Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Weatherburn, G. C.
Right arrow Articles by Davies, J. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weatherburn, G. C.
Right arrow Articles by Davies, J. G.
(Radiology. 2000;217:707-712.)
© RSNA, 2000

Medical Physics

Comparison of Doses for Bedside Examinations of the Chest with Conventional Screen-Film and Computed Radiography: Results of a Randomized Controlled Trial1

Gwyneth C. Weatherburn, PhD, Stirling Bryan, PhD 2 and J. Glyn Davies, MSc 3

1 From the Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8 3PH, England. Received February 9, 2000; revision requested March 17; revision received April 25; accepted May 1. Supported by the Wales Office of Research and Development for Health and Social Care. Address correspondence to G.C.W. (e-mail: gwyneth.weatherburn@brunel.ac.uk).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
PURPOSE: To compare the radiation doses received by patients during bedside chest radiography when a computed radiography system was used and when a 400-speed screen-film system was used.

MATERIALS AND METHODS: A randomized controlled trial was performed whereby all patients who were admitted to an intensive care unit were randomly assigned at admission to have all radiographic chest images obtained with either computed or conventional screen-film radiography. Doses were measured for 1 year, during which 269 patients underwent imaging. For these patients, surface entry doses were measured by means of individual thermoluminescent dosimeters placed on the skin at the center of the radiation beam. In addition, data were collected relating to the patient and examination characteristics, as well as to repeat examinations. Effective doses were calculated.

RESULTS: The patients in the two arms of the study were well matched. The surface entry doses were higher in the computed radiography group (median, 0.21 mGy for computed radiography and 0.16 mGy for conventional radiography), and the effective doses were also higher (median, 0.036 mSv for computed radiography and 0.027 mSv for conventional radiography). Fewer examinations were repeated when computed radiography was used.

CONCLUSION: When computed radiography was used, patient doses increased. The speed of this computed radiography system, which uses phosphor plate imaging, equates approximately to a 300-speed screen-film system.

Index terms: Radiations, exposure to patients and personnel • Radiography, bedside, **.114 • Radiography, comparative studies, **.11 • Radiography, computer-assisted, **.11 • Radiography, storage phosphor, **.11 • Thorax, abnormalities, **.11 • Thorax, radiography, **.11


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
During the past decade, picture archiving and communication systems, or PACS, have emerged, which aim to make images available to all clinicians when clinically required and thus save staff and patient time and improve the treatment of patients. The systems frequently use phosphor plate, computed radiographic technology to obtain radiographs. These plates have a wider useful latitude than does conventional radiography, thus producing acceptable images with a wide range of incident radiation and patient disease (1,2). Several authors (3–6) suggest that dose reduction can be achieved by means of a reduction in the number of examinations that must be repeated owing to incorrect exposure factors. In addition, it is often suggested that computed radiography could be used with lower radiation doses than conventional screen-film systems and thus reduce patient doses (7).

An early study by Pettersson et al (8) showed that for the demonstration of certain features of bone, doses could be reduced by 50% without loss of information. However, the computed radiography doses were compared with a 140-speed screen-film combination, and systems in use today are more likely to have a speed of 400. In 1992, Galanski et al (9) reported no dose reduction for bedside chest examinations for the detection of low-contrast catheters, which result in little contrast between the catheter and the adjacent areas on a radiograph, compared with that for a 300-speed system.

In more recent publications, MacMahon and Giger (10) suggested that, in their experience, a dose reduction of approximately 20% compared with a 250-speed screen-film system produces a reasonable compromise between quantum noise and motion artifact for computed chest radiography. Sandmayr and Wallentin (11) have reported that doses were reduced by 50% compared with those with a conventional 200-speed system. Bragg et al (12) reported 80% dose increases for bedside chest examinations compared with those for a 400-speed conventional radiography system, as well as dose increases of 33%–58% for a range of other examinations. In addition, Busch (13) reported that for bedside chest radiography, storage phosphor technology has exposure parameters corresponding to a 400-speed screen-film image. There is thus uncertainty in the literature about the magnitude and direction of any change in dose that can be achieved for radiographic examinations, including bedside chest examinations.

