Patient dose monitoring and the use of diagnostic reference levels for the optimization of protection in medical imaging: current status and challenges worldwide

Abstract

Optimization is one of the key concepts of radiation protection in medical imaging. In practice, it involves compromising between the image quality and dose to the patient; the dose should not be higher than necessary to achieve an image quality (or diagnostic information) needed for the clinical task. Monitoring patient dose is a key requirement toward optimization. The concept of diagnostic reference level (DRL) was introduced by the International Commission on Radiological Protection as a practical tool for optimization. Unfortunately, this concept has not been applied consistently worldwide. To review the current strengths and weaknesses worldwide and to promote improvements, the International Atomic Energy Agency organized a Technical Meeting on patient dose monitoring and the use of DRLs on May 2016. This paper reports a summary of the findings and conclusions from the meeting. The strengths and weaknesses were generally different in less-developed countries compared with developed countries. Possible improvements were suggested in six areas: human resources and responsibilities, training, safety and quality culture, regulations, funding, and tools and methods. An overall conclusion was that radiation protection requires a patient-centric approach and a transfer from purely reactive to increasingly proactive optimization, whereby the best outcome is expected from good teamwork.

Organ doses evaluation for chest computed tomography procedures with TL dosimeters: Comparison with Monte Carlo simulations

“…4,6 Currently, CT utilization faces challenges related to justification of the procedure (i.e., benefits should outweigh potential risks) and dose optimization. 7,8 With the development of the CT technology, scanners have become more complex and efficient, challenging the accuracy of traditional dosimetry methods. 1 Although the computed tomography dose index (CTDI) and the dose length product (DLP) are well stablished metrics nowadays, these quantities only provide the information about how the machine was operated.…”

Assessment of diagnostic reference levels awareness and knowledge amongst CT radiographers

“…However, lack of sufficient patient dose data for setting up DRLs is related to lack of qualified personnel, tools, appropriate methodology and coordination at the national level. These are the main factors limiting the setting up of DRLs in low and middle-income countries and the reason why practices in such countries are referenced to other countries' DRLs [8,13]. Consequently, radiological practices in Nigeria are referenced to the United Kingdom (UK) DRLs values since there is no national DRLs at present [14][15][16][17].…”

“…Consequently, radiological practices in Nigeria are referenced to the United Kingdom (UK) DRLs values since there is no national DRLs at present [14][15][16][17]. These findings are of clinical concern because monitoring patient dose is a crucial prerequisite towards dose optimisation [13]. However, increased training and awareness on the relevance of dose monitoring amongst CT radiographers in the affected countries, including Nigeria, may increase the practice of local dose evaluation for identification and review or correction of abnormal doses.…”

Optimization of low-dose chest CT protocols for the evaluation of the ground glass nodules using different iterative reconstruction algorithms

“…Вклад КТ в коллективную дозу населения РФ за последние 10 лет возрос в 5 раз; на 2018 г. вклад КТ в структуру лучевой диагностики в 4,2% случаев соответствовал вкладу в коллективную дозу в 54% [1]. Аналогичная ситуация наблюдается и в зарубежных странах [1,3].…”

“…КТ является наиболее перспективной и актуальной областью лучевой диагностики для обеспечения радиационной безопасности пациентов за счет применения принципов обоснования и оптимизации [1][2][3][4]. Принцип оптимизации заключается в поддержании доз облучения пациентов на таком низком уровне, который возможен при условии получения качественной полноценной диагностической информации с учетом экономических и социальных факторов [5][6][7][8].…”