Justification of exposure including referral criteria and exposure protocols guidelines

IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
Justification of exposure including
referral criteria and exposure
protocols guidelines
GENERAL RADIOGRAPHY
Under the Ionising Radiation (Medical Exposures) Regulations
2000 no medical exposure to radiation can take place without prior
justification of the exposure by a practitioner.
General radiographic exposures can be authorised by the operator
if the referral complies with the enclosed guidelines and criteria
which have been approved by the entitled practitioner.
Referrers should provide sufficient medical data relevant to the
medical exposure requested to enable the operator who is
authorising, or the practitioner, to decide whether there is a
sufficient net benefit.
Radiographers, acting as operator authorising the exposure,
should be satisfied that the information provided by the referrer
conforms to the approved referral criteria.
Any referral not meeting the criteria should be referred to an
entitled practitioner who will make a decision on the justification of
the exposure.
The person authorising or justifying the exposure should be
recorded on the referral and the RIS according to the IRMER
Pathways charts.
Practitioner for General Radiography
DR. S. ANTHONY
Practitioner for Trauma, Musculoskeletal, Emergency
Department and Orthopaedic Referrals
……………………….
DR. S. OSTLERE
………………………
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:1 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
CONTENTS
1.
Referral Criteria for General Radiography
1.2
Exceptions to Recommended Referral Criteria
4
1.3
Contraindications to General Radiography
6
2.
Adults
2.1
Justification Guidelines: Abdomen Examinations
8
2.2
Exposure Guidelines: Abdomen Views
9
2.3
Justification Guidelines: Chest Examinations
10
2.4
Exposure Guidelines: Chest Views
12
2.5
Justification Guidelines: Upper Limb Examinations
12
2.6
Upper Limb Views and Exposure Guidelines
13
2.7
Justification Guidelines: Lower Limb Examinations
14
2.8
Lower Limb Views and Exposure Guidelines
15
2.9
Justification Guidelines: Pelvis and Hip Examinations
16
3.0
Pelvis and Hip Views and Exposure Guidelines
17
3.1
Spine Examinations
18
3.2
Justification Guidelines: Cervical Spine
18
3.3
Justification Guidelines: Thoracic Spine
18
3.4
Justification Guidelines: Lumbar Spine
19
3.5
Spine Views and Exposure Guidelines
19
3.6
Justification Guidelines: Facial Bone Examinations
20
3.7
Facial Bone Views and Exposure Guidelines
20
3.8
Justification Guidelines: Skull Examinations
21
3.9
Skull Views and Exposure Guidelines
21
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:2 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
4
Paediatric
22
4.1
Justification Guidelines: Abdomen Examinations
22
4.2
Justification Guidelines: Chest Examinations
23
4.3
Justification Guidelines: Lower and Upper Limb
Examinations
24
4.4
Justification Guidelines: Pelvis and Hip Examinations
24
4.5
Justification Guidelines: Spine Examinations
25
4.6
Justification Guidelines: Skull and Facial Bone
Examinations
26
4.7
Justification Guidelines: Skeletal Surveys
28
5.0
Paediatric Views and Exposure Guidelines
29
5.1
Computed Radiography (CR) Views and Exposure
Guidelines
5.2
29
Digital Radiography (DR) Views and Exposure Guidelines
33
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:3 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
1. Referral Criteria for General
Radiography
Referral Criteria
Referral criteria will be based on the current version of Royal
College of Radiologists (RCR) booklet entitled “Making the best
use of clinical radiology services” (Version 6.03, 2007), MBUR 6th
Edition.
These RCR recommendations are available on the Trust’s intranet
on the ‘Radiology and PACS’ site.
1.2
Exceptions to recommended referral criteria
OUH referral criteria which deviates from the RCR Guidelines
(version 6).
Cardio-vascular /
Thoracic System
Referral
Action
Air entry decrease
Added to
guidelines
Added to
guidelines
Anaphylactic
reaction if
pulmonary oedema
suspected
Aspiration
Added to
guidelines
Chronic Cough
Added to
guidelines
Cardiomegaly
Added to
guidelines
Respiratory Tract
Infection
Tuberculosis
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Added to
guidelines
Added to
guidelines
Suggested
Examination
CXR PA or AP
CXR PA or AP
CXR PA or AP
CXR PA or AP
CXR PA or AP
PA preferred to
see enlargement
of heart
CXR PA or AP
CXR PA or AP
Issue Date: March 2011
Review Date: March 2012
Page No:4 of 20
IRMER Procedure
Justification of Exposures
Post CABG
Days 1-5
Pyrexia
Heart murmur
Confusion over 65
yrs of age
Consolidation
Oxford University Hospitals NHS Trust Radiology
Department
Added to
guidelines
Added to
guidelines
Added to
guidelines
Added to
guidelines
Added to
guidelines
Added to
guidelines
CXR PA or AP
CXR PA or AP
CXR PA or AP
CXR PA or AP
CXR PA or AP
Bronchiolitis
(wheeze or
striddor)
Collapse (excluding Added to
vaso-vagal)
guidelines
Oxygen Sats low
Added to
guidelines
CXR PA or AP
Urological,
Adrenal and
Genitourinary
