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TU-AB-207A-03: Image Quality, Dose, and Clinical Applications

Practicing medical physicists are often time charged with the tasks of evaluating and troubleshooting complex image quality issues related to CT scanners. This course will equip them with a solid and practical understanding of common CT imaging chain and its major components with emphasis on acquisition physics and hardware, reconstruction, artifacts, image quality, dose, and advanced clinical applications. The core objective is to explain the effects of these major system components on the image quality. This course will not focus on the rapid-changing advanced technologies given the two-hour time limit, but the fundamental principles discussed in this course may facilitate better understanding of those more complicated technologies. The course will begin with an overview of CT acquisition physics and geometry. X-ray tube and CT detector are important acquisition hardware critical to the overall image quality. Each of these two subsystems consists of several major components. An in-depth description of the function and failure modes of these components will be provided. Examples of artifacts related to these failure modes will be presented: off-focal radiation, tube arcing, heel effect, oil bubble, offset drift effect, cross-talk effect, and bad pixels. The fundamentals of CT image reconstruction will first be discussed on an intuitive level. Approaches that do not require rigorous derivation of mathematical formulations will be presented. This is followed by a detailed derivation of the Fourier slice theorem: the foundation of the FBP algorithm. FBP for parallel-beam, fan-beam, and cone-beam geometries will be discussed. To address the issue of radiation dose related to x-ray CT, recent advances in iterative reconstruction, their advantages, and clinical applications will also be described. Because of the nature of fundamental physics and mathematics, limitations in data acquisition, and non-ideal conditions of major system components, image artifact often arise in the reconstructed images. Because of the limited scope of this course, only major imaging artifacts, their appearance, and possible mitigation and corrections will be discussed. Assessment of the performance of a CT scanner is a complicated subject. Procedures to measure common image quality metrics such as high contrast spatial resolution, low contrast detectability, and slice profile will be described. The reason why these metrics used for FBP may not be sufficient for statistical iterative reconstruction will be explained. Optimizing radiation dose requires comprehension of CT dose metrics. This course will briefly describe various dose metrics, and interaction with acquisition parameters and patient habitus. CT is among the most frequently used imaging tools due to its superior image quality, easy to operate, and a broad range of applications. This course will present several interesting CT applications such as a mobile CT unit on an ambulance for stroke patients, low dose lung cancer screening, and single heartbeat cardiac CT. Learning Objectives: Understand the function and impact of major components of X-ray tube on the image quality. Understand the function and impact of major components of CT detector on the image quality. Be familiar with the basic procedure of CT image reconstruction. Understand the effect of image reconstruction on CT image quality and artifacts. Understand the root causes of common CT image artifacts. Be familiar with image quality metrics especially high and low contrast resolution, noise power spectrum, slice sensitivity profile, etc. Understand why basic image quality metrics used for FBP may not be sufficient to characterize the performance of advanced iterative reconstruction. Be familiar with various CT dose metrics and their interaction with acquisition parameters. New development in advanced CT clinical applications. JH: Employee of GE Healthcare. FD: No disclosure.; J. Hsieh, Jiang Hsieh is an employee of GE Healthcare.

60 APPLIED LIFE SCIENCES↗

SU-E-I-04: A Mammography Phantom to Measure Mean Glandular Dose and Image Quality

Purpose: To evaluate mean glandular dose (MGD) and image quality in a selection of mammography systems using a novel phantom based on thermoluminescent dosemeters and the ACR wax insert. Methods: The phantom consists of two acrylic, 19 cm diameter, 4.5 cm thick, semicircular modules, used in sequence. The image quality module contains the ACR insert and is used to obtain a quality control image under automatic exposure conditions. The dosimetric module carries 15 TLD-100 chips, some under Al foils, to determine air kerma and half-value-layer. TL readings take place at our laboratory under controlled conditions. Calibration was performed using an ionization chamber and a Senographe 2000D unit for a variety of beam qualities, from 24 to 40 kV, Mo and Rh anodes and filters. Phantom MGD values agree, on the average, within 3% with ionization chamber data, and their precision is better than 10% (k=1). Results: MGD and image quality have been evaluated in a selection of mammography units currently used in Mexican health services. The sample includes analogic (screen/film), flexible digital (CR), and full-field digital image receptors. The highest MDG are associated to the CR technology. The most common image quality failure is due to artifacts (dust, intensifying screen scratches, and processor marks for film/screen, laser reader defects for CR). Conclusion: The developed phantom permits the MGD measurement without the need of a calibrated ionization chamber at the mammography site and can be used by a technician without the presence of a medical physicist. The results indicate the urgent need to establish quality control programs for mammography.

