[Prediction of the Incomplete Region of Fat Suppression Using the Banding Artifact of the Balanced Steady-state Free Precession Sequence].

When the fat-suppression technique was used in the MRI examinations of neck and extremities, incomplete regions of fat suppression were depicted frequently. These incomplete regions were caused by the non-uniform static magnetic field (B0). On the other hand, a non-uniform B0 caused banding artifacts using a balanced steady-state free precession (bSSFP) sequence. We investigated the prediction of incomplete regions of fat suppression using the banding artifacts of the bSSFP sequence. The fat-suppression techniques used in this study were the chemical shift selective and spectral adiabatic inversion recovery methods for turbo spin echo imaging. Using an oil bottle attached to a staple, the scan parameters of the bSSFP sequence were adjusted to overlap with the banding artifacts in the incomplete regions of fat suppression. The neck, ankle joint and femur of healthy volunteers were scanned using the obtained scan parameters, and a visual assessment was performed. As a result, the incomplete region of fat suppression matched the region of the banding artifact. We were able to predict the incomplete region of fat suppression using the banding artifacts of the bSSFP sequence. If the optimized bSSFP sequence is used as the localizer, we can assess the situation of incomplete fat suppression before the main scanning and reduce rescanning due to incomplete fat suppression.

[Analysis of the Environmental Factor of a Patient Falls in Department of Radiology-Proposal of Scientific Analysis Method in Patient Safety].

We analyzed 197 fall incidents in the questionnaire survey about the incident that occurred in Department of Radiology. In the past paper about the patient safety, there is no report that evaluated incident data directly. The purpose of this paper is to analyze the factor of the medical incidents using statistical technique scientifically. In this paper, we do not suggest concrete precaution. At first, we found the number of patients (each gender, modality, generation) in the five facilities of the coworker of one week. We found an incident rate from this patient total number, and we normalized data. As a result, we were able to do each risk evaluation because a risk ratio and relative risk degree was found. And, we were able to identify modality and the generation with the significant difference using the testing for differences in population rate. By our analyses, we revealed the chapter which must strengthen safety management.

[The Knowledge Gained from Questionnaire Survey of the Patients Fall in the Radiological Examinations -Focus on the Severity Due to Fall Accidents].

PURPOSE: The purpose of this study is to analyze the factors of patient's fall that causes serious injury in the radiological examinations. METHODS: We conducted a questionnaire survey on cases of medical accidents occurring in the radiological examination department in medical institutions. The number of responses to the questionnaire surveys was 372. Among them, 197 cases were related to fall. The incident influence classification divided into eight clusters (0, 0H, 1, 2, 3a, 3b, 4, 5) was divided into three clusters (tiny, moderate, serious injury) depending on severity. We analyzed the factors that cause serious injury. RESULTS: In the case of patient's fall, several factors have been found to cause serious injury. The factors were general radiography, standing position, outside working hours. CONCLUSION: All falls can cause serious injury. To reduce falls, it is important to analyze what kind of patient and in what situation tend to fall, and prevent falls in advance.

[The Actual Condition of Fall Accident and Suggestion of Improvement for Accident Prevention in the Department of Radiology].

We conducted a questionnaire survey (situation, patient factor, environmental factor, operator factor, degree of disability, countermeasure etc.) on cases that occurred up to the present to investigate the actual situation of the medical accidents that occur in the radiological examination department of medical institutions. There were 373 questionnaires collected. Among them, there were 197 cases of falls. In this study, we examined the age of patients who fell, the background of the accident, and factors. As for the accident, 11.7% of accidents with risk impact level 3b or higher occurred including the fatal accident. Of the accidents, 44.2% were foreseeable and 55.8% were unforeseeable. The most accident-prone age was elderly in their 60s to 80s. As the causative factor for the accident, the patient factor was the largest at 63.5%. We can prevent about 30% of the accident by improving the operator factor and the environmental factor which are parts other than patient factor. It is important for us to understand what kind of people tend to fall. Among foreseeable accidents, the causes of patient factors can be reduced.

