Radiation Protection Opportunities in Medical Imaging

A special issue of Tomography (ISSN 2379-139X).

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 18958

Special Issue Editors

Former Full Professor of Radiology and Chairman, University of Pisa, 56124 Pisa, Italy
Interests: radiation protection; information technology applications in medical imaging; cross-sectional radiology; oncologic imaging
1. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
2. Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
Interests: radiation protection; oncologic imaging; chest imaging; abdominal imaging

Special Issue Information

Dear Colleagues,

A large part of medical imaging is based on techniques involving the use of ionizing radiations. This has spurred interest to reduce the risks associated with ionizing radiations for both patients and personnel. Recent advances in hardware and software are enabling high-quality imaging with a lower radiation dose when compared to older technologies. Higher awareness has improved justification and optimization while reducing dose variations that are not dependent on the clinical situation of the patient. Moreover, dose management systems are currently able to monitor doses associated with all performed procedures, giving the opportunity to detect dose performances that need to be improved in a timely manner. In this setting, continuing education for healthcare professionals is pivotal to minimize unnecessary examinations and radiation exposure, while training radiologists and radiographers is mandatory to optimize data acquisition and reduce dose variability.

This Special Issue will focus on pertinent research papers, perspectives, and reviews informing readers about innovative approaches to radiation protection in medical imaging implemented for the benefit of patients and personnel. We welcome submissions describing how radiation protection can be seen not only as a tool for reducing risk, but also as an opportunity to improve the quality of the procedures that are carried out in imaging centers around the world. Manuscripts that cover issues about justification and optimization and technological advances in image acquisition are encouraged. Of interest are applications of artificial intelligence enabling data acquisition optimization with lower radiation dose exposure as well as radiation dose monitoring by means of dedicated software tools. Dose monitoring is particularly challenging in interventional radiology: we encourage submissions that describe technologies enabling real-time monitoring of the doses to patients as well as personnel in interventional radiology, including innovative dosimetry approaches and Internet of Things applications. Radiation protection of patients and staff is an important issue in nuclear medicine as well; therefore, manuscripts on radiation safety in diagnostic and therapeutic nuclear medicine are highly appreciated.

Prof. Dr. Davide Caramella
Dr. Chiara Pozzessere
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tomography is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ionizing radiations
  • radiation protection
  • radiation dose awareness
  • radiation protection education and training
  • exam justification
  • exam optimization

Published Papers (9 papers)

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Editorial

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4 pages, 199 KiB  
Editorial
Optimizing Communication of Radiation Exposure in Medical Imaging, the Radiologist Challenge
Tomography 2023, 9(2), 717-720; https://doi.org/10.3390/tomography9020057 - 23 Mar 2023
Cited by 1 | Viewed by 1291
Abstract
Since I started my residency program in Radiology, I have been committed to promoting radiation protection, paying particular attention to the justification and optimization of the examinations [...] Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)

Research

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10 pages, 565 KiB  
Article
Coronary Computed Tomography Angiography with Deep Learning Image Reconstruction: A Preliminary Study to Evaluate Radiation Exposure Reduction
Tomography 2023, 9(3), 1019-1028; https://doi.org/10.3390/tomography9030083 - 16 May 2023
Viewed by 1270
Abstract
Coronary computed tomography angiography (CCTA) is a medical imaging technique that produces detailed images of the coronary arteries. Our work focuses on the optimization of the prospectively ECG-triggered scan technique, which delivers the radiation efficiently only during a fraction of the R–R interval, [...] Read more.
Coronary computed tomography angiography (CCTA) is a medical imaging technique that produces detailed images of the coronary arteries. Our work focuses on the optimization of the prospectively ECG-triggered scan technique, which delivers the radiation efficiently only during a fraction of the R–R interval, matching the aim of reducing radiation dose in this increasingly used radiological examination. In this work, we analyzed how the median DLP (Dose-Length Product) values for CCTA of our Center decreased significantly in recent times mainly due to a notable change in the technology used. We passed from a median DLP value of 1158 mGy·cm to 221 mGy·cm for the whole exam and from a value of 1140 mGy·cm to 204 mGy·cm if considering CCTA scanning only. The result was obtained through the association of important factors during the dose imaging optimization: technological improvement, acquisition technique, and image reconstruction algorithm intervention. The combination of these three factors allows us to perform a faster and more accurate prospective CCTA with a lower radiation dose. Our future aim is to tune the image quality through a detectability-based study, combining algorithm strength with automatic dose settings. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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12 pages, 2829 KiB  
Article
Making CT Dose Monitoring Meaningful: Augmenting Dose with Imaging Quality
Tomography 2023, 9(2), 798-809; https://doi.org/10.3390/tomography9020065 - 07 Apr 2023
Cited by 1 | Viewed by 1559
Abstract
Due to the concerns about radiation dose associated with medical imaging, radiation dose monitoring systems (RDMSs) are now utilized by many radiology providers to collect, process, analyze, and manage radiation dose-related information. Currently, most commercially available RDMSs focus only on radiation dose information [...] Read more.
Due to the concerns about radiation dose associated with medical imaging, radiation dose monitoring systems (RDMSs) are now utilized by many radiology providers to collect, process, analyze, and manage radiation dose-related information. Currently, most commercially available RDMSs focus only on radiation dose information and do not track any metrics related to image quality. However, to enable comprehensive patient-based imaging optimization, it is equally important to monitor image quality as well. This article describes how RDMS design can be extended beyond radiation dose to simultaneously monitor image quality. A newly designed interface was evaluated by different groups of radiology professionals (radiologists, technologists, and physicists) on a Likert scale. The results show that the new design is effective in assessing both image quality and safety in clinical practices, with an overall average score of 7.8 out of 10.0 and scores ranging from 5.5 to 10.0. Radiologists rated the interface highest at 8.4 out of 10.0, followed by technologists at 7.6 out of 10.0, and medical physicists at 7.5 out of 10.0. This work demonstrates how the assessment of the radiation dose can be performed in conjunction with the image quality using customizable user interfaces based on the clinical needs associated with different radiology professions. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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12 pages, 1750 KiB  
Article
Comparing Radiation Dose of Cerebral Angiography Using Conventional and High kV Techniques: A Retrospective Study on Intracranial Aneurysm Patients and a Phantom Study
Tomography 2023, 9(2), 621-632; https://doi.org/10.3390/tomography9020050 - 08 Mar 2023
Cited by 2 | Viewed by 1444
Abstract
Evaluation of patient radiation dose after the implementation of a high kV technique during a cerebral angiographic procedure is an important issue. This study aimed to determine and compare the patient radiation dose of intracranial aneurysm patients undergoing cerebral angiography using the conventional [...] Read more.
Evaluation of patient radiation dose after the implementation of a high kV technique during a cerebral angiographic procedure is an important issue. This study aimed to determine and compare the patient radiation dose of intracranial aneurysm patients undergoing cerebral angiography using the conventional and high kV techniques in a retrospective study and a phantom study. A total of 122 cases (61 cases with conventional technique and 61 cases with high kV technique) of intracranial aneurysm patients, who underwent cerebral angiographic procedure and met the inclusion criteria, were recruited. The radiation dose and the angiographic exposure parameters were reviewed retrospectively. The radiation dose in the phantom study was conducted using nanoDotTM optically stimulating luminescence (OSLD), which were placed on the scalp of the head phantom, the back of the neck, and the phantom skin at the position of the eyes. The standard cerebral angiographic procedure using the conventional and high kV techniques was performed following the standard protocol. The results showed that the high kV technique significantly reduced patient radiation dose and phantom skin dose. This study confirms that the implementation of a high kV technique in routine cerebral angiography for aneurysm diagnosis provides an effective reduction in radiation dose. Further investigation of radiation dose in other interventional neuroradiology procedures, particularly embolization procedure, should be performed. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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25 pages, 2450 KiB  
Article
Radiation-Free Microwave Technology for Breast Lesion Detection Using Supervised Machine Learning Model
Tomography 2023, 9(1), 105-129; https://doi.org/10.3390/tomography9010010 - 12 Jan 2023
Cited by 1 | Viewed by 2059
Abstract
Mammography is the gold standard technology for breast screening, which has been demonstrated through different randomized controlled trials to reduce breast cancer mortality. However, mammography has limitations and potential harms, such as the use of ionizing radiation. To overcome the ionizing radiation exposure [...] Read more.
Mammography is the gold standard technology for breast screening, which has been demonstrated through different randomized controlled trials to reduce breast cancer mortality. However, mammography has limitations and potential harms, such as the use of ionizing radiation. To overcome the ionizing radiation exposure issues, a novel device (i.e. MammoWave) based on low-power radio-frequency signals has been developed for breast lesion detection. The MammoWave is a microwave device and is under clinical validation phase in several hospitals across Europe. The device transmits non-invasive microwave signals through the breast and accumulates the backscattered (returned) signatures, commonly denoted as the S21 signals in engineering terminology. Backscattered (complex) S21 signals exploit the contrast in dielectric properties of breasts with and without lesions. The proposed research is aimed to automatically segregate these two types of signal responses by applying appropriate supervised machine learning (ML) algorithm for the data emerging from this research. The support vector machine with radial basis function has been employed here. The proposed algorithm has been trained and tested using microwave breast response data collected at one of the clinical validation centres. Statistical evaluation indicates that the proposed ML model can recognise the MammoWave breasts signal with no radiological finding (NF) and with radiological findings (WF), i.e., may be the presence of benign or malignant lesions. A sensitivity of 84.40% and a specificity of 95.50% have been achieved in NF/WF recognition using the proposed ML model. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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13 pages, 11360 KiB  
Article
Reduction in Radiation Exposure in Minimally Invasive Pedicle Screw Placement Using a Tubular Retractor: A Pilot Study
Tomography 2023, 9(1), 12-24; https://doi.org/10.3390/tomography9010002 - 20 Dec 2022
Viewed by 3194
Abstract
Background and Objectives: Percutaneous pedicle screw (PPS) placement is a minimally invasive spinal procedure that has been rapidly adopted over the last decade. However, PPS placement has elicited fear of increased radiation exposure from some surgeons, medical staff, and patients. This is because [...] Read more.
Background and Objectives: Percutaneous pedicle screw (PPS) placement is a minimally invasive spinal procedure that has been rapidly adopted over the last decade. However, PPS placement has elicited fear of increased radiation exposure from some surgeons, medical staff, and patients. This is because PPS placement is performed using a K-wire, and the operator must perform K-wire insertion into the pedicle under fluoroscopy. In order to prevent erroneous insertion, there are many occasions when direct insertion is required during radiation exposure, and the amount of radiation exposure to hands and fingers in particular increases. Although these problems are being addressed by navigation systems, these systems are still expensive and not widely available. Attempts have been made to address this situation using instrumentation commonly used in spinal surgery. First, it was considered to visualize anatomical bone markers using a tubular retractor and a microscope. In addition, the use of a self-drilling pin was adopted to locate the pedicle in a narrower field of view. Based on these considerations, a minimally invasive and highly accurate pedicle screw placement technique was developed while avoiding direct radiation exposure. This study evaluated radiation exposure and accuracy of pedicle screw placement using this new procedure in one-level, minimally invasive, transforaminal lumbar interbody fusion (MIS-TLIF). Materials and Methods: Data were collected retrospectively to review pedicle screw placement in single-level MIS TLIFs using a tubular retractor under a microscope. The total fluoroscopy time, radiation dose, and screw placement accuracy were reviewed. Extension of operating time was also evaluated. Results: Twenty-four patients underwent single-level MIS TLIFs, with placement of 96 pedicle screws. There were 15 females and 9 males, with an average age of 64.8 years and a mean body mass index of 25.5 kg/m2. The mean operating time was 201.8 min. The mean fluoroscopic time was 26.8 s. The mean radiation dose of the area dose product was 0.0706 mGy∗m2. The mean radiation dose of air kerma was 6.0 mGy. The mean radiation dose of the entrance skin dose was 11.31 mGy. Postoperative computed tomography scans demonstrated 93 pedicle screws confined to the pedicle (97%) and three pedicle screw breaches (3.2%; two lateral, one medial). A patient with screw deviation of the medial pedicle wall developed right-foot numbness necessitating reoperation. There were no complications after reoperation. The average added time with this combined procedure was 39 min (range 16–69 min) per patient. Conclusions: This novel pedicle screw insertion technique compares favorably with other reports in terms of radiation exposure reduction and accuracy and is also useful from the viewpoint of avoiding direct radiation exposure to hands and fingers. It is economical because it uses existing spinal surgical instrumentation. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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Review

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12 pages, 295 KiB  
Review
Radiation Exposure to Low-Dose Computed Tomography for Lung Cancer Screening: Should We Be Concerned?
Tomography 2023, 9(1), 166-177; https://doi.org/10.3390/tomography9010015 - 24 Jan 2023
Cited by 1 | Viewed by 2497
Abstract
Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, [...] Read more.
Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, thus eventually reducing the participation in an LCS program. Therefore, the present review aims to assess the potential radiation risk from LDCT in this setting, providing estimates of cumulative dose and radiation-related risk in LCS in order to improve awareness for an informed and complete attendance to the program. After summarizing the results of the international trials on LCS to introduce the benefits coming from the implementation of a dedicated program, the screening-related and participant-related factors determining the radiation risk will be introduced and their burden assessed. Finally, future directions for a personalized screening program as well as technical improvements to reduce the delivered dose will be presented. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
21 pages, 1811 KiB  
Review
Radiation Dose Reduction Opportunities in Vascular Imaging
Tomography 2022, 8(5), 2618-2638; https://doi.org/10.3390/tomography8050219 - 21 Oct 2022
Cited by 2 | Viewed by 2003
Abstract
Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for [...] Read more.
Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for vascular pathology. However, the radiation dose experienced by the patient during imaging has long been a concern of this image acquisition method. Advancements in CT image acquisition techniques in combination with advancements in non-ionizing radiation imaging techniques including magnetic resonance angiography (MRA) and contrast-enhanced ultrasound (CEUS) present growing opportunities to reduce total radiation dose to patients. This review provides an overview of advancements in imaging technology and acquisition techniques that are helping to minimize radiation dose associated with vascular imaging. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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10 pages, 573 KiB  
Review
Can Chest Ultrasound Replace Chest X-ray in Thoracic Surgery?
Tomography 2022, 8(4), 2083-2092; https://doi.org/10.3390/tomography8040175 - 20 Aug 2022
Cited by 2 | Viewed by 1899
Abstract
Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to [...] Read more.
Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the accuracy of CUS after thoracic surgery. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Six studies with a total of 789 patients were included in this meta-analysis. Performing CXR decreased in up to 61.6% of cases, with the main reasons for performing CXR being massive subcutaneous emphysema or complex hydrothorax. Agreement between CUS and routine-based therapeutic options was, in some studies, up to 97%. Conclusions: The selectively postoperative use of CUS may reduce the number of routinely performed CXR. However, if CUS findings are inconclusive, further radiological examinations are obligatory. Full article
(This article belongs to the Special Issue Radiation Protection Opportunities in Medical Imaging)
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