Written to assist the implementation in medical imaging practice of the requirements of the IAEA Safety Standards Series No. GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, this publication provides consolidated information and detailed advice for setting and implementing patient radiation exposure monitoring programmes at the local or national level. In medical imaging using ionizing radiation, including X ray diagnostic radiology, diagnostic nuclear medicine and image guided interventional procedures, radiation protection of patients is achieved by selecting the most appropriate imaging procedure for the individual needs of the patient and by keeping exposure to the minimum necessary to achieve the diagnostic and interventional objective. Monitoring of radiation exposure of patients provides critical information for health care professionals and authorities who are responsible for ensuring justified and optimized use of radiation in medicine. This Safety Report provides guidance on recording, collecting and analysing relevant patient exposure data by using manual or automatic means. An aim of the publication is to encourage the future use and development of automatic digital systems to improve access to information about patient radiation exposure and thus contribute to improved implementation of the requirements for radiation protection of patients throughout the world.

• 1. INTRODUCTION
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. PATIENT RADIATION EXPOSURE MONITORING GOALS AND STRUCTURE
  • 2.1. Goals of patient radiation exposure monitoring in medical imaging
  • 2.2. Elements of patient radiation exposure monitoring and terminology
• 3. COMPONENTS OF PATIENT RADIATION EXPOSURE DATA
  • 3.1. Image acquisition and processing parameters
  • 3.2. Radiation exposure metrics
    • 3.2.1. Modality-specific metrics
    • 3.2.2. Size-specific metrics
    • 3.2.3. Organ doses
    • 3.2.4. Effective dose and other risk estimates
  • 3.3. Image quality metrics
    • 3.3.1. Phantom based image quality
    • 3.3.2. Patient based image quality
    • 3.3.3. Clinical risk index
  • 3.4. Overall patient risk
• 4. PATIENT RADIATION EXPOSURE MONITORING WORKFLOW
  • 4.1. Recording of patient radiation exposure data
  • 4.2. Collecting patient radiation exposure data
  • 4.3. Analysing and reporting patient radiation exposure data
• 5. RECORDING PATIENT RADIATION EXPOSURE DATA
  • 5.1. Patient radiation exposure data to be recorded
  • 5.2. Methods of recording patient radiation exposure data
    • 5.2.1. Automated versus manual data recording
    • 5.2.2. DICOM Standard
    • 5.2.3. IHE profile
• 6. COLLECTION OF PATIENT RADIATION EXPOSURE DATA
  • 6.1. Techniques for collecting patient radiation exposure data
  • 6.2. Definition of the patient exposure data cohort
  • 6.3. Classification of medical radiological procedures
    • 6.3.1. General features of classification and coding systems for medical procedures
    • 6.3.2. Practical examples of classification and coding systems for medical procedures
• 7. ANALYSING PATIENT RADIATION EXPOSURE DATA
  • 7.1. Optimization of protection and practice consistency
    • 7.1.1. DRLs and typical values
    • 7.1.2. Protocol- and size-specific dose boundary range
    • 7.1.3. Consistency analyses
    • 7.1.4. Tracking frequency of equipment utilization
    • 7.1.5. Protocol discrepancy and optimization
  • 7.2. Individual patient exposure analysis
    • 7.2.1. Setting and using trigger and alert levels
    • 7.2.2. Outlier identification
    • 7.2.3. Special patients
    • 7.2.4. Unintended and accidental exposures
    • 7.2.5. Tracking patient exposure history
  • 7.3. Supporting the process of justification and appropriateness
  • 7.4. Population dose estimations
• 8. IMPLEMENTATION OF PATIENT RADIATION EXPOSURE MONITORING
  • 8.1. Organizational structure for patient radiation exposure monitoring
    • 8.1.1. Health care facility structure
    • 8.1.2. Multifacility, national or international structure
  • 8.2. Specifications and functionalities of a patient radiation exposure monitoring system
    • 8.2.1. Informatics
    • 8.2.2. Features
    • 8.2.3. Access
    • 8.2.4. Administration and support
  • 8.3. Quality control for data integrity in patient radiation exposure monitoring
    • 8.3.1. Calibration and quality control
    • 8.3.2. Integrity in data recording, collection and analysis
  • 8.4. Training and communication in patient radiation exposure monitoring
  • 8.5. Integration of a digital patient radiation exposure monitoring system with other health care systems
  • 8.6. Priorities for implementation of a patient radiation exposure monitoring system
  • 8.7. Obstacles and challenges in implementing patient radiation exposure monitoring
• APPENDIX
• REFERENCES
• GLOSSARY
• LIST OF ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW