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This review compiles and assesses data from recent studies on mammographic radiation doses in Saudi Arabia, aiming to evaluate mean glandular dose (MGD) exposure during mammography and its implications in breast cancer risk. The reviewed studies spanned from 2019 to 2023 and included a range of sample sizes and institutional settings, with patients’ ages from 27 to 85 years. Considerations such as the number of mammographic views and compressed breast thickness were examined. The studies reported average MGDs below the National Diagnostic Reference Level set by the Saudi Food and Drug Authority. However, limitations were noted regarding sample size selection and incomplete data on all mammographic projections. Despite these limitations, the findings highlight the need for continued assessment of patient doses to optimize mammography practices and address the absence of quality standardization acts in Saudi Arabia. These insights are critical for governing authorities to ensure that effective patient dose monitoring occurs regularly and that the establishment of minimum quality standards for breast cancer screening is intact.

The International Commission on Radiological Protection has highlighted the large number of medical specialties that use fluoroscopy outside diagnostic imaging departments without radiation protection programmes for patients and staff. Vascular surgery is one of these specialties. Thoracic endovascular aortic repair (TEVAR) is a complicated procedure requiring radiation protection guidance and optimisation. The recent EU Basic Safety Standards Directive requires the use and periodic updating of diagnostic reference levels (DRLs) for interventional procedures. The aim of this study was to determine doses for patients undergoing TEVAR with mobile Xray systems and hybrid rooms (fixed Xray systems) to obtain national DRLs and to suggest optimisation actions. This was a retrospective cross sectional study. The Spanish Chapter of Endovascular Surgery conducted a national survey in 11 autonomous communities representing around 77.6% of the Spanish population (47.33 million inhabitants). A total of 266 TEVAR procedures from 17 Spanish centres were analysed, of which 53.0% were performed in hybrid operating rooms. National DRLs were obtained and defined as the third quartile of the median values from the different participating centres. The proposed national DRLs are: for kerma area product (KAP), 113.81 Gy·cm2 for mobile Xray systems and 282.59 Gy·cm2 for hybrid rooms; and for cumulative air kerma (CAK) at the patient entry reference point, 228.38 mGy for mobile systems and 910.64 mGy for hybrid rooms. Based on the requirement to know radiation doses for standard endovascular procedures, this study of TEVARs demonstrated that there is an increased factor of 2.48 in DRLs for KAP when the procedure is performed in a hybrid room compared with mobile C-arm systems, and an increased factor of 3.98 in DRLs for CAK when the procedure is performed with hybrid equipment. These results will help to optimise strategies to reduce radiation doses during TEVAR procedures. [ABSTRACT FROM AUTHOR]

The major purpose of this work is to assess the entrance surface dose-(ESD) for adult patients who undertaking a routine pelvis (AP) radiography. This is lies within the quality control measures that should be taken to guarantee that the patient would not receive an excessive radiation dosage this radiography. This investigation was performed in four selected hospitals (i.e. Al-Hussein Teaching Hospital (AHTH), Al-Nasiriyah Teaching Hospital (ANTH), Al-Haboubi Teaching Hospital (AHTH), Al- Zahraa Main Hospital (AZMH)) in Dhi Qar-Iraq, namely in eight X-ray units. In this work, the ESD was calculated for 102 adult patients who underwent conventional pelvis AP X-ray examinations indirectly using a mathematical formula relying on exposure factors (i.e. Peak potential (kVp), tube loading (mAs), distance from tube X-ray to detector (SID)), as well as on the X-ray tube output that was assessed utilizing (Rad-Check Plus) dosimeter. The results demonstrated that the average ESD values obtained were (1.339, 1.111, 2.093, 5.124, 2.866, 3.402, 11.885 and 1.580) mGy for each of AHTH1, AHTH2, AHTH3, ANTH1, ANTH2, ANTH3, AHTH, AZMH, respectively. The ESD values were seen to be almost comparable with the internationally recognized sources UK 2012, and with previously published studies such as those in Sudan 2020, Iran 2020, Ghana 2020 and Nigeria 2021, while the dose was very high in few hospitals. Lastly, further study is required to verify that the radiation dose is within the recommended range, and the concerned institutions must train radiographers on a continuous basis to ensure quality control (QC) checking with dose audit is largely advised. [ABSTRACT FROM AUTHOR]

The purpose this work research to determine the entrance surface dose (ESD) for adult patients undergoing routine skull projections (AP and Lat) X-ray examinations, and therefore quality control is carried out to ensure that the patient is receive no excessive radiation dose during the radiography. This investigation was conducted in four selected hospitals (i.e. Al-Hussein Teaching Hospital (AHTH), Al-Nasiriyah Teaching Hospital (ANTH), Al-Haboubi Teaching Hospital (AHTH), Sayed Dakhil Hospital (SDH)) in Dhi Qar-Iraq, with a reality eight X-ray units. The ESD was estimated for 198 adult patients who underwent conventional skull (AP/Lat) X-ray examinations indirectly using a mathematical formula and based on exposure factors (i.e. tube potential (kVp), tube loading (mAs), distance from tube X-ray to detector (SID)), as well as on the X-ray tube output that was measured using (RAD-CHECK PLUS) dosimeter. Demographic data were recorded for all patients who participated in this work (gender, weight and height). The results showed that the average ESD values obtained for projection AP skull were (0.426,1.324,0.338,1.576,3.095,1.343,0.755,0.526) mGy, whereas the ESD average for projection Lat skull were (0.392,0.729,0.311,1.570,2.211,1.315,0.900,0.609) mGy for AHTH1, AHTH2, AHTH3, ANTH1, ANTH2, AHTH, SDH 1, SDH 2, respectively. The ESD values of projection (AP and Lat) skull radiography were considered within the values stated in internationally recognized levels UK 2012, UNSCEA 2010, IAEA and European Commission (CE), exception some X-ray units, which were higher than the UK and UNSCEA survey, and lower than the values reported by the comparison organizations. Finally, to guarantee that the radiation dose is within the advised range, more research has to be done and the Concerned institutions need to conduct ongoing training radiographers to ensure quality control (QC) checking with dose audit is largely advised. [ABSTRACT FROM AUTHOR]

The work is aimed at investigating the entrance surface dose (ESD) for adult patients undertaking routine lumbar X-ray examination, and therefore ensure that the patients receive no excessive radiation dose during this radiography. This study was conducted at 4 selected hospitals: Al-Hussein Teaching Hospital (AHTH), Al-Nasiriyah Teaching Hospital (ANTH), Al-Haboubi Teaching Hospital (AHTH) and Souq Al-Shuyoukh General Hospital (SASGH) in Dhi Qar, Iraq. The ESD was calculated for 102 adult patients who underwent X-ray examinations of the lumbar spine using the physical parameters (i.e. Tube voltage-kVp, Tube loading- mAs and distance between X-ray tube and detector- SID) from all considered X-ray units, as well as on the X-ray tube output that was measured using an ionization chamber (Rad-Check Plus). The enrolled patients also had their demographic information recorded (gender, weight and height). The finding demonstrated that the average ESD values were (4.886, 4.288, 6.047, 6.378, 5.949, 9.322, 12.731, 4.094) mGy for AHTH1, AHTH2, AHTH3, ANTH1, ANTH2, ANTH3, AHTH, SASGH, respectively. The ESD values were seen to be comparable with internationally recognized sources UNSCEAR 2010, UK 2012, EC, and IAEA and with previously published studies such as those in Sudan 2014, Iran 2020, Nigeria 2019, and Ghana 2023. Finally, further studies must be carried out, and the relevant institutions must conduct continuous training courses for radiographers to ensure that the radiation dose is within the recommended level.

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This study establishes typical Diagnostic Reference Levels (DRL) values and assesses patient doses in computed tomography (CT)-guided biopsy procedures. The Effective Dose (ED), Entrance Skin Dose (ESD), and Size-Specific Dose Estimate (SSDE) were calculated using the relevant literature-derived conversion factors. A retrospective analysis of 226 CT-guided biopsies across five categories (Iliac bone, liver, lung, mediastinum, and para-aortic lymph nodes) was conducted. Typical DRL values were computed as median distributions, following guidelines from the International Commission on Radiological Protection (ICRP) Publication 135. DRLs for helical mode CT acquisitions were set at 9.7 mGy for Iliac bone, 8.9 mGy for liver, 8.8 mGy for lung, 7.9 mGy for mediastinal mass, and 9 mGy for para-aortic lymph nodes biopsies. In contrast, DRLs for biopsy acquisitions were 7.3 mGy, 7.7 mGy, 5.6 mGy, 5.6 mGy, and 7.4 mGy, respectively. Median SSDE values varied from 7.6 mGy to 10 mGy for biopsy acquisitions and from 11.3 mGy to 12.6 mGy for helical scans. Median ED values ranged from 1.6 mSv to 5.7 mSv for biopsy scans and from 3.9 mSv to 9.3 mSv for helical scans. The study highlights the significance of using DRLs for optimizing CT-guided biopsy procedures, revealing notable variations in radiation exposure between helical scans covering entire anatomical regions and localized biopsy acquisitions. [ABSTRACT FROM AUTHOR]

The clinical anteroposterior (AP) chest images taken with a mobile radiography system were analyzed in this study to utilize the clinical exposure index (EI) as a patient dose-monitoring tool. The digital imaging and communications in medicine header of 6048 data points exposed under the 90 kVp and 2.5 mAs were extracted using Python for identifying the distribution of clinical EI. Even under the same exposure conditions, the clinical EI distribution was 137.82–4924.38. To determine the cause, the effect of a patient's body shape on EI was confirmed using actual clinical chest AP image data binarized into 0 and 255-pixel values using Python. As a result, the relationship between the direct X-ray area of the chest AP image, the higher the clinical EI, the larger the rate of the direct X-ray area. A conversion equation was also derived to infer entrance surface dose through clinical EI based on the patient thickness. This confirmed the possibility of directly monitoring patient dose through EI without a dosimeter in real-time. Therefore, to use the clinical EI of the mobile radiography system as a patient dose-monitoring tool, the derivation method of clinical EI considers several factors, such as the relationship between patient factors.

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. [ABSTRACT FROM AUTHOR]

Background: Computed tomography (CT) scan is one of the main tools to diagnose and grade COVID-19 progression. To avoid the side effects of CT imaging, low-dose CT imaging is of crucial importance to reduce population absorbed dose. However, this approach introduces considerable noise levels in CT images. Methods: In this light, we set out to simulate four reduced dose levels (60% dose, 40% dose, 20% dose, and 10% dose) of standard CT imaging using Beer--Lambert's law across 49 patients infected with COVID-19. Then, three denoising filters, namely Gaussian, bilateral, and median, were applied to the different low-dose CT images, the quality of which was assessed prior to and after the application of the various filters via calculation of peak signal-to-noise ratio, root mean square error (RMSE), structural similarity index measure, and relative CT-value bias, separately for the lung tissue and whole body. Results: The quantitative evaluation indicated that 10%-dose CT images have inferior quality (with RMSE = 322.1 ± 104.0 HU and bias = 11.44% ± 4.49% in the lung) even after the application of the denoising filters. The bilateral filter exhibited superior performance to suppress the noise and recover the underlying signals in low-dose CT images compared to the other denoising techniques. The bilateral filter led to RMSE and bias of 100.21 ± 16.47 HU and -0.21% ± 1.20%, respectively, in the lung regions for 20%-dose CT images compared to the Gaussian filter with RMSE = 103.46 ± 15.70 HU and bias = 1.02% ± 1.68% and median filter with RMSE = 129.60 ± 18.09 HU and bias = -6.15% ± 2.24%. Conclusions: The 20%-dose CT imaging followed by the bilateral filtering introduced a reasonable compromise between image quality and patient dose reduction. [ABSTRACT FROM AUTHOR]

