk management** is **FALSE**? a. Obtain a duplicate copy of a new patient’s radiographs if possible. b. Use the best equipment currently available for exposing radiographs. c. Take radiographs only if the dentist is present. d. Establish a written quality assurance system for radiographic equipment.

Answer 130

c. **Take radiographs only if the dentist is present.** The radiographer should be aware of state laws governing the practice of professional responsibilities and take radiographs accordingly. It is not likely that state law prohibits a properly licensed, certified, or trained dental assistant or dental hygienist from taking dental radiographs that have been prescribed by the dentist.

Question 131

**Direct supervision** when radiographs are taken means that the dentist: a. must be present in the office. b. must be present in an adjacent operatory. c. need not be present in the office but must be readily available. d. has authorized the number of films to be taken.

Answer 131

a. **must be present in the office.** Direct supervision means the dentist is present in the office when the radiographs are taken.

Question 132

Policies and procedures used to **reduce the chances a patient will file legal action** against the oral health care team is known as: a. code of ethics. b. risk management. c. standards protocol. d. radiation health and safety.

Answer 132

b. **risk management.** ## Footnote Risk management can be defined as the policies and procedures to be followed by the radiographer to reduce the chances that a patient will file legal action against the dentist and oral health care team.

Question 133

To give **informed consent**, each of the following must be explained to the patient EXCEPT one. Which one is the **EXCEPTION**? a. The purpose of taking radiographs b. The risks and benefits of taking radiographs c. The possible risks of refusing radiographs d. How the radiographs will be taken

Answer 133

d. **How the radiographs will be taken** ## Footnote To make a decision regarding informed consent, the patient must be informed of the following: the purpose of taking radiographs, the benefits the radiographs will supply, the possible risks of radiation exposure, the possible risks of refusing the radiographs, and the person who will perform the procedure.

Question 134

Legally, radiographs are the property of: a. the dentist who originally prescribed the radiographs. b. a new dentist if the patient leaves the original practice. c. both the original dentist who prescribed the radiographs and a new dentist if the patient leaves the original practice. d. the patient.

Answer 134

a. **the dentist who originally prescribed the radiographs.** The courts have ruled that radiographs are the property of the dentist who originally prescribed the radiographs.

Question 135

Patients may have reasonable access to their radiographs if: a. changing dentists. b. having a consult with a specialist. c. needed for litigation against the dentist. d. All of the above.

Answer 135

d**. All of the above.** ## Footnote Patients may have reasonable access to their radiographs. They may request a copy of their radiographs if they decide to change dentists, request a consultation with a dental specialist, or for any other reason.

Question 136

Dental radiographs must be retained for 7 years after the: a. date of exposure. b. patient is deceased. c. patient ceases to be a patient. d. completion of treatment.

Answer 136

c. **patient ceases to be a patient.** ## Footnote Dental radiographs must be retained for 7 years after the patient ceases to be a patient. However, because of statute of limitation laws, it is recommended that all records (including radiographs) be retained indefinitely.

Question 137

Who has a legal right to request copies of a patient’s radiographs? a. Another dentist b. The patient c. An insurance company d. All of the above

Answer 137

d. **All of the above** ## Footnote Patients may request a copy of their radiographs if they decide to change dentists, request a consultation with a dental specialist, or for any other reason. Insurance companies have the right to request pretreatment radiographs to evaluate the dental treatment plan for which services they will be paying.

Question 138

The **statute of limitations** for bringing a malpractice suit **begins**: a. from the date that treatment was started. b. from the date that treatment was completed. c. from the date that the patient discovers an injury. d. within 5 years from the date that the patient discovered an injury.

Answer 138

c. **from the date that the patient discovers an injury.** ## Footnote The statute of limitations is the time period during which a patient may bring a malpractice action against a dentist or radiographer. State laws govern this time period, which begins when the **patient discovers**, or **should have discovered**, an injury due to negligent dental treatment.

Question 139

Certification and/or licensure to expose dental radiographs: a. is regulated by individual state laws, which may vary. b. is not required in all states if one has accredited training. c. may or may not be regulated by the dentist/employer. d. is required by law in all fifty states and the District of Columbia.

Answer 139

a. **is regulated by individual state laws, which may vary.** ## Footnote State laws regulating personnel who expose dental radiographs vary considerably for on-the-job–trained dental assistants. Whereas many states have a mandatory state examination or a continuing education requirement, some states allow these uncertified dental assistants with proper training to take radiographs under the direct supervision of a dentist without certification

Question 140

The legal right of the patient to refuse radiographs is a form of: a. the statute of limitations. b. liability. c. self-determination. d. disclosure.

Answer 140

c. **self-determination.** ## Footnote All patients have the legal right to make choices about the health care they receive. This is called self-determination. Self-determination includes the right to refuse treatment.

Question 141

The _State Performance Act_ of 1974 requires all x-ray equipment manufactured or sold in the United States to meet _federal performance standards._ True False

Answer 141

**True** ## Footnote The Federal Performance Act of 1974 requires that all x-ray equipment manufactured or sold in the United States meet federal performance standards. These standards include requirements for filtration, collimation, and other x-ray machine characteristics.

Question 142

Radiographers in all states must conform to the Consumer-Patient Radiation Health and Safety Act. True False

Answer 142

**False** Adoption of this federal standard was made **discretionary with each state**. Not all states have voluntarily established licensure laws for personnel who place and expose radiographs.

Question 143

**Some states** require **additional credentials** beyond passing the National Board Dental Hygiene Examination or Dental Assisting National Board Examination **to place and expose dental radiographs.** True False

Answer 143

**True** ## Footnote In some states, the radiographer is required to take an additional examination or fulfill continuing education requirements to be certified in radiation safety or radiography techniques.

Question 144

There are variations between states in terms of requirements for a dental hygienist or assistant to place and expose radiographs. True False

Answer 144

**True** ## Footnote Because laws and regulations vary for each state, the radiographer should contact the state’s dental commission directly to learn about legal requirements for placing and exposing radiographs in that state.

Question 145

There are national guidelines regarding who can place and expose dental radiographs. True False

Answer 145

**True** Passed into law in 1981 and updated in 1991, the federal Consumer-Patient Radiation Health and Safety Act was drafted to protect patients from unnecessary radiation. **This act established minimum standards for state certification and licensure of personnel who administer radiation**.

Question 146

In malpractice cases, the dentist may be sued for the actions of the radiographer. True False

Answer 146

**True** ## Footnote In malpractice cases, **both the supervising dentist and the dental radiographer may be sued for the actions of the radiographer**. Even though radiographers work under the supervision of the dentist, they are legally liable for their own actions.

Question 147

“**Liable**” means to be **legally obligated to make good any loss or damage that may occur.** True False

Answer 147

**True** ## Footnote State law requires dentists to supervise the performance of dental radiographers. Despite this, dental radiographers are still legally liable for their own actions. In malpractice cases, both the dentist and the dental radiographer may be sued for the actions of the radiographer.

Question 148

**Original radiographs** are the **property of the dentist** in whose practice they were made. True False

Answer 148

**True** ## Footnote The courts have ruled that original radiographs are the property of the dentist. However, patients may have reasonable access to their radiographs and request a copy if they change dentists or request a consultation with a specialist.

Question 149

Dental radiographs must be retained by the dentist for **10 years** after the patient leaves the practice. True False

Answer 149

**False** ## Footnote Although dental radiographs must be retained for **7 years** after an individual ceases to be a patient, it is recommended that they be kept indefinitely. Legal actions that can be brought against a dentist may vary according to state-specific malpractice and limitation statutes.

Question 150

**Insurance companies** and other **third-party payers** of treatment require **original radiographs** for **pretreatment** authorization purposes. True False

Answer 150

**False** **Only duplicate radiographs should be sent.** The dental practice must retain the original radiographs.

Question 151

Patients have the right to **reasonable access** to their radiographs. True False

Answer 151

**True** ## Footnote Patients have a right to reasonable access to their radiographs. They may request a copy of their radiographs if they decide to change dentists or request a consultation with a dental specialist. The original radiographs, however, belong to the dentist.

Question 152

The process of **informing** the patient about the **risks and benefits** of a treatment procedure is called “**self-determination.**” True False

Answer 152

**False** The process of **informing** the patient about the **risks and benefits** of a treatment procedure is called “**disclosure**.”

