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FEASIBILITY OF DISPLAYED EXPOSURE INDEX IN IEC STANDARD FRAMEWORK AS A DOSE OPTIMISATION TOOL FOR DIGITAL RADIOGRAPHY SYSTEMS
Abstract
International Electrotechnical Commission (IEC) established the framework for the use of exposure index (EI) for evaluating the exposure conditions with various digital systems. In this study, we investigated the feasibility of EI, as per the IEC, by comparing the EIs obtained through manual calculated and that displayed on the console of two computed radiography (CR) and digital radiography (DR) systems with radiation beam qualities of RQA3,5,7 and 9. As a result, both two systems indicated an uncertainty of less than 20% for both calculated and displayed EI with all beam qualities except displayed EI obtained by RQA3. However, the displayed EI values were different even under the same exposure conditions because of the characteristics of the imaging receptor materials, such as BaFI or CsI, of two systems. Therefore, when an operator attempts to introduce displayed EI for managing radiation dose, it is essential to understand the characteristics of the digital system.
In digital radiography (DR) systems, the sensitivity index, also known as the exposure indicator, exhibits unique behavior, depending on the manufacturer. The exposure index (EI) was introduced by the International Electrotechnical Commission to standardize the sensitivity indices of DR systems produced by different manufacturers for general radiography. This EI value is directly proportional to the dose incident on the imaging detector, providing valuable insight into exposure dose levels and radiographic noise. Recently, technological advancements have enabled some DR systems to display the EI value on the console immediately after exposure. This study investigated the characteristics of the displayed EI value and radiographic noise for an indirect flat-panel detector across four X-ray beam qualities based on added aluminum filters: RQA3, 5, 7, and 9. The displayed EI values for all the X-ray beam qualities proportionally increased to the dose incident on the detector. However, the displayed EI values for RQA3 deviated from those for RQA5, 7, and 9 at the same doses incident on the imaging detector. Furthermore, the Wiener spectrum (WS) was used to evaluate radiographic noise. For similar EI values, the WS of RQA3, which had the highest dose incident on the imaging detector, was slightly lower than those of other X-ray beam qualities. Our findings suggest that the relationship between the displayed EI and radiographic noise varies with the X-ray beam quality.
The clinical anteroposterior (AP) chest images taken with a mobile radiography system were analyzed in this study to utilize the clinical exposure index (EI) as a patient dose-monitoring tool. The digital imaging and communications in medicine header of 6048 data points exposed under the 90 kVp and 2.5 mAs were extracted using Python for identifying the distribution of clinical EI. Even under the same exposure conditions, the clinical EI distribution was 137.82–4924.38. To determine the cause, the effect of a patient's body shape on EI was confirmed using actual clinical chest AP image data binarized into 0 and 255-pixel values using Python. As a result, the relationship between the direct X-ray area of the chest AP image, the higher the clinical EI, the larger the rate of the direct X-ray area. A conversion equation was also derived to infer entrance surface dose through clinical EI based on the patient thickness. This confirmed the possibility of directly monitoring patient dose through EI without a dosimeter in real-time. Therefore, to use the clinical EI of the mobile radiography system as a patient dose-monitoring tool, the derivation method of clinical EI considers several factors, such as the relationship between patient factors.
Objective:
To present an optimized examination model by analyzing the risk of disease and image quality according to the combination of the ion chamber of automatic exposure control (AEC) with digital radiography (DR).
Methods:
The X-ray quality was analyzed by first calculating the percentage average error (PAE) of DR. After that, when using AEC, the combination of the ion chambers was the same as the left and centre and right, right and centre, left and centre, centre, right, and left, for a total of six. Accordingly, the entrance surface dose (ESD), risk of disease, and image quality were evaluated. ESD was obtained by attaching a semiconductor dosimeter to the L4 level of the lumbar spine, and then irradiating X-rays to dosimeter centre through average and standard deviation of radiation dose. The calculated ESD was input into the PCXMC 2.0 programme to evaluate disease risk caused by radiation. Meanwhile, image quality according to chamber combination was quantified as the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) through Image J.
Results:
X-ray quality of DR used in the experiment was within the normal range of±10. ESD of six ion chamber combinations was 1.363mGy, 0.964mGy, 0.946mGy, 0.866mGy, 0.748mGy, 0.726mGy for lumbar anteroposterior (AP), and the lumbar lateral values were 1.126mGy, 0.209mGy, 0.830mGy, 0.662mGy, 0.111mGy, and 0.250mGy, respectively. Meanwhile, disease risk analyzed through PCXMC 2.0 was bone marrow, colon, liver, lung, stomach, urinary and other tissue cancer, and disease risk showed a tendency to increase in proportion to ESD. SNR and CNR recorded the lowest values when three chambers were combined and did not show proportionality with dose, while showed the highest values when two chambers were combined.
Conclusion:
In this study, combination of three ion chambers showed the highest disease risk and lowest image quality. Using one ion chamber showed the lowest disease risk, but lower image quality than two ion chambers. Therefore, if considering all above factors, combination of two ion chambers can optimally maintain the disease risk and image quality. Thus, it is considered an optimal X-ray examination parameter.
Background:
The International Electrotechnical Commission established the concept of the exposure index (EI), target exposure index (EIT) and deviation index (DI). Some studies have conducted to utilize the EI as a patient dose monitoring tool in the digital radiography (DR) system.
Objective:
To establish the appropriate clinical EIT, this study aims to introduce the diagnostic reference level (DRL) for general radiography and confirm the usefulness of clinical EI and DI.
Methods:
The relationship between entrance surface dose (ESD) and clinical EI is obtained by exposure under the national radiography conditions of Korea for 7 extremity examinations. The EI value when the ESD is the DRL is set as the clinical EIT, and the change of DI is then checked.
Results:
The clinical EI has proportional relationship with ESD and is affected by the beam quality. When the clinical EIT is not adjusted according to the revision of DRLs, there is a difference of up to 2.03 in the DI value and may cause an evaluation error of up to 1.6 time for patient dose.
Conclusions:
If the clinical EIT is periodically managed according to the environment of medical institution, the appropriate patient dose and image exposure can be managed based on the clinical EI, EIT, and DI.
The International Electrotechnical Commission (IEC) 62494-1 has defined the exposure index (EI) that have a proportional relationship with the dose incident on the image receptor, and target exposure index (EI T), deviation index (DI). In this study, an appropriate EI T for skull radiography was established through the diagnostic reference level (DRL) and changes in DI were confirmed. Entrance surface dose (ESD) and EI were obtained using the computed radiography system displayed the EI as per IEC on console and skull phantom by experiment based on the national average exposure conditions announced in 2012 and 2019. And appropriate EI T was established by applying the DRL in 2012 and 2019. As a results, the EI T is changed according to the change in the DRL, and the exposure condition that becomes the ideal DI according to the change in the EI T also has a difference of about 1.41 times. DRL is recommended to optimize the patient dose, however it is difficult to measure in real time at medical institutions whereas EI and DI are displayed on the console at the same time as exposure. When the EI T is set based on the DRL and the DI is closed to an ideal value, it is useful as a patient dose management tool. Therefore, when the EI T is periodically managed along with the revision of the DRLs, the patient dose can be optimized through the EI, EI T and DI.
In radiography, the exposure index (EI), as per the International Electrotechnical Commission standard, depends on the incident beam quality and exposure dose to the digital radiography system. Today automatic exposure control (AEC) systems are commonly employed to obtain the optimal image quality. An AEC system can maintain a constant incident exposure dose on the image receptor regardless of the patient thickness. In this study, we investigated the relationship between body thickness, entrance surface dose (ESD), EI, and the exposure indicator (S value) with the aim of using EI as the dose optimization tool in digital chest radiography (posterior-anterior and lateral projection). The exposure condition from the Korean national survey for determining diagnostic reference levels and two digital radiography systems (photostimulable phosphor plate and indirect flat panel detector) were used. As a result, ESD increased as the phantom became thicker with constant exposure indicator, which indicates similar settings to an AEC system, but the EI indicated comparatively constant values without following the tendency of ESD. Therefore, body thickness should be considered under the AEC system for introducing EI as the dose optimization tool in digital chest radiography.
