Michigan

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Michigans Standard of Care Patient Exposure
Values

• Bruce Matkovich
• Radiation Safety Section
• Michigan Department of Community Health

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Exposure at Skin Entrance

• Measure common radiographic projections during
  regulatory inspection
• Common patient thicknesses
• Measured with MDH X-Ray Monitor
• Monthly workloads collected

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Exposure at Skin Entrance - 2

• Exposure data entered into Radiation Safety Data
  System
• Recent update distinguishes between digital modes
  Computed Radiography (CR) and Direct Radiography
  (DR)

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Standard of Care Exposure Values

• Established by advisory committee near the 85th
  percentile of ESE data
• Last adjustment in 1995
• Mostly based on 200 speed screen-film
• Non-regulatory

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Standard of Care Exposure Values
Michigan
PA Chest (without a grid) 20 mR
PA Chest (with a grid) 25 mR
AP Lumbar Spine 500 mR
AP Cervical Spine 125 mR
DP Foot 35 mR
Hand 15 mR
Dental Cephalometric 25 mR
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Standard of Care Exposure Values and AAPM
Reference Values
Michigan AAPM
PA Chest (without a grid) 20 mR 25 mR
PA Chest (with a grid) 25 mR 25 mR
AP Lumbar Spine 500 mR 500 mR
AP Cervical Spine 125 mR 125 mR
DP Foot 35 mR
Hand 15 mR
Dental Cephalometric 25 mR 25 mR
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Exposures Reported to Facility

• Measured Entrance at Skin Exposure along with the
  Standard of Care for that projection
• Advised to reduce exposure if over the Standard
  of Care
• Good cooperation from facilities in reducing
  exposures when appropriate

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Exposure Distribution Graphs

• Most recent 5 year period
• Screen-film and digital imaging displayed
  separately
• Number of machines tested, median exposure, and
  85th percentile data included

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Exposure Trends

• The difference between the 85th percentile and
  the median exposure is being reduced
• Outriders are being becoming less of a problem

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Trend - AP Lumbar Spine
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Trend - AP Cervical Spine
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Trend - PA Chest (without a grid)
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Trend - PA Chest (with a grid)
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Trend - DP Foot
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Trend - Hand
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Trend Dental Cephalometric
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Standard of Care Conclusions

• Standard of Care values or reference values are
  effective in controlling exposures
• They do not adversely drive exposures below what
  is necessary for diagnostic quality images

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For more information
Radiation Safety Section
www.michigan.gov/rss