This verification list is intended for the radiology technician or equipment operator. Run through it after each acquisition, before delivering the study to the patient or sending it to the requester. If any critical item is not met, evaluate — before invalidating the study — whether the essential diagnostic information is still available: sometimes an artifact in an area not relevant to the main diagnosis can be tolerated.
1. Administrative data
- Patient’s full name matches the request
- Correct study date
- ID document and contact details registered
- Medical request received and filed
- Signed informed consent
- Pregnancy ruled out (female patient of childbearing age) or specific pregnancy consent signed
2. Patient positioning
- Frankfurt plane horizontal (orbito-meatal line parallel to the floor)
- Mid-sagittal plane centered and perpendicular to the floor (no lateral head rotation)
- Bite in habitual occlusion or with interocclusal separator per protocol
- Tongue at rest (not interposed between arches, except for airway protocols)
- Head supported and stable in the cephalic holder
- Relaxed shoulders, comfortable patient, no foreseeable movement during acquisition
3. FOV (Field of View) and centering
- FOV fully covers the requested region
- FOV is not excessively large for the indication (ALARA principle)
- Correct centering: the region of interest is in the central area of the volume
- No inadvertent cropping of critical structures (e.g., root apices, mandibular condyle if requested)
4. Exposure and equipment parameters
- kVp and mA matched to the indication protocol (pediatric, adult, high resolution, etc.)
- Correct exposure time (most equipment: 10–40 s)
- Equipment set to the lowest dose mode compatible with diagnostic quality
- If pediatric patient: optimized pediatric parameters applied
5. Image quality — Common artifacts
- No motion artifact (double lines on bone edges, blurry slices)
- No critical metal artifact obscuring the region of interest (crowns, implants, brackets)
- No ring artifact from miscalibrated detector
- No truncation artifact (insufficient FOV to include peripheral tissues)
- No excessive beam hardening artifact in the critical area
- No aliasing artifact from undersampling (if observed, consider reconstruction with finer voxel)
6. Anatomical completeness
- Requested region fully included in the volume
- Reference structures visible per indication: inferior alveolar nerve, maxillary sinus, orbital floor, nasal fossae, mandibular condyle, etc.
- If orthodontic/cephalometric: airways and soft tissues included when applicable
- If TMJ: condyle and glenoid fossa bilaterally when bilateral was requested
7. Secondary reconstructions
- Axial, sagittal and coronal slices generated correctly
- Panoramic reconstructed over the patient’s mandibular curve (not a generic curve)
- Cross-sectional slices adjacent to the curve, with appropriate spacing and thickness
- 3D render / iso-surface generated if the indication requires it
- Brightness/contrast (Window Level) tuned to the predominant tissue type for the case
8. DICOM data and delivery
- DICOM headers with correct patient and equipment data
- Anonymization applied if the study will be shared externally and the patient requires it
- Study saved in the imaging center’s archive system
- Delivery to the patient: shared link / DVD / USB per stated preference
- If applicable: radiology report attached or pending and scheduled
- Delivery receipt or system record
9. Final documentation
- Referral form filed (paper or digital)
- Informed consent filed
- Audit log or study record in the system
- Study backup performed (if the system does not do it automatically)
Frequent errors to watch out for
- Motion artifact: the most common one. Appears as double contours on bone edges. Increases in patients with cough, anxiety, or children. Mitigation: prior explanation, firm cephalic support, explicit instruction not to swallow during acquisition.
- Metal artifact: implants, metal-ceramic crowns, and orthodontic brackets generate streaks and shadowing. If the patient has a removable fixed appliance (Hawley, plate), remove it before the study.
- Misaligned FOV: apical apices outside the volume in endodontic studies, or condyle cut off in TMJ studies. Always check the vertical extent of the FOV.
- Incorrect bite: excessive opening or forced closure distorts condylar position and alters the recorded occlusion. Use the center’s standard interocclusal separator.
- Misaligned Frankfurt plane: in 3D cephalometry and orthodontics, poor initial alignment can invalidate measurements. Verify before starting the acquisition.
- Tongue or cheek interposed: they mimic pathological structures on upper axial slices of the maxilla. Instruct the patient to keep the tongue "at rest" before the acquisition.