Question 153

The _Consumer-Patient Health and Safety Act_ provides patients with more control over how their **personal health information is used and disclosed.** True False

Answer 153

**False** The Health Insurance Portability and Accountability Act (**HIPAA**) provides patients with more control over how their **personal health information is used and disclosed.**

Question 154

The legal right of an individual to **make choices concerning health care treatment** is called “**self-determination**.” True False

Answer 154

**True** ## Footnote The legal right of an individual to make choices concerning health care treatment is called “self-determination.”

Question 155

As **prudent risk management**, radiographs should be retained as part of a client’s record for **7 years.** True False

Answer 155

**False** As **prudent risk management,** radiographs should be retained as part of a client’s record **indefinitely**.

Question 156

**Federal laws** regulate the **manufacture of dental x-ray machines** and **state** regulations **control** the use of **x-ray equipment**. True False

Answer 156

**False** Both **federal and state** regulations **control** the **manufacture** and **use of x-ray equipment.**

Question 157

Many states consider a **certified** dental assistant and a registered dental hygienist **competent** to **place and expose dental radiographs**. True False

Answer 157

**True** ## Footnote Many states consider dental hygienists and dental assistants who have passed the National Board Dental Hygiene Examine (NBDHE) and the Dental Assisting National Board Examination (DANB), respectively, and hold a license to practice in the state as a Registered Dental Hygienist or Certified Dental Assistant, respectively, to meet the requirements of the **Consumer-Patient Radiation Health and Safety Act.**

Question 158

**All states** have **certification requirements** for personnel taking **dental radiographs**. True False

Answer 158

**False** Adoption of the **Consumer-Patient Radiation Health and Safety Act’s** standards was made **discretionary with each state.** As a result, not all states have voluntarily established licensure laws for personnel who place and expose dental radiographs. Nevertheless, most state laws require that operators of x-ray equipment be trained and certified or licensed to take dental radiographs.

Question 159

Providing the radiographers with a **radiation monitoring device** is **good risk management**. True False

Answer 159

**True** **Providing all radiographers with a radiation monitoring badge, whether required by law or not, is also good risk management.** Monitoring radiation exposure, or more precisely the lack of exposure, will provide the practice with documentation of safe work habits.

Question 160

**Good patient relations** can **reduce the risk** of possible legal action. True False

Answer 160

**True** ## Footnote It is important to make the patient feel comfortable by establishing a relaxing and confident chairside manner. Always explain to the patient what and how procedures are to be performed. Answer all questions the patient may have concerning the procedures. Good patient relations reduce the risk of possible legal action.

Question 161

Each of the following statements regarding **retake radiographs** is correct EXCEPT one. Which one is the EXCEPTION? a. All errors create a need to re-expose the patient. b. If one radiograph in a set of bitewings is overlapped, it should be determined whether adjacent radiographs image the area adequately. c. Determining when a retake is necessary will keep radiation exposure to a minimum. d. All errors reduce the quality of the radiograph.

Answer 161

a. **All errors create a need to re-expose the patient.** **Not all errors create a need to re-expose the patient.** Two examples of this are when the error **does not affect** the **area of interest** and when the **error affects only one radiograph** in a series, where the area of **interest can be viewed in an adjacent radiograph**.

Question 162

Each of the following would result in a **retake radiograph** EXCEPT one. Which one is the **EXCEPTION**? a. Not imaging the correct tooth b. Imaging 2 millimeters of supporting bone beyond tooth apices c. Cone cutting the area of interest d. Imaging a herringbone or tire track pattern.

Answer 162

b. **Imaging 2 millimeters of supporting bone beyond tooth apices** ***Imaging 2 millimeters of supporting bone beyond the tooth apices is a requirement of a quality image and would not necessitate a retake.***

Question 163

Which of the following statements regarding **positioning** of the image receptor is correct? a. Absence of apical structures results when the image receptor is not placed low enough in the oral cavity. b. Inadequate horizontal angulation will result in less of the crown recorded. c. Excessive vertical angulation will result in overlap error. d. Not placing the image receptor parallel with the occlusal plane results in cone cutting.

Answer 163

a. **Absence of apical structures results when the image receptor is not placed low enough in the oral cavity.** When the image receptor is not placed low enough in the patient’s oral cavity, the entire tooth including the **root tip and at least 2 millimeters of supporting bone beyond the apices will not be recorded.**

Question 164

An image receptor placed **too far back i**n the mouth will result in not imaging the: a. maxillary structures. b. mandibular structures. c. anterior structures. d. posterior structures.

