Review of portable CT with assessment of a dedicated head CT scanner.

This article reviews a number of portable CT scanners for clinical imaging. These include the CereTom, Tomoscan, xCAT ENT, and OTOscan. The Tomoscan scanner consists of a gantry with multisection detectors and a detachable table. It can perform a full-body scanning, or the gantry can be used without the table to scan the head. The xCAT ENT is a conebeam CT scanner that is intended for intraoperative scanning of cranial bones and sinuses. The OTOscan is a multisection CT scanner intended for imaging in ear, nose, and throat settings and can be used to assess bone and soft tissue of the head. We also specifically evaluated the technical and clinical performance of the CereTom, a scanner designed specifically for neuroradiologic head imaging. The contrast performance of this scanner permitted the detection of 4-mm low-contrast lesions, and the limiting spatial resolution was 7 line pairs per centimeter. The measured volume of the CT dose index (CTDI(vol)) for a standard head CT scan was 41 mGy (120 kV/14 mAs). All clinical images were of diagnostic quality, and the average patient effective dose was 1.7 mSv. We conclude that the CereTom portable CT scanner generates satisfactory clinical images at acceptable patient doses.

Effect of dose metrics and radiation risk models when optimizing CT x-ray tube voltage.

We investigated the effect of different CT dose metrics, as well as the implications of various radiation risk models, on the optimization of x-ray tube voltage (kV) in CT. Soft tissue attenuation characteristics and noise levels, obtained from CT scans of a Rando phantom, were used to compute contrast-to-noise ratios (CNR) at x-ray tube voltages between 80 and 140 kV. Four CT dose metrics were evaluated: (a) CTDIair, (b) weighted CTDIw, (c) organ dose (Dorgan), and (d) effective dose (E). All doses were obtained using the ImPACT CT Dosimetry software package. Soft tissue CNR was adjusted by the modification of the mAs by assuming that CNR(2) was proportional to mAs. Optimization criteria were: (a) maintaining a constant CNR at each kV and identifying the value that minimizes patient dose; and (b) maintaining a constant dose at each kV and identifying the value that maximizes CNR. We also investigated the implication for optimization strategies assuming that radiation risk is proportional to En, with n varying between 0 and 2. Optimizing with respect to phantom measurements (i.e., CTDIair and CTDIw) could generate results that differed quantitatively and qualitatively from those obtained using patient doses (i.e., Dorgan and E). For head CT scans, 140 kV offered the lowest patient doses as well as the highest CNR, whereas in abdominal scans 80 kV was optimal. Use of an optimal kV for CT imaging over current practice of using 120 kV might reduce patient doses by 10-15%, or improve CNR by 5-10%. Assuming that the risk was proportional to En made no difference to the optimal kV for positive values of n up to 2. We conclude that (a) CT optimization with respect to kV should generally be performed with respect to the patient effective dose, (b) neither CTDIair nor the body CTDIw are appropriate for use in CT optimization, (c) the range of current radiation risk models should not affect the optimal kV value in CT imaging.

Assessment of the problem: pediatric doses in screen-film and digital radiography.

In diagnostic radiology, radiation exposure measures the amount of radiation at a given location in an x-ray beam, dose measures the energy deposited in a specified absorber, and equivalent dose quantifies the biological harm expected from this deposited energy. The effective dose attempts to account for the energy deposited in all irradiated organs as well as their relative radiosensitivity, and is the best available descriptor of the stochastic patient risk. Effective doses can be estimated from measures of the radiation beam incident on the patient as either entrance skin dose or dose-area product in conjunction with appropriate conversion coefficients. These effective dose-conversion coefficients are influenced by the patient size, exposed body region, x-ray beam quality, and x-ray beam area. We present values of skin dose, dose-area product, and effective dose for common examinations in pediatric patients whose size ranges from the newborn to adolescents. In screen-film radiography, the system speed defines the amount of radiation required to generate a satisfactory radiographic film density. Changing the screen thickness normally modifies the speed of screen-film systems, which affects the system resolution but not the level of image noise (mottle). By contrast, digital systems have a fixed resolution but can operate satisfactorily over a wide range of receptor dose, with the amount of noise in the resultant image being inversely related to the amount of radiation used. To ensure that patient doses are kept as low as reasonably achievable (ALARA), it is essential that digital receptor doses be monitored to ensure they stay constant. It is also important that protocols in digital radiography are specific for the imaging task to be performed, and use no more radiation than needed to achieve a satisfactory diagnosis.

