Research Article
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Are The Exposure Index Values Consistent? A Manufacturer Investigation

Year 2026, Volume: 28 Issue: 82, 15 - 21, 27.01.2026
https://doi.org/10.21205/deufmd.2026288203

Abstract

In screen/film radiography, if the exposure parameters are low or high, the resulting radiographs may be underexposed or overexposed, leading to increased film repeats and waste. In digital X-ray devices, even if these risks are thought to be eliminated due to the wide dynamic range, very low or high irradiations affect image quality and patient doses. Manufacturers offer an exposure index (EI) value as a safety measure against overdose in computed radiography devices, which is a digital radiography method, and this is defined as a measure of irradiation in radiography acquisition, not a patient dose indicator. In order to make radiation dose assessments in digital x-ray devices, it is essential to check the exposure index value to monitor the doses given to the patient. Therefore, this study aimed to evaluate the consistency of IgM defined as the exposure index value in Agfa CR systems. For this purpose, quality control tests were performed on the dose outputs of 16 different model Agfa CR devices, and the IgM values read and calculated on the device were determined and compared. As a result of this study, the tube output and IgM values of the CR systems were found to be within the acceptance limits, and the fluctuations in the data between the devices were thought to be related to the age of the device or life of the x-ray tube. The accurate and reliable use of IgM data from Agfa CR systems plays an important role in monitoring and predicting patient doses.