[The Prevention of the Root Accident in the Department of Radiological Examination Room -Analysis of the Results of Questionnaire Survey about Medical Accident to Many Hospital].

PURPOSE: The purpose of this paper is to analyze the characteristics of incidents related to routes and drains that occur in the radiological examination room for the prevention of these incidents. METHODS: We conducted a questionnaire survey on incident cases that occurred in the radiological examination room. There were 373 responses, of which 76 responses were related to routes and drains. The question contents were the number of hospital beds, radiology department of occurrence, time of occurrence, patient's situation, method of visiting, years of experience of the radiological technologists, and countermeasures, and so on. Based on these answers to these questions, we analyzed which factors were involved in the occurrence of the incidents. RESULTS: Incidents related to routes and drains often occur when moving examination table or transferring the patients to the examination table using the slider. On the other hand, the years of experience of the radiological technologists hardly participated in the factor of these incidents. From these answers to questions, 75% of incidents might predictable, and these incidents could be prevented by improvement of human factors accounted for the majority rather than that of physical factors. CONCLUSION: The number of incidents related to routes and drains may reduce by that all staff involved in the radiological examination recognizing the characteristic of these incidents.

Saturation Recovery Myocardial T1 Mapping with a Composite Radiofrequency Pulse on a 3T MR Imaging System.

PURPOSE: To evaluate the effect of a composite radiofrequency (RF) pulse on saturation recovery (SR) myocardial T1 mapping using a 3T MR system. MATERIALS AND METHODS: Phantom and in vivo studies were performed with a clinical 3T MR scanner. Accuracy and reproducibility of the SR T1 mapping using conventional and composite RF pulses were first compared in phantom experiments. An in vivo study was performed of 10 healthy volunteers who were imaged with conventional and composite RF pulse methods twice each. In vivo reproducibility of myocardial T1 value and the inter-segment variability were assessed. RESULTS: The phantom study revealed significant differences in the mean T1 values between the two methods, and the reproducibility for the composite RF pulse was significantly smaller than that for the conventional RF pulse. For both methods, the correlations of the reference and measured T1 values were excellent (r2 = 0.97 and 0.98 for conventional and composite RF pulses, respectively). The in vivo study showed that the mean T1 value for composite RF pulse was slightly lower than that for conventional RF pulse, but this difference was not significant (P = 0.06). The inter-segment variability for the composite RF pulse was significantly smaller than that for conventional RF pulse (P < 0.01). Inter-scan correlations of T1 measurements of the first and second scans were highly and weakly correlated to composite RF pulses (r = 0.83 and 0.29, respectively). CONCLUSION: SR T1 mapping using composite RF pulse provides accurate quantification of T1 values and can lessen measurement variability and enable reproducible T1 measurements.

Quantification of hazard prediction ability at hazard prediction training (Kiken-Yochi Training: KYT) by free-response receiver-operating characteristic (FROC) analysis.

The ability to predict hazards in possible situations in a general X-ray examination room created for Kiken-Yochi training (KYT) is quantified by use of free-response receiver-operating characteristics (FROC) analysis for determining whether the total number of years of clinical experience, involvement in general X-ray examinations, occupation, and training each have an impact on the hazard prediction ability. Twenty-three radiological technologists (RTs) (years of experience: 2-28), four nurses (years of experience: 15-19), and six RT students observed 53 scenes of KYT: 26 scenes with hazardous points (hazardous points are those that might cause injury to patients) and 27 scenes without points. Based on the results of these observations, we calculated the alternative free-response receiver-operating characteristic (AFROC) curve and the figure of merit (FOM) to quantify the hazard prediction ability. The results showed that the total number of years of clinical experience did not have any impact on hazard prediction ability, whereas recent experience with general X-ray examinations greatly influenced this ability. In addition, the hazard prediction ability varied depending on the occupations of the observers while they were observing the same scenes in KYT. The hazard prediction ability of the radiologic technology students was improved after they had undergone patient safety training. This proposed method with FROC observer study enabled the quantification and evaluation of the hazard prediction capability, and the application of this approach to clinical practice may help to ensure the safety of examinations and treatment in the radiology department.

