Scan Length Research Articles

IPEM topical report: the first UK survey of cone beam CT dose indices in radiotherapy verification imaging for adult patients

Cone beam CT is integral to most modern radiotherapy treatments. The application of daily and repeat CBCT imaging can lead to high imaging doses over a large volume of tissue that extends beyond the treatment site. Hence, it is important to ensure exposures are optimised to keep doses as low as reasonably achievable, whilst ensuring images are suitable for the clinical task. This IPEM topical report presents the results of the first UK survey of dose indices in radiotherapy CBCT. Dose measurements, as defined by the cone beam dose index (CBDIw), were collected along with protocol information for seven treatment sites. Where a range of optimised protocols were available in a centre, a sample of patient data demonstrating the variation in protocol use were requested. Protocol CBDIwvalues were determined from the average dosimetry data for each type of linear accelerator, and median CBDIwand scan length were calculated for each treatment site at each centre. Median CBDIwvalues were compared and summary statistics derived that enable the setting of national dose reference levels (DRLs). A total of 63 UK radiotherapy centres contributed data. The proposed CBDIwDRLs are; prostate 20.6 mGy, gynaecological 20.8 mGy, breast 5.0 mGy, 3D-lung 6.0 mGy, 4D-lung 11.8 mGy, brain 3.5 mGy and head/neck 4.2 mGy. However, large differences between models of imaging system were noted. Where centres had pro-active optimisation strategies in place, such as sized based protocols with selection criteria, dose reductions on the 'average' patient were possible compared with vendor defaults. Optimisation of scan length was noted in some clinical sites, with Elekta users tending to fit different collimators for prostate imaging (relatively short) compared with gynaecological treatments (longest). This contrasts with most Varian users who apply the default scan length in most cases.

Estimation of weighted computed tomography dose index (CTDIw) in megavoltage computed tomography (MVCT)

Abstract Introduction Advanced technologies in radiation treatment deliveries require high accuracy and precision in setup before treatment to get accurate dose delivery for planned target volumes. During imaging procedures, patients are getting extra doses from kilovoltage computed tomography (KVCT) and megavoltage computed tomography (MVCT). Computed tomography dose index is an important dosimetric parameter to know the degree of radiation-induced side effects. Aim The main aim of this study is to quantify the dose received by patients during MVCT imaging procedures, weighted computed tomography dose index (CTDIw), volume computed tomography dose index (CTDIvol) and dose length product (DLP). Methods and materials This study has been performed on Radixact X9 LINAC machine with 6MV flattening filter-free (FFF) photon beam for treatment and imaging with 3.5 MeV average photon energy. CTDIw and dose length product (DLP) have been calculated for different scanning lengths 18 cm, 10 cm and 0.7 cm with fine, normal and coarse modes with standard imaging A1SL1 ion chamber, cheese phantom and tomoelectrometer. Results CTDIw, CTDIvol, and DLP have been calculated with cheese phantom using A1SL1 ion chamber. CTDIw for 0.7 cm is 2.16 cGy, 1.14 cGy and 0.77 cGy for fine normal and coarse modes, respectively. Conclusion CTDIw is a dosimetric index to know the dose levels at center and periphery of patient according to scan length. It gives an idea about how much additional dose is received by the patient during the imaging procedures. High pitch gives the lesser absorbed dose. DLP gives the knowledge about stochastic effects from radiation to patients after MVCT.

Introduction and evaluation of size-specific DLP for radiation dose estimation in CT examinations.

The increased utilization of computed tomography (CT) has raised concerns about patient radiation exposure. Effective dose (ED), which requires precise estimation, is crucial for assessing and managing these risks. Traditional ED estimation methods, which are based on the dose-length product (DLP), often lack accuracy due to variations in patient size and anatomy. This study aims to evaluate the efficacy of size-specific DLP (SS-DLP), a novel metric that combines the size-specific dose estimate (SSDE) with scan length, to provide a more accurate estimation of radiation exposure from CT examinations. Focusing on adult chest-abdomen-pelvis (CAP) scans, we calculated SSDE and SS-DLP and utilized two simulation tools, Radimetrics and WAZA-ARI, for a detailed analysis. Our findings indicate that SS-DLP is highly correlated with EDs from Monte Carlo simulations, suggesting its reliability. Additionally, SS-DLP showed a moderate reduction in errors based on patient sex and body mass index compared to traditional DLP-based methods. Thus, SS-DLP offers a more accurate and personalized radiation exposure estimate, potentially enhancing patient safety.