References

  • Butler ML, Rainford L, Last J, Brennan PC. Are exposure index values consistent in clinical practice? A multi-manufacturer investigation. Radiation Protection Dosimetry 2010;139(1–3):371–4. doi:10.1093/rpd/ncq094.
  • Willis CE. Computed radiography: A higher dose? Pediatric Radiology 2002;32(10):745–50. doi:10.1007/s00247-002-0804-6.
  • Don S, Whiting BR, Rutz LJ, Apgar BK. New exposure indicators for digital radiography simplified for radiologists and technologists. American Journal of Roentgenology 2012;199(6):1337–41. doi:10.2213/AJR.12.8678.
  • Andriole KP, Ruckdeschel T, Flynn M, Hangiandreou N, Jones A, Krupinski E, et al. ACR-AAPM-SIIM practice guideline for digital radiography. Journals of Digital Imaging 2013;26(1):26-37. doi:10.1007/s10278-012-9523-1.
  • Foos DH, Sehnert WJ, Reiner B, Siegel EL, Segal A, Waldman DL. Digital radiography reject analysis: Data collection methodology, results, and recommendations from an in-depth investigation at two hospitals. Journal of Digital Imaging 2009;22(1):89–98. doi:10.1007/s10278-008-9112-5.
  • Yurt A, Tintaş M, Yüksel R. Reject analysis in digital radiography a prospective study. International Journal of Anatomy, Radiology and Surgery 2018;7(4):R027–R039. doi:10.7860/IJARS/2018/37410:2436.
  • Mackenzi A, Doyle P, Honey I, Marshall N, O’Neill J, Smail M. Measurement of the performance characteristics of diagnostic X ray Systems: Digital imaging systems. IPEM Report 32, Part VII. IPEM–IOP Series in Physics and Engineering in Medicine and Biology; 2010.
  • Shepard SJ, Wang J, Flynn M, Gingold E, Goldman L, Krugh K, et al. An exposure indicator for digital radiography: AAPM Task Group 116 (executive summary). Medical Physics 2009;36:2898–14. doi:10.1118/1.3266686.
  • European Commission. Radiation Protection N° 162 Criteria for acceptability of medical radiological equipment used in diagnostic radiology, nuclear medicine and radiotherapy. Luxembourg: Publications Office of the European Union; 2012. doi:10.2768/2256.
  • Shaw D, Fazakerley J, Honey I, Saunders D. IPEM Report 32, Part I, Ed. 3: measurement of performance characteristics of diagnostic radiology X-ray tubes and generators. Institute of Physics Publishing; 2022. doi:10.1088/978-0-7503-3219-4.
  • Erenstein HG, Browne D, Curtin S, Dwyer R, Higgins R, Hommel S, et al. The validity and reliability of the exposure index as a metric for estimating the radiation dose to the patient. Radiography 2020;26:S94–S99. doi:10.1016/j.radi.2020.03.012.
  • Silva TR, Yoshimura EM. Patient dose, gray level and exposure index with a computed radiography system. Radiation Physics and Chemistry 2014;95:271–3. doi:10.1016/j.radphyschem.2012.12.043.
  • Seibert JA. Performance Testing of Digital Radiographic Systems: Part I. In: Goldman LW, Yester MV, editors. Specifications, performance evaluations, and quality assurance of radiographical fluoroscopic systems in the digital era, Medical Physics Monograph No.30. Madison, WI: Medical Physics Publishing; 2004, p. 239-70.
  • IEC 62494-1:2008. Medical electrical equipment - exposure index of digital X-ray imaging systems - Part 1: definitions and requirements for general radiography. International Electrotechnical Commission Standard; 2008.
  • Samei E, Seibert JA, Willis CE, Flynn MJ, Mah E, Junck KL. Performance evaluation of computed radiography systems. Medical Physics 2001;28(3):361–71. doi:10.1118/1.1350586.
  • Mothiram U, Brennan PC, Lewis SJ, Moran B, Robinson J. Digital radiography exposure indices: A review. Journal of Medical Radiation Sciences 2014;61(2):112–8. doi:10.1002/jmrs.49.
  • Gibbs J. Agfa HealthCare provides technology and tools for patient X-ray dose reduction optimizing patient dose 2. AGFA Healthcare; 2012.
  • Gauntt DM, Ranger NT, Willis CE, Al-Senan R, Bercha I, Dave JK, et al. The report of AAPM task group 150 acceptance testing and quality control of digital radiographic imaging systems. American Association of Physicist in Medicine; 2024.
  • Seibert JA, Bogucki TM, Ciona T, Huda W, Karellas A, Mercier JR, et al. AAPM RPT 93, acceptance testing and quality control of photostimulable storage phosphor imaging systems. American Association of Physicist in Medicine; 2006. doi:10.37206/94.
  • Shepard SJ, Pal Lin PJ, Boone JM, Cody DD, Fisher JR, Frey GD, et al. AAPM report no.74, quality control in diagnostic radiology. Published for the American Association of Physicists in Medicine by the American Institute of Physics; 2002.
  • KCARE. Protocol for the QA of computed radiography systems, commissioning and annual QA tests, KCARE CR QA Protocol Draft 4.0.
  • Peters SE, Brennan PC. Digital radiography: Are the manufacturers’ settings too high? Optimisation of the Kodak digital radiography system with aid of the computed radiography dose index. European Radiology 2002;12(9):2381–7. doi:10.1007/s00330-001-1230-0.
  • Muhogora W, Padovani R, Bonutti F, Msaki P, Kazema R. Performance evaluation of three computed radiography systems using methods recommended in American Association of Physicist in Medicine Report 93. Journal of Medical Physics 2011;36(3):138-46. doi:10.4103/0971-6203.83478.

Işınlama Indeksi Değerleri Tutarlı mı? Bir Üretici Araştırması

Year 2026, Volume: 28 Issue: 82, 15 - 21, 27.01.2026
https://doi.org/10.21205/deufmd.2026288203

