Toshizo Katsuda

Evaluation of GAFCHROMIC EBT2 dosimetry for the low dose range using a flat-bed scanner with the reflection mode

Recently developed radiochromic films can easily be used to measure absorbed doses because they do not need development processing and indicate a density change that depends on the absorbed dose. However, in GAFCHROMIC EBT2 dosimetry (GAF-EBT2) as a radiochromic film, the precision of the measurement was compromised, because of non-uniformity problems caused by image acquisition using a flat-bed scanner with a transmission mode. The purpose of this study was to improve the precision of the measurement using a flat-bed scanner with a reflection mode at the low absorbed dose dynamic range of GAF-EBT2. The calibration curves of the absorbed dose versus the film density for GAF-EBT2 were provided. X-rays were exposed in the range between ~0 and 120xa0mGy in increments of about 12xa0mGy. The results of the method using a flat-bed scanner with the transmission mode were compared with those of the method using the same scanner with the reflection mode. The results should that the determination coefficients (r2) for the straight-line approximation of the calibration curve using the reflection mode were higher than 0.99, and the gradient using the reflection mode was about twice that of the one using the transmission mode. The non-uniformity error that is produced by a flat-bed scanner with the transmission mode setting could be almost eliminated by converting from the transmission mode to the reflection mode. In light of these findings, the method using a flat-bed scanner with the reflection mode (only using uniform white paper) improved the precision of the measurement for the low absorbed dose range.

Predicting sentinel lymph node metastasis in breast cancer with lymphoscintigraphy

ObjectiveLymphoscintigraphy is an effective method for detecting sentinel lymph nodes (SLNs). However, the rate and degree of SLN detection is not uniform. We quantified SLNs detected with lymphoscintigraphy, and investigated correlations with factors that may influence detection. We then attempted to predict SLN metastasis from lymph node counts, comparing the predictions to subsequent biopsy results.MethodsWe assessed lymph node counts in 100 breast cancer patients in whom a single SLN was detected with a fixed lymphoscintigraphy procedure. We examined correlations between the counts and factors known to influence lymphoscintigraphic SLN detection (age, body mass index, tumor size, and presence or absence of metastasis), and determined reference values (lymph node counts of 10.0, 19.4 and 53.0) which were used to predict SLN metastasis in 100 subsequent patients. The predictions were then compared with the SLN biopsy findings.ResultsSLN counts correlated strongly with the presence or absence of metastasis, with metastasis-positive lymph nodes showing significantly lower counts than negative nodes (pxa0<xa00.001). Prediction of SLN metastasis achieved a 100% positive predictive value at a reference value of 10.0, and a 100% negative predictive value at a reference value of 53.0. At a reference value of 19.4, the sensitivity, specificity, and diagnostic accuracy were 77.8, 73.2, and 74.0%, respectively.ConclusionsThe SLN counts detected with lymphoscintigraphy were significantly lower in metastasis-positive lymph nodes than in metastasis-negative lymph nodes. This suggests that prediction of SLN metastasis in breast cancer is possible using lymphoscintigraphy.

Energy response of the GAFCHROMIC EBT3 in diagnosis range

Although GAFCHROMIC EBT3 (EBT3) as a radiochromic film shows only slight energy dependency errors in comparison with other radiochromic films, the influence of energy dependence in the diagnosis energy range (less than 100 keV) is larger in the high energy range (over 100 keV). Based on this characteristic, adaptation of the EBT3 dosimetry in the diagnosis range was investigated. The energy response of the EBT3 in the diagnosis range at 30, 40, 50, 60 keV was measured using the density-absorbed dose calibration curve of the absorbed dose versus film density for the EBT3. Various data (degree of leaning, coefficient of determination) of each effective energy were compared. The density - absorbed dose calibration curves were linearly correlated in each of the effective energies. There was an energy dependent error of approximately 0.2 % from 30 to 60 keV. As a result, it can be seen that the EBT3 is available in the diagnosis energy range. However, the influence of the non-uniformity error caused by the repeatability of the scan method must be considered because EBT3 distortion has a serious influence on measurement precision.

Comparing three UV wavelengths for pre‐exposing Gafchromic EBT2 and EBT3 films

Gafchromic films are used for X‐ray dose measurements during diagnostic examinations and have begun to be used for three‐dimensional X‐ray dose measurements using the high‐resolution characteristics of Gafchromic films for computed tomography. However, the problem of unevenness in Gafchromic film active layers needs to be resolved. Double exposures using X‐rays are performed during therapeutic radiology, although this is difficult for a diagnostic examination because of a heel effect. Thus, it has been suggested that ultraviolet (UV) radiation be used as a substitute for X‐rays. However, the appropriate UV wavelength has not been determined. Thus, we conducted this study to decide an appropriate UV wavelength. UV peak wavelengths of 245 nm (UV‐A), 310 nm (UV‐B), and 365 nm (UV‐C) were used to irradiate EBT2 and EBT3 films. Each UV wavelength was irradiated for 5, 15, 30, and 60 min, and irradiation was then repeated every 60 min up to 360 min. Gafchromic films were scanned after every irradiation using a flatbed scanner. Images were split into RGB images, and red images were analyzed using ImageJ, version 1.44, image analysis software. A region of interest (ROI) one‐half inch in diameter was placed in the center of subtracted Gafchromic film images, and UV irradiation times were plotted against mean pixel values. There were reactions in the front and back of Gafchromic EBT3 and the back of Gafchromic EBT2 with UV‐A and UV‐B. However, UV‐C resulted in some reactions in both sides of Gafchromic EBT2 and EBT3. The UV‐A and UV‐B wavelengths should be used. PACS number(s): 87.53 BnGafchromic films are used for X-ray dose measurements during diagnostic examinations and have begun to be used for three-dimensional X-ray dose measurements using the high-resolution characteristics of Gafchromic films for computed tomography. However, the problem of unevenness in Gafchromic film active layers needs to be resolved. Double exposures using X-rays are performed during therapeutic radiology, although this is difficult for a diagnostic examination because of a heel effect. Thus, it has been suggested that ultraviolet (UV) radiation be used as a substitute for X-rays. However, the appropriate UV wavelength has not been determined. Thus, we conducted this study to decide an appropriate UV wavelength. UV peak wavelengths of 245 nm (UV-A), 310 nm (UV-B), and 365 nm (UV-C) were used to irradiate EBT2 and EBT3 films. Each UV wavelength was irradiated for 5, 15, 30, and 60 min, and irradiation was then repeated every 60 min up to 360 min. Gafchromic films were scanned after every irradiation using a flatbed scanner. Images were split into RGB images, and red images were analyzed using ImageJ, version 1.44, image analysis software. A region of interest (ROI) one-half inch in diameter was placed in the center of subtracted Gafchromic film images, and UV irradiation times were plotted against mean pixel values. There were reactions in the front and back of Gafchromic EBT3 and the back of Gafchromic EBT2 with UV-A and UV-B. However, UV-C resulted in some reactions in both sides of Gafchromic EBT2 and EBT3. The UV-A and UV-B wavelengths should be used. PACS number(s): 87.53 Bn.

Improved detection of gastric cancer during screening by additional radiographs as judged necessary by the radiographer

PurposeThe aim of this study was to determine whether additional radiographs, as judged necessary by the radiographer, improves cancer detection during gastric cancer screening.Materials and methodsWe analyzed 144 gastric cancer cases among 137 744 individuals who underwent X-ray screening for gastric cancer. Radiographs were obtained by 17 radiographers at a screening center in Japan from April 2004 to March 2008. Additional radiographs were taken based on the radiographer’s judgment in cases of suspected cancer. During double-blind reinterpretation of the cancer case radiographs by two radiologists, we determined the number of cancer cases that were detected by standard radiographs alone. We next determined the number of cancer cases detected using both standard radiographs and additional radiographs.ResultsCompared to the number of cancer cases detected with standard radiographs alone (120 cases detected, 24 cases undetected), the number of cancer cases detected with both standard and additional radiographs (137 cases detected, 7 cases undetected) significantly increased (17 cases; P < 0.001, McNemar test).ConclusionWe found that taking additional radiographs, when judged necessary by the radiographer during radiographic gastric cancer screening, improves cancer detection.

