Diagnostic X-ray Research Articles

Influence of distant scatterer on air kerma measurement in the evaluation of diagnostic X-rays using Monte Carlo simulation

The evaluation of the entrance surface dose (ESD) ensures safe radiation doses for X-ray imaging patients. The air kerma free-in-air value used to estimate ESD may be affected by those X-rays that scatter from the scatterer placed behind the chamber at the time of measurement, thereby leading to assessment errors. Therefore, the influence of scattered radiation on air kerma measurements was investigated. Monte Carlo simulations were performed for various detector-to-scatterer distances and scatterer materials. The simulation results were compared with actual measurements to confirm the simulation accuracy. The source-chamber distance was set to 50 and 100cm for the experimental measurements and simulation, respectively, and the chamber-scatterer distance was varied. The Monte Carlo simulation results reproduced the actual measurements with an accuracy of 3.5%. The effect of backscattering varied with the tube voltage and irradiation field size. The effect was observed in the order of prominence for the following scatterer materials: water-equivalent phantom, acrylic, concrete, lead, and iron. Furthermore, this effect decreased exponentially with increasing chamber-scatterer distance. For a field size of 10 × 10 cm2, the finite-distance backscatter factor decreased with an increasing chamber-scatterer distance for all materials. The cause of backscattering in diagnostic X-ray energy regions differs depending on the scatterer material, as well as the photon energy and field size. Backscattering decreases exponentially as the distance between the detector and scatterer increases.

CALIBRATION METHOD AND ABSOLUTE MEASUREMENTS OF AIR KERMA OF DIAGNOSTIC X-RAY REFERENCE QUALITIES USING A FREE-AIR IONISATION CHAMBER.

Accurate dose measurement is very important for diagnosing X-ray equipment. These equipment should be traced directly or indirectly to primary standard with as little uncertainty as possible. A parallel-plate free-air chamber was designed to measure air kerma of diagnostic X-ray absolutely. Different thickness of aluminium filters were used to obtain different radiation qualities according with IEC 61267. Correction factors were obtained by experiments and simulation, especially the air attenuation factor measured with vacuum method. The relative standard uncertainty of air kerma rate measurement was 0.46% and calibration factor was 0.53%. A transfer ionisation chamber was calibrated with Radiation Qualities in Radiation beams (RQR) qualities in National Research Council of Canada and National Institute of Metrology (NIM), the differences of calibration factors are less than 0.68%.

Infection Prevention, Operational Workflows, and Implementation Checklists for Whole-Lung Low-Dose Radiation Therapy (LD-RT) for COVID-19-Related Pneumonia

Purpose/Objective(s)Low-Dose Radiation Therapy (LD-RT) is an emerging treatment option for patients with COVID-19 related pneumonia. Infectivity of the SARS-CoV-2 virus complicates incorporation of LD-RT into existing radiation oncology clinics.Materials/MethodsThe first phase I/II trial of LD-RT for COVID-19-related pneumonia implemented novel operational protocols to address risk of infection and respiratory events. Patients were transported from hospital rooms to linear accelerators and treated with 0.5 Gy or 1.5 Gy using pre-planned, two-dimensional treatments prepared using diagnostic x-rays and caliper measurements. Workflows were revised over time to balance infection risks with implementation burden.ResultsBetween April 24 and December 7, 2020, fifty-two patients were enrolled and forty were treated. The end-to-end process comprised 16 distinct teams and > 120 cooperating staff members (> 50 core radiation oncology staff). The trial was operationalized at two hospitals at the onset of the COVID-19 pandemic, prior to vaccine availability. Teams included trial leadership/screening (n > 4), inpatient floor staff (n > 10), clinical trials staff and coordinators (n = 8), transport (n = 2), radiation therapists (n > 20), respiratory therapists (n = 5), radiation nursing (n > 7), ICU nursing (n = 4), rapid response teams (n = 4), medical physics (n > 4), dosimetry (n > 3), infection prevention (n > 3), environmental services (n > 6), security (n = 7), lab personnel (n = 1), and physicians from radiation oncology (n = 7), infectious diseases (n = 2), pulmonary/critical care medicine (n = 2), anesthesia (n = 2), and internal medicine (n > 20) [total > 120]. All non-intubated patients were transported by a multi-disciplinary team, consisting of a physician, nurse, transporter, infection prevention specialist, and (when needed) a respiratory therapist. Treatments occurred after normal clinic hours, were initiated by team huddles, check lists, and included personal protective equipment supervision at multiple time points. Transport routes were 880 to 1760 feet (0.33 miles) one-way, with 1 to 3 elevator banks and required 20-35 minutes for round-trip transport and treatment. Oxygen supplementation in non-intubated patients ranged from 2 to 15 L/min. One intubated patient was transported with a portable ventilator and accompanying ICU staff. There were no code-level events during transport. No patient-facing staff contracted COVID-19 from trial activities. Workflow burden was successfully reduced and protocols relaxed over time with increased staff experience.ConclusionWhole-lung low-dose radiation therapy (LD-RT) for COVID-19-related pneumonia was successfully incorporated into existing workflows at a major academic university. Forty patients were treated with no code-level events, and no staff contracted the virus during eight months of trial accrual. Instructional materials and implementation check lists are provided.

