Lowering Your Patients’s Entrance Skin Exposures (ESEs):
X-Ray Guidance

The following steps may be taken to reduce the ESEs from x-ray units in your office:

1. The first step is to ensure that your x-ray unit is calibrated properly. Like cars, an x-ray unit is a machine and requires periodic maintenance. If maintenance is not conducted, the x-ray unit, will not run at its optimum performance level.
2. Secondly, the processor must be cleaned and the chemicals changed. If manually developing films, the chemical/film manufacturer’s recommendation for time/temperature development must be used. Development by sight results in higher ESEs when the film is under processed. If using an automatic processor, the timer needs to be calibrated to assure that the film stays in the proper chemical for the appropriate length of time, and the chemical temperature needs to be correctly adjusted to ensure the proper time/temperature development.
3. The darkroom needs to be clean and free of dust. This will aid in eliminating artifacts on your films. In addition, the room needs to be “light tight.” This will help to eliminate film fogging.
4. Check the storage of your x-ray film. Film should be stored in an area free from heat, moisture, and exposure to scatter radiation. If the film is exposed to these adverse conditions, the film may fog causing an increase of film density which would require an increase in exposure time to compensate for the increased density.
5. Once steps 1 through 4 have been taken, you are ready to take a reference film. A reference film is taken by using a step wedge. Place the step wedge over a film and position the x-ray field over the step wedge. Record the kVp, mA, time, and source to image receptor distance. This information will be necessary to conduct this test in the future. Take an exposure and develop the film. Save this film as a reference film.
6. Approximately once a month or any time that you suspect that there may be a problem with your x-ray system, create another film in the same manner as described in “5”. Compare this film to the reference film. (Be sure to have the “steps” properly aligned between the two films). If you notice an increase or a decrease in film density of “2 steps,” you are alerted that there is a problem and corrective actions should be taken before your radiographs deteriorate in diagnostic quality.

If you have additional questions please contact DWMRC at contact (801) 536-0200.