New technology in radiological diagnosis: An investigation of diagnostic image quality in digital displays of radiographs

Digital radiology is undergoing rapid evolution. Its objectives can be summarized as the creation within the modern radiology department - and indeed within the entire hospital - of a harmonious, integrated, electronic network capable of handling all diagnostic radiological images, obviating the need for conventional film-based radiology. One of the limiting factors in the introduction and exploitation of digital technology is the issue of image display quality: if electronic display systems are to be widely used for primary radiological diagnosis, it is essential that the diagnostic quality of the displayed images should not be compromised. From the perspective of the practising radiologist, this study examines the performance of the first two commercially available digital radiological display systems to be purchased and installed in a British hospital. This work incorporates an extensive observer performance investigation of image quality from existing 1024- and 1280-line display systems, and suggests that displayed images digitized at a pixel size of 210?m show a significant reduction in diagnostic performance when compared with original film. Such systems appear to be unsuitable for primary radiological diagnosis of subtle lesions. Some of the physical properties of such systems, some relevant methodological issues, and the relationship between image quality and other factors influencing the development acceptance and implementation of digital technology, have also been investigated; the results are presented. This is a controversial subject, and conflicting views have been expressed in the British literature concerning the issue of whether or not the technology is now ready for total system implementation; the view of this author is that careful testing of display systems, and of every other component of digital networks, should precede their entry into clinical use

Dosimetry and optimisation in high dose fluoroscopic and fluorographic procedures

This thesis describes the search for a practical skin dosimetry method for cardiac catheterization procedures, and the application of an optimisation strategy in barium enema imaging. Kodak EDR2 film was characterised across the range of exposure conditions used in the cardiac catheterization laboratory. Its dose-response curve was modelled using a novel equation, and overall uncertainty in film response was estimated. The film saturated at 1 Gy, limiting its usefulness for skin dosimetry. Its performance was found to be strongly dependent on beam filtration, an aspect that had not previously been studied. The film was then used to measure skin doses to patients undergoing coronary angiograms and angioplasties. For angiograms, all skin doses were well below 1 Gy. For angioplasties, 23% of films showed localised saturation, indicating peak skin doses of at least 1 Gy. Dose-area-product was shown to be a poor predictor of high peak skin dose. A mathematical model was developed and software written, to calculate patient skin dose maps from exposure and projection data stored in the image files. This offered a practical method for assessing the magnitude and approximate location of the peak skin dose. Accuracy was limited by a lack of information regarding fluoroscopic exposures, couch position and beam limitation. After including an estimated contribution from fluoroscopy, the model successfully identified those patients whose skin doses exceeded 1 Gy. Following a baseline survey of local barium enema practice, several dose reduction methods were considered. It was decided to introduce copper filtration. 0.1 mm copper reduced mean patient DAP by 37%, without any measurable difference in contrast detail detectability. A detailed phantom study determined the optimal copper thickness as 0.3 mm. This reduced mean patient DAP by 55%, relative to the baseline survey. A visual grading analysis study showed no significant difference in clinical image quality

Investigation of the barium enema x-ray examination as a significant contributor to the genetically-significant dose from diagnostic radiology

