The impact of body mass index on patient radiation dose in general radiography.

The aim of the present study was to determine the influence of the body mass index (BMI) on the dose area product (DAP) and effective dose (ED) in overweight and obese patients. We also wanted to determine the typical dose values as well as suggest adjustments to clinical practice for overweight and obese patients. In this study we considered 597 patients referred for imaging of the chest in posteroanterior and lateral projection, the lumbar spine in anteroposterior (AP) and lateral projection, the pelvis, the knee in AP and lateral projection, and the shoulder in AP projection. For each examination, the image field size, tube voltage, mAs product, source-to-image receptor distance and values of DAP were collected. Based on their BMI, the patients were divided into three groups (normal weight, overweight and obese). At the end, PCXMC 2.0 software was used to calculate the ED. The study showed a statistically significant DAP and ED increase in overweight and obese patients by 28.9% up to 275.4% in the case of DAP and an increase in ED from 11.0% to 241.9% in all mentioned examinations except knee and shoulder imaging. Typical DAP values ranged from 2.2 to 54.8µGym2for normal-weight patients, from 2.2 to 87.6µGym2for overweight patients, and from 2.2 to 172.5µGym2for obese patients. Spearman's correlation coefficient revealed very weak to very strong correlations when comparing BMI and DAP, as well as when comparing BMI and ED. A strong and very strong correlation was found in the case of examinations of the torso (except for the comparison of BMI and ED in the case of lateral lumbar spine projection).

Availability of technology for managing cancer patients in the Southeast European (SEE) region.

Background: The Southeast European (SEE) region of 10 countries and about 43 million people differs from Western Europe in that most SEE countries lack active cancer registries and have fewer diagnostic imaging devices and radiotherapy (RT) units. The main objective of this research is to initiate a common platform for gathering SEE regional cancer data from the ground up to help these countries develop common cancer management strategies. Methods: To obtain detailed on-the-ground information, we developed separate questionnaires for two SEE groups: a) ONCO - oncologists regarding cancer treatment modalities and the availability of diagnostic imaging and radiotherapy equipment; and b) REG - national radiation protection and safety regulatory bodies regarding diagnostic imaging and radiotherapy equipment in SEE facilities. Results: Based on responses from 13/17 ONCO participants (at least one from each country) and from 9/10 REG participants (all countries but Albania), cancer incidence rates are higher in those SEE countries that have greater access to diagnostic imaging equipment while cancer mortality-to-incidence (MIR) ratios are higher in countries that lack radiotherapy equipment. Conclusion: By combining unique SEE region information with data available from major global databases, we demonstrated that the availability of diagnostic imaging and radiotherapy equipment in the SEE countries is related to their economic development. While immediate diagnostic imaging and radiation therapy capacity building is necessary, it is also essential to develop both national and SEE-regional cancer registries in order to understand the heterogeneity of each country's needs and to establish regional collaborative strategies for combating cancer.

Typical air kerma area product values for trauma orthopaedic surgical procedures.

BACKGROUND: The aim of study was to establish the typical radiation quantity values for the most common trauma orthopaedic surgical procedures and to compare them with reference values of equivalent procedures performed in other institutions. In addition, we assess the impact of image intensifier and flat panel detector technology used for fluoroscopically guidance on patient exposure. MATERIALS AND METHODS: Five most frequently performed fluoroscopically guided trauma orthopaedic procedures in University Medical Centre Ljubljana were analysed. Data on 199 cases over a 6 months period from December 2016 to June 2017 were gathered retrospectively. Study covered 40 dynamic hip screw fixations (DHS), 23 proximal femoral nail insertions (PFN), 20 proximal humeral nail insertions (PHN), 77 partial hip endoprosthesis implantations (PEP) and 39 percutaneous posterior spine fixations (PPS). The median and average along with the first and third quartile values of air kerma area product (KAP) for each procedure type were calculated as well as median and average value of fluoroscopy screening time. RESULTS: Typical KAP value for dynamic hip screw fixation was set at 0.52 Gycm2; for proximal femoral nail insertion at 0.53 Gycm2 and for proximal humeral nail insertion at 0.26 Gycm2. For implantation of partial endoprosthesis typical KAP value utilizing flat panel technology was set at 0.08 Gycm2 and at 0.21 Gycm2 when the image intensifier technology was used. Typical KAP value for percutaneous posterior spine fixation was set at 1.26 Gycm2, using flat panel technology and at 3.98 Gycm2 using image intensifier technology. CONCLUSIONS: Established typical KAP levels of surgical orthopaedic procedures in traumatology will serve as a valuable tool for further radiation exposure optimization.

