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SU-F-J-214: Dose Reduction by Spatially Optimized Image Quality Via Fluence Modulated Proton CT (FMpCT)

Purpose: Proton CT (pCT) is a promising imaging modality for reducing range uncertainty in image-guided proton therapy. Range uncertainties partially originate from X-ray CT number conversion to stopping power ratio (SPR) and are limiting the exploitation of the full potential of proton therapy. In this study we explore the concept of spatially dependent fluence modulated proton CT (FMpCT), for achieving optimal image quality in a clinical region of interest (ROI), while reducing significantly the imaging dose to the patient. Methods: The study was based on simulated ideal pCT using pencil beam (PB) scanning. A set of 250 MeV protons PBs was used to create 360 projections of a cylindrical water phantom and a head and neck cancer patient. The tomographic images were reconstructed using a filtered backprojection (FBP) as well as an iterative algorithm (ITR). Different fluence modulation levels were investigated and their impact on the image was quantified in terms of SPR accuracy as well as noise within and outside selected ROIs, as a function of imaging dose. The unmodulated image served as reference. Results: Both FBP reconstruction and ITR without total variation (TV) yielded image quality in the ROIs similar to the reference images, for modulation down to 0.1 of the full proton fluence. The average dose was reduced by 75% for the water phantom and by 40% for the patient. FMpCT does not improve the noise for ITR with TV and modulation 0.1. Conclusion: This is the first work proposing and investigating FMpCT for producing optimal image quality for treatment planning and image guidance, while simultaneously reducing imaging dose. Future work will address spatial resolution effects and the impact of FMpCT on the quality of proton treatment plans for a prototype pCT scanner capable of list mode data acquisition. Acknowledgement: DFG-MAP DFG - Munich-Centre for Advanced Photonics (MAP)

60 APPLIED LIFE SCIENCES↗

SU-E-I-59: Image Quality and Dose Measurement for Partial Cone-Beam CT

Purpose: To characterize performance of cone beam CT (CBCT) used in dentistry investigating quantitatively the image quality and radiation dose during dental CBCT over different settings for partial rotation of the x-ray tube. Methods: Image quality and dose measurements were done on a variable field of view (FOV) dental CBCT (Carestream 9300). X-ray parameters for clinical settings were adjustable for 2–10 mA, 60–90 kVp, and two optional voxel size values, but time was fixed for each FOV. Image quality was assessed by scanning cylindrical poly-methyl methacrylate (PMMA) image quality phantom (SEDENTEXCT IQ), and then the images were analyzed using ImageJ to calculate image quality parameters such as noise, uniformity, and contrast to noise ratio (CNR). A protocol proposed by SEDENTEXCT, dose index 1 (DI1), was applied to dose measurements obtained using a thimble ionization chamber and cylindrical PMMA dose index phantom (SEDENTEXCT DI). Dose distributions were obtained using Gafchromic film. The phantoms were positioned in the FOV to imitate a clinical positioning. Results: The image noise was 6–12.5% which, when normalized to the difference of mean voxel value of PMMA and air, was comparable between different FOVs. Uniformity was 93.5ß 99.7% across the images. CNR was 1.7–4.2 and 6.3–14.3 for LDPE and Aluminum, respectively. Dose distributions were symmetric about the rotation angle's bisector. For large and medium FOVs at 4 mA and 80–90 kVp, DI1 values were in the range of 1.26–3.23 mGy. DI1 values were between 1.01–1.93 mGy for small FOV (5×5 cm{sup 2}) at 4–5 mA and 75–84 kVp. Conclusion: Noise decreased by increasing kVp, and the CNR increased for each FOV. When FOV size increased, image noise increased and CNR decreased. DI1 values were increased by increasing tube current (mA), tube voltage (kVp), and/or FOV. Funding for this project from NSERC Discovery grant, UBC Faculty of Dentistry Research Equipment Grant and UBC Faculty of Dentistry S. Wah Leung Endowment Fund.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Objective assessment of image quality and dose reduction in CT iterative reconstruction

Purpose: Iterative reconstruction (IR) algorithms have the potential to reduce radiation dose in CT diagnostic imaging. As these algorithms become available on the market, a standardizable method of quantifying the dose reduction that a particular IR method can achieve would be valuable. Such a method would assist manufacturers in making promotional claims about dose reduction, buyers in comparing different devices, physicists in independently validating the claims, and the United States Food and Drug Administration in regulating the labeling of CT devices. However, the nonlinear nature of commercially available IR algorithms poses challenges to objectively assessing image quality, a necessary step in establishing the amount of dose reduction that a given IR algorithm can achieve without compromising that image quality. This review paper seeks to consolidate information relevant to objectively assessing the quality of CT IR images, and thereby measuring the level of dose reduction that a given IR algorithm can achieve. Methods: The authors discuss task-based methods for assessing the quality of CT IR images and evaluating dose reduction. Results: The authors explain and review recent literature on signal detection and localization tasks in CT IR image quality assessment, the design of an appropriate phantom for these tasks, possible choices of observers (including human and model observers), and methods of evaluating observer performance. Conclusions: Standardizing the measurement of dose reduction is a problem of broad interest to the CT community and to public health. A necessary step in the process is the objective assessment of CT image quality, for which various task-based methods may be suitable. This paper attempts to consolidate recent literature that is relevant to the development and implementation of task-based methods for the assessment of CT IR image quality.

60 APPLIED LIFE SCIENCES↗

MO-D-213-06: Quantitative Image Quality Metrics Are for Physicists, Not Radiologists: How to Communicate to Your Radiologists Using Their Language

Purpose: A framework for explaining differences in image quality to non-technical audiences in medial imaging is needed. Currently, this task is something that is learned “on the job.” The lack of a formal methodology for communicating optimal acquisition parameters into the clinic effectively mitigates many technological advances. As a community, medical physicists need to be held responsible for not only advancing image science, but also for ensuring its proper use in the clinic. This work outlines a framework that bridges the gap between the results from quantitative image quality metrics like detectability, MTF, and NPS and their effect on specific anatomical structures present in diagnostic imaging tasks. Methods: Specific structures of clinical importance were identified for a body, an extremity, a chest, and a temporal bone protocol. Using these structures, quantitative metrics were used to identify the parameter space that should yield optimal image quality constrained within the confines of clinical logistics and dose considerations. The reading room workflow for presenting the proposed changes for imaging each of these structures is presented. The workflow consists of displaying images for physician review consisting of different combinations of acquisition parameters guided by quantitative metrics. Examples of using detectability index, MTF, NPS, noise and noise non-uniformity are provided. During review, the physician was forced to judge the image quality solely on those features they need for diagnosis, not on the overall “look” of the image. Results: We found that in many cases, use of this framework settled mis-agreements between physicians. Once forced to judge images on the ability to detect specific structures inter reader agreement was obtained. Conclusion: This framework will provide consulting, research/industrial, or in-house physicists with clinically relevant imaging tasks to guide reading room image review. This framework avoids use of the overall “look” or “feel” to dictate acquisition parameter selection. Equipment grants GE Healthcare.

60 APPLIED LIFE SCIENCES↗

Quantifying the impact of respiratory-gated 4D CT acquisition on thoracic image quality: A digital phantom study

