Automated development of the contrast-detail curve based on statistical low-contrast detectability in CT images.

PURPOSE: We have developed a software to automatically find the contrast-detail (C-D) curve based on the statistical low-contrast detectability (LCD) in images of computed tomography (CT) phantoms at multiple cell sizes and to generate minimum detectable contrast (MDC) characteristics. METHODS: A simple graphical user interface was developed to set the initial parameters needed to create multiple grid region of interest of various cell sizes with a 2-pixel increment. For each cell in the grid, the average CT number was calculated to obtain the standard deviation (SD). Detectability was then calculated by multiplying the SD of the mean CT numbers by 3.29. This process was automatically repeated as many times as the cell size was set at initialization. Based on the obtained LCD, the C-D curve was obtained and the target size at an MDC of 0.6% (i.e., 6-HU difference) was determined. We subsequently investigated the consistency of the target sizes for a 0.6% MDC at four locations within the homogeneous image. We applied the software to images with six noise levels, images of two modules of the American College of Radiology CT phantom, images of four different phantoms, and images of four different CT scanners. We compared the target sizes at a 0.6% MDC based on the statistical LCD and the results from a human observer. RESULTS: The developed system was able to measure C-D curves from different phantoms and scanners. We found that the C-D curves follow a power-law fit. We found that higher noise levels resulted in a higher MDC for a target of the same size. The low-contrast module image had a slightly higher MDC than the distance module image. The minimum size of an object detected by visual observation was slightly larger than the size using statistical LCD. CONCLUSIONS: The statistical LCD measurement method can generate a C-D curve automatically, quickly, and objectively.

Dose estimation for cone-beam computed tomography in image-guided radiation therapy using mesh-type reference computational phantoms and assuming head and neck cancer.

This study aimed to estimate the additional dose the cone-beam computed tomography (CBCT) system integrated into the Varian TrueBeam linear accelerator delivers to a patient with head and neck cancer using mesh-type International Commission on Radiological Protection reference computational phantoms. In the first part, for use as a benchmark for the accuracy of the Monte Carlo geometry of CBCT, Particle and Heavy Ion Transport code System (PHITS) calculations were confirmed against measured lateral and depth dose profiles using a computed tomography dose profiler. After obtaining good agreement, organ dose calculations were performed by PHITS using mesh-type reference computational phantom (MRCP) and irradiating the neck region; the effective dose was calculated utilising absorbed organ doses and tissue weighting factors for male and female MRCP. Substantially, it has been found that the effective doses for male and female MRCP are 0.81 and 1.06 mSv, respectively. As this study aimed to assess the imaging dose from the CBCT system used in image-guided radiation therapy, it is required to take into account this dose in terms of both the target organ and surrounding tissues. Although the absorbed organ dose values and effective dose values obtained for both MRCP males and females were small, attention should be paid to the additional dose resulting from CBCT. This study can create awareness on the importance of doses arising from imaging techniques, especially CBCT.

Development and evaluation of the effectiveness of educational material for radiological protection that uses augmented reality and virtual reality to visualise the behaviour of scattered radiation.

Understanding the behaviour of scattered radiation is important for learning appropriate radiation protection methods, but many existing visualisation systems for radiation require special devices, making it difficult to use them in education. The purpose of this study was to develop teaching material for radiation protection that can help visualise the scattered radiation with augmented reality (AR) and virtual reality (VR) on a web browser, develop a method for using it in education and examine its effectiveness. The distribution of radiation during radiography was calculated using Monte Carlo simulation, and teaching material was created. The material was used in a class for department of radiological technology students and its influence on motivation was evaluated using a questionnaire based on the evaluation model for teaching materials. In addition, text mining was used to evaluate impressions objectively. Educational material was developed that can be used in AR and VR for studying the behaviour of scattered radiation. The results of the questionnaire showed that the average value of each item was more than four on a five-point scale, indicating that the teaching material attracted the interest of users. Through text mining, it could be concluded that there was improved understanding of, and confidence in, radiation protection.

Radiation protection education using virtual reality for the visualisation of scattered distributions during radiological examinations.

