Use of Images and Clinical Experience to Calibrate Dental Surgeons for the Diagnosis of Molar Incisor Hypomineralization

ABSTRACT Objective: To evaluate an imaging protocol for use as a diagnostic and calibration tool for dentists before and after practical activity. Material and Methods: Thirty photos of children's teeth with or without changes in dental enamel were selected and evaluated by a group of experienced dentists previously calibrated to establish the diagnosis defined as the gold standard. After instructions, the images were shown to a group of postgraduate dentists for free identification of dental changes. Subsequently, a lecture on molar incisor hypomineralization (MIH) was carried out, and, at 14 days and all calibration was performed using the criteria previously. The retest was performed at 28 days. After experience in clinical activity in the following two weeks, the post-test was performed at 49 days. Data were analyzed using Cohen's kappa coefficient. Results: Theoretical learning on the subject showed low inter-examiner agreement when the diagnosis of defects was made from images obtained from intraoral photographs. After clinical practice, there was greater intra-examiner agreement. After theoretical training, dentists started to identify different types of enamel alteration, although with low agreement between them. Conclusion: Clinical experience in theoretical and imaging training favored the identification of defects. However, it is necessary to improve the protocol to establish a reliable and viable diagnostic method for calibration in MIH.

Normatização da Bateria de Provas de Raciocínio (BPR-5) usando a Teoria de Resposta ao Item / Standardization of the Reasoning Tests Battery (BPR-5) using Item Response Theory / Estandarización de la Batería de Pruebas de Razonamiento (BPR-5) usando la teoría de respuesta al ítem

A Bateria de Provas de Raciocínio (BPR-5) é um instrumento bastante utilizado para avaliação da inteligência no Brasil, possuindo três formas: infantil (1º ao 6º ano do Ensino Fundamental), Forma A (7º ao 9º ano do Ensino Fundamental) e Forma B (Ensino Médio e Superior). Visando a possibilidade de comparar os resultados entre sujeitos que respondem a formas diferentes, o presente estudo objetivou: (a) calibrar os itens das três formas pelo modelo de Rasch, realizando a equalização por itens comuns de modo a obter uma escala equiparável para as três formas, (b) atualizar as normas expandindo a representatividade das amostras e produzindo-se normas para diferentes combinações de idade, escolaridade e sexo, (c) descrever padrões de desenvolvimento da inteligência a partir da escala, comum, produzida entre 6 e 52 anos. Dois estudos foram relatados, o primeiro sobre a calibração dos parâmetros segundo o modelo de Rasch indicando um bom ajuste ao modelo. O segundo estudo exemplificou a utilização de regressão múltipla para criação de normas para testes psicológicos, considerando as variáveis idade, escolaridade e sexo como preditoras dos escores na BPR-5. Essas três variáveis tiveram efeitos significativos explicando 8% (Raciocínio Abstrato), 13% (Raciocínio Verbal), 12% (Raciocínio Espacial), 8% (Raciocínio Numérico) e 22% (Raciocínio Mecânico).(AU)

The Reasoning Tests Battery (BPR-5) is widely used in Brazil for the assessment of intelligence. It has three different forms: children (1st to 6th grade of elementary school), Form A (7th to 9th grade of elementary school) and Form B (high school and higher education). This study describes the steps followed to create a common metric across the forms. It aimed to: (a) calibrate the items of the three forms using Rasch model, link items and equate subjects' scores across forms using the anchoring of common items method, (b) update the norms by expanding the representativeness of the samples by producing norms for different combinations of age, education and sex, and (c) describe the developmental patterns of the BPR-5 subtests across a wide age range, from 6 to 52 years. We present two studies, the first reporting the calibration of item and person parameters with the Rasch model and a good fit to the model. The second illustrated the use of multiple regression analysis to create norms for the psychological tests considering the variables age, education and gender as predictors of the BPR-5 scores. These three variables had significant effects explaining 8% (Abstract Reasoning), 13% (Verbal Reasoning), 12% (Spatial Reasoning), 8% (Numerical Reasoning) and 22% (Mechanical Reasoning) of the variance. (AU)

