NOVE ZAIN WISUDA, Amd.Rad, SKMLamongan, 30 Agustus 2015

DOSE OPTIMIZATION IN COMPUTED

RADIOGRAPHY

� TO MAKE AWARNESS ABOUT OPTIMIZATION OF PATIENT DOSE IN USAGE OF COMPUTED RADIOGRAPHY

OBJECTIVE

USAGE OF COMPUTED RADIOGRAPHY

WHY DO WE CARE ABOUT PATIENT DOSE?

� WE MUST ENSURE THAT THE PATIENT GET BENEFIT OVER THE RISK OF IONIZING RADIATION

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)

WHAT IS THE PROBLEM?

INCREASE PATIENT DOSE

Aldrich, et al, 2006

POOR COLLIMATION PRACTICE

Zetterberg & Espeland, 2011

POOR LUMBOSACRAL COLLIMATION PRACTICE

TEND TO USE HIGHER EXPOSURE FACTOR

� UNDER EXPOSURE WILL RESULT NOISE IMAGE BUT OVER EXPOSURE WILL RESULT BETTER IMAGE / EASIER TO PROCESSPROCESS

UNNOTICED INCREASE IN PATIENT DOSE

� BECAUSE OF WIDE DYNAMIC RANGE, OVER EXPOSURE WILL NOT SEEN AS A DARK IMAGE

UNDEREXPOSURE VS OVEREXPOSURE

Siebert & Morin, 2011

WHAT CAN WE DO AS A MODERN

RADIOGRAPHER?

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

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

EXPOSURE INDEX & DOSE

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

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

DO THE BETTER COLLIMATION PRACTICE

� BETTER COLLIMATION PRACTICE WILL HELP REDUCING PATIENT DOSE

DO THE BETTER COLIMATION PRACTICE

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

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

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

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

� THANK YOU