Radiography education with VR using head mounted display: proficiency evaluation by rubric method.

BACKGROUND: The use of head mounted display (HMD)-based immersive virtual reality (VR) coaching systems (HMD-VRC) is expected to be effective for skill acquisition in radiography. The usefulness of HMD-VRC has been reported in many previous studies. However, previous studies have evaluated the effectiveness of HMD-VRC only through questionnaires. HMD-VRC has difficulties in palpation and patient interaction compared to real-world training. It is expected that these issues will have an impact on proficiency. The purpose of this study is to determine the impact of VR constraints in HMD-VRC, especially palpation and patient interaction, on radiographic skills proficiency in a real-world setting. METHODS: First-year students (n = 30) at a training school for radiology technologists in Japan were randomly divided into two groups, one using HMD-VRC (HMD-VRC group) and the other practicing with conventional physical equipment (RP group) and trained for approximately one hour. The teachers then evaluated the students for proficiency using a rubric method. RESULTS: In this study, it was found that some skills in the HMD-VRC group were equivalent to those of the RP group and some were significantly lower than those of the RP group. There was a significant decrease in proficiency in skills related to palpation and patient interaction. CONCLUSIONS: This study suggests that HMD-VRC can be less effective than real-world training in radiographic techniques, which require palpation and patient interaction. For effective training, it is important to objectively evaluate proficiency in the real world, even for HMD-VRC with new technologies, such as haptic presentation and VR patient interaction. TRIAL REGISTRATION: The study was conducted with the approval of the Ethics Committee of International University of Health and Welfare (Approval No.21-Im-035, Registration date: September 28, 2021).

[Incident Analysis in Radiography Focusing on the Experience Period of Radiological Technologist].

We investigated the causes and trends of incidents related to radiography. From April 2014 to March 2016, 384 incident reports related to radiography were posted. We analyzed based on the nature of the incidents and the experience period of radiological technologist (RT). The types of incidents were 'Incorrect examination order by medical doctor' (50.0%), 'X-ray retake' (24%), 'Incorrect examination procedure' (9.9%), 'Fall or injury of the patient under examination' (3.6%), 'selection error of X-ray detector' (3.1%), 'patient mismatch' (1.8%), 'overdose' (1.3%), and 'others' (a malfunctioning device, trouble of systems and the other) (6.5%). There was no relationship between the number of incidents per person and the experience period as RT; (7.8/person for <3 years of experience, 9.7/person for 3-10 years, 6.4/person for 11-25 years of experience, 7.4/person for <25 years of experience). The experience period as RT are related to some types of incident reduction. 'Fall or injury of the patient under examination' and 'overdose' were more frequently reported by RTs of shorter experience (<3 years and 3-10 years of experience) than RTs of longer experience (11-25 years and <25 of experience). On the other hand, 'patient mismatch' and 'selection error of X-ray detector' were more frequently reported by RTs of long experience than RTs of short experience.

Survey of Careers and Achievements on Delegates in JSRT International Delegation Projects.

Japanese society of radiological technology (JSRT) categorizes three international delegation projects; short-term studying abroad program (STSAP), international academic society visit program (overseas) (IASVP), and international internship visit program (Stanford University) (IIVP) for driving globalization of JSRT. In this survey, we conducted a questionnaire evaluating effectiveness of the international delegations. The survey covered 50 delegates of STSAP, 180 delegates of IASVP, and 100 delegates of IIVP. This survey includes detailed histories of career, current position, academic articles, and presentations as a first presenter before and on, and after each program. We categorized into six groups (change career, promoted in a position in hospital, kept a current position in hospital, promoted in a position in university, kept a current position in university, and others) in three programs. The response rate is approximately 58% (191/330 delegators). In all programs, almost all the delegates were radiological technologists in the hospital. They had reported a lot of academic articles and made a lot of presentations, and promoted in the hospital and/or university. STSAP, IASVP and IIVP were descending order of the average number of the articles as a first author and presentations as a first presenter. They published more the academic articles in Japanese than in English compared to JJRT and RPT. Therefore, research achievements and human resource conducted by this project provide great technologists and technique, and education. For further JRST globalization, it is desirable that we can continue these international delegations and verify the effectiveness.

Automatic ROI construction for analyzing time-signal intensity curve in dynamic contrast-enhanced MR imaging of the breast.

