Purpose. Primarily to evaluate the radiation dose delivered to patients with obesity in projection radiography and its relationship to the patient’s size. A secondary purpose is to estimate the subsequent projected radiation-related lifetime cancer risk to patients with obesity compared to normal-weight patients. Method and material. Data from 1964 patients from a bariatric clinic in the UK were reviewed with the relevant permission. 630 patients were identified to have a projection radiography history and were included in the study. Patients’ dose area product (DAP) data were collected for all projection radiography. Multiple exams in one day including a single DAP reading and exams with no records of DAP and exposure factors were excluded. Correlations were calculated and data analysed to yield the third quartile for each examination using STATA 14. Absorbed doses were generated from PCXMC simulation, utilising DAP data from this study and the UK national diagnostic reference level (NDRL), to calculate the effective risk for patients with obesity compared to patients with normal-weight. Results. Patients with obesity received higher DAPs for all examinations included in this study compared to NDRL. Abdominal and lumbar spine radiographs DAPs were the highest (17.6 and 30.31 Gy cm2) compared to the NDRL (2.5 and 4 Gy cm2). Only moderate to low correlations were found between patient’s size and DAPs in the abdomen and chest radiographs. The projected radiation-related lifetime cancer risk for patients with obesity is up to 153% higher than for adult patients with normal weight. Conclusion. Patients with obesity receive higher DAPs than normal-weight adults which may be in excess of that expected due to their size. Therefore, radiation-related lifetime cancer risk is increased in patients with obesity as a result of medical radiation exposures. This indicates more dose optimisation research is needed in this group of patients to reduce dose rate and variation.
Objective: Phantom studies and a prior patient study have shown up to 53% effective dose reduction when lumbar spine radiographs are acquired posteroanterior (PA) instead of anteroposterior (AP). Since November 2017, Taunton and Somerset NHS Foundation Trust has acquired all standing lumbar spine radiographs PA. The aim of this study was to locally evaluate dose and image quality in both projections and survey current UK practice. Methods: 80 outpatients having a standing lumbar spine radiograph (40 AP; 40 PA) had their dose–area product recorded at a constant KV and focus film distance. Effective dose was calculated using PCXMC software. Each blinded radiograph was scored against an optimal reference image using European Guidelines criteria. The data were analyzed using Mann–Whitney U tests and linear regression. Eighty radiologists nationally were sent an anonymous survey to establish their current practice. Results: A lumbar spine radiograph acquired PA instead of AP reduced effective dose by 41% (p < 0.001) with no difference in image quality (p = 0.9). 21 radiologists completed our survey and only 1 NHS Trust is currently using PA. Conclusion: PA lumbar spine radiography reduces patient radiation exposure with no affect on image quality, acquisition time or cost. The majority of NHS Trusts nationally are still using AP and it is time to standardize to PA. Advances in knowledge: This patient study provides further good evidence of how reduction in exposure to ionizing radiation can be achieved in lumbar spine radiography and more widespread adoption of PA protocol could improve patient safety.
PET iterative reconstruction algorithms with resolution modelling (RM) can be used to improve spatial resolution in the images. However, RM has a significant impact on quantification, which raises issues for harmonization across multicentre networks or collaborations. This investigation compared quantification from two modern time-of-flight (TOF) PET/CT systems from different manufacturers with RM with the intention to harmonize recovery. Images of a National Electrical Manufacturers Association image quality phantom with a sphere-to-background concentration ratio of 4 : 1 were acquired on a GE Discovery 710 and a Siemens Biograph mCT and reconstructed with RM and TOF. Voxel dimensions and image noise (background coefficient of variation) were matched. One to five iterations were used with 2 and 4 mm Gaussian filters. Mean and maximum contrast recovery (CR) were measured for the 10, 13, 17 and 22 mm hot phantom spheres. Notable differences in CR for images reconstructed with matched reconstruction parameters were observed between the scanners. A set of parameters was found that reduced differences in CR between scanners. Using these parameters, relative differences for the Biograph compared with the Discovery were -8.1, -3.7, +7 and +0.7% for mean CR and -23.1, -6.9, +9.1 and +0.9% for maximum CR in the 10, 13, 17 and 22 mm spheres, respectively. This study has used a technique of harmonizing standardized uptake value recovery on PET/CT systems from different vendors with advanced reconstructions including TOF and RM using phantom data. Considerable quantitative differences may occur in images, which highlights the need to apply methods such as those used in this work for multicentre studies.
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