Chest PA Examination Research Articles

205 - The Study of Detector Exposure Index regarding Chest PA examination with Auto Exposure Control

205 - The Study of Detector Exposure Index regarding Chest PA examination with Auto Exposure Control

Evaluation of patient radiation doses using DAP meter in diagnostic radiology procedures in Birjand, Iran

BackgroundThe concept of diagnostic reference level (DRL) is considered a regular method to optimize radiation protection in diagnostic imaging system. The objective of implementing a reference level for dose is to produce high-quality images by applying a minimum dose of radiation based on the As Low As Reasonably Achievable (ALARA) principle. Therefore, this study aimed to evaluate the status of radiation protection in diagnostic radiology wards of educational hospitals affiliated with Birjand University of Medical Sciences.MethodsThis study was performed during a period of 11-months in the radiology center of the teaching hospital of Birjand University of Medical Sciences. The studied population included 477 patients who were referred to as clinically indicated x-ray radiography. In order to calculate local DRLs, dose area product (DAP) was measured by a DAP-meter (KERMAX-plus SPD, model 120–131 HS) for 11 devices at educational hospitals affiliated with Birjand University of Medical Sciences. The local DRL values was calculated as 75% of the mean DAP distribution for a specific patient trial at each center.ResultsDAP for Chest PA examination was gained to be in the range from 0.12 Gy.cm2 to 0.42 Gy.cm2 with an average value of 0.23 Gy.cm2 which is above the value of the reference level (0.12 Gy.cm2) for Chest PA. For Chest lateral the observed DAP was found to be in the range from 0.18 Gy.cm2 to 1.48 Gy.cm2 with an average value of 0.65 Gy.cm2 and are therefore twice the reference value (0.3 Gy.cm2). The higher DRL values (average = 2.73) are for lumbar spine lateral radiography. It is observed that the DRL values of chest PA, abdomen AP and Lumbar spine AP are much lower with the earlier studies.ConclusionsThe DRLs helps in understanding the current practices in radiographic examinations. Comparison with other hospitals, the scope of dose optimization and ultimately patient dose reduction in hospitals affiliated with Birjand University of Medical Sciences needs further investigation.

Correlation between mAs and ESAK (mGy) for male and female chest x-ray in Digital radiography

The data were collected from 350 patients, who underwent routine x-ray examinations for chest PA examination with digital imaging in the x-ray department of Alshab Teaching Hospital in Khartoum state in Sudan. During the period from November 2019 to February 2020. The data for optimization phase were collected from phantom from computed radiography, which include chest PA, chest AP in Karary University during the period from January 2020 to February 2020. It was passed successfully the extensive quality control tests performed by Sudan atomic energy commission. The objective was to correlate between mAs and ESAK (mGy) for male and female chest x-ray. The study concluded that there was a strong relationship between mAs and ESAK, also significant correlation between Age groups and incidence risk cancer and mortality.

Exposure Factor Control with Exposure Index Guide As Optimizing Efforts in Chest Pa Examination

Participation between radiographers and medical physicists is needed in optimizing efforts to control the selection of exposure factors by the required clinical radiographic examination. This research is descriptive quantitative by analyzing of exposure index results used in the chest PA examination as an effort to optimizing radiation dose. Also, statistical analysis was carried out to determine the relationship between exposure and the exposure factor using the Spearman test. Results the Spearman test results for underexposure to kV 0.207, and mAs 0.012, meanwhile for overexposed to kV -0.283 and mAs 0.166, the radiographer can make efforts to optimize radiographic examinations by considering the optimal selection of exposure factor parameters which can use a combination of exposure index by assessing the deviation index indicator and maximizing use post-processing or windowing to improve image quality.