Effects of the Maximum Luminance in a Medical-grade Liquid-crystal Display on the Recognition Time of a Test Pattern: Observer Performance Using Landolt Rings.

This study was conducted to measure the recognition time of the test pattern and to investigate the effects of the maximum luminance in a medical-grade liquid-crystal display (LCD) on the recognition time. Landolt rings as signals of the test pattern were used with four random orientations, one on each of the eight gray-scale steps. Ten observers input the orientation of the gap on the Landolt rings using cursor keys on the keyboard. The recognition times were automatically measured from the display of the test pattern on the medical-grade LCD to the input of the orientation of the gap in the Landolt rings. The maximum luminance in this study was set to one of four values (100, 170, 250, and 400 cd/m(2)), for which the corresponding recognition times were measured. As a result, the average recognition times for each observer with maximum luminances of 100, 170, 250, and 400 cd/m(2) were found to be 3.96 to 7.12 s, 3.72 to 6.35 s, 3.53 to 5.97 s, and 3.37 to 5.98 s, respectively. The results indicate that the observer's recognition time is directly proportional to the luminance of the medical-grade LCD. Therefore, it is evident that the maximum luminance of the medical-grade LCD affects the test pattern recognition time.

Hyaluronic acid controls the uptake pathway and intracellular trafficking of an octaarginine-modified gene vector in CD44 positive- and CD44 negative-cells.

The cellular uptake pathway for a gene vector is an important factor in transgene expression. We previously constructed an original gene vector, multifunctional envelope-type nano device (MEND). The use of octaarginine (R8), a cell-penetrating peptide dramatically enhanced the transfection activity of the MEND since efficient cellular uptake via macropinocytosis, while the R8 should overcome its poor cell selectivity. Here we prepared an R8-MEND equipped with GALA (a peptide for endosomal escape) (R8/GALA-MEND) coated with hyaluronic acid (HA) (HA-R8/GALA-MEND), a natural ligand for cancer cells overexpressing CD44. We investigated the cellular uptake pathway of the HA-R8/GALA-MEND and the R8/GALA-MEND using HCT116 cells overexpressing CD44. Both carriers were taken up by cells mainly via macropinocytosis, whereas only the HA-R8/GALA-MEND was partially internalized into cells via a CD44-mediated pathway. Investigation of transgene expression showed that the HA-R8/GALA-MEND had a high transfection activity in HCT116 cells via both macropinocytotic and CD44-mediated pathways. On the other hand, the value for the HA-R8/GALA-MEND was significantly decreased compared with the value for the R8/GALA-MEND in NIH3T3 cells (CD44-negative cells). These findings indicate that the HA-coating controls the intracellular pathway for R8-modified nanocarriers, and that a CD44-mediated pathway is an important route for transgene expression.

Incident reports related to tasks performed by radiological technologists: an analysis of ten years of incident reports.

In the past 10 years at our university hospital, 202 incident reports related to tasks performed by radiological technologists were posted. In order to investigate the causes and trends of these incidents, we classified the incident reports into four groups based on the event content, level of harm caused to the patient, years of experience of the concerned radiological technologist, and relevant departmental section. In the event content group, 'a malfunctioning device' was the most common event (26.2%), whereas the other events were 'wrong examination procedure or therapy' (15.3%), 'patient fall' (10.9%), 'procedure-patient mismatch' (8.4%), 'accidental removal of patients' tubes or other intravenous devices' (7.9%), and 'bringing metallic material into the magnetic resonance imaging (MRI) room' (7.4%). In the level of harm caused to the patient group, level one events occurred frequently. Radiological technologists with 6-16 years of experience reported incidents most frequently. With regard to the relevant departmental section where the incidents occurred, departments with the highest number of reports were ranked as follows in descending order: general X-ray examination section, MRI section, radiation therapy section, nuclear medicine (NM) section, computed tomography (CT) section, angiography section, and fluoroscopy section. The following events in each corresponding section require careful monitoring: patient fall in the general X-ray examination section and NM section, bringing metallic material into the MRI room, malfunctioning devices in the radiation therapy section, accidental removal of the patient's tubes in the CT section, incorrect handling of the automatic contrast medium injector in the angiography section, and damage of device or article in the fluoroscopy section.

