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This research measured the entrance surface radiation
dose to the gonadal region of male patients’ who were underwent the lumbar
spine X-ray examinations and analyzed the testicular radiation doses with the
patients’ BMI.

Male patients’ testicular region received high
radiation dose in lumbar spine X-ray examination after hip, pelvis and
abdominal X-ray examinations (Wall, et al., 2011). ESD is also high for a
lumbar spine examination (Aliasgharzadeh, et al., 2015). ESD vary with exposure
parameters while exposure parameters vary with the patient body thickness, type
of the equipment, imaging method, FFD, image processing conditions and also
different radiographic persons. With applying of same conditions for a specific
projection, one radiographer will use minimum possible exposure factors while
another person using the maximum possible exposure parameters for the same

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According to the above circumstances researchers were
used same X-ray equipment (Shimadzu), imaging method (CR), 100cm FFD and
16*43cm FOV with same exposure factors specified for the lumbar spine region on
digital radiographic unit (300mA,80kV,71mAs for AP and 300mA,80kV,80mAs for

According to test results total mean testicular
radiation dose varies from 41.066µSv to 131.990µSv while the mean value was
73.356µSv. Previous researchers said that the doses as low as 0.15Gy will
reduce the sperm count and doses greater than 0.5Gy and 6Gy will result absence
of living spermatozoa and permanent sterility, respectively (Amanda, et al., 1993).
With conversion of these values in to equivalent dose values, shows that there
is no possible effect on testes with our test results for temporary or
permanent sterility.

BMI was selected as a variable to compare the patient testicular
radiation dose in two lumbar spine projections. In this research 16.10 to 36.20
BMI range was observed within the population with 23.47 mean value. Variation
between above parameter and total testicular radiation dose, AP and lateral testicular
radiation doses were analyzed separately. According to the analyzed result less
positive correlation was found between patient BMI and AP testicular radiation dose.
 Previous study conducted in Sri Lanka evaluated
the testicular radiation dose during the KUB radiography also found the similar
result that there is a weak positive correlation between BMI and testicular
radiation dose (Horadigala and Jayasinghe, 2014). In the present study, pearson
correlation test identified that the less negative significant correlation
between testicular radiation dose in lateral projection and patient BMI while
total testicular radiation dose shows least negative correlation with patient

Distribution of AP and lateral dose values, total
testicular dose and BMI values were tested by normality test and determined
that distribution of total testicular ESD, ESD in lateral and patient BMI were
not normally distributed (p<0.05). Testicular radiation dose in AP projection was normally distributed with normality test. The result of this study shown that the mean testicular radiation dose in lumbar spine AP projection was 58.79µSv with 34.05µSv to 79.99µSv dose range while mean testicular radiation dose in lumbar spine lateral projection was 14.55µSv with 1.37µSv to 52.00µSv dose range. From a simple calculation above two mean values, around 75% of testicular radiation dose reduction was achieved in lumbar spine lateral projection with respect to the AP projection. As a percentage, testicular dose reduction (72%) in lumbar spine lateral than the AP projection nearly equal to previous research done in Ireland with 0.036mGy testicular AP dose and 0.0102mGy testicular lateral dose (conor, et al., 2009). The previous study prove that lumbar spine lateral projection already receives the testicular dose reduction due the lateral location of the iliac bone (conor, et al., 2009). Present study result (14.55µSv) also compatible with their results. According to the literature, research study done in India found that mean SRD to the testes from lumbar spine AP as 282.29µGy in CR and 75.24µGy in DDR with 70% dose reduction in DR than CR while testes dose from lumbar spine lateral was 506.69µGy in CR and 96.02µGy in DR with 78% dose reduction with DR than CR (Priyankara, et al). Present study test values was not compatible with these values and it may be due to manual selection of exposure factors by radiographer in CR system and Philip medical systems automatic exposure control (AEC) based factors select for the DR system. They were proved that with the use of AEC in DR system could reduce the patient testicular SRD. Present study also used the AEC for select the exposure parameters and test results revealed that lower doses received by the testes with Sri Lankan practice. Another related research study on reduction of radiation risks in patients underwent some X-ray examinations by using optimal projections with monte-carlo mathematical calculation found that the 0.429mGy mean absorbed dose with AP and 0.053mGy mean testicular absorbed dose with lumbar lateral projection received for standard sized patient with 178.6cm height and 73.2Kg weight (Chaparian, et al., 2013). Present study results were deviate from these values and it may be due to use of different X-ray unit with different exposure parameters and radiation field size. 

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