ESE is the measurement of radiation output at the point of skin entry for common X-ray examinations. Based on our measured data and clinical techniques, we periodically report ESE and ESER, comparing the results with regulatory or advisory standards. Most importantly, we advise our clients about whether or not any changes should be made to provide optimized imaging at ALARA dose levels. With CR and DR imaging, this has become even more critical, since images obtained with too little or too much radiation do not appear light or dark.