Product Meter Research Articles

An SSDLs calibration method for the kerma-area product meter

The kerma-area product meter (KAP meter) is mainly used for quality assurance in medical imaging research, providing dose quality assessment or dose monitoring for patients. It can be calibrated either in the laboratory or on-site. The purpose of this study is to propose a method for calibrating the KAP meter using a plane-parallel transmission ionization chamber in the SSDLs. In the range of 50 kV–150 kV, under RQR (standard radiation qualities) and RQR additional filtering conditions of the KAP meter, the correction factor NQm of the transmission ionization chamber is calculated to select two types of KAP meters for the calibration of the transmitted beam. The collimators used to limit the size of the radiation field are respectively 50.07 mm in length, 30.03 mm in length, and 20.05 mm in radius. This method, with uncertainty not exceeding 3.0% while improving calibration efficiency, can replace the unit-specific correction of the laboratory method (Toroi et al., 2008).

Investigation of the optimal tube voltage kV exposure parameters for general X-ray of dental cone-beam computed tomography: A cephalometric view

This study aims to investigate and optimize the effect of different exposure parameters on the reduction of noise and radiation dose and to find the optimal balance among tube voltage, tube current, and exposure time for the latest-generation cone-beam computed tomography system (CBCT) at Advanced Medical and Dental Institute, Universiti Sains Malaysia, using the dose area product (DAP) meter. The DAP meter was attached to the X-ray detector of the CBCT device to cover the entire irradiated area and then connected to a Raysafe electrometer. The DAP meter was scanned with the following exposure parameter: constant tube voltage of 70 kV with a varying tube current ranging from 5 mA – 16 mA and then at a constant tube current of 10mA and a varying tube voltage ranging from 60 kV – 80 kV. For each scanning protocol, the noise was determined. At constant tube voltage and varying tube current, the noise level ranged from 41.99 – 82.16, while at constant tube current and varying tube voltage, the noise level ranged from 50.66 – 60.76 with equal exposure time. A 0.09% increase in noise was observed when the tube voltage was varied. Therefore, low noise protocols should consist of a reduction in the tube current setting rather than a reduction in peak voltage (kVp), as this would result in a smaller level of noise and consequently less quality degradation in the image.

Characterization of a 3D prototyping semi-automated filter holder system for RQR radiation qualities

Characterizing radiation measurement systems, such as diagnostic radiology systems for RQR and RQA, is essential for ensuring reliable results in standardized instrument calibration laboratories. Quality control of dosimetry devices, such as patient dose calibrators (PDCs), a reference meter, is crucial for ensuring accurate measurements. This study demonstrates the use of spectrometry and ionization chambers to characterize a set of semi-automated 3D prototyping filter holder systems, developed in a previously project, designed for applications such as Kerma-Area Product (KAP) meter calibration. The set of 3D prototypes were adjusted to a filter wheel and characterized using an X-ray spectrometer, followed by an ionization chamber, according to international standards. The characterization of radiation qualities from 50 to 150 kV in diagnostic radiology was performed using the substitution method: first with an ionization chamber, then with a PDC. The PDC was calibrated for KAP and Air Kerma quantities, considering the conditions of the X-ray system and factors such as temperature, humidity, and pressure. Spectrometric analysis and the use of an ionization chamber were effective in determining these parameters. Spectral characterization allowed for accurate measurements to establish proper quality control, then it is possible to use the PDC calibrated for calibration procedures for KAP meters. Future studies intend to compare these results with computational simulations using the TOPAS Monte Carlo code to validate the calibration method.

