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5th Yr - CP5- IRMER > Quality assurance > Flashcards

Quality assurance Flashcards

1
Q

What principle do we use to ensure patients receive minimal ionising radiation

A

ALARP Principle

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2
Q

What Does the ALARP principle stand for

A

As
Low
As
Reasonably
Possible

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3
Q

What is the ALARP principle

A

Principle of radiation protection to keep radiation doses to patients as low as reasonably possible

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4
Q

How is the ALARP principle upheld

A
  1. Dose optimisation by choice of technique
  2. Use of selection criteria to justify all exposures
  3. Production of optimal quality images W
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5
Q

What is quality assurance

A

The planned and systematic execution of procedures to ensure high quality images of high diagnostic yield at minimum radiation doseage

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6
Q

What does quality assurance entail

A
  1. Getting it right the first time every time
  2. Ensuring the consistent production of radiographs of adequate quality for diagnostic purposes
  3. Keeping doses to patients ALARP
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7
Q

Why is quality assurance important

A
  1. Reduces the necessity for retakes
  2. Minimises radiation exposure to patient
  3. Minimise costs
  4. Minimise inconvenience
  5. Saves time
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8
Q

What does IRMER 2017 say about quality assurance

A

The employer must implement and maintain a QA programme
AND
The operator must select equipment and methods to ensure that for each exposure the dose of ionising radiation to the individual undergoing the exposure is ALARP and in doing so must pay particular attention to quality assurance

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9
Q

List the overarching principles that define the operations within the quality assurance programme

A

Programme should be:
1. Comprehensive
2. Based one evidence based guidance
3. Convient to operate and maintain
4. Standards should require infrequent verification or modification
5. Formally recorded

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10
Q

When formulating a quality assurance programme which subject areas need to be covered

A
  1. QA of IRMER17 employers procedures
  2. QA of x ray equipment and patient dose
  3. QA of image processing and display equipment
  4. QA of image quality
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11
Q

Which documents are includes in the QA of IRMER17 Employers procedures

A
  1. Radiation protection file
  2. QA Procedures for training
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12
Q

What does the radiation protection file contain

A

All documentation, procedures and records that are essential to the safe use of x ray equipment
eg legal documents such as local rules, employers procedure, contingency plans

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13
Q

How often is the radiation protection file reviewed

A

Reviewed when practice circumstances change
or
at no greater than 3 year intervals

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14
Q

What should the QA programme for radiation protection files include

A
  1. A record of the existence of relent documents and procedures
  2. Record of review and modification of these documents
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15
Q

What does the QA of X ray equipment and patient dose ensure

A

that all equipment remains capable of adequate dose restriction

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16
Q

What should the QA of X ray equipment and patient dose documents include

A
  1. Inventory of all dental x-ray equipment and ancillary equipment which would influence patient dose
  2. Record of testing
  3. In-house checks
  4. Representative patient doses
  5. Remedial and suspension levels for action
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17
Q

List all the x ray equipment

A
  1. X ray set
  2. image receptor
  3. Phosphor paste readers
  4. Film cassettes
  5. Light boxes
  6. Computer screens used for viewing digital images
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18
Q

What are the 4 parts of testing dental x ray equipment

A
  1. Critical examintion
  2. Adequate testing
  3. Routine testing
  4. In house QA checks
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19
Q

What is the critical examination

A

Examination done on the rx ray equipment before it comes into clinical use

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20
Q

What does the critical examination include

A
  1. correct operation of safety features and Warning devices
  2. Sufficient protection for persons from exposure to ionising radiation
  3. Provide employer with adequate information about proper use testing and maintained of the equipment
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21
Q

Who is legally responsible to carry put the critical examination

A

Legal respossiblty of installer but the employer is advised to ensure that it has been performed

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22
Q

Who should the installer consult following their critical examination

A

The radiation protection advisor with regard to the nature, extent and rust soft the examination

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23
Q

What is adequate testing also referred to as

A

Acceptance testing

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24
Q

When does adequate testing need to happen

A

Prior to equipment being put into clinical use

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25
Q

What does adequate testing do

A

It confirmed that equipment is operating correctly and capable of adequate dose restriction

26
Q

Who carries out the adequate testing

A

The installer usually at the same time as the critical examination

27
Q

How often is routine testing performed

A
  1. 3 yearly expect when annual testing is necessary
  2. Following relocation and re installation
  3. Following repalcement of important features of equipment
  4. If you upgrade the equipment
28
Q

How often should a routine test be carried out for hand held x ray equipment

A

Annual

29
Q

How often should in house QA checks be carried out

A

Routinely every 6 months

30
Q

What should the in house QA checks include

A
  1. Safety and warning
  2. Exposure switch
  3. Equipment arm counterbalance
  4. Smooth movement of rotational equipment
  5. General condition of the x ray tube head
31
Q

