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817 records · Page 46

Organ doses, effective doses, and risk indices in adult CT: Comparison of four types of reference phantoms across different examination protocols

Purpose: Radiation exposure from computed tomography (CT) to the public has increased the concern among radiation protection professionals. Being able to accurately assess the radiation dose patients receive during CT procedures is a crucial step in the management of CT dose. Currently, various computational anthropomorphic phantoms are used to assess radiation dose by different research groups. It is desirable to better understand how the dose results are affected by different choices of phantoms. In this study, the authors assessed the uncertainties in CT dose and risk estimation associated with different types of computational phantoms for a selected group of representative CT protocols. Methods: Routinely used CT examinations were categorized into ten body and three neurological examination categories. Organ doses, effective doses, risk indices, and conversion coefficients to effective dose and risk index (k and q factors, respectively) were estimated for these examinations for a clinical CT system (LightSpeed VCT, GE Healthcare). Four methods were used, each employing a different type of reference phantoms. The first and second methods employed a Monte Carlo program previously developed and validated in our laboratory. In the first method, the reference male and female extended cardiac-torso (XCAT) phantoms were used, which were initially created from the Visible Human data and later adjusted to match organ masses defined in ICRP publication 89. In the second method, the reference male and female phantoms described in ICRP publication 110 were used, which were initially developed from tomographic data of two patients and later modified to match ICRP 89 organ masses. The third method employed a commercial dosimetry spreadsheet (ImPACT group, London, England) with its own hermaphrodite stylized phantom. In the fourth method, another widely used dosimetry spreadsheet (CT-Expo, Medizinische Hochschule, Hannover, Germany) was employed together with its associated male and female stylized phantoms. Results: For fully irradiated organs, average coefficients of variation (COV) ranged from 0.07 to 0.22 across the four male phantoms and from 0.06 to 0.18 across the four female phantoms; for partially irradiated organs, average COV ranged from 0.13 to 0.30 across the four male phantoms and from 0.15 to 0.30 across the four female phantoms. Doses to the testes, breasts, and esophagus showed large variations between phantoms. COV for gender-averaged effective dose and k factor ranged from 0.03 to 0.23 and from 0.06 to 0.30, respectively. COV for male risk index and q factor ranged from 0.06 to 0.30 and from 0.05 to 0.36, respectively; COV for female risk index and q factor ranged from 0.06 to 0.49 and from 0.07 to 0.54, respectively. Conclusions: Despite closely matched organ mass, total body weight, and height, large differences in organ dose exist due to variation in organ location, spatial distribution, and dose approximation method. Dose differences for fully irradiated radiosensitive organs were much smaller than those for partially irradiated organs. Weighted dosimetry quantities including effective dose, male risk indices, k factors, and male q factors agreed well across phantoms. The female risk indices and q factors varied considerably across phantoms.

61 RADIATION PROTECTION AND DOSIMETRY↗

Feature-space assessment of electrical impedance tomography coregistered with computed tomography in detecting multiple contrast targets

