Research activity among diagnostic and therapeutic radiographers: An international survey.

INTRODUCTION: Various national solutions have been considered and implemented to address the factors which limit radiographer engagement in conducting research. Nevertheless, national literature continues to suggest that radiographer engagement in research remains low. The aim of this study was to extend the existing evidence base by conducting an international survey to assess diagnostic radiographers and therapeutic radiographers involvement with, barriers to and support mechanisms for research. METHODS: Data collection was obtained via an online questionnaire which was distributed by the International Society of Radiographers and Radiologic Technologists (ISRRT). The study population included an international sample of qualified diagnostic radiographers and therapeutic radiographers across clinical and academic contexts in a variety of different roles such as clinical practice, management, education and research. RESULTS: In total, 420 diagnostic radiographers and therapeutic radiographers completed the survey. Multiple reasons were identified that were considered to inhibit respondents from conducting research. 69.3% indicated a combination of reasons for lack of engagement with research, rather than one single issue. Examples of reasons include: lack of time, insufficient research funding, limited research expertise, and lack of a suitable mentorship scheme. CONCLUSION: A minor segment of survey respondents indicated involvement in research activity. Lack of dedicated time to research, mentors, and funding were among the main barriers to conduct research. Further research is required to explore what solutions are available to overcoming the barriers.

CellPalmSeq: A curated RNAseq database of palmitoylating and de-palmitoylating enzyme expression in human cell types and laboratory cell lines.

The reversible lipid modification protein S-palmitoylation can dynamically modify the localization, diffusion, function, conformation and physical interactions of substrate proteins. Dysregulated S-palmitoylation is associated with a multitude of human diseases including brain and metabolic disorders, viral infection and cancer. However, the diverse expression patterns of the genes that regulate palmitoylation in the broad range of human cell types are currently unexplored, and their expression in commonly used cell lines that are the workhorse of basic and preclinical research are often overlooked when studying palmitoylation dependent processes. We therefore created CellPalmSeq (https://cellpalmseq.med.ubc.ca), a curated RNAseq database and interactive webtool for visualization of the expression patterns of the genes that regulate palmitoylation across human single cell types, bulk tissue, cancer cell lines and commonly used laboratory non-human cell lines. This resource will allow exploration of these expression patterns, revealing important insights into cellular physiology and disease, and will aid with cell line selection and the interpretation of results when studying important cellular processes that depend on protein S-palmitoylation.

Examining the effectiveness of supplementary imaging modalities for breast cancer screening in women with dense breasts: A systematic review and meta-analysis.

PURPOSE: To systematically review studies on the effectiveness of supplementary imaging for breast cancer screening in women with dense breasts. MATERIALS AND METHODS: A systematic search of peer-reviewed publications in English (January 2000 to March 2021) was carried out. Eight databases were used to retrieve the studies: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Clinical Answers, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, PubMed, and Web of Science. Two radiographers and an academic independently reviewed the articles to determine if the studies met inclusion criteria. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Summary estimates of diagnostic accuracy were obtained by using proportion and diagnostic metanalysis. RESULTS: From 3764 studies that underwent title and abstract screening, 221 studies underwent full-text screening. Of these 42 were included in the qualitative and quantitative synthesis. Results for sensitivity, specificity, positive and negative predictive values, cancer detection rates, recall and biopsy rates in women with dense breasts undergoing supplementary imaging were reported. Studies included in this review were heterogeneous, as was the proportion of women undergoing prevalence and incidence screening rounds. CONCLUSIONS: Supplementary screening among women with dense breasts who had recent negative mammograms can consistently identify additional cancers and lead to further recalls and biopsies.

Exploring the expression patterns of palmitoylating and de-palmitoylating enzymes in the mouse brain using the curated RNA-seq database BrainPalmSeq.

