Alisa Walz-Flannigan

Dose Reduction in Helical CT: Dynamically Adjustable z-Axis X-Ray Beam Collimation

OBJECTIVE The purpose of this study was to measure the dose reduction achieved with dynamically adjustable z-axis collimation. MATERIALS AND METHODS A commercial CT system was used to acquire CT scans with and without dynamic z-axis collimation. Dose reduction was measured as a function of pitch, scan length, and position for total incident radiation in air at isocenter, accumulated dose to the center of the scan volume, and accumulated dose to a point at varying distances from a scan volume of fixed length. Image noise was measured at the beginning and center of the scan. RESULTS The reduction in total incident radiation in air at isocenter varied between 27% and 3% (pitch, 0.5) and 46% and 8% (pitch, 1.5) for scan lengths of 20 and 500 mm, respectively. Reductions in accumulated dose to the center of the scan were 15% and 29% for pitches of 0.5 and 1.5 for 20-mm scans. For scan lengths greater than 300 mm, dose savings were less than 3% for all pitches. Dose reductions 80 mm or farther from a 100-mm scan range were 15% and 40% for pitches of 0.5 and 1.5. With dynamic z-axis collimation, noise at the extremes of a helical scan was unchanged relative to noise at the center. Estimated reductions in effective dose were 16% (0.4 mSv) for the head, 10% (0.8 and 1.4 mSv) for the chest and liver, 6% (0.8 mSv) for the abdomen and pelvis, and 4% (0.4 mSv) and 55% (1.0 mSv) for coronary CT angiography at pitches of 0.2 and 3.4. CONCLUSION Use of dynamic z-axis collimation reduces dose in helical CT by minimizing overscanning. Percentage dose reductions are larger for shorter scan lengths and greater pitch values.

ACR–AAPM–SIIM Practice Guideline for Digital Radiography

This guideline was developed collaboratively by the American College of Radiology (ACR), the American Association of Physicists in Medicine (AAPM), and the Society for Imaging Informatics in Medicine (SIIM). Increasingly, medical imaging and patient information are being managed using digital data during acquisition, transmission, storage, display, interpretation, and consultation. The management of these data during each of these operations may have an impact on the quality of patient care. “CR” and “DR” are the commonly used terms for digital radiography detectors. CR is the acronym for computed radiography, and DR is an acronym for digital radiography. CR uses a photostimulable storage phosphor that stores the latent image, which is subsequently read out using a stimulating laser beam. It can be easily adapted to a cassette-based system analogous to that used in screen-film (SF) radiography. Historically, the acronym DR has been used to describe a flat-panel digital X-ray imaging system that reads the transmitted X-ray signal immediately after exposure with the detector in place. Generically, the term CR is applied to passive detector systems, while the term DR is applied to active detectors. This guideline is applicable to the practice of digital radiography. It defines motivations, qualifications of personnel, equipment guidelines, data manipulation and management, and quality control (QC) and quality improvement procedures for the use of digital radiography that should result in high-quality radiological patient care. In all cases for which an ACR practice guideline or technical standard exists for the modality being used or the specific examination being performed, that guideline or standard will continue to apply when digital image data management systems are used.

Artifacts in Digital Radiography

OBJECTIVE The purpose of this article is to discuss flat-panel digital radiography (DR) artifacts to help physicists, radiologists, and radiologic technologists visually familiarize themselves with an expanded range of artifact appearance. CONCLUSION Flat-panel DR is a growing area of general radiography. As a radiology community, we are still becoming familiar with these systems and learning about clinically relevant artifacts and how to avoid them. These artifacts highlight important limitations or potential complications in using flat-panel DR systems.

