‘Back to Basics’ Targets Digital X-ray Dose Reduction

A new Image Gently initiative to improve radiation protection in pediatric X-ray exams emphasizes proper imaging procedures as technology shifts from standard screen-film X-ray to digital X-ray.

The Back to Basics campaign aims to “to reinforce the good habits taught with screen-film radiography,” said Steven Don, MD, co-chair of the campaign committee. The program, launched by Image Gently, includes online teaching materials, checklists and quality improvement projects.

Over time, radiation exposure was rising with the use of computed radiography equipment - without radiologists noticing, Don explained. Vendors also were using different terminology, which could confuse technologists and affect dose, Don said. A standard terminology, which includes a target exposure index, was accepted a couple years ago, and new equipment follows this standard.

“We realize that various hospitals use different techniques, and we know exposure creep is occurring, and there’s this new terminology that few people are aware of,” Don said, adding this campaign calls for a return to the procedures done before the digital switch.

Children are at particular risk because they are more sensitive to radiation and cumulative exposure could have adverse effects. They are also more likely to receive X-rays than any other exam, according to the campaign.

The initiative encourages providers to:

• Measure patient thickness for “child-size” technique
• Avoid using grids for body parts less than 10 to 12 cm thick
• X-ray only the affected area with proper collimation and shielding
• Check exposure indicators and image quality

If not accounted for, differences between screen-film and digital radiology processes could result in patients receiving higher-than-necessary dose, Susan D. John, MD, FACR, co-chair of the Back to Basics campaign committee, said in a statement.

“This initiative seeks to make radiology medical professionals aware of the differences and how to account for them. Modern radiation reduction techniques include a return to simple techniques, such as collimation, that allow children to consistently get low-dose exams,” she said.

Image Gently is conducted by the Alliance for Radiation Safety in Pediatric Imaging, founded by the Society for Pediatric Radiology, the American College of Radiology, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine.