Determination of the surface dose of a water phantom using a semiconductor detector for diagnostic kilovoltage x-ray beams

PurposeTo determine the surface dose of a water phantom using a semiconductor detector for diagnostic kilovoltage x-ray beams.MethodsAn AGMS-DM+ semiconductor detector was calibrated in terms of air kerma measured with an ionization chamber. Air kerma was measured for 20 x-ray beams with tube voltages of 50–140 kVp and a half-value layer (HVL) of 2.2–9.7 mm Al for given quality index (QI) values of 0.4, 0.5, and 0.6, and converted to the surface dose. Finally, the air kerma and HVL measured by the AGMS-DM+ detector were expressed as a ratio of the surface dose for 10 × 10 and 20 × 20 cm² fields. The ratio of both was represented as a function of HVL for the given QI values and verified by comparing it with that calculated using the Monte Carlo method.ResultsThe air kerma calibration factor, CF, for the AGMS-DM+ detector ranged from 0.986 to 1.016 (0.9% in k = 1). The CF values were almost independent of the x-ray fluence spectra for the given QI values. The ratio of the surface dose to the air kerma determined by the PTW 30,013 chamber and the AGMS-DM+ detector was less than 1.8% for the values calculated using the Monte Carlo method, and showed a good correlation with the HVL for the given QI values.ConclusionIt is possible to determine the surface dose of a water phantom from the air kerma and HVL measured by a semiconductor detector for given QI values.     

Optimization of image quality and accuracy of low iodine concentration quantification as function of kVp pairs for abdominal imaging using dual-source CT: A phantom study

PurposeTo determine the suitable kVp pair for optimal image quality of the virtual monochromatic images (VMIs) and iodine quantification accuracy at low concentration, using a third generation dual-source CT (DSCT).Materials and methodsMulti-energy CT phantoms with and without body rings were scanned with a DSCT using four kVp pairs (tube “A”/“B” voltage): 100/Sn150, 90/Sn150, 80/Sn150 and 70/Sn150 kVp. The reference mAs was adjusted to obtain a CTDI_vol close to 11 mGy. HU values accuracy (RMSD_HU), noise (SD) and contrast-to-noise ratio (CNR) of iodine inserts of 0.5, 1, 2 and 5 mg/mL concentrations were assessed on VMIs at 40/50/60/70 keV. Iodine quantification accuracy was assessed using the RMSD_iodine and iodine bias (IB_iodine).ResultsThe RMSD_HU decreased when the tube “A” voltage increased. The mean noise value increased significantly with tube “A” voltage (p < 0.001) but decreased between 80/Sn150 and 90/Sn150 kVp for the small phantom (1.1 ± 0.1%; p = 0.047). The CNR significantly decreased with tube “A” voltage (p < 0.001), except between 80/Sn150 and 90/Sn150 kVp for all inserts and between 90/Sn150 kVp and 100/Sn150 kVp for the 1.0 and 0.5 mg/mL inserts in the large phantom. In the small phantom, no significant difference was found between 80/Sn150 kVp and 90/Sn150 kVp for all inserts and between 80/Sn150, 90/Sn150 and 100/Sn150 kVp for the 1 and 0.5 mg/mL inserts. The RMSD_iodine and IB_iodine decreased as the tube “A” voltage of the kVp pair increased.ConclusionThe kVp pair of 70/Sn150 led to better image quality in VMIs and sufficient iodine accuracy.     

Monte Carlo determination of a nanoDot OSLD response using quality index for diagnostic kilovoltage X-ray beams

PurposeThis study aims to investigate the energy response of an optically stimulated luminescent dosimeter known as nanoDot for diagnostic kilovoltage X-ray beams via Monte Carlo calculations.MethodsThe nanoDot response is calculated as a function of X-ray beam quality in free air and on a water phantom surface using Monte Carlo simulations. The X-ray fluence spectra are classified using the quality index (QI), which is defined as the ratio of the effective energy to the maximum energy of the photons. The response is calculated for X-ray fluence spectra with QIs of 0.4, 0.5, and 0.6 with tube voltages of 50–137.6 kVp and monoenergetic photon beams. The surface dose estimated using the calculated response is verified by comparing it with that measured using an ionization chamber.ResultsThe nanoDot response in free air for monoenergetic photon beams (QI = 1.0) varies significantly at photon energies below 100 keV and reaches a factor of 3.6 at 25–30 keV. The response differs by up to approximately 6% between QIs of 0.4 and 0.6 for the same half-value layer (HVL). The response at the phantom surface decreases slightly owing to the backscatter effect, and it is almost independent of the field size. The agreement between the surface dose estimated using the nanoDot and that measured using the ionization chamber for assessing X-ray beam qualities is less than 2%.ConclusionsThe nanoDot response is indicated as a function of HVL for the specified QIs, and it enables the direct surface dose measurement.     

A validation of SpekPy: A software toolkit for modelling X-ray tube spectra

PurposeTo validate the SpekPy software toolkit that has been developed to estimate the spectra emitted from tungsten anode X-ray tubes. The model underlying the toolkit introduces improvements upon a well-known semi-empirical model of X-ray emission.Materials and methodsUsing the same theoretical framework as the widely-used SpekCalc software, new electron penetration data was simulated using the Monte Carlo (MC) method, alternative bremsstrahlung cross-sections were applied, L-line characteristic emissions were included, and improvements to numerical methods implemented. The SpekPy toolkit was developed with the Python programming language. The toolkit was validated against other popular X-ray spectrum models (50 to 120 kVp), X-ray spectra estimated with MC (30 to 150 kVp) as well as reference half value layers (HVL) associated with numerous radiation qualities from standard laboratories (20 to 300 kVp).ResultsThe toolkit can be used to estimate X-ray spectra that agree with other popular X-ray spectrum models for typical configurations in diagnostic radiology as well as with MC spectra over a wider range of conditions. The improvements over SpekCalc are most evident at lower incident electron energies for lightly and moderately filtered radiation qualities. Using the toolkit, estimations of the HVL over a large range of standard radiation qualities closely match reference values.ConclusionsA toolkit to estimate X-ray spectra has been developed and extensively validated for central-axis spectra. This toolkit can provide those working in Medical Physics and beyond with a powerful and user-friendly way of estimating spectra from X-ray tubes.     

Method for determining the half-value layer in computed tomography scans using a real-time dosimeter: Application to dual-source dual-energy acquisition

PurposeWe have proposed a method for determining the half-value layers (HVL) in dual-source dual-energy computed tomography (DS-DECT) scans without the need for the X-ray tubes to be fixed.MethodsA custom-made lead-covered case and an ionizing chamber connected with a multi-function digitizer module (a real-time dosimeter) were used. The chamber was placed in the center of the case, and aluminum or copper filters were placed in front of the aperture. The HVL was measured using aperture widths of 1.0, 2.0, and 3.0 cm for tube potentials of 80, 120, and 150 kV in single-source single-energy CT (SS-SECT) scans and was calculated from the peak air kerma rate (peak method) and the integrated air kerma rate (integrating method); the obtained values were compared with those from a conventional non-rotating method performed using the same procedure. The HVL was then measured using an aperture width of 1.0 cm for tube potential combinations of 70/Sn150 kV and 100/Sn150 kV in DS-DECT scans using the peak method.ResultsIn the SS-SECT scans, the combination of a 1.0-cm aperture and the peak method was adequate due to the small differences in the HVL values obtained for the conventional non-rotating method. The method was also found to be applicable for the DS-DECT scans.ConclusionsOur proposed method can determine the HVL in SS-SE and DS-DECT scans to a good level of accuracy without the need for the X-ray tubes to be fixed. The combination of a 1.0-cm aperture and the peak method was adequate.     

Simultaneous achievement of accurate CT number and image quality improvement for myocardial perfusion CT at 320-MDCT volume scanning

PurposeTo investigate differences in image-to-image variations between full- and half-scan reconstruction on myocardial CT perfusion (CTP) study.MethodsUsing a cardiac phantom we performed ECG-gated myocardial CTP on a second-generation 320-multidetector CT volume scanner. The heart rate was set at 60 bpm; once per second for a total of 24 s were performed. CT images were acquired at 80- and 120 kVp and subjected to full- and half-scan reconstruction. On images acquired at the same slice level we then measured image-to-image variations, coefficients of variance (CV), and image noise.ResultsThe image-to-image variations with full- and half-scan reconstruction were 1.3 HU vs. 27.2 HU at 80 kVp (p < 0.001) and 0.70 HU vs. 9.3 HU at 120 kVp (p < 0.001) even though the mean HU value was almost the same for both reconstruction methods. The CV of 80- and 120-kVp images of the left ventricular cavity decreased by 0.16% and 0.17%, respectively, with full-scan reconstruction; with half-scan reconstruction it decreased by 3.34% and 2.30%, respectively. Compared with half-scan reconstruction, the image noise was reduced by 27.2% at 80 kVp and by 28.0% at 120 kVp with full-scan reconstruction.ConclusionMyocardial CTP with full-scan reconstruction substantially decreased image-to-image variations and provided accurate CT attenuation.     

Low-tube-voltage selection for non-contrast-enhanced CT: Comparison of the radiation dose in pediatric and adult phantoms

PurposeWe used pediatric and adult anthropomorphic phantoms to compare the radiation dose of low- and standard tube voltage chest and abdominal non-contrast-enhanced computed tomography (CT) scans. We also discuss the optimal low tube voltage for non-contrast-enhanced CT.MethodsUsing a female adult- and three differently-sized pediatric anthropomorphic phantoms we acquired chest and abdominal non-contrast-enhanced scans on a 320-multidetector CT volume scanner. The tube voltage was set at 80-, 100-, and 120 kVp. The tube current was automatically assigned on the CT scanner in response to the set image noise level. On each phantom and at each tube voltage we measured the surface and center dose using high-sensitivity metal-oxide-semiconductor field-effect transistor detectors.ResultsThe mean surface dose of chest and abdominal CT scans in 5-year olds was 4.4 and 5.3 mGy at 80 kVp, 4.5 and 5.4 mGy at 100 kV, and 4.0 and 5.0 mGy at 120 kVp, respectively. These values were similar in our 3-pediatric phantoms (p > 0.05). The mean surface dose in the adult phantom increased from 14.7 to 19.4 mGy for chest- and from 18.7 to 24.8 mGy for abdominal CT as the tube voltage decreased from 120 to 80 kVp (p < 0.01).ConclusionCompared to adults, the surface and center dose for pediatric patients is almost the same despite a decrease in the tube voltage and the low tube voltage technique can be used for non-contrast-enhanced chest- and abdominal scanning.     

Image quality assessment with dose reduction using high kVp and additional filtration for abdominal digital radiography

PurposeDose reduction using additional filters with high kilovoltage peak (kVp) for abdominal digital radiography has received much attention recently. We evaluated image quality with dose reduction in abdominal digital radiography by using high kVp and additional copper filters at a tertiary hospital.MethodsBetween June 2016 and July 2016, 82 patients underwent abdominal digital radiography using 80 kVp in X-ray room 1 and 82 were imaged using 92 kVp with 0.1-mm copper filtration in X-ray room 2. The effective dose was calculated using a PC-based Monte Carlo program. Image quality of the abdominal radiography acquired in the two rooms was evaluated using a five-point ordinal scale, as well as the signal-to-noise and contrast-to-noise ratios.ResultsThe mean effective dose decreased by 25.8% and 25.7% for the supine and standing positions, respectively, when abdominal digital radiography using 92 kVp with 0.1-mm copper filtration was performed. In the 20 patients who performed abdominal digital radiography twice in each room, visual grading scores for visualisation of psoas outlines and kidney outlines are higher in room 1. However, there was no statistical significant difference of visual grading scores among the 124 patients who underwent only one abdominal radiography in the room 1 or 2 (P > 0.05).ConclusionsDose reduction for abdominal digital radiography can be achieved with comparable image quality by performing abdominal digital radiography using 92 kVp with 0.1-mm copper filtration, despite the higher AEC dose.     

Gold coated contact lens-type ocular in vivo dosimeter (CLOD) for monitoring of low dose in computed tomography: A Monte Carlo study

PurposeThis study reports a sensitivity enhancement of gold-coated contact lens-type ocular in vivo dosimeters (CLODs) for low-dose measurements in computed tomography (CT).MethodsMonte Carlo (MC) simulations were conducted to evaluate the dose enhancement from the gold (Au) layers on the CLODs. The human eye and CLODs were modeled, and the X-ray tube voltages were defined as 80, 120, and 140 kVp. The thickness of the Au layer attached to a CLOD ranged from 100 nm to 10 μm. The thickness of the active layer ranged from 20 to 140 μm. The dose ratio between the active layer of the Au-coated CLOD and a CLOD without a layer, i.e., the dose enhancement factor (DEF), was calculated.ResultsThe DEFs of the first 20-μm thick active layer of the 5-μm thick Au-coated CLOD were 18.4, 19.7, 20.2 at 80, 120, and 140 kVp, respectively. The DEFs decreased as the thickness of the active layer increased. The DEFs of 100-nm to 5-μm thick Au layers increased from 1.7 to 5.4 for 120-kVp X-ray tube voltage when the thickness of the active layer was 140 μm.ConclusionsThe MC results presented a higher sensitivity of Au-coated CLODs (∼20-times higher than that of CLODs without a gold layer). Au-coated CLODs can be applied to an evaluation of very low doses (a few cGy) delivered to patients during CT imaging.     

