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Parents' attitudes about their children's schools matter. Their views can shape their children's attitudes about school, affect their levels of family-school engagement, and influence their residential and school enrollment decisions. In this article, we describe the development of a survey scale to assess parent perceptions of the climate of their child's school. Our comprehensive scale development process incorporated feedback from academics and potential respondents from the outset of the design process to enhance scale quality. We conducted 3 studies with national samples of parents (n = 385; n = 253; n = 266) to gather evidence of scale score reliability and valid score inferences based on convergent and discriminant validity. Through confirmatory factor analysis, we identified a theoretically grounded factor structure that fit the data well but found no evidence that parental response patterns distinguish between academic and social elements of school climate. Furthermore, we found that parents of younger children, on average, had a more positive perception of the school's climate than did parents of older children. We conclude by discussing how researchers and Pre-K-12 schools and districts can use the scale to aid school improvement efforts., (2014 APA)

Background: Mammographic breast density is a strong breast cancer risk factor but is not used in the clinical setting, partly because of a lack of standardization and automation. We developed an automated and objective measurement of the grayscale value variation within a mammogram, evaluated its association with breast cancer, and compared its performance with that of percent density (PD)., Methods: Three clinic-based studies were included: a case-cohort study of 217 breast cancer case subjects and 2094 non-case subjects and two case-control studies comprising 928 case subjects and 1039 control subjects and 246 case subjects and 516 control subjects, respectively. Percent density was estimated from digitized mammograms using the computer-assisted Cumulus thresholding program, and variation was estimated from an automated algorithm. We estimated hazards ratios (HRs), odds ratios (ORs), the area under the receiver operating characteristic curve (AUC), and 95% confidence intervals (CIs) using Cox proportional hazards models for the cohort and logistic regression for case-control studies, with adjustment for age and body mass index. We performed a meta-analysis using random study effects to obtain pooled estimates of the associations between the two mammographic measures and breast cancer. All statistical tests were two-sided., Results: The variation measure was statistically significantly associated with the risk of breast cancer in all three studies (highest vs lowest quartile: HR = 2.0 [95% CI = 1.3 to 3.1]; OR = 2.7 [95% CI = 2.1 to 3.6]; OR = 2.4 [95% CI = 1.4 to 3.9]; [corrected] all P (trend) < .001). [corrected]. The risk estimates and AUCs for the variation measure were similar to [corrected] those for percent density (AUCs for variation = 0.60-0.62 and [corrected] AUCs for percent density = 0.61-0.65). [corrected]. A meta-analysis of the three studies demonstrated similar associations [corrected] between variation and breast cancer (highest vs lowest quartile: RR = 1.8, 95% CI = 1.4 to 2.3) and [corrected] percent density and breast cancer (highest vs lowest quartile: RR = 2.3, 95% CI = 1.9 to 2.9)., Conclusion: The association between the automated variation measure and the risk of breast cancer is at least as strong as that for percent density. Efforts to further evaluate and translate the variation measure to the clinical setting are warranted.

Objective: The purpose of this article is to discuss flat-panel digital radiography (DR) artifacts to help physicists, radiologists, and radiologic technologists visually familiarize themselves with an expanded range of artifact appearance., Conclusion: Flat-panel DR is a growing area of general radiography. As a radiology community, we are still becoming familiar with these systems and learning about clinically relevant artifacts and how to avoid them. These artifacts highlight important limitations or potential complications in using flat-panel DR systems.

This software tool locates and computes the intensity of radiation skin dose resulting from fluoroscopically guided interventional procedures. It is comprised of multiple modules. Using standardized body specific geometric values, a software module defines a set of male and female patients arbitarily positioned on a fluoroscopy table. Simulated X-ray angiographic (XA) equipment includes XRII and digital detectors with or without bi-plane configurations and left and right facing tables. Skin dose estimates are localized by computing the exposure to each 0.01 × 0.01 m(2) on the surface of a patient irradiated by the X-ray beam. Digital Imaging and Communications in Medicine (DICOM) Structured Report Dose data sent to a modular dosimetry database automatically extracts the 11 XA tags necessary for peak skin dose computation. Skin dose calculation software uses these tags (gantry angles, air kerma at the patient entrance reference point, etc.) and applies appropriate corrections of exposure and beam location based on each irradiation event (fluoroscopy and acquistions). A physicist screen records the initial validation of the accuracy, patient and equipment geometry, DICOM compliance, exposure output calibration, backscatter factor, and table and pad attenuation once per system. A technologist screen specifies patient positioning, patient height and weight, and physician user. Peak skin dose is computed and localized; additionally, fluoroscopy duration and kerma area product values are electronically recorded and sent to the XA database. This approach fully addresses current limitations in meeting accreditation criteria, eliminates the need for paper logs at a XA console, and provides a method where automated ALARA montoring is possible including email and pager alerts.

