Body Mass Index role in Lumbar Sacrum Spine Anterio-Posterior and Lateral Radiography by adjusting the radiation exposure factor mAs & kVp to avoid unnecessary radiation dose in patient- An Observational Study

Body Mass Index role in Lumbar Sacrum Spine Anterio-Posterior and Lateral Radiography by adjusting the radiation exposure factor mAs & kVp to avoid unnecessary radiation dose in patient- An Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Body Mass Index role in Lumbar Sacrum Spine Anterio-Posterior and Lateral Radiography by adjusting the radiation exposure factor mAs & kVp to avoid unnecessary radiation dose in patient- An Observational Study Kripanand Yadav, Navreet Boora, Nitish Virmani, BB Sharma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-131245/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background - To evaluate the role of BMI values before each L. S. spine radiograph and to choose the optimum radiation exposure factors without compromised the radiographic image quality. The data of BMI values of each patient’s and radiation exposure values like mAs & kVp were collected. This study was based on the observation analysis of BMI values with radiation exposure parameters like mAs & kVp. Forty patients were added to this study. Out of which, 26 were female and 14 male patients were added. Result - In the result, the exposure factors were used in the first two categories i.e. normal BMI and overweight BMI were found optimum with good anatomical details and good quality radiographs. But in the rest three BMI categories i.e Pre-Obese, Pre-obese 1, and Obese, the radiation exposure factors were not found appropriate in different BMI values/categories. Conclusion - The study concludes that blind selection of radiation exposure factors (mAs & kVp) for each X-Ray procedure, is unprofessional behavior of radiographer. Appropriate radiation exposure chart, the amount of radiation dose can be reduced by 20–30% without compromising the radiographic image quality. Nuclear Medicine & Medical Imaging Body Mass Index L.S Spine AP & Lateral Radiation dose Reduction Obese Overweight Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Introduction The clinical application of X-Rays was started almost immediately after the discovery by Sir Wilhelm Conrad Roentgen on 8 November 1895. Since 1895, diagnostic X-Ray equipment has placed their presence in each clinician’s center. Discovery of X-Rays tremendously changed the medicine world and worked as eye opener for each clinician & surgeon. As technology get going improved day by day, as the quality of X-Ray images getting improved (1) . In New Delhi India, the 1 st X-Ray equipment was installed at Lady Hardinge hospital in 1918 and a radiology department was established in 1923 in the hospital (2) . The role of spine radiography has importance in trauma, lower backache, jerk cases (Sudden or sharp movements of spine), Heavy weight lifting, radiating lower limb pain on either one side or both sides, and in case of metastatic diseases (3) . This study is hypothesized that the role of Body Mass Index (BMI) in the Lumbo-Sacral (L.S) Spine AP & LAT radiography may help in improvement of imaging quality and reduce the amount of patient absorbed dose. This will be beneficial for not only the patients but it will also help the radiographer or radiologist to choose optimum radiation exposure parameters. Which can help in to decrease the amount of radiation dose in each patient and can archive quality X-Rays images. Low or high radiation dose to patient is harmful, So the responsibility of radiographer is to choose the appropriate radiation exposure for each patient. The major responsibility of the radiographer is to avoid the unnecessary or extra radiation exposure to the patient (4) . In the diagnostics, poor X-Ray imaging quality may lead to repeat exposure or false/mis-diagnosis of patient’s the disease. The radiation dose in a L.S Spine AP & LAT radiograph for adult is approximately 0.06 mSv (5) and this radiation dose is differ from patient to patient. The density of the tissues at L.S Spine region is different in AP position and it is different in Lateral position. Blindly selection of radiation exposure parameters may lead to unprofessional behavior of the radiographer. Good contrast images are required in each X-Ray procedure. Contrast of the x-ray image was defined according to the different density levels of tissues between the lighter shade to darker shades of gray scale (6) . Ionizing radiation has sufficient energy to affect the atoms of living cells and also can damage their genetic material (DNA). Radiation interactions with genetic material of living cell may produce direct and indirect biologic effects (7) . It involves rupture of cell membrane and breakdown of chromosomes structure and that is known as DNA strands break (8) . For radiation protection radiographer must follow the term “ALARA” (As Low As Reasonably Achievable), and TDS (Time Distance Shielding) principals in his routine practice (9) . In the Anatomy of L.S Spine X-Ray Figure 1a AP view showing the 1. Lower chest ribs. 2. Transverse process, 3. Pedicle, 4. Spinous process, 5. Sacrum, 6. Sacroiliac joint and Figure 1.b lateral view showing the 1. Sacrum, 2. Spinous process, 3. Vertebral body, 4. Intervertebral disc space, 5. Intervertebral foramen, 6. Pedicle, 7. Inferior articular process, 8. Superior articular process, 9. Lower Chest Ribs. All these anatomical regions should be clearly visualized in X-Ray image (10) . Body Mass Index (BMI) values are the key index of the relationship in weight and height of the human beings. BMI is calculated as, weight kg/height m 2 . This is commonly use to surrogate in diagnosis of the obesity and fat distribution. As the fat increases or decreases near or at the lumbar region, on the basis of BMI values calculation patient can consider as fatty/obese or normal patient as shown in Table 1. On the basis of BMI values radiographer can adjust the radiation exposure parameter to the optimum level to achieve the good quality of radiographs also can eliminate the extra radiation absorbed dose to patients (11, 12) . Vasileios I. et al. conducted a study and says that the dose audit is important in the optimization of the patient’s radiation protection in diagnostic. In this study, the effect of body mass index (BMI) on radiation dose were calculated. Total 1869 adult patients underwent chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis radiography. All procedures was done for both, overweight and obese patients and compared with normal patients through Mann–Whitney test (p < 0.0001) and were found significantly positive relationship between patient body size and exposure factor (13) . Patrick Knott, et al. performed a study on reducing the X-Rays exposure in pediatric patient’s scoliosis patients. In this study, such significant advance changes have been made in current diagnostic techniques. In general, adolescents are exposed to less radiation dose for radiographic imaging, and proved that newer imaging techniques are able to decrease the amount of radiation exposure. Researcher well explained that it should be noted the rates of cancer secondary to primary radiation exposure are not specific in scoliosis patients. Dosages for the spine radiograph were reduced from 1/6 th to 1/9 th from the standard amount of radiation dose. By following the standard exposure chart as suggested by researcher (9) , the radiation dose to patient in higher BMI (Pre-obese and obese) vales, can be minimized by 30-40% without compromise the quality, contrast and resolution of radiographic images (14) . Need of this study- In