Stress Triggers Expression of Bovine Herpesvirus 1 Infected Cell Protein 4 (bICP4) RNA during Early Stages of Reactivation from Latency in Pharyngeal Tonsil

Bovine herpesvirus 1 (BoHV-1), an important pathogen of cattle, establishes lifelong latency in sensory neurons within trigeminal ganglia (TG) after acute infection. The BoHV-1 latency-reactivation cycle, like other alphaherpesvirinae subfamily members, is essential for viral persistence and transmission. Notably, cells within pharyngeal tonsil (PT) also support a quiescent or latent BoHV-1 infection. The synthetic corticosteroid dexamethasone, which mimics the effects of stress, consistently induces BoHV-1 reactivation from latency allowing early stages of viral reactivation to be examined in the natural host. Based on previous studies, we hypothesized that stress-induced cellular factors trigger expression of key viral transcriptional regulatory genes. To explore this hypothesis, RNA-sequencing studies compared viral gene expression in PT during early stages of dexamethasone-induced reactivation from latency. Strikingly, RNA encoding infected cell protein 4 (bICP4), which is translated into an essential viral transcriptional regulatory protein, was detected 30 min after dexamethasone treatment. Ninety minutes after dexamethasone treatment bICP4 and, to a lesser extent, bICP0 RNA were detected in PT. All lytic cycle viral transcripts were detected within 3 h after dexamethasone treatment. Surprisingly, the latency related (LR) gene, the only viral gene abundantly expressed in latently infected TG neurons, was not detected in PT during latency. In TG neurons, bICP0 and the viral tegument protein VP16 are expressed before bICP4 during reactivation, suggesting distinct viral regulatory genes mediate reactivation from latency in PT versus TG neurons. Finally, these studies confirm PT is a biologically relevant site for BoHV-1 latency, reactivation from latency, and virus transmission. IMPORTANCE BoHV-1, a neurotropic herpesvirus, establishes, maintains, and reactivates from latency in neurons. BoHV-1 DNA is also detected in pharyngeal tonsil (PT) from latently infected calves. RNA-sequencing studies revealed the viral infected cell protein 4 (bICP4) RNA was expressed in PT of latently infected calves within 30 min after dexamethasone was used to initiate reactivation. As expected, bICP4 RNA was not detected during latency. All lytic cycle viral genes were expressed within 3 h after dexamethasone treatment. Conversely, bICP0 and the viral tegument protein VP16 are expressed prior to bICP4 in trigeminal ganglionic neurons during reactivation. The viral latency related gene, which is abundantly expressed in latently infected neurons, was not abundantly expressed in PT during latency. These studies provide new evidence PT is a biologically relevant site for BoHV-1 latency and reactivation. Finally, we predict other alphaherpesvirinae subfamily members utilize PT as a site for latency and reactivation.

P-glycoprotein inhibition with verapamil overcomes mometasone resistance in Chronic Sinusitis with Nasal Polyps

BACKGROUND

P-glycoprotein (P-gp) is a membrane efflux pump which is overexpressed in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and promotes Type 2 inflammation. Glucocorticoids (GC) are substrates of P-gp suggesting that overexpression may additionally contribute to GC resistance in CRSwNP. This study aims to determine whether P-gp inhibition using verapamil enhances mometasone retention and efficacy in nasal polyp explants.

METHODOLOGY

IRB approved study in which organotypic polyp explants were exposed to mometasone (4.15 μg/mL) and verapa- mil (125 μg/mL) as mono and combination therapy. The effect of verapamil on mometasone tissue retention over time was deter- mined using HPLC. The effect of verapamil on mometasone anti-inflammatory function was determined using ELISA for secreted IL-5. Groups were compared using Kruskal-Wallis test.

RESULTS

P-gp expression strongly and significantly inversely correlated with mometasone retention 1hr after exposure, with a ne- arly 6-fold reduction in tissue retention between the lowest and highest P-gp expressing polyp explants. P-gp inhibition reversed this effect and significantly improved mometasone retention at 1hr relative to mometasone alone. The combination of mome- tasone and verapamil significantly reduced IL-5 secretion relative to vehicle control and outperformed either treatment alone.

CONCLUSIONS

Our study confirms that P-gp contributes to mometasone resistance. This P-gp mediated resistance was successfully reversed by addition of the P-gp inhibitor verapamil. Verapamil further significantly enhanced the anti-inflammatory effect of mometasone when given as a combination therapy.

