Dose-reducing strategies in combination offers substantial potential benefits to females requiring X-ray examination

Abstract

This work, using an adult anthropomorphic phantom, aimed to establish an optimised technique for ladies of child-bearing age undergoing antero-posterior (AP) pelvis and AP and lateral lumbar spine examinations. Phase one of the work involved introducing the following dose-reducing measures individually: increased kVp, increased focus-film distances, a carbon fibre cassette, a faster film/screen combination. The second phase established an optimised technique based on a combination of the parameters listed above. Radiation dose was measured using thermoluminescent dosimeters and image quality was evaluated using anatomical criteria. All dose-reducing methods were compared with a standard technique, currently being used in a Dublin hospital. The results demonstrated that the optimised procedure reduced effective dose by 77, 62 and 66% for AP pelvis and AP and lateral lumbar spine respectively (p < 0.05) compared with the standard technique, with no significant changes in image quality. Dose-reducing measures used in combination offer substantial potential for optimisation of radiological procedures.

Patient‐based radiographic exposure factor selection: a systematic review

“…A well‐defined system of exposure adaptation is required to allow accurate exposure selection for a variety of patients. Some research has gone into finding optimal exposure parameter settings for the ‘average patient’ . However, the patients that radiographers encounter will deviate from the ‘average’ and exposures will need to be adjusted accordingly.…”

“…Some research has gone into finding optimal exposure parameter settings for the 'average patient'. 11,12 However, the patients that radiographers encounter will deviate from the 'average' and exposures will need to be adjusted accordingly. The aim of the following review is to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems.…”

Reducing Dose for Digital Cranial Radiography: The Increased Source to the Image-receptor Distance Approach

“…Uffmann and SchaeferProkop [4] maintain that throughout the transition from film screen to digital technology in the clinical environment many of the examination parameters such as tube current (mA), tube voltage (kVp), and filtration were translated directly from film screen exposures to computed radiography and direct digital radiography (dDR) without appropriate radiographic adjustment [4]. A review of the available optimization techniques is required so that the evidence base for optimized radiographic practice is increased and ongoing dose reductions with digital acquisition devices are achieved [5]. One such optimization technique is increasing the source to image-receptor distance (SID) for x-ray examinations within direct digital radiography.…”

“…Previous work established that increasing the SID had the advantage of being a low-cost method of dose reduction that did not negatively impact patient comfort or image quality [8]. However, a review of the literature revealed that the research does not cover a broad range of radiographic examinations; seven studies researched anterior-posterior (AP) pelvis examinations [5,[8][9][10][11][12][13], four studies researched AP and lateral lumbar spine examinations [5,6,11,12], one study researched AP abdomen examinations [12], and one study researched AP knee examinations [7]. In addition, the level of effective dose reduction varied among authors, ranging from 8.1% for computer-simulated calculations [14] to a maximum of 44% for patient studies [6].…”

“…Evidence shows that increasing the SID from 100 to 130 cm can optimize lumbar spine, pelvic, abdominal, and lower-extremity examinations [5][6][7][8][9][10][11][12][13] although no literature is currently found for patient and/or phantom use of an increased SID for skull examination. Poletti and McLean [14] produced Monte Carlo calculations and showed that increasing the SID to 200 cm resulted in a reduction in the effective dose of 35.4% for postero-anterior (PA) skull projection and 34.3% for lateral skull projection when the collimation borders were simulated to the outer surface of the skull at each SID.…”