Effective Detective Quantum Efficiency (eDQE) Evaluation for the Influence of Focal Spot Size and Magnification on the Digital Radiography System / 의학물리

The magnification technique has recently become popular in bone radiography, mammography and other diagnostic examination. However, because of the finite size of X-ray focal spot, the magnification influences various imaging properties with resolution, noise and contrast. The purpose of study is to investigate the influence of magnification and focal spot size on digital imaging system using eDQE (effective detective quantum efficiency). Effective DQE is a metric reflecting overall system response including focal spot blur, magnification, scatter and grid response. The adult chest phantom employed in the Food and Drug Administration (FDA) was used to derive eDQE from eMTF (effective modulation transfer function), eNPS (effective noise power spectrum), scatter fraction and transmission fraction. According to results, spatial frequencies that eMTF is 10% with the magnification factor of 1.2, 1.4, 1.6, 1.8 and 2.0 are 2.76, 2.21, 1.78, 1.49 and 1.26 lp/mm respectively using small focal spot. The spatial frequencies that eMTF is 10% with the magnification factor of 1.2, 1.4, 1.6, 1.8 and 2.0 are 2.21, 1.66, 1.25, 0.93 and 0.73 lp/mm respectively using large focal spot. The eMTFs and eDQEs decreases with increasing magnification factor. Although there are no significant differences with focal spot size on eDQE (0), the eDQEs drops more sharply with large focal spot than small focal spot. The magnification imaging can enlarge the small size lesion and improve the contrast due to decrease of effective noise and scatter with air-gap effect. The enlargement of the image size can be helpful for visual detection of small image. However, focal spot blurring caused by finite size of focal spot shows more significant impact on spatial resolution than the improvement of other metrics resulted by magnification effect. Based on these results, appropriate magnification factor and focal spot size should be established to perform magnification imaging with digital radiography system.

Survey of Technical Parameters for Pediatric Chest X-ray Imaging by Using Effective DQE and Dose / 의학물리

The purpose of this study was to investigate the effect of various technical parameters for the dose optimization in pediatric chest radiological examinations by evaluating effective dose and effective detective quantum efficiency (eDQE) including the scatter radiation from the object, the blur caused by the focal spot, geometric magnification and detector characteristics. For the tube voltages ranging from 40 to 90 kVp in 10 kVp increments at the FDD of 100, 110, 120, 150, 180 cm, the eDQE was evaluated at the same effective dose. The results showed that the eDQE was largest at 60 kVp when compares the eDQE at different tube voltage. Especially, the eDQE was considerably higher without the use of an anti-scatter grid on equivalent effective dose. This indicates that the reducing the scatter radiation did not compensate for the loss of absorbed effective photons in the grid. When the grid is not used the eDQE increased with increasing FDD because of the greater effective modulation transfer function (eMTF). However, most of major hospitals in Korea employed a short FDD of 100 cm with an anti-scatter grid for the chest radiological examination of a 15 month old infant. As a result, the entrance surface air kerma (ESAK) values for the hospitals of this survey exceeded the Korean DRL (diagnostic reference level) of 100 microGy. Therefore, appropriate technical parameters should be established to perform pediatric chest examinations on children of different ages. The results of this study may serve as a baseline to establish detailed reference level of pediatric dose for different ages.

Comparison Study of Image Quality of Direct and Indirect Conversion Digital Mammography System / 의학물리

The purpose of this study is to comprehensively compare and evaluate the characteristics of image quality for digital mammography systems which use a direct and indirect conversion detector. Three key metrics of image quality were evaluated for the direct and indirect conversion detector, the modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE), which describe the resolution, noise, and signal to noise performance, respectively. DQE was calculated by using a edge phantom for MTF determination according to IEC 62220-1-2 regulation. The contrast to noise ratio (CNR) was evaluated according to guidelines offered by the Korean Institute for Accreditation of Medical Image (KIAMI). As a result, the higher MTF and DQE was measured with direct conversion detector compared to indirect conversion detector all over spatial frequency. When the average glandular dose (AGD) was the same, direct conversion detector showed higher CNR value. The direct conversion detector which has higher DQE value all over spatial frequency would provide the potential benefits for both improved image quality and lower patient dose in digital mammography system.

