A strategy for achieving optimisation of radiological protection in digital radiology proposed by ICRP

Radiology is now predominantly a digital medium and this has extended the flexibility, efficiency and application of medical imaging. Achieving the full benefit of digital radiology requires images to be of sufficient quality to make a reliable diagnosis for each patient, while minimising risks from radiation exposure, and so involves a careful balance between competing objectives. When an optimisation programme is undertaken, a knowledge of patient doses from surveys can be valuable in identifying areas needing attention. However, any dose reduction measures must not degrade image quality to the extent that it is inadequate for the clinical purpose. The move to digital imaging has enabled versatile image acquisition and presentation, including multi-modality display and quantitative assessment, with post-processing options that adjust for optimal viewing. This means that the appearance of an image is unlikely to give any indication when the dose is higher than necessary. Moreover, options to improve performance of imaging equipment add to its complexity, so operators require extensive training to be able to achieve this. Optimisation is a continuous rather than single stage process that requires regular monitoring, review, and analysis of performance feeding into improvement and development of imaging protocols. The ICRP is in the process of publishing two reports about optimisation in digital radiology. The first report sets out components needed to ensure that a radiology service can carry optimisation through. It describes how imaging professionals should work together as a team and explains the benefits of having appropriate methodologies to monitor performance, together with the knowledge and expertise required to use them effectively. It emphasises the need for development of organisational processes that ensure tasks are carried out. The second ICRP report deals with practical requirements for optimisation of different digital radiology modalities, and builds on information provided in earlier modality specific ICRP publications.