Purpose: Prospective respiratory-gated 4D CT has been shown to reduce tumor image artifacts by up to 50% compared to conventional 4D CT. However, to date no studies have quantified the impact of gated 4D CT on normal lung tissue imaging, which is important in performing dose calculations based on accurate estimates of lung volume and structure. To determine the impact of gated 4D CT on thoracic image quality, the authors developed a novel simulation framework incorporating a realistic deformable digital phantom driven by patient tumor motion patterns. Based on this framework, the authors test the hypothesis that respiratory-gated 4D CT can significantly reduce lung imaging artifacts. Methods: Our simulation framework synchronizes the 4D extended cardiac torso (XCAT) phantom with tumor motion data in a quasi real-time fashion, allowing simulation of three 4D CT acquisition modes featuring different levels of respiratory feedback: (i) “conventional” 4D CT that uses a constant imaging and couch-shift frequency, (ii) “beam paused” 4D CT that interrupts imaging to avoid oversampling at a given couch position and respiratory phase, and (iii) “respiratory-gated” 4D CT that triggers acquisition only when the respiratory motion fulfills phase-specific displacement gating windows based on prescan breathing data. Our framework generates a set of ground truth comparators, representing the average XCAT anatomy during beam-on for each of ten respiratory phase bins. Based on this framework, the authors simulated conventional, beam-paused, and respiratory-gated 4D CT images using tumor motion patterns from seven lung cancer patients across 13 treatment fractions, with a simulated 5.5 cm{sup 3} spherical lesion. Normal lung tissue image quality was quantified by comparing simulated and ground truth images in terms of overall mean square error (MSE) intensity difference, threshold-based lung volume error, and fractional false positive/false negative rates. Results: Averaged across all simulations and phase bins, respiratory-gating reduced overall thoracic MSE by 46% compared to conventional 4D CT (p ∼ 10{sup −19}). Gating leads to small but significant (p < 0.02) reductions in lung volume errors (1.8%–1.4%), false positives (4.0%–2.6%), and false negatives (2.7%–1.3%). These percentage reductions correspond to gating reducing image artifacts by 24–90 cm{sup 3} of lung tissue. Similar to earlier studies, gating reduced patient image dose by up to 22%, but with scan time increased by up to 135%. Beam paused 4D CT did not significantly impact normal lung tissue image quality, but did yield similar dose reductions as for respiratory-gating, without the added cost in scanning time. Conclusions: For a typical 6 L lung, respiratory-gated 4D CT can reduce image artifacts affecting up to 90 cm{sup 3} of normal lung tissue compared to conventional acquisition. This image improvement could have important implications for dose calculations based on 4D CT. Where image quality is less critical, beam paused 4D CT is a simple strategy to reduce imaging dose without sacrificing acquisition time.

60 APPLIED LIFE SCIENCES↗

SU-F-18C-01: Minimum Detectability Analysis for Comprehensive Sized Based Optimization of Image Quality and Radiation Dose Across CT Protocols

Purpose: This work involved a comprehensive modeling of task-based performance of CT across a wide range of protocols. The approach was used for optimization and consistency of dose and image quality within a large multi-vendor clinical facility. Methods: 150 adult protocols from the Duke University Medical Center were grouped into sub-protocols with similar acquisition characteristics. A size based image quality phantom (Duke Mercury Phantom) was imaged using these sub-protocols for a range of clinically relevant doses on two CT manufacturer platforms (Siemens, GE). The images were analyzed to extract task-based image quality metrics such as the Task Transfer Function (TTF), Noise Power Spectrum, and Az based on designer nodule task functions. The data were analyzed in terms of the detectability of a lesion size/contrast as a function of dose, patient size, and protocol. A graphical user interface (GUI) was developed to predict image quality and dose to achieve a minimum level of detectability. Results: Image quality trends with variations in dose, patient size, and lesion contrast/size were evaluated and calculated data behaved as predicted. The GUI proved effective to predict the Az values representing radiologist confidence for a targeted lesion, patient size, and dose. As an example, an abdomen pelvis exam for the GE scanner, with a task size/contrast of 5-mm/50-HU, and an Az of 0.9 requires a dose of 4.0, 8.9, and 16.9 mGy for patient diameters of 25, 30, and 35 cm, respectively. For a constant patient diameter of 30 cm, the minimum detected lesion size at those dose levels would be 8.4, 5, and 3.9 mm, respectively. Conclusion: The designed CT protocol optimization platform can be used to evaluate minimum detectability across dose levels and patient diameters. The method can be used to improve individual protocols as well as to improve protocol consistency across CT scanners.

60 APPLIED LIFE SCIENCES↗

SU-F-207-02: Use of Postmortem Subjects for Subjective Image Quality Assessment in Abdominal CT Protocols with Iterative Reconstruction

