Radiation dose in barium swallow examinations: an Oxford tertiary care centre experience

Abstract

To assess the radiation dose in standard barium swallow studies (BaSS) performed at a large tertiary referral centre, benchmarked against the national diagnostic reference level (NDRL), and to provide evidence to support reducing radiation dose through improving operator's training. In this retrospective observational study, 1,004 adult BaSS (M:F=411:593) were assessed. The radiation dose was first compared with NDRL, and then stratified by the operator's training level and compared using analysis of variance (ANOVA). The operators were categorised as radiology residents, advanced radiography practitioners, GI radiology fellows, and GI radiology consultants. Further comparative analysis is performed by comparing the test radiation dose when stratified based on the referrer's specialty, and whether they were performed for female patients of childbearing age. The findings show 68.2% of BaSS performed are within the NDRL and demonstrated statistically significant correlation (p<0.0001) between radiation dose and operator's training level, and for female patients of childbearing age (p<0.002) and the rest. The median dose was lower with more senior operators. There was no significant correlation between radiation dose and the referrer's specialty. The study presents evidence to support revisiting consultant-supervised BaSS training, in the interests of lowering the radiation exposure to patients and improving compliance with the NDRL.