Characterization of patient dose distributions and probabilistic risk analysis in cardiovascular catheterization laboratories.

Purpose: Patient radiation doses in cardiovascular and interventional radiology are highly variable for similar procedures. This random nature may be better described by a distribution function, compared to a linear regression. This study develops a distribution function to characterize patient dose distributions and estimate probabilistic risk.Methods: Reference air kerma from 8647 patients over six years were retrospectively collected from an EP lab and two Cath labs. Data was first sorted into low dose (<100mGy) and high dose cases (>100mGy), and histograms of the data created. Dagum and Inverse gamma distributions were chosen to initially fit to both low and high dose cases. Fits between model and the data was optimized, and a linear regression analysis performed to obtain R squared values and standard errors for the correlation between model and data. Risk probabilities were estimated according to the modeled distribution function. BMI and time distributions were analyzed to understand their influence on the inverse gamma distribution error found in the data. 75th percentiles from both descriptive statistics and model were calculated.Results: The inverse gamma distribution can be used to characterize radiation dose distributions. Model predicted cases for radiation dose 3000mGy< x <5000mGy and >5000mGy are approximately 42 and 0 for 3651 cases for lab#1, and 14 and 1 for 3197 cases for lab#2, respectively, while the actual cases are 10 and 0, and 16 and 2. Descriptive and model statistics generated different 75th percentile levels for sorted data compared to unsorted data. Time has a greater influence on inverse gamma distribution function than BMI.Conclusion: This study creates a framework to understand the random error present in radiology practices that cause wide variations in patient radiation doses. It also provides an approach to evaluate different IR areas in terms of effectiveness of dose reduction measures.

A polynomial approximation to an exponential growth function for calculating equilibrium dose in CT.

We propose a polynomial approach to approximate equilibrium dose [Formula: see text] reported in AAPM TG111 method of wide beam CT dosimetry. A formula for [Formula: see text] was derived by expanding the exponential growth function in a Taylor series and comparing the resulting function to a polynomial. The formula incorporates coefficients of polynomial fits up to 3rd order. The polynomial coefficients were obtained as fits of the point dose data and used to calculate the length constant ß and [Formula: see text] The length constant could also be made available to users by the vendors of various makes and models of CT scanners. We evaluated our polynomial approximation formula for [Formula: see text] by comparing with [Formula: see text] obtained from measured data in a 256 slice GE revolution CT scanner. To that end, point dose data was collected in 600 mm body and head phantoms with a Farmer chamber for beam widths from 40 to 160 mm. A table of [Formula: see text] and length constants ß, and plots of fits for various filters (pediatric head, adult head, large body, medium body and small body bowtie filters) were presented. For the 256 slice GE revolution CT scanner, a length constant of [Formula: see text] can be used for pediatric head, adult head, body (large filter), body (medium filter), and body (small filter) at 120 kV when growth function fit is used. The estimated [Formula: see text] using the proposed polynomial based method is within 86.79% (83.14%-90.38%) of [Formula: see text] obtained from fitting the growth function for beam widths from 40 to 160 mm. The proposed polynomial based estimation to the equilibrium dose, [Formula: see text] can be readily implemented in practice for point dose measurements of wide beam CT scanners.

Technical Note: Using linear and polynomial approximations to correct IEC CTDI measurements for a wide-beam CT scanner.

PURPOSE: To investigate a feasible correction to align the international electrotechnical commission (IEC) computed tomography dose index (CTDI) measurement with other approaches for an accurate measure of radiation output. METHODS: Radiation dose measurements were performed in a GE 256-slice CT scanner using three methods. The first method used a 0.6 cc Farmer chamber to measure peak dose and then to calculate dose length integral (DLI). The second method integrated dose profiles with a pencil chamber over 600 mm for both body and head phantoms. Both methods achieved scatter equilibrium using a 600 mm long body and head phantom. The third method followed IEC recommendations by adjusting traditional CTDI with beam width. We performed measurements using polymethyl methacrylate (PMMA) 32 cm diameter body and 16 cm diameter head phantoms, combining with various available bowtie filters and at different kV settings. Correction factors using linear or polynomial functions were developed based on these measurements. RESULTS: CTDI measurements using the DLI method and direct integration (DLP) method align with each other with an error of <6.7% for the body phantom, and 6.9% for head phantom respectively. The IEC method underestimates radiation dose for body and head phantoms relative to the DLI, with an error range from 8.9% to 19.4%, depending on the phantom and bowtie filter. A correction factor of 0.15 (15%) could be used for body and head phantom measurements with large body, head and pediatric head bowtie filters. While for body phantom with medium filter and head phantom with small body filter which are not routinely used for CTDI measurements, a correction factor of 0.30 (30%) could be used. The proposed correction factors are validated using various kV and filter combinations. Compared to a linear approximation, a polynomial correction is better at adjusting the IEC measurements, with an error of 5.2%. We found that the a1 coefficient of the polynomial correction is approximately equal to Aeq obtained from DLI measurements for all cases studied, with an average percent difference of 6.7%. CONCLUSION: Both linear and polynomial approximations can be used to correct the IEC measurements, aligning them with the direct integration of dose profiles or the point detector method of CT dosimetry on a 256 slice GE Revolution scanner. Using a polynomial correction may potentially bypass the need for an elongated phantom in the DLI method since the a1 coefficients are approximately equal to Aeq obtained from the DLI method.

Radiation Dose Measurements in a 256-Slice Computed Tomography Scanner.

PURPOSE: The purpose of this study is to compare computed tomography (CT) radiation dose measurement methods proposed by TG111, International Electrotechnical Commission (IEC), and a direct dose profile integral (DPI) measurement method. METHODS: Pencil and Farmer ion chambers are used for integrating dose profiles at different beam widths in a 60 cm long body phantom. Resulting DPI is used to calculate CT dose index (CTDI) at each beam width. Measurements are also done for a pencil chamber inserted into a 15 cm body phantom at the reference beam width. The reference measurement is scaled with pencil chamber measurements in air at different beam widths, according to the IEC approach. Finally, point dose measurements are done with a Farmer chamber under equilibrium conditions according to the TG111 method. All CTDIs calculated from measured data are compared to the scanner displayed CTDIs. RESULTS: Calculated CTDIs, at different beam widths, using the IEC approach are within 20% of CTDIs calculated from DPI measurements in a 60 cm long body phantom. Dose Length Integral (DLI) obtained from TG111 method is close to the results obtained from DPI measurements. Scanner displayed CTDIs are lower than all measured values by up to 38% at the techniques used. CONCLUSION: Although the IEC method is the easiest to use compared to the TG111 and direct DPI measurement method, it underestimates dose indices by about 20%. CTDIs displayed on the GE scanner are lower than those measured in this study by up to 38%.

Clinical Evaluation of Protective Garments with Respect to Garment Characteristics and Manufacturer Label Information.

PURPOSE: To test operator exposures inside radiation protection garments in a simulated clinical setup, examining trends related to multiple characteristics. MATERIALS AND METHODS: Sixteen garment models containing lead or nonlead materials and a suspended device (Zero-Gravity) were tested for operator exposure from X rays scattered from an acrylic patient phantom. Weight and surface area were determined. The operator phantom was a wooden frame containing a dosimeter in its cavity. Garments were draped over the frame, and the setup was placed in a typical working position. RESULTS: There was substantial variability in exposures for all garments, ranging from 0.52 to 13.8 µSv/h (mean, 5.39 µSv/h ± 3.82), with a 12-fold difference for garments labeled 0.5 mm Pb equivalent. Most of the especially poor protectors were nonlead, even when not lightweight. Nonlead models were not more protective per weight overall. For closed-back garments labeled 0.5 mm Pb equivalent, mean exposures were lower for lead than for nonlead materials (mean, 1.48 µSv/h ± 0.434 vs 6.26 µSv/h ± 5.13, respectively). Density per exposure-1 was lower for lead than nonlead materials in the 0.5-mm Pb equivalent group, counter to advertised claims. Open-back configurations were lighter than closed (3.3 kg vs 6.0 kg, respectively), with similar mean exposures (5.30 µSv/h vs 5.39 µSv/h, respectively). The lowest exposure was 0.52 µSv/h (9.8% of the mean of all garments) for the suspended device. CONCLUSIONS: Operator exposure in a realistic interventional setup is highly variable for similarly labeled protective garments, highlighting the necessity of internal validation when considering nonlead and lightweight models.

A model of CT dose profiles in Banach space; with applications to CT dosimetry.

In this paper the scatter component of computed tomography dose profiles is modeled using the solution to a nonlinear ordinary differential equation. This scatter function is summed with a modeled primary function of approximate trapezoidal shape. The primary dose profile is modeled to include the analytic continuation of the Heaviside step function. A mathematical theory is developed in a Banach space. The modeled function is used to accurately fit data from a 256-slice GE Revolution scanner. A 60 cm long body phantom is assembled and used for data collection with both a pencil chamber and a Farmer-type chamber.

Dosimetric characterization and image quality evaluation of the AIRO mobile CT scanner.

Radiation dose and image quality from a recently introduced mobile CT imaging system are presented. Radiation dose was measured using a conventional 100 mm pencil ionization chamber and CT polymethylmetacrylate (PMMA) body and head phantoms. Image quality was evaluated with a CATPHAN 500 phantom. Spatial resolution, low contrast resolution, Modulation Transfer Function (MTF), and Normalized Noise Power Spectrum (NNPS) were analyzed. Radiation dose and image quality were compared to those from a multi-detector CT scanner (Siemens Sensation 64). Under identical technique factors radiation dose (mGy/mAs) from the AIRO mobile CT system (AIRO) is higher than that from a 64 slice CT scanner. Based on MTF analysis, both Soft and Standard filters of the AIRO system lost resolution quickly compared to the Sensation 64 slice CT. The Siemens scanner had up to 7 lp/cm for the head FOV and H40 kernel and up to 5 lp/cm at body FOV for the B40f kernel. The Standard kernel in the AIRO system was evaluated to have 3 lp/cm and 4 lp/cm for the body and head FOVs respectively. NNPS of the AIRO shows low frequency noise due to ring-like artifacts which may be caused by detector calibration or lack of artifact reducing image post-processing. Due to a higher dose in terms of mGy/mAs at both head and body FOV, the contrast to noise ratio is higher in the AIRO system than in the Siemens scanner. However detectability of the low contrast objects is poorer in the AIRO due to the presence of ring artifacts in the location of the targets.

Impact of physician practice on patient radiation dose during CT guided biopsy procedures.

PURPOSE: Patient radiation dose during Computed Tomography (CT) guided biopsy procedures is determined by both acquisition technical parameters and physician practice. The potential effect of the physician practice is of concern. This study is to investigate the effects of those intangibles on patient radiation dose. METHODS: Patient radiation dose from 252 patients who underwent CT guided biopsy from 2009 to 2010 were retrospectively studied. Ten physicians who used conventional intermittent shots, low mA dose saving feature, or both were included in the study. The patient dose reports were retrieved and the total dose length products (DLPs) were analyzed. Linear regression analysis performed between various variables and reported dose. Patient detriment index (PDI) was developed, which sets threshold (standard of practice) for comparing physician practice with their peers. Odds ratio was calculated to determine odds of a group of patients receiving dose above threshold when compared to another group. RESULTS: Median DLP among ten physicians was 1194 mGy-cm. There was a significant difference (p< 0.01) between reported DLPs doses when physicians used dose saving feature vs. when feature not used (539.8 ± 169.4 mGy-cm vs. 1269.7 ± 659.0 mGy-cm). In general, physicians who used dose saving feature had lower relative PDIs (< 1) compared to the PDIs (> 1) without the dose feature. Odds ratio estimate of 7.7 at 95% confidence level indicates that the odds of a group receiving a high dose depends on practitioner. CONCLUSION: Adjustments of practice habits, use of dose saving features or both may be needed to improve patient care for CT biopsy.

Towards omni-tomography--grand fusion of multiple modalities for simultaneous interior tomography.