Purpose: New radiation dose reduction technologies are emerging constantly in the medical imaging field. The latest of these technologies, iterative reconstruction (IR) in CT, presents the ability to reduce dose significantly and hence provides great opportunity for CT protocol optimization. However, without effective analysis of image quality, the reduction in radiation exposure becomes irrelevant. This work explores the use of postmortem subjects as an image quality assessment medium for protocol optimizations in abdominal CT. Methods: Three female postmortem subjects were scanned using the Abdomen-Pelvis (AP) protocol at reduced minimum tube current and target noise index (SD) settings of 12.5, 17.5, 20.0, and 25.0. Images were reconstructed using two strengths of iterative reconstruction. Radiologists and radiology residents from several subspecialties were asked to evaluate 8 AP image sets including the current facility default scan protocol and 7 scans with the parameters varied as listed above. Images were viewed in the soft tissue window and scored on a 3-point scale as acceptable, borderline acceptable, and unacceptable for diagnosis. The facility default AP scan was identified to the reviewer while the 7 remaining AP scans were randomized and de-identified of acquisition and reconstruction details. The observers were also asked to comment on the subjective image quality criteria they used for scoring images. This included visibility of specific anatomical structures and tissue textures. Results: Radiologists scored images as acceptable or borderline acceptable for target noise index settings of up to 20. Due to the postmortem subjects’ close representation of living human anatomy, readers were able to evaluate images as they would those of actual patients. Conclusion: Postmortem subjects have already been proven useful for direct CT organ dose measurements. This work illustrates the validity of their use for the crucial evaluation of image quality during CT protocol optimization, especially when investigating the effects of new technologies.

60 APPLIED LIFE SCIENCES↗

TU-H-CAMPUS-JeP1-04: Deformable Image Registration Performances in Pelvis Patients: Impact of CBCT Image Quality

Purpose: To investigate the accuracy and robustness, against image noise and artifacts (typical of CBCT images), of a commercial algorithm for deformable image registration (DIR), to propagate regions of interest (ROIs) in computational phantoms based on real prostate patient images. Methods: The Anaconda DIR algorithm, implemented in RayStation was tested. Two specific Deformation Vector Fields (DVFs) were applied to the reference data set (CTref) using the ImSimQA software, obtaining two deformed CTs. For each dataset twenty-four different level of noise and/or capping artifacts were applied to simulate CBCT images. DIR was performed between CTref and each deformed CTs and CBCTs. In order to investigate the relationship between image quality parameters and the DIR results (expressed by a logit transform of the Dice Index) a bilinear regression was defined. Results: More than 550 DIR-mapped ROIs were analyzed. The Statistical analysis states that deformation strenght and artifacts were significant prognostic factors of DIR performances, while noise appeared to have a minor role in DIR process as implemented in RayStation as expected by the image similarity metric built in the registration algorithm. Capping artifacts reveals a determinant role for the accuracy of DIR results. Two optimal values for capping artifacts were found to obtain acceptable DIR results (DICE> 075/ 0.85). Various clinical CBCT acquisition protocol were reported to evaluate the significance of the study. Conclusion: This work illustrates the impact of image quality on DIR performance. Clinical issues like Adaptive Radiation Therapy (ART) and Dose Accumulation need accurate and robust DIR software. The RayStation DIR algorithm resulted robust against noise, but sensitive to image artifacts. This result highlights the need of robustness quality assurance against image noise and artifacts in the commissioning of a DIR commercial system and underlines the importance to adopt optimized protocols for CBCT image acquisitions in ART clinical implementation.

60 APPLIED LIFE SCIENCES↗

SU-E-J-74: Impact of Respiration-Correlated Image Quality On Tumor Motion Reconstruction in 4D-CBCT: A Phantom Study