MacMahon and Giger (10) have suggested that the number of chest examinations that are bedside examinations is increasing and is between 40% and 50% in several large medical centers in the United States. This study was performed to determine, with a randomized controlled trial, whether there was any statistically significant difference between patient doses for bedside chest examinations when computed and conventional radiography systems were used. The authors are not aware of any other studies in which these patient doses have been measured within a randomized controlled trial.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Background
This work formed part of an evaluation of a mini picture archiving and communication system that linked the radiology department with an intensive care unit (ICU). The ICU contained eight beds and was part of a 550-bed district general hospital at Glan Clwyd Hospital in North Wales that serves a resident population of 175,000, with an additional influx of summer tourists. The computed radiography system had been operating for 1 year before the evaluation study commenced. A conventional screen-film system was also in routine use in the hospital. Since the two systems were already being used, the research design chosen was a randomized controlled trial that included a contemporaneous comparison of patient doses. The approval of the ethics committee was obtained, and all patients, predominantly adults, who were admitted to the ICU were included in the trial.

Comparison of Radiographic Systems
The computed radiography system (CR 3110 KESPR; Kodak Ektascan Storage Phosphor Reader; Kodak, Rochester, NY) was situated in a room adjacent to the ICU and linked to the radiology department via an Ethernet network (IEEE 10 Base 5, ISO 88027). This system used 43 x 35-cm general purpose phosphor plates (GP-25; Kodak), which are also used by another system (CR 400; Kodak). Soft-copy images were used by the clinicians in the ICU when making decisions about the treatment of the patients. The radiologists chose to report from hard-copy images in the radiology department. The conventional screen-film system used films (TMat LRA; Kodak) with screens (Lanex Regular; Kodak) with a combined speed class of 400. The films were processed in a daylight processor (X-OMAT RA 480; Kodak) with 45-second processing by using developer (RA/30; Kodak) and fixer (LO RP; Kodak). If the computed radiography unit was out of service, the conventional radiography system was used in the ICU.

Study Period
During the period from February 1995 to February 1996, data were recorded prospectively for each radiographic examination in each patient. If it was necessary to repeat an examination because the image was unsatisfactory, data were also collected for the repeat exposure. Details of the data collected are shown in Table 1. At the end of this 1-year period, the data were analyzed.


View this table:
[in this window]
[in a new window]

  		TABLE 1. Data Collected by Radiographers for Each Examination
 
Randomization Process
At admission to the ICU, each patient was randomly allocated to have all radiographic images obtained by using either the computed radiography or conventional screen-film system. The randomization process was determined by an ICU nurse opening an opaque envelope with a tamper-proof seal. A record was kept of the order in which the patients were admitted to the ICU, and a check was made to ensure that the randomization sequence was correct. Each envelope contained colored adhesive labels indicating the arm of the trial to which the patient was allocated, the order having been determined by tossing a coin. The envelopes were numbered and stored in a box at the reception desk for the ICU, and the nurse opened the top envelope. If the patient was readmitted to the ICU during the trial, the patient remained in the same arm of the trial as allocated at the first admission. The colored labels were attached to a study form located on the wall of the ICU and to the patients’ nursing records stored at the foot of the patients’ beds. By using this method, the nurses, radiographers, and clinical staff could obtain information about the arm of the trial to which each patient was allocated.

Measurement of Doses and Associated Exposure Conditions
The aim was that on each occasion when a radiographer went to the ICU to perform chest radiographic examinations, the radiation dose to the patient should be measured. To do this, a thermoluminescent dosimeter (TLD) was attached to the front of the patient’s chest at the centering point. A separate, numbered TLD was used for each exposure. The TLDs were obtained from, calibrated by, and read by the National Radiological Protection Board, or NRPB (14). The TLDs were obtained, by mail, in batches of 70 or 100 and stored away from sources of radiation in a labeled box in the room in which the computed radiography processor and quality control workstation were housed. Used (exposed) TLDs were placed in a separate labeled box in the same room. This box also contained the control TLDs used to monitor background radiation.

Details of the exposure factors used and the conditions in which each examination was conducted were recorded. At the time of the study, secondary radiation grids and automatic exposure devices were not used for bedside chest examinations in the ICU. The radiographers routinely used the mobile radiography unit (Explorer PX301V; Picker International, Highland Heights, Ohio), which was kept in the ICU. This unit was a three-phase 12-pulse generator battery unit with a single-focus focal spot of 0.75 mm. If this was out of operation, another mobile unit was brought to the ICU. An anonymous code was used to record the identity of the radiographer who performed each examination.

