Entrance Surface Air Kerma Research Articles

Measurements of pediatric radiation exposure during barium imaging procedures

Radiological imaging has been considered a vital tool in the diagnosis of gastrointestinal tract (GIT) disorders. Gastrointestinal radiography (GIR) has been a major and first-choice method for diagnosing GIT diseases with barium as contrast media since its emergence in 1910. Radiographic examination of children, especially neonates, attracts particular interest because of the increased opportunity for expression of delayed radiogenic cancers as a consequence of relative longer life expectancy. Barium studies are of particular interest because it constitutes 5% of the total number of radiological examinations and 17% of the collective doses. Although, the task is important, there are few data on radiation doses to infants and children undergoing barium procedures. The current study intends to evaluate the radiation dose to pediatric patients during barium studies and to estimate the effective doses and radiation risk of the aforementioned procedures. A total of 43 pediatric barium procedures were performed in this study. 21.7% of the sample was barium meal, 8.6% were undergone barium swallow while 69.5% of the sample were barium enemas. Entrance surface air kerma (ESAKs) were calculated from patient exposure parameters using DosCal software. Effective doses (E) were calculated using published conversion factors and methods recommended by the national Radiological Protection Board (NRPB). The mean film numbers was 12.4, 8.9 and 8 for barium meal, barium enema and barium swallow, respectively. The maximum number of X rays was obtained in barium meal (21 film per a single procedure). The mean patient doses per procedure were 2.1 ± 0.8 mGy, 3.0 ± 23 mGy and 1.2 ± 0.2 mGy for barium meal, swallow and enema, respectively. The mean effective doses were 0.3 mSv, 1.0 mSv and 0.2 mSv at the same order. The dose values in this study were higher than previous studies. The unnecessary radiation exposure can be reduced significantly by reducing the number of films and screening time. Diagnostic reference level is recommended to improve the practice. Disclosure Authors have nothing to disclose.

Assessment of the mean glandular dose using LiF:Mg,Ti, LiF:Mg,Cu,P, Li2B4O7:Mn and Li2B4O7:Cu TL detectors in mammography radiation fields

The aim of this paper is the characterization of four thermoluminescence detectors (TLD), namely, LiF:Mg,Ti, LiF:Mg,Cu,P, Li2B4O7:Mn and Li2B4O7:Cu for the measurement of the entrance surface air kerma (ESAK) and estimation of the mean glandular dose (MGD) in digital mammography examinations at hospitals and clinics. Low-energy x-ray beams in the typical energy ranges of mammography, produced with a tungsten target and additional 60 µm molybdenum filtration were implemented and characterized at the Laboratory of Metrology of Ionizing Radiation at Instituto Superior Técnico. These beams were used for the characterization of the TLDs in terms of sensitivity, linearity, reproducibility, energy dependence and fading at 40 °C. The energy dependence test was further extended using clinical beams produced by mammography units at hospitals and clinics. The method proposed by the International Atomic Energy Agency was used for the measurement of ESAK and assessment of MGD. The combined standard uncertainty for the measurement of ESAK (and MGD) was determined in accordance to the Guide to the expression of uncertainty in measurement. The x-ray beams generated in the 23–40 kVp range presented HVL values from 0.36 to 0.46 mm Al. The beam produced at 28 kVp (HVL 0.39 mm Al) was considered as reference. The radiation field defined a circle with 84 mm diameter with a maximum variation of the beam intensity of less than 1% at the top flat (plateau) within 4 cm of the central axis. The estimated total uncertainty for the measurement of air kerma was 0.42%. All the TL detectors tested showed good performance except the commercial Li2B4O7:Mn (or TLD-800) which was excluded due to its poor sensitivity in our experimental set up. Both lithium fluorides showed better linearity and reproducibility as well as lower energy dependence and fading when compared to lithium borates. The stable behaviour of LiF:Mg,Ti and LiF:Mg,Cu,P detectors is reflected in the low combined standard uncertainty of ±5.6% and ±4.3% respectively (or ±5.1% and ±3.6% if fading is neglected). In general a total combined uncertainty lower than ±10% for the measurement of ESAK was obtained for the four TL materials studied.