Abstract

Ekran film radyografisinde ışınlama parametrelerinin çok düşük ya da yüksek seçilmesi ve buna bağlı olarak filmde kararma derecelerinin düşük ya da yüksek olması film atık/tekrar oranlarının artmasına neden olmaktadır. Dijital röntgen cihazlarında ise dinamik aralığın geniş olması nedeniyle bu risklerin ortadan kalktığı düşünülse bile çok düşük veya yüksek ışınlamalar görüntü kalitesi ve hasta dozlarını etkilemektedir. Üretici firmalar bir dijital radyografi yöntemi olan bilgisayarlı radyografi cihazlarında aşırı doza karşın bir güvenlik önlemi olarak ışınlama indeksi (EI) değeri sunmaktadırlar ve bu bir hasta doz göstergesi olmayıp radyografi elde ediminde ışınlamanın bir ölçüsü olarak tanımlanmaktadır. Dijital röntgen cihazlarında radyasyon doz değerlendirmelerini yapabilmek amacıyla ışınlama indeksi değerini kontrol etmek hastaya verilen dozları takip etmek için önem taşımaktadır. Bu nedenle, bu çalışmada Agfa CR sistemlerinde ışınlama indeksi değeri olarak tanımlanan IgM’nin tutarlılığının değerlendirilmesi amaçlanmıştır. Bu amaçla, farklı model 16 Agfa CR cihazının doz çıkışları ile ilgili kalite kontrol testleri yapılarak cihazın verdiği ve hesaplanan IgM değerleri belirlenmiş ve karşılaştırılmıştır. Bu çalışma sonucunda cihazların tüp çıkış değerleri ve IgM değerleri kabul sınırlarında bulunmuş olup, cihazlar arasındaki verilerdeki dalgalanmaların cihazın yaşı ya da x ışını tüpü ömrü ile ilişkili olduğu düşünülmüştür. Agfa CR cihazlarının IgM verilerinin doğru ve güvenle kullanılabilmesi, hasta doz takibi ve hasta dozlarının tahmininde önemli bir rol oynamaktadır.

Ethical Statement

Bu makale etik kurul onayı gerektirmez ve herhangi bir kişi veya kurumla çıkar çatışması yoktur.

Thanks

Yazarlar, Atatürk Eğitim Araştırma Hastanesi, Behçet Uz, Seyfi Demirsoy ve Eşrefpaşa hastanesi Radyoloji Bölümü Başteknikeri ve teknikerlerine çalışmalarımızdaki destekler için teşekkür eder.

