1
|
Ball S, McKerrow M, Murphy A. Do radiographers collimate? A retrospective analysis of radiographic collimation of common musculoskeletal examinations at an adult trauma centre. J Med Radiat Sci 2023; 70:21-29. [PMID: 36319191 PMCID: PMC9977647 DOI: 10.1002/jmrs.630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Collimation of the primary beam is an important factor in radiography to reduce dose and improve image quality. The introduction of larger detector plates in direct digital radiography (DR) allows the exposed area to be calculated by removing cropping applied to the image. The aim of this study was to assess whether the exposed area was larger than a reference standard across five different projections on different body types, with the reference size being the corresponding cassette size used in traditional film/screen or computed radiography (CR). METHOD A retrospective clinical audit of five common musculoskeletal radiographic projections (AP knee, AP shoulder, horizontal beam lateral hip, lateral cervical spine and lateral facial bones), of 359 patients was undertaken. The electronic cropping was removed from projections, and the superior-inferior, antero-posterior and medio-lateral collimation size was measured, depending on the projection. The two measurements were multiplied to give an exposed field of view area. The three measurements were compared with a reference standard, being the size of the corresponding cassette size used in the department on film/screen or computed radiography. RESULTS From the five projections, 1071 measurements were analysed. 416 (38.8%) of these measurements were less than or equal to the agreed reference standard. 655 (61.2%) were greater than the agreed reference standard. CONCLUSION The study demonstrates that the majority (61.2%) of the measurements taken were above the reference standard. This results in an increase in radiation dose to patients and detrimental impacts on image quality.
Collapse
Affiliation(s)
- Sally Ball
- Department of Medical ImagingPrincess Alexandra HospitalBrisbaneAustralia
| | - Megan McKerrow
- Department of Medical ImagingPrincess Alexandra HospitalBrisbaneAustralia
| | - Andrew Murphy
- Department of Medical ImagingPrincess Alexandra HospitalBrisbaneAustralia,School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| |
Collapse
|
2
|
Hayre C, Makanjee C, Lewis S. Collimation and cropping in diagnostic radiography: How concerned are we? J Med Radiat Sci 2023; 70:8-10. [PMID: 36608354 PMCID: PMC9977650 DOI: 10.1002/jmrs.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023] Open
Abstract
This editorial examines current collimation and cropping practices in general radiography. We critically reflect on whether we are concerned by the practice of collimation creep amongst radiographers. Discussions around policy, evidence‐based practice and potential hypocrisies are outlined in this editorial piece.
Collapse
Affiliation(s)
- Christopher Hayre
- Department of Health and Care Professions, University of Exeter, Exeter, UK
| | - Chandra Makanjee
- Department of Medical Radiation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Shantel Lewis
- Department of Medical Imaging and Radiation Sciences, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
3
|
Singh T, Muscroft N, Collier N, England A. A comparison of effective dose and risk for different collimation options used in AP shoulder radiography. Radiography (Lond) 2021; 28:394-399. [PMID: 34887196 DOI: 10.1016/j.radi.2021.11.007] [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: 08/04/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Radiography forms the cornerstone of the evaluation of shoulder disorders. While the benefits of radiography exceed the risks, there continues to be a compelling case for reduction of radiation exposure from diagnostic radiography. The aim of this project was to evaluate the radiation dose and risk for a variety of collimation settings used during anteroposterior (AP) shoulder radiography. METHODS This was a phantom based study where an ATOM adult dosimetry phantom was loaded with 272 thermoluminescent dosimeters (TLDs). Following loading, the phantom was setup for an AP shoulder X-ray projection with standard 25 × 30 cm rectangular collimation. The phantom was exposed three times and then the TLDs were removed and read. The experiment was repeated using a diamond shaped collimation and rectangular collimation with a minimum field of view to portray only relevant anatomy. Using the TLD dose measurements the effective doses and radiation risks were determined and compared. RESULTS As expected, organs neighbouring the shoulder experienced the highest absorbed doses (greater than 0.01 mGy); these organs included breast, lung and thyroid gland. The effective doses for standard rectangular, small rectangular and diamond collimation were 0.011, 0.008 and 0.016 mSv, respectively. When compared to standard collimation, a small field of view reduced effective dose by 27.3% and when moving to a diamond shape there was a 45.5% increase. The differences are likely driven by differences in the coverage of the radiosensitive lung and breast tissue. CONCLUSION By utilising a variety of different collimation settings, effective dose can be reduced. Reducing the radiation dose is both financially beneficial and results in a lower stochastic risk for patients. Image quality must also be considered when choosing different collimation settings. It stands to reason that by reducing the field size, dose will be reduced, and our study has served to quantify the effects in a practical situation. IMPLICATIONS FOR PRACTICE The utilisation of smaller/tight collimation is recommended as it offers the lowest dose when compared with other types of collimations. Although well-known this study serves to remind practitioners of the practical importance of collimation and is associated effect on effective dose and risk.
