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TMS-thk basis samenvatting
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Samenvatting van de lesstof en de bijhorende artikelen
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TMS-THK BASISTENTAMEN 2022 samenvatting van de lesstof en de bijhorende artikelen.
,Inhoudsopgave
College 1 - Röntgentoestel en straling ............................................................................................................... 4
Wet Besluit Basisveiligheidsnormen Stralingsbescherming (BBS)................................................................. 4
Stralingsopleiding ACTA curriculum tandheelkunde erkend ........................................................................ 4
Röntgenbuis................................................................................................................................................... 4
Verschil lek- en röntgenstraling..................................................................................................................... 4
Anode ............................................................................................................................................................ 5
Karakteristieke straling .................................................................................................................................. 5
Remstraling ................................................................................................................................................... 5
Remstralingsspectrum (volledig spectrum) ................................................................................................... 6
Effect van buisspanning (kV) ......................................................................................................................... 6
Wisselspanning .............................................................................................................................................. 6
Effect van de buisstroom (mA) ...................................................................................................................... 7
kV en mA ....................................................................................................................................................... 7
Betekenis mAs ............................................................................................................................................... 7
Filter .............................................................................................................................................................. 8
Effect filter op het remstralingsspectrum ..................................................................................................... 8
Besluit stralingsbescherming filtering ........................................................................................................... 8
Stralingstypen ................................................................................................................................................ 8
Strooistraling ................................................................................................................................................. 9
Indeling dosimetrische grootheden .............................................................................................................. 9
Stralingsproductie in het röntgentoestel ...................................................................................................... 9
Grote object-film afstand .............................................................................................................................. 9
College 2A – Radiologische grootheden ........................................................................................................... 10
ICRP = International Comission Radiologica Protaction .............................................................................. 10
Geabsorbeerde dosis (D) ............................................................................................................................. 10
Equivalente Dosis (H)................................................................................................................................... 10
Stralingsweegfactor (WR)............................................................................................................................. 10
Weefselweegfactor (WT) ............................................................................................................................. 11
Effectieve dosis (ED) .................................................................................................................................... 11
Deel van het weefsel/orgaan dat wordt bestraald...................................................................................... 11
ED vaststellen .............................................................................................................................................. 12
Entrée Dosis................................................................................................................................................. 12
Dosis Oppervlakte Product (DOP) ............................................................................................................... 12
Straling......................................................................................................................................................... 13
College 2B – Stralingsdetectie/Dosimetrie ....................................................................................................... 13
Gas gevulde Dosismeters ............................................................................................................................ 13
Vaste stof detectoren .................................................................................................................................. 14
Beelddetectie .............................................................................................................................................. 14
Vloeistof detectie ........................................................................................................................................ 14
Persoonsdosismetrie ................................................................................................................................... 14
College 3 – Radiobiologie ................................................................................................................................. 14
Ioniserend vermogen .................................................................................................................................. 15
Wisselwerking van straling en materie........................................................................................................ 15
Elektromagnetische straling ........................................................................................................................ 15
Waarom zoveel dosismaten ........................................................................................................................ 15
Radiobiologie ............................................................................................................................................... 16
Weefsel reacties/deterministische effecten ............................................................................................... 16
Stochastische effecten ................................................................................................................................ 17
Lineair No Threshold Theorie ...................................................................................................................... 17
Verschil in risico ........................................................................................................................................... 17
Mogelijke alternatieven voor LNT ............................................................................................................... 18
Zwangerschap.............................................................................................................................................. 18
Risico medische toepassingen in relatie tot andere risico’s ........................................................................ 18
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, Risico medische toepassingen in relatie tot andere risico’s ........................................................................ 18
Artikel NTvT Radiobiologische aspecten van röntgendiagnostiek .................................................................... 19
Leerdoelen................................................................................................................................................... 19
Effecten van röntgenstraling ....................................................................................................................... 19
Relatie tussen dosis en risico ....................................................................................................................... 20
Risico’s van tandheelkundige röntgendiagnostiek ...................................................................................... 21
Conclusie ..................................................................................................................................................... 21
College 4 – Deel 1 Principes van en procedures voor rechtvaardiging ............................................................. 21
Basisprincipes .............................................................................................................................................. 21
Rechtvaardiging ........................................................................................................................................... 22
Schade ......................................................................................................................................................... 22
Artikel NTvT Indicatie voor en frequentie van intraorale röntgenopnamen .................................................... 22
Leerdoelen................................................................................................................................................... 22
Rechtvaardiging en ALARA .......................................................................................................................... 22
Kwaliteitsbewaking van het proces ............................................................................................................. 23
Kwaliteit van de diagnostiek: sensitiviteit en specificiteit ........................................................................... 23
Frequentie van bitewing-opnamen bij kinderen ......................................................................................... 24
Frequentie van bitewing-opnamen bij volwassenen................................................................................... 25
Frequentie overige intraorale röntgenopnamen ........................................................................................ 25
Veilig gebruiken van röntgenopnamen (door de ICRP): .............................................................................. 26
College 4 – Deel 2 Waarom richtlijnen? ........................................................................................................... 26
Richtlijnen .................................................................................................................................................... 26
Waarom richtlijnen...................................................................................................................................... 27
Basis richtlijnen ........................................................................................................................................... 27
College 4 – Deel 3 Rechtvaardiging volgens de richtlijnen ............................................................................... 27
Rechtvaardiging volgens de richtlijnen........................................................................................................ 27
Keuze opname ............................................................................................................................................. 27
Rechtvaardiging bitewings .......................................................................................................................... 28
Rechtvaardiging bitewings kinderen ........................................................................................................... 28
Rechtvaardiging bitewings volwassenen ..................................................................................................... 29
Indicaties solo opname................................................................................................................................ 30
Rechtvaardiging solo opname ..................................................................................................................... 30
Rechtvaardiging panorama ......................................................................................................................... 30
College 4 – Deel 4 Panorama vs intraoraal ...................................................................................................... 31
College 4 – Deel 6a Rechtvaardiging CBCT voor algemeen practicus .............................................................. 31
Conebeam CT .............................................................................................................................................. 31
Rechtvaardiging ........................................................................................................................................... 32
Verwijzing .................................................................................................................................................... 32
Europese Richtlijn CBCT............................................................................................................................... 32
Indicaties voor CBCT scan ............................................................................................................................ 32
College 4 – Deel 6b Indicaties voor CBCT.......................................................................................................... 32
Indicatiestelling: implantologie ................................................................................................................... 32
Indicatiestelling: Endodontie ....................................................................................................................... 33
Indicatiestelling: orthodontie ...................................................................................................................... 33
Kaakgewricht diagnostiek............................................................................................................................ 33
Indicatiestelling: 3de molaren impactie ........................................................................................................ 33
Algemene pathologie .................................................................................................................................. 33
College 5 – Stralingsbescherming bij patiënten: ALARA ................................................................................... 33
Basisprincipes .............................................................................................................................................. 33
Rechtvaardiging ........................................................................................................................................... 34
Dosislimiet ................................................................................................................................................... 34
ALARA/ALADA ............................................................................................................................................. 34
2
, Eisen apparatuur ......................................................................................................................................... 35
Beeldreceptor .............................................................................................................................................. 35
Veldgrootte (collimator röntgenbundel) ..................................................................................................... 35
Diafragmering .............................................................................................................................................. 35
Kwaliteit van röntgenopnamen ................................................................................................................... 36
Opnametechniek ......................................................................................................................................... 36
Belichtingstijd .............................................................................................................................................. 36
Timer ........................................................................................................................................................... 36
Loodschild/kraag ......................................................................................................................................... 37
Loodschort ................................................................................................................................................... 37
CTP en ACC .................................................................................................................................................. 37
Artikel NTvT Het ALARA-principe. Achtergronden en toepassing in de praktijk ............................................... 37
Historie ........................................................................................................................................................ 37
Het ALARA-principe ..................................................................................................................................... 37
Diagnostisch Referentieniveau (DRN) ......................................................................................................... 38
ALARA in de praktijk .................................................................................................................................... 38
Praktijk, medewerkers en omgeving ........................................................................................................... 40
College 7 – Wet- en regelgeving in de stralingsbescherming - Deel 1 Wettelijke context................................ 40
Implementatie in de Nederlandse wetgeving ............................................................................................. 40
Richtlijnen en regels .................................................................................................................................... 41
Besluit basisveiligheidsnormen stralingsbescherming ................................................................................ 41
Opzet praktijkrichtlijn .................................................................................................................................. 41
College 7 – Wet- en regelgeving in de stralingsbescherming - Deel 2 Organisatorische aspecten .................. 41
Organisatorisch ........................................................................................................................................... 41
Eisen aan apparatuur .................................................................................................................................. 43
Eisen aan apparatuur .................................................................................................................................. 43
College 7 – Wet- en regelgeving in de stralingsbescherming - Deel 3 Basisprincipes stralingsbescherming
rechtvaardiging ................................................................................................................................................ 43
Rechtvaardiging ........................................................................................................................................... 43
Bbs artikel 8.5 Rechtvaardiging bij individuele medische blootstellingen .................................................. 44
Bbs artikel 8.6 Rechtvaardiging medisch-radiologische procedure bij asymptomatische personen .......... 44
Artikel 8.11. Medische blootstelling van vrouwen die zwanger zijn en borstvoeding geven...................... 44
College 7 – Wet- en regelgeving in de stralingsbescherming - Deel 3 Basisprincipes stralingsbescherming
optimalisatie .................................................................................................................................................... 45
Artikel 8.3 Optimalisatie medische blootstelling......................................................................................... 45
ALADA .......................................................................................................................................................... 46
Artikel 8.14 Eisen aan procedures en apparatuur ....................................................................................... 46
Conebeam CT .............................................................................................................................................. 46
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