Technical Note: A new phantom design for routine testing of Doppler ultrasound.

PURPOSE: The objective of this project is to demonstrate the principle and operation for a simple, inexpensive, and highly portable Doppler ultrasound quality assurance (QA) phantom intended for routine QA testing. A prototype phantom has been designed, fabricated, and evaluated. The phantom described here is powered by gravity alone, requires no external equipment for operation, and produces a stable fluid velocity useful for quality assurance. Many commercially available Doppler ultrasound testing systems can suffer from issues such as a lengthy setup, prohibitive cost, nonportable size, or difficulty in use. This new phantom design aims to address some of these problems and create a phantom appropriate for assessing Doppler ultrasound stability. METHODS: The phantom was fabricated using a 3D printer. The basic design of the phantom is to provide gravity-powered flow of a Doppler fluid between two reservoirs. The printed components were connected with latex tubing and then seated in a tissue mimicking gel. Spectral Doppler waveforms were sampled to evaluate variations in the data, and the phantom was evaluated using high frame rate video to find an alternate measure of mean fluid velocity flowing in the phantom. RESULTS: The current system design maintains stable flow from one reservoir to the other for approximately 7 s. Color Doppler imaging of the phantom was found to be qualitatively consistent with laminar flow. Using pulsed spectral Doppler, the average fluid velocity from a sample volume approximately centered in the synthetic vessel was measured to be 56 cm/s with a standard deviation of 3.2 cm/s across 118 measurements. An independent measure of the average fluid velocity was measured to be 51.9 cm/s with a standard deviation of 0.7 cm/s over 4 measurements. CONCLUSIONS: The developed phantom provides stable fluid flow useful for frequent clinical Doppler ultrasound testing and attempts to address several obstacles facing Doppler phantom testing. Such an ultrasound phantom can make routine testing more approachable for institutions that wish to initiate a Doppler QA program or complement a previously existing QA program.

Development and validation of a GEANT4 radiation transport code for CT dosimetry.

The authors have created a radiation transport code using the GEANT4 Monte Carlo toolkit to simulate pediatric patients undergoing CT examinations. The focus of this paper is to validate their simulation with real-world physical dosimetry measurements using two independent techniques. Exposure measurements were made with a standard 100-mm CT pencil ionization chamber, and absorbed doses were also measured using optically stimulated luminescent (OSL) dosimeters. Measurements were made in air with a standard 16-cm acrylic head phantom and with a standard 32-cm acrylic body phantom. Physical dose measurements determined from the ionization chamber in air for 100 and 120 kVp beam energies were used to derive photon-fluence calibration factors. Both ion chamber and OSL measurement results provide useful comparisons in the validation of the Monte Carlo simulations. It was found that simulated and measured CTDI values were within an overall average of 6% of each other.

Comparison of functional MRI image realignment tools using a computer-generated phantom.

This study discusses the development of a computer-generated phantom to compare the effects of image realignment programs on functional MRI (fMRI) pixel activation. The phantom is a whole-head MRI volume with added random noise, activation, and motion. It allows simulation of realistic head motions with controlled areas of activation. Without motion, the phantom shows the effects of realignment on motion-free data sets. Prior to realignment, the phantom illustrates some activation corruption due to motion. Finally, three widely used realignment packages are examined. The results showed that the most accurate algorithms are able to increase specificity through accurate realignment while maintaining sensitivity through effective resampling techniques. In fact, accurate realignment alone is not a powerful indicator of the most effective algorithm in terms of true activation.

Cortical activation during Braille reading is influenced by early visual experience in subjects with severe visual disability: a correlational fMRI study.

Functional magnetic resonance imaging was performed on blind adults resting and reading Braille. The strongest activation was found in primary somatic sensory/motor cortex on both cortical hemispheres. Additional foci of activation were situated in the parietal, temporal, and occipital lobes where visual information is processed in sighted persons. The regions were differentiated most in the correlation of their time courses of activation with resting and reading. Differences in magnitude and expanse of activation were substantially less significant. Among the traditionally visual areas, the strength of correlation was greatest in posterior parietal cortex and moderate in occipitotemporal, lateral occipital, and primary visual cortex. It was low in secondary visual cortex as well as in dorsal and ventral inferior temporal cortex and posterior middle temporal cortex. Visual experience increased the strength of correlation in all regions except dorsal inferior temporal and posterior parietal cortex. The greatest statistically significant increase, i.e., approximately 30%, was in ventral inferior temporal and posterior middle temporal cortex. In these regions, words are analyzed semantically, which may be facilitated by visual experience. In contrast, visual experience resulted in a slight, insignificant diminution of the strength of correlation in dorsal inferior temporal cortex where language is analyzed phonetically. These findings affirm that posterior temporal regions are engaged in the processing of written language. Moreover, they suggest that this function is modified by early visual experience. Furthermore, visual experience significantly strengthened the correlation of activation and Braille reading in occipital regions traditionally involved in the processing of visual features and object recognition suggesting a role for visual imagery.

