Exposure Creep

Ann T. Ver RT · Guest

When using CR, I have noted that it is very hard for RT's to accept that numbers out of the recommended range should be repeated for under or over exposure. It is hard to deviate from the mental film library that we have in our heads...instead - RT's are "blasting" patients so that they can adjust the window/level of the image on the viewer instead of calculating a technique before they expose the patient. If we continue to behave this way, other allied health professionals may grab a piece of our pie when the RT shortage hits its high. Why are RT's so afraid of technique books or charts? Crying or Very sad

iraydee8 · Power User Joined: 14 Oct 2004 Posts: 64 Location: AZ

Yes, Dose creep is alive and growing rampant! I urge all of you who are using CR to take a look at your techniques! Check you exposure index numbers!

I challange all of you to decrease the dose to all our patients and urge all your coworkers to do the same. Here is a great article regarding this very subject.

http://www.auntminnie.com/index.asp?Sec=sup&Sub=xra&Pag=dis&ItemId=75779
_________________
iraydee8

Chuck Speers · Guest

I have several years of experience with different CR systems (Agfa, Fugi, Kodak, Picker, Phillips, etc.) Any way, I was initially taught to use higher KV settings than used with film, and subsequently, the exposure levels are lower. For example, I used 70-75KV for KUB film exposures (phototimed), but now tend to use 75-85KV depending of the patient's body habitus Cool

Nonetheless, I know techs who are of the mindset that over-exposure isn't bad a work ethic since the CR system and their "photo-chopping" skills will reveal the images' diagnostic qualities...the swimmer's view comes to mind as I type this message Confused

iraydee8 · Power User Joined: 14 Oct 2004 Posts: 64 Location: AZ

As with any radiation exposure, it is always best to have and use a good (yes, I said good) technique chart. This will hopefully keep techs in check when using cr/dr imaging.

As you are aware,there is the issue with dose creep and it is a very real issue. For when we take an image using the correct technical factors it looks good. And then aftera bit we find that those images using a low technique don't look as good as those overexposed. Why? Because we can physically see underexposure issues with out own eyes. The image is grainy! So human nature starts to take over and since we don't like grainy images we slowly increase the dose to the pateint. And never see those grainy images again.

I also recomend having the vendor of your DR/CR return every2-3 years to ree-ducate the staff on cr/dr use and to review your current images and put your techniques in check. And enhance your use of the system.
_________________
iraydee8

papa · Posted: Thu Feb 28, 2008 10:11 am Post subject:

very good ideas..

while we're on the subject of CR DR and techs over exposing patients, something i've noticed (and maybe it's the techs who were trained on CR, or techs that have just gotten lazy) the lack of collimation. i take pride in myself when i shoot a lumbar spine on 10X12 cassettes and have at least the 2 boarders on the sides.

now granted, i myself have been known to use the 14X17 film, and just not use all of it. but i still collimate. a majority of the techs here just leave the collimation open, and use the computer to "collimate" the image.

this is wrong. i've stopped saying something to them because "you're the CT tech, you really don't shoot x-rays anymore", wich isn't true. they've recently aquired the CR system (like 6 months ago), where as i've been working on CR and DR since '98, and i know the systems inside and out. nevertheless, x-ray is still, and will always be, x-ray. coning down on the computer does nothing for the radiation dose given to the patient. there is only so much that the computer can edit. one of the techs the other day asked me how to set a breathing technique. before i could say anything, one of the other techs yelled out "you don't really need breathing techniques on this new system". boy am i glad i'm in my own little world at this office. old school rules... like i tell every student i come in contact with, the best advice i can give anybody, is find an old school tech, and soak up as much as you can. if you let the computers do your thinking for you, you become an x-ray technician.

a technician pushes buttons. a technologist knows what he/she's doing, and why.

sorry for the rant, just my $.02

papa RT(R)(CT)
_________________
Mr. Green

papa RT(R)(CT) Mr. Green

http://sites.google.com/site/delusionalradiology

never meddle in the affairs of a dragon, for you are crunchy, and taste good with ketchup