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A Clinically Optimal Protocol for the Imaging of Enteric Tubes: On the Basis of Radiologist Interpreted Diagnostic Utility and Radiation Dose Reduction. Acad Radiol 2022; 29:e279-e288. [PMID: 35504809 DOI: 10.1016/j.acra.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to develop and evaluate a patient thickness-based protocol specifically for the confirmation of enteric tube placements in bedside abdominal radiographs. Protocol techniques were set to maintain image quality while minimizing patient dose. MATERIALS AND METHODS A total of 226 pre-intervention radiographs were obtained to serve as a baseline cohort for comparison. After the implementation of a thickness-based protocol, a total of 229 radiographs were obtained as part of an intervention cohort. Radiographs were randomized and graded for diagnostic quality by seven expert radiologists based on a standardized conspicuity scale (grades: 0 non-diagnostic to 3+). Basic patient demographics, body mass index, ventilatory status, and enteric tube type were recorded and subgroup analyses were performed. Effective dose was estimated for both cohorts. RESULTS The dedicated thickness-based protocol resulted in a significant reduction in effective dose of 80% (p-value < 0.01). There was no significant difference in diagnostic quality between the two cohorts with 209 (92.5%) diagnostic radiographs in the baseline and 221 (96.5%) diagnostic radiographs in the thickness-based protocol (p-value 0.06). CONCLUSION A protocol optimized for the confirmation of enteric tube placements was developed. This protocol results in lower patient effective dose, without sacrificing diagnostic accuracy. The technique chart is provided for reference. The protocol development process outlined in this work could be readily generalized to other imaging clinical tasks.
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Alshamrani KM, Alkenawi AA, Alghamdi BN, Honain RH, Alshehri HA, Alshatiri MO, Mail N, Subahi A, Alsharif SS, Qurashi AA, Aldahery S, Kaifi R. Patient-Based Dose Audit for Common Radiographic Examinations With Digital Radiology Systems: A Retrospective Cross-Sectional Study. Cureus 2021; 13:e15005. [PMID: 34150373 PMCID: PMC8202450 DOI: 10.7759/cureus.15005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/21/2022] Open
Abstract
This study aims to audit radiation doses of adult patients who underwent common diagnostic X-ray examinations and compare dose area product (DAP) values with the established International Diagnostic Reference Level (IDRLs). Retrospective cross-sectional records of 339-patients who underwent 699-radiographic examinations between October 2018 and March 2019 were obtained. Patient-related factors, exposure, and DAP data were recorded for the six most common examinations. The mean and 75th percentile of DAPs were recorded and compared to IDRLs values. The 75th percentiles of the locally measured DAPs were below IDRLs for all examinations except for lateral lumbar, AP, and lateral thoracic spine, in which DAP-75th-percentile exceeded all IDRLs by up to 40.7%, 2.8%, 365.5%, respectively. Considering the type of detector used, the mean of the locally measured DAPs significantly exceeded the UK DRLs for the lateral thoracic spine and lateral lumbar spine. Locally measured DAP values were below the IDRLs except for thoracic and lumbar spine projections, which significantly exceeded.
