ORAL SURGERY GROUP P.A. PRACTICE LIMITED TO ORAL AND MAXILLOFACIAL SURGERY DENTAL IMPLANTS, WISDOM TEETH, ORAL PATHOLOGY, AND ORAL MEDICINE iCAT ® Precise ™ Policy and Procedure Manual Serial Number NU011247 Dr. David M. Rauch Dr. Philip S. Engel Dr. Richard K. Stern Dr. Constantine Simos Dr. Michael E. Stern FELLOWS OF THE AMERICAN ASSOCIATION OF ORAL & MAXILLOFACIAL SURGEONS DIPLOMATES OF THE AMERICAN BOARD OF ORAL & MAXILLOFACIAL SURGEONS
Transcript
ORAL SURGERY GROUP P.A.
PRACTICE LIMITED TO ORAL AND MAXILLOFACIAL SURGERY DENTAL IMPLANTS, WISDOM TEETH, ORAL PATHOLOGY, AND ORAL MEDICINE
iCAT® Precise™
Policy and Procedure Manual
Serial Number NU011247
Dr. David M. Rauch Dr. Philip S. Engel Dr. Richard K. Stern Dr. Constantine Simos Dr. Michael E. Stern FELLOWS OF THE AMERICAN ASSOCIATION OF
ORAL & MAXILLOFACIAL SURGEONS
DIPLOMATES OF THE AMERICAN BOARD OF
ORAL & MAXILLOFACIAL SURGEONS
iCAT®
Precise™
Policy and Procedure Manual
Table of Contents
1. Individuals Responsible for QA and QC Program
2. Staff NJ X-Ray License Documentation
3. CBCT Exemption Forms
4. NJ DEP Registration Form
1. Tests Performed and Required and Frequencies
2. Description and Acceptable Limits for Each Test Performed
3. Sample Form for Each Test Performed
4. Annual Medical Physicist QC Survey
1. Rules for Radiation Safety
2. Initial Radiation Safety Survey
3. Annual QA Program Review Policy
1. QC Tests (for the most recent year)
2. Initial Medical Physicist QC Survey + Two Most Recent Survey’s
3. Corrective Action for Two Most Recent Years
4. NJ DEP Inspection Results – Most Recent Letter of Compliance
Staff Training and Certification
Daily and Weekly QC Tests
Radiation Policies and Procedures
Service and/or Repair Protocol: Plan for Corrective Action
Reference Materials
Record Keeping
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Staff Training and
Certification
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Policy and Procedure Manual
Individuals Responsible for QA and QC Program
The following staff members are responsible for the QA and QC Program as it pertains to the
iCAT Precise Unit:
Angel Willis – Primary
Shannon Hanson – Secondary
Jena Bussey – Secondary
Staff X-Ray License and Training Documentation
The following table reflects the all current employees certified to take x-rays in the state of New
Jersey. Additionally, staff members trained to take cone beam CT scans is noted.
Last Name First Name NJ Lic # License
Type
X-Ray
License
Expiration
Date
CBCT
Trained?
CBCT
Training
Completion
Date
CBCT Training
Certificate or
Exemption Form?
Brown Christina 643584 3 (dental) 12/31/16 No NA NA
Bussey Jena 651953 3 (dental) 12/31/16 Yes 01/28/15 Exempt Form
Demers Judith 630645 3 (dental) 12/31/16 Yes 11/29/11 Both
Devaney Jeannine 627703 3 (dental) 12/31/16 Yes 11/29/11 Both
Grosso Jennifer 648304 3 (dental) 12/31/16 Yes 12/18/14 Exempt Form
Hanson Shannon 652077 3 (dental) 12/31/16 Yes 01/28/15 Exempt Form
Osei Marisa 648307 3 (dental) 12/31/16 No NA NA
Reinitz Laura 636768 3 (dental) 12/31/16 No NA NA
Reinitz MaryEllen 623232 3 (dental) 12/31/16 Yes 11/29/11 Both
Rodgers Barbara 639197 3 (dental) 12/31/16 No NA NA
Strok Ada 630599 3 (dental) 12/31/16 No NA NA
Willis Angel 635895 3 (dental) 12/31/16 Yes 11/29/11 Both
Updated 01-10-2015
Each new assistant must be trained by a doctor on how to properly use the CBCT scanner.
Upon completion, the Licensed Dental Radiologic Technologist CBCT Exemption Form must
be completed and signed by the appropriate people. A copy will be put in the employee’s
permanent file and a copy will also be put into this manual.
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CBCT Exemption Forms
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New Jersey DEP Registration Form – Updated 03-03-2016
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Quality Control (QC)
and
Quality Assurance (QA):
Daily and Weekly Tests
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Policy and Procedure Manual
Tests Performed and Required Frequencies
In order to maintain the quality assurance protocol, there are a number of tests that need to be
performed on the CBCT scanner. The tests and associated frequency in which they are to be
performed are listed in the table below. When performing each test, the corresponding
worksheet in the QA Log Book (green) is to be completed. The staff member completing each
test is to date and initial the top of the worksheet.
The following tests need to be executed by a qualified and licensed staff member:
The following tests need to be executed annually by a qualified Medical Physicist.
The following tests do not need to be performed, as they do not pertain to Oral Surgery Group.
These tests are for offices that use film.
Test Frequency
QA Water Phantom Test Required by NJ DEP Daily
Field Uniformity Required by NJ DEP Daily
Calibration Required by manufacturer Weekly
Collimation Required by manufacturer Weekly
Test
Low Contrast Resolution
High Contrast Resolution
Noise
Scan Localization Light Accuracy
Medical Physicists QC Survey
Quality Assurance Program Review
Test
Film Processing QC Test
Laser Film Printer QC
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Description and Acceptable Limits of Each Test Performed
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Sample Test Form
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Annual Medical Physicists QC Survey
Performed 10-2015
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Radiation
Policies and Procedures
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Rules for Radiation Safety
1. Only individuals required for the medical procedure, for training, or for equipment
maintenance shall be in the radiographic room during an exposure.
2. Only staff members and doctors with a New Jersey Radiological License in good
standing will be permitted to operate CBCT scanner and position a patient for
radiographic exposure.
3. Individuals present during the radiographic exposure shall wear a protective apron of
at least 0.25mm lead equivalent during every exposure.
4. When a patient must be provided with auxiliary support during a radiation exposure
and mechanical holding devices are insufficient, the following procedures shall be
followed:
a. The person holding the patient shall be protected with a lead apron of at least
0.25mm lead equivalent.
b. No licensed practitioner shall order or otherwise cause a New Jersey licensed
technologist to hold a patient during radiation exposure, except in a life
threatening situation.
c. No person shall be employed, routinely assigned, or required to hold a patient
during a radiographic exposure.
d. If a person must be held during the x-ray exposure, non-radiation workers such
as aides, orderlies, nurses, or members of the patient’s family may be asked to
perform this duty.
5. Gonadal shielding of not less than 0.5mm lead equivalent shall be used on a patient
during radiographic procedures.
6. On units that do not have positive beam limitation, the operator shall collimate x-ray
beam to ensure that the field does not extend beyond the image receptor.
7. The radiographic field shall be restricted to the area of clinical interest as far as
practical.
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8. A mirror attached to the adjacent doorway is the object employed to observe the
patient during the x-ray.
9. Observation of the patient shall be made from the shielded area.
10. During radiographic exposure, the operator shall stand behind the protective barrier.
11. No person shall permit or arrange for the intentional irradiation of a human being
except for the purpose of medical diagnosis or treatment.
12. Before taking any x-rays, operators must ask female patients of child bearing age
about the possibility of pregnancy. If the patient is unsure, the procedure should be
delayed until the pregnancy status is confirmed.
13. Signs should be placed near the CBCT scanner reminding the patient to inform the
doctor/technologist if they are pregnant.
14. Pregnant radiation workers shall be provided with a personal radiation monitoring
device to assure the allowable limits to the fetus is not exceeded. Oral Surgery
Group policy regarding pregnant staff members taking x-rays is written in the Oral
Surgery Group Employee Handbook.
15. All staff members who operate the CBCT scanner are to sign below stating they
have read the safety manual:
Operator Printed Name Operator Signature Date
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Initial Radiation Safety Survey
Performed 01-2012
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Annual QA Program Review Policy
The QA and QC Policy and Protocol will be reviewed on an annual basis, in conjunction with
the annual Medical Physicist Survey (every October). Review of this manual and its contents
will be evaluated and updated, as necessary, at that time also.
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Service
and/or
Repair Protocol:
Plan for Corrective Action
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When performing the Phantom Water Test, you must confirm that the “mean”
is within the normal limits of (+) or (-) 90. If the “mean” is not within this
range, DO NOT USE THE UNIT! Call ISI and speak with Technical
Support.
iCAT Precise - Imaging Sciences International (ISI)
(800) 205-3570
Option 5 = Technical Support
If you have questions regarding the testing process, you can contact:
Steve Glennon, Medical Physicist
RJ Tokarz Medical Imaging Radiation Safety Corporation