X-ray guided procedures are being performed by an increasing variety of medical specialties. Due to improvements in vascular transcatheter therapies, there is an increasing overlap of imaged anatomy between medical specialties. There is concern that non-radiology fluoroscopic operators may not have sufficient training to be well informed of the potential implications of radiation exposure and mitigation strategies to reduce dose. This was a prospective, observational, single center study to compare occupational and patient dose levels when imaging different anatomical regions during fluoroscopically guided cardiac and endovascular procedures. Occupational radiation dose was measured at the level of the temple of 24 cardiologists and 3 vascular surgeons (n = 1369), 32 scrub nurses (n = 1307) and 35 circulating nurses (n = 885). The patient dose was recorded for procedures (n = 1792) performed in three angiography suites. Abdominal imaging during endovascular aneurysm repair (EVAR) procedures was associated with a comparatively high average patient, operator and scrub nurse dose despite additional table-mounted lead shields. Air kerma was relatively high for procedures performed in the chest, and chest + pelvis. Higher dose area product and staff eye dose were recorded during procedures of the chest + pelvis due to the use of digital subtraction angiography to evaluate access route prior to/during transaortic valve implantation. Scrub nurses were exposed to higher average radiation levels than the operator during some procedures. Staff should be cognizant of the potentially higher radiation burden to patients and exposed personnel during EVAR procedures and cardiac procedures using digital subtraction angiography. [ABSTRACT FROM AUTHOR]

The Computed Tomography Dose Index (CTDI) is an indicator for dose management in computed tomography (CT), but has limited use for patient dosimetry. To evaluate the patient dose, the size-specific dose estimate (SSDE), reported by the American Association of Physics in Medicine task groups 204, 220, and 293, must be calculated by the CTDIvol(z) displayed on the CT console, and the conversion factor f(D(z)) from the effective diameter (DEff) or water equivalent diameter (Dw). However, no reports have verified the appropriateness of using the 320-mm diameter phantom for dose assessment in CT examinations involving the lower limbs. Therefore, we validated a new method for evaluating the SSDE(z) of the lower limbs, using two 160-mm diameter phantoms instead of the 320-mm diameter phantom. The CTDIvol(z) obtained from Monte Carlo (MC) simulation study was reliable because they were almost the same as obtained in a dosimetry study. The conversion factor f (D (zl.l.)) for the lower limbs was evaluated based on the CTDIvol(z) obtained by MC simulation performed using two polymethyl methacrylate cylinder phantoms of 160-mm diameter. The MC simulation was performed by the International Commission on Radiological Protection publication 135 reference adult phantom and was used to evaluate the absorbed dose of the pelvis, thighs, knees, and ankles. The dose showing the greatest difference was the thighs, which was 8.3 mGy (16%) lower than the absorbed dose. Thus, the SSDE (zl.l.) could be estimated from the CTDI vol 320 z displayed on the CT scanner console. [ABSTRACT FROM AUTHOR]

We propose determining the entrance surface air kerma (ESAK) from the kerma area product (PKA) in digital radiology. ESAK values were derived from the X-ray tube outputs and patient exposure factors across five X-ray departments. Using linear regression between ESAK and PKA values, the slope and intercept coefficients were determined for each X-ray equipment and procedure. The method was examined using the data collected from patients who underwent chest PA/LAT, abdomen, pelvic AP, and lumbar spine AP/LAT X-ray examinations. The results showed a highly significant correlation between ESAK and PKA values and correlation coefficients, ranging from 0.77 to 1 with P-value < 0.001 in most studies. This method can be employed by incorporating dose data and related parameters into the X-ray device's software, similar to other dose-displayed information. The online determination of ESAK from PKA could help with quality assurance and patient dose management in digital radiology. [ABSTRACT FROM AUTHOR]

This study establishes typical Diagnostic Reference Levels (DRL) values and assesses patient doses in computed tomography (CT)-guided biopsy procedures. The Effective Dose (ED), Entrance Skin Dose (ESD), and Size-Specific Dose Estimate (SSDE) were calculated using the relevant literature-derived conversion factors. A retrospective analysis of 226 CT-guided biopsies across five categories (Iliac bone, liver, lung, mediastinum, and para-aortic lymph nodes) was conducted. Typical DRL values were computed as median distributions, following guidelines from the International Commission on Radiological Protection (ICRP) Publication 135. DRLs for helical mode CT acquisitions were set at 9.7 mGy for Iliac bone, 8.9 mGy for liver, 8.8 mGy for lung, 7.9 mGy for mediastinal mass, and 9 mGy for para-aortic lymph nodes biopsies. In contrast, DRLs for biopsy acquisitions were 7.3 mGy, 7.7 mGy, 5.6 mGy, 5.6 mGy, and 7.4 mGy, respectively. Median SSDE values varied from 7.6 mGy to 10 mGy for biopsy acquisitions and from 11.3 mGy to 12.6 mGy for helical scans. Median ED values ranged from 1.6 mSv to 5.7 mSv for biopsy scans and from 3.9 mSv to 9.3 mSv for helical scans. The study highlights the significance of using DRLs for optimizing CT-guided biopsy procedures, revealing notable variations in radiation exposure between helical scans covering entire anatomical regions and localized biopsy acquisitions.