The position of the patient was determined by the patient’s condition. All patients in the ICU are very sick and are invariably examined in bed in the anteroposterior position. When possible, the patients are examined erect, but if the patient is too unwell to adopt this position, the semierect or supine position is used. When the patient is supine, the distances between the x-ray tube head and both the patient and the imaging plate are restricted by the maximum height to which the tube head can be moved vertically. When the patient is erect or semierect, longer distances can be achieved. Ideally, long distances are used to produce less magnification of the image and give an accurate heart size (15).

The effective doses were calculated by using a software package (SR262; National Radiological Protection Board, Chilton, Oxon, United Kingdom) (16). The calculations required the use of surface entry doses as measured by means of the TLD and the tube kilovoltage used for each exposure.

Data Analysis
The data were analyzed by using a commercially available statistical analysis software package (SAS version 6; SAS Institute, Cary, NC). The analysis was performed first according to the actual modality that was used for each examination. The analysis according to "intention to treat" (ie, the modality to which the patient was randomly assigned rather than the modality actually used) (17) was also performed. This was of interest because, if the patient underwent imaging with the incorrect modality, the radiographer may have used experience gained from a previous examination with the other modality, and this may have influenced practice. For example, if it was seen that the exposure factors were incorrect, these could be modified for subsequent images.

The comparability of the study patients in the two arms of the trial was investigated by comparing groups in terms of general characteristics: age, sex, and thickness of the chest (ie, focus-to-film distance minus focus-to-skin distance). Comparisons of the radiographic techniques used were made by comparing the exposure factors (kilovoltage, milliampere seconds, focus-to-film distance), mobile unit used, patient position, and radiographer performing the examination.

Doses for conventional and computed radiography were compared on the basis of the surface entry doses for one study for each patient. Some patients underwent many studies during their stay in the ICU, whereas others underwent only one and some underwent no studies at all. Since the patient was the unit of randomization, it would have been inappropriate to analyze the dose data with the study as the unit because some patients underwent more than one study. Thus, the study dose data are repeated measures and do not represent independent observations. To assess the importance of any missing dose data, observations for which dose data were missing were compared with observations for which dose data were available.

All comparisons of data between the groups in the two arms of the trial were made by using the Mann-Whitney and Student t tests for continuous data, depending on their distribution ("not normal" and "normal," respectively) and {chi}2 tests for comparisons of proportions. A P value less than .05 was considered to indicate a statistically significant difference.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
During the period of this study, 414 patients were admitted to the ICU and included in the study. Of these, 269 (65%) patients (168 male patients, 99 female patients, two unknown; age range, 1.1–94.3 years; mean age, 59 years) underwent imaging during their stay in the ICU, and 928 chest images were obtained (Figure). Dose data were available for 198 patients—103 (66 male patients, 37 female patients; age range, 5.7–87.7 years; mean age, 60.2 years) who underwent computed radiography and 95 (56 male patients, 38 female patients, one unknown; age range, 2.5–89.4 years; mean age, 57.3 years) who underwent conventional radiography.



View larger version (19K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1. Bar graph shows the number of chest examinations per patient: 61% of patients who underwent radiography underwent a single chest examination while in the ICU; the mean number of examinations was 3.3. One patient (not shown) underwent 81 chest examinations.

 
Patient Characteristics
The patients in the two arms of the trial were well matched for sex ({chi}2, P = .22), age (Mann-Whitney, P = .98), and thickness of the chest (Student t test, P = .75) (Table 2).


View this table:
[in this window]
[in a new window]

  		TABLE 2. Patient Characteristics
 
Exposure Conditions
Statistically significant increases in both kilovoltage (Mann-Whitney, P < .001) and milliampere seconds (Mann-Whitney, P = .002) were found when computed radiography was used. Neither the focus-to-skin distance nor the focus-to-film distance differed significantly between the two groups (Table 3). This implies that there is unlikely to have been a difference between the two groups in the use of nonroutine ICU beds—for example, specialized beds (Clinitron; Hill-Rom, Charleston, NC), which might have resulted in larger patient-to-film or patient-to-plate distances. There were no statistically significant differences in patient position during the study: for patients who underwent imaging with computed radiography, 102 were supine, 15 were semierect, and four were erect; for patients who underwent imaging with conventional radiography, 101 were supine, 15 were semierect, and four were erect ({chi}2, P = .99) or underwent imaging with the mobile unit used to perform the examination ({chi}2, P = .434).