General radiographic patient dose monitoring using conformity test data

Currently, the Nuclear Energy Supervisory Agency (BAPETEN) is actively guiding users or license holders related to patient protection against radiation hazards or often referred to as radiation protection and safety on medical exposure. Protection against medical exposure became a big issue when the mandatory compliance test on X-ray equipment for diagnostic and interventional radiology was introduced. In addition, license holders through their medical practitioners are also required to use the level of medical exposure guidelines. While PERKA BAPETEN No. 9, 2011 concerning the Suitability Test of Diagnostic and Interventional Radiology X-Ray device, states that one of the test parameters that directly affect the patient's radiation dose and determine the feasibility of operating the X-Ray device to the patient is information on the dose or rate of radiation dose received by the patient. Monitoring doses with Entrance Surface Air Kerma (ESAK) or what is often referred to as ESD (entrance surface dose) using suitability conformity test data starting from 50,60,70,80,90 and 100 kVp with 20 mAs at SID 100 meters. The results of the research on the value of ESAK was 0.049 mGy, an ESAK value that still met the national I-DRL value from BAPETEN Regulation No. 1211/K/V/2021.

Survey of Absorbed Dose from Chest X-Ray of Paediatric Patients in Port Harcourt, Nigeria: A Cross-Sectional Study

Background: Radiation protection in paediatric radiology deserves special attention as children are supposed to be more sensitive to radiation than adults. Aim: This study was designed to evaluate the radiation doses for paediatric patients undergoing diagnostic chest X-ray examination. Materials and Methods: This was a cross-sectional survey, which targeted paediatric patients of (0-10) years who were referred by their physicians for chest X-rays examination. The data used for this work were generated using a Thermoluminescence dosimeter (TLD) chip. One TLD chips was placed in the front of the chest to measure the Entrance Surface Dose (ESD) (µGy) and another at the back of the patient directly opposite the one in front to measure the Exit Dose (ED) (µGy). Patient dose, age, ESD, ED and absorbed dose were obtained. The obtained data were analyzed using descriptive statistics. Results: The mean ESD, ED and absorbed dose values were 1.8330± 1.122mGy, 1.0913± 0.7505mGy and 0.7520 ± 3.8160mGy respectively. The ED values in chest X-rays were 0.73± 0.30mGy for age group <1 year, 1.15± 0.91mGy for age group 1-5 years and 6-10 years 1.09± 0.75mGy. The ESD were 3.06 ± 1.76mGy for age group <1, 3.02± 2.04mGy for age group 1-5 years and 6-10 years 1.83± 1.12mGy. The absorbed dose values obtained were 1.88± 1.75mGy for age group <1 year, 1.88± 1.67mGy for age group 1-5 years and 0.75± 3.82mGy for age group 6-10 year. Conclusion: The values for Exit Dose, Entrance Surface Doses, and Absorbed Dose have been determined and it was found to be slightly higher than UNSCEAR values. Keywords: Children, Diagnostic reference level, Radiation.

Green conversion of hazardous red mud into diagnostic X-ray shielding tiles

Red mud is a solid hazardous alumina industrial waste, which is rich in iron, titanium, aluminum, silicon, calcium, etc. The red mud contains 30–60% of hematite, which is suitable for shielding high energy X- and gamma rays. So, the iron rich red mud was converted into diagnostic X-ray shielding tiles through ceramic route by adding a certain weight percentage of BaSO4 and binders (kaolin clay or sodium hexametaphosphate) with it. The kaolin clay tile possess sufficient impact strength (failure point is 852 mm for 19 mm steel ball) and flexural strength of ~25 N/mm2, which is suitable for wall applications. The 10.3 mm and 14.7 mm thick red mud:BaSO4:kaolin clay tile possess the attenuation equivalent to 2 mm and 2.3 mm lead at 125 kVp and 140 kVp, respectively. No heavy elements were found to leach out except chromium and arsenic from the sintered tiles. However, the leaching of Cr (0.6 ppm) and As (0.015 ppm) was found to be well below the permissible limit. These tiles can be used in the X-ray diagnosis, CT scanner, bone densitometry, and cath labs instead of toxic lead sheet and thereby to protect the operating personnel, public, and environment from radiation hazards.

COVID-19 diagnosis from chest x-rays: developing a simple, fast, and accurate neural network

PurposeChest x-rays are a fast and inexpensive test that may potentially diagnose COVID-19, the disease caused by the novel coronavirus. However, chest imaging is not a first-line test for COVID-19 due to low diagnostic accuracy and confounding with other viral pneumonias. Recent research using deep learning may help overcome this issue as convolutional neural networks (CNNs) have demonstrated high accuracy of COVID-19 diagnosis at an early stage.MethodsWe used the COVID-19 Radiography database [36], which contains x-ray images of COVID-19, other viral pneumonia, and normal lungs. We developed a CNN in which we added a dense layer on top of a pre-trained baseline CNN (EfficientNetB0), and we trained, validated, and tested the model on 15,153 X-ray images. We used data augmentation to avoid overfitting and address class imbalance; we used fine-tuning to improve the model’s performance. From the external test dataset, we calculated the model’s accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1-score.ResultsOur model differentiated COVID-19 from normal lungs with 95% accuracy, 90% sensitivity, and 97% specificity; it differentiated COVID-19 from other viral pneumonia and normal lungs with 93% accuracy, 94% sensitivity, and 95% specificity.ConclusionsOur parsimonious CNN shows that it is possible to differentiate COVID-19 from other viral pneumonia and normal lungs on x-ray images with high accuracy. Our method may assist clinicians with making more accurate diagnostic decisions and support chest X-rays as a valuable screening tool for the early, rapid diagnosis of COVID-19.

Psoriasis and imaging progression in early axial spondyloarthritis: results from a 48-month follow-up (Italian arm of SPACE study).

To assess the influence of psoriasis on spinal/pelvic radiographic progression and MRI features in early-stage axial spondyloarthritis (axSpA). Analysis of baseline data from the Italian SPACE cohort, including patients with chronic back pain (CBP; duration ≥3 months and ≤2 years; onset <45 years) was performed. Patients underwent a diagnostic work-up, including MRI and X-rays of the sacroiliac joints (SIJ), to establish diagnosis of axSpA (Assessment of Spondyloarthritis International Society criteria). Clinical features, disease activity and functional indices, imaging were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRIs were scored by two readers following Spondyloarthritis Research Consortium of Canada score, Stoke Ankylosing Spondylitis Spinal Score System modified by Creemers and modified New York criteria. Characteristics of axSpA patients with/without psoriasis were compared over time with descriptive statistics; multivariate logistic regression model was constructed to assess predictors of spinal/pelvic radiographic progression. Eighty-eight patients had axSpA (84.1% non-radiographic; 15.9% radiographic); 36.4% had psoriasis. Patients with psoriasis were older; less frequently had HLA-B27+ and radiographic sacroiliitis with unilateral/asymmetric pattern and more signs of spondylitis. Functional and disease activity indices decreased with slightly higher BASDAI and BASFI in axSpA with psoriasis. All patients showed slight spinal/pelvic radiographic progression. Patients without psoriasis showed increased sacroiliitis progression and low-grade spinal progression. More inflammatory corner lesions on cervical/thoracic MRI-spine were observed in patients with psoriasis. A significant downtrend of SPARCC SIJ/spine scores in all patients was found. Psoriasis was a predictor of increased spinal progression (odds ratio = 0.18; 95% CI: 0.04, 0.78). Psoriasis was associated with distinct axSpA features, increased spinal radiographic progression and low-grade radiographic sacroiliitis.

