Impact of super-resolution and image acquisition on the detection of calcifications in digital breast tomosynthesis.

OBJECTIVES: A virtual clinical trial (VCT) method is proposed to determine the limit of calcification detection in tomosynthesis. METHODS: Breast anatomy, focal findings, image acquisition, and interpretation (n = 14 readers) were simulated using screening data (n = 660 patients). Calcifications (0.2-0.4 mm3) were inserted into virtual breast phantoms. Digital breast tomosynthesis (DBT) acquisitions were simulated assuming various acquisition geometries: source motion (continuous and step-and-shoot), detector element size (140 and 70 µm), and reconstructed voxel size (35-140 µm). VCT results were estimated using multiple-reader multiple-case analyses and d' statistics. Signal-to-noise (SNR) analyses were also performed using BR3D phantoms. RESULTS: Source motion and reconstructed voxel size demonstrated significant changes in the performance of imaging systems. Acquisition geometries that use 70 µm reconstruction voxel size and step-and-shoot motion significantly improved calcification detection. Comparing 70 with 100 µm reconstructed voxel size for step-and-shoot, the ΔAUC was 0.0558 (0.0647) and d' ratio was 1.27 (1.29) for 140 µm (70 µm) detector element size. Comparing step-and-shoot with a continuous motion for a 70 µm reconstructed voxel size, the ΔAUC was 0.0863 (0.0434) and the d' ratio was 1.40 (1.19) for 140 µm (70 µm) detector element. Small detector element sizes (e.g., 70 µm) did not significantly improve detection. The SNR results with the BR3D phantom show that calcification detection is dependent upon reconstructed voxel size and detector element size, supporting VCT results with comparable agreement (ratios: d' = 1.16 ± 0.11, SNR = 1.34 ± 0.13). CONCLUSION: DBT acquisition geometries that use super-resolution (smaller reconstructed voxels than the detector element size) combined with step-and-shoot motion have the potential to improve the detection of calcifications. CLINICAL RELEVANCE: Calcifications may not always be discernable in tomosynthesis because of differences in acquisition and reconstruction methods. VCTs can identify strategies to optimize acquisition and reconstruction parameters for calcification detection in tomosynthesis, most notably through super-resolution in the reconstruction. KEY POINTS: • Super-resolution improves calcification detection and SNR in tomosynthesis; specifically, with the use of smaller reconstruction voxels. • Calcification detection using step-and-shoot motion is superior to that using continuous tube motion. • A detector element size of 70 µm does not provide better detection than 140 µm for small calcifications at the threshold of detectability.

Feasibility of virtual non-iodine coronary calcium scoring on dual source photon-counting coronary CT angiography: a dynamic phantom study.

BACKGROUND: The aim of our current systematic dynamic phantom study was first, to optimize reconstruction parameters of coronary CTA (CCTA) acquired on photon counting CT (PCCT) for coronary artery calcium (CAC) scoring, and second, to assess the feasibility of calculating CAC scores from CCTA, in comparison to reference calcium scoring CT (CSCT) scans. METHODS: In this phantom study, an artificial coronary artery was translated at velocities corresponding to 0, < 60, and 60-75 beats per minute (bpm) within an anthropomorphic phantom. The density of calcifications was 100 (very low), 200 (low), 400 (medium), and 800 (high) mgHA/cm3, respectively. CCTA was reconstructed with the following parameters: virtual non-iodine (VNI), with and without iterative reconstruction (QIR level 2, QIR off, respectively); kernels Qr36 and Qr44f; slice thickness/increment 3.0/1.5 mm and 0.4/0.2 mm. The agreement in risk group classification between CACCCTA and CACCSCT scoring was measured using Cohen weighted linear κ with 95% CI. RESULTS: For CCTA reconstructed with 0.4 mm slice thickness, calcium detectability was perfect (100%). At < 60 bpm, CACCCTA of low, and medium density calcification was underestimated by 53%, and 15%, respectively. However, CACCCTA was not significantly different from CACCSCT of very low, and high-density calcifications. The best risk agreement was achieved when CCTA was reconstructed with QIR off, Qr44f, and 0.4 mm slice thickness (κ = 0.762, 95% CI 0.671-0.853). CONCLUSION: In this dynamic phantom study, the detection of calcifications with different densities was excellent with CCTA on PCCT using thin-slice VNI reconstruction. Agatston scores were underestimated compared to CSCT but agreement in risk classification was substantial. CLINICAL RELEVANCE STATEMENT: Photon counting CT may enable the implementation of coronary artery calcium scoring from coronary CTA in daily clinical practice. KEY POINTS: Photon-counting CTA allows for excellent detectability of low-density calcifications at all heart rates. Coronary artery calcium scoring from coronary CTA acquired on photon counting CT is feasible, although improvement is needed. Adoption of the standard acquisition and reconstruction protocol for calcium scoring is needed for improved quantification of coronary artery calcium to fully employ the potential of photon counting CT.

