Lumbar Spine AP Research Articles

Results of a patient dose survey on diagnostic radiology in Lithuania

One of the most effective means towards optimisation of radiation protection for patients undergoing radiodiagnostic examinations are the diagnostic reference levels. In order to ensure the effective use of these levels, they have to be set properly. National characteristics, such as the conditions of the radiological equipments, the training of the staff, the availability of quality assurance systems, etc., have to be taken into account when these levels are established. Measurements under real conditions were considered as the best tools to achieve these reference levels. With an aim to establish the Lithuanian national diagnostic reference levels, the nationwide survey of entrance surface doses received by the patients during the most typical X-ray examinations has been performed. The most common types of examinations, such as chest PA, skull PA and LAT, abdomen AP, lumbar spine AP and LAT, thorax spine AP and LAT, and hip joint AP, were included in the list of procedures under consideration. Hospitals of different size and levels using different X-ray machines were represented in the survey. The standard thermoluminescence dosemeter techniques with pellets attached to the skin of the patient in the centre of radiation field were applied. The data were analysed statistically, and the averages and 75th percentile were calculated. The results show that the Lithuanian diagnostic reference levels might be rather close to the ones promoted by the International Atomic Energy Agency and the European Commission.

Determinants Of Bone Mineral Density In Premenopausal Women

In premenopausal women, osteoporosis may be diagnosed by low bone mineral density (BMD) in conjunction with secondary causes of bone loss or with risk factors for fracture. Therefore, it is important to identify determinants of low bone mass and/or risk for bone loss in this age group of women. PURPOSE The purpose of this study was to examine the influence of body composition, calcium intake, physical activity and menstrual characteristics on BMD in women, 18–30 years of age. METHODS All subjects (n=65) completed questionnaires to assess physical activity levels (Baecke), menstrual status, and calcium intakes. 36 of the women recruited for the study were taking oral contraceptives (OC). BMD and bone mineral content (BMC) at the AP lumbar spine, left proximal femur, and total body sites was measured by a pencil beam DXA. In this laboratory, in vivo precision for the spine and total body is 1.0% and ranges from 0.7% to 1.3% for the proximal femur regions of interest. Body composition variables were analyzed from the total body scans. RESULTS There were no significant differences in BMD or B between women taking OC and those not taking OC. Significant (p<.05) moderate correlations were found between BMD variables and bone-free lean body mass (r=.41−.55), whereas low correlations existed between physical activity scores and BMD (r=.27−.29). Stepwise multiple regression analyses determined that bone-free lean body mass was a significant (p<.05) predictor for each BMD site, accounting for 19.1% (spine) to 32.3% (total hip) of the variance. Fat mass and the Baecke work index score were also significant predictors of total body BMD. None of the other independent variables (calcium intake, OC use, sport index, leisure index) used in the regression analyses were significant predictors for the BMD variables. CONCLUSION Lean body mass had the strongest influence on BMD at the lumbar spine, proximal femur and total body sites. Generally, OC use, calcium intake, and physical activity scores were not significant determinants of BMD in these young women.

Osteoporosis assessment by whole body region vs. site-specific DXA

The ability of regional data from whole body scans to provide an accurate assessment of site-specific BMD, osteoporosis prevalence and fracture risk has not been fully explored. To address these issues, we measured total body (TBBD) and site-specific BMD in an age-stratified population sample of 351 women (21-93 years) and 348 men (22-90 years). We found an excellent correlation between AP lumbar spine and total body lumbar spine subregion BMD (r2=0.92), but weaker ones for total hip compared to pelvis region (r2=0.72) or between total wrist and left arm subregion from the whole body scan (r2=0.83). The error in estimating site-specific BMD from total body regions ranged from 4.3% (lumbar spine) to 11.2% (femoral neck) in women and from 4.9 to 11.1%, respectively, in men. Site-specific versus regional measurements at the lumbar spine and total hip/pelvis provided comparable overall estimates of osteoporosis prevalence, but disagreed on the status of individuals; measurements at whole body regions underestimated osteoporosis as assessed at the femoral neck or total wrist. All measurements were associated with a history of various fractures [age adjusted odds ratios (OR), 1.3 to 2.1 in women and 1.2 to 1.5 in men] and were generally interchangeable, but femoral neck BMD provided the best estimate of osteoporotic fracture risk in women (OR, 2.9; 95% CI, 1.7-5.0). Although there are strong correlations between BMD from dedicated scans of the hip, spine and distal forearm and corresponding regions on the whole body scan, the measurements provide somewhat different estimates of osteoporosis prevalence and fracture risk.

