Transition from Screen-Film to Digital Radiography: Evolution of Patient Radiation Doses at Projection Radiography

Abstract

To retrospectively evaluate patient radiation doses in projection radiography after the transition to computed radiography (CR) in the authors' hospital. The hospital's ethical committee approved the study and waived informed consent. In 2001, a dose reduction initiative was implemented, which involved collecting radiographic parameters, calculating patient entrance doses, and monitoring changes with an online computer, and a training program for radiographers was conducted. A database with 204 660 patient dose values was used to compute changes in patient doses over time. Sample sizes ranged from 1800 to 23 000 examinations. Doses were compared with European and American reference values. Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis. Median values for patient entrance doses increased 40%-103% after implementation of CR. Initial increases were corrected during the 1st year, and additional dose decreases were achieved after the dose reduction initiative was launched. At present, doses range between 15% and 38% of the European diagnostic reference levels established for screen-film radiography and between 28% and 41% of the reference values recommended by the American Association of Physicists in Medicine, representing an effective 20%-50% reduction in the initial values for CR. Though patient doses can increase considerably during the transition from conventional screen-film radiography to CR, dose management programs, including specific training of radiographers and patient dose audits, allow for reductions of the previous values.