Measurement and validation of benchmark-quality thick-target tungsten X-ray spectra below 150 kVp.

Pulse-height distributions of two constant potential X-ray tubes with fixed anode tungsten targets were measured and unfolded. The measurements employed quantitative alignment of the beam, the use of two different semiconductor detectors (high-purity germanium and cadmium-zinc-telluride), two different ion chamber systems with beam-specific calibration factors, and various filter and tube potential combinations. Monte Carlo response matrices were generated for each detector for unfolding the pulse-height distributions into spectra incident on the detectors. These response matrices were validated for the low error bars assigned to the data. A significant aspect of the validation of spectra, and a detailed characterization of the X-ray tubes, involved measuring filtered and unfiltered beams at multiple tube potentials (30-150 kVp). Full corrections to ion chamber readings were employed to convert normalized fluence spectra into absolute fluence spectra. The characterization of fixed anode pitting and its dominance over exit window plating and/or detector dead layer was determined. An Appendix of tabulated benchmark spectra with assigned error ranges was developed for future reference.

Using measured 30-150 kVp polychromatic tungsten x-ray spectra to determine ion chamber calibration factors, Nx (Gy C(-1)).

Two methods for determining ion chamber calibration factors (Nx) are presented for polychromatic tungsten x-ray beams whose spectra differ from beams with known Nx. Both methods take advantage of known x-ray fluence and kerma spectral distributions. In the first method, the x-ray tube potential is unchanged and spectra of differing filtration are measured. A primary standard ion chamber with known Nx for one beam is used to calculate the x-ray fluence spectrum of a second beam. Accurate air energy absorption coefficients are applied to the x-ray fluence spectra of the second beam to calculate actual air kerma and Nx. In the second method, two beams of differing tube potential and filtration with known Nx are used to bracket a beam of unknown Nx. A heuristically derived Nx interpolation scheme based on spectral characteristics of all three beams is described. Both methods are validated. Both methods improve accuracy over the current half value layer Nx estimating technique.

Modification and benchmarking of MCNP for low-energy tungsten spectra.

The MCNP Monte Carlo radiation transport code was modified for diagnostic medical physics applications. In particular, the modified code was thoroughly benchmarked for the production of polychromatic tungsten x-ray spectra in the 30-150 kV range. Validating the modified code for coupled electron-photon transport with benchmark spectra was supplemented with independent electron-only and photon-only transport benchmarks. Major revisions to the code included the proper treatment of characteristic K x-ray production and scoring, new impact ionization cross sections, and new bremsstrahlung cross sections. Minor revisions included updated photon cross sections, electron-electron bremsstrahlung production, and K x-ray yield. The modified MCNP code is benchmarked to electron backscatter factors, x-ray spectra production, and primary and scatter photon transport.

An improved method for rapid objective measurement of gamma camera resolution.

An improved method for an easy, rapid measurement of the intrinsic spatial resolution of a gamma camera is presented. A simplified model was previously developed based solely on mean and standard deviation measurements taken from a region of interest in bar pattern images. This led to an estimate of the modulation transfer function and the full width at half maximum (FWHM) of a line spread function (LSF). The improved method involved expanding the simplified model to incorporate input modulation, square wave input versus the assumed sinusoidal input, aperture (pixel) size, and scatter from the plastic in the bar pattern. The input square wave modulation was calculated to be unity for the typical bar patterns used for gamma camera quality control assessment. For the typical range of bar sizes available, in combination with the typical resolving capabilities of gamma cameras, the sinusoidal approximation of the bar pattern was found to be valid (<1% contribution to the measured resolution from higher harmonic frequencies present in a square wave input with an effective input modulation greater than unity by a factor of 4/pi). The aperture correction factor was calculated for numerous bar and pixel size combinations. Applying the aperture correction factor results in an improvement in the accuracy of the calculated FWHM values, especially for large apertures (pixel sizes). For a camera with a specified FWHM value of 3.5 mm, the simplified model predicts values ranging from 3.2 to 4.1 mm, when the acquisition matrix varies from 128(2) to 512(2). When the expanded model is used with the aperture correction applied, this range was reduced to 3.6-3.9 mm. The scatter correction further improved the calculated FWHM (from 3.6 to 3.8 mm). It is suggested that the expanded model should be used when more accurate measurements are desired, such as in acceptance testing.

Rapid objective measurement of gamma camera resolution using statistical moments.

An easy and rapid method for the measurement of the intrinsic spatial resolution of a gamma camera was developed. The measurement is based on the first and second statistical moments of regions of interest (ROIs) applied to bar phantom images. This leads to an estimate of the modulation transfer function (MTF) and the full-width-at-half-maximum (FWHM) of a line spread function (LSF). Bar phantom images were acquired using four large field-of-view (LFOV) gamma cameras (Scintronix, Picker, Searle, Siemens). The following factors important for routine measurements of gamma camera resolution with this method were tested: ROI placement and shape, phantom orientation, spatial sampling, and procedural consistency. A 0.2% coefficient of variation (CV) between repeat measurements of MTF was observed for a circular ROI. The CVs of less than 2% were observed for measured MTF values for bar orientations ranging from -10 degrees to +10 degrees with respect to the x and y axes of the camera acquisition matrix. A 256 x 256 matrix (1.6 mm pixel spacing) was judged sufficient for routine measurements, giving an estimate of the FWHM to within 0.1 mm of manufacturer-specified values (3% difference). Under simulated clinical conditions, the variation in measurements attributable to procedural effects yielded a CV of less than 2% in newer generation cameras. The moments method for determining MTF correlated well with a peak-valley method, with an average difference of 0.03 across the range of spatial frequencies tested (0.11-0.17 line pairs/mm, corresponding to 4.5-3.0 mm bars). When compared with the NEMA method for measuring intrinsic spatial resolution, the moments method was found to be within 4% of the expected FWHM.

Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent diabetes mellitus.

BACKGROUND: Many patients with insulin-dependent diabetes mellitus have an increase in the glomerular filtration rate and renal enlargement early in the course of their disease. Both these changes may be risk factors for the later development of diabetic nephropathy. Their cause is not known, but they could be due to augmented renal responses to the increase in plasma amino acid concentrations that occurs when dietary protein intake is high, a factor known to increase glomerular filtration and renal blood flow in normal subjects. METHODS: We measured the glomerular filtration rate and renal plasma flow after an overnight fast and during an infusion of amino acids in 12 patients with insulin-dependent diabetes mellitus and 9 normal subjects. The diabetic patients were studied when they were hyperglycemic, when they were euglycemic after an insulin infusion for 36 hours, and after intensive insulin therapy for 3 weeks. Kidney volume was measured by ultrasonography before and after the period of intensive insulin therapy. RESULTS: The glomerular filtration rate and renal plasma flow were normal after fasting when the patients were hyperglycemic (mean [+/- SE] fasting plasma glucose level, 11.5 +/- 0.7 mmol per liter). After the amino acid infusion, these values increased more in the patients (glomerular filtration rate, 2.65 +/- 0.07 ml per second per 1.73 m2 of body-surface area; renal plasma flow, 13.30 +/- 0.68 ml per second per 1.73 m2; P less than 0.05 for both) than in the normal subjects (2.25 +/- 0.08 and 11.20 +/- 0.65 ml per second per 1.73 m2, respectively). The 36-hour infusion of insulin in the diabetic patients did not alter the glomerular filtration rate or renal plasma flow either before or during the amino acid infusion. After three weeks of intensive insulin therapy (fasting plasma glucose level, 5.3 +/- 0.2 mmol per liter), the glomerular filtration rate and renal plasma flow after the amino acid infusion (2.33 +/- 0.03 and 11.30 +/- 0.43 ml per second per 1.73 m2, respectively) were similar to those in the normal subjects. The kidney volumes in the normal subjects and the patients with diabetes were 219 +/- 14 and 312 +/- 14 ml per 1.73 m2, respectively (P less than 0.01); the volume decreased to 267 +/- 22 ml per 1.73 m2 (P less than 0.001) in the diabetic patients after three weeks of intensive insulin therapy, which was not significantly different from the volume in the normal subjects (P = 0.1). CONCLUSIONS: Conventionally treated diabetic patients who have normal renal function while fasting have augmented renal hemodynamic responses to increased plasma amino acid concentrations. The concomitant decrease in these hemodynamic responses and in kidney size with strict glycemic control suggests that these phenomena are related and influenced by the metabolic state.

