Radiation Exposure from the Patient Perspective: An Argument for the Inclusion of Dose History.

ABSTRACT: Patients in diagnostic imaging departments often ask about the risk of injury from x radiation. They are referred to wall posters or consent forms that declare (rightly) that the risk of harm from the proposed exam is very small and is far outweighed by the benefit. If a comparative risk value is provided, most likely it is based on a single exposure and derived from population estimates of cancer incidence and mortality. But is that information the most relevant for the patient? In a recent position statement, the AAPM recommends that only current exam risk should be considered, and that risk is independent of previous exams. We argue that if an exam carries risk of a negative event, the likelihood that a negative event occurred over all events increases with the number of exams. This cumulative risk, though still very small, must be a relevant consideration for health management.

Cell Surface Remodeling of Mycobacterium abscessus under Cystic Fibrosis Airway Growth Conditions.

Understanding the physiological processes underlying the ability of Mycobacterium abscessus to become a chronic pathogen of the cystic fibrosis (CF) lung is important to the development of prophylactic and therapeutic strategies to better control and treat pulmonary infections caused by these bacteria. Gene expression profiling of a diversity of M. abscessus complex isolates points to amino acids being significant sources of carbon and energy for M. abscessus in both CF sputum and synthetic CF medium and to the bacterium undergoing an important metabolic reprogramming in order to adapt to this particular nutritional environment. Cell envelope analyses conducted on the same representative isolates further revealed unexpected structural alterations in major cell surface glycolipids known as the glycopeptidolipids (GPLs). Besides showing an increase in triglycosylated forms of these lipids, CF sputum- and synthetic CF medium-grown isolates presented as yet unknown forms of GPLs representing as much as 10% to 20% of the total GPL content of the cells, in which the classical amino alcohol located at the carboxy terminal of the peptide, alaninol, is replaced with the branched-chain amino alcohol leucinol. Importantly, both these lipid changes were exacerbated by the presence of mucin in the culture medium. Collectively, our results reveal potential new drug targets against M. abscessus in the CF airway and point to mucin as an important host signal modulating the cell surface composition of this pathogen.

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

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

Automated breast image classification using features from its discrete cosine transform.

PURPOSE: This work aimed to improve breast screening program accuracy using automated classification. The goal was to determine if whole image features represented in the discrete cosine transform would provide a basis for classification. Priority was placed on avoiding false negative findings. METHODS: Online datasets were used for this work. No informed consent was required. Programs were developed in Mathematica and, where necessary to improve computational performance ported to C++. The use of a discrete cosine transform to separate normal from cancerous breast tissue was tested. Features (moments of the mean) were calculated in square sections of the transform centered on the origin. K-nearest neighbor and naive Bayesian classifiers were tested. RESULTS: Forty-one features were generated and tested singly, and in combination of two or three. Using a k-nearest neighbor classifier, sensitivities as high as 98% with a specificity of 66% were achieved. With a naive Bayesian classifier, sensitivities as high as 100% were achieved with a specificity of 64%. CONCLUSION: Whole image classification based on discrete cosine transform (DCT) features was effectively implemented with a high level of sensitivity and specificity achieved. The high sensitivity attained using the DCT generated feature set implied that these classifiers could be used in series with other methods to increase specificity. Using a classifier with near 100% sensitivity, such as the one developed in this project, before applying a second classifier could only boost the accuracy of that classifier.

Automatic detection of anomalies in screening mammograms.

BACKGROUND: Diagnostic performance in breast screening programs may be influenced by the prior probability of disease. Since breast cancer incidence is roughly half a percent in the general population there is a large probability that the screening exam will be normal. That factor may contribute to false negatives. Screening programs typically exhibit about 83% sensitivity and 91% specificity. This investigation was undertaken to determine if a system could be developed to pre-sort screening-images into normal and suspicious bins based on their likelihood to contain disease. Wavelets were investigated as a method to parse the image data, potentially removing confounding information. The development of a classification system based on features extracted from wavelet transformed mammograms is reported. METHODS: In the multi-step procedure images were processed using 2D discrete wavelet transforms to create a set of maps at different size scales. Next, statistical features were computed from each map, and a subset of these features was the input for a concerted-effort set of naïve Bayesian classifiers. The classifier network was constructed to calculate the probability that the parent mammography image contained an abnormality. The abnormalities were not identified, nor were they regionalized.The algorithm was tested on two publicly available databases: the Digital Database for Screening Mammography (DDSM) and the Mammographic Images Analysis Society's database (MIAS). These databases contain radiologist-verified images and feature common abnormalities including: spiculations, masses, geometric deformations and fibroid tissues. RESULTS: The classifier-network designs tested achieved sensitivities and specificities sufficient to be potentially useful in a clinical setting. This first series of tests identified networks with 100% sensitivity and up to 79% specificity for abnormalities. This performance significantly exceeds the mean sensitivity reported in literature for the unaided human expert. CONCLUSIONS: Classifiers based on wavelet-derived features proved to be highly sensitive to a range of pathologies, as a result Type II errors were nearly eliminated. Pre-sorting the images changed the prior probability in the sorted database from 37% to 74%.

