Entrance Surface Dose Research Articles

Entrance Surface Dose for patient`s undergoing X-ray examinations at Sebha medical center "Libya"

Entrance Surface Dose for patient`s undergoing X-ray examinations at Sebha medical center "Libya"

Radiation Reduction in Low Dose Pulsed Fluoroscopy versus Standard Dose Continuous Fluoroscopy during Fluoroscopically-Guided Lumbar Punctures: A Prospective Controlled Study.

Purpose:The purpose of this study was to evaluate radiation dose reduction in fluoroscopically guided lumbar punctures (FGLP) using “pulsed fluoroscopy in a low dose mode” compared with the commonly used “continuous fluoroscopy in a standard dose mode” while maintaining the technical success.Materials and Methods:Thirty-five consecutive patients who underwent FGLP divided randomly to seventeen patients in the control group with standard dose continuous FGLP and eighteen patients in the study group with low-dose low-frame-rate of 3 frames per second (fps) FGLP. Entrance surface dose measurements from a dosimeter device were recorded as well as the dose area product (DAP).Results:A total of 35 patients with average age of 52 years (range: 15–87 [±17 standard deviation [SD]]) were evaluated. Average entrance surface dose of the study group was significantly lower (3.81 mGy [range: 0.21–11.14, [±2.8 SD]]) compared with the control group (22.45 mGy [range: 1.23–73.44, [±19.41 [SD]]). The average DAP of the study group (10 mGy·cm2 [range: 1–41, [±9.8 SD]]) was also significantly lower than the control group (65 mGy·cm2 [range: 5–199, [±53 SD]]). Success rate was similar between the study and control groups.Conclusion:Low dose pulsed fluoroscopy of 3 fps significantly reduces radiation exposure by about 600% compared with standard dose continuous fluoroscopy in FGLP. Utilizing this radiation saving strategy will allow to dramatically reduce radiation exposure, without impacting the technical success rate.

Correlation and uncertainties evaluation in backscattering of entrance surface air kerma measurements

The air kerma measurement is important to verify the applied doses in radiodiagnostic. The literature determines some methods to measure the entrance surface air kerma or entrance surface dose but some of these methods may increase the measurement with the backscattering. Was done setups os measurements to do correlations between them. The expanded uncertainty exceeded 5% for measurements with backscattering, reaching 8.36%, while in situations where the backscattering was avoided, the uncertainty was 3.43%.

Assessment of Breast Doses in Mammography Screening

Thermoluminescent dosimeters (TLD-100H) were in use for the assessment of average glandular dose to breast in mammography screening with GE machine, King Abdul Aziz University Hospital for 45 mm breast compressed thickness, 26 kVp, 100 mAs and Mo/Mo target/filter combination. Reader’s calibration factor for the TLDs was generated with the same exposure parameters using RadCal mammo ionization chamber as reference. The calibration factor was reproduced within 3% standard deviation. Several sets of selected TLD-100H placing in different configurations were exposed to X-ray beam under identical exposure condition as it was used for generation of calibration factor. The entrance surface doses were calculated by using the measured net TL-response and the calibration factor. Thereafter, the average glandular doses (AGD) were calculated. The measured average entrance surface dose (AGD) at the reference position (6 cm laterally centered from the chest edge wall) was 7.704 mGy with less than 2% standard deviation. The calculated average glandular dose to the breast at the reference location has been found to be 1.429 ± 0.037 mGy.Bangladesh J. Nuclear Med. 18(2): 161-167, July 2015

Propose for the Benchmark Dose (BD) for the Optimization of Protection in Medical Exposure in General Radiography

The goal of this research was to create the most appropriate index dose for the optimization of protection in medical exposure in general radiography in Kanagawa prefecture. We distributed questionnaires to 272 medical institutions in Kanagawa prefecture. The investigation period was from October 2015 to February 2016. Entrance surface dose (ESD) was used as the index dose. Investigated regions in general radiography were the adult chest, adult abdomen, and infant chest (anterior-posterior projections for all regions). The effective response rate was 35%. ESD was significantly lower with a flat panel detector (FPD) than with computed radiography (CR) in all regions (adult chest and abdomen: p<0.001; infant chest: p<0.05) [e.g., mean (±standard deviation) ESD in the adult chest was 0.16±0.06 mGy with FPD and 0.24±0.10 mGy with CR]. In the infant chest with CR, ESD was significantly higher using a grid (0.15±0.07 mGy) compared to not using a grid (0.10±0.05 mGy; p<0.05). Based on these results, we propose the benchmark dose of each medical equipment, such as adult chest: FPD, 0.2 mGy; CR, 0.3 mGy.