Answer 164

c. **anterior structures.** Not recording enough of the anterior structures results when the image receptor is placed too far back in the patient’s oral cavity.

Question 165

A **slanted** or **tilted occlusal plane** results from which of the following? a. Not using a cotton roll to stabilize the image receptor holder b. Not positioning the edge of the image receptor parallel to the occlusal plane c. Orienting the image receptor vertically when it should have been oriented horizontally d. Placing the image receptor in the mouth backward

Answer 165

b. **Not positioning the edge of the image receptor parallel to the occlusal plane** ## Footnote If the edge of the image receptor contacts the lingual gingiva or curvature of the palate when the patient closes, it may shift to a position not parallel to the occlusal plane resulting in a slanted or tilted appearance.

Question 166

**Elongation error** results from which of the following? a. Excessive vertical angulation using the bisecting technique b. Excessive vertical angulation using the paralleling technique c. Inadequate vertical angulation using the bisecting technique d. Inadequate vertical angulation using the paralleling technique

Answer 166

c. **Inadequate vertical angulation using the bisecting technique** Elongation and **foreshortening** are dimensional errors caused by **improper vertical angulation** when using the **bisecting technique**. When the vertical angulation is inadequate, elongated images result.

Question 167

Which of the following identifies the cause and **corrective action** for an image with **overlapping** of the **proximal contacts** in which the overlap appears **more severe** in the **posterior** region than the **anterior** region? a. Mesiodistal projection of the central ray caused the error. Shift the tube toward the anterior to correct this error. b. Mesiodistal projection of the central ray caused the error. Shift the tube toward the posterior to correct this error. c. Distomesial projection of the central ray caused the error. Shift the tube toward the anterior to correct this error. d. Distomesial projection of the central ray caused the error. Shift the tube toward the posterior to correct this error.

Answer 167

b. **Mesiodistal projection of the central ray caused the error. Shift the tube toward the posterior to correct this error.** ## Footnote If there is less overlap in the anterior region, a mesiodistal projection of the central ray is the cause. To correct this error, the tube should be shifted toward the region where the overlapping is more severe. In this case, the tube should be shifted toward the posterior.

Question 168

**Light (thin) images** may result from each of the following EXCEPT one. Which one is the EXCEPTION? ## Footnote a. Placing the image receptor (film) in the mouth backward b. Not depressing the exposure button for the duration of the cycle c. Using an mA setting that was too high d. Developing in weak processing solutions

Answer 168

c. **Using an mA setting that was too high** **Increasing the mA setting would result in a dark image caused by overexposure.**

Question 169

What term is used to describe **images other than anatomy or pathology** that **do not contribute to a diagnosis** of the patient’s condition? a. Artifacts b. Cone cuts c. Double images d. Pressure marks

Answer 169

a. **Artifacts** ## Footnote Artifacts are images other than anatomy or pathology that do not contribute to, and **may detract from, the diagnostic quality of the radiograph.**

Question 170

**Overdevelopment** results in which of the following? a. Green areas b. Dark images c. White or clear spots d. Cracked emulsions

Answer 170

b. **Dark images** **Overdevelopment,** or leaving film **too long in the developer** solution, will result in a **dark image.**

Question 171

**Failing** to record the **apical region** of the teeth on a **periapical** radiograph most likely results from an error made in which of the following steps? a. Placement of the image receptor b. Horizontal angulation c. Vertical angulation d. Centering the x-ray beam

Answer 171

c. **Vertical angulation** ## Footnote Inadequate (not steep enough) vertical angulation will result in less of the apical region being recorded onto the radiograph.

Question 172

Failing to record the **incisal or occlusal edges** of the teeth on a **periapical** radiograph most likely results from an error made in which of the following steps? a. Placement of the image receptor b. Horizontal angulation c. Vertical angulation d. Centering the x-ray beam

Answer 172

c. **Vertical angulation** **Excessive (too steep) vertical angulation will result in not recording the incisal/occlusal edges on the radiograph.**

Question 173

**Cone cutting** of the radiographic image most likely results from an error made in which of the following steps? a. Placement of the image receptor b. Horizontal angulation c. Vertical angulation d. Centering the x-ray beam

Answer 173

d. **Centering the x-ray beam** Conecutting error results when the primary beam of **radiation is not directed toward the center of the image receptor and does not completely expose the entire surface area of the receptor.**

