I am the head of the Diagnostic Medical Physics group at Environmental Health and Safety department. Our group support medical imaging services for Stanford Health Care, Lucille Packard Children's Hospital, and Veterans Affairs Palo Alto Health Care System. The scope of our work includes:
• Radiation safety of diagnostic x-ray imaging practice to ascertain the compliance of State and Federal regulations, Joint Commission recommendations, and University policies
• Quality control program of diagnostic X-ray imaging practice (Computed tomography, Interventional Radiology, Fluoroscopy and Radiography): accreditation, continuous quality control procedures
• Radiation dose monitoring and CT protocol optimization; Work with each clinical section on task-specific CT Dose and Image Quality optimization by utilizing our state-of-the-art CT equipment and novel iterative reconstruction techniques
• Review proposed research uses of x-rays in human subjects for Stanford IRB: evaluate doses and estimate risks and advise research investigators on radiation safety issues and how to solve related problems.
• Staff and trainee education on topics including CT technology, CT dose optimization, Fluoroscopy dose optimization, and radiation risk from ionizing imaging exams
• Support clinical innovation projects and activities that can be readily translated to patient care in Stanford health care system
Honors & Awards
People’s Scholarship, Nanjing University (2000-2003)
Editor’s recognition award, ‘Radiology’ for Reviewing (2011)
Education & Certifications
Board Certification, American Board of Radiology, Diagnostic Medical Physics (2014)
Ph.D., Dartmouth College, Physics / Biomedical Imaging (2009)
B.S., Nanjing University, Physics (2003)
Research fellow, Mayo Clinic (5/2009 - 4/2012)
I worked at the CT Clinical Innovation Center ( http://www.mayo.edu/research/centers-programs/ct-clinical-innovation-center/overview) in Department of Radiology at Mayo Clinic. At Mayo, my research was focused on the physics and clinical implementation of radiation dose optimization strategies in Computed tomography (CT). I have also investigated clinical applications of Dual energy CT for material differentiation and quantification. My specific research projects included:
1. Investigation on dose reduction techniques for thoracic and head CT: tube current modulation, bismuth shielding and global tube current reduction
2. Patient size estimation based on CT topogram (prior scan) and images (after scan) for size specific dose estimation using: analytical model, Monte Carlo simulation, and phantom experiment.
3. Non-invasive differentiation of renal stone composition using Dual-Energy Computed Tomography (DECT) technology and material decomposition analysis
4. Iron quantification as a marker of hemorrhage into atherosclerotic plaques using DECT with an animal model
5. Noise reduction in material specific images for multi-energy x-ray imaging using: energy bin optimization with CRLB calculation and a local highly constrained back projection reconstruction algorithm
Professional Affiliations and Activities
Member of Task Group No. 233 - Performance Evaluation of Computed Tomography Systems, American Association of Physicists in Medicine (AAPM) (2013 - 2019)
Vice Chair of Alliance for Quality Computed Tomography Working Group, American Association of Physicists in Medicine (AAPM) (2017 - Present)
Member of Medical Physics Clinical Committee, American Board of Radiology (2019 - Present)
Voting Member of Task Group No. 257 - MPPG #6 Selection of a Patient Dose Monitoring System, American Association of Physicists in Medicine (AAPM) (2013 - 2017)
Voting Member of TG 220 Determination of a Patient Size Metric for CT Size Specific Dose Estimation, American Association of Physicists in Medicine (AAPM) (2012 - 2014)
Efficient Evaluation of Low-contrast Detectability of Deep-CNN-based CT Reconstruction Using Channelized Hotelling Observer on the ACR Accreditation Phantom.
Proceedings of SPIE--the International Society for Optical Engineering
As deep-learning-based denoising and reconstruction methods are gaining more popularity in clinical CT, it is of vital importance that these new algorithms undergo rigorous and objective image quality assessment beyond traditional metrics to ensure diagnostic information is not sacrificed. Channelized Hotelling observer (CHO), which has been shown to be well correlated with human observer performance in many clinical CT tasks, has a great potential to become the method of choice for objective image quality assessment for these non-linear methods. However, practical use of CHO beyond research labs have been quite limited, mostly due to the strict requirement on a large number of repeated scans to ensure sufficient accuracy and precision in CHO computation and the lack of efficient and widely acceptable phantom-based method. In our previous work, we developed an efficient CHO model observer for accurate and precise measurement of low-contrast detectability with only 1-3 repeated scans on the most widely used ACR accreditation phantom. In this work, we applied this optimized CHO model observer to evaluating the low-contrast detectability of a deep learning-based reconstruction (DLIR) equipped on a GE Revolution scanner. The commercially available DLIR reconstruction method showed consistent increase in low-contrast detectability over the FBP and the IR method at routine dose levels, which suggests potential dose reduction to the FBP reconstruction by up to 27.5%.
View details for DOI 10.1117/12.2612414
View details for PubMedID 35813246
View details for PubMedCentralID PMC9262078
Low-dose coronary calcium scoring CT using a dedicated reconstruction filter for kV-independent calcium measurements.
In this prospective, pilot study, we tested a kV-independent coronary artery calcium scoring CT protocol, using a novel reconstruction kernel (Sa36f). From December 2018 to November 2019, we performed an additional research scan in 61 patients undergoing clinical calcium scanning. For the standard protocol (120 kVp), images were reconstructed with a standard, medium-sharp kernel (Qr36d). For the research protocol (automated kVp selection), images were reconstructed with a novel kernel (Sa36f). Research scans were sequentially performed using a higher (cohort A, n=31) and a lower (cohort B, n=30) dose optimizer setting within the automatic system with customizable kV selection. Agatston scores, coronary calcium volumes, and radiation exposure of the standard and research protocol were compared. A phantom study was conducted to determine inter-scan variability. There was excellent correlation for the Agatston score between the two protocols (r=0.99); however, the standard protocol resulted in slightly higher Agatston scores (29.4 [0-139.0] vs 17.4 [0-158.2], p=0.028). The median calcium volumes were similar (11.5 [0-109.2] vs 11.2 [0-118.0] mm3; p=0.176), and the number of calcified lesions was not significantly different (p=0.092). One patient was reclassified to another risk category. The research protocol could be performed at a lower kV and resulted in a substantially lower radiation exposure, with a median volumetric CT dose index of 4.1 vs 5.2mGy, respectively (p<0.001). Our results showed that a consistent coronary calcium scoring can be achieved using a kV-independent protocol that lowers radiation doses compared to the standard protocol. KEY POINTS: The Sa36f kernel enables kV-independent Agatston scoring without changing the original Agatston weighting threshold. Agatston scores and calcium volumes of the standard and research protocols showed an excellent correlation. The research protocol resulted in a significant reduction in radiation exposure with a mean reduction of 22% in DLP and 25% in CTDIvol.
View details for DOI 10.1007/s00330-021-08451-2
View details for PubMedID 34989838
- Material Decomposition and Post-processing: History and Basic Principles Spectral Imaging: Dual-Energy, Multi-Energy and Photon-Counting CT Springer. 2022: 3-14
Radiopaque Recreations of Lung Pathologies From Clinical Computed Tomography Images Using Potassium Iodide Inkjet 3-dimensional Printing: Proof of Concept.
Journal of thoracic imaging
PURPOSE: The purpose of this study was to develop a 3-dimensional (3D) printing method to create computed tomography (CT) realistic phantoms of lung cancer nodules and lung parenchymal disease from clinical CT images.MATERIALS AND METHODS: Low-density paper was used as substrate material for inkjet printing with potassium iodide solution to reproduce phantoms that mimic the CT attenuation of lung parenchyma. The relationship between grayscale values and the corresponding CT numbers of prints was first established through the derivation of exponential fitted equation from scanning data. Next, chest CTs from patients with early-stage lung cancer and coronavirus disease 2019 (COVID-19) pneumonia were chosen for 3D printing. CT images of original lung nodule and the 3D-printed nodule phantom were compared based on pixel-to-pixel correlation and radiomic features.RESULTS: CT images of part-solid lung cancer and 3D-printed nodule phantom showed both high visual similarity and quantitative correlation. R2 values from linear regressions of pixel-to-pixel correlations between 5 sets of patient and 3D-printed image pairs were 0.92, 0.94, 0.86, 0.85, and 0.83, respectively. Comparison of radiomic measures between clinical CT and printed models demonstrated 6.1% median difference, with 25th and 75th percentile range at 2.4% and 15.2% absolute difference, respectively. The densities and parenchymal morphologies from COVID-19 pneumonia CT images were well reproduced in the 3D-printed phantom scans.CONCLUSION: The 3D printing method presented in this work facilitates creation of CT-realistic reproductions of lung cancer and parenchymal disease from individual patient scans with microbiological and pathology confirmation.
