Mobile Workflow in Computed Tomography of the Chest.

A CT system with a tablet as mobile user interface and a wireless remote control for positioning and radiation release has recently been presented. Our aim was to evaluate the effects of a mobile CT examination workflow on the radiographers' performance compared to conventional examinations. A prototype of a radiation protection cabin was installed besides the gantry of a CT system. The CT system was equipped with a simplified user interface on a portable tablet and a mobile remote control. 98 patients with an indication for CT of the chest were randomly assigned to examination using the mobile devices (study group, n = 47) or using the conventional stationary workflow on the console (reference group, n = 51). Three ceiling mounted fisheye cameras were used for motion tracking of the radiographers, two in the examination room and one in the control room. Relative density of detection heat-maps and area counts were assessed using a dedicated software tool to quantify radiographers' movements. Duration of each task of the examination was manually recorded using a stopwatch. In the reference group 25% of the area counts were located inside of the examination room, while it was 48% in the study group. The time spent in the same room with the patient increased from 3:06 min (29%) to 6:01 min (57%) using the mobile workflow (p < 0.05), thereof 0:59 min (9%) were spent in moderate separation with maintained voice and visual contact in the radiation protection cabin. Heat-maps showed an increase of the radiographer's working area, indicating a higher freedom of movement. Total duration of the examination was slightly less in the study group without statistical significance (median time: study 10:36, reference 10:50 min; p = 0.29). A mobile CT examination transfers the radiographers' interaction with the scanner from the control room into the examination room. There, radiographers' freedom of movement is higher, without any tradeoffs regarding the examination duration.

Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience.

OBJECTIVE: We evaluated radiation exposure and image quality of a new coronary CT angiography protocol, high-pitch spiral acquisition, using dual source CT (DSCT). MATERIAL AND METHODS: Coronary CTAwas performed in 25 consecutive patients with a stable heart rate of 60 bpm or less after premedication, using 2 x 128 0.6-mm sections, 38.4-mm collimation width and 0.28-s rotation time. Tube settings were 100 kV/320 mAs and 120 kV/400 mAs for patients below and above 100-kg weight, respectively. Data acquisition was prospectively ECG-triggered at 60% of the R-R interval using a pitch of 3.2 (3.4 for the last 10 patients). Images were reconstructed with 75-ms temporal resolution, 0.6-mm slice thickness and 0.3-mm increment. Image quality was evaluated using a four-point scale (1 = excellent, 4 = unevaluable). RESULTS: Mean range of data acquisition was 113 +/- 22 mm, mean duration was 268 +/- 23 ms. Of 363 coronary artery segments, 327 had an image quality score of 1, and only 2 segments were rated as "unevaluable". Mean dose-length product (DLP) was 71 +/- 23 mGy cm, mean effective dose was 1.0 +/- 0.3 mSv (range 0.78-2.1 mSv). For 21 patients with a body weight below 100 kg, mean DLP was 63 +/- 5 mGy cm (0.88 +/- 0.07 mSv; range 0.78-0.97 mSv). CONCLUSION: Prospectively ECGtriggered high-pitch spiral CT acquisition provides high and stable image quality at very low radiation dose.

Feasibility of dual-source cardiac CT angiography with high-pitch scan protocols.

BACKGROUND: Cardiac CT angiography (CCTA) has become a frequently used diagnostic tool in clinical practice, but concern remains about the radiation exposure. Because of the second x-ray acquisition system, dual-source CT systems might allow for high-pitch CT data acquisition and thus for examination of the whole heart during a single heart beat, with the potential for radiation dose reduction. OBJECTIVE: We assessed the feasibility of a high-pitch scan mode with a dual-source CT system. METHODS: High-pitch modes were used in patients undergoing CCTA with a dual-source CT system. Diagnostic image quality for cardiac structures and coronary arteries was assessed. Radiation dose was estimated from the scanner-generated dose-length product (DLP). RESULTS: CCTA was performed in 14 patients during a single heart beat applying a pitch value of 3.4. Mean heart rate during examination was 56.4+/-8.1 beats/min. Diagnostic image quality for the assessment of larger cardiac structures was obtained in all patients, whereas diagnostic image quality could be achieved in 82% of all coronary segments. With a mean DLP of 145+/-47 mGy x cm, the resulting estimated radiation dose was 2.0+/-0.7 mSv. CONCLUSIONS: This proof-of-concept study shows the ability of dual-source CT scanners to scan the whole heart during one single heart beat at low radiation dose.

4D-Imaging of the lung: reproducibility of lesion size and displacement on helical CT, MRI, and cone beam CT in a ventilated ex vivo system.

