The quality of dental X-ray images that are referred to oral surgeons A multinational study in the Middle East and United Kingdom
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The dental profession is committed to delivering the highest quality of care to each of its individual patient and applying advancements in technology and science to continually improve the oral health status of the population. Several guidelines have been developed to serve as an adjunct to the dentist’s professional judgment on how to best use diagnostic imaging for a patient. Radiographs can help the dental practitioner evaluate and definitively diagnose a number of oral diseases and conditions. However, the dentist must weigh the benefits of taking dental radiographs against the risk of exposing a patient to radiation, the effects of which accumulate from multiple sources over time. The dentist, knowing the patient’s health history and vulnerability to oral disease, is in the best position to make this judgment in the interest of the patient. The purpose of this study is to evaluate the different perceptions of what makes a proper dental X-ray image, and to compare if there is a difference in dentists’ perspectives of the quality of dental X-ray images against established criteria in the “National Radiological Protection Board (NRPB)”, between dentists in the Middle East and the dentists in the United Kingdom. This was a cross-sectional study of a total of 400 dentists of all specialties, who were invited to participate in a survey, using a structured questionnaire shown on a tablet screen that included 10 different X-ray images of teeth intended for extraction. These images were selected for the questionnaire by expert radiologists and oral surgery consultants from a pool of referred dental X-ray images to oral surgeon in UK. The criteria used for answering the questionnaire is an adaptation of the “National Radiological Protection Board (NRPB)” criteria which uses subjective quality rating of radiographs. The criteria included two ratings (acceptable and unacceptable) for the purpose of the extraction of a tooth. All ten images were pre-evaluated by a calibrated panel of experts composed of seven specialists in the field of maxillofacial radiology. The questionnaire also included other information obtained for the purposes of comparison and description regarding the area of specialty, years of experience, location of current practice and country of qualification in dentistry. A total of 342 participants were included in the study out of 400 with a response rate of 85.5%. The inclusion criteria of the selected questionnaire depended on completion of all elements of the questions included. There were 215 (62.9 %) males and 127 (37.1 %) females. The experience in dentistry ranged from 1 year to 45 years with a mean range of experience of 13.28 years. The distribution of participants according to the place of qualification was 182 (53.7%) from the Middle-East, while 160 (46.8%) were from the United Kingdom. The average of the score of reading the ten photos correctly in agreement of the panel of experts was 4.95 (S.D. 1.62) overall in both groups of participants from the Middle East and from the United Kingdom. There is no association between the number of years of experience and the score of correct answers (p-value=0.113). This study has revealed that there is a significant difference in the overall correct score of the questionnaire in favour of the participants group with a qualification in dentistry from the United Kingdom (p-value= 0.013). The participants qualified from the United Kingdom performed better than the Eastern participants in answering the questionnaire. The perception of dentists of varying specialties in the Middle East in regards to the quality of referred dental X-ray images needs to be addressed. This perception affects the quality of care that the patients receive, through either repeated X-ray exposure or by management of patients with inadequate X-ray images. More attention is needed to highlight this issue and strict protocols for the quality of referred dental X-ray images must be put in place.