Radiation exposure and image quality in chest CT examinations.

OBJECTIVE: The purpose of this study was to determine how changes in radiographic tube current affect patient dose and image quality in unenhanced chest CT examinations. SUBJECTS AND METHODS: Ten sets of CT images were obtained from patients undergoing CT-guided chest biopsies. For each patient, six images of the same region were obtained at settings between 40 and 280 mAs. CT data were used to reconstruct tomographic sections with a field of view limited to the normal contralateral lung. Images were printed using lung and mediastinal image display settings. Image quality was determined by asking radiologists to assess the perceived level of mottle in CT images. Five chest radiologists ranked the relative image quality of six images. Patient effective doses were computed for chest CT examinations performed at each milliampere-second setting. Radiologists indicated whether any perceived improvement of image quality at the higher radiation exposures was worth the additional radiation dose. RESULTS: The differences in quality of chest CT images generated at greater than or equal to 160 mAs were negligible. Reducing the radiographic technique factor below 160 mAs resulted in a perceptible reduction in image quality. Differences in CT image quality for radiographic techniques between 120 and 280 mAs were deemed to be insufficient to justify any additional patient exposure. However, the use of 40 mAs results in an inferior image quality that would justify increased patient exposure. CONCLUSION: Radiographic techniques for unenhanced chest CT examinations can be reduced from 280 to 120 mAs without compromising image quality.

Radiation doses to infants and adults undergoing head CT examinations.

For routine noncontrast CT examinations of the head, we compared the radiation doses of infant patients aged no more than two years old, with those of "adults" defined as any patient whose weight was greater than 40 kg. Data were obtained for 23 infants, and an equal number of "adults," who underwent CT head examinations between May 1997 and March 1998. Patient CT data acquired included the x-ray tube potential (kVp), mAs, section thickness, and total number of sections. For radiation dosimetry purposes, the head was modeled as a uniform cylinder of water using patient size data obtained from a representative cross-sectional image. CT techniques and patient size data permitted the computation of the mean section doses in the head region, total energy imparted, and the corresponding effective doses. All CT scans were performed at 120 kVp, with an average current-exposure time product of 271 +/- 73 and 340 +/- 0 mAs for infants and "adults," respectively. The radius of the water cylinder used to model the patient head increased from 58 mm for 4 kg newborns to 70 mm for 8 kg infants. For "adults," there was little correlation between the weight of the patient and the mean water equivalent radius of 88 mm (r2 = 0.14). Mean section doses were 44.4 +/- 11.1 mGy for infants, and 44.2 +/- 1.5 mGy for "adults." The energy imparted to infants correlated with patient weight (r2= 0.35) much more than did that of "adults" (r2= 0.02). The average infant energy imparted (66.4 +/- 28.7 mJ) was approximately half the value obtained for "adults" (140 +/- 10 mJ). The average effective dose to the infants (7.6 +/- 3.1 mSv), however, was approximately six times higher than that for "adults" (1.3 +/- 0.1 mSv). There was no significant correlation between patient effective dose and patient mass for either the infant (r2 = 0.12) or the "adult" group of patients (r2= 0.02). Infant doses varied much more than "adult" doses, primarily because of a wider range of x-ray technique factors selected and secondarily due to the variation in infant head size. The observed variability in the computed radiation dose parameters indicates that it should be possible to reduce infant doses routinely in head CT examinations without any adverse effect on diagnostic imaging performance. For such routine head CT scans, the average dose reduction for infants weighing between 4 and 8 kg would be expected to range between 40% and 60%.

Technique factors and image quality as functions of patient weight at abdominal CT.

