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J Am Coll Radiol. 2013 Oct;10(10):781-8. doi: 10.1016/j.jacr.2013.02.026.

The Image Gently pediatric digital radiography safety checklist: tools for improving pediatric radiography.

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Department of Diagnostic and Interventional Imaging, The University of Texas Medical School, Houston, Texas; Department of Pediatrics, The University of Texas Medical School, Houston, Texas. Electronic address:


Transition from film-screen to digital radiography requires changes in radiographic technique and workflow processes to ensure that the minimum radiation exposure is used while maintaining diagnostic image quality. Checklists have been demonstrated to be useful tools for decreasing errors and improving safety in several areas, including commercial aviation and surgical procedures. The Image Gently campaign, through a competitive grant from the FDA, developed a checklist for technologists to use during the performance of digital radiography in pediatric patients. The checklist outlines the critical steps in digital radiography workflow, with an emphasis on steps that affect radiation exposure and image quality. The checklist and its accompanying implementation manual and practice quality improvement project are open source and downloadable at The authors describe the process of developing and testing the checklist and offer suggestions for using the checklist to minimize radiation exposure to children during radiography.


Digital radiography; checklist; children; quality; radiation dose; safety

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