[The new radiation protection legislation-part 2 : Modifications in radiology regarding approval procedure and special fields including teleradiology]. / Die neue Strahlenschutzgesetzgebung ­ Teil 2 : Änderungen in der Radiologie bezüglich Vorabkontrolle und Sonderbereiche, einschließlich Teleradiologie.

BACKGROUND: The entry of the new Radiation Protection Act and new Radiation Protection Regulation into force in Germany created many changes for radiology with regard to the old Radiation Protection Regulation and X­ray Regulation. OBJECTIVES: The substantial modifications in radiology regarding the areas of approval and notification procedures, teleradiology, screening, research and radon in the workplace are summarized. METHOD: Changes in the new Radiation Protection Act and Regulation compared to the old Radiation Protection Regulation and X­ray Regulation were evaluated. Thereby, the focus was on areas beyond the workflow in clinical routine. RESULTS AND CONCLUSION: The requirements for the approval and notification procedure have increased. For example, proof must be provided that a medical physics expert can be consulted. The establishment of deadlines for the process by the responsible authorities may accelerate the procedure and create planning certainty.

[The new radiation protection legislation-part 1 : Modifications in radiology for the workflow in clinical routine]. / Die neue Strahlenschutzgesetzgebung ­ Teil 1 : Änderungen für die arbeitstägliche Routine in der Radiologie.

BACKGROUND: On 31 December 2018, the new Radiation Protection Regulation came into effect in Germany and made the new Radiation Protection Act more concrete. The old Radiation Protection Regulation and X­ray Regulation have thereby been replaced. OBJECTIVES: The substantial modifications regarding the practical daily routine in radiology are summarized. METHODS: Modifications and innovations of the New Radiation Protection Act and Regulation compared to the old Radiation Protection Regulation and X­ray Regulation and accordances were evaluated. Thereby the main focus was in the relevance for workflow in clinical routine. RESULTS AND CONCLUSION: The new legislation contains a number of regulations that provide crucial tools for implementation of radiation protection, quality assurance, and dose optimization. However, this also requires additional time and personnel.

Modification of chest radiography exposure parameters using a neonatal chest phantom.

BACKGROUND: The acquisition of chest radiographs in neonates is of critical importance in diagnostics because of the risk of respiratory distress syndrome and pneumothorax in preterm infants. OBJECTIVE: To achieve a dose reduction while preserving a diagnostic image quality for chest radiographs of neonates. MATERIALS AND METHODS: All radiographs, generated on a fully digital X-ray unit by using a neonatal chest phantom, were evaluated under variation of the tube voltage (40-70 kV) and mAs levels (1-10.2 mAs) with and without an additional 0.1-mm copper (Cu) filtration. Noise, contrast and contrast-to-noise ratio for bronchus, heart, lungs and vessels were determined. Visual assessment of the image quality was carried out by three radiologists using a Likert scale. To evaluate a maximally possible dose reduction, the dose of the radiographs with still acceptable image quality at a minimal dose was compared to the dose of the radiographs with the standard settings used in clinical routine. RESULTS: The noise showed decreasing values with increasing dose, while the contrast values were increased. For the contrast-to-noise ratio, a digressive course of the values as a function of the tube voltage was found. The visual evaluation of image quality showed the best evaluation of the structures at the lowest possible dose in the settings (44 kV, 3.36 mAs) with copper filtration and in the settings (44 kV, 1.56 mAs) without copper filtration. A maximum dose reduction from 8.29 µSv to 2.21 µSv (about 73%) was obtained. CONCLUSION: A dose reduction while preserving diagnostic image quality in a digital X-ray system is generally possible by reducing the tube voltage and simultaneous adaptation of the mAs settings.

Optimization of Whole-Body CT Examinations of Polytrauma Patients in Comparison with the Current Diagnostic Reference Levels. / Optimierung von Ganzkörper-CT-Untersuchungen an Polytraumatisierten anhand des Vergleichs mit den aktuellen diagnostischen Referenzwerten.

PURPOSE: Evaluation of the dose values of a polytrauma whole-body CT examination used in clinical practice with regard to the 2016 updated diagnostic reference levels and reduction of the mean exposure levels using simple optimization steps. MATERIALS AND METHODS: In each case, 100 exposure values before and after dose optimization were compared with the old and new diagnostic reference levels. The grayscale values and the signal-to-noise ratio (SNR) were determined for the lung, the aortic arch and the liver. A visual assessment of the image quality was performed by two radiologists on the basis of a Likert scale (0 - non-diagnostic, 1 - poor visualization, 2 - moderate visualization, 3 - good visualization, 4 - excellent visualization) for CT examinations both before and after optimization. RESULTS: The acquired exposure values after dose optimization were below the old and new diagnostic reference levels (1319.98 ±â€Š463.16 mGy ·â€Šcm) while the mean value of the exposure values before optimization (1774.96 ±â€Š608.78 mGy ·â€Šcm) exceeded the current diagnostic reference levels. The measured grayscale values (HU) were (before versus after optimization): lung - 833 HU vs. - 827 HU (p = 0.43), aortic arch 341 HU vs. 343 HU (p = 0.70) and liver 68 HU vs. 67 HU (p = 0.35). After dose optimization the SNR in the lung was minimally higher, while it was minimally lower in the two other regions than before the optimization. Visual assessment of the image quality showed almost identical values with 3.85 evaluation points before and 3.82 evaluation points after dose optimization (p = 0.57). CONCLUSION: Due to the updating of the diagnostic reference levels, an analysis of the own exposure values is necessary in order to be able to detect high values promptly and to initiate appropriate measures for dose reduction. Appropriate adaptation of the examination parameters with consideration of the necessary image quality allows a significant reduction of the radiation exposure in most cases, also on CT devices of older generations. KEY POINTS: · In many cases a dose reduction below the DRLs is already possible by optimizing the examination technique.. · In order to ensure a diagnostic image quality, the control of the image quality is unavoidable in a dose reduction.. · Through suitable parameter adjustments a compliance with the DRLs is also possible, using CT devices of older generation without iterative image reconstruction.. CITATION FORMAT: · Schäfer SB, Rudolph C, Kolodziej M et al. Optimization of Whole-Body CT Examinations of Polytrauma Patients in Comparison with the Current Diagnostic Reference Levels. Fortschr Röntgenstr 2019; 191: 1015 - 1025.