The influence of motion-compensated reconstruction on coronary artery analysis for a dual-layer detector CT system: a dynamic phantom study.

OBJECTIVES: Cardiac motion artifacts hinder the assessment of coronary arteries in coronary computed tomography angiography (CCTA). We investigated the impact of motion compensation reconstruction (MCR) on motion artifacts in CCTA at various heart rates (HR) using a dynamic phantom. MATERIALS AND METHODS: An artificial hollow coronary artery (5-mm diameter lumen) filled with iodinated contrast agent (400 HU at 120 kVp), positioned centrally in an anthropomorphic chest phantom, was scanned using a dual-layer spectral detector CT. The artery was translated at constant horizontal velocities (0-80 mm/s, increment of 10 mm/s). For each velocity, five CCTA scans were repeated using a clinical protocol. Motion artifacts were quantified using the in-plane motion area. Regression analysis was performed to calculate the reduction in motion artifacts provided by MCR, by division of the slopes of non-MCR and MCR fitted lines. RESULTS: Reference mean (95% confidence interval) motion artifact area was 24.9 mm2 (23.8, 26.0). Without MCR, motion artifact areas for velocities exceeding 20 mm/s were significantly larger (up to 57.2 mm2 (40.1, 74.2)) than the reference. With MCR, no significant differences compared to the reference were shown for all velocities, except for 70 mm/s (29.0 mm2 (27.0, 31.0)). The slopes of the fitted data were 0.44 and 0.04 for standard and MCR reconstructions, respectively, resulting in an 11-time motion artifact reduction. CONCLUSION: MCR may improve CCTA assessment in patients by reducing coronary artery motion artifacts, especially in those with elevated HR who cannot receive beta blockers or do not attain the targeted HR. CLINICAL RELEVANCE STATEMENT: This vendor-specific motion compensation reconstruction may improve coronary computed tomography angiography assessment in patients by reduction of coronary artery motion artifacts, especially in those with elevated various heart rates (HR) who cannot receive beta blockers or do not attain the targeted HR. KEY POINTS: • Motion artifacts are known to hinder the assessment of coronary arteries on coronary CT angiography (CCTA), leading to more non-diagnostic scans. • This dynamic phantom study shows that motion compensation reconstruction (MCR) reduces motion artifacts at various velocities, which may help to decrease the number of non-diagnostic scans. • MCR in this study showed to reduce motion artifacts 11-fold.

Radiation dose optimization for photon-counting CT coronary artery calcium scoring for different patient sizes: a dynamic phantom study.

PURPOSE: To systematically assess the radiation dose reduction potential of coronary artery calcium (CAC) assessments with photon-counting computed tomography (PCCT) by changing the tube potential for different patient sizes with a dynamic phantom. METHODS: A hollow artery, containing three calcifications of different densities, was translated at velocities corresponding to 0, < 60, 60-75, and > 75 beats per minute within an anthropomorphic phantom. Extension rings were used to simulate average- and large -sized patients. PCCT scans were made with the reference clinical protocol (tube potential of 120 kilovolt (kV)), and with 70, 90, Sn100, Sn140, and 140 kV at identical image quality levels. All acquisitions were reconstructed at a virtual monoenergetic energy level of 70 keV. For each calcification, Agatston scores and contrast-to-noise ratios (CNR) were determined, and compared to the reference with Wilcoxon signed-rank tests, with p < 0.05 indicating significant differences. RESULTS: A decrease in radiation dose (22%) was achieved at Sn100 kV for the average-sized phantom. For the large phantom, Sn100 and Sn140 kV resulted in a decrease in radiation doses of 19% and 3%, respectively. Irrespective of CAC density, Sn100 and 140 kVp did not result in significantly different CNR. Only at Sn100 kV were there no significant differences in Agatston scores for all CAC densities, heart rates, and phantom sizes. CONCLUSION: PCCT at tube voltage of 100 kV with added tin filtration and reconstructed at 70 keV enables a ≥ 19% dose reduction compared to 120 kV, independent of phantom size, CAC density, and heart rate. KEY POINTS: • Photon-counting CT allows for reduced radiation dose acquisitions (up to 19%) for coronary calcium assessment by reducing tube voltage while reconstructing at a normal monoE level of 70 keV. • Tube voltage reduction is possible for medium and large patient sizes, without affecting the Agatston score outcome.

