Oops! Are You Exposed?

 Now that we have unraveled the levels of oversight and exactly who has authority over the use of radiology and laser equipment within your Dental practice in our most recent post "Can Your Radiation Compliance Withstand The X-Ray Of Scrutiny?", it's time to go even deeper on this topic.

Continuing down this radiation compliance path, let's take an even closer look those most common violations identified in "The 'Sweet 16' Of Radiology Violations." In this article, I will discuss those violations in even greater detail in an effort to help you understand (generally) what the rules require…in plain English, no mumbo-jumbo. Moving from the top down, we're going to explore the four most-cited compliance violations I see across the board in Dental practices, starting with #1.

REGISTRATION ISSUES

As I understand it, currently only one or two states do not require the registration of X-ray equipment. For those requiring  registration, issues often arise when a Dentist sells their practice to another Dentist. In this situation, the seller needs to terminate their registration so the buyer-Dentist can obtain a new registration in their name. Unfortunately, the new Dentist cannot obtain a new registration until the old registration is terminated.
 
This can be a challenge when the seller has sold their practice and resides on a yacht in the Caribbean (hence, they could be hard to locate). All too often, the new Dentist ‘assumes command’ of their practice and hit the ground running with the naïve belief that all is well with the status quo. Radiation and laser registrations should be addressed in practice transitions to ensure the proper hand off from buyer to seller – some things do not transfer with the sale of a practice! 
 
Most states requiring X-ray registration also mandate payment of registration fees… whether that be annual, biennial (every two years) or triennial. Failure to pay your registration fees can cause the inadvertent termination of your registration. Set your renewal payment date in your Dental software as you would any patient appointment to remind yourself and your staff to pay your registrations fees in a timely manner. Many states’ regulations allow them to confiscate your radiation equipment for rule violations. Fortunately, I have never heard of this actually happening, however with the increasing "heavy-handedness" of regulatory enforcement there’s no telling how this might change moving down the road. Wouldn't it so completely ruin your day to have the government show up with a moving truck to seize your X-ray machines simply because you forgot to pay your fees? Just because it has not happened does not mean that it will not happen in the future.
 
SAFETY PLANS
 
Most state regulations are based on federal standards or recommendations. Such is the case with radiation regulations, which are largely based on those of the U.S. Nuclear Regulatory Commission (NRC) also known as the Standards For Protection Against Radiation (10 CFR – Part 20). Under these federal guidelines, along with your state regulations, Dentists are required to have written plans to outline the safety and compliance measures they follow in relation to the "As Low and Reasonable Achievable" requirement. This ensures X-ray exposures are not only below applicable legal levels but to also keep the radiation exposure levels as far below the applicable levels as reasonable  – while still ensuring adequate exposure to obtain diagnostic-quality film and images.
 
Safety plans are often called Operating and Safety procedures, Radiation Exposure Control Plans, or Standard Operating Procedures (SOP). However you choose to implement these referenced standards, every office needs to have written safety plans. The Radiation Safety Officer, most often the Dentist, needs to ensure the written SOP actually reflects the specific, actual practices of your Dental office. The greatest written plans are worthless if they do not accurately protray what you actually do, if your staff is not trained on them, or the SOPs are not enforced or followed. Staff training needs to be documented. This can be accomplished by attaching an acknowledgment to the end of the SOP and having your staff sign this acknowledgment (be sure to note you have given them the opportunity to ask questions about any information they are may not be clear about).
 
  COMPLIANCE TASKS
 
There are a number of compliance tasks that need to be completed at varying time intervals. For instance, Dentists are required to document darkroom light leak checks. Depending on the state where you practice, this could vary from every three months to once a year. Remember, if it is not written it did not happen! If your office has a darkroom you are also required to ensure your safelight produces the correct result with regard to exposures (the light does not harm the exposure). Is the lightbulb of the correct wattage and proper distance from the developer? It is recommended safelights be replaced every three years. If these checks are completed, did you take steps to ensure the violations have been mitigated (corrected) in a timely manner? Do you have records to demonstrate your fixer and developer solutions are replaced within specified intervals (usually every three months)? What about records to indicate daily developer temperatures? Geez, I can see why more and more Dental offices are going digital, aside from quality and convenience.

In closing, it is my experience that radiation compliance agents are usually pretty easy to deal with as compared to other regulatory agents. However, like other government agencies, even they are becoming more heavy-handed with their fine assessments. You really have a few choices:

  1.  D-I-Y compliance efforts, which require more time than money to ensure your office meets or exceeds standards.
  2.  How much is your time worth? Focus your time on high-dollar tasks and hire an expert to help you ensure your compliance, which is a much smarter investment than giving a LOT more money to the government in fines.
  3. Drill, fill and bill – nevermind that compliance stuff, you can deal with the calculated risks. However, if you happen to get busted, it can cut into production time and profits and result in unplanned expenses. It is at least a distraction – if not a source of great stress to you – since you now have to deal with the government for your mistake.

Regardless of your choice, just think about the level of YOUR exposure and whether or not you're ready to be laid naked before your patients, your peers…and most of all, the government. Maybe it's time to investment in something that will cover your @$$!