Radiation dose optimization in radiology is a critical aspect of modern healthcare, aimed at balancing the necessity of diagnostic imaging with the imperative of patient safety. This comprehensive review explores the fundamental principles, techniques, and considerations in optimizing radiation dose to safeguard patients while preserving image fidelity. Beginning with acknowledging the inherent risks associated with medical radiation exposure, the review highlights strategies such as the As Low as Reasonably Achievable (ALARA) principle, technological advancements, and quality assurance measures to minimize radiation dose without compromising diagnostic accuracy. Regulatory guidelines and the importance of patient education and informed consent are also discussed. Through a synthesis of current knowledge and emerging trends, the review underscores the pivotal role of radiation dose optimization in radiology practice. Furthermore, it emphasizes the need for ongoing research and collaboration to advance dose reduction strategies, establish standards for radiation safety, and explore personalized dose optimization approaches. By prioritizing radiation dose optimization, healthcare providers can ensure the highest standards of patient care while minimizing potential risks associated with medical radiation exposure.

OBJECTIVE: In pediatric musculoskeletal disorders, a distinction is made between normal and abnormal development.
METHODS: X‑ray examination is the standard diagnostic procedure.
UNASSIGNED: Cross-sectional imaging, such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (US) are increasingly used.
METHODS: X‑ray imaging is still the examination method of choice but can be supplemented by cross-sectional imaging depending on clinical situation.
RESULTS: Cross-sectional imaging is helpful and necessary in many cases but significantly more time-consuming and costly than x‑ray examinations.
CONCLUSIONS: Initially standard x‑rays should be taken, which can then be supplemented with cross-sectional imaging depending on the result and clinical question (MRI and US are preferred as there is no radiation).
UNASSIGNED: KLINISCHES/METHODISCHES PROBLEM: Bei den pädiatrischen Entwicklungsstörungen wird zwischen einer normalen und einer pathologischen Entwicklung unterschieden.
UNASSIGNED: Die Röntgenuntersuchung stellt das diagnostische Standardverfahren dar.
UNASSIGNED: Zunehmend kommt auch die Schnittbilddiagnostik, wie Magnetresonanztomographie (MRT), Computertomographie (CT) und Sonographie, zum Einsatz. LEISTUNGSFäHIGKEIT: Die Röntgenaufnahme stellt nach wie vor die Untersuchungsmethode der ersten Wahl dar, jedoch kann diese je nach Fragestellung durch eine Schnittbilddiagnostik ergänzt werden.
UNASSIGNED: Die Schnittbilddiagnostik erweist sich in vielen Fällen hilfreich und notwendig, ist aber deutlich aufwendiger als die Röntgenuntersuchung. EMPFEHLUNG FüR DIE PRAXIS: Zunächst sollte eine Röntgenaufnahme angefertigt werden, die dann abhängig von Ergebnis und Fragestellung durch ein schnittbildgebendes Verfahren ergänzt werden kann, bevorzugt MRT und Sonographie, da diese nicht mit einer Strahlenbelastung einhergehen.

Wearing lead aprons and thyroid collars for long periods of time has a subjective component: to balance the effective dose reduction with the effort of carrying a heavy load. Occupational radiation exposure has decreased dramatically in the last century within the health care system. During the same period the use of lead aprons and thyroid collars has also gone up. Therefore, a question that may be raised is: how safe is safe enough? In order to promote stakeholder involvement, the aim of the present study was to investigate staff\'s experience of discomforts associated with wearing lead aprons and thyroid collars for long periods of time, and also to investigate staff\'s willingness to tolerate personal dose equivalent (expressed as radiation dose) and the corresponding increase in future cancer risk to avoid wearing these protective tools. A questionnaire was developed and given to staff working in operating or angiography rooms at Skaraborg Hospital in Sweden. The results from the 245 respondents showed that 51% experienced bothersome warmth, 36% experienced fatigue and 26% experienced ache or pain that they believed was associated with wearing lead aprons. One third of the respondents would tolerate a personal dose equivalent of 1 mSv per year to avoid wearing lead aprons, but only a fifth would tolerate the corresponding increase in future cancer risk (from 43% to 43.2%). In conclusion, discomforts associated with wearing lead aprons and thyroid collars for long periods of time are common for the staff using them. At the same time, only a minority of the staff would tolerate a small increase in future cancer risk to avoid wearing them. The present study gives an example of stakeholder involvement and points at the difficulties in making reasonable decisions about the use of these protective tools.

