Removing conventional grid results in effectively managing patient doses
The following case was submitted by a participant for Radiographer of the year 2017 contest sharing his best practices for radiation dose management.
Indicate the purpose and objective of the case
In 2015 with the installation of one of our x-ray imaging systems our department got offered gridless anti-scatter software. (SkyFlow by Philips). Software was quite expensive so we ended up having the free trial period. During this period we wanted to find out if the patient dose can be effectively managed without ruining the clinical image quality and if the software actually makes radiographers work easier.
Describe the dose management methods/techniques used
Anti-scatter software (SkyFlow) by Philips in this case. Similar softwares are now available by multiple companies but this study was completed with SkyFlow. As a result of removing the conventional grid we also ended up lowering the exposure values, thus effectively managing patient doses.
Provide brief clinical and patient background
Patient doses for thorax study were measured at our hospital’s intensive care unit and compared to our previously used system with conventional anti-scatter grid. Clinical image quality was evaluated by our wards radiologists (Blinded experiment; they were only asked to rate the image quality without any background information).
Entrance surface dose and dose area product both were effectively managed. Image quality remained good; it was even rated to be better than with the previous setup. This is most likely a result from newer detector but difference between software and conventional grid was not visible to radiologists”.
Explain the results and conclusions reached
Entrance surface dose and dose area product both were effectively managed. Image quality remained good; it was even rated to be better than with the previous setup. This is most likely a result from newer detector but difference between software and conventional grid was not visible to radiologists. In some cases, especially with heavier patients, there was slightly more noise. This is most likely a result from user using already too low exposure values.
Discuss the case outcome(s), future implications, etc.
Our hospital ended up buying the software for our mobile units and the intention is to buy it also for our fixed systems. Dose save is significant and improvements in workflow are real.
In the future it would be interesting to compare anti-scatter softwares from different companies. Gridless imaging is most likely going to be future standard.
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Producing images of high diagnostic quality using low dose by scrutinizing protocol parameters
Computed tomography protocols have extensive choice of adjustable dose saving features that have been proven to effectively manage the dose without detriment to the diagnostic quality of the CT images when properly used.
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Management of radiation dosage through use of multiple functions of the device
Proper use of the fluoroscopy save option allows for the DSFS to be substituted for cases requiring hand injection DSA images or upper/lower extremity angiography to ultimately allow efficient control over patients’ and operators’ radiation dosage.
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Using image reconstruction techniques in computed tomography
Using this image reconstruction technique as standard can potentially save dose down the line with CT scans being repeated less and less.
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