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  1. Article ; Online: Changing the practice of routine gonadal shielding during radiography: 'Y'?

    Frush, Donald P / Strauss, Keith J

    Pediatric radiology

    2021  Volume 52, Issue 1, Page(s) 7–9

    MeSH term(s) Humans ; Radiation Protection ; Radiography
    Language English
    Publishing date 2021-11-06
    Publishing country Germany
    Document type Editorial
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-021-05230-5
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    Zs.A 927: Show issues Location:
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  2. Article ; Online: Advancing Safety: Role of Equipment Design and Configuration Change in Pediatric Fluoroscopy.

    Strauss, Keith J

    Health physics

    2019  Volume 116, Issue 2, Page(s) 256–262

    Abstract: Diagnostic x-ray exams irradiate the patient to produce an x-ray pattern in space, which is captured and processed into a visible image, followed by clinical interpretation. Diagnostic-quality images at a well-managed radiation dose are required. ... ...

    Abstract Diagnostic x-ray exams irradiate the patient to produce an x-ray pattern in space, which is captured and processed into a visible image, followed by clinical interpretation. Diagnostic-quality images at a well-managed radiation dose are required. Improvements to image receptors and image processing algorithms have resulted in improved images at reduced dose levels. However, careful management of x-ray production via design or configuration changes of the imaging device also affect patient dose. This initial dose management step is the focus of this discussion. Imaging equipment vendors, in general, have produced quality images of adults at reasonably managed patient doses. This achievement required teamwork between leading adult hospital staff members and representatives of the imaging equipment vendor within the adult hospital. Most manufacturers have had less opportunity to develop similar optimized configurations for pediatric imaging, the imaging of patients ranging from 2-200 kg between 0-21 y of age. Challenges: The wider dynamic range of patient thicknesses in the pediatric size range compared to the adult range of only 45-140 kg challenges automatic control features. In recent years reduction of patient dose as opposed to proper management has been stressed. The principal objectives of end users and vendors, respectively, are patient care and the bottom line. This too often hampers (if not prevents) a productive working relationship between the vendor and the end user. Too many end users rely too heavily on their equipment vendor to solve imaging/dose concerns. The vendors have an important role to play in this challenge but should not be the sole solution. Qualified medical physicists need an understanding of the design of the imaging device, an understanding that many vendors do not support out of proprietary concerns. The performance of the equipment should be judged based on data acquired with better tools. Solutions: Multiple equipment configurations are needed-each designed to excel at a reduced size of patients. Dose reductions that significantly impact image quality must be rejected. Radiologists and their qualified medical physicists should develop target patient doses (size based) for their unique imaging equipment and preferred level of quantum mottle. Once target doses are established as a function of patient size, vendor application specialists and design engineers should leverage the equipment's strengths and weaknesses to best achieve desired results. The qualified medical physicist should function as an interpreter between the end user and the vendor's design engineers. Are the radiologists' and technologists' expectations of the vendor reasonable and vice versa? While better tools are being developed, vendors may hesitate to make them available or charge excessive dollars for these new features to further slow their adoption. Conclusion: The challenges and solutions require the radiologist, technologist, qualified medical physicist, and vendor representatives to work as a team to manage patient dose and maintain image quality. The installed imaging device will be only as successful as the working relationship between the parties. These challenges and conflicts must continually be overcome to provide the best patient care.
    MeSH term(s) Adult ; Body Size ; Child ; Equipment Design ; Fluoroscopy/adverse effects ; Fluoroscopy/instrumentation ; Fluoroscopy/methods ; Humans ; Patient Care Team ; Patient Safety ; Radiometry
    Language English
    Publishing date 2019-02-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2406-5
    ISSN 1538-5159 ; 0017-9078
    ISSN (online) 1538-5159
    ISSN 0017-9078
    DOI 10.1097/HP.0000000000001002
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  3. Article ; Online: Application of reference air kerma alert levels for pediatric fluoroscopic examinations.

    Somasundaram, Elanchezhian / Brady, Samuel L / Strauss, Keith J

    Journal of applied clinical medical physics

    2022  Volume 23, Issue 9, Page(s) e13721

    Abstract: The purpose of this study was to provide an empirical model to develop reference air kerma (RAK) alert levels as a function of patient thickness or age for pediatric fluoroscopy for any institution to use in a Quality Assurance program. RAK and patient ... ...

