Benefits of using removable filters in dual-layer flat panel detectors.

Objective.Existing dual-layer flat panel detectors (DL-FPDs) use a thin scintillator layer to preferentially detect low-energy x-rays, followed by a permanent Cu filter to absorb residual low-energy x-rays, and finally, a thicker scintillator layer to preferentially detect high-energy x-rays. The image outputs of the two scintillator layers can be jointly processed for dual-energy (DE) planar and cone-beam CT imaging. In clinical practice, a given FPD is often used for not only DE imaging but also routine single-energy (SE) imaging. With the permanent Cu layer, the total x-ray absorption is unsatisfactory for SE imaging since more than 30% of x-rays can be lost in the Cu layer. The purpose of this work was to demonstrate the benefits of using a removable filter material in DL-FPDs for SE and DE imaging applications.Approach.The proposed detector contains a removable filter between the two scintillator layers. The filter can be either a chamber filled with a liquid high-Zeffmaterial or a removable solid filter. When DE imaging is not clinically indicated, the DL-FPD can switch to a high-efficiency SE imaging mode by retracting the filter from the inter-scintillator space. For commonly available filter materials (iodine, gadolinium, and Cu), their optimal area densities were theoretically calculated for both water-bone decomposition and water-iodine decomposition DE imaging tasks. Preliminary experimental studies were also performed to compare the SE performance of the proposed DL-FPD with the existing DL-FPD with the permanent Cu filter and study the stability of the liquid filter on a rotating gantry.Main results.The optimal filter material was found to be an iodine solution (approximately 375 mg cm-2). With this liquid filter in place, the proposed DL-FPD has equivalent or better DE imaging performance compared with the existing DL-FPD with the Cu filter. When the filter is removed from the inter-scintillator space for SE imaging, the total x-ray absorption efficiency of the proposed DL-FPD ranges from 73% (100 kVp) to 54% (140 kVp), compared with 51% (100 kVp) to 41% (140 kVp) for the existing DL-FPD with a permanent 1 mm Cu filter.Significance.The removable filter provides a boost to the total x-ray absorption efficiency of DL-FPDs for SE imaging without compromising DE imaging. This can facilitate the adoption of DL-FPDs in clinical x-ray imaging systems that usually perform more SE imaging procedures than DE imaging series.

Association of multiple primary melanomas with malignancy risk: A population-based analysis of entries from the Surveillance, Epidemiology, and End Results program database during 1973-2014.

BACKGROUND: Genetic and environmental risk factors have been associated with the development of multiple primary melanomas (MPMs). We hypothesized that individuals with MPMs might have an increased incidence of internal malignancies. OBJECTIVE: To identify the risk for subsequent malignancies in MPM patients. METHODS: Multiple primary standardized incidence ratios were analyzed for individuals with ≥1, ≥2 and ≥3 primary melanomas (PMs) recorded in the Surveillance, Epidemiology, and End Results database during 1973-2014. RESULTS: We identified 223,799 individuals with ≥1 PM, 19,709 with ≥2 PMs, and 3,995 with ≥3 PMs. Risks of subsequent internal malignancy increased with number of PMs, with observed:expected ratios of 0.99, 1.14, and 1.23 (P < .05) for patients with ≥1 PM, ≥2 PMs, and ≥3 PMs, respectively. Internal malignancy was higher in younger MPM patients and those with superficial spreading melanoma. The most common malignancies among MPM patients included breast, prostate, thyroid, soft tissue, brain, kidney, non-Hodgkin lymphoma, and chronic lymphocytic leukemia. Risk for subsequent cutaneous melanoma increased with observed:expected ratios of 8.09, 22.52, 41.03 (P < .05) for patients with ≥1 PM, ≥2 PMs, and ≥3 PMs, respectively. LIMITATIONS: Surveillance, Epidemiology, and End Results records limited information about pigmentation phenotypes, histology, and treatments. CONCLUSION: Patients with MPMs have an increased risk for subsequent internal and cutaneous malignancies and might benefit from tight adherence to age-specific cancer screening.

Diagnostic Distinction of Malignant Melanoma and Benign Nevi by a Gene Expression Signature and Correlation to Clinical Outcomes.

Background: Histopathologic examination alone can be inadequate for diagnosis of certain melanocytic neoplasms. Recently, a 23-gene expression signature was clinically validated as an ancillary diagnostic test to differentiate benign nevi from melanoma. The current study assessed the performance of this test in an independent cohort of melanocytic lesions against clinically proven outcomes.Methods: Archival tissue from primary cutaneous melanomas and melanocytic nevi was obtained from four independent institutions and tested with the gene signature. Cases were selected according to pre-defined clinical outcome measures. Malignant lesions were defined as stage I-III primary cutaneous melanomas that produced distant metastases (metastatic to sites other than proximal sentinel lymph node(s)) following diagnosis of the primary lesion. Melanomas that were metastatic at the time of diagnosis, all re-excisions, and lesions with <10% tumor volume were excluded. Benign lesions were defined as cutaneous melanocytic lesions with no adverse long-term events reported.Results: Of 239 submitted samples, 182 met inclusion criteria and produced a valid gene expression result. This included 99 primary cutaneous melanomas with proven distant metastases and 83 melanocytic nevi. Median time to melanoma metastasis was 18 months. Median follow-up time for nevi was 74.9 months. The gene expression score differentiated melanoma from nevi with a sensitivity of 93.8% and a specificity of 96.2%.Conclusions: The results of gene expression testing closely correlate with long-term clinical outcomes of patients with melanocytic neoplasms.Impact: Collectively, this provides strong evidence that the gene signature adds valuable adjunctive information to aid in the accurate diagnosis of melanoma. Cancer Epidemiol Biomarkers Prev; 26(7); 1107-13. ©2017 AACR.