Systems
Renal stones
See abdomen
section or
paediatric section
Musculo-skeletal
system
Spine Added to
Degenerative
guidelines
change/spondylosis
Pagets
Added to
guidelines
Shoulder –
Impingement
Cervical Rib
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Added to
guidelines
Added to
guidelines
Added to
guidelines
CXR PA or AP
CXR PA or AP
AP and Lateral
X-ray affected
area only- AP and
lateral
AP only (glenohumeral joint)
Thoracic Inlet and
CXR PA or AP
Issue Date: March 2011
Review Date: March 2012
Page No:5 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
1.3 Contraindications to General Radiography
The following cannot be justified for general X-ray
Clinical Problem
Suggested Investigation
Musculo-Skeletal
Heel pain: Suspected plantar
fasciitis
Chronic Back Pain: Unless
osteoporotic collapse
Bony Metastases
Soft tissue mass
Radiolucent Foreign Body
Rotator cuff shoulder
Severs Disease (heel pain with
no history of trauma)
Sternoclavicular joints
Trauma
2nd to 5th toes: undisplaced
fracture
Coccyx #
Nasal Bones
Fractured Ribs
C-spine injury over 65 years of
age
Gastrointestinal System
Abdominal Aortic Aneurysm
GI Bleed
Dysphagia/ Difficulty in
Swallowing
Heartburn/ Hiatus Hernia
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
NM, US, MRI
MRI
NM
MRI
US
US
None. Clinical management only
CT
None. Clinical management only
None. Clinical management only
None. Clinical management only
None. Clinical management only
CT
US, CT, MRI
CTA
Ba Swallow
Ba Swallow/Meal
Issue Date: March 2011
Review Date: March 2012
Page No:6 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
2. Justification Guidelines and
Exposure Protocols
This is a guide for radiographers for the following:
 Justification of referrals
 An exposure guide – please see specific exposures available
in each X-ray room
 Expected dose levels – an average is given as these will
differ dependent on X-ray equipment
 Comments to offer tips and advice
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:7 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
ADULTS
2.1 Justification Guidelines: Abdomen Examinations
28 day rule applies – 12 to 55 years
Clinical Problem
Investigation
Gastrointestinal System
Acute Abdominal Pain
AP Supine
Looking for either obstruction or (to exclude obstruction)
perforation
Erect CXR
(to exclude perforation
see ‘perforation’)
Acute Small Bowel Obstruction AP Supine
Acute Large Bowel Obstruction AP Supine
Acute Pancreatitis
AP Supine
When non-specific acute pain
(to exclude obstruction)
Erect CXR
(to exclude perforation
see ‘perforation’)
Chronic Pancreatitis
AP Supine
May show calcification
Constipation
AP Supine
Maybe helpful in
(Specialist request only)
Geriatric/Psychiatric to show the
extent of impaction
Inflammatory Bowel disease
AP Supine
Looking for toxic dilatation
Palpable mass
Refer to radiologist
Perforation
Toxic Megacolon
Urological, Adrenal and
Genitourinary Systems
Renal Stones
Possible
investigation:
US/CT
LT Lateral Decubitus or
Erect CXR
(Erect CXR preferred)
AP Supine
CTKUB if no imaging in
last 6 months
If imaging in last 6
months AP Supine film.
Trauma
Foreign Body
AP Supine
Stab Injury
AP supine, Erect CXR
File: justification-guidelines.doc
Author’s Initials: DS
Comments
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:8 of 20
IRMER Procedure
2.2
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
Exposure Guidelines: Abdomen Views
Examination
Views
Exposure
Abdomen
AP Supine
(To include
diaphragm and
symphysis
pubis)
Decubitus
LT Lateral
Erect (right
side up)
75 KV and
both side
chambers
using AEC
(preferred
method)
75KV + 25mAs
with stationary
grid
75KV and
middle
chamber using
AEC upright
bucky
(preferred
method)
75KV 25mAs
With stationary
Grid
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Expected
Dose
cGycm2
Issue Date: March 2011
Review Date: March 2012
 150
Page No:9 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
2.3 Justification Guidelines: Chest Examinations
Please do PA erect image when possible
Clinical Problem
Investigation
Gastrointestinal System
Acute abdominal Pain
Chest and Cardiovascular
System
Acute Chest Pain
Angina (Unstable)
Air Entry Decreased
Anaphylactic Reaction (if
pulmonary oedema)
Aortic Dissection
PA or AP
Asthma
PA or AP
Aspiration
PA or AP
Bronchiectasis
Bronchiolitis
Cardiomegaly
Chronic Cough
COPD/COAD
Collapse (excluding Vaso-vagal)
Confusion (over 65 years)
Consolidation
Cystic Fibrosis
Haemothorax
Heart Failure
Heart Murmur
Hypertension
Lower Respiratory Tract Infection
Lung Disease
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP +
Lateral
PA (+ Lateral
over 50yrs)
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
Malignancy
PA or AP
Haemoptysis
File: justification-guidelines.doc
Author’s Initials: DS
Comments
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
Version No: 5
Authorised By: MC
to exclude other
causes
when patient does
not respond to
treatment OR
suffering from
pyrexia/leucocytosis
or localising pain
when change in
symptoms
Issue Date: March 2011
Review Date: March 2012
Page No:10 of 20
IRMER Procedure
