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Fluoroscopic vs Blind Positioning: Comparing Entrance Skin Exposure

Background In some institutions, it has become commonplace for some radiographers to use fluoroscopy as an aid in positioning patients for radiographic examinations.

Objective The purpose of this study was to determine which provides a lower dose of radiation to the patient: activating the fluoroscope prior to exposure to aid in positioning or blind positioning using anatomic landmarks.

Methods This study was performed using anthropomorphic, synthetic-bone teaching phantoms of the abdomen and chest/thorax. A radiation monitor controller was used to measure the entrance skin exposure for the examinations. A total of 4 exposures were measured: 2 of the abdomen phantom, including 1 using fluoroscopic-guided positioning (FGP) and 1 using blind positioning; plus 2 exposures of the chest, 1 using FGP and 1 using blind positioning. The amounts of radiation received per exposure were calculated and converted to skin exposure in milliroentgens.

Results The results of this study indicate that FGP increases patient entrance skin exposure (ESE) compared with blind positioning. However, this increase is less than the ESE associated with a repeat examination.

Conclusion The use of FGP reduces ESE compared with repeating an examination. However, FGP is a violation of an ASRT position statement, the American Registry of Radiologic Technologists Standards of Ethics and the as low as reasonably achievable (ALARA) principle. This issue merits further study.