Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing.

This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.

Effect of the Effortful Swallow on Pharyngeal Cavity Volume: Kinematic Analysis in Three Dimensions Using 320-Row Area Detector Computed Tomography.

This study evaluated the effects of the effortful swallow (ES) on pharyngeal cavity volume using three-dimensional kinematic analyses. Nine healthy volunteers (30.7 ± 7.8 years old) underwent a CT scan while swallowing 10 ml of honey thick liquid using no maneuvers (control) and during an ES. Upper and lower volumes (bordered by valleculae) of the pharyngeal air column and the bolus were measured at every frame and were compared between ES and control swallows. Duration of pharyngeal obliteration and the timing of swallowing events were also measured. Maximum volume and volume at the onset of hyoid anterosuperior movement using ES were significantly smaller than those in control swallows (p = 0.012, p = 0.015) in the upper pharynx but not significantly different in lower pharynx. Minimum pharyngeal volume was sustained for a longer time when ES was used compared to control swallows in both upper and lower pharynx (upper p = 0.016, lower p = 0.027). Onset of velopharyngeal closure was earlier when comparing ES and control swallows (p = 0.04). Termination of all events was significantly delayed when the ES was used (p < 0.05). Changes in the upper pharyngeal volume and in the onset of velopharyngeal closure suggest earlier pharyngeal constriction when using the ES. Longer pharyngeal obliteration and prolonged termination of velopharyngeal closure and epiglottis inversion suggest the prolonged pharyngeal constriction during the ES. These findings suggest the ES can be useful for improving the efficiency of swallowing.

Evaluation of radiation dose for inferior vena cava filter placement during pregnancy: A comparison of dosimetry and dose calculation software.

Numerous medical conditions are associated with pregnancy in women, including pulmonary thromboembolism, which can be fatal. An effective treatment of this condition is the positioning of an inferior vena cava filter (IVC-F) under the guidance of X-ray imaging. However, this procedure involves the risk of high radiation exposure to pregnant women and fetuses. Moreover, there are no published reports comparing the values of fetal dose, received during IVC-F placement in pregnant women, determined using dose calculation software and actual measurements. To address this issue, we compared the fetal radiation dose and entrance surface dose (ESD) for pregnant women for gestation periods of 6 and 9 months based on software calculations and actual measurements. The ESD and fetal doses were estimated for a pregnant woman for gestation periods of 6 and 9 months during IVC-F placement. For actual measurements, one pregnant model phantom was constructed using an anthropomorphic phantom, and two custom-made different-sized abdomen phantoms were used to simulate pregnancy. The custom-made abdomen phantoms were constructed using polyurethane. For software calculations, the software utilized a set of anatomically realistic pregnant patient phantoms. The ESD estimated using the software was consistent with the measured ESD, but the fetal dose estimations were more complicated due to fetal positioning. During fetal dose evaluation using software calculations, the user must carefully consider how much of the fetal length is in the irradiation field to prevent underestimation or overestimation. Despite the errors, the software can assist the user in identifying the magnitude of the dose approaching critical limits.

Evaluation of Velopharyngeal Closure Function With 4-Dimensional Computed Tomography and Assessment of Radiation Exposure in Pediatric Patients: A Cross-Sectional Study.

OBJECTIVE: Some patients with cleft palate (CP) need secondary surgery to improve functionality. Although 4-dimensional assessment of velopharyngeal closure function (VPF) in patients with CP using computed tomography (CT) has been existed, the knowledge about quantitative evaluation and radiation exposure dose is limited. We performed a qualitative and quantitative assessment of VPF using CT and estimated the exposure doses. DESIGN: Cross-sectional. SETTING: Computed tomography images from 5 preoperative patients with submucous CP (SMCP) and 10 postoperative patients with a history of CP (8 boys and 7 girls, aged 4-7 years) were evaluated. PATIENTS: Five patients had undergone primary surgery for SMCP; 10 received secondary surgery for hypernasality. MAIN OUTCOME MEASURES: The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area (CSA) of VPI was evaluated via CT findings. Organ-absorbed radiation doses were estimated in 5 of 15 patients. The differences between cleft type and VPI, VPC patterns, and CSA of VPI were evaluated. RESULTS: All patients had VPI. The VPC patterns (SMCP/CP) were evaluated as coronal (1/4), sagittal (0/1), circular (1/2), and circular with Passavant's ridge (2/2); 2 patients (1/1) were unevaluable because of poor VPF. The CSA of VPI was statistically larger in the SMCP group (P = .0027). The organ-absorbed radiation doses were relatively lower than those previously reported. CONCLUSIONS: Four-dimensional CT can provide the detailed findings of VPF that are not possible with conventional CT, and the exposure dose was considered medically acceptable.

Fetal radiation dose of four tube voltages in abdominal CT examinations during pregnancy: A phantom study.

This study aimed to compare the dose and noise level of four tube voltages in abdominal computerized tomography (CT) examinations in different abdominal circumference sizes of pregnant women. Fetal radiation doses were measured with two anthropomorphic pregnant phantoms and real-time dosimeters of photoluminescence sensors using four tube voltages for abdominal CT. The noise level was measured at the abdomen of two anthropomorphic pregnant phantoms. In the large pregnant phantom, the mean fetal doses performed using 120 and 135 kV were statistically significantly lower than the lower tube voltages (P < 0.05). In the small pregnant phantom, the mean fetal dose performed by 100, 120, and 135 kV was significantly lower than the lowest tube voltage tested (P < 0.05). The ratios of the peripheral mean dose to the centric mean dose showed that the ratios of 80 kV were the highest and those for 135 kV were the lowest in both pregnant phantoms. The ratios of the peripheral mean dose to the centric mean dose decreased as the tube voltage increased. Compared with low tube voltages, high tube voltages such as 120 and 135 kV could reduce radiation doses to the fetus without compromising the image uniformity in abdominal CT examinations during pregnancy. On low tube voltage protocols, the dose near the maternal skin surface may be increased in large pregnant women because of reduced penetration of the x rays.

Novel pregnant model phantoms for measurement of foetal radiation dose in x-ray examinations.

This study presents a comparison of novel pregnant model phantoms with a handmade phantom in terms of shape and radiation measurement points to determine which model is more suitable for measuring the foetal radiation dose during x-ray examinations. Novel pregnant model phantoms were constructed using an anthropomorphic phantom in combination with two differently-sized custom-made abdomen phantoms simulating pregnancy, which were constructed from a polyurethane resin. The size and shape of the polyurethane resin were designed based on abdominal sizes and shapes collected from the computed tomography examinations at 18 pregnant patients of one hospital. The handmade pregnant model phantom was constructed using an anthropomorphic phantom and a beach ball containing water. Compared with the handmade phantom, there were additional dose measurement points on the novel pregnant model phantoms. Our model phantoms improved upon the handmade phantom in terms of shape and radiation measurement points. We produced pregnant model phantoms that simulated the shapes and sizes of actual patients for the first time.

Proposed diagnostic reference levels for general radiography and mammography in Japan.

Diagnostic reference levels (DRLs 2015) in Japan were first published in 2017, on the Japan Network for Research and Information on Medical Exposures network. Medical facilities in Japan are now presumably reconsidering radiation doses at their facilities and approaching protection optimisation through the application of DRLs 2015. However, since more than 3 years have elapsed since publication, radiation doses received by patients in Japan may have diverged from DRLs 2015. We therefore undertook the present study. Based on our questionnaire survey implemented in 2017, we estimated the entrance skin dose (ESD) under general radiography fields and the mean glandular dose (MGD) under mammography, to compile a report on the doses received by patients under general radiography fields and mammography, and to propose new DRLs as replacements for DRLs 2015. Radiation doses under general radiography fields and mammography were estimated from the results of the 2017 questionnaire survey and applied to determine new DRLs at 75% values of dose distributions in general radiography fields and at 95% values of dose distributions in mammography. Among all the modes for general radiography fields and mammography, median ESD and MGD were significantly smaller with flat panel detector systems than with computed radiography systems. Comparison of the results with DRLs 2015 values showed a trend toward decreases in all imaging methods of the general radiography fields and mammography ranging from 5.0% (child chest radiography) to 31.7% (skull radiography). Moreover, responses showed that DRLs 2015 were recognised and used for comparison at many facilities. We have described the doses received by patients in general radiography fields and mammography in 2017 and proposed new DRLs as replacements for DRLs 2015. The DRLs we proposed for general radiography fields and mammography were determined to be lower than DRLs 2015 for all modes.

[Influence of Absorbed Dose by Difference of Scanning Starting Angle in Multiphasic CT Imaging].

Presently, the scanning start angle of the X-ray tube of X-ray computed tomography (CT) scanners cannot be controlled. As a result, there is room for reducing patient dose because the peaks of the dose distributions may overlap during multiphasic CT imaging. This study investigated methods of dose reduction by performing a Monte Carlo simulation of the X-ray tube scanning start angle and locally absorbed dose in multiphasic CT imaging. In the Monte Carlo simulation, the largest decrease in the absorbed dose was seen, when the scanning start angle between the phases was±180°. Even though with present X-ray CT scanners, the scanning start angle cannot be controlled, it is possible to decrease the absorbed dose by taking the orbital synchronized scanning and scanning range into consideration. In future we hope that, we will be able to easily reduce the dose by controlling the scanning start angle.

Fetal dose conversion factor for fetal computed tomography examinations: A mathematical phantom study.

This study aimed to examine the relationship between fetal dose and the dose-length product, and to evaluate the impact of the number of rotations on the fetal doses and maternal effective doses using a 320-row multidetector computed tomography unit in a wide-volume mode. The radiation doses for the pregnant woman and the fetus were estimated using ImPACT CT Patient Dosimetry Calculator software for scan lengths ranging from 176 to 352 mm, using a 320-row unit in a wide-volume mode and an 80-row unit in a helical scanning mode. In the 320-row unit, the fetal doses in all scan lengths ranged from 3.51 to 6.52 mGy; the maternal effective doses in all scan lengths ranged from 1.05 to 2.35 mSv. In the 80-row unit, the fetal doses in all scan lengths ranged from 2.50 to 3.30 mGy; the maternal effective doses in all scan lengths ranged from 0.83 to 1.68 mSv. The estimated conversion factors from the dose-length product (mGy・cm) to fetal doses (mGy) for the 320-row unit in wide-volume mode and the 80-row unit in helical scanning mode were 0.06 and 0.05 (cm-1 ) respectively. While using a 320-row MDCT unit in a wide-volume mode, operators must take into account the number of rotations, the beam width as automatically determined by the scanner, the placement of overlap between volumetric sections, and the ratio of overlapping volumetric sections.

Tube Current Modulation Between Single- and Dual-Energy CT With a Second-Generation Dual-Source Scanner: Radiation Dose and Image Quality.

OBJECTIVE: The purpose of this study was to compare the effects of tube current modulation between single- and dual-energy CT with a second-generation dual-source scanner. MATERIALS AND METHODS: Custom-made elliptic polymethylmethacrylate phantoms for slim and large patients were used. Absorbed radiation dose at the central point of the phantoms was measured with a solid-state detector while the phantoms were scanned in single-energy (120 kV) and dual-energy (100/Sn140, 80/Sn140, and 140/80 kV) modes with a second-generation dual-source CT scanner. Tube current modulation was activated in both modes, and quality reference tube current-time settings of 150, 300, 450, and 600 mAs were selected. Scanning was performed three times under the same conditions, and image noise was evaluated by measuring the SD of CT numbers in four separate regions of three adjacent images of the phantoms. RESULTS: Absorbed dose increased and image noise decreased with an increase in quality reference tube current-time setting when the slim phantom was scanned. For the large phantom, the radiation dose and noise level reached a plateau above quality reference tube current-time settings of 300 mAs for 100/Sn140 kV and 450 mAs for 120 kV. The radiation dose was small and the noise level was large with 80/Sn140 kV compared with that obtained with 120 and 100/Sn140 kV at all quality reference tube current-time settings. CONCLUSION: When a large phantom is scanned with 100/Sn140 kV, exposure demand for tube current modulation exceeds system limits at a lower quality reference tube current-time setting than for scanning 120 kV.

Electrocardiogram-gated coronary CT angiography dose estimates using ImPACT.

The primary study objective was to assess radiation doses using a modified form of the Imaging Performance Assessment of Computed Tomography (CT) scanner (ImPACT) patient dosimetry for cardiac applications on an Aquilion ONE ViSION Edition scanner, including the Ca score, target computed tomography angiography (CTA), prospective CTA, continuous CTA/cardiac function analysis (CFA), and CTA/CFA modulation. Accordingly, we clarified the CT dose index (CTDI) to determine the relationship between heart rate (HR) and X-ray exposure. As a secondary objective, we compared radiation doses using modified ImPACT, a whole-body dosimetry phantom study, and the k-factor method to verify the validity of the dose results obtained with modified ImPACT. The effective dose determined for the reference person (4.66 mSv at 60 beats per minute (bpm) and 33.43 mSv at 90bpm) were approximately 10% less than those determined for the phantom study (5.28 mSv and 36.68 mSv). The effective doses according to the k-factor (0.014 mSv•mGy-1•cm-1; 2.57 mSv and 17.10 mSv) were significantly lower than those obtained with the other two methods. In the present study, we have shown that ImPACT, when modified for cardiac applications, can assess both absorbed and effective doses. The results of our dose comparison indicate that modified ImPACT dose assessment is a promising and practical method for evaluating coronary CTA.

