Introduction: The introduction of digital radiography has led to a significant problem in terms of dose creep. To address this problem, manufacturers have established a set of exposure indicators (EI) as a feedback mechanism to safeguard against overexposure. The EI is the measure of incident exposure to the detector that is directly proportional to the signal-to-noise ratio and can be related to image quality. The aim of this study was to evaluate the influence of EI on image quality and radiation dose for the posterior anterior (PA) chest radiography. Material and Methods: This study was conducted in three phases, namely pre-optimization, experimental, and post-optimization. A total of 60 patients that could fulfill the inclusion and exclusion criteria for the PA chest radiography were recruited. The radiographic technical parameters, dose area product, and EI were recorded. Radiographs were printed and evaluated by two recruited radiologists using the modified evaluation criteria established by the Commission of European Communities in 1996. Results: Statistical analysis using Spearman’s Rho Correlation showed an insignificant relationship between EI and image quality for the PA chest radiography (p >0.05). Conversely, there was a significant relationship between EI and radiation dose (p <0.05). Conclusion: TheEI can be used as an indirect measure of image quality and radiation dose. The EI does not directly determine image quality since the radiographic technique and parameters used can affect image quality. Although EI can be used as a measure of radiation dose, it cannot provide an accurate measurement of the radiation received by the patient.
Seeram E, Davidson R, Bushong S, Swan H. Radiation dose optimization research: Exposure technique approaches in CR imaging: A literature review. Radiography. 2013; 19: 331-8.
Moey SF, Shazli ZA, Sayed I. Dose Evaluation for Common Digital Radiographic Examinations in Selected Hospitals in Pahang Malaysia. Iran J Med Phys. 2017; 14: 155-61.
Arthur L, Clapham K, Cook A, Hobson L, Lou D, Skinner R, et al. An assessment of exposure indices in computed radiography for the posterior-anterior chest and the lateral lumbar spine. The British journal of radiology. 2007; 80 (949): 26-31.
Fauber TL, Cohen TF, Dempsey MC. High kilovoltage digital exposure techniques and patient dosimetry. Radiol Technol. 2011; 82(6): 501–10.
Shepard SJ, Wang J, Flynn M, Gingold E, Goldman L, Krugh K, et al. An exposure indicator for digital radiography: AAPM Task Group 116 (Executive Summary). Medical Physics. 2009; 36(7): 2898–914.
Walker S, Allen D, Burnside C, Small L. Determining the between exposure factors, dose and exposure index value in digital radiographic imaging. Synergy. 2011; 10:14–7.
Mothiram U, Brennan PC, Robinson J, Lewis SJ, Moran B. Retrospective evaluation of exposure index (EI) values from plain radiographs reveals important considerations for quality improvement. J Med Radiat Sci. 2013; 60: 115–22.
Moore QT, Don S, Goske MJ, Strauss KJ, Cohen M, Herrmann T, et al. Image gently: using exposure indicators to improve pediatric digital radiography. Radiologic technology. 2012; 84(1):93-9.
Johnston J, Comello RJ, Vealé BL, Killion J. Radiation exposure dose trends and radiation dose reduction strategies in medical imaging. J Med Imaging Radiat Sci. 2010; 41:137–44.
Don S, MacDougall R, Strauss K, Moore QT, Goske MJ, Cohen M, et al. Image gently campaign back to basics initiative: Ten steps to help manage radiation dose in paediatric digital radiography. AJR Am J Roentgenol. 2013; 200: 431–6.
Butler ML, Rainford L, Last J, Brennan PC. Optimization of exposure index values for the antero-posterior pelvis and anteroposterior knee examination. InMedical Imaging 2009: Image Perception, Observer Performance, and Technology Assessment. 2009; 7263: 726302. Doi: 10.1117/12.810748.
Silva TR , Yoshimura EM. Patient dose, gray level and exposure index with a computed radiography system. Radiat Phys Chem. 2014; 95: 271–3.