The Wnt Signaling Pathway Is Differentially Expressed during the Bovine Herpesvirus 1 Latency-Reactivation Cycle: Evidence That Two Protein Kinases Associated with Neuronal Survival, Akt3 and BMPR2, Are Expressed at Higher Levels during Latency

Sensory neurons in trigeminal ganglia (TG) of calves latently infected with bovine herpesvirus 1 (BoHV-1) abundantly express latency-related (LR) gene products, including a protein (ORF2) and two micro-RNAs. Recent studies in mouse neuroblastoma cells (Neuro-2A) demonstrated ORF2 interacts with β-catenin and a β-catenin coactivator, high-mobility group AT-hook 1 (HMGA1) protein, which correlates with increased β-catenin-dependent transcription and cell survival. β-Catenin and HMGA1 are readily detected in a subset of latently infected TG neurons but not TG neurons from uninfected calves or reactivation from latency. Consequently, we hypothesized that the Wnt/β-catenin signaling pathway is differentially expressed during the latency and reactivation cycle and an active Wnt pathway promotes latency. RNA-sequencing studies revealed that 102 genes associated with the Wnt/β-catenin signaling pathway were differentially expressed in TG during the latency-reactivation cycle in calves. Wnt agonists were generally expressed at higher levels during latency, but these levels decreased during dexamethasone-induced reactivation. The Wnt agonist bone morphogenetic protein receptor 2 (BMPR2) was intriguing because it encodes a serine/threonine receptor kinase that promotes neuronal differentiation and inhibits cell death. Another differentially expressed gene encodes a protein kinase (Akt3), which is significant because Akt activity enhances cell survival and is linked to herpes simplex virus 1 latency and neuronal survival. Additional studies demonstrated ORF2 increased Akt3 steady-state protein levels and interacted with Akt3 in transfected Neuro-2A cells, which correlated with Akt3 activation. Conversely, expression of Wnt antagonists increased during reactivation from latency. Collectively, these studies suggest Wnt signaling cooperates with LR gene products, in particular ORF2, to promote latency.IMPORTANCE Lifelong BoHV-1 latency primarily occurs in sensory neurons. The synthetic corticosteroid dexamethasone consistently induces reactivation from latency in calves. RNA sequencing studies revealed 102 genes associated with the Wnt/β-catenin signaling pathway are differentially regulated during the latency-reactivation cycle. Two protein kinases associated with the Wnt pathway, Akt3 and BMPR2, were expressed at higher levels during latency but were repressed during reactivation. Furthermore, five genes encoding soluble Wnt antagonists and β-catenin-dependent transcription inhibitors were induced during reactivation from latency. These findings are important because Wnt, BMPR2, and Akt3 promote neurogenesis and cell survival, processes crucial for lifelong viral latency. In transfected neuroblastoma cells, a viral protein expressed during latency (ORF2) interacts with and enhances Akt3 protein kinase activity. These findings provide insight into how cellular factors associated with the Wnt signaling pathway cooperate with LR gene products to regulate the BoHV-1 latency-reactivation cycle.

Development of a broadly protective modified-live virus vaccine candidate against porcine reproductive and respiratory syndrome virus

Modified-live virus (MLV) vaccines are widely used to protect pigs against porcine reproductive and respiratory syndrome virus (PRRSV). However, current MLV vaccines do not confer adequate levels of heterologous protection, presumably due to the substantial genetic diversity of PRRSV isolates circulating in the field. To overcome this genetic variation challenge, we recently generated a synthetic PRRSV strain containing a consensus genomic sequence of PRRSV-2. We demonstrated that our synthetic PRRSV strain confers unprecedented levels of heterologous protection. However, the synthetic PRRSV strain at passage 1 (hereafter designated CON-P1) is highly virulent and therefore, is not suitable to be used as a vaccine in pigs. In the present study, we attenuated CON-P1 by continuously passaging the virus in MARC-145 cells, a non-natural host cell line. Using a young pig model, we demonstrated that the synthetic virus at passages 90 and 122 (designated as CON-P90 and CON-P122, respectively) were fully attenuated, as evidenced by the significantly reduced viral loads in serum and tissues and the absence of lung lesion in the infected pigs. Most importantly, CON-P90 confers similar levels of heterologous protection as its parental strain CON-P1. Taken together, the results indicate that CON-P90 is an excellent candidate for the formulation of next generation of PRRSV MLV vaccines with improved levels of heterologous protection.

