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Welarathna S, Velautham S, Sarasanandarajah S. Patient dose and associated exposure parameters in pelvic x-ray examinations: dependence on radiographic system. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:433-442. [PMID: 39020221 DOI: 10.1007/s00411-024-01080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
Technological differences between computed radiography (CR) and digital radiography (DR) systems can influence patient doses and exposure parameters in pelvic x-ray examinations. The presence of radiosensitive organs in the pelvic region underscores the need to optimize these parameters for both CR and DR systems. This prospective study aimed to compare the patient doses and exposure parameters for adult patients undergoing pelvic x-ray examinations using CR and DR systems, based on data from Sri Lanka. The study included data from 56 x-ray examinations, with 25 using CR and 31 using DR. Patient demographic characteristics and exposure parameters (kVp: kilovoltage peak, mAs: tube current-exposure time product) were recorded, and patient doses were measured in terms of the kerma-area product (PKA) using a PKA meter. Despite similar mean weight and body mass index (BMI), the CR systems showed significantly higher mean kVp (7.4%), mAs (16.4%), and PKA (29.7%) than the DR systems (CR - kVp: 73.2, mAs: 37.8, PKA: 2.29 Gy cm2; DR - kVp: 67.8, mAs: 31.6, PKA: 1.61 Gy cm2). The Mann-Whitney U test revealed statistically significant differences in PKA and kVp between the CR and DR systems (p < 0.05). Furthermore, even with lower patient weight and BMI, the mean mAs and PKA in this study were substantially higher than those reported in the literature for both CR and DR systems. These results suggest the need to optimize current mAs settings for the studied hospitals and introduce radiographic system-specific exposure parameters and reference dose levels for pelvic x-ray examinations in order to enhance patient protection.
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Affiliation(s)
- Sachith Welarathna
- Department of Physics, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
| | - Sivakumar Velautham
- Department of Physics, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Sivananthan Sarasanandarajah
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, 3052, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3000, Australia
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Sayed M, Knapp KM, Fulford J, Heales C, Alqahtani SJ. The impact of X-ray scatter correction software on abdomen radiography in terms of image quality and radiation dose. Radiography (Lond) 2024; 30:1125-1135. [PMID: 38797045 DOI: 10.1016/j.radi.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The conventional anti-scatter grid is widely used in X-ray radiography to reduce scattered X-rays, but it increases patient dose. Scatter-correction software offers a dose-reducing alternative by correcting for scattered X-rays without a physical grid. Grids and software correction are necessary to reduce scatter radiation and improve image quality especially for the large body parts. The scatter correction can be beneficial in situations where the use of grid is challenging. The implementation of grids and advanced software correction techniques is imperative to ensure that radiographic images maintain high levels of clarity, contrast, and resolution, and ultimately facilitating more accurate diagnoses. This study compares image quality and radiation dose for abdomen exams using scatter correction software and physical grids. METHODS An anthropomorphic phantom (abdomen) underwent imaging with varying fat and lean tissue layers and body mass index (BMI) configurations. Imaging parameters included 70 kVp tube voltage, 110 cm SID, and Automatic Exposure Control (AEC) both lateral and central chambers. AP abdomen X-ray projections were acquired with and without an anti-scatter grid, and scatter correction software was applied. Image quality was assessed using contrast to noise ratio (CNR) and signal to noise ratio (SNR) metrics. The tube current mAs was considered an exposure factor that affected radiation dose and was used to compare the VG software and physical grid. Radiation dose was measured using Dose Area Products (DAP). The effective dose was estimated using Monte Carlo simulation-PCXMC software. Paired t-tests were used to investigate the image quality difference between the Gridless and VG software, Gridless and PG, and VG software and PG approaches. For the DAP and effective dose, paired t-test was used to investigate the difference between VG software and PG. RESULTS Images acquired with a grid had the highest mean CNR (71.3 ± 32) compared to Gridless (50 ± 33.8) and scatter correction software (59.3 ± 37.9). The mean SNR of the grid images was (82.7.3 ± 38.9), which is 18% higher than the scatter correction software images (70.4 ± 36.7) and 29% higher than in the Gridless images (62.9.3 ± 34). The mean DAP value was reduced by 81% when the scatter correction software was used compared to the grid (mean: 65.4 μGy.m2 and 338.2 μGy.m2, respectively) with a significant difference (p = 0.001). Scatter correction software resulted in a lower effective dose compared to physical grid use, (mean difference± SD = -0.3 ± 0.18 mSv) with a significant difference (P = 0.02). CONCLUSION Scatter correction software reduced the radiation dose required but images employing a grid yielded higher CNR and SNR. However, the radiation dose reduction might affect the image quality to a level that impacts the diagnostic information available. Thus, further research needs to be conducted to optimise the use of the scatter correction software. IMPLICATION FOR PRACTICE Objectively, X-ray scatter correction software might be promising in conditions where a grid cannot be applied.
