Dose optimization in pediatric cardiac x‐ray imaging

Abstract

For pediatric patients, using 0.25-0.9 mm Cu filtration in the x-ray beam while maintaining 50-55 kVp, depending on patient size, provided optimal x-ray image quality to dose ratios. These settings, adjusted for x-ray tube loading limits and clinically acceptable image quality, should provide a useful strategy for optimizing iodine contrast agent based cardiac x-ray imaging. Removing the antiscatter grid improved the FOM for the 8.5 and 12 cm phantoms, therefore grid removal is recommended for younger children. Improvement for the 16 cm phantom declined into the estimated margin of error for the FOM; the need for grid removal for older children would depend on practical feasibility in the clinical environment.

Optimization of image quality and patient dose in radiographs of paediatric extremities using direct digital radiography

“…8 This approach to quantitative IQ assessment has been successfully adopted in other comparable optimization studies. 15,17,21 The CNR relates to the contrast/signal difference between the structure of interest and the background and can be measured using pixel values in an image that contains a particular contrast detail of interest.…”

“…There have been some optimization studies completed in areas such as cardiac imaging using a flat panel detector 15 and paediatric chest, abdomen and pelvis radiography using CR, 16 but there is very little literature available on optimization in paediatric extremity imaging. Work by Hess and Neitzel 17 questions the use of filtration and suggests tube potentials as low as 40 kV p and the removal of any additional filtration can improve the IQ in extremity radiographs of very young patients whilst keeping a fixed ED.…”

Comparison of pediatric radiation dose and vessel visibility on angiographic systems using piglets as a surrogate: antiscatter grid removal vs. lower detector air kerma settings with a grid — a preclinical investigation

“…Conventionally, pediatric imaging has been viewed as an opportunity to reduce patient dose by removing the antiscatter grid. The reduction of pediatric patient dose has been quantified numerous times, 7 , 13 , 16 , 17 , 18 , 19 but the loss of image quality, due to the increase in scatter (increased scatter/primary) when evaluated, was quantified with phantoms as opposed to live animal models 7 , 9 , 14 , 16 , 17 , 20 . This manuscript suggests the alternative of leaving the grid in place to preserve contrast, but lowering detector ${\mathrm{K}}_{\text{air}}$ setting to reduce piglet ${\mathrm{K}}_{\text{air}}/\text{fr}$ which reduces the piglet's dose.…”

“…To this end, numerous authors over a number of years have recommended removing the antiscatter grid from the X‐ray beam during fluoroscopic examinations of small children 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 . While some authors have quantified the reduction in patient dose to these pediatric patients, 7 , 13 , 16 , 17 , 18 , 19 the loss of image quality associated with this reduction in patient dose has been measured only on a limited basis 7 , 9 , 14 , 16 , 17 , 20 with phantoms as opposed to live models. In addition, the studies that do exist 7 , 20 , 21 tend to address the pediatric interventional cardiology laboratory application as opposed to the pediatric interventional radiology laboratory.…”

X-Ray Tubes Quality Control in the Optimization of Doses to Patients and Personnel in Conventional Radiology

“…The numerous induced recoveries eventually increased the dose of irradiation.A uniformly distributed irradiation dose on the receiver defines a homogeneous beam. According to the manufacturers' recommendations, a variation in dose density between the 4 corners and the center of the film is tolerated when it remains less than 10% [12,14,18]. This in homogeneity responsible for uneven irradiation of the exposed surfaces, impacts the quality of X-ray images.…”