What's EI? A look into Exposure Index and Image Impression

Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue What's EI? Objective 1 Objective 1 Objective 1 Objective 1 Objective 4 Objective 2 Objective 2 Objective 2 Objective 2 Objective 3 Objective 3 Objective 3 Objective 3 Select each button to learn more. What's that EI? A look into Exposure Index and image impression for the technologist online training ? Welcome & Objectives option 1 In this online training, E-X-I will be defined with a deeper look into clinical E-X-I Values. Select each button to the right to review the course objectives. Objective 1 Learn how the E-X-I number is calculated. Objective 2 Navigate how to use the E-X-I number to evaluate the image impression. Objective 3 Describe how to adjust the image impression or save an image from the repeat. Objective 4 Demonstrate how to use the D-I number to adjust a technique for repeat. Objective four Learn how to use Deviation Index (DI#) to adjust your technique when a repeat is needed 4 4 4 4 Objective three Describe how to adjust image impression to save an image from being repeated 3 3 3 3 Objective two Navigate how to use the EXI number to evaluate the image impression 2 2 2 2 Objective One Discover how the EXI number is calculated 1 1 1 1 EXI value EXI value To avoid systematic errors, like under or overexposure, the imaging system provides the exposure index as an initial indication for the applied dose.  The exposure index is intended to be a rough indicator of the dose applied to the receptor for a particular examination.  Our systems Provide both Physical and Clinical EXI values: • The Physical EXI measures the mean gray value in the middle area of the image. • The Clinical EXI analyzes the mean gray value of the diagnostic part in the image. ( leaves out the dead/ blank space). The exposure index is an important indicator for the accurate exposure of the acquisitions. The exposure’s bottom-left index, Physical EXI and/r Clinical EXI, is derived from the image data and displayed on the image.  Clinical examples Clinical examples Clinical examples Clinical examples Physical & Clinical EXI Footnote Physical EXI Physical EXI Physical EXI Physical EXI Acceptable range Acceptable range Acceptable range Clinical EXI Clinical EXI Clinical EXI Clinical EXI ? Physical & Clinical EXI The Physical EXI is a measure of the mean gray value in the middle area of the image This value is going to be based on the central region of the image- so positioning/centering is an important factor for Physical EXI values. Clinical EXI At Siemens Healthineers, we focus on Clinical EXI numbers this is a more useful EXI measurement because it ignores the raw radiation on an image and provides an average (mean) of what’s left. EXI ranges are strongly dependent on multiple different factors: patient positioning-always looking for the body part to be centered and is using AEC over the active chamber/cell At the pre-defined proper SID- this means for tabletop work as well; we at siemens use a 45in SID Proper collimation (no extra space) and geometry. appliances/including shields, measuring devices, marker balls,/etc are also factored into the calculation Tab 3 Now that we know how Clinical EXI values are calculated let’s learn about the acceptable range. The acceptable Clinical EXI Range is from 125 to 500, with 250 being an optimal or perfect exposure. How do we produce that acceptable range? The desired range is determined by the dose given to the detector- Siemens Healthineer’s default dose setting is 2.5 at a sensitivity of 400.  Radiographic sensitivity, as defined by Iowa State University, is a measure of the quality of an image in terms of the smallest detail or discontinuity that may be detected. Sensitivity depends on the combined effects of the contrast (differences in photographic density) and definition (the abruptness of change from one density to another.) Clinical examples Here we look at EXI Range.. EXI is 232- what does this mean? What do we think of the image quality? How many of you would repeat this image? EXI is 93- what does this mean? What do we think of the image quality? How many of you would repeat this image? EXI is 507- what does this mean? What do we think of the image quality? How many of you would repeat this image? Tab Slide Please click on one of the tabs to display the corresponding content on this page. The desired clinical EXI range EXI numbers are directly proportional: low #=under exposed, high #=over exposed Clinical EXI value is defined as an estimation of the entire image to determine if under/overexposure. The Physical EXI is determined as an average of the image signal of a centered region in the image.  Current collimation is considered. ? DI Numbers and Effect on Image Quality​ Deviation Index (DI) Shows the deviation from the EI target Value  DI Numbers and Effect on Image Quality​ The Deviation Index detects the exposure tolerance in correlation with the Clinical EXI value; it can tell us if something is under or overexposed in the diagnostic area. By showing us the deviation from the target EXI value.  