Volume of lung nodules is an important biomarker, quantifiable from computed tomography (CT) images. The usefulness of volume quantification, however, depends on the precision of quantification. Experimental assessment of precision is time consuming. A mathematical estimability model was used to assess the quantification precision of CT nodule volumetry in terms of an index (e′), incorporating image noise and resolution, nodule properties, and segmentation software. The noise and resolution were characterized in terms of noise power spectrum and task transfer function. The nodule properties and segmentation algorithm were modeled in terms of a task function and a template function, respectively. The e′ values were benchmarked against experimentally acquired precision values from an anthropomorphic chest phantom across 54 acquisition protocols, 2 nodule sizes, and 2 volume segmentation softwares. e′ exhibited correlation with experimental precision across nodule sizes and acquisition protocols but dependence on segmentation software. Compared to the assessment of empirical precision, which required ∼300 h to perform the segmentation, the e′ method required ∼3 h from data collection to mathematical computation. A mathematical modeling of volume quantification provides efficient prediction of quantitative performance. It establishes a method to verify quantitative compliance and to optimize clinical protocols for chest CT volumetry.
This study aimed to estimate the organ dose reduction potential for organ-dose-based tube current modulated (ODM) thoracic computed tomography (CT) with a wide dose reduction arc. Twenty-one computational anthropomorphic phantoms (XCAT) were used to create a virtual patient population with clinical anatomic variations. The phantoms were created based on patient images with normal anatomy (age range: 27 to 66 years, weight range: 52.0 to 105.8 kg). For each phantom, two breast tissue compositions were simulated: 50/50 and 20/80 (glandular-to-adipose ratio). A validated Monte Carlo program (PENELOPE, Universitat de Barcelona, Spain) was used to estimate the organ dose for standard tube current modulation (TCM) (SmartmA, GE Healthcare) and ODM (GE Healthcare) for a commercial CT scanner (Revolution, GE Healthcare) using a typical clinical thoracic CT protocol. Both organ dose and CTDIvol-to-organ dose conversion coefficients (h factors) were compared between TCM and ODM. ODM significantly reduced all radiosensitive organ doses (p<0.01). The breast dose was reduced by 30±2%. For h factors, organs in the anterior region (e.g., thyroid and stomach) exhibited substantial decreases, and the medial, distributed, and posterior region saw either an increase of less than 5% or no significant change. ODM significantly reduced organ doses especially for radiosensitive superficial anterior organs such as the breasts.
The purpose of this study was to investigate relationships between patient attributes and organ dose for a population of computational phantoms for 20 tomosynthesis and radiography protocols. Organ dose was estimated from 54 adult computational phantoms (age: 18 to 78 years, weight 52 to 117 kg) using a validated Monte-Carlo simulation (PENELOPE) of a system capable of performing tomosynthesis and radiography. The geometry and field of view for each exam were modeled to match clinical protocols. For each protocol, the energy deposited in each organ was estimated by the simulations, converted to dose units, and then normalized by exposure in air. Dose to radiosensitive organs was studied as a function of average patient thickness in the region of interest and as a function of body mass index. For tomosynthesis, organ doses were also studied as a function of x-ray tube position. This work developed comprehensive information for organ dose dependencies across a range of tomosynthesis and radiography protocols. The results showed a protocol-dependent exponential decrease with an increasing patient size. There was a variability in organ dose across the patient population, which should be incorporated in the metrology of organ dose. The results can be used to prospectively and retrospectively estimate organ dose for tomosynthesis and radiography.
This study aimed to model virtual human lung phantoms including both non-parenchymal and parenchymal structures. Initial branches of the non-parenchymal structures (airways, arteries, and veins) were segmented from anatomical data in each lobe separately. A volume-filling branching algorithm was utilized to grow the higher generations of the airways and vessels to the level of terminal branches. The diameters of the airways and vessels were estimated using established relationships between flow rates and diameters. The parenchyma was modeled based on secondary pulmonary lobule units. Polyhedral shapes with variable sizes were modeled, and the borders were assigned to interlobular septa. A heterogeneous background was added inside these units using a non-parametric texture synthesis algorithm which was informed by a high-resolution CT lung specimen dataset. A voxelized based CT simulator was developed to create synthetic helical CT images of the phantom with different pitch values. Results showed the progressive degradation in depiction of lung details with increased pitch. Overall, the enhanced lung models combined with the XCAT phantoms prove to provide a powerful toolset to perform virtual clinical trials in the context of thoracic imaging. Such trials, not practical using clinical datasets or simplistic phantoms, can quantitatively evaluate and optimize advanced imaging techniques towards patient-based care.
This study aimed to estimate the organ dose reduction potential for organ-dose-based tube current modulated (ODM) thoracic CT with wide dose reduction arc. Twenty-one computational anthropomorphic phantoms (XCAT, age range: 27– 75 years, weight range: 52.0-105.8 kg) were used to create a virtual patient population with clinical anatomic variations. For each phantom, two breast tissue compositions were simulated: 50/50 and 20/80 (glandular-to-adipose ratio). A validated Monte Carlo program was used to estimate the organ dose for standard tube current modulation (TCM) (SmartmA, GE Healthcare) and ODM (GE Healthcare) for a commercial CT scanner (Revolution, GE Healthcare) with explicitly modeled tube current modulation profile, scanner geometry, bowtie filtration, and source spectrum. Organ dose was determined using a typical clinical thoracic CT protocol. Both organ dose and CTDIvol-to-organ dose conversion coefficients (h factors) were compared between TCM and ODM. ODM significantly reduced all radiosensitive organ doses (p<0.01). The breast dose was reduced by 30±2%. For h factors, organs in the anterior region (e.g. thyroid, stomach) exhibited substantial decreases, and the medial, distributed, and posterior region either saw an increase or no significant change. The organ-dose-based tube current modulation significantly reduced organ doses especially for radiosensitive superficial anterior organs such as the breasts.