PATTERN OF CHEST RADIOGRPAHIC FINDINGS IN RELATION TO CD4 COUNT AMONG THE HAART NAÏVE HIV POSITIVE ADULTS IN SOKOTO NORTHWESTERN NIGERIA

Background: HIV/AIDS epidemic has evolved to become a major task in global health with the greatest impact in sub-Saharan Africa, where most of the transmission occurs horizontally between sexually active individuals. The CD4 count being a reliable pointer of immunosuppression has a close relationship with the likelihood of developing some pulmonary diseases and other chest conditions in HIV patients, which can be picked on chest radiograph. Aims and Objectives: To determine the pattern of chest radiographic findings in relation to CD4 count among the HAART naïve HIV positive adults in Sokoto. Materials and Methods: One hundred and forty newly diagnosed HIV positive adults, yet to commence any antiviral treatment were recruited. They had chest radiographs done in the Radiology Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, North-western Nigeria, using Silhoutte VR System GE diagnostic x-ray equipment. The findings from the radiographs and the result of their CD4 counts were analysed using SPSS version 23. Results: The CD4 count of the studied participants ranged from 69-1222 cells/?L with mean (± SD) of 448.3(± 287.0) cells/?L. Most of the participants 59(42.1%) had CD4 counts &lt;200 cells/?L. Pulmonary consolidation was the predominant radiographic finding in the CD4 range of 200-499cells/?L while a normal appearance was the commonest finding amongst participants with CD4 count ?500 cells/?L There was statistically significant association between the level of CD4 counts and the overall chest radiographic findings using chi- square test with a chi value of 23.993 and p-value of 0.000. Conclusion: The study showed abnormal chest radiographic finding as the predo

What is the role of chest X-ray imaging in the acute management of children with sickle cell disease?

Children with sickle cell disease (SCD) frequently present to hospital acutely unwell and are often exposed to diagnostic chest X-rays (CXRs). Little evidence exists to determine when CXRs are clinically useful. Using electronic hospital records, we audited CXR use in children aged 0-18 who presented to hospital over the past 10years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28·2% of CXRs (n=258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52·3%, effusion 8·9%, cardiomegaly 8·4% and sickle cell-related bone changes 6·3%. Indications for CXR of respiratory distress (OR=3·74, 95% CI 2·28-6·13), hypoxia (OR=1·86, 95% CI 1·50-2·31) and cough (OR=1·64, 95% CI 1·33-2·02), were more likely to have significant CXR findings. Patients who had higher peak fever (38·4°C vs. 37·4°C, P=0·001), higher peak CRP (156·4 vs. 46·1, P<0·001) and higher WCC (20·2 vs. 13·6, P<0·001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T>38°C, CRP>50 or WCC>15×109 /l as indications for CXR, to have a sensitivity of 88% (with 95% CI 0·78-0·95) and specificity of 46% (95% CI 0·43-0·50) for clinically significant findings.

Study of epoxy shielding material with barium sulphate for development of radiation protection materials in low-dose diagnostic X-ray

In radiological work, it is necessary to use radiation protection devices to reduce the negative health effects of radiation. Currently, the most used material for protection is lead, but it has disadvantages such as environmental toxicity. The objective of this research is to study the epoxy shielding material for the development of radiation protection material. The materials were mixed epoxy resin and barium sulphate in various proportions and the radiation absorption properties were studied. The results found that the epoxy shielding material mixing with 70% barium sulphate had the highest radiation absorption properties at 97%. The conclusions of this study show that the epoxy shielding material mixed with barium sulphate can provide appropriate protection to low doses of radiation in diagnostic X-rays.

