Size based dependence of patient dose metrics, and image quality metrics for clinical indicator-based imaging protocols in abdominal CT procedures.

INTRODUCTION: Diagnostic reference level (DRL) values for computed tomography (CT) based on clinical indication are warranted since imaging protocols are indication-dependent. This study proposes clinical DRL values using the CT dose metrics and five patient size-related parameters while considering image quality. METHODS: The volumetric CT dose index (CTDIvol), dose-length product (DLP) and five size-related parameters of size-specific dose estimates (SSDE), namely the anterior-posterior (AP) dimension, lateral (LAT) dimension, sum dimension, effective diameter, and the body mass index (BMI), were used to calculate DRL values for CT chest-abdomen-pelvis (CAP) and abdomen-pelvis (AbP) protocols. DRL values of the clinical indications for cancer, urinary system stones and other pathologies were assessed based on the BMI classifications using the median and 75th percentile. An image subtraction algorithm was used to assess the image quality metrics (IQM) of the CT images. RESULTS: The 75th percentile for SSDEAP dimension for CAP cancer was 19.7, 14.9 and 12.7 mGy at Hospitals A, C and E, respectively. The median DLP for other AbP pathologies was 556.3, 1452.0 and 1960.7 mGy.cm for normal weight, overweight and obese patients, respectively, at Hospital A. The image quality varied among BMI classifications for different clinically indicated examinations. Although the dose increased with BMI, the image quality index was consistent because automatic tube current modulation (ATCM) was used. CONCLUSION: DRL values are influenced by patient size-related parameters and the clinical indication protocols, while the image quality index is independent of the BMI. IMPLICATIONS FOR PRACTICE: Size-related clinical DRL values and image quality index can be used to monitor and optimise dose and image quality. Acquisition parameters and image quality indexes should be investigated and adjusted when unusually high DRL values are noted.

A multiple methods approach: radiation associated cataracts and occupational radiation safety practices in interventionalists in South Africa.

Ionising radiation is a modality used in diagnostic and therapeutic medicine. The technology has improved and resulted in lower dose exposure but there has been an escalation in the quantity of procedures, their duration and complexity. These factors have meant increased occupational radiation exposure for interventionalists. Ionising radiation exposure can have detrimental health effects and includes radiation skin burns, various carcinomas, genetic and chromosomal aberrations and cataractogenesis of the lenses of the eye. The lenses of the eye are of the most radiosensitive organs and the risk of cataracts is high despite low radiation dose exposures. The use of personal protective equipment (PPE) is a method that can be used to mitigate the risk for developing lens opacifications. The consistent and effective utilisation of PPE is marred by availability, proper fit and ease of use when performing procedures. Radiation safety training is imperative to enforce a culture of radiation safety among interventionalists. The aim of this study was to quantify and describe cataracts among South African interventionalists and to understand their radiation safety practices. For this purpose, a cross sectional study was designed using multiple methods. A survey was conducted to determine the demographics and the risk factors of doctors exposed to radiation to doctors not exposed. The radiation workload and radiation safety practices of interventionalists were explored. Both groups had slit lamp examinations. The data were analysed analytically and a regression model developed looking at the outcomes and the risk factors. Qualitative in-depth interviews and group interviews were conducted to explore the perceptions of interventionalists regarding radiation safety. Deductive and inductive thematic analysis was done. Interdisciplinary research is challenging but offers tremendous opportunity for exploring and tackling complex issues related to securing a safe radiation work environment.

Perceptions of radiation safety training among interventionalists in South Africa

Exposure to ionising radiation may have deterministic and stochastic health effects, which include skin changes, chromosomal aberrations, cataracts and carcinomas. Formalised training in radiation safety and protection improves knowledge on the subject and facilitates greater compliance in safety practices. This qualitative study included 54 interventionalists (adult and paediatric cardiologists, and interventional radiologists). The participants were purposively selected and interviewed to explore their perceptions about radiation safety. A thematic analysis of the transcripts was done using a deductive and inductive approach. Findings showed participating cardiologists had less knowledge about radiation safety than participating radiologists. Cardiologists reported little or no formal training on radiation safety and did not display a culture of radiation safety. There was no consensus on how the training gap should be addressed. There is a perceived need to change and enhance the radiation safety culture among interventionists, and the participants proffered some ideas. These included the need for re-curricularisation of cardiologists' training to create awareness of radiation safety practices

Dependence of Shape-Based Descriptors and Mass Segmentation Areas on Initial Contour Placement Using the Chan-Vese Method on Digital Mammograms.

Variation in signal intensity within mass lesions and missing boundary information are intensity inhomogeneities inherent in digital mammograms. These inhomogeneities render the performance of a deformable contour susceptible to the location of its initial position and may lead to poor segmentation results for these images. We investigate the dependence of shape-based descriptors and mass segmentation areas on initial contour placement with the Chan-Vese segmentation method and compare these results to the active contours with selective local or global segmentation model. For each mass lesion, final contours were obtained by propagation of a proposed initial level set contour and by propagation of a manually drawn contour enclosing the region of interest. Differences in shape-based descriptors were quantified using absolute percentage differences, Euclidean distances, and Bland-Altman analysis. Segmented areas were evaluated with the area overlap measure. Differences were dependent upon the characteristics of the mass margins. Boundary moments presented large percentage differences. Pearson correlation analysis showed statistically significant correlations between shape-based descriptors from both initial locations. In conclusion, boundary moments of digital mass lesions are sensitive to the placement of initial level set contours while shape-based descriptors such as Fourier descriptors, shape convexity, and shape rectangularity exhibit a certain degree of robustness to changes in the location of the initial level set contours for both segmentation algorithms.

Neurological, visual, and MRI brain scan findings in 87 South African patients with HIV-associated cryptococcal meningoencephalitis.

BACKGROUND: HIV-associated cryptococcal meningoencephalitis (CM) is a leading cause of adult meningitis in sub-Saharan Africa. Neuroradiological data is however limited to case reports and small case series from developed countries and/or immunocompetent patients. METHODS: Eighty seven patients aged ≥18 hospitalized with a first episode of CM had magnetic resonance (MRI) imaging during the first two weeks of admission. A subset of eleven patients had follow-up scans approximately one month from their initial MRI scan. All had prospectively-recorded detailed neurological and visual examinations. RESULTS: An abnormal finding on neurological examination was detected in 33 (39%) patients. 38 (48%) patients experienced some visual loss. Neuroradiological lesions presumed to be cryptococcosis-related, as defined by the presence of dilated Virchow Robin spaces, pseudocysts or cryptococcomas, enhancing nodules, hydrocephalus, meningitis, focal perilesional oedema and infarcts, were detected in 55 (63%) patients. MRI findings suggestive of a second diagnosis were found in 18 (21%) patients. Visual loss was associated with the presence of cryptococcal-related lesions (p = 0.02). Blindness was associated with raised intracranial pressure (ICP) (p = 0.02). Of eleven patients with paired scans, brain swelling was identified on the initial scan in only one patient. CONCLUSION: The majority of patients had MRI brain scan abnormalities presumed secondary to CM. Dilated Virchow Robin spaces were the commonest neuroradiological lesion. Visual loss was associated with the degree of cerebral involvement as reflected by the presence of MRI abnormalities. Blindness was associated with the presence of raised ICP. Initial generalised brain swelling does not appear to be common, but further studies with paired scans are needed.

Evaluation of an uncollimated printed paper transmission source used under scatter limiting conditions.

