Entrance Surface Dose Research Articles

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.

A study on the reduction of radiation dose using carbon fiber-reinforced plastic during X-ray examination of children and infants

The purpose of this study was to investigate the suitability of an assistive device for radiological examination. A Carbon Fiber-Reinforced Plastic (CFRP) with relatively high transmission factor was used to reduce unnecessary radiation exposure for patients and examiners and maintain a stable examination posture and reduce falling of the infant. An average of 10 entrance surface doses (ESDs) were used for the ATOM Phantom T-spine (T6) and the Rando Phantom Thyroid (T), Inguinal Area (I), and Eye Ball (E) for patients and examiners during each infant chest X-ray examination. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also measured and analyzed via paired sample T-test and Pearson's correlation analysis using SPSS statistics version 21.0 (Chicago, IL, U.S.A.) to quantitatively evaluate changes in image quality before and after using the ancillary device. During infant chest X-ray examination, EST results were as follow: ESDT6 of infants, 233.70 ± 5.74 μGy; ESTs for the examination assistant: ESDT151.40 ± 4.01 μGy; ESDI, 143.20 ± 3.22 μGy; and ESDE, 146.20 ± 3.19 μGy. When the SNR and CNR values of chest X-ray images involving infants were compared using Pearson's correlation analysis, significant (p < 0.001) differences were found between values obtained before and after applying the ancillary device. The radiological examination assist device can stabilize the infant's posture during examination. Thus, it can reduce unnecessary exposure of patients and examination assistants to radiation, ultimately improving the safety of infant X-ray examinations.

A Comparison of Density and Patient Doses According to kVp and mAs Changes in General Radiography

Low energy x-rays that occur in the low tube voltage radiography of general radiography are absorbed strongly in the body and do not aid image quality enhancement. This study maintains titer in general radiography while using tube current that are proportional to density and the tube voltage 15% principle according to density to reduce patient exposure doses, and area doses and entrance surface doses were measured to compare patient exposure doses. In hand, knee, abdomen, and skull radiography, kVp was increased to 115% and mAs was decreased to 50% and kVp was decreased to 85% while mAs was increased to 200% and area doses and entrance surface doses were measured to compare relative doses. Also, 5 places in each image were set, density was measured, and Kruskal wallis H test was conducted to observe significance probabilities between groups. To fix density, kVp was increased to 115% and mAs was decreased to 50% and after measurements of mean area doses and entrance surface doses were made by each part, each decreased to 58.68% and 59.85% when standard doses were set to 100%, and each increased to 147.28% and 159.9% when kVp was decreased to 85% and mAs was increased to 200%. Comparisons of density changes showed that hand, knee, abdomen, and skull radiography all displayed significance probabilities>0.05, showing no changes in concentration. Radiography that increases kVp and lowers mAs through reasonable calculations within ranges that don’t affect resolution and contrast seems to be a simple way to decrease patient exposure doses.

Establishment of Diagnostic Reference Levels for Radiography in 10-year-old Pediatric Patients in Republic of Korea

The diagnostic reference levels (DRLs) for a 10-year-old patient were established for the most common types of general radiography in this study, using a glass dosimeter and a phantom corresponding to the international standards. The DRLs are set by measuring the entrance surface doses (ESD) at 211 medical institutions. The ESD of the skull posterior-anterior (PA) projection is between 0.11 and 5.59 mGy, with the average dose at 1.03 mGy, and the third quartile value at 1.17 mGy. The ESD of the skull lateral (LAT) projection is between 0.08 and 5.20 mGy, with the average dose at 0.78 mGy, and the third quartile value at 0.96 mGy. The ESD of the chest PA projection is between 0.01 and 1.38 mGy, with the average dose at 0.18 mGy, and the third quartile value at 0.20 mGy. The ESD of the chest LAT projection is between 0.04 and 3.36 mGy, with the average dose at 0.42 mGy, and the third quartile value at 0.46 mGy. The ESD of the abdomen AP projection is between 0.09 and 4.64 mGy, with the average dose at 0.85 mGy, and the third quartile value at 1.13 mGy. The ESD of the pelvis AP projection is between 0.1 and 5.26 mGy, with the average dose at 0.85 mGy, and the third quartile value at 1.06 mGy. Based on third quartile values and through clinical expert consultation, the DRLs for 10-year-olds in Korea were established at 1.1 mGy for skull PA, 0.9 mGy for skull LAT, 0.2 mGy for chest PA, 0.4 mGy for chest LAT, 1.1 mGy for abdomen AP, and 1.0 mGy for pelvis AP.

