Direct measurement of CTDIw on helical CT scans.

PURPOSE: Medical physics computed tomography (CT) practice involves measurements to determine CTDIvol on representative clinical CT protocols. In current practice the majority of CT exams employ helical scans. To determine CTDIvol for a helical scan, one measures CTDIw with an axial scan, then divides by the pitch. Problems arise in CT units where one is unable to select an axial scan with the same detector configuration and pre-patient (bowtie) filtration that is employed on the helical scan. Presented is a method to measure CTDIw on helical scans. METHODS: The body and head CTDI phantoms were supported on the gantry shroud with brackets attached to the phantom. The phantom is above the tabletop and remains stationary during helical scans as the table moves beneath the phantom. With the phantom stationary, the CTDIw associated with head and body helical scans was measured. CTDIw was also measured for head and body axial scans with the same pre-patient filtrations and detector configurations. RESULTS: For both the head and body CTDI phantom the agreement between the axial and helical CTDIw measurements was <1.5%. CONCLUSIONS: Body and head CTDIw and CTDIvol can be directly measured by employing helical scans with the method in this paper.

High-ratio grid considerations in mobile chest radiography.

PURPOSE: Grids are often not used in mobile chest radiography, and when used, they have a low ratio and are often inaccurately aligned. Recently, a mobile radiography automatic grid alignment system (MRAGA) was developed that accurately and automatically aligns the focal spot with the grid. The objective of this study is to investigate high-ratio grid tradeoffs in mobile chest radiography at fixed patient dose when the focal spot lies on the focal axis of the grid. METHODS: The chest phantoms (medium and large) used in this study were modifications of the ANSI (American National Standards Institute) chest phantom and consisted of layers of Lucite™, aluminum, and air. For the large chest phantom, the amount of Lucite and aluminum was increased by 50% over the medium phantom. Further modifications included a mediastinum insert and the addition of contrast targets in the lung and mediastinum regions. Five high-ratio grids were evaluated and compared to the nongrid results at x-ray tube potentials of 80, 90, 100, and 110 kVp for both phantoms. The grids investigated were from two manufacturers: 12:1 and 15:1 aluminum interspace grids from one and 10:1, 13:1, and 15:1 fiber interspace grids from another. MRAGA was employed to align the focal spot with the grid. All exposures for a given kVp and phantom size were made using the same current-time product (CTP). The phantom images were acquired using computed radiography, and contrast-to-noise ratios (CNR) and CNR improvement factors (k(CNR)) were determined from the resultant images. The noise in the targets and the contrast between the targets and their backgrounds were calculated using a local detrending correction, and the CNR was calculated as the ratio of the target contrast to the background noise. k(CNR) was defined as the ratio of the CNR imaged with the grid divided by the CNR imaged without a grid. RESULTS: The CNR values obtained with a high-ratio grid were 4%-65% higher than those obtained without a grid at the same phantom dose. The improvement was greater for the large chest phantom than the medium chest phantom and greater for the mediastinum targets than for the lung targets. In general, the fiber interspace grids performed better than the aluminum interspace grids. In the lung, k(CNR) for both types of grids exhibited little dependence on kVp or grid ratio. In the mediastinum, k(CNR) decreased 4%-10% with increasing kVp, and varied up to 5.3% with grid ratio. CONCLUSIONS: When the focal spot is accurately aligned with the grid, the use of a high-ratio grid in mobile chest radiography improves image quality with no increase in dose to the phantom. For the grids studied, the performance of the fiber interspace grids was superior to the performance of the aluminum interspace grids, with the fiber interspace 13:1 grid producing the best overall results for the medium chest phantom and the fiber interspace 15:1 producing the best overall results for the large chest phantom.

Black hole artifacts-a new potential pitfall for DXA accuracy?

Certain types of metallic objects apparently have high attenuation (a white image) on dual-energy X-ray absorptiometry (DXA) scan images, but instead show up as black (black hole artifacts). When small, these artifacts may easily be missed on visual inspection. We hypothesized that such "black hole" artifacts could have a significant effect on bone mineral density (BMD) results. Human use approval (Institutional Review Board [IRB]) was obtained to publish patient scans and an IRB waiver was obtained for nonhuman research. We placed individual surgical clips and cassettes of clips of tantalum, stainless steel and titanium, and a bullet over the third lumbar vertebra (L3) of a Hologic spine phantom. In addition, 4 or 8 individual tantalum or stainless steel clips and tantalum squares were placed over L3 of cadaveric spines (high-density spine L1-L4 BMD=1.049 g/cm2) and low-density spine BMD (L1-L4 BMD=0.669 g/cm2) with attached soft tissues. Stainless steel and titanium clips scanned as white objects with DXA. A bullet and tantalum clips scanned black (black holes). All clip types were visible on single-energy scans as white objects. Eight tantalum clips significantly lowered L3 BMD compared to 4 or 0 clips in the high-density spine. There were no significant differences in BMD L1-L4 between 0, 4, and 8 tantalum clips in the high-density spine. In the low-density spine, 8 tantalum clips over L3 had significantly lower BMD compared to 4 tantalum clips overlying L3 and 4 clips lateral to L3 and 4 clips over L3. All of these scenarios had lower L3 BMD than no tantalum clips overlying L3. The BMD of L1-L4 was lowest with 8 clips at L3, but was not significantly different than no clips overlying L3. Eight tantalum clips lateral to L3 was significantly higher than no clips over L3. Black hole artifacts can occur in DXA scans containing certain metals like tantalum surgical clips. Although these surgical clips could decrease BMD at a localized area, they do not significantly decrease the L1-L4 spine BMD in a high-density spine specimen. In a low-density spine specimen, tantalum clips do have the potential to alter BMD of a single vertebral body and L1-L4. Attention should be paid to the possibility of black hole artifacts on DXA scans and the effect they may have on spine results. Viewing scans in the single-energy mode can be used to verify the presence of tantalum clips.