Justification of Exposures
Myocardial Infarction
Oesophageal Perforation
Osteosarcoma
Oxygen Sats Decrease
Perforation
Pericarditis/pericardial Effusion
PICC line insertion
Pleural Effusion
Pulmonary Embolism
Pre-Cardiac Intervention
Pneumonia
Pneumonia Follow-up (usually 6
weeks time)
Pneumothorax
Post Biopsy (Lung)
Post CABG
Post Pace-Maker Insertion
Pyrexia
Respiratory Tract Infection
Shortness of Breath
Sternal Fracture
Oxford University Hospitals NHS Trust Radiology
Department
PA or AP
PA or AP
PA or AP +
Lateral
PA or AP
PA or AP (Erect)
PA or AP
PA or AP
PA or AP
(Erect)
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP
PA or AP +
Lateral
PA or AP
PA or AP
PA or AP
PA or AP +
Coned Lateral
Thoracic Inlet Obstruction
Tuberculosis
Valvular Heart Disease
Trauma
Stab Injury
Foreign Body
Pre-Employment/emigration
(Specific jobs e.g. deep-sea
diving – ask radiologist if not sure)
Apical View Only
PA or AP
PA or AP
ITU CXR
AP
PA or AP
PA or AP
PA or AP
Inspiration only
PA preferred to see
mediastinal
widening
Specific paperwork
required for
emigration
purposes
when change in
condition
Pre-Op (Cardiac patients and
PA or AP
patients with a # NOF and are 65
years +)
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:11 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
2.4 Exposure Guidelines: Chest Views
Please refer to specific room settings
Examination
Chest
Chest
Chest
Views
PA
Exposure
Expected
Dose
cGycm2
FFD = 150cm
150kV +
2.5mAs (use
Airgap)
FFD = 100cm
85kV + 2.5mAs
FFD = 120cm
150kV +
10mAs (use
airgap)
AP
Lateral
<5
< 10
< 20
2.5 Justification Guidelines: Upper Limb Examinations
Refer to Views and Exposure Guidelines for Specific Investigation
Clinical Problem
Musculo-skeletal System
Arthropathy
Bony Mass/Primary Bone
Tumour
Bone Pain
Diabetes – Hands Only
Osteomalacia
Osteomyelitis
Painful Prosthesis
Pagets
AP (affected area only)
AP + Lateral
Comments
for all cases
of unresolved
bone pain
AP + Lateral
DP
AP + Lateral
AP + Lateral
AP + Lateral
AP + Lateral (affected
area only)
Trauma
Trauma
Trauma Follow-up (e.g. post
manipulation/reduction)
Stress Fracture
Subluxation
Dislocation
Foreign Body
(Radio-opaque only)
File: justification-guidelines.doc
Author’s Initials: DS
Investigation
AP + Lateral
AP + Lateral
AP + Lateral
AP + Lateral
AP + Lateral
AP and Lateral and
tangential view of
affected area.
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
 Use
marker to
indicate
site/wound
Page No:12 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
 Remove
dressings
Foreign Body ? bony
involvement
(Radio-opaque only)
AP and Lateral view of
Object
2.6 Upper Limb Views and Exposure Guidelines
Please refer to specific room settings
Examination
Fingers
Hand
Thumb
Scaphoid
Wrist
Views
DP, Lateral
(45° Oblique
for MCPJ)
DP + Oblique
(lateral if #’d
MC)
AP + Lateral
DP, Lateral,
Oblique, 25°
Axial
DP + Lateral
Exposure
50-52kV +
1.4-1.6mAs
52-55kV +
1.6mAs (60Kv +
2mAs for lateral)
50-52kV +
1.4-1.6mAs
52-55kV +
1.5mAs – 2mAs
Forearm
AP + Lateral
DP = 55kV +
2mAs
Lateral = 56kV +
2mAs
55kV + 2.5mAs
Elbow
Humerus
AP + Lateral
AP + Lateral
60kV + 2mAs
65kV + 3.2mAs
Shoulder (Trauma)
AP+
Axial/modified
axial (Lateral
for proximal
humerus)
AP Oblique
(45° to view
gleno-humeral
joint) +
Axial/modified
axial –see
AP: 64.5kV +
4mAs
Lateral/axial:
75kV + 3.2mAs
Shoulder Joint
(Trauma) (post
manipulation and
follow-up)
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Expected
Dose
cGycm2
<2
<3
<2
<3
<4
< 5 (for both
views)
<2
< 10 (for both
views)
<4
<8
AP: As above
Axial: 75kV +
3.2mAs
Issue Date: March 2011
Review Date: March 2012
<6
Page No:13 of 20
IRMER Procedure
Scapula
Clavicle
ACJ
Justification of Exposures
protocol folder
for modified
axial
projection.
AP +Lateral
AP + AP 20°
Cranial
Deviation
AP
Oxford University Hospitals NHS Trust Radiology
Department
Same as
Shoulder
65kV + 2.5mAs
Same as
Shoulder
< 10 (for both
views)
64.5kV + 4mAs
<4
2.7 Justification Guidelines: Lower Limb Examinations
Refer to Views and Exposure Guidelines for Specific Investigation
Clinical Problem
Investigation
Musculo-skeletal System
Arthropathy
Bony Mass/Primary Bone
Tumour
Bone Pain
Diabetes (for osteomyelitis
feet)
Loose Body (Knee)
Knee Pain without Trauma
(Arthritic/arthropathy changes
may be seen)
Osteomalacia
Pagets
Osteomyelitis
Painful Prothesis
Hallux Valgus
Other
Stress Views/Weight bearing
Trauma
Trauma
Trauma Follow-up (e.g. post
manipulation/reduction)
Tibial Plateau Fracture
File: justification-guidelines.doc
Author’s Initials: DS
AP (affected area only)
AP + Lateral
Comments
for all cases of
unresolved bone
pain
AP + Lateral
DP + 45° Oblique
AP + Lateral
AP + Lateral
AP + Lateral
AP + Lateral (affected
area only)
AP + Lateral
AP + Lateral
AP + Lateral
AP + Lateral
Trauma referral
only
AP + Lateral
AP + Lateral
AP + Lateral
Version No: 5
Authorised By: MC
Both 45° obliques
if cannot see
fracture but see
Issue Date: March 2011
Review Date: March 2012
Page No:14 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
Foreign Body
(Radio-opaque only)
AP and Lateral and
tangential view of
affected area.