    Abstract The purpose of this study was to provide an empirical model to develop reference air kerma (RAK) alert levels as a function of patient thickness or age for pediatric fluoroscopy for any institution to use in a Quality Assurance program. RAK and patient thickness were collected for 10&663 general fluoroscopic examinations and 1500 fluoroscopically guided interventions (FGIs). RAK and patient age were collected for 6137 fluoroscopic examinations with mobile-C-arms (MC). Coefficients of linear regression fits of logarithmic RAK as a function of patient thickness or age were generated for each fluoroscopy group. Regression fits of RAK for 50%, 90%, and 98% upper prediction levels were used as inputs to derive an empirical formula to estimate alert levels as a function of patient thickness. A methodology is presented to scale results from this study for any patient thickness or age for any institution, for example, the patient thickness dependent RAK alert level at the top 1% of expected RAK can be set using the 98% upper prediction interval boundary given by:
    MeSH term(s) Child ; Fluoroscopy/methods ; Humans ; Radiation Dosage ; Radiography, Interventional/methods ; Records
    Language English
    Publishing date 2022-08-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2010347-5
    ISSN 1526-9914 ; 1526-9914
    ISSN (online) 1526-9914
    ISSN 1526-9914
    DOI 10.1002/acm2.13721
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  4. Article ; Online: Image Gently: Getting It Right.

    Frush, Donald P / Strauss, Keith J

    Journal of the American College of Radiology : JACR

    2017  Volume 14, Issue 4, Page(s) 575–576

    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2274861-1
    ISSN 1558-349X ; 1546-1440
    ISSN (online) 1558-349X
    ISSN 1546-1440
    DOI 10.1016/j.jacr.2017.02.052
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  5. Article ; Online: Dose indices: everybody wants a number.

    Strauss, Keith J

    Pediatric radiology

    2014  Volume 44 Suppl 3, Page(s) 450–459

    Abstract: This paper discusses the merits and weaknesses of the standard terms that have been developed to quantify CT dose: CT dose indices (CTDI), dose length product (DLP) and effective dose. The difference between the measured CTDIvol and the CTDIvol displayed ...

    Abstract This paper discusses the merits and weaknesses of the standard terms that have been developed to quantify CT dose: CT dose indices (CTDI), dose length product (DLP) and effective dose. The difference between the measured CTDIvol and the CTDIvol displayed on the CT scanner illustrates a clinical dilemma. Displayed CTDIvol represents the radiation dose delivered to a plastic phantom, which is significantly different from the dose delivered to the patient, depending on the size of the patient. Although effective dose is simple to calculate for an individual patient, it was never intended for this purpose. The need for a simple, appropriate method to estimate pediatric patient doses led to the development of the size-specific dose estimate (SSDE), the newest CT dose index. Here I compare SSDE and its merits to the use of effective dose to estimate patient dose. The discussion concludes with a few sample calculations and basic clinical applications of SSDE to better quantify pediatric patient dose from CT scans.
    MeSH term(s) Child ; Humans ; Patient Safety/standards ; Pediatrics/standards ; Practice Guidelines as Topic ; Radiation Dosage ; Radiation Injuries/prevention & control ; Radiation Protection/standards ; Radiology/standards ; Radiometry/standards ; Reference Values ; Risk Assessment/methods ; Tomography, X-Ray Computed/standards
    Language English
    Publishing date 2014-10-11
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-014-3104-z
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  6. Article ; Online: Developing patient-specific dose protocols for a CT scanner and exam using diagnostic reference levels.

    Strauss, Keith J

    Pediatric radiology

    2014  Volume 44 Suppl 3, Page(s) 479–488

    Abstract: The management of image quality and radiation dose during pediatric CT scanning is dependent on how well one manages the radiographic techniques as a function of the type of exam, type of CT scanner, and patient size. The CT scanner's display of expected ...

    Abstract The management of image quality and radiation dose during pediatric CT scanning is dependent on how well one manages the radiographic techniques as a function of the type of exam, type of CT scanner, and patient size. The CT scanner's display of expected CT dose index volume (CTDIvol) after the projection scan provides the operator with a powerful tool prior to the patient scan to identify and manage appropriate CT techniques, provided the department has established appropriate diagnostic reference levels (DRLs). This paper provides a step-by-step process that allows the development of DRLs as a function of type of exam, of actual patient size and of the individual radiation output of each CT scanner in a department. Abdomen, pelvis, thorax and head scans are addressed. Patient sizes from newborns to large adults are discussed. The method addresses every CT scanner regardless of vendor, model or vintage. We cover adjustments to techniques to manage the impact of iterative reconstruction and provide a method to handle all available voltages other than 120 kV. This level of management of CT techniques is necessary to properly monitor radiation dose and image quality during pediatric CT scans.
    MeSH term(s) Algorithms ; Child ; Equipment Failure Analysis/instrumentation ; Equipment Failure Analysis/standards ; Humans ; Patient-Centered Care/standards ; Pediatrics/standards ; Practice Guidelines as Topic ; Radiation Dosage ; Radiology/standards ; Radiometry/instrumentation ; Radiometry/standards ; Reference Values ; Tomography, X-Ray Computed/instrumentation ; Tomography, X-Ray Computed/standards ; United States
    Language English
    Publishing date 2014-07-19
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-014-3088-8
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  7. Article ; Online: Advances in the Decision to Image or Not to Image.

    Callahan, Michael J / Strauss, Keith J

    JAMA oncology

    2016  Volume 3, Issue 4, Page(s) 564–565

    MeSH term(s) Decision Making ; Humans ; Image Processing, Computer-Assisted
    Language English
    Publishing date 2016-12-08
    Publishing country United States
    Document type Journal Article ; Comment
    ISSN 2374-2445
    ISSN (online) 2374-2445
    DOI 10.1001/jamaoncol.2016.5061
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  8. Article ; Online: Achievable dose reductions with gonadal shielding for children and adults during abdominal/pelvic radiographic examinations: A Monte Carlo simulation.

    Somasundaram, Elanchezhian / Brady, Samuel L / Strauss, Keith J

    Medical physics

    2020  Volume 47, Issue 11, Page(s) 5514–5522

    Abstract: Purpose: Recently, medical professionals have reconsidered the practice of routine gonadal shielding for radiographic examinations. The objective of this study was to evaluate the gonadal dose reduction achievable with gonadal shields in the primary ... ...

    Abstract Purpose: Recently, medical professionals have reconsidered the practice of routine gonadal shielding for radiographic examinations. The objective of this study was to evaluate the gonadal dose reduction achievable with gonadal shields in the primary beam during abdominal/pelvic radiographic examinations under ideal and non-ideal shielding placement.
    Methods: CT scans of CIRS anthropomorphic phantoms were used to perform voxelized Monte Carlo simulations of the photon transport during abdominal/pelvic radiographic examinations with standard filtration and 0.1 mm Cu + 1 mm Al added filtration to estimate gonadal doses for an adult, 5 yr old, and newborn phantom with and without gonadal shields. The reduction in dose when the shields were not placed at the ideal locations was also evaluated. The ratio of the number of scattered-to-primary photons (SPR) across the anteroposterior (AP) dimension of the phantoms was also reported.
    Results: The simulated dose reduction with ideal shielding placement for the testes and ovaries ranged from 80% to 90% and 55% to 70% respectively. For children, a misalignment of the shield to the gonad of 4 cm reduced the measured dose reduction to the gonads to <10%. For adults, this effect did not occur until the misalignment increased to ~6 cm. Effects of dose reduction with and without the gonadal shields properly placed were similar for standard filtration and added filtration. SPR at the level of the testes was consistently <1 for all phantoms. SPR for ovaries was ~1.5 for the adult and 5-yr old, and ~1 for the newborn phantom.
    Conclusion: Dose reduction with ideal alignment of the simulated gonadal shield to the gonads in this study was greater for the testes than the ovaries; both reductions were substantial. However, the dose reductions were greatly reduced (to <10%) for both sexes with misalignment of the gonads to the shields by 4 cm for children and 6 cm for adults.
    MeSH term(s) Adult ; Child ; Drug Tapering ; Female ; Humans ; Infant, Newborn ; Male ; Monte Carlo Method ; Phantoms, Imaging ; Radiation Dosage ; Radiation Protection ; Radiography, Abdominal
    Language English
    Publishing date 2020-10-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 188780-4
    ISSN 2473-4209 ; 0094-2405
    ISSN (online) 2473-4209
    ISSN 0094-2405
    DOI 10.1002/mp.14495
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  9. Article ; Online: Reducing Pediatric Intraoral Radiography Radiation Dose Using Reduced-Power Dental X-Ray Units: A Randomized Trial.

    Cully, Jennifer L / Somasundaram, Elanchezhian / Campbell, Richard / Brady, Samuel L / Gosnell, Elizabeth S / Specht, Sarah / Candon, Lisa Atlas / Strauss, Keith J

    Journal of dentistry for children (Chicago, Ill.)

    2022  Volume 89, Issue 2, Page(s) 95–103

    Abstract: Purpose: ...

    Abstract Purpose:
    MeSH term(s) Alloys ; Child ; Humans ; Prospective Studies ; Radiation Dosage ; X-Rays
    Chemical Substances Alloys
    Language English
    Publishing date 2022-05-01
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 390120-8
    ISSN 1935-5068 ; 1551-8949 ; 0022-0353
    ISSN (online) 1935-5068
    ISSN 1551-8949 ; 0022-0353
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  10. Article ; Online: KERMA ratios vs. SSDE: is one better at estimating pediatric CT radiation doses?

    Strauss, Keith J

    Pediatric radiology

    2012  Volume 42, Issue 5, Page(s) 525–526

    MeSH term(s) Humans ; Phantoms, Imaging ; Radiation Dosage ; Radiometry/methods ; Tomography, X-Ray Computed
    Language English
    Publishing date 2012-03-20
    Publishing country Germany
    Document type Journal Article ; Comment
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-012-2371-9
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