Protein S-palmitoylation is a reversible post-translational lipid modification that plays a critical role in neuronal development and plasticity, while dysregulated S-palmitoylation underlies a number of severe neurological disorders. Dynamic S-palmitoylation is regulated by a large family of ZDHHC palmitoylating enzymes, their accessory proteins, and a small number of known de-palmitoylating enzymes. Here, we curated and analyzed expression data for the proteins that regulate S-palmitoylation from publicly available RNAseq datasets, providing a comprehensive overview of their distribution in the mouse nervous system. We developed a web-tool that enables interactive visualization of the expression patterns for these proteins in the nervous system (http://brainpalmseq.med.ubc.ca/), and explored this resource to find region and cell-type specific expression patterns that give insight into the function of palmitoylating and de-palmitoylating enzymes in the brain and neurological disorders. We found coordinated expression of ZDHHC enzymes with their accessory proteins, de-palmitoylating enzymes and other brain-expressed genes that included an enrichment of S-palmitoylation substrates. Finally, we utilized ZDHHC expression patterns to predict and validate palmitoylating enzyme-substrate interactions.

Improving Competency in Safe Patient Handling Through Online Learning Beyond the Classroom: A Longitudinal Study.

IMPORTANCE: Safe patient handling is intrinsic in health care provision, yet education in the skills required for safe patient handling is inconsistently delivered, with limited evidence that traditional face-to-face training reduces risk. OBJECTIVE: To assess the long-term effectiveness of replacing annual practical handling updates with an online training system, combined with competency assessment of skill and safety. DESIGN: Quasi-experimental longitudinal 3-yr study to track practical people handling skill development among undergraduate occupational therapy students. All participants had access to a multimedia online training system (that replaced tutor-led practical training), used in combination with annual competency evaluations to measure skills and safety in four people handling tasks. SETTING: All competency assessment took place on site in the School of Health and Society, University of Salford (Salford, United Kingdom). PARTICIPANTS: Undergraduate BSc(Hons) occupational therapy students (N = 243). Outcomes and Measures: Participants attended individual 45-min competency evaluations at three data collection points: beginning of Years 2 and 3 and end of Year 3. Data were collected by trained assessors using a competency assessment tool. RESULTS: Results demonstrate significant increases in skill level for sit-to-stand and repositioning in the chair (p < .05) and for hoisting and slide sheet maneuvers (p < .0001). Participants achieved 100% safety scores for repositioning in the chair and hoisting. CONCLUSIONS AND RELEVANCE: Students using the online system performed significantly better than students receiving traditional annual practical updates, providing an evidence base to reduce tutor-led training hours while increasing skill and safety levels using a combination of the online system and competency assessment. What This Article Adds: This approach was found to reinforce safe handling techniques and increase independence, competency, and safety of service users and caregivers working in health and social care environments while reducing time spent delivering annual people handling updates. The findings support replacement of face-to-face training updates, particularly in the current climate of social distancing.

Bulk Dye Loading for In Vivo Calcium Imaging of Visual Responses in Populations of Xenopus Tectal Neurons.

Bulk loading of neurons with fluorescent calcium indicators in transparent albino Xenopus tadpoles offers a rapid and easy method for tracking sensory-evoked activity in large numbers of neurons within an awake developing brain circuit. In vivo two-photon time-lapse imaging of an image plane through the optic tectum allows defining receptive field properties from visual-evoked responses for studies of single-neuron and network-level encoding and plasticity. Here, we describe loading the Xenopus tadpole optic tectum with the membrane-permeable AM ester of Oregon Green 488 BAPTA-1 (OGB-1 AM) for in vivo imaging experiments.

Quantifying neuronal structural changes over time using dynamic morphometrics.

Brain circuit development involves tremendous structural formation and rearrangement of dendrites, axons, and the synaptic connections between them. Direct studies of neuronal morphogenesis are now possible through recent developments in multiple technologies, including single-neuron labeling, time-lapse imaging in intact tissues, and 4D rendering software capable of tracking neural growth over periods spanning minutes to days. These methods allow detailed quantification of structural changes of neurons over time, called dynamic morphometrics, providing new insights into fundamental growth patterns, underlying molecular mechanisms, and the intertwined influences of external factors, including neural activity, and intrinsic genetic programs. Here, we review the methods of dynamic morphometrics sampling and analyses, focusing on their applications to studies of activity-driven dendritogenesis in vertebrate systems.

Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose.

OBJECTIVES: Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. METHODS: 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose-area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). RESULTS: Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. CONCLUSION: Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.

Pressure distribution analysis of X-Ray table mattresses.

