To evaluate whether chest x-rays done with no

history to its relation is justifiable and contributes to a

diagnosis.
PART A

In a radio-diagnostic scenario, x-rays are prescribed to a patient to primarily diagnose a suspecting

characteristic feature that corresponds to a condition in the patient. Now, when one talks about any
form of radiation, it is understood that the radiation imparted to a subject should be kept to a
minimal level as achievable. According to the radiation principles drafted in the ‘Atomic Energy
Regulatory Board’ (AERB), any radiation-based study/diagnosis should be: a) Justified b) Protection
and safety should be optimised and c) Factors should not exceed the dose limits. Keeping these
principles in mind, one could ask; whether the x-rays prescribed, especially the chest x-rays that is
under the evaluation, are keeping the grounds of the principles stated above?

PART-B

In the case of the chest x-rays, one can visualize the mediastinal and cardiac contour with their
minimum capacity to attenuate and display any form of obvious bronchial and parenchymal diseases
(the less obvious cases are however visualised only in higher form of x-rays, e.g. CT scan). It
therefore becomes a necessary protocol in the early assessment of the mediastinum along with its
relative structures. Albeit, in today’s daily OPD’s and clinics, ordering a chest x-ray has become a
norm to follow, irrespective of whether the patient has any conditions relating to it or not. This is
not only a question of justification but also secondarily may or may not contribute to the increase in
scatter radiation to the occupational workers (radiographers and technologists) thereby increasing
(if increase in scatter radiation occurs) the possibility of dose absorptions. Since the main source of
radiation to the technologist is not the x-ray source itself but by the scatter radiation. Also, if the PPE
aspects in XYZ are not in par with the radiation protection guidelines, it becomes more of an ethical
concern rather than just a question of analysis.

PART-C

In response to this ‘often ignored’ dilemma, my study proposes to evaluate the nature of how and
why are chest x-rays ordered when there is no clinical evidence to have one done. I plan to record
the selected patients, with the above criteria, diagnosis and follow up after their x-ray. The
measurements of the scattered dose from all the chest x-rays (with and without history) will also be
calculated, from which only the ‘criteria eligible’ patients scattered doses will be determined. This
may give an insight into the ‘how much’ of dose is being contributed as an ‘extra’. The personal
protection equipment will also be taken under the evaluation considering the principles that are
mandated to be followed under the AERB license. The PPE evaluation might give me a further
analysis on the ‘extra dose’ on whether it could have been a help to keep the doses nulled or at the
least reduced to the minimum.

RESEARCH QUESTIONS:

1. When and how are chest x-rays justifiable?

2. Does and how much are unjustified x-rays contribute to scatter radiation?
 3. Does inadequate PPE affect the increase in the scatter radiation dose?

OBJECTIVES:

1. To underline the scepticism of unjustified chest x-rays contributing to a diagnosis.

2. To set the ground for further evaluation and analysis in the radiation protection of the
occupational workers.