Radiation doses and detriment from chest x-ray examinations

Dosimetry on first clinical dark-field chest radiography

PURPOSE

The purpose of this study was to evaluate the dose characteristic for patient examinations at the first clinical X-ray dark-field chest radiography system and to determine whether the effective patient dose is within a clinically acceptable dose range.

METHODS

A clinical setup for grating-based dark-field chest radiography was constructed and commissioned, operating at a tube voltage of 70 kVp. Thermoluminescent dosimeter (TLD) measurements were conducted using an anthropomorphic phantom modeling the reference person to obtain a conversion coefficient relating dose area product (DAP) to effective patient dose at the dark-field system. For 92 patients, the DAP values for posterior-anterior measurements were collected at the dark-field system. Using the previously determined conversion coefficient, the effective dose was calculated.

RESULTS

A reference person, modeled by an anthropomorphic phantom, receives an effective dose of 35 µSv. For the examined patients, a mean effective dose of 39 µSv was found.

CONCLUSIONS

The effective dose at the clinical dark-field radiography system, generating both attenuation and dark-field images, is within the range of reported standard dose values for chest radiography.

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

PURPOSE

Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods.

METHODS

A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definium 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDIvol and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report.

RESULTS

The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics only increased slightly for radiographic modalities and for chest tomosynthesis. Effective and organ doses normalized to mAs all illustrated an exponential decrease with increasing patient size. As a surface organ, breast doses had less correlation with body size than that of lungs or liver.

CONCLUSIONS

Patient body size has a much greater impact on radiation dose of chest CT examinations than chest radiography and tomosynthesis. The size of a patient should be considered when choosing the best thoracic imaging modality.

Radiation dose measurements for optimisation of chest X-ray examinations of children in general radiography hospitals

This study was performed to measure the entrance surface air kerma (ESAK) for optimisation of chest X-ray examination of children in general radiography hospitals in Khartoum. ESAK was estimated using the X-ray tube output exposure and patient-specific exposure parameters collected during routine examinations. The estimated ESAK values per radiography ranged from 17 to 89 μGy, 32 to 161, 67 to 242, 77 to 278; and from 95 to 389 μGy for Newborn, 1, 5, 10 and 15 y children, respectively. Doses are comparable with a previous study and are somewhat higher than the UK reference dose levels. The study demonstrated the necessity to follow guidelines for quality radiograph as a key element in the optimisation of X-ray examination of children. Frequent dose measurements are of particular importance for the optimisation of X-ray examination of children in general radiography hospitals.

Estimating cancer risks to adults undergoing body CT examinations

The purpose of the study is to estimate cancer risks from the amount of radiation used to perform body computed tomography (CT) examination. The ImPACT CT Patient Dosimetry Calculator was used to compute values of organ doses for adult body CT examinations. The radiation used to perform each examination was quantified by the dose-length product (DLP). Patient organ doses were converted into corresponding age and sex dependent cancer risks using data from BEIR VII. Results are presented for cancer risks per unit DLP and unit effective dose for 11 sensitive organs, as well as estimates of the contribution from 'other organs'. For patients who differ from a standard sized adult, correction factors based on the patient weight and antero-posterior dimension are provided to adjust organ doses and the corresponding risks. At constant incident radiation intensity, for CT examinations that include the chest, risks for females are markedly higher than those for males, whereas for examinations that include the pelvis, risks in males were slightly higher than those in females. In abdominal CT scans, risks for males and female patients are very similar. For abdominal CT scans, increasing the patient age from 20 to 80 resulted in a reduction in patient risks of nearly a factor of 5. The average cancer risk for chest/abdomen/pelvis CT examinations was ∼26 % higher than the cancer risk caused by 'sensitive organs'. Doses and radiation risks in 80 kg adults were ∼10 % lower than those in 70 kg patients. Cancer risks in body CT can be estimated from the examination DLP by accounting for sex, age, as well as patient physical characteristics.

Fourier X-ray scattering radiography yields bone structural information

PURPOSE

To characterize certain aspects of the microscopic structures of cortical and trabecular bone by using Fourier x-ray scattering imaging.

MATERIALS AND METHODS

Protocols approved by the National Institutes of Health Animal Care and Use Committee were used to examine ex vivo the hind limb of a rat and the toe of a pig. The Fourier x-ray scattering imaging technique involves the use of a grid mask to modulate the cone beam and Fourier spectral filters to isolate the harmonic images. The technique yields attenuation, scattering, and phase-contrast (PC) images from a single exposure. In the rat tibia cortical bone, the scattering signals from two orthogonal grid orientations were compared by using Wilcoxon signed rank tests. In the pig toe, the heterogeneity of scattering and PC signals was compared between trabecular and compact bone regions of uniform attenuation by using F tests.