The International Electrotechnical Commission introduced the concepts of exposure index (EI), target exposure index (EI T) and deviation index (DI) to manage and optimize patient dose in real time. In this study, we have proposed an appropriate method for setting the EI T based on the Korean national diagnostic reference levels (DRLs). Furthermore, we evaluated the use of clinical EI, EI T and DI as tools for patient dose optimization in clinical environments by observing the changes in DI with those in EI T. According to the Korean national exposure conditions, we conducted experiments on three representative radiographic examinations (chest posterior-anterior, lateral and abdomen anterior-posterior) of clinical environments. As the exposure conditions and DRLs varied, the clinical EI, EI T and DI also varied. These results reveal that the clinical EI, EI T and DI can be used as tools for optimizing the patient dose if EI T is periodically and properly updated.
Radiation dose monitoring in medical imaging examination areas is mandatory for the reduction of patient radiation exposure. Recently, dose monitoring techniques that use digital imaging and communications in medicine (DICOM) dose structured reports (SR) have been introduced. The present paper discusses the setup of a radiation dose monitoring system based on DICOM data from university hospitals in Korea. This system utilizes the radiation dose data-archiving method of standard DICOM dose SR combined with a DICOM modality performed procedure step (MPPS). The analysis of dose data based on a method utilizing DICOM tag information is proposed herein. This method supports the display of dose data from non-dosimeter-attached X-ray equipment. This system tracks data from 62 pieces of equipment to analyze digital radiographic, mammographic, mobile radiographic, CT, PET-CT, angiographic, and fluorographic modalities.
Digital cardiovascular angiography accounts for a major portion of the radiation dose among the examinations performed at cardiovascular centres. However, dose-related information is neither monitored nor recorded systemically. This report concerns the construction of a radiation dose monitoring system based on digital imaging and communications in medicine (DICOM) data and its use at the cardiovascular centre of the University Hospitals in Korea. The dose information was analysed according to DICOM standards for a series of procedures, and the formulation of diagnostic reference levels (DRLs) at our cardiovascular centre represents the first of its kind in Korea. We determined a dose area product (DAP) DRL for coronary angiography of 75.6 Gy cm(2) and a fluoroscopic time DRL of 318.0 s. The DAP DRL for percutaneous transluminal coronary intervention was 213.3 Gy cm(2), and the DRL for fluoroscopic time was 1207.5 s.
Digital radiography is often performed at a higher dose rate than analogue radiography for image acquisition. The authors
measured the Entrance Surface Dose (ESD) of analogue and digital radiography techniques for 14 radiographic examinations from
randomly selected medical centres in the central district of Korea.
It was that the mean ESD of the digital examinations was 2.84 mGy (range, 0.37–6.38 mGy) and that of the analogue examinations
was 1.83 mGy (range, 0.38–4.74 mGy), resulting in a 55.25 % higher ESD for digital technique. Although this survey is not
completely representative of Korea, findings of this study indicate a need for closer exposure management in digital radiography
to minimise patient dose.
The exposure index is currently a method by which digital radiography manufacturers provide feedback to the technologist regarding the estimated exposure on the detector, as a surrogate for image signal-to-noise ratio and an indirect indication of digital image quality. Unfortunately, there are as many exposure index values and methods as there are manufacturers, and in an environment with multiple vendors and a need to share data across institutions and dose registry databases, the situation is complicated. Fortunately, a new exposure index of digital X-ray imaging systems has been implemented. Developed concurrently by the International Electrotechnical Commission and the American Association of Physicists in Medicine in cooperation with digital radiography system manufacturers, the index has been implemented as an international standard. As explained, the exposure index does not indicate patient dose but rather a linearly proportional estimate of the incident radiation exposure to the detector. However, the use of the standardized exposure index and its associated target exposure index and deviation index values will likely lead to improved technologist performance in terms of uniformity and use of optimized radiographic techniques, leading to safer care of children needing radiographic examinations. Radiologists will benefit from standardized terminology, and institutions and clinics will be able to compare exposure index values with others through a national dose index registry database now under development. The Alliance for Radiation Safety in Pediatric Imaging, in its role as a benefactor of and advocate for the pediatric patient, is using the Image Gently campaign to disseminate information regarding the exposure index standard for digital radiography so that these benefits can be achieved in a rapid and effective manner.
