Comparative Dosimetric Analysis of System Displayed versus Calculated Entrance Skin Dose in Routine Radiographic Imaging

Abstract X-ray examinations are integral to medical diagnostics but pose risks from ionizing radiation. Adhering to the ALARA (as low as reasonably achievable) principle in diagnostic radiography is essential. This study evaluates the accuracy and reliability of entrance skin dose (ESD) values displayed on digital radiographic X-ray machine by comparing them with estimated ESD values during common radiographic examinations. ESD was estimated for 250 radiographs of 150 patients (90 females, 60 males) undergoing five common radiographic views: lumbosacral (LS) spine anterior–posterior (AP)/lateral (LAT), pelvis AP, and abdomen supine/erect. Using the formula, estimated ESD values were calculated and compared with displayed ESD values from the console of the digital X-ray machine. The mean estimated and displayed ESD values were: LS spine AP (1.31 mGy, 0.92 mGy), LS spine LAT (2.12 mGy, 1.63 mGy), pelvis AP (0.69 mGy, 0.62 mGy), abdomen supine (0.67 mGy, 0.65 mGy), and abdomen erect (1.44 mGy, 1.06 mGy). Statistical analysis revealed a significant correlation between estimated and displayed ESD values across all views (p <0.001). The intraclass correlation coefficient ranged from 62.60 to 84.30%, indicating moderate to strong agreement. These findings were compared with studies from Canada, India, and the UK. Displayed ESD values showed significant deviation from the independently estimated ESD values, indicating that console-generated estimates provide only an approximate indication of patient exposure. Therefore, they should not be considered a precise substitute for direct dosimetric measurements. Reliable ESD values displayed on radiographic equipment facilitate effective radiation protection measures. Incorporating regular ESD monitoring into clinical practice can enhance patient safety and adherence to radiation safety protocols in diagnostic radiology.