We recently elevated interior tomography from its origin in computed tomography (CT) to a general tomographic principle, and proved its validity for other tomographic modalities including SPECT, MRI, and others. Here we propose "omni-tomography", a novel concept for the grand fusion of multiple tomographic modalities for simultaneous data acquisition in a region of interest (ROI). Omni-tomography can be instrumental when physiological processes under investigation are multi-dimensional, multi-scale, multi-temporal and multi-parametric. Both preclinical and clinical studies now depend on in vivo tomography, often requiring separate evaluations by different imaging modalities. Over the past decade, two approaches have been used for multimodality fusion: Software based image registration and hybrid scanners such as PET-CT, PET-MRI, and SPECT-CT among others. While there are intrinsic limitations with both approaches, the main obstacle to the seamless fusion of multiple imaging modalities has been the bulkiness of each individual imager and the conflict of their physical (especially spatial) requirements. To address this challenge, omni-tomography is now unveiled as an emerging direction for biomedical imaging and systems biomedicine.

Assessing the clinical utility of quantitative computed tomography with a routinely used diagnostic computed tomography scanner in a cancer center.

The purpose of this study was to characterize quantitative computed tomography (QCT) in our multi-detector computed tomography (MDCT) scanner with regard to the influence of the QCT phantom on dose and the influence of varying mA and CIRS phantom size on bone mineral density (BMD) measurements. We accomplish this by scanning a commercially available QCT phantom and a corresponding quality assurance phantom. To assess the feasibility of having the QCT phantom in place while patients are being scanned, we measured radiation dose difference in a CT body phantom with and without the QCT phantom on the CT table and also, with and without the use of dose modulation programs. We also analyzed reconstructed QCT phantom images with the manufacturer's software to measure BMD. Although patient characteristics may be different, leading to different mA values, the influence of the QCT phantom on the dose to patients was minimal when compared with doses measured without the phantom in place. Average BMD measurements were not significantly affected by varying mA, for a fixed-size phantom. The average BMD exhibited a weak dependence on computerized imaging reference systems (CIRS) torso phantom size, with a propensity for decreasing BMD with increasing size. Measurement precision was unaffected by varying CIRS size. Having the ability to measure bone density as part of the routine management of cancer patients, with no added cost, time, or radiation dose, will allow for the prospective evaluation of bone mineral changes. We believe that this ability will facilitate the detection of abnormal bone loss and will lead to better management of this loss and, thus, reduce the complications and associated morbidity in these cancer survivors.

Dosimetric characterization of a cone-beam O-arm imaging system.

This study compared patient dose and image quality of a mobile O-arm cone beam imaging system in the 3D scan acquisition mode to those of a 64 slice Computed Tomography (CT) imaging system. The investigation included patient dose, scattered radiation, and image quality measurements. The patient dose was measured using a 0.6 cc Farmer ion chamber and 30 cm long Computed Tomography (CT) head and body polymethylmethacrylate (PMMA) phantoms. The results show that under identical radiographic techniques (kVp, mAs, etc.) and with the same scan length, the O-arm in 3D scan acquisition mode delivers approximately half the radiation dose of a 64 slice CT scanner. Scattered radiation was measured at several locations around the O-arm, at 1 m, 2 m and 3 m distances in 3D CT scan acquisition mode with a RadCal 10 x 5-180 pancake ion chamber using a 30 cm long CT body phantom as the source of scatter. Similar measurements were made in a 64 slice CT scanner. The data demonstrate that scattered radiation from the O-arm to personnel involved in a clinical procedure is comparable to that from a 64 slice CT scanner. Image quality was compared by exposing a CATPHAN phantom to comparable doses in both the O-arm and the CT scanner. The resultant images were then evaluated for modulation transfer function (MTF), high-contrast spatial resolution, and low contrast sensitivity for clinical application purpose. The O-arm shows comparable high contrast to the CT (7 lp/cm vs. 8 lp/cm). The low contrast in the O-arm is not visible due to fixed pattern noise. For image guided surgery applications where the location of a structure is emphasized over a survey of all image details, the O-arm has some advantages due to wide radiation beam coverage and lower patient dose. The image quality of the O-arm needs significant improvement for other clinical applications where high image quality is desired.