Radiography
Volume 14, Issue 4 , Pages 349-355 , November 2008

Justification of x-ray examinations: General principles and an Irish perspective

Received 23 October 2007 ,Revised 11 January 2008 ,Accepted 23 January 2008.

References 

  1. SI No 478 European Communities (medical ionising radiation protection) regulations. Dublin Stationery Office; 2002;
  2. HPC . Standards of proficiency. London: Radiographers Health Professions Council; 2003;
  3. CEU . Council Directive 97/43 Euratom on health protection of individuals against the dangers of ionising radiation in relation to medical exposure and repealing Directive 84/466 Euratom. Luxembourg: Council of the European Union; 1997;
  4. ICRP . History, policies, procedures. Ann ICRP. 1998;28(Suppl. 1):1–29
  5. Saunders P. Radiation and you. Luxembourg: OOPEC; 1990;
  6. ICRP Draft recommendations of the International Commission on Radiological Protection 2007.
  7. ICRP . Publication 60. 1990 recommendations of the International Commission on Radiological Protection. Ann ICRP. 1991;21:1–3
  8. ICRP . Publication 73. Radiological protection and safety in medicine. Ann ICRP. 1997;26(2):1–31
  9. ICRP . Publication 99. Low dose extrapolation of radiation-related cancer risk. Ann ICRP. 2005;35(4):1–140
  10. Martin CJ. The LNT model provides the best approach for practical implementation of radiation protection. Br J Radiol. 2005;78:14–16
  11. Medical Council . Protocols for standard radiological practice – good practice guidelines as defined by SI 478 of 2002. Irish Medical Council; 2004;<http://www.medicalcouncil.ie/medical_ionising_radiation/default.asp>[accessed 16.04.07]
  12. European Commission . EUR 16260 EN European guidelines on quality criteria for diagnostic radiographic images. Luxembourg: OOPEC; 1996;
  13. European Commission . EUR 16261 EN: European guidelines on quality criteria for diagnostic radiographic images in paediatrics. Luxembourg: OOPEC; 1996;
  14. Almen A, Tinberg A, Mattsson S, Besjakov J, Kheddache S, Lanhede B, et al. The influence of different technique factors on image quality of lumbar spine radiographs as evaluated by established CEC image criteria. Br J Radiol. 2000;73:1192–1199
  15. Brennan PC, Johnston D. Irish X-ray departments demonstrate varying levels of adherence to European guidelines on good radiographic technique. Br J Radiol. 2002;75:243–248
  16. Brennan PC, McDonnell S, O'Leary D. Increasing film–focus distance (ffd) reduces radiation dose for X-ray examinations. Rad Protect Dosimetry. 2004;108(3):263–268
  17. McVey G, Sandborg M, Dance DR, Carlsson ALM. A study and optimization of lumbar spine X-ray imaging systems. Br J Radiol. 2003;76:177–188
  18. Offiah AC, Hall CM. Evaluation of the Commission of the European Communities quality criteria for the paediatric lateral spine. Br J Radiol. 2003;76:885–890
  19. Vano E, Oliete S, Gonzalez L, Guibelalde E, Velasco A, Fernandez JM. Image quality and dose in lumbar spine examinations: results of a 5 year quality control programme following the European quality criteria trial. Br J Radiol. 1995;68:1332–1335
  20. Axelsson B, Petersen U, Wiltz HJ. Digital skeletal radiography. Reduction of absorbed dose by adaptation of exposure factors and image processing. Acta Radiol. 2001;42(6):592–598
  21. Bacher K, Smeets P, Bonnarens K, De Hauwere A, Verstraete K, Thierens H. Dose reduction in patients undergoing chest imaging: digital amorphous silicon flat-panel detector radiography versus conventional film-screen radiography and phosphor-based computed. Am J Roentgenol. 2003;181:923–929
  22. Hufton AP, Doyle SM, Carty HM. Digital radiography in paediatrics: radiation dose considerations and magnitude of possible dose reduction. Br J Radiol. 1998;71:186–199
  23. Neofotistou V, Tsapaki V, Kottou S, Schreiner-Karoussou A, Vano E. Does digital imaging decrease patient dose? A pilot study and review of the literature. Radiat Prot Dosimetry. 2005;117(1–3):204–210
  24. Schreiner-Karoussou A. Dose optimisation in computed radiography. Radiat Prot Dosimetry. 2005;117(1–3):139–142
  25. Tingberg A, Sjöström D. Optimisation of image plate radiography with respect to tube voltage. Radiat Prot Dosimetry. 2005;114(1–3):286–293