[Development of a quality assurance phantom for brachytherapy: the feasibility of daily check with the phantom].

PURPOSE: We developed a quality assurance (QA) phantom to enable easy confirmation of radiation source output measurements of a high dose rate (192)Ir intracavitary brachytherapy unit in gynecology. The purpose of this study was to evaluate the feasibility of daily checks using the QA phantom. METHODS AND MATERIALS: The QA phantom was designed with tough water phantoms to hold a Farmer-type ionization chamber, with semiconductor detectors used as in vivo dosimeters to measure rectal dose, and three transfer tubes for gynecology. To test the reliability of our QA phantom for the detection of abnormalities in source output or semiconductor detectors, we applied different doses. RESULTS: Variations due to different settings of the QA phantom were within 2%. The temporal variations were less than 2% and 5% in the Farmer-type ionization chamber and semiconductor detectors, respectively. Interobserver variations were below 3%. CONCLUSIONS: With tolerance levels of 2% and 5% for a Farmer-type ionization chamber and semiconductor detectors, respectively, a QA phantom is potentially useful for easily detecting abnormalities by applying daily checks of the brachytherapy unit.

An approach to transgene expression in liver endothelial cells using a liposome-based gene vector coated with hyaluronic acid.

Dysfunctional sinusoidal liver endothelial cells (LECs) are associated with liver diseases, such as liver fibrosis, cirrhosis, and portal hypertension. Because of this, gene therapy targeted to LECs would be a useful and productive strategy for directly treating these diseases at the level of genes. Here, we report on the development of a transgene vector that specifically targets LECs. The vector is a liposome-based gene vector coated with hyaluronic acid (HA). HA is a natural ligand for LECs and confers desirable properties on particles, rendering them biodegradable, biocompatible, and nonimmunogenic. In this study, we constructed HA-modified carriers, and evaluated cellular uptake and transfection activity using cultured LECs from KSN nude mice (KSN-LECs). Cellular uptake analyses showed that KSN-LECs recognized the HA-modified carriers more effectively than skin endothelial cells. The transfection assay indicated that the efficient gene expression in KSN-LECs, using the HA-modified carriers, required an adequate lipid composition and a functional device to control intracellular trafficking. This finding contributes to our overall knowledge of transgene expression targeted to LECs.

Comparison of 3D phase-sensitive inversion-recovery and 2D inversion-recovery MRI at 3.0 T for the assessment of late gadolinium enhancement in patients with hypertrophic cardiomyopathy.

RATIONALE AND OBJECTIVES: To compare free-breathing three-dimensional (3D) phase-sensitive inversion recovery (PSIR) with breath-holding two-dimensional (2D) IR sequences to determine which is better for detecting and characterizing myocardial late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) patients. MATERIALS AND METHODS: Thirty HCM patients clinically underwent 3.0 T cardiac magnetic resonance imaging that included 3D-PSIR and 2D-IR. The amount of LGE lesions was calculated and expressed as %LGE of the myocardial mass, and the average of the %LGE value reported by two observers was recorded as the final %LGE. We also counted the number of LGE lesions and recorded their location. The myocardium-LGE contrast, margin sharpness, artifacts, and overall image quality were graded on a 4-point grading scale (1 = poor, 2 = fair, 3 = good, 4 = excellent). RESULTS: The mean %LGE on 2D-IR was 24.7 ± 0.6, 17.5 ± 0.6, and 8.5 ± 0.3, respectively, for the basal, mid-, and apical myocardium; the corresponding values were 24.2 ± 0.4, 20.0 ± 0.4, and 7.7 ± 0.3 on 3D-PSIR (2D-IR versus 3D-PSIR, P = .87). On 2D IR and 3D-PSIR images, 13, 52, and 53, and 9, 74, and 33 LGE lesions were detected in the subendocardial, midwall, subepicardial area, respectively. The myocardium-LGE contrast and overall image quality were significantly higher on 3D-PSIR than 2D-IR images (P < .001); the sequences did not differ significantly with respect to margin sharpness and artifact. CONCLUSION: Three-dimensional PSIR sequence yields higher image contrast, better image quality, and greater detection ability for LGE lesions than 2D-IR sequence.