Image quality and dose differences caused by vendor-specific image processing of neonatal radiographs.

Image processing plays an important role in optimizing image quality and radiation dose in projection radiography. Unfortunately commercial algorithms are black boxes that are often left at or near vendor default settings rather than being optimized. We hypothesize that different commercial image-processing systems, when left at or near default settings, create significant differences in image quality. We further hypothesize that image-quality differences can be exploited to produce images of equivalent quality but lower radiation dose. We used a portable radiography system to acquire images on a neonatal chest phantom and recorded the entrance surface air kerma (ESAK). We applied two image-processing systems (Optima XR220amx, by GE Healthcare, Waukesha, WI; and MUSICA(2) by Agfa HealthCare, Mortsel, Belgium) to the images. Seven observers (attending pediatric radiologists and radiology residents) independently assessed image quality using two methods: rating and matching. Image-quality ratings were independently assessed by each observer on a 10-point scale. Matching consisted of each observer matching GE-processed images and Agfa-processed images with equivalent image quality. A total of 210 rating tasks and 42 matching tasks were performed and effective dose was estimated. Median Agfa-processed image-quality ratings were higher than GE-processed ratings. Non-diagnostic ratings were seen over a wider range of doses for GE-processed images than for Agfa-processed images. During matching tasks, observers matched image quality between GE-processed images and Agfa-processed images acquired at a lower effective dose (11 ± 9μSv; P < 0.0001). Image-processing methods significantly impact perceived image quality. These image-quality differences can be exploited to alter protocols and produce images of equivalent image quality but lower doses. Those purchasing projection radiography systems or third-party image-processing software should be aware that image processing can significantly impact image quality when settings are left near default values.

Biplane interventional pediatric system with cone-beam CT: dose and image quality characterization for the default protocols.

The aim of this study was to assess image quality and radiation dose of a biplane angiographic system with cone‐beam CT (CBCT) capability tuned for pediatric cardiac procedures. The results of this study can be used to explore dose reduction techniques. For pulsed fluoroscopy and cine modes, polymethyl methacrylate phantoms of various thicknesses and a Leeds TOR 18‐FG test object were employed. Various fields of view (FOV) were selected. For CBCT, the study employed head and body dose phantoms, Catphan 504, and an anthropomorphic cardiology phantom. The study also compared two 3D rotational angiography protocols. The entrance surface air kerma per frame increases by a factor of 3–12 when comparing cine and fluoroscopy frames. The biggest difference in the signal‐to‐noise ratio between fluoroscopy and cine modes occurs at FOV 32 cm because fluoroscopy is acquired at a 1440×1440 pixel matrix size and in unbinned mode, whereas cine is acquired at 720×720 pixels and in binned mode. The high‐contrast spatial resolution of cine is better than that of fluoroscopy, except for FOV 32 cm, because fluoroscopy mode with 32 cm FOV is unbinned. Acquiring CBCT series with a 16 cm head phantom using the standard dose protocol results in a threefold dose increase compared with the low‐dose protocol. Although the amount of noise present in the images acquired with the low‐dose protocol is much higher than that obtained with the standard mode, the images present better spatial resolution. A 1 mm diameter rod with 250 Hounsfield units can be distinguished in reconstructed images with an 8 mm slice width. Pediatric‐specific protocols provide lower doses while maintaining sufficient image quality. The system offers a novel 3D imaging mode. The acquisition of CBCT images results in increased doses administered to the patients, but also provides further diagnostic information contained in the volumetric images. The assessed CBCT protocols provide images that are noisy, but with very good spatial resolution.PACS number(s): 87.59.‐e, 87.59.‐C, 87.59.‐cf, 87.59.Dj, 87.57. uq

Implementation of a patient dose monitoring system in conventional digital X-ray imaging: initial experiences.

