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Radiology, X-Ray<br />
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Study: Training, audits will keep reins<br />
on CR/DR radiation dose<br />
By: Wayne Forrest<br />
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Adequate training of radiographers (radiologic technologists) <strong>and</strong> patient dose audits are<br />
the most effective ways to keep radiation dose as low as possible when a facility converts<br />
from film-screen radiography to computed <strong>and</strong> digital radiography (CR/DR).<br />
Researchers from Universidad Complutense de Madrid <strong>and</strong> San Carlos University Hospital,<br />
both in Madrid, saw the value of such efforts in a survey of more than 204,000 patient dose<br />
values from film-screen radiographic patient exams <strong>and</strong> those from CR. Their findings are<br />
published online in Radiology (March 13, 2007).<br />
The study retroactively reviewed patient radiation dose prior to <strong>and</strong> after installation of CR<br />
technology at the university's hospital. Patient dose results from 1997 to 1999 were<br />
"scarce," the report noted, when the facility used film-screen radiography, because<br />
radiographic data was documented manually for quality-control purposes only. At the time,<br />
the hospital was required to take only a sample of 10 patients from each imaging modality<br />
per year.<br />
In 1999, the hospital installed CR systems <strong>and</strong>, by 2001, had implemented a dose<br />
reduction program, collecting radiographic parameters, calculating patient radiation doses,<br />
<strong>and</strong> commencing a training program for its radiographers.<br />
Before 2001, there was no program for radiographers to effectively optimize patient<br />
radiation dose or image quality beyond the vendors' recommended guidelines. Thus, the<br />
hospital's medical physics service department initiated its own internal training program in<br />
2001. Radiographers were trained for 10 hours over the course of one week in topics such<br />
as digital imaging, CR <strong>and</strong> flat-panel DR, patient dose management in CR, <strong>and</strong> radiation<br />
protection.<br />
During the first three months of 1999, the study found an overall increase in patient<br />
radiation dose in CR exams compared with film-screen radiography.<br />
After uneven results following the implementation of CR in 1999, a slow decrease<br />
in median entrance dose values occurred for analyzed examinations from 1999 to<br />
2001, with considerable decreases after training activities <strong>and</strong> routine QC<br />
operation of online audit system in 2001. AP = anteroposterior, LA = lateral.<br />
Figure 1. Vaño E, Fernández JM, Ten JI, Carlos Prieto C et al, "Transition from<br />
Screen-Film to Digital Radiography: Evolution of Patient Radiation Doses at<br />
Projection Radiography," Radiology 2007, 10.1148/radiol.2432050930.<br />
"It is not surprising that average doses increased for some examinations when CR was<br />
introduced," the researchers stated, adding that the increases were "very apparent for<br />
chest <strong>and</strong> lumbar spinal examinations, the only examinations for which data were available<br />
before 1999."<br />
Because the hospital staff had "no or limited experience" with digital radiographic<br />
technology, researchers surmised that radiographers "probably attempted to avoid noisy<br />
images by using milliampere-second settings higher than necessary for good image<br />
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quality."<br />
In addition, radiographers also were prone to mistakenly use low kilovolt peaks to boost<br />
image contrast, as well as short source-to-skin distance (SSD), even after their CR <strong>and</strong><br />
digital imaging training.<br />
During the hospital's dose reduction efforts from 1999 through 2003, median values<br />
decreased by 50% for posteroanterior (PA) <strong>and</strong> 37% for lateral chest radiography. The<br />
study concluded that the "dose reductions could be interpreted as a benefit of training<br />
conducted by the hospital's medical physics service staff <strong>and</strong> application of the online<br />
patient dose audit system."<br />
From 2003 to 2004, the study found slight increases in dose for chest <strong>and</strong> lumbar spinal<br />
examinations, "suggesting a need for more training activities, especially for radiographers<br />
who joined the department after 2001."<br />
Currently, the report stated, the median entrance dose values for CR exams monitored by<br />
the hospital's radiology department range between 15% to 38% of the recommended<br />
European diagnostic reference levels for conventional film-screen radiography, <strong>and</strong> 28% to<br />
41% of the reference levels recommended by the American Association of Physicists in<br />
Medicine (AAPM) in the U.S.<br />
The results also support recommendations by the International Commission on<br />
Radiological Protection (ICRP) for training of radiographers <strong>and</strong> frequent patient dose<br />
audits.<br />
By Wayne Forrest<br />
AuntMinnie.com staff writer<br />
April 23, 2007<br />
Related Reading<br />
CR/DR image quality: Issues <strong>and</strong> concerns, April 12, 2007<br />
Strategies for reducing 'dose creep' in digital x-ray, April 11, 2007<br />
Study suggests ways to cut CR radiation, March 5, 2007<br />
Korean rads find no edge for high-res CR in chest exams, January 22, 2007<br />
Study: DR delivers lower radiation dose, November 7, 2006<br />
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Last updated bc 4/18/2007 12:38:37 PM<br />
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