Neonatal digital chest radiography– should we be using additional copper filtration?

Abstract

Objectives: Copper filtration removes lower energy X-ray photons, which do not enhance image quality but would otherwise contribute to patient radiation dose. This study explores the use of additional copper filtration for neonatal mobile chest imaging. Methods: A controlled factorial-designed experiment was used to determine the effect of independent variables on image quality and radiation dose. These variables included: copper filtration (0 Cu, 0.1 Cu and 0.2 Cu), exposure factors, source-to-image distance and image receptor position (direct / tray). Image quality was evaluated using absolute visual grading analysis (VGA) and contrast-to-noise ratio (CNR) and entrance surface dose (ESD) was derived using an ionising chamber within the central X-ray beam. Results: VGA, CNR and ESD significantly reduced (p < 0.01) when using added copper filtration. For 0.1 Cu, the percentage reduction was much greater for ESD (60%) than for VGA (14%) and CNR (20%), respectively. When compared to the optimal combinations of parameters for incubator imaging using no copper filtration, an increase in kV and mAs when using 0.1-mm Cu resulted in better image quality at the same radiation dose (direct) or, equal image quality at reduced dose (in-tray). The use of 0.1-mm Cu for neonatal chest imaging with a corresponding increase in kV and mAs is therefore recommended. Conclusion: Using additional copper filtration significantly reduces radiation dose (at increased mAs) without a detrimental effect on image quality. Advances in knowledge: This is the first study, using an anthropomorphic phantom, to explore the use of additional Cu for digital radiography neonatal chest imaging and therefore helps inform practice to standardise and optimise this imaging examination.