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Objective: The utility of routine post-operative imaging in clinically asymptomatic patients is unclear. We sought to determine how frequently X-rays following operatively treated ankle fractures result in a change in management., Design: Retrospective cohort study conducted with hospital electronic health record SETTING: Single level 1 trauma center in major urban city., Patients/participants: 193 patients with operatively treated ankle fractures at our institution between January 2020 and December 2021., Main Outcome Measures: Patient radiographs were categorized as surveillance X-rays and clinically indicated X-rays. Changes in management were defined as alteration in follow-up, deviation from standard post-operative protocols, or revision surgery. A logistic regression was performed looking at factors predicting whether an X-ray changes management. A cost analysis was also performed looking at the financial implications of asymptomatic surveillance of ankle fractures., Results: 438 post-operative X-rays were found and included in analysis. Of these, 391 were considered surveillance X-rays and 47 clinically indicated. 23 X-rays were determined to have resulted in changes in management (18 clinically indicated, 5 taken in asymptomatic patients). The number of management changing X-rays was significantly higher in the clinically indicated group (p < 0.0001). The only factor associated with whether an X-ray changed management was whether the patient was symptomatic at the visit (p < 0.0001). Asymptomatic surveillance X-rays cost our institution 21,825.62 USD per year., Conclusions: Radiographs in clinically asymptomatic patients with operatively managed ankle fractures have a low likelihood of changing management. Such imaging represents costs to the healthcare system, increased time for patients during clinic visits, and radiation exposure. The use of screening radiographic studies remains commonplace because the risk of delayed diagnosis is great, and the goal of any surgeon should be the swift identification of complications in order to minimize patient morbidity. Future surveillance protocols should consider the findings of this and other studies on the use of screening radiographs and strike a careful balance between minimizing unnecessary imaging, maximizing early complication detection, and ensuring a personalized approach towards patient-level factors to optimize care and efficiency for both patient and health system., Level of Evidence: Level III., Competing Interests: Declaration of competing interest The above authors have no conflicts of interest or disclosures to report., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

An analysis and evaluation has been carried out on each test parameter contained in the compliance test of 1016 stationary and 480 mobile radiography devices compiled by the Indonesian Nuclear Energy Regulatory Agency (Badan Pengawas Tenaga Nuklir, BAPETEN) from 2019 to 2020. The data were categorised and analysed based on the devices' age to observe the correlation of performance with the age of the X-ray machine. In addition, the implementation level of the Automatic Exposure Control (AEC) system test of the stationary radiography X-ray modality is also reviewed. The results of the evaluation showed that 89.9% of the stationary radiography devices unconditionally pass the test, 5.2% are in the status of 'conditional pass' and 4.9% fail the test. On the other hand, 84.8% of mobile radiography devices unconditionally pass the test, 2.1% are in the status of 'conditional pass' and 13.1% fail the test. From the evaluation conducted, there is no observable correlation between the age of the modality and the results of the compliance test. Overall, only 9.2% of stationary radiography X-ray compliance test reports have included the AEC test since it is not a mandatory requirement of the national protocol., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Image quality is an important factor in imaging optimisation and diagnosis. Many determinants of image quality are controlled by the radiographer; therefore, radiographer-led strategies may be key to improving X-ray image quality. This review examines the literature on radiographer-led diagnostic evaluation to establish its potential to improve X-ray image quality., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews and the Joanna Briggs Institute Manual for Evidence Synthesis Scoping Review were used to review studies relevant to the impact of radiographer-led diagnostic evaluation on image quality. CINHAL, Embase, Scopus, Web of Science and Medline databases were searched for relevant articles. Search terms synonymous with radiographer, commenting, and image quality were used and studies that examined any type of radiographer-led image interpretation and its relationship to image quality in X-ray based modalities were reviewed., Results: Fourteen studies that met the inclusion criteria were reviewed. All the studies reviewed unanimously reported a positive association between radiographer image interpretation and image quality in X-ray based modalities. Five emerging themes were identified to be responsible for the improvement in image quality: increased understanding of image quality requirements, improved technical skills, enhanced ability to utilise supplementary imaging and repeats, collaborative upskilling of colleagues, and a complementary interaction between diagnostic and radiographic skills that serves to enhance image quality., Conclusions: The findings demonstrate that radiographer image interpretation is a useful strategy to optimise the quality of X-ray examinations., Implications for Practice: The findings highlight a new avenue to improve X-ray quality in the clinical environment and support evidence-based uptake of preliminary image evaluation systems. These findings also support the integration of radiographer commenting alongside technical image quality in teaching curricula., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

X-ray directional dark-field imaging is a recent technique that can reveal a sample's small-scale structural properties which are otherwise invisible in a conventional imaging system. In particular, directional dark-field can detect and quantify the orientation of anisotropic structures. Here, we present an algorithm that allows for the extraction of a directional dark-field signal from X-ray speckle-based imaging data. The experimental setup is simple, as it requires only the addition of a diffuser to a full-field microscope setup. Sandpaper is an appropriate diffuser material in the hard x-ray regime. We propose an approach to extract the mean scattering width, directionality, and orientation from the recorded speckle images acquired with the technique. We demonstrate that our method can detect and quantify the orientation of fibres inside a carbon fibre reinforced polymer (CFRP) sample within one degree of accuracy and show how the accuracy depends on the number of included measurements. We show that the reconstruction parameters can be tuned to increase or decrease accuracy at the expense of spatial resolution., Competing Interests: The authors have declared that no competing interests exist.

Development of portable X-ray fluorescence devices has made it easier to quickly assess trace elements such as zinc in human tissue. A TOPAS Monte Carlo code was used to investigate the use of a portable X-ray fluorescence system for detecting zinc in nail clippings. The obtained energy spectra from different nail thicknesses were analyzed and three different normalization techniques (coherent, Compton, and entire spectrum) were introduced. The simulation results suggested that coherent normalization can be a particularly robust normalization procedure., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The purpose of this study was to investigate the x-ray energy dependence of the measured response of detectors (TLD-100) and to estimate the accurate dose delivered to patients during routine X-ray examinations. The response of thermoluminescent dosimeters TLD as a function of low energy range was determined using the X-ray tube at the Ionizing Radiation Met. Lab in the National Institute of Standards, (Secondary Standard Dosimetry Lab (SSLD) Cairo, Egypt. The X-ray dose was measured at 25, 50 and 100 kVp nominal x-ray energies. TLD-100 linearity, reproducibility and relative sensitivity were studied. Several sets of TLD-100 were to different x-ray beam energy to determine the calibration coefficient of the TLD system and the correction factors applied for the dose calculation (readings (nC)/radiation dose (mGy)) was determined in the dose range (0.69 mGy to 350 mGy). The radiation dose to the patient was estimated in diagnostic radiology for the existing working protocols (skull, pelvis, abdomen, and lumbar Spine). TLD-100 was exposed at various nominal energy used for diagnostic (40-100 kVp) and various tube current (50-120 mA) which is normally used in clinical X-ray examinations. The TLD-100 was exposed three times for each kVp value, and the exposure doses were measured in mGy. The obtained results showed a linear behavior of the TLD-100 response as a function of X-ray dose with estimated uncertainty within 10%. This indicates a good accuracy when assessing the entrance dose in diagnostic radiology procedures). The sensitivity of the TLD cards showed a standard deviation of 4.7%. Moreover, the dose-nC factor has the same value (within the standard uncertainty). Mean Entrance Skin Dose for skull, pelvis, abdomen, and lumbar spine were 0.46 ± 0.01, 1.5 ± 0.05, 7.3 ± 0.21 and 9.2 ± 0.29 mGy respectively. The obtained results reflect the agreement with the recommended values and will be useful for the formulation of national reference levels as recommended by the International Atomic Energy Agency (IAEA) SAFETY STANDARDS SERIES No. GSR Part 3 2014., (Copyright © 2021. Published by Elsevier Ltd.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

As part of ongoing efforts to assess lifespan disease mortality and incidence in 63,715 patients from the Canadian Fluoroscopy Cohort Study (CFCS) who were treated for tuberculosis between 1930 and 1969, we developed a new FLUoroscopy X-ray ORgan-specific dosimetry system (FLUXOR) to estimate radiation doses to various organs and tissues. Approximately 45% of patients received medical procedures accompanied by fluoroscopy, including artificial pneumothorax (air in pleural cavity to collapse of lungs), pneumoperitoneum (air in peritoneal cavity), aspiration of fluid from pleural cavity and gastrointestinal series. In addition, patients received chest radiographs for purposes of diagnosis and monitoring of disease status. FLUXOR utilizes age-, sex- and body size-dependent dose coefficients for fluoroscopy and radiography exams, estimated using radiation transport simulations in up-to-date computational hybrid anthropomorphic phantoms. The phantoms include an updated heart model, and were adjusted to match the estimated mean height and body mass of tuberculosis patients in Canada during the relevant time period. Patient-specific data (machine settings, exposure duration, patient orientation) used during individual fluoroscopy or radiography exams were not recorded. Doses to patients were based on parameter values inferred from interviews with 91 physicians practicing at the time, historical literature, and estimated number of procedures from patient records. FLUXOR uses probability distributions to represent the uncertainty in the unknown true, average value of each dosimetry parameter. Uncertainties were shared across all patients within specific subgroups of the cohort, defined by age at treatment, sex, type of procedure, time period of exams and region (Nova Scotia or other provinces). Monte Carlo techniques were used to propagate uncertainties, by sampling alternative average values for each parameter. Alternative average doses per exam were estimated for patients in each subgroup, with the total average dose per individual determined by the number of exams received. This process was repeated to produce alternative cohort vectors of average organ doses per patient. This article presents estimates of doses to lungs, female breast, active bone marrow and heart wall. Means and 95% confidence intervals (CI) of average organ doses across all 63,715 patients were 320 (160, 560) mGy to lungs, 250 (120, 450) mGy to female breast, 190 (100, 340) mGy to heart wall and 92 (47, 160) mGy to active bone marrow. Approximately 60% of all patients had average doses to the four studied organs of less than 10 mGy, 10% received between 10 and 100 mGy, 25% between 100 and 1,000 mGy, and 5% above 1,000 mGy. Pneumothorax was the medical procedure that accounted for the largest contribution to cohort average doses. The major contributors to uncertainty in estimated doses per procedure for the four organs of interest are the uncertainties in exposure duration, tube voltage, tube output, and patient orientation relative to the X-ray tube, with the uncertainty in exposure duration being most often the dominant source. Uncertainty in patient orientation was important for doses to female breast, and, to a lesser degree, for doses to heart wall. The uncertainty in number of exams was an important contributor to uncertainty for ∼30% of patients. The estimated organ doses and their uncertainties will be used for analyses of incidence and mortality of cancer and non-cancer diseases. The CFCS cohort is an important addition to existing radio-epidemiological cohorts, given the moderate-to-high doses received fractionated over several years, the type of irradiation (external irradiation only), radiation type (X rays only), a balanced combination of both genders and inclusion of people of all ages., (©2021 by Radiation Research Society. All rights of reproduction in any form reserved.)

X-ray phase contrast imaging can provide improved or complementary information to traditional attenuation-based X-ray imaging, making the field a vast and rapidly evolving research subject. X-ray speckle-based imaging (SBI) is one phase-contrast imaging approach that has shown significant potential in providing both high sensitivity and high resolution while using a very simple experimental setup. With the aim of transferring such phase-contrast-based imaging techniques from synchrotron to laboratory X-ray sources, the issue of the deposited radiation dose still remains to be addressed. In this work, we experimentally and quantitatively compare the results from three different SBI phase retrieval algorithms using both phantoms and biological samples in order to infer the optimal configuration. The results obtained using a synchrotron beam suggest that the technique based on optical flow conservation achieves the most accurate retrieval from the lowest number of sample exposures. This constitutes an important step toward the possibility of transferring SBI into the clinic.