"Will I change nodule management recommendations if I change my CAD system?"-impact of volumetric deviation between different CAD systems on lesion management.

OBJECTIVES: To evaluate and compare the measurement accuracy of two different computer-aided diagnosis (CAD) systems regarding artificial pulmonary nodules and assess the clinical impact of volumetric inaccuracies in a phantom study. METHODS: In this phantom study, 59 different phantom arrangements with 326 artificial nodules (178 solid, 148 ground-glass) were scanned at 80 kV, 100 kV, and 120 kV. Four different nodule diameters were used: 5 mm, 8 mm, 10 mm, and 12 mm. Scans were analyzed by a deep-learning (DL)-based CAD and a standard CAD system. Relative volumetric errors (RVE) of each system vs. ground truth and the relative volume difference (RVD) DL-based vs. standard CAD were calculated. The Bland-Altman method was used to define the limits of agreement (LOA). The hypothetical impact on LungRADS classification was assessed for both systems. RESULTS: There was no difference between the three voltage groups regarding nodule volumetry. Regarding the solid nodules, the RVE of the 5-mm-, 8-mm-, 10-mm-, and 12-mm-size groups for the DL CAD/standard CAD were 12.2/2.8%, 1.3/ - 2.8%, - 3.6/1.5%, and - 12.2/ - 0.3%, respectively. The corresponding values for the ground-glass nodules (GGN) were 25.6%/81.0%, 9.0%/28.0%, 7.6/20.6%, and 6.8/21.2%. The mean RVD for solid nodules/GGN was 1.3/ - 15.2%. Regarding the LungRADS classification, 88.5% and 79.8% of all solid nodules were correctly assigned by the DL CAD and the standard CAD, respectively. 14.9% of the nodules were assigned differently between the systems. CONCLUSIONS: Patient management may be affected by the volumetric inaccuracy of the CAD systems and hence demands supervision and/or manual correction by a radiologist. KEY POINTS: • The DL-based CAD system was more accurate in the volumetry of GGN and less accurate regarding solid nodules than the standard CAD system. • Nodule size and attenuation have an effect on the measurement accuracy of both systems; tube voltage has no effect on measurement accuracy. • Measurement inaccuracies of CAD systems can have an impact on patient management, which demands supervision by radiologists.

Coronary calcium scores on dual-source photon-counting computed tomography: an adapted Agatston methodology aimed at radiation dose reduction.

OBJECTIVES: The aim of this study was to determine mono-energetic (monoE) level-specific photon-counting CT (PCCT) Agatston thresholds, to yield monoE level independent Agatston scores validated with a dynamic cardiac phantom. Also, we examined the potential of dose reduction for PCCT coronary artery calcium (CAC) studies, when reconstructed at low monoE levels. METHODS: Theoretical CAC monoE thresholds were calculated with data from the National Institute of Standards and Technology (NIST) database. Artificial CAC with three densities were moved in an anthropomorphic thorax phantom at 0 and 60-75 bpm, and scanned at full and 50% dose on a first-generation dual-source PCCT. For all densities, Agatston scores and maximum CT numbers were determined. Agatston scores were compared with the reference at full dose and 70 keV monoE level; deviations (95% confidence interval) < 10% were deemed to be clinically not-relevant. RESULTS: Averaged over all monoE levels, measured CT numbers deviated from theoretical CT numbers by 6%, 13%, and - 4% for low-, medium-, and high-density CAC, respectively. At 50% reduced dose and 60-75 bpm, Agatston score deviations were non-relevant for 60 to 100 keV and 60 to 120 keV for medium- and high-density CAC, respectively. CONCLUSION: MonoE level-specific Agatston score thresholds resulted in similar scores as in standard reconstructions at 70 keV. PCCT allows for a potential dose reduction of 50% for CAC scoring using low monoE reconstructions for medium- and high-density CAC. KEY POINTS: • Mono-energy level-specific Agatston thresholds allow for reproducible coronary artery calcium quantification on mono-energetic images. • Increased calcium contrast-to-noise ratio at reduced mono-energy levels allows for coronary artery calcium quantification at 50% reduced radiation dose for medium- and high-density calcifications.