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Affiliation(s)
- M Sayed
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - K M Knapp
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - J Fulford
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - C Heales
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - S J Alqahtani
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
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Alzyoud K, Al-Murshedi S, England A. Effective dose and image quality for different patient sizes during AP upper abdominal radiography: A phantom study. Appl Radiat Isot 2023; 202:111060. [PMID: 37806283 DOI: 10.1016/j.apradiso.2023.111060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Undertaking medical imaging examinations on obese patients can present practical challenges. Choosing optimal imaging protocols can be difficult, especially when promoting the ALARA principle. The aim of this study was to assess the effects of increasing body part thickness on image quality (IQ) and effective dose (ED) during upper abdominal radiography. A secondary aim was to determine the optimum exposure settings for larger sized patients. METHODS Underweight, standard, overweight and obese abdomen sizes were simulated using an anthropomorphic upper abdomen phantom, without and with additional fat layers (6, 10 and 16 cm). Phantoms were imaged using a variety of tube potentials (70-110 kVp), automatic exposure control (AEC) and a source-to-image distance of 120 cm. IQ was assessed visually using a relative visual grading analysis (VGA) method. Radiation dose was evaluated by calculating the ED using the Monte Carlo PCXMC 2.0 computer program. RESULTS IQ values showed a statistical reduction (p = 0.006) with increasing phantom size across all examined tube potentials. The highest IQ scores (3.3, 2.8, 2.5 and 2.2, respectively) were obtained at 70/75 kVp for all phantom thicknesses. As tube potential increased the IQ was also shown to decrease. ED showed a statistically significant increase (p < 0.001) with increasing phantom thicknesses. CONCLUSION Higher EDs were evident when applying lower tube potentials. Using an AEC with high tube potentials (105/110 kVp) can lead to a considerable decrease in ED with acceptable IQ when undertaking upper abdomen radiography on patients with large body part thicknesses. IMPLICATION FOR PRACTICE Applying higher values of tube potentials for patients who have a thicker abdomen can lead to decreased ED.
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Affiliation(s)
- Kholoud Alzyoud
- Department of Medical Imaging, Faculty of Applied Health Science, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan.
| | - Sadeq Al-Murshedi
- AL-Zahraa University for Women, College of Health and Medical Technology, Karbala, Iraq
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Velonis M, Papanastasiou E, Hatziioannou K, Siountas A, Kamperis E, Papavasileiou P, Koukourakis MI, Seimenis I. Dose optimization of 2D X-ray image acquisition protocols in image-guided radiotherapy. Phys Med 2023; 115:103161. [PMID: 37847953 DOI: 10.1016/j.ejmp.2023.103161] [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: 11/06/2022] [Revised: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE In contemporary radiotherapy, patient positioning accuracy relies on kV imaging. This study aims at optimizing planar kV image acquisition protocols regarding patient dose without degrading image quality. MATERIALS AND METHODS An image quality test-object was placed in-between PMMA plates, suitably arranged to model head or pelvis. Constructed phantoms were imaged using default protocols, the resultant image quality was assessed and the corresponding radiation dose was measured. The process was repeated using numerous kV/mAs combinations to identify those acquisition settings providing images at lower dose than the default protocols but without deterioration in image quality. Default and dose-optimized protocols were then tested on an anthropomorphic phantom and on 51 patients during two successive treatment sessions. Image quality was independently assessed by two readers. Organ and effective doses were estimated using a Monte Carlo simulation software. RESULTS Low-contrast detectability exhibited a stronger dependence on kV/mAs settings, compared to high-contrast resolution. Dose-optimized protocols resulted in significant dose reductions (anteroposterior-head 48.0 %, lateral-head 30.0 %, anteroposterior-pelvis 28.4 %, lateral-pelvis 27.0 %) compared to the default ones, without compromising image quality. Optimized protocols decreased effective doses by 54 % and 29.6 % in head and pelvic acquisitions, respectively. Regarding image quality, anthropomorphic and patient images acquired using the dose-optimized protocols were subjectively evaluated equivalent to those obtained with the corresponding default settings, indicating that the proposed protocols may be routinely used. CONCLUSIONS Given the potentially large number of radiotherapy fractions and the pertinent image acquisitions, dose-optimized protocols could significantly reduce patient dose associated with planar imaging without compromising positioning accuracy.