A Standardised Approach to Optimisation

ABSTRACTPurposeOptimisation of radiographic images is said to have been obtained if the patient has achieved an acceptable level of dose and the image is of diagnostic value. In the near future, it will probably be recommended that radiographers measure patient doses and compare them to reference levels. The aim of this paper is to describe a standardised approach to optimisation of radiographic examinations in a diagnostic imaging department.MethodA three‐step approach is outlined with specific examples for some common examinations (chest, abdomen, pelvis and lumbar spine series). Step One: Patient doses are calculated. Step Two: Doses are compared to existing reference levels and the technique used compared to image quality criteria. Step Three: Appropriate action is taken if doses are above the reference level.ResultsAverage entrance surface doses for two rooms were as follows AP Abdomen (6.3mGy and 3.4mGy); AP Lumbar Spine (6.4mGy and 4.1mGy) for AP Pelvis (4.8mGy and 2.6mGy) and PA chest (0.19mGy and 0.20mGy). Comparison with the Commission of the European Communities (CEC) recommended techniques identified large differences in the applied potential. The kVp values in this study were significantly lower (by up to 10kVp) than the CEC recommendations.DiscussionThe results of this study have indicated that there is a need to monitor radiation doses received by patients undergoing diagnostic radiography examinations. Not only has the assessment allowed valuable comparison with International Diagnostic Reference Levels and Radiography Good Practice but has demonstrated large variations in mean doses being delivered from different rooms of the same radiology department. Following the simple 3‐step approach advocated in this paper should either provide evidence that department are practising the ALARA principle or assist in making suitable changes to current practice.

Comparison of Bone Density in Competitive Male Cyclists and Recreationally Active Men

1081 PURPOSE: The purpose of this study was to examine the effects of cycling training on the total body, lumbar spine, and proximal femur bone mineral density (BMD) of men aged 20–45 years (n = 27). A sample (n = 10) of age-matched and body weight-matched recreationally active men served as the comparison group. METHODS: The athletes were competitive racing cyclists (USCF categories 1–5) with an average of 8.9 years of racing experience who trained 7–20 hours per week. Subjects completed calcium intake, health status, and training history questionnaires. BMD was measured using Dual Energy X-Ray Absorptiometry (GE Lunar, Prodigy, v. 6.70.021) at the AP lumbar spine (L2-L4), the dual femur (femoral neck, Ward's Area, trochanter, total hip) and the total body sites. Body composition variables were obtained from the total body scan. RESULTS: There were no significant (p>.05) differences between the cyclists (CYC) and controls (CON) for age, height, or body weight, however, the % body fat for the CYC group was significantly lower (p<.05) than the CON group. The calcium intake of the CON group was significantly lower (p<.05) than the CYC group (910 ± 113 vs1536 ± 144). There were no significant (p>.05) group differences for the total body and hip sites. The spine BMD was significantly (p<.01) lower for the CYC than CON. Based on the ISCD guidelines (2002) for osteoporosis diagnosis in men, 11% of the CYC had lumbar spine T-scores in the osteoporotic range(≥-2.5), whereas 19% and 20% of CYC and CON, respectively had osteopenia (T-score −1.1 to −2.4) at the spine. In addition, 22% of CYC fell into the osteopenia category for the total hip compared to 10% for the CON group. CONCLUSIONS: In conclusion, these findings suggest that competitive road cycling does not load the spine. However, mechanical loading may occur at the hip as a result of the high levels of muscular contraction by the leg and hip musculature during this type of training.Table

Comparison of Bone Density in Competitive Male Cyclists and Recreationally Active Men

