Evaluation of X-ray table mattresses for radiation attenuation and impact on image quality

Introduction: Mattresses in the radiology department tend to be an overlooked aspect of imaging equipment. This paper evaluates the radiation attenuation characteristics of mattresses and the effect they have on image quality. Methods: Thirteen mattresses (from new to 20 years of age) were evaluated. Incident air kerma (IAK) was measured in two conditions, with and without mattress over a range of exposure factors using a digital dosimeter. Image quality was assessed by calculating the inverse image quality factor (IQF_inv) using a commercially available phantom (CDRAD) for the same exposure factors. The correlation of age and attenuation and image quality was calculated. Results: Measured IAK and image quality was affected by the addition of a mattress with older mattresses having greater attenuation; there is a moderate/large correlation (0.38–0.51) between age and IAK. IQF_inv deteriorated with the addition of a mattress but there was no correlation with age (−0.41 to 0.16). Clinically, there is no impact of any mattress in the study as changes to the exposure factors to account for the attenuation are smaller than the increments in mAs available on X-ray equipment. Conclusion: The results indicate that while the presence of a mattress does impact on transmitted radiation and the quality of the image, the clinical impact is insignificant. Attenuation correlates with age but with no clinical significance. There is no correlation between age and image quality. Implications for practice: Quality control tests for attenuation and impact on image quality are not required in clinical practice. The method could be used by manufacturers to test new materials and mattresses and could provide users with specifications of new products.