Background: In connection with X-ray examinations of pregnant patients, good communication of benefit and risk is important to provide adequate patient care. Pregnant women often become concerned about the foetus and are unsure of the risk of malformations and the development of cancer. Health professionals who are involved in imaging pregnant women require specif knowledge about risks and benefits so they can convey information without creating unnecessary fear., Purpose: This study identifies the information needs of pregnant women in connection with X-ray examinations and how they prefer to have the information communicated., Method: A qualitative study using semi-structured interviews of seven pregnant women aged 28-36 in weeks 16-33 of their pregnancy. The interviews were analysed using interpretive phenomenological analysis., Results: The participants had expectations regarding the information provided about X-ray examinations during pregnancy. They needed concrete information on radiation doses, risks and any effects on the foetus. The risk was thought to be low, but several of the participants would still have been concerned when undergoing an X-ray examination., Conclusion: To provide adequate care of pregnant women in connection with X-ray examinations, healthcare professionals must have knowledge of pregnancy and radiation and have expertise in risk communication. This will prevent unnecessary concern in the pregnant woman, ensure that justified necessary examinations are carried out, and avoid adverse decisions such as termination of pregnancy based on erroneous grounds., (Copyright © 2021. Published by Elsevier Inc.)

X-ray based lung function (XLF) as a planar method uses dramatically less X-ray dose than computed tomography (CT) but so far lacked the ability to relate its parameters to pulmonary air volume. The purpose of this study was to calibrate the functional constituents of XLF that are biomedically decipherable and directly comparable to that of micro-CT and whole-body plethysmography (WBP). Here, we developed a unique set-up for simultaneous assessment of lung function and volume using XLF, micro-CT and WBP on healthy mice. Our results reveal a strong correlation of lung volumes obtained from radiographic XLF and micro-CT and demonstrate that XLF is superior to WBP in sensitivity and precision to assess lung volumes. Importantly, XLF measurement uses only a fraction of the radiation dose and acquisition time required for CT. Therefore, the redefined XLF approach is a promising tool for preclinical longitudinal studies with a substantial potential of clinical translation.

Artificial intelligence (AI) presents a key opportunity for radiologists to improve quality of care and enhance the value of radiology in patient care and population health. The potential opportunity of AI to aid in triage and interpretation of conventional radiographs (X-ray images) is particularly significant, as radiographs are the most common imaging examinations performed in most radiology departments. Substantial progress has been made in the past few years in the development of AI algorithms for analysis of chest and musculoskeletal (MSK) radiographs, with deep learning now the dominant approach for image analysis. Large public and proprietary image data sets have been compiled and have aided the development of AI algorithms for analysis of radiographs, many of which demonstrate accuracy equivalent to radiologists for specific, focused tasks. This article describes (1) the basis for the development of AI solutions for radiograph analysis, (2) current AI solutions to aid in the triage and interpretation of chest radiographs and MSK radiographs, (3) opportunities for AI to aid in noninterpretive tasks related to radiographs, and (4) considerations for radiology practices selecting AI solutions for radiograph analysis and integrating them into existing IT systems. Although comprehensive AI solutions across modalities have yet to be developed, institutions can begin to select and integrate focused solutions which increase efficiency, increase quality and patient safety, and add value for their patients.

Radiographic imaging with x-rays and protons is an omnipresent tool in basic research and applications in industry, material science and medical diagnostics. The information contained in both modalities can often be valuable in principle, but difficult to access simultaneously. Laser-driven solid-density plasma-sources deliver both kinds of radiation, but mostly single modalities have been explored for applications. Their potential for bi-modal radiographic imaging has never been fully realized, due to problems in generating appropriate sources and separating image modalities. Here, we report on the generation of proton and x-ray micro-sources in laser-plasma interactions of the focused Texas Petawatt laser with solid-density, micrometer-sized tungsten needles. We apply them for bi-modal radiographic imaging of biological and technological objects in a single laser shot. Thereby, advantages of laser-driven sources could be enriched beyond their small footprint by embracing their additional unique properties, including the spectral bandwidth, small source size and multi-mode emission.

As a very fast and non-invasive examination, conventional X-ray radiography is well established as the first line diagnostic imaging method of the human bone system. While major bone injuries such as fractures and dislocations are usually easily detectable on conventional X-ray images, more subtle injuries such as microfractures are often missed, leading to mistreatment and potential long-term consequences. The technology of Photon-Counting Dual-Energy Radiography (PCDER) yields the possibility to decompose conventional X-ray images into basis material images such as bone- and soft-tissue-equivalence images. The obtained basis material images offer significant advantages in terms of image contrast and image details over the raw attenuation image which shows an overlap of bone and soft tissue. Whereas the advantages of bone- and soft-tissue-equivalence images have been broadly discussed referring to bone subtraction images in the detection of pulmonary diseases, this method has not been considered for the analysis of musculoskeletal images until present. In this study we show that basis component equivalence images have high potential to improve the diagnostic accuracy of the detection of minor bone lesions during clinical trauma imaging. A reader study performed by three experienced radiologists compares the image quality of basis material images to a standard radiograph image of a non-fractured cadaveric hand.

We present an end-to-end deep learning frame-work for X-ray image diagnosis. As the first step, our system determines whether a submitted image is an X-ray or not. After it classifies the type of the X-ray, it runs the dedicated abnormality classification network. In this work, we only focus on the chest X-rays for abnormality classification. However, the system can be extended to other X-ray types easily. Our deep learning classifiers are based on DenseNet-121 architecture. The test set accuracy obtained for 'X-ray or Not', 'X-ray Type Classification', and 'Chest Abnormality Classification' tasks are 0.987, 0.976, and 0.947, respectively, resulting into an end-to-end accuracy of 0.91. For achieving better results than the state-of-the-art in the 'Chest Abnormality Classification', we utilize the new RAdam optimizer. We also use Gradient-weighted Class Activation Mapping for visual explanation of the results. Our results show the feasibility of a generalized online projectional radiography diagnosis system.

Disaster victim identification following a mass fatality incident is focussed on identifying the deceased and returning them to their families as quickly as possible, while gathering as much information as practical to aid investigators in establishing the cause of the incident. Ante-mortem data is gathered and compared with the post-mortem data obtained in order to positively identify the deceased. This paper presents results from a study concerned with the first part of the process of identifying the deceased-the triage or Primary Survey and how this can be done without access to hospital facilities such as conventional X-ray imaging or computed tomography. In particular, this study focuses on the imaging undertaken prior to the opening of the body bag by a multidisciplinary team, and how this imaging can assist particularly when forensic anthropologists are involved in the identification process. There are several advantages to imaging the body bags before they are opened and one of the most important is safety. Thus, this paper examines the viability of using a baggage scanner as a practical resource for X-ray imaging, as many regions worldwide may not be able to access conventional imaging equipment. Baggage scanners are readily available and found in airports and various government buildings. The baggage scanner is particularly suited to this task and produces images that can be used by forensic anthropologists to distinguish between human and non-human remains, identify items of evidence and personal effects, and even perform a preliminary or partial biological profile. When considering their response plans, emergency responders should consider including baggage scanners as a contingency for screening body bags if no other imaging system is available.

This work aims to characterize the novel DRX Plus 3543C detector in terms of detective quantum efficiency (DQE) using both a mobile x-ray system called Carestream DRX Revolution Nano and a traditional x-ray system (Carestream DRX Evolution). We used the commercial system DRX Revolution Nano, equipped with a new x-ray source based on CNT technology and field emission (FE) as the electron emitter (cathode). An innovative aspect of this device is its intrinsic selection of the focal spot size. We tested the system using three IEC-specified beam qualities (RQA3, 5 and 7) in terms of modulation transfer function (MTF), normalized noise power spectra (NNPS) and DQE as defined in the IEC 62220-1-1:2015. We compared the results obtained using DRX Revolution Nano and DRX Evolution with correlation and with Bland-Altman plots to study their agreement. RQA3 MTF is slightly lower than the RQA5 and 7 curves between 0.5 and 2.5 cycles mm -1 . We measured MTF values of about 0.6 at 1 lp mm -1 and about 0.28 lp mm -1 at 2 lp mm -1 . The NNPS curves show a decreasing trend with the energy regarding the DRX Revolution Nano. On the other hand, the DRX Evolution NNPS curve at RQA3 is greater than the one at RQA5, but the one at RQA5 is less than the one at RQA7. The DQE(0) ranged between about 0.82 (DRX Evolution at RQA3) and 0.54 (DRX Evolution at RQA7). As expected, the squared Pearson's correlation coefficients between the two x-ray tubes were always in an optimal agreement, and Bland-Altman plots confirmed a substantial equivalence between the two physical characterizations of the wireless detector. In conclusion, we can show that the dynamic focal selection of the system equipped with CNT does not play a substantial role in image quality compared to a traditional system in terms of physical characterisation of the detector in our measurement conditions.

This study investigates the x-ray scattering characteristics of microsphere particles in x-ray-grating-based interferometric imaging at different concentrations, bubble sizes and tube voltages (kV). Attenuation (ATI), dark-field (DFI) and phase-contrast (PCI) images were acquired. Signal-to-noise (SNR) and contrast-to-noise ratios with water (CNR w ) and air as reference (CNR a ) were determined. In all modalities, a linear relationship between SNR and microbubbles concentration, respectively, microsphere size was found. A significant gain of SNR was found when varying kV. SNR was significantly higher in DFI and PCI than ATI. The highest gain of SNR was shown at 60 kV for all media in ATI and DFI, at 80 kV for PCI. SNR for all media was significantly higher compared to air and was slightly lower compared to water. A linear relationship was found between CNR a , CNR w , concentration and size. With increasing concentration and decreasing size, CNR a and CNR w increased in DFI, but decreased in PCI. Best CNR a and CNR w was found at specific combination of kV and concentration/size. Highest average CNR a and CNR w was found for microspheres in ATI and PCI, for microbubbles in DFI. Microspheres are a promising contrast-media for grating-based-interferometry, if kV, microsphere size and concentration are appropriately combined.

X-ray images play an important role in providing physicians with satisfactory information correlated to fractures and diseases; unfortunately, most of these images suffer from low contrast and poor quality. Thus, enhancement of the image will increase the accuracy of correct information on pathologies for an autonomous diagnosis system. In this paper, a new approach for low-contrast X-ray image enhancement based on brightness adjustment using a fuzzy gamma reasoning model (FGRM) is proposed. To achieve this, three phases are considered: pre-processing, Fuzzy model for adaptive gamma correction (GC), and quality assessment based on blind reference. The proposed approach's accuracy is examined through two different blind reference approaches based on statistical measures (BR-SM) and dispersion-location (BR-DL) descriptors, supported by resulting images. Experimental results of the proposed FGRM approach on three databases (cervical, lumbar, and hand radiographs) yield favorable results in terms of contrast adjustment and providing satisfactory quality images. Graphical Abstract Graphical abstract of the proposed enhancement method.

In surgical correction of cavovarus deformity bony hindfoot procedures are required in most cases. For treatment planning X‑rays in two or more planes are usually used. In conventional X‑ray-techniques the hindfoot and ankle joint are presented in a more or less outward rotated position. Moreover, the peritalar complex is not delineated in the most corrected position. Therefore, the frequently used talus-metatarsal-I-angle (Meary angle) cannot be measured correctly. By application of the Coleman block test and additional adjustment of the malrotation in the lateral view, the peritalar complex and ankle joint can be evaluated in the corrected and "hindfoot-centred" position. Also, the frequently seen anterior ankle impingement can be observed precisely. Planning of osteotomies or corrective peritalar fusions is supported thereby. Some treatment examples are presented.

