Radiography Unit Research Articles

KNOWLEDGE ABOUT RISK AND PROTECTIVE MEASURES RELATED TO DIAGNOSTIC RADIATION AMONG MEDICAL STAFF IN TEACHING HOSPITALS (WASIT PROVINCE)

The aim: The goal of this research is to find out how much medical staff is acknowledged about radiation protection. Materials and methods: In Teaching Hospitals, Wasit Province, a questionnaire study in 165 medical personnel was conducted. Part 1 of the questionnaire included sociodemographic information such as age, gender, and employment, whereas part 2 included 16 knowledge-related questions, divided into two sections: health risk (8 questions) and preventative strategies (8 questions). The descriptive analysis was carried out according to the data types: qualitative data were described using frequency and percentages, while quantitative data was described using the mean and standard deviation. The Chi-square test or Fisher’s Exact Test were employed to analyze the relationship between the variables. Participants were given a score of 1 for all accurate answers, and a score of 0 for wrong and “don’t know” responses. There were 165 participants general, among them 93 males and 72 females; with a mean age of 35.489.570. Results: Only 27 people (16.36%) had a good knowledge score, while more than half (61.21%) earned an average knowledge score. 30% of radiology technicians had a good level of knowledge, and 26.5 % of those working in radiology units had a good level of expertise as well. Increasing the frequency of radiation exposure showed to have a strong relationship with participant knowledge score, with those with repeated exposure during the day having the greatest proportion (21.4%) of good knowledge. Conclusions: This study had shown that there is a need to increase awareness about risks of radiation exposures among those who works in this field. Considering the above, the study recommends making training about the risks and methods of radiation protection compulsory, especially for workers in radiography units. In addition, the curricula of medical institutes must be updated and the latest research findings on ways to prevent radiation should be added. Finally, the issue of exposure to radiation is very important and dangerous, therefore, all sectors of society must join for the best awareness of its risks.

The comparison of five proton linac beams in order to set up a thermal neutron radiography installation

Radiography without doubt is maybe the most famous non-destructive technique with many applications in a number of scientific fields. In the present study, the performance of five photo-neutrons which delivered by proton linear accelerators with energy equal with 8, 12, 16, 20 and 24 MeV for a thermal neutron radiography unit has been designed and simulated with the help of the MCNPX 2.5.0 software which based on the Monte Carlo statistical method. The geometrical arrangement of the unit has been simulated with primary goal to provide the highest thermal neutron flux in the location of the examined item. For every energy of the proton beam all the significant parameters with the thermal neutron radiography theory like the flux of the thermals neutrons, the (collimator length)/(aperture diameter) ratio and the percentage of the thermal neutron within the neutron beam simulated for a wide series of values. Owing to the fact that the there are many fast neutrons inside the beam, it is obligatory to decrease the quantity of the fast neutrons. For this reason, the addition of a single sapphire for fast neutron filtering has as a consequence a neutron beam with better quality. According to the simulations, the presence of the filter improves the % presence of the thermal neutrons with no substantial abatement in the flux of the slow neutrons.

Initial experiences in the use of portable chest radiography as a tool to guide clinical management of COVID-19 positive patients in resource limited settings

Introduction: Radiological diagnosis of COVID-19 has shifted from the use of routine chest X-rays (CXRs) early on during the pandemic to high-resolution computed tomography (HRCT) of the chest to accurately describe the pattern of COVID involvement of the lungs. The morphological patterns seen at HRCT are increasingly being tapped into by a clinician in the management of this uncharted territory, for example, HRCT lung findings are categorized into three distinct phenotypes by an intensivist for guiding advanced ventilatory management of COVID patients. However, in resource-limited settings, HRCT places a heavy burden on the radiology departments and poses an enormous challenge to infection control in the CT suite. Our study aims to describe CXR patterns of COVID-19 acquired by portable radiography units and correlate them to symptom onset and progression in an attempt to enroll it as a reliable tool to assist clinical management including intensive unit care and ventilatory support. Methodology: Our study was a retrospective observational study of portable CXR findings in all patients diagnosed as COVID-19 positive by reverse transcription-polymerase chain reaction at a tertiary medical center from April to May 2020. Results: A total of fifty patients were included in the study, and the presence or absence of CXR findings in the presence or absence of clinical symptoms was analyzed. Our study showed that 24 (48%) patients had baseline features of lung involvement on CXR. Patients who presented with fever or breathlessness were found to be highly likely to show changes on the CXR. The most commonly noted changes were ground-glass opacities in 31 (63%) of patients with a bilateral, peripheral pattern of involvement seen in the lower zones of the lungs. Conclusion: While the higher sensitivity of the HRCT is of great clinical value, the portable CXR offers a feasible alternative to screen, follow clinical progress, and assist management of COVID-19 patients and should be considered as a means to reduce radiological service demands and reduce the risk of cross-infection.