Optimization of Dose and Image Quality in Full-fiand Computed Radiography Systems for Common Digital Radiographic Examinations

IntroductionA fine balance of image quality and radiation dose can be achieved by optimization to minimize stochastic and deterministic effects. This study aimed in ensuring that images of acceptable quality for common radiographic examinations in digital imaging were produced without causing harmful effects. Materials and MethodsThe study was conducted in three phases. The pre-optimization involved ninety physically abled patients aged between 20 to 60 years and weighed between 60 and 80 kilograms for four common digital radiographic examinations. Kerma X_plus, DAP meter was utilized to measure the entrance surface dose (ESD) while effective dose (ED) was estimated using CALDose_X 5.0 Monte Carlo software. The second phase, an experimental study utilized an anthropomorphic phantom (PBU-50) and Leeds test object TOR CDR for relative comparison of image quality. For the optimization phase, the imaging parameters with acceptable image quality and lowest ESD from the experimental study was related to patient’s body thickness. Image quality were evaluated by two radiologists using the modified evaluation criteria score lists. ResultsSignificant differences were found for image quality for all examinations. However significant difference for ESD were found for PA chest and AP abdomen only. The ESD for three of the examinations were lower than all published data. Additionally, the ESD and ED obtained for all examinations were lower than that recommended by radiation regulatory bodies. ConclusionOptimization of image quality and dose was achieved by utilizing an appropriate tube potential, calibrated automatic exposure control and additional filtration of 0.2mm copper.

Correlations Analysis of the Entrance Surface Dose according to the BMI at Computed Tomography and Angiography in Cardiovascular Examination

Background/Objectives: The purpose of this study was to investigate the correlation between the entrance surface dose (ESD) and the patient’s body mass index (BMI) in coronary angiography (CAG) of the cardiovascular center and coronary computed tomography angiography (CCTA). Methods/Statistical analysis: This study was conducted on 300 patients (CAG 100 persons; CTA 200 persons), who underwent CAG and CCTA in this hospital from December 2012 to March 2017. To analyze the ESD, the CTDIvol value was obtained from CCTA, and the air kerma value was obtained from CAG for retrospective analysis. CCTA was conducted using the prospective ECG gating technique (PGT) and the retrospective ECG gating technique (RGT). Findings: In the cardiovascular lesion examinations, PGT showed a higher ESD compared to RGT, but the difference was not statistically significant (403.8±118.7 vs. 384.7±117.4, P=0.553). In the correlation between BMI and ESD, there were statistically significant differences among the three groups (PGT, RGT, and CAG) (p<0.05). In the linear relationship examined with a scatter plot, the dose in CAG increased with the increase in BMI (R2=0.144, p<0.001), but the doses in PGT (R2=0.04, p<0.05) and RGT (R2=0.144, p<0.05) decreased with the increase in BMI. Improvements/Applications: Although the dose of CAG tended to increase with the increase in the patient’s BMI, the dose of CCTA tended to decrease inversely. Therefore, BMI may be used as the criterion for the selection of an appropriate examination considering the exposure dose.

Evaluation of Entrance Surface Dose in Chest Radiography Using Clinical Images: Estimation of Subject Thickness Using Two-direction Radiography

The International Commission on Radiological Protection recommends adaptation of the diagnostic reference levels as an indicator of optimization of protection, and diagnostic reference levels of 2015 were also published in Japan in 2015 (Japan DRLs 2015). The entrance surface dose (ESD) is evaluated to the published standard subject thickness in Japan DRLs 2015. However, the standard radiographic settings of each facility may not be a radiographic condition of the standard subject thickness of Japan DRLs 2015. We measure and record the thickness of the subject in every examination, and it can solve this problem, but it is difficult to carry out it in the actual clinical scene. In this study, we aimed to estimate the subject thickness by using chest clinical images and to calculate ESD for each radiography. We evaluated and compared with Japan DRLs 2015 using these data. The subject thickness was estimated from 200 cases of digital imaging and communications in medicine (DICOM) image obtained by both the frontal and lateral views of the chest radiography. Also, at the same time, the radiographic settings were acquired from the information of the DICOM tag. The subject thickness was 23.60 cm on the average, and the median of the ESD was 0.104 mGy. Also, the median of the ESD at the standard subject thickness of 20 cm in Japan DRLs 2015 was 0.075 mGy. The ESD can be calculated without measuring the body thickness of the patient of every examination by using the method of this study.

Pertinence of Children’s Chest X-Ray Request Form and Practice at the Regional Hospital of Ngaoundere Cameroon

Background: Chest X-ray is frequently performed for evaluation of chest disease in both adults and children. Children are more exposed to the adverse effects of radiation as compared to adults. During our daily practice, we noticed that most of children’s chest X-ray results were normal. Purpose: This study aimed to evaluate the indications, the technic, the irradiation and the result of chest X-rays in children in order to know if the practice of these X-rays was relevant. Method: Cross-sectional and descriptive study conducted at the Imaging Regional Center of Ngaoundere from April to August 2017. A total number of 145 radiographs and 140 X-ray requests of 140 children were considered in this work. The conformity of the request were verified according to the recommendations of the National Agency for Accreditation and Health Evaluation in France (NAAHE), technical condition of realization and results were appreciated and the entrance surface dose (ESD) of the patients was estimated using a mathematical algorithm. Results: Children under 5 years (63.5%) were more represented in our study. The main indications were: cough (22.1%), suspicion of pneumonia (16.4%) and bronchitis (15.7%). No indication was mentioned on 69.3% of the request forms. After confrontation to the “Guide for proper use of medical imaging examinations” (GPU), we only had 24% conformity of indications. 82.7% of the examinations required immobilization assistance by the parents. Most of the children were imaged in a standing-up position (82.9%) and the anterior-posterior view (77.9%) was more practiced. After the analysis of the pictures, 62% of them presented an optimal contrast, while 42.1% of X-ray were performed without beam collimation. 25 X-rays were repeated: 12 (48%) because of patient’s motion and 13 (52%) of mispositionning. After interpretation, 87 (62.14%) chest X-ray were normal. Main lesion observed were pneumonia (17.14%) followed by bronchopeumopathy (5.71%) and bronchitis (5%). The obtained ESD values were 0.11, 0.15 and 0.17 mGy respectively for the 0 - 1 year, 1 - 5 year and 5 - 10 year age groups; 0.2 and 0.57 respectively for postero-anterior (PA) and lateral (LAT) view for the age group 10 - 15 years, which were slightly greater than the values in internationally published studies. Conclusion: The request for children chest X-ray is not relevant in terms of indication, technical conditions of realization and irradiation.

&amp;lt;i&amp;gt;In-Vivo&amp;lt;/i&amp;gt; Dosimetry Method for Measuring Peak Surface Dose Using Radiochromic Films during Computed Tomography Scanning of the Sinus

Purpose: During computed tomography (CT) helical scanning mode the patient surface dose distribution is assumed to be non-uniform, therefore point dose measurement methods may lead to imprecise estimation of the radiation dose received by the patient skin in particular. We have used XRQA2 films as in-vivo dosimeters to measure the entrance skin dose during sinus exams. Methods: The films were placed under the patient head rest in order to sample the entrance surface dose in-vivo. We have performed in-vivo film irradiation on 23 patients in this study to verify the clinical suitability of the method and were found adequate. Results: The measured average ESD in the sinus exam was 11.7 ± 1.0 mGy, the PSD was 15.7 ± 1.7 mGy and the CTDI(vol) was 13.3 ± 0.1 mGy. The ratio of ESD/CTDI(vol) and PSD/CTDI(vol) was 0.88 and 1.18 respectively. The results indicate that the scanner registered CTDI(vol) underestimates the PSD and in the same time it overestimates the ESD by 18% and 13.6% respectively. Conclusion: The observed differences between the ESD, PSD and CTDI(vol) although seem small for the radiation dose range measured during CT of the sinus [13.2 - 13.4] mGy, but important for the medical physicist to know, since monitoring of patients’ doses from CT examinations is becoming more mandatory. The use of radiochromic film as in-vivo dosimeter does not interfere with the clinical radiological exam and does not produce any image artifacts. The method can be used to study other CT examinations specially the ones with large beam width, high pitch factor and high dose exams. The method allows measurement of the peak skin dose, examination of the CT dose profile and the 2D dose distribution in the XZ plan.