PURPOSE: To investigate how changes in kilovolt peak and milliampere second settings, and patient weight affect transmitted x-ray energy fluence and the image contrast-to-noise ratio (CNR) at abdominal computed tomography (CT). MATERIALS AND METHODS: Cylinders of water were used as patient models, and x-ray spectra, including x-ray tube potentials of 80-140 kVp, were investigated. The mean photon energy and energy fluence transmitted through water cylinders with varying diameters and the image contrast for fat, muscle, bone, and iodine relative to water were determined. The effect of changing the x-ray tube potential on CNR also was investigated. RESULTS: At a constant kVp, increasing patient weight from 10 kg to 120 kg reduced the transmitted energy fluence by two orders of magnitude. Changing the x-ray tube potential from 80 kVp to 140 kVp increased the mean photon energy from approximately 52 keV to approximately 72 keV and thus reduced the image contrast relative to water by 12% for muscle, 21% for fat, 39% for bone, and 50% for iodine (approximate reduction values). Increasing the x-ray tube potential from 80 kVp to 140 kVp increased the CNR by a factor of 2.6 for muscle and by a factor of 1. 4 for iodine. CONCLUSION: With changes in patient weight at abdominal CT, x-ray tube potentials must be varied to maintain a constant detector energy fluence. Increasing the x-ray tube potential generally improves CNR.

Radiation doses to patients undergoing scoliosis radiography.

In this study we computed the radiation doses associated with scoliosis radiography and investigated how these radiation doses are influenced by the weight of the patient. We recorded the radiographic technique factors of 61 consecutive patients (46 females and 15 males) undergoing scoliosis radiography. A wedge-shaped aluminium filter attenuated the X-ray beam in the "chest region" relative to the "abdomen region". X-ray tube air kerma output factors (microGy mAs-1) and half value layers (HVLs) were determined experimentally for the "chest region" and "abdomen region". The energy imparted to each patient was computed from the air kerma area product, X-ray beam HVL and measured patient thickness. Values of patient effective dose were obtained using effective dose-to-energy conversion factors for specified radiographic projections, taking into account each patient's weight. The median patient age was 17 years, and the median patient weight was 53 kg. Entrance skin air kerma values in the "chest region" were approximately a factor of four lower than those in the "abdomen region". The air kerma values increased by a factor of two when the patient weight increased from 30 kg to 70 kg. Approximately 80% of the total energy imparted to a patient undergoing a scoliosis examination was in the "abdomen region", with the remaining 20% imparted to the "chest region". Energy imparted increased with patient weight, and was approximately 3 mJ for a 30 kg patient and approximately 8 mJ for a 70 kg adult patient. Effective doses showed little correlation with patient weight, with an average-sized patient (50 kg) receiving an effective dose of approximately 140 microSv. Patients undergoing scoliosis radiography receive effective doses that are low in comparison with other types of radiographic examination.

Effective doses to patients undergoing thoracic computed tomography examinations.

The purpose of this study was to investigate how x-ray technique factors and effective doses vary with patient size in chest CT examinations. Technique factors (kVp, mAs, section thickness, and number of sections) were recorded for 44 patients who underwent a routine chest CT examination. Patient weights were recorded together with dimensions and mean Hounsfield unit values obtained from representative axial CT images. The total mass of directly irradiated patient was modeled as a cylinder of water to permit the computation of the mean patient dose and total energy imparted for each chest CT examination. Computed values of energy imparted during the chest CT examination were converted into effective doses taking into account the patient weight. Patient weights ranged from 4.5 to 127 kg, and half the patients in this study were children under 18 years of age. All scans were performed at 120 kVp with a 1 s scan time. The selected tube current showed no correlation with patient weight (r2=0.06), indicating that chest CT examination protocols do not take into account for the size of the patient. Energy imparted increased with increasing patient weight, with values of energy imparted for 10 and 70 kg patients being 85 and 310 mJ, respectively. The effective dose showed an inverse correlation with increasing patient weight, however, with values of effective dose for 10 and 70 kg patients being 9.6 and 5.4 mSv, respectively. Current CT technique factors (kVp/mAs) used to perform chest CT examinations result in relatively high patient doses, which could be reduced by adjusting technique factors based on patient size.

