A comparison of fluoroscopy time and dose area product (DAP) readings for outpatient barium enema examinations

Historically, the radiologist was the operator for the barium enema examination. However, as a result of the worldwide shortage of radiologists, and the development of the four-tier service delivery model, radiographers at this Trust have undertaken postgraduate training, and now perform and report their own barium enema examinations. Periodic clinical audit is required to ensure that the patient receives the same high standard of care, in terms of radiation dose, irrespective of the health care professional undertaking the examination. This study seeks to assess the situation at this large hospital in East Anglia. Fluoroscopy time and dose area product (DAP) measurements from 92 barium enema examinations, performed by radiographers (90.2%) and radiologists (9.8%), were compared to see if there were significant differences in the radiation dose to the patient, as a result of the operator group undertaking the examination. The study shows that although radiographers produce more undercouch images (a mean of 12.1 images compared to 9.3 images), their fluoroscopy times (a mean of 1.74 min compared with 2.82 min) and undercouch DAP readings (a mean of 1244.9 cGycm2 compared with 1971.3 cGycm2) were lower than that of the radiologists. This resulted in a lower total DAP (a mean of 1536.8 cGycm2 compared with 2236.0 cGycm2), and therefore a lower radiation dose to the patient, when the examination was undertaken by a radiographer, as opposed to a radiologist. The researchers believe that this study highlights the ability of the radiographer to assume the role of the operator for the barium enema examination. Nevertheless, it is acknowledged that continued assessment is required to ensure that performance is maintained.