NEMA XR-29 Compliance: Dose Check Attribute


What is the Dose Check attribute of the NEMA XR-29 standard and how to achieve XR-29 compliance?

Dose Check is one of four attributes of the NEMA XR-29 standard.  The details of Dose Check are covered in the NEMA XR-25 standard which is also considered part of the NEMA XR-29 standard..

To achieve XR-29 compliance with your CT scanners, the Dose Check feature (Notifications and Alerts) is automatically triggered prior to scanning a patient. Dose Check is associated with displaying dose notifications and alerts on the CT Operator's monitor to:

1. Notify the CT technologist, prior to scanning, when the CTDI/DLP value of a particular series exceeds the predefined threshold.  The CTDI/DLP values for each series will be automatically recorded in a secure dose database.  This database can only be accessed by authorized users.

2. Alert the CT technologist (prior to scanning) when the accumulated CTDI/DLP value of the total exam exceeds the total predefined threshold of the exam.


XR-29 Compliance

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As shown in the figure above, after performing a topogram (Siemens), scout (GE), surview (Philips) or scanogram (Toshiba), the dose check feature becomes active to monitor the CTDI/DLP values per series and compares it to predefined thresholds.  If the CTDI/DLP values exceed the threshold, Dose Notifications or Alerts will appear in the form of a message box on the CT Operator's monitor, visible to the CT Operator.  This is how the technologist acknowledges that a Notification condition for a series (or an Alert condition for the exam) is present and he/she can decide on the next action to take. 

In case of a notification appearing on the CT screen, the CT technologist will decide to either:

1. Adjust the protocol's parameters and reduce the CTDI/DLP value, or

2. Proceed with the same protocol parameters without making changes. In this case, a popup box will appear on the CT screen and the technologist will enter his/her name and the reason for choosing to exceed the predefined threshold.

In case of an Alert condition, the CT technologist will have to enter a secure password to enable scanning. But if scanning an emergency case, the CT technologist may elect to bypass the Dose Check feature and proceed directly to scanning.

The Dose Check CTDI/DLP values are recorded in the dose database, these values can be viewed and compared to the actual CTDI/DLP values recorded after the scan is completed. This dose database is not a replacement for the DICOM Radiation Dose Structured Report, it is a nice tool that is available to keep track of dose values and results.  It will help you and your physicist to monitor CTDI and DLP values and make adjustments to manage dose exposure to patients.

Zetta offers the most innovative solution for the XR-29 standard, Z-DOSE29.  Dose Check with Z-DOSE29 is easy to use, Dose Notifications and Alerts are displayed on the CT Operator's Console, as specified by XR-25 and XR-29. Z-DOSE29 has a small foot print and the installation process is quick and simple.

Z-DOSE29 is the only 3rd party XR-29 solution that displays DOSE CHECK notifications and alerts on the CT monitor as required by the NEMA XR-25 and XR-29 standards.

Z-DOSE29 includes detailed dose reports to compare dose values and charts for easy analysis.  Your authorized users can view these reports and charts and they can customize comparisons per exam type among other criteria. Z-DOSE29 also includes a detailed DICOM Radiation Dose Structured Report which integrates into the ACR Dose Index Registry (DIR).  This will be discussed in a different article. For now, you can read the details of our intuitive solution on the Z-DOSE29 webpage and view our customers' feedback and testimonials.

For prices and installation availability please give us a call at 800-991-1021 or:

Please visit our website at for more information. Zetta is not affiliated with any OEM.

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