Assessment of dose & optimisation of image quality in the XVI cone beam CT system

Background: Colour and power Doppler have become integral parts of many clinical ultrasound investigations and, due to this, refinements are made to the current technology to ensure accurate results for clinical perception of image quality.Method: The aim of this study was to modify and evaluate existing Doppler Ultrasound devices for the assessment of Colour Doppler spatial resolution. In this study a convention flow phantom design was modified to have a set of line pairs of varying     

Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography

Aims

The consequences of high radiation dose for patient and staff demand constant improvements in X-ray dose reduction technology. This study assessed non-inferiority of image quality and quantified patient dose reduction in interventional cardiology for an anatomy-specific optimised cine acquisition chain combined with advanced real-time image noise reduction algorithms referred to as ‘study cine’, compared with conventional angiography.

Methods

Fifty patients underwent two coronary angiographic acquisitions: one with advanced image processing and optimised exposure system settings to enable dose reduction (study cine) and one with standard image processing and exposure settings (reference cine). The image sets of 39 patients (18 females, 21 males) were rated by six experienced independent reviewers, blinded to the patient and image characteristics. The image pairs were randomly presented. Overall 85 % of the study cine images were rated as better or equal quality compared with the reference cine (95 % CI 0.81–0.90). The median dose area product per frame decreased from 55 to 26 mGy.cm²/frame (53 % reduction, p < 0.001).

Conclusion

This study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction.     

Performance of longitudinal and volumetric tube current modulation in a 64-slice CT with different choices of acquisition and reconstruction parameters

Aim of the study was to evaluate the performance of a tube current modulation (TCM) system (^SUREExposure 3D).On a 64 detector-row CT scanner (Aquilion 64, Toshiba), performance of fixed tube current, longitudinal TCM, and volumetric TCM acquisitions were assessed. A homogeneous cone-shaped phantom and an anthropomorphic phantom were used. Tube current and noise profiles were quantitatively analysed by box and whisker plots when phantom size, acquisition, and reconstruction parameters were varied.At similar median noise, fixed tube current scanning showed a noise range of 16.8–38.3 HU, while longitudinal TCM showed a range of 19.4–31.4 HU and volumetric TCM showed an even lower range of 20.7–28.7 HU. When acquisitions resulting in similar image quality (noise) were compared, the use of volumetric compared to longitudinal TCM resulted in a variable radiation dose reduction up to 6.6%.In conclusion, ^SUREExposure 3D resulted in more uniform image quality at a lower dose. Volumetric TCM shows improved results over longitudinal TCM.     

Comparison between integrated backscatter intravascular ultrasound and 64-slice multi-detector row computed tomography for tissue characterization and volumetric assessment of coronary plaques

ABSTRACT: BACKGROUND: The purpose of this study was to determine the cut-off values of Hounsfield units (HU) for the discrimination of plaque components and to evaluate the feasibility of measurement of the volume of plaque components using multi-detector row computed tomography (MDCT). Methods: Coronary lesions (125 lesions in 125 patients) were visualized by both integrated backscatter intravascular ultrasound (IB-IVUS) and 64-slice MDCT at the same site. The IB values were used as a gold standard to determine the cut off values of HU for the discrimination of plaque components. Results: Plaques were classified as lipid pool (n =50), fibrosis (n =65) or calcification (n =35) by IB-IVUS. The HU of lipid pool, fibrosis and calcification were 18 +/- 18 HU (-19 to 58 HU), 95 +/- 24 HU (46 to 154 HU) and 378 +/- 99 HU (188 to 605 HU), respectively. Using receiver operating characteristic curve analysis, a threshold of 50 HU was the optimal cutoff values to discriminate lipid pool from fibrosis. Lipid volume measured by MDCT was correlated with that measured by IB-IVUS (r =0.66, p <0.001), whereas fibrous volume was not (r =0.21, p =0.059). Conclusion: Lipid volume measured by MDCT was moderately correlated with that measured by IB-IVUS. MDCT may be useful for volumetric assessment of the lipid volume of coronary plaques, whereas the assessment of fibrosis volume was unstable.     

