Reassessing lead protective garment assessment using ICRP 103 tissue weighting factors.

Lead protective garments worn by medical staff in the presence of x-rays develop defects over time. This work proposes a novel method of assessing the protective efficacy of the garments as defects develop. The proposed method applies updated radiobiology data from ICRP 103. This work applied the as low as reasonably achievable principle to devise a formula through which a maximum allowed defect area in lead protective garments can be calculated. This formula depends on the cross-sectional areas (A) and ICRP 103 tissue weighting factors (wt) of the most radiosensitive and overlapping organs protected by the garment, the maximum allowed additional effective dose to the garment wearer due to the defects (d), and the unattenuated absorbed dose at the surface of the garment (D). The maximum allowed defect areas are separated into three regions:above the waist, below the waist, andthyroid. To be conservative, it was assumed thatD= 50 mGy yr-1, andd= 0.3 mSv yr-1. Also conservatively, transmission was assumed to be 0%, as employing a non-zero transmission factor would increase the maximum allowed defect area. Maximum allowed defect areas were as follows: 370 mm2for above the waist, 37 mm2for below the waist, and 279 mm2for the thyroid. These values can be compared to commonly published values which are 670 mm2for an apron, 15 mm2over the gonads, and 11-20 mm2for the thyroid. The proposed method for lead protective garment assessment is highly adaptable as values can be adjusted as radiobiology data are updated, and as values such as radiation dose limits vary across jurisdictions. Future works will include collection of data for unattenuated dose to apron (D) as it varies across professions, so that garments may be allowed different defect areas if relegated to individuals of specific professions.

COMP Report: A survey of radiation safety regulations for medical imaging x-ray equipment in Canada.

X-ray regulations and room design methodology vary widely across Canada. The Canadian Organization of Medical Physicists (COMP) conducted a survey in 2016/2017 to provide a useful snapshot of existing variations in rules and methodologies for human patient medical imaging facilities. Some jurisdictions no longer have radiation safety regulatory requirements and COMP is concerned that lack of regulatory oversight might erode safe practices. Harmonized standards will facilitate oversight that will ensure continued attention is given to public safety and to control workplace exposure. COMP encourages all Canadian jurisdictions to adopt the dose limits and constraints outlined in Health Canada Safety Code 35 with the codicil that the design standards be updated to those outlined in NCRP 147 and BIR 2012.

Cascaded systems analysis of anatomic noise in digital mammography and dual-energy digital mammography.

In x-ray based imaging of the breast, contrast between fibroglandular (Fg) tissue and adipose (Ad) tissue is a source of anatomic noise. The goal of this work was to validate by simulation and experiment a mathematical framework for modelling the Fg component of anatomic noise in digital mammograpy (DM) and dual-energy (DE) DM. Our mathematical framework unifies and generalizes existing approaches. We compared mathematical predictions directly with empirical measurements of the anatomic noise power spectrum of the CIRS BR3D structured breast phantom using two clinical mammography systems and four beam qualities. Our simulation and experimental results showed agreement with mathematical predictions. As a demonstration of utility, we used our mathematical framework in a theoretical spectral optimization of DM for the task of detecting breast masses. Our theoretical optimization showed that the optimal tube voltage for DM may be higher than that based on predictions that do not account for anatomic noise, in agreement with recent theoretical findings. Additionally, our theoretical optimization predicts that filtering tungsten-anode x-ray spectra with rhodium has little influence on lesion detectability, in contrast with previous findings. The mathematical methods validated in this work can be incorporated easily into cascaded systems analysis of breast imaging systems and will be useful when optimizating novel techniques for x-ray-based imaging of the breast.

Characterization of brain tumours with spin-spin relaxation: pilot case study reveals unique T 2 distribution profiles of glioblastoma, oligodendroglioma and meningioma.

Prolonged spin-spin relaxation times in tumour tissue have been observed since some of the earliest nuclear magnetic resonance investigations of the brain. Over the last three decades, numerous studies have sought to characterize tumour morphology and malignancy using quantitative assessment of T 2 relaxation times, although attempts to categorize and differentiate tumours have had limited success. However, previous work must be interpreted with caution as relaxation data were typically acquired using a variety of multiple echo sequences with a range of echoes and T 2 decay curves and were frequently fit with monoexponential analysis. We defined the distribution of T 2 components in three different human brain tumours (glioblastoma, oligodendroglioma, meningioma) using a multi-echo sequence with a greater number of echoes and a longer acquisition window than previously used (48 echoes, data collection out to 1120 ms) with no a priori assumptions about the number of exponential components contributing to the T 2 decay. T 2 relaxation times were increased in tumour tissue and each tumour showed a distinct T 2 distribution profile. Tumours have complex and unique compartmentalization characteristics. Quantitative assessment of T 2 relaxation in brain cancer may be useful in evaluating different grades of brain tumours on the basis of their T 2 distribution profile, and has the potential to be a non-invasive diagnostic tool which may also be useful in monitoring therapy. Further study with a larger sample size and varying grades of tumours is warranted.

Radiation Dose Survey for Common Computed Tomography Exams: 2013 British Columbia Results.

In 2013 Health Canada conducted a national survey of computed tomography (CT) radiation usage. We analysed contributions from all 7 public health authorities in the province of British Columbia, which covered scanner age, number of slices, and common adult protocols (≥ 19 years: 70 ± 20 kg, head, chest, abdomen/pelvis, and trunk). Patient doses were recorded for common protocols. Diagnostic reference levels (DRLs) was calculated using scanner data with >10 patient doses recorded for each protocol. Data was analysed based on image reconstruction (filtered backprojection vs iterative reconstruction [IR] vs IR available but not in use). Provincial response was 92%, with 59 of 64 CT data used for analysis. The average scanner age was 5.5 years old, with 39% of scanners installed between 2008-2013; 78.5% of scanners were multislice (>64 slices), and 44% of scanners had IR available. Overall British Columbia DRLs were: head = 1305, chest = 529, abdomen/pelvis = 819, and trunk = 1225. DRLs were consistent with Health Canada recommendations and other Canadian published values, but above international standards. For sites with IR available, less than 50% used this technology routinely for head, chest and trunk exams. Overall, use of IR reduced radiation usage between 11%-32% compared to filtered backprojection, while sites using IR vs IR available used 30%/43% less radiation for head/chest exams (P < .05). No significant difference was observed for abdomen/pelvis exams (P = .385). With the fast pace of CT technical advancement, DRLs should reflect the technology used, instead of just globally applied to anatomical regions. Federal guidelines should be updated at a higher frequency to reflect new technology. In addition, new technologies must be utilised to optimize image quality vs radiation usage.

Canadian Association of Radiologists Radiation Protection Working Group: Automated Patient-Specific Dose Registries­What Are They and What Are They Good for?

Medical radiation should be used appropriately and with a dose as low as reasonably achievable. Dose monitoring technologies have been developed that automatically accumulate patient dose indicators, providing effective dose estimates and patient-specific dose histories. Deleterious radiation related events have prompted increased public interest in the safe use of medical radiation. Some view individualized patient dose histories as a tool to help manage the patient dose. However, it is imperative that dose monitoring technologies be evaluated on the outcomes of dose reduction and effective patient management. Patient dose management needs to be consistent with the widely accepted linear no-threshold model of stochastic radiation effects. This essay reviews the attributes and limitations of dose monitoring technologies to provoke discussion regarding resource allocation in the current fiscally constrained health care system.

Pathological correlates of magnetic resonance imaging texture heterogeneity in multiple sclerosis.

OBJECTIVE: To analyze the texture of T2-weighted magnetic resonance imaging (MRI) of postmortem multiple sclerosis (MS) brain, and to determine whether and how MRI texture correlates with tissue pathology. METHODS: Ten brain samples from 3 subjects with MS were examined. Areas of complete, partial, or no loss of Luxol fast blue (myelin) and Bielschowsky (axons) staining were marked on histological images, and matched on corresponding MRI as lesions, diffusely abnormal white matter (DAWM), and normal-appearing white matter (NAWM). The number of CD45(+) cells (inflammation) was also counted. MRI texture was computed using polar Stockwell transform and compared to histology. RESULTS: Thirty-four lesions, 17 DAWM regions, and 36 NAWM regions were identified. After mixed effects modeling, MRI texture heterogeneity was greater in lesions than in DAWM (p < 0.001) and NAWM (p < 0.001), and was greater in DAWM than in NAWM (p < 0.001); the number of CD45+ cells was greater in both lesions (p < 0.001) and DAWM (p = 0.005) than in NAWM. In MRI, a gradient of texture heterogeneity was detected in lesions, with gradual tapering toward perilesional NAWM. Moreover, besides univariate correlation with histological markers, texture heterogeneity correlated independently with normalized myelin density (p < 0.01) when random effects were considered. Within sample, MRI texture correlated with myelin and axonal density in 7 of 10 samples (p < 0.01). INTERPRETATION: Texture analysis performed on routine clinical magnetic resonance images may be a potential measure of tissue integrity. Tissues with more severe myelin and axonal pathology are associated with greater texture heterogeneity.

Temporal phase correction of multiple echo T2 magnetic resonance images.