[Comparison of various image guided radiation therapy systems; image-guided localization accuracy and patient throughput].

In this study, we evaluated various image guided radiation therapy (IGRT) systems regarding accuracy and patient throughput for conventional radiation therapy. We compared between 2D-2D match (the collation by 2 X-rays directions), cone beam computed tomography (CBCT), and ExacTrac X-Ray system using phantom for CLINAC iX and Synergy. All systems were able to correct within almost 1 mm. ExacTrac X-Ray system showed in particular a high accuracy. As for patient throughput, ExacTrac X-Ray system was the fastest system and 2D-2D match for Synergy was the slowest. All systems have enough ability with regard to accuracy and patient throughput on clinical use. ExacTrac X-Ray system showed superiority with accuracy and throughput, but it is important to note that we have to choose the IGRT technique depending on the treatment site, the purpose, and the patient's state.

[Reduction of radiation exposure and image quality using dose reduction tool on computed tomography fluoroscopy].

The purpose of our study was to measure the reduction rate of radiation dose and variability of image noise using the angular beam modulation (ABM) on computed tomography (CT) fluoroscopy. The Alderson-Rando phantom and the homemade phantom were used in our study. These phantoms were scanned at on-center and off-center positions at -12 cm along y-axis with and without ABM technique. Regarding the technique, the x-ray tube is turned off in a 100-degree angle sector at the center of 12 o'clock, 10 o'clock, and 2 o'clock positions during CT fluoroscopy. CT fluoroscopic images were obtained with tube voltages, 120 kV; tube current-time product per reconstructed image, 30 mAs; rotation time, 0.5 s/rot; slice thickness, 4.8 mm; and reconstruction kernel B30s in each scanning. After CT scanning, radiation exposure and image noise were measured and the image artifacts were evaluated with and without the technique. The reduction rate for radiation exposure was 75-80% with and without the technique at on-center position regardless of each angle position. In the case of the off-center position at -12 cm, the reduction rate was 50% with and without the technique. In contrast, image noise remained constant with and without the technique. Visual inspection for image artifacts almost have the same scores with and without the technique and no statistical significance was found in both techniques (p>0.05). ABM is an appropriate tool for reducing radiation exposure and maintaining image-noise and artifacts during CT fluoroscopy.

[Comparison of dose accuracy between 2D array detectors for pre-treatment IMRT QA].

The dosimetric properties between various 2D array detectors were compared and were evaluated with regard to the accuracy in absolute dose and dose distributions for clinical treatment fields. We used to check the dose accuracy: 2D array detectors; MapCHECK (Sun Nuclear), EPID (Varian Medical Systems), EPID-based dosimetry (EPIDose, Sun Nuclear), COMPASS (IBA) and conventional system; EDR2 film (Eastman Kodak), Exradin A-14SL ion chamber (0.016 cc, Standard Imaging). First, we compared the dose linearity, dose rate dependence, and output factor between the 2D array detectors. Next, the accuracy of the absolute dose and dose distributions were evaluated for clinical fields. All detector responses for the dose linear were in agreement within 1%, and the dose rate dependence and output factor agreed within a standard deviation of ±1.2%, except for EPID. This is because EPID is fluence distributions. In all the 2D array detectors, the point dose agreed within 5% with treatment planning system (TPS). Pass rates of each detector for TPS were more than 97% in the gamma analysis (3 mm/3%). EPIDose was in a good agreement with TPS. All 2D array detectors used in this study showed almost the same accuracy for clinical fields. EPIDose has better resolution than other 2D array detectors and thus this is expected for dose distributions with a small field.