Radiation dose and image quality optimization in lumbar spine digital radiography for overweight and obese patients: Phantom study

Abstract

Background: Lumbar spine radiography plays an important role in routine use for clinical practice in overweight and obese patients. The radiographer is responsible for setting suitable exposure factors for the tradeoffs between radiation dose and image quality (IQ). Objective: To investigate the effect of different kVp values combined with AEC used on radiation dose and IQ for routine lumbar spine radiography in overweight and obese patients. Materials and methods: A 1.5 and 3 cm thickness of frozen pork lard was placed on a pelvis phantom to simulate an overweight and obese patient, respectively. The phantom was imaged at 10 kVp intervals in combination with AEC used. For IQ evaluation, CNR and SNR were calculated, and the observer study was determined using visual grading scores (VGS) with a 5-point Likert scale. The radiation dose was measured using a DAP meter, and then the figure of merit (FOM) was calculated. Results: SNR and CNR for both AP and lateral projection showed a slightly decreasing trend when kVp increased in all groups. The DAP values decreased when the higher kVp was selected with AEC used in each group. The VGS by five radiographers showed good image quality in all groups, while the FOM at 100 and 109 kVp was the highest score for both AP and lateral projections. Conclusion: The optimal kVp setting in this study ranged from 100 to 109 kVp in combination with AEC used, indicating minimal radiation dose, while maintaining diagnostic IQ.