The purpose was to report on the initial experience after implementation of a patient dose-monitoring system in conventional X-ray imaging. A dose-monitoring system collected dose data relating to different radiographs (one projection) and studies (two or more projections). Images were acquired on digital X-ray systems equipped with flat-panel detectors. During period 1, examinations were performed in a routine fashion in 12,614 patients. After period 1, technical modifications were performed and radiographers underwent training in radiation protection. During period 2, examinations were performed in 14,514 patients, and the radiographers were advised to read dose data after each radiograph/study. Dose data were compared by means of kerma area product (KAP, gray × centimetre squared) and entrance surface air kerma (ESAK, milligray). During period 1, 13,955 radiographs and 8,466 studies were performed, and in period 2 16,090 radiographs and 10,389 studies. In period 2, KAP values for radiographs were an average of 25% lower and for studies 7% lower, and ESAK values for radiographs were 24% lower and for studies 5% lower. The reduction in KAP was significant in 8/13 radiographs and in 6/14 studies, and the reduction in ESAK was significant in 6/13 radiographs and 5/14 studies. Implementation of a patient dose-monitoring system in conventional X-ray imaging allows easy data collection, supports dose reduction efforts, and may increase radiographers' dose awareness. • A dose-monitoring system enables easy dose data collection in X-ray imaging. • The system facilitates dose reduction efforts and may increase radiographers' radiation awareness. • Mean kerma-area-product significantly declined in period 2 in 8/13 radiographs and 6/14 studies. • In ESAK a significant decline was evident in 6/13 radiographs and 5/14 studies.

Benchmarking the performance of fixed-image receptor digital radiography systems. Part 2: system performance metric.

This is part two of a two-part study in benchmarking system performance of fixed digital radiographic systems. The study compares the system performance of seven fixed digital radiography systems based on quantitative metrics like modulation transfer function (sMTF), normalised noise power spectrum (sNNPS), detective quantum efficiency (sDQE) and entrance surface air kerma (ESAK). It was found that the most efficient image receptors (greatest sDQE) were not necessarily operating at the lowest ESAK. In part one of this study, sMTF is shown to depend on system configuration while sNNPS is shown to be relatively consistent across systems. Systems are ranked on their signal-to-noise ratio efficiency (sDQE) and their ESAK. Systems using the same equipment configuration do not necessarily have the same system performance. This implies radiographic practice at the site will have an impact on the overall system performance. In general, systems are more dose efficient at low dose settings.

Operator eye doses during computed tomography fluoroscopic lung biopsy

The aim of this work was to examine the peak entrance surface air kerma (peak ESAK) to the eyes during CT fluoroscopy lung biopsy, and the impact of lead glasses, exposure parameters, head rotation, and height on peak ESAK to the eyes.Two phantoms simulating the patient and radiologist were used, and 108 exposures were made using a 16-slice Toshiba Alexion CT scanner (Toshiba Medical Systems, Nasu, Japan). ESAK to the phantom radiologist’s right eye was measured using an Unfors Xi dosimeter (RaySafe, Billdal, Sweden) with and without lead glasses at two kilovoltages (120 kVp and 135 kVp) and three milliampere settings (10 mA, 20 mA, and 30 mA. A paired t test was used to compare peak ESAK to the eye at different angles, heights, and kVp and mA with and without lead glasses.Peak ESAK was higher without compared to with lead glasses (p ⩽ 0.001). The peak ESAK to the eyes increased as the phantom radiologist rotated toward the gantry without lead glasses, from 2.42 μGy at 120° to 10.54 μGy at 30° (p = 0.001). No significant difference was noted in peak ESAK with change in phantom radiologist height (p > 0.05). An increase from 120 kVp to 135 kVp resulted in 23% and 26% increases in peak ESAK with and without lead glasses respectively (p = 0.001). An increase of tube current from 10 mA to 20 mA almost doubled peak ESAK (p = 0.005).Findings demonstrate that lead glasses reduce ESAK to the eyes, and that increased kVp, mA, and eye rotation to the gantry increase ESAK to the eyes.

Dosimetric evaluation of X-ray examinations of paranasal sinuses in pediatric patients.

