Dual-energy computed tomography quality control: Initial experiences with a semi-automatic analysis tool

PURPOSE

A quality control (QC) system for dual-energy CT (DECT) was developed. The scope of the QC system was to monitor both the constancy of the CT images and the software used in calculating the DECT derived maps. Longitudinal analysis was based on a standard imaging protocol, a commercial multi-energy phantom, and a semi-automatic analysis tool.

METHODS

The phantom consisted of an elliptical body section with round slots for interchangeable inserts. It was scanned with 90kVp/Sn150kVp, automatic tube current modulation, and 9.6 mGy CTDIvol. From the two conventional CT images, scanner manufacturer's software was used to provide virtual monoenergetic images at two different energies, effective atomic number (Zeff) maps, and iodine concentration maps. The images were analyzed using an open-source tool allowing user-selected statistics of interest. The means and standard deviations of the phantom background and the iodine, calcium, and water inserts were recorded. The QC tool is available at github.com/tomakela/dectqatool.

RESULTS

The obtained results were generally highly consistent over time, except for the smaller diameter iodine inserts. A small change inZeff was observed after a DECT software update. The developed QC tool aided the analysis robustness: the segmentations were modifiable when needed, and small rotations or air bubbles in the water insert were easily corrected.

CONCLUSION

The developed QC system provided easy-to-use workflow for constancy measurements. A small deviation due to change in the post-processing was detected. The proposed imaging protocol and analysis steps, and the reported measurement variations can aid in determining action levels for DECT QC.

Automatic chest computed tomography image noise quantification using deep learning

PURPOSE

This study aimed to develop a deep learning (DL) method for noise quantification for clinical chest computed tomography (CT) images without the need for repeated scanning or homogeneous tissue regions.

METHODS

A comprehensive phantom CT dataset (three dose levels, six reconstruction methods, amounting to 9240 slices) was acquired and used to train a convolutional neural network (CNN) to output an estimate of local image noise standard deviations (SD) from a single CT scan input. The CNN model consisting of seven convolutional layers was trained on the phantom image dataset representing a range of scan parameters and was tested with phantom images acquired in a variety of different scan conditions, as well as publicly available chest CT images to produce clinical noise SD maps.

RESULTS

Noise SD maps predicted by the CNN agreed well with the ground truth both visually and numerically in the phantom dataset (errors of < 5 HU for most scan parameter combinations). In addition, the noise SD estimates obtained from clinical chest CT images were similar to running-average based reference estimates in areas without prominent tissue interfaces.

CONCLUSIONS

Predicting local noise magnitudes without the need for repeated scans is feasible using DL. Our implementation trained with phantom data was successfully applied to open-source clinical data with heterogeneous tissue borders and textures. We suggest that automatic DL noise mapping from clinical patient images could be used as a tool for objective CT image quality estimation and protocol optimization.

The effect of optimum, indication-specific imaging fields on the radiation exposure from CBCT examinations of impacted maxillary canines and mandibular third molars

OBJECTIVE

Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs.

METHODS

An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses.

RESULTS

The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa.

CONCLUSIONS

Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures.

Quality assurance framework for rapid automatic analysis deployment in medical imaging

PURPOSE

Automatic image analysis algorithms have an increasing role in clinical quality assurance (QA) in medical imaging. Although the implementation of QA calculation algorithms may be straightforward at the development level, actual deployment of a new method to clinical routine may require substantial additional effort from supporting services. We sought to develop a multimodal system that enables rapid implementation of new QA analysis methods in clinical practice.

METHODS

The QA system was built using freely available open-source software libraries. The included features were results database, database interface, interactive user interface, e-mail error dispatcher, data processing backend, and DICOM server. An in-house database interface was built, providing the developers of analyses with simple access to the results database. An open-source DICOM server was used for image traffic and automatic initiation of modality-specific QA image analyses.

RESULTS

The QA framework enabled rapid adaptation of new analysis methods to automatic image processing workflows. The system provided online data review via an easily accessible user interface. In case of deviations, the system supported simultaneous review of the results for the user and QA expert to trigger corrective actions. In particular, embedded error thresholds, trend analyses, and error-feedback channels were provided to facilitate continuous monitoring and to enable pre-emptive corrective actions.

CONCLUSION

An effective and novel QA framework incorporating easy adaptation and scalability to automated image analysis methods was developed. The framework provides an efficient and responsive web-based tool to manage the normal operation, trends, errors, and abnormalities in medical image quality.

Comparison of cone beam computed tomography and plane radiographs of radial fractures as a basis for radiographical measurements

BACKGROUND

The purpose of this study was to determine whether radiological measurements of radial fracture position made in cone beam computed tomography (CBCT) projection images are comparable to those made on traditional radiographs and could potentially substitute them.

METHODS

Sixteen patients with fractures of the distal radius referred for radiographs were recruited for an additional CBCT scan which was performed immediately afterwards. Projection images and volumetric data were saved from the CBCT scans. Measurements of ulnar variance, radial inclination and volar tilt were made from all three sets of images.

RESULTS

Agreement of projection image based measurements with radiographs was nearly as good as as the agreement of cross sectional image measurements with radiographs. The average difference between the results for projection images and radiographs were -1.2 mm (SD 1.9 mm), for radial inclination 0.7° (SD 2.9°) and for volar tilt 1.9° (SD 5.6°).

CONCLUSION

Differences between radiological measurements between the modalities studied are small and projection images could be used for the assessment of distal radial fractures.

Intraoperative CBCT imaging in endovascular abdomen aneurysm repair - Optimization of exposure parameters using a stent phantom

Cone beam computed tomography (CBCT) may provide essential additional image guidance to endovascular abdominal aneurysm repair (EVAR) operations but also significant radiation exposure to patients if scans are not carefully optimized. The purpose of our study was to define the image quality requirements for intraoperative EVAR CBCT imaging and to optimize the CBCT exposure parameters accordingly. A Multi-Energy CT phantom simulating a large patient was used by replacing the central phantom cylinder with a custom water-filled insert including an EVAR stent. Different exposure parameters covering a range of radiation qualities and dose levels were used to define the optimal image quality level regarding stent graft evaluation (compressed, bent, or collapsed). The radiation dose was measured with a calibrated air kerma-area product (KAP) meter and organ doses were calculated based on Monte Carlo simulations and a mathematical patient model. Based on the results, updated exposure parameters with the highest mean energy and lowest dose level available were recommended. With the updated protocol, the radiation exposure could be significantly decreased. The KAP value decreased from 9720 μGy·m2 to 440 μGy·m2 and reference point air kerma from 351 mGy to 16 mGy (a reduction of 96%) and organ doses of the organs in the irradiated region decreased on an average 91%. The new protocol resulted in acceptable clinical image quality based on testing with clinical cases.

EFFECT OF PELVIC LEAD SHIELD ON ORGAN DOSES IN POSTERO-ANTERIOR CHEST RADIOGRAPHY

Lead shields are commonly used in X-ray imaging to protect radiosensitive organs and to minimise patient's radiation dose. However, they might also complicate or interfere with the examination, and even decrease the diagnostic value if they are positioned incorrectly. In this study, the radiation dose effect of waist half-apron lead shield was examined via Monte Carlo simulations of postero-anterior (PA) chest radiography examinations using a female anthropomorphic phantom. Relevant organs for dose determination were lungs, breasts, liver, kidneys and uterus. The organ dose reductions varied depending on shield position and organ but were negligible for properly positioned shields. The shield that had the largest effective dose reduction (9%) was partly positioned inside the field of view, which should not be done in practice. Dose reduction was practically 0% for properly positioned shields. Therefore, the use of lead shield in the pelvic region during chest PA examinations should be discontinued.

Institutional transition from invasive to non-invasive imaging in children with univentricular heart defects: safety and cost savings

OBJECTIVES

Patients with univentricular heart defects require lifelong imaging surveillance. Recent advances in non-invasive imaging have enabled replacing these patients' routine catheterisation. Our objective was to describe the safety and cost savings of transition of a tertiary care children's hospital from routine invasive to routine non-invasive imaging of low-risk patients with univentricular heart defects.

METHODS

This single-centre cohort study consists of 1) a retrospective analysis of the transition from cardiac catheterisation (n = 21) to CT angiography (n = 20) before bidirectional Glenn operation and 2) a prospective study (n = 89) describing cardiac magnetic resonance before and after the total cavopulmonary connection in low-risk patients with univentricular heart defects.

RESULTS

Pre-Glenn: The total length of CT angiography was markedly shorter compared to the catheterisation: 30 min (range: 20-60) and 125 min (range: 70-220), respectively (p < 0.001). Catheterisation used more iodine contrast agents than CT angiography, 19 ± 3.9 ml, and 10 ± 2.4 ml, respectively (p < 0.001). Controlled ventilation was used for all catheterised and 3 (15%) CT angiography patients (p < 0.001). No complications occurred during CT angiography, while they emerged in 19% (4/21) catheterisation cases (p < 0.001). CT angiography and catheterisation showed no significant difference in the radiation exposure. Pre-/post-total cavopulmonary connection: All cardiac magnetic resonance studies were successful, and no complications occurred. In 60% of the cardiac magnetic resonance (53/89), no sedation was performed, and peripheral venous pressure was measured in all cases. Cost analysis suggests that moving to non-invasive imaging yielded cost savings of at least €2500-4000 per patient.

CONCLUSION

Transition from routine invasive to routine non-invasive pre-and post-operative imaging is safely achievable with cost savings.

The impact of vertical off-centering on image noise and breast dose in chest CT with organ-based tube current modulation: A phantom study

PURPOSE

To determine the effects of patient vertical off-centering when using organ-based tube current modulation (OBTCM) in chest computed tomography (CT) with focus on breast dose.

MATERIALS AND METHODS

An anthropomorphic adult female phantom with two different breast attachment sizes was scanned on GE Revolution EVO and Siemens Definition Edge CT systems using clinical chest CT protocols and anterior-to-posterior scouts. Scans with and without OBTCM were performed at different table heights (GE: centered, ±6 cm, and ± 3 cm; Siemens: centered, -6 cm, and ± 3 cm). The dose effects were studied with metal-oxidesemiconductor field-effect transistor dosimeters with complementary Monte Carlo simulations to determine full dose maps. Changes in image noise were studied using standard deviations of subtraction images from repeated acquisitions without dosimeters.

RESULTS

Patient off-centering affected both the behavior of the normal tube current modulation as well as the extent of the OBTCM. Generally, both OBTCM techniques provided a substantial decrease in the breast doses (up to 30% local decrease). Lateral breast regions may, however, in some cases receive higher doses when OBTCM is enabled. This effect becomes more prominent when the patient is centered too low in the CT gantry. Changes in noise roughly followed the expected inverse of the change in dose.

CONCLUSIONS

Patient off-centering was shown to affect the outcome of OBTCM in chest CT examination, and on some occasions, resulting in higher exposure. The use of modern dose optimization tools such as OBTCM emphasizes the importance of proper centering when preparing patients to CT scans.

Automatic head computed tomography image noise quantification with deep learning

PURPOSE

Computed tomography (CT) image noise is usually determined by standard deviation (SD) of pixel values from uniform image regions. This study investigates how deep learning (DL) could be applied in head CT image noise estimation.

METHODS

Two approaches were investigated for noise image estimation of a single acquisition image: direct noise image estimation using supervised DnCNN convolutional neural network (CNN) architecture, and subtraction of a denoised image estimated with denoising UNet-CNN experimented with supervised and unsupervised noise2noise training approaches. Noise was assessed with local SD maps using 3D- and 2D-CNN architectures. Anthropomorphic phantom CT image dataset (N = 9 scans, 3 repetitions) was used for DL-model comparisons. Mean square error (MSE) and mean absolute percentage errors (MAPE) of SD values were determined using the SD values of subtraction images as ground truth. Open-source clinical head CT low-dose dataset (N_train = 37, N_test = 10 subjects) were used to demonstrate DL applicability in noise estimation from manually labeled uniform regions and in automated noise and contrast assessment.

RESULTS

The direct SD estimation using 3D-CNN was the most accurate assessment method when comparing in phantom dataset (MAPE = 15.5%, MSE = 6.3HU). Unsupervised noise2noise approach provided only slightly inferior results (MAPE = 20.2%, MSE = 13.7HU). 2DCNN and unsupervised UNet models provided the smallest MSE on clinical labeled uniform regions.

CONCLUSIONS

DL-based clinical image assessment is feasible and provides acceptable accuracy as compared to true image noise. Noise2noise approach may be feasible in clinical use where no ground truth data is available. Noise estimation combined with tissue segmentation may enable more comprehensive image quality characterization.

NMR-based metabolomics approach on optimization of malolactic fermentation of sea buckthorn juice with Lactiplantibacillus plantarum

This work investigated the impact of malolactic fermentation on the metabolomic profile of sea buckthorn juice to optimize the fermentation process for flavor modification. Six strains of L. plantarum were used with varied pH of the juice, cell acclimation, and fermentation time. ¹H-NOESY spectra were acquired from fresh and fermented juices with a total of 46 metabolites identified. Less sugars and quinic acid were metabolized at pH 2.7 while oxidation of ascorbic acid was reduced at pH 3.5. l-Malic acid, essential amino acids, and nucleosides were consumed early during fermentation while sugars in general were consumed later in the fermentation. If deacidification is the main target of fermentation, strains that produce less acids and ferment less sugars, shorter fermentation time, and lower starter pH should be used. Higher starter pH and longer fermentation time promote formation of antimicrobial compounds and potentially increase antioxidant stability.

Dental cone beam CT: An updated review

Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony structures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging and summarise the technical features of currently used CBCT scanner models, extending to recent developments in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diagnostic reference levels. We also consider the outlook of potential techniques along with issues that should be resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the patient.

A European perspective on dental cone beam computed tomography systems with a focus on optimisation utilising diagnostic reference levels

Cone beam computed tomography (CBCT) has been available since the late 1990s for use in dentistry. European legislation requires optimisation of protection and the use of diagnostic reference levels (DRLs) as well as regular quality control (QC) of the imaging devices, which is well outlined in existing international recommendations. Nevertheless, the level of application is not known. Earlier studies have indicated that few European countries have established DRLs and that patient doses (exposure parameters) have not been properly optimised. The EURADOS Working Group 12-Dosimetry in Medical Imaging undertook a survey to identify existing practices in Member States. Questionnaires were developed to identify equipment types, clinical procedures performed, and exposure settings used. The surveys were circulated to 22 countries resulting in 28 responses from 13 countries. Variations were identified in the exposure factors and in the doses delivered to patients for similar clinical indicators. Results confirm that patient doses are still not properly optimised and DRLs are largely not established. There is a need to promote the importance of performing QC testing of dental CBCT equipment and to further optimise patient exposure by establishment and use of DRLs as a part of a continuous optimisation process.

PATIENT-SPECIFIC DOSE ESTIMATES IN DYNAMIC COMPUTED TOMOGRAPHY MYOCARDIAL PERFUSION EXAMINATION

The study aimed to implement realistic source models of a computed tomography (CT) scanner and Monte Carlo simulations to actual patient data and to calculate patient-specific organ and effective dose estimates for patients undergoing dynamic CT myocardial perfusion examinations. Source models including bowtie filter, tube output and x-ray spectra were determined for a dual-source Siemens Somatom Definition Flash scanner. Twenty CT angiography patient datasets were merged with a scaled International Commission on Radiological Protection (ICRP) 110 voxel phantom. Dose simulations were conducted with ImpactMC software. Effective dose estimates varied from 5.0 to 14.6 mSv for the 80 kV spectrum and from 8.9 to 24.7 mSv for the 100 kV spectrum. Significant differences in organ doses and effective doses between patients emphasise the need to use actual patient data merged with matched anthropomorphic anatomy in the dose simulations to achieve a reasonable level of accuracy in the dose estimation procedure.

Metal artifacts in intraoperative O-arm CBCT scans

Background

Cone-beam computed tomography (CBCT) has become an increasingly important medical imaging modality in orthopedic operating rooms. Metal implants and related image artifacts create challenges for image quality optimization in CBCT. The purpose of this study was to develop a robust and quantitative method for the comprehensive determination of metal artifacts in novel CBCT applications.

Methods

The image quality of an O-arm CBCT device was assessed with an anthropomorphic pelvis phantom in the presence of metal implants. Three different kilovoltage and two different exposure settings were used to scan the phantom both with and without the presence of metal rods.

Results

The amount of metal artifact was related to the applied CBCT imaging protocol parameters. The size of the artifact was moderate with all imaging settings. The highest applied kilovoltage and exposure level distinctly increased artifact severity.

Conclusions

The developed method offers a practical and robust way to quantify metal artifacts in CBCT. Changes in imaging parameters may have nonlinear effects on image quality which are not anticipated based on physics.

ESTIMATION OF OCCUPATIONAL RADIATION EXPOSURE FOR MEDICAL WORKERS IN RADIOLOGY AND CARDIOLOGY IN THE UNITED ARAB EMIRATES: NINE HOSPITALS EXPERIENCE

PURPOSE

Occupational radiation exposure for medical workers in radiology and cardiology was analyzed in nine hospitals in the UAE between 2002 and 2016. The purpose of the study was to determine the time trend and the differences in occupational radiation exposure among worker groups and hospitals in the country.

METHODS

Readings of 5700 thermoluminescence dosimeters (TLDs) were obtained from 1011 medical workers and grouped into 5 worker groups (radiographers, diagnostic radiologists, nurses, cardiologists and physicians).

RESULTS

The mean annual effective dose was from 0.38 to 0.62 mSv per worker. Even though an increase in the collective effective dose has been noticed during the study period, no significant time trend was observed in the mean effective dose. Furthermore, cardiologists received higher mean and maximum effective doses than the other worker groups.

CONCLUSION

The annual effective doses were below the limits set by national legislation and international standards, and for the average worker, the likelihood of high exposure is small. However, improvements in radiation protection practices could be implemented to reduce occupational radiation dose to cardiologists, who were the most exposed worker group in this study.

CT beam dosimetric characterization procedure for personalized dosimetry

Personalized dosimetry in computed tomography (CT) can be realized by a full Monte Carlo (MC) simulation of the scan procedure. Essential input data needed for the simulation are appropriate CT x-ray source models and a model of the patient's body which is based on the CT image. The purpose of this work is to develop comprehensive procedures for the determination of CT x-ray source models and their verification by comparison of calculated and measured dose distributions in physical phantoms. Mobile equipment together with customized software was developed and used for non-invasive determination of equivalent source models of CT scanners under clinical conditions. Standard and physical anthropomorphic CT dose phantoms equipped with real-time CT dose probes at five representative positions were scanned. The accumulated dose was measured during the scan at the five positions. ImpactMC, an MC-based CT dose software program, was used to simulate the scan. The necessary inputs were obtained from the scan parameters, from the equivalent source models and from the material-segmented CT images of the phantoms. 3D dose distributions in the phantoms were simulated and the dose values calculated at the five positions inside the phantom were compared to measured dose values. Initial results were obtained by means of a General Electric Optima CT 660 and a Toshiba (Canon) Aquilion ONE. In general, the measured and calculated dose values were within relative uncertainties that had been estimated to be less than 10%. The procedures developed were found to be viable and rapid. The procedures are applicable to any scanner type under clinical conditions without making use of the service mode with stationary x-ray tube position. Results show that the procedures are well suited for determining and verifying the equivalent source models needed for personalized CT dosimetry based on post-scan MC calculations.

