Tru-Align Frequently Asked Questions
Q. If digital sensors reduce radiation by 80 to 90% as claimed, why should I care about the additional radiation reduction provided by Tru-Align™?
A. With rectangular collimation the beam pattern is almost 50% smaller. This dramatically reduces the skin surface exposure and by extension, the overall dose to the tissues deeper in the area. It also reduces dose by 60%, including with digital sensor systems. Irrespective of the speed of the receptor, this is a substantial percentage dose savings and should be followed to assure a dose As Low As Reasonably Achievable (ALARA Principle). 60% would not seem to be a small savings. Radiation dose savings with present digital imaging systems are less than indicated as smaller pixel size has resulted in a need to increase dose to provide sufficient signal-to-noise ratios. At the same time, faster film has brought dose from film to a position where it rivals digital imaging sensors. Taking a linear effect assumption, this would be a 60% reduction in probability of fatal cancer consequences for any given sensor speed.
Additionally the image is captured “the first time.” Tru-Align eliminates retakes, one of the main sources of overexposure to the patient. This also is a large source of frustration for the operator and especially the dentist who must wait for the “second” or additional images before a clinical decision can be made.
Finally, rectangular collimation of the X-ray beam, versus a round collimator, provides a far superior diagnostic quality image with any acquisition system—digital, phosphor plate or film.
Q. How does Tru-Align eliminate retakes?
A. According to the ADA, 40+% of all intraoral X-ray images are retakes. With digital imaging systems, retakes increase due to the ease of acquisition and difficulty positioning the sensor. The name, Tru-Align, says it all. The acquisition device (sensor, film or phosphor plate) is perfectly aligned with the beam from the tube-head when the Tru-Align Positioning System is used. Tru-Align emits a beep and a light flashes when alignment is perfect. If done properly, Tru-Align will eliminate retakes.
Q. Will adopting the TA require me to go back to using a film holder and aiming ring? Now my hygienist places the sensor and the patient holds it with a finger. Then the cone is aligned by site with the sensor. It’s very efficient.
A. Think of it this way. A shotgun requires no sites or scope. Does that make it efficient? No because only a portion of the “shot” actually hits the target, the rest is scattered. The reason you can get away with the method you’re using is because the radiation exits the cone (read barrel of the shot gun) in a spreading pattern. Less than half of it actually hits the target… in this case the sensor. The rest is scattered into the patients’ cranial tissues and some bounces back onto the sensor/film in the form of noise diminishing the diagnostic quality of the image. A rifle uses sites or a scope (Tru-align) to aim the projectile (Photons) at the target. There is no scatter effect and no noise. Tru-align is actually better than a scope as it actually beeps and flashes when the target (sensor/film) is in perfect alignment with the bullet … i.e. photon beam. The film holder and aiming ring are critical parts of the aiming device.
Q. In dental school we were taught to use rectangular collimation and we had a lot of cone cuts? How does Tru-Align eliminate cone cuts?
A. Part of the answer is covered in the answer above. Rectangular collimation by itself is very difficult to use. In relationship to the sprayed radiation from a round cone (shotgun) it provides a highly targeted beam (bullet). The reason the industry and profession moved away from rectangular collimation, even though it provides better images and is far safer, was due to the high incidence of cone cuts resulting in frequent retakes. Tru-align solves this problem with its patented aiming and positioning system. This reduces the beam size to a pattern that is only 2% larger than the acquisition device, thereby eliminating retakes, cone cuts and reducing exposure to ionizing radiation. The reduced exposure pattern fulfills the newest NCRP Guidelines noted in NCRP Publication 145.
Q. How does Tru-Align improve image quality?
A. The collimation of the beam improves image quality by reducing the overall scatter radiation to the receptor. This is a concept from medical radiography that dentistry has never truly adopted because operators could not aim the beam precisely enough to “hit” the target receptor. Tru-Align makes this automatic and precise. In risk-benefit assessment, the diagnostic quality of images is of importance. Rectangular collimation can improve quality by reducing noise/fog from X-ray scatter.
Q. Is Tru-Align accepted by patients?
A. Dentists are concerned with excess radiation, as are their staff members, because their patients are VERY concerned. It’s like any other addition to your protocol; it needs to be explained to the patient. Savvy dentists will market the Tru-align to show they truly care about dose reduction and excess exposure. This “marketing” and patient education has already made its way into the professional culture because of digital imaging. There is NO reason to think that even further reduction of dose created by a simple add-on device that adapts easily to existing dental X-rays, won’t do the same. The dose reduction is NOT “incremental” because, as stated above, the area of exposure is at least 50% less.
Q. Is Tru-Align a device that is more targeted toward newer X-ray generators?
A. In 2009 X-ray safety protocol was the second most popular area of concern for which dentists reached out to the ADA for greater information. This would seem to indicate that users of both new and older machines are interested in improving radiation hygiene and the diagnostic information on their images. Tru-Align equally benefits users of new and older generators.
Q. Do I need a technician to install Tru-Align?
A. No. It will probably take more time to unpack the box the device comes in than it will to install it on your machine.
Q. How can I tell if Tru-Align will fit on my X-ray?
A. If the external diameter of your existing round cone is between 2.5 and 3 inches it will fit. 95% of all existing X-rays will fall into this category. If your cone is outside this parameter, call our customer service department to learn about custom fitting options.
Q. Do I need any special tools to install Tru-Align?
A. No tools are required for installation. Simply slip the device over your existing cone and turn the slip ring until the device is firmly attached… that’s it!
Q. What is the typical learning curve?
A. Tru-Align is very intuitive. It is impossible to use it incorrectly. Each unit includes an instructional video and a detailed set of instructions. Most hygienists and assistants become very comfortable with Tru-Align in less than an hour, including new staff members that have not taken X-rays in the past. Tru-align greatly reduces training time with new hires allowing them to take perfect radiographs with minimal training.
Q. Is there any routine maintenance required?
A. Other than performing the normal cleaning you already do on your X-ray, three AAA batteries will need to be replaced occasionally.
Q. Am I required to notify the governing body that regulates x-rays in my area?
A. Tru-Align is a rectangular collimator and as such actually brings the x-ray unit into compliance with NCRP #145 and the guidelines disseminated by the ADA, FDA, and AAOMR. As a retrofit to the existing round cone on most x-ray units, Tru-Align does not require that the regulatory bodies be informed.