Investigating the adjacent patient radiation dose received during a simulated ward chest X-ray examination

Patient radiation dose received from a chest X-ray


  • Hayley Langfield Radiology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
  • Paul Lockwood School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Kent, United Kingdom



Chest X-ray, Dose, Radiation, Radiography


Introduction: A patient having a chest X-ray will inevitably be exposed to radiation from the primary beam. Using a light beam diaphragm (LBD) on the X-ray tube reduces scattered radiation at the X-ray tube through longitudinal and horizontal collimation. But not scattered secondary radiation resulting from interactions of the primary beam. This study aimed to investigate whether lead protection on simulated hospital ward inpatients (opposite and adjacent to a simulated chest X-ray examination) would change the secondary scattered radiation dose received.

Method: Two rando phantoms (simulated patients) were positioned at different distances from the simulated patient receiving the chest X-ray. The phantoms were positioned one metre adjacent (either side of the phantom being X-rayed) and two metres opposite. The scattered radiation dose to radiosensitive organs (thyroid, breast, and gonads) was recorded using Thermoluminescent Dosimeters (TLDs). Six exposures were conducted, three with lead protection and three without. The mean radiation dose and standard deviation were compared using a paired two-sample t-test for statistical significance (p>0.05).

Results: The lead protection reduced the radiation dose to the radiosensitive organs by 64%-100% (p=0.51-0.18) one metre adjacent and 65%-100% (p=0.65-0.18) two metres opposite. Noticeably the phantom two metres opposite had substantial individual organ dose reductions due to the distance from the primary beam.

Conclusion: Lead aprons, thyroid collars, and distance reduced the radiation dose to the radiosensitive organs of the surrounding phantoms (simulated patients) from an adjacent chest X-ray examination and present opportunities for dose reduction techniques during ward chest X-ray examinations.


UK Government. The Ionising Radiation (Medical Exposure) Regulations 2017. UK Statutory Instruments; 2017.

Hayre C, Bungay H, Jeffery C, Cobb C, Atutornu J. Can placing lead-rubber inferolateral to the light beam diaphragm limit ionising radiation to multiple radiosensitive organs? Radiography. 2018;24(1):15-21. doi:10.1016/j.radi.2017.09.002

Roser P, Zhong X, Birkhold A, et al. Simultaneous Estimation of X-Ray Back-Scatter and Forward-Scatter Using Multi-task Learning. In: Medical Image Computing and Computer Assisted Intervention–MICCAI 2020: 23rd International Conference, Lima, Peru, October 4–8, Proceedings, Part II 23 . ; 2020:199-208. doi:10.1007/978-3-030-59713-9_20

Boone MN, Vlassenbroeck J, Peetermans S, van Loo D, Dierick M, van Hoorebeke L. Secondary radiation in transmission-type X-ray tubes: Simulation, practical issues and solution in the context of X-ray microtomography. Nucl Instrum Methods Phys Res A. 2012;661(1):7-12. doi:10.1016/j.nima.2011.09.046

Shaw DJ, Crawshaw I, Rimmer SD. Effects of tube potential and scatter rejection on image quality and effective dose in digital chest X-ray examination: An anthropomorphic phantom study. Radiography. 2013;19(4):321-325. doi:10.1016/j.radi.2013.07.007

Cho PK. Distribution of the Scatter Ray on Chest X-ray Examinations. The Journal of the Korea Contents Association. 2012;12(7):255-260. doi:10.5392/JKCA.2012.12.07.255

Oh HJ, Kim SS, Kim YI, et al. A study on the directional dependence of scatter ray in radiography. Journal of radiological science and technology . 1995;18(1):63-67.

