Reduction of radiation dose to patients undergoing barium enema by dose audit

Nowadays, new fluoroscopic machines are usually equipped with a dose-area product (DAP) meter for dose measurement. In our hospital, DAP meters have been used in the Diagnostic Radiology Department for dose audit since June 1997. Demographic patient data, name of radiologist, fluoroscopic duration and DAP readings of every case were recorded by radiographers. In early 1999, questionnaires were distributed to radiologists who had performed fluoroscopic examinations during the auditing period. 23 radiologists with varying years of experience completed the questionnaire and their practice was analysed. Since familiarization with the examination technique would affect radiologists' practice, these radiologists were divided into two groups for analysis. Radiologists with less than 3 years of experience were grouped together as junior radiologists, whilst others were grouped as senior radiologists. Results of the questionnaire indicated that radiologists generally found DAP meters useful for dose evaluation in the process of technique refinement. Radiologists aware of being under continuous surveillance of their practice showed significant reduction of doses (junior radiologists 25%, p <0.005; senior radiologists 36%, p <0.05) and fluoroscopic times (junior radiologists 36%, p <0.001; senior radiologists 18%, p <0.05) compared with radiologists who were unaware that they were under surveillance but with similar radiological experience. This effect is believed to be because of increased awareness of radiation dose through audit. In addition, this "audit effect" may also affect junior radiologists in decision-making regarding the number of radiographs (p <0.05), but no effect was found for senior radiologists (p >0.5).