Digital radiographic imaging systems, such as those using photostimulable storage phosphor, amorphous selenium, amorphous silicon, CCD, and MOSFET technology, can produce adequate image quality over a much broader range of exposure levels than that of screen/film imaging systems. In screen/film imaging, the final image brightness and contrast are indicative of over- and underexposure. In digital imaging, brightness and contrast are often determined entirely by digital postprocessing of the acquired image data. Overexposure and underexposures are not readily recognizable. As a result, patient dose has a tendency to gradually increase over time after a department converts from screen/film-based imaging to digital radiographic imaging. The purpose of this report is to recommend a standard indicator which reflects the radiation exposure that is incident on a detector after every exposure event and that reflects the noise levels present in the image data. The intent is to facilitate the production of consistent, high quality digital radiographic images at acceptable patient doses. This should be based not on image optical density or brightness but on feedback regarding the detector exposure provided and actively monitored by the imaging system. A standard beam calibration condition is recommended that is based on RQA5 but uses filtration materials that are commonly available and simple to use. Recommendations on clinical implementation of the indices to control image quality and patient dose are derived from historical tolerance limits and presented as guidelines.
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The importance of radiation dose display of medical X-ray equipment was emphasized, while third edition of IEC(International Electrotechnical Commission) 60601 started to apply. The existing medical X-ray equipment selected a method for attaching the DAP(Dose Area Product) meter when the dose display. However, because the DAP meter was dependent on all of the income, And it did not yet produced in Korea. So, we received the support of Seoul R&BD Program(Grants No. C1152055) to produce DAP meter prototype of the Domestically technology. In this study, the performance of this prototype was evaluated by comparing the German company’s product
Evaluation item was an electronic capture performance, radiation dose dependence, radiation quality dependence, energy transmittance, repeatability, light transmittance of 6 entries. And IEC 60580 was based on this evaluation. Evaluation results were electronic capture performance intrinsic error 9.5%, radiation dose dependence limits of variation 1%, repeatability coefficient of variation 2%, energy transmittance 91% each assessment was passed. However radiation quality dependence limits of variation 29%, light transmittance 55% was less than acceptance criteria.
현재 시중에 설치되어 있는 의료용 X선 장치는 선량표시를 할 때 일반적으로 DAP(Dose Area Product) meter 를 부착한다. 그러나 DAP meter가 전부 수입에 의존하고 있기 때문에 고가의 설치 비용 등의 문제가 있다. 본 연 구에서는 서울시의 지원을 받아 순수 국산기술의 DAP meter 프로토타입을 제작하였고, 이 프로토타입의 성능을 독일산 I사의 제품과 비교하여 평가하였다.
평가 항목은 전자포집효율, 선량의존성, 선질의존성, 재현성, 자체흡수율, 광투과율 6개 항목으로 IEC 60580를 평가 기준으로 삼았다. 평가 결과 전자포집효율이 고유오차 9.5%, 선량의존성이 선형성 99%, 재현성이 변동계수 2%, 자체흡수율이 9%로 각각 합격기준을 만족시켰으나, 선질의존성이 변동한계 29%, 광투과율이 55%로 합격기준 에 미달하였다.
아직 프로토타입이기에 앞으로 개선될 여지가 많다. 회로부터 재료까지 국산기술로 개발하고 있기 때문에 합격 기준에 미달하는 항목은 추후 해결 가능할 것으로 사료된다.
The use of cardiac angiography (CA) and the interventional procedures is rapidly increasing due to the increase in modern adult diseases. Cardiovascular intervention (CI) is an examination method where radiation is applied to the same area for a long period, and thus may cause skin injury. In this study, we investigate the diagnostic reference level (DRL) of the cardiovascular intervention (CI) carried out by medical institutions and use it as a tool to reduce patient exposure dose. In this study, the DRL was set by acquiring information about the cumulative fluoroscopy time, cumulative fluoroscopy dose-area product (DAP), radiography DAP, cumulative DAP, air kerma, number of video clips, and the total number of images from the cardiac angiography and interventional procedures performed on 147 patients. The DAPs corresponding to the DRL of cardiac angiography( CA) and that of the interventional procedures were shown to be 44.4Gy·cm2 and 298.6Gy·cm2, respectively; the corresponding DRLs of fluoroscopy time were shown to be 191.5s and 1935.3s, respectively. A DRL is not a strict upper bound for radiation exposure. However, the process of setting, enacting, and reviewing the DRLs for the dose by medical institutions will contribute to a reduction in the unnecessary exposure dose of patients.