Purpose: To investigate the effects of scanning parameters and respiratory patterns on the image quality for 4-dimensional cone-beam computed tomography(4D-CBCT) imaging, and assess the accuracy of computed tumor trajectory for lung imaging using registration of phased 4D-CBCT imaging with treatment planning-CT. Methods: We simulated a periodic and non-sinusoidal respirations with various breathing periods and amplitudes using a respiratory phantom(Quasar, Modus Medical Devices Inc) to acquire respiration-correlated 4D-CBCT images. 4D-CBCT scans(Elekta Oncology Systems Ltd) were performed with different scanning parameters for collimation size(e.g., small and medium field-of-views) and scanning speed(e.g., slow 50°·min{sup −1}, fast 100°·min{sup −1}). Using a standard CBCT-QA phantom(Catphan500, The Phantom Laboratory), the image qualities of all phases in 4D-CBCT were evaluated with contrast-to-noise ratio(CNR) for lung tissue and uniformity in each module. Using a respiratory phantom, the target imaging in 4D-CBCT was compared to 3D-CBCT target image. The target trajectory from 10-respiratory phases in 4D-CBCT was extracted using an automatic image registration and subsequently assessed the accuracy by comparing with actual motion of the target. Results: Image analysis indicated that a short respiration with a small amplitude resulted in superior CNR and uniformity. Smaller variation of CNR and uniformity was present amongst different respiratory phases. The small field-of-view with a partial scan using slow scan can improve CNR, but degraded uniformity. Large amplitude of respiration can degrade image quality. RMS of voxel densities in tumor area of 4D-CBCT images between sinusoidal and non-sinusoidal motion exhibited no significant difference. The maximum displacement errors of motion trajectories were less than 1.0 mm and 13.5 mm, for sinusoidal and non-sinusoidal breathings, respectively. The accuracy of motion reconstruction showed good overall agreement with the 4D-CBCT image quality results only using sinusoidal breathings. Conclusion: This information can be used to determine the appropriate acquisition parameters of 4D-CBCT imaging for registration accuracy and target trajectory measurements in a clinical setting.

60 APPLIED LIFE SCIENCES↗

Prediction of Viking lander camera image quality

Formulations are presented that permit prediction of image quality as a function of camera performance, surface radiance properties, and lighting and viewing geometry. Predictions made for a wide range of surface radiance properties reveal that image quality depends strongly on proper camera dynamic range command and on favorable lighting and viewing geometry. Proper camera dynamic range commands depend mostly on the surface albedo that will be encountered. Favorable lighting and viewing geometries depend mostly on lander orientation with respect to the diurnal sun path over the landing site, and tend to be independent of surface albedo and illumination scattering function. Side lighting with low sun elevation angles (10 to 30 deg) is generally favorable for imaging spatial details and slopes, whereas high sun elevation angles are favorable for measuring spectral reflectances.

Huck, F. O.↗

SU-E-I-94: Automated Image Quality Assessment of Radiographic Systems Using An Anthropomorphic Phantom

Purpose: In a large, academic medical center, consistent radiographic imaging performance is difficult to routinely monitor and maintain, especially for a fleet consisting of multiple vendors, models, software versions, and numerous imaging protocols. Thus, an automated image quality control methodology has been implemented using routine image quality assessment with a physical, stylized anthropomorphic chest phantom. Methods: The “Duke” Phantom (Digital Phantom 07-646, Supertech, Elkhart, IN) was imaged twice on each of 13 radiographic units from a variety of vendors at 13 primary care clinics. The first acquisition used the clinical PA chest protocol to acquire the post-processed “FOR PRESENTATION” image. The second image was acquired without an antiscatter grid followed by collection of the “FOR PROCESSING” image. Manual CNR measurements were made from the largest and thickest contrast-detail inserts in the lung, heart, and abdominal regions of the phantom in each image. An automated image registration algorithm was used to estimate the CNR of the same insert using similar ROIs. Automated measurements were then compared to the manual measurements. Results: Automatic and manual CNR measurements obtained from “FOR PRESENTATION” images had average percent differences of 0.42%±5.18%, −3.44%±4.85%, and 1.04%±3.15% in the lung, heart, and abdominal regions, respectively; measurements obtained from “FOR PROCESSING” images had average percent differences of -0.63%±6.66%, −0.97%±3.92%, and −0.53%±4.18%, respectively. The maximum absolute difference in CNR was 15.78%, 10.89%, and 8.73% in the respective regions. In addition to CNR assessment of the largest and thickest contrast-detail inserts, the automated method also provided CNR estimates for all 75 contrast-detail inserts in each phantom image. Conclusion: Automated analysis of a radiographic phantom has been shown to be a fast, robust, and objective means for assessing radiographic image quality. The method reduces the burden of manual measurements and provides a means by which to monitor and compare radiographic system performance.

