G. Panayiotakis

A review of patient dose and optimisation methods in adult and paediatric CT scanning

An increasing number of publications and international reports on computed tomography (CT) have addressed important issues on optimised imaging practice and patient dose. This is partially due to recent technological developments as well as to the striking rise in the number of CT scans being requested. CT imaging has extended its role to newer applications, such as cardiac CT, CT colonography, angiography and urology. The proportion of paediatric patients undergoing CT scans has also increased. The published scientific literature was reviewed to collect information regarding effective dose levels during the most common CT examinations in adults and paediatrics. Large dose variations were observed (up to 32-fold) with some individual sites exceeding the recommended dose reference levels, indicating a large potential to reduce dose. Current estimates on radiation-related cancer risks are alarming. CT doses account for about 70% of collective dose in the UK and are amongst the highest in diagnostic radiology, however the majority of physicians underestimate the risk, demonstrating a decreased level of awareness. Exposure parameters are not always adjusted appropriately to the clinical question or to patient size, especially for children. Dose reduction techniques, such as tube-current modulation, low-tube voltage protocols, prospective echocardiography-triggered coronary angiography and iterative reconstruction algorithms can substantially decrease doses. An overview of optimisation studies is provided. The justification principle is discussed along with tools that assist clinicians in the decision-making process. There is the potential to eliminate clinically non-indicated CT scans by replacing them with alternative examinations especially for children or patients receiving multiple CT scans.

Evaluating x-ray detectors for radiographic applications: A comparison of ZnSCdS:Ag with and screens

ZnSCdS:Ag was evaluated as a radiographic image receptor and was compared with and phosphors often used in radiography. The evaluation of a radiographic receptor was modelled as a three-step process: (i) determination of light output intensity as related to the input radiation dose, (ii) determination of visible light characteristics with respect to radiographic optical detectors, and (iii) determination of image information transfer efficiency. The light intensity emitted per unit of x-ray exposure rate was measured and theoretically calculated for laboratory prepared screens with coating thicknesses from 20 to and tube voltages from 50 to 250 kVp. ZnSCdS:Ag light intensity was higher than that of or for tube voltages less than 70 and 80 kVp respectively. ZnSCdS:Ag displayed the highest x-ray to light conversion efficiency (0.207) and had optical properties close to those of and , and its emission spectrum was well matched to optical detectors. The image information transfer properties described by the modulation transfer function, the quantum noise transfer function, and the detective quantum efficiency were calculated for both general radiographic and mammographic conditions and were found to be intermediate between those of and screens. Conclusively, ZnSCdS:Ag is an efficient phosphor well suited to radiography.

An evaluation of the Y2O3:Eu3+ scintillator for application in medical x-ray detectors and image receptors.

The suitability off a Y2O3:Eu3+ scintillator for use in radiation detectors and medical image receptors was studied. Y2O3:Eu3+ was used in the form of laboratory prepared screens of different coating thicknesses. The x-ray luminescence efficiency of the screens was measured for tube voltages between 50-200 kVp and in both transmission and reflection modes of observation. The intrinsic x ray to light conversation efficiency (nc) and other parameters of the Y2O3:Eu3+ phosphor material related to optical scattering, absorption, and reflection were determined. These were used in the calculation of the image transfer characteristics, MTF and zero frequency DQE, for various screen coating thicknesses and x-ray tube voltages. The light emission spectrum of Y2O3:Eu3+ was measured (narrow band peak at 613 nm) and its spectral compatibility to the spectral sensitivity of several commonly employed optical photon detectors was determined. The x-ray luminescence efficiency varied with x-ray tube voltage, attaining maximum value at about 80 kVp for all screen thicknesses. It also varied with coating thickness reaching 25 microW m(-2)/mR s(-1) and 18 microW m(-2)/mR s(-1) at 175 mg/cm2 for reflection and transmission modes, respectively. The intrinsic x ray to light conversion efficiency and the image transfer characteristics were found to be comparable to several commercially used phosphors: nc = 0.095, MTF0.05 ranged between 10 and 25 line pairs per mm and peal values of DQE(0) varied between 0.33 and 0.14 in the coating thickness and kVp ranges useful for x-ray imaging. Spectral compatibility to some red sensitive optical photon detectors was excellent (0.9 or better). Results indicated that Y2O3:Eu3+ is a medium to high overall performance material that could be used in medical x-ray detectors and image receptors.

