REPORT FROM COMMITTEE ON EDUCATION STANDARDS, IAMDMFR. JUNE ...Document Transcript
REPORT FROM COMMITTEE ON EDUCATIONSTANDARDS, IAMDMFR. JUNE 1997 Members of committee Laetia M Brocklebank, UK Hans-Goran Grongahl, Sweden Agnar Halse, Norway Kanji Kishi, Japan Stephen Matteson, USA Tae Won Park, Korea Irmela Reuter, Germany Madeleine Rohlin, Sweden Keiji Tanimoto, Japan Xandra L Velders, The Netherlands Ann Wenzel, Denmark Stuart C. White, USA
ContentsPreface1 General Issues2 Undergraduate Education3 Postgraduate Education4 Proposal for Future Tasks of the CommitteeEnclosures1. Ad hoc curriculum committee report to draft guidelines for the teaching ofundergraduate dento-maxillo-facial radiology. Issued 1988.2. Address list of members of the committee.3. Article “Global trends in oral and maxillofacial radiology education”. Oral Surg OralMed Oral Pathol Oral Radiol Endod 1995;80:517-26 by Rohlin M, Hirschmann PN andMatteson S.4. Curriculum of undergraduate education in oral radiology from the Royal DentalCollege, University of Aarhuss, Denmark, by Professor A Wenzel.5. Article “Manual for developing and formatting competency statements”. J Dent Educ1994;58:361-6 by Chambers DW and Gerrow JD.6. Article “The rationale behind problem-based learning” by Schmidt HG.7. Regulations for the Diploma in Dental Radiology, The Royal College of Radiologists.8. ABOMR Application Information for Diplomate Status, USA.9. Abstract of the curriculum for specialist training in maxillo-facial radiology, Sweden.
PREFACEThe Committee on Education Standards was established at the General Assembly of the10th Congress of the International Association of Dento-Maxillo-Facial Radiology(IADMFR) in Seoul Korea, 1994. As President of the IADMFR, Professor Allan Farmanof University Louisville (Kentucky, USA) took the responsibilities of ensuring theprogress of the committees appointed. Professor Madeleine Rohlin, Lund University(Malmo, Sweden) was appointed chairperson of the Committee on Education Standards.Prior to the Committee on Education Standards, an ad hoc committee consisting of ARuprecht (chairperson), LM Brocklebank, C-O Henrikson, N Serman and NJD Smithprepared a report on undergraduate education in dento-maxillo-facial radiology. Thisreport (Enclosure 1) was published in the IADMFR-1994-Seoul, Korea. A workshop onundergraduate education was held on the 9th Congress of IADMFR in Budapest,Hungary, 1991. There was a vivid discussion, which was summarized and published inthe IADMFR Newsletter Winter 1991-1992.The Committee on Education Standards is conscious of its responsibility to promotedental education. Member’s experience in dental education may be different, asacademic learning in different countries appeals to different intellectual abilities.However, we are united on a common belief that education at all levels leads toimproved oral health. Better-educated students make better practitioners, better able todeliver an enhanced quality of oral health care. Dental education experiences an excitingphase of development worldwide. Innovations of dental education occur at the level ofdental school, department, or the individual course and range from computer-assistedlearning to attitude development and student assessment. As a radiologist I want tophrase it in this way: “Learning is in focus”. Learning is a philosophy and should belooked upon as a process. Teaching is intended to support the student’s learning and tostimulate the active curiosity and alertness needed for the complex tasks of clinicalpractice. If life-long learning is accepted by all practitioners this will generate a need foreducators to promote and evaluate the effectiveness of programmes, both for continuingprofessional development and postgraduate training for specialization. Thus, our aim isto stimulate our future colleagues and our colleagues in striving to develop theirprofessional competence.As a Swedish proverb says: “It is a question of whetting the appetite rather than spoon-feeding it.” (Det galler att vacka aotiten, inte att mata).Malmo in June 1997Madeline Rohlin1 General Issues1.1 Members of the Committee
Laetia M Brocklebank, UKHans-Goran Grongahl, SwedenAgnar Halse, NorwayKanji Kishi, JapanStephen Matteson, USATae Won Park, KoreaIrmela Reuter, GermanyMadeleine Rohlin, SwedenKeiji Tanimoto, JapanXandra L Velders, The NetherlandsAnn Wenzel, DenmarkStuart C. White, USAThe intention is not to make this Committee exclusive but to increase the number ofmembers gradually. It is the mention to invite those who are interested in educationalissues. We hope that you feel free to contact any of the members of the Committee.Addresses are presented in Enclosure 2.1.2 CommunicationsLetter 1 was sent on December 29, 1994 to ask colleagues to join the Committee. The“IADMFR-objectives of undergraduate education”, an example of EC-objectives ofundergraduate education prepared by Ann Wenzel in Aarhus, Denmark, and theSwedish curriculum of specialist training were enclosed.Almost all colleagues who received the letter were positive were to join the Committee.However, representatives from some countries, even continents, are still missing.Letter 2 was sent on March 30, 1995. Two subgroups were formed: - the group on postgraduate education and the group on undergraduate educationThe members were asked to answer two questions on the specialty in oral andmaxillofacial radiology. They were also asked to send short descriptions onexaminations of the undergraduate education. A glossary for the definition of objectives,a paper on problem-based learning (PBL), the Regulations for the Diploma in DentalRadiology for UK and Application Information for Diplomate Status for USA wereenclosed in letter 2.Excellent examples on examinations/assessments were received. Furthermore,suggestions on postgraduate as well a undergraduate education were included.Interim meeting on November 8, 1995 in Cologne, Germany. The main topic of thismeeting was specialist training. There were diversities among the members whether thespecialist should serve as a clinician or as a researcher. It was concluded that astrategic plan presenting visions, goals, and action plans was needed for the Committee.Article “Global trends in oral and maxillofacial radiology education”. Oral Surg Oral MedOral Pathol Oral Radiol Endod 1995;80:517-26 written by Rohlin M, Hirschmann P Nand Matteson S (Enclosure 3).
