Secured computed tomography scanner using a random bit

BACKGROUND

Patient data in current computed tomography scanner machines are transferred through several communication channels, such as WiFi, to the mobile channel platform. Therefore, patient information is an important security concern. Medical imaging must be protected using various methods.

OBJECTIVE

The current hardware-dependent method for generating random bits exhibits predictable or inconvenient physical characteristics. Therefore, a more flexible random-bit generation technique is to be devised.

METHODS

We propose a deterministic random bit generation algorithm that uses a mathematical periodic function.

RESULTS

After randomizing the image using the proposed random bit, the performance is analyzed and compared with that of the processed image.

CONCLUSION

The random bit generation method using a mathematical algorithm shows higher entropy than the random bit generated by hardware.

Decoders configurations based on Unet family and feature pyramid network for COVID-19 segmentation on CT images

Coronavirus Disease 2019 (COVID-19) pandemic has been ferociously destroying global health and economics. According to World Health Organisation (WHO), until May 2021, more than one hundred million infected cases and 3.2 million deaths have been reported in over 200 countries. Unfortunately, the numbers are still on the rise. Therefore, scientists are making a significant effort in researching accurate, efficient diagnoses. Several studies advocating artificial intelligence proposed COVID diagnosis methods on lung images with high accuracy. Furthermore, some affected areas in the lung images can be detected accurately by segmentation methods. This work has considered state-of-the-art Convolutional Neural Network architectures, combined with the Unet family and Feature Pyramid Network (FPN) for COVID segmentation tasks on Computed Tomography (CT) scanner samples from the Italian Society of Medical and Interventional Radiology dataset. The experiments show that the decoder-based Unet family has reached the best (a mean Intersection Over Union (mIoU) of 0.9234, 0.9032 in dice score, and a recall of 0.9349) with a combination between SE ResNeXt and Unet++. The decoder with the Unet family obtained better COVID segmentation performance in comparison with Feature Pyramid Network. Furthermore, the proposed method outperforms recent segmentation state-of-the-art approaches such as the SegNet-based network, ADID-UNET, and A-SegNet + FTL. Therefore, it is expected to provide good segmentation visualizations of medical images.

National audit on the appropriateness of CT and MRI examinations in Luxembourg

OBJECTIVES

In Luxembourg, the frequency of CT and MRI examinations per inhabitant is among the highest in Europe. A national audit was conducted to evaluate the appropriateness of CT and MRI examinations according to the national referral guidelines for medical imaging.

METHODS

Three hundred and eighty-eight CT and 330 MRI requests corresponding to already performed examinations were provided by all radiology departments in Luxembourg. Four external radiologists evaluated the clinical elements for justification present in each request. They consensually assessed the appropriateness of each requested examination with regard to the national referral guidelines and their clinical experience.

RESULTS

The appropriateness rate (AR) was higher for MRI requests than for CT requests (79% vs. 61%; p < 0.001). AR was higher for requests referred by medical specialists rather than by general practitioners, both for CT requests (70% vs. 37%; p < 0.001) and MRI requests (83% vs. 64%; p = 0.002). For CT, AR was higher when the requests concerned paediatric rather than adult patients (82% vs. 58%; p < 0.001), when the radiology departments were equipped with both CT and MRI units rather than with only CT units (65% vs. 47%, p = 0.004) and when the requests concerned head-neck (79%), chest (77%) and chest-abdominal-pelvic (81%) areas rather than spinal (28%), extremity (51%) and abdominal-pelvic (63%) areas (p < 0.001).

CONCLUSIONS

The appropriateness of CT and MRI in Luxembourg is not satisfactory and collective efforts to improve should be continued. The focus should be on general practitioners and on spinal CT examinations.

Imaging of pulmonary perfusion using subtraction CT angiography is feasible in clinical practice

Abstract

Subtraction computed tomography (SCT) is a technique that uses software-based motion correction between an unenhanced and an enhanced CT scan for obtaining the iodine distribution in the pulmonary parenchyma. This technique has been implemented in clinical practice for the evaluation of lung perfusion in CT pulmonary angiography (CTPA) in patients with suspicion of acute and chronic pulmonary embolism, with acceptable radiation dose. This paper discusses the technical principles, clinical interpretation, benefits and limitations of arterial subtraction CTPA.

Key Points

• SCT uses motion correction and image subtraction between an unenhanced and an enhanced CT scan to obtain iodine distribution in the pulmonary parenchyma.

• SCT could have an added value in detection of pulmonary embolism.

• SCT requires only software implementation, making it potentially more widely available for patient care than dual-energy CT.

The clinical experience of computed tomographic-guided navigation system in c1-2 spine instrumentation surgery

Objective

To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports.

Methods

Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach.

Results

Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases.

Conclusion

Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.

Distinction of internal tissue of raw ginseng root using a computed tomography scanner

Raw ginseng root of Panax ginseng is graded according to its shape and the quality of its internal tissue. A variety of grades are sold with prices according to grade. If an inferior raw ginseng is purchased, the consumer experience an economic loss. This research was conducted in order to explore the possibility of developing a noninvasive method for investigating raw ginseng’s internal tissue. It has been determined that computed tomography (CT) scanner images agreed with actual cross-sections of raw ginseng. CT images were obtained to assess the internal portions of raw ginseng, and CT scans of raw ginseng were thoroughly measured using the Hounsfield unit (HU) system, since it allows for a more detailed analysis compared to nuclear magnetic resonance imaging. HU is a measure of attenuation used for CT images, with each pixel being assigned a value using a scale on which air is defined as -1000, water as 0 and compact bone as +1000. It takes about one second to process are slice and produce an image of the raw ginseng by a one channel CT scanner. An image good enough to discriminate the internal tissues can be obtained in 1/24 seconds with a one-channel CT scanner. Using this method, images of raw ginseng can be obtained and the characteristics of the internal tissues can be observed in a short time.

