Radiographic quality and radiation protection in general medical practice and small hospitals

Radiation protection and image quality were assessed in a survey of 22 general medical practices and the 24 smallest hospitals with x-ray facilities. Limited radiography, usually of extremities for trauma, was being performed in these facilities since access to regular radiology services was restricted, mainly for geographic reasons. An anthropomorphic ankle phantom with simulated fractures was presented at each facility for radiography, and the resulting films assessed for radiographic technique and basic diagnostic usefulness. While the standard of radiographic techniques was lower than in regular x-ray departments, most films of the phantom ankle were still diagnostically useful and only 4 were rejected entirely. The principal deficiency in general practice x-ray was in darkrooms and x-ray film processing. Generally, the x-ray equipment was adequate for the range of procedures performed and complied with the National Radiation Laboratory Code of Safe Practice for the Use of X-rays in Diagnosis (Medical). Radiation doses to the ankle phantom ranged widely for effectively the same procedure although none was excessive. Improved x-ray film processing, and tighter x-ray beam collimation, would result in a narrower range of doses to patients. Personnel exposures to radiation were satisfactorily low and special shieldings are not required in general practice.