[Use of artificial intelligence for image reconstruction]. / Einsatz künstlicher Intelligenz für die Bildrekonstruktion.

CLINICAL/METHODOLOGICAL PROBLEM: In the reconstruction of three-dimensional image data, artifacts that interfere with the appraisal often occur as a result of trying to minimize the dose or due to missing data. Used iterative reconstruction methods are time-consuming and have disadvantages. STANDARD RADIOLOGICAL METHODS: These problems are known to occur in computed tomography (CT), cone beam CT, interventional imaging, magnetic resonance imaging (MRI) and nuclear medicine imaging (PET and SPECT). METHODOLOGICAL INNOVATIONS: Using techniques based on the use of artificial intelligence (AI) in data analysis and data supplementation, a number of problems can be solved up to a certain extent. PERFORMANCE: The performance of the methods varies greatly. Since the generated image data usually look very good using the AI-based methods presented here while their results depend strongly on the study design, reliable comparable quantitative statements on the performance are not yet available in broad terms. EVALUATION: In principle, the methods of image reconstruction based on AI algorithms offer many possibilities for improving and optimizing three-dimensional image datasets. However, the validity strongly depends on the design of the respective study in the structure of the individual procedure. It is therefore essential to have a suitable test prior to use in clinical practice. PRACTICAL RECOMMENDATIONS: Before the widespread use of AI-based reconstruction methods can be recommended, it is necessary to establish meaningful test procedures that can characterize the actual performance and applicability in terms of information content and a meaningful study design during the learning phase of the algorithms.

EURAMED's vision on medical radiation protection (research).

While many areas of radiation protection have formed so-called 'platforms' in Europe which provide strategic research agendas for their areas of interest, this did not happen for a long while for medical exposure, which is the application of ionising radiation that causes the greatest man-made exposure, at least in first world countries. Finally, in 2015, a European medical radiation protection strategic research agenda was set up, and a corresponding platform was launched in 2016. This was named 'EURAMED' - the European Alliance for Medical Radiation Protection Research. In its strategic research agenda, EURAMED defined its vision for medical radiation protection and the corresponding research needed. Five major topics were identified, ranging from measurements of medical application-related parameters such as exposures and image quality and radiation biology aspects relevant for medical applications to individual optimisation strategies, to optimal use of techniques and harmonisation of practises, and finally to justification of the use of ionising radiation in medicine, all based on sufficient infrastructures for quality assurance. The ultimate goal is to reduce radiation exposure and risk individually for patients and staff by interdisciplinary research between clinicians, physicists, and engineers. Therefore, it is essential that the results are translated into clinical practice.

Simulation on the molecular radiosensitization effect of gold nanoparticles in cells irradiated by x-rays.

Abundant studies have focused on the radiosensitization effect of gold nanoparticles (GNPs) in the cellular environment with x-ray irradiation. To better understand the physical foundation and to initially study the molecular radiosensitization effect within the nucleus, a simple cell model with detailed DNA structure in the central nucleus was set up and complemented with different distributions of single and multiple GNPs in this work. With the biophysical Monte Carlo simulation code PARTRAC, the radiosensitization effects on both physical quantities and primary biological responses (DNA strand breaks) were simulated. The ratios of results under situations with GNPs compared to those without GNPs were defined as the enhancement factors (EFs). The simulation results show that the presence of GNP can cause a notable enhancement effect on the energy deposition within a few micrometers from the border of GNP. The greatest upshot appears around the border and is mostly dominated by Auger electrons. The enhancement effect on the DNA strand breakage becomes smaller because of the DNA distribution inside the nucleus, and the corresponding EFs are between 1 and 1.5. In the present simulation, multiple GNPs on the nucleus surface, the 60 kVp x-ray spectrum and the diameter of 100 nm are relatively more effective conditions for both physical and biological radiosensitization effects. These results preliminarily indicate that GNP can be a good radiosensitizer in x-ray radiotherapy. Nevertheless, further biological responses (repair process, cell survival, etc) need to be studied to give more accurate evaluation and practical proposal on GNP's application in clinical treatment.

Age-dependent inhalation doses to members of the public from indoor short-lived radon progeny.

