Patient Radiation Exposure Monitoring in Medical Imaging

By IAEA

Written to assist the implementation in medical imaging practice of the requirements of the IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, this publication provides consolidated information and detailed advice for setting and implementing patient radiation exposure monitoring programmes at the local or national level. In medical imaging using ionizing radiation, including X ray diagnostic radiology, diagnostic nuclear medicine and image guided interventional procedures, radiation protection of patients is achieved by selecting the most appropriate imaging procedure for the individual needs of the patient and by keeping exposure to the minimum necessary to achieve the diagnostic and interventional objective. Monitoring of radiation exposure of patients provides critical information for health care professionals and authorities who are responsible for ensuring justified and optimized use of radiation in medicine. This Safety Report provides guidance on recording, collecting and analysing relevant patient exposure data by using manual or automatic means. An aim of the publication is to encourage the future use and development of automatic digital systems to improve access to information about patient radiation exposure and thus contribute to improved implementation of the requirements for radiation protection of patients throughout the world.

• Language: English
• Publisher: International Atomic Energy Agency
• Release date: Jul 6, 2023
• ISBN: 9789201494221

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PATIENT RADIATION

EXPOSURE MONITORING

IN MEDICAL IMAGING

SAFETY REPORTS SERIES No. 112

PATIENT RADIATION

EXPOSURE MONITORING

IN MEDICAL IMAGING

INTERNATIONAL ATOMIC ENERGY AGENCY

VIENNA, 2023

COPYRIGHT NOTICE

All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at:

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© IAEA, 2023

Printed by the IAEA in Austria

July 2023

STI/PUB/1976

IAEA Library Cataloguing in Publication Data

Names: International Atomic Energy Agency.

Title: Patient radiation exposure monitoring in medical imaging / International Atomic Energy Agency.

Description: Vienna : International Atomic Energy Agency, 2023. | Series: IAEA safety reports series, ISSN 1020–6450 ; no. 112 | Includes bibliographical references.

Identifiers: IAEAL 22-01584 | ISBN 978–92–0–149222–7 (paperback : alk. paper) | ISBN 978–92–0–149322–4 (pdf) | ISBN 978–92–0–149422–1 (epub)

Subjects: LCSH: Radiography, Medical — Patients — Safety measures. | Radiography, Medical — Quality control. | Radiation — Safety measures. | Diagnostic imaging — Safety measures.

Classification: UDC 614.876 | STI/PUB/1976

FOREWORD

The IAEA’s Statute authorizes the Agency [T]o establish or adopt, in consultation and, where appropriate, in collaboration with the competent organs of the United Nations and with the specialized agencies concerned, standards of safety for protection of health and minimization of danger to life and property…, and to provide for the application of these standards. In terms of the radiation exposure of patients during the medical use of ionizing radiation, the application of the principles of radiation protection and safety as defined in the IAEA Safety Fundamentals requires a special approach. In accordance with IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, dose limits do not apply to patients. Consequently, the focus for ensuring the radiation protection of patients is on the application of the principles of justification and optimization. In medical imaging using ionizing radiation, including X ray diagnostic radiology, diagnostic nuclear medicine and image guided interventional procedures, radiation protection of patients is achieved by selecting the most appropriate imaging procedure for the individual needs of the patient and keeping the exposure to the minimum necessary to achieve the necessary diagnostic and interventional objective.

Reviews of the radiation exposure of patients in medical imaging have proved to be key tools for the optimization of the radiation protection of patients, the analysis of individual as well as population based exposures and the process of justification. Information on patient exposure at the population level is informative for assessing trends in collective doses and as a basis for epidemiological studies on the effects of radiation. The rapid technological developments in medical imaging have improved access to information on the exposure of patients and facilitated the analytical uses of these data.

The purpose of this publication is to respond to the lack of definitive guidelines on this subject and provide consolidated information on monitoring patient radiation exposure in medical imaging, including recording, collecting and analysing relevant patient exposure data by manual or automatic means. Considering the ease of access to a large volume of digital data on patient exposure, emphasis has been placed on the use of automatic digital systems for patient radiation exposure monitoring, for which there is also a lack of appropriate guidelines. The purpose is also to encourage the future development and use of automatic digital systems to improve access to information about patient radiation exposure and thus contribute to improved implementation of the requirements for radiation protection of patients throughout the world.

The target audience for this publication is anyone involved in setting up and implementing a patient radiation exposure monitoring programme at the level of a medical facility, group of facilities, State or region. The scope of this publication is limited to the process of making radiation exposure data available in a meaningful way, framed for the intended purpose and user group. Guidance on patient dosimetry, as well as on specific actions for improving radiation protection and patient care through the proper management and utilization of available exposure data, is specific to each imaging modality and is outside of the scope of this publication.