Multi-user test of the data quality matrix for product life cycle inventory data

The data quality matrix for product life cycle inventory data proposed inWhdkma &Wlsnaus (J. Cleaner Prod. (1996), 4: 167-174) was subjected to a multi-user test, in which 7 persons scored the same 10 datasets representing 10 different processes. Deviations among scores were listed, and the causes for deviations were determined and grouped into a limited number of well-defined classes. For the majority of the scores, the different test persons arrived at the same score. Deviations occur most often among neighbouring scores. Only a smaller number of the deviations (less than 10% of all scores) affect the overall assessment of the data quality and/or uncertainty of the corresponding dataset. Based on the analysis of the causes of the deviations, improvements to the matrix and its accompanying explanations were suggested and implemented (reported in the appendix to this paper). The average time consumption for the scoring by the different test persons was less than 10 minutes per data set. It is concluded that the time consumption and the number of deviating scores can be kept at an acceptable level for the pedigree matrix to be recommended for internal data quality management and for comprehensive communication of quality assessments of large amounts of data.     

Association between subjective evaluation and physical parameters for radiographic images optimization

PurposeThe purpose of this study was to develop a methodology to optimize computed radiographic techniques to image the skull, chest, and pelvis of a standard patient.MethodsOptimization was performed by varying exposure levels with different tube voltages to generate images of an anthropomorphic phantom. Image quality was evaluated using visual grading analysis and measuring objective parameters such as the effective detective quantum efficiency and the contrast-to-noise ratio. Objective and subjective evaluations were compared to obtain an optimized technique for each anatomic region.ResultsGold standard techniques provided a significant reduction in X-ray doses compared to the techniques used in our radiology service, without compromising diagnostic accuracy. They were chosen as follows 102 kVp/1.6 mAs for skull; 81 kVp/4.5 mAs for pelvis and 90 kVp/3.2 mAs for chest.ConclusionThere is a range of acceptable techniques that produce adequate images for diagnosis in computed radiography systems. This aspect allows the optimization process to be focused on the patient dose without compromising diagnostic capabilities. This process should be performed through association of quantitative and qualitative parameters, such as effective detective quantum efficiency, contrast-to-noise ratio, and visual grading analysis.     

Energy and dose dependence of GafChromic EBT3-V3 film across a wide energy range

AimTo determine the energy and dose dependence of GafChromic EBT3-V3 film over an energy range 0.2 mm Al HVL to 6 MV.BackgroundThe decay scheme of a brachytherapy source may be complex and the spectrum of energy can be wide. LiF TLDs are the golden standard recommended for dosimetric measures in brachytherapy, for their energy independence, but TLDs could be not available in some centres. An alternative way to perform dose measurements is to use GafChromic films, but they show energy dependence.Methods and materialsFilms have been irradiated at increasing dose with three different beams: 6 MV beam, TPR20, 10 = (0.684 ± 0.01), HVL = (2.00 ± 0.01)mmAl and HVL = (0.20 ± 0.01)mmAl. Calibration curves were generated using the same dose range (0cGy to 850cGy) for the three energies. Using the 6 MV calibration curve as reference, the film response in terms of net optical density (OD) was evaluated.ResultsThe difference in the calibration curve obtained by irradiating the film with 6 MV and 2 mm Al HVL energy beams is less than 3 %, within the calibration uncertainty, in the dose range 500-850cGy. The OD of EBT3-V3 film is significantly lower at 0.2 mmAl HVL compared to 6 MV, showing differences up to 25 %.ConclusionWithin the range 6 MV-2 mm Al HVL and dose higher than 500cGy, GafChromic EBT3-V3 films are energy independent. In this dose range, films can be calibrated in a simple geometry, using a 6 MV Linac beam, and can be used for brachytherapy sources dose measures. The use of EBT3 films can be extended to reference dosimetry in Ir-192 clinical brachytherapy.     

High-Pitch,Low-Voltage and Low-Iodine-Concentration CT Angiography of Aorta: Assessment of Image Quality and Radiation Dose with Iterative Reconstruction

ObjectiveTo assess the image quality of aorta obtained by dual-source computed tomography angiography (DSCTA), performed with high pitch, low tube voltage, and low iodine concentration contrast medium (CM) with images reconstructed using iterative reconstruction (IR).MethodsOne hundred patients randomly allocated to receive one of two types of CM underwent DSCTA with the electrocardiogram-triggered Flash protocol. In the low-iodine group, 50 patients received CM containing 270 mg I/mL and were scanned at low tube voltage (100 kVp). In the high-iodine CM group, 50 patients received CM containing 370 mg I/mL and were scanned at the tube voltage (120 kVp). The filtered back projection (FBP) algorithm was used for reconstruction in both groups. In addition, the IR algorithm was used in the low-iodine group. Image quality of the aorta was analyzed subjectively by a 3-point grading scale and objectively by measuring the CT attenuation in terms of the signal- and contrast-to-noise ratios (SNR and CNR, respectively). Radiation and CM doses were compared.ResultsThe CT attenuation, subjective image quality assessment, SNR, and CNR of various aortic regions of interest did not differ significantly between two groups. In the low-iodine group, images reconstructed by FBP and IR demonstrated significant differences in image noise, SNR, and CNR (p<0.05). The low-iodine group resulted in 34.3% less radiation (4.4 ± 0.5 mSv) than the high-iodine group (6.7 ± 0.6 mSv), and 27.3% less iodine weight (20.36 ± 2.65 g) than the high-iodine group (28 ± 1.98 g). Observers exhibited excellent agreement on the aortic image quality scores (κ = 0.904).ConclusionsCT images of aorta could be obtained within 2 s by using a DSCT Flash protocol with low tube voltage, IR, and low-iodine-concentration CM. Appropriate contrast enhancement was achieved while maintaining good image quality and decreasing the radiation and iodine doses.     

Crude and adjusted comparisons of cesarean delivery rates using the Robson classification: A population-based cohort study in Canada and Sweden, 2004 to 2016

BackgroundThe Robson classification has become a global standard for comparing and monitoring cesarean delivery (CD) rates across populations and over time; however, this classification does not account for differences in important maternal, fetal, and obstetric practice factors known to impact CD rates. The objectives of our study were to identify subgroups of women contributing to differences in the CD rate in Sweden and British Columbia (BC), Canada using the Robson classification and to estimate the contribution of maternal, fetal/infant, and obstetric practice factors to differences in CD rates between countries and over time.Methods and findingsWe conducted a population-based cohort study of deliveries in Sweden (January 1, 2004 to December 31, 2016; n = 1,392,779) and BC (March 1, 2004 to April 31, 2017; n = 559,205). Deliveries were stratified into Robson categories and the CD rate, relative size of each group and its contribution to the overall CD rate were compared between the Swedish and the Canadian cohorts. Poisson and log-binomial regression were used to assess the contribution of maternal, fetal, and obstetric practice factors to spatiotemporal differences in Robson group-specific CD rates between Sweden and BC.Nulliparous women comprised 44.8% of the study population, while women of advanced maternal age (≥35 years) and women with overweight/obesity (≥25 kg/m²) constituted 23.5% and 32.4% of the study population, respectively. The CD rate in Sweden was stable at approximately 17.0% from 2004 to 2016 (p for trend = 0.10), while the CD rate increased in BC from 29.4% to 33.9% (p for trend < 0.001). Differences in CD rates between Sweden and BC varied by Robson group, for example, in Group 1 (nullipara with a term, single, cephalic fetus with spontaneous labor), the CD rate was 8.1% in Sweden and 20.4% in BC (rate ratio [RR] for BC versus Sweden = 2.52, 95% confidence interval [CI] 2.49 to 2.56, p < 0.001) and in Group 2 (nullipara, single, cephalic fetus, term gestation with induction of labor or prelabor CD), the rate of CD was 37.3% in Sweden and 45.9% in BC (RR = 1.23, 95% CI 1.22 to 1.25, p < 0.001). The effect of adjustment for maternal characteristics (e.g., age, body mass index), maternal comorbidity (e.g., preeclampsia), fetal characteristics (e.g., head position), and obstetric practice factors (e.g., epidural) ranged from no effect (e.g., among breech deliveries; Groups 6 and 7) to explaining up to 5.2% of the absolute difference in the CD rate (Group 2: adjusted CD rate in BC 40.7%, adjusted RR = 1.09, 95% CI 1.08 to 1.12, p < 0.001). Adjustment also explained a substantial fraction of the temporal change in CD rates among some Robson groups in BC. Limitations of the study include a lack of information on intrapartum details, such as labor duration as well as maternal and perinatal outcomes associated with the observed differences in CD rates.ConclusionsIn this study, we found that several factors not included in the Robson classification explain a significant proportion of the spatiotemporal difference in CD rates in some Robson groups. These findings suggest that incorporating these factors into explanatory models using the Robson classification may be useful for ensuring that public health initiatives regarding CD rates are evidence informed.

Giulia Muraca and colleagues examine differences in the rates of cesarean delivery between British Columbia, Canada and Sweden over time using the Robson classification with and without adjusting for maternal, fetal/infant, and obstetric practice factors.     

Image quality characteristics for virtual monoenergetic images using dual-layer spectral detector CT: Comparison with conventional tube-voltage images

PurposeTo investigate the image quality characteristics for virtual monoenergetic images compared with conventional tube-voltage image with dual-layer spectral CT (DLCT).MethodsHelical scans were performed using a first-generation DLCT scanner, two different sizes of acrylic cylindrical phantoms, and a Catphan phantom. Three different iodine concentrations were inserted into the phantom center. The single-tube voltage for obtaining virtual monoenergetic images was set to 120 or 140 kVp. Conventional 120- and 140-kVp images and virtual monoenergetic images (40–200-keV images) were reconstructed from slice thicknesses of 1.0 mm. The CT number and image noise were measured for each iodine concentration and water on the 120-kVp images and virtual monoenergetic images. The noise power spectrum (NPS) was also calculated.ResultsThe iodine CT numbers for the iodinated enhancing materials were similar regardless of phantom size and acquisition method. Compared with the iodine CT numbers of the conventional 120-kVp images, those for the monoenergetic 40-, 50-, and 60-keV images increased by approximately 3.0-, 1.9-, and 1.3-fold, respectively. The image noise values for each virtual monoenergetic image were similar (for example, 24.6 HU at 40 keV and 23.3 HU at 200 keV obtained at 120 kVp and 30-cm phantom size). The NPS curves of the 70-keV and 120-kVp images for a 1.0-mm slice thickness over the entire frequency range were similar.ConclusionVirtual monoenergetic images represent stable image noise over the entire energy spectrum and improved the contrast-to-noise ratio than conventional tube voltage using the dual-layer spectral detector CT.     

Dosimetric characterization of a small-scale (Zn,Cd)S:Ag inorganic scintillating detector to be used in radiotherapy

PurposeIn modern radiotherapy techniques, to ensure an accurate beam modeling process, dosimeters with high accuracy and spatial resolution are required. Therefore, this work aims to propose a simple, robust, and a small-scale fiber-integrated X-ray inorganic detector and investigate the dosimetric characteristics used in radiotherapy.MethodsThe detector is based on red-emitting silver-activated zinc-cadmium sulfide (Zn,Cd)S:Ag nanoclusters and the proposed system has been tested under 6 MV photons with standard dose rate used in the patient treatment protocol. The article presents the performances of the detector in terms of dose linearity, repeatability, reproducibility, percentage depth dose distribution, and field output factor. A comparative study is shown using a microdiamond dosimeter and considering data from recent literature.ResultsWe accurately measured a small field beam profile of 0.5 × 0.5 cm² at a spatial resolution of 100 µm using a LINAC system. The dose linearity at 400 MU/min has shown less than 0.53% and 1.10% deviations from perfect linearity for the regular and smallest field. Percentage depth dose measurement agrees with microdiamond measurements within 1.30% and 2.94%, respectively for regular to small field beams. Besides, the stem effect analysis shows a negligible contribution in the measurements for fields smaller than 3x3 cm². This study highlights the drastic decrease of the convolution effect using a point-like detector, especially in small dimension beam characterization. Field output factor has shown a good agreement while comparing it with the microdiamond dosimeter.ConclusionAll the results presented here anticipated that the developed detector can accurately measure delivered dose to the region of interest, claim accurate depth dose distribution hence it can be a suitable candidate for beam characterization and quality assurance of LINAC system.     