Discussing X-Ray Shielding With Patients: First Do No Harm.

It was recognized early that diagnostic x-ray could be harmful. The discussion of shielding patients from x-ray as a safety measure began in 1905, after it was demonstrated that x-ray could produce female and male sterility. As x-ray equipment improved and radiation doses declined, the recommendations for shielding to prevent infertility were dropped. In the 1950s, recommendations for shielding of the female and male gonads were reintroduced out of concern that hereditable mutations might result from x-ray examinations.

Using patient shielding - What is the risk?

The practice of placing radiation protective shielding on patients ('in contact') in order to reduce the dose to certain radiosensitive organs for diagnostic X-ray examination, has been employed for decades. However, there has been a growing body of evidence that this practice is often ineffective or even counterproductive and the use of such shielding can also overemphasise the hazards of ionising radiation in the public mind. This has led to a growing disparity in the application of patient contact shielding and culminated in several professional bodies issuing guidance and statements to provide a consistent approach to patient contact shielding. This, in turn, has led to a healthy discussion and re-evaluation of when and why patient contact shielding should be used, where the main issue centres around the criteria used to arrive at the recommendations. The decision process involves considering, among others, the reported effectiveness of the shielding and a subjective assessment of the subsequent risks from their use. In order to improve the transparency of these recommendations, it is therefore suggested that a threshold for dose and/or risk should be clearly stated, below which no protection is required. A suggested starting point for defining this threshold is discussed. This would enhance uniformity of application and provide clarity for staff, patients and the public. It would also ensure that any future research in this area could be easily incorporated into the general guidance.

Diagnostic chest X-rays and breast cancer risk among women with a hereditary predisposition to breast cancer unexplained by a BRCA1 or BRCA2 mutation

BackgroundDiagnostic ionizing radiation is a risk factor for breast cancer (BC). BC risk increases with increased dose to the chest and decreases with increased age at exposure, with possible effect modification related to familial or genetic predisposition. While chest X-rays increase the BC risk of BRCA1/2 mutation carriers compared to non-carriers, little is known for women with a hereditary predisposition to BC but who tested negative for a BRCA1 or BRCA2 (BRCA1/2) mutation.MethodsWe evaluated the effect of chest X-rays from diagnostic medical procedures in a dataset composed of 1552 BC cases identified through French family cancer clinics and 1363 unrelated controls. Participants reported their history of X-ray exposures in a detailed questionnaire and were tested for 113 DNA repair genes. Logistic regression and multinomial logistic regression models were used to assess the association with BC.ResultsChest X-ray exposure doubled BC risk. A 3% increased BC risk per additional exposure was observed. Being 20 years old or younger at first exposure or being exposed before first full-term pregnancy did not seem to modify this risk. Birth after 1960 or carrying a rare likely deleterious coding variant in a DNA repair gene other than BRCA1/2 modified the effect of chest X-ray exposure.ConclusionEver/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene.Further studies are needed to evaluate other DNA repair genes or variants to identify those which could modify radiation sensitivity. Identification of subpopulations that are more or less susceptible to ionizing radiation is important and potentially clinically relevant.