1081 PURPOSE: The purpose of this study was to examine the effects of cycling training on the total body, lumbar spine, and proximal femur bone mineral density (BMD) of men aged 20–45 years (n = 27). A sample (n = 10) of age-matched and body weight-matched recreationally active men served as the comparison group. METHODS: The athletes were competitive racing cyclists (USCF categories 1–5) with an average of 8.9 years of racing experience who trained 7–20 hours per week. Subjects completed calcium intake, health status, and training history questionnaires. BMD was measured using Dual Energy X-Ray Absorptiometry (GE Lunar, Prodigy, v. 6.70.021) at the AP lumbar spine (L2-L4), the dual femur (femoral neck, Ward's Area, trochanter, total hip) and the total body sites. Body composition variables were obtained from the total body scan. RESULTS: There were no significant (p>.05) differences between the cyclists (CYC) and controls (CON) for age, height, or body weight, however, the % body fat for the CYC group was significantly lower (p<.05) than the CON group. The calcium intake of the CON group was significantly lower (p<.05) than the CYC group (910 ± 113 vs1536 ± 144). There were no significant (p>.05) group differences for the total body and hip sites. The spine BMD was significantly (p<.01) lower for the CYC than CON. Based on the ISCD guidelines (2002) for osteoporosis diagnosis in men, 11% of the CYC had lumbar spine T-scores in the osteoporotic range(≥-2.5), whereas 19% and 20% of CYC and CON, respectively had osteopenia (T-score −1.1 to −2.4) at the spine. In addition, 22% of CYC fell into the osteopenia category for the total hip compared to 10% for the CON group. CONCLUSIONS: In conclusion, these findings suggest that competitive road cycling does not load the spine. However, mechanical loading may occur at the hip as a result of the high levels of muscular contraction by the leg and hip musculature during this type of training.Table

Attainment of peak bone mass at the lumbar spine, femoral neck and radius in men and women: relative contributions of bone size and volumetric bone mineral density.

The age at which peak bone mineral content (peak BMC) is reached remains controversial and the mechanism underlying bone mass "consolidation" is still undefined. The aims of this study were to investigate; (1) the timing of peak BMC by studying bone size and volumetric BMD (vBMD) as separate entities and (2) to determine the relative contributions of bone size and vBMD to bone mass "consolidation". A total of 132 healthy Caucasian children (63 boys and 69 girls, ages 11-19 years) and 134 healthy Caucasian adults (66 men and 68 women, ages 20-50 years) were studied. BMC was measured by DXA at the AP and lateral lumbar spine (LS) femoral neck (FN) and ultradistal radius (UDR). vBMD and bone volume (size) were estimated. Bone mass "consolidation" was examined between age 16 years to the age peak bone values were attained. During growth, BMC and bone size increased steeply with age and approximately 80-90% of peak values were achieved by late adolescence. vBMD at the spine and UDR (in women) increased gradually, but vBMD at the FN and UDR in men remained almost constant. During "consolidation", bone size continued to increase with little change in vBMD. Peak vBMD at the lumbar spine was reached at 22 and 29 years in men and women, respectively, but earlier at the FN at 12 years. At the UDR peak vBMD was achieved at age 19 years in women, with little change in men. In conclusion, peak vBMD and bone size are almost fully attained during late adolescence. Although speculative, the lack of change in vBMD during consolidation implies that the continued increase in bone mass may primarily be due to increases in bone size rather than increases in either trabecular volume, cortical thickness or the degree of mineralisation of existing bone matrix (vBMD). Skeletal growth and maturation is heterogeneous, but crucial in understanding how the origins of osteoporosis may begin during childhood and young adulthood.

The impact of increased Al filtration on x-ray tube loading and image quality in diagnostic radiology.

Previous work has shown that for nine common radiographic projections (AP abdomen, AP cervical spine, LAT cervical spine, PA chest, LAT chest, AP hip, AP lumbar spine, LAT lumber spine, and AP pelvis) increasing the total x-ray tube filtration from 2.5 mm Al equivalent (the regulatory minimum for general diagnostic radiology) to 4.0 mm Al equivalent, reduces the average effective dose and average skin entrance dose by 9% and 16%, respectively, using a 400 speed screen-film system. In this study, the effects of this filtration increase on x-ray tube loading and image quality were assessed. For the above projections and filtration increase, mean absolute and percentage increases in tube loading were 2.9 mAs and 15%, respectively, for a constant film density and fixed kVp. Tube current (mA) increases of 25% (a worst case) resulted in no statistically significant loss in focal spot resolution due to blooming for both large (1.2 mm) and small (0.6 mm) focal spot sizes, except at high mA low kVp techniques. The latter losses were below 10%, and when the image receptor blur was incorporated, the total system spatial resolution losses were on the order of one-quarter to one-half these values for typical clinical geometries. Radiographs of a contrast phantom taken with 2.5 and 4.0 mm total Al equivalent x-ray tube filtration were compared at 60, 70, 81, 90, 102, and 121 kVp. No statistically significant changes were observed with regard to (1) test object conspicuity as reported by three observers, (2) image contrast, as measured using a densitometer with a 3 mm aperture (+/-0.0017 OD, 95% confidence level), and (3) pixel value image noise, image contrast-to-noise ratios, and image signal-to-noise ratios, as measured using a scanning densitometer with a 12-bit acquisition depth and 85 micron pixel size (+/-2.5%, +/-3.1%, and +/-2.5%, 95% confidence levels, respectively). These results, combined with the linear no-threshold model for radiation risk and the ALARA principle, suggest that general radiography should be carried out using a minimum of 4.0 mm total Al equivalent filtration.