Towards bespoke gas permeability by functionally graded structures in laser-based powder bed fusion of metals

Permeable, media transporting, components are an integral part in numerous technical applications. In gas turbines combustors, for example, gaseous oxidizer and fuel are transported separately into the burner, where they are injected and mixed, and subsequently combusted. The mixture homogeneity strongly affects the combustion performance and emissions formation and is, amongst other, determined by the spatial distribution of fuel injection ports. In this context, porous media provide the limiting case for a spatial distribution of media-injecting pores, yet is typically associated with a high pressure drop that yields a loss in efficiency. In this study, possibilities of achieving gas permeability in additively manufactured porous structures are investigated. The objective is to selectively functionalize the permeable layers for gaseous media supply with low pressure loss and, when needed, enable a targeted mixing of different gas streams. For this purpose, a laser-based powder bed fusion process (PBF-LB/M) was used in this study. It offers the opportunity to manufacture varying porosities inside complex monolithic metal parts. To produce the porous structures and to achieve gas permeability, the effect of scan rotation angle, hatch distance, build-up direction and length of the porous specimen is investigated. Due to the high temperatures present in combustion systems, the present work utilizes Inconel 718 material. The AM gas permeable specimen are experimentally characterized by means of surface topography, micro X-ray computed tomography (µXRCT) as well as flow and pressure loss test. The results show, that the AM process parameter provide effective control parameters to adjust the permeability. The strongest effect originates from the hatch distance for a given build-up direction. Depending on the scan rotation, the flow transitions from a turbulent pipe flow to a Darcy flow as present in conventional porous media. A structured alignment and connectivity of pores can be realized as evident in the µXRCT results, surface topography and the flow measurements. Residual powder, powder adhering to the pore walls and stochastic closure of pores or channels lead to deviations and need to be considered when designing respective parts. Nonetheless, the results further show that a directional dependence of the permeability and the build-up direction can be realized and controlled. Consequently, when considering the AM build-strategy in the design of components, this directed permeability can be functionalized in the generation of gas transporting and gas mixing layers separately by adjusting the AM processing parameter.

88 - Exploring the Effects of fMRI Scan Length on Brainstem Parcellations: Overactive Bladder Patients Versus Healthy Participants

88 - Exploring the Effects of fMRI Scan Length on Brainstem Parcellations: Overactive Bladder Patients Versus Healthy Participants

Artificial intelligence in diagnostic radiology for dose management : Advances and perspectives using the example of computed tomography

Imaging procedures employing ionizing radiation require compliance with European directives and national regulations in order to protect patients. Each exposure must be indicated, individually adapted, and documented. Unacceptable dose exceedances must be detected and reported. These tasks are time-consuming and require meticulous diligence. Computed tomography (CT) is the most important contributor to medical radiation exposure. Optimizing the patient's dose is therefore mandatory. Use of modern technology and reconstruction algorithms already reduces exposure. Checking the indication, planning, and performing the examination are further important process steps with regard to radiation protection. Patient exposure is usually monitored by dose management systems (DMS). In special cases, arisk assessment is required by calculating the organ doses. Artificial intelligence (AI)-assisted techniques are increasingly used in various steps of the process: they support examination planning, improve patient positioning, and enable automated scan length adjustments. They also provide real-time estimates of individual organ doses. The integration of AI into medical imaging is proving successful in terms of dose optimization in various areas of the radiological workflow, from reconstruction to examination planning and performing exams. However, the use of AI in conjunction with DMS has not yet been considered on alarge scale. AI processes offer promising tools to support dose management. However, their implementation in the clinical setting requires further research, extensive validation, and continuous monitoring.

Reproducibility of [18F]MK-6240 kinetics in brain studies with shortened dynamic PET protocol in healthy/cognitively normal subjects

Background[18F]MK-6240 is a neurofibrillary tangles PET radiotracer that has been broadly used in aging and Alzheimer’s disease (AD) studies. Majority of [18F]MK-6240 PET studies use dynamic acquisitions longer than 60 min to assess the tracer kinetic parameters. As of today, no consensus has been established on the optimum dynamic PET scan time. In this study, we assess the reproducibility of [18F]MK-6240 quantitative metrics using shortest dynamic PET protocols in cognitively normal subjects. PET metrics were measured through two-tissue compartment model (2TCM) and Logan model to estimate VT and DVR, as well as SUVR from 90 to 120 min (SUVR90 − 120 min) post-tracer injection for brain regions. 2TCM was carried out using the 120 min dynamic coffee break dataset (first scan from 0 to 60 min p.i., second scan from 90 to 120 min p.i.) and then repeated after stepwise shortening it by 5 min. The dynamic scan length that reproduced the 120 min dynamic scans-based VT to within 10% error was defined as the shortest acquisition time (SAT). The SAT SUVR90 − 120 min was deduced from the SAT dataset by extrapolation of each image pixel time-activity curve to 120 min. The reproducibility of the 120 min dynamic scans-based VT2TCM, DVR2TCM, DVRLogan, and SUVR using the SAT was assessed using Passing-Bablock analysis. The limits of reproducibility of each PET metrics were determined using Bland-Altman analysis.ResultsA dynamic SAT of 40 min yielded < 10% error in [18F]MK-6240 VT2TCM’s for all brain regions, compared to those measured using the 120 min datasets. SAT-based analysis did not show statistically significant systemic or proportional biases in VT2TCM, DVR2TCM, DVRLogan, or SUVR compared to those deduced from the full dynamic dataset of 120 min. A mean difference between the 120 min- and SAT-based analysis of less than 4%, 10%, 15%, and 20% existed in the VT2TCM, DVR2TCM, DVRLogan, and SUVR respectively.ConclusionKinetic modeling of [18F]MK-6240 PET can be accurately performed using dynamic scan times as short as 40 min. This can facilitate studies with [18F]MK-6240 PET and improve patients accrual. Further work would be necessary to confirm the reproducibility of these results for patients in dementia spectra.

Child life specialists predict successful MRI scanning in unsedated children 4 to 12years old.

It can be challenging for children to cooperate for a magnetic resonance imaging (MRI) exam. General anesthesia is often used to ensure a high-quality image. When determining the need for general anesthesia, many institutions use a simple age cutoff. Decisions on the necessity for anesthesia are often left to schedulers who lack training on determination of patient compliance. The study aimed to evaluate whether screening questions administered by certified child life specialists (CCLS) could successfully predict which children could complete an MRI without sedation. This is a retrospective, institutional review board approved study. Data was collected as part of a quality improvement program, where a CCLS screened 4- to 12-year-old children scheduled for MRI scanning using a questionnaire. Parent responses to the screening questions, CCLS's recommendation for scheduling the MRI awake, start and end time for the MRI scan, and scan success were recorded. A predictive model for the CCLS's recommendation was developed using the child's age, estimated scan length, scan difficulty, and the parent's responses to the screening questions. The primary outcome measure was a successfully completed MRI not requiring additional imaging under anesthesia. Of the 403 screened children, 317 (79%) were recommended to attempt the MRI without anesthesia. The median age of participants was 7 (IQR 4-17) years. Overall, 309 of 317 (97.5%) participants, recommended by the CCLS for the program, met the primary outcome of successful MRI completion on their first attempt. The multivariable regression model which included clinical information about the child's age, estimated scan length, scan difficulty, and four of the six parent screening questions had excellent performance (area under the curve = 0.89). Information collected by the CCLS via screening along with the child's age, the estimated scan length, and difficulty can help predict which children are likely to successfully complete a non-sedate MRI.

3D Landmark scout imaging accurately assesses presence and extent of coronary calcification with lower radiation exposure

