Trauma is an injury that can be life threatening and cause psychological and physical impacts. Recently, in Saudi Arabia, the number of traffic accidents and their effects has increased significantly. There is no clear protocol to describe radiation exposure of patients during radiation investigations. The usual radiation exposure varies between 10 and 100 mGy, which may increase the possibility of cancer incidence, especially among a population with high exposure [1-3]. Trauma x-ray imaging is one of the most common diagnostic tools used to analyze and identify pathological conditions [4-5]. However, it results in a significant radiation dose to patients. Because the applications of trauma radiology are growing quickly, it is crucial to appraise the radiation dosages during the examination and try to reduce them as much as possible [6-7]. Demographic data and exposure measurements are needed for all patients who are admitted to the radiology department. Radiation exposure is a main hazard in medical x-ray investigations [8]. Those exposures result from improper use of equipment and high exposure factors. The existence of diverse dose standards for exposure for the same medical investigation is a sufficient reason to draw attenuation to this matter. Radiation exposure can result in severe injuries and, possibly, cancer. Radiation medical imaging is used commonly for trauma assessment [9-10]. Imaging examinations help in the appropriate analysis of numerous disorders. They provide quick and precise analysis for the emergency physicians for the judgment of the serious afflictions in patients, particularly in some patients whose injuries are difficult to diagnose [11]..

Background: Radiation exposure is the main hazard in medical x-ray investigations. The aim of this study was to evaluate the radiation dose received in x-rays examination for trauma patients in the Majmaah area. The results were compared with other national and international findings. Furthermore, the reference radiation dose level was measured for different examinations by conventional x-rays. Thus, a conventional x-ray examination of trauma patients was investigated.

Materials and Methods: Seven hundred patients were evaluated at King Khaled Hospital, Majmaah. The average and range of exposure parameters were 73.5±9.1 (65.9–124.9) and 2.7±0.71 (0.2–9.6) for x-ray tube potential (kVp) and current multiplied by the exposure time (s) (mAs), respectively.

Results: The entrance surface air kerma dose measured for chest (PA), skull (AP and LAT), lumbosacral (AP and LAT), and knee joint (AP and LAT) were 0.20+0.07 with a range of 0.13–0.37, 0.86±0.01 with a range of 0.09–2.92 and 0.09±0.02 with a range of 0.04–0.17, 0.10 ± 0.02 with a range of (0.04–0.17 and 0.1±0.02 with a range of 0.03–0.16, and 0.86±0.01 with a range of 0.09–2.92, respectively. The measured doses for pediatric patients were 0.20±0.07 (0.13–0.37) and 0.18±0.03 (0.06–0.23) for female and male patients, respectively.

Conclusion: It was concluded that 90% of the procedures had normal findings. However, a precise justification is required, especially for young patients. For dose measurement techniques, the machine- and patient-related factors must be fixed in order to obtain accurate results.

Materials and Methods

Sample and Definition Research

A survey of 700 patients at King Khaled Hospital, Majmaah, Saudi Arabia's radiological department, was carried out from October 2018 to June 2019. The institutional review board (IRB) of King Abdelaziz City for Science and Technology (KACST) and the Ministry of Health, Saudi Arabia, have endorsed all data gathering techniques used for the study.

Specification of Radiography System

The Siemens AXIOM imaging system (Germany 2014, model AlOIC) with pipe filtration 2.0–3.0 mm AL/70 kVp, was used.

Dose Measurement Technique

Entrance surface air kerma (ESAK) (mGy) was assessed for evaluating the x-ray scans of the head, skull, lumbosacral joint, and knee joint. This dose was used to measure ionizing radiation for trauma radiology patients nationally and internationally, consistent with previous studies. Data were analyzed using version 22 of the SPSS software, and results were obtained as graphs and tables. Thermoluminescent dosimeters (TLDs) were additionally used for dosage evaluation in this study. They were equipped with separate electrodes (LIF: MG and Cu) and ranged between .001 rad and 100 Gy.

Statistical Analysis

All data from this study are shown as mean plus standard range variability. Analysis of variance and t-tests were used for statistical analysis using SPSS under Windows.

Table 1 shows mean, median, minimum, and maximum values of the patients' weight, height, and body mass index (BMI) for both genders in this study. Table 2 shows the mean age of the patients for both genders in this study and the exposure factors logged for each patient during the examination of each projection. The exposure factors logged were projection, kVp, mA, time, field size, part under examination, and tube-to-film distance. This study involved 700 patients (80% of the patients were males and 20% were females) undergoing chest, skull, lumbosacral, and knee joint x-ray examinations in the radiology departments at King Khalid Hospital in Majmaah. Table 3 shows the measured doses in patients at the King Khalid Hospital, Majmaah, and at other national and international hospitals. The doses were compared to national and international radiation dose limits. The measured ESAK for chest (PA), skull (anteroposterior (AP) and lateral (LAT)), lumbosacral joint (AP and LAT), and knee joint (AP and LAT) were recorded (Tables 3–5). These amounts were dissimilar in patients at King Khalid, Majmaah and other Saudi hospitals (KKUH, KACST, and SFH) and at international locations such as the UK, China, Greece, Canada, and Italy and organizations such as the International Atomic Energy Agency (IAEA) and the Health Physics Society (HPS). The measured dose for chest x-rays in this study was 0.20±0.07 mGy with a range of 0.13–0.37 mGy, while the lowest amount was 0.02 mGy at the HPS and the highest level was 0.69 mGy in Greece. The measured dose for PA projection of skull x-rays in this study was 0.86±0.01 mGy with a range of 0.09–2.92 mGy, while the lowest dose level was 0.86 mGy in King Khalid, Majmaah and the highest level was 5.0 mGy in IAEA. Nevertheless, the measured dose for lateral projection of skull x-rays in this study was 0.09+0.02 mGy with range of (0.04–0.17 mGy), while the lowest dose level was 0.69 mGy in Nigeria, and the uppermost level was 3.00 mGy for the IAEA. The measured dosage for AP projection of lumbosacral joint x-ray scans in this study was 8.27±3.01 mGy with a range of 0.20–22.3 mGy. The lowest dose level was 0.20 mGy in King Khalid, Majmaah, while the highest level was 40 mGy in KACST. Nevertheless, the measured dosage for lateral projection of lumbosacral joint x-rays in this study was 10.04±3.43 mGy with a range of 2.05–29.21 mGy. The lowest dose level was 1.17 in King Khalid University Hospital (KKUH), while the highest level was 44 mGy in Greece (Tables 3–5).

The measured dose for AP projection of knee joint x-ray scans in this study was 0.10±0.02 mGy with a range of (0.02–0.17 mGy), which was the lowest dose level, while the highest level was 0.30 mGy in KKUH. Nevertheless, the measured dose for lateral projection of knee joint x-ray scans in this study was 0.1±0.02 mGy with a range of (0.03–0.18 mGy), which was the lowest dose level. The highest level was 0.33 mGy in KKUH (Tables 3–5).

Table 1. Patient demographic features

Patients (male: n = 560, 80.0%, female: n = 140, 20.0%), age: 37.1 ± 13.3 years with range of 18-63 years

Table 2. Patient x-ray image acquisition features

Table 3. Mean and standard deviation of radiation dose measured in King Khalid Hospital, Majmaah and national and international hospitals for chest, skull, lumbosacral joint, and knee joint  

Table 4. Mean values of entrance skin dose (ESD) (mGy) of chest examination for all age groups of the study sample

Table 5. Correlation between the entrance skin dose (ESD) and the body characteristics (p < 0.05)

Finally, in this study, it was found that radiation amounts for chest (PA), skull (AP, LAT), lumbosacral joint (AP, LAT), cervical (AP, LAT), and knee joint (AP, LAT) for the entire examination were higher. The ESDs for conventional radiology were lower in AP than those for lateral projection and LA/LS, respectively. Unlike in previous studies, the dose in L/S radiography was higher in conventional radiography compared with other techniques. Recently, DR and CR have become more popular because the important advantages of digital imaging are cost-effectiveness and ease of access. Therefore, the importance of dose optimization during conventional radiology imaging must be considered. This study concluded that the doses for chest, skull, cervical, and knee joints were lower than in other comparable studies nationwide and globally. The dose in L/S radiography was higher in conventional radiography compared with other techniques. Recently, the utilization of an automatic exposure calculator has become more useful and reduced the dose to patients. CR is becoming more popular because of its value, access, and good dose changes. This study should help investigators discover the critical parts of radiation protection in trauma radiology departments that many investigators have not been able to explore.

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The author thanks the Deanship of Scientific Research at Majmaah University for funding this research [Project No. 38/147].