Impact of miscentering on patient dose and image noise in x-ray CT imaging: Phantom and clinical studies

The operation of the bowtie filter in x-ray CT is correct if the object being scanned is properly centered in the scanner’s field-of-view. Otherwise, the dose delivered to the patient and image noise will deviate from optimal setting. We investigate the effect of miscentering on image noise and surface dose on three commercial CT scanners. Six cylindrical phantoms with different size and material were scanned on each scanner. The phantoms were positioned at 0, 2, 4 and 6 cm below the isocenter of the scanner’s field-of-view. Regression models of surface dose and noise were produced as a function of miscentering magnitude and phantom’s size. 480 patients were assessed using the calculated regression models to estimate the influence of patient miscentering on image noise and patient surface dose in seven imaging centers. For the 64-slice CT scanner, the maximum increase of surface dose using the CTDI-32 phantom was 13.5%, 33.3% and 51.1% for miscenterings of 2, 4 and 6 cm, respectively. The analysis of patients’ scout scans showed miscentering of 2.2 cm in average below the isocenter. An average increase of 23% and 7% was observed for patient dose and image noise, respectively. The maximum variation in patient miscentering derived from the comparison of imaging centers using the same scanner was 1.6 cm. Patient miscentering may substantially increase surface dose and image noise. Therefore, technologists are strongly encouraged to pay greater attention to patient centering.     

Noise reduction and image quality improvement of low dose and ultra low dose brain perfusion CT by HYPR-LR processing

Purpose

To evaluate image quality and signal characteristics of brain perfusion CT (BPCT) obtained by low-dose (LD) and ultra-low-dose (ULD) protocols with and without post-processing by highly constrained back-projection (HYPR)–local reconstruction (LR) technique.

Methods and Materials

Simultaneous BPCTs were acquired in 8 patients on a dual-source-CT by applying LD (80 kV,200 mAs,14×1.2 mm) on tube A and ULD (80 kV,30 mAs,14×1.2 mm) on tube B. Image data from both tubes was reconstructed with identical parameters and post-processed using the HYPR-LR. Correlation coefficients between mean and maximum (MAX) attenuation values within corresponding ROIs, area under attenuation curve (AUC), and signal to noise ratio (SNR) of brain parenchyma were assessed. Subjective image quality was assessed on a 5-point scale by two blinded observers (1:excellent, 5:non-diagnostic).

Results

Radiation dose of ULD was more than six times lower compared to LD. SNR was improved by HYPR: ULD vs. ULD+HYPR: 1.9±0.3 vs. 8.4±1.7, LD vs. LD+HYPR: 5.0±0.7 vs. 13.4±2.4 (both p<0.0001). There was a good correlation between the original datasets and the HYPR-LR post-processed datasets: r = 0.848 for ULD and ULD+HYPR and r = 0.933 for LD and LD+HYPR (p<0.0001 for both). The mean values of the HYPR-LR post-processed ULD dataset correlated better with the standard LD dataset (r = 0.672) than unprocessed ULD (r = 0.542), but both correlations were significant (p<0.0001). There was no significant difference in AUC or MAX. Image quality was rated excellent (1.3) in LD+HYPR and non-diagnostic (5.0) in ULD. LD and ULD+HYPR images had moderate image quality (3.3 and 2.7).

Conclusion

SNR and image quality of ULD-BPCT can be improved to a level similar to LD-BPCT when using HYPR-LR without distorting attenuation measurements. This can be used to substantially reduce radiation dose. Alternatively, LD images can be improved by HYPR-LR to higher diagnostic quality.     

Pin-photodiode array for the measurement of fan-beam energy and air kerma distributions of X-ray CT scanners

PurposePatient dose estimation in X-ray computed tomography (CT) is generally performed by Monte Carlo simulation of photon interactions within anthropomorphic or cylindrical phantoms. An accurate Monte Carlo simulation requires an understanding of the effects of the bow-tie filter equipped in a CT scanner, i.e. the change of X-ray energy and air kerma along the fan-beam arc of the CT scanner. To measure the effective energy and air kerma distributions, we devised a pin-photodiode array utilizing eight channels of X-ray sensors arranged at regular intervals along the fan-beam arc of the CT scanner.MethodsEach X-ray sensor consisted of two plate type of pin silicon photodiodes in tandem – front and rear photodiodes – and of a lead collimator, which only allowed X-rays to impinge vertically to the silicon surface of the photodiodes. The effective energy of the X-rays was calculated from the ratio of the output voltages of the photodiodes and the dose was calculated from the output voltage of the front photodiode using the energy and dose calibration curves respectively.ResultsThe pin-photodiode array allowed the calculation of X-ray effective energies and relative doses, at eight points simultaneously along the fan-beam arc of a CT scanner during a single rotation of the scanner.ConclusionsThe fan-beam energy and air kerma distributions of CT scanners can be effectively measured using this pin-photodiode array.     

Effect of diagnostic cone-beam computed tomography protocols on image quality,patient dose,and lesion detection

ObjectiveTo evaluate the effect of cone-beam computed tomography (CBCT) image acquisition protocols on image quality, lesion detection, delineation, and patient dose.Methods100-patients and a CTDI phantom combined with an electron density phantom were examined using four different CBCT-image acquisition protocols during image-guided transarterial chemoembolization (TACE). Protocol-1 (time: 6 s, tube rotation: 360°), protocol-2 (5 s, 300°), protocol-3 (4 s, 240°) and protocol-4 (3 s, 180°) were used. The protocols were first investigated using a phantom. The protocols that were found to be clinically appropriate in terms of image quality and radiation dose were then assessed on patients. A higher radiation dose and/or a poor image quality were inappropriate for the patient imaging. Patient dose (patient-entrance dose and dose-area product), image quality (Hounsfield Unit, noise, signal-to-noise ratio and contrast-to-noise ratio), and lesion delineation (tumor-liver contrast) were assessed and compared using appropriate statistical tests. Lesion detectability, sensitivity, and predictive values were estimated for CBCT-image data using pre-treatment patient magnetic resonance imaging.ResultsThe estimated patient dose showed no statistical significance (p > 0.05) between protocols-2 and -3; the assessed image quality between these protocols manifested insignificant difference (p > 0.05). Two other phantom protocols were not considered for patient imaging due to significantly higher dose (protocols-1) and poor image quality (protocol-4). Lesion delineation and detection were insignificant (p > 0.05) between protocols-2 and -3. Lesion sensitivities generated were 81–89% (protocol-2) and 81–85% (protocol-3) for different lesion types.ConclusionData acquisition using protocols-2 and -3 provided good image quality, lesion detection and delineation with acceptable patient dose during CBCT-imaging mainly due to similar frame numbers acquired.     

64排螺旋CT下肢血管成像技术与DSA评估动脉狭窄的效果对比研究

目的探讨64排螺旋CTA评估下肢动脉狭窄闭塞性疾病的效果。方法对43例下肢动脉闭塞性疾病患者行64排螺旋CTA扫描,18例一周后行双下肢DSA检查,将每侧下肢血管分成8段,动脉狭窄程度分为：正常、轻度狭窄、中度狭窄、重度狭窄、闭塞5个级别。并以DSA为标准来评估。结果对18例患者双侧下肢共288段血管进行研究,CTA与DSA对血管狭窄程度显示一致的有275段,被CTA高估有ll段血管,低估有2段血管。结论64排螺旋CTA是下肢动脉狭窄硬化性疾病可靠的评估方法。     

64排螺旋CT三维透明化VR重建在内耳畸形诊断中的应用

目的:研究三维透明化VR重建在内耳畸形中的表现,为先天性内耳疾病提供准确的影像诊断和临床治疗信息.方法:回顾32耳内耳畸形的64排HRCT容积数据,行三维透明化重建处理,按内耳畸形分类总结三维透明化重建方法及影像表现.结果:32耳的三维透明化VR重建图像结合透明化MPR重组图像均能很好揭示内耳畸形病变部位及程度,其中VR图像可以直观、立体地显示畸形的空间形态结构,透明化MPR重组图像可很好显示病变细节.本组先天内耳发育畸形有以下几种:耳蜗未发育(2耳);共同腔畸形(4耳);不完全分隔Ⅰ型(2耳,两例患者对侧耳均为共同腔畸形);不完全分隔Ⅱ型(即Mondini型)(16耳,多合并前庭、半规管及前庭导水管畸形);单纯前庭-半规管畸形2耳;单纯前庭导水管扩大(6耳).结论:三维透明化个性重建能准确评价内耳先天性疾病的类型和程度,为临床治疗提供重要的参考依据.     

Effect of varying dose-per-pulse and average dose rate in X-ray beam irradiation on cultured cell survival

Characterizing the biological effects of flattening filter-free (FFF) X-ray beams from linear accelerators is of importance, due to their increasing clinical availability. The purpose of this work is to determine whether in vitro cell survival is affected by the higher dose-per-pulse present in FFF beams in comparison with flattened X-ray beams. A Varian TrueBeam^® linear accelerator was used to irradiate the T98G, V79-4 and U87-MG cell lines with a single fraction of 5 Gy or 10 Gy doses of X-rays. Beams with energies of 6 MegaVolt (MV), 6 MV FFF and 10 MV FFF were used, with doses-per-pulse as measured at the monitor chamber of 0.28, 0.78 and 1.31 mGy/pulse for 6 MV, 6 MV FFF and 10 MV FFF, respectively. The dose delivered to each Petri dish was verified by means of ionization chamber measurements. No statistically significant effects on survival fraction were observed for any of the cell lines considered, either as a function of dose-per-pulse, average dose rate or total dose delivered. Biological effects of higher instantaneous rates should not be excluded on the basis of in vitro experimental results such as the ones presented in this work. The next step toward an assessment of the biological impact of FFF beams will require in vivo studies.     

The relative hardening of roots and shoots and the influence of day-length during hardening in perennial ryegrass

The influence of long and short days during the hardening period on the cold hardiness of perennial ryegrass seedlings was studied as was the relative hardiness of roots and shoots. Hardiness was assessed by the electrolyte release method which was a measure of the amount of damage subsequent to low temperature treatment. Long days promoted hardiness in shoots of Pax 0tofte plants and in one case under short days the roots were found to be hardy. Generally roots were less hardy than shoots in Pax 0tofte and S23 plants hardened under long days for 2 wk. When hardened at the fourth leaf stage for 2 wk at + 5 ^oC under long day conditions, Pax 0tofte plants were more hardy than those of S23. The long day effect on hardiness was arrived at more rapidly, there being no difference in hardiness after 3 wk in Pax 0tofte hardened under long or short days, whereas a significant degree of hardening was observed after 1 wk of hardening under long days at – 4 ^oC. The results obtained are discussed in relation to winter kill of grasses in the West of Scotland, and it is considered that root damage is not an important factor in causing winter kill. The promotive effect of long days on hardiness when hardening commences in late autumn is considered an advantage in temperate regions as it may also allow early frosts to be withstood.     

A study on the correlation between plan complexity and gamma index analysis in patient specific quality assurance of volumetric modulated arc therapy

Aim

To evaluate the new Octavius 4D system for patient specific quality assurance and to study the correlation between plan complexity and gamma index analysis in patient specific quality assurance of VMAT using the Octavius 4D system.

Background

McNiven (2010) proposed a study to evaluate the utility of a complexity metric, the Modulation Complexity Score, to evaluate the relationship of the metric with deliverability in IMRT.

Materials and methods

Evaluation of the Octavius 4D system was carried out by gamma evaluation of user defined MLC created patterns and AAPM TG 119 benchmark plans. The relationship between plan complexity expressed as Modulation Complexity Score (MCS) and the gamma index analysis was established by a planar and volumetric gamma analysis of 106 clinically approved VMAT patient plans of different sites.

