Validation of MRI assessment of foot perfusion for improving treatment of patients with peripheral artery disease.

INTRODUCTION: Information on tissue perfusion in the foot is important when treating patients with chronic limb-threatening ischemia. This study aims to test the reliability of different magnetic resonance sequences when measuring perfusion in the foot. METHODS: Sixteen healthy volunteers had their right foot scanned in a test/retest study with six different magnetic resonance sequences (BOLD, multi-echo gradient echo (mGRE), 2D and 3D pCASL, PASL FAIR, and DWI with intravoxel incoherent motion (IVIM) with quantitative measurements of perfusion. For five sequences, cuff-induced ischemia followed by a hyperactive response was measured. Images of the feet were segmented into angiosomes and perfusion data were extracted from the five angiosomes. RESULTS: BOLD, PASL FAIR, mGRE, and DWI with IVIM had low mean differences between the first and second scans, while the results of 2D and 3D pCASL had the highest differences. Based on a paired t-test, BOLD, and FAIR were able to distinguish between perfusion and no perfusion in all angiosomes with p-values below 0.01. This was not the case with 2D and 3D pCASL with p-values above 0.05 in all angiosomes. The mGRE could not distinguish between perfusion and no perfusion in the lateral side of the foot. CONCLUSION: BOLD, mGRE, pASL FAIR, and DWI with IVIM seem to give more robust results compared to 2D and 3D pCASL. Further studies on patients with peripheral artery disease should explore if the sequences can have clinical relevance when assessing tissue ischemia and results of revascularization. IMPLICATIONS FOR PRACTICE: This study provides knowledge that could be used to improve the diagnosis of patient with chronic limb-threatening ischemia to explore tissue perfusion.

Radiographers use of social media - SoMe in a Nordic perspective.

INTRODUCTION: Social media (SoMe) is widely used as a communication platform in everyday life. Also, healthcare professionals have embraced SoMe as a communication tool for both peers and patients. It is becoming an interactive tool for discussing professionals' issues and a place where learning and education occur. This study explores the specific patterns of SoMe use for radiographers' in the Nordic countries. The aim of this survey was to investigate radiographers use of social platforms in a professional setting. METHODS: A 29-item survey was prepared, and pilot-tested. The survey was produced in Danish a language that all Nordic countries master. In general, most Nordic languages are very similar. The survey was distributed by online platforms such as Facebook, LinkedIn, Twitter/X, and also distributed by newsletters by the Norwegian and Danish national radiographers societies. All data was collected anonymously. An Ethical Research approval was obtained from the University of Southern Denmark. RESULTS: A total of 242 respondents completed the survey (Denmark n = 183, Norway n = 48, Sweden n = 8, and n = 3 from other Scandinavian countries). The respondents included 186 females, 52 males and four were undisclosed. On average, the respondents spent approximately 2 h and 23 min daily on SoMe, with 27 min specifically dedicated to content relevant to radiographers. Facebook was the preferred platform with 93 % (n = 226). A total of 5.4 % (n = 13) respondents had experienced contact from patients and/or next of kin, while 92 % (n = 222) reported no such interactions and 2.9 % (n = 7) were undisclosed. A total of 52.8 % (n = 128) used SoMe in relation to courses, conferences, or online meetings. This shows that time spent on content relevant to radiographers imply that SoMe can be a relevant tool for reaching radiographers. CONCLUSION: The survey demonstrates radiographers' use of SoMe for personal and professional interest, with Facebook as the preferred social media platform. SoMe were mostly used during courses, conferences, or online meetings with half of the respondent reported using SoMe platforms during working hours. These results underscore the untapped potential of SoMe in professional healthcare settings. Additionally, the study offers insight into current practices, facilitating comparisons to identify trends in SoMe usage within the radiographer community. IMPLICATIONS FOR PRACTICE: The findings advocate for the strategic use of SoMe by radiographers', emphasizing professional networking and knowledge sharing. However, clear guidelines are necessary to ensure patient confidentiality and data security in these digital interactions.

Pill or pump? Nitroglycerin 0.5 mg tablet vs 0.8 mg spray: Effect on proximal vessel diameters at Coronary CT Angiography (CCTA).

INTRODUCTION: The administration of sublingual Nitroglycerin (NTG) prior to CT coronary angiography (CCTA) can be perfomed using pump spray or tablets. Choice of method seems to be based on local preference, rather than published guidelines. This retrospective analysis tested whether proximal coronary diameters differed dependent on the sublingual administration of 0.5 mg Nitroglycerin (NTG) tablets or 0.8 mg NTG spray. METHODS: 287 ECG-gated CCTA studies with optimal image quality and Agatston scores<400 were included in this retrospective analysis. 143 of the patients were dosed with NTG tablets at a dose of 0.5 mg prior to CCTA. 144 patients received 2 puffs of 0.4 mg NTG spray for a total dose of 8 mg. All were scanned on a second-generation Dual Source CT. Diameters of proximal segments of Left Main (LM), Right (RCA), Left Anterior (LAD) and circumflex (CX) coronary arteries were measured using semi-automatic electronic callipers by two blinded readers. Results were summarised as the mean of maximum and minimum diameters. Sex-specific analysis of diameters was carried out using repeated-measures ANOVA for each vessel. Agreement between readers was examined with Bland-Altman analysis and intra-class-correlation coefficient (ICC). RESULTS: No significant differences in coronary diameters were found except in the RCA for women and LM for men. In both cases, diameters were smaller in the spray group (11 and 9%, respectively). Reader agreement was excellent, with ICC>0.96 for all vessels, and no significant bias, except in CX (0.03 mm). CONCLUSIONS: We found no evidence for the systematic superiority of either administration method in proximal coronary vessels. IMPLICATIONS FOR PRACTICE: Choosing between tablet or spray NTG prior to CCTA can be guided by practical, economical and hygienic considerations alone.

How to set up a mobile X-ray unit in the community - Implementation initiatives for patient-centred care.

BACKGROUND: Mobile X-ray unit have previously been widely used within hospitals in general, predominately for imaging patients admitted to intensive care units or for patients who cannot tolerate a visit to the radiology department. It is now possible to have an X-ray examination outside the hospital in nursing homes or to bring the service to frail, vulnerable or disabled patients. A visit to the hospital can be a frightening experience for vulnerable patients living with dementia or other neurological disorder. It can potentially have a long-term impact on the patient's recovery or behaviour. This technical note aimed to provide insight into the planning and running of a mobile X-ray unit in a Danish setting. METHODS: This technical note draws on the lived experiences of radiographers operating and managing a mobile X-ray service, sharing experiences with the implementation process and the challenges and successes of a mobile X-ray unit. RESULTS AND KEY FINDINGS: Successes include that frail patient, especially those with dementia, benefit from mobile X-ray examinations, as they can remain in familiar surroundings during an X-ray procedure. In general, patients experienced an increased quality of life and less need for sedation medication due to anxiety. Also, working within a mobile X-ray unit is meaningful work for radiographers. Challenges included increased physicality of work, the funding required for the mobile unit, planning a communication strategy to the referring general practitioners, and permission from authorities to perform mobile examinations. CONCLUSION: We have successfully implemented a mobile radiography unit that provides a better service for vulnerable patients through learning from successes and challenges. IMPLICATIONS FOR PRACTICE: The mobile radiography setup can benefit vulnerable patients and provide meaningful work for the radiographers. However, transportation of mobile radiography equipment outside the hospital includes many considerations and challenges.

Can advanced edge enhancement software improve image quality to visualise tubes, catheters and wires in digital chest radiographs?

