A patient tumour-on-a-chip system for personalised investigation of radiotherapy based treatment regimens.

Development of personalised cancer models to predict response to radiation would benefit patient care; particularly in malignancies where treatment resistance is prevalent. Herein, a robust, easy to use, tumour-on-a-chip platform which maintains precision cut head and neck cancer for the purpose of ex vivo irradiation is described. The device utilises sintered discs to separate the biopsy and medium, mimicking in vivo microvascular flow and diffusion, maintaining tissue viability for 68 h. Integrity of tissues is demonstrated by the low levels of lactate dehydrogenase release and retained histology, accompanied by assessment of cell viability by trypan blue exclusion and flow cytometry; fluid dynamic modelling validates culture conditions. An irradiation jig is described for reproducible delivery of clinically-relevant doses (5 × 2 Gy) to newly-presenting primary tumours (n = 12); the addition of concurrent cisplatin is also investigated (n = 8) with response analysed by immunohistochemistry. Fractionated irradiation reduced proliferation (BrdU, p = 0.0064), increased DNA damage (Æ´H2AX, p = 0.0043) and caspase-dependent apoptosis (caspase-cleaved cytokeratin-18) compared to control; caspase-dependent apoptosis was further increased by concurrent cisplatin compared to control (p = 0.0063). This is a proof of principle study showing the response of cancer tissue to irradiation ex vivo in a bespoke system. The novel platform described has the potential to personalise treatment for patients in a cost-effective manner with applicability to any solid tumour.

Current perspectives in the interpretation of gunshot residues in forensic science: A review.

The traces produced when a firearm is discharged can provide important information in cases when questions regarding a possible association of the firearm with a person of interest (POI), time since discharge or shooting distance are raised. With advances in technology, the forensic challenges presented by these traces, known as gunshot residues (GSR), are moving from the analytical domain to the interpretation of the analytical results. Different interpretation frameworks are currently competing. Formal classification of particles, using standards such as that produced by ASTM, focusses only on evaluation of evidence at the sub-source level. Another approach, based on the application of Bayesian reasoning - namely the case-by-case approach - has been proposed that allows evaluation of evidence in regards to activity-related questions. This alternative approach allows an evaluation of the evidence that is more closely aligned to judicial and investigative aims. This paper critically presents the state of the art in regards to GSR interpretation in a holistic manner.

Automatic exposure control calibration and optimisation for abdomen, pelvis and lumbar spine imaging with an Agfa computed radiography system.

The use of three physical image quality metrics, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQm) have recently been examined by our group for their appropriateness in the calibration of an automatic exposure control (AEC) device for chest radiography with an Agfa computed radiography (CR) imaging system. This study uses the same methodology but investigates AEC calibration for abdomen, pelvis and spine CR imaging. AEC calibration curves were derived using a simple uniform phantom (equivalent to 20 cm water) to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated abdomen, pelvis and spine images (created from real patient CT datasets) with appropriate detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated images contained clinically realistic projected anatomy and were scored by experienced image evaluators. Constant DDI and CNR curves did not provide optimized performance but constant eNEQm and SNR did, with the latter being the preferred calibration metric given that it is easier to measure in practice. This result was consistent with the previous investigation for chest imaging with AEC devices. Medical physicists may therefore use a simple and easily accessible uniform water equivalent phantom to measure the SNR image quality metric described here when calibrating AEC devices for abdomen, pelvis and spine imaging with Agfa CR systems, in the confidence that clinical image quality will be sufficient for the required clinical task. However, to ensure appropriate levels of detector air kerma the advice of expert image evaluators must be sought.

Host innate inflammatory factors and staphylococcal protein A influence the duration of human Staphylococcus aureus nasal carriage.