Purpose: We propose a novel methodology for generating synthetic X-rays from 2D RGB images. This method creates accurate simulations for use in non-diagnostic visualization problems where the only input comes from a generic camera. Traditional methods are restricted to using simulation algorithms on 3D computer models. To solve this problem, we propose a method of synthetic X-ray generation using conditional generative adversarial networks (CGANs)., Methods: We create a custom synthetic X-ray dataset generator to generate image triplets for X-ray images, pose images, and RGB images of natural hand poses sampled from the NYU hand pose dataset. This dataset is used to train two general-purpose CGAN networks, pix2pix and CycleGAN, as well as our novel architecture called pix2xray which expands upon the pix2pix architecture to include the hand pose into the network., Results: Our results demonstrate that our pix2xray architecture outperforms both pix2pix and CycleGAN in producing higher-quality X-ray images. We measure higher similarity metrics in our approach, with pix2pix coming in second, and CycleGAN producing the worst results. Our network performs better in the difficult cases which involve high occlusion due to occluded poses or large rotations., Conclusion: Overall our work establishes a baseline that synthetic X-rays can be simulated using 2D RGB input. We establish the need for additional data such as the hand pose to produce clearer results and show that future research must focus on more specialized architectures to improve overall image clarity and structure.

Low-energy x-ray imaging of secondary electron bremsstrahlung x-rays emitted during carbon-ion irradiation is a promising method for range estimation and could be used for imaging with almost clinical dose levels of carbon ion. However, the number of counts in images with clinical dose levels is relatively small, making it difficult to obtain precise range estimations. Since improving the sensitivity of the x-ray camera may solve this issue, we developed two new types of x-ray cameras. One uses a 1 mm thick, 40 mm × 40 mm cerium-doped yttrium aluminum perovskite (YA1O 3 : YAP(Ce)) scintillator plate combined with a 2 inch square flat panel photomultiplier tube (FP-PMT) contained in a 2 cm thick tungsten shield with a pinhole collimator positioned 50 mm from the scintillator; the other uses a 0.5 mm thick, 20 mm × 20 mm YAP(Ce) scintillator plate combined with a 1 inch square position sensitive photomultiplier tube (PSPMT) contained in the same tungsten shield with a pinhole collimator, but with the scintillator positioned closer (30 mm) to the pinhole collimator to obtain a similar field of view. For both cameras, we used a wider angle (∼55°) pinhole collimator to measure the phantom closer to improve sensitivity. Although the 40 mm × 40 mm YAP(Ce) camera had high system spatial resolution, the background count fractions were high and produced a high count area at the center of the images due to the pulse pileup of the signals. With the 20 mm × 20 mm YAP(Ce) camera, we obtained x-ray images with low background counts without a high count area at the image center. By smoothing the measured images, we were able to estimate the ranges even for clinical dose levels. We therefore confirmed that one of our newly developed YAP(Ce) cameras had high sensitivity and is promising for the imaging of secondary electron bremsstrahlung x-rays during irradiation of carbon ions in clinical conditions.

We present novel multi-energy X-ray imaging methods for direct radiography and computed tomography. The goal is to determine the contribution of thickness, mass density and atomic composition to the measured X-ray absorption in the sample. Algorithms have been developed by our own to calculate new X-ray images using data from an unlimited amount of scans/images of different tube voltages by pixelwise fitting of the detected gray levels. The resulting images then show a contrast that is influenced either by the atomic number of the elements in the sample (photoelectric interactions) or by the mass density (Compton scattering). For better visualization, those images can be combined to a color image where different materials can easily be distinguished. In the case of computed tomography no established true multi-energy methodology that does not require an energy sensitive detector is known to the authors. The existing dual-energy methods often yield noisy results that need spatial averaging for clear interpretation. The goal of the method presented here is to qualitatively calculate atomic number and mass density images without loosing resolution while reducing the noise by the use of more than two X-ray energies. The resulting images are generated without the need of calibration stan-dards in an automatic and fast data processing routine. They provide additional information that might be of special interest in cases like archaeology where the destruction of a sample to determine its composition is no option, but a increase in measurement time is of little concern., Competing Interests: The authors have declared that no competing interests exist.

The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.

In our paper we report a brief history of the X-rays discovery and discuss the implications of their use and abuse in the Italian pedriatic schools of the early 20th century. Indeed, history of the X-ray treatment in the Italian Pediatric School has not yet been well studied. Even if the scientific experience of many physicians is well known in literature, a summary was missing. In Italy, in 1900, exposure to Röntgenand ultraviolet radiation or to large amounts of solar rays was a widespread medical practice, especially in several pediatric schools. During those years, diagnosis and treatment of childhood pathologies underwent considerable changes, especially after the twenties, when scientists developed an unquestionable trust in the therapeutic properties of radiation, considered harmless at that time. We report the main steps of the scientific research of the early 20th century in Italy.

We investigate the combination of two emerging X-ray imaging technologies, namely spectral imaging and differential phase contrast imaging. By acquiring spatially and temporally registered images with several different X-ray spectra, spectral imaging can exploit differences in the energy-dependent attenuation to generate material selective images. Differential phase contrast imaging uses an entirely different contrast generation mechanism: The phase shift that an X-ray wave exhibits when traversing an object. As both methods can determine the (projected) electron density, we propose a novel material decomposition algorithm that uses the spectral and the phase contrast information simultaneously. Numerical experiments show that the combination of these two imaging techniques benefits from the strengths of the individual methods while the weaknesses are mitigated: Quantitatively accurate basis material images are obtained and the noise level is strongly reduced, compared to conventional spectral X-ray imaging.

