Beam Computed Tomography Research Articles

The use of pencil ionization chamber with temporal readout capabilities to measure CT beam full width half maximum.

Measurement of Computed Tomography (CT) beam width is required by accrediting and regulating bodies for routine physics evaluations due to its direct correlation to patient dose. Current methods for performing CT beam width measurement require special hardware, software, and/or consumable films. Today, most 100-mm pencil chambers with a digital interface used to evaluate Computed Tomography Dose Index (CTDIvol) have a sufficiently high sampling rate to reconstruct a high-resolution dose profile for any acquisition mode. The goal of this study is to measure the CT beam width from the sampled dose profile under a single helical acquisition with the 100-mm pencil chamber used for CTDIvol measurements. The dose profiles for different scanners were measured for helical scans with varying collimation settings using a 100-mm pencil chamber placed at the isocenter and co-moving with the patient table. The measured dose profiles from the 100-mm pencil chamber were corrected for table attenuation by extracting a periodic correction function (PCF) to eliminate table interference. The corrected dose profiles were then deconvolved with the response function of the chamber to compute the beam profile. The beam width was defined by the full width half maximum (FWHM) of the resulting beam profile. Reference dose profiles were also measured using Gafchromic film for comparison. The beam widths, estimated using the innovative deconvolution method from the 100-mm pencil chamber, exhibit an average percentage difference of 1.6±1.8 when compared with measurements obtained through Gafchromic film for beam width assessment. The proposed approach to deconvolve the pencil chamber response demonstrates the potential of obtaining the CT beam width at high accuracy without the need of special hardware, software, or consumable films. This technique can improve workflow for routine performance evaluation of CT systems.

Interlaboratory comparison of two homemade pencil type ionization chambers

Computed tomography (CT) is a diagnostic exam responsible for the highest dose values received by the patients during the procedure. Over the years, this kind of equipment has been improved to ensure that the patients do not receive unnecessary doses. For this reason it is important to keep a quality control program for the CT equipment. To perform the dosimetry in CT beams, the instrument used is usually a pencil type ionization chamber with a sensitive volume length of 10 cm. However, this kind of detector is available with different sensitive volume lengths. The aim of this study was to compare the response of two homemade pencil type ionization chambers with sensitive volume lengths of 10 cm and 30 cm in the laboratories of Instituto de Pesquisas Energéticas e Nucleares (IPEN, Brazil) and National Physical Laboratory (NPL, UK). The characterization tests were performed, and the results obtained are within the international recommended limits. The only difference observed in the response of the two chambers in both laboratories is the fact that the ionization current obtained in all the tests at the IPEN is higher than at the NPL, because of the beam characteristics.

Radiological evaluation of an iodised hydrogel for prostate radiotherapy applications

PurposePhysical separation of healthy tissue and target volumes in prostate radiotherapy through the insertion of hydrogel can improve patient toxicity rates. An iodised hydrogel may provide anatomical separation of prostate and rectum while being easily visualised through radio-opacity. The aim of this study was to characterise SpaceOAR Vue™ in kilovoltage (kV) images and megavoltage (MV) radiotherapy treatment planning. MethodsTwo cassettes were 3D-printed, one filled with water and the other with SpaceOAR Vue™. Transmission dose through each cassette was measured in slab phantom geometry and compared for 6MV and 10MV photon energies. The SpaceOAR Vue™ slab phantom setup was simulated using computed tomography (CT) and a treatment plan created. The plan was calculated with the hydrogel segmented and material assignment set to water, and the resultant dose compared to corresponding measurement doses. The first 5 patients treated with SpaceOAR Vue™ were assessed with the volume and Hounsfield units (HU) of the hydrogel evaluated in CT and cone beam computed tomography (CBCT) imaging. ResultsTransmission through Water and SpaceOAR Vue™ agreed to within 0.5% for both photon energies. Furthermore, the segmentation of SpaceOAR Vue™ and material assignment to water, resulted in a plan dose that agreed to measurement to within 0.5%. Clinically, the SpaceOAR Vue™ volume and HU did not vary over patient treatment course, however was found to display differently on different kV imaging modalities. ConclusionsSpaceOAR Vue™ was found to be radio-opaque on kV images, but dosimetrically behaved similarly to water in MV treatment beams, making it suitable for clinical use.