View details for DOI 10.1097/RTI.0000000000000607
View details for PubMedID 34334783
Coronary Artery Calcium Scoring: Toward a New Standard.
OBJECTIVES: Although the Agatston score is a commonly used quantification method, rescan reproducibility is suboptimal, and different CT scanners result in different scores. In 2007, McCollough et al (Radiology 2007;243:527-538) proposed a standard for coronary artery calcium quantification. Advancements in CT technology over the last decade, however, allow for improved acquisition and reconstruction methods. This study aims to investigate the feasibility of a reproducible reduced dose alternative of the standardized approach for coronary artery calcium quantification on state-of-the-art CT systems from 4 major vendors.MATERIALS AND METHODS: An anthropomorphic phantom containing 9 calcifications and 2 extension rings were used. Images were acquired with 4 state-of-the-art CT systems using routine protocols and a variety of tube voltages (80-120 kV), tube currents (100% to 25% dose levels), slice thicknesses (3/2.5 and 1/1.25 mm), and reconstruction techniques (filtered back projection and iterative reconstruction). Every protocol was scanned 5 times after repositioning the phantom to assess reproducibility. Calcifications were quantified as Agatston scores.RESULTS: Reducing tube voltage to 100 kV, dose to 75%, and slice thickness to 1 or 1.25 mm combined with higher iterative reconstruction levels resulted in an on average 36% lower intrascanner variability (interquartile range) compared with the standard 120 kV protocol. Interscanner variability per phantom size decreased by 34% on average. With the standard protocol, on average, 6.2 ± 0.4 calcifications were detected, whereas 7.0 ± 0.4 were detected with the proposed protocol. Pairwise comparisons of Agatston scores between scanners within the same phantom size demonstrated 3 significantly different comparisons at the standard protocol (P < 0.05), whereas no significantly different comparisons arose at the proposed protocol (P > 0.05).CONCLUSIONS: On state-of-the-art CT systems of 4 different vendors, a 25% reduced dose, thin-slice calcium scoring protocol led to improved intrascanner and interscanner reproducibility and increased detectability of small and low-density calcifications in this phantom. The protocol should be extensively validated before clinical use, but it could potentially improve clinical interscanner/interinstitutional reproducibility and enable more consistent risk assessment and treatment strategies.
View details for DOI 10.1097/RLI.0000000000000808
View details for PubMedID 34261083
Multi-institution consensus paper for acquisition of portable chest radiographs through glass barriers.
Journal of applied clinical medical physics
BACKGROUND: To conserve personal protective equipment (PPE) and reduce exposure to potentially infected COVID-19 patients, several Californian facilities independently implemented a method of acquiring portable chest radiographs through glass barriers that was originally developed by the University of Washington.METHODS: This work quantifies the transmission of radiation through a glass barrier using six radiographic systems at five facilities. Patient entrance air kerma (EAK) and effective dose were estimated both with and without the glass barrier. Beam penetrability and resulting exposure index (EI) and deviation index (DI) were measured and used to adjust the tube current-time product (mAs) for glass barriers. Because of beam hardening, the contrast-to-noise ratio (CNR) was measured with image quality phantoms to ensure diagnostic integrity. Finally, scatter surveys were performed to assess staff radiation exposure both inside and outside the exam room.RESULTS: The glass barriers attenuated a mean of 61% of the normal X-ray beams. When the mAs was increased to match EI values, there was no discernible degradation of image quality as determined by the CNR. This was corroborated with subjective assessments of image quality by chest radiologists. The glass-hardened beams acted as a filter for low energy X-rays, and some facilities observed slight changes in patient effective doses. There was scattering from both the phantoms and the glass barriers within the room.CONCLUSIONS: Glass barriers require an approximate 2.5 times increase in beam intensity, with all other technique factors held constant. Further refinements are necessary for increased source-to-image distance and beam quality in order to adequately match EI values. This does not result in a significant increase in the radiation dose delivered to the patient. The use of lead aprons, mobile shields, and increased distance from scattering sources should be employed where practicable in order to keep staff radiation doses as low as reasonably achievable.
View details for DOI 10.1002/acm2.13330
View details for PubMedID 34216091
A calibration CT mini-lung-phantom created by 3-D printing and subtractive manufacturing.
Journal of applied clinical medical physics
We describe the creation and characterization of a calibration CT mini-lung-phantom incorporating simulated airways and ground-glass densities. Ten duplicate mini-lung-phantoms with Three-Dimensional (3-D) printed tubes simulating airways and gradated density polyurethane foam blocks were designed and built. Dimensional accuracy and CT numbers were measured using micro-CT and clinical CT scanners. Micro-CT images of airway tubes demonstrated an average dimensional variation of 0.038mm from nominal values. The five different densities of incorporated foam blocks, simulating ground-glass, showed mean CT numbers (±standard deviation) of -897.0±1.5, -844.1±1.5, -774.1±2.6, -695.3±1.6, and -351.0±3.7HU, respectively. Three-Dimensional printing and subtractive manufacturing enabled rapid, cost-effective production of ground-truth calibration mini-lung-phantoms with low inter-sample variation that can be scanned simultaneously with the patient undergoing lung quantitative CT.
View details for DOI 10.1002/acm2.13263
View details for PubMedID 33949078
Fully Automated Quantification Method (FQM) of Coronary Calcium in an Anthropomorphic Phantom.
OBJECTIVE: Coronary artery calcium (CAC) score is a strong predictor for future adverse cardiovascular events. Anthropomorphic phantoms are often used for CAC studies on computed tomography (CT) to allow for evaluation or variation of scanning or reconstruction parameters within or across scanners against a reference standard. This often results in large number of datasets. Manual assessment of these large datasets is time consuming and cumbersome. Therefore, this study aimed to develop and validate a fully automated, open-source quantification method (FQM) for coronary calcium in a standardized phantom.MATERIALS AND METHODS: A standard, commercially available anthropomorphic thorax phantom was used with an insert containing nine calcifications with different sizes and densities. To simulate two different patient sizes, an extension ring was used. Image data was acquired with four state-of-the-art CT systems using routine CAC scoring acquisition protocols. For inter-scan variability, each acquisition was repeated five times with small translations and/or rotations. Vendor-specific CAC scores (Agatston, volume, and mass) were calculated as reference scores using vendor-specific software. Both the international standard CAC quantification methods as well as vendor-specific adjustments were implemented in FQM. Reference and FQM scores were compared using Bland-Altman analysis, intraclass correlation coefficients, risk reclassifications, and Cohen's kappa. Also, robustness of FQM was assessed using varied acquisitions and reconstruction settings and validation on a dynamic phantom. Further, image quality metrics were implemented: noise power spectrum, task transfer function, and contrast- and signal-to-noise ratio among others. Results were validated using imQuest software.RESULTS: Three parameters in CAC scoring methods varied among the different vendor-specific software packages: the Hounsfield unit (HU) threshold, the minimum area used to designate a group of voxels as calcium, and the usage of isotropic voxels for the volume score. The FQM was in high agreement with vendor-specific scores and ICC's (median [95% CI]) were excellent (1.000 [0.999-1.000] to 1.000 [1.000-1.000]). An excellent inter-platform reliability of kappa = 0.969 and kappa = 0.973 was found. TTF results gave a maximum deviation of 3.8% and NPS results were comparable to imQuest.CONCLUSIONS: We developed a fully automated, open-source, robust method to quantify CAC on CT scans in a commercially available phantom. Also, the automated algorithm contains image quality assessment for fast comparison of differences in acquisition and reconstruction parameters.
View details for DOI 10.1002/mp.14912
View details for PubMedID 33932026
Performance Evaluation of Computed Tomography Systems: Summary of AAPM Task Group 233.
