Mean Entrance Surface Dose Research Articles

Assessment of radiation dose received from knee joint X-ray examinations

BackgroundMedical exposure from diagnostic X-ray machines represents the primary artificial source of human exposure to low ionizing radiation. Knee X-rays are a standard examination to diagnose multiple conditions ranging from traumatic injuries, degeneration, and cancer. In Saudi Arabia, there is a lack of available data and pertinent information regarding the assessment of the patient entrance surface dose (ESD) from knee X-rays. This study aims to estimate the ESD for adult patients undergoing knee X-ray examinations at four major medical centres in Saudi Arabia. Methods and materialsThe ESD was estimated indirectly using X-ray exposure factors for patients and directly using optically stimulated luminescence (OSL). The results were compared with previous studies conducted nationally and internationally and with international reference levels. ResultsThe results of this research showed that the mean patient ESD was 1.4 ± 0.37 mGy using the direct method and 1.12 ± 0.20 mGy using the indirect method. The estimated mean ESD values were found to be much higher than the mean ESD reference values, emphasizing the crucial requirement for optimizing radiation doses in conventional radiology to improve patient safety and diagnostic effectiveness. ConclusionThis confirms the requirement for reducing patients’ doses to the tolerable levels recommended by many international radiation protection commissions.

Evaluation of the Entrance Surface Doses (ESD) for common diagnostic X-ray examinations

ObjectiveThe purpose of this study was to assess the Entrance Skin Dose (ESD) in patients undergoing multiple types of radiographic examinations across three hospitals in Saudi Arabia. MethodsThe patient ESD was estimated directly using optically stimulated luminesces (OSL) and indirectly using a survey meter and calculations for 100 adult patients undergoing common diagnostic X-ray examinations, including a posterior anterior chest, posterior anterior hand, anterior posterior foot, and anterior posterior knee examinations, in three hospitals in Saudi Arabia. Comparative analysis with national and international reference values was conducted. ResultsOur analyses revealed considerable heterogeneity in X-ray exposure parameters among the hospitals. The mean ESD values for the chest examination were 0.28 ± 0.13 mGy for the direct method and 0.19 ± 0.11 mGy for the indirect method. Hand examination using the direct method resulted in a mean ESD of 0.42 ± 0.15 mGy, while the indirect method yielded 0.23 ± 0.06 mGy. Remarkably, the ESD values in most cases exceeded national and international guidelines, with the knee examination ESD using the direct and indirect methods showing an alarming value of 1.54 ± 0.31 mGy and 1.18 ± 0.21 mGy, respectively. The correlation between direct ESD, indirect ESD showed a strong positive correlation exists between direct ESD and Indirect ESD (r = 0.8, p < 0.001). ConclusionThe study highlights the urgent need for standardized protocols and quality control measures across radiographic facilities in Saudi Arabia. The elevated ESD values signify a critical issue that requires immediate attention to minimize patient radiation exposure while maintaining diagnostic image quality. Quality control tests and adjustments in examination parameters are strongly advised.

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study.

The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations. Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding. A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant. This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.

Evaluation of patient dose during a digital breast tomosynthesis

IntroductionWhen the patient dose in mammography is assessed, it is important to evaluate both average glandular dose (AGD) and entrance surface dose (ESD). A dose survey on both AGD and ESD in mammography has never been studied in Sri Lanka. Therefore, the present study aimed to evaluate the patient dose received during a full-field digital breast tomosynthesis (DBT) examination by determining both AGD and ESD. MethodsThe study was performed on 140 patients who underwent DBT examination. The AGD, ESD, compression breast thickness (CBT), half-value layer (HVL), target/filter combination, kVp, and mAs values were obtained from the machine, and AGD for each projection was calculated using the equation proposed by the Dance 2011. ResultsThe measured mean AGDs and ESDs of both the breasts were statistically significantly lower than the reference values given by European protocol (p < 0.05). There were no statistically significant differences in both AGDs and ESDs between the right and left breast, between right craniocauidal (RCC) and left craniocaudal (LCC), and between right mediolateral oblique (RMLO) and left mediolateral oblique (LMLO) examinations (p > 0.05). The measured median AGDs and ESDs received for MLO projections of both breasts were statistically significantly higher than that of CC projections (p < 0.05). ConclusionThe patients receive a low radiation dose during their DBT examination with both lowered AGD and ESD than the recommended values. Implications for practiceThe results can be used as a baseline to optimize the radiation dose in mammography in Sri Lanka

DETERMINATION OF ENTRANCE SURFACE DOSE FOR THREE COMMON PLANAR DIAGNOSTIC X-RAY EXAMINATIONS.