The effect of common artifacts lateral to the spine on bone mineral density in the lumbar spine.

Artifacts such as surgical clips, gallstones, and kidney stones are often present in the soft tissue stripe lateral to vertebral bodies. Using cadaveric specimens, we placed bra wires, gallbladder clips, a large gallstone, a calcium carbonate or a calcium citrate pill lateral to L1, or a large or small calcium-containing kidney stone lateral to L3 and compared the mean bone mineral density (BMD) of individual vertebral bodies and L1-L4 with and without the soft tissue artifact. The specimens used had high BMD (L1-L4 BMD=1.049 g/cm2) and low BMD (L1-L4 BMD=0.669 g/cm2) and were scanned with a Hologic Discovery W scanner with 12.7 software in the array mode. None of the artifacts affected L1 or L3 BMD or L1-L4 BMD significantly in the high BMD spine. However, bra wires, a large calcium citrate pill lateral to L1, 3 calcium citrate pills lateral to L1, a calcium carbonate pill over L1, and 3 calcium carbonate pills lateral to L1 did affect L1-L4 BMD in low BMD torso. Gallbladder clips or gallstone did not affect L1-L4 BMD in either specimen. We conclude that artifacts lateral to the spine, particularly in a low BMD spine, can affect the interpretation of L1-L4 BMD using a Hologic Discovery W scanner with 12.7 software in array mode.

AAPM Task Group 108: PET and PET/CT shielding requirements.

The shielding of positron emission tomography (PET) and PET/CT (computed tomography) facilities presents special challenges. The 0.511 MeV annihilation photons associated with positron decay are much higher energy than other diagnostic radiations. As a result, barrier shielding may be required in floors and ceilings as well as adjacent walls. Since the patient becomes the radioactive source after the radiopharmaceutical has been administered, one has to consider the entire time that the subject remains in the clinic. In this report we present methods for estimating the shielding requirements for PET and PET/CT facilities. Information about the physical properties of the most commonly used clinical PET radionuclides is summarized, although the report primarily refers to fluorine-18. Typical PET imaging protocols are reviewed and exposure rates from patients are estimated including self-attenuation by body tissues and physical decay of the radionuclide. Examples of barrier calculations are presented for controlled and noncontrolled areas. Shielding for adjacent rooms with scintillation cameras is also discussed. Tables and graphs of estimated transmission factors for lead, steel, and concrete at 0.511 MeV are also included. Meeting the regulatory limits for uncontrolled areas can be an expensive proposition. Careful planning with the equipment vendor, facility architect, and a qualified medical physicist is necessary to produce a cost effective design while maintaining radiation safety standards.

Patient self-attenuation and technologist dose in positron emission tomography.

Positron emission tomography (PET), with 511-keV radiation and long patient-uptake times, presents unique radiation safety concerns. This two-part study considers aspects of PET radiation safety as they relate to PET suite design, dose to the public, and technologist occupational dose. In the first part of the study, the self-attenuation of radiation by patients' bodies was quantified. The radiation exposure was measured at three positions from 64 patients injected with fluorine-18 fluorodeoxyglucose (FDG) during the uptake period. Compared with an in vitro control used as a point source, a significant decrease in exposure (>40% at 1 m) was observed due to nonuniform distribution of FDG and attenuation within the patients. The attenuation data are consistent with results from simulations [M. E. Phelps, "Comments and Perspectives," J. Nucl. Med. 45, 1601 (2004)] that treat the body as a uniform, water-filled cylinder. As distance is often the principal source of protection for 511-keV radiation, the considerable self-attenuation may allow for more compact PET suites. However, despite high patient self-attenuation, shielding, and standard precautionary measures, PET technologist occupational doses can remain quite high (approximately 12 mSv/year). The second part of this study tracked the daily dose received by PET technologists. Close technologist-patient interaction both during and following FDG administration, as much as 20 min/study, contribute to the high doses and point to the need for a more innovative approach to radiation protection for PET technologists.