医学影像的使用继续增加,对全球人工辐射源的人群暴露做出了最大的贡献。保护优化的原则是,发生暴露的可能性,暴露的人数,和他们的个体剂量的大小都应保持在合理可实现的低(ALARA),考虑到经济和社会因素。医学成像的优化涉及的不仅仅是ALARA-它需要将患者个体暴露保持在最低限度以实现所需的医学目标。换句话说,类型,number,图像质量必须足以获得诊断或干预所需的信息。如果图像质量降低到图像不足以用于临床目的,则不应该使用成像或X射线图像引导程序的剂量减少。向数字成像的转变提供了通用的采集,后处理,和演示选项,并实现了图像信息的广泛且通常立即的可用性。然而,因为调整图像以获得最佳观看效果,如果剂量高于必要,外观可能不会给出任何指示。然而,数字图像提供了进一步优化的机会,并允许人工智能方法的应用。优化数字放射学的放射防护(射线照相术,透视,和计算机断层扫描)涉及设备的选择和安装,设施的设计和施工,选择最佳设备设置,日常操作方法,质量控制方案,并确保所有人员接受适当的初始和职业生涯培训。患者接受的辐射剂量水平也对工作人员的剂量产生影响。随着新的成像设备包含更多选项来提高性能,它变得更复杂,更不容易理解,所以操作员必须接受更广泛的培训。持续监测,review,和性能分析需要反馈到成像协议的改进和发展。本出版物中阐述了与需要开发的保护优化相关的几个不同方面。首先是放射科医生/其他放射科医生之间的合作,放射技师/医疗放射技师,和医学物理学家,每个人都有关键技能,只有当个人作为核心团队一起工作时,才能有效地促进这一过程。二是适当的方法和技术,具有有效使用每一种所需的知识和专业知识。第三个涉及确保所需任务的组织过程,如设备性能测试,患者剂量调查,和协议的审查,进行了。设备变化很大,资金,和世界各地的专业知识,大多数设施没有所有的工具,专业团队,和专业知识,以充分拥抱优化的所有可能性。因此,本出版物对不同设施可能实现的优化方面进行了广泛的阐述,通过它他们可以逐步进步:D级——初级;C级——基本;B级——中级;A级——高级。专业协会的指导对于帮助用户评估系统和采用最佳实践非常宝贵。列出了为实现不同级别应采取的系统和活动的示例。然后成像设施可以评估他们已经拥有的安排,并使用此出版物指导有关优化其成像服务的下一步行动的决策。
Use of medical imaging continues to increase, making the largest contribution to the exposure of populations from artificial sources of radiation worldwide. The principle of optimisation of protection is that \'the likelihood of incurring exposures, the number of people exposed, and the magnitude of their individual doses should all be kept as low as reasonably achievable (ALARA), taking into account economic and societal factors\'. Optimisation for medical imaging involves more than ALARA - it requires keeping individual patient exposures to the minimum necessary to achieve the required medical objectives. In other words, the type, number, and quality of images must be adequate to obtain the information needed for diagnosis or intervention. Dose reductions for imaging or x-ray-image-guided procedures should not be used if they degrade image quality to the point where the images are inadequate for the clinical purpose. The move to digital imaging has provided versatile acquisition, post-processing, and presentation options, and enabled wide and often immediate availability of image information. However, because images are adjusted for optimal viewing, the appearance may not give any indication if the dose is higher than necessary. Nevertheless, digital images provide opportunities for further optimisation, and allow the application of artificial intelligence methods.Optimisation of radiological protection for digital radiology (radiography, fluoroscopy, and computed tomography) involves selection and installation of equipment, design and construction of facilities, choice of optimal equipment settings, day-to-day methods of operation, quality control programmes, and ensuring that all personnel receive proper initial and career-long training. The radiation dose levels that patients receive also have implications for doses to staff. As new imaging equipment incorporates more options to improve performance, it becomes more complex and less easily understood, so operators have to be given more extensive training. Ongoing monitoring, review, and analysis of performance is required that feeds back into the improvement and development of imaging protocols. Several different aspects relating to optimisation of protection that need to be developed are set out in this publication. The first is collaboration between radiologists/other radiological medical practitioners, radiographers/medical radiation technologists, and medical physicists, each of whom have key skills that can only contribute to the process effectively when individuals work together as a core team. The second is appropriate methodology and technology, with the knowledge and expertise required to use each effectively. The third relates to organisational processes which ensure that required tasks, such as equipment performance tests, patient dose surveys, and review of protocols, are carried out. There is wide variation in equipment, funding, and expertise around the world, and the majority of facilities do not have all the tools, professional teams, and expertise to fully embrace all the possibilities for optimisation. Therefore, this publication sets out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally: Level D - preliminary; Level C - basic; Level B - intermediate; and Level A - advanced. Guidance from professional societies can be invaluable in helping users to evaluate systems and aid in adoption of best practice. Examples of systems and activities that should be in place to achieve the different levels are set out. Imaging facilities can then evaluate the arrangements they already have, and use this publication to guide decisions about the next actions to be taken in optimising their imaging services.