Monte Carlo generated mammograms : development and validation

We have developed a model using Monte Carlo methods to simulate x-ray mammography. All possible physical processes of interaction of x-rays with matter have been taken into account. A simplified geometry of the mammographic apparatus has been considered along with a software phantom of compressed breast. The phantom may contain inhomogeneities of various compositions and sizes. We have used this model to produce Monte Carlo mammograms under realistic conditions. The validation of the simulation includes both the modelling of physical processes and the production of Monte Carlo mammograms. The first part is accomplished by the demonstration of the coincidence between Monte Carlo and theoretical data, whereas the second is accomplished by the comparison of real mammograms, taken from irradiation of a simplified breast phantom that we have constructed, and Monte Carlo mammograms taken from simulation of the above phantom under the corresponding exposure conditions. The limitations of the model as well as the future use of Monte Carlo mammograms are discussed.

X-ray luminescence of ZnSCdS:Au,Cu phosphor using X-ray beams for medical applications

Abstract The purpose of the present study was to evaluate the X-ray luminescence and imaging performance of phosphor screens prepared from ZnSCdS:Au,Cu. Absolute efficiency, X-ray luminescence efficiency, detector optical gain, and gain transfer function were experimentally determined. Theoretical models were also employed to fit experimental data and to determine optical properties of the phosphor material. Additionally, the emission spectrum of ZnSCdS:Au,Cu was measured and its compatibility with the spectral sensitivity of radiographic optical detectors (films, photodiodes) was determined. Results showed that ZnSCdS:Au,Cu is an efficient phosphor exhibiting high intrinsic X-ray to light conversion efficiency (0.17) and an excellent spectral compatibility (0.9) with amorphous silicon photodiodes, used in optical detectors of modern digital radiography systems.

A study of X-ray luminescence and spectral compatibility of europium-activated yttrium-vanadate (YVO4: Eu) screens for medical imaging applications

The X-ray luminescence efficiency of laboratory-prepared YVO4: Eu screens and their spectral compatibility to common optical detectors were studied under medical fluoroscopy conditions. YVO4: Eu screens were prepared by sedimentation and with different coating thickness. Luminescence efficiency of the YVO4: Eu screens was measured at various X-ray tube voltages (50–250 kVp) and for screens of different coating thicknesses (20–180 mg/cm2). Spectral response was also measured and spectral matching factors between the YVO4: Eu screens and some common optical detectors (photocathodes, photodiodes, photographic emulsion) were calculated. Experimental results on efficiency were fitted by formulas of the theoretical model developed by Hamaker and Ludwig in order to determine phosphor intrinsic X-ray-to-light conversion efficiency and intrinsic optical characteristics, such as coefficients related to light scattering and absorption. Although the luminescence efficiency of YVO4: Eu screens was found to be relatively low (3–11 μM s/mR m2), the matching factor of YVO4 : Eu screens with some red sensitive optical detectors was excellent, of the order of 0.96. High spectral compatibility may indicate that YVO4: Eu scintillators could be used in medical image detectors.

Modeling quantum and structure noise of phosphors used in medical X-ray imaging detectors

The noise properties of granular phosphors used in X-ray imaging detectors are studied in terms of a noise transfer function, NTF. This study is performed in high-exposure conditions where the contribution of structure noise to total screen noise is considerable. An analytical model, based on the cascaded linear systems methodology presented in the literature, is developed. This model takes into account the quantum noise and structure noise. Furthermore, it considers the effect of the K X-rays reabsorption on the phosphor material and the effect of screen thickness on the NTF. The model was validated against experimental results obtained by a set of Zn2SiO4:Mn phosphor screens prepared by sedimentation. The model may be used to evaluate the effect of screen thickness and the effect of the characteristic Xrays on NTF in high-exposure conditions where structure noise is considerable. r 2002 Elsevier Science B.V. All rights reserved.