Patient dose during diagnostic radiography procedures primarily depends on the entrance surface dose (ESD) and the exposure area. The purpose of this study was to determine ESD for five common diagnostic X-ray examinations using dose area product and X-ray tube output. The ESDs were estimated in a sample of 340 patients using normalised X-ray output from Philips-PrimaryDiagnost digital X-ray machine equipped with digital flat panel scintillator detector. The resultant mean ESDs for chest postero-anterior/lateral, lumbar spine antero-posterior (AP)/lateral and abdomen AP were 0.49, 2.00, 5.74, 12.79 and 4.62mGy, respectively. The mean and third quartile ESD values of this study were significantly higher than the values found in the literature. This can be attributed to the lower tube potential (kVp) values and the higher tube current-time products (mAs). The methodology used here is a better option for low-resources countries for routine dose monitoring.

X-Ray Dose Audit and Potential Local Diagnostic Reference Levels in Select Hospitals In Kaduna State, Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background: Dosimetry in diagnostic radiology is fundamental to providing information to practitioners regarding the level of their doses and to ensure adequate optimization of the protection of patients presenting for radiological examinations. The introduction and implementation of diagnostic reference levels (DRLs) in diagnostic radiology has proven to be a potent tool for quality control and dose reduction. This has not been comprehensively addressed in Nigeria.&#x0D; Objective: To carryout dose audit of patients presenting for common radiographic projections in select hospitals in Kaduna State, Nigeria.&#x0D; Methodology: Thermoluminescent dosimeters (TLDs) were used to measure entrance surface dose (ESD) on 420 randomly selected adult patients presenting for x-ray examination of the chest PA/Lateral, skull PA/Lateral, lumbar spine AP/Lateral, abdomen and pelvic AP, respectively. Results were compared with existing literature.&#x0D; Results: The range of the mean ESD determined for the study population on various x-ray examinations were: chest PA (0.44 – 0.9 mGy), and lateral (0.9 – 1.5 mGy); skull PA (2.0 – 4.7 mGy), and lateral (1.7 – 3.4 mGy); lumbar spine AP (3.4 -7.8 mGy), and lateral (6.8 –11.3 mGy); abdomen AP (3.6 – 6.2 mGy); and pelvic AP (2.4 – 6.9 mGy). Comparison showed dose levels were below IAEA recommendations.&#x0D; Conclusion: In the absence of arbitrary high doses, practice is generally safe and will not result in unwarranted hazards to the patients.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

X-Ray Dose Audit and Potential Local Diagnostic Reference Levels in Select Hospitals In Kaduna State, Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background: Dosimetry in diagnostic radiology is fundamental to providing information to practitioners regarding the level of their doses and to ensure adequate optimization of the protection of patients presenting for radiological examinations. The introduction and implementation of diagnostic reference levels (DRLs) in diagnostic radiology has proven to be a potent tool for quality control and dose reduction. This has not been comprehensively addressed in Nigeria.&#x0D; Objective: To carryout dose audit of patients presenting for common radiographic projections in select hospitals in Kaduna State, Nigeria.&#x0D; Methodology: Thermoluminescent dosimeters (TLDs) were used to measure entrance surface dose (ESD) on 420 randomly selected adult patients presenting for x-ray examination of the chest PA/Lateral, skull PA/Lateral, lumbar spine AP/Lateral, abdomen and pelvic AP, respectively. Results were compared with existing literature.&#x0D; Results: The range of the mean ESD determined for the study population on various x-ray examinations were: chest PA (0.44 – 0.9 mGy), and lateral (0.9 – 1.5 mGy); skull PA (2.0 – 4.7 mGy), and lateral (1.7 – 3.4 mGy); lumbar spine AP (3.4 -7.8 mGy), and lateral (6.8 –11.3 mGy); abdomen AP (3.6 – 6.2 mGy); and pelvic AP (2.4 – 6.9 mGy). Comparison showed dose levels were below IAEA recommendations.&#x0D; Conclusion: In the absence of arbitrary high doses, practice is generally safe and will not result in unwarranted hazards to the patients.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Patient X-Ray Entrance Surface Dose at a Tertiary Hospital in Sokoto, North-West Nigeria.

