Spatio-temporal generalized Model Observers methods for Low Contrast Detectability assessment in digital angiography: Application to moving targets.

The purpose of this work is to investigate the feasibility of spatio-temporal generalized Model Observer methods for protocol optimization programs in the field of interventional radiography. Two Model Observers were taken under examination: a Channelized Hotelling Observer with 24 spatio-temporal Gabor channels and a Non Pre-Whitening Model Observer with two different implementations of the spatio-temporal contrast sensitivity function. The images of targets, both stationary and in motion, were acquired in fluoroscopic mode using a CDRAD phantom for signal-present images and an homogenous slab of PMMA for signal-absent ones. After the processing, these images were used to build three series of two alternative forced choice experiments, designed to simulate tasks of clinical interest, and submitted to three human observers in order to set a goal on detectability. A first set of images was used for model tuning and subsequently the verified models were validated throughout a second set of images. Results from the validation phase, for both models, show good agreement with the human observer performances (Root Mean Square Error RMSE ≤ 12%). The tuning phase emerges as a crucial step in building models for angiographic dynamic images; the final agreement underlines the good capability of these spatio-temporal models in simulating human performances, allowing to consider them as a useful and worthwhile tool in protocol optimization when dynamic images are involved.

Statement of the Italian Association of Medical Physics (AIFM) task group on radiation dose monitoring systems.

The evaluation of radiation burden in vivo is crucial in modern radiology as stated also in the European Directive 2013/59/Euratom-Basic Safety Standard. Although radiation dose monitoring can impact the justification and optimization of radiological procedure, as well as effective patient communication, standardization of radiation monitoring software is far to be achieved. Toward this goal, the Italian Association of Medical Physics (AIFM) published a report describing the state of the art and standard guidelines in radiation dose monitoring system quality assurance. This article reports the AIFM statement about radiation dose monitoring systems (RDMSs) summarizing the different critical points of the systems related to Medical Physicist Expert (MPE) activities before, during, and after their clinical implementation. In particular, the article describes the general aspects of radiation dose data management, radiation dose monitoring systems, data integrity, and data responsibilities. Furthermore, the acceptance tests that need to be implemented and the most relevant dosimetric data for each radiological modalities are reported under the MPE responsibility.

A single phantom, a single statistical method for low-contrast detectability assessment.

PURPOSE: The assessment of low-contrast-details is a part of the quality control (QC) program in digital radiology. It generally consists of evaluating the threshold contrast (Cth) detectability details for different-sized inserts, appropriately located in dedicated QC test tools. This work aims to propose a simplified method, based on a statistical model approach for threshold contrast estimation, suitable for different modalities in digital radiology. METHODS: A home-madelow-contrast phantom, made of a central aluminium insert with a step-wedge, was assembled and tested. The reliability and robustness of the method were investigated for Mammography, Digital Radiography, Fluoroscopy and Angiography. Imageswere analysed using our dedicated software developed on Matlab®. TheCth is expressed in the same unit (mmAl) for all studied modalities. RESULTS: This method allows the collection of Cthinformation from different modalities and equipment by different vendors, and it could be used to define typical values. Results are summarized in detail. For 0.5 diameter detail, Cthresults are in the range of: 0.018-0.023 mmAl for 2D mammography and 0.26-0.34 mmAl DR images. For angiographic images, for 2.5 mm diameter detail, the Cths median values are 0.55, 0.4, 0.06, 0.12 mmAl for low dose fluoroscopy, coronary fluorography, cerebral and abdominal DSA, respectively. CONCLUSIONS: The statistical method proposed in this study gives a simple approach for Low-Contrast-Details assessment, and the typical values proposed can be implemented in a QA program for digital radiology modalities.

Patient dose in angiographic interventional procedures: A multicentre study in Italy.

