Optimisation of radiographic technique factors for direct digital radiography: a systematic review

Abstract

As the uptake of direct digital radiography technology increases across radiology departments in Australia, it is an important time to review currently accepted best practice. It has been widely reported across the literature that in the move from analogue to digital, most of the previously accepted techniques were simply translated across without review. Optimisation of radiographic technique parameters is important to ensure that the optimal balance between image quality and dose is struck. The objective of this review was to uncover and synthesise all available literature regarding appropriate technique parameters for direct digital radiography. A comprehensive search of published and unpublished literature was undertaken to find studies that compared different radiographic technique parameters on direct digital radiography systems. Outcomes measured were subjective image quality and patient dose. Eight hundred and fifty-eight studies were retrieved for title and abstract screening. Ninety-one studies were retrieved for full-text screening, and 23 were included for review and methodological quality screening. Unfortunately, due to the high level of methodological heterogeneity, meta-analysis was unable to be performed for any of the included studies. Narrative synthesis of the 23 included studies revealed some promising results for increasing source-to-image distance to maintain image quality whilst reducing patient dose, but there is limited evidence for any other interventions. A key finding of this thesis was that the goals of optimisation research varied greatly across the included studies. The author proposes a new naming convention and two distinct methodologies for future research to increase the applicability and validity of future work.