The value of a quality improvement programme for panoramic radiography: A cluster randomised controlled trial

Objectives: To assess the value of a quality improvement programme for panoramic radiography. Methods: A prospective, cluster randomised controlled trial was conducted in 40 dental practices in England. Practices were randomly assigned into two groups, an 'active' practice receiving regular feedback on film quality and a 'control' practice receiving no feedback until the completion of the study. Results: 800 panoramic radiographs were examined for technical and processing faults. Following the first feedback to the 'active' practices, 100 films showed that the films taken were a significant predictor of a reduction in the number of technical (effect coefficient 0.51 (standard error SE 0.06); P <0.001) and processing (effect coefficient 0.42 (SE 0.08); P <0.001) faults compared to those in 'control' practices (n = 400). The 'active' practices continued to benefit from the second round of feedback, showing a marked reduction in technical (effect coefficient 1.31 (SE 0.06); P <0.001) and processing (effect coefficient 1.18 (SE 0.11); P <0.001) faults. Two months after completion of the study, a further 120 panoramic radiographs from 12 practices in each group were examined for quality. Significant differences between the two groups for both technical faults (effect coefficient 0.62 (SE 0.22); P = 0.02) and processing faults (effect coefficient 0.65 (SE 0.17); P <0.001) were found. Conclusions: This cluster randomised controlled trial showed that distance feedback is an effective method in instructing dental practitioners to correct technical and processing errors experienced in producing panoramic radiographs. This intervention was effective in the short term whilst the practitioners were actively receiving feedback and for 8 weeks afterwards. Clinical significance: Panoramic radiography quality is often poor due to a lack of knowledge of correct patient positioning. A failure to comply with manufacturers' instructions regarding the changing frequency for processing chemistry also compounds the problem. Distant feedback is effective in improving film quality in the short term and after 8 weeks. © 2013 Elsevier Ltd.