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Patient Dose and X-ray Equipment

Learn more about the key aspects of quality assurance programmes for X-ray equipment and patient dose.
© UK Health Security Agency

IRMER17 requires the employer to establish a QA programme for X-ray equipment and for patient dose. This step will cover some of the key aspects that must be included.

Equipment Inventory

An inventory of the X-ray sets must be kept by the dental practice. The inventory must include the following details for each X-ray set:

  • The manufacturer
  • Model name or number
  • Serial number or another unique identifier
  • Year of manufacture
  • Year of installation

The performance of each piece of equipment should be reviewed periodically, to confirm that it is operating as expected and capable of restricting patient dose as far as is reasonably practicable.

X-ray Equipment Inventory

An example of an X-ray equipment inventory table - details of the X-ray equipment must be filled in under the following headings: Manufacturer, Model, Serial number/identifier, Year of manufacture, Year of installation, Last review

Routine Surveillance Programme

Both IRR17 and IRMER17 require employers to maintain routine surveillance of those features of X-ray equipment that could affect the radiation safety of staff or patients. Operators should check the correct functioning of the following on every day that the equipment is used:

  • Safety and warning systems (eg. warning lights and audible warnings)
  • Exposure switch
  • Intra oral arm counterbalance
  • Smooth rotational or scanning motion of panoramic, cephalometric and dental CBCT equipment
  • The overall general condition of the X-ray set

A record of these checks should be completed at least once every six months to confirm that this routine surveillance has been maintained.

X-ray equipment: routine surveillance log

An example of a routine surveillance log, which should be filled out under the following headings: Manufacturer and mode, Serial number/identifier. The second part of the table requests the date, then the following headings are checks which must be maintained (if they are deemed satisfactory these headings should be completed with a tick): Warning systems, Exposure switch, Intra-oral counterbalance, Tube head, Pan, ceph or CBCT rotational/scanning motion. There is then space for comments.

Maintenance Records

The QA programme for equipment should include the maintenance and inspection schedule recommended by the manufacturer to ensure the equipment operates properly and safely at all times. This would normally recommend that the electrical and mechanical features of the X-ray equipment are serviced on an annual basis by a qualified service agent. Service reports should be kept as evidence that the equipment is being well maintained.

Fault Records

Any faults that occur with the X-ray set should be recorded. The record should include:

  • The equipment at fault
  • Details of the fault
  • Whether it was withdrawn from use
  • What corrective action was carried out
  • What testing was done to confirm the equipment is ready to put back in to use

Fault Log

Details of any equipment faults (including X-ray equipment, film processors and digital systems) may be recorded in this log. It is recommended that equipment currently unfit for clinical use should be disabled (switched off at the mains) and an appropriate notice posted on the control panel. Details of any test made before the equipment was returned to clinical use may also be recorded here.

Example of a fault log table to be complete under the following headings: Data, manufacturer and model, serial number/identifier, nature of fault, was equipment withdrawn from clinical use?, Corrective action taken, Test details.

Routine Performance Tests and QA of Patient Dose

In addition to the acceptance testing carried out prior to X-ray equipment entering use, routine QA tests of operating parameters and performance characteristics should be carried out. This should be at intervals not exceeding three years, except for handheld equipment which should be tested every year, or for any X-ray set where the MPE advises more frequent testing is necessary.

As part of the routine test, a measurement of representative patient doses must be made and compared to the practice’s diagnostic reference levels (DRLs), to confirm that patient doses are being adequately restricted. Should these levels be exceeded, the reasons for this should be investigated on the advice of the MPE.

X-ray equipment would also require testing following any relocation, repair or modification that could significantly affect image quality or patient doses. If in doubt as to whether testing is required, the MPE should be consulted.

© UK Health Security Agency
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