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The International Commission on Radiological Protection (ICRP) approved the publication of a document on ‘Managing
patient dose in digital radiology’ in 2003. The paper describes the content of the report and some of its key points, together
with the formal recommendations of the Commission on this topic. With digital techniques exists not only the potential to
improve the practice of radiology but also the risk to overuse radiation. The main advantages of digital imaging: wide dynamic
range, post-processing, multiple viewing options, electronic transfer and archiving possibilities are clear but overexposures can
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ICRP PATIENT DOSE IN DIGITAL RADIOLOGY
In the chapter of introduction it is highlighted the digital imaging system makes it more difficult to
that the diagnostic information provided by modern recognise overexposure or underexposure.
digital detectors can be equal or superior to conven- In digital fluoroscopy examinations, it is very easy
tional film-screen systems, with comparable patient to obtain a large number of images because it is not
doses. Digital imaging has practical technical advan- necessary to introduce cassettes or film changers,
tages compared with film techniques, for example, as in conventional systems. In addition, a large
wide contrast dynamic range, post-processing number of exposures per examination allow a larger
functionality, multiple image viewing options and selection of images, with the potential to improve
electronic transfer and archiving possibilities. clinical diagnosis. All these practices result in higher
With digital systems, an overexposure can occur absorbed dose for the patient.
without an adverse impact on image quality. Over- Axelsson et al.(3) have demonstrated that in upper
exposure may not be recognised by the radiologist gastrointestinal examinations, some centres with
or radiographer. In conventional radiography, digital fluoroscopy use a mean number of 68 expos-
excessive exposure produces a ‘black’ film and ures per examination in comparison with 16 expos-
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Image quality can also be compromised by An outline of training topics for DR is presented
inappropriate levels of data compression and/or in one of the Annexes of the ICRP report(1).
post-processing techniques. Data compression and
post-processing requirements should be defined by
REGULATORY ASPECTS AND QUALITY
modality and the medical imaging task.
MANAGEMENT
If patient dose parameters are displayed at
the operator console (and inside the X-ray room Commissioning of digital systems, or introduction of
for interventional procedures), radiographers and new techniques, should ensure that imaging capabil-
medical physics specialists can better manage patient ity and radiation dose management are integrated to
dose to agreed protocols. achieve acceptable clinical image production using
Real-time collection of dose data, that is, an easily appropriate patient doses.
visible indication on the control panel, would allow Justification criteria should be one of the key
comparison with DRLs, facilitate management of components considered in the update of a quality
dose and help to prevent excessive patient doses(10). assurance programme when a facility converts to
Table 2. Examples of actions influencing patient dose and image quality or diagnostic information.
Table 3. Present and the desired situation in the future for the different digital technologies for data on patient doses.
CR (computed radiography) Dose or exposure index Link with radiographic technique, patient dose
estimation and patient data. Archive in the RIS
(Radiological Information System)
DR (digital radiography Radiographic technique, patient Automatic extraction of the information from
with flat panel) data and patient dose estimation the DICOM header. Archive in the RIS
Fluoroscopy Radiographic technique, radiation Fluoroscopy information. On-line skin dose maps
field geometry and dose and automatic extraction of information from
parameters per series DICOM header. Archive in the RIS
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ICRP PATIENT DOSE IN DIGITAL RADIOLOGY
number of examinations per visit) increased by 21% with the justification criteria for requesting
(from 0.108 to 0.131 examinations per visit) medical X-ray imaging procedures.
compared with a net decrease of 19% (from 0.148 to (8) Industry should promote tools to inform radi-
0.120 examinations per visit) nationally at film-based ologists, radiographers and medical physicists
hospitals. about the exposure parameters and the resultant
These increases most likely result from the relative patient doses. The exposure parameters and the
ease of obtaining and archiving images with digital resultant patient doses should be standardised,
systems. Thus, justification criteria should be one displayed and recorded.
of the key components considered in the update
of a quality assurance programme when a facility
APPENDICES
converts to digital imaging.
Once digital systems are in use, comprehensive The three appendices incorporated deal with
quality control programmes are required to ensure fundamentals of DR, patient dosimetry: quantities
that image quality and patient dose management are and units and the training outline.
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an image. An incorrect window setting may also be REFERENCES
interpreted as an underexposure or overexposure by
1. International Commission on Radiological Protection.
mistake. Managing patient dose in digital radiology. ICRP
A poorly performing image display device can Publication 93 Annals of the ICRP (2004).
compromise the quality of the acquired data. The 2. Food and Drug Administration, Department of Health
user should have complete information with respect and Human Services, Center for Devices and Radio-
to a minimum set of requirements for the image- logical Health, USA.Technical Electronic Product
display device either by physical specification of Radiation Safety Standards Committee, 28th Meeting,
important display parameters or by reference to May (2001). Available at www.fda.org/ohrms/dockets/
specific models of image-display devices. ac/01/minutes/3751m1.pdf (last accessed on 8 February
2005).
3. Axelsson, B., Boden, K., Fransson, S. G., Hansson, I. B.,
Persliden, J. and Witt, H. H. A comparison of analogue
and digital techniques in upper gastrointestinal exami-
SECTION OF GLOSSARY AND ACRONYMS nations: absorbed dose and diagnostic quality of the
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