ADDENDUM to first submission
Page 13, line 438
Considering the large variation of paediatric patient size on the expression “small children” I suggest adding, in brackets, the AP diameter of the structure of 10 -12 cm, according to Image Gently recommendations.
Avoid using grids for body parts less than 10 - 12 cm thick
https://www.imagegently.org/Procedures/Digital-Radiography
This will be mentioned on page 18 however include the cm on the key messages can be useful.
Page 17
The use of tube voltage 75 – 85 kV on chest, without grid, increase the ESAK and KAP. Some studies indicate better results with the use of 100 kV, especially in case of digital systems. Even with portable systems, to perform AP exposures, the 100kV revealed better results.
Page 18
Some worries with the AEC:
- The use of both (right and left) ionisation chambers for chest radiographs is contrary to the recommendation of European guidelines on quality criteria, that indicate the use of the chamber that corresponds to the right lung (AP or PA exposures). Local experimental tests, during optimisation processes, and with DR systems show the use of the right lung chamber obtained better results.
- It is also relevant to emphasise that systems with 5 chambers are now available and these must be appropriately tested.
- In AEC for paediatric (Pag 19 line 631) instead of only recommending manual selection of the exposure parameters, the recommendation to use the central chamber (when is possible) can be added.
Page 20, 675
The use of exposure indicator can be tricky in patients with pathology.
Page 26
The impact of correct positioning and central beam are relevant to optimisation. For example, in the case of a bad positioning the ionisation chamber can work in wrong mode and increase the exposure.
Page 35
There some health care units with fluoroscopy guided procedures without radiologists, maybe on the sentence on the line 1083 other medical doctors can be included.?
General comment: Absence of new Image quality criteria guidelines