AAPM task group report 305: Guidance for standardization of vendor-neutral reject analysis in radiography.

Reject rate analysis is considered an integral part of a diagnostic radiography quality control (QC) program. A rejected image is a patient radiograph that was not presented to a radiologist for diagnosis and that contributes unnecessary radiation dose to the patient. Reject rates that are either too high or too low may suggest systemic department shortcomings in QC mechanisms. Due to the lack of standardization, reject data often cannot be easily compared between radiography systems from different vendors. The purpose of this report is to provide guidance to help standardize data elements that are required for comprehensive reject analysis and to propose data reporting and workflows to enable an effective and comprehensive reject rate monitoring program. Essential data elements, a proposed schema for classifying reject reasons, and workflow implementation options are recommended in this task group report.

Lek habitat suitability for the sharp-tailed grouse (Tympanuchus phasianellus jamesi) on the Northern Great Plains.

Grassland birds in North America face many problems as a result of habitat loss and fragmentation; understanding their habitat requirements is critical for their conservation and management. The sharp-tailed grouse (Tympanuchus phasianellus) can be found throughout North American grasslands and is a species of economic and cultural importance, but it has experienced population declines over the last few decades. A large part of sharp-tailed grouse life history is focused on and around lekking grounds, which makes leks an essential feature for sharp-tailed grouse management. We used information from 596 leks and landcover predictors within 1-km and 5-km squares to perform Habitat Suitability Index modeling for sharp-tailed grouse on the Northern Great Plains in Saskatchewan, Canada. The proportion of grasslands at the 5-km scale and the 1-km scale were the two most important factors affecting lek occurrence (permutation importance = 34.8% and 26.9%, respectively). In every case, the 5-km scale predictors were ranked as having a more significant influence on lek occurrence than the 1-km scale. Other factors of importance included topographic roughness (9.7% permutation importance), and the proportion of human disturbance at the 5-km scale (5% permutation importance). Our study highlights the importance of large patches of grassland to support the occurrence of sharp-tailed grouse leks, and that a diverse set of habitat features are needed for sharp-tailed grouse management.

AAPM Task Group Report 272: Comprehensive acceptance testing and evaluation of fluoroscopy imaging systems.

Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, whereas others do not, making acceptance testing a subjective and time-consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology and continues with general fluoroscopy and mobile C-arms. Finally, the appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail.

Necrotizing Fasciitis and Mediastinitis after Wisdom Tooth Extraction: A Case Report.

Necrotizing soft tissue infections with mediastinal extension are exceedingly rare. This submission provides dynamic and static visual stimuli (CT images) and a case report describing the history of present illness, initial ED presentation and inpatient course of a 33-year-old man who developed facial necrotizing fasciitis complicated by mediastinitis secondary to odontogenic infection following wisdom tooth extraction. Discussion of the key features of this rare presentation, the diagnostic and therapeutic approaches to making the diagnosis (including CT), and the role of the Emergency Physician, are highlighted. Topics: Necrotizing fasciitis, necrotizing mediastinitis, odontogenic infection, CT scan.

Current state of practice regarding digital radiography exposure indicators and deviation indices: Report of AAPM Imaging Physics Committee Task Group 232.

