List three practical ALARA actions you can take in a diagnostic radiology department to reduce dose to staff and patients.

• A. Optimize imaging protocols and exposure factors; use shielding and collimation; minimize fluoroscopy time and use last-image hold; ensure appropriate distance.
• B. Increase exposure factors for faster results.
• C. Use the same exposure for all studies.
• D. Rely solely on digital post-processing to reduce dose.

Answer: (A)

ALARA in diagnostic radiology means keeping doses as low as reasonably achievable while still obtaining a diagnostic image. Three practical actions that directly support this are: first, tailor imaging protocols and exposure factors to the patient and clinical task so you use the lowest acceptable mAs and appropriate kVp, ensuring image quality without excess dose. Second, use shielding and collimation to restrict the beam to the area of interest and protect radiosensitive tissues, which also reduces scatter reaching both patient and staff. Third, minimize fluoroscopy time and use aids like last-image hold (or pulsed fluoroscopy when available), and maintain a safe distance from the source whenever possible, because reducing exposure time and increasing distance cuts dose significantly by the inverse square relationship. These together address dose for patients and staff while preserving diagnostic utility. The other options would increase or fail to manage dose: increasing exposure factors raises dose, applying the same exposure for all studies ignores patient size and task, and relying only on post-processing cannot compensate for high initial exposure.