DEN 130 1 H - Dental Radiology- 40

LEGAL ISSUES, QUALITY ASSURANCE, AND INFECTION PREVENTION

Chapter 40

LEARNING OBJECTIVES

Lesson 40.1: Legal Considerations

  • Key Terms: Pronounce, define, spell key terms related to legal considerations in dental imaging.

  • Major Categories of Legal Considerations:

    • Types of laws affecting dental radiography.

    • Consumer-Patient Radiation Health and Safety Act.

    • Components of informed consent in dental imaging.

    • Legal ownership of dental images.

INTRODUCTION

  • Responsibility of Dental Assistants: Understand relevant laws when exposing dental radiographs.

  • Regulations: Federal and state regulations govern dental x-ray equipment use.

  • Quality Assurance Program: Essential for producing high-quality images and minimizing exposure risks.

  • Infection Control Needs: Risks of cross-contamination exist with improper infection control procedures in place.

LEGAL CONSIDERATIONS

Three Major Categories

  1. Federal and State Regulations: Control the use of dental x-ray equipment.

  2. Licensure: Required for individuals exposing dental images.

  3. Risk Management: Strategies to avoid potential lawsuits.

FEDERAL AND STATE REGULATIONS

  • All dental x-ray machinery sold or manufactured in the U.S. post-1974 must comply with federal regulations, which stipulate:

    • Minimum filtration requirements.

    • Accuracy of milliamperage, time, and kilovoltage settings.

  • Compliance with state, county, or city radiation health codes is also necessary.

LICENSURE REQUIREMENTS

  • Consumer-Patient Radiation Health and Safety Act: Ensures personnel taking dental radiographs are trained and certified.

  • State Policies: Each state determines licensure policies; requirements vary, with some mandating certification by the Dental Assisting National Board.

RISK MANAGEMENT

  • Policies aim to reduce malpractice lawsuit risk for dentists.

  • Role of Dental Assistants: Must avoid negative comments about x-ray equipment, which could lead to patients feeling uncomfortable or raising suspicions in potential lawsuits.

  • Statements made before alleged negligent acts can be used as evidence in court.

INFORMED CONSENT

  • It is the dentist’s duty to explain the need for radiographs and treatment; assistants aid in this process.

  • Patient's Rights: Informed consent is necessary for dental imaging and other procedures.

  • Criteria for Valid Informed Consent:

    • Risks and benefits of procedures must be explained.

    • Identity of the person exposing the radiographs.

    • Type and number of radiographs taken.

    • Consequences of not performing radiographs.

    • Alternative diagnostics available.

LIABILITY

  • Under state laws, supervising dentists are liable for their auxiliaries' actions, governed by the doctrine of respondeat superior.

  • Legal Responsibility: Dental assistants are also liable for their conduct under supervision.

PATIENT RECORDS

  • Dental images, whether in film or digital format, constitute a legal document and part of the patient's dental record.

  • Documentation Requirements: Log the number of films taken and their quality due to potential implications in malpractice suits.

DOCUMENTATION OF DENTAL RADIOGRAPHS

  • Records must include:

    • Informed consent documentation.

    • Types and numbers of radiographs exposed.

    • Rationale for taking images.

    • Diagnostic interpretations made.

OWNERSHIP OF DENTAL RADIOGRAPHS

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  • Property Status: Dental images are owned by the dentist, despite payment being made by the patient or their insurance.

  • Patient Rights: Patients may request copies of their dental images via written and signed requests.

  • Records Management: Keep records of when and whom copies were sent to; never send original radiographs to patients.

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  • Retention of Records: Dental images and records should be kept indefinitely; destruction is governed by statutes of limitations.

  • Storage Protocols: Ensure proper storage to prevent damage or loss, including backing up computer files both on-site and off-site.

DIGITAL FILES SECURITY

  • Transmission of Files: Digital imaging files can be transmitted electronically; however, adherence to confidentiality regulations from local, state, and federal levels must be observed.

  • Protection Measures: Encrypt files or employ VPNs rather than using public internet for sensitive data transfers.

PATIENT REFUSAL OF DENTAL IMAGING

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  • Assessment by Dentist: In such cases, the dentist must evaluate the feasibility of diagnosis and treatment without imaging; generally, lack of images can hinder accurate diagnosis.

  • Standard of Care: Current acceptance of dental radiographs as a standard requirement for dental diagnosis.