Potential occupational exposures in diagnostic and interventional radiology: statistical modeling based on Finnish national dose registry data

BACKGROUND

Radiation worker categorization and exposure monitoring practices must be proportional to the current working environment.

PURPOSE

To analyze exposure data of Finnish radiological workers and to estimate the magnitude and frequency of their potential occupational radiation exposure, and to propose appropriate radiation worker categorization.

MATERIAL AND METHODS

Estimates of the probabilities of annual effective doses exceeding certain levels were obtained by calculating the survival function of a lognormal probability density function (PDF) fitted in the measured occupational exposure data.

RESULTS

The estimated probabilities of exceeding annual effective dose limits of 1 mSv, 6 mSv, and 20 mSv were in the order of 1:200, 1:10,000, and 1:500,000 per person, respectively.

CONCLUSION

It is very unlikely that the Category B annual effective dose limit of 6 mSv could even potentially be exceeded using modern equipment and appropriate working methods. Therefore, in terms of estimated effective dose, workers in diagnostic and interventional radiology could be placed into Category B in Finland. Current national personal monitoring practice could be replaced or supplemented using active personal dosimeters, which offer more effective means for optimizing working methods.

The Use of Model-based Iterative Reconstruction to Optimize Chest CT Examinations for Diagnosing Lung Metastases in Patients with Sarcoma: A Phantom Study

RATIONALE AND OBJECTIVES

This phantom study aimed to evaluate low-dose (LD) chest computed tomography (CT) protocols using model-based iterative reconstruction (MBIR) for diagnosing lung metastases in patients with sarcoma.

MATERIALS AND METHODS

An adult female anthropomorphic phantom was scanned with a 64-slice CT using four LD protocols and a standard-dose protocol. Absorbed organ doses were measured with 10 metal-oxide-semiconductor field-effect transistor dosimeters. Furthermore, Monte Carlo simulations were performed to estimate organ and effective doses. Image quality in terms of image noise, contrast, and resolution was measured from the CT images reconstructed with conventional filtered back projection, adaptive statistical iterative reconstruction, and MBIR algorithms. All the results were compared to the performance of the standard-dose protocol.

RESULTS

Mean absorbed organ and effective doses were reduced by approximately 95% with the LD protocol (100-kVp tube voltage and a fixed 10-mA tube current) compared to the standard-dose protocol (120-kVp tube voltage and tube current modulation) while yielding an acceptable image quality for diagnosing round-shaped lung metastases. The effective doses ranged from 0.16 to 2.83 mSv in the studied protocols. The image noise, contrast, and resolution were maintained or improved when comparing the image quality of LD protocols using MBIR to the performance of the standard-dose chest CT protocol using filtered back projection. The small round-shaped lung metastases were delineated at levels comparable to the used protocols.

CONCLUSIONS

Radiation exposure in patients can be reduced significantly by using LD chest CT protocols and MBIR algorithm while maintaining image quality for detecting round-shaped lung metastases.

The effect of vertical centering and scout direction on automatic tube voltage selection in chest CT: a preliminary phantom study on two different CT equipments

Purpose

To determine the effect of patient's vertical off-centering and scout direction on the function of automatic tube voltage selection (ATVS) and tube current modulation (TCM) in chest computed tomography (CT).

Methods

Chest phantom was scanned with Siemens and GE CT systems using three clinical chest CT protocols exploiting ATVS and a fixed 120 kVp chest protocol. The scans were performed at five vertical positions of the phantom (-6 to +6 cm from the scanner isocenter). The effects of scout direction (posterior-to-anterior, anterior-to-posterior, and lateral) and vertical off-centering on the function of ATVS and TCM were studied by examining changes in selected voltage, radiation dose (volume CT dose index, CTDI_vol), and image noise and contrast.

Results

Both scout direction and vertical off-centering affected ATVS. The effect differed between the vendors for the studied geometry, demonstrating differences in technical approaches. The greatest observed increase in CTDI_vol due to off-centering was 91%. Anterior-to-posterior scout produced highest doses at the uppermost table position, whereas posterior-to-anterior scout produced highest doses at the lowermost table position. Dose varied least using lateral scouts. Vertical off-centering impacted image noise and contrast due to the combined effect of ATVS, TCM, structural noise, and bowtie filters.

Conclusions

Patient vertical off-centering and scout direction affected substantially the CTDI_vol and image quality in chest CT examinations. Vertical off-centering caused variation also in the selected tube voltage. The function of ATVS and TCM methods differ significantly between the CT vendors, resulting in differences in CTDI_vol and image noise characteristics.

The European Federation of Organisations for Medical Physics (EFOMP) White Paper: Big data and deep learning in medical imaging and in relation to medical physics profession

Big data and deep learning will profoundly change various areas of professions and research in the future. This will also happen in medicine and medical imaging in particular. As medical physicists, we should pursue beyond the concept of technical quality to extend our methodology and competence towards measuring and optimising the diagnostic value in terms of how it is connected to care outcome. Functional implementation of such methodology requires data processing utilities starting from data collection and management and culminating in the data analysis methods. Data quality control and validation are prerequisites for the deep learning application in order to provide reliable further analysis, classification, interpretation, probabilistic and predictive modelling from the vast heterogeneous big data. Challenges in practical data analytics relate to both horizontal and longitudinal analysis aspects. Quantitative aspects of data validation, quality control, physically meaningful measures, parameter connections and system modelling for the future artificial intelligence (AI) methods are positioned firmly in the field of Medical Physics profession. It is our interest to ensure that our professional education, continuous training and competence will follow this significant global development.

Medical imaging dose optimisation from ground up: expert opinion of an international summit

As in any medical intervention, there is either a known or an anticipated benefit to the patient from undergoing a medical imaging procedure. This benefit is generally significant, as demonstrated by the manner in which medical imaging has transformed clinical medicine. At the same time, when it comes to imaging that deploys ionising radiation, there is a potential associated risk from radiation. Radiation risk has been recognised as a key liability in the practice of medical imaging, creating a motivation for radiation dose optimisation. The level of radiation dose and risk in imaging varies but is generally low. Thus, from the epidemiological perspective, this makes the estimation of the precise level of associated risk highly uncertain. However, in spite of the low magnitude and high uncertainty of this risk, its possibility cannot easily be refuted. Therefore, given the moral obligation of healthcare providers, 'first, do no harm,' there is an ethical obligation to mitigate this risk. Precisely how to achieve this goal scientifically and practically within a coherent system has been an open question. To address this need, in 2016, the International Atomic Energy Agency (IAEA) organised a summit to clarify the role of Diagnostic Reference Levels to optimise imaging dose, summarised into an initial report (Järvinen et al 2017 Journal of Medical Imaging 4 031214). Through a consensus building exercise, the summit further concluded that the imaging optimisation goal goes beyond dose alone, and should include image quality as a means to include both the benefit and the safety of the exam. The present, second report details the deliberation of the summit on imaging optimisation.

