Let’s get things straight: A quality improvement project to assess the orientation of upper standard occlusal radiographs prior to the management of ectopic maxillary teeth

Background: Accurate labelling and orientation of radiographs are essential for safe patient care, particularly when imaging informs surgical management. Incorrectly labelled Upper Standard Occlusal radiographs can lead to confusion during interpretation and treatment planning, with potential implications for wrong site or inappropriate surgical management of ectopic maxillary teeth. This quality improvement project aimed to improve the accuracy of radiograph labelling and orientation through a multidisciplinary approach.
Methods: The project was undertaken within the Oral and Maxillofacial department at Royal Gwent Hospital, Newport, South Wales. Baseline data was collected over 10 weeks for all patients undergoing Upper Standard Occlusal radiography for the management of ectopic maxillary teeth. Radiographs were assessed for correct left and right labelling and orientation. A multidisciplinary team involving Orthodontics, Oral Surgery, Oral and Maxillofacial Surgery and Radiology collaborated throughout the project. Two interventions were introduced sequentially. The first targeted radiograph referrers through a concise aid card outlining five key pieces of information required to facilitate accurate radiograph processing and orientation. This was developed collaboratively following discussion with the dental radiology department at University Hospital of Wales and presented at a multidisciplinary audit day. The second intervention targeted the radiology department directly through teaching for radiographers, followed by the introduction of a visual poster highlighting key principles for correct labelling and orientation.
Results: Baseline data included 26 patients over 10 weeks. All radiographs were incorrectly labelled, while only 4 (15%) were correctly orientated. Following the first intervention, 27 patients were assessed over a further 10 weeks. Labelling remained incorrect in all cases, with only 2 (7%) radiographs correctly orientated. Following the second intervention, 36 patients were assessed over a further 10 weeks. Correct labelling improved substantially, with 27 (75%) radiographs correctly labelled. Correct orientation was achieved in 8 (22%) cases.
Conclusion: This project demonstrates the value of multidisciplinary collaboration in addressing patient safety issues that cross departmental boundaries. Referrer focused guidance alone produced little measurable improvement, whereas education and visual prompts implemented at the point where radiographs were processed resulted in a marked improvement in labelling accuracy. Simple, low cost interventions can therefore produce meaningful improvements in clinical processes, supporting more efficient treatment planning and reducing the risk of surgical error. Sustainable quality improvement requires engagement of all teams involved in the patient pathway, with interventions targeted towards the underlying cause of the problem.