Digital Radiographic Equipment Research Articles

ACPSEM position paper: recommendations for a digital general X-ray quality assurance program

This guideline has been prepared by the ACPSEM to provide a standardised quality assurance program to be used within General X-ray imaging environments. The guideline includes the responsibilities of various multidisciplinary team members within medical imaging facilities. It must be noted that the listed tests and testing frequencies are not intended to replace or become regulatory requirements. Implementing a quality assurance program as outlined in this position paper is there to ensure best practice for imaging facilities by providing a framework to establish and monitor correct equipment performance. The current document has been produced through an extensive review of current international practices and local experience within the Australasian healthcare environment. Due to the constant evolution of digital radiographic equipment, there is no current consensus in international quality assurance guidelines as they continue to be adapted and updated. This document describes the current state of the use of digital General X-ray equipment in the Australasian environment and provides recommendations of test procedures that may be best suited for the current medical imaging climate in Australasia. Due to the everchanging developments in the medical imaging environment and the ability of new technologies to perform more complex tasks it is believed that in the future this document will be further reviewed in the hopes of producing a more globally agreed upon standard quality assurance program. Any such adjustments that are deemed to be necessary to Version 1.0 of this document will be provided in electronic format on the ACPSEM website with a notification to all parties involved in the use of digital General X-ray equipment. This guideline does not provide detailed methodologies for all the quality control tests recommended as it is it is expected that the professionals implementing aspects of this quality assurance program have the working knowledge and access to appropriate resources to develop testing methodologies appropriate for their local imaging environment.

Knowledge and practice of radiation safety in Brazilian equine veterinarians are less than optimal: An online survey.

Exposure to ionizing radiation is an occupational risk for veterinarians due to the potential for carcinogenesis, reproductive disorders, cataracts, and hereditary genetic changes. This survey study aimed to identify the radiological protection practices routinely used by veterinarians who work with portable digital X-ray equipment in horses in Brazil and assess their knowledge regarding current legislation. A total of 120 voluntary participation questionnaires were sent to veterinarians who used portable digital radiographic equipment in horses nationwide. The frequencies of the answers were analyzed using the chi-square test and logistic regression models. Thirty-five veterinarians responded (29% response rate). Of these, there was a greater participation of professionals in public institutions (40%, 14/35, p<.001), with 69% from the southeast region (24/35, p<.001) and 69% (24/35, p=.028) being male. We found that self-employed veterinarians had a higher odds ratio (OR) (9.00; 95% confidence interval (CI) [1.39-58.44]; p=.021) of not using personal protective equipment compared with those in professional public institutions. In addition, not knowing the current legislation Collegiate Directorate Resolution 611/22 was a potential risk factor for lower radiological protection (OR, 8.00; 95% CI, [0.79-81.33]; p=0.079). In conclusion, findings indicated that Brazilian equine veterinarians generally do not adopt adequate radiological protection against ionizing radiation during radiographic examinations and have low knowledge of the current legislation. Results can be used as background for the formulation of specific radiation protection guidelines for veterinarians and incentive educational and training strategies to reduce risks inherent to occupational exposure.

Patient Radiation Doses Assessment at Diagnostic X-rays Department of King Khalid hospital (KKH)-Majmaah.

The study was conducted on patients who received diagnostic X-rays in King Khalid Hospital (KKH), Majmaah. The study included the seven most frequently performed investigations, which were carried out on over 1504 patients using digital radiography equipment. The X-ray tube's output and exposure parameters were used to calculate the effective dose (ED) and patient entry surface air kerma (ESAK). Additionally, based on these results, conversion coefficients were determined. This study also examined the 75th percentile distributions of ESAK and KAP. The findings of this research were compared with the findings of other researchers throughout the country and the world. The study presents the uncertainty U values, as well as the mean ESAK, KAP, and ED values. The results of the ESAK, KAP, and ED values were 0.12-5.74 mGy, 0.9-1.84 Gy cm2, and 0.01-0.23 mSv, respectively. As a result, the dosages were much lower than those previously published for the European DRL, national standards, and other studies. The study concludes that during dose surveys, the importance of detecting and comprehending radiation doses, as well as the proper technique for taking the finest photos possible, can be emphasized to patients in order to assist them in avoiding radioactive particles and radiation exposure.

