Evaluation of HNA-expressing cell line-based antigen capture systems and a solid-phase system for detecting HNA-1a antibodies.

Granulocyte immunofluorescence and granulocyte agglutination tests are standard methods for detecting human neutrophil antigen (HNA) antibodies (Abs); however, these require a typed panel of neutrophils, which can be time-consuming to develop, and it remains difficult to determine antibody specificity in some cases. We established and evaluated four detection systems for HNA-1a Abs based on an HNA-1a-expressing cell line (KY cells) and antigen capture. We additionally evaluated a commercial solid-phase system. Eleven HNA-1a antibody-positive samples, including the World Health Organization Reference Reagent, and 40 serum samples derived from male blood donors were used as positive and negative control samples, respectively. Although specificity was >0.90 in all systems evaluated, the sensitivity varied among the systems. The KY cell-based monoclonal antibody specific immobilisation of granulocyte antigens (KY-MAIGA) system using certain, but not all, monoclonal Abs, and the solid-phase system revealed higher sensitivity than other systems. In conclusion, the KY-MAIGA and commercial solid-phase systems were superior in terms of specific and sensitive detection of HNA-1a Abs.

Determination of point spread function in computed tomography accompanied with verification.

A method for verifying the point spread function (PSF) measured by computed tomography has been previously reported [Med. Phys. 33, 2757-2764 (2006)]; however, this additional PSF verification following measurement is laborious. In the present study, the previously described verification method was expanded to PSF determination. First, an image was obtained by scanning a phantom. The image was then two-dimensionally deconvolved with the object function corresponding to the phantom structure, thus allowing the PSF to be obtained. Deconvolution is implemented simply by division of spatial frequencies (corresponding to inverse filtering), in which two parameters are used as adjustable ones. Second, an image was simulated by convolving the object function with the obtained PSF, and the simulated image was compared to the above-measured image of the phantom. The difference indicates the inaccuracy of the PSF obtained by deconvolution. As a criterion for evaluating the difference, the authors define the mean normalized standard deviation (SD) in the difference between simulated and measured images. The above two parameters for deconvolution can be adjusted by referring to the subsequent mean normalized SD (i.e., the PSF is determined so that the mean normalized SD is decreased). In this article, the parameters were varied in a fixed range with a constant increment to find the optimal parameter setting that minimizes the mean normalized SD. Using this method, PSF measurements were performed for various types of image reconstruction kernels (21 types) in four kinds of scanners. For the 16 types of kernels, the mean normalized SDs were less than 2.5%, indicating the accuracy of the determined PSFs. For the other five kernels, the mean normalized SDs ranged from 3.7% to 4.8%. This was because of a large amount of noise in the measured images, and the obtained PSFs would essentially be accurate. The method effectively determines the PSF, with an accompanying verification, after one scanning of a phantom.

Effective doses in four-dimensional computed tomography for lung radiotherapy planning.

The recent broad adoption of 4-D computed tomography (4DCT) scanning in radiotherapy has allowed the accurate determination of the target volume of tumors by minimizing image degradation caused by respiratory motion. Although the radiation exposure of the treatment beam is significantly greater than that of CT scans used for treatment planning, it is important to recognize and optimize the radiation exposure in 4DCT from the radiological protection point of view. Here, radiation exposure in 4DCT was measured with a 16 multidetector CT. Organ doses were measured using thermoluminescence radiation dosimeter chips inserted at respective anatomical sites of an anthropomorphic phantom. Results were compared with those with the helical CT scan mode. The effective dose measured for 4DCT was 24.7 mSv, approximately four times higher than that for helical CT. However, the increase in treatment accuracy afforded by 4DCT means its use in radiotherapy is inevitable. The patient exposure in the 4DCT could be of value by clarifying the advantage of the treatment planning using 4DCT.

Patient dose estimation for multi-detector-row CT examinations.

The spread of Multi-detector-row computed tomography (MDCT) has been remarkable. Here, various organ and tissue doses were evaluated with six types of MDCT scanners in common use in Japan; using thermoluminescence dosimeters and anthropomorphic phantoms under condition of routine clinical examinations of the chest in adult and child, of the head in child and of the abdomen-pelvis in adult. Estimated lung doses and averaged effective dose in chest examinations were 19.2 +/- 2.03 mGy and 9.54 +/- 0.90 mSv for the adult and 15.7 +/- 1.88 mGy and 7.42 +/- 0.82 mSv for the child phantom, respectively. The numerical difference between effective dose and organ or tissue doses was about 2-2.5 times. For the adult abdomen-pelvis examinations, averaged effective dose was 13.0 +/- 3.72 mSv. Averaged effective dose for the child head examinations was 2.6 +/- 1.32 mSv. In one case, the dose approached 80 mGy for the brain in the head examination, giving a difference from the effective dose of 10 times or more.

Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner.

BACKGROUND: The 256-multislice CT (256MSCT) obtains volumetric data with 128-mm coverage in a single rotation. This coverage allows satisfactory visualization of the whole heart, allowing the 256MSCT to visualize the cardiac chambers and coronary arteries by cine scan without ECG gating. These characteristics provide a solution to the problems of MSCT. Although a wider beam width provides more efficient imaging over a wider coverage area, patient doses with the 256MSCT are of considerable concern. OBJECTIVE: We assessed potential radiation exposure with the 256MSCT in a cardiac CT protocol and compared the results to those with 16- and 64MSCT (collimated 64x0.5mm using 256MSCT). METHODS: Organ or tissue doses were measured in an anthropomorphic phantom under a coronary artery imaging protocol with the 256MSCT in cine scan mode without ECG gating, and with the 16- and 64MSCT in helical scan mode with ECG gating. RESULTS: Average effective doses were 22.8mSv for the 16MSCT, 27.8mSv for the 64MSCT and 14.1mSv for the 256MSCT. The 16- and 64MSCT doses were thus approximately 1.6- and 2.0-fold higher than those of the 256MSCT. CONCLUSIONS: Use of the 256MSCT in cardiac volumetric cine imaging offers lower radiation exposure than 16- and 64MSCT, and suggests the potential of this equipment in single-beat cardiac imaging without ECG gating. This effective dose is acceptable for routine cardiac imaging.

Imaging of small spherical structures in CT: simulation study using measured point spread function.

Size and density measurements of objects undertaken using computed tomography (CT) are clinically significant for diagnosis. To evaluate the accuracy of these quantifications, we simulated three-dimensional (3D) CT image blurring; this involved the calculation of the convolution of the 3D object function with the measured 3D point spread function (PSF). We initially validated the simulation technique by performing a phantom experiment. Blurred computed images showed good 3D agreement with measured images of the phantom. We used this technique to compute the 3D blurred images from the object functions, in which functions are determined to have the shape of an ideal sphere of varying diameter and assume solitary pulmonary nodules with a uniform density. The accuracy of diameter and density measurements was determined. We conclude that the proposed simulation technique enables us to estimate the image blurring precisely of any 3D structure and to analyze clinical images quantitatively.

Feasibility study of glass dosimeter postal dosimetry audit of high-energy radiotherapy photon beams.

INTRODUCTION: The characteristics of a glass dosimeter were investigated for its potential use as a tool for postal dose audits. Reproducibility, energy dependence, field size and depth dependence were compared to those of a thermoluminescence dosimeter (TLD), which has been the major tool for postal dose audits worldwide. MATERIALS AND METHODS: A glass dosimeter, GD-302M (Asahi Techno Glass Co.) and a TLD, TLD-100 chip (Harshaw Co.) were irradiated with gamma-rays from a (60)Co unit and X-rays from a medical linear accelerator (4, 6, 10 and 20 MV). RESULTS: The dosimetric characteristics of the glass dosimeter were almost equivalent to those of the TLD, in terms of utility for dosimetry under the reference condition, which is a 10 x 10 cm(2) field and 10 cm depth. Because of its reduced fading, compared to the TLD, and easy quality control with the ID number, the glass dosimeter proved to be a suitable tool for postal dose audits. Then, we conducted postal dose surveys of over 100 facilities and got good agreement, with a standard deviation of about 1.3%. CONCLUSIONS: Based on this study, postal dose audits throughout Japan will be carried out using a glass dosimeter.

Estimation of uncertainties on dose calculations of the 99mTc-MDP-injected patients in nuclear medicine.

