Dose optimisation from CR to DR: A paediatric perspective

In 2017, the first DR X-ray system was installed in the OPD of a Paediatric Hospital, where it was primarily used for extremity and orthopaedic work. A second was installed in 2018 when the main X-ray room in Radiology was upgraded from CR to DR. A preliminary dose audit from procedures conducted in the OPD DR room was undertaken and compared with values from another paediatric hospital. The audit concluded that the exposure parameters and protocols used required adjustment in order to improve dose optimisation for paediatrics. To achieve this, Medical Physics, from both hospitals, worked with the service engineer to calibrate the AEC system. They also liaised with radiographers and the application specialist to ensure protocols were set up to suit paediatric patients, following manufacturer and published guidelines. This included the addition of 0.1mm of copper to all truck examinations. After the first month of use, and further adjustments to settings, a follow up dose audit was undertaken. This showed a significant reduction in DAP values while ensuring diagnostic image quality was maintained. Good agreement was also found with DAP measurements from the other paediatric hospital. Further follow up audits are required for the different X-ray procedures in order to provide a more comprehensive cross site comparison. Once clinical and medical physics staff are satisfied that adequate dose optimisation has been achieved, the exposure factors will be applied across all future paediatric sites. This will ensure a high standard of care and dose optimisation for paediatric patients in Ireland.