Investigation of the usability of cone-beam computed tomography images using digital radiography equipment for boron neutron capture therapy treatment planning in the sitting position

In boron neutron capture therapy (BNCT), treatment planning images are acquired in the recumbent position. However, treatment is occasionally performed in the sitting position. For BNCT treatment planning, we investigated the usability of cone-beam computed tomography (CBCT) images using digital radiography equipment that allows imaging in the sitting position. The dose calculation results in both CBCT and fan beam CT were in good agreement. This method will eliminate the posture difference between planning and treatment.

Awareness and practice of dentomaxillofacial imaging among paediatric dentists: a questionnaire survey of members of the European Academy of Paediatric Dentistry.

Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics. An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher's exact test. Statistical significance was set at p < 0.05. More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient's movement (55%). The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

Dose Optimization and Image Quality in Digital Radiography: A Review Article

Imaging techniques have been upgraded due to the invention of digital radiography. This advancement has made a massive change in the development of diagnostic procedures. This technique has displaced conventional radiography with digital methods of radiography. This radiography technique was accepted in all kinds of radiography, excluding mammography. There are many assets of using a digital process for imaging, like good quality of image with less dose. It gave accurate diagnosis for assured quality of image with high resolution and to avoid overdose proper guidelines are needed. The technician should be well trained and have adequate knowledge of the appropriate use of digital radiography. The flat detector system depicts a more efficient way to form an image of high quality with a low dose; the quality of the image increases due to the storage phosphor. Many institutions have accepted this digital radiography as it has proven beneficial for diagnostic procedures. Digital radiography has a flat panel detector that results in a high-resolution image. It has been noticed that screen-film radiography has been superseded by Digital radiography. Nowadays, manufacturers have made many improvements derived from the detector and different technology to Digital radiography equipment. Due to digital imaging techniques, x-rays are allowed to store digitally that can use anytime by adjusting contrast according to the interest of vision. This technology has given assurity of not losing any radiograph and allows dispensing throughout hospitals digital by online technology derived from the web. There are so many assets of using digital radiography as it increases patient count. The vigorous high scale of the digital detector with as low as possible radiation dose for the proper usage of this technology, radiologists and radiographers should have adequate knowledge of various technical postulates &amp; image calibre. They should know how to tackle the problem of overexposure or radiation dose.

Rational and practical use of imaging in COVID-19 pneumonia.

The severe form of the COVID-19 pandemic caused by the SARS-CoV-2 virus, has largely manifested as a predominant respiratory illness causing severe pneumonia characterized by bilateral, subpleural ground glass haze, progressing to consolidation, and fibrosis on imaging. There is some discrepancy between the governmental guidelines, professional Societies and Radiology and Respiratory Medicine specialists with divided opinions between the use of the chest X-rays and CT scan, and whether the use be screening or diagnostic. So far, the most balanced recommendations have been proposed by the Fleischner Society, which are endorsed by the Radiological Society of Pakistan as well. This writeup describes the approach for a rational use of imaging to the best advantage in the current situation according to local resources, and restricting the spread of infection. The most practical compromise for Pakistan appears to be the use of portable digital radiography equipment, and point-of- care ultrasound; with CT scan reserved for clinical situations not explained by the above two modalities, or demanding disease stratification.

Quality Control Implementation on Digital Radiography Equipment at Fundación Valle Del Lili

Either national regulatory process or international accreditation process obligates the healthcare institutions to implement a quality control programs to the digital radiography equipment. These are made in order to assurance the high quality image and to reduce the unnecessary exposure doses on people. In radiology, a good diagnostic is related with the high quality of the image. In this research it is showed the results of 90 quality control tests performed on three different equipment located at Fundación Valle del Lili (FVL). These tests were particularly: physical location inspection, geometrical features, quality of the beam, automatic exposure control (AEC), quality image in digital systems, dose measurement systems, etc. Outcomes were compared with manufacturer’s reference values. A percentage of 92.23 % were found out in optimal conditions, this means 83 checks. The Dose Area Product (DAP) tests’ results are in a range between 5.57 to 2574.70 μGy*m2, which are reported in the literature. Those tests that not belong in the reference values, were subject to corrective actions and it is generated a feedback about the possible failures.

Current dorsal myelographic column and dural diameter reduction rules do not apply at the cervicothoracic junction in horses.