This work focuses on the determination of the radiation doses for a total sample of 916 children, categorised into four age groups (<1, 1â€"5, <5â€"10, <10â€"15 years) undergoing the most frequent paediatric CT scans performed in different scan facilities in Tunisia in order to establish the national diagnostic reference levels (DRLs). Dose evaluation concerned the dosimetric indicators: volume computed tomography dose index (CTDIvol) and doseâ€"length product (DLP). The different paediatric CT protocols and practices were also evaluated. The results show a large variation in doses between different radiology departments. For head scans, the respective DRLs for children aged <1, 1â€"5, 5â€"10 and 10â€"15 years were 26, 38, 51 and 51 mGy, respectively, for CTDIvol and 384, 664, 873 and 978 mGy cm, respectively, for DLP. For the chest, the equivalent respective DRLs were 8, 10, 12 and 15 mGy for CTDIvol and 118, 330, 442 and 526 mGy cm for DLP. For the abdomen, the respective DRLs were 9, 13, 19 and 18 mGy for CTDIvol and 353, 485, 592 and 1073 mGy cm for DLP. This study shows that the optimisation of paediatric CT procedures should be a priority, especially within regional hospitals. The implementation of corrective actions will take place after the initial DRLs. These actions, including recommendations and guidelines to good practice, should be a joint effort of all stakeholders, including health authorities, the radiation protection regulator, professional societies and universities. [ABSTRACT FROM AUTHOR]

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., (Creative Commons Attribution license.)

Kelly Wilson-Stewart,1,2 Davide Fontanarosa,3,4 Eva Malacova,3,5 Steven Gett,2 Allan Kruger,2,6 Jamie V Trapp1 1School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia; 2Cardiiovascular Suites, Greenslopes Private Hospital, Brisbane, QLD, 4120, Australia; 3School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; 4Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD, 4000, Australia; 5QMIR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia; 6Department of Vascular Surgery, Royal Brisbane and Women’s Hospital, Herston, QLD, 4029, AustraliaCorrespondence: Kelly Wilson-StewartCardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, AustraliaTel +61 73394 7962Fax +61 73394 7969Email ks.stewart@hdr.qut.edu.auPurpose: Cardiologists often perform angiography of the common femoral artery (CFA) access site to evaluate whether the anatomy is suitable for deployment of a vascular closure device or to assess whether iatrogenic vessel damage has occurred. The choice of acquisition mode has radiation dose implications. The objective of this study was to investigate the influence of the selected type of CFA x-ray imaging mode (fluoro save, cine acquisition and digital subtraction angiography (DSA)) and tube angle on patient and staff dose during coronary angiography.Materials and Methods: Assessment of image quality for the different modes was performed to determine whether lower dose modes provide images of sufficient clinical quality to be routinely employed. Radiation dose levels for the patients (n=782), cardiologists (n=17), scrub nurses (n=27) and scout nurses (n=32) were measured in a prospective single-centre study between February 2017 and August 2019. Three Philips angiographic units and DoseAware dose monitoring systems were used.Results: Among the acquisition modes, fluoro save provided acceptable diagnostic quality for visualizing femoral access points and diagnosing pathology in 99% of cases. Average patient dose area product (DAP) was 83.95, 742.50, and 3363.41mGy2 and average patient air kerma (AK) was 0.87, 8.44, and 18.61mGy for fluoro save, cine, and DSA acquisitions, respectively. The use of higher dose imaging modes, imaging in the contralateral view and utilizing steeper TA was associated with a higher patient dose. Due to staff dose being highly correlated with DAP and AK, it was difficult to observe any association between staff dose and CFA imaging mode. However, this does not discount a potential increase in occupational dose due to the use of cine angiography or digital subtraction angiography during CFA imaging.Conclusion: DSA of the CFA should be avoided during transfemoral coronary angiography unless critical to diagnostic analysis. It is recommended that fluoroscopic operators consider utilizing lower dose modes in the ipsilateral orientation ≤ 32° TA to reduce the risk of patient and staff radiation exposure.Keywords: occupational exposure, cardiac catheterization, vascular closure device, patient dose, theater nurse, x-ray imaging

The aim of this work is to verify the potential use of GAFchromic™ EBT3 and FILMQA™ pro software for patient specific quality assurance (QA) for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) treatment plans in clinical routine use. In particular, encephalic, pulmonary and lymph node treatments plans were selected for this study. The agreement between the calculated and measured dose distributions were evaluated in terms of ɣ index with 3%3mm, 2%2mm, 1.5%1.5mm and 3%1.5mm criteria. The obtained results were then compared to the routine pretreatment verification method which uses electronic portal imaging device (EPID) and EPIQA analysis software. EBT3-FilmQA method results show a mean ɣ index passing rate >95% with 2%1.5mm analysis criteria and an improvement of about 7% compared with EPID-EPIQA method results. [ABSTRACT FROM AUTHOR]

The role of radiology imaging in incomplete colonoscopy studies is discussed in terms of justification of barium enema and computed tomography colonography in accordance with current guidelines and practice. [ABSTRACT FROM AUTHOR]

Introduction: Nowadays the use of cone beam computed tomography in dental imaging is increasing, although this method has a much lower dose than conventional CT scans, it delivers a higher dose than the panoramic and periapical patients therefore, , the aim of this study was to investigate the factors affecting the patients' dose in dental CBCTs and methods of optimizing and reducing the patients' dose. Various factors such as the use of thyroid collar, lead goggles, field size, device type, imaging parameters such as tube voltage and current, alternating or pulsed radiation; type, amount and shape of the filter, 360 degree or partial rotation of tube and scan time, can affect the absorbed dose of the patient in dental CT scans. Among these, the use of thyroid collar (42% reduction), lead goggles (6% reduction),the smallest possible field of view ( up to 90%), pulse irradiation, patient sitting position and 180o rotation angle instead of 360o (more than 50% reduction) cause significant reduction in the organ doses and effective dose of the patients. It should also be kept in mind that measures taken to reduce the patients' dose should not impair image quality and, depending on the patient's condition, the radiographer will select the dose reduction parameters without degrading the image quality.

Background: During interventional cardiology processes, patients especially women and children receive high radiation doses due to their sensitivity.Objective: In this study, we evaluated a pediatric patient dose separately in those undergone intervention cardiac procedure. Material and Methods: In this cross sectional study, a public hospital with 252 patients, Entrance Skin Dose (ESD) and Dose-Area Product (DAP) were recorded. Prior to the beginning of fluoroscopic procedure, the chest thickness and Body Mass Index (BMI) of patients were measured. Furthermore, kV, mAs, angle of tube and time of angiography and angioplasty were recorded. Results: Children ratio to all patients underwent the cardiovascular imaging was 1.8. The means of patients’ ESD, DAP and fluoroscopy time were 178.3±17 mGy, 1123.6±11 μGycm2 and 281.4±181.2 s, respectively for coronary angiography. The females were 96.8 under 30 years and their dose mean was 276±37 mGy, 368±24 μGycm2 for ESD and DAP received, respectively with 376s fluoroscopy time. Mean mAs was 359±34 and kV was 71.23±2.7. Above all, a direct and significant correlation was found between the patients’ chest thickness with kV (p=0.037, r = 0.11) and mAs (pConclusion: The results demonstrated that the number of children referred to the cardiology department and also the dose rate received by them during this test was higher than the data provided for children in developing countries. Paying attention to the children’s perception of high-fluorescence time is necessary in comparison with total angiography time in order to reduce the number of radiation injuries among pediatrics.

Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions., (© 2024 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

• Nurses may be exposed to more radiation than cardiologists. • Biventricular pacemaker procedures have comparatively high levels of staff dose. • Low dose protocols during electrophysiology have reduced cardiologist dose. There is a paucity of literature comparing patient and staff dose during coronary angiography (CA), implantable cardiac devices, permanent pacemakers (PPM) and electrophysiology (EP) procedures and little noting dose to staff other than cardiologists. This study sought to compare patient and occupational dose during a range of fluoroscopically guided cardiac procedures. Radiation dose levels for the patients (n = 1651), cardiologists (n = 24), scrub (n = 32) and scout nurses (n = 35) were measured in a prospective single-centre study between February 2017 and August 2019. A comparison of dose during CA, device implantation, PPM insertion and EP studies was performed. Three angiographic units were used, with dosimeters worn on the temple of staff. Results indicated that occupational dose during PPM was significantly higher than other procedures. The cardiologist had the highest mean dose during biventricular implantable cardioverter-defibrillators; levels were approximately five times that of 'normal' pacemaker insertions. Transcatheter aortic valve implantations (TAVI) were associated with relatively high mean doses for both staff and patients and had a statistically significant higher (>2 times) mean patient dose area product than all other categories. TAVI workups were also related to higher mean cardiologist and scrub nurse dose. It was observed that the mean scrub nurse dose can exceed that of the cardiologist. The highest mean dose for Scout nurses were recorded during EP studies. Given the significantly higher temple dose associated with PPM insertion, cardiologists should consider utilizing ceiling mounted lead shields, lead glasses and/or skull caps where possible. Efforts should also be made to minimize the use of DSA during TAVI and TAVI workups to reduce cardiologist, nurse and patient dose. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to propose an algorithm for the automated calculation of water‐equivalent diameter (Dw) and size‐specific dose estimation (SSDE) from clinical computed tomography (CT) images containing one or more substantial body part. Methods: All CT datasets were retrospectively acquired by the Toshiba Aquilion 128 CT scanner. The proposed algorithm consisted of a contouring stage for the Dw calculation, carried out by taking the six largest objects in the cross‐sectional image of the patient's body, followed by the removal of the CT table depending on the center position (y‐axis) of each object. Validation of the proposed algorithm used images of patients who had undergone chest examination with both arms raised up, one arm placed down and both arms placed down, images of the pelvic region consisting of one substantial object, and images of the lower extremities consisting of two separated areas. Results: The proposed algorithm gave the same results for Dw and SSDE as the previous algorithm when images consisted of one substantial body part. However, when images consisted of more than one substantial body part, the new algorithm was able to detect all parts of the patient within the image. The Dw values from the proposed algorithm were 9.5%, 15.4%, and 39.6% greater than the previous algorithm for the chest region with one arm placed down, both arms placed down, and images with two legs, respectively. The SSDE values from the proposed algorithm were 8.2%, 11.2%, and 20.6% lower than the previous algorithm for the same images, respectively. Conclusions: We have presented an improved algorithm for automated calculation of Dw and SSDE. The proposed algorithm is more general and gives accurate results for both Dw and SSDE whether the CT images contain one or more than one substantial body part. [ABSTRACT FROM AUTHOR]

