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Quality Assurance in Dental Radiography


this presentation is intended for the
Dental Assisting student the topic is quality assurance in dental radiography
what is quality assurance it’s the planning implementation and evaluation
of procedures used to produce our number one goal maximum diagnostic quality
images with minimum exposure to the patient and the radiographer so how is
this accomplished we can accomplish this by administrative procedures certainly
the competency of the radiographer quality control control tests for our
equipment and armamentarium and a radiation protection program let’s look
at administrative procedures so one aspect is to develop a needs assessment
where your staff or the dental staff can meet either monthly or quarterly to
determine what do we need to do in order to have high quality diagnostic images
and work within the principle of ALARA as low as reasonably achievable when
utilizing dental x-rays so hopefully your staff is going to volunteer and
someone will keep the records or somebody will take care of the equipment
maybe go out and get additional training and come back and train the staff and
then someone to be in charge of all of these areas it should be written down so
you have a written plan and i’ve already talked about the various
responsibilities and who would be willing to be in charge it’s important
that you monitor and maintain and actually have a schedule written down
which would be a log and we have the little photograph over here so that
you’re keeping track of what you’re doing to
you have a high quality radiographic treatment for your patient or diagnostic
aides I should say for your patient and most states do have a radiological
division sometimes it’s part of Public Health your equipment should be
registered with the state or your county you need to check in your area and see
what the regulations are but they also want to see information in writing so
that there’s some proof that you’re actually working to create minimum
exposure and you should have a periodic review of all of these areas that you
are going to implement maintain in order to have a quality x-ray area in your
dental practice certainly we want competency of the dental radiographer
which will achieve ALARA as as low as reasonably achievable for all for the
patient and for the dental assistant or the dental health care worker we can
achieve competency by having really good technique right and avoid retakes if we
have errors we want to be able to recognize them and certainly correct for
those errors and it’s important to maintain your education in dental
radiography whether that’s through videos on the internet perhaps your
local dental assistant Society offers continuing education many of the dental
supply companies also have education for the staff so it’s important to keep
current in dental radiography practices also having quality control tests will
ensure diagnostic quality images so there are a series of tests that you can
perform for your x-ray unit function for your digital sensor function and your
computer software if you’re still using film I’m sorry that your film is fresh
it’s not expired and of course you need a processor of some sort whether it is a
automatic processor or if you’re still using a dip tank you want to make sure
that the darkroom is in good condition and the chemicals that you would use for
film processing let’s look at the dental x-ray machine so monitoring here would
be is it registered with your state if that’s required or your county and has
it been inspected by a health physicist so they come with little machines to
make sure that your x-ray units are have the proper output of radiation and also
you can look at it in a moment make sure that there’s no PID drifting and we’ll
look at that in just a moment something else that a inspector might look for
would be to have a control or a reference film so you want to have a
film if you’re still using film to make sure that the contrast the density is of
diagnostic quality you can achieve this by using a little device that’s called a
step wedge and so this is made out of very metal and there’s varying
thicknesses so you put it on top of a film and you expose the film with the
little step wedge on top and you can see when it’s developed that you actually
have a an image of contrast here and so that’s
the varying degrees of white shades of white and gray and black and you can
actually make your own step wedge with either lead foil or even with a little
object on top you can put a penny on top of the film and actually take an image
there so that’s what a step wedge is a little device to help with making or
obtaining a reference or a control film and it shows the contrast and you can
see that you want to date this film if you have a number of dental x-ray units
you should have a control or a reference film for each one and you want to make
sure that you do this periodically you want to check for tube head stability so
your tube head shouldn’t be drifting like this assistant saying this tube
head keeps moving one assistant says I’ll hold it for you no no one else
should be in the room when the x-ray unit is exposing and your patient
shouldn’t be holding it either so you want to make sure that you can call a
repairman or excuse me person dental repair person to come and check and make
sure that the arm is in good working order and that you don’t have PID drift
also it’s good for safety to have it in a non operative position I just found
this picture on the Internet you can see this x-ray had just kind of hanging out
here you can have an accident or just have undue stress on the arm of the tube head if you’re using film you want to make sure that your processing room your
darkroom that you don’t have any light leak
because that would lead to a black film and that will look at chemicals in just
a moment if you’re using a daylight loader or with an automatic processor
excuse me an automatic processor you want to make sure that you maintain it
properly this just happens to be an AT-2000 but there is weekly maintenance and
cleaning the racks and the rollers and changing the solutions it’s good to keep
a log of that information as well make sure that you don’t lean on the daylight
loader because you can actually there’s it’s a you know the loader attaches on
to the main processor and so if you’re leaning on it you can actually cause a
light leak also make sure that the cuff assembly isn’t torn that that’s in good
shape and for proper operation whenever you turn on your automatic processor you
want to run a clean sheet or a cleaning sheet of some sort
and this would allow you to see do you have any black specks or marks on the
sheet that would indicate you need to clean the rollers and possibly change
the solutions speaking of the processing solutions you want to make sure that
they’re not expired that your processor is getting regular
plenishment, replenishment excuse me you want to make sure that your processing
solutions or chemical solutions have a rather clear in color sometimes your
developer will have a slight yellow tinge which is okay but you don’t want
it to be brown or black or really dark yellow they should also I mean the
chemicals have a strong smell strong odor but they shouldn’t smell like
sulfur or rotten eggs or any thing like that if you’re using film you
want to make sure that your film has not expired that is stored outside of the
exposing room possibly in a lead lined box or a drawer and that it is out of
heat and moisture if you’re still using film you want to make sure your view
boxes are in good working order so you don’t have to be holding this film up to
the ceiling lights if you’re using a digital system you want to make sure
that your sensors are in good shape that your cords you want to be very careful (throat clearing)
pardon me with sensor cords that they’re not bent that when you store them they’re
not all curled up make sure that your programs are up to date and the same
thing for indirect digital systems the phosphor plates you want to make sure
that they’re not scratched or bent and that your software and your scanner is
in good working order radiation protection and safety program you want
to look at your state to see if there is a state code of regulation that defines
safety protocols you also want to check with the public health radiological
Department for any regulations that they may have in your county and make sure
that your x-ray units are registered within your state or county and that you
have a written plan for safety any training your quality assurance your
quality control tests can be all be included in your written plan so let’s
review quality assurance our procedures to identify radiography
problems and corrections needed to achieve those quality diagnostic images
and ALARA for all you want to develop some quality control tests so that you
have proper functioning of equipment and proper technique and proper
armamentarium you should have a radiation protection program which will
be mandated possibly by your state and also assign responsibilities but anyone
who is working with the radiographic or processing, processing equipment is
really responsible for the result which we are looking for those diagnostic
quality images and you also should check with your state regarding regulations
for a certification or a licensure for dental radiation I thank you very much
for listening and I hope you’ve enjoyed this presentation and that you’ve
learned something thank you


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