[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To compare image quality of a standard-dose (SD) and a low-dose (LD) cervical spine CT protocol using filtered back-projection (FBP) and iterative reconstruction (IR). MATERIALS AND METHODS: Forty patients investigated by cervical spine CT were prospectively randomised into two groups: SD (120 kVp, 275 mAs) and LD (120 kVp, 150 mAs), both applying automatic tube current modulation. Data were reconstructed using both FBP and sinogram-affirmed IR. Image noise, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were measured. Two radiologists independently and blindly assessed the following anatomical structures at C3-C4 and C6-C7 levels, using a four-point scale: intervertebral disc, content of neural foramina and dural sac, ligaments, soft tissues and vertebrae. They subsequently rated overall image quality using a ten-point scale. RESULTS: For both protocols and at each disc level, IR significantly decreased image noise and increased SNR and CNR, compared with FBP. SNR and CNR were statistically equivalent in LD-IR and SD-FBP protocols. Regardless of the dose and disc level, the qualitative scores with IR compared with FBP, and with LD-IR compared with SD-FBP, were significantly higher or not statistically different for intervertebral discs, neural foramina and ligaments, while significantly lower or not statistically different for soft tissues and vertebrae. The overall image quality scores were significantly higher with IR compared with FBP, and with LD-IR compared with SD-FBP. CONCLUSION: LD-IR cervical spine CT provides better image quality for intervertebral discs, neural foramina and ligaments, and worse image quality for soft tissues and vertebrae, compared with SD-FBP, while reducing radiation dose by approximately 40 %.
[show abstract][hide abstract] ABSTRACT: This article expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about radiation protection for endoscopic procedures, in particular endoscopic retrograde cholangiopancreatography (ERCP). Particular cases, including pregnant women and pediatric patients, are also discussed. This Guideline was developed by a group of endoscopists and medical physicists to ensure that all aspects of radiation protection are adequately dealt with. A two-page executive summary of evidence statements and recommendations is provided. The target readership for this Guideline mostly includes endoscopists, anesthesiologists, and endoscopy assistants who may be exposed to X-rays during endoscopic procedures.
[show abstract][hide abstract] ABSTRACT: In many European countries, image quality for digital x-ray systems used in screening mammography is currently specified using a threshold-detail detectability method. This is a two-part study that proposes an alternative method based on calculated detectability for a model observer: the first part of the work presents a characterization of the systems. Eleven digital mammography systems were included in the study; four computed radiography (CR) systems, and a group of seven digital radiography (DR) detectors, composed of three amorphous selenium-based detectors, three caesium iodide scintillator systems and a silicon wafer-based photon counting system. The technical parameters assessed included the system response curve, detector uniformity error, pre-sampling modulation transfer function (MTF), normalized noise power spectrum (NNPS) and detective quantum efficiency (DQE). Approximate quantum noise limited exposure range was examined using a separation of noise sources based upon standard deviation. Noise separation showed that electronic noise was the dominant noise at low detector air kerma for three systems; the remaining systems showed quantum noise limited behaviour between 12.5 and 380 µGy. Greater variation in detector MTF was found for the DR group compared to the CR systems; MTF at 5 mm(-1) varied from 0.08 to 0.23 for the CR detectors against a range of 0.16-0.64 for the DR units. The needle CR detector had a higher MTF, lower NNPS and higher DQE at 5 mm(-1) than the powder CR phosphors. DQE at 5 mm(-1) ranged from 0.02 to 0.20 for the CR systems, while DQE at 5 mm(-1) for the DR group ranged from 0.04 to 0.41, indicating higher DQE for the DR detectors and needle CR system than for the powder CR phosphor systems. The technical evaluation section of the study showed that the digital mammography systems were well set up and exhibiting typical performance for the detector technology employed in the respective systems.
Physics in Medicine and Biology 06/2011; 56(14):4201-20. · 2.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: Assessment of image quality for digital x-ray mammography systems used in European screening programs relies mainly on contrast-detail CDMAM phantom scoring and requires the acquisition and analysis of many images in order to reduce variability in threshold detectability. Part II of this study proposes an alternative method based on the detectability index (d') calculated for a non-prewhitened model observer with an eye filter (NPWE). The detectability index was calculated from the normalized noise power spectrum and image contrast, both measured from an image of a 5 cm poly(methyl methacrylate) phantom containing a 0.2 mm thick aluminium square, and the pre-sampling modulation transfer function. This was performed as a function of air kerma at the detector for 11 different digital mammography systems. These calculated d' values were compared against threshold gold thickness (T) results measured with the CDMAM test object and against derived theoretical relationships. A simple relationship was found between T and d', as a function of detector air kerma; a linear relationship was found between d' and contrast-to-noise ratio. The values of threshold thickness used to specify acceptable performance in the European Guidelines for 0.10 and 0.25 mm diameter discs were equivalent to threshold calculated detectability indices of 1.05 and 6.30, respectively. The NPWE method is a validated alternative to CDMAM scoring for use in the image quality specification, quality control and optimization of digital x-ray systems for screening mammography.