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background: The entrance surface dose (ESD) has been used to determine the diagnostic reference levels (DRL) by regulatory bodies to help medical radiation workers to checkmate excessive dose to patients.&#x0D; Objective: To peer review practice in our centre using recommended diagnostic reference levels (DRLs) as standard.&#x0D; Methods: A prospective cross-sectional study of fifty x-ray patients who had thermoluminescent dosimeters (TLD-100) taped on their skin to quantify entrance surface dose (ESD) during x-ray investigation. The patients appeared in Radiology Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto between 1st August and 30th September 2018. Their weights and heights were measured directly. Thereafter, they were divided into 5 groups of ten each for five specific anatomical areas: PA chest, AP of pelvis, abdomen, lumbosacral spine, and lateral lumbosacral spine. Irradiated TLDs were read, and the mean ESD was calculated.&#x0D; Results: Entrance surface dose (ESD) was 0.26 mGy (chest), 0.46 mGy (AP lumbosacral), 0.71 mGy (pelvis), 1.3 mGy (abdomen), and 1.6 mGy (lateral lumbosacral). The ESD values were found to be lower than similar studies carried out in Nigeria, as well as diagnostic reference levels in UK.&#x0D; Conclusion: Optimization of patient protection in UDUTH was comparable to recommended practices locally and internationally.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Local Diagnostic Reference Levels (LDRLs) for routine X-ray examinations in Morocco

In Morocco, the radiation protection of patients undergoing medical imaging examinations using ionizing radiation sources is now governed by specific provisions of Chapter VII of Law no142-12 (Loi no142-12 – AMSSNuR, 2015). The principle of justification of procedures and the principle of optimization of doses delivered constitute the basis of the legislation governing medical exposure. DRLs are considered as an important optimization tool encouraging healthcare professionals to optimize their practice and assure a better patient safety. In this survey, Local Diagnostic Reference Levels (LDRLs) were established for the eight most frequent examinations in Morocco. Data from 1747 patients were collected from seven regional hospitals. The proposed LDRLs were defined as the 75th percentile of the mean entrance surface dose distribution (ESD) in mGy using the indirect dosimetry method according to the IAEA Report Series No. 457. The LDRLs values reported in this study were for the eight examinations: skull (PA) 2.8 mGy, chest (PA) 0.51 mGy, abdomen (AP) 7.6 mGy, pelvis (AP) 6.45 mGy, lumbar (AP) 7.8 mGy, lumbar (Lat) 10.7 mGy, cervical (AP) 2.2 mGy, and cervical (Lat) 2.4 mGy. The DRLs reported in Morocco were compared with those of international authorities and other countries: IRSN (France), NRPB (UK), Japan, Sudan, and Iran. The present work assesses the local DRLs in Morocco and constitutes a starting point that will provide professionals with a tool to help them optimize the doses delivered to patients. Furthermore, the definition of national DRLs by radiography is an essential step in the process of optimizing medical exposures.

Measurement of Entrance Skin Dose in Radiographic Examinations of Pediatric Patients.

This study was conducted to measure the entrance skin dose in radiographic examinations of pediatric patients in King Khalid Hospital, Majmaah, Saudi Arabia. Children have been given special attention since they are often regarded as especially vulnerable to potential hazards. The pediatric population is more susceptible to radiation than the adult population for certain tumor types. The aim of this study is to determine the amount of Entrance Surface Dose (ESD) received by pediatric patients attending the emergency department. Traumatic department registers for pediatric patients admitted to the King Khalid hospital (Majmaah, Saudi Arabia) between 1st February and 31st December 2018 were retrospectively studied for all diagnostic (plain radiographs examinations) imaging did on pediatric (<18 years old) trauma patients. The entrance surface dose was used to calculate the total radiation dose for each patient. One hundred and twenty patients encountered the inclusion criteria of the study and their doses (chest, skull, and extremities) were assessed. The mean of radiation exposure factors were 65.4 ± 7.9 (71.3 - 89.9) and 1.3 ± 0.2 (0.3-2.5) for X-ray tube potential (kVp) and current (mAs), respectively. The measured dose for pediatric patients were 0.10 ± 0.02 (0.09 - 0.37), 0.18 ± 0.04 (0.06 -0.59) and 0.09 ± 0.03 (0.03 -0.45) for chest, skull, and extremities, respectively. The mean Entrance surface dose received by trauma patients was 0.03-0.59 mGy. 51.7% (62 patients) of the patients received ≤ 0.25 mGy while around 48.3% (58 patients) received ≥ 0.26 mGy radiation dose from those examinations. Trauma patients attending to traumatic radiology department obtain substantial Entrance surface dose from chest, skull, and extremities imaging procedures within their initial assessment. The radiation exposure can also be lowered by optimizing each examination, therefore more studies are recommended for this task. The results obtained can be used as the basis for local reference dosages for X-ray examinations.