Actual and Potential Radiation Exposures in Digital Radiology: Analysis of Cumulative Data, Implications to Worker Classification and Occupational Exposure Monitoring

Radiation worker categorization and exposure monitoring are principal functions of occupational radiation safety. The aim of this study was to use the actual occupational exposure data in a large university hospital to estimate the frequency and magnitude of potential exposures in radiology. The additional aim was to propose a revised categorization and exposure monitoring practice based on the potential exposures. The cumulative probability distribution was calculated from the normalized integral of the probability density function fitted to the exposure data. Conformity of the probabilistic model was checked against 16 years of national monitoring data. The estimated probabilities to exceed annual effective dose limits of 1 mSv, 6 mSv and 20 mSv were 1:1000, 1:20 000 and 1:200 000, respectively. Thus, it is very unlikely that the class A categorization limit of 6 mSv could be exceeded, even in interventional procedures, with modern equipment and appropriate working methods. Therefore, all workers in diagnostic and interventional radiology could be systematically categorized into class B. Furthermore, current personal monitoring practice could be replaced by use of active personal dosemeters that offer more effective and flexible means to optimize working methods.

CT of facial fracture fixation: an experimental study of artefact reducing methods

OBJECTIVES

This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material.

METHODS

Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120- and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metal-induced artefacts.

RESULTS

The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT.

CONCLUSIONS

CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.

Dental cone beam CT: A review

For the maxillofacial region, there are various indications that cannot be interpreted from 2D images and will benefit from multiplanar viewing. Dental cone beam CT (CBCT) utilises a cone- or pyramid-shaped X-ray beam using mostly flat-panel detectors for 3D image reconstruction with high spatial resolution. The vast increase in availability and amount of these CBCT devices offers many clinical benefits, and their ongoing development has potential to bring various new clinical applications for medical imaging. Additionally, there is also a need for high quality research and education. European guidelines promote the use of a medical physics expert for advice on radiation protection, patient dose optimisation, and equipment testing. In this review article, we perform a comparison of technical equipment based on manufacturer data, including scanner specific X-ray spectra, and describe issues concerning CBCT image reconstruction and image quality, and also address radiation dose issues, dosimetry, and optimisation. We also discuss clinical needs and what type of education users should have in order to operate CBCT systems safely. We will also take a look into the future and discuss the issues that still need to be solved.

Limiting CT radiation dose in children with craniosynostosis: phantom study using model-based iterative reconstruction

BACKGROUND

Medical professionals need to exercise particular caution when developing CT scanning protocols for children who require multiple CT studies, such as those with craniosynostosis.

OBJECTIVE

To evaluate the utility of ultra-low-dose CT protocols with model-based iterative reconstruction techniques for craniosynostosis imaging.

MATERIALS AND METHODS

We scanned two pediatric anthropomorphic phantoms with a 64-slice CT scanner using different low-dose protocols for craniosynostosis. We measured organ doses in the head region with metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters. Numerical simulations served to estimate organ and effective doses. We objectively and subjectively evaluated the quality of images produced by adaptive statistical iterative reconstruction (ASiR) 30%, ASiR 50% and Veo (all by GE Healthcare, Waukesha, WI). Image noise and contrast were determined for different tissues.

RESULTS

Mean organ dose with the newborn phantom was decreased up to 83% compared to the routine protocol when using ultra-low-dose scanning settings. Similarly, for the 5-year phantom the greatest radiation dose reduction was 88%. The numerical simulations supported the findings with MOSFET measurements. The image quality remained adequate with Veo reconstruction, even at the lowest dose level.

CONCLUSION

Craniosynostosis CT with model-based iterative reconstruction could be performed with a 20-μSv effective dose, corresponding to the radiation exposure of plain skull radiography, without compromising required image quality.

Radiation exposure to foetus and breasts from dental X-ray examinations: effect of lead shields

OBJECTIVES

Dental radiography may involve situations where the patient is known to be pregnant or the pregnancy is noticed after the X-ray procedure. In such cases, the radiation dose to the foetus, though low, needs to be estimated. Uniform and widely used guidance on dental X-ray procedures during pregnancy are presently lacking, the usefulness of lead shields is unclear and practices vary.

METHODS

Upper estimates of radiation doses to the foetus and breasts of the pregnant patient were estimated with an anthropomorphic female phantom in intraoral, panoramic, cephalometric and CBCT dental modalities with and without lead shields.

RESULTS

The upper estimates of foetal doses varied from 0.009 to 6.9 μGy, and doses at the breast level varied from 0.602 to 75.4 μGy. With lead shields, the foetal doses varied from 0.005 to 2.1 μGy, and breast doses varied from 0.002 to 10.4 μGy.

CONCLUSIONS

The foetal dose levels without lead shielding were <1% of the annual dose limit of 1 mSv for a member of the public. Albeit the relative shielding effect, the exposure-induced increase in the risk of breast cancer death for the pregnant patient (based on the breast dose only) and the exposure-induced increase in the risk of childhood cancer death for the unborn child are minimal, and therefore, need for foetal and breast lead shielding was considered irrelevant. Most important is that pregnancy is never a reason to avoid or to postpone a clinically justified dental radiographic examination.

Characterization of MOSFET dosimeters for low-dose measurements in maxillofacial anthropomorphic phantoms