INTRODUCTION: This study aimed to test whether Advanced Edge Enhancement (AEE) software could improve the localisation of tubes, catheters or wires, while also affecting the overall image quality in chest x-rays (CXR). METHODS: In total, 50 retrospective CXRs were included. All images were obtained utilising the Canon X-ray system (CANON/Arcoma Precision T3 DR System, Canon Europe, Amsterdam, NL) with a CXDI-810C wireless detector. A clinical image, plus three additional AEE algorithms were applied using post processing (two intensity variations 1 and 4) on all CXRs totalling 350 different images. Three radiologists evaluated the images using a subjective Absolute Visual Grading Analysis (VGA). The clinical images used in post processing were not applied as reference in the analysis. Each radiologist graded the images separately in a randomized order, with a score of three indicating suitability for diagnostic assessment. RESULTS: The three AEE algorithms contributed to an overall improvement (average 16-49%) in visualisation of tube, catheter or wire on CXR images. The Mann-Whitney U tests showed a statistically significant (p < 0.05) improvement in contrast resolution and sharpness, indicating an increased ability to differentiate tubes, wires or catheters tips from surrounding tissues. For the noise criterion, not applying any AEE algorithm showed a significantly higher homogeneity in soft tissue (p < 0.001), reducing the ability to visualise soft tissue. The high-intensity catheter algorithm was the only algorithm to achieve a statistically significant (p = 0.017) increase in the ability to differentiate pulmonary tissues of similar density. CONCLUSION: An overall improvement in the visualisation of tube, catheter and wire placement was obtained using the three AEE-algorithms. The bone and catheter algorithms showed the highest consistency, with the small structure algorithm underperforming in resolution and low contrast resolution. In general, image noise increased regardless of algorithm type or applied intensity. The AEE-algorithms should therefore be seen as a supplementary tool to the clinical image protocol, while having the potential to improve image quality to specific clinical situations. IMPLICATIONS FOR PRACTICE: AEE filtered images appear to be a supplement to the current practice of using CXRs in the diagnosis in placement of catheters, tubes and wires in the chest region. The use of AEE-algorithms has the potential to improve the daily work in clinical practice, which serves the basis for further investigation of its effect on radiographic practices.

Research ethics systems, processes, and awareness across Europe: Radiography research ethics standards for Europe (RRESFE).

INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs. METHODS: A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe. RESULTS: 285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X2 (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X2 (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X2 (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X2 (1, n = 231) = 15.448, p = <0.001) within respondents' country. CONCLUSION: Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements. IMPLICATIONS FOR PRACTICE: Results are informative of the current status of research ethics within evidence-based radiography.

Research ethics training, challenges, and suggested improvements across Europe: Radiography research ethics standards for Europe (RRESFE).

INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks. METHODS: This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice. RESULTS: There were 232 responses received across 33 European countries. Most (n = 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n = 72; 38%), diversity and inclusivity (n = 62; 33%), or research with healthy volunteers (n = 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p = 0.031) and with the establishment of EQF Level 6 training (p = 0.038). The proportion of formally trained researchers also varied by region (p = <0.001). Time-to-ethics-approval was noted as the biggest challenge for professionals making research ethics applications. CONCLUSION: Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined. IMPLICATIONS FOR PRACTICE: The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs in Radiography and has identified hurdles to obtaining research ethics approval for further investigation and address.

Design of a 3D printed coronary artery model for CT optimization.

INTRODUCTION: To design a custom phantom of the coronary arteries to optimize CT coronary angiography (CCTA) protocols. METHODS: Characteristics of the left and right coronary arteries (mean Hounsfield Unit (HU) values and diameters) were collected from consecutive CCTA examinations (n = 43). Four different materials (two mixtures of glycerine, gelatine and water, pig hearts, Ecoflex™ silicone) were scanned inside a Lungman phantom using the CCTA protocol to find the closest model to in vivo data. A 3D printed model of the coronary artery tree was created using CCTA data by exporting a CT volume rendering into Autodesk Meshmixer™ software. The model was placed in an acid bath for 5 h, then covered in Ecoflex™, which was removed after drying. Both the Ecoflex™ and pig heart were later filled with a mixture of contrast (Visipaque 320 mg I/ml), NaCl and gelatin and scanned with different levels of tube current and iterative reconstruction (ASiR-V). Objective (HU, noise and size (vessel diameter) and subjective analysis were performed on all scans. RESULTS: The gelatine mixtures had HU values of 130 and 129, Ecoflex™ 65 and the pig heart 56. At the different mA/ASiR-V levels the contrast filled Ecoflex™ had a mean HU 318 ± 4, noise 47±7HU and diameter of 4.4 mm. The pig heart had a mean HU of 209 ± 5, noise 38±4HU and a diameter of 4.4 mm. With increasing iterative reconstruction level the visualisation of the pig heart arteries decreased so no measurements could be performed. CONCLUSION: The use of a 3D printed model of the arteries and casting with the Ecoflex™ silicone is the most suitable solution for a custom-designed phantom. IMPLICATIONS FOR PRACTICE: Custom designed phantoms using 3D printing technology enable cost effective optimisation of CT protocols.