X-ray patterns of COVID-19 in patients presenting to Lady Reading Hospital, Peshawar, Pakistan.

Objective:To determine the pattern of COVID-19 on chest radiograph in patients presenting to Lady Reading Hospital, Peshawar, Pakistan.Methods:This prospective observational study was conducted on 178 consecutive swab positive COVID-19 patients presenting to Lady Reading Hospital, Peshawar, Pakistan from 15th March to 15th June 2020. Patients of all ages and both genders were included. Chest X-rays performed by portable radiography unit were viewed for different patterns by two consultant radiologists independently and results were analyzed using IBM SPSS 20.Results:Out of 178 patients 134 were male. Mean age was 55.67 years. Radiographic patterns observed were ground glass haze without or with reticulation and/or consolidation (45.5 % and 33.2% respectively) and predominant consolidation either alone or in combination with ground glass haze or other findings (27.1% collectively). Peripheral distribution pattern was seen in 69.1% of patients with bilateral findings in 84.3%. Further categorization was based on pulmonary zonal demarcation with changes most commonly involving four zones (33.1%) i.e., the lower and mid zones bilaterally.Conclusion:Portable chest radiography is an essential supporting tool for assessing different patterns in COVID-19 infection. The most common pattern observed is alveolar opacities with predominant peripheral distribution either unilateral or more frequently bilateral, starting from the lower and mid zones extending to the upper zones and becoming diffuse with disease progression.

Development of a Neutron Radiography System based on a 10 MeV Electron Linac

A thermal neutron radiography unit using the neutrons which emits a 10 MeV electron linac compact has been designed and simulated via MCNPX Monte Carlo code. The facility was carried out for an extensive range of values for the collimator ratio L/D, the main parameter which describes the quality of the produced radiographic images. The results show that the presented facility provides high thermal neutron flux; while with the use of single sapphire filter fulfills all the suggested values which characterize a high quality thermal neutron radiography system. A comparison with other similar facilities indicates that the use of a photoneutron source using a 10 MeV electrons beam is a useful substitutional for radiographic purposes.

Phase 3 of COVID-19: Treat your patients and care for your radiographers. A designed projection for an aware and innovative radiology department

Abstract Since the spread of Covid-19 outbreak, healthcare workers (HCWs) have faced an unprecedented and unpredictable situation on the frontlines. The aim of this document is therefore to provide useful and operative recommendations to radiographers who perform imaging services, such as chest X-ray (XR) and Computer Tomography (CT) scans to three types of patients: negative, suspected or suffering from Severe Acute Respiratory Syndrome by Coronavirus (SARS-CoV-2). It is paramount to design two different paths’ layouts for patients entering the Radiology Department. One path should care for the confirmed and suspected SARS-CoV-2 patients, whereas the other path should be for negative patients. A setting envisaging two radiographers is highly recommended when managing Covid-19 patients. One radiographer fully-equipped with proper personal protective equipment (PPE) should deal with the patient in the scanning or x-ray room. The second one should stay in the console room wearing essential PPE. Disinfection plays a crucial role in reducing the risk of disease transmission. Moreover, having clear protocols is key to ensure personal safety and avoid cross-infections. Taking care of patients and HCWs, such as radiographers, is crucial to minimize the risk of disease transmission. Within a Radiology Department, different designed pathways should be taken into consideration both for everyday and epidemic/pandemic healthcare situations. Though Covid-19 pandemic has been a harsh experience in terms of world health and care systems for patients and health professionals - being radiographers among the most involved - we must not miss this chance to learn from what happened. There is the need to address wider causes through learning and in order to prevent failures. The distinction between passive learning (where lessons are identified but not put into practice) and active learning (where those lessons are embedded into an organization’s culture and practices) is crucial in understanding why truly effective learning so often fails to take place.

Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

Performance Characteristics of Radiographic equipment in Selected Healthcare Institutions in Southwest Nigeria

BACKGROUND: Evaluation of radiographic equipment performance is the recommended strategy for the verification of factors used in radiodiagnosis. Sometimes, the performance of the equipment is compromised due to the lack of adoption of the appropriate procedures and/or techniques.
 AIM: The aim of this study was to determine the performance quality of the radiographic equipment in the study area in order to optimize the radiation dose delivered to the patients using these facilities and enhance their safety.
 METHODS: The performance characteristic of selected radiographic equipment was determined using MagicMax quality control kits and test object. Radiographic equipment in eight selected radiodiagnostic centers designated as C1-C8 was assessed.
 RESULTS: The results showed that all the radiography units in the studied centers passed the kVp reproducibility and mAs linearity tests with the exception of center C2. The kVp deviation for the centers varied between 2.0 and 7.7%, with the highest deviation in center C5 and lowest value in center C6. Center C7 has the highest deviation (–13%) of mAs, while the lowest value was obtained in center C6 (0%). The dose was lowest in center C1 and highest in center C3. The half-value layer, mAs, and filtration values had a stronger correlation with the incident air kerma dose compared to the other parameters. In addition, 50% of the equipment passed all the performance tests.
 CONCLUSION: The study revealed that the performance characteristics of radiographic equipment in the studied area require improvement. Periodic monitoring of the equipment performance is recommended for adoption and enforcement to enhance quality practices and radiation safety.

Computed Tomography Enhances Diagnostic Accuracy in Challenging Medial Coronoid Disease Cases: An Imaging Study in Dog Breeding Appeal Cases.

The aim of this study was to determine the radiographic sensitivity in detecting medial coronoid disease (MCD), using computed tomography (CT) as reference in dogs presented for an official second opinion, and to compare the medial coronoid process (MCP) in fragmented and fissured MCP as well as those unaffected by MCD. The data of dogs, presented for official second opinion radiographs and CT, were reviewed by three board-certified observers and in accordance with the International Elbow Working Group guidelines regarding MCD. Radiographic delineation, radiopacity and Hounsfield Units (HU) of the MCP were recorded additionally and the correlation between radiography and CT was investigated. Sensitivity and specificity of radiography compared with CT yielded values of 83.6% for the former and 83.5% for the latter. False-negative grading in radiography correlated significantly (p = 0.0001) with a present fissure line in CT. The mean delineation (p = 0.03) and mean HU of fragmented MCP (p = 0.0045) were significantly reduced compared with fissured MCP and no significant differences in measured HU for fissured MCP were detected in comparison to elbows unaffected by MCD. The results of the present study show substantial agreement between radiography and CT in second opinion cases. However, sensitivity is reduced compared with not preselected cases. A present fissure line in CT was significantly associated with a false-negative grading in radiography. Therefore, CT imaging of the elbows is strongly recommended in cases of appeal.

Portable Chest Radiography Through Glass During COVID-19 Pandemic-Initial Experience in a Tertiary Care Center.

Portable chest radiograph for COVID-19 positive patients and persons under investigation can be acquired through glass doors or walls of isolation rooms to limit exposure to the pathogen and conserve resources. To report our initial experience with acquiring portable chest radiographs through glass doors of isolation rooms. Only 1 of 2 radiology technologist team members donned personal protective equipment and stayed inside the isolation room, while the second technologist and the radiography unit remained outside during the procedure. First hundred radiographs acquired through glass at the emergency department of our institute formed the "through glass radiograph" group. Hundred consecutive portable chest radiographs performed in a conventional manner formed the "conventional radiograph" group for comparison. Imaging database and feedback from operations leader were used to identify occurrences of a failed procedure. Suggestion of repeating the study and comments related to quality of the study were recorded from the reports of the staff radiologist. There was no instance of failed acquisition, nondiagnostic examination, or suggestion of repetition in both groups. No significant difference in the number of reports with quality related remarks (P > .05) was found between the 2 groups. Radiography through glass doors was associated with increased suboptimal positioning related remarks in radiology reports (P < .05). No significant association was identified among other comments about image quality. Our initial clinical experience suggests that the acquisition of portable chest radiographs through the glass doors of isolation rooms is technically feasible and results in diagnostic quality studies.

