Radiation Exposure to the Sacroiliac Joint From Low-Dose CT Compared With Radiography.

OBJECTIVE: The primary objective of this study was to estimate the effective dose delivered to the sacroiliac joint (SIJ) from low-dose (LD) CT compared with that from radiography. Secondary objectives included evaluation of diagnostic quality of LD CT of the SIJ and development of a clinical protocol for LD CT of the SIJ. MATERIALS AND METHODS: Data from 36 patients (19 women, 17 men) undergoing LD CT for suspected renal colic were analyzed. Two effective dose estimates were calculated: one for the SIJ and another for an extended region from the iliac crest to 1 cm below the SIJ. Thirty-six anteroposterior pelvic and 36 SIJ view radiographs were age-, sex-, and body width-matched to CT scans. Effective dose from radiography was estimated using the method described in International Commission on Radiologic Protection Publication 60. RESULTS: Maximum effective dose to the SIJ from LD CT was less than 1 mSv in all cases, with a mean ± SD of 0.42 ± 0.18 mSv (range, 0.14-0.83 mSv), whereas mean dose to the extended region was 0.57 ± 0.24 mSv (range, 0.19-1.11 mSv). Mean dose from SIJ radiographs was 0.15 ± 0.10 mSv (range, 0.07-1.38 mSv), and mean dose from a single pelvic radiograph was 0.09 ± 0.06 mSv (range, 0.04-0.37 mSv). All CT studies were of diagnostic quality for assessment of the SIJ. CONCLUSION: LD CT of the SIJ can be consistently performed with an effective radiation dose of less than 1 mSv. Because reliability and sensitivity of radiography for sacroiliitis is poor, we recommend that LD CT replace radiography for dedicated evaluation of the SIJ.

Estimating wetland connectivity to streams in the Prairie Pothole Region: an isotopic and remote sensing approach.

Understanding hydrologic connectivity between wetlands and perennial streams is critical to understanding the reliance of stream flow on inputs from wetlands. We used the isotopic evaporation signal in water and remote sensing to examine wetland-stream hydrologic connectivity within the Pipestem Creek watershed, North Dakota, a watershed dominated by prairie-pothole wetlands. Pipestem Creek exhibited an evaporated-water signal that had approximately half the isotopic-enrichment signal found in most evaporatively enriched prairie-pothole wetlands. Groundwater adjacent to Pipestem Creek had isotopic values that indicated recharge from winter precipitation and had no significant evaporative enrichment, indicating that enriched surface water did not contribute significantly to groundwater discharging into Pipestem Creek. The estimated surface-water area necessary to generate the evaporation signal within Pipestem Creek was highly dynamic, varied primarily with the amount of discharge, and was typically greater than the immediate Pipestem Creek surface-water area, indicating that surficial flow from wetlands contributed to stream flow throughout the summer. We propose a dynamic range of spilling thresholds for prairie-pothole wetlands across the watershed allowing for wetland inputs even during low flow periods. Combining Landsat estimates with the isotopic approach allowed determination of potential (Landsat) and actual (isotope) contributing areas in wetland-dominated systems. This combined approach can give insights into the changes in location and magnitude of surface water and groundwater pathways over time. This approach can be used in other areas where evaporation from wetlands results in a sufficient evaporative isotopic signal.

Biota: Providing often-overlooked connections among freshwater systems.

When we think about connections in and among aquatic systems, we typically envision clear headwater streams flowing into downstream rivers, river floodwaters spilling out onto adjacent floodplains, or groundwater connecting wetlands to lakes and streams. However, there is another layer of connectivity moving materials among freshwater systems, one with connections that are not always tied to down-gradient flows of surface waters and groundwater. These movements are those of organisms, key components of virtually every freshwater system on the planet. In their movements across the landscape, biota connect aquatic systems in often-overlooked ways.

The effect of skin thickness determined using breast CT on mammographic dosimetry.

