All good points. But it may be worth mentioning in passing how few (according to charts in the report cited) areas of the world have met the "Golden Rules" - many failing to do so by quite a wide margin.
To my mind that indicates that - perhaps - the Rules are a bit on the optimistic side.
In the Real World (including that of Private Hospitals, hospitals in the "Developing World" and what-have-you), other factors weigh heavily when decisions are made about replacing capital equipment. For instance, the availability (or otherwise) of large amounts of money, and the ongoing serviceability (or otherwise) of existing equipment. Sometimes it may be deemed more prudent simply to carry on on supporting (servicing, repairing - or even upgrading) old equipment whilst saving-up (hopefully) for the latest innovations.
Don't forget also that in some parts of the world the latest "high tech" systems may not actually be appropriate (for all of the reasons that we may guess at). I have worked on old systems (Happy Days) that were more or less indestructible (they were repairable "in the field", and laptops - and the internet - had yet to be invented) - whilst noticing modern systems that (whilst generally looking very nice) did not appear to be actually "built to last".
Meanwhile, I am interested in the matter of x-ray exposure dose. Myself, I doubt that dose for equivalent examinations have decreased that much over the last ten, twenty (or perhaps even thirty) years. I know that early CT blasted out hefty doses of the "magic rays", but I reckon they improved quite quickly (maybe as far back as thirty years ago). But I am more interested in traditional (conventional) radiography (the sort of thing that Dr.Röntgen would instantly recognise). Does anyone have any documentation (charts etc.) about exposure dose-rates over the years?
In my experience, the highest risk of unnecessary patients doses arose from "repeat" exposures due (in the main) to what we might call "operator error" (bad patient positioning, incorrect selection of factors, etc.).
Aren't we really talking about the welcome change from film cassettes (and wet-processing) to Computerised Radiography? And won't most (almost all) exposures these days be terminated by AEC techniques such as (Siemens) Iontomat? Has anyone we know had a go at retro-fitting CR to old x-ray systems? Was it a cost-effective solution? And (perhaps most importantly) did patient doses decrease - or even increase?
Lastly, and by the way, image quality of modern diagnostic ultrasound is also noticeably better than in times gone by. "Image quality" can be a bit subjective ... but having machines from different eras operating side-by-side should convince most observers. But whether such an improvement would warrant immediately binning the old machine (or rushing out to buy a new one) is something I would doubt. It would probably be better to "let nature take its course" and simply purchase a new unit when the old one can no longer be supported (unreliable, lacks of spares or whatever).