Foreign Body ? bony
involvement
(Radio-opaque only)
Dislocation
AP and Lateral view of
Object
lipohaemarthrosis
 Use marker to
indicate
site/wound
 Remove
dressings
AP + Lateral
2.8 Lower Limb Views and Exposure Guidelines
Please refer to specific room settings
Examination
Big Toe
Toes
Foot
Calcaneum
Ankle
Tib/Fib
Knee
Patella
File: justification-guidelines.doc
Author’s Initials: DS
Views
Exposure
Expected
Dose
cGycm2
DP + Lateral
DP + 45°
Oblique
DP + 45°
Oblique
Lateral + 45°
Axial (see
protocols for
Broden’s View)
AP + Lateral
(See protocols
for gravity
stress view)
AP + Lateral
(Obliques may
be requested
by Trauma)
AP + Lateral
(HBL for
Trauma)
AP + Lateral
Knee (Skyline
View may be
requested by
Trauma)
60kV + 1.4mAs
60kV + 1.4mAs
<1
<1
60kV + 1.6mAs
<2
Version No: 5
Authorised By: MC
Lateral: 60kV + < 5 (for both
2mAs
images)
Axial: 63kV +
2.5mAs
60kV + 2mAs
<4
65kV + 2.5mAs
< 8 (for both
images)
64.5kV + 4mAs
< 15 (for both
images)
64.5kV + 4mAs
< 20 (for all
images)
Issue Date: March 2011
Review Date: March 2012
Page No:15 of 20
IRMER Procedure
Femur
Justification of Exposures
AP + Lateral
Oxford University Hospitals NHS Trust Radiology
Department
70kV + AEC
centre
chamber
(16mAs with
Grid)
< 15
2.9 Justification Guidelines: Pelvis and Hip Examinations
28 day rule applies – 12 to 55 years
Clinical Problem
Investigation
Musculo-skeletal System
Arthropathy
Avascular Necrosis
Bone Pain
Hip Pain
Osteomyelitis
Osteomalacia
Painful Prosthesis
Post op – THR, ETS (All
prosthesis must be included;
DHS patients should have
had X-rays in theatre)
Primary Bone Tumour
Sacroiliac Pain
Pagets
Trauma
Trauma
Trauma Follow-up (Post
reduction)
Acetabular Fixation/Fracture
Fall
Injury to pelvic ring
File: justification-guidelines.doc
Author’s Initials: DS
Comments
AP Pelvis
AP Pelvis
AP Pelvis and Lateral
AP Pelvis + Lateral
AP + Lateral
AP + Lateral
AP + Lateral
AP Pelvis (Top of
cassette at ASIS for
hips) + HBL Lateral
AP + Lateral
AP Pelvis
AP Pelvis(affected area
only)
AP Pelvis + (HBL
Lateral for Hip, Judet
views for acetabular)
AP + Lateral
Judet Views
AP Pelvis + HBL Lateral
Inlet and Outlet
Trauma referral
only
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:16 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
3.0 Pelvis and Hip Views and Exposure Guidelines
Please refer to specific room settings
Examination
Pelvis
Pelvis
Pelvis
Pelvis
Hip
Hip
SIJ
File: justification-guidelines.doc
Author’s Initials: DS
Views
Exposure
Expected Dose
AP
Use AEC both
side chambers
or stationary
grid
85kV (+
32mAs)
Judet (45°
Use AEC all 3
Oblique pelvis) chambers or
stationary grid
90kV ( +
40mAs)
Inlet (30°
Use AEC all 3
down)
chambers or
stationary grid
95kV (4050mAs)
Outlet (40° up) Use AEC all 3
chambers or
stationary grid
95kV (4050mAs)
Horizontal
85kV + 85mAs
Beam Lateral
with stationary
grid
AP or
Use AEC
Turned Lateral centre
chamber or
stationary grid
80kV (+
25mAs)
AP – 15
degrees
cranial
PA – 15
degrees
caudal
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
< 100
< 200
<200
< 200
< 350
< 100
Page No:17 of 20
IRMER Procedure
3.1
3.2
Justification of Exposures
Spine Examinations
Justification Guidelines: Cervical Spine
Clinical Problem
Investigation
Musculo-Skeletal System
Atlanto-Axial Subluxation
(To identify congenital or
structural abnormalities)
Atlanto-occipital Subluxation
Brachialgia
Degenerative
change/spondylosis
Nerve Compression
Trauma
Suspected Ligamentous
Injury
Trauma
Unconscious Trauma
Foreign Body
Neck Pain/Injury with
Neurological Deficit
3.3
Oxford University Hospitals NHS Trust Radiology
Department
Comments
Lateral
Lateral
Refer to radiologist
AP + Lateral
MRI
Refer to radiologist
MRI
Flexion + Extension
(movement undertaken
by referrer)
AP, Peg, Lateral –
swimmers if C7/T1 is
not visualised
Refer to radiologist
Lateral or tangential
Views (dependent on
location)
AP, Peg, Lateral swimmers if C7/T1 is
not visualised
Trauma referral
only
CT
CT If patient
over 65 years of
age
Justification Guidelines: Thoracic Spine
Clinical Problem
Investigation
Musculo-Skeletal System
Degenerative
change/spondylosis
Osteoporotic Collapse
Spondyloarthropathies
Trauma
Trauma
Trauma with neurological
deficit
File: justification-guidelines.doc
Author’s Initials: DS
Comments
AP + Lateral
Lateral
AP + Lateral
AP + Lateral
AP + Lateral
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:18 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
3.4 Justification Guidelines: Lumbar Spine
28 day rule applies – 12 to 55 years
Clinical Problem
Musculo-Skeletal System
Acute Back Pain
Degenerative
change/spondylosis
Osteoporotic Collapse
Spondyloarthropathies
Trauma
Trauma
Trauma with neurological
deficit
Investigation
Comments
Refer to radiologist
AP + Lateral
MRI
Lateral
AP + Lateral
AP + Lateral
AP + Lateral
3.5 Spine Views and Exposure Guidelines
Please refer to specific room settings
Examination
Cervical
Views
AP
Peg
Lateral
Swimmers
Thoracic
AP
Lateral
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Exposure
65kV + 5mAs
(no grid)
65kV + 5mAs
(no grid)
65kV + 12mAs
(no grid)
Use AEC
centre
chamber or set
exposure
85- 90kV (+
150-300mAs)
Use AEC
centre