Improved coronary calcium detection and quantification with low-dose full field-of-view photon-counting CT: a phantom study.

OBJECTIVE: The aim of the current study was to systematically assess coronary artery calcium (CAC) detection and quantification for spectral photon-counting CT (SPCCT) in comparison to conventional CT and, in addition, to evaluate the possibility of radiation dose reduction. METHODS: Routine clinical CAC CT protocols were used for data acquisition and reconstruction of two CAC containing cylindrical inserts which were positioned within an anthropomorphic thorax phantom. In addition, data was acquired at 50% lower radiation dose by reducing tube current, and slice thickness was decreased. Calcifications were considered detectable when three adjacent voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). Quantification of CAC (as volume and mass score) was assessed by comparison with known physical quantities. RESULTS: In comparison with CT, SPCCT detected 33% and 7% more calcifications for the small and large phantoms, respectively. At reduced radiation dose and reduced slice thickness, small phantom CAC detection increased by 108% and 150% for CT and SPCCT, respectively. For the large phantom size, noise levels interfered with CAC detection. Although comparable between CT and SPCCT, routine protocols CAC quantification showed large deviations (up to 134%) from physical CAC volume. At reduced radiation dose and slice thickness, physical volume overestimations decreased to 96% and 72% for CT and SPCCT, respectively. In comparison with volume scores, mass score deviations from physical quantities were smaller. CONCLUSION: CAC detection on SPCCT is superior to CT, and was even preserved at a reduced radiation dose. Furthermore, SPCCT allows for improved physical volume estimation. KEY POINTS: • In comparison with conventional CT, increased coronary artery calcium detection (up to 156%) for spectral photon-counting CT was found, even at 50% radiation dose reduction. • Spectral photon-counting CT can more accurately measure physical volumes than conventional CT, especially at reduced slice thickness and for high-density coronary artery calcium. • For both conventional and spectral photon-counting CT, reduced slice thickness reconstructions result in more accurate physical mass approximation.

Coronary calcium scoring potential of large field-of-view spectral photon-counting CT: a phantom study.

OBJECTIVE: The aim of the current study was, first, to assess the coronary artery calcium (CAC) scoring potential of spectral photon-counting CT (SPCCT) in comparison with computed tomography (CT) for routine clinical protocols. Second, improved CAC detection and quantification at reduced slice thickness were assessed. METHODS: Raw data was acquired and reconstructed with several combinations of reduced slice thickness and increasing strengths of iterative reconstruction (IR) for both CT systems with routine clinical CAC protocols for CT. Two CAC-containing cylindrical inserts, consisting of CAC of different densities and sizes, were placed in an anthropomorphic phantom. A specific CAC was detectable when 3 or more connected voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). For all reconstructions, total CAC detectability was compared between both CT systems. Significant differences in CAC quantification (Agatston and volume scores) were assessed with Mann-Whitney U tests. Furthermore, volume scores were compared with the known CAC physical. RESULTS: CAC scores for routine clinical protocols were comparable between SPCCT and CT. SPCCT showed 34% and 4% higher detectability of CAC for the small and large phantom, respectively. At reduced slice thickness, CAC detection increased by 142% and 169% for CT and SPCCT, respectively. In comparison with CT, volume scores from SPCCT were more comparable with the physical volume of the CAC. CONCLUSION: CAC scores using routine clinical protocols are comparable between conventional CT and SPCCT. The increased spatial resolution of SPCCT allows for increased detectability and more accurate CAC volume estimation. KEY POINTS: • Coronary artery calcium scores using routine clinical protocols are comparable between conventional CT and spectral photon-counting CT. • In comparison with conventional CT, increased coronary artery calcium detectability was shown for spectral photon-counting CT due to increased spatial resolution. • Volumes scores were more accurately determined with spectral photon-counting CT.

A dose-neutral image quality comparison of different CBCT and CT systems using paranasal sinus imaging protocols and phantoms.