Intraoperative CBCT imaging in endovascular abdomen aneurysm repair – Optimization of exposure parameters using a stent phantom

Cone beam computed tomography (CBCT) may provide essential additional image guidance to endovascular abdominal aneurysm repair (EVAR) operations but also significant radiation exposure to patients if scans are not carefully optimized. The purpose of our study was to define the image quality requirements for intraoperative EVAR CBCT imaging and to optimize the CBCT exposure parameters accordingly. A Multi-Energy CT phantom simulating a large patient was used by replacing the central phantom cylinder with a custom water-filled insert including an EVAR stent. Different exposure parameters covering a range of radiation qualities and dose levels were used to define the optimal image quality level regarding stent graft evaluation (compressed, bent, or collapsed). The radiation dose was measured with a calibrated air kerma-area product (KAP) meter and organ doses were calculated based on Monte Carlo simulations and a mathematical patient model. Based on the results, updated exposure parameters with the highest mean energy and lowest dose level available were recommended. With the updated protocol, the radiation exposure could be significantly decreased. The KAP value decreased from 9720 μGy·m2 to 440 μGy·m2 and reference point air kerma from 351 mGy to 16 mGy (a reduction of 96%) and organ doses of the organs in the irradiated region decreased on an average 91%. The new protocol resulted in acceptable clinical image quality based on testing with clinical cases.

Influence of additional filters on radiation dose during chest radiography.

The goal of this study was to examine the impact of using additional aluminum (Al) and copper (Cu) filters on radiation dose during the adult chest x-ray examination. Adult chest phantoms without and with different slabs of animal fat were used for simulating underweight, overweight, and obese patients, respectively. Phantoms were examined without and with various levels of extra Al and Cu filtering over a range of exposure parameters. A dose area product (DAP) meter was used to measure the radiation dose. Results demonstrated that radiation doses were significantly reduced (p=0.001) when applying extra filters compared with no filters for all of the different phantom sizes. The highest reduction in radiation dosage was 38, 41, and 42 percent for underweight, overweight, and obese phantom size, respectively, by 1mm Al+0.2mm Cu. In conclusion, the use of extra filters in chest x-ray imaging provides an optimal dose reduction choice regardless of the thickness of the chest region to be radiographed. DOI: http://dx.doi.org/10.31257/2018/JKP/2022/140206

Correlation analysis between radiation exposure and the image quality of cone-beam computed tomography in the dental clinical environment.

PurposeThis study was conducted to measure the radiation exposure and image quality of various cone-beam computed tomography (CBCT) machines under common clinical conditions and to analyze the correlation between them.Materials and MethodsSeven CBCT machines used frequently in clinical practice were selected. Because each machine has various sizes of fields of view (FOVs), 1 large FOV and 1 small FOV were selected for each machine. Radiation exposure was measured using a dose-area product (DAP) meter. The quality of the CBCT images was analyzed using 8 image quality parameters obtained using a dental volume tomography phantom. For statistical analysis, regression analysis using a generalized linear model was used.ResultsPolymethyl-methacrylate (PMMA) noise and modulation transfer function (MTF) 10% showed statistically significant correlations with DAP values, presenting positive and negative correlations, respectively (P<0.05). Image quality parameters other than PMMA noise and MTF 10% did not demonstrate statistically significant correlations with DAP values.ConclusionAs radiation exposure and image quality are not proportionally related in clinically used equipment, it is necessary to evaluate and monitor radiation exposure and image quality separately.

Effect of equalization filters on measurements with kerma-area product meter in a cardiovascular angiography system.

PurposeThis study aimed to evaluate the effect of equalization filters (EFs) on the kerma‐area product (KAPQKM) and incident air‐kerma (Ka,i,QKM) using a kerma‐area product (KAP) meter. In addition, potential underestimations of the Ka,i,QKM values by EFs were identified.Materials and methodsA portable flat‐panel detector (FPD) was placed to measure the X‐ray beam area (A) and EFs dimension at patient entrance reference point (PERP). Afterward, a 6‐cm3 external ionization chamber was placed to measure incident air‐kerma (Ka,i,Qext) at PERP instead of the portable FPD. KAP reading and Ka,i,Qext were simultaneously measured at several X‐ray beam qualities with and without EFs. The X‐ray beam quality correction factor by KAP meter (kQ,Q0KM) was calculated by A, Ka,i,Qext and KAP reading to acquire the KAPQKM and Ka,i,QKM. Upon completion of the measurements, KAPQKM, Ka,i,QKM, and Ka,i,Qext were plotted as functions of tube potential, spectral filter, and EFs dimension. Moreover, Ka,i,QKM/Ka,i,Qext values were calculated to evaluate the Ka,i,QKM underestimation.ResultsThe kQ,Q0KM values increased with an increase in the X‐ray tube potential and spectral filter, and the maximum kQ,Q0KM was 1.18. KAPQKM and Ka,i,QKM decreased as functions of EFs dimension, whereas Ka,i,Qext was almost constant. Ka,i,QKM/Ka,i,Qext decreased with an increase in EFs dimension but increased with an increase in tube potential and spectral filter, and the range was 0.55–1.01.Conclusions Ka,i,QKM value was up to approximately two times lower than the Ka,i,Qext values by EFs. When using the Ka,i,QKM value, the potential Ka,i,QKM underestimation with EFs should be considered.