Correction of nonuniformity error of Gafchromic EBT2 and EBT3

This study investigates an X‐ray dose measurement method for computed tomography using Gafchromic films. Nonuniformity of the active layer is a major problem in Gafchromic films. In radiotherapy, nonuniformity error is reduced by applying the double‐exposure technique, but this is impractical in diagnostic radiology because of the heel effect. Therefore, we propose replacing the X‐rays in the double‐exposure technique with ultraviolet (UV)‐A irradiation of Gafchromic EBT2 and EBT3. To improve the reproducibility of the scan position, Gafchromic EBT2 and EBT3 films were attached to a 3‐mm‐thick acrylic plate. The samples were then irradiated with a 10 W UV‐A fluorescent lamp placed at a distance of 72 cm for 30, 60, and 90 minutes. The profile curves were evaluated along the long and short axes of the film center, and the standard deviations of the pixel values were calculated over large areas of the films. Paired t‐test was performed. UV‐A irradiation exerted a significant effect on Gafchromic EBT2 (paired t‐test; p=0.0275) but not on EBT3 (paired t‐test; p=0.2785). Similarly, the homogeneity was improved in Gafchromic EBT2 but not in EBT3. Therefore, the double‐exposure technique under UV‐A irradiation is suitable only for EBT2 films. PACS number(s): 87.53 BnThis study investigates an X-ray dose measurement method for computed tomography using Gafchromic films. Nonuniformity of the active layer is a major problem in Gafchromic films. In radiotherapy, nonuniformity error is reduced by applying the double-exposure technique, but this is impractical in diagnostic radiology because of the heel effect. Therefore, we propose replacing the X-rays in the double-exposure technique with ultraviolet (UV)-A irradiation of Gafchromic EBT2 and EBT3. To improve the reproducibility of the scan position, Gafchromic EBT2 and EBT3 films were attached to a 3-mm-thick acrylic plate. The samples were then irradiated with a 10 W UV-A fluorescent lamp placed at a distance of 72 cm for 30, 60, and 90 minutes. The profile curves were evaluated along the long and short axes of the film center, and the standard deviations of the pixel values were calculated over large areas of the films. Paired t-test was performed. UV-A irradiation exerted a significant effect on Gafchromic EBT2 (paired t-test; p=0.0275) but not on EBT3 (paired t-test; p=0.2785). Similarly, the homogeneity was improved in Gafchromic EBT2 but not in EBT3. Therefore, the double-exposure technique under UV-A irradiation is suitable only for EBT2 films. PACS number(s): 87.53 Bn.

Effective energy measurement using radiochromic film: Application of a mobile scanner

Abstract The effective energy calculated using the half-value layer (HVL) is an important parameter for quality assurance (QA) and quality control (QC). However constant monitoring has not been performed because measurements using an ionization chamber (IC) are time-consuming and complicated. To solve these problems, a method using radiochromic film (GAFCHROMIC EBT2 dosimetry film (GAF-EBT2) with slight energy dependency errors), a mobile scanner and step-shaped aluminum (SSAl) filter is developed. The results of the method using a mobile scanner were compared with those of the recommended method using an IC in order to evaluate its applicability. The difference ratios of the effective energies by each method using a mobile scanner with GAF-EBT2 were less than 5% compared with results of an IC. It is considered that this method offers a simple means of determining HVL for QA and QC consistently and quickly without the need for an IC dosimeter.

Noise reduction of radiochromic film: median filter processing of subtraction image

Pre-ultraviolet rays exposure is a useful method to reduce non-uniformity error of radiochromic films. However, dust and scratch noises such as spike noise disturb precise measurement. To reduce these noises, median filter processing is applied for pre-subtraction and subtraction images. To reduce non-uniformity error of the thickness unevenness of Gafchromic EBT film, ultraviolet rays were exposed to correct data. There were three kinds of images obtained: first ultraviolet exposure image, second ultraviolet exposure image and the subtraction image of both. Median filer processing was performed on all these images. Eleven kinds of median filter radius factors (0.0 to 5.0) were applied using image analysis software. Data and graphs were then estimated. The maximum pixels value of dust was 229 on the second ultraviolet exposure image of film 3. After median filter preprocessing, the pixel value of the noises were similar to the minimum value. A 2.0-radius median filer is a useful factor for processing. Noise reduction that affected data of estimated images may be applied to measure radiation doses on a variety of radiochromic films. Ultraviolet exposure and subtraction method with median filter processing enable precise measurement and high spatial resolution dose distribution.

