New patient-controlled abdominal compression method in radiography: radiation dose and image quality

Background The radiation dose for patients can be reduced with many methods and one way is to use abdominal compression. In this study, the radiation dose and image quality for a new patient-controlled compression device were compared with conventional compression and compression in the prone position . Purpose To compare radiation dose and image quality of patient-controlled compression compared with conventional and prone compression in general radiography. Material and Methods An experimental design with quantitative approach. After obtaining the approval of the ethics committee, a consecutive sample of 48 patients was examined with the standard clinical urography protocol. The radiation doses were measured as dose-area product and analyzed with a paired t-test. The image quality was evaluated by visual grading analysis. Four radiologists evaluated each image individually by scoring nine criteria modified from the European quality criteria for diagnostic radiographic images. Results There was no significant difference in radiation dose or image quality between conventional and patient-controlled compression. Prone position resulted in both higher dose and inferior image quality. Conclusion Patient-controlled compression gave similar dose levels as conventional compression and lower than prone compression. Image quality was similar with both patient-controlled and conventional compression and was judged to be better than in the prone position.

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Feasibility of low-dose digital pulsed video-fluoroscopic swallow exams (VFSE): effects on radiation dose and image quality

Acta Radiologica ◽

10.1177/0284185116685924 ◽

2017 ◽

Vol 58 (9) ◽

pp. 1037-1044 ◽

Cited By ~ 1

Author(s):

Jakob Weiss ◽

Mike Notohamiprodjo ◽

Klement Neumaier ◽

Minglun Li ◽

Wilhelm Flatz ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Dose Reduction ◽

Low Dose ◽

Research Evaluation ◽

Diagnostic Image Quality ◽

Organ Doses ◽

Dose Area Product ◽

Thermoluminescent Dosimeters ◽

Area Product

Background Fluoroscopy is a frequently used examination in clinical routine without appropriate research evaluation latest hardware and software equipment. Purpose To evaluate the feasibility of low-dose pulsed video-fluoroscopic swallowing exams (pVFSE) to reduce dose exposure in patients with swallowing disorders compared to high-resolution radiograph examinations (hrVFSE) serving as standard of reference. Material and Methods A phantom study (Alderson-Rando Phantom, 60 thermoluminescent dosimeters [TLD]) was performed for dose measurements. Acquisition parameters were as follows: (i) pVFSE: 76.7 kV, 57 mA, 0.9 Cu mm, pulse rate/s 30; (ii) hrVFSE: 68.0 kV, 362 mA, 0.2 Cu mm, pictures 30/s. The dose area product (DAP) indicated by the detector system and the radiation dose derived from the TLD measurements were analyzed. In a patient study, image quality was assessed qualitatively (5-point Likert scale, 5 = hrVFSE; two independent readers) and quantitatively (SNR) in 35 patients who subsequently underwent contrast-enhanced pVFSE and hrVFSE. Results Phantom measurements showed a dose reduction per picture of factor 25 for pVFSE versus hrVFSE images (0.0025 mGy versus 0.062 mGy). The DAP (µGym2) was 28.0 versus 810.5 (pVFSE versus hrVFSE) for an average examination time of 30 s. Direct and scattered organ doses were significantly lower for pVFSE as compared to hrVFSE ( P < 0.05). Image quality was rated 3.9 ± 0.5 for pVFSE versus the hrVFSE standard; depiction of the contrast agent 4.8 ± 0.3; noise 3.6 ± 0.5 ( P < 0.05); SNR calculations revealed a relative decreased of 43.9% for pVFSE as compared to hrVFSE. Conclusion Pulsed VFSE is feasible, providing diagnostic image quality at a significant dose reduction as compared to hrVFSE.

