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Raising DR Tube Voltage Reduces Dose for Lumbar Studies

AuntMinnie | Ignoring manufacturer guidelines for imaging equipment is usually inadvisable, but Kuwaiti researchers have found that doing so for digital radiography (DR) lumbar studies can reduce radiation exposure, according to a poster presentation at last week’s American Association of Physicists in Medicine (AAPM) meeting.

The researchers focused on changing the recommended x-ray tube voltage (kVp) settings in a study using an anthropomorphic lumbar spine phantom. Ajit Brindhaban, PhD, an associate professor of radiologic sciences at Kuwait University, and colleagues found entrance surface dose can be cut in half by raising kVp 30% above the manufacturer’s recommendations for any of the three systems examined in the study. Lower doses were realized at the cost of modestly lower image quality, but the differences were not statistically significant.

“We can reduce patient dose by experimenting with exposure settings,” Brindhaban said. “The message from this poster is not to rely on manufacturers’ recommended exposure factors to optimize the balance between image quality and patient dose.”

The study demonstrated how higher kVp values and correspondingly lower tube current-time product (mAs) values reduce radiation exposure. Settings for kVp that were 15% and 30% higher than manufacturer recommendations led to a decline in mAs of 25% and 50%, respectively.

The researchers examined DR systems from three vendors: Revolution XR/d from GE Healthcare, DirectView 9000 from Carestream Health, and ddRFormula from Swissray International. Dose reductions were observed for lumbar imaging performed on all three systems, but the absolute amount of dose reduction may be system-specific, according to Brindhaban.

Effect of high kVp and low mA on lumbar anteroposterior radiography

GE Carestream Swissray
Image quality
score		 Effective dose
(mSv)		 Image quality
score		 Effective dose
(mSv)		 Image quality
score		 Effective dose
(mSv)
Reference kVp level 4.2 0.34 4.2 0.52 4.8 0.7
Reference + 15% kVp 4.1 0.23 3.9 0.36 4.4 0.43
Reference + 30% kVp 3.9 0.16 3.7 0.25 4.0 0.29
p-value for image quality 0.802 — 0.39 — 0.146 —

The entrance surface dose to the phantom and calculated effective dosage fell about 30% when the kVp was raised 15% above the vendor’s guidelines. The two radiation measures fell 50% when kVp was raised 30% above the recommended level.

The kVp and mAs modifications had no statistically significant effect on image quality as judged by three experienced radiologists (see chart). Although the average image quality score decreased as kVp increased, scores remained at approximately 3 on a five-point scale. A rating of 3 represents clinically acceptable image quality based on European Union criteria, Brindhaban noted.

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Kyle Henneberry, M.D.

Associate Chief Medical Officer
Dr. Kyle Henneberry is a radiologist, health-tech innovator and one of the founders and principals of Direct Radiology. A native of Spokane, Washington, he graduated with honors in Biomedical Engineering from Northwestern University, received his medical degree from Case Western Reserve University in Cleveland, Ohio, and completed radiology residency at the University of Colorado. Dr. Henneberry has United States, Europe, Australia, and New Zealand.

Jerry Lee

Chief Technology Officer

Jerry Lee has over 25 years of experience in healthcare IT. and has been with ONRAD since 2013. As the CTO, he is responsible for developing the organization’s technology strategy including IT infrastructure, application development, data analytics, cybersecurity and overall risk management. Lee’s focus is on strategic road mapping, leveraging emerging technologies and business intelligence to automate, streamline and optimize business processes. He previously worked as a senior healthcare IT consultant, where he implemented best practices, policies & procedures, and risk mitigation strategies for a variety of clients. He also previously worked as the Business Intelligence and Analytics Project Manager for a leading healthcare SaaS organization. He graduated with a B.S. from the University of California, Irvine.

Leandra Hutchinson

President, Direct Radiology

Leandra Hutchinson joined ONRAD alongside the acquisition of Direct Radiology in December 2024. Hutchison has broad experience in the healthcare industry, spending her career in healthcare technology and innovation. Prior to joining Direct Radiology in 2019, Leandra was the co-founder and Vice President of Operations of a health-tech company specializing in radiology analytics and healthcare asset management. Previously, Leandra worked in marketing, strategy, and operations roles for more than 10 years at a $7B integrated delivery system of hospitals and medical centers with more than 900 employed physicians. Hutchison earned her Bachelor’s degree from Kent State University and graduate certificate in health care policy and administration and MBA from the University of Toledo.

Ron Jackson

President, AllRads

Ron Jackson serves as President of AllRads at ONRAD, bringing over 30 years of comprehensive healthcare leadership across the provider, payer, and technology landscape. With deep expertise in radiology, he has spent more than 25 years in revenue cycle management, operations, finance, and practice management roles at leading organizations including HBOC, Per-Se Technologies, McKesson, and Zotec Partners. At ONRAD, Jackson leads day-to-day operations and strategic execution of AllRads, drawing on his cross-functional experience to drive efficiency, scalability, and growth. His 360-degree perspective of the healthcare ecosystem uniquely positions him to align organizational strategy with market dynamics in teleradiology and imaging services.

Alix Vincent, M.D.

Chief Medical Officer

Dr. Alix Vincent was one of the founding physicians at ONRAD. With over 26 years of radiology leadership experience, Dr. Vincent oversees medical staff activities, including patient safety, quality, and risk management initiatives. He manages ONRAD’s Regional Medical Directors, evaluates staff physicians, and drives clinical improvements to enhance physician alignment within the organization. Additionally, Dr. Vincent leads medical operations and played a key role in developing the company’s PACS and RIS Network capabilities. He previously served as Chief Radiologist and Chairman of the Radiology Department at Riverside Regional Medical Center. Dr. Vincent holds an M.D. in Radiology from Loma Linda University.

Lyn Mize

Chief Financial Officer

Lyn Mize serves as Chief Financial Officer at ONRAD, a role she has held since June 2022. With over two decades of experience in financial leadership, Mize has held CFO positions at various healthcare organizations, including Sunset Media Entertainment and Oncology Convergence, Inc. She also served as Vice President of Accounting at Health Choice and System Director of Accounting at Scottsdale Healthcare. Mize has a strong background in financial management, having worked with Banner Health and Greeley Medical Clinic, where she provided financial leadership for multi-specialty clinics and physician networks. Mize holds extensive expertise in driving financial performance and strategic growth across the healthcare sector and has a B.S. from DeVry University and a Masters from Grand Canyon University.

Dave Engert

President & CEO

Dave Engert started at Onrad as President and CEO in 2017. Engert is a seasoned healthcare executive with over 35 years of experience and a proven track record of leading and transforming healthcare technology organizations to drive growth and improve operational and financial performance. He previously served as President and CEO of Nighthawk Radiology, the largest teleradiology provider, and led its successful sale to vRad. Engert also held the role of President and CEO of Quality Care Solutions (QCSI), a leading provider of health insurance software, which was sold to Trizetto. Additionally, he has held leadership roles at McKesson, HBOC, and other notable companies and invested in several healthcare technology ventures. Engert holds a B.S. in Industrial Engineering from Louisiana State University.