Comparison of Chest Radiograph Interpretations by Artificial Intelligence Algorithm vs Radiology Residents

IMPORTANCE

Chest radiography is the most common diagnostic imaging examination performed in emergency departments (EDs). Augmenting clinicians with automated preliminary read assistants could help expedite their workflows, improve accuracy, and reduce the cost of care.

OBJECTIVE

To assess the performance of artificial intelligence (AI) algorithms in realistic radiology workflows by performing an objective comparative evaluation of the preliminary reads of anteroposterior (AP) frontal chest radiographs performed by an AI algorithm and radiology residents.

DESIGN, SETTING, AND PARTICIPANTS

This diagnostic study included a set of 72 findings assembled by clinical experts to constitute a full-fledged preliminary read of AP frontal chest radiographs. A novel deep learning architecture was designed for an AI algorithm to estimate the findings per image. The AI algorithm was trained using a multihospital training data set of 342 126 frontal chest radiographs captured in ED and urgent care settings. The training data were labeled from their associated reports. Image-based F1 score was chosen to optimize the operating point on the receiver operating characteristics (ROC) curve so as to minimize the number of missed findings and overcalls per image read. The performance of the model was compared with that of 5 radiology residents recruited from multiple institutions in the US in an objective study in which a separate data set of 1998 AP frontal chest radiographs was drawn from a hospital source representative of realistic preliminary reads in inpatient and ED settings. A triple consensus with adjudication process was used to derive the ground truth labels for the study data set. The performance of AI algorithm and radiology residents was assessed by comparing their reads with ground truth findings. All studies were conducted through a web-based clinical study application system. The triple consensus data set was collected between February and October 2018. The comparison study was preformed between January and October 2019. Data were analyzed from October to February 2020. After the first round of reviews, further analysis of the data was performed from March to July 2020.

MAIN OUTCOMES AND MEASURES

The learning performance of the AI algorithm was judged using the conventional ROC curve and the area under the curve (AUC) during training and field testing on the study data set. For the AI algorithm and radiology residents, the individual finding label performance was measured using the conventional measures of label-based sensitivity, specificity, and positive predictive value (PPV). In addition, the agreement with the ground truth on the assignment of findings to images was measured using the pooled κ statistic. The preliminary read performance was recorded for AI algorithm and radiology residents using new measures of mean image-based sensitivity, specificity, and PPV designed for recording the fraction of misses and overcalls on a per image basis. The 1-sided analysis of variance test was used to compare the means of each group (AI algorithm vs radiology residents) using the F distribution, and the null hypothesis was that the groups would have similar means.

RESULTS

The trained AI algorithm achieved a mean AUC across labels of 0.807 (weighted mean AUC, 0.841) after training. On the study data set, which had a different prevalence distribution, the mean AUC achieved was 0.772 (weighted mean AUC, 0.865). The interrater agreement with ground truth finding labels for AI algorithm predictions had pooled κ value of 0.544, and the pooled κ for radiology residents was 0.585. For the preliminary read performance, the analysis of variance test was used to compare the distributions of AI algorithm and radiology residents' mean image-based sensitivity, PPV, and specificity. The mean image-based sensitivity for AI algorithm was 0.716 (95% CI, 0.704-0.729) and for radiology residents was 0.720 (95% CI, 0.709-0.732) (P = .66), while the PPV was 0.730 (95% CI, 0.718-0.742) for the AI algorithm and 0.682 (95% CI, 0.670-0.694) for the radiology residents (P < .001), and specificity was 0.980 (95% CI, 0.980-0.981) for the AI algorithm and 0.973 (95% CI, 0.971-0.974) for the radiology residents (P < .001).

CONCLUSIONS AND RELEVANCE

These findings suggest that it is possible to build AI algorithms that reach and exceed the mean level of performance of third-year radiology residents for full-fledged preliminary read of AP frontal chest radiographs. This diagnostic study also found that while the more complex findings would still benefit from expert overreads, the performance of AI algorithms was associated with the amount of data available for training rather than the level of difficulty of interpretation of the finding. Integrating such AI systems in radiology workflows for preliminary interpretations has the potential to expedite existing radiology workflows and address resource scarcity while improving overall accuracy and reducing the cost of care.

Analyzing medical device connectivity and its effect on cyber security in german hospitals

BACKGROUND

Modern healthcare devices can be connected to computer networks and many western healthcare institutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence that cybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively, the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked.

METHODS

To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitals and especially University Medical Center UMCs.

RESULTS

The results show a strong correlation between the networking degree and the number of medical devices. The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual key users of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, Nuclear Medicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medical devices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strong correlation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquired hospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion of competencies on an organizational level facilitates the right behavior here. Most hospitals rated themselves predominantly positively in the self-assessment but also stated the usefulness of IT security insurance.

CONCLUSIONS

Concluding our results, hospitals are already facing the consequences of omitted measures within their growing pool of medical devices. Continuously relying on historically grown structures without adaption and trusting manufactures to solve vectors is a critical behavior that could seriously endanger patients.

Validation of an automated shape-matching algorithm for biplane radiographic spine osteokinematics and radiostereometric analysis error quantification

Biplane radiography and associated shape-matching provides non-invasive, dynamic, 3D osteo- and arthrokinematic analysis. Due to the complexity of data acquisition, each system should be validated for the anatomy of interest. The purpose of this study was to assess our system’s acquisition methods and validate a custom, automated 2D/3D shape-matching algorithm relative to radiostereometric analysis (RSA) for the cervical and lumbar spine. Additionally, two sources of RSA error were examined via a Monte Carlo simulation: 1) static bead centroid identification and 2) dynamic bead tracking error. Tantalum beads were implanted into a cadaver for RSA and cervical and lumbar spine flexion and lateral bending were passively simulated. A bead centroid identification reliability analysis was performed and a vertebral validation block was used to determine bead tracking accuracy. Our system’s overall root mean square error (RMSE) for the cervical spine ranged between 0.21–0.49mm and 0.42–1.80° and the lumbar spine ranged between 0.35–1.17mm and 0.49–1.06°. The RMSE associated with RSA ranged between 0.14–0.69mm and 0.96–2.33° for bead centroid identification and 0.25–1.19mm and 1.69–4.06° for dynamic bead tracking. The results of this study demonstrate our system’s ability to accurately quantify segmental spine motion. Additionally, RSA errors should be considered when interpreting biplane validation results.

