Task Group 108: Part 2

Optimisation of Radiological Protection in Digital Radiology Techniques for Medical Imaging

20 March 2023 | 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.

Learn More About Task Group 108

Use of medical imaging continues to increase and become more sophisticated, making the major contribution to population exposure from artificial sources of radiation world-wide. The move to digital imaging has provided versatile acquisition, post-processing, and presentation options, but because images are adjusted for optimal viewing, the appearance may not give any indication of whether the dose might be higher than necessary. Nevertheless, digital images provide opportunities for further optimisation and offer the possibility of applying artificial intelligence methods in the future. This report builds on Part 1 which described the layered approach to the development and maturation of optimisation (levels from D to C to B to A), applying it to the ionising radiation modalities in digital imaging.

ICRP Task Group 108 has prepared two reports that describe aspects of optimisation that different facilities might achieve, and through which they can progress incrementally. The first report has already been the subject of a workshop, held in October 2022. This new Workshop sets out the areas that are dealt with in the second report, which was available for public consultation until 31 March 2023. The report is concerned with practical aspects of optimisation of radiological protection for the digital x-ray imaging modalities radiography, fluoroscopy and computed tomography. It builds on the structures for optimisation developed in the first part.

The workshop will be concerned with the topics addressed in the report and will summarize practical approaches to optimisation in the three modalities. There will also be presentations concerning special considerations for paediatric patients and imaging pregnant patients. There will be a panel discussion on Global Optimisation Strategies as well as time allocated for Questions and answers from the audience.

Participants are likely to gain most from the workshop if they have viewed the consultation document. Participants who attend at least 50% of the workshop will receive a Certificate of Attendance via email within 48 hours of the event.

Publication Abstract

Digital radiology is playing an increasingly important role in medicine world-wide. The use of computed tomography (CT) has risen dramatically in recent decades and makes up about half of the population dose from medical exposures in many parts of the world. In addition, ever more complex interventional procedures guided by fluoroscopy are replacing more invasive surgical techniques, thus substituting risks from surgery with lesser ones from radiation. These radiological techniques provide significant health benefits, but the associated radiation dose levels need to be kept commensurate with the benefit accrued. Key factors in achieving this are ensuring that examinations are only carried out when they can contribute to management of a patient’s condition and that the radiological protection aspects for all exposures are optimised. The latter is the subject of the present publication. Digital imaging data contribute versatility in image acquisition, post-processing, and presentation, and provide opportunities for optimisation. However, unlike their analogue equivalent, images acquired digitally may not provide an indication that a dose is too high or images are not collimated, so there are new problems that have to be addressed. In the companion to this publication three fundamental requirements for taking the optimisation process forward were described. These are 1) the need for collaboration between radiologists and other physicians, radiographers, medical physicists and managers, 2) access to the appropriate methodology, technology and expertise, and 3) provision of organisational processes that ensure tasks, such as equipment performance tests, patient dose surveys and reviews of protocols are carried out. A high-level requirement is the integration and use of decision sciences, and harmonisation of these optimisation processes across multispecialty clinical teams and equipment types within healthcare systems. This publication contains information on practical methods needed to carry optimisation forward for different imaging techniques; radiography, fluoroscopy (and fluoroscopically guided interventional procedures) and CT. Many features of digital equipment allow dose levels to be reduced while still maintaining adequate image quality for the clinical task. Staff need to understand the relationship between the different selectable options to use the features effectively. However, there is a wide range in available equipment and training around the world. Provision ranges from clinics with simple radiographic units to specialist hospitals with complex state-of-the-art equipment. Some countries have established communities of medical physicists, while in others there is little or no medical physics support. This presents challenges in communicating requirements for optimisation. This document addresses these challenges by providing information for facilities, within broad categories linked to optimisation arrangements already in place, D: Preliminary, C: Basic, B: Intermediate, and A: Advanced (ICRP, 2022). 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.

Each of the speakers will provide insight into a particular issue addressed in the publication, i.e. Digital Radiography, Fluoroscopy & FGI, CT, paediatrics and the special case of the pregnant patient.