Ultraviolet exposure of Gafchromic XR-RV3 and XR-SP2 films

Gafchromic film has been used for X‐ray dose measurement in diagnostic examinations. Their use has been initiated for three‐dimensional X‐ray dose measurement by using the high‐resolution characteristics of Gafchromic films in computed tomography. However, it is necessary to solve the problem of nonuniform thickness in the active layers of Gafchromic films. A double exposure technique using X‐rays is performed in therapeutic radiology; it is difficult to use in a diagnostic examination because of the heel effect. Therefore, it is suggested that ultraviolet (UV) rays be substituted for X‐rays. However, the appropriate UV wavelength is unknown. In this study, we aimed to determine which UV wavelengths are effective to expose Gafchromic XR‐RV3 and XR‐SP2. UV lamps with peak wavelengths of 245 nm, 310 nm, and 365 nm were used. The three UV wavelengths were used to irradiate Gafchromic XR‐RV3 and XR‐SP2 films for 60 min, and irradiation was repeated every 60 min for 600 min thereafter. Films were scanned after each irradiation period on a flatbed scanner. The images were split into their red‐green‐blue components, and red images were stored using ImageJ version 1.44o image analysis software. Regions of interest (ROI), 0.5 inches in diameter, were placed at the centers of the subtracted Gafchromic film images, and graphs of UV irradiation duration and mean pixel values were plotted. There were reactions to UV‐A on both Gafchromic XR‐RV3 and XR‐SP2; those to UV‐B were moderate. However, UV‐C demonstrated few reactions with Gafchromic XR‐RV3 and XR‐SP2. From these results, irradiation with UV‐A may be able to correct nonuniformity errors. Uniform UV‐A irradiation of Gafchromic films with large areas is possible, and UV rays can be used as a substitute for X‐rays in the double exposure technique. PACS number: 87.53 BnGafchromic film has been used for X-ray dose measurement in diagnostic examinations. Their use has been initiated for three-dimensional X-ray dose measurement by using the high-resolution characteristics of Gafchromic films in computed tomography. However, it is necessary to solve the problem of nonuniform thickness in the active layers of Gafchromic films. A double exposure technique using X-rays is performed in therapeutic radiology; it is difficult to use in a diagnostic examination because of the heel effect. Therefore, it is suggested that ultraviolet (UV) rays be substituted for X-rays. However, the appropriate UV wavelength is unknown. In this study, we aimed to determine which UV wavelengths are effective to expose Gafchromic XR-RV3 and XR-SP2. UV lamps with peak wavelengths of 245 nm, 310 nm, and 365 nm were used. The three UV wavelengths were used to irradiate Gafchromic XR-RV3 and XR-SP2 films for 60 min, and irradiation was repeated every 60 min for 600 min thereafter. Films were scanned after each irradiation period on a flatbed scanner. The images were split into their red-green-blue components, and red images were stored using ImageJ version 1.44o image analysis software. Regions of interest (ROI), 0.5 inches in diameter, were placed at the centers of the subtracted Gafchromic film images, and graphs of UV irradiation duration and mean pixel values were plotted. There were reactions to UV-A on both Gafchromic XR-RV3 and XR-SP2; those to UV-B were moderate. However, UV-C demonstrated few reactions with Gafchromic XR-RV3 and XR-SP2. From these results, irradiation with UV-A may be able to correct nonuniformity errors. Uniform UV-A irradiation of Gafchromic films with large areas is possible, and UV rays can be used as a substitute for X-rays in the double exposure technique. PACS number: 87.53 Bn.

Effectiveness of the new injection program ‘saline test injection mode’ for use power injector in pediatric contrast CT

To improve the safety of the use of a power injector for pediatric contrast CT, we newly developed a saline test injection mode for a power injector and investigated its usefulness. We used an injection route and investigated the relationship of the injection pressure to the injection rate of saline and the contrast medium. From this relationship, we investigated it was possible to estimate the change of pressure injection of contrast medium from the pressure change of saline injection. The correlation between the saline test injection pressure and the contrast medium injection pressure was investigated in 64 clinical cases. The detection rate of side effects from the saline test injection was investigated in 473 patients. Regarding the correlation between the injection rate and pressure for both saline and contrast, the pressure rose as the rate increased. The contrast medium injection pressure could be estimated from the correlation observed with saline. The clinical data were obtained had a relationship similar to that with phantom data. The detection rate of side effects from the saline test injection was 4.4xa0% in the clinical cases. In these cases, examinations were completed by re-establishing an injection route or administering hypnotics. Our results suggest that contrast medium pressure can be estimated from a saline test injection, thus aiding in prediction of the risk of injection abnormality. Reactions to injections could be observed in the present study, facilitating the prevention of examination failure. Countermeasures can be taken against the cause of the reaction, and the examination can be performed after confirming the absence of a reaction to injection. Therefore, a saline test injection may be useful in pediatric contrast CT.