Monte Carlo quantification of organ doses and risks in chest X-ray projections

Background: X-ray imaging is a pivotal diagnostic tool that poses health risks from absorbed radiation doses. This study aimed to determine the variation in the effective dose between posterior–anterior (PA) and anterior–posterior (AP) projections and assess the impact of sex on these doses using the PCXMC simulation software. Methods: A Philips radiography machine and Piranha and Browser dosimeter kits were used to measure the entrance dose of a whole-body phantom. These doses were input into the PCXMC to calculate the effective doses for the organ/tissue. The measured data were used to calculate the risk associated with exposure using a linear no-threshold model. Results: The PA projections were associated with lower effective doses (0.003628 mSv) than the AP projections (0.008424 mSv). Sex comparisons showed no significant difference in effective doses due to uniform organ doses across sexes, except for the reproductive organs and weighted remainder, where shielding minimized radiation exposure. Risk calculation analysis revealed overarching trends, confirming the documented higher sensitivity in female patients and the predominant risk contributions from critical organs, such as the lungs. Conclusion: AP projections yield higher effective doses than PA projections; however, sex does not significantly affect organ dose estimation, suggesting that both projections can be used interchangeably with patient sex. Recommendations and methodological limitations are detailed in the Supplementary Information.