AAPM Task Group Report 261: Comprehensive quality control methodology and management of dental and maxillofacial cone beam computed tomography (CBCT) systems.

Cone-beam computed tomography (CBCT) systems specifically designed and manufactured for dental, maxillofacial imaging (MFI) and otolaryngology (OLR) applications have been commercially available in the United States since 2001 and have been in widespread clinical use since. Until recently, there has been a lack of professional guidance available for medical physicists about how to assess and evaluate the performance of these systems and about the establishment and management of quality control (QC) programs. The owners and users of dental CBCT systems may have only a rudimentary understanding of this technology, including how it differs from conventional multidetector CT (MDCT) in terms of acceptable radiation safety practices. Dental CBCT systems differ from MDCT in several ways and these differences are described. This report provides guidance to medical physicists and serves as a basis for stakeholders to make informed decisions regarding how to manage and develop a QC program for dental CBCT systems. It is important that a medical physicist with experience in dental CBCT serves as a resource on this technology and the associated radiation protection best practices. The medical physicist should be involved at the pre-installation stage to ensure that a CBCT room configuration allows for a safe and efficient workflow and that structural shielding, if needed, is designed into the architectural plans. Acceptance testing of new installations should include assessment of mechanical alignment of patient positioning lasers and x-ray beam collimation and benchmarking of essential image quality performance parameters such as image uniformity, noise, contrast-to-noise ratio (CNR), spatial resolution, and artifacts. Several approaches for quantifying radiation output from these systems are described, including simply measuring the incident air-kerma (Kair) at the entrance surface of the image receptor. These measurements are to be repeated at least annually as part of routine QC by the medical physicist. QC programs for dental CBCT, at least in the United States, are often driven by state regulations, accreditation program requirements, or manufacturer recommendations.

Impact of a seated-standing protocol on postures and pain among undergraduate dental hygiene students: A pilot study.

Purpose: Although repetitive movements may lead to musculoskeletal pain, static and sedentary postures may be primary contributors to musculoskeletal disorders. The purpose of this pilot study was to determine whether an alternating seated-standing protocol would improve postures, decrease ergonomic risks, and reduce perceived pain scores among dental hygiene students.Methods: Thirty undergraduate dental hygiene students enrolled during the summer term were recruited to participate in the randomized control design pilot study. Participants were randomly assigned to the training (n=15) and control (n=15) groups. The training group alternated between sitting and standing every 30 minutes while providing dental hygiene care. The Modified-Dental Operator Posture Assessment Instrument (M-DOPAI) was used to evaluate ergonomic scores, the Rapid Upper Limb Assessment (RULA) was used to evaluate ergonomic risk, and the Modified-Standardized Nordic Musculoskeletal Questionnaire (M-SNMQ) was used to assess self-reported pain. Photographs were captured and levels of perceived pain were assessed at baseline, week-4, and week-8. Three raters independently evaluated the photographs using the M-DOPAI and RULA. Participants completed a survey about their experiences in the study at the end of week-8. Descriptive statistics and repeated measures ANOVAs were used to analyze the quantitative data; thematic analysis was used to analyze the qualitative data.Results: Although all participants perceived a reduction of pain over the duration of the eight-week study (p<.05), the training group demonstrated no significant differences in ergonomic scores, ergonomic risks, or pain scores at the three time points (p>.05). Qualitatively, participants in the training group perceived that the seated-standing protocol clinically improved their postures and reduced their pain.Conclusion: The results suggest there were minimal impacts of the alternating seated standing protocol on ergonomic scores, ergonomic risks, or perceived pain. More research is needed to determine whether there are objective benefits to an alternating seated-standing protocol.

Maxillary Lateral Incisor Injection Pain Using the Dentapen Electronic Syringe.

INTRODUCTION: When patients express fear and anxiety about dentistry, 1 main source involves the administration of local anesthetic. The Dentapen (Septodont, Lancaster, PA) is a computer-controlled local anesthetic device that regulates the rate of anesthetic deposition to reduce pain associated with dental injections. The purpose of this study was to evaluate differences in perceived pain during the administration of local anesthesia of the maxillary lateral incisors using the ramp-up and continuous injection modes of the Dentapen. METHODS: This study used a randomized, controlled, double-blind, crossover, experimental design. The investigators randomly assigned the order of the teeth (#7 or #10) and the 2 delivery modes (continuous or ramp-up). Participants completed a Corah dental anxiety scale at each visit and were injected on 2 separate visits at least 2 weeks apart. After each injection, participants rated their perceived pain using a Heft-Parker visual analog scale at needle insertion, needle placement, and solution deposition. Repeated measures analysis of variance was used to determine differences in perceived pain between the 2 modes. RESULTS: The data from 116 participants were analyzed. The perceived pain at deposition with the ramp-up mode (mean = 51.98, standard deviation = 30.04) was less than the continuous mode (mean = 59.98, standard deviation = 36.28) although not statistically significant (F1230 = 2.569, P > .05). Clinically, the perceived pain with the ramp-up mode was in the mild range (<54 mm), whereas the mean perceived pain with the continuous mode was in the moderate/severe range (>54 mm). CONCLUSIONS: Further research should evaluate whether the ramp-up mode could be used to reduce the pain perceived with other dental injections.

