Technique, radiation safety and image quality for chest X-ray imaging through glass and in mobile settings during the COVID-19 pandemic

Phys Eng Sci Med. 2020 Sep;43(3):765-779. doi: 10.1007/s13246-020-00899-8. Epub 2020 Jul 13.


The COVID-19 pandemic in 2020 has led to preparations within our hospital for an expected surge of patients. This included developing a technique to perform mobile chest X-ray imaging through glass, allowing the X-ray unit to remain outside of the patient's room, effectively reducing the cleaning time associated with disinfecting equipment. The technique also reduced the infection risk of radiographers. We assessed the attenuation of different types of glass in the hospital and the technique parameters required to account for the glass filtration and additional source to image distance (SID). Radiation measurements were undertaken in a simulated set-up to determine the appropriate position for staff inside and outside the room to ensure occupational doses were kept as low as reasonably achievable. Image quality was scored and technical parameter information collated. The alternative to imaging through glass is the standard portable chest X-ray within the room. The radiation safety requirements for this standard technique were also assessed. Image quality was found to be acceptable or borderline in 90% of the images taken through glass and the average patient dose was 0.02 millisieverts (mSv) per image. The majority (67%) of images were acquired at 110 kV, with an average 5.5 mAs and with SID ranging from 180 to 300 cm. With staff positioned at greater than 1 m from the patient and at more than 1 m laterally from the tube head outside the room to minimise scatter exposure, air kerma values did not exceed 0.5 microgray (µGy) per image. This method has been implemented successfully.

Keywords: COVID-19; Chest imaging; Pandemic; Portable; Radiation safety; X-ray.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections* / diagnostic imaging
  • Coronavirus Infections* / prevention & control
  • Glass
  • Humans
  • Infection Control* / instrumentation
  • Infection Control* / methods
  • Infection Control* / standards
  • Occupational Health / standards
  • Pandemics* / prevention & control
  • Pneumonia, Viral* / diagnostic imaging
  • Pneumonia, Viral* / prevention & control
  • Radiography, Thoracic* / instrumentation
  • Radiography, Thoracic* / methods
  • Radiography, Thoracic* / standards
  • Radiology Department, Hospital / organization & administration
  • Radiology Department, Hospital / standards
  • SARS-CoV-2