Our purpose in this study was to construct a 3-dimensional (3D) region of interest (ROI) for analyzing the time-signal intensity curve (TIC) semi-automatically in dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging of the breast. DCE-MR breast imaging datasets were acquired by a 3.0-Tesla MR system with the use of a 3D fast gradient echo sequence. The essential idea in the new method was to analyze each pixel and to construct an ROI made up of pixels with similar TICs. First, an analyst selected a starting point in the contrast media-enhanced tumor. Second, we calculated Pearson's correlation coefficients (CCs) between the TIC in the starting coordinate selected by the analyst and the TIC in the other coordinates. Third, ROI pixels were selected if their CC threshold satisfied a level of coefficient variation of the ROI determined by prior research performed in our institution. We made a retrospective review of patients who underwent breast DCE-MR examination for pre-operative diagnosis. To confirm the feasibility of the resulting 3D-ROI from TIC analysis, we compared Fischer's score obtained from 3D-ROI by applying a new method to a score obtained from a manually selected 2-dimensional (2D) ROI which was used during routine clinical examination. The Fischer's scores obtained from both the automatically selected 3D-ROI and the manually selected 2D-ROI showed almost equivalent results. Thus, we considered that the new method was comparable to the conventional method. Furthermore, the new method has the potential to be used for evaluation of the extent of tumors.

Usefulness of biological fingerprint in magnetic resonance imaging for patient verification.

The purpose of our study is to investigate the feasibility of automated patient verification using multi-planar reconstruction (MPR) images generated from three-dimensional magnetic resonance (MR) imaging of the brain. Several anatomy-related MPR images generated from three-dimensional fast scout scan of each MR examination were used as biological fingerprint images in this study. The database of this study consisted of 730 temporal pairs of MR examination of the brain. We calculated the correlation value between current and prior biological fingerprint images of the same patient and also all combinations of two images for different patients to evaluate the effectiveness of our method for patient verification. The best performance of our system were as follows: a half-total error rate of 1.59 % with a false acceptance rate of 0.023 % and a false rejection rate of 3.15 %, an equal error rate of 1.37 %, and a rank-one identification rate of 98.6 %. Our method makes it possible to verify the identity of the patient using only some existing medical images without the addition of incidental equipment. Also, our method will contribute to patient misidentification error management caused by human errors.

Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Subarachnoid clots play an important role in development of delayed vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to compare clearance of subarachnoid clots using external ventricular drainage (EVD) or lumbar drainage (LD) after Guglielmi detachable coil (GDC) embolization for aneurysmal SAH. METHODS: The subjects were 51 treated with GDC coil embolization for aneurysmal Fisher group 3 SAH within 72 h of ictus. Software-based volumetric quantification of the subarachnoid clots was performed on CT scans and the hemoglobin (Hb) level was measured in CSF drained from each catheter. RESULTS: Clearance of subarachnoid clots was more rapid in patients treated with LD (n=34) compared to those treated with EVD (n=17). The Hb level in CSF was significantly higher in the LD group on Days 4-5 after onset of SAH (P<0.05), but was higher in the EVD group on Days 8-9. The incidence of symptomatic vasospasm did not differ between the two groups. The rate of occurrence of a new low density area on CT scans was higher in patients treated with EVD, but not significantly higher than the rate in the LD group. CONCLUSION: GDC embolization followed by lumbar drainage accelerates the reduction of subarachnoid clots, but EVD may contribute to stasis of hemorrhage within subarachnoid spaces.

Correction of liver displacement due to irregular respiration for SPECT images obtained using a multiple short-time acquisition with breath-holding technique.

Recently, a new method for acquiring single photon emission computed tomography (SPECT) data during breath-holding with a high-speed rotation (HSR-SPECT) technique was applied to hepatic-function scintigraphy. This technique can suppress motion artifact caused by respiration. However, it is challenging to apply this technique to patients with respiratory problems. Our purpose in this study was to analyze projection data and correct liver displacement due to irregular respiration during technetium-99m-diethylenetriaminepentaacetic acid galactosyl human serum albumin ((99m)Tc-GSA) liver SPECT scans. We calculated cross-correlation functions (CCFs) for both intra- and inter-projections to correct irregular projections by shifting them in the longitudinal direction enough to maximize the CCFs. We integrated all of the shifted projections and created a synthesis projection which was used to reconstruct SPECT images. To confirm the effectiveness of our method, we did both a phantom study and a clinical retrospective review. In the phantom study, blurring artifacts due to displacement were reduced using our method. Post-processing using our method showed improvements in the normalized mean square error values ranging from 0.18 to 0.06. Furthermore, our method showed no disadvantage or miss-correction if we applied our method to data without displacement. In the clinical review, our method improved the image clarity for patients who could not repeat consistent respiration. In both the phantom simulation and the clinical application, the results showed the usefulness of our method. The efficiency of our method has the potential to reduce the displacement problem caused by respiration and provides excellent matching SPECT/CT fusion images.

Fate of clots in patients with subarachnoid hemorrhage after different surgical treatment modality: a comparison between surgical clipping and Guglielmi detachable coil embolization.

BACKGROUND: Subarachnoid clot is important in the development of delayed vasospasm after subarachnoid hemorrhage (SAH). OBJECTIVE: To compare the clearance of subarachnoid clot and the incidence of symptomatic vasospasm in surgical clipping and embolization with Guglielmi detachable coils for aneurysmal SAH. METHODS: The subjects were 115 patients with Fisher group 3 aneurysmal SAH on computed tomography scan at admission whose aneurysm was treated by surgical clipping (clip group; n = 86) or Guglielmi detachable coil embolization (coil group; n = 29) within 72 hours of ictus. Software-based volumetric quantification of the subarachnoid clot was performed, and the amount of hemoglobin in drained cerebrospinal fluid was measured. RESULTS: Clearance of the subarachnoid clot on the computed tomography scan was rapid in the clip group until the day after the operation but slow in the coil group (58.9% removed vs 27.8% removed; P = .008). However, postoperative clearance of the clot occurred more rapidly in the coil group. Reduction of the clot until days 3 through 5 did not differ significantly between the 2 groups (72.9% removed vs 75.2% removed). The amount of hemoglobin in the clip group was > 0.8 g/d until day 3 and then gradually decreased (n = 15), but hemoglobin in the coil group remained at > 0.8 g/d until day 5 (n = 17). The incidence of symptomatic vasospasm did not differ between the groups. CONCLUSION: Subarachnoid clot can be removed directly during surgical clipping, which is not possible with endovascular treatment. However, the percentage reduction of the clot on days 3 through 5 did not differ between the 2 groups.

[Evaluation of image quality of multiplanar reconstruction images: Effect of Z-increment of original axial images].

PURPOSE: The aim of our study was to evaluate the image quality of multiplanar reconstruction images (MPRs) focusing on the effect of z-increment of original axial images using signal to noise ratio (SNR) measurement in in- plane and longitudinal directions. METHODS AND MATERIALS: SNRs of MPRs were calculated using modulation transfer function (MTF) and noise power spectrum (NPS). We scanned a bead phantom with a diameter of 0.1 mm and a water phantom with a diameter of 250 mm for calculating MTF and NPS using a MDCT with 0.5 s per rotation, 1.0 pitch and 64 x 0.6 mm collimation, and 50 mm field of view. Axial images for generating MPRs were reconstructed with standard kernel (B40), and 1.00 mm slice width. Coronal images were generated from two datasets with 0.1 mm and 0.5 mm z-increments of axial images respectively. For measuring the SNRs, the MTFs and NPSs in in-plane and longitudinal directions of each dataset were calculated from coronal bead images and coronal uniform noise images, respectively. Differences of MTF, NPS, and SNR were compared in in-plane and longitudinal directions. RESULTS: The MTF of longitudinal direction of the dataset with 0.1 mm z-increment was higher than the dataset with 0.5 mm z-increment. 10% MTFs of longitudinal direction with 0.1 mm and 0.5 mm z-increments were 0.75 cycles/mm and 0.68 cycles/mm, respectively. Conversely, the NPS of longitudinal direction of the dataset with a 0.1 mm z-increment was lower than the dataset with a 0.5 mm z-increment. As a consequence, the SNRs of longitudinal direction had relatively no difference between the datasets. In in-plane direction, MTFs, NPSs and SNRs had no differences between the datasets. CONCLUSION: A tradeoff relationship was indicated between spatial resolution and noise characteristic in the longitudinal direction due to the effects of different z-increment of original axial images used in generating MPRs. MPR using 0.5 mm z-increment of axial images had comparable SNR to MPR using 0.1 mm z-increment of axial images in our experimental condition. CLINICAL RELEVANCE/APPLICATION: Using 0.5 mm z-increment of original axial images for generating MPRs is effective for reducing the data volume, reconstruction time and transfer time without reducing image quality.

[Measurement of residual effect in the amorphous selenium flat panel detector system].