VALIDATION OF A BEAMNRC MONTE CARLO SIMULATION OF A BROAD BEAM DIAGNOSTIC X-RAY UNIT

A BEAMnrc Monte Carlo simulation of a diagnostic X-ray unit in a broad beam geometry intended for the derivation of effective linear attenuation coefficients was validated against measurements made on the X-ray unit on which the simulation was based. The validation process assessed the size of the beam, the first and second half value layer, the variation in kerma with anode-heel effect and the accuracy of values of effective linear attenuation coefficient for water and solid water attenuators. The agreement between the simulated and measured results for all tests was consistently within the experimental uncertainty for the measurements. The average deviation between values of effective linear attenuation coefficient for simulated and measured results is 3.8%, with the highest individual deviation 7.1%. The simulation can be used to produce values of effective linear attenuation coefficient for a range of kVp, field size and attenuator thickness that are close to those measured.

Comparison of CsI:Tl and Gd2 O2 S:Tb indirect flat panel detector x-ray imaging performance in front- and back-irradiation geometries

PURPOSE

The detective quantum efficiency (DQE) of indirect flat panel detectors (I-FPDs) is limited at higher x-ray energies (e.g., 100-140 kVp) by low absorption in their scintillating x-ray conversion layer. While increasing the thickness of the scintillator can improve its x-ray absorption efficiency, this approach is potentially limited by reduced spatial resolution and increased noise due to depth dependence in the scintillator's response to x rays. One strategy proposed to mitigate these deleterious effects is to irradiate the scintillator through the pixel sensor in a "back-irradiation" geometry. This work directly evaluates the impact of irradiation geometry on the inherent imaging performance of I-FPDs composed with columnar CsI:Tl and powder Gd2 O2 S:Tb (GOS) scintillators.

METHODS

A "bidirectional" FPD was constructed which allows scintillator samples to be interchangeably coupled with the detector's active matrix to compose an I-FPD. Radio-translucent windows in the detector's housing permit imaging in both "front-irradiation" (FI) and "back-irradiation" (BI) geometries. This test device was used to evaluate the impact of irradiation geometry on the x-ray sensitivity, modulation transfer function (MTF), noise power spectrum (NPS), and DQE of four I-FPDs composed using columnar CsI:Tl scintillators of varying thickness (600-1000 µm) and optical backing, and a Fast Back GOS screen. All experiments used an RQA9 x-ray beam.

RESULTS

Each I-FPD's x-ray sensitivity, MTF, and DQE was greater or equal in BI geometry than in FI. The I-FPD composed with CsI:Tl (1 mm) and an optically absorptive backing had the largest variation in sensitivity (17%) between FI and BI geometries. The detector composed with GOS had the largest improvement in limiting resolution (31%). Irradiation geometry had little impact on MTF(f) and DQE(f) measurements near zero frequency, however, the difference between FI and BI measurements generally increased with spatial frequency. The CsI:Tl scintillator with optically absorptive backing (1 mm) in BI geometry had the highest spatial resolution and DQE over all frequencies.

CONCLUSIONS

Back irradiation may improve the inherent x-ray imaging performance of I-FPDs composed with CsI:Tl and GOS scintillators. This approach can be leveraged to improve tradeoffs between detector dose efficiency, spatial resolution and noise for higher energy x-ray imaging.

An innovative method to visualise mastoiditis using a hand-held X-ray system

OBJECTIVE

We explore the utility of using a hand-held X-ray system to diagnose mastoiditis in archaeological populations.

MATERIALS

A sample (n = 56) of hunter-fisher-gatherers from the Early Neolithic (8,000-7,000/6,800 cal. BP) Cis-Baikal cemetery of Shamanka II (Russia) were examined.

METHODS

Images were taken medio-laterally, approximately 90° to a sensor temporarily affixed to the lateral surface of the mastoid process. Digital radiographs were analysed for signs of mastoiditis occurring pre- and/or post-puberty.

RESULTS

Two thirds of individuals (39/56) exhibited evidence of mastoiditis. Chronic mastoiditis and chronic sinusitis co-occurred in 61.5% (24/39) of observable individuals.

CONCLUSIONS

This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging.

SIGNIFICANCE

This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection.

LIMITATIONS

The cost of the imaging system is limiting and there are few comparative images taken in the same plane.

SUGGESTIONS FOR FURTHER RESEARCH

Further research should create a larger catalogue of comparative radiographs and assess the diagnostic potential of imaging the mastoid process to rather than imaging the entire pneumatized portion of the temporal bone.

Multimodality imaging approach in a patient with Klippel-Trenaunay syndrome

Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder presenting with asymmetric limb hypertrophy, cutaneous capillary malformations and lower extremity varicosities. We discuss a 27-year-old man born with varicosities on both lower extremities, which progressively enlarged. Physical examination showed a grossly enlarged right hand. There were multiple compressible varicosities, diffuse port-wine stains on the right leg and limb-length discrepancy on the left leg. CT angiogram and Doppler ultrasound revealed several venous varicosities. Ectatic veins in the right leg converge into the lateral marginal vein of Servelle, an embryonic vein, typically seen in KTS patients. KTS is diagnosed clinically and imaging plays a role in differentiating this from other disease entities that present similarly. Doppler ultrasound is the initial imaging of choice to characterise varicosities and to identify thrombosis and reflux. Plain radiographs confirm limb hypertrophy. MRI and CT angiograms are useful to evaluate vascular anomalies and its accompanying soft tissue changes.

Projection X-ray Imaging: Radiography, Mammography, Fluoroscopy

Recent advances in digital detector technology for medical radiography and fluoroscopy have resulted in improved workflow efficiency, operational flexibility, image quality, and diagnostic accuracy. This is attributed to the implementation of portable flat-panel x-ray detector devices able to provide real-time readout, processing, and display of medical images. As a result, digital radiography flat-panel detectors are rapidly replacing computed radiography passive detectors for projection imaging exams and image intensifier detectors for dynamic fluoroscopy exams. Advanced exam capabilities now include digital tomosynthesis and dual-energy radiography; the former is based on rapid acquisition of multiple angle-dependent image projections to synthesize tomographic slabs at selectable depths within the patient, and the latter is based on rapid back-to-back acquisition of the same anatomy at low and high x-ray energies to generate separate soft tissue and bone images. In both situations, superimposition of anatomy is reduced or eliminated, with the possibility of enhanced diagnostic confidence. Increased x-ray absorption efficiency and lower electronic noise of digital radiography detectors compared to computed radiography detectors enable equal image quality at lower patient dose; however, because of a disconnect between image appearance and radiation dose, lower patient dose is not always achieved. Education, training, and implementation of standards such as the International Electrotechnical Commission 62494-1 Digital Radiography Exposure Index are needed to ensure image quality at the lowest appropriate radiation dose. The National Council on Radiation Protection and Measurements can contribute to radiation responsibility in medical imaging by providing guidance on use of digital radiography, including recommendations for acquisition protocols and exposure index standards, for development of radiographic exam diagnostic reference levels, and for oversight of retake and reject analysis.

