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