Management of pediatric radiation dose using Canon digital radiography

A Canon CXDI-11 digital radiography (DR) system has been in use at Shands Hospital at the University of Florida for the past 2 1/2 years. A first clinical implementation phase was utilized to develop imaging protocols for adult patients, with a second phase incorporating pediatric chest and abdominal studies a few months later. This paper describes some of the steps taken during the modality implementation stages, as well as the methodologies and procedures utilized to monitor compliance by the technologists. The Canon DR system provides the technologist with an indication of the radiation exposure received by the detector (and thus of the patient dose) by means of an indirect exposure level number called the reached exposure (REX) value. The REX value is calculated by the system based on the default grayscale curve preselected for a given anatomical view and used by the system to optimize the appearance of the image. The brightness and contrast of the image can be modified by the user at the QC/control screen for the purpose of improving the appearance of the image. Such changes modify the actual grayscale curve (position and slope, respectively) and thus the calculated REX value. Thus, undisciplined use of the brightness and contrast functions by the technologist can render the REX value meaningless as an exposure indicator. The paper also shows how it is possible to calibrate AEC (phototimer) systems for use with the Canon DR system, and utilize the REX value as a valuable dose indicator through proper training of technologists and strict, disciplined QC of studies. A team consisting of the site's medical physicist, radiologists, and technologists, as well as Canon engineers, can work together in properly calibrating and setting up the system for the purposes of monitoring patient doses (especially pediatric) in DR studies performed in a Canon DR system.