Evaluation of image lag in a flat-panel, detector-equipped cardiovascular X-ray machine using a newly developed dynamic phantom.

We developed a dynamic phantom for use in routine checks. This phantom can be used to physically evaluate image lag that occurs in dynamic images. It has a unique measurement method. ROIs on the target are chosen, and, with the position of ROIs fixed on the image, changes in pixel value are detected physically when the target passes through the ROIs over time and perceived as image lag. Thus, it was possible to physically detect different intensities of image lag lasting less than one second while maintaining the same intensity trends. The checking technique we propose with the dynamic phantom that we developed could be effective for routine checking of fluoroscopy X-ray machines, and could become an established method.

[Usefulness of virtual vessel images in ppi for treatment of complete obstruction of leg arteries].

Following recent rapid advances in devices and treatment technology, indications for percutaneous peripheral intervention (PPI) have been expanded to include complex lesions (long-segment lesions, completely obstructed chronic lesions, etc.) and even lesions of the superficial femoral artery and arteries distal to the popliteal artery. However, when PPI is used for treatment of complete obstruction, treatment can take a long time or its outcome can be less satisfactory for reasons such as difficulty in assessing the vascular distribution/arrangement or the direction of calcification in the obstructed area or excessively long lesions. In the present study, we conducted three-dimensional image processing of CT data from leg arteries conventionally used for preoperative diagnosis. Using this processing technique, we created virtual images of the blood vessels of the completely obstructed area and mapped these virtual vessel images onto the fluoroscopic monitor image during catheter treatment. The usefulness of this technique for PPI was then evaluated. We succeeded in creating virtual vessel images of the completely obstructed parts of leg arteries with the use of preoperative CT images of leg arteries that we then mapped onto the fluoroscopic monitor images during treatment. We were successful in mapping virtual images onto the abdominal aorta in 96.8% of cases and in 95.7% with the common iliac artery. This technique is thus able to supply reliable information on vascular distribution/arrangement, suggesting that it can enable the surgeon to advance the treatment device precisely along the vessels, making it useful for treatment with PPI. The study additionally showed that differences in the angle of imaging affect the manual mapping of the CT images onto angiograms.

[Examination of the shoulder joint using true anterior-posterior photography, employing a body surface index].

Radiographic examination of the anterior part of the shoulder includes routine anterior-posterior imaging that enables easy visualization of traumatic injuries and true anterior-posterior imaging that enables the visualization of intra-articular injuries. The X-ray incident angle of true anterior-posterior imaging is affected by physique and posture. However, in many reports, the angle is uniformly determined on the basis of the antero-posterior axis and the horizontal plane. We previously reported that the glenohumeral joint can be visualized with good reproducibility by establishing a reference line on the basis of three points on the body as indicators, namely the posterior view of the under-surface of the acromion, the coracoid process, and the inferior angle of the scapula. However, visualizing the undersurface of the acromion using physical indicators to set the angle for imaging remains problematic. In previous reports, the angle was consistently set at 20° to the horizontal plane, regardless of physique or posture, which resulted in poor reproducibility. After examining the imaging techniques described in previous reports, we describe here an imaging technique using a reference line based on indicators on the surface of the scapula that enables the glenohumeral joint and the undersurface of the acromion to be visualized with good reproducibility.

[Study of heart region of interest setting method in the hepatic functional reserve index of (99m)tc-diethylenetriamine pentaacetic Acid-galactosyl human serum albumin].

In this study we analyzed the influence of region of interest (ROI) selection on the uptake ratio of the liver to the liver plus heart at 15 min (LHL15) during (99m)Tc-galactosyl human serum albumin (GSA) scintigraphy and determined the optimal ROI by evaluating the individual effects of different ROIs in the heart on LHL15. Twenty patients were randomly selected from those who had undergone (99m)Tc-GSA scintigraphy GSA between April 2008 and June 2009. The liver body (L/B) ratio, liver uptake 15 min (LU15), and LHL15 were analyzed and compared among the following ROIs: entire heart, both ventricles, right ventricle, and left ventricle. There were significant differences in the L/B ratio and LU15 values among the different ROIs. However, LHL15 showed a tendency to shift toward a normal value when the size of the ROI was small (only the right or left ventricle), resulting in a lack of distinction between normal and abnormal LHL15 values. Furthermore, setting the entire heart as the ROI was difficult and reproducibility was low. Our results suggest that the use of both ventricles as the ROI provides optimal LHL15 values during (99m)Tc-GSA scintigraphy.

[Failure analysis of medical linear accelerator with reliability analyses].

We analyzed a number of cases about the Linac troubles in our hospital and have examined the effect of preventive maintenance with Weibull analysis and exponential distribution from April 2001 to March 2012. The total failure by irradiation disabled was 1, 192. (1) Medical linear accelerator (MLC) system was 24.0%, (2) radiation dosimetry system 13.1%, and the (3) cooling-water system was 26.5%. It accounts for 63.6% of the total number of failures. Each parameter value m, which means the shape parameter, and the failure period expectancy of parts µ were (1) 1.21, 1.46/3.9, 3.8 years. 3.7, 3.6 years. (2) 2.84, 1.59/6.6, 4.3 years. 6.7, 5.9 years. (3) 5.12, 4.16/6.1, 8.5 years. 6.1, 8.5 years. Each shape parameter was m>1. It is believed that they are in the worn-out failure period. To prevent failure, MLC performance should be overhauled once every 3 years and a cooling unit should be overhauled once every 7 years. Preventive maintenance is useful in assessing the failure of radiation therapy equipment. In a radiation dosimetry part, you can make a preemptive move before the failure by changing the monitor's dosimeter board with a new part from the repairs stockpiled every 6 months for maintenance.

[A review of the position adopted by patients when acquiring images of the base of the hamate hook].

The hamate bone, one of the carpal (wrist) bones, has a large uncinate process protruding from the palm side. In sports such as golf and tennis, the hamate bone can break if is subjected to a high external force, such as from the handle of a racquet or club. At our hospital we take X-ray images of the hamate bone from two directions: an axial image through the carpal tunnel and an image at the base of the hamate hook (conventional method). While the conventional method makes it easy to create images of the base of the hamate hook, the patient may suffer pain during image-taking because the hamate bone is pulled to cause radial flexion. We therefore investigated a method of imaging that would create three-dimensional computed tomography (3DCT) images of the base of the hamate hook in which the patient would only have to only rotate the wrist externally and elevate the fore-arm without any radial flexion. Our results suggest that it is possible to obtain images of the base of the hamate hook as clear as those acquired using the conventional method with the patient in a comfortable and painless position taking images at an external rotation angle of 50.3° and a forearm elevation angle of 20.3°.

[Proposal for an auxiliary tool designed to reduce retake rates for lateral radiography of the knee joint].

The reproducibility of lateral radiography of the knee joint in the lateral position is low because patient positioning can be easily affected by passive rotation of the knee joint. We calculated the correction angle of the femoral external rotation and the lower leg elevation and developed our own auxiliary tool for obtaining a lateral view image. We were able to obtain, in a single attempt, an image with misalignment of the condyle limited to less than 7 mm. Our tool also contributed to the reduction of the re-imaging rate, suggesting its usefulness in contributing to a lower re-imaging rate for lateral radiography of the knee joint.

[Observations of deterioration of photo-stimulable phosphor plates used in digital mammography and its effects on mammography diagnoses].

We noted that breast-like artifacts occur in photo-stimulable phosphor plates (PSPs) used for long periods in digital mammography systems. This prompted us to investigate the effects on mammography diagnoses of these artifacts. Our study took the form of a comparison between the images generated by a long-term use PSP (four years use) and a short-term use PSP. First, an acrylic phantom and an in-house-made phantom for visual evaluation were imaged using X-ray PSPs under the same exposure conditions. They were then scanned under the same conditions to generate images. The mean values of the digital signals were measured in the 35 locations of region of interest present in the images of the acrylic phantom. The images of the in-house-made phantom were then visually evaluated by five certified experts, who examined 22 clinical images taken with both PSPs while referring to a visual evaluation scale. Differences were detected in all the evaluated items: the short-term use PSP gave a higher rate than the long-term use PSP (p<0.01), suggesting that long-term use PSPs might adversely affect the results of diagnostic mammography.

[Effect of Kiken-Yochi training (KYT) induction on patient safety at the department of radiological technology].

PURPOSE: In this report, we evaluated whether radiological technologists' (RTs') awareness of patient safety would improve and what kind of effects would be seen at the department of radiological technology by introducing KYT [K: kiken (hazard), Y: yochi (prediction), T: (training)]. METHODS: KYT was carried out by ten RTs based on a KYT sheet for the department of radiological technology. To evaluate the effects of KYT, we asked nine questions each to ten participants before and after KYT enforcement with regard to their attitude to patient safety and to operating procedures for working safely. RESULTS: Significant improvements after KYT enforcement were obtained in two items concerning medical safety: It is important for any risk to be considered by more than one person; The interest in preventive measures against medical accident degree conducted now) and one concerning operating procedures (It is necessary to have a nurse assist during testing with the mobile X-ray apparatus) (p<0.05). CONCLUSIONS: Performing KYT resulted in improved awareness of the importance of patient safety. KYT also enabled medical staffers to evaluate objectively whether the medical safety measures currently performed would be effective for patients.

[Radiation dose reduction using a non-linear image filter in MDCT].

The development of MDCT enabled various high-quality 3D imaging and optimized scan timing with contrast injection in a multi-phase dynamic study. Since radiation dose tends to increase to yield such high-quality images, we have to make an effort to reduce radiation dose. A non-linear image filter (Neuro 3D filter: N3D filter) has been developed in order to improve image noise. The purpose of this study was to evaluate the physical performance and effectiveness of this non-linear image filter using phantoms, and show how we can reduce radiation dose in clinical use of this filter. This N3D filter reduced radiation dose by about 50%, with minimum deterioration of spatial reduction in phantom and clinical studies. This filter shows great potential for clinical application.

[Development of a prevention of body movement fixation appliance in leg digital subtraction angiography].

In the peripheral angiography to evaluate blood flow below the knee levels in patients with arteriosclerosis obliterans, a motion artifact occurs as a result of body movements of a patient in normal fixation. This sometimes makes a correct evaluation difficult. Therefore, we developed a fixed appliance which can restrain body movement without affecting image quality and blood flow in digital subtraction angiography of a leg. The appliance is filled with the styrofoam of 1 mm diameter in a sealed bag, after air is aspirated from inside the bag. The appliance is stiffened to fit the shape of the crus. We measured signal to noise ratio / contrast to noise ratio / a resolution limit by visual evaluation to examine the influence of the image before and after usage of this appliance. In addition, the blood velocity of the dorsalis artery in ultrasound was measured to examine the effect on the blood flow. As a result, the fixed appliance did not affect blood flow in peripheral angiography to evaluate the clinical significance, the usual 5-point evaluate scale was used. The scale was significantly improved (p <0.01) after usage of this appliance. The newly developed fixed appliance for digital subtraction angiography of a leg is useful to avoid motion artifacts in clinical settings.

[Examination of safety improvement by failure record analysis that uses reliability engineering].

How the maintenance checks of the medical treatment system, including start of work check and the ending check, was effective for preventive maintenance and the safety improvement was verified. In this research, date on the failure of devices in multiple facilities was collected, and the data of the trouble repair record was analyzed by the technique of reliability engineering. An analysis of data on the system (8 general systems, 6 Angio systems, 11 CT systems, 8 MRI systems, 8 RI systems, and the radiation therapy system 9) used in eight hospitals was performed. The data collection period assumed nine months from April to December 2008. Seven items were analyzed. (1) Mean time between failures (MTBF) (2) Mean time to repair (MTTR) (3) Mean down time (MDT) (4) Number found by check in morning (5) Failure generation time according to modality. The classification of the breakdowns per device, the incidence, and the tendency could be understood by introducing reliability engineering. Analysis, evaluation, and feedback on the failure generation history are useful to keep downtime to a minimum and to ensure safety.

[Improvement of method of determining fluoroscopy loading factor in digital angiographic x-ray system with a flat panel detector].

A catheterization study and treatment of coronary arteriopathy are performed by investigating the coronary artery from different angles to find the region to be treated. In doing so, our system always started from the initial value of the loading factor, using this only for the first time, and the system started from the last loading factor the second time and later, at all angles. Therefore, depending on the angle, the loading factor at the start of fluoroscopy sometimes became unstable, and it took time to stabilize. This made the starting image too dark (undershoot x-ray condition) or fogged by halation (overshoot x-ray condition). With the system manufacturer, we developed a tube voltage and tube current setting method for the initial value of the loading factor. We installed software which preset the loading factor at the start of fluoroscopy depending on the angle, and an auto memory function of the last loading factor for each angle. This function allows the system to control the tube voltage and tube current for any angle. As a result, the system can acquire a more stabilized image from the start of fluoroscopy. This method of determining the initial loading factor is an effective way to stabilize the fluoroscopy image quickly.

[A characteristic of angiographic cone-beam CT].

Angiographic cone-beam CT, called DynaCT by SIEMENS, is a 3D imaging tool reconstructed from projection data by a rotational C-arm with a flat panel detector. It can visualize low-contrast objects such as soft tissue or small vessels as well as high-contrast structures such as enhanced vessels or bone. We need to understand its image characteristics and dose distribution during 200 degree rotation around a patient. In this research, we evaluated fundamental characteristics and dose effectiveness for optimized clinical images. DynaCT, including soft tissue information and isochronal voxel data along the z-axis, could provide enough CT-like image quality for IVR use. In addition, evaluation of accumulated dose distribution helped us to predict and avoid the occurrence of radiodermatitis. Thus, DynaCT is useful as a support and navigation tool for IVR.

[Utility of positioning the gamma camera at 30 degrees at RAO on (99m)Tc-GSA hepatic scintigraphy].

(99m)Tc-GSA hepatic scintigraphy can evaluate the physiopathology and hepatic functions in liver diseases. The procedure usually proceeds by placing a gamma camera in the anterior and frontal positions parallel to the frontal cross section of the patient. However, because the liver is situated from the front towards the right side of the body, the distance between the liver and the gamma camera can attenuate the isotope count. The present study examines the notion that placing the gamma camera at a RAO position for imaging will augment the counts from the liver, thus enabling a more accurate evaluation of hepatic function. We analyzed the Time Activity Curve on a RAO image selected from raw data acquired using dynamic SPECT. A comparison of images obtained in this manner with analytical data from frontal images indicated that positioning the gamma camera at 30 degrees at RAO, can capture more radioisotope counts than the frontal view, thus enabling a more accurate evaluation of hepatic function.

[Improvement of body diffusion image using addition technique].

It is difficult to obtain body diffusion weighted images (BDWI) using MRI that does not support parallel imaging and multi-NEX in clinical usage. Therefore, we evaluated whether a multiple image additions technique on the workstation could improve BDWI image quality and be good for clinical use by considering SNR and image distortion. We added 2 to 5 images on the same slice location with changing FOV, slice thickness, or reconstruction matrix in the phantom studies, and confirmed SNR improvement under all conditions. We also confirmed that this addition technique did not affect image distortion. We found that in 16 of the 18 clinical cases, BDWI with 5 images addition match pathology and T2 weighted images. We believe that this addition technique in available in the clinical practice.

[Elimination of bowel fluid artifact on abdominal DWI using oral contrast agent ferric ammonium citrate].

The clinical usefulness, as well as the advantages and limitations of DWI in the abdomen and pelvis, currently are under discussion. One of the limitations is the artifact from bowel fluid that may obscure lesion signals or make it difficult to detect them. The purpose of this study was to examine evidence as to whether an oral contrast agent of ferric ammonium citrate could eliminate this artifact from the bowel loop. The study consisted of a phantom study and clinical study. The density of the phantom compounded it to 1-6 times, 8 times and 12 times. We changed the density with ferric ammonium citrate to find the best density. The pulse sequence used SE-PEI and, variable parameter changed TE and b value. The signal intensity of the phantoms was visually analyzed. We took the results to an outside observer as a clinical study and confirmed the effect visually. When a signal of ferric ammonium citrate extended TE time and increased b value, it fell. As it thickened the density of phantom, it was the result that the signal deteriorated, and was good. However, an artifact from ferric ammonium citrate appeared when we exceeded 5x density. The signal of the bowel fluid artifact disappeared by having a normal person take the 4x density as in the clinical study. Elimination of bowel fluid artifact on abdominal DWI was able to suggest the possibility of taking the ferric ammonium citrate solution at 4x density.

[Stereometry of the prostate using MRI-A comparison between TRUS, CT, and MRI-].

I-125 permanently implanted sealed-source radiotherapy is one of the treatments for early localized prostate carcinoma. In order to choose treatment parameters such as the number of implanted sources, accurately determining the volume of the prostate is vital for this type of therapy. We compared the usefulness of transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) for preoperative stereometry of the prostate, and we further reviewed the utility of the MRI measurement. We performed prostate stereometry with TRUS, CT, and MRI in each of 45 patients who had provided informed consent. Taking TRUS stereometry as the standard, we computed the correlation of the MRI results with TRUS, and that of the CT results with TRUS, and found that MRI had a higher correlation.

[Survey on scanning pediatric patients' heads with CT].

Pediatric patients are especially sensitive to radiation, and when scanning their heads with CT, it is necessary to do so with a low dose and pay very close attention. However, there are many problems when scanning pediatric patients, and it is often confusing to set the conditions for scanning. To do a survey and comparison, we issued a questionnaire to 23 pediatric hospitals and 89 university hospitals, asking about their usage of sedation, studied disorders, as well as how and under what conditions they scan their patients. The percentage of response was 40% in total. Based on the questionnaire results, we could not see much difference in the conditions for scanning. However, there was a significant difference in the usage of sedation and studied disorders between pediatric hospitals and university hospitals. The most studied disorders at pediatric hospitals were convulsion and consciousness disorders, and low-contrast areas such as the albocinereous, which requires images without movement artifacts. In order to obtain clear images, the patient was put under sedation. On the other hand, university hospitals often deal with external injuries, which usually involve danger in using sedation, and patients are usually examined without it. In addition, the usage of sedation is rare because bleeding brings up high-contrast images, and it is easy to make a diagnosis even if there is some movement artifact. Also to aim at setting a standard for medical technology, from here on, guidelines of examining methods and setting conditions should be made depending on how the different disorders should be treated.

[Creation of a crystalline lens radiation exposure defense cover and the effect of radiation exposure decrease on neuro-interventions].

A variety of radiation hazards resulting from interventional radiology (IVR) have been reported in recent years. Particularly affected are the skin and the crystalline lens, with their high radiation sensitivity. During neurological interventions, the radiological technologist should consider decreasing radiation exposure. We found exposure projections where the exposure dose became a radiation hazard for the crystalline lens, and examined an efficient method of cover for the exposure projections used for neurological interventions. The exposure projection for maximum crystalline lens radiation exposure was a lateral projection. In the crystalline lens the maximum exposure to radiation was on the X-ray tube side. The method of defense adopted was that of installing a lead plate of the appropriate shape on the surface of the X-ray tube collimator. In other exposure projections, this cover did not become a redundant shadow. With the cover that was created, the X-ray side crystalline lens lateral projection could be defended effectively.