routine X-Ray procedures, maximum number of patients underwent for spine radiography and took high radiation dose exposure. In which some of them also get repeated exam due to the lack of optimum radiation exposure or poor image quality radiograph and if not repeated then radiologist need to compromised with the poor image quality radiograph and diagnosis has to made for patient. To optimize the radiation dose and improve the image quality of spine radiograph, some bull’s eye technique is required. No any study has been yet published in “India” on spine radiograph with consideration of BMI values before performing the examination. BMI values may provide an idea to choose appropriate radiation exposure factors, which can be help to radiographer to minimize the amount of radiation dose to patient. Aim: To evaluate the role of BMI values before each L. S. spine radiograph and to choose the optimum radiation exposure factors without compromised the radiographic image quality. Method And Material The data of BMI values of each patient’s and radiation exposure values like mAs & kVp were collected with the help of radiographer in the department. This study was based on the observation analysis of BMI values with radiation exposure parameters like mAs & kVp. As per pre-decided selection criteria, the patients only from Out Patient Department (OPD) with clinical history of lower back pain were added in this study. And trauma patients, patient form in-patient department (IPD), pediatric, unwilling patient and pregnant patient were excluded from this study. Each set of data after selection criteria was collected on the single stationary 600 mA Allenger X-Ray equipment. Total 60 patient’s data have been collected after the exclusion criteria out of 60, total 40 patients were added in this study. Out of forty patients, 26 were female and 14 male patients (Figure-2) were added. The data was collected in a proper manner by the researcher only. Measurement of BMI values & radiation exposure factor values were taken. Total number of patients in highest and lowest BMI range, the lowest value of BMI was observed 19.0 which is under Normal range and highest value of BMI was observed 32.5 which is under obese-1 category as shown in Figure 3. After the compilation of data set from minimum to maximum BMI values (Figure 3), the data were further segregated in different aspect to see the various pattens like- Number of patients in each BMI categories, 9 patients were found under normal range, 9 patients were found under overweight, 10 patients were found under Pre-obese, 7 patients were found under Pre-obese 1 and in the obese-1 category 5 patients were found as shown in Figure 4. Number of male and females in each BMI category, 2 male and 7 females patients were forum under normal, 3 male and 6 females patients were found under overweight, 7 male and 3 female patients were under Pre-obese, 2 male and 5 female patients were under Pre-obese 1, no any male patient in last category described as obese-1 this category have only 5 female patients as shown in Figure 5. Observation report of various BMI values correlation with radiation exposure factor mAs & kVp is shown in Table 2. The minimum and maximum radiation exposure factors (kVp & mAs) was used for the L. S. Spine Anterior-Posterior radiograph in different BMI categories. Whereas mAs range was from 30 to 100 and kVp range was from 65 to 92 were used in different BMI categories patients as shown in Figure 6. The minimum and maximum exposure factors (kVp & mAs) used for the L. S. Spine Lateral view radiograph in different BMI categories. Where mAs range was from 50 to 150 and kVp range was from 70 to 96 in different BMI categories as shown in Figure 7. Recommended and purposed systematic mAs & kVp values as per different BMI categories are shown in figure 8 & 9. Result Out of forty patients 65% were male and 35% were female those underwent the X-Ray L. S. Spine AP & Lateral were added in this study. After that patient’s data set further distributed in different categories as explain in method and material. In different BMI category, the amount of radiation exposure factor is different and the values are: in normal BMI, the minimum values of radiation exposure factors were 30 mAs & 70 kVp. and maximum were 38 mAs & 75 kVp in anterio-posterior (AP) radiograph and in the lateral radiograph, minimum values of radiation exposure factors 52 mAs & 70 kVp and maximum 58 mAs & 76 kVp were found optimum with good quality of anatomical details. In overweight of BMI, the minimum value of radiation exposure factors 40 mAs & 70 kVp and maximum values 46 mAs & 78 kVp in AP radiograph, and in lateral radiograph minimum 72 mAs and 75 kVp and maximum 86 mAs and 80 kVp were also found optimum with good anatomical details. In under Pre-obese of BMI, the minimum values of radiation exposure factors 50 mAs & 60 kVp and maximum 100 mAs and 88 kVp in AP radiograph, and in lateral minimum 80 mAs & 70 kVp and maximum 130 mAs & 91 kVp were found satisfactory with normal image quality. In under sub category of Pre-obese (PO1) BMI i.e. Pre-obese1, the minimum values of radiation exposure factors 40 mAs & 70 kVp and maximum 90 mAs and 92 kVp in AP radiograph, and in lateral radiograph minimum 70 mAs & 69 kVp and maximum 150 mAs & 96 kVp were not found up to the mark with low anatomical details. In the sub category of Obese BMI, i.e. Obese1, the minimum values of radiation exposure factors 50 mAs & 75 kVp and maximum 85 mAs & 90 kVp in AP radiograph, and in lateral radiograph minimum 100 mAs & 80 kVp and maximum 150 mAs & 85 kVp were also not found satisfactory with low anatomical details. In the result, the exposure factors were used in first two categories i.e. normal BMI and overweight BMI were found optimum with good anatomical details and good quality radiographs. But in rest three BMI categories i.e Pre-Obese, Pre-obese 1 and Obese, the radiation exposure factors were not found appropriate in different BMI values/category. After the correlation of BMI values with radiation exposure factor mAs & kVp values, new systematic optimum radiation exposure factors were calculated by simple mathematical formula. New radiation exposure factors mAs & kVp values are purposed for the L. S. Spine Anterior-Posterior & Lateral radiographs. In which different BMI categories consist of their own minimum and maximum values of mAs & kVp are shown in Table 3 & 4. Discussion In this study role of Body Mass Index (BMI) in Lumbar Sacrum (L.S) Spine Anterio-posterior (AP) and Lateral radiography, radiation factor was calculated before each examination. This study was inspired by various researches conducted by different authors in which like S. Reena, S. Sunil Dutt, Ajay Chaubey, et al. described the screen-film system is replaced by computed radiography system by recording the images of the patients during X-Rays radiography examinations. The change in imaging system was required and to reestablishment of the institutional diagnostic reference levels (DRLs), different types of X-Rays procedures was conducted at the hospital. For the same purpose, patient specific parameters like age, height, weight, body mass index (BMI), object to image distance (OID) and machine specific parameters like kVp, mAs, distance and collimation sizes were recorded. Total 1875 patients under 21 different types of X-Rays examinations was added in this study to estimating the entrance skin dose (ESD) (15,16) . In this study radiation exposure factors were observed with BMI values of each patient to find out the appropriate range of exposure in each BMI category. Study recommends that BMI vales are important indicator to