Decision Making and Variation in Radiation Exposure Factor Selection by Radiologic Technologists

The goal of radiographic imaging is to produce a diagnostically useful image while minimizing patient radiation dose. This study aimed to review variations in exposure factor selection by radiologic technologists for virtual patients with varying body mass index characteristics. Eleven technologists were asked to assign exposure parameters (kVp, mAs, source-to-image receptor distance, and grid use) to 10 computer-generated patient images for each of four radiographic examinations (anteroposterior [AP] shoulder; AP lumbar spine; lateral lumbar spine; AP portable chest). The virtual patients represented five body mass index categories-underweight, healthy weight, overweight, obese, and superobese. As participants assigned exposures, their visual patterns were recorded by a Tobii TX300 eye-tracker. Significant (P < .05) correlation was found between radiographer age/experience and assignment of mAs for AP shoulder and lumbar examinations. Greater age/experience correlated with higher mAs for the AP shoulder examination, but with lower values for lumbar examinations. Strong correlations also existed between times to first fixations on relevant anatomic areas, and kVp/mAs values existed for the AP portable chest examination. Exposure selection differences related to age/experience highlight inconsistencies in the practice of exposure parameter setting. The reason for these inconsistencies requires further investigation, and how to address deficiencies in practice requires consideration to optimize safe patient care. Because of the small sample size used, further research into the relationship between visual factors and individual examinations is suggested, after the findings regarding the AP portable chest examination.