This paper provides a summary of Task Group Report 233 of the American Association of Physicists in Medicine (AAPM) on the performance evaluation of computed tomography (CT) systems. The report and this associated paper aim to complement existing and prior equipment performance testing guidelines by an enhanced focus on the operational performance of CT systems and further address more advanced aspects of current systems including iterative reconstruction and automatic exposure control (AEC). They provide detailed methods to assess the noise, resolution, and task-based performance of CT systems under varying reconstruction and tube current modulation conditions. The methods aim to offer a set of common testing procedures that can be utilized towards the optimal clinical utilization of CT imaging devices, benchmarking across varying systems and times, and a basis to develop future performance-based criteria for CT imaging. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/mp.13763
View details for PubMedID 31408540
Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations.
Journal of neurosurgery. Pediatrics
Children with intracranial arteriovenous malformations (AVMs) undergo digital DSA for lesion surveillance following their initial diagnosis. However, DSA carries risks of radiation exposure, particularly for the growing pediatric brain and over lifetime. The authors evaluated whether MRI enhanced with a blood pool ferumoxytol (Fe) contrast agent (Fe-MRI) can be used for surveillance of residual or recurrent AVMs.A retrospective cohort was assembled of children with an established AVM diagnosis who underwent surveillance by both DSA and 3-T Fe-MRI from 2014 to 2016. Two neuroradiologists blinded to the DSA results independently assessed Fe-enhanced T1-weighted spoiled gradient recalled acquisition in steady state (Fe-SPGR) scans and, if available, arterial spin labeling (ASL) perfusion scans for residual or recurrent AVMs. Diagnostic confidence was examined using a Likert scale. Sensitivity, specificity, and intermodality reliability were determined using DSA studies as the gold standard. Radiation exposure related to DSA was calculated as total dose area product (TDAP) and effective dose.Fifteen patients were included in this study (mean age 10 years, range 3-15 years). The mean time between the first surveillance DSA and Fe-MRI studies was 17 days (SD 47). Intermodality agreement was excellent between Fe-SPGR and DSA (κ = 1.00) but poor between ASL and DSA (κ = 0.53; 95% CI 0.18-0.89). The sensitivity and specificity for detecting residual AVMs using Fe-SPGR were 100% and 100%, and using ASL they were 72% and 100%, respectively. Radiologists reported overall high diagnostic confidence using Fe-SPGR. On average, patients received two surveillance DSA studies over the study period, which on average equated to a TDAP of 117.2 Gy×cm2 (95% CI 77.2-157.4 Gy×cm2) and an effective dose of 7.8 mSv (95% CI 4.4-8.8 mSv).Fe-MRI performed similarly to DSA for the surveillance of residual AVMs. Future multicenter studies could further investigate the efficacy of Fe-MRI as a noninvasive alternative to DSA for monitoring AVMs in children.
View details for DOI 10.3171/2019.5.PEDS1957
View details for PubMedID 31323627
Ultrafast pediatric chest computed tomography: comparison of free-breathing vs. breath-hold imaging with and without anesthesia in young children.
BACKGROUND: General anesthesia (GA) or sedation has been used to obtain good-quality motion-free breath-hold chest CT scans in young children; however pulmonary atelectasis is a common and problematic accompaniment that can confound diagnostic utility. Dual-source multidetector CT permits ultrafast high-pitch sub-second examinations, minimizing motion artifact and potentially eliminating the need for a breath-hold.OBJECTIVE: The purpose of this study was to evaluate the feasibility of free-breathing ultrafast pediatric chest CT without GA and to compare it with breath-hold and non-breath-hold CT with GA.MATERIALS AND METHODS: Young (≤3years old) pediatric outpatients scheduled for chest CT under GA were recruited into the study and scanned using one of three protocols: GA with intubation, lung recruitment and breath-hold; GA without breath-hold; and free-breathing CT without anesthesia. In all three protocols an ultrafast high-pitch CT technique was used. We evaluated CT images for overall image quality, presence of atelectasis and motion artifacts.RESULTS: We included 101 scans in the study. However the GA non-breath-hold technique was discontinued after 15 scans, when it became clear that atelectasis was a major issue despite diligent attempts to mitigate it. This technique was therefore not included in statistical evaluation (86 remaining patients). Overall image quality was higher (P=0.001) and motion artifacts were fewer (P<.001) for scans using the GA with intubation and recruitment technique compared to scans in the non-GA free-breathing group. However no significant differences were observed regarding the presence of atelectasis between these groups.CONCLUSION: We demonstrated that although overall image quality was best and motion artifact least with a GA-breath-hold intubation and recruitment technique, free-breathing ultrafast pediatric chest CT without anesthesia provides sufficient image quality for diagnostic purposes and can be successfully performed both without and with contrast agent in young infants.
View details for PubMedID 30413857
Improving Spatial Resolution at CT: Development, Benefits, and Pitfalls.
View details for PubMedID 29944083
Can image-domain filtering of FBP CT reconstructions match low-contrast performance of iterative reconstructions?
Proc. SPIE Medical Imaging 2018: Physics of Medical Imaging
View details for DOI 10.1117/12.2292599
AAPM medical physics practice guideline 6.a.: Performance characteristics of radiation dose index monitoring systems.
Journal of applied clinical medical physics
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: •Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. •Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
View details for DOI 10.1002/acm2.12089
View details for PubMedID 28497529
Reduced dose CT with model-based iterative reconstruction compared to standard dose CT of the chest, abdomen, and pelvis in oncology patients: intra-individual comparison study on image quality and lesion conspicuity.
To compare image quality and lesion conspicuity of reduced dose (RD) CT with model-based iterative reconstruction (MBIR) compared to standard dose (SD) CT in patients undergoing oncological follow-up imaging.Forty-four cancer patients who had a staging SD CT within 12 months were prospectively included to undergo a weight-based RD CT with MBIR. Radiation dose was recorded and tissue attenuation and image noise of four tissue types were measured. Reproducibility of target lesion size measurements of up to 5 target lesions per patient were analyzed. Subjective image quality was evaluated for three readers independently utilizing 4- or 5-point Likert scales.Median radiation dose reduction was 46% using RD CT (P < 0.01). Median image noise across all measured tissue types was lower (P < 0.01) in RD CT. Subjective image quality for RD CT was higher (P < 0.01) in regard to image noise and overall image quality; however, there was no statistically significant difference regarding image sharpness (P = 0.59). There were subjectively more artifacts on RD CT (P < 0.01). Lesion conspicuity was subjectively better in RD CT (P < 0.01). Repeated target lesion size measurements were highly reproducible both on SD CT (ICC = 0.987) and RD CT (ICC = 0.97).RD CT imaging with MBIR provides diagnostic imaging quality and comparable lesion conspicuity on follow-up exams while allowing dose reduction by a median of 46% compared to SD CT imaging.
View details for DOI 10.1007/s00261-017-1140-5
View details for PubMedID 28417170
How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach.
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging
To provide clinically useful gadolinium-free whole-body cancer staging of children and young adults with integrated positron emission tomography/magnetic resonance (PET/MR) imaging in less than 1 h.In this prospective clinical trial, 20 children and young adults (11-30 years old, 6 male, 14 female) with solid tumors underwent 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) PET/MR on a 3T PET/MR scanner after intravenous injection of ferumoxytol (5 mg Fe/kg) and [(18)F]FDG (2-3 MBq/kg). Time needed for patient preparation, PET/MR image acquisition, and data processing was compared before (n = 5) and after (n = 15) time-saving interventions, using a Wilcoxon test. The ferumoxytol-enhanced PET/MR images were compared with clinical standard staging tests regarding radiation exposure and tumor staging results, using Fisher's exact tests.Tailored workflows significantly reduced scan times from 36 to 24 min for head to mid thigh scans (p < 0.001). These streamlined PET/MR scans were obtained with significantly reduced radiation exposure (mean 3.4 mSv) compared to PET/CT with diagnostic CT (mean 13.1 mSv; p = 0.003). Using the iron supplement ferumoxytol "off label" as an MR contrast agent avoided gadolinium chelate administration. The ferumoxytol-enhanced PET/MR scans provided equal or superior tumor staging results compared to clinical standard tests in 17 out of 20 patients. Compared to PET/CT, PET/MR had comparable detection rates for pulmonary nodules with diameters of equal or greater than 5 mm (94 vs. 100 %), yet detected significantly fewer nodules with diameters of less than 5 mm (20 vs 100 %) (p = 0.03). [(18)F]FDG-avid nodules were detected with slightly higher sensitivity on the PET of the PET/MR compared to the PET of the PET/CT (59 vs 49 %).Our streamlined ferumoxytol-enhanced PET/MR protocol provided cancer staging of children and young adults in less than 1 h with equivalent or superior clinical information compared to clinical standard staging tests. The detection of small pulmonary nodules with PET/MR needs to be improved.