Background: Clinical practice shows degrading image quality in heavier patients who undergo myocardial perfusion imaging (MPI) with Rubidium-82 (Rb-82) PET when using a fixed tracer activity. Our aim was to derive and validate a patient-specific activity protocol resulting in a constant image quality in PET MPI.Methods: We included 251 patients who underwent rest MPI with Rb-82 PET (Discovery 670, GE Healthcare). 132 patients were included retrospectively and were scanned using a fixed activity of 740 MBq. The total number of measured prompts was normalized to activity and correlated to body weight, mass per body length and body mass index to find the best predicting parameter. Next, a patient-specific activity was derived and subsequently validated in 119 additional patients. Image quality was scored by three experts on a four-point scale.Results: Both image quality and prompts decreased in heavier patients when using a fixed activity (p < .005). Body weight was used to derive a new activity formula: Activity = 8.3 MBq/kg. When applying this formula, both measured prompts and scored image quality became independent of body weight (p > .60).Conclusion: Administrating a Rb-82 activity that linearly depends on body weight resulted in a constant image quality across all patients and is recommended. [ABSTRACT FROM AUTHOR]

Cardiovascular nuclear medicine (NM) imaging examinations expose patients to extremely high absorbed doses of ionizing radiation, which necessitates extensive efforts to reduce the doses without compromising the quality of images. This study aims to assess patients' radiation doses to patients and public exposure in Cardiac rest and stress single photon emission computed tomography (SPECT) scans. The patients' exposure was calculated for 21 patients using the administered activity (AA, MBq). (GE SPECT) was the device used for all patients. AA (MBq) mean and range were 370 for Rest and 1110 for Stress. The average range of the dose rate was 1.59 (0.67–2.34) mR/h for rest and 7.29 (4.2–9.98) mR/h for stress when computed at 30 cm from the patient's chest level after injection. At 100 cm from the patient, the mean dose rate values were 0.37 (0.16–0.73) mR/h for rest and 1.39 (1.01–2.0) mR/h for stress. The overall effective dose is 12.1 mSv per rest and stress SPECT procedure. The mean effective dose for cardiac rest is comparable with previously published studies while the effective dose from cardiac stress is higher than previously published studies. The variation in the effective dose depends on several factors, including the department's clinical indication imaging protocols and radiation safety measures. • The patient's effective dose and dose were quantified during cardiac rest and stress SPECT procedures. • The mean effective dose for cardiac rest is comparable with previously published studies. • The effective dose from cardiac stress is higher than previously published studies. • The current AA activity for rest and stress is lower than the DRL and the previous studies. [ABSTRACT FROM AUTHOR]

Medical exposure of the general population due to radiological investigations is the foremost source of all artificial ionising radiation. Here, we focus on a particular diagnostic radiological procedure, as only limited data are published with regard to radiation measurements during urethrograpic imaging. Specifically, this work seeks to estimate patient and occupational effective doses during urethrographic procedures at three radiology hospitals. Both staff and patient X-ray exposure levels were calculated in terms of entrance surface air kerma (ESAK), obtained by means of lithium fluoride thermoluminescent dosimeters (TLD-100(LiF:Mg:Cu.P)) for 243 urethrographic examinations. Patient radiation effective doses per procedure were estimated using conversion factors obtained from the use of Public Health England computer software. In units of mGy, the median and range of ESAK per examination were found to be 10.8 (3.6–26.2), 7.0 (0.2–32.3), and 24.3 (9.0–32.0) in Hospitals A, B, and C, respectively. The overall mean and range of staff doses (in µGy) were found to be 310 (4.0–1750) per procedure. With the exception of hospital C, the present evaluations of radiation dose have been found to be similar to those of previously published research. The wide range of patient and staff doses illustrate the need for radiation dose optimisation. [ABSTRACT FROM AUTHOR]

Objectives: The diagnostic reference level (DRL) is a useful tool for the optimisation of medical exposures. Thus, a Working Party coordinated by the Italian National Institute of Health and the National Workers Compensation Authority has been formed to provide Italian DRLs, for both diagnostic and interventional procedures, to be used as appropriate for the implementation of the 2013/59 European Directive into the national regulation. Materials and methods: The multidisciplinary Working Party was formed by professionals involved in diagnostic and interventional radiology medical exposures and started from a critical revision of both the literature and the results of previous Italian surveys. The procedures were divided into five sections for adult (projection radiography, mammography, diagnostic fluoroscopy, CT and interventional radiology) and two sections for paediatric patients (projection radiography and CT). The provided DRL values have been identified for "normal" adult patients and for age-classes of paediatric patients. Results: Some of the DRL values provided by the Working Party are reported in this study as an example, divided by adult/paediatric patients, radiological technique and examination: specifically, DRLs for new radiological practices and new dose quantities as DRLs metric were introduced. The median value (rather than the mean) for each procedure, derived from a sample of patients, has to be compared with the corresponding DRL value, and dosimetric data related to a minimum number of patients should be collected for each examination. Conclusions: The approach to the definition and use of DRLs through guidelines of national Authorities in collaboration with scientific Associations should simplify the periodical updating and could be useful for keeping the optimisation of medical exposures faithful to the development of radiological practice. [ABSTRACT FROM AUTHOR]

The field of artificial intelligence (AI) is transforming almost every aspect of modern society, including medical imaging. In computed tomography (CT), AI holds the promise of enabling further reductions in patient radiation dose through automation and optimisation of data acquisition processes, including patient positioning and acquisition parameter settings. Subsequent to data collection, optimisation of image reconstruction parameters, advanced reconstruction algorithms, and image denoising methods improve several aspects of image quality, especially in reducing image noise and enabling the use of lower radiation doses for data acquisition. Finally, AI-based methods to automatically segment organs or detect and characterise pathology have been translated out of the research environment and into clinical practice to bring automation, increased sensitivity, and new clinical applications to patient care, ultimately increasing the benefit to the patient from medically justified CT examinations. In summary, since the introduction of CT, a large number of technical advances have enabled increased clinical benefit and decreased patient risk, not only by reducing radiation dose, but also by reducing the likelihood of errors in the performance and interpretation of medically justified CT examinations. [ABSTRACT FROM AUTHOR]