60 APPLIED LIFE SCIENCES↗

Effects of characteristics of image quality in an immersive environment

Image quality issues such as field of view (FOV) and resolution are important for evaluating "presence" and simulator sickness (SS) in virtual environments (VEs). This research examined effects on postural stability of varying FOV, image resolution, and scene content in an immersive visual display. Two different scenes (a photograph of a fountain and a simple radial pattern) at two different resolutions were tested using six FOVs (30, 60, 90, 120, 150, and 180 deg.). Both postural stability, recorded by force plates, and subjective difficulty ratings varied as a function of FOV, scene content, and image resolution. Subjects exhibited more balance disturbance and reported more difficulty in maintaining posture in the wide-FOV, high-resolution, and natural scene conditions.

Non-NASA Center↗

SU-F-I-02: Comparative Analysis and Constancy Check of Image Quality Parameters for Three Linear Accelerators Per TG 142 Protocol

Purpose: To compare image quality parameters and assessing the image stability of three different linear accelerators (linac) for 2D and 3D imaging modalities: planar kV, MV images and cone-beam CT (CBCT). Methods: QCkV1, QC-3 and Cathpan-600 phantoms were utilized to acquire kV, MV and CBCT images respectively on monthly basis per TG142 QA protocol for over 2 years on 21Ex, NovalisTx and TrueBeam linacs. DICOM images were analyzed with the help of QA analysis software: PIPsPro from Standard Imaging. For planar kV and MV images, planar spatial resolution, contrast to noise ratio (CNR) and noise; for CBCT, HU values were collected and analyzed. Results: Two years of monthly QA measurements were analyzed for the planar and CBCT images. Values were normalized to the mean and the standard deviations (STD) are presented. For the kV planar radiographic images the STD of spatial resolution for f30, f40, f50, CNR and noise for 21Ex are 0.006, 0.011, 0.013, 0.046, 0.026; Novalis-Tx are 0.009, 0.016, 0.016, 0.067, 0.053 ; TrueBeam are 0.007, 0.005, 0.009, 0.017, 0.016 respectively. For the MV planar radiographic images, the STD of spatial resolution for f30, f40, f50, CNR and noise for 21Ex are 0.009, 0.010, 0.008, 0.023, 0.023; for Novalix-Tx are 0.012, 0.010, 0.008, 0.029, 0.023 and for TrueBeam are 0.010, 0.010, 0.007, 0.022, 0.022 respectively. For the CBCT images, HU constancies of Air, Polystyrene, Teflon, PMP, LDPE and Delrin for 21Ex are 0.014, 0.070, 0.031, 0.053, 0.076, 0.087; for Novalis Tx are 0.019, 0.047, 0.035, 0.059, 0.077, 0.087 and for TrueBeam are 0.011, 0.044, 0.025, 0.044, 0.056, 0.020 respectively. Conclusion: These Imaging QA results demonstrated that the TrueBeam, performed better in terms of image quality stability for both kV planer and CBCT images as well as EPID MV images, however other two linacs were also satisfied TG142 guidelines.

60 APPLIED LIFE SCIENCES↗

SU-E-J-154: Image Quality Assessment of Contrast-Enhanced 4D-CT for Pancreatic Adenocarcinoma in Radiotherapy Simulation

Purpose: This study presents quantitative and qualitative assessment of the image qualities in contrast-enhanced (CE) 3D-CT, 4D-CT and CE 4D-CT to identify feasibility for replacing the clinical standard simulation with a single CE 4D-CT for pancreatic adenocarcinoma (PDA) in radiotherapy simulation. Methods: Ten PDA patients were enrolled and underwent three CT scans: a clinical standard pair of CE 3D-CT immediately followed by a 4D-CT, and a CE 4D-CT one week later. Physicians qualitatively evaluated the general image quality and regional vessel definitions and gave a score from 1 to 5. Next, physicians delineated the contours of the tumor (T) and the normal pancreatic parenchyma (P) on the three CTs (CE 3D-CT, 50% phase for 4D-CT and CE 4D-CT), then high density areas were automatically removed by thresholding at 500 HU and morphological operations. The pancreatic tumor contrast-to-noise ratio (CNR), signal-tonoise ratio (SNR) and conspicuity (C, absolute difference of mean enhancement levels in P and T) were computed to quantitatively assess image quality. The Wilcoxon rank sum test was used to compare these quantities. Results: In qualitative evaluations, CE 3D-CT and CE 4D-CT scored equivalently (4.4±0.4 and 4.3±0.4) and both were significantly better than 4D-CT (3.1±0.6). In quantitative evaluations, the C values were higher in CE 4D-CT (28±19 HU, p=0.19 and 0.17) than the clinical standard pair of CE 3D-CT and 4D-CT (17±12 and 16±17 HU, p=0.65). In CE 3D-CT and CE 4D-CT, mean CNR (1.8±1.4 and 1.8±1.7, p=0.94) and mean SNR (5.8±2.6 and 5.5±3.2, p=0.71) both were higher than 4D-CT (CNR: 1.1±1.3, p<0.3; SNR: 3.3±2.1, p<0.1). The absolute enhancement levels for T and P were higher in CE 4D-CT (87, 82 HU) than in CE 3D-CT (60, 56) and 4DCT (53, 70). Conclusions: The individually optimized CE 4D-CT is feasible and achieved comparable image qualities to the clinical standard simulation. This study was supported in part by Philips Healthcare.