Safety evaluation of mobile X-ray equipment using super-capacitor

In this study, we designed mobile X-ray equipment that generates high-power X-rays, using an internal power source by means of a super-capacitor, and evaluated its safety. The proposed X-ray equipment uses the charging voltage of a battery to store high density energy, supplementing the electric charge of the super-capacitor, which can instantly release a large amount of energy. Further, pulse frequency modulation was applied to produce high voltage and thereby improve energy efficiency. The developed mobile X-ray equipment enables to generate an output of 30 kW and, therefore, can be applied to many diagnostic fields. In addition, various devices and control circuits were employed to ensure convenience and safety of using the equipment in clinical applications. This study analyzed the error ranges regarding tube voltage, tube current, irradiation time, coefficient variation, half-value layer, and the output characteristics. The results showed that the proposed X-ray equipment was able to generate 800mR X-ray power under the condition of 30 kW. The coefficient variation was less than 0.05 at all measurement points, which indicates that it is possible to generate the equal amount of X-ray when the driving conditions are same. Results also showed 51.25% of transmittance at 3.5mmAL in the case of the wire, which is thicker than a common reference of 2.3mmAL and indicates that this new mobile equipment is possible to generate X-rays with relatively high permeability. In conclusion, the findings in this study suggest that the new equipment can generate consistent high-power X-rays and, therefore, can be used safely by minimizing unnecessary re-taking of images and radiation exposure.

Guidelines for Instrumentation for Total Knee Replacement Based on Frontal Plane Radiographs

OBJECTIVE

The objective of this study was to measure the dimensions and the angulations of the femur and tibia for arthritic knees that were scheduled for total knee surgery. The purpose was to provide information for the design of surgical instruments such as cutting guides. Instruments made using three-dimensional printing were a particular consideration because of the variations in sizing that are possible.

MATERIALS AND METHODS

Sixty-six frontal plane EOS radiographs were obtained of patients with osteoarthritis who were under consideration for total knee arthroplasty. The images were imported into computer-assisted design software. The anatomic and mechanical axes and the joint lines were constructed for the femur and tibia. The angles between the axes and lines and key dimensions including the femoral canal diameters were measured.

RESULTS

The angle between the anatomic and mechanical axes was 5.5° ± 1.4°, the femoral joint line sloped 2.2°, and the tibial joint line 4.3° to the mechanical axes. The values were similar to non-arthritic knees except for a higher tibial slope. The femoral canal diameter at 150 mm from distal was 19 ± 5 mm.

CONCLUSIONS

In a total knee replacement procedure, aligning perpendicular to the mechanical axis results on average about 2° more valgus and 2° to 3° tilt of the joint line. Instruments could be calibrated for individual patients, but the maximum variations based on long-term follow-up should be recognized. A multi-diameter system is needed for the femoral intramedullary rod to limit errors to 1° or less.

Nano-printed miniature compound refractive lens for desktop hard x-ray microscopy

Hard x-ray lenses are useful elements in x-ray microscopy and in creating focused illumination for analytical applications such as x-ray fluorescence imaging. Recently, polymer compound refractive lenses for focused illumination in the soft x-ray regime (< 10 keV) have been created with nano-printing. However, there are no such lenses yet for hard x-rays, particularly of short focal lengths for benchtop microscopy. We report the first instance of a nano-printed lens for hard x-ray microscopy, and evaluate its imaging performance. The lens consists of a spherically focusing compound refractive lens designed for 22 keV photon energy, with a tightly packed structure to provide a short total length of 1.8 mm and a focal length of 21.5 mm. The resulting lens technology was found to enable benchtop microscopy at 74x magnification and 1.1 μm de-magnified image pixel size at the object plane. It was used to image and evaluate the focal spots of tungsten-anode micro-focus x-ray sources. The overall system resolution with broadband illumination from a tungsten-anode x-ray tube at 30 kV and 10 mm focal distance was measured to be 2.30±0.22 μm.

Effect of Spectral Degradation and Spatio-Energy Correlation in X-Ray PCD for Imaging

Charge sharing, scatter, and fluorescence events in a photon counting detector can result in counting of a single incident photon in multiple neighboring pixels, each at a fraction of the true energy. This causes energy distortion and correlation of data across energy bins in neighboring pixels (spatio-energy correlation), with the severity depending on the detector pixel size and detector material. If a "macro-pixel" is formed by combining the counts from multiple adjacent small pixels, it will exhibit correlations across its energy bins. Understanding these effects can be crucial for detector design and for model-based imaging applications. This paper investigates the impact of these effects in basis material and effective monoenergetic estimates using the Cramér-Rao Lower Bound. To do so, we derive a correlation model for the multi-counting events. CdTe detectors with grids of pixels with side length of $250~\mu \text{m}$ , $500~\mu \text{m}$ , and 1 mm were compared, with binning of $4\times4$ , $2\times2$ , and $1\times1$ pixels, respectively, to keep the same net 1 mm2 aperture constant. The same flux was applied to each. The mean and covariance matrix of measured photon counts were derived analytically using spatio-energy response functions precomputed from Monte Carlo simulations. Our results show that a 1 mm2 macro-pixel with $250\times 250\,\,\mu \text{m}^{\textsf {2}}$ sub-pixels shows 35% higher standard deviation than a single 1 mm2 pixel for material-specific imaging, while the penalty for effective monoenergetic imaging is <10% compared with a single 1 mm $^{\textsf {2}}$ pixel. Potential benefits of sub-pixels (higher spatial resolution and lower pulse pile-up effects) are important but were not investigated here.

Helium ion beam imaging for image guided ion radiotherapy

BACKGROUND

Ion beam radiotherapy provides potential for increased dose conformation to the target volume. To translate it into a clinical advantage, it is necessary to guarantee a precise alignment of the actual internal patient geometry with the treatment beam. This is in particular challenging for inter- and intrafractional variations, including movement. Ion beams have the potential for a high sensitivity imaging of the patient geometry. However, the research on suitable imaging methods is not conclusive yet. Here we summarize the research activities within the "Clinical research group heavy ion therapy" funded by the DFG (KFO214). Our aim was to develop a method for the visualization of a 1 mm thickness difference with a spatial resolution of about 1 mm at clinically applicable doses.