The main contribution of radiation dose to the human lungs from natural exposure originates from short-lived radon progeny. In the present work, the inhalation doses from indoor short-lived radon progeny, i.e., (218)Po, (214)Pb, (214)Bi, and (214)Po, to different age groups of members of the public were calculated. In the calculations, the age-dependent systemic biokinetic models of polonium, bismuth, and lead published by the International Commission on Radiological Protection (ICRP) were adopted. In addition, the ICRP human respiratory tract and gastrointestinal tract models were applied to determine the deposition fractions in different regions of the lungs during inhalation and exhalation, and the absorption fractions of radon progeny in the alimentary tract. Based on the calculated contribution of each progeny to equivalent dose and effective dose, the dose conversion factor was estimated, taking into account the unattached fraction of aerosols, attached aerosols in the nucleation, accumulation and coarse modes, and the potential alpha energy concentration fraction in indoor air. It turned out that for each progeny, the equivalent doses to extrathoracic airways and the lungs are greater than those to other organs. The contribution of (214)Po to effective dose is much smaller compared to that of the other short-lived radon progeny and can thus be neglected in the dose assessment. In fact, 90 % of the effective dose from short-lived radon progeny arises from (214)Pb and (214)Bi, while the rest is from (218)Po. The dose conversion factors obtained in the present study are 17 and 18 mSv per working level month (WLM) for adult female and male, respectively. This compares to values ranging from 6 to 20 mSv WLM(-1) calculated by other investigators. The dose coefficients of each radon progeny calculated in the present study can be used to estimate the radiation doses for the population, especially for small children and women, in specific regions of the world exposed to radon progeny by measuring their concentrations, aerosol sizes, and unattached fractions.

Effects of diet-matrix on volatile organic compounds in breath in diet-induced obese mice.

Breath gas analysis in humans proved successful in identifying disease states and assessing metabolic functions in a non-invasive way. While many studies report diagnostic capability using volatile organic compounds (VOC) in breath, the inter-individual variability even in healthy human cohorts is rather large and not completely understood in its biochemical origin. Laboratory mice are the predominant animal model system for human disorders and are analysed under highly standardized and controlled conditions. We established a novel setup to monitor VOCs as biomarkers for disease in the breath gas of non-anesthetized, non-restrained mice using a proton transfer reaction mass spectrometer with time of flight detection. In this study, we implemented breath gas analysis in a dietary intervention study in C57BL/6J mice with the aim to assess the variability in VOC signatures due to a change in the diet matrix. Mice were fed a standard laboratory chow and then exposed to four semi-purified low- or high-fat diets for four weeks. Random forest (RF++) was used to identify VOCs that specifically respond to the diet matrix change. Interestingly, we found that the change from a chow diet to semi-purified diets resulted in a considerable drop of several VOC levels. Our results suggest that the diet matrix impacts VOC signatures and the underlying metabolic functions and may be one source of variability in exhaled volatiles.

[Usability of smartphones for dose alerts]. / Smartphones jetzt noch smarter? - Möglichkeit des Einsatzes als "Dosiswarner"

PURPOSE: Smartphone apps for measuring ionizing radiation use the capability of (CMOS) camera chips to detect not only perceivable light but also electromagnetic wave radiation. The present study evaluates the accuracy of hardware and software and defines possible applications for the detection of X-ray radiation fields. MATERIALS AND METHODS: 2 apps and 2 different devices were tested in comparison with a calibrated ionization chamber and a personal electronic dosimeter. A calibration curve was determined for dose rates between 12 700 µSv/h and 5.7 µSv/h generated by a C-arm system. RESULTS: The measured scattered radiation produced by an Alderson-Rando phantom ranged from 117 µSv/h (at a distance of 2 m) to 5910 µSv/h (at a distance of 0.3 m) and was 1.4 times less than the values of the ionization chamber. The exposure rate for the operator's thyroid was within 4200 - 4400 µSv/h. We found a strong dependence of the measurements on the angulation of the Smartphone, especially for short distances from the phantom (at a distance of 0.3 m, a 45° rotation downwards in a vertical direction caused a decrease from 3000 µSv/h to 972 µSv/h, while an upwards rotation resulted in an increase to 5000 µSv/h). For a distance of 1 m, this effect was remarkably smaller. CONCLUSION: Smartphones can be used to detect ionizing radiation but showed limited accuracy and are heavily dependent on the angulation of the device. Qualitative measurements and utilization for dose alerts are possible.

Dose conversion coefficients for paediatric CT examinations with automatic tube current modulation.

A common dose-saving technique used in modern CT devices is automatic tube current modulation (TCM), which was originally designed to also reduce the dose in paediatric CT patients. In order to be able to deduce detailed organ doses of paediatric models, dose conversion coefficients normalized to CTDI(vol) for an eight-week-old baby and seven- and eight-year-old children have been computed accounting for TCM. The relative difference in organ dose conversion coefficients with and without TCM is for many organs and examinations less than 10%, but can in some cases amount up to 30%, e.g., for the thyroid in the chest CT of the seven-year-old child. Overall, the impact of TCM on the conversion coefficients increases with increasing age. Besides TCM, also the effect of collimation and tube voltage on organ dose conversion coefficients has been investigated. It could be shown that the normalization to CTDI(vol) leads to conversion coefficients that can in most cases be considered to be independent of collimation and tube voltage.

Inhalation dose assessment of indoor radon progeny using biokinetic and dosimetric modeling and its application to Jordanian population.

High indoor radon concentrations in Jordan result in internal exposures of the residents due to the inhalation of radon and its short-lived progeny. It is therefore important to quantify the annual effective dose and further the radiation risk to the radon exposure. This study describes the methodology and the biokinetic and dosimetric models used for calculation of the inhalation doses exposed to radon progeny. The regional depositions of aerosol particles in the human respiratory tract were firstly calculated. For the attached progeny, the activity median aerodynamic diameters of 50 nm, 230 nm and 2500 nm were chosen to represent the nucleation, accumulation and coarse modes of the aerosol particles, respectively. For the unattached progeny, the activity median thermodynamic diameter of 1 nm was chosen to represent the free progeny nuclide in the room air. The biokinetic models developed by the International Commission on Radiological Protection (ICRP) were used to calculate the nuclear transformations of radon progeny in the human body, and then the dosimetric model was applied to estimate the organ equivalent doses and the effective doses with the specific effective energies derived from the mathematical anthropomorphic phantoms. The dose conversion coefficient estimated in this study was 15 mSv WLM(-1) which was in the range of the values of 6-20 mSv WLM(-1) reported by other investigators. Implementing the average indoor radon concentration in Jordan, the annual effective doses were calculated to be 4.1 mSv y(-1) and 0.08 mSv y(-1) due to the inhalation of radon progeny and radon gas, respectively. The total annual effective dose estimated for Jordanian population was 4.2 mSv y(-1). This high annual effective dose calculated by the dosimetric approach using ICRP biokinetic and dosimetric models resulted in an increase of a factor of two in comparison to the value by epidemiological study. This phenomenon was presented by the ICRP in its new published statement on radon.

Influences of mixed expiratory sampling parameters on exhaled volatile organic compound concentrations.

Breath gas analysis is a promising technology for medical applications. By identifying disease-specific biomarkers in the breath of patients, a non-invasive and easy method for early diagnosis or therapy monitoring can be developed. In order to achieve this goal, one essential prerequisite is the reproducibility of the method applied, i.e. the quantification of exhaled volatile organic compounds (VOCs). The variability of breath gas VOC measurements can be affected by many factors. In this respect, sampling-specific parameters like flow rate and volume of exhalation, exhalation with or without breath holding, exhalation in single or multiple breathing and volume of air inhaled before breath gas exhalation can play a vital role. These factors affecting the measurements must be controlled by optimizing the sampling procedure. For such an optimization, it is important to know how exactly the different parameters affect the exhaled VOC concentrations. Therefore, a study has been undertaken in order to identify some effects of different breath sampling-specific parameters on the exhaled VOC profile using the mixed expired breath sampling technique. It was found that parameters such as filling the sampling bag with high or low flow rate of exhalation, with multiple or single exhalations, in different volumes of exhalation, with breath holding and under different surrounding air conditions significantly affect the concentrations of the exhaled VOCs. Therefore, the specific results of this work should be taken into account before planning new breath gas studies or developing new breath gas collection systems in order to minimize the number of artefacts affecting the concentration of exhaled VOCs.

Headspace measurements of irradiated in vitro cultured cells using PTR-MS.