Genetic subgroup of small ruminant lentiviruses that infects sheep homozygous for TMEM154 frameshift deletion mutation A4Δ53

Small ruminant lentivirus (SRLV) infections of sheep are influenced by genetics on both the host and pathogen sides. Genetic variation in the ovine transmembrane 154 (TMEM154) gene associates with infection susceptibility, and distinct SRLV genetic subgroups infect sheep in association with their TMEM154 diplotypes. In this study, a novel SRLV subgroup was identified that naturally infected sheep with various TMEM154 diplotypes, including those homozygous for a rare frameshift mutation (A4 delta53), which is predicted to abolish TMEM154 protein function. Thus, these SRLVs may infect sheep that lack functional TMEM154, and may not be restricted by TMEM154 diplotypes in establishing infections.

Inflammation regulates the differentiation of CD4 T cells with cytolytic potential (P6088)

Cytolytic CD4 T cells have been described during viral infections; however, the factors necessary for driving the cytolytic phenotype have not been identified. Our data indicate IL-2 regulates granzyme B (GrB) expression in CD4 T cells but IL-12 and IL-6 enhance GrB expression and promote perforin-mediated cytotoxicity in CD4 effectors. To further dissect the role of inflammation in CD4 CTL generation in vivo, we used an adoptive transfer system and infection with highly pathogenic influenza virus PR8, compared to x31 with lower pathogenicity. At relatively low doses (1000 EID50), Ova specific CD4 cells expressing GrB differentiated in PR8/Ova infected mice but not x31/Ova infected mice. This pattern was observed at 10-fold higher dose of x31/Ova compared to PR8/Ova. In addition, CD4 T cell influx to the lung and IFN-γ expression was increased in mice infected with PR8/Ova compared to x31/Ova. Importantly, these differences were seen in the endogenous, polyclonal population of CD4 T cells. Inflammatory mediators including IL-6, CXCL-9, CXCL-10 and MIP1β were 3-5 fold higher in PR8/Ova infected lungs at day 4 post infection compared to x31/Ova infected lungs. Whether these inflammatory cytokines are responsible for inducing CD4 CTL is being investigated. These data suggest that CD4 CTL are induced in vivo by strong inflammatory responses and may provide an extra layer of protection against highly pathogenic IAV infection.

CD25 signaling via STAT5 is necessary for development of cytolytic CD4 T cells (163.13)

Cytolytic CD4 cells have been identified in vivo during viral infections; however, the factors necessary for driving the cytolytic phenotype have not been characterized. Previously, we found that IL-2 is necessary and sufficient to drive the in vitro differentiation of naïve CD4 cells into cytolytic effectors. To further dissect the role of IL-2 in CD4 CTL generation, TCR transgenic mice deficient in IL-2 production or IL-2Rα (CD25) were used. In vitro, CD25 deficient cells do not express granzyme B (GrB) or acquire cytolytic activity when cultured in the presence of IL-2. In contrast, CD25+/- cells exhibit half maximal expression of GrB and reduced cytotoxicity when compared to WT cells. In vitro, IL-2 activates STAT5 phosphorylation, peaking at 18-24 h, correlating with GrB expression and cytotoxicity by 72-96 h. Inhibition of the JAK3/STAT5 pathway resulted in a dose dependent reduction of GrB expression. Surprisingly, other common γc cytokines such as IL-7 and IL-15 induce STAT5 phosphorylation but do not induce cytotoxicity, most likely due to the timing of STAT5 activation. Studies determining whether STAT5 activation synergizes with other signaling pathways to induce optimal CTL activity are underway. Further, the role of CD25 signaling in the induction of cytolytic activity in vivo during influenza infection will be discussed. These data have implications in the design of vaccines and in adoptive immunotherapy against certain tumors.