SURFACE DOSE ESTIMATION BY A KAP METER FOR KILOVOLTAGE X-RAY BEAMS.

This study aims to estimate the entrance surface dose (ESD) of a water phantom for kilovoltage x-ray beams using an air kerma area product meter (KAP meter) equipped in an x-ray unit. The KAP meter was calibrated in terms of the ESD determined by a plane-parallel ionization chamber based on a 60Co absorbed dose-to-water calibration coefficient, ${N}_{D,w}^{{}^{60}\mathrm{C}\mathrm{o}}$. The ESD measured using the KAP meter was verified by comparing it with that estimated by the air kerma calibration coefficient, NK, for x-ray beam qualities. The ratio of ESDs based on ${N}_{D,w}^{{}^{60}\mathrm{C}\mathrm{o}}$ and NK was 1.003 on average and independent of the beam quality. The ESD by the KAP meter was an agreement within ±1.5% with that measured using the plane-parallel chamber for 10×10-30×30cm2 fields with a source-surface distance of 75-150cm. It was possible to estimate the ESD directly in a water phantom for x-ray beams without correction factors compared to the existing air kerma calibration, using a KAP meter calibrated based on ${N}_{D,w}^{{}^{60}\mathrm{C}\mathrm{o}}$.

Radiation exposure during therapeutic cardiac interventional procedures

The purpose the current work were to assess the radiation exposure given to patients during percutaneous coronary interventions (PCI), pacemaker (PM) and coronary angiography (CA), procedures. In total, 419 procedures were carried out in 4 specialized hospitals. Calibrated Kerma area product meters were used to quantify the patient doses. Effective dose was extrapolated using the national radiological protection board (NRPB) software program. The mean KAP (Gy.cm2) per procedure were 8.6, 6.2 and 5.6 for PCI, PM, and CA procedures, respectively. While in that order, e mean and Entrance Surface Air Kerma (ESAK, mGy) per procedure were 705.9,509, and 464.7 for PCI, PM, and CA. Patients’ doses is below the level of the deterministic effects and the effective dose per procedure is low. Patients radiation doses is lowest compared to the previous studies.

A Study of Patient's Dose Control at Radiography by Using a Dose Area Product Meter

The International Commission on Radiological Protection recommends adaptation of the diagnostic reference levels (DRLs). Japan DRLs 2020 apply the entrance surface dose (ESD) in radiography. However, it is difficult to measure ESD in the clinical setting. A dose area product meter has been proposed for use as a dose index in interventional radiology. We investigated the basic characteristic of a dose area product meter and the relationship of ESD and dose area product meter values in radiography. We measured calibration factors from phantom studies and estimated ESD from the dose area product meter. Subject thickness was measured from the chest clinical images for calculation of ESD. Estimated ESD from the dose area product meter was compared with that calculated from program software (Surface Dose Evaluation Code, Sdec). Relative dose (dose area product meter/ionization chamber) decreased when tube voltage was lower (60 kV) or higher (130 kV). A positive correlation was found between the estimated and calculated ESD. Dose area product meter can be used for patient's dose control in radiography.

