1. Introduction

The advancement of science and technology has resulted in the revolution of the field of medicine. Today, hospitals are able to make more accurate diagnosis and prognosis thanks to the electronic devices engineered to test the functionality of the human body. Although this is a major highlight in the medical field, electronic gadgets are associated with radiation. As such, continuous use may present massive danger to patients as well as the examining medical practitioner. Dose creep is classified as the seventh most dangerous hospital health hazards. Dose creep is a radiation hazard that results from continuous exposure to high levels radiation. It is a common consequence that arises when the practitioners use more radiation in developing defined imaging for diagnostic radiography. Although there are no immediate threats to the patients’ health, continuous exposure creates a buildup of radiation that may have a long term effect on the patients’ health. Fortunately, as technology continues to advance healthcare facilitates are able to find remedies to such hazards. Dose creep occurs as unpreventable consequence of transition from film to digital detectors in providing radiography diagnosis. Most digital imaging technology uses ionizing radiation to be able to penetrate within the skin and develop high resolution imaging. However, this result in massive exposure to higher doses of radiation that may result in the development of cancer among other associated risks. Therefore, medical practitioners are advised to employ the use of the lowest dose possible to achieve the intended diagnostic results. As such, it should just the right amount radiation to create the prefect quality diagnostic image.

2. Dose Creep

This refers to the unintentional exposure of patients to radiation.

 

2.1 What is Dose Creep

 

Dose creep is a radiation hazard that occurs unintentionally when a patient is exposed to high levels of radiation. Ionizing radiation is used to provide imaging and medical diagnostic. However, in huge doses radiation puts patients at risk of medical complications. Dose creep exposes patients to higher levels of radiation than intended especially when more precise diagnostics are required. Apart from patients, medical practitioners are also at risk to the exposure of radiation when carrying out the examination. Thus, the need for practitioner to only employ the amount radiation necessary and recommended by the institution.

 

2.2.1    How does creep differ in film radiography and digital radiography

Film radiography refers to the traditional system of conduct x ray. It involves the use of photosensitive films. Digital radiography are modern systems that use of digital detectors in developing images

 

2.2.2   Exposure creep in film radiography

X rays are among the most common techniques of body imaging used by medical institution to provide diagnostics for internal body complications. X ray employ the use of films to produce images from dark rooms. Exposure creep in film based radiography gradual increases with continuous exposure of the patient to increased radiation dosage. Dose creep in film radiography is associated with computed radiography and direct radiography. Nonetheless, when the radiation is too high or too low, then the imaging may be unusable due to the lack of precision. As such, it is easier for the radiographer to detect changes in the exposure index by viewing the film.  Film radiography requires optimal exposure to ensure the imaging is comprehensive. One of the most essential requirements for the implementation of CR in film radiography is the reduction of patient’s radiation dose. Eliminating dose creep is very essential in producing the right results for film radiography.

5.1.1    Exposure creep in digital radiography

Digital radiography produces better images when radiation exposure is increased. Thus, increase in dose creep results in better diagnostics. However, compared to film radiography, digital radiography require relative lower rates of radiation to produce comprehensive imaging. Nonetheless, most radiographers are bound to increase dosage when carrying out digital radiography to produce better images as well as reduce the noise associated with low levels of radiation. However, this creates a huge risk for both patients and practitioners if continuously repeated over time.

5.1.2    Digital detectors compared to conventional screen film systems

Most health institutions are transitioning from screen film systems to digital detectors in producing X- ray imaging. Digital detectors are more convenient compared to screen film systems. They do not produce as much radiation, images are develop instantly unlike screen films that take time to process. Digital detectors are environmental friendly and cost effective, unlike screen films that are expensive and subject to errors.

 

 

5.1.3    Methods followed to reduce dose creep in film and digital radiography

These are the techniques that can be employed to reduce dose creep in both film and digital radiography.

Hospital are encouraged to use the newest and advanced technology in carrying out radiography. Newer technology present more heightened detector sensitivity that produces less noise and results in proper image development due to improved detective quantum efficiency (DQE).

The use of modern digital image processors fitted with noise reduction processors result in reduced noise as such there is no need for increased dose.

Hospitals are also encouraged to use electronics whose manufacturers have already set a standard Exposure Index value, this makes tracking easier.

Use of machines with Automatic Exposure Control (AEC) for X ray, this allows regulation and constituent application of standard dose.

Practitioners are also required to follow the ALARA principle (As Low as Reasonably achievable) as a regulatory measure.

 

 

 

 

1.1    Cause of dose creep (250)

Dose creep may be as a result of the human error. The practitioner has the mandate to apply the ALARA principle in using the required amount of radiation. There are instance when one when overexpose or underexpose a patient to radiation.