A Study on the Presentation of Entrance Surface Dose Model using Semiconductor Dosimeter, General Dosimeter, Glass Dosimeter: Focusing on Comparative Analysis of Effective Dose and Disease Risk through PCXMC 2.0 based on Monte Carlo Simulation

A Study on the Presentation of Entrance Surface Dose Model using Semiconductor Dosimeter, General Dosimeter, Glass Dosimeter: Focusing on Comparative Analysis of Effective Dose and Disease Risk through PCXMC 2.0 based on Monte Carlo Simulation

Medical imaging: Contribution toward background radiation and human exposure

Annual public exposure from background radiation is about 2.8 mSv which comes from both natural and manmade sources. The medical applications of ionizing radiation contribute around 98% of the manmade sources of background radiation. The annual per caput dose rose from 0.35 to 0.62 mSv by the worldwide usage of radiation diagnostic examinations. Based on the published reports, the diagnostic examinations – computed tomography (CT) scan and cerebral angiography are high (7.4 mSv and 9.3 mSv, respectively) in the average effective dose. In our study, we measured the entrance surface dose at different anatomical locations using thermoluminescence dosimeter in patients who underwent CT examinations and neurointerventional radiology procedures. The measured dose values range between 0.70 and 518.12 mGy for CT and 0.99 and 777.31 mGy for interventional procedures. Thus, X-radiation based procedures delivered a considerable amount of radiation dose to the patients. To minimize the risks of developing any health effects, safety measures should be taken to reduce the dose without compromising the image quality.

Improving Molecular Sensitivity in X-Ray Fluorescence Molecular Imaging (XFMI) of Iodine Distribution in Mouse-Sized Phantoms via Excitation Spectrum Optimization

X-ray fluorescence molecular imaging (XFMI) has shown great promise as a low-cost molecular imaging modality for clinical and pre-clinical applications with high sensitivity. Recently, progress has been made in enabling the XFMI technique with laboratory X-ray sources for various biomedical applications. However, the sensitivity of XFMI still needs to be improved for in vivo biomedical applications at a reasonably low radiation dose. In laboratory X-ray source-based XFMI, the main factor that limits the molecular sensitivity of XFMI is the scatter X-rays that coincide with the fluorescence X-rays from the targeted material. In this paper, we experimentally investigated the effects of excitation beam spectrum on the molecular sensitivity of XFMI, by quantitatively deriving minimum detectable concentration (MDC) under a fixed surface entrance dose of 200 mR at three different excitation beam spectra. XFMI experiments were carried out on two customized mouse-sized phantoms. The result shows that the MDC can be readily increased by a factor of 5.26 via excitation spectrum optimization. Furthermore, a numerical model was developed and validated by the experimental data. The numerical model can be used to optimize XFMI system configurations to further improve the molecular sensitivity. Findings from this investigation could find applications for in vivo pre-clinical small-animal XFMI in the future.

Direct Anterior Hip Replacement Does Not Pose Undue Radiation Exposure Risk to the Patient or Surgeon.

The fluoroscopically assisted direct anterior approach for total hip arthroplasty has gained interest in recent years. One of the perceived advantages is the use of fluoroscopy to aid in the positioning of implants. The purpose of this study was to measure the radiation entrance surface dose to anatomically important areas of both patients and surgeons during direct anterior approach total hip arthroplasty. Radiation dosimetry badges were placed at the sternal notch and pubic symphysis of 50 patients undergoing direct anterior approach total hip arthroplasty. Badges were also placed on the surgeons outside of their lead aprons at the level of the thyroid. Three fellowship-trained arthroplasty surgeons were involved in the study. Radiation exposure of each badge was measured after each case (surgeon and patient). The cumulative dose was also calculated for the surgeons. To limit surgeon bias during the study, 50 consecutive direct anterior approach total hip arthroplasties that occurred prior to this study were analyzed for total fluoroscopic dose and time and served as a control group. Forty-five subjects met study criteria. In the study group, 1 patient had a detectable thyroid exposure equal to 1 mrem. Seven patients had a detectable radiation entrance surface dose at the pubic symphysis (range, 1 to 7 mrem). No radiation entrance surface dose was detectable in the remaining 44 patients at the sternal notch and 38 patients at the pubic symphysis. Surgeons in the study did not experience a detectable radiation entrance surface dose. The mean fluoroscopic time was 13.72 seconds (range, 6.7 to 28.7 seconds). The mean patient radiation exposure was 178 mrem (range, 54 to 526 mrem). This study demonstrates that during direct anterior approach total hip arthroplasty, the mean patient entrance surface dose at the pubic symphysis and the sternal notch is not detectable in most patients. The mean patient exposure in this study during direct anterior approach total hip arthroplasty was 178 mrem, which is less than a single pelvic radiograph (600 mrem). No surgeon in our study demonstrated a detectable radiation entrance surface dose. Our data suggest that direct anterior approach total hip arthroplasty typically results in a negligible or very low dose of absorbed radiation exposure to the patient and the surgeon. We believe this study to have clinical relevance because both patients and surgeons have evidence that utilization of fluoroscopy during direct anterior total hip replacement places both parties at a relatively low radiation exposure risk.

