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

Document Type : Original Paper


Department of Diagnostic Imaging and Radiotherapy, Kulliyyah (Faculty) of Allied Health Sciences, International Islamic University Malaysia, Kuantan Campus, 25200 Kuantan, 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.


Main Subjects


    1. Osei EK, Darko J. A survey of organ equivalent and effective doses from diagnostic radiology procedures. ISRN radiology. 2012; 2013: 1-9. DOI: 10.5402/2013/204346.
    2. Hoffman EA, Jiang R, Baumhauer H, Brooks MA, Carr JJ, Detrano R, et al. Reproducibility and validity of lung density measures from cardiac CT scans – the multi – Ethnic study of Atherosclerosis (MESA) lung study. Acad Radiol. 2009; 16(6): 689-99. DOI: 10.1016/j.acra.2008.12.024.
    3. ICRP, Valentin J. Release of Patients after Therapy with Unsealed Radionuclides. ICRP Publication 94. Ann. ICRP 34 (2). Elsevier; 2004. DOI: 10.1097/00004032-200507000-00010.
    4. Aliasgharzadeh A, Mihandoost E, Masoumbeigi M, Salimian M, Mohseni M. Measurement of entrance skin dose and calculation of effective dose for common diagnostic x-ray examination in Kashan, Iran. Global Journal of Health Science. 2015; 7(5): 202-7. DOI: 10.5539/gjhs.v7n5p202.
    5. ICRP, 2002. Basic anatomical and physiological data for use in radiological protection: reference values. A report of age- and gender-related differences in the anatomical and physiological characteristics of reference individuals. ICRP Publication 89. Ann ICRP 32(3-4): 5-265.
    6. Davies M, McCallum H, Whiter G, Brown J, Helm M. Patient dose audit in diagnostic radiography using custom designed software. Elsevier. 1997; 3(1): 17-25. DOI: 10.1016/S1078-8174(97)80021-1.
    7. ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37 (2-4).
    8. Abdullah MHRO, Kandaiya S, Lim TH, Chumiran SH. Preliminary study on the trend of patient dose arising from diagnostic x-ray examination in Penang, Malaysia.  Journal of Applied Sciences Research. 2010; 6(12): 2257-63.
    9. European Commission. European guidelines on quality criteria for diagnostic radiographic images. Luxembourg: European Commission; 1996. EUR 16260 EN.
    10. Hart D, Hillier M, Shrimpton P. (HPA CRCE-034) on Doses to patients from radiographic and fluoroscopic X-ray imaging procedures in the UK. Chilton: Health Protection Agency Centre for Radiation, Chemical and Environmental Hazards. 2010.
    11. United Nations Scientific Committee on the effects of atomic radiation (Report to the general assembly Vol 11 with scientific annexes C, D, E) on the sources and effects of atomic radiation. New York: Off J UNSEAR. 2008.
    12. Compagnone G, Pgan L, Baleni MC, Calzolaio FL, Barozzi L, Bergamini C. Patient dose in digital projection radiography. Radiat Prot Dosimetry. 2008; 129(1-3): 135-7. DOI: 10.2349/biij.3.2.e26.
    13. Lanca L , Silva A. Digital radiography detector: A technical overview. Digital Imaging Systems for Plain Radiography. New York: Springer Science + Business Media; 2013. DOI: 10.1007/978-1-4614-5067-2_2.
    14. Bor D, Birgul O, Onal U, Olgar T. Investigation of grid performance using simple image quality tests. Journal of Medical Physics. 2016; 41(1): 21-8. DOI: 10.4103/0971-6203.177280.
    15. Suliman II, AbbasN, Habbani FI. Entrance surface doses to patients undergoing selected diagnostic x-ray examinations in Sudan. Radiation Protection Dosimetry. 2007; 123(2), 209-14. DOI: 10.1093/rpd/ncl137.