Advancements in and increasing usage of complex diagnostic examinations with interventional procedures and surgeries has led to an increase in the occupational radiation doses received by physicians and other medical staff. Measuring the scattered radiation doses received by these staff is vital for the development-effective radiation protection programs. In this study, we measured scattered doses during angiography and digital breast tomosynthesis examinations with small-type dosimeters using our jungle gym (JG) method with measurement points at 50-cm intervals. The results were compared with measurements taken using the conventional ion chamber method. The JG method uses paper pipe tubes and a plastic joint structure and allows measurements at different points inside an examination room. The difference between measurements can be attributed to the radiation absorption characteristics of the components used in the JG method. A maximum radiation dose reduction of 20% was observed due to absorption by the JG components. This effect was smaller than the measurement error produced because of reproducibility issues and other limitations of the conventional method. The conventional measurement has disadvantages that are associated with the reproducibility of measurement points, equipment load, and the radiation exposure experienced by the measurer. The proposed JG method exhibits significant improvements in all these aspects. Furthermore, the measurer does not have to be present in the measurement room; therefore, the JG method is extremely safe and useful for radiation protection.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Talbot-Lau interferometry (TLI) provides additional contrast modes for x-ray imaging that are complementary to conventional absorption radiography. TLI is particularly interesting because it is one of the few practical methods for realizing phase contrast with x-rays that is compatible with large-spot high power x-ray sources. A novel micro array anode structured target (MAAST) x-ray source offers several advantages for TLI over the conventional combination of an extended x-ray source coupled with an absorption grating including higher flux and larger field of view, and these advantages become more pronounced for x-ray energies in excess of 30 keV. A Monte Carlo simulation was performed to determine the optimal parameters for a MAAST source for use with TLI. It was found that the both spatial distribution of x-ray production and the number of x-ray produced in the MAAST have a strong dependence on the incidence angle of the electron beam.

Purpose: This technical note presents an inexpensive tool and method for determining lead equivalency using digital radiography x-ray equipment., Methods: A test tool was developed using commercially available lead tape (3M™ Lead Foil Tape 421). The test tool consisted of nine varying lead thick squares arranged in a larger square (0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, and 1.0 mm). It was imaged on a DR plate with a digital portable x-ray unit across a range of energies (60-120 kVp) and two beam filtrations. Lead equivalency was determined by using the linear relationship between dose to the detector and pixel values in the raw images. The lead equivalency of the tape was validated using known lead thicknesses (physically measured with caliper). Additional lead equivalency measurements were made for protective eyewear, a thyroid shield, and a lead apron., Results: The test tool and method measured the two known lead thicknesses to be -9.7% to 7.1% different from the actual values across the range of energies under normal x-ray beam conditions and under a 1-mm copper filtered x-ray beam. The additional lead equivalency measurements of radiation protection apparel across energies ranged from -6% to 20% for both beam conditions when compared with the values provided by the manufacturer., Conclusion: This work validates the test tool and methodology as an inexpensive alternative to checking the lead equivalency of radiation protection apparel in a clinical setting. The methodology is equipment independent with a few prerequisites., (© 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Radioprotection of the eye lens of medical staff involved in Surgical procedures is a subject of international debates since ICRP recommended, on 2011, a lower equivalent dose limit for the lens of the eye. In this work we address the effectiveness of different models of X-ray protective eyewear by relating actual dosimetry measurements to an ad hoc developed mathematical model, in order to disentangle the contribution of geometrical factors and shield capabilities. Phantom irradiation was carried out in fixed exposure conditions in angiographic room: we found that measured Dose Reduction Factors (DRF) strongly depend on the ergonomics of the investigated eyewear. Actually a very poor DRF was observed in the case of a glass model in spite of its high nominal attenuation, whereas a protective tool with low shielding capabilities such a visor resulted much more effective as a consequence of is shape (i.e. extended geometric protection of the eye lens). Our work highlights the need of the introduction of a specific parameter to quantify the effectiveness of the protection tools and able to predict their DRF by taking into account the geometry of the clinical condition of exposure. Aiming at making steps forward the standardization of the guidelines concerning the features of eye protective tools, we developed a simple mathematical model describing the eye lens irradiation geometry which allows the introduction, for each eyewear, of a comprehensive parameter, the Eye Protection Effectiveness (EPE), that, for any defined clinical irradiation condition and glass shielding capabilities and shape, defines the overall effective X-ray protection of the eyewear., (Copyright © 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Since their discovery by Wilhelm Conrad Röntgen in 1895, X-rays have become the most widely available, typically fastest, and usually most cost-effective medical imaging modality today. From the early radiographic approaches using X-ray films as detectors, the portfolio of medical X-ray imaging devices developed into a large range of dedicated instrumentation for various applications. While X-ray imaging has come a long way, there are some physical properties of X-rays, which have not yet been fully exploited, and which may offer quite some room for further enhancements of current X-ray imaging equipment. Firstly, X-ray imaging today is mainly black and white, despite the fact that X-ray generators actually create a full spectrum of X-ray energies, and that the interactions of X-rays that occur within the human body are not the same for all energies and every material. Exploiting these spectral dependencies allows to not only obtain a black and white CT image, but also to obtain more molecularly specific information, which is relevant particularly in oncological precision radiology. The second aspect of X-rays, and so far in radiology mainly neglected and unused, is the physical fact that X-rays can also be interpreted in the wave picture, and not only as presently been done in the particle picture. If interpreted as waves, X-rays-just like visible light-experience a phase shift in matter, and this-if exploited correctly-can produce a new class of X-ray images, which then depict the wave interactions of X-rays with matter, rather than only the attenuating properties, as done until now.

Cost-risk-benefit analysis has been applied to protection of the patient in diagnostic radiology with special reference to the application of referral guidelines. The analysis presented has extended previous work in this field to provide a theoretical framework that encompasses key factors that need to be considered in the optimisation of patient protection from both diagnostic and radiation risks. The fraction of patients whose symptoms do not meet criteria contained in the referral guidelines and, therefore, for whom an X-ray examination is not indicated has been termed the selectivity of the guidelines. Also included are the detriments arising from rejected or repeated examinations as well as the levels of patient dose employed in order to achieve given levels of true and false diagnostic outcomes. A comprehensive framework for optimisation is outlined and its relationship to justification discussed., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The present study aimed to propose local diagnostic reference levels (DRLs) formulated by calculating entrance surface doses for general radiography at 20 facilities of Aichi prefecture in Japan, by comparing these values with DRLs established in Japan in 2015 (DRLs 2015) and assessing radiation dose differences among facilities. X-ray outputs (half-value layer and air kerma) of each facility were measured with a non-invasive type of detector. The results were employed to formulate local DRLs based on the 75th percentiles of dose distributions. These local DRLs were lower than the DRLs 2015 for all examinations. If proposed local DRLs from other 46 prefectures can be collected, this paper can be used to benefit the next effort to draft better DRL for Japan., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