Quantified color Doppler sonography of tumor vascularity in an animal model.

This study was designed to evaluate the accuracy of a system to quantitate tumor vascularity with amplitude (power) color Doppler sonography two- and three-dimensionally. The vascularity of 20 transplanted murine tumors was determined with quantitated amplitude color Doppler sonography both two- and three-dimensionally and compared to tumor vascularity estimated by histologic examination. Serial examinations were performed 15, 30, 45, and 60 min after the injection of the exotoxin CM-101 and saline solution to assess changes in tumor vascularity. Three-dimensional amplitude color Doppler sonography best depicted the overall vascularity of tumor when compared to histologic estimation of vessel density. However, neither two- nor three-dimensional amplitude color power angiography correlated well to the microvessel count, probably a reflection of the difference in the method for vessel quantification using sonographic versus histologic techniques. Three-dimensional amplitude Doppler sonography correlated better with counts of large vessels (> 100 microm) as opposed to small vessels (> 15 microm). Time-activity curves showed no difference in tumor flow at the times measured in the experimental group injected with CM-101 or when compared to saline solutions in either the peripheral or central portions of the tumor. This three-dimensional amplitude color Doppler sonographic system affords global quantification of tumor vascularity and flow that may, in turn, be useful in determining the probability of malignancy (by determination of branching patterns and vessel regularity) or tumor response or both to treatment.

Quantification of tumor vascularity and flow with amplitude color Doppler sonography in an experimental model: preliminary results.

This study was designed to evaluate a system to quantitate vascularity and tumor blood flow with amplitude (power) color Doppler sonography. The vascularity of nine transplanted murine tumors was determined with quantitated amplitude color Doppler sonography and compared to tumor vascularity estimated by histologic examination. The system used seemed to provide an accurate depiction of the vascularity of tumor vis-àa-vis histologic estimation of vessel density (r = 0.80). Time-activity curves showed greater flow in the experimental group injected with an exotoxin than in the group injected with saline solution. Vascular density quantification with amplitude color Doppler sonography also was more accurate when an intravascular agent (such as an exotoxin) was used than when saline infusions were given. This quantification scheme may allow the development of a system to assess the probability of malignancy and to monitor tumor response to treatment on the basis of the vascularity of the mass.

Attenuation of monochromatic X-rays by normal and abnormal breast tissues.

RATIONALE AND OBJECTIVES: A prior study indicated that differences in the x-ray linear attenuation coefficients of cancerous and normal breast tissues tend to increase as the energy of the incident beam decreases. The authors investigated x-ray energies down to 20 keV. In the current study, the linear attenuation coefficients for normal and selected cancerous breast tissues within the energy range of 14 to 18 keV were determined. METHODS: Fifty breast biopsy specimens consisting of a mixture of breast malignancies, normal tissues, fat specimens, and tumors grown in rats were used. X-ray linear attenuation coefficients were measured for each sample within the energy range of 14.15 to 18 keV, using monoenergetic x-rays from beamline X-19A at the National Synchrotron Light Source at Brookhaven National Laboratory. Each sample was measured at 130 different energies starting at 14.15 keV with step sizes of 0.030 keV. Correlation of the measured attenuation coefficients for cellular makeup was performed. RESULTS: The mean of linear attenuation coefficients for samples classified as "cancers" was 10.9% higher than the mean of samples classified as "normal" breast tissues and was 66.5% higher than the mean of samples classified as normal breast fat. CONCLUSIONS: Differences in the linear attenuation coefficients of monochromatic x-rays between 14.15 and 18 keV do exist between normal and cancerous tissues, but there is some degree of overlap.

Current Status of the VU MFEL Compton X-Ray Program.

The Vanderbilt University medical FEL (free electron laser) Compton x-ray program is close to being operational. The FEL modifications necessary for this new capability are near completion. The transport and detection systems for electron and IR beams have been designed, delivered, and tested. We initially expect to produce 108 x-ray photons per second in the 15- to 20-keV region.

Perfusion/diffusion quantitation with magnetic resonance imaging.

Quantitation of perfusion and diffusion in tissues using magnetic resonance imaging (MRI) techniques is an active area of research in many laboratories. Several different approaches have been taken to address the problem of determining microcirculatory flow or perfusion in the body with MRI. Methods have been developed that depend on pulse sequence designs to sensitize the acquisitions to proton movement that is part of physiologic perfusion. Other methods that are being studied take a different approach by using injected MR contrast agents coupled with high temporal resolution acquisitions to produce time-density curves that can be related to perfusion in the tissues of interest. Yet other approaches use blood as the tracer itself to provide a means of determining perfusion. All of these techniques and others provide quantitative information related to microcirculatory flow in tissues.

