Effects of body part thickness on low-contrast detail detection and radiation dose during adult chest radiography

Introduction: Differences in patient size often provide challenges for radiographers, particularly when choosing the optimum acquisition parameters to obtain radiographs with acceptable image quality (IQ) for diagnosis. This study aimed to assess the effect of body part thickness on IQ in terms of low-contrast detail (LCD) detection and radiation dose when undertaking adult chest radiography (CXR). Methods: This investigation made use of a contrast detail (CD) phantom. Polymethyl methacrylate (PMMA) was utilised to approximate varied body part thicknesses (9, 11, 15 and 17 cm) simulating underweight, standard, overweight and obese patients, respectively. Different tube potentials were tested against a fixed 180 cm source to image distance (SID) and automatic exposure control (AEC). IQ was analysed using bespoke software thus providing an image quality figure inverse (IQFinv ) value which represents LCD detectability. Dose area product (DAP) was utilised to represent the radiation dose. Results: IQFinv values decreased statistically (P = 0.0001) with increasing phantom size across all tube potentials studied. The highest IQFinv values were obtained at 80 kVp for all phantom thicknesses (2.29, 2.02, 1.8 and 1.65, respectively). Radiation dose increased statistically (P = 0.0001) again with increasing phantom thicknesses. Conclusion: Our findings demonstrate that lower tube potentials provide the highest IQFinv scores for various body part thicknesses. This is not consistent with professional practice because radiographers frequently raise the tube potential with increased part thickness. Higher tube potentials did result in radiation dose reductions. Establishing a balance between dose and IQ, which must be acceptable for diagnosis, can prevent the patient from receiving unnecessary additional radiation dose.