Beginning with the advent of digital radiography systems in 1981, manufacturers of these systems provided indicators of detector exposure. These indicators were manufacturer-specific, and users in facilities with equipment from multiple manufacturers found it a challenge to monitor and manage variations in indicated exposure in routine clinical use. In 2008, a common definition of exposure index (EI) was realized in International Electrotechnical Commission (IEC) International Standard 62494-1 Ed. 1, which also introduced and defined the deviation index (DI), a number quantifying the difference between the detector EI for a given radiograph and the target exposure index (EIT ). An exposure index that differed by a constant from that established by the IEC and the concept of the deviation index also appear in American Association of Physicists in Medicine (AAPM) Report No. 116 published in 2009. The AAPM Report No. 116 went beyond the IEC standard in supplying a table (Table II in the report of TG-116) titled "Exposure Indicator DI Control Limits for Clinical Images," which listed suggested DI ranges and actions to be considered for each range. As the IEC EI was implemented and clinical DI data were gathered, concerns were voiced that the DI control limits published in the report of TG-116 were too strict and did not accurately reflect clinical practice. The charge of task group 232 (TG-232) and the objective of this final report was to investigate the current state of the practice for CR/DR Exposure and Deviation Indices based on AAPM TG 116 and IEC-62494, for the purpose of establishing achievable goals (reference levels) and action levels in digital radiography. Data corresponding to EI and DI were collected from a range of practice settings for a number of body parts and views (adults and pediatric radiographs) and analyzed in aggregate and separately. A subset of radiographs was also evaluated by radiologists based on criteria adapted from the European Guidelines on Quality Criteria for Diagnostic Radiographic Images from the European Commission. Analysis revealed that typical DI distribution was characterized by a standard deviation (SD) of 1.3-3.6 with mean DI values substantially different from 0.0, and less than 50% of DI values fell within the significant action limits proposed by AAPM TG-116 (-1.0 ≤ DI ≤ 1.0). Recommendations stemming from this analysis include targeting a mean DI value of 0.0 and action limits at ±1 and ±2 SD of the DI based on actual DI data of an individual site. EIT values, DI values, and associated action limits should be reviewed on an ongoing basis and optimization of DI values should be a process of continuous quality improvement with a goal of reducing practice variation.

Radiological and histopathological examination of apparent lytic lesions in allograft long bones-No cause for concern.

OBJECTIVE: Identify the nature of apparent lytic lesions within human allograft specimens from patients with no known malignancy, using radiological and histopathological analysis. METHODS: 123 Post-retrieval radiographs from 23 donors were examined. Sixty-seven radiographs were noted to show apparent lytic lesions. The number, size, character and position of the apparent lesions were recorded. RESULTS: CT scanning of 9 specimens confirmed the lesions to be of air pockets causing artefact. Histopathological analysis showed no malignant or pathological process. CONCLUSIONS: Apparent lesions were not pathological. PRACTICE IMPLICATIONS: Specimens with similar appearances, in donors with no malignancy, can be safely used in donation.

Super-size me: adipose tissue-equivalent additions for anthropomorphic phantoms.

Physical anthropomorphic phantoms have been utilized for a variety of dosimet- ric studies across a range of procedures utilizing diagnostic imaging equipment. Unfortunately, these phantoms are often limited to a single reference size, which often may not be representative of the patient population at large. This work set out to develop an adipose tissue-equivalent substitute material that could be used to create low cost physical additions for existing anthropomorphic phantoms. Using commercially available products, a methodology was developed to accomplish this, and an addition was built to create a 90th percentile by weight phantom from an existing 50th percentile model. This methodology can easily be used to expand the utility of existing anthropomorphic phantoms in order to better represent patients of various body morphologies, and investigate the effects of patient size in diagnostic procedures. 

Monte Carlo simulations of adult and pediatric computed tomography exams: validation studies of organ doses with physical phantoms.

PURPOSE: To validate the accuracy of a Monte Carlo source model of the Siemens SOMATOM Sensation 16 CT scanner using organ doses measured in physical anthropomorphic phantoms. METHODS: The x-ray output of the Siemens SOMATOM Sensation 16 multidetector CT scanner was simulated within the Monte Carlo radiation transport code, MCNPX version 2.6. The resulting source model was able to perform various simulated axial and helical computed tomographic (CT) scans of varying scan parameters, including beam energy, filtration, pitch, and beam collimation. Two custom-built anthropomorphic phantoms were used to take dose measurements on the CT scanner: an adult male and a 9-month-old. The adult male is a physical replica of the University of Florida reference adult male hybrid computational phantom, while the 9-month-old is a replica of the University of Florida Series B 9-month-old voxel computational phantom. Each phantom underwent a series of axial and helical CT scans, during which organ doses were measured using fiber-optic coupled plastic scintillator dosimeters developed at the University of Florida. The physical setup was reproduced and simulated in MCNPX using the CT source model and the computational phantoms upon which the anthropomorphic phantoms were constructed. Average organ doses were then calculated based upon these MCNPX results. RESULTS: For all CT scans, good agreement was seen between measured and simulated organ doses. For the adult male, the percent differences were within 16% for axial scans, and within 18% for helical scans. For the 9-month-old, the percent differences were all within 15% for both the axial and helical scans. These results are comparable to previously published validation studies using GE scanners and commercially available anthropomorphic phantoms. CONCLUSIONS: Overall results of this study show that the Monte Carlo source model can be used to accurately and reliably calculate organ doses for patients undergoing a variety of axial or helical CT examinations on the Siemens SOMATOM Sensation 16 scanner.

