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Run: Dental Radiograph Exposure and Retake Justification Log

Use this log to review dental radiograph exposures, retakes, and ALARA justification in one place. It helps you document image quality, repeat exposures, and...

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Inspection Details

Date of radiograph review critical (required)

Practice location or operatory critical (required)

Inspector name and role critical (required)

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 critical (required)

Exposure Documentation

Exposure date and time recorded critical (required)

Radiograph exposure parameters documented critical (required)

Record available exposure settings such as kVp, mA, exposure time, and sensor/film type.

Operator or clinician who obtained the image identified critical (required)

Image quality adequate for diagnostic purpose critical (required)

Yes No N/A

Exposure record complete and legible critical (required)

Yes No N/A

Retake Review

Retake occurred critical (required)

Yes No N/A

Retake reason documented critical (required)

Retake minimized and justified under ALARA critical (required)

Confirm the repeat exposure was clinically necessary and that no lower-dose alternative was appropriate.

Yes No N/A

Supervisor or dentist reviewed the retake decision

Yes No N/A

Number of retakes for this case critical (required)

ALARA and Radiation Safety Controls

Collimation, shielding, and positioning practices followed critical (required)

Yes No N/A

Repeat exposure avoided when image quality was clinically acceptable critical (required)

Yes No N/A

Radiation dose reduction measures documented

Staff followed facility radiation safety protocol critical (required)

Yes No N/A

Any deviation from protocol explained

Corrective Actions and Sign-Off

Corrective action required for any deficiency

Yes No N/A

Follow-up verification scheduled

Inspector comments

Inspector signature critical (required)

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