View this table:
[in this window]
[in a new window]

  		TABLE 3. Examination Conditions
 
Patient Doses
There was a statistically significant increase in the surface entry dose per study (Mann-Whitney, P = .003) when computed radiography was used (Table 4).


View this table:
[in this window]
[in a new window]

  		TABLE 4. Patient Doses
 
The median entry doses were 0.21 mGy for computed radiography and 0.16 mGy for conventional radiography—an increase of 31% in moving from conventional to computed radiography. Similarly, the median effective dose was significantly higher, by 33%, for computed radiography (Mann-Whitney, P = .002).

There was a significant difference between groups ({chi}2, P = .01) in the number of repeat exposures. The majority—more than 90%—of examinations for both groups did not need to be repeated, but there were fewer repeat studies in the computed radiography group (three of 117 patients) than in the conventional radiography group (11 of 101 patients).

Dose data were missing in 71 (26%) patients in the study. No important differences were found between groups for which data were missing and those for which data were available.

The dose data were reanalyzed on the basis of intention to treat. There was no difference in the nature of the results obtained.


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
REFERENCES
 
Dose data were missing for 71 patients, likely for one of three reasons: there were no TLDs available in the ICU for the radiographer to use, it was not possible to match the TLD reading provided by the National Radiological Protection Board with other data on the exposure, or the radiographer did not comply with the data collection process and failed to use a TLD. It was rare for the radiographers not to cooperate with this study. To assess the importance of the missing dose data problem, comparison was made of the observations for which dose data were missing with the observations for which the data were available. No important differences between groups were found.

The results of this study show an important negative aspect of the computed radiography installation in this hospital. The median patient radiation surface entry dose per exposure was 31% higher for computed radiography. This finding is of concern, particularly since some patients underwent several examinations. For example, one patient underwent 81 radiographic examinations of the chest while in the ICU. However, the increase in dose in this study must be seen in the context of a comparison with a 400-speed screen-film system.

In another similar study (18), which was performed by two of the authors of this article, no change in surface entry and effective doses for lateral lumbar spine were found when the Hammersmith Hospital (London, England) replaced its 300-speed screen-film system with a hospitalwide picture archiving and communication system in which phosphor plate imaging (AC-1; Fuji Medical Systems, Tokyo, Japan) was used. Thus, the findings of this trial are neither entirely unexpected nor in contradiction with those of other studies.

The small but significant ({chi}2, P = .01) reduction in the number of examinations that had to be repeated. The rejection rate for all ICU images at Glan Clwyd Hospital was small; however, the reduction in repeat studies might be more important in other hospitals with higher repeat rates. At this hospital, when computed radiography was used, the dose saved by fewer repeated examinations did not compensate for the dose increase due to the sensitivity of the computed radiography plates.

The increase in patient doses found in this study must be put into perspective. The difference in the effective dose per examination between conventional and computed radiography was approximately 0.01 mSv. The mean number of examinations per patient who underwent imaging was 3.3, so the additional effective dose per patient with computed radiography was 0.033 mSv. The effective doses for chest examinations is low compared with those for other body areas, such as an anteroposterior view of the abdomen or pelvis, each of which has a typical effective dose of 0.7 mSv (19).

For the group of 269 patients in this study, who underwent a total of 928 chest examinations, the increase in collective effective dose was approximately 10 mSv (20). In this population, in which the mean age was approximately 59 years, the risk is 3.5% per sievert (20), and the use of the computed radiography imaging system represented an increased risk of 0.00035 of the patients developing a fatal cancer, other cancer, or other serious defect, including hereditary effects during the course of their life. Thus, nearly 1 million patients, of similar age, would each have to undergo 3.3 chest examinations with use of this system to produce one additional health defect in this population.

