The impact of processing delay on the exposure index value

Abstract

Digital radiography poses the risk of unnoticed increases in patient dose. Manufacturers responded to this by offering an exposure index (EI) value to clinicians. Use of the EI value in clinical practice is encouraged by the American College of Radiology and American Association of Physicists in Medicine. This study assesses the impact of processing delay on the EI value. An anthropormorphic phantom was used to simulate three radiographic examinations; skull, pelvis and chest. For each examination, the phantom was placed in the optimal position and exposures were chosen in accordance with international guidelines. A Carestream (previously Kodak) computed radiography system was used. The imaging plate was exposed, and processing was delayed in various increments from 30 seconds to 24 hours, representing common delays in clinical practice. The EI value was recorded for each exposure. The EI value decreased considerably with increasing processing delay. The EI value decreased by 100 within 25 minutes delay for the chest, and 20 minutes for the skull and pelvis. Within 1 hour, the EI value had fallen by 180, 160 and 100 for the chest, skull and pelvis respectively. After 24 hours, the value had decreased by 370, 350 and 340 for the chest, skull and pelvis respectively, representing to the clinician more then a halving of exposure to the detector in Carestream systems. The assessment of images using EI values should be approached with caution in clinical practice when delays in processing occur. The use of EI values as a feedback mechanism is questioned.