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DEQ.utah.gov -Utah Department of Environmental Quality

Division of Radiation Control

Utah Chiropractic Radiograph

Entrance Skin Exposures

The desired state for the use of radiation in chiropractic offices is to obtain necessary diagnostic information with minimal exposure to the patient, office personnel and the general public.

The Utah Division of Radiation Control has determined that patient exposure levels for radiographs throughout the state can vary tremendously from office to office. Division personnel have measured entrance skin exposures (ESE's) from as low as 48 milliroentgen (mR) to as high as 1500 mR for chiropractic AP lumbar spine (AP L-Spine) radiographs. A measurement of patient (ESE's) provides chiropractors with knowledge of their patient exposure levels and provides data which may be compared with national or state data which has been collected from their peers.

There is no regulated standard for the amount of radiation exposure a patient should receive for a specific radiographic examination. The physician must use professional judgement to evaluate the need for the radiographic examination by determining that there will be sufficient benefit to the exposed individual to offset the risks from the radiation exposure. In evaluating the data, it was determined that the average ESE for an AP L-Spine in Utah was 414 mR and the third quartile for AP L-Spine ESE's in Utah was 522.5 mR. The third quartile indicates the ESE level which 75% of the surveyed facilities fall below. If 75% of the facilities can obtain diagnostic quality radiographs at levels below 522.5 mR, perhaps, the remaining 25% of the facilities surveyed can lower their ESE's to attain exposure levels of 522.5 mR or below. It is the goal of the Division of Radiation Control to aide the chiropractic community of Utah in reducing unnecessary radiation exposure to their patients.

Chart comparing ESE data for Chiropractic AP L-Spines (click to view full size in a new window)

The attached graph, compares ESE data for Chiropractic AP L-Spines collected in a nationwide survey to ESE data collected in the State of Utah. The graph shows that in some of the ESE ranges, the percentage of Utah ESE's exceeds the percentage of the units found in the natiowide study. Therefore, there are opportunities for improvement, but overall the ESE's for AP L-Spines in Utah compare favorably with those across the nation.

The following factors are the most prevalent causes for higher or lower ESE's, and it may be any combination of these factors which can cause an increase or decrease in the measured ESE's in a facility.

  1. the use of lower vs. higher kVps
  2. the speed of the screen/film combination used
  3. maintenance of the processor and x-ray unit
  4. film developing techniques
  5. clinical preference for light vs. dark films

Attached are two references, "Lowering Your ESE's" and "A Guide for Reducing Patient Exposure" to aid you in evaluating your entire x-ray system in order to obtain good quality radiographs while adhering to the radiation exposure philosophy of "ALARA" (As Low As Reasonably Acceptable).

If you have any questions regarding this matter please contact a member of the Division of Radiation Control's x-ray staff at 536-4250.

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