Investigation of Scatter and Septal Penetration in I-131 Imaging Using GATE Simulation / 의학물리

Scatter correction for I-131 plays a very important role to improve image quality and quantitation. I-131 has multiple and higher energy gamma-ray emissions. Image quality and quantitative accuracy in I-131 imaging are degraded by object scatter as well as scatter and septal penetration in the collimator. The purpose of this study was to estimate scatter and septal penetration and investigate two scatter correction methods using Monte Carlo simulation. The gamma camera system simulated in this study was a FORTE system (Phillips, Nederland) with high energy, general-purpose, parallel hole collimator. We simulated for two types of high energy collimators. One is composed of lead, and the other is composed of artificially high Z number and high density. We simulated energy spectrum using a point source in air. We estimated both full width at half maximum (FWHM) and full width at tenth maximum (FWTM) using line spread function (LSF) in cylindrical water phantom. We applied two scatter correction methods, triple energy window scatter correction (TEW) and extended triple energy window scatter correction (ETEW). The TEW method is a pixel-by pixel based correction which is easy to implement clinically. The ETEW is a modification of the TEW which corrects for scatter by using abutted scatter rejection window, which can overestimate or the underestimate scatter. The both FWHM and FWTM were estimated as 41.2 mm and 206.5 mm for lead collimator, respectively. The FWHM and FWTM were estimated as 27.3 mm and 45.6 mm for artificially high Z and high density collimator, respectively. ETEW showed that the estimation of scatter components was close to the true scatter components. In conclusion, correction for septal penetration and scatter is important to improve image quality and quantitative accuracy in I-131 imaging. The ETEW method in scatter correction appeared to be useful in I-131 imaging.

Evaluation of Unexposed Images after Erasure of Image Plate from CR System / 의학물리

It is important to initialize Image Plate (IP) completely for removing residual latent image by sodium lamp for reliability and repeatability of computed radiography (CR) system. The purpose of this study was to evaluate latent images of computed radiography (CR) images respect to delay time after erasure of foregone latent image and its effect, and erasure level. Erasure thoroughness for CR acceptance test from American Association of Physicist in Medicine (AAPM) Report 93 (2006) was also evaluated. Measurements were made on a CR (Agfa CR 25; Agfa, BELGIUM) system. Chest postero-anterior (PA), Hand PA, L-spine lateral radiographs were chosen for evaluation. Chest phantom (3D-torso; CIRS, USA) was used for Chest PA and L-spine lateral radiography. For Hand PA radiography, projections was done without phantom. Except Hand PA radiographs, noise was increased with delay time, and ghost image was appeared on overexposed area. Effect of delay after erasure on latent image was not seen on naked eye, but standard deviation (SD) of pixel value on overexposed area was relatively higher than that of other areas. On Hand PA and Chest PA radiographs, noise were not occurred by adjustment of erasure level. On L-spine lateral images at lower erasure level than standard level, noise including ghost image were occurred because of high tube current. Erasure thoroughness of CR system in our department was to be proved by these evaluation. The results of this study could be used as a baseline for IP initialization and reliability of CR images.

Standardization of the Method of Measuring Average Glandular Dose (AGD) and Evaluation of the Breast Composition and Thickness for AGD / 의학물리

Breast cancer is the most common form of cancer among korean woman. Therefore, the early detection activities of breast cancer such as breast self-examinations, clinical breast examinations, mammography are important. A yearly mammography examination has been recommended for women aged 40 and older for the early detection of breast cancer in asymptomatic periods. However, the glandular tissue of breast is the most radiation-sensitive tissue, and the determination of average glandular dose (AGD) forms an important part of the quality control of the mammographic systems. Because of the difficulty of estimating AGD directly, it is often estimated from the measurements of the incident air kerma and by applying the appropriate conversion factors. The primary objective of this study was to standardize the method of measuring AGD. The secondary objective was to evaluate the relationships between AGD per various composition and thickness of the breast using Monte Carlo simulations. As a result, we standardized the method of measuring AGD according to International Atomic Energy Agency (IAEA) guidelines (CoP: an international code of practice). Overall, AGD for mammographic practice in Korea was less than 3.0 mGy recommended by the Korea Food and Drug Adminstration (KFDA) protocol, and Korean Institute for Accreditation of Medical Image (KIAMI). The measured and simulated AGD for a given condition were calculated as 1.7 and 1.6 mGy, respectively. For the AGDs obtained, there was no significant difference between them. The simulated AGD was dependent on the fraction of glandular tissue of the breast. The AGD increases with increasing of the breast glandularity due to increasing absorption of low energy photons. The AGD also increases as a function of breast thickness. In conclusion, the results of this study could be used as a baseline to establish a reference level of radiation dose in mammography.

Imaging Characteristics of Computed Radiography Systems / 의학물리

With recent advancement of the medical imaging systems and picture archiving and communication system (PACS), installation of digital radiography has been accelerated over past few years. Moreover, Computed Radiography (CR) which was well established for the foundation of digital x-ray imaging systems at low cost was widely used for clinical applications. This study analyzes imaging characteristics for two systems with different pixel sizes through the Modulation Transfer Function (MTF), Noise Power Spectrum (NPS) and Detective Quantum Efficiency (DQE). In addition, influence of radiation dose to the imaging characteristics was also measured by quantitative assessment. A standard beam quality RQA5 based on an international electro-technical commission (IEC) standard was used to perform the x-ray imaging studies. For the results, the spatial resolution based on MTF at 10% for Agfa CR system with I.P size of 8x10 inches and 14x17 inches was measured as 3.9 cycles/mm and 2.8 cycles/mm, respectively. The spatial resolution based on MTF at 10% for Fuji CR system with I.P size of 8X10 inches and 14x17 inches was measured as 3.4 cycles/mm and 3.2 cycles/mm, respectively. There was difference in the spatial resolution for 14x17 inches, although radiation dose does not effect to the MTF. The NPS of the Agfa CR system shows similar results for different pixel size between 100 micrometer for 8x10 inch I.P and 150 micrometer for 14x17 inch I.P. For both systems, the results show better NPS for increased radiation dose due to increasing number of photons. DQE of the Agfa CR system for 8X10 inch I.P and 14x17 inch I.P resulted in 11% and 8.8% at 1.5 cycles/mm, respectively. Both systems show that the higher level of radiation dose would lead to the worse DQE efficiency. Measuring DQE for multiple factors of imaging characteristics plays very important role in determining efficiency of equipment and reducing radiation dose for the patients. In conclusion, the results of this study could be used as a baseline to optimize imaging systems and their imaging characteristics by measuring MTF, NPS, and DQE for different level of radiation dose.

ROC Analysis of Simulated Chest Lesions for Computed Radiography and Digital Radiography at Various Tube Voltages / 의학물리

Current digital radiographic systems are rapidly growing in clinical applications. The purpose of this study was to evaluate the diagnostic performance of computed radiography (CR) and digital radiography (DR) at different tube voltages in the detection of simulated chest lesions. Patterns of simulated interstitial lung disease, incipient infiltration, and nodules were superimposed over an anthropomorphic chest phantom. A simulated chest phantom radiograph was obtained with CR and DR at different tube voltages (70 kV, 90 kV, and 120 kV). A total of 18,000 observations were analyzed using a receiver operating characteristic (ROC) analysis. The detection of all lesions showed higher Az values at 70 kV than 120 kV with CR. For the DR, mean Az values at 70 kV were higher than other tube voltages not all lesions but for micro-nodule interstitial lung disease, linear interstitial lung disease, and incipient infiltration. Based on these results, a clinical study should be performed to judge the use of suitable tube voltage according to the type of detector system and lesions.

Plasma Concentrations of Lidocaine Associated with Axillary Brachial Plexus Block / 대한마취과학회지

Brachial plexus block, axillary approach appears to be a safe and reliable technique for upper extremity surgery from shoulder to hand. However, the maximum dose of lidocaine that is recommended by the manufactured is 4 mg per kg (approximately 300 mg) regardless of the injection site. The maximum recommended dose for lidocaine with epinephrine is 7 mg per kg (approximately 500 mg). These maximum recommended amounts are insufficient for brachial plexus block. We question the logic behind these recommended dosages and may exceed them. The aim of this study was to determine whether commonly acceptable dosages used in brachial plexus block within a safe range. The time courses of the plasma concentration were observed in 20 healthy patients to whom were axillary injected with 1.5% lidocaine mixed 1: 200,000 epinephrine. The plasma concentrations were measured by immunofluororesence assay at the intervals of 5, 10, 20, 30 and 60 minutes. The values of plasma concentration were 2.65+/-75, 4.29+/-2.75, 5.95 +/-2.02, 4.76+/-1.91 and 4.48+/-1.90 pg/ml in group 1, and 3.71+/-1.68, 4.76+/-1.91, 6.68+/-3.43, 5.57+/-3.08 and 5.56+/-2.86 ug/ml in group 2, and 2.86+/-1.82, 5.08+/-3.74, 5.92+/-3.84, 6.82+/-3.84 and 5.49+/-3.29 ug/ml in group 3 (Mean+SD). The peak plasma concentration was 5.95+/-2.02 and 6.68+/-3.43 ug/ml at 20 minutes in group 1 and 2 respectively and 6.82+/-3.84 ug/ml at 30 minutes in group 3. These results indicated that the lidocaine 750 mg with epinephrine (5 ug/ml) in brachial plexus block is considered to be safe because plasma concentration dose not exceed the toxic level.