Binocular three-dimensional perception through stereoscopic generation from rotating images.

RATIONALE AND OBJECTIVES: The authors evaluated the clinical utility and potential applications of a binocular three-dimensional (3D) image display in diagnostic radiology. MATERIALS AND METHODS: Rotating video displays of computed tomographic (CT), magnetic resonance (MR) angiographic, and digital subtraction angiographic (DSA) image data were used to generate stereoscopic image displays with a 3D appearance. Eight physicians viewed and scored eight skeletal and eight vascular-interventional studies with a planar display mode and a cathode ray tube. Each physician then viewed the 3D display of the same data and assessed the change in image findings, as well as any corresponding changes in level of diagnostic confidence. RESULTS: Image findings changed in 78 (61%) of the 128 studies after viewing the 3D displays. In 94 (73%) of all 128 studies, the interpreters reported increased confidence in their perception of the findings. Results for the vascular-interventional and skeletal cases were generally very similar. CONCLUSION: Binocular 3D stereoscopic displays from rotating images were reported to provide better image conceptualization and a higher degree of confidence in the findings on the images.

Image mottle in abdominal CT.

RATIONALE AND OBJECTIVES: To investigate image mottle in conventional CT images of the abdomen as a function of radiographic technique factors and patient size. METHODS: Water-filled phantoms simulating the abdomens of adult (32 cm in diameter) and pediatric (16 cm in diameter) patients were used to investigate image mottle in CT as a function of x-ray tube potential and mAs. CT images from 39 consecutive patients with noncontrast liver scans and 49 patients with iodine contrast scans were analyzed retrospectively. Measurements were made of the mean liver parenchyma Hounsfield unit value and the corresponding image mottle. RESULTS: For a given water phantom and x-ray tube potential, image mottle was proportional to the mAs-0.5. Increasing the phantom diameter from 16 cm (pediatric) to 32 cm increased the mottle by a factor of 2.4, and increasing the x-ray tube potential from 80 kVp to 140 kVp reduced the mottle by a factor of 2.5. All patients were scanned at 120 kVp, with no correlation between patient size and the x-ray tube mAs. The mean mottle level was 7.8 +/- 2.2 and 10.0 +/- 2.5 for the noncontrast and contrast studies, respectively. An increase in patient diameter of 3 cm would require approximately 65% more mAs to maintain the same level of image mottle. CONCLUSIONS: The mottle in abdominal CT images may be controlled by adjusting radiographic technique factors, which should be adjusted to take into account the size of the patient undergoing the examination.

Radiation effective doses to patients undergoing abdominal CT examinations.

PURPOSE: To determine the radiation effective dose to adult and pediatric patients undergoing abdominal computed tomographic (CT) examinations. MATERIALS AND METHODS: Technique factors were obtained for three groups of randomly selected patients undergoing abdominal CT examinations: 31 children aged 10 years or younger; 32 young adults aged 11-18 years; and 36 adults older than 18 years. The radiographic techniques, together with the measured cross sections of patients, were used to estimate the total energy imparted to each patient. Each value of energy imparted was subsequently converted into the corresponding effective dose to the patient, taking into account the mass of the patient. RESULTS: All abdominal CT examinations were performed at 120 kVp with a section thickness of approximately 7 mm for all sizes of patients. The mean number of CT sections increased from 22.0 for children to 31.5 for adults, and the mean quantity of x radiation in milliampere-seconds increased from 220 mAs for children to 290 mAs for adults. The mean values (+/- SD) of energy imparted were 72.1 mJ +/- 24.4 for children, 183.5 mJ +/- 44.8 for young adults, and 234.7 mJ +/- 89.4 for adults. The corresponding mean values of patient effective dose were 6.1 mSv +/- 1.4 for children, 4.4 mSv +/- 1.0 for young adults, and 3.9 mSv +/- 1.1 for adults. CONCLUSION: Values of energy imparted to patients undergoing abdominal CT examinations were a factor of three higher in adults than in children, but the corresponding patient effective doses were 50% higher in children than in adults.

