Patient-Based Dose Audit for Common Radiographic Examinations With Digital Radiology Systems: A Retrospective Cross-Sectional Study.

Khalid M Alshamrani,Abdulkader A Alkenawi,Abdulaziz A Qurashi,Shrooq Aldahery,Bushra N Alghamdi,Ahmed Subahi,Reham Kaifi,Marwah O Alshatiri,Shaza S Alsharif,Haneen A Alshehri,Noor Mail,Rawan H Honain

doi:10.7759/cureus.15005

Abstract

This study aims to audit radiation doses of adult patients who underwent common diagnostic X-ray examinations and compare dose area product (DAP) values with the established International Diagnostic Reference Level (IDRLs). Retrospective cross-sectional records of 339-patients who underwent 699-radiographic examinations between October 2018 and March 2019 were obtained. Patient-related factors, exposure, and DAP data were recorded for the six most common examinations. The mean and 75th percentile of DAPs were recorded and compared to IDRLs values. The 75th percentiles of the locally measured DAPs were below IDRLs for all examinations except for lateral lumbar, AP, and lateral thoracic spine, in which DAP-75th-percentile exceeded all IDRLs by up to 40.7%, 2.8%, 365.5%, respectively. Considering the type of detector used, the mean of the locally measured DAPs significantly exceeded the UK DRLs for the lateral thoracic spine and lateral lumbar spine. Locally measured DAP values were below the IDRLs except for thoracic and lumbar spine projections, which significantly exceeded.

Highlights

Plain radiography is a valuable and most cost-effective technique for diagnosis and screening purposes in medicine to begin a procedure with, constituting the largest contribution worldwide compared to all other diagnostic imaging examinations, and accounting for 53% of all imaging procedures reported in England between the year of 2018-2019 [1]
This study further reports a comparison between the locally audited dose area product (DAP) and the established international Diagnostic Reference Level (DRL)
The high mAs technique seen for lateral lumbar and thoracic examination could be due to inaccuracy in the manufactures’ defaulted and programmed reference exposure technique or inaccurate manual adjustment of exposure factors by the radiology technologist in response to variations in patient size that exceeded the recommended exposure technique provided by the manufacturers, which can lead to an increase in the incident dose and a dose creep or overexposure that can go unnoticed [23,24,25,26]

Summary

Introduction

Plain radiography is a valuable and most cost-effective technique for diagnosis and screening purposes in medicine to begin a procedure with, constituting the largest contribution worldwide compared to all other diagnostic imaging examinations, and accounting for 53% of all imaging procedures reported in England between the year of 2018-2019 [1]. To control the excessive dose to the patient, the Task Group 116 (American Association of Physicists in Medicine) identified a method of providing feedback, in the form of a standard index, to operators of digital radiographic systems, which reflects the adequacy of the exposure that has reached the detector after every exposure event [5] It is of high priority and importance for the quality system of all types of radiographic imaging to reduce the radiation risk without compromising clinical efficiency [6] and to monitor the actual radiation dose in and across radiology departments utilizing suitable and well-defined procedures [7]

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Discussion

Conclusion