Assessment of patient organ dose in CT virtual colonoscopy for bowel cancer screening

Justification and optimisation form the basic elements for the radiological protection of individuals for medical exposures. Justification includes the assessment of patient organ doses from which radiation risks are deduced. Medical radiation exposures are justified only in the case of a sufficient net benefit. For screening examinations, such as CT virtual colonoscopy, this implies that patient organ doses should be relatively low to minimise the radiation detriment. Image quality should be sufficient to maximise the potential diagnostic benefits. The Medical Exposures Directive places special attention on medical exposures as part of health screening programmes and examinations involving high individual doses to the patient, both of which apply to CT virtual colonoscopy. Technical factors were recorded for a series of patients having virtual colonoscopy on a CT scanner. In addition, the dose-length product was assessed. Patient organ doses were deduced using a CT dose calculation program. The typical effective dose was 7.5 mSv for male patients and 10.2 mSv for female patients. The effective dose is higher for female patients, as some gender-specific organs are irradiated during virtual colonoscopy. Each patient has two series of scans resulting in doses of 15 mSv for male patients and 20 mSv for female patients.     

Effective dose for scoliosis patients undergoing full spine radiography

Scoliotic patients underwent many radiological examinations during their control and treatment periods. Nowadays, few studies have calculated effective dose which is the primary indicator of radiation risk. In this study, the PCXMC program is used to calculate the effective doses associated with scoliosis radiography. Five age groups of patients, proposed by the National Radiological Protection Board, have been chosen: <1, 1-4, 5-9, 10-15 and ≥16 y (adult patients). Patient and radiographic data were collected from 99 patient examinations for both anteroposterior and lateral full spine X-ray projections. Results showed the effective dose ranged from 118 to 1596 μSv for the frontal projection and from 97 to 1370 μSv for the lateral projection, with patient age varying from 3 months to 22 y. This study presents the effective dose against patient age and demonstrates the necessity to optimise patient protection for this type of examination.     

Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels

Diagnostic reference levels (DRLs) were established for 21 indication-based CT examinations for adults in Switzerland. One hundred and seventy-nine of 225 computed tomography (CT) scanners operated in hospitals and private radiology institutes were audited on-site and patient doses were collected. For each CT scanner, a correction factor was calculated expressing the deviation of the measured weighted computed tomography dose index (CTDI) to the nominal weighted CTDI as displayed on the workstation. Patient doses were corrected by this factor providing a realistic basis for establishing national DRLs. Results showed large variations in doses between different radiology departments in Switzerland, especially for examinations of the petrous bone, pelvis, lower limbs and heart. This indicates that the concept of DRLs has not yet been correctly applied for CT examinations in clinical routine. A close collaboration of all stakeholders is mandatory to assure an effective radiation protection of patients. On-site audits will be intensified to further establish the concept of DRLs in Switzerland.     

Comparison of technical and anatomical noise in digital thorax X-ray images

Former studies by Hoeschen and Buhr indicated a higher total noise in a thorax image than expected from technical noise, i.e. quantum and detector noise. This difference results from the overlay of many small anatomical structures along the X-ray beam, which leads to a noise-like appearance without distinguishable structures in the projected image. A method is proposed to quantitatively determine this 'anatomical noise' component, which is not to be confused with the anatomical background (e.g. ribs). This specific anatomical noise pattern in a radiograph changes completely when the imaging geometry changes because different small anatomical structures contribute to the projected image. Therefore, two images are taken using slightly different exposure geometry, and a correlation analysis based on wavelet transforms allows to determining the uncorrelated noise components. Since the technical noise also differs from image to image, which makes it difficult to separate the anatomical noise, images of a lung phantom were produced on a low-sensitive industrial X-ray film using high-exposure levels. From these results, the anatomical noise level in real clinical thorax radiographs using realistic exposure levels is predicted using the general dose dependence described in the paper text and compared with the quantum and detector noise level of an indirect flat-panel detector system. For consistency testing, the same lung phantom was imaged with the same digital flat-panel detector and the total image noise including anatomical noise is determined. The results show that the relative portion of anatomical noise may exceed the technical noise level. Anatomical noise is an important contributor to the total image noise and, therefore, impedes the recognition of anatomical structures.     

Radiation doses to neonates during X ray computed tomography examinations

As the survival rate of newborns has increased, the number of X ray computed tomography (CT) examinations performed on neonates has been increasing. The exposure doses from CT examinations are known to be higher than those from conventional radiography. Although radiation sensitivity of neonates is higher than that of adults, there are few reports on dose estimates of neonates in CT examinations. Four cylindrical phantoms and one neonatal phantom have been developed to estimate doses to neonates during CT examinations. Using these phantoms and glass dosemeters, absorbed doses were measured. Estimated exposure doses to neonates were higher than those to adults, and our results suggest a need to optimise carefully CT examinations in newborns.     

