H.A.A.B. Mraity a, b, *
, L. Walton b
, A. England b
, J. Thompson b
, L. Lanca c
, P. Hogg b, d
a University of Kufa, Faculty of Science, Department of Physics, Najaf, Iraq
b University of Salford, School of Health Sciences, Salford, United Kingdom
c Singapore Institute of Technology, Singapore
d Department of Radiography, Karolinska Institute, Stockholm, Sweden
Introduction: A study was conducted to determine whether the anode heel effect can be used to influence optimisation of radiation dose and image quality (IQ) for AP pelvis radiography.
Methods: ATOM dosimetry phantom and an anthropomorphic phantom were positioned for AP pelvis.
Using a CR system, images were acquired and doses were measured with phantom feet toward anode
and then feet toward cathode. Exposure factors (kVp, mAs and SID) were systematically generated using
a factorial design. Images were scored visually for quality using relative visual grading together with a 3
point Likert scale. Signal to noise ratio was also calculated as a physical measure of image quality.
Dosimetry data were collected for the ovaries and testes.
Results: The optimum technique for male, which resulted in lower dose and suitable image quality, was
with feet positioned toward the anode (0.80 ± 0.03 mGy; SNR of 38 ± 2.9; visual IQ score 3.13 ± 0.35). The
optimum technique for female was with feet toward anode (0.23 ± 0.02 mGy; SNR of 34.7 ± 2.6; visual IQ
score 3.15 ± 0.26). kVp had the biggest effect on both visual and physical image quality metrics (p <
0.001) for both tube orientations, whereas SID had the lowest effect on both visual and physical image
quality metrics compared with mAs and kVp (p < 0.001). The effect of SID on the SNR was not significant
(p > 0.05) with feet toward anode.
Conclusion: Positioning the patient with feet toward the anode, as opposed to the cathode, has no
adverse effect on visual image quality assessment but it does have an effect on physical image quality.
Implications for practice: This study would add a new clinical concept in positioning of AP pelvis radiography especially for male positioning.
© 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved