Pediatric Radiology

, Volume 41, Issue 5, pp 592–601 | Cite as

Quality assurance: using the exposure index and the deviation index to monitor radiation exposure for portable chest radiographs in neonates

  • Mervyn D. CohenEmail author
  • Matt L. Cooper
  • Kelly Piersall
  • Bruce K. Apgar



Many methods are used to track patient exposure during acquisition of plain film radiographs. A uniform international standard would aid this process.


To evaluate and describe a new, simple quality-assurance method for monitoring patient exposure. This method uses the “exposure index” and the “deviation index,” recently developed by the International Electrotechnical Commission (IEC) and American Association of Physicists in Medicine (AAPM). The deviation index measures variation from an ideal target exposure index value. Our objective was to determine whether the exposure index and the deviation index can be used to monitor and control exposure drift over time.

Materials and methods

Our Agfa workstation automatically keeps a record of the exposure index for every patient. The exposure index and deviation index were calculated on 1,884 consecutive neonatal chest images. Exposure of a neonatal chest phantom was performed as a control.


Acquisition of the exposure index and calculation of the deviation index was easily achieved. The weekly mean exposure index of the phantom and the patients was stable and showed <10% change during the study, indicating no exposure drift during the study period.


The exposure index is an excellent tool to monitor the consistency of patient exposures. It does not indicate the exposure value used, but is an index to track compliance with a pre-determined target exposure.


Exposure index Deviation index Radiation safety Neonate 


Conflict of interest

Quality Assurance: Using the Exposure Index and the Deviation Index to Monitor Radiation Exposure for Portable Chest Radiographs in Neonates

Mervyn Cohen has a conflict of interest. He received $2000.00 from Agfa to support the study.

Bruce Apgar works for Agfa corporation. He provided help with data collection and analysis


  1. 1.
    Goske MJ, Applegate KE, Boylan J et al (2008) The image gently campaign: working together to change practice. AJR 190:273–274PubMedCrossRefGoogle Scholar
  2. 2.
    Don S (2004) Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Pediatr Radiol 34(Suppl 3):S167–S172, discussion S234–241PubMedCrossRefGoogle Scholar
  3. 3.
    Uffmann M, Schaefer-Prokop C (2009) Digital radiography: the balance between image quality and required radiation dose. Eur J Radiol 72:202–208PubMedCrossRefGoogle Scholar
  4. 4.
    Vaño E, Fernández JM, Ten JI et al (2007) Transition from screen-film to digital radiography: evolution of patient radiation doses at projection radiography. Radiology 243:461–466PubMedCrossRefGoogle Scholar
  5. 5.
    International commission on radiological protection (2004) Managing patient dose in digital radiology: a report of the International Commission on Radiological Protection. Ann ICRP 34:1–73Google Scholar
  6. 6.
    Schaetzing R (2004) Management of pediatric radiation dose using Agfa computed radiography. Pediatr Radiol 34(Suppl 3):S207–S214PubMedCrossRefGoogle Scholar
  7. 7.
    Shepard SJ, Wang J, Flynn M et al (2009) An exposure indicator for digital radiography: AAPM Task Group 116 (executive summary). Med Phys 36:2898–2914, Erratum in: Med Phys (2010) 37:405PubMedCrossRefGoogle Scholar
  8. 8.
    (2008) Medical electrical equipment—exposure index of digital X-ray imaging systems. Part 1: definitions and requirements for general radiography, International Electrotechnical Commission (IEC), international standard IEC 62494-1:2008-08 Geneva, SwitzerlandGoogle Scholar
  9. 9.
    Willis CE, Leckie RG, Carter JR et al (1995) Objective measures of quality assurance in a computed radiography-based radiology department. SPIE 2432:12CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Mervyn D. Cohen
    • 1
    • 2
    Email author
  • Matt L. Cooper
    • 1
  • Kelly Piersall
    • 1
  • Bruce K. Apgar
    • 3
  1. 1.Department of Radiology, Riley Children’s HospitalIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of RadiologyRiley Hospital for ChildrenIndianapolisUSA
  3. 3.Agfa HealthCare CorporationGreenvilleUnited States

Personalised recommendations