Nodule detection in digital chest radiography: introduction to the RADIUS chest trial

Most digital radiographic systems of today have wide latitude and are hence able to provide images with a small constraint on dose level. This opens up for an unprejudiced dose optimisation. However, in order to succeed in the optimisation task, good knowledge of the imaging and detection processes is needed. As a part of the European-wide research project 'unification of physical and clinical requirements for medical X-ray imaging'-governed by the Radiological Imaging Unification Strategies (RADIUS) Group-a major image quality trial was conducted by members of the group. The RADIUS chest trial was focused on the detection of lung nodules in digital chest radiography with the aims of determining to what extent (1) the detection of a nodule is dependent on its location, (2) the system noise disturbs the detection of lung nodules, (3) the anatomical noise disturbs the detection of lung nodules and (4) the image background and anatomical background act as pure noise for the detection of lung nodules. The purpose of the present paper is to give an introduction to the trial and describe the framework and set-up of the investigation.     

Radiation dose management in CT, SPECT/CT and PET/CT techniques

New imaging technologies utilising X rays and radiopharmaceuticals are continuously under development. The benefit of computed tomography (CT) has been so dramatic that there is a tendency to overuse it and not to place enough efforts into optimisation of the technique. It is also now more and more common to combine two imaging techniques into a single investigation, such as PET/CT and SPECT/CT--the so-called 'hybrid imaging'. The increasing radiation exposure from CT has been of concern for some years and is now receiving increased attention from health professionals, authorities, manufacturers and patient groups. The relatively high radiation doses from PET and SPECT investigations have only recently been discussed. The aim of this article is to provide information on developing technologies and clinical techniques for 3D imaging using ionising radiation and their associated radiation dose to patients and staff. Tools for improved dose management are also discussed.     

A high-resolution voxel phantom of the breast for dose calculations in mammography

Though mammography is one of the most sensitive methods to detect breast cancer, the benefit of the mammography screening programmes is still not clearly proven. One of the reasons is the radiation dose delivered by the examinations. Simulations of the radiation transport based on realistic breast phantoms are a useful tool to estimate the dose for the risk relevant parenchymal tissue. Specimens of real breasts have been fixated using a specially designed process while being compressed as in mammography. They have been scanned using the high-resolution mode of a CT. A segmentation has been carried out by assigning the voxels to different tissues. The resulting voxel phantom allows the assessment of tissue doses by Monte-Carlo calculations and can be used to simulate the diagnostic outcome of different imaging procedures. Three different tissues were separated: skin, adipose and 'breast tissue'. This allows reasonable calculations of the average glandular doses in mammography.     

Sparse‐view statistical iterative head CT image reconstruction via joint regularization

It is a significant challenge to accurately reconstruct medical computed tomography (CT) images with important details and features. Reconstructed images always suffer from noise and artifact pollution because the acquired projection data may be insufficient or undersampled. In reality, some “isolated noise points” (similar to impulse noise) always exist in low‐dose CT projection measurements. Statistical iterative reconstruction (SIR) methods have shown greater potential to significantly reduce quantum noise but still maintain the image quality of reconstructions than the conventional filtered back‐projection (FBP) reconstruction algorithm. Although the typical total variation‐based SIR algorithms can obtain reconstructed images of relatively good quality, noticeable patchy artifacts are still unavoidable. To address such problems as impulse‐noise pollution and patchy‐artifact pollution, this work, for the first time, proposes a joint regularization constrained SIR algorithm for sparse‐view CT image reconstruction, named “SIR‐JR” for simplicity. The new joint regularization consists of two components: total generalized variation, which could process images with many directional features and yield high‐order smoothness, and the neighborhood median prior, which is a powerful filtering tool for impulse noise. Subsequently, a new alternating iterative algorithm is utilized to solve the objective function. Experiments on different head phantoms show that the obtained reconstruction images are of superior quality and that the presented method is feasible and effective.     

Evaluation of a novel method of noise reduction using computer-simulated mammograms

A novel method of noise reduction has been tested for mammography using computer-simulated images for which the truth is known exactly. This method is based on comparing two images. The images are compared at different scales, using a cross-correlation function as a measure of similarity to define the image modifications in the wavelet domain. The computer-simulated images were calculated for noise-free primary radiation using a quasi-realistic voxel phantom. Two images corresponding to slightly different geometry were produced. Gaussian noise was added with certain properties to simulate quantum noise. The added noise could be reduced by >70% using the proposed method without any noticeable corruption of the structures. It is possible to save 50% dose in mammography by producing two images (each 25% of the dose for a standard mammogram). Additionally, a reduction of the anatomical noise and, therefore, better detection rates of breast cancer in mammography are possible.     

