Kanae Nishizawa

Enlarged longitudinal dose profiles in cone-beam CT and the need for modified dosimetry

In order to examine phantom length necessary to assess radiation dose delivered to patients in cone-beam CT with an enlarged beamwidth, we measured dose profiles in cylindrical phantoms of sufficient length using a prototype 256-slice CT-scanner developed at our institute. Dose profiles parallel to the rotation axis were measured at the central and peripheral positions in PMMA (polymethylmethacrylate) phantoms of 160 or 320 mm diameter and 900 mm length. For practical application, we joined unit cylinders (150 mm long) together to provide phantoms of 900 mm length. Dose profiles were measured with a pin photodiode sensor having a sensitive region of approximately 2.8 x 2.8 mm2 and 2.7 mm thickness. Beamwidths of the scanner were varied from 20 to 138 mm. Dose profile integrals (DPI) were calculated using the measured dose profiles for various beamwidths and integration ranges. For the body phantom (320-mm-diam phantom), 76% of the DPI was represented for a 20 mm beamwidth and 60% was represented for a 138 mm beamwidth if dose profiles were integrated over a 100 mm range, while more than 90% of the DPI was represented for beamwidths between 20 and 138 mm if integration was carried out over a 300 mm range. The phantom length and integration range for dosimetry of cone-beam CT needed to be more than 300 mm to represent more than 90% of the DPI for the body phantom with the beamwidth of more than 20 mm. Although we reached this conclusion using the prototype 256-slice CT-scanner, it may be applied to other multislice CT-scanners as well.

Determinations of organ doses and effective dose equivalents from computed tomographic examination

The organ or tissue doses were determined with a phantom measurement for 12 types of CT scanners widely used in Japan. Two types of thermoluminescent dosimeters were used for the dose determinations in a Rando woman phantom. The effective dose equivalents recommended by the International Commission on Radiological Protection were calculated using the measured organ or tissue doses. It was found that the CT scanners currently available give quite different organ or tissue doses. When selecting the optimum technical factors for scanning, therefore, it is important to take into consideration the balance of the image quality and the radiation exposure to patients.

Radiation dose evaluation in 64-slice CT examinations with adult and paediatric anthropomorphic phantoms

The objective of this study was to evaluate the organ dose and effective dose to patients undergoing routine adult and paediatric CT examinations with 64-slice CT scanners and to compare the doses with those from 4-, 8- and 16-multislice CT scanners. Patient doses were measured with small (<7 mm wide) silicon photodiode dosemeters (34 in total), which were implanted at various tissue and organ positions within adult and 6-year-old child anthropomorphic phantoms. Output signals from photodiode dosemeters were read on a personal computer, from which organ and effective doses were computed. For the adult phantom, organ doses (for organs within the scan range) and effective doses were 8-35 mGy and 7-18 mSv, respectively, for chest CT, and 12-33 mGy and 10-21 mSv, respectively, for abdominopelvic CT. For the paediatric phantom, organ and effective doses were 4-17 mGy and 3-7 mSv, respectively, for chest CT, and 5-14 mGy and 3-9 mSv, respectively, for abdominopelvic CT. Doses to organs at the boundaries of the scan length were higher for 64-slice CT scanners using large beam widths and/or a large pitch because of the larger extent of over-ranging. The CT dose index (CTDI(vol)), dose-length product (DLP) and the effective dose values using 64-slice CT for the adult and paediatric phantoms were the same as those obtained using 4-, 8- and 16-slice CT. Conversion factors of DLP to the effective dose by International Commission on Radiological Protection 103 were 0.024 mSvmGy(-1)cm(-1) and 0.019 mSvmGy(-1)cm(-1) for adult chest and abdominopelvic CT scans, respectively.

