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

Jones, A. Kyle; Ansell, C; Jerrom, C; Honey, Ian

doi:10.1259/bjr.20140660

Cited by 17 publications

(18 citation statements)

References 26 publications

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“…Jones et al reported that an improved clinical image quality can be achieved for paediatric ankle radiographs by using 40 kV instead of 55 kV, and removing any additional filtration. 9 This finding was contrary to current EU guidelines on paediatric imaging which were established for screen-film technology, and state that filtration and tube voltages greater than 60 kV should be used. 6 The purpose of this study was two-fold; firstly, to assess the current practice in place for SPA imaging, and compare protocols in use between sites, and with national guidance; secondly, to explore the potential to optimize tube voltage and X-ray beam filtration combination to improve image quality without detrimental impact on radiation dose to paediatric patients.…”

Section: Introductionmentioning

confidence: 76%

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Comparison and optimization of imaging techniques in suspected physical abuse paediatric radiography

Pascoal

2018

BJR

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This study showed that there is a variation in the protocols and a range of techniques in use for SPA imaging across the four participant sites. The skeletal surveys undertaken on the newborn phantom at two sites resulted in an ED of 57 ± 3 µSv and 90 ± 4 µSv, on the DR unit and digital radiography/fluoroscopy (dRF) unit, respectively. Measurements of the abdomen AP projection achieved an improved CNR (4%) at a lower tube potential (55 kV) without increasing ED, compared with the current clinical setting (64 kV). Advances in knowledge: This study showed that an improved CNR can be achieved for newborn and 1-year-old abdomen AP radiographs using 0.1 mm copper filtration and a reduced kV (55 kV) without increasing ED.

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Section: Introductionmentioning

confidence: 76%

“…Therefore, it is important to undertake optimization on X-ray equipment, to determine whether these changes in technology have impacted the validity of the advice in the EU guidelines, such as in the study at Evelina Children's Hospital. 6,9 The guidelines currently advise the following settings for an abdomen AP exposure: 6…”

Section: Optimizationmentioning

confidence: 99%

Comparison and optimization of imaging techniques in suspected physical abuse paediatric radiography

Pascoal

2018

BJR

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“…Multiple studies have demonstrated image quality optimisation by decreasing kVp and increasing mAs around a fixed dose pointeither dose-area product (DAP), entrance skin dose or more preferably effective dose. 3,4 Experimentation is required to find the exposure parameters used to obtain the highest image quality or contrast-to-noise ratio (CNR) for the clinical requirement being investigated, for a constant radiation dose. This optimisation paradigm will typically result in a lower SNR and EI.…”

Section: Detector Exposure Does Not Need To Be Fixedmentioning

confidence: 99%

Contemporary research in digital radiography

Knight

2020

J of Medical Radiation Sci

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Whilst digital radiography (DR) is often seen as the “bread and butter” of medical imaging, there have been considerable advances in technology in the last two decades. Research and education need to move with these new technologies to recognise and take advantage of evolving technologies and optimisation methods that are not constrained by film/screen limitations. Now is an excellent time for radiographers, physicists and students to embark on original and contemporary research into DR.

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“…16,20,21 Paediatric phantoms are used to simulate the clinical environment. 20 The radiographic exposure setting can be adjusted, and the contrast-to-noise ratio or diagnostic accuracy measured. In RT, the validity of the exposure setting can be measured by how accurately the radiation therapist matches acquired images when they are blinded to the known offsets and image exposure settings.…”

Section: Introductionmentioning

confidence: 99%

“…Optimisation of paediatric exposures for diagnostic examinations is frequently undertaken . Paediatric phantoms are used to simulate the clinical environment . The radiographic exposure setting can be adjusted, and the contrast‐to‐noise ratio or diagnostic accuracy measured.…”

Section: Introductionmentioning

confidence: 99%

Paediatric image‐guided radiation therapy: determining and evaluating appropriate kilovoltage planar exposure factors for the Varian on‐board imager

Ryan

Willis

2019

J of Medical Radiation Sci

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Introduction Kilovoltage (kV) orthogonal imaging is commonly used for image‐guided radiation therapy (IGRT) in paediatrics. Paediatrics have an increased sensitivity to radiation. Exposure factors need to be optimised so that imaging dose is kept as low as reasonably achievable (ALARA). Methods A table of low‐dose IGRT radiographic exposure factors for paediatric IGRT was determined through a phantom study. Four anatomical sites, head and neck, thorax, abdomen and pelvis, were investigated. The table was evaluated against standard manufacturer pre‐sets. Dose was evaluated in terms of system‐reported entrance surface air kerma (ESAK). Qualified participants volunteered to perform offline image matching in a further phantom study, recording misalignments detected and providing subjective assessments of image quality using an electronic survey tool. A statistical comparison of matching accuracy was conducted. Results Twelve radiation therapists or radiation oncologists completed the image matching task and survey. The low‐dose exposure table reduced imaging dose by 20–94% compared to manufacturer pre‐sets. No significant difference was observed in the accuracy of image matching (head and neck P = 0.82, thorax P = 0.15, abdomen P = 0.33, pelvis P = 0.59). Participant image exposure preference was largely equivocal. Conclusions Optimising radiographic exposures in paediatric IGRT is feasible, logical and therefore reasonably achievable. Implementation of the low‐dose exposure table presented in this study should be considered by paediatric radiotherapy departments wishing to image gently without compromising the potential to detect set up errors. Further study using a contrast detail phantom and contrast to noise image analysis software is recommended.

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

Cited by 17 publications

References 26 publications

Comparison and optimization of imaging techniques in suspected physical abuse paediatric radiography

Comparison and optimization of imaging techniques in suspected physical abuse paediatric radiography

Contemporary research in digital radiography

Paediatric image‐guided radiation therapy: determining and evaluating appropriate kilovoltage planar exposure factors for the Varian on‐board imager

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