Chapter 40 Legal Issues, Quality Assurance, & Infection Control-D26

Viewbox

an illuminated boxlike device used to view radiographs

Positioning device

an instrument used to hold the film, phospr storage plate (PSP), or digital sensor in the proper position. or XCP

federal/state regulation x-ray equipment and its use, licensure for people who Expose/take radiograph images, and Risk Management to reduce changes of patient taking legal action

3 major categories of legal consideration

Artifact

A blemish or unintended radiographic image that is not present in the actual structure being imaged. (caused by a technique error) you don't want errors since you would have to re-expose patient to radiation!

Liable

Accountable or legally responsible under the law

CDC - Transport and handle exposed film in a (BLANK) manner to prevent contamination of the developing equipment.

Aseptic

How can you check the developer strength?

By using a reference radiograph or a stepwedge radiograph.

When the FIXER is at full strength the film should...

Clear within 2 minutes

Dental assistants can still be held liable for their own actions.

DA's May be sued for their actions.

How often must you replenish processing solution?

Daily and change them every 3-4 weeks as recommended by the manufacturer.

Types of quality control tests:

Dental Film Dental x-ray machine Cassettes and Phosphor storage plates (PSPs) Safelighting Automatic Processor Manual Processor

How often should you check the processing solution?

Each day before any patient films are processed.

If the FIXER loses its strength the..

Film takes longer time to "clear," or become transparent, in exposed areas.

If the DENSITY on the daily radiograph differs from that on the reference radiograph or standard stepwedge radiograph by more than two steps, the developer solution is depleted and must be changed before patient films are processed.

How can you tell when the developer loses its strength?

When the fixer solution loses its strength, the film takes a longer time to "CLEAR," or become TRANSPARENT, in unexposed areas.

How can you tell when the fixer loses its strength?

Replenish the processing solutions daily and change them every 3 to 4 weeks, as recommended by the manufacturer.

How often should the processing solutions be replenished?

why should you never give original films to a patient?

If a lawsuit should occur, no defense is possible without the dental images.

How long should dental images be retained?

Indefinitely.

Patient records - Documentation of all imaging must include what information?

Informed consent Number and type of images Rationale for requiring images Diagnostic interpretation

Quality control tests can be used to...

Monitor the strength of the developer and fixer solutions

Can a waiver be signed to release the Dentist from taking x-rays?

No. Such a document would be invalid if an injury would result. It should be stated in the patient's record if a patient refuses recommended treatment

Quality assurance (QA)

Plan/program to ensure that the dental office produces consistent, high-quality images with a minimum of exposure to patients and personnel- QA means regular testing to detect equipment malfunctions, monitoring techniques, and scheduled maintenance

No. Screens that appear visibly scratched should be replaced.

Should you use a film cassette that has scratches?

Quality control test

Specific test that are used to ensure quality in dental x-ray equipment supplies and film processing-example-step wedge, coin test, film freshness test

Dentist

Under the state laws, who is allowed to prescribe dental radiographs?

CDC - Digital Radiography sensors:

Use FDA- cleared barriers Clean & heat or high lvl disinfectant sterilze between pts. At Minimum use hospital disinfectant (with Tuberculocidal claim) between pts.

To ensure the highest quality for radiographs and the least risk for exposure to patients and personnel. To ensure compliance with state and federal regulations.

What are the purposes of quality administration program?

A plan to ensure that the dental office produces consistent high-quality images with a minimum of exposure to patients and personnel.

What is it meant by quality assurance?

Film processing is one of the most critical aspects of a quality control program and must be monitored on a daily basis.

What is one of the most critical areas of a quality control program?

Test the effectiveness of the safelight.

What is the purpose of the coin test? This is another Quality Control test

What is meant by quality assurance?

a way of insuring the everything possible is being done to produce high quality diagnostic images

monthly

how often should intensifying screens be cleaned with a commercial cleaner?

What are quality control tests?

tests that monitor dental x-ray equipment supplies, and image processing.

When giving patients a copy of their dental images..

the request must be written and signed The dentist should be informed Entry should be made (when and for whom they were sent to)

The cassette and screen are safe to use if..

the wire mesh image seen in the film exhibits uniform density, good film-screen contact has taken place

what federal act requires persons who take radiographs to be trained and certified?

The Consumer-Patient Radiation Health and Safety Act Requirements for Certification in Radiography for dental assisting vary from state to state.

Who owns dental images

The dentist. However, it is reasonable for patients to have a copy of their records. make duplicate

What is the most critical component in the quality control of film processing?

The processing solution.

Who is legally responsible or LIABLE for the actions of denta auxiliary personnel?

The supervising dentist AKA the resoindeat superior doctrine.

If the developer loses its strength the..

Time temperature chart is no longer accurate

Always wear gloves and protective clothing while exposing radiographs and handling contaminated films. You should also wear a mask and eyewear if there is a likelihood that blood or other body fluids may spatter. Masks also are indicated if you or the patient has a cough or a cold.

What personal protective equipment (PPE) should the operator wear while exposing radiographs?

Once the film has dried, place it into a disposable container (plastic bag or paper cup) that is labeled with the patient's name. This container will be used to transport films to the darkroom. Be careful not to touch the outside surface of this container.

What precautions must be taken when transporting the films to the darkroom?

Once films are removed from the mouth, they are obviously contaminated and should be handled only with gloved hands. One technique that can be used to minimize contamination of the film packet by saliva is to place a clear-plastic barrier envelope over the film packet.

What precautions should be taken when handling contaminated film?

Surfaces that cannot be easily cleaned and disinfected should be protected by barriers, usually plastic or foil.

What surfaces must be covered with barriers?

informed consent

What type of consent is necessary before exposing radiographs on a patient?

Be sure to wear utility gloves while disinfecting the surfaces.

What type of gloves should be worn while disinfecting the radiography operatory?

Dental radiography presents unique infection control problems because of the potential for cross-contamination of equipment and environmental surfaces with blood and saliva.

What unique infection control problems occur in dental radiography?

Sterilized film-holding devices (XCP) should remain packaged until the patient is seated and can view the opening of the package.

When should the packages containing the film-holding device be opened?

Test each new box for freshness by processing one packet.

When should you check a box of film for freshness?

Dentist. Dental radiographs are a part of the patient's dental records.

Who legally owns patient's dental radiographs?

Stepwedge

a device constructed of layered aluminum steps used to demonstrate film densities and contrast scales-this is a QA test

Inspection of dental x-rays

every 5 years & must be registered & charged a fee for this registration

Informed Content

permission granted by the patient after being informed about the details, risks, benefits & alternatives of the procedure

Disclosure

process of informing the patient about a procedure, for example, the procedure for taking x-rays

image receptor

recording medium for an image - a digital sensor, a phospor storage plate (PSP), or conventional dental x-ray film

PSP (phospor storage plates)

reusable film-sized flexible plate coated with phospor as the image receptor.

CDC - Heat tolerant holding items

should be heat sterilized between patients

The use of dental imaging is now the accepted...

standard of care. Lack of images compromises patients treatment and diagnosis

fluorescent bulbs

what kind of light bulb is in the view box?

The Consumer Patient Radiation Health & safety act

what law is a federal law that requires all persons who use x-rays be properly trained & certified?