Previously published myelographic studies do not report findings at the junction between the seventh cervical (C7) and first thoracic vertebrae (T1). Modern digital radiographic equipment allows improved visualization of C7-T1. Based on clinical experience, we hypothesized that 50% reduction of the dorsal myelographic column or 20% reduction of the dural diameter, criteria commonly used as a supportive finding for spinal cord compression in the cervical vertebral column, do not apply at C7-T1. A myelographic study was performed on 12 healthy, neurologically normal horses. Our hypothesis was confirmed; using established criteria eight of 12 horses would have been classified as having evidence of spinal cord compression at C7-T1. The dorsal myelographic column reduction at C7-T1 was 48 ± 12%, while the C6-C7 dorsal myelographic column reduction was 33 ± 17% (mean ± standard deviation) (P=0.010). The dural diameter reduction at C7-T1 (22.0 ± 6.7%) was significantly greater than the dural diameter reduction at C6-C7 (13.2 ± 9.5%) (P=0.0007). Further measurements and comparisons suggested that the apparent greater reduction of dorsal myelographic column and dural diameter at C7-T1 was due to larger intravertebral measurements at C7 rather than smaller intervertebral values at C7-T1. Based on these findings, alternative criteria should be used at C7-T1 when assessing clinical cases for cervical stenotic myelopathy. Reduction of the dorsal myelographic column by 60% or of the dural diameter by 30% would avoid high numbers of false positive myelographic cases at C7-T1.

An option for optimising the radiographic technique for horizontal beam lateral (HBL) hip radiography when using digital X-ray equipment

Abstract Aim To investigate the optimum technique for the horizontal beam lateral (HBL) hip projection considering image quality and radiation dose. Methods Using digital radiography equipment an anthropomorphic phantom was positioned for a HBL projection of the hip. Radiographic exposures were undertaken across a range of acquisition parameters (tube potentials, source to image distances, object to detector distances, with and without an anti-scatter radiation grid/additional copper filtration). Each acquisition combination was imaged three times and the dose area product (DAP) and post-AEC mAs recorded. 168 images were acquired. A single observer evaluated five anatomical areas on all images using a two-alternative force choice technique. The reference image was selected based on the current locally accepted technique. 50 images out of the original 168 were independently assessed by a further four observers to ensure reliability of the results. Results Image quality, when comparing all the images to the reference, was improved on in two cases; however the radiation dose had increased. 18 images had equal image quality with some having an 80% reduction in the DAP. In terms of the diagnostic acceptability, 51 were considered acceptable with a lower radiation dose. Conclusion By optimising acquisition factors for the HBL hip projection the radiation dose to the patient can be reduced. Based on the findings the factors proposed for HBL hip projections are 90 kVp, 135 cm SID, 45 cm ODD, grid and 0.1 mm copper filtration.

WE‐G‐204‐08: Optimized Digital Radiographic Technique for Lost Surgical Devices/Needle Identification

Purpose:Small surgical devices and needles are used in many surgical procedures. Conventionally, an x‐ray film is taken to identify missing devices/needles if post procedure count is incorrect. There is no data to indicate smallest surgical devices/needles that can be identified with digital radiography (DR), and its optimized acquisition technique.Methods:In this study, the DR equipment used is a Canon RadPro mobile with CXDI‐70c wireless DR plate, and the same DR plate on a fixed Siemens Multix unit. Small surgical devices and needles tested include Rubber Shod, Bulldog, Fogarty Hydrogrip, and needles with sizes 3‐0 C‐T1 through 8‐0 BV175‐6. They are imaged with PMMA block phantoms with thickness of 2–8 inch, and an abdomen phantom. Various DR techniques are used. Images are reviewed on the portable x‐ray acquisition display, a clinical workstation, and a diagnostic workstation.Results:all small surgical devices and needles are visible in portable DR images with 2–8 inch of PMMA. However, when they are imaged with the abdomen phantom plus 2 inch of PMMA, needles smaller than 9.3 mm length can not be visualized at the optimized technique of 81 kV and 16 mAs. There is no significant difference in visualization with various techniques, or between mobile and fixed radiography unit. However, there is noticeable difference in visualizing the smallest needle on a diagnostic reading workstation compared to the acquisition display on a portable x‐ray unit.Conclusion:DR images should be reviewed on a diagnostic reading workstation. Using optimized DR techniques, the smallest needle that can be identified on all phantom studies is 9.3 mm. Sample DR images of various small surgical devices/needles available on diagnostic workstation for comparison may improve their identification. Further in vivo study is needed to confirm the optimized digital radiography technique for identification of lost small surgical devices and needles.