Clinical impact of picture archiving and communication systems: evaluation of a prototype system.

Opinion surveys were gathered before and 6 months after installation of a prototype picture archiving and communication system (PACS) (PACS/1, Siemens Medical Systems, Iselin, NJ). Median turnaround times and the percent of delayed or missing reports were calculated for 1,026 baseline and 8,438 follow-up studies at 6 months. Neuroradiological (neuro) computed tomography (CT) used PACS, while neuro magnetic resonance (MR), body CT, and body MR served as controls. The opinion surveys showed improved service in all categories, including those not directly affected by PACS. PACS images favorably impressed 86% of respondents, but most considered the system too slow, unreliable, and the storage capacity too low. A majority of 81% recommended against purchase of PACS now. There was an overall increase in the median report turnaround time for both neuro CT and the controls. Neuro CT showed a 41% decrease in delayed or missing reports, but controls also showed similar decreases. The effects of this prototype PACS on turnaround time or on report delivery could not be distinguished from section-wide changes in CT and MR services. Future improvements in PACS should vigorously address increased speed, reliability, and storage capacity.

Magnetic resonance perfusion/diffusion imaging of the excised dog kidney.

RATIONALE AND OBJECTIVES: The authors developed a model of tissue capillary beds applicable to perfusion/diffusion imaging with magnetic resonance imaging (MRI). The model consists of a formalin-fixed excised dog kidney attached to a variable speed pump. With this system, it is possible to perfuse the kidney at selected rates. METHODS: Using the intravoxel incoherent motion model (IVIM), the apparent diffusion coefficient (ADC), diffusion coefficient (D), and perfusion fraction (f) were computed for a region of interest (ROI) in the renal cortex and in the medulla of seven kidneys, one of which was injected with a vasodilator before fixation. ADC and D values were computed for both cortex and medulla. These values were normalized to zero flow and plotted against renal perfusion. The perfusion fraction f was expressed in percent and was not normalized to zero flow. RESULTS: Normalized ADC and f were correlated with tissue perfusion rates using the Spearman rank-sum test (n = 18, rs greater than 0.5, P less than or equal to .02 for the standard preparation in both cortex and medulla), whereas normalized D (rs much less than 0.5) was uncorrelated for both preparations in cortex and medulla. CONCLUSIONS: The isolated perfused dog kidney is a useful model of tissue capillary beds for perfusion imaging technique development. The perfusion/diffusion-related parameters ADC and f increase as flow increases in the tissues, whereas D does not.

Magnetic resonance diffusion/perfusion phantom experiments.

Recently, several models for determining microcirculatory parameters using magnetic resonance imaging have been proposed. These include the intravoxel incoherent motion (IVIM) model, the intravoxel coherent motion (IVCM) model, and various tracer models. In order to evaluate these models before extension into physiological systems, phantom studies were used to assess model assumptions, measurement uncertainties, and sensitivity to changes in perfusion. Emphasis is placed on the IVIM model, but the techniques discussed could be extended to evaluation of other models as well. An overview of considerations in pulse sequence development, phantom design, and data interpretation is presented for a variety of phantoms ranging in complexity from stationary volumes of fluid and mechanically pumped phantoms to isolated animal kidneys and finally to an in vivo animal model.

Near-monochromatic X-ray beams produced by the free electron laser and Compton backscatter.

The intense photon output of a free electron laser may be made to collide with its own high energy electron beam to create nearly monochromatic x-rays using Compton backscatter techniques. These x-rays can be used for imaging and non-imaging diagnostic and therapeutic experiments. The initial configuration of the Vanderbilt Medical Free Electron Laser (Sierra Laser Systems, Sunnyvale, CA) produces intense x-rays up to 17.9 keV, although higher energies are easily attainable through the use of frequency doubling methods, alteration of the energy of the electron beam and coupling to conventional laser inputs.

Qualitative and quantitative evaluation of charge capture by a radiology information system.

Installation of a radiology information management system (RIS) is usually justified on the basis of improved departmental efficiency and improved charge capture. However, evaluation of the success of these expected improvements is often difficult. The installation and operation of such a system in a medium-sized tertiary care hospital has permitted the effects of the RIS on the operation of the department to be studied and the improvements in charge capture provided by the system to be quantitatively assessed. As a result of a side-by-side comparison with a conventional check-sheet manual billing system, it is apparent that the RIS reduces the errors inherent in manual systems. Subjectively, it is also apparent that personnel prefer the computerized system to the manual charge sheets.

Adaptive search space scaling in digital image registration.

An image registration technique for application in X-ray, gamma-ray, and magnetic resonance imaging is described. The technique involves searching a real-valued, multidimensional, rectangular, symmetric space of bilinear geometrical transformations for a globally optimal transformation. Physical considerations provide theoretical limits on the search space, but the theoretically maximum allowable space is still often much larger than the smallest rectangular symmetric subspace that contains the optimal transformation. To reduce the search time, the current practice is to guess an optimal subspace from the maximum allowable space. This reduced space is then discretized and searched. An automatic technique to estimate adaptively a subspace from the maximum space during the search process itself is described. This adaptive technique is tested with two quite different types of search algorithms, namely, genetic algorithms and simulated annealing.

Digital image motion correction by spatial warp methods.

A technique for correction of motion between images which are obtained in high-speed digital subtraction or cine angiographic acquisitions is being tested. The method is based on the application of quadratic polynomial equations which transform one image so that it matches a reference image. Images which have been processed in this manner can be summed to improve the signal-to-noise ratios over individual images. The technique for motion correction currently being tested uses operator interaction to establish the appropriate polynomial transformation. An operator selects fiducial (reference) points on an image which will be the reference. Then he selects the corresponding fiducial points on the image to be processed. The algorithm calculates the coefficients of a pair of quadratic polynomial equations and applies them to each pixel in the image. Results demonstrate the application of the technique in phantoms and in digitized cine angiograms.

Medical image management.

Medical image management is becoming increasingly complex as additional data are produced by equipment using digital techniques. As the requirements to store and display these images increase, the following questions become important: (a) What methods can be used to ensure that information given to the physician represents the originally acquired data? (b) What technology and methods are needed to guarantee that information is presented in a timely fashion when requested? (c) How can an image archiving and transmission system be designed to protect the patient's rights of confidentiality? The authors discuss the legal implications of digital archiving of image information and propose some approaches to designing systems that provide the most information to the physician and yet attempt to minimize infringement of the patient's rights.

Medical image management: practical, legal and ethical considerations.

The data acquired by the new medical imaging techniques, in many ways, exceeded our ability to properly store, transmit and use the images produced. As diagnostic imaging procedures become progressively less invasive and traumatic, they are being applied to a much larger patient population. The decrease in memory and other instrumentation costs, along with expanded technological capability of computer systems, has provided medicine an opportunity to create network systems for the storage, processing, recall, and remote location of these diagnostic images. Therefore, problems of access and confidentiality have become increasingly important. This communication will consider certain medical, legal, and ethical aspects of these technologies of data acquisition, storage, manipulation and retrieval.

Women in radiology in the United States: 1982 survey of their professional practices.

In 1982, the American Association of Women Radiologists surveyed women radiologists practicing in the United States to acquire information concerning their training, practice patterns, lifestyles, and opinions about employment equity. This report summarizes the resulting data from 336 responses to the 1,700 questionnaires that were distributed. As would be expected with the increasing number of women currently graduating from medical school, women radiologists responding to the questionnaire are younger than the group of radiologists as a whole. However, geographic distribution and percentage of board certification (96%) are comparable for the two groups. Data from the survey indicate that at least 61% of women radiologists are involved in private practice and 39% in academic radiology. For all radiologists, the respective figures are 82% and 18%. Most women responding to the survey believed that their income was comparable to that of men in similar positions. On the other hand, 56% of respondents perceived inequities in the ability of women radiologists to secure desirable jobs.

Evaluation of left ventricular performance using digital subtraction angiography.

Cardiac applications for digital subtraction angiography appear promising, but few correlative studies with contrast ventriculography have been done. Left ventricular volume, ejection fraction, and regional wall motion by digital subtraction angiography were evaluated after intravenous injection of 40 ml of iodinated contrast medium and after left ventricular injection of 5 to 10 ml of contrast medium. A film-based system of the authors' own design was used. Results were compared with those after direct left ventricular injection of 40 ml of contrast medium. The ventriculograms after intravenous injection were of diagnostic quality in 9 of 12 studies, and there were close correlations between intravenous and direct-injection studies for left ventricular ejection fraction (r = 0.89, n = 9, and p = 0.001) and for left ventricular volume (r = 0.91, n = 18, and p less than 0.001). Regional wall motion scores showed close correspondence in 83% of sectors. After small-volume left ventricular injections, the ventricular image was enhanced considerably by digital subtraction. Correlations between small- and large-volume ventriculograms were close for left ventricular ejection fraction (r = 0.91, n = 8, and p = 0.002) and for left ventricular volume (r = 0.96, n = 16, and p less than 0.001). There was close correspondence of wall motion scores in 87% of sectors. Thus, digital subtraction angiography improves the visibility of the left ventricle after either intravenous or small-volume direct left ventricular injection. Digital images produce excellent estimates of left ventricular volume and should have considerable usefulness for the study of cardiac performance and anatomy.