A survey investigating postero-anterior chest X-ray clinical technique amongst radiographers and assistant practitioners in the UK: An extended pilot study

IntroductionWhilst many technical factors for the postero-anterior (PA) chest projection are well-researched and standardised, anecdotal evidence suggests a discrepancy regarding positioning of the X-ray tube; some radiographers using a horizontal tube, and others apply an angle. Currently there is a lack of published evidence supporting the benefits of either technique.MethodsFollowing University ethical approval, an invitation e-mail containing a link to a short questionnaire and participant information sheet was sent to radiographers and assistant practitioners in Liverpool and the surrounding areas, via professional networks/research team contacts. Questions related to length of experience, highest qualification and reasoned choice of horizontal versus angled tube preference in Computed Radiography (CR) and Digital Radiography (DR) rooms. The survey was open for nine weeks, with reminders at five and eight weeks.ResultsThere were 63 respondents. Both techniques were commonplace, with a non-statistically significant preference (p = 0.439) for a horizontal tube in both DR rooms (59%, n = 37) and CR rooms (52%, n = 30). Angled technique was employed by 41% (n = 26) of participants in DR rooms and 48% (n = 28) in CR rooms. Many participants indicated 'taught', or 'protocol', influenced their approach (46% [n = 29] in DR, 38% [n = 22] in CR). 35% (n = 10) of participants using caudal angulation, identified dose optimisation as the rationale in both CR and DR rooms. Most specifically noted reduced dose to the thyroid (69% [n = 11] in CR, 73% [n = 11] in DR).ConclusionsThere is evidence of variation in practice regarding horizontal versus an angled X-ray tube but no consistent rationale for either choice.Implications for practiceThere is a need to standardise tube positioning in PA chest radiography in line with future empirical research into the dose-optimisation implications of tube angulation