The technological causes of dose creep

 

 

Dose creep majorly results from technological issues. There is not stipulated industrial measure of EI, as such different manufacturers of X ray machines provide different measures for exposure indicator. Some machines provide measures in real time whereas other display measures before the machine is switched on.  Therefore since technologists have a difficult time establishing the accurate measures, they cannot determine the appropriate exposure index. This may result in underexposure or overexposure to radiation especially for digital radiography.

5.1.4    How is the workplace culture related to dose creep

In most instance, dose creep is as a result of human error as compared to workplace culture. Hospitals conventionally evaluate radiography competency with image clarity. Low radiation results in the production of duplicate images from the noise produced as the radiation penetrates the object.  Underexposure blurry imaging results in reprimand. As such, most practitioners would resolve to double the radiation to produce clear images. It is common to find radiologist adjust dosage levels to have clear views of the image quality. Unfortunately, this increases medical risks for patients and practitioners from the high exposure to radiation.

5.2    Balancing image quality and radiation risk in radiography (250)

Most hospital are in the process of transition from film radiography to digital radiography. Some few element of film radiography such as tube voltage, and current are also applied to digital radiography. Digital radiography unlike film radiography offers radiologist with varied options. In digital systems given the imaging parameter are optimized, then the dose can be reduced at the expense of image quality and comprehensive image will be produced. Digital systems are also fitted with dose monitors and indicators as a means of regulating the amount of dose required for the production of a clear image.

 

5.2.1    Estimating patient and organ doses

Although digital radiography offers more effective radiography diagnostics the risks of overexposure to radiation are greater. There is a need to carry out estimation of absorbed organ dose and effective dose to ensure the patient is not overexposed to unnecessary radiation. Practitioners must also measure patient’s weight and height, entrance surface dose (ESD).  ESD increases with increase in BMI.  Therefore smaller individuals absorb more voltage and radiation as compared to huge individuals. Organs such as ovaries and testicles are radiosensitive as such increased radiation dosages may have adverse effects on the individual’s health or result in cancer in the radiosensitive regions. As such, there is need to regulate organ dosage.

5.3    recommendation to lower the dose creep in radiography field (250)

There is growing concern on the agenda of medical radiation, with most medical practitioners suggesting the need to lower the levels of administered CT dosages. Dose creep from radiation exposure is a concern for many patients who do not desire to get much sicker than they were while trying to receive treatment.  The common perception is that most radiographers are increase radiation rates to develop image clarity without considering the long term health effects patients may be exposed to. The higher the radiation the clearer the image, result in few complaints from radiologists. Radiologists also increase radiation to avoid noises, however this is a challenge that can be tackled by adopting the use of advanced technologies. It is recommended that radiographers lower the dose creep to protect the patients as well as themselves from the effects of continuous exposure to radiation.

7. Exposure Indicators in DR (250)

Unlike the film radiography where exposure indicators are controlled by exposure factors such as light, image contrast and density, digital radiography produces clear images despite the inconsistency of exposure factors.  The digital image receptor is one of the most essential tool digital radiography. It assists in maintain visual connection with the image. The exposure indicator provides necessary feedback on the type of exposure provided by the image receptor. Over and under exposure results in incorrect reading on exposure indicator. For digital radiography systems the exposure indicator varies with manufacturing detail. The exposure indicator determines image accuracy. Among the most common used exposure indicators are REG, IgM, and S- number among others.  The exposure indicator can also be referred to as the exposure index (EI).

 

7.1    Exposure index

Digital systems are flexible, however, they present great risks of overexposure to radiation if not properly examined. The exposure index provides an indication or measurement of the exposure of radiation reaching the image detector.  Exposure index depends on the image processing technique, exposure to radiation and the type of radiation examination conducted. It is one of the determinants of image quality. Exposure index does not provide the figure on dose but indicate the exposure to radiation provided to the detector. Unfortunately, there is no standardized industrial measure of exposure index, as such technologist are bound to make errors, Therefore, there is need to develop uniformity in the use of radiographic equipment to promote improvements in radiography administration in institutions.

 

 

7.2    Target exposure index

Target Exposure Index refers to the amount of radiation passed through an object give the optimum conditions are maintained. This measure is provided by the hospital radiology center and the manufacturer of the X ray machine. The values obtained vary according to the procedure and examination done, the organ or part of the body under imaging, and the types of detector used. Target exposure Index ensures that the ALARA principle is applied by the radiologists.

 

 

7.3    Deviation Index

Deviation index are among the measures used to create standard measures of exposure index.  Deviation index similarly provides feedback of radiation exposure to radiologists by measuring noise. This measure is related to positioning, and movement of the object across the x ray machine. Deviation Index also quantifies the variation of exposure index in relation to the target index.

 

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