Evaluation of workload distribution and exposure factors in common use in ten general x-ray rooms in Ireland: An initial step towards protocol optimisation

Introduction: This study aimed to assess current practice in general x-ray rooms in three Irish hospitals. Evaluating the extent to which x-ray protocols are currently standardised can be considered as a preparatory step towards the larger goal of implementing optimisation in a diagnostic radiology department. Methods: Data on various aspects of general x-ray room exposures was manually collected and analysed to highlight variations with exposure factors in use and workload distribution across each of the ten hospital x-ray rooms included in the study. Results: Workload distribution for the x-ray rooms surveyed demonstrated the most commonly performed x-ray, the chest x-ray, to account for 44 % of exposures acquired, compared to the most recently published national statistic of 31 %¹, suggesting a potential change in referral practices over the past decade. A high degree of protocol variation for the same imaging indications exists across the x-ray rooms included in the study, for example there were 14 protocols in routine use for shoulder imaging across the 10 x-ray rooms, spanning a wide range of tube potentials from 55 to 81 kVp. Conclusion: The lack of x-ray protocol standardisation (and associated image quality variation) prompts questions around the implementation of optimisation, as required by Irish legislation, for general x-ray protocols. National review of x-ray referral practices or most common general x-ray exposures in use would be welcomed, as deviations from the previously published dataset are locally evident. Implications for practice: This body of work considers the variety of x-ray protocols in use for specific anatomical areas and outlines how similar analyses at a local level could provide a foundation for targeted optimisation exercises.