The best way to ensure compliance with radiation safety requirements is to have a strong radiation safety program in place that includes training for all affected employees, proper x-ray machine registration, internal hazard assessment of x-ray machines (which includes baseline personal dosimetry), effective recordkeeping and documentation, and the active involvement of employees.

In our ongoing commitment to provide valuable customer service, OSHA Review, Inc. has developed this checklist to help dental offices assess the safety and effectiveness of their x-ray procedures. The information provided below is intended for general information purposes only, and is recommended as a tool to assess safety and effectiveness.

Although every effort has been made to ensure the accuracy of this information, OSHA Review, Inc. is not responsible for any errors and omissions, or any agency’s interpretations, applications and changes of regulations described herein. It is not a substitute for review of the applicable regulations and standards, and should not be construed as legal advice.

Checklist for Dental X-ray Safety Assessment

       Complete and keep on file the following checklist to assess the effectiveness of your radiation protection program.

General/Administrative

• Always follow manufacturers’ instructions for proper operation and maintenance procedures. (Manufacturers include makers of x-ray film, x-ray machine, developer, processing chemicals, safelight, etc.)
• Each staff member authorized to take x-rays has an x-ray certificate from the Dental Board of California.
• Staff members who take x-rays have been properly trained on radiation safety practices, and have been instructed to follow the ALARA (As Low As Reasonably Achievable) principle.
• Staff members who take x-rays have been instructed to provide shielding devices (leaded aprons, thyroid collars) to patients. (Note: Protective aprons are required, while thyroid collars are recommended.)
• All staff members have been informed about the RHB radiation regulation excerpts, that they are available for review in Section X of your OSHA Review
• The OSHA Review Poster Set, containing the RHB Notice to Employees, is posted.
• Areas or rooms that contain permanently installed dental x-ray machines are posted with a sign with the wording “CAUTION – X-RAY”.

X-Ray Machine/Equipment

• All x-ray machines are registered with the state enforcement agency. (In California, this is the California Department of Public Health – Radiological Health Branch.)
• All x-ray machines are inspected/checked periodically to ensure optimum performance.
• All staff members in California who operate the x-ray machines have a radiation safety course certificate from an approved course:
• Staff members who take x-rays understand the importance of and know how to do the following:

        – Establish correct exposure times.

– Filter the beam.

– Restrict/collimate the size of the beam.

– Use the fastest available film (Speed E or faster).

– Align film and beam precisely to the body area of clinical interest to be imaged.

• The darkroom is maintained properly:

        – The film developer is operated properly, according to manufacturer’s instructions. If possible, an automated developer is used.

– Darkroom is clean, free of dust and chemical spills.

– No smoking, eating or drinking is permitted in the darkroom.

– Proper PPE for chemical protection and infection control is used in the darkroom.

– Light leaks are eliminated.

– Proper safelight is used.

– Processing chemicals are fresh, at proper concentrations and temperatures, with separate mixers.

– X-ray film is up-to-date and stored properly in a protective container at proper temperature and humidity, away from chemical fumes or background radiation exposure.

Occupational Safety

• Staff members who take x-rays have been instructed to stand at least 6 feet from the beam behind the unit, preferably behind a wall.
• All female staff members have been instructed to report their pregnancies as soon as they know about them.
• Baseline personal exposure monitoring has been conducted, and is continued for pregnant employees.
• Investigations occur when films are unreadable or consistently marginal to determine whether the problem is a result of operator, machine, or developer error. The investigation results are recorded for future reference.

Since 1992, OSHA Review, Inc. has provided dental professionals with comprehensive programs to support regulatory compliance and infection control. We are a registered continuing education provider in the state of California, specializing in Dental Practice Act, infection control, and OSHA training.