select or calculate the radiation exposure factors before each procedure. Because as the BMI values increases tissue variation in region of interest changes. Hence it is better to measure BMI values before performing radiation exposure which helps to get better quality radiographs without losing the anatomical details, image resolution and contrast. Pagan L, et. al., Aldrich J et. al., Faulkner K et.al., conducted study on the patient radiation absorbed dose in digital projection radiography with reference to optimization of radiation absorbed dose, the role of image quality with dose and measurement of patient dose in various diagnostic radiology procedures respectively. These three studies well explain the role of optimum radiation dose with image quality and requirement of minimizing the amount radiation dose on the basis of radiation exposure factors selection. As understood the amount radiation absorbed dose varies from patient to patient as well as the area of interest under the X-Ray examination. Responsibility of healthcare professionals are to reduce the amount of radiation dose for patient in all possible manner (16,17) . Priority is to achieve the best quality radiograph to make radiologist job easy and best diagnosis for the patient. Radiographer can do his/her job easily with the minimum possible exposure factors which can gave optimum radiograph quality and decrease the unwanted radiation to the patient (18,19) . Conclusion The study concludes that blind selection of radiation exposure factors (mAs & kVp) for each X-Ray procedure is unprofessional behavior of radiographer. Appropriate radiation exposure factor mAs & kVp) selection, the amount of radiation dose for can be reduced by 20-30% without compromising the radiographic image quality. Recommendations Radiographers must follow the term ALARA & TDS principal. Calculation of BMI values should take under consideration before L.S Spine AP & Lateral radiography. Manipulation in radiation exposing factors mAs & kvp must done as per the need of different BMI values/categories New radiation exposure factor mAs & kVp values for L.S Spine AP & Lateral are purposed as per different BMI categories shown in table 3 & 4. Abbreviations ALARA- As Low As Reasonably Achievable AP- Anterio-Posterior BMI- Body Mass Index CT- Computed Tomography DRL - Diagnostic Reference Levels kVp- Kilo Voltage Peak LAT- Lateral S.- Lumbar Sacrum mAs- Milli Ampere Second OID - Object to Image Distance PO1- Pre-Obese 1 TDS- Time Distance & Shielding Declarations Ethics approval and consent to participate – Ethical approval was taken from the central institutional committee of SGT University Hospital & Research Institute and all methods were performed according to guidelines and regulations provided by central committee under "Ethics approval and consent to participate" section. Approved Informed consent forms were obtained from each participant. Consent for publication - Hereby, all author agrees to publish this study and give consent for the availability of the data set. Availability of data and materials- Radiation dose technical factors (mAs & kVp) & BMI values data-set carefully taken and recorded by the researcher. The datasets generated and/or analysed during the current study are available in the MS Excel. Data can also be shared by the corresponding author on reasonable request. Competing financial and/or non-financial interests - No, I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding - The authors neither received nor wants any type of commercial support in the form of either compensation or financial support for the study or for personal interest. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions- Virmani Nitish (3) and Yadav Kripanand (1) conception, design of the work, the data acquisition, analysis, and interpretation of the data. Navreet Boora (2) & BB Sharma (4) contributed in commenting on the paper and have approved the final version. All authors reviewed the manuscript. Acknowledgements- We are thankful to Mr. Mohit Deswal & Mr. Vaibhav M.Sc Fellows for CT scan procedures and data compiling. Conflict of Interest No conflict of interest. References Panchbhai A. Wilhelm Conrad Röntgen and the discovery of X-rays: Revisited after centennial. JIAOMR. 2015;27(1):90. Dhawan S K(N.A.) “A brief history of Indian Radiology” ; Radiology Education Foundation Pye S, Reid D, Adams J, Silman A, O'Neill T. Influence of weight, body mass index and lifestyle factors on radiographic features of lumbar disc degeneration. Annals of the Rheumatic Diseases. 2007;66(3):426-27. Adejoh T, Ewuzie O, Ogbonna J, Nwefuru S, Onuegbu N. A Derived Exposure Chart for Computed Radiography in a Negroid Population. Health. 2016;08(10):953-58. Al-Nasiri M, Rowlands J. Lumbar spine X-ray – computer says no!. Clinical Radiology. 2015;70:S11. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. AJCN. 1998;68(4):899-917. Onyemaechi N, Anyanwu G, Obikili E, Onwuasoigwe O, Nwankwo O. Impact of overweight and obesity on the musculoskeletal system using lumbosacral angles. Patient Preference and Adherence. 2016;:291. Yanch J, Behrman R, Hendricks M, McCall J. Increased Radiation Dose to Overweight and Obese Patients from Radiographic Examinations. Radiology. 2009;252(1):128-39. Hendee W, Marc Edwards F. ALARA and an integrated approach to radiation protection. Seminars in Nuclear Medicine. 1986;16(2):142-50. Simpson A, Whang P, Jonisch A, Haims A, Grauer J. The Radiation Exposure Associated with Cervical and Lumbar Spine Radiographs. Journal of Spinal Disorders & Techniques. 2008;21(6):409-12. Nuttall F. Body Mass Index. Nutrition Today. 2015;50(3):117-28. Parashar P, Banasal R, Sharama S, Varshney A, Shukla A, Ahmad S. Body mass index for age criteria: a school based study in Meerut (U. P). APJHS. 2014;1(4):395-400. Metaxas V, Messaris G, Lekatou A, Petsas T, Panayiotakis G. Patient Dose In Digital Radiography Utilising Bmi Classification. Radiation Protection Dosimetry.2018. Knott P, Pappo E, Cameron M, deMauroy J, Rivard C, Kotwicki T et al. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis. Scoliosis. 2014;9(1). Sharma R, Sharma S, Pawar S, Chaubey A, Kantharia S, Babu D. Radiation dose to patients from X-ray radiographic examinations using computed radiography imaging system. JMP. 2015;40(1):29. Exposure-factors [Internet]. Dentalcare.com. 2019. Available from: https://www.dentalcare.com/en-us/professional-education/ce-courses/ce71/exposure-factors. Compagnone G, Pagan L, Baleni M, Calzolaio F, Barozzi L, Bergamini C. Patient dose in digital projection radiography. Radiation Protection Dosimetry. 2008;129(1-3):135-37. Aldrich J, Duran E, Dunlop P, Mayo J. Optimization of Dose and Image Quality for Computed Radiography and Digital Radiography. JDI. 2006;19(2):126-31. Faulkner K, Corbett R. Reference doses and quality in medical imaging. The British Journal of Radiology. 