Results

Average volumetric 3D global gamma evaluation (3 mm/3%) results for the evaluation plans was 97.41% for 6 MV X-rays and 98.30% for 15 MV X-rays. Average MCS values for the head and neck, pelvic and thoracic plans were 0.2224, 0.3615 and 0.1874. Average volumetric 3D global gamma analysis (3 mm/3%) results for the head and neck, pelvic and thoracic VMAT plans were 95.45%, 97.51% and 96.98%, respectively. Out of 90 correlation analyses between the MCS and gamma passing rate, only 3 had the r value greater than 0.5.

Conclusions

The Octavius 4D system is a suitable device for patient specific pretreatment QA. Global and local gamma analysis results showed a weak correlation with the MCS.     

Critical influence of seasonal sampling on the ecological quality assessment of small headwater streams

Variability in the ecological quality assessment of reference sites was tested on small headwater streams in Ireland. Although headwater streams constitute a large portion of the river channel network, they are not routinely monitored for water quality. Various metrics were used including the Irish Q-value and the newly developed Small Streams Risk Score (SSRS), and metrics applied elsewhere in the Atlantic biogeographic region in Europe, including the Biological Monitoring Working Party score (BMWP), the Average Score per Taxon (ASPT), the Ephemeroptera, Plecoptera and Trichoptera taxa (EPT), the Belgium Biotic Index (BBI) and the Danish Stream Fauna Index (DSFI). The AQEM (version 2.5a) assessment software was used to apply some of these metrics. The spring and summer datasets are used to test the performance of biotic metrics with respect to season, and the applicability of their use to assess the ecological quality of wadeable streams. The quality status of most sites assigned by the various metrics was high using the spring invertebrate data, and an apparent considerable deviation in quality status occurred when the summer data was applied. Seasonal differences were noted using all the biotic indices and are attributed to the absence of pollution-sensitive groups in summer. Seasonal variability in the water quality status was particularly evident in acidic streams draining non-calcareous geologies with peaty soils that had relatively lower numbers of taxa. Some indices applied reflect a greater seasonal difference in the quality category assigned. The least amount of variability between seasons was obtained using the ASPT and the SSRS risk assessment system. Results suggest that reference status is reliably reflected in spring when more pollution-sensitive taxa were present, and that a new ecological quality assessment tool is required for application in summer when impacts may be most severe. This highly heterogeneous freshwater habitat seems to have too few taxa present in the summer to reliably determine the ecological quality of the stream using the available indices. Handling editor: R. Bailey     

Experimental low-level direct current therapy in liver metastases: influence of polarity and current dose

Several authors recently reported on the successful local treatment of malignant disease with low-level direct current therapy. However, antitumoral effects in colorectal metastases has not been investigated experimentally. The aim of the present study was to assess the effectiveness of this therapy and the influence of polarity and current dose. Colorectal metastases were established in BD IX rats by the injection of colon cancer cells under the liver capsule. After three weeks, the liver tumor volumes were determined by magnetic resonance imaging of the liver. Low-level direct current therapy was applied via five platinum electrodes. Four different applications were used: 60 C/cm(3), anode at the center; 60 C/cm(3), cathode at the center; 80 C/cm(3), anode at the center; and 80 C/cm(3), cathode at the center. In the control group, five electrodes were placed without applying any direct current. All animals were sacrificed on postoperative day 7. Liver metastases were histologically examined for vital tumor cells. Statistical analysis was performed with chi(2)-test. The mean initial tumor diameter before treatment was 3.6 +/- 1.4 mm (volume: 25.2 +/- 9.7 mm(3)). Histological examination of the removed livers revealed significant destruction of the metastases with localized necroses in all treatment groups; 37% had a complete response rate and 63% a partial response rate. There were no significant necroses in the control group (P < 0.0001). The best treatment results were obtained in the group with an anode at the center and a current dose of 80 C/cm(3). Direct current therapy offers a new and safe method for the local treatment of liver metastases. We were able to observe that tumor damage is related to current dose but not to the polarity of the central electrode.