View details for PubMedID 28721605
Computed Tomography Angiography A Review and Technical Update
RADIOLOGIC CLINICS OF NORTH AMERICA
2016; 54 (1): 1-?
The principles of computed tomography angiography (CTA) remain the following with modern-day computed tomography (CT): high-resolution volumetric CT data acquisition, imaging at maximum contrast medium enhancement, and subsequent angiographic two- and three-dimensional visualization. One prerequisite for adapting CTA to ever evolving CT technology is understanding the principle rules of contrast medium enhancement. Four key rules of early arterial contrast dynamics can help one understand the relationship between intravenously injected contrast medium and the resulting time-dependent arterial enhancement. The technical evolution of CT has continued with many benefits for CT angiography. Well-informed adaptations of CTA principles allow for leveraging of these innovations for the benefit of patients with cardiovascular diseases.
View details for DOI 10.1016/j.rcl.2015.09.002
View details for Web of Science ID 000367215000002
View details for PubMedID 26654388
Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers.
JACC. Cardiovascular imaging
2015; 8 (8): 873-884
The purpose of this study was to evaluate whether radiation exposure from cardiac computed tomographic angiography (CTA) is associated with deoxyribonucleic acid (DNA) damage and whether damage leads to programmed cell death and activation of genes involved in apoptosis and DNA repair.Exposure to radiation from medical imaging has become a public health concern, but whether it causes significant cell damage remains unclear.We conducted a prospective cohort study in 67 patients undergoing cardiac CTA between January 2012 and December 2013 in 2 U.S. medical centers. Median blood radiation exposure was estimated using phantom dosimetry. Biomarkers of DNA damage and apoptosis were measured by flow cytometry, whole genome sequencing, and single cell polymerase chain reaction.The median dose length product was 1,535.3 mGy•cm (969.7 to 2,674.0 mGy•cm). The median radiation dose to the blood was 29.8 mSv (18.8 to 48.8 mSv). Median DNA damage increased 3.39% (1.29% to 8.04%, p < 0.0001) and median apoptosis increased 3.1-fold (1.4- to 5.1-fold, p < 0.0001) post-radiation. Whole genome sequencing revealed changes in the expression of 39 transcription factors involved in the regulation of apoptosis, cell cycle, and DNA repair. Genes involved in mediating apoptosis and DNA repair were significantly changed post-radiation, including DDB2 (1.9-fold [1.5- to 3.0-fold], p < 0.001), XRCC4 (3.0-fold [1.1- to 5.4-fold], p = 0.005), and BAX (1.6-fold [0.9- to 2.6-fold], p < 0.001). Exposure to radiation was associated with DNA damage (odds ratio [OR]: 1.8 [1.2 to 2.6], p = 0.003). DNA damage was associated with apoptosis (OR: 1.9 [1.2 to 5.1], p < 0.0001) and gene activation (OR: 2.8 [1.2 to 6.2], p = 0.002).Patients exposed to >7.5 mSv of radiation from cardiac CTA had evidence of DNA damage, which was associated with programmed cell death and activation of genes involved in apoptosis and DNA repair.
View details for DOI 10.1016/j.jcmg.2015.04.016
View details for PubMedID 26210695
Pediatric CT quality management and improvement program
2014; 44: 519-524
View details for DOI 10.1007/s00247-014-3039-4
View details for Web of Science ID 000343721300023
Use of Water Equivalent Diameter for Calculating Patient Size and Size-Specific Dose Estimates (SSDE) in CT: The Report of AAPM Task Group 220.
2014; 2014: 6-23
View details for PubMedID 27546949
View details for PubMedCentralID PMC4991550
Electronic Noise in CT Detectors: Impact on Image Noise and Artifacts
AMERICAN JOURNAL OF ROENTGENOLOGY
2013; 201 (4): W626-W632
The objective of our study was to evaluate in phantoms the differences in CT image noise and artifact level between two types of commercial CT detectors: one with distributed electronics (conventional) and one with integrated electronics intended to decrease system electronic noise.Cylindric water phantoms of 20, 30, and 40 cm in diameter were scanned using two CT scanners, one equipped with integrated detector electronics and one with distributed detector electronics. All other scanning parameters were identical. Scans were acquired at four tube potentials and 10 tube currents. Semianthropomorphic phantoms were scanned to mimic the shoulder and abdominal regions. Images of two patients were also selected to show the clinical values of the integrated detector.Reduction of image noise with the integrated detector depended on phantom size, tube potential, and tube current. Scans that had low detected signal had the greatest reductions in noise, up to 40% for a 30-cm phantom scanned using 80 kV. This noise reduction translated into up to 50% in dose reduction to achieve equivalent image noise. Streak artifacts through regions of high attenuation were reduced by up to 45% on scans obtained using the integrated detector. Patient images also showed superior image quality for the integrated detector.For the same applied radiation level, the use of integrated electronics in a CT detector showed a substantially reduced level of electronic noise, resulting in reductions in image noise and artifacts, compared with detectors having distributed electronics.
View details for DOI 10.2214/AJR.12.10234
View details for Web of Science ID 000324868000015
View details for PubMedID 24059402
Differentiation of Calcium Oxalate Monohydrate and Calcium Oxalate Dihydrate Stones Using Quantitative Morphological Information from Micro-Computerized and Clinical Computerized Tomography
JOURNAL OF UROLOGY
2013; 189 (6): 2350-2356
We differentiated calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones using micro and clinical computerized tomography images.A total of 22 calcium oxalate monohydrate and 15 calcium oxalate dihydrate human kidney stones were scanned using a commercial micro-computerized tomography scanner with a pixel size of 7 to 23 μm. Under an institutional review board approved protocol, image data on 10 calcium oxalate monohydrate and 9 calcium oxalate dihydrate stones greater than 5 mm were retrieved from a total of 80 patients who underwent clinical dual energy computerized tomography for clinical indications and had stones available for infrared spectroscopic compositional analysis. Micro and clinical computerized tomography images were processed using in-house software, which quantified stone surface morphology with curvature based calculations. A shape index was generated as a quantitative shape metric to differentiate calcium oxalate monohydrate from calcium oxalate dihydrate stones. Statistical tests were used to test the performance of the shape index.On micro-computerized tomography images the shape index of calcium oxalate monohydrate and calcium oxalate dihydrate stones significantly differed (ROC curve AUC 0.92, p <0.0001). At the optimal cutoff sensitivity was 0.93 and specificity was 0.91. On clinical computerized tomography images a significant morphological difference was also detected (p = 0.007). AUC, sensitivity and specificity were 0.90, 1 and 0.73, respectively.On micro and clinical computerized tomography images a morphological difference was detectable in calcium oxalate monohydrate and calcium oxalate dihydrate stones larger than 5 mm. The shape index is a highly promising method that can distinguish calcium oxalate monohydrate and calcium oxalate dihydrate stones with reasonable accuracy.
View details for DOI 10.1016/j.juro.2012.11.004
View details for Web of Science ID 000319985900107
View details for PubMedID 23142201
Urinary stone differentiation in patients with large body size using dual-energy dual-source computed tomography
2013; 23 (5): 1408-1414
To evaluate the ability of 100/Sn140 kV (Sn, tin filter) dual-energy computed tomography (CT) to differentiate urinary stone types in a patient cohort with a wide range of body sizes.Eighty human urinary stones were categorised into four groups (uric acid; cystine; struvite, oxalate and brushite together; and apatite) and imaged in 30-50-cm-wide water tanks using clinical 100/Sn140 kV protocols. The CT number ratio (CTR) between the low- and high-energy images was calculated. Thresholds for differentiating between stone groups were determined using receiver operating characteristics (ROC) analysis. Additionally, 86 stones from 66 patients were characterised using the size-adaptive CTR thresholds determined in the phantom study.In phantoms, the area under the ROC curve for differentiating between stone groups ranged from 0.71 to 1.00, depending on phantom size. In patients, body width ranged from 28.5 to 50.0 cm, and 79.1 % of stones were correctly characterised. Sensitivity and specificity for correctly identifying the stone category were 100 % and 100 % (group 1), 100 % and 95.3 % (group 2), 85.7 % and 60.9 % (group 3), and 52.6 % and 92.5 % (group 4).Dual-energy CT can provide in vivo urinary stone characterisation for patients over a wide range of body sizes.• Dual-energy CT helps assessment of urinary stone composition in vivo. • 100/Sn140 kV DECT differentiates among four stone types with 79.1 % accuracy. • In vivo diagnostic test achievable in patients with many body sizes.