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Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose

British Journal of Radiology ◽

10.1259/bjr.20210047 ◽

2021 ◽

pp. 20210047

Author(s):

Kevin Flintham ◽

Kholoud Alzyoud ◽

Andrew England ◽

Peter Hogg ◽

Beverly Snaith

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Supine Position ◽

Pelvic Tilt ◽

Weight Bearing ◽

Functional Anatomy ◽

Dose Area Product ◽

Sagittal Diameter ◽

Using Data ◽

Area Product

Objectives: Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared the supine and erect radiographic examinations for anatomical features, radiation dose and image quality. Methods: Sixty 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 (DAP) 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 versus 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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Pelvis imaging: Achieving dose reduction with different patient positions

Nuclear Technology and Radiation Protection ◽

10.2298/ntrp190818037r ◽

2019 ◽

Vol 34 (4) ◽

pp. 375-383

Author(s):

Anja Resnik ◽

Janez Zibert ◽

Nejc Mekis

Keyword(s):

Image Quality ◽

Effective Dose ◽

Signal To Noise Ratio ◽

Absorbed Dose ◽

Field Size ◽

Optimal Position ◽

Dose Area Product ◽

Significant Difference ◽

Noise Ratio ◽

Area Product

The purpose of this research was to determine how dose area product, effective dose, absorbed doses to specific organs, and image quality changed according to different automatic exposure control positions in pelvis imaging. The research was carried out in two parts. The study was conducted on an anthropomorphic phantom and 200 patients referred to pelvic imaging. We measured the dose area product, field size, height, and mass. Then we calculated the effective dose and absorbed dose for individual organs accordingly. Lateral ionizing cells were first positioned in line with the iliac crests (head towards position) and subsequently, with the femoral neck (head away position). All the images were independently evaluated by three radiologists using ViewDEX and objective image analysis was performed measuring contrast-to-noise ratio and signal-to-noise ratio. We found no significant differences in the Siemens Luminos unit in any of the inspected parameters. However, there was a significant difference in dose area product (37.3 %), effective dose (35.7 %) and average absorbed dose to selected individual organs (36.7 %) when the head away position of the patient was used and the image quality increased. Based on these results, we can propose that the optimal position of the patient regarding the ionizing cells is the head away position.

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European Guidelines on Radiographic Image Quality in Chiropractic Practice – Proposal of a Cross-Sectional Graded Classification Reporting Principle

10.21203/rs.3.rs-171515/v1 ◽

2021 ◽

Author(s):

Klaus Knarberg Doktor ◽

Maria Lind Vilholm ◽

Aldis Hardardóttir ◽

Henrik Wulff Christensen ◽

Jens Lauritsen

Keyword(s):

Lumbar Spine ◽

Image Quality ◽

Radiation Dose ◽

Radiation Exposure ◽

Quality Criteria ◽

Cross Sectional ◽

Radiographic Images ◽

Reference Dose ◽

European Guidelines ◽

Patient Radiation Dose

Abstract BackgroundThe Commission of the European Communities (CEC) has published: European Guidelines on Quality Criteria for Diagnostic Radiographic Images. These guidelines are considered a gold standard, recommended for use in quality assurance protocols. The objectives of this study: 1) Propose a graded classification format for Danish chiropractic clinics according to the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. 2) Propose a reporting principle for quality of radiographic images. 3) Document variation in radiation exposure among clinics.MethodsThis is a cross-sectional study of image quality based on random sampling from 148 chiropractic clinics. Clinics were included if using: 1) Digital radiography and 2) The chiropractic picture and achieving system(KirPACS) at the Nordic Institute of Chiropractic and Clinical Biomechanics(NIKKB) in Denmark. A sample of 296 lumbar spine series were randomly collected from KirPACS. Two independent observers reviewed 50 lumbar spine series twice with a 4-week interval, testing intra- and inter-observer reproducibility. The same observers then reviewed the remaining 246 radiographic studies. All studies were evaluated up against the CEC Quality Criteria. Patient radiation dose values were retrieved from KirPACS. ResultsA reporting and classification principle of diagnostic image quality was used in 148 chiropractic clinics. Compliance with the 22 CEC Quality Criteria had proportions ranging from 0.72-0.96 for 18 criteria, while 4 criteria specifying detail and definition ranged between 0.20-0.66. The proposed rating system (A to E) revealed: 18 A clinics, 28 B clinics, 32 C clinics, 25 D clinics and 45 E clinics (A = highest quality; E= lowest quality). The patient radiation reference dose in Denmark is 7 mGy for the AP/PA lumbar spine. Very few clinics exceed the reference dose value, approximately 50 % of clinics were below 5 mGy.ConclusionA reporting principle is proposed for a graded classification format based on the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. The Quality Criteria are for the most part met satisfactory in 148 Danish chiropractic clinics, but important image details are compromised, in most cases, because of low patient radiation doses. The results of a patient radiation dose survey enabled documentation of variation in radiation exposure among chiropractic clinics.