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Affiliation(s)
- Marios Velonis
- Department of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Greece; Department of Medical Physics, Papageorgiou General Hospital, Thessaloniki, Greece.
| | - Emmanouil Papanastasiou
- Medical Physics & Digital Innovation Laboratory, Medical School, Aristotle University of Thessaloniki, Greece
| | | | - Anastasios Siountas
- Medical Physics & Digital Innovation Laboratory, Medical School, Aristotle University of Thessaloniki, Greece
| | - Efstathios Kamperis
- Department of Radiotherapy, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Periklis Papavasileiou
- Department of Biomedical Sciences, School of Health Sciences, University of West Attica, Greece
| | - Michael I Koukourakis
- Department of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
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Lin JR, Cheng IH, Liang YS, Li JJ, Tsai JM, Wang MT, Lin TP, Huang SL, Chou MC. Investigation of the Relationship between Body Parameters and mAs Using Non-Contact Two-Dimensional Thickness Measurement in Chest Digital Radiography. SENSORS (BASEL, SWITZERLAND) 2023; 23:7169. [PMID: 37631704 PMCID: PMC10458936 DOI: 10.3390/s23167169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
The current study aimed to investigate the relationship between body parameters and the current-time product (mAs) in chest digital radiography using a non-contact infrared thickness-measurement sensor. An anthropomorphic chest phantom was first used to understand variations in mAs over multiple positionings during chest radiography when using the automatic exposure control (AEC) technique. In a human study, 929 consecutive male subjects who underwent regular chest examinations were enrolled, and their height (H), weight (W), and body mass index (BMI) were recorded. In addition, their chest thickness (T) was measured at exhalation using a non-contact infrared sensor, and chest radiography was then performed using the AEC technique. Finally, the relationship between four body parameters (T, BMI, T*BMI, and W/H) and mAs was investigated by fitting the body parameters to mAs using three curve models. The phantom study showed that the maximum mAs was 1.76 times higher than the lowest mAs during multiple positionings in chest radiography. In the human study, all chest radiographs passed the routine quality control procedure and had an exposure index between 100 and 212. In curve fitting, the comparisons showed that W/H had a closer relationship with mAs than the other body parameters, while the first-order power model with W/H fitted to mAs performed the best and had an R-square of 0.9971. We concluded that the relationship between W/H and mAs in the first-order power model may be helpful in predicting the optimal mAs and reducing the radiation dose for chest radiography when using the AEC technique.
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Affiliation(s)
- Jia-Ru Lin
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - I-Hao Cheng
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - Yu-Syuan Liang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Jyun-Jie Li
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - Jen-Ming Tsai
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - Min-Tsung Wang
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - Te-Pao Lin
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - Su-Lan Huang
- Department of Radiology, Kaohsiung Armed Force General Hospital, Kaohsiung 802, Taiwan; (J.-R.L.); (I.-H.C.); (J.-J.L.); (J.-M.T.); (M.-T.W.); (T.-P.L.); (S.-L.H.)