RESULTS

In cortical bone, the scattering signal was significantly higher (P < 10(-15)) when the grid was parallel to the periosteal surface. Trabecular bone, as compared with cortical bone, appeared highly heterogeneous on the scattering (P < 10(-34)) and PC (P < 10(-27)) images.

CONCLUSION

The ordered alignment of the mineralized collagen fibrils in compact bone was reflected in the anisotropic scattering signal in this bone. In trabecular bone, the porosity of the mineralized matrix accounted for the granular pattern seen on the scattering and PC images.

Effective doses in radiology and diagnostic nuclear medicine: a catalog

Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.

Estimation of radiographic doses in a case-control study of acute myelogenous leukemia

Radiation exposure from dental and medical radiography is inherently difficult to estimate. Because no single resource is available for this type of data, gathering the information needed to estimate exposure in epidemiologic studies is a labor-intensive, imprecise process. For a case-control study of adult-onset acute myelogenous leukemia in Los Angeles County and radiography, a database was created of estimates of dose to the red bone marrow for each radiographic procedure reported by subjects in interviews and recorded in subjects' medical records. Resources used included the medical literature as well as personal communications with radiology experts. Dose estimates for each procedure based on this database are reported. Methods and complications are contrasted with a past effort to estimate dose from dental radiography for a case-control study of parotid gland tumors. Among the more difficult aspects of medical radiography dose estimation are the wide variety of examinations performed, the continually-changing environment of diagnostic imaging, and the number of variables that contribute to the delivered dose to an individual from a specific imaging procedure.

Effective dose in diagnostic radiology as a function of x-ray beam filtration for a constant exit dose and constant film density

Individual organ absorbed dose and total effective dose for nine common radiographic projections were investigated as a function of half-value-layer, HVL, and total equivalent filtration for the following cases: (1) with the patient exit dose held constant and (2) with the film density held constant. As expected, the absorbed dose to organs proximal to the x-ray beam entry point tracked with skin dose as a function of HVL, whereas organ dose distal to the x-ray beam entry point was almost independent of HVL. Dose to organs near mid-line showed an intermediate HVL dependence. For the nine radiographic projections, increasing the total filtration from 1.5 to 4.0 mm Al while holding the kVp fixed resulted in mean decreases in the effective dose of 17% for the case of a constant exit dose, and 25% for a constant film density with a "400 speed" rare-earth screen-film system. The decreases in the mean skin entrance doses were 38% and 45%, respectively. With the screen-film system, the average effective dose decreased at 16% per mm of added Al between 1.5 and 2.5 mm Al total filtration, and at 7% per mm between 2.5 and 4.0 mm. These results partially support the NCRP Report No. 102 recommendation that the minimum filtration be 2.5 mm Al for general diagnostic x-ray tubes. They also suggest, using the linear no-threshold radiation risk model, that further significant reductions in stochastic risk to the U.S. population can be achieved by raising the minimum beyond 2.5 mm. Experience over a 12 year period in our tertiary care teaching hospital indicates that adding 1-1.5 mm Al filtration beyond the 2.5 mm minimum does not pose a problem in terms of additional tube loading or reduction in image quality. However, these issues need to be more formally addressed.

Effective dose and energy imparted in diagnostic radiology

The patient effective dose, E, is an indicator of the stochastic radiation risk associated with radiographic or fluoroscopic x-ray examinations. Determining effective doses for radiologic examinations by measurement or calculation is generally very difficult. By contrast, the energy imparted, epsilon, to the patient may be obtained from the x-ray exposure-area product incident on the patient. As energy imparted is approximately proportional to the effective dose for any given x-ray radiographic view, the availability of E/epsilon ratios for common radiographic projections provides a convenient way for estimating effective doses. Ratios of E/epsilon were obtained for 68 projections using E and epsilon values obtained from published dosimetry data computed using Monte Carlo techniques on an adult anthropomorphic phantom. The average E/epsilon ratio for the 68 projections in adults was 17.8+/-1.4 mSv/J, whereas uniform whole body irradiation corresponds to 14.1 mSv/J. The major determinant of E/epsilon ratios was the projection employed (the body region irradiated and x-ray beam orientation), whereas the tube potential and beam filtration were of secondary importance. Adult E/epsilon ratios may also be used to obtain effective doses to pediatric patients undergoing x-ray examinations by application of a correction factor based on the patient mass.

