Victor Weir

Dosimetric characterization of a cone-beam O-arm™ imaging system

This study compared patient dose and image quality of a mobile O-arm cone beam imaging system in the 3D scan acquisition mode to those of a 64 slice Computed Tomography (CT) imaging system. The investigation included patient dose, scattered radiation, and image quality measurements. The patient dose was measured using a 0.6 cc Farmer ion chamber and 30 cm long Computed Tomography (CT) head and body polymethylmethacrylate (PMMA) phantoms. The results show that under identical radiographic techniques (kVp, mAs, etc.) and with the same scan length, the O-arm in 3D scan acquisition mode delivers approximately half the radiation dose of a 64 slice CT scanner. Scattered radiation was measured at several locations around the O-arm, at 1 m, 2 m and 3 m distances in 3D CT scan acquisition mode with a RadCal 10 x 5-180 pancake ion chamber using a 30 cm long CT body phantom as the source of scatter. Similar measurements were made in a 64 slice CT scanner. The data demonstrate that scattered radiation from the O-arm to personnel involved in a clinical procedure is comparable to that from a 64 slice CT scanner. Image quality was compared by exposing a CATPHAN phantom to comparable doses in both the O-arm and the CT scanner. The resultant images were then evaluated for modulation transfer function (MTF), high-contrast spatial resolution, and low contrast sensitivity for clinical application purpose. The O-arm shows comparable high contrast to the CT (7 lp/cm vs. 8 lp/cm). The low contrast in the O-arm is not visible due to fixed pattern noise. For image guided surgery applications where the location of a structure is emphasized over a survey of all image details, the O-arm has some advantages due to wide radiation beam coverage and lower patient dose. The image quality of the O-arm needs significant improvement for other clinical applications where high image quality is desired.

Towards Omni-Tomography-Grand Fusion of Multiple Modalities for Simultaneous Interior Tomography

We recently elevated interior tomography from its origin in computed tomography (CT) to a general tomographic principle, and proved its validity for other tomographic modalities including SPECT, MRI, and others. Here we propose “omni-tomography”, a novel concept for the grand fusion of multiple tomographic modalities for simultaneous data acquisition in a region of interest (ROI). Omni-tomography can be instrumental when physiological processes under investigation are multi-dimensional, multi-scale, multi-temporal and multi-parametric. Both preclinical and clinical studies now depend on in vivo tomography, often requiring separate evaluations by different imaging modalities. Over the past decade, two approaches have been used for multimodality fusion: Software based image registration and hybrid scanners such as PET-CT, PET-MRI, and SPECT-CT among others. While there are intrinsic limitations with both approaches, the main obstacle to the seamless fusion of multiple imaging modalities has been the bulkiness of each individual imager and the conflict of their physical (especially spatial) requirements. To address this challenge, omni-tomography is now unveiled as an emerging direction for biomedical imaging and systems biomedicine.

Dosimetric characterization and image quality evaluation of the AIRO mobile CT scanner.

Radiation dose and image quality from a recently introduced mobile CT imaging system are presented. Radiation dose was measured using a conventional 100 mm pencil ionization chamber and CT polymethylmetacrylate (PMMA) body and head phantoms. Image quality was evaluated with a CATPHAN 500 phantom. Spatial resolution, low contrast resolution, Modulation Transfer Function (MTF), and Normalized Noise Power Spectrum (NNPS) were analyzed. Radiation dose and image quality were compared to those from a multi-detector CT scanner (Siemens Sensation 64). Under identical technique factors radiation dose (mGy/mAs) from the AIRO mobile CT system (AIRO) is higher than that from a 64 slice CT scanner. Based on MTF analysis, both Soft and Standard filters of the AIRO system lost resolution quickly compared to the Sensation 64 slice CT. The Siemens scanner had up to 7 lp/cm for the head FOV and H40 kernel and up to 5 lp/cm at body FOV for the B40f kernel. The Standard kernel in the AIRO system was evaluated to have 3 lp/cm and 4 lp/cm for the body and head FOVs respectively. NNPS of the AIRO shows low frequency noise due to ring-like artifacts which may be caused by detector calibration or lack of artifact reducing image post-processing. Due to a higher dose in terms of mGy/mAs at both head and body FOV, the contrast to noise ratio is higher in the AIRO system than in the Siemens scanner. However detectability of the low contrast objects is poorer in the AIRO due to the presence of ring artifacts in the location of the targets.

Impact of physician practice on patient radiation dose during CT guided biopsy procedures.

PURPOSE Patient radiation dose during Computed Tomography (CT) guided biopsy procedures is determined by both acquisition technical parameters and physician practice. The potential effect of the physician practice is of concern. This study is to investigate the effects of those intangibles on patient radiation dose. METHODS Patient radiation dose from 252 patients who underwent CT guided biopsy from 2009 to 2010 were retrospectively studied. Ten physicians who used conventional intermittent shots, low mA dose saving feature, or both were included in the study. The patient dose reports were retrieved and the total dose length products (DLPs) were analyzed. Linear regression analysis performed between various variables and reported dose. Patient detriment index (PDI) was developed, which sets threshold (standard of practice) for comparing physician practice with their peers. Odds ratio was calculated to determine odds of a group of patients receiving dose above threshold when compared to another group. RESULTS Median DLP among ten physicians was 1194 mGy-cm. There was a significant difference (p< 0.01) between reported DLPs doses when physicians used dose saving feature vs. when feature not used (539.8 ± 169.4 mGy-cm vs. 1269.7 ± 659.0 mGy-cm). In general, physicians who used dose saving feature had lower relative PDIs (< 1) compared to the PDIs (> 1) without the dose feature. Odds ratio estimate of 7.7 at 95% confidence level indicates that the odds of a group receiving a high dose depends on practitioner. CONCLUSION Adjustments of practice habits, use of dose saving features or both may be needed to improve patient care for CT biopsy.

SU-E-I-21: Dosimetric Characterization and Image Quality Evaluation of the AIRO Mobile CT Scanner

Purpose: The AIRO Mobile CT system was recently introduced which overcomes the limitations from existing CT, CT fluoroscopy, and intraoperative O-arm. With an integrated table and a large diameter bore, the system is suitable for cranial, spine and trauma procedures, making it a highly versatile intraoperative imaging system. This study is to investigate radiation dose and image quality of the AIRO and compared with those from a routine CT scanner. Methods: Radiation dose was measured using a conventional 100mm pencil ionization chamber and CT polymethylmetacrylate (PMMA) body and head phantoms. Image quality was evaluated with a CATPHAN 500 phantom. Spatial resolution, low contrast resolution (CNR), Modulation Transfer Function (MTF), and Normalized Noise Power Spectrum (NNPS) were analyzed. Results: Under identical technique conditions, radiation dose (mGy/mAs) from the AIRO mobile CT system (AIRO) is higher than that from a 64 slice CT scanner. MTFs show that both Soft and Standard filters of the AIRO system lost resolution quickly compared to the Sensation 64 slice CT. With the Standard kernel, the spatial resolutions of the AIRO system are 3lp/cm and 4lp/cm for the body and head FOVs, respectively. NNPSs show low frequency noise due to ring-like artifacts. Due to a higher dose in terms of mGy/mAs at both head and body FOV, CNR of the AIRO system is higher than that of the Siemens scanner. However detectability of the low contrast objects is poorer in the AIRO due to the presence of ring artifacts in the location of the targets. Conclusion: For image guided surgery applications, the AIRO has some advantages over a routine CT scanner due to its versatility, large bore size, and acceptable image quality. Our evaluation of the physical performance helps its future improvements.

Image quality of a cone beam o-arm 3D imaging system

The O-arm is a cone beam imaging system designed primarily to support orthopedic surgery and is also used for image-guided and vascular surgery. Using a gantry that can be opened or closed, the O-arm can function as a 2-dimensional (2D) fluoroscopy device or collect 3-dimensional (3D) volumetric imaging data like a CT system. Clinical applications of the O-arm in spine surgical procedures, assessment of pedicle screw position, and kyphoplasty procedures show that the O-arm 3D mode provides enhanced imaging information compared to radiographs or fluoroscopy alone. In this study, the image quality of an O-arm system was quantitatively evaluated. A 20 cm diameter CATPHAN 424 phantom was scanned using the pre-programmed head protocols: small/medium (120 kVp, 100 mAs), large (120 kVp, 128 mAs), and extra-large (120 kVp, 160 mAs) in 3D mode. High resolution reconstruction mode (512×512×0.83 mm) was used to reconstruct images for the analysis of low and high contrast resolution, and noise power spectrum. MTF was measured using the point spread function. The results show that the O-arm image is uniform but with a noise pattern which cannot be removed by simply increasing the mAs. The high contrast resolution of the O-arm system was approximately 9 lp/cm. The system has a 10% MTF at 0.45 mm. The low-contrast resolution cannot be decided due to the noise pattern. For surgery where locations of a structure are emphasized over a survey of all image details, the image quality of the O-arm is well accepted clinically.

SU‐E‐I‐33: Advances in Dose Metrics and Dose Reduction Strategies for Interventional Fluoroscopy

PURPOSE To explore recent advances in available dose metrics and dose reduction features and their impacts during various fluoroscopy procedures. METHODS Besides traditional dose metrics (cumulative dose, DAP, etc), recent methods such as real time dose mapping and dose calculation from DICOM information and their relevance to entrance skin exposure (ESE) are demonstrated. Dose reduction features and their potential effects on ESE are explored for different interventional procedures, including dose setting options, frame rate settings, wedges, software options and how these help reduce patient dose, etc. Real time dose monitoring techniques such as DoseAware are investigated. Dose alert such as flagging higher doses at about half of the Joint Commission sentinel event limit, Dose Index Registry and their impacts are discussed. Habit related practices, such as a physician leaning over patients, are highlighted, also taking foot off the fluoroscopy pedal when not needed, and best places to stand are illustrated. A practice improvement procedure involving measurement, analysis and improvement actions is instituted. We also discuss the impact of physician follow up letters to patients who might not have reached the JC Sentinel Event limits but may still have skin issues. RESULTS In our institutes, these efforts have led to reduction of both patient dose and personnel exposure for interventional procedures. The recording of technical parameters and fluoroscopy dose by the staff has led to a better understanding of appropriate dose levels and technique settings for each procedure. CONCLUSIONS This article can serve as a refresher for radiological staff on how to protect patients and themselves from high doses, while providing the best care possible. It can also serve as criteria for health care providers to institute changes and make quality improvement in interventional practices.