The internal exposures of the patients in nuclear medicine can be calculated based on the equations and data in ICRP Publications 53 and 80. Physical and biological parameters are used for the calculation, and both include uncertainties. Physical parameters can be considered as more precise than biological parameters, so that uncertainties originated from biological parameters are more important. Absorbed fractions (AFs) have been calculated by Monte-Carlo method using medical internal radiation dose (MIRD)-type mathematical phantoms. They depend on the shapes and sizes of the phantoms used in simulations. For estimating shape- and size-related uncertainties, AFs of pairs of source regions and target tissues of the patient-injected 99mTc-MDP were calculated by using EGS4 codes and a voxel phantom of Japanese male. By simply resizing the voxels of the phantom, the dependencies of size for AFs were calculated, and the uncertainties caused by the cumulated activities in source regions were also estimated by assuming these parameters distributions as Gaussian.

[Evaluation of the accuracy of line spread function (LSF) and point spread function (PSF) measured in the computed tomography.].

We propose a method to estimate the accuracy of the line spread function (LSF) in computed tomography (CT). When we assume an object for scanning has a shape and CT-value in the x-y scan-plane that are constant in the z-direction perpendicular to the scan-plane, blurring in the image of the object is predicted with calculation by the LSF measured in the scanner. When using the precise LSF, the calculated image must agree well with the scanned image of the phantom corresponding to the object. Then, verification of LSF is performed by comparing the calculated image with the scanned image. We measured the LSF in our scanner, and scanned a cylindrical phantom with constant diameter and CT-value in which the direction of cylinder was parallel to the z-direction, as mentioned above. Images calculated by using the LSF corresponded well to scanned images, indicating the validity of the LSF. We obtained another LSF by an inappropriate manner, and calculated images using it. Those images showed an apparent difference with scanned images, indicating the inaccuracy of the LSF. Our technique is effective to evaluate the accuracy of LSF, PSF, and also modulation transfer function (MTF) derived from the LSF or PSF.

[Nationwide survey of nuclear medicine practice and estimation of collective effective dose in Japan.].

For the estimation of collective effective dose from radiopharmaceuticals used in nuclear medicine diagnosis, a national survey was carried out in Japan. The survey contents covered radiopharmaceutical use, sex, age, activity, and so on of each patient in October 1997 and the monthly number of examinations in 1997. The annual number of diagnostic examinations using radiopharmaceuticals was 0.82 million for males and 0.74 million for females. The frequency of examination was about 3% for patients less than 17 years old and about 60% for those more than 60 years old. Effective dose was calculated on the basis of such literature as ICRP publications. The dose used most frequently was 5-6mSv per examination. The collective effective doses from diagnostic nuclear medicine examinations were estimated to be 13100 man .Sv for males and 20200 man .Sv for females.

An effective method to verify line and point spread functions measured in computed tomography.

This study describes an effective method for verifying line spread function (LSF) and point spread function (PSF) measured in computed tomography (CT). The CT image of an assumed object function is known to be calculable using LSF or PSF based on a model for the spatial resolution in a linear imaging system. Therefore, the validities of LSF and PSF would be confirmed by comparing the computed images with the images obtained by scanning phantoms corresponding to the object function. Differences between computed and measured images will depend on the accuracy of the LSF and PSF used in the calculations. First, we measured LSF in our scanner, and derived the two-dimensional PSF in the scan plane from the LSE Second, we scanned the phantom including uniform cylindrical objects parallel to the long axis of a patient's body (z direction). Measured images of such a phantom were characterized according to the spatial resolution in the scan plane, and did not depend on the spatial resolution in the z direction. Third, images were calculated by two-dimensionally convolving the true object as a function of space with the PSF. As a result of comparing computed images with measured ones, good agreement was found and was demonstrated by image subtraction. As a criterion for evaluating quantitatively the overall differences of images, we defined the normalized standard deviation (SD) in the differences between computed and measured images. These normalized SDs were less than 5.0% (ranging from 1.3% to 4.8%) for three types of image reconstruction kernels and for various diameters of cylindrical objects, indicating the high accuracy of PSF and LSF that resulted in successful measurements. Further, we also obtained another LSF utilizing an inappropriate manner, and calculated the images as above. This time, the computed images did not agree with the measured ones. The normalized SDs were 6.0% or more (ranging from 6.0% to 13.8%), indicating the inaccuracy of the PSF and LSE We could verify LSFs and PSFs for three types of reconstruction kernels, and demonstrated differences between modulation transfer functions (MTFs) derived from validated LSFs and inaccurate LSFs. Our technique requires a simple phantom that is suitable for clinical scanning, and does not require a particular phantom containing some metals or specific fine structures, as required in methods previously used for measurements of spatial resolution. Therefore, the scanned image of the phantom will be reliable and of good quality, and this is used directly as a confident reference image for the verification. When one obtains LSF, PSF or MTF values, verification using our method is recommended. Further, when another method for the measurement of LSF and PSF is developed, it could be validated using our technique, as illustrated in the method proposed by Boone [Med. Phys. 28, 356-360 (2001)] and used in this paper.

