Dose Reduction in Radiology: An Industrywide Initiative

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Gregg CretellaThere is no more compelling story in radiology today than the urgency with which organized radiology and imaging modality vendors have come together to address the issue of dose management in radiology. Yes, more work lies ahead, and significant challenges remain—but the swiftness and decisiveness with which providers and vendors have cooperated, and their accomplishments to date, might be unprecedented in the history of the specialty.

On the provider side, radiologists—worldwide—have adopted pediatric CT protocols that protect children from receiving adult-size radiation doses, under an initiative aggressively promoted by the Image Gently™ campaign. At the Image Gently Dose Summit held in St Louis, Missouri, in February 2010, the industry turned its attention to radiography and to the adoption of an international standard that will eliminate confusing and sometimes contradictory user interfaces on various acquisition devices and will smooth the way for technologists, administrators, and radiologists to monitor dose.

Gregg Cretella, manager, clinical science, FUJIFILM Medical Systems USA (Stamford, Connecticut), articulates the technical progress that has been made on the radiography front thus far, the challenges that lie ahead, and the significance of these advances in an interview with Which organizations are involved in the initiative?
Cretella: The Alliance for Radiation Safety in Pediatric Imaging (with the Image Gently campaign) was probably the number-one driver, but also included in the list of associations would be the American Society of Radiologic Technologists (ASRT), the Medical Imaging and Technology Alliance (MITA), the American Association of Physicists in Medicine (AAPM), and the American College of Radiology (ACR). All of the CR and DR vendors participated in the Image Gently Summit, and Image Gently requested that all vendors move toward and adopt the international standard for exposure index, International Electrotechnical Commission (IEC) standard 62494-1. This was supported by the AAPM, and vendors were encouraged to begin the engineering work for adopting that standard.

Historically, each vendor had its own proprietary index. Sometimes, when the dose goes up, the exposure index goes up, but on other systems, when the dose goes up, the exposure index goes down. Also, the numerical values used to represent these exposure indices are usually different, vendor to vendor, so you can imagine the difficulties, in a multivendor facility, for a technologist, as he or she moves from system to system.

The whole idea behind adopting the international standard is this: Regardless of the systems the technologist is operating, they would all display and present to the technologist roughly the same information.

More importantly, the new IEC standard produces a deviation index. This index, provides immediate feedback to the technologist , indicating how far an exam’s exposure deviated from the facility’s established, optimum exposure conditions.

If each technologist logs into the acquisition workstation when he or she needs to use it, the system should be able to provide information on which technologists are overexposing on a given exam or underexposing—thus allowing a facility, once it analyzes such data, to identify training opportunities for the technologist.

Almost a year ago, all of Fujifilm’s acquisition workstations became compliant with IEC 62494-1. Industrywide, I think there’s a little ways to go. The last time I looked, there still were a few vendors who had not yet adopted the standard, but I expect they will, at some point. As this standard becomes more understood, adopted, and accepted by the market, then certainly all vendors will adopt it. Fujifilm was an early adopter, with engineering activity that preceded requests from the Image Gently campaign. Tell us about the vendor activities underway to mitigate radiation dose at the modality and imaging IT levels?
Cretella: Vendors are working very hard in developing technology and tools to improve dose efficiency or facilitate dose management. On the technology side, vendors continue to refine their detectors so that with each new release, there is the potential for reduced dose while still achieving excellent image quality, compared with detectors of a previous version. For example, on the CR front, Fujifilm offers its exclusive dual-side reading image plates, and on the