07 ISOTOPE AND RADIATION SOURCES↗

A widefield fluorescence microscope with a linear image sensor for image cytometry of biospecimens: Considerations for image quality optimization

Linear image sensors have been widely used in numerous research and industry applications to provide continuous imaging of moving objects. Here, we present a widefield fluorescence microscope with a linear image sensor used to image translating objects for image cytometry. First, a calibration curve was characterized for a custom microfluidic chamber over a span of volumetric pump rates. Image data were also acquired using 15 μm fluorescent polystyrene spheres on a slide with a motorized translation stage in order to match linear translation speed with line exposure periods to preserve the image aspect ratio. Aspect ratios were then calculated after imaging to ensure quality control of image data. Fluorescent beads were imaged in suspension flowing through the microfluidics chamber being pumped by a mechanical syringe pump at 16 μl min{sup −1} with a line exposure period of 150 μs. The line period was selected to acquire images of fluorescent beads with a 40 dB signal-to-background ratio. A motorized translation stage was then used to transport conventional glass slides of stained cellular biospecimens. Whole blood collected from healthy volunteers was stained with 0.02% (w/v) proflavine hemisulfate was imaged to highlight leukocyte morphology with a 1.56 mm × 1.28 mm field of view (1540 ms total acquisition time). Oral squamous cells were also collected from healthy volunteers and stained with 0.01% (w/v) proflavine hemisulfate to demonstrate quantifiable subcellular features and an average nuclear to cytoplasmic ratio of 0.03 (n = 75), with a resolution of 0.31 μm pixels{sup −1}.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

TH-C-18A-06: Combined CT Image Quality and Radiation Dose Monitoring Program Based On Patient Data to Assess Consistency of Clinical Imaging Across Scanner Models

Purpose: One of the principal challenges of clinical imaging is to achieve an ideal balance between image quality and radiation dose across multiple CT models. The number of scanners and protocols at large medical centers necessitates an automated quality assurance program to facilitate this objective. Therefore, the goal of this work was to implement an automated CT image quality and radiation dose monitoring program based on actual patient data and to use this program to assess consistency of protocols across CT scanner models. Methods: Patient CT scans are routed to a HIPPA compliant quality assurance server. CTDI, extracted using optical character recognition, and patient size, measured from the localizers, are used to calculate SSDE. A previously validated noise measurement algorithm determines the noise in uniform areas of the image across the scanned anatomy to generate a global noise level (GNL). Using this program, 2358 abdominopelvic scans acquired on three commercial CT scanners were analyzed. Median SSDE and GNL were compared across scanner models and trends in SSDE and GNL with patient size were used to determine the impact of differing automatic exposure control (AEC) algorithms. Results: There was a significant difference in both SSDE and GNL across scanner models (9–33% and 15–35% for SSDE and GNL, respectively). Adjusting all protocols to achieve the same image noise would reduce patient dose by 27–45% depending on scanner model. Additionally, differences in AEC methodologies across vendors resulted in disparate relationships of SSDE and GNL with patient size. Conclusion: The difference in noise across scanner models indicates that protocols are not optimally matched to achieve consistent image quality. Our results indicated substantial possibility for dose reduction while achieving more consistent image appearance. Finally, the difference in AEC methodologies suggests the need for size-specific CT protocols to minimize variability in image quality across CT vendors.

60 APPLIED LIFE SCIENCES↗

Rapid kVp switching dual-energy CT in the assessment of urolithiasis in patients with large body habitus: preliminary observations on image quality and stone characterization

Purpose: The purpose of this study was to investigate the image quality (IQ) considerations of rapid kVp switching dual-energy CT (rsDECT) in the assessment of urolithiasis in patients with large body habitus and to evaluate whether it allows stone characterization. Materials and methods: In this IRB-approved, HIPAA compliant retrospective study, 93 consecutive patients (M/F = 72/21, mean age 56.9 years, range 23–83 years) with large body habitus (> 90 kg/198 lbs) who underwent dual-energy (DE) stone protocol CT on a rapid kVp switching DECT scanner between January 2013 and December 2016 were included. Scan acquisition protocol included an initial unenhanced single-energy CT (SECT) scan of KUB followed by targeted DECT in the region of stones. Two readers evaluated both CT data sets (axial 5 mm 120 kVp/140 kVp QC/70 keV monoenergetic, material density water/iodine images and coronal/sagittal 3 mm images) for the assessment of image quality (Scores: 1–4) and characterization of stone composition (reference standard: crystallography). Results: One hundred and five CT examinations were performed in 93 patients (mean body weight 105.12 ± 13.53 kg, range 91–154 kg), and a total of 321 urinary tract calculi (mean size-4.8 ± 3.2 mm, range 1.2–22 mm) were detected. Both SECT and targeted monoenergetic images were of acceptable image quality (mean IQ: 3.77 and 3.83, kappa 0.79 and 0.87 respectively). Material density water and iodine images had lower IQ scores (mean IQ: 2.97 and 3.09 respectively) with image quality deterioration due to severe photon starvation/streak artifacts in 20% (21/105) and 17% (18/105) scans, respectively. Characterization of stone composition into uric acid/non-uric acid stones was achieved in 93.14% (299/321) of calculi (mean size: 4.99 ± 3.3 mm, range 1.2–22 mm), while 7% (22/321) stones could not be characterized (mean size 3.03 ± 1.16 mm, range 1.6–6.4 mm) (p < 0.001). Most common reason for non-characterization was image quality deterioration of the material density iodine images due to severe photon starvation artifacts. On multivariate regression, stone size and patient weight were predictors of stone composition determination on DECT (p < 0.05). The transverse diameter had a weak negative correlation with stone composition determination, but it was not statistically significant. Stone characterization into uric acid vs. non-uric acid stones was accurate in 95% (n = 38/40) of stones in comparison with crystallography. Conclusion: In patients with large body habitus, rsDECT allowed characterization of most calculi (93%) despite image quality deterioration due to photon starvation/streak artifacts in up to 20% of material density images. Stone size and patient weight were predictors of stone composition determination on DECT, and small calculi in very large patients may not be characterized.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Image quality in thoracic 4D cone-beam CT: A sensitivity analysis of respiratory signal, binning method, reconstruction algorithm, and projection angular spacing

