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Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.
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Purpose: Optimization studies in digital radiology help to reduce the radiological risk to patients and maximize the benefits associated with their clinical purpose. The aim of this study was to assess the optimization of lateral lumbar spine projection via a combination of exposure parameters adjustments and additional filtration using a sectional anthropomorphic phantom. Materials and methods: We evaluated the effects of peak voltage, tube loading, and low-cost filters made of copper, titanium, brass, and nickel on both the perceived and physical quality of 125 radiographs obtained in a computer radiography system. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with their Figure of Merit (FOM), based on the entrance surface air kerma with backscatter (ESAK), was used to assess physical image quality. Results: The standard image had a perceived image quality, SNR, FOMSNR, CNR, FOMCNR and ESAK of 3.4, 22.3, 386.4, 23.6, 433.7 and 1.28 mGy, respectively. Copper (90.3% purity) and titanium (95.0% purity) filters reduced ESAK by an average of 60% without compromising diagnostic quality, while brass and nickel filters increased dose under the conditions of the study. Conclusions: Our findings show that optimizing lumbar spine projection can reduce radiation dose without compromising image quality. Low-cost copper and titanium filters can be valuable in resource-limited settings. Further research can explore additional strategies for radiological optimization.
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RESUMEN: La información que aportan los procedimientos de radiología dental, tanto en la evaluación, como en el diagnóstico y tratamiento de patologías y/o alteraciones dento maxilofaciales, hace que correspondan al tipo más frecuente de estudio radiológico. Sin embargo, existe un escaso conocimiento en nuestro país respecto de los niveles de dosis que se imparten en dichos procedimientos, haciendo necesaria su determinación para maximizar el beneficio derivado de los mismos y minimizar el riesgo radiológico para los pacientes. El presente estudio determinó el nivel de referencia para diagnóstico (NRD) local en la radiografía periapical de Molar maxilar e Incisivo, para ello se realizaron simulaciones de los procedimientos radiográficos en un maniquí antropomorfo seccional y se determinó el valor de Kerma aire en la superficie de entrada con retrodispersión mediante dosimetría termoluminiscente. Los NRD locales determinados en la radiografía periapical de Molar maxilar fueron 5,6 mGy para adultos y 4,0 mGy para niños; mientras que en la radiografía periapical de Incisivo fue de 9,2 mGy para pacientes adultos y 1,8 mGy para niños. Los resultados obtenidos buscan orientar la ejecución de futuras investigaciones en el área y aportar información del nivel de radiación en estos procedimientos, con lo que se espera promover una cultura de radioprotección y motivar la optimización de las dosis registradas.
ABSTRACT: The information provided by dental radiology procedures, both in evaluation, as well as in the diagnosis and treatment of pathologies and / or dentomaxilofacial alterations, makes them the most frequent type of radiological study. However, there is a meager knowledge in our country regarding dose levels applied in such procedures, making their determination necessary to maximize the benefits and to minimize the radiological risk to patients. The present study determined the local diagnostic reference level (LDRL) for the periapical radiography of the Maxillary molar and Incisive. Simulations of radiographic procedures were performed and the value of air Kerma at the entrance surface with backscattering, was estimated using thermo luminescent dosimetry. The LDRL determined in the maxillary molar periapical radiography was 5.6 mGy for adults and 4.0 mGy for children; while on the incisive periapical radiography it was 9.2 mGy for adult patients and 1.8 mGy for children. The results obtained seek to guide the execution of future research in the area and provide information on the radiation doses delivered in these procedures, which is expected to promote a radiation protection culture and motivate the optimization of the registered doses.