Analysis of the cell cycle regulatory protein (E2F1) after infection of cultured cells with bovine herpesvirus 1 (BHV-1) or herpes simplex virus type 1 (HSV-1)

The E2F family of cellular transcription factors controls cell cycle progression and cell death. During cell cycle progression, activated cyclin-dependent kinases phosphorylate the retinoblastoma (Rb) protein, causing the release and activation of E2F family members. Previous studies demonstrated that bovine herpes virus 1 (BHV-1) productive infection increases E2F1 protein levels, the bICP0 early promoter is activated more than 100 fold by E2F1 or E2F2, and silencing E2F1 reduced the efficiency of productive infection. In this study, the effect of herpes simplex virus type 1 (HSV-1) productive infection on E2F protein levels and regulation of E2F dependent transcription was compared to BHV-1 infection in the same permissive cell line, rabbit skin (RS) cells. Silencing E2F1 with a specific siRNA reduced HSV-1 productive infection approximately 10 fold in RS cells, and total E2F1 protein levels increased during productive infection. In contrast to RS cells infected with BHV-1, a fraction of total E2F1 protein was localized to the cytoplasm in HSV-1 infected RS cells. Furthermore, E2F1 did not efficiently trans-activate the HSV-1 ICP0 or ICP4 promoter. When RS cells were transfected with an E2F reporter construct or the cyclin D1 promoter and then infected with BHV-1, promoter activity increased after infection. In contrast, HSV-1 infection of RS cells had little effect on E2F dependent transcription and cyclin D1 promoter activity was reduced. In summary, these studies indicated that silencing E2F1 reduced the efficiency of HSV-1 and BHV-1 productive infection. However, only BHV-1 productive infection induced E2F dependent transcription.

A protein (ORF2) encoded by the latency-related gene of bovine herpesvirus 1 interacts with Notch1 and Notch3

Like other Alphaherpesvirinae subfamily members, bovine herpesvirus 1 (BHV-1) establishes latency in sensory neurons. The latency-related RNA (LR-RNA) is abundantly expressed in latently infected sensory neurons. An LR mutant virus with stop codons at the amino terminus of the first open reading frame (ORF) in the LR gene (ORF2) does not reactivate from latency, in part because it induces higher levels of apoptosis in infected neurons. ORF2 is not the only viral product expressed during latency, but it is important for the latency reactivation cycle because it inhibits apoptosis. In this study, a yeast 2-hybrid screen revealed that ORF2 interacted with two cellular transcription factors, Notch1 and Notch3. These interactions were confirmed in mouse neuroblastoma cells by confocal microscopy and in an in vitro "pulldown" assay. During reactivation from latency, Notch3 RNA levels in trigeminal ganglia were higher than those during latency, suggesting that Notch family members promote reactivation from latency or that reactivation promotes Notch expression. A plasmid expressing the Notch1 intercellular domain (ICD) stimulated productive infection and promoters that encode the viral transcription factor bICP0. The Notch3 ICD did not stimulate productive infection as efficiently as the Notch1 ICD and had no effect on bICP0 promoter activity. Plasmids expressing the Notch1 ICD or the Notch3 ICD trans-activated a late promoter encoding glycoprotein C. ORF2 reduced the trans-activation potential of Notch1 and Notch3, suggesting that ORF2 interfered with the trans-activation potential of Notch. These studies provide evidence that ORF2, in addition to inhibiting apoptosis, has the potential to promote establishment and maintenance of latency by sequestering cellular transcription factors.

Productive infection and bICP0 early promoter activity of bovine herpesvirus 1 are stimulated by E2F1

Bovine herpesvirus 1 (BoHV-1) is an important viral pathogen of cattle. Like other members of the subfamily Alphaherpesvirinae, BoHV-1 establishes latency in sensory neurons and has the potential to reactivate from latency. Dexamethasone (DEX) treatment of latently infected calves or rabbits consistently leads to reactivation from latency. The BoHV-1 transcript encoding the infected cell protein 0 (bICP0) is consistently detected during reactivation from latency, in part because the bICP0 early promoter is activated by DEX. During DEX-induced reactivation from latency, cyclin expression is stimulated in infected sensory neurons. Cyclin-dependent kinase activity phosphorylates Rb (retinoblastoma tumor suppressor gene product) family proteins and consequently releases the E2F family of transcription factors, suggesting that E2F family members stimulate productive infection and/or reactivation from latency. In this study, we provide evidence that repression of E2F1 by a specific small interfering RNA (siRNA) reduced productive infection approximately 5-fold. E2F1 or E2F2 stimulated bICP0 early promoter activity at least 100-fold in transient transfection assays. Two E2F-responsive regions (ERR) were identified within the early promoter, with one adjacent to the TATA box (ERR1) and one approximately 600 bp upstream from the TATA box (ERR2). Mobility shift assays suggested that E2F interacts with ERR1 and ERR2. E2F1 protein levels were increased at late times after infection, which correlated with enhanced binding to a consensus E2F binding site, ERR1, or ERR2. Collectively, these studies suggest that E2F1 stimulates productive infection and bICP0 early promoter activity, in part because E2F family members interact with ERR1 and ERR2.

Small noncoding RNAs encoded within the bovine herpesvirus 1 latency-related gene can reduce steady-state levels of infected cell protein 0 (bICP0)

Following acute infection in mucosal epithelium, bovine herpes virus 1 (BHV-1) establishes lifelong latency in sensory neurons within trigeminal ganglia. The latency-related RNA (LR-RNA) is abundantly expressed in sensory neurons of latently infected calves. Expression of LR proteins is necessary for the latency reactivation cycle because a mutant virus that does not express LR proteins is unable to reactivate from latency after dexamethasone treatment. LR-RNA sequences also inhibit bICP0 expression, productive infection, and cell growth. However, it is unclear how LR-RNA mediates these functions. In this study, we identified a 463-bp region within the LR gene (the XbaI-PstI [XP] fragment) that inhibited bICP0 protein and RNA expression in transiently transfected mouse neuroblastoma cells. Small noncoding RNAs (sncRNAs) encoded within the XP fragment (20 to 90 nucleotides in length) were detected in transiently transfected mouse neuroblastoma cells. Two families of sncRNAs were cloned from this region, and each family was predicted to contain a mature microRNA (miRNA). Both miRNAs were predicted to base pair with bICP0 mRNA sequences, suggesting that they reduce bICP0 levels. To test this prediction, sequences encompassing the respective sncRNAs and mature miRNAs were synthesized and cloned into a small interfering RNA expression vector. Both sncRNA families and their respective miRNAs inhibited bICP0 protein expression in mouse neuroblastoma cells and productive infection in bovine cells. In trigeminal ganglia of latently infected calves, an sncRNA that migrated between nucleotides 20 and 25 hybridized to the XP fragment. During dexamethasone-induced reactivation from latency, XP-specific sncRNA levels were reduced, suggesting that these sncRNAs support the establishment and maintenance of lifelong latency in cattle.

Efficacy of a combination viral vaccine for protection of cattle against experimental infection with field isolates of bovine herpesvirus-1

OBJECTIVE

To determine whether a combination viral vaccine containing a modified-live bovine herpesvirus-1 (BHV-1) would protect calves from infection with virulent field strains of BHV-1 for weeks or months after vaccination.

DESIGN

Randomized controlled trial, performed in 2 replicates.

ANIMALS

63 weaned 4- to 6-month-old crossbred beef calves seronegative for antibody against BHV-1.

PROCEDURES

Calves were randomly allocated to 1 of 2 treatment groups. Control calves (n = 10/replicate) received a combination modified-live mixed viral vaccine without BHV-1, and treatment calves (20 and 23/replicate) received a combination modified-live mixed viral vaccine containing BHV-1. Each group was challenged via aerosol with 1 of 2 field strains of BHV-1, 30 days after vaccination in replicate 1 and 97 days after vaccination in replicate 2. After challenge, calves were commingled in 1 drylot pen. Clinical signs, immune responses, and nasal shedding of virus were monitored for 10 days after challenge, after which the calves were euthanatized and tracheal lesions were assessed.

RESULTS

Vaccination stimulated production of BHV-1-specific IgG antibody that cross-neutralized several field and laboratory strains of BHV-1. Challenge with both field strains of BHV-1 resulted in moderate to severe respiratory tract disease in control calves. Treatment calves had significantly fewer signs of clinical disease, shed less BHV-1, had less or no weight loss after challenge, and had fewer tracheal lesions than control calves for at least 97 days after vaccination.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of the combination modified-live BHV-1 vaccine yielded significant disease-sparing effects in calves experimentally infected with virulent field strains of BHV-1.

Patient dose from 3D rotational neurovascular studies

The use of image-guided interventional radiological techniques is increasing in prevalence and complexity. Imaging system developments have helped improve the information available to interventionalists to plan and guide procedures. Information on doses to patients resulting from alternative imaging techniques or protocols is useful for both the process of justifying particular procedures and in optimizing the resultant exposures. Such information is not always available, especially for new or developing imaging techniques. We have undertaken a study of doses to patients associated with two alternative imaging methods for pre-intervention assessment of intracranial aneurysms. In the first technique the aneurysm is assessed from a series of digital subtraction angiography (DSA) runs taken at different imaging projections. The second technique involved acquiring images from one single image run while the imaging system rotated 180 degrees around the patient's head. In this technique, the aneurysm was then evaluated from a 3D reconstruction of the projection images. Effective doses were calculated using a computer model to simulate the exposure geometry and parameters. The mean dose from the DSA protocol used at our centre was 3.4 mSv and from the 3D rotational angiography (RA) technique was 0.20 mSv.