PURPOSE: The Council Directive 2013/59/EURATOM considers interventional radiology to be a special practice involving high doses of radiation and requiring strict monitoring to ensure the best quality assurance programs. This work reports the early experience of managing dose data from patients undergoing angiography in a multicentre study. MATERIALS AND METHODS: The study was based on a survey of about 15,200 sample procedures performed in 21 Italian hospitals centres involved on a voluntary basis. The survey concerned the collection of data related to different interventional radiology procedures: interventional cardiology, radiology, neuroradiology, vascular surgery, urology, endoscopy and pain therapy from a C-Arm and fixed units. The analysis included 11 types of procedures and for each procedure, air-kerma, kerma-area product and fluoroscopy time were collected. RESULTS: The duration and dose values of fluoroscopic exposure for each procedure is strongly dependent on individual clinical circumstances including the complexity of the procedure; the observed distribution of patient doses was very wide, even for a specified protocol. The median values of the parameters were compared with the diagnostic reference levels (DRL) proposed for some procedures in Italy (ISTISAN) or internationally. This work proposes local DRL values for three procedures. CONCLUSION: This first data collection serves to take stock of the situation on patient's dosimetry in several sectors and is the starting point for obtaining and updating DRL recalling that these levels are dependent on experience and technology available.

Model observers for Low Contrast Detectability evaluation in dynamic angiography: A feasible approach.

PURPOSE: To evaluate the feasibility of spatio-temporal generalisation of mathematical methods for protocol optimisation in interventional radiology. MATERIALS AND METHODS: Two model observers were considered:Furthermore, Low Contrast Detectability (LCD) was evaluated with a generalised statistical method by taking into account the noise integration capability of the human eye. A series of two alternative force choices (2AFC) experiments performed by four observers were used to evaluate the reliability of the proposed models. The evaluation of the mathematical methods was performed by comparing their results to the human observer performances in two steps: 1. Firstly, a series of simulated images were used to tune the models 2. In the second phase, tuned models were applied both to simulated images and actual images obtained with a commercial phantom to evaluate detectability scores. RESULTS: Evaluation with simulated images shows a good agreement with 2AFC results (RMSE < 10%). Phantom-based evaluations show a general decrease of such agreement, characterized by an RMSE lower than 16%. CONCLUSIONS: The agreement with human observer experiments supports the feasibility of the proposed generalisations. Thus, they could be introduced in quality control programmes for a deeper protocol-characterisation or for clinical protocol-optimization when dynamic images are involved.

Evaluation of a commercial Model Based Iterative reconstruction algorithm in computed tomography.

INTRODUCTION: Iterative reconstruction algorithms have been introduced in clinical practice to obtain dose reduction without compromising the diagnostic performance. PURPOSE: To investigate the commercial Model Based IMR algorithm by means of patient dose and image quality, with standard Fourier and alternative metrics. MATERIALS AND METHODS: A Catphan phantom, a commercial density phantom and a cylindrical water filled phantom were scanned both varying CTDIvol and reconstruction thickness. Images were then reconstructed with Filtered Back Projection and both statistical (iDose) and Model Based (IMR) Iterative reconstruction algorithms. Spatial resolution was evaluated with Modulation Transfer Function and Target Transfer Function. Noise reduction was investigated with Standard Deviation. Furthermore, its behaviour was analysed with 3D and 2D Noise Power Spectrum. Blur and Low Contrast Detectability were investigated. Patient dose indexes were collected and analysed. RESULTS: All results, related to image quality, have been compared to FBP standard reconstructions. Model Based IMR significantly improves Modulation Transfer Function with an increase between 12% and 64%. Target Transfer Function curves confirm this trend for high density objects, while Blur presents a sharpness reduction for low density details. Model Based IMR underlines a noise reduction between 44% and 66% and a variation in noise power spectrum behaviour. Low Contrast Detectability curves underline an averaged improvement of 35-45%; these results are compatible with an achievable reduction of 50% of CTDIvol. A dose reduction between 25% and 35% is confirmed by median values of CTDIvol. CONCLUSION: IMR produces an improvement in image quality and dose reduction.

Quality assurance multicenter comparison of different MR scanners for quantitative diffusion-weighted imaging.

