Dose comparison between conventional and quasi-monochromatic systems for diagnostic radiology

A proposal for a quality control protocol in breast CT with synchrotron radiation

Background

The SYRMA-3D collaboration is setting up the first clinical trial of phase-contrast breast CT with synchrotron radiation at the Elettra synchrotron facility in Trieste, Italy. In this communication, a quality control protocol for breast CT is proposed, and a first test of image quality measurements is performed by means of a custom-made radiographic phantom.

Materials and methods

A set of projections is acquired and used to perform a CT reconstruction of two selected portions of the phantom. Such portions contain a uniform layer of water and a set of radiographic inserts, respectively. Together, they allow to perform several image quality measurements, namely CT number linearity, reconstruction accuracy, uniformity, noise, and low contrast resolution. All measurements are repeated at different beam energies in the range of interest, and at two different dose values.

Results

Measurements show a good linearity in the soft tissue range, paired to a high accuracy of the CT number reconstruction. Uniformity and noise measurements show that reconstruction inhomogeneities are bound to a few percent of the average pixel values. However, low contrast detectability is limited to the higher portion of the explored energy range.

Conclusions

The results of the measurements are satisfactory in terms of their quality, feasibility and reproducibility. With minimal modifications, the phantom is promising to allow a set of image quality measurements to be used in the upcoming clinical trial.

Breast tomosynthesis with monochromatic beams: a feasibility study using Monte Carlo simulations

The aim of this study is to investigate the impact on image quality of using monochromatic beams for lower dose breast tomosynthesis (BT). For this purpose, modeling and simulation of BT and mammography imaging processes have been performed using two x-ray beams: one at 28 kVp and a monochromatic one at 19 keV at different entrance surface air kerma ranging between 0.16 and 5.5 mGy. Two 4 cm thick computational breast models, in a compressed state, were used: one simple homogeneous and one heterogeneous based on CT breast images, with compositions of 50% glandular-50% adipose and 40% glandular-60% adipose tissues by weight, respectively. Modeled lesions, representing masses and calcifications, were inserted within these breast phantoms. X-ray transport in the breast models was simulated with previously developed and validated Monte Carlo application. Results showed that, for the same incident photon fluence, the use of the monochromatic beam in BT resulted in higher image quality compared to the one using polychromatic acquisition, especially in terms of contrast. For the homogenous phantom, the improvement ranged between 15% and 22% for calcifications and masses, respectively, while for the heterogeneous one this improvement was in the order of 33% for the masses and 17% for the calcifications. For different exposures, comparable image quality in terms of signal-difference-to-noise ratio and higher contrast for all features was obtained when using a monochromatic 19 keV beam at a lower mean glandular dose, compared to the polychromatic one. Monochromatic images also provide better detail and, in combination with BT, can lead to substantial improvement in visualization of features, and particularly better edge detection of low-contrast masses.

Design and characterization of a spatially distributed multibeam field emission x-ray source for stationary digital breast tomosynthesis

