An anthropomorphic chest phantom (Neonatal Chest Phantom,Gammex 610,Middleton,USA) representing accurate transmission characteristics of a 1-2 kg neonate was imaged in this study (Fig.1).
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Fig. 1: The GammexR neonatal chest phantom. (Image courtesy of Gammex Inc, USA)References: Gammex Inc, USA' href='https://epos.myesr.org/posterimage/esr/ecr2015/127633/mediagallery/594566'>
References: Gammex Inc, USA
Interchangeable lung insert pieces permit evaluations in different clinical conditions: normal chest,pneumothorax and hyaline membrane disease.
Two additional vascular lines (PremicathR28G) were included: one upper left subclavian line simulation and one lower peripheral line simulation in the inferior caval vein with tip projection on the right atrium (Fig.2).
Fig. 2: The GammexR neonatal chest phantom showing the two additional vascular lines.References: Gammex Inc. USA' href='https://epos.myesr.org/posterimage/esr/ecr2015/127633/mediagallery/594567'>
References: Gammex Inc. USA
X-ray images of the GammexR neonatal chest phantom with simulation of hyaline membrane disease and pneumothorax and additional simulated vascular lines were made (Fig.3).
Fig. 3: X-ray image of the GammexR neonatal chest phantom with simulation of hyaline membrane disease and pneumothorax. Striped arrow: left subclavian vein line simulation. Full arrow: tip of the simulated subclavian catheter. Open arrow: tip of the simulated lower peripheral catheter. Dotted arrow: pneumothorax.' href='https://epos.myesr.org/posterimage/esr/ecr2015/127633/mediagallery/594568'>
Comparison of different detectors with identical exposure settings and covering variable doses is not easy to perform in clinical practice for ethical reasons.The anthropomorphic GammexR neonatal chest phantom is an ideal alternative that can be used for image analysis of all components in the imaging chain: physical detector performance,acquisition parameter optimization,image post-processing analysis and perceived image quality.
The GammexR neonatal chest phantom was imaged on three Agfa HealthCare detectors (Fig.4): a computed radiography (CR) powder phosphor (MD4.0/DX-M,using BaFBr),a CR needle crystal based phosphor (HD5.0/DX-M,using CsBr) and a needle crystal based digital radiography (DR) detector (DR DX-D35C,using CsI).Exposure settings were identical for all detectors,covering an entrance surface dose range from 12.3 microGy to 122 microGy at 63kV,yielding 66 images in total. Dedicated Musica2 paediatric post-processing (Agfa HealthCare) was applied [1,2].
Visual grading analysis (VGA) was applied.This is a well-described method for evaluating image quality differences that may exist between two imaging modalities [3-6].
Three experienced paediatric radiologists (S.M,M.E,B.L) scored the image quality of the images on a five-point rating scale (Table 1) using the Viewdex software program [7,8]. Physics ch.11lightmr.s learning website. Avast vpn crack 2020.
This program presents the images blindly and randomly and offers the facility to answer questions regarding quality criteria directly on the screen (Fig.5).
Fig. 5: Viewdex software for Visual Grading Analysis (VGA). Combined view of the X-ray images with easy access to the image quality criteria and scoring window.' href='https://epos.myesr.org/posterimage/esr/ecr2015/127633/mediagallery/594572'>The image quality was scored based on IQ criteria formulated in the European guidelines [9]: they require an evaluation of the reproduction of important normal anatomical structures (Table2).
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Table 2: Image quality criteria used in this study' href='https://epos.myesr.org/posterimage/esr/ecr2015/127633/mediagallery/594574'>Epos 4 Excel
Criteria on the visibility of the long vascular lines,noise and disease simulations were added.The scoring of 66 images was done in three sessions lasting about 1 hour for each session: results were exported into Microsoft Excel for further analysis.
To examine intra-observer agreement,50 % of the images were scored a second time by two of the radiologists two weeks after the first reading.
The Wilcoxon Signed Rank test was used for comparative analysis of the image quality scores between the three detector types and Cohen’s Kappa statistics were performed for the calculation of inter- and intra-observer agreement (SPSS version 13.0,IBM,New York,USA).