Physics in Medicine and Biology 06/2011; 56(14):4221-38. · 2.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: This work examines the use of a detectability index to control an Automatic Exposure Control (AEC) system for an amorphous-Selenium digital mammography detector. The default AEC mode for the system was evaluated using homogeneous poly(methyl methacrylate) (PMMA) plates of thickness 20, 40, 60 and 70 mm to find the tube potential and anode/filter settings selected by the system. Detectability index (d') using a non-prewhitened model observer with eye filter (NPWE) was calculated for these beam qualities as a function of air kerma at the detector. AEC settings were calculated that gave constant d' as a function of beam quality for a homogeneous background; a target d' was used that ensured the system passed the achievable image quality criterion for the 0.1 mm diameter disc in the European Guidelines. Threshold gold thickness was measured using the CDMAM test object as a function of beam quality for the AEC mode, which held pixel value (PV) constant, and for the constant d' mode. Threshold gold thickness for the 0.1 mm disc increased by a factor of 2.18 for the constant PV mode, while constant d' mode held threshold gold thickness constant to within 7% and signal-difference-to-noise-ratio (SdNR) constant to within 5%. The constant d' settings derived for homogeneous images were then applied to a phantom with a structured background. Threshold gold thickness for the 0.13 mm disc increased by a factor of 1.90 for the constant PV mode, while constant d' mode held threshold gold thickness constant within 38% for 0.13 mm disk.
Medical Imaging 2011: Physics of Medical Imaging; 02/2011
[show abstract][hide abstract] ABSTRACT: A wide variation in patient exposure has been observed in interventional radiology and cardiology. The purpose of this study was to investigate the patient dose from fluoroscopy-guided procedures performed in non-academic centres when compared with academic centres. Four procedures (coronary angiography, percutaneous coronary intervention, angiography of the lower limbs and percutaneous transluminal angioplasty of the lower limbs) were evaluated. Data on the dose-area product, fluoroscopy time and number of images for 1000 procedures were obtained from 23 non-academic centres and compared with data from 5 academic centres. No differences were found for cardiology procedures performed in non-academic centres versus academic ones. However, significantly lower doses were delivered to patients for procedures of the lower limbs when they were performed in non-academic centres. This may be due to more complex procedures performed in the academic centres. Comparison between the centres showed a great variation in the patient dose for these lower limb procedures.
[show abstract][hide abstract] ABSTRACT: Physicians who frequently perform fluoroscopic examinations are exposed to high intensity radiation fields. The exposure monitoring is performed with a regular personal dosimeter under the apron in order to estimate the effective dose. However, large parts of the body are not protected by the apron (e.g. arms, head). Therefore, it is recommended to wear a supplemental dosimeter over the apron to obtain a better representative estimate of the effective dose. The over-apron dosimeter can also be used to estimate the eye lens dose. The goal of this study was to investigate the relevance of double dosimetry in interventional radiology. First the calibration procedure of the dosimeters placed over the apron was tested. Then, results of double dosimetry during the last five years were analyzed. We found that the personal dose equivalent measured over a lead apron was underestimated by ∼20% to ∼40% for X-ray beam qualities used in radiology. Measurements made over five-year period confirm that the use of a single under-apron dosimeter is inadequate for personnel monitoring. Relatively high skin dose (>10mSv/month) would have remained undetected without a second dosimeter placed on the apron.
[show abstract][hide abstract] ABSTRACT: Diagnostic reference levels (DRLs) were established for 21 indication-based CT examinations for adults in Switzerland. One hundred and seventy-nine of 225 computed tomography (CT) scanners operated in hospitals and private radiology institutes were audited on-site and patient doses were collected. For each CT scanner, a correction factor was calculated expressing the deviation of the measured weighted computed tomography dose index (CTDI) to the nominal weighted CTDI as displayed on the workstation. Patient doses were corrected by this factor providing a realistic basis for establishing national DRLs. Results showed large variations in doses between different radiology departments in Switzerland, especially for examinations of the petrous bone, pelvis, lower limbs and heart. This indicates that the concept of DRLs has not yet been correctly applied for CT examinations in clinical routine. A close collaboration of all stakeholders is mandatory to assure an effective radiation protection of patients. On-site audits will be intensified to further establish the concept of DRLs in Switzerland.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to evaluate and compare organ doses delivered to patients in wrist and petrous bone examinations using a multislice spiral computed tomography (CT) and a C-arm cone-beam CT equipped with a flat-panel detector (XperCT). For this purpose, doses to the target organ, i.e. wrist or petrous bone, together with those to the most radiosensitive nearby organs, i.e. thyroid and eye lens, were measured and compared. Furthermore, image quality was compared for both imaging systems and different acquisition modes using a Catphan phantom. Results show that both systems guarantee adequate accuracy for diagnostic purposes for wrist and petrous bone examinations. Compared with the CT scanner, the XperCT system slightly reduces the dose to target organs and shortens the overall duration of the wrist examination. In addition, using the XperCT enables a reduction of the dose to the eye lens during head scans (skull base and ear examinations).