METHODS

We designed and built a dedicated system prototype for ion radiography using exclusively the pixelated semiconductor technology Timepix developed at CERN. Helium ions were chosen as imaging radiation due to their decreased scattering in comparison to protons, and lower damaging potential compared to carbon ions. The data acquisition procedure and a dedicated information processing algorithm were established. The performance of the method was evaluated at the ion beam therapy facility HIT in Germany with geometrical phantoms. The quality of the images was quantified by contrast-to-noise ratio (CNR) and spatial resolution (SR) considering the imaging dose.

RESULTS

Using the unique method for single ion identification, degradation of the images due to the inherent contamination of the outgoing beam with light secondary fragments (hydrogen) was avoided. We demonstrated experimentally that the developed data processing increases the CNR by 350%. Consideration of the measured ion track directions improved the SR by 150%. Compared to proton radiographs at the same dose, helium radiographs exhibited 50% higher SR (0.56 ± 0.04lp/mm vs. 0.37 ± 0.02lp/mm) at a comparable CNR in the middle of the phantom. The clear visualization of the aimed inhomogeneity at a diagnostic dose level demonstrates a resolution of 0.1 g/cm2 or 0.6% in terms of water-equivalent thickness.

CONCLUSIONS

We developed a dedicated method for helium ion radiography, based exclusively on pixelated semiconductor detectors. The achievement of a clinically desired image quality in simple phantoms at diagnostic dose levels was demonstrated experimentally.

Qualitative study of mechanical parameters of conventional diagnostic X-ray machines in Mizoram

The present study examined the mechanical attributes of 135 conventional diagnostic X-ray machines in Mizoram, India. The purpose of studying the X-ray mechanical parameters, such as congruency, perpendicularity of the central beam, and half-value layer, was to improve the quality of the diagnostic image and reduce the patient dose. A battery-operated portable dosimeter was used to measure output radiation of the X-ray machine. The half-value layer was measured at a constant accelerating potential of 70 kVp and tube load. To measure the congruency and beam alignment perpendicularity, a congruence and alignment tool was used. The survey data were collected between June 2015 and June 2016. The authors followed international standard test procedures, and the results were compared to national and international standards. SPSS Statistics for Windows, Version 17 was used to calculate the mean, range, and standard deviation. The half-value layer ranged from 0.45 to 3.00 mm; the mean half-value layer was 1.60 ± 0.51 SD mm. In comparison with national and international standards, only 27.83% (national) and 15.64% (international) of the machines' filtration were found to be within acceptable limits. The congruence misalignment of the x-axis varied between 0.50% and 15.30% of the source-to-image distance; for the y-axis, it ranged from 0.50 to 10.90%. When the congruence between the radiation beam and optical field was tested, 80.85% of diagnostic X-ray machines did not meet the prescribed acceptance parameters. When the perpendicularity between the central beam and the image receptor was tested, 69.81% did not meet safety standards.

Impact of anti-charge sharing on the zero-frequency detective quantum efficiency of CdTe-based photon counting detector system: cascaded systems analysis and experimental validation

Inter-pixel communication and anti-charge sharing (ACS) technologies have been introduced to photon counting detector (PCD) systems to address the undesirable charge sharing problem. In addition to improving the energy resolution of PCD, ACS may also influence other aspects of PCD performance such as detector multiplicity (i.e. the number of pixels triggered by each interacted photon) and detective quantum efficiency (DQE). In this work, a theoretical model was developed to address how ACS impacts the multiplicity and zero-frequency DQE [DQE(0)] of PCD systems. The work focused on cadmium telluride (CdTe)-based PCD that often involves the generation and transport of K-fluorescence photons. Under the parallel cascaded systems analysis framework, the theory takes both photoelectric and scattering effects into account, and it also considers both the reabsorption and escape of photons. In a new theoretical treatment of ACS, it was considered as a modified version of the conventional single pixel (i.e. non-ACS) mode, but with reduced charge spreading distance and K-fluorescence travel distance. The proposed theoretical model does not require prior knowledge of the detailed ACS implementation method for each specific PCD, and its parameters can be experimentally determined using a radioisotope without invoking any Monte-Carlo simulation. After determining the model parameters, independent validation experiments were performed using a diagnostic x-ray tube and four different polychromatic beams (from 50 to 120 kVp). Both the theoretical and experimental results demonstrate that ACS increased the first and second moments of multiplicity for a majority of the x-ray energy and threshold levels tested, except when the threshold level was much lower than the x-ray energy level. However, ACS always improved DQE(0) at all energy and threshold levels tested.

[Wrapping of X-ray Cassette by a Plastic Bag in Portable Radiography: For Infection Prevention and Alleviation of Patient's Discomfort]

Portable radiography is available for the patient who is postoperative, severe condition and old. As they have weak immunity, it is important to prevent from hospital infection. Wrapping of 14×14 inch or 14×17 inch X-ray cassette by a plastic (polyethylene) bag a little bit bigger than the cassette was proposed for infection prevention in portable radiography. How to wrap the cassette easily was devised using the sheath of a polyester bag cutting at the bottom. In radiography with the grid, the plastic bag fastens the X-ray grid to the cassette substantially without any other means. In addition, the wrapped cassette, or the cassette with grid covered by the foamed plastic sheet alleviates patient's discomfort.

A study on the characteristics of mobile X-ray device using supercapacitor as internal power

Mobile X-ray device is widely employed because it is useful for diagnosis in patients having mobility difficulties and in medical emergencies. As various devices for X-ray generation have continued to be developed, X-ray devices can now be used more safely and effectively. However, mobile X-ray devices generate relatively low X-ray doses due to the limitation of the power input. Therefore, the use of mobile X-ray devices is limited to thin parts of body. In this study, a new device was designed in order to increase the usefulness of mobile X-ray devices by offsetting the weaknesses of the existing mobile X-ray devices, rendering them useable independently. A supercapacitor and battery were used as the internal power source for the X-ray generation in the manufactured device. The pulse width modulation (PWM) method is applied to control the tube voltage and current required for generating the X-ray, and the pulse frequency modulation (PFM) method is applied to the control to generate the high voltage in order to enhance the precision and efficiency. The manufactured X-ray device was used to evaluate the control signal, frequency, and output characteristics according to changes in tube voltage and current. Based on the results of X-ray generation, it is confirmed that precise control was achieved by X-ray generation increases linearly with increasing tube voltage and tube current. This means that precise control of the manufactured mobile X-ray device is passible. In addition, the study confirmed that stable output was achieved by checking the tube voltage, tube current and exposure rate during the exposure times by high power condition.

