An Enumeration Survey on Diagnostic X-Ray Generators and Essential Safety Parameters in Mizoram, India

Document Type : Original Paper


1 Department of Physics, School of Physical Sciences, Mizoram University (A Central University), Tanhril campus, Aizawl

2 Department of Physics, Mizoram University

3 Mizoram State Cancer Institute, Zemabawk, Aizawl-796017, Mizoram, India


Introduction: Best radiography practice involves operational optimal machine performance, delivering cost-effective healthcare services under appropriate safety conditions for workers and the public. The present study aimed to investigate the safety status of diagnostic X-ray installations in Mizoram, India.
Material and Methods: Linearity of time (sec), linearity of current (mA), output reproducibility, table dose (μGy/mAs), peak voltage (kVp) accuracy, and 16 essential safety parameters of 135 X-ray machines were considered in this study. A battery-operated dosimeter and wide-range digital kVp meter were used to measure output radiation and effective peak potential of X-ray tube. Data analysis was performed using SPSS software to obtain the mean, standard deviation, and coefficient of variation.
Results: Among different electronic parameters, 59.2% linearity of time, 82.6% linearity of current, 89.7% kVp accuracy, 35.1% output reproducibility, and 92.8% table dose were beyond the acceptable limits. Based on 16 essential safety parameters, it was observed that 98.7% of X-ray machines did not receive proper quality assurance test, 1.9% of the installations employed lead-line patient entrance doors, 46.8% of the machines were operated without any protective barriers and 83.1% of the units were operated without personnel monitoring service.
Conclusion: The present study had concluded with more problems than the previous studies in different parts of the world in this regard. Due to the absence of proper quality control (QC) programs, many installations did not follow standard installation guidelines. The authors recommended that proper QC should be implemented by the frequent monitoring of each and every diagnostic X-ray installation.


Main Subjects

  1. References


    1. United Nations. Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation: sources. United Nations Publications; 2000.
    2. Hashemi M, BayaniSh, Shahedi F, Momennezhad M, Zare H, Gholamhosseinian H. Quality assessment of conventional X-ray diagnostic equipment by measuring X-ray exposure and tube output parameters in Great Khorasan Province, Iran. Iranian Journal of Medical Physics. 2019 Jan; 16(1):34–40.
    3. Zoetelief J. Quality Control in Diagnostic Radiology in the Netherlands. Radiation Protection Dosimetry. 1998; 77(4):257–66. DOI: 10.1093/oxfordjournals.rpd.a032321.
    4. International Commission on Radiological Protection. ICRP Publication 60. 1990 Recommendations of the International Commission on Radiological Protection. Ann. ICRP. 1991; 21(1–3).
    5. Pernicka F, McLean ID. Dosimetry in diagnostic radiology: an international code of practice. International Atomic Energy Agency; 2007.
    6. National Council on Radiation Protection and Measurements. Quality assurance for diagnostic imaging, NCRP Report 99, Bethesda, Md. 1990.
    7. International Commission on Radiological Protection. ICRP 103:The 2007 Recommendations of the International Commission on Radiological Protection. Ann. ICRP.2007;37(2–4).
    8. World health organization (WHO). Quality Assurance in diagnostic Radiology. A guide prepared following workshop held in Neuherberg, Geneva. 1982.
    9. Kharita MH, Khedr MS, Wannus KM. A comparative study of quality control in diagnostic radiology. Radiation Protection Dosimetry. 2008; 130(4):447–51. DOI: 10.1093/rpd/ncn096.
    10. Lalrinmawia J, Pau KS, Tiwari RC. Qualitative study of mechanical parameters of conventional diagnostic X-ray machines in Mizoram. Radiological Physics and Technology. 2018; 11(3): 274–83.
    11. Lalrinmawia J, Pau KS, Tiwari RC. Evaluation of radiation doses at diagnostic X-ray control panels and outside patient entrance doors in Aizawl district, India. Radiological Physics and Technology. 2019; 12(3): 312–24.
    12. Wagner LK, Fontenla DP, Kimme-Smith C, Rothenberg LN, Shepard J, Boone JM. Recommendations on performance characteristics of diagnostic exposure meters: Report of AAPM Diagnostic X-ray Imaging Task Group No. 6. Medical Physics. 1992; 19(1):231–41.
    13. Shepard SJ, Lin PJ, Boone JM.Quality Control in Diagnostic Radiology. AAPM: Report. 2002 (74).
    14. Papp J. Quality management in the imaging sciences. 4th. ed. 2011.
    15. Institute of Physics and Engineering in Medicine (IPEM). Recommended standards for the routine performance testing of diagnostic x-ray imaging systems, Report No. 77. York. 1998.
    16. Format for quality assurance test for diagnostic X-ray equipment. Available from:
    17. Atomic Energy Organization of Iran (AEOI). Quality Control Procedure in Diagnostic Medical Imaging Devices. 2012(INRA-RP-RE-121-00/25-0-Esf.1387):103.
    18. Rasuli B, Pashazadeh AM, TahmasebiBirgani MJ, Ghorbani M, Naserpour M, Fatahi-Asl J. Quality control of conventional radiology devices in selected hospitals of Khuzestan province, Iran. Iranian Journal of Medical Physics. 2015; 12(2):101–8. DOI: 10.22038/ijmp.2015.4773.
    19. Sonawane AU, Meghraj S, Kumar Sunil JVK, Kulkarni A, Shirva VK, Pradhan AS. Radiological safety status and quality assurance audit of medical X-ray diagnostic installations in India. Journal of Medical Physics. 2010; 35(4):229–34.
    20. Jomehzadeh Z, Jomehzadeh A, Tavakoli MB. Quality control Assessment of Radiology Devices in Kerman Province, Iran. Iranian Journal of Medical Physics. 2016; 13(1):25–35. DOI: 10.22038/ijmp.2016.7142.
    21. KhoshbinKhosnazar A, Hejazi P, Mokhtarian M, Nooshi S. Quality Control of radiography equipments in Golestan Province of Iran. Iranian Journal of Medical Physics. 2013; 10(1): 37–44. DOI: 10.22038/ijmp.2013.917.
    22. Asadinezhad M, BahreyniToossi MT, EbrahiminiaA, Giahi M. Quality Control Assessment of Conventional Radiology Devices in Iran. Iranian Journal of Medical Physics. 2017;14(1): 1–7.
    23. Neofotistou V, Molfetas M, Panagiotakis N. Quality Control in Conventional Diagnostic Radiology in Greece. Radiation Protection Dosimetry. 1995; 57(1–4): 293–6. DOI 10.1093/oxfordjournals.rpd.a082545.
    24. Saghatchi F, Salouti M, Bahreini MT. The quality control of x-ray Machines in Hospitals of Zanjan. International Conference on Quality Assurance and New Techniques in Sciences. Radiation Medicine [QANTRM]. 2006; 13–15.
    25. Gholamhosseinian-Najjar H, Bahreyni-Toosi MT, Zare MH, Sadeghi HR, Sadoughi HR. Quality Control Status of Radiology Centers of Hospitals Associated with Mashhad University of Medical Sciences. Iranian Journal of Medical Physics. 2014; 11(1): 182–7. DOI: 10.22038/ijmp.2014.2625.
    26. Esmaeili S. Measurement of patient skin dose of common techniques in diagnostic radiology in 15 radiology centers and quality control of those units in Mashhad. Master Thesis of Medical Physics, Mashhad University of Medical Sciences. 2006.
    27. Bosnjak J, Ciraj-Bjelac O, Strbac B. Implementation of quality assurance in diagnostic radiology in Bosnia and Herzegovina (Republic of Srpska). Radiation Protection Dosimetry. 2008;129(1–3): 249–52. DOI: 10.1093/rpd/ncn011.
    28. Sungita YY, Mdoe SSL, Msaki P. Diagnostic X-ray facilities as per quality control performances in Tanzania. Journal of Applied Clinical Medical Physics. 2006;7(4): 66–73.
    29. Operator Manual 06-526 Rad-CheckTM Plus. P/N 136201, Rev. 6, Fluke corporation, USA. 2006.
    30. Operator Manual Victoreen 07-494. Manual No. 168001 Rev 4, Fluke Biomedical, Radiation Management Services, 6045 Cochran Road, Cleveland, Ohio 44139, USA. 2006.
    31. Atomic Energy Regulatory Board, Government of India. e-licensing of radiations applications (eLORA) system, Mumbai. 2019. Available from:
    32. Hassan GM, Rabie N, Mustafa KA, Abdel-Khalik SS. Study on the quality assurance of diagnostic X-ray machines and assessment of the absorbed dose to patients. Radiation Effects & Defects in Solids. 2012; 167(9): 704–11. DOI: 10.1080/10420150.2011.559238