Snapshot of current carotid artery stenting practice and accreditation in the USA.

OBJECTIVE: The aim of this exploratory study was to compare the performance of carotid artery stenting (CAS) best practices between Intersocietal Accreditation Commission (IAC) accredited facilities and non-accredited facilities certified by the Centers for Medicare and Medicaid Services (CMS). METHODS: A random, anonymous survey was sent to CMS and IAC accredited facilities querying facility routine performance of 16 CAS procedure components found in published guidelines and utilised during clinical trials. RESULTS: There were 28 responses (response rate=17%). Significant differences were found between the CMS and the IAC facilities for four of 16 procedure measures: determination of modified Rankin Scale score prior to stenting (p=0.012, 95% CI 20% to 80%), accurate measurement of per cent stenosis using electronic callipers (p=0.005, 95% CI 24% to 84%), confirmation of anticoagulation with activated clotting time greater than 250 s prior to crossing the lesion (p=0.03, 95% CI 7% to 69%), and comparison of facility outcomes to accepted benchmarks for stroke and death (p=0.03, 95% CI 7% to 69%). Overall, IAC facilities performed all 16 procedures more frequently (97%) than CMS facilities (66%) (p<0.001, 95% CI 24% to 36%). CONCLUSIONS: Although the sample size was small, the results demonstrated IAC accredited facilities are more likely to follow best practices, to use quantitative tools to select appropriate patients, and quantitively measure patient-centred clinical outcomes compared with CMS certified facilities. The findings raise the question as to the value of CMS certification versus IAC accreditation as a requirement for reimbursement.

Usefulness of the Intersocietal Accreditation Commission (IAC) Quality Improvement Self-assessment Tool After 1 Year.

BACKGROUND AND OBJECTIVES: The Intersocietal Accreditation Commission (IAC) created a voluntary quality improvement (QI) tool that allows imaging facilities to self-assess and document the quality of imaging studies. This study aimed to evaluate users' perceptions of the effectiveness and usefulness of the new QI self-assessment tool. METHODS: The IAC's QI tool evaluates 4 quality measures: test appropriateness; technical quality/safety; interpretive quality; and report timeliness/completeness. A survey was appended to the tool to assess the perceived value. RESULTS: Between May 2016 and July 2017, a total of 829 facilities completed 5312 self-assessments. During that time, 936 respondents completed the survey. There was a high level of agreement that the tool is easy to use (91.8%), encouraged critical thinking (90.3%), and the activity was worthwhile (89.6%). CONCLUSION: The results show that most respondents find value in using the voluntary IAC QI Self-assessment Tool. Respondents believed tool use encouraged critical thinking, and they were satisfied with the QI self-assessment process.

Effect of Facility IAC-Accreditation on CT Dose Awareness and Reduction.

PURPOSE: To assess characteristics of computed tomography (CT) facilities accredited by the Intersocietal Accreditation Commission (IAC) and evaluate the perceived effect of accreditation on CT radiation dose awareness and reduction. METHODS: IAC-accredited CT facilities were sent a survey in April 2016, which included 20 questions categorized into 5 groups: equipment and facility (7), patient safety/practice (5), protocols (2), dose reduction practice (3), and quality improvement (3). RESULTS: The response rate was 20.7% (N = 607). A majority of facilities (80%) reported that radiation dose was adjusted based on patient size. Before undergoing accreditation, 79% of facilities reported annual review of CT protocols and radiation exposure. Following accreditation, that number increased to 93%. A majority (77%) of respondents indicated that the accreditation process, along with the IAC Standards and Guidelines, increased awareness of radiation exposure; in addition, 36% indicated that radiation doses were lower after undertaking accreditation. DISCUSSION: This study demonstrated that most IAC-accredited facilities followed recommended radiation safety practices by adjusting radiation dose based on patient size, reviewing protocols annually, and participating in quality improvement activities that focus on patient radiation exposure. CONCLUSION: IAC-accredited facilities reported that the accreditation process had a positive effect on radiation dose awareness and reduced dose associated with CT examinations.