PURPOSE: To compare the image quality produced by equivalent low-dose and default sinus imaging protocols of a conventional dental cone-beam computed tomography (CBCT) scanner, an extremity CBCT scanner and a clinical multidetector computed tomography (MDCT) scanner. METHODS: Three different phantoms were scanned using dose-neutral ultra-low-dose and low-dose sinus imaging protocols, as well as default sinus protocols of each device. Quantified parameters of image quality included modulation transfer function (MTF) to characterize the spatial response of the imaging system, contrast-to-noise ratio, low contrast visibility, image uniformity and Hounsfield unit accuracy. MTF was calculated using the line spread and edge spread functions (LSF and ESF). RESULTS: The dental CBCT had superior performance over the extremity CBCT in each studied parameter at similar dose levels. The MDCT had better contrast-to-noise ratio, low contrast visibility and image uniformity than the CBCT scanners. However, the CBCT scanners had better resolution compared to the MDCT. Accuracy of HU values for different materials was on the same level between the dental CBCT and MDCT, but substantially poorer performance was observed with the extremity CBCT. CONCLUSIONS: The studied dental CBCT scanner showed superior performance over the studied extremity CBCT scanner when using dose-neutral imaging protocols. In case a dental CBCT is not available, the given extremity CBCT is still a viable option as it provides the benefit of high resolution over a conventional MDCT.

Classification of moving coronary calcified plaques based on motion artifacts using convolutional neural networks: a robotic simulating study on influential factors.

BACKGROUND: Motion artifacts affect the images of coronary calcified plaques. This study utilized convolutional neural networks (CNNs) to classify the motion-contaminated images of moving coronary calcified plaques and to determine the influential factors for the classification performance. METHODS: Two artificial coronary arteries containing four artificial plaques of different densities were placed on a robotic arm in an anthropomorphic thorax phantom. Each artery moved linearly at velocities ranging from 0 to 60 mm/s. CT examinations were performed with four state-of-the-art CT systems. All images were reconstructed with filtered back projection and at least three levels of iterative reconstruction. Each examination was performed at 100%, 80% and 40% radiation dose. Three deep CNN architectures were used for training the classification models. A five-fold cross-validation procedure was applied to validate the models. RESULTS: The accuracy of the CNN classification was 90.2 ± 3.1%, 90.6 ± 3.5%, and 90.1 ± 3.2% for the artificial plaques using Inception v3, ResNet101 and DenseNet201 CNN architectures, respectively. In the multivariate analysis, higher density and increasing velocity were significantly associated with higher classification accuracy (all P < 0.001). The classification accuracy in all three CNN architectures was not affected by CT system, radiation dose or image reconstruction method (all P > 0.05). CONCLUSIONS: The CNN achieved a high accuracy of 90% when classifying the motion-contaminated images into the actual category, regardless of different vendors, velocities, radiation doses, and reconstruction algorithms, which indicates the potential value of using a CNN to correct calcium scores.

Visual grading analysis of digital neonatal chest phantom X-ray images: Impact of detector type, dose and image processing on image quality.

OBJECTIVES: To evaluate the impact of digital detector, dose level and post-processing on neonatal chest phantom X-ray image quality (IQ). METHODS: A neonatal phantom was imaged using four different detectors: a CR powder phosphor (PIP), a CR needle phosphor (NIP) and two wireless CsI DR detectors (DXD and DRX). Five different dose levels were studied for each detector and two post-processing algorithms evaluated for each vendor. Three paediatric radiologists scored the images using European quality criteria plus additional questions on vascular lines, noise and disease simulation. Visual grading characteristics and ordinal regression statistics were used to evaluate the effect of detector type, post-processing and dose on VGA score (VGAS). RESULTS: No significant differences were found between the NIP, DXD and CRX detectors (p>0.05) whereas the PIP detector had significantly lower VGAS (p< 0.0001). Processing did not influence VGAS (p=0.819). Increasing dose resulted in significantly higher VGAS (p<0.0001). Visual grading analysis (VGA) identified a detector air kerma/image (DAK/image) of ~2.4 µGy as an ideal working point for NIP, DXD and DRX detectors. CONCLUSIONS: VGAS tracked IQ differences between detectors and dose levels but not image post-processing changes. VGA showed a DAK/image value above which perceived IQ did not improve, potentially useful for commissioning. KEY POINTS: • A VGA study detects IQ differences between detectors and dose levels. • The NIP detector matched the VGAS of the CsI DR detectors. • VGA data are useful in setting initial detector air kerma level. • Differences in NNPS were consistent with changes in VGAS.

Effect of CT Acquisition Parameters on Iodine Density Measurement at Dual-Layer Spectral CT.

