Preclinical validation of the advection diffusion flow estimation method using computational patient specific coronary tree phantoms.

Coronary computed tomography angiography (CCTA) does not allow the quantification of reduced blood flow due to coronary artery disease (CAD). In response, numerical methods based on the CCTA image have been developed to compute coronary blood flow and assess the impact of disease. However to compute blood flow in the coronary arteries, numerical methods require specification of boundary conditions that are difficult to estimate accurately in a patient-specific manner. We describe herein a new noninvasive flow estimation method, called Advection Diffusion Flow Estimation (ADFE), to compute coronary artery flow from CCTA to use as boundary conditions for numerical models of coronary blood flow. ADFE uses image contrast variation along the tree-like structure to estimate flow in each vessel. For validating this method we used patient specific software phantoms on which the transport of contrast was simulated. This controlled validation setting enables a direct comparison between estimated flow and actual flow and a detailed investigation of factors affecting accuracy. A total of 10 CCTA image data sets were processed to extract all necessary information for simulating contrast transport. A spectral element method solver was used for computing the ground truth simulations with high accuracy. On this data set, the ADFE method showed a high correlation coefficient of 0.998 between estimated flow and the ground truth flow together with an average relative error of only 1 % . Comparing the ADFE method with the best method currently available (TAFE) for image-based blood flow estimation, which showed a correlation coefficient of 0.752 and average error of 20 % , it can be concluded that the ADFE method has the potential to significantly improve the quantification of coronary artery blood flow derived from contrast gradients in CCTA images.

Differentiation of Hemorrhage from Iodine Using Spectral Detector CT: A Phantom Study.

BACKGROUND AND PURPOSE: Conventional CT often cannot distinguish hemorrhage from iodine extravasation following reperfusion therapy for acute ischemic stroke. We investigated the potential of spectral detector CT in differentiating these lesions. MATERIALS AND METHODS: Centrifuged blood with increasing hematocrit (5%-85%) was used to model hemorrhage. Pure blood, blood-iodine mixtures (75/25, 50/50, and 25/75 ratios), and iodine solutions (0-14 mg I/mL) were scanned in a phantom with attenuation ranging from 12 to 75 HU on conventional imaging. Conventional and virtual noncontrast attenuation was compared and investigated for correlation with calculation of relative virtual noncontrast attenuation. Values for all investigated categories were compared using the Mann-Whitney U test. Sensitivity and specificity of virtual noncontrast, relative virtual noncontrast, conventional CT attenuation, and iodine quantification for hemorrhage detection were determined with receiver operating characteristic analysis. RESULTS: Conventional image attenuation was not significantly different among all samples containing blood (P > .05), while virtual noncontrast attenuation showed a significant decrease with a decreasing blood component (P < .01) in all blood-iodine mixtures. Relative virtual noncontrast values were significantly different among all investigated categories (P < .01), with correct hemorrhagic component size estimation for all categories within a 95% confidence interval. Areas under the curve for hemorrhage detection were 0.97, 0.87, 0.29, and 0.16 for virtual noncontrast, relative virtual noncontrast, conventional CT attenuation, and iodine quantification, respectively. A ≥10-HU virtual noncontrast, ≥20-HU virtual noncontrast, ≥40% relative virtual noncontrast, and combined ≥10-HU virtual noncontrast and ≥40% relative virtual noncontrast attenuation threshold had a sensitivity/specificity for detecting hemorrhage of 100%/23%, 89%/95%, 100%/82%, and 100%/100%, respectively. CONCLUSIONS: Spectral detector CT can accurately differentiate blood from iodinated contrast in a phantom setting.

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study.

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

ENERGY AND ANGULAR DEPENDENCE OF RADIOPHOTOLUMINESCENT GLASS DOSEMETERS FOR EYE LENS DOSIMETRY.

Recent studies demonstrated that lens opacities can occur at lower radiation doses than previously accepted. In view of these studies, the International Commission of Radiological Protection recommended in 2011 to reduce the eye lens dose limit from 150 mSv/y to 20 mSv/y. This implies in the need of monitoring doses received by the eye lenses. In this study, small rod radiophotoluminescent glass dosemeters (GD-300 series; AGC, Japan) were characterized in terms of their energy (ISO 4037 X-rays narrow spectrum series, S-Cs and S-Co) and angular dependence (0  up to 90 degrees, with 2 ISO energies: N-60 and S-Cs). All acquisitions were performed at SCK•CEN-Belgium, using the ORAMED proposed cylindrical phantom. For selected energies (N-60, N-80, N-100, N-120 and N-250), the response of dosemeters irradiated on the ISO water slab phantom, at the Ruder Boskovic Institute-Croatia, was compared to those irradiated on the cylindrical phantom. GD-300 series showed good energy dependence, relative to S-Cs, on the cylindrical phantom. From 0 up to 45 degrees, the dosemeters showed no significant angular dependence, regardless whether they were tested when placed vertically or horizontally on the cylindrical phantom. However, at higher angles, some angular dependence was observed, mainly when the dosemeters were irradiated with low-energy photons (N-60). Results showed that GD-300 series have good properties related to Hp(3), although some improvements may be necessary.

Comparison of ventilation-perfusion single-photon emission computed tomography (V/Q SPECT) versus dual-energy CT perfusion and angiography (DECT) after 6 months of pulmonary embolism (PE) treatment.

BACKGROUND: The natural evolution of treated symptomatic pulmonary embolism shows often incomplete resolution of pulmonary thrombi. The prevalence of perfusion defects depend on the image modality used. This study directly compares V/Q SPECT with DECT. METHODS: A single-center prospective observational cohort study of patients with intermediate risk PE, reassessed at the end of treatment with V/Q SPECT. Abnormal V/Q SPECT images were compared with DECT. RESULTS: We compared DECT en V/Q SPECT in 28 consecutive patients with persistent V/Q mismatch on V/Q SPECT, 13 men and 15 woman, mean age 60 (+17), range 23-82 year. One patient was excluded from the final analysis due to inferior quality DECT. In 18/27 (66.7%) the results were concordant between CTPA (persistent embolus visible), DECT (segmentary defects on iodine map) and V/Q SPECT (segmentary ventilation-perfusion mismatch). In 3/18 (11.1% of the total group) the partialy matched V/Q SPECT defect could be explained on DECT lung images by lung infarction. In 6/27 (22.1%) only hypoperfusion was seen on DECT iodine map. In 3/27 (11.1%) results were discordant between V/Q SPECT and DECT images. CONCLUSION: Six months after diagnosis of first or recurrent PE, residual pulmonary perfusion-defects encountered on V/Q-SPECT corresponds in the majority of patients with chronic thromboembolic disease seen on DECT. In 22.1% of patients V/Q SPECT mismatch only corresponds with hypoperfusion on iodine map DECT scan. Some (11.1%) of the chronic thromboembolic lesions seen on V/Q SPECT can not be explained by DECT results.

Mapping very low level occupational exposure in medical imaging: a useful tool in risk communication and decision making.

OBJECTIVES: The use of ionising radiation in medical imaging is accompanied with occupational exposure which should be limited by optimised room design and safety instructions. These measures can however not prevent that workers are exposed to instantaneous dose rates, e.g. the residual exposure through shielding or the exposure of discharged nuclear medicine patients. The latter elements are often questioned by workers and detailed assessment should give more information about the impact on the individual radiation dose. METHODS: Cumulated radiation exposure was measured in a university hospital during a period of 6 months by means of thermoluminescent dosimeters. Radiation exposure was measured at background locations and at locations where enhanced exposure levels are expected but where the impact on the individual exposure is unclear. RESULTS: The results show a normal distribution of the cumulated background radiation level. No enhanced cumulated radiation exposure which significantly differs from this background level could be found during the operation of intra-oral apparatus, during ultrasonography procedures among nuclear medicine patients and at operator consoles of most CT-rooms. CONCLUSIONS: This 6 months survey offers useful information about occupational low level exposure in medical imaging and the findings can be useful in both risk communication and decision making.

Initial axillary staging of breast cancer using ultrasound-guided fine needle aspiration: a liquid-based cytology study.