Survey of Absorbed Dose from Chest X-Ray of Paediatric Patients in Port Harcourt, Nigeria: A Cross-Sectional Study

Background: Radiation protection in paediatric radiology deserves special attention as children are supposed to be more sensitive to radiation than adults. Aim: This study was designed to evaluate the radiation doses for paediatric patients undergoing diagnostic chest X-ray examination. Materials and Methods: This was a cross-sectional survey, which targeted paediatric patients of (0-10) years who were referred by their physicians for chest X-rays examination. The data used for this work were generated using a Thermoluminescence dosimeter (TLD) chip. One TLD chips was placed in the front of the chest to measure the Entrance Surface Dose (ESD) (µGy) and another at the back of the patient directly opposite the one in front to measure the Exit Dose (ED) (µGy). Patient dose, age, ESD, ED and absorbed dose were obtained. The obtained data were analyzed using descriptive statistics. Results: The mean ESD, ED and absorbed dose values were 1.8330± 1.122mGy, 1.0913± 0.7505mGy and 0.7520 ± 3.8160mGy respectively. The ED values in chest X-rays were 0.73± 0.30mGy for age group &lt;1 year, 1.15± 0.91mGy for age group 1-5 years and 6-10 years 1.09± 0.75mGy. The ESD were 3.06 ± 1.76mGy for age group &lt;1, 3.02± 2.04mGy for age group 1-5 years and 6-10 years 1.83± 1.12mGy. The absorbed dose values obtained were 1.88± 1.75mGy for age group &lt;1 year, 1.88± 1.67mGy for age group 1-5 years and 0.75± 3.82mGy for age group 6-10 year. Conclusion: The values for Exit Dose, Entrance Surface Doses, and Absorbed Dose have been determined and it was found to be slightly higher than UNSCEAR values. Keywords: Children, Diagnostic reference level, Radiation.

STATUS OF RADIATION DOSE LEVELS IN PAEDIATRIC CHEST RADIOGRAPHY IN A TERTIARY HOSPITAL IN GHANA.

Determination of appropriate radiation doses to paediatric patients in accordance with the as low as reasonably achievable (ALARA) principle is important, as it allows for effective optimization of imaging techniques. This study assessed the status of radiation dose levels in paediatric patients undergoing chest X-ray examinations at a tertiary hospital in Ghana. A population encompassing 86 paediatric patients categorised as infants (<1y), young children (1-5y) and older children (6-12y) was selected using a quasi-experimental study design. The patients' anatomical data and X-ray beam exposure parameters were used to indirectly calculate the entrance surface doses (ESDs) received during the examinations. The infants received the highest mean ESD of 196 μGy (uncertainty=0.37) compared to 158 μGy (uncertainty=0.46) among the older children. The risk of developing radiation-induced biological effects was therefore higher for infant patients. The ESDs were generally higher than the internationally recommended reference doses. Careful adoption of internationally accepted exposure factors (high tube voltage and low tube load) is most recommended to optimise the dose.

PATIENT DOSE ASSESSMENT AND OPTIMISATION OF PELVIC RADIOGRAPHY WITH COMPUTED RADIOGRAPHY SYSTEMS.