OBJECTIVE: We aimed to evaluate the effect of tube voltage, tube current-time product, and iterative reconstruction on iodine quantification using a dual-layer spectral CT scanner. MATERIALS AND METHODS: Two mediastinal iodine phantoms, each containing six tubes of different iodine concentrations (0, 1, 2.5, 5, 10, and 20 mg I/mL; the two phantoms had tubes with contrast media diluted in water and in 10% amino acid solution, respectively), were inserted into an anthropomorphic chest phantom and scanned with varying acquisition parameters (120 and 140 kVp; 20, 40, 60, 80, 100, 150, and 200 mAs; and spectral reconstruction levels 0 and 6). Thereafter, iodine density was measured (in milligrams of iodine per milliliter) using a dedicated software program, and the effect of acquisition parameters on iodine density and on its relative measurement error (RME) was analyzed using a linear mixed-effects model. RESULTS: Tube voltages (all, p < 0.001) and tube current-time products (p < 0.05, depending on the interaction terms for iodine density; p = 0.023 for RME) had statistically significant effects on iodine density and RME. However, the magnitude of their effects was minimal. That is, estimated differences between tube voltage settings ranged from 0 to 0.8 mg I/mL for iodine density and from 1.0% to 4.2% for RME. For tube current-time product, alteration of 100 mAs caused changes in iodine density and RME of approximately 0.1 mg I/mL and 0.6%, respectively. Spectral level was not an affecting factor for iodine quantification (p = 0.647 for iodine density and 0.813 for RME). CONCLUSION: Iodine quantification using dual-layer spectral CT was feasible irrespective of CT acquisition parameters because their effects on iodine density and RME were minimal.

Influence of principal component analysis acceleration factor on velocity measurement in 2D and 4D PC-MRI.

OBJECTIVE: The objective of the study was to determine how to optimize 2D and 4D phase-contrast magnetic resonance imaging (PC-MRI) acquisitions to acquire flow velocities in millimetric vessels. In particular, we search for the best compromise between acquisition time and accuracy and assess the influence of the principal component analysis (PCA). MATERIALS AND METHODS: 2D and 4D PC-MRI measurements are conducted within two in vitro vessel phantoms: a Y-bifurcation phantom, the branches of which range from 2 to 5 mm in diameter, and a physiological subject-specific phantom of the carotid bifurcation. The same sequences are applied in vivo in carotid vasculature. RESULTS: For a vessel oriented in the axial direction, both 2D and axial 4D PC-MRI provided accuracy measurements regardless of the k-t PCA factor, while the acquisition time is reduced by a factor 6 for k-t PCA maximum value. The in vivo measurements show that the proposed sequences are adequate to acquire 2D and 4D velocity fields in millimetric vessels and with clinically realistic time durations. CONCLUSION: The study shows the feasibility of conducting fast, high-resolution PC-MRI flow measurements in millimetric vessels and that it is worth maximizing the k-t PCA factor to reduce the acquisition time in the case of 2D and 4D axial acquisitions.

Bismuth Infusion of ABS Enables Additive Manufacturing of Complex Radiological Phantoms and Shielding Equipment.

Radiopacity is a critical property of materials that are used for a range of radiological applications, including the development of phantom devices that emulate the radiodensity of native tissues and the production of protective equipment for personnel handling radioactive materials. Three-dimensional (3D) printing is a fabrication platform that is well suited to creating complex anatomical replicas or custom labware to accomplish these radiological purposes. We created and tested multiple ABS (Acrylonitrile butadiene styrene) filaments infused with varied concentrations of bismuth (1.2-2.7 g/cm³), a radiopaque metal that is compatible with plastic infusion, to address the poor gamma radiation attenuation of many mainstream 3D printing materials. X-ray computed tomography (CT) experiments of these filaments indicated that a density of 1.2 g/cm³ of bismuth-infused ABS emulates bone radiopacity during X-ray CT imaging on preclinical and clinical scanners. ABS-bismuth filaments along with ABS were 3D printed to create an embedded human nasocranial anatomical phantom that mimicked radiological properties of native bone and soft tissue. Increasing the bismuth content in the filaments to 2.7 g/cm³ created a stable material that could attenuate 50% of 99mTechnetium gamma emission when printed with a 2.0 mm wall thickness. A shielded test tube rack was printed to attenuate source radiation as a protective measure for lab personnel. We demonstrated the utility of novel filaments to serve multiple radiological purposes, including the creation of anthropomorphic phantoms and safety labware, by tuning the level of radiation attenuation through material customization.

Automatic Estimation of Volumetric Breast Density Using Artificial Neural Network-Based Calibration of Full-Field Digital Mammography: Feasibility on Japanese Women With and Without Breast Cancer.

