Dental Radiograph Exposure and Retake Justification Log

Inspection log for documenting dental radiograph exposures, retakes, and ALARA justification to support radiation safety audits and quality assurance.

Inspection Details

• Date of radiograph review
• Practice location or operatory
• Inspector name and role
• Patient record or case identifier
  Use a non-sensitive internal identifier; do not enter full patient identifiers if not required by policy.
• Radiograph type reviewed

Exposure Documentation

• Exposure date and time recorded
• Radiograph exposure parameters documented
  Record available exposure settings such as kVp, mA, exposure time, and sensor/film type.
• Operator or clinician who obtained the image identified
• Image quality adequate for diagnostic purpose
• Exposure record complete and legible

Retake Review

• Retake occurred
• Retake reason documented
• Retake minimized and justified under ALARA
  Confirm the repeat exposure was clinically necessary and that no lower-dose alternative was appropriate.
• Supervisor or dentist reviewed the retake decision
• Number of retakes for this case

ALARA and Radiation Safety Controls

• Collimation, shielding, and positioning practices followed
• Repeat exposure avoided when image quality was clinically acceptable
• Radiation dose reduction measures documented
• Staff followed facility radiation safety protocol
• Any deviation from protocol explained

Corrective Actions and Sign-Off

• Corrective action required for any deficiency
• Follow-up verification scheduled
• Inspector comments
• Inspector signature