A pilot study was performed to evaluate a new concept for a radiation biodosimetry method. Proton transfer reaction-mass spectrometry (PTR-MS) was used to find out whether radiation induces changes in the composition of volatile organic compounds (VOCs) in the headspace of in vitro cultured cells. Two different cell lines, retinal pigment epithelium cells hTERT-RPE1 and lung epithelium cells A-549, were irradiated with gamma radiation at doses of 4 Gy and 8 Gy. For measuring the cell-specific effects, the VOC concentrations in the headspace of flasks containing cells plus medium, as well as of flasks containing pure medium were analyzed for changes before and after irradiation. No significant radiation-induced alterations in VOC concentrations in the headspace could be observed after irradiation.

Dose conversion coefficients for CT examinations of adults with automatic tube current modulation.

Automatic tube current modulation (TCM) is used in modern CT devices. This is implemented in the numerical calculation of dose conversion coefficients for CT examinations. For four models of adults, the female and male reference models of ICRP and ICRU and a lighter and a heavier female model, dose conversion coefficients normalized to CTDI(vol) (DCC(CT)) have been computed with a Monte Carlo transport code for CT scans with and without TCM. It could be shown for both cases that reliable values for spiral CT scans are obtained when combining the results from an appropriate set of axial scans. The largest organ DCC(CT) are presented for typical CT examinations for all four models. The impact of TCM is greatest for chest, pelvis and whole-trunk CT examinations, where with TCM the effective DCC(CT) can be 20-25% lower than without TCM. Typical organs with strong dependence on TCM are thyroid, urinary bladder, lungs and oesophagus. While the DCC(CT) of thyroid and urinary bladder are mainly sensitive to angular TCM, the DCC(CT) of lungs and oesophagus are influenced primarily by longitudinal TCM. The impact of the body stature on the effective DCC(CT) is of the same order as the effect of TCM. Thus, for CT scans in the trunk region, accurate dose values can only be obtained when different sets of DCC(CT) are employed that are appropriate for the patient's sex and stature and the actual TCM settings.

Impact on 141Ce, 144Ce, 95Zr, and 90Sr beta emitter dose coefficients of photon and electron SAFs calculated with ICRP/ICRU reference adult voxel computational phantoms.

The current dose coefficients for internal dose assessment of occupationally exposed persons and the general public were derived using the methodology of the International Commission on Radiological Protection (ICRP), which is similar to the Medical Internal Radiation Dose (MIRD)-type methodology. One component of this methodology is the mathematical representation of the human body (so-called MIRD-type phantoms) developed at the Oak Ridge National Laboratory for calculations of photon specific absorbed fractions (SAFs). Concerning the beta emissions, it is assumed in general that they irradiate only the organ where the radionuclide resides, whereas for walled organs, a fixed fraction of the emitted energy is absorbed within the wall. For the active marrow and bone surface targets, absorbed fractions were explicitly provided in ICRP Publication 30. The ICRP Publications 66 and 100 contain further detailed energy-dependent absorbed fraction data for the airways and the segments of the alimentary tract. In the present work, the voxel phantoms representing the reference male and female adults, recently developed at the Helmholtz Zentrum München-German Research Center for Environmental Health (HMGU) in collaboration with the Task Group DOCAL of ICRP Committee 2, were used for the Monte Carlo computation of photon as well as electron SAFs. These voxel phantoms, being constructed from computed tomography (CT) scans of individuals, are more realistic in shape and location of organs in the body than the mathematical phantoms; therefore, they provide photon SAFs that are more precise than those stemming from mathematical phantoms. In addition, electron SAFs for solid and walled organs as well as tissues in the alimentary tract, the respiratory tract, and the skeleton were calculated with Monte Carlo methods using these phantoms to complement the data of ICRP Publications 66 and 100 that are confined to self-irradiation. The SAFs derived for photons and electrons are then used to calculate the dose coefficients of the beta emitters 141Ce, 144Ce, 95Zr, and 90Sr. It is found that the differences of the dose coefficients due to the revised SAFs are much larger for injection and ingestion than for inhalation. The equivalent doses for colon and ingestion with the new voxel-based SAFs are significantly smaller than the values with the MIRD-type photon SAFs and simplifying assumptions for electrons. For lungs and inhalation, no significant difference was observed for the equivalent doses, whereas for injection and ingestion, an increase of the new values is observed.