Exploring radiographers' experience with mobile X-ray of patients in their homes.

INTRODUCTION: To offer citizens with frailty or dementia living in nursing homes or other institutions a less stressful and anxious X-ray examination, a Danish hospital offers to perform the examination in the citizen's residence. This has changed the working procedure for the radiographers performing the examination. The aim of this study was to explore if the radiographers self-perceived competencies have changed whilst working in the mobile X-ray unit and if so, how these competencies are utilised within the department-based medical imaging team. METHOD: This study had a qualitative design following a hermeneutic approach. Individual semi structured interviews included nine radiographers, four radiographers working in the mobile X-ray unit and five radiographers working exclusively in the medical imaging team. RESULTS: Radiographers who worked in the mobile X-ray unit did acquire new competencies such as better communication and creative positioning skills. All nine participants recognised the advantage of sharing experiences and competencies with colleagues, and recommended a formal forum to do so. They sought opportunities for the use of the mobile X-ray unit to be more widespread within their own region, and within the profession. CONCLUSION: This study indicates that radiographers working with mobile X-ray unit gained new competencies in communication and positioning, but without spread of new knowledge to colleagues in the medical imaging team. IMPLICATION FOR PRACTICE: The use of home-based mobile X-ray is a new way to provide health care services and gain new competencies for the radiographers to focus on patient centred care.

The influence of a novel edge enhancement software on image quality of DR hand images of patients with rheumatoid arthritis.

INTRODUCTION: This study aimed to evaluate the effects of a newly developed Advanced Edge Enhancement software (AEE) (Canon Europe, Amsterdam, NL) on image quality (IQ) of Digital Radiography (DR) hand images focusing on rheumatoid arthritis (RA). METHODS AND MATERIALS: Fifty posterior-anterior hand images with or suspected for RA were collected. For each of the 50 images, six copies were made with each their AEE algorithm settings. A total of 330 images (30 images iterated) were evaluated using relative Visual Grading Analysis (VGA) by three observers and combined into a VGA Score (VGAS). Second, 50 images of a technical Contrast Detail Radiography Phantom (CDRAD) was produced with three different AEE software settings, each at level 1,5 and without the AEE software yielding 350 CDRAD images. All images was analysed by the CDRAD Analyser and included for an objective analysis of the AEE software. RESULTS: The VGA study showed a significant difference in image quality between a standard image and images with AEE software applied. The average VGA score of the AEE software was better than the standard images (interval between 0.2 and 0.9). The AEE algorithms at level 5 scored significantly lower for noise but significantly higher for spatial resolution, sharpness and contrast in the VGA. The CDRAD images showed that all AEE algorithms had a statistically significant improvement for level 1 and deterioration for level 5 compared to the standard image. CONCLUSION: Overall the AEE algorithm: small structure level 1 showed an improvement of all IQ criteria in the VGA and a better technical IQ. IMPLICATIONS FOR PRACTICE: The AEE software ought to be considered as a useful addition to the current software, possibly enabling visualisation of structures currently visible.

Anode heel effect: Does it impact image quality in digital radiography? A systematic literature review.

