May 5, 2017

Part 1: Patient Protection vs. Personnel Protection – Which Matters Most?

When it comes to controlling scatter radiation and radiation dose to patients and personnel in medical imaging, those of us in the industry (particularly in North America and Europe) have seen a recent trend arise. Patient dose reduction has become a center point for all modalities of diagnostic radiography that uses ionizing radiation.

Organizations such as Image Gently and Image Wisely focus on dose reduction for the patient, but not so much on the personnel administering the radiographs. The industry is claiming to lower patient dose via new software methods rather than traditional hardware methods. Has the radiographic industry really considered all the outcomes this may cause? Are we causing more harm than good?

Though the software trend may be popular and convenient, unfortunately, that doesn’t mean it’s the safest or smartest way to achieve results. This trend of using new software in place of proven hardware to counter the effects of scatter radiation during X-ray exams may have some negative side effects that have not been considered or even reviewed – such as safety testing for the X-ray tech.

Scatter radiation mainly occurs when X-rays bounce off of a patient’s body during an exam. X-ray photons interact with body tissue at different angles, and these photons blur the X-ray image. This can lead to a poor quality radiograph and the potential for missed pathology.

Grid Removal Software Advantages

There are benefits to using grid removal software. Techniques can be lowered, radiographers no longer have to locate and carry grids on portable exams, patient comfort can be increased and retakes from user error due to misalignment or using incorrect grid specifications will be reduced. Those are a fair number of benefits for software utilization, but are they enough?

Scatter radiation causes the greatest occupational threat to the users administering the X-ray, and this is what we are most concerned with in this discussion.

Are We Offering the Best Protection for Personnel?

“The objective of a safety program in health physics is to keep the exposure of personnel as low as reasonably achievable so as to avoid the slightest radiation injury,” (Selmen, 9th edition pg. 402).

The use of anti-scatter grids has been an industry standard for decades and the physics of ionizing radiation have not changed. When used and paired properly, anti-scatter grids can yield a more detailed real image, and this allows the radiologist to provide a more accurate reading. Again, anti-scatter grids absorb scatter radiation – this means they provide an extra layer of protection for the radiographer.

Grid removal software does not absorb scatter radiation – it merely compensates for the scatter radiation to provide a similarly detailed image as a grid. This presumably will not protect the user from a higher radiation dose as the scatter is never absorbed by the grid.

By simulating actual grid use, the software purports to “Eliminate physical grid-related misalignment issues and precisely tune image contrast while suppressing image noise,” among other things.

However, recent research indicates this new type of software may not function as well as a properly used anti-scatter grid when it comes to image quality.

Not only is image quality potentially sacrificed, but once again, this software does nothing to remove scatter radiation, which may lead to an increased occupational hazard for radiographers.

The question remains: Is it medically ethical to potentially lower dose to the patient if we potentially increase dose to the radiographer? Will there be any long term biological effects to radiographers who use this software?

Stay tuned for Part 2 of this series where we delve deeper into this important discussion.