Experiences with the European guidelines on quality criteria for radiographic images in Tanzania.

Objective assessment of the quality of radiographic images is practically a difficult task and protocols that address this problem are few. In 1996, the European union published nearly objective image quality criteria to unify the practices in Europe. However, experience with these criteria in countries of lower health care levels is little documented. As a case study in Tanzania, we present the general performance of European guidelines in some Tanzanian hospitals to a total of 200 radiographs obtained from some common x‐ray examinations. The results show that more than 70% of chest (PA), lumbar spine (AP), and pelvis AP radiographs passed the quality criteria, while the performance of lumbar spine LAT x‐ray examinations was about 50% and therefore less satisfactory. The corresponding mean entrance dose to the patient for specified x‐ray techniques was of range 0.08–0.56 mGy, 3.1–7.7 mGy, 2.53–5.4 mGy, and 4.0–16.78 mGy for chest PA, lumbar spine AP, pelvis AP and lumbar spine LAT x‐ray examinations, respectively. Although a good number of observers were not well familiar to the guidelines, the quality criteria have been found useful and their adoption in the country recommended. The need to provide relevant education and training to staff in the radiology departments is of utmost importance.PACS number(s): 87.57.–s, 87.52.–g

The potential for reduction of radiation doses to patients undergoing some common X ray examinations in Tanzania.

The potential for patient dose reduction in diagnostic radiology was investigated in five major Tanzanian hospitals. The aim of this study was to follow up previously reported suggestions for improved practices to achieve dose reductions. The suggestions were implemented and entrance surface dose measurement repeated by using well-calibrated LiF thermoluminescence dosemeters. The results show that dose reductions in chest PA X ray examinations ranged from 15% to 50%. For abdomen AP and pelvis AP X ray examinations, the dose reductions ranged from 24% to 73% and from 25% to 72%, respectively. The respective dose reductions for lumbar spine AP and LAT projections ranged from 4% to 58% and from 16% to 77%. Interestingly, the majority of radiographs obtained after the implementation of dose reduction measures were useful for intended diagnosis according to the opinion of radiologists. It is concluded that significant dose reductions can be achieved in the country without loss of diagnostic information. Such dose reductions also predict reductions of radiation risk to patients.

Estimation of doses received by patients undergoing radiological examinations in Greece.

This study deals with the estimation of doses received by patients undergoing radiological examinations in order to establish diagnostic reference levels (DRLs) within the process of optimisation of patients' exposure in Greece. Six large hospitals in Athens were selected and 385 patients made up the sample. The entrance surface doses (ESDs) to patients undertaking five common X ray examinations (chest, cervical spine, lumbar spine AP and LAT, pelvis) were estimated using both thermoluminescence dosemeters (TLDs) attached to the patient's skin and an ionisation chamber for air kerma measurements. Exposure settings and patient's data were recorded. Results concerning the kilovoltage and focus-to-film-distance (FFD) settings and the ESD values were analysed and compared to those recommended by the EU. Discrepancies in the patient doses and techniques used for the examinations studied were found among the different hospitals denoting the importance of establishing a national quality assurance programme and examination protocols to ensure patient doses are kept as low as possible. All the examinations studied fulfilled the EU recommendations except that for the chest where the doses were considerably higher due to the use of low kVP settings.