La Batería de Pruebas de Razonamiento (BPR-5) es un instrumento muy utilizado para la evaluación de la inteligencia en Brasil, disponiendo de tres formas: infantil (1° al 6° año de la Enseñanza Fundamental), Forma A (7° al 9° año de la Enseñanza Fundamental) y Forma B (Bachillerato y Educación Superior). Teniendo como finalidad la posibilidad de comparar los resultados entre sujetos que responden a diferentes versiones, el presente estudio tuvo como objetivo: (a) calibrar los ítems de las tres formas por el modelo de Rasch, realizando la igualación por ítems comunes a fin de obtener una escala equiparable para las tres formas, (b) actualizar las normas ampliando la representatividad de las muestras y produciendo normas para diferentes combinaciones de edad, escolarización y sexo, (c) describir patrones de desarrollo de la inteligencia a partir de la escala, común, producida entre los 6 y los 52 años. Dos estudios fueron reportados, el primer sobre la calibración de los parámetros de acuerdo con el modelo de Rasch, indicando un buen ajuste al modelo. El segundo estudio ejemplificó la utilización de regresión múltiple para crear normas para tests psicológicos, considerando las variables edad, educación y sexo como predictivos de los escores en el BPR-5. Esas tres variables tuvieron efectos significativos explicando 8% (Razonamiento Abstracto), 13% (Razonamiento Verbal), 12% (Razonamiento Espacial), 8% (Razonamiento Numérico), y 22% (Razonamiento Mecánico).(AU)

Calibration Factors for STS Risk Model Predictions: Why, How and When They Are Used.

The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database is the world's premier adult cardiac surgery outcomes registry. This tutorial explains the following: how STS updates the risk models that are used to calculate the predicted risks of adverse events in the registry; why STS on a quarterly basis adjusts or "calibrates" the observed-to-expected ratios to equal 1 (O/E = 1), thereby effectively making the annual number of adverse events predicted by the model match the annual number of adverse events observed in the entire registry; the differences between the calibrated and uncalibrated O/E ratios; and how and when to use each.

Controle de termômetros / Control de los termómetros / Control of thermometers

Esta Norma Técnica tem por objetivo estabelecer as orientações necessárias para aferição e leitura dos termômetros utilizados no controle de temperatura nos Bancos de Leite Humano e Postos de Coleta de Leite Humano, visando a garantia da qualidade nestes serviços e sua certificação.

Esta Norma Técnica tiene como objetivo establecer las orientaciones necesarias para la medición y la lectura de los termómetros utilizados en el control de la temperatura en los Bancos de Leche Humana y en los Centros de Recolección de Leche Humana, con el fin de garantizar la calidad de estos servicios y su certificación.

IPEM code of practice for high-energy photon therapy dosimetry based on the NPL absorbed dose calibration service.

The 1990 code of practice (COP), produced by the IPSM (now the Institute of Physics and Engineering in Medicine, IPEM) and the UK National Physical Laboratory (NPL), gave instructions for determining absorbed dose to water for megavoltage photon (MV) radiotherapy beams (Lillicrap et al 1990). The simplicity and clarity of the 1990 COP led to widespread uptake and high levels of consistency in external dosimetry audits. An addendum was published in 2014 to include the non-conventional conditions in Tomotherapy units. However, the 1990 COP lacked detailed recommendations for calibration conditions, and the corresponding nomenclature, to account for modern treatment units with different reference fields, including small fields as described in IAEA TRS483 (International Atomic Energy Agency (IAEA) 2017, Vienna). This updated COP recommends the irradiation geometries, the choice of ionisation chambers, appropriate correction factors and the derivation of absorbed dose to water calibration coefficients, for carrying out reference dosimetry measurements on MV external beam radiotherapy machines. It also includes worked examples of application to different conditions. The strengths of the 1990 COP are retained: recommending the NPL2611 chamber type as secondary standard; the use of tissue phantom ratio (TPR) as the beam quality specifier; and NPL-provided direct calibration coefficients for the user's chamber in a range of beam qualities similar to those in clinical use. In addition, the formalism is now extended to units that cannot achieve the standard reference field size of 10 cm × 10 cm, and recommendations are given for measuring dose in non-reference conditions. This COP is designed around the service that NPL provides and thus it does not require the range of different options presented in TRS483, such as generic correction factors for beam quality. This approach results in a significantly simpler, more concise and easier to follow protocol.

Dosimetric evaluation of incorporating the revised V4.0 calibration protocol for breast intraoperative radiotherapy with the INTRABEAM system.

