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Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Dose reduction with added filtration
Dose reduction with added filtration
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Antiscatter grids
Antiscatter grids
Antiscatter grids
Antiscatter grids
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Film-screen systems
Film-screen systems
Film-screen systems
Film-screen systems
Equipment, practice, dose and image quality
Equipment, practice, dose and image quality
Cook, J.V., Imaging, 13 (2001), 229–238
Cook, J.V., Imaging, 13 (2001), 229–238
Cook, J.V., Imaging, 13 (2001), 229–238
Cook, J.V., Imaging, 13 (2001), 229–238
Patient Positioning and Immobilization
Patient Positioning and Immobilization
Patient Positioning and Immobilization
Patient Positioning and Immobilization
Patient Positioning and Immobilization
Patient Positioning and Immobilization
Mobile radiography
Mobile radiography
Mobile radiography
Mobile radiography
Criteria related to images
Criteria related to images
Criteria related to images
Criteria related to images
Criteria related to images
Criteria related to images
Quality Criteria List
Quality Criteria List
Chest-PA/AP projection
Chest-PA/AP projection
Chest radiography-PA/AP projection
Chest radiography-PA/AP projection
Chest radiography-PA/AP projection
Chest radiography-PA/AP projection
ICRP-ISR “smart” message for paediatrics
ICRP-ISR “smart” message for paediatrics
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Radiation Protection of Children in Screen Film Radiography

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1Radiation Protection of Children in 30Film-screen systems. Fast screen-film
Screen Film Radiography. L03. Radiation system: shorter exposure times (requires a
Protection in Paediatric Radiology. good generator) reduction in radiation
2Educational objectives. At the end of dose and prevention of artefacts
the programme, the participants should: Recommendations: 200 speed: bone 400
Become familiar with specific radiation speed: general >700 speed –
protection issues in paediatric constipation transit abdominal
radiography Identify the features of radiographs, follow-up films, e.g.
radiographic imaging equipment used in scoliosis and hips, swallowed foreign
paediatric radiology List important body,… Radiation Protection in Paediatric
operational considerations in paediatric Radiology L03.Radiation protection in
radiography Discuss important screen-film radiography. 30.
considerations in paediatric radiography 31Equipment, practice, dose and image
using mobile X-ray units. Radiation quality. 10. Collimation The most
Protection in Paediatric Radiology important factor for improving image
L03.Radiation protection in screen-film quality whilst also reducing dose The most
radiography. 2. common radiographic fault Good
3Answer True or False. Added filtration collimation/coning is essential to achieve
will reduce the dose to the patient. Short better contrast and avoid exposing
exposure time is a disadvantage. Proper unnecessarily other body parts (dose
collimation reduce dose. Shielding of reduction) Body parts outside the region
radiosensitive organs is recommended in of interest should not be in the X-ray
paediatric radiography. Radiation field. Radiation Protection in Paediatric
Protection in Paediatric Radiology Radiology L03.Radiation protection in
L03.Radiation protection in screen-film screen-film radiography. 31.
radiography. 3. 32Collimation. Require a basic knowledge
4Contents. Justification in radiography of paediatric pathology Lung fields
Practical optimisation in paediatric extremely large in congestive heart
radiography Equipment related Radiographic failure & emphysematous pulmonary
technique related Important consideration diseases Diaphragm, high in intestinal
for mobile radiography Image quality and meteorism, chronic obstruction or
patient dose. Radiation Protection in digestive diseases Beam-limiting devices
Paediatric Radiology L03.Radiation automatically adjusting the field size to
protection in screen-film radiography. 4. the full size of the cassette are
5Introduction. Children have higher inappropriate for children Minimal
radiation sensitivity than adults due to a deviation from the radiation and light
longer life expectancy For children under beam may have large effects in relation to
age of 10, the probability for fatal the usually small field of interest -
cancer is 2-3 times higher than for whole check light beam diaphragm regularly.
population The higher radio-sensitivity of Radiation Protection in Paediatric
the patients should be taken into account. Radiology L03.Radiation protection in
Radiation Protection in Paediatric screen-film radiography. 32.