ANALYSIS EXPOSURE INDEX AS AN OPTIMIZATION EFFORT ON EXAMINATION CHEST POSTERIOR ANTERIOR

Background: Radiographers are responsible for producing image quality which can provide accurate diagnostic information by considering the lowest possible radiation dose according to the As Low As Reasonably Achievable (ALARA) principle. Participation between radiographers and medical physicists is needed in optimizing efforts to control the selection of exposure factors by the required clinical radiographic examination. Purpose: To analyze the exposure index on examination chest posterior-anterior. Methods: Quantitative descriptive by analyzing the percentage of exposure index results used in chest PA radiographs as an effort to optimize: image quality and radiation dose indicators on chest PA examinations. Results: Optimization of exposure percentage results of 68%, 25% underexposure, 4% underexposure, 2% overexposure, 1% overexposure (noise). Radiographers have tried to optimize: image quality and image radiation dose by selecting exposure factors that are tailored to the patient’s condition and maximizing post-processing for increased quality. Conclusion: In optimizing the CR imaging system, it is necessary to understand exposure index, this is related to the underexposed, optimal, and overexposed categories, besides radiographers can take advantage of post-processing to improve image quality.

Dose Assessment during Pregnancy in Chest PA Examination

Dose Assessment during Pregnancy in Chest PA Examination

Entrance skin dose assessment of selected computed radiography facilities in Ghana

Background: The basic challenge with computed radiography (CR) systems is the large dynamic range which provides an opportunity for radiographers to gradually increase exposure factors and still produce good image quality, a practice that can lead to dose creep. Materials and Methods: The aim of this study was to establish the entrance skin dose (ESD) values for nine selected examinations in three CR facilities in Ghana (chest PA, abdomen AP, lumbar Pelvis AP, lumbar spine LAT, cervical spine AP, cervical spine LAT, skull PA and skull LAT). ESD was estimated by the indirect method involving the use of a standard equation. The study involved 150 females and 120 males with the average age of 50 ± 14 years. The average weight of the study population was 69 ± 8 kg, and the average height of 162 ± 9 cm. The CR systems used at all the hospitals were manufactured by Shimadzu medical systems (Kyoto, Japan) and the model number was UD150L-40E. Results: The average ESDs (mGy) for each examination were; 0.93 ± 0.7, 3.04 ± 0.4 , 4.95 ± 0.9, 0.59 ± 0.3, 0.63 ± 0.4, 1.77 ± 0.3, 1.64 ± 0.3, 2.31 ± 0.4 and 3.15 ± 0.6 for chest PA, lumbar spine AP, lumber spine LAT, cervical spine AP, cervical spine LAT, skull PA, skull LAT, pelvis AP, and abdomen AP respectively. The single factor ANOVA t-test that was performed indicated a significant difference (p-value = 5.73 x 10-15) among the ESDs for chest PA examination. Conclusion: Over exposure of patients is very possible with CR systems, it is therefore important for patient dose to be audited periodically in order to achieve the principles of As Low As Reasonably Achievable (ALARA).

LOW BMI PATIENT DOSE IN DIGITAL RADIOGRAPHY.

In this study, the radiation dose received by 364 low body mass index (BMI) adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis X-ray examinations in an X-ray room with a digital radiography system was evaluated. The patients' kerma area product (KAP) values were recorded, and the entrance surface air kerma (ESAK) was calculated based on the X-ray tube output, exposure parameters and technical data. The 75th percentiles of the distribution of ESAK and KAP values were also estimated. The dose values were compared with the corresponding values for normal patients obtained from a previous survey in our hospital, as well as with the national and UK diagnostic reference levels (DRLs). The correlation of dose values with patient size metrics (mass, height, BMI) was also investigated. A statistically significant difference was found in KAP and the ESAK values between low BMI and normal patients (Mann-Whitney test, p<0.05), for all examinations studied. The percentage difference for chest PA, chest LAT, abdomen PA, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP examinations was 40, 36, 48, 68, 57, 46 and 67% for median KAP and 26, 43, 52, 48, 19, 44 and 51% for median ESAK, respectively. The corresponding 75th percentiles for low BMI patients were 0.065, 0.349, 0.683, 1.54, 3.92, 1.11, 0.67mGy and 0.042, 0.218, 0.450, 0.280, 0.598, 0.597, 0.267 Gycm2 in terms of ESAK and KAP values, respectively. They were 74-90% lower compared to the national diagnostic reference levels (DRLs), 35-84% and 58-82% compared to the UK DRLs, for ESAK and KAP values, respectively. Regarding the gender of the patients, no statistically significant difference was found in the dose values between female and male patients (Mann-Whitney test, p>0.05), for all examinations studied. A statistically significant correlation was found between ESAK and KAP values with BMI for KUB AP, pelvis AP, lumbar spine AP, lumbar spine LAT and chest PA, while for chest LAT examinations, only the ESAK were significantly correlated with BMI. They also significantly correlated with the mass for KUB AP, lumbar spine LAT, abdomen PA and chest PA examinations, while no significant correlation was found between the dose values and patients' height. It can be concluded that the low BMI patients received a significantly reduced radiation dose compared to normal patients. Additional studies need to be conducted for these patient groups, which could contribute to the further development of a radiation protection culture in diagnostic radiography.