BACKGROUND: There is a risk of developing pressure ulcers from lying on an X-ray table mattress, if the mattress pressure redistribution properties are poor. AIM: To assess the pressure redistribution properties of 'new' and 'in current clinical use' X-ray table mattresses. METHODS AND MATERIALS: Twenty one X-ray table mattresses, each of 2.5 cm thickness, were evaluated. An anthropomorphic human phantom of adult stature with five different weights (minimum, first quartile, mean, third quartile and maximum) was used to simulate human head, pelvis and heels (pressure ulcer jeopardy areas). Using Xsensor technology, peak pressure was measured and Interface Pressure Ratio was calculated for the three pressure ulcer jeopardy areas 'with' and 'without' an X-ray table mattress. RESULTS: For all mattresses, statistically significant differences (p < 0.05) were found between the peak pressure values with and without using an X-ray table mattress for the three pressure ulcer jeopardy areas; similarly, for all mattresses, statistically significant differences (p < 0.05) were found between the Interface Pressure Ratio values with and without using x-ray table mattress. The type and age of the mattress was observed to have an impact on peak pressure values and Interface Pressure Ratios, with older mattresses performing worse. CONCLUSION: Peak pressure values and Interface Pressure Ratios are reduced significantly when using newer X-ray table mattresses. This could be because newer mattresses use more appropriate materials in their construction and/or older mattresses have lost their pressure redistribution properties. Radiology departments should consider assessing mattresses pressure redistribution properties, perhaps on an annual basis.

An Experimental Intervention Study Assessing the Impact of a Thin Silicone Gel Surface Overlay on Interface Pressure.

INTRODUCTION: The incidence of pressure ulcers (PUs) presents a substantial threat to patients, especially geriatric patients, those with restricted mobility, and patients suffering from chronic diseases such as cancer. PUs creates a huge financial burden on healthcare authorities and patients, costing billions to treat and manage. Radiography and radiotherapy patients may experience medical device related (MDR) PUs and studies have shown that high interface pressure (IP) values exist for the head when placed on an X-ray table without a mattress. These high IP values pose a PU risk to patients, especially those accessing prolonged radiography/radiology and radiotherapy procedures. The current study assessed the impact on IP values for the head from using a thin silicone gel surface overlay during radiographic procedures and identified whether this reduced the risk of PUs. MATERIALS AND METHODS: A calibrated XSENSOR pressure mat was used to measure IP for the head on an X-ray table with and without a thin silicone gel surface overlay. Prior to pressure mapping, the silicone gel surface overlay was assessed for its impact on radiation attenuation and image quality. RESULTS: Study participants were 14 males (70%) and six females (30%), with an age range of 25-53 years (mean = 34.4 ± 7.0). Paired-samples t-test results indicated that there was a statistically significant decrease in the mean IP for the head on the X-ray table without the silicone gel surface overlay (mean = 83.9 ± 8.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 62.4 ± 6.1 in mmHg), p ≤ 0.001. Paired-samples t-test results indicated that there was a statistically significant decrease in the mean peak pressure index (PPI) for the head on the X-ray table without the silicone gel surface overlay (mean = 205.1 ± 28.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 159.8 ± 26.8 in mmHg), p ≤ 0.001. CONCLUSIONS: The use of a thin silicone gel surface overlay could reduce IP risk for the head by approximately 25%. The reduction in IP risk could have a significant impact in reducing the risk of developing a PU. To ensure maximum benefit, the silicone gel surface overlay should be evaluated to address the specific needs within radiography and radiotherapy planning and treatment settings.

Radiation dose from digital breast tomosynthesis screening - A comparison with full field digital mammography.