BackgroundCardiac CT for coronary artery calcium (CAC) scoring exposes patients to 1 ​mSv of radiation. A new CT scout method utilizing ultra-low dose CT (3D Landmark) offers tomographic cross-sectional imaging, which provides axial images from which CAC can be estimated. The purpose of our study is to analyze the association between estimated CAC burden on 3D Landmark scout imaging vs dedicated ECG-gated CACS. MethodsConsecutive patients over a 9-month period undergoing non-contrast ECG-gated CACS planned with 3D Landmark scout imaging were included. Extent of CAC on 3D Landmark scout imaging was scored from 0 to 3 (none, mild, moderate, severe). Agatston CACS was converted to an ordinal score from 0 to 3, corresponding to absent (0), mild (1–99), moderate (100–400), or severe (>400). Fischer's exact test, weighted kappa coefficient, and paired t-tests were used for analysis. ResultsOf 150 patients, 51.3% were female with mean age 49.0 ​± ​16.8 and BMI 28.6 ​± ​12.3. Sensitivity of 3D Landmark in identifying calcium was 96.2%, with specificity of 100%. There was strong interrater agreement between 3D Landmark calcium scoring and CACS, with weighted kappa coefficient 0.97 ​± ​0.01(CI 0.95–0.99).Radiation dose-length-product was significantly lower for 3D Landmark imaging vs. dedicated ECG-gated CACS (9.7 ​± ​3.6 vs 43.8 ​± ​26.4 ​mGy ​cm, p ​< ​0.001) despite longer scan length (465.0 ​± ​160.8 vs 123.0 ​± ​12.7 ​mm, respectively). ConclusionEstimated coronary artery calcium on 3D Landmark scout images correlates strongly with Agatston CACS, demonstrating utility in assessing cardiovascular risk without introducing additional radiation or costs.

Stacking models of brain dynamics to improve prediction of subject traits in fMRI

Abstract Beyond structural and time-averaged functional connectivity brain measures, modelling the way brain activity dynamically unfolds can add important information to our understanding and characterisation of individual cognitive traits. One approach to leveraging this information is to extract features from models of brain network dynamics to predict individual traits. However, these predictions are susceptible to variability due to factors such as variation in model estimation induced by the choice of hyperparameters. We suggest that, rather than merely being statistical noise, this variability may be useful in providing complementary information that can be leveraged to improve prediction accuracy. To leverage this variability, we propose the use of stacking, a prediction-driven approach for model selection. Specifically, we combine predictions developed from multiple hidden Markov models—a probabilistic generative model of network dynamics that identifies recurring patterns of brain activity—to demonstrate that stacking can slightly improve the accuracy and robustness of cognitive trait predictions. By comparing analysis from the Human Connectome Project and UK Biobank datasets, we show that stacking is relatively effective at improving prediction accuracy and robustness when there are enough subjects, and that the effectiveness of combining predictions from static and dynamic functional connectivity approaches depends on the length of scan per subject. We also show that the effectiveness of stacking predictions is driven by the accuracy and diversity in the underlying model estimations.

Thermokinetics driven microstructure and phase evolution in laser-based additive manufacturing of Ti-25wt.%Nb and its performance in physiological solution

A bio-compatible Ti-25 wt% Nb alloy fabricated from a blend of pure elemental powders using laser powder bed fusion additive manufacturing technique. The present work investigated the effects of processing conditions on the evolution of microstructures and its consequential material attributes, such as mechanical properties and corrosion performance. Thermal management strategies comprising laser powers of 200 W and 300 W in complement with a shorter scan length (1 mm) and substrate preheating above β-transus temperature (1123 K) were considered to achieve complete dissolution of niobium particles. The microstructure in the 200 W sample showed thin α′′ martensite needles in β matrix while martensite laths in the 300 W condition appear coarse and were twice the area fraction compared to that in 200 W build. On the other hand, microstructures in the heated substrate sample exhibited the evolution of α and β phases. A multi-scale finite element method based thermo-kinetic model spanning from melt pool scale to the component scale was incorporated to understand the mechanism of the evolution of microstructures during liquid–solid and solid–solid state transformation. Electrochemical performance in the simulated body fluid of the printed alloys was found to be significantly affected by the presence of martensite fractions. Both mechanical and corrosion behaviors were favorably influenced by adoption of the substrate preheating during additive manufacturing due to promotion of diffusional transformation of β to α at the expense of martensitic transformation.