The aims of this study were to characterize reinforced metal‐oxide‐semiconductor field‐effect transistor (MOSFET) dosimeters to assess the measurement uncertainty, single exposure low‐dose limit with acceptable accuracy, and the number of exposures required to attain the corresponding limit of the thermoluminescent dosimeters (TLD). The second aim was to characterize MOSFET dosimeter sensitivities for two dental photon energy ranges, dose dependency, dose rate dependency, and accumulated dose dependency. A further aim was to compare the performance of MOSFETs with those of TLDs in an anthropomorphic phantom head using a dentomaxillofacial CBCT device. The uncertainty was assessed by exposing 20 MOSFETs and a Barracuda MPD reference dosimeter. The MOSFET dosimeter sensitivities were evaluated for two photon energy ranges (50–90 kVp) using a constant dose and polymethylmethacrylate backscatter material. MOSFET and TLD comparative point‐dose measurements were performed on an anthropomorphic phantom that was exposed with a clinical CBCT protocol. The MOSFET single exposure low dose limit (25% uncertainty, k=2) was 1.69 mGy. An averaging of eight MOSFET exposures was required to attain the corresponding TLD (0.3 mGy) low‐dose limit. The sensitivity was 3.09±0.13 mV/mGy independently of the photon energy used. The MOSFET dosimeters did not present dose or dose rate sensitivity but, however, presented a 1% decrease of sensitivity per 1000 mV for accumulated threshold voltages between 8300 mV and 17500 mV. The point doses in an anthropomorphic phantom ranged for MOSFETs between 0.24 mGy and 2.29 mGy and for TLDs between 0.25 and 2.09 mGy, respectively. The mean difference was −8%. The MOSFET dosimeters presented statistically insignificant energy dependency. By averaging multiple exposures, the MOSFET dosimeters can achieve a TLD‐comparable low‐dose limit and constitute a feasible method for diagnostic dosimetry using anthropomorphic phantoms. However, for single in vivo measurements (<1.7 mGy) the sensitivity is too low.

PACS number: 87.50.wj

Fetal radiation dose in computed tomography

The connection between recorded volumetric CT dose index (CTDI vol) and determined mean fetal dose (Df) was examined from metal-oxide-semiconductor field-effect transistor dose measurements on an anthropomorphic female phantom in four stages of pregnancy in a 64-slice CT scanner. Automated tube current modulation kept the mean Df fairly constant through all pregnancy stages in trauma (4.4-4.9 mGy) and abdomino-pelvic (2.1-2.4 mGy) protocols. In pulmonary angiography protocol, the mean Df increased exponentially as the distance from the end of the scan range decreased (0.01-0.09 mGy). For trauma protocol, the relative mean Df as a function of gestational age were in the range 0.80-0.97 compared with the mean CTDI vol. For abdomino-pelvic protocol, the relative mean Df was 0.57-0.79 and for pulmonary angiography protocol, 0.01-0.05 compared with the mean CTDI vol, respectively. In conclusion, if the fetus is in the primary beam, the CTDI vol can be used as an upper estimate of the fetal dose. If the fetus is not in the primary beam, the fetal dose can be estimated by considering also the distance of the fetus from the scan range.

Indication-based national diagnostic reference levels for paediatric CT: a new approach with proposed values

Indication-based national diagnostic reference levels (DRLs) for a few most common paediatric computed tomography (CT) examinations are proposed. Patient dose data (CTDI vol and dose length product) were collected for over 1000 patients in 4 university hospitals with best experiences in paediatric CT. Four indications for chest CT and two for abdomen (abdomen + pelvis), chest + abdomen and head CT were considered. The DRLs for the body examinations are proposed as exponential DRL-curves, where CTDI vol and dose length product are presented as a function of patient weight. The same DRL curve applies to all the indications studied. The basic 75 % level curve is supplemented by 50 % level curve to enable considerations on varying levels of technology. For head CT, DRLs are proposed for a few age groups (1, 1-5, 5-10 and 10-15 y), separately for routine CT and CT for ventricular size. The proposed DRLs are generally lower than the few published DRLs in other countries.

Conformance of mean glandular dose from phantom and patient data in mammography

In mammography dosimetry, phantoms are often used to represent breast tissue. The conformance of phantom- and patient-based mean glandular dose (MGD) estimates was evaluated mainly from the aspect of diagnostic reference levels. Patient and phantom exposure data were collected for eight diagnostic and three screening mammography devices. More extensive assessments were performed for two devices. The average breast thickness was close to the nationally used reference of 50 mm in diagnostic (50 mm, SD = 13 mm, n = 5342) and screening (47 mm, SD = 13 mm, n = 395) examinations. The average MGD for all breasts differed by 2% from the MGD determined for breasts in the limited compressed thickness range of 40-60 mm. The difference between phantom- and patient-based MGD estimations was up to 30%. Therefore, phantom measurements cannot replace patient dose data in MGD determination.

[CT imaging--towards patient- and indication-specific optimization]

The same CT imaging program should not be applied to all patients, because the required image quality and dose of radiation vary according to the indications and regions. The programs should be optimized on the basis of indication, size of the patient and usage of intravenously administered iodine contrast agent. New technical options are available for reducing the radiation exposure. Additional means of optimization include proper definition of the region being imaged, avoidance of redundant series of images, selection of correct image quality, tube current and voltage, and new methods of calculating images. Patients' radiation exposure and clinical image quality should also be monitored.

Assessment of effective radiation dose of an extremity CBCT, MSCT and conventional X ray for knee area using MOSFET dosemeters

The objective of this study was to assess and compare the organ and effective doses in the knee area resulting from different commercially available multislice computed tomography devices (MSCT), one cone beam computed tomography device (CBCT) and one conventional X-ray radiography device using MOSFET dosemeters and an anthropomorphic RANDO knee phantom. Measurements of the MSCT devices resulted in effective doses ranging between 27 and 48 µSv. The CBCT measurements resulted in an effective dose of 12.6 µSv. The effective doses attained using the conventional radiography device were 1.8 µSv for lateral and 1.2 µSv for anterior-posterior projections. The effective dose resulting from conventional radiography was considerably lower than those recorded for the CBCT and MSCT devices. The MSCT effective dose results were two to four times higher than those measured on the CBCT device. This study demonstrates that CBCT can be regarded as a potential low-dose 3D imaging technique for knee examinations.

Characterization of MOSFET dosimeter angular dependence in three rotational axes measured free-in-air and in soft-tissue equivalent material

When performing dose measurements on an X-ray device with multiple angles of irradiation, it is necessary to take the angular dependence of metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters into account. The objective of this study was to investigate the angular sensitivity dependence of MOSFET dosimeters in three rotational axes measured free-in-air and in soft-tissue equivalent material using dental photon energy. Free-in-air dose measurements were performed with three MOSFET dosimeters attached to a carbon fibre holder. Soft tissue measurements were performed with three MOSFET dosimeters placed in a polymethylmethacrylate (PMMA) phantom. All measurements were made in the isocenter of a dental cone-beam computed tomography (CBCT) scanner using 5º angular increments in the three rotational axes: axial, normal-to-axial and tangent-to-axial. The measurements were referenced to a RADCAL 1015 dosimeter. The angular sensitivity free-in-air (1 SD) was 3.7 ± 0.5 mV/mGy for axial, 3.8 ± 0.6 mV/mGy for normal-to-axial and 3.6 ± 0.6 mV/mGy for tangent-to-axial rotation. The angular sensitivity in the PMMA phantom was 3.1 ± 0.1 mV/mGy for axial, 3.3 ± 0.2 mV/mGy for normal-to-axial and 3.4 ± 0.2 mV/mGy for tangent-to-axial rotation. The angular sensitivity variations are considerably smaller in PMMA due to the smoothing effect of the scattered radiation. The largest decreases from the isotropic response were observed free-in-air at 90° (distal tip) and 270° (wire base) in the normal-to-axial and tangent-to-axial rotations, respectively. MOSFET dosimeters provide us with a versatile dosimetric method for dental radiology. However, due to the observed variation in angular sensitivity, MOSFET dosimeters should always be calibrated in the actual clinical settings for the beam geometry and angular range of the CBCT exposure.

