Radiography


radiographs Errors in dental


A local retrospective audit by Andrew MacInnes, Donald Thomson and Alison Menhinick of Dundee Dental Hospital


Introduction Dental radiographs are an essential adjunct in the diagnosis of many oral conditions. In addition to a comprehensive clinical exami- nation, good quality dental radiographs can provide essen- tial diagnostic information when accurately interpreted. In order to limit the radiation


dose given to a patient for diagnosis of a dental condition, practitioners are encouraged to provide relevant radiographs with referrals to Dundee Dental Hospital. This local retrospec- tive audit of an anonymised bank of referral radiographs analysed 50 intra-oral and 50 panoramic radiographs for common errors.


Aim The aim of this audit was to analyse and highlight common errors in the radio- graphs provided with referrals to Dundee Dental Hospital. Audit results would then be used to provide feedback to referring practitioners on radiograph errors.


Target In accordance with the National Radiological Protection Board Guidance Notes for Dental Practitioners4 , no more than 30 per cent of dental radiographs should have one or more errors present. We therefore set our audit target that 70 per cent of images should be devoid of common radiographic errors.


Methodology This local retrospective audit involved a review of an anonymised bank of referral radiographs sent in to Dundee Dental Hospital. A sample of 50 intra-oral and 50 panoramic radiographs were assessed. After an initial assessor


calibration stage, a spreadsheet data collection tool was used to collect the data for each type of radiograph. Only specific intra-oral subtypes and panoramic radiographs were included in our audit. Lateral oblique, occlusal and CT radiographs were excluded. The standards we used


to assess these radiographs were related to the Faculty of General Dental Practitioners’ three-point grading scale of dental radiographs2 and our assessment criteria included:


Intra-oral radiographs • The image should be unaffected by collimation


• Image contrast should be such that images are clearly visible


• Horizontal angulation should be such that the inter-proximal surfaces of teeth can be identified


• Vertical angulation should be such that there is no elongation or foreshortening of the image


• Images should be devoid of artefacts including; scratches, evidence of delam- inated plates and evidence of cracked sensors.


Panoramic radiographs • Image contrast should be such that images are clearly visible


• Patient positioning should be such that the anterior teeth are not too wide or narrow


• Patient positioning should be such that the occlusal plane is correctly aligned (Frankfort plane horizontal)


• Patient positioning should be such that, where appro- priate, the left and right sides are similar in orientation and magnification (patient not rotated)


• There should be no air shadows obscuring areas of interest


• Jewellery should not be visible on the image


• Patient should be positioned


Fig 1 Frankfort plane error – patient positioned ‘chin down’ TABLE 1


Results: intra-oral with faults


without faults Cone cutting Contrast


Vertical angulation errors Horizontal angulation errors Scratches


Delaminated plates Cracked plates


% of Radiographs 84 16 16


66 20 12 16 18 0


Scottish Dental magazine 59


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