An online cross-scatter correction algorithm for dual-source CT: effects on CT number accuracy and noise

Dual-source computed tomography (CT) utilizes two x-ray tubes and two detectors simultaneously for the purpose of obtaining 83 msec temporal resolution, 160 kW of x-ray power reserve, or dual-kV (dual-energy) scan capabilities. One inherent constraint of such a design is cross-scatter radiation, which occurs when x-rays from tube A are scattered by the patient and detected by detector B, or vice versa. In the evaluated dual-source CT scanner, an on-line cross-scatter correction technique is used to address this limitation. The technique, available using the 14×1.2-mm collimation, measures scattered radiation along the z axis using detector rows beyond those corresponding to the 16.8 mm nominal total beam width. These direct measurements of scattered radiation are used to correct the measured projection data (scattered and primary radiation) for cross-scatter. A semi-anthropomorphic thorax phantom was used with increasing thicknesses of tissue-equivalent material to simulate small, medium, large and extra-large patients. Phantoms were scanned using single-source and dual-source protocols at 80, 100, 120 and 140 kV, and the mean and standard deviation of the CT numbers in a water-equivalent cylinder located centrally within the phantom measured. For this comparison, images reconstructed using only tube A data from the dual-source acquisition were compared to the single-source images, also obtained using tube A. The differences in the mean and standard deviation of the measured CT numbers between the dual-source tube A images, which were corrected for cross-scatter, and the single-source images, where no cross-scatter existed, were determined for all tube energies and phantom sizes. The differences in mean CT number ranged from -5.2 to 1.3 HU, and the differences in standard deviations ranged from -4.5 to 3.0 HU. We conclude, therefore, that use of the evaluated on-line cross-scatter correction algorithm results in negligible differences in CT number and image noise between single-source and dual-source image data, independent of phantom size and tube potential.

Implementing a Radiology- Information Technology Project: Mobile Image Viewing Use Case and a General Guideline for Radiologist-Information Technology Team Collaboration

OBJECTIVE This article illustrates the importance of radiologist engagement in the successful implementation of radiology-information technology (IT) projects through the example of establishing a mobile image viewing solution for health care professionals. CONCLUSION With an understanding of the types of decisions that benefit from radiologist input, this article outlines an overall project framework to provide a context for how radiologists might engage in the project cycle.

SU-E-I-15: Comparison of Radiation Dose for Radiography and EOS in Adolescent Scoliosis Patients

PURPOSE To estimate patient radiation dose for whole spine imaging using EOS, a new biplanar slot-scanning radiographic system and compare with standard scoliosis radiography. METHODS The EOS imaging system (EOS Imaging, Paris, France) consists of two orthogonal x-ray fan beams which simultaneously acquire frontal and lateral projection images of a standing patient. The patient entrance skin air kerma was measured for each projection image using manufacturer-recommended exposure parameters for spine imaging. Organ and effective doses were estimated using a commercially-available Monte Carlo simulation program (PCXMC, STUK, Radiation and Nuclear Safety Authority, Helsinki, Finland) for a 15 year old mathematical phantom model. These results were compared to organ and effective dose estimated for scoliosis radiography using computed radiography (CR) with standard exposure parameters obtained from a survey of pediatric radiographic projections. RESULTS The entrance skin air kerma for EOS was found to be 0.18 mGy and 0.33 mGy for posterior-anterior (PA) and lateral projections, respectively. This compares to 0.76 mGy and 1.4 mGy for CR, PA and lateral projections. Effective dose for EOS (PA and lateral projections combined) is 0.19 mSv compared to 0.51 mSv for CR. CONCLUSION The EOS slot-scanning radiographic system allows for reduced patient radiation dose in scoliosis patients as compared to standard CR radiography.

Human contrast-detail performance with declining contrast.