Assessment of distortion in a three-dimensional rotational angiography system

The purpose of this project was to determine the degree of geometrical distortion in a three-dimensional (3D) image volume generated by a digital fluorography system with rotational image acquisition capabilities. 3D imaging is a valuable adjunct in neuroangiography for visualization and measurement of cerebral aneurysms and for determination of the optimum projection for intervention. To enable spatially accurate 3D reconstruction the system must correct for geometrical distortion in the image intensifier television system as well as for deviations in gantry motion. 3D volumes were reconstructed from 100 X-ray projections acquired over a 180 degrees arc over a period of 8 s. A phantom was constructed to assess geometrical distortion in the three dimensions. The phantom consisted of 1 mm diameter ball bearings embedded in Perspex in a cubic lattice configuration. The ball bearings were placed at 20 mm intervals over a 140 mm cubic volume. Distortion was assessed by taking measurements between points of known separation and using a differential distortion measurement. The maximum error in the 3D location of objects was found to be 1.4 mm, while the differential distortion was found to range from -1.0% to +2.3%. The 3D images were found to have negligible visual distortion, enabling subjective assessments to be made with confidence to aid intervention.

A comparison of the imaging properties of CCD-based devices used for small field digital mammography

The objective imaging characteristics of three systems that use charge coupled devices (CCD) for small-field digital mammography (SFDM) have been compared in terms of spatial resolution and signal to noise ratio. The results indicate that although they are designed for nominally the same tasks of stereotactic localization and spot imaging these detectors have significantly differing physical imaging properties. Imaging system design parameters such as the phosphor screen type and thickness, screen configuration and method of optically coupling the phosphor to the CCD have significant effects on the imaging performance of the detectors.

Radiation doses to patients during ERCP

BACKGROUND

There is a scarcity of data regarding the radiation dose and associated risks to patients during ERCP. Dose area product (DAP) measurements can be used to estimate an effective dose (ED) to patients undergoing ERCP. This measure allows radiation risk associated with such procedures to be quantified. The aim of this study was to evaluate the ED to patients undergoing ERCP.

METHODS

A DAP meter was fitted to the x-ray tube before each ERCP. DAP reading (Gy-cm(2)), fluoroscopy time, average screening kVp, number of films, and kVp per film were recorded. Mean ED was estimated by using DAP readings and Monte Carlo computer software to model radiation exposure conditions.

RESULTS

Data were recorded on 20 subjects. Average DAP was 13.5 Gy-cm(2) (6.8-23.9) for diagnostic and 66.8 Gy-cm(2) (28.7-108.5) for therapeutic ERCP (p < 0.05). Average fluoroscopy time was 2.3 minutes (1.1-5.3) for diagnostic and 10.5 minutes (5.9-16.6) for therapeutic ERCP (p < 0.05). DAP showed a linear relationship with fluoroscopy time (R(2) = 0.928). Mean number of diagnostic and therapeutic films was 2.8 and 3.7, respectively. Fluoroscopic exposure represented 69% of the DAP for diagnostic ERCP and 90% of the DAP for therapeutic ERCP. Average ED was 3.1 mSv for diagnostic and 12.4 mSv for therapeutic ERCP.

CONCLUSIONS

Therapeutic ERCP is associated with significantly higher radiation exposure than diagnostic ERCP. ED in therapeutic ERCP is a result largely of fluoroscopy time as opposed to number of films.

Application of draft European Commission reference levels to a regional CT dose survey

A survey of CT doses in Northern Ireland in the period between October 1995 and March 1997 was carried out. The survey included all but one of the 10 scanners in use at the time, and, additionally, two others that were replacement machines. The method used was to study standard protocols and calculate doses to the NRPB mathematical phantom, so that a direct comparison could be made with other surveys carried out in a similar fashion elsewhere. The survey addressed the patient radiation dose but not image quality or clinical outcomes. It is estimated that in Northern Ireland the contribution to collective dose to the population from CT is about 40% of that from all medical X-rays. The proposed European Commission reference quantities, weighted CT dose index and dose-length product were computed and their potential use evaluated. A full study of mean values of effective dose per examination revealed the average dose per examination was not significantly different from that found in the 1989 UK survey, although several procedures gave rise to doses that were high enough to be investigated with a view to justification or reduction. One of the scanners was found to give consistently high doses. It is likely that a revision of the mAs values used on this scanner will produce a significant reduction in patient doses without compromising image quality. When compared with the draft EC reference levels, fewer procedures were found to have excessively high dose values. The proposed EC reference levels would therefore be useful for continual monitoring of CT dose status, but do not appear to provide as comprehensive an assessment of patient exposure as that given by consideration of effective doses.

Protocol for measurement of patient entrance surface dose rates for fluoroscopic X-ray equipment

While patient entrance surface dose rate is an important indicator of dose performance for fluoroscopic units, there has been no standardized approach to measuring this. Since results are strongly dependent on the type of phantom used and the relative positions of the X-ray tube, intensifier and phantom, comparisons of the performance for different units are difficult to make. This document sets out a protocol for making these measurements using a standard phantom and standard configurations for different types of X-ray unit Values of dose rates which might be expected are given.

Radiation doses to patients during pharyngeal videofluoroscopy

Pharyngeal videofluoroscopy (VTF) is a well-recognized technique for investigating and assessing swallowing disorders. There is, however, a paucity of data available regarding the radiation dose to patients during such procedures, but there is general concern that fluorographic imaging modalities are associated with significant radiation exposure. We have recorded the dose received by 23 patients undergoing VTF in our department using a Dose-Area Product (DAP) Meter and have used the data to calculate the effective dose to the patients. The mean effective dose is 0.4 mSv (range 0.027-1.1) which compares favorably with the effective doses associated with other common radiological procedures. We therefore conclude that the radiation detriment associated with pharyngeal VTF is well within acceptable levels.

Physical performance measures of radiographic imaging systems

New systems and technologies for dental radiographic imaging are being introduced at an increasing rate. Established methods of physical measurement allow the imaging performance of these systems to be quantified. These quantitative measures are important when comparing the imaging performance of competing systems. This review presents an overview of the main concepts in the assessment of the physical performance of imaging systems including signal transfer, as described by both the characteristic curve and modulation transfer function (MTF), and image noise, as described by the Noise Power Spectra. These measures can be combined to produce signal-to-noise ratio descriptors such as Noise Equivalent Quanta and Detective Quantum Efficiency which give an overall description of imaging system performance. Subjective means of measuring image quality, which naturally include the performance of the image display system and the observer, are also considered as a gauge of system performance.

The imaging performance of a storage phosphor system for dental radiography

Direct digital imaging systems are becoming increasingly common in dental radiography. The majority of these systems are based on charge coupled device (CCD) technology. A relatively new system, based on photo-stimulable phosphor luminescence (PSPL), is now commercially available. This system appears to overcome some of the restrictions of CCD systems including those associated with the bulky detector, connecting wire, limited image size and limited exposure latitude. A physical evaluation of the PSPL system was conducted including measurements of sensitometric response, modulation transfer function (MTF), noise power spectrum (NPS), noise equivalent quanta (NEQ) and detective quantum efficiency (DQE). These measurements were compared with results obtained previously for Kodak Ektaspeed (E-speed) film. The results of the evaluation indicate that the PSPL system may be capable of operating at exposures up to 80% lower than for film with comparable image quality.

Improved image quality utilizing dual plate computed radiography

A method of improving image quality in computed radiography (CR) using dual plate exposure has been developed. Two CR image plates are used to increase the fraction of X-ray quanta absorbed from the beam. Spatial registration and combination of images from the two plates leads to an image with improved signal-to-noise ratio characteristics. A cross correlation technique is used to register spatially the images from the front and rear plates. The modulation transfer function and noise power spectrum were measured for the single plate and combined dual plate images. Results indicate a potential increase of approximately 60% in the detective quantum efficiency (DQE) of the dual plate combined image compared with the single plate image. The improvement of DQE at high spatial frequencies is dependent on the accuracy of the registration of the two images. The actual improvement in imaging performance was measured using a contrast detail test piece. A computerized method was used to measure the imaged detail signal-to-noise ratio of the details of different dimension. Results indicate an improvement of 21% in the signal-to-noise ratio of the details imaged with the dual plate arrangement compared with the single plate. This indicates that this technique can result in a significant increase in image quality for the same exposure level. Alternatively this technique could allow reduction in exposure while maintaining the same image quality achievable with the single plate system.