Diagnostic reference levels in paediatric intra oral peri apical (IOPA) dental radiography at University Dental Hospital, Peradeniya

Dental radiography is a common diagnostic technique practiced among the paediatric patients visiting the dentist. Therefore, to abide the ALARA (as low as reasonably achievable) principal and reduce the undesired exposure especially for the pediatric patients the DRLs in paediatric intraoral periapical dental radiographs was developed using the patient entrance surface doses (ESD).

Assessment and comparative study of Entrance Skin Dose for digital panoramic x-Ray equipments

Background and objective: A panoramic radiograph is a panoramic scanning dental x-ray of the upper and lower jaw. It shows a two-dimensional view of a half-circle. The aim of this study was to estimate of entrance surface dose (ESD) to the patient, in diagnostic panoramic radiology, to compare ESD (Entrance skin dose) for panoramic radiographies, analyze the relative advantage and disadvantage of their modalities. Methods: FONTA X Pan DG Plus devices (version 121001 code 6968271110) in dental clinical hospital and Planmeca pro max (ASENTAJANKATO 6 FI -00880 Hilsinki) in Xanzad centre were used in this study. panoramic imaging units offer an advanced and versatile 2D imaging experience. From flexible patient positioning to creative innovations and high image quality, these panoramic imaging units represent 2D dental imaging at its finest. ESD was estimated using ESD equation methods. A hundred patients were enrolled in this study for determination of the entrance surface dose that divided into five age groups theoretical. Results: As a result showed that the mean of the entrance skin dose for patient up to 6 years, 7-12 year, female adult, male adult and large adult are (0.12mGy, 0.13mGy, o.14mGy,1.51mGy, 1.53mGy) for digital panoramic radiography in Dental x-ray respectively and (0.06mGy,0.07mGy, o.o7mGy, o.11mGy, o.13mGy) for digital radiography in Xanzad centre of dental treatment. Conclusion: The study showed a significant association between entrance skin dose received by patient in dental clinical hospital and Xanzad centre and the study concludes that the received entrance skin dose by patients in clinical dental Erbil hospital higher than the other patient in Xanzad centre. It is recommended that the use of the newer equipment and the use of the proper radiological parameter can significantly reduce the Entrance skin dose.

Supplements and adjustments to the method of the assessment of the effective dose from the external exposure of the patients

The current study was aimed at the justification and proposal of the supplements and corrections that are planned for the implementation in the updated version of the Methodical guidelines “Control of the effective doses of the patients from the X-ray examinations” (MU 2.6.1.2944-11). This study included estimation and/ or update of the values of the conversion coefficients from measurable dose characteristics (entrance-surface dose, dose-area product) to the effective dose for various X-ray examinations. Estimation of the updated conversion coefficients was based both on the home analytical and experimental studies based on the modern protocols of the X-ray examinations, and the results of the published data. Updated values of the conversion coefficients were presented for: fluoroscopic examinations of the gastro-intestinal tract with barium media for adult and pediatric patients; interventional examinations of the adult patients; computed tomography examinations for adult and pediatric patients; dental intraoral examinations. For the first time, the methods of the estimation of the effective dose and corresponding conversion coefficients were presented for: computed tomography of the extremities, whole body, scan of several anatomic regions; angiographic examinations of the heart vessels of the pediatric patients of different age categories; slot-scanning X-ray examinations; bone densitometry.

Relation between body mass index and position of chest examination as a function of entrance surface dose

X-ray is ionic radiation which is now a necessity in the health sector as a tool in establishing diagnosis. Calculation of exposure doses in patients generally only considers gender and age, but from a theoretical point of view, energy absorption will be greater with increasing thickness of material. The thickness of the material in terms of chest examination using X-rays is indicated by position of the examination where the lateral examination makes the material exposed to radiation thicker than the posterioranterior or anteriorposterior examination position, as well as the patient's body mass index. Therefore, the relationship between the position of examination and body mass index to the entrance surface dose is the topic of this study. Analysis of chest examination data in several patients with various examination positions and different body mass indices showed an increase in entrance surface dose with increasing body mass index and examination position. The highest entrance surface dose was observed in patients with lateral examination positions, as well as in patients with large body mass indexes.