We investigated the effect of X-ray beam qualities RQA3, 5, 7, and 9 on the exposure index (EI) as defined by International Electrotechnical Commission guideline 62494-1. Half-value layers (HVLs) of RQA5 X-rays passing through anti-scatter grids (grid ratios 6:1, 8:1, 10:1, and 12:1) were also evaluated because grids are frequently used in clinical situations. The maximum percent differences in the EIs for RQA3, 7, and 9 with respect to RQA5 were 35.0, 11.6, and 38.7 %, respectively. The range of HVLs for RQA5-7 beams was 7.10-9.10 mm of aluminum (mm Al). This was wider than the range of HVLs when grids were used (6.94-7.29 mm Al). The effect of variations in X-ray beam qualities in the RQA series on the EI was significantly greater than the effect of grids. This study indicated that, in clinical settings, the EI should be used carefully in X-ray examinations with different X-ray beam qualities.
Computed radiography (CR) is gradually replacing conventional
screen-film system in Brazil. To assess image quality, manufactures
provide the calculation of an exposure index through the acquisition
software of the CR system. The objective of this study is to verify if
the CR image can be used as an evaluator of patient absorbed dose too,
through a relationship between the entrance skin dose and the exposure
index or the gray level values obtained in the image. The CR system used
for this study (Agfa model 30-X with NX acquisition software) calculates
an exposure index called Log of the Median (lgM), related to the
absorbed dose to the IP. The lgM value depends on the average gray level
(called Scan Average Level (SAL)) of the segmented pixel value histogram
of the whole image. A Rando male phantom was used to simulate a human
body (chest and head), and was irradiated with an X-ray equipment, using
usual radiologic techniques for chest exams. Thermoluminescent
dosimeters (LiF, TLD100) were used to evaluate entrance skin dose and
exit dose. The results showed a logarithm relation between entrance dose
and SAL in the image center, regardless of the beam filtration. The
exposure index varies linearly with the entrance dose, but the angular
coefficient is beam quality dependent. We conclude that, with an
adequate calibration, the CR system can be used to evaluate the patient
absorbed dose.
According to the International Electro-technical Commission, manufacturers of X-ray equipment should indicate the number of
radiation doses to which a patient can be exposed. Dose–area product (DAP) meters are readily available devices that provide
dose indices. Collimators are the most commonly employed radiation beam restrictors in X-ray equipment. DAP meters are attached
to the lower surface of a collimator. A DAP meter consists of a chamber and electronics. This separation makes it difficult
for operators to maintain the accuracy of a DAP meter. Developing a comprehensive system that has a DAP meter in place of
a mirror in the collimator would be effective for measuring, recording the dose and maintaining the quality of the DAP meter.
This study was conducted through experimental measurements and a simulation. A DAP meter built into a collimator was found
to be feasible when its reading was multiplied by a correction factor.
The purpose of this paper is to review the literature on exposure technique approaches in Computed Radiography (CR) imaging as a means of radiation dose optimization in CR imaging. Specifically the review assessed three approaches: optimization of kVp; optimization of mAs; and optimization of the Exposure Indicator (EI) in practice. Only papers dating back to 2005 were described in this review.
The major themes, patterns, and common findings from the literature reviewed showed that important features are related to radiation dose management strategies for digital radiography include identification of the EI as a dose control mechanism and as a “surrogate for dose management”. In addition the use of the EI has been viewed as an opportunity for dose optimization. Furthermore optimization research has focussed mainly on optimizing the kVp in CR imaging as a means of implementing the ALARA philosophy, and studies have concentrated on mainly chest imaging using different CR systems such as those commercially available from Fuji, Agfa, Kodak, and Konica-Minolta. These studies have produced “conflicting results”. In addition, a common pattern was the use of automatic exposure control (AEC) and the measurement of constant effective dose, and the use of a dose-area product (DAP) meter.
