10 H. Sekkat et al.: Radioprotection 2025, 60( 1), 9 – 19
Similarly, NCRP Report 184 notes a continued increase in radiological procedures in the United States up to 2016, although less dramatically than between the early 80s and 2006( NCRP, 2009, 2019). Research from over 135 million imaging exams between 2000 and 2016 in Canada and the U. S. shows the highest annual increase in CT exams occurred in the early 2000s( Smith-Bindman et al., 2019; Tsapaki, 2020).
Diagnostic radiology has evolved from using simple equipment with minimal radiation to complex equipment requiring higher doses and greater accuracy. This evolution has expanded the concept of quality in radiology, emphasizing a broader framework of excellence and the essential role of clinically certified medical physicists( IAEA, 2021).
In many low and middle-income countries, imaging equipment often lacks proper supervision, with quality assessments primarily during licensing inspections. This approach is inadequate for ensuring equipment safety and overall diagnostic facility excellence, including staff and procedures( Delis et al., 2017).
This review addresses optimizing radiation doses in radiology, considering both diagnostic and interventional aspects. It proposes steps to achieve this objective and discusses the challenges in dose optimization and quality assessment, highlighting the role of certified medical physicists.
2 Methods
2.1 Selection criteria for studies
The studies chosen for the narrative review adhered to specific selection criteria designed to guarantee the incorporation of pertinent and dependable research. The inclusion criteria encompassed studies published in indexed peer-reviewed scientific journals, with a specific focus on radiology optimization and quality assessment for both diagnostic and interventional aspects. To maintain language consistency, only studies published in English or French were considered. Through the application of these criteria, a thorough and targeted collection of studies was identified for detailed analysis.
2.2 Data analysis and quality assessment for selected studies
The process of selecting studies for the present review followed a systematic approach to ensure the identification of pertinent and high-quality research( Appendix 1). Starting with a literature search conducted between December 2023 and April 2024, 97 potentially relevant articles and reports were initially identified. The screening process involved reviewing titles and abstracts to assess their relevance to the topic of this narrative review. Subsequently, full-text articles were obtained for the studies meeting the inclusion criteria. A comprehensive evaluation of these full-text articles was then conducted, leading to the exclusion of studies that did not meet the specified criteria or lacked relevant data. This rigorous selection process led up to the inclusion of a final set of 67 studies in this narrative review.
3 Results
The studies included in this narrative review collectively highlight the significance of optimizing radiation doses in both diagnostic and interventional radiology and quality assessment procedures. Moreover, these studies highlight the central role of certified medical physicists in ensuring the effectiveness of these processes. The results are categorized based on the specific radiological modalities studied, detailing specific actions and responsibilities for each radiology team member in the optimization process, emphasizing their integral participation in an overarching quality assurance program.
3.1 Essential optimization implied by risks associated to low radiation doses
The cancer risk associated with diagnostic radiology, particularly in high-dose procedures like CT scans, remains a topic of ongoing debate( Brenner et al., 2007; Mathews et al., 2013; Bawazeer et al., 2022; Bertho et al., 2023). European projects like the“ Implications of Medical Low Dose Radiation Exposure”( MEDIRAD) and“ Epidemiological study to quantify risks for pediatric computerized tomography and to optimize doses”( EPI-CT) are underway to address low-dose radiation risk and radiation protection in medical practice. Despite a 70-year follow-up of A-bomb survivors in Hiroshima and Nagasaki, direct epidemiological data indicate only a small but statistically significant increase in cancer risk, highlighting the ongoing debate within the scientific community regarding the significance of cancer risk at low radiation doses( Brenner et al., 2007; Tsapaki, 2020).
Key reports, including BEIR VII 2006 and UNSCEAR 2008, recommend the“ linear no-threshold model”( LNT) as a reasonable framework for understanding the relationship between low-dose ionizing radiation and solid cancer incidence( National Research Council, 2006; UNSCEAR, 2008). These findings highlight the importance of optimizing radiation doses, especially for specific patient groups such as pediatrics, pregnant individuals, and those requiring repeated exams due to clinical conditions.
3.2 Levels of radiation exposure
With the increasing use, diversity, and complexity of X-ray procedures, the critical question arises regarding the associated radiation dose levels. This consideration is essential for strategic planning in the optimization process. Radiological examinations typically range from sub-mSv( chest X-ray) to dozens( even hundreds) of mSv( CT or interventional procedures). Technological advancements have provided opportunities to reduce radiation doses in medical imaging. The international literature has predominantly focused on CT due to its higher doses compared to other conventional X-ray techniques( National Research Council, 2006; Brenner et al., 2007; UNSCEAR, 2008; El Mansouri et al., 2022, 2024; Talbi et al., 2022; MirDerikvand et al., 2023).
Concerns about radiation dose in CT have led to increased research for accurate dose estimation and optimization tools. The 2011 Summit on Management of Radiation Dose in CT sponsored by the National Institute of Biomedical Imaging and Bioengineering, the Coalition for Imaging and Bioengineering Research, the National Institute of Child Health and Human Development, and the National Heart Lung and Blood Institute and supported by the U. S. Food and Drug, emphasized the goal