Digital breast tomosynthesis (DBT) is a limited angle computed tomography technique that can distinguish tumors from its overlying breast tissues and has potentials for detection of cancers at a smaller size and earlier stage. Current prototype DBT scanners are based on the regular full-field digital mammography systems and require partial isocentric motion of an x-ray tube over certain angular range to record the projection views. This prolongs the scanning time and, in turn, degrades the imaging quality due to motion blur. To mitigate the above limitations, the concept of a stationary DBT (s-DBT) scanner has been recently proposed based on the newly developed spatially distributed multibeam field emission x-ray (MBFEX) source technique using the carbon nanotube. The purpose of this article is to evaluate the performance of the 25-beam MBFEX source array that has been designed and fabricated for the s-DBT system. The s-DBT system records all the projection images by electronically activating the multiple x-ray beams from different viewing angles without any mechanical motion. The configuration of the MBFEX source is close to the published values from the Siemens Mammomat system. The key issues including the x-ray flux, focal spot size, spatial resolution, scanning time, beam-to-beam consistency, and reliability are evaluated using the standard procedures. In this article, the authors describe the design and performance of a distributed x-ray source array specifically designed for the s-DBT system. They evaluate the emission current, current variation, lifetime, and focal spot sizes of the source array. An emission current of up to 18 mA was obtained at 0.5 x 0.3 mm effective focal spot size. The experimentally measured focal spot sizes are comparable to that of a typical commercial mammography tube without motion blurring. Trade-off between the system spatial resolution, x-ray flux, and scanning time are also discussed. Projection images of a breast phantom were collected using the x-ray source array from 25 different viewing angles without motion. These preliminary results demonstrate the feasibility of the proposed s-DBT scanner. The technology has the potential to increase the resolution and reduce the imaging time for DBT. With the present design of 25 views, they demonstrated experimentally the feasibility of achieving 11 s scanning time at full detector resolution with 0.5 x 0.3 mm source resolution without motion blur. The flexibility in configuration of the x-ray source array will also allow system designers to consider imaging geometries that are difficult to achieve with the conventional single-source rotating approach.

Vision 20/20: increased image resolution versus reduced radiation exposure

This is a review of methods, currently and potentially, available for significantly reducing x-ray exposure in medical x-ray imaging. It is stimulated by the radiation exposure implications of the growing use of helical scanning, multislice, x-ray computed tomography for screening, such as for coronary artery atherosclerosis and cancer of the colon and lungs. Screening requires high-throughput imaging with high spatial and contrast resolution to meet the need for high sensitivity and specificity of detection and classification of specific imaged features. To achieve this goal beyond what is currently available with x-ray imaging methods requires increased x-ray exposure, which increases the risk of tissue damage and ultimately cancer development. These consequences limit the utility of current x-ray imaging in screening of at-risk subjects who have not yet developed the clinical symptoms of disease. Current methods for reducing x-ray exposure in x-ray imaging, mostly achieved by increasing sensitivity and specificity of the x-ray detection process, may still have potential for an up-to-tenfold decrease. This could be sufficient for doubling the spatial resolution of x-ray CT while maintaining the current x-ray exposure levels. However, a spatial resolution four times what is currently available might be needed to adequately meet the needs for screening. Consequently, for the proposed need to increase spatial resolution, an additional order of magnitude of reduction of x-ray exposure would be needed just to keep the radiation exposure at current levels. This is conceivably achievable if refraction, rather than the currently used attenuation, of x rays is used to generate the images. Existing methods that have potential for imaging the consequences of refracted x ray in a clinical setting are (1) by imaging the edge enhancement that occurs at the interfaces between adjacent tissues of different refractive indices, or (2) by imaging the changes in interference patterns resulting from moving grids which alter the refraction of x rays, that have passed through the body, in a predictable fashion, and (3) theoretically, by an image generated from the change in time-of-flight of x-ray photons passing through the body. Imaging phase shift or change in time-of-flight, rather than attenuation, of x-ray photons through tissues presents formidable technological problems for whole-body 3D imaging. However, if achievable in a routine clinical setting, these approaches have the potential for greatly expanding the use of x-ray imaging for screening. This overview examines the increased contrast resolution and reduced radiation exposure that might be achievable by the above-mentioned methods.

Monte Carlo estimation of radiation doses in red bone marrow and breast in common pediatric x-ray examinations

Radiation exposure was investigated for children undergoing various common radiographies in three dedicated pediatric hospitals in Greece. Kerma in air at the entrance of the beam (Ka,e) was measured with thermoluminescent dosimeters. Ka,e values ranged from 0.09 mGy to 5.52 mGy and were found to be greater in Hospital C, because of the increased high voltage and time-current product used by the radiation technologists. Equivalent doses in red bone marrow and breast were estimated with Monte Carlo simulation by PCXMC code. Values ranged from 2 microSv to 204 microSv for red bone marrow and from 0 to 817 muSv for breast. Variation in doses occurred due to field size, high voltage setting, and Ka,e.