Have providers and staff familiarized themselves with the ADA and FDA guidelines for limiting radiation exposure?

Have clinical protocols been revised and updated to ensure consistency with the ADA and FDA guidelines?

Are professional and auxiliary staff trained to ensure common understanding and adherence to new protocols?

Are radiographs prescribed only after the dentist has reviewed the patient’s health history, completed a clinical examination, considered the patient’s symptoms, and assessed and reassessed the patient’s risk status to determine the need for radiographic examination (extraoral vs. intraoral radiography), per FDA’s Guidelines for Prescribing Dental Radiographs?

Are dentists prepared to discuss with patients the benefits and risks of X-ray exams (see the American Academy of Oral and Maxillofacial Radiology and the Alliance for Radiation Safety in Pediatric Imaging brochure What Parents Should Know about the Safety of Dental Radiology and ECRI Institute’s Communication and Disclosure Training Program)?

Is the number of images obtained limited to the minimum necessary to obtain essential diagnostic information?

Is the dentist made responsible for following the ALARA (as low as reasonably achievable) principle to minimize exposure?

Is the beam collimated to the size of the receptor whenever feasible (note that the use of long source-to-skin distances of 40 cm, rather than short distances of 20 cm, decreases exposure by 10% to 25%; distances between 20 cm and 40 cm are appropriate, but longer distances are optimal)?

Are operating potential of dental X-ray units set between 60 and 70 kVp and settings above 90 kVp prohibited?

When using hand-held X-ray units, does the operator hold the device at mid-torso height, orient the shielding ring properly with respect to the operator, and keep the cone as close as practical to the patient’s face?

Are hand-held units stored in locked areas when not under direct supervision of an individual authorized to use them?

Is the fastest image receptor (F-speed or digital) compatible with the diagnostic task used (note that D-speed receptors should not be used; switching from D-speed to F-speed reduces radiation exposure by 44% to 70%)?

Are receptor-holding devices that align precisely with the collimated beam used when taking periapicals and bite-wing radiographs so that dental professionals do not hold the receptor holder during exposure?

Are protective aprons and thyroid collars used?

Are protective aprons and thyroid collars hung or laid flat and never folded?

Are protective shields evaluated for damage on a monthly basis, X-rayed annually to detect cracks, and replaced when cracks are detected?

Do operators of radiographic equipment use barrier protection when possible?

Do barriers contain a leaded glass window to enable the operator to observe the patient during exposure?

When shielding is not possible, does the operator stand at least 2 m from the tube head and out of the path of the primary beam?

Are personal dosimeters worn by dental personnel to monitor exposure to scattered radiation?

Has the dental clinic developed and implemented quality assurance protocols for the following:

• X-ray unit?
• Imaging receptor?
• Film processing?
• Dark room?
• Patient shielding?

Does a qualified expert survey all X-ray units on their placement and resurvey the equipment every four years or after any changes that may affect the radiation exposure of the operator and others?

Has the dental clinic identified radiographic examination dental quality measures as part of quality improvement initiatives?