Breast cancer is the most common invasive cancer among women and its incidence is increasing. Risk assessment is valuable and recent methods are incorporating novel biomarkers such as mammographic density. Artificial neural networks (ANN) are adaptive algorithms capable of performing pattern-to-pattern learning and are well suited for medical applications. They are potentially useful for calibrating full-field digital mammography (FFDM) for quantitative analysis. This study uses ANN modeling to estimate volumetric breast density (VBD) from FFDM on Japanese women with and without breast cancer. ANN calibration of VBD was performed using phantom data for one FFDM system. Mammograms of 46 Japanese women diagnosed with invasive carcinoma and 53 with negative findings were analyzed using ANN models learned. ANN-estimated VBD was validated against phantom data, compared intra-patient, with qualitative composition scoring, with MRI VBD, and inter-patient with classical risk factors of breast cancer as well as cancer status. Phantom validations reached an R 2 of 0.993. Intra-patient validations ranged from R 2 of 0.789 with VBD to 0.908 with breast volume. ANN VBD agreed well with BI-RADS scoring and MRI VBD with R 2 ranging from 0.665 with VBD to 0.852 with breast volume. VBD was significantly higher in women with cancer. Associations with age, BMI, menopause, and cancer status previously reported were also confirmed. ANN modeling appears to produce reasonable measures of mammographic density validated with phantoms, with existing measures of breast density, and with classical biomarkers of breast cancer. FFDM VBD is significantly higher in Japanese women with cancer.

Comparison of typical radiation doses and risks using an anthropomorphic 'bone fracture' phantom for commonly performed X-ray projections in a 5-year-old.

INTRODUCTION: Diagnostic reference levels (DRLs) are typical dose levels for medical imaging examinations for groups of standard-sized patients or standard phantoms for broadly defined types of equipment used as a tool to aid optimisation of protection for medical exposures. Currently, there are no paediatric DRLs for conventional radiography (i.e. general X-rays) published in Australia. The aim of this study was to establish typical radiation doses and risks that are representative of those delivered for commonly performed X-ray projections for a 5-year-old/20 kg child using a 5-year-old anthropomorphic 'bone fracture' phantom in three dedicated paediatric radiology departments in Victoria. METHODS: A total of 20 projection images were acquired for a standard 5-year-old/20 kg phantom using digital radiography X-ray equipment. The air kerma-area product (KAP) measured at each centre by a KAP metre, which was calibrated to a national primary standard, was considered to represent the median value for that centre for each X-ray projection. Organ doses and effective dose were estimated using PCXMC software, and risks of radiation-induced cancer and radiation-induced death were calculated based on the BEIR VII report. RESULTS: The typical doses for the individual X-ray projections ranged from 3 mGy•cm2 to 86 mGy•cm2 , whilst the effective doses ranged from 0.00004 to 0.07 mSv. The radiation risks were 'minimal' to 'negligible'. CONCLUSION: The estimation of typical radiation doses and associated risks for a 5-year-old/20 kg phantom study provides reference values for guidance and is a first step in assisting optimisation at other institutions until national DRLs, based on patient data from the clinical setting, are published.

Customization of Computed Tomography Radio-Opacity in 3D-Printed Contrast-Injectable Tumor Phantoms.

Medical Imaging Phantoms (MIPs) calibrate imaging devices, train medical professionals, and can help procedural planning. Traditional MIPs are costly and limited in customization. Additive manufacturing allows for customizable, patient-specific phantoms. This study examines the CT attenuation characteristics of contrast-injectable, chambered 3D-printed phantoms to optimize tissue-mimicking capabilities. A MIP was constructed from a CT of a complex pelvic tumor near the iliac bifurcation. A 3D reconstruction of these structures composed of three chambers (aorta, inferior vena cava, tumor) with ports for contrast injection was 3D printed. Desired attenuations were 200 HU (arterial I), 150 HU (venous I), 40 HU (tumor I), 150 HU (arterial II), 90 HU (venous II), and 400 HU (tumor II). Solutions of Optiray 350 and water were injected, and the phantom was scanned on CT. Attenuations were measured using ROIs. Mean attenuation for the six phases was as follows: 37.49 HU for tumor I, 200.50 HU for venous I, 227.92 HU for arterial I, 326.20 HU for tumor II, 91.32 HU for venous II, and 132.08 HU for arterial II. Although the percent differences between observed and goal attenuation were high, the observed relative HU differences between phases were similar to goal HU differences. The observed attenuations reflected the relative concentrations of contrast solutions used, exhibiting a strong positive correlation with contrast concentration. The contrast-injectable tumor phantom exhibited a useful physiologic range of attenuation values, enabling the modification of tissue-mimicking 3D-printed phantoms even after the manufacturing process.