View details for DOI 10.1007/s00330-012-2727-4
View details for Web of Science ID 000317427500032
View details for PubMedID 23263603
View details for PubMedCentralID PMC3780962
Pilot Study of Detection, Radiologist Confidence and Image Quality With Sinogram-Affirmed Iterative Reconstruction at Half-Routine Dose Level
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY
2013; 37 (2): 203-211
The objective of this study was to determine the effect of Sinogram-Affirmed Iterative Reconstruction (SAFIRE) on radiological detection, diagnostic confidence, and image quality at half-dose, contrast-enhanced abdominopelvic computed tomography.Forty dual-source examinations were reconstructed using routine-dose with filtered back projection, half-dose filtered back projection, and half-dose SAFIRE. Three radiologists detected lesions in abdominopelvic organs, reporting findings of potential medical significance, diagnostic confidence, and image quality.There was greater than 78% concordance between full- and half-dose images ± SAFIRE, and no difference in the detection of lesions within organs between half-dose images ± SAFIRE (P = 0.22 - 1.0). Detection of potentially important findings varied by reader, but not between dose/reconstruction methods. Diagnostic confidence varied widely (P < 0.001 to P > 0.91). Sinogram-Affirmed Iterative Reconstruction significantly improved image quality in the pelvis (P ≤ 0.04).Half-dose images ± SAFIRE had organ-specific detections similar to routine-dose images. Sinogram-Affirmed Iterative Reconstruction improved image quality in the pelvis, but diagnostic confidence and image quality scores in the abdomen depended on the reader.
View details for DOI 10.1097/RCT.0b013e31827e0e93
View details for Web of Science ID 000316337700012
View details for PubMedID 23493209
Characterisation of urinary stones in the presence of iodinated contrast medium using dual-energy CT: a phantom study
2012; 22 (12): 2589-2596
To develop a dual-energy CT (DECT) method for differentiating uric acid (UA) from non-UA stones in the presence of iodinated contrast medium.Thirty UA and 45 non-UA stones were selected after infra-red spectroscopic analysis and independently placed in a 1.5-ml vial, which was filled first with saline and then with increasing concentrations of iodine. For each condition, tubes were put in a 35-cm water phantom and examined using a dual-source CT system at 100 and 140 kV. Virtual unenhanced images created from CT data sets of the stones in iodine-containing solutions provided position and volume information. This map was used to calculate a CT number ratio to differentiate stone type. A region-growing method was developed to improve the ability to differentiate between UA and non-UA stones with iodinated contrast medium.The sensitivity for detecting UA stones was 100 % for unenhanced images but fell to 18 % with 20 mgI/ml iodine solution and 0 % for higher concentrations. With region growing, the sensitivity for detecting UA stones was increased to 100 %, 82 %, 57 %, 50 % and 21 % for iodine solutions of 20, 40, 60, 80 and 100 mgI/ml.The region-growing method improves differentiation of UA from non-UA stones on contrast-enhanced DECT urograms.Computed tomography is widely used to assess renal tract calculi. Dual-energy CT can assess stone composition and provide virtual unenhanced images. However, iodinated contrast medium affects the volume estimation for urinary stones. CTR of stones is altered by the surrounding iodine in CT urograms. The region-growing method improves the identification of uric acid stones.
View details for DOI 10.1007/s00330-012-2532-0
View details for Web of Science ID 000310590400004
View details for PubMedID 22865225
Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. Part I. Development and validation of methods using the CT image
2012; 39 (11): 6764-6771
For the purpose of size-specific dose estimation, information regarding patient attenuation is required. The purpose of this work is to describe a method for measuring patient attenuation and expressing the results in terms of a water cylinder, with cross sectional area A(w), which would absorb the same average dose as the irradiated patient. The ability to calculate A(w) directly from the CT image was validated with Monte Carlo simulations and an analytical model.A series of virtual cylinders were created with diameters ranging from 10 to 40 cm and lengths of 40 cm. The cylinders were given an atomic number equal to that of water; the density of the cylinders was varied from 0.26 to 1.2 g∕cm(3). The average dose to the cylinders from an axial scan at the longitudinal center position was calculated using Monte Carlo simulation and an analytical model. The relationship between phantom cross sectional area and calculated dose was determined for each density value to determine the dependence of A(w) on object attenuation. In addition, A(w) was estimated from the virtual CT images based on two derived models expressing the potential dependence of A(w) on object attenuation, one model assuming a linear dependence and the other assuming a quadratic dependence. Model results were compared with those from the Monte Carlo simulation and the analytical dose calculation approach. Virtual thorax and abdomen phantoms of adult and pediatric sizes were created, and A(w) was estimated using geometrical size parameters or the derived models. The accuracy of each approach for estimating A(w) was determined by comparing the average dose to the virtual phantom calculated using Monte Carlo simulation to the average dose to a water equivalent phantom of cross sectional area A(w).In the absence of a bowtie filter, both the Monte Carlo simulation and analytical model showed that (A(w)∕A) had a quadratic dependence on (μ∕μ(w)). However, including a bowtie filter in the Monte Carlo simulation altered the relationship, such that A(w)∕A was linearly dependent on μ∕μ(w). Using this relationship, the dose absorbed by a water cylinder of area A(w) agreed with the dose absorbed by adult and pediatric, thorax and abdomen phantoms to within 6% (mean difference = 0.5 ± 4.8%). Estimates of A(w) (or the water equivalent diameter D(w)) using only anterior-posterior and lateral phantom dimensions led to dose estimates that agreed with Monte Carlo-derived dose values within 3% and 6% for the abdomen adult and pediatric phantoms, respectively. However, because of density differences between lung and tissue, larger differences in dose relative to Monte Carlo-derived values were observed in the thorax adult and pediatric phantoms (15% and 11%, respectively) when only geometrical parameters were used to estimate D(w).Patient attenuation can be quantified in terms of the diameter of a water cylinder that absorbs same average dose as the irradiated cross section of the patient. The linear dependence of A(w) on object attenuation makes it straightforward to calculate A(w) from a CT image on most operator consoles or clinical workstations.
View details for DOI 10.1118/1.4754303
View details for Web of Science ID 000310726300024
View details for PubMedID 23127070
Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. Part II. Implementation on abdomen and thorax phantoms using cross sectional CT images and scanned projection radiograph images
2012; 39 (11): 6772-6778
To estimate attenuation using cross sectional CT images and scanned projection radiograph (SPR) images in a series of thorax and abdomen phantoms.Attenuation was quantified in terms of a water cylinder with cross sectional area of A(w) from both the CT and SPR images of abdomen and thorax phantoms, where A(w) is the area of a water cylinder that would absorb the same dose as the specified phantom. SPR and axial CT images were acquired using a dual-source CT scanner operated at 120 kV in single-source mode. To use the SPR image for estimating A(w), the pixel values of a SPR image were calibrated to physical water attenuation using a series of water phantoms. A(w) and the corresponding diameter D(w) were calculated using the derived attenuation-based methods (from either CT or SPR image). A(w) was also calculated using only geometrical dimensions of the phantoms (anterior-posterior and lateral dimensions or cross sectional area).For abdomen phantoms, the geometry-based and attenuation-based methods gave similar results for D(w). Using only geometric parameters, an overestimation of D(w) ranging from 4.3% to 21.5% was found for thorax phantoms. Results for D(w) using the CT image and SPR based methods agreed with each other within 4% on average in both thorax and abdomen phantoms.Either the cross sectional CT or SPR images can be used to estimate patient attenuation in CT. Both are more accurate than use of only geometrical information for the task of quantifying patient attenuation. The SPR based method requires calibration of SPR pixel values to physical water attenuation and this calibration would be best performed by the scanner manufacturer.
