title: Comprehensive optimization process of paranasal sinus radiography.
abstract: BACKGROUND
  The optimization of radiological examinations is important in order to reduce unnecessary patient radiation exposure.
  
  
  OBJECTIVE
  To perform a comprehensive optimization process for paranasal sinus radiography at Mikkeli Central Hospital, Finland.
  
  
  METHODS
  Patients with suspicion of acute sinusitis were imaged with a Kodak computed radiography (CR) system (n=20) and with a Philips digital radiography (DR) system (n=30) using focus-detector distances (FDDs) of 110 cm, 150 cm, or 200 cm. Patients' radiation exposure was determined in terms of entrance surface dose and dose-area product. Furthermore, an anatomical phantom was used for the estimation of point doses inside the head. Clinical image quality was evaluated by an experienced radiologist, and physical image quality was evaluated from the digital radiography phantom.
  
  
  RESULTS
  Patient doses were significantly lower and image quality better with the DR system compared to the CR system. The differences in patient dose and physical image quality were small with varying FDD. Clinical image quality of the DR system was lowest with FDD of 200 cm. Further, imaging with FDD of 150 cm was technically easier for the technologist to perform than with FDD of 110 cm.
  
  
  CONCLUSIONS
  After optimization, it was recommended that the DR system with FDD of 150 cm should always be used at Mikkeli Central Hospital. We recommend this kind of comprehensive approach in all optimization processes of radiological examinations.
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland. simo.saarakkala@uku.fi
authors.forename: S
authors.initials: S
authors.lastname: Saarakkala
authors.forename: K
authors.initials: K
authors.lastname: Nironen
authors.forename: H
authors.initials: H
authors.lastname: Hermunen
authors.forename: J
authors.initials: J
authors.lastname: Aarnio
authors.forename: J O
authors.initials: JO
authors.lastname: Heikkinen
mesh_terms: D000208:Acute Disease; D000328:Adult; D005387:Finland; D006801:Humans; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000592:standards*; D012015:Reference Standards; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000000981:diagnostic imaging*; D013819:Thermoluminescent Dosimetry / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000592:standards*; D055815:Young Adult