Radiology Report: Dose Management, Advancements, and Patient Flow

This radiology report addresses dose management in computed tomography (CT) using diagnostic reference levels (DRLs) and explores the creation of local DRLs, particularly in the context of Qatar. It delves into innovations in radiation dose management, including digital radiation tracking software and real-time monitoring solutions like RTS. The report further examines future advancements in diagnostic plain radiography (X-ray), computed tomography, imaging quality, radiation dose management, and patient flow within radiography. It highlights the potential of X-ray for early cancer detection, CT for revascularization planning, dual-energy CT for improved imaging quality, and strategies to reduce patient waiting times in CT procedures through modeling and resource optimization. The report also touches upon future innovations in X-ray, CT, and imaging quality, emphasizing their potential application in emergency radiography departments and the importance of effective dose management, particularly for pediatric patients, and the impact of patient flow in radiographic studies.

Running head: RADIOLOGY
Radiology
Name of the Student
Name of the University
Author Note

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Answer 1a.
Diagnostic Reference Level (DRL) is used in medical imaging in order to indicate the
dosage of the radiopharmaceuticals administered under specific radiological procedure of
medical imaging is high or low for that particular procedure. DRLs are practical tools used to
promote the process of optimization of dosage without affecting the process of medical
diagnosis. Computed Tomography (CT) is an X-ray imaging modality with high radiation
dosage that is higher than the conventional x-ray. This will help in reducing the chances of
radiation induced cancer. DRL will help in understanding the situations where the level of
patient-radiation dose is much higher than the requirement (Toori et al. 2015). DRL helps in
proposing applicable approaches for decreasing the dosage of the patient within a permissible
range. There are different types of DRLs dosage chart for radiation based on the location over
which the CT will be conducted like in brain, chest, cervical spine, abdomen, pelvic region
and lumbar spine. Depending on the mAs frequency used for the process of radiation by the
CT machine, the value of the projected radiation (CTDIw and CTDIvol) gets altered. The
radiation required for scanning of the brain is higher than the radiation used for the abdomen
and pelvic centre (Toori et al. 2015). The dosage of the paediatric patient is not same that of
the adults, the dosage of the paediatric patients must be calculated depending on the age,
gender and body mass (Toori et al. 2015).
Answer 1b.
The values of the National Diagnostic Reference Levels (NDRLs) for the state of
Qatar are selected from several regional and national diagnostic reference level data and are
simultaneously approved by the Qatar Medical Physics Society (QaMPS) during the year
2018 (Middle East Federation of Organizations of Medical Physics 2019). According to
Toori et al. (2015) numerous studies have highlighted a large differences in the dosage of

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radiation for the same CT examination under different hospital settings and these variations
occurs due to difference in the examination procedure and the scanner model of CT that is
used for the assessment. Thus establishment of the reference levels of the activity is helpful in
reducing the chances of the getting over-exposure from the ionising wavelength of radiation.
In order to establish the standard wavelength of radiation for the each of the local health-care
organization in Qatar the process of optimization must start by taking the reference level of
NDRLs. The data and levels of NDRLs must be considered by the employees while setting
their local, hospital based DRLs for conducting the CT (Middle East Federation of
Organizations of Medical Physics, 2019). In order to set the local diagnostic level of the
radiation wavelength for conduction of the CT, patient-related data based on the CT protocol
for the four most prescribed CT examinations must be collected. The four most exercised CT
examination in Qatar and its regional areas include brain, chest, sinus, pelvic and abdomen.
In each centre, the CT Dose Index (CDI) measurements must be performed by the use of the
pencil ionization chamber and CT dosimetry phantom as per the National Diagnostic
Reference Levels (NDRLs). Depending on this level of radiation, the standardization of the
CT system along with optimization of the CT radiation must be done. Optimizing the
wavelength of radiation for CT will help to reduce the chances of development of cancer
from excessive exposure to ionizing radiation (Toori et al. 2015).
Answer 1c.
Increasing concerns for radiation exposure arising from the CT have lead to several
advances in the dose reduction technologies. While required justifications and proper
optimization of scans has been the principal focus for addressing the increase in the dosage
levels, the value of the effective management of the radiation exposure or in other words
dosage management has been significantly over-looked (Zinsser et al., 2018). Parakh,

