ArticleJournal of applied clinical medical physics2026
Bridging TG-116 and TG-232: A retrospective multi-vendor evaluation of deviation index re-centering and process control in digital radiography.
Article in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe deviation index (DI) is a vendor-neutral indicator of detector exposure relative to the configured target exposure index (TEI). Because TEI is a protocol value rather than a calibrated physical quantity, poorly aligned TEI settings can create systematic DI offsets, obscure protocol problems, and prevent meaningful statistical process control.
objectiveThis retrospective multi-vendor study evaluated whether routine DICOM metadata can identify biased DI distributions, separate fixed TEI-setting offsets from protocol-adherence variation, estimate candidate TEI updates, and support TG-232-aligned standard deviation-based monitoring after DI re-centering.
methodsWe retrospectively analyzed 38 916 digital radiography examinations performed from January 1, 2024 through August 27, 2024 using three vendor platforms at a tertiary hospital. DICOM metadata were benchmarked against published technical standards using a composite adherence index (CAI) for SID, kVp, mAs, grid use, and AEC use. A secondary gradient-boosting/SHAP analysis was retained as a non-causal variance discovery to rank the metadata patterns used to predict DI. Candidate TEI updates were estimated within the vendor-region-projection groups by algebraically re-centering the observed mean DI (
resultsThe baseline
conclusionIn this retrospective, multi-vendor study, the TEI setting review was operationalized as a structured, data-driven responsibility of a clinical site. By verifying protocol adherence, equipment performance, image quality, and dose indicators before centering the
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