Patient dosimetry measurement methods.

This article reviews patient dosimetry measurement methods applied to diagnostic radiology examinations. Various dose quantities and their relevance to patient dose surveys are described. When contemplating a patient dose survey it is important to develop a clear measurement strategy. This involves a detailed consideration of the most applicable dose measurement method for the intended survey. Various approaches to patient dosimetry are described and reviewed.

The impact of cardiology on the collective effective dose in the North of England.

Two cardiology X-ray rooms were monitored with dose-area product meters as part of a Regional Patient Dosimetry Programme. Dose-area product measurements on over 2000 patients undergoing examinations in the cardiology rooms are presented. The data have been corrected according to patient size where possible. In room A mean dose-area product values for coronary angiography, coronary angioplasty, radiofrequency ablation and mitral valvuloplasty were found to be 47.7, 72.2, 91.1 and 161.9 Gy cm2 respectively. In room B mean dose-area product values for coronary angiography and coronary angioplasty were found to be 23.4 and 51.6 Gy cm2 respectively. Observational studies were used to deduce the typical projections and technique factors. This typical examination was used to simulate an angiogram from which it was possible to derive factors to convert measured dose-area product values into estimates of effective dose. In room A, the effective doses were estimated to be 9.4, 14.2, 17.3 and 29.3 mSv for coronary angiography, coronary angioplasty, radiofrequency ablation and mitral valvuloplasty, respectively. The effective doses during coronary angiography and coronary angioplasty, performed in room B, were found to be 4.6 and 10.2 mSv, respectively. A regional survey of the frequency of these cardiac procedures was performed. It was deduced that the annual collective effective dose from these cardiac procedures in the North of England, the former Northern Region, was 45.7 manSv.

A phantom based method for deriving typical patient doses from measurements of dose-area product on populations of patients.

One of the chief sources of uncertainty in the comparison of patient dosimetry data is the influence of patient size on dose. Dose has been shown to relate closely to the equivalent diameter of the patient. This concept has been used to derive a prospective, phantom based method for determining size correction factors for measurements of dose-area product. The derivation of the size correction factor has been demonstrated mathematically, and the appropriate factor determined for a number of different X-ray sets. The use of phantom measurements enables the effect of patient size to be isolated from other factors influencing patient dose. The derived factors agree well with those determined retrospectively from patient dose survey data. Size correction factors have been applied to the results of a large scale patient dose survey, and this approach has been compared with the method of selecting patients according to their weight. For large samples of data, mean dose-area product values are independent of the analysis method used. The chief advantage of using size correction factors is that it allows all patient data to be included in a survey, whereas patient selection has been shown to exclude approximately half of all patients. Reduction of the size of the data set may lead to mean dose-area product values that are less reliable indicators of typical practice. The use of size correction factors will be of particular benefit in the analysis of paediatric dosimetry data, where a wide range of sizes exist, even within accepted age bands.

The impact of digital imaging on patient doses during barium studies.

Barium studies performed on 10 digital and four non-digital fluoroscopic systems were monitored with dose-area product meters as part of a Regional Patient Dosimetry Audit programme. The data have been collected using a computer to read and reset the dose-area product meter and also to collect patient and examination details. A comparison of dose-area product measurements from digital and non-digital fluoroscopy units on over 10,000 barium studies is presented. The data have been corrected according to patient size. The mean size corrected dose-area product for a barium meal examination was found to be 7.62 Gy cm2 for a digital set compared with 15.45 Gy cm2 for a non-digital set with 2462 and 1308 patients included in each measurement series, respectively. Dose-area products were also a factor of approximately two lower for barium enema, barium swallow and barium follow-through examinations performed on digital systems.