Purpose: Fusion of electrical impedance tomography (EIT) with computed tomography (CT) can be useful as a clinical tool for providing additional physiological information about tissues, but requires suitable fusion algorithms and validation procedures. This work explores the feasibility of fusing EIT and CT images using an algorithm for coregistration. The imaging performance is validated through feature space assessment on phantom contrast targets. Methods: EIT data were acquired by scanning a phantom using a circuit, configured for injecting current through 16 electrodes, placed around the phantom. A conductivity image of the phantom was obtained from the data using electrical impedance and diffuse optical tomography reconstruction software (EIDORS). A CT image of the phantom was also acquired. The EIT and CT images were fused using a region of interest (ROI) coregistration fusion algorithm. Phantom imaging experiments were carried out on objects of different contrasts, sizes, and positions. The conductive medium of the phantoms was made of a tissue-mimicking bolus material that is routinely used in clinical radiation therapy settings. To validate the imaging performance in detecting different contrasts, the ROI of the phantom was filled with distilled water and normal saline. Spatially separated cylindrical objects of different sizes were used for validating the imaging performance in multiple target detection. Analyses of the CT, EIT and the EIT/CT phantom images were carried out based on the variations of contrast, correlation, energy, and homogeneity, using a gray level co-occurrence matrix (GLCM). A reference image of the phantom was simulated using EIDORS, and the performances of the CT and EIT imaging systems were evaluated and compared against the performance of the EIT/CT system using various feature metrics, detectability, and structural similarity index measures. Results: In detecting distilled and normal saline water in bolus medium, EIT as a stand-alone imaging system showed contrast discrimination of 47%, while the CT imaging system showed a discrimination of only 1.5%. The structural similarity index measure showed a drop of 24% with EIT imaging compared to CT imaging. The average detectability measure for CT imaging was found to be 2.375 ± 0.19 before fusion. After complementing with EIT information, the detectability measure increased to 11.06 ± 2.04. Based on the feature metrics, the functional imaging quality of CT and EIT were found to be 2.29% and 86%, respectively, before fusion. Structural imaging quality was found to be 66% for CT and 16% for EIT. After fusion, functional imaging quality improved in CT imaging from 2.29% to 42% and the structural imaging quality of EIT imaging changed from 16% to 66%. The improvement in image quality was also observed in detecting objects of different sizes. Conclusions: The authors found a significant improvement in the contrast detectability performance of CT imaging when complemented with functional imaging information from EIT. Along with the feature assessment metrics, the concept of complementing CT with EIT imaging can lead to an EIT/CT imaging modality which might fully utilize the functional imaging abilities of EIT imaging, thereby enhancing the quality of care in the areas of cancer diagnosis and radiotherapy treatment planning.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Evaluation of interpolation methods for surface-based motion compensated tomographic reconstruction for cardiac angiographic C-arm data

Purpose: For interventional cardiac procedures, anatomical and functional information about the cardiac chambers is of major interest. With the technology of angiographic C-arm systems it is possible to reconstruct intraprocedural three-dimensional (3D) images from 2D rotational angiographic projection data (C-arm CT). However, 3D reconstruction of a dynamic object is a fundamental problem in C-arm CT reconstruction. The 2D projections are acquired over a scan time of several seconds, thus the projection data show different states of the heart. A standard FDK reconstruction algorithm would use all acquired data for a filtered backprojection and result in a motion-blurred image. In this approach, a motion compensated reconstruction algorithm requiring knowledge of the 3D heart motion is used. The motion is estimated from a previously presented 3D dynamic surface model. This dynamic surface model results in a sparse motion vector field (MVF) defined at control points. In order to perform a motion compensated reconstruction, a dense motion vector field is required. The dense MVF is generated by interpolation of the sparse MVF. Therefore, the influence of different motion interpolation methods on the reconstructed image quality is evaluated. Methods: Four different interpolation methods, thin-plate splines (TPS), Shepard's method, a smoothed weighting function, and a simple averaging, were evaluated. The reconstruction quality was measured on phantom data, a porcine model as well as on in vivo clinical data sets. As a quality index, the 2D overlap of the forward projected motion compensated reconstructed ventricle and the segmented 2D ventricle blood pool was quantitatively measured with the Dice similarity coefficient and the mean deviation between extracted ventricle contours. For the phantom data set, the normalized root mean square error (nRMSE) and the universal quality index (UQI) were also evaluated in 3D image space. Results: The quantitative evaluation of all experiments showed that TPS interpolation provided the best results. The quantitative results in the phantom experiments showed comparable nRMSE of Almost-Equal-To 0.047 {+-} 0.004 for the TPS and Shepard's method. Only slightly inferior results for the smoothed weighting function and the linear approach were achieved. The UQI resulted in a value of Almost-Equal-To 99% for all four interpolation methods. On clinical human data sets, the best results were clearly obtained with the TPS interpolation. The mean contour deviation between the TPS reconstruction and the standard FDK reconstruction improved in the three human cases by 1.52, 1.34, and 1.55 mm. The Dice coefficient showed less sensitivity with respect to variations in the ventricle boundary. Conclusions: In this work, the influence of different motion interpolation methods on left ventricle motion compensated tomographic reconstructions was investigated. The best quantitative reconstruction results of a phantom, a porcine, and human clinical data sets were achieved with the TPS approach. In general, the framework of motion estimation using a surface model and motion interpolation to a dense MVF provides the ability for tomographic reconstruction using a motion compensation technique.

60 APPLIED LIFE SCIENCES↗

Using Radiochromic Films to Characterize the Dispersion of ZrO{sub 2} Nano-sized Grain Clusters in Protective Polymer Composites

Radiation dosimetry is commonly used to prevent deterministic radiation effects in high dose medical procedures. Radiochromic films find nowadays widely application in radiotherapy, interventional procedures and CT exams for isodose and maximum skin dose measurements. Moreover the size of the irradiated area and its distribution can be performed through the reading of the individual components in the RGB-spectrum. Particularly, radiochromic film has multiple advantages over alternative dosimeters for low-kV X-rays dosimetry. Concerned to spatial resolution it is far superior to that of ionization chambers and thermoluminescent dosimeters. For high energy photon fields (keV to MeV) the most used radiochromic film commercially available belongs to the EBT Gafchromic{sup R} series. On the other hand, for low energy photon fields in the x-ray range (20 kVp to 200 kVp) the best choice belongs to the XR-QA Gafchromic{sup R} film series. In this work we demonstrate the possibility of generating 2D images of thin polymeric composites films using EBT3 and XR-QA2 Gafchromic{sup R} films exposed to 6 MeV and 40 keV x-ray photons, respectively, using the digital filtering tools of the ImageJ{sup R} free software. In this context, EBT3 films were placed on the surface of a rigid anthropomorphic phantom. Then, they were covered with a thermoplastic mask made of PCL polymer. This setup was then exposed to 2.0 Gy absorbed dose in the Linear Accelerator beam. The EBT3 films were then scanned in the high resolution mode in a commercial scanner and the images subsequently treated with digital filters. It is somehow possible to see the image of the thermoplastic mask in the scanned image. However, in the treated image it is easy to observe the mask arrangement. The unexpected phenomenon here is the EB3 film ability to detect the attenuation of high energy photons by a plastic material, which in turn has a very low mass-energy attenuation coefficient, producing a very clear 2D image. This result is discussed in terms of the high Z halides added to the sensitive layer of EB3 film, once the main components are C (42.3%), H (39.7%) and O (16.0%)1-2. Based on the above results, we have speculated about the abilities of XR-AQ films in the detection of the distribution of nano-sized particles that has high mass-energy attenuation coefficients for low energy x-rays, in polymer composites. In another investigation we tested the ability of XR-QA2 Gafchromic{sup R} films to evaluate the dispersion of ZrO{sub 2} nano-sized grain clusters in protective composites. The P(VDFTrFE)/ ZrO{sub 2} film was sandwiched between two XR-QA2 radiochromic films. In this setup, one radiochromic film is directly exposed to 100 mGy of the x-rays beam and another one measures the attenuated beam. After storage for 24 hours at room temperature under no light conditions, the irradiated radiochromic films were scanned under the same conditions in order to obtain a more reliable result. All films were scanned using the same size ROI in high resolution mode and saved as tagged image file format (TIFF). The untreated scanned image of the XR-AQ2 film directed exposed to the X-ray beam and the correspondent treated image with digital filters are shown. The untreated and treated image of the XR-AQ2 film that was exposed to the attenuated x-ray beam is shown. The image treated with digital filters seems to reproduce the dispersion of ZrO{sub 2} nano-sized grain clusters in the P(VDF-TrFE) copolymer matrix. This result is also discussed in terms of the high Z halides added to the sensitive layer of XR-AQ2 film and compared to the MEV images obtained from the P(VDF-TrFE)/ZrO{sub 2} composites. The results indicate a clear correlation between the 2D radiochromic image and the MEV photography.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

A bidirectional coupling procedure applied to multiscale respiratory modeling

In this study, we present a novel multiscale computational framework for efficiently linking multiple lower-dimensional models describing the distal lung mechanics to imaging-based 3D computational fluid dynamics (CFDs) models of the upper pulmonary airways in order to incorporate physiologically appropriate outlet boundary conditions. The framework is an extension of the modified Newton’s method with nonlinear Krylov accelerator developed by Carlson and Miller [1], Miller [2] and Scott and Fenves [3]. Our extensions include the retention of subspace information over multiple timesteps, and a special correction at the end of a timestep that allows for corrections to be accepted with verified low residual with as little as a single residual evaluation per timestep on average. In the case of a single residual evaluation per timestep, the method has zero additional computational cost compared to uncoupled or unidirectionally coupled simulations. We expect these enhancements to be generally applicable to other multiscale coupling applications where timestepping occurs. In addition we have developed a “pressure-drop” residual which allows for stable coupling of flows between a 3D incompressible CFD application and another (lower-dimensional) fluid system. We expect this residual to also be useful for coupling non-respiratory incompressible fluid applications, such as multiscale simulations involving blood flow. The lower-dimensional models that are considered in this study are sets of simple ordinary differential equations (ODEs) representing the compliant mechanics of symmetric human pulmonary airway trees. To validate the method, we compare the predictions of hybrid CFD–ODE models against an ODE-only model of pulmonary airflow in an idealized geometry. Subsequently, we couple multiple sets of ODEs describing the distal lung to an imaging-based human lung geometry. Boundary conditions in these models consist of atmospheric pressure at the mouth and intrapleural pressure applied to the multiple sets of ODEs. In both the simplified geometry and in the imaging-based geometry, the performance of the method was comparable to that of monolithic schemes, in most cases requiring only a single CFD evaluation per time step. Thus, this new accelerator allows us to begin combining pulmonary CFD models with lower-dimensional models of pulmonary mechanics with little computational overhead. Moreover, because the CFD and lower-dimensional models are totally separate, this framework affords great flexibility in terms of the type and breadth of the adopted lower-dimensional model, allowing the biomedical researcher to appropriately focus on model design. Research funded by the National Heart and Blood Institute Award 1RO1HL073598.

60 APPLIED LIFE SCIENCES↗

Radiation Field of Packages Carrying Spent Co-60 Radioactive Sources - 12437

Among the diverse radioactive sources commonly exploited in medical and industrial applications, Co- 60 is increasingly used as strong gamma emitter. Over time, source manufacturers favored Co-60 as opposed to other gamma emitters because its relatively short half-life (5.27 year) that minimizes issues related to the management of disused sources. Disused Co-60 sources can retain a significant amount of radioactivity (from hundreds of MBq to several GBq) that still poses safety concerns on their handling and transportation. In this context a detailed knowledge of their radiation field would provide the necessary information for taking actions in preventing unnecessary doses to the workers and the population by optimizing transportation procedures and handling operations. We modeled the geometry and the materials constituting a transportation packaging of a spent Co-60 source which had an original maximum activity of a few GBq and was enclosed in a small lead irradiator. Then we applied a Monte Carlo transport code (MCNP5) for tracking down the gamma photons emitted by the source, including the secondary photons resulting by the interaction of the source photons with the surrounding materials. This allowed for the evaluation of the radiation field inside and outside the packaging, and the corresponding equivalent dose useful for checking the compliance with the regulations and the health risk of possible radiation exposure. We found that a typical 60-liters drum carrying a spent Co-60 source, enclosed in its original irradiator, with a residual activity of 300 MBq could already overcome an equivalent dose of 0.2 mSv/h on the drum external surface, which is the maximum equivalent dose at any point of the surface for this packaging as prescribed by local regulations. This condition is even more apparent when the source is slightly displaced with respect to the rotation axis of the drum, an easily occurring condition for sources not properly packaged, generating non-compliant hot-spots on the drum surface. As an example, a displacement of 5 cm translates in an increase of 80% in the dose level on the nearest side of the drum. We also found that the equivalent dose is significantly influenced by the scattered source photons and the secondary photons, whose contribution to the radiation field is mainly determined by the package geometry. The developed model resulted in an important tool for exploring the detail of the radiation field of a spent Co-60 source packaged for transportation allowing to check for compliance with the regulations and to evaluate risks to the workers and the population. It is worth to point out that this modeling approach is completely general and can be applied to a variety of different problems not limited to the transportation of radioactive material. In the example illustrated in this work, a small Co-60 source inside its irradiator and properly packaged in a drum for transport, presents a hot-spot on the drum surface if the irradiator is displaced of just few centimeters with respect to the rotation axis of the drum. A Monte Carlo simulation provided a complete description of the radiation field in the volume surrounding the packaging as a function of photon energy showing that a significant contribution comes from source photons scattered by the package itself. As an example, the Transport Index (TI) of this packaging was calculated, resulting in a value of 0.5. This value is low when compared to the regulations, however suggests that an individual just 1 meter afar from the packaging receives, in a few hours, a dose comparable to that received with a radiograph. This might be the case of the driver of a truck transporting the packaging, in particular when a number of packages are transported at the same time. It is important to notice that the results presented in this work are general, and can be appropriately scaled to represent the radiation field of similar geometries with gamma sources of different activity. However, this quick application of a Monte Carlo simulation provides useful insights in the process of preparing a packaging for transport. This simple model suggests that this approach can be efficient for screening a number of packaging configurations and flagging those potentially not compliant with regulations, that will require a more thorough care in the packaging process. Furthermore the knowledge of the details of the radiation field can be useful for optimizing the geometry of the transport cargo, and becomes essential when a variety of packaging are transported or stored, in order to prevent hazardous situations during their handling, and hence preventing unnecessary doses to the workers and the populations. It is worth to point out that this modeling approach is completely general and can be applied to a variety of different problems not limited to the transportation of radioactive material. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

MO-PIS-Exhibit Hall-01: Imaging: CT Dose Optimization Technologies I

Partners in Solutions is an exciting new program in which AAPM partners with our vendors to present practical “hands-on” information about the equipment and software systems that we use in our clinics. The imaging topic this year is CT scanner dose optimization capabilities. Note that the sessions are being held in a special purpose room built on the Exhibit Hall Floor, to encourage further interaction with the vendors. Dose Optimization Capabilities of GE Computed Tomography Scanners Presentation Time: 11:15 – 11:45 AM GE Healthcare is dedicated to the delivery of high quality clinical images through the development of technologies, which optimize the application of ionizing radiation. In computed tomography, dose management solutions fall into four categories: employs projection data and statistical modeling to decrease noise in the reconstructed image - creating an opportunity for mA reduction in the acquisition of diagnostic images. Veo represents true Model Based Iterative Reconstruction (MBiR). Using high-level algorithms in tandem with advanced computing power, Veo enables lower pixel noise standard deviation and improved spatial resolution within a single image. Advanced Adaptive Image Filters allow for maintenance of spatial resolution while reducing image noise. Examples of adaptive image space filters include Neuro 3-D filters and Cardiac Noise Reduction Filters. AutomA adjusts mA along the z-axis and is the CT equivalent of auto exposure control in conventional x-ray systems. Dynamic Z-axis Tracking offers an additional opportunity for dose reduction in helical acquisitions while SmartTrack Z-axis Tracking serves to ensure beam, collimator and detector alignment during tube rotation. SmartmA provides angular mA modulation. ECG Helical Modulation reduces mA during the systolic phase of the heart cycle. SmartBeam optimization uses bowtie beam-shaping hardware and software to filter off-axis x-rays - minimizing dose and reducing x-ray scatter. The DICOM Radiation Dose Structured Report (RDSR) generates a dose report at the conclusion of every examination. Dose Check preemptively notifies CT operators when scan parameters exceed user-defined dose thresholds. DoseWatch is an information technology application providing vendor-agnostic dose tracking and analysis for CT (and all other diagnostic x-ray modalities) SnapShot Pulse improves coronary CTA dose management. VolumeShuttle uses two acquisitions to increase coverage, decrease dose, and conserve on contrast administration. Color-Coding for Kids applies the Broselow-Luten Pediatric System to facilitate pediatric emergency care and reduce medical errors. FeatherLight achieves dose optimization through pediatric procedure-based protocols. Adventure Series scanners provide a child-friendly imaging environment promoting patient cooperation with resultant reduction in retakes and patient motion. Philips CT Dose Optimization Tools and Advanced Reconstruction Presentation Time: 11:45 ‘ 12:15 PM The first part of the talk will cover “Dose Reduction and Dose Optimization Technologies” present in Philips CT Scanners. The main Technologies to be presented include: DoseRight and tube current modulation (DoseRight, Z-DOM, 3D-DOM, DoseRight Cardiac) Special acquisition modes Beam filtration and beam shapers Eclipse collimator and ClearRay collimator NanoPanel detector DoseRight will cover automatic tube current selection that automatically adjusts the dose for the individual patient. The presentation will explore the modulation techniques currently employed in Philips CT scanners and will include the algorithmic concepts as well as illustrative examples. Modulation and current selection technologies to be covered include the Automatic Current Selection component of DoseRight, ZDOM longitudinal dose modulation, 3D-DOM (combination of