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European guidelines on radiographic image quality in chiropractic practice – proposal of a cross-sectional graded classification reporting principle

Chiropractic & Manual Therapies ◽

10.1186/s12998-021-00375-4 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Klaus Doktor ◽

Maria Lind Vilholm ◽

Aldis Hardardóttir ◽

Henrik Wulff Christensen ◽

Jens Lauritsen

Keyword(s):

Lumbar Spine ◽

Image Quality ◽

Radiation Dose ◽

Radiation Exposure ◽

Quality Criteria ◽

Cross Sectional ◽

Radiographic Images ◽

Reference Dose ◽

European Guidelines ◽

Patient Radiation Dose

Abstract Background The Commission of the European Communities (CEC) has published: European Guidelines on Quality Criteria for Diagnostic Radiographic Images. These guidelines are considered a gold standard, recommended for use in quality assurance protocols. The objectives of this study: 1) Propose a graded classification format for Danish chiropractic clinics according to the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. 2) Propose a reporting principle for quality of radiographic images. 3) Document variation in radiation exposure among clinics. Methods This is a cross-sectional study of image quality based on random sampling from 148 chiropractic clinics. Clinics were included if using: 1) Digital radiography and 2) The chiropractic picture and archiving system (KirPACS) at the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) in Denmark. A sample of 296 lumbar spine series were randomly collected from KirPACS (January 2018). Two independent observers reviewed 50 lumbar spine series twice with a 4-week interval, testing intra- and inter-observer reproducibility. The same observers then reviewed the remaining 246 radiographic studies. All studies were evaluated using the CEC Quality Criteria. Patient radiation dose values were retrieved from KirPACS (First quarter of 2020). Results A reporting and classification principle of diagnostic image quality was used in 148 chiropractic clinics. Compliance with the 22 CEC Quality Criteria had proportions ranging from 0.72–0.96 for 18 criteria, while 4 criteria specifying detail and definition ranged between 0.20–0.66. The proposed rating system (A to E) revealed: 18 A clinics, 28 B clinics, 32 C clinics, 25 D clinics and 45 E clinics (A = highest quality; E = lowest quality). The patient radiation reference dose in Denmark is 7 mGy for the AP/PA lumbar spine. Very few clinics exceed the reference dose value, approximately 50% of clinics were below 5 mGy. Conclusion A reporting principle is proposed for a graded classification format based on the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. The Quality Criteria are for the most part met satisfactorily in 148 Danish chiropractic clinics, but important image details are compromised, in most cases, because of low patient radiation doses. The results of a patient radiation dose survey enabled documentation of variation in radiation exposure among chiropractic clinics.

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Assessment of image quality and radiation dose in some models of digital radiography systems – A Pehamed FLUORAD A + D phantom study

Radioprotection ◽

10.1051/radiopro/2018012 ◽

2018 ◽

Vol 53 (2) ◽

pp. 139-144

Author(s):

