Expert consensus on technical and protection standards for digital chest X-ray examination in the Guangdong-Hong Kong-Macao Greater Bay area

Digital chest radiography is a widely used modality for screening and diagnosing respiratory diseases. Within the Guangdong–Hong Kong–Macao Greater Bay Area, however, regional differences in equipment parameters, operating procedures, and radiation-protection standards have hindered medical collaboration, mutual recognition of results, and multicenter research. Meanwhile, although dynamic digital radiography (DDR) has been introduced into clinical practice, unified standards for image acquisition, functional evaluation, and radiation protection remain lacking. To address these challenges and promote high-quality integration of imaging services across the Greater Bay Area, there is an urgent need for a consensus that integrates both static and dynamic chest radiography while accommodating the regulatory frameworks and clinical practices of the three regions. The consensus establishes technical specifications, quality-control standards, and radiation-protection requirements applicable to both conventional and dynamic digital chest radiography. For the first time, it systematically integrates DDR acquisition under quiet breathing, forced breathing, and blood-flow sequences; defines methods for functional parameter extraction and clinical application scenarios; and provides BMI-stratified exposure recommendations with reference dose ranges. In addition, the consensus harmonizes relevant radiation-protection provisions from the Chinese Mainland, Hong Kong, China, and Macao, China, thereby forming a unified and actionable system for quality control and safety management.