In breast-targeted intraoperative radiotherapy (TARGIT) clinical trials (TARGIT-B, TARGIT-E, TARGIT-US), a single fraction of radiation is delivered to the tumor bed during surgery with 1.5- to 5.0-cm diameter spherical applicators and an INTRABEAM x-ray source (XRS). This factory-calibrated XRS is characterized by two depth-dose curves (DDCs) named "TARGIT" and "V4.0." Presently, the TARGIT DDC is used to treat patients enrolled in clinical trials; however, the V4.0 DDC is shown to better represent the delivered dose. Therefore, we reevaluate the delivered prescriptions under the TARGIT protocols using the V4.0 DDC. A 20-Gy dose was prescribed to the surface of the spherical applicator, and the TARGIT DDC was used to calculate the treatment time. For a constant treatment time, the V4.0 DDC was used to recalculate the dosimetry to evaluate differences in dose rate, dose, and equivalent dose in 2-Gy fractions (EQD2) for an α/ß = 3.5 Gy (endpoint of locoregional relapse). At the surface of the tumor bed (i.e., spherical applicator surface), the calculations using the V4.0 DDC predicted increased values for dose rate (43-16%), dose (28.6-23.2 Gy), and EQD2 (95-31%) for the 1.5- to 5.0-cm diameter spherical applicator sizes, respectively. In general, dosimetric differences are greatest for the 1.5-cm diameter spherical applicator. The results from this study can be interpreted as a reevaluation of dosimetry or the dangers of underdosage, which can occur if the V4.0 DDC is inadvertently used for TARGIT clinical trial patients. Because the INTRABEAM system is used in TARGIT clinical trials, accurate knowledge about absorbed dose is essential for making meaningful comparisons between radiation treatment modalities, and reproducible treatment delivery is imperative. The results of this study shed light on these concerns.

Risk analysis of electronic intraoperative radiation therapy for breast cancer.

PURPOSE: To evaluate the process and improve safety of intraoperative radiation therapy (IORT) for early-stage breast cancers treated with electronic brachytherapy. METHODS AND MATERIALS: A multidisciplinary team conducted a failure mode and effects analysis (FMEA) for IORT breast cancer treatments by first developing a process map. This map was then used to identify failure modes for all steps in the treatment workflow. Risk priority numbers (RPNs) were assigned to each failure mode and were calculated as the product of the failure mode's probability of occurrence (O), severity (S), and lack of detectability (D). Corrective steps were implemented to address failure modes with the highest risk, and a revised process was generated. RESULTS: The steps with the highest risk failure modes were related to source calibration, use of correct plan and dwell times, and the correct site and intent. The introduction of a physician calibration check and an extended time-out checklist reduced the risk of these failure modes. The highest risk steps in the Xoft breast IORT treatment process are associated with source calibration and manual entry of dwell positions for each balloon size and volume combination. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. CONCLUSION: High-risk failure modes are identified with FMEA and addressed with corrective steps. This application of FMEA can be used in principle for clinical processes throughout breast cancer care. This analysis demonstrates the importance of well-designed QC policies, procedures, and oversight in a Xoft electronic brachytherapy program for breast cancer IORT.

Using Calibration to Reduce Measurement Error in Prevalence Estimates Based on Electronic Health Records.

INTRODUCTION: Increasing adoption of electronic health record (EHR) systems by health care providers presents an opportunity for EHR-based population health surveillance. EHR data, however, may be subject to measurement error because of factors such as data entry errors and lack of documentation by physicians. We investigated the use of a calibration model to reduce bias of prevalence estimates from the New York City (NYC) Macroscope, an EHR-based surveillance system. METHODS: We calibrated 6 health indicators to the 2013-2014 NYC Health and Nutrition Examination Survey (NYC HANES) data: hypertension, diabetes, smoking, obesity, influenza vaccination, and depression. We classified indicators into having low measurement error or high measurement error on the basis of whether the proportion of misclassification (ie, false-negative or false-positive cases) was greater than 15% in 190 reviewed charts. We compared bias (ie, absolute difference between NYC Macroscope estimates and NYC HANES estimates) before and after calibration. RESULTS: The health indicators with low measurement error had the same bias after calibration as before calibration (diabetes, 2.5 percentage points; smoking, 2.5 percentage points; obesity, 3.5 percentage points; hypertension, 1.1 percentage points). For indicators with high measurement error, bias decreased from 10.8 to 2.5 percentage points for depression, and from 26.7 to 8.4 percentage points for influenza vaccination. CONCLUSION: The calibration model has the potential to reduce bias of prevalence estimates from EHR-based surveillance systems for indicators with high measurement errors. Further research is warranted to assess the utility of the current calibration model for other EHR data and additional indicators.