2. UNDERGRADUATE EDUCATION2.1 Members of the subgroup are:Laetitia Brocklebank, Agnar Halse, Tae Won Park, Irmela Reuter, Madeleine Rohlin,Xandra Velders, Ann Wenzel and Stuart White.2.2 ObjectivesAs mentioned above a curriculum with guidelines for the teaching of undergraduatedento-maxillo-facial radiology was presented 1988. During the last 10 years severalinnovative changes in educational thinking have occurred. In Europe sectoral directiveswere issued in respect to dentistry, Medicine, Veterinary Medicine Architecture,Pharmacy, Nursing and Midwifery to promote convergence towards acceptability highstandards of education and training within the European Union. Directive 78/687/EECprovides a list of subjects to be studied in dentistry. Professor Ann Wenzel from Aarhus(Aarhus University, Denmark) has prepared a curriculum in Oral Radiology (Enclosure 4)that has been formally accepted according to the directives.Another major contribution to dental education was the study by the Institute of Medicine(IOM) in the United States. The study carried out was “to assess dental education in theUnited State sand make recommendations regarding the future”. The report wassummarized as “Dental Education at the Crossroads – Summary”. The report and eightbackground papers developed to assist the report were published in the Januarybackground papers developed to assist the report were published in the January 1995issue of the Journal of Dental Education.Overall there is an increasing stress on the staff of dental and medical schools to identifythe core competencies of their graduates. An integrated approach to competence is oneway to capture the complexity of practice. This defines competence as a complexcombination of knowledge, attitudes, values, and skills necessary for performance indifferent situations. There is some confusion on how to phrase this approach. IN thearticle “Manual for Developing and Formatting Competency Statements” which was sentto the members of the Committee, several key terms are discussed. (Enclosure 5)Based on the presented changes the members of our Committee were asked if weshould modify existing objectives which are presented in Enclosure 1. The majorityanswered NO. A few members suggested that we should discuss the objectives orallywhen together. Objectives on digital radiography should, however, be added.2.3 Educational processThe numerous names such as action learning, case-based education, competency-based education, contextual learning, problem-based learning and self-directed learningreflect an interest for the educational process. There is an increasing stress on learningand on human competence to cope with change and the unknown. In problem-basedlearning (PBL) which is one way to meet these demands, the control of the learningprocess is transferred from the teacher to the students. As the members f the Committeeexpressed an interest to know more about PBL a short description of PBL was sent tothem (Enclosure 6)
2.4 Information on Computer Aided Instructions (CAI)-programs*ACTA has several in Dutch; “Anatomic landmarks” available also in English/Swedish inSeptember, 1995*Aarhus, Denmark, has approximately 15 programs running. Some of them are inEnglish.*UCLA: ORAD (Oral Radiographic Diagnosis) described by White SC. Computer-aideddifferential diagnosis of oral radiographic lesions. Dentomaxillofac Radiol 1989;18:53-4.*NorDig, a group chaired y Professor Hans-Goran Grondahl, consisting of thedepartments of oral radiology in all Scandinavian dental schools, works on thedevelopment of several programs.2.5 Examinations/assessmentsThe members enclosed excellent examples of different types of examinations. There aremultiple-choice questions, short essay questions and modified essay questions, whichevaluate knowledge. There are also examples on how to evaluate skills.This topic will be discussed during the 11th Congress of IADMFR in Louisville, USA,1997.
3 POSTGRADUATE EDUCATION.3.1 Members of the subgroupHans-Goran Grondahl, Kanji Kishi, Stephen Matteson and Keiji Tanimoto3.2 Specialist training in oral and maxillofacial radiology in different countriesCountry Length of Education Certified byBrazil 2 University Board Federal Council of DentistryCanada 2-3 Canadian Dental Association Royal College of Dentists of CanadaChile 1.5 University Board and Chilean Society of Dental RadiologyFinland 3 University BoardJapan 3Sweden 3-4 Board of Health and WelfareUnited Kingdom 4 The Royal College of RadiologistsUnited States 2-3 American Board of Oral and Maxillofacial Radiology3.3 Motives for the specialtyIn letter 2 we formulated based on our individual experience from our own country theideas on the specialty in oral and maxillofacial radiology. The following two questionswere posed: - For what purpose are specialists in oral and maxillofacial radiology needed? - Why should be any specialists in oral and maxillofacial radiology?The answers varied and were mainly influenced on which country the member was from.Some statements are cited:“Whether a specific country should accept a specialty in oral and maxillofacial radiologyis a function of tradition, economic situation, skill levels, public health needs and socialfabric.”“Specialists in oral and maxillofacial radiology are needed to provide patients with thebest care regarding socialized examinations fro imaging and diagnosis of diseases andabnormalities of the maxillofacial complex.”“Specialists in oral and maxillofacial radiology are needed to promote good practice inthe use of ionizing radiations through research and education.”3.4 Curriculum for specialist trainingThree curricula were distributed among the members. Those are:
* Regulations for The Diploma in Dental Radiology published by The Royal College ofRadiologists in the UK, 1993.*Application Information for Diplomate Status published by The American Board of Oraland Maxillofacial Radiology, 1993. (Enclosure)*Abstract of the Curriculum for Specialist Training in Maxillo-Facial Radiology publishedby The Swedish Board for Health and Welfare, 1993. (Enclosure 9).
4. PROPOSAL FOR FUTURE TASKS OF THE COMMITTEE There are several tasks for the Committee on Education Standards. A strategic plan presenting visions, goals and action plans is needed. Such a plan will facilitate the development of education programs which help students to become competent in solving health problems of individuals as well as of communities. Specific considerations may be different for undergraduate education as compared to postgraduate education. Below some of these specific considerations are listed: 4.1 Tasks in undergraduate education • To improve the definitions of competencies of graduates such as relevant skills, including skills in problem-solving, independence learning, critical appraisal of evidence. • To develop learning tools such as CAI_-programs in English and stimulate exchange of these programs • To improve the design of procedures and tools fro assessing student and graduate performance. • To disseminate information on improvements in undergraduate education4.2 Tasks in postgraduate educationThe need to disseminate results if clinical research and to promote concepts ofevidence-based best practice is rapidly increasing in dento-maxillo-facial radiology.Therefore we should play an important role as facilitators of the continuity of dentaleducation.When it comes to the specialty in oral and maxillofacial radiology we could discussconsiderations such as which are the minimal standards for specialty competence,definition of the specialty and should there be an international diploma?
