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Article ; Online: Radiation dose optimization in diagnostic and interventional radiology: Current issues and future perspectives.

Tsapaki, Virginia

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)

2020 Volume 79, Page(s) 16–21

Abstract: The medical radiological imaging technological evolution and wide availability has resulted in the exponential increase in utilization. Evidence for a risk of cancer arising from radiation doses of lower than 100 mSv is still limited. There is a need for ...

Abstract	The medical radiological imaging technological evolution and wide availability has resulted in the exponential increase in utilization. Evidence for a risk of cancer arising from radiation doses of lower than 100 mSv is still limited. There is a need for patient dose optimization. A literature review was conducted to identify the reasons why optimization is important and the steps to be followed for a successful optimization process in digital radiology, Computed Tomography, interventional radiology and mammography. Based on recent literature, 5 steps for a dose optimization process are proposed. These steps are: 1) establishment of a quality assurance programme; a mistake, misuse or malfunction of an X-ray machine can potentially affect the health or life of thousands of people, 2) establishment of a dose optimization team consisting of a radiologist, medical physicist and radiation technologist, 3) determination of baseline dose levels and image quality as well as comparisons with benchmarks to decide which exam protocols should be optimized, 4) modification of protocols by the medical physicist and 5) evaluation of the optimization process and its effect on patient dose and image quality. The optimization process should include joint efforts focused on 1) equipment performance 2) exam protocol customization and 3) staff behaviour. Manufacturers should provide detailed descriptions of exam protocols and training on the use of dose reduction features. The diagnostic radiology medical physicist should emerge and take a proactive lead in the everyday clinical routine in order to promote the value of optimization process.
MeSH term(s)	Humans ; Radiation Dosage ; Radiographic Image Enhancement ; Radiography ; Radiology, Interventional ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-10-06
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1122650-x
ISSN	1724-191X ; 1120-1797
ISSN (online)	1724-191X
ISSN	1120-1797
DOI	10.1016/j.ejmp.2020.09.015
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Article ; Online: Automatic image quality evaluation in digital radiography using for-processing and for-presentation images.

Tsalafoutas, Ioannis A / AlKhazzam, Shady / Tsapaki, Virginia / Kharita, Mohammed Hassan

Journal of applied clinical medical physics

2024 Volume 25, Issue 4, Page(s) e14285

Abstract: Purpose: To investigate the impact of digital image post-processing algorithms on various image quality (IQ) metrics of radiographic images under different exposure conditions.: Methods: A custom-made phantom constructed according to the instructions ...

Abstract	Purpose: To investigate the impact of digital image post-processing algorithms on various image quality (IQ) metrics of radiographic images under different exposure conditions. Methods: A custom-made phantom constructed according to the instructions given in the IAEA Human Health Series No.39 publication was used, along with the respective software that automatically calculates various IQ metrics. Images with various exposure parameters were acquired with a digital radiography unit, which for each acquisition produces two images: one for-processing (raw) and one for-presentation (clinical). Various examination protocols were used, which incorporate diverse post-processing algorithms. The IQ metrics' values (IQ-scores) obtained were analyzed to investigate the effects of increasing incident air kerma (IAK) on the image receptor, tube potential (kVp), additional filtration, and examination protocol on image quality, and the differences between image type (raw or clinical). Results: The IQ-scores were consistent for repeated identical exposures for both raw and clinical images. The effect that changes in exposure parameters and examination protocol had on IQ-scores were different depending on the IQ metric and image type. The expected positive effect that increasing IAK and decreasing tube potential should have on IQ was clearly exhibited in two IQ metrics only, the signal difference-to-noise-ratio (SDNR) and the detectability index (d'), for both image types. No effect of additional filtration on any of the IQ metrics was detected on images of either type. An interesting finding of the study was that for all different image acquisition selections the d' scores were larger in raw images, whereas the other IQ metrics were larger in clinical images for most of the cases. Conclusions: Since IQ-scores of raw and their respective clinical images may be largely different, the same type of image should be consistently used for monitoring IQ constancy and when results from different X-ray systems are compared.
MeSH term(s)	Humans ; Radiographic Image Enhancement ; Radiation Dosage ; Radiography ; X-Rays ; Software ; Phantoms, Imaging
Language	English
Publishing date	2024-02-05
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/acm2.14285
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Article ; Online: Clinical diagnostic reference levels in neuroradiology based on clinical indication.

Aly, Antar / Tsapaki, Virginia / Ahmed, Ayman Zakaria / Own, Ahmed / Patro, Satya / Al Naemi, Huda / Kharita, Mohammad Hassan

Radiation protection dosimetry

2024

Abstract: This study focuses on patient radiation exposure in interventional neuroradiology (INR) procedures, a field that has advanced significantly since its inception in the 1980s. INR employs minimally invasive techniques to treat complex cerebrovascular ... ...

Abstract	This study focuses on patient radiation exposure in interventional neuroradiology (INR) procedures, a field that has advanced significantly since its inception in the 1980s. INR employs minimally invasive techniques to treat complex cerebrovascular diseases in the head, neck, and spine. The study establishes diagnostic reference levels (DRLs) for three clinical indications (CIs): stroke (S), brain aneurysms (ANs), and brain arteriovenous malformation (AVM). Data from 209 adult patients were analyzed, and DRLs were determined in terms of various dosimetric and technical quantities. For stroke, the established DRLs median values were found to be 78 Gy cm2, 378 mGy, 118 mGy, 12 min, 442 images, and 15 runs. Similarly, DRLs for brain AN are 85 Gy cm2, 611 mGy, 95.5 mGy, 19.5, 717 images, and 26 runs. For brain AVM, the DRL's are 180 Gy cm2, 1144 mGy, 537 mGy, 36 min, 1375 images, and 31 runs. Notably, this study is unique in reporting DRLs for specific CIs within INR procedures, providing valuable insights for optimizing patient safety and radiation exposure management.
Language	English
Publishing date	2024-05-03
Publishing country	England
Document type	Journal Article
ZDB-ID	225912-6
ISSN	1742-3406 ; 0144-8420
ISSN (online)	1742-3406
ISSN	0144-8420
DOI	10.1093/rpd/ncae113
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Article ; Online: A simple manual method to estimate water-equivalent diameter for calculating size-specific dose estimate in chest computed tomography.

Mihailidis, Dimitris / Tsapaki, Virginia / Tomara, Pelagia

The British journal of radiology

2020 Volume 94, Issue 1117, Page(s) 20200473

Abstract: Objectives: The American Association of Physicists in Medicine (AAPM) Task Groups (TG) 204 and 220 introduced a method to estimate patient dose by introducing the Size-Specific Dose Estimate (SSDE). They provided patient size-specific conversion factors ...

Abstract	Objectives: The American Association of Physicists in Medicine (AAPM) Task Groups (TG) 204 and 220 introduced a method to estimate patient dose by introducing the Size-Specific Dose Estimate (SSDE). They provided patient size-specific conversion factors that could be applied to volumetric CT Dose Index CTDI Methods: For 16 adult patients undergoing chest CT, the method employed an average relative electron density (ρ Results: The results showed comparable behavior for all methods. There is overall agreement especially between this study and TG220. Largest differences were +13.3% and+15.9% from TG220 and Huda values, respectively. Patient size correlation showed strong correlation with the TG220 and Huda et al methods. Conclusions: A simple, quick manual method to estimate CT patient radiation dose in terms of SSDE was proposed as an alternative where sophisticated computer programming is not available. It can be readily used during any clinical chest CT scanning. Advances in knowledge: The paper is novel as it presents simple, quick manual method to estimate CT patient radiation dose in chest imaging. The process can be used as alternative in cases no sophisticated computer programming is available.
MeSH term(s)	Humans ; Lung/anatomy & histology ; Radiation Dosage ; Radiography, Thoracic/methods ; Radiography, Thoracic/statistics & numerical data ; Tomography, X-Ray Computed/methods ; Tomography, X-Ray Computed/statistics & numerical data ; Water
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2020-10-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20200473
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Article ; Online: Development and implementation of a quality control protocol for B-mode ultrasound equipment.

Tsapaki, Virginia / Tsalafoutas, Ioannis A / Triantopoulou, Sotiria S / Triantopoulou, Charikleia

Journal of ultrasound

2021 Volume 25, Issue 2, Page(s) 155–165

Abstract: Purpose: Quality assurance (QA) of ultrasound (US) equipment is currently required in only a few countries around the world. In Greece, no national or other norms exist for regulating the use of US equipment. However, to obtain accreditation for the ... ...

Abstract	Purpose: Quality assurance (QA) of ultrasound (US) equipment is currently required in only a few countries around the world. In Greece, no national or other norms exist for regulating the use of US equipment. However, to obtain accreditation for the radiology department of a Greek hospital, the establishment and implementation of a quality control (QC) protocol and a QA programme for US equipment was required. Materials and methods: A literature review regarding US QC/QA procedures was performed. The information collected was used as a guide to create a QC/QA protocol and to obtain an appropriate US QC phantom. Drafting and testing of the initial protocol lasted 6 months. Its final version was implemented for 18 months in two US systems and five US transducers. Results: The QC tests included in the protocol evaluate mechanical and electrical safety, image display, uniformity, penetration depth, distance accuracy, greyscale display, anechoic object imaging, geometric distortion, and axial/lateral resolution. The only QC test that failed was the test for uniformity since intense non-uniformities were observed that led to the replacement of two linear transducers. Conclusion: US imaging is considered safe and, where appropriate, is preferred over imaging modalities that use ionizing radiation. However, the lack of QC/QA implies that US image quality is not routinely monitored. Therefore, the possibility of malfunctions that may go undetected and lead to wrong diagnosis cannot be excluded. A QC/QΑ programme can contribute to the elimination of such errors and ensure that performance is maintained over time.
MeSH term(s)	Humans ; Phantoms, Imaging ; Quality Control ; Review Literature as Topic ; Transducers ; Ultrasonography
Language	English
Publishing date	2021-04-08
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2365426-0
ISSN	1876-7931 ; 1971-3495
ISSN (online)	1876-7931
ISSN	1971-3495
DOI	10.1007/s40477-021-00579-7
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Article ; Online: Digital radiography image quality evaluation using various phantoms and software.

Tsalafoutas, Ioannis A / AlKhazzam, Shady / Tsapaki, Virginia / AlNaemi, Huda / Kharita, Mohammed Hassan

Journal of applied clinical medical physics

2022 , Page(s) e13823

Abstract: Purpose: To investigate the effect of the exposure parameters on image quality (IQ) metrics of phantom images, obtained automatically using software or from visual evaluation.: Methods: Three commercial phantoms and a homemade phantom constructed ... ...

Abstract	Purpose: To investigate the effect of the exposure parameters on image quality (IQ) metrics of phantom images, obtained automatically using software or from visual evaluation. Methods: Three commercial phantoms and a homemade phantom constructed according to the instructions given in the IAEA Human Health Series No. 39 publication were used, along with the respective software that estimate automatically various IQ metrics. Images with various exposure parameters were acquired in a digital radiography (DR) unit. For the commercial phantoms, visual evaluations were also performed. The IQ scores obtained were analyzed to investigate the effects of increasing incident air kerma (IAK), tube potential (kVp), additional filtration, and acquisition protocol on IQ. Results: The effects of the exposure parameters on the IQ metrics, determined with the commercial and the IAEA phantoms, were not the same. For example, clear trends of improvement of IQ scores with increased IAK and reduction of most IQ scores with increased kVp were observed mostly with the IAEA phantom, but not with the commercial phantoms (for both automatic and visual scoring methods). For all phantoms, the maximum variations in IQ scores observed for repeated identical exposures were almost always below 10% with automatic evaluation whereas, for visual evaluation, reached 17%. Conclusions: Failure to detect some expected trends with the complex commercial phantoms may be attributed to the fact that IQ in DR is more strongly affected by the post-processing procedures, which may mask the effect of other parameters on IQ, something that was not observed with the simple IAEA phantom.
Language	English
Publishing date	2022-11-07
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/acm2.13823
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Article: How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement.

Damilakis, John / Frija, Guy / Brkljacic, Boris / Vano, Eliseo / Loose, Reinhard / Paulo, Graciano / Brat, Hugues / Tsapaki, Virginia

Insights into imaging

2023 Volume 14, Issue 1, Page(s) 27

Language	English
Publishing date	2023-02-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2543323-4
ISSN	1869-4101
ISSN	1869-4101
DOI	10.1186/s13244-023-01369-x
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Article ; Online: Technical specifications of dose management systems: An international atomic energy agency survey.

Tsalafoutas, Ioannis A / Arlany, Laurentcia / Titovich, Egor / Pynda, Yaroslav / Ruggeri, Ricardo / Sánchez, Roberto Mariano / Reiser, Ingrid / Tsapaki, Virginia

Journal of applied clinical medical physics

2023 Volume 25, Issue 1, Page(s) e14219

Abstract: Purpose: Dose management systems (DMS) have been introduced in radiological services to facilitate patient radiation dose management and optimization in medical imaging. The purpose of this study was to gather as much information as possible on the ... ...

Abstract	Purpose: Dose management systems (DMS) have been introduced in radiological services to facilitate patient radiation dose management and optimization in medical imaging. The purpose of this study was to gather as much information as possible on the technical characteristics of DMS currently available, regarding features that may be considered essential for simply ensuring regulatory compliance or desirable to fully utilize the potential role of DMS in optimization of many aspects of radiological examinations. Methods: A technical survey was carried out and all DMS developers currently available (both commercial and open source) were contacted and were asked to participate. An extensive questionnaire was prepared and uploaded in the IAEA International Research Integration System (IRIS) online platform which was used for data collection process. Most of the questions (93%) required a "Yes/No" answer, to facilitate an objective analysis of the survey results. Some free text questions and comments' slots were also included, to allow participants to give additional information and clarifications where necessary. Depending on the answer, they were considered either as "Yes" or "No." Results: Given the way that the questions were posed, every positive response indicated that a feature was offered. Thus, the percentage of positive responses was used as a measure of adherence. The percentages of positive answers per section (and sub-section) are presented in graphs and limitations of this type of analysis are discussed in detail. Conclusions: The results of this survey clearly exhibit that large differences exist between the various DMS developers. Consequently, potential end users of a DMS should carefully determine which of the features available are essential for their needs, prioritize desirable features, but also consider their infrastructure, the level of support required and the budget available before selecting a DMS.
MeSH term(s)	Humans ; Surveys and Questionnaires ; Nuclear Energy
Language	English
Publishing date	2023-12-07
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/acm2.14219
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Article ; Online: Does clinical indication play a role in CT radiation dose in pediatric patients?

Triantopoulou, Sotiria / Tsapaki, Virginia

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)

2017 Volume 41, Page(s) 53–57

Abstract: Purpose: The purpose of this study was to identify the main pathologies for which CT is applied on pediatric patients and the related radiation doses as reported in the literature in order to facilitate justification and CT optimization.: Methods: A ... ...

Abstract	Purpose: The purpose of this study was to identify the main pathologies for which CT is applied on pediatric patients and the related radiation doses as reported in the literature in order to facilitate justification and CT optimization. Methods: A critical analysis of a literature review was performed. Different search engines were used such as PubMed, Google Scholar and Science Direct. Various terms and keywords were used to locate pertinent articles such as Pediatric, Computed tomography, Radiation Dose, Organ dose, Effective dose. Results: The results showed that the main pathologies for which CT is applied are: Crohn's disease, hydrocephalus, cystic fibrosis and pediatric malignancies-mainly lymphoma. The related radiation dose data are extremely scarce and are in the range of 3.48-17.56, 0.2-15.3mSv, 0.14-6.20mSv, and 2.8-518.0mSv, respectively. The radiation doses reported are high especially in pediatric oncology. Conclusions: Pediatric patients with malignancies are those exposed to the higher levels of radiation during CT imaging. Literature is lacking reporting of dose in Pediatric CT imaging. More studies need to be realized for the determination of radiation dose in those patients. Special protocols need to be recommended in order to reduce the exposure of children in radiation.
Language	English
Publishing date	2017-09
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1122650-x
ISSN	1724-191X ; 1120-1797
ISSN (online)	1724-191X
ISSN	1120-1797
DOI	10.1016/j.ejmp.2017.03.014
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Article ; Online: Medical physics workforce: A global perspective.

Tsapaki, Virginia / Tabakov, Slavik / Rehani, Madan M

Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)

2018 Volume 55, Page(s) 33–39

Abstract: Purpose: The International Organization for Medical Physics (IOMP) performed a detailed study following the first survey published in 2015 with the particular objectives: 1) gather data on global medical physicists (MPs) workforce, 2) identify ... ...

Abstract	Purpose: The International Organization for Medical Physics (IOMP) performed a detailed study following the first survey published in 2015 with the particular objectives: 1) gather data on global medical physicists (MPs) workforce, 2) identify differences between geographical regions and, 3) investigate whether there is a gender dimension in higher hierarchy positions. Methods: An online questionnaire was send to IOMP members and contact points in countries where no professional MPs society existed. Information requested: total number (N) of MPs (men and women), N of current elected executive board (EB) of societies and women proportion in the board, president gender and number of women presidents for the last 10 years. IOMP archives were also investigated for data on gender composition related to chairs of committees, officers and IOMP awardees. Results: Ninety three countries reported 29,179 MPs, from which 8702 were women (29.8%) and 20,477 men. The most dense MPs population was in Europe (34%), followed by North America (33%) and Asia/Oceania (24%). Societies EB women members constitute 21-40%, but rarely reach the presidential position. The IOMP archived data show that women MP representation decreases in higher hierarchy positions. Conclusions: Global MPs production does not meet clinical needs especially in Latin America/Caribbean and Africa (6% of total MPs workforce and small number of MPs/million of population). Rough estimations showed that approximately 58,950 MPs will be required by 2035. Women representation is away from the United Nations and European Commissions goals. Women representation in higher hierarchy position is low.
MeSH term(s)	Female ; Humans ; Internationality ; Male ; Medicine ; Physics ; Societies, Medical ; Surveys and Questionnaires ; Workforce/statistics & numerical data
Language	English
Publishing date	2018-10-22
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1122650-x
ISSN	1724-191X ; 1120-1797
ISSN (online)	1724-191X
ISSN	1120-1797
DOI	10.1016/j.ejmp.2018.10.012
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