Suitability of new anode materials in mammography: Dose and subject contrast considerations using Monte Carlo simulation

Mammography is the technique with the highest sensitivity and specificity, for the early detection of nonpalpable lesions associated with breast cancer. As screening mammography refers to asymptomatic women, the task of optimization between the image quality and the radiation dose is critical. A way toward optimization could be the introduction of new anode materials. A method for producing the x-ray spectra of different anode/filter combinations is proposed. The performance of several mammographic spectra, produced by both existing and theoretical anode materials, is evaluated, with respect to their dose and subject contrast characteristics, using a Monte Carlo simulation. The mammographic performance is evaluated utilizing a properly designed mathematical phantom with embedded inhomogeneities, irradiated with different spectra, based on combinations of conventional and new (Ru, Ag) anode materials, with several filters (Mo, Rh, Ru, Ag, Nb, Al). An earlier developed and validated Monte Carlo model, for deriving both image and dose characteristics in mammography, was utilized and overall performance results were derived in terms of subject contrast to dose ratio and squared subject contrast to dose ratio. Results demonstrate that soft spectra, mainly produced from Mo, Rh, and Ru anodes and filtered with k-edge filters, provide increased subject contrast for inhomogeneities of both small size, simulating microcalcifications and low density, simulating masses. The harder spectra (W and Ag anode) come short in the discrimination task but demonstrate improved performance when considering the dose delivered to the breast tissue. As far as the overall performance is concerned, new theoretical spectra demonstrate a noticeable good performance that is similar, and in some cases better compared to commonly used systems, stressing the possibility of introducing new materials in mammographic practice as a possible contribution to its optimization task. In the overall optimization task in terms of subject contrast to dose ratio, tube voltage was found to have a minor effect, while with respect to the filter material, a lesion specific performance was noticed, with Al filtered spectra showing improved characteristics in case of the inhomogeneities simulating microcalcifications, while softer k-edge filtered spectra are more suitable for the discrimination of inhomogeneities simulating masses.

A Monte Carlo simulation model of mammographic imaging with x-ray sources of finite dimensions.

A simulation model of mammographic x-ray sources with finite size has been developed. The model is based on Monte Carlo methods and it takes into account the electron penetration inside the anode, the anode geometry and material, as well as the resulting heel effect and the spectral and spatial distribution of x-rays. This x-ray source simulation model has been embedded into an earlier developed simulation package of a mammography unit. The main outputs of this model are Monte Carlo generated images that correspond to the irradiation of properly designed phantoms. In this way it is possible to make studies of the influence of x-ray source characteristics on MTF. This paper presents the development of the mammographic x-ray source model, accompanied by a set of simulation studies concerning the influence of magnification effects as well as that of the x-ray spatial and spectral distribution on the mammographic spatial resolution for a certain magnification factor (m = 1.4). The validity level of the model, as well as its limitations and perspectives, rise through comparisons with experimental and theoretical data.

An experimental method for the determination of spatial-frequency-dependent detective quantum efficiency (DQE) of scintillators used in X-ray imaging detectors

Abstract The spatial-frequency-dependent detective quantum efficiency (DQE) of imaging scintillators was studied independently of the optical detector (film, photocathode, or photodiode) employed in medical imaging devices. A method was developed to experimentally determine the scintillator DQE in terms of its luminescence efficiency (LE), quantum detection efficiency, modulation transfer function, and light emission spectrum. Gd2O2S : Tb, La2O2S : Tb, Y2O2S : Tb and ZnSCdS : Ag scintillating screens were prepared in laboratory and were excited to luminescence by a medical X-ray tube. Maximum DQE values varied between 0.13 and 0.33 depending on the scintillator material, the screen coating weight, and the tube voltage; Gd2O2S : Tb was superior to La2O2S : Tb followed by ZnSCdS : Ag and Y2O2S : Tb. This ranking was maintained at frequencies up to 100 cycles/cm. Considering the same material, DQE of thin screens was found superior to DQE of thicker screens at medium-to-high frequencies. The proposed method allows for the comparison of imaging characteristics of scintillating materials without the inclusion of optical detector imaging properties.