Dental X-Ray Safety Checklist: Radiation Protection & Calibration

Ensure patient and staff safety with our Dental X-Ray Safety Checklist! Covering radiation protection, equipment calibration, and protocol adherence, this essential guide helps dental practices minimize risk and maintain compliance. Download now for a safer, more confident X-ray experience.

This Template was installed 2 times.

Pre-Procedure Checks

1 of 8

Ensuring equipment readiness and personnel understanding of safety protocols before X-ray exposure.

Last Equipment Calibration Date

Tube Current (mA) Setting

Kilovoltage (kVp) Setting

Exposure Time Setting

Collimation Check

Digital Receptor Check

Image Processing Software Status

Patient Preparation

2 of 8

Verifying patient shielding, positioning, and consent regarding radiation exposure.

Pregnancy Status?

Approximate Gestational Age (if applicable)

Patient Communication Regarding Radiation Concerns?

Details of Patient Concerns (if any)

Appropriate Shielding Applied?

Consent Form (if applicable)

Patient Acknowledgement

Equipment Calibration & Testing

3 of 8

Validating the accuracy and safety of X-ray equipment through regular calibration and quality control measures.

Tube Current (mA) Reading

Kilovoltage (kVp) Setting

Exposure Time (seconds)

Detector Type

Calibration Date

Calibration Time

Output Reading (mR)

Calibration Status

Shielding & Protective Barriers

4 of 8

Confirming adequate shielding for patients and personnel during exposure.

Lead Apron Thickness (for patient)

Thyroid Shield Used?

Gonadal Shield Used (if applicable)?

Distance from X-ray Unit (feet)

Barrier Integrity Verified?

Comments on Shielding/Barriers (e.g., repairs needed)

Exposure Parameters

5 of 8

Reviewing and documenting exposure settings (mA, kVp, time) for optimal image quality with minimal radiation dose.

kVp (Kilovoltage Peak)

mA (MilliAmperes)

Exposure Time (Seconds)

Image Receptor Type

Collimation Technique

Notes on Exposure Settings (e.g., adjustments made, rationale)

Date of Parameter Validation

Personnel Safety & Monitoring

6 of 8

Ensuring personnel are properly trained, wear appropriate protective gear, and are monitored for radiation exposure.

Last Radiation Exposure Badge Reading (mSv)

Date of Last Radiation Safety Training

Radiation Safety Role (e.g., Radiation Safety Officer)

PPE Utilized During Exposure

Notes on Individual Radiation Exposure Concerns

Date of Next Scheduled Radiation Safety Review

Record Keeping & Documentation

7 of 8

Maintaining accurate records of equipment maintenance, calibration, and personnel monitoring.

Calibration Date

Exposure Meter Reading (mR)

Notes on Calibration Procedure

Calibration Certificate (PDF)

Last Personnel Radiation Monitoring Date

Personnel Exposure Dose (mSv)

Equipment Maintenance Log Reviewed?

Emergency Procedures

8 of 8

Reviewing and ensuring accessibility of emergency protocols related to radiation incidents.

Contact Information for Radiation Safety Officer (RSO)

Emergency Contact Information (Police, Fire, Hazmat)

Dose Limits for Personnel (mSv/year)

Procedure for Reporting Radiation Incidents

Date of Last Emergency Drill

Time of Last Emergency Drill

Steps Taken During Radiation Incident

Photos/Documentation of Incident (if applicable)

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