Update on the recommended viewing protocol for FAXIL threshold contrast detail detectability test objects used in television fluoroscopy

The significance of varying the viewing conditions that may affect the perceived threshold contrast of X-ray television fluoroscopy systems has been investigated. Factors investigated include the ambient room lighting and the viewing distance. The purpose of this study is to find the optimum viewing protocol with which to measure the threshold detection index. This is a particular problem when trying to compare the image quality of television fluoroscopy systems in different input field sizes. The results show that the viewing distance makes a significant difference to the perceived threshold contrast, whereas the ambient light conditions make no significant difference. Experienced observers were found to be capable of finding the optimum viewing distance for detecting details of each size, in effect using a flexible viewing distance. This allows the results from different field sizes to be normalized to account for both the magnification and the entrance air kerma rate differences, which in turn allow for a direct comparison of performance in different field sizes.

Physical evaluation of computed radiography as a mammographic X-ray imaging system

The physical imaging properties of a computed radiography (CR) system operating under mammographic exposure conditions have been measured. These measurements include modulation transfer function (MTF), sensitometric response and noise power spectrum (NPS). These figures were used to derive signal-to-noise ratio (SNR) descriptors of the system performance. The same measures were derived for a mammographic film-screen system. The SNR properties of the CR system indicate superior low frequency performance over a wider dynamic range than the film-screen system. The spatial frequency dependent SNR properties of the CR system are, however, limited. The results of a psychophysical test support the results obtained from physical measurements. These results indicate that despite its limited sharpness, details of dimensions relevant to diagnosis in mammography (circular details 0.25 mm diameter to represent microcalcifications and 3 mm diameter to represent small masses) are reproduced using CR with SNRs which are at least comparable with those of a mammographic film-screen system.

Physical aspects of photostimulable phosphor computed radiography

Currently photostimulable phosphor computed radiography (PPCR) promises to be the digital X-ray image acquisition technology of choice for classical radiography (i.e. X-ray examinations of natural anatomy). For the last two years we have been carrying out a physical evaluation of modern PPCR technology and some of our findings relevant to general radiographic applications are reviewed here. Topics covered include the function of the auto-reader system and the reliability of image reproduction, the radiation exposure requirement and physical image quality. The latter is based upon both objective and subjective measures of image quality. These studies have yielded a favourable comparison of the image quality of modern PPCR technology with that of medium-speed and fast radiographic screen-film combinations. The major advantages of PPCR appear to be the maintenance of high imaging efficiency (DQE) over a much wider range of signal levels than film and consistent image acquisition and presentation independent of exposure level. In general radiographic applications no major limitations due to the comparatively modest limiting spatial resolution of PPCR [maximum limiting resolution = 5 line-pair mm-1] have been experienced. Digital image enhancement is a central element of PPCR image reproduction. The authors believe that advances in image enhancement algorithms remain a potential area for further improving the presented quality of PPCR images.

The computer enhancement of digital grey-scale fluorography images

In this article we describe the results of a preliminary investigation of computerized processing of digital grey-scale fluorography (DGF) images. Image processing techniques used include dynamic range equalization, adaptive contour enhancement and non-linear transformation of grey-scale data. Original and processed images derived from non-subtractive digital angiography and digital spot-film investigations are used to illustrate our findings. The quality of the processed images confirms the promise of digital image processing in DGF.

A set of X-ray test objects for image quality control in digital subtraction fluorography. II: Application and interpretation of results

In the previous article we introduced a set of test objects for quality control of digital subtraction fluorography (DSF) systems. These test objects have been evaluated using several commercial DSF systems in their clinical environment. In this second article we present test images and results obtained during these trails and explain how the test objects can be used to analyse the imaging performance of DSF systems.

A set of X-ray test objects for image quality control in digital subtraction fluorography. I: Design considerations

A set of X-ray test objects has been developed for quality control in digital subtraction fluorography (DSF). Factors which can be assessed include dynamic range, highlight overload and signal-to-noise ratio, low contrast sensitivity, unsharpness, and systematic misregistration. These test objects complement, both in design and calibration, those previously developed to evaluate the imaging performance of television fluoroscopy and small-format fluorography systems. In this article, the first of two, we describe the Leeds DSF test objects, paying particular attention to the reasoning behind their design.