Precision of dual-energy X-ray absorptiometry of the knee and heel: methodology and implications for research to reduce bone mineral loss after spinal cord injury.

STUDY DESIGN: Methodological validation of dual-energy x-ray absorptiometry (DXA)-based measures of leg bone mineral density (BMD) based on the guidelines of the International Society for Clinical Densitometry. OBJECTIVES: The primary objective of this study was to determine the precision of BMD estimates at the knee and heel using the manufacturer provided DXA acquisition algorithm. The secondary objective was to determine the smallest change in DXA-based measurement of BMD that should be surpassed (least significant change (LSC)) before suggesting that a biological change has occurred in the distal femur, proximal tibia and calcaneus. SETTING: Academic Research Centre, Canada. METHODS: Ten people with motor-complete SCI of at least 2 years duration and 10 people from the general population volunteered to have four DXA-based measurements taken of their femur, tibia and calcaneus. BMDs for seven regions of interest (RIs) were calculated, as were short-term precision (root-mean-square (RMS) standard deviation (g cm-2), RMS-coefficient of variation (RMS-CV, %)) and LSC. RESULTS: Overall, RMS-CV values were similar between SCI (3.63-10.20%, mean=5.3%) and able-bodied (1.85-5.73%, mean=4%) cohorts, despite lower absolute BMD values at each RIs in those with SCI (35%, heel to 54%, knee; P<0.0001). Precision was highest at the calcaneus and lowest at the femur. Except at the femur, RMS-CV values were under 6%. CONCLUSIONS: For DXA-based estimates of BMD at the distal femur, proximal tibia and calcaneus, these precision values suggest that LSC values >10% are needed to detect differences between treated and untreated groups in studies aimed at reducing bone mineral loss after SCI.

Reduced cortical BACE1 content with one bout of exercise is accompanied by declines in AMPK, Akt, and MAPK signaling in obese, glucose-intolerant mice.

Obesity and type 2 diabetes are significant risk factors in the development of neurodegenerative diseases, such as Alzheimer's disease. A variety of cellular mechanisms, such as altered Akt and AMPK and increased inflammatory signaling, contribute to neurodegeneration. Exercise training can improve markers of neurodegeneration, but the underlying mechanisms remain unknown. The purpose of this study was to determine the effects of a single bout of exercise on markers of neurodegeneration and inflammation in brains from mice fed a high-fat diet. Male C57BL/6 mice were fed a low (LFD; 10% kcal from lard)- or a high-fat diet (HFD; 60% kcal from lard) for 7 wk. HFD mice underwent an acute bout of exercise (treadmill running: 15 m/min, 5% incline, 120 min) followed by a recovery period of 2 h. The HFD increased body mass and glucose intolerance (both P < 0.05). This was accompanied by an approximately twofold increase in the phosphorylation of Akt, ERK, and GSK in the cortex (P < 0.05). Following exercise, there was a decrease in beta-site amyloid precursor protein cleaving enzyme 1 (BACE1; P < 0.05) and activity (P < 0.001). This was accompanied by a reduction in AMPK phosphorylation, indicative of a decline in cellular stress (P < 0.05). Akt and ERK phosphorylation were decreased following exercise in HFD mice to a level similar to that of the LFD mice (P < 0.05). This study demonstrates that a single bout of exercise can reduce BACE1 content and activity independent of changes in adiposity. This effect is associated with reductions in Akt, ERK, and AMPK signaling in the cortex.

X-ray optics for better diagnostic imaging.

Polycapillary x-ray optics provide an innovative new way to control x-ray beams. Placing these optics after the object to be imaged provides very efficient rejection of Compton scatter, while allowing image magnification without loss of resolution, image demagnification, or image shaping to match with digital detectors. Measured scatter rejection optics had primary transmissions greater than 50% and scatter transmission of less than 1%. For a 5-cm thick Lucite phantom, this resulted in a contrast enhancement of nearly a factor of two at 20 keV and three at 40 keV. The magnification from the tapered capillary optics improved the MTF at all frequencies out to 1.8 times the original system resolution. Increases below the system resolution are most important because clinically relevant structures generally occupy lower spatial frequencies. Alternatively, placing a collimating optic and diffracting crystal before the patient provides sufficient monochromatic beam intensity for medical imaging. Contrast, resolution, and intensity measurements were performed with both high and low angular acceptance crystals. At 8 keV, contrast enhancement was a factor of 5 relative to the polychromatic case, in good agreement with theoretical values. At 17.5 keV, monochromatic subject contrast was more than a factor of 2 times greater than the conventional polychromatic contrast. An additional factor of two increase in contrast, for a total factor of four, is expected from the removal of scatter in a large beam clinical system. The measured angular resolution after the crystal was 0.4 mrad for a silicon crystal.

Implementing a Java-based image and report distribution system in a non-picture archiving and communication system environment.

The benefits and pitfalls of implementing a Java-based system to distribute results and images to referring physicians are addressed. The basic requirements for and barriers to implementing this system in a non-picture archiving and communication system (PACS) environment will also be discussed. The majority of radiology information systems (RIS) and hospital information systems (HIS) currently only distribute the text data for radiology examinations. This is generally adequate for low-acuity exams in a relatively healthy patient; however, many clinicians prefer to review images so they can correlate the reported findings with the image data, as well as review the exam themselves. A web-based solution eliminates the need for specialized review software and/or hardware at each review site. In addition, there is no need for support personnel to travel to each site to set up and upgrade software.

Use of a slit camera for MTF measurements.

The slit camera was analyzed in order to establish its utility and limitations as an MTF measurement tool for characterizing radiographic imaging systems. Commercial slit cameras are attractive for MTF measurements because the beveled edges significantly reduce their alignment sensitivity as compared to the conventional parallel jaw slit. Radiation passing through the beveled edges increases the effective width of the slit camera so that a correction based on the nominal slit width would leave residual error in the MTF measurement. Experimental and Monte Carlo simulated MTF measurements were made on a slit camera (10 microm nominal slit width) in order to estimate its sensitivity in alignment, quantify the error in MTF due to transmission through the beveled jaws, and provide a correction factor. The alignment tolerances of the slit camera were found to be about 12 times larger than for the parallel jaw slit at small HVLs (approximately 1.3 mm Al) of the incident beam and 9 times larger at higher HVLs (approximately 7 mm Al). The magnitude of the residual error in MTF was dependent on the quality of the incident spectrum. For incident spectra with high kVp and HVL (> or = 120 kVp, > or =5 mm Al HVL), transmission through the beveled edges produced errors in MTF up to 15% at 5 cycles/mm and 30% at 10 cycles/mm. By assuming a rectangular slit profile with an effective width based on the kVp, HVL, and filtration material of the incident beam, an MTF correction factor was determined. Application of this correction factor reduced the errors to less than 4% up to 10 cycles/mm. At low beam energies and spatial frequencies, the correction is less critical. Ease of alignment and greater availability make a commercial slit camera useful for MTF measurements. Accurate MTF measurements can be made if appropriate correction factors are applied.

Performance characteristics of a Kodak computed radiography system.

The performance characteristics of a photostimulable phosphor based computed radiographic (CR) system were studied. The modulation transfer function (MTF), noise power spectra (NPS), and detective quantum efficiency (DQE) of the Kodak Digital Science computed radiography (CR) system (Eastman Kodak Co.-model 400) were measured and compared to previously published results of a Fuji based CR system (Philips Medical Systems-PCR model 7000). To maximize comparability, the same measurement techniques and analysis methods were used. The DQE at four exposure levels (30, 3, 0.3, 0.03 mR) and two plate types (standard and high resolution) were calculated from the NPS and MTF measurements. The NPS was determined from two-dimensional Fourier analysis of uniformly exposed plates. The presampling MTF was determined from the Fourier transform (FT) of the system's finely sampled line spread function (LSF) as produced by a narrow slit. A comparison of the slit type ("beveled edge" versus "straight edge") and its effect on the resulting MTF measurements was also performed. The results show that both systems are comparable in resolution performance. The noise power studies indicated a higher level of noise for the Kodak images (approximately 20% at the low exposure levels and 40%-70% at higher exposure levels). Within the clinically relevant exposure range (0.3-3 mR), the resulting DQE for the Kodak plates ranged between 20%-50% lower than for the corresponding Fuji plates. Measurements of the presampling MTF with the two slit types have shown that a correction factor can be applied to compensate for transmission through the relief edges.

Imaging characteristics of x-ray capillary optics in digital mammography.

Computed radiography (CR) has shown promise in digital mammographic screening due to its good low spatial frequency MTF and its relatively wide exposure latitude. The CR image format has not gained acceptance clinically because of reduced high spatial frequency resolution as compared to film-screen images. X-ray capillary optics, aligned between the breast and CR phosphor imaging plate, will capture primary x-ray photons almost exclusively. Due to the very small angle of acceptance, scattered photons angled more than about 1.6 x 10(-3) radians from primary trajectory will not be accepted at the capillary optic entrance. The virtual elimination of detected scatter means almost 100% of the possible primary contrast should be visible in the image. In addition, the image can be magnified without focal spot blurring. Effective resolution of CR images can be increased by a factor equal to that magnification. Clinical implementation of future capillary optics are expected to be either in the form of a large, stationary, post-patient optic that accepts primary from the entire breast or a fan-shaped optic that is scanned across the breast. Measurements of a test capillary optic showed a reduction of scatter fraction to 0.018. Images of a lucite contrast detail phantom revealed a corresponding increase in image contrast when compared to anti-scatter grid and no grid methods. Spectral transmission measurements using a high-purity germanium detector showed good primary transmission (45%-50%) in the mammographic energy range. The MTF measurements of both stationary and scanned capillary optics showed improvement at the 5% MTF level to 8.4 mm-1 for scanned optics and 9.2 mm-1 for stationary optics representing a 68% and 84% respective increase over the CR MTF without magnification or capillary optics.

Measurements of capillary x-ray optics with potential for use in mammographic imaging.

Capillary optic arrays are bundles of hollow glass capillaries which guide x rays in a manner similar to the way fiber optics guide light. Focused postpatient capillary optic arrays have the potential to significantly improve both contrast and resolution of mammographic images compared to conventional antiscatter grids. Contrast can be improved by the nearly total scatter rejection of the optic. Effective resolution can be improved by geometric magnification without increased focal spot blurring. The best results were found for borosilicate glasses, with transmissions in excess of 60% for 22-cm-long fibers. To evaluate the scatter rejection properties, the transmission of off-axis radiation was measured. Transmission drops to < 1% at an angular displacement of 2.7 mrad. Transmission of a bulk capillary array dropped to near zero if the source was at an angle of 2.5 mrad. This implies excellent scatter rejection capabilities. To evaluate whether unchanneled photons might still reach the detector, absorption measurements were also performed on fibers and arrays. Absorption was found to be adequate for scatter rejection. All of the data agreed well with numerical simulations. Performance calculations for two potential optics geometries gave promising results.

A regional convolution kernel algorithm for scatter correction in dual-energy images: comparison to single-kernel algorithms.

Single kernel scatter correction algorithms are based on the model that the scatter field can be predicted by convolution of the primary intensity (Iprim) with a spatially invariant scatter point-spread function (PSF). Practical limitations (Iprim unknown) suggest the substitution of the total detected intensity (Idet) for Iprim as the source image in the convolution. In regions of high scatter fraction (SF), Idet is a poor approximation of Iprim, thereby causing an overestimation of scatter originating in the region. This contributes to errors in estimating detected scatter in the mediastinum and neighboring regions. A technique using a regionally variable point-spread function that significantly reduces RMS error in estimation of the primary image as compared to the single PSF method is investigated. The regionally variable convolution method employs a larger PSF in the mediastinum and a smaller PSF in the lungs to reduce the error in estimating the scatter throughout the image. The method to allow for patient differences has also been expanded and various implementations of these methods have been compared. Results show that the dual-kernel algorithm is always more effective than an equivalent single-kernel algorithm. The dual-kernel algorithm using a predicted scatter fraction curve gives an overall RMS error in the primary of as low as 20.8% which is equivalent to 8.7% RMS error in the scatter. The dual-kernel method using a predicted scatter fraction curve approaches the accuracy of the single-kernel method using patient specific scatter measurements. Because using individual scatter measurements is a less desirable method for clinical use, we feel that the dual-kernel algorithm which uses two regions specific convolution kernels and a variable scatter fraction curve is the preferable method.

Conventional chest radiography vs dual-energy computed radiography in the detection and characterization of pulmonary nodules.

OBJECTIVE: We evaluated a single-exposure, phosphor-plate, dual-energy imaging device that produces, in addition to conventional chest radiographs, both tissue- and bone-selective images. Our purpose was to determine whether dual-energy radiography was more accurate than routine chest radiography for detection and characterization of pulmonary nodules. SUBJECTS AND METHODS: Two hundred patients undergoing chest CT were asked to volunteer to have dual-energy and conventional chest radiographs obtained immediately before or after their CT scan. Radiographs from a subset of 50 of these patients with 116 CT-detected nodules and 10 patients with normal findings on CT scans of the chest were presented to the observers for the nodule detection study. Similarly, radiographs from a subset of 29 patients with 20 calcified and 20 uncalcified nodules were presented to five observers to determine nodule calcification. Dual-energy images were produced by filtering the X-ray tube output with a gadolinium sheet while using a multiple phosphor plate receptor. A dual-energy triad of images consisting of a conventional image, a tissue-selective image, and a bone-selective image were produced. The conventional chest radiographs and dual-energy image sets were presented to observers in random order. Data from a free response receiver operating curve and a receiver operating curve were generated for nodule detection and characterization, respectively. RESULTS: By using the dual-energy images, all five observers improved their ability to diagnose pulmonary nodules (p = .0005) and to characterize nodules as calcified (p = .005). CONCLUSION: By eliminating rib shadows with tissue-selective images and enhancing calcified structures with bone-selective images, dual-energy chest radiography improved the ability of all observers, regardless of expertise, to detect and characterize pulmonary nodules.

Densitometric assessment of regional left ventricular systolic function during graded ischemia in the dog by use of dual-energy digital subtraction ventriculography.

Densitometric analysis of images obtained by digital subtraction angiography (DSA) allows for more reproducible and less operator-dependent quantitation of ventricular function. Conventional DSA uses temporal subtraction but is limited by misregistration artifacts. Dual-energy digital subtraction angiography (DE-DSA) is immune to such misregistration artifacts. The ability of DE-DSA to quantitate changes in regional ventricular volume resulting from ischemia was tested. Densitometric analysis of both phase-matched and ejection fraction DE-DSA images was used to quantitate regional left ventricular systolic function during four levels of ischemia ranging from mild to severe in open-chest dogs (n = 10). DE-DSA left ventriculograms were obtained by means of central venous injections of iodinated contrast medium. Ischemia was graded according to percentage of systolic wall thickening as measured by sonomicrometry. Phase-matched end-systolic images were obtained at each of four levels of ischemia by subtracting an end-systolic control image from each end-systolic ischemic image. Ejection fraction images were obtained at the control level and at each level of ischemia by subtracting an end-systolic image from an end-diastolic image of the same cardiac cycle. The resulting wall motion difference signals represent the changes in regional ventricular volumes and were quantitated by densitometry. Densitometry was able to detect the effect of all levels of ischemia on regional function, even the mildest. Densitometric analysis of both phase-matched and ejection fraction DE-DSA images provides a sensitive technique for detecting and quantitating the changes in regional left ventricular systolic volume that occur with ischemia.

Coronary blood flow measurement using an angiographic first pass distribution technique: a feasibility study.

Due to the well-documented problems associated with visual interpretation of coronary angiograms, more physiologic means of assessing coronary artery stenosis are being investigated. One physiologic parameter that has been suggested is coronary flow reserve (CFR). A digital subtraction angiographic technique based on first pass distribution analysis (FPA) is proposed as a means of measuring CFR and absolute coronary flow. The theory of the FPA method is first outlined, and the implementation of a preliminary version of the FPA algorithm is described. Experiments verifying the utility of this algorithm for measuring absolute flow through a flow phantom, and through the canine circumflex artery are reported. It was determined that the preliminary FPA algorithm is capable of measuring canine coronary flow ratios (R) with accuracy and precision characteristics meeting or exceeding those reported for the parametric imaging technique (RFPA = 0.933.Rtrue, SEE = 0.16, r = 0.984). Accurate absolute flow (Q) measurements were obtained in all of the phantom experiments (QFPA = 1.054.Qtrue, r = 0.993), and in one of the three dogs that were studied (QFPA = 0.977.Qtrue, r = 0.935). The difficulty encountered in the other two dog experiments is attributed to the effects of system temporal lag, and would likely be corrected through the use of improved cameras. The feasibility of the general FPA method for measuring relative flow is established, and the potential for routine, absolute flow measurement is demonstrated.

Geometric quantitative coronary arteriography. A comparison of unsubtracted and dual energy-subtracted images.

The application of dual energy (DE) subtraction techniques to quantitative coronary arteriography (QCA) has the advantage of removing the tissue signal surrounding the vessel profile. We have compared the performance of two geometric QCA algorithms on DE-subtracted and -unsubtracted images to determine, for each, if DE subtraction is advantageous. The two algorithms under study were an edge detection algorithm and a Fourier analysis-based algorithm. For each algorithm, linear regression analysis was performed of measured cross-sectional area (CSA) versus actual CSA of coronary vessel phantoms. The edge detection algorithm was found to have improved precision (P less than .05) when applied to the DE-subtracted images. The Fourier analysis algorithm, however, was not effected by the DE subtraction. Among the unsubtracted image results, the Fourier measurements were more accurate (P less than .05) than the edge detection measurements. We conclude that the benefits to edge detection QCA of DE tissue subtraction outweigh the disadvantages of increased image noise and possible misregistration artifacts. However, the Fourier algorithm is relatively insensitive to tissue signal variations.

K-edge digital subtraction arthrography of the painful hip prosthesis: a feasibility study.

K-edge energy subtraction radiography is a method for detecting the presence of iodinated contrast material by subtracting two digital radiographs produced by X-ray beams with energies above and below the iodine K edge. We performed a feasibility study on the application of K-edge energy digital subtraction arthrography (KEDSA) to painful hip prostheses. During arthrography, loosening of the prosthesis is implied if contrast material is seen dissecting around the prosthesis, an often difficult detection task because of adjacent prosthesis metal or cement. In conventional arthrography a preliminary mask image is thus used from which films obtained after injection of iodinated contrast material are subtracted. Movement by the patient during this process may preclude subsequent subtraction. With KEDSA, since multiple image pairs may be obtained after the injection of contrast material, the problem of patient motion is virtually eliminated. A conventional X-ray tube operating between 55 and 65 kVp was alternately filtered by iodine and cerium filters to produce the KEDSA images. The apparatus was capable of producing a subtracted image within 3 sec. The technique was applied to phantoms and to six patients immediately after hip arthrography that had been positive for prosthesis loosening. Although of lower spatial resolution, the KEDSA images were, in all cases, positive for loosening in a pattern consistent with the conventional arthrographic images. KEDSA was shown to be successful in detecting extraarticular contrast material. During a single study, subtraction in various imaging planes as well as postexercise subtraction imaging can be accomplished-techniques not heretofore possible in routine subtraction arthrography.

Quantitative dual-energy coronary arteriography.

Subtraction techniques for digital cardiac imaging have been hampered by misregistration artifacts. The use of dual-energy imaging is being evaluated as a means for reducing these artifacts. Results reported previously indicate that the dual-energy technique may be useful for applications such as exercise ventriculography and general quantification tasks. The purpose of the current study is to investigate the use of dual-energy subtraction imaging for quantitative coronary arteriography. In vivo coronary vessel phantoms (0.2 to 7 mm2 in cross-sectional area) were used to study the potential advantages of tissue suppressed energy subtracted images over unsubtracted images for quantification of absolute vessel cross-sectional area when cardiac motion is present. Estimates of lumen cross-sectional area (N = 20) were determined using videodensitometric analysis of selected energy subtracted and unsubtracted images. Linear regression analysis of measured and actual cross-sectional area showed energy subtracted image data (slope = 1.06, intercept = 0.48 mm2, r = 0.99) to have improved accuracy (P less than .05) and precision (P less than .05) over unsubtracted image data (slope = 1.24, intercept = 1.07 mm2, r = 0.95).

A correlated noise reduction algorithm for dual-energy digital subtraction angiography.

It has long been recognized that the problems of motion artifacts in conventional time subtraction digital subtraction angiography (DSA) may be overcome using energy subtraction techniques. Of the variety of energy subtraction techniques investigated, non-k-edge dual-energy subtraction offers the best signal-to-noise ratio (SNR). However, this technique achieves only 55% of the temporal DSA SNR. Noise reduction techniques that average the noisier high-energy image produce various degrees of noise improvement while minimally affecting iodine contrast and resolution. A more significant improvement in dual-energy DSA iodine SNR, however, results when the correlated noise that exists in material specific images is appropriately cancelled. The correlated noise reduction (CNR) algorithm presented here follows directly from the dual-energy computed tomography work of Kalender who made explicit use of noise correlations in material specific images to reduce noise. The results are identical to those achieved using a linear version of the two-stage filtering process described by Macovski in which the selective image is filtered to reduce high-frequency noise and added to a weighted, high SNR, nonselective image which has been processed with a high-frequency bandpass filter. The dual-energy DSA CNR algorithm presented here combines selective tissue and iodine images to produce a significant increase in the iodine SNR while fully preserving iodine spatial resolution. Theoretical calculations predict a factor of 2-4 improvement in SNR compared to conventional dual-energy images. The improvement factor achieved is dependent upon the x-ray beam spectra and the size of blurring kernel used in the algorithm.(ABSTRACT TRUNCATED AT 250 WORDS)