Step Wedges Still Matter: Why Your Dental Office Needs This Simple QA Tool
In today’s high-tech dental world, quality assurance (QA) often brings to mind automated sensors and software calibration. But there's one old-school, low-tech tool that remains just as essential as ever: the step wedge. Health Canada’s Safety Code 30 and best practice guidelines still recommend regular use of this tool to ensure your dental radiography systems are functioning correctly (Health Canada, 2022). If your practice is overlooking step wedge testing, or not logging it properly, you may be putting diagnostic accuracy and patient safety at risk.
What Is a Step Wedge Test?
A step wedge is a radiographic quality control tool made of graduated thicknesses of aluminum. When exposed to X-rays, it produces a pattern of varying density levels on the image. This test helps evaluate the consistency of image quality and monitor changes in exposure, sensor calibration, or processing systems (for film or digital).
Why Are Step Wedge Tests Still Required?
Step wedge testing is essential for the early detection of image quality drift, long before a patient X-ray reveals a problem. Whether using film, PSP, or digital sensors, this test confirms that the X-ray equipment is delivering consistent results. It also fulfills legal and regulatory QA documentation requirements, supporting patient safety and protecting the clinician in the event of a complaint or audit.
What Needs to Be Logged and Where?
For proper quality assurance, the step wedge test results along with the number of x-rays taken and re-takes must be logged. A log sheet must include and consider the following:
- Date
- # of radiographs taken
- Pass/Fail result for the step wedge image
- # of re-takes (if any), and a note about why the re-take was needed
- Initials of each operator who used the operatory that day (if more then one operator)
- A separate log per operatory, not per clinician
- Even overflow or rarely used ops must have their own step wedge and QA record
- Panoramic and cephalometric units also require their own step wedge tests and logs
Having a system where operators initial the form keeps accountability clear and ensures issues are addressed quickly by the right people. A sample log sheet is available for downloading.
What Do You Use as a Step Wedge?
A standard aluminum step wedge is sufficient. They are reusable and compatible with both film and digital sensors. For digital systems, simply place the wedge directly on the sensor or plate and expose using your usual test settings. Consistency is key … same settings, same sensor, same position every time. If the step wedge will not stay in place on the sensor, use tape or a rubber band to secure it.
Integration Into Daily Routine
Store the step wedge and log sheet together in a clearly labeled bin or drawer in each operatory. Make it part of the daily start-up routine. It’s quick, it’s easy, and it ensures catching potential problems before a patient is ever exposed to an image. For clinics using digital radiography and client management software, create a “fake patient” profile named after the operatory (e.g., “Op 2 Step Wedge”). This profile is used solely for daily step wedge tests. Taking the image under this profile means the date and time will be automatically recorded in the imaging software, helping eliminate missed entries and simplifying audits. It also allows to track consistency over time with ease.
Final Thoughts: It’s Not Just a Box to Check
The step wedge isn’t a formality; it’s a frontline defense for diagnostic quality and client protection. QA is everyone’s responsibility, and consistent, accurate logging makes it a team-based safety net. If a patient image ever comes into question, logs speak volumes about attention to detail and clinical standards. So, whether it’s the busiest operatory or the one used once a month, every X-ray unit needs to prove it can perform. And every clinician needs to prove they care.
Reference:
Health Canada. (2022). Radiation protection in dentistry: Safety procedures for the installation, use
and control of dental X-ray equipment (Safety Code 30). Government of Canada.
https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-publications/radiation/radiation-protection-dentistry-recommended-safety-procedures-use-dental-equipment-safety-code-30.html
Michelle Aubé (Simmonds) RDH, maxill Dental Hygiene Educator
Michelle is a Dental Hygiene Speaker, Consultant and Educator with over 30 years of experience as a RDH and 4 years as a CDA. She is a professor and curriculum writer at Fanshawe College in both the dental hygiene and continuing education program sharing her knowledge in IPAC, professional practice, periodontal classification, social justice, advocacy and clinical applications. She is maxill's CE and IPAC Director and wears various IPAC hats including auditing federal correctional facilities dental clinics for IPAC standards. Michelle is ODHA's Regional Board Director and authors articles for CDHA's OH Canada professional publication and continues to practice clinically in London ON. She is a CDHO IPAC Remedial Facilitator and IPAC Expert Opinion. Her strong ethics has allowed her to serve on the Discipline Committee at Algonquin College and hold the position of a CDHO Quality Assurance Assessor for 7 years. As a lifelong learner she is completing a BA in Adult Education at Brock University. Her diverse dental background and current status as a practicing RDH offer a fulsome and realistic view of dental-related topics. As a passionate champion for the profession, she advocates for equity, professional autonomy, and systemic change, true grassroots leadership at its finest.
Michelle can be reached at [email protected]