EFFECTIVE DOSE AND RISK ESTIMATES IN ADULT PATIENTS FROM FOUR RADIOLOGICAL PROCEDURES EXTRAPOLATED OVER TWO POPULATIONS AT SOME SELECTED CENTERS IN LAGOS STATE, NIGERIA.

In this study, risk of exposure to adult patients in some common radiological procedures was estimated at selected diagnostic centers in Lagos State, Nigeria using estimated average effective doses. The results showed that pelvis lateral (LAT) examination with the lowest estimated mean effective dose level (2.61) recorded the highest probability of cancer incidence and mortality occurrences, while lumbar anteroposterior (AP) had the lowest (3.61). A high sum total of probability of fatal cancers and the total weighted probability of non-fatal cancer in a single exposure to low-dose ionizing radiation were recorded in pelvic procedure among others. Also, a high-percentage mortality increase of solid cancers was recorded in chest PA examination (53.7%), while the lowest was in lumbar spine radiography (with lumbar AP =0.14%, lumbar LAT =0.15%). The data obtained suggested the possibility of having higher percentage mortality and cancer-related incidence in the chest.

A survey of X-ray diagnostic services in Imo State, Nigeria

A survey was conducted on the technical parameters (exposure factor) used on some X-ray examinations (skull posteroanterior printarticle.asp?issn=0972-0464;year=2019;volume=42;issue=4;spage=159;epage=167;aulast=Eke;type=0, skull anteroposterior [AP], skull lateral [LAT], chest posteroanterior printarticle.asp?issn=0972-0464;year=2019;volume=42;issue=4;spage=159;epage=167;aulast=Eke;type=0, chest lateral [LAT], abdomen anteroposterior [AP], and pelvis anteroposterior [AP]) in six hospitals across the three senatorial zones (Owerri, Orlu, and Okigwe) in Imo State, Nigeria. A total of 100 patients were included in the survey. For each patient, the technical parameters (mAs and kVp) were recorded during the specific medical examination. Patients' information such as age, mass, and height was also taken. The results showed that the kVp mean values obtained were 80.00, 75.00, 75.00, 73.58, 83.36, and 75.08 for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examination, respectively, and the mAs mean values obtained were 26.30, 30.00, 31.29, 32.76, 41.46, and 29.00 for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, and pelvis AP examinations, respectively. These values are lower than international standards which imply that the personnel at the X-rays diagnostic center visited are doing fine.

Entrance Skin Dose (Radiation) Measurement and Evaluation (for all age groups) at the State Specialist Hospital, Okitipupa, Nigeria

This study was carried out on entrance skin dose (ESD) (Radiation) measurement and evaluation (for all age groups) at the State Specialist Hospital, Okitipupa, Ondo State, Nigeria. Entrance skin doses for randomly selected patients between 0-4 years, 5-9 years, 10-17 years and above 18 years old undergoing X-ray chest (Poster Anterior) examinations were measured and evaluation of the source-to-skin distance (SSD) records for the patients during the x-ray chest examinations were carried out. The mean ESD reported for chest PA projections were 66.43 µGy, 105.10 µGy, 215.76 µGy and 291.81 µGy respectively for age range 0 - 4 years, 5 - 9 years, 10 - 17 years and above 18 years. The ESD values reported in this present study were same with the NRPB recommendations of year 2000 of 50 µGy for newborn to 1-year-old, 70 µGy for 5 years and 120 µGy for 10 years old children. The values reported for age 1 to 4 years were lower than 0.1 mGy recommended and the mean ESD for age 5 to 9 years for chest PA examination was 0.11 mGy which is lower than the recommended 0.12 mGy. However, other values reported in this present study were compared with the guidance levels set by the International regulation bodies and were found to be within safe limits and they do not pose any significant health risk to the patients of all age ranges or the health workers. The effective radiation doses (ERDs) for all the age groups were computed, and by comparisons, it was found that the radiation risk factors (RRFs) are relatively low.