Purpose: Respiratory signal, binning method, and reconstruction algorithm are three major controllable factors affecting image quality in thoracic 4D cone-beam CT (4D-CBCT), which is widely used in image guided radiotherapy (IGRT). Previous studies have investigated each of these factors individually, but no integrated sensitivity analysis has been performed. In addition, projection angular spacing is also a key factor in reconstruction, but how it affects image quality is not obvious. An investigation of the impacts of these four factors on image quality can help determine the most effective strategy in improving 4D-CBCT for IGRT. Methods: Fourteen 4D-CBCT patient projection datasets with various respiratory motion features were reconstructed with the following controllable factors: (i) respiratory signal (real-time position management, projection image intensity analysis, or fiducial marker tracking), (ii) binning method (phase, displacement, or equal-projection-density displacement binning), and (iii) reconstruction algorithm [Feldkamp–Davis–Kress (FDK), McKinnon–Bates (MKB), or adaptive-steepest-descent projection-onto-convex-sets (ASD-POCS)]. The image quality was quantified using signal-to-noise ratio (SNR), contrast-to-noise ratio, and edge-response width in order to assess noise/streaking and blur. The SNR values were also analyzed with respect to the maximum, mean, and root-mean-squared-error (RMSE) projection angular spacing to investigate how projection angular spacing affects image quality. Results: The choice of respiratory signals was found to have no significant impact on image quality. Displacement-based binning was found to be less prone to motion artifacts compared to phase binning in more than half of the cases, but was shown to suffer from large interbin image quality variation and large projection angular gaps. Both MKB and ASD-POCS resulted in noticeably improved image quality almost 100% of the time relative to FDK. In addition, SNR values were found to increase with decreasing RMSE values of projection angular gaps with strong correlations (r ≈ −0.7) regardless of the reconstruction algorithm used. Conclusions: Based on the authors’ results, displacement-based binning methods, better reconstruction algorithms, and the acquisition of even projection angular views are the most important factors to consider for improving thoracic 4D-CBCT image quality. In view of the practical issues with displacement-based binning and the fact that projection angular spacing is not currently directly controllable, development of better reconstruction algorithms represents the most effective strategy for improving image quality in thoracic 4D-CBCT for IGRT applications at the current stage.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Retinal Image Quality Assessment for Spaceflight-Induced Vision Impairment Study

Long-term exposure to space microgravity poses significant risks for visual impairment. Evidence suggests such vision changes are linked to cephalad fluid shifts, prompting a need to directly quantify microgravity-induced retinal vascular changes. The quality of retinal images used for such vascular remodeling analysis, however, is dependent on imaging methodology. For our exploratory study, we hypothesized that retinal images captured using fluorescein imaging methodologies would be of higher quality in comparison to images captured without fluorescein. A semi-automated image quality assessment was developed using Vessel Generation Analysis (VESGEN) software and MATLAB® image analysis toolboxes. An analysis of ten images found that the fluorescein imaging modality provided a 36% increase in overall image quality (two-tailed p=0.089) in comparison to nonfluorescein imaging techniques.

retina↗

Characteristic image quality of a third generation dual-source MDCT scanner: Noise, resolution, and detectability

Purpose: The purpose of this work was to assess the inherent image quality characteristics of a new multidetector computed tomography system in terms of noise, resolution, and detectability index as a function of image acquisition and reconstruction for a range of clinically relevant settings. Methods: A multisized image quality phantom (37, 30, 23, 18.5, and 12 cm physical diameter) was imaged on a SOMATOM Force scanner (Siemens Medical Solutions) under variable dose, kVp, and tube current modulation settings. Images were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) with iterative strengths of 3, 4, and 5. Image quality was assessed in terms of the noise power spectrum (NPS), task transfer function (TTF), and detectability index for a range of detection tasks (contrasts of approximately 45, 90, 300, −900, and 1000 HU, and 2–20 mm diameter) based on a non-prewhitening matched filter model observer with eye filter. Results: Image noise magnitude decreased with decreasing phantom size, increasing dose, and increasing ADMIRE strength, offering up to 64% noise reduction relative to FBP. Noise texture in terms of the NPS was similar between FBP and ADMIRE (<5% shift in peak frequency). The resolution, based on the TTF, improved with increased ADMIRE strength by an average of 15% in the TTF 50% frequency for ADMIRE-5. The detectability index increased with increasing dose and ADMIRE strength by an average of 55%, 90%, and 163% for ADMIRE 3, 4, and 5, respectively. Assessing the impact of mA modulation for a fixed average dose over the length of the phantom, detectability was up to 49% lower in smaller phantom sections and up to 26% higher in larger phantom sections for the modulated scan compared to a fixed tube current scan. Overall, the detectability exhibited less variability with phantom size for modulated scans compared to fixed tube current scans. Conclusions: Image quality increased with increasing dose and decreasing phantom size. The CT system exhibited nonlinear noise and resolution properties, especially at very low-doses, large phantom sizes, and for low-contrast objects. Objective image quality metrics generally increased with increasing dose and ADMIRE strength, and with decreasing phantom size. The ADMIRE algorithm could offer comparable image quality at reduced doses or improved image quality at the same dose. The use of tube current modulation resulted in more consistent image quality with changing phantom size.