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Kortesniemi and Schindera (2016) have highlighted the important of the digital radiation
tracking software for the analysis of the big-data on the disease in auditing the level of
patients’ safety, proper utilization of the scanner and productivity. This approach has
significant implications both at the personal and institutional level. Digital radiation
management is an automated solution for radiation dosage management in CT. The manual
process of the dosage optimization for CT is done picture archiving and communication
system (PACS). However, manual system is associated with typographic errors such that
digital process is favoured than manual process. One of the widely used approach in digital
optimization of CT wavelength optimization include RTS solution (radimetrics) (Zinsser et
al., 2018). It helps in dose tracking and also provides exposure information extracted from
PACS. This helps in real time monitoring of the wavelength and is also provides a cost-
effective solution in comparison to the manual technique. The real-time availability of the
cumulative data facilitates the proper assessment of the trends (that is increase or decrease)
along with the detection of th deviation and hazards in an ordered and timely manner (Zinsser
et al., 2018).
Answer 2a.
The X-ray technology is one of the safest tools in 19th century and is regarded as one
of the reliable approach for treating patients. The X-ray technology in future can be used for
early detection of cancer as it can provide a proper image that helps to understand whether a
tumour is more transforming into more vascular types or is transforming into fatty tissue. A
tumour that is transformed into fatty issue is not cancerous. Thus analysis of the cancer cell
with the help to X-ray provides a detailed examination of the path of cancer prognosis. X-ray
examination will also help to gain a detailed understanding about the prognosis of bone
cancer and at the same time will help in diagnosis of osteoporosis or the assessment of the

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vulnerability of developing fragile bone in the near future. It can also be use to fast diagnosis
of the internal injuries occurring after car crash such that helping the doctors to operate
immediately (Kumar et al. 2018). The research conducted by Yan et al. (2018) highlighting in
the recent future, multi-modal hard x-ray imaging with high resolution approaching at 10nm
will be helpful for the material science. Kumar et al. (2018) stated that advancement in x-ray
imaging in the near future would help to provide proper diagnosis and early intervention of
rheumatoid arthritis.
Answer 2b.
The study conducted by Opolski (2018) showed that cardiac computed tomography
can be used in the recent future for effective planning of the revascularization procedures.
This approach is on trail process, is popularly known as coronary computed tomography
angiography (coronary CTA), and is used for the ruling out the false positive diagnosis of
coronary artery stenoses. The physiological information included from a single-one-stop-shop
CT will help in the detection of the pinpoint lesion-specific ischemia. The future
advancement in the CT can be used for detection of the surgical mandibular advancement in
the pharyngeal airway dimension. The linear and cross-sectional area along with the
volumentric parameters of the velopharynx, hypopharynx and oropharynx can be studied with
high resolution CT in order to provide a detailed overview of the mandibular advancement
(Kochar et al., 2016). CT in collaboration with interdisciplinary dentofacial therapy can be
used for the effective risk assessment of the dentoalveolar bone change that influence the
management of tooth (Mandelaris, Neiva and Chambrone 2017).
Answer 2c.
Future advancement in the imaging quality can be achieved by the use of the dual
energy CT (DECT) in the radiology units. This can be helpful for the multistep DECT

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imaging chain. The DECT advancement in the radiology under the trial process and
calculation accuracy is improved by the use of proton therapy and reduction in the exposure
of the metal artifact (van Elmpt et al. 2017). This will help to increase the overall
characterization of the normal tissue image. Improvement in the radio imaging technique will
help to increase the cross-sectional visibility of the tissues and thus facilitating non-traditional
reporting practice (Gunn et al. 2015). The advancement in the imaging technique and
imaging quality will help to laid the foundation of the digital mammography. This will help
to achieve revolution in the screening of the breast cancer. The digital mammography as a
medical imaging technique will help to provide a greater level of detail and will help in the
generation of the same results like that of the conventional mammography technique without
the use of the x-rays or x-ray films. This will help in the proper assessment of the thick breast
tissue (Rafferty et al., 2016).
Answer 2d.
The future advancement in the radiation dosage management will help to reduce the
chances of developing cancer arising out of the over-exposure of the ionizing radiation. The
effective management of the radiation dosage will help in managing the exposure of the
wavelength of the ionizing radiation along with the duration of the radiation. This controlled
exposure of the radiation will help to reduce the harmful effect of the ionizing radiation over
the human body. In order words it can be said that the dosage management in CT will help to
reduce the overall carcinogenic effect of the radiation and thereby helping to reduce the level
of harm (Toori et al. 2015). Mayo-Smith et al. (2014) are of the opinion that effective dosage
management is extremely helpful for the pediatric patients. Moreover, effective management
of the dosage will help to reduce the chances of the over-exposure and thereby helping to

