An Audit on the Quality of Intra-Oral Digital Radiographs Taken in a Postgraduate Paediatric Dentistry Setting

Abstract

Abstract: Background: Quality assurance (QA) for radiographs sustains accurate diagnostic information while maintaining radiation doses as low as reasonably achievable (ALARA). Aims: To audit the quality of digital intraoral periapical (IOPAs) and bitewings (BWs) radiographs taken in a postgraduate paediatric dentistry setting.

Standards: The National Radiological Protection Board (NRPB) guidance describes three grades of radiograph quality. Excellent (Grade 1 >70% of total exposures), diagnostically acceptable (Grade 2 <20%) and unacceptable (Grade 3 <10%).

Methodology: A pilot study was performed on 10 IOPAs and 10 BWs. 50 IOPAs and 50 BWs were reviewed in 2 audit cycles with a 6 month interval (total of 200 X-rays). Results: First Cycle: Of 50 IOPAs: 18 (36%) scored Grade 1, 25 (50%) Grade 2 and 7 (14%) Grade 3. Of 50 BWs: 10 (20%) scored Grade 1, 33 (66%) Grade 2 and 7 (14%) Grade 3. Second Cycle: Of 50 IOPAs: 28 (56%) scored Grade 1, 15 (30%) Grade 2 and 7 (14%) Grade 3. Of 50 BWs: 27 (54%) scored Grade 1, 17 (34%) Grade 2 and 6 (12%) Grade 3. Rejection rate of Grade 3 was analysed in both cycles. A clear improvement in radiograph quality was demonstrated between both cycles, but the standard was not met.

Action plan and recommendations: Results were disseminated to all staff and recommendations to improve radiograph quality were made to use film holders and paediatric film sizes.

Conclusion: Although a significant improvement was observed in the 2nd cycle, the overall standard of radiographs fell short of the guidelines. Thus, the quality of radiographs requires continuous auditing to reach the gold standard. An audit spiral is planned.