Functional dynamic radiography with computer analysis-for physiological chest imaging and kinematic joint imaging.

We developed a functional digital radiography system that provides physiological and functional information of the chest and/or joints using an X-ray flat-panel detector (FPD) system. During chest examination, sequential chest radiographs are taken from inspiration to expiration in order to analyze diaphragmatic movements. Pixel value changes in localized areas of the lung are then assessed to analyze ventilation and circulation. For limb joints, such as the wrist, shoulder, and knee, sequential radiographs during flexion and extension or rotational movement are considered, and movement angles are analyzed. These imaging techniques and quantitative analyses are promising in screening examinations because they provide physiological and functional information. The entrance surface dose for the detector is approximately 1.9 mGy for chest examination, which is comparable to the dose limit recommended by the International Atomic Energy Agency. Recent related studies are reviewed in this paper.

Imaging dose assessment for cyberknife intra-cranial treatments

The aim of this study was to retrospectively assess patient treatment log files to determine an optimal imaging frequency for Intracranial Stereotactic Cyberknife treatments and thus, reducing the imaging dose received by the patient to ALARA while maintaining acceptable delivery accuracy. Image guided radiotherapy (IGRT) and stereotactic radiotherapy (SRT) have become fundamental treatment modalities in radiotherapy for ensuring accurate dose distribution to the intended target. To assess intra-fractional motion, frequent tracking can be employed to accurately track target motion during treatment. If an ionising radiation modality is used, the additional imaging dose received by the patient should be optimised.Patient entrance surface dose (ESD) was measured utilising solid water phantoms to mimic patient scatter for exposures used clinically. Imaging dose was quantified by applying ESD measurements to retrospective data for a cohort of 100 fractions and analysing patient position at each acquired image pair. Patient movement was established by the difference between two consecutive images for the duration of the treatment fraction. Patient movement along with plan robustness was used to determine imaging frequency. ESD was measured to be 0.24 mGy per image pair. In comparison to an original average imaging frequency of 43 s over all patients, an imaging frequency of 64 and 15 s has been suggested for Meningiomas (MEN)/Acoustic Neuromas (AN) and Trigeminal Neuralgia (TGN) respectively. By optimising the imaging frequency, the imaging dose received by patients may increase by up to 150% (TGN) or decrease by up to 20% (MEN/AN) while adequately tracking patient movement.

Dose Evaluation for Common Digital Radiographic Examinations in Selected Hospitals in Pahang Malaysia

Introduction: In digital radiography, radiographers tend to increase exposure factors to acquire an acceptable image quality thereby increasing radiation dose to patients. Regarding this, the present study aimed to re-evaluate the exposure parameters and to ascertain the entrance surface dose (ESD) and effective dose (ED) of posterior-anterior (PA) chest, abdomen, and anterior-posterior (AP) lumbosacral spine radiography. Materials and Methods: This study was conducted on 180 physically able patients with age of 20-60 years and weight of 60-80 kg referred to Hospital Sultan Haji Ahmad Shah (HOSHAS) and Hospital Tengku Ampuan Afzan (HTAA).Image acquisition was performed using digital radiography. The ESD and ED were determined using CALDose_X 5.0 software. Results: The ESD and ED for PA chest were 0.098 mGy and 0.012 mSv in HOSHAS, while in HTAA were 0.161 mGy and 0.021 mSv respectively. Regarding the abdomen, the ESD and ED were 2.57 mGy and 0.311 mSv in HOSHAS and 2.16 mGy and 0.262 mSv in HTAA respectively. For AP lumbosacral spine, the ESD and ED for HOSHAS were 2.65 mGy and 0.222 mSv, while in HTAA were 2.357 mGy and 0.201 mSv respectively. Conclusion: The findings revealed the use of high kVp, automatic exposure control, correct focus image receptor distance, tight collimation and additional filter resulted in a lower ESD. The ESD and ED obtained in this study were comparable with those reported by other studies and lower than the values recommended by the United Nations Scientific Committee on the Effects of Atomic Radiation in 2008.