Monte Carlo simulation of eye lens dose reduction from CT scan using organ based tube current modulation

PurposeTo investigate lens dose reduction with organ based tube current modulation (TCM) using the Monte Carlo method.MethodsTo calculate lens dose with organ based TCM, 36 pairs of X-ray sources with bowtie filters were placed around the patient head using a projection angle interval of 10° for one rotation of Computed Tomography (CT). Each projection was simulated respectively. Both voxelized and stylized eye models and Chinese reference male phantoms were used in the simulation, and tube voltages 80, 100, 120 and 140 kVp were used.ResultsDose differences between two eye models were less than 20%, but large variations were observed among dose results from different projections of all tube voltages investigated. Dose results from 0° (AP) directions were 60 times greater than those from 180° (PA) directions, which enables organ based TCM reduce lens doses by more than 47%.ConclusionsOrgan based TCM may be used to reduce lens doses. Stylized eye models are more anatomically realistic compared with voxelized eye models and are more reliable for dose evaluation.     

3D dosimetric validation of ultrasound-guided radiotherapy with a dynamically deformable abdominal phantom

ObjectivesThe purpose of this study was to dosimetrically benchmark gel dosimetry measurements in a dynamically deformable abdominal phantom for intrafraction image guidance through a multi-dosimeter comparison. Once benchmarked, the study aimed to perform a proof-of-principle study for validation measurements of an ultrasound image-guided radiotherapy delivery system.MethodsThe phantom was dosimetrically benchmarked by delivering a liver VMAT plan and measuring the 3D dose distribution with DEFGEL dosimeters. Measured doses were compared to the treatment planning system and measurements acquired with radiochromic film and an ion chamber. The ultrasound image guidance validation was performed for a hands-free ultrasound transducer for the tracking of liver motion during treatment.ResultsGel dosimeters were compared to the TPS and film measurements, showing good qualitative dose distribution matches, low γ values through most of the high dose region, and average 3%/5 mm γ-analysis pass rates of 99.2%(0.8%) and 90.1%(0.8%), respectively. Gel dosimeter measurements matched ion chamber measurements within 3%. The image guidance validation study showed the measurement of the treatment delivery improvements due to the inclusion of the ultrasound image guidance system. Good qualitative matching of dose distributions and improvements of the γ-analysis results were observed for the ultrasound-gated dosimeter compared to the ungated dosimeter.ConclusionsDEFGEL dosimeters in phantom showed good agreement with the planned dose and other dosimeters for dosimetric benchmarking. Ultrasound image guidance validation measurements showed good proof-of-principle of the utility of the phantom system as a method of validating ultrasound-based image guidance systems and potentially other image guidance methods.     

Optimal Dose Levels in Screening Chest CT for Unimpaired Detection and Volumetry of Lung Nodules,with and without Computer Assisted Detection at Minimal Patient Radiation

Objectives

The aim of this phantom study was to minimize the radiation dose by finding the best combination of low tube current and low voltage that would result in accurate volume measurements when compared to standard CT imaging without significantly decreasing the sensitivity of detecting lung nodules both with and without the assistance of CAD.

Methods

An anthropomorphic chest phantom containing artificial solid and ground glass nodules (GGNs, 5–12 mm) was examined with a 64-row multi-detector CT scanner with three tube currents of 100, 50 and 25 mAs in combination with three tube voltages of 120, 100 and 80 kVp. This resulted in eight different protocols that were then compared to standard CT sensitivity (100 mAs/120 kVp). For each protocol, at least 127 different nodules were scanned in 21–25 phantoms. The nodules were analyzed in two separate sessions by three independent, blinded radiologists and computer-aided detection (CAD) software.

Results

The mean sensitivity of the radiologists for identifying solid lung nodules on a standard CT was 89.7%±4.9%. The sensitivity was not significantly impaired when the tube and current voltage were lowered at the same time, except at the lowest exposure level of 25 mAs/80 kVp [80.6%±4.3% (p = 0.031)]. Compared to the standard CT, the sensitivity for detecting GGNs was significantly lower at all dose levels when the voltage was 80 kVp; this result was independent of the tube current. The CAD significantly increased the radiologists’ sensitivity for detecting solid nodules at all dose levels (5–11%). No significant volume measurement errors (VMEs) were documented for the radiologists or the CAD software at any dose level.

Conclusions

Our results suggest a CT protocol with 25 mAs and 100 kVp is optimal for detecting solid and ground glass nodules in lung cancer screening. The use of CAD software is highly recommended at all dose levels.