Portable chest x-rays for hospital patients: Implication, justification and image quality

Abstract Background and aim Portable Chest X-ray (PCXR) is service provided to patients who are unable to travel to radiology department. However, the unjustified PCXR leads to unnecessary radiation exposure to radiographer and other patients on ward. Currently, there are no guidelines to justify PCXR requests in UK. Therefore, it was aimed to use the evidence-based guidelines with addition of National Early Warning Score (NEWS) for justifying PCXR requests and to determine the image quality and scatter radiation dose for patient positionings. Patients and Methods Guidelines and NEWS ≥5 were used as a trial for 3 months (July to September 2023). Scatter radiation dose of each patient was calculated. ANOVA test was used to find the relation between patient positionings (AP erect, AP semi-erect and supine) and scatter radiation. The dose area product (DAP) of patients was collected from Computerised Radiology Information System (CRIS) and images were assessed using Picture Archiving and Communication System (PACS). All the portables were done on Samsung and Agfa DR machines. Results The guidelines were successful in justifying the portable CXR requests for 96 patients out of 102. The 24 PCXR images (25%) were rotated and of sub-optimal exposure. AP semi-erect position (mean scatter radiation = 1.21 μGy) was found to be related with high scatter radiation dose ( Q = 6.97, P = <0.01). Conclusion Radiology departments may consider using published criteria with NEWS ≥5 as a method for justifying PCXR. AP semi-erect position leads to higher scatter dose and 25% of radiographs were of less diagnostic value.