[show abstract][hide abstract] ABSTRACT: The aim of this work is to compare two methods used for determining the proper shielding of computed tomography (CT) rooms while considering recent technological advances in CT scanners. The approaches of the German Institute for Standardisation and the US National Council on Radiation Protection and Measurements were compared and a series of radiation measurements were performed in several CT rooms at the Lausanne University Hospital. The following three-step procedure is proposed for assuring sufficient shielding of rooms hosting new CT units with spiral mode acquisition and various X-ray beam collimation widths: (1) calculate the ambient equivalent dose for a representative average weekly dose length product at the position where shielding is required; (2) from the maximum permissible weekly dose at the location of interest, calculate the transmission factor F that must be taken to ensure proper shielding and (3) convert the transmission factor into a thickness of lead shielding. A similar approach could be adopted to use when designing shielding for fluoroscopy rooms, where the basic quantity would be the dose area product instead of the load of current (milliampere-minute).
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to assess the spatial resolution of a computed tomography (CT) scanner with an automatic approach developed for routine quality controls when varying CT parameters. The methods available to assess the modulation transfer functions (MTF) with the automatic approach were Droege's and the bead point source (BPS) methods. These MTFs were compared with presampled ones obtained using Boone's method. The results show that Droege's method is not accurate in the low-frequency range, whereas the BPS method is highly sensitive to image noise. While both methods are well adapted to routine stability controls, it was shown that they are not able to provide absolute measurements. On the other hand, Boone's method, which is robust with respect to aliasing, more resilient to noise and provides absolute measurements, satisfies the commissioning requirements perfectly. Thus, Boone's method combined with a modified Catphan 600 phantom could be a good solution to assess CT spatial resolution in the different CT planes.
[show abstract][hide abstract] ABSTRACT: A method of objectively determining imaging performance for a mammography quality assurance programme for digital systems was developed. The method is based on the assessment of the visibility of a spherical microcalcification of 0.2 mm using a quasi-ideal observer model. It requires the assessment of the spatial resolution (modulation transfer function) and the noise power spectra of the systems. The contrast is measured using a 0.2-mm thick Al sheet and Polymethylmethacrylate (PMMA) blocks. The minimal image quality was defined as that giving a target contrast-to-noise ratio (CNR) of 5.4. Several evaluations of this objective method for evaluating image quality in mammography quality assurance programmes have been considered on computed radiography (CR) and digital radiography (DR) mammography systems. The measurement gives a threshold CNR necessary to reach the minimum standard image quality required with regards to the visibility of a 0.2-mm microcalcification. This method may replace the CDMAM image evaluation and simplify the threshold contrast visibility test used in mammography quality.
[show abstract][hide abstract] ABSTRACT: The purpose of this paper is to present a strategy to define diagnostic reference levels DRL for fluoroscopic, dose-intensive
examinations in cardiology and interventional radiology. This work is part of the project of the Federal Office of Public
Health of Switzerland to translate the guidelines of the ICRP and the EU into action. After the 2002 survey in all University
Hospitals in Switzerland this work will present the results of the 2006-2007 survey performed in small and medium sized hospitals.
The data of the small and medium sized hospitals are analyzed to establish DRL. They are corrected to patient size and analyzed
in respect to the difficulty of the examination, the experience of the operator and the type of image detection system. The
results of the study will be compared to those of the former study in the University Hospitals.
KeywordsDiagnostic Reference Level DRL-Cardiology-Interventional Radiology
[show abstract][hide abstract] ABSTRACT: Over the past few years the frequency of computed tomography (CT) examinations has dramatically increased. Simultaneously,
there has been also a significant increase in CT patient dose due to high-resolution imaging and application of more complex
scan techniques. Since no dose limit exists for patients, the International Commission on Radiological Protection introduced
the concept of diagnostic reference levels (DRL) as a means of dose optimization. The aim of this project is to collect patient
doses for the most frequently applied CT protocols and to provide a realistic basis for establishing DRL in CT in Switzerland.
