# 12                  HOW LOW CAN YOU GO?                  6/15 /13

     This is how I teach ALARA (As Low As Reasonably Achievable) to all of my students and whenever I give any kind of talk on digital radiography techniques to students or techs.  It's all about using the smallest/lowest mAs possible so that the dose is as low as it can be.  This can only be done by using the optimum kV (see blog #7 "Optimum kV for DR & CR Equipment" from April 1), which is a noticeably higher kV than was used with film.  With a higher kV, less mAs can then be used.               

     This new technique is only the first step in discovering how low you can go, although by adding 15% more kV and halving the mAs the entrance dose to the patient will be cut by about 33%!!  With such a quick and obvious way to save a patient 1/3 of the dose, you would think everyone would want to be doing this.  The fact is though, that instead of techniques being at an all time low (about 75% of the country now uses digital equipment which can employ lower doses than film) mAs/Dose Creep has occurred.  To read more about that, please see my first blog " The Problems of “CreepingmAs/Dose” in America" from January 1.

     The second step is knowing how perfect the image needs to be.  Some radiologist's want an image with absolutely no noise/mottle in it while others are absolutely fine with a little bit of noise.  In fact, the radiologist's at my hospital (Community Hospital of the Monterey Peninsula - CHOMP) want to see a little bit of noise.  This is called acceptable mottle and they actually dictate this term into their reading.  They know that by seeing a little bit of mottle we truly are taking the mAs/dose as low as we can go.  They also know that they cannot miss any kind of pathology with this small amount of noise in the image.

     I tell the students and radiographers that I would love it if they would make getting the lowest mAs a competition.  It is total bragging rights for whoever can use the lowest mAs for any given body type/size.  As the software in our digital computers allow for an inordinate amount of over radiation and still get a get a perfect looking image (automatic rescaling), the skill of "technique-ing" is becoming a lost art.  To see this first hand, go to the archive section in my Current Research and look up "Howmuch can you over-radiate and still get a perfect image?". 

     Basically anyone can use too much mAs and still have a perfect image every time, so that doesn't really take any talent.  What does take real technique-ing skill is to make an exposure that is very close to whatever Exposure Index (EI) number shows that the minimum amount of radiation was used.  My goal is to go for the perfect EI number to 50% more than that number.  If I am in that zone I know I nailed it!!

 Link to Digital Radiography Solutions Website

# 11       Supertech is our newest advertiser        06/01 /13

     Today's post is going to be a bit different than my usual fair of writing about  CR and DR.  Today I'm going to tell you about Supertech.  Although you may think I'm writing this about you,  Supertech is actually this amazing diagnostic imaging online store that is celebrating its 40th anniversary this year.

     If you've been to my website you know that I have two company's advertising on the right hand side of the home page.  The beauty of running my own business is I get to pick who I will do advertising with.  I decided when I founded the company and website it wasn't worth the money to have anyone on the site that I didn't have 100% respect for.  That's why I started with just 2 businesses, MTMI and the Ferlic Filter Co.  Now Supertech makes three.

     Needless to say, all great companies need a strong leader, and Supertech most certainly has that.  The president/CEO and owner is Judy McNitt-Mell, an amazing woman who started working with Supertech ten years ago.  Her father actually started the business back in 1973, owning just 10% of the company, but over the years ended up owning it outright.  In 2009, Judy's father retired and she took control of the company lock, stock and barrel.

     I've met Judy a few times over the years because I would see her in the vendors room at many of the largest radiology conferences around the country.  One can't walk through a vendor's room without stopping at her booth, because Supertech has so many different products they sell. 

     Here are just a few of them: X-Ray Technique Calculator, Anthropomorphic and Multi-Modality Phantoms, Quality Assurance Phantoms, Aprons, Barriers and Filters as well as pages of other products for CT, Ultra Sound, MRI and Nuclear Medicine.

     I had personal experience with Judy's wonderful customer care when I purchased ALL of our phantoms from Supertech many years ago.   We started with just the abdomen phantom, but a few years later we were able to acquire the head and neck, thorax, entire right arm, elbow and the wonderful "DUKE" quality control phantom.   I still remember thinking how incredibly knowledgeable  she was (and is!!) about all of these different phantoms considering how many different products they carried. Being the inquisitive guy I am,  I had grilled her as I wanted to know everything about every one of them.

     One of the things Judy is proudest of is the SPoRT Pediatric Sectional Phantom.  She had attended several meetings which addressed the topic of pediatric imaging.  The big push for "Image Gently" made her think that it would be helpful for the market if there were Pediatric Phantoms which would help new technologists learn how to image gently.  Telling someone what to do and having something for them to use in a laboratory setting are vastly different.  Judy knew that Computerized Imaging Reference Systems, Inc (CIRS) would have the engineers and physicists who could handle a tough project like this.  She was very grateful to CIRS for creating SPoRT and she is very excited about this product.

To check out Supertech, click here.