The purpose of this study was to evaluate the residual effect generated by the amorphous selenium flat panel detector system (a-Se FPD). A residual effect occurs as a result of the addition of delayed electrons by previous X-ray irradiation joining the signal and change in detector sensitivity caused by hole-electron recombination or trapped electrons in a-Se. To evaluate the effect of previous radiation exposure, we irradiated a-Se FPD that were half-shielded by a 3 mm thick lead plate. A residual effect was generated in irradiated areas, with the unirradiated areas serving as reference points. Next, we removed the lead plate and took a new image using uniform irradiation. The difference in pixel value between irradiated and nonirradiated areas was measured using a variety of time intervals between each exposure. Through a comparison of pixel values from images taken over various time intervals, we discovered our system needs 20 hours to return to a normal state and become capable of producing a residual-free image.

Evaluation of the spatial resolution of multiplanar reconstruction images.

We present a simple method for evaluating the spatial resolution of multi-slice computed tomography (MSCT) multiplanar reconstruction images (MPRs). We scanned a bead phantom to obtain the three-dimensional point spread function (PSF), and bead-centric MPRs were generated. The modulation transfer function (MTF) was calculated from the MPRs via a two-dimensional Fourier transform (2DFFT) of the PSF. The results showed that, when MPRs were reconstructed using axial images less than or equal to a nominal 1.0-mm slice-width with a standard kernel for the abdomen, the MTF in the longitudinal direction (z-direction) was superior to that in the in-plane (x-y plane) direction. It was also found that the arbitrary-angle MTFs of MPRs were between the MTFs of the in-plane and longitudinal directions. It was confirmed that this method can be used to evaluate MPR spatial resolution.

CT lymphography-navigated sentinel lymph node biopsy in patients with superficial esophageal cancer.

BACKGROUND: To evaluate experimentally and clinically the feasibility of a newly developed technique of endoscopic computed tomography (CT) lymphography with endoscopic submucosal injection of iopamidol for esophageal sentinel lymph node (SLN) mapping and biopsy examination. METHODS: Nine anesthetized dogs underwent CT after endoscopic submucosal injection of 2 mL iopamidol; 1.25-mm thick CT images were obtained before and at 1, 3, 5, 7, and 10 minutes after contrast injection. Clinically, 12 patients with superficial esophageal cancer (preoperative imaging stage: cT1, cN0) underwent CT lymphography in a similar fashion at 1, 5, and 10 minutes after peritumoral injection, followed by radical esophagectomy and regional lymph node dissection under CT lymphography guidance. RESULTS: CT lymphography visualized the draining lymphatic vessels and SLNs within 5 minutes after contrast injection. All 14 SLNs in dogs (average, 1.5 nodes per animal; range, 1-2) and 28 SLNs in patients (average, 2.3 nodes per patient; range, 1-4) were found intraoperatively at the correct location under CT lymphography guidance. Lymph node metastasis could be detected with excellent sensitivity and accuracy in this small number of patients with no false-negative findings; metastasis was positive only in the preoperatively identified SLNs in 4 patients and in both SLNs and distant nodes in 1 patient, and was negative in all resected nodes in the remaining 7 patients. CONCLUSIONS: Endoscopic CT lymphography appears to allow accurate identification of direction and locations of lymph flow and SLNs, and has the potential clinical applicability for esophageal SLN mapping and biopsy examination, but will require a large study to determine its accuracy and usefulness.

Preoperative imaging of the lung sentinel lymphatic basin with computed tomographic lymphography: a preliminary study.

BACKGROUND: Preoperative localization of the sentinel node basin would guide selective lymph node dissection. We tried to identify these nodal stations with indirect computed tomographic lymphography using a conventional extracellular contrast agent, iopamidol. METHODS: Eleven consecutive patients scheduled to undergo anatomic resection of suspected lung cancer, without lymphadenopathy, were given a peritumoral injection of undiluted iopamidol under computed tomography guidance, and lymphatic migration was assessed by multidetector-row helical computed tomography. RESULTS: There were no complications such as bleeding, pneumothorax, or allergic reactions. Enhanced nodes were detected in all but 1 patient who had diffuse lymph nodal calcification. Enhanced nodes were identified at 32 ipsilateral intrathoracic nodal stations (20 hilar stations and 12 mediastinal stations). The average length of the longer axis of the enhanced nodes was 4.8 mm (range, 3 to 8 mm), and the average attenuation of the enhanced nodes was 132 (range, 46 to 261) Hounsfield units. In 9 patients with confirmed lung cancer, enhanced nodes appeared at 26 nodal stations, and all apparent enhanced nodes were identified as actual lymph nodes at appropriate position during lymphadenectomy. None of the resected lymph nodes had metastatic involvement. CONCLUSIONS: Indirect computed tomographic lymphography with the peritumoral injection of iopamidol effectively depicts the drainage nodes unless they are diffusely calcified. Although further study is required, this method could guide selective lymph node dissection.

Sentinel lymph node biopsy using computed tomography-lymphography in patients with breast cancer.

BACKGROUND: The sentinel lymph node biopsy (SLNB) technique is established in the treatment of breast cancer. The current technique of mapping the SLN with blue dye or radiotracers requires a learning period. Tracer and injection site selection and intraoperative pathologic examination have been discussed. METHODS: We developed a three-dimensional computed tomography lymphography (3D CT-LG) technique with commercially available iopamidol. SLNB and backup dissection were performed in 40 patients with T1 and T2 breast cancer. Feasibility and efficacy of CT-LG were examined. RESULTS: In all patients, lymph flow and the surrounding anatomical environment were visualized with 3D CT-LG. SLNB was successful because of accurate navigation by 3D CT-LG. SLN was detected in all patients, whereas dye navigation failed in seven fatty axilla and two patients with prior excisional biopsy. Backup dissection confirmed the accuracy of CT-LG-guided SLNB. A false negative result was found in only one patient. Preoperative prediction was feasible in cases of SLN metastasis. CONCLUSIONS: CT-LG allowed accurate SLN localization by quickly and adequately visualizing the direct connection between the SLN and its afferent lymphatic vessels. Detailed cross-sectional images of lymphatic anatomy during CT resulted in successful SLNB with shortening of the presurgical examination schedule.

Air trapping at CT: high prevalence in asymptomatic subjects with normal pulmonary function.

PURPOSE: To determine the degree and extent of air trapping at computed tomography (CT) in subjects with normal pulmonary function test results. MATERIALS AND METHODS: The study group consisted of 50 subjects with normal pulmonary function, including 26 nonsmokers and 24 smokers (14 current and 10 ex-smokers; 11 mild and 13 heavy smokers). All 50 subjects underwent thin-section CT at which images were obtained during deep inspiration and expiration at three lung levels. The mean expiratory increase in lung attenuation was measured at each level. Air trapping was visually classified into four degrees (none, lobular, mosaic, or extensive), and the extent of air trapping was also semiquantitatively calculated. The visual grade and semiquantitative ratio of air trapping were compared among nonsmokers, current smokers, and ex-smokers and among nonsmokers, mild smokers, and heavy smokers by using the Kruskal-Wallis rank test and the Fisher protected least significant difference test, respectively. RESULTS: The mean increase in lung attenuation in the three levels at expiration was 111.9 HU +/- 46.3 (SD). The overall frequency of air trapping was 64%. Lobular, mosaic, and extensive air trapping were seen in 10 (20%), 14 (28%) and eight (16%) patients, respectively. There was no significant difference in the visual grade of air trapping among the nonsmokers, current smokers, and ex-smokers (P =.387) or among the nonsmokers, mild smokers, and heavy smokers (P =.231). There was also no significant difference in the semiquantitative ratio of air trapping among nonsmokers, current smokers, and ex-smokers (P =.859) or among nonsmokers, mild smokers, and heavy smokers (P =.897). CONCLUSION: Various degrees of air trapping, including the mosaic or extensive types, can be observed in subjects with normal pulmonary function and have no correlation with the subject's current smoking status or cigarette consumption.

Modified Blalock-Taussig shunt patency for pulmonary atresia: assessment with electron beam CT.

PURPOSE: The purpose of this work was to evaluate electron beam CT (EBCT) for the noninvasive assessment of modified Blalock-Taussig (BT) shunt patency in patients with pulmonary atresia. METHOD: Five infants and children with pulmonary atresia and modified BT shunts underwent contrast-enhanced EBCT. Modified BT shunts from the subclavian artery to the pulmonary artery were performed to improve the pulmonary blood flow. Electrocardiogram (ECG)-triggered EBCT was obtained with a 100 ms exposure, 3 mm section thickness, and 2 mm table feed after intravenous administration of contrast material. Three-dimensional (3D) or maximum intensity projection (MIP) EBCT images were compared with conventional angiography. The visibility of modified BT shunts was graded and recorded with use of a four-point scale. RESULTS: Satisfactory visualization was achieved in both 3D and MIP EBCT images to evaluate modified BT shunt patency. CONCLUSION: Contrast-enhanced 3D or MIP EBCT imaging with ECG trigger may be used as an effective substitute to evaluate modified BT shunts with low radiation dose exposure.