Question 174

**Overlapping** of adjacent teeth on the radiographic image most likely results from an error made in which of the following steps? a. Placement of the image receptor b. Horizontal angulation c. Vertical angulation d. Centering the x-ray beam

Answer 174

b. **Horizontal angulation** Incorrect rotation of the tube head and PID in the horizontal plane results in overlap error. Superimposition of the proximal surfaces occurs when the central ray of the **x-ray beam is not directed perpendicular through the interproximal spaces to the image receptor.** Overlapped contacts result when the central ray of the x-ray beam is directed obliquely toward the image receptor from the distal or from the mesial.

Question 175

When using the **paralleling technique**, **excessive vertical angulation** will result in: a. elongation of the teeth. b. foreshortening of the teeth. c. cutting off the apices of teeth. d. cutting off the occlusal/incisal edges of the teeth.

Answer 175

d. **cutting off the occlusal/incisal edges of the teeth.** ## Footnote Excessive (too steep) vertical angulation will result in not recording the incisal/occlusal edges on the radiograph.

Question 176

When using film, the **corrective action** for a radiograph that displays a "**tire track"** pattern is to: a. thoroughly clean the rollers of the automatic processor. b. position film intraorally with the tube side toward the source of radiation. c. carefully separate the lead foil from the film packet before processing. d. lower the temperature of the processing chemicals.

Answer 176

b. **position film intraorally with the tube side toward the source of radiation.** ## Footnote A pattern representing the embossed lead foil that is in the back of a film packet will leave a pattern resembling a tire track or diamond pattern on the processed radiograph if the film packet was placed backward in the mouth.

Question 177

If using film, a **blank image** indicates that: a. there was an overexposure to radiation. b. there was no exposure to radiation. c. a full denture blocked the film from radiation. d. the film was accidentally exposed to white light.

Answer 177

b. **there was no exposure to radiation.** **If no radiation reached the film, the result is a blank radiograph.**

Question 178

If a **film** is **accidentally** placed in the **fixer** before placing it in the **developer,** the resultant image will: a. be light. b. be dark. c. be blank. d. have a herringbone pattern.

Answer 178

c. **be blank** **Fixer will remove all of the undeveloped silver halide crystals from the emulsion, resulting in a blank or clear radiograph.**

Question 179

**Residual glove powder** on the fingers or hands that **touches the film** results in: a. white marks. b. pressure marks. c. black smudges. d. film fogging.

Answer 179

c. **black smudges.** **Handling the film with damp fingers or latex treatment gloves, or with residual glove powder on the fingers will leave black smudges.**

Question 180

**Improper** or **insufficient washing** of radiographic films will result in: a. brown films. b. green films. c. black films. d. white/clear films.

Answer 180

a. **brown films.** ## Footnote Insufficient or improper washing results in brown films. Films will turn brown over a period of several weeks after processing as the chemicals that remain on the surface of the film erode the image.

Question 181

**Misuse** of a **cotton roll to stabilize** the image receptor may result in **root tips being cut off from the image.** True False

Answer 181

**True** The cotton roll must be used on the **opposite side of the bite block from where the teeth occlude** to prevent the image receptor from being placed incorrectly so as not to record the entire tooth and apices.

Question 182

The image receptor should be placed with the **long dimension horizontal** for exposure of **anterior periapical radiographs.** True False

Answer 182

**False** The image receptor should be placed with the **long dimension vertical** for exposure of **anterior periapical radiographs.**

Question 183

A **herringbone** or **tire track pattern** appears on the image if the **film packet** was placed in the oral cavity **reversed.** True False

Answer 183

**True** The pattern represents an image of the **embossed lead foil**. The image also will be significantly underexposed.

Question 184

**Elongation** error causes the images to appear **stretched out.** True False

Answer 184

**True** Elongation error refers to the appearance of images that are elongated. **When the vertical angulation is inadequate, the images appear elongated.**

Question 185

**Assembling an image receptor holder** with external aiming device **incorrectly** may lead to **conecut error.** True False

Answer 185

**True** ## Footnote If the primary beam of radiation is not directed toward the center of the image receptor, cone-cut error results. Assembling an image receptor holder incorrectly has the potential to direct the x-ray beam to the wrong place.