View details for DOI 10.1118/1.4757586
View details for Web of Science ID 000310726300025
View details for PubMedID 23127071
Kidney Stone Volume Estimation from Computerized Tomography Images Using a Model Based Method of Correcting for the Point Spread Function
JOURNAL OF UROLOGY
2012; 188 (3): 989-995
We propose a method to improve the accuracy of volume estimation of kidney stones from computerized tomography images.The proposed method consisted of 2 steps. A threshold equal to the average of the computerized tomography number of the object and the background was first applied to determine full width at half maximum volume. Correction factors were then applied, which were precalculated based on a model of a sphere and a 3-dimensional gaussian point spread function. The point spread function was measured in a computerized tomography scanner to represent the response of the scanner to a point-like object. Method accuracy was validated using 6 small cylindrical phantoms with 2 volumes of 21.87 and 99.9 mm(3), and 3 attenuations, respectively, and 76 kidney stones with a volume range of 6.3 to 317.4 mm(3). Volumes estimated by the proposed method were compared with full width at half maximum volumes.The proposed method was significantly more accurate than full width at half maximum volume (p <0.0001). The magnitude of improvement depended on stone volume with smaller stones benefiting more from the method. For kidney stones 10 to 20 mm(3) in volume the average improvement in accuracy was the greatest at 19.6%.The proposed method achieved significantly improved accuracy compared with threshold methods. This may lead to more accurate stone management.
View details for DOI 10.1016/j.juro.2012.04.098
View details for Web of Science ID 000307551200109
View details for PubMedID 22819107
Validation of Dual-Source Single-Tube Reconstruction as a Method to Obtain Half-Dose Images to Evaluate Radiation Dose and Noise Reduction: Phantom and Human Assessment Using CT Colonography and Sinogram-Affirmed Iterative Reconstruction (SAFIRE)
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY
2012; 36 (5): 560-569
To evaluate a method for obtaining half-dose CT images for observer studies evaluating lower-dose CT.Phantoms of varying sizes were scanned at multiple tube potentials using dose-matched dual-source (DS) and single-source (SS) protocols. Images from single-tube reconstruction of DS data were compared with SS images acquired at half-original CTDIvol. Thirty patients underwent supine SS and dose-matched prone DS CT colonography (CTC). Half-dose prone images were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Two radiologists scored image quality on 2-dimensional (2D) and 3D images.Image noise was similar between half-dose SS images and DS images reconstructed from one tube only with tube potential of 120 kV or more for phantoms 40 cm or smaller (P < 0.05). For both readers, the patients' CTC image quality scores were more than 84% concordant between SS or DS CTC images, and half-dose-prone CTC images with SAFIRE had 84% or more concordance with routine-dose CTC except for 3D image noise.In appropriately sized patients, DS acquisition with single-tube reconstruction can create half-dose images, permitting comparison to full-dose images. For CTC, there is comparable image quality for colonic evaluation between full-dose and half-dose images reconstructed with SAFIRE.
View details for DOI 10.1097/RCT.0b013e318263cc1b
View details for Web of Science ID 000309518100011
View details for PubMedID 22992607
Point/counterpoint.The use of bismuth breast shields for CT should be discouraged.
2012; 39 (5): 2321-2324
View details for DOI 10.1118/1.3681014
View details for PubMedID 22559601
Bismuth Shielding, Organ-based Tube Current Modulation, and Global Reduction of Tube Current for Dose Reduction to the Eye at Head CT
2012; 262 (1): 191-198
To compare the dose and image quality of three methods for reducing the radiation dose to the eye at head computed tomography (CT): bismuth shielding, organ-based tube current modulation (TCM), and global reduction of the tube current.An anthropomorphic head phantom was scanned under six conditions: (a) without any dose reduction techniques (reference scanning); (b) with one bismuth eye shield; (c) with organ-based TCM; (d) with reduced tube current to yield the same dose reduction as one bismuth shield; (e) with two layers of bismuth shields; and (f) with organ-based TCM and one bismuth shield. Dose to the eye, image noise, and CT numbers in the brain region were measured and compared. The effect of increasing distance between the bismuth shield and eye lens was also investigated.Relative to the reference scan, the dose to the eye was reduced by 26.4% with one bismuth shield, 30.4% with organ-based TCM, and 30.2% with a global reduction in tube current. A combination of organ-based TCM with one bismuth shield reduced the dose by 47.0%. Image noise in the brain region was slightly increased for all dose reduction methods. CT numbers were increased whenever the bismuth shield was used. Increasing the distance between the bismuth shield and the eye lens helped reduce CT number errors, but the increase in noise remained.Organ-based TCM provided superior image quality to that with bismuth shielding while similarly reducing dose to the eye. Simply reducing tube current globally by about 30% provides the same dose reduction to the eye as bismuth shielding; however, CT number accuracy is maintained and dose is reduced to all parts of the head.
View details for DOI 10.1148/radiol.11110470
View details for Web of Science ID 000298611500023
View details for PubMedID 22190658
Virtual monochromatic imaging in dual-source dual-energy CT: Radiation dose and image quality
2011; 38 (12): 6371-6379
To evaluate the image quality of virtual monochromatic images synthesized from dual-source dual-energy computed tomography (CT) in comparison with conventional polychromatic single-energy CT for the same radiation dose.In dual-energy CT, besides the material-specific information, one may also synthesize monochromatic images at different energies, which can be used for routine diagnosis similar to conventional polychromatic single-energy images. In this work, the authors assessed whether virtual monochromatic images generated from dual-source CT scanners had an image quality similar to that of polychromatic single-energy images for the same radiation dose. First, the authors provided a theoretical analysis of the optimal monochromatic energy for either the minimum noise level or the highest iodine contrast to noise ratio (CNR) for a given patient size and dose partitioning between the low- and high-energy scans. Second, the authors performed an experimental study on a dual-source CT scanner to evaluate the noise and iodine CNR in monochromatic images. A thoracic phantom with three sizes of attenuating rings was used to represent four adult sizes. For each phantom size, three dose partitionings between the low-energy (80 kV) and the high-energy (140 kV) scans were used in the dual-energy scan. Monochromatic images at eight energies (40 to 110 keV) were generated for each scan. Phantoms were also scanned at each of the four polychromatic single energy (80, 100, 120, and 140 kV) with the same radiation dose.The optimal virtual monochromatic energy depends on several factors: phantom size, partitioning of the radiation dose between low- and high-energy scans, and the image quality metrics to be optimized. With the increase of phantom size, the optimal monochromatic energy increased. With the increased percentage of radiation dose on the low energy scan, the optimal monochromatic energy decreased. When maximizing the iodine CNR in monochromatic images, the optimal energy was lower than that when minimizing noise level. When the total radiation dose was equally distributed between low and high energy in dual-energy scans, for minimum noise, the optimal energies were 68, 71, 74, and 77 keV for small, medium, large, and extra-large (xlarge) phantoms, respectively; for maximum iodine CNR, the optimal energies were 66, 68, 70, 72 keV. With the optimal monochromatic energy, the noise level was similar to and the CNR was better than that in a single-energy scan at 120 kV for the same radiation dose. Compared to an 80 kV scan, however, the iodine CNR in monochromatic images was lower for the small, medium, and large phantoms.In dual-source dual-energy CT, optimal virtual monochromatic energy depends on patient size, dose partitioning, and the image quality metric optimized. With the optimal monochromatic energy, the noise level was similar to and the iodine CNR was better than that in 120 kV images for the same radiation dose. Compared to single-energy 80 kV images, the iodine CNR in virtual monochromatic images was lower for small to large phantom sizes.
View details for DOI 10.1118/1.3658568
View details for Web of Science ID 000298250100006
View details for PubMedID 22149820
Bismuth Shields for CT Dose Reduction: Do They Help or Hurt?
JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY
2011; 8 (12): 878-879
View details for DOI 10.1016/j.jacr.2011.09.001
View details for Web of Science ID 000306202200017
View details for PubMedID 22137008
Quantification of iron in the presence of calcium with dual-energy computed tomography (DECT) in an ex vivo porcine plaque model
PHYSICS IN MEDICINE AND BIOLOGY
2011; 56 (22): 7305-7316
Iron deposits secondary to microbleeds often co-exist with calcium in coronary plaques. The purpose of this study was to quantify iron in the presence of calcium in an ex vivo porcine arterial plaque model using a clinical dual-energy CT (DECT) scanner. A material decomposition method to quantify the mass fractions of iron and calcium within a mixture using DECT was developed. Mixture solutions of known iron and calcium concentrations were prepared to calibrate and validate the DECT-based algorithm. Simulated plaques with co-existing iron and calcium were created by injecting the mixture solutions into the vessel wall of porcine carotid arteries and aortas. These vessel regions were harvested and scanned using a clinical DECT system and iron mass fraction was calculated for each sample. Iron- and calcium-specific staining was conducted on 5 µm thick histological sections of vessel samples to confirm the co-existence of iron and calcium in the simulated plaques. The proposed algorithm accurately quantified iron and calcium amounts in mixture solutions. Maps of iron mass fraction of 60 artery segments were obtained from CT images at two energies. The sensitivity for detecting the presence of iron was 83% and the specificity was 92% using a threshold at an iron mass fraction of 0.25%. Histological analysis confirmed the co-localization of iron and calcium within the simulated plaques. Iron quantification in the presence of calcium was feasible in excised arteries at an iron mass fraction of around 1.5% or higher using current clinical DECT scanners.
View details for DOI 10.1088/0031-9155/56/22/019
View details for Web of Science ID 000296768700023
View details for PubMedID 22036792
Radiation dose reduction to the breast in thoracic CT: Comparison of bismuth shielding, organ-based tube current modulation, and use of a globally decreased tube current
2011; 38 (11): 6084-6092
The purpose of this work was to evaluate dose performance and image quality in thoracic CT using three techniques to reduce dose to the breast: bismuth shielding, organ-based tube current modulation (TCM) and global tube current reduction.Semi-anthropomorphic thorax phantoms of four different sizes (15, 30, 35, and 40 cm lateral width) were used for dose measurement and image quality assessment. Four scans were performed on each phantom using 100 or 120 kV with a clinical CT scanner: (1) reference scan; (2) scan with bismuth breast shield of an appropriate thickness; (3) scan with organ-based TCM; and (4) scan with a global reduction in tube current chosen to match the dose reduction from bismuth shielding. Dose to the breast was measured with an ion chamber on the surface of the phantom. Image quality was evaluated by measuring the mean and standard deviation of CT numbers within the lung and heart regions.Compared to the reference scan, dose to the breast region was decreased by about 21% for the 15-cm phantom with a pediatric (2-ply) shield and by about 37% for the 30, 35, and 40-cm phantoms with adult (4-ply) shields. Organ-based TCM decreased the dose by 12% for the 15-cm phantom, and 34-39% for the 30, 35, and 40-cm phantoms. Global lowering of the tube current reduced breast dose by 23% for the 15-cm phantom and 39% for the 30, 35, and 40-cm phantoms. In phantoms of all four sizes, image noise was increased in both the lung and heart regions with bismuth shielding. No significant increase in noise was observed with organ-based TCM. Decreasing tube current globally led to similar noise increases as bismuth shielding. Streak and beam hardening artifacts, and a resulting artifactual increase in CT numbers, were observed for scans with bismuth shields, but not for organ-based TCM or global tube current reduction.Organ-based TCM produces dose reduction to the breast similar to that achieved with bismuth shielding for both pediatric and adult phantoms. However, organ-based TCM does not affect image noise or CT number accuracy, both of which are adversely affected by bismuth shielding. Alternatively, globally decreasing the tube current can produce the same dose reduction to the breast as bismuth shielding, with a similar noise increase, yet without the streak artifacts and CT number errors caused by the bismuth shields. Moreover, globally decreasing the tube current reduces the dose to all tissues scanned, not simply to the breast.
View details for DOI 10.1118/1.3651489
View details for Web of Science ID 000296534000029
View details for PubMedID 22047373
Noise reduction in spectral CT: Reducing dose and breaking the trade-off between image noise and energy bin selection
2011; 38 (9): 4946-4957
Our purpose was to reduce image noise in spectral CT by exploiting data redundancies in the energy domain to allow flexible selection of the number, width, and location of the energy bins.Using a variety of spectral CT imaging methods, conventional filtered backprojection (FBP) reconstructions were performed and resulting images were compared to those processed using a Local HighlY constrained backPRojection Reconstruction (HYPR-LR) algorithm. The mean and standard deviation of CT numbers were measured within regions of interest (ROIs), and results were compared between FBP and HYPR-LR. For these comparisons, the following spectral CT imaging methods were used:(i) numerical simulations based on a photon-counting, detector-based CT system, (ii) a photon-counting, detector-based micro CT system using rubidium and potassium chloride solutions, (iii) a commercial CT system equipped with integrating detectors utilizing tube potentials of 80, 100, 120, and 140 kV, and (iv) a clinical dual-energy CT examination. The effects of tube energy and energy bin width were evaluated appropriate to each CT system.The mean CT number in each ROI was unchanged between FBP and HYPR-LR images for each of the spectral CT imaging scenarios, irrespective of bin width or tube potential. However, image noise, as represented by the standard deviation of CT numbers in each ROI, was reduced by 36%-76%. In all scenarios, image noise after HYPR-LR algorithm was similar to that of composite images, which used all available photons. No difference in spatial resolution was observed between HYPR-LR processing and FBP. Dual energy patient data processed using HYPR-LR demonstrated reduced noise in the individual, low- and high-energy images, as well as in the material-specific basis images.Noise reduction can be accomplished for spectral CT by exploiting data redundancies in the energy domain. HYPR-LR is a robust method for reducing image noise in a variety of spectral CT imaging systems without losing spatial resolution or CT number accuracy. This method improves the flexibility to select energy bins in the manner that optimizes material identification and separation without paying the penalty of increased image noise or its corollary, increased patient dose.
View details for DOI 10.1118/1.3609097
View details for Web of Science ID 000294482900005
View details for PubMedID 21978039
Dose Reduction to Anterior Surfaces With Organ-Based Tube-Current Modulation: Evaluation of Performance in a Phantom Study
AMERICAN JOURNAL OF ROENTGENOLOGY
2011; 197 (3): 689-695
The purpose of this study was to evaluate in phantoms the dose reduction to anterior surfaces and image quality with organ-based tube-current modulation in head and thoracic CT.Organ-based tube-current modulation is designed to reduce radiation dose to superficial radiosensitive organs, such as the lens of the eye, thyroid, and breast, by decreasing the tube current when the tube passes closest to these organs. Dose and image quality were evaluated in phantoms for clinical head and thorax examination protocols with and without organ-based tube-current modulation. Surface dose reduction as a function of position was measured using a 32-cm CT dose index (CTDI) phantom, an anthropomorphic adult phantom, and ion chambers. Surface dose reduction as a function of patient size was investigated using three semianthropomorphic phantoms with posteroanterior dimensions of 14, 25, and 31 cm. Image noise (the SD of CT numbers in regions of interest) was evaluated for the anthropomorphic and the semianthropomorphic phantoms.For equivalent scanner output (volume CTDI), the dose to the midline of the anterior surface was reduced by 27-50%, depending on the anatomic region (head or thorax) and phantom size, and the dose to the posterior surface was correspondingly increased. Image noise was not significantly different between scans with and without organ-based tube-current modulation (p = 0.85).Organ-based tube-current modulation can reduce the dose to the anterior surface of patients without increasing image noise by commensurately increasing the dose to the posterior surface. This technique can reduce the dose to anterior radiosensitive organs for head and thoracic CT scans.
