Title: what is “radiological protection”? Is this standard ICRP terminology? Isn’t this mostly dealing with radiation protection?
Abstract
L122: why doesn’t ALARA include what follows in L123–125? Because ALARA originally was occupational exposure and not to be applied to image quality?
L127: considering adding very important wide and often immediate availability and essentially eliminating study loss
L132: listed studies should follow “digital radiography” not “patients” (English usage)
L143 only radiologists? In general, in this report, it is stated that only radiologist are to function as imaging specialist but there are other specialties that may perform CT, fluoroscopy, and radiography. Perhaps say imaging experts or early in report that when the word radiologist is used this may also apply to other non-radiologic imaging experts
L142: clinicians? How about care providers or is clinicians acceptable for all medical and surgical specialties?
L147: dose vs dose estimate (or exposure) surveys?
L163: enabling “correct” or enabling “better informed”?
L164: what should be minimized, image quality or is radiation exposure needing to be inserted?
L171: isn’t comprehensive quality assurance program inclusive of what is stated in mid portion of this bullet point? Why the and, following comprehensive program to ongoing monitoring, etc.
L173: development, but also affirmation of appropriate protocols, as well as necessary modifications for existing protocols, not just development
L182: why do clinicians need high-level knowledge and skill? This would imply they be in the same text then with radiologists in report
Executive Summary:
L200: most significant? Would say “greatest“. Something could be infrequent and still be significant
L201: and what “field“ when you say “this field“?
L203: Is “appropriate coverage“ necessary to call out?
L207–209: clinical risk singular so change “are” to “” or say clinical risks. And what do you mean by clinical risk(s)?
L208: may not only be visualized but characterized, more than just detecting
L214: what is meant by “uncertainties“?
L216: carried out versus maximized? Not sure optimization is ever totally agreeably achieved
In general, information technology needs to be incorporated in discussion of the teams earlier in this report.
L247: consider changing “will not” to “may not” (two times in this sentence)
L254: other acceptable comparisons than diagnostic reference levels which may be acceptable?
In general, information technology needs to be incorporated in discussion of the teams earlier in this report.
L272: clinical assessments = what? Impact such as an outcome?
L290: why increase optimization levels also mean they are strengthening justification? Are you saying this does happen (and not clear why) or needs to happen?
L296: training for staff but also imagers and trainees. Many times, focus only on staff importance
Pages 21–27 The X-ray Installation and X-ray Equipment Life Cycle.:
L721: 2nd half of second bullet point is redundant if “optimization” portion could be added to the end of the first sentence.
L784: team needs (with an s)
In general, there probably needs to be earlier inclusion in this lifecycle with administrative leadership, clinical and business managers, as they often control personnel, funding, timelines and this entire process. In addition, clinical engineering.
L804, figure 2.1: so there is nothing between “clinical use” and “decision to dispose “?
L813–14: no administration is acknowledged in this discussion
In general, need pediatric population should be called out more when discussing issues related to “patient size”. Perhaps mentioning patient age as well in these settings to assure that people are addressing the needs of radiologic practice in children
L1039: “disposal” versus “retirement”? Is disposal a standard term?
L1041: consider also new value of equipment that may offer better synergy with the mission of the clinical practice. This is another reason to replace equipment particularly with technologic advancements
P53–71: Evaluation of Image Quality
L1880: difference between informing care decisions and providing guidance for intervention? Do you mean image-guided intervention? Even then it isn’t necessarily different than care decisions.
L1898: is this practical/achievable?: “The subjective evaluation of clinical image quality should
1be graded based on image quality criteria for each modality and clinical indication.”
L2299: in this submitted figure, cannot see the bones, for example the pedicles well. Is this needing to be replaced? Will the image quality be better in the final publication?
In general, are there any suggested frequencies for regular process tasks such as audits in this report?
L2425/2449: also lack of testing of artificial intelligence in the pediatric population
L2460: “D” in bullet point include metrics for pass/fail or is this sufficiently implied in the second bullet?
C: bullet 2: “regular reporting” equals what?
Anexes:
Call out pediatric patients more clearly: F1
“estimate radiation doses to be delivered to patients across all ages/sizes for a range of different imaging procedures”.
In Knowledge in F1: important to include some reference to pediatric use. For example, noise tolerance in CT exams for young/small children is lower than with larger adults.
General comments 1:
1. Going through the Main Points one does not find anything contemporary. A document written 20 years ago would have the same text.
2. The document can be condensed to half its size without losing any useful message. Doing that would rather make the document clearer as there is too much unnecessary text that causes confusion.
3. Every bullet point in Key points should have a single point or message. Invariably there is mixture of messages in a single key point and one gets lost.
4. In 2020s if the approach of optimization is to be based on DRL which has been the case for the last over 2 decades, then what is the need for this document. The new document should help in individual patient optimization. There have been a number of publications in recent years in that direction.
5. If the document is written for physicists then use of PKA; Ka,e may not be bad. But if the audience is radiographers/radiologists, these abbreviations should be replaced with corresponding words.
6. The language in Key points should be simple, easy to be understood by 9th grader, not just a copy/paste of technical stuff from the document.
7. The whole approach suggested in this document is based on traditional approach as practiced in UK.
8. ICRP and global community could benefit from extensive network of optimization actions ongoing on regular (rather on daily basis) through national dose index registries like ACR-DIR. ICRP could invite contribution from someone who is involved in this activity.
General comments 2:
1. L2498: The importance of leadership actions to install, promote, and demonstrate a committee to a positive safety culture could be more explicit. hese references may help:
◦ Moore, Q.T., Walker, D.A., Frush, D.P., Daniel, M., Pavkov, T. (2022) “Intrapersonal and Institutional
Influences on Overall Perception of Radiation Safety among Radiologic Technologists.”
Radiologic Technology. 93(3): 255-267.
◦ Moore, Q.T. (2021). “Determinants of Overall Perception of Radiation Safety among RTs.” Radiologic
Technology. 93(1): 8-24.
2. L2542-3: add”.. for the specific imaging modality.”
3. L2544: change to “… familiar with each other and the new technology” (since team building is a key component)
4. Table 6.1, Radiographers or Imaging Technologists box : “…a patient plays a key role
in optimizing care”
5. Same table, Facility Managers box: This indicator speaks to the importance of leadership actions but the associated text in the document needs to be built up.
6. Content around L 2566: This reference will help: Moore, Q.T. (2021). “Validity and Reliability of a Radiation Safety Culture Survey Instrument for Radiologic Technologists.” Radiologic Technology. 92(6): 547-560.
7. L2600: “…for all the staff involved including those on variorum workshifts…”
8. L2614: “…with a need for teamwork between technologists (intra-teamwork), and between imaging stakeholders (inter-teamwork)...”
9. L2634: “and support non punitive education”
10. L2671-73: include “virtual reality headsets and software”
11. L2676: “…opportunities for all imaging team members (not just the leadership circle)…”
12. In Paragraph 6.4.2.: This reference may help:
◦ Moore, Q.T. (2016). “Interdisciplinary Approach to Radiation Protection Improvement in Digital Radiography.” Radiologic Technology. 88(1): 9-17.
13. L2694-97: Consider using TeamSTEPPS/Crew Resource Management techniques. This reference may help: Moore, Q.T. (2017). “TeamSTEPPS: Addressing Imaging Procedure Appropriateness.” Radiologic Technology. 88(5): 550-555.