TG108 Digital Workshop: Part 1 

Optimisation of Radiological Protection in Digital Radiology Techniques for Medical Imaging

26 October 2022  |  Virtual Event

Over the next decade, ICRP will be hosting several Digital Events each year as we look to review and revise the System of Radiological Protection for the next generation. This Digital Workshop took place over two days, with one, two-hour session taking place on both 26 October 2022 and 27 October 2022.

Session 1: Structure and Components for Optimisation
Moderators: Colin Martin & Kimberly Applegate

Learn More About Task Group 108




Overview of TG108 Report: Components to Establish a Successful Optimisation Programme
Colin Martin (ICRP/University of Glasgow)

This report is the first of two prepared by ICRP Task Group 108. It sets out an approach to aid in developing optimisation of radiological protection for radiological imaging programmes. There are several different aspects relating to optimisation of protection. The first is collaboration between radiologists/clinicians, radiographer/imaging technologists, and medical physicists, each of whom have key skills that can only contribute to the process effectively when individuals work together as a core team. The second is appropriate methodology and technology, with the knowledge and expertise required to use each effectively. The third relates to organisational processes that ensure required tasks, such as equipment performance tests, patient dose surveys, and review of protocols are carried out. There is a wide range in equipment, funding, and expertise around the world, and the majority of facilities do not have all the tools, professional teams and expertise to fully embrace all the possibilities for optimisation. The reports set out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally; D: Preliminary, C: Basic, B: Intermediate, and A: Advanced. It is hoped that through this approach, radiology teams will be able to plan strategies for introducing optimisation techniques that are appropriate for their own facilities and equipment.



X-ray Equipment Life Cycle and Patient Dosimetry
David Sutton (ICRP/NHS Tayside/University of Dundee)

Optimisation is hard to pin down but is the key to protection. The process of image interpretation is both task and reader dependent, so the choice of factors that influence both patient dose and image quality depend on the patient, the clinical question, the examination, the operator performing the procedure, the equipment used to image the patient, and the person interpreting the eventual image.

Two of the key areas discussed in the report are the equipment life cycle and the analysis of patient doses. This presentation briefly describes the treatment afforded to both.

The equipment life cycle is a well understood concept, and describes medical equipment, including imaging equipment, from ‘cradle to grave’. Optimisation is a continual process and is inextricably bound up with the minutiae of the imaging equipment life cycle. Professional skills, methodology and process all play a vital role in the management of the equipment life cycle; understanding and managing it appropriately is essential if optimisation is to be achieved.

Knowledge of the doses delivered to patients is one of the first steps in the clinical optimisation process and personnel involved in performing the exams should have ownership or involvement in the process of dose audit. Patient dose surveys are essential in the development and implementation of an organisation’s dose management strategy. A multi-disciplinary team approach helps to ensure that results of dose surveys are fed back to operators who make changes that are needed.



Taking Account of Image Quality
Mika Kortesniemi (ICRP/Helsinki University)


Roles, Responsibilities and the Team Approach
Dina Husseiny (ICRP/IAEA)
Feedback From International Societies
John Damilakis
Guy Frija
Stewart Whitley



27 OCTOBER 2022
Session 2: Putting Optimisation Into Practice



Building Optimisation Into Routine Practice
Mika Kortesniemi (ICRP/Helsinki University)



The Importance of Education and Training
Kimberly Applegate (ICRP/University of Kentucky COM)

The use of radiation in medicine may result in unnecessary radiation exposure where equipment is in the hands of untrained or undertrained operators. But this could be largely avoided if the operators were adequately trained in techniques for the optimisation of protection. Although the delay in manifestation of long-term health effects resulting from exposure to ionising radiation makes the associated risks difficult to comprehend or monitor, the overarching requirement ‘to do more good than harm’ makes radiological protection of patients an important ethical duty. Education and training in radiological protection can enhance personnel understanding, foster the development of a culture of safety, of teamwork, and of professionalism, and improve workers’ satisfaction and commitment to radiological protection principles. Investment in an adequate staffing level, with trained healthcare staff and a commitment to their continuous professional development (CPD) are essential when considering investment in new imaging equipment and software.

ICRP Publication 113 sets out a comprehensive discussion of the basic education and ongoing training of all stakeholders in radiological protection in medicine, including suggested content, objectives, management approaches, and the approximate minimum time needed for this training. The recommended knowledge content about radiological protection and dosimetry is important, but effective optimisation also requires other critical skills, namely building a strong team and safety culture based on mutual respect and effective interaction and collaboration between the professional groups. This becomes ever more important due to the complexity of the work environment and with the increasing complexity of modern x-ray equipment. Radiologists and radiographers need to work closely with medical physicists to ensure the operation of dose reduction features are understood and facilities are used properly. Professional links and mutual understanding should be developed from the start through collaborative training and continuing dialogue, with regular reviews and update training focused on maintaining and developing competencies in optimisation through a team approach.




Current Issues With Optimisation Around the World and Support from the IAEA
Jenia Vassileva (ICRP/IAEA)



View from WHO (World Health Organization)
Emilie van Deventer (WHO)

The World Health Organization contributed to the development of this ICRP publication as it is expected to support the implementation of the International Basic Safety Standards in our Member States. This document on digital radiology is presented with a clinical perspective, linking the concept and practice of optimization of medical imaging with quality of health care. It will be a useful tool towards the Global Action Plan on Patient Safety, and towards the enactment of Universal Health Coverage.

Question & Answer

Views From Around the World
Kwan Ng
Boris Brkljačić
Mónica Bernardo
Michael Kawooya
Panel Discussion: Application in Different Parts of the World