Typically, magnetic resonance imaging (MRI) analysis is performed on magnitude data, and multiple echo T2 data consist of numerous images of the same slice taken with different echo spacing, giving voxel-wise temporal sampling of the noise as the signals decay according to T2 relaxation. Magnitude T2 decay data has Rician distributed noise which is characterized by a change in the noise distribution from Gaussian, through a transitional region, to Rayleigh as the signal to noise ratio decreases with increasing echo time. Non-Gaussian noise distributions may produce errors in the commonly applied non-negative least squares (NNLS) algorithm that is used to assess multiple echo decays for compartmentalized water environments through the creation of T2 distributions. Typically, Gaussian noise is sought by performing spatial-based phase correction on the MRI data however, these methods cannot capitalize on the temporal information available from multiple echo T2 acquisitions. Here we describe a temporal phase correction (TPC) algorithm that utilizes the temporal noise information available in multiple echo T2 acquisitions to put the relevant decay information in the Real portion of the decay data and leave only noise in the Imaginary portion. We apply this TPC algorithm to create real-valued multiple echo T2 data from human subjects measured at 1.5 T. We show that applying TPC causes changes in the T2 distribution estimates; notably the possible resolution of separate extracellular and intracellular water environments, and the disappearance of the commonly labeled cerebrospinal fluid peak, which might be an artefact observed in many previously published multiple echo T2 analyses.

Health Canada Safety Code 35: awareness of the impacts for diagnostic radiology in Canada.

Health Canada Safety Code 35 brings Canada's diagnostic imaging radiation output and protection standards to an international level. This Safety Code is comprehensive and will have broad implications for most health care facilities. This Safety Code outlines quality control procedures that will ultimately reduce patient dose while providing the best quality diagnostic images, all within a safe working environment. However, the Safety Code has some important omissions and errors of which radiologists should be aware, especially if they act as radiation safety officers. We hope that highlighting these issues will be the beginning of an ongoing dialogue between Health Canada, radiologists, medical physicists, and technologists that will not only bring awareness of Safety Code 35 but will provide a basis for updating, correcting, and improving future revisions of the Safety Code.

Assessment of patient doses in CR examinations throughout a large health region.

Optimization and standardization of radiographic procedures in a health region minimizes patient exposure while producing diagnostic images. This report highlights the dose variation in common computed radiography (CR) examinations throughout a large health region. The RadChex cassette was used to measure the radiation exposure at the table or wall bucky in 20 CR rooms, in seven hospitals, using CR technology from two vendors. Exposures were made to simulate patient exposure (21 cm polymethyl methacrylate) under standard conditions for each bucky: 81 kVp at 100 cm for anteroposterior abdomen table bucky exposures (180 cm for posteroanterior chest wall bucky exposures), using the left, the right, or the center automatic exposure control (AEC) cells. Protocol settings were recorded. An average of 37% variation was found between AEC chambers, with a range between 4% and 137%. A 60% difference in dose was discovered between manufacturers, which was the result of the manufacture's image processing algorithm and subsequently corrected via software updates. Finally, standardizing AEC cell selection during common chest examinations could reduce patient dose by up to 30%. In a large health region, variation in exam protocols can occur, leading to unnecessary patient dose from the same type of examination. Quality control programs must monitor exam protocols and AEC chamber calibration in CR to ensure consistent, minimal, patient dose, regardless of hospital or CR vendor. Furthermore, this report highlights the need for communication between radiologists, technologists, medical physicist, service engineers, and manufacturers required to optimize CR protocols.

The functional microstructure of tendon collagen revealed by high-field MRI.

T2 was used in this study to assess tendon microstructure. Two unloaded digital extensor tendons were bent such that their long axes were imaged throughout 180° with respect to B0. T2-weighted images reveal periodic banding (∼200 µm) when tendons were oriented at ±55° with respect to B0. Five pairs of tendons were used to study the influence of load on T2W MRI: one tendon of each pair was loaded with a 7.8-N mass, and both tendons were fixed in formalin then imaged at 55° to B0. MRI banding was present in the unloaded, but not loaded, tendons. In unloaded tendons, polarized-light microscopy revealed collagen crimp with a periodicity similar to MRI. In loaded tendons, there was a strain-induced extinction of periodicity on both MRI and polarized-light microscopy. These studies confirm that crimp is detectable by high-field MRI and could serve as an in vivo index of physiological strains in collagenous tissues.

Insight into in vivo magnetization exchange in human white matter regions.

Water exchange can play an important role in interpreting compartment-specific magnetic resonance imaging data in brain. For example, an MR method of myelin measurement, known as myelin water fraction imaging, assumes that water exchange processes are slow compared with the measurement time scale. In this article, we examined whether water exchange processes have an effect on myelin water fraction values. A previously established four pool model of white matter was used to simulate the interactions between two aqueous compartments (myelin water and intra/extracellular water) and nonaqueous compartments (myelin and nonmyelin tissues). To extract the water exchange cross relaxation times, the Bloch equations were solved analytically. As the water exchange time scales are dependent on the spin-lattice T(1) relaxation of each of these four pools and due to the current uncertainties regarding the T(1) associated with each pool, exchange cross relaxation times for three different T(1) scenarios were calculated. The corrections that need to be considered in order for myelin water fraction to be an accurate marker for myelin were found to be less than 15%. This work indicates that regional variations in white matter myelin water fraction values are most likely due to variations in myelin content rather than regional differences in exchange rates.