Geleijns J, Schultze Kool LJ, Zoetelief J, Zweers D, Broerse JJ. Image Quality and Dosimetric Aspects of Chest X Ray Examinations: Measurements with Various Types of Phantoms. Radiat Prot Dosimetry. 1993;49(1-3):83-88. doi:10.1093/rpd/49.1-3.83

Veldkamp WJH, Kroft LJM, Boot M v., Mertens BJA, Geleijns J. Contrast-detail evaluation and dose assessment of eight digital chest radiography systems in clinical practice. Eur Radiol. 2006;16(2):333-341. doi:10.1007/s00330-005-2887-6

Ma WK, Hogg P, Tootell A, et al. Anthropomorphic chest phantom imaging – The potential for dose creep in computed radiography. Radiography. 2013;19(3):207-211. doi:10.1016/j.radi.2013.04.002

Al-Murshedi S, Hogg P, England A. Relationship between body habitus and image quality and radiation dose in chest X-ray examinations: A phantom study. Physica Medica. 2019;57:65-71. doi:10.1016/j.ejmp.2018.12.009

Burrage JW, Rampant PL, Beeson BP. Scatter and transmission doses from several pediatric X-ray examinations in a nursery. Pediatr Radiol. 2003;33(10):704-708. doi:10.1007/s00247-003-0999-1

Trinh AM, Schoenfeld AH, Levin TL. Scatter radiation from chest radiographs: is there a risk to infants in a typical NICU? Pediatr Radiol. 2010;40(5):704-707. doi:10.1007/s00247-009-1474-4

UK Government. The Ionising Radiations Regulations 2017 . UK Government; 2017. Accessed October 4, 2022.

McVey G, Weatherburn H. A study of scatter in diagnostic X-ray rooms. Br J Radiol. 2004;77(913):28-38. doi:10.1259/bjr/93969091

Simpkin DJ, Dixon RL. Secondary Shielding Barriers for Diagnostic X-Ray Facilities. Health Phys. 1998;74(3):350-365. doi:10.1097/00004032-199803000-00008

Landauer. ⅛" x ⅛" x 0.15" TLD-100H . TLD chip: single point radiation assessments. Published 2022. Accessed October 4, 2022.

Carbolite Gero. TLD/3 Rapid Cooling Oven . Accessed October 10, 2022.

Vosper M. Dosimetry 13.6-13.11 . In: A. Ramlaul, ed. Medical Imaging and Radiotherapy Research: Skills and Strategies. Springer International Publishing AG ; 2020:243-251.

Siemens Healthineers AG. X-ray tube Opti 150/30/50HC-100. Published online 2009.

Saint-Gobain crystals and detectors. Thermo Fisher WinREMS software (v.PL-26732. . Published online 2012.

Thermo Electron Corporation. Thermo Fisher Scientific Harshaw TLD Model 5500 Reader with WinREMS Operator’s Manual (5500-0-S-0399-001-S1) .; 2005.

Stratakis J, Papadakis A. Chapter 1 Dosimetry. In: Radiation Dose Management of Pregnant Patients, Pregnant Staff and Paediatric Patients. IOP Publishing; 2019. Accessed October 4, 2022.

Corredor CE. Dose Analysis by Radiation Treatment Planning System (TPS) Software Vs. Thermoluminescent Dosimeters Output. University of Tennessee ; 2004.

Bos AJJ. High sensitivity thermoluminescence dosimetry. Nucl Instrum Methods Phys Res B. 2001;184(1-2):3-28. doi:10.1016/S0168-583X(01)00717-0

Thermo Electron Corporation. Thermo Fisher Scientific Harshaw TLD Model 5500 Reader with WinREMS Operator’s Manual (5500-W-O-0805-006). .; 2005.

Hanna DW. Development and Optimization of a Thermoluminescent Dosimeter (TLD) Analyser System for Low-Dose Measurements Utilizing Photon Counting Techniques. Kansas State University; 1979.

Alderson SW, Lanzl LH, Rollins M, Spira J. An instrumented phantom system for analog computation of treatment plans. Am J Roentgenol Radium Ther Nucl Med. 1962;87:185-195.

AGFA Healthcare. NX3.0 Muscia Acquisition Workstation, AGFA DX-D 40C cassette 43x35cm. Published online 2015.

Winslow JF, Hyer DE, Fisher RF, Tien CJ, Hintenlang DE. Construction of anthropomorphic phantoms for use in dosimetry studies. J Appl Clin Med Phys. 2009;10(3):195-204. doi:10.1120/jacmp.v10i3.2986

Adam Rouilly. AR10A anthropomorphic X-ray/Radiographic positioning Doll. Published online 2020. Accessed May 27, 2023.

ProtecX Medical. One-Piece Regular Lead Apron 0.25 Equivalence. ProtecX Medical . Published 2018. Accessed November 11, 2022.