Transmission sources used for image attenuation correction, allowing image quantification, are collimated to reduce scatter. We propose the same effect can be achieved for an uncollimated source by increasing source to patient distance. The aim was to compare planar image performance characteristics and absorbed doses of uncollimated and collimated radioactive printed paper transmission sources. The scatter contribution to the uncollimated (99m)Tc source data was evaluated for different combinations of detector phantom distance, detector source distance and phantom source distance. Measurements were performed by increasing the Lucite phantom thickness in 1cm steps to 20 cm. Spatial resolution, detection efficiency and entrance absorbed dose rate were measured for the uncollimated and collimated transmission source images. Results derived from the energy spectra, obtained with the uncollimated transmission source indicate that scatter contribution increases with decreasing detector source distance. The scatter component in the uncollimated transmission images (detector source distances ≥ 60 cm; phantom source distances ≥ 40 cm) was comparable to that obtained with collimated transmission images. Attenuation coefficients obtained compared well (0.168 cm⁻¹ vs. 0.171 cm⁻¹). The full widths at half maxima differed by less than 0.9 mm. The detection efficiency of the uncollimated source was 2.5 times higher than obtained with the collimated source. The entrance absorbed dose obtained from an uncollimated source was 3.75 times larger than that obtained from the collimated source. An uncollimated transmission source (detector source distance ≥ 60 cm) results in acceptable image characteristics and presents a low cost, low dose, high efficiency option for transmission imaging.

Identification of the breast edge using areas enclosed by iso-intensity contours.

The segmentation of a mammogram into background and breast is a crucial first step in the computer aided diagnosis of mammograms that has the advantage of simplifying further processing of the image (by eliminating the background) and also provides a reference for the alignment of views when two views are being compared. A novel method of segmenting the breast from the background by analysing the area enclosed by iso-intensity contours is presented. Results are evaluated by comparison with manual borders drawn by three radiologists for a set of 25 mammograms. The effect of different pre-processing methods, on the accuracy of automated borders, is investigated. The best methods yielded average root-mean-square differences between the manual and automated iso-intensity borders of 3.0+/-0.3 mm for the image set containing clear breast edges and 4.8+/-0.5 mm for the image set containing indistinct breast edges compared to 5.1+/-0.8 and 7.9+/-0.9 mm for the two data sets with no pre-processing. Results are also compared to those obtained from global thresholding.

Chelator effect on ion diffusion in ferrous-sulfate-doped gelatin gel dosimeters as analyzed by MRI.

Ferrous-sulfate-doped gelatin gel dosimeters are useful tools for the measurement of three-dimensional absorbed radiation dose distributions. The diffusion of ferric ions through these gels causes degradation with time of the dose distribution image. It would be useful to reduce ferric ion diffusion without decreasing gel sensitivity. The amount of ferric ion diffusion is a function of the time delay after radiation, the gel temperature, and the gel concentration. These effects can be quantified by measuring the ferric ion diffusion coefficient. Determination of the diffusion coefficient by irradiating the lower section of a cylinder of gel, which was then imaged repeatedly over time with a clinical magnetic resonance imager, is described. Analysis of the edge spread function formed at each of several times after irradiation by drawing a profile over the imaged junction between the irradiated and unirradiated halves of the cylinder, gave estimates of the variance of the edge spread function. These variances were used to obtain an estimate of the ferric ion diffusion coefficient for the gel. A method of reducing ferric ion diffusion by adding a chelator and the cross linkage agent formaldehyde is suggested. The chelators investigated were 1,10 phenanthroline, xylenol orange, and bathophenanthroline disulfonic acid. These reduced diffusion to varying extents, and influenced the gel sensitivity. The diffusion coefficient in gels containing xylenol orange was found to be 0.44 mm2h-1. The gel sensitivity was 0.0093 s-1Gy-1. This compared with a diffusion coefficient of 0.82 mm2h-1 for the base line gel that did not contain formaldehyde or chelators. The sensitivity of this base line gel was 0.0129 s-1Gy-1. The addition of xylenol orange produced the most improved gel dosimeter of the gels studied. This gel had a decreased ferric ion diffusion coefficient and a decreased sensitivity. It was still sensitive enough to be useful.