OBJECTIVES: To compare Mean Glandular Dose (MGD) and effective dose from digital breast tomosynthesis (DBT) screening with that from full field digital mammography (FFDM) screening. METHOD: To simulate compressed breasts, two Perspex-polyethylene breast phantoms were used, one phantom for compressed breast in craniocaudal and the other for compressed breast in mediolateral oblique. An adult ATOM dosimetry phantom was loaded with high sensitivity thermoluminescence dosimeters; the phantom was then positioned on Hologic Selenia Dimensions mammographic machine to imitate DBT and 4-view FFDM screening. Organ radiation doses were measured from 4-view DBT and 4-view FFDM (craniocaudal and mediolateral oblique views for each breast). Organ radiation doses were used to calculate effective dose from one screening session. RESULTS: MGD for DBT was 3.6 mGy; MGD for FFDM was 2.8 mGy. For DBT, other organs (e.g. thymus, lungs, salivary glands, thyroid, contralateral breast and bone marrow) radiation dose was also higher than for FFDM. The use of DBT for breast cancer screening increases the effective dose (E) of one screening session by 22%. E for DBT was 0.44 mSv; E for FFDM was 0.34 mSv. CONCLUSION: The use of DBT for breast cancer screening increases the radiation dose to screening clients.

A narrative review on pressure ulcer (PU) studies relevant to medical imaging.

Pressure ulcers (PUs) are defined as localised injuries to the skin and/or underlying tissue as a result of pressure or pressure together with shear. PUs present significant health implications to patients; costing billions to manage and/or treat. The burden of PU prevention in hospitals must be the concern of all healthcare professionals, including radiographers. The purpose of this narrative review article was to identify and critically evaluate relevant literature and research conducted into pressure ulcers (PUs) relevant to medical imaging. It is expected that this review article will increase the level of awareness about PUs amongst radiographers and help to develop appropriate interventions to minimise the risk of PUs. A literature search was conducted in PubMed/Medline, Scopus, CINAHL, and Google Scholar to retrieve relevant articles. Also, books, professional body guidelines, magazines, grey and unpublished literatures were also searched. The search was limited to English Language articles. Only five articles were retrieved and reviewed. There are limited studies on PUs relevant to medical imaging. Available studies provide some evidence that radiographic procedures and settings subject patients attending for radiographic procedures to the risk of PUs. Further studies are needed into PU risk assessment, minimisation and management in medical imaging to help raise awareness and address the problem of the potential for PU development.

A Phantom-Based Method to Assess X-Ray Table Mattress Interface Pressures.

BACKGROUND: Pressure redistribution performance of x-ray table mattresses can influence the development of pressure ulcers in at-risk populations. Interface pressure analysis, with human participants, is a common method to assess mattresses. This approach has limitations that relate to the lack of standardisation between and within humans. AIM: This study aimed to develop and validate an anthropomorphic phantom-based method to assess x-ray table mattress interface pressures as an index of mattress performance. METHODS: A three dimensional phantom simulating an adult's head, pelvis, and heels was printed from x-ray computed tomography image data and attached to a metal frame 175 cm in length. Dry sand was added to the phantom head, pelvis, and heels to represent a range of human weights. Pressure distribution was assessed using XSensor. Phantom validation was achieved by comparing phantom mattress interface pressure characteristics, for five human equivalent weights, against 27 sets of human mattress interface pressure data. RESULTS: Using the correlation coefficient R, phantom and human pressure data showed good correlation for the five phantom weights (R values: head = 0.993, pelvis = 0.997, and heels = 0.996). CONCLUSION: A novel method to test x-ray mattresses for interface pressure was developed and validated. The method could have utility in the testing of x-ray mattresses that are in routine use and for new mattress development. Phantom interface pressure data could be provided by manufacturers to help inform procurement decisions when matching mattress characteristics to medical imaging demands and the underlying patient populations.

Dose optimisation in paediatric radiography - Using regression models to investigate the relative impact of acquisition factors on image quality and radiation dose.

OBJECTIVE: To investigate the optimum pelvis X-ray acquisition factors for a 10-year-old child. Secondly, to evaluate the impact of each acquisition factor on image quality (IQ) and radiation dose. METHOD: Images were acquired using a pelvis phantom and a range of acquisition parameters; e.g. tube potential, additional filtration and source-to-image distance (SID). Automatic exposure control (AEC) was used with two orientations (head towards/away from two outer chambers) and three different chamber selections. Visual IQ was evaluated using relative and absolute-VGA methods. Radiation doses were measured by placing a dosimeter on the anterior surface of the phantom. Regression analysis was used to determine optimum parameters. RESULTS: The optimised technique (178.8 µGy), with diagnostic IQ, was with 89kVp, 130 cm SID and with 1 mm Al + 0.1 mm Cu filtration. This technique was with the head towards the two outer AEC chambers. Regression analysis showed that SID had the lowest impact on IQ (ß = 0.002 95% CI -0.001 to 0.005) and dose (ß = -0.96 95% CI -0.40 to -1.53). The impact of filtration on dose (ß = -76.24 95% CI -86.76 to -85.72) was higher than tube potential (ß = -13.44 95% CI -14.34 to -12.53). The following impact ratios were higher on IQ than radiation dose: filtration/kVp; 11.28 times, filtration/SID; 7.01 times and kVp/SID; 0.62 times. CONCLUSION: Optimised parameters were identified as 89 kVp, 130 cm SID and with 1 mm Al + 0.1 mm Cu additional filtration. Regression analysis demonstrated that filtration and tube potential had the greatest effect on radiation dose and IQ, respectively.

Impact of acquisition parameters on dose and image quality optimisation in paediatric pelvis radiography-A phantom study.

PURPOSE: Within paediatric pelvis imaging there is a lack of systematic dose optimisation studies which consider age and size variations. This paper presents data from dose optimisation studies using digital radiography and pelvis phantoms representing 1 and 5-year-old children. MATERIAL AND METHOD: Dose optimisation included assessments of image quality and radiation dose. Systematic variations using a factorial design for acquisition factors (kVp, mAs, source-detector distance [SDD] and filtration) were undertaken to acquire AP pelvis X-ray images. Perceptual image quality was assessed using a relative and absolute visual grading assessment (VGA) method. Radiation doses were measured by placing a dosimeter at the radiographic centring point on the surface of each phantom. Statistical analyses for determining the optimised parameters included main effects analysis. RESULTS: Optimised techniques, with diagnostically acceptable image quality, for each paediatric age were: 1-year-old; 65 kVp, 2 mAs and 115 cm SDD, while, 5-year-old; 62 kVp, 8 mAs and 130 cm SDD both included 1 mm Al +0.1 mm Cu additional filtration. The main effect analysis identified situations in which image quality and radiation dose increased or decreased, except for kVp which showed peak image quality when exposure factors were increased. A set of minimum mAs values for producing diagnostic image quality were identified. Increasing SDD, unlike the other exposure factors, showed no trends for producing non-diagnostic images. CONCLUSION: The factorial design provided an opportunity to identify suitable acquisition factors. This study provided a method for investigating the combined effect of multiple acquisition parameters on image quality and radiation dose for children.

Impact of Contralateral Breast Shielding on the Risk of Developing Radiation-induced Cancer from Full-field Digital Mammography Screening.

OBJECTIVE: The objective of this study was to investigate the impact of contralateral breast shielding on the risk of developing radiation-induced cancer from four-view full-field digital mammography (FFDM) screening. METHODS: A poly methyl methacrylate-polyethylene breast phantom and adult ATOM dosimetry phantom were used to measure organ dose on four FFDM machines using craniocaudal and mediolateral oblique projections for each breast. A lead rubber shield of 0.25 mm equivalent lead thickness was used to protect the contralateral breast. Organs dose, effective dose, and effective risk were calculated. For effective risk estimations, the impact of the shield was considered for the routine screening views. RESULTS: The contralateral breast dose was reduced by more than 95%. For each FFDM machine, contralateral breast dose reduction in µGy were 35.20 reduced to 1.93, 41.40 reduced to 0.01, 22.85 reduced to 1.24, and 22.76 reduced to 1.66. Effective risk reduction was significant (P < .05). For all FFDM machines, a small reduction was identified in sternum bone marrow dose due to the use of contralateral breast shield. CONCLUSIONS: The results of the study demonstrate the value of a contralateral breast shield. More research is required to determine whether such a shield has clinical utility.

Comparative analysis of radiation dose and low contrast detail detectability using routine paediatric chest radiography protocols.