chamber or
stationary grid
80kV (+
30mAs)
Use AEC
centre
chamber or
stationary grid
80kV (+ 4050mAs)
Expected Dose
cGycm2
< 20 (for all views)
< 50
< 100 (for both
views)
Issue Date: March 2011
Review Date: March 2012
Page No:19 of 20
IRMER Procedure
Justification of Exposures
Lumbar
AP
Use AEC
centre
chamber or
stationary grid
90kV (+ 40
mAs)
Use AEC
centre
chamber or
stationary grid
95kV(+50mAs)
Lateral
3.6
Oxford University Hospitals NHS Trust Radiology
Department
< 300 (for both
views)
Justification Guidelines: Facial Bone Examinations
Clinical Problem
Investigation
Trauma
 Blunt Injury
 Middle Third of Face
 Mandibular Trauma
 Dislocation
 Subluxation of TMJ
 Foreign Body
 Orbits
ENT/Head and Neck
Abscess
Dental Reasons
Impacted 8’S
Other
Pre-Op valve replacement
? tooth decay
Comments
OM +OM 30
OM +OM 30
OPG + PA Mandible
OPG + PA Mandible
OPG
Tangential Views
Orbit Views
OPG
OPG
OPG
OPG
3.7 Facial Bone Views and Exposure Guidelines
Please refer to specific room settings
Examination
Facial Bones
File: justification-guidelines.doc
Author’s Initials: DS
Views
OM
Version No: 5
Authorised By: MC
Exposure
Expected
Dose
cGycm2
Use AEC
centre
chamber or
skull unit
85kV (+
12mAs)
Issue Date: March 2011
Review Date: March 2012
< 20
Page No:20 of 20
IRMER Procedure
Justification of Exposures
OM 30
Mandible
Use AEC
centre
chamber or
skull unit
85kV (+
16mAs)
65kV + 12mA
+ 8sec
OPG
PA
< 15
< 20
Justification Guidelines: Skull Examinations
Clinical Problem
Trauma
Foreign Body
Trauma
3.9
< 20
Use AEC
centre
chamber or
skull unit
75kV (+
12mAs)
Use AEC
centre
chamber or
skull unit
80KV (+
16mAs)
Obliques
3.8
Oxford University Hospitals NHS Trust Radiology
Department
Investigation
Tangential View
Refer to radiologist
Comments
CT
Skull Views and Exposure Guidelines
Examination
Foreign Body
File: justification-guidelines.doc
Author’s Initials: DS
Views
Tangential
View
Version No: 5
Authorised By: MC
Exposure
60 KV and
2mAs
Expected
Dose
cGycm2
>2
Issue Date: March 2011
Review Date: March 2012
Page No:21 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
4.
PAEDIATRICS
4.1 Justification Guidelines: Abdomen Examinations
28 day rule applies 12 years +
Clinical Problem
Gastrointestinal System
Abdominal Pain
Constipation
Distention
GI bleeding (If necrotising
enterocolitis or intussusception
is suspected)
Paediatric Transit Study
(Image taken on day 5 post
ingestion of pellets)
Obstruction
Perforation
Position of epidural Baclofen
pump
Urological, Adrenal and
Genitourinary Systems
Renal Stones
Investigation
Supine
Supine
Comments
Requested by
Paed. Specialist
Supine
Supine
Supine
See local protocol
in Children’s
Radiology Dept.
Supine
Supine AXR and
Erect AP/PA Chest
Neonatal = decubitus
abdomen
Supine AXR and
lateral thoracolumbar spine is
requested
Ultrasound and
Supine Abdomen if
requested by
radiologist
Show abdomen Xray first to
radiologist.
Pump sits in iliac
fossa with lead
entering spinal
canal.
Ultrasound first
Discuss with Paed
radiologist if
unsure
Larger children for
CTKUB
Supine
Stent Position
Trauma
Ingested Foreign Body which
Supine Abdomen
is Sharp, >1 magnet, or Battery and PA/AP Chest
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:22 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
4.2 Justification Guidelines: Chest Examinations
In addition to those stipulated in the adult section
Please refer to local protocol (protocol folder) for guidance for
when to do AP/PA/Sitting/Standing in accordance with age of
patient
Clinical Problem
Chest and Cardiovascular
System
Acute Chest Infection
Cystic Fibrosis
Perforation
PA/AP
PA/AP and lateral
Comments
Annual Review
Abdominal U/S
also required
PA/AP Erect
AP/PA Erect Chest
Neonatal = decubitus
abdomen
PA/AP
Mr Grant’s
Lateral only if
request = Lateral
requested by Mr
only
Grant
PH Probe Position
PICC Line Insertion
Post Pace-Maker Insertion
Pulmonary Metastases
Trauma
Inhaled Foreign Body
Investigation
PA/AP - to include
appropriate arm if
brachial insertion
PA/AP
Views as requested
by cardiologist
PA/AP and Lateral
May not always
require a lateral
view
PA/AP to include
neck
Foreign Body
AP + Lateral
(Radio-opaque only)
(affected area only)
Ingested Foreign Body
PA/AP (Abdomen not
(Radio-opaque only)
needed)
Ingested Foreign Body which
PA/AP and Supine
is Sharp, >1 magnet, or Battery Abdomen
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:23 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
4.3 Justification Guidelines: Lower and Upper Limb
Examinations
Clinical Problem
Musculo-Skeletal System
Bone Age
Investigation
Left Hand and Lt
Wrist DP
Rickets
DP/AP 1 joint only
Bone Pain (including ?Osgood
Schlatter’s Disease on referral)
AP and Lateral of
Affected Bone
Referrals from Plastics Clinic
Views as requested
by operating team
Trauma
Trauma
? FB (other than inhaled or
ingested)
Radio-opaque only
Foreign Body ? bony
involvement
(Radio-opaque only)
AP and Lateral of
Affected Area
AP and Lateral of
affected area using
marker to indicate
site/wound
Comments
Must include
complete hand
/wrist and thumb to include tips of
phalanges and
soft tissues fingers just not
touching, not
spread out.