Comparison with Overlap Area of Scapular and Lung Field according to Position on Chest Radiography

Background/Objects: The purpose of this study is to compare a representative position and two positions what are used clinically at Chest PA examination. Methods/Statistical Analysis: The first position is generally known for minimizing overlap of lung fields and scapulae, and the other 2 positions are mainly used in actual clinics. 3 Radiologic technologists with an average of 7 years' experienced reviewed the images. The overlapping area was measured by connecting the overlapping part of the lung field and the scapula in the radiograph with dots and lines. Findings: We compared the incidence of overlap of scapulae and lung fields depending on sex and age. There were no statistically significant differences between males and females in CP (p>0.05). However, in IRP and HP, there were meaningful differences in the incidence of overlap depending on sex (p0.05). CP showed the least overlapping area followed by HP and IRP. Regarding the ratio of overlapping area, CP had the highest ratio and IRP had the least ratio, but this difference was not statistically meaningful according to Kruskal-Wallis H examination. For reference, a value closer to 1 in this test indicates less of an overlap between the scapula and lung field. Therefore, a position with a value closer to 1 is more useful in separating the scapula and the lung field when conducting Chest PA. Applications/Improvement: The research revealed that both positions are useful in minimizing the overlap between the lung field and scapula.

English

Due to the universality and high percentage demand of chest X-rays and the importance of this examination in diagnostic radiology, there is a strong need for the assessment of its entrance surface air kerma. Entrance surface air kerma (ESAK) has been measured for a total of 60 patients undergoing posteroanterior chest x-ray from conventional diagnostic radiology in three diagnostic centers in Ogun State, Nigeria. ESAK was measured based on the x-ray equipment output obtained from a CONNY II dose rate meter. The entrance surface air kerma for the selected hospitals A, B and C are 0.20, 0.30 and 0.43 mGy, respectively with an average of 0.31 mGy. Variance analysis was performed to evaluate the significance of the difference between the entrance surface air kermas. The variation in entrance surface air kerma found among diagnostic centers in this survey showed that there is need to assess radiological techniques of x-ray examination and the personnel, among different diagnostic centers. In addition, when the ESAK average value is compared with other average values in some countries, it showed that the ESAK for Nigeria in chest PA examination is higher than other countries except Iran. This shows that optimal protection of patient against excessive radiation dose is possible by improving the influencing factors in diagnostic radiology examinations. &nbsp; Key words: ESAK, posteroanterior, CONNY II, radiological techniques, optimal protection.

SU‐E‐P‐57: Radiation Doses Assessment to Paediatric Patients for Some Digital Diagnostic Radiology Examination in Emergency Department in Qatar

Purpose:The aim of this study was to evaluate radiation doses to pediatric patients undergoing standard radiographic examinations using Direct Digital Radiography (DDR) in Paediatric emergency center of Hamad General Hospital (HGH) in state of Qatar and compared with regional and international Dose Reference Levels (DRLs).Methods:Entrance Skin Dose (ESD) was measured for 2739 patients for two common X‐ray examinations namely: Chest AP/PA, Abdomen. Exposure factors such as kV, mAs and Focal to Skin Distance (FSD) were recorded for each patient. Tube Output was measured for a range of selected kV values. ESD for each individual patient was calculated using the tube output and the technical exposure factors for each examination. The ESD values were compared with the some international Dose Reference Levels (DRL) for all types of examinations.Results:The most performed procedure during the time of this study was chest PA/PA (85%). The mean ESD values obtained from AP chest, PA chest and AP abdomen ranged 91–120, 80–84 and 209 – 659 µGy per radiograph for different age's groups respectively. Two protocols have been used for chest AP and PA using different radiological parameters, and the different of ESD values for chest PA and were 41% for 1 years old child, 57% for 5 years old for chest AP.Conclusion:The mean ESD were compared with those found in literature and were found to be comparable. The radiation dose can be reduced more for Chest AP and PA examination by optimization of each investigation and hence more studies are required for this task. The results presented will serve as a baseline data needed for deriving local reference doses for pediatric X‐ray examinations in this local department and hence it can be applied in the whole Qatar.

화병의 불안 증상에 대한 시호가용골모려탕의 효능 임상연구 중간보고

Objectives : The purpose of this study is to investigate the effect of Sihogayonggolmoryeo-tang on the anxiety of Hwa-byung. Methods : In this randomized, double blinded, placebo-controlled study, we planned to give Sihogayonggolmoryeo-tang or controlled medication for anxiety of Hwa-byung. Hamilton Anxiety Scale (HAM-A) was measured as the 1st evaluative instrument, and Korean State-Trait Anxiety Inventory (STAI-K), Likert scale for major symptom of Hwa-byung, Hwa-Byung Scale Score, Korean Beck's Depression Inventory (BDI-K), Korean State-Trait Anger Expression Inventory (STAXI-K), Insomnia severity Index (ISI), Instrument of Oriental Medical Evaluation for Hwa-Byung, WHO Quality of Life Avvreviated (WHOQOL-BREF), genral self-Efficacy Scale (GSES), Rosenberg Self-Esteem Inventory (SRE) and Heart Rate Variability (HRV) were also measured as the 2nd evaluative instrument before treatment. Results : Clinical characteristics-vital signs and demographic characteristics showed no significant difference between both groups. The characteristics of disease-chief complaint, pattern Identification, period, etiological factor, and etc, also showed similarity of distribution in both groups. The results of Chest PA, EKG and clinicopathologic examination showed no significant difference between both groups. There were no significant difference between both groups in all valuation scales; HAM-A was measured as the first evaluative instrument, and STAI-K, Likert scale for major symptom of Hwa-byung, Hwa-Byung Scale Score, BDI-K, STAXI-K, ISI, Instrument of Oriental Medical Evaluation for Hwa-Byung, WHOQOL-BREF, GSES, SRE and HRV. Conclusions : We considered that establishment of the experimental group and controlled group was objective and worth conducting this research. In addition, this methodology is expected to be applied to the subsequent research. Further, we hope to make up for this study through various study and discussion.

A preliminary study into performing routine tube output and automatic exposure control quality assurance using radiology information system data

Data are currently being collected from hospital radiology information systems in the North West of the UK for the purposes of both clinical audit and patient dose audit. Could these data also be used to satisfy quality assurance (QA) requirements according to UK guidance? From 2008 to 2009, 731 653 records were submitted from 8 hospitals from the North West England. For automatic exposure control QA, the protocol from Institute of Physics and Engineering in Medicine (IPEM) report 91 recommends that milliamperes per second can be monitored for repeatability and reproducibility using a suitable phantom, at 70-81 kV. Abdomen AP and chest PA examinations were analysed to find the most common kilovoltage used with these records then used to plot average monthly milliamperes per second with time. IPEM report 91 also recommends that a range of commonly used clinical settings is used to check output reproducibility and repeatability. For each tube, the dose area product values were plotted over time for two most common exposure factor sets. Results show that it is possible to do performance checks of AEC systems; however more work is required to be able to monitor tube output performance. Procedurally, the management system requires work and the benefits to the workflow would need to be demonstrated.

Experience of Ovarian Function Suppression Therapy: Endocrine Response Preand Perimenopausal Korean Breast Cancer Patients in the Adjuvant Setting

