[Usability of smartphones for dose alerts]. / Smartphones jetzt noch smarter? - Möglichkeit des Einsatzes als "Dosiswarner"

PURPOSE: Smartphone apps for measuring ionizing radiation use the capability of (CMOS) camera chips to detect not only perceivable light but also electromagnetic wave radiation. The present study evaluates the accuracy of hardware and software and defines possible applications for the detection of X-ray radiation fields. MATERIALS AND METHODS: 2 apps and 2 different devices were tested in comparison with a calibrated ionization chamber and a personal electronic dosimeter. A calibration curve was determined for dose rates between 12 700 µSv/h and 5.7 µSv/h generated by a C-arm system. RESULTS: The measured scattered radiation produced by an Alderson-Rando phantom ranged from 117 µSv/h (at a distance of 2 m) to 5910 µSv/h (at a distance of 0.3 m) and was 1.4 times less than the values of the ionization chamber. The exposure rate for the operator's thyroid was within 4200 - 4400 µSv/h. We found a strong dependence of the measurements on the angulation of the Smartphone, especially for short distances from the phantom (at a distance of 0.3 m, a 45° rotation downwards in a vertical direction caused a decrease from 3000 µSv/h to 972 µSv/h, while an upwards rotation resulted in an increase to 5000 µSv/h). For a distance of 1 m, this effect was remarkably smaller. CONCLUSION: Smartphones can be used to detect ionizing radiation but showed limited accuracy and are heavily dependent on the angulation of the device. Qualitative measurements and utilization for dose alerts are possible.

Comparison of the image quality of various fixed and dose modulated protocols for soft tissue neck CT on a GE Lightspeed scanner.

PURPOSE: Up-to-date CT scanners provide high quality soft tissue imaging of the neck, but scanning protocols often are not optimized regarding radiation dose. Thus, we tried to find a dose-optimized protocol for soft tissue imaging of the neck. MATERIAL AND METHODS: 70 patients were scanned with a 16-row CT-scanner (Lightspeed, GE) with seven different protocols. We used four fixed tube current settings (225, 200, 175 and 150 mA; corresponding CTDI(vol)=10.6, 9.5, 8.3 and 7.1 mGy) and three z-axis dose modulations with a relatively high, moderate and low dose (calculated CTDI(vol)=10.5, 9.1, 7.7 mGy). Representative slices of seven anatomical regions (from the nasopharynx to the aortic arch) were subjectively judged by two radiologists with respect to image quality (five-point rating scale for noise and sharpness). For each protocol and for each judged anatomical region we determined and compared mean values regarding image quality and local tube current. For each protocol, mean values regarding the volume CT dose index (CTDI(vol)) and the dose-length product (DLP) were statistically compared. Moreover, using the software CT-Expo the respective effective doses and the cumulative organ doses of the thyroid gland were compared. RESULTS: For a fixed tube current of at least 200 mA (CTDI(vol)=9.5 mGy) and for dose modulations with a moderate or high dose adjustment (calculated CTDI(vol)=9.1 and 10.5 mGy) the image quality was sufficient to excellent. As compared to a fixed tube current of 200 mA, dose modulation with a moderate dose adjustment improved the image quality in regions more vulnerable to noise-related artifacts such as at the level of the shoulder, without a noteworthy difference regarding the DLP. However, the cumulative organ dose of the thyroid gland was 17% lower using dose modulation with a moderate dose adjustment as compared to the fixed tube current of 200 mA. Thus, for a comparison with other scanners, we recommend dose modulation and an averaged CTDI(vol)<9 mGy (or a DLP<250 mGycm). CONCLUSION: A combination of dose modulation and an averaged CTDI(vol)<9 mGy or a DLP<250 mGycm yields sufficient image quality for soft tissue CT-imaging of the neck.

[5 years of "concerted action dose reduction in CT" -- what has been achieved and what remains to be done?]. / 5 Jahre Konzertierte Aktion Dosisreduktion CT--was wurde erreicht, was ist noch zu tun?

In May 1998, the German "Concerted Action Dose Reduction in CT" was founded by all parties involved in CT. Its intention was to achieve a significant reduction of the radiation exposure caused by CT, a matter that has increasingly been considered a major challenge since the early nineties. As a result of a number of joint efforts, the essential preconditions have been established by now. The fifth anniversary of the Concerted Action gave rise for both retrospection and outlook on the tasks that have already been accomplished and those that still need to be done. For this purpose, a one-day symposium took place in Berlin on November 4, 2003. The contents of a total of 18 contributions will be outlined here in brief.

Assessment of a theoretical formalism for dose estimation in CT: an anthropomorphic phantom study.

Dose assessment in computed tomography (CT) is challenging due to the vast variety of CT scanners and imaging protocols in use. In the present study, the accurateness of a theoretical formalism implemented in the PC program CT-EXPO for dose calculation was evaluated by means of phantom measurements. Phantom measurements were performed with four 1-slice, four 4-slice and two 16-slice spiral CT scanners. Firstly, scanner-specific nCTDIw values were measured and compared with the corresponding standard values used for dose calculation. Secondly, effective doses were determined for three CT scans (head, chest and pelvis) performed at each of the ten installations from readings of thermoluminescent dosimeters distributed inside an anthropomorphic Alderson phantom and compared with the corresponding dose values computed with CT-EXPO. Differences between standard and individually measured nCTDIw values were less than 16%. Statistical analysis yielded a highly significant correlation (P < 0.001) between calculated and measured effective doses. The systematic and random uncertainty of the dose values calculated using standard nCTDIw values was about -9 and +/- 11%, respectively. The phantom measurements and model calculations were carried out for a variety of CT scanners and representative scan protocols validate the reliability of the dosimetric formalism considered-at least for patients with a standard body size and a tube voltage of 120 kV selected for the majority of CT scans performed in our study.

[CT-based liver volumetry in a porcine model: impact on clinical volumetry prior to living donated liver transplantation]. / CT-basierte Lebervolumetrie im Tiermodell: Bedeutung für die klinische Volumetrie im Rahmen der Leberlebendspende.

PURPOSE: Exact preoperative determination of the liver volume is of great importance prior to hepatobiliary surgery, especially in living donated liver transplantation (LDLT). In the current literature, a strong correlation between preoperatively calculated and intraoperatively measured liver volumes has been described. Such accuracy seems questionable, primarily due to a difference in the perfusion state of the liver in situ versus after explantation. Purpose of the study was to asses the influence of the perfusion state on liver volume and the validity of the preoperative liver volumetry prior to LDLT. METHODS: In an experimental study, 20 porcine livers were examined. The livers were weighted and their volumes were determined by water displacement prior and after fluid infusion to achieve a pressure physiologically found in the liver veins. The liver volumes in the different perfusion states were calculated based on CT-data. The calculated values were compared with the volume measured by water displacement and the weight of the livers. RESULTS: Assessment of calculated CT volumes and water displacements at identical perfusion states showed a tight correlation and differed on average by 4 +/- 5 %. However, livers before and after fluid infusion showed a 33 +/- 8 % (350 +/- 150 ml) difference in volume. CONCLUSION: CT-volumetry acquires highly accurate data as confirmed by water displacement studies. However, the perfusion state has major impact on liver volume, which has to be accounted for in clinical use.

Radiation exposure in multi-slice versus single-slice spiral CT: results of a nationwide survey.

Multi-slice (MS) technology increases the efficacy of CT procedures and offers new promising applications. The expanding use of MSCT, however, may result in an increase in both frequency of procedures and levels of patient exposure. It was, therefore, the aim of this study to gain an overview of MSCT examinations conducted in Germany in 2001. All MSCT facilities were requested to provide information about 14 standard examinations with respect to scan parameters and frequency. Based on this data, dosimetric quantities were estimated using an experimentally validated formalism. Results are compared with those of a previous survey for single-slice (SS) spiral CT scanners. According to the data provided for 39 dual- and 73 quad-slice systems, the average annual number of patients examined at MSCT is markedly higher than that examined at SSCT scanners (5500 vs 3500). The average effective dose to patients was changed from 7.4 mSv at single-slice to 5.5 mSv and 8.1 mSv at dual- and quad-slice scanners, respectively. There is a considerable potential for dose reduction at quad-slice systems by an optimisation of scan protocols and better education of the personnel. To avoid an increase in the collective effective dose from CT procedures, a clear medical justification is required in each case.

[CT-expo--a novel program for dose evaluation in CT]. / CT-Expo - ein neuartiges Programm zur Dosisevaluierung in der CT.

CT-Expo is a novel MS Excel application for assessing the radiation doses delivered to patients undergoing CT examinations, based on computational methods that were used to analyze the data collected in the German survey on CT practice in 1999. The program enables the calculation of all dose quantities of practical value, such as axial dose free-in-air, weighted CTDI, dose-length product, effective dose and uterine dose. In contrast to existing programs for CT dose assessment, CT-Expo offers a number of unique features, such as gender-specific dose calculation for all age groups (adults, children, newborns), applicability to all existing scanner models including correction of scanner-specific influences, and the possibility of comparison with the results from the German CT survey on CT practice. Three different application modules offer free and standardized dose calculations as well as a comprehensive benchmarking section including guidance on dose optimization. The program is available as shareware in both German and English version. Additional information and a demo version free of charge can be requested via e-mail from the author's address stamm.georg@mh-hannover. de) or from the web page http://www.mh-hannover.de/kliniken/radiologie/str_04.html.

Precise determination of aortic length in patients with aortic stent grafts: in vivo evaluation of a thinning algorithm applied to CT angiography data.

The aim of this study was to develop a technique for precise determination of the aortic length using volumetric CT data for potential use prior to endovascular stent-graft placement. The study population consisted of 20 patients (38 measurements) with already performed endoluminal grafting. This allowed for in vivo evaluation of our technique. Its length according to the graft specifications served as a gold standard for our own measurements. The implemented graft length varied between 120 and 195 mm. Computed tomography angiography was performed with 3-mm slice collimation, 5-mm table feed and a reconstruction interval of 2 mm. Following semi-automatic segmentation of the aorta and its large side branches, the median centerline (skeleton) of the vessels was determined employing a modified three-dimensional thinning algorithm. The algorithm was validated by comparing the calculated length of the resulting skeleton with the specifications of the grafts. The calculated length was sufficiently precise despite the limiting reconstruction interval of 2 mm of our CT data which only permitted an assessment of stent length in 2-mm steps. The differences in the measured length and graft length were in the range between 0 and 8 mm (< 5%) with a mean fractional error of 2.46 +/- 2.37 mm. The use of an intelligent region growing algorithm capable of coping with variable arterial enhancement significantly reduced operator post-processing time. The average time necessary for segmentation was 7 min (range 3-10 min). Our algorithm provides a non-invasive method for objective and precise measurement of aortic length apparently even in tortuous vessels. It has the potential to replace angiography for aortic and iliac length measurements with calibrated catheters prior to endovascular intervention.

[Individual planning of liver surgery interventions with a virtual model of the liver and its associated structures]. / Individuelle Planung leberchirurgischer Eingriffe an einem virtuellen Modell der Leber und ihrer Leitstrukturen.

BACKGROUND: In an interdisciplinary approach, HepaVision (MEVIS, Bremen), a software tool specifically developed for 3D visualization of the liver, was employed for individual planning of extensive liver resections and evaluation of living-relative donations. So far there is experience with more than 50 biphasic spiral CT examinations. RESULTS: The spatial relationship of large tumors to crucial hepatic structures, the demonstration and evaluation of anatomic variants regarding vascular supply and the risk stratification of liver failure by volumetric analysis on the basis of portal venous drainage supported precise indication for surgery. Surgical safety is increased by preoperative planning and simulation of necessary vessel reconstructions. By hiding selective areas of portal venous drainage or applying freely selectable clip planes, segmental as well as non-anatomical resections can be simulated and their effects analyzed. The virtual preoperative situs was confirmed intraoperatively in all 17 patients of our study population who underwent segmental liver resection for either a tumor or living-relative donation.

[Basic principles of data acquisition and data processing for construction of high quality virtual models]. / Grundregeln der Datenakquisition und Datennachverarbeitung für die Erstellung hochwertiger virtueller Modelle.

Creating models for virtual reality subdivides into several steps. The aim of the data acquisition is the extraction of nearly isotropic (same solution in all three axes) data sets with low noise content. An approximate isotropy can be achieved by suitable choice of scan parameters. For raw data reconstruction, the application of high-resolution reconstruction algorithms is prohibited due to increased noise. A missing isotropy can computationally be approximated by interpolation. Further noise suppression is achieved by applying filters. Additionally, the contrast of the object for segmentation can be increased by image processing operators. The correct choice of the segmentation method and the editing tools is essential for a precise segmentation with minimal user interaction. Prior to visualization, smoothing the shape of the segmented model (shape-based or morphological interpolation, polygon reduction of wire frame model) further improves the visual appearance of the 3D model.

[3-dimensional (3-D) visualization of the liver for planning extensive liver resections]. / Dreidimensionale (3-D) Visualisierung der Leber zur Planung erweiterter Leberresektionen.

Preoperative planning of liver resections in patients with liver tumors is based on sonography, computed tomography and magnetic resonance imaging. A new three-dimensional (3D) visualization program was developed based on CT data. This visualization program was used for preoperative planning in 6 patients with liver tumors in problematic intrahepatic localizations. In 5 out of 6 patients the liver resection could be performed as preoperatively planned. The intraoperative findings agreed with the 3D visualization in all these patients. 3D Visualization of the liver allowed clear and interactive planning of liver resections and improved the preparation of complex liver resections.

Quantitation of TNP-470 and its metabolites in human plasma: sample handling, assay performance and stability.

A selective and sensitive assay for the determination of TNP-470 and two of its metabolites, AGM-1883 and M-II, in human plasma was developed. The assay involved liquid-liquid extraction followed by analysis using high-performance liquid chromatography-atmospheric pressure chemical ionization tandem mass spectrometry. Because TNP-470 is most stable in a pH of 4-5, an acidification procedure was utilized to prevent degradation of TNP-470 during sample collection which involved acidifying the whole blood sample collected with 5 mg of citric acid per ml of blood. Liquid-liquid extraction using an organic solvent mixture was chosen over solid-phase extraction to minimize the degradation of TNP-470 during solvent evaporation.

[Comparison of film-screen combinations in contrast-detail diagram and with interactive image analysis. 3: Trimodal histograms of gray scale distribution in bar groups of lead pattern images]. / Vergleich von Film-Folien-Kombinationen im Kontrast-Detail-Diagramm und mit interaktiver Bildanalyse. Teil 3: Trimodale Histogramme der Grauwert-verteilungen in Liniengruppen von Bleistegraster-Aufnahmen.

The following four screen film combinations were compared: a) a combination of anticrossover film and UV-light emitting screens, b) a combination of blue-light emitting screens and film and c) two conventional green fluorescing screen film combinations. Radiographs of a specially designed plexiglass phantom (0.2 x 0.2 x 0.12 m3) with bar patterns of lead and plaster and of air, respectively were obtained using the following parameters: 12 pulse generator, 0.6 mm focus size, 4.7 mm aluminum prefilter, a grid with 40 lines/cm (12:1) and a focus-detector distance of 1.15 m. Image analysis was performed using an Ibas system and a Zeiss Kontron computer. Display conditions were the following: display distance 0.12 m, a vario film objective 35/70 (Zeiss), a video camera tube with a PbO photocathode, 625 lines (Siemens Heimann), an Ibas image matrix of 512 x 512 pixels with a spatial resolution of ca. 7 cycles/mm, the projected matrix area was 5000 micron 2. Maxima in the histograms of a grouped bar pattern were estimated as mean values from the bar and gap regions ("mean value method"). They were used to calculate signal contrast, standard deviations of the means and scatter fraction. Comparing the histograms with respect to spatial resolution and kV setting a clear advantage of the UVR system becomes obvious. The quantitative analysis yielded a maximum spatial resolution of approx. 3 cycles/mm for the UVR system at 60 kV which decreased to half of this value at 117 kV caused by the increasing influence of scattered radiation. A ranking of screen-film systems with respect to image quality and dose requirement is presented. For its evaluation an interactive image analysis using the mean value method was found to be superior to signal/noise ratio measurements and visual analysis in respect to diagnostic relevance and saving of time.

[Comparison of film-screen combinations with contrast detail diagram and interactive image analysis. 2: Linear assessment of grey scale ranges with interactive image analysis]. / Vergleich von Film-Folien-Kombinationen im Kontrast-Detail-Diagramm und mit interaktiver Bildanalyse. Teil 2: Lineare Vermessung von Grauwertverteilungen mit interaktiver Bildanalyse.

The following three screen-film combinations were compared: a) a combination of anticrossover film and UV-light emitting screens, b) a combination of blue-light emitting screens and film, and c) a conventional green fluorescing screen-film combination. Radiographs of a specially designed plexiglass phantom (0.2 x 0.2 x 0.12 m3) with bar patterns of lead and plaster and of air, respectively were obtained using the following parameters: 12 pulse generator, 0.6 mm focus size, 4.7 mm aluminum pre-filter, a grid with 40 lines/cm (12:1) and a focus-detector distance of 1.15 m. Image analysis was performed using an IBAS system and a Zeiss Kontron computer. Display conditions were the following: display distance 0.12 m, a vario film objective 35/70 (Zeiss), a video camera tube with a PbO photocathode, 625 lines (Siemens Heimann), an IBAS image matrix of 512 x 512 pixels with a resolution of 7 lines/mm, the projected matrix area was 5000 microns2. Grey scale ranges were measured on a line perpendicular to the grouped bar patterns. The difference between the maximum and minimum density value served as signal. The spatial resolution of the detector system was measured when the signal value was three times higher than the standard deviation of the means of multiple density measurements. The results showed considerable advantages of the two new screen-film combinations as compared to the conventional screen-film combination. The result was contradictory to the findings with pure visual assessment of thresholds (part I) that had found no differences. The authors concluded that (automatic) interactive image analysis algorithms serve as an objective measure and are specifically advantageous when small differences in image quality are to be evaluated.

Sensitive method for the assay of sertindole in plasma by high-performance liquid chromatography and fluorimetric detection.

A simple and highly sensitive normal-phase HPLC method is described for determining sertindole concentrations in human plasma using fluorimetric detection. A short C8 column was used to extract sertindole and the internal standard from plasma; the column was rinsed with acetonitrile, and the analytes were recovered by elution with methanol. This uncommon selectivity between the two solvents allowed clean extraction and near- quantitative recovery of the analytes (> 89%). Separation was done on a 5-microns silica-gel column and detection was performed by fluorimetry, with emission at 340 nm and excitation at 260 nm. The detection and lower quantifiable limits were 0.01 and 0.025 ng/ml, respectively, with no interference from plasma or potential metabolites.