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Radiation Safety in Bedside Digital Radiography: Reducing Exposure

Mark P. Bowes, PhD

*Medical Writer, Portland, Oregon.
Address correspondence to: Mark P. Bowes, PhD, Medical Writer, 7135 SE 18th Avenue, Portland, OR, 97202. E-mail: mpbowes@gmail.com.

Disclosure Statement: Dr Bowes reports having no financial or advisory relationships with corporate organizations related to this activity. 

ABSTRACT

Bedside chest X-ray (CXR) is an essential tool in the diagnosis and monitoring of critically ill patients, many of whom cannot be safely transported to the radiology department for conventional imaging. Patients in the Intensive Care Unit often require frequent imaging to evaluate changes in health status and to confirm the placement and functioning of tubes, lines, and medical devices. Bedside imaging presents many significant challenges, including the presence of medical devices and tubing that interfere with image acquisition and interpretation, difficulties positioning patients, and characteristics of the mobile radiography devices. However, due to the need for frequent imaging in critically ill patients, it is especially important to understand current recommendations regarding the appropriate indications for bedside CXR, and to identify practices that reduce unnecessary radiation exposure for patients, radiologic technologists, and others. Because each radiograph entails additional radiation exposure for patient and healthcare staff, a primary focus of radiation safety has been the use of appropriate patient positioning, collimation, and optimizing other technical aspects of the procedure to reduce the need for repeat images. Digital radiography, although offering many technical advantages over earlier screen-film technology, has also been associated with a trend toward use of higher radiation levels, a phenomenon that has been referred to as "dose creep." Most radiation exposure for radiographers originates from the patient in the form of scattered low-energy radiation. For radiographers, important steps toward reducing occupational exposure include appropriate use of shielding and maintaining a safe distance from the X-ray tube and the patient. This article, which focuses on bedside CXR, examines some of the barriers to image acquisition in the mobile radiography setting, reviews recommendations to improve efficiency and decrease the number of images required, and identifies methods to reduce radiographer exposure.

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