AD HOC CURRICULUM COMMITTEE REPORT Axel Ruprecht Report of the Ad Hoc Committee to Draft Guidelines for the Teaching of Undergraduate Dento-Maxillo-Facial RadiologyThe study of Dento-Maxillo-Facial Radiology by undergraduate dental students is ofimportance, not only to the members of this organization, who devote a great deal oftime and effort to the advancement of this science, but to the dental profession at large.The study of diagnosis is part of a sound education in dental sciences, because withoutproper diagnosis all else that is performed can at best be only empirical. Radiologyforms an integral part of the diagnosis process and, thus, its study id of equal importanceto other aspects of diagnosis. Since radiology employs ionizing radiation and electricaland chemical variables in the production of images, it follows that the dentist must havea solid grasp of the principles that underlie the Physics of Radiology, if he is to produceimages of the dentist must have a solid grasp of the principles that underlie the Physicsof Radiology, if he is to produce images of tissue injury, however slight that possibilitymight be in individual cases, the dentist must understand how such injury may occur,how best to minimize the risk and how to make judgments concerning the potential riskrelative to the potential benefits of making a radiograph. This requires an understandingof radiation biology and radiation hygiene linked to the physics that underlies thesesciences.Even when these principles are properly understood and utilized the dentist will be ableto produce a technically correct radiograph only if he is familiar with the techniquesinvolved in producing specific views of areas of concern, so that radiographs whichdepict clearly the area of interest can be consistently produced. This requires not onlydidactic teaching but also clinical and darkroom experience which can be gained only ina controlled supervised environment. Once the student dentist has mastered all of thishe should be able to make those radiographs hat are required in the day-to-day practiceof dentistry.This, however, is only half the battle. Since the dentist is his own radiologist for most ofhis radiographic requirements, he must be able to interpret competently the radiographsproduced with the above knowledge and skill. This requires a thorough knowledge ofdisciplines outside the narrowly defined field of radiology. It requires that the studentdentist have a thorough knowledge of head and neck anatomy, physiology, andpathology, since all radiographs will depict images of anatomy of the area underinvestigation, its variants (based not only on developmental variation, but on function inits broadest sense) and changes due to pathological processes. It is assumed thatstudents will have acquired this requisite knowledge for various parts of the radiologycourse. What is required, however, is that the prerequisite knowledge for carious parts ofthe course be learned prior to the study the specific area of radiology. For example, it isnot necessary to have mastered anatomy when the student is studying the physics of x-ray production, but it is necessary when he starts to learn about the various areas underinvestigation. No attempt is made here, nor is any implication intended, as to how thesevital prerequisite subjects should be taught and by whom. What is important to us is thatthey be taught adequately and at the proper time.We present a curriculum outline that should be seen as a guideline of what to teach, withsuggestions as to how and when appropriate. We do not suggest that the outline need
be followed to the letter. Indeed, we should be disappointed if all institutions were toattempt to implement the outline without question. This would rob the field of Dento-Maxillo-Facial Radiology of a rich diversity from which come experimentation andchange which ultimately lead to advances. Also, what works well in one area, given theresources and expertise available could well be a disaster elsewhere. We present this asa guide of what should be included in a course in radiology to assist those who aresetting up courses, revising older courses, or who wish to have a comparison to see iftheir own courses are deficient in any area.It is our hope that this document will not just be filed away, but used and updatedfrequently. It is written on a word processor to allow for easy change, not carved intotablets of stone, to be preserved, immutable, for all ages.A. Ruprecht (Chairperson) June 3, 1998L.M BrocklebankC. O HenriksonN. SermanN.J.D. Smith
I. RADIATION PHYSICSI.A. Production of X-Rays The material to be presented should include the atomic interactions that lead tothe production of x rays, the circuitry that is required to produce these interactions, andthe effect of various electrical factors (kVp, mA and time). Wavelength and themechanism by which scattering of the primary beam occurs should be explained. Theconstruction of the unit housing, including collimation, filtration and position – indicatingdevices should be explained. The material presented in this section will provide the student with sufficientknowledge to make decisions regarding techniques that are based on a properconsideration of the consequences of these decisions, not on rote memory that does notallow modification when required.I.B. Interaction of X-rays The material presented will enable the student to base his decisions aboutradiation protection, as well as interpretation; on a clear understating of how x raysinteract with matter, and the effect of material within the path of the beam.I.I. RADIATION BIOLOGY AND RADIATION PROTECTIONII.A. Radiation BiologyThe interaction between ionizing radiation and biological tissue constitutes the base forradiology. This interaction will inevitably produce physical, chemical, and biologic effectsas a consequence of ionization with the tissue. In order to understand the processesfollowing ionization it is necessary to have some fundamental knowledge of the effect ofradiation, and the reactions of specific tissues, somatic and genetic, to it.II. B. Radiation Protection The use of radiation in DMF radiology is necessary to provide ssential information of diagnostic value for the individual. To ensure that radiation is used wisely, it is necessary to acquire knowledge about the connection between dose and risk, so that the individual, as well as the collective, dose can be kept to acceptable levels by means of adequate radiation protection. The risk for the individual, as well as for the population, will then be so low that most indicated examinations may be performed. The level of indication is influenced by the knowledge of the diagnostic efficacy of the examination, its technical standard and the ability of the examiner to make a proper interpretation.II. B. 1 One fundamental base for radiation protection is the technical design of the x-ray machine, the image receptors and the darkroom.II. B. 2
Another fundamental base for radiation protection is a proper handling of the x- ray equipment, adequate shielding for adequate examination, proper equipment alignment, and processing techniques.II. C. Quality Control Quality Control and record keeping in DMK radiography should be described in sufficient detail to allow the operator to meet all government regulations and professional standards.III. PRODUCTION OF THE RADIOGRAPH: TECHNIQUES AND DARKROOMIII.A. TechniquesThe course on production of the radiograph should be designed to provide the studentwith an understanding of the theoretical aspect s of producing a radiograph andadequate experience of putting this theory into practice, as demonstrated bycompetence at executing oral radiographic techniques.It is strongly recommended that all techniques are first practiced on manikins and/or dryskulls and that competence is demonstrated in each technique before the student isallowed to carry out radiographic examination of patients.III.A.1Theoretical knowledge and practical experience in this section is designed to enable thestudent to decide on the appropriate radiographic technique to be used to produce aradiograph of a given area, to expose the film using the proper technique, process thefilm, evaluate the radiograph for diagnostic acceptability and correct any faults that haveoccurred in the production of the radiograph.III.A. 2Projection geometry in intraoral radiographic techniques, and its effect on imageproduction should be described. Specific geometry as it relates to specific views will beconsidered in detail.III.A. 3Image receptor systems (film and film-screen combinations) should be described.Screen-films and non-screen films will be compared, especially how each is affected byx-rays to produce the latent image. Exposure factors and their influence on radiographicdensity and contrast should be explained.III.A. 4The production of extraoral radiographs should be dealt with, at least to the extent thatthe more commonly used views are explained to the student. This area will be the mostvariable, depending on geographic location and types of patients to be seen, but an
introduction to the major types of extraoral radiographic examinations should beincluded.III. B.The processing of a film to produce the finished radiograph should be considered. Theeffect of the various chemicals on the emulsion will be discussed. Common techniqueand processing errors will be taught, both from the point of view of how and why theyoccur, and how to determine what the causes of specific errors are when they are firstseen.III.C.The proper orientation for mounting, viewing and labeling of radiographs should bestresses, showing what diagnostic problems can arise if not properly carried out. Theproper viewing conditions are described here, showing why various factors areimportant. These will be reinforced in the interpretation section of the course.III.E.Practical (tutor) demonstrations may be given fro various aspects of radiography. Theseare listed in Appendix A.III. F.Practical experience should be gained in all intraoral techniques, and in those extraoraltechniques that are emphasized regionally, and are within the remit of locally practicingdentists e.g. panoramic radiography, oblique lateral jaw radiography. The student shouldat the end of his training be able to demonstrate competence in all techniques andprocedures in which he has received instruction; adequate experience may be obtainedthrough the use of clock hours or number of procedures.It is strongly recommended that all techniques are first practiced on manikins and/or dryskulls and that competence is demonstrated in each technique before the student isallowed to carry out radiographic examination of patients.Appendix B lists those areas in which the student become competent by supervisedpractical experience.Appendix B lists those areas in which the student should become competent bysupervised practical experience.IV RADIOLOGIC INTERPRETATIONIV. A.Radiologic interpretation represents the goal of all else that has been done inradiography prior to this step. Before this phase can be undertaken, the student musthave a thorough knowledge of all steps that have gone before, inasmuch as each oneaffects the image produced and must be taken into consideration in the interpretation. Aswith the previous section the tenets of radiologic interpretation require a didactic(lecture/seminar) and a practical (clinical) component. It is not necessary that all aspectsbe taught by the members of the radiology department, but it is important that there beconsistency in terminology presented to the student. This terminology varies from areato area, and thus no attempt will be made here to present a list that should be universallyused. Although this might be a valid goal in itself, it is beyond the mandate of thecommittee. The teaching of interpretation can be divided into sections that deal with
normal and abnormal, and then in many subsections. The exact content in each sectionwill be influenced by the techniques and equipment used in each institution.IV. BNormal radiographic anatomy must be well understood, both in its classis form and withits many variations. The material presented should be relevant to the population(s) thatthe student will encounter, in the dental school and in practice, but should includeexamples from other groups so that an appreciation of variability is fostered.The normal appearance, together with common variations, of all dental and skeletalstructures in the dento-maxillo-facial region, as demonstrated by intraoral and commonextraoral views should be taught in depth.IV C. Pathological processes that manifest on radiographs cause changes in theappearances of normal anatomical structures. The lesions and processes that should beincluded in a didactic radiology course includeIV.C.1. developmental anomalies and disturbances of the teeth, the jaws and the faceIV.C.2 pathological processes in dental hard tissuesIC.C.3 infection/inflammation of the jawsIV.C.4 periodontal diseasesIV.C.5 cysts and tumors of the jaws of odontogenic originIV.C.6 cysts and tumors of the jaws of non-odontogenic originIV.C.7 diseases of bone manifested in the jawsIV.C.8 systemic disease manifested in the jawsIV.C.9 pathological calcification and ossification of the soft tissuesIV.C.10 dysplastic/fibro-osseous lesionsIV.C.11 injuries to DMF regionIV.C.12 diseases of the TMJIV.C.13 disease of the paranasal sinusesIV.C.14 diseases of the salivary glandsIV.C.15 effects of irradiation upon teeth and the jaw boneEach of these broad areas can be expanded to include those lesions prevalent in agiven geographical location. For example, if fluorosis is common in an are it would becovered under developmental anomalies. The great interest in so-called TMJ problems
requires that students/practitioners learn what can and what cannot be seen on views ofthe joint. In all such lectures it is assumes that indications, lack of indication, contra-indications for radiographic investigation of certain problems will be included.Students must also have the opportunity to use the knowledge acquired in lectures, toorganize it in a useful format so that for example they know (in simplified form) not onlythat a cyst has a hydraulic appearance, but also, conversely, that a radiolucent lesionwith a hydraulic appearance might be a cyst.There are two possible methods, which are complimentary, not mutually exclusive.One is the controlled method, such as clinical radiologic conferences when the instructorcan determine which types of lesions will be reviewed, ensuring that the student seethose that are necessary.The other is the random method, which occurs when students interpret radiographs ofpatients in the clinic as they occur. This does not assume that all lesions are presented,but does give realism to the learning. In this second exercise students learn how to writeproper radiology reports that can be clearly understood by other practitioners.Both should be under close supervision and review of a trained instructor.
Appendix APRACTICAL (TUTOR) DEMONSTRATIONS FOR VARIOUS ASPECTS OFRADIOGRAPHYA.1 image receptorsA.2a. film packets i. construction ii. handling iii. orientationA.2.b cassettes i. construction ii. handling iii. mode of functionA.2.c films i. construction ii. handling iii. differences in size and speed iv. proper storage before useA.2 darkroom use i. elimination of white, use of safe-lights and testing of blackout efficiency ii. care of equipment iii. chemical storage iv. general organization v. film identification methodsA.3 processing i. correct use of chemicals and containers ii. use of manual and automated systems iii. trouble shooting iv. quality controlA.4 film holders i. construction and specific uses ii. sterilization iii. relation between film holders and collimatorsA.5 the x-ray machine i. exposure variables and their selection ii. avoidance of unnecessary irradiation iii. filtration of the beam iv. collimation of the beam v. warning devicesA.6 protection measures i. for the patient ii. for the operator
iii. for the publicA.7 intraoral radiography techniques on manikins and dry skulls with radiation exposure, and on individuals for positioning demonstration only without radiation exposure except in those cases where films are required for diagnostic evaluation. Film packet immobilization should be carried out by non-manual means. Modification of techniques to suit individual situations, e.g. endodontic radiography, should be demonstrated.A.8 correct use of extraoral and intraoral landmarks and of film holders in order to minimize repeats due to technical errors such as cone cutting, incorrect horizontal angulation, incorrect vertical angulation.A.9 assessment of patient (type, condition) for modification of exposure factors.A.10 film identification and viewing i. use of anatomical landmarks ii. purpose of raised dot iii. correct arrangement iv. mounting and labeling v. records vi. storageA.11 extra-oral radiographic techniques i. patient positioning ii. film position iii. tube angle and centering iv. exposure values v. identificationA.12 duplication of radiographsA.13 quality control i. processor/chemical ii. darkroom, including white light and safelight leaks iii. unit output iv. storage of films and chemicals in main stores v. storage of films in x-ray roomsA.14 decontamination i. disinfection of the x-ray room ii. disinfection of the darkroom iii. sterilization of film holders and other instrumentsAppendix BAREAS IN WHICH THE STUDENT SHOULD BECOME COMPETENT THROUGHSUPERVISED PRACTICAL EXPERIENCE
B.1 film packets and cassettes i. handling of both in the operatory and the darkroomB.2 processing i. manual methods emphasizing time/temperature control ii. automated methods iii. error recognition and correctionB.3 film holders i. assembly ii. use iii. sterilization and maintenanceB.4 intraoral radiographic techniques i. relevant exposure settings ii. radiation protection and hygiene measures iii. bitewing technique iv. paralleling technique for periapical radiographs v. occlusal techniquesB.5 intraoral radiographic techniques i. patient positioning ii. film position iii. tube angle and centering iv. exposure values v. identification Enclosure 2Address Phone FaxLaetitia M. Brocklebank 44-41-2119640 44-41-2119800Dept of Oral RadiologyGlasgow Dental Hospital and School378 Sauchiedal StreetGlasgow, G2 3JZ, Scotland, UKHans-Goran Grondhal 46-31-7733000 46-31-827351Dept. of Oral RadiologyFaculty of OdontologyMedicinaregatanS-413 90 Goteborg, SwedenAgnar Halse 47-55-206598 47-55-206494Dept of Oral RadiologySchool of DentistryArstadveien 17N-5009 Bergen, Norway
Keith Horner 44-61-2756690 44-61-2756840Dept of Dental and Maxillofacial RadiologyTurner Dental SchoolUniversity Dental HospitalHigher Cambridge StreetManchester M15 6FH, EnglandKanji Kishi 81-862-237151 81-862-224572Dept of Oral RadiologyOkayama University Dental School5-1, Shikata-cho, 2 chomeOkayama City, JapanStephen Matteson 1-210-5673334 1-210-5673334Dept of Dental Diagnostic ScienceUTHSCSA7703 Floyd Curl DriveSan Antonio, Texas 78284-7919, USATae-Won Park 82-2-7602620 82-2-7408742Department of Oral and Maxillofacial RadiologyCollege of DentistrySeoul National University28 Yeun Gun-Dong Chong Ro-KuSeoul 110-744, KoreaAddress Phone FaxIrmela Reuter 49-251-837168 49-251-87184Institut fur Zahnarztliche RoentgenologiZentrum fur Zahn-, Mund- und KeiferheilkundeWaldeyerstrasse 3048129 Munster, GermanyMadeleine Rohlin 46-40-322013 46-40-322023Dept of Oral RadiologyCentre for Oral Health SciencesCarl Gustafs vag 34S-214 21 Malmo, SwedenKeiji Tanimoto 81-82-2575691 81-82-2575692Dept of Oral and Maxillofacial RadiologyHiroshima UniversitySchool of Dentistry1-2-3 Kasumi, Minami-kuHiorshima, 734, JapanXandra L. Velders 31-20-5188398 31-20-5188480Dept of Oral RadiologyACTA Louwesweg 1
1066 EA Amsterdam, The NetherlandsAnn Wenzel 45-86-132533 45-86-196029Dept of Oral RadiologyRoyal Dental CollegeAarhus UniversityVennelyst BoulevardDK-8000 Aarhus C, DenmarkStuart C. White 1-310-8255711 1-310-2065539Section of Oral RadiologySection of Oral RadiologySchool of DentistryUCLA10833 Le Conte AvenueLos Angeles, CA 90024-1668
Enclosure 4CURRICULUM OF UNDERGRADUATE EDUCATION IN ORAL RADIOLOGYROYAL DENTAL COLLEGE, UNIVERSITY OF AARHUS, DENMARKDr. Anne Wenzel ORAL RADIOLOGYORAD4-1 RADIOLOGY (techniques + anatomy) lec sem lab pcl cli additional CAL – course (techniques)9 4 4ORAD4-2 CLINICAL ORAL RADIOGRAPHY (intraoral) 5ORAD5-1 PATHOLOGY OF THETEETH AND JAW BONE10 (develop, anomalies, caries, resumptions, cysts, infections, trauma)ORAD5-2 CLINCIAL ORAL RADIOGRAPHY (intra-+extraoral) 10ORAD6-1 RADIOLOGY (instruments, radiophysics, and digital 6 radiology, x-ray hygiene and riscs) additional CAL-courses 5ORAD6-2 PATHOLOGY OF THE SKULL AND TMJ8 (tumor, TMJ, and salivary, differentials)ORAD6-3 CLINCIAL ORAL RADIOGRAPHY 10 (extraoral – spec. TMJ)TOTAL 33 9 4 25