Precise measurement of inner diameter of mono-capillary optic using X-ray imaging technique

BACKGROUND

Mono-capillary optics have been applied to increase the performance of X-ray instruments. However, performance of a mono-capillary optic strongly depends on the shape accuracy, which is determined by the diameters of the inner hollow of the capillary along the axial direction.

OBJECTIVE

To precisely determine the inner diameter of the capillary optic used in X-ray imaging technique, which aims to replace the conventional method using a visible microscope.

METHODS

High spatial resolution X-ray images of the mono-capillary optic were obtained by a synchrotron radiation beamline. The inner diameter of the mono-capillary optic was measured and analyzed by the pixel values of the X-ray image.

RESULT

Edge enhancement effect was quite useful in determining the inner diameter, and the accuracy of the diameter determination was less than 1.32 μm. Many images obtained by scanning the mono-capillary optic along the axial direction were combined, and the axial profile, consisting of diameters along the axial direction, was obtained from the combined image. The X-ray imaging method could provide an accurate measurement with slope error of±19 μrad.

CONCLUSIONS

Applying X-ray imaging technique to determine the inner diameter of a mono-capillary optic can contribute to increasing fabrication accuracy of the mono-capillary optic through a feedback process between the fabrication and measurement of its diameter.

Feasibility and its characteristics of CO2 laser micromachining-based PMMA anti-scattering grid estimated by MCNP code simulation

BACKGROUND

Anti-scattering grid has been used to improve the image quality. However, applying a commonly used linear or parallel grid would cause image distortion, and focusing grid also requires a precise fabrication technology, which is expensive.

OBJECTIVE

To investigate and analyze whether using CO2 laser micromachining-based PMMA anti-scattering grid can improve the performance of the grid at a lower cost. Thus, improvement of grid performance would result in improvement of image quality.

METHODS

The cross-sectional shape of CO2 laser machined PMMA is similar to alphabet 'V'. The performance was characterized by contrast improvement factor (CIF) and Bucky. Four types of grid were tested, which include thin parallel, thick parallel, 'V'-type and 'inverse V'-type of grid.

RESULTS

For a Bucky factor of 2.1, the CIF of the grid with both the "V" and inverse "V" had a value of 1.53, while the thick and thick parallel types had values of 1.43 and 1.65, respectively.

CONCLUSION

The 'V' shape grid manufacture by CO2 laser micromachining showed higher CIF than parallel one, which had same shielding material channel width. It was thought that the 'V' shape grid would be replacement to the conventional parallel grid if it is hard to fabricate the high-aspect-ratio grid.

FEASIBILITY STUDY FOR IDENTIFICATION OF STATIC AND DYNAMIC EXPOSURE USING CCD IMAGING TECHNIQUE FOR Caso4:Dy TL DOSEMETERS

The occupational exposure incurred by the radiation workers due to the external radiation is estimated using personal dosemeter placed on the human body during the monitoring period. In certain situations, it is required to determine whether the dosemeter alone was exposed accidentally/intentionally in radiation field (static exposure) or was exposed while being worn by a worker moving in his workplace (dynamic exposure). The present thermoluminscent (TL) based personnel monitoring systems are not capable of distinguishing between the above stated (static and dynamic) exposure conditions. The feasibility of a new methodology developed using the charge coupled device based imaging technique for identification of the static/dynamic exposure of CaSO4:Dy based TL detectors for low energy photons has been investigated. The techniques for the qualitative and the quantitative assessments of the exposure conditions are presented in this paper.

Radiographic capsule-based system for non-cathartic colorectal cancer screening

Many patients are reluctant to undergo optical colonoscopy for colorectal cancer screening. The Check-Cap colon imaging system is a non-invasive test that comprises an ingestible imaging capsule that emits and detects ultra-low-dose radiation. The capsule generates a 3D reconstruction of the colonic lumen for detection of polyps and cancer. Preliminary preclinical and clinical testing has demonstrated safety and feasibility. Mean radiation dose is estimated at 0.04 mSv. In conclusion, we describe a novel capsule-based, patient-friendly colorectal test that holds potential for non-invasive screening.

The Mini C-arm Adds Quality and Efficiency to the Pediatric Orthopedic Outpatient Clinic

The mini C-arm has become increasingly popular in the practice of orthopedics. To the authors' knowledge, its use in the pediatric orthopedic outpatient clinic has not been reported. The purpose of this study was to evaluate the practice efficiency and radiation exposure to the patient when the mini C-arm was used in the pediatric orthopedic outpatient clinic. One hundred consecutive midshaft and distal forearm fractures were evaluated by one orthopedic surgeon in follow-up using a mini C-arm. For each case, the radiation physicist calculated the amount of skin exposure in milligray (mGy). The average skin exposure to the patient from the mini C-arm was 0.58 mGy, compared with 0.2 mGy for anteroposterior view and lateral view radiographs. Use of the mini C-arm, in place of plain radiographs obtained in the radiology department, decreased time waiting during clinic visits by 23 minutes. This study reports 2 important findings. First, surprisingly, the mini C-arm used a slightly higher radiation dose than standard imaging with plain radiographs. Second, use of the mini C-arm saved time and improved the efficiency of the clinic visit. Overall, the mini C-arm improves quality and efficiency in the pediatric orthopedic outpatient clinic. [Orthopedics. 2016; 39(6):e1097-e1099.].

2-Butoxyethanol Female-Rat Model of Hemolysis and Disseminated Thrombosis: X-Ray Characterization of Osteonecrosis and Growth-Plate Suppression

We recently proposed a chemically induced rat model for human hemolytic disorders associated with thrombosis. The objective of the present investigation was to apply a noninvasive, high-magnification X-ray analysis, the Faxitron radiography system, to characterize the protracted bone damage associated with this 2-butoxyethanol model and to validate it by histopathology. Groups of female Fischer 344 rats were given 0, 250, or 300 mg of 2-butoxyethanol/kg body weight daily for 4 consecutive days. Groups were then sacrificed 2 hours or 26 days after the final treatment. The treated animals displayed a darkened purple-red discoloration on the distal tail. Histopathological evaluation, including phosphotungstic acid-hematoxylin staining of animals sacrificed 2 hours after the final treatment, revealed disseminated thrombosis and infarction in multiple organs, including bones. The Faxitron MX-20 specimen radiography system was used to image selected bones of rats sacrificed 26 days posttreatment. Premature thinning of the growth plate occurred in the calcaneus, lumbar and coccygeal vertebrae, femur, and ilium of the treated animals. Areas of decreased radiographic densities were seen in the diaphysis of the femur of all treated animals. The bones were then examined histologically and showed a range of changes, including loss or damage to growth plates and necrosis of cortical bone. No thrombi were seen in the animals sacrificed at 30 days, but bone and growth plate changes consistent with prior ischemia were noted. The Faxitron proved to be an excellent noninvasive tool that can be used in future studies with this animal model to examine treatment modalities for the chronic effects of human thrombotic disorders.