| | - Ming-Chung Chou
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Erect pelvic radiography with fat tissue displacement: Impact on radiation dose and image quality. Radiography (Lond) 2023; 29:546-551. [PMID: 36934682 DOI: 10.1016/j.radi.2023.03.004] [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: 10/30/2022] [Revised: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Pelvic radiography is one of the most frequent general radiography imaging procedures. Pelvic radiography is usually performed in the supine position, but in some cases erect imaging is performed. The aim of this study was to determine whether radiation dose and image quality differ between two different erect pelvic radiographic procedures in overweight and obese patients, with and without displacement of anterior adipose tissue. METHODS This research was a two-part study. The first part of the study was to determine a suitable fat displacement band that would not produce artifacts on the resulting radiograph when fat tissue was displaced. The second part of the study was performed in a clinical setting on 60 overweight or obese patients (BMI ≥25) referred for erect pelvic imaging. Patients were randomly divided into two equal groups, half of which displaced adipose tissue from the region of interest and the other group did not. Waist and hip circumference, height, weight, dose-area- product (DAP), primary field size, source-to-skin distance, mAs, and kV were measured. Body Mass Index (BMI), entrance surface dose (ESD), and effective dose (ED) were then calculated. The resulting images were evaluated by three radiologists. RESULTS It was found that a thin cotton triangular bandage produced no visible radiographic artefacts. In the group of patients using the fat displacement protocol, a statistically significant reduction in waist circumference (4.7%), DAP (38.5%), ESD (44%) and ED (38.7%) were observed (p < 0.05). In addition, a significant (p < 0.05) increase was found for all the observed image quality criteria and overall total image score with exception of sacroiliac joint, iliac crest and pubic/ischial rami. CONCLUSION Based on the results, the use of the adipose tissue displacement protocol for radiography of the pelvis and hip in the erect position in overweight and obese patients is recommended. IMPLICATIONS FOR PRACTICE The use of cotton bands to remove adipose tissue during pelvic imaging in obese and overweight patients results in a reduction of radiation dose received by the patient and improves image quality. This technique is quick, easy, and inexpensive.
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Mifsud K, Portelli J, Zarb F, Couto J. Evaluating the use of higher kVp and copper filtration as a dose optimisation tool in digital planar radiography. Radiography (Lond) 2022; 28:586-592. [DOI: 10.1016/j.radi.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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Imaging individuals with obesity. J Med Imaging Radiat Sci 2022; 53:291-304. [DOI: 10.1016/j.jmir.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/04/2022] [Accepted: 02/08/2022] [Indexed: 01/03/2023]
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Tugwell-Allsup JR, Morris RW, Thomas K, Hibbs R, England A. Neonatal digital chest radiography- should we be using additional copper filtration? Br J Radiol 2022; 95:20211026. [PMID: 34797726 PMCID: PMC8822573 DOI: 10.1259/bjr.20211026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Copper filtration removes lower energy X-ray photons, which do not enhance image quality but would otherwise contribute to patient radiation dose. This study explores the use of additional copper filtration for neonatal mobile chest imaging. METHODS A controlled factorial-designed experiment was used to determine the effect of independent variables on image quality and radiation dose. These variables included: copper filtration (0 Cu, 0.1 Cu and 0.2 Cu), exposure factors, source-to-image distance and image receptor position (direct / tray). Image quality was evaluated using absolute visual grading analysis (VGA) and contrast-to-noise ratio (CNR) and entrance surface dose (ESD) was derived using an ionising chamber within the central X-ray beam. RESULTS VGA, CNR and ESD significantly reduced (p < 0.01) when using added copper filtration. For 0.1 Cu, the percentage reduction was much greater for ESD (60%) than for VGA (14%) and CNR (20%), respectively. When compared to the optimal combinations of parameters for incubator imaging using no copper filtration, an increase in kV and mAs when using 0.1-mm Cu resulted in better image quality at the same radiation dose (direct) or, equal image quality at reduced dose (in-tray). The use of 0.1-mm Cu for neonatal chest imaging with a corresponding increase in kV and mAs is therefore recommended. CONCLUSION Using additional copper filtration significantly reduces radiation dose (at increased mAs) without a detrimental effect on image quality. ADVANCES IN KNOWLEDGE This is the first study, using an anthropomorphic phantom, to explore the use of additional Cu for digital radiography neonatal chest imaging and therefore helps inform practice to standardise and optimise this imaging examination.