The effect of breast skin thickness on dosimetry in mammography was investigated. Breast computed tomography (CT) acquisition techniques, combined with algorithms designed for determining specific breast metrics, were useful for estimating skin thickness. A radial-geometry edge detection scheme was implemented on coronal reconstructed breast CT (bCT) images to measure the breast skin thickness. Skin thickness of bilateral bCT volume data from 49 women and unilateral bCT volume data from 2 women (10 healthy women and 41 women with BIRADS 4 and 5 diagnoses) was robustly measured with the edge detection scheme. The mean breast skin thickness (+/-inter-breast standard deviation) was found to be 1.45 +/- 0.30 mm. Since most current published normalized glandular dose (DgN) coefficients are based on the assumption of a 4-mm breast skin thickness, the DgN values computed with Monte Carlo techniques will increase up to 18% due to the thinner skin layers (e.g., 6-cm 50% glandular breast, 28 kVp Mo-Mo spectrum). The thinner skin dimensions found in this study suggest that the current DgN values used for mammographic dosimetry lead to a slight underestimate in glandular dose.

Dedicated breast CT: initial clinical experience.

PURPOSE: To prospectively and intraindividually compare dedicated breast computed tomographic (CT) images with screen-film mammograms. MATERIALS AND METHODS: All patient studies were performed according to protocols approved by the institutional review board and Radiation Use Committee; informed consent was obtained. A breast CT scanner prototype was used to individually scan uncompressed breasts in 10 healthy volunteers (mean age, 52.1 years) and 69 women with Breast Imaging Reporting and Data System category 4 and 5 lesions (mean age, 54.4 years). In women with lesions, breast CT images were compared with screen-film mammograms by an experienced mammographer and ranked with a continuous scale of 1-10 (score 1, excellent lesion visualization with CT and poor visualization with mammography; score 5.5, equal visualization with both modalities; and score 10, poor visualization with CT and excellent visualization with mammography). A Wilcoxon signed rank procedure was used to test the null hypothesis that ratings were symmetric at about a score of 5.5 for the entire group and for distinguishing microcalcifications versus masses and other findings and benign versus malignant lesions and for effect of breast density on lesion visualization. Women were asked to compare their comfort during CT with that during mammography on a continuous scale of 1-10. With a Wilcoxon signed rank procedure, the null hypothesis that comfort ratings were symmetric about a score of 5.5 (equal comfort with CT and mammography) was tested. RESULTS: Overall, CT was equal to mammography for visualization of breast lesions. Breast CT was significantly better than mammography for visualization of masses (P = .002); mammography outperformed CT for visualization of microcalcifications (P = .006). No significant differences between CT and mammography were seen among benign versus malignant lesions or for effect of breast density on lesion visualization. Subjects found CT significantly more comfortable than mammography (P < .001). CONCLUSION: Some technical challenges remain, but breast CT is promising and may have potential clinical applications.

Noise power properties of a cone-beam CT system for breast cancer detection.

The noise power properties of a cone-beam computed tomography (CT) system dedicated for breast cancer detection were investigated. Uniform polyethylene cylinders of various diameters were scanned under different system acquisition conditions. Noise power spectra were calculated from difference data generated by subtraction between two identical scans. Multidimensional noise power spectra (NPS) were used as the metric to evaluate the noise properties of the breast CT (bCT) under different system acquisition and reconstruction conditions. A comprehensive investigation of the noise properties was performed in regard to system acquisition parameters including kVp, mA, number of cone-beam projection images used, cone angle, and object size. The influence on reconstruction parameters including interpolation method, reconstruction filter, field of view, matrix size, and slice thickness were also studied. Under certain conditions, the zero-dimensional NPS (image variance) was used as a quantitative index to compare the influence from different scan parameters, especially the radiation dose. If the total scan dose is changed by linearly changing the total number of projection images while the dose per frame is kept constant, the noise power has a linear relationship with the reciprocal of the total dose. If the total scan dose is changed by linearly changing the dose per frame while the total number of projection images is kept constant, the noise power has a quadratic relationship with the reciprocal of the total dose. With the same amount of total dose, using fewer projection images results in lower image noise power in the CT image. Quantitative results from this noise power analysis provide guidance for the bCT system operation, optimization, and data reconstruction.

Computer modeling of the spatial resolution properties of a dedicated breast CT system.

Computer simulation methods were used to evaluate the spatial resolution properties of a dedicated cone-beam breast CT system. X-ray projection data of a 70 microm nickel-chromium wire were simulated. The modulation transfer function (MTF) was calculated from the reconstructed axial images at different radial positions from the isocenter to study the spatial dependency of the spatial resolution of the breast CT scanner. The MTF was also calculated in both the radial and azimuthal directions. Subcomponents of the cone beam CT system that affect the MTF were modeled in the computer simulation in a serial manner, including the x-ray focal spot distribution, gantry rotation under the condition of continuous fluoroscopy, detector lag, and detector spatial resolution. Comparison between the computer simulated and physically measured MTF values demonstrates reasonable accuracy in the simulation process, with a small systematic difference (approximately 9.5 +/- 6.4% difference, due to unavoidable uncertainties from physical measurement and system calibration). The intrinsic resolution in the radial direction determined by simulation was about 2.0 mm(-1) uniformly through the field of view. The intrinsic resolution in the azimuthal direction degrades from 2.0 mm(-1) at the isocenter to 1.0 mm(-1) at the periphery with 76.9 mm from the isocenter. The results elucidate the intrinsic spatial resolution properties of the prototype breast CT system, and suggest ways in which spatial resolution can be improved with system modification.

Physiological response of glandular-haired alfalfa to potato leafhopper (Hemiptera: Cicadellidae) injury.

Plant tolerance to herbivory is a key approach for managing pests. In alfalfa, Medicago sativa, the potato leafhopper, Empoasca fabae, is a major pest as a result of the cascade of plant responses to piercing-sucking injury. To identify tolerance to its injury based on alfalfa physiology, experiments were conducted in the field and greenhouse. In our comparison of the response of field-grown alfalfa cultivars to standardized leafhopper densities, net photosynthesis and transpiration rates of 'Geneva' leaves were reduced by 18 and 21%, respectively, by leafhopper presence compared with a rate change of <1% of resistant 'EverGreen' leaves. Under greenhouse conditions, alfalfa clones varied in their level of gas exchange (net photosynthesis and transpiration) and stem elongation responses to leafhopper injury. For example, in the comparison of seven clones, net photosynthesis declined an average of 40.7% with leafhopper injury, although individual clones varied from 26.6 to 74.3% reduction. Internode elongation after 2 d was 60.3% less on injured stems compared with healthy stems, but again, the individual clones varied from 17.3 to 91.9%. In a time-course study of selected clones, clones varied in their level of injury just after and 3 d after insect removal. Gas exchange responses of all clones recovered by 7 d after cessation of injury. In a choice test, leafhoppers spent similar amounts of time on the susceptible clone and the most tolerant clone; however, their precise feeding behaviors were not measured. Thus, the variable response of clones to injury may be either true physiological tolerance or antixenosis from a change in feeding behavior. This study showed putative tolerance to leafhopper injury among alfalfa genotypes, suggesting that tolerance could be the basis for crop protection in alfalfa from potato leafhopper injury.

Evaluation of the spatial resolution characteristics of a cone-beam breast CT scanner.

The purpose of this study was to examine the spatial resolution of a prototype pendant-geometry cone-beam breast computed tomography (CT) system. Modulation transfer functions (MTFs) of the reconstructed image in the coronal (x and y) plane were computed as a function of the cone angle, the radial distance from the axis of rotation, the size of the reconstruction matrix, the back-projection filter used, and the number of projections acquired for the reconstruction. The results show that the cone angle and size of the reconstruction matrix have minimal impact on the MTF, while the MTF degraded radially from the axis of rotation (from 0.76 at 2.6 mm from axis of rotation down to 0.37 at 76.9 mm from axis of rotation at f=0.5 mm(-1)). The Ramp reconstruction filter increases the MTF near the axis of rotation relative to the Shepp-Logan filter, while an increase in the number of projections from 500 to 1000 increased the MTF near the periphery of the reconstructed image. The MTF in the z direction (anterior-posterior direction) was also evaluated. The z-direction MTF values tend to be higher when compared to the coronal MTF (0.85 at f =0.5 mm(-1)), and tend to be very constant throughout the coronal plane direction. The results suggest that an increase in the MTF for the prototype breast CT system is possible by optimizing various scanning and reconstruction parameters.

A geometric calibration method for cone beam CT systems.

Cone beam CT systems are being deployed in large numbers for small animal imaging, dental imaging, and other specialty applications. A new high-precision method for cone beam CT system calibration is presented in this paper. It uses multiple projection images acquired from rotating point-like objects (metal ball bearings) and the angle information generated from the rotating gantry system is also used. It is assumed that the whole system has a mechanically stable rotation center and that the detector does not have severe out-of-plane rotation (<2 degrees). Simple geometrical relationships between the orbital paths of individual BBs and five system parameters were derived. Computer simulations were employed to validate the accuracy of this method in the presence of noise. Equal or higher accuracy was achieved compared with previous methods. This method was implemented for the geometrical calibration of both a micro CT scanner and a breast CT scanner. The reconstructed tomographic images demonstrated that the proposed method is robust and easy to implement with high precision.

An improved method for flat-field correction of flat panel x-ray detector.

In this Technical Note, the effects of different flat-field techniques are examined for a cesium iodide flat panel detector, which exhibited a slightly nonlinear exposure response. The results indicate that the variable flat-field correction method with the appropriate polynomial fit provides excellent correction throughout the entire exposure range. The averaged normalized variation factor, used to assess the nonuniformity of the flat-field correction, decreased from 30.76 for the fixed correction method to 4.13 for the variable flat-field correction method with a fourth-order polynomial fit for the 60 kVp spectrum, and from 16.42 to 3.97 for the 95 kVp spectrum.

Evaluation of x-ray scatter properties in a dedicated cone-beam breast CT scanner.

The magnitude of scatter contamination on a first-generation prototype breast computed tomography (CT) scanner was evaluated using the scatter-to-primary ratio (SPR) metric. The SPR was measured and characterized over a wide range of parameters relevant to breast CT imaging, including x-ray beam energy, breast diameter, breast composition, isocenter-to-detector distance, collimated slot thickness, and grid ratio. The results demonstrated that in the absence of scatter reduction techniques, the SPR levels for the average breast (e.g., 14 cm diameter 50/50 composition cylindrical phantom) are quite high (approximately 0.5 at the center of the phantom for 80 kVp in true cone-beam CT geometry), and increases as the diameter of the phantom is increased (to approximately 1.0 at the center of a 18 cm diameter 50/50 phantom). The x-ray beam energy and the phantom compositions had only minimal impact on the measured SPR. When an ideal bowtie filter was used, the SPRs at the central axis of the 14 and 18 cm cylindrical phantoms were reduced while the SPRs at the edge of the phantoms were increased. Lastly, collimation in the vertical direction had a significant impact on the SPRs at the central axis of the phantoms. These high SPR levels might lead to cupping artifacts and increased noise in the reconstructed CT images, and this suggests that efficient scatter rejection and/or correction techniques may be required to improve the quality and accuracy of cone beam CT images.

Technique factors and their relationship to radiation dose in pendant geometry breast CT.

The use of breast computed tomography (CT) as an alternative to mammography in some patients is being studied at several institutions. However, the radiation dosimetry issues associated with breast CT are markedly different than in the case of mammography. In this study, the spectral properties of an operational breast CT scanner were characterized both by physical measurement and computer modeling of the kVp-dependent spectra, from 40 to 110 kVp (Be window W anode with 0.30 mm added Cu filtration). Previously reported conversion factors, normalized glandular dose for CT-DgN(ct), derived from Monte Carlo methods, were used in concert with the output spectra of the breast scanner to compute the mean glandular dose to the breast based upon different combinations of x-ray technique factors (kVp and mAs). The mean glandular dose (MGD) was measured as a function of the compressed breast thickness (2-8 cm) and three different breast compositions (0%, 50%, and 100% glandular fractions) in four clinical mammography systems in our institution. The average MGD from these four systems was used to compute the technique factors for breast CT systems that would match the two-view mammographic dose levels. For a 14 cm diameter breast (equivalent to a 5 cm thick compressed breast in mammography), air kerma levels at the breast CT scanner's isocenter (468 mm from the source) of 4.4, 6.4, and 9.0 mGy were found to deliver equivalent mammography doses for 0%, 50%, and 100% glandular breasts (respectively) at 80 kVp. At 80 kVp (where air kerma was 11.3 mGy/100 mAs at the isocenter), 57 mAs (integrated over the entire scan) was required to match the mammography dose for a 14 cm 50% glandular breast. At 50 kVp, 360 mAs is required to match mammographic dose levels. Tables are provided for both air kerma at the isocenter and mAs for 0%, 50%, and 100% glandular breasts. Other issues that impact breast CT technique factors are also discussed.