OBJECTIVE: To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)-guided fine needle aspiration cytology (FNAC) and liquid-based cytology (Surepath(®)) to reduce sentinel node procedures. METHODS: In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. RESULTS: US-guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US-guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node-negative. The correlation between malignant FNAC and histopathology was 100%. US-guided liquid-based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. CONCLUSIONS: We advocate that US-guided fine needle aspiration (FNA) combined with liquid-based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.

Quality control of micro-computed tomography systems.

The rapid proliferation of micro-computed tomography (micro-CT) scanners in preclinical small animal studies has created a need for a method on scanner performance evaluation and scan parameter optimisation. The purpose of this study was to investigate the performance of the scanner with a dedicated micro-CT phantom. The phantom was developed with different independent sections that allow for measurement of major scanner characteristics such as uniformity, linearity, contrast response, dosimetry and resolution. The results of a thorough investigation are discussed.

Development of a multi-spectral, multi-geometry computational model for X-ray breast imaging.

The introduction of novel applications in X-ray breast imaging warrants new research for image acquisition optimisation. A simulation model was developed to investigate the influence of different imaging techniques and acquisition parameters. It was modelled in Monte Carlo N-Particle Extended and contains an X-ray tube with photon production, a breast model and antiscatter grid model. This paper describes the simulation model, compares the results with experimental and literature data and presents the influence of breast and antiscatter grid parameters on scatter radiation.

Dealing with pregnancy in radiology: a thin line between science, social and regulatory aspects.

The participation of pregnant women in radiology can be an emotional experience. The word "radiation" understandably invokes fear and uncertainty. Irradiation of a foetus should be avoided whenever possible. However, radiological examinations of pregnant women are often justified and unintended exposures do occur. Also pregnant radiology staff may remain working in the department. Lack of knowledge about the effects of both ionising (X-rays) and non-ionising (MRI) radiation is responsible for anxiety of patients and workers. If foetal exposures occur, they must be quantitatively evaluated and the risk put into perspective. This paper is intended to inform radiology managers, radiologists, technologists and referring clinicians in their management with pregnant patients and co-workers. The paper describes conceptus doses for both patient and worker that are associated with radiology practice, reviews the risks and effects of in utero irradiation, and discusses current national policies, international guidelines and practical aspects.

Comparison of double dosimetry algorithms for estimating the effective dose in occupational dosimetry of interventional radiology staff.

'Double dosimetry' i.e. measurement with two dosemeters, one located above the protective apron and one under has been recommended in interventional radiology (IR) to determine the effective dose to staff. Several algorithms have been developed to calculate the effective dose from the readings of the two dosemeters, but there is no international consensus on what is the best algorithm. In this work, a few of the most recently developed algorithms have been tested in typical IR conditions. The effective dose and personnel dosemeter readings were obtained experimentally by using thermoluminescent dosemeters in and on a Rando-Alderson phantom provided with a lead apron. In addition, the effective dose and personnel dosemeter readings were calculated by the Monte Carlo method for the same irradiation geometry. The results suggest that most of the algorithms overestimate effective dose in the selected IR conditions, but there is also a risk of underestimation by using the least conservative algorithms. Two of the algorithms seem to comply best with the chosen criteria of performance, i.e. no underestimation, minimum overestimation and close estimation of effective dose in typical IR conditions. However, it might not be justified to generalise the results. It is recommended that whenever personnel doses approach or exceed the dose limit, IR conditions should be further investigated and the possibility of over- or under-estimation of effective dose by the algorithm used should be considered.

Overview of double dosimetry procedures for the determination of the effective dose to the interventional radiology staff.

In interventional radiology, for an accurate determination of effective dose to the staff, measurements with two dosemeters have been recommended, one located above and one under the protective apron. Such 'double dosimetry' practices and the algorithms used for the determination of effective dose were reviewed in this study by circulating a questionnaire and by an extensive literature search. The results indicated that regulations for double dosimetry almost do not exist and there is no firm consensus on the most suitable calculation algorithms. The calculation of effective dose is mainly based on the single dosemeter measurements, in which either personal dose equivalent, directly, (dosemeter below the apron) or a fraction of personal dose equivalent (dosemeter above the apron) is taken as an assessment of effective dose. The most recent studies suggest that there might not be just one double dosimetry algorithm that would be optimum for all interventional radiology procedures. Further investigations in several critical configurations of interventional radiology procedures are needed to assess the suitability of the proposed algorithms.