Differences in exhaled gas profiles between patients with type 2 diabetes and healthy controls.

AIMS: Recent advances in analytical technology allow the detection of several hundred volatile organic compounds (VOCs) in human exhaled air, many of which reflect unidentified endogenous pathways. This study was performed to determine whether a breath gas analysis using proton transfer reaction-mass spectrometry (PTR-MS) could serve as a noninvasive method to distinguish between patients with type 2 diabetes mellitus and healthy controls. METHODS: Breath and room air samples were measured from 21 patients with insulin-treated type 2 diabetes and 26 healthy controls. VOCs in the mass range of 20-200 atomic mass units were analyzed using PTR-MS. RESULTS: We identified eight masses characteristic of endogenous VOCs that showed significant differences in the gas profiles of patients with type 2 diabetes and healthy control subjects. Using these VOCs for linear discriminant analysis, the sensitivity and specificity were found to be 90% and 92%, respectively. CONCLUSIONS: These results suggest that it is possible to separate patients with diabetes mellitus type 2 from healthy controls by multivariate analysis of exhaled endogenous VOCs. This is a first step towards the development of a noninvasive test using breath gas of at-risk persons and making it an attractive option for large-scale testing of at-risk populations. However, the establishment of exhaled volatiles as metabolic markers requires additional confirmatory investigations.

Discrimination of cancerous and non-cancerous cell lines by headspace-analysis with PTR-MS.

Proton transfer reaction mass spectrometry (PTR-MS) has been used to analyze the volatile organic compounds (VOCs) emitted by in-vitro cultured human cells. For this purpose, two pairs of cancerous and non-cancerous human cell lines were selected:1. lung epithelium cells A-549 and retinal pigment epithelium cells hTERT-RPE1, cultured in different growth media; and 2. squamous lung carcinoma cells EPLC and immortalized human bronchial epithelial cells BEAS2B, cultured in identical growth medium. The VOCs in the headspace of the cell cultures were sampled: 1. online by drawing off the gas directly from the culture flask; and 2. by accumulation of the VOCs in PTFE bags connected to the flask for at least 12 h. The pure media were analyzed in the same way as the corresponding cells in order to provide a reference. Direct comparison of headspace VOCs from flasks with cells plus medium and from flasks with pure medium enabled the characterization of cell-line-specific production or consumption of VOCs. Among all identified VOCs in this respect, the most outstanding compound was m/z = 45 (acetaldehyde) revealing significant consumption by the cancerous cell lines but not by the non-cancerous cells. By applying multivariate statistical analysis using 42 selected marker VOCs, it was possible to clearly separate the cancerous and non-cancerous cell lines from each other.

Cascaded systems analysis in conventional X-ray CT: a new, objective approach.

The objective of this study is to separately analyse the effects of detection and image reconstruction on computed tomography (CT) performance to characterise standard and new CT systems. The focus here was on the determination of quantifiable parameters, such as the modulation transfer function, noise power spectrum and quantum efficiency of the detector and the entire system, considering the CT image and the raw data set. Because of the conversion of raw data and image data to the absolute scale of the photon number, a quantitative comparison between the quality parameters of both data sets is possible in this approach. The effort of the proposed method using simple, standardised test phantoms is comparable with the effort in the quality control in classical projection radiography. For the first time, the quantum efficiency of a CT detector and the entire system that is used in the daily clinical practice could be determined. This system reached a quantum efficiency up to 12 %.

Minimising activity and dose with enhanced image quality by radiopharmaceutical administrations.