When working in radiology and patient assistance in medical facilities, radiation workers need to understand how to properly protect themselves and others from scattered radiation. In this study, a visualisation method is examined to facilitate the understanding of the spread of scattered radiation in radiography, computerised tomography (CT), and angiography rooms, and the application of this system for radiation protection education is proposed. X-ray radiography, x-ray CT, and angiography rooms were constructed using the particle and heavy ion transport code system, and the scattered radiation distributions that occurred when a patient was irradiated with x-rays were simulated. The three-dimensional (3D) distribution of each moment was continuously displayed to create a four-dimensional (4D) distribution. Using the obtained data, a radiation protection education seminar was conducted that included exercises to allow the students to confirm the presence of scattered radiation from any direction. The effectiveness of the scattered radiation visualisation data was evaluated using an interview. The position of the assistant for conducting standing chest radiographs that experienced the least scattered radiation was determined to be at the side and foot side of the patient. As a result of an interview that was provided to the participants following the seminar, the effectiveness of this system for providing education about radiation protection was confirmed. The visualisation method allowed the students to better understand the behaviour of radiation and the sources of scattered radiation. The visualisation of 3D and 4D scattered radiation distributions in radiological examination rooms can intuitively enhance the understanding of the spread of invisible radiation and the appropriate methods of mitigating radiation exposure.

Development of an application to visualise the spread of scattered radiation in radiography using augmented reality.

As radiation is widely used in medical institutions, the lack of radiation protection education for health workers increases the risk of radiation exposure. The purpose of this study is to develop an application for radiation medical personnel that visualises the distribution of scattered radiation by using augmented reality (AR). The irradiation conditions for mobile chest and pelvic radiography were simulated using Monte Carlo simulations (Particle and Heavy Ion Transport code System). Monte Carlo results were verified using physical measurements. The behaviour of scattered radiation was displayed three-dimensionally in virtual reality using ParaView. Subsequently, an application to visualise scattered rays was developed in Unity for tablet devices. An application with a sense of reality was developed by visualising the scattered radiation distribution of a mobile imaging in a real space in AR in a three-dimensional size, which is close to the actual size. The radiation dose could be estimated at any position and the behaviour of scattered radiation became easier to understand.

Comparison of central, peripheral, and weighted size-specific dose in CT.

The objective of this study is to determine X-ray dose distribution and the correlation between central, peripheral and weighted-centre peripheral doses for various phantom sizes and tube voltages in computed tomography (CT). We used phantoms developed in-house, with various water-equivalent diameters (Dw) from 8.5 up to 42.1 cm. The phantoms have one hole in the centre and four holes at the periphery. By using these five holes, it is possible to measure the size-specific central dose (Ds,c), peripheral dose (Ds,p), and weighted dose (Ds,w).The phantoms are scanned using a CT scanner (Siemens Somatom Definition AS), with the tube voltage varied from 80 up to 140 kVps. The doses are measured using a pencil ionization chamber (Ray safe X2 CT Sensor) in every hole for all phantoms. The relationships between Ds,c, Ds,p, and Ds,w, and the water-equivalent diameter are established. The size-conversion factors are calculated. Comparisons between Ds,c, Ds,p, and Ds,ware also established. We observe that the dose is relatively homogeneous over the phantom for water-equivalent diameters of 12-14 cm. For water-equivalent diameters less than 12 cm, the dose in the centre is higher than at the periphery, whereas for water-equivalent diameters greater than 14 cm, the dose at the centre is lower than that at the periphery. We also find that the distribution of the doses is influenced by the tube voltage. These dose distributions may be useful for calculating organ doses for specific patients using their CT images in future clinical practice.

An evaluation of computed tomography dose index measurements using a pencil ionisation chamber and small detectors.

The aim of this study was to compare the values of the computed tomography dose index 100 (CTDI100) obtained using two small detectors (i.e. a small ionisation chamber and a small solid state detector) with those obtained from a 100 mm pencil ionisation chamber for various input CT parameters: beam width, kVp, mAs, pitch, and head-body phantom variation. The measurement of CTDI100 using the 100 mm pencil chamber was carried out in a single rotation of axial mode, while the measurement using small detectors was carried out in helical mode. The differences of CTDI100 values obtained with two small detectors were about 7% for all variations. The differences of CTDI100 values obtained with small detectors and a 100 mm pencil ionisation chamber for beam widths of more than 4 mm were within 40%. However, for the narrowest beam widths (4 mm), the difference between them was very large (about 150%).

Development of a novel artifact-free eye shield based on silicon rubber-lead composition in the CT examination of the head.