Computation of energy imparted in diagnostic radiology

Energy imparted is a measure of the total ionizing energy deposited in the patient during a radiologic examination and may be used to quantify the patient dose in diagnostic radiology. Values of the energy imparted per unit exposure-area product, omega (z), absorbed by a semi-infinite water phantom with a thickness z, were computed for x-ray spectra with peak x-ray tube voltages ranging from 50-140 kV and with added filtration, ranging from 1-6 mm aluminum. For a given phantom thickness and peak x-ray tube voltage, the energy imparted was found to be directly proportional to the x-ray beam half-value layer (HVL) expressed in millimeters of aluminum. Values of omega (z) were generated for constant waveform x-ray tube voltages and an anode angle of 12 degrees, and were fitted to the expression omega (z) = alpha x HVL + beta. Fitted alpha and beta parameters are provided that permit the energy imparted to be determined for any combination of tube voltage, half-value layer, and phantom thickness from the product of the entrance skin exposure (free-in-air) and the corresponding x-ray beam area. The results obtained using our method for calculating energy imparted were compared with values of energy imparted determined using Monte Carlo techniques and anthropomorphic phantoms for a range of diagnostic examinations. At 60, 80, and 120 kV, absolute values of energy imparted obtained using our method differed by 8%, 10%, and 12%, respectively, from the corresponding results of Monte Carlo computations obtained for an anthropomorphic phantom. The method described in this paper permits a simple determination of energy imparted for any type of diagnostic x-ray examination which may be used to compare the radiologic risks from differing types of x-ray examinations, optimize imaging techniques with respect to the patient dose, or estimate the patient effective dose equivalent.

A comparison of radiation dose in examination of the abdomen using different radiological imaging techniques

Typical radiation doses for abdominal examinations were determined for field sizes and entrance doses commonly selected on image intensifier based digital radiographic systems. In addition, measurements were also performed using conventional film-screen methods, a 100 mm camera combination and a phosphor storage computed radiography system. Both antero-posterior and postero-anterior projections were assessed. An anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosimeters was used to measure entrance surface doses. Organ equivalent doses, deduced using normalized organ dose data, were used to calculate effective dose and effective dose equivalent. A comparison of the imaging techniques on the basis of effective dose indicated that significant dose reductions (by approximately a factor of 3) may be expected if the abdomen is imaged using a postero-anterior rather than an antero-posterior projection for a given imaging system. If digital imaging systems are used instead of a conventional film-screen technique, patient effective dose for a given projection can be lower by at least a factor of 5.

An investigation into the radiation dose associated with different imaging systems for chest radiology

With the advent of digital imaging there now exists a range of imaging techniques which may be used to acquire chest images. The purpose of this investigation was to determine typical radiation doses associated with the use of a conventional film-screen system, 100 mm film technique, large-field digital image intensifier radiography, computed radiography and a scanning slit system (AMBER, Oldeft, Netherlands). Radiation doses to relevant organs were assessed using direct measurements made with lithium fluoride thermoluminescent dosemeters, together with calculations made using normalized dose data. Typical doses were assessed using anthropomorphic phantoms for both postero-anterior and lateral projections. The risk-related quantities, i.e. effective dose and effective dose equivalent, were then calculated from these organ doses. When compared on the basis of effective dose equivalent, certain imaging techniques were seen to offer the potential for significant dose reduction, possibly at the expense of image quality.

Effective dose--how effective for patients?

The question discussed in this paper is whether effective dose can reflect the risk to patients from radiological procedures and can be used, for example, to optimise procedures and compare risks of various methods, to define dose constraints, and to estimate the risks to individuals or populations attributed to medical exposures. This report demonstrates that the use of effective dose for patients could be misleading or even wrong due to inappropriate simplifications of the underlying biological mechanisms and inappropriateness of the weighting factors connected with the definition of effective dose for a given patient population. We show that the choice of the most meaningful quantities to express patient exposure depends strongly on the respective situation.

Estimation of doses to patients from "complex" conventional X-ray examinations

A numerical method has been developed to estimate the organ doses and effective dose-equivalent for patients undergoing three "complex" examinations (barium meal, barium enema and intravenous urography). The separation of radiological procedures into a set of standard numerical views is based on the use of Monte Carlo conversion factors and measurements within a Remab phantom. The radiation doses measured in a phantom for such examinations have been compared with the predictions of the "numerical" method. Dosimetric measurements with thermoluminescent dosemeters attached to the patient's skin along with measurements of the dose-area product during the examination have enabled us to derive organ doses and to estimate the effective dose-equivalent. Mean frequency weighted values of dose-area product, energy imparted to the patient, doses to a set of organs and effective dose-equivalent in the area of Madrid are reported. Comparisons of the results with those from similar surveys in other countries have been made.