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Bushra A, Sulieman A, Edam A, Tamam N, Babikir E, Alrihaima N, Alfaki E, Babikir S, Almujally A, Otayni A, Alkhorayef M, Abdelradi A, Bradley DA. Patient's effective dose and performance assessment of computed radiography systems. Appl Radiat Isot 2023; 193:110627. [PMID: 36584412 DOI: 10.1016/j.apradiso.2022.110627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Computed tomography is widely used for planar imaging. Previous studies showed that CR systems involve higher patient radiation doses compared to digital systems. Therefore, assessing the patient's dose and CR system performance is necessary to ensure that patients received minimal dose with the highest possible image quality. The study was performed at three medical diagnostic centers in Sudan: Medical Corps Hospital (MCH), Advance Diagnostic Center (ADC), and Advance Medical Center (AMC). The following tools were used in this study: Tape measure, Adhesive tape, 1.5 mm copper filtration (>10 × 10 cm), TO 20 threshold contrast test object, Resolution test object (e.g., Huttner 18), MI geometry test object or lead ruler, Contact mish, Piranha (semiconductor detector), Small lead or copper block (∼5 × 5 cm), and Steel ruler, to do a different type of tests (Dark Noise, Erasure cycle efficiency, Sensitivity Index calibration, Sensitivity Index consistency, Uniformity, Scaling errors, Blurring, Limiting spatial Resolution, Threshold, and Laser beam Function. Entrance surface air kerma (ESAK (mGy) was calculated from patient exposure parameters using DosCal software for three imaging modalities. A total of 199 patients were examined (112 chest X rays, 77 lumbar spine). The mean and standard deviation (sd) for patients ESAK (mGy) were 2.56 ± 0.1 mGy and 1.6 mGy for the Anteroposterior (AP) and lateral projections for the lumbar spine, respectively. The mean and sd for the patient's chest doses were 0.1 ± 0.01 for the chest X-ray procedures. The three medical diagnostic centers' CR system performance was evaluated and found that all of the three centers have good CR system functions. All the centers satisfy all the criteria of acceptable visual tests. CR's image quality and sensitivity were evaluated, and the CR image is good because it has good contrast and resolution. All the CR system available in the medical centers and upgraded from old X-ray systems to new systems, has been found to work well. The patient's doses were comparable for the chest X-ray procedures, while patients' doses from the lumbar spine showed variation up to 2 folds due to the variation in patients' weight and X-ray machine setting. Patients dose optimization is recommended to ensure the patients received a minimal dose while obtaining the diagnostic findings.
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Affiliation(s)
- A Bushra
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - A Sulieman
- Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O.Box 422, Alkharj 11942, Saudi Arabia.
| | - A Edam
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - N Tamam
- Physics Department, College of Science, Princess Nourah bint Abdulrahman University, P.O Box 84428, Riyadh, 11671, Saudi Arabia
| | - E Babikir
- Radiologic Technology Program, Allied Health Department, College of Health and Sport Sciences, University of Bahrain, Bahrain
| | - N Alrihaima
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - E Alfaki
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - S Babikir
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - A Almujally
- Department of Biomedical Physics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Otayni
- Radiology Department, King Khaled Hospital and Prince Sultan Center for Health Care, Ministry of Health, Alkharj, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O Box 10219, Riyadh, 11433, Saudi Arabia
| | - A Abdelradi
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - D A Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK; Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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Forbes A, Geryes BH, Hornbeck A, Kien N, Quelquejay C, Adamsbaum C, Farah J, le Pointe HD. Harmonisation of imaging protocols, radiation doses and image quality in gastrointestinal fluoroscopy examinations - multicentre study. Pediatr Radiol 2022; 52:50-57. [PMID: 34657168 DOI: 10.1007/s00247-021-05194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/24/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paediatric gastrointestinal fluoroscopy examinations can impart varying amounts of radiation for the same patient size and exam type. OBJECTIVE To investigate the variability of imaging protocol, radiation dose and image quality in paediatric fluoroscopy examinations in order to provide recommendations for the harmonisation and optimisation of local practices. MATERIALS AND METHODS Five paediatric radiology departments performing fluoroscopically-guided contrast enema, micturating cystourethrography and upper gastrointestinal tract examinations participated in this study. Information on imaging protocols and radiation doses was retrospectively collected for more than 2,400 examinations. Image quality was analysed on clinical and phantom images. RESULTS Patient doses showed great variability among centers with up to a factor of 5 for similar fluoroscopy times. The five departments had imaging protocols with major differences in fluoroscopy dose regulation curves and additional filtration. Image quality analysis on phantoms and patients images showed no major improvement in contrast, spatial resolution or noise when increasing the radiation dose. Age-based diagnostic reference levels using both dose area product and fluoroscopy time were proposed per procedure type. CONCLUSION Disparities between centers and no correlation of radiation dose with image quality criteria create margins for optimisation. These results highlight the need for guidelines on fluoroscopy image quality and dose reference levels in paediatric gastrointestinal examinations to harmonise practices and optimise patient dose.