Digital radiography systems can reduce radiation dose, this capability was harnessed to explore dose and image quality (IQ) optimisation strategies. Entrance surface dose (ESD), effective dose (ED) and organ doses were determined by the indirect method for patients undergoing pelvic anteroposterior X-ray examinations with computed radiography systems. The IQ of patients' radiographs was assessed in terms of signal-to-noise ratio (SNR). An anthropomorphic phantom was exposed with varying tube potential (kVp), tube current-time product (mAs), and focus-to-detector distance (FDD) to determine phantom-entrance dose for the optimisation studies. SNR of each phantom radiograph was determined. Patients' mean ESD of 2.38±0.60mGy, ED of 0.25±0.07mSv and SNR of 8.5±2.2 were obtained. After optimisation, entrance dose was reduced by 29.2% with 5cm increment in FDD, and 5 kVp reduction in tube potential. kVp and/or mAs reduction with an increment in FDD reduced entrance dose without adversely compromising radiographic-IQ.

KERMA-AREA PRODUCT, ENTRANCE SURFACE DOSE AND EFFECTIVE DOSE IN ABDOMINAL ENDOVASCULAR ANEURYSM REPAIR.

This study aims to evaluate patient radiation dose during fluoroscopically guided endovascular aneurysm repair (EVAR) procedures. Fluoroscopy time (FT) and kerma-area product (KAP) were recorded from 87 patients that underwent EVAR procedures with a mobile C-arm fluoroscopy system. Effective dose (ED) and organs' doses were calculated utilising appropriate conversion coefficients based on the recorded KAP values. Entrance surface dose (ESD) was calculated based on KAP values and technical parameters. The mean FT was 22.7min (range 6.4-76.8min), resulting in a mean KAP of 36.6Gycm2 (range 2.0-167.8Gycm2), a mean ED of 6.2mSv (range 0.3-28.5mSv) and a mean ESD of 458mGy (range 26-2098mGy). The corresponding median values were 17.4min, 25.6Gycm2, 4.4mSv and 320mGy. The threshold of 2Gy for skin erythema was exceeded in two procedures for a focus-to-skin distance (FSD) of 40cm and six procedures when an FSD of 30cm was considered. The highest doses absorbed by the adrenals, kidneys, spleen and pancreas and ranged between 3.7 and 313.3mGy (average 66.8mGy), 3.3 and 285.1mGy (average 60.8mGy), 1.3 and 111.1mGy (average 23.7mGy), 1.1 and 92.1mGy (average 19.6mGy), respectively. A wide range of patient doses was reported in the literature. The radiation dose received by the patients was comparative or lower than most of the previously reported values. However, higher doses can be revealed due to the X-ray system's non-optimum use and extended FTs, mainly affected by complex clinical conditions, patients' body habitus and vascular surgeon experience. The large variation of patient doses highlights the potential to optimise the EVAR procedure by considering the balance between the radiation dose and the required image quality. Additional studies need to be conducted in increasing the vascular surgeons' awareness regarding patient dose and radiation protection issues during EVAR procedures.

Is the 28-Day Rule Safe for Use in Abdominal Radiography?

Introduction: The 28-day rule is utilized as a precautionary measure for irradiating the fetus at an early stage of conception for abdominal and pelvic radiography. There is a probability of the women being pregnant if the 28-day rule is applied for this examination and thus irradiating the conceptus. It is difficult to convince people that low radiation doses during early pregnancy will not cause any harm to the conceptus. As such this study was to ascertain whether the 28-day rule can be used safely for abdominal radiography in women of reproductive age. Material and Methods: The experimental study was conducted at the Radiography Laboratory, International Islamic University Malaysia, Kuantan using an anthropomorphic PBU-50 phantom. The entrance surface dose (ESD), organ dose and effective dose (ED) were estimated using CALDose_X 5.0 software, based on the exposure parameters and tube output of the x-ray unit. Results: The mean ESD for AP abdominal radiographic examination of 3.162 mGy is within that recommended by radiation protection regulatory bodies. Additionally, the mean organ dose of 0.468 mGy is lower than the threshold value of 100 mSv for the “all-or-none” phenomenon to happen. Further, the mean ED of 0.73 mSv is within the recommendation of the International Atomic Energy Agency (IAEA) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Conclusion: This study indicated that the 28-day rule is safe to be used for abdominal radiography for a woman of reproductive age.