Dose assessment in petrous bone CT: Effect of tube current modulation and scan length

The aim of this study is to compare the dosimetric performance of two CT acquisition protocols for the petrous bone: a standard fixed mAs protocol and a protocol using tube current modulation (TCM). By analyzing the scan length, dose-length product (DLP) and effective dose (ED) obtained with each protocol, we investigate whether TCM offers an advantage in terms of dose reduction while maintaining comparable image quality. To this end, 249 patients (women: 52%; men: 48%) were included in this study. The first center used TCM (120 kVp, 150 mA reference) for image acquisition, while the other centers opted for fixed mAs values. Acceptability of image quality was assessed using a standardized phantom (model 610 AAPM) by measuring noise uniformity and accuracy, contrast-to-noise ratio (CNR) and spatial resolution. The CTDIvol was not significantly different between center A and the other centers (p > 0.05), while DLP and ED were significantly different (p < 0.001), being reduced by a factor of 2 and 2.23 for scan length. We concluded that a scan with a 14.28% decrease in tube voltage from 140 kVp (136–170–210) mAs fixed to 120 kVp with TCM to 150 mA reference in helical scan mode can be recommended as an optimized protocol during CT examination of petrous bone while reducing DLP and ED to 50% without loss of diagnostic accuracy.

The Effect of Scan Length on Effective Dose in Emergency Brain CT Scans in Pediatric Patients

The Effect of Scan Length on Effective Dose in Emergency Brain CT Scans in Pediatric Patients

Reliability of variability and complexity measures for task and task-free BOLD fMRI.

Brain activity continuously fluctuates over time, even if the brain is in controlled (e.g., experimentally induced) states. Recent years have seen an increasing interest in understanding the complexity of these temporal variations, for example with respect to developmental changes in brain function or between-person differences in healthy and clinical populations. However, the psychometric reliability of brain signal variability and complexity measures-which is an important precondition for robust individual differences as well as longitudinal research-is not yet sufficiently studied. We examined reliability (split-half correlations) and test-retest correlations for task-free (resting-state) BOLD fMRI as well as split-half correlations for seven functional task data sets from the Human Connectome Project to evaluate their reliability. We observed good to excellent split-half reliability for temporal variability measures derived from rest and task fMRI activation time series (standard deviation, mean absolute successive difference, mean squared successive difference), and moderate test-retest correlations for the same variability measures under rest conditions. Brain signal complexity estimates (several entropy and dimensionality measures) showed moderate to good reliabilities under both, rest and task activation conditions. We calculated the same measures also for time-resolved (dynamic) functional connectivity time series and observed moderate to good reliabilities for variability measures, but poor reliabilities for complexity measures derived from functional connectivity time series. Global (i.e., mean across cortical regions) measures tended to show higher reliability than region-specific variability or complexity estimates. Larger subcortical regions showed similar reliability as cortical regions, but small regions showed lower reliability, especially for complexity measures. Lastly, we also show that reliability scores are only minorly dependent on differences in scan length and replicate our results across different parcellation and denoising strategies. These results suggest that the variability and complexity of BOLD activation time series are robust measures well-suited for individual differences research. Temporal variability of global functional connectivity over time provides an important novel approach to robustly quantifying the dynamics of brain function. PRACTITIONER POINTS: Variability and complexity measures of BOLD activation show good split-half reliability and moderate test-retest reliability. Measures of variability of global functional connectivity over time can robustly quantify neural dynamics. Length of fMRI data has only a minor effect on reliability.

Estimating Effective Diameter and Scan Length of Abdomen and Pelvis for Radiation Dose Optimization in Computed Tomography Imaging Suitable for the Indian Population – A Preliminary Study

Abstract Background: Utilization of computed tomography (CT) has dramatically increased during the last decade with a concurrent increase in exposure to ionizing radiation. Even low levels of exposure have been linked to the development of cancer. Various dose reduction and optimization techniques have been attempted to minimize the risk. Dose optimization becomes crucial when scanning thin and small-built individuals, particularly children. Reference phantoms of European or North American descent are used to develop radiological protocols. CT dose index (CTDI) metrics like scan length, volume CTDI, and dose-length product help to measure the amount of radiation dose received by patients during CT scans. Methodolgy: We studied the anatomical dimensions of the CT abdomen and pelvis from the topographic and tomographic images using the standard bony landmarks in 340 children and 500 adults (F = 250, M = 250) and. Cross-sectional measurements and effective diameter were also used to generate CT phantom models. Results: Using measured variables, phantom models have been generated in different age groups in children and adults representative of the Indian population showing a significant increase in dimensions from pediatric to adult phantom. Dimensions vary from classic reference phantoms of European or North American descent. Conclusion: Diagnostic reference levels must be adjusted according to the age of the patient, size of organs, or surface area of examination as body proportions vary between age groups, sex, and race. Data from this study can be used to generate the age- and sex-specific preset protocols for dose optimization in the adult Indian and pediatric population to minimize exposure risk, particularly in young children.