View box luminance measurements and their effect on reader performance.

RATIONALE AND OBJECTIVES: The purpose of this study was to investigate the importance of view box luminance and viewing conditions on low-contrast detection by readers. MATERIALS AND METHODS: Radiographs of a mammographic contrast-detail phantom were examined on 632 view box panels. The luminance of these panels was obtained by using a calibrated meter and ranged from 860 to 3,300 nit. Twelve radiologists reported the number of contrast-detail disks for each size (diameter, 0.3-7.0 mm) deemed to be visible on films with optical densities of 1.00-2.60. Radiologist performance in reading low-contrast phantom images was also studied as a function of room illuminance and image masking. RESULTS: Median luminance was 1,700 nit, with 25- and 75-percentile values of 1,450 and 2,150 nit, respectively. Low-contrast visibility generally was independent of view box luminance, regardless of film density or disk diameter. Low-contrast visibility deteriorated when masking around the image was removed and at normal room illuminance. The greatest deterioration in performance occurred at the highest film densities and with the smallest size disks. CONCLUSION: Detection of low-contrast features on radiographs is relatively independent of view box luminance, but it is degraded by the presence of stray light and by increased room illuminance.

Radiation dosimetry for extremity radiographs.

The energy imparted, epsilon, to a patient undergoing an extremity x-ray examination may be obtained from the dose-area product incident on the patient. Values of energy imparted can be subsequently converted into the corresponding effective dose, E, using an extremity specific E/epsilon ratio. In this study, an E/epsilon ratio of 3 mSv/J was used to convert values of energy imparted into the corresponding upper limit of adult effective doses for all types of extremity examinations. A modification factor, based on the patient mass, was employed to determine the corresponding extremity effective doses to pediatric patients undergoing extremity examinations. Representative clinical technique factors for six common extremity examinations (hand, forearm, elbow, ankle, tibia/fibula, knee) were used to determine the dose-area product and the corresponding values of energy imparted. For adult extremity x-ray examinations, values of energy imparted ranged from 55 microJ to 920 microJ, with the energy imparted to 1-y-old patients being a factor of about 20 lower. Upper limits of effective doses for adult extremity x-ray examinations ranged from 0.17 to 2.7 microSv, whereas the corresponding doses to 1-y-old patients were about a factor of three lower.

Scattered radiation in scanning slot mammography.

Monte Carlo simulations were used to quantify the amount of scattered radiation a scanning slot detector geometry designed for use in digital mammography. Ratios of the scatter to primary (S/P) x-ray photon energy absorbed in the detector were obtained for a Lucite phantom, and were investigated as a function of photon energy, phantom thickness, and slot detector width. Over a Lucite phantom thickness range of 2-6 cm, the S/P ratios range from about 0.10 to 0.17 for a 4 mm wide slot detector at the x-ray photon energies used in mammography. These ratios increased by a factor of approximately 1.8 when the slot width was increased to 10 mm. In general, 20 keV photons gave S/P ratios similar to those of a 30 kVp x-ray spectrum (Mo target + 30 microns Mo filtration). The use of a 3 cm air gap reduced the S/P ratios by a factor of between 2.5 and 3.4, depending on the phantom thickness. For a constant primary energy fluence, coherent scatter was reduced as photon energy increased, whereas Compton scatter increased with increasing photon energy. With no air gap, the contributions of coherent and Compton scatter were found to be equal at 25 keV, whereas the introduction of a 3 cm air gap resulted in equal contributions for the two scatter processes at 36 keV. A 10 mm wide slot detector consisting of a 36.7 mg/cm2 thick Gd2O2S:Tb phosphor screen was compared to an ideal detector absorbing all incident primary/scatter photons. Average differences in the S/P ratios for these two detectors were 7% with no air gap and approximately 4% with a 3 cm air gap. The results obtained in this study will assist in the design of an optimal slot detector for use in digital mammography.