An alternative way of looking at this issue is in terms of the expected loss of life years associated with the dose increase. The total loss in life years to this population of 269 patients if they had all undergone computed radiography examinations of the chest during the study period is approximately 2.7 days (21). The risk associated with exposure to radiation is related to the age of the patient; older patients have a lower risk. The majority of study patients were more than 65 years of age at admission to the ICU, and the calculation given earlier has taken this into account. Therefore, although an increase in patient doses was found in this study, the increased risk to this population is small. However, if this imaging system were used more widely for the examination of other body areas that require the use of higher exposure factors, or in a younger population, and a similar increase in effective dose were seen, there would be an increased risk to the population, which might be of greater importance.

In conclusion, the doses for bedside imaging of the chest in adult patients with use of this computed radiography system were approximately the same as those for a 300-speed screen-film system. When computed radiography systems that use phosphor plate imaging replace imaging systems with speeds higher than 300, there is an increase in the dose to adult patients for bedside chest examinations.


   ACKNOWLEDGMENTS
 
The authors thank the radiographers, anesthetists, radiologists, and all staff in the Radiology Department and Intensive Therapy Unit at Glan Clwyd Hospital for their help with this study; Ian Russell, PhD, FRCGP, FRCPEdin, Department of Health Sciences, University of York, and Martin Buxton, Health Economics Research Group, Brunel University, for their continuing support and valuable advice; and Karen Arnold for her secretarial expertise.


   FOOTNOTES
 
2 Current address: Health Services Management Centre, University of Birmingham, England. Back

3 Current address: Department of Radiology, Glan Clwyd Hospital, Bodelwyddan, Clwyd, Wales. Back

**. Multiple body systems Back

Abbreviations: ICU = intensive care unit, TLD = thermoluminescent dosimeter

Author contributions: Guarantor of integrity of entire study, G.C.W.; study concepts, G.C.W., S.B.; study design, all authors; definition of intellectual content, G.C.W., S.B.; literature research, G.C.W.; clinical studies, J.G.D.; data acquisition, all authors; data analysis, G.C.W., S.B.; statistical analysis, G.C.W., S.B.; manuscript preparation, G.C.W.; manuscript editing, G.C.W., S.B.; manuscript review, all authors.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 

  1. Tylen U. Stimulable phosphor plates in chest radiology. Eur Radiol 1997; 7(suppl 3):S83-S86.
  2. Sagel SS, Jost RG, Glazer HS, Molina PL, Anderson DJ. Digital mobile radiography. J Thorac Imaging 1990; 5:36-48.[Medline]
  3. De Silva M. Computed radiography in pediatric radiology. Semin Roentgenol 1997; 32:57-63.[Medline]
  4. Artz DS. Computed radiography for the radiological technologist. Semin Roentgenol 1997; 32:12-24.[Medline]
  5. Bowman JE. The future is now: digital radiography. Bytes Imaging’s Future 1998; 30:12-15.
  6. Weatherburn GC, Bryan S, West M. A comparison of image reject rates when using film, hard copy computed radiography and soft copy images on picture archiving and communication systems (PACS) workstations. Br J Radiol 1999; 72:653-660.[Abstract]
  7. Murphey MD, Quale JL, Martin NL, Bramble JM, Cook LT, Dwyer SJ. Computed radiography in musculoskeletal imaging: state of the art. AJR Am J Roentgenol 1992; 158:19-27.[Abstract/Free Full Text]
  8. Pettersson H, Aspelin P, Boijsen E, Herrlin K, Egund N. Digital radiography of the spine, large bones and joints using stimulable phosphor: early clinical experience. Acta Radiol 1988; 29:267-271.[Medline]
  9. Galanski M, Prokop M, Thorns E, et al. The visibility of a central venous catheter using digital luminescence radiography in intensive care radiology. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1992; 156:68-72[German].[Medline]
  10. MacMahon H, Giger M. Portable chest radiography techniques and teleradiology. Radiol Clin North Am 1996; 34:1-20.[Medline]
  11. Sandmayr H, Wallentin D. Computer integrated radiology system: analogue goes digital. Eur Radiol 1997; 7(suppl 3):S90-S93.
  12. Bragg DG, Murray KA, Tripp D. Experiences with computed radiography: can we afford the cost?. AJR Am J Roentgenol 1997; 169:935-941.[Abstract/Free Full Text]
  13. Busch HP. Digital radiography for clinical applications. Eur Radiol 1997; 7(suppl 3):S66-S72.
  14. Shrimpton P, Hillier M, Bungy D. Radiological protection bulletin 156 Chilton, United Kingdom: National Radiological Protection Board, 1994; 13-16.
  15. Bryan GJ. Diagnostic radiography: a concise practical manual 4th ed. Edinburgh, United Kingdom: Churchill Livingstone, 1995.
  16. Hart D, Jones D, Wall B. Normalised organ doses for medical x-ray examinations calculated using Monte Carlo techniques NRPB-SR262 Chilton, United Kingdom: National Radiological Protection Board, 1994.
  17. Schwartz D, Lellouch J. Explanatory and pragmatic attitudes in therapeutical trials. J Chronic Dis 1967; 20:637-648.[Medline]
  18. Weatherburn GC, Bryan S. The effect of a picture archiving and communication system (PACS) on patient radiation doses for examination of the lateral lumbar spine. Br J Radiol 1999; 72:534-545.[Abstract]
  19. Wall BF, Hart D. Revised radiation doses for typical x-ray examinations: report on a recent review of doses to patients from medical x-ray examinations in the UK by NRPB—National Radiological Protection Board. Br J Radiol 1997; 70:437-439.[Medline]
  20. International Commission on Radiological Protection. Recommendations of the International Commission on Radiological Protection Oxford, United Kingdom: Pergamon Press, 1990; Publication 60.
  21. Robb JD, Webb GAM. Values of unit collective dose for use in the 1990s NRPB-4 Chilton, United Kingdom: National Radiological Protection Board, 1993; 77-80.