The purpose of this study was to provide patient-specific organ dose estimation based on an atlas of human models for twenty tomosynthesis and radiography protocols. The study utilized a library of 54 adult computational phantoms (age: 18-78 years, weight 52-117 kg) and a validated Monte-Carlo simulation (PENELOPE) of a tomosynthesis and radiography system to estimate organ dose. Positioning of patient anatomy was based on radiographic positioning handbooks. The field of view for each exam was calculated to include relevant organs per protocol. Through simulations, the energy deposited in each organ was binned to estimate normalized organ doses into a reference database. The database can be used as the basis to devise a dose calculator to predict patient-specific organ dose values based on kVp, mAs, exposure in air, and patient habitus for a given protocol. As an example of the utility of this tool, dose to an organ was studied as a function of average patient thickness in the field of view for a given exam and as a function of Body Mass Index (BMI). For tomosynthesis, organ doses can also be studied as a function of x-ray tube position. This work developed comprehensive information for organ dose dependencies across tomosynthesis and radiography. There was a general exponential decrease dependency with increasing patient size that is highly protocol dependent. There was a wide range of variability in organ dose across the patient population, which needs to be incorporated in the metrology of organ dose.
In thoracic CT, organ-based tube current modulation (OTCM) reduces breast dose by lowering the tube current in the 120°
anterior dose reduction zone of patients. However, in practice the breasts usually expand to an angle larger than the dose
reduction zone. This work aims to simulate a breast positioning technique (BPT) to constrain the breast tissue to within
the dose reduction zone for OTCM and to evaluate the corresponding potential reduction in breast dose. Thirteen female
anthropomorphic computational phantoms were studied (age range: 27-65 y.o., weight range: 52-105.8 kg). Each phantom
was modeled in the supine position with and without application of the BPT. Attenuation-based tube current (ATCM,
reference mA) was generated by a ray-tracing program, taking into account the patient attenuation change in the
longitudinal and angular plane (CAREDose4D, Siemens Healthcare). OTCM was generated by reducing the mA to 20%
between ± 60° anterior of the patient and increasing the mA in the remaining projections correspondingly (X-CARE,
Siemens Healthcare) to maintain the mean tube current. Breast tissue dose was estimated using a validated Monte Carlo
program for a commercial scanner (SOMATOM Definition Flash, Siemens Healthcare). Compared to standard tube
current modulation, breast dose was significantly reduced using OTCM by 19.8±4.7%. With the BPT, breast dose was
reduced by an additional 20.4±6.5% to 37.1±6.9%, using the same CTDIvol. BPT was more effective for phantoms
simulating women with larger breasts with the average breast dose reduction of 30.2%, 39.2%, and 49.2% from OTCMBP
to ATCM, using the same CTDIvol for phantoms with 0.5, 1.5, and 2.5 kg breasts, respectively. This study shows that a
specially designed BPT improves the effectiveness of OTCM.
The purpose of this study was to substantiate the interdependency of image quality, radiation dose, and contrast
material dose in CT towards the patient-specific optimization of the imaging protocols. The study deployed two
phantom platforms. First, a variable sized phantom containing an iodinated insert was imaged on a representative CT
scanner at multiple CTDI values. The contrast and noise were measured from the reconstructed images for each
phantom diameter. Linearly related to iodine-concentration, contrast to noise ratio (CNR), was calculated for
different iodine-concentration levels. Second, the analysis was extended to a recently developed suit of 58 virtual
human models (5D-XCAT) with added contrast dynamics. Emulating a contrast-enhanced abdominal image
procedure and targeting a peak-enhancement in aorta, each XCAT phantom was “imaged” using a CT simulation
platform. 3D surfaces for each patient/size established the relationship between iodine-concentration, dose, and CNR.
The Sensitivity of Ratio (SR), defined as ratio of change in iodine-concentration versus dose to yield a constant
change in CNR was calculated and compared at high and low radiation dose for both phantom platforms. The results
show that sensitivity of CNR to iodine concentration is larger at high radiation dose (up to 73%). The SR results were
highly affected by radiation dose metric; CTDI or organ dose. Furthermore, results showed that the presence of
contrast material could have a profound impact on optimization results (up to 45%).
Neutron stimulated emission computed tomography (NSECT) is being developed as a non-invasive technique to
diagnose iron overload in the liver. It uses inelastic scatter interactions between fast neutrons and iron nuclei to quantify
localized distributions of iron within the liver. Preliminary studies have demonstrated the feasibility of iron overload
detection through NSECT using a Monte-Carlo simulation model in GEANT4. The work described here uses the
GEANT4 simulation model to analyze iron-overload detection sensitivity in NSECT. A simulation of a clinical NSECT
system was designed in GEANT4. Simulated models were created for human liver phantoms with concentrations of iron
varying from 0.5 mg/g to 20 mg/g (wet). Each liver phantom was scanned with 100 million neutron events to generate
gamma spectra showing gamma-lines corresponding to iron in the liver. A background spectrum was obtained using a
water phantom of equal mass as the liver phantom and was subtracted from each liver spectrum. The height of the
gamma line at 847 keV (corresponding to 56Fe) was used as a measure of the detected iron concentration in each
background-corrected spectrum. The variation in detected gamma counts was analyzed and plotted as a function of the
liver iron concentration to quantify measurement error. Analysis of the differences between the measured and expected
value of iron concentration indicate that NSECT sensitivity for detection of iron in liver tissue may lie in the range of 0.5
mg/g - 1 mg/g, which represents a clinically significant range for iron overload detection in humans.
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