BACKGROUND: Ultrasound tends to produce biological effects on body tissues. Therefore, the application of ultrasound safety rules is needed in all ultrasound examinations to avoid bioeffects that may occur because of a high thermal index (TI) and mechanical index (MI). This study aimed to explore the Saudi sonographers\' awareness of ultrasound safety and bioeffects.
METHODS: A descriptive cross-sectional study was conducted, and the data was collected using an online survey google forms questionnaire disseminated through social media (Telegram, WhatsApp, and Twitter) as an electronic link. A total of 70 participants responded to the survey directly, and then, the data was analyzed using SPSS (Statistical Package for Social Science).
RESULTS: Regarding the awareness of TI and MI, 64.3% of the participants were aware of TI and 65.7% of MI as safety ultrasound indices; moreover, 74.3% of the participants were aware of the ALARA principle \"As Low as Reasonably Achievable.\" Participants\' knowledge concerning more heat production in pulsed Doppler ultrasound modes was poor (31.5%). Most of the sonographers, i.e., 77.1% were aware of the relationship between the risk of activation and MI, and 58.6% of the participants were acquainted with the current FDA output limits. In comparison, 58.6% of the participants were aware of the bioeffects of ultrasound contrast agents. There was no significant correlation between the educational level and the degree of awareness of ultrasound bioeffects and safety (P-value> 0.05).
CONCLUSIONS: In this study, it was found that sonographers were aware of the theoretical principles of ultrasound safety indices and the ALARA principle, although they had poor knowledge of ultrasound bioeffects in Doppler mode.

Ionising radiation stands as an indispensable protagonist in the narrative of medical imaging, underpinning diagnostic evaluations and therapeutic interventions across an array of medical conditions. However, this protagonist poses a paradox - its inestimable service to medicine coexists with an undercurrent of potential health risks, primarily DNA damage and subsequent oncogenesis. The narrative of this comprehensive review unfurls around this intricate enigma, delicately balancing the indispensable diagnostic utility against the non-negotiable commitment to patient safety. In this critical discourse, the intricacies of ionising radiation are dissected, illuminating not only its sources but also the associated biological and health hazards. The exploration delves into the labyrinth of strategies currently deployed to minimise exposure and safeguard patients. By casting light on the scientific nuances of X-rays, computed tomography (CT), and nuclear medicine, it traverses the complex terrain of radiation use in radiology, to promote safer medical imaging practices, and to facilitate an ongoing dialogue about diagnostic necessity and risk. Through a rigorous examination, the pivotal relationship between radiation dose and dose response is elucidated, unravelling the mechanisms of radiation injury and distinguishing between deterministic and stochastic effects. Moreover, protection strategies are illuminated, demystifying concepts such as justification, optimisation, the As Low As Reasonably Achievable (ALARA) principle, dose and diagnostic reference levels, along with administrative and regulatory approaches. With an eye on the horizon, promising avenues of future research are discussed. These encompass low-radiation imaging techniques, long-term risk assessment in large patient cohorts, and the transformative potential of artificial intelligence in dose optimisation. This exploration of the nuanced complexities of radiation use in radiology aims to foster a collaborative impetus towards safer medical imaging practices. It underscores the need for an ongoing dialogue around diagnostic necessity and risk, thereby advocating for a continual reassessment in the narrative of medical imaging.

