Simpo PDF Merge and Split Unregistered Version - http ...dent.zaums.ac.ir/uploads/1_296_chapter...

assurance program in radiology is a Compare Radiographs With Reference FilmA simple and effective means for constant monitoringof the quality of images produced in an office is tocheck daily films against a reference film. Soon afterfilm-processing solutions are replaced, mount a patientfilm that has been properly exposed and processed withexact time-temperature technique on a corner of theviewbox. This image, with optimal density and contrast,serves as a reference for the radiographs made in thefollowing days and weeks (Fig. 7-1). All subsequentimages should be compared with this reference film.

Comparison of daily images with the reference filmmay reveal problems before they interfere with the diag-nostic quality of the images. When a problem is identi-fied, it is important to determine the probable sourceand take corrective action. For instance, if the process-ing solutions have become depleted, the resultant radi-ographs are light and have reduced contrast. Bothdeveloper and fixer should be changed when degrada-tion of the image quality is evident. Light images mayalso result from cold solutions or insufficient develop-ing time. Dark images may be caused by excessive devel-oping time, developer that is too warm, or light leaks.

consistent operation of each component in the imagingchain. When all components are functioning properly,the result is consistently high-quality radiographs madewith low exposure to patients and office personnel.

The goal of an infection control program is to avoidcross-contamination among patients and betweenpatients and operators.

Radiographic QualityAssuranceBecause radiographs are indispensable for patient diag-nosis, the dentist must ensure that optimal exposureand film processing conditions are maintained. Toreach this goal, a quality assurance program includesevaluation of the performance of x-ray machines,manual and automatic processing procedures, imagereceptors, and viewing conditions. Optimization ofthe$e components results in the most diagnostic imagesand the lowest exposure for patients. It is best if oneindividual is given the responsibility for implementingthe quality assurance program and to take correctiveaction when indicated. Most of these steps are quicklyaccomplished yet can have a significant influence onradiographic quality (Box 7-1).

Enter Findings in Retake LogAnother simple and effective means of reducing thenumber of faulty radiographs is to keep a retake log.Record all errors for films that must be reexposed.

Replenish Processing SolutionsAt the beginning of each workday, check the levels ofthe processing solutions and replenish if necessary.Replenish the developer with fresh developing solutionand the fixer with fresh fixing solution.

DAILY TASKS

Several tasks should be performed daily to ensure excel-lent radiographs.

110

Simpo PDF Merge and Split Unregistered Version - http://www.simpopdf.com

111RADIOGRAPHIC QUALITY ASSURANCE AND INFECTION CONTROLCHAPTER 7

their temperature to vary during the day. Propertemperature regulation is required for accurate time-

temperature processing.

FIG. 7-1 Check radiographs daily against a reference filmmade with fresh solutions. As processing solutions becomeexhausted, the daily images become increasingly light andlose contrast. When these changes are clear, change boththe developer and the fixer. (Courtesy C.L. Crabtree, DDS,Bureau of Radiological Health, Rockville, Md.)

Make Step-Wedge Test of Processing SystemQuality control of manual and automatic film process-ing is important because deficiencies in this process arethe most common cause of faulty radiographs. A step-wedge test provides accurate monitoring of day-to-dayprocessing conditions. It measures the speed of theimaging system and image contrast. Both are sensitivemeasures of the processing environment. A step wedgeis readily made with the lead foil from film packets.Stack five sheets together and staple at one end(Fig. 7-2). Cut off 4/5 of the top layer, 3/5 of the secondlayer, 2/5 of the third layer, and 1/5 of the fourth layerto create a five-step wedge. Lay the wedge on top of afilm packet and expose using the usual setting for anadult bitewing view. The resultant image should showfive steps from dark to light. Save the first film afterchanging to fresh processing solution for comparisonwith images made on subsequent days.

Monitor the processing solutions at the beginningof each day with a step-wedge image to ensure thatthe processing system is operational for patient care.If a step-wedge image is too light, it is most likelythat the processing solutions are depleted or too cold.If the solutions are at the proper temperature, thedeveloper has become depleted and should bechanged. Solutions that are excessively warm cause adark image.

WEEKLY TASKS

Replace Processing Solutions

The replacement frequency of processing solutionsdepends primarily on the rate of use of the solutionsbut also on the size of tanks, whether a cover is used,and the temperature of the solutions. In most officesthe solutions should be changed weekly or every otherweek. The results of the step-wedge test will help deter-mine the proper frequency.

Daily.Compare radiographs with reference film.Enter findings in retake log.Replenish processing solutions.Check temperature of processing solutions.Make step-wedge test of processing system

Weekly.Replace processing solutions.Clean processing equipment.Clean viewboxes.Review retake log

Monthly.Check darkroom safelighting.Clean intensifying screens.Rotate film stock.Check exposure charts

Yearly.Calibrate x-ray machine

Check Temperature of Processing SolutionsAt the beginning of each workday, check the tempera-ture of the processing solutions. The solutions mustreach the optimal temperature before use-68° F(200 C) for manual processing and 820 F (280 C) forheated automatic processors. The instructions accom-panying the film and processor verify the optimal tem-perature. Unheated automatic processors should belocated away from windows or heaters that may cause

Clean Processing EquipmentRegular cleaning of the processing equipment is nec-essary for optimal operation. Clean the solution tanksof manual and automatic processing equipment whenthe solutions are changed. Clean the rollers of auto-matic film processors weekly according to the manu-facturer's instructions. Mter cleaning, rinse the tanksand rollers twice as long as the manufacturer recom-mends to prevent the cleaner from interfering with theaction of the film-processing solutions.


,112 PART IV IMAGING PRINCIPLES AND TECHNIQUES

Clean ViewboxesClean viewboxes weekly to remove any particles ordefects that may interfere with film interpretation.

Review Retake LogReview the retake record weekly and identify any recur-ring problems with film processing conditions or oper-ator technique. Use this information to educate staff orto initiate corrective actions.

MONTHLY TASKS

The following simple penny test can be used monthlyto evaluate for fogging caused by inappropriate safe-lighting conditions (Fig. 7-3):1. Open the packet of an exposed film and place

the test film in the area where the films areusually unwrapped and clipped on the filmhanger.

2. Place a penny on the film and leave it in this posi-tion for the approximate time required to unwrapand mount a full-mouth set of films, usually about 5minutes.

3. Develop the test film as usual. If the image of thepenny is visible on the resultant film, the room is notlight-safe for the particular film tested. Each type offilm used in the office should be tested to measurethe integrity of the darkroom.

Check Darkroom Safelighting

Film becomes fogged in the darkroom because of inap-propriate safelight filters, excessive exposure to safe-lights, and stray light from other sources. Such films aredark, show low contrast, and have a muddy gray appear-ance. Inspect the darkroom monthly to assess the integrityof the safelights (preferably GBX-2 filters with IS-wattbulbs). The glass filter should be intact, with no cracks.To check for light leaks in a darkroom, turn off all lights,allow your vision to accommodate to the dark, andcheck for light leaks, especially around doors and vents.Mark light leaks with chalk or masking tape. Weatherstripping is useful for sealing light leaks under doors.

Clean Intensifying ScreensClean all intensifying screens in panoramic andcephalometric film cassettes monthly. The presence ofscratches or debris results in recurring light areas onthe resultant images. The foam supporting the screensmust be intact and capable of holding both screensclosely against the film. If close contact between thefilm and screens is not maintained, the image loses

sharpness.