An effective method to verify line and point spread functions measured in computed tomography

This study describes an effective method for verifying line spread function (LSF) and point spread function (PSF) measured in computed tomography (CT). The CT image of an assumed object function is known to be calculable using LSF or PSF based on a model for the spatial resolution in a linear imaging system. Therefore, the validities of LSF and PSF would be confirmed by comparing the computed images with the images obtained by scanning phantoms corresponding to the object function. Differences between computed and measured images will depend on the accuracy of the LSF and PSF used in the calculations. First, we measured LSF in our scanner, and derived the two-dimensional PSF in the scan plane from the LSE Second, we scanned the phantom including uniform cylindrical objects parallel to the long axis of a patients body (z direction). Measured images of such a phantom were characterized according to the spatial resolution in the scan plane, and did not depend on the spatial resolution in the z direction. Third, images were calculated by two-dimensionally convolving the true object as a function of space with the PSF. As a result of comparing computed images with measured ones, good agreement was found and was demonstrated by image subtraction. As a criterion for evaluating quantitatively the overall differences of images, we defined the normalized standard deviation (SD) in the differences between computed and measured images. These normalized SDs were less than 5.0% (ranging from 1.3% to 4.8%) for three types of image reconstruction kernels and for various diameters of cylindrical objects, indicating the high accuracy of PSF and LSF that resulted in successful measurements. Further, we also obtained another LSF utilizing an inappropriate manner, and calculated the images as above. This time, the computed images did not agree with the measured ones. The normalized SDs were 6.0% or more (ranging from 6.0% to 13.8%), indicating the inaccuracy of the PSF and LSE We could verify LSFs and PSFs for three types of reconstruction kernels, and demonstrated differences between modulation transfer functions (MTFs) derived from validated LSFs and inaccurate LSFs. Our technique requires a simple phantom that is suitable for clinical scanning, and does not require a particular phantom containing some metals or specific fine structures, as required in methods previously used for measurements of spatial resolution. Therefore, the scanned image of the phantom will be reliable and of good quality, and this is used directly as a confident reference image for the verification. When one obtains LSF, PSF or MTF values, verification using our method is recommended. Further, when another method for the measurement of LSF and PSF is developed, it could be validated using our technique, as illustrated in the method proposed by Boone [Med. Phys. 28, 356-360 (2001)] and used in this paper.

Prototype heel effect compensation filter for cone-beam CT

The prototype cone-beam CT (CBCT) has a larger beam width than the conventional multi-detector row CT (MDCT). This causes a non-uniform angular distribution of the x-ray beam intensity known as the heel effect. Scan conditions for CBCT tube current are adjusted on the anode side to obtain an acceptable clinical image quality. However, as the dose is greater on the cathode side than on the anode side, the signal-to-noise ratio on the cathode side is excessively high, resulting in an unnecessary dose amount. To compensate for the heel effect, we developed a heel effect compensation (HEC) filter. The HEC filter rendered the dose distribution uniform and reduced the dose by an average of 25% for free air and by 20% for CTDI phantoms compared to doses with the conventional filter. In addition, its effect in rendering the effective energy uniform resulted in an improvement in image quality. This new HEC filter may be useful in cone-beam CT studies.

EFFECTIVE DOSES IN FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY FOR LUNG RADIOTHERAPY PLANNING

The recent broad adoption of 4-D computed tomography (4DCT) scanning in radiotherapy has allowed the accurate determination of the target volume of tumors by minimizing image degradation caused by respiratory motion. Although the radiation exposure of the treatment beam is significantly greater than that of CT scans used for treatment planning, it is important to recognize and optimize the radiation exposure in 4DCT from the radiological protection point of view. Here, radiation exposure in 4DCT was measured with a 16 multidetector CT. Organ doses were measured using thermoluminescence radiation dosimeter chips inserted at respective anatomical sites of an anthropomorphic phantom. Results were compared with those with the helical CT scan mode. The effective dose measured for 4DCT was 24.7 mSv, approximately four times higher than that for helical CT. However, the increase in treatment accuracy afforded by 4DCT means its use in radiotherapy is inevitable. The patient exposure in the 4DCT could be of value by clarifying the advantage of the treatment planning using 4DCT.