Starting in 2007, patient doses of every Swiss radiological institute operating a CT scanner were going to be collected. Volume
computed tomography dose index (CTDIvol) and dose-length product (DLP) for standard patients was collected for selected clinical CT protocols. The 75th percentile of the CTDIvol and DLP distribution was calculated and compared to the proposed DRL which is partly based on the Swiss survey in 1998 and
recommendations of the European Union. For standard examination of the skull/brain the 75th percentiles are higher than the proposed DRL (72 mGy vs. 60 mGy; 1180 mGy∙cm vs. 1000 mGy∙cm). For examination of thorax
and abdomen/pelvis the 75th percentiles are close to the proposed DRL (thorax: 15 mGy vs. 15 mGy; 511 mGy∙cm vs. 450 mGy∙cm;
abdomen/ pelvis: 16 mGy vs. 15 mGy; 701 mGy∙cm vs. 700 mGy∙cm). In conclusion, there is always a trade-off between dose reduction
and diagnostic image quality. However, especially for skull/brain examinations, optimization is still feasible. The concept
of DRL provides a valuable means for practitioners and manufacturers in optimizing CT protocols.
KeywordsDiagnostic Reference Level-Computed Tomography-Switzerland-CTDI-DLP
[show abstract][hide abstract] ABSTRACT: Surveying the frequency of medical x-ray examinations is of prime importance in the assessment of the collective detriment
due to diagnostic and interventional radiology. In the past, this was performed using paper questionnaires, but today there
is an increasing interest in the automatic collection of the frequency data for reasons related to reducing the work load
and increasing the accuracy of the results. This paper present the work performed in Switzerland to explore the use of the
Tarmed coding system for this purpose. The preliminary investigation covering a sample of examinations indicates that Tarmed
coding can easily be used for the collection of radiography and CT examinations, but presents some difficulties for fluoroscopy,
mainly in the case of complex angiography and interventional examinations.
Keywordsdiagnostics-x-ray examinations-frequency surveys-coding systems-population exposure
[show abstract][hide abstract] ABSTRACT: We studied the influence of signal variability on human and model observers for detection tasks with realistic simulated masses superimposed on real patient mammographic backgrounds and synthesized mammographic backgrounds (clustered lumpy backgrounds, CLB). Results under the signal-known-exactly (SKE) paradigm were compared with signal-known-statistically (SKS) tasks for which the observers did not have prior knowledge of the shape or size of the signal. Human observers' performance did not vary significantly when benign masses were superimposed on real images or on CLB. Uncertainty and variability in signal shape did not degrade human performance significantly compared with the SKE task, while variability in signal size did. Implementation of appropriate internal noise components allowed the fit of model observers to human performance.
Journal of the Optical Society of America A 03/2009; 26(2):425-36. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: We studied the influence of signal variability on human and model observer performances for a detection task with mammographic backgrounds and computer generated clustered lumpy backgrounds (CLB). We used synthetic yet realistic masses and backgrounds that have been validated by radiologists during previous studies, ensuring conditions close to the clinical situation. Four trained non-physician observers participated in two-alternative forced-choice (2-AFC) experiments. They were asked to detect synthetic masses superimposed on real mammographic backgrounds or CLB. Separate experiments were conducted with sets of benign and malignant masses. Results under the signal-known-exactly (SKE) paradigm were compared with signal-known-statistically (SKS) experiments. In the latter case, the signal was chosen randomly for each of the 1,400 2-AFC trials (image pairs) among a set of 50 masses with similar dimensions, and the observers did not know which signal was present. Human observers' results were then compared with model observers (channelized Hotelling with Difference-of-Gaussian and Gabor channels) in the same experimental conditions. Results show that the performance of the human observers does not differ significantly when benign masses are superimposed on real images or on CLB with locally matched gray level mean and standard deviation. For both benign and malignant masses, the performance does not differ significantly between SKE and SKS experiments, when the signals' dimensions do not vary throughout the experiment. However, there is a performance drop when the SKS signals' dimensions vary from 5.5 to 9.5 mm in the same experiment. Noise level in the model observers can be adjusted to reproduce human observers' proportion of correct answers in the 2-AFC task within 5% accuracy for most conditions.
[show abstract][hide abstract] ABSTRACT: Standardized uptake values (SUV) are widely used in positron emission tomography (PET) to quantify [18F]2-fluoro-2-deoxy-d-glucose (18F-FDG) uptake, particularly in therapeutic follow-up. However, this index depends on many factors, be they methodological or biological, and its use is still a subject of debate. In this context, it is fundamental to establish a regular quality control to ensure quantitative indices constancy. In this perspective, a specific phantom with different size cylinder-shaped inserts was developed. The purpose of this study is to show the sensitivity and the interest of this phantom.
Medecine Nucleaire-imagerie Fonctionnelle Et Metabolique - MED NUCL. 01/2008; 32(11):589-595.
[show abstract][hide abstract] ABSTRACT: A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.
European Radiology 07/2007; 17(6):1621-33. · 3.55 Impact Factor