Dose management software implementation in mammography.

PURPOSE: This work aimed to evaluate the use of a dose management software (DMS) in mammography and analyse the clinical practice in terms of radiation exposure in screening and diagnostic mammography. METHODS: Mean glandular dose (MGD) from approximately 10,000 images were collected and analysed taking into account anode/filter combination, projection, compressed breast thickness (CBT) and compression force. Causes of increased MGD were investigated and actions were taken when malpractice was detected. RESULTS: MGD values for craniocaudal (CC) and mediolateral oblique (MLO) exposures for different CBT were defined. The average MGD for CBT of 60-69 mm was 1.84 mGy for CC images and 1.85 mGy for MLO images for screening examinations, while for diagnostic examinations the MGD was 1.95 mGy for CC and 2.01 mGy for MLO images. As no national diagnostic reference levels (DRLs) for mammography exist in Switzerland, typical mean glandular dose (MGD) values were defined as a first step towards their establishment for both screening and diagnostic examinations. CONCLUSIONS: The use of DMS facilitated immensely the analysis of all clinical and technical parameters, the evaluation of radiation dose received by the patients, as well as the overall evaluation of radiographers' performance. The DMS disclosed the role of the medical physicist in dose management and optimization.

An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres?

A wide variation in patient exposure has been observed in interventional radiology and cardiology. The purpose of this study was to investigate the patient dose from fluoroscopy-guided procedures performed in non-academic centres when compared with academic centres. Four procedures (coronary angiography, percutaneous coronary intervention, angiography of the lower limbs and percutaneous transluminal angioplasty of the lower limbs) were evaluated. Data on the dose-area product, fluoroscopy time and number of images for 1000 procedures were obtained from 23 non-academic centres and compared with data from 5 academic centres. No differences were found for cardiology procedures performed in non-academic centres versus academic ones. However, significantly lower doses were delivered to patients for procedures of the lower limbs when they were performed in non-academic centres. This may be due to more complex procedures performed in the academic centres. Comparison between the centres showed a great variation in the patient dose for these lower limb procedures.

Fluoroscopy-guided procedures in cardiology: is patient exposure being reduced over time?

The number of fluoroscopy-guided procedures in cardiology is increasing over time and it is appropriate to wonder whether technological progress or change of techniques is influencing patient exposure. The aim of this study is to examine whether patient dose has been decreasing over the years. Patient dose data of more than 7700 procedures were collected from two cardiology centres. A steady increase in the patient dose over the years was observed in both the centres for the two cardiological procedures included in this study. Significant increase in dose was also observed after the installation of a flat-panel detector. The increasing use of radial access may lead to an increase in the patient exposure. The monitoring of dose data over time showed a considerable increase in the patient exposure over time. Actions have to be taken towards dose reduction in both the centres.