Radiation Dose during Transarterial Radioembolization: A Dosimetric Comparison of Cone-Beam CT and Angio-CT Technologies

PurposeTo evaluate the radiation dose differences for intraprocedural computed tomography (CT) imaging between cone-beam CT and angio-CT acquired during transarterial radioembolization (TARE) therapies for hepatocellular carcinoma. Materials and MethodsA retrospective cohort of 22 patients who underwent 23 TARE procedures were selected. Patients were imaged in both cone-beam CT and angio-CT rooms as a part of their conventional treatment plan. Effective dose contributions from individual CT acquisitions as well as the cumulative dose contributions from procedural 3D imaging were evaluated. Angiography dose contributions were omitted. Cone-beam CT images were acquired on a C-arm Philips Allura system. Effective doses were evaluated by coupling previously published conversion factors (effective dose per dose-area product) to patient’s dose-area product meter readings after the procedure. Angio-CT images were acquired on a hybrid Canon Infinix-i Aquilion PRIME system. Effective doses from angio-CT scans were estimated using Radimetrics. Comparisons of a single patient’s dose differential between the 2 technologies were made. ResultsThe mean effective dose from a single CT scan was 6.42 mSv and 5.99 mSv in the cone-beam CT room and the angio-CT room, respectively (P = .3224), despite the greater field of view and average craniocaudal scan coverage in angio-CT. The mean effective dose summed across all CTs in a procedure was 12.89 mSv and 34.35 mSv in the cone-beam CT room and the angio-CT room, respectively (P = .0018). ConclusionsThe mean effective dose per CT scan is comparable between cone-beam CT and angio-CT when considered in direct comparison for a single patient.

Entrance Surface Dose (ESD) Measurement During Pediatric Chest X-Rays

Introduction Given the high radiation tissue sensitivity of pediatric patients, it is necessary to monitor their received dose in order to optimize radiation protection. The first aim of this study was to evaluate of the entrance surface dose (ESD) in pediatric patients undergoing chest x-ray at the main hospital of Dezful, Iran. The second aim was to compare our results with the established dose reference levels (DRL). Materials and Methods The studied population included 204 pediatric patients less than 15 year who were referred to chest x-ray. A calibrated dose area product meter (DAP-meter) with permanent installation on x-ray unit was used to radiation dose measurements. For each patient, the demographic data, exposure parameters and the dose read by DAP-meter were recorded and ESD was calculated using standard mathematical formula. Results The average value of ESD was 119 μGy in patients less than 15 years. This value was 51.3, 122.3, 131.5 and 171.2 μGy for the age groups less than 1 year, 1 to 5 year, 5 to 10 year and 10 to 15 year, respectively. A statistical significant difference was seen between ESD values ​​in different age groups (P&lt;0.001), whereas no statistical difference was seen between ESD values in ​ girls and boys (P =0.993). Conclusion Pediatric patients in hospital investigated (except age group less than 1 year) are subjected to unnecessary radiation exposure, especially due to use of non-optimize x-ray protocols.

Modified Technique for the Visualization of C6/C7 in Lateral Cervical Spine Radiography

Introduction: In the Swimmer’s view, the C6 and C7 can be visualized as superimposed on the shoulders. This study aimed to explore the technique to demonstrate C1 to C7 in the lateral spine and improve the diagnostic value in that region. Material and Methods: An experimental study was carried out using a RANDO phantom to obtain images of the lateral cervical spine. Twelve radiographs were taken using different kVps at different centering points. The image quality of the radiographs was evaluated by two radiographers using the modified image quality criteria score sheet adapted from the Commission of European Communities on image quality. A dose area product meter was utilized to estimate the entrance surface dose (ESD); however, CALDose_X5 Monte Carlo software was used to estimate the effective dose. Results: The findings indicated that a higher centering point at 2 inches above the pinna of the ear can clearly visualize the lower cervical spine (C6/C7) and cervicothoracic junction (C7/T1). The results of the Kruskal-Wallis test revealed significant differences (p 0.05) in the ESD between different utilized centering points. The effective dose of the modified technique was reported to be lower, compared to that for the Swimmer’s view. Conclusion: The modified lateral technique can be used to replace the Swimmer’s view to adequately demonstrate the lower cervical spine and cervicothoracic junction with a lower radiation dose while not harming the patient due to movement during positioning.