OPTIMAL COLLIMATION SIGNIFICANTLY IMPROVES LUMBAR SPINE RADIOGRAPHY.

PURPOSE: To determine the influence of optimal collimation during lumbar spine radiography on radiation dose and image quality. MATERIAL AND METHODS: 110 lumbar spine patients were split into two groups-the first imaged with standard collimation and the second with optimal collimation. Body mass index, image field size, exposure conditions and dose area product were measured. Effective and absorbed organ doses were calculated. Image quality was assessed. RESULTS: Optimal collimation reduced the primary field by up to 40%. The effective dose was reduced by 48% for the AP projection, while no differences were found for the LAT projection due to incorrect positioning of the central beam with standard collimation. The absorbed dose to selected radiosensitive organs decreased by 41 and 10% in the AP and LAT projections, respectively. Image quality for the LAT projection improved by 24% and maintained for the AP projection. CONCLUSION: Optimal collimation in lumbar spine imaging significantly influences patient exposure to radiation.

Comparison of anteroposterior and posteroanterior projection in lumbar spine radiography.

Background The aim of the study was to compare patient radiation dose and image quality in planar lumbar spine radiography using the PA and AP projection in a large variety of patients of both sexes and different sizes. Patients and methods In the first phase data of image field size, DAP, effective dose and image quality were gathered for AP and PA projection in lumbar spine imaging of anthropomorphic phantom. In the second phase, data of BMI, image field size, diameter of the patient's abdomen, DAP, effective dose and image quality were gathered for 100 patients of both sexes who were referred to lumbar spine radiography. The patients were divided into two groups of 50 patients, one of which was imaged using the AP projection while the other the PA projection. Results The study on the phantom showed no statistically significant difference in image field size, DAP and image quality. However, the calculated effective dose in the PA projection was 25% lower compared to AP projection (p =0.008). Measurements on the patients showed no statistically significant difference between the BMI and the image field size. In the PA projection, the thickness of abdomen was 10% (p < 10-3) lower, DAP 27% lower (p = 0.009) and the effective dose 53% (p < 10-3) lower than in AP projection. There was no statistically significant difference in image quality between the AP and the PA projection. Conclusions The study results support the use of the PA projection as the preferred method of choice in planar lumbar spine radiography.

The impact of reconstruction algorithms and time of flight information on PET/CT image quality.

BACKGROUND: The aim of the study was to explore the influence of various time-of-flight (TOF) and non-TOF reconstruction algorithms on positron emission tomography/computer tomography (PET/CT) image quality. MATERIALS AND METHODS: Measurements were performed with a triple line source phantom, consisting of capillaries with internal diameter of ∼ 1 mm and standard Jaszczak phantom. Each of the data sets was reconstructed using analytical filtered back projection (FBP) algorithm, iterative ordered subsets expectation maximization (OSEM) algorithm (4 iterations, 24 subsets) and iterative True-X algorithm incorporating a specific point spread function (PSF) correction (4 iterations, 21 subsets). Baseline OSEM (2 iterations, 8 subsets) was included for comparison. Procedures were undertaken following the National Electrical Manufacturers Association (NEMA) NU-2-2001 protocol. RESULTS: Measurement of spatial resolution in full width at half maximum (FWHM) was 5.2 mm, 4.5 mm and 2.9 mm for FBP, OSEM and True-X; and 5.1 mm, 4.5 mm and 2.9 mm for FBP+TOF, OSEM+TOF and True-X+TOF respectively. Assessment of reconstructed Jaszczak images at different concentration ratios showed that incorporation of TOF information improves cold contrast, while hot contrast only slightly, however the most prominent improvement could be seen in background variability - noise reduction. CONCLUSIONS: On the basis of the results of investigation we concluded, that incorporation of TOF information in reconstruction algorithm mostly affects reduction of the background variability (levels of noise in the image), while the improvement of spatial resolution due to incorporation of TOF information is negligible. Comparison of traditional and modern reconstruction algorithms showed that analytical FBP yields comparable results in some parameter measurements, such as cold contrast and relative count error. Iterative methods show highest levels of hot contrast, when TOF and PSF corrections were applied simultaneously.