지고 유방암 선별검사가 전국적으로 활발히 진행되면서 전체 유 Purpose: Published Early Breast Cancer Trialists’ Collaborative Group overview results have been the beneficial effects of tamoxifen and ovarian ablation for pre and perimenopausal women with node negative breast cancer. Chemotherapy and Luteinizing Hormone Releasing Hormone (LHRH) agonists (medical ovarian ablation) have been shown to be effective adjuvant therapies for early stage breast cancer in several clinical trials however, the efficacy and tolerance of LHRH agonists in Korean breast cancer patients has not been evaluated. Methods: Three thousand one hundred fifty breast cancer patients were treated at Asan Medical Center between January 2003 and December 2005. We selected 185 patients with node negative early breast cancer who were endocrine responsive (more than intermediate intensity), with a tumor size more than 1 cm, and who were reluctant to undergo chemotherapy due to the side effects. They received LHRH agonists (Zoladex 3.6 mg) every 28 days with tamoxifen for two years. We prospectively evaluated mammography, chest PA, and physical examination every six months and evaluated the side effects and quality of life. Results: The mean age was 43.5 yr, and the mean tumor size was 1.62 cm. One hundred sixty-two patients had Stage I, and 23 Stage II disease. The incidence of severe menopausal symptoms was 24.1%, but these symptoms were reported to be ‘‘tolerable’’ during the two year follow-up. Quality of life and physical activity were essentially unchanged. The median follow-up duration was 18 months, and there was no local recurrence or distant metastases during the study. Conclusion: Adjuvant therapy with LHRH agonists is safe and tolerable, and may be an alternative to chemotherapy for pre-and perimenopausal women with hormone responsive early breast cancer who are reluctant to undergo chemotherpy. (J Breast Cancer 2007;10:134-40)

Comparison of clinical and physical measures of image quality in chest and pelvis computed radiography at different tube voltages

The aim of this work was to study the dependence of image quality in digital chest and pelvis radiography on tube voltage, and to explore correlations between clinical and physical measures of image quality. The effect on image quality of tube voltage in these two examinations was assessed using two methods. The first method relies on radiologists' observations of images of an anthropomorphic phantom, and the second method was based on computer modeling of the imaging system using an anthropomorphic voxel phantom. The tube voltage was varied within a broad range (50-150 kV), including those values typically used with screen-film radiography. The tube charge was altered so that the same effective dose was achieved for each projection. Two x-ray units were employed using a computed radiography (CR) image detector with standard tube filtration and antiscatter device. Clinical image quality was assessed by a group of radiologists using a visual grading analysis (VGA) technique based on the revised CEC image criteria. Physical image quality was derived from a Monte Carlo computer model in terms of the signal-to-noise ratio, SNR, of anatomical structures corresponding to the image criteria. Both the VGAS (visual grading analysis score) and SNR decrease with increasing tube voltage in both chest PA and pelvis AP examinations, indicating superior performance if lower tube voltages are employed. Hence, a positive correlation between clinical and physical measures of image quality was found. The pros and cons of using lower tube voltages with CR digital radiography than typically used in analog screen-film radiography are discussed, as well as the relevance of using VGAS and quantum-noise SNR as measures of image quality in pelvis and chest radiography.

Entrance surface doses to patients undergoing selected diagnostic X-ray examinations in Sudan

The aim of the study was to evaluate the entrance surface doses (ESDs) to patients undergoing selected diagnostic X-ray examinations in major Sudanese hospitals. ESD per examination was estimated from X-ray tube output parameters in four hospitals comprising eight X-ray units and a sample of 346 radiographs. Hospital mean ESDs estimated range from 0.17 to 0.27 mGy for chest AP, 1.04-2.26 mGy for Skull AP/PA, 0.83-1.32 mGy for Skull LAT, 1.31-1.89 mGy for Pelvis AP, 1.46-3.33 mGy for Lumbar Spine AP and 2.9-9.9 mGy for Lumbar Spine LAT. With exception of chest PA examination at two hospitals, mean ESDs were found to be within the established international reference doses. The results are useful to national and professional organisations and can be used as a baseline upon which future dose measurements may be compared.

Does digital imaging decrease patient dose? A pilot study and review of the literature

The potential for decreasing patient dose is one of the main arguments for the justification of the cost of digital imaging equipment. However, the literature review with respect to patient doses using digital imaging modalities, presents conflicting results. During this study, patients' entrance surface doses were measured for three simple radiographic examinations, in European centres equipped with a computed radiography digital system. Results showed that doses between centres varied from 30% for chest LAT to 250% for chest PA examination. With the digital image quality criteria still under discussion, and with the post-processing parameters and/or image documentations varying, any dose comparisons between conventional/digital systems, as well as dose comparisons between different centre using digital units, are difficult. Clinical trials are required in order to define reference levels associated with quality of digital image necessary to address specific clinical requirements.