Repeat film analysis and its implications for quality assurance in dental radiology: An institutional case study

Effect of using different strips on reducing the most common error in panoramic imaging: A randomised controlled trial on palatoglossal air space shadow

INTRODUCTION

Panoramic radiography quality can be impaired by some errors such as positioning errors. Palatoglossal air space shadow error is one of the most common positioning errors and it is due to the tongue not sticking to the roof of the palate. Techniques used to deal with this error might help prevent unnecessary radiation to patients and save them time and money. The study aimed to investigate the effects of using celluloid matrix and edible tapes (fruit leather and chewing gum) on reducing the palatoglossal air space shadow error in panoramic imaging.

METHODS

In our study, 270 patients referred to the Department of Radiology were randomised into three groups: a control group, a celluloid matrix group and an edible tapes group. Before panoramic imaging, all patients were instructed to adhere their tongues to the roof of their mouths, with the distinction that for the celluloid matrix and edible tapes groups, patients were asked to place celluloid tapes, fruit leathers, or chewing gums on their tongues before doing so. The routine imaging process was then performed, and the results were compared across groups to evaluate the incidence of palatoglossal air space shadow error.

RESULTS

The number of error-free images in each fruit leather, chewing gum and celluloid tape group were significantly higher than the control group (all cases P < 0.05). The chances of error-free images in the fruit leather groups were the highest (9.57 times). The age (P = 0.136) and gender (P = 0.272) of patients had no significant effect on the results of interventions.

CONCLUSION

The application of fruit leathers, chewing gums and celluloid tapes reduced the palatoglossal air space shadow error of panoramic imaging.

The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

INTRODUCTION

This study illustrates image rejection rates of the lateral wrist x-ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image-repeat decision-making skills existing between radiologists, experienced radiographers and junior radiographers.

METHODS

A retrospective review was conducted of all rejected lateral wrist x-ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study.

RESULTS

The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers.

CONCLUSIONS

This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision-making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.

Attitudes and knowledge of dental radiography amongst students of dentistry and related fields

OBJECTIVES

This study aimed to evaluate the level of knowledge and attitude towards quality control in dental radiography amongst students of dentistry, allied dental sciences and radiologic technology programmes.

METHODS

A cross-sectional survey was conducted using self-administered questionnaire on a convenience sample of 580 students from three universities in Jordan. The questionnaire was divided into sections that include personal sociodemographic variables, knowledge about quality assurance in dental radiography and attitude towards quality assurance in dental radiography.

RESULTS

A total of 286 students completed the questionnaire (response rate = 49.3%), of whom 70% were women. The respondents' knowledge scores ranged from 12.2% (n = 35) to 35.2% (n = 100). The mean of the quality assurance knowledge scores for the whole study sample was 20.3% ± 14.5%, with no significant difference between men and women (p = .643). Allied dental sciences students showed significantly higher knowledge scores (25.0 ± 13.0) than dentistry (17.8 ± 14.40) or radiologic technology students (20.9 ± 14.8). The average attitude scores towards quality assurance in dental radiography were fairly good (69.5 ± 26.4) with no statistically significant differences by study programme.

CONCLUSION

Knowledge of students about quality assurance in the three programmes is inadequate. The participants' attitude towards quality assurance was fairly good. The study provides feedback to dental schools to improve their curriculum by including quality assurance into student clinical practices. Further studies are requested to investigate the reasons behind this low level of knowledge.

Reject Rates of Radiographic Images in Dentomaxillofacial Radiology: A Literature Review

This report surveyed the image reject rates of intra-oral, extra-oral, and cone-beam computed tomography (CBCT) imaging in the academic literature. PubMed, Web of Science, and Scopus databases were queried in mid-April 2021. Manual screening of the reference lists of the identified publications was performed to identify papers missed from the database search. All publications returned by the searches were initially included. Exclusion criteria included irrelevance, no reporting of reject rate, no access to the article, and not original article. The total number of images and the number of rejects were recorded for each type of radiographic images. Factors and commonest errors associated with the rejects were recorded. Twenty-six original articles were identified and reviewed. The average reject rate was 11.25% for bitewings, 16.38% for periapicals, 4.10% for panoramics, 6.08% for lateral cephalography, and 2.77% for CBCT. Positioning error and patient movement were two common reasons for the rejects. The average reject rates computed from data pooled across studies should form the reference values for quality assurance programs to follow. Future reject analysis studies should report more radiographic parameters such as type of collimation for intra-oral radiography and patient posture for CBCT.

Image retake rates of cone beam computed tomography in a dental institution

OBJECTIVES

To investigate the frequency and reasons for retaking cone beam computed tomography (CBCT) scans in an oral and maxillofacial radiology imaging clinic in a dental institution.

MATERIALS AND METHODS

A retrospective cohort chart audit of the patient image database was performed for 1737 patients attending the Diagnostic Imaging clinic at the Prince Philip Dental Hospital from February 2016 to May 2019, and the rate of, and reasons for, CBCT image re-exposure was tallied. Patient demographics (age and gender) and CBCT acquisition parameters (CBCT unit, field-of-view (FOV), scanned region of interest, and exposure time) were recorded and correlated to retake analysis.

RESULTS

The retake rate was 4.6% (80/1737). The most common reasons for re-exposure were incomplete FOV coverage (57.5%) and motion artifacts (27.5%). Patients under 12 years of age had a significantly higher risk for motion artifacts. CBCT for the temporomandibular joint (TMJ) had a significantly higher risk for incomplete FOV coverage.

CONCLUSIONS

Children (less than 12 years of age) demonstrate a higher frequency of retakes, principally due to motion artifacts. TMJ CBCT examinations have a higher frequency of retakes due to an incomplete FOV coverage.

CLINICAL RELEVANCE

Information regarding the frequency and reasons for CBCT retakes is beneficial to identify procedures, practices, or patients susceptible to additional radiation exposure and implement appropriate and specific quality control protocols.

X-ray beam angulation can compromise 2-dimensional diagnosis of interradicular space for mini-implants

INTRODUCTION

The aim of this research was to evaluate the influence of x-ray projection geometry on interradicular space of the posterior maxillary arch.

METHODS

Cone-beam computed tomography (CBCT) scans of 32 patients (16.85 ± 4.93 years) who met the selection criteria were enrolled. One hundred ninety-two interradicular sites of the posterior maxillary arch were evaluated. Before measurements, each side of the maxillary arch was orientated in all 3 planes of space to obtain CBCT synthesized periapical radiographs with 0° projection geometry (orthogonal x-ray beam-orthogonal X-ray angulation [OX]). Standardized CBCT axial rotations (10°, 20°, -10°, and -20°) were used to simulate periapical radiographs taken with mesial and distal angulation of the x-ray beam (mesial x-ray angulation [MX] and distal x-ray angulation [DX]). Interradicular space widths were measured on OX, MX, and DX CBCT synthesized periapical radiographs. Measurements were performed parallel to the occlusal plane at 3 mm and 6 mm apical to the midpoint of the alveolar crest. Interradicular distances were statistically compared (P <0.05).

RESULTS

Interradicular distances measured on MX and DX CBCT synthesized periapical radiographs were significantly smaller than those measured on OX. Interradicular distance was significantly correlated with the horizontal angulation of the x-ray beam. X-ray projection angle was the most influential variable on interradicular distance. About 30% reduction in interradicular space was observed for every 10° of deviation from orthogonal x-ray.

CONCLUSION

Two-dimensional radiographs obtained away from the 0° projection geometry can reduce the actual interradicular space for mini-implants, inducing misdiagnosis.

Digital Intraoral Imaging Re-Exposure Rates of Dental Students

A guiding principle of radiation safety is ensuring that radiation dosage is as low as possible while yielding the necessary diagnostic information. Intraoral images taken with conventional dental film have a higher re-exposure rate when taken by dental students compared to experienced staff. The aim of this study was to examine the prevalence of and reasons for re-exposure of digital intraoral images taken by third- and fourth-year dental students in a dental school clinic. At one dental school in Canada, the total number of intraoral images taken by third- and fourth-year dental students, re-exposures, and error descriptions were extracted from patient clinical records for an eight-month period (September 2015 to April 2016). The data were categorized to distinguish between digital images taken with solid-state sensors or photostimulable phosphor plates (PSP). The results showed that 9,397 intraoral images were made, and 1,064 required re-exposure. The most common error requiring re-exposure for bitewing images was an error in placement of the receptor too far mesially or distally (29% for sensors and 18% for PSP). The most common error requiring re-exposure for periapical images was inadequate capture of the periapical area (37% for sensors and 6% for PSP). A retake rate of 11% was calculated, and the common technique errors causing image deficiencies were identified. Educational intervention can now be specifically designed to reduce the retake rate and radiation dose for future patients.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

INTRODUCTION

An organization's transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time.

AIM

To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services.

MATERIALS AND METHODS

To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP's), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis.

RESULTS

A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP.

CONCLUSION

Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety.