Patient radiation dose and image quality in plain radiography: An assessment of three common procedures in ten hospitals

Abstract

This study aimed to assess the main factors affecting radiographic image quality in selected routine radiography procedures, to establish guidelines for maintaining the expected quality, while keeping the patient radiation doses as low as possible.Entrance surface air kerma (ESAK) for 811 patients undergoing chest, abdomen and pelvis x-ray procedures in ten X-ray departments were assessed using the European Image Criteria method. Basic quality control (QC) tests were performed to check the compliance of x-ray machines with the international standards. The mean percentage and range of good quality images were 71.3 (56–86.1) for chest posterior anterior (PA), 76.1 (65–91) for abdomen anterior posterior (AP) and 70.7 (35.7–92.6) for pelvis anteroposterior (AP). The corresponding ESAK (mGy) were 0.5 ± 0.3, 3.7 ± 1.7 and 3.6 ± 1.6 per procedure, respectively. These image quality findings reveal wide inter and intra-hospital variations. The ESAK values for patients undergoing abdominal and pelvic X-ray procedures showed comparable values in relation to the international diagnostic reference levels (DRLs), while they were twice as high for chest X-ray procedures. Improper image processing, exposure factor errors, and suboptimal patient communication and instructions prior to examination were the main factors commonly responsible for inadequate quality radiographs. The radiation dose variations are according to variable patient demographic data across the hospitals and type of examination, besides the variations of the applied technical parameters for each given examination. The film reject rates are higher in most hospital compared to the World Health Organization (WHO) recommended value. Establishment of image quality criteria will improve the department productivity and will reduce the reject rate.