Effects of Kilovoltage on Image Quality and Entrance Surface Dose in Lumbar Spine Digital Radiography

Introduction: Digital radiography possesses a wide dynamic range and has a major advantage in producing an acceptable image of diagnostic value even though overexposure occurs. Lumbar spine (LS) radiography is the most common examinations that gives high radiation dose to patients and accounts for the highest collective population dose of any conventional radiographic examinations. As such, this study was carried out to ascertain the impact of image quality and entrance surface dose (ESD) with different exposure settings in the anteroposterior (AP) and lateral LS. Material and Methods: The torso of the PBU-50 phantom was exposed to medium and high kilovoltage peak (kVp). A total of 14 images for LS were obtained. Relative image quality was assessed using Leeds Test Objects TOR CDR whilst the ESD was ascertained using an optically stimulated luminescence dosimeter. Results: The results of Friedman test indicated a significant difference in image quality when using medium and high kVp. Wilcoxon signed-rank test also reflected a significant difference in ESD between the use of medium and high kVp for both AP and lateral LS. Conclusion: Significant differences in image quality and ESD were obtained using medium and high kVp with medium kVp resulting in high contrast but low contrast sensitivity and vice versa. The findings of the present study indicated that the recommended kVp for AP LS was from 75kVp to 81kVp whilst for lateral LS the recommended kVp was from 85kVp to 90kVp for an average adult patient.

Prediction of Entrance Surface Dose in Chest Digital Radiography

The purpose of this study is predicted easily the entrance surface dose (ESD) in chest digital radiography. We used two detector type such as flat-panel detector (FP) and IP (Imaging plate detector). ESD was measured at each exposure condition combined tube voltage with tube current using dosimeter, after attaching on human phantom, it was repeated 3 times. Phantom images were evaluated independently by three chest radiologists after blinding image . Dose-area product (DAP) or exposure index (EI) was checked by Digital Imaging and Communications in Medicine (DICOM) header on phantom images. Statistical analysis was performed by the linear regression using SPSS ver. 19.0. ESD was significant difference between FP and IP(85.7 μGy vs. 124.6 μGy, p=0.017). ESD was positively correlated with image quality in FP as well as IP. In FP, adjusted R square was 0.978 (97.8%) and linear regression model was ESD=0.407+68.810×DAP. DAP was 4.781 by calculating the DAP=0.021+0.014×340 μGy.In IP, adjusted R square was 0.645 (64.5%) and linear regression model was ESD=-63.339+0.188×EI. EI was 1748.97 by calculating the EI=565.431+3.481×340 μGy. In chest digital radiography, the ESD can be easily predicted by the DICOM header information.

Consideration of diagnostic reference levels for pediatric chest X-ray examinations.

The use of diagnostic reference levels (DRLs) is currently recommended, and dose evaluation is considered to be important for establishing a Japanese radiological protection system in radiological medicine. Children, in particular, are sensitive to radiation, and their exposure levels must be taken into account. The DRL for the entrance surface dose (ESD) used in pediatric chest X-ray examinations in Japan is 0.2mGy. However, the bodies of infants and young children show major changes with rapidly developing organs. Thus, the possibility that organ development may also be affected by radiation exposure should be taken into account. Therefore, radiological technologists must be conservative in setting radiographic conditions for pediatric examinations. The objective of this study was to evaluate the doses used in pediatric chest X-ray examinations at our hospital and compare them with the current DRLs, considering the assumption that setting conditions individually for different ages and subject thicknesses and performing more detailed dose evaluations will help reduce radiation exposure. The study was carried out to estimate the ESDs in 163 pediatric patients who underwent frontal or lateral chest X-ray examinations at our hospital. All doses were lower than 0.2mGy, the dose recommended in the Japanese DRLs 2015. The doses showed a strong correlation with age, but a weaker correlation with subject thickness. These results suggest that instead of considering a common DRL for all children, the DRL should be evaluated on the basis of age.

