Abstract
Imaging, which plays a crucial role in the diagnosis and treatment of diseases, has become an indispensable part of modern medical practice. However, this process has also led to increased radiation exposure and potential health risks. Strategies such as justification, optimization, and the establishment of diagnostic reference levels are implemented to protect patients from radiation. In this context, the measurement, recording, and analysis of patient doses are of critical importance. With the advancement of digital technologies, dose tracking/management systems (DTS) have emerged as vital tools for monitoring and optimizing radiation doses. DTS collect, analyze, and report dose data obtained from radiological procedures. These systems not only enhance patient safety but also help minimize radiation exposure and optimize imaging quality. However, to ensure the effective use of DTS, attention must be paid to data accuracy, staff training, and system integration. This review addresses a wide range of topics related to dose management processes, including dose metrics, image quality assessment, the fundamental components of DTS, and artificial intelligence applications. Additionally, it provides recommendations for balancing patient safety and imaging quality.
Keywords: Radiation dose, dose optimization, diagnostic reference level, dose tracking/management systems
References
United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Effects and Risks of Ionizing Radiation, 2020/2021 Report, Volume 1.United Nations.2022.
International Atomic Energy Agency (IAEA). Radiation protection and safety of radiation sources: international basic safety standards.International Atomic Energy Agency.2014.
The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103.Ann ICRP. ; 37: 1-332.
Uniyal S. Patient radiation exposure monitoring in medical imaging (IAEA Safety Report Series No. 112).J Med Phys. ; 49: 316-7.
Järvinen H, Vassileva J, Samei E, Wallace A, Vano E, Rehani M. Patient dose monitoring and the use of diagnostic reference levels for the optimization of protection in medical imaging: current status and challenges worldwide.J Med Imaging (Bellingham). ; 4: 31214.
Brambilla M, Vassileva J, Kuchcinska A, Rehani MM. Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action.Eur Radiol. ; 30: 2493-501.
Ataç GK, Parmaksız A, İnal T, et al. Patient doses from CT examinations in Turkey.Diagn Interv Radiol. ; 21: 428-34.
International Atomic Energy Agency (IAEA). Diagnostic radiology physics: a handbook for teachers and students. International Atomic Energy Agency. 2014.
International Atomic Energy Agency (IAEA). Dosimetry in diagnostic radiology: an international code of practice.International Atomic Energy Agency. 2007.
Patient Dosimetry for X Rays Used in Medical Imaging.J ICRU. ; 5.
Brink JA, Morin RL. Size-specific dose estimation for CT: how should it be used and what does it mean?Radiology. ; 265: 666-8.
Fu W, Ria F, Segars WP, Choudhury KR, Wilson JM, Kapadia AJ, et al. Patient-informed organ dose estimation in clinical CT: implementation and effective dose assessment in 1048 clinical patients.AJR Am J Roentgenol. ; 216: 824-34.
Martin CJ, Harrison JD, Rehani MM. Effective dose from radiation exposure in medicine: past, present, and future.Phys Med. ; 79: 87-92.
Li X, Samei E, Segars WP, Sturgeon GM, Colsher JG, Frush DP. Patient-specific radiation dose and cancer risk for pediatric chest CT.Radiology. ; 259: 862-74.
Lacy T, Ding A, Minkemeyer V, Frush D, Samei E. Patient-based performance assessment for pediatric abdominal CT: an automated monitoring system based on lesion detectability and radiation dose.Acad Radiol. ; 28: 217-24.
Precht H, Hansson J, Outzen C, Hogg P, Tingberg A. Radiographers’ perspectives’ on visual grading analysis as a scientific method to evaluate image quality.Radiography (Lond). ; 25 Suppl 1: 14-8.
Samei E, Järvinen H, Kortesniemi M, Simantirakis G, Goh C, Wallace A, et al. Medical imaging dose optimisation from ground up: expert opinion of an international summit.J Radiol Prot. ; 38: 967-89.
Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, et al. ICRP publication 135: diagnostic reference levels in medical imaging.Ann ICRP. ; 46: 1-144.
Damilakis J, Frija G, Brkljacic B, Vano E, Loose R, Paulo G, et al. How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement.Insights Imaging. ; 14: 27.
Loose RW, Vano E, Mildenberger P, Tsapaki V, Caramella D, Sjöberg J, et al. Radiation dose management systems-requirements and recommendations for users from the ESR EuroSafe Imaging initiative.Eur Radiol. ; 31: 2106-14.
Bakanlığı TCS. Teletıp Entegrasyon Kılavuzu (v3.39).
Li X, Zhang D, Liu B. Automated extraction of radiation dose information from CT dose report images.AJR Am J Roentgenol. ; 196: 781-3.
Public Health England. Doses from computed tomography (CT) examinations in the UK-2011 review (PHE-CRCE-013).
Kommission E, Directorate-General for Mobility and Transport, Directorate-General for Energy. Radiation Protection 154: European guidance on estimating population doses from medical X-ray procedures.Dictus Publishing; 2011.
(RSNA) RSoNA.RadLex Playbook.
Bakanlığı S. Ulusal Sağlık Veri Sözlüğü (USVS) 2.2. T.C. Sağlık Bakanlığı. Published 2017. Accessed 10.26.2024.
Kahraman G, Haberal KM, Ağıldere AM. Establishment of local diagnostic reference levels for computed tomography with cloud-based automated dose-tracking software in Türkiye.Diagn Interv Radiol. ; 30: 205-11.
Ria F, Davis JT, Solomon JB, Wilson JM, Smith TB, Frush DP, et al. Expanding the concept of diagnostic reference levels to noise and dose reference levels in CT.AJR Am J Roentgenol. ; 213: 889-94.
Vano E, Loose R, Frija G, Paulo G, Efstathopoulos E, Granata C, et al. Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures.Eur Radiol. ; 32: 5525-31.
Faulkner K, Ortiz-Lopez P, Vano E. Patient dosimetry in diagnostic and interventional radiology: a practical approach using trigger levels.Radiat Prot Dosimetry. ; 117 :166-8.
Martin CJ, Vassileva J, Vano E, Mahesh M, Ebdon-Jackson S, Ng KH, et al. Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention.J Radiol Prot. ; 37: 883-906.
Tsalafoutas IA, Arlany L, Titovich E, Pynda Y, Ruggeri R, Sánchez RM, et al. Technical specifications of dose management systems: An international atomic energy agency survey.J Appl Clin Med Phys. ; 25: 14219.
Tsapaki V. Radiation dose optimization in diagnostic and interventional radiology: current issues and future perspectives.Phys Med. ; 79: 16-21.
MacGregor K, Li I, Dowdell T, Gray BG. Identifying institutional diagnostic reference levels for ct with radiation dose index monitoring software.Radiology. ; 276: 507-17.
Frija G, Hoeschen C, Granata C, Vano E, Paulo G, Damilakis J, et al. ESR EuroSafe imaging and its role in promoting radiation protection - 6 years of success.Insights Imaging. ; 12: 3.
Vano E, Fernández JM, Ten JI, Sanchez RM. Benefits and limitations for the use of radiation dose management systems in medical imaging. Practical experience in a university hospital.Br J Radiol. ; 95: 20211340.
Caruso D, De Santis D, Polidori T, Zerunian M, Laghi A. Radiation dose optimization: the role of artificial intelligence. In: De Cecco CN, van Assen M, Leiner T, editors. Artificial intelligence in cardiothoracic imaging. Cham: Springer International Publishing; 2022. p. 173-180.
Garajová L, Garbe S, Sprinkart AM. [Artificial intelligence in diagnostic radiology for dose management : Advances and perspectives using the example of computed tomography].Radiologie (Heidelb). ; 64: 787-92.