References

  • Butler ML, Rainford L, Last J, Brennan PC. Are exposure index values consistent in clinical practice? A multi-manufacturer investigation. Radiation Protection Dosimetry 2010;139(1–3):371–4. doi:10.1093/rpd/ncq094.
  • Willis CE. Computed radiography: A higher dose? Pediatric Radiology 2002;32(10):745–50. doi:10.1007/s00247-002-0804-6.
  • Don S, Whiting BR, Rutz LJ, Apgar BK. New exposure indicators for digital radiography simplified for radiologists and technologists. American Journal of Roentgenology 2012;199(6):1337–41. doi:10.2213/AJR.12.8678.
  • Andriole KP, Ruckdeschel T, Flynn M, Hangiandreou N, Jones A, Krupinski E, et al. ACR-AAPM-SIIM practice guideline for digital radiography. Journals of Digital Imaging 2013;26(1):26-37. doi:10.1007/s10278-012-9523-1.
  • Foos DH, Sehnert WJ, Reiner B, Siegel EL, Segal A, Waldman DL. Digital radiography reject analysis: Data collection methodology, results, and recommendations from an in-depth investigation at two hospitals. Journal of Digital Imaging 2009;22(1):89–98. doi:10.1007/s10278-008-9112-5.
  • Yurt A, Tintaş M, Yüksel R. Reject analysis in digital radiography a prospective study. International Journal of Anatomy, Radiology and Surgery 2018;7(4):R027–R039. doi:10.7860/IJARS/2018/37410:2436.
  • Mackenzi A, Doyle P, Honey I, Marshall N, O’Neill J, Smail M. Measurement of the performance characteristics of diagnostic X ray Systems: Digital imaging systems. IPEM Report 32, Part VII. IPEM–IOP Series in Physics and Engineering in Medicine and Biology; 2010.
  • Shepard SJ, Wang J, Flynn M, Gingold E, Goldman L, Krugh K, et al. An exposure indicator for digital radiography: AAPM Task Group 116 (executive summary). Medical Physics 2009;36:2898–14. doi:10.1118/1.3266686.
  • European Commission. Radiation Protection N° 162 Criteria for acceptability of medical radiological equipment used in diagnostic radiology, nuclear medicine and radiotherapy. Luxembourg: Publications Office of the European Union; 2012. doi:10.2768/2256.
  • Shaw D, Fazakerley J, Honey I, Saunders D. IPEM Report 32, Part I, Ed. 3: measurement of performance characteristics of diagnostic radiology X-ray tubes and generators. Institute of Physics Publishing; 2022. doi:10.1088/978-0-7503-3219-4.
  • Erenstein HG, Browne D, Curtin S, Dwyer R, Higgins R, Hommel S, et al. The validity and reliability of the exposure index as a metric for estimating the radiation dose to the patient. Radiography 2020;26:S94–S99. doi:10.1016/j.radi.2020.03.012.
  • Silva TR, Yoshimura EM. Patient dose, gray level and exposure index with a computed radiography system. Radiation Physics and Chemistry 2014;95:271–3. doi:10.1016/j.radphyschem.2012.12.043.
  • Seibert JA. Performance Testing of Digital Radiographic Systems: Part I. In: Goldman LW, Yester MV, editors. Specifications, performance evaluations, and quality assurance of radiographical fluoroscopic systems in the digital era, Medical Physics Monograph No.30. Madison, WI: Medical Physics Publishing; 2004, p. 239-70.
  • IEC 62494-1:2008. Medical electrical equipment - exposure index of digital X-ray imaging systems - Part 1: definitions and requirements for general radiography. International Electrotechnical Commission Standard; 2008.
  • Samei E, Seibert JA, Willis CE, Flynn MJ, Mah E, Junck KL. Performance evaluation of computed radiography systems. Medical Physics 2001;28(3):361–71. doi:10.1118/1.1350586.
  • Mothiram U, Brennan PC, Lewis SJ, Moran B, Robinson J. Digital radiography exposure indices: A review. Journal of Medical Radiation Sciences 2014;61(2):112–8. doi:10.1002/jmrs.49.
  • Gibbs J. Agfa HealthCare provides technology and tools for patient X-ray dose reduction optimizing patient dose 2. AGFA Healthcare; 2012.
  • Gauntt DM, Ranger NT, Willis CE, Al-Senan R, Bercha I, Dave JK, et al. The report of AAPM task group 150 acceptance testing and quality control of digital radiographic imaging systems. American Association of Physicist in Medicine; 2024.
  • Seibert JA, Bogucki TM, Ciona T, Huda W, Karellas A, Mercier JR, et al. AAPM RPT 93, acceptance testing and quality control of photostimulable storage phosphor imaging systems. American Association of Physicist in Medicine; 2006. doi:10.37206/94.
  • Shepard SJ, Pal Lin PJ, Boone JM, Cody DD, Fisher JR, Frey GD, et al. AAPM report no.74, quality control in diagnostic radiology. Published for the American Association of Physicists in Medicine by the American Institute of Physics; 2002.
  • KCARE. Protocol for the QA of computed radiography systems, commissioning and annual QA tests, KCARE CR QA Protocol Draft 4.0.
  • Peters SE, Brennan PC. Digital radiography: Are the manufacturers’ settings too high? Optimisation of the Kodak digital radiography system with aid of the computed radiography dose index. European Radiology 2002;12(9):2381–7. doi:10.1007/s00330-001-1230-0.
  • Muhogora W, Padovani R, Bonutti F, Msaki P, Kazema R. Performance evaluation of three computed radiography systems using methods recommended in American Association of Physicist in Medicine Report 93. Journal of Medical Physics 2011;36(3):138-46. doi:10.4103/0971-6203.83478.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Metrology, Applied and Industrial Physics
Journal Section Research Article
Authors

Ayşegül Yurt 0000-0001-6512-4950

Recep Kandemir 0000-0003-0979-7354

İsmail Özsoykal 0000-0002-5812-9347

Submission Date February 5, 2025
Acceptance Date March 15, 2025
Publication Date January 27, 2026
Published in Issue Year 2026 Volume: 28 Issue: 82

Cite

Vancouver Yurt A, Kandemir R, Özsoykal İ. Işınlama Indeksi Değerleri Tutarlı mı? Bir Üretici Araştırması. DEUFMD. 2026;28(82):15-21.

This journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

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