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What is quality assurance in the Dental office?
Special prodedures that are used to ensure the production of high-quality diagnostic radiographs
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Who is ultimately responsible for administration of quality assurance?
The dentist
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How can the dental radiographer aid in implementation of administration of quality assurance?
By being knowledgable of the quality assurance plan
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Quality control tests
specific tests used to monitor dental radiograph equipment
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What do quality control tests monitor?
- Dental x-ray machine
- Dental x-ray film
- Screens and cassettes
- Dark room lighting
- processing equipment
- processing solutions
- Viewing equipment
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Describe quality administration procedures
- Description of plan
- Assignment of duties
- monitoring schedule
- maintenance schedule
- record-keeping logs
- evaluation and revision plan
- in-service training
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What must you do to care for x-ray machine?
check for calbration, and adjust for accuracy
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how often must you test dental x-ray machine?
once a year
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What does x-ray machine testing look for?
- minor malfuncionts
- machine output variations
- inadequate collimation
- tubehead drift
- timing errors
- inaccurate kilovoltage and milliamperage readings
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How do you test for freshness of x-ray film?
process one unexposed film
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How will a fresh unexposed film appear after testing?
clear with a slight blue tint
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How will an unfresh film appear after testing? Why does it appear this way?
- appears fogged
- expired film, improper storage, exposed to radiation
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What are extraoral screens used within a cassette holder examined for? how do you avoid this condition?
- dirt or scratches
- clean monthly with recommended cleaners
- appy astistatic solutions
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What are cassette holders examined for?
- worn closures
- light leaks
- warping resulting in fogged or blurred radiographs
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How do you check for adequate film-screen contact?
flim-screen contact test using wire mesh
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How does the film appear if there is adequate film-screen contact?
wire mesh image has uniform density
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How does the image appear if there is inadequate film-screen contact?
- the film exhibits varying densities
- areas of poor contact appear darker
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What should you examine on the radiograph viewing equipment?
- dirt and discoloration of plexiglass
- should emit uniform and subdued light
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How do you care for radiograph viewing equipment?
- wipe daily
- replace discolored plexiglass
- replace blackened flourescent bulbs
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Why is film processing one of the most critical areas in quality control?
because in can result in a large number of nondiagnostic film
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What must the dark room be tested for? and how often?
- light-tightness and proper safe-lighting
- every 6 months
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How do you check for light-tightness in the dark room
turn off all the light including safe-light, and observe room for light leaks
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How do you correct light leaks in the dark room?
with weather stripping or black tape
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How do you test the safe light?
with the coin test method (after the light leak test has been performed)
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How will the film appear if there is proper safe lighting?
no visible image is present on the processed radiograph
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How wil the film appear if there is improper safe lighting?
the image of the coin and fogged background appear on the film
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how often must the proccessing equipment be monitored?
Daily
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What do you check in the processing equipment?
- water circulation system
- solution levels
- replenishment system
- temperatures
- processing time
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How do you test to see if the processing equipment is running properly?
run 2 films, one exposed, one not exposed
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How will the films appear if the processing equipment is running properly?
- exposed film-pure black
- unexposed film- clear bluish tint and dry
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How will films appear if the processing equipment is not functioning properly?
- exposed flim- not black and dry
- unexposed film- not clear and dry
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Describe general care for processing solutions
- replenish daily
- change every 3-4 weeks
- evaluate daily before patient films are run
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Name 2 methods for checking developer strength
- reference radiograph
- stepwedge radiographs
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Reference radiograph
processed under ideal conditions and then used to compare the film densities of radiographs processed daily
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What do matched densities in reference radiograph testing indicate?
developer solution strength is adequate
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What do unmatched densities on reference radiograph test indicate?
- if dinsities on daily radiographs are light-developer is weak or cold
- if densities on daily radiographs are dark-developer is too strong or hot
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Stepn wedge radiograph
process one of twenty exposed radiographs under ideal conditions
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When the fixer solution is at full strength how long should it take the film to clear?
no longer than 2 minutes
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Name the 3 types of radiographic examination that use intraoral film
- periapical exam
- inter proximal exam
- occlusal exam
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Periapical exam purpose
exam entire tooth and supporting bone
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periapical film type
PA film-shows root and apex and surrounding bone
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technique used for PA exam
- paralleling techniqu
- bisecting technique
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interproximal exam purpose
- examine crowns of maxillary and mandibular teeth on a single film
- examine adjacent tooth surfaces and crestal bone
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interproximal exam film type
bite-wing film including bitewing tab
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interproximal exam technique used
bitewing technique
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Occlusal exam purpose
to examine large area of jaw on one film
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occlusal exam type
occlusal film-pt bites on film
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occlusal exam technique
occlusal technique
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Complete Mouth Radiographic series
series of intraoral dental radiographs that show all the tooth-bearing areas of the maxilla and mandible
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what film types does the CMRS include?
- 4 maxillary molar-premolar PA's
- 3 maxillary anterior PA's
- 4 bitewing films
- 4 mandibular molar-premolar PA's
- 3 mandibular anterior PA's
- include edentulous areas as well
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When is the CMRS appropriate?
new adult pt. presents with clinical evidence of generalized dental diseas, or a history of extensive dental treatment
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Diagnostic criteria for intraoral radiographs
- images with opyimum density, contrast, definition and detail
- images with least amount of distortion as possible-same size and shape as tooth
- FMX must show include all tooth-bearing areas
- PAX must show entire crown and root of teeth being examined as well as 2-3 mm beyond root apices
- BWX must show open contacts or interproximal tooth surfaces- not overlapped
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Prescribing of dental radiographs is based on_______. Professional judgement is made by_____________. indentifies what 3 things?