Radiographic Detectability of Retained Neuropatties in a Cadaver Model

Counts are the commonest method used to ensure that all sponges and neuropatties are removed from a surgical site before closure. When the count is not reconciled, plain radiographs of the operative site are taken to determine whether the missing patty has been left in the wound. The purpose of this study was to describe the detectability of commonly used neuropatties in the clinical setting using digital technologies. Neuropatties were implanted into the anterior and posterior cranial fossae and the thoracolumbar extradural space of a mature male cadaver. Four neuropatty sizes were used: 3× 1 in, 2× ½ in, ½× ½ in, and ¼× ¼ in. Neuropatties, with size and location chosen at random, were placed in the surgical sites and anteroposterior/posterior-anterior and lateral radiographs were taken using standard portable digital radiographic equipment. Six clinicians reviewed the digital images for the presence or absence of neuropatties. The readers were not aware of the number and size of the patties that were included in each image. The detectability of neuropatties is dependent on the size of the neuropatty's radiopaque marker and the operative site. Neuropatties measuring 2× ½ in and 3× 1 in were detected reliably regardless of the operative site. ¼× ¼ in neuropatties were poorly detected by neurosurgeons and radiologists in all three operative sites. Readers of various experience and background were similar in their ability to detect neuropatties under these conditions. Under simulated operating room conditions and using currently available neuropatties and plain radiograph imaging technology, small ¼-in and ½-in neuropatties are poorly visible/detectable on digital images.

Optimisation of radiological protocols for chest imaging using computed radiography and flat-panel X-ray detectors

Digital radiography technology has replaced conventional screen-film systems in many hospitals. Despite the different characteristics of new detector materials, frequently, the same radiological protocols previously optimised for screen film are still used with digital equipment without any critical review. This study addressed optimisation of exposure settings for chest examinations with digital systems, considering both image quality and patient dose. Images acquired with direct digital radiography equipment and a computed radiography system were analysed with specially developed commercial software with a four-alternative forced-choice method: the most promising protocols were then scored by two senior radiologists. Digital technology offers a wide dynamic range and the ability to postprocess images, allowing use of lower tube potentials in chest examinations. The computed radiography system showed both better image quality and lower dose at lower energies (85 kVp and 95 kVp) than those currently used (125 kVp). Direct digital radiography equipment confirmed both its superior image quality and lower dose requirements compared with the storage phosphor plate system. Generally, lowering tube potentials in chest examinations seems to allow better image quality/effective dose ratio when using digital equipment.

Pediatric digital radiography summit overview: state of confusion

On Feb. 4, 2010, the Alliance for Radiation Safety in Pediatric Radiology held a Pediatric Digital Radiography Summit. The goal was for radiologists, radiologic technologists, medical physicists, and vendor representatives, including engineers, medical physicists and education specialists, to discuss the challenges to achieving the ALARA (as low as reasonably achievable) principle in pediatric digital radiography and to lay the groundwork for overcoming these obstacles. This article focuses on the state of confusion that exists for radiologists and radiologic technologists who use digital radiography equipment. Radiologists might have a difficult time accepting lower dose (noisy images), and radiologic technologists might respond by increasing patient exposures, which results in excessive patient doses. For reporting exposures, vendors have a history of using proprietary terms that confuse users. In addition, technical parameters cannot be easily exported for quality assurance, and there is no national standard for digital radiography. Presentations in this minisymposium focus on suggestions for the cooperative development of new technical standards, education and training to improve the quality of digital radiography in pediatric patients and promote radiation protection for children.

Evolution of a Humanitarian Dental Mission to Madagascar from 1999 to 2008

In this article, we report on the evolution of a series of dental outreach missions sponsored by Stony Brook University to remote areas of Madagascar over a nine-year period. The project evolved from one dental resident performing only dental extractions in 1999 to a team comprised of two dentists, six third-year dental students, and two dental assistants performing dental restorations, extractions, and endodontic procedures using digital radiographic equipment in 2008. The ability during the latest mission to utilize digital radiography in remote areas lacking running water, electricity, and dental facilities significantly enhanced the range and efficacy of dental procedures. This long-term project offered senior dental students and residents from Stony Brook University's School of Dental Medicine an educationally valuable opportunity to engage in international dental outreach and to make a significant contribution to the improvement of oral health in the underserved rural communities of Madagascar.

A Service Robot for Subsea Flexible Risers

This article presents the development of a remotely operated vehicle (ROV) for the underwater inspection of subsea flexible riser, proposing effective solutions for the associated robotic manipulation system. Novel, underactuated end-effectors have been conceived and developed to firmly hold the robot on the riser during locomotion or operation, without affecting riser's integrity. By using these end-effectors, the robot is able to move along the riser, like an inchworm does, and rotate around the riser at any angle. In principle, the current design could operate up to 2,000 m sea depth with minor modifications. In this study, the service robot carries and deploys digital radiographic equipment for the volumetric inspection of flexible risers. Several preliminary tests, as well as a series of underwater tests, prove the robot's encouragingly positive performance.