longitudinal and rotational dose modulation), Cardiac Dose right (an ECG based dose modulation scheme), and the DoseRight Index (DRI) IQ index. The special acquisition modes covers acquisition techniques such as prospective gating that is designed to reduce exposure to the patient through the Cardiac Step and Shoot scan mode. This mode can substitute the much higher dose retrospective scan modes for certain types of cardiac imaging. The beam filtration and beam shaper portion will discuss the variety of filtration and beam shaping configurations available on Philips scanners. This topic includes the x-ray beam characteristics, tube filtration as well as dose compensator characteristics. The Eclipse collimator, ClearRay collimator and the NanoPanel detector portion will discuss additional technologies specific to wide coverage CT that address some of the unique challenges encountered and techniques employed to optimize image quality and optimize dose utilization. The Eclipse collimator reduces extraneous exposure by actively blocking the radiation tails at either end of helical scans that do not contribute to the image generation. The ClearRay collimator and the NanoPanel detector optimize the quality of the signal that reaches the detectors by addressing the increased scattered radiation present in wide coverage and the NanoPanel detector adds superior electronic noise characteristics valuable when imaging at a low dose level. The second part of the talk will present “Advanced Reconstruction Technologies” currently available on Philips CT Scanners. The talk will cover filtered back projection (FBP), iDose4 and Iterative Model Reconstruction (IMR). Each reconstruction method will include a discussion of the algorithm as well as similarities and differences between the algorithms. Examples illustrating the merits of each algorithm will be presented, and techniques and metrics to characterize the performance of each type of algorithm will be presented. The Filtered Back projection portion will discuss and provide a brief summary of relevant standard image reconstruction techniques in common use, and discuss the common tradeoffs when using the FBP algorithm. The iDose4 portion will present the algorithms used for iDose4 as well the different levels. The meaning of different levels of iDose4 available will be presented and quantified. Guidelines for selection iDose4 parameters based on the imaging need will be explained. The different image quality goals available with iDose4 and specifically how iDose4 enables noise reduction, spatial resolution improvement or both will be explained. The approaches to leveraging the benefits of iDose4 such as improved spatial resolution, decreased noise, and artifact prevention will be described and quantified; and measurements and metrics behind the improvements will be presented. The image quality benefits in specific imaging situations as well as how to best combine the technology with other dose reduction strategies to ensure the best image quality at a given dose level will be presented. Insight into the IMR algorithm as well as contrast to the iDose4 techniques and performance characteristics will be discussed. Metrics and techniques for characterizing this class of algorithm and IQ performance will be presented. The image quality benefits and the dose reduction capabilities of IMR will be explored. Illustrative examples of the noise reduction, spatial resolution improvement, and low contrast detectability improvements of the reconstruction method will be presented: clinical cases and phantom measurements demonstrating the benefits of IMR in the areas of low dose imaging, spatial resolution and low contrast resolution are discussed and the technical details behind the measurements will be presented compared to both iDose4 and traditional filtered back projection (FBP)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