Distance and depth measurements of radioactive objects utilizing rotating slant-hole collimators.

It is desirable to have an accurate method to determine the depth of various organs which are commonly imaged in nuclear medicine. The method presented here utilizes the geometrical characteristics of the rotating slant-hole collimator to calculate distances and depth. The accuracy of the calculated distance was evaluated for point sources in air separated by 11 cm. The reproducibility of the calculated distance was evaluated as a function of the extent of collimator rotation between observations for angular differences of 45 degrees, 90 degrees, 135 degrees, and 180 degrees. The theory of the method is discussed and the relative error in distance calculation analyzed mathematically as a function of (1) collimator rotation angle error, (2) collimator slant angle error, and (3) position calculation error. Our findings indicate this method to be accurate to within 2% with a reproducibility range of 3%-5% for point sources.

Normal and stenotic renal arteries: experimental balloon-expandable intraluminal stenting.

Elastic recoil of the vessel wall is a common cause of failure of percutaneous transluminal angioplasty in renal arteries. To oppose such recoil, balloon-expandable metal stents were implanted in artificially stenotic renal arteries in pigs and normal renal arteries in dogs and pigs. The stents were then examined angiographically and histologically at regular intervals. All stents were completely covered with endothelialized neointima in 3 weeks. There was no difference in intimal thickness between the stenotic and nonstenotic renal arteries. A large stent diameter and a large open or nonmetal surface may cause less intimal hyperplasia, but nonturbulent, fast arterial flow is probably the most important factor in ensuring long-term patency of the vessel.

Expandable intrahepatic portacaval shunt stents in dogs with chronic portal hypertension.

A canine experimental model was used to investigate the feasibility of using balloon-expandable portacaval shunts in humans with chronic portal hypertension. Intrahepatic portacaval shunts were created in nine dogs with stable portal hypertension previously induced by intraportal injections of polyvinyl alcohol (Ivalon). Embolic material was injected periodically through a subcutaneous port that allowed repeated access to the portal system. Shunts were placed 14 weeks after the last embolization. A shunt patency rate of 100% was observed up to 48 weeks. Low portacaval pressure gradient and high shunt flow accounted for the good results.

Effect of errors in reangulation on planar and tomographic thallium-201 washout profile curves.

Cardiac phantom studies were performed with and without a defect present to test the hypothesis that myocardial 201TI quantitative circumferential washout profile curves calculated from planar and rotating slant hole (RSH) collimator tomographic images are equally affected by errors in axial repositioning. Simulated stress images were acquired with the long axis of the phantom perpendicular to the camera surface and redistribution images were acquired to represent 50% 201TI washout with axial repositioning errors relative to the stress position ranging from 0 to 20 degrees in 5 degrees increments. There was a decrease in the 201TI washout profile curves compared to that expected (50%) in the wall tilted away from the camera surface, and a reciprocal increase in the 201TI washout profile curves in the wall tilted towards the camera surface for both imaging techniques whether a lesion was present or not. This effect became more pronounced as the error in axial repositioning was increased for both the planar (p less than 0.001) and the RSH tomographic (p less than 0.001) techniques. However, the deviation of the 201TI washout profile curves from that expected (50%) was greater for the planar imaging technique with or without a lesion (p less than 0.05 to 0.001). Thus, we conclude that 201TI quantitative circumferential washout profile curves calculated using this tomographic imaging technique are less affected by errors in axial repositioning than those calculated using an equivalent projection by standard planar imaging methods. These data emphasize the importance which must be placed on the repositioning of patients to obtain valid 201TI washout profile curves for the detection and localization of coronary artery disease.