Initial data from an experiment to implement a safe procedure to perform PA erect chest radiographs for COVID-19 patients with a mobile radiographic system in a “clean” zone of the hospital ward

IntroductionWith the current Covid-19 pandemic, general wards have been converted into cohort wards for Covid-19 patients who are stable and ambulant. A 2-radiographer mobile radiography team is required to perform bedside Chest X-rays (CXR) for these patients. Hospital guidelines require both radiographers to be in full Personal Protective Equipment (PPE) throughout the image acquisition process and the mobile radiographic unit needs to be disinfected twice after each case. This affects the efficiency of the procedure and an increase usage of limited PPE resources. This study aims to explore the feasibility of performing mobile chest radiography with the mobile radiographic unit in a “clean” zone of the hospital ward. MethodsAn anthropomorphic body phantom was used during the test. With the mobile radiographic unit placed in a “clean” zone, the phantom and the mobile radiographic unit was segregated by the room door with a clear glass panel. The test was carried out with the room door open and closed. Integrated radiation level and patient dose were measured. A consultant radiologist was invited to review and score all the images acquired using a Barco Medical Grade workstation. The Absolute Visual Grading Analysis (VGA) scoring system was used to score these images. ResultsA VGA score of 4 was given to all the 40 test images, suggesting that there is no significant differences in the image quality of the images acquired using the 2 different methods. Radiation exposure received by the patient at the highest kV setting through the glass is comparable to the regular CXR on patient without glass panel at 90 kV, suggesting that there is no significant increase in patient dose. ConclusionThe result suggests that acquiring CXR with the X-ray beam attenuating through a glass panel is a safe and feasible way of performing CXR for COVID-19 patients in the newly converted COVID wards. This will allow the mobile radiographic unit as well as one radiographer to be completely segregated from the patient. Implications for practiceThis new method of acquiring CXR in an isolation facility set up requires a 2-Radiographer mobile radiography team, and is applicable only for patients who are generally well and not presented with any mobility issues. It is also important to note that a clear glass panel must be present in the barriers set up for segregation between the “clean” zone and patient zone in order to use this new method of acquiring CXR.

Development of Quality-Controlled Low-Dose Protocols for Radiography in the Neonatal ICU Using a New Mobile Digital Radiography System

OBJECTIVE. The aim of this study was to develop a low-dose radiography protocol for the neonatal ICU (NICU) using a new mobile digital radiography system with advanced denoising image processing and to evaluate the noninferiority of that protocol. SUBJECTS AND METHODS. In this prospective randomized study, 40 neonates in the NICU underwent radiography of the thorax and abdomen with two different mobile radiography units: conventional technique on one unit (50 kV, 1.6 mAs, and no additional filtration) and a new technique on another unit (54 kV, 0.1-mm Cu filtration). Three low-dose protocols for the second unit were developed in a phantom study: protocol A (100% equivalent dose with conventional protocol), protocol B (80% equivalent dose), and protocol C (64% equivalent dose). The noninferiority of each low-dose protocol was assessed by three independent readers using image quality criteria. RESULTS. Forty patients each underwent three pairs of radiography examinations (protocol A and the conventional protocol, protocol B and the conventional protocol, and protocol C and the conventional protocol), except one pair that did not include one image of the conventional protocol. The interrater reliability among the three readers was 0.91 (p < 0.001). Both of the low-dose protocols (B and C) were statistically noninferior to the conventional protocol with respect to overall image quality. Protocol B better depicted almost all anatomic landmarks and had better overall image quality than the conventional protocol. CONCLUSION. Using appropriate technique and acquisition factors, radiation dose can be lowered on a digital radiography system without significant effect on the image quality by adding filtrations and a new denoising technique.

Design of Reference Phantom for Quality Control of Conventional X-ray Radiography Units in Port Sudan

The Quality Control (QC) system, based on simple, cheap equipment and minimum personnel time, enables a resource-limited facility and staff to control the fundamental components of the imaging process on a low cost basis. Quality Assurance (QA) is a product or service quality management program. Customer reviews, capacity building and quality control can also be included. Quality control requires specific measures for ensuring measurable process-related aspects of product output or for the delivery of services within a given limit. Research was conducted at the Medical Physics Department of Red Sea University. The main objective of this work was to boost quality assurance rays. The imagination is more user-friendly and produces better results than a person or object. Phantoms, including fluoroscopy or x-rays, and certain image quality measurements have been used in x-rays imaging. The manufactured phantom in this study showed high precision in different QC tests.