  26. European Commission . Referral guidelines for imaging: radiation protection 118. Luxembourg: OOPEC; 2001;
  27. IIR Web site of the Irish Institute of Radiography, available from: <www.iir.ie> [accessed 20.04.07].
  28. Armstrong J. Directive aims to cut X-rays. Irish Times. 7th January 2000;p. 55
  29. Houston M. New EU law aims to stop patients having unnecessary X-rays. Irish Times. 1st May 2000;p. 8
  30. Murray L. Do you really need that X-ray?. <Irishhealth.com><http://www.irishhealth.com/index.html?level=4&id=1759>2002;[accessed 24.04.07]
  31. Oxman AD, Fretheim A, Schünemann HJ. [SURE] Improving the use of research evidence in guideline development: introduction. Health Res Pol Syst. 2006;4:12
  32. RCR . Making the best use of a department of clinical radiology: guidelines for doctors. 5th ed.. London: Royal College of Radiologists; 2003;
  33. Needham G. Guidelines not directives. Br J Radiol. 2002;75:565–566
  34. Goddard P. Guidelines: commentary and controversy. Br J Radiol. 2002;75:291–292
  35. Polmear AF, Kenney IJ, Barnard SA. Should GPs have direct access to imaging for children with urinary tract infections? An observational study. Br J Gen Pract. 1999;49:115–117
  36. Chisholm R. Editorial radiology guidelines. Clin Radiol. 1997;52:409–411
  37. Kerry S, Oakeshott P, Dundas D, Williams J. Influence of postal distribution of The Royal College of Radiologists' guidelines, together with feedback on radiological referral rates, on X-ray referrals from general practice: a randomized controlled trial. Fam Pract. 2000;17:46–52
  38. Morgan B, Mullick S, Harper WM, Finlay DB. An audit of knee radiographs performed for general practitioners. Br J Radiol. 1997;70:256–260
  39. Smith T. Evidence based medical imaging (EBMI). Radiography. 2008;14:233–237
  40. Hampton JR. Guest editorial: from evidence to guidelines. Radiography. 2000;6:75–77
  41. Dhingsa R, Finlay DBL, Robinson GD, Lidicoat AJ. Assessment of agreement between general practitioners and radiologists as to whether a radiation exposure is justified. Br J Radiol. 2002;75:136–139
  42. Medical Council . Policy document on the use of medical ionising radiation. Irish Medical Council; 2005;<http://www.medicalcouncil.ie/medical_ionising_radiation/default.asp>[accessed 16.04.07]
  43. IIR . Authorisation of procedures: clinical guidelines. Dublin: Irish Institute of Radiography; 1999;
  44. Triantopoulou Ch, Tsalafoutas I, Maniatis P, Papavdis D, Raios G, Siafas I, et al. Analysis of radiological examination request forms in conjunction with justification of X-ray exposures. Eur J Radiol. 2005;53:306–311
  45. Bell RE, McLaughlin RE. Ionising radiation (medical exposure) regulations (Northern Ireland) 2000 and their implications for accident and emergency (A&E) doctors in training. Ulster Med J. 2001;70(No. 1):19–21
  46. Morris-Stiff G, Stiff RE, Morris-Stiff H. Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting 1. Ann R Coll Surg Engl. 2006;88(3):270–274[Abstract only]
  47. Kenneally C. An investigation of the clinical information provided on requests for lumbar spine radiography: project dissertation presented for final year examination of the degree of Bachelor of Science (radiography), University College Dublin, Summer Examination 2006. Available from Room A223, Health Sciences, UCD Belfield.
  48. Loy CT, Irwig L. Accuracy of diagnostic tests read with and without clinical information – a systematic review. J Am Med Assoc. 2004;292(13):1602–1609
  49. Rickett AB, Finlay DB, Jagger C. The importance of clinical details when reporting accident and emergency radiographs. Injury. 1992;23(7):458–460
  50. Larsson W, Aspelin P, Bergquist M, Hillerga K, Jacobsson B, Lindsko L, et al. The effects of PACS on radiographer's work practice. Radiography. 2006;1–6
  51. Bury B. X-ray dose training: are we exposed to enough?. Clin Radiol. 2004;59:926–927
  52. Jacob K, Vivian G, Steel JR. X-ray dose training: are we exposed to enough?. Clin Radiol. 2004;928–934

PII: S1078-8174(08)00005-9

doi: 10.1016/j.radi.2008.01.004

Radiography
Volume 14, Issue 4 , Pages 349-355 , November 2008