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limit the get blurry images or over-exposed image. This approach will help to provide proper
clarity in digital imaging.
Answer 2d.
The major future advancement in the patient flow in the radiography include increase
in the overall footfall of the patient in the radiographic study. This is because, with effective
dosage management of the radiation, the harmful effect of ionizing radiation can be reduced
effectively and thereby helping to increase more footfall in the radiographic unit, including
the pediatric population as well (Behjati et al. 2016). Zafar et al. (2016) conducted a study in
order to understand the pre-procedure of the patient flow in IR. The study also aimed towards
understanding the preprocedural delays in the interventional radiology. The analysis of the
objective measurement of the preprocedural IR patient flow showed that there is considerable
waste and also helped in revealing the high-yield areas focused towards the potential
improvements. Zafar et al. (2016) proposed that a data driven approach might help to aid the
efficient delivery of the IR care.
Answer 3
Babashov et al. (2017) conducted a study in order to analyze the steps that must be
used in order to reduce the overall waiting time in the CT. Rational of the study is, these
initiatives will help to increase the flow of the patient in the CT. Thus, it will help in the early
detection of the disease and effective implementation of the intervention. The main points
that has been highlighted in the study in order to reduce the waiting time in the CT unit
include modeling of an effective radiotherapy planning process within the oncology treatment
facility. This will be followed by the bottle-neck analysis followed the effective scrutiny of
the resource level impact of the quantification in order to reduce the overall waiting time of
the patients. Additionally these efforts must be supported b y the additional dosimetrist

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improvement. This will help in the reduction of the waiting time by 6.5%. Additionally,
removal of the one physicist will lead to a dramatic worsening of the waiting time. Thus the
roster of the physicist must be done as per the patient flow and the requirement of the
expertise. The last approach that must be undertaken include increase in the overall
applicability and transportability of the model into other facilities. This will help to increase
the overall skills of the radiologist and other nursing professionals who are planning to assist
the radiologist and thereby helping to reduce the overall waiting time of the patients
(Babashov et al. 2017). Santos et al. (2019), stated that analysis of the CT results done under
the computer simulation helps in gaining of the productivity and thereby helping to reduce
the overall waiting time of the patients. However, Santos et al. (2019) further stated that
productivity gains is regarded as smaller than the expectation when replacing simpler models
by the use of more sophisticated ones and the patient care time is not regarded as function of
the speed data acquisition and the overall organizational changes can occur leading overall
reduction of the time.
Answer 4
The major future innovations of the x-ray include: The use of the photonic
technologies. The use of the photonic technologies in x-ray imaging will help in conducting
phase contrast imaging. This will help in the earlier detection of the cancer by exploiting the
refraction index and the interference effects. The clarity achieved in the photonic imaging of
the X-rays will help to generate higher contrast image and thereby helping to reveal higher
boundaries between the materials with differing refractive incides. Photonic imaging
technique in x-ray will help in generation of content-sensitive spectroscopy and
triboluminescence. The triboluminescence will analyze the image within the flashes of blue
light and thus helping to reduce the waiting light (Stampanoni et al. 2015).

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The major future innovations of CT include: The major future innovation in the CT
technology will help in getting a clearer image in the of the tissue dissection. This will help in
early detection of cancer like breast cancer and thereby helping in the implementation of the
early chemotherapeutic approaches depending on the stage of cancer (Haaga and Boll 2016).
The CT will also help in analysis of the bone density and thus helping in the analysis of the
chances of developing rheumatoid arthritis (Haaga and Boll 2016).
The major future innovations of imaging quality include: Reduction in the waiting of
the patient in the radiology unit and at the same time helping to reduce the time of obtaining
clear images and thus helping in proper and accurate diagnosis. It will also help in promoting
digitalized analysis of the image through computer and thus helping to reduce the chances of
the manual error (Haaga and Boll 2016).
While working as a radiographer in the emergency radiographic department in future
will utilize the advancement in the imaging technology in order to reduce the overall waiting
time of the patient. I will also educate the patient regarding how the use of the CT will help in
the early detection of the disease. The education will also be directed towards how the use of
the ionizing radiation through regulated dosage of the administration will help to reduce the
chances of harmful effect of the ionizing radiation. This education will help to increase the
footfall of the patients in the radiology unit.

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