The U.S. National Press has brought to full public discussion concerns regarding the use of medical radiation, specifically x-ray computed tomography (CT), in diagnosis. A need exists for developing methods whereby assurance is given that all diagnostic medical radiation use is properly prescribed, and all patients' radiation exposure is monitored. The "DICOM Index Tracker©" (DIT) transparently captures desired digital imaging and communications in medicine (DICOM) tags from CT, nuclear imaging equipment, and other DICOM devices across an enterprise. Its initial use is recording, monitoring, and providing automatic alerts to medical professionals of excursions beyond internally determined trigger action levels of radiation. A flexible knowledge base, aware of equipment in use, enables automatic alerts to system administrators of newly identified equipment models or software versions so that DIT can be adapted to the new equipment or software. A dosimetry module accepts mammography breast organ dose, skin air kerma values from XA modalities, exposure indices from computed radiography, etc. upon receipt. The American Association of Physicists in Medicine recommended a methodology for effective dose calculations which are performed with CT units having DICOM structured dose reports. Web interface reporting is provided for accessing the database in real-time. DIT is DICOM-compliant and, thus, is standardized for international comparisons. Automatic alerts currently in use include: email, cell phone text message, and internal pager text messaging. This system extends the utility of DICOM for standardizing the capturing and computing of radiation dose as well as other quality measures.

Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described., Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL., Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K(a,r)) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K(a,r) exceeds the 75th percentile of the ADS and (2) when the percent of instances where K(a,r) exceeds the facility-selected SRDL is greater for the FDS than for the ADS., Conclusions: Analysis of the two data sets (ADS and FDS) and of the percent of instances that exceed the SRDL provides a means for the facility to better manage radiation dose (and therefore both deterministic and stochastic radiation risk) to the patient during FGI procedures.

Staff are exposed to potentially high levels of radiation exposure during interventional radiology procedures. Radiation protection shielding devices should be used to help maintain personnel exposures as low as reasonably achievable. Body protection tools include lead aprons, thyroid shields, radiation protection cabins, and floor- and table-mounted shields. Eye protection tools include leaded glasses, ceiling-mounted shields, and protective patient drapes. Hand protection tools include leaded surgical gloves and protective patient drapes. For the most part, these radiation protection tools provide substantial dose reduction for personnel, with several notable exceptions. Leaded glasses without lateral protection do not provide adequate protection to operators because they are typically exposed to scatter radiation from the side. Leaded surgical gloves are not useful for hand protection when hands are placed in the primary x-ray beam. Although other radiation protection tools are effective, they come with drawbacks, including staff physical discomfort and reduced procedure efficiency. As a result, further development of new protection devices is encouraged., (Copyright 2010 Elsevier Inc. All rights reserved.)

Grid evaluation for a screen-film x-ray system has typically included independent measurement of the opposing contrast improvement factor and Bucky factor. Neither of these metrics, however, is appropriate when assessing grid performance in a digital imaging environment. For digital radiographic systems, the benefit of an anti-scatter grid is well characterized by the quantum signal-to-noise ratio improvement factor (K(SNR)) provided by the grid. The purpose of this work was to measure K(SNR) of prototype grids designed for use with digital radiographic systems. The prototype grids had 5 mm tall lead septa, fiber interspace material, line rate N = 25 and 36 cm(-1) and ratio r = 15 and 21, respectively. The primary and scatter transmission properties of the grids were measured, and K(SNR) was evaluated over a phantom thickness range of 10-50 cm. To provide a comparison, the K(SNR) of similarly constructed N44r15 and N80r15 grids is also reported. K(SNR) of the prototype grids ranged from 1.4 for the 10 cm phantom to 2.4 for the 50 cm phantom. For the thickest phantom, the SNR improvement factor of the prototype grids was 18-83% higher than that of the N44r15 and N80r15 grids, respectively.

Background and Purpose: As the use of 3D rotational angiography (3D RA) for the evaluation of cerebral vasculature becomes more widespread, it is important to evaluate this imaging method's effect on patient radiation dose. The purpose of the study is to measure 3D RA radiation dose as compared with biplanar digital subtraction angiography (DSA)., Methods: The distribution and peak skin dose were measured for 3D RA and biplanar DSA by using an anthropomorphic skull phantom. In addition, the cumulative incident dose, summed over all images in each acquisition, was determined. Measurements were acquired for our facility's standard 3D RA acquisition mode (25 degrees /s rotational speed; 162 total frames) and other available acquisition mode selections., Results: For 3D RA, the skin dose was found to be distributed across the back and sides of the skull with the peak skin dose located at the center of the back of the skull. The peak skin dose for the standard 3D RA acquisition mode was 15 mGy. For a biplanar DSA run, the peak skin dose was 58 mGy, also located at the back of the skull. The cumulative incident dose for the standard 3D RA acquisition mode was 33 mGy, compared with 53 mGy for biplanar DSA., Conclusion: The patient radiation dose for 3D RA is significantly lower than for biplanar DSA, by nearly a factor of 4 in peak skin dose and 40% lower in cumulative incident dose.