INTRODUCTION: The anode heel effect can be used to optimize image quality and/or patient dose in digital radiography (DR). In film-screen radiography, the effect can equalize optical density in regions of varying attenuation. Clinical experience suggests that the implementation of DR has led to less awareness of anode orientation. Post-processing is assumed to compensate, but may also alter image impression and potentially obscure image details. Published evidence was examined for the influence of the anode heel effect on image quality in DR. METHOD: A systematic literature search was carried out using PubMed, Embase, and Web of Science databases. Title and abstracts were screened blinded by three authors, according to in-/exclusion criteria, followed by full-text analysis for final inclusion. Studies where technical and/or visual image quality were reported, was included. All studies were analyzed and assigned quality scores, according to relevant questions. The authors devised a scoring system based on reported information pertaining to reproducibility, interpretation, and generalizability of the methods and conclusions. RESULTS: Five studies were included of heterogeneous design, each with methodological shortcomings. Only a few anatomical areas were covered. Very few patients were examined, and in no studies were images evaluated by radiologists or reporting radiographers. Relevant information such as post-processing, image quality criteria and analysis was insufficient in most studies, making reproduction difficult. Results were contradictory, especially concerning technical vs visual image quality. CONCLUSION: Limited published evidence was found quantifying the influence of the anode heel effect on image quality using DR technology. More methodologically, robust studies are needed. The published evidence neither proves nor disproves the impact of the heel effect on image quality in DR. IMPLICATIONS FOR PRACTICE: Based on a systematic review, no firm recommendations for anode orientation relating to image quality in DR can be provided.

Organ-based tube current modulation in chest CT. A comparison of three vendors.

INTRODUCTION: Organ-based tube current modulation (OBTCM) is designed for anterior dose reduction in Computed Tomography (CT). The purpose was to assess dose reduction capability in chest CT using three organ dose modulation systems at different kVp settings. Furthermore, noise, diagnostic image quality and tumour detection was assessed. METHODS: A Lungman phantom was scanned with and without OBTCM at 80-135/140 kVp using three CT scanners; Canon Aquillion Prime, GE Revolution CT and Siemens Somatom Flash. Thermo-luminescent dosimeters were attached to the phantom surface and all scans were repeated five times. Image noise was measured in three ROIs at the level of the carina. Three observers visually scored the images using a fivestep scale. A Wilcoxon Signed-Rank test was used for statistical analysis of differences. RESULTS: Using the GE revolution CT scanner, dose reductions between 1.10 mSv (12%) and 1.56 mSv (24%) (p < 0.01) were found in the anterior segment and no differences posteriorly and laterally. Total dose reductions between 0.64 (8%) and 0.91 mSv (13%) were found across kVp levels (p < 0.00001). Maximum noise increase with OBTCM was 0.8 HU. With the Canon system, anterior dose reductions of 6-10% and total dose reduction of 0.74-0.76 mSv across kVp levels (p < 0.001) were found with a maximum noise increase of 1.1 HU. For the Siemens system, dose increased by 22-51% anteriorly; except at 100 kVp where no dose difference was found. Noise decreased by 1 to 1.5 HU. CONCLUSION: Organ based tube current modulation is capable of anterior and total dose reduction with minimal loss of image quality in vendors that do not increase posterior dose. IMPLICATIONS FOR PRACTICE: This research highlights the importance of being familiar with dose reduction technologies.

Exploring the patient perspectives of mobile X-ray in nursing homes - A qualitative explorative pilot study.

INTRODUCTION: For patients with dementia, behaviour and reactions to stimuli can change and an X-ray examination in the hospital can have be a frightening experience. The aim of this study was to identify the experiences and perspectives of patients with dementia and their caregivers on receiving a mobile x-ray examination in nursing homes. METHODS: This study was designed as a qualitative study using patient observation and semi structured interviews, with a phenomenology-hermeneutic approach. In total, 23 patients were observed during X-ray examinations in nursing homes, and six semi structured interviews were conducted with the caregivers who participated in the examination. RESULTS: The observations and interviews indicated that a known environment, a recognizable framework and calmness were central for a patient with dementia. The patients appeared calm and relaxed during the examination in their usual environment (nursing homes) where there are less stimuli and impressions based of the observations. CONCLUSION: Mobile X-ray examinations for patients with dementia living in nursing homes had a positive impact on patients' reactions towards the X-ray examination. The examinations were performed in the patients' usual and safe environments, where impressions and stimuli were less disturbing for patients with dementia. IMPLICATIONS FOR PRACTICE: The mobile x-ray unit can be of benefit for patients suffering from dementia and result in less impact. The patients living in nursing homes have the opportunity to be examined in their familiar environment, because of the mobile x-ray unit.

