Patient-size based dose optimization in projection radiography examinations: A BMI-guided approach

Area of Science:

• Radiological Sciences
• Medical Physics
• Public Health

Background:

• Rising global obesity rates present challenges for radiation dose optimization in projection radiography.
• Standard diagnostic reference levels (DRLs) may not sufficiently address anatomical variations in overweight and obese patients.
• Patient protection can be suboptimal without accounting for diverse body habitus.

Purpose of the Study:

• To establish benchmark doses (BMDs) tailored to patient body mass index (BMI) for common projection radiography examinations.
• To provide a supplementary method for dose optimization alongside existing DRLs in Sri Lanka.
• To address the need for personalized radiation dose management in diverse patient populations.

Main Methods:

• A prospective study involving 1989 adult patients across six tertiary care hospitals.
• Collection of patient demographics (including BMI) and radiographic exposure parameters (kVp, mAs).
• Measurement of patient doses using kerma-area product (P_KA) and formulation of BMI-based BMDs across underweight, normal, overweight, and obese categories.

Main Results:

• Benchmark doses (BMDs) progressively increased with higher BMI categories for all examined projections.
• Significant variations in BMDs were observed across BMI groups, with obese patients showing higher doses compared to normal weight individuals.
• Proposed DRLs for standard-sized patients were established, providing a reference for comparison with BMI-based BMDs.

Conclusions:

• BMI-based BMDs are crucial for personalized dose optimization, effectively addressing patient body habitus variations.
• Integrating BMI-based BMDs with DRLs can improve patient protection and promote best practices in radiography.
• There is a need for international guidelines on DRLs stratified by BMI to ensure consistent implementation worldwide.