Pediatric high KV/filtered airway radiographs: comparison of CR and film-screen systems

• Published in: Pediatric radiology Vol. 32; no. 7; pp. 476 - 484
• Main Authors: NICKOLOFF, Edward L, BERDON, Walter E, LU, Zheng F, RUZAL-SHAPIRO, Carrie B, SO, James C, DUTTA, Ajoy K
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.07.2002; Springer Nature B.V
• Subjects: Biological and medical sciences; Child; Child, Preschool; Diagnostic Equipment - standards; Dose-Response Relationship, Radiation; Humans; Infant; Infant, Newborn; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiographic Image Interpretation, Computer-Assisted - methods; Radiographic Image Interpretation, Computer-Assisted - standards; Respiratory system; Respiratory System - diagnostic imaging; X-Ray Intensifying Screens - standards; Human; Lung disease; Radiodiagnosis; Film screen system; Respiratory disease; Lung; Thorax; Digital image; Image quality; Radiography; Radiation dose; Filter; Medical imagery; Computerized axial tomography; Dosimetry; Child; Spatial resolution; Comparative study
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-002-0689-4

The imaging of pediatric airways presents a challenge because of the superimposition of the airway over the bone of the spine on the AP view. In recent years, some radiology departments have replaced conventional X-ray films by computed radiography (CR). The effect of the various changes upon image quality and radiation doses has not been clearly demonstrated. The goal of this paper was to investigate and identify potential improvements and/or degradations to pediatric airways imaging from the application of new technology, in particular to high KV/filtered radiographs; a new filter was designed. Two modern film-screen combinations and a CR system were evaluated for a range of tube potentials from 60 to 140 kVp. The spatial resolutions were measured for different geometrical magnifications. Relative radiation doses were also determined. Clinical airway images of children taken with the different imaging methods were subjectively compared. Our study confirmed that the visualization of the pediatric airways is enhanced by using high X-ray tube potentials with proper X-ray beam filtration. For CR systems, the selection of the cassette size, cassette type, focal spot, and geometrical magnification impact upon the image quality. Despite the increased dynamic range and image processing advantage with CR systems, CR techniques need to be improved to be more comparable with high kVp filtered magnification radiographs using film screens and small X-ray tube focal spots. With appropriate X-ray beam filtration and high kVp's, CR image receptors can provide adequate image quality for pediatric airway imaging. However, the transition to digital radiography involves certain caveats. In general, radiation doses with CR systems are greater than typical doses with film-screen systems.