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

Objective: The purpose of this study was to assess the Entrance Skin Dose (ESD) in patients undergoing multiple types of radiographic examinations across three hospitals in Saudi Arabia.

Methods: The patient ESD was estimated directly using optically stimulated luminesces (OSL) and indirectly using a survey meter and calculations for 100 adult patients undergoing common diagnostic X-ray examinations, including a posterior anterior chest, posterior anterior hand, anterior posterior foot, and anterior posterior knee examinations, in three hospitals in Saudi Arabia. Comparative analysis with national and international reference values was conducted.

Results: Our analyses revealed considerable heterogeneity in X-ray exposure parameters among the hospitals. The mean ESD values for the chest examination were 0.28 ± 0.13 mGy for the direct method and 0.19 ± 0.11 mGy for the indirect method. Hand examination using the direct method resulted in a mean ESD of 0.42 ± 0.15 mGy, while the indirect method yielded 0.23 ± 0.06 mGy.

Remarkably, the ESD values in most cases exceeded national and international guidelines, with the knee examination ESD using the direct and indirect methods showing an alarming value of 1.54 ± 0.31 mGy and 1.18 ± 0.21 mGy, respectively. The correlation between direct ESD, indirect ESD showed a strong positive correlation exists between direct ESD and Indirect ESD (r = 0.8, p <0.001).

Conclusion: The study highlights the urgent need for standardized protocols and quality control measures across radiographic facilities in Saudi Arabia. The elevated ESD values signify a critical issue that requires immediate attention to minimize patient radiation exposure while maintaining diagnostic image quality. Quality control tests and adjustments in examination parameters are strongly advised.