The Thai Journal of Radiological Technology

Quality control of chest radiograph procedure

Jaruwan Santinun — 2023-10-28

Chest radiography, also known as a chest x-ray. The images show the internal organs of the chest and neighboring structures. A chest radiograph which an X-ray beam enters behind the patient and exits the front of patient to an anterior image receptor, known as the Posteroanterior (PA) and X-ray beam passes from anterior the patient to the image receptor behind, known as the Anteroposterior (AP), is the most common radiological investigation for diagnosing chest abnormalities. As a guideline to reduce the repetitive rate of x-rays, radiological technologist should have knowledge and understanding for quality control of chest radiographs. Starting from patients’ factors that come in different conditions, which requires skill and experience in the work of radiological technologist to assess the appropriate positioning for each case. Somes requires a method of positioning that is different from the routine from the textbook including the factors from the radiological technologist that should be known to adjust the various parameters of the X-ray machine in order to provide the appropriate radiation dose from different positions in each patient. Additionally, the process of evaluating whether the obtained photographs are sufficient quality for the radiologist to report the accurately results. The factors to control the quality of chest radiographs should begin from the process of patient preparation, positioning, X-ray machine parameters setting and post image processing from the software of the x-ray machine to be accurately. If the radiological technologist does not have accurate knowledge of chest radiographs, this may cause in the radiologist receive improper image, resulting in inaccurate or unclear report affecting recipients to lose the opportunity to receive the correct diagnosis. Therefore, it is necessary to have standards to have quality control of chest radiographs before sending the images to the PACs system for radiologist’s report.

Analysis and assessing of radiotherapy service at the National Cancer Institute: productivity, infrastructure, and facilities

Somsak Khuanchana — 2023-01-16

Background: Cancer is a major public health problem in Thailand, and the incidence tended to be increased. Radiation therapy play an important and necessary role in treatment of both early and late-stage cancer patients. At present, in Thailand, there is no clear study and analysis of the radiation therapy work system in terms of services and infrastructures. Objective: This study aimed to analysis and evaluation of radiotherapy services of the National Cancer Institute both the statistics of cancer patients who received the service and infrastructure. Methods: The study was a retrospective data collection and description statistic. Data were collected from all radiotherapy clients and infrastructure for the past 3 years and collected from the population and hospital cancer registry reports for the past 10 years Results: The National Cancer Institute found a 60 percent decrease in new patients, but an 11 percent decrease in new cancer patients, females more than males, and more than 70 percent from Bangkok and nearby areas receiving chemotherapy. The most therapies found the most breast cancer. There were 4 specific and different systems of irradiation machine and TPS system and OIS system. Irradiated patients are reduced by 14.37%. Irradiation service is provided by technique 3 DCRT and the highest service value is 50.58%. The irradiator of Cyber Knife had the highest maintenance cost equal to 307.95 percent of the service value. The number of radiotherapy personnel meets the specified criteria. where medical physicists have high turnover rate. Conclusion: The new cancer patients found a slight decrease and the most common breast cancer. There were 4 types of irradiators and TPS and OIS system. The four different specificity systems were the limitations of radiation techniques and number of personnel as well as expertise development. Most breast cancer patients were irradiated. Therefore, it was imperative to provide a suitable kit to check the irradiation positioning to increase efficiency. It had been found that irradiation with more advanced techniques increases. But there was still a high proportion of maintenance costs of the irradiator and tends to increase with age and deterioration. It was necessary to procure or replace the obsolete, low-power, long-lived system to increase the quality/number of patients/reduce the waiting time/increase the cost of radiation charges and different types of cancer in each area and the availability of radiotherapy systems, TPS, OIS, the potential of personnel, as well as the efficiency in reimbursement of radiation fees from various funds in order to continue to treat cancer patients with effective, quality and cost-effective radiation.