GENERAL OBJECTIVESHaving attended the course in oral radiology, the student must be capable of1.Using his radiographic equipment optimally in due consideration of the radiation risks.2.Performing intraoral radiographic and the most common extraoral radiographicexaminations on patients in dental practice.3.Interpreting radiographs and, by comparing the images with the clinical findings, attainto a diagnosis in due consideration of differential-diagnostic problems.LiteratureRecommended:Goaz PW, White SC: “Oral Radiology – Principles and Interpretation”. CV Mosby Comp.,St. Louis, 1987Sewerin I (Ed): “Radiation biology and protection”. Danish Dental Association,Copenhagen, 1990 (in Danish)Sundhedsstyrelsen: “Bekendtgorelser om dental rontgenanlaeg- nr. 217 af 29. April1977” (in Danish).Additional:Computer Assisted Learning Programs (approx. 20 programs in English and Danish).EvaluationCourse certificate and a written 4-hour examination after 6th semester.CREDIT VALUE FOR RADIOLOGY 8 points
Teaching objectives in Oral Radiology, Royal Dental College, University of Aarhus.AIMHaving attended the course in oral radiology, the student must be capable of5.1 Using his radiographic equipment optimally in due consideration of the radiation risks. Performing intraoral and the most common extraoral radiographic examinationson patients in dental practice. Interpreting radiographs and, by comparing the images with the clinical findings,attain to a diagnosis in due consideration of differential – diagnostic problems.5.2 Physics and radiation biologyThe student must be capable of1.1 defining x-rays1.2 explaining how they are produced1.3 describing their characteristics1.4 defining how they are applied1.5 providing protection against their harmful consequences1.6 surveying radiation protection of any operator, patient or persons who arecasually present within the x-ray monitored area.Thus, the student has to attain a positive attitude to active radiation protection of thesethree categories, specifically by continuously monitoring passive radiation protectioncombined with an optimal active radiation hygiene in each case. The definition ofpassive radiation protection is: the protection provided by an appropriate set-up as wellas installment and use of radiographic units. The definition of active radiation protectionis: the correct procedure at radiographic examination.2. Projection geometry, exposure, film, and darkroom techniques2.1 Basic projection geometry. The student must be capable of describing.2.1.1 the rules for how 3-dimensional radiolucent and radiopaque structures aretransformed into a 2-dimensioanl radiograph,2.1.2 the image distortion due to form and size of the focal spot,2.1.3 the image distortion due to the diverging x-ray beam.2.2 Intraoral technique. The student must be capable of describing2.2.1 the theory of the bisecting angle technique, and of performing radiographs by useof this technique,2.2.2. the theory of the paralleling technique using long cone and filmholder, and ofperforming radiographs by use of this technique; in addition, of performing2.2.3 standard radiographs of the dentition, e.g. a 14-film survey,2.2.4 bitewings of premolars and molars,2.2.5 occlusal plane radiographs: semiaxials, symmetric and asymmetric, of the mandibular and maxillary regions, and axials of the mandible,
2.2.6 eccentric exposures,2.2.7 exposures ad modum Le Master2.3 Extraoral techniques. The student must be capable of performing radiographsof:2.3.1 The TMJ: in the oblique lateral, transphrayngeal, transmaxillary, and postero- anterior projections2.3.2 the maxillary sinus: in the lateral and postero-anterior projections,2.3.3 the skull and jaw bones, and axial projections2.4 Extraoral technique. The student must be capable of defining the orthopantomographic, the cephalographic, and the cranial table techniques; and to account for the theoretical background behind the equipments.2.5 Extraoral technique. The student must be capable of describing the principle of tomography.2.6 Film and image display. The student must be capable of describing the basis for conventional silver-halde-based film imaging and for digital imaging.2.7 Photograph technique. The student must be capable of describing the processing technique form the phase of exposure to the finished radiograph, and of performing the developing process of standard radiographs.3. Indication for and interpretation of radiographs3.1 The student must be capable of defining the most relevant radiographs3.2 The student must be capable of describing the principles of contrast injection in the salivary gland – and TMJ region3.3 The student must be capable of detecting unsuccessful radiographs and of identifying errors in exposure, film handling, and processing.3.4 The student must be capable of identifying normal anatomic structures, and of detecting deviations from normal structures on the below types of radiographs:3.4.1 all intraoral radiographs,3.4.2 orthopantomograms, cephalograms, and TMJ radiographs.3.5 The student must be capable of stating a radiographic diagnosis of disease in the teeth and jaw bones:3.5.1 anomalies in the tooth structure, development, position, and number.3.5.2 deviations in tooth eruption,3.5.3 dental caries and subsequent conditions3.5.4 the marginal and apical periodontal bone,3.5.5 conditions caused by traumas of the teeth and jaws.3.5.6 foreign bodies3.5.7 resorptive processes of teeth and adjacent regions,3.5.8 infection processes, degeneration processes, benign tissue formations, cysts, and tumors in the jaw bones,3.5.9 TMJ diseases,3.5.10 diseases of the maxillary sinus,3.5.11 diseases of the salivary glands5.3 the total course in oral radiology, i.e. the theoretical as well as the clinical teaching, is mandatory. Seminar attendance is checked by student signature, and clinical attendance by the supervisors in the radiography clinic. Having completed the clinical course and received the course certificate, the student enrolls for the final exam. This is a 4-hour written examination consisting of 15 multiple-choice questions and 10 patient cases described by clinical information and radiographs. The student is to answer questions regarding radiographic
techniques, normal anatomy, and tooth and bone pathology based on thesecases. An external censor (head of the Oral Radiology Department atCopenhagen University) together with the head of Oral Radiology Department atthis Institute evaluate students’ answers resulting in a grade (scale from 0 to 13).Approximately 60% correct answers imply the grade “6” which is the minimum forpassing the exam.