Question 186

A **dark image** occurs when the **developing solution** is **diluted**. True False

Answer 186

**False** A **dark image** may result when the film has been in the **developing solution too long** or when the **solution is too hot or too strong.** A **diluted** developing solution would produce a **light image**.

Question 187

A **black film** indicates **accidental exposure** to **white light.** True False

Answer 187

**True** ## Footnote White-light exposure will expose all of the silver halide crystals within the emulsion. The developing step will change all of the exposed crystals to black.

Question 188

Formation of a **partial image** on the radiograph occurs if the **developing solution is too weak.** True False

Answer 188

**False** A **partial image** results when the level of **developer is too low to cover the entire film.** Processing solutions should be replenished to the proper levels to prevent this error.

Question 189

**White spots** on the film are caused by **premature contact** with the **developer** solution. True False

Answer 189

**False** **White spots** on the film are caused by **premature contact** with the **fixer** solution.

Question 190

**Dark spots** on the film are caused by **premature contact** with the **developer.** True False

Answer 190

**True** ## Footnote The role of the **developer** is to produce the **dark or black images** on the film. Dark spots on the film result if premature contact with the developer occurs.

Question 191

A **light radiograph** can result from either **underexposure** or **underdeveloping.** True False

Answer 191

**True** ## Footnote **Insufficient exposure time in relation to milliamperage, kilovoltage, and PID length selected by the operator all result in light image**s. Not leaving the film in the developer solution long enough and processing in cold or weak solutions will result in light images.

Question 192

A **dark radiograph** can result from either **overexposure** or **overdeveloping**. True False

Answer 192

**True** ## Footnote Excessive exposure time in relation to milliamperage, kilovoltage, and PID length selected by the operator all result in dark images. Leaving the film in the developer solution too long and processing in hot or strong solutions will result in dark images.

Question 193

A **scratched safelight filter** or **incorrect bulb wattage** can result in **film fog**. True False

Answer 193

**True** ## Footnote A safelight will fog film if the wattage of the safelight bulb is stronger than recommended; the distance the safelight is located over the work space area is too close; the filter is the incorrect type or color for the film being used; or the filter is scratched or otherwise damaged, allowing white light through.

Question 194

A **white line** will appear on a processed film at the point where a film packet was **bent or subjected to excessive pressure.** True False

Answer 194

**False** A **black line** will appear on a processed film at the point where a film packet was bent or subjected to excessive pressure.

Question 195

A **distomesial** projection of the x-ray beam results in more **severe overlapping** in the **posterior region** of the radiograph. True False

Answer 195

**False** A **mesiodistal** projection of the x-ray beam results in **more severe overlapping** in the posterior region of the radiograph.

Question 196

Exposing film to excessive **heat** and **humidity** can compromise radiographic quality. True False

Answer 196

**True** ## Footnote Film fog will result when film is stored in a warm, damp area or in the vicinity of fume-producing chemicals.

Question 197

**Electronic noise** is the digital **equivalent** of **film fog**. True False

Answer 197

**True** Electronic noise diminishes contrast and makes it difficult and often impossible to interpret digital radiographic images.

Question 198

To avoid radiographic error while opening a film packet in the darkroom, the **film should be removed from the outer packaging rapidly.** True False

Answer 198

**False** **Static electricity may be produced when the film is pulled out of the packet wrapping too fast.** Static electricity creates a white-light spark that exposes (blackens) the film.

Question 199

If the **darkroom door** is **accidentally opened** during unwrapping of the film packets, the resultant image will appear **clear, or blank** of any image. True False

Answer 199

**False** Film accidentally exposed to white light will be **black after processing.**

Question 200

Bending a phosphor plate will result in a black crimp line. True False

Answer 200

False ## Footnote Bending a phosphor plate will damage the surface. Damaged phosphors on the plate’ aqs surface will not retain an image. The most likely result will be a white or missing image area.