The Optimisation of Lumbar Spine AP Radiography Using a Realistic Computer Model

A Monte Carlo computer program has been developed to model X ray imaging systems realistically using an adult voxel phantom. Image quality is quantified in terms of contrast and signal-to-noise ratio (SNR) for six important anatomical details chosen in accordance with recent European guidelines. The program has been used to study and optimise lumbar spine (LS) radiographic systems. As an example, the effect of tube potential on contrast, SNR and effective dose for the LS AP examination is demonstrated. Optimisation involves comparison of performance with that of a reference system. Configurations (tube potential, grid and screen-film) have been found which approximately match the reference image quality, but at lower effective dose. Various configurations give good performance. Some result in significant dose reduction. For LS AP 400 and 600 speed-class systems, dose savings of 21% and 34% are achievable. The model is thus a powerful tool for system optimisation.

Comparison of Model Predictions of Image Quality with Results of Clinical Trials in Chest and Lumbar Spine Screen-film Imaging

The ability to predict image quality from known physical and technical parameters is a prerequisite for making successful dose optimisation. In this study, imaging systems have been simulated using a Monte Carlo model of the imaging systems. The model includes a voxelised human anatomy and quantifies image quality in terms of contrast and signal-to-noise ratio for 5-6 anatomical details included in the anatomy. The imaging systems used in clinical trials were simulated and the ranking of the systems by the model and radiologists compared. The model and the results of the trial for chest PA both show that using a high maximum optical density was significantly better than using a low one. The model predicts that a good system is characterised by a large dynamic range and a high contrast of the blood vessels in the retrocardiac area. The ranking by the radiologists and the model agreed for the lumbar spine AP.

Calculation of Patient Doses Using a Human Voxel Phantom of Variable Diameter

The voxel phantom Golem was used for the dosimetric part of the EU research project 'Predictivity and Optimisation in Medical Radiation Protection'. A risk-related dose quantity, HGolem was evaluated using calculated organ equivalent dose conversion coefficients and entrance air kerma values measured during the clinical examinations. Two types of examinations were considered: chest PA examinations, which were performed in 16 groups involving different speed classes, mean optical densities, tube voltages and methods of scatter reduction; and lumbar spine AP examinations, for which four different combinations of speed class and tube voltage were used. For the chest examinations, the expected effects of different examination techniques are clearly mirrored by the dosimetric results. For the lumbar spine examinations, part of the expected results was concealed by the unwanted influence of the patient diameters on the doses, which could be partially eliminated by adapting the voxel phantom to different sizes.

Objective Image Quality Measurements and the EC Quality Criteria for Lumbar Spine Radiographs

A series of AP lumbar spine radiographs taken in four different hospitals were examined and compared with EC Quality Criteria for radiographic technique and film density. Two of the hospitals assessed had modern X ray equipment installed within the last five years and two hospitals had much older X ray equipment. Individual patient doses were measured using thermoluminescence dosemeters calibrated following the UK National Dose Protocol. All the radiographs were reported as being clinically acceptable. The radiographic techniques used mostly complied with the EC quality criteria. Mean doses were less than 50% of the recommended levels. The films were digitised using a Lumisys film digitiser. The mean density of the AP radiographs was 1.24 which compared well with the density measured using a 20 cm water phantom and was within the target range 1.0 to 1.4 recommended in the Quality Criteria. The mean density of the lateral films was 1.4. The spread of mean density was much narrower in the two hospitals with AEC devices. Densities of four anatomical regions were measured and differences between adjacent regions were calculated and found to be small.

Measurement of Entrance Skin Doses to Patients in Four Common Diagnostic Examinations by Thermoluminescence Dosimetry in Nigeria

Entrance surface doses (ESD) to patients were monitored in four common diagnostic X ray examinations (chest, hand and wrist, lumbar spine and skull) at the outpatient X ray department of the University College Hospital (UCH), Ibadan. Measurement was based on thermoluminescence dosimetry (TLD) techniques using lithium fluoride discs and a Vinten Solaro TLD reader. Some spread was observed in the values of doses received by patients for each of the examinations. It is greatest for the examination of the skull PA and least for the examination of the skull LAT and lumbar spine AP; due mainly to variations in the sizes of the patients examined. For all examinations the values of the mean ESD obtained range from a minimum of 0.310 ± 0.071 mGy to a maximum of 5.66 ± 0.782 mGy for the examination of the hand and wrist PA and lumbar spine LAT, respectively.

