Low-dose abdominal radiography based on high peak kilovoltage: image quality at standard dose abdominal radiography and potentially 64% dose reduction in a randomized trial

Q: What was the main goal of this study on low-dose abdominal radiography?

To evaluate whether a low-dose abdominal radiography protocol for acute abdomen can maintain image quality while reducing radiation dose compared with standard-dose radiography.

Q: How were patients assigned to the low-dose and standard-dose groups?

A total of 354 patients were randomly assigned to a LDAR group using 121 kVp with automatic exposure control (AEC) or to a SDAR group using 81 kVp with AEC after admission with acute abdomen and planned acute abdominal surgery.

Q: What dose reduction and image quality differences did the trial find?

LDAR significantly reduced entrance skin dose and effective dose by about 64% while producing superior image quality for overimpression and diaphragm measures, with no statistically significant difference for intestinal gas scores.

Sep 30, 2026

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Acute abdomen requires fast and reliable imaging, yet abdominal radiography carries an ongoing concern about ionizing radiation. This randomized trial evaluated a low-dose abdominal radiography (LDAR) protocol for patients undergoing surgery, comparing it against a standard-dose abdominal radiography (SDAR) approach while assessing diagnostic image adequacy and multiple quality metrics. Results showed comparable suitability for direct diagnosis and consistently improved plain LDAR image quality, alongside substantial reductions in entrance skin dose and effective dose without added patient exposure.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Background

Methods

Results

Conclusions

Original Article Low-dose abdominal radiography based on high peak kilovoltage: image quality at standard dose abdominal radiography and potentially 64% dose reduction in a randomized trial Yuchuan Yang1, Lijuan Yu2^ 1Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China; 2Department of PET/CT-MR, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China Contributions: (I) Conception and design: None; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: L Yu; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Lijuan Yu, PhD. Department of PET/CT-MR, The Affiliated Tumor Hospital of Harbin Medical University, No. 150 Haping Road, Nangang District, Harbin 150081, [China. Email: wsx1869sci@163.com](China. Email: wsx1869sci@163.com). Background: Acute abdomen is a common clinical emergency requiring rapid and accurate diagnosis. Abdominal radiography (AR) remains a first-line imaging tool due to its accessibility and specificity for certain conditions, but minimizing radiation exposure is a persistent concern. This study aimed to evaluate the effectiveness of a low-dose abdominal radiography (LDAR) protocol for patients with acute abdomen. Methods: A total of 354 patients (189 men, 165 women; mean age, 50 years) who underwent acute abdominal surgery after being admitted with an acute abdomen were randomly assigned to a LDAR group [121 kVp, with automatic exposure control (AEC)] and a standard-dose abdominal radiography group (SDAR; 81 kVp, with AEC) group. Plain LDAR and SDAR were independently reviewed by two radiologists for the overimpression, diaphragm, and intestinal gas, and program analysis was performed in a delayed manner, with diaphragm sharpness computed by Matlab. The mean values of parameters assessed by the two radiologists were compared. Results: All images, from both the LDAR group and the SDAR group, were appropriate for direct diagnosis. No patients were exposed to additional doses in this study. The imaging quality of plain LDAR was superior to that of the plain SDAR, with higher mean scores for overimpression (4.97±0.18 vs. 4.68±0.55; P<0.001), diaphragm (4.97±0.18 vs. 4.69±0.55; P<0.001), and lower diaphragm sharpness (1.27±0.35 vs. 1.90±0.48; P<0.001) . There was no statistically significant difference between the LDAR and SDAR groups based on the mean scores of intestinal gas (P=0.057) . The radiation dose was significantly lowered by approximately 64% for entrance skin dose (ESD; 1.13±0.22 vs. 3.13±1.30, P<0.001) and effective dose (ED; 0.19±0.04 vs. 0.53±0.22, P<0.001) demonstrated in the LDAR group. Conclusions: The LDAR with 121 kVp could significantly reduce radiation dose while maintaining comparable image quality to that of SDAR, holding value in specific clinical scenarios. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR-DCD-15006231 . Keywords: Low-dose abdominal plain film; dose reduction; imaging quality; acute abdomen; radiation exposure Submitted Dec 05, 2024. Accepted for publication Oct 14, 2025. Published online Dec 31, 2025. doi: 10.21037/qims-2024-2749 View this article at: [https://dx.doi.org/10.21037/qims-2024-2749](https://dx.doi.org/10.21037/qims-2024-2749) ^ ORCID: 0009-0003-1728-6295. © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):85 | [https://dx.doi.org/10.21037/qims-2024-2749](https://dx.doi.org/10.21037/qims-2024-2749) Page 2 of 8 Yang and Yu. LDAR: high kV, 64% less dose Introduction Acute abdomen is a clinical condition marked by the sudden appearance of intense abdominal pain, which may be caused by a wide range of associated conditions such as intestinal obstruction, diverticulitis, pancreatitis, or intraabdominal hemorrhage, among others (1) . Ra

FAQs

What was the main goal of this study on low-dose abdominal radiography?

To evaluate whether a low-dose abdominal radiography protocol for acute abdomen can maintain image quality while reducing radiation dose compared with standard-dose radiography.

How were patients assigned to the low-dose and standard-dose groups?

A total of 354 patients were randomly assigned to a LDAR group using 121 kVp with automatic exposure control (AEC) or to a SDAR group using 81 kVp with AEC after admission with acute abdomen and planned acute abdominal surgery.

What dose reduction and image quality differences did the trial find?

LDAR significantly reduced entrance skin dose and effective dose by about 64% while producing superior image quality for overimpression and diaphragm measures, with no statistically significant difference for intestinal gas scores.

Sep 30, 2026

Uploaded by Cart