Question 201

The **generation of radiation** occurs at the: 1. Copper stem 2. Focusing cup 3. Tungsten target 4. Cathode

Answer 201

C. **Tungsten target**

Question 202

Increasing the mA will cause 1. Increase in density, the film will be darker 2. Increase in density, the film will be lighter 3. Decrease in density, the film will be darker 4. Decrease in density, the film will be lighter

Answer 202

a. Increase in **density**, the film will be **darker**

Question 203

# Choose the best description of **long scale contrast**: 1. Also known as high contrast, many blacks and whites 2. The type of contrast preferred for diagnosis of interproximal caries 3. Also known as low contrast, many shades of gray 4. Produced with low kvp settings

Answer 203

c. Also known as low contrast, many shades of gray

Question 204

All of the following are indirect effects of radiation except 1. Direct alteration of molecules 2. Production of free radicals 3. Ionization 4. Radiolysis of water

Answer 204

a. Direct alteration of molecules

Question 205

**Increasing** the **time and mA settings** on the exposure panel will 1. Increase the quality of radiation produced 2. Increase the quantity 3. Decrease the quality 4. Decrease the quantity

Answer 205

C. **Increase** the **quantity**

Question 206

The radiograph was exposed with too much vertical angulation 1. Cut off edges 2. Cut of apices 3. Be overlapped 4. Be very dark

Answer 206

a. **Cut off edges**

Question 207

From the following choose the **cell** that is **least sensitive** to **radiation (Most radioresistant)** 1. Reproductive tissues 2. Intestines 3. Nerve tissue 4. Mucous membranes

Answer 207

c. Nerve tissue

Question 208

Which of the following **reduces** the number of **low energy** x rays (**long wave**) in the beam 1. Collimation 2. Aluminum filtration 3. milliamperage 4. Kilovoltage

Answer 208

b. **Aluminum filtration**

Question 209

Which of the following are **functions** of the **cathode** (select all that apply) 1. Location of the focal spot 2. Thermionic emission occurs 3. Converts bombarding electrons into photons 4. Produces a cloud of electrons 5. Absorbs excess heat 6. Supplies the electrons necessary to generate x rays

Answer 209

b. Thermionic emission occurs d. Produces a cloud of electrons f. Supplies the electrons necessary to generate x rays

Question 210

A **higher kvp** will produce an image with which of the following characteristics (choose all that apply) 1. Low density 2. High density 3. Low contrast 4. Long scale contrast 5. An image with many shades of gray

Answer 210

b. High density c. Low contrast d. Long scale contrast e. An image with many shades of gray

Question 211

The **mA** setting **controls** which items (select all that apply): 1. Thermionic emission 2. Number of free electrons in tube 3. Number of photons ultimately produced 4. Density of the film 5. Contrast of the film

Answer 211

a. Thermionic emission b. Number of free electrons in tube c. Number of photons ultimately produced d. Density of the film

Question 212

The mean **penetrability** of an x-ray beam is related to all in the list below except: 1. Kvp 2. Filtration 3. Wavelength 4. mA

Answer 212

d. **mA**

Question 213

For optimal detection of **incipient interproximal carious lesions** (high contrast), which of the following machine settings is preferable? 1. 90 kVp, 5mA. 2. 85kVp, 10mA. 3. 75kVp, 5mA. 4. 65 kVp, 10mA.

Answer 213

d. 65 kVp, 10mA.

Question 214

Primary purpose of **sodium thiosulfate** is to 1. Preserve the image 2. Allow further blackening of the film 3. Remove silver that has been developed 4. Remove silver bromine that has not been developed

Answer 214

d. **Remove silver bromine** that has **not** been **developed**

Question 215

Which is the **greatest** cause of **human radiation effects** in dental radiographs? 1. Lysis of proteins 2. Destruction of enzymes 3. Free radicals of water 4. Mutations

Answer 215

c. **Free radicals of water**

Question 216

**Cell sensitivity** to radiation is **most pronounce**d: 1. During mitosis 2. During periods of increased metabolism 3. During embryonic development 4. In mature bone

Answer 216

d. **In mature bone**

Question 217

Which of the following **controls** the **penetration ability or quality** of the x-ray beam? 1. kVp, high kVp creates short wavelength 2. mA, high mA creates short wavelength 3. mA, high mA creates long wavelength 4. kVp, high kVp creates long wavelength

Answer 217

a. **kVp**, high kVp creates **short wavelength**

Question 218

Which of the following represents the **frequency** with which **dental radiographs should be taken?** 1. Every 6 months 2. Annually 3. Every 12-18 months 4. Determined by patient’s dental and clinical history 5. Determined by patient dental, medical, and clinical history

Answer 218

e. Determined by patient **dental, medical,** and **clinical history**