AnalyzeNNLS: magnetic resonance multiexponential decay image analysis.

Exponential decays are fundamental to magnetic resonance imaging, yet adequately sampling and analyzing multiexponential decays is rarely attempted. The advantage of multiexponential analysis is the quantification of sub-voxel structure caused by water compartmentalization, with application as a non-invasive imaging biomarker for myelin. We have developed AnalyzeNNLS, software designed specifically for multiexponential decay image analysis that has a user-friendly graphical user interface and can analyze data from many MR manufacturers. AnalyzeNNLS is a simple, platform independent analysis tool that was created using the extensive mathematical and visualization libraries in Matlab, and released as open source code allowing scientists to evaluate, scrutinize, improve, and expand.

Quantitative T2 analysis: the effects of noise, regularization, and multivoxel approaches.

Typical quantitative T2 (qT2) analysis involves creating T2 distributions using a regularized algorithm from region-of-interest averaged decay data. This study uses qT2 analysis of simulated and experimental decay signals to determine how (a) noise-type, (b) regularization, and (c) region-of-interest versus multivoxel analyses affect T2 distributions. Our simulations indicate that regularization causes myelin water fraction and intra/extracellular water geometric mean T2 underestimation that worsens as the signal-to-noise ratio decreases. The underestimation was greater for intra/extracellular water geometric mean T2 measures using Rician noise. Simulations showed significant differences between myelin water fractions determined using region-of-interest and multivoxel approaches compared to the true value. The nonregularized voxel-based approach gave the most accurate measure of myelin water fraction and intra/extracellular water geometric mean T2 for a given signal-to-noise ratio and noise type. Additionally, multivoxel analysis provides important information about the variability of the analysis. Results obtained from in vivo rat data were similar to our simulation results. In each case, a nonregularized, multivoxel analysis provided myelin water fractions significantly different from the regularized approaches and obtained the largest myelin water fraction. We conclude that quantitative T2 analysis is best performed using a nonregularized, multivoxel approach.

Multiexponential T2 and magnetization transfer MRI of demyelination and remyelination in murine spinal cord.

Identification of remyelination is important in the evaluation of potential treatments of demyelinating diseases such as multiple sclerosis. Local injection of lysolecithin into the brain or spinal cord provides a murine model of demyelination with spontaneous remyelination. The aim of this study was to determine if quantitative, multicomponent T(2) (qT(2)) analysis and magnetization transfer ratio (MTR), both indicative of myelin content, could detect changes in myelination, particularly remyelination, of the cervical spinal cord in mice treated with lysolecithin. We found that the myelin water fraction and geometric mean T(2) value of the intra/extracellular water significantly decreased at 14 days then returned to control levels by 28 days after injury, corresponding to clearance of myelin debris and remyelination which was shown by eriochrome cyanine and oil red O staining of histological sections. The MTR was significantly decreased 14 days after lysolecithin injection, and remained low over the time course studied. Evidence of demyelination shown by both qT(2) and MTR lagged behind the histological evidence of demyelination. Myelin water fraction increased with remyelination, however MTR remained lower after 28 days. The difference between qT(2) and MTR may identify early remyelination.

Myelin water measurement in the spinal cord.

The desire to monitor the spatial-temporal characteristics of myelination in the spinal cord (SC), in the context of pathological change in demyelinating diseases or proposed neuroregenerative protocols, has led to an interest in noninvasive image-based myelin measurement methods. We present one strategy: a magnetic resonance-based measure that capitalizes on the characteristics of T(2) relaxation of water compartmentalized within tissue. In this study, 32-echo relaxation studies for measuring the myelin water fraction (MWF) were applied in healthy control SC in vivo using a sagittal inversion recovery multiecho sequence, and findings were supported with supplemental studies in bovine SC samples in vitro. Mean human MWF varied according the level of the SC examined: cervical, thoracic, and lumbar MWF was found to be 21.8 (SD=2.1)%, 24.3 (3.6)%, and 11.4 (6.4)%, respectively. Noteworthy reductions were observed in areas consistent with the expected locations of the cervical and lumbar enlargements. Average bovine MWF was 30.0 (2.7)% in white matter and 8.2 (0.4)% in gray matter. The potential applications of T(2) measurement in SC, both in characterizing disease processes like multiple sclerosis and in monitoring neuroregenerative therapies, should encourage future research in this area.