Optimizing image quality using automatic exposure control based on the signal-difference-to-noise ratio: a phantom study.

This study proposes to adjust the sensitivity of automatic exposure control (AEC) for achieving consistent image quality over a range of subject thicknesses in abdominal radiography simulations. The relation between image quality and subject thickness was investigated using a digital radiography system with 10-, 15-, 20-, and 25-cm-thick acrylic phantom. Simple pixel signal-to-noise ratio (SNR) was measured to check the default AEC accuracy for each thickness, and image quality was evaluated using the signal-difference-to-noise ratio (SDNR) with an additional acrylic plate and bone-equivalent material. Based on the figure of merit theory, dose ratios to obtain constant image quality regardless of the subject thickness were calculated from SDNR results. The AEC setup was manually modified using this dose ratio, and visibility was examined using a CDRAD 2.0 contrast-detail analysis phantom. Moreover, the entrance surface dose (ESD) was estimated as an index of exposure dose using exposure parameters. The default AEC setup provided a constant simple pixel SNR for each subject thickness with a high accuracy. SDNRs decreased with an increase in the subject thickness. The calculated dose ratios relative to the results for 20cm thickness were 0.424, 0.647, and 1.43 for 10, 15 and 25cm, respectively, and a > 25% decrease in ESD was observed for smaller patients. CDRAD analysis using the modified AEC setup showed almost identical visibility for each thickness. Adjusting the sensitivity of AEC according to subject thickness can contribute toward the optimization of the exposure condition.

PROPOSAL FOR LOCAL DIAGNOSTIC REFERENCE LEVELS IN GENERAL RADIOGRAPHY IN JAPAN.

The present study aimed to propose local diagnostic reference levels (DRLs) formulated by calculating entrance surface doses for general radiography at 20 facilities of Aichi prefecture in Japan, by comparing these values with DRLs established in Japan in 2015 (DRLs 2015) and assessing radiation dose differences among facilities. X-ray outputs (half-value layer and air kerma) of each facility were measured with a non-invasive type of detector. The results were employed to formulate local DRLs based on the 75th percentiles of dose distributions. These local DRLs were lower than the DRLs 2015 for all examinations. If proposed local DRLs from other 46 prefectures can be collected, this paper can be used to benefit the next effort to draft better DRL for Japan.

Dose reduction and image quality improvement of chest radiography by using bone-suppression technique and low tube voltage: a phantom study.

To clarify the relationship between entrance surface dose (ESD) and physical image quality of original and bone-suppressed chest radiographs acquired using high and low tube voltages. An anthropomorphic chest phantom and a 12-mm diameter spherical simulated nodule with a CT value of approximately + 100HU were used. The lung field in the chest radiograph was divided into seven areas, and the nodule was set in a total of 66 positions. A total of 264 chest radiographs were acquired using four ESD conditions: approximately 0.3mGy at 140 and 70kVp and approximately 0.2 and 0.1mGy at 70kVp. The radiographs were processed to produce bone-suppressed images. Differences in contrast and contrast-to-noise ratio (CNR) values of the nodule between each condition and between the original and bone-suppressed images were analyzed by a two-sided Wilcoxon signed-rank test. In the areas not overlapping with the ribs, both contrast and CNR values were significantly increased with the bone-suppression technique (p < 0.01). In the bone-suppressed images, these values of the three conditions at 70kVp were equal to or significantly higher than those of the condition at 140kVp. There was no apparent decrease in these values between the ESD of approximately 0.3 and 0.1mGy at 70kVp. By using the shortest exposure time and the lowest tube voltage possible not to increase in blurring artifact and image noise, it is possible to improve the image quality of bone-suppressed images and reduce the patient dose. • The effectiveness of bone-suppression techniques differs in areas of lung field. • Image quality of bone-suppressed chest radiographs is improved by lower tube voltage. • Applying lower tube voltage to bone-suppressed chest radiographs leads to dose reduction.

Assessment of Patient Absorbed Radiation Dose during Hysterosalpingography: A Pilot Study in Southwest Nigeria.