Double-dosimetry algorithm for workers in interventional radiology.

Based on double-dosemeter readings, a conservative effective dose (E) estimation algorithm for lead apron workers in interventional radiology is proposed. Typical radiation conditions for various exposure geometries were simulated using the MCNPX 2.4.0 code. The simulation model consisted of an X-ray source and image intensifier, a patient phantom and a voxelised staff member phantom with lead apron. The effective staff dose and dosemeter readings for several positions of the worker were calculated. The effective dose to a physician, positioned in close proximity to the primary beam, can be estimated within a 10% underestimation margin by E = 1.64 H(p)(10)thorax,under + 0.075 H(p)(10)neck,over. The dose to the eye lens can be estimated by a dosemeter reading at collar level (R2 = 0.98).

A study of the correlation between dose area product and effective dose in vascular radiology.

The purpose of the multi-centre study was to assess dose area product (DAP) and effective dose of patients undergoing angiography of the lower limbs in Belgium and to investigate the correlation between DAP and effective dose. DAP values were measured in 12 centres and compared with the national diagnostic reference levels (DRLs). The effective dose (E) was estimated by multiplying the DAP with case-specific conversion coefficients (CCs) that were calculated with Monte Carlo software MCNP5. As a model for the patient, a mathematical hermaphrodite phantom was used. Calculations showed that tube configurations and extra Cu filtration have a large influence on these CCs. Due to the use of Cu filtration, effective dose can be twice as high for comparable DAP values. Also the use of an over-couch tube configuration is a disadvantage when compared with the under-couch tube configuration. For centres working under-couch without the use of extra Cu-filtration, the DAP values correlate very well with effective dose (Spearman's rank correlation rho ; = 0.97). For these conditions, general CCs between DAP and E were calculated. They were 0.083 mSv Gy(-1) cm(-2) (ICRP 60) and 0.065 mSv Gy(-1) cm(-2) (ICRP 103).

Diagnostic reference levels in angiography and interventional radiology: a Belgian multi-centre study.

The purpose of this study was to determine diagnostic reference levels (DRLs) for common angiographic and interventional procedures in Belgium. Dose Area Product (DAP) measurements were performed on 21 systems, (13 angiography and 4 vascular surgery centres). Type of procedure, total DAP, patient weight and height were collected on a daily basis during 1 y. The 75th percentile of the distribution of DAP values was defined as DRL. Preliminary DRLs were calculated for the three most frequent procedures for the whole population, for a weight class of patients (65-80 kg) and normalised to the standard size patient. Among them, the DRL for angiography of the lower limbs (30% of the procedures) from the whole population was 74.6 and 63.2 Gycm2 for the size corrected. The mean DAP values of each room was then compared to these DRLs.

Personal dose monitoring in hospitals: global assessment, critical applications and future needs.

It is known that medical applications using ionising radiation are wide spread and still increasing. Physicians, technicians, nurses and others constitute the largest group of workers occupationally exposed to man-made sources of radiation. Many hospital workers are consequently subjected to routine monitoring of professional radiation exposures. in the university hospital, UZ Brussel, 600 out of 4000 staff members are daily monitored for external radiation exposures. The most obvious applications of ionising radiation are diagnostic radiology, diagnostic or therapeutic use of radionuclides in nuclear medicine and external radiation therapy or brachytherapy in radiotherapy departments. Other important applications also include various procedures in interventional radiology (IR), in vitro biomedical research and radiopharmaceutical production around cyclotrons. Besides the fact that many of the staff members, involved in these applications, are not measurably exposed, detailed studies were carried out at workplaces where routine dose monitoring encounters difficulties and for some applications where relatively high occupational exposures can be found. most of the studies are concentrated around nuclear medicine applications and IR. They contain assessments of both effective dose and doses at different parts of the body. The results contribute to better characterisation of the different workplaces in a way that critical applications can be identified. Moreover, conclusions point out future needs for practical routine dose monitoring and optimisation of radiation protection.