PURPOSE: Four-dimensional (4D) imaging is a key to motion-adapted radiotherapy of lung tumors. We evaluated in a ventilated ex vivo system how size and displacement of artificial pulmonary nodules are reproduced with helical 4D-CT, 4D-MRI, and linac-integrated cone beam CT (CBCT). METHODS AND MATERIALS: Four porcine lungs with 18 agarose nodules (mean diameters 1.3-1.9 cm), were ventilated inside a chest phantom at 8/min and subject to 4D-CT (collimation 24 x 1.2 mm, pitch 0.1, slice/increment 24 x 10(2)/1.5/0.8 mm, pitch 0.1, temporal resolution 0.5 s), 4D-MRI (echo-shared dynamic three-dimensional-flash; repetition/echo time 2.13/0.72 ms, voxel size 2.7 x 2.7 x 4.0 mm, temporal resolution 1.4 s) and linac-integrated 4D-CBCT (720 projections, 3-min rotation, temporal resolution approximately 1 s). Static CT without respiration served as control. Three observers recorded lesion size (RECIST-diameters x/y/z) and axial displacement. Interobserver- and interphase-variation coefficients (IO/IP VC) of measurements indicated reproducibility. RESULTS: Mean x/y/z lesion diameters in cm were equal on static and dynamic CT (1.88/1.87; 1.30/1.39; 1.71/1.73; p > 0.05), but appeared larger on MRI and CBCT (2.06/1.95 [p < 0.05 vs. CT]; 1.47/1.28 [MRI vs. CT/CBCT p < 0.05]; 1.86/1.83 [CT vs. CBCT p < 0.05]). Interobserver-VC for lesion sizes were 2.54-4.47% (CT), 2.29-4.48% (4D-CT); 5.44-6.22% (MRI) and 4.86-6.97% (CBCT). Interphase-VC for lesion sizes ranged from 2.28% (4D-CT) to 10.0% (CBCT). Mean displacement in cm decreased from static CT (1.65) to 4D-CT (1.40), CBCT (1.23) and MRI (1.16). CONCLUSIONS: Lesion sizes are exactly reproduced with 4D-CT but overestimated on 4D-MRI and CBCT with a larger variability due to limited temporal and spatial resolution. All 4D-modalities underestimate lesion displacement.

Respiratory-gated helical computed tomography of lung: reproducibility of small volumes in an ex vivo model.

PURPOSE: Motion-adapted radiotherapy with gated irradiation or tracking of tumor positions requires dedicated imaging techniques such as four-dimensional (4D) helical computed tomography (CT) for patient selection and treatment planning. The objective was to evaluate the reproducibility of spatial information for small objects on respiratory-gated 4D helical CT using computer-assisted volumetry of lung nodules in a ventilated ex vivo system. METHODS AND MATERIALS: Five porcine lungs were inflated inside a chest phantom and prepared with 55 artificial nodules (mean diameter, 8.4 mm +/- 1.8). The lungs were respirated by a flexible diaphragm and scanned with 40-row detector CT (collimation, 24 x 1.2 mm; pitch, 0.1; rotation time, 1 s; slice thickness, 1.5 mm; increment, 0.8 mm). The 4D-CT scans acquired during respiration (eight per minute) and reconstructed at 0-100% inspiration and equivalent static scans were scored for motion-related artifacts (0 or absent to 3 or relevant). The reproducibility of nodule volumetry (three readers) was assessed using the variation coefficient (VC). RESULTS: The mean volumes from the static and dynamic inspiratory scans were equal (364.9 and 360.8 mm3, respectively, p = 0.24). The static and dynamic end-expiratory volumes were slightly greater (371.9 and 369.7 mm3, respectively, p = 0.019). The VC for volumetry (static) was 3.1%, with no significant difference between 20 apical and 20 caudal nodules (2.6% and 3.5%, p = 0.25). In dynamic scans, the VC was greater (3.9%, p = 0.004; apical and caudal, 2.6% and 4.9%; p = 0.004), with a significant difference between static and dynamic in the 20 caudal nodules (3.5% and 4.9%, p = 0.015). This was consistent with greater motion-related artifacts and image noise at the diaphragm (p <0.05). The VC for interobserver variability was 0.6%. CONCLUSION: Residual motion-related artifacts had only minimal influence on volumetry of small solid lesions. This indicates a high reproducibility of spatial information for small objects in low pitch helical 4D-CT reconstructions.

Four-dimensional multislice helical CT of the lung: qualitative comparison of retrospectively gated and static images in an ex-vivo system.

PURPOSE: To analyse the image quality of retrospectively gated helical CT using controlled respiratory motion of porcine lung explants. MATERIALS AND METHODS: Five porcine lungs were examined inside a chest phantom. A silicone membrane was rhythmically inflated and deflated to simulate diaphragmatic respiration. Dynamic images (regular respiration at 8/min) and static scans (w/o respiration) at 0/25/50/75 and 100% of maximum inspiration were acquired with a 40-row detector CT scanner (rotation time 1s, pitch 0.1). Image quality on multi-planar reformations was evaluated by two observers. Partial projection artifacts, stepladder-artifacts and noise were compared for upper, middle and lower parts of the lung and different respiratory phases (scores 0-3 for absent, minimal, moderate and diagnostically relevant artifacts). RESULTS: Partial projection effects were limited to dynamic scans (mean score 1.33). Stepladder artifacts predominated in dynamic series compared to static series (mean score 0.55 versus 0.1; p<0.001). Image noise was not related to lung motion (mean scores 0.68-0.81). All artifacts predominated close to the diaphragm compared to the upper and middle parts of the lung (p<0.001 to p=0.02, respectively). Partial projection and stepladder artifacts were less in end-inspiration and end-expiration than within the respiration (p<0.001 and p=0.17, respectively). Diagnostically relevant artifacts were noted 9 times (9/9 close to diaphragm, 7/9 partial-projection). CONCLUSIONS: Even in ideal realistic conditions, helical 4D-CT produced tolerable artifacts which could be overcome by radiologists.