BEAM QUALITY CORRECTION FACTORS FOR KAP METERS FOR LIGHTLY AND HEAVILY FILTERED X-RAY BEAMS

Kerma-area product (KAP) meters have a pronounced energy dependence when measuring air KAP for lightly filtered X-ray beams (RQR). Today, it is also common with more heavily filtered beams. In this work, the energy dependence for lightly as well as heavily filtered beams (RQC) was investigated for several KAP meter models. The relative energy dependence of the readings of an external and an internal KAP meter was determined relative to an ionisation chamber, which had been calibrated at the primary standards laboratory. As a complement to the measurements, the sensitivity of a KAP meter for various X-ray beam qualities was modelled using Monte Carlo simulations of photon transport and absorption. The result showed a variation in relative energy dependence of up to 30 % for KAP meters for RQC beam qualities compared with RQR qualities. A reduced sensitivity of KAP meters for heavily filtered beams in comparison with lightly filtered ones was found, and it is important that the beam-specific radiation quality correction factors are applied to correct the registered KAP values.

Primary Beam Air Kerma Dependence on Distance from Cargo and People Scanners

The distance dependence of air kerma or dose rate of the primary radiation beam is not obvious for security scanners of cargo and people in which there is relative motion between a collimated source and the person or object being imaged. To study this problem, one fixed line source and three moving-source scan-geometry cases are considered, each characterized by radiation emanating perpendicular to an axis. The cases are 1) a stationary line source of radioactive material, e.g., contaminated solution in a pipe; 2) a moving, uncollimated point source of radiation that is shuttered or off when it is stationary; 3) a moving, collimated point source of radiation that is shuttered or off when it is stationary; and 4) a translating, narrow "pencil" beam emanating in a flying-spot, raster pattern. Each case is considered for short and long distances compared to the line source length or path traversed by a moving source. The short distance model pertains mostly to dose to objects being scanned and personnel associated with the screening operation. The long distance model pertains mostly to potential dose to bystanders. For radionuclide sources, the number of nuclear transitions that occur a) per unit length of a line source or b) during the traversal of a point source is a unifying concept. The "universal source strength" of air kerma rate at 1 m from the source can be used to describe x-ray machine or radionuclide sources. For many cargo and people scanners with highly collimated fan or pencil beams, dose varies as the inverse of the distance from the source in the near field and with the inverse square of the distance beyond a critical radius. Ignoring the inverse square dependence and using inverse distance dependence is conservative in the sense of tending to overestimate dose.

Proton Radiography With Timepix Based Time Projection Chambers

The development of a proton radiography system to improve the imaging of patients in proton beam therapy is described. The system comprises gridpix based time projection chambers, which are based on the Timepix chip designed by the Medipix collaboration, for tracking the protons. This type of detector was chosen to have minimal impact on the actual determination of the proton tracks by the tracking detectors. To determine the residual energy of the protons, a BaF 2 crystal with a photomultiplier tube is used. We present data taken in a feasibility experiment with phantoms that represent tissue equivalent materials found in the human body. The obtained experimental results show a good agreement with the performed simulations.

Increasing the field of view in grating based X-ray phase contrast imaging using stitched gratings

Grating based X-ray differential phase contrast imaging (DPCI) allows for high contrast imaging of materials with similar absorption characteristics. In the last years' publications, small animals or parts of the human body like breast, hand, joints or blood vessels have been studied. Larger objects could not be investigated due to the restricted field of view limited by the available grating area. In this paper, we report on a new stitching method to increase the grating area significantly: individual gratings are merged on a carrier substrate. Whereas the grating fabrication process is based on the LIGA technology (X-ray lithography and electroplating) different cutting and joining methods have been evaluated. First imaging results using a 2×2 stitched analyzer grating in a Talbot-Lau interferometer have been generated using a conventional polychromatic X-ray source. The image quality and analysis confirm the high potential of the stitching method to increase the field of view considerably.

[PECULIARITY OF NATIONAL TUBERCULOSIS PROGRAM, JAPAN--Public-Private Mix from the Very Beginning, and Provision of X-ray Apparatus in Most General Practitioner's Clinics]

Modern National Tuberculosis Program (NTP) of Japan started in 1951 when Tuberculosis (TB) Control Law was legislated, and 3 major components were health examination by tuberculin skin test (TST) and miniature X-ray, BCG vaccination and extensive use of modern TB treatment. As to the treatment program, Japan introduced Public-Private Mix (PPM) from the very beginning, and major reasons why PPM was adopted are (1) TB was then highly prevalent (Table 1), (2) TB sanatoria where many specialists are working are located in remote inconvenient places due to stigma against TB, (3) health centers (HCs) in Japan are working exclusively on prophylactic activities, and minor exceptions are treatment of sexually transmitted diseases and artificial pneumothorax for TB cases, however, as it covers on the average 100,000 population, access is not so easy in rural area, (4) Out-patients clinics mainly operated by general practitioners (GPs) are located throughout Japan, and the access is easy. Methods of TB treatment was developing rapidly in early 1950s, however, in 1952, as shown in Table 2, artificial pneumothorax and peritoneum were still used in many cases, and to fix the dosage of refill air, fluoroscopy was needed. Hence, GPs treating TB under TB Control Law had to be equipped with X-ray apparatus. To maintain the quality of TB treatment, "Criteria for TB treatment" was provided and revised taking into consideration the progress in TB treatment. If applied methods of treatment fit with the above criteria, public support is made for the cost of TB treatment. To discuss the applied treatment, TB Advisory Committee was set in each HC, composing of 5 members, director of HC, 2 TB specialists and 2 doctors recommended by the local medical association. In 1953, the first TB prevalence survey using stratified random sampling method was carried out, and the prevalence of TB requiring treatment was estimated at 3.4%, and only 21% of found cases knew their own disease, and more than half of all TB were found above 30 years of age. Based on these results, mass screening was expanded to cover whole population in 1955, and since 1957, cost of mass screening and BCG vaccination was covered 100% by public fund. Unified TB registration system covering whole Japan was introduced in 1961, and in the same year, national government subsidy for the hospitalization of infectious TB cases was raised from 50% to 80%. Hence, Japan succeeded to organize PPM system in TB care, and with 10% annual decline of TB, in 1975, Japan moved into the TB middle prevalence country.