CHAPTER 7 11:5KAUIUl.KAI'HIL llUALl1 Y A~~UKANL~ ANU INt-~L liON LUN I KUL

if}, '

A

D

FIG. 7-3 Penny test for unsafe il/umination. A, Leavea penny on the exposed duplicate film from the double-film pack on the working surface during the time thatany film would be opened (usually about 5 minutes). B, Ifthe processed radiograph shows an outline of the penny,the film is being fogged by inappropriate safelightingconditions.

t-lu. 1-4 :lample wall cnart snowing Identification intor-mation for x-ray machine, film type, mA and kVp settings,and appropriate exposure times for various anatomic loca-tions and patient sizes. Note that the optimal exposure timesmust be determined empirically in each office because theyvary with the machine settings used, source-to-skin distance,and other factors.

Rotate Film StoCk.

Dental x-ray film is quite stable when properly handled.Store it in a cool, dry facility away from a radiationsource. Rotate stock when new film is received so thatold film does not accumulate in storage. Always use theoldest film first-but never after its expiration date has

passed.

YtAKlY IA~K~

Check Exposure ChartsEach month inspect exposure tables listing the properpeak kilovoltage (kVp), milliamperes (mA), and expo-,sure times for making radiographs of each region ofthe oral cavity posted by each x-ray machine (Fig. 7-4).Verify that the information is legible and accurate.These tables help ensure that all operators use theappropriate exposure factors. Typically the mA isfixed at its highest setting; the kVp is fixed, usually at70 kVp; and the exposure time is varied to accountfor patient size and location of the area of interest inthe mouth. Exposure times are initially determinedempirically. Careful time-temperature processing(described in Chapter 6) must be used with fresh solu-tions during this initial determination of exposuretimes.

LallDrate A-Kay Machine

X-ray machines are generally quite stable and onlyrarely is a malfunction of the machine the cause of poorradiographs. Accordingly, machines need to be cali-brated only annually unless a specific problem is iden-tified or substantive repair is necessary that may affectoperation. Usually dental service companies or healthphysicists should make these machine measurementsbecause of the specialized equipment required. The fol-lowing parameters should be measured:1. X-ray output-Use a radiation dosimeter to measure

the intensity and reproducibility of radiation output(Fig. 7-5). Acceptable values are shown in Fig. 3-2.

2. Collimation and beam alignment-The field diame-ter for dental intraoral x-ray machines should be nogreater than 23/4 inches. The tip of the position-indicating device (PID, aiming cylinder) should be



closely aligned with the x-ray beam. This may beevaluated by making a star pattern with dental films,marking them with pinholes, and centering theaiming cylinder over the pattern (Fig. 7-6). Exposethe films using usual bitewing values, process thefilms, and reconstitute the star pattern. The size ~pdalignment of the beam can then be determine(i..oFor panoramic machines the beam exiting the

patient should not be larger than the film slit holdingthe film cassette. This may be tested by taping dentalfilms in front of and behind the slit. A pin stick shouldbe made through both films to allow subsequent

realignment. Expose, process, and realign both films.The exposure to the film in front of the slit should becomparable in size to the film exposure behind the slit.Service is required if the front film exposure is largerthan or not well oriented with the film exposure behindthe slit.3. Beam energy-The kVp or half-value layer (HVL) of

the beam should be measured to ensure that thebeam has sufficient energy for film exposure withoutexcessive soft tissue dosage. Measurement of kVprequires specialized equipment. It should be accu-rate within 5 kVp. Measurement of HVL requires adosimeter. The HVL should be at least 1.5 mm alu-minum (AI) at 70kVp and 2.5mm AI at 90kVp.

4. Timer-Electric pulse counters count the number ofpulses generated by an x-ray machine during apreset time interval. The timer should be accurateand reproducible.

5. mA-Verify the linearity of the mA control if two ormore mA settings are available on the machine.Make an exposure using the usual adult bitewingsetting. Then reduce the mA to the lower value andselect another exposure time, ensuring that theproduct of the mA and time in seconds (impulses)is the same as for the adult bitewing. For example,if the machine has 10- and 15-mA settings, and 15mA and 24 impulses are used for adult bitewings,select 15 mA and 24 impulses for the first exposureand measure the dose. Make a second exposure at10mA and 36 impulses and measure the dose. Thedose at each exposure combination should be thesame (15 x 24 = 10 x 36). A discrepancy implies non-linearity in the mA control or a fault in the timer.