Comparing food limitation among three stages of nesting: supplementation experiments with the burrowing owl.

Food availability is an important limiting factor for avian reproduction. In altricial birds, food limitation is assumed to be more severe during the nestling stage than during laying or incubation, but this has yet to be adequately tested. Using food-supplementation experiments over a 5-year period, we determined the degree and timing of food limitation for burrowing owls (Athene cunicularia) breeding in Canada. Burrowing owls are an endangered species and food limitation during the nestling stage could influence reproductive performance of this species at the northern extent of their range. Supplemented pairs fledged on average 47% more owlets than unfed pairs, except during a year when natural food was not limiting (i.e., a prey irruption year). The difference in fledgling production resulted from high nestling mortality in unfed broods, with 96% of all nestling deaths being attributed to food shortage. Supplemental feeding during the nestling period also increased fledgling structural size. Pairs fed from the start of laying produced the same number of hatchlings as pairs that received no supplemental food before hatch. Furthermore, pairs supplemented from egg laying to fledging and pairs supplemented during the nestling period alone had the same patterns of nestling survival, equal numbers of fledglings, and similar fledgling mass and structural size. Our results provide empirical support for the hypothesis that the nestling period is the most food-limited phase of the breeding cycle. The experimental design we introduce here could be used with other altricial species to examine how the timing of food limitation differs among birds with a variety of life-history strategies. For burrowing owls, and other species with similar life histories, long-term, large-scale, and appropriately timed habitat management increasing prey abundance or availability is critical for conservation. Our results provide empirical support for the hypothesis that the nestling period is the most food-limited phase of the breeding cycle. For burrowing owls, and other species with similar life histories, long-term, large-scale, and appropriately timed habitat management increasing prey abundance or availability is critical for conservation.

Organ doses for reference adult male and female undergoing computed tomography estimated by Monte Carlo simulations.

PURPOSE: To develop a computed tomography (CT) organ dose estimation method designed to readily provide organ doses in a reference adult male and female for different scan ranges to investigate the degree to which existing commercial programs can reasonably match organ doses defined in these more anatomically realistic adult hybrid phantoms METHODS: The x-ray fan beam in the SOMATOM Sensation 16 multidetector CT scanner was simulated within the Monte Carlo radiation transport code MCNPX2.6. The simulated CT scanner model was validated through comparison with experimentally measured lateral free-in-air dose profiles and computed tomography dose index (CTDI) values. The reference adult male and female hybrid phantoms were coupled with the established CT scanner model following arm removal to simulate clinical head and other body region scans. A set of organ dose matrices were calculated for a series of consecutive axial scans ranging from the top of the head to the bottom of the phantoms with a beam thickness of 10 mm and the tube potentials of 80, 100, and 120 kVp. The organ doses for head, chest, and abdomen/pelvis examinations were calculated based on the organ dose matrices and compared to those obtained from two commercial programs, CT-EXPO and CTDOSIMETRY. Organ dose calculations were repeated for an adult stylized phantom by using the same simulation method used for the adult hybrid phantom. RESULTS: Comparisons of both lateral free-in-air dose profiles and CTDI values through experimental measurement with the Monte Carlo simulations showed good agreement to within 9%. Organ doses for head, chest, and abdomen/pelvis scans reported in the commercial programs exceeded those from the Monte Carlo calculations in both the hybrid and stylized phantoms in this study, sometimes by orders of magnitude. CONCLUSIONS: The organ dose estimation method and dose matrices established in this study readily provides organ doses for a reference adult male and female for different CT scan ranges and technical parameters. Organ doses from existing commercial programs do not reasonably match organ doses calculated for the hybrid phantoms due to differences in phantom anatomy, as well as differences in organ dose scaling parameters. The organ dose matrices developed in this study will be extended to cover different technical parameters, CT scanner models, and various age groups.