Owing to the introduction of new diagnostic procedures, such as computed tomography (CT), positron emission tomography (PET) and single photon emission computed tomography (SPECT), the individual dose caused by medical exposures has grown rapidly in the last years. This is especially a subject to radiation protection for nuclear medical diagnosis, since in this case radiopharmaceuticals are administered to the patient, meaning not only a radiation exposure to the diseased tissue but also to the healthy tissues of large parts of the body. 'Minimizing Activity and Dose with Enhanced Image quality by Radiopharmaceutical Administrations' (MADEIRA) is a project cofunded by the European Commission within the Seventh Euratom Framework Programme that aims to improve three-dimensional (3D) nuclear medical imaging technologies significantly. MADEIRA is aiming to improve the efficacy and safety of 3D PET and SPECT functional imaging by optimising the spatial resolution and the signal-to-noise ratio, improving the knowledge of the temporal variation of the radiopharmaceuticals' uptake in and clearance from tumourous and healthy tissues, and evaluation of the corresponding patient dose. Using an optimised imaging procedure that improves the information gained per unit administered dose, MADEIRA aims especially to reduce the dose to healthy tissues of the patient. In this paper, an overall summary of the current achievements will be presented.

X-Ray protective clothing: does DIN 6857-1 allow an objective comparison between lead-free and lead-composite materials?

PURPOSE: The validity of DIN 6857-1 to establish lead equivalence for protective clothing is evaluated by Monte Carlo simulations and measurements. MATERIALS AND METHODS: Commercially available protective clothing made of lead, lead-free and lead-composite materials has been tested regarding its protective efficacy. The analysis has been performed on the one hand in accordance with the test conditions described in the manufacturing standard DIN EN 61331-3 and on the other hand following the new DIN 6857-1 standard. Additionally, measurements have been carried out under simulated patient conditions by using an Alderson-Rando phantom. RESULTS: Following DIN EN 61331-3, the lead-free protective clothing achieved the required protective efficacy only at a restricted tube-voltage range. The test according to DIN 6857-1 showed that the protective criteria were fulfilled only by one lead-composite apron, but not by the three lead-free aprons examined. Thus, in order to guarantee the same protection as lead between 50 and 120 kV, the conditions of DIN 6857-1 must be fulfilled. CONCLUSION: A modification of DIN EN 61331-3 to account for secondary radiation is strongly advised in the case of lead-free materials. In summary, most of the protective lead-free aprons in use should be used with care, particularly for examinations with a high dose.

New calculations for internal dosimetry of beta-emitting radiopharmaceuticals.

The calculation of absorbed dose from internally incorporated radionuclides is based on the so-called specific absorbed fractions (SAFs) which represent the fraction of energy emitted in a given source region that is absorbed per unit mass in a specific target organ. Until recently, photon SAFs were calculated using MIRD-type mathematical phantoms. For electrons, the energy released was assumed to be absorbed locally ('ICRP 30 approach'). For this work, photon and electron SAFs were derived with Monte Carlo simulations in the new male voxel-based reference computational phantom adopted by the ICRP and ICRU. The present results show that the assumption of electrons being locally absorbed is not always true at energies above 300-500 keV. For source/target organ pairs in close vicinity, high-energy electrons escaping from the source organ may result in cross-fire electron SAFs in the same order of magnitude as those from photons. Examples of organ absorbed doses per unit activity are given for (18)F-choline and (123)I-iodide. The impact of the new electron SAFs used for absorbed dose calculations compared with the previously used assumptions was found to be small. The organ dose coefficients for the two approaches differ by not more than 6 % for most organs. Only for irradiation of the urinary bladder wall by activity in the contents, the ICRP 30 approach presents an overestimation of approximately 40-50%.

Investigation of biokinetics of radioiodine with a population kinetics approach.

The dosimetric studies required for planning individually tailored radioiodine therapy of benign thyroid pathologies may be too complex and time-demanding for many ordinary nuclear medicine departments. In this work, a preliminary population kinetics approach was applied to a model structure for iodine biokinetics in order to identify those model features that actually need to be individually investigated, in order to simplify the protocol for data collection in patients. Data from 29 patients undergoing radioiodine therapy for the treatment of the autonomous nodule syndrome were used in the analysis. The greatest inter-individual variations were observed in the parameters describing the transformation of iodide into organic iodine in the thyroid and in the kinetics of the organic form.

Main features of the tomographic reconstruction algorithm OPED.

This paper discusses the advantages of both geometry of data required for the reconstruction algorithm, orthogonal polynomial expansion on disc (OPED), and polynomial structure of this algorithm. We show that this type of geometry is a result of special parameterisation used within the OPED formalism. The practicability of the OPED data geometry is discussed and it is shown that the data of such geometry can be acquired directly. A method of reducing typical artefacts by using the polynomial structure of the algorithm is summarised as well.