A comparative study of analytical models of diffuse reflectance in homogeneous biological tissues: Gelatin-based phantoms and Monte Carlo experiments.

Information about tissue oxygen saturation (StO2) and other related important physiological parameters can be extracted from diffuse reflectance spectra measured through non-contact imaging. Three analytical optical reflectance models for homogeneous, semi-infinite, tissue have been proposed (Modified Beer-Lambert, Jacques 1999, Yudovsky 2009) but these have not been directly compared for tissue parameter extraction purposes. We compare these analytical models using Monte Carlo (MC) simulated diffuse reflectance spectra and controlled gelatin-based phantoms with measured diffuse reflectance spectra and known ground truth composition parameters. The Yudovsky model performed best against MC simulations and measured spectra of tissue phantoms in terms of goodness of fit and parameter extraction accuracy followed closely by Jacques' model. In this study, Yudovsky's model appeared most robust; however, our results demonstrated that both Yudovsky and Jacques models are suitable for modeling tissue that can be approximated as a single, homogeneous, semi-infinite slab.

A simplified low-cost phantom for image quality assessment of dental cone beam computed tomography unit.

INTRODUCTION: A standardised testing protocol for evaluation of a wide range of dental cone beam computed tomography (CBCT) performance and image quality (IQ) parameters is still limited and commercially available testing tool is unaffordable by some centres. This study aims to assess the performance of a low-cost fabricated phantom for image quality assessment (IQA) of digital CBCT unit. METHODS: A customised polymethyl methacrylate (PMMA) cylindrical phantom was developed for performance evaluation of Planmeca ProMax 3D Mid digital dental CBCT unit. The fabricated phantom consists of four different layers for testing specific IQ parameters such as CT number accuracy and uniformity, noise and CT number linearity. The phantom was scanned using common scanning protocols in clinical routine (90.0 kV, 8.0 mA and 13.6 s). In region-of-interest (ROI) analysis, the mean CT numbers (in Hounsfield unit, HU) and noise for water and air were determined and compared with the reference values (0 HU for water and -1000 HU for air). For linearity test, the correlation between the measured HU of different inserts with their density was studied. RESULTS: The average CT number were -994.1 HU and -2.4 HU, for air and water, respectively and the differences were within the recommended acceptable limit. The linearity test showed a strong positive correlation (R2 = 0.9693) between the measured HU and their densities. CONCLUSION: The fabricated IQ phantom serves as a simple and affordable testing tool for digital dental CBCT imaging.

Patient-derived PixelPrint phantoms for evaluating clinical imaging performance of a deep learning CT reconstruction algorithm.

Objective. Deep learning reconstruction (DLR) algorithms exhibit object-dependent resolution and noise performance. Thus, traditional geometric CT phantoms cannot fully capture the clinical imaging performance of DLR. This study uses a patient-derived 3D-printed PixelPrint lung phantom to evaluate a commercial DLR algorithm across a wide range of radiation dose levels.Method. The lung phantom used in this study is based on a patient chest CT scan containing ground glass opacities and was fabricated using PixelPrint 3D-printing technology. The phantom was placed inside two different size extension rings to mimic a small- and medium-sized patient and was scanned on a conventional CT scanner at exposures between 0.5 and 20 mGy. Each scan was reconstructed using filtered back projection (FBP), iterative reconstruction, and DLR at five levels of denoising. Image noise, contrast to noise ratio (CNR), root mean squared error, structural similarity index (SSIM), and multi-scale SSIM (MS SSIM) were calculated for each image.Results.DLR demonstrated superior performance compared to FBP and iterative reconstruction for all measured metrics in both phantom sizes, with better performance for more aggressive denoising levels. DLR was estimated to reduce dose by 25%-83% in the small phantom and by 50%-83% in the medium phantom without decreasing image quality for any of the metrics measured in this study. These dose reduction estimates are more conservative compared to the estimates obtained when only considering noise and CNR.Conclusion. DLR has the capability of producing diagnostic image quality at up to 83% lower radiation dose, which can improve the clinical utility and viability of lower dose CT scans. Furthermore, the PixelPrint phantom used in this study offers an improved testing environment with more realistic tissue structures compared to traditional CT phantoms, allowing for structure-based image quality evaluation beyond noise and contrast-based assessments.