Automatic quantitative low contrast analysis of digital chest phantom radiographs.

Up to the present, the majority of low contrast object evaluations performed on phantom images have been accomplished in a subjective fashion. This is mainly due to the time and effort required to manually measure each radiograph with a densitometer to obtain quantitative results. However, with the development of digital radiographic systems, it has become feasible to automate the detection and computation processes. In this work, a method that can automatically detect and compute the subject-to-noise ratio of the low contrast disks inside a geometric chest phantom is examined. This algorithm has the ability to locate the low contrast objects to an accuracy of less than one pixel, and provides results that are consistent with the understanding of subject-to-noise ratio. This algorithm should simplify the task of quantitative evaluation of contrast detail phantoms.

Herpes simplex esophagitis in a renal transplant patient treated with cyclosporine A: a case report.

Herpes simplex esophagitis is a rare disease occurring mostly in immunocompromised and cancer patients. We report the first case of herpes esophagitis in a renal transplant patient treated with Cyclosporine A while on chronic steroid therapy. With the increasing use of Cyclosporine A in transplant patients, the incidence of herpes esophagitis may increase. The disease is suggested endoscopically by its typical appearance. The diagnosis is confirmed by cytology, tissue studies, and viral cultures. Based on the limited knowledge of the natural history of herpetic esophagitis and lack of prospective antiviral trials, symptomatic therapy with viscous Xylocaine appears reasonable. The definitive role of antiviral therapy is yet to be clarified.

Pregnancy-specific beta-glycoprotein (SP1) in normal pregnancy in Nigeria.

The circulating levels of pregnancy-specific beta 1-glycoproteins (SP1) were measured in 71 normal pregnant women in Northern Nigeria by immunoelectrophoresis. The levels showed a steady rise up to 34 weeks as in Caucasians and then plateaued with a slight fall just before term. The mean individual values were lower than those found in Caucasians at comparable gestation periods. This was thought to be related to the lower mean fetal weight in the Nigerian women.

Immunological evaluation of renal transplant patients: changes in levels of beta-2-microglobulin, immunoglobulins and complement components during graft rejection.

Levels of IgG and IgM and complement components C4 and C3 were measured using rate nephelometry and serum levels of beta-2-microglobulin (beta 2m) by rocket immunoelectrophoresis (RIEP) and these assays have been applied serially following cadaveric renal transplantation on 28 patients 14 of whom were treated with cyclosporin A. There were 31 rejection episodes of which 7 were irreversible. Elevated pre-transplant serum beta 2m levels fell rapidly in the first 24-48 hr post-transplant in all patients with primary functioning grafts and the mean base-line control value was 4.5 +/- 1.27 micrograms/ml in patients with stable graft function in the period 5-10 days post-transplant. At the onset of all 31 rejection episodes however the level of beta 2m increased compared to control values and significantly exceeded the 95% confidence limits of +/- 2.0 micrograms/ml. Control values for serum IgG and IgM were significantly lower than paired pre-transplant levels and, whereas IgM increased during rejection episodes with significant differences between paired rejection and control values, no significant changes in IgG levels were detected. In contrast mean control values for C4 and C3 were not significantly different to mean pre-transplant values; however, mean levels of C4 and C3 decreased significantly during rejection episodes compared to both pre-transplant and control values.

beta-2-microglobulin. Quantitation by rocket immunoelectrophoresis and evaluation of serum levels in renal transplant patients.

An assay using Laurell rocket immunoelectrophoresis has been developed for quantitation of beta-2-microglobulin (beta 2m) and serial levels of beta 2m have been measured in sera obtained daily from 52 patients following renal transplantation. The RIEP assay was performed using 1% low-endosmosis agarose gels containing 4% polyethylene glycol 6000 and the IgG fraction of rabbit antihuman beta 2m. Elevated beta 2m levels pretransplant fell markedly in the first 48 hr posttransplant in all patients with primary functioning grafts. Base-line control values for serum beta 2m were obtained in patients when stable graft function was established. Serum beta 2m levels increased during renal graft rejection, and significant elevations of serum beta 2m were detected at the onset of all graft rejection episodes as compared with control values. It is suggested that serum beta 2m quantitation by rocket immunoelectrophoresis is a simple and valuable assay to assess posttransplant renal graft function.