Digital radiology technology has improved many work outcomes since its inception.? Faster exam times, lower overall patient dose and the ability to post-process images makes digital radiography very attractive.?
But how did you learn to operate digital radiography equipment? Were you trained by the equipment vendor when it was installed? Did you attend a conference or workshop? Perhaps you gained this knowledge during your formal radiography program. Depending on how many years you have been in the profession, any of the previously mentioned training options are possible.?
I want to challenge you to do some of your own research, especially if you were taught by the vendor that sold the equipment to your department.? Many professionals are not using the equipment to the best of its potential, which can lead to increased patient doses, compromised image quality, and even misdiagnosis.? Here are some common errors I’ve observed in radiology departments:?
- Using a kVp lower than what is recommended, due to being “stuck” in the film/screen techniques.???
- Cropping or masking images instead of utilizing collimation to limit the beam, thus removing legal medical information from the image before sending it to MIMPS/PACS.?
- Altering the window level/window width on the image prior to sending it for a radiologist reading without reverting back to the original, unaltered image.?
- Not using lead anatomic markers when taking the radiograph and just adding it during post-processing.?
- Using excessively high mAs because the system can correct overexposure, but not underexposure.?
The things listed above are definitely NOT taught in a formal radiography program, nor are they included in the American Society of Radiologic Technologists (ASRT) practice standards.? Why are they problematic you ask?? Well, let’s take a closer look!?
- Using a suboptimal kVp means you are using a mAs higher than what is needed, thus increasing patient dose.? kVp no longer controls overall image contrast, that is controlled by the system Look Up Table.? So, increase your “old” kVp by 15% and cut your mAs in half to reduce patient dose while still maintaining image quality.? One example is using 90-100 kVp on a lumbar spine.? I used to use no more than 80 with film/screen, but the images look the same at 90, so why not cut that dose in half??
- Masking or cropping anatomy visible on the monitor before sending the image for reading is actually illegal, as it removes part of the medical record. You are removing part of the medical record.? There are documented cases of instances where this led to litigation due to mis-diagnosis due to the lost anatomic information.?
- Altering the window level/width removes the radiologist’s ability to get the full picture. When you “take out” this information, you limit their ability to adjust the image to make the diagnosis.? Reverting to the unaltered image so they can alter it when reading is the best way to do this.? Nothing wrong with adjusting what you are seeing to make sure the information is visible, just make sure to reset to the original image before saving.?
- Using lead anatomic markers during the radiograph is essential for accuracy and legality in imaging. Lead markers provide a reliable record of laterality (left/right) and time of imaging, which cannot be authentically recreated in post-processing. Digital markers added afterward can be prone to error or alteration, which may lead to misinterpretation or even legal issues if an error affects diagnosis or treatment. Consistently using lead markers at the time of exposure upholds the integrity of the medical record and aligns with industry standards, ensuring a clear, accurate image for radiologist interpretation.?
- Dose creep has been an issue since digital imaging started. Sometimes we tend to get lazy and just say, “just double the mAs, I don’t want to chance repeating it”.? This approach is unethical, and I doubt you’d do it if your own family member were on the exam table. As trained, credentialed professionals, we should have the knowledge and confidence to make sound decisions about radiographic technique.?
If you feel you need more education on these topics, please seek it out!? Make sure you are practicing like the trained and credentialed technologist you are so that you can take pride in your work and better serve your patients!?
Author: Cindy Kramer, MA Ed., R.T. (R)(QM)?
