Optimisation of Radiological Protection in Digital Radiology Techniques for Medical Imaging
Abstract
Use of medical imaging continues to increase, making the largest contribution to the exposure of populations from artificial sources of radiation worldwide. The principle of optimisation of protection is that ‘the likelihood of incurring exposures, the number of people exposed, and the magnitude of their individual doses should all be kept as low as reasonably achievable (ALARA), taking into account economic and societal factors’. Optimisation for medical imaging involves more than ALARA – it requires keeping individual patient exposures to the minimum necessary to achieve the required medical objectives. In other words, the type, number, and quality of images must be adequate to obtain the information needed for diagnosis or intervention. Dose reductions for imaging or x-ray-image-guided procedures should not be used if they degrade image quality to the point where the images are inadequate for the clinical purpose. The move to digital imaging has provided versatile acquisition, post-processing, and presentation options, and enabled wide and often immediate availability of image information. However, because images are adjusted for optimal viewing, the appearance may not give any indication if the dose is higher than necessary. Nevertheless, digital images provide opportunities for further optimisation, and allow the application of artificial intelligence methods. Optimisation of radiological protection for digital radiology (radiography, fluoroscopy, and computed tomography) involves selection and installation of equipment, design and construction of facilities, choice of optimal equipment settings, day-to-day methods of operation, quality control programmes, and ensuring that all personnel receive proper initial and career-long training. The radiation dose levels that patients receive also have implications for doses to staff. As new imaging equipment incorporates more options to improve performance, it becomes more complex and less easily understood, so operators have to be given more extensive training. Ongoing monitoring, review, and analysis of performance is required that feeds back into the improvement and development of imaging protocols. Several different aspects relating to optimisation of protection that need to be developed are set out in this publication. The first is collaboration between radiologists/other radiological medical practitioners, radiographers/medical radiation technologists, and medical physicists, each of whom have key skills that can only contribute to the process effectively when individuals work together as a core team. The second is appropriate methodology and technology, with the knowledge and expertise required to use each effectively. The third relates to organisational processes which ensure that required tasks, such as equipment performance tests, patient dose surveys, and review of protocols, are carried out. There is wide variation in equipment, funding, and expertise around the world, and the majority of facilities do not have all the tools, professional teams, and expertise to fully embrace all the possibilities for optimisation. Therefore, this publication sets out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally: Level D – preliminary; Level C – basic; Level B – intermediate; and Level A – advanced. Guidance from professional societies can be invaluable in helping users to evaluate systems and aid in adoption of best practice. Examples of systems and activities that should be in place to achieve the different levels are set out. Imaging facilities can then evaluate the arrangements they already have, and use this publication to guide decisions about the next actions to be taken in optimising their imaging services.
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The implementation of DRLs is a crucial element of radiation protection protocols in medical imaging, designed to uphold the principle of optimization.
“The implementation of DRLs is a crucial element of radiation protection protocols in medical imaging, designed to uphold the principle of optimization.70,71”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [70]
The concept of DRLs emerged in the 1950s through national surveys in the United States and the United Kingdom, which assessed patient dosage indicators to inform safer radiography practices.
“The concept emerged in the 1950s through national surveys in the United States and the United Kingdom, which assessed patient dosage indicators to inform safer radiography practices.70,97”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [70]
The lack of standardized electronic patient record systems hinders routine dose tracking and national data aggregation, both crucial for the creation of DRL.
“The lack of standardized electronic patient record systems hinders routine dose tracking and national data aggregation, both crucial for the creation of DRL.70”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [70]
Despite the broad endorsement of DRLs for the optimization of radiation protection, their implementation is complex.
“Despite the broad endorsement of DRLs for the optimization of radiation protection, their implementation is complex.”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [70]
The World Health Organization (WHO) has noted the absence of regulatory agencies and quality assurance systems as significant barriers to the introduction of DRL in numerous countries.
“The World Health Organization (WHO) has noted the absence of regulatory agencies and quality assurance systems as significant barriers to the introduction of DRL in numerous countries.”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [70]
The ICRP indicates that DRLs are valuable instruments for dose optimization, however they are often underutilized, particularly in LMICs.
“The ICRP indicates that DRLs are valuable instruments for dose optimization, however they are often underutilized, particularly in LMICs.70”
From Computed Tomography Diagnostic Reference Levels Worldwide and in Jordan: Implications for Patient Dose Reduction (2026) · cites this paper as [70]
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Oglat, A., Shdaifat, S., Sayah, M., Abukonna, A., & Khogali, W. (2026) · Drug, Healthcare and Patient Safety · doi:10.2147/dhps.s595721
“70”
- Authors
- 154, I. P.
- Corresponding author
- ICRP PUBLICATION 154
- Venue
- Annals of the ICRP
- Publisher
- SAGE Publications
- Published
- 2023-07
- Volume
- 52
- Issue
- 3
- Pages
- 11-145
- ISSN
- 0146-6453 (ISSN-L)
- 1872-969X
- OpenAlex
- W4402385015
- Cited by
- 37
- References
- 97
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 3
- FWCI
- 6.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of the ICRP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Digital Radiography and Breast Imaging
- Health Sciences › Dentistry › Oral Surgery › Dental Radiography and Imaging
- Keywords
- radiation protection, digital radiology, ALARA principle, patient radiation dose, dose optimization, image quality, fluoroscopy, computed tomography, radiography, image-guided interventions, quality control, employee training, multidisciplinary team, imaging protocols, equipment performance testing, occupational radiation exposure, radiographers, radiologists
- MeSH terms
- Radiation Exposure, Diagnostic Imaging, Humans, Radiation Dosage, Radiation Protection, Radiographic Image Enhancement
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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