1998;71(850):1001-2. Tables Table 1. Showing the specimen images and range of BMI values according to categories prescribed by Asian Criteria. Nutritional status based on the WHO and “Asian criteria” values Nutritional Status WHO criteria BMI cut-off “Asian criteria” BMI cut-off Underweight <18.5 <18.5 Normal 18.5-24.9 18.5 – 22.9 Overweight 25-29.9 23 – 24.9 Pre-Obese - 25.0 - 27.5 Pre-Obese 1 More than 30 27.6 – 29.7 Obese1 30 – 40 30 - 40 Table 2. Radiation exposure factors of various BMI categories BMI Categories mAs kVp Normal AP 30- 35 65-70 Lat 50-55 70-75 Over weight AP 40-45 70-75 LAT 55-60 75-80 Pre obese AP 80 80 LAT 108 86 Pre obese 1 AP 74 78 LAT 110 88 Obese 1 AP 75 80 LAT 120 84 Table 3 Purposed radiation exposure factors for L.S. Spine Antero-Posterior view Radiation Factors Minimum mAs Minimum kVp Maximum mAs Maximum kVp BMI Categories NORMAL 30 65 35 70 OVER WEIGHT 40 70 45 75 PRE-OBESE 50 75 55 80 PRE-OBESE 1 55 80 60 85 OBESE 1 75 100 80 100 Table 4 Purposed radiation exposure factors for L.S. Spine Lateral view Radiation Factors Minimum mAs Minimum kVp Maximum mAs Maximum kVp BMI Categories NORMAL 50 70 55 75 OVER WEIGHT 55 75 60 80 PRE-OBESE 65 80 70 85 PRE-OBESE 1 70 85 75 90 OBESE 1 80 100 90 100 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-131245","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":7621088,"identity":"1fe833f2-99eb-441a-9270-1a631d5c639d","order_by":0,"name":"Kripanand Yadav","email":"","orcid":"","institution":"Maharishi Markandeshwar University, Mullana","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kripanand","middleName":"","lastName":"Yadav","suffix":""},{"id":7621089,"identity":"38948af9-52f7-4c26-bd3d-78e8e3ae9b59","order_by":1,"name":"Navreet Boora","email":"","orcid":"","institution":"Teerthanker Mahaveer Medical College \u0026 Research Centre","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Navreet","middleName":"","lastName":"Boora","suffix":""},{"id":7621090,"identity":"2be28081-a3d6-4e90-9053-7d0f96ff5cd1","order_by":2,"name":"Nitish Virmani","email":"data:image/png;base64,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","orcid":"","institution":"Shree Guru Gobind Singh Tricentenary University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Nitish","middleName":"","lastName":"Virmani","suffix":""},{"id":7621091,"identity":"0ff5ad5f-a6f5-4044-a6d7-3287201feaa1","order_by":3,"name":"BB Sharma","email":"","orcid":"","institution":"Shree Guru Gobind Singh Tricentenary University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"BB","middleName":"","lastName":"Sharma","suffix":""}],"badges":[],"createdAt":"2020-12-18 06:29:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-131245/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-131245/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":4824283,"identity":"34d06031-4ba2-4d57-848d-f89bae2bdeea","added_by":"auto","created_at":"2021-01-08 22:03:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":324834,"visible":true,"origin":"","legend":"1a and 1b showing the common anatomical areas need to be visualized clearly in L.S. Spine radiography.","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/d6a7f1e09337355ebb4f1d94.png"},{"id":4824217,"identity":"49655e9c-cc74-40fc-977d-d9844efc8950","added_by":"auto","created_at":"2021-01-08 22:00:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19923,"visible":true,"origin":"","legend":"Represents the demographic data of total 40 patients include 14 male and 26 female patients in the study for sample collection.","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/d7ced6df9d672f113be59d0c.png"},{"id":4824215,"identity":"2bc3a1c5-68f2-499f-b578-c14c54fc6f62","added_by":"auto","created_at":"2021-01-08 22:00:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":20911,"visible":true,"origin":"","legend":"Represent the data of lowest and highest BMI range of patient included this study.","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/54fabf1a80c3483724ebf7d5.png"},{"id":4824285,"identity":"f7f46819-1c73-46e7-801a-0e42fd865d77","added_by":"auto","created_at":"2021-01-08 22:03:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":33136,"visible":true,"origin":"","legend":"Represents the data of total number of patients in each BMI category","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/b3a54e196c01dd2086289bf5.png"},{"id":4824380,"identity":"b0f51111-6488-4c5d-8dca-8a5dd61a5d80","added_by":"auto","created_at":"2021-01-08 22:06:13","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":25288,"visible":true,"origin":"","legend":"Representation of data with number of male and female patients as per each BMI category.","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/ecd80e37af198b8529149a8f.png"},{"id":4824221,"identity":"455fbc3c-2595-4d08-ae4c-bae5ef11fdb5","added_by":"auto","created_at":"2021-01-08 22:00:13","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":39988,"visible":true,"origin":"","legend":"Represent the variation in radiation exposure factors in different BMI categories for the Anterior-Posterior view of L.S Spine.","description":"","filename":"Fig6.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/45f96090d0b5e4b21b67a5c6.png"},{"id":4824448,"identity":"44ecec0e-6422-499b-aaa6-d81b4581650f","added_by":"auto","created_at":"2021-01-08 22:09:13","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":41661,"visible":true,"origin":"","legend":"Represents variation of radiation exposure factors in different BMI category for the Lateral view of L.S Spine.","description":"","filename":"Fig7.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/08e358c4d4b4d646a8442fde.png"},{"id":4824288,"identity":"4ca0cbe8-2f27-496a-9f12-8e126204c589","added_by":"auto","created_at":"2021-01-08 22:03:13","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":39051,"visible":true,"origin":"","legend":"Represents the minimum \u0026 maximum mAs and kVp in each BMI category of radiography of L.S Spine AP view","description":"","filename":"Fig8.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/f58cce1848b56695fd4ab688.png"},{"id":4824382,"identity":"3281b733-abe4-44b9-9cbd-50a6cfb6d04d","added_by":"auto","created_at":"2021-01-08 22:06:13","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":41779,"visible":true,"origin":"","legend":"Represents the minimum \u0026 maximum mAs and kVp in each BMI category of radiography of L.S Spine lateral view\n\n","description":"","filename":"Fig9.png","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/4e0abc010261af913c619d23.png"},{"id":13644022,"identity":"0508170f-c282-40b2-9fe4-9e31229dd39d","added_by":"auto","created_at":"2021-09-17 09:14:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":864740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-131245/v1/744b7441-d586-400a-8d89-8397a55a0fca.pdf"}],"financialInterests":"","formattedTitle":"Body Mass Index role in Lumbar Sacrum Spine Anterio-Posterior and Lateral Radiography by adjusting the radiation exposure factor mAs \u0026 kVp to avoid unnecessary radiation dose in patient- An Observational Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe clinical application of X-Rays was started almost immediately after the discovery by Sir Wilhelm Conrad Roentgen on 8 November 1895. Since 1895, diagnostic X-Ray equipment has placed their presence in each clinician\u0026rsquo;s center. Discovery of X-Rays tremendously changed the medicine world and worked as eye opener for each clinician \u0026amp; surgeon. As technology get going improved day by day, as the quality of X-Ray images getting improved \u003csup\u003e(1)\u003c/sup\u003e. In New Delhi India, the 1\u003csup\u003est\u003c/sup\u003e X-Ray equipment was installed at Lady Hardinge hospital in 1918 and a radiology department was established in 1923 in the hospital \u003csup\u003e(2)\u003c/sup\u003e. The role of spine radiography has importance in trauma, lower backache, jerk cases (Sudden or sharp movements of spine), Heavy weight lifting, radiating lower limb pain on either one side or both sides, and in case of metastatic\u0026nbsp;diseases \u003csup\u003e(3)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study is hypothesized that the role of Body Mass Index (BMI) in the Lumbo-Sacral (L.S) Spine AP \u0026amp; LAT radiography\u0026nbsp;may help in improvement of imaging quality and reduce the amount of patient absorbed dose. This will be beneficial for not only the patients but it will also help the radiographer or radiologist to choose optimum radiation exposure parameters. Which can help in to decrease the amount of radiation dose in each patient and can archive quality X-Rays images. Low or high radiation dose to patient is harmful, So the responsibility of radiographer is to choose the appropriate radiation exposure for each patient. The major responsibility of the radiographer is to avoid the unnecessary or extra radiation exposure to the patient \u003csup\u003e(4)\u003c/sup\u003e. In the diagnostics, poor X-Ray imaging quality\u0026nbsp;may lead to repeat exposure or false/mis-diagnosis of patient\u0026rsquo;s the disease. The radiation dose in a L.S Spine AP \u0026amp; LAT radiograph for adult is approximately 0.06 mSv \u003csup\u003e(5)\u003c/sup\u003e and this radiation dose is differ from patient to patient.