ObjectiveTo estimate the entrance surface air kerma (Ka,e) and air kerma in the region of radiosensitive organs in radiographs of pediatric paranasal sinuses.Materials and MethodsPatient data and irradiation parameters were collected in examinations of the paranasal sinuses in children from 0 to 15 years of age at two children's hospitals in the city of Recife, PE, Brazil. We estimated the Ka,e using the X-ray tube outputs and selected parameters. To estimate the air kerma values in the regions of the eyes and thyroid, we used thermoluminescent dosimeters.ResultsThe Ka,e values ranged from 0.065 to 1.446 mGy in cavum radiographs, from 0.104 to 7.298 mGy in Caldwell views, and from 0.113 to 7.824 mGy in Waters views. Air kerma values in the region of the eyes ranged from 0.001 to 0.968 mGy in cavum radiographs and from 0.011 to 0.422 mGy in Caldwell and Waters views . In the thyroid region, air kerma values ranged from 0.005 to 0.932 mGy in cavum radiographs and from 0.002 to 0.972 mGy in Caldwell and Waters views.ConclusionThe radiation levels used at the institutions under study were higher than those recommended in international protocols. We recommend that interventions be initiated in order to reduce patient exposure to radiation and therefore the risks associated with radiological examination of the paranasal sinuses.

Radiation exposure in pediatric patients during micturating cystourethrography procedures

The objectives of this study were to measure the entrance surface air kerma (ESAK) and the effective doses in pediatric patients undergoing micturating cystourethrography (MCU) procedures. The ESAK was determined using calibrated thermoluminescent dosimeters (TLD- GR 200 A) in 167 pediatric patients. The patient population was categorized into three groups according to age (0–5 years (group 1), 6–10 years (group 2) and 11–15 years (group 3)). The mean ESAK±SD and range (mGy) resulting from a MCU procedure was estimated to be 2.2±0.5 (0.8–9.2), 2.48±0.6 (0.9–8.1) and 3.90±0.6 (1.1–10.3) for group 1, 2 and 3, respectively. The mean effective dose was between 0.03 and 0.4 mSv per procedure for the pediatric population. Pediatric patients were exposed to avoidable radiation doses because no gonad shields were used.

Assessment of patient dose and radiogenic risks during endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive technique that has been used for over 30 years in the diagnosis and management of pancreaticobiliary disorders. The objectives of this study were to evaluate the patient entrance surface air kerma doses (ESAK) and estimate the organ and effective doses during ERCP in three hospitals in Khartoum. A total of 55 patients were examined in three hospitals in Khartoum state, Sudan. Calibrated thermoluinescent dosimeters (TLD) were used to measure patients' ESAK. Organ and effective doses were estimated using National Radiological Protection Board (NRPB) software. The overall mean of ESAK for all ERCP procedures was 42.4mGy. The mean patient ESAK in Fedail (A), Soba (B) and Ibn sena (C) hospitals were 26.7mGy, 26.0mGy and 72.4mGy, respectively. The effective doses in three hospitals were 1.60, 1.56 and 2.67mSv in that order and the overall mean effective dose was 1.94mSv. Patient radiation doses vary widely among the hospitals. Patient ESAK is low compared to previous studies in the light of the current practice. Patient dose was decreased significantly in the last two decades.

Effect of filter on average glandular dose and image quality in digital mammography

To determine the average glandular dose and entrance surface air kerma in both phantoms and patients to assess image quality for different target-filters (W/Rh and W/Ag) in digital mammography system. The compressed breast thickness, compression force, average glandular dose, entrance surface air kerma, peak kilovoltage and tube current time were recorded and compared between W/Rh and W/Ag target filter. The CNR and the figure of merit were used to determine the effect of target filter on image quality. The mean AGD of the W/Rh target filter was 1.75 mGy, the mean ESAK was 6.67 mGy, the mean CBT was 54.1 mm, the mean CF was 14 1bs. The mean AGD of W/Ag target filter was 2.7 mGy, the mean ESAK was 12.6 mGy, the mean CBT was 75.5 mm, the mean CF was 15 1bs. In phantom study, the AGD was 1.2 mGy at 4 cm, 3.3 mGy at 6 cm and 3.83 mGy at 7 cm thickness. The FOM was 24.6, CNR was 9.02 at thickness 6 cm. The FOM was 18.4, CNR was 8.6 at thickness 7 cm. The AGD from Digital Mammogram system with W/Rh of thinner CBT was lower than the AGD from W/Ag target filter.