Collapse
Affiliation(s)
- T Singh
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK
| | - N Muscroft
- Warrington & Halton Teaching Hospitals NHS Trust, Warrington, UK
| | - N Collier
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - A England
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK; Discipline of Medical Imaging, School of Medicine, University College Cork, Ireland.
| |
Collapse
|
4
|
Satharasinghe D, Jeyasugiththan J, Jeyasuthan M, Amalaraj T, Abeyweera AL, Wanninayake WMNMB, Pallewatte AS. IMPACT OF COLLIMATION ON RADIATION EXPOSURE IN ADULT AND PAEDIATRIC DIGITAL X-RAY IMAGING. RADIATION PROTECTION DOSIMETRY 2021; 197:19-27. [PMID: 34718821 DOI: 10.1093/rpd/ncab155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to evaluate the collimation practices and quantify the overexposure due to extensive X-ray field area. The study was carried out in four digital X-ray units (including one paediatric X-ray unit). A total of 749 X-ray projections (555 adult and 194 paediatric) were evaluated. In adult X-ray units, the radiation field size was two times larger than the electronically collimated field. In the paediatric unit, the radiation field was 3.7 times larger than the electronic collimated field. The average additional entrance surface dose due to the excess radiation field used in a paediatric X-ray unit varied between 9.3 (2.5%) and 201.4 $\mu $Gy (10.9%). Therefore, proper pre-patient collimation should be applied whenever feasible, which reduces the patient radiation dose considerably.
Collapse
Affiliation(s)
- Duminda Satharasinghe
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka
- Horizon Campus, Malabe, Sri Lanka
| | - J Jeyasugiththan
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - M Jeyasuthan
- Department of Radiology, Tellippalai Base Hospital, Jaffna, Sri Lanka
| | - T Amalaraj
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | | | | | - A S Pallewatte
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| |
Collapse
|
5
|
How does a non-optimal tube potential influence radiation dose to the patient in lumbar spine radiography? Radiography (Lond) 2021; 27:1105-1109. [PMID: 34011453 DOI: 10.1016/j.radi.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/08/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION When comparing the radiation dose to the patient, the lumbar spine has one of the highest dose values in general radiography, therefore the procedure needs to be optimised. The aim of this study was to investigate the effect of a non-optimal tube potential (66 kV) during anteroposterior (AP) lumbar spine radiography on the radiation dose received by the patient compared with the radiation dose when an optimal tube potential (79 kV) is used, in accordance with European guidelines. METHODS This retrospective study involved 100 patients referred for lumbar radiography in two different diagnostic departments. Half of the patients were admitted to a department which used optimal tube potential and the other half to the department which used non-optimal tube potential for AP lumbar spine radiography protocols. The height and weight of the patients were collected to calculate the body mass index (BMI) of the patients. The image field size and dose area product (DAP) values were collected after each imaging session. The effective dose and selected organ dose were calculated using the PCXMC 2.0 program. RESULTS The results showed that a non-optimal tube potential resulted in a significant increase in the DAP value by 360% (p < 0.001) and a significant increase in the effective dose by 160% (p < 0.001). Dose to selected organs due to non-optimal tube potential increased from 107% (breasts) up to 631% (prostate) (p < 0.001). The images were not assessed using visual grading characteristics (VGC) analysis, but the radiologists evaluated all the images appropriate for diagnostic reading. CONCLUSION Based on our study's stated results, we can conclude that optimal tube potential use is essential to achieve the ALARA principle. IMPLICATIONS FOR PRACTICE The study shows the effect of a non-optimal tube potential on the radiation dose received by the patient during radiography of the lumbar spine. This could influence possible diagnostic departments to consider protocol optimisation due to the high radiation dose received by the patient.
Collapse
|
6
|
Luan FJ, Zhang J, Mak KC, Liu ZH, Wang HQ. Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks. Int J Med Sci 2021; 18:73-80. [PMID: 33390775 PMCID: PMC7738971 DOI: 10.7150/ijms.48050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally.
Collapse
Affiliation(s)
- Fu-Jun Luan
- Department of Orthopaedics, Yongchuan Hospital of Chongqing Medical University, Chongqing City, P. R. China, 402160
| | - Jun Zhang
- Department of Orthopaedics, Baoji Municipal Central Hospital, Baoji, Shaanxi, China, 721008
| | - Kin-Cheung Mak
- Spine Central, Specialist Central, The Hong Kong Adventist Hospital, Hong Kong SAR, China
| | - Zhi-Heng Liu
- Department of Orthopaedics, Chinese PLA No.986 Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, P. R. China, 710054
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, P. R. China, 712046
| |
Collapse
|
7
|
Pfeifer CM. Improving Pediatric Chest Radiograph Collimation: A Quality Initiative. Curr Probl Diagn Radiol 2020; 49:355-357. [DOI: 10.1067/j.cpradiol.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/03/2019] [Accepted: 09/03/2019] [Indexed: 11/22/2022]
|
8
|
Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3123-3134. [PMID: 32852591 DOI: 10.1007/s00586-020-06573-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/12/2020] [Accepted: 08/16/2020] [Indexed: 01/08/2023]
|
9
|
Pazanin A, Skrk D, O'Driscoll JC, McEntee MF, Mekis N. OPTIMAL COLLIMATION SIGNIFICANTLY IMPROVES LUMBAR SPINE RADIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2020; 189:420-427. [PMID: 32363403 DOI: 10.1093/rpd/ncaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To determine the influence of optimal collimation during lumbar spine radiography on radiation dose and image quality. MATERIAL AND METHODS 110 lumbar spine patients were split into two groups-the first imaged with standard collimation and the second with optimal collimation. Body mass index, image field size, exposure conditions and dose area product were measured. Effective and absorbed organ doses were calculated. Image quality was assessed. RESULTS Optimal collimation reduced the primary field by up to 40%. The effective dose was reduced by 48% for the AP projection, while no differences were found for the LAT projection due to incorrect positioning of the central beam with standard collimation. The absorbed dose to selected radiosensitive organs decreased by 41 and 10% in the AP and LAT projections, respectively. Image quality for the LAT projection improved by 24% and maintained for the AP projection. CONCLUSION Optimal collimation in lumbar spine imaging significantly influences patient exposure to radiation.
Collapse
Affiliation(s)
- Anamaria Pazanin
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, Ljubljana 1000, Slovenia
| | - Damijan Skrk
- Slovenian Radiation Protection Administration, Ljubljana, Slovenia
| | - Jessica C O'Driscoll
- Discipline of Diagnostic Radiography, UG 12 ÁSSERT, Brookfield Health Sciences, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Mark F McEntee
- Discipline of Diagnostic Radiography, UG 12 ÁSSERT, Brookfield Health Sciences, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Nejc Mekis
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, Ljubljana 1000, Slovenia
| |
Collapse
|
10
|
Lai ZH, Sá Dos Reis C, Sun Z. Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study. Eur Radiol Exp 2020; 4:13. [PMID: 32056045 PMCID: PMC7018898 DOI: 10.1186/s41747-019-0132-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022] Open
Abstract
Background To investigate lateral lumbar spine radiography technical parameters for reduction of effective dose whilst maintaining image quality (IQ). Methods Thirty-six radiograms of an anthropomorphic phantom were acquired using different exposure parameters: source-to-detector distance (SDD) (100, 130 or 150 cm), tube potential (75, 85 or 95 kVp), tube current × exposure time product (4.5, 9, 18 mAs) and additional copper (Cu) filter (no filter, 0.1-, 0.2-, or 0.3-mm thickness. IQ was assessed using an objective approach (contrast-to-noise-ratio [CNR] calculation and magnification measurement) and a perceptual approach (six observers); ED was estimated using the PCXMC 2.0 software. Descriptive statistics, paired t test, and intraclass correlation coefficient (ICC) were used. Results The highest ED (0.022 mSv) was found with 100 cm SSD, 75 kVp, 18 mAs, and without Cu filter, whilst the highest CNR (7.23) was achieved at 130 cm SSD, 75 kVp, 18 mAs, and without Cu filter. The lowest ED and CNR were generated at 150 cm SDD, 95 kVp, 4.5 mAs, and 0.3-mm Cu filter. All observers identified the relevant anatomical structures on all images with the lowest ED and IQ. The intra-observer (0.61–0.79) and inter-observer (0.55–0.82) ICC ranged from moderate to excellent. Conclusion All relevant anatomical structures were identified on the lateral lumbar spine radiographs despite using low-dose protocols. The lowest ED (0.002 mSv) was obtained with 150 cm SDD, 95 kVp, 4.5 mAs, and 0.3-mm Cu filter. Further technical and clinical studies are needed to verify these preliminary findings.