The aim of this work was to develop a novel artifact-free eye shield and evaluate its effect on the dose received by the eye lens and the resulting image quality in the CT examination of the head. A new material for an eye shield was synthesised from silicon rubber (SR) and lead (Pb) using a simple method. The percentage of Pb was varied from 0 to 5% wt. An anthropomorphic head phantom was scanned with and without the SR-Pb eye shield, and compared with a tungsten paper (WP) eye shield. The distance from the eye shield and head was varied from 0 to 5 cm. The dose to the eye lens was measured using photo-luminescence detectors (PLDs). The presence of artifacts was determined by measuring CT numbers at different eye lens locations and by subtracting images with and without the eye shield. The dose reduction increases with increasing Pb content in the SR-Pb eye shield. A 5% wt SR-Pb eye shield reduced the eye lens dose by up to 50%, whereas the WP eye shield reduced the dose by up to 86%. The CT numbers in images with the SR-Pb eye shield in the regions of both eyes and the center of the head phantom is similar to those without the eye shield, indicating that there is no artifact in the resulting image. Using the WP eye shield, there is considerable artifact with the CT number increasing by up to 700% in the regions of both eyes and the center of the head. It is found that the distance between the SR-Pb eye shield and the head does not affect either the dose or the resulting images. A SR-Pb-based eye shield can be applied in clinical environments and should be placed directly above the eye surface for dose optimisation.

Assessment of patient dose and noise level of clinical CT images: automated measurements.

We investigated comparisons between patient dose and noise in pelvic, abdominal, thoracic and head CT images using an automatic method. 113 patient images (37 pelvis, 34 abdominal, 25 thoracic, and 17 head examinations) were retrospectively and automatically examined in this study. Water-equivalent diameter (Dw), size-specific dose estimates (SSDE) and noise were automatically calculated from the center slice for every patient image. The Dw was calculated based on auto-contouring of the patients' edges, and the SSDE was calculated as the product of the volume CT dose index (CTDIvol) extracted from the Digital Imaging and Communications in Medicine (DICOM) header and the size conversion factor based on the Dw obtained from AAPM 204. The noise was automatically measured as a minimum standard deviation in the map of standard deviations. A square region of interest of about 1 cm2 was used in the automated noise measurement. The SSDE values for the pelvis, abdomen, thorax, and head were 21.8 ± 7.3 mGy, 22.0 ± 4.5 mGy, 21.5 ± 4.7 mGy, and 65.1 ± 1.7 mGy, respectively. The SSDEs for the pelvis, abdomen, and thorax increased linearly with increasing Dw, and for the head with constant tube current, the SSDE decreased with increasing Dw. The noise in the pelvis, abdomen, thorax, and head were 5.9 ± 1.5 HU, 5.2 ± 1.4 HU, 4.9 ± 0.8 HU and 3.9 ± 0.2 HU, respectively. The noise levels for the pelvis, abdomen, and thorax of the patients were relatively constant with Dw because of tube current modulation. The noise in the head image was also relatively constant because Dw variations in the head are very small. The automated approach provides a convenient and objective tool for dose optimizations.

[Examination of Application to Radiation Protection Education by Four-dimensional Visualization of Scatter Distribution in Radiological Examination Using Virtual Reality].

PURPOSE: When working on fluoroscopy and patient assistance in a healthcare facility, workers need to understand how to properly protect scattered radiation. In this study, we examined a four-dimensional visualization method to make it easy to understand the spread of scattered radiation visually, and proposed its application to radiation protection education. METHODS: We constructed the X-ray room, X-ray CT room, and angiography room using Particle Heavy Ion Transport code System (PHITS), and calculated the scattered radiation distribution when the patient was irradiated with X-rays. The three-dimensional distribution of each moment was continuously displayed to create a four-dimensional distribution. Using the created data, we conducted radiation protection education including exercises to make the students confirm the scatter distribution from any direction. The effectiveness of the scattered radiation visualization data was evaluated by a questionnaire. RESULTS: The position of assistance for standing chest radiograph was less scattered radiation at the side and below the patient. As a result of the questionnaire, this education has confirmed the effect of attracting attention about radiation protection. The fourdimensional visualization allowed students to understand the behavior of radiation and the source of scattered radiation. CONCLUSION: Visualization of three- and four-dimensional scattered radiation distribution in the radiological examination room can intuitively enhance the understanding of the invisible radiation spread and appropriate aids.