Cohen MD, Markowitz R, Hill J, Huda W, Babyn P, Apgar B. Quality assurance: A comparison study of radiographic exposure for neonatal chest radiographs at 4 academic hospitals. Pediatr Radiol. 2012; 42: 668–73.
Butler ML, Rainford L, Last J, Brennan PC. Are exposure index values consistent in clinical practice? A multi-manufacturer investigation. Radiat Prot Dosimetry. 2010; 139: 371–4.
Ching W, Robinson J, McEntee M. Patient based radiographic exposure factor selection: a systematic review. Journal of Medical Radiation Science. 2014; 61(3): 176-90.
Moey SF, Shazli ZA. Optimization of Dose and Image Quality in Full-field Digital and Computed Radiography Systems for Common Digital Radiographic Examinations. Iran J Med Phys. 2018; 15: 28-38.
Seibert JA, Morin RL. The standardized exposure index for digital radiography: An opportunity for optimization of radiation dose to the pediatric population. Pediatric Radiology. 2011; 41(5): 573-81.
Moey SF, Shazli ZA, Shah Sayed I. Goharian N, Moghimi S, Kalani H, et al. The Practice of Chest Radiography Using Different Digital Imaging Systems: Dose and Image Quality. Iran J Med Phys. 2018; 15:101-7.
Peters SE, Brennan PB. Digital radiography: Are the manufacturers. settings too high? Optimization of the Kodak digital radiography system with aid of the computed radiography dose index. Eur. Radiol. 2002; 12: 2381–7.
Ekpo EU, Hoban AC, McEntree MF. Optimization of direct chest radiography using Cu filtration. Radiography. 2014; 20: 346-50.
Schaefer-Prokop C, Neitzel U, Venema HK, Uffmann M, Prokop M. Digital chest radiography: An update on modern technology, dose containment and control of image quality. European Radiology. 2008; 18(9): 1818-30.
Herrmann TL, Fauber TL, Gill J, Hoffman C, Orth DK, Peterson PA, et al. Best practices in digital radiography. Radiol Technol. 2012; 84: 83-9.
Yang S, Han JB, Choi NG, Lee SG. The review of exposure index in digital radiography and image quality. Journal of Radiation Protection. 2013; 38(1):29.
Tsalafoutas IA, Blastaris GA, Moutsatsos AS, Chios PS, Efstathopoulos EP. Correlation of image quality with exposure index and processing protocol in a computed radiography system. Radiation Protection Dosimetry. 2007; 130(2): 162-71.
International Electrotechnical Commission (IEC). Medical electrical equipment: Exposure index of digital x-ray imaging systems. Part 1. Definitions and requirements for general radiography. Geneva: International standard IEC 62494-1. 2008.
Butler ML, Rainford L, Last J, Brennan PC. Optimization of exposure index values for the antero-posterior pelvis and antero-posterior knee examination. SPIE Proceedings. 2009.
Carroll QB. Radiography in the digital age: Physics, exposure, radiation biology. Springfield: Charles Thomas. 2014.
Moey, S., & Fatin Naimah, M. A. (2019). Evaluation of the Influence of Exposure Index on Image Quality and Radiation Dose. Iranian Journal of Medical Physics, 16(4), 294-299. doi: 10.22038/ijmp.2018.33156.1404
Soo-Foon Moey; Mohamad Asri Fatin Naimah. "Evaluation of the Influence of Exposure Index on Image Quality and Radiation Dose". Iranian Journal of Medical Physics, 16, 4, 2019, 294-299. doi: 10.22038/ijmp.2018.33156.1404
Moey, S., Fatin Naimah, M. A. (2019). 'Evaluation of the Influence of Exposure Index on Image Quality and Radiation Dose', Iranian Journal of Medical Physics, 16(4), pp. 294-299. doi: 10.22038/ijmp.2018.33156.1404
Moey, S., Fatin Naimah, M. A. Evaluation of the Influence of Exposure Index on Image Quality and Radiation Dose. Iranian Journal of Medical Physics, 2019; 16(4): 294-299. doi: 10.22038/ijmp.2018.33156.1404