3. Explaining benefit and risk (outcome A)

Agreement before exposure

Patients need enough information to agree to a radiograph: why you recommend it, what you hope to learn, what happens if you do not take it, and that the dose is low but not zero. This is GDC Outcome A as well as good IR(ME)R practice. A signed “X-ray consent” stamp with no conversation is weak evidence.

Plain language

• Benefit: “I cannot see between these teeth; a small radiograph will show decay or bone support so we treat the right problem.”
• Risk: “The extra radiation is very small — similar to a short period of natural background radiation in the UK.” Avoid invented numbers unless you use a current official comparison your employer has approved.
• Alternative: “I could wait and watch, but we might miss decay that is already into dentine.”

When a patient declines

Record the discussion. Do not expose them. Adjust the treatment plan and explain the limits of care without the image (for example you cannot start RCT blindly). Pressure or “we cannot treat you at all on the NHS without bitewings” as a blanket rule is not justification.

Year 5 covers quality assurance, accidental exposures and audit — the records that show the system works.

Always follow current national guidance and your employer’s procedures.