As you can see here, a target EXI value of 250 = DI number or 0 Deviation Index (DI) How its calculated DI = 10 x log (EI / EIT) Normal Range: - 3 to + 3  0 = optimal exposure Learn more ? DI - How its calculated The formula used to calculate DI is: 10X EI (actual exposure index)divided by EIT (Target value for the examination) There is an acceptable range of DI on all images; this range is -3 to +3, with 0 indicating an optimal exposure.  What is the DI? What this number indicate? Indicates an under exposed image Would you repeat it? What is the DI? What this number indicate? Indicates an over exposed image Would you repeat it? Next Next Adjusting image impression without repeating the exposure My image is out of range, but I wouldn’t repeat it, what can I do? Adjusting image impression Is there a way to adjust image impression without repeating the exposure? Your image is out of range.. but it wouldn't warrant a repeat. Is there anything a technologist can do to improve the image impression? Drag the slider bar to learn more about cropping. Layer 1 The first thing we can do on all systems is to adjust the region of interest using the cropping tool...  While we don’t encourage cutting off any anatomy,.. we do know that adjusting the R-O-I of your image with the cropping tool will allow the system to readjust the Clinical E-X-I number and can change the overall image impression...  Layer 2 This shows SIemens Healthineers cropping tool on each of the systems software formats.  The Ysio X.pree, Multix impact Family and The FLC systems. Important to note: Image cropping is a latent source of additional radiation dose to the patients, which can easily go unnoticed. Good collimation practices need to be reinforced. Layer 3 Removing the excess air in this Xray as well as bring the region of interest back to the spine  and can significantly change both the CEXi number and DI number  ? Removing unwanted air Removing unwanted air will recalculate the EXI value . Removing unwanted air Removing the excess air in this xray as well as bringing the region of interest back to the spine  and can significantly change both the CEXi number and DI number. 1Gudjonsdottir, Jonina. (2019). The unnecessary dose behind cropped radiographs. Radiography Open. 5. 10. 10.7577/radopen.3611. Image courtesy of Mott’s Children’s Cropping tools ? Cropping? 1Gudjonsdottir, Jonina. (2019). The unnecessary dose behind cropped radiographs. Radiography Open. 5. 10. 10.7577/radopen.3611. Image courtesy of Mott’s Children’s Image cropping Image cropping is a latent source of additional radiation dose to the patients which can easily go unnoticed. Good collimation practices need to be reinforced.1 Drag the slider button to review content before moving on to next slide. ? Amplification and Flavor The second thing that can be changed is the Amplification or Flavor of the image. Select the tab arrows to learn more about amplification. Fluorospot Compact (FLC) Amplification Flavor MULTIX Impact Flavors Ysio X.pree Flavors Amplification & Flavor The second thing we can do is change the Amplification or Flavor of the image. Amplification  and flavor are used to help keep image impression consistent regardless of the technical factors. Pros – consistent images, regardless of technique Cons – improper techniques can be hidden using these tools.  Select the tab arrows to learn more about amplification and it uses. FLC layer -Amplification is used on our FLC systems to change the overall look of an image without repeating an exposure. Amplification works by repeating the raw image processing while slightly altering the original data. When this data is altered it can significantly change the overall image impression. FLC systems use a default amplification setting of 2.0- this default setting provides a particular look to the image. This default setting is directly related to the default technique of each individual organ program (ogp). Amplification can help the technologist make technical adjustment to an image if a repeat is warranted. for each 2.0 change in amplification needed, the mAs will need doubled or halved for negative values. Amplification layer If the exposure parameters are greatly changed from the default settings, the pre-programed amplification of 2.0 and the actual applied dose may not match. This leads to a less than optimal result after the raw image data is processed. Instead of repeating these images, amplification can be adjusted to salvage the image impression. If an image is under exposed increasing your amplification number will improve the image impression but applying more contrast/darkening the image and if your image is over exposed decreasing the amplification will improve the overall image impression by lightening the image contrast. This slide shows how simply adjusting amplification changes the overall image impression. Flavor tab An image flavor is a certain image impression that is consistent over a vast variety of possible • examinations • body parts or clinical tasks A specific Flavor shall create a comparable look. On our Ysio X.pree systems these flavors are numbered.  