PURPOSE How do display settings and ambient lighting affect contrast detection thresholds for human observers? Can recalibrating a display for high ambient lighting improve object detection? METHODS Contrast∕detail (CD) threshold detection performance was measured for observers using four color displays with varying overall contrast (e.g., differing maximum luminance and ambient lighting conditions). Detailed mapping of contrast detection performance (for fixed object size) was tracked as a function of: display maximum luminance, ambient lighting changes (with and without recalibrating for the higher ambience), and the performance of radiologists vs. nonradiologists. RESULTS The initial phase was analyzed with a hierarchical linear model of observer performance using: background gray level, maximum display luminance, and radiologist vs. nonradiologist. The only statistically significant finding was a maximum luminance of 100 cd∕m(2) display performing worse than a baseline peak of 400 cd∕m(2). The second phase examined ambient lighting effects on detection thresholds. Background gray level and maximum display luminance were examined coupled with ambient lighting for: baseline at 30, 435 uncorrected, and 435 lx with display recalibration for the ambient conditions. Results showed ambient correction improved sensitivity for small background digital driving level, but not at higher luminance backgrounds. CONCLUSIONS For CD study, nonradiologist observers can be used without loss of applicability. Contrast detection thresholds improved significantly between displays with peak luminance from 100 cd∕m(2) to 200 cd∕m(2), but improvement beyond that was not statistically significant for contrast detection thresholds in a reading room environment. Applying a calibration correction at high ambience (435 lx) improved detection tasks primarily in the darker background regions.

Aging and Quality Control of Color LCDs for Radiologic Imaging

Our practice has long been concerned with the effects of display quality, including color accuracy and matching among paired color displays. Three years of data have been collected on the historical behavior of color stability on our clinical displays. This has permitted an analysis of the color-aging behavior of those displays over that time. The results of that analysis show that all displays tend to yellow over time, but that they do so together. That is, neither the intra- nor inter-display color variances observed at initial deployment diverge over time as measured by a mean radial distance metric in color space (Commission Internationale d’Eclairage L’, u’, v’ 1976). The consequence of this result is that color displays that are matched at deployment tend to remain matched over their lifetime even as they collectively yellow.

Pictorial Review of Digital Radiography Artifacts

Visual familiarity with the variety of digital radiographic artifacts is needed to identify, resolve, or prevent image artifacts from creating issues with patient imaging. Because the mechanism for image creation is different between flat-panel detectors and computed radiography, the causes and appearances of some artifacts can be unique to these different modalities. Examples are provided of artifacts that were found on clinical images or during quality control testing with flat-panel detectors. The examples are meant to serve as learning tools for future identification and troubleshooting of artifacts and as a reminder for steps that can be taken for prevention. The examples of artifacts provided are classified according to their causal connection in the imaging chain, including an equipment defect as a result of an accident or mishandling, debris or gain calibration flaws, a problematic acquisition technique, signal transmission failures, and image processing issues. Specific artifacts include those that are due to flat-panel detector drops, backscatter, debris in the x-ray field during calibration, detector saturation or underexposure, or collimation detection errors, as well as a variety of artifacts that are processing induced. ©RSNA, 2018.

SU-G-IeP3-14: Updating Tools for Radiographic Technique Charts

PURPOSE Manual technique selection in radiography is needed for imaging situations where there is difficulty in proper positioning for AEC, prosthesis, for non-bucky imaging, or for guiding image repeats. Basic information about how to provide consistent image signal and contrast for various kV and tissue thickness is needed to create manual technique charts, and relevant for physicists involved in technique chart optimization. Guidance on technique combinations and rules-of-thumb to provide consistent image signal still in use today are based on measurements with optical density of screen-film combinations and older generation x-ray systems. Tools such as a kV-scale chart can be useful to know how to modify mAs when kV is changed in order to maintain consistent image receptor signal level. We evaluate these tools for modern equipment for use in optimizing proper size scaled techniques. METHODS We used a water phantom to measure calibrated signal change for CR and DR (with grid) for various beam energies. Tube current values were calculated that would yield a consistent image signal response. Data was fit to provide sufficient granularity of detail to compose technique-scale chart. Tissue thickness approximated equivalence to 80% of water depth. RESULTS We created updated technique-scale charts, providing mAs and kV combinations to achieve consistent signal for CR and DR for various tissue equivalent thicknesses. We show how this information can be used to create properly scaled size-based manual technique charts. CONCLUSION Relative scaling of mAs and kV for constant signal (i.e. the shape of the curve) appears substantially similar between film-screen and CR/DR. This supports the notion that image receptor related differences are minor factors for relative (not absolute) changes in mAs with varying kV. However, as demonstrated creation of these difficult to find detailed technique-scales are useful tools for manual chart optimization.