Estimated collective effective dose to the population from radiological examinations in Slovenia.

BACKGROUND: The aim of the study was to systematically evaluate population exposure from diagnostic and interventional radiological procedures in Slovenia. METHODS: The study was conducted in scope of the "Dose Datamed 2" project. A standard methodology based on 20 selected radiological procedures was adopted. Frequencies of the procedures were determined via questionnaires that were sent to all providers of radiological procedures while data about patient exposure per procedure were collected from existing databases. Collective effective dose to the population and effective dose per capita were estimated from the collected data (DLP for CT, MGD for mammography and DAP for other procedures) using dose conversion factors. RESULTS: The total collective effective dose to the population from radiological in 2011 was estimated to 1300 manSv and an effective dose per capita to 0.6 mSv of which approximately 2/3 are due to CT procedures. CONCLUSIONS: The first systematic study of population exposure to ionising radiation from radiological procedures in Slovenia was performed. The results show that the exposure in Slovenia is under the European average. It confirmed large contributions of computed tomography and interventional procedures, identifying them as the areas that deserve special attention when it comes to justification and optimisation.

Estimated collective effective dose to the population from nuclear medicine examinations in Slovenia.

BACKGROUND: A national survey of patient exposure from nuclear medicine diagnostic procedures was performed by Slovenian Radiation Protection Administration in order to estimate their contribution to the collective effective dose to the population of Slovenia. METHODS: A set of 36 examinations with the highest contributions to the collective effective dose was identified. Data about frequencies and average administered activities of radioisotopes used for those examinations were collected from all nuclear medicine departments in Slovenia. A collective effective dose to the population and an effective dose per capita were estimated from the collected data using dose conversion factors. RESULTS: The total collective effective dose to the population from nuclear medicine diagnostic procedures in 2011 was estimated to 102 manSv, giving an effective dose per capita of 0.05 mSv. CONCLUSIONS: The comparison of results of this study with studies performed in other countries indicates that the nuclear medicine providers in Slovenia are well aware of the importance of patient protection measures and of optimisation of procedures.

The effect of breast shielding during lumbar spine radiography.

BACKGROUND: The aim of the study was to determine the influence of lead shielding on the dose to female breasts in conventional x-ray lumbar spine imaging. The correlation between the body mass index and the dose received by the breast was also investigated. MATERIALS AND METHODS: Breast surface dose was measured by thermoluminescent dosimeters (TLD). In the first phase measurements of breast dose with and without shielding from lumbar spine imaging in two projections were conducted on an anthropomorphic phantom. In the second stage measurements were performed on 100 female patients, randomly divided into two groups of 50, with breast shielding only used in one group. RESULTS: On average, breast exposure dose in lumbar spine imaging in both projections (anteroposterior (AP) and lateral) was found reduced by approximately 80% (p < 0,001) when shielding with 0.5 mm lead equivalent was used (from 0.45±0.25 mGy to 0.09±0.07 mGy on the right and from 0.26±0.14 mGy to 0.06±0.04 mGy on the left breast). No correlation between the body mass index (BMI) and the breast surface radiation dose was observed. CONCLUSIONS: Although during the lumbar spine imaging breasts receive low-dose exposure even when shielding is not used, the dose can be reduced up to 80% by breast shielding with no influence on the image quality.