H. Kaheni ◽

A. Chaparian ◽

R. Nafisi-Moghadam ◽

N. Hamzian

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Digital Radiography ◽

Quality Parameters ◽

Digital Systems ◽

Quality Performance ◽

Dose Area Product ◽

Ideal Situation ◽

Conventional Film ◽

Area Product

Digital radiography (DR) systems have been recently introduced as a developed technology that is replacing conventional film–screen systems in many countries around the world. Ideal situation in radiography is to maximize the image quality while minimizing the patient dose. The purpose of this study was to compare image quality and radiation dose in different digital radiography systems. Four different digital systems are compared in terms of their image quality performance and dose area product (DAP). Images of Pehamed FLUORAD A + D phantom were obtained for each DR system. Image quality parameters (contrast resolution (CR), spatial resolution (SR), and contrast-to-noise ratio (CNR)) and DAP were significantly different between different digital systems. It was shown that all four quantities increased with increasing exposure parameters in all systems. Image quality parameters of the SEDECAL system were higher than that in other systems (p ≤ 0.05). At the stable DAP (100 mGy.cm2), means of CR, CNR, and SR in the SEDECAL system were 6.38 ± 0.797, 29.70 ± 0.85 and 3.10 ± 0.38 lp/mm, respectively. The results of this investigation can be taken into consideration in the selection and purchasing of new systems in order to preserve patients as well as radiographers from unnecessary radiation dose.

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RADIATION DOSE DURING PELVIC RADIOGRAPHY IN RELATION TO BODY MASS INDEX

Radiation Protection Dosimetry ◽

10.1093/rpd/ncaa042 ◽

2020 ◽

Vol 189 (3) ◽

pp. 294-303

Author(s):

Nika Zalokar ◽

Anja Resnik ◽

Nejc Mekiš

Keyword(s):

Body Mass Index ◽

Image Quality ◽

Radiation Dose ◽

Body Mass ◽

Normal Weight ◽

Obese Patients ◽

Dose Area Product ◽

Pelvic Radiography ◽

Area Product ◽

The Impact

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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Influence of the use of various imaging units and projections on the radiation dose received by children during chest digital radiography

PLoS ONE ◽

10.1371/journal.pone.0255749 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255749

Author(s):

Hongrong Xu ◽

Kaiping Huang ◽

Bo Liu ◽

Jinhua Cai ◽

Huan Zheng ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Digital Radiography ◽

Visual Grading ◽

Dose Area Product ◽

Visual Grading Analysis ◽

Area Product ◽

The Right ◽

The Impact ◽

Field Area

Objective To investigate the impact of the use of different imaging units and projections on radiation dose and image quality during chest digital radiography (DR) in 3- and 4-year-old children. Methods Two hundred forty 3- and 4-year-old participants requiring chest DR were included; they were divided into three groups: supine anterior-posterior projection (APP), standing APP and standing posterior-anterior projection (PAP). Each group included 40 participants who were evaluated using the same imaging unit. The dose area product (DAP) and the entrance surface dose (ESD) were recorded after each exposure. The visual grading analysis score (VGAS) was used to evaluate image quality, and the longitudinal distance (LD) from the apex of the right lung to the apex of the right diaphragm was used to evaluate the inspiration extent. Results DAP and ESD were significantly lower in the standing PAP and APP groups than in the supine APP group (P<0.05), but LD was significantly higher in the standing PAP and APP groups than in the supine APP group (P<0.05). Additionally, the pulmonary field area was significantly higher for the standing PAP group than for the standing and supine APP groups (P<0.05). The correlations between ESD, DAP, and VGAS were positive (P<0.001), showing that larger ESD and DAP correspond to higher VGAS. The correlations between ESD, DAP, and body mass index (BMI) were also positive (P<0.05), indicating that higher BMI corresponds to larger ESD and DAP. Finally, no differences in DAP, ESD, VGAS, LD, pulmonary field area, or BMI were noted between males and females (P>0.05). Conclusion The radiation dose to superficial organs may be lower with standing PAP than with standing APP during chest DR. Standing PAP should be selected for chest DR in 3- and 4-year-old children, as it may decrease the required radiation dose.

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Primary operator radiation dose in the cardiac catheter laboratory

British Journal of Radiology ◽

10.1259/bjr.20200018 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20200018

Author(s):

James A Crowhurst ◽

Mark Whitby ◽

Nicholas Aroney ◽

Rustem Dautov ◽

Darren Walters ◽

...

Keyword(s):

Radiation Dose ◽

Radiation Protection ◽

Reference Level ◽

Protection Measures ◽

Dose Area Product ◽

Primary Operator ◽

Significant Difference ◽

Operator Dose ◽

The Individual ◽

Area Product

Objectives: Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. Methods: Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose–area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. Results: In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). Conclusion: DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. Advances in knowledge: This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.

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