\u003c/p\u003e\n\u003cp\u003eThe density of the tissues at L.S Spine region is different in AP position and it is different in Lateral position. Blindly selection of radiation exposure parameters may lead to unprofessional behavior of the radiographer. Good contrast images are required in each X-Ray procedure. Contrast of the x-ray image was defined according to the different density levels of tissues between the lighter shade to darker shades of gray scale \u003csup\u003e(6)\u003c/sup\u003e. Ionizing radiation has sufficient energy to affect the atoms of living cells and also can damage their genetic material (DNA). Radiation interactions with genetic material of living cell may produce direct and indirect biologic effects \u003csup\u003e(7)\u003c/sup\u003e. It involves rupture of cell membrane and breakdown of chromosomes structure and that is known as DNA strands break \u003csup\u003e(8)\u003c/sup\u003e. For radiation protection radiographer must follow the term \u0026ldquo;ALARA\u0026rdquo; (As Low As Reasonably Achievable), and TDS (Time Distance Shielding) principals in his routine practice \u003csup\u003e(9)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn the Anatomy of L.S Spine X-Ray Figure 1a AP view showing the 1. Lower chest ribs. 2. Transverse process, 3. Pedicle, 4. Spinous process, 5. Sacrum, 6. Sacroiliac joint and Figure 1.b lateral view showing the 1. Sacrum, 2. Spinous process, 3.\u0026nbsp;Vertebral body, 4.\u0026nbsp;Intervertebral disc space, 5.\u0026nbsp;Intervertebral foramen, 6.\u0026nbsp;Pedicle, 7.\u0026nbsp;Inferior articular process, 8.\u0026nbsp;Superior articular process, 9.\u0026nbsp;Lower Chest Ribs. All these anatomical regions should be clearly visualized in X-Ray image \u003csup\u003e(10)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBody Mass Index (BMI) values are the key index of the relationship in weight and height of the human beings. BMI is calculated as, weight kg/height m\u003csup\u003e2\u003c/sup\u003e. This is commonly use to surrogate in diagnosis of the obesity and fat distribution. As the fat increases or decreases near or at the lumbar region, on the basis of BMI values calculation patient can consider as fatty/obese or normal patient as shown in Table 1. On the basis of BMI values radiographer can adjust the radiation exposure parameter to the optimum level to achieve the good quality of radiographs also can eliminate the extra radiation absorbed dose to patients \u003csup\u003e(11, 12)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eVasileios I. et al. conducted a study and says that the dose audit is important in the optimization of the patient\u0026rsquo;s radiation protection in diagnostic. In this study, the effect of body mass index (BMI) on radiation dose were calculated. Total 1869 adult patients underwent chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis radiography. All procedures was done for both, overweight and obese patients and compared with normal patients through Mann\u0026ndash;Whitney test (p \u0026lt; 0.0001) and were found significantly positive relationship between patient body size and exposure factor \u003csup\u003e(13)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePatrick Knott, et al. performed a study on reducing the X-Rays exposure in pediatric patient\u0026rsquo;s scoliosis patients. In this study, such significant advance changes have been made in current diagnostic techniques. In general, adolescents are exposed to less radiation dose for radiographic imaging, and proved that newer imaging techniques are able to decrease the amount of radiation exposure. Researcher well explained that it should be noted the rates of cancer secondary to primary radiation exposure are not specific in scoliosis patients. Dosages for the spine radiograph were reduced from 1/6\u003csup\u003eth\u003c/sup\u003e to 1/9\u003csup\u003eth\u003c/sup\u003e from the standard amount of radiation dose. By following the standard exposure chart as suggested by researcher \u003csup\u003e(9)\u003c/sup\u003e, the radiation dose to patient in higher BMI (Pre-obese and obese) vales, can be minimized by 30-40% without compromise the quality, contrast and resolution of radiographic images \u003csup\u003e(14)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eNeed of this study- In routine X-Ray procedures, maximum number of patients underwent for spine radiography and took high radiation dose exposure. In which some of them also get repeated exam due to the lack of optimum radiation exposure or poor image quality radiograph and if not repeated then radiologist need to compromised with the poor image quality radiograph and diagnosis has to made for patient. To optimize the radiation dose and improve the image quality of spine radiograph, some bull\u0026rsquo;s eye technique is required. No any study has been yet published in \u0026ldquo;India\u0026rdquo; on spine radiograph with consideration of BMI values before performing the examination. BMI values may provide an idea to choose appropriate radiation exposure factors, which can be help to radiographer to minimize the amount of radiation dose to patient. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTo evaluate the role of BMI values before each L. S. spine radiograph and to choose the optimum radiation exposure factors without compromised the radiographic image quality.\u003c/p\u003e"},{"header":"Method And Material","content":"\u003cp\u003eThe data of BMI values of each patient\u0026rsquo;s and radiation exposure values like mAs \u0026amp; kVp were collected with the help of radiographer in the department. This study was based on the observation analysis of BMI values with radiation exposure parameters like mAs \u0026amp; kVp. As per pre-decided selection criteria, the patients only from Out Patient Department (OPD) with clinical history of lower back pain were added in this study. And trauma patients, patient form in-patient department (IPD), pediatric, unwilling patient and pregnant patient were excluded from this study. Each set of data after selection criteria was collected on the single stationary 600 mA Allenger X-Ray equipment.\u003c/p\u003e\n\u003cp\u003eTotal 60 patient\u0026rsquo;s data have been collected after the exclusion criteria out of 60, total 40 patients were added in this study. Out of forty patients, 26 were female and 14 male patients (Figure-2) were added. The data was collected in a proper manner by the researcher only. Measurement of BMI values \u0026amp; radiation exposure factor values were taken.\u003c/p\u003e\n\u003cp\u003eTotal number of patients in highest and lowest BMI range, the lowest value of BMI was observed 19.0 which is under Normal range and highest value of BMI was observed 32.5 which is under obese-1 category as shown in Figure 3.