Assessment of radiation dose to pediatric patients during routine digital chest X-ray procedure in a government medical centre in Asaba, Nigeria

Objective: Radiation dose to pediatric patients have been widely reported, it is however necessary that imaging expert keep doses as low as possible to forestall stall long term cancer risk. This study is aimed at determining pediatric entrance surface dose (ESD), 75th percentile ESD, absorbed dose (D) and effective dose (E) for 0-15 years.&#x0D; Material and Methods: The study used a digital radiography (DR) unit with a grid system for each chest X-ray. The thermoluminescent dosimeter (TLD) used was encapsulated in transparent nylon, it was then attached to the patient skin (chest wall) and the second was placed directly at the posterior end of it.&#x0D; Results: The mean ESDs for the 4 age groups were as follows: 0- &lt; 1 (1.54±0.74mGy), 1- &lt; 5 (1.53±0.83mGy), 5- &lt; 10 (0.55±0.39mGy) and 10- ≤15 (1.30±0.57mGy), with an overall mean of 1.23mGy. The 75th percentile ESD for each age group above 10 patients (excluding 5- &lt; 10yrs) was 2.18, 2.19 and 1.75mGy respectively. The absorbed dose (D) ranged from 0.03-2.39mGy. The mean effective dose (E) for the 4 age groups was 0.18±0.03mSv. There was a good correlation between ESD and D (P = 0.001). A One-Way ANOVA shows that the field size and focus to film distance (FFD) affected the ESD and D (P &lt; 0.001) respectively. The risk of childhood cancer from a single radiograph was of the order of (1.54-23.4) ×10-6.&#x0D; Conclusion: The 75th percentile ESD, E and childhood risk of cancer was higher than most studies it was compared with. The study reveals that machine parameters such as the field size and FFD played a major role in dose increase. Protocol optimization is currently needed for pediatric patients in the studied facility.

Estimation of dose and cancer risk to newborn from chest X-ray in South-South Nigeria: a call for protocol optimization

BackgroundThe use of X-ray as a diagnostic tool for complication and anomaly in the neonatal patient has been helpful, but the effect of radiation on newborn stands to increase their cancer risk. This study aims to determine the mean, 50th percentile (quartile 2 (Q2)), and 75th percentile (quartile 3 (Q3)) entrance surface dose (ESD) from anteroposterior (AP) chest X-ray and to compare our findings with other relevant studies. The study used calibrated thermoluminescent dosimeters (TLDs), which was positioned on the central axis of the patient. The encapsulated TLD chips were held to the patients’ body using paper tape. The mean kilovoltage peak (kVp) and milliampere seconds (mAs) used was 56.63(52–60) and 5.7 (5–6.3). The mean background TLD counts were subtracted from the exposed TLD counts and a calibration factor was applied to determine ESD.ResultsThe mean ESDs of the newborn between 1 and 7, 8 and 14, 15 and 21, and 22 and 28 days were 1.09 ± 0.43, 1.15 ± 0.50, 1.19 ± 0.45, and 1.32 ± 0.47 mGy respectively. A one-way ANOVA test shows that there were no differences in the mean doses for the 4 age groups (P = 0.597). The 50th percentile for the 4 age groups was 1.07, 1.26, 1.09, and 1.29 mGy respectively, and 75th percentile were 1.41, 1.55, 1.55, and 1.69 mGy respectively. The mean effective dose (ED) in this study was 0.74 mSv, and the estimated cancer risk was 20.7 × 10−6.ConclusionESD was primarily affected by the film-focus distance (FFD) and the patient field size. The ESD at 75th percentile and ED in this study was higher compared to other national and international studies. The estimated cancer risk to a newborn was below the International Commission on Radiological Protection (ICRP) limit for fatal childhood cancer (2.8 × 10−2Sv−1).

Assessment of Patient Radiation Dose during Conventional Diagnostic X-ray Examinations in Three Public Hospitals in Northern Jordan using TLDs.

