General Recommendations for All Imaging Modalities

Regulatory Oversight

Compliance with all applicable local, state, and federal regulatory requirements for the safe and effective use of radiographic imaging modalities subsumes adherence with proper equipment installation, utilization, and maintenance, as well as optimization (balancing image quality with patient dose), patient and operator protection, infection control measures, and operator training for radiographic procedures and equipment.² In new facilities or in facilities installing or relocating radiographic and/or CBCT equipment, local and state regulations must be followed with regard to radiation safety and structural requirements during office construction or renovation.² Manufacturer’s instructions for safe and proper machine operation, maintenance, and infection control measures for radiographic, CBCT, and related radiographic imaging equipment must be followed.²

Radiation Safety Program and Staff Training

The dental practice must develop and implement a radiation safety program for all staff members that provides instructions and guidance to maintain safe and effective radiographic imaging systems.² The program must align with nationally accepted radiation safety recommendations for the protection of both patients and staff personnel and be facilitated under the guidance of a qualified expert.² Reviewed on a regular basis, the program must be updated periodically to ensure it is current and in compliance with established regulations and contemporary guidance.² Staff members who perform radiography-based dental and maxillofacial imaging must possess the requisite education, training, qualifications, and licensure as required by local, state, and federal regulations.²

Quality Assurance and Quality Control Program

Personnel utilizing radiographic equipment also must establish a quality assurance and quality control program.^2,24 The program must be implemented and monitored by a qualified expert and reflect current guidance.² Quality assurance (QA) in dental and maxillofacial radiography requires that specific steps are taken to provide diagnostic images while minimizing patient radiation exposure.^2,24 This is accomplished through compliance with manufacturer and regulatory measures regarding device usage.^2,24 In addition, machine operators must be qualified and credentialed according to state regulations.^2,24

Quality Control (QC), an integral part of QA, concentrates on testing and measurement of radiographic devices, image receptors, and other technical components of the imaging chain.^2,25 The purpose of QC is to ensure that the entire imaging system maintains a consistent level of acceptable performance as determined by QA activities.^2,24,26,27 NCRP Report 177 provides detailed guidance on the parameters of QA/QC and procedures for documentation of QC measures, designation of qualified personnel responsible for each activity, monitoring of results, and mechanisms to enact corrective actions to remedy identified issues or substandard performance.^2,24 Specifically intraoral, panoramic, and cephalometric x-ray machines should be inspected at least every four years or as required by state law, whichever is more stingent.^2,24 Regular testing, planned monitoring, and scheduled maintenance of x-ray equipment, digital image receptors, scanning and display equipment are all important aspects of a comprehensive QA/QC program.²⁴ CBCT imaging units should be inspected every two years, but preferably on an annual basis.^2,24 Specific guidance for CBCT quality control is available through both national and international organizations and agencies.^28-30