Clinical utility of ultra-low-dose pre-test exposure to avoid unnecessary patient exposure due to positioning errors: a simulation study

The use of digital radiographic systems has decreased the frequency of image retakes due to over/underexposure in general radiography. However, image retakes owing to patient positioning errors are likely to increase because of the convenience of a real-time image check on a console table. The purpose of the present study is to propose a novel radiographic examination procedure with an ultra-low-dose pre-test exposure that may be utilized to check patient positioning prior to taking an actual image, thereby reducing unnecessary patient exposure owing to image retakes. In this study, examination data from 714 knee joint radiographs, both submitted and retaken images, were included. Twelve radiological technologists (RTs) took all images. The actual total exposure dose for each patient was compared with simulated total doses utilized in the proposed procedure. The simulation assumed that each examination was completed following pre-test exposure. Therefore, this method did not involve retaking images although at least one pre-test exposure had been applied to all patients. Pre-test exposures at four dose levels corresponding to 25, 10, 5, and 2% of the actual exposure dose were evaluated to determine whether each dose level could be used to check patient positioning. The results indicated that when the pre-test exposure dose rate was 10% or lower, the total exposure dose reduction equaled or exceeded 8% for all patients. The use of the proposed procedure reduced the total exposure dose for all patients when compared to the exposure dose calculated from records.