- pt. needs
- the dentist
- number, type, and frequency
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Parallel
moving or lying in the same plane (railroad tracks)
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Perpendicular
intersecting or forming a right angle
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intersecting
to cut across or through
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right angle
angle of 90 degrees formed by 2 perpendicular lines
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long axis of tooth
imaginary line that divides tooth longitudinally into 2 equal halves
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central ray
central portionof the beam of x-radiation
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Describe the principles of the paralleling technique
- film is placed parallel to the long axis of tooth
- central ray of the x-ray beam is directed perpendicular to the film and long axis
- film holder must be used
- object-film distance must be increased to keep film parallel
- target film distance must be increased as a result of object-film distance
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What must you increase the target-film distance to to compensate for magnification and loss of definition?
16" using long cone or PID
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What does rectangular collimator do?
reduces radiation exposure to pt. by 70%
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Name 5 types of film holders
- Rinn XCP
- precision film holders (collimator)
- Stabe bite block (disposable)
- EEZEE-grip film holder (Snap-a-ray)
- hemostat with bite-block
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Size of film used in anterior regions
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Size of film used in posterior regions
- size 2
- placed horizontally
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Film placement
positioned to cover teeth examined
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Film position
positioned parallel to long axis of tooth, and away from tooth
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Vertical angulation
rays must be perpendicular to film and long axis of tooth
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Horizontal angulation
central rays must be directed through the contact areas between the teeth
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film exposure
x-ray beam must be centered on the film to ensure that all areas of the film are exposed
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Describe pt. preparation for radiographs
- explain radiographic procedure
- adjust chair to upright and comfortable height
- adjust headrest so upper arch is parallel to floor and midline is perpendicular to the floor
- place lead apron with thyroid collar
- remove all objecs from mouth and glasses
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Describeradiographic equipment preparation
- set kVp and mA
- open sterilized package and assemble
- insert film packet into holder
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What is the exposure sequence for anterior teeth?
- start with maxillary right canine
- move to maxillary right lateral and central incisor
- move to left maxillary central and lateral incisor
- move to left maxillary canine
- move to left mandibular canine
- move to mandibular incisors
- move to right mandibular canine
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Describe the sequence for posterior exposure sequence
- assemble XCP for maxillary right premolars
- then move to maxillary right molars
- then mandibular left premolars
- then mandibular left molars
- then assemble XCP form maxillary left premolars
- then move to maxillary left molars
- then mandibular left premolars
- then mandubular left molars
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Maxillary canine exposure
should show center of canine, mesial of 1st premolar, and distal of lateral incisor
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Maxillary incisor exposure
centered on contact between lateral and central incisor
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mandibular canine exposure
centered on canine, shows mesial of 1st premolar and distal of lateral incisor
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mandibular incisor exposure
centered on contact between central incisors- show all lateral and central incisors
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maxillary premolar exposure
centered on second premolar, show from canine to 1st molar
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maxillary molar exposure
centered on second molar, show from distal of 2nd premolar to 3rd molar
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mandibular premolar exposure
center film on second premolar, show from canine to first molar
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mandibular molar exposure
center on 2nd molar, show all three molars
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What can you do to modify the paralleling technique in case of shallow palate?
Use cotton roll if tilt exceeds 20 degrees
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What are the advantages of the parallel technique?
- Accuracy-image that has dimensional accuracy and is free of distortion and exhibits maximum detail
- simplicity-simple and easy to use and learn
- duplication- easy to duplicate and repeat comparisons of series have great validity
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What are the disadvantages of the paralleling technique?
- film placement is difficult
- can be uncomfortable to patients
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Film exposure errors
- result in nondiagnostic film
- additional radiation to the pt. if retake is necessary
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How does an unexposed film appear? Why did this happen?
- film appears clear
- occured becuase the film was not exposed
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How does a film exposed to light appear? What caused this
- black
- the film was exposed to white light
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How does an overexposed film appear? Why did this happen
- images are darker
- excessive exposure time, kVP, or mA
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How does an underexposed film appear? Why did this happen
- image is light
- inadequate exposure time, kVP, or mA
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How might a film appear if incorrect film placement was performed?
- absence of apices- film was not positioned into pt. mouth to cover apices
- occlusal plane appears tipped or tilted - the edge of the film was not placed parallel to the incisal-occlusal surface of teeth
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How does the film appear if incorrect horizontal angulation was used?
contacts on teeth appear overlapped
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How do forshortened images appear? Why did this happen?
- teeth appear short with blunted roots
- verticle angulation was excessive (too steep)
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How do elongated images appear? Why did this happen?
- long distored teeth appear on film
- vertical angulation was insufficient (too flat)
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How does a cone cut appear? Why did this happen?
- unexposed area appears on film
- PID was not aligned with the XCP
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name 6 types of miscellaneous technique errors
- film bending
- film creasing
- phalangiona
- double exposure
- movement
- reversed film
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