Phantom-based Quality Assurance of a Clinical Dose Accumulation Technique Used in an Online Adaptive Radiation Therapy Platform

This study aimed to develop a routine quality assurance method for a dose accumulation technique provided by a radiation therapy platform for online treatment adaptation. Two commonly used phantoms were selected for the dose accumulation QA: Electron density and anthropomorphic pelvis. On a computed tomography (CT) scan of the electron density phantom, 1 target (gross tumor volume [GTV]; insert at 6 o'clock), a subvolume within this target, and 7 organs at risk (OARs; other inserts) were contoured in the treatment planning system (TPS). Two adaptation sessions were performed in which the GTV was recontoured, first at 7 o'clock and then at 5 o'clock. The accumulated dose was exported from the TPS after delivery. Deformable vector fields were also exported to manually accumulate doses for comparison. For the pelvis phantom, synthetic Gaussian deformations were applied to the planning CT image to simulate organ changes. Two single-fraction adaptive plans were created based on the deformed planning CT and cone beam CT images acquired onboard the radiation therapy platform. A manual dose accumulation was performed after delivery using the exported deformable vector fields for comparison with the system-generated result. All plans were successfully delivered, and the accumulated dose was both manually calculated and derived from the TPS. For the electron density phantom, the average mean dose differences in the GTV, boost volume, and OARs 1 to 7 were 0.0%, -0.2%, 92.0%, 78.4%, 1.8%, 1.9%, 0.0%, 0.0%, and 2.3%, respectively, between the manually summed and platform-accumulated doses. The gamma passing rates for the 3-dimensional dose comparison between the manually generated and TPS-provided dose accumulations were >99% for both phantoms. This study demonstrated agreement between manually obtained and TPS-generated accumulated doses in terms of both mean structure doses and local 3-dimensional dose distributions. Large disagreements were observed for OAR1 and OAR2 defined on the electron density phantom due to OARs having lower deformation priority over the target in addition to artificially large changes in position induced for these structures fraction-by-fraction. The tests applied in this study to a commercial platform provide a straightforward approach toward the development of routine quality assurance of dose accumulation in online adaptation.

Craniomaxillofacial trauma in immature dogs-etiology, treatments, and outcomes.

Treatment of craniomaxillofacial (CMF) trauma in dogs often requires a multidisciplinary approach and a thorough understanding of the CMF anatomical structures involved. This retrospective study aimed to utilize computed tomography (CT) studies of immature dogs evaluated for CMF trauma and to describe common fracture locations, treatment modalities, and complications, as well as the fracture healing outcomes. The medical records and CT studies of 94 dogs under 1 year of age over a 13-year period were evaluated. The skeletal location of CMF fractures, as well as the severity of displacement and fragmentation of each fracture, was recorded. Case demographic data and trauma etiology were also recorded. Animal bites accounted for the majority of trauma (71.0%). The most likely bone or region to be fractured was the maxillary bones, followed by the molar region of the mandibles. Up to 37 bones or specific regions were fractured in any given patient, with an average of 8.8 ± 3.1 fractured bones or regions per dog. Rostral mandibular trauma was associated with intra-articular fractures of the temporomandibular joint (p = 0.016). Patients sustained concomitant injuries in 32% of the cases. Muzzle therapy was the main treatment performed for most dogs (53.2%), followed by soft tissue closure (47.9%) and selective dental extractions (27.6%). Healing complications were recorded in 71.6% of the dogs, with malocclusion being the most reported complication (55.2%), and associated with dentate mandibular jaw fractures (p = 0.05). The average number of complications per dog was 2.4. No statistically significant association was found between treatment modality and healing outcome. There was a positive correlation between the severity of fracture fragmentation and displacement and a negative healing outcome (all rho >0.7). Further treatment was required in 55.6% of the dogs. Additional dental extractions were performed in 77.7% of patients. Healing complications were common in the immature CMF trauma case. Thus, the need for a comprehensive assessment of the entire CMF region during the initial visit, as well as follow-up, preferably using CT or cone beam CT, is underscored.