This Safety Report was developed in cooperation with the World Health Organization and the United Nations Scientific Committee on the Effects of Atomic Radiation. Working Group 28 (Physics) of Digital Imaging and Communications in Medicine and Integrating the Healthcare Enterprise also contributed to this publication.

The IAEA is grateful to all those who assisted in the drafting and review of this publication, in particular H. Järvinen (Finland), E. Samei (USA) and A. Trianni (Italy) with contributions by R. Loose (Germany), M. Rehani (USA) and E. Vano (Spain). The IAEA officer responsible for this publication was J. Vassileva of the Division of Radiation, Transport and Waste Safety.

EDITORIAL NOTE

Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use.

This publication does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person.

Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States.

The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries.

The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA.

The IAEA has no responsibility for the persistence or accuracy of URLs for external or third party Internet web sites referred to in this book and does not guarantee that any content on such web sites is, or will remain, accurate or appropriate.

The authoritative versions of the publications are the hard copies issued and available as PDFs on www.iaea.org/publications.To create the versions for e-readers, certain changes have been made, including the movement of some figures and tables.

CONTENTS

1. INTRODUCTION

1.1. Background

1.2. Objective

1.3. Scope

1.4. Structure

2. PATIENT RADIATION EXPOSURE MONITORING GOALS AND STRUCTURE

2.1. Goals of patient radiation exposure monitoring in medical imaging

2.2. Elements of patient radiation exposure monitoring and terminology

3. COMPONENTS OF PATIENT RADIATION EXPOSURE DATA

3.1. Image acquisition and processing parameters

3.2. Radiation exposure metrics

3.3. Image quality metrics

3.4. Overall patient risk

4. PATIENT RADIATION EXPOSURE MONITORING WORKFLOW

4.1. Recording of patient radiation exposure data

4.2. Collecting patient radiation exposure data

4.3. Analysing and reporting patient radiation exposure data

5. RECORDING PATIENT RADIATION EXPOSURE DATA

5.1. Patient radiation exposure data to be recorded

5.2. Methods of recording patient radiation exposure data

6. COLLECTION OF PATIENT RADIATION EXPOSURE DATA

6.1. Techniques for collecting patient radiation exposure data

6.2. Definition of the patient exposure data cohort

6.3. Classification of medical radiological procedures

7. ANALYSING PATIENT RADIATION EXPOSURE DATA

7.1. Optimization of protection and practice consistency

7.2. Individual patient exposure analysis

7.3. Supporting the process of justification and appropriateness

7.4. Population dose estimations

8. IMPLEMENTATION OF PATIENT RADIATION EXPOSURE MONITORING

8.1. Organizational structure for patient radiation exposure monitoring

8.2. Specifications and functionalities of a patient radiation exposure monitoring system

8.3. Quality control for data integrity in patient radiation exposure monitoring

8.4. Training and communication in patient radiation exposure monitoring

8.5. Integration of a digital patient radiation exposure monitoring system with other health care systems

8.6. Priorities for implementation of a patient radiation exposure monitoring system

8.7. Obstacles and challenges in implementing patient radiation exposure monitoring

APPENDIX:

REFERENCES

GLOSSARY

LIST OF ABBREVIATIONS

CONTRIBUTORS TO DRAFTING AND REVIEW

1. INTRODUCTION

1.1. Background

The use of ionizing radiation in medical imaging has brought significant benefit to human health. This benefit has encouraged increased utilization of medical imaging in recent decades and, as a consequence, there has been a marked increase in collective doses from radiological imaging [1, 2]. Although these increased utilizations are largely justified, in the light of the derived benefit, the consequent increased exposures necessitate a higher degree of oversight of radiation protection for patients. This is of particular importance in view of published reports on the unjustified and unoptimized use of radiological imaging [3–7]. Among the reasons for this are the increasing use of imaging technology by medical professionals with limited or no training in radiation protection, and the rising complexity and diversity of imaging systems and features [8, 9]. This landscape has led to several actions by the IAEA on strengthening patient radiation protection under the umbrella of the International Action Plan on Radiation Protection of Patients and the Bonn Call for Action [10–12].

Following the recommendations of the International Commission on Radiological Protection (ICRP) [13, 14], and on the basis of IAEA Safety Standards Series No. SF-1, Fundamental Safety Principles [15], IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards [16], requirements are established in IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards [16], for patient dosimetry in diagnostic and interventional procedures, as well as diagnostic reference levels (DRLs) to support and facilitate the optimization of radiation protection of patients. These pertain to