An algorithm for automated modulation transfer function measurement using an edge of a PMMA phantom: Impact of field of view on spatial resolution of CT images.

PURPOSE: The purpose of this study was to introduce a new algorithm for automated measurement of the modulation transfer function (MTF) using an edge of a readily available phantom and to evaluate the effect of reconstruction filter and field of view (FOV) on the spatial resolution in the CT images. METHODS: Our automated MTF measurement consisted of several steps. The center of the image was established and an appropriate region of interest (ROI) designated. The edge spread function (ESF) was determined, and a suitably interpolated ESF curve was differentiated to obtain the line spread function (LSF). The LSF was Fourier transformed to obtain the MTF. All these steps were accomplished automatically without user intervention. The results of the automated MTF from the edge phantom were validated by comparing them with a point image, and the results of the automated calculation were validated by the standard fitting method. The automated MTF calculation was then applied to the images of two polymethyl methacrylate (PMMA) phantoms and a wire phantom which had been scanned by a Toshiba Alexion 4-slice CT scanner and reconstructed with various filter types and FOVs. RESULTS: The difference in the 50% MTF values obtained from the edge and point phantoms were within ±4%. The values from the automated and fitted methods agreed to within ±2%, indicating that the automated MTF calculation was accurate. The automated MTF calculation was able to differentiate MTF curves for various filters. The spatial resolution values were 0.37 ± 0.00, 0.71 ± 0.01, and 0.78 ± 0.01 cycles/mm for FC13, FC30 and FC52 filters, respectively. The spatial resolution of the images decrease linearly (R2  > 0.98) with increasing FOVs. CONCLUSION: An automated MTF method was successfully developed using an edge phantom, the PMMA phantom. The method is easy to implement in a clinical environment and is not influenced by user experience.

[Effective Techniques to Reduce Radiation Exposure to Medical Staff during Assist of X-ray Computed Tomography Examination].

Medical staffs like radiological technologists, doctors, and nurses are at an increased risk of exposure to radiation while assisting the patient in a position or monitor contrast medium injection during computed tomography (CT). However, methods to protect medical staff from radiation exposure and protocols for using radiological protection equipment have not been standardized and differ among hospitals. In this study, the distribution of scattered X-rays in a CT room was measured by placing electronic personal dosimeters in locations where medical staff stands beside the CT scanner gantry while assisting the patient and the exposure dose was measured. Moreover, we evaluated non-uniform exposure and revealed effective techniques to reduce the exposure dose to medical staff during CT. The dose of the scattered X-rays was the lowest at the gantry and at the examination table during both head and abdominal CT. The dose was the highest at the trunk of the upper body of the operator corresponding to a height of 130 cm during head CT and at the head corresponding to a height of 150 cm during abdominal CT. The maximum dose to the crystalline lens was approximately 600 µSv during head CT. We found that the use of volumetric CT scanning and X-ray protective goggles, and face direction toward the gantry reduced the exposure dose, particularly to the crystalline lens, for which lower equivalent dose during CT scan has been recently recommended in the International Commission on Radiological Protection Publication 118.

Decontamination of the Activation Product Based on a Legal Revision of the Cyclotron Vault Room on the Non-self-shield Compact Medical Cyclotron.

The non-self-shield compact medical cyclotron and the cyclotron vault room were in operation for 27 years. They have now been decommissioned. We efficiently implemented a technique to identify an activation product in the cyclotron vault room. Firstly, the distribution of radioactive concentrations in the concrete of the cyclotron vault room was estimated by calculation from the record of the cyclotron operation. Secondly, the comparison of calculated results with an actual measurement was performed using a NaI scintillation survey meter and a high-purity germanium detector. The calculated values were overestimated as compared to the values measured using the NaI scintillation survey meter and the high-purity germanium detector. However, it could limit the decontamination area. By simulating the activation range, we were able to minimize the concrete core sampling. Finally, the appropriate range of radioactivated area in the cyclotron vault room was decontaminated based on the results of the calculation. After decontamination, the radioactive concentration was below the detection limit value in all areas inside the cyclotron vault room. By these procedures, the decommissioning process of the cyclotron vault room was more efficiently performed.