Calorimetry in Computed Tomography Beams.

A portable calorimeter for direct realization of absorbed dose in medical computed tomography (CT) procedures was constructed and tested in a positron emission tomography (PET) CT scanner. The calorimeter consists of two small thermistors embedded in a polystyrene (PS) cylindrical "core" (1.5 cm diameter) that can be inserted into a cylindrical high-density polyethylene (HDPE) phantom (30 cm diameter). The cylindrical design of core and phantom allows coaxial alignment of the system with the scanner rotation axis, which is necessary to minimize variations in dose that would otherwise occur as the X-ray source is rotated during scanning operations. The core can be replaced by a cylindrical ionization chamber for comparing dose measurement results. Measurements using the core and a calibrated thimble ionization chamber were carried out in a beam of 6 MV X-rays from a clinical accelerator and in 120 kV X-rays from a CT scanner. Doses obtained from the calorimeter and chamber in the 6 MV beam exhibited good agreement over a range of dose rates from 0.8 Gy/min to 4 Gy/min, with negligible excess heat. For the CT beam, as anticipated for these X-ray energies, the calorimeter response was complicated by excess heat from device components. Analyses done in the frequency domain and time domain indicated that excess heat increased calorimetric temperature rise by a factor of about 15. The calorimeter's response was dominated by dose to the thermistor, which contains high-atomic-number elements. Therefore, for future construction of calorimeters for CT beams, lower-atomic-number temperature sensors will be needed. These results serve as a guide for future alternative design of calorimeters toward a calorimetry absorbed dose standard for diagnostic CT.

Role of Radiology in Diagnosis of Temporomandibular Joint Disorders

The diagnosis and management of temporomandibular disorders (TMD) require both clinical andimaging examinations of the temporomandibular joint (TMJ). A variety of modalities can be used toimage the TMJ, including magnetic resonance imaging (MRI), computed tomography (CT), cone beamCT, ultrasonography, conventional radiography. The present review outlines the indications of the mostfrequently used imaging techniques in TMD diagnosis.Because of the anatomic complexity of the TMJ, imaging can be difficult. Choosing the properimaging technique is essential. Conventional radiography, nowadays, is of limited interest. The useof flat plane films for TMJ pathology is not sufficient, because this joint requires three dimensionalimaging views. Osseous changes are better visualized with CT and cone beam CT. Cone beam CTprovides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, withoutsuperimposition of the bony structures. MRI is a noninvasive technique, considered to be the goldstandard in imaging the soft tissue components of the TMJ. MRI is used to evaluate the articular disc interms of location and morphology. Moreover, the early signs of TMD and the presence of joint effusioncan be determined. High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imagingtechnique, which can be useful in diagnosing TMJ disc displacements. The diagnostic value of highresolutionultrasonography is strictly dependent on the examiner’s skills and on the equipment used.

Characterization of an Iodinated Rectal Spacer for Prostate Photon and Proton Radiation Therapy

PurposeConventional rectal spacers (nonI-SPs) are low-contrast on computed tomography (CT), often necessitating magnetic resonance imaging for accurate delineation. A new formulation of spacers (I-SPs) incorporates iodine to improve radiopacity and CT visualization. We characterized placement, stability, and plan quality of I-SPs compared to nonI-SPs. Methods and MaterialsPatients with intact prostate cancer (n = 50) treated with I-SPs and photons were compared to randomly selected patients (n = 50) with nonI-SPs (photon or proton therapy). The I-SP was contoured on the planning CT and cone beam CTs at 3 timepoints: first, middle, and final treatment (n = 200 scans). I-SPs Hounsfield units (HU), volume, surface area (SA), centroid position relative to prostate centroid, and distance between prostate/rectum centroids were compared on the planning CTs between each cohort. I-SP changes were evaluated on cone beam CTs over courses of treatment. Dosimetric evaluations of plan quality and robustness were performed. I-SP was tested in a phantom to characterize its relative linear stopping power for protons. ResultsI-SPs yielded a distinct visible contrast on planning CTs compared to nonI-SPs (HU 138 vs 12, P < .001), allowing delineation on CT alone. The delineated volume and SA of I-SPs were smaller than nonI-SPs (volume 8.9 vs 10.6 mL, P < .001; SA 28 vs 35 cm2, P < .001), yet relative spacer position and prostate-rectal separation were similar (P = .79). No significant change in HU, volume, SA, or relative position of the I-SPs hydrogel occurred over courses of treatment (all P > .1). Dosimetric analysis concluded there were no significant changes in plan quality or robustness for I-SPs compared to nonI-SPs. The I-SP relative linear stopping power was 1.018, necessitating HU override for proton planning. ConclusionsI-SPs provide a manifest CT contrast, allowing for delineation on planning CT alone with no magnetic resonance imaging necessary. I-SPs radiopacity, size, and relative position remained stable over courses of treatment from 28 to 44 fractions. No changes in plan quality or robustness were seen comparing I-SPs and nonI-SPs.

Performance comparison of an extrapolation chamber in computed tomography standard beams of two laboratories

The doses received by the patients during the computed tomography (CT) exams are the highest when compared to other diagnostic radiology procedures. This fact makes it so important to keep the quality control using the correct instrument. For dosimetry in CT, a pencil type ionization chamber is usually utilized with a sensitive volume length of 10 cm. A comparison of the performance of an extrapolation chamber in two different laboratories, at the Instrument Calibration Laboratory (LCI) from Instituto de Pesquisas Energéticas e Nucleares (IPEN, Brazil) and at the National Physical Laboratory (NPL, UK) was undertaken. Two chamber characteristics were determined (zero depth and extrapolation curve), and the main recommended characterization tests were performed (stabilization time, saturation curve, polarity effect, ion collection efficiency, linearity of response, and variation of response with source-detector distance). This extrapolation chamber was calibrated using the standard system of NPL laboratory, and the energy dependence was determined. The results obtained were within the international recommendations of IEC 61674, except for the energy dependence, as already expected. This study also established a reference system for the LCI of the IPEN, using a homemade extrapolation chamber for X-ray CT beams. Using the extrapolation curves obtained in the characterization tests and the correction factors of ionic recombination, and scattering and fluorescence, the air kerma rates were obtained, as a reference system in standard laboratory computed tomography beams. The last correction factor was obtained using computer simulations by the MCNP5 code (Monte Carlo). Moreover, two pencil type ionization chambers were calibrated using the replacement method in relation to the extrapolation chamber.

Dosimetric tests of an extrapolation chamber in standard computed tomography beams

Computed tomography (CT) diagnostic exams are responsible for the highest dose values to the patients. Therefore, the radiation doses in this procedure must be accurate. For the dosimetry of CT beams, the radiation detector is usually a pencil-type ionization chamber. This type of dosimeter presents a uniform response to the incident radiation beam from all angles, which makes it suitable for such equipment since the X-ray tube executes a circular movement around the table during irradiation. However, there is no primary standard system for this kind of radiation beam yet. In order to search for a CT primary standard, an extrapolation chamber built at the Calibration Laboratory (LCI) of the Instituto de Pesquisas Energéticas e Nucleares (IPEN) was tested. An extrapolation chamber is a parallel-plate ionization chamber that allows the variation of its sensitive air volume. This chamber was used previously for low-energy radiation beams and showed results within the international recommended limits. The aim of this work is to perform some characterization tests (saturation curve, polarity effect, ion collection efficiency and linearity of response) considering the chamber depth of 1.25 mm in the radiation qualities for computed tomography beams at the LCI. The results showed to be within the international recommended limits.

Comparison of two established 2D staging techniques to their appliance in 3D cone beam computer-tomography for dental age estimation