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Affiliation(s)
- Aurélie Forbes
- Radiology Department, Public Assistance - Paris Hospitals Antoine Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Bouchra Habib Geryes
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Amaury Hornbeck
- Radiology Department, Public Assistance - Paris Hospitals Armand-Trousseau Paediatric Hospital, Paris, France
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Nicolas Kien
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Caroline Quelquejay
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Catherine Adamsbaum
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Jad Farah
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Hubert Ducou le Pointe
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
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Radiation exposure to infants undergoing voiding cystourethrography: The importance of the digital imaging technology. Phys Med 2021; 85:123-128. [PMID: 34000681 DOI: 10.1016/j.ejmp.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the radiation burden to infants undergoing voiding cystourethrography (VCUG) in a single institution and investigate the effect of shifting from analogue to digital imaging that allowed the use of a radiography-free examination protocol. METHODS Anthropometric and exposure data were prospectively collected for 35 consecutive infants undergoing VCUG on a digital system with a standardized examination protocol not including radiographs. Thermoluminescent dosimeters were used to determine entrance-skin dose. Monte Carlo simulations and patient-specific anthropomorphic phantoms were employed to determine organ/tissue doses and effective dose (ED). The associated theoretical risk of radiation-induced cancer was determined and compared to the nominal risk of cancer induction. The radiation burden from VCUG on a modern digital system with a contemporary examination protocol was compared to corresponding data reported previously for an analogue system in the same institution. RESULTS The median ED from VCUG was found 47 μSv. The associated total life attributable risk of radiation-induced cancer was found 10x10-6 and 13x10-6 for boys and girls, respectively. VCUG was found to increase the nominal risk of cancer by a factor of 1.000025 in boys and 1.000034 in girls. Shifting from analogue to digital imaging system resulted in 89% reduction of the radiation burden from VCUG. CONCLUSION The theoretical radiation risks for infants undergoing VCUG using a modern digital imaging system and a radiography-free protocol were found to be minor. The transition from analogue to digital equipment resulted in considerable reduction of the radiation burden from VCUG.
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Becker A, Yaslowitz O, Dubose J, Peleg K, Daskal Y, Givon A, Kessel B. Is computed tomography cystography indicated in children with pelvic fractures? Chin J Traumatol 2020; 23:181-184. [PMID: 32001130 PMCID: PMC7296357 DOI: 10.1016/j.cjtee.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/31/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images. METHODS A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant. RESULTS A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients). CONCLUSION The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.
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Affiliation(s)
- Alexander Becker
- Department of Surgery, Emek Medical Center, Afula, Israel,The Rappaport School of Medicine, Technion, Haifa, Israel,Corresponding author. Department of Surgery, Emek Medical Center, Afula, 18000, Israel.
| | - Ori Yaslowitz
- Department of Surgery A, Meir Medical Center, Kfar-Saba, Israel
| | - Joseph Dubose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Kobi Peleg
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel,Emergency and Disaster Management Department, Faculty of Medicine, School of Public Health, Tel-Aviv University, Israel
| | - Yaakov Daskal
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | | | - Boris Kessel
- The Rappaport School of Medicine, Technion, Haifa, Israel,Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
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Sulieman A, Elhag B, Alkhorayef M, Babikir E, Theodorou K, Kappas C, Bradley D. Estimation of effective dose and radiation risk in pediatric barium studies procedures. Appl Radiat Isot 2017; 138:40-44. [PMID: 28757351 DOI: 10.1016/j.apradiso.2017.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
The objectives of this study are to assess pediatric radiation exposure in certain barium studies and to quantify the organ and effective doses and radiation risk resultant from patients' irradiation. A total of 69 pediatric barium studies for upper and lower gastrointestinal tract. Patients' radiation dose was quantified in terms of Entrance surface air kerma (ESAKs) using exposure parameters and DosCal software. Organ and effective doses (E) were extrapolated using national Radiological Protection Board software (NRPB-R279). The mean ± (SD) and the range of patient doses per procedure were 3.7 ± 0.4 (1.0-13.0)mGy, 7.4 ± 1.7(5.5-8.0)mGy and 1.4 ± 0.9 (0.5-3.6)mGy for barium meal, swallow and enema, respectively. The mean effective doses were 0.3 ± 0.03 (0.08-1.1)mSv, 0.2 ± 1.6 (0.44-0.7)mSv and 0.3 ± 0.9 (0.1-0.8)mSv at the same order. The radiation dose were higher compared to previous studies. Therefore, pediatrics are exposed to avoidable radiation exposure. Certain optimization measures are recommended along with establishing national diagnostic reference level (DRL) to reduce the radiation risk.
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Affiliation(s)
- A Sulieman
- Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O.Box 422, 11942, Saudi Arabia.
| | - B Elhag
- Alghad International Colleges for Applied Medical Sciences, Radiology and Medical Imaging Department, Almadinah Almunawra, Saudi Arabia
| | - M Alkhorayef
- King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O.Box 10219, Riyadh 11433, Saudi Arabia; Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - E Babikir
- King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O.Box 10219, Riyadh 11433, Saudi Arabia
| | - K Theodorou
- Medical Physics Department, University Hospital of Larissa, PO Box 1425, Larissa 41110, Greece
| | - C Kappas
- Medical Physics Department, University Hospital of Larissa, PO Box 1425, Larissa 41110, Greece
| | - D Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom; Sunway University, Institute for Health Care Development, Jalan Universiti, 46150 PJ, Malaysia
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