dose optimization in computed radiography · computed radiography and digital radiography, journal...
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NOVE ZAIN WISUDA, Amd.Rad, SKMLamongan, 30 Agustus 2015
DOSE OPTIMIZATION IN COMPUTED
RADIOGRAPHY
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� TO MAKE AWARNESS ABOUT OPTIMIZATION OF PATIENT DOSE IN USAGE OF COMPUTED RADIOGRAPHY
OBJECTIVE
USAGE OF COMPUTED RADIOGRAPHY
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WHY DO WE CARE ABOUT PATIENT DOSE?
� WE MUST ENSURE THAT THE PATIENT GET BENEFIT OVER THE RISK OF IONIZING RADIATION
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COMPUTED RADIOGRAPHY ADVANTAGES
� FASTER IMAGE ACQUISITION PROCESS (CAN BE LESS THAN 15 SECONDS)
� DRY PROCESSING (WITHOUT CHEMICAL)� WIDE DYNAMIC RANGE � POST PROCESSING � FLEXIBILITY TO BE STORED OR
DISTRIBUTED (DIGITAL FORMAT)
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WHAT IS THE PROBLEM?
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INCREASE PATIENT DOSE
Aldrich, et al, 2006
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POOR COLLIMATION PRACTICE
Zetterberg & Espeland, 2011
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POOR LUMBOSACRAL COLLIMATION PRACTICE
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TEND TO USE HIGHER EXPOSURE FACTOR
� UNDER EXPOSURE WILL RESULT NOISE IMAGE BUT OVER EXPOSURE WILL RESULT BETTER IMAGE / EASIER TO PROCESSPROCESS
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UNNOTICED INCREASE IN PATIENT DOSE
� BECAUSE OF WIDE DYNAMIC RANGE, OVER EXPOSURE WILL NOT SEEN AS A DARK IMAGE
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UNDEREXPOSURE VS OVEREXPOSURE
Siebert & Morin, 2011
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WHAT CAN WE DO AS A MODERN
RADIOGRAPHER?
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COLABORATE WITH THE MANUFACTURER TO SET
THE CR TO THE MAXIMUM PERFORMANCE
� ASK TRAINING HOW TO SET PARAMETER WE NEED
� ASK TRAINING HOW TO USE NOISE REDUCTIONREDUCTION
� ASK TRAINING HOW TO USE EXPOSURE INDEX
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OPTIMIZE THE EXPOSURE FACTOR
� DISCUSS WITH THE RADIOLOGIST & PHYSICHIST ABOUT THE ADEQUATE IMAGE QUALITY WITH MINIMUM EXPOSURE FACTOR
� CONSIDER EXPOSURE FACTOR IN FILM/SCREEN RADIOGRAPHYFILM/SCREEN RADIOGRAPHY
� USE THE PRINCIPLE OF ALARA (AS LOW AS REASONABLY ACHIEVABLE)
� DIAGNOSTIC REFERENCE LEVEL CAN BE USED AS DOSE REFERENCE
� EXPOSURE INDEX
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EXPOSURE INDEX & DOSE
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EXAMPLE: EXPOSURE FACTOR PRACTICE IN
RSUD PADANGAN
PROJECTION FILM/SCREEN COMPUTED RADIOGRAPHY
kV mAs kV mAs
THORAX PA 62 4,48 62 4,48
� NO DIFFERENCE EXPOSURE FACTOR � NO DIFFERENCE EXPOSURE FACTOR AND THE RADIOLOGIST STILL ACCEPT THE IMAGE QUALITY
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EXAMPLE: EXPOSURE FACTOR PRACTICE IN
RS SEMEN GRESIK
PROJECTION FILM/SCREEN COMPUTED RADIOGRAPHY
kV mAs kV mAs
THORAX PA 75 2,5 70 2
LS AP 70 28 65 25
LS LATERAL 85 36 80 40
� DECREASE mAs (ALTHOUGH LS LATERAL STILL HIGHER THAN FILM/SCREEN)
� SET THE NEW PARAMETER TO GET BETTER IMAGE
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DO THE BETTER COLLIMATION PRACTICE
� BETTER COLLIMATION PRACTICE WILL HELP REDUCING PATIENT DOSE
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DO THE BETTER COLIMATION PRACTICE
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MAKE BETTER POSITIONING BEFORE TAKE THE
IMAGE (EXPOSE)
� ENSURE GOOD POSITIONING BEFORE EXPOSE THE PATIENT
� GOOD POSITIONING WILL PREVENT � GOOD POSITIONING WILL PREVENT RETAKE
� DO NOT TRIAL & ERROR
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ANALYZE REJECT EXPOSURE (NOT ONLY REJECT
FILM) FOR INTERNAL IMPROVEMENT
� DO NOT ERASE THE REJECT EXPOSURE� ANALYZE WHAT’S THE PROBLEM:
UNDEREXPOSURE? BAD POSITIONING? � TRAIN THE RADIOGRAPHER WHO MAKE � TRAIN THE RADIOGRAPHER WHO MAKE
MANY REJECT EXPOSURE
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CONCLUSION
� COLABORATE WITH MANUFACTURER TO GET CR MAXIMUM PERFORMANCE
� COLABORATE WITH RADIOLOGYST & PHYSICIST TO GET GOOD QUALITY IMAGE WITH LOWER EXPOSURE FACTORWITH LOWER EXPOSURE FACTOR
� DO BETTER COLLIMATION PRACTICE� MAKE GOOD POSITIONING� ANALYZE REJECT EXPOSURE FOR
INTERNAL IMPROVEMENT
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REFERENCE
� Aldrich, et.al (2006), Optimization of Dose and Image Quality for Computed Radiography and Digital Radiography, Journal of Digital Imaging, Vol 19, No 2 (June), 2006: pp 126Y131
� Procop, et.al, (2008), Digital chest radiography: an update on modern technology, dose containment and control of image q uality , Eur Radiol (2008) 18: 1818–1830
� Schreiner, Dose Optimisation in Computed Radiography , DIMOND III Research Project CEC 5th Framework ProgrammeResearch Project CEC 5th Framework Programme
� Sharma, et.al (2015), Radiation dose to patients from Xray radiographic examinations using computed radiography imaging sys tem, J Med Phys. 2015 JanMar; 40(1): 29–37
� Siebet & Morin (2011), The standardized exposure index for digital radiography: an opportunity for optimization of radi ation dose to the pediatric population , Pediatr Radiol (2011) 41:573–581
� Zetterberg & Espeland (2011), Lumbar spine radiography — poor collimation practices after implementation of digit al technology , The British Journal of Radiology, 84 (2011), 566–569
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� THANK YOU