Monitoring clinical exposure index and deviation index for dose optimization based on national diagnostic reference level: Focusing on general radiography of extremities.

BACKGROUND: The International Electrotechnical Commission established the concept of the exposure index (EI), target exposure index (EIT) and deviation index (DI). Some studies have conducted to utilize the EI as a patient dose monitoring tool in the digital radiography (DR) system. OBJECTIVE: To establish the appropriate clinical EIT, this study aims to introduce the diagnostic reference level (DRL) for general radiography and confirm the usefulness of clinical EI and DI. METHODS: The relationship between entrance surface dose (ESD) and clinical EI is obtained by exposure under the national radiography conditions of Korea for 7 extremity examinations. The EI value when the ESD is the DRL is set as the clinical EIT, and the change of DI is then checked. RESULTS: The clinical EI has proportional relationship with ESD and is affected by the beam quality. When the clinical EIT is not adjusted according to the revision of DRLs, there is a difference of up to 2.03 in the DI value and may cause an evaluation error of up to 1.6 times for patient dose. CONCLUSIONS: If the clinical EIT is periodically managed according to the environment of medical institution, the appropriate patient dose and image exposure can be managed based on the clinical EI, EIT, and DI.

USE OF CLINICAL EXPOSURE INDEX AND DEVIATION INDEX BASED ON NATIONAL DIAGNOSTIC REFERENCE LEVEL AS DOSE-OPTIMIZATION TOOLS FOR GENERAL RADIOGRAPHY IN KOREA.

The International Electrotechnical Commission introduced the concepts of exposure index (EI), target exposure index (EIT) and deviation index (DI) to manage and optimize patient dose in real time. In this study, we have proposed an appropriate method for setting the EIT based on the Korean national diagnostic reference levels (DRLs). Furthermore, we evaluated the use of clinical EI, EIT and DI as tools for patient dose optimization in clinical environments by observing the changes in DI with those in EIT. According to the Korean national exposure conditions, we conducted experiments on three representative radiographic examinations (chest posterior-anterior, lateral and abdomen anterior-posterior) of clinical environments. As the exposure conditions and DRLs varied, the clinical EI, EIT and DI also varied. These results reveal that the clinical EI, EIT and DI can be used as tools for optimizing the patient dose if EIT is periodically and properly updated.

Monte Carlo simulation-based feasibility study of a dose-area product meter built into a collimator for diagnostic X-ray.

According to the International Electro-technical Commission, manufacturers of X-ray equipment should indicate the number of radiation doses to which a patient can be exposed. Dose-area product (DAP) meters are readily available devices that provide dose indices. Collimators are the most commonly employed radiation beam restrictors in X-ray equipment. DAP meters are attached to the lower surface of a collimator. A DAP meter consists of a chamber and electronics. This separation makes it difficult for operators to maintain the accuracy of a DAP meter. Developing a comprehensive system that has a DAP meter in place of a mirror in the collimator would be effective for measuring, recording the dose and maintaining the quality of the DAP meter. This study was conducted through experimental measurements and a simulation. A DAP meter built into a collimator was found to be feasible when its reading was multiplied by a correction factor.

Estimation of absorbed organ doses and effective dose based on body mass index in digital radiography.

With the introduction of digital radiography, patients undergoing radiographic procedures are subject to being overexposed to radiation. Therefore, it is necessary to estimate the absorbed organ dose and the effective dose, which are significant for patient health, along with body type. During chest radiographic examinations conducted in 899 patients for screening, the absorbed dose of the 13 major organs, the average whole-body dose, and two effective doses weighted by factors published in ICRP 60 and ICRP 103 were calculated on the basis of patient information such as height, weight and examination condition, including kilovolt potential, focus-skin distance and entrance surface dose (ESD), using a PC-based Monte Carlo program simulation. It was found that dose per unit ESD had a tendency to decrease with body mass index (BMI). In particular, the absorbed dose for most organs was larger at high voltages (140 kVp) than at low voltages (120 kVp, 100 kVp). In addition, the effective dose which was based on ICRP 60 and ICRP 103 also represented the same tendency in respect of BMI and tube voltage.