An investigation into the validity of utilising the CDRAD 2.0 phantom for optimisation studies in digital radiography

Objectives: To determine if a relationship exists between low contrast detail (LCD) detectability using the CDRAD 2.0 phantom, visual measures of image quality (IQ) and simulated lesion visibility (LV) when performing digital chest radiography (CXR). Methods: Using a range of acquisition parameters, a CDRAD 2.0 phantom was used to acquire a set of images with different levels of image quality. LCD detectability using the CDRAD 2.0 phantom, represented by an image quality figure inverse (IQFinv) metric, was determined using the phantom analyser software. A Lungman chest phantom was loaded with two simulated lesions, of different sizes / placed in different locations, and was imaged using the same acquisition factors as the CDRAD phantom. A relative visual grading analysis (VGA) was used by seven observers for IQ and LV evaluation of the Lungman images. Correlations between IQFinv, IQ and LV were investigated. Results: Pearson’s correlation demonstrated a strong positive correlation (r=0.91; p<0.001) between the IQ and the IQFinv. Spearman’s correlation showed a good positive correlation (r=0.79; p<0.001) and (r=0.68; p<0.001) between the IQFinv and the LV for the first lesion (left upper lobe) and the second lesion (right middle lobe), respectively. Conclusions: From results presented in this study, the automated evaluation of LCD detectability using CDRAD 2.0 phantom is likely to be a suitable option for IQ and LV evaluation in digital CXR optimisation studies

A novel method for comparing radiation dose and image quality, between and within different X-ray units in a series of hospitals

Objectives: To develop a novel method for comparing radiation dose and image quality (IQ) to evaluate adult chest X-ray (CXR) imaging among several hospitals. Methods: CDRAD 2.0 phantom was used to acquire images in eight hospitals (17 digital X-ray units) using local adult CXR protocols. IQ was represented by image quality figure inverse (IQFinv), measured using CDRAD analyser software. Signal to noise ratio (SNR), contrast to noise ratio (CNR) and conspicuity index (CI) were calculated as additional measures of IQ. Incident air kerma (IAK) was calculated using a solid-state dosimeter for each acquisition. Figure of merit (FOM) was calculated to provide a single estimation of IQ and radiation dose. Results: IQ, radiation dose and FOM varied considerably between hospitals and X-ray units. For IQFinv, the mean (range) between and within the hospitals were 1.42 (0.83-2.18) and 1.87 (1.52-2.18), respectively. For IAK, the mean (range) between and within the hospitals were 93.56 (17.26 to 239.15) µGy and 180.85 (122.58-239.15) µGy, respectively. For FOM, the mean (range) between and within hospitals were 0.05 (0.01 to 0.14) and 0.03 (0.02-0.05), respectively. Conclusions: The suggested method for comparing IQ and dose using FOM concept along with the new proposed FOM, is a valid, reliable and effective approach for monitoring and comparing IQ and dose between and within hospitals. It is also can be beneficial for the optimisation of X-ray units in clinical practice. Further optimisation for the hospitals /X-ray units with low FOM are required to minimise radiation dose without degrading IQ

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. Keywords: Paediatric chest radiography, CDRAD phantom, low contrast detail detectability and radiation dose

Neonatal chest radiography : influence of standard clinical protocols and radiographic equipment on pathology visibility and radiation dose using a neonatal chest phantom

Introduction: Little is known about the variations in pathology visibility (PV) and their corresponding radiation dose values for neonatal chest radiography, between and within hospitals. Large variations in PV could influence the diagnostic outcome and the variations in radiation dose could affect the risk to patients. The aim of this study is to compare the PV and radiation dose for standard neonatal chest radiography protocols among a series of public hospitals. Methods: A Gammex 610 neonatal chest phantom was used to simulate the chest region of neonates. Radiographic acquisitions were conducted on 17 X-ray machines located in eight hospitals, utilising their current neonatal chest radiography protocols. Six qualified radiographers assessed PV visually using a relative visual grading analysis (VGA). Signal to noise ratios (SNR) and contrast to noise ratios (CNR) were measured as a measure of image quality (IQ). Incident air kerma (IAK) was measured using a solid-state dosimeter. Results: PV and radiation dose varied substantially between and within hospitals. For PV, the mean (range) VGA scores, between and within the hospitals, were 2.69 (2.00 to 3.50) and 2.73 (2.33 to 3.33), respectively. For IAK, the mean (range), between and within the hospitals, were 24.45 (8.11 to 49.94) µGy and 34.86 (22.26 to 49.94) µGy, respectively. Conclusion: Between and within participating hospitals there was wide variation in the visibility of simulated pathology and radiation dose (IAK). Implications for practice: X-ray units with lower PV and higher doses require optimisation of their standard clinical protocols. Institutions which can offer acceptable levels of PV but with lower radiation doses should help facilitate national optimisation processes

Effects of body part thickness on low‐contrast detail detection and radiation dose during adult chest radiography

Introduction Differences in patient size often provide challenges for radiographers, particularly when choosing the optimum acquisition parameters to obtain radiographs with acceptable image quality (IQ) for diagnosis. This study aimed to assess the effect of body part thickness on IQ in terms of low‐contrast detail (LCD) detection and radiation dose when undertaking adult chest radiography (CXR). Methods This investigation made use of a contrast detail (CD) phantom. Polymethyl methacrylate (PMMA) was utilised to approximate varied body part thicknesses (9, 11, 15 and 17 cm) simulating underweight, standard, overweight and obese patients, respectively. Different tube potentials were tested against a fixed 180 cm source to image distance (SID) and automatic exposure control (AEC). IQ was analysed using bespoke software thus providing an image quality figure inverse (IQFinv) value which represents LCD detectability. Dose area product (DAP) was utilised to represent the radiation dose. Results IQFinv values decreased statistically (P = 0.0001) with increasing phantom size across all tube potentials studied. The highest IQFinv values were obtained at 80 kVp for all phantom thicknesses (2.29, 2.02, 1.8 and 1.65, respectively). Radiation dose increased statistically (P = 0.0001) again with increasing phantom thicknesses. Conclusion Our findings demonstrate that lower tube potentials provide the highest IQFinv scores for various body part thicknesses. This is not consistent with professional practice because radiographers frequently raise the tube potential with increased part thickness. Higher tube potentials did result in radiation dose reductions. Establishing a balance between dose and IQ, which must be acceptable for diagnosis, can prevent the patient from receiving unnecessary additional radiation dose

SPARC 2017 retrospect & prospects : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2017 SPARC conference. This year we not only celebrate the work of our PGRs but also the 50th anniversary of Salford as a University, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 130 presenters, the conference truly showcases a vibrant PGR community at Salford. These abstracts provide a taster of the research strengths of their works, and provide delegates with a reference point for networking and initiating critical debate. With such wide-ranging topics being showcased, we encourage you to exploit this great opportunity to engage with researchers working in different subject areas to your own. To meet global challenges, high impact research inevitably requires interdisciplinary collaboration. This is recognised by all major research funders. Therefore engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers

Loss of UGP2 in brain leads to a severe epileptic encephalopathy, emphasizing that bi-allelic isoform-specific start-loss mutations of essential genes can cause genetic diseases.

Developmental and/or epileptic encephalopathies (DEEs) are a group of devastating genetic disorders, resulting in early-onset, therapy-resistant seizures and developmental delay. Here we report on 22 individuals from 15 families presenting with a severe form of intractable epilepsy, severe developmental delay, progressive microcephaly, visual disturbance and similar minor dysmorphisms. Whole exome sequencing identified a recurrent, homozygous variant (chr2:64083454A > G) in the essential UDP-glucose pyrophosphorylase (UGP2) gene in all probands. This rare variant results in a tolerable Met12Val missense change of the longer UGP2 protein isoform but causes a disruption of the start codon of the shorter isoform, which is predominant in brain. We show that the absence of the shorter isoform leads to a reduction of functional UGP2 enzyme in neural stem cells, leading to altered glycogen metabolism, upregulated unfolded protein response and premature neuronal differentiation, as modeled during pluripotent stem cell differentiation in vitro. In contrast, the complete lack of all UGP2 isoforms leads to differentiation defects in multiple lineages in human cells. Reduced expression of Ugp2a/Ugp2b in vivo in zebrafish mimics visual disturbance and mutant animals show a behavioral phenotype. Our study identifies a recurrent start codon mutation in UGP2 as a cause of a novel autosomal recessive DEE syndrome. Importantly, it also shows that isoform-specific start-loss mutations causing expression loss of a tissue-relevant isoform of an essential protein can cause a genetic disease, even when an organism-wide protein absence is incompatible with life. We provide additional examples where a similar disease mechanism applies

Expanding the genetic heterogeneity of intellectual disability

Intellectual disability (ID) is a common morbid condition with a wide range of etiologies. The list of monogenic forms of ID has increased rapidly in recent years thanks to the implementation of genomic sequencing techniques. In this study, we describe the phenotypic and genetic findings of 68 families (105 patients) all with novel ID-related variants. In addition to established ID genes, including ones for which we describe unusual mutational mechanism, some of these variants represent the first confirmatory disease-gene links following previous reports (TRAK1, GTF3C3, SPTBN4 and NKX6-2), some of which were based on single families. Furthermore, we describe novel variants in 14 genes that we propose as novel candidates (ANKHD1, ASTN2, ATP13A1, FMO4, MADD, MFSD11, NCKAP1, NFASC, PCDHGA10, PPP1R21, SLC12A2, SLK, STK32C and ZFAT). We highlight MADD and PCDHGA10 as particularly compelling candidates in which we identified biallelic likely deleterious variants in two independent ID families each. We also highlight NCKAP1 as another compelling candidate in a large family with autosomal dominant mild intellectual disability that fully segregates with a heterozygous truncating variant. The candidacy of NCKAP1 is further supported by its biological function, and our demonstration of relevant expression in human brain. Our study expands the locus and allelic heterogeneity of ID and demonstrates the power of positional mapping to reveal unusual mutational mechanisms

SPARC 2018 Internationalisation and collaboration : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2018 SPARC conference. This year we not only celebrate the work of our PGRs but also the launch of our Doctoral School, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 100 presenters, the conference truly showcases a vibrant PGR community at Salford. These abstracts provide a taster of the research strengths of their works, and provide delegates with a reference point for networking and initiating critical debate. With such wide-ranging topics being showcased, we encourage you to take up this great opportunity to engage with researchers working in different subject areas from your own. To meet global challenges, high impact research inevitably requires interdisciplinary collaboration. This is recognised by all major research funders. Therefore engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers