Clinical image quality assessment and mean glandular dose for full field digital mammography.

This study aims to assess the image quality (IQ) of 12 mammographic units and to identify units with potential optimisation needs. Data for 350 mammography examinations meeting inclusion criteria were collected retrospectively from April 2021 to April 2022. They were categorised based on the medical reports into 10 normal cases, 10 cases displaying calcifications and 10 cases presenting lesions. Two radiologists assessed the IQ of 1400 mammograms, evaluating system performance per Boitaet al's study and positioning performance following European guidelines. To measure agreement between the two radiologists, the Cohen's Kappa coefficient (κ) was computed, quantifying the excess of agreement beyond chance. The visual grading analysis score (VGAS) was computed to compare system and positioning performance assessments across different categories and facilities. Median average glandular dose (AGD) values for cranio caudal and medio lateral oblique views were calculated for each category and facility and compared to the national diagnostic reference levels. The health facilities were categorised by considering both IQ VGAS and AGD levels. Inter-rater agreement between radiologists ranged from poor (κ< 0.20) to moderate (0.41 <κ< 0.60), likely influenced by inherent biases and distinct IQ expectations. 50% of the facilities were classified as needing corrective actions for their system performance as they had IQ or high AGD that could increase recall rate and radiation risk and 50% of the health facilities exhibited insufficient positioning performance that could mask tumour masses and microcalcifications. The study's findings emphasise the importance of implementing quality assurance programs to ensure optimal IQ for accurate diagnoses while adhering to radiation exposure guidelines. Additionally, comprehensive training for technologists is essential to address positioning challenges. These initiatives collectively aim to enhance the overall quality of breast imaging services, contributing to improved patient care.

Monte Carlo study of the scattered radiation field near the eyes of the operator in interventional procedures.

Interventional radiology and cardiology guarantee high benefits for patients, but are known to be associated with a high level of radiation exposure of medical staff. The recently suggested decrease of the annual dose limit for the eye lens, from 150 to 20 mSv, caused a need for a reconsideration of practices ensuring sufficient protection for the lens of the eyes of medical staff. In such context the study of the scattered radiation around the operator's head could help in finding the best solutions to be adopted for the ceiling-suspended shield and lead glasses in the most common situations in interventional practices. MCNPX Monte Carlo code was employed with anthropomorphic mathematical phantoms to simulate interventional practice projections. For each projection the effect of changing selected parameters on the evaluated scattered radiation towards the operator's head has been calculated. The variety of modelled situations provides plentiful material regarding the spatial distribution of the scattered radiation, useful to improve eye lens radiation protection, such as the following:  (a) Glasses, which provide shielding from both lateral and bottom-up scattered radiation, can reduce by ten times the exposure to the most exposed eyes;  (b) The ceiling-suspended shield offers valuable protection, but such effectiveness can diminish by 90% if the shielding is not correctly positioned;  (c) The transition from femoral to radial access usually intensifies the scattered radiation toward the operator head (a factor of 1.5 for AP projection), but for RAO projections, a reduction of the order by two to three times, in the case of radial access, can be seen, due to the protection provided by the image receptor. The detailed fluence outcomes show that there is a preferential direction of the impinging scattered radiation that should be considered when radiation protection options are evaluated or when a dedicated eye lens dosemeter is used for monitoring.

Creation of ORNL NURBS-based phantoms: evaluation of the voxel effect on absorbed doses from radiopharmaceuticals.

Doses from radiopharmaceuticals absorbed by organs can be assessed using Monte Carlo simulations and computational phantoms. Patient-based voxel phantoms improve the realism of organ topology but present unrealistic stair-stepped surfaces. The goal of this research was to study the voxel effect on the basis of creation and voxelisation of a series of non-uniform rational B-spline (NURBS) reference phantoms issued from the publication of the Oak Ridge National Laboratory (ORNL). Absorbed doses from various radiopharmaceuticals were calculated and compared with the values obtained for the corresponding analytical phantoms for models of an adult male and a 5-y-old child. Dose differences lower than 12.5 % were observed when the critical structure of the skin was excluded. Moreover, the highest differences were noted for small organs and walls. Finally, all NURBS phantoms of the ORNL series, their voxelised version and the corresponding Monte Carlo N-Particle eXtended input files were programmed and are available for further simulations.

Examples of Mesh and NURBS modelling for in vivo lung counting studies.

Realistic calibration coefficients for in vivo counting installations are assessed using voxel phantoms and Monte Carlo calculations. However, voxel phantoms construction is time consuming and their flexibility extremely limited. This paper involves Mesh and non-uniform rational B-splines graphical formats, of greater flexibility, to optimise the calibration of in vivo counting installations. Two studies validating the use of such phantoms and involving geometry deformation and modelling were carried out to study the morphologic effect on lung counting efficiency. The created 3D models fitted with the reference ones, with volumetric differences of <5 %. Moreover, it was found that counting efficiency varies with the inverse of lungs' volume and that the latter primes when compared with chest wall thickness. Finally, a series of different thoracic female phantoms of various cup sizes, chest girths and internal organs' volumes were created starting from the International Commission on Radiological Protection (ICRP) adult female reference computational phantom to give correction factors for the lung monitoring of female workers.

Creation and use of adjustable 3D phantoms: application for the lung monitoring of female workers.

In vivo counting measurements, used for the monitoring of workers with internal contamination risks, are based on the use of calibration physical phantoms. However, such phantoms do not exist for female subjects. Computational calibration using numerical representations, Mesh and non-uniform rational basis spline (NURBS) geometries, was thus considered. The study presented here is focused on the creation of different female thoracic phantoms with various breast sizes and chest girths. These 3D models are used to estimate the radiation attenuation with morphology and the resulting variation of the calibration coefficient of a typical 4-germanium in vivo counting system. A basic Mesh female thoracic phantom was created from the International Commission on Radiological Protection Adult Female Reference Computational Phantom. Using this basic phantom, different chest girths (85, 90, 100, 110, and 120) and cup sizes (A to F) were created representing the most common thoracic female morphologies, as recommended by the available and relevant literature. Variation of breast tissue composition and internal organ volumes with morphology were also considered. As a result, 34 thoracic female phantoms were created combining different cup sizes and chest girths. For the 85 chest girth, at very low energies (15 keV), a relative counting efficiency variation of about 85% was observed between the A and E cups. As a result of this study, breast size dependent calibration coefficients, between 15 keV and 1.4 MeV, were obtained and tabulated for a typical lung counting germanium system.