Assessment of Patient Radiation Dose in Interventional Procedures at Shahid Madani Heart Center in Khorramabad, Iran

Introduction: Coronary angiography is the most common angiographic procedure for diagnosis and treatment of the heart diseases. Herein, we aimed to evaluate the entrance surface dose (ESD), dose area product (DAP), as well as cancer risk in interventional cardiology procedures. Materials and Methods: This study was conducted during July-December 2015 at Shahid Madani Heart Center in Khorramabad, Iran. A total of 225 adult patients including 122 females and 103 males regardless of the risk factors for coronary diseases were participated. Of them, 199 and 26 patients underwent diagnostic coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA), respectively. Each patient underwent CA or PTCA separately. All the procedures were carried out using Siemens angiography system with the pulsed fluoroscopy of 10-30 pulses/s and cine frame rate of 15 frames/s. DAP, ESD, fluoroscopy time (FT), as well as the number of sequences and frames per sequence were collected for each 199 CA and 26 PTCA procedures. Results: The median values of DAP were 19.77±14.88 and 57.11±33.36 Gy.cm2 in CA and PTCA, respectively. In addition, the median values of ESD were 323.12±245.39 and 1145.22±594.42 mGy in CA and PTCA, respectively. FTs were 114.59±74.33 s in CA and 424.15±292.93 s in PTCA. Conclusion: The average patient dose and cancer risk estimates in both CA and PTCA were consistent with the reference levels. However, in agreement with other interventional procedures, dose levels in the interventional cardiology are influenced by staff and clinical protocols, as well as the type of equipment.Â

X-ray examination to measurement radiation doses of patients in three Erbil hospitals

Thermo luminescent dosimeters (TLDs) have been used to measure the entrance surface doses (ESDs) of patients undergoing pelvis, abdomen and lumbar spine diagnostic X-ray examinations in Erbil. A total of three public hospitals and 171 patients were included in this investigation. The ages of the patients involved were from 40 years to 85 years, while their weights ranged from 64 kg to 73 kg. Mean, of ESDs are reported. The results showed that in most cases, for each of the examinations, the individual ESD values are found to be comparable with, and higher than, those from Ghana and Tanzania, respectively. The ranges found in this work are high and this indicates more attention needs to be given to X-ray facilities in the country. This also suggests that radiographic departments need to review their radiographic practices in order to bring their doses to optimum levels. Effective doses were also calculated from the ESD values. The radiographic parameters used for all the patients were also compared with the European criteria. It is recommended that the tube filtration at one hospital be increased. The importance of good regulatory activities and trained personnel is stressed in this work. Apart from the fact that the data provided inthis work will be useful for the formulation of national guidance levels, they also provide patient dosimeter information on healthcare level countries.

Assessment of Pediatrics Radiation Dose from Routine X-Ray Examination at Jimma University Hospital, Southwest Ethiopia.

Given the fact that children are more sensitive to ionizing radiation than adults, with an increased risk of developing radiation-induced cancer, special care should be taken when they undergo X-ray examinations. The main aim of the current study was to determine Entrance Surface Dose (ESD) to pediatric patients arising from routine x-ray examination in the Radiology Department of Jimma University Specialized Hospital (JUSH). Descriptive cross-sectional study was conducted on pediatric patients less than 15 years of age who visited to seek x-ray examinations in JUSH. In this study, chest (AP), skull (AP), Abdomen (AP) and Pelvic (AP) x-ray examinations were analyzed. Radiographic exposure factors were recorded in each examination. ESD was calculated using exposure parameters. The calculated ESD values were weighed against the Diagnostic Reference Level (DRL) recommended doses and similar published studies. Comparison was made among different age groups through mean comparison. The obtained ESD values were mostly higher than the values in internationally published studies and DRL for all age groups. For chest AP, the mean ESD values were 1.82mGy which is higher than similar studies in Nigeria (0.642Mgy), Brazil (o.o62mGy) and NRPB (0.050mGy) for ages of 0-1 years. The higher pediatric patient dose obtained in this study is a further indicator that doses delivered to pediatric patients are not according to ALARA principle, and there is a need to optimize service and patients' radiation exposure in JUSH in particular and in Ethiopia in general.