Control Materials and Digital PCR Methods for Evaluation of Circulating Cell-Free DNA Extractions from Plasma.

Cell-free DNA is an accessible source of genetic material found naturally in plasma that could be used in many diagnostic applications. Translation of cfDNA analysis methods from research laboratories into the clinic would benefit from controls for monitoring the efficiency of patient sample purification and for quality control of the whole workflow from extraction through to analysis. Here we describe two types of control materials that can be "spiked" into plasma samples to monitor and evaluate different aspects of the workflow. The first control material is an internal control that enables evaluation of extraction efficiency, fragment size bias, and sample inhibition. The second control material serves as a parallel quality control material for measurement of specific genetic targets such as tumor mutations.

Development of an Enzyme-Linked Immune Sorbent Assay to Measure Nivolumab and Pembrolizumab Serum Concentrations.

BACKGROUND: Treatment with monoclonal antibodies (mAbs) against programmed cell death protein 1 receptor is subject to high variation in treatment outcome among cancer patients. For these agents, no exposure-response (ER) relationships have been investigated in routine health care settings. However, ER relationships have been identified for several other mAbs used in oncology. Methods to conveniently measure serum concentrations of anti-programmed cell death protein 1 mAbs in routine health care may clarify possible ER relationships. Therefore, the authors aimed to develop an enzyme-linked immune sorbent assay (ELISA) for the measurement of both nivolumab and pembrolizumab serum concentrations of treated cancer patients. METHODS: Optimal capture antigen and detection antibody concentrations were selected based on titrations. Nivolumab calibration standards ranging from 0.2 to 300 ng/mL were tested in duplicate. Accuracy was assessed in 2 recovery experiments. Intra- and interassay variations were assessed on 3 different days by 2 independent technicians. The developed ELISA was also set up for pembrolizumab calibration curves. Cross-reactivity of nivolumab measurements with ipilimumab was assessed. Of one nivolumab treated patient, serum concentrations in follow up samples were measured and presented. RESULTS: Nivolumab calibration standards of 0.20-25 ng/mL were used. Nivolumab trough concentrations after 1 cycle in 8 patients ranged from 17.3 to 31.1 mcg/mL. The range of accuracy was 84%-105%, whereas intra- and interassay variations showed a coefficient of variation of 5.5% and 10.1%, respectively. No cross-reactivity with ipilimumab was detected. Pembrolizumab trough concentrations (n = 8) ranged from 9.1 to 19.7 mcg/mL after 1 infusion. CONCLUSIONS: The in-house-developed ELISA provides the opportunity to measure both nivolumab and pembrolizumab serum concentrations. This may help identify possible ER relationships in treated cancer patients and may potentially lead to dose adjustments in the future.

Assessment of a source position checking tool for the quality assurance of transfer tubes used in HDR 192Ir brachytherapy treatments.

PURPOSE: The determination of source positions before treatment is an essential part of the quality assurance (QA) associated with high dose rate brachytherapy treatments. The purpose of this study was to design and commission a tool to allow the quantification of source positions across multiple transfer tube types. METHODS AND MATERIALS: A bespoke flexi-adapter jig, three transfer tube adapters, and a film piercing pointer were designed and built for source position QA across three transfer tube types-the standard, 6 French, and gynae transfer tubes. The jig was calibrated against a manufacturer source position check tool, and intratube and intertube source position variations investigated across a total of 40 transfer tubes, using strips of Gafchromic film irradiated at multiple positions 20 mm apart with a microSelectron V3 afterloader (Elekta, Holland). The performance of the jig in localizing the nominal dwell positions relative to the manufacturer check tool was assessed. Associated expanded uncertainties were quantified in line with the International Organization for Standardization Guidelines. RESULTS: The mean expanded uncertainty associated with the use of the jig was 0.4 ± 0.0 mm (k = 1). The performance of the jig was 0.3 ± 0.0 mm, while the intratube and intertube source positional variations were observed to be within ±1.0 mm across most transfer tubes. CONCLUSIONS: A bespoke flexi-adapter jig capable of allowing source position measurements to be carried out on various transfer tube types has been designed. Measurement results highlight the need for routine QA of all transfer tubes in clinical use.