OBJECTIVES: To compare low contrast detail (LCD) detectability and radiation dose for routine paediatric chest X-ray (CXR) imaging protocols among various hospitals. METHODS: CDRAD 2.0 phantom and medical grade polymethyl methacrylate (PMMA) slabs were used to simulate the chest region of four different paediatric age groups. Radiographic acquisitions were undertaken on 17 X-ray machines located in eight hospitals using their existing CXR protocols. LCD detectability represented by image quality figure inverse (IQFinv) was measured physically using the CDRAD analyser software. Incident air kerma (IAK) measurements were obtained using a solid-state dosimeter. RESULTS: The range of IQFinv, between and within the hospitals, was 1.40-4.44 and 1.52-2.18, respectively for neonates; 0.96-4.73 and 2.33-4.73 for a 1-year old; 0.87-1.81 and 0.98-1.46 for a 5-year old and 0.90-2.39 and 1.27-2.39 for a 10-year old. The range of IAK, between and within the hospitals, was 8.56-52.62 µGy and 21.79-52.62 µGy, respectively for neonates; 5.44-82.82 µGy and 36.78-82.82 µGy for a 1-year old; 10.97-59.22 µGy and 11.75-52.94 µGy for a 5-year old and 13.97-100.77 µGy and 35.72-100.77 µGy for a 10-year old. CONCLUSIONS: Results show considerable variation, between and within hospitals, in the LCD detectability and IAK. Further radiation dose optimisation for the four paediatric age groups, especially in hospitals /X-ray rooms with low LCD detectability and high IAK, are required.

An Investigation of Pressure Ulcer Risk, Comfort, and Pain in Medical Imaging.

INTRODUCTION: Pressure ulcers present significant trauma to patients and are expensive to manage. In medical imaging (MI), no study has been conducted to rigorously investigate interface pressure (IP) risk on MI table surfaces. IP is defined as the pressure between human body and a supporting surface. The aims of this research were to investigate whether IP risks exist on MI table surfaces and to assess pain and comfort when lying on MI table surfaces. METHODS: A calibrated XSENSOR mat was used to measure IP for three jeopardy areas (head, sacrum, and heels) in healthy volunteers on an x-ray table surface with no mattress, an x-ray table surface with a thin radiolucent mattress, and a computed tomography table surface, after which they completed a pain and comfort questionnaire. RESULTS: The sample consisted of 26 females and 23 males aged 18-59 years (mean = 34.6; standard deviation [SD] = 10.5). Analysis of variance identified statistically significant differences in the mean IP for the jeopardy areas across the three MI table surfaces (P ≤ .001). Results also indicated high mean IP value for the head (75.9 mmHg; SD = 6.9) on the x-ray table with no mattress. Seventy percent of the volunteers found lying on the x-ray table with no mattress to be very uncomfortable. Sixty-seven percent experienced most pain whilst lying on the x-ray table with no mattress and over 81% of the pain occurred at the head. CONCLUSION: IP risk exists on x-ray tables with no mattress. This could increase the risk of developing pressure ulcers in patients accessing prolonged radiography/radiology procedures.

Relationship between body habitus and image quality and radiation dose in chest X-ray examinations: A phantom study.

PURPOSE: To evaluate the influence of being overweight on image quality (IQ), radiation dose and acquisition parameters when undertaking adult chest X-ray (CXR) examinations using routine acquisition protocols. METHODS: The Lungman chest phantom, with and without chest plates, was used to simulate the chest region for larger size and average adult patients, respectively. Radiographic acquisitions were conducted using 17 X-ray machines located in eight hospitals using their routine clinical protocols. IQ was assessed using relative visual grading analysis (VGA) and 2 alternative forced choice (2AFC) by six observers. Incident air kerma (IAK) was measured using a solid-state dosimeter. RESULTS: IQ mean (range) scores between the hospitals were 16.2 (12.0-21.3) with a 56.0% difference and 20.9 (14.1-23.6) with a 50.2% difference for the standard and larger size phantoms, respectively. IAK mean (range) scores 63 µGy (19-136 µGy) with a 150% difference and 159 µGy (27-384 µGy) with a 173% difference for the standard and larger size phantoms, respectively. The chest plates had a significant negative impact on IQ (P = 0.001) and lead to an increased in IAK by approximately 50%. CONCLUSION: Visual measures of IQ and IAK showed large differences between hospitals for standard and larger phantom sizes; differences within the hospitals was lower. Overall, Lungman with chest plates was found to degrade IQ and increase radiation dose by a factor of two. Further optimisation is required especially for the larger sized patient's imaging protocols for all eight hospitals.