Typical Radiation Doses to Patients from Some Common X Ray Examinations in Tanzania

The results of entrance surface dose measurements on adult patients in diagnostic radiology are presented. The measurements were carried out using calibrated LiF thermoluminescence dosemeters for five simple projections of X ray examinations in major Tanzanian hospitals. The mean entrance dose per X ray examination at each hospital ranged from 0.1 to 0.9 mGy for chest AP, 3.5-13.9 mGy for abdomen AP, 1.6-13.1 mGy for pelvis AP, 3.6-12.7 mGy for lumbar spine AP and 10.0-29.6 mGy for lumbar spine LAT. Inter-hospital and intra-hospital dose variations up to a factor of 5 were observed for the same type of X ray examination, which suggests that operational conditions are not fully optimised. Under the limitations of the available resources, the techniques and skills employed are found to be the first possible sources of unoptimised doses to patients.

Cytokine production and bone mineral density at the lumbar spine and femoral neck in premenopausal women.

Cytokines such as interleukin-1 (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor (TNF-alpha) can influence both bone resorption and bone formation. The objective of this cross-sectional study was to examine the relationship between cytokine production by peripheral blood mononuclear cells (PBMC) and bone mineral density (BMD); the annual rate of change in BMD was examined. Subjects participating in a randomized clinical trial entitled the Women's Healthy Lifestyle Project in Allegheny County, Pennsylvania were used. They included 50 healthy premenopausal women, aged 45-52 years, who had regular menses within the past 3 months and were not on replacement estrogens. Dual-energy X-ray absorptiometry measurements at the AP lumbar spine and femoral neck were made at baseline and at the first annual exam using a Hologic QDR 2000 densitometer. Cytokine production of IL-1beta, IL-6, and TNF-alpha by PBMC was measured at the annual exam. The median values for stimulated cytokine production by PBMC were 3.92 ng/ml, 31.3 ng/ml, and 1.05 ng/ml, for IL-1beta, IL-6, and TNF-alpha, respectively. There were modest correlations between cytokine production and cross-sectional BMD, ranging from r = -0.30 to r = -0.13. Trends of greater spinal bone loss were observed in women with "high" (>/=75th percentile) cytokine production of stimulated IL-1beta and IL-6 (IL-1beta: "high" = -1.56% +/- 0.70 versus "low" (<75th percentile) = -0.56% +/- 0.35, P = 0.21). In contrast, greater annual gains in femoral neck BMD were observed in those with high cytokine production of IL-1beta and IL-6 (IL-1beta: high = 3.39% +/- 1.16 versus low = -0. 85 +/- 0.58, P = 0.002). There was no association between stimulated TNF production and annual change in BMD. In this population of healthy premenopausal women, the relationship between cytokine production by PBMC and the rate of change in BMD was significantly different for the lumbar spine and femoral neck, possibly reflecting differences in the proportion of trabecular and cortical bone at these sites.

Entrance Surface Dose and its Correlation with Patient Parameters

Reference doses defined only for a standard patient (70 kg, 170 cm) make less sense as this standard patient will rarely be met during typical examinations. The entrance surface dose (ESD) was measured for three types of radiographic examination (lumbar spine AP and lateral and pelvis) using a small dosemeter placed at a well defined position in the radiation field. As expected, the ESD shows a significant correlation with patient diameter, with the measured mean values being smaller than a quarter of CEC reference dose levels. Therefore it is suggested that the reference dose values be reduced or defined not as an upper limit for a standard patient but for intervals of the thickness of the patient region to be examined. A suitable and easy to measure parameter to estimate patient exposure is the dose-area product.

Analysis of Dose and Dose Distribution for Patients Undergoing Selected X-Ray Diagnostic Procedures in Ghana

The levels of dose and dose distributions for adult patients undergoing five selected common types of X ray examination in Ghana were determined using thermoluminescence dosemeters (TLD) attached to the skin where the beam enters the patient. To assess the performance of each X ray room surveyed, the mean of the entrance surface dose for patients whose statistics were close to a standard patient (70 kg weight and 20 cm AP trunk thickness) were compared to the Commission of the European Communities guideline values for chest PA, lumbar spine AP, pelvis/abdomen AP and skull AP examinations. The third quartiles dose values were 1.3 mGy, 14.5 mGy, 12.0 mGy and 7.9 mGy for chest PA, lumbar spine AP, pelvis/abdomen AP and skull AP respectively. Analysis of the data show that 86%, 58%, 37.5% and 50% of radiographic rooms delivered a mean dose greater than the CEC guideline values for chest PA, lumbar spine AP, pelvis/abdomen and skull AP respectively. This suggests that radiographic departments should undertake a review of their radiographic practice in order to bring their doses to optimum levels.