For medicolegal purposes, orthodontic or orthognathic treatment various stomatological staging technique for age estimation with appliance of conventional radiographic images have been published. It remains uninvestigated if cone beam computer-tomography delivers comparable staging results to the conventional radiographic stages of third molar analysis. We conducted a retrospective cross-sectional study of 312 patients aged 13–21 years. Dental age estimation staging technique, introduced by Nolla and Demirjian, were applied on the left lower third molar imaged by conventional panoramic radiographs and cone beam computer-tomography. It was investigated if 2D and 3D imaging presented different staging results for dental age estimation. In 21% the Demirjian’s staging differed by a single stage between 2 and 3D images. The greatest congruence (87%) between 2 and 3D images was revealed for stage 7 (G). In contrary, stage 5 (E) presented the lowest level of congruence with 47.4%. The categorization of Nolla revealed divergences in staging for than two categorical variables in Nolla’s stages 3, 4, 5 and 6. In general, the analysis of the data displayed the divergence for Nolla’s stages 4–8. The staging results for 2D and 3D imaging in accordance to the rules of Nolla and Demirjian showed significant differences. Individuals of 18 years may present immature third molars, thus merely an immature third molar cannot reject legal majority. Nolla’s and Demirjian’s 2D and 3D imaging present significantly different staging results.

Relationship of computed tomography–verified degenerative condylar morphology with temporomandibular joint disk displacement and sex

This study investigated the association of computed tomography (CT)-verified degenerative condylar changes with disk displacement (DD) and sex. Multidetector CT and cone beam CT scans of 165 condyles were evaluated for erosion, osteophyte formation, flattening, subcortical sclerosis, generalized sclerosis, subcortical defects, and loose joint bodies. Disk position was determined using magnetic resonance imaging. The association of degenerative alterations with disk position and sex was analyzed. The risks of erosion, osteophyte formation, and flattening were significantly increased by 3.72, 9.00, and 6.35 times, respectively, in the joints with DD without reduction (DDNR); however, the risks of these changes did not increase significantly in joints with DD with reduction. The risks of extensive erosion and slight and moderate osteophyte formation significantly increased only in the joints with DDNR. The degenerative changes were more likely to exist together in the joints with DDNR than in those with a normal disk position. The association of DD and most degenerative morphologies was not significantly influenced by sex. Erosion, osteophyte formation, and flattening were significantly associated with DDNR, regardless of sex.

Imaging-guided radiofrequency ablation of osteoid osteoma in typical and atypical sites: Long term follow up.

PurposeTo assess efficacy and safety of imaging-guided radiofrequency ablation (RFA) of Osteoid Osteoma (OO) in both typical and atypical sites.Methods and materialsBetween January 2014 and March 2019, 102 consecutive percutaneous RFA were performed and retrospectively reviewed. The procedures were performed using a RFA bipolar ablation system (Covidien, exposed tip of 0.7-1cm), under Computed Tomography (CT) guidance or using a navigation system (Masmec) under CT and Cone Beam CT (CBCT) guidance. Patients were followed up over 24 months. Clinical success and recurrences were considered on the base of established criteria. In patients with clinical failure and/or imaging evidence of relapse, retreatment was considered.ResultsAdministered power per-procedure was ≤8 W (mean temperature, 90°C). The pre-procedure average value of visual analog scale (VAS) was 8.33+/-0.91. Primary and secondary success rate 96.08% (98/102) and100% (102/102), respectively. No major complication was described. Technical success was proved in every patient by CT scan acquisition after needle positioning. Relapse and tumour location were significantly correlated (p-value = 0.0165). The mean dose-length product was 751.55 mGycm2. Advanced bone healing was noted in 68 lesions after 1y-follow up and in 86 lesions after 2y-follow up.ConclusionImaging-guided percutaneous RFA is a highly effective technique for OO, both in typical and atypical sites. CT or CBCT guidance, navigation systems and operator experience grant the technical success, which is the most crucial parameter affecting outcome.

Some characterization tests for an extrapolation chamber in CT standard beams in a specific chamber depth

The use of Computed Tomography (CT) for diagnostic images has been growing due to technological advances of this equipment. Therefore, there is a concern regarding the dose received by the patients undergoing this procedure, and this procedure needs to be performed with the highest precision and accuracy possible.The radiation detector used for CT beams is a pencil-type ionization chamber. However, there is no primary standard system for this kind of radiation beam. In this work a homemade extrapolation chamber was used to establish a CT primary standard [1]. This detector was tested for low-energy radiation beams and showing results within the internationally acceptable limits [2].This work had the objective to study the response stability of an extrapolation chamber, as well as obtaining the energy dependence and the angular dependence in standard CT beams of the Calibration Laboratory of IPEN (LCI).