The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a need for a similar dose quantity linked to risk for making everyday decisions relating to medical procedures. Coefficients were developed to enable the calculation of doses to organs and tissues, and effective doses for procedures in nuclear medicine and radiology during the 1980s and 1990s. Effective dose has provided a valuable tool that is now used in the establishment of guidelines for patient referral and justification of procedures, choice of appropriate imaging techniques, and providing dose data on potential exposure of volunteers for research studies, all of which require the benefits from the procedure to be weighed against the risks. However, the approximations made in the derivation of effective dose are often forgotten, and the uncertainties in calculations of risks are discussed. An ICRP report on protection dose quantities has been prepared that provides more information on the application of effective dose, and concludes that effective dose can be used as an approximate measure of possible risk. A discussion of the way in which it should be used is given here, with applications for which it is considered suitable. Approaches to the evaluation of risk and methods for conveying information on risk are also discussed. [ABSTRACT FROM AUTHOR]

The International Commission on Radiological Protection (ICRP) has highlighted the large number of medical specialties using fluoroscopy outside imaging departments without programmes of radiation protection (RP) for patients and staff. Vascular surgery is one of these specialties and endovascular aneurysm repair (EVAR) is one of the most challenging procedures requiring RP guidance and optimisation actions. The recent European Directive on Basic Safety Standards requires the use and regular update of diagnostic reference levels (DRL) for interventional procedures. The objective of the study was to know the doses of patients undergoing EVAR with mobile Xray systems and with hybrid rooms (fixed Xray systems), to obtain national DRLs and suggest optimisation actions. The Spanish Chapter of Endovascular Surgery launched a national survey that involved hospitals for 10 autonomous communities representing the 77% of the Spanish population (46.7 million inhabitants). Patient dose values from mobile Xray systems were available from nine hospitals (sample of 165 EVAR procedures) and data from hybrid rooms, from seven hospitals, with dosimetric data from 123 procedures. The initial national DRLs have been obtained, as the third quartile of the median values from the different centres involved in the survey. The proposed national DRLs are 278 Gy cm2 for hybrid rooms and 87 Gy cm2 for mobile Xray systems, and for cumulative air kerma (cumulative AK) at the patient entrance reference point, 1403 mGy for hybrid rooms, and 292 mGy for mobile systems. An audit of patient doses for EVAR procedures to identify optimised imaging protocol strategies is needed. It is also appropriate to evaluate the diagnostic information required for EVAR procedures. The increase by a factor of 3.2 (for kerma area product) and 4.8 (for cumulative AK) in the DRLs needs to be justified when the procedures are performed in the hybrid rooms rather than with mobile Xray systems. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate the skin radiation dose received by adults' patients undergoing most common eight X-ray examinations. The study was conducted in three hospitals in three different Iraqi cities: Najaf, Babylon and Salah AL-Din. A minimum number of 10 patients were considered for each type of X-ray examination in each hospital. The skin radiation dose calculation was performed by mathematical equation using exposure factors, namely, X-ray tube voltage (kVp), tube loading (mAs) and source-skin distance (SSD). The skin radiation dose values were obtained for all patients involved in this study who undergoing skull (AP and Lat), cervical (Lat), chest (PA), abdomen (AP), lumbar (Lat), pelvis (AP) and knee (AP) examinations. The resulted data were analyzed and compared with international reference doses. The average skin radiation dose ± standard deviation (SD) for the three hospitals were 0.77±0.43mGy for skull (AP), 0.66±0.39mGy for skull (Lat), 0.63±0.34mGy for cervical (Lat), 0.28±0.25mGy for chest (PA), 4.36±2.92 mGy for abdomen (AP), 4.37±2.30mGy for lumbar (Lat), 1.65±1.09mGy for pelvis (AP) and 0.40±0.25 mGy for knee (AP) examinations. For majority of the considered radiographic examinations Balad general hospital recorded the highest skin radiation dose. Overall most of the recorded radiation doses were within the internationally acceptable dose levels with some variations amongst different hospitals. [ABSTRACT FROM AUTHOR]