Even if both have
been requested
Looking for bone
tumour or
infection
 See chest for
inhaled or
ingested
 Remove
dressings
AP and Lateral view
of Object
4.4 Justification Guidelines: Pelvis and Hip Examinations
28 day rule applies 12 years +
Clinical Problem
Musculo-Skeletal System
DDH (Developmental
Dysplasia of Hips)
Change of Plaster (Hip Spica)
– for treatment of DDH
File: justification-guidelines.doc
Author’s Initials: DS
Investigation
Comments
AP pelvis
AP Pelvis
Version No: 5
Authorised By: MC
 Patient needs to
go to plaster
room to have
plaster cut first.
Issue Date: March 2011
Review Date: March 2012
Page No:24 of 20
IRMER Procedure
Justification of Exposures
Limping Child-request to X-ray
whole leg
Oxford University Hospitals NHS Trust Radiology
Department
AP Pelvis and AP
and lateral limb
bones as directed by
clinical team
Limping Child ?Irritable Hip
AP pelvis if
requested by
radiologist
Perthes/Avascular necrosis
Frog Legs Lateral
only
SUFE (Slipped Upper Femoral Frog Legs Lateral
Epiphysis) – Approx. age 10-16 only
yrs
Trauma
Trauma
AP pelvis and HBL
lateral
 Remove top
section and Xray child whilst
still in posterior
section of cast.
 Child needs to
be immobilised
in cast for X-ray.
 Replace
anterior section
and bandage in
place for
transfer back to
ward.
Gonad protection
not to be used on
1st image but
should be used on
subsequent
imaging.
U/S first
4.5 Justification Guidelines: Spine Examinations
28 day rule applies for L-Spine 12 years +
Clinical Problem
Musculo-Skeletal System
Post Scoliosis Repair
File: justification-guidelines.doc
Author’s Initials: DS
Investigation
AP and Lateral
Thoracic and Lumbar
Spine Standing AP
and Lateral views
may be requested
Version No: 5
Authorised By: MC
Comments
Images must
overlap and
include whole T
and L Spine
Images may be
requested whilst
Issue Date: March 2011
Review Date: March 2012
Page No:25 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
patient is sitting in
their own wheel
chair
Spinal vertebral Anomalies
Constipation with suspected
underlying spinal cause
Chronic Back Pain
Spondylolisthesis
C-Spine Instability/Subluxation
Trauma
Trauma
AP and Lateral
Lumbar/Sacral Spine
AP Lumbar/scaral
Spine
Review with Pead.
Radiologist as a
lateral may also be
required
Refer to Radiologist
Lateral
Lumbar/Sacral Spine
and review with
Paed. Radiologist
As requested
May need Flexion
and Extension
Views. A Lateral
may suffice
Vertebral anomaly
may affect nerve
supply to bowel
hence causing
constipation.
Often can’t see on
AP due to
constipation but
this is view of
choice.
Often presents in
sporty children
Must be
performed in
presence of
referring
clinician
AP and Lateral of
Effected Area
Peg view for C-spine
injury
4.6 Justification Guidelines: Skull and Facial Bone
Examinations
Clinical Problem
Musculo-Skeletal System
Craniosynostosis (premature
fusing of sutures)
Post Cranio-Facial Surgery.
Frontal Advancement
ENT/Head and Neck
Cochlear Implants
File: justification-guidelines.doc
Author’s Initials: DS
Investigation
Comments
AP, Townes and
Lateral
Views as requested
by cranio-facial team.
