Kate Leeann Bechtel

X-ray dose reduction by adaptive source equalization and electronic region-of-interest control

Radiation dose is particularly a concern in pediatric cardiac fluoroscopy procedures, which account for 7% of all cardiac procedures performed. The Scanning-Beam Digital X-ray (SBDX) fluoroscopy system has already demonstrated reduced dose in adult patients owing to its high-DQE photon-counting detector, reduced detected scatter, and the elimination of the anti-scatter grid. Here we show that the unique flexible illumination platform of the SBDX system will enable further dose area product reduction, which we are currently developing for pediatric patients, but which will ultimately benefit all patients. The SBDX system has a small-area detector array and a large-area X-ray source with up to 9,000 individually-controlled X-ray focal spots. Each focal spot illuminates a small fraction of the full field of view. To acquire a frame, each focal spot is activated for a fixed number of 1-microsecond periods. Dose reduction is made possible by reducing the number of activations of some of the X-ray focal spots during each frame time. This can be done dynamically to reduce the exposure in areas of low patient attenuation, such as the lung field. This spatially-adaptive illumination also reduces the dynamic range in the full image, which is visually pleasing. Dose can also be reduced by the user selecting a region of interest (ROI) where full image quality is to be maintained. Outside the ROI, the number of activations of each X-ray focal spot is reduced and the image gain is correspondingly increased to maintain consistent image brightness. Dose reduction is dependent on the size of the ROI and the desired image quality outside the ROI. We have developed simulation software that is based on real data and can simulate the performance of the equalization and ROI filtration. This software represents a first step toward real-time implementation of these dose-reduction methods. Our simulations have shown that dose area product reductions of 40% are possible using equalization, and dose savings as high as 74% are possible with the ROI approach. The dose reduction achieved in clinical use will depend on patient anatomy.

Modeling of transdermal fluorescence measurements from first-in-human clinical trials for renal function determination using fluorescent tracer agent MB-102

The fluorescent tracer agent 3,6-diamino-2,5-bisN-[(1R)-1-carboxy-2-hydroxyethyl]carbamoylpyrazine, designated MB-102, is cleared from the body solely by the kidneys. A prototype noninvasive fluorescence detection device has been developed for monitoring transdermal fluorescence after bolus intravenous injection of MB-102 in order to measure kidney function. A mathematical model of the detected fluorescence signal was created for evaluation of observed variations in agent kinetics across body locations and for analysis of candidate instrument geometries. The model comprises pharmacokinetics of agent distribution within body compartments, local diffusion of the agent within the skin, Monte Carlo photon transport through tissue, and ray tracing of the instrument optics. Data from eight human subjects with normal renal function and a range of skin colors shows good agreement with simulated data. Body site dependence of equilibration kinetics was explored using the model to find the local vasculature-to-interstitial diffusion time constant, blood volume fraction, and interstitial volume fraction. Finally, candidate instrument geometries were evaluated using the model. While an increase in source-detector separation was found to increase sensitivity to tissue optical properties, it reduced the relative intensity of the background signal with minimal effect on the measured equilibration kinetics.