Assessment of Entrance Surface Air Kerma from Chest X-ray Examination at Klongthom Hospital

Sumanat Piriyaudomporn — 2023-04-02

Introduction: Entrance Surface Air Kerma (ESAK) obtained from radiographic chest x-ray examination should be evaluated for optimizing radiation exposure to patients. This work aimed to evaluate the radiation dose in terms of ESAK of the patients who underwent radiographic chest radiography examinations at Klomthom Hospital and to compare the ESAK with the Thailand National Diagnostic Reference Levels (NDRLs) and the other studies. Methods: The ESAK was calculated using the radiation output of a radiographic machine and backscatter factor (BSF) obtained from a total of 100 chest radiographic patients. The radiation output was carried out with Piranha x-ray dosimeter. Values of typical dose level was established using the median of ESAK. Results: The results revealed that the mean, median and 75^th percentile of ESAK for posterior-anterior (PA) chest radiography at Klongthom Hospital were 0.12 mGy, 0.11 mGy and 0.14 mGy, respectively. The median ESAK of the patients in this study was lower than the 75^th percentile ESAK of national DRLs and comparable to the ESAK values published in the literatures. Conclusion: Entrance Surface Air Kerma derived from radiographic chest x-ray examination using exposure parameter settings in our hospital was within the acceptable level and DRLs.

The effect of tube voltage and current on the CT number and relative electron density in computed tomography simulator

Yanisa Wattanasriroj — 2023-04-14

Background: Nowadays, the dominant role in cancer treatment is radiotherapy. For accurate dose calculations, it is necessary to provide a correct relationship between the CT numbers and electron density because the change in electron voltage and current leads to changing relationship between CT number and the relative electron density in the computed tomography simulator. Objective: To study the effect of tube voltage and current on the CT number and relative electron density in the computed tomography simulator. Methods: Two trials were performed by providing tube voltage 70, 80, 100, 120, and 140 kVp with a constant current set to 300 mAs and the second experiment was set to the constant tube voltage by adjusting the current value from the lowest to the largest. For 70 kVp vary the current from 100-500 mAs, for 80 kVp vary the current from 100-600 mAs, for 100 kVp vary the current from 100-700 mAs, for 120 kVp vary the current from 100-700 mAs and 140 kVp vary the current from 100-600 mAs. Results: The tube voltage increases the differences between RED–CT number curves due to the current variations decrease. In the range of tube voltage 100-140 kVp, the difference between CT number is 0.25 ± 1.05, 0.47 ± 3.02 and 0.02 ± 0.21, respectively. Conclusions: The appropriate tube voltage was in the range of 100-140 kVp, where the current has little effect on the relationship between the CT number and the relative electron density.

Post evaluation of seamless radiologic management for Covid-19 patient, Samutsakhon Hospital

Nutchanun Promubol — 2023-09-03

Objective: The purpose of this study was to evaluate the results of radiological management service for coronavirus disease 2019 (Covid-19) patients under investigate at Samutsakhon Hospital in terms of radiological service management process and outcomes of radiological service for under investigate covid-19 patients. Methods: The “CIPP model” was used in this study. The studied samples were taken from 36 persons; doctors, radiologists, nurses, radiological technician, healthcare providers, and patients who under investigate with for coronavirus disease 2019 at Samutsakhon Hospital and field hospital. The patient satisfaction questionnaire data of radiological management service for coronavirus disease 2019 patients were used for data collection during 1 June 2021 - 30 September 2021. Analysis of qualitative data were presented by descriptive satisfaction assessments and analyzed quantitative radiological service used statistics. Results: Evaluation of the outcomes of Seamless Radiologic for COVID-19 patients under investigate at Samutsakhon Hospital showed that 1) Contextual aspects radiological services for COVID-19 patients under investigate were most necessary 92.8%. 2) On preliminary assessment of factors; The number of x-ray machines provided was adequate 77.2%, radiological services adequacy 81.2%, Proper staffing 78.4%, good technology 83.8% 3) On process evaluation; Service procedures are appropriate 81.6% , appropriate access to radiological services were 83.8%, radiological protection was 83.8%, safe from COVID-19 infection was 82.8% 4) Productivity assessment: There was an increase in chest x-ray for COVID-19 patients during June-September 2021 compared to chest x-ray in 2018-2020. Benefits of radiological service arrangement was very useful 91.2%, service quality is reasonably good 87.8%, meet expectations 80%, satisfaction with the overall radiological service for COVID-19 is 86.2%. Conclusion: Radiological chest x-ray service for coronavirus disease 2019 patients at Samutsakhon Hospital is an important investigation for diagnosis pneumonia for Covid-19 patients under investigate. System has been set up at the hospital and field hospitals to ensure that staffs are safe from Covid-19 infection and radiological protection. Doctors and medical personnel can view chest x-ray image at the hospital, field hospital or other field hospitals. The history of chest x-ray image of COVID-19 patients under investigate will remain up-to-date, it will not be lost and searchable even though COVID-19 has become endemic. This model can be used for radiological service management in the future pandemic concerning respiratory infection emergence disease.

The development of an automated scheduling system for radiological technologists: a case study of the department of diagnostic radiology at Songklanagarind Hospital

Natee Ina — 2023-09-01

Introduction: The duty schedule at Songkhlanakarin Hospital is staffed by experienced radiological technologists or department managers. There are a variety of factors in scheduling that are very different. make it take a lot of time as a consequence, reduced radiological technologists were available for daily work. In addition, errors are possible and not appropriate for individual radiological technologists. In order to solve this problem, the researcher has developed an algorithm to automate the scheduling of radiology department responsibilities at Songkhlanakarin Hospital. Methods: The software Visual Studio Code, that was written in Python, was used to build a GUI based on the Figma program. Songkhlanakarin Hospital by evaluating the 10-item overview of the shift schedule generated by the program's automatic shift scheduler, with a maximum score of 5 for each item. Results: The duty schedules were well organized, accurate, and appropriate, with a mean and standard deviation of 4.59 ± 0.50. The ordered duty schedule provides a clear perspective of the employees in the entire system. The satisfaction level for various aspects of the duty schedule was as follows: equitable duty schedule 4.45 ± 0.74, familiar work schedule 4.59 ±0.50, convenience of system usage 4.66 ± 0.48, work schedule capable of accommodating advance leave requests 4.79 ± 0.41, satisfied with overall program work 4.41 ± 0.68, duty schedule capable of addressing advance leave issue in duty management 4.69 ± 0.47, the duty schedule can handle the advance leave problem in duty management 5.00, and the program's font is contemporary and legible 4.62 ± 0.49. Conclusions: The development of an automated work scheduling approach aims to improve work administration, reduce mistakes, improve usability, minimize scheduling cycle times, and avoid and resolve scheduling inequities within the diagnostic radiology department's staff at Songkhlanakarin Hospital.

The determination of the radiation dose and image quality for abdominal radiography using a digital X-ray machine without an automatic exposure control system at King Chulalongkorn Memorial Hospital

Petcharleeya Suwanpradit — 2023-09-03

Background: Radiographic procedures with automatic exposure control (AEC) system are the exposure technique to obtain the optimal diagnostic image quality. However, there is a higher dose under AEC compared with a lack of AEC. Objective: The aim of this study was to determine the radiation dose and image quality for abdominal digital radiography of human-like phantom using a routine clinical protocol with AEC and a modified protocol without AEC at King Chulalongkorn Memorial Hospital. Methods: A digital X-ray system (Digital Diagnost, Philips) with a CsI:Ti image receptor and the human-like phantom (PBU-60, Kyoto Kagaku) were used. The abdominal anteroposterior (AP) projections were performed with and without AEC systems. The entrance surface air kerma (ESAK) was measured on the phantom surface using optically stimulated luminescence dosimeters (OSLDs), while the kerma area product (KAP) was simultaneously recorded. The qualitative image quality was scored by two experienced radiologists. Results: We found that the ESAK and KAP values trended to the similar direction. The ESAK obtained from the modified parameter without AEC (81 kVp and 3.2 mAs) was lower by 90% compared to the routine clinical parameter with AEC (85 kVp and 32 mAs), while the optimal image quality was maintained in the acceptable level for diagnostic abdominal radiography. Conclusion: Applying the exposure parameter without AEC for abdominal digital radiography reduces the radiation while the image quality is optimal for diagnosis.

The development of application for general radiography in skull

Phornpailin Pairodsantikul — 2023-10-23

Background: Correct positioning of the patient according to the anatomy to be examined is important in general X-ray work. It affects the quality of X-ray images and the doctor's diagnosis. According to the survey conducted by radiology students and radiologists, patient positioning error mostly occurs in Skull radiography. Meanwhile, smartphones have become more and more active in daily life. From the problem, researchers were interested in creating a smartphone application providing patient positioning information and techniques of craniofacial imaging in general x-rays.

Objective: To develop a mobile application for providing patient positioning information and techniques of craniofacial imaging in general x-rays.

