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Optimizing Radiation Dose Levels in Prospectively Electrocardiogram-Triggered Coronary Computed Tomography Angiography Using Iterative Reconstruction Techniques: A Phantom and Patient Study  [PDF]
Yang Hou, Jiahe Zheng, Yuke Wang, Mei Yu, Mani Vembar, Qiyong Guo
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0056295
Abstract: Aim To investigate the potential of reducing the radiation dose in prospectively electrocardiogram-triggered coronary computed tomography angiography (CCTA) while maintaining diagnostic image quality using an iterative reconstruction technique (IRT). Methods and Materials Prospectively-gated CCTA were first performed on a phantom using 256-slice multi-detector CT scanner at 120 kVp, with the tube output gradually reduced from 210 mAs (Group A) to 125, 105, 84, and 63 mAs (Group B–E). All scans were reconstructed using filtered back projection (FBP) algorithm and five IRT levels (L2-6), image quality (IQ) assessment was performed. Based on the IQ assessment, Group D(120 kVp, 84 mAs) reconstructed with L5 was found to provide IQ comparable to that of Group A with FBP. In the patient study, 21 patients underwent CCTA using 120 kV, 210 mAs with FBP reconstruction (Group 1) followed by 36 patients scanned with 120 kV, 84 mAs with IRT L5 (Group 2). Subjective and objective IQ and effective radiation dose were compared between two groups. Results In the phantom scans, there were no significant differences in image noise, contrast-to-noise ratio (CNR) and modulation transfer function (MTF) curves between Group A and the 84 mAs, 63 mAs groups (Groups D and E). Group D (120 kV, 84 mAs and L5) provided an optimum balance, producing equivalent image quality to Group A, at the lowest possible radiation dose. In the patient study, there were no significant difference in image noise, signal-to-noise ratio (SNR) and CNR between Group 1 and Group 2 (p = 0.71, 0.31, 0.5, respectively). The effective radiation dose in Group 2 was 1.21±0.14 mSv compared to 3.20±0.58 mSv (Group 1), reflecting dose savings of 62.5% (p<0.05). Conclusion iterative reconstruction technique used in prospectively ECG-triggered 256-slice coronary CTA can provide radiation dose reductions of up to 62.5% with acceptable image quality.
Comparison of radiation doses using weight-based protocol and dose modulation techniques for patients undergoing biphasic abdominal computed tomography examinations  [cached]
Livingstone Roshan,Dinakaran Paul,Cherian Rekha,Eapen Anu
Journal of Medical Physics , 2009,
Abstract: Computed tomography (CT) of the abdomen contributes a substantial amount of man-made radiation dose to patients and use of this modality is on the increase. This study intends to compare radiation dose and image quality using dose modulation techniques and weight- based protocol exposure parameters for biphasic abdominal CT. Using a six-slice CT scanner, a prospective study of 426 patients who underwent abdominal CT examinations was performed. Constant tube potentials of 90 kV and 120 kV were used for all arterial and portal venous phase respectively. The tube current-time product for weight-based protocol was optimized according to patient′s body weight; this was automatically selected in dose modulations. The effective dose using weight-based protocol, angular and z-axis dose modulation was 11.3 mSv, 9.5 mSv and 8.2 mSv respectively for the patient′s body weight ranging from 40 to 60 kg. For patients of body weights ranging 60 to 80 kg, the effective doses were 13.2 mSv, 11.2 mSv and 10.6 mSv respectively. The use of dose modulation technique resulted in a reduction of 16 to 28% in radiation dose with acceptable diagnostic accuracy in comparison to the use of weight-based protocol settings.
High-Quality Three-Dimensional Computed Tomography Angiography of Abdominal Viscera with Small Focal Spot, Low Tube Voltage, and Iterative Model Reconstruction Technique  [PDF]
Masafumi Uchida
Open Journal of Radiology (OJRad) , 2015, DOI: 10.4236/ojrad.2015.51002
Abstract: Purpose: To evaluate the quality of three-dimensional (3D) CT angiography images of the abdominal viscera with small focal spot, low tube voltage, and iterative model reconstruction technique (IMR). Materials and Methods: Seven patients with suspected disease of the pancreatobiliary system had undergone CT with high-quality CTA protocol in the present study. There were 5 men and 2 women, ranging in age from 52 to 80 years (mean: 64 years). Results: Depiction of abdominal small artery, small portal vein was possible in all cases. In two cases that we were able to compare, it was superior to standard CTA in small vascular depiction in CTA made clearly in high quality protocol. Conclusions: Although the use of small focal spot, low tube voltage, and IMR can produce higher-quality images of abdominal vessels than standard CTA, this improvement is not significant at elevated radiation doses.
Evaluation of Algebraic Iterative Image Reconstruction Methods for Tetrahedron Beam Computed Tomography Systems  [PDF]
Joshua Kim,Huaiqun Guan,David Gersten,Tiezhi Zhang
International Journal of Biomedical Imaging , 2013, DOI: 10.1155/2013/609704
Abstract: Tetrahedron beam computed tomography (TBCT) performs volumetric imaging using a stack of fan beams generated by a multiple pixel X-ray source. While the TBCT system was designed to overcome the scatter and detector issues faced by cone beam computed tomography (CBCT), it still suffers the same large cone angle artifacts as CBCT due to the use of approximate reconstruction algorithms. It has been shown that iterative reconstruction algorithms are better able to model irregular system geometries and that algebraic iterative algorithms in particular have been able to reduce cone artifacts appearing at large cone angles. In this paper, the SART algorithm is modified for the use with the different TBCT geometries and is tested using both simulated projection data and data acquired using the TBCT benchtop system. The modified SART reconstruction algorithms were able to mitigate the effects of using data generated at large cone angles and were also able to reconstruct CT images without the introduction of artifacts due to either the longitudinal or transverse truncation in the data sets. Algebraic iterative reconstruction can be especially useful for dual-source dual-detector TBCT, wherein the cone angle is the largest in the center of the field of view. 1. Introduction Image-guided radiation therapy (IGRT) is essential to ensure proper dose delivery to the target while sparing the surrounding tissue [1, 2]. Cone beam CT (CBCT) is a popular online imaging modality used for LINAC-based IGRT [3, 4]. Although CBCT is convenient to use, the performance of CBCT systems is less than ideal. The image quality for the CBCT is significantly degraded due to excessive scattered photons [5–8] as well as suboptimal performance of the flat panel detector [9]. These issues limit the use of CBCT for certain advanced radiation therapy techniques such as online adaptive radiotherapy [8, 10]. It is also well known that at large cone angles, there are artifacts caused by using approximate reconstruction methods that appear in CBCT reconstructions [11], but this issue has largely been ignored in IGRT because the scatter and detector issues are the dominant factors in the degradation of CBCT image quality. Tetrahedron beam computed tomography (TBCT) is a novel volumetric CT modality that overcomes the scatter and detector problems of CBCT [12, 13]. A TBCT system is composed of a minimum of one linear source array with one linear detector array positioned opposite and orthogonal to it. In TBCT, scattered photons are largely rejected due to the fan-beam geometry of the system. A TBCT
Radiation dose in paediatric computed tomography: risks and benefits
GI Ogbole
Annals of Ibadan Postgraduate Medicine , 2010,
Abstract: Computed tomography (CT) is a powerful tool for the accurate and effective diagnosis and treatment of a variety of conditions because it allows high-resolution three-dimensional images to be acquired very quickly. However as the number of CT procedures performed globally have continued to increase; with growing concerns about patient protection. Currently, no system is in place to track patient doses and the lifetime cumulative dose from medical sources. The widespread use of CT even in developing countries has raised questions regarding the possible threat to public health especially in children. The best available risk estimates suggest that paediatric CT will result in significantly increased lifetime radiation risk over adult CT. Studies have shown that lower milliampere-second (mAs) settings can be used for children without significant loss of information. Although the risk–benefit balance is still strongly tilted toward benefit, there is still need for caution. Furthermore since the frequency of paediatric CT examinations is rapidly increasing, and estimates suggest that quantitative lifetime radiation risks for children are not negligible, efforts should be made toward more active reduction of CT exposure settings in paediatric patients. This article hopes to address this concerns and draw attention to the fact that children are not ‘small adults ’ and should therefore be treated differently.
Patient dose considerations in computed tomography examinations  [cached]
Ioannis A Tsalafoutas , Georgios V Koukourakis
World Journal of Radiology , 2010,
Abstract: Ionizing radiation is extensively used in medicine and its contribution to both diagnosis and therapy is undisputable. However, the use of ionizing radiation also involves a certain risk since it may cause damage to tissues and organs and trigger carcinogenesis. Computed tomography (CT) is currently one of the major contributors to the collective population radiation dose both because it is a relatively high dose examination and an increasing number of people are subjected to CT examinations many times during their lifetime. The evolution of CT scanner technology has greatly increased the clinical applications of CT and its availability throughout the world and made it a routine rather than a specialized examination. With the modern multislice CT scanners, fast volume scanning of the whole human body within less than 1 min is now feasible. Two dimensional images of superb quality can be reconstructed in every possible plane with respect to the patient axis (e.g. axial, sagital and coronal). Furthermore, three-dimensional images of all anatomic structures and organs can be produced with only minimal additional effort (e.g. skeleton, tracheobronchial tree, gastrointestinal system and cardiovascular system). All these applications, which are diagnostically valuable, also involve a significant radiation risk. Therefore, all medical professionals involved with CT, either as referring or examining medical doctors must be aware of the risks involved before they decide to prescribe or perform CT examinations. Ultimately, the final decision concerning justification for a prescribed CT examination lies upon the radiologist. In this paper, we summarize the basic information concerning the detrimental effects of ionizing radiation, as well as the CT dosimetry background. Furthermore, after a brief summary of the evolution of CT scanning, the current CT scanner technology and its special features with respect to patient doses are given in detail. Some numerical data is also given in order to comprehend the magnitude of the potential radiation risk involved in comparison with risk from exposure to natural background radiation levels.
Computed Tomography (CT) Perfusion in Abdominal Cancer: Technical Aspects  [PDF]
Martin Lundsgaard Hansen,Rikke Norling,Carsten Lauridsen,Eva Fallentin,Lene B?ksgaard,Klaus Fuglsang Kofoed,Lars Bo Svendsen,Michael Bachmann Nielsen
Diagnostics , 2013, DOI: 10.3390/diagnostics3020261
Abstract: Computed Tomography (CT) Perfusion is an evolving method to visualize perfusion in organs and tissue. With the introduction of multidetector CT scanners, it is now possible to cover up to 16 cm in one rotation, and thereby making it possible to scan entire organs such as the liver with a fixed table position. Advances in reconstruction algorithms make it possible to reduce the radiation dose for each examination to acceptable levels. Regarding abdominal imaging, CT perfusion is still considered a research tool, but several studies have proven it as a reliable non-invasive technique for assessment of vascularity. CT perfusion has also been used for tumor characterization, staging of disease, response evaluation of newer drugs targeted towards angiogenesis and as a method for early detection of recurrence after radiation and embolization. There are several software solutions available on the market today based on different perfusion algorithms. However, there is no consensus on which protocol and algorithm to use for specific organs. In this article, the authors give an introduction to CT perfusion in abdominal imaging introducing technical aspects for calculation of perfusion parameters, and considerations on patient preparation. This article also contains clinical cases to illustrate the use of CT perfusion in abdominal imaging.
The Effects of Computed Tomography with Iterative Reconstruction on Solid Pulmonary Nodule Volume Quantification  [PDF]
Martin J. Willemink, Jaap Borstlap, Richard A. P. Takx, Arnold M. R. Schilham, Tim Leiner, Ricardo P. J. Budde, Pim A. de Jong
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058053
Abstract: Background The objectives of this study were to evaluate the influence of iterative reconstruction (IR) on pulmonary nodule volumetry with chest computed tomography (CT). Methods Twenty patients (12 women and 8 men, mean age 61.9, range 32–87) underwent evaluation of pulmonary nodules with a 64-slice CT-scanner. Data were reconstructed using filtered back projection (FBP) and IR (Philips Healthcare, iDose4-levels 2, 4 and 6) at similar radiation dose. Volumetric nodule measurements were performed with semi-automatic software on thin slice reconstructions. Only solid pulmonary nodules were measured, no additional selection criteria were used for the nature of nodules. For intra-observer and inter-observer variability, measurements were performed once by one observer and twice by another observer. Algorithms were compared using the concordance correlation-coefficient (pc) and Friedman-test, and post-hoc analysis with the Wilcoxon-signed ranks-test with Bonferroni-correction (significance-level p<0.017). Results Seventy-eight nodules were present including 56 small nodules (volume<200 mm3, diameter<8 mm) and 22 large nodules (volume≥200 mm3, diameter≥8 mm). No significant differences in measured pulmonary nodule volumes between FBP, iDose4-levels 2, 4 and 6 were found in both small nodules and large nodules. FBP and iDose4-levels 2, 4 and 6 were correlated with pc-values of 0.98 or higher for both small and large nodules. Pc-values of intra-observer and inter-observer variability were 0.98 or higher. Conclusions Measurements of solid pulmonary nodule volume measured with standard-FBP were comparable with IR, regardless of the IR-level and no significant differences between measured volumes of both small and large solid nodules were found.
Learned Shrinkage Approach for Low-Dose Reconstruction in Computed Tomography  [PDF]
Joseph Shtok,Michael Elad,Michael Zibulevsky
International Journal of Biomedical Imaging , 2013, DOI: 10.1155/2013/609274
Abstract: We propose a direct nonlinear reconstruction algorithm for Computed Tomography (CT), designed to handle low-dose measurements. It involves the filtered back-projection and adaptive nonlinear filtering in both the projection and the image domains. The filter is an extension of the learned shrinkage method by Hel-Or and Shaked to the case of indirect observations. The shrinkage functions are learned using a training set of reference CT images. The optimization is performed with respect to an error functional in the image domain that combines the mean square error with a gradient-based penalty, promoting image sharpness. Our numerical simulations indicate that the proposed algorithm can manage well with noisy measurements, allowing a dose reduction by a factor of 4, while reducing noise and streak artifacts in the FBP reconstruction, comparable to the performance of a statistically based iterative algorithm. 1. Introduction 1.1. Problem Statement Computed tomography (CT) imaging produces a 3D map of the scanned object, where the different materials are distinguished by their X-ray attenuation properties. In medicine, such a map has a great diagnostic value, making the CT scan one of the most frequent noninvasive exploration procedures practiced in almost every hospital. The attenuation of biological tissues is measured by comparing the intensity of the X-rays entering and leaving the body. The main problem precluding pervasive use of the CT scan for diagnostics and monitoring is the damage caused to the tissues by the X-ray radiation. CT manufacturers make great efforts to reduce the X-ray dose required for images of diagnostic quality. In this work we propose an algorithm that enables a high-quality reconstruction from low-dose (and thus noisy) measurements. In ideal conditions, the information obtained in the scan suffices to build an exact attenuation map, called the CT image. In practice, the measurements are degraded by a number of physical phenomena. The main factors are off-focal radiation, afterglow and crosstalk in the detectors, beam hardening, and Compton scattering (see [1] for a detailed overview). These introduce a structured error into the measurements, mostly the type that is modeled by a convolution with some kernel. Another source of deterioration, dominant in the low-dose scenario, is the stochastic noise. One type of such noise stems from the low photon counts, which occur when the X-rays pass through high-attenuation areas. This phenomenon is similar to the shot noise, encountered in photo cameras in poor lighting conditions.
3D SPIRAL COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF AN ABDOMINAL TUMOUR  [PDF]
R.C. Tiutiuca,Iuliana Eva
Jurnalul de Chirurgie , 2006,
Abstract: Patients with digestive illnesses requires a full exploration, cases where imagistic assets support (echographic examination, radiological data, computed tomography, magnetic resonance) are very usefully. Computed tomography, in this process, has a special value. The results from axial images are sustained by the informations supplied from three-dimensional reconstruction processes (3D reconstruction) with relevant importance in establishment of diagnosis and therapeutic plan.
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