Effect of vertical positioning on organ dose, image noise and contrast in pediatric chest CT--phantom study

BACKGROUND

CT optimization has a special importance in children. Smaller body size accentuates the importance of patient positioning affecting both radiation dose and image quality.

OBJECTIVE

To determine the effect of vertical positioning on organ dose, image noise and contrast in pediatric chest CT examination.

MATERIALS AND METHODS

Chest scans of a pediatric 5-year anthropomorphic phantom were performed in different vertical positions (-6 cm to +5.4 cm) with a 64-slice CT scanner. Organ doses were measured with metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters. Image noise and contrast were determined from the CT number histograms corresponding to different tissues.

RESULTS

Significant changes in organ doses resulting from vertical positioning were observed, especially in radiosensitive anterior organs. The breast dose increased up to 16% and the thyroid dose up to 24% in lower positions. The noise was increased up to 45% relative to the centre position in the highest and lowest vertical positions, with a particular increase observed on the anterior and posterior sides, respectively. Off-centering also affected measured image contrast.

CONCLUSION

Vertical off-centering markedly affects organ doses and measured image-quality parameters in pediatric chest CT examination. Special attention should be given to correct patient centering when preparing patients for CT scans, especially when imaging children.

CT arthrography of the wrist using a novel, mobile, dedicated extremity cone-beam CT (CBCT)

PURPOSE

To evaluate the feasibility and intra- and interobserver agreement of CBCT arthrography of wrist ligaments, triangular fibrocartilaginous complex (TFCC), and to assess the sensitivity (SE), specificity (SP), accuracy (ACC), and positive and negative predictive value (PPV, NPV) of CBCT arthrography in the diagnosis of scapholunate (SLL) and lunotriquetral (LTL) ligament tears, TFCC, and cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) using a novel, mobile, dedicated extremity CBCT scanner.

MATERIALS AND METHODS

Fifty-two consecutively enrolled subjects (26 M, 26 F, mean age 38 years, range 18-66 years) with suspected wrist ligament tears underwent CBCT-arthrography before normally scheduled MR arthrography.An extremity CBCT was used for imaging with isotropic voxel size of 0.4 × 0.4 × 0.4 mm(3). Subsequent routine 1.5 T MRI was performed using a dedicated wrist coil.Two observers reviewed the anonymized CBCT images twice for contrast enhancement (CE) and technical details (TD), for tears of the SLL, LTL, and TFCC. Also, cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) were evaluated. Inter- and intraobserver agreement was determined using weighted kappa statistics. Since no surgery was performed, MRI served as a reference standard, and SE and SP, ACC, PPV, and NPV were calculated.

RESULTS

Intra- and interobserver kappa values for both readers (reader 1/reader 2; first reading/second reading) with 95 % confidence limits were: CE 0.54 (0.08-1.00)/ 0.75 (0.46-1.00); 0.73 (0.29-1.00)/ 0.45 (0.07-0.83), TD 0.53 (0.30-0.88)/ 0.86 (0.60-1.00); 0.56 (0.22-0.91)/ 0.67 (0.37-0.98), SLL 0.59 (0.25-0.93)/ 0.66 (0.42-0.91); 0.31 (0.06-0.56)/ 0.49 (0.26-0.73), LTL 0.83 (0.66-1.00)/ 0.68 (0.46-0.91); 0.90 (0.79-1.00)/ 0.48 (0.22-0.74); TFCC (0.72-1.00)/ (0.79-1.00); 0.65 (0.43-0.87)/ 0.59 (0.35-0.83), radius (scaphoid fossa) 0.45 (0.12-0.77)/ 0.64 (0.31-0.96); 0.58 (0.19-0.96)/ 0.38 (0.09-0.66), scaphoid 0.43 (0.12-0.74)/ 0.76 (0.55-0.96); 0.37 (0.00-0.75)/ 0.32 (0.04-0.59), radius (lunate fossa) 0.68 (0.36-1.00)/ 0.42 (0.00-0.86); 0.62 (0.29-0.96)/ 0.51 (0.12-0.91), and lunate 0.53 (0.16-0.90)/ 0.68 (0.44-0.91); 0.59 (0.29-0.88)/ 0.42 (0.00-0.84), respectively. The overall mean accuracy was 82-92 % and specificity was 81-94 %. Sensitivity for LTL and TFCC tears was 76-83, but for SLL tears it was 58 %. For cartilage abnormalities, the accuracy and negative predictive value were high, 90-98 %.

CONCLUSIONS

A dedicated CBCT extremity scanner is a new method for evaluating the wrist ligaments and radiocarpal cartilage. The method has an overall accuracy of 82-86 % and specificity 81-91 %. For cartilage abnormalities, the accuracy and negative predictive value were high.

Aspects of forward scattering from the compression paddle in the dosimetry of mammography

The best compression paddle position during air kerma measurement in mammography dosimetry was studied. The amount of forward scattering as a function of the compression paddle distance was measured with different X-ray spectra and different types of paddles and dose meters. The contribution of forward scattering to the air kerma did not present significant dependency on the beam quality or of the compression paddle type. The tested dose meter types detected different amounts of forward scattering due to different internal collimation. When the paddle was adjusted to its maximum clinical distance, the proportion of the detected forward scattering was only 1 % for all dose meter types. The most consistent way of performing air kerma measurements is to position the compression paddle at the maximum distance from the dose meter and use a constant forward scattering factor for all dose meters. Thus, the dosimetric uncertainty due to the forward scatter can be minimised.

Assessment of radiation exposure in dental cone-beam computerized tomography with the use of metal-oxide semiconductor field-effect transistor (MOSFET) dosimeters and Monte Carlo simulations

OBJECTIVES

The aims of this study were to assess the organ and effective dose (International Commission on Radiological Protection (ICRP) 103) resulting from dental cone-beam computerized tomography (CBCT) imaging using a novel metal-oxide semiconductor field-effect transistor (MOSFET) dosimeter device, and to assess the reliability of the MOSFET measurements by comparing the results with Monte Carlo PCXMC simulations.

