Assessment of scattered and leakage radiation from ultra-portable X-ray systems in chest imaging: An independent study.

Ultraportable (UP) X-ray devices are ideal to use in community-based settings, particularly for chest X-ray (CXR) screening of tuberculosis (TB). Unfortunately, there is insufficient guidance on the radiation safety of these devices. This study aims to determine the radiation dose by UP X-ray devices to both the public and radiographers compared to international dose limits. Radiation dose measurements were performed with four UP X-ray devices that met international criteria, utilizing a clinically representative CXR set-up made with a thorax phantom. Scatter and leakage radiation dose were measured at various positions surrounding the phantom and X-ray tube, respectively. These measurements were used to calculate yearly radiation doses for different scenarios based on the median of all UP X-ray devices. From the yearly scatter doses, the minimum distances from the phantom needed to stay below the international public dose limit (1 mSv/year) were calculated. This distance was longest in the direction back towards the X-ray tube and shortest to the left/right sides of the phantom, e.g., 4.5 m and 2.5 m resp. when performing 50 exams/day, at 90 kV, 2.5 mAs and source skin distance (SSD) 1 m. Additional calculations including leakage radiation were conducted at a typical radiographer position (i.e., behind the X-ray tube), with a correction factor for wearing a lead apron. At 2 m behind the X-ray tube, a radiographer wearing a lead apron could perform 106 exams/day at 2.5 mAs and 29 exams/day at 10 mAs (90 kV, SSD 1 m), while keeping his/her radiation dose below the public dose limit (1 mSv/year) and well below the radiographer dose limit (20 mSv/year). In most CXR screening scenarios, the radiation dose of UP X-ray devices can be kept below 1 mSv/year by employing basic radiation safety rules on time, distance and shielding and using appropriate CXR exposure parameters.