THE ROYAL OF RADIOLOGISTSTel: 071-636-4432 38 PORTLAND PlaceFax: 071-323-3100 LONDON W1N 3DG Regulations for the Diploma in Dental RadiologyTo be eligible to commence training candidates are required:(a) to have had two years of clinical experience after qualification;(b) to have Registration with the General Dental Council (either Full or Temporary) if training is to be undertaken in the United Kingdom.All trainees must enroll with Royal College of Radiologists at the commencement oftraining. Heads of Training Departments should ensure that trainees are aware of thisrequirement and that they comply with regulations concerning clinical experience.TrainingThe minimum full time training is two years, which must be spent in departments fullyrecognized by the Royal College of Radiologists. During this time, the trainee shouldobtain experience of IV injections, CT scanning, ultrasound, and MRI.An academic year of training is required for the Part I examination, not less than halftime receiving instruction in general and dental radiology and the remainder preferably inother relevant general dental hospital work. There must also be a period of secondment,equivalent to a minimum of six weeks full time, to a General Radiology Department. It isrecommended that the initial three weeks of this period should be spent as a blockallocation.One further year of full time, or two years’ half time, training is required for the Part IIexamination. This must include a period of secondment, equivalent to a minimum ofeight weeks full time, to a General Radiology Department, for which there must be adefined programme.ExaminationsPart I The DDR Part I examination comprises the following subjects:(1) Physics, apparatus, photography and film faults.(2) Radiological anatomy and radiography(3) Principles of modern imaging techniques and procedures, and the use of contrast media and drugs.Candidates are allowed only four attempts that the Part I examination. The examinationis held twice each year in June and September. The examination consists of: (a) multiple choice question paper (b) A written paper in subjects (1) and (2) above (c) A film viewing session (d) Two oral examinations
Part II the examination is held in October of each year and consists of:(a) Two three hour written papers pertaining to dental radiology, maxillo-facialimaging and general radiology. Oral pathology and clinical aspects will be included inthese papers.(b) An oral examination. In order to pass the examination as a whole, it is essentialfor a candidate to obtain a pass standard in the oral part. A candidate can compensateto some extent for a slightly weak performances in the written part by performingparticularly well in the oral examination.An essential requirement for taking the examinations is certification by the Head ofDepartment concerned that the course of instruction has been completed satisfactorily.No exemption is granted from any part of the examination. Candidates who withdrawfrom part of any examination will be deemed to have failed the examination as a whole.SyllabusA syllabus is available free of charge from the Examinations Secretary of the RoyalCollege of Radiologists.Examination FeesDetails of examination fees may be obtained form the Examination Secretary. If acandidate withdraws after the closing date for an examination, the whole of theexamination fee is forfeit. The college may make exceptions to this rule in specialcircumstances. Cheques for examination fees should be made payable to “The RoyalCollege of Radiologists”.DiplomaEach successful candidate will receive a diploma.AccreditationApplication for a certificate of Accreditation may be made by holders of the DDR oncompletion of the equivalent of three years full time recognized training. Full timeresearch, experience in related clinical fields, or time spent gaining specialist experienceis encouraged but may not be counted wholly towards the accreditation period. Approvalby the Royal College of Radiologists should be obtained prospectively if accreditation isto be sought for such experience. Each candidate approved for accreditation will receivea certificate on payment of the required accreditation fee.March 1993. THE ROYAL COLLEGE OF RADIOLOGISTSDIPLOMA IN DENTAL RADIOLOGY: PART I
The syllabus is based on these objectives. It has been constructed so that all lecturesand formal tutorials for Part I DDR training can be accomplished in the equivalent of twosessions per week, with the physics portion designed so that it can be covered in 40hours of formal teaching. This will allow training departments to arrange for each traineeto spend at least five sessions per week in radiological environment. The collegestrongly supports the principle that trainees should participate in the work of theirdepartments as far as practically possible and as early as possible in their training.The general comments, which introduce each of the following sections, are intended tohelp define the level of knowledge, which will be tested in the examination. Although thesyllabus for the physics section is set out in greater detail, trainees and teachers shouldrealize that this section would contribute only on third of the marks of the wholeexamination.
THE SYLLABUS1.0 RADIOLOGICAL ANATOMY AND TECHNIQUES1.1 Radiological Anatomy General comments:The candidate should be familiar not only with the basic anatomy relevant to all thecommon radiological examinations but should also be familiar with cross-sectionalanatomy in the axial, coronal, sagittal and, where appropriate, oblique planes. Aknowledge of normal anatomical variations will be expected. It is expected that theformal teaching course will build on the anatomical knowledge already expected of aradiological trainee, in much the same way as the interpretation of radiologicalabnormalities is built on a sound knowledge of basic pathology.Candidates should know the normal dental development of the growing child.Detailed knowledge of the normal radiological anatomy of:(a) The skull and facial bones; including the teeth and their development, the temporo-mandibular joints, the paranasal sinuses, the orbits and salivary glands.(b) Pharynx, larynx major blood vessels and lymph nodes in the neck.A broad knowledge of the radiological anatomy of:(a) Cervical spine, brain(b) The respiratory system and cardiovascular system(c) The abdomen1.2 Radiological Techniques1.2.1 The candidate will be expected to show familiarity with, and experience of, everyday investigations. A detailed knowledge is required for those techniques which a candidate is expected to have carried out personally and on his/her own during the first nine months of training in radiology.1.2.2 A broad knowledge of the basic principles underlying the techniques used in arteriography, interventional radiology, nuclear medicine, ultrasound, CT and MRI will also be expected. For these investigations, the candidate should know, in outline only, the following: Patient preparation. Radiographic apparatus used. Contrast media (see 1.3 below) Outline of technique with main variations. Principal complications and their treatment.1.3 Contrast Media, Radiopharmaceuticals and Drugs
1.3.1 Contrast Media: The contrast media to be studied are those which relate to thepractical procedures mentioned in 1.2 above. They include the contrast media in currentclinical use for radiography, computed tomography and magnetic resonance imaging.For each contrast agent the following are expected: Official name. Doses, including doses for children. Constitution (not the detailed formula). Modes of administration and the clinical uses. Routes of elimination. Relative advantages of the different types of media. Side effects and treatment of reactions. Contra-indications to use.1.3.2 Radiopharmaceuticals: The choice of radiopharmaceuticals.1.3.3 Drugs: Some knowledge is expected of those drugs – commonly used in radiological practice, including their dosage. These can be considered under the following headings: Sedation before radiological procedures. Prophylaxis and treatment of reactions to contrast media.1.4 RadiographyGeneral comments:Candidates will be expected to demonstrate a knowledge of the staff the standardradiographic projections relating to the regions outlined in the radiological anatomysyllabus (section 1.1 above). Candidates should, therefore, be able to comment on thepositioning and tube angulation used to obtain the image and should be able to givepractical advice on improving the quality of the film. A knowledge of infrequently usedprojections will not be expected.1.4.1 Knowledge of, and practical familiarity with, the following will be expected:Positioning of patients. The use of immobilizing devices and protective devices.Standard radiographic projections and angles. Correction of errors in centering anexposure.2.0 PHYSICSGeneral comments:A basic knowledge of physics is assumed.On the assumption that the whole of the physics syllabus can be covered inapproximately 40 hours of formal teaching, the hours indicated in brackets are a guide
as to how these 40 hours might be divided. The suggested time for each section is anindication of the approximate proportion of questions devoted to each topic in the MCQpart of the examination and the depth of knowledge expected in the topic.The changes in content and recommended time contained in this revision of the syllabusare designed to reflect the introduction of the newer imaging modalities.Equipment design and construction details will not be examined, but an understanding ofthe function of the equipment components relevant to image formation may be tested.A mathematical approach to the physics in inappropriate; the emphasis should be placedon a clear understanding of the physical basis of radiological practice in a qualitativesense. However, the knowledge of the approximate magnitude of quantities encounteredin daily practice will be expected, e.g. percentage transmission of X-radiation through apatient; the activity of a radionuclide used for bone scanning.Basic electricity, magnetism and mathematics are not included in the syllabus andquestions on these subjects will not be included in the examination.During formal teaching, all physics demonstration/practicals should have a directrelevance to everyday radiology.Knowledge of the principles of quality assurance, contrast resolution, spatial resolutionand noise is excepted for all the sections listed below.2.1 Ionising radiation (5 hours) Structure of the atom. Radioactivity and radionuclides: basic definition of alpha, beta and gamma radiation; principles of exponential decay, half-life, specific activity and units of activity. Electromagnetic spectrum. General properties of X and rays with matter: coherent, Compton and photoelectric interactions; concepts of attenuation, absorption and scatter – and their practical consequences.2.2 Radiation Protection (7 hours) Statutory responsibilities: an appreciation of relevant legislation and Codes of Practice. The content of the “core of knowledge” as specified by the Ionising Radiation (POPUMET) Regulations (1988) or subsequent revisions. Genetic and somatic effects of ionizing radiations. Relative risks of ionizing radiations.