The results of a study conducted by Maree (1995) indicated that the genetically-significant dose (GSD) for the white, female population in South Africa was considerably higher than the GSD for females in Great Britain, France and the United States of America. Further to this finding, Maree's study demonstrated that the barium enema x-ray examination was the major contributor to the GSD for this population group. A study of barium enema examinations was embarked on in order to explain the findings of Maree. The study was designed to include dose-area product measurements on patients having the barium enema procedure. In addition patient data and technique factors were recorded. The x-ray equipment used for the investigation was one digital and two non-digital fluoroscopic systems in the Western Cape. The digital unit utilised an overhead tube as did one of the conventional units. The other unit had an undercouch fluoroscopic tube and an overhead tube used for the standard radiography views. Comparison of the dose-area product measurements demonstrated that the unit having an undercouch tube had a mean dose-area product of 99.69 Gy cm² which culminates in a higher dose to the patient than the equipment utilising an overhead tube. The mean dose-area product of the two units with an overhead tube was 56.57 Gy cm² and 51.94 Gy cm² respectively. Free Air Exposure tables based on "RADCOMP Entrance Skin Exposure Software Program" (Nuclear Associates and Zamenhof, 1990) were used together with average technique factors to calculate skin entrance doses. These skin entrance doses were used to calculate gonad doses with the aid of a computer program from the Food and Drug Administration in the USA (Peterson and Rosenstein, 1989). The results were compared with the results of the barium enema component of the research conducted by Maree. The comparison indicated an average gonad dose for males of 242 μGy x 10⁻¹ (present study) compared to 485 μGy x 10⁻¹ (Maree) and an average gonad dose for females of 11185 μGy x 10⁻¹ (present study) compared to 16111 μGy x 10⁻¹ (Maree). Air-kerma at skin entrance was calculated using dose-area product measurements, recorded during the present study, for individual exposures and screening. These values were used to calculate the gonad dose. A discrepancy was demonstrated between the calculation of gonad dose from calculated as opposed measured skin entrance dose. The average gonad dose calculated by Maree is 16111 μGy x 10⁻¹ and the average gonad dose calculated for the present study using the measured skin entrance dose is 4236 μGy x 10⁻¹. This seems to explain the larger GSD estimated by Maree for the white female patients. A national protocol for measuring patient doses from x-ray examinations is proposed for South Africa

Optimisation of the digital radiographic imaging of suspected non-accidental injury.

Aim: To optimise the digital (radiographic) imaging of children presenting with suspected non-accidental injury (NAI).;Objectives: (i) To evaluate existing radiographic quality criteria, and to develop a more suitable system if these are found to be inapplicable to skeletal surveys obtained in suspected NAI. (ii) To document differences in image quality between conventional film-screen and the recently installed Fuji5000R computed radiography (CR) system at Great Ormond Street Hospital for Children, (iii) To document the extent of variability in the standard of skeletal surveys obtained in the UK for suspected NAI. (iv) To determine those radiographic parameters which yield the highest diagnostic accuracy, while still maintaining acceptable radiation dose to the child, (v) To determine how varying degrees of edge-enhancement affect diagnostic accuracy. (vi) To establish the accuracy of soft compared to hard copy interpretation of images in suspected NAI.;Materials and Methods: (i) and (ii) Retrospective analysis of 286 paediatric lateral spine radiographs by two observers based on the Commission of European Communities (CEC) quality criteria, (iii) Review of the skeletal surveys of 50 consecutive infants referred from hospitals throughout the United Kingdom (UK) with suspected NAI. (iv) Phantom studies. Leeds TO. 10 and TO. 16 test objects were used to compare the relationship between film density, exposure parameters and visualisation of object details, (iv) Clinical study. Anteroposterior and lateral post mortem skull radiographs of six consecutive infants were obtained at various exposures. Six observers independently scored the images based on visualisation of five criteria, (v) and (vi) A study of diagnostic accuracy in which six observers independently interpreted 50 radiographs from printed copies (with varying degrees of edge-enhancement) and from a monitor.;Results: The CEC criteria are useful for optimisation of imaging parameters and allow the detection of differences in quality of film-screen and digital images. There is much variability in the quality and number of radiographs performed as part of skeletal surveys in the UK for suspected NAI. The Leeds test objects are either not sensitive enough (TO. 10) or perhaps over sensitive (TO. 16) for the purposes of this project. Furthermore, the minimum spatial resolution required for digital imaging in NAI has not been established. Therefore the objective interpretation of phantom studies is difficult. There is scope for reduction of radiation dose to children with no effect on image quality. Diagnostic accuracy (fracture detection) in suspected NAI is generally low, and is not affected by image display modality.;Conclusions: The CEC quality criteria are not applicable to the assessment of clinical image quality. A national protocol for skeletal surveys in NAI is required. Dedicated training, close supervision, collaboration and consistent exposure of radiologists to cases of NAI should improve diagnostic accuracy. The potential exists for dose reduction when performing skeletal surveys in children and infants with suspected NAI. Future studies should address this issue

Dosimetry and optimisation in high dose fluoroscopic and fluorographic procedures

This thesis describes the search for a practical skin dosimetry method for cardiac catheterization procedures, and the application of an optimisation strategy in barium enema imaging. Kodak EDR2 film was characterised across the range of exposure conditions used in the cardiac catheterization laboratory. Its dose-response curve was modelled using a novel equation, and overall uncertainty in film response was estimated. The film saturated at 1 Gy, limiting its usefulness for skin dosimetry. Its performance was found to be strongly dependent on beam filtration, an aspect that had not previously been studied. The film was then used to measure skin doses to patients undergoing coronary angiograms and angioplasties. For angiograms, all skin doses were well below 1 Gy. For angioplasties, 23% of films showed localised saturation, indicating peak skin doses of at least 1 Gy. Dose-area-product was shown to be a poor predictor of high peak skin dose. A mathematical model was developed and software written, to calculate patient skin dose maps from exposure and projection data stored in the image files. This offered a practical method for assessing the magnitude and approximate location of the peak skin dose. Accuracy was limited by a lack of information regarding fluoroscopic exposures, couch position and beam limitation. After including an estimated contribution from fluoroscopy, the model successfully identified those patients whose skin doses exceeded 1 Gy. Following a baseline survey of local barium enema practice, several dose reduction methods were considered. It was decided to introduce copper filtration. 0.1 mm copper reduced mean patient DAP by 37%, without any measurable difference in contrast detail detectability. A detailed phantom study determined the optimal copper thickness as 0.3 mm. This reduced mean patient DAP by 55%, relative to the baseline survey. A visual grading analysis study showed no significant difference in clinical image quality

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. Methods: A selective review of the credible literature during the past decade (2005?2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140295/1/tmj.2016.0149.pd

Radiological perspective of the formation of pressure ulcers - a comparison of pressure and experience on two imaging surfaces

Introduction: Pressure ulcers are a high cost, high volume issue for health and medical care providers, affecting patients’ recovery and psychological wellbeing. The current research of pressure on support surfaces as a risk factor in the development of pressure ulcers is not relevant to the specialised, controlled environment of the radiological setting. Method: 38 healthy participants aged 19-51 were positioned supine on two different imaging surfaces (X-ray Table & Mattressed Table). Interface pressure data was acquired using the XSENSOR pressure mapping over a time of 2073 minutes, preceded by 6 minutes settling time to reduce measurement error. Qualitative data regarding participants’ opinion of pain and comfort was recorded using a questionnaire. Data analysis was performed using SPSS 22. Results: Data was collected from 30 participants aged 19 to 51 (mean 25.77, SD 7.72), BMI from 18.7 to 33.6 (mean 24.12, SD 3.29), for both imaging surfaces, following eight participant exclusions. Total average pressure, average pressure for jeopardy areas (head, sacrum & heels) and peak pressure for jeopardy areas were calculated as interface pressure in mmHg. Qualitative data showed that a significant difference (P<0.05) in experiences of pain and discomfort between the two surfaces. A significant difference is seen in average pressure between the two surfaces. Conclusion: Pain and comfort data also show a significant difference between the surfaces. All findings support the proposal for further investigation into the effects of radiological surfaces and overlays as a risk factor for the formation of pressure ulcers

Diseases of the Chest, Breast, Heart and Vessels 2019-2022

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology

Diseases of the Chest, Breast, Heart and Vessels 2019-2022

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology

Ultrasound Imaging

Ultrasound Imaging - Current Topics presents complex and current topics in ultrasound imaging in a simplified format. It is easy to read and exemplifies the range of experiences of each contributing author. Chapters address such topics as anatomy and dimensional variations, pediatric gastrointestinal emergencies, musculoskeletal and nerve imaging as well as molecular sonography. The book is a useful resource for researchers, students, clinicians, and sonographers looking for additional information on ultrasound imaging beyond the basics