[ROENTGENOLOGICAL IMAGING FEATURES IN PATIENTS WITH LUNG CANCER AND METASTATIC OF LUNG AFFECTION]

The most often radiological imaging features in patients with lung cancer and metastasis of lung were presented.

Analysis of licensed South African diagnostic imaging equipment

INTRODUCTION OBJECTIVE

To conduct an analysis of all registered South Africa (SA) diagnostic radiology equipment, assess the number of equipment units per capita by imaging modality, and compare SA figures with published international data, in preparation for the introduction of national health insurance (NHI) in SA.

METHODS

The SA Radiation Control Board's database of registered diagnostic radiology equipment was analysed by modality, province and healthcare sector. Access to services was reflected as number of units/million population, and compared with published international data.

RESULTS

General X-ray units are the most equitably distributed and accessible resource (34.8/million). For fluoroscopy (6.6/million), mammography (4.96/million), computed tomography (5.0/million) and magnetic resonance imaging (2.9/million), there are at least 10-fold discrepancies between the least and best resourced provinces. Although SA's overall imaging capacity is well above that of other countries in sub-Saharan Africa, it is lower than that of all Organisation for Economic Co-operation and Development (OECD). While SA's radiological resources most closely approximate those of the United Kingdom, they are substantially lower than the UK.

CONCLUSION

SA access to radiological services is lower than that of any OECD country. For the NHI to achieve equitable access to diagnostic imaging for all citizens, SA will need a more homogeneous distribution of specialised radiological resources and customized imaging guidelines.

Using Skin Markers for Spinal Curvature Quantification in Main Thoracic Adolescent Idiopathic Scoliosis: An Explorative Radiographic Study

Background and Purpose

Although the relevance of understanding spinal kinematics during functional activities in patients with complex spinal deformities is undisputed among researchers and clinicians, evidence using skin marker-based motion capture systems is still limited to a handful of studies, mostly conducted on healthy subjects and using non-validated marker configurations. The current study therefore aimed to explore the validity of a previously developed enhanced trunk marker set for the static measurement of spinal curvature angles in patients with main thoracic adolescent idiopathic scoliosis. In addition, the impact of inaccurate marker placement on curvature angle calculation was investigated.

Methods

Ten patients (Cobb angle: 44.4±17.7 degrees) were equipped with radio-opaque markers on selected spinous processes and underwent a standard biplanar radiographic examination. Subsequently, radio-opaque markers were replaced with retro-reflective markers and the patients were measured statically using a Vicon motion capture system. Thoracolumbar / lumbar and thoracic curvature angles in the sagittal and frontal planes were calculated based on the centers of area of the vertebral bodies and radio-opaque markers as well as the three-dimensional position of the retro-reflective markers. To investigate curvature angle estimation accuracy, linear regression analyses among the respective parameters were used. The impact of inaccurate marker placement was explored using linear regression analyses among the radio-opaque marker- and spinous process-derived curvature angles.

Results and Discussion

The results demonstrate that curvatures angles in the sagittal plane can be measured with reasonable accuracy, whereas in the frontal plane, angles were systematically underestimated, mainly due to the positional and structural deformities of the scoliotic vertebrae. Inaccuracy of marker placement had a greater impact on thoracolumbar / lumbar than thoracic curvature angles. It is suggested that spinal curvature measurements are included in marker-based clinical gait analysis protocols in order to enable a deeper understanding of the biomechanical behavior of the healthy and pathological spine in dynamic situations as well as to comprehensively evaluate treatment effects.

Phase-preserving beam expander for biomedical X-ray imaging

The BioMedical Imaging and Therapy beamlines at the Canadian Light Source are used by many researchers to capture phase-based imaging data. These experiments have so far been limited by the small vertical beam size, requiring vertical scanning of biological samples in order to image their full vertical extent. Previous work has been carried out to develop a bent Laue beam-expanding monochromator for use at these beamlines. However, the first attempts exhibited significant distortion in the diffraction plane, increasing the beam divergence and eliminating the usefulness of the monochromator for phase-related imaging techniques. Recent work has been carried out to more carefully match the polychromatic and geometric focal lengths in a so-called `magic condition' that preserves the divergence of the beam and enables full-field phase-based imaging techniques. The new experimental parameters, namely asymmetry and Bragg angles, were evaluated by analysing knife-edge and in-line phase images to determine the effect on beam divergence in both vertical and horizontal directions, using the flat Bragg double-crystal monochromator at the beamline as a baseline. The results show that by using the magic condition, the difference between the two monochromator types is less than 10% in the diffraction plane. Phase fringes visible in test images of a biological sample demonstrate that this difference is small enough to enable in-line phase imaging, despite operating at a sub-optimal energy for the wafer and asymmetry angle that was used.

[Use of diagnostic nanosecond X-ray pulse apparatuses]

OBJECTIVE

The study the specific features of using diagnostic nanosecond X-ray pulse apparatuses versus X-ray diagnostic apparatuses using direct current X-ray tubes.

MATERIAL AND METHODS

Dosimetric tests of ARDP-01 and Yasen-01 X-ray pulse apparatuses versus RUM2O and Siemens Axiom Iconos R200 apparatuses using direct current X-ray tubes were carried out.

RESULTS

The tests established that the patient radiation dose by a Yasen-01 apparatus is 2.5-3 times lower than that by a Siemens Axiom Iconos R200 apparatus. The radiation dose by an ARDP-01 apparatus was 10-20 times lower than that by a RUM20 apparatus when using film radiation detectors.

CONCLUSION

The performed investigations demonstrate a manifold reduction in the lower X-ray radiation with the use of nanosecond X-ray pulse apparatuses as compared to the continuous radiation. Without changing the characteristics of a radiation detector, the dose can be further reduced by increasing the amplitude and decreasing the duration of the pulse of X-ray tube current, and raising the pulse ratio.

Developing a method and deriving an uncertainty budget for the internal calibration of dosemeters for radiographic equipment

Any institution wishing to perform an internal cross calibration of its diagnostic dosemeters should first quantify the uncertainty associated with this to demonstrate that it remains appropriate for the measurements being undertaken.An uncertainty budget for internal cross calibration that covers a range of locally used dosemeters has been derived using the methodology of the International Atomic Energy Agency. The specific internal cross calibration protocol requirements necessary for this uncertainty budget to be valid are discussed.The final quantified uncertainty is 5.31%; this is dominated by the 5% uncertainty associated with the calibration of the reference instrument. The next largest contributions are from differences in temperature and pressure and dosemeter energy dependence.It has been demonstrated that with careful adherence to a well designed internal cross calibration protocol, dosemeters can be calibrated in-house against a calibrated reference dosemeter with very little increase in the associated calibration uncertainty.