Background: Hysterosalpingography (HSG) is an indispensable tool for diagnosing infertility in females. The procedure exposes female reproductive organs to ionizing radiation as the genitals are irradiated during the process. Investigating patient absorbed dose during the procedures is essential for effective radiological protection of the patient.Objective: This study aims to investigate the radiation dose received by patient during HSG examination in the study environment in order to enhance optimization of procedures and the associated dose, thereby minimizing radiation risks.Material and Methods: The prospective pilot study, was conducted in four tertiary healthcare institutions in Southwest Nigeria. Thermoluminescence dosimeter (TLD 100) was used to determine the Entrance Surface Dose (ESD) of 80 patients presented for HSG investigation. The corresponding effective dose, ovary, uterus and urinary bladder doses were evaluated using PCXMC software.Results: The mean entrance surface doses (ESD) obtained from the four centers were 18.58±6.31 mGy, 15.18±2.27 mGy, 17.44±3.43 mGy and 34.24±11.98 mGy for SW1, SW2, SW3 and SW4 centers, respectively. The corresponding mean of effective doses were 1.54±0.63 mSv, 1.24±0.28 mSv, 1.41±0.30 mSv and 2.53±0.94 mSv for SW1, SW2, SW3 and SW4 centers, respectively. The resulting mean doses to the ovary, urinary bladder and uterus were also presented.Conclusion: The results obtained in general are comparable with international standards. It was, however, recommended that study centers with high doses should conduct dose audit in order to enhance patient safety.

Effectiveness of Al2O3:C OSL dosimeter towards entrance surface dose measurement in common X-ray diagnostics

We report the successful use of nanoDots Optically Stimulated Luminescence Dosimeters (OSLDs) for the determination of the entrance surface dose (ESD) in common X-ray diagnostics. ESD evaluation is made on six radiographic projections including abdomen (AP and LAT), chest (AP and PA), skull (AP), and thoracic spine (AP). Indirect and direct ESD measurements have been performed with and without whole-body anthropomorphic phantom using GE radiography system installed at the Diagnostic Imaging Laboratory, Universiti Kebangsaan Malaysia (UKM), wherein the International Atomic Energy Agency protocol (IAEA TRS-457) has been followed. The CALDose_X 5.0 software is used to calculate ESDs in these projections. The mean ESDs obtained with indirect measurements for AP abdomen, LAT abdomen, AP chest, PA chest, AP thoracic spine, and AP skull projections are 4.8, 8.3, 0.7, 0.2, 7.2, and 3.7 mGy respectively, and with direct measurements, the respective mean ESDs are 4.3, 8.3, 0.7, 0.3, 6.8, and 2.8 mGy. The values obtained by CALDose_X calculations are 8.3, NA, 1.1, 0.7, 8.8, and 4.5 mGy, respectively. Significant variations ranging from 18% to 59% are observed between measured and calculated ESDs, which are attributed to the difference in phantom size and field size. The overall uncertainty for direct measurements has a maximum of ±0.86 mGy compared to ±0.47 mGy for indirect measurement. Measured ESDs are within the IAEA and European Commission (EC) DRLs range, while calculated ESDs are slightly above the measured values. It is concluded that the use of nanoDots OSLD is beneficial for ESD measurement in routine X-ray examinations.

Direct and indirect entrance surface dose measurement in X-ray diagnostics using nanoDot OSL dosimeters

This study investigated the suitability of nanoDot optically stimulated luminescence (OSL) dosimeters for entrance surface dose (ESD) measurements in common X-ray diagnostics. OSL dosimetry system supplied by Landauer Inc, (Glenwood, IL, USA) consisting of nanoDot OSL dosimeters and microStar reader were used. ESDs were measured with nanoDots placed on whole-body anthropomorphic phantom (for direct measurements) and in free air without backscatter material (for indirect measurements) in accordance with the IAEA Technical Report Series No. 457. Measurements were carried out in five X-ray projections including AP abdomen, AP chest, PA chest, AP thoracic spine and AP skull. The mean ESD for each projection was evaluated from multiple measurements with three different field sizes. Mean ESDs (direct measurements) for AP abdomen, AP chest, PA chest, AP thoracic spine and AP skull were 4.3 mGy, 0.7 mGy, 0.3 mGy, 6.8 mGy and 2.8 mGy respectively. While in the case of indirect measurements, the corresponding mean ESD values were 4.8 mGy, 0.7 mGy, 0.2 mGy, 7.2 mGy and 3.7 mGy respectively. The results were found to be within IAEA and European Commission (EC) diagnostic reference levels (DRLs) range. The percentage difference of the ESDs measured by direct and indirect methods in all projections were between 0 to 40%. It was affirmed that nanoDot OSL dosimeter is a good candidate for ESD measurement in common radiographic examinations, while taking into account the effect of energy dependence.