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Affiliation(s)
| | | | - Kate Thomas
- Betsi Cadwaladr University Health Board, Bangor, UK
| | | | - Andrew England
- Discipline of Medical Imaging, School of Medicine, University College Cork, Cork, Ireland
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Gatt S, Portelli JL, Zarb F. Optimisation of the AP abdomen projection for larger patient body thicknesses. Radiography (Lond) 2021; 28:107-114. [PMID: 34544645 DOI: 10.1016/j.radi.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study aims to identify optimal exposure parameters, delivering the lowest radiation dose while maintaining images of diagnostic quality for the antero-posterior (AP) abdomen x-ray projection in large patients with an AP abdominal diameter of >22.3 cm. METHODOLOGY The study was composed of two phases. In phase 1, an anthropomorphic phantom (20 cm AP abdominal diameter) was repetitively radiographed while adding 3 layers (5 cm thick each) of fat onto the phantom reaching a maximum AP abdominal diameter of 35 cm. For every 5 cm thickness, images were taken at 10 kVp (kilovoltage peak) intervals, starting from 80 kVp as the standard protocol currently in use at the local medical imaging department, to 120 kVp in combination with the use of automatic exposure control (AEC). The dose area product (DAP), milliampere-second (mAs) delivered by the AEC, and measurements to calculate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) were recorded. Phase 2 included image quality evaluation of the resultant images by radiographers and radiologists through absolute visual grading analysis (VGA). The resultant VGA scores were analysed using visual grading characteristics (VGC) curves. RESULTS The optimal kVp setting for AP abdominal diameters at: 20 cm, 25 cm and 30 cm was found to be 110 kVp increased from 80 kVp as the standard protocol (with a 56.5% decrease in DAP and 76.2% in mAs, a 54.2% decrease in DAP and 76.2% decrease in mAs and a 29.2% decrease in DAP and 59.7% decrease in mAs, respectively). The optimal kVp setting for AP abdominal diameter at 35 cm was found to be 120 kVp increased from 80 kvp as the standard protocol (with a 50.7% decrease in DAP and 73.4% decrease in mAs). All this was achieved while maintaining images of diagnostic quality. CONCLUSION Tailoring the exposure parameters for large patients in radiography of the abdomen results in a significant reductions in DAP which correlates to lower patient doses while still maintaining diagnostic image quality. IMPLICATIONS FOR CLINICAL PRACTICE This research study and resultant parameters may help guide clinical departments to optimise AP abdomen radiographic exposures for large patients in the clinical setting.
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Affiliation(s)
- S Gatt
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - J L Portelli
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - F Zarb
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
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Abbeyquaye D, Inkoom S, Hammond NB, Fletcher JJ, Botwe BO. PATIENT DOSE ASSESSMENT AND OPTIMISATION OF PELVIC RADIOGRAPHY WITH COMPUTED RADIOGRAPHY SYSTEMS. RADIATION PROTECTION DOSIMETRY 2021; 195:41-49. [PMID: 34320643 DOI: 10.1093/rpd/ncab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
Digital radiography systems can reduce radiation dose, this capability was harnessed to explore dose and image quality (IQ) optimisation strategies. Entrance surface dose (ESD), effective dose (ED) and organ doses were determined by the indirect method for patients undergoing pelvic anteroposterior X-ray examinations with computed radiography systems. The IQ of patients' radiographs was assessed in terms of signal-to-noise ratio (SNR). An anthropomorphic phantom was exposed with varying tube potential (kVp), tube current-time product (mAs), and focus-to-detector distance (FDD) to determine phantom-entrance dose for the optimisation studies. SNR of each phantom radiograph was determined. Patients' mean ESD of 2.38 ± 0.60 mGy, ED of 0.25 ± 0.07 mSv and SNR of 8.5 ± 2.2 were obtained. After optimisation, entrance dose was reduced by 29.2% with 5 cm increment in FDD, and 5 kVp reduction in tube potential. kVp and/or mAs reduction with an increment in FDD reduced entrance dose without adversely compromising radiographic-IQ.
