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The importance of the ANSI ADA Standard for digital intraoral radiographic systems—a pragmatic approach to quality assurance

      The need for quality assurance (QA) for digital dental radiography has existed since the introduction of digital imaging; however, the methods and phantoms required to achieve it were not available. This resulted in a chaotic approach to address QA based largely upon subjective analysis of image quality. The American National Standards Institute (ANSI)/American Dental Association (ADA) Quality Assurance Standard 1094 for Digital Intraoral Radiographic Systems (DIRS) presents a paradigm shift to a scientific and objective method of QA rather than one based on subjective assessments. This standard takes into account the contributions of all components of the digital imaging chain that affect final image quality rather than assessing the various components in isolation. The optimal image is determined for each DIRS through objective analysis of the image quality properties of dynamic range, spatial resolution, and contrast perceptibility. Image optimization, a critical component of a quality assurance program, is the proper balance between diagnostic image quality and radiation dose to the patient. This publication counters disseminated myths and misconceptions with scientific evidence and will help dental practitioners appreciate and understand the benefits of the new ANSI/ADA Standard on QA for DIRS.
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      References

      1. Hilohi MC, Eicholtz G, Eckerd J, Spelic DC. Nationwide Evaluation of X-ray Trends (NEXT) Tabulation and Graphical Summary of the 2014–2015 Dental Survey. Available at:https://cdn.ymaws.com/www.crcpd.org/resource/collection/720B159D-BBFC-4C72-AB22-36BD9F25FCFE/E-19-2_2014-2015_Dental_NEXT_Summary_Report.pdf. Accessed February 21, 2021.

        • Reeves TE
        • Lien W
        • Mah P.
        Quality assurance: acceptance testing for digital dental intraoral sensors.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2020; 129: 388-400
        • Walker TF
        • Mah P
        • Dove SB
        • McDavid WD.
        Digital intraoral radiographic quality assurance and control in private practice.
        Gen Dent. 2014; 62: 22-29
        • Udupa H
        • Mah P
        • Dove SB
        • McDavid WD.
        Evaluation of image quality parameters of representative intraoral digital radiographic systems.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116: 774-783
        • Hellén-Halme K
        • Johansson C
        • Nilsson M.
        Comparison of the performance of intraoral X-ray sensors using objective image quality assessment.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 121: E129-E137
        • Greenall C
        • Drage N
        • Ager M.
        Quality assurance tests for digital radiography in general dental practice.
        Dent Update. 2014; 41 (126-128): 131-134
        • Buchanan A
        • Morales C
        • Looney S
        • Kalathingal S.
        Fish scale artefact on an intraoral imaging receptor.
        Dentomaxillofac Radiol. 2017; 4620170224
        • Buchanan A
        • Orta A
        • Kalathingal S.
        Postprocessing of all-zirconia restorations in digital dental radiographs: a quality assurance predicament.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127: 330-338
        • Buchanan A
        • Hancock R
        • Kalathingal S.
        The role of software in quality assurance for indirect digital intraoral imaging.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2020; 130: 313-321
        • Mol A
        • Yoon DC.
        Guide to digital radiographic imaging.
        J Calif Dent Assoc. 2015; 43: 503-511
        • Christensen GJ.
        Do dental radiographs show incipient carious lesions?.
        Clinicians Report. 2011;
      2. Dentaltown. The truth about digital X-ray sensors. Dentaltown.com >Message Boards >Oral & Maxillofacial Radiology (Imaging) and Photography >Digital Radiography 07/08/04. Available at: https://www.dentaltown.com/Images/Dentaltown/magimages/0716/MBXRpg74.pdf. Accessed January 18, 2021.

      3. California Dental Association. Radiation safety in dental practice. Available at: https://www.cda.org/Portals/0/pdfs/practice_support/radiation_safety_in_dental_practice.pdf. Accessed January 18, 2021.

      4. Schick USB Module and Sensors User Guide Part Number 100003870 REV. Available at:https://assets.dentsplysirona.com/websites/dentsplysironasupport/schick-brand-software/Schick%20USB%20and%20Sensors%20User%20Guide.pdf. Accessed January 18, 2021.

        • Olsson L
        • Nilsson M
        • Svenson Börn
        • Hellén-Halme K
        The effect of anatomical noise on perception of low contrast in intra-oral radiographs: an in vitro study.
        Dentomaxillofac Radiol. 2016; 4520150402
        • National Council on Radiation Protection and Measurements
        Radiation protection in dentistry and oral and maxillofacial imaging, NCRP Report 177.
        NCRP, 2019
        • American Association of Physicists in Medicine (AAPM)
        Acceptance Testing and Quality Control of PhotostimulableStorage Phosphor Imaging Systems.
        AAPM, 2006 (Available at:) (Accessed February 18, 2021)
        • Yoshiura K
        • Kawazu T
        • Chikui T
        • et al.
        Assessment of image quality in dental radiography, part 1 Phantom validity.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87: 115-122
        • Mah P
        • McDavid WD
        • Dove SB.
        Quality assurance phantom for digital dental imaging.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: 632-639
      5. American National Standard Institute/American Dental Association Standard No.1094 Quality assurance for digital intraoral radiographic systems (ANSI/ADA Standard No. 1094). 2020.

        • American Association of Physicists in Medicine (AAPM)
        Acceptance Testing and Quality Control of Dental Imaging Equipment.
        AAPM, 2016 (Available at:) (Accessed February 18, 2021)
        • Mah P
        • Buchanan A
        • Reeves TE.
        Applying the new ADA quality assurance standard to digital intraoral radiographic systems.
        J Calif Dent Assoc. 2021; 49: 291-299
        • National Council on Radiation Protection and Measurements
        Radiation protection in dentistry. 145. National Council on Radiation Protection and Measurements, Bethesda, MD2003
        • Van der Stelt PF.
        Better imaging the advantages of digital radiography JADA. 2008; 139: 7s-13s
        • Hellén-Halme K
        • Rohlin M
        • Petersson A.
        Digital radiography in general dental practice: a field study.
        Swed Dent J. 2005; 29: 81-87
      6. Medical Physicists Should Join the Movement— Image Gently… in Dentistry. Available at:https://www.imagegently.org/Portals/6/Dental/2016%20-%20What%20a%20Medical%20physicist%20needs%20to%20Know!.pdf?ver=2016-11-03-111541-297. Accessed February 18, 2021.

        • National Council on Radiation Protection and Measurements
        Reference levels and achievable doses in medical and dental imaging: recommendations for the United States.
        National Council on Radiation Protection and Measurements, Bethesda, MD2012 (172)
        • Hellén-Halme K
        • Nilsson M.
        The effects on absorbed dose distribution in intraoral X-ray imaging when using tube voltages of 60 and 70 kV for bitewing imaging.
        J Oral Maxillofac Res. 2013; 4: 1-7
      7. International Atomic Energy Agency. Optimization in dental radiology: FAQs for health professionals. Available at:https://www.iaea.org/resources/rpop/health-professionals/dentistry/optimization#1. Accessed November 14, 2021.

        • Kal BI
        • Baski G
        • Dündar N
        • Sen BH.
        Effect of various digital processing algorithms on the measurement accuracy of endodontic file length.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 280-284
        • Smith-Bindman R
        • Kwan ML
        • Marlow EC
        • et al.
        Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000–2016.
        JAMA. 2019; 322: 843-856
        • American Dental Association Council on Scientific Affairs
        The use of dental radiographs: update and recommendations.
        J Am Dent Assoc. 2006; 137: 1304-1312
      8. American Dental Association. Dental standards. Available at:https://www.ada.org/resources/practice/dental-standards. Accessed June 1, 2022.