Practical gamma camera quality control with a four-point phantom.

A gamma camera QC phantom for practical assessment of resolution (average FWHM), spatial calibration (pixels/mm), nonhomogeneity of spatial calibration, and average point-source sensitivity (cpm/muCi) was developed and evaluated. The phantom consists of four 57Co-point sources mounted on a Plexiglas base at corners of a square 10 cm on each side. Computer acquisition and processing are fully automated and require less than 1 min for point sources totaling 100 muCi (3.7 MBq) activity. The normal range of variability of measured QC parameters from a 12 wk evaluation period with four different gamma cameras (assumed to be operating normally) yielded coefficients of variation ranging from 0.3% for spatial calibration (pixels/mm) to 2.3% for sensitivity (cpm/muCi) assessments. From the normal range of variability a minimum detectable difference (MDD) was determined for each measured parameter and each gamma camera. The range of acceptable operation of a gamma camera system was set as the measured value +/- MDD for each QC parameter. The ability to detect and track small changes in the measured QC parameters was evaluated.

Factors affecting radiation exposure and radiographic image contrast in urology.

An evaluation of certain radiographic factors affecting patient exposure during urography is made. Factors considered include selection of tube kilovoltage, total beam filtration and film-screen combination. The effect on image quality is also considered. Experimental results suggest specific actions which would result in decreased patient exposure without compromising quality of the examination.

Predicting splenic abnormality in Hodgkin disease using volume response to epinephrine administration.

The change in relative splenic volume following epinephrine administration was used to determine splenic abnormality noninvasively. Selective splenic imaging was accomplished with 99mTc-labeled heat-treated red blood cells, an LFOV gamma camera, a 30 degrees bilateral rotating slant hole collimator, and bilateral slant hole tomographic software. Relative splenic volumes were plotted over time, and correlated with clinical and histologic data. Eight patients with Hodgkin disease and other lymphomas were examined. Volume response to epinephrine appears to be significantly less in abnormal spleens, and may serve to identify patients with unequivocally normal spleens prior to treatment.

Infusion tomography and the total body opacification effect: appraisal in the diagnosis of acute cholecystitis.

Clinical and laboratory investigations were performed to test the criteria used in infusion tomography of the gallbladder (ITGB) for the diagnosis of acute cholecystitis. The results demonstrated a 14% incidence of gallbladder wall visualization in 200 patients asymptomatic for gallbladder disease undergoing excretory urography with tomography. The animal investigation showed no significant difference (0.1 less than p less than 0.2) in radiographic results between control (n = 6) and acute cholecystitis (n = 7) groups. Serious questions are raised regarding the clinical reliability of ITGB using currently accepted diagnostic criteria.

Simultaneous measurement of triiodothyronine and thyroxine in unextracted serum samples using a double-tracer radioimmunoassay method.

A method is described for the simultaneous measurement of triiodothyronine (T3) and thyroxine T4) in 0.04 ml of unextracted serum. Antibodies were prepared by immunization of rabbits with T3 and T4 conjugated with human serum albumin. Bound and free labeled hormones were separated by the double-antibody technique, and 8-anilino-1-naphthalene sulfonic acid was used to inhibit binding of the two hormones to thyroxine-binding globulin. The validity of the assay using 125I-T3 and 131I-T4 is shown by the excellent recovery of T3 and T4 added to serum and by the finding that curves obtained by assaying various dilutions of a hyperthyroid serum run parallel to the standard curves. In all clinical serum T3 and T4 values obtained using the double-tracer radioimmunoassay method were in excellent agreement with those obtained by single-tracer RIA techniques. The combined T3-T4 method appears to be accurate, sensitive, and specific, thus making the assay highly desirable as a technical time-saver.