A phantom based evaluation of the clinical imaging performance of electronic portal imaging devices.

Purpose: In this study an evaluation of the imaging performance of an electronic portal imaging device (EPID) is presented. The evaluation performed employing the QC-3V image quality phantom. Methods: An EPID system of a 6 MV LINAC, was used to obtain images of a QC-3V EPID phantom. The X-ray source to phantom distance was 100 cm and the field size was 15x15 cm2. The irradiation conditions comprised Dose Rates (DR) of 200, 400 and 600 for a 2 MU-100 MU range. The Contrast Transfer Function (CTF), the Noise Power Spectrum (NPS), the Normalized Noise Power Spectrum (NNPS) and the Contrast-to-Noise Ratio (CNR) were studied. In addition, an alternative factor showing a frequency related output signal-to-noise ratio (SNR), the Signal-to-Noise-Frequency Response (SNFR), has been introduced. SNFR is a comprehensive quality index, easily determined in clinical environment. Results: The CTF curves were found comparable to each other. The lowest values were measured at 2 MU and 200 MU/min. Concerning the NPS and NNPS graphs it was found that the values decrease up to approximately 0.3 lp/mm and demonstrate a white noise shape afterwards. SNFR values were found reducing with spatial frequency. Highest CNR were found between the region 7 and 11 of the phantom. Conclusions: The influence of MU and DR on EPID performance were investigated. Image quality was assessed using the QC-3V phantom. The presented results can lead to image quality amelioration and act supportively to current image quality control routine protocols.

A Novel Method for Developing Thin Resin Scintillator Screens and Application in an X-ray CMOS Imaging Sensor.

Scintillating screens for X-ray imaging applications are prepared with various methods. Among them, the classic sedimentation method presents certain weak points. In this context, a novel fabrication process was developed that offers simplicity, economy of resources and time, while the screens exhibit adequate durability and image quality performance. The proposed technique involves a resin mixture that contains the phosphor in powder form (Gd2O2S:Tb in the present work) and graphite. The novel method was optimized and validated by coupling the screens to a complementary metal oxide semiconductor (CMOS) X-ray sensor. Indicatively, screens of two surface densities were examined; 34 mg/cm2 and 70 mg/cm2. Various established image quality metrics were calculated following the IEC 62220-1 international standard, including the detective quantum efficiency (DQE). Comparisons were carried out under the same conditions, with a sedimentation screen reported previously and a screen of wide commercial circulation (Carestream Min-R 2190). The novel screens exhibit has comparable or even better performance in image-quality metrics. The 34 mg/cm2 screen achieves a DQE 15-20% greater than its comparison counterpart, and its limiting resolution was 5.3 cycles/mm. The detector coupled to the 70 mg/cm2 screen achieved a DQE 10-24% greater than its own counterpart, and its limiting resolution was found to be 5.4 cycles/mm.

A Novel Method to Model Image Creation Based on Mammographic Sensors Performance Parameters: A Theoretical Study.

BACKGROUND: Mammographic digital imaging is based on X-ray sensors with solid image quality characteristics. These primarily include (a) a response curve that yields high contrast and image latitude, (b) a frequency response given by the Modulation Transfer Function (MTF), which enables small detail imaging and (c) the Normalize Noise Power Spectrum (NNPS) that shows the extent of the noise effect on image clarity. METHODS: In this work, a methodological approach is introduced and described for creating digital phantom images based on the measured image quality properties of the sensor. For this purpose, a mathematical phantom, simulating breast tissue and lesions of blood, adipose, muscle, Ca and Ca(50%)-P(50%) was created by considering the corresponding X-ray attenuation coefficients. The simulated irradiation conditions of the phantom used four mammographic spectra assuming exponential attenuation. Published data regarding noise and blur of a commercial RadEye HR CMOS imaging sensor were used as input data for the resulting images. RESULTS: It was found that the Ca and Ca(50%)-P(50%) lesions were visible in all exposure conditions. In addition, the W/Rh spectrum at 28 kVp provided more detailed images than the corresponding Mo/Mo spectrum. CONCLUSIONS: The presented methodology can act complementarily to image quality measurements, leading to initial optimization of the X-ray exposure parameters per clinical condition.

Grain Size Distribution Analysis of Different Activator Doped Gd2O2S Powder Phosphors for Use in Medical Image Sensors.

The structural properties of phosphor materials, such as their grain size distribution (GSD), affect their overall optical emission performance. In the widely used gadolinium oxysulfide (Gd2O2S) host material, the type of activator is one significant parameter that also changes the GSD of the powder phosphor. For this reason, in this study, different phosphors samples of Gd2O2S:Tb, Gd2O2S:Eu, and Gd2O2S:Pr,Ce,F, were analyzed, their GSDs were experimentally determined using the scanning electron microscopy (SEM) technique, and thereafter, their optical emission profiles were investigated using the LIGHTAWE Monte Carlo simulation package. Two sets of GSDs were examined corresponding to approximately equal mean particle size, such as: (i) 1.232 µm, 1.769 µm and 1.784 µm, and (ii) 2.377 µm, 3.644 µm and 3.677 µm, for Tb, Eu and Pr,Ce,F, respectively. The results showed that light absorption was almost similar, for instance, 25.45% and 8.17% for both cases of Eu dopant utilizing a thin layer (100 µm), however, given a thicker layer (200 µm), the difference was more obvious, 22.82%. On the other hand, a high amount of light loss within the phosphor affects the laterally directed light quanta, which lead to sharper distributions and therefore to higher resolution properties of the samples.

On the Response of a Micro Non-Destructive Testing X-ray Detector.

Certain imaging performance metrics are examined for a state-of-the-art 20 µm pixel pitch CMOS sensor (RadEye HR), coupled to a Gd2O2S:Tb scintillator screen. The signal transfer property (STP), the modulation transfer function (MTF), the normalized noise power spectrum (NNPS) and the detective quantum efficiency (DQE) were estimated according to the IEC 62220-1-1:2015 standard. The detector exhibits excellent linearity (coefficient of determination of the STP linear regression fit, R2 was 0.9978), while its DQE peaks at 33% and reaches 10% at a spatial frequency of 3 cycles/mm, for the measured with a Piranha RTI dosimeter (coefficient of variation CV = 0.03%) exposure value of 28.1 µGy DAK (detector Air Kerma). The resolution capabilities of the X-ray detector under investigation were compared to other commercial CMOS sensors, and were found in every case higher, except from the previous RadEye HR model (CMOS-Gd2O2S:Tb screen pair with 22.5 µm pixel pitch) version which had slightly better MTF. The present digital imager is designed for industrial inspection applications, nonetheless its applicability to medical imaging, as well as dual-energy is considered and certain approaches are discussed in this respect.

Detective quantum efficiency (DQE) in PET scanners: A simulation study.

The aim of the present study is to introduce the detective quantum efficiency (DQE) for the image quality assessment of positron emission tomography (PET) scanners. For this purpose, a thin layer chromatography (TLC) plane source was simulated using a previously validated, scanner and source geometry, Monte Carlo (MC) model. The model was developed with the Geant4 application for tomographic emission (GATE) MC package and reconstructed images obtained with the software for tomographic image reconstruction (STIR), with cluster computing. The GE Discovery ST PET scanner was simulated by using a previously validated code. A plane source consisting of a TLC plate, was simulated by a layer of silica gel on aluminum (Al) foil substrate, immersed in 18F-FDG bath solution (1MBq). Image quality was assessed in terms of the modulation transfer function (MTF) and the normalized noise power spectrum (NNPS) in order to obtain the detective quantum efficiency (DQE). MTF curves were estimated from transverse reconstructed images of the plane source, whereas the NNPS data were estimated from the corresponding coronal images. Images were reconstructed by the maximum likelihood estimation ordered subsets maximum a posteriori one step late (MLE)-OS-MAP-OSL algorithm, by using various subsets 1-21) and iterations 1-20). MTF values were found to increase up to the 12th iteration whereas remain almost constant thereafter. However, the range of the increase in the MTF is limited as the number of subsets increases. The noise levels were found to increase with the corresponding increase of both the number of iterations and subsets. The maximum NNPS value (0.517mm2) was observed for the 420 MLEM-equivalent iterations reconstructed image at 0cycles/mm. Finally DQE values were found to increase for spatial frequencies up to 0.038cycles/mm and to decrease thereafter with the corresponding increase in both number of iterations and subsets. The maximum DQE value (0.48 at 0.038cycles/mm) was obtained for the 8 MLEM-equivalent iterations image. The simulated PET evaluation method based on the TLC plane source can be useful in the quality control and in the further development of PET and SPECT scanners though GATE simulations.

A novel method for the optimization of positron emission tomography scanners imaging performance.

OBJECTIVE: The aim of the present study was to propose a comprehensive method for positron emission tomography (PET) scanners image quality assessment, by simulation of a thin layer chromatography (TLC) flood source with a previously validated Monte Carlo model. METHODS AND MATERIALS: We used the GATE Monte Carlo package (GEANT4 application for tomographic emission) and the reconstructed images were obtained using the software for tomographic image reconstruction (STIR), with cluster computing. The PET scanner used in this simulation study was the General Electric Discovery-ST (USA). The plane source that was used for the image quality assessment was a TLC plate, consisting of an aluminum (Al) foil, coated with a thin layer of silica and immersed in fluorodeoxyglucose (18F-FDG) bath solution (1 MBq). The influence of different scintillating crystals on PET scanner's image quality, in terms of the modulation transfer function (MTF), the normalized noise power spectrum (NNPS) and the detective quantum efficiency (DQE), were also investigated. Modulation transfer function was estimated from transverse slices of the plane source, whereas the NNPS from the corresponding coronal slices. Images were reconstructed by the commonly used 2D filtered back projection (FBP2D), the Kinahan and Rogers FPB3DRP and the maximum likelihood estimation (MLE)-OSMAPOSL algorithms. Images obtained using the OSMAPOSL algorithm were assessed by using 15 subsets and 3 iterations. RESULTS: The PET scanner configuration, equipped with LuAP crystals, exhibited the optimum MTF values in both 2D and 3D FBP image reconstruction, whereas the corresponding configuration with BGO crystals exhibited the optimum MTF values after the iterative algorithm. The scanner equipped with the BGO crystals was also found to exhibit overall the lowest noise levels and the highest DQE values after algorithms. These finding indicate that the GE Discovery ST PET scanner exhibits the optimum image quality parameters, in terms of MTF, NNPS and DQE, with BGO scintillating crystals. CONCLUSION: Our new method showed that the imaging performance of PET scanners can be fully characterized and further improved by investigation of the imaging chain components through Monte Carlo methods. To this aim, a TLC based plane source was used during the simulation, in order to assess the impact of the scintillating crystal material on PET image quality, with the application of a previously validated Monte Carlo model. The aforementioned plane source can be also useful for the further development of PET and SPET scanners through GATE simulations, for clinical applications.

A robust method, based on a novel source, for performance and diagnostic capabilities assessment of the positron emission tomography system.

The aim of our work was to provide a robust method for evaluating imaging performance of positron emission tomography (PET) systems and particularly to estimate the modulation transfer function (MTF) using the line spread function (LSF) method. A novel plane source was prepared using thin layer chromatography (TLC) of a fluorine-18-fluorodeoxyglucose ((18)F-FDG) solution. The source was placed within a phantom, and imaged using the whole body (WB) two dimensional (2D) and three dimensional (3D) standard imaging protocols in a GE Discovery ST hybrid PET/CT scanner. Modulation transfer function was evaluated by determining the LSF, for various reconstruction methods and filters. The proposed MTF measurement method was validated against the conventional method, based on point spread function (PSF). Higher MTF values were obtained with 3D scanning protocol and 3D iterative reconstruction algorithm. All MTF obtained using 3D reconstruction algorithms showed better preservation of higher frequencies than the 2D algorithms. They also exhibited better contrast and resolution. MTF derived from LSF were more precise compared with those obtained from PSF since their reproducibility was better in all cases, providing a mean standard deviation of 0.0043, in contrary to the PSF method which gave 0.0405. In conclusion, the proposed method is novel and easy to implement for characterization of the signal transfer properties and image quality of PET/computed tomography (CT) systems. It provides an easy way to evaluate the frequency response of each kernel available. The proposed method requires cheap and easily accessible materials, available to the medical physicist in the nuclear medicine department. Furthermore, it is robust to aliasing and since this method is based on the LSF, is more resilient to noise due to greater data averaging than conventional PSF-integration techniques.

A new PET resolution measurement method through Monte-Carlo simulations.

OBJECTIVE: The aim of this study was to propose a novel method for image quality assessment in PET scanners through estimation of the modulation transfer function (MTF) of a plane source. The simulation was implemented using the previously validated Monte-Carlo model. A comparison of the proposed method with the more traditional technique, based on a line source, was also performed. MATERIALS AND METHODS: The Geant4 application for tomographic emission (GATE) Monte-Carlo package was used for model development, and reconstructed images were obtained using software for tomographic image reconstruction (STIR) with cluster computing. A novel plane source consisting of a radioactive ((18)F-fluorodeoxyglucose) thin-layer chromatography plate was simulated (total source activity: 44.4 MBq) to assess image quality through the MTF. All images were reconstructed with the three-dimensional filtered back projection (FBP3DRP) and ordered-subsets expectation maximization (OSEM) reprojection algorithms. RESULTS: The MTFs obtained using ordered-subsets expectation maximization show, in all cases, that higher frequencies are preserved compared with those obtained using the FBP3DRP. In addition, the plane source method is less prone to noise than the conventional line source method (SD=0.0031 and 0.0203, respectively). CONCLUSION: The thin-layer chromatography-based plane source presented requires materials commonly found in a clinical environment and could be used to assess image quality in nuclear medicine departments and to further develop PET and single-photon emission computed tomography scanners through Monte-Carlo simulations.

Figure of image quality and information capacity in digital mammography.

OBJECTIVES: In this work, a simple technique to assess the image quality characteristics of the postprocessed image is developed and an easy to use figure of image quality (FIQ) is introduced. This FIQ characterizes images in terms of resolution and noise. In addition information capacity, defined within the context of Shannon's information theory, was used as an overall image quality index. MATERIALS AND METHODS: A digital mammographic image was postprocessed with three digital filters. Resolution and noise were calculated via the Modulation Transfer Function (MTF), the coefficient of variation, and the figure of image quality. In addition, frequency dependent parameters such as the noise power spectrum (NPS) and noise equivalent quanta (NEQ) were estimated and used to assess information capacity. RESULTS: FIQs for the "raw image" data and the image processed with the "sharpen edges" filter were found 907.3 and 1906.1, correspondingly. The information capacity values were 60.86 × 10(3) and 78.96 × 10(3) bits/mm(2). CONCLUSION: It was found that, after the application of the postprocessing techniques (even commercial nondedicated software) on the raw digital mammograms, MTF, NPS, and NEQ are improved for medium to high spatial frequencies leading to resolving smaller structures in the final image.

Towards the optimization of nuclear medicine procedures for better spatial resolution, sensitivity, scan image quality and quantitation measurements by using a new Monte Carlo model featuring PET imaging.

The aim of this study was to develop a Monte-Carlo model that can be used for the optimization of positron emission tomography (PET) procedures and image quality metrics. This model was developed using the Monte Carlo package of Geant4 application for tomographic emission (GATE) and the software for tomographic image reconstruction (STIR) with cluster computing to obtain reconstructed images. The PET scanner used in this study was the General Electric Discovery-ST (US). The GATE model was validated by comparing results obtained in accordance with the National Electrical Manufacturers Association NEMA-NU-2-2001 protocol [Mawlawi et al (2004) and Bettinardi et al (2004)]. All images were reconstructed with the commonly used 2D filtered back projection and the 3D reprojection algorithms. We found that the simulated spatial resolution in terms of full width at half maximum (FWHM) agreed within less than 3.29% in 2D and less than 2.51% in 3D with published data of others, respectively. The 2D values for the sensitivity, scatter fraction and count-rate were found to agree within less than 0.46%, 4.59% and 7.86%, respectively with these published values. Accordingly, our study showed that the corresponding 3D values were found to agree to less than 1.62%, 2.85% and 9.13%, respectively with Mawlawi et al (2004) published values. Sensitivity, which was also estimated without the presence of attenuation material by simulating an ideal source, showed differences between the extrapolated and the ideal source values (with and without attenuation) ranging in 2D from 0.04% to 0.82% (radial location R=0cm) and 0.52% to 0.67% in 3D mode (radial locations R=10cm). The simulated noise equivalent count rate was found to be 94.31kcps in 2D and 66.9kcps in 3D at 70 and 15kBq/mL respectively, compared to 94.08kcps in 2D and 70.88kcps in 3D at 54.6kBq/mL and 14kBq/mL respectively, from the published by others values. The simulated image quality was found in excellent agreement with these published values. In conclusion, our study showed that our Monte Carlo model can be used to assess, optimize, simplify and reduce the simulation time for the quality control procedure of PET scanners. By using this model, sensitivity can be obtained in a more simplified procedure. Reconstructed images by STIR can be also used to obtain radiopharmaceutical distribution of images and direct dose maps, quite useful to nuclear medicine practitioners.