Determination of point spread function in computed tomography accompanied with verification

A method for verifying the point spread function (PSF) measured by computed tomography has been previously reported [Med. Phys. 33, 2757-2764 (2006)]; however, this additional PSF verification following measurement is laborious. In the present study, the previously described verification method was expanded to PSF determination. First, an image was obtained by scanning a phantom. The image was then two-dimensionally deconvolved with the object function corresponding to the phantom structure, thus allowing the PSF to be obtained. Deconvolution is implemented simply by division of spatial frequencies (corresponding to inverse filtering), in which two parameters are used as adjustable ones. Second, an image was simulated by convolving the object function with the obtained PSF, and the simulated image was compared to the above-measured image of the phantom. The difference indicates the inaccuracy of the PSF obtained by deconvolution. As a criterion for evaluating the difference, the authors define the mean normalized standard deviation (SD) in the difference between simulated and measured images. The above two parameters for deconvolution can be adjusted by referring to the subsequent mean normalized SD (i.e., the PSF is determined so that the mean normalized SD is decreased). In this article, the parameters were varied in a fixed range with a constant increment to find the optimal parameter setting that minimizes the mean normalized SD. Using this method, PSF measurements were performed for various types of image reconstruction kernels (21 types) in four kinds of scanners. For the 16 types of kernels, the mean normalized SDs were less than 2.5%, indicating the accuracy of the determined PSFs. For the other five kernels, the mean normalized SDs ranged from 3.7% to 4.8%. This was because of a large amount of noise in the measured images, and the obtained PSFs would essentially be accurate. The method effectively determines the PSF, with an accompanying verification, after one scanning of a phantom.

Imaging of small spherical structures in CT: simulation study using measured point spread function

Size and density measurements of objects undertaken using computed tomography (CT) are clinically significant for diagnosis. To evaluate the accuracy of these quantifications, we simulated three-dimensional (3D) CT image blurring; this involved the calculation of the convolution of the 3D object function with the measured 3D point spread function (PSF). We initially validated the simulation technique by performing a phantom experiment. Blurred computed images showed good 3D agreement with measured images of the phantom. We used this technique to compute the 3D blurred images from the object functions, in which functions are determined to have the shape of an ideal sphere of varying diameter and assume solitary pulmonary nodules with a uniform density. The accuracy of diameter and density measurements was determined. We conclude that the proposed simulation technique enables us to estimate the image blurring precisely of any 3D structure and to analyze clinical images quantitatively.

Leukaemia and lymphoma mortality in the vicinity of nuclear power stations in Japan, 1973-1987

In many countries, studies have been carried out on cancer mortality near nuclear facilities. In the present paper, we examine the standardised mortality ratios (SMR) and the relative risks (RR) of five malignant neoplasms (leukaemia, malignant lymphoma, non-Hodgkin`s lymphoma, multiple myeloma and acute non-lymphatic leukaemia) for two age groups (0-14 years and all ages) during different periods (1973-1977, 1978-1982, 1983-1987 and 1973-1987) in the 18 site municipalities and in the four control municipalities selected near each nuclear power station site in Japan. For some sites, as well as for control groups, SMRs of certain malignant neoplasms were sometimes high, even before the startup of a nuclear power station. It is concluded that leukaemia and lymphoma mortality in the Japanese municipalities containing nuclear power stations is not significantly different from the control areas.

Research on potential radiation risks in areas with nuclear power plants in Japan: leukaemia and malignant lymphoma mortality between 1972 and 1997 in 100 selected municipalities.

The results of a geographical correlation study using Poisson regression analysis are reported for leukaemia and malignant lymphoma mortality between 1972 and 1997 in 100 selected Japanese municipalities with or without a nuclear power plant (NPP). The data did not support social concerns of an increased risk of malignant lymphoma in the vicinity of Japanese NPPs. However, some estimates of overall excess relative risk (ERR; relative risk minus one) were statistically significantly positive for leukaemia mortality in 20 NPP municipalities compared with mortality in the remaining 80 control areas, taking into account a minimum two-year latency following the start of commercial operation. One estimate was 0.228 (95% CI: 0.074-0.404) from a simple area adjustment using the mortality in all Japan as the external baseline rate. This superficial increase is not due to leukaemia among young people, aged less than 25 years at death. The ERR estimate for ages at death of 50-74 years was confounded to be positive for leukaemia and distorted to be negative for malignant lymphoma. For leukaemia, a positive ERR estimate was seen, especially for females and during specific periods. Confounding of the ERR estimate for two causes was also seen in some NPP areas including a high adult T-cell leukaemia (ATL) area. Temporal area variations associated with ATL misclassification and a temporal increasing trend of leukaemia mortality in the elderly caused the confounding effects. Our findings do not support the hypothesis of a leukaemogenic impact of NPPs in Japan.