60 APPLIED LIFE SCIENCES↗

Evaluation of imaging quality for flat-panel detector based low dose C-arm CT system

The image quality associated with the extent of the angle of gantry rotation, the number of projection views, and the dose of X-ray radiation was investigated in flat-panel detector (FPD) based C-arm cone-beam computed tomography (CBCT) system for medical applications. A prototype CBCT system for the projection acquisition used the X-ray tube (A-132, Varian inc.) having rhenium-tungsten molybdenum target and flat panel a-Si X-ray detector (PaxScan 4030CB, Varian inc.) having a 397 x 298 mm active area with 388 μm pixel pitch and 1024 x 768 pixels in 2 by 2 binning mode. The performance comparison of X-ray imaging quality was carried out using the Feldkamp, Davis, and Kress (FDK) reconstruction algorithm between different conditions of projection acquisition. In this work, head-and-dental (75 kVp/20 mA) and chest (90 kVp/25 mA) phantoms were used to evaluate the image quality. The 361 (30 fps x 12 s) projection data during 360 deg. gantry rotation with 1 deg. interval for the 3D reconstruction were acquired. Parke weighting function were applied to handle redundant data and improve the reconstructed image quality in a mobile C-arm system with limited rotation angles. The reconstructed 3D images were investigated for comparison of qualitative image quality in terms of scan protocols (projection views, rotation angles and exposure dose). Furthermore, the performance evaluation in image quality will be investigated regarding X-ray dose and limited projection data for a FPD based mobile C-arm CBCT system. (authors)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Metal Artifact Reduction for Orthopedic Prosthesis in Lower Extremity CT Venography: Evaluation of Image Quality and Vessel Conspicuity

Purpose: This study evaluates the image quality of lower extremity CT venography reconstructed with orthopedic metal artifact reduction (O-MAR) in patients with unilateral or bilateral metallic prostheses in the hip or knee. Methods: This retrospective study was approved by our institutional review board, and informed consent was waived. Twenty-nine patients of lower extremity CT with 51 metallic hip or knee prostheses were reconstructed to both standard CT images and O-MAR images. The subjective image quality and vessel conspicuity for both images were evaluated by two readers using five-point scales (0–4). Vessel conspicuity scores of 3 or 4 were considered diagnostically acceptable. Image noise was measured in the air and subcutaneous fat. Results: O-MAR images showed significantly higher scores of subjective image quality (p < .001) and vessel conspicuity (p = .002) than standard CT images. Diagnostic acceptance of vessel conspicuity was not significantly different between O-MAR images and standard CT images (p = 1.000). O-MAR images showed significantly less image noise than conventional CT images (p < .001 for both air and subcutaneous fat). Conclusion: O-MAR may be an effective solution for the metal artifacts in lower extremity CT venography; however, the distance between prostheses and vessels affects the diagnostic acceptance in patients with metallic hip or knee prostheses. Level of Evidence: Level 4, Case Series.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-F-J-143: Initial Assessment of Image Quality of An Integrated MR-Linac System with ACR Phantom

Purpose/Objective(s): To assess the image quality of an integrated MR-Linac system and compare with other MRI systems that are primarily used for diagnostic purposes. Materials/Methods: An ACR MRI quality control (QC) phantom was used to evaluate the image quality of a fully integrated 1.5T MRI-Linac system recently installed at our institution. This system has a new split magnet design which gives the magnetic field strength of 1.5T. All images were acquired with a set of phased-array surface coils which are designed to have minimal attention of radiation beam. The anterior coil rests on a coil holder which keeps the anterior coil’s position consistent for QA purposes. The posterior coil is imbedded in the patient couch. Multiple sets of T1, T2/PD images were acquired using the protocols as prescribed by the ACR on three different dates, ranging 3 months apart. Results: The geometric distortion are within 0.5 mm in the axial scans and within 1mm in the saggital (z-direction) scans. Slice thickness accuracy, image uniformity, ghosting ratio, high contrast detectability are comparable to other 1.5T diagnostic MRI scanners. The low-contrast object detectability are lower comparatively, which is a result of using the body array coil. Additionally, the beam’s-eye-view images (oblique coronal and saggital images) have minimal geometric distortion at all linac gantry angles tested. No observable changes or drift in image quality is found from images acquired 3 month apart. Conclusion: Despite the use of a body array surface coil, the image quality is comparable to that of an 1.5T MRI scanner and is of sufficient quality to pass the ACR MRI accreditation program. The geometric distortion of the MRI system of the integrated MR-Linac is within 1mm for an object size similar to the ACR phantom, sufficient for radiation therapy treatment purpose. The authors received corporate sponsored research grants from Elekta which is the vendor for the MR-Linac evaluated in this study.