Prototype heel effect compensation filter for cone-beam CT.

The prototype cone-beam CT (CBCT) has a larger beam width than the conventional multi-detector row CT (MDCT). This causes a non-uniform angular distribution of the x-ray beam intensity known as the heel effect. Scan conditions for CBCT tube current are adjusted on the anode side to obtain an acceptable clinical image quality. However, as the dose is greater on the cathode side than on the anode side, the signal-to-noise ratio on the cathode side is excessively high, resulting in an unnecessary dose amount. To compensate for the heel effect, we developed a heel effect compensation (HEC) filter. The HEC filter rendered the dose distribution uniform and reduced the dose by an average of 25% for free air and by 20% for CTDI phantoms compared to doses with the conventional filter. In addition, its effect in rendering the effective energy uniform resulted in an improvement in image quality. This new HEC filter may be useful in cone-beam CT studies.

Enlarged longitudinal dose profiles in cone-beam CT and the need for modified dosimetry.

In order to examine phantom length necessary to assess radiation dose delivered to patients in cone-beam CT with an enlarged beamwidth, we measured dose profiles in cylindrical phantoms of sufficient length using a prototype 256-slice CT-scanner developed at our institute. Dose profiles parallel to the rotation axis were measured at the central and peripheral positions in PMMA (polymethylmethacrylate) phantoms of 160 or 320 mm diameter and 900 mm length. For practical application, we joined unit cylinders (150 mm long) together to provide phantoms of 900 mm length. Dose profiles were measured with a pin photodiode sensor having a sensitive region of approximately 2.8 x 2.8 mm2 and 2.7 mm thickness. Beamwidths of the scanner were varied from 20 to 138 mm. Dose profile integrals (DPI) were calculated using the measured dose profiles for various beamwidths and integration ranges. For the body phantom (320-mm-diam phantom), 76% of the DPI was represented for a 20 mm beamwidth and 60% was represented for a 138 mm beamwidth if dose profiles were integrated over a 100 mm range, while more than 90% of the DPI was represented for beamwidths between 20 and 138 mm if integration was carried out over a 300 mm range. The phantom length and integration range for dosimetry of cone-beam CT needed to be more than 300 mm to represent more than 90% of the DPI for the body phantom with the beamwidth of more than 20 mm. Although we reached this conclusion using the prototype 256-slice CT-scanner, it may be applied to other multislice CT-scanners as well.

[Survey of CT practice in Japan and collective effective dose estimation].

Computed tomography(CT) has been established as an important diagnostic tool in clinical medicine and has become a major source of medical exposure. A nationwide survey regarding CT examinations was carried out in Japan in 2000. CT units per million people in Japan numbered 87.8. The annual number of examinations was 0.1 million in those 0-14 years old, 3.54 million for those 15 years old and above, and 3.65 million in total. Eighty percent of examinations for those 0-14 years old were examinations of the head, as were 40% for those 15 years old and above. The number of examinations per 1000 population was 290. The collective effective dose was 295 x 10(3) person.Sv, and the effective dose per caput was evaluated as 2.3 mSv.

Research on potential radiation risks in areas with nuclear power plants in Japan: leukaemia and malignant lymphoma mortality between 1972 and 1997 in 100 selected municipalities.

