Effects of a Radiography Checklist on Reducing Retake Exposures

Purpose: Typically implemented as a safety measure, checklists can reduce risks and improve patient outcomes. Checklists have been widely used in medicine, but rarely applied to dentistry. The purpose of this replication study was to evaluate the effectiveness of a dental radiography checklist intervention for improving the diagnostic value of bitewing images and reducing retake exposures.Methods: Two cohorts of dental hygiene students from programs in the same community college district participated in the mixed methods study; one as intervention group (n=22), the other as control group (n=23). The intervention group used a checklist each time bitewing images were acquired on manikins and live patients while the control group followed the usual protocol for image acquisition. Calibrated faculty evaluated all images and recorded whether images passed, failed, or required retakes. All participants completed a demographic survey at the study conclusion while the experimental group completed two additional surveys regarding perceived value of the checklist and intention to continue its use outside the educational setting. Descriptive and inferential statistics were used to analyze the data.Results: Image failure and retake rates were significantly lower in the experimental group on both manikins and live patients (p<0.001). The control group experienced a lower failure rate on patients versus manikins; however, overall retake rates were higher than the experimental group. While the retake rate improved among both groups from manikin to human exposures, the magnitude of change across groups did not differ (p=0.992). Sensor placement was the most common cause for a failing image. Participants generally considered the checklist thorough and easy to use, however there was less agreement that it improved image quality or that they would continue its use outside the educational setting.Conclusion: A radiography checklist used in an educational setting was successful in reducing bitewing image failure and retake rates, thus benefiting patient safety with reduced radiation exposure.