Application of Dose Area Product (DAP) to Estimate Entrance Surface Dose (ESD) in Pediatric Chest X-Rays

Introduction: Given the high radiation tissue sensitivity of pediatric patients, it is necessary to monitor their received dose to optimize radiation protection. The first aim of this study was to evaluate the entrance surface dose (ESD) in pediatric patients undergoing a chest X-ray at the main hospital of Dezful, Iran. The second aim was to compare our results with the established dose reference levels (DRLs).&#x0D; Materials and Methods: The studied population included 204 pediatric patients less than 15 years who were referred to as chest X-ray. A calibrated dose area product meter (DAP-meter) with permanent installation on the X-ray unit was used to radiation dose measurements. For each patient, the demographic data, exposure parameters and the dose read by DAP-meter were recorded and ESD was calculated using a standard mathematical formula.&#x0D; Results: The average value of ESD was 119 μGy in patients less than 15 years. This value was 51.3, 122.3, 131.5 and 171.2 μGy for the age groups for less than 1 year, 1 to 5 years, 5 to 10 years and 10 to 15 years, respectively. A statistically significant difference was seen between ESD values ​​in different age groups (P&lt;0.001), whereas no statistical difference was seen between ESD values in ​ girls and boys (P =0.993).&#x0D; Conclusion: Pediatric patients in hospital investigated (except age group less than 1 year) are subjected to unnecessary radiation exposure, especially due to the use of non-optimize X-ray protocols.

Measurement of the average radiation dose to the local skin and thyroid gland during intracranial aneurysm coil embolization

IntroductionIntracranial aneurysm coil embolisation is a fluoroscopically guided procedure associated with high radiation dose. The increase in the number of coil embolisation procedures raises concern for the amount of radiation and the associated radiation risks to the patients. This research study was conducted to determine the average radiation dose to patients’ thyroid glands and local skin during intracranial aneurysm coil embolisation and to establish preliminary local diagnostic reference levels for this procedure. In this paper, local skin dose refers to the absorbed radiation dose on the areas of the skin exposed to radiation during intracranial aneurysm coil embolisation, namely neck, face and scalp. MethodsThis study employed air-kerma area product meters to determine the local skin dose and diagnostic reference levels during intracranial aneurysm coil embolisation. In addition, thyroid radiation doses were measured using thermo-luminescent dosimeters on a phantom during simulation of embolisation procedures. ResultsThe local skin doses as determined by air-kerma area product ranged between 33 and 125 Gy.cm2. The mean thyroid dose was 9.87 mGy. The established local diagnostic reference level was 52.1 Gy cm2, 17.8 min’ fluoroscopy time and 503 image frames. ConclusionThe average air-kerma area product values and the proposed diagnostic reference levels were lower than most published values for intracranial aneurysm coil embolisation. Implications for practiceThe established local diagnostic reference levels are recommended for use as radiation dose optimisation tool at the research site. The findings of this study cannot be generalised or applied to other hospitals. The complexity of the embolisation procedures was not classified for this study. Further research on diagnostic reference levels for intracranial aneurysm coil embolisation, taking into account the complexity of the procedures, is recommended.

ESTIMATES OF PATIENT DOSES AND KERMA-AREA PRODUCT MONITORING IN DIGITAL RADIOGRAPHY.