Human Staphylococcus aureus (SA) nasal carriage provides a reservoir for the dissemination of infectious strains; however, factors regulating the establishment and persistence of nasal colonization are mostly unknown. We measured carriage duration and nasal fluid inflammatory markers after nasally inoculating healthy participants with their previously isolated SA strains. Out of 15 studies, 10 resulted in rapid clearance (9±6 days) that corresponded with upregulated chemokines, growth factors, and predominantly Th1-type cytokines, but not interleukin (IL)-17. Nasal SA persistence corresponded with elevated baseline levels of macrophage inflammatory protein-1ß, IL-1ß, and IL-6, no induction of inflammatory factors after inoculation, and decreased IL-1 receptor antagonist/IL-1ß ratio. SA-expressed staphylococcal protein A (SpA) levels correlated positively with carriage duration. Competitive inoculation studies revealed that isogenic SpA knockout (ΔSpA) strains were cleared faster than wild type only in participants with upregulated inflammatory markers after inoculation. The remaining participants did not mount an inflammatory response and did not clear either strain. ΔSpA strains demonstrated lower growth rates in carrier nasal fluids and lower survival rates when incubated with neutrophils. Collectively, the presented studies identify innate immune effectors that cooperatively modulate nasal carriage duration, and confirm SpA as a bacterial codeterminant of SA nasal carriage.

Correlation between the signal-to-noise ratio improvement factor (KSNR) and clinical image quality for chest imaging with a computed radiography system.

This work assessed the appropriateness of the signal-to-noise ratio improvement factor (KSNR) as a metric for the optimisation of computed radiography (CR) of the chest. The results of a previous study in which four experienced image evaluators graded computer simulated chest images using a visual grading analysis scoring (VGAS) scheme to quantify the benefit of using an anti-scatter grid were used for the clinical image quality measurement (number of simulated patients = 80). The KSNR was used to calculate the improvement in physical image quality measured in a physical chest phantom. KSNR correlation with VGAS was assessed as a function of chest region (lung, spine and diaphragm/retrodiaphragm), and as a function of x-ray tube voltage in a given chest region. The correlation of the latter was determined by the Pearson correlation coefficient. VGAS and KSNR image quality metrics demonstrated no correlation in the lung region but did show correlation in the spine and diaphragm/retrodiaphragmatic regions. However, there was no correlation as a function of tube voltage in any region; a Pearson correlation coefficient (R) of -0.93 (p = 0.015) was found for lung, a coefficient (R) of -0.95 (p = 0.46) was found for spine, and a coefficient (R) of -0.85 (p = 0.015) was found for diaphragm. All demonstrate strong negative correlations indicating conflicting results, i.e. KSNR increases with tube voltage but VGAS decreases. Medical physicists should use the KSNR metric with caution when assessing any potential improvement in clinical chest image quality when introducing an anti-scatter grid for CR imaging, especially in the lung region. This metric may also be a limited descriptor of clinical chest image quality as a function of tube voltage when a grid is used routinely.

A practical method to standardise and optimise the Philips DoseRight 2.0 CT automatic exposure control system.

Given the increasing use of computed tomography (CT) in the UK over the last 30 years, it is essential to ensure that all imaging protocols are optimised to keep radiation doses as low as reasonably practicable, consistent with the intended clinical task. However, the complexity of modern CT equipment can make this task difficult to achieve in practice. Recent results of local patient dose audits have shown discrepancies between two Philips CT scanners that use the DoseRight 2.0 automatic exposure control (AEC) system in the 'automatic' mode of operation. The use of this system can result in drifting dose and image quality performance over time as it is designed to evolve based on operator technique. The purpose of this study was to develop a practical technique for configuring examination protocols on four CT scanners that use the DoseRight 2.0 AEC system in the 'manual' mode of operation. This method used a uniform phantom to generate reference images which form the basis for how the AEC system calculates exposure factors for any given patient. The results of this study have demonstrated excellent agreement in the configuration of the CT scanners in terms of average patient dose and image quality when using this technique. This work highlights the importance of CT protocol harmonisation in a modern Radiology department to ensure both consistent image quality and radiation dose. Following this study, the average radiation dose for a range of CT examinations has been reduced without any negative impact on clinical image quality.

Retrospective review of locally set tolerances for VMAT prostate patient specific QA using the COMPASS(®) system.

PURPOSE: This study retrospectively reviewed locally set pass rates/tolerances for COMPASS(®) pre-treatment quality assurance results for RapidArc prostate plans to determine if these are appropriate. This was performed via quantifying the agreement between treatment planning system calculations and measurements based on absolute dose comparisons (3% tolerance for all dose points) and global gamma index assessment (3%/3 mm criterion for 97% of points). METHOD: Seventy-three prostate one-arc RapidArc plans, delivered by four dosimetrically matched linacs, were measured using the MatriXX Evolution two-dimensional array and analysed using COMPASS(®) (v.3, IBA Dosimetry). For the planning target volumes (PTV) considered, the D99%, D50%, D1% and DMean differences were analysed. The percentage volume with gamma greater than 1, average gamma and DMean difference were investigated for all structures. Nine plans were also assessed across the linac fleet to investigate potential linac dependence of results. RESULTS AND CONCLUSIONS: Regarding PTV DMean differences, all plans fell within the 3% tolerance and mostly within 2%, although there was a relatively small systematic difference. The absolute percentage differences of average and median doses suggested a weak linac dependence of the results which was found to be clinically insignificant. New stricter tolerances were established both for dose comparisons and gamma evaluation. Correlation between the gamma pass rates and the differences in the D99%, D50% and D1% was found to be moderate suggesting that gamma analysis in isolation has questionable clinical meaning and should only be used to indicate outliers for further analysis.

Investigating the use of an antiscatter grid in chest radiography for average adults with a computed radiography imaging system.

OBJECTIVE: The aim of this study was to investigate via simulation a proposed change to clinical practice for chest radiography. The validity of using a scatter rejection grid across the diagnostic energy range (60-125 kVp), in conjunction with appropriate tube current-time product (mAs) for imaging with a computed radiography (CR) system was investigated. METHODS: A digitally reconstructed radiograph algorithm was used, which was capable of simulating CR chest radiographs with various tube voltages, receptor doses and scatter rejection methods. Four experienced image evaluators graded images with a grid (n = 80) at tube voltages across the diagnostic energy range and varying detector air kermas. These were scored against corresponding images reconstructed without a grid, as per current clinical protocol. RESULTS: For all patients, diagnostic image quality improved with the use of a grid, without the need to increase tube mAs (and therefore patient dose), irrespective of the tube voltage used. Increasing tube mAs by an amount determined by the Bucky factor made little difference to image quality. CONCLUSION: A virtual clinical trial has been performed with simulated chest CR images. RESULTS indicate that the use of a grid improves diagnostic image quality for average adults, without the need to increase tube mAs, even at low tube voltages. ADVANCES IN KNOWLEDGE: Validated with images containing realistic anatomical noise, it is possible to improve image quality by utilizing grids for chest radiography with CR systems without increasing patient exposure. Increasing tube mAs by an amount determined by the Bucky factor is not justified.

Validation of a technique for estimating organ doses for kilovoltage cone-beam CT of the prostate using the PCXMC 2.0 patient dose calculator.

The use of cone beam CT in common radiotherapy treatments is increasing with the growth of image guided radiotherapy. Whilst the benefits that this technology offers are clear, such as improved patient positioning prior to treatment, it is always important to consider the implications of such intensive imaging regimes on the patient, especially when considering the fundamental radiation protection requirements for justification and optimisation.The purpose of this study was to develop a technique that uses readily available dose calculation software (PCXMC 2.0) to estimate the organ and effective doses that result from these types of examination in prostate treatments on the Varian OBI system. It has been shown that by separating these types of examinations into 28 different projections, with a range of x-ray beam qualities, it is possible to reproduce the complex geometry that is used on these imaging systems in PCXMC i.e. asymmetric radiation field with a half bowtie filter rotating 360° around the patient.This new technique has been validated with thermo-luminescent dosimeter measurements in the Rando anthropomorphic phantom, and has been shown to give excellent agreement with this established method (R(2) = 0.995). This technique will prove to be valuable to radiotherapy departments that are looking to optimise their CBCT imaging protocols as it allows a rapid evaluation of the impact of any changes on patient dose. It also serves to further highlight the levels of dose that these types of patient are subject to when having daily CBCT scans as part of the treatment, which further reinforces the need for optimisation of both patient dose and image quality on these systems.

An investigation of automatic exposure control calibration for chest imaging with a computed radiography system.

