SOUTH WEST CLINICAL AUDIT AND PEER REVIEW ASSESSMENT PANEL
Dental Clinical Audit
2. Quality of Radiographs
CAP ref:
Audit start date:
Completion date:
Panel member contact: Bernard Jones email -
Dental Clinical Audit report (tick) check list: All sections need to be completed and included when returning your report:
1. Completed data capture sheets pages: 4 – 72.1 NHS England Area Team Mandatory Aims & Objectives page: 8
2.2 NHS England Area Team Mandatory Action Plan page: 8
2.3 NHS England Area Team Mandatory Feedback section page: 8
(how useful you found the audit)
3. Declaration Tick confirmation box and Date page: 9
Please note –when returning your audit do not include any Dentist, Practice or Patient demographic details.
2013 Structured Dental Clinical Audit on the 2.Quality of Radiographs
Prepared by: South West Clinical Audit & Peer Review Assessment Panel,
South West Commissioning Support (SWCS), Mallard Court, Express Park, Bristol Road, Bridgwater, Somerset, TA6 4RN.
CLINICAL AUDIT FOR DENTAL PRACTITIONERS
South West Clinical Audit and Peer Review Assessment Panel
2. Audit on the Quality of Radiographs
WHY?
If radiographs are of good quality first time then, diagnosis can proceed, patients are not exposed to unnecessary radiation and practice time and resources are conserved.
Repeat radiographs because of poor quality are not to be confused with second radiographs taken because additional information is sought (often prompted by the first radiograph). Careful thought is needed during the audit, so that performance can be accurately measured and improvements to practice implemented.
AIMS
The aims of the audit are:
1. To set criteria and standards for good practice in the taking of radiographs.
2. Compare current practice with the standard set.
3. To collect data which will help decide what action is to be taken to improve
performance. (e.g. improvement in technique, processing and performance of X-ray equipment).
4. To make changes where appropriate and to re-audit on a regular basis.
OBJECTIVES
1. To reduce radiation exposure to patients.
2. To improve the diagnostic capabilities of radiographs.
Source material
www.bda.org/advice/docs/a11radiation.pdf
http://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/136_en.pdf
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947310610
The proposed standard
Each radiograph should be graded according to NRPB standards in quality, which are:
1. Excellent-no errors of exposure, positioning or processing.
2. Diagnostically acceptable-some errors, but these errors do not detract from the
diagnostic utility of the radiograph.
3. Unacceptable-errors present, which render the radiograph diagnostically unusable.
Initially an acceptable standard to aim for would be for all radiographs to reach:
>70% Grade 1
<20% Grade 2
<10% Grade 3
South West Clinical Audit and Peer Review Assessment Panel
2. Audit on the Quality of Radiographs
METHOD
The audit consists of two cycles, a retrospective audit and a prospective audit.
The retrospective audit involves analysing a random selection of 25 recently taken radiographs.
Data should be collected on the attached forms so that the quality of each film can be captured.
With reference to the grading system, analyse each film and put them into grades 1, 2 or 3.
Radiographs from grades 2 and 3 are further examined in order to determine the causes of error and these are classified into faults due to:
(a) Positioning.
(b) Exposure
(c) Chemical Processing
(d) Digital Processing
When the results of the first cycle have been collected and compared to the set standard, you will be able to see whether your technique for taking and processing radiographs requires any improvements.
Analysis of the data from the grade 2 and 3 groups will highlight any changes that are required to improve on the results from the retrospective audit.
For example,
· Do the radiographs show overlapping contact points?
· Is the exposure correct for the type of film?
· Do the developing and fixing chemicals need renewing more frequently?
· Are you changing your digital sensors appropriately?
Changes can then be implemented and assessed with the use of the prospective audit cycle, consisting of another sample size of 25 radiographs.
The effectiveness of these changes will be measured by the same method of data collection and analysis used in the retrospective audit.
Your conclusion should make mention of the changes that were implemented and the results of both cycles displayed.
e.g.
1st Cycle 2nd Cycle
65% Grade 1 85% Grade 1
23% Grade 2 14% Grade 2
12% Grade 3 1% Grade 3
If more than one dentist in the same practice completes the same audit, each dentist must complete their individual audit, data and feedback sheets.
The proposed timetable for this activity should not usually exceed three months.
South West Clinical Audit and Peer Review Assessment Panel CAP Ref:
2. QUALITY OF RADIOGRAPHS DATA COLLECTION SHEET
Audit cycle 1
Rad. No. / Holder usedYes = Y No = N / New diagnostic information
Yes = Y
No = N / Grade 1 / Grade 2 / Grade 3
Positioning / Exposure / Chemical Processing / Digital Processing / Positioning / Exposure / Chemical Processing / Digital Processing
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Audit Cycle One Results as a percentage
Grade 1 / %
Grade 2 / %
Grade 3 / %
South West Clinical Audit and Peer Review Assessment Panel CAP Ref:
2. Audit on the Quality of Radiographs
First Audit cycle results
For Grade 2 or 3 fill in details below:
Positioning
Type of films assessed / No. of unacceptable films) / Film faults (%)Apex missing / Apex obscured / Incorrect vertical angulation / Incorrect horizontal angulation / Film bending / Cone cutting / Positioning errors / Inadequate density and contrast
Bitewing radiographs / N/A / N/A /
/
Periapical radiographs /
For Grade 2 or 3 reasons for processing faults:
Digital sensors degradedWeak developer
Weak fixer
Wrong temperature
South West Clinical Audit and Peer Review Assessment Panel CAP Ref:
2. QUALITY OF RADIOGRAPHS DATA COLLECTION SHEET
Audit cycle 2
Rad. No. / Holder usedYes = Y No = N / New diagnostic information
Yes = Y
No = N / Grade 1 / Grade 2 / Grade 3
Positioning / Exposure / Chemical Processing / Digital Processing / Positioning / Exposure / Chemical Processing / Digital Processing
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Audit Cycle Two Results as a percentage
Grade 1 / %
Grade 2 / %
Grade 3 / %
South West Clinical Audit and Peer Review Assessment Panel CAP Ref:
2. Audit on the Quality of Radiographs
The European Directive on protection in dental radiology states that all X-ray examinations should be justified on an individual basis and that a quality assurance programme should be in place in every dental facility.
For all those patients in the second cycle answer the following questions:
1. Did you obtain consent for the radiograph(s) taken? / Yes No2. Did you take a history and perform a clinical examination prior to
taking the radiograph(s)? / Yes No
3. Did the radiograph(s) provide new information to aid the
patient’s management in every case? (as a fraction of 25 see
2nd column of data capture sheet)
4. Did you carry out a caries risk assessment before taking
bitewing radiographs? / Yes No
5. How frequently do you take bitewing radiograph(s) for:
(a) a high risk patient?
(b) a low risk patient? / (a)
(b)
6. Did the radiograph(s) show evidence of undiagnosed
periodontal disease? / Yes No
7. If you took radiograph(s) for endodontics, were they all of grade
1 or 2? / Yes No
8. How many retakes did you take in this second cycle?
9. What is the main fault evident in the radiographs taken for this
audit?
Quality assurance:
The EU Directive (and a directive is a MUST do) states that a QA programme should address:
Image quality assessment
Practical radiographic technique
Patient dose and xray equipment
Darkroom, film, cassettes and processing
Do you have a programme in place? / Yes NoDo you have a written log of this programme? / Yes No
Do you have a specific named person responsible for a QA programme? / Yes No
NHS ENGLAND AREA TEAM MANDATORY PAGE CAP Ref:
South West Clinical Audit and Peer Review Assessment Panel
2. Quality of Radiographs Audit
Please complete this mandatory page as part of your Clinical Audit activity, which will be sent anonymously to your NHS England Area Team.
Quality of Radiographs Audit feedback:Were the following AIMS & OBJECTIVES ACHIEVED / Yes / No
AIMS
1. To set criteria and standards for good practice in the taking of radiographs.2. Compare current practice with the standard set.
3. To collect data which will help decide what action is to be taken to
improve performance. e.g. improvement in technique, processing and
performance of X-ray equipment.
4. To make changes where appropriate and to re-audit on a regular basis.
OBJECTIVES
1. To reduce radiation exposure to patients.2. To improve the diagnostic capabilities of radiographs.
Action Plan as a result of your Clinical Audit including any changes made between first and second audit cycles:
How useful did you find this Dental Clinical Audit?
Please tick one of the following: No use Useful Very Useful
Any comments on this Structured Dental Clinical Audit especially if you ticked no use:
For Panel use only:
Approved / Not ApprovedSouth West Clinical Audit and Peer Review Assessment Panel CAP ref:
2. Audit on the Quality of Radiographs
The results of your audit will be recorded by the Panel who will feedback the overall findings for the area to yourself and the NHS England Area Team in an anonymous form. This will enable the NHS England Area Team to identify any areas that need support and enable you to compare your results with those of your local colleagues.
Please return all the information in your report as detailed below within three months of the start date (If you would like longer than 3 months to complete your audit please contact Jackie).
Dental Clinical Audit report check list: All sections need to be completed and included when returning your report:
1. Completed data capture sheets: (pages 4 – 7)2.1 NHS England Area Team Mandatory page: Aims & Objectives
2.2 NHS England Area Team Mandatory page: Action Plan
2.3 NHS England Area Team Mandatory page: Feedback section
(how useful you found the audit)
3. Declaration Tick confirmation box and Date
Please note: a copy of your completed Dental Clinical Audit should be retained by the practice as part of your practice clinical governance portfolio. Your NHS England Area Team may wish to examine your audit during any Clinical Governance practice inspections that may take place.
I confirm that I have completed the enclosed Dental Clinical Audit activity
Date:
Please e-mail your completed Dental Clinical Audit to Jackie Derrick at:
Permission to reproduce any of the South West Clinical Audit & Peer Review Assessment Panel Structured Dental Clinical Audits will need to be obtained from the Panel.
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