The application of the kerma-area product (PKA) meter is increased rapidly in dosimetry. This study presents measurements of PKA in adherence to the International Atomic Energy Agency protocol for 300 adult patients in digital radiographic procedures. Effective doses (ED) were calculated from PKA measurements and conversion coefficients (E-103/PKA) obtained from the International Commission on radiological protection 103. In skull posteroanterior (PA), skull lateral (LAT), cervical spine anteroposterior (AP), cervical spine LAT, chest PA, abdomen AP, lumbar spine AP, pelvis AP and lumbar spine LAT, the third-quartile PKA values were found to be 0.2, 0.28, 0.33, 0.19, 0.26, 0.95, 0.93, 0.96 and 3.15Gycm2, and estimated mean EDs were 0.005, 0.008, 0.056, 0.021, 0.037, 0.146, 0.165, 0.097 and 0.258mSv, respectively. The third-quartile PKA values were suggested as local diagnostic reference levels (LDRLs). Results were compared with the diagnostic reference levels (DRLs) of the UK, the European Commission, previously published LDRLs in Greece and China by Metaxas etal. and Zhang and Chu, respectively. The PKA (third-quartile) value for cervical spine AP was 120% higher than UK 2010 DRLs, lumbar spine LAT was 123% higher than LDRLs given by Metaxas etal. and chest PA was 160% higher than UK 2010 DRLs and 225% higher than Metaxas etal. provided LDRLs. The PKA results were lower than the UK, and two studies in Greece by Metaxas etal. except for chest PA, cervical spine AP and lumbar spine LAT showed the need for further optimization. The LDRLs reported in this study may further contribute to establishing future national DRLs.

Technical Note: Assessment of scatter originating from the x-ray tube collimator assembly of modern angiography systems.

While scatter from the patient is assumed to be the primary source of occupational radiation dose associated with fluoroscopically guided interventional procedures, the potential contribution of scatter from the x-ray collimator assembly is unknown. The purpose of this work was to survey clinical x-ray angiography systems to assess the potential contribution of collimator assembly scatter on occupational radiation dose. Experimental methods were designed to measure the relative contributions of scatter originating from within the collimator assembly of the x-ray tube to total scatter, which included scatter from a patient-simulating phantom. Measurements were acquired as a function of lateral distance from the x-ray beam center using a posterior anterior (PA) projection and at a fixed location for variable right anterior oblique to left anterior oblique projections in the range -90º to 90º. For one system, the collimator assembly was partially disassembled to assess the scatter contribution of individual components. For two systems, 0.5mm Pb was added to the inner surface of the collimator assembly cover and tested for efficacy to block collimator assembly scatter. Considering all x-ray systems and only the PA projection, collimator assembly scatter contributed 20-50% to total scatter. For x-ray projection angles of -90º to 90º, the relative contribution of collimator assembly to total scatter was dependent on projection angle and ranged from 5% to 56%. X-ray systems with kerma-area product meters demonstrated higher collimator assembly scatter than those without. Considering all projection angles, the addition of 0.5mm Pb to the inside of the collimator assembly cover reduced collimator assembly scatter from 28% to 16% of total scatter for both systems. Findings from this work suggest that contemporary radiation safety practices and guidelines should be revised to account for scatter originating from the collimator assembly of angiographic x-ray tubes.

Radiogenic risks to patients and staff from fluoro-assisted therapeutic cardiac catheterizations

Advances in sectional imaging have led to prolonged x-ray fluoro-assisted therapeutic cardiac catheterizations. Given the frequency of such procedures, limited data are available for patient and staff doses. For certain pediatric cardiac catheterization procedures we examine: (i) effective and organ doses, also the radiogenic and tissue reaction risks and; (ii) staff effective dose during cardiac interventions. At four cardiac catheterization centres, patient doses were measured with a calibrated kerma area product (KAP) meter; staff doses were measured using calibrated TLDs. The mean and range of age (years) and weight (kg) for patients were 4.3 (0.04–14.0) and 10.8 (3.0–46.0) respectively; the overall mean and range of fluoroscopic time (min) was 13.0 (1.4–54.8). For coronary angiography and pacemaker procedures the overall mean and range of cumulative kerma area product (CKAP, cGy.cm2) were 350 (12.0–510). The average annual staff dose of 9.0 (7.2–14.4) mSv is relatively low given the current workload. Some patients received high doses approaching the threshold for tissue reactions. Optimisation of radiation dose is required as is follow-up of patients receiving high doses to detect the possibility of tissue reactions.