PURPOSE: To propose a magnetic resonance imaging (MRI) quality assurance procedure that can be used for multicenter comparison of different MR scanners for quantitative diffusion-weighted imaging (DWI). MATERIALS AND METHODS: Twenty-six centers (35 MR scanners with field strengths: 1T, 1.5T, and 3T) were enrolled in the study. Two different DWI acquisition series (b-value ranges 0-1000 and 0-3000 s/mm(2) , respectively) were performed for each MR scanner. All DWI acquisitions were performed by using a cylindrical doped water phantom. Mean apparent diffusion coefficient (ADC) values as well as ADC values along each of the three main orthogonal directions of the diffusion gradients (x, y, and z) were calculated. Short-term repeatability of ADC measurement was evaluated for 26 MR scanners. RESULTS: A good agreement was found between the nominal and measured mean ADC over all the centers. More than 80% of mean ADC measurements were within 5% from the nominal value, and the highest deviation and overall standard deviation were 9.3% and 3.5%, respectively. Short-term repeatability of ADC measurement was found <2.5% for all MR scanners. CONCLUSION: A specific and widely accepted protocol for quality controls in DWI is still lacking. The DWI quality assurance protocol proposed in this study can be applied in order to assess the reliability of DWI-derived indices before tackling single- as well as multicenter studies.

Simultaneous liver iron and fat measures by magnetic resonance imaging in patients with hyperferritinemia.

OBJECTIVE: Hyperferritinemia is frequent in chronic liver diseases of any cause, but the extent to which ferritin truly reflects iron stores is variable. In these patients, both liver iron and fat are found in variable amount and association. Liver biopsy is often required to quantify liver fat and iron, but sampling variability and invasiveness limit its use. We aimed to assess single breath-hold multiecho magnetic resonance imaging (MRI) for the simultaneous lipid and iron quantification in patients with hyperferritinemia. MATERIAL AND METHODS: We compared MRI results for both iron and fat with their respective gold standards - liver iron concentration and computer-assisted image analysis for steatosis on biopsy. We prospectively studied 67 patients with hyperferritinemia and other 10 consecutive patients were used for validation. We estimated two linear calibration equations for the prediction of iron and fat based on MRI. The agreement between MRI and biopsy was evaluated. RESULTS: MRI showed good performances in both the training and validation samples. MRI information was almost completely in line with that obtained from liver biopsy. CONCLUSION: Single breath-hold multiecho MRI is an accurate method to obtain a valuable measure of both liver iron and steatosis in patients with hyperferritinemia.

Dosimetric evaluation of a 256-slice computed tomography scanner.

PURPOSE: This study evaluated the effectiveness of patient dose reduction tools on a 256-slice computed tomography scanner (Brilliance iCT, Philips). MATERIALS AND METHODS: The performance of the Brilliance iCT scanner was described in terms of cumulative dose and dose-normalised contrast-to-noise ratio (CNRD). The efficiency of automatic tube current modulation (Z-Dom and D-Dom), shaping filters (SmartShape and IntelliBeam) and asymmetric collimator (Eclipse) was evaluated using appropriate phantoms. RESULTS: The scattered radiation contribution from the peripheral regions to the cumulative dose is not negligible. The CNRD is 20 % better compared to a traditional 16-slice scanner, with a dose reduction of 40 %. The application of shaping filters decreases the dose in the peripheral regions. The application of D-Dom and Z-Dom modulations reduces the current-time product (mAs) values by 23 and 18 %, respectively, but they are not yet integrated. The over-ranging effect is not negligible, despite the use of an Eclipse asymmetric collimator. CONCLUSIONS: Brilliance iCT dose reduction tools are efficient, but should be analysed carefully and used correctly.

Acceptance tests of diagnostic displays in a PACS system according to AAPM TG18.

In a filmless environment it is necessary to execute acceptance and constancy tests on monitors used for interpretation of medical images. Performances of Barco CRT MGD521 MKII, Barco LCD L685EX monitors have been evaluated. Acceptancepress were executed following AAPM Task Group 18 guidelines. Visual and instrumental evaluations of geometric distortions, reflections, luminances response, contrast, uniformity, resolution, angular response and veiling glare were made. Barco monitors showed optimal performances, while EIZO monitors were accepted with some reserve on their quality level. Finally a comparative evaluation between monitors and film (the actual gold standard) was performed by an interview of ten radiologists: the monitors showed a quality at least equal to film. These monitors are currently in use for routine medical interpretation.