A BEAMnrc Monte Carlo simulation of a diagnostic X-ray unit in a broad beam geometry intended for the derivation of effective linear attenuation coefficients was validated against measurements made on the X-ray unit on which the simulation was based. The validation process assessed the size of the beam, the first and second half value layer, the variation in kerma with anode-heel effect and the accuracy of values of effective linear attenuation coefficient for water and solid water attenuators. The agreement between the simulated and measured results for all tests was consistently within the experimental uncertainty for the measurements. The average deviation between values of effective linear attenuation coefficient for simulated and measured results is 3.8%, with the highest individual deviation 7.1%. The simulation can be used to produce values of effective linear attenuation coefficient for a range of kVp, field size and attenuator thickness that are close to those measured., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: Measurement of vertebral axial rotation (VAR) is relevant for the assessment of scoliosis. Stokes method allows estimating VAR in frontal X-rays from the relative position of the pedicles and the vertebral body. This method requires identifying these landmarks for each vertebral level, which is time-consuming. In this work, a quasi-automated method for pedicle detection and VAR estimation was proposed., Method: A total of 149 healthy and adolescent idiopathic scoliotic (AIS) subjects were included in this retrospective study. Their frontal X-rays were collected from multiple sites and manually annotated to identify the spinal midline and pedicle positions. Then, an automated pedicle detector was developed based on image analysis, machine learning and fast manual identification of a few landmarks. VARs were calculated using the Stokes method in a validation dataset of 11 healthy (age 6-33 years) and 46 AIS subjects (age 6-16 years, Cobb 10°-46°), both from detected pedicles and those manually annotated to compare them. Sensitivity of pedicle location to the manual inputs was quantified on 20 scoliotic subjects, using 10 perturbed versions of the manual inputs., Results: Pedicles centers were localized with a precision of 84% and mean difference of 1.2 ± 1.2 mm, when comparing with manual identification. Comparison of VAR values between automated and manual pedicle localization yielded a signed difference of - 0.2 ± 3.4°. The uncertainty on pedicle location was smaller than 2 mm along each image axis., Conclusion: The proposed method allowed calculating VAR values in frontal radiographs with minimal user intervention and robust quasi-automated pedicle localization. These slides can be retrieved under Electronic Supplementary Material.

Analytical methods based on X-Ray radiation proved to be reliable and sensitive techniques to study activated carbons (ACs). An X-Ray absorption analysis based on digital radiographic images (XRA) is applied for the determination of the exhaustion degree of granular activated carbon (GAC) used in a water purification system for hemodialysis. XRA-method demonstrated the possibility to determine the exhaustion degree at different layers of the GAC filter. The results of the XRA-method were successfully correlated with X-Ray Fluorescence (XRF), TGA, Elemental analysis (EA), SEM, TD-GC/MS, ATR-FTIR, X Ray Diffraction (XRD) and Nuclear Magnetic Resonance relaxometry (NMR) analyses. It was demonstrated that the XRA-method is a fast and reliable analytical tool to give indirect information on the exhaustion degree of GAC at different layers. It is also demonstrated that XRA results can be correlated with the results of the other analytical techniques, rather dealing with the composition and morphology of GAC at different layers., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: The study evaluated the performance of a cohort of healthcare professionals in image interpretation of appendicular radiographic examinations following a preliminary clinical evaluation (PCE) course., Methods: A systematic review and meta-analysis of image interpretation performance by non-medical staff was undertaken. Thirty three participants (seven radiographers, nineteen nurses, five paramedics, and two physiotherapists) completed an image based Objective Structured Examination (OSE) following a short course on PCE of appendicular radiographs. The case bank comprised 25 appendicular radiographic examinations. Prevalence of abnormal examinations approximated 52% (traumatic conditions). The OSE test scores were analysed with Alternative Free-response Receiver Operating Characteristic (AFROC) calculation of Area Under the Curve (AUC), sensitivity, specificity, and Cohen's Kappa (k) for multi-reader agreement. Professional subgroup results were compared with Analysis of Variance (ANOVA), and compared to the literature review., Results: The participant subgroup results for radiographers were sensitivity 79.7%, specificity 92.9%, k = 72; AUC 86.5. Nurses sensitivity 76.2%, specificity 80.4%, k = 56; AUC 78.3. Paramedics sensitivity 80.3%, specificity 81.6%, k = 61; AUC 81.5. Physiotherapists sensitivity 90.4%, specificity 91.6%, k = 82; AUC 91.8. ANOVA Samples scores (f = 1.5; p = 0.23), sensitivity (f = 0.5; p = 0.65), specificity (f = 2.8; p = 0.05). The comparison of the radiographers and nurses results to the published literature were encouraging (SROC AUC 93.1 and 91.2, respectively). The paramedics and physiotherapists results could not be compared to published standards or abilities on the task due to a lack of literature available., Conclusion: The study results of image interpretation and commentary of appendicular radiographs in an academic environment by this multi-professional sample were to a high standard, further work is recommended on a larger sample., (Copyright © 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Imaging bone tumors often causes uncertainty, especially outside dedicated sarcoma treatment centers. Conventional radiography remains the backbone of bone tumor diagnostics, but MR imaging has a role. Radiographs are crucial for assessing the tumor matrix and aggressiveness. MR imaging is the best modality for local staging. This article reviews semiological aspects of bone tumors: patient age, tumor localization, pattern of bone destruction/margins, aggressiveness, growth speed, matrix formation, periosteal reaction, cortical involvement, size, and number of lesions. All aspects are discussed in terms of their appearance on radiographs and MR imaging, with a focus on the correlation between the 2 modalities., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Irradiators utilizing radioactive cesium-137 ( 137 Cs) or cobalt-60 ( 60 Co) gamma-ray sources have been used for biological applications for many decades. These applications include irradiation of much of the nation's blood supply and radiation biology research. In 2005, the U.S. Nuclear Regulatory Commission was assigned the task of preventing the misuse of radioactive materials by persons with malicious intentions; gamma-ray sources, in particular, were given high priority. This resulted in increased security requirements, including constant surveillance, controlled access and personnel background checks. As a result of such regulations being introduced, organizations considering the purchase of a gamma-ray irradiator for the first time or as a replacement to an existing one due to radioactive decay, are now looking into alternative technologies, primarily an X-ray irradiator. To make an educated decision on whether a particular type of X-ray irradiator is of sufficient equivalency to a particular type of 137 Cs irradiator for specific applications, one must rely on relevant published comparison studies from other researchers, or perform the comparison studies on their own. This work focuses on the comparison of the radiation physics aspects of two 137 Cs irradiator models and three X-ray irradiator models, for the purpose of determining whether the X-ray irradiator models could validly replace the 137 Cs irradiator models for certain applications. Although evaluating the influence of relative biological effectiveness (RBE) differences among irradiators could be part of this study, that has been left for a related publication focused on the theoretical aspects of this topic. These evaluations were performed utilizing 47-g and 120-g tissue-equivalent rodent dosimetry phantoms. Our results indicate that, depending upon the user's dose uncertainty budget and maximum areal density of specimens to be irradiated, the RS 2000 160 kVp X-ray irradiator, X-RAD160 X-ray irradiator or X-RAD320 X-ray irradiator could successfully replace a 137 Cs irradiator. Technically, any X-ray irradiator model providing similar irradiation geometry, and average energy similar to or higher than these three X-ray models, could also successfully replace a 137 Cs irradiator. The results also reveal that differences in inherent source geometry, field geometry and irradiation geometry can counter some of the influence due to differences in energy spectrum. Our goal is that this publication be used as a guide for other similar studies, providing investigators with information on important details that can make the difference between strong and weak comparison conclusions.