[Evaluation of an Experimental Production Wireless Dose Monitoring System for Radiation Exposure Management of Medical Staff].

Because of the more advanced and more complex procedures in interventional radiology, longer treatment times have become necessary. Therefore, it is important to determine the exposure doses received by operators and patients. The aim of our study was to evaluate an experimental production wireless dose monitoring system for pulse radiation in diagnostic X-ray. The energy, dose rate, and pulse fluoroscopy dependence were evaluated as the basic characteristics of this system for diagnostic X-ray using a fully digital fluoroscopy system. The error of 1 cm dose equivalent rate was less than 15% from 35.1 keV to 43.2 keV with energy correction using metal filter. It was possible to accurately measure the dose rate dependence of this system, which was highly linear until 100 µSv/h. This system showed a constant response to the pulse fluoroscopy. This system will become useful wireless dosimeter for the individual exposure management by improving the high dose rate and the energy characteristics.

[Verification of the protective effect of a testicular shield in postoperative radiotherapy for seminoma].

In postoperative radiotherapy for seminoma, control of the testicular absorbed dose is important, since exposure of the testis can lead to temporary or permanent infertility. In this case, instead of using a dog-leg-shaped field, treatment using a field focused near the aorta was provided in several disease stages of seminoma. However, the precise need for testicular shielding during treatment and dose of testis exposure was not clear. We examined these questions by measuring the testicular absorbed dose with and without a testicular shield using two clinical treatment plans and a phantom. The distance from the testis phantom and the lower end of the irradiation field was varied. Where the total dose for the tumor was 20 Gy, the testicular absorbed dose was below 0.1 Gy, the threshold dose for temporary infertility. At this dosage, the distance between the testis phantom and the edge of the irradiation field was 14.6 cm without the shield and 9.99 cm with the shield. Using a testes shield, it was thus possible to reduce the dose by 58.5%.

Developing simulation-based learning application for radiation therapy students at pre-clinical stage.

INTRODUCTION: Simulation-based education has been particularly valuable as a preclinical training method that adequately prepares students for clinical practice, including simulation in educational programs enhances the quality of learning outcomes. However, relevant previous research has exhibited several crucial limitations, with most of them having focused solely on the setup procedures. This study aimed to outline the development of an educational application in radiationtherapy and emphasizes the essential factors that radiation therapist technologists(RTTs) must consider in the treatment room from the perspective of experienced RTTs. METHOD: We connected the virtual pendants to the linear accelerator components using C# programming and Unity. Customized scripts were assigned to specific linear accelerator (LINAC) functions, and the patient and RTT avatars were developed. We also included audio feedback for the realistic gantry movement sounds. RESULT: This study outlines various aspects of radiotherapy procedures duringtreatment, such as the simulation of patient positioning, treatment fields, and pendantfunctions, aimed toward enabling the effective use of virtual reality technology inradiation therapy. DISCUSSION: This study explores the potential of an avatar-based app for radiotherapy education, providing foundational data for future trials. CONCLUSION: Simulation learning is the most advantageous pre-clinical instrument for equipping students with the skills necessary for clinical practice. This study's resultsare expected to facilitate radiotherapy students' adoption of clinical replacement applications and improve collaborative partnerships and knowledge sharing. Notably, this application complements traditional learning methods, further enhancing the overall educational experience.

Directional vector visualization of scattered rays in mobile c-arm fluoroscopy.

Previous radiation protection-measure studies for medical staff who perform X-ray fluoroscopy have employed simulations to investigate the use of protective plates and their shielding effectiveness. Incorporating directional information enables users to gain a clearer understanding of how to position protective plates effectively. Therefore, in this study, we propose the visualization of the directional vectors of scattered rays. X-ray fluoroscopy was performed; the particle and heavy-ion transport code system was used in Monte Carlo simulations to reproduce the behavior of scattered rays in an X-ray room by reproducing a C-arm X-ray fluoroscopy system. Using the calculated results of the scattered-ray behavior, the vectors of photons scattered from the phantom were visualized in three dimensions. A model of the physician was placed on the directional vectors and dose distribution maps to confirm the direction of the scattered rays toward the physician when the protective plate was in place. Simulation accuracy was confirmed by measuring the ambient dose equivalent and comparing the measured and calculated values (agreed within 10%). The directional vectors of the scattered rays radiated outward from the phantom, confirming a large amount of backscatter radiation. The use of a protective plate between the patient and the physician's head part increased the shielding effect, thereby enhancing radiation protection for the physicians compared to cases without the protective plate. The use of directional vectors and the surrounding dose-equivalent distribution of this method can elucidate the appropriate use of radiation protection plates.

