[Effect of Gonadal Protection on Image Quality in Frontal Hip Radiography].

PURPOSE: In recent years, there has been a growing movement in Western countries toward the abolition of gonadal protection during radiography. The reasons for this recommendation are that there are few reports of increased risk of genetic effects, that the ovarian dose is not due to direct X-rays but due to internally scattered X-rays that cannot be shielded, and that the presence of gonadal protection may adversely affect the automatic exposure control mechanism and may mask important findings. In addition, the gonadal protection is a large high absorber of X-rays, and its presence in the irradiation field may have some effect on image quality, but the effect of the gonadal protection on image quality has not been clarified. In addition, after the abolition of gonadal protection, the optimal irradiation field setting is expected to become even more important to avoid unnecessary exposure. In this study, we investigated the effect of gonadal protection on image quality in frontal hip radiographs of adults with different radiation qualities and clarified the image quality under conditions in which the irradiation field is appropriately narrowed. METHOD: Frontal hip radiographs were taken using a human phantom as the subject, and the image quality of the femoral head was evaluated. Two irradiation fields were used: (a) 14×17 inch field and (b) an appropriate field (11.6×15 inch) that does not impair the reference line and image information necessary for reading hip joint images. The imaging tube voltage was set at 70 kV, and conditions for adding a copper filter were also considered. The incident surface air kerma was set to 1.25 mGy. The incident surface dose at this time was sufficiently lower than the diagnostic reference level (2.5 mGy) in Japan and was judged to be appropriate for imaging using an indirect conversion flat panel detector. The image quality evaluation item was the signal difference to noise ratio (SdNR) including scatterers. RESULT: The SdNR decreased by 4.6% when a gonadal shield was placed, indicating that the gonadal shield reduced image quality. When the irradiation field size was appropriately narrowed down, SdNR slightly increased or decreased depending on the quality of the imaging material, but the change was small compared to the change in SdNR with and without the gonadal protection shield. CONCLUSION: The results of this study confirm that the elimination of gonadal protection in hip radiography has significant advantages, such as reducing unnecessary X-ray exposure while ensuring image quality, when the irradiation field is set appropriately.

Fundamental study on diagnostic reference level quantities for endoscopic retrograde cholangiopancreatography using a C-arm fluoroscopy system.

The diagnostic reference level (DRL) is an effective tool for optimising protection in medical exposures to patients. However regarding air kerma at the patient entrance reference point (Ka,r), one of the DRL quantities for endoscopic retrograde cholangiopancreatography (ERCP), manufacturers use a variety of the International Electrotechnical Commission and their own specific definitions of the reference point. The research question for this study was whetherKa,ris appropriate as a DRL quantity for ERCP. The purpose of this study was to evaluate the difference betweenKa,rand air kerma incident on the patient's skin surface (Ka,e) at the different height of the patient couch for a C-arm system. Fluoroscopy and radiography were performed using a C-arm system (Ultimax-i, Canon Medical Systems, Japan) and a over-couch tube system (CUREVISTA Open, Fujifilm Healthcare, Japan).Ka,ewas measured by an ion chamber placed on the entrance surface of the phantom. Kerma-area product (PKA) andKa,rwere measured by a built-inPKAmeter and displayed on the fluoroscopy system.Ka,edecreased whileKa,rincreased as the patient couch moved away from the focal spot. The uncertainty of theKa,e/Ka,rratio due to the different height of the patient couch was estimated to be 75%-94%.Ka,rmay not accurately representKa,e.PKAwas a robust DRL quantity that was independent of the patient couch height. We cautioned against optimising patient doses in ERCP with DRLs set in terms ofKa,rwithout considering the patient couch height of the C-arm system. Therefore, we recommend thatKa,ris an inappropriate DRL quantity in ERCP using the C-arm system.

[Relative Error between Organ Doses and Size-specific Dose Estimates for a Specific Location When the Mean CTDIvol Value Is Used for Calculation].