60 APPLIED LIFE SCIENCES↗

SU-E-P-11: Comparison of Image Quality and Radiation Dose Between Different Scanner System in Routine Abdomen CT

Purpose To evaluate image quality and radiation dose of routine abdomen computed tomography exam with the automatic current modulation technique (ATCM) performed in two different brand 64-slice CT scanners in our site. Materials and Methods A retrospective review of routine abdomen CT exam performed with two scanners; scanner A and scanner B in our site. To calculate standard deviation of the portal hepatic level with a region of interest of 12.5 mm x 12.5mm represented to the image noise. The radiation dose was obtained from CT DICOM image information. Using Computed tomography dose index volume (CTDIv) to represented CT radiation dose. The patient data in this study were with normal weight (about 65–75 Kg). Results The standard deviation of Scanner A was smaller than scanner B, the scanner A might with better image quality than scanner B. On the other hand, the radiation dose of scanner A was higher than scanner B(about higher 50–60%) with ATCM. Both of them, the radiation dose was under diagnostic reference level. Conclusion The ATCM systems in modern CT scanners can contribute a significant reduction in radiation dose to the patient. But the reduction by ATCM systems from different CT scanner manufacturers has slightly variation. Whatever CT scanner we use, it is necessary to find the acceptable threshold of image quality with the minimum possible radiation exposure to the patient in agreement with the ALARA principle.

60 APPLIED LIFE SCIENCES↗

MO-DE-209-03: Assessing Image Quality

Digital Breast Tomosynthesis (DBT) is rapidly replacing mammography as the standard of care in breast cancer screening and diagnosis. DBT is a form of computed tomography, in which a limited set of projection images are acquired over a small angular range and reconstructed into tomographic data. The angular range varies from 15° to 50° and the number of projections varies between 9 and 25 projections, as determined by the equipment manufacturer. It is equally valid to treat DBT as the digital analog of classical tomography – that is, linear tomography. In fact, the name “tomosynthesis” stands for “synthetic tomography.” DBT shares many common features with classical tomography, including the radiographic appearance, dose, and image quality considerations. As such, both the science and practical physics of DBT systems is a hybrid between computed tomography and classical tomographic methods. In this lecture, we will explore the continuum from radiography to computed tomography to illustrate the characteristics of DBT. This lecture will consist of four presentations that will provide a complete overview of DBT, including a review of the fundamentals of DBT acquisition, a discussion of DBT reconstruction methods, an overview of dosimetry for DBT systems, and summary of the underlying image theory of DBT thereby relating image quality and dose. Learning Objectives: To understand the fundamental principles behind tomosynthesis image acquisition. To understand the fundamentals of tomosynthesis image reconstruction. To learn the determinants of image quality and dose in DBT, including measurement techniques. To learn the image theory underlying tomosynthesis, and the relationship between dose and image quality. ADM is a consultant to, and holds stock in, Real Time Tomography, LLC. ADM receives research support from Hologic Inc., Analogic Inc., and Barco NV.; ADM is a member of the Scientific Advisory Board for Gamma Medica Inc.; A. Maidment, Research Support, Hologic, Inc.; Research Support, Barco, Inc.; Scientific Advisory Board, Gamma Medica, Inc.; Scientific Advisory Board, Real-Time Tomography, LLC.; Shareholder, Real-Time Tomography, LLC; J. Mainprize, Our lab has a research agreement with GE Healthcare on various topics in digital mammography and digital tomosynthesis; W. Zhao, Research grant from Siemens Health Care.

