Quantification of fluoroscopic imaging system contrast by using video waveform monitoring.

A noninvasive method was developed for quantifying the overall contrast of fluoroscopic imaging systems within the clinical setting by using a simple phantom and common video test equipment. In this method, an acrylic phantom with four holes filled with varying amounts of air and aluminum is placed on the entrance exposure side of a patient-equivalent acrylic phantom. The air- and aluminum-filled holes provide a stepped gray-scale pattern that is displayed on the examination room viewing monitor when the phantom is fluoroscopically imaged under automatic brightness control. A video waveform monitor or oscilloscope is then used to quantify those video signal voltage levels as a contrast index value, which is defined as the maximum range of the video signal voltage levels of the gray-scale steps. The method is repeatable and allows quantification of the contrast of the imaging system. It can also be used to optimize video parameters, provide comparative data for quality control monitoring, and characterize overall contrast differences between systems. Experience with this method suggests that there is excellent correlation between the clinical perception of image contrast and the contrast index, with contrast index changes of approximately 15% being seen clinically.

Techniques for measuring radiographic repeat rates.

Radiographs that must be repeated, which are commonly referred to as "repeats," represent additional, non-billable costs due to increased film, chemistry, and equipment use as well as increased personnel time. Furthermore, patients receive additional radiation exposure from repeats and must remain on the premises until the second exam is completed. Compounding the overt negative financial impact on the department is an increased burden on the waiting room and support staff, and a decrease in patient throughput. A continuous improvement team was assigned to develop an improved technique for monitoring and reducing the number of repeated radiographs in a subset of our radiology department. This paper presents a novel method of accurately measuring the repeat rate through the use of radiographic repeat labels. The labels remove the guesswork from repeat analysis and heighten the technologists' awareness of common problems. Additionally, the labels allow for detailed analysis of the cause of repeated radiographs, which can provide insight for determining remedial actions. Repeat analysis data from our institution acquired using the labels before and after implementing remedial actions are presented.

Technical aspects of twin screen-film chest radiography: cost effective lung and mediastinal imaging.

OBJECTIVE: To determine the sensitometry and 'cross-talk' of a twin screen-film cassette and to assess its clinical potential. MATERIALS AND METHODS: The twin cassette utilises two sets of screens, divided by filter material, to provide an optimised image of the mediastinum and the lungs. The exposure difference for the two images was measured sensitometrically. The contribution to film density of visible light and K-characteristic radiation, from adjacent screens in the absence of a dividing filter, was investigated. RESULT: Clinical experience indicated that an exposure difference of 3.4 between the front and back screens, was optimal. Visible light and K-characteristic radiation from the front screens, contributed up to 20 and 24% respectively, of the back film exposure and screen absorbed energy respectively. This was reduced to 0 and 6% with the use of the filter. CONCLUSIONS: The twin screen-film cassette provides extended latitude to enable optimal visualisation of the lung and mediastinal regions. Adjacent screen 'cross-talk' has been overcome to allow standard and portable chest applications.

Clinical evaluation of twin screen-film chest radiography: cost effective lung and mediastinal imaging.

OBJECTIVE: A new twin screen-film cassette system optimised for conventional chest radiography was evaluated by four thoracic radiologists. MATERIALS AND METHODS: The twin screen-film cassette system produces two film images, the front film optimised for the mediastinal region of the chest, the rear for the lung region. Image degradation on either screen-film system due to internal photon scatter has been virtually eliminated due to the use of a dividing filter. Fifty patients were included in a trial that resulted in a set of chest images for each patient, taken on the same inspiration, by both the twin screen-film cassette and the conventional system. The resultant fifty sets of images were evaluated by four chest radiologists who scored 12 radiographic features of the chest and patient pathologies present, using a paired difference technique. RESULTS: The image quality of the twin screen-film cassette system was judged to be significantly superior to the conventional screen-film system in nine of the 12 radiographic features scored (P < 0.003). In the three other regions and for the patient pathologies, no significant conclusions were drawn. CONCLUSION: The new twin screen-film system showed improved visualisation of radiographic features, particularly in the mediastinal and retrocardiac lung regions. This new system shows promise in both standard and portable clinical applications.