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Affiliation(s)
- Khalid M Alshamrani
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Abdulkader A Alkenawi
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Bushra N Alghamdi
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rawan H Honain
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Haneen A Alshehri
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Marwah O Alshatiri
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Noor Mail
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed Subahi
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Shaza S Alsharif
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | | | - Shrooq Aldahery
- College of Applied Medical Sciences, University of Jeddah, Jeddah, SAU
| | - Reham Kaifi
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
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Sánchez AA, Reiser I, Baxter T, Zhang Y, Finkle JH, Lu ZF, Feinstein KA. Portable abdomen radiography: moving to thickness-based protocols. Pediatr Radiol 2018; 48:210-215. [PMID: 29130139 DOI: 10.1007/s00247-017-4025-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/09/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Default pediatric protocols on many digital radiography systems are configured based on patient age. However, age does not adequately characterize patient size, which is the principal determinant of proper imaging technique. Use of default pediatric protocols by inexperienced technologists can result in patient overexposure, inadequate image quality, or repeated examinations. OBJECTIVE To ensure diagnostic image quality at a well-managed patient radiation exposure by transitioning to thickness-based protocols for pediatric portable abdomen radiography. MATERIALS AND METHODS We aggregated patient thickness data, milliamperes (mAs), kilovoltage peak (kVp), exposure index (EI), source-to-detector distance, and grid use for all portable abdomen radiographs performed in our pediatric hospital in a database with a combination of automated and manual data collection techniques. We then analyzed the database and used it as the basis to construct thickness-based protocols with consistent image quality across varying patient thicknesses, as determined by the EI. RESULTS Retrospective analysis of pediatric portable exams performed at our adult-focused hospitals demonstrated substantial variability in EI relative to our pediatric hospital. Data collection at our pediatric hospital over 4 months accumulated roughly 800 portable abdomen exams, which we used to develop a thickness-based technique chart. CONCLUSION Through automated retrieval of data in our systems' digital radiography exposure logs and recording of patient abdomen thickness, we successfully developed thickness-based techniques for portable abdomen radiography.
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Affiliation(s)
- Adrian A Sánchez
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA.
| | - Ingrid Reiser
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA
| | - Tina Baxter
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA
| | - Yue Zhang
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA
| | - Joshua H Finkle
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA
| | - Zheng Feng Lu
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA
| | - Kate A Feinstein
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Ave., MC2026, Chicago, IL, 60637, USA
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Jones AK, Heintz P, Geiser W, Goldman L, Jerjian K, Martin M, Peck D, Pfeiffer D, Ranger N, Yorkston J. Ongoing quality control in digital radiography: Report of AAPM Imaging Physics Committee Task Group 151. Med Phys 2015; 42:6658-70. [DOI: 10.1118/1.4932623] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- A. Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Philip Heintz
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico 87104
| | - William Geiser
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Lee Goldman
- Hartford Hospital, Hartford, Connecticut 06102
| | | | | | - Donald Peck
- Henry Ford Health System, Detroit, Michigan 48202
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Hsieh CY, Gladish G, Willis CE. Evaluation of a commercial cardiac motion phantom for dual-energy chest radiography. J Appl Clin Med Phys 2014; 15:4508. [PMID: 24710435 PMCID: PMC5875465 DOI: 10.1120/jacmp.v15i2.4508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/10/2013] [Accepted: 10/03/2013] [Indexed: 11/23/2022] Open
Abstract
Misregistration due to cardiac motion causes artifacts in two-exposure dual-energy subtraction images, in both the soft-tissue-only image and the bone-only image. Two previous investigations have attempted to avoid misregistration artifacts by using cardiac gating of the first and second exposures. The severity of misregistration was affected by the heart rate, the time interval between the low- and high-energy exposures, the total duration of the two exposures, and the phase of the cardiac cycle at the start of the exposure sequence. We sought to determine whether a commercial phantom with a simulated beating heart can be used to investigate the factors affecting misregistration in dual-energy chest radiography. We made dual-energy images of the phantom in postero-anterior orientation using the indirect digital radiography system (GE XQ/i). We acquired digital images at heart rates between 40 beats per minute and 120 beats per minute and transferred them to a computer, where the area of the artifact on the silhouette of the heart was measured from both soft-tissue-only and bone-only images. For comparison, we measured misregistration in clinical dual-energy subtraction images by the same method. Generally speaking, without synchronization of the exposure sequence with the cardiac cycle, the area of the misregistration artifact increased with heart rate for both the phantom and clinical images. However, the phantom exaggerated the magnitude of misregistration relative to clinical images. Although this phantom was designed for horizontal operation and computed tomography imaging, it can be used in an upright configuration to simulate heart motion for investigation of dual-energy misregistration artifacts and control.
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