Acute radiation syndrome and chronic radiation syndrome.

Acute radiation syndrome (ARS) or sickness or poisoning or toxicity is induced after a whole body exposure of men to high doses of radiation between 1-12Gy. First symptoms are from the gastrointestinal system, which together with bone marrow are the most sensitive parts of our body. Chronic radiation syndrome (CRS) may be induced by smaller than 1Gy radiation doses or after a mild form of ARS. Prophylaxis and treatment suggestions are described. In cases of ARS, a large part of the exposed population after proper medical care may survive, while without medical care this part of the population will be lost. Prophylaxis may also save another part of the population.

[Is major depression in middle-aged men correlated with bone density decrease? A study on Greek population].

During the last 10 years there has been an increasing interest in studying the coexistence of osteoporosis and depression in the male population, due to the increased morbidity and mortality in the patients' life. The present retrospective study evaluates the effect of major depression on the bone density of Greek middle-aged men. By using the method of dual-energy X-rays absorptiometry (DEXA) we reviewed the bone mineral density (BMD) studies performed in the lumbar spine (LS) and/or femoral neck, in 97 men of the white race, aged 55 years with mean age±standard deviation (SD)= 65±10.6 years, and body mass index (BMI) 30.2±4. The patients were divided in two groups, based on the coexistence (Group A) or absence of major depression (Group B). In group A men, the incidence of osteoporosis was 34.8% and osteopenia 39.5%, while in group B the corresponding percentages were 9.3% and 42.6%. Statistically significant difference was observed in mean BMD between Group A (0.876±0.170) and Group B (0.961±0.136) at the level of P=0.008, and also in mean T score (-1.72±1.57 versus -1.06±1.17) at the level of P value: 0.02 in both groups, while the diagnosis of osteoporosis between the two groups was statistically significantly different too (P=0.001. Pearson R: 0.3, P=0.004). Furthermore, the model of multiple linear regression and ANOVA table revealed statistically significantly depression of 0.252 and 0.575 units in mean BMD value and mean T score respectively in man with major depression in comparison to a mentally healthy man of the same age and BMI (regression coefficient b, P< 0.02). In conclusion, we observed statistically significant difference in mean BMD and mean T score values between major depression and mentally healthy men. Moreover, almost triple relative risk for the development of osteoporosis was shown in men with depression as compared to mentally healthy men (RR: 3.8, P=0.02). Cortisone intake, hypertension and smoking were statistically independent factors for male depression and BMD. The clarification of the underlying interactive mechanism between major depression, sympathetic system activation, age and bone resorption is important.

The physician should benefit, not harm the patient.

Six hundred years before Christ, Hippocrates said that physicians on exercising their medical duties, should benefit but not harm their patients. Seventy years ago increased medical radiation caused radiologists in the US an excess risk of leukemia, lymphoma and multiple myeloma. Now medical radiation is rather safe for the physician but the question remains if proper prophylactic measures are being taken to make it safe for the subjects examined. Roughly, first trimester of pregnancy radiography has a much greater fatal cancer risk than that of exposures taken later in pregnancy. It is suggested that women should be administered the minimum activity consistent with achieving the desired clinical information, whether or not they are known to be pregnant. The best available risk estimates suggest that pediatric CT diagnostic procedures will induce significantly increased lifetime radiation risk in children. Professor Roger Clarke wrote that there may be a need to reduce or prevent doses of medical radiation up to 3 mSv if there is no benefit to the individual. 30 mSv is described as "a dose which should not be exceeded" and can be approached only if there is a benefit to individuals and the dose is difficult to reduce or prevent. In WHO Category III a) Static brain imaging with technetium-99m pertechnetate, b) Gated cardiac imaging c) Bone imaging with technetium-99m MDP, c) Quantitative haemodynamics with technetium-99m pertechnetate, d) myocardial imaging with thallous-201 chloride and e) abscess imaging with gallium-67 citrate, induce an effective dose equivalent of 5-9 mSv. A CT scan commonly gives 25 mSv to the subject examined. BEIR VI indicated that a 10 mSv single population dose is associated with a lifetime attributable risk for developing a solid cancer or leukemia in 1:1000. Multiple CT examinations have administered to some patients with renal colic a dose of 19.5-153.7 mSv. One may suggest that there should be "justification" and informed written patients' consent for nuclear medicine examinations administering to the patient doses greater than 5 mSv, especially doses around or above 30 mSv / year.