Association of collimation training with radiation dose in adult chest radiography: a real‑world retrospective before‑and‑after study

PURPOSE: To evaluate changes in patient radiation dose following a targeted collimation training program for radiographers during routine adult chest radiography. METHODS: This single-center retrospective before-and-after study included adult chest radiographs acquired on a single digital radiography system during two consecutive 3-month periods: pre-training (May-July 2025) and post-training (August-October 2025). A structured collimation training session emphasizing anatomical boundaries and the limitations of digital cropping was implemented on August 1, 2025. Dose area product (DAP) values were extracted from Digital Imaging and Communications in Medicine (DICOM) metadata. Group comparisons were performed using the Mann-Whitney U test and paired analysis using the Wilcoxon signed-rank test. Age-adjusted regression with robust standard errors was used to assess the independent association between the intervention and radiation dose. RESULTS: < 0.001). CONCLUSION: Targeted collimation training was associated with a significant reduction in radiation dose in chest radiography. Structured training represents a simple and effective strategy for dose optimization in routine clinical practice. CLINICAL SIGNIFICANCE: In digital radiography, electronic cropping may mask inadequate collimation and lead to unrecognized unnecessary radiation exposure. Effective pre-exposure collimation, by limiting the irradiated field to the area of clinical interest, plays a key role in reducing patient dose and improving radiation safety in routine practice.