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Optimizing Dose or Image Quality – What’s Your Priority?

The emphasis today in reducing radiation dose to the imaged patient has grown to a fever pitch. Beginning in 2016 imaged patient billing reimbursement mandates related to dose reduction have been driven by Center of Medicaid and Medicare Services (CMS) with linkage to CT and general radiography. But what real effect does dose play on the adult patient population? Very little and the radiobiologists community will confirm that fact. The real emphasis and push to reduce dose resides especially with the pediatric population which makes all the sense in the world. Let us not forget the sensitivity of the imaged pediatric patient – a developing human being whose body cells, organs and growth pattern can be susceptible to the harmful dangers of excessive ionizing radiation.

The focus on clinical dose optimization as a reduction mindset does come with a trade-off regarding image quality. Sure, the significant advances in technology, software and new application techniques enable quality imaging of the patient but is it as “crisp” and “clean” as compared to when a higher dose is applied? Probably not. A “hotter” image can do wonders in cancelling out “noise” that many times is prevalent when dose reduced techniques are applied.

The good news is that imaging technology continues to advance the equipment used in the clinical environment. Image capture through flat panel detectors and algorithms designed to reduce exposure are truly breakthroughs of our day. With all of this advancement, however, there still seems to be a high decile ratio of radiologist that are saying, “optimization of image quality not dose should be the emphasis.” The ability to “read” the image clearly and accurately is the main concern of the “reading radiologist” and the generally preferred method of radiologista to achieve this – increase the dose!


Alan has been in the Clinical Engineering industry for 29+ years having served directly in the academic, governmental and community hospital settings. Alan’s career has spanned from imaging/ biomedical engineer to Director of Clinical Engineering. Alan currently serves today at the Vice President and Senior Advisor level with a leading medical equipment consultative and asset management firm.



1 Comment

  1. Bob Burbury

    General Purpose X-Ray Systems Even Portable & Mobile Machines have varying dose to the patient differences,even at the same technique kV and mAs settings.
    To make sure the optimum image quality and resolution is produced we forget about the quality of the x-ray beam from the x-ray tube HVL. Many older systems produce soft radiation that is absorbed by the patient and and is not
    useful in producing a sharp crisp image. If USA would adapt the DAP (dose area product system to our collimators we could begin to be aware of what dose rates we are producing to each patient. This information could be part of each digital image record.


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