Determination of effective doses in image-guided radiation therapy system

The organ and effective doses in image-guided radiotherapy system are determined in this study. For 2D imaging, incident air kerma (Ki) was measured by 6cc ionization chamber with Accu-Pro dosimeter. The entrance surface air kerma (ESAK) was calculated by multiplying Ki with backscatter factor. The effective dose was calculated by multiplying ESAK with conversion coefficient. For 3D imaging, computed tomography/cone-beam dose index (CTDI/CBDI) measurements were performed by using 100mm pencil ionization chamber with Accu-Pro dosimeter. The dose index in air and in CTDI phantom from planning CT and cone- beam CT were measured. Then, effective dose was calculated by ImPACT software. The effective doses from 2D conventional simulator for anteroposterior and lateral projections were 01 and 0.02mSv for head, 0.15 and 0.16mSv for thorax, 0.22 and 0.21mSv for pelvis, respectively. The effective doses from 3D, planning CT and CBCT, were 3.3 and 0.1mSv for head, 13 and 2.4mSv for thorax and 7.2 and 4.9mSv for pelvis, respectively. Based on 30 fractions of treatment course, total effective dose (3D CT, 2D setup verification and 6 times CBCT) of head, thorax and pelvis were 3.93, 27.71 and 37.03mSv, respectively. Therefore, IGRT should be administered with significant parameters to reduce the dose.

Reducing radiation dose by application of optimized low-energy x-ray filters to K-edge imaging with a photon counting detector

K-edge imaging with photon counting x-ray detectors (PCXDs) can improve image quality compared with conventional energy integrating detectors. However, low-energy x-ray photons below the K-edge absorption energy of a target material do not contribute to image formation in the K-edge imaging and are likely to be completely absorbed by an object. In this study, we applied x-ray filters to the K-edge imaging with a PCXD based on cadmium zinc telluride for reducing radiation dose induced by low-energy x-ray photons. We used aluminum (Al) filters with different thicknesses as the low-energy x-ray filters and implemented the iodine K-edge imaging with an energy bin of 34–48 keV at the tube voltages of 50, 70 and 90 kVp. The effects of the low-energy x-ray filters on the K-edge imaging were investigated with respect to signal-difference-to-noise ratio (SDNR), entrance surface air kerma (ESAK) and figure of merit (FOM). The highest value of SDNR was observed in the K-edge imaging with a 2 mm Al filter, and the SDNR decreased as a function of the filter thicknesses. Compared to the K-edge imaging with a 2 mm Al filter, the ESAK was reduced by 66%, 48% and 39% in the K-edge imaging with a 12 mm Al filter for 50 kVp, 70 kVp and 90 kVp, respectively. The FOM values, which took into account the ESAK and SDNR, were maximized for 8, 6 to 8 and 4 mm Al filters at 50 kVp, 70 kVp and 90 kVp, respectively. We concluded that the use of an optimal low-energy filter thickness, which was determined by maximizing the FOM, could significantly reduce radiation dose while maintaining image quality in the K-edge imaging with the PCXD.

Assessment of ESAK and ED for Adult’s Patients Examined by Computed Radiography

This study designed to evaluate the entrance surface air kerma (ESAK) to the patient during X-ray examination to the skull antero-posterior (AP), skull Lateral (LAT), chest postero-anterior (PA), Lumber spine AP/LAT and Pelvis AP. Totally, 408 patients were included in this study using computed radiography (CR) in different three hospitals in Khartoum; five X-ray machines were covered. The entrance surface air kerma (ESAK) was calculated for each patient from the exposure parameters using different peak tube voltages. Patient’s data such as (age and weight) and exposure parameters (kVp) and (mAs) were recorded. The result obtained showed that, the entrance surface air kerma ranged from 0.88 to 3.30 mGy for Skull (AP), 0.588 to 1.87 mGy for skull (LAT), 0.03 to 2 mGy for chest PA, 1.50 to 3.40 mGy Lumbar spine AP, 2.60 to 5.15 mGy for Lumbar spine (LAT), and 1.05 to 4.40 mGy for Pelvis. This study provides additional data that can help the regulatory authority to establish reference dose level for diagnostic radiology in Sudan. This study recommends that the CR operator must be used to optimize the patient dose by using the best strategies available for reducing radiation dose. Computed radiography must be used with high level training for medical staff to reduce the dose; each radiology department should implement a patient dose measurement quality assurance programme. Doses to the patients should be regularly monitored and the proposed national DRLs should be taken as guidance for optimization.