SU‐E‐I‐30: Impact of Physician Practice on Patient Radiation Dose during CT Guided Biopsy Procedures

PURPOSE The major concern with CT fluoroscopy is patient radiation dose, which is determined by applied technical parameters as well as practitioner/operator practice, e.g. habits and choice of dose saving features. This study is to investigate the effects of these intangible factors on patient doses. METHODS 381 patients underwent CT biopsy were retrospectively studied. Patient doses (dose length product, DLP) were analyzed and compared. Comparisons were made among physicians using only conventional intermittent shots, physicians using a low mA dose saving feature, and physicians using a combination of both. Linear regression analyses were performed to investigate any possible relationship between the variables and the patient dose. The Patient detriment index (PDI) was developed to set a threshold for the purpose of the Joint Commission sentinel dose events monitoring. An odds ratio was calculated to determine the odds of a group of patients receiving a dose above the median threshold when compared to another group. RESULTS The median DLP for all physicians was 1194 mGy-cm. There is a significant difference (p<0.01) between the doses patients received (DLP=539.8 ±76 mGy-cm) when physicians used dose saving feature vs. when the feature was not used (DLP=1269.7±659 mGy-cm). In general, those physicians who used dose saving feature have a lower relative PDI (<1) compared to the PDIs (>1) without dose feature. This is not absolute since some physicians who did not use the dose saving feature have PDIs<l. An odds ratio estimate of 7.7 with a 95% confidence interval of 3.27 to 18.1 indicates that patient radiation dose strongly depends on the practitioner. CONCLUSIONS Adjustments of practice habits, the use of CT dose saving features or both may be needed to improve patient care for CT fluoroscopy.

WE‐E‐332‐02: Dosimetric Characterization of a Cone Beam O‐Arm Imaging System

Purpose: The O‐arm is a cone beam imaging system designed primarily to support orthopedic surgery as well as for image‐guided and vascular surgery. Using a gantry that can be opened or closed, the O‐arm can function as a 2D fluoroscopy device or collect 3D volumetric imaging data like a CT system. Our clinical applications of the O‐arm in spine surgical procedures, assessment of pedicle screw position, kyphoplasty procedures, and etc show that the O‐arm 3D mode provides enhanced imaging information in the surgical procedure compared to radiographs or fluoroscopy alone. However, the radiation dose of the O‐arm has remained uninvestigated. This study is to investigate patient dose and scatter radiation from an O‐arm and compare the results to those from a CT scanner and a conventional C‐arm. Method and Materials: The patient dose was measured using a 0.6 cc Farmer ion chamber and 30 cm long CT head and body phantoms. Scatter radiation was measured at several locations around the O‐arm, at 1m, 2m and 3m distances from the iso‐center of the O‐arm, in both the 2D fluoroscopic mode and the 3D mode with a Radcal 10×5−180 pancake ion chamber using a 30 cm long CTDI body phantom as the source of scatter. The same measurements were made for an OEC C‐arm and a 64 slice CT scanner, respectively. Results: The results show that under identical technical conditions and with the same scan length, the O‐arm 3D mode delivers radiation dose to patients and scatterdose to personnel that is comparable to that of the 64 slice CT scanner. The O‐arm 2D mode produces similar scatter radiation as a conventional GE OEC fluoroscopic C‐arm system. Conclusion: Our study demonstrated that the O‐arm had comparable radiation dose to patients and radiologists as CT and C‐arm systems.

Effect of multiple dopants on the quantum efficiency of LiF thermoluminescent dosimeters (TLD) and BaFX (X = Br,Cl,I) storage phosphors

The radiant quantum efficiency (RQE) of x-ray phosphors is defined as the ratio of the emitted luminescent power and the power absorbed by the material. For a given x-ray imaging technique, a high RQE phosphor means a lower x-ray exposure to patients and a better image quality. To improve RQE, phosphors such as LiF and BaFX:Eu ( X = Br, Cl, I) host lattices, which are commonly used in medical dosimetry and imaging system, are always doped with Cu, Ti, or Tb. Experimental observations showed that these dopants can increase phosphor RQE significantly. In this study, we theoretically investigated the effect of additional dopants on the RQE of LiF:Mg and BaFX:Eu host lattices using Density Functional Theory (DFT) in the Local Density Approximation (LDA). Self-consistent charge density calculations were performed. The energy loss function L(w) was obtained and used to calculate the RQE for different phosphors. The results showed that additional dopants produced changes in the optical properties of the phosphors, particularly the energy loss function L(w). Doping with more substitutional impurities increased the RQE of all host lattices except the BaFI lattice where the RQE decreased.