With copper ruler
on edge of image
May ask for both
laterals
Coned AP
 Centre through
EAMs
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:26 of 20
IRMER Procedure
Justification of Exposures
Post Nasal Space for enlarged
adenoids
Shunt Insertion – to show
position of Ventroperitoneal
(VP)Shunt
Trauma
Facial Trauma
 Only need to
see position of
leads in
cochlea
 No need to
include the
external
component
attached to
head
 Most patients
have bilateral
Lateral Face
Ideally with
“Sniffing In”
Collimate to avoid
eyes
VP shunt drains
VP Shunt Series:
from ventricles in
Lateral Skull to
the brain into the
include neck
peritoneum
PA/AP chest to
Treatment for
include lower neck
hydrocephalus
Supine Abdomen to
include lung bases to Important to get
overlap of the
symphysis pubis
images to ensure
that there are no
breaks in the
shunt
OM and OM30°
Head Trauma (18mths and
under)
File: justification-guidelines.doc
Author’s Initials: DS
Oxford University Hospitals NHS Trust Radiology
Department
AP/PA and Lateral,
(even if CT
requested)
Version No: 5
Authorised By: MC
If unsure speak to
Consultant
Paediatric
If unsure speak to
Consultant
Paediatric
Radiologist
Issue Date: March 2011
Review Date: March 2012
Page No:27 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
4.7 Justification Guidelines: Skeletal Surveys
NAI
Must be discussed with
 Abdomen to include Please see specific
Paediatric Consultant
folder in Paediatric
Pelvis
Radiologist
 Chest to include all Hospital or Level
One
ribs
 Oblique Ribs to
 For live children
include all ribs
arrange a mutually
 Lateral C-spine
convenient time
 Lateral thoracowith the patient’s
lumbar Spine
nurse and the
 Skull AP and
radiologist
Lateral – lateral to
 Make sure the
include mandible
patient has had a
Separate AP views on
good feed and/or
both:
sleep and comes
 Feet
to the dept with a
 Femurs
dummy if they
 Tib/Fib
have one
 Humeri
 2 people will be
 Rad/Ulna
required to
 Hands
immobilise the
patient. Ensure
Additional views as
that neither are
directed by Consultant
pregnant before
Paediatric Radiologist
they come to the
dept
 If parent is
assisting please
ensure they know
why the
examination is
being carried out
before arrival to
the X-ray Dept
General
As directed by radiologist Protocol for each
individual patient
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
Page No:28 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
5.0
5.1
Paediatric Views and Exposure Guidelines
Computed Radiography (CR) Views and Exposure
Guidelines
Please refer to specific room settings
Examinations
Based on CR
method
Chest
Chest
0 - 6 months
Chest
6 months – 5 years
Chest 5 years +
Lateral Chest
< 5 years
Lateral Chest
> 5 years
Abdomen/Pelvis
Abdomen or Pelvis
Baby
Views
Supine
60 – 63kV +
1 - 2mAs
180 FFD
AP Sitting
65kV + 1.6 –
3.2mAs
180cm FFD
AP/PA
65-77KV + 2
Standing
– 3.2
180cm FFD
Lateral Sitting 70KV +
or Standing
3.2mAs
180cm FFD
Lateral Sitting 73KV + 4or Standing
5mAs
180cm FFD
Supine
Abdomen or Pelvis
1- 10 years
Supine
Abdomen or Pelvis
10 + years
Supine
File: justification-guidelines.doc
Author’s Initials: DS
Exposure
Version No: 5
Authorised By: MC
60KV + 1-2
mAs
100cm FFD
No Grid
65kV -75KV
+ 2-10 mAs
100cm FFD
Use AEC,
both side
chambers
75kV (+1625mAs with
stationary
grid)
100cm FFD
Issue Date: March 2011
Review Date: March 2012
Expected
Dose
cGycm2
1
1-2
1-5
3
5-8
1 -2
2-11
<150
Page No:29 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
Spine
C-Spine
Lateral
65-70KV +
6mAs
180cm FFD
AP
60KV +
4mAs
100cm FFD
60KV +
4mAs
100cm FFD
75-80KV +
AEC centre
chamber or
manual
exposure of
80-120mAs
110cm FFD
Peg
Swimmers
T-Spine
<10 years
Lateral
<10 years
AP
>10 years
Lateral
>10 years
AP
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
65-75KV
10-16mAS
180cm FFD
(no Grid –
use air gap)
60-70KV +
6-10mAs
(no grid)
70-80KV
AEC centre
chamber
100cm FFD
65-75KV +
AEC centre
chamber
(10-16 mAs
with
stationary
grid)
Issue Date: March 2011
Review Date: March 2012
Whole
series (no
swimmers)
<20
Whole
series (with
swimmers)
< 150
Whole
Series < 25
Whole
Series <
200
Page No:30 of 20
IRMER Procedure
Justification of Exposures
Oxford University Hospitals NHS Trust Radiology
Department
L-Spine
<10 years
Lateral
70-75KV +
14-18mAs
180cm FFD
(no Grid –
use air gap)
<10 years
AP
>10 years
Lateral
>10 years
AP
65-75KV 1012mAs (no
grid)
75-85KV +
Whole
AEC centre Series <
chamber
500
100cm FFD
70-80KV +
AEC centre
chamber
(18-25mAs
with
stationary
grid)
Skull
<10 years
AP
<10 years
Lateral
>10 years
AP
>10 years
Lateral
Facial Bones
<10 years
OM
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Whole
Series < 30
60-70KV +
2.5-4mAs
(no Grid)
60-70KV +
2.5-4mAs
(no Grid)
70KV + AEC
centre
chamber
(10-16mAs
with Grid)
65KV + AEC
centre
chamber
(10mAs)
Whole
Series < 20
60-70KV +
2.5-4mAs
(no Grid)
Whole
Series < 20
Issue Date: March 2011
Review Date: March 2012
Whole
Series < 80
Page No:31 of 20
IRMER Procedure
Justification of Exposures
<10 years
OM 30°
>10 years
OM
>10 years
OM 30°
Upper and Lower
Limbs
Hands
Oxford University Hospitals NHS Trust Radiology
Department
60-70KV +
2.5-4mAs