Patient dose measurement in common medical X‐ray examinations in Iran

The main purpose of this study was to investigate patient dose in the chest (PA/AP/LAT) and skull (PA/AP/LAT) X‐ray examinations, as frequent procedures. The study was performed in eight public hospitals of Khuzestan province, Iran. Patient dosimetry was conducted on 567 standard patient X‐ray examinations (males: 61.2%, female: 38.2%). Dosimetry protocol in this study was indirect method, according to the International Atomic Energy Agency (IAEA) Technical Reports series No. 457. Patients weighing 70±10 kg were considered as standard. In the indirect dosimetry approach, exposure parameters such as kVp, mAs, focal film distance (FFD), and tube outputs recorded during data acquisition were used for calculating incident air kerma on the patient's skin, entrance surface air kerma (ESAK) that is recommended by the IAEA as the most appropriate patient dosimetry quantity in simple radiographic examinations. This survey reveals significant variations in the radiological practice. Results showed that the parameters set by radiologic technologists change in a wide range: mAs varied from 2 to 80 for skull PA, 2 to 202 for chest LAT, and FFD varied from 50 to 180 for skull LAT projection. The study showed that patient doses in three chest projections exceed the IAEA and European Commission dose reference levels (EC DRLs) — 1.0, 1.12, and 2.20 mGy for chest PA, chest AP, and chest LAT, respectively. Results also showed that mean ESAKs of patients in skull projections were generally lower than the IAEA and EC DRLs, 1.5, 1.72, and 2.25 for skull LAT, skull AP, and skull PA, respectively. This study provides evidence that dose reduction in the simple X‐ray examinations is feasible by updating clinical audits and implementation of systematic quality assurance (QA) and quality control (QC) programs. The authors recommend that DRLs obtained in this study can be used as local DRLs in Khuzestan area and dose surveys must be performed in all provinces to establish national dose reference levels (NDRLs) in Iran.PACS numbers: 87.53.Bn, 87.57.uq, 87.59.B

Patient and staff doses in paediatric interventional cardiology derived from experimental measurements with phantoms

The aim of this paper was to determine experimentally the entrance surface air kerma (ESAK) and kerma-area product (KAP) levels to patients and scatter doses at the cardiologist's eyes during paediatric interventional cardiology (IC) procedures for Chile, on the basis of measurements taken from X-ray systems characterization for different thicknesses of polymethyl methacrylate, together with the average values of fluoroscopy time and number of cine frames for ten paediatric IC procedures. The range of cumulative ESAK values when the different clinical procedures were simulated was from 2 to 1100 mGy. KAP values ranged from 0.30 to 150 Gy cm2. Scatter doses at cardiologist's eyes for the simulated procedures ranged from 0.20 to 116 µSv per procedure. Large differences between the X-ray systems were found in our study. Standardized guidelines in terms of X-ray system setting and protocols should be developed for hospitals that perform paediatric IC procedures in Chile.

VERIFICATION OF INDICATED SKIN ENTRANCE AIR KERMA FOR CARDIAC X-RAY-GUIDED INTERVENTION USING GAFCHROMIC FILM

The aim of this work was to verify the indicated maximum entrance surface air kerma (ESAK) using a GE Innova IGS 520 imaging system during cardiac interventional procedures. Gafchromic XR RV3 films were used for the patient measurements to monitor the maximum ESAK. The films were scanned and calibrated to measure maximum ESAK. Thermoluminescent dosemeters were used to measure the backscatter factor from an anthropomorphic thorax phantom. The measured backscatter factor, 1.53, was in good agreement with Monte Carlo simulations but higher than the one used by the imaging system, 1.20. The median of the ratio between indicated maximum ESAK and measured maximum ESAK was 0.68. In this work, the indicated maximum ESAK by the imaging system's dose map model underestimates the measured maximum ESAK by 32 %. The threshold ESAK for follow-up procedures for patient with skin dose in excess of 2 Gy will be reduced to 1.4 Gy.