Radiation Therapy Deficiencies Identified During On-Site Dosimetry Visits by the Imaging and Radiation Oncology Core Houston Quality Assurance Center.

PURPOSE: To review the dosimetric, mechanical, and programmatic deficiencies most frequently observed during on-site visits of radiation therapy facilities by the Imaging and Radiation Oncology Core Quality Assurance Center in Houston (IROC Houston). METHODS AND MATERIALS: The findings of IROC Houston between 2000 and 2014, including 409 institutions and 1020 linear accelerators (linacs), were compiled. On-site evaluations by IROC Houston include verification of absolute calibration (tolerance of ±3%), relative dosimetric review (tolerances of ±2% between treatment planning system [TPS] calculation and measurement), mechanical evaluation (including multileaf collimator and kilovoltage-megavoltage isocenter evaluation against Task Group [TG]-142 tolerances), and general programmatic review (including institutional quality assurance program vs TG-40 and TG-142). RESULTS: An average of 3.1 deficiencies was identified at each institution visited, a number that has decreased slightly with time. The most common errors are tabulated and include TG-40/TG-142 compliance (82% of institutions were deficient), small field size output factors (59% of institutions had errors ≥3%), and wedge factors (33% of institutions had errors ≥3%). Dosimetric errors of ≥10%, including in beam calibration, were seen at many institutions. CONCLUSIONS: There is substantial room for improvement of both dosimetric and programmatic issues in radiation therapy, which should be a high priority for the medical physics community. Particularly relevant was suboptimal beam modeling in the TPS and a corresponding failure to detect these errors by not including TPS data in the linac quality assurance process.

Método manométrico alternativo de calibración de transductores de presión para la monitorización hemodinámica invasiva / Alternative manometric method of calibration of pressure transducers for invasive hemodynamic monitoring

Introducción: La calibración de los transductores tiene gran importancia para la medición precisa de las presiones, durante la monitorización hemodinámica invasiva de los pacientes que requieren observación estrecha en las unidades de atención al grave y en el quirófano. Objetivo: Desarrollar y validar un método de calibración para transductores de presión, sencillo, eficaz y de bajo costo. Métodos: Se desarrolló un método manométrico alternativo, basado en la ley de Pascal, para la calibración de los transductores de presión durante la monitorización hemodinámica invasiva que se realiza en la Unidad de Cuidados Intensivos de Cirugía Cardiovascular del Hospital Clínico-Quirúrgico Hermanos Ameijeiras. Este método fue validado mediante la comparación con el estándar recomendado en un total de 215 pacientes que requirieron monitorización hemodinámica invasiva entre los meses de enero y junio del 2015. Resultados: Con el método manométrico alternativo creado se obtiene el mismo resultado que con el método hidráulico recomendado por la literatura. Conclusiones: El método alternativo creado es preciso, eficaz y costo-efectivo(AU)

Introduction: Transducer calibration is very important for the accurate measurement of pressures during invasive hemodynamic monitoring of patients requiring close observation in the primary care units and in the operating room. Objective: To develop and validate a method of calibration of pressure transducers, which is simple, efficient and low-cost. Methods: An alternative manometric method, based on Pascal's law, was developed for the calibration of pressure transducers during invasive hemodynamic monitoring performed at the intensive care unit of the cardiovascular surgery department at Hermanos Ameijeiras Clinical-Surgical Hospital. This method was validated by its comparison with the recommended standard in a total of 215 patients who required invasive hemodynamic monitoring between January and June 2015. Results: With the alternative manometric method created, the same result was obtained as with the hydraulic method recommended by the literature. Conclusions: The alternative method created is accurate, efficient and cost-effective(AU)

Design of Interrogation Protocols for Radiation Dose Measurements Using Optically-Stimulated Luminescent Dosimeters.

Optically-stimulated luminescent dosimeters are capable of being interrogated multiple times post-irradiation. Each interrogation removes a fraction of the signal stored within the optically-stimulated luminescent dosimeter. This signal loss must be corrected to avoid systematic errors in estimating the average signal of a series of optically-stimulated luminescent dosimeter interrogations and requires a minimum number of consecutive readings to determine an average signal that is within a desired accuracy of the true signal with a desired statistical confidence. This paper establishes a technical basis for determining the required number of readings for a particular application of these dosimeters when using certain OSL dosimetry systems.