Typetesting of physical characteristics of digital mammography systems: first experiences within the Flemish breast cancer screening programme.

To avoid the purchase of a digital mammography system by radiologists with intrinsic characteristics not able to fulfil the physical-technical quality requirements of the acceptance tests of the European guidance document, typetesting of digital equipment was introduced in the organisation and legislation of the Flemish breast cancer screening programme. Typetesting is performed for two types of instrumentation: systems for image capture and -processing and systems for image presentation. Typetesting is finalised or ongoing for eight DR systems and four CR systems. Eight workstations were or are submitted to the typetesting for image presentation. Experiences gained in typetesting of systems for image capture and -processing up to now show that the contrast-detail analysis of CDMAM phantom imaging and the homogeneity tests are most stringent. In general DR performs better than CR in imaging performance. Typetesting for image presentation has shown no difference in quality between CRT and LCD monitors. Furthermore, 3 MP monitors also pass the tests. However, to get the full resolution capabilities of the image capture system zooming in and scrolling over the image is necessary, which is time-consuming in clinical practice. Finally, we emphasize that typetesting involves also an evaluation of a set of clinical images by the working party of radiologists and that succeeding in typetesting does not mean that a particular system passes automatically the acceptance testing. A perfect tuning of the system and the coupling to a high quality X-ray system is necessary as well.

Influence of display quality on radiologists' performance in the detection of lung nodules on radiographs.

The purpose of this study was to evaluate the influence of display quality on radiologists' performance in the detection of lung nodules. Display systems with various technical properties were considered based on their general availability in a radiology department. Their quality was assessed by physical tests. Multireader-multicase receiver operating characteristic (ROC) analysis was used to evaluate observer performance. The area under the curve (Az) was used as a metric for detectability of simulated lung nodules with diameters of 5 mm and 10 mm, and peak contrast values ranging from 0.1 (subtle) to 0.4 (evident) that were digitally superimposed on normal chest radiographs. Three experienced radiologists interpreted a batch of 60 radiographs on five different display systems; four monitors (two liquid crystal display (LCD) and two cathode ray tube (CRT) monitors) and one printed hardcopy. The physical tests showed superior performance of the two LCD monitors. ROC analysis resulted in the following Az scores: LCD-5MP Az = 0.78, hardcopy Az = 0.77, LCDc-2MP Az = 0.75, CRT-5MP Az = 0.72 and CRTc-1MP Az = 0.71. Difference in Az scores between the LCD-5MP monitor and both the CRT-5MP (p = 0.04) and CRTc-1MP (p = 0.01) monitors was significant. The primary class CRT-5MP monitor that showed reduced observer performance failed to comply with physical acceptance requirements. Luminance response was particularly observed to be insufficient. The results indicate that a quality assurance program has the potential to detect non-optimised display systems that could otherwise result in reduced observer performance.

An ancient Roman bowl embedded in a soil sample: surface shaded three dimensional display using data from a multi-detector CT.

We present an unusual application of multidetector CT and shaded surface rendering in the investigation of a soil sample, containing an ancient Roman bronze bowl. The CT findings were of fundamental importance in helping the archaeologists study the bronze bowl from the soil sample.

The use of extremity dosemeters in a hospital environment.

A general overview is given on the use of extremity dosemeters, their calibration, the units and phantoms to be used. One of the major applications of extremity dosemeters is to monitor the personnel in a hospital environment. In nuclear medicine, brachytherapy and interventional radiology (IR) skin doses to hands and legs can be substantial. Here, we report on two studies that are presently being undertaken in Belgium. The first one tries to map the dose distribution on the hands, in function of the manipulation in nuclear medicine. Some preliminary results are also given from a nationwide survey study for patient and personnel doses during IR and cardiology. The radiologists' hands, legs and forehead are monitored during a whole range of procedures in different hospitals.