Modification of chest radiography exposure parameters using a neonatal chest phantom

Background The acquisition of chest radiographs in neonates is of critical importance in diagnostics because of the risk of respiratory distress syndrome and pneumothorax in preterm infants. Objective To achieve a dose reduction while preserving a diagnostic image quality for chest radiographs of neonates. Materials and methods All radiographs, generated on a fully digital X-ray unit by using a neonatal chest phantom, were evaluated under variation of the tube voltage (40–70 kV) and mAs levels (1–10.2 mAs) with and without an additional 0.1-mm copper (Cu) filtration. Noise, contrast and contrast-to-noise ratio for bronchus, heart, lungs and vessels were determined. Visual assessment of the image quality was carried out by three radiologists using a Likert scale. To evaluate a maximally possible dose reduction, the dose of the radiographs with still acceptable image quality at a minimal dose was compared to the dose of the radiographs with the standard settings used in clinical routine. Results The noise showed decreasing values with increasing dose, while the contrast values were increased. For the contrast-to-noise ratio, a digressive course of the values as a function of the tube voltage was found. The visual evaluation of image quality showed the best evaluation of the structures at the lowest possible dose in the settings (44 kV, 3.36 mAs) with copper filtration and in the settings (44 kV, 1.56 mAs) without copper filtration. A maximum dose reduction from 8.29 μSv to 2.21 μSv (about 73%) was obtained. Conclusion A dose reduction while preserving diagnostic image quality in a digital X-ray system is generally possible by reducing the tube voltage and simultaneous adaptation of the mAs settings.