While the Multix Impact systems provide 4 predefined flavors and one customizable flavor for ultimate customer satisfaction Multix Impact flavors layer Multix Impact Flavors: Finely Detailed: increases edge enhancement, High Contract: makes a more black and white image, Smooth: is a balanced look with normal gray scale. Standard: moderate contrast level with less gray scale, and Customized; is adjusted for the customer preference. Ysio layer Ysio X.pree Flavors are numbered: 2.0 moderate contrast, balance of gray scale, 1.0= high contrast, a more black and white look to the image.. 3.0= focuses on bone contrast. the end numbers .1= low edge enhancement, .2 =medium edge enhancement, .3= high edge enhancement. Ysio X.pree Flavors Images obtained from Ysio X.pree Smart Simulator MULTIX Impact Flavors Images obtained from MULTIX Impact Smart Simulator Flavor Amplification of 2.0 Amplification of 4.0 Amplification of 8.0 Amplification Images obtained from presentation Dose Optimization for Fluoroscopy and Radiography Amplification on the Fluorospot Compact (FLC) Image courtesy of presentation XP RAD Ysio X.pree Image Adjustment Applying what we learned Button 1 Button 1 Button 1 Button 2 Button 2 Button 2 Button 3 Button 3 Button 3 Button 4 Button 4 Button 4 Select each button for more information. Click to view the disclaimer ? Image Adjustment Now that we have discovered how E-X-I and D-I are calculated, and reviewed images. Lets focus on how these numbers can be used if we choose to repeat an image. Select each button to begin. Low EXI The image here represents a low EXI Value and Low DI number Although the image looks diagnostic, there are a few things we can do to improve these numbers and adjust the overall image quality. adjust crop layer The first thing you can do to improve or change image impression on any system is to adjust your ROI by using cropping. Removing extra, unnecessary anatomy or blank space can improve image impression This will also change the DI and EXI – at time this change may be significant.  Flavor adjusted layer Adjusting Cropping and processing with a new flavor can significantly change the look of your images. Side by side comparison Cropped and Flavor Adjusted Adjusting cropping and ROI Low EXI value and low DI number ? Repeating using the DI number to adjust the technique Step 1 > Step 1 > Step 1 > Step 1 > Step 2 > Step 2 > Step 2 > Step 2 > Select each button to view the steps for using the DI number to adjust the technique. Repeating using the DI number Step 1 Clinical E-X-I and D-I numbers out of normal range do not mean you HAVE to repeat your image.... They are to be USED AS A GUIDE. IF. the customer desires to repeat the image to obtain a different image quality.. in the event that you have an under or over exposed image, and you do want to repeat, you should always reference your D-I number. Step 2 The D-I number can be used to adjust a technique in order to obtain an optimal exposure... To do this,, first take the D-I number and multiply it by 2,,, this will provide the number of exposure clicks needed to change to obtain an optimal technique..... For a negative value, technique will be raised.. for a positive value, the technique will be lowered.... Note: this new technique will only be optimal if no other factors are changed.. This includes positioning, collimation, and centering. the image shown here shows a D-I of negative 3.5.... The original technique was 70 @ 71.. after multiplying -3.5 by 2, technique should be increased by 7 exposure clicks... This brings the new technique to 70 @ 140 for an optimal exposure.... Adjustments in technique should be made in the mass, to avoid changing the overall gray scale of the image... Adjusting technique Let’s use DI to correct my exposure. Kadi Untch kadi.untch@siemens-healthineers.com Innovations for Healthcare Professionals Education Symposium 2023 Siemens Healthineers Applications Service Manager XPRF Thank you Kadi for this great content! Thank you Untitled Slide ? Course Review Congratulations. You have completed the What's that EI? A look into Exposure Index and Image Impression course. Select the numbered buttons below to review the material before proceeding to the final assessment. Objective Three Objective Two Objective One 1 1 1 3 3 3 2 2 2 4 4 4 Objective Four Course Review Learn how to use Deviation Index (DI#) to adjust your technique when a repeat is needed Describe how to adjust image impression to save an image from being repeated Adjust the region of interest using the cropping tool Adjusting the ROI of the image with the cropping tool will allow the system to readjust the Clinical EXI number and can change the overall image impression.  