Neuroimaging assessment of memory-related brain structures in a rat model of acute space-like radiation.

PURPOSE: To investigate the acute effects on the central nervous system (CNS) of (56)Fe radiation, a component of high-energy charged particles (HZE) in space radiation, using quantitative magnetic resonance imaging (MRI) noninvasively. MATERIALS AND METHODS: Sprague-Dawley rats were exposed to whole-brain (56)Fe (0, 1, 2, and 4 Gy). At 1 week postirradiation, MRI scans were made using T2-weighted (T2WI), diffusion-weighted (DWI), and contrast enhanced T1-(CET1) imaging. T2 relaxation time and apparent diffusion coefficient (ADC) values were obtained from memory-related brain regions of interest (ROIs). Histopathology was correlated using ex vivo tissues. RESULTS: No overt abnormalities were visualized using T2WI and DWI at 1 week postradiation. CET1 values did not differ significantly between the irradiated and control animals. Compared to 0 Gy, there were significant prolongations in T2 values and reductions in ADC after irradiation. In the absence of evident neuronal pathology, immunohistochemistry revealed astrocytic activation in 4 Gy animals. CONCLUSION: At 1 week after whole-brain (56)Fe exposure, T2 and ADC values can differentiate radiosensitivity in regions critical for hippocampal-related memory. MRI may provide noninvasive assessment of the initial molecular/cellular disturbances in vivo after HZE irradiation.

Nuclear magnetic resonance spectroscopy of bovine ovarian follicular fluid at four selected times of the oestrous cycle.

The objective of the study was to determine if nuclear magnetic resonance (NMR) spectral features of ovarian follicular fluid were correlated with the physiological status of follicles so that we could assess the feasibility of using NMR spectroscopy during assisted reproduction therapy. Thirty-five sexually mature, nullparious heifers were monitored by transrectal ultrasonography to assess their follicle wave status during the oestrous cycle. Ovariectomies were performed on Day 3 of wave 1 (D3W1, n = 10), Day 6 of wave 1 (D6W1, n = 9), Day 1 of wave 2 (D1W2, n = 9), or in the immediate preovulatory period of at least 17 days after ovulation (De17, n = 9). Follicle status was determined to be dominant or subordinate. Follicular fluid was extracted from the follicles and NMR spectra were collected. Principal components were extracted from ratios of line amplitudes and tested for effects of follicle status (dominant v. subordinate) and cycle time point (D1W3, D1W6, D1W2 and De17) using multivariate analysis of variance. For most line ratio combinations, main effects of status, time point and their interaction were found (P < 0.05). We concluded that NMR spectra may be used for the determination of ovarian follicle physiological status.

Magnetic resonance diffusion imaging of ovarian masses: a first experience with 12 cases.

OBJECTIVE: The objective of the study was to determine the feasibility of using apparent diffusion coefficient (ADC) measurement for the differential diagnosis of malignancy in ovarian masses. MATERIALS AND METHODS: Twelve cases involving ovarian masses were imaged using spin echo diffusion magnetic resonance imaging (MRI). Five cases involved malignant ovarian masses, on the basis of postoperative histologic examination, and the rest involved benign masses. The ovarian masses were imaged in vivo (10 cases) before surgery and ex vivo (8 cases) after surgical resection. Diffusion-weighted data were corrected for motion using the phase data from unweighted data in nine cases. Multifactorial analysis of variance was used to evaluate the effects of malignancy, location (in vivo versus ex vivo), and motion correction on the measurement of ADC intensity and texture. RESULTS: Motion correction caused an undesirable spatial smoothing of the ADC maps and a significant interaction (p=0.047) was found between location and motion correction. ADC value (p=0.028) and texture (p=0.001) differences were found between malignant and nonmalignant ovarian masses. CONCLUSION: Measurement of ADC intensity and texture has the potential to differentially diagnose malignancy in individual ovarian masses if the problem of image motion artifact can be eliminated through the use of faster imaging sequences.