Radiology L03.Radiation protection in 33Collimation. Alignment agreement among
screen-film radiography. 5. the collimators, radiation beam and the
6Introduction. Radiologists and light beam must be regularly assessed
radiographers should be specifically Beyond the neonatal period, the tolerance
trained for paediatrics A paediatric for maximal field size should be less than
radiological procedure should be 2 cm greater than the minimal In the
individually planned and projections neonatal period, the tolerance level
should be limited to what is absolutely should be reduced to 1.0 cm at each edge
necessary for a diagnosis. Radiation In paediatric patients, evidence of the
Protection in Paediatric Radiology field limits should be apparent by clear
L03.Radiation protection in screen-film rims of unexposed film. Radiation
radiography. 6. Protection in Paediatric Radiology
7General recommendations. Key areas in L03.Radiation protection in screen-film
radiation protection in paediatric radiography. 33.
radiology: Justification Optimisation 34Cook, J.V., Imaging, 13 (2001),
Evaluation of patient dose and image 229–238. Neonatal anteroposterior supine
quality “Do you really need a glossy chest and abdomen radiograph of newborn:
picture to make that diagnosis”. Radiation all four cone marks visible, with no
Protection in Paediatric Radiology extraneous body parts included and lead
L03.Radiation protection in screen-film masking of the gonads. Lateral skull
radiography. 7. radiograph (horizontal beam and round
8Justification in radiography. cone). Radiation Protection in Paediatric
Justification is required for all Radiology L03.Radiation protection in
radiographic studies Ask referring screen-film radiography. 34.
practitioner, patient, and/or family about 3511. Shielding Standard equipment of
previous procedures Use referral lead-rubber shielding of the body in the
guidelines where appropriate and available immediate proximity of the diagnostic
Use alternative approaches, such as field Special shielding has to be added
ultrasound, MRI where appropriate Consent, for certain examinations to protect
implied or explicit, is required for against external scattered and extra-focal
justification Include justification in radiation. Equipment, practice, dose and
clinical audit. Radiation Protection in image quality. Radiation Protection in
Paediatric Radiology L03.Radiation Paediatric Radiology L03.Radiation
protection in screen-film radiography. 8. protection in screen-film radiography. 35.
9Justification in radiography. Referral 36Shielding. For exposures of 60 - 80
guidelines for radiological examinations: kV, maximum gonadal dose reduction of
EUROPEAN COMMISSION, Referral Guidelines about 30 to 40% can be obtained by
for Imaging, Luxembourg, Radiation shielding with 0.25 mm lead equivalent
Protection 118, Office for Official rubber immediately at the field edge
Publications of the European Communities, However, this is only true when the
Luxembourg (2001) and Update (2008) THE protection is placed correctly at the
ROYAL COLLEGE OF RADIOLOGISTS, Making the field edge. Radiation Protection in
Best use of Clinical Radiology Services Paediatric Radiology L03.Radiation
(MBUR), 6th edition, RCR, London (2007). protection in screen-film radiography. 36.
Radiation Protection in Paediatric 36.
Radiology L03.Radiation protection in 37Shielding. The gonads in "hot
screen-film radiography. 9. examinations", when they lie within
10Examples of radiography examinations or close to (nearer than 5 cm) the primary
not routinely indicated. Skull radiograph beam, should be protected whenever this is
in a child with epilepsy Skull radiograph possible without impairing necessary
in a child with headaches Sinus radiograph diagnostic information It is best to make
in a child, under 5 years, suspected of one's own lead contact shields for girls
having sinusitis Cervical spine radiograph and lead capsules for boys Must be
in a child with torticollis without trauma available in varied sizes. Radiation
Radiographs of the opposite side for Protection in Paediatric Radiology
comparison in limb injury. Radiation L03.Radiation protection in screen-film
Protection in Paediatric Radiology radiography. 37. 37.