The purpose of this study was to examine the use of three physical image quality metrics in the calibration of an automatic exposure control (AEC) device for chest radiography with a computed radiography (CR) imaging system. The metrics assessed were signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQm), all measured using a uniform chest phantom. Subsequent calibration curves were derived to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated chest images with correct detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated chest images contained clinically realistic projected anatomy and anatomical noise and were scored by experienced image evaluators. Constant DDI and CNR curves do not appear to provide optimized performance across the diagnostic energy range. Conversely, constant eNEQm and SNR do appear to provide optimized performance, with the latter being the preferred calibration metric given as it is easier to measure in practice. Medical physicists may use the SNR image quality metric described here when setting up and optimizing AEC devices for chest radiography CR systems with a degree of confidence that resulting clinical image quality will be adequate for the required clinical task. However, this must be done with close cooperation of expert image evaluators, to ensure appropriate levels of detector air kerma.

Commissioning of a new wide-bore MRI scanner for radiotherapy planning of head and neck cancer.

OBJECTIVE: A combination of CT and MRI is recommended for radiotherapy planning of head and neck cancers, and optimal spatial co-registration is achieved by imaging in the treatment position using the necessary immobilisation devices on both occasions, something which requires wide-bore scanners. Quality assurance experiments were carried out to commission a newly installed 1.5-T wide-bore MRI scanner and a dedicated, flexible six-channel phased array head and neck coil. METHODS: Signal-to-noise ratio (SNR) and spatial signal uniformity were quantified using a homogeneous aqueous phantom, and geometric distortion was quantified using a phantom with water-filled fiducials in a grid pattern. Volunteer scans were also used to determine the in vivo image quality. Clinically relevant T1 weighted and T2 weighted fat-suppressed sequences were assessed in multiple scan planes (both sequences fast spin echo based). The performance of two online signal uniformity correction schemes, one utilising low-resolution reference scans and the other not utilising low-resolution reference scans, was compared. RESULTS: Geometric distortions, for a ±35-kHz bandwidth, were <1 mm for locations within 10 cm of the isocentre rising to 1.8 mm at 18 cm away. SNR was above 50, and uniformity in the axial plane was 71% and 95% before and after uniformity correction, respectively. CONCLUSION: The combined performance of the wide-bore scanner and the dedicated coil was adjudged adequate, although superior-inferior spatial coverage was slightly limited in the lower neck. ADVANCES IN KNOWLEDGE: These results will be of interest to the increasing number of oncology centres that are seeking to incorporate MRI into planning practice using dedicated equipment.

Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system.

OBJECTIVE: The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system. METHODS: The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson's correlation coefficient. RESULTS: Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, p<0.033) and eDE (R=0.77, p<0.008) were observed. CONCLUSION: Medical physics experts may use the physical image quality metrics described here in quality assurance programmes and optimisation studies with a degree of confidence that they reflect the clinical image quality in chest CR images acquired without an antiscatter grid. ADVANCES IN KNOWLEDGE: A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography.

Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future?

The prognosis of patients with glioblastoma (GBM) remains poor, and the use of hyperfractionation or dose escalation beyond 60 Gy has not conferred any survival benefit. More recently, hypofractionated radiotherapy (HFRT) has been employed as a novel approach for achieving dose escalation, with interesting results. We present here a systematic overview of the role and development of HFRT as a possible therapeutic strategy in patients with GBM. We searched the PubMed database for studies published since 1990 that reported on the tolerance, safety and survival outcomes after HFRT. These studies reported on the paradox of improved survival in patients developing central radionecrosis within the high-dose volume. Most series reported no significant increase in early or late toxicity, except for one study that reported visual loss in one patient at 7 months after treatment. More recently, studies of HFRT combined with concurrent temozolomide (TMZ) reported a trend towards improved survival compared with historical controls, with a few studies reporting a median survival of approximately 20 months. The interpretation of data from the above studies is limited by the heterogeneities of patient population and the significant variation in the range of employed dose schedules. However, high-dose HFRT using intensity-modulated radiotherapy appears to be a safe and feasible therapeutic option. There is a suggestion of improved outcomes on combining HFRT with TMZ, which warrants further investigation in a randomised trial.

Use of a digitally reconstructed radiograph-based computer simulation for the optimisation of chest radiographic techniques for computed radiography imaging systems.

OBJECTIVES: The purpose of this study was to derive an optimum radiographic technique for computed radiography (CR) chest imaging using a digitally reconstructed radiograph computer simulator. The simulator is capable of producing CR chest radiographs of adults with various tube potentials, receptor doses and scatter rejection. METHODS: Four experienced image evaluators graded images of average and obese adult patients at different potentials (average-sized, n=50; obese, n=20), receptor doses (n=10) and scatter rejection techniques (average-sized, n=20; obese, n=20). The quality of the images was evaluated using visually graded analysis. The influence of rib contrast was also assessed. RESULTS: For average-sized patients, image quality improved when tube potential was reduced compared with the reference (102 kVp). No scatter rejection was indicated. For obese patients, it has been shown that an antiscatter grid is indicated, and should be used in conjunction with as low a tube potential as possible (while allowing exposure times <20 ms). It is also possible to reduce receptor air kerma by 50% without adversely influencing image quality. Rib contrast did not interfere at any tube potential. CONCLUSIONS: A virtual clinical trial has been performed with simulated chest CR images. Results indicate that low tube potentials (<102 kVp) are optimal for average and obese adults, the former acquired without scatter rejection, the latter with an anti-scatter grid. Lower receptor (and therefore patient doses) than those used clinically are possible while maintaining adequate image quality.

WE-G-BRA-06: Calibrating an Ionisation Chamber: Gaining Experience Using a Dosimetry 'flight Simulator'.

PURPOSE: Recently there has been great interest in the use of simulation training, with the view to enhance safety within radiotherapy practice. We have developed a Virtual Environment for Radiotherapy Training (VERT) which facilitates this, including the simulation of a number of 'Physics practices'. One such process is the calibration of an ionisation chamber for use in Linac photon beams. METHODS: The VERT system was used to provide a life sized 3D virtual environment within which we were able to simulate the calibration of a departmental chamber for 6MV and 15 MV beams following the UK 1990 Code of Practice. The characteristics of the beams are fixed parameters in the simulation, whereas default (Absorbed dose to water) correction factors of the chambers are configurable thereby dictating their response in the virtual x-ray beam. When the simulation is started, a random, realistic temperature and pressure is assigned to the bunker. Measurement and chamber positional errors are assigned to the chambers. A virtual water phantom was placed on the Linac couch and irradiated through the side using a 10 × 10 field. With a chamber at the appropriate depths and irradiated iso-centrically, the Quality Indices (QI) of the beams were obtained. The two chambers were 'inter-compared', allowing the departmental chamber calibration factor to be calculated from that of the reference chamber. RESULTS: For the virtual 6/15 MV beams, the QI were found to be 0.668/ 0.761 and the inter-comparison ratios 0.4408/ 0.4402 respectively. The departmental chamber calibration factors were calculated; applying these and appropriate environmental corrections allowed the output of the Linac to be confirmed. CONCLUSIONS: We have shown how a virtual training environment can be used to demonstrate practical processes and reinforce learning. The UK CoP was used here, however any relevant protocol could be demonstrated. Two of the authors (Beavis and Ward) are Founders of Vertual Ltd, a spin-out company created to commercialise the research presented in this abstract.

WE-G-BRA-04: The Development of a Virtual Reality Dosimetry Training Platform for Physics Training.

PURPOSE: Recently there has been a great deal of interest in the application of Simulation methodologies for training. We have previously developed a Virtual Environment for Radiotherapy Training, VERT, which simulates a fully interactive and functional Linac. Patient and plan data can be accessed across a DICOM interface, allowing the treatment process to be simulated. Here we present a newly developed range of Physics equipment, which allows the user to undertake realistic QC processes. Five devices are available: 1) scanning water phantom, 2) 'solid water' QC block/ion chamber, 3) light/ radiation field coincidence phantom, 4) laser alignment phantom and 5) water based calibration phantom with reference class and 'departmental' ion chamber. METHODS: The devices were created to operate realistically and function as expected, each has an associated control screen which provides control and feedback information. The dosimetric devices respond appropriately to the beam qualities available on the Linac. Geometrical characteristics of the Linac, e.g. isocentre integrity, laser calibration and jaw calibrations can have random errors introduced in order to enable the user learn and observe fault conditions. In the calibration module appropriate factors for temperature and pressure must be set to correct for ambient, simulated, room conditions. RESULTS: The dosimetric devices can be used to characterise the Linac beams. Depth doses with Dmax of 15mm/29mm and d10 of 67%/77% respectively for 10cm square 6/15MV beams were measured. The Quality Indices (TPR20/10 ratios) can be measured as 0.668 and 0.761 respectively. CONCLUSIONS: At a simple level the tools can be used to demonstrate beam divergence or the effect of the inverse square law; They are also designed to be used to simulate the calibration of a new ion chamber. We have developed a novel set of tools that allow education of Physics processes via simulation training in our virtual environment. Both Authors are Founders and Directors of Vertual Ltd, a spin-out company that exists to commericalise the results of the research work presented in this abstract.

Validation of a large-scale audit technique for CT dose optimisation.

The expansion and increasing availability of computed tomography (CT) imaging means that there is a greater need for the development of efficient optimisation strategies that are able to inform clinical practice, without placing a significant burden on limited departmental resources. One of the most fundamental aspects to any optimisation programme is the collection of patient dose information, which can be compared with appropriate diagnostic reference levels. This study has investigated the implementation of a large-scale audit technique, which utilises data that already exist in the radiology information system, to determine typical doses for a range of examinations on four CT scanners. This method has been validated against what is considered the 'gold standard' technique for patient dose audits, and it has been demonstrated that results equivalent to the 'standard-sized patient' can be inferred from this much larger data set. This is particularly valuable where CT optimisation is concerned as it is considered a 'high dose' technique, and hence close monitoring of patient dose is particularly important.

A method to produce and validate a digitally reconstructed radiograph-based computer simulation for optimisation of chest radiographs acquired with a computed radiography imaging system.

OBJECTIVES: The purpose of this study was to develop and validate a computer model to produce realistic simulated computed radiography (CR) chest images using CT data sets of real patients. METHODS: Anatomical noise, which is the limiting factor in determining pathology in chest radiography, is realistically simulated by the CT data, and frequency-dependent noise has been added post-digitally reconstructed radiograph (DRR) generation to simulate exposure reduction. Realistic scatter and scatter fractions were measured in images of a chest phantom acquired on the CR system simulated by the computer model and added post-DRR calculation. RESULTS: The model has been validated with a phantom and patients and shown to provide predictions of signal-to-noise ratios (SNRs), tissue-to-rib ratios (TRRs: a measure of soft tissue pixel value to that of rib) and pixel value histograms that lie within the range of values measured with patients and the phantom. The maximum difference in measured SNR to that calculated was 10%. TRR values differed by a maximum of 1.3%. CONCLUSION: Experienced image evaluators have responded positively to the DRR images, are satisfied they contain adequate anatomical features and have deemed them clinically acceptable. Therefore, the computer model can be used by image evaluators to grade chest images presented at different tube potentials and doses in order to optimise image quality and patient dose for clinical CR chest radiographs without the need for repeat patient exposures.

Investigating the exposure class of a computed radiography system for optimisation of physical image quality for chest radiography.

The purpose of this study was to investigate whether the exposure (speed) class (EC) of an Agfa computed radiography (CR) system could be used to optimise chest radiography. The frequency-dependent normalised noise-power spectra (NNPS(f)) were determined for a range of EC settings (25-1200) for a receptor dose of 4 microGy. Signal-to-noise ratios (SNRs) were measured in the lung, heart and diaphragm areas of a chest phantom with ECs of 400 and 600 at four tube voltages (60, 75, 90 and 125 kVp). As anatomical background can be a factor in detection of lung nodules, a tissue to rib ratio (TRR), which measures the ratio of pixel values in the nodule to that of rib, was measured in the lung region of the phantom to assess the suppression of the rib at ECs of 400 and 600. The NNPS(f) at ECs lower than 400 was relatively high. The NNPS(f) at EC 600 was found to be 7% lower when averaged over all frequencies than that at EC 400. The statistical significance of this difference was verified. The EC 800 and EC 1200 settings offered no extra advantages in terms of lowering frequency-dependent noise. The EC 600 setting offered improvements in SNR of between 10% and 18% in the lung, 11% and 16% in the heart, and 15% and 20% in the diaphragm compared with EC 400. Statistical analysis verified the significant difference. The EC 600 setting increased the TRR, thereby helping to suppress rib. This work indicates that an exposure class setting of 600 is the most appropriate for standard chest radiography, but clinical verification is required.