Feasibility of 3D tracking and adaptation of VMAT based on VMAT-CT

BackgroundLocal computed tomography (CT) reconstruction is achievable with portal images acquired during volumetric-modulated arc therapy (VMAT) delivery and was named as VMAT-CT. However, the application of VMAT-CT is limited because it has limited field of view and no density information. In addition, the new generation of multi-leaf collimator with faster speed and various collimator angles used in patients’ plans could cause more artifacts in VMAT-CT. The goal of this study was to extend VMAT-CT concept, generate complete three-dimensional (3D) CT images, calculate new 3D dose, track and adapt VMAT plan based on updated images and dose. Materials and methodsVMAT-CT and planning CT of phantoms were fused by rigid or deformable registration to create VMAT-CT+ images. Trackings based on planning CT, VMAT-CT+, and cone beam CT (CBCT) were compared. When prescription dose was not met for planning target volume (PTV), re-planning was demonstrated on an in-house deformable phantom. Possible uncertainties were also evaluated. ResultsTracking based on VMAT-CT+ was accurate and superior to those based on planning CT and CBCT since VMAT-CT+ can detect changes during treatment. PTV coverage in the deformable phantom decreased after deformations but went up and met the prescription goal after re-planning. The impact of uncertainties on dose was minimal. Conclusion3D tracking and adaptation of VMAT based on VMAT-CT are feasible. Our study has the potential to increase the confidence of beam delivery, catch and remedy errors during VMAT.

Evaluation of an extrapolation chamber for dosimetry in computed tomography beams using Monte Carlo code (MCNP5)

Computed tomography (CT) is responsible for the highest dose values to the patients during the exams. Therefore, the radiation doses in this procedure must be accurate. However, there is no primary standard system for this kind of radiation beam yet. A homemade extrapolation ionization chamber was preliminary evaluated for the establishment of a CT beam primary standard. The aim of this study was to determine the influence that the various components of the extrapolation chamber may present on the energy deposited in its sensitive volume. Different materials for its collecting electrode were also studied for this type of radiation beam. The evaluation of the homemade extrapolation chamber showed the highest influence of 25.9% for the collecting electrode, and the best material for the collecting electrode for CT radiation beams was graphite.

Use of bismuth shield for protection of superficial radiosensitive organs in patients undergoing computed tomography: a literature review and meta-analysis.

The study aimed to assess the effect of bismuth (Bi) shielding on dose reduction and image quality in computed tomography (CT) through a literature review. A search was conducted in the following databases: Web of Science, PubMed, Google Scholar, and Scopus. Studies that reported estimated dose reduction with bismuth shielding during imaging of the eye, thyroid, and breast were included, and a meta-regression analysis was used to examine the influence of the CT scanner type on the dose reduction. The studies included a total of 237 patients and 34 pediatric and adult anthropomorphic phantoms for whom the radiation dose was reported. Bismuth shielding was recommended in 88.89% of the studies based on the maintenance of appropriate image quality under shielding. Noise associated with Bi shielding was 7.5%, 263%, and 23.5% for the eye, thyroid, and breast, respectively. The fixed-effects pooled estimate of dose reduction was 34% (95% CI: 13-55; p < 0.001) for the eye, 37% (95% CI 14-61; p < 0.001) for the thyroid, and 36% (95% CI 36-55; p < 0.001) for the breast. The image quality, usage of foams, CT scanner type, beam energies, and backscatter radiation were important factors that directly affected the efficacy of Bi shielding to reduce the radiation dose at the superficial radiosensitive organs.

Increasing organ dose accuracy through voxel phantom organ matching with individual patient anatomy