L03.Radiation protection in screen-film 38Shielding. With appropriate shielding
radiography. 10. the absorbed dose in the testes can be
11Optimisation in radiography. Justified reduced by up to 95% In girls, shadow
studies must be optimised Various actions masks within the diaphragm of the
taken contribute to systematic dose collimator are as efficient as direct
savings (from a factor of two to ten, with shields. When shielding of the female
the result that their combined effect can gonads is effective, the reduction of the
dramatically reduce dose) Sustain good absorbed dose in the ovaries can be about
practice through a quality assurance and 50%. Radiation Protection in Paediatric
constancy checking program. Radiation Radiology L03.Radiation protection in
Protection in Paediatric Radiology screen-film radiography. 38. 38.
L03.Radiation protection in screen-film 39Shielding. The eyes should be shielded
radiography. 11. for X-ray examinations involving high
12Optimisation in radiography. Selection absorbed doses in the eyes, e.g., for
of equipment: Influence on patient dose conventional tomography of the petrous
and image quality But, good radiographic bone, when patient cooperation permits The
technique is the main factor in improving absorbed dose in the eyes can be reduced
quality without increasing dose. Radiation by 50% - 70% In any radiography of the
Protection in Paediatric Radiology skull the use of PA-projection rather than
L03.Radiation protection in screen-film the AP-projection can reduce the absorbed
radiography. 12. dose in the eyes by 95%. Radiation
13Practical optimisation measures in Protection in Paediatric Radiology
radiography (I). Have a standard type and L03.Radiation protection in screen-film
number of projections for specific radiography. 39. 39.
indications Views in addition to standard 40Equipment, practice, dose and image
should only be performed on a case-by-case quality. 12. Patient Positioning and
basis Use manual technique selection Immobilization Patient positioning must be
pending equipment developments on small exact, whether or not the patient
patients or body parts Where practical use co-operates. In infants, toddlers and
a long (or the recommended) Focus-to-Film younger children immobilization devices,
Distance. Radiation Protection in properly applied, must ensure that: the
Paediatric Radiology L03.Radiation patient does not move the beam can be
protection in screen-film radiography. 13. centred correctly the film is obtained in
14Practical optimisation measures in the proper projection accurate collimation
radiography (II). Carefully collimate the limits the field size exclusively to the
X-ray beam to area of interest, excluding required area shielding of the remainder
other regions, especially gonads, breast, of the body is possible. Radiation
thyroid and eyes Use appropriate gonad, Protection in Paediatric Radiology
thyroid, and breast shielding Fast L03.Radiation protection in screen-film
film-screen combinations are acceptable radiography. 40.
for the majority of indications 41Patient Positioning and
Antiscatter grid is often unnecessary in Immobilization. Radiation Protection in
children – do not use grid for abdominal Paediatric Radiology L03.Radiation
examination in patients under age of 3, protection in screen-film radiography. 41.
for skull radiography for patients under 42Patient Positioning and
age of 1 and any fluoroscopy examination Immobilization. Immobilization devices
unless high detail is required (Cook, V. must be easy to use Their usefulness
Imaging, (13) 2001:229–238). Radiation should be explained to the accompanying
Protection in Paediatric Radiology parent(s) Radiological staff members
L03.Radiation protection in screen-film should only hold a patient under
radiography. 14. exceptional circumstances Even in quite
15Practical optimisation measures in young children the time allocation for an
radiography (III). Use PA projections, examination must include the time to
where practical, for chest and spine explain the procedure not only to the
radiographs Make sure the correct parents but also to the child. Radiation
filtration is used to reduce entry dose Protection in Paediatric Radiology
Use as high a kVp as is consistent with L03.Radiation protection in screen-film
examination requirements Consider radiography. 42.