The results of a geographical correlation study using Poisson regression analysis are reported for leukaemia and malignant lymphoma mortality between 1972 and 1997 in 100 selected Japanese municipalities with or without a nuclear power plant (NPP). The data did not support social concerns of an increased risk of malignant lymphoma in the vicinity of Japanese NPPs. However, some estimates of overall excess relative risk (ERR; relative risk minus one) were statistically significantly positive for leukaemia mortality in 20 NPP municipalities compared with mortality in the remaining 80 control areas, taking into account a minimum two-year latency following the start of commercial operation. One estimate was 0.228 (95% CI: 0.074-0.404) from a simple area adjustment using the mortality in all Japan as the external baseline rate. This superficial increase is not due to leukaemia among young people, aged less than 25 years at death. The ERR estimate for ages at death of 50-74 years was confounded to be positive for leukaemia and distorted to be negative for malignant lymphoma. For leukaemia, a positive ERR estimate was seen, especially for females and during specific periods. Confounding of the ERR estimate for two causes was also seen in some NPP areas including a high adult T-cell leukaemia (ATL) area. Temporal area variations associated with ATL misclassification and a temporal increasing trend of leukaemia mortality in the elderly caused the confounding effects. Our findings do not support the hypothesis of a leukaemogenic impact of NPPs in Japan.

An accidental exposure by a medical linear accelerator under construction.

A radiation accident occurred at a medical linear accelerator facility under construction in Japan. The radiation source was a 3- and 6-MV potential drop accelerator designed to produce X-rays for radiation therapy. This accelerator was also capable of producing a 5 to14-MV swept electron beam. During setting up, an operator turned on the accelerator to test the beam not knowing that a man was working on the ceiling above the accelerator. Thus, an X-ray beam was emitted against the ceiling and the man was exposed to 10-MV of X-ray irradiation. However, no obvious physical symptoms were noted. Dose estimation was made from reconstruction of the accident and clinical examinations including chromosome analysis. Mean dose of the whole body ranged from 70 to 180 mSv. Estimated dose from his right foot to hand was between180 to 900 mSv.

Dose evaluation and effective dose estimation from multi detector CT.

Computed tomography (CT) has evolved remarkably through device improvement and advancement of peripherals, including computers. In 1999, multi detector-row CT (MDCT) appeared and rapid high-speed scanning became possible. However, usefulness of MDCT in actual clinical application cannot be assessed until the exposure doses are assessed appropriately. Since CT examinations need a comparatively high dose, it is necessary to evaluate patient exposure for introduction of MDCT. Patient doses by three types of MDCTs were evaluated for cases of scanning of the chest and abdomen-pelvis. The examination conditions were the same as those in actual clinical examinations. The obtained effective doses were 9.4-28 mSv for the chest examination and 13-28 mSv for the abdomen-pelvis. The average surface doses varied between 16-43 mGy for the chest examination and 20-37 mGy for the abdomen-pelvis. The highest surface dose was 57 mGy for the abdomen-pelvis examination. The exposed doses differed according to scanning method and imaging conditions such as tube current, slice thickness and so on. It seemed that there is room for dose reduction by proper adjustment of scan conditions in MDCT examinations.

Dose evaluation and effective dose estimation from CT fluoroscopy-guided lung biopsy.

The development of computerized tomography (CT) has made CT fluoroscopy possible with real-time CT images. However examination are expected to have high medical and occupational exposures. Then, exposures to patients and operating and assisting physicians during the CT fluoroscopy-guided lung biopsy were estimated. And changes in the examination conditions to lower the dose were made. Patient exposure was measured using an anthropomorphic phantom by simulation of clinical examination conditions. The surface dose to the physician was measured during actual clinical examinations. The average effective dose for the patient was 34+/-22mSv. The highest surface dose amounted to 1.9 Gy, although this was in a very narrow field. Patient doses could be reduced by a factor of 2.5-3 by changing examination methods while still retaining diagnostic quality. The highest dose to the operating physician was 10mGy which was recorded on the back of the hand and the average effective dose was estimated as 5.99&mgr;Sv per 1-minute examination. Doses were reduced by about a factor of 50 by lowering the tube voltage from 120kV to 80 kV and using a supplementary tool. The doses for assisting physicians were not significant. The exposure for physicians and patients was much affected by lowering the tube voltage used for fluoroscopy. Using a supplementary tool was effective for reducing the dose for physicians.