The impact of COVID-19 upon student radiographers and clinical training.

INTRODUCTION: To investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning. METHODS: Between mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases. RESULTS: 1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were 'Not at all worried' about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be 'Not worried at all' compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use. CONCLUSION: Student radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience. IMPLICATIONS FOR PRACTICE: As the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.

Comparison of image quality in chest, hip and pelvis examinations between mobile equipment in nursing homes and static indirect radiography equipment in the hospital.

INTRODUCTION: A hospital environment can be a significant burden and a health risk especially for dementia patients. Mobile x-ray equipment (ME) is used to enable imaging of these patients at home. The aim was to compare image quality (IQ) of chest, hip and pelvis images from ME to the stationary equipment (SE) used in a hospital department. METHODS: We analysed examinations of the chest (n = 20), hip (n = 64) and pelvis (n = 32). Images were equally obtained from each setting of ME and SE. All images were graded using Visual Grading Analysis (VGA) by three radiographers (hip and pelvis) and three radiologists (chest). Technical IQ assessment was done by 80 additional images of a Contrast-Detail Radiography phantom (CDRAD). RESULTS: All chest images were approved for diagnostic use, as well as the hip AP and pelvis images from SE. 'Approved proportion of ME images was for HIP antero-posterior (AP) and pelvis, 78% [95% CI: 52-94%] and 81% [95% CI: 54-96%] respectively. Hip axial had an overall low, but not significant different approval rate. Ordered logistic regression indicated higher IQ of HIP AP and pelvic images from SE. This contrasts that the CDRAD substudy indicated better IQ, expressed as IQFinv, from ME. CONCLUSION: The VGA showed higher IQ for the SE system, while the CDRAD showed higher IQ for the ME system. IMPLICATIONS FOR PRACTICE: Dementia patients can be examined at their home if the acquisition is optimised according to image quality in conjunct to radiation dose. Performing imaging out of the hospital and coordinating the patients' further treatment are new work areas for radiographers and requires excellent communication skills.

Radiographers' perspectives' on Visual Grading Analysis as a scientific method to evaluate image quality.

INTRODUCTION: Radiographers routinely undertake many initiatives to balance image quality with radiation dose (optimisation). For optimisation studies to be successful image quality needs to be carefully evaluated. Purpose was to 1) discuss the strengths and limitations of a Visual Grading Analysis (VGA) method for image quality evaluation and 2) to outline the method from a radiographer's perspective. METHODS: A possible method for investigating and discussing the relationship between radiographic image quality parameters and the interpretation and perception of X-ray images is the VGA method. VGA has a number of advantages such as being low cost and a detailed image quality assessment, although it is limited to ensure the images convey the relevant clinical information and relate the task based radiography. RESULTS: Comparing the experience of using VGA and Receiver Operating Characteristic (ROC) it is obviously that less papers are published on VGA (Pubmed n=1.384) compared to ROC (Pubmed n=122.686). Hereby the scientific experience of the VGA method is limited compared to the use of ROC. VGA is, however, a much newer method and it is slowly gaining more and more attention. CONCLUSION: The success of VGA requires a number of steps to be completed, such as defining the VGA criteria, choosing the VGA method (absolute or relative), including observers, finding the best image display platforms, training observers and selecting the best statistical method for the study purpose should be thoroughly considered. IMPLICATION FOR PRACTICE: Detailed evaluation of image quality for optimisation studies related to technical definition of image quality.

Does software optimization influence the radiologists' perception in low dose paediatric pelvic examinations?

