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Clinical utility of postprocessed low-dose radiographs in skeletal imaging

OBJECTIVES: Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing h...

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Autores principales: Kolck, Johannes, Ziegeler, Katharina, Walter-Rittel, Thula, Hermann, Kay Geert A., Hamm, Bernd, Beck, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Institute of Radiology. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8822553/
https://www.ncbi.nlm.nih.gov/pubmed/34919419
http://dx.doi.org/10.1259/bjr.20210881
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author Kolck, Johannes
Ziegeler, Katharina
Walter-Rittel, Thula
Hermann, Kay Geert A.
Hamm, Bernd
Beck, Alexander
author_facet Kolck, Johannes
Ziegeler, Katharina
Walter-Rittel, Thula
Hermann, Kay Geert A.
Hamm, Bernd
Beck, Alexander
author_sort Kolck, Johannes
collection PubMed
description OBJECTIVES: Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography. METHODS: In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader’s total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores. RESULTS: Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value. CONCLUSION: In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice. ADVANCES IN KNOWLEDGE: The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value.
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spelling pubmed-88225532022-02-17 Clinical utility of postprocessed low-dose radiographs in skeletal imaging Kolck, Johannes Ziegeler, Katharina Walter-Rittel, Thula Hermann, Kay Geert A. Hamm, Bernd Beck, Alexander Br J Radiol Full Paper OBJECTIVES: Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography. METHODS: In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader’s total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores. RESULTS: Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value. CONCLUSION: In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice. ADVANCES IN KNOWLEDGE: The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value. The British Institute of Radiology. 2022-02-01 2022-01-05 /pmc/articles/PMC8822553/ /pubmed/34919419 http://dx.doi.org/10.1259/bjr.20210881 Text en © 2022 The Authors. Published by the British Institute of Radiology https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
spellingShingle Full Paper
Kolck, Johannes
Ziegeler, Katharina
Walter-Rittel, Thula
Hermann, Kay Geert A.
Hamm, Bernd
Beck, Alexander
Clinical utility of postprocessed low-dose radiographs in skeletal imaging
title Clinical utility of postprocessed low-dose radiographs in skeletal imaging
title_full Clinical utility of postprocessed low-dose radiographs in skeletal imaging
title_fullStr Clinical utility of postprocessed low-dose radiographs in skeletal imaging
title_full_unstemmed Clinical utility of postprocessed low-dose radiographs in skeletal imaging
title_short Clinical utility of postprocessed low-dose radiographs in skeletal imaging
title_sort clinical utility of postprocessed low-dose radiographs in skeletal imaging
topic Full Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8822553/
https://www.ncbi.nlm.nih.gov/pubmed/34919419
http://dx.doi.org/10.1259/bjr.20210881
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