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Referral for an X-ray scan

You can download the referral for an X-ray scan in doc format her:

 

X-ray room is open on weekdays (Mon–Fri) from 8:00 AM to 6:00 PM
(with a break from 1:00 to 2:00 PM).

 

Guide for filling in the referral form

Please be sure to fill in the fields with the patient’s and doctor’s data and, where necessary, specify the area to be scanned as free-form text.

Intraoral

You can choose between a standard scan and a bitewing scan and add tooth numbers as free-form text. Where possible, our radiology technicians will try to fit all the requested teeth in one image, but if this is not possible, several images will be taken.

Panoramic

You can choose between different programs for panoramic shots. For all of them, you can specify the requested segments or an area as free-form text.

CEPH

You can choose between skull AP (anteroposterior) or lateral views.

3D

The referral form lists the most commonly used options, but you can also describe any areas of diagnostic interest in the free-text section.

  • Teeth – the size of the cylinder is 4 x 5 cm (D x H) and one image can fit 2–4 teeth, depending on the size of the teeth. If you want a 3D image of individual teeth, you can choose whether to take a high or standard resolution image. The difference lies in selecting high resolution, where the voxel (slice) size is 0.1 x 0.1 x 0.1 mm. This allows for viewing the smallest changes, but it also has the drawback of more "noise" on the image due to reflections of X-rays, which can interfere with viewing. When choosing the standard resolution, the voxel size is 0.2 x 0.2 x 0.2 mm, there are fewer disturbing factors in the image and the image is easier to view. A high-resolution image is suitable for examining individual teeth (root canals, cracks, etc.), standard resolution is suitable for most other cases. For the purposes of the price list, it is a single area.
  • The entire dentition – the size of the cylinder is 8 x 8 cm (D x H) and you can choose between standard resolution and low resolution (voxel size 0.4 x 0.4 x 0.4 mm). For the purposes of the price list, it is a single area. In most cases, the entire dentition fits into a single area.  Since the dimensions of a single area are limited and people are anatomically different, it may happen that the entire dentition does not always fit in a single area (for example wisdom teeth). To avoid confusion, please specify the area of the scan as a free-form text. If a composite area is requested, this should be indicated in the specification of the scan.
  • Sinus – the size of the cylinder is 8 x 8 cm (D x H) and you can choose between standard resolution and low resolution. If one sinus is selected, the centre of the cylinder is in the middle of this sinus, if both sinuses, the centre of the cylinder is between the two sinuses. If both sinuses are selected and a composite area is not recommended, depending on the size of the patient’s head, the cheekbones may be left out of the image.  For the purposes of the price list, it is a single area. If a composite area is requested, this should be indicated in the specification of the scan.
  • TMJ – single area or horizontal pair (two areas) and you can choose between standard resolution and low resolution. Unless otherwise specified as a free-form text in the scan specification, radiology technicians default to selecting a cylinder size of 8 x 8 cm (D x H) for both single areas and horizontal pairs. If one side is selected, it is a single area for the purposes of the price list; if two sides are selected, it is two areas. If a larger scan area is requested, please indicate it as a free-form text in the scan specification.
  • JAW 3D - for a larger area scan including the lower and upper jaw with joints, if not otherwise specified in the examination details as free-text, radiology technicians default to selecting a cylinder size of 8 x 8 cm.