Synthesis of barium-doped PVC/Bi2WO6 composites for X-ray radiation shielding

In this study, composites containing undoped and barium-doped Bi2WO6:Ba2+were investigated for their shielding against diagnostic X-ray. At first, Bi2WO6 and barium-doped Bi2WO6 were synthesized with different weight percentages of barium oxide through a hydrothermal process. The as-synthesized nanostructures were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS) and Raman spectroscopy (RS). After that, some shields were generated with undoped and barium-doped Bi2WO6:Ba2+ nanostructure particles incorporated into polyvinyl chloride (PVC) polymer with different thicknesses and 15% weight of the nanostructure. Finally, the prepared samples were exposed to an X-ray tube at 40, 80, and 120 kV voltages, 10 mAs and, 44.5 cm SID (i.e. the distance from the X-ray beam source to the specimen). Linear and mass attenuation coefficients were also calculated for different samples. The results indicated that, among the samples, the one with 7.5 mmol barium-doped Bi2WO6 had the most attenuation at the voltage of 40kV, and the attenuation coefficients would increase with an increase in the amount of barium. The samples with 15 and 17.5 mmol barium-doped Bi2WO6 had higher attenuation than the others at 80 and 120 kV. Moreover, the half-value layer (HVL), tenth-value layer (TVL) and 0.25 mm lead equivalent thickness were calculated for all the samples. The lowest HVL value was for the sample with 7.5 mmol barium-doped Bi2WO6. As the result clearly show, an increment in the barium-doping content leads to a decrease in both HVL and TVL.In every three voltages, 0.25 mm lead equivalent thickness of the barium-doped composites (7.5 mmol and 15 mmol) had less than the other composites. The lowest value of 0.25 mm lead equivalent thickness was 7.5 barium-doped in 40 kV voltage and 15 mmol barium-doped in 80 kV and 120 kV voltages. These results were obtained only for 15% weight of the nanostructure.

Prenatal X-ray Exposure and the Risk of Developing Pediatric Cancer-A Systematic Review of Risk Markers and a Comparison of International Guidelines.

Since the first Oxford Survey of Childhood Cancer's results were published, people have become more aware of the risks associated with prenatal exposure from diagnostic x rays. As a result, it has since been the subject of many studies. In this review, the results of recent epidemiological studies are summarized. The current international guidelines for diagnostic x-ray examinations were compared to the review. All epidemiological studies starting from 2007 and all relevant international guidelines were included. Apart from one study that involved rhabdomyosarcoma, no statistically significant associations were found between prenatal exposure to x rays and the development of cancer during 2007-2020. Most of the studies were constrained in their design due to too small a cohort or number of cases, minimal x-ray exposure, and/or data obtained from the exposed mothers instead of medical reports. In one of the studies, computed tomography exposure was also included, and this requires more and longer follow-up in successive studies. Most international guidelines are comparable, provide risk coefficients that are quite conservative, and discourage abdominal examinations of pregnant women.

Experimental Assessment of Workplace Radiation Exposure in Diagnostic X-ray Medical Imaging Centres in Benin from 2019 to 2020.

The ease of prescribing radiological examinations has prompted an expansion in radiological procedures and, consequently, an increase of occupational dose to medical imaging workers. However, little is known about radiation exposure in the workplace of medical radiology professionals in many countries, and in Benin particularly. The purpose of this study was to assess ambient radiation doses in diagnostic X-ray medical facilities in Benin and to observe whether exposure levels are below reference levels. A total of 72 public and private medical imaging centres participated in a cross-sectional study carried out from June 2019 to February 2020 in Benin. These centres had 59 X-ray, four chest and six computed tomography (CT) scan rooms. A calibrated radiameter able to measure short, pulsed or continuous X fields and gamma/beta (50 nSv to 10 Sv) was used to measure exposure levels in these functional rooms. Scattered X-ray doses and exposure time from radiological examinations both behind the lead glass of the control area to assess the levels of exposure of professionals and outside of the examination room to evaluate the level of exposure of the public (including non-exposed workers) have been provided. Equivalent doses estimated per hour were compared with the reference levels of 7.50 and 0.05 µSv per hour for workers and the public, respectively. At the control area, the mean/median (min-max) equivalent doses were 0.09/0.07 (0.00-0.21), 2.39/0.13 (0.00-75.67), and 228.39/28.65 (0.39-869.75) µSv per hour for the chest, X-ray, and CT-scan rooms, respectively. Among 69 examination rooms, 13.04% of the equivalent dose estimated in the workplace behind the lead glass was greater than 7.50 µSv per hour; 65 out of 69 examination rooms showed that 40.00% of the equivalent dose estimated behind the doors was greater than 0.05 µSv per hour. These results demonstrated that current controls, including leaded glass separating the control panel and leaded doors between the examination room and the corridor, are inadequate to limit radiation exposures. The controls must be upgraded and a dosimetry program should be implemented to monitor exposures of employees, patients, and visitors.