Size-specific dose estimates (SSDEs) are dose indices that account for differences in body shape in computed tomography (CT) scans, allowing the evaluation of approximate absorbed doses in any cross section that could not be obtained with the volume CT dose index (CTDIvol). When using automatic exposure control (AEC), CTDIvol is modulated in the body axis direction, but the value displayed after the examination is the mean CTDIvol for the entire scan, and it is expected that the SSDE value will change depending on which value is used in the calculation. In this study, using a human body phantom, we examined the influence of whether the mean CTDIvol or the modulation value for each slice is used to calculate the SSDE on local organ dose evaluation. A program to calculate water equivalent diameter according to the procedure in the American Association of Physicists in Medicine Report No. 220 was developed and compared. As a result, SSDE calculated using the mean CTDIvol (local-SSDEmean) overestimated organ doses in the lung region by 18%-56% compared with those calculated by a web system for evaluating CT exposure doses (WAZA-ARIv2, Japan). In contrast, local-SSDEmodulated, which was calculated using the modulated value of the CTDIvol, was able to estimate the organ dose with a relative error of 10%-13%. The average local-SSDE over the entire body axis direction was not significantly different between the two methods, regardless of which method was used for CTDIvol. If the mean CTDIvol is stored in the Digital Imaging and Communications in Medicine (DICOM) header tag (0018, 9345) of the CT image and the modulated CTDIvol value is not available for each slice, the calculated local SSDE will contain many errors and will not correctly reflect the organ doses at the scan region. In such cases, it is available to use the method of evaluating local organ doses by multiplying the SSDE, which is the average of the SSDE for the entire scan, by a factor for each organ.

Evaluation of radiation dose and image quality for dental cone-beam computed tomography in pediatric patients.

Children are sensitive to radiation; therefore, it is necessary to reduce radiation dose as much as possible in pediatric patients. In addition, it is crucial to investigate the optimal imaging conditions as they considerably affect the radiation dose. In this study, we investigated the effect of different imaging conditions on image quality and optimized the imaging conditions for dental cone-beam computed tomography (CBCT) examinations to diagnose ectopic eruptions and impacted teeth in children. To achieve our aims, we evaluated radiation doses and subjective and objective image quality. The CBCT scans were performed using 3D Accuitomo F17. All combinations of a tube voltage (90 kV), tube currents (1, 2, 3 mA), fields of view (FOVs) (4 × 4, 6 × 6 cm), and rotation angles (360°, 180°) were used. Dose-area product values were measured. SedentexCT IQ cylindrical phantom was used to physically evaluate the image quality. We used the modulation transfer function as an index of resolution, the noise power spectrum as an index of noise characteristics, and the system performance function as an overall evaluation index of the image. Five dentists visually evaluated the images from the head-neck phantom. The results showed that the image quality tended to worsen, and scores for visual evaluation decreased as tube currents, FOVs and rotation angles decreased. In particular, image noise negatively affected the delineation of the periodontal ligament space. The optimal imaging conditions were 90 kV, 2 mA, 4 × 4 cm FOV and 180° rotation. These results suggest that CBCT radiation doses can be significantly reduced by optimizing the imaging conditions.

Usefulness of copper filters in digital chest radiography based on the relationship between effective detective quantum efficiency and deep learning-based segmentation accuracy of the tumor area.

This study aimed to determine the optimal radiographic conditions for detecting lesions on digital chest radiographs using an indirect conversion flat-panel detector with a copper (Cu) filter. First, we calculated the effective detective quantum efficiency (DQE) by considering clinical conditions to evaluate the image quality. We then measured the segmentation accuracy using a U-net convolutional network to verify the effectiveness of the Cu filter. We obtained images of simulated lung tumors using 10-mm acrylic spheres positioned at the right lung apex and left middle lung of an adult chest phantom. The Dice coefficient was calculated as the similarity between the output and learning images to evaluate the accuracy of tumor area segmentation using U-net. Our results showed that effective DQE was higher in the following order up to the spatial frequency of 2 cycles/mm: 120 kV + no Cu, 120 kV + Cu 0.1 mm, and 120 kV + Cu 0.2 mm. The segmented region was similar to the true region for mass-area extraction in the left middle lobe. The lesion segmentation in the upper right lobe with 120 kV + no Cu and 120 kV + Cu 0.1 mm was less successful. However, adding a Cu filter yielded reproducible images with high Dice coefficients, regardless of the tumor location. We confirmed that adding a Cu filter decreases the X-ray absorption efficiency while improving the signal-to-noise ratio (SNR). Furthermore, artificial intelligence accurately segments low-contrast lesions.

[Relationship between Image Quality and Reconstruction FOV in Deep Learning Reconstructed Images of CT].