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  • Patient Education: Importance of imaging should be reiterated to patients. Release forms waiving liability are not valid if an injury results from refusal. Document the patient’s refusal in their record.

PATIENT EDUCATION

  • Role of Dental Assistants: Understand and address patient fears regarding radiation exposure during imaging.

  • Communication: Assistants can inform patients of the significance of imaging in treatment planning and disease detection, as well as relevant laws designed for patient protection. Educational materials should also be made available.

LEARNING OBJECTIVES

Lesson 40.2: Quality Assurance

  • Quality Assurance Components: Discuss annual tests for x-ray equipment, quality control tests for processing solutions including reference and stepwedge radiographs, and overall components of a quality assurance program.

QUALITY ASSURANCE IN THE DENTAL OFFICE

  • Quality assurance (QA) aims to create high-quality diagnostic imagery through both quality control tests and administrative procedures.

  • Key Components: Regular monitoring of x-ray equipment, supplies, and image processing, along with maintenance schedules and logs are essential.

QUALITY CONTROL TESTS

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  • Testing Focus: To monitor x-ray equipment, supplies, and film processing.

  • Tests to Identify Malfunctions: Include:

    • Radiation output variations.

    • Inadequate collimation.

    • Tubehead drift.

    • Timing errors.

    • Inaccurate kilovoltage and milliamperage readings.

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  • Tubehead Positioning: When not in use, keep the tubehead and extension arm closed to prevent drifting due to weight.

TYPES OF QUALITY CONTROL TESTS

  • Dental Film: Test each new box for freshness.

  • Dental X-ray Machine: Require regular calibration.

  • Cassettes and PSPs: Should be cleaned and inspected for scratches regularly.

  • Safelighting: Must be checked for darkroom light-tightness.

  • Automatic Processor: Must follow maintenance recommendations; manual processors need daily replenishment and changes every 3 to 4 weeks.

DENTAL X-RAY MACHINES

  • Periodical Inspections: Required by regulation, with some agencies providing free inspections as part of service.

  • Calibration: Requires regular adjustments for accuracy using basic test materials and maintaining logs for results.

X-RAY MACHINE QUALITY CONTROL STEPS

  1. Test x-ray output.

  2. Assess focal spot size.

  3. Evaluate tubehead stability.

  4. Verify timer accuracy.

  5. Measure milliamperage.

  6. Assess kilovoltage accuracy.

DENTAL X-RAY FILM

  • Ensuring film remains fresh is critical; to do so:

    • Open the box and unwrap one unexposed film; process it using fresh chemicals.

    • Successful processing results in a slight blue tint indicating freshness; fogged films indicate improper storage.

PHOSPHOR STORAGE PLATES (PSP)

  • Radiation Exposure: Reusable PSPs require lower radiation settings than traditional film, and careful handling is critical to prevent contamination during exposure and processing.

SCREENS AND CASSETTES

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  • Maintenance Practices: Intensifying screens should be cleaned monthly; apply antistatic solution post-cleaning.

  • Replacement Protocol: Visibly scratched screens must be replaced, and cassettes checked for wear and light leaks to avoid image quality issues.

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  • Testing for Adequate Film-Screen Contact:

    1. Insert film between the screens in the cassette.

    2. Place wire mesh test object on top.

    3. Expose film while directed at target.

    4. View results six feet away in dim lighting.

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  • Evaluation Outcomes: Uniform density indicates good contact, while varying densities signify poor contact, necessitating cassette repair or replacement.

VIEW BOXES

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  • Functionality Check: Proper operation is critical for interpreting radiographs; a uniform subdued light should be emitted.

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  • Cleaning Protocols: View boxes must be cleaned daily; replace discolored Plexiglas and burnt-out fluorescent bulbs promptly.

DARKROOM LIGHTING

  • Regular checks for light leaks every six months are critical; corrections should be made with weather stripping or tape if leaks are found.

SAFELIGHT TEST

  • Coin Test Process:

    • Place an exposed film under a coin away from the safelight; expose, and process the film.

    • No visible image = safelight functions correctly; otherwise, it requires replacement.

FILM PROCESSING

  • Routine quality control in film processing is crucial; both manual and automatic processing steps should be strictly adhered to.

MANUAL PROCESSING

  • Ensure accurate thermometer and timer readings, and check developer and fixer temperatures alongside recommended processing techniques.