Material and methods: The “Cranix” application was developed via the "Thunkable" website, which can be used for both iOS and Android operating systems. For assessment of the application and the satisfaction of using the application, there were inquired by radiological technology students from various universities and radiological technologists in Thailand by the System usability scale (SUS) and Linkert scale.

Results: From 105 users, the result showed that the application was efficient at finding all necessary information. The satisfaction assessment was 4.40 ± 0.60 at a very good level and the assessment of SUS score was averaging by 80.69 ± 13.55 at an acceptable level.

Conclusion: “Cranix” application can provide all the necessary information and make it easy to find and reduce the time spent for searching information for radiological technology students and radiological technologists.

The comparative study of left ventricular ejection fraction (LVEF) between gated blood pool tomography and multiple gated acquisition (MUGA) scan

Nontacha Siritranont — 2023-10-23

Background: MUGA scan is the nuclear medicine technique used to evaluate left ventricular ejection fraction of the heart. It had high reproducibility in each examination. In cases which MUGA is failed or incorrect result due to tumor obscured the heart, GBPS (gated blood-pool SPECT) is an alternative method. GBPS is not routine practiced at King Chulalongkorn Memorial Hospital (KCMH) service. It is according to capability of scanner and software package for processing. Now, KCMH has the scanner that has this capability but no experience to perform processing and the reliability of results. This study will help technologist to make confidence in processing and nuclear medicine physician to interpret result. Methods: Patients with request for pre- chemotherapy %LVEF base line and volunteer, who did not on drug which affect red blood cell labeling with technetium pertechnetate, were included in this study. The method of RBC (red blood cell) labeling was modified in vivo technique. Perform MUGA acquisition in LAO (left anterior oblique) view with best septal seen. Preset 1000 heart beats with 64 x 64 matrix, zoom 1.45 with LEUR (low energy ultra-high resolution) collimator on Siemens Symbia T camera and followed by GBPS acquisition with 64 x 64 matrix, zoom 1.45, 64 views over 180 degree rotation arc, duration 50 sec/view, perpendicular configuration detector and start from RAO (right anterior oblique)45 degree. Perform reconstruction and processing for nuclear medicine physician interpretation. Results: Total study was 55 cases (17 males and 38 females) with the age (mean±SD) was 44.38±10.54 years. The relationship between MUGA and GBPS was good correlation with R =0.84. Nuclear medicine physician interpreted 54 cases were within normal limits and one case was abnormal %LVEF. The mean normal value of %LVEF by MUGA was 65.67±4.43 and GBPS was 77.33±7.0. Conclusion: The Patient whom fail to perform MUGA processing can used GBPS for %LVEF evaluation. %LVEF by GBPS was reproducible for automated processing and correlated well with MUGA with R =0.84. %LVEF by GBPS was higher than MUGA due to left atrium counts was included in MUGA calculation.

The incidence of adverse reactions from non-ionic contrast media administration in the patients who underwent thoracic and abdominal computed tomography scans at Sichon Hospital, Nakhon Si Thammarat Province

Kunwika Rattanasomboon — 2023-12-30

Objective: This study aims to investigate the incidence of adverse reactions from non-ionic contrast media administration in the patients who underwent thoracic and abdominal computed tomography (CT) scans at Sichon Hospital, Nakhon Si Thammarat province. Methods: In a retrospective cohort study, the study population were patients with age range of 15-85 years-old who underwent thoracic and abdominal CT scan between October 1, 2017 to September 30, 2022 and had an adverse reaction from non-ionic contrast media administration within 24 hours. Twenty-eight patients were selected by purposive sampling. The SPSS program was used to analyze the frequency, percentage, and incidence of adverse reactions. Results: 27 out of 5060 patients who underwent thoracic and abdominal CT scan had mild adverse reaction (0.53%). Most of them were female with age range 15-59 years-old. One patient had moderate adverse reaction (0.02%). The history taking and a survey questionnaire can help the staff to recognize the risk of adverse reaction in each patient. Conclusion: Patients with risk factors received premedication. Among the 17 patients without risk factors, 60.71% experienced adverse reactions. The most frequent onset of adverse events occurred within 5-10 minutes (69.52 per 10,000), with rashes being the most common symptom (54.07 per 10,000). The second most common onset was at the time of contrast administration (30.90 per 10,000), with hot flashes as the predominant symptom (27.04 per 10,000).

Innovation of inexpensive customized bolus in radiotherapy from 3D printer using silicone bolus

Wisan Arphasetthasakul — 2023-12-30

Introduction: Bolus is a water-equivalent material that is commonly used to increase the buildup region dose and compensate for missing tissue in radiotherapy. The commercial superflab bolus is quite expensive and cannot perform the perfect contact with the irregular shape of the patient’s surface. The aim of this study was to study the characteristics of in-house silicone rubber bolus to apply in radiotherapy. Methods: The methods start with mixing the RA-00A and RA-00B solutions into a homogeneous substance. The solutions were poured into the holder to create a 1 cm silicone rubber thickness with the size of 30x30 cm^2. The physical properties of thickness, density, and hardness were evaluated and compared with the commercial bolus. A piece of silicone rubber bolus was scanned by a CT simulator. The CT images of the silicone rubber bolus were used to evaluate the Hounsfield unit (HU) and the dose attenuation was also evaluated in the Eclipse treatment planning system. The 3D shape of the nose was created as a 3D customized bolus using 3D printed technology. Results: We found that the commercial bolus and the customized one showed a thickness of 1.05±0.00 cm and 1.07±0.01 cm, density of 1.03 and 0.99 g/cm3, and hardness of 2.5 HA and 1.5 HA, respectively. The HU of commercial bolus and customized bolus were -124±63.3 and -73±42.5, respectively. The surface dose differences between silicone bolus and commercial bolus of 6 MV, 10 MV, 6 MeV, and 9 MeV were 0.4%, 0.9%, 0.7%, and -0.4%, respectively. The silicone bolus can increase surface doses in clinics of 68.5%, 67.1%, 17.7%, and 7.4% compared to the amount of radiation at the surface without the bolus, it will be 30,23.1,81.5, and 86.9 for 6 MV, 10 MV, 6 MeV, and 9 MeV, respectively. comparable to the result from a commercial superflab bolus. The 3D customized bolus presented the perfect fit to the irregular surface shape phantom and significantly increased the buildup region dose. Conclusion: Silicone rubber is an alternative material that can replace commercial bolus because of the comparable properties with more than 20 times cheaper prices. It can also be molded into 3D shapes according to organs and lesions.

Assessment of radiation dose from abdominal computed tomography at Maharat Nakhon Ratchasima Hospital

Boonyapat Chokchai — 2023-12-31

Background: Abdominal computed tomography (CT) plays a crucial role in a diagnosis of disease and continually increases. However, X-ray radiation is harmful and requires a careful monitoring of patient radiation dose obtained from this procedure. Objectives: This study aimed to determine patient radiation dose from upper abdomen CT, lower abdomen CT and whole abdomen CT at Maharat Nakhon Ratchasima Hospital and compare this data with national diagnostic reference levels (NDRLs). Moreover, the evaluation of entrance surface air kerma (ESAK) of abdomen, eyes, and thyroid were performed. Methods: Patients who had undergone upper abdomen CT, lower abdomen CT, and whole abdomen CT (30 patients for each examination) between February and April 2023, and met the inclusion criteria, were recruited. The nanoDot optically stimulated luminescence dosimeters (OSLDs) were placed on patient’s skin at the eyes, thyroid, and abdomen to measure the ESAK. The radiation dose parameters including volumetric CT dose index (CTDI_vol), dose length product (DLP), total DLP were recorded. Furthermore, an effective dose was calculated. Results: The highest values of CTDI_vol (13.45 mGy), DLP (714.19 mGy.cm), total DLP (2575.20 mGy.cm), and effective dose (38.50 mSv) were obtained from the whole abdomen CT examination. However, CTDI_vol and DLP values for upper abdomen CT and whole abdomen CT were lower than the NDRLs. The highest ESAK values were consequently observed for the eyes (0.88 ± 0.19 mGy), thyroid (1.28 ± 0.23 mGy), and abdomen (36.98 ± 1.54 mGy) for the whole abdomen CT examination. Conclusion: The CTDI_vol and DLP values obtained from abdominal CT at Maharat Nakhon Ratchasima Hospital were within the NDRLs, indicating that our abdominal CT protocols for both upper abdomen and whole abdomen can be used to examine patients appropriately.