Modification of the Projection from Anterior-Posterior to Posterior-Anterior for Abdominal Radiographic Examinations

Abstract

The technological development improvement in healthcare, specifically in medical imaging, resulted in an increase in the number of examinations performed in diagnostic medical imaging. These examinations involve the use of ionizing radiation in both adult and pediatric patients. The aim of the study is to provide the foundation for the modification of the current practice of using Anterior-posterior (AP) projection in favor of Posterior-Anterior (PA) projection. The modification will facilitate adherence to the "as low as reasonably achievable" (ALARA) principle. This study was conducted at the Main X-ray of the Radiology Department, Ministry of National Guard-Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. A cross-sectional study, with an experimental research study, were performed and measured in different phases. We included 110 patients (57 males, and 53 females) who required an abdominal radiographic examination. The majority (63) were exposed to the AP and 47 to the PA orientation. A nonparametric Mann Whitney U test was used to analyze the data. A total of 110 patients participated in this study. Statistical significance (P <0.001) was observed in the overweight Body mass index (BMI) category, with a mean Dose area product (DAP) of 11.8 dGycm 2 and 6.8 dGycm 2 for the AP and PA projections. In the overweight BMI category, the Entrance Skin Dose (ESD) was 1.51 mGy and 0.83 mGy for the AP and PA projections, respectively, with a statistically significant 58.11% difference (P<0.001). Similarly, in the obese BMI category, the ESD was 2.35 mGy and 1.6 mGy for the AP and PA projections, indicating a statistically significant 37.97% difference (P<0.046). The study provided evidence that the PA projection is an easily implementable method to reduce the dose, with no loss of diagnosis for the patient and no additional cost to the department.