(no Grid)
70KV + AEC Whole
Series < 80
centre
chamber
(10-16mAs
with Grid)
70KV + AEC
centre
chamber
(10-16mAs
with Grid)
Thumb
DP + Oblique
(lateral if #’d
MC)
DP, Lateral
(45° Oblique
for MCPJ)
AP + Lateral
Feet
DP + Oblique
Toes
DP + Oblique
Long Bones + Joints
(Humeri, tib/fib,
radius/ulna, femora,
elbow,)
AP + Lateral
(Scaphoid
does not
appear till
about 10
years of age)
55-60KV +
AP and
2mAs
review
Axial/modified
axial (Lateral
for proximal
humerus)
AP + Lateral 55-60KV +
2mAs
Fingers
Shoulder (Trauma)
Scapula (Trauma)
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
50-55KV +
1mAs
<2
50-55KV +
1mAs
<2
50-55KV +
1mAs
50-55KV +
1.6mAs
50-55KV +
1mAs
55-60KV +
2mAs
<2
Issue Date: March 2011
Review Date: March 2012
<2
<2
<5
<5
<5
Page No:32 of 20
IRMER Procedure
Justification of Exposures
Clavicle/ACJ
(Trauma)
Skeletal Survey
As per individual
protocol and using
views and exposures
above
AP only
Oxford University Hospitals NHS Trust Radiology
Department
55-60KV +
2mAs
<5
<35 total for
small baby
5.2
Digital Radiography (DR) Views and Exposure
Guidelines
Please refer to specific room settings
Based on DR
(Children’s
Hospital)
Chest
Chest
Supine
60-63KV + 10 - 6months
(through table) 2mAs
120cm FFD
Chest
AP Sitting
65KV + 26 months – 5
3.2mAs (or
years
AEC both side
chambers)
180cm FFD
Chest 5 years +
AP/PA
65-77KV
Standing
Use AEC,
both side
chambers,
180cm FFD
Lateral Chest
Lateral Sitting 70KV + 3.2
< 5 years
or Standing
mAs
180cm FFD
Lateral Chest
Lateral Sitting 73KV, Use
> 5 years
or Standing
AEC centre
chamber
180cm FFD
Abdomen/Pelvis
Abdomen or
Supine
60KV + AEC
Pelvis
centre
Baby
chamber
110cm FFD
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Issue Date: March 2011
Review Date: March 2012
1
1-2
1-5
3
5-8
1 -2
Page No:33 of 20
IRMER Procedure
Justification of Exposures
Abdomen or
Pelvis
1- 10 years
Supine
Abdomen or
Pelvis
10 + years
Supine
Oxford University Hospitals NHS Trust Radiology
Department
No Grid
65kV-75KV +
AEC both side
chambers
110cm FFD
Use AEC with
Grid both side
chambers
75kV
110cm FFD
2-11
<150
Spine
C-Spine
Lateral
AP
T-Spine
<10 years
Lateral
<10 years
AP
>10 years
Lateral
>10 years
AP
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
65-70KV +
AEC centre
chamber
180cm FFD
65-70KV
+AEC centre
chamber
110cm FFD
<10 for whole
series
65-70KV AEC
centre
chamber
110cm FFD
65-70KV AEC
centre
chamber
110cm FFD
65-70KV AEC
centre
chamber
using Grid
110cm FFD
65-70KV AEC
centre
chamber
110cm FFD
<10 for whole
series
<30 for whole
series
Issue Date: March 2011
Review Date: March 2012
Page No:34 of 20
IRMER Procedure
Justification of Exposures
L-Spine
<10 years
Lateral
<10 years
AP
>10 years
Lateral
>10 years
AP
Skull
<10 years
AP/PA
<10 years
Lateral
>10 years
AP/PA
>10 years
Lateral
Facial Bones
<10 years
OM
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Oxford University Hospitals NHS Trust Radiology
Department
65KV -75KV
AEC centre
chamber
110cm FFD
65-75KV
AEC centre
chamber
110FFD
65KV -75KV
AEC centre
chamber with
grid
110cm FFD
65-75KV
AEC centre
chamber
110FFD
<20 for whole
series
63-75KV AEC
Centre
chamber
110cm FFD
63-75KV
AEC Centre
chamber
110cm FFD
63-75KV
AEC Centre
chamber with
Grid
110cm FFD
63-75KV
AEC Centre
chamber with
Grid
110cm FFD
<15
63-75KV
AEC Centre
chamber
<15
<150 for
whole series
Issue Date: March 2011
Review Date: March 2012
<15
<15
<15
Page No:35 of 20
IRMER Procedure
Justification of Exposures
<10 years
OM 30°
>10 years
OM
>10 years
OM 30°
Post nasal space Lateral
Upper and
Lower Limbs
Hands
DP + Oblique
(lateral if #’d
MC)
Fingers
DP, Lateral
(45° Oblique
for MCPJ)
Thumb
AP + Lateral
Feet
DP + Oblique
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Oxford University Hospitals NHS Trust Radiology
Department
110cm FFD
63-75KV
AEC Centre
chamber
110cm FFD
63-75KV
AEC Centre
chamber with
Grid
110cm FFD
63-75KV
AEC Centre
chamber with
Grid
110cm FFD
63-75KV
AEC Centre
chamber
110cm FFD
60KV +
1.25mAs
directly onto
detector
110cm FFD
60KV +
1.25mAs
directly onto
detector
110cm FFD
60KV +
1.25mAs
directly onto
detector
110cm FFD
60KV +
1.25mAs
directly onto
detector
110cm FFD
Issue Date: March 2011
Review Date: March 2012
<15
<15
<15
<10
<2
<2
<2
<2
Page No:36 of 20
IRMER Procedure
Justification of Exposures
Toes
DP + Oblique
Long Bones +
Joints
(Humeri, tib/fib,
radius/ulna,
femora, elbow,)
AP + Lateral
(Scaphoid
does not
appear till
about 10 years
of age)
AP and review
Axial/modified
axial (Lateral
for proximal
humerus)
AP + Lateral
Shoulder
(Trauma)
Scapula
(Trauma)
Clavicle/ACJ
(Trauma)
AP only
Skeletal Survey
As per individual
protocol and
using views and
exposures above
File: justification-guidelines.doc
Author’s Initials: DS
Version No: 5
Authorised By: MC
Oxford University Hospitals NHS Trust Radiology
Department
60KV +
1.25mAs
directly onto
detector
110cm FFD
60KV + AEC
Centre
Chamber
110cm FFD
<2
60KV + AEC
Centre
Chamber
110cm FFD
<5
60KV + AEC
Centre
Chamber
110cm FFD
60KV + AEC
Centre
Chamber
110cm FFD
<5
Directly onto
detector
where
possible
<35 total for
small baby
Issue Date: March 2011
Review Date: March 2012
<5
<5
Page No:37 of 20
`