Relationship between the use of new or used computed tomography scanners and image retake rates in South Korea

BACKGROUND

The use of high-cost imaging has increased worldwide, contributing to increased healthcare expenditures. Without proper quality verification, the installation of used imaging equipment may lead to wasteful increases in cost due to ineffective and poor-quality imaging that requires repeat scans.

PURPOSE

To examine the relationship between the use of new or used computed tomography (CT) scanners and image retake rates to evaluate the comparative quality of used and new CT scanners.

MATERIAL AND METHODS

This was a retrospective cohort study of patients who first underwent CT from January 1 to June 30, 2008 (n = 258,572). Data were obtained by linking the Health Care Institution Registration Data with the Korean National Health Insurance Claims Database. Image retake rates within 30, 60, 90, and 180 days after the first CT scan were calculated, and differences in the image retake rate by new versus used CT scanners were assessed.

RESULTS

After adjusting for confounders, use of a used CT scanner for the first scan increased the odds of retake within 30 days (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.22-1.48), 60 days (OR: 1.59, 95% CI: 1.47-1.72), 90 days (OR: 1.48, 95% CI: 1.38-1.59), and 180 days (OR: 1.38, 95% CI: 1.30-1.46) compared with use of a new CT scanner. Such results were evident in scans of the spine, abdomen, chest, and face or skull base.

CONCLUSION

The quality control associated with import of used CT scanners should be improved. Moreover, regular and detailed quality inspections of used CT scanners currently operating in healthcare institutions are necessary.

[Description of tuberculosis outbreak and usefulness of mediastinal ultrasound]

OBJECTIVES

Describe a school outbreak of tuberculosis and compare the features with other outbreaks. Propose mediastinal ultrasound as an aid in its diagnosis and monitoring.

PATIENTS AND METHODS

Retrospective descriptive study of the transmission of tuberculosis infection in a micro-epidemic. Infection criteria: Mantoux ≥ 5mm, asymptomatic patient, with normal radiological, microbiological and analytical studies. Disease criteria: Mantoux ≥ 5mm and any of the above pathological studies. Mediastinal ultrasound was used as a complementary method of chest radiography (CXR). Computed tomography (CT) as the combined result of ultrasound and CXR was inconclusive.

RESULTS

Seventeen out of 412 students were infected and 16 with tuberculosis disease. In addition, 4 out-school contacts were diagnosed of tuberculosis.

CLINICAL MANIFESTATIONS

one erythema nodosum, one Henoch-Schönlein purpura, twelve with cough and fever nine. CXR results in patients: 3 normal, 7 inconclusive, and 10 with the following findings: 2 pneumonia, 2 pulmonary atelectasis, 2 primary complexes, 4 patients only with lymphadenopathy. All patients with normal or indeterminate CXR showed mediastinal lymphadenopathy visualized on ultrasound but 3 demonstrated by CT. Microbiological isolation: 6 cases (31%).

CONCLUSIONS

The number of infected patients was higher compared to other outbreaks There is great variability in the diagnostic approach to tuberculosis micro-epidemics. It is complex to differentiate between infection and disease. The clinical, laboratory and CXR are nonspecific. There are patients with normal CXR, pathological ultrasound and microbiological isolation. Mediastinal ultrasound can play an important role in the diagnosis and management of tuberculosis disease.

Improved correlation between CT emphysema quantification and pulmonary function test by density correction of volumetric CT data based on air and aortic density

OBJECTIVES

To determine the improvement of emphysema quantification with density correction and to determine the optimal site to use for air density correction on volumetric computed tomography (CT).

METHODS

Seventy-eight CT scans of COPD patients (GOLD II-IV, smoking history 39.2±25.3 pack-years) were obtained from several single-vendor 16-MDCT scanners. After density measurement of aorta, tracheal- and external air, volumetric CT density correction was conducted (two reference values: air, -1,000 HU/blood, +50 HU). Using in-house software, emphysema index (EI) and mean lung density (MLD) were calculated. Differences in air densities, MLD and EI prior to and after density correction were evaluated (paired t-test). Correlation between those parameters and FEV1 and FEV1/FVC were compared (age- and sex adjusted partial correlation analysis).

RESULTS

Measured densities (HU) of tracheal- and external air differed significantly (-990 ± 14, -1016 ± 9, P<0.001). MLD and EI on original CT data, after density correction using tracheal- and external air also differed significantly (MLD: -874.9 ± 27.6 vs. -882.3 ± 24.9 vs. -860.5 ± 26.6; EI: 16.8 ± 13.4 vs. 21.1 ± 14.5 vs. 9.7 ± 10.5, respectively, P<0.001). The correlation coefficients between CT quantification indices and FEV1, and FEV1/FVC increased after density correction. The tracheal air correction showed better results than the external air correction.

CONCLUSION

Density correction of volumetric CT data can improve correlations of emphysema quantification and PFT.