\u003c/p\u003e\n\u003cp\u003eAfter the compilation of data set from minimum to maximum BMI values (Figure 3), the data were further segregated in different aspect to see the various pattens like-\u003c/p\u003e\n\u003cp\u003eNumber of patients in each BMI categories, 9 patients were found under normal range, 9 patients were found under overweight, 10 patients were found under Pre-obese, 7 patients were found under Pre-obese 1 and in the obese-1 category 5 patients were found as shown in Figure 4.\u003c/p\u003e\n\u003cp\u003eNumber of male and females in each BMI category, 2 male and 7 females patients were forum under normal, 3 male and 6 females patients were found under overweight, 7 male and 3 female patients were under Pre-obese, 2 male and 5 female patients were under Pre-obese 1, no any male patient in last category described as obese-1 this category have only 5 female patients as shown in Figure 5.\u003c/p\u003e\n\u003cp\u003eObservation report of various BMI values correlation with radiation exposure factor mAs \u0026amp; kVp is shown in Table 2.\u003c/p\u003e\n\u003cp\u003eThe minimum and maximum radiation exposure factors (kVp \u0026amp; mAs) was used for the L. S. Spine Anterior-Posterior radiograph in different BMI categories. Whereas mAs range was from 30 to 100 and kVp range was from 65 to 92 were used in different BMI categories patients as shown in Figure 6.\u003c/p\u003e\n\u003cp\u003eThe minimum and maximum exposure factors (kVp \u0026amp; mAs) used for the L. S. Spine Lateral view radiograph in different BMI categories. Where mAs range was from 50 to 150 and kVp range was from 70 to 96 in different BMI categories as shown in Figure 7.\u003c/p\u003e\n\u003cp\u003eRecommended and purposed systematic mAs \u0026amp; kVp values as per different BMI categories are shown in figure 8 \u0026amp; 9.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eOut of forty patients 65% were male and 35% were female those underwent the X-Ray L. S. Spine AP \u0026amp; Lateral were added in this study. After that patient\u0026rsquo;s data set further distributed in different categories as explain in method and material. In different BMI category, the amount of radiation exposure factor is different and the values are: in normal BMI, the minimum values of radiation exposure factors were 30 mAs \u0026amp; 70 kVp. and maximum were 38 mAs \u0026amp; 75 kVp in anterio-posterior (AP) radiograph and in the lateral radiograph, minimum values of radiation exposure factors 52 mAs \u0026amp; 70 kVp and maximum 58 mAs \u0026amp; 76 kVp were found optimum with good quality of anatomical details.\u003c/p\u003e\n\u003cp\u003eIn overweight of BMI, the minimum value of radiation exposure factors 40 mAs \u0026amp; 70 kVp and maximum values 46 mAs \u0026amp; 78 kVp in AP radiograph, and in lateral radiograph minimum 72 mAs and 75 kVp and maximum 86 mAs and 80 kVp were also found optimum with good anatomical details.\u003c/p\u003e\n\u003cp\u003eIn under Pre-obese of BMI, the minimum values of radiation exposure factors 50 mAs \u0026amp; 60 kVp and maximum 100 mAs and 88 kVp in AP radiograph, and in lateral minimum 80 mAs \u0026amp; 70 kVp and maximum 130 mAs \u0026amp; 91 kVp were found satisfactory with normal image quality.\u003c/p\u003e\n\u003cp\u003eIn under sub category of Pre-obese (PO1) BMI i.e. Pre-obese1, the minimum values of radiation exposure factors 40 mAs \u0026amp; 70 kVp and maximum 90 mAs and 92 kVp in AP radiograph, and in lateral radiograph minimum 70 mAs \u0026amp; 69 kVp and maximum 150 mAs \u0026amp; 96 kVp were not found up to the mark with low anatomical details.\u003c/p\u003e\n\u003cp\u003eIn the sub category of Obese BMI, i.e. Obese1, the minimum values of radiation exposure factors 50 mAs \u0026amp; 75 kVp and maximum 85 mAs \u0026amp; 90 kVp in AP radiograph, and in lateral radiograph minimum 100 mAs \u0026amp; 80 kVp and maximum 150 mAs \u0026amp; 85 kVp were also not found satisfactory with low anatomical details.\u003c/p\u003e\n\u003cp\u003eIn the result, the exposure factors were used in first two categories i.e. normal BMI and overweight BMI were found optimum with good anatomical details and good quality radiographs. But in rest three BMI categories i.e Pre-Obese, Pre-obese 1 and Obese, the radiation exposure factors were not found appropriate in different BMI values/category.\u003c/p\u003e\n\u003cp\u003eAfter the correlation of BMI values with radiation exposure factor mAs \u0026amp; kVp values, new systematic optimum radiation exposure factors were calculated by simple mathematical formula. New radiation exposure factors mAs \u0026amp; kVp values are purposed for the L. S. Spine Anterior-Posterior \u0026amp; Lateral radiographs. In which different BMI categories consist of their own minimum and maximum values of mAs \u0026amp; kVp are shown in Table 3 \u0026amp; 4.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study role of Body Mass Index (BMI) in Lumbar Sacrum (L.S) Spine Anterio-posterior (AP) and Lateral radiography, radiation factor was calculated before each examination. This study was inspired by various researches conducted by different authors in which like S. Reena, S. Sunil Dutt, Ajay Chaubey, et al. described the screen-film system is replaced by computed radiography system by recording the images of the patients during X-Rays radiography examinations. The change in imaging system was required and to reestablishment of the institutional diagnostic reference levels (DRLs), different types of X-Rays procedures was conducted at the hospital. For the same purpose, patient specific parameters like age, height, weight, body mass index (BMI), object to image distance (OID) and machine specific parameters like kVp, mAs, distance and collimation sizes were recorded. Total 1875 patients under 21 different types of X-Rays examinations was added in this study to estimating the entrance skin dose (ESD) \u003csup\u003e(15,16)\u003c/sup\u003e. In this study radiation exposure factors were observed with BMI values of each patient to find out the appropriate range of exposure in each BMI category. Study recommends that BMI vales are important indicator to select or calculate the radiation exposure factors before each procedure. Because as the BMI values increases tissue variation in region of interest changes. Hence it is better to measure BMI values before performing radiation exposure which helps to get better quality radiographs without losing the anatomical details, image resolution and contrast.\u003c/p\u003e\n\u003cp\u003ePagan L, et. al., Aldrich J et. al., Faulkner K et.al., conducted study on the patient radiation absorbed dose in digital projection radiography with reference to optimization of radiation absorbed dose, the role of image quality with dose and measurement of patient dose in various diagnostic radiology procedures respectively. These three studies well explain the role of optimum radiation dose with image quality and requirement of minimizing the amount radiation dose on the basis of radiation exposure factors selection. As understood the amount radiation absorbed dose varies from patient to patient as well as the area of interest under the X-Ray examination. Responsibility of healthcare professionals are to reduce the amount of radiation dose for patient in all possible manner\u003csup\u003e (16,17)\u003c/sup\u003e. Priority is to achieve the best quality radiograph to make radiologist job easy and best diagnosis for the patient. Radiographer can do his/her job easily with the minimum possible exposure factors which can gave optimum radiograph quality and decrease the unwanted radiation to the patient \u003csup\u003e(18,19)\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study concludes that blind selection of radiation exposure factors (mAs \u0026amp; kVp) for each X-Ray procedure is unprofessional behavior of radiographer. Appropriate radiation exposure factor mAs \u0026amp; kVp) selection, the amount of radiation dose for can be reduced by 20-30% without compromising the radiographic image quality.\u003c/p\u003e"},{"header":"Recommendations","content":"\u003col\u003e\n\u003cli\u003eRadiographers must follow the term ALARA \u0026amp; TDS principal.\u003c/li\u003e\n\u003cli\u003eCalculation of BMI values should take under consideration before L.S Spine AP \u0026amp; Lateral radiography.\u003c/li\u003e\n\u003cli\u003eManipulation in radiation exposing factors mAs \u0026amp; kvp must done as per the need of different BMI values/categories\u003c/li\u003e\n\u003cli\u003eNew radiation exposure factor mAs \u0026amp; kVp values for L.S Spine AP \u0026amp; Lateral are purposed as per different BMI categories shown in table 3 \u0026amp; 4.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eALARA- \u003c/strong\u003eAs Low As Reasonably Achievable\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAP- \u003c/strong\u003eAnterio-Posterior\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBMI- \u003c/strong\u003eBody Mass Index\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCT- \u003c/strong\u003eComputed Tomography\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDRL\u003c/strong\u003e - Diagnostic Reference Levels\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ekVp- \u003c/strong\u003eKilo Voltage Peak\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLAT- \u003c/strong\u003eLateral\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eS.- \u003c/strong\u003eLumbar Sacrum\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003emAs- \u003c/strong\u003eMilli Ampere Second\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eOID\u003c/strong\u003e- Object to Image Distance\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePO1- \u003c/strong\u003ePre-Obese 1\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTDS-\u003c/strong\u003e Time Distance \u0026amp; Shielding\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u0026ndash; Ethical approval was taken from the central institutional committee of SGT University Hospital \u0026amp; Research Institute and all methods were performed according to guidelines and regulations provided by central committee under \"Ethics approval and consent to participate\" section. Approved Informed consent forms were obtained from each participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e- Hereby, all author agrees to publish this study and give consent for the availability of the data set.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials- \u003c/strong\u003eRadiation dose technical factors (mAs \u0026amp; kVp) \u0026amp; BMI values data-set carefully taken and recorded by the researcher. The datasets generated and/or analysed during the current study are available in the MS Excel. Data can also be shared by the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting financial and/or non-financial interests\u003c/strong\u003e - No, I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e- The authors neither received nor wants any type of commercial support in the form of either compensation or financial support for the study or for personal interest. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions- \u003c/strong\u003eVirmani Nitish (3) and Yadav Kripanand (1) conception, design of the work, the data acquisition, analysis, and interpretation of the data. Navreet Boora (2) \u0026amp; BB Sharma (4) contributed in commenting on the paper and have approved the final version. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements- \u003c/strong\u003eWe are thankful to Mr. Mohit Deswal \u0026amp; Mr. Vaibhav M.Sc Fellows for CT scan procedures and data compiling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePanchbhai A. Wilhelm Conrad R\u0026ouml;ntgen and the discovery of X-rays: Revisited after centennial. JIAOMR. 2015;27(1):90.\u003c/li\u003e\n\u003cli\u003eDhawan S K(N.A.) \u0026ldquo;A brief history of Indian Radiology\u0026rdquo; ; Radiology Education Foundation\u003c/li\u003e\n\u003cli\u003ePye S, Reid D, Adams J, Silman A, O'Neill T. Influence of weight, body mass index and lifestyle factors on radiographic features of lumbar disc degeneration. Annals of the Rheumatic Diseases. 2007;66(3):426-27.\u003c/li\u003e\n\u003cli\u003eAdejoh T, Ewuzie O, Ogbonna J, Nwefuru S, Onuegbu N. A Derived Exposure Chart for Computed Radiography in a Negroid Population. Health. 2016;08(10):953-58.\u003c/li\u003e\n\u003cli\u003eAl-Nasiri M, Rowlands J. Lumbar spine X-ray \u0026ndash; computer says no!. Clinical Radiology. 2015;70:S11.\u003c/li\u003e\n\u003cli\u003eClinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. AJCN. 1998;68(4):899-917.\u003c/li\u003e\n\u003cli\u003eOnyemaechi N, Anyanwu G, Obikili E, Onwuasoigwe O, Nwankwo O. Impact of overweight and obesity on the musculoskeletal system using lumbosacral angles. Patient Preference and Adherence. 2016;:291.\u003c/li\u003e\n\u003cli\u003eYanch J, Behrman R, Hendricks M, McCall J. Increased Radiation Dose to Overweight and Obese Patients from Radiographic Examinations. Radiology. 2009;252(1):128-39.\u003c/li\u003e\n\u003cli\u003eHendee W, Marc Edwards F. ALARA and an integrated approach to radiation protection. Seminars in Nuclear Medicine. 1986;16(2):142-50.\u003c/li\u003e\n\u003cli\u003eSimpson A, Whang P, Jonisch A, Haims A, Grauer J. The Radiation Exposure Associated with Cervical and Lumbar Spine Radiographs. Journal of Spinal Disorders \u0026amp; Techniques. 2008;21(6):409-12.\u003c/li\u003e\n\u003cli\u003eNuttall F. Body Mass Index. Nutrition Today. 2015;50(3):117-28.\u003c/li\u003e\n\u003cli\u003eParashar P, Banasal R, Sharama S, Varshney A, Shukla A, Ahmad S. Body mass index for age criteria: a school based study in Meerut (U. P). APJHS. 2014;1(4):395-400.\u003c/li\u003e\n\u003cli\u003eMetaxas V, Messaris G, Lekatou A, Petsas T, Panayiotakis G. Patient Dose In Digital Radiography Utilising Bmi Classification. Radiation Protection Dosimetry.2018.\u003c/li\u003e\n\u003cli\u003eKnott P, Pappo E, Cameron M, deMauroy J, Rivard C, Kotwicki T et al. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis. Scoliosis. 2014;9(1).\u003c/li\u003e\n\u003cli\u003eSharma R, Sharma S, Pawar S, Chaubey A, Kantharia S, Babu D. Radiation dose to patients from X-ray radiographic examinations using computed radiography imaging system. JMP. 2015;40(1):29.\u003c/li\u003e\n\u003cli\u003eExposure-factors [Internet]. Dentalcare.com. 2019. Available from: https://www.dentalcare.com/en-us/professional-education/ce-courses/ce71/exposure-factors.\u003c/li\u003e\n\u003cli\u003eCompagnone G, Pagan L, Baleni M, Calzolaio F, Barozzi L, Bergamini C. Patient dose in digital projection radiography. Radiation Protection Dosimetry. 2008;129(1-3):135-37.\u003c/li\u003e\n\u003cli\u003eAldrich J, Duran E, Dunlop P, Mayo J. Optimization of Dose and Image Quality for Computed Radiography and Digital Radiography. JDI. 2006;19(2):126-31.\u003c/li\u003e\n\u003cli\u003eFaulkner K, Corbett R. Reference doses and quality in medical imaging. The British Journal of Radiology. 1998;71(850):1001-2.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Showing the specimen images and range of BMI values according to categories prescribed by Asian Criteria.