FIG. 7-5 Device'for measuring exposure output of an x-ray machine. The aiming cylinder of the x-ray machine ispositioned on the center of the top and an exposure made.The display on the front gives the output in Roentgens.

A BFIG. 7-6 A, The alignment of the collimation of the x-ray beam and the end of theaiming cylinder can be checked by making a cross pattern of film, centering the aimingcylinder, marking the periphery with needles, and making an exposure. B, One of theprocessed radiographs showing the dark exposed area just inside the holes. If this patternis seen on all films, then good alignment is demonstrated.


,115CHAPTER 7 RADIOGRAPHIC QUALITY ASSURANCE AND INFECTION CONTROL

a practice, usually the dentist, assumes responsibility forimplementing these procedures. This person also edu-cates other members of the practice.

APPLY UNIVERSAL PRECAUTIONS

Universal precautions are infection control guidelinesdesigned to protect workers from exposure to diseasesspread by blood and certain body fluids. Under uni-versal precautions, all human blood and saliva aretreated as if known to be infectious for human immun-odeficiency virus (HIV) and hepatitis B virus. Acc-ordingly, the means used to protect against cross-contamination are used universally, that is, for allindividuals. The American Dental Association and theCenters for Disease Control and Prevention stress theuse of universal precautions because many patients areunaware that they are carriers of infectious disease orchoose not to reveal this information.

The step wedge described above may also be used inplace of the dosimeter. In this case the density ofeach step of each image should be the same.

6. Tube head stability-The tube head should be stablewhen placed around the patient's head, and itshould not drift during the exposure. When the tu~head is not stable, service is necessary to adjust thesuspension mechanism.

7. Focal spot size-Measure the size of the focal spotbecause it may become enlarged with excessive heatbuildup within an x-ray machine. An enlarged focalspot contrib~tes to geometric fuzziness in the result-ant image. A specialized piece of equipment isrequired for this test.

Infection Control

Dental personnel and patients are at increased risk foracquiring tuberculosis, herpes viruses, upper respira-tory infections, and hepatitis strains A through E. Mterthe recognition of acquired immunodeficiency syn-drome (AIDS) in the 1980s, rigorous hygienic proce-dures were introduced in dental offices. The primarygoal of infection-control procedures is to prevent cross-contamination between patients as well as betweenpatients and health care providers. The potential forcross-contamination in dental radiography is great. Anoperator's hands may become contaminated by contactwith a patient's mouth and saliva-contaminated filmsand film holders. The operator then must adjust the x-ray tube head and Pill, as well as the x-ray machinecontrol panel, to make the exposure. Cross-contamina-tion also may occur when operators open film packetsto process the films in the darkroom. The proceduresdescribed in the following sections minimize or elimi-nate cross-contamination (Box 7-2). Each dental officeor practice should have a written policy describing itsinfection control practices. It is best if one individual in

Wear Gloves During All RadiographicProceduresAlways wear gloves when making radiographs or han-dling contaminated film packets or associated materialssuch as cotton rolls and film-holding instruments, orwhen removing barrier protections from surfaces andradiographic equipment. After seating the patient,wash your hands and put on disposable gloves in sightof the patient if the operatory arrangement permits.

Keep charts away from sources of contamination anddo not handle them during the radiographic examina-tion. Make chair adjustments in advance, or makeadjustments on control surfaces that are covered, suchas the headrest control.