PurposeGiven the large use of computed tomography (CT) worldwide, the potential harmful effects and the radiation dose delivered to the patient have become high-interest topics among the scientific community. The main objective of this work was to modify existing three-dimensional (3D) voxel phantom models to resemble real patients as much as possible, thus trying to give a contribute towards the concept of a more personalized patient dosimetry. Moreover, comparisons were made of organ dose computed in the standard reference phantom and phantoms modified to match patient body size and organ size. This study focused essentially on one of the biggest and most radiosensitive organs in the thorax, the lungs. MethodsIn order to accomplish this objective a FORTRAN-based program was developed, which is able to semi-automatically modify the volumetric information of organs of interest in a standard voxel phantom (Female ICRP Adult Reference). Monte Carlo (MC) PENELOPE simulation code was used to mimic CT previews and, therefore, generate 2D projections, used for visual organ matching with clinical patient CT images, and calculate organ dose in both phantoms (ICRP standard and ICRP modified). Two CT scan irradiation setups were considered, namely Fan Beam CT (FBCT) and Cone Beam CT (CBCT) geometries. Validation of the implemented MC model (voxel phantom plus X-ray sources in diagnostic energy range) was accomplished through the calculation of lung-absorbed dose per fluence conversion coefficients for the Anterior-Posterior (AP) geometry setup with subsequent comparison with ICRP 116 tabulated values. ResultsThe main results reported that matching the voxel phantom's size and lungs provides organ dose values substantially different from the ones calculated in the ICRP reference phantom. According to the data presented in this study, organ dose can be up to 20% underestimated and 40% overestimated when compared to organ dose in the reference phantom, considering both irradiation setups. ConclusionsThis study demonstrates that voxel phantoms developed using single patient data could provide a better and more precise organ dose assessment by MC methods with respect to a standard phantom.

A Virtual Monochromatic Imaging Method for Spectral CT Based on Wasserstein Generative Adversarial Network With a Hybrid Loss

Spectral computed tomography (CT) has become a popular clinical diagnostic technique because of its unique advantage in material distinction. Specifically, it can perform virtual monochromatic imaging to obtain accurate tissue composition with less beam hardening artifacts. It is an ill-posed problem that monochromatic images are acquired by material decomposition matrix, suffering from amplified noise due to various uncertain factors. Aiming at modeling spatial and spectral correlations, this paper proposes a Wasserstein generative adversarial network with a hybrid loss (WGAN-HL) for monochromatic imaging instead of voxel-by-voxel decomposition. A min-max concept about the optimal transport is introduced in WGAN to make a tradeoff between generated images and target images where the authenticity of data cannot be distinguished anymore by network. The hybrid loss focuses on the data distribution of the generated images and target images from voxel space together with feature space to meet clinical requirements. Thereby, the proposed network can generate robust monochromatic images with accurate decomposition at any energy, while identifying and removing noise and artifacts. The advantages of this method are demonstrated in CT value measurement, beam hardening, and metal artifacts removal. Simulations and real tests prove that the WGAN-HL method preserves the important tissue details with less noise and it can reconstruct more accurate CT value. Both qualitative and quantitative comparisons show that the network is superior to other monochromatic imaging method.

Temporal Bone CT Scan for Malleal Ligaments Assessment.

To determine the feasibility of using temporal bone computed tomography (CT) scans to identify malleal ligaments and the prevalence of calcification in malleal ligaments. Retrospective case review. CT scans were blindly and retrospectively reviewed by two physicians (a radiologist and a nonradiologist). Scans differed by slice thickness, and included both conventional CT and cone beam CT (CBCT). Ambulatory tertiary referral center. One hundred fifty-one temporal bone CT scans, obtained between the years 2014 and 2017, were initially screened, which included 302 ears. Patients with previous tympanomastoid surgery or middle ear opacification were excluded, leaving 187 ears in the study. Diagnostic. Percentage of visible normal and calcified malleal ligaments. Scans with submillimeter slice thickness were more likely to demonstrate all three malleal ligaments than those with 1 ml and larger slices (83.7% versus 50.0% for nonradiologist, p < 0.0001; 59.6 versus 34.8% for radiologist, p < 0.0001). Calcification was seen in 11.8% of ears reviewed. The ability to detect malleal ligaments with cone beam CT was 86.2%, while the rate with conventional CT was 71.1%, a difference that persisted when controlling for slice thickness. Interobserver agreement for the detection of malleal ligaments was 65% with a Cohen's kappa coefficient of κ = 0.27. Visualization of the malleal ligaments using CT scans is feasible in a majority of aerated ears. Detection of malleal ligaments improves with thinner slice thickness and cone-beam technique. Low interobserver agreement suggests the importance of experience and a need for standardized review.