Amplification and Flavor change Amplification  and flavor are used to help keep image impression consistent regardless of the technical factors. Pros – consistent images, regardless of technique Cons – improper techniques can be hidden using these tools  Navigate how to use the EXI number to evaluate the image impression. To avoid systematic errors, like under or overexposure, the imaging system provides the exposure index as an initial indication for the applied dose. The exposure index is intended to be a rough indicator of the dose applied to the receptor for a particular examination.  Our systems Provide both Physical and Clinical EXI values: • The Physical EXI measures the mean gray value in the middle area of the image. • The Clinical EXI analyzes the mean gray value of the diagnostic part in the image. Discover how the EXI number is calculated The exposure index is intended to be a rough indicator of the dose applied to the receptor for a particular examination.  Our systems Provide both Physical and Clinical EXI values: The Physical EXI measures the mean gray value in the middle area of the image. The Clinical EXI analyzes the mean gray value of the diagnostic part in the image. (leaves out the dead/ blank space). The exposure index is an important indicator for the accurate exposure of the acquisitions. The Physical and/or Clinical EXI is derived from image data and displayed in the bottom left corner of our images. Disclaimer Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. 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Next Tmeline Select the buttons to learn more about a topic. Be sure to review all topics before navigating to the next slide. Click Next to continue. Next Tab Arrow Slide Select the icon above to open the table of contents. Click Next to continue. Next Welcome Slide Select the CC icon to display closed captioning (subtitles). Click Next to continue. Next Caption Icon Select the X to close the pop-up. Click Next to continue. Next Layer Slide Some images may have a magnifier icon. Select the image to see an enlarged view. Select it again to return to the normal view. Click Next to continue. Next Zoom Slide Some images have a magnifier icon in the bottom-left corner. Select these image to see an enlarged view of the image. Select the image again to return to the normal view. Select Submit to record your response. Click the X in the upper right corner to exit the navigation help. Assessment Slide Assessment Welcome to the assessment. For each question, select the button to the left of your answer, and then select Submit. You will have 3 attempts to take this assessment and to successfully pass this course, you must receive a score of 80% or higher. You will receive your score when you have completed the assessment. Note: If you close the learning activity at any time before you have finished the quiz, your answers will not be saved. Select Start to begin. Assessment Start ? Assessment Select the best answer. ? Exposure Index Exposure Image Question 1 of 4 EXI stands for __________ ____________. Example Image Extra Image Multiple Choice EXI stands for __________ ____________. Select the best answer. ? - 2 to + 2 0 to + 3 Question 2 of 4 What is normal DI range? - 1 to + 1 - 3 to + 3 Multiple Choice What is normal DI range? Select the best answer. ? True Question 3 of 4 Cropping an image changes the EXI or DI values. False Multiple Choice Cropping an image changes the EXI or DI values. Select the best answer. ? An image always needs repeating if the CEXI or DI number is not within range. An image should only be repeated if the image impression is not up to your facilities standards, never based on number alone. Question 4 of 4 Which of the following statements is correct? All of the above. An image only needs repeating if the DI number is not within range. Multiple Choice Which of the following statements is correct? Retry %Quiz2.ScorePercent%% %Quiz2.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Assessment Results Results Slide Exit Exit Exit You have exceeded your number of assessment attempts. You did not pass the course. Select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Certificates tab from the learning activity overview page. You can also access the certificate from your PEPconnect transcript. ? You have completed the What's that EI? A look into Exposure Index and image impression for the technologist online training. Completion details, certificates tab whats_ei_evls 1 What's EI? 1.1 Welcome & Objectives option 1 1.2 EXI value 1.3 Physical & Clinical EXI 1.4 DI Numbers and Effect on Image Quality​ 1.5 DI - How its calculated 1.6 Adjusting image impression 1.7 Amplification & Flavor 1.8 Image Adjustment 1.9 Repeating using the DI number 1.10 Thank you 1.11 Course Review 1.12 Disclaimer 3 Assessment 3.1 Assessment 3.7 Completion