View details for DOI 10.2214/AJR.10.6061
View details for Web of Science ID 000294165600055
View details for PubMedID 21862813
CT scanner x-ray spectrum estimation from transmission measurements
2011; 38 (2): 993-997
In diagnostic CT imaging, multiple important applications depend on the knowledge of the x-ray spectrum, including Monte Carlo dose calculations and dual-energy material decomposition analysis. Due to the high photon flux involved, it is difficult to directly measure spectra from the x-ray tube of a CT scanner. One potential method for indirect measurement involves estimating the spectrum from transmission measurements. The expectation maximization (EM) method is an accurate and robust method to solve this problem. In this article, this method was evaluated in a commercial CT scanner.Two step-wedges (polycarbonate and aluminum) were used to produce different attenuation levels. Transmission measurements were performed on the scanner and the measured data from the scanner were exported to an external computer to calculate the spectra. The EM method was applied to solve the equations that represent the attenuation processes of polychromatic x-ray photons. Estimated spectra were compared to the spectra simulated using a software provided by the manufacturer of the scanner. To test the accuracy of the spectra, a verification experiment was performed using a phantom containing different depths of water. The measured transmission data were compared to the transmission values calculated using the estimated spectra.Spectra of 80, 100, 120, and 140 kVp from a dual-source CT scanner were estimated. The estimated and simulated spectra were well matched. The differences of mean energies were less than 1 keV. In the verification experiment, the measured and calculated transmission values were in excellent agreement.Spectrum estimation using transmission data and the EM method is a quantitatively accurate and robust technique to estimate the spectrum of a CT system. This method could benefit studies relying on accurate knowledge of the x-ray spectra from CT scanner.
View details for DOI 10.1118/1.3547718
View details for Web of Science ID 000286945000046
View details for PubMedID 21452736
MR Water Quantitative Priors Improves the Accuracy of Optical Breast Imaging
IEEE TRANSACTIONS ON MEDICAL IMAGING
2011; 30 (1): 159-168
Magnetic resonance (MR) guided optical breast imaging is a promising modality to improve the specificity of breast imaging, because it provides high-resolution quantitative maps of total hemoglobin, oxygen saturation, water content, and optical scattering. These properties have been shown to distinguish malignant from benign lesions. However, the optical detection hardware required for deep tissue imaging has poor spectral sensitivity which limits accurate water quantification; this reduces the accuracy of hemoglobin quantification. We present a methodology to improve optical quantification by utilizing the ability of Dixon MR imaging to quantitatively estimate water and fat; this technique effectively reduces optical crosstalk between water and oxyhemoglobin. The techniques described in this paper reduce hemoglobin quantification error by as much as 38%, as shown in a numerical phantom, and an experimental phantom. Error is reduced by as much 20% when imperfect MR water quantification is given. These techniques may also increase contrast between diseased and normal tissue, as shown in breast tissue in vivo. It is also shown that using these techniques may permit fewer wavelengths to be used with similar quantitative accuracy, enabling higher temporal resolution. In addition, it is shown that these techniques can improve the ability of MRI to quantify water in the presence of bias in the Dixon water/fat separation.
View details for DOI 10.1109/TMI.2010.2071394
View details for Web of Science ID 000285844900014
View details for PubMedID 20813635
View details for PubMedCentralID PMC3774063
The use of breast shielding for dose reduction in pediatric CT: arguments against the proposition
2010; 40 (11): 1744-1747
View details for DOI 10.1007/s00247-010-1808-2
View details for Web of Science ID 000282590000003
View details for PubMedID 20730422
In vivo quantitative imaging of normal and cancerous breast tissue using broadband diffuse optical tomography
2010; 37 (7): 3715-3724
A NIR tomography system that combines frequency domain (FD) and continuous wave (CW) measurements was used to image normal and malignant breast tissues.FD acquisitions were confined to wavelengths less than 850 nm because of detector limitations, whereas light from longer wavelengths (up to 948 nm) was measured in CW mode with CCD-coupled spectrometer detection. The two data sets were combined and processed in a single spectrally constrained reconstruction to map concentrations of hemoglobin, water, and lipid, as well as scattering parameters in the breast.Chromophore concentrations were imaged in the breasts of nine asymptomatic volunteers to evaluate their intrasubject and intersubject variability. Normal subject data showed physiologically expected trends. Images from three cancer patients indicate that the added CW data is critical to recovering the expected increases in water and decreases in lipid content within malignancies. Contrasts of 1.5 to twofold in hemoglobin and water values were found in cancers.In vivo breast imaging with instrumentation that combines FD and CW NIR data acquisition in a single spectral reconstruction produces more accurate hemoglobin, water, and lipid results relative to FD data alone.
View details for DOI 10.1118/1.3455702
View details for Web of Science ID 000279845300025
View details for PubMedID 20831079
Near-infrared tomography of breast cancer hemoglobin, water, lipid, and scattering using combined frequency domain and cw measurement
2010; 35 (1): 82-84
In this study, near-IR tomography was implemented in the wavelength range from 661 to 948 nm to characterize breast tumors in vivo. Frequency-domain measurements provide amplitude and phase transmitted at wavelengths below 850 nm, where photomultiplier tube detection is efficient. Continuous-wave detection at additional longer wavelengths (903, 912, and 948 nm) was collected using a CCD-based spectrometer. Phantom validation experiments showed improved accuracy in hemoglobin and water concentrations using this technique. Three women with malignant breast tumors were studied. The addition of cw data at longer wavelengths increased the recovered contrast of water in the tumor region relative to surrounding tissue and allowed quantification of lipid.
View details for Web of Science ID 000273877700028
View details for PubMedID 20664680
Differentiation of uric acid versus non-uric acid kidney stones in the presence of iodine using dual-energy CT
MEDICAL IMAGING 2010: PHYSICS OF MEDICAL IMAGING
View details for DOI 10.1117/12.845046
View details for Web of Science ID 000285047200125
- Broadband frequency-domain near-infrared spectral tomography using a mode-locked Ti:sapphire laser APPLIED OPTICS 2009; 48 (10): D198-D207
Wavelength band optimization in spectral near-infrared optical tomography improves accuracy while reducing data acquisition and computational burden
JOURNAL OF BIOMEDICAL OPTICS
2008; 13 (5): 054037
Multispectral near-infrared (NIR) tomographic imaging has the potential to provide information about molecules absorbing light in tissue, as well as subcellular structures scattering light, based on transmission measurements. However, the choice of possible wavelengths used is crucial for the accurate separation of these parameters, as well as for diminishing crosstalk between the contributing chromophores. While multispectral systems are often restricted by the wavelengths of laser diodes available, continuous-wave broadband systems exist that have the advantage of providing broadband NIR spectroscopy data, albeit without the benefit of the temporal data. In this work, the use of large spectral NIR datasets is analyzed, and an objective function to find optimal spectral ranges (windows) is examined. The optimally identified wavelength bands derived from this method are tested using both simulations and experimental data. It is found that the proposed method achieves images as qualitatively accurate as using the full spectrum, but improves crosstalk between parameters. Additionally, the judicious use of these spectral windows reduces the amount of data needed for full spectral tomographic imaging by 50%, therefore increasing computation time dramatically.
View details for DOI 10.1117/1.2976425
View details for Web of Science ID 000261764900046
View details for PubMedID 19021417
View details for PubMedCentralID PMC3801165
- Spectral tomography with diffuse near-infrared light: inclusion of broadband frequency domain spectral data JOURNAL OF BIOMEDICAL OPTICS 2008; 13 (4): 1-10
Image-guided diffuse optical fluorescence tomography implemented with Laplacian-type regularization
2007; 15 (7): 4066–82
A promising method to incorporate tissue structural information into the reconstruction of diffusion-based fluorescence imaging is introduced. The method regularizes the inversion problem with a Laplacian-type matrix, which inherently smoothes pre-defined tissue, but allows discontinuities between adjacent regions. The technique is most appropriately used when fluorescence tomography is combined with structural imaging systems. Phantom and simulation studies were used to illustrate significant improvements in quantitative imaging and linearity of response with the new algorithm. Images of an inclusion containing the fluorophore Lutetium Texaphyrin (Lutex) embedded in a cylindrical phantom are more accurate than in situations where no structural information is available, and edge artifacts which are normally prevalent were almost entirely suppressed. Most importantly, spatial priors provided a higher degree of sensitivity and accuracy to fluorophore concentration, though both techniques suffer from image bias caused by excitation signal leakage. The use of spatial priors becomes essential for accurate recovery of fluorophore distributions in complex tissue volumes. Simulation studies revealed an inability of the "no-priors" imaging algorithm to recover Lutex fluorescence yield in domains derived from T1 weighted images of a human breast. The same domains were reconstructed accurately to within 75% of the true values using prior knowledge of the internal tissue structure. This algorithmic approach will be implemented in an MR-coupled fluorescence spectroscopic tomography system, using the MR images for the structural template and the fluorescence data for region quantification.
View details for DOI 10.1364/OE.15.004066
View details for Web of Science ID 000245406400045
View details for PubMedID 19532650