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Nocetti D, Villalobos K, Marín N, Monardes M, Tapia B, Toledo MI, Villegas C. Radiation dose reduction and image quality evaluation for lateral lumbar spine projection. Heliyon 2023; 9:e19509. [PMID: 37681134 PMCID: PMC10481289 DOI: 10.1016/j.heliyon.2023.e19509] [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: 04/03/2023] [Revised: 07/29/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose Optimization studies in digital radiology help to reduce the radiological risk to patients and maximize the benefits associated with their clinical purpose. The aim of this study was to assess the optimization of lateral lumbar spine projection via a combination of exposure parameters adjustments and additional filtration using a sectional anthropomorphic phantom. Materials and methods We evaluated the effects of peak voltage, tube loading, and low-cost filters made of copper, titanium, brass, and nickel on both the perceived and physical quality of 125 radiographs obtained in a computer radiography system. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with their Figure of Merit (FOM), based on the entrance surface air kerma with backscatter (ESAK), was used to assess physical image quality. Results The standard image had a perceived image quality, SNR, FOMSNR, CNR, FOMCNR and ESAK of 3.4, 22.3, 386.4, 23.6, 433.7 and 1.28 mGy, respectively. Copper (90.3% purity) and titanium (95.0% purity) filters reduced ESAK by an average of 60% without compromising diagnostic quality, while brass and nickel filters increased dose under the conditions of the study. Conclusions Our findings show that optimizing lumbar spine projection can reduce radiation dose without compromising image quality. Low-cost copper and titanium filters can be valuable in resource-limited settings. Further research can explore additional strategies for radiological optimization.
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Affiliation(s)
- Diego Nocetti
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Kathia Villalobos
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Nelson Marín
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Martina Monardes
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Benjamín Tapia
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - María Ignacia Toledo
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Camila Villegas
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
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Peacock NE, Steward AL, Riley PJ. An evaluation of the effect of tube potential on clinical image quality using direct digital detectors for pelvis and lumbar spine radiographs. J Med Radiat Sci 2020; 67:260-268. [PMID: 32495517 PMCID: PMC7753839 DOI: 10.1002/jmrs.403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION High kVp techniques, 15% or 10-kVp rules, are well-known dose reduction methods. Traditionally, the use of high tube potential (i.e. increased kVp) is associated with decreased radiographic contrast and overall image quality. Recent studies suggest contrast and image quality are not heavily reliant on kVp with digital systems. This study aims to assess the effects of the high tube potential technique on clinical radiographic image quality when using digital systems, to validate high kVp as a dose saving technique. METHODS A selection of comparable pelvis and lumbar spine radiographs were collected from the hospital's picture archiving and communication system (PACS), with technical factors recorded. All clinical radiographs were assessed by 5 senior radiographers using a 15-point visual grading analysis (VGA) rubric. RESULTS For 40 AP pelvis radiographs and 40 lateral lumbar spine radiographs, reduction in the dose area product (DAP) with higher kVp is seen. Average pelvis DAP at 75 kVp = 14.06 mGy.cm2 ; 85 kVp = 7.47 mGy.cm2 . Average lumbar spine DAP at 80 kVp = 15.76 mGy.cm2 ; 90 kVp = 14.83 mGy.cm2 . Image quality and contrast scores showed no statistically significant difference between the high and low kVp groups (z = 0.06 and 0.12, respectively). Average pelvis VGA score at 75 kVp = 11.26; 85 kVp = 12.55. Average lumbar spine VGA score at 80 kVp = 9.23; 90 kVp = 10.64. CONCLUSIONS The high tube potential techniques allowed for reduced patient radiation doses whilst showing no degradation of diagnostic image quality in a clinical setting. This study successfully validates the high kVp technique as a useful tool for reducing patient radiation doses whilst maintaining high diagnostic image quality for digital pelvis and lumbar spine radiography.
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Affiliation(s)
- Nicole E Peacock
- Department of Medical ImagingWestern HealthFootscrayVICAustralia
- School of Medicine, Faculty of HealthDeakin UniversityWaurn PondsVICAustralia
| | - Adam L Steward
- Department of Medical ImagingWestern HealthFootscrayVICAustralia
| | - Peter J Riley
- School of Medicine, Faculty of HealthDeakin UniversityWaurn PondsVICAustralia
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Kivistö S, Kotiaho A, Henner A, Nevala T, Niinimäki J, Nieminen MT, Hanni M. Air gap technique is recommended in axiolateral hip radiographs. J Appl Clin Med Phys 2020; 21:210-217. [PMID: 32959511 PMCID: PMC7592970 DOI: 10.1002/acm2.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose To investigate the replacement of conventional grid by air gap in axiolateral hip radiographs. The optimal air gap distance was studied with respect to radiation dose and image quality using phantom images, as well as 26 patient axiolateral hip radiographs. Methods The CDRAD phantom, along with polymethylmethacrylate slabs with thicknesses of 10.0, 14.6, and 20.0 cm was employed. The inverse image quality index and dose area product (DAP), as well as their combination, so called figure‐of‐merit (FOM) parameter, were evaluated for these images, with air gaps from 20 to 50 cm in increments of 10 cm. Images were compared to those acquired using a conventional grid utilized in hip radiography. Radiation dose was measured and kept constant at the surface of the detector by using a reference dosimeter. Verbal consent was asked from 26 patients to participate to the study. Air gap distances from 20 to 50 cm and tube current‐time products from 8 to 50 mAs were employed. Exposure index, DAP, as well as patient height and weight were recorded. Two radiologists evaluated the image quality of 26 hip axiolateral projection images on a 3‐point nondiagnostic — good/sufficiently good — too good scale. Source‐to‐image distance of 200 cm and peak tube voltage of 90 kVp were used in both studies. Results and conclusion Based on the phantom study, it is possible to reduce radiation dose by replacing conventional grid with air gap without compromising image quality. The optimal air gap distance appears to be 30 cm, based on the FOM analysis. Patient study corroborates this observation, as sufficiently good image quality was found in 24 of 26 patient radiographs, with 7 of 26 images obtained with 30 cm air gap. Thus, air gap method, with an air gap distance of 30 cm, is recommended in axiolateral hip radiography.