Objective criteria for acceptability and constancy tests of digital subtraction angiography

PurposeDemonstrate an objective procedure to quantify image quality in digital subtraction angiography (DSA) and suggest thresholds for acceptability and constancy tests. MethodsSeries of images were obtained in a DSA system simulating a small (paediatric) and a large patient using the dynamic phantom described in the IEC and DIN standards for acceptance tests of DSA equipment. Image quality was quantified using measurements of contrast-to-noise ratio (CNR). Overall scores combining the CNR of 10–100 mg/ml Iodine at a vascular diameter of 1–4 mm in a homogeneous background were defined. Phantom entrance surface air kerma (Ka,e) was measured with an ionisation chamber. ResultsThe visibility of a low-contrast vessel in DSA images has been identified with a CNR value of 0.50 ± 0.03. Despite using 14 times more Ka,e (8.85 vs 0.63 mGy/image), the protocol for large patients showed a decrease in the overall score CNRsum of 67% (4.21 ± 0.06 vs 2.10 ± 0.05). The uncertainty in the results of the objective method was below 5%. ConclusionObjective evaluation of DSA images using CNR is feasible with dedicated phantom measurements. An objective methodology has been suggested for acceptance tests compliant with the IEC/DIN standards. The defined overall scores can serve to fix a reproducible baseline for constancy tests, as well as to study the device stability within one acquisition series and compare different imaging protocols. This work provides aspects that have not been included in the recent European guidelines on Criteria for Acceptability of Medical Radiological Equipment.

Measuring skin dose in CT examinations under complex geometries: Instruments, methods and considerations

ObjectiveTo investigate skin dose in Computed Tomography (CT) and its dependence on scanning geometry. Materials and methodsMeasurements of entrance surface air kerma (ESAK) in free air and entrance skin dose (ESD) on an anthropomorphic phantom were performed in a 64-slice CT scanner, using two different instruments: the Dose Profiler (DP) and the QED skin diode (QEDSD). Using DP and QEDSD, the ESAK rate profiles at the isocenter and at different distances from it, were measured using axial scans. Using DP and helical scans the ESAK rate profile in the Z-axis was acquired. The same profile was acquired with the QEDSD also, using many axial scans and manual table translation. ESD measurements were performed with the DP and QEDSD, in axial and helical scan mode. ResultsESAK measurements with DP and QEDSD were in good agreement, for both point dose and profile measurements. The agreement was also good for ESD measurements but not for helical scans, due to variable X-ray beam overlapping and different tube angular positions at each scan start. It was observed that the ESD values at different Y-axis offsets were comparable to the respective ESAK values recorded at the same Y-axis offset distances without the phantom. ConclusionsBoth DP and QEDSD were proven suitable for performing point ESD measurements. However, calculating the skin dose distribution in CT examinations is a very challenging task. A practical approach would be for CT scanners to provide a conservative estimate of the peak skin dose using the isocenter ESAK value.

Assessment of patient dose and optimization levels in chest and abdomen CR examinations at referral hospitals in Tanzania.

The aim of this study was to evaluate the radiation doses to patient during chest and abdomen CR examinations, and assess the related level of optimization at five referral hospitals in Tanzania. The international code of practice for dosimetry in diagnostic radiology was applied to determine the entrance surface air kerma (ESAK) to patients. The level of optimization was assessed from low‐contrast objects scores of phantom images at different exposures. The results show that mean ESAK varied from 0.16 to 0.37 mGy for chest PA and from 2 to 6 mGy for abdomen AP. Assuming similar patient and phantom attenuations, the optimization performed at all facilities was consistent with phantom evaluations in terms of tube potential settings in use. However, all facilities seemed to operate at higher tube load values above 5 mAs for chest examination, which can lead to unnecessary patient doses. Inadequate initial training on CR technology explains in large proportion the inappropriate use of exposure parameters.PACS numbers: 87.50.up, 87.59bd