Disinfect and Cover X-Ray Machine, WorkingSurfaces, Chair, and ApronThe goal of preventing cross-contamination isaddressed in part by disinfecting all surfaces and byusing barriers to isolate equipment from direct contact.Although barriers greatly aid infection control, they donot replace the need for effective surface cleaning anddisinfection. Experience has demonstrated that, duringthe daily activity of treatment, failure of mechanical bar-riers is common. It is advantageous and reassuring tothe operator to know that whenever this happens, thesurfaces that may become accidentally exposed areclean and disinfected. Any surface that may be con-taminated should be surface-disinfected. This includesthe x-ray machine control panel, tube head, and beamalignment device, dental chair and headrest, surfaceson which film is placed, leaded apron and thyroidcollar, and doorknob of operatory. Operators shouldavoid touching walls and other surfaces with contami-



nated gloves.' Good surface disinfectants includeiodophors, chlorines, and synthetic phenolic com-pounds. Although the American Dental Associationdoes not recommend specific chemical disinfectantsand sterilants, it does suggest that when dentists use achemical agent for disinfection or sterilization,ir;heagent should carry Environmental Protection Agency(EPA) registration. The agent should also be tubercu-locidal-an effective killer of tuberculosis-andcapable of preventing other infectious diseases, includ-ing hepatitis Band HIV.

Use barrie;s to cover working surfaces that were pre-viously cleaned and disinfected. Barriers protect theunderlying surface from becoming contaminated. Aneffective barrier for the countertops and x-ray controlconsole is plastic wrap, which may be convenientlystored in a butcher's paper dispenser mounted on awall (Fig. 7-7). When covering the x-ray control console,be sure to include the exposure switch and the expo-

sure time control if they are integral parts of the unit(Fig. 7-8). The application of plastic wrap over the kVpmeter may cause electrostatic deflection of the meterneedle and result in an erroneous voltage reading.Experiment with your equipment to determinewhether the application of plastic wrap influences themeter reading. Cover an x-ray exposure switch that isindependent of the console with a sandwich bag or foodstorage bag, or wrap it with plastic wrap.

The dental chair headrest, headrest adjustments, andchair back may be easily covered with a plastic bag (Fig.7-9). Cover the x-ray tube head, PID, and yoke while theyare still wet with disinfectant with a barrier to stop anydripping (Fig. 7-10). Secure the bag by tying a knot inthe open end or by placing a heavy rubber band over thex-ray tube head just proximal to the swivel. Also clean,disinfect, and cover the leaded apron between patientsbecause it is frequently contaminated with saliva as theresult of handling (readjusting its position) during aradiographic procedure. Suspend the apron on a heavycoat hanger to permit turning front to back. Spray itwith a detergent containing disinfectant; then wipe andcover with the same type of plastic garment bag used forthe x-ray head and chair back (Fig. 7-11). The operatoryis now prepared for radiography.

Panoramic and cephalometric equipment shouldreceive the same maintenance for decontamination anddisinfection as other equipment. Clean the panoramicbite blocks, chin rest, and patient handgrips with deter-gent-iodine disinfectant and cover with a plastic bag.Disposable bite blocks may be used. Carefully wipe thehead-positioning guides, control panel, and exposure

FIG. 7-7 Obtain plastic wrap from dispenser to covercountertops and x-ray machine console.

FIG. 7 -8 Cover console with plastic wrap on parts that aretouched during the radiographic examination.

FIG. 7-9 Place a new garment bag over chair and head-rest for each patient.


117RADIOGRAPHIC QUALITY ASSURANCE AND INFECTION CONTROL

\CHAPTER 7

ing those in the darkroom) and the apron with disin-fectant, and wipe them as described previously. Thenreplace the barriers in preparation for the next patient.

Sterilize Nondisposable InstrumentsThe film-holding instruments described in Chapter 8can be sterilized with steam under pressure (auto-claved) or with exposure to ethylene oxide gas. The Pre-cision instrument can also be dry-heat sterilized, but theplastic XCP instruments cannot. Both should bemechanically cleaned in soapy water and well rinsed toremove saliva before sterilizing. The instruments maynow be placed in sterilization bags. The bite blocks usedwith the Precision instruments are disposable andshould be discarded after use. Mter sterilization, keepthe instruments in bags for storage and subsequenttransport to the radiography area. When the instru-ments are taken to the radiography area, it is good tech-nique to remove them from the bag immediately beforeuse. Mter use, replace instruments in the bag to rein-force cleanliness in the area. Use the same sterilizationbag to transport the contaminated instruments back tothe cleaning and sterilizing room.