Acceptance experimentation and quality monitor of x-ray radiography units

This study presents the 2019 findings of the acceptance testing and routine quality control (QC) for the general radiographic X-ray equipment such as film/screen fixed systems in Malaysia. Acceptance testing and routine QC of the diagnostic X-ray imaging equipment are the requirements for the standard radiation apparatus and should be compared to the requirements for European and RADIATION SAFETY STANDARD HR001:2010 legislation, which were considered the standard values of all general radiographic X-ray equipment since it identical to the manufacture's data. The general radiographic X-ray system test was conducted in the Biophysics lab, University Science Malaysia, and it has failed to meet the required QC guidelines, whereby one or more faults were identified. The major failures identified were minor, requiring attention by the suppliers at the next routine service. The suppliers were requested to investigate the issues and take the necessary corrective action. A review of the QC results highlights the need to perform comprehensive acceptance and routine testing of the systems.

Implementation of a 24-Hour Teleradiology Service for Cruise Ships: A Pilot Study.

OBJECTIVE. The purpose of this study was to introduce a 24-hour teleradiology service for cruise ships as a novel concept in maritime telemedicine. SUBJECTS AND METHODS. One cruise ship equipped with a mobile radiography unit and digital storage imaging plates was involved in this pilot study. Radiographs were transmitted via satellite internet to a tertiary hospital on shore for image interpretation by expert radiologists. Use of a virtual private network (VPN) enabled secure data transfer. Radiographs and patient data were automatically integrated into the PACS and radiology information system of the radiology department at the hospital. Images were analyzed by the staff radiologist at the hospital, and reports were immediately returned via e-mail through the VPN tunnel. RESULTS. Seventy-five radiographs of 47 patients were obtained on board within 2 months. All datasets were successfully transmitted. Most of the examinations (35 [≈ 75%]) were skeletal radiographs; the other 12 (≈ 25%) were chest radiographs. The turnaround time for the radiology reports was within 30 minutes in 43 cases (≈ 92%). In four cases (≈ 8%), delay was due to technical and organizational issues at the tertiary hospital. CONCLUSION. With the objective of supporting ship physicians with expert analyses of radiographs, a secure and stable method of image and radiology report transmission between an onboard hospital and a land-based radiology department was established.

Development of modified micro computed tomography system for nondestructive testing

This paper presents a development of micro Computed Tomography (microCT) imaging system based on digital radiography. The system comprises stepper motor, CMOS detector, microcontroller and digital radiography unit. Scanning process was done by rotating the object while exposing its cross-sectional surface to X-ray radiation. The object was rotated by using stepper motor controlled by microcontroller. The normal of cross-sectional surface taken as the rotation axis. Therefore, a number of 2D image slices were obtained by rotating the object from 0° to 360°. The 2D image slices were then reconstructed to form 3D image using computer. By using the proposed microCT, analysis of surface and internal of the object can be done in 3D image and 2D image (slice) for nondestructive testing (NDT) application.

The impact of image processing algorithms on digital radiography of patients with metalic hip implants

ObjectiveTo investigate the impact of image processing algorithms on image quality of digital radiographs. This study was motivated from a case of a patient with metallic hip implant, where the anatomy around the implant was misrepresented, due to failure of the processing algorithm. Materials & methodsA quality control phantom was imaged using a digital radiographic unit and the standard examination protocol for Pelvis anteroposterior (AP) projection. The original image was reprocessed with all available selections of Diamond View, which is a processing algorithm for optimizing image quality of different anatomic regions. The same procedure was repeated for two other examination protocols, Femur AP and Hip AP, which differ in terms of harmonization kernel and gain, and look up table settings. The whole procedure was repeated with a Pb strip, 2 cm wide and 3 mm thick, positioned close to the right phantom edge, in order to simulate a metallic hip implant.Using ImageJ a number of regions of interest (ROIs) were positioned on the phantom images and the impact of processing parameters on certain image characteristics and image quality indices was evaluated. ResultsProcessing parameters have a strong impact on image characteristics, but in terms of image quality, differences between images with and without the implant are small. Exception is the regions in the vicinity of the implant, where larger differences, that could affect diagnosis, were observed. ConclusionIn case of doubt, additional processing with settings which minimize the risk of anatomic misrepresentation should be used.

Accuracy in Detecting Artificial Root Resorption in Panoramic Radiography versus Tomosynthetic Panoramic Radiographs

IntroductionThe aim of this study was to compare the detection accuracy of panoramic radiography (PAN) and tomosynthetically reconstructed panoramic radiography (TPAN) for the detection of artificial external root resorption in a multiobserver approach. MethodsThirty-six teeth in 5 dry human mandibles were prepared with artificial root resorption by means of diamond bur defects (0.8, 1.0, and 1.2 mm). The samples were exposed in a digital panoramic radiographic unit in a predetermined appropriate position using a wax layer (6.25 mm thickness) as soft tissue scatter equivalent and a water-filled plastic bottle to mimic the absorption of the cervical spine. This resulted in 5 panoramic radiographs and 5 tomosynthetically reconstructed panoramic radiographs, which were evaluated by 13 observers regarding the visibility of artificial root resorption by means of a 5-point confidence scale. Seven of these observers repeated the process after a minimum interval of 30 days. A receiver operating characteristic analysis was conducted with the area beneath the receiver operating characteristic curves (Az) as the main accuracy parameter. Inter- and intrarater reproducibility were calculated by means of the intraclass coefficient using a 2-way random effects model. ResultsThe mean Az for TPAN (0.76; median = 0.77; range, 0.70–0.85) was slightly yet significantly higher (P < .05, Wilcoxon test) than for PAN (0.75; median = 0.75; range, 0.69–0.82). The Az values for both methods were highest in the premolar and lowest in the molar region. The mean sensitivity for TPAN was 0.54 (specificity = 0.96) and 0.50 (specificity = 0.96) for PAN. Intraclass coefficient values indicated that intra- (PAN: mean = 0.53 ± 0.088; TPAN: mean = 0.55 ± 0.102; P < .05,Wilcoxon test) and interrater (PAN: mean = 0.47 [0.43–0.51], TPAN: mean = 0.47 [0.42–0.51]) reproducibility were both moderate. ConclusionsFrom our ex vivo study, we observed slightly higher accuracy in the detection of artificial root resorption from tomosynthetically reconstructed panoramic radiographs compared with conventional digital panoramic radiographs.

Challenges facing the implementation of quality control by radiographers in Tanzania

Quality control (QC) programme is vital for quality radiological services at low radiation dose and costs. However, the QC implementation by radiographers in Tanzania is inadequate. This study aimed at investigating the challenges facing the implementation of the QC programme by radiographers in diagnostic radiography units in Tanzania and recommend strategies to mitigate the challenges. The study was conducted on a sample of 84 radiographers who have been trained on the QC programme, and who were practicing in 54 hospitals within Tanzania. Majority of respondents agreed that the lack of standardized test tools (98.8%) and lack of managerial support (51.8%) were hindering the QC programme. Also, the lack of care of equipment by radiographers and lack of motivation were identified. The strategies suggested to improve the programme include more enforcement (63.9%), assistance by the government (44.6%), motivation (33.7%) and improvement of the QC training (32.5%). Also, professional development activities and QC awareness to hospital management teams were suggested. It is crucial that the barriers to the QC programme are addressed and the strategies identified are considered if comprehensive implementation of the QC programme is to be realized.

Lack of radioprotection knowledge and compliance in Norwegian equine ambulatory practice.

There is an increasing use of mobile radiographic units in equine ambulatory practices in Norway. Horse owners or handlers often participate in the radiographic examination in a non-controlled area. The aim of this descriptive, cross-sectional, survey study was to evaluate the radiation safety and protection in use of mobile radiography, and to identify areas where special attention from the regulatory authorities as well as veterinary educators would be required. A questionnaire was distributed to all equine veterinarians assumed to have access to mobile radiographic units, as part of a formal inspection in cooperation with the Norwegian Radiation Protection Authority. Few practices met the regulatory requirements of notifying the authorities of their radiographic units and designation of a radiation protection officer. The minority of the practices performed periodic quality assurance of their equipment. Many of the practices performed all of their radiographic examinations off-site. The examinations were most often performed in the aisle outside the horses' stalls, and few practices established an operating zone. The horse owner or handler participated in the radiographic examination in almost all of the practices. Few practices used dosimeters for determination of the radiation exposure. The study shows that there are major deficits in regulatory compliance in ambulatory equine radiography practices in Norway. The study also suggests that less stringent regulations and supervision may translate into less stringent radioprotection practices.