Evaluation of organ doses and effective dose according to the ICRP Publication 110 reference male/female phantom and the modified ImPACT CT patient dosimetry.

We modified the Imaging Performance Assessment of CT scanners (ImPACT) to evaluate the organ doses and the effective dose based on the International Commission on Radiological Protection (ICRP) Publication 110 reference male/female phantom with the Aquilion ONE ViSION Edition scanner. To select the new CT scanner, the measurement results of the CTDI100,c and CTDI100,p for the 160 (head) and the 320 (body) mm polymethylmethacrylate phantoms, respectively, were entered on the Excel worksheet. To compute the organ doses and effective dose of the ICRP reference male/female phantom, the conversion factors obtained by comparison between the organ doses of different types of phantom were applied. The organ doses and the effective dose were almost identical for the ICRP reference male/female and modified ImPACT. The results of this study showed that, with the dose assessment of the ImPACT, the difference in sex influences only testes and ovaries. Because the MIRD-5 phantom represents a partially hermaphrodite adult, the phantom has the dimensions of the male reference man including testes, ovaries, and uterus but no female breasts, whereas the ICRP male/female phantom includes whole-body male and female anatomies based on high-resolution anatomical datasets. The conversion factors can be used to estimate the doses of a male and a female accurately, and efficient dose assessment can be performed with the modified ImPACT.

Assessment of fetal radiation exposure in pregnant women undergoing computed tomography and rotational angiography examinations for pelvic trauma.

This study aimed to assess fetal radiation exposure in pregnant women undergoing computed tomography (CT) and rotational angiography (RA) examinations for the diagnosis of pelvic trauma. In addition, this study aimed to compare the dose distributions between the two examinations. Surface and average fetal doses were estimated during CT and RA examinations using a pregnant phantom model and real-time dosemeters. The pregnant model phantom was constructed using an anthropomorphic phantom, and a custom-made abdominal phantom was used to simulate pregnancy. The total average fetal dose received by pregnant women from both CT scans (plain, arterial and equilibrium phases) and a single RA examination was ~60 mGy. Because unnecessary repetition of radiographic examinations, such as CT or conventional 2D angiography can increase the radiation risk, the irradiation range should be limited, if necessary, to reduce overall radiation exposure.

Estimating organ dose with optimized peak dose index in cone-beam CT scans.

PURPOSE: Organ dose evaluation is important for optimizing cone beam computed tomography (CBCT) scan protocols. However, an evaluation method for various CBCT scanners is yet to be established. In this study, we developed scanner-independent conversion coefficients to estimate organ doses using appropriate peak dose (f(0)) indices. METHODS: This study included various scanners (angiography scanners and linear accelerators) and protocols for the head and body (thorax, abdomen, and pelvis) scan regions. f(0) was measured at five conventional positions (center position (f(0)c) and four peripheral positions (f(0)p) at 90° intervals) in the CT dose index (CTDI) phantom. To identify appropriate measurement positions for organ dose estimation, various f(0) indices were considered. Organ doses were measured by using optically stimulated luminescence dosimeters positioned in an anthropomorphic phantom. Thereafter, the conversion coefficients were calculated from each obtained f(0) value and organ or tissue dose using a linear fit for all scanners, and the coefficient of variation (CV) of the conversion coefficients was calculated for each organ or tissue. The f(0) index with the minimum CV value was proposed as the appropriate index. RESULTS: The appropriate f(0) index was determined as f(0)c for the body region and a maximum of four f(0)p values for the head region. Using the proposed conversion coefficients based on the appropriate f(0) index, the organ/tissue doses were well estimated with a mean error of 14.2% across all scanners and scan regions. CONCLUSIONS: The proposed scanner-independent coefficients are useful for organ dose evaluation using CBCT scanners.

[Evaluation and examination of accuracy for the conversion factors of effective dose per dose-length product].

The purpose of this paper is to reappraise the accuracy of a conversion coefficient (k) reported by International Commission on Radiological Protection Publication 102 Table A.2. The effective doses of the routine head computed tomography (CT), the routine chest CT, the perfusion CT, and the coronary CT were evaluated using the conversion coefficient (adult head: 0.021 mSv·mGy⁻¹·cm⁻¹, adult chest: 0.014 mSv·mGy⁻¹·cm⁻¹). The dose length product (DLP) used the value displayed on the console on each scanning condition. The effective doses were evaluated using a human body type phantom (Alderson Rando phantom) and thermoluminescent dosimeter (TLD) elements for comparison with the converted value. This paper reported that the effective doses evaluated from conversion coefficient became different by 0.3 mSv (17%) compared with measurements, the effective dose computed with the conversion coefficient of the adult chest may be underestimated by 45%, and the bolus-tracking which scans the narrow beams should not use a conversion coefficient.