additional filtration at higher kVp 43Mobile radiography. Mobile radiography
Balance the use of a small focal spot size is valuable on occasions when it is
and short exposure times. Radiation impossible for the patient to come to the
Protection in Paediatric Radiology radiology department It can result in
L03.Radiation protection in screen-film poorer quality images unnecessary staff
radiography. 15. and patient exposures Where practicable,
16Practical optimisation measures in X-ray examinations should be carried out
radiography (IV). Use of quality with fixed units in an imaging department
assessment, quality assurance and audit Mobile units should only be used with
programs for all aspects of the those who cannot safely be moved to such a
department’s work, including film unit. Radiation Protection in Paediatric
processing and justification Introduce and Radiology L03.Radiation protection in
use a system that allows patient dose be screen-film radiography. 43.
assessed regularly Monitor reject rate and 44Mobile radiography. High output
the causes (overexposure, underexposure, converter generators are recommended
positioning, motion, and collimation Capacitor discharge systems should be
problems). Radiation Protection in avoided (they have significant pre- and
Paediatric Radiology L03.Radiation post-peak soft radiation) Appropriate
protection in screen-film radiography. 16. collimation is essential to avoid exposing
17Equipment, practice, dose and image organs outside the diagnostic area of
quality. 1. Generators For paediatric interest Other principles outlined above,
examinations, the generator should be: a should be followed with mobile
high frequency multi-pulse (converter) of radiography. Radiation Protection in
sufficient power nearly rectangular Paediatric Radiology L03.Radiation
waveform with minimal voltage ripple. protection in screen-film radiography. 44.
Radiation Protection in Paediatric 45Mobile radiography. Scattered
Radiology L03.Radiation protection in radiation must be managed to reduce dose
screen-film radiography. 17. to the patient, parents/guardians and to
18Equipment, practice, dose and image hospital personnel The advice of the
quality. 2. Exposure time When children medical physicist/radiation protection
are uncooperative they may need officer should be obtained on how best to
immobilization They have faster heart and do this. Radiation Protection in
respiratory rates Short exposure times Paediatric Radiology L03.Radiation
improve quality without increasing dose protection in screen-film radiography. 45.
Only possible with powerful generators and 46Mobile radiography. Recommendations
accurate exposure time switches. Radiation for Intensive Care Unit (Duetting et. al.
Protection in Paediatric Radiology Pediat. Radiol. 29: 158-62 (1999)): No
L03.Radiation protection in screen-film additional protection for neighbouring
radiography. 18. premature infants is necessary The
19Equipment, practice, dose and image radiographer should wear a lead apron
quality. 3. Focal Spot Small focal spot Parents and personnel need not interrupt
Improves image quality May in some their activities or leave the room during
machines increase exposure time and motion an X-ray examination When using a
artefacts Choice depends on exposure horizontal beam, the beam, must be
parameters: time, kVp and FFD directed away from other persons – use
(Focus-to-Film Distance) Recommendation: lead shield. Radiation Protection in
focal spot should be 0.6 -1.3mm. Radiation Paediatric Radiology L03.Radiation
Protection in Paediatric Radiology protection in screen-film radiography. 46.
L03.Radiation protection in screen-film 47Criteria related to images. Incorrect
radiography. 19. positioning is the most frequent cause of
20Equipment, practice, dose and image inadequate image quality in paediatric
quality. 4. Additional filtration radiographs Image criteria for the
Additional filtration may lead to dose assessment of adequate positioning
reduction 0.1 mm of Cu in addition to 2.5 (symmetry and absence of tilting etc) are
mm of Al* reduce ESAK by 20% barely much more important in paediatric imaging
noticeable reduction in image quality Some than in adults A lower level of image
modern systems can automatically insert quality than in adults may be acceptable
either 0.1mm or 0.2 mm Cu depending on the for certain clinical indications.
