Audit for extraoral radiographic examinations in a digital department

To investigate whether extraoral radiographs requested by clinicians were actually viewed by the clinicians after recording.

Digital extraoral images recorded at the radiology department were tracked over a 1-year period. Digital images are communicated to the clinical departments through our Picture Archiving and Communication System and may be viewed at any computer which houses the image display and enhancement software "DigiView". DigiView keeps track of user actions, among others where and when an image is opened. An image was defined as viewed if it had been opened in DigiView within 3 months after it had been recorded. The number of opened and non-opened images was calculated in relation to the referring clinical departments/units in the dental school.

2374 digital extraoral images were requested by the clinical departments. Two-thirds of these images were requested from the orthodontic department. Twenty-two percent (n=346) of their requested images were not opened. The distribution of non-opened images for the other clinical departments was: oral surgery=3% (18 images); periodontology=17% (1 image); treatment planning=33% (1 image); prosthetic=5% (6 images); county=21% (8 images) and oral physiology=23% (6 images). Panoramic images constituted the majority (58%) of non-opened images. Twenty-six percent of the images were opened once, 15% were opened twice and 41% were opened three times or more.

Digital imaging offers new possibilities for audit compared with conventional film radiography. It seems that custom in some disciplines rules the referral of patients to radiographic examination and that this may lead to over-prescription.