Tradeoffs between image quality and dose.

Image quality takes on different perspectives and meanings when associated with the concept of as low as reasonably achievable (ALARA), which is chiefly focused on radiation dose delivered as a result of a medical imaging procedure. ALARA is important because of the increased radiosensitivity of children to ionizing radiation and the desire to keep the radiation dose low. By the same token, however, image quality is also important because of the need to provide the necessary information in a radiograph in order to make an accurate diagnosis. Thus, there are tradeoffs to be considered between image quality and radiation dose, which is the main topic of this article. ALARA does not necessarily mean the lowest radiation dose, nor, when implemented, does it result in the least desirable radiographic images. With the recent widespread implementation of digital radiographic detectors and displays, a new level of flexibility and complexity confronts the technologist, physicist, and radiologist in optimizing the pediatric radiography exam. This is due to the separation of the acquisition, display, and archiving events that were previously combined by the screen-film detector, which allows for compensation for under- and overexposures, image processing, and on-line image manipulation. As explained in the article, different concepts must be introduced for a better understanding of the tradeoffs encountered when dealing with digital radiography and ALARA. In addition, there are many instances during the image acquisition/display/interpretation process in which image quality and associated dose can be compromised. This requires continuous diligence to quality control and feedback mechanisms to verify that the goals of image quality, dose and ALARA are achieved.