60 APPLIED LIFE SCIENCES↗

SU-E-J-09: Image Quality Comparison and Dose Quantification for 2.5 MV

Purpose: To compare the image quality of the 2.5MV imaging beam (2.5X-IMB) to that of a 6MV beam and to quantify the imaging dose of a 2.5X-IMB for constancy as specified by AAPM TG-142 Methods: The image quality of the 2.5X-IMB was compared to the 6MV imaging beam using the SNC ImagePro MV-QA phantom and the Varian supplied Las Vegas phantom (LVP). High resolution (1280×1280×16, 2 frames at 1.5MU/frame) and low resolution (640×640×16, 2 frames at 0.75MU/frame) images were compared for each phantom. MV-QA phantom images were evaluated quantitatively, and the LVP images were evaluated qualitatively. The imaging dose for 2.5X-IMB was quantified using the procedure outlined in TG51. PTWCC13-31013 chambers were used to measure a percent depth dose (PDD) curve for the 2.5X-IMB. All the factors described in TG51 were calculated using the 2.5X-IMB and a PTW30013 farmer chamber. Results: A comparison between 2.5X-IMB and 6MV image quality was performed both visually and with DoseLab software. The optimal window and level were set for each image of the LVP by the user. Visual inspection showed greater contrast resolution with the 2.5MV beam, but no significant difference with the change in imaging resolution. DoseLab reported similar spatial resolutions between the two energies, but the contrast-to-noise ratio (CNR) was greater for 2.5MV. The PDDx(10cm) for a 10x10cm2 field was measured to be 51.5%. Although this PDD value is off the scale of Figure 4 in TG51, the trend of the curve corresponding to the PTW31003 (equivalent) chamber led to an approximate kQ value of 1.00. Conclusion: When compared to 6MV imaging, 2.5X-IMB results in a better CNR. At low resolution, the DoseLab results for the two energies are comparable, but visual analysis favors the 2.5X-IMB images. Imaging dose was quantified for the 2.5X-IMB after following the TG51 methodology with appropriate approximations.

60 APPLIED LIFE SCIENCES↗

SU-E-J-183: Quantifying the Image Quality and Dose Reduction of Respiratory Triggered 4D Cone-Beam Computed Tomography with Patient- Measured Breathing

Purpose: Respiratory triggered four dimensional cone-beam computed tomography (RT 4D CBCT) is a novel technique that uses a patient's respiratory signal to drive the image acquisition with the goal of imaging dose reduction without degrading image quality. This work investigates image quality and dose using patient-measured respiratory signals for RT 4D CBCT simulations instead of synthetic sinusoidal signals used in previous work. Methods: Studies were performed that simulate a 4D CBCT image acquisition using both the novel RT 4D CBCT technique and a conventional 4D CBCT technique from a database of oversampled Rando phantom CBCT projections. A database containing 111 free breathing lung cancer patient respiratory signal files was used to create 111 RT 4D CBCT and 111 conventional 4D CBCT image datasets from realistic simulations of a 4D RT CBCT system. Each of these image datasets were compared to a ground truth dataset from which a root mean square error (RMSE) metric was calculated to quantify the degradation of image quality. The number of projections used in each simulation is counted and was assumed as a surrogate for imaging dose. Results: Based on 111 breathing traces, when comparing RT 4D CBCT with conventional 4D CBCT the average image quality was reduced by 7.6%. However, the average imaging dose reduction was 53% based on needing fewer projections (617 on average) than conventional 4D CBCT (1320 projections). Conclusion: The simulation studies using a wide range of patient breathing traces have demonstrated that the RT 4D CBCT method can potentially offer a substantial saving of imaging dose of 53% on average compared to conventional 4D CBCT in simulation studies with a minimal impact on image quality. A patent application (PCT/US2012/048693) has been filed which is related to this work.