Simulating the head of a TrueBeam linear particle accelerator and calculating the photoneutron spectrum on the central axis of a 10-MV photon using particle and heavy-ion transport system code.

Photon energy is higher than the (γ,n) threshold, allowing it to interact with the nuclei of materials with high z properties and liberate fast neutrons. This represents a potentially harmful source of radiation for humans and the environment. This study validated the Monte Carlo simulation, using the particle and heavy-ion transport code system (PHITS) on a TrueBeam 10-MV linear particle accelerator's head shielding model and then used this PHITS code to simulate a photo-neutron spectrum for the transport of the beam. The results showed that, when comparing the simulated to measured PDD and crosslines, 100% of the γ-indexes were <1 (γ3%/3mm) for both simulations, for both phase-space data source and a mono energy source. Neutron spectra were recorded in all parts of the TrueBeam's head, as well as photon neutron spectra at three points on the beamline.

A Practical Method for Slice Spacing Measurement Using the American Association of Physicists in Medicine Computed Tomography Performance Phantom.

Background: The slice spacing has a crucial role in the accuracy of computed tomography (CT) images in sagittal and coronal planes. However, there is no practical method for measuring the accuracy of the slice spacing. Purpose: This study proposes a novel method to automatically measure the slice spacing using the American Association of Physicists in Medicine (AAPM) CT performance phantom. Methods: The AAPM CT performance phantom module 610-04 was used to measure slice spacing. The process of slice spacing measurement involves a pair of axial images of the module containing ramp aluminum objects located at adjacent slice positions. The middle aluminum plate of each image was automatically segmented. Next, the two segmented images were combined to produce one image with two stair objects. The centroid coordinates of two stair objects were automatically determined. Subsequently, the distance between these two centroids was measured to directly indicate the slice spacing. For comparison, the slice spacing was calculated by accessing the slice position attributes from the DICOM header of both images. The proposed method was tested on phantom images with variations in slice spacing and field of view (FOV). Results: The results showed that the automatic measurement of slice spacing was quite accurate for all variations of slice spacing and FOV, with average differences of 9.0% and 9.3%, respectively. Conclusion: A new automated method for measuring the slice spacing using the AAPM CT phantom was successfully demonstrated and tested for variations of slice spacing and FOV. Slice spacing measurement may be considered an additional parameter to be checked in addition to other established parameters.

A novel method for developing contrast-detail curves from clinical patient images based on statistical low-contrast detectability.

Purpose. To develop a method to extract statistical low-contrast detectability (LCD) and contrast-detail (C-D) curves from clinical patient images.Method. We used the region of air surrounding the patient as an alternative for a homogeneous region within a patient. A simple graphical user interface (GUI) was created to set the initial configuration for region of interest (ROI), ROI size, and minimum detectable contrast (MDC). The process was started by segmenting the air surrounding the patient with a threshold between -980 HU (Hounsfield units) and -1024 HU to get an air mask. The mask was trimmed using the patient center coordinates to avoid distortion from the patient table. It was used to automatically place square ROIs of a predetermined size. The mean pixel values in HU within each ROI were calculated, and the standard deviation (SD) from all the means was obtained. The MDC for a particular target size was generated by multiplying the SD by 3.29. A C-D curve was obtained by iterating this process for the other ROI sizes. This method was applied to the homogeneous area from the uniformity module of an ACR CT phantom to find the correlation between the parameters inside and outside the phantom, for 30 thoracic, 26 abdominal, and 23 head images.Results. The phantom images showed a significant linear correlation between the LCDs obtained from outside and inside the phantom, with R2values of 0.67 and 0.99 for variations in tube currents and tube voltages. This indicated that the air region outside the phantom can act as a surrogate for the homogenous region inside the phantom to obtain the LCD and C-D curves.Conclusion. The C-D curves obtained from outside the ACR CT phantom show a strong linear correlation with those from inside the phantom. The proposed method can also be used to extract the LCD from patient images by using the region of air outside as a surrogate for a region inside the patient.