Development of a Lightweight Tungsten Shielding Fiber That Can Be Used for Improving the Performance of Medical Radiation Shields

Radiation exposure in medical institutions is mainly due to low doses. Low-dose radiation mainly means scattered radiation, and such scattered radiation can be shielded with a lightweight shielding suit. In this study, the shielding performance of shielding fabrics woven by winding polyethylene (PE) yarn around a 30 μm tungsten wire was evaluated. To improve the shielding performance, an air pressure dispersion process of coating tungsten nanopowder on the fiber was developed. The radiation shielding effectiveness of the shielding fibers with and without dispersed tungsten nanopowder were compared by measuring the spatial dose inside the diagnostic X-ray imaging room of a medical institution. The results of the experiment confirmed that the fabric coated with tungsten nanopowder improved the shielding performance of the general tungsten fiber by approximately 15% and provided relatively effective low-dose radiation shielding at approximately 1.2 m of the X-ray imaging equipment. This study shows that tungsten fiber can be helpful in manufacturing lightweight shielding clothing for protection from scattered radiation in medical institutions.

Effect of Adenotonsillectomy on Peak Expiratory Flow Rate Among Children.

Cross sectional, prospective, observational study. Department of otorhinolaryngology in tertiary care centre. Included 40 children aged between 5 and 15years, who had adenotonsillar hypertrophy and underwent adenotonsillectomy. Diagnostic nasal endoscopy and X-ray, nasopharynx, was done to assess the grade of adenoid hypertrophy endoscopically and radiologically respectively. Peak expiratory flow rate was assessed using Mini Wright peak expiratory flow meter pre-operatively and 1month post-operatively and both the readings were compared. Subjective improvement was also compared pre-operatively and post-operatively using visual analogue score. This study included 40 patients with male to female ratio of 1.6:1, 92.5% presented with mouth breathing. 92.5% presented with grade III tonsillar hypertrophy and 70% with grade III adenoid hypertrophy endoscopically. After adenotonsillectomy, improvement in Peak expiratory flow rate ranged from 16 to 25.3% which was statistically significant. Patients with grade III tonsillar and grade IV adenoid hypertrophy showed 25.3% improvement. Subjective improvement was 98.8% in the complaint of snoring. Adenotonsillectomy significantly improves pulmonary functions. This may help to improve physical and cognitive development in children and decrease chances of getting cardiopulmonary problems in later life.

Determination of Entrance Surface Dose of Digital Radiography for Adults at Public Medical Imaging Centers, Erbil

Introduction: Diagnostic X-ray is one of the ionizing radiations, the level of radiation dose received by the patient during medical examination is essential to prevent cancer risks. The aim of this study is to calculate entrance surface dose (ESD) and effective dose (ED) were estimated during chest, and lumber spine for adult patients in three hospitals in Erbil, using NOMEX MULTIMETER and PCXMC software. &#x0D; Material and Methods: The study was conducted in three public hospitals, in Erbil on (250) adult patients, whose ages between (18-70) years, based on the results study, ESD and ED were calculated for chest (PA, lateral), and lumbar spine (AP, lateral) examinations. NOMEX MULTIMETER (PTW, Freiburg), used in measurement of tube voltage, dose, dose rate, time product current, and total filtration automatically during examination. ED was calculated by using PCXMC software (version 2.5).&#x0D; Results: The results of this work are compared with published international literatures. The mean entrance skin dose for examinations of chest (PA, Lat), and lumber spine (AP, Lat) 1.02, 1.06, 2.61 and 3.92 mGy respectively. ED value was from 0.08, 0.19, 0.32, and 0.33 mSv, for chest (PA, Lat), and lumber spine (AP, Lat), respectively.&#x0D; Conclusion: The ESD, and ED were calculated in this work were found to be agreement with the published reference values for chest, and lumber spine set by international levels. ALARA principle should be considered by radiographer, to reduce absorbed dose of adults’ patient undergoing imaging radiography.