BACKGROUND: Three-dimensional (3D) navigation has become routinely used in spine surgery, allowing more accurate and safe procedures. However, radiation exposure related to the use of imaging is an unresolved issue, and information about it is relatively scarce. The \"as low as reasonably achievable\" (ALARA) principle aims to reduce the radiation exposure for the patients as low as possible. The objective of this study was to compare the effective dose related to the use of the O-arm in standard settings with adapted features for dose reduction during percutaneous cementoplasty.
METHODS: From March 2021 to October 2022, all consecutive patients who underwent navigated percutaneous cementoplasty with the use of the O-arm were prospectively included. Demographic, operative, irradiation, and radiological data were collected. The main outcome was the effective dose (E) in millisievert (mSv). Secondary outcomes were the absolute risk of cancer (AR) in percent equivalent to a whole-body exposition, operative time, and radiological results according to Garnier. In group A, patients were operated on with standard settings of the O-arm, whereas in group B, navigation on the field of view, collimation, and low-dose settings were used.
RESULTS: A total of 70 patients were included in the study: 43 in group A and 27 in group B. Also, 109 vertebrae were operated: 59 in group A and 50 in group B. Mean E was significantly higher in group A than in group B (9.94 and 4.34 mSv, respectively; P < 0.01). The 3D-related E followed the same trend (7.82 and 3.97 mSv, respectively), as did 2-dimensional-related E (2.12 and 0.37 mSv, respectively; P < 0.01). Average AR was also significantly higher in group A than in group B (5.10-4% and 2.10-4% respectively; P < 0.01). Operative time was similar in both groups, but the rate of satisfactory radiological results was higher in group A than in group B (95% and 84%, respectively; P = 0.11), and we found similar rates of cement leakage (22% and 24%, respectively; P = 0.71).
CONCLUSIONS: The application of settings of the O-arm in accordance with the ALARA principle helped to significantly reduce the radiation exposure and should be routinely used for O-arm-assisted cementoplasty procedures.
CONCLUSIONS: This study details technical aspects and settings that may help users of the O-arm to decrease radiation exposure to patients and surgeons alike, especially in cementoplasty procedures, as well as in other procedures performed under O-arm guidance.
METHODS:

The Council Directive 2013/59/Euratom has introduced binding requirements for the management of radon in the workplace in Member States of the European Union. How does it work in practice? In 2021, the European ALARA Network created a working group on ALARA for Radon at Work with the objective of collecting and sharing experiences from the field. A survey was developed to detail each step of the national regulations for the control of radon and to describe case studies showing implementation. This article presents a qualitative analysis of the answers received from seven countries. There are no two similar national regulations and, at each step, different provisions, protocols, techniques etc are applicable or recommended. This diversity contributes to the richness of the results and can inform about interesting and good practices, where \'good\' is defined by what is appropriate in the nationally and locally prevailing circumstances. All national regulations follow a graded approach, which is a key component for the implementation of the optimisation (ALARA) principle, yet several potential weak points that may be challenging to ALARA have been identified and are discussed, namely the radon risk assessment, the focus on numerical values, uncertainties in the measurement, how to obtain economically efficient remediation, and the interface with other regulations. Strengthening collaboration between risk prevention and radiation protection actors could help to provide and build expertise on radon management in the workplace, especially when exposure is managed as a planned exposure situation.