FIG. 7-10 Slip a plastic garment bag over x-ray tubehead. Place a large rubber band just proximal to the swivelor tie ends, as shown here. Pull the plastic tight over the PIDand secure with a light rubber band slipped over the PID andplaced next to the head.

FIG. 1-11 Spray hanging apron with disinfectant; thendry and cover with a garment bag.

Use Barrier-Protected Film (Sensor)or Disposable ContainerFilm should be obtained in advance from a centralsource. To prevent contamination of bulk supplies offilm, dispense them in procedure quantities. Prepack-age the required number of films for a full-mouth orinterproximal series in coin envelopes or paper cups inthe central preparation room. Dispense theseenvelopes of films with the film-holding instruments.For unanticipated occasions in which an unusualnumber of films are required, a small container of filmscan be on hand in the central preparation and steriliz-ing room. No one wearing contaminated gloves shouldretrieve a film from this supply. Films should be dis-pensed only by staff members with clean hands orwearing clean gloves.

Film packets may be packaged in a plastic envelope(Fig. 7-12), which protects the film from contact withsaliva and blood during exposure. Barrier-protectedfilm fits in the Precision and XCP film-holding instru-ments (Fig. 7-13). An attractive feature of the protec-tive envelopes is the ease with which they may beopened and the film extracted. For best results,immerse the packet in a disinfectant after the films havebeen exposed in the patient's mouth. Then dry thepacket and open, allowing the film to drop out. Thebarrier envelopes can be conveniently opened in alighted area, the film dropped onto a clean work areaor into a clean paper or plastic cup, and the filmtransferred to the daylight loader or darkroom for

processmg.

switch with a paper towel that is well moistened with dis-infectant. The radiographer should wear disposablegloves while positioning and exposing the patient.Remove gloves before removing the cassette from themachine for processing because the cassette and filmremain extraoral and should not be handled whilewearing contaminated disposable gloves. Clean and dis-infect cephalostat ear posts, ear post brackets, and fore-head support or nasion pointer with iodine-detergentdisinfectant. These may then also be covered in plastic.

Mter completing patient exposures, remove thebarriers,:spray contaminated working surfaces (includ-


118 PART IV IMAGING P!tINCIPLES AND TECHNIQUES

A BFIG. 7-12 Dental film with a plastic barrier to protect film from contact with saliva.A, Note notch on side of plastic envelope for opening. B, During opening, the plastic isremoved and the dean film allowed to drop into a container.

Sensors for digital imaging are not sterilizable; thusit is important to use a barrier to protect them fromcontamination when placed in the patient's mouth.Typically the manufacturers of these sensors recom-mend use of plastic barrier sheaths. However, experi-ence has shown that these plastic barrier sheaths oftentear or leak and thus cannot be relied on for protectionof the sensor. The supplemental use of latex finger cotsprovides significant added protection and is recom-mended for routine use when using digital sensors.

FIG. 7-13 Film-holding instrument with barrier envelopeprotecting film from saliva.

Prevent Contamination of ProcessingEquipmentMter making all exposures, remove your gloves and takethe container of contaminated films to the darkroom.The goal in the darkroom is to break the infection chainso that only clean films are placed into processing solu-tions. Layout two towels on the darkroom working sur-face. Place the container of contaminated films on oneof these towels. Mter removing the exposed film from itspacket, place it on the second towel. The film packagingis discarded on the first towel with the container.