Simultaneous sealing and bisection of porcine renal blood vessels, ex vivo, using a continuous-wave, infrared diode laser at 1470 nm

Electrosurgical and ultrasonic devices are used in surgical procedures for hemostatic sealing and bisection of vascular tissues. Previous benchtop studies alternatively demonstrated successful infrared laser sealing and cutting of blood vessels, in a sequential, two-step approach. This study describes a smaller, laparoscopic device compatible design, and simultaneous approach to sealing and bisection of vessels, with potential optical feedback. A 1470-nm infrared diode laser sealed and bisected 40 porcine renal arteries, ex vivo. A reciprocating, side-firing, optical fiber, housed in a transparent square quartz optical chamber (2.7 × 2.7 × 25 mm outer dimensions), delivered laser energy over an 11 mm scan length, with a range of incident powers (41–59 W) and treatment times (5–21 s). Vessel diameters ranged from 2.5 to 4.8 mm. Vessel burst pressure measurements were performed on each cut end (n = 80) with success indicated by pressures exceeding 360 mmHg. All vessel ends were successfully sealed and bisected (80/80). The highest incident power, 59 W, yielded short treatment times of 5–6 s. Peak temperatures on the external chamber surface reached 103 oC. Time to cool down to body temperature measured 37 s. Infrared lasers simultaneously seal and bisect blood vessels, with treatment times comparable to, and temperatures and cooling times lower than reported for conventional devices. Future work will focus on integrating the fiber and chamber into a standard 5-mm-outer-diameter laparoscopic device. Customization of fiber scan length to match vessel size may also reduce laser energy deposition, enabling lower peak temperatures, treatment times, and cooling times.

Relationship between assistant’s lens exposure and dose information during computed tomography examinations

According to International Commission of Radiological Protection, the equivalent dose limit for the eye lens for occupational exposure is recommended to be 20 mSv yr−1, averaged over 5 years, with no single year above 50 mSv. Some studies reported the measurement of assistant’s lens exposure in diagnostic computed tomography (CT) examinations, but further investigation is still required in the association between the lens dose for assistants and various dose parameters. Therefore, we measured the assistant’s lens exposure using small optically stimulated luminescence dosimeters. The type of occupation, type of assistance, total scan time, total mAs, total scan length, and dose-length product (DLP) were recorded and analyzed in association with air kerma at the lens position. The assistance was classified into four types: ‘assisted ventilation,’ ‘head holding,’ ‘body holding,’ and ‘raising patient’s arm.’ The air kerma of lens position was not significantly different for each assistance type (p < 0.05, Kruskal–Wallis test). Further, the lens doses for assistants correlated with DLP, but with various strengths of correlation with the assistance type and were influenced by the distance from the CT gantry. In conclusion, lens dose during assistance and DLP demonstrated the strongest correlation. ‘Raising patient’s arm’ and ‘head holding’ exhibited stronger correlations, which required less table movement during the CT scan than ‘assisted ventilation’ and ‘body holding’.

Size matters: Exploring part size effects on microstructure, defects, and mechanical property in optimized laser powder bed fusion (L-PBF) additive manufacturing

In laser-based metal additive manufacturing (MAM), effective process optimization requires a thorough analysis of variations across the process window. Despite the common practice of utilizing small-sized coupons to optimize process parameters in laser-based MAM, this study challenges this convention. Through an analysis of microstructure and defect differences in Fe-Ni material parts produced via laser-powder bed fusion (L-PBF), the study reveals significant discrepancies in microstructure, defect and mechanical property based on part size. As part size increases, lack-of-fusion defects and cracks become more pronounced, resulting in a decrease in density from 8.11 g/cm3 to 8.02 g/cm3, leading to constrained grain growth with a decrease of grain size from 41.88 μm to 23.07 μm in the scanning plane. Each defect and microstructural difference was traced back to variations in thermal history based on part size. Finite element method simulations, highlighting differences in thermal history from scanning a single layer to the entire part, showed that an increase in scan length with a widened scan area enlarged the period of the thermal history cycle, leading to considerable cooling. This study underscores crucial considerations for future researchers engaged in process optimization for novel alloy systems using laser-based MAM processes.