This retrospective study provides an insight into the levels of radiation exposure of six nuclear medicine (NM) staff (four technologists and two nurses) performing routine diagnostic 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) at the University Clinical Centre of the Republic of Srpska, Department of Nuclear Medicine and Thyroid Disorders, Banja Luka, Bosnia and Herzegovina. Data analysis included monthly staff exposure measured with personal thermoluminescent dosimeters (TLD) between June and December 2018, quantified in terms of normalised dose for the whole body [Hp(10)] and dominant hand [Hp(0.07)] and their comparison between each staff member and between the two groups (technologists and nurses). The study goal was to establish how our Department compared with reports from other PET/CT centres worldwide in terms of annual number of procedures and exposure limits and whether there could be room for further improvements in radiation protection. The number of procedures rose considerably from 208 in 2016 to 876 in 2019 and was 423 in the observed seven-month period. Mean individual whole-body exposure dose per GBq of injected 18F-FDG activity, [Hp(10)/A] was 18.55 μSv/GBq for the four technologists and 15.61 μSv/GBq for the two nurses. Mean dominant-hand exposure dose per GBq of injected 18F-FDG activity [Hp(0.07)/A] was 16.99 μSv/GBq and 25.44 μSv/GBq for the two groups, respectively. The average annual cumulative dose for all staff was (1.06±0.29) mSv for Hp(10) and (1.15±0.32) mSv for Hp(0.07). These results are comparable with those of similar studies. Staff doses were well below the annual limits. Nurses received slightly higher extremity doses than technologists. In view of the increasing trends in the number of PET/CT procedures, dose monitoring should be continued to identify exposure hotspots and maintain doses as low as possible.
Ova retrospektivna studija pruža uvid u razinu izloženosti ionizirajućem zračenju za šestero zaposlenih (četiri radiološka tehničara i dvije medicinske sestre) koji izvode rutinska dijagnostička ispitivanja primjenom 18F-FDG na PET/CT-u u Kliničkom zavodu za nuklearnu medicinu i bolesti štitne žlijezde Univerzitetskoga kliničkog centra Republike Srpske (Banja Luka, Bosna i Hercegovina). Analiza podataka obuhvatila je mjesečnu izloženost osoblja, koja je od lipnja do prosinca 2018. mjerena osobnim termoluminiscentnim dozimetrima (TLD-ima), a izražena je normaliziranom dozom za cijelo tijelo [Hp(10)] te dozom za dominantnu ruku [Hp(0,07)]. Također, u obzir je uzeta i usporedba tih veličina između svakoga člana osoblja te između dviju skupina (radiološki tehničari i medicinske sestre). Cilj studije bio je usporediti izvješća našega Zavoda i drugih PET/CT centara u svijetu u pogledu godišnjega broja postupaka, granica izloženosti osoblja te mogućnosti uvođenja dodatnih poboljšanja mjera zaštite od zračenja. Ustanovljeno je da se broj postupaka znatno povećao (s 208 u 2016. na 876 u 2019. godini), a tijekom praćenoga sedmomjesečnog razdoblja iznosio je 423. Srednja vrijednost pojedinačne doze za cijelo tijelo po jedinici aplicirane aktivnosti 18F-FDG [Hp(10)/A] iznosila je 18,55 μSv/GBq za četvero radioloških tehničara i 15,61 μSv/GBq za dvije medicinske sestre. Srednja vrijednost doze za dominantnu ruku po jedinici aplicirane aktivnosti 18F-FDG [Hp(0,07)/A] iznosila je 16,99 μSv/GBq i 25,44 μSv/GBq za te dvije skupine. Srednja vrijednost godišnje kumulativne doze za svih šestero zaposlenih iznosila je (1,06±0,29) mSv za Hp(10) i (1,15±0,32) mSv za Hp(0,07). Ovi su rezultati usporedivi s rezultatima sličnih studija. Doze za osoblje bile su znatno ispod propisanih godišnjih limita. Medicinske sestre imale su nešto više vrijednosti doza za ekstremitete (ruke) nego radiološki tehničari. Imajući u vidu tendenciju povećanja broja PET/CT postupaka, potrebno je nastaviti monitoring doza za osoblje kako bi se identificirale faze radnoga procesa koje dovode do najveće izloženosti osoblja, a zatim smanjile doze za osoblje.

The aim of the present study was to demonstrate cases of cost-benefit analysis within healthcare, of how economic factors can be considered in occupational radiological protection, in agreement with the as low as reasonably achievable principle and present Swedish legislations. In the first part of the present study, a comparison of examples within health economics used by authorities and institutes in Sweden was made. The comparison focused on value of a statistical life, quality-adjusted life year, and monetary cost assigned to a unit of collective dose for radiation protection purposes (α-value). By this comparison, an α-value was determined as an interval between $45 and $450 per man-mSv, for the Swedish society in 2021. The α-value interval can be interpreted as following: Less than $45 per man-mSv is a good investment. From $45 to $450 per man-mSv, other factors than costs and collective dose are important to consider. More than $450 per man-mSv is too expensive. In the second part of the present study, seven cases of cost-benefit analyses in occupational radiological protection were provided. The present study focused specifically on cases where the relevant factors were costs and collective dose. The present case study shows a large variation in costs per collective dose from different types of occupational radiological protection, used at Skaraborg Hospital in Sweden.

Computed tomography (CT) is a key imaging technique in diagnostic radiology, providing highly sensitive and specific information. While its use has increased dramatically in recent years, the quantity and associated risks of radiation from CT scans present major challenges, particularly in paediatrics. The fundamental principles of radiation protection require that radiation quantities be as low as reasonably achievable and CT use must be justified, particularly for paediatric patients. CT radiation knowledge is a key factor in optimising and minimising radiation risk. The objective of this study was to analyse knowledge level, expertise, and competency regarding CT radiation dose and its hazards in paediatrics among radiologists in Saudi Arabian hospitals. A self-reported, multiple-choice questionnaire assessed the attitudes and opinions of radiologists involved in imaging studies using ionising radiation. Among the total respondents, 65% ± 13.5% had a good comprehension of the dangers of carcinogenicity to the patient resulting from CT scans, with 80% presuming that cancer risks were elevated. However, only 48.5%, 56.5%, and 65% of the respondents were aware of specific radiation risks in head, chest, and abdominal paediatric examinations, respectively. Regular, frequent, and specific training courses are suggested to improve the fundamental knowledge of CT radiation among radiologists and other physicians.