Collapse
Affiliation(s)
- Zer Hau Lai
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Cláudia Sá Dos Reis
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia. .,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Av. de Beaumont 21, 1011, Lausanne, Switzerland. .,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| |
Collapse
|
11
|
Alsleem H, Davidson R, Al‐Dhafiri B, Alsleem R, Ameer H. Evaluation of radiographers' knowledge and attitudes of image quality optimisation in paediatric digital radiography in Saudi Arabia and Australia: a survey-based study. J Med Radiat Sci 2019; 66:229-237. [PMID: 31697039 PMCID: PMC6920681 DOI: 10.1002/jmrs.366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Digital radiography (DR) systems enable radiographers to reduce the radiation dose to patients while maintaining optimised image quality. However, concerns still exist about paediatric patients who may be exposed to an increased level of radiation dose which is not needed for clinical practice. The purpose of this study was to evaluate the knowledge, awareness and attitudes, in terms of image quality optimisation of radiographers undertaking paediatric DR in Australia and Saudi Arabia. METHODS A survey-based study was devised and distributed to radiographers from Australia and Saudi Arabia. Questions focused on Australian and Saudi Arabian radiographers' knowledge and attitude of paediatric DR examinations. RESULTS There were 376 participants who responded to the survey from both countries. A major finding showed that most participants lack knowledge in the area of paediatric DR examinations. Most participants from Australia had received no formal training in paediatric digital radiography (79%), whereas nearly half of the participants from Saudi Arabia received no training (45%). Approximately three out of four radiographers from both countries believed that when using DR they did not need to change the way they collimate the beam as DR images can be cropped using post-processing methods. CONCLUSION The finding of this study demonstrates that radiographers from both countries should improve their understanding and clinical use of DR in paediatric imaging. More education and training for both students and clinicians is needed to enhance radiographer performance in digital radiography and improve their clinical practices.
Collapse
Affiliation(s)
- Haney Alsleem
- Imam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
- University of CanberraCanberraAustralia
| | | | | | | | - Hussain Ameer
- Imam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| |
Collapse
|
12
|
The Use of Digital Side Markers (DSMs) and Cropping in Digital Radiography. J Med Imaging Radiat Sci 2019; 50:234-242. [PMID: 31176431 DOI: 10.1016/j.jmir.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/08/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This article explores two phenomena in the general radiography environment-the increasing use of digital side markers (DSMs) by radiographers and the possibility for radiographers to "crop" radiographs post-exposure. This article offers originality by identifying the rationales of radiographers when using digital equipment. METHODS This study formed part of a larger ethnographic study undertaken in the United Kingdom (UK). Participant observation and semi-structured interviews were used. Overt participant observation identified cropping and DSM placement within the X-ray room. Semi-structured interviews later supported and/or refuted the rationale for DSMs and cropping clinically. RESULTS Two themes are discussed. First, radiographers support the use of DSMs by suggesting that mistakes will happen regardless of using an ASM and/or DSM. Furthermore, it is proposed that ASMs and DSMs can be interchangeably used in practice. Second, radiographers acknowledge the use of cropping ensuring their radiographs resemble "a textbook image." This leads to question the optimum use of collimation in the clinical environment and how it may go unnoticed. CONCLUSION This article concludes by recognizing some challenges digital radiography currently provides. The rationale and continuing use of DSMs and cropping of radiographs by radiographers highlights alternate complexities with digital technology in the clinical environment and how we may best overcome such challenges that influence the profession.
Collapse
|