Chapter 40 - Legal Issues, Quality Assurance, and Infection Prevention

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Consumer-Patient Radiation Health & Safety Act: (1981)

A Federal last that requires that those who are exposing radiographs must be properly trained and certified

What is a stepwedge?

A device constructed of layered aluminum steps

Calibration of dental x-ray equipment should be performed by?

A qualified technician.

quality control: dental X-ray machine

Calibrate equipment regularly

Since processing, duplicating, etc. film takes time the DA

Can charge patient a reasonable amount

Quality control: safelighting

Check for light-tightness in darkroom

What is the safelight test?

Check to see if the film is truly safe while exposed in safelight; 4 feet away for 3-4 minutes

What does the wire mesh test do?

Checks that the film in the extraoral cassette exhibits uniform dentsity

Quality control: cassettes and PSPs

Clean and examine for scratches

Film has been properly stored if when unexposed and processed the film appears

Clean w slight blue tint

How often should view boxes be wiped clean?

Daily

_____ are the property of the dentist

Dental images

Risk Management Policies

Designed to reduce the likelihood of a malpractice lawsuit again the dentist

It is the dentist responsibility to

Discuss the need for radiographs

If cassette or screen is scratched or does not pass the mesh test...

Do not use and replace

To test the developer, use

A reference radiograph or a stepwedge radiograph

Quality Assurance (QA)

A way of ensuring that everything possible is being done to produce high-quality diagnostic images

How often should the lead apron be disinfected?

After each use

What is used to transfer PSP's?

Black transfer box

According to the test for x-ray film freshness, the film is fresh and has been properly stored and handled when the processed film appears clean with a slight ______ tint.

Blue

How long should dental images/records be kept for?

Indefinitely/forever

Documentation of dental radiographs includes

Informed consent, number and type, rationale/reason for exposing, diagnostic interpretations, anything you/patient/ dentist says

When a patient refuses recommended images,

It should be recorded in the patient's chart

PSP's requires ___ radiation

Less

How often should extraoral cassettes he checked for dirt and scratches?

Monthly

A record-keeping log for processing solution does not need to include the?

Name of the solution used to clean the tanks.

For automatic processing, what should be done at the beginning of the day?

Process 2 films; one opened in white light, one opened in safeligt

Most critical component in quality control of film processing

Processing solutions

Quality assurance in dental office includes

Quality control test that monitor dental X-ray equipment, supplies, and image processing. Also quality administration procedures such as keeping schedules of maintenance and record-keeping logs

Quality control: manual processor

Replenish daily; change every 3-4 weeks

Who is the person patient is most likely to confide fears in?

The dental assistant

Dental images are the property of the?

The dentist

The only person who can prescribe radiographs is

The dentist

When patient refuses dental imaging

The dentist can misdiagnose them

If film is lighter...

The developer is too cool or not concentrated enough (too weak)

If a film is darker...

The developer is too warm or concentrated

What does the EPA regulate?

The environment; chemicals

If film is not cleared in 3-4 minutes...

The fixer is depleted

When the film takes longer to clear..

The fixer is losing its strength

What does the FDA regulate?

The manufacturer of all medical devices

All the following are true regarding the transfer of dental images except?

The originals are sent.

When state checks equipment they test...

The output of X-rays, size of focal spot, tubehead for stability, timer for accuracy, milliamperage, kilovoltage

What should you not touch on a PSP?

The plate

The processor should be checked if after processing 2 films (1 white light/1 safelight)

The unexposed is not clear and dry or the exposed to white light film is not completely black and dry

To test for film freshness

Unwrap one unexposed film in dark room and process

Quality control tests designed to identify minor malfunctions include

Variation in radiation output, inadequate collimator, tubehead drift, timing errors, inaccurate kilovoltage and miliamperade readings

When sending files over the internet,

Virtual private networks (VPNs) should be used

When should the tubehead and extension arm be in closed position?

When not in use

What do you do after removing each image receptor from the patient's mouth?

Wipe saliva off

Standard settings for dental X-ray machine

10 mA, 70 kVp, and 15 impulses

How fast should film clear of fixer is at full strength?

2 minutes

An administrative quality control plan?

Ensures that each individual is trained to perform assigned duties. Maintains a written description of the quality assurance plan. Maintains records of control tests.

How often should the darkroom be checked for light leaks?

Every 6 months

To create a reference radiograph...

Expose fresh film, process, view reference and compare to radiograph taken

What barriers are approved?

FDA approves barriers, not plastic wrap or tin foil

Three major categories of legal considerations regarding the use of images in dentistry

Federal and State regulations (equipment and use), Licensure (for those exposing), and Risk management (avoiding potential lawsuits)

The use of dental xray equipment is regulated by

Federal and state regulations

Most critical aspect of quality control program

Film processing

Film has NOT been properly stored if when unexposed and processed the film appears

Fogged

Quality control: automatic processor

Follow manufacturers recommendations carefully regarding maintenance

A good protocol to follow for decreasing the contamination of dental imaging equipment and supplies is to?

Gather all supplies needed before beginning the procedure. Use over gloves if additional supplies are needed during a procedure. Ask for help.

What do you wear when exposing images and handling contaminated items?

Gloves and protective clothing

What does a stepwedge do?

Helps make sure the contrast of films are good

X-rays are legal documents and can be used to

Identify people

Valid Informed Consent includes:

Risks/benefits, person exposing, number and type of radiographs, consequences of not having them done, alternative diagnostics

All the following statements are true regarding the care of intensifying screens?

Screens should be cleaned with a commercial cleaner after each use. An antistatic solution should be applied after cleaning. Screens that are scratched should be replaced.

Request for a copy of patient images

Should be written and be signed by patient

According to the Centers for Disease Control (CDC) Guidelines for Infection Control in Dental Healthcare Settings—2003, digital radiography sensors?

Should use FDA-cleared barriers.

What are quality control tests?

Specific tests that are used to monitor dental x-ray equipment, supplies, and film processing

How often is film contrast tested?

Take 20 stepwedge X-rays and develop one a day, compare to densities of original radiograph

Quality control: dental film

Test each box for freshness (smell)


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