This article has been cited by other articles:


Home page
 RadioGraphicsHome page
M. Korner, C. H. Weber, S. Wirth, K.-J. Pfeifer, M. F. Reiser, and M. Treitl
Advances in Digital Radiography: Physical Principles and System Overview
RadioGraphics, May 1, 2007; 27(3): 675 - 686.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
E. Vano, J. M. Fernandez, J. I. Ten, C. Prieto, L. Gonzalez, R. Rodriguez, and H. de Las Heras
Transition from Screen-Film to Digital Radiography: Evolution of Patient Radiation Doses at Projection Radiography
Radiology, May 1, 2007; 243(2): 461 - 466.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Radiol.Home page
G Compagnone, M C. Baleni, L Pagan, F L Calzolaio, L Barozzi, and C Bergamini
Comparison of radiation doses to patients undergoing standard radiographic examinations with conventional screen-film radiography, computed radiography and direct digital radiography.
Br. J. Radiol., November 1, 2006; 79(947): 899 - 904.
[Abstract] [Full Text] [PDF]

Home page
 Radiat Prot DosimetryHome page
S. Mazzocchi, G. Belli, S. Busoni, C. Gori, I. Menchi, P. Salucci, A. Taddeucci, and G. Zatelli
AEC set-up optimisation with computed radiography imaging
Radiat Prot Dosimetry, December 1, 2005; 117(1-3): 169 - 173.
[Abstract] [Full Text] [PDF]

Home page
 Radiat Prot DosimetryHome page
V. Neofotistou, V. Tsapaki, S. Kottou, A. Schreiner-Karoussou, and E. Vano
Does digital imaging decrease patient dose? A pilot study and review of the literature
Radiat Prot Dosimetry, December 1, 2005; 117(1-3): 204 - 210.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Radiol.Home page
L Gonzalez, R Fernandez, V Ziraldo, E Vano, and R Ortega
Reference level for patient dose in dental skull lateral teleradiography
Br. J. Radiol., September 1, 2004; 77(921): 735 - 739.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
E. Vano, J. M. Fernandez, J. I. Ten, E. Guibelalde, L. Gonzalez, and C. S. A. Pedrosa
Real-Time Measurement and Audit of Radiation Dose to Patients Undergoing Computed Radiography
Radiology, October 1, 2002; 225(1): 283 - 288.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Weatherburn, G. C.
Right arrow Articles by Davies, J. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weatherburn, G. C.
Right arrow Articles by Davies, J. G.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE