Elite Batch 2012

Quality assurance
I-Quality control tests: are specific tests that are used to maintain and monitor dental

x-

ray equipment ,supplies,and film processing .why to do such tests? To avoid excess exposure of
patients and personnel to x-radiation.
-equipment and supplies
Quality control tests are necessary to monitor dental x-ray machines
,films, screens and cassettes ,and viewing equipment to produce diagnostic quality radiographs.
-dental x-ray machines
i-All dental x-ray machines must be inspected and monitored periodically also they must be calibrated and
adjusted for accuracy by a qualified technician to ensure consistent x-ray machine performance and the
production of diagnostic radiographs .
ii-some states and local agencies provide dental x-ray equipment inspection services as part of their
registration and licensing procedures .
iii- the American academy of dental radiology recommends a number of annual tests for dental x-ray
machine .these tests are designed to identify minor malfunction including :machine output variations
,inadequate collimation ,tubehead drift ,timing errors, inaccurate kilovoltage and milliamperage.
those tests are:1- focal spot size test. 2-half-value layer test. 3- collimation beam alignment test .4kilovoltage test . 5- milliamperage test. 6- x-ray output test. 7-timer test . 8-tubehead stability test .
iv-those annual tests can be performed by the dentist, the dental hygienist ,dental assistant ,manufacturers
service representative.
v- those annual tests requires: basic testing material ,film, test logs to record the results.
-dental x-ray film
Films must be properly stored, protected and used before expiration date .
For quality control purpose ,when each box of film is opened it should be tested for freshness .how to do
this? 1-prepare the film .unwrap one unexposed film from a newly opened box .
2-process the film .use fresh chemicals to process the unexposed film .
The results of this test can be interrupted as follows :
1-if the processed film appears clear with a slight blue tint,the film is freash.
2-if the processed film appears fogged .the film should not be used.

-screens and cassettes

page |1

Elite Dental Team

Elite Batch 2012

They must be examined periodically for the presence of any scratches (if there are any scratches it
should be replaced) or dirt.
Screens should be cleaned on a monthly basis with cleaner recommended by the manufacturer
then antistatic solution should be applied to it.
Cassette holders must be examined every month for worn closures ,light leaks, warping ,all which
lead to fogged and blurred radiographs ;these cassettes should be repaired or replaced ,also
cassettes should be checked for adequate film to screen contact.
The following film to screen contact test is recommended:
1- insert one film between the screens in the cassette holder.
2-place a wire mesh test object on top of the loaded cassette.
3-position the position-indicating device using a 40-inch target film, while directing the
central ray perpendicular to the cassette.
4- expose the film using a 10 mA ,70 kVp ,and 15 impulses.
5-processe the exposed film.
6-chech it on a view box in a dimly lit room at a distance of 6 ft.
The results of this test can be interpreted as follows;
-adequate contact:if the wire mesh image seen on the film exhibits a uniform density ,so
proceed with the screen and the cassette.
-inadequate contact : if the wire mesh image seen on the film exhibits varying densities
(poor film to screen contact ,those areas appear darker than good contact areas) ,so replace
or repair the cassette.
- viewing equipment
-What is the viewbox or illuminator? It is a light source that is used to view dental
radiographs and it is important for interpreting dental radiographs, it contains a florescent
light bulbs that emit light throw plastic or plexiglass front .
-To say this viewbox function properly it should emit a uniform and subdued light.to check
for this (the proper viewing brightness) we use a photographic light meter.
-The viewbox should be periodically examined for the presence of dirt on the plexiglass
surface and ny discoloration.
-The surface of the viewbox should be wiped clean every week.

page |2

Elite Dental Team

Elite Batch 2012

-Any permanently discolored plexiglass surface or blackened fluorescent light bulbs must be
replaced.
-film processing
-It is one of the most critical areas in quality control ,so it is monitored daily .
It has the potential to result in a large number of nondiagnostic radiographs.
-We must routinely perform a quality control tests to determine whether the conditions for
film processing are acceptable.
-darkroom lighting
-it must be checked for light-tightness monthly and for proper safelighting every 6 months
.the following light leak test is recommended for the darkroom:
1- prepare the darkroom.close the darkroom door,and turn off all lights ,including the
safelight.
2-examine the darkroom once your eyes become accustomed to the darkness,observe the
areas around the door,the seams of the walls and ceiling,the vent areas and the keyhole for
light leaks.
-the results of this test can be interpreted as following:
1-no light leaks.if the darkroom is light - tight .no visible light is seen.so proceed with film
processing.
2-light leaks,if present are seen around the door through the seams of the walls or ceiling or
through a vent or a keyhole .so you can eliminate those leaks using a stripping or black tap
before proceeding the film processing .
Note: only after the light-tightness has been established can the safelighting be checked .we
use the following safelighting test (coin test):
1-prepare the darkroom,turn off all lights including the safelights.
2-prepare the film.unwarp one unexposed film.place it on a flate surface at least 4 ft from
the safelight,place coin on top of the film.
3- turn on the safelights,allowing the coin and the film to be exposed to the safelights.
4- remove the coin and process the film
The results of this test can be interpreted as the following:

page |3

Elite Dental Team

Elite Batch 2012

-proper safelighting.if no visible image is seen on the processed radiograph.this means that
safelight is correct so proceed with the film proessing.
-improper safelighting.if the image of the coin and the fogged background appear on the
processed radiograph,so the safelighting is not safe to use with this type of films.
* to avoid safelighting problems we must:
1-use the film manufacturer's recommended safelightfilters an bulb wattages 2- the film
must be unwrapped at least 4 ft away from the safelight.
*safelight problems must be corrected before proceeding the film processing.
7-processing equipment
-those equipment must be meticulously maintained and monitored daily.
-thermometer,developer,tempreture, level of water bath ,fixer solutions and timer must be
checked for accuracy with manual processing technique.
- the processing time and temperature recommendations of the film manufacturer must be
strictly followed.
-if you are using an automatic processing equipment ,we must check the water circulation
system and we must monitor the solution level ,the replenishment system and the
temperature .
-the manufacturer's procedure and maintenance directions must be followed carefully.
-each day 2 films must be tested in the automatic processor.the following automatic
processor test films is recommended:
1-prepare the films. Unwrap two unexposed films and expose one of them to light.
2- process both films in the automatic processor
The results can be interrupted as following:
-functioning processor. If the unexposed film appears clear and dry and the exposed to light film
appears dark and dry.so proceed with processing.
-nonfunctioning processor. If the unexposed film does not appear clear and dry and the exposed to
light film does not clearly appear dark and dry.so the processing solutions and dryer temperature
must be checked and corrections must be done before proceeding the processing.
8-processing solutions
Monitoring processing solutions is the most critical component of film processing quality control.
page |4

Elite Dental Team

Elite Batch 2012

-the processing solution must be replenished daily and changed every 3to 4 weeks as
recommended by the manufacturer.
-we can use quality control tests as an alternative to using the calendar to determine the freshness
of solutions.
-processing solutions must be evaluated each day before any patient films are processed.
-developer strength .when developer solutions loses strength ,the time temperature
recommendations of manufacturer can no longer be used as the standard of measurements . if you
want to check the strength of developer solutions is to compare film densities to a standard.and
one of the following tests can be used (for more details see table 10-1 in the book ,page 115):
I-reference radiograph: is one that is processed under ideal conditions and then used to compare
the film densities of radiographsthat are processed daily.the following teps can be taken to create a
refrane radiograph:
1-preparethe film.use fresh film to mke a refrance radiograph.
2-expose the film,using correct exposure factors.
3- process the film ,using fresh chemicals at the recommended time and temperature.
4- view the reference radiograph and the daily radiographs side on a viewbox.then compare
densities on reference radiograph with the densities on the daily radiograph.and this can be
interrupted as follows:
-matched densities: if the densities of reference and daily radiographs are matched ,the strength of
developer solution is adequate ,proceed the processing.
-unmatched densities: : if the densities of reference and daily radiographs are unmatched( daily
radiographs appears lighter ;the developer solution is even weak or cold but if the daily radiograph
appear darker; the developer solution is too concentrated or too warm).in the case of weak or
concentrated solution replace the developer solution ,but in the case of warm or cold solution the
temperature must be adjusted.

II-stepwedge radiograph: is a device constructed of layered Aluminum steps.when a stepwedge is

placed on top of a film and then exposed to x-ray ,the different steps absorb varying amounts of xray.when processed ,different film densities are seen .the following steps can be taken to create
stepwedge radiograph:
1-prepare the film.use a 20 fresh films to create a supply of films for daily testing.place an
aluminum stepwedge on top of one film.
2-expose the film. Repeate those two steps for the rest of the 20 films.
page |5

Elite Dental Team

Elite Batch 2012

3-using fresh chemicals ,process only one of the exposed films.this radiograph will exhibit a
different densities as result of using stepwedge(it is called standard stepwedge radiograph)
4-store the remaining 19 exposed films in a cool ,dry area protected from x-ray.
5-each day,after the chemicals have been replenished, process one of the exposed stepwedge
films.
6-- view the standard radiograph and the daily radiographs side by side on a viewbox .then
compare densities seen on standaredradiograph with the densities on the daily one.and results can
be interpreted as follows:
-matched densities:use the middle density seen on the standard stepwedge radiograph , if the
densities of standared and daily radiographs are matched ,the strength of developer solution is
adequate ,proceed the processing.
-unmatched densities: : if the density of daily radiograph is different from the standard by more
than 2 steps on the stepwedge .the developer solution must be changed.
III-normalizing device:it can be used to monitor developer strength and film densities,and it is
commercially available
Now,we will talk about fixer strength: fixer solution removes the unexposed silver halide crystals
on the film that results in clear areas on the processed film.if the fixer becomes weak the film takes
aa longer time to clear or to become transparent in the un exposed area ,but if it was strong the
film will be clear in 2 minuteswithout agitation.to monitor the fixer solution a clear test can be
done:
1-prepare the film.unwrap the film and immediately place it in the fixer solution.
2-check the film for clearing ,measure the time needed for clearing.
The results can be interpreted as follows:
-fast clearing .if the film clears in 2 min the fixer strength is adequate .proceed the processing.
-slow clearing.if the film is not completely clear within 2 min ,re-immerse in the fixer,if the film does
not completely clear within 3-4 min,the fixer is depleted and must be replaced
-

9- digital imaging
page |6

Elite Dental Team

Elite Batch 2012

-along with annual tests for the calibrations of the imaging equipment ,the receptors (whether for
direct or indirect imaging) also require periodic examination for bending ,scratching, and general
wear and tear.
-since digital sensors and imaging plates are used multiple times ,greater care in handling and
cleaning of the sensors.
-the damaged (by debris or bending) imaging sensors shows the same artifacts repeatedly.
-if there is any signs of separation from the sensor or deterioration ,the dental professionals who
use direct digital imaging must inspect the wired connection.
-commercial kits that are available include a set of test objects ,which can be used quickly and easily
on an ongoing basis to check the imaging performance, particularly those aspect that are subject to
deterioration.
-those kits allow for the following checks ;
Image retention ,sensitivity ,uniformity ,erasure cycle efficiency ,scaling errors ,blurring artifacts,
and resolution .

II-quality administration procedures

Definition: it is the management of the quality assurance plan in the dental office.
-the basic element of of a quality administration program include the following:
1-description of the plan: it should be on file and made available to all participating staff members(
staff members must plan must understand the standards of quality , the purpose and the
importance of maintaining quality control ) ,the standards of quality must be outlined by the
dentist.
2-assignment of duties: it should be on file and made available to all participating staff members
,each staff member assigned to perform a duty must understand the purpose and importance of
that specific duty.
3-monitoring schedule :this schedule must be posted in the office and it must contain all quality
control tests and the frequency of testing for all dental x-ray equipment ,supplies ,and film
processing.
4-maintainence schedule :this schedule must be posted in the office ,and it must contain the
routine service and inspection of dental x-ray machines and processing equipment.
5-record-keeping log : it should carefully maintained and kept o file in dental office and it should
contain all quality control tests including; the test performed, the date performed ,and the test

page |7

Elite Dental Team

Elite Batch 2012

results also it should contain processing solutions which lists the dates of solution replacement
,replenishment , and processor or tank cleaning.
6-plan for evaluation and revision: it should be a part of the quality administration plan.
7-In-service training :it is recommended periodically for staff members to upgrade and improve xray exposure techniques and film processing procedure.

III-operator competence
-the dentist is ultimately the responsible for the overall quality assurance plan ,also the dentist is
responsible for the diagnostic quality for all radiographs regardless of who expose and process the
films.
- to ensure the production of diagnostic radiographs ,the dentist depends on the skills of competent
dental radiographer ,who is competent in both exposure and processing techniques.
- if a nondiagnostic image was produced,the operator must retake the image ,and the number of
retakes must be kept to an absolute minimum .

That's all
Thank you
Done by :hadeel aljarrah

page |8

Elite Dental Team