Tables and graphs of the photon mass attenuation coefficient mu/rho and the mass energy-absorption coefficient mu(en)/rho are presented for all of the elements Z=1 to 92, and for 48 compounds and mixtures of radiological interest. The tables cover energies of the photon (x ray, gamma ray, bremsstrahlung) from 1 keV to 20 MeV. The mu/rho values are taken from the current photon interaction database at the National Institute of Standards and Technology, and the mu(en)/rho values are based on the new calculations by Seltzer described in Radiation Research. These tables of mu/rho and mu(en)/rho replace and extend the tables given by Hubbell in the International Journal of Applied Radiation and Isotopes.
The image quality and potential usefulness for patient skin-dose reduction of a newly developed flat-panel detector (FPD) system employing irradiation side sampling (ISS) were investigated and compared to a conventional computed radiography (CR) system. We used the X-ray beam quality of RQA 9 as noted in the standard evaluation method by the International Electrotechnical Commission 62220-1 to evaluate the image quality of the detector for chest radiography. The presampled modulation transfer function (MTF) of the ISS-FPD system was slightly higher than that of the CR system in the horizontal direction at more than 2.2 cycles/mm. However, the presampled MTF of the ISS-FPD system was slightly lower than that of the CR system in the vertical direction. The Wiener spectrum of the ISS-FPD system showed a 50-65 % lesser noise level than that of the CR system under the same exposure condition. The detective quantum efficiency of the ISS-FPD system was at least twice as great as that of the CR system. We conclude that the ISS-FPD system has the potential to reduce the patient skin dose compared to a conventional CR system for chest radiography.
We measured physical image properties of a flat panel detector (FPD) system and a computed radiography (CR) system, targeting to a low dose range (reference dose: 2.58×10(-7) C/kg: to 1/20 dose). Input-output properties, pre-sampled modulation transfer functions (pre-sampled MTFs), and normalized noise power spectra for an FPD system equipped with a CsI scintillator (FPDcsi) and a CR system with an imaging plate coated with storage phosphor (CR) were measured at the low dose range for radiation quality of RQA3 (≍50 skV) and RQA5 (≍70 kV), and detective quantum efficiencies (DQEs) were calculated. In addition, in order to validate the DQE results, component fractions of Poisson and multiplicative and additive noise were analyzed using relative standard deviation analysis. The DQE values of FPDcsi were decreased with dose decrease, and contrarily to these, those of CR were increased. At the 1/10 and 1/20 doses for RQA3, the DQEs of FPDcsi and CR became almost the same. From the results of RSD analysis, it was proved that the main cause of DQE deterioration on FPDcsi are non-negligible additive (electronic) noise, and the DQE improvement on CR was caused by both of significant multiplicative (structure) noise and very low electronic noise. The DQE results were validated by comparing burger phantom images of each dose and radiation quality.
To find the tube voltage that results in the highest image quality per effective dose unit for chest and pelvis radiography, respectively, using image plates.
Two anthropomorphic phantoms (chest and pelvis) were imaged with several different tube voltages. The mA s settings were chosen so that the effective dose to the phantom was the same, regardless of the tube voltage, for the two examinations, respectively. The quality of the images was evaluated by six experienced radiologists using visual grading analysis.
For both the chest and the pelvis examinations, the image quality increased when the tube voltage was reduced compared with the standard settings (125 and 70 kV for chest and pelvis, respectively), which were used for screen-film radiography previously.
The image quality of image plate radiography can be increased by lowering the tube voltage compared with the one that was used for screen-film radiography.
Over the last 50 years, diagnostic imaging has grown from a state of infancy to a high level of maturity. Many new imaging modalities have been developed. However, modern medical imaging includes not only image production but also image processing, computer-aided diagnosis (CAD), image recording and storage, and image transmission, most of which are included in a picture archiving and communication system (PACS). The content of this paper includes a short review of research and development in medical imaging science and technology, which covers (a) diagnostic imaging in the 1950s, (b) the importance of image quality and diagnostic performance, (c) MTF, Wiener spectrum, NEQ and DQE, (d) ROC analysis, (e) analogue imaging systems, (f) digital imaging systems, (g) image processing, (h) computer-aided diagnosis, (i) PACS, (j) 3D imaging and (k) future directions. Although some of the modalities are already very sophisticated, further improvements will be made in image quality for MRI, ultrasound and molecular imaging. The infrastructure of PACS is likely to be improved further in terms of its reliability, speed and capacity. However, CAD is currently still in its infancy, and is likely to be a subject of research for a long time.
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