ProtecX Medical. Thyroid Collar 0.35 Lead Equivalence. ProtecX Medical. Published 2018. Accessed November 11, 2022.

International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP . 2007;103.

Lockwood P, Mitchell M. An assessment of the dose and image quality difference between AP and PA positioned adult radiographic knee examinations. J Med Imaging Radiat Sci. 2023;54(1):123-134. doi:10.1016/j.jmir.2022.12.004

Microsoft 365. Excel. Published online 2022.

Marshall G, Jonker L. An introduction to inferential statistics: A review and practical guide. Radiography. 2011;17(1):e1-e6. doi:10.1016/j.radi.2009.12.006

Flinton DM, Malamateniou C. Quantitative Methods and Analysis. In: Ramlaul A, ed. Medical Imaging and Radiotherapy Research: Skills and Strategies. 2nd ed. Springer; 2020:273-322.

Lakhwani OP, Dalal V, Jindal M, Nagala A. Radiation protection and standardization. J Clin Orthop Trauma. 2019;10(4):738-743. doi:10.1016/j.jcot.2018.08.010

Xie Z, Liao X, Kang Y, Zhang J, Jia L. Radiation Exposure to Staff in Intensive Care Unit with Portable CT Scanner. Biomed Res Int. 2016;2016:1-4. doi:10.1155/2016/5656480

Linet MS, Kim KP, Miller DL, Kleinerman RA, Simon SL, de Gonzalez AB. Historical Review of Occupational Exposures and Cancer Risks in Medical Radiation Workers. Radiat Res. 2010;174(6b):793-808. doi:10.1667/RR2014.1

Martin CJ. A review of radiology staff doses and dose monitoring requirements. Radiat Prot Dosimetry. 2009;136(3):140-157. doi:10.1093/rpd/ncp168

Oyar O, Kislalioglu A. How protective are the lead aprons we use against ionizing radiation. Diagnostic and Interventional Radiology. Published online 2011. doi:10.4261/1305-3825.DIR.4526-11.1

Cupitt JM, Vinayagam S, McConachie I. Radiation exposure of nurses on an intensive care unit. Anaesthesia. 2001;56(2):183-183. doi:10.1046/j.1365-2044.2001.01870.x

UK Government. Ionising Radiation: Dose Comparisons. Ionising Radiation: Dose Comparisons. Published March 18, 2011. Accessed May 2, 2023.

Hayre CM, Bungay H, Jeffery C. How effective are lead-rubber aprons in protecting radiosensitive organs from secondary ionizing radiation? Radiography. 2020;26(4):e264-e269. doi:10.1016/j.radi.2020.03.013

Johansen S, Hauge IHR, Hogg P, et al. Are Antimony-Bismuth Aprons as Efficient as Lead Rubber Aprons in Providing Shielding against Scattered Radiation? J Med Imaging Radiat Sci. 2018;49(2):201-206. doi:10.1016/j.jmir.2018.02.002

Cheon BK, Kim CL, Kim KR, et al. Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management. Korean J Pain. 2018;31(4):244-252. doi:10.3344/kjp.2018.31.4.244

Mitchell EL, Furey P. Prevention of radiation injury from medical imaging. J Vasc Surg. 2011;53(1):22S-27S. doi:10.1016/j.jvs.2010.05.139

Balonov MI, Shrimpton PC. Effective dose and risks from medical x-ray procedures. Ann ICRP. 2012;41(3-4):129-141. doi:10.1016/j.icrp.2012.06.002

Goldhill DR, McNarry AF, Hadjianastassiou VG, Tekkis PP. The longer patients are in hospital before Intensive Care admission the higher their mortality. Intensive Care Med. 2004;30(10):1908-1913. doi:10.1007/s00134-004-2386-2

Menéndez R, Cremades MJ, Martínez-Moragón E, Soler JJ, Reyes S, Perpiñá M. Duration of length of stay in pneumonia: influence of clinical factors and hospital type. European Respiratory Journal. 2003;22(4):643-648. doi:10.1183/09031936.03.00026103




How to Cite

Langfield, H., & Lockwood, P. (2023). Investigating the adjacent patient radiation dose received during a simulated ward chest X-ray examination: Patient radiation dose received from a chest X-ray . Radiography Open, 9(1 in progress), 13–26.

Cited by