Phantom Development for Constancy and Acceptance Test for Digital Radiographic Equipment

The development of specific phantoms to study the image obtained by computerized and direct digital radiographic equipment is the objective of this work to characterize the physical properties of the image chain. We have developed a specific phantom, named RACON, that is applied to an acceptance and constancy test to assess the image quality of digital radiographic equipment. This phantom has been designed with different test objects recommended by international and national associations (IEC-61223-2-9, RD 1976-1999) as low-contrast objects varying in diameter and size for threshold contrast resolution, a high-resolution test for the limiting spatial resolution, a dynamic step wedge for the dynamic range of the system, and a homogeneity zone and alignment marks for the position and size of the radiation field. Furthermore, we have developed specific software to analyze automatically and objectively the phantom images. The algorithms are based on digital image processing techniques, and they have been specifically designed for each test object in the phantom. The developed phantom is sensitive enough to the operating conditions of the radiographic digital system, and the automatic image evaluation allows the objective study of the global state of the image system.

Image Quality Assessment of Digital Dental Radiography Systems with Specifically Developed Phantom and Software

The purpose of this work is to assess the image quality of dental digital systems with computed radiography (phosphor plate) and direct radiography (charge-coupled-device sensor), by developing a specific dental phantom named RADEN and software to analyze the phantom image automatically. The phantom developed to evaluate the image quality of dental radiographic equipment has specific test objects of contrast-detail combinations appropriated for the resolution of the dental digital systems. The image quality is evaluated by using contrast-detail curves and an image quality index. The phantom was made of a square aluminum block 7.5 × 7.5 cm that has a lodge of size 3.2 × 3.2 cm for fixing the sensor of the digital dental system, and it contains specific test objects of contrast-detail combinations that are cylindrical holes. The diameters of the holes ranged from 0.3 to 1.6 mm, and the depths ranged from 0.14 to 1.28 mm; these ranges for the diameters and depths are suitable for resolution of the dental digital systems and the contrast attenuation curves of the X-radiation, and the results are sensitive to the operating conditions of the dental radiographic system.We have also developed specific software to analyze the RADEN phantom image automatically obtained by the digital radiographic equipment. The algorithms are based on digital image processing techniques, and they have been implemented in a user-friendly tool with a graphical interface.

In Practice: How Going Digital Will Affect the Dental Office

The impact of digital imaging on dental practice depends upon the degree of planning conducted before implementation. Digital technologies have the potential to improve diagnosis; facilitate patient treatment procedures; and streamline storage, transfer and retrieval. These technologies also provide for secure backup of patients' image data, critical to re-establishing the practice should fire, flood or earthquake occur. The decision to invest in digital radiographic equipment should be a simple one for dental practitioners. Although digital x-ray sensors have long equaled analog film for diagnostic tasks, they have several advantages over film radiography, including immediate image production with solid-state devices; interactive display on a monitor with the ability to enhance image features and make direct measurements; integrated storage with access to images through practice management software systems; security of available backup and off-site archiving; perfect radiographic duplicates to accompany referrals; security mechanisms to identify original images and differentiate them from altered images; the ability to tag information such as a patient identifier, date of exposure and other relevant details; and interoperability of the Digital Imaging and Communications in Medicine file format. Most clinicians should contemplate integrating, at a minimum, intraoral digital x-ray sensors and a digital panoramic system into their practices.

Comparison of radiation doses to patients undergoing standard radiographic examinations with conventional screen–film radiography, computed radiography and direct digital radiography

New flat-panel direct digital radiography equipment has recently been installed in our Accident and Emergency Department; its characteristics and versatility are well suited to the work undertaken in this environment. The aim of this study was to compare radiation doses to patients undergoing standard radiographic examinations using conventional screen-film radiography, computed radiography and direct digital radiography; entrance surface dose and effective dose were calculated for six standard examinations (a total of 10 projections) using standard patient exposure parameters for the three imaging modalities. It was found that doses for computed radiography (all examinations) were higher than the doses for the other two modalities; effective doses for direct digital radiography were approximately 29% and approximately 43% lower than those for screen-film radiography and computed radiography, respectively. The image quality met the criteria in the European guidelines for all modalities.