PURPOSE: To investigate whether software optimisation can improve an observers' perception of image quality in low dose paediatric pelvic examinations. METHODS: Twenty-five consecutive patients (3-7 years old) were referred for a pelvic digital radiography (DR) examination. They were prospectively enrolled in the study over a 3-month period. Images were taken at 80 kV and 2-4 mAs depending on pelvic thickness (9-15 cm). A small focal spot, 130 cm SID: 10 cm air gap and 1 mm Al and 0.2 mm Cu additional filtration were also utilised. Images were acquired on a Canon DR detector and optimised using five different combinations of the multi-frequency processing software (Canon DR system version NE, Version 7.1 with SPECTRA) to comply with the ALARA principle. Image quality was blindly evaluated using the subjective Visual Grading Analysis (VGA) by five experienced musculoskeletal radiologists, including the evaluation of six anatomical image quality criteria (scored from 1 to 5). RESULTS: Consistently, the VGA results indicated that by using software optimised parameters, image quality was suitable for diagnosis in 48-71% of all images. Based on a VGC analysis all software optimised images did have significant better image quality then the one with just the clinical settings. Noise reduction was the software setting which influenced the image quality the most, area under the curve (AUC) of 0.8172 95%CI 0.7953-0.8375. CONCLUSION: Software optimisation improve the radiologists' perception of image quality and should thus be thoroughly considered within clinical practise. Noise reduction is the software parameter which has the greatest influence.

First experiences with model based iterative reconstructions influence on quantitative plaque volume and intensity measurements in coronary computed tomography angiography.

PURPOSE: Investigate the influence of adaptive statistical iterative reconstruction (ASIR) and the model-based IR (Veo) reconstruction algorithm in coronary computed tomography angiography (CCTA) images on quantitative measurements in coronary arteries for plaque volumes and intensities. METHODS: Three patients had three independent dose reduced CCTA performed and reconstructed with 30% ASIR (CTDIvol at 6.7 mGy), 60% ASIR (CTDIvol 4.3 mGy) and Veo (CTDIvol at 1.9 mGy). Coronary plaque analysis was performed for each measured CCTA volumes, plaque burden and intensities. RESULTS: Plaque volume and plaque burden show a decreasing tendency from ASIR to Veo as median volume for ASIR is 314 mm3 and 337 mm3-252 mm3 for Veo and plaque burden is 42% and 44% for ASIR to 39% for Veo. The lumen and vessel volume decrease slightly from 30% ASIR to 60% ASIR with 498 mm3-391 mm3 for lumen volume and vessel volume from 939 mm3 to 830 mm3. The intensities did not change overall between the different reconstructions for either lumen or plaque. CONCLUSION: We found a tendency of decreasing plaque volumes and plaque burden but no change in intensities with the use of low dose Veo CCTA (1.9 mGy) compared to dose reduced ASIR CCTA (6.7 mGy & 4.3 mGy), although more studies are warranted.

Digital radiography: optimization of image quality and dose using multi-frequency software.

BACKGROUND: New developments in processing of digital radiographs (DR), including multi-frequency processing (MFP), allow optimization of image quality and radiation dose. This is particularly promising in children as they are believed to be more sensitive to ionizing radiation than adults. OBJECTIVE: To examine whether the use of MFP software reduces the radiation dose without compromising quality at DR of the femur in 5-year-old-equivalent anthropomorphic and technical phantoms. MATERIALS AND METHODS: A total of 110 images of an anthropomorphic phantom were imaged on a DR system (Canon DR with CXDI-50 C detector and MLT[S] software) and analyzed by three pediatric radiologists using Visual Grading Analysis. In addition, 3,500 images taken of a technical contrast-detail phantom (CDRAD 2.0) provide an objective image-quality assessment. RESULTS: Optimal image-quality was maintained at a dose reduction of 61% with MLT(S) optimized images. Even for images of diagnostic quality, MLT(S) provided a dose reduction of 88% as compared to the reference image. Software impact on image quality was found significant for dose (mAs), dynamic range dark region and frequency band. CONCLUSION: By optimizing image processing parameters, a significant dose reduction is possible without significant loss of image quality.