60 APPLIED LIFE SCIENCES↗

TU-F-9A-01: Balancing Image Quality and Dose in Radiography

Emphasis is often placed on minimizing radiation dose in diagnostic imaging without a complete consideration of the effect on image quality, especially those that affect diagnostic accuracy. This session will include a patient image-based review of diagnostic quantities important to radiologists in conventional radiography, including the effects of body habitus, age, positioning, and the clinical indication of the exam. The relationships between image quality, radiation dose, and radiation risk will be discussed, specifically addressing how these factors are affected by image protocols and acquisition parameters and techniques. This session will also discuss some of the actual and perceived radiation risk associated with diagnostic imaging. Regardless if the probability for radiation-induced cancer is small, the fear associated with radiation persists. Also when a risk has a benefit to an individual or to society, the risk may be justified with respect to the benefit. But how do you convey the risks and the benefits to people? This requires knowledge of how people perceive risk and how to communicate the risk and the benefit to different populations. In this presentation the sources of errors in estimating risk from radiation and some methods used to convey risks are reviewed. Learning Objectives: Understand the image quality metrics that are clinically relevant to radiologists. Understand how acquisition parameters and techniques affect image quality and radiation dose in conventional radiology. Understand the uncertainties in estimates of radiation risk from imaging exams. Learn some methods for effectively communicating radiation risk to the public.

60 APPLIED LIFE SCIENCES↗

Effect of low tube voltage and low iodine concentration abdominal CT on image quality and radiation dose in children: preliminary study

Purpose: To evaluate the image quality of a double-low protocol (low tube voltage and low iodine concentration) for abdominal CT in children. Materials and methods: The double-low protocol was compared to the conventional protocol in pediatric patients weighing less than 40 kg from May 2016 to December 2016. Double-low protocol (Group A, n = 18): tube voltage, 70 kVp; and iodine concentration,: 250 mgI/mL versus Conventional protocol (Group B, n = 13): tube voltage, 80–100 kVp; and iodine concentration, 350 mgI/mL. Mean attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between the two groups. Image contrast, noise, beam-hardening artifacts, and overall image quality were subjectively scored. Reader performance for correctly differentiating two groups by visual assessment was evaluated. Radiation dose and total iodine load were recorded. Results: The mean attenuations of the portal vein and liver and the mean image noise in Group A were higher than in Group B (p = 0.04, 0.03, 0.004, respectively). The mean SNR and CNR of the main portal vein and liver were lower in Group A without any statistically significant difference. There were no statistically significant differences between the two groups in qualitative analysis (image contrast, image noise, and overall image quality) with substantial agreement between the reviewers (weighted kappa values; 0.59–0.76). Significantly diminished radiation dose and iodine load were observed in Group A compared with Group B (25.0%, 36.8% reduction; p = 0.007, 0.006, respectively). Conclusion: The double-low protocol was feasible for pediatric abdominal CT and reduced both radiation dose and iodine load, while maintaining image quality.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Investigation into image quality and dose for different patient geometries with multiple cone-beam CT systems