Method of simulating dose reduction for digital radiographic systems

The optimisation of image quality vs. radiation dose is an important task in medical imaging. To obtain maximum validity of the optimisation, it must be based on clinical images. Images at different dose levels can then either be obtained by collecting patient images at the different dose levels sought to investigate-including additional exposures and permission from an ethical committee-or by manipulating images to simulate different dose levels. The aim of the present work was to develop a method of simulating dose reduction for digital radiographic systems. The method uses information about the detective quantum efficiency and noise power spectrum at the original and simulated dose levels to create an image containing filtered noise. When added to the original image this results in an image with noise which, in terms of frequency content, agrees with the noise present in an image collected at the simulated dose level. To increase the validity, the method takes local dose variations in the original image into account. The method was tested on a computed radiography system and was shown to produce images with noise behaviour similar to that of images actually collected at the simulated dose levels. The method can, therefore, be used to modify an image collected at one dose level so that it simulates an image of the same object collected at any lower dose level.     

Estimating cancer risks to adults undergoing body CT examinations

The purpose of the study is to estimate cancer risks from the amount of radiation used to perform body computed tomography (CT) examination. The ImPACT CT Patient Dosimetry Calculator was used to compute values of organ doses for adult body CT examinations. The radiation used to perform each examination was quantified by the dose-length product (DLP). Patient organ doses were converted into corresponding age and sex dependent cancer risks using data from BEIR VII. Results are presented for cancer risks per unit DLP and unit effective dose for 11 sensitive organs, as well as estimates of the contribution from 'other organs'. For patients who differ from a standard sized adult, correction factors based on the patient weight and antero-posterior dimension are provided to adjust organ doses and the corresponding risks. At constant incident radiation intensity, for CT examinations that include the chest, risks for females are markedly higher than those for males, whereas for examinations that include the pelvis, risks in males were slightly higher than those in females. In abdominal CT scans, risks for males and female patients are very similar. For abdominal CT scans, increasing the patient age from 20 to 80 resulted in a reduction in patient risks of nearly a factor of 5. The average cancer risk for chest/abdomen/pelvis CT examinations was ～26 % higher than the cancer risk caused by 'sensitive organs'. Doses and radiation risks in 80 kg adults were ～10 % lower than those in 70 kg patients. Cancer risks in body CT can be estimated from the examination DLP by accounting for sex, age, as well as patient physical characteristics.     

Clinical aspects of quality criteria in digital radiography

In clinical radiological practice two main questions regarding image quality have to be looked at: Which degree of image quality is needed? and: How can this image quality be objective? Image quality requirements depend on size, density and contrast of the objects of interest and on the clinical question which has to be answered. In comparison to conventional radiography, the digital radiographic techniques offer additional features concerning optimisation of image quality and dose, like a wider dynamic range, digital fluoroscopic techniques and post-processing. Therefore it is necessary to define new quality criteria for these techniques. In the following, typical examples demonstrate the development of the 'Diagnostic Requirements for Digital Radiographic Procedures'. These examinations include projection radiographs with digital luminiscent radiography, fluoroscopic procedures with digital image intensifier radiography and angiographic procedures with digital subtraction angiography. The clinical question of a radiological examination also forms the background to optimisation strategies considering image quality and radiation dose.     

Evaluation of patient exposure in computerised tomogram in Poland

The increasing number of computerised tomography (CT) procedures performed in Poland in recent years has resulted in a growing contribution of these examinations to the whole exposure of the population to ionising radiation from medical sources. (The number of CT examinations in Poland was 170,000 in 1995 and 460,000 in 1999.) An evaluation is presented of doses to patients in CT examinations performed with different types of CT unit. To evaluate the exposure to patients dose linear product (DLP) was measured using a NOMEX dosemeter with a pencil chamber (PTW, Frieburg) and the cylindrical PMMA phantoms 'head' and 'body'. CTDI values were evaluated according to current methodology as described in European Guidelines (EUR 16262). The measurements were performed for seven types of CT unit made by different companies. The CTDI values were also compared to reference levels recommended by IAEA. In conclusion it was found that the value of collective effective dose (2200 man.Sv), has increased in Poland nearly 4 times in comparison to 1995, whereas the number of CT examinations increased nearly 3 times in this period. For most of the 'controlled' CT scanners the values of CTDI in head procedures are near to or higher than the IAEA Reference Level (50 mGy); this can result from the protocols, which are chosen without a dose analysis.     