SIZE-specific dose estimate for lower-limb CT.

The Computed Tomography Dose Index (CTDI) is an indicator for dose management in computed tomography (CT), but has limited use for patient dosimetry. To evaluate the patient dose, the size-specific dose estimate (SSDE), reported by the American Association of Physics in Medicine task groups 204, 220, and 293, must be calculated by the CTDIvol(z) displayed on the CT console, and the conversion factor f(D(z)) from the effective diameter (DEff) or water equivalent diameter (Dw). However, no reports have verified the appropriateness of using the 320-mm diameter phantom for dose assessment in CT examinations involving the lower limbs. Therefore, we validated a new method for evaluating the SSDE(z) of the lower limbs, using two 160-mm diameter phantoms instead of the 320-mm diameter phantom. The CTDIvol(z) obtained from Monte Carlo (MC) simulation study was reliable because they were almost the same as obtained in a dosimetry study. The conversion factor f (D (zl.l.)) for the lower limbs was evaluated based on the CTDIvol(z) obtained by MC simulation performed using two polymethyl methacrylate cylinder phantoms of 160-mm diameter. The MC simulation was performed by the International Commission on Radiological Protection publication 135 reference adult phantom and was used to evaluate the absorbed dose of the pelvis, thighs, knees, and ankles. The dose showing the greatest difference was the thighs, which was 8.3 mGy (16%) lower than the absorbed dose. Thus, the SSDE (zl.l.) could be estimated from the [Formula: see text] displayed on the CT scanner console.

SIZE-SPECIFIC DOSE ESTIMATES IN FETAL COMPUTED TOMOGRAPHY.

During fetal computed tomography (CT) imaging, because of differences in the pregnancy period and scanning conditions, different doses of radiation are absorbed by the fetus. We propose a correction coefficient for determining the fetal size-specific dose estimate (SSDE) from the CT dose index (CTDI) displayed on the console at tube voltages of 80-135 kVp. The CTDIs corresponding to pregnant women and fetuses were evaluated using a Monte Carlo (MC) simulation, and the ratio of these CTDIs was defined as the Fetus-factor. When the effective diameter of a fetus was approximately 10 cm, the Fetus-factor was 1.0. The estimated pregnant SSDE was multiplied by the Fetus-factor to estimate the fetal SSDE, which was compared with the fetal dose obtained by the MC simulation of the image of the fetal CT examination. The fetal dose could be estimated with an error of 31.5% in fetal examinations conducted using helical CT.

A new cone-beam computed tomography dosimetry method providing optimal measurement positions: A Monte Carlo study.

PURPOSE: The conventional weighted computed tomography dose index (CTDIw) may not be suitable for cone-beam computed tomography (CBCT) dosimetry because a cross-sectional dose distribution is angularly inhomogeneous owing to partial angle irradiations. This study was conducted to develop a new dose metric (f(0)CBw) for CBCT dosimetry to determine a more accurate average dose in the central cross-sectional plane of a cylindrical phantom using Monte Carlo simulations. METHODS: First, cross-sectional dose distributions of cylindrical polymethyl methacrylate phantoms over a wide range of phantom diameters (8-40 cm) were calculated for various CBCT scan protocols. Then, by obtaining linear least-squares fits of the full datasets of the cross-sectional dose distributions, the optimal radial positions, which represented measurement positions for the average phantom dose, were determined. Finally, the f(0)CBw method was developed by averaging point doses at the optimal radial positions of the phantoms. To demonstrate its validity, the relative differences between the average doses and each dose index value were estimated for the devised f(0)CBw, conventional CTDIw, and Haba's CTDIw methods, respectively. RESULTS: The relative differences between the average doses and each dose index value were within 4.1%, 16.7%, and 11.9% for the devised, conventional CTDIw, and Haba's CTDIw methods, respectively. CONCLUSIONS: The devised f(0)CBw value was calculated by averaging four "point doses" at 90° intervals and the optimal radial positions of the cylindrical phantom. The devised method can estimate the average dose more accurately than the previously developed CTDIw methods for CBCT dosimetry.