Purpose: To provide quantitative and qualitative image quality metrics and imaging dose for modern Varian On-board Imager (OBI) (ver. 1.5) and Elekta X-ray Volume Imager (XVI) (ver. 4.5R) cone-beam computed tomography (CBCT) systems in a clinical adaptive radiation therapy environment by accounting for varying patient thickness. Methods: Image quality measurements were acquired with Catphan 504 phantom (nominal diameter and with additional 10 cm thickness) for OBI and XVI systems and compared to planning CT (pCT) (GE LightSpeed). Various clinical protocols were analyzed for the OBI and XVI systems and analyzed using image quality metrics, including spatial resolution, low contrast detectability, uniformity, and HU sensitivity. Imaging dose measurements were acquired in Wellhofer Scanditronix i'mRT phantom at nominal phantom diameter and with additional 4 cm phantom diameter using GafChromic XRQA2 film. Calibration curves were generated using previously published in-air Air Kerma calibration method. Results: The OBI system full trajectory scans exhibited very little dependence on phantom thickness for accurate HU calculation, while half-trajectory scans with full-fan filter exhibited dependence of HU calculation on phantom thickness. The contrast-to-noise ratio (CNR) for the OBI scans decreased with additional phantom thickness. The uniformity of Head protocol scan was most significantly affected with additional phantom thickness. The spatial resolution and CNR compared favorably with pCT, while the uniformity of the OBI system was slightly inferior to pCT. The OBI scan protocol dose levels for nominal phantom thickness at the central portion of the phantom were 2.61, 0.72, and 1.88 cGy, and for additional phantom thickness were 1.95, 0.48, and 1.52 cGy, for the Pelvis, Thorax, and Spotlight protocols, respectively. The XVI system scans exhibited dependence on phantom thickness for accurate HU calculation regardless of trajectory. The CNR for the XVI scans decreased with additional phantom thickness. The uniformity of the XVI scans was significantly dependent on the selection of the proper FOV setting for all phantom geometries. The spatial resolution, CNR, and uniformity for XVI were lower than values measured for pCT. The XVI scan protocol dose levels at the central portion of the phantom for nominal phantom thickness were 2.14, 2.15, and 0.33 cGy, and for additional phantom thickness were 1.56, 1.68, and 0.21 cGy, for the Pelvis M20, Chest M20, and Prostate Seed S10 scan protocols, respectively. Conclusions: The OBI system offered comparable spatial resolution and CNR results to the results for pCT. Full trajectory scans with the OBI system need little-to-no correction for HU calculation based on HU stability with changing phantom thickness. The XVI system offered lower spatial resolution and CNR results than pCT. In addition, the HU calculation for all scan protocols was dependent on the phantom thickness. The uniformity for each CBCT system was inferior to that of pCT for each phantom geometry. The dose for each system and scan protocol in the interior of the phantom tended to decrease by approximately 25% with 4 cm additional phantom thickness.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Quantitative metrics for assessment of chemical image quality and spatial resolution

Rationale: Currently objective/quantitative descriptions of the quality and spatial resolution of mass spectrometry derived chemical images are not standardized. Development of these standardized metrics is required to objectively describe chemical imaging capabilities of existing and/or new mass spectrometry imaging technologies. Such metrics would allow unbiased judgment of intra-laboratory advancement and/or inter-laboratory comparison for these technologies if used together with standardized surfaces. Methods: We developed two image metrics, viz., chemical image contrast (ChemIC) based on signal-to-noise related statistical measures on chemical image pixels and corrected resolving power factor (cRPF) constructed from statistical analysis of mass-to-charge chronograms across features of interest in an image. These metrics, quantifying chemical image quality and spatial resolution, respectively, were used to evaluate chemical images of a model photoresist patterned surface collected using a laser ablation/liquid vortex capture mass spectrometry imaging system under different instrument operational parameters. Results: The calculated ChemIC and cRPF metrics determined in an unbiased fashion the relative ranking of chemical image quality obtained with the laser ablation/liquid vortex capture mass spectrometry imaging system. These rankings were used to show that both chemical image contrast and spatial resolution deteriorated with increasing surface scan speed, increased lane spacing and decreasing size of surface features. Conclusions: ChemIC and cRPF, respectively, were developed and successfully applied for the objective description of chemical image quality and spatial resolution of chemical images collected from model surfaces using a laser ablation/liquid vortex capture mass spectrometry imaging system.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