In this study, we propose to remove Moiré image artifact induced by system instabilities in grating-based x-ray interferometry imaging using convolutional neural network (CNN) technique. This method reduces Moiré image artifact in image-domain via a learned image post-processing procedure, rather than developing signal retrieval optimization algorithms to minimize the inconsistencies between acquired phase stepping data and assumed signal model. To achieve this aim, we suggested to train the CNN network using dataset synthesized from both natural images and experimentally acquired Moiré artifact-only images. In particular, a novel approach is developed to generate a large number of various high quality Moiré artifact-only images from finite groups of experimental phase stepping data. Both numerical and experimental results demonstrate that the developed CNN method is able to effectively remove the undesired Moiré image artifact. As a result, the image quality of a practical grating-based x-ray interferometry system can be greatly improved.

Purpose: Minimally invasive alternatives are now available for many complex surgeries. These approaches are enabled by the increasing availability of intra-operative image guidance. Yet, fluoroscopic X-rays suffer from projective transformation and thus cannot provide direct views onto anatomy. Surgeons could highly benefit from additional information, such as the anatomical landmark locations in the projections, to support intra-operative decision making. However, detecting landmarks is challenging since the viewing direction changes substantially between views leading to varying appearance of the same landmark. Therefore, and to the best of our knowledge, view-independent anatomical landmark detection has not been investigated yet., Methods: In this work, we propose a novel approach to detect multiple anatomical landmarks in X-ray images from arbitrary viewing directions. To this end, a sequential prediction framework based on convolutional neural networks is employed to simultaneously regress all landmark locations. For training, synthetic X-rays are generated with a physically accurate forward model that allows direct application of the trained model to real X-ray images of the pelvis. View invariance is achieved via data augmentation by sampling viewing angles on a spherical segment of [Formula: see text]., Results: On synthetic data, a mean prediction error of 5.6 ± 4.5 mm is achieved. Further, we demonstrate that the trained model can be directly applied to real X-rays and show that these detections define correspondences to a respective CT volume, which allows for analytic estimation of the 11 degree of freedom projective mapping., Conclusion: We present the first tool to detect anatomical landmarks in X-ray images independent of their viewing direction. Access to this information during surgery may benefit decision making and constitutes a first step toward global initialization of 2D/3D registration without the need of calibration. As such, the proposed concept has a strong prospect to facilitate and enhance applications and methods in the realm of image-guided surgery.

Purpose: Image-guided percutaneous interventions are safer alternatives to conventional orthopedic and trauma surgeries. To advance surgical tools in complex bony structures during these procedures with confidence, a large number of images is acquired. While image-guidance is the de facto standard to guarantee acceptable outcome, when these images are presented on monitors far from the surgical site the information content cannot be associated easily with the 3D patient anatomy., Methods: In this article, we propose a collaborative augmented reality (AR) surgical ecosystem to jointly co-localize the C-arm X-ray and surgeon viewer. The technical contributions of this work include (1) joint calibration of a visual tracker on a C-arm scanner and its X-ray source via a hand-eye calibration strategy, and (2) inside-out co-localization of human and X-ray observers in shared tracking and augmentation environments using vision-based simultaneous localization and mapping., Results: We present a thorough evaluation of the hand-eye calibration procedure. Results suggest convergence when using 50 pose pairs or more. The mean translation and rotation errors at convergence are 5.7 mm and [Formula: see text], respectively. Further, user-in-the-loop studies were conducted to estimate the end-to-end target augmentation error. The mean distance between landmarks in real and virtual environment was 10.8 mm., Conclusions: The proposed AR solution provides a shared augmented experience between the human and X-ray viewer. The collaborative surgical AR system has the potential to simplify hand-eye coordination for surgeons or intuitively inform C-arm technologists for prospective X-ray view-point planning.

During the first half of the twentieth century, the mining industry in Britain was subject to recurrent disputes about the risk to miners' lungs from coal dust, moderated by governmental, industrial, medical and mining bodies. In this environment, precise measurements offered a way to present uncontested objective knowledge. By accessing primary source material from the National Archives, the South Wales Miners Library and the University of Bristol's Special Collections, I demonstrate the importance that the British Medical Research Council (MRC) attached to standardized instrumental measures as proof of objectivity, and explore the conflict between objective and subjective measures of health. Examination of the MRC's use of spirometry in their investigation of pneumoconiosis (miner's lung) from 1936 to 1945 will shed light on this conflict and illuminate the politics inherent in attempts to quantify disability and categorize standards of health.