Firstly, the European Federation of Radiographer Societies welcomes this publication, which is especially relevant for radiographers and all those involved in practical aspects of optimisation of radiation protection of medical exposures. Our experts have reviewed the document and wish to provide the following feedback for consideration. firstly we do want tp congratulate the authors as the document is very comprehensive and practical and will no doubt benefit optimisation in imaging.
(41) Perhaps a better example can be listed for (41) - as it is stated a lower tube potential may be used to visualise a rib fracture (correct) than that required for soft tissue imaging (not necessarily correct, given the need for higher radiographic contrast increase when trying to visualise soft tissues with fewer attenuation differences (e.g. abdominal organs etc)
(53) Table 2.2 is dated and was updated in AAPM 232
(55). Keep wording throughout consistent and use 'radiographer' rather than 'technologist'. Analysing the percentage of images that fall outside an acceptable range can be used to educate technologists... Same for (223) Likewise, the local or vendor specific expert teams (including technologists, medical physicist, radiologist and vendor application specialist)
Box 2.4 (pg 31) is adapted from Image Gently but includes reference to placing Shielding - although this is advised against in the earlier section. Suggest delete this for consistency
Box 3.4 (pg 43) important to highlight here also (as in Box 3.5) the limitation associated with using fluoroscopy time alone as a metric of patient dose due to the more sizeable influence of exposure factors (beam energy and photon fluence with collimated field of view size) and instead should be identified as an an additional simplistic measure which may assist with local optimistion.
(126) typo: measure dose quantities
Box 3.7 - suggest instead of singling out the gonads for protection that instead all radiosensitive organs be highlighted - e.g. Use accurate collimation for protection of radiosensitive organs, rather than contact shields
(179), line 1800, describes the Bowtie filter, but I think it is missing a sentence on that it only works properly if the patient is placed in the ISO center.
(Section 4.4.3) position of the patient; again the importance of patient positioning should be highlighted as off-centred positioning may result in the skin dose increasing or decrease depending on the direction, but it might not be seen in the CTDI and DLP values.
(Section 4.4.4) Organ dose modulation: important to point out vendor differences in implementation as some vendors systems increase the radiation dose significantly. In the section, they have used an old reference from 2012 and might be good with a newer one.