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Affiliation(s)
- Susanne Kivistö
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Antti Kotiaho
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Anja Henner
- Oulu University of Applied Sciences, Oulu, Finland
| | - Terhi Nevala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Matti Hanni
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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Steffensen C, Trypis G, Mander GTW, Munn Z. Optimisation of radiographic acquisition parameters for direct digital radiography: A systematic review. Radiography (Lond) 2020; 27:663-672. [PMID: 32948453 DOI: 10.1016/j.radi.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of this systematic review was to uncover and synthesise all available literature regarding appropriate acquisition parameters for direct digital radiography. It sought to either confirm current practices as optimal, or to uncover practices that may produce more optimised results. METHODS A comprehensive search of published and unpublished literature was undertaken to find studies that evaluated how adjustment of different acquisition parameters affected subjective image quality and patient radiation dose. Eight hundred and fifty-eight studies were retrieved for title and abstract screening. Eighty-nine studies were retrieved for full-text screening, and 23 were included for review and methodological quality screening. RESULTS Narrative synthesis of the 23 included studies revealed limited evidence to guide any potential change or acceptance of currently accepted best practice. Meta-analysis was unable to be performed for any of the included studies due to high levels of methodological heterogeneity. A key finding of this review was that the goals of optimisation research varied greatly across the included studies. CONCLUSION Significant methodological heterogeneity in the included studies limited the number of clinically relevant findings that would give evidence to an acceptance of, or suggest changes to, currently accepted best practice. Improving consistency in approach across future works of technique optimisation will ensure future systematic reviews will be able to provide strong evidence and meta-analysis will be able to be performed. IMPLICATIONS FOR CLINICAL PRACTICE This review highlights that in the literature, studies of optimisation of radiographic acquisition parameters have varying goals. This methodological heterogeneity limits the applicability of systematic reviews and precludes the use of meta-analysis. The authors recommend that a framework for optimisation research be produced as a priority to help improve homogeneity in future research.
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Affiliation(s)
- C Steffensen
- Philips Australia and New Zealand, North Ryde, Australia; JBI, The University of Adelaide, Adelaide, Australia.
| | - G Trypis
- Department of Medical Imaging, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - G T W Mander
- Department of Medical Imaging, Toowoomba Hospital, Darling Downs Health, Toowoomba, Australia; JBI, The University of Adelaide, Adelaide, Australia
| | - Z Munn
- JBI, The University of Adelaide, Adelaide, Australia
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The impact of gonad shielding in anteroposterior (AP) pelvis projections in an adult: A phantom study utilising digital radiography (DR). Radiography (Lond) 2020; 26:240-247. [PMID: 32089492 DOI: 10.1016/j.radi.2020.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/12/2020] [Accepted: 01/17/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Positioning relative to the lateral automatic exposure control (AEC) chambers (cranial/caudal orientation) optimises dose and image quality in pelvic radiography. In the cranial orientation introducing gonad shielding (GS) in females may increase radiation dose. The aim of this study was to fully optimise the combination of pelvis orientation and use of GS in both male and females. METHODS An anthropomorphic pelvis phantom was exposed, with dose area product (DAP) recorded, in both orientations without GS and four conditions with GS: cranial orientation (female/male), caudal orientation (female/male). A 4 cm × 4 cm grid incorporating thirteen positions for the GS resulted in 52 experimental settings. Blind image quality assessment, utilising a modified scale, was undertaken by two experienced observers. RESULTS Comparing no GS (caudal orientation) to female GS, no significant change in DAP was seen (3.97 v 4.03 dGy*cm2; Mann-Whitney p = 0.060). Comparing no GS (cranial orientation) to male GS no significant change in DAP was seen (8.66 v 8.77 dGy*cm2; Mann-Whitney; p = 0.210). DAP increased significantly with introduction of female GS in the cranial orientation (23%: 8.66 v 10.65 dGy*cm2, Mann-Whitney; p < 0.001) and male GS in the caudal orientation (22.8%: 3.97 v 4.87 dGy*cm2, Mann-Whitney; p < 0.001). Significantly higher repeat rates (Chi-squared test; p < 0.001) were seen for GS in female (85-100%) compared to male (30.8%). CONCLUSION The use of gonad shielding can increase DAP and lead to repeats being required, with more required for female GS usage, suggesting the utility of GS for pelvis examinations is questionable. IMPLICATIONS FOR PRACTICE Optimisation of radiation dose in pelvic radiographic examinations utilising AEC terminated exposures requires consideration of AEC chamber position and GS usage.
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