Removing film from a packet without touching (con-taminating) it is a relatively simple procedure. Fig. 7-14illustrates the method for opening a contaminated filmpacket while wearing contaminated gloves withouttouching the film. Put on a clean pair of gloves, pick upthe film packet by the color-coded end, and pull the tab

Ifbarrier-protected film is not used, the exposed filmshould be placed in a disposable container for latertransport to the darkroom for processing. Paper filmpackets are exposed to saliva and possibly blood duringexposure in the patient's mouth. To prevent saliva fromseeping into a paper film packet, place a paper towelbeside the container for exposed films. Use this towelto wipe each film as you remove it from the patient'smouth and before placing it with the other exposedfilms. This problem may also be avoided by using filmpackaged in vinyl.


\119RADIOGRAPHIC QUALITY ASSURANCE AND INFECTION CONTROLCHAPTER 7

BA

c D

upward and away from the packet to reveal the blackpaper tab wrapped over the end of the film. Now,holding the film over the second towel, carefully graspthe black paper tab that wraps the film and pull the filmfrom the packet. When the film is pulled from thepacket, it will fall from the paper wrapping onto theclean towel. The paper wrapper may need to be shakenlightly to cause the film to fall free. Place the packag-ing materials on the first paper towel. Mter opening allfilms, gather the contaminated packaging and con-tainer and discard them along with the contaminatedgloves. Process the clean films in the usual manner. It

is not necessary to wear gloves when handlingprocessed films, film mounts, or patient charts.

An alternate procedure when exposing films in vinylpackaging is to place the exposed film, still in the pro-tective plastic envelope, in an approved disinfectingsolution when it is removed from the mouth and afterwiping it with a paper towel. It should remain in the dis-infectant after the exposure of the last film for the rec-ommended time. Immersion for 30 seconds in a 5.25%solution of sodium hypochlorite is effective.

Automatic film processors with daylight loaders offera special problem because of the risk for contaminat-


120 PART IV IMAGING PRINCIPLES AND TECHNIQUES

ing the sleeves with contaminated gloves or filmpackets. One approach is to clean the films by immer-sion in a disinfectant, with or without a plastic envelope,as described above. With this method the operatorcleans the films, puts on clean gloves, and then takesonly cleaned film packets into the daylight lo:ad~r. Analternate approach is to open the top of the: loader,place a clean barrier on the bottom, and insert the cupof exposed film packets and a clean cup. The operatorthen closes the top, puts on clean gloves, pushes his orher hands through the sleev~, and opens the filmpackets, allowing the film to drop into the clean cup.Mter all film packets have been opened, remove thecontaminated gloves, load the films into the developer,and remove hands. Then the top of the loader may beremoved and the contaminated materials removed.

BIBLIOGRAPHY

QUALITY ASSURANCEADA Council on Scientific Mfairs: An update on radiographic

practices: information and recommendations, J Am DentAssoc 132:234-8, 2001.

American Academy of Dental Radiology Quality AssuranceCommittee: Recommendations for quality assurance indental radiography, Oral Surg Oral Med Oral Pathol55:421, 1983.

Goren AD et al: Updated quality assurance self-assessmentexercise in intraoral and panoramic radiography, AmericanAcademy of Oral and Maxillofacial Radiology, RadiologyPractice Committee, Oral Surg Oral Med Oral Pathol OralRadiol Endod 89:369-74, 2000.

Michel R, Zimmerman TL: Basic radiation protection con-siderations in dental practice, Health Phys 77:S81-3, 1999.

National Radiological Protection Board: Guidance Notes forDental Practitioners on the Safe Use of X-Ray Equipment,June 2001 (www.nrpb.org.uk).

Platin E, Janhom A, Tyndall D: A quantitative analysis ofdental radiography quality assurance practices amongNorth Carolina dentists, Oral Surg Oral Med Oral PatholOral Radiol Endod 1998;86:115-20.

Kodak Dental Radiography Series: Quality assurance in dentalradiography, N-416, Rochester, ~ 1995, Eastman Kodak.

Whaites E, BrownJ: An update on dental imaging, Br DentJ185:166-72, 1998.