In this study, we compared the image quality of deep learning reconstruction (DLR) with that of conventional image reconstruction methods under the same conditions of reconstruction FOV and acquisition dose assuming abdomen computed tomography (CT) in children. Standard deviation (SD) of the CT value, noise power spectrum (NPS), and task-based modulation transfer function (TTF) were evaluated. DLR reduced image noise while maintaining sharpness, and the noise reduction effect showed a different characteristic depending on the size of reconstruction FOV from the conventional image reconstruction methods. The SD of CT value increased gradually in the range from 320 mm to 240 mm, but there was almost no change from 240 mm to 200 mm. The NPS showed completely different characteristics. The low-frequency component increased, and the high-frequency component decreased at 240 mm. However, the frequency component below 0.5 cycle/mm decreased at 200 mm and the peak frequency moved to the lower side at 320 mm. DLR showed the highest TTF value compared to the conventional reconstruction methods.

Evaluation of dose reduction potential in scatter-corrected bedside chest radiography using U-net.

Bedside radiography has increasingly attracted attention because it allows for immediate image diagnosis after X-ray imaging. Currently, wireless flat-panel detectors (FPDs) are used for digital radiography. However, adjustment of the X-ray tube and FPD alignment are extremely difficult tasks. Furthermore, to prevent a poor image quality caused by scattered X-rays, scatter removal grids are commonly used. In this study, we proposed a scatter-correction processing method to reduce the radiation dose when compared with that required by the X-ray grid for the segmentation of a mass region using deep learning during bedside chest radiography. A chest phantom and an acrylic cylinder simulating the mass were utilized to verify the image quality of the scatter-corrected chest X-rays with a low radiation dose. In addition, we used the peak signal-to-noise ratio and structural similarity to quantitatively assess the quality of the low radiation dose images compared with normal grid images. Furthermore, U-net was used to segment the mass region during the scatter-corrected chest X-ray with a low radiation dose. Our results showed that when scatter correction is used, an image with a quality equivalent to that obtained by grid radiography is produced, even when the imaging dose is reduced by approximately 20%. In addition, image contrast was improved using scatter radiation correction as opposed to using scatter removal grids. Our results can be utilized to further develop bedside chest radiography systems with reduced radiation doses.

[Relationship between Quantitativeness of Iodine and Accuracy of Virtual Non-contrast Image in Dual-energy Computed Tomography].

Dual-energy computed tomography (DE-CT) is the promising technology, such as enabling material decomposition, generation of the virtual monochromatic image, and measurement of effective atomic numbers. There are reports that utilization of the virtual non-contrast (VNC) image, the iodine map image, and the virtual monochromatic image can contribute to the improvement of lesion detection and its characterization, compared with conventional contrast CT by single-energy computed tomography (SE-CT). In addition, acquisition of the VNC images makes it possible to skip scanning of true non-contrast CT, which is also expected to reduce exposure. However, a reliable evaluation of the accuracy of the VNC image has not been established, and only a few reports have verified their accuracy. In this study, we evaluated the relationship between the quantitativeness of iodine and the CT value of VNC image. As a result of our study, when the iodine volume was overestimated, the CT value of the VNC image was lower than the reference value, and when the iodine volume was underestimated, the CT value was upper than the reference value. Moreover, we clarified that the CT value of the VNC image greatly diverges as the iodine volume increases.

[Results of combined therapy for maxillary sinus squamous cell carcinoma].

The results of 54 cases of maxillary sinus squamous cell carcinoma treated between 1980 and 2002 were analyzed retrospectively. The T classification according to the 1997 UICC was as follows: 2 with stage T1, 29 with T3, and 23 with T4. Ten patients(18.5%) had lymph node metastases at diagnosis. All patients underwent combined therapy including radiotherapy, surgery, and regional or systemic chemotherapy. Fifteen patients received hyperfractionated twice-daily radiotherapy (1.2 Gy or 1.5 Gy/fraction), and the remaining 39 patients received a conventional once-daily regimen(1.5-2 Gy/fraction). The 5-year overall survival and 5-year disease-free survival for all patients were 56.0% and 46.7%, respectively. The N classification was the only significant prognostic factor for 5-year disease-free survival by univariate analysis (favoring N = 0, p = 0.04). There were no significant differences in other prognostic factors including gender, T classification (T1-3 vs. T4), hyperfractionated radiotherapy (yes vs. no), total dose (BED: < 69 Gy10 vs. > or = 69 Gy10), and intra-arterial chemotherapy(yes vs. no). Although radiation-induced cataract was observed in 9 patients, no other severe late complications developed.