Biological and Methodological Variability in Retinal Nerve Fiber Layer OCT: The Framingham Heart Study

ObjectiveTo explore participant-level biological attributes and scan-level methodological attributes associated with retinal nerve fiber layer (RNFL) thickness variability in a population-based sample of elderly United States adults. DesignCross-sectional analysis using data from the Framingham Heart Study. Participants1,347 eyes from 825 participants with at least one optical coherence tomography (OCT) scan and axial length data were included. MethodsThree or more successive RNFL scans of each eye of each participant were obtained in a single session. Multivariable linear mixed models were employed to explore the associations between average RNFL thickness with participant-level biological attributes (age, gender, race, ethnicity, and axial length) and scan-level attributes (signal strength [SS]) as independent variables in the whole population as well as a sub-sample of adults with no self-reported history of glaucoma. Similar analyses were designed to assess methodological variability with average within-eye standard deviation (SD) for repeated scans as the dependent variable. Main Outcomes1) Biological variability: average RNFL thickness, 2) Methodological variability: average within- participant SD across repeated scans. ResultsAge (β= −0.19 microns/year, [95% CI: −0.29, −0.09]), female gender (β= +1.48 microns vs. male, [95% CI: 0.09,2.86]), axial length (β= −1.24 microns/mm of greater length, [95% CI: −1.80, −0.67]), and SS (β= +1.62 microns/1 unit greater SS, [95% CI: 1.16,2.09]) were significantly associated with RNFL thickness, while race and ethnicity were not (p>0.05). In analyses designed to assess methodological variability, higher RNFL thickness (β= +0.02 per micron increase, [95% CI: 0.01,0.03]), and lower SS (β= +0.19 per 1 unit lower SS, [95% CI: 0.10,0.27]) were significantly associated with greater RNFL variability. In adults with no self-reported history of glaucoma (n of eyes = 1165, n of participants = 712), female gender was not associated with RNFL, while African-American race was associated with thicker RNFL (β= +4.65 microns vs. Whites, [95% CI: 1.28,8.03]). ConclusionsRNFL thickness is lower with older age, male gender, greater axial length, lower signal strength, and Whites (as compared to African-Americans) without self-reported glaucoma. Measurement variability (SD) is higher with greater RNFL thickness and lower SS. Understanding these biological and methodological variations is important to aid in OCT interpretation.

Advanced Computational Methods for Radiation Dose Optimization in CT.

In planning radiotherapy treatments, computed tomography (CT) has become a crucial tool. CT scans involve exposure to ionizing radiation, which can increase the risk of cancer and other adverse health effects in patients. Ionizing radiation doses for medical exposure must be kept "As Low As Reasonably Achievable". Very few articles on guidelines for radiotherapy-computed tomography scans are available. This paper reviews the current literature on radiation dose optimization based on the effective dose and diagnostic reference level (DRL) for head, neck, and pelvic CT procedures used in radiation therapy planning. This paper explores the strategies used to optimize radiation doses, and high-quality images for diagnosis and treatment planning. A cross-sectional study was conducted on 300 patients with head, neck, and pelvic region cancer in our institution. The DRL, effective dose, volumetric CT dose index (CTDIvol), and dose-length product (DLP) for the present and optimized protocol were calculated. DRLs were proposed for the DLP using the 75th percentile of the distribution. The DLP is a measure of the radiation dose received by a patient during a CT scan and is calculated by multiplying the CT dose index (CTDI) by the scan length. To calculate a DRL from a DLP, a large dataset of DLP values obtained from a specific imaging procedure must be collected and can be used to determine the median or 75th-percentile DLP value for each imaging procedure. Significant variations were found in the DLP, CTDIvol, and effective dose when we compared both the standard protocol and the optimized protocol. Also, the optimized protocol was compared with other diagnostic and radiotherapy CT scan studies conducted by other centers. As a result, we found that our institution's DRL was significantly low. The optimized dose protocol showed a reduction in the CTDIvol (70% and 63%), DLP (60% and 61%), and effective dose (67% and 62%) for both head, neck, and pelvic scans. Optimized protocol DRLs were proposed for comparison purposes.