J. I. Ten

Image Retake Analysis in Digital Radiography Using DICOM Header Information

A methodology to automatically detect potential retakes in digital imaging, using the Digital Imaging and Communications in Medicine (DICOM) header information, is presented. In our hospital, neither the computed radiography workstations nor the picture archiving and communication system itself are designed to support reject analysis. A system called QCOnline, initially developed to help in the management of images and patient doses in a digital radiology department, has been used to identify those images with the same patient identification number, same modality, description, projection, date, cassette orientation, and image comments. The pilot experience lead to 6.6% and 1.9% repetition rates for abdomen and chest images. A thorough analysis has shown that the real repetitions were 3.3% and 0.9% for abdomen and chest images being the main cause of the discrepancy being the wrong image identification. The presented methodology to automatically detect potential retakes in digital imaging using DICOM header information is feasible and allows to detect deficiencies in the department performance like wrong identifications, positioning errors, wrong radiographic technique, bad image processing, equipment malfunctions, artefacts, etc. In addition, retake images automatically collected can be used for continuous training of the staff.

Paediatric entrance doses from exposure index in computed radiography.

Over the last two years we have evaluated paediatric patient doses in projection radiography derived from exposure level (EL) in computed radiography (CR) in a large university hospital. Entrance surface air kerma (ESAK) for 3501 paediatric examinations was calculated from the EL, which is a dose index parameter related to the light emitted by the phosphor-stimulable plate, archived in the Digital Imaging and Communications in Medicine (DICOM) header of the images and automatically transferred to a database using custom-built dedicated software. Typical mean thicknesses for several age bands of paediatric patients was estimated to calculate ESAK from the EL values, using results of experimental measurements with phantoms for the typical x-ray beam qualities used in paediatric examinations. Mean/median ESAK values (in microGy) for the age bands of <1 year, 1-5 years, 6-10 years and 11-15 years have been obtained for chest without a bucky: 51/41, 57/34, 91/54 and 122/109; chest with a bucky (for only the last three age bands): 114/87, 129/105 and 219/170; abdomen: 119/91, 291/225, 756/600 and 1960/1508 and pelvis: 65/48, 455/314, 943/707 and 2261/1595. Sample sizes of clinical images used for the (indirect) measurements were 1724 for chest without a bucky, 799 for chest with a bucky, 337 for abdomen and 641 for pelvis. The methodology we describe could be applicable to other centres using CR as an imaging modality for paediatrics. Presently, this method is the only practical approach to automatically extract parameters contained in the DICOM header, for the calculation of patient dose values for the CR modality.

Automatic management system for dose parameters in interventional radiology and cardiology

The purpose of this work was to develop an automatic management system to archive and analyse the major study parameters and patient doses for fluoroscopy guided procedures performed in cardiology and interventional radiology systems. The X-ray systems used for this trial have the capability to export at the end of the procedure and via e-mail the technical parameters of the study and the patient dose values. An application was developed to query and retrieve from a mail server, all study reports sent by the imaging modality and store them on a Microsoft SQL Server data base. The results from 3538 interventional study reports generated by 7 interventional systems were processed. In the case of some technical parameters and patient doses, alarms were added to receive malfunction alerts so as to immediately take appropriate corrective actions.

AUTOMATIC PATIENT DOSE REGISTRY AND CLINICAL AUDIT ON LINE FOR MAMMOGRAPHY

The use of automatic registry systems for patient dose in digital mammography allows clinical audit and patient dose analysis of the whole sample of individual mammography exposures while fulfilling the requirements of the European Directives and other international recommendations. Further parameters associated with radiation exposure (tube voltage, X-ray tube output and HVL values for different kVp and target/filter combinations, breast compression, etc.) should be periodically verified and used to evaluate patient doses. This study presents an experience in routine clinical practice for mammography using automatic systems.

Benefits of an automatic patient dose registry system for interventional radiology and cardiology at five hospitals of the Madrid area.

The purpose of this article is to present the results of connecting the interventional radiology and cardiology laboratories of five university hospitals to a unique server using an automatic patient dose registry system (Dose On Line for Interventional Radiology, DOLIR) developed in-house, and to evaluate its feasibility more than a year after its introduction. The system receives and stores demographic and dosimetric parameters included in the MPPS DICOM objects sent by the modalities to a database. A web service provides a graphical interface to analyse the information received. During 2013, the system processed 10 788 procedures (6874 cardiac, 2906 vascular and 1008 neuro interventional). The percentages of patients requiring clinical follow-up due to potential tissue reactions before and after the use of DOLIR are presented. The system allowed users to verify in real-time, if diagnostic (or interventional) reference levels are fulfilled.

Experience in retake analysis for digital mammography at a university hospital

Data from one digital mammograph (flat detector active area of 19.2 × 23 cm(2)) were collected over a 1-year period using locally developed software in order to evaluate retakes, their rates, their causes and the possible measures to reduce their occurrence. Among them, 7.1 % of the images were marked as repetitions, and in 16 % of the studies, at least one image was repeated. When evaluating causes of retakes, the primary cause was incorrect positioning (49 %), closely followed by additional retakes in cases of large breasts (44 %). When dealing with large breasts and using a small flat panel, additional images were necessary to fully visualise the breast, and as a consequence, some breast regions received repeated radiation exposure. Moreover, a small detector increases retakes in breasts slightly wrongly positioned. To try and reduce the retake rate, it is important to plan training sessions based on images selected from the retake analysis.