What equipment needs to be quality checked in regards to imagine processing and display equipment

A
  1. Digital systems: image receptor, display screens
  2. Film based systems: light tightness, overall processing performance, light boxes and viewing conditions W
32
Q

When should tests be carried out on intra oral digital image sensors

A

3 months or when damage is suspected

33
Q

What tests should we carry out when assessing intra oral digital image sensors

A
  1. Visual inspection
  2. Image uniformity
  3. Subjective check of image quality
34
Q

How do we carry out an image uniformity test

A
  1. Remove receptor from package
  2. Put to low dose exposure mode
  3. Use the same x ray set and exposure setting to allow for comparable result
  4. Review the resultant image for uniform dentistry across the exposed portion of the plate
35
Q

What are some common defects found on Photo situated phsophors

A
  1. Cracking of phosphor
  2. Delamination of phosphor
  3. Scratches, bite marks and abrasion
  4. Debris on plate
36
Q

What is the subjective image quality assessment perfumed using

A

Step wedge or test object

37
Q

How is the subjective image quality assessment carried out

A

Exposure is made using the same x ray set each time and tg abnormal clinical exposure setting
Resultant image is inspected and compare to baseline

38
Q

What tests do we carry out to inspect panoramic and cephalometric image receptors

A
  1. Visual inspection
  2. Image uniformity
  3. Image quality assessment
39
Q

How often should displace screen be tested

A
  1. Image display monitor condition monthly
  2. Image display monitor calibration every 3 months
  3. Image display monitor resolution every 3 months
40
Q

How do we test display screens

A

Test patterns such as SMPTE pattern or the TG-18 QC

41
Q

What standards should be given regarding film and their processing

A
  1. Film expiry date and storage conditions
  2. Processign conditions
  3. Frequency of changing solutions
  4. Cleaning instructions for automatic processors
42
Q

Whats crucially important for quality of film imaging systems

A

Light tightness any light can result in fog across the image reducing the diagnostic value

43
Q

How do we assess the light tightness

A

Assess the quality of safelights found in the dark room or desktop processing unit

44
Q

How often should light tightness be assessed

A

Not greater than 12 months

45
Q

Give an example of how light tightness can be assessed in a dark room

A

The coin test

46
Q

Talk through the coin test

A
  1. Place a coin on a film image receptor
  2. Place it into the dark room with the safe lights an close the door
  3. If the image you receive shows an outline of the coin then there is light coming into the dark room
47
Q

How do we assess the processing performance of film imaging systems

A

Step wedge and compare to reference radiograph

48
Q

When should the processing of a film image system be assessed

A

After every change of processing chemical or more frequently if image quality needs to be monitored closely

49
Q

How can we QA image quality

A
  1. Three point subjective image quality (old system)
  2. 2 point scale now used
50
Q

What are the 2 categories image quality can be rated into

A

A. Diagnostically acceptable
N. Diagnostically unacceptable

51
Q

What is prospective evaluation

A

Ratings for radiographs are assigned and recorded as viewed
Analysis of results at intervals are not greater than 6 months

52
Q

What is retrospective evaluations

A

Representative sample is drawn at regular intervals and rated and recorded
Results are analysed at intervals to greater than 6months

53
Q

If you take a diagnostically unacceptable radiograph what should you do

A

Note:
date
nature of fault
known or suspected cause
number of repeat radioagraphs if taken

then carry out a reject analysis to be undertaken at the same time as teh image quality analysis

54
Q

What can errors in radiogrpah quality be categorised into

A
  1. Patient preparation
  2. patient positioning
  3. Exposure
  4. Image receptor processing
  5. Handling/ image construction
  6. Too dark
  7. Too pale
  8. Not enough contrast
  9. Dark marks
  10. White marks
  11. Poor positionign
  12. Movement
55
Q

Which errors are common in both film and digital radiogrpahs

A
  1. Patient preparation
  2. Patient positioning
56
Q

By patient preparation what do we mean

A

Make sure patient removes:
1. Dentures
2. Orthodontic appliances
3. Glasses
4. Earrings
5. Necklaces and chains
6. Hair grips
7. High zips

57
Q

What does proper technique allow fro

A

Increases diagnostic yield of radiograph and reduces need for repeat radiographs

58
Q

Give some unique errors for film based radiographs

A

Processing
Handling

59
Q

Why might a radiographic image be too dark

A

It has been over exposed or over processed

60
Q

Why might a radiographic image be too light

A

It has been under exposed or under processed

61
Q

Give examples of some errors unique to Digital radiographs

A
  1. Different appearance of exposure errors
  2. Image receptor damage/ degradation
  3. Incorrect placement of image receptor
  4. Image processing errors
  5. Software issues

5th Yr - CP5- IRMER (6 decks)

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