examination. *Cook, V., Imaging, (13) Radiation Protection in Paediatric
2001:229–238. Radiation Protection in Radiology L03.Radiation protection in
Paediatric Radiology L03.Radiation screen-film radiography. 47.
protection in screen-film radiography. 20. 48Criteria related to images. Guideline
21Dose reduction with added filtration. resources: European Guidelines on Quality
Added filtration. 0 mm Al. 3 mm Al. Criteria for Diagnostic Radiographic
Examination. Mean ESD (?Gy). Reduction. Images in Paediatrics American College of
Abdomen AP 10 months (62 kVp). 200. 30 %. Radiology. Radiation Protection in
Chest AP 10 months (55 kVp). 64. 40 %. Paediatric Radiology L03.Radiation
Pelvis AP 4 months (50 kVp). 94. 51 %. protection in screen-film radiography. 48.
From: Mooney and Thomas : Dose reduction 49Quality Criteria List. Radiation
in a paediatric X-ray department following Protection in Paediatric Radiology
optimization of radiographic technique, L03.Radiation protection in screen-film
BJR (77) 1998:852-860. Radiation radiography. 49.
Protection in Paediatric Radiology 50Chest-PA/AP projection. Radiation
L03.Radiation protection in screen-film Protection in Paediatric Radiology
radiography. 21. L03.Radiation protection in screen-film
22Equipment, practice, dose and image radiography. 50. 50.
quality. 5. Exposure factors Increased kVp 51Chest radiography-PA/AP projection.
(reduced mAs): Greater penetration and Radiation Protection in Paediatric
less absorption Reduced patient dose for a Radiology L03.Radiation protection in
constant film density Neonatal chest: screen-film radiography. 51.
Minimum 60kVp: less contrast but better 52Typical dose levels in paediatric
assessment of lung parenchyma Lower kVp if radiography. Examination. Examination.
looking for bone detail. Radiation Examination. ESAK (µGy). ESAK (µGy). ESAK
Protection in Paediatric Radiology (µGy). ESAK (µGy). ESAK (µGy). Age. Age.
L03.Radiation protection in screen-film Age. Age. Age. 0. 1. 5. 10. 15. Abdomen
radiography. 22. AP. 110. 340. 590. 860. 2010. Chest PA/AP.
23Equipment, practice, dose and image 60. 80. 110. 70. 110. Pelvis AP. 170. 350.
quality. 6. Antiscatter grid Often 510. 650. 1300. Skull AP. /. 600. 1250. /.
unnecessary in children because smaller /. Skull LAT. /. 340. 580. /. /. NATIONAL
irradiated volume (and mass) results in RADIOLOGICAL PROTECTION BOARD, Doses to
less scattered radiation. Limited Patient from Medical X Ray Examinations in
improvement in image quality but increased the UK: 2000 review, NRPB-W14, Chilton
dose of ~50% with the use of antiscatter (2002). Radiation Protection in Paediatric
grids. Radiation Protection in Paediatric Radiology L03.Radiation protection in
Radiology L03.Radiation protection in screen-film radiography. 52.
screen-film radiography. 23. 53ICRP-ISR “smart” message for
24Antiscatter grids. Antiscatter grid paediatrics. Radiation Protection in
should be removable in paediatric Paediatric Radiology L03.Radiation
equipment Remove antiscatter grid for: protection in screen-film radiography. 53.
abdominal imaging in young children 54http://rpop.iaea.org/RPoP/RPoP/Content
especially <3 years old skull imaging index.htm. Radiation Protection in
<1 year old in most fluoroscopic Paediatric Radiology L03.Radiation
imaging. Cook, V., Imaging, (13) protection in screen-film radiography. 54.
2001:229–238. Radiation Protection in 55Summary. Particular attention should
Paediatric Radiology L03.Radiation be given to technical specifications of
protection in screen-film radiography. 24. X-ray equipment Good radiographic
25Antiscatter grids. If used for technique is the main factor in improving
children, Antiscatter grids should have*: quality without increasing dose for
Grid ratio (r) > 8:1 Line numbers: protocols used in X-ray paediatric
>100 cm-1 Low attenuation intersperse radiology Justification of practice
material, such as carbon fibre Application of practical optimisation
Alternative: air gap technique (reduces measures in radiography. Radiation
the effect of scatter without dose Protection in Paediatric Radiology
increase, but the image is magnified). L03.Radiation protection in screen-film
*Cook, V., Imaging, (13) 2001:229–238. radiography. 55. 55.
Radiation Protection in Paediatric 56Answer True or False. Added filtration
Radiology L03.Radiation protection in will reduce the dose to the patient. Short
screen-film radiography. 25. exposure time is a disadvantage. Proper
26Equipment, practice, dose and image collimation reduce dose. Shielding of
quality. 7. Automatic Exposure Control radiosensitive organs is recommended in
(AEC) Generally not appropriate for small paediatric radiography. Radiation
children Sensors (size and geometry) are Protection in Paediatric Radiology
normally designed for adult patients AEC L03.Radiation protection in screen-film
use may be associated with the use of the radiography. 56.
grid (where the grid is not removable), 57Answer True or False. True -
which is frequently unnecessary AEC should Filtration absorbs low energy photons that
have specific technical requirements for are absorbed in patient’s skin and
paediatrics If not appropriate or superficial organs and thus giving
available, carefully applied exposure contributing to dose but not to image
charts are preferred. Radiation Protection formation. False - It prevents motion
in Paediatric Radiology L03.Radiation artefacts and unnecessary repetitions.
protection in screen-film radiography. 26. True - Collimation reduces exposed volume,
27Automatic Exposure Control. Specially and reduces scatter radiation that affects
designed paediatric AEC: Small mobile both image quality and dose. True - It is
detector for use behind a lead-free especially important for radiosensitive
cassette Position can be selected with organs as breast, gonads and eyes.
respect to the most important region of Radiation Protection in Paediatric
interest This must be done extremely Radiology L03.Radiation protection in
carefully, as even minor patient movement screen-film radiography. 57.
may be disastrous. Radiation Protection in 58References. European Guidelines on
Paediatric Radiology L03.Radiation Quality Criteria for Diagnostic
protection in screen-film radiography. 27. Radiographic Images in Paediatrics, July
28Equipment, practice, dose and image 1996. EUR 16261. Available at:
quality. 8. Focus-to-film distance (FFD) http://www.cordis.lu/fp5-euratom/src/lib_d
Longer focus-to-film distances Smaller cs.htm Huda W, Assessment of the problem:
skin dose Combined with a small paediatric doses in screen-film and
object-to-film distance, results in less digital radiography, Pediatr Radiol
magnification (less geometric distortion) 34(Suppl 3) 2004:S173-S182
and improved quality. Radiation Protection Duetting,Foerste,Knoch,Darge and Troeger,
in Paediatric Radiology L03.Radiation Radiation exposure during chest X-ray
protection in screen-film radiography. 28. examinations in a premature intensive care
29Equipment, practice, dose and image unit: phantom studies, Pediatr Radiol (29)
quality. 9. Image receptors Fast 1999:158-162 Mooney and Thomas : Dose
screen-film combinations have advantages reduction in a paediatric X-ray department
(reduction of dose) and limitations following optimization of radiographic
(reduced resolution) Low-absorbing technique, BJR (77) 1998:852-860 Cook, V.,
materials in cassettes, tables, etc., are Radiation protection and quality assurance
specially important in paediatric in paediatric radiology, Imaging, (13)
radiology (carbon fibre). Radiation 2001:229–238. Radiation Protection in
Protection in Paediatric Radiology Paediatric Radiology L03.Radiation
L03.Radiation protection in screen-film protection in screen-film radiography. 58.
radiography. 29.
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