Abstract This study aimed to assess the main factors affecting radiographic image quality in selected routine radiography procedures, to establish guidelines for maintaining the expected quality, while keeping the patient radiation doses as low as possible. Entrance surface air kerma (ESAK) for 811 patients undergoing chest, abdomen and pelvis x-ray procedures in ten X-ray departments were assessed using the European Image Criteria method. Basic quality control (QC) tests were performed to check the compliance of x-ray machines with the international standards. The mean percentage and range of good quality images were 71.3 (56–86.1) for chest posterior anterior (PA), 76.1 (65–91) for abdomen anterior posterior (AP) and 70.7 (35.7–92.6) for pelvis anteroposterior (AP). The corresponding ESAK (mGy) were 0.5 ± 0.3, 3.7 ± 1.7 and 3.6 ± 1.6 per procedure, respectively. These image quality findings reveal wide inter and intra-hospital variations. The ESAK values for patients undergoing abdominal and pelvic X-ray procedures showed comparable values in relation to the international diagnostic reference levels (DRLs), while they were twice as high for chest X-ray procedures. Improper image processing, exposure factor errors, and suboptimal patient communication and instructions prior to examination were the main factors commonly responsible for inadequate quality radiographs. The radiation dose variations are according to variable patient demographic data across the hospitals and type of examination, besides the variations of the applied technical parameters for each given examination. The film reject rates are higher in most hospital compared to the World Health Organization (WHO) recommended value. Establishment of image quality criteria will improve the department productivity and will reduce the reject rate.

中文翻译：

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平片中患者的辐射剂量和图像质量：对十家医院三种常见程序的评估

摘要 本研究旨在评估在选定的常规放射摄影程序中影响放射影像质量的主要因素，以建立维持预期质量的指南，同时使患者的辐射剂量尽可能低。使用欧洲图像标准方法评估了 811 名在十个 X 射线科室接受胸部、腹部和骨盆 X 射线手术的患者的入口表面空气比释动能 (ESAK)。执行基本质量控制 (QC) 测试以检查 X 光机是否符合国际标准。胸部后前 (PA) 的优质图像的平均百分比和范围为 71.3 (56-86.1)，腹部前后 (AP) 为 76.1 (65-91)，骨盆前后 (AP) 为 70.7 (35.7-92.6) . 相应的 ESAK (mGy) 为 0.5 ± 0.3、3.7 ± 1.7 和 3.6 ± 1。每个程序分别6个。这些图像质量发现揭示了医院间和医院内的广泛差异。接受腹部和盆腔 X 射线手术的患者的 ESAK 值与国际诊断参考水平 (DRL) 相比显示出可比的值，而胸部 X 射线手术的 ESAK 值则高出两倍。图像处理不当、曝光系数错误以及检查前患者沟通和指导不理想是导致 X 光片质量不足的主要因素。除了每次给定检查的应用技术参数的变化之外，辐射剂量的变化还取决于医院中可变的患者人口统计数据和检查类型。与世界卫生组织 (WHO) 的推荐值相比，大多数医院的胶片废品率更高。建立图像质量标准将提高部门生产力并降低废品率。