The principles of dose limitation, the various practical means of dose reduction to staff and patient with special consideration of females and children. Staff and patient doses: magnitude and measurement.2.3 Production of X-rays (3 hours) The basic principles of a rotating anode X-ray Basic factors which influence X-ray output from differing types of X-ray machinery; anode material kV, mA, focal spot size, tube rating, filtration. Design and construction details will not be examined)2.4 Geometric factors and magnification, effect of focal spot size, geometric movement and unsharpness. Convention film/screen systems: basic structure: characteristic curve; latitude; density; speed; contrast and how to influence or manipulate it. Basic principles and effects of film processing. Basic principles of image intensification. Operator-controlled variables. Principles of tomography, particularly CT, with emphasis on operator-controlled variables, e.g. slice thickness, partial volume effect, field size and effect on resolution, data storage and display, pixel/voxel, window width and level, and gray scale. Basic principles of digital imaging and picture archiving and communications systems (PACS).2.5 Principles of diagnostic ultrasound (5 hours) The basic components of ultrasound system. Types of transducer and the production of ultrasound with emphasis on operator- controlled variables. The frequencies of medical ultrasound. The interaction of ultrasound with tissue, including biological effects. The basic principles of A, B, M, real-time and duplex scanning. The basic principles of pulsed, continuous wave and colour Doppler ultrasound. Recognition and explanation of common artifacts.2.6 Magnetic resonance imaging (5 hours) Basic principles and origin of the signal.
Principles of basic sequences in clinical use. Concept of T1, T2, proton density and effect of motion on signal. Magnetic field hazards to patients, staff and passers by.2.7 Radionuclide imaging (5 hours) The function of a gamma camera. Properties of radiopharmaceuticals. Static and dynamic imaging. Handling of radionuclides. Introduction to single photon emission computed tomography (SPECT) and positron emission tomography (PET).
MAXILLO-FACIAL RADIOLOGY. I. DEFINITION AND OBJECTIVES IN GENERAL The specialty of maxillo-facial radiology comprises knowledge and skills concerning the diagnostic utilization of ionizing radiations. The focus of the specialty should be on interpretation of information on the teeth, jaws, facial skeleton, oral cavity, nasal sinuses, temporomandibular joints, salivary glands and pharynx with surrounding tissues and functions. The scope of the specialty shall include diagnosis of pathological lesions, traumatic and post-surgical changes and other craniofacial deviations in individuals of all ages. Education in maxillo-facial radiology shall result in specific knowledge and skills in radiological examination techniques that have odontological applications and also in knowledge of other techniques. Knowledge of the biological, physical and technical basis underlying different diagnostic methods, equipment and different imaging processes is also required. In addition to the above mentioned, the education shall provide knowledge in stomatognathic physiology, oral surgery, oral pathology, medical radiology and ear, nose, and throat diseases (ENT). II. DIAGNOSIS IN ORAL HEALTH A. Independently and in an experienced manner be able to perform: - examination and diagnostics diseases and anatomical deviations of the teeth, jaws, and facial skeleton with the aid of optimal radiological techniques. - examination and diagnosis of the salivary glands and of the soft tissues, of the temporomandibular joints, and the nasal sinuses - cephalometric examinations and analyses B. Having good knowledge and come experience of: - existing imaging techniques for the examination and diagnostics of the functions of the oral cavity, jaws, salivary glands and pharynx C. Have theoretical examinations on and have attended the handling/examination of:- ultrasound examinations and radiological examinations of the neurocranium and the neck III. PREVENTIVE DUTIES The specialist with her/his specific knowledge shall be able to inform and advise on:
- radiation protection - radiation dosages and measurement of dosages - evaluation of radiation risks and diagnostic methods IV. COOPERATION WITHIN AND OUTSIDE THE ORAL HEALTH SYSTEM The specialist in maxillo-facial radiology gets into contact with many individuals in general dentistry, in other health specialists, in medical radiology and in other medical specialties in particular in ENT but also in oncology and rheumatology. Therefore the specialist shall be able to cooperate with representatives of all these disciplines. CURRICULUM FOR SPECIALIST TRAINING IN ORAL HEALTH decided by the Swedish Board Health and Welfare, 1993 In the general description the following issues are defined for specialist training in general: -directions -objectives -knowledge and skills common to all the specialties -time-limits (the education should be minimum 3 years. The supervisor should decide if the described objectives of knowledge, skills, and attitudes are accomplished after 3 years. If not, the education should be extended or discontinued).- certification (accreditation) of educational programs of a clinic- certification on completion of education- certificate on specialist competence that is given by the Board fro Health and Welfare- general advice on o the aims and structure of the objectives o supplementary education o supervision o quality assurance of specialist education Then there is a description for each of the eight specialties: Pedodontics, orthodontics, periodontics, oral surgery, prosthodontics, maxillo-facial radiology, and stomatognathic physiology.