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Affiliation(s)
- D Abbeyquaye
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Department of Biomedical Engineering Technology, Faculty of Health and Allied Sciences, Koforidua Technical University, P.O. Box KF-981, Koforidua, Ghana
| | - S Inkoom
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Radiation Protection and Consultancy Centre, Radiation Protection Institute, Ghana Atomic Energy Commission, P.O. Box LG 80, Legon-Accra, Ghana
| | - N B Hammond
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Department of Nuclear Medicine, National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - J J Fletcher
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Department of Applied Physics, Faculty of Applied Sciences, University for Development Studies, Navrongo Campus, Upper East Region, P.O. Box TL 1350, Tamale, Ghana
| | - B O Botwe
- Department of Radiography, School of Biomedical and Allied Health Science, College of Health Sciences, University of Ghana, P.O. Box KB143, Korle-Bu Campus, Accra, Ghana
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Flintham K, Alzyoud K, England A, Hogg P, Snaith B. Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose. Br J Radiol 2021; 94:20210047. [PMID: 33989034 DOI: 10.1259/bjr.20210047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. METHODS 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose-area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). RESULTS Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. CONCLUSION Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.
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Affiliation(s)
| | - Kholoud Alzyoud
- Hashemite University, Zarqa, Jordan.,University of Salford, Salford, UK
| | - Andrew England
- University of Salford, Salford, UK.,University of Keele, Newcastle, UK
| | | | - Beverly Snaith
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.,University of Bradford, Bradford, UK
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Peacock NE, Steward AL, Riley PJ. An explanation of the limitations relating to 'An evaluation of the effect of tube potential on clinical image quality using direct digital detectors for pelvis and lumbar spine radiographs' and the reasoning behind the study - Authors response to letter to the editor. J Med Radiat Sci 2020; 67:362-363. [PMID: 32897001 PMCID: PMC7753745 DOI: 10.1002/jmrs.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nicole E Peacock
- Department of Medical ImagingWestern HealthFootscrayVictoriaAustralia
- School of MedicineFaculty of HealthDeakin UniversityWaurn PondsVictoriaAustralia
| | - Adam L Steward
- Department of Medical ImagingWestern HealthFootscrayVictoriaAustralia
| | - Peter J Riley
- School of MedicineFaculty of HealthDeakin UniversityWaurn PondsVictoriaAustralia
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Alzyoud K, Snaith B, Hogg P, England A. The complete evaluation of tube potential on clinical image quality when using direct digital detectors for pelvis and lumbar spine radiography: Re: 'An evaluation of the effect of tube potential on clinical image quality using direct digital detectors for pelvis and lumbar spine radiographs' by Peacock, Steward and Riley. J Med Radiat Sci 2020; 67:360-361. [PMID: 33275837 PMCID: PMC7754054 DOI: 10.1002/jmrs.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zalokar N, Resnik A, Mekiš N. RADIATION DOSE DURING PELVIC RADIOGRAPHY IN RELATION TO BODY MASS INDEX. RADIATION PROTECTION DOSIMETRY 2020; 189:294-303. [PMID: 32342096 DOI: 10.1093/rpd/ncaa042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this research was to investigate the impact of body mass index (BMI) on dose area product (DAP), effective dose (E), dose to the organs and image quality (IQ) on 200 patients referred to pelvic radiography. Patients were classified into three groups according to BMI: normal (<24.99), overweight (25.0-29.99) and obese (>30). The results showed 52% and 135% higher DAP for overweight and obese patients compared to normal-weight patients (p < 0.001). A 46 and 123% rise of E for overweight and obese patients compared to normal-weight patients (p < 0.001) was discovered. Overweight patients received 37% higher dose and obese patients 107% higher dose to the organs compared to normal-weight patients. There were no statistically significant differences between IQ, except between normal weight and overweight patients. A strong correlation (r = 0.733) was found between BMI and DAP and between BMI and E (r = 0.776).
