Portable chest x-rays for hospital patients: Implication, justification and image quality

Usman Raza

doi:10.1556/1647.2026.00341

Portable chest x-rays for hospital patients: Implication, justification and image quality

Usman Raza

School of Education, Sport and Health

Research output: Contribution to journal › Article › peer-review

Abstract

Background and aim
Portable Chest X-ray (PCXR) is service provided to patients who are unable to travel to radiology department. However, the unjustified PCXR leads to unnecessary radiation exposure to radiographer and other patients on ward. Currently, there are no guidelines to justify PCXR requests in UK. Therefore, it was aimed to use the evidence-based guidelines with addition of National Early Warning Score (NEWS) for justifying PCXR requests and to determine the image quality and scatter radiation dose for patient positionings. Patients and Methods Guidelines and NEWS ≥5 were used as a trial for 3 months (July to September 2023). Scatter radiation dose of each patient was calculated. ANOVA test was used to find the relation between patient positionings (AP erect, AP semi-erect and supine) and scatter radiation. The dose area product (DAP) of patients was collected from Computerised Radiology Information System (CRIS) and images were assessed using Picture Archiving and Communication System (PACS). All the portables were done on Samsung and Agfa DR machines.
Results
The guidelines were successful in justifying the portable CXR requests for 96 patients out of 102. The 24 PCXR images (25%) were rotated and of sub-optimal exposure. AP semi-erect position (mean scatter radiation = 1.21 μGy) was found to be related with high scatter radiation dose ( Q = 6.97, P = <0.01).
Conclusion
Radiology departments may consider using published criteria with NEWS ≥5 as a method for justifying PCXR. AP semi-erect position leads to higher scatter dose and 25% of radiographs were of less diagnostic value.

Original language	English
Number of pages	5
Journal	Imaging
DOIs	https://doi.org/10.1556/1647.2026.00341
Publication status	Published - 1 Apr 2026

Bibliographical note

Publisher Copyright:
© 2026 The Author(s). Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

Keywords

portable chest x-ray
National early warning score
scatter radiation dose

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1647-article-10.1556-1647.2026.00341Final published version, 461 KBLicence: CC BY-NC

Cite this

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title = "Portable chest x-rays for hospital patients: Implication, justification and image quality",

abstract = "Background and aim Portable Chest X-ray (PCXR) is service provided to patients who are unable to travel to radiology department. However, the unjustified PCXR leads to unnecessary radiation exposure to radiographer and other patients on ward. Currently, there are no guidelines to justify PCXR requests in UK. Therefore, it was aimed to use the evidence-based guidelines with addition of National Early Warning Score (NEWS) for justifying PCXR requests and to determine the image quality and scatter radiation dose for patient positionings. Patients and Methods Guidelines and NEWS ≥5 were used as a trial for 3 months (July to September 2023). Scatter radiation dose of each patient was calculated. ANOVA test was used to find the relation between patient positionings (AP erect, AP semi-erect and supine) and scatter radiation. The dose area product (DAP) of patients was collected from Computerised Radiology Information System (CRIS) and images were assessed using Picture Archiving and Communication System (PACS). All the portables were done on Samsung and Agfa DR machines. Results The guidelines were successful in justifying the portable CXR requests for 96 patients out of 102. The 24 PCXR images (25\%) were rotated and of sub-optimal exposure. AP semi-erect position (mean scatter radiation = 1.21 μGy) was found to be related with high scatter radiation dose ( Q = 6.97, P = <0.01). Conclusion Radiology departments may consider using published criteria with NEWS ≥5 as a method for justifying PCXR. AP semi-erect position leads to higher scatter dose and 25\% of radiographs were of less diagnostic value.",

keywords = "portable chest x-ray, National early warning score, scatter radiation dose",

author = "Usman Raza",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes {\textendash} if any {\textendash} are indicated.",

year = "2026",

month = apr,

day = "1",

doi = "10.1556/1647.2026.00341",

language = "English",

journal = "Imaging",

issn = "2732-0960",

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T1 - Portable chest x-rays for hospital patients

T2 - Implication, justification and image quality

AU - Raza, Usman

N1 - Publisher Copyright: © 2026 The Author(s). Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

PY - 2026/4/1

Y1 - 2026/4/1

N2 - Background and aim Portable Chest X-ray (PCXR) is service provided to patients who are unable to travel to radiology department. However, the unjustified PCXR leads to unnecessary radiation exposure to radiographer and other patients on ward. Currently, there are no guidelines to justify PCXR requests in UK. Therefore, it was aimed to use the evidence-based guidelines with addition of National Early Warning Score (NEWS) for justifying PCXR requests and to determine the image quality and scatter radiation dose for patient positionings. Patients and Methods Guidelines and NEWS ≥5 were used as a trial for 3 months (July to September 2023). Scatter radiation dose of each patient was calculated. ANOVA test was used to find the relation between patient positionings (AP erect, AP semi-erect and supine) and scatter radiation. The dose area product (DAP) of patients was collected from Computerised Radiology Information System (CRIS) and images were assessed using Picture Archiving and Communication System (PACS). All the portables were done on Samsung and Agfa DR machines. Results The guidelines were successful in justifying the portable CXR requests for 96 patients out of 102. The 24 PCXR images (25%) were rotated and of sub-optimal exposure. AP semi-erect position (mean scatter radiation = 1.21 μGy) was found to be related with high scatter radiation dose ( Q = 6.97, P = <0.01). Conclusion Radiology departments may consider using published criteria with NEWS ≥5 as a method for justifying PCXR. AP semi-erect position leads to higher scatter dose and 25% of radiographs were of less diagnostic value.

AB - Background and aim Portable Chest X-ray (PCXR) is service provided to patients who are unable to travel to radiology department. However, the unjustified PCXR leads to unnecessary radiation exposure to radiographer and other patients on ward. Currently, there are no guidelines to justify PCXR requests in UK. Therefore, it was aimed to use the evidence-based guidelines with addition of National Early Warning Score (NEWS) for justifying PCXR requests and to determine the image quality and scatter radiation dose for patient positionings. Patients and Methods Guidelines and NEWS ≥5 were used as a trial for 3 months (July to September 2023). Scatter radiation dose of each patient was calculated. ANOVA test was used to find the relation between patient positionings (AP erect, AP semi-erect and supine) and scatter radiation. The dose area product (DAP) of patients was collected from Computerised Radiology Information System (CRIS) and images were assessed using Picture Archiving and Communication System (PACS). All the portables were done on Samsung and Agfa DR machines. Results The guidelines were successful in justifying the portable CXR requests for 96 patients out of 102. The 24 PCXR images (25%) were rotated and of sub-optimal exposure. AP semi-erect position (mean scatter radiation = 1.21 μGy) was found to be related with high scatter radiation dose ( Q = 6.97, P = <0.01). Conclusion Radiology departments may consider using published criteria with NEWS ≥5 as a method for justifying PCXR. AP semi-erect position leads to higher scatter dose and 25% of radiographs were of less diagnostic value.

KW - portable chest x-ray

KW - National early warning score

KW - scatter radiation dose

UR - https://www.scopus.com/pages/publications/105034591317

U2 - 10.1556/1647.2026.00341

DO - 10.1556/1647.2026.00341

M3 - Article

SN - 2732-0960

JO - Imaging

JF - Imaging

ER -

Portable chest x-rays for hospital patients: Implication, justification and image quality

Abstract

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Keywords

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