60 APPLIED LIFE SCIENCES↗

Weight-adapted ultra-low-dose pancreatic perfusion CT: radiation dose, image quality, and perfusion parameters

Purpose: We evaluate the reliability and feasibility of weight-adapted ultra-low-dose pancreatic perfusion CT. Methods: A total of 100 (47 men, 53 women) patients were enrolled prospectively and were assigned to five groups (A, B, C, D, and E) with different combination of tube voltage and tube current according to their body weight. Radiation dose parameters including volume CT dose index (CTDI) and dose-length product (DLP) were recorded. Image quality was evaluated both subjectively and objectively (noise, signal-to-noise ratio, contrast-to-noise ratio). Perfusion parameters including blood flow (BF), blood volume (BV), and permeability (PMB) were measured. The dose, image quality measurements, and perfusion parameters were compared between the five groups using one-way analysis of variance (ANOVA). Results: Radiation dose reached 8.7 mSv in patients under 50 kg and was 18.9 mSv in patients above 80 kg. The mean subjective image quality score was above 4.45 on a 5-point scale with good agreement between two radiologists. Groups A–D had equivalent performance on objective image quality (P > 0.05), while Group E performed even better (P < 0.05). No significant differences emerged in comparison with perfusion parameters (BF, BV, PMB) of normal pancreas parenchyma between the five groups. Conclusion: Weight-adapted ultra-low-dose pancreatic perfusion CT can effectively reduce radiation dose without prejudice to image quality, and the perfusion parameters of normal parenchyma are accurate and reliable.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A quality assurance framework for the fully automated and objective evaluation of image quality in cone-beam computed tomography

Purpose: Thousands of cone-beam computed tomography (CBCT) scanners for vascular, maxillofacial, neurological, and body imaging are in clinical use today, but there is no consensus on uniform acceptance and constancy testing for image quality (IQ) and dose yet. The authors developed a quality assurance (QA) framework for fully automated and time-efficient performance evaluation of these systems. In addition, the dependence of objective Fourier-based IQ metrics on direction and position in 3D volumes was investigated for CBCT. Methods: The authors designed a dedicated QA phantom 10 cm in length consisting of five compartments, each with a diameter of 10 cm, and an optional extension ring 16 cm in diameter. A homogeneous section of water-equivalent material allows measuring CT value accuracy, image noise and uniformity, and multidimensional global and local noise power spectra (NPS). For the quantitative determination of 3D high-contrast spatial resolution, the modulation transfer function (MTF) of centrally and peripherally positioned aluminum spheres was computed from edge profiles. Additional in-plane and axial resolution patterns were used to assess resolution qualitatively. The characterization of low-contrast detectability as well as CT value linearity and artifact behavior was tested by utilizing sections with soft-tissue-equivalent and metallic inserts. For an automated QA procedure, a phantom detection algorithm was implemented. All tests used in the dedicated QA program were initially verified in simulation studies and experimentally confirmed on a clinical dental CBCT system. Results: The automated IQ evaluation of volume data sets of the dental CBCT system was achieved with the proposed phantom requiring only one scan for the determination of all desired parameters. Typically, less than 5 min were needed for phantom set-up, scanning, and data analysis. Quantitative evaluation of system performance over time by comparison to previous examinations was also verified. The maximum percentage interscan variation of repeated measurements was less than 4% and 1.7% on average for all investigated quality criteria. The NPS-based image noise differed by less than 5% from the conventional standard deviation approach and spatially selective 10% MTF values were well comparable to subjective results obtained with 3D resolution pattern. Determining only transverse spatial resolution and global noise behavior in the central field of measurement turned out to be insufficient. Conclusions: The proposed framework transfers QA routines employed in conventional CT in an advanced version to CBCT for fully automated and time-efficient evaluation of technical equipment. With the modular phantom design, a routine as well as an expert version for assessing IQ is provided. The QA program can be used for arbitrary CT units to evaluate 3D imaging characteristics automatically.

62 RADIOLOGY AND NUCLEAR MEDICINE↗