Organ dose evaluation for multi-slice spiral CT scans based on China Sichuan chest anthropomorphic phantom measurements

The authors measured organ radiation doses during multi-slice computed tomography (MSCT) chest scans using a China Sichuan anthropomorphic phantom (CDP-1C). Chest CT images from live volunteers based on automatic tube current modulation (ATCM) techniques were similar to those obtained using the CDP-1C phantom, indicating that the phantom accurately modelled the anatomic structure and X-ray absorbance of the human torso. Indeed, attenuation values differed by <5%. Organ radiation doses were measured using thermoluminescence dosemeters in the CDP-1C. With increased noise index, the CT dose index, the dose-length product and the average organ dose all decreased. Thus, the CDP-1C phantom can also assess dose levels during CT examinations in Chinese patients. The noise index (based on ATCM techniques) should be set to 8.5 or higher to reduce X-ray exposure while maintaining appropriate resolution for diagnosis.     

Patient exposure in medical X-ray imaging in Europe

Patients are exposed to X rays when undergoing medical examinations in diagnostic radiology. Exposure data acquired and assessed in Germany for the year 1997 resulted in a mean annual effective dose of 2 +/- 0.5 mSv per head of the population, thereby reaching or exceeding the average level of environmental radiation in many cases. The underlying frequency of medical X-ray examinations was approximately 136 million, i.e. approximately 1.7 examinations annually per head of the population. For comparison, corresponding data of other countries were extracted from the UNSCEAR 2000 report or originate from the literature. Data analysis shows significant differences in national radiological practices and a very uneven distribution of patient doses amongst the world population. The mean annual effective dose per head of the population varies by up to a factor of 60 between health care level I and IV countries, and still by a factor of approximately 6 within health care level I countries. While projection radiography has succeeded in reducing dose consumption, computed tomography and radiological interventions have given rise to a significant growth of patient exposure, and interventional radiology can even exceed thresholds for deterministic radiation effects. Patient exposure is further shown to result from misadministration and retakes of X-ray examinations, usually not registered, as well as from technical failures of X-ray facilities, which can cause significantly enhanced exposure times. Corresponding data are presented and comments are made on the international situation of non-harmonised data collection on patient exposure as well as of parameters affecting the assessment of exposure and risk.     

Robustness of homodyne tomography to phase-insensitive noise

Abstract

We study the effects of phase-insensitive noise on homodyne measurements of a radiation density matrix. We prove that this noise has an effect equivalent to a non-unit quantum efficiency at detectors. The overall effective quantum efficiency η_? of the measurement is evaluated in terms of the quantum efficiency at detectors and of the average number of noise photons added to the radiation field. For pure Gaussian-displacement noise, we show that half a photon of noise is enough to prevent the homodyne measurement of the density matrix.     

Maltese CT doses for commonly performed examinations demonstrate alignment with published DRLs across Europe

This work recommends dose reference levels (DRLs) for abdomen, chest and head computerised tomography (CT) examinations in Malta as the first step towards national CT dose optimisation. Third quartiles volume CT dose index values for abdomen: 12.1 mGy, chest: 13.1 mGy and head: 41 mGy and third quartile dose-length product values for abdomen: 539.4, chest: 492 and head: 736 mGy cm(-1) are recommended as Maltese DRLs derived from this first Maltese CT dose survey. These values compare well with DRLs of other European countries indicating that CT scanning in Malta is consistent with standards of good practice. Further work to minimise dose without affecting image quality and extending the establishment of DRLs for other CT examinations is recommended.     

Radiation protection dosimetry for diagnostic radiology patients

The radiation protection of patients undergoing medical X-ray examinations is governed by the principles of justification and optimisation. Radiation dosimetry is required to inform medical practitioners of the levels of exposure and hence the risks from the diagnostic procedures that they have to justify and to assist the operators of X-ray imaging equipment to determine whether their procedures are optimised. This paper describes the main dosimetric methods that have been developed to meet these requirements. Suitable radiation risk projection models are used to predict the risks to patients in the UK from computed tomography examinations, as a function of age at exposure and sex, and show that the lifetime risk of fatal cancer can reach 1 in 1000 for children. The concept of 'diagnostic reference levels' as an aid to the optimisation of medical exposures is described, and progress in implementing them in the UK is reported.     

Validation of a large-scale audit technique for CT dose optimisation

The expansion and increasing availability of computed tomography (CT) imaging means that there is a greater need for the development of efficient optimisation strategies that are able to inform clinical practice, without placing a significant burden on limited departmental resources. One of the most fundamental aspects to any optimisation programme is the collection of patient dose information, which can be compared with appropriate diagnostic reference levels. This study has investigated the implementation of a large-scale audit technique, which utilises data that already exist in the radiology information system, to determine typical doses for a range of examinations on four CT scanners. This method has been validated against what is considered the 'gold standard' technique for patient dose audits, and it has been demonstrated that results equivalent to the 'standard-sized patient' can be inferred from this much larger data set. This is particularly valuable where CT optimisation is concerned as it is considered a 'high dose' technique, and hence close monitoring of patient dose is particularly important.