Optimization of simulated cranial, thorax, and abdominal examination in paediatric digital radiography

This study was aimed to obtain optimum parameter combination in simulated cranial, thorax, and abdominal examinations using computed radiography (CR) and direct digital radiography (DDR) systems. Optimization was performed using in-house phantom with contrast objects on Siemens Luminos Agile Max DDR and Siemens Axiom Luminos TF CR. Paediatric patients were separated into four age groups; 0-1 year (group A), 1-5 years (group B), 5-10 years (group C), and 10-15 years (group D). Slab phantoms with different total thickness were used to simulate patients belonging to each age group for different anatomical region (cranial, thorax, and abdomen). Optimization were performed in three steps; first kVp, followed by mAs, and then additional filter optimization. All the steps of optimization were performed based on FOM (figure of merit) values calculated as ratio of squared SDNR (signal difference to noise ratio) and entrance surface dose with the highest FOM representing the optimum condition. The results of this optimization were evaluated based on the highest FOM generated from each exposure. For both CR and DDR, optimum parameters (i.e. highest FOM) are different for each age group and anatomical region. Even with different X-Ray units, the CR device had slightly similar optimized parameters.

DNA damage and gene expression changes in patients exposed to low-dose X-radiation during neuro-interventional radiology procedures

Interventional radiology-based imaging is the preferred choice for diagnosis and therapy of many complex diseases, despite possible adverse effects of the radiation exposures. We have measured induced DNA damage and changes in gene expression in relation to entrance surface dose (ESD) in peripheral blood samples of patients (n = 51) who underwent neuro-interventional radiological procedures. The ESD values, measured by thermoluminescence dosimetry, were 4.9–273 mGy (forehead), 14–398 mGy (eyes), 8–433.3 mGy (shoulders), and 4.7–242.5 mGy (thyroid). The in-built recorded Dose Area Product (DAP) values were 74.61–558.55 and 13.17–2825.12 Gy*cm2 for diagnostic and therapeutic procedures, respectively. The mean fluorescence intensity (MFI) on the phosphorylation of γ-H2AX and p53ser−15 was higher in samples obtained post-exposure vs. pre-exposure. However, the increase was statistically significant only for p53ser−15 (P < 0.01). Consistent with γ-H2AX, CDKN1A, FDXR, BAX, DDB2, SESN1, BCL2, MDM2, TNFSF10B, and PCNA showed (non-significant) decreased expression while GADD45A, ATM, and TNFSF9 showed (non-significant) increased expression. Our results suggest that most of the patients had increased DNA damage and altered gene expression after receiving relatively low doses of ionising radiation. This implies that these procedures should be carried out at the lowest possible doses of radiation that do not compromise image quality.

Calculation application of patient’s dose on fluoroscopy x-ray machine

Dose recording in patients is not well implemented and so far has not been supported by the dose panel on the X-ray machine. Therefore, it is necessary to develop a dose-record application capable of storing dose data to support the patient’s radiation safety. It also refers to the regulation of diagnostic radiology service standards, medical records, and hospital accreditation standards regulated by the Ministry of Health. This study aimed to design an application of patient dosage record for abdominal examination with a Fluoroscopy X-ray machine. The design of dosage record application is done by exposing to radiation output and voltage (kV) variation of X-ray irradiation on 63-94.8 kV, current strength on 0.9-3.1 mA, and phantom thickness on 5-21 cm. The data is processed and multiplied by backscatter factor (BSF) is 1.35 to get entrance surface dose (ESD). ESD formula that can be included in the program script in the XAMPP software application. The dosage record application design can be used to record patient data with the calculated formulation obtained.