X-Ray Inspection Service: Quality assurance for dental facili-ties, Ontario, Canada, 1990, Ministry of Health.

Yoshiura K et al: Assessment of image quality in dental radi-ography, part 1: phantom validity, Oral Surg Oral Med OralPathol Oral Radiol Endod 87:115-22,1999.

INFECTION CONTROLAmerican Academy of Oral and Maxillofacial Radiology infec-

tion control guidelines for dental radiographic procedures,Oral Surg Oral Med Oral Pathol 73:248,1992.

American Dental Association: Infection control recommen-dations for the dental office and dental laboratory, JADA127:672, 1996.

American Dental Association Council on Scientific Mfairs andAmerican Dental Association Council on Dental Practice:Infection control recommendations for the dental officeand the dentallaboratory,JADA 127:672,1996.

Anderson K: Staying healthy in the dental office, CDS Rev90:16-23, 1997.

Bachman CE et al: Bacterial adherence and contaminationduring radiographic processing, Oral Surg Oral Med OralPathol 70:669, 1990.

Centers for Disease Control and Prevention: Recommendedinfection-control practices for dentistry, MMWR 42(RR-8):1, 1993.

Cottone JA, Terezhalmy GT, Molinari JA: Practical infectioncontrol in dentistry, Baltimore, 1996, Williams & Wilkins.

Glass BJ: Infection control in dental radiology, NY State DentJ 60:42, 1994.

Hokett SD, Honey JR, Ruiz F, Baisden MK, Hoen MM: Assess-ing the effectiveness of direct digital radiography barriersheaths and finger cots,J Am Dent Assoc 131:463-7, 2000.

Hubar JS, Gardiner DM: Infection control procedures used inconjunction with computed dental radiography, Int JComput Dent 3:259-67, 2000.

Hubar JS, Oeschger MP: Optimizing efficiency of radiographdisinfection, Cen Dent 43:360-2, 1995.

KatzJO et al: Infection control protocol for dental radiology,Cen Dent 38:261, 1990.

Miller CH, Palenik CJ: Infection control and management ofhazardous materials for the dental team, ed 2, St. Louis,1998, Mosby.

Packota GV, Komiyama K: Surface disinfection of saliva-contaminated dental X-ray film packets, J Can Dent Assoc58:747-51, 1992.

Puttaiah R, Langlais RP, Katz JO, Langland OE: Infectioncontrol in dental radiology, CDAJ 23:21-2, 1995.

Rahmatulla M, Almas K, al-Bagieh N: Cross infection in thehigh-touch areas of dental radiology clinics, IndianJ DentRes 7:97-102, 1996.

Reams GJ, BaumgartnerJC, KulildJC: Practical application ofinfection control in endodontics,J Endod 21:281-4,1995.

Stanczyk DA, Paunovich ED: Microbiologic contaminationduring dental radiographic film processing, Oral Surg OralMed Oral Patho176:112, 1993.

Thomas LP, Abramovitch K: Aseptic techniques for dentalradiography,J Greater Houston Dent Soc 63:21,1992.

Tullner JB, Zeller G, Hartwell G, BurtonJ: A practical barriertechnique for infection control in dental radiology, Com-pendium 13:1054-6, 1992.

U.S. Department of Labor, Occupational Safety and HealthAdministration: Occupational exposure to bloodborne pat-hogens, final rule, Federal Register 56(235):64004,1991.

Wolfgang L: Analysis of a new barrier infection control systemfor dental radiographic film, Compend Cont Ed Dent13:68, 1993.

Wyche CJ: Infection control protocols for exposing and pro-cessing radiographs,J Dent Hyg 70:122-6,1996.


Simpo PDF Merge and Split Unregistered Version - http ...dent.zaums.ac.ir/uploads/1_296_chapter...

Documents

Transcript of Simpo PDF Merge and Split Unregistered Version - http ...dent.zaums.ac.ir/uploads/1_296_chapter...