IAEA Training Material on

Radiation Protection in Digital Radiology

Lecture

Topic

Educational objectives

No.
1

Contents

At the end of the programme, the participants

should know these
Fundamentals of
Digital
radiography

Explain how ordinary radiographic images can

be captured in digital form
Discuss the advantages and limitations of
digital images
Explain how the dissociation of acquisition and
display in DR can contribute to unnecessary
radiation exposure to patients

Details on digital radiographic image with information on discrete

physical pixel dimensions and grey-levels.
The discrete nature of the DR image as a source of its advantages and
limitations
Methods of acquiring digital radiographs: Digitisation of screen-film
radiographs; Non-photographic capture and digitisation; Direct
capture with or without conversion to light
Advantages of DR with respect to availability, flexibility, and
convenience over conventional screen-film.
The utilities of DR image with respect to patient demographics, type
of examination, and processing information from the DICOM header
Potential for unnecessary patient radiation exposure using DR systems
except for digitised film i.e., exposure factor creep

Exposure
indicators and
patient dose
estimation in CR
and DR

Explain why exposure indicators are necessary

in digital radiography.
Explain why exposure factor control is
complicated in digital projection radiography.
Show the relationship between derived
exposure indicators and radiation dose.
List other factors that influence image quality

Importance of exposure indicators in digital radiography due to

adjustability of density and potentials for over exposure.
Understanding the basis for exposure indicator; subjective and
objective assessment of patient exposure.
Interpreting exposure indicators and its subject to interferences

Optimisation in
CR & DR

even when appropriate values of exposure are

reported.
Differentiate between receptor exposure
indicators and KAP
Provide rationale for optimisation in Computed
Radiography (CR) and Digital Radiography
(DR)
Describe components of optimisation and
specific methods to detect, correct, and avert
errors in CR and DR
Identify standards and references for
optimisation in CR and DR

Discuss basic principles of Quality Control (QC) applied to computed

radiography and digital radiography
Compare QC for CR and DR to accepted practices in conventional
radiography.
Explore opportunities for error prevention, detection and correction in
context of process map for creating, distributing and displaying CR
and DR images.
Discuss optimisation of image quality versus patient dose.
Describe status of efforts to standardise QC for CR and DR by
manufacturers and professional organisations
Highlight references useful in establishing and maintaining a QC
program for CR and DR

Optimisation of
Digital
Fluoroscopy

Distinguish between digital fluoroscopy using

an Image Intensifier (II) and digital fluoroscopy
using a flat panel detector
Differentiate between Automatic Brightness
Control (ABC) and Automatic Dose Rate
Control (ADRC) and Automatic Exposure Rate
Control
Patient dose parameters

Types of digital fluoroscopy images, i.e video frame capture, digital

spot film from II, flat panel detectors

How raw digital image is modified by digital image processing to

improve correct non-uniformities and to improve contrast

List three main purposes of digital image

processing
Explain the term greyscale histogram

Show how radiographic technique factors affect

Edge restoration and noise limitation are two additional purposes of

Digital
Radiographic
Image
Processing

Image quality using flat panel versus II

Rotational angiography and tomographic reconstruction
Patient dose parameters

A greyscale histogram is rescaled to adjust output and match latitude

the greyscale histogram

Suggest how errors in digital image processing
can contribute to unnecessary radiation
exposure to patients

digital image processing.

Contrast modification can be accomplished by applying a look-uptable (LUT) or by more digital post processing methods
Segmentation algorithms automatically determine the values of
interest (VOI) in the digital image
Noise imposes a practical limitation on digital image processing

Avoiding
Artefacts in
Computed
Radiography

Explain how the CR image is created

CR is based on the principle of photostimulable luminescence

Explain how errors in the process can produce

sub-standard images
Artefacts in CR

The CR image is subject to fading, fogging and physical and chemical

phosphor defects

CR image must be corrected for non-uniformity in collection

efficiency across one dimension
Types of artefacts from imaging plate, CR reader and how these
artefacts can be avoided
Failure to follow collimation rules comprises algorithms for
determining VOI and can cause loss of contrast

Avoiding
Artefacts in
Digital
Radiography

Explain how the DR image is created.

Correction of non-uniformity critical to DR image quality

Explain how errors in the process can produce

sub-standard images
Explain about the artefacts in DR

DR systems are subject to lag and ghosting

Optimising DR
Displays

List three major differences between DR

displays and trans-illuminated films
Explain how CRTs and LCDs differ with
respect to the display of medical images
Appreciate the differences between medical and
commercial grade flat panels
Give an example of how differences between a
technologists display and a radiologists
display can contribute to unnecessary radiation

Active matrix liquid crystal (LCD) displays and cathode ray tube
display medical imaging monitors

The composition of the DR image affects the outcome of digital image

processing

Displays for medical imaging that requires special calibration

according to DICOM Part 14 GSDF
Increasing use of pseudo-colour in digital imaging imposes special
demands on displays.
Novel display technologies are likely to find use in specific limited
applications.

exposure.
9

10

Picture Archival
and
Communication
System (PACS)

Understand how digital radiology depends on

Picture Archiving and Communications
Systems (PACS)
List the four components of PACS

Explain how errors in each of the four

components of PACS can contribute to
unnecessary radiation exposure to patients

List reasonable expectations of CR and DR

systems
Consider how to test these expectations

Practical
Exercises

Illustrate how poor quality images arise when

these expectations are violated

General overview of PACS components. Examples of unnecessary

radiation exposure from accommodation of incorrect exposure factor
selection, incorrect association of examination and demographic
information with the image, lost images and inappropriate rendering
of images for interpretation. Challenges for oversight of radiographer
practice by radiologist including exposure indicators, digital shutters,
post-acquisition annotation, and deletion of rejected images.
Simple QC tests for CR and DR which includes
Visual inspection
Develop unexposed receptor
Flat field test
Gain verification
Step wedge
Bar pattern
Laser jitter
Commercial QC phantoms and automated analysis to accomplish
similar goals
For maximum value, QC tests should be performed routinely with
attention to longitudinal results.