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"574\"\u003e\n\u003cp\u003eNutritional status based on the WHO and \u0026ldquo;Asian criteria\u0026rdquo; values\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003eNutritional Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003eWHO criteria BMI cut-off\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026ldquo;Asian criteria\u0026rdquo; BMI cut-off\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003eUnderweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e18.5-24.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e18.5 \u0026ndash; 22.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003eOverweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e25-29.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e23 \u0026ndash; 24.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003ePre-Obese\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e25.0 - 27.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003ePre-Obese 1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003eMore than 30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e27.6 \u0026ndash; 29.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"168\"\u003e\n\u003cp\u003eObese1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e30 \u0026ndash; 40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e30 - 40\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Radiation exposure factors of various BMI categories\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;BMI Categories\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003emAs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003ekVp\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eAP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e30- 35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e65-70\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eLat\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e50-55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e70-75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003eOver weight\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eAP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e40-45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e70-75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eLAT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e55-60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e75-80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003ePre obese\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eAP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eLAT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003ePre obese 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eAP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e78\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eLAT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e88\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u003cstrong\u003eObese 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eAP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"127\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eLAT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Purposed radiation exposure factors for L.S. Spine Antero-Posterior view\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003eRadiation Factors\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"90\"\u003e\n\u003cp\u003e\u003cstrong\u003eMinimum mAs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"89\"\u003e\n\u003cp\u003e\u003cstrong\u003eMinimum kVp\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"105\"\u003e\n\u003cp\u003e\u003cstrong\u003eMaximum mAs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"111\"\u003e\n\u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ekVp\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI Categories\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003eNORMAL\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"105\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003eOVER WEIGHT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"105\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003ePRE-OBESE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"105\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003ePRE-OBESE 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"105\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003eOBESE 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"105\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"111\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Purposed radiation exposure factors for L.S. Spine Lateral view\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eRadiation Factors\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003emAs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ekVp\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003emAs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ekVp\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI Categories\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eNORMAL \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eOVER WEIGHT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003ePRE-OBESE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003ePRE-OBESE 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eOBESE 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Body Mass Index, L.S Spine AP \u0026 Lateral, Radiation dose Reduction, Obese, Overweight","lastPublishedDoi":"10.21203/rs.3.rs-131245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-131245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e- To evaluate the role of BMI values before each L. S. spine radiograph and to choose the optimum radiation exposure factors without compromised the radiographic image quality. The data of BMI values of each patient\u0026rsquo;s and radiation exposure values like mAs \u0026amp; kVp were collected. This study was based on the observation analysis of BMI values with radiation exposure parameters like mAs \u0026amp; kVp. Forty patients were added to this study. Out of which, 26 were female and 14 male patients were added.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003e- In the result, the exposure factors were used in the first two categories i.e. normal BMI and overweight BMI were found optimum with good anatomical details and good quality radiographs. But in the rest three BMI categories i.e Pre-Obese, Pre-obese 1, and Obese, the radiation exposure factors were not found appropriate in different BMI values/categories.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e- The study concludes that blind selection of radiation exposure factors (mAs \u0026amp; kVp) for each X-Ray procedure, is unprofessional behavior of radiographer. Appropriate radiation exposure chart, the amount of radiation dose can be reduced by 20\u0026ndash;30% without compromising the radiographic image quality.\u003c/p\u003e","manuscriptTitle":"Body Mass Index role in Lumbar Sacrum Spine Anterio-Posterior and Lateral Radiography by adjusting the radiation exposure factor mAs \u0026amp; kVp to avoid unnecessary radiation dose in patient- An Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-08 22:00:11","doi":"10.21203/rs.3.rs-131245/v1","editorialEvents":[{"type":"communityComments","content":3}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b1a9246-0872-4cf6-8d19-02b49911e77b","owner":[],"postedDate":"January 8th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1770194,"name":"Nuclear Medicine \u0026 Medical Imaging"}],"tags":[],"updatedAt":"2021-02-08T05:59:35+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-08 22:00:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-131245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-131245","identity":"rs-131245","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}