Use of Transportable Radiation Detection Instruments to Assess Internal Contamination from Intakes of Radionuclides Part II: Calibration Factors and ICAT Computer Program.

The detonation of a radiological dispersion device or other radiological incidents could result in widespread releases of radioactive materials and intakes of radionuclides by affected individuals. Transportable radiation monitoring instruments could be used to measure radiation from gamma-emitting radionuclides in the body for triaging individuals and assigning priorities to their bioassay samples for in vitro assessments. The present study derived sets of calibration factors for four instruments: the Ludlum Model 44-2 gamma scintillator, a survey meter containing a 2.54 × 2.54-cm NaI(Tl) crystal; the Captus 3000 thyroid uptake probe, which contains a 5.08 × 5.08-cm NaI(Tl) crystal; the Transportable Portal Monitor Model TPM-903B, which contains two 3.81 × 7.62 × 182.9-cm polyvinyltoluene plastic scintillators; and a generic instrument, such as an ionization chamber, that measures exposure rates. The calibration factors enable these instruments to be used for assessing inhaled or ingested intakes of any of four radionuclides: Co, I, Cs, and Ir. The derivations used biokinetic models embodied in the DCAL computer software system developed by the Oak Ridge National Laboratory and Monte Carlo simulations using the MCNPX radiation transport code. The three physical instruments were represented by MCNP models that were developed previously. The affected individuals comprised children of five ages who were represented by the revised Oak Ridge National Laboratory pediatric phantoms, and adult men and adult women represented by the Adult Reference Computational Phantoms described in Publication 110 of the International Commission on Radiological Protection. These calibration factors can be used to calculate intakes; the intakes can be converted to committed doses by the use of tabulated dose coefficients. These calibration factors also constitute input data to the ICAT computer program, an interactive Microsoft Windows-based software package that estimates intakes of radionuclides and cumulative and committed effective doses, based on measurements made with these instruments. This program constitutes a convenient tool for assessing intakes and doses without consulting tabulated calibration factors and dose coefficients.

Evaluation of a two-part regression calibration to adjust for dietary exposure measurement error in the Cox proportional hazards model: A simulation study.

Dietary questionnaires are prone to measurement error, which bias the perceived association between dietary intake and risk of disease. Short-term measurements are required to adjust for the bias in the association. For foods that are not consumed daily, the short-term measurements are often characterized by excess zeroes. Via a simulation study, the performance of a two-part calibration model that was developed for a single-replicate study design was assessed by mimicking leafy vegetable intake reports from the multicenter European Prospective Investigation into Cancer and Nutrition (EPIC) study. In part I of the fitted two-part calibration model, a logistic distribution was assumed; in part II, a gamma distribution was assumed. The model was assessed with respect to the magnitude of the correlation between the consumption probability and the consumed amount (hereafter, cross-part correlation), the number and form of covariates in the calibration model, the percentage of zero response values, and the magnitude of the measurement error in the dietary intake. From the simulation study results, transforming the dietary variable in the regression calibration to an appropriate scale was found to be the most important factor for the model performance. Reducing the number of covariates in the model could be beneficial, but was not critical in large-sample studies. The performance was remarkably robust when fitting a one-part rather than a two-part model. The model performance was minimally affected by the cross-part correlation.

Optimizing the Exposure Indicator as a Dose Management Strategy in Computed Radiography.

PURPOSE: To investigate a technique for optimizing radiation dose and image quality for a computed radiography system. METHODS: Entrance skin doses were measured for phantom models of the pelvis and lumbar spine imaged using the vendor's recommended exposure settings (ie, the reference doses) as well as doses above and below the vendor's recommended settings for both body parts. Images were assessed using visual grading analysis (VGA). RESULTS: The phantom dosimetry results revealed strong positive linear relationships between dose and milliampere seconds (mAs), mAs and inverse exposure indicator (EI), and dose and inverse EI for both body parts. The VGA showed that optimized values of 16 mAs/EI = 136 for the anteroposterior (AP) pelvis and 32 mAs/EI = 139 for the AP lumbar spine did not compromise image quality. DISCUSSION: Selecting optimized mAs reduced dose by 36% compared with the vendor's recommended mAs (dose) values. CONCLUSION: Optimizing the mAs and associated EIs can be an effective dose management strategy.