Multi-facility Survey on Accuracy and Calibration Method for Dose Area Product Meter of Angiography Systems

In many facilities, the displayed dose of dose-area product (DAP) is used for the dose management of interventional radiology. In this study, we investigated the measured dose at the patient entrance reference point (interventional reference point) and the displayed dose on each angiography systems. Also, we investigated the calibration method of each DAP. The errors of the measured dose and the displayed dose were less than 35%, but that dispersion was wide between the systems. The calibration methods varies according to a system. And even in the same manufacturer, the calibration methods were different. Therefore, to use the displayed dose of DAP for patient dose management, we need to compare that with the measured dose regularly. The differences of calibration methods induce the wide dispersion of the errors of the measured and the displayed dose. So the standardization of the calibration method in each manufacturer is expected.

284. Protocol of verification of dose indicators of radiological equipment for the correct archiving and recording of dosimetric data

Purpose Dose report in radiological examination will be an issue soon with the Euratom directive 2013/59 [ [1] European Commission. Councile Directive 2013/59Euratom. Google Scholar ]. Our purpose is to analyze our results on approximately 10 years of dose control activity in our Hospital as required by the current regulations D.Lvo 187/00. The aim of the work is to analyze the measurement methods implemented on the installed radiological equipment DAP, KAP, CTDI, ESD, and compare them with our reference measurement. Methods During the acceptance tests and the annual constancy tests of all radiological equipment installed since 2007, we have set up a verification protocol of dose indicator through direct measurements with calibrated instruments [ [2] CEI EN 60580 Dose area product meter; 2001. Google Scholar ]. For DAP/KAP direct digital X-ray equipment, angiography systems radiography e fluoroscopy systems our adopted protocol controls the following parameters: accuracy, reproducibility, dependence on the field, dependence on the quality of the beam with an external calibrated DAP meter: Dose guard 100 (RTI electron ics). For CTDI vol values provided from CT scanners: Pencil ionization camera (Victoreen Instruments) and PMMA phantoms. For mammography (ESD and AGD displayed dose): measurements with calibrated dosimeter and phantoms in mammography. Results Conclusions Calibrations were requested on dose display devices in direct digital equipment (DAP) in 4% of equipments with a discrepancy of more than 20%, [Fig. 1] due to the loss of calibration due to the drop in tube efficiency. For the remaining equipment the discrepancies detected are within the limits. The verification protocol is reliable and compliant with the guidelines, useful in the preliminary phase to the registration of the dosimetric data protocol [ [3] AIFM Report: Radiation dose index monitoring (RDIM); 2016. Google Scholar ]. Dose report in radiological examination will be an issue soon with the Euratom directive 2013/59 [ [1] European Commission. Councile Directive 2013/59Euratom. Google Scholar ]. Our purpose is to analyze our results on approximately 10 years of dose control activity in our Hospital as required by the current regulations D.Lvo 187/00. The aim of the work is to analyze the measurement methods implemented on the installed radiological equipment DAP, KAP, CTDI, ESD, and compare them with our reference measurement. During the acceptance tests and the annual constancy tests of all radiological equipment installed since 2007, we have set up a verification protocol of dose indicator through direct measurements with calibrated instruments [ [2] CEI EN 60580 Dose area product meter; 2001. Google Scholar ]. For DAP/KAP direct digital X-ray equipment, angiography systems radiography e fluoroscopy systems our adopted protocol controls the following parameters: accuracy, reproducibility, dependence on the field, dependence on the quality of the beam with an external calibrated DAP meter: Dose guard 100 (RTI electron ics). For CTDI vol values provided from CT scanners: Pencil ionization camera (Victoreen Instruments) and PMMA phantoms. For mammography (ESD and AGD displayed dose): measurements with calibrated dosimeter and phantoms in mammography. Calibrations were requested on dose display devices in direct digital equipment (DAP) in 4% of equipments with a discrepancy of more than 20%, [Fig. 1] due to the loss of calibration due to the drop in tube efficiency. For the remaining equipment the discrepancies detected are within the limits. The verification protocol is reliable and compliant with the guidelines, useful in the preliminary phase to the registration of the dosimetric data protocol [ [3] AIFM Report: Radiation dose index monitoring (RDIM); 2016. Google Scholar ].