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Affiliation(s)
- Nika Zalokar
- University of Ljubljana, Faculty of Health Sciences, Department of Medical Imaging and Radiotherapy, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Anja Resnik
- University of Ljubljana, Faculty of Health Sciences, Department of Medical Imaging and Radiotherapy, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Nejc Mekiš
- University of Ljubljana, Faculty of Health Sciences, Department of Medical Imaging and Radiotherapy, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Panayiotakis GS. LOW BMI PATIENT DOSE IN DIGITAL RADIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2020; 189:1-12. [PMID: 32043128 DOI: 10.1093/rpd/ncaa007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
In this study, the radiation dose received by 364 low body mass index (BMI) adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis X-ray examinations in an X-ray room with a digital radiography system was evaluated. The patients' kerma area product (KAP) values were recorded, and the entrance surface air kerma (ESAK) was calculated based on the X-ray tube output, exposure parameters and technical data. The 75th percentiles of the distribution of ESAK and KAP values were also estimated. The dose values were compared with the corresponding values for normal patients obtained from a previous survey in our hospital, as well as with the national and UK diagnostic reference levels (DRLs). The correlation of dose values with patient size metrics (mass, height, BMI) was also investigated. A statistically significant difference was found in KAP and the ESAK values between low BMI and normal patients (Mann-Whitney test, p < 0.05), for all examinations studied. The percentage difference for chest PA, chest LAT, abdomen PA, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP examinations was 40, 36, 48, 68, 57, 46 and 67% for median KAP and 26, 43, 52, 48, 19, 44 and 51% for median ESAK, respectively. The corresponding 75th percentiles for low BMI patients were 0.065, 0.349, 0.683, 1.54, 3.92, 1.11, 0.67 mGy and 0.042, 0.218, 0.450, 0.280, 0.598, 0.597, 0.267 Gycm2 in terms of ESAK and KAP values, respectively. They were 74-90% lower compared to the national diagnostic reference levels (DRLs), 35-84% and 58-82% compared to the UK DRLs, for ESAK and KAP values, respectively. Regarding the gender of the patients, no statistically significant difference was found in the dose values between female and male patients (Mann-Whitney test, p > 0.05), for all examinations studied. A statistically significant correlation was found between ESAK and KAP values with BMI for KUB AP, pelvis AP, lumbar spine AP, lumbar spine LAT and chest PA, while for chest LAT examinations, only the ESAK were significantly correlated with BMI. They also significantly correlated with the mass for KUB AP, lumbar spine LAT, abdomen PA and chest PA examinations, while no significant correlation was found between the dose values and patients' height. It can be concluded that the low BMI patients received a significantly reduced radiation dose compared to normal patients. Additional studies need to be conducted for these patient groups, which could contribute to the further development of a radiation protection culture in diagnostic radiography.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
| | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
- Department of Medical Physics, University Hospital of Patras, Patras 265 04, Greece
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The validity and reliability of the exposure index as a metric for estimating the radiation dose to the patient. Radiography (Lond) 2020; 26 Suppl 2:S94-S99. [PMID: 32291123 DOI: 10.1016/j.radi.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION With the introduction of digital radiography, the feedback between image quality and over-exposure has been partly lost which in some cases has led to a steady increase in dose. Over the years the introduction of exposure index (EI) has been used to resolve this phenomenon referred to as 'dose creep'. Even though EI is often vendor specific it is always a related of the radiation exposure to the detector. Due to the nature of this relationship EI can also be used as a patient dose indicator, however this is not widely investigated in literature. METHODS A total of 420 dose-area-product (DAP) and EI measurements were taken whilst varying kVp, mAs and body habitus on two different anthropomorphic phantoms (pelvis and chest). Using linear regression, the correlation between EI and DAP were examined. Additionally, two separate region of interest (ROI) placements/per phantom where examined in order to research any effect on EI. RESULTS When dividing the data into subsets, a strong correlation between EI and DAP was shown with all R-squared values > 0.987. Comparison between the ROI placements showed a significant difference between EIs for both placements. CONCLUSION This research shows a clear relationship between EI and radiation dose which is dependent on a wide variety of factors such as ROI placement, body habitus. In addition, pathology and manufacturer specific EI's are likely to be of influence as well. IMPLICATIONS FOR PRACTICE The combination of DAP and EI might be used as a patient dose indicator. However, the influencing factors as mentioned in the conclusion should be considered and examined before implementation.
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