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quality assurance radiology e lec Flashcards

1
Q

what is quality assurance

A

the planned and systematic exclusion of procedures to ensure high quality images of high diagnostic yield at min radiation dosage

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2
Q

why is important with quality assurance

A

getting it right the first time
procedures in place to get a high quality image
overall review with feedback from previous records

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3
Q

why do we do QA

A 
reduces the necessity of retakes 
minimises radiation to patient
minimise costs
minimises inconvenience 
saves time
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4
Q

what is the no 4 core of knowledge

A

a person physically directing medical exposure is expected to have an acquired the principles of QA and quality control applied to both equip and technique

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5
Q

what is the purpose of QA

A

adequate diagnostic information
radiation doses need to be as low as possible
relevant statutory requirements

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6
Q

who should do it

A 
named person responsoble for implementation 
the whole dental team 
radiation protection supervisor 
operator 
dental nurse
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7
Q

how should we do it

A

comprehensive programme
inexpensive
shouldn’t require infrequent verification and modification
formal records to be kept and frequency of checks to be defined

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8
Q

the aim of QA programme

A

written down common sense

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9
Q

what are the essential procedures

A 
image quality 
patient dose and x ray equipment 
darkroom films and processing
training 
audits
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10
Q

how is quality rated

A

prospective evaluation:

retrospective evaluation

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11
Q

what is prospective evaluation

A

ratings are assigned and recorded as viewed. analysis of results at intervals not greater than 6 months

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12
Q

retrospective evaluation

A

representative sample drawn at regular intervals and rated and recorded
analysis not greater than 6 month

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13
Q

rating of image quality

A

excellent
acceptable
unacceptable errors

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14
Q

what does it mean if an imagine quality is excellent

A

no errors of prep

exposure, positioning, processing or handling

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15
Q

what does an image quality mean if its acceptable

A

some errors but which do not detect from the diagnostic utility of the radiograph

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16
Q

what does an image quality mean if its unacceptable errors

A

render the radiograph diagnostically unacceptable

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17
Q

what is the issue with image quality

A

it is subjective eg one persons acceptable is another persons unacceptable

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18
Q

quality ratings should be kept with

A

any actions taken

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19
Q

what do we do if there is an unacceptable radiograph

A

record the date, nature of fault, known or suspected cause, number of repeat radiographs

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20
Q

what do we need to look at in regards to patient dose and x ray equipment

A

need to monitor patient dose
low as practicable- x ray must comply with standards
if the representative dose is higher than the diagnostic reference levels( DRL) and review needs to be carried out
routine surveillance

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21
Q

what is the equipment consist of

A

X ray set
image receptor
intensifying screens and cassettes
viewing boxes

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22
Q

the x ray set: electrical safety

A

must comply with the latest regulations including safe use of work equipment, and guidance on the provision and use of work equipment regulations 1998

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23
Q

who checks equipment

A

appropriately qualified person

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24
Q

what do we also need to write when we check equipment

A

records of maintenance checks

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25
what tests to dental x ray equipment go under
routine tests acceptance tests critical examination
26
what is the critical examination test
legal responsibility of the installer but the legal person is advised to obtain it also the installer must consult with the radiation protection adviser (RPA)
27
what does the installer need to consult the RPA about
in regards to nature, extent, and results of examination
28
what is the essential content of the critical examination
``` clear and unambiguous description of equipment and location acceptability of location evaluation of warning signals evaluation of exposure control sufficient radiation protection evaluation of safety systems ```
29
what statement needs to be given to the user
provided with adequate info about proper use, testing and maintenance
30
who is responsible of carrying out the the acceptance test
legal person
31
who needs to be consulted in the acceptance test
the RPA
32
what should the routine test values be compared against
baseline values
33
what in regards to dosage needs to be tested
if the equipment is operating within agreed parameters | and assessment of typical patient dose for comparison with DRL
34
how is the routine etch different
different emphasis
35
what does the routine test confirm
no significant change to equipment and location
36
what can we compare our previous results with
with our actual results of the routine test
37
which body analyses the results form the x ray
THE NRBP( national radiological protection board)
38
what does the image look like if you have poor contact
slightly blurry
39
what is included in the inventory of x ray equipment
``` name of manufacturer model number serial number year of manufacture year of installation ```
40
how are the errors categorised
1. patient prep 2. patient positioning 3 exposure 4 processing 5 film handling
41
what do we need to be aware of when taking x rays
``` patients jewellery- lip piercings necklace, earrings and glasses braces hair grips dentures ```
42
what patient errors can occur
cone cutting- can be an error with the patient, x ray tube or film holder
43
how should a bitewing be taken
should be the occlusal plane almost horizontal parallel with the long axis of the film no more overlap of enamel than half the thickness of enamel
44
what is the percentage of errors if no film holders are used
28%
45
what is the percentage of errors if film holders are used
4%
46
what is the issue with panoramic positioning
very susceptible to patient positioning errors esp anteriors
47
what does it usually mean if we see black on an x ray
over exposure to radiation or light
48
what could be shown on the panoramic radiograph
a very obvious white shadowing in the central region due to slumping
49
what are the classes of malocclusion
``` class 1- normal incisal relationship- just slightly overlapping the lower incisor class 2- upper incisor have an increased overbite either anteroposteriorly or sup inferiorly class 3- the upper incisors are behind the lower incisors ```
50
what can the panoramic radiograph look like if the patient is moving their tongue
obvious black shadowing on the mandible and a white undulating shadow line
51
what is recommended when taking a panoramic
it is recommended to have the patient put their tongue on the roof of their mouth
52
what can we use for adequate panoramic positioning
bite block chin rest use light bean diaphragms-vertical and horizontal lights to help with positioning
53
where do light beam diaphragms help position
mid face canine region frankfort plane
54
what is the frankfort plane
a line from the tragus of the ear through the palpable bony infraorbital rim area and is parallel to the floor
55
what can go wrong with exposure factors
underexposure overexposure double exposure]
56
what exposure factors are under our control
depends on machine and technique kV time mA
57
what factor can we control in a panoramic
time
58
what should you be given when you have an intra oral set installed
should be given typical exposure values eg from lower molar PA and you should extrapolate
59
what can you work out from the typical exposure values given
extrapolate | list of typical exposure values for different techniques, different sizes of patient and different areas of the mouth
60
what should viewing conditions be like
use proper viewing box- with analogue film get rid of extraneous light magnifying glass x viewer- which blacks out extraneous light with a magnifying glass
61
how many % of dental practices used 50% greater exposure than was required due to faulty processing
30%
62
why can pale films develop
due to exhausted developer over diluted developer time too short temperature too low
63
why can dark films develop
too long in the developer concentration in the developer too much temperature too high developer contaminated by fixer
64
why do we get low contrast
``` overdevelopment underdevelopment fixer contamination inadequate fixation fixer exhaustion ```
65
who lays down the standards of QA films and processing
suppliers
66
what standards are laid down by suppliers in regards to QA films and processing
``` film speed expiry date storage conditions processing conditions frequency of changing solutions cleaning instructions for automatic processors ```
67
what are some QA procedures put in place
records to control film stock records to control and validate chemical changes cleaning procedures for automatic processes
68
how do you monitor chemicals
expose test object( standard distance and time) developed in new chemical used as reference at regular intervals expose new film under same conditions compare with reference
69
what can you use as a test object
pre prepared strips step wedge teeth
70
what do we need to be careful of when taking a panoramic but in regards to gloves
the talc from our gloves can transfer on the film when we are adjusting it and leave finger print marks on the radiograph
71
what are crimp marks
semi lunar dark marks which are due to bending of the films
72
how are you meant to store sheet film
upright as if something presses on the film it can result in static electricity showing up on the film
73
what do we need to do for QA for darkrooms processing
routine tests for light tightness safelights checks at least every year keep a log
74
how do you test for light tightness
the coin test put a coin on a exposed film- sensitisies the emulsion and left out with the safelight and the film processed and see if you can see the outline of the coin- if you see the outline it is not safe
75
what should intensifying screen be cleaned with
a lint free cloth and a proprietary cleaner
76
what should be kept in the radiation protection files
``` QA of working procedures local rules legal persons procedures procedural and operational elements procedures not directly linked to x ray equipment ```
77
what should the procedure log have
the existence of local rules record each time modified intervals not exceeding 12 months

CSA (51 decks)

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