Construction of anthropomorphic phantoms for use in dosimetry studies.

This paper reports on the methodology and materials used to construct anthropomorphic phantoms for use in dosimetry studies, improving on methods and materials previously described by Jones et al. [Med Phys. 2006;33(9):3274-82]. To date, the methodology described has been successfully used to create a series of three different adult phantoms at the University of Florida (UF). All phantoms were constructed in 5 mm transverse slices using materials designed to mimic human tissue at diagnostic photon energies: soft tissue-equivalent substitute (STES), lung tissue-equivalent substitute (LTES), and bone tissue-equivalent substitute (BTES). While the formulation for BTES remains unchanged from the previous epoxy resin compound developed by Jones et al. [Med Phys. 2003;30(8):2072-81], both the STES and LTES were redesigned utilizing a urethane based compound which forms a pliable tissue-equivalent material. These urethane based materials were chosen in part for improved phantom durability and easier accommodation of real-time dosimeters. The production process has also been streamlined with the use of an automated machining system to create molds for the phantom slices from bitmap images based on the original segmented computed tomography (CT) datasets. Information regarding the new tissue-equivalent materials as well as images of the construction process and completed phantom are included.

Characterization of a water-equivalent fiber-optic coupled dosimeter for use in diagnostic radiology.

This work reports on the characterization of a new fiber-optic coupled (FOC) dosimeter for use in the diagnostic radiology energy range. The FOC dosimeter was constructed by coupling a small cylindrical plastic scintillator, 500 microm in diameter and 2 mm in length, to a 2 m long optical fiber, which acts as a light guide to transmit scintillation photons from the sensitive element to a photo-multiplier tube (PMT). A serial port interface on the PMT permits real-time monitoring of light output from the dosimeter via a custom computer program. The FOC dosimeter offered excellent sensitivity and reproducibility, allowing doses as low as 0.16 mGy to be measured with a coefficient of variation of only 3.64%. Dose linearity was also excellent with a correlation coefficient of 1.000 over exposures ranging from 0.16 to 57.29 mGy. The FOC dosimeter exhibited little angular dependence from axial irradiation, varying by less than 5% over an entire revolution. A positive energy dependence was observed and measurements performed within a scatter medium yielded a 10% variation in sensitivity as beam quality changed due to hardening and scatter across a 16 cm depth range. The current dosimetry system features an array of five PMTs to allow multiple FOC dosimeters to be monitored simultaneously. Overall, the system allows for rapid and accurate dose measurements relevant to a range of diagnostic imaging applications.

Nest site attributes and temporal patterns of northern flicker nest loss: effects of predation and competition.

To date, most studies of nest site selection have failed to take into account more than one source of nest loss (or have combined all sources in one analysis) when examining nest site characteristics, leaving us with an incomplete understanding of the potential trade-offs that individuals may face when selecting a nest site. Our objectives were to determine whether northern flickers (Colaptes auratus) may experience a trade-off in nest site selection in response to mammalian nest predation and nest loss to a cavity nest competitor (European starling, Sturnus vulgaris). We also document within-season temporal patterns of these two sources of nest loss with the hypothesis that flickers may also be constrained in the timing of reproduction under both predatory and competitive influence. Mammalian predators frequently depredated flicker nests that were: lower to the ground, less concealed by vegetation around the cavity entrance and at the base of the nest tree, closer to coniferous forest edges and in forest clumps with a high percentage of conifer content. Proximity to coniferous edges or coniferous trees increased the probability of nest predation, but nests near conifers were less likely to be lost to starlings. Flickers may thus face a trade-off in nest site selection with respect to safety from predators or competitors. Models suggested that peaks of nest predation and nest loss to eviction occurred at the same time, although a competing model suggested that the peak of nest loss to starlings occurred 5 days earlier than the peak of mammalian predation. Differences in peaks of mammalian predation and loss to starlings may constrain any adjustment in clutch initiation date by flickers to avoid one source of nest loss.