This study aims to measure entrance surface doses during routine chest and abdomen x-ray examinations of adult and child patients. Radiation dose measurements were performed using thermoluminescent dosimeters TLD-100s in three major public hospitals in northern Jordan on a total of 100 patients. Wide variations in entrance surface doses were observed within and between hospitals, which might be attributed to significant variations of the selected exposure parameters. For adult patients, the results have shown that the majority of entrance surface dose values from both chest and abdomen examinations were within recommended values of diagnostic reference levels. For child patients, the mean entrance surface dose from chest examinations in three age groups were 0.131 mGy (0-1 y), 0.136 mGy (1-5 y), and 0.191 mGy (5-10 y). These values were considered relatively high compared to the European reference levels and published results in the literature. However, for abdomen examinations, entrance surface dose values were relatively lower than European reference levels. Patient effective doses were estimated using a PCXMC 2.0 Monte Carlo program. The results for both adults and children were found to be relatively lower than the values reported by international publications. Due to the wide variations of entrance surface dose and the higher radiation doses delivered to child patients, this study recommends implementing a quality assurance program in such hospitals to achieve optimization between good image quality and minimum dose according to the as low as reasonably achievable principle. Moreover, the results of this work will provide a useful base for establishing local diagnostic reference levels for chest and abdomen examinations in Jordan.

Evaluation of effective dose and entrance skin dose in digital radiology

Abstract Background: Ionizing radiation has an indispensable role in diagnostic radiology and clinical treatments. Apparently, medical exposure in diagnostic radiology pertains to be the preeminent man-made source of radiation. Objective: The aim of the present scientific study is to calculate the Entrance Surface Dose (ESD) and Effective Dose (ED) in digital radiography in Mazandaran province. Materials and methods: The study was performed on 3600 patients in digital X-ray rooms 15 hospitals and the required data were collected from two age groups (10&gt;15 years and adults) in each projection. Based on the results of this study, ESD and ED were calculated for skull (PA), skull (lateral), cervical spine (AP), cervical spine (lateral), chest (PA), chest (lateral), abdomen (AP), lumbar spine (AP), lumbar spine (lateral), pelvis (AP), thoracic spine (AP) and thoracic spine (lateral) examinations. It was calculated using PCXMC software (version 2.0). Results: In this study, mean ESDs for the 10-15 year group varied from 0.97±0.21 mGy to 3.62±1.38 mGy for chest (PA) and lumbar spine (lateral), respectively. For the adult group varied from 1.05±0.31 to 3.85±1.44 for cervical spine (AP) and lumbar spine (lateral), respectively. And also ED value was from in the range of 10.40 µSv to 378.46 µSv for skull (PA) 10-15 year group and abdomen adults, respectively Conclusion: This survey revealed a significant variation in the radiation dose of digital radiology examinations among hospitals in Mazandaran province. Application of a dose reference level (DRL) could be an optimization procedure for reducing the patient’s dose in Mazandaran province.

Radiation Exposure of Interventional Radiologists during Computed Tomography Fluoroscopy-Guided Percutaneous Cryoablation.

Purpose: The principal aim of this study was to evaluate radiation exposure of interventionalists during computed tomography (CT) fluoroscopy-guided percutaneous cryoablation (PCA) using radiophotoluminescent glass dosimeters (RPLDs). The radioprotective effects of safety glasses and lead apron were also evaluated. Materials and Methods: Radiation exposure of interventionalists during 46 CT fluoroscopy-guided PCA procedures was evaluated. Entrance surface dose (ESD) was measured using RPLDs on multiple sites: five sites, representing eye lens exposure; five sites, representing body exposure; and four sites, representing skin exposure. The ESD values on multiple sites were compared between different PCA procedures (renal, liver, and bone). Results: The mean ESD on the X-ray-side hand exhibited the highest value (358.8 μGy). Regarding evaluation sites representing exposure to the eye lens, the highest ESD inside the radiation protective glasses was detected on the X-ray-side cheek (167.1 μGy). Most ESD values among multiple sites (10/14) were linearly correlated with CT fluoroscopy time. Among them, the ESD values measured during renal and liver PCA were relatively higher than those measured during bone PCA, especially on the chest area outside the lead apron, and on the X-ray tube-side elbow and hand during renal and bone PCA. Radioprotective effects of safety glasses and lead apron ranged from 44.6 to 50.6% and from 30.2 to 79.6%, respectively, on each evaluation site. Conclusion: The site with the highest radiation exposure on interventionalists during CT fluoroscopy-guided PCA was the X-ray tube-side hand. Radiation exposure of interventionalists was at acceptable levels and consistent with the recommended dose limits.