Portable radiography: a reality and necessity for ISS and explorer-class missions

On ISS missions and explorer class missions, unexpected medical and surgical emergencies could be disastrous. Lack of ability to rapidly assess and make critical decisions affects mission capability. Current imaging modalities on ISS consist only of ultrasound. There are many acute diagnoses which ultrasound alone cannot diagnose. Portable X-Ray imaging (radiography) technology has advanced far enough to where it is now small enough, cheap enough, and accurate enough to give diagnostic quality images sent wirelessly to the onboard computer and on Earth for interpretation while fitting in something the size of a briefcase. Although further research is warranted, Portable Radiography is an important addition to have on ISS and future Explorer Class Missions while maintaining a very small footprint.

Radiation safety of sealed radioactive sources

Sealed radioactive sources are used in a wide variety of occupational settings and under differing regulatory/licensing structures. The definition of a sealed radioactive source varies between U.S. regulatory authorities and standard-setting organizations. Potential problems with sealed sources cover a range of risks and impacts. The loss of control of high activity sealed sources can result in very high or even fatal doses to members of the public who come in contact with them. Sources that are not adequately sealed and that fail can cause spread of contamination and potential intake of radioactive material. There is also the possibility that sealed sources may be (or threaten to be) used for terrorist purposes and disruptive opportunities. Until fairly recently, generally licensed sealed sources and devices received little, if any, regulatory oversight and were often forgotten, lost or unaccounted for. Nonetheless, generally licensed devices can contain fairly significant quantities of radioactive material, and there is some potential for exposure if a device is treated in a way for which it was never designed. Industrial radiographers use and handle high activity and/or high dose-rate sealed sources in the field with a high degree of independence and minimal regulatory oversight. Failure to follow operational procedures and properly handle radiography sources can and has resulted in serious injuries and death. Industrial radiographers have experienced a disproportionately large fraction of incidents that have resulted in unintended exposure to radiation. Sources do not have to contain significant quantities of radioactive material to cause problems in the event of their failure. A loss of integrity can cause the spread of contamination and potential exposure to workers and members of the public. The National Council on Radiation Protection and Measurements has previously provided recommendations on select aspects of sealed source programs. Future efforts to provide recommendations for sealed source programs are discussed.

The effect of jet shape on jet injection

The effects of the dispersion pattern of a needle-free jet injector are explored. The shape of the jets were compared using a high-speed video camera and jet injections of collimated and dispersed fluid jets with a Lorentz-force actuated jet injector were made into acrylamide gel and post-mortem porcine tissue. A custom-built high-speed X-ray imaging system was used in order to observe the dynamics of the dispersion mechanism for each injection in real time. We show that a collimated jet stream results in greater tissue penetration than a dispersed jet stream.

Monte Carlo simulation-based feasibility study of a dose-area product meter built into a collimator for diagnostic X-ray

According to the International Electro-technical Commission, manufacturers of X-ray equipment should indicate the number of radiation doses to which a patient can be exposed. Dose-area product (DAP) meters are readily available devices that provide dose indices. Collimators are the most commonly employed radiation beam restrictors in X-ray equipment. DAP meters are attached to the lower surface of a collimator. A DAP meter consists of a chamber and electronics. This separation makes it difficult for operators to maintain the accuracy of a DAP meter. Developing a comprehensive system that has a DAP meter in place of a mirror in the collimator would be effective for measuring, recording the dose and maintaining the quality of the DAP meter. This study was conducted through experimental measurements and a simulation. A DAP meter built into a collimator was found to be feasible when its reading was multiplied by a correction factor.

A proposal for a collecting mirror assembly for large divergence x-ray sources

We propose a new type of collecting mirror assembly (CMA) for x rays, which will enable us to build a powerful optical system for collecting x rays from large divergence sources. The CMA consists of several mirror sections connected in series. The angle of each section is designed so that the x rays reflected from it are parallel to the x rays directly incident on the following sections. A simplified CMA structure is designed and applied to the Al-Kα emission line. It is estimated that by using the CMA the number of x rays detected could be increased by a factor of about 2.5.

Review on the characteristics of radiation detectors for dosimetry and imaging

The enormous advances in the understanding of human anatomy, physiology and pathology in recent decades have led to ever-improving methods of disease prevention, diagnosis and treatment. Many of these achievements have been enabled, at least in part, by advances in ionizing radiation detectors. Radiology has been transformed by the implementation of multi-slice CT and digital x-ray imaging systems, with silver halide films now largely obsolete for many applications. Nuclear medicine has benefited from more sensitive, faster and higher-resolution detectors delivering ever-higher SPECT and PET image quality. PET/MR systems have been enabled by the development of gamma ray detectors that can operate in high magnetic fields. These huge advances in imaging have enabled equally impressive steps forward in radiotherapy delivery accuracy, with 4DCT, PET and MRI routinely used in treatment planning and online image guidance provided by cone-beam CT. The challenge of ensuring safe, accurate and precise delivery of highly complex radiation fields has also both driven and benefited from advances in radiation detectors. Detector systems have been developed for the measurement of electron, intensity-modulated and modulated arc x-ray, proton and ion beams, and around brachytherapy sources based on a very wide range of technologies. The types of measurement performed are equally wide, encompassing commissioning and quality assurance, reference dosimetry, in vivo dosimetry and personal and environmental monitoring. In this article, we briefly introduce the general physical characteristics and properties that are commonly used to describe the behaviour and performance of both discrete and imaging detectors. The physical principles of operation of calorimeters; ionization and charge detectors; semiconductor, luminescent, scintillating and chemical detectors; and radiochromic and radiographic films are then reviewed and their principle applications discussed. Finally, a general discussion of the application of detectors for x-ray nuclear medicine and ion beam imaging and dosimetry is presented.

Phase contrast portal imaging using synchrotron radiation

Microbeam radiation therapy is an experimental form of radiation treatment with great potential to improve the treatment of many types of cancer. We applied a synchrotron radiation phase contrast technique to portal imaging to improve targeting accuracy for microbeam radiation therapy in experiments using small animals. An X-ray imaging detector was installed 6.0 m downstream from an object to produce a high-contrast edge enhancement effect in propagation-based phase contrast imaging. Images of a mouse head sample were obtained using therapeutic white synchrotron radiation with a mean beam energy of 130 keV. Compared to conventional portal images, remarkably clear images of bones surrounding the cerebrum were acquired in an air environment for positioning brain lesions with respect to the skull structure without confusion with overlapping surface structures.