STUDY DESIGN

Organ dose measurements were performed using 20 MOSFET dosimeters that were embedded in the 8 most radiosensitive organs in the maxillofacial and neck area. The dose-area product (DAP) values attained from CBCT scans were used for PCXMC simulations. The acquired MOSFET doses were then compared with the Monte Carlo simulations.

RESULTS

The effective dose measurements using MOSFET dosimeters yielded, using 0.5-cm steps, a value of 153 μSv and the PCXMC simulations resulted in a value of 136 μSv.

CONCLUSIONS

The MOSFET dosimeters placed in a head phantom gave results similar to Monte Carlo simulations. Minor vertical changes in the positioning of the phantom had a substantial affect on the overall effective dose. Therefore, the MOSFET dosimeters constitute a feasible method for dose assessment of CBCT units in the maxillofacial region.

A proposed protocol for acceptance and constancy control of computed tomography systems: a Nordic Association for Clinical Physics (NACP) work group report

BACKGROUND

Quality assurance (QA) of computed tomography (CT) systems is one of the routine tasks for medical physicists in the Nordic countries. However, standardized QA protocols do not yet exist and the QA methods, as well as the applied tolerance levels, vary in scope and extent at different hospitals.

PURPOSE

To propose a standardized protocol for acceptance and constancy testing of CT scanners in the Nordic Region.

MATERIAL AND METHODS

Following a Nordic Association for Clinical Physics (NACP) initiative, a group of medical physicists, with representatives from four Nordic countries, was formed. Based on international literature and practical experience within the group, a comprehensive standardized test protocol was developed.

RESULTS

The proposed protocol includes tests related to the mechanical functionality, X-ray tube, detector, and image quality for CT scanners. For each test, recommendations regarding the purpose, equipment needed, an outline of the test method, the measured parameter, tolerance levels, and the testing frequency are stated. In addition, a number of optional tests are briefly discussed that may provide further information about the CT system.

CONCLUSION

Based on international references and medical physicists' practical experiences, a comprehensive QA protocol for CT systems is proposed, including both acceptance and constancy tests. The protocol may serve as a reference for medical physicists in the Nordic countries.

Organ dose calculation in CT based on scout image data and automatic image registration

BACKGROUND

Computed tomography (CT) has become the main contributor of the cumulative radiation exposure in radiology. Information on cumulative exposure history of the patient should be available for efficient management of radiation exposures and for radiological justification.

PURPOSE

To develop and evaluate automatic image registration for organ dose calculation in CT.

MATERIAL AND METHODS

Planning radiograph (scout) image data describing CT scan ranges from 15 thoracic CT examinations (9 men and 6 women) and 10 abdominal CT examinations (6 men and 4 women) were co-registered with the reference trunk CT scout image. 2-D affine transformation and normalized correlation metric was used for image registration. Longitudinal (z-axis) scan range coordinates on the reference scout image were converted into slice locations on the CT-Expo anthropomorphic male and female models, following organ and effective dose calculations.

RESULTS

The average deviation of z-location of studied patient images from the corresponding location in the reference scout image was 6.2 mm. The ranges of organ and effective doses with constant exposure parameters were from 0 to 28.0 mGy and from 7.3 to 14.5 mSv, respectively. The mean deviation of the doses for fully irradiated organs (inside the scan range), partially irradiated organs and non-irradiated organs (outside the scan range) was 1%, 5%, and 22%, respectively, due to image registration.

CONCLUSION

The automated image processing method to registrate individual chest and abdominal CT scout radiograph with the reference scout radiograph is feasible. It can be used to determine the individual scan range coordinates in z-direction to calculate the organ dose values. The presented method could be utilized in automatic organ dose calculation in CT for radiation exposure tracking of the patients.

Effect of varying displays and room illuminance on caries diagnostic accuracy in digital dental radiographs

In clinical practice, digital radiographs taken for caries diagnostics are viewed on varying types of displays and usually in relatively high ambient lighting (room illuminance) conditions. Our purpose was to assess the effect of room illuminance and varying display types on caries diagnostic accuracy in digital dental radiographs. Previous studies have shown that the diagnostic accuracy of caries detection is significantly better in reduced lighting conditions. Our hypothesis was that higher display luminance could compensate for this in higher ambient lighting conditions. Extracted human teeth with approximal surfaces clinically ranging from sound to demineralized were radiographed and evaluated by 3 observers who detected carious lesions on 3 different types of displays in 3 different room illuminance settings ranging from low illumination, i.e. what is recommended for diagnostic viewing, to higher illumination levels corresponding to those found in an average dental office. Sectioning and microscopy of the teeth validated the presence or absence of a carious lesion. Sensitivity, specificity and accuracy were calculated for each modality and observer. Differences were estimated by analyzing the binary data assuming the added effects of observer and modality in a generalized linear model. The observers obtained higher sensitivities in lower illuminance settings than in higher illuminance settings. However, this was related to a reduction in specificity, which meant that there was no significant difference in overall accuracy. Contrary to our hypothesis, there were no significant differences between the accuracy of different display types. Therefore, different displays and room illuminance levels did not affect the overall accuracy of radiographic caries detection.

Transition in occupational radiation exposure monitoring methods in diagnostic and interventional radiology

Radiation exposure monitoring is a traditional keystone of occupational radiation safety measures in medical imaging. The aim of this study was to review the data on occupational exposures in a large central university hospital radiology organisation and propose changes in the radiation worker categories and methods of exposure monitoring. An additional objective was to evaluate the development of electronic personal dosimeters and their potential in the digitised radiology environment. The personal equivalent dose of 267 radiation workers (116 radiologists and 151 radiographers) was monitored using personal dosimeters during the years 2006-2010. Accumulated exposure monitoring results exceeding the registration threshold were observed in the personal dosimeters of 73 workers (59 radiologists' doses ranged from 0.1 to 45.1 mSv; 14 radiographers' doses ranged from 0.1 to 1.3 mSv). The accumulated personal equivalent doses are generally very small, only a few angiography radiologists have doses >10 mSv per 5 y. The typical effective doses are <10 µSv y(-1) and the highest value was 0.3 mSv (single interventional radiologist). A revised categorisation of radiation workers based on the working profile of the radiologist and observed accumulated doses is justified. Occupational monitoring can be implemented mostly with group dosimeters. An active real-time dosimetry system is warranted to support radiation protection strategy where optimisation aspects, including improving working methods, are essential.