Digital radiography is gaining popularity among general dental practitioners. It includes digital intraoral radiography, digital panoramic radiography, digital cephalography, and cone-beam computed tomography. In this study, we focused on the methods to assess image quality of these techniques, except for digital cephalography, in the light of historical issues. We stressed on the importance of the development of a standardized phantom and quantitative analysis of diagnostic image quality using it, especially in the aspect of psychophysical properties of these digital systems. There is no missing link in the image quality assessment in digital intraoral radiography and cone-beam computed tomography in dental use. However, there are missing links between physical and diagnostic image qualities in panoramic radiography. The development of a semi-standardized phantom and the corresponding quantitative analysis method for image quality may be required in digital panoramic radiography. Quantitative image quality assessment using a standardized phantom will also be promising in the future artificial intelligence era. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to establish the conversion factors to normalize the output dose of volumetric computed tomography dose index (CTDIvol) to the patient dose (i.e. size-specific dose estimate (SSDE)) for various phantom diameters and tube voltages. Material and Methods: In-house cylindrical acrylic phantoms with physical diameters ranging from 8 to 40 cm were developed in this study. Each phantom had a hole in the center and four holes in the peripheral areas. The phantoms were scanned by a Siemens Somatom Definition AS CT Scanner using different tube voltages (i.e. 80, 100, 120, and 140 kVps) and with 200 mAs and 10 mm slice thickness. In addition, the doses in every hole and phantom were measured using a Raysafe X2 CT Sensor. The weighted SSDE (SSDEw) values were calculated using the five holes in every measurement. The size-conversion factors for the body and the head CTDI phantoms were established by dividing the SSDEw for various sizes with the SSDEw at the water-equivalent diameter of 33.90 cm and 16.95 cm, respectively. Results: The results revealed that the size-conversion factor exponentially decreased with an increase in the phantom size. It was also found that the size-conversion factor was affected by the tube voltages. Furthermore, the different size-conversion factor between 80 and 140 kVp was more than 15% in very thin and obese patients. Conclusion: Higher accuracy of the size-specific dose estimation can be achieved considering the impact of the tube voltages beside the size of the patient. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the patient and the neurointerventionalist radiation dose levels during endovascular treatment of acute ischemic stroke, and to analyze factors affecting doses.Materials and Methods: From October 2017 to January 2019, we prospectively collected patient radiation data and neurointerventionalist data from real-time dosimetry from all consecutive thrombectomies. Multivariate analysis was performed to analyze patient total dose area product (DAP) and neurointerventionalist dose variability in terms of clinical characteristics and the technical parameters of thrombectomies. Local dose reference levels (RL) were derived as the 75th percentile of the patient dose distributions.Results: A total of 179 patients were treated during the study period and included in this study. Local dose RL for thrombectomy was derived for total DAP to 34 Gy cm2, cumulative air kerma of 242 mGy and fluoroscopy time of 12 min. The mean neurointerventionalist dose for thrombectomy was 7.7 ± 7.4 µSv. Height (P = 0.018), weight (P = 0.004), body mass index (P = 0.015), puncture to recanalisation (P < 0.001), fluoro time (P < 0.001), number of passes (P < 0.001), thrombolysis in cerebral infarction 2b/3 recanalisation (P = 0.034) and aspiration thrombectomy (P < 0.001) were independent factors affecting patient total DAP, whereas baseline National Institutes of Health Stroke Scale (P = 0.043), puncture to recanalisation (P = 0.003), fluoroscopy time (P = 0.009) and number of passes (P = 0.009) were factors affecting the neurointerventionalist dose.Conclusion: New reference patient doses lower than those in previously published studies were defined. However, the operator's doses were higher than those in the only available study reporting on operator's dose during cerebral interventions. [ABSTRACT FROM AUTHOR]

Objective: Use of Computed Tomography (CT) in the diagnosis of diseases is increasing parallel to the technological advances in scanner designs, however, leading to a large increase in patient doses. Although the CT scans offer clinically useful information, the radiation dose and the potential risk of cancer is considered as the biggest problem for the future. For this reason, reducing the patient dose without leading to any degradation in the image quality must be the primary concern in CT scans. Objectives: In this study, we aimed to investigate the effects of the use of automatic tube current modulation (ATCM) technique on patient dose and image quality in head-neck CT angiography scans. Method: 23 patients have been included in the study who are being followed for their cerebrovascular diseases. Following the routine head and neck CT angiography protocol performed using constant tube current (mAs), next scan for the patients were carried out by using automatic tube current modulation technique, with all other exposure parameters held constant. Results obtained from two scanning methods were compared based on both dosimetric parameters and image quality. Results: With the use of automatic tube current modulation technique, 35% reduction was observed in the effective dose. For objective evaluation, signal-to-noise ratio (SNR) values of 3 different anatomical regions of the head and neck were reduced by 49% in the brain stem, 25% in the shoulder region, and 42% in the cerebellum, respectively. In the subjective evaluation, images have been rated by 2 radiologists according to a grading scale between 0-4 and an average grade of 2.2 was obtained for the images acquired using automatic tube current modulation technique. Conclusion: There was a significant decrease in radiation doses with the use of automatic tube current modulation in head and neck CT angiography. Despite decreases in SNR values, there was no handicap observed for achieving diagnostic purpose. According to these results, the routine use of automatic tube current modulation technique in CT neuroangiography exams is highly recommended. [ABSTRACT FROM AUTHOR]

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• New X-ray systems with "patient dose reduction techniques" use high copper filtration for cine acquisitions. • Monte Carlo software with data from each radiation event (using RDSR) allow refining the calculation of effective doses. • Conversion factors for the new dose reduction systems, increased by 38% in comparison to the standard X-ray systems. • The impact of filtration should be considered to estimate effective and population doses from interventional cardiology. There is a large variation in the factors used to estimate effective doses from kerma area product (KAP) for interventional cardiology. These factors are required to estimate population doses. This paper presents the results for this conversion factor for cardiac procedures using tissue weighting factors of ICRP-103 and the impact of the added copper filtration in the X-ray beam. The data from 925 cardiac procedures and 75,347 radiation events were collected from two angiography laboratories using the DICOM Radiation Dose Structured Reports (RDSR). Effective doses were calculated with Monte Carlo software and the dosimetric, technical and geometrical information included in the RDSR. In one laboratory, with an X-ray system without Cu filtration for the cine runs, a factor of 0.21 ± 0.05 mSv/(Gy·cm2) was obtained. In other laboratory, incorporating a patient dose reduction technique, and 0.4 mm of Cu filtration for cine runs, the conversion factor was 0.29 ± 0.05 mSv/(Gy·cm2). The analysis of the radiation events for the different Cu filtrations (0.0; 0.1; 0.4 and 0.9 mm) resulted in conversion factors of: 0.16; 0.27; 0.34 and 0.40 mSv/(Gy·cm2) respectively. The estimation of effective and population doses from KAP should take into account the Cu filtration in the X-ray beam. For the X-ray system with patient dose reduction technique, using 0.4 mm Cu for cine runs, the global conversion factor increased by 38%, from 0.21 to 0.29 mSv/(Gy·cm2) in comparison to the standard X-ray system with a protocol that did not include copper filtration for cine acquisitions. [ABSTRACT FROM AUTHOR]