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Decker JA, O'Doherty J, Schoepf UJ, Todoran TM, Aquino GJ, Brandt V, Baruah D, Fink N, Zsarnoczay E, Flohr T, Schmidt B, Allmendinger T, Risch F, Varga-Szemes A, Emrich T. Stent imaging on a clinical dual-source photon-counting detector CT system-impact of luminal attenuation and sharp kernels on lumen visibility. Eur Radiol 2023; 33:2469-2477. [PMID: 36462045 DOI: 10.1007/s00330-022-09283-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/07/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To assess the impact of scan modes and reconstruction kernels using a novel dual-source photon-counting detector CT (PCD-CT) on lumen visibility and sharpness of different stent sizes. METHODS A phantom containing six balloon-expandable stents (2.5 to 9 mm diameter) in silicone tubing was scanned on a PCD-CT with standard (0.6 mm and 0.4 mm thicknesses) and ultra-high-resolution (0.2 mm thickness) modes. With the use of increasing contrast medium concentrations, densities of 0, 200, 400, and 600 HU were achieved. Standard-resolution scans were reconstructed using increasing sharpness kernels, using both polyenergetic quantitative soft tissue "conventional" ((Qr40c(0.6 mm), Qr40c(0.4 mm), Qr72c(0.2 mm)) and vascular (Bv) virtual monoenergetic reconstructions (Bv44m(0.4 mm), Bv60m(0.4 mm)) at 70 keV. In-stent lumen visibility, sharpness (max. ΔHU of the stent measured in profile plots), and in-stent noise (standard deviation of HU) were measured. RESULTS In-stent lumen visibility was highest for Qr72c(0.2 mm) (86.5 ± 2.8% to 88.3 ± 2.6%) and in Bv60m(0.4 mm) reconstructions (77.3 ± 2.9 to 82.7 ± 2.5%). Lumen visibility was lowest in the smallest stent (2.5 mm) ranging from 54.1% in Qr40c(0.6 mm) to 74.1% in Qr72c(0.2 mm) and highest in the largest stent (9 mm) ranging from 93.8% in Qr40c(0.6 mm) to 99.1% in the Qr72c(0.2 mm) series. Lumen visibility decreased by 2.1% for every 200-HU increase in lumen attenuation. Max. ΔHU between stents and stent lumen was highest in Qr72c(0.2 mm) (ΔHU 892 ± 504 to 1526 ± 517) and Bv60m(0.4 mm) series (ΔHU 480 ± 357 to 1030 ± 344). Improvement of lumen visibility and sharpness in UHR and Bv60m(0.4 mm) series was strongest in smaller stent sizes. CONCLUSION UHR acquisition mode and sharp reconstruction kernels on a novel PCD-CT system significantly improve in-stent lumen visibility and sharpness-especially for smaller stent sizes. KEY POINTS • In-stent lumen visibility and sharpness of stents significantly improve using sharp reconstruction kernels (Bv60) and ultra-high-resolution mode in photon-counting detector computed tomography. • The observed improvement of stent-lumen visibility was highest in smaller stent sizes.
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Affiliation(s)
- Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Siemens Medical Solutions, Malvern, PA, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Thomas M Todoran
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Cardiology and Angiology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Dhiraj Baruah
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | | | | | - Franka Risch
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
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Ligero M, Jordi-Ollero O, Bernatowicz K, Garcia-Ruiz A, Delgado-Muñoz E, Leiva D, Mast R, Suarez C, Sala-Llonch R, Calvo N, Escobar M, Navarro-Martin A, Villacampa G, Dienstmann R, Perez-Lopez R. Minimizing acquisition-related radiomics variability by image resampling and batch effect correction to allow for large-scale data analysis. Eur Radiol 2021. [PMID: 32909055 DOI: 10.1007/s00330-020-07174-0/figures/6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To identify CT-acquisition parameters accounting for radiomics variability and to develop a post-acquisition CT-image correction method to reduce variability and improve radiomics classification in both phantom and clinical applications. METHODS CT-acquisition protocols were prospectively tested in a phantom. The multi-centric retrospective clinical study included CT scans of patients with colorectal/renal cancer liver metastases. Ninety-three radiomics features of first order and texture were extracted. Intraclass correlation coefficients (ICCs) between CT-acquisition protocols were evaluated to define sources of variability. Voxel size, ComBat, and singular value decomposition (SVD) compensation methods were explored for reducing the radiomics variability. The number of robust features was compared before and after correction using two-proportion z test. The radiomics classification accuracy (K-means purity) was assessed before and after ComBat- and SVD-based correction. RESULTS Fifty-three acquisition protocols in 13 tissue densities were analyzed. Ninety-seven liver metastases from 43 patients with CT from two vendors were included. Pixel size, reconstruction slice spacing, convolution kernel, and acquisition slice thickness are relevant sources of radiomics variability with a percentage of robust features lower than 80%. Resampling to isometric voxels increased the number of robust features when images were acquired with different pixel sizes (p < 0.05). SVD-based for thickness correction and ComBat correction for thickness and combined thickness-kernel increased the number of reproducible features (p < 0.05). ComBat showed the highest improvement of radiomics-based classification in both the phantom and clinical applications (K-means purity 65.98 vs 73.20). CONCLUSION CT-image post-acquisition processing and radiomics normalization by means of batch effect correction allow for standardization of large-scale data analysis and improve the classification accuracy. KEY POINTS • The voxel size (accounting for the pixel size and slice spacing), slice thickness, and convolution kernel are relevant sources of CT-radiomics variability. • Voxel size resampling increased the mean percentage of robust CT-radiomics features from 59.50 to 89.25% when comparing CT scans acquired with different pixel sizes and from 71.62 to 82.58% when the scans were acquired with different slice spacings. • ComBat batch effect correction reduced the CT-radiomics variability secondary to the slice thickness and convolution kernel, improving the capacity of CT-radiomics to differentiate tissues (in the phantom application) and the primary tumor type from liver metastases (in the clinical application).
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Affiliation(s)
- Marta Ligero
- Radiomics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Olivia Jordi-Ollero
- Medical Physics and Radiation Protection Department, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, Barcelona, Spain
| | - Kinga Bernatowicz
- Radiomics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Eric Delgado-Muñoz
- Radiomics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - David Leiva
- Radiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Richard Mast
- Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cristina Suarez
- Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Roser Sala-Llonch
- Department of Biomedicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Nahum Calvo
- Radiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Manuel Escobar
- Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, Barcelona, Spain
| | - Guillermo Villacampa
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus (Spain), Barcelona, Spain.
- Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
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Saint Martin MJ, Orlhac F, Akl P, Khalid F, Nioche C, Buvat I, Malhaire C, Frouin F. A radiomics pipeline dedicated to Breast MRI: validation on a multi-scanner phantom study. MAGMA 2020; 34:355-366. [PMID: 33180226 DOI: 10.1007/s10334-020-00892-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/27/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Quantitative analysis in MRI is challenging due to variabilities in intensity distributions across patients, acquisitions and scanners and suffers from bias field inhomogeneity. Radiomic studies are impacted by these effects that affect radiomic feature values. This paper describes a dedicated pipeline to increase reproducibility in breast MRI radiomic studies. MATERIALS AND METHODS T1, T2, and T1-DCE MR images of two breast phantoms were acquired using two scanners and three dual breast coils. Images were retrospectively corrected for bias field inhomogeneity and further normalised using Z score or histogram matching. Extracted radiomic features were harmonised between coils by the ComBat method. The whole pipeline was assessed qualitatively and quantitatively using statistical comparisons on two series of radiomic feature values computed in the gel mimicking the normal breast tissue or in dense lesions. RESULTS Intra and inter-acquisition variabilities were strongly reduced by the standardisation pipeline. Harmonisation by ComBat lowered the percentage of radiomic features significantly different between the three coils from 87% after bias field correction and MR normalisation to 3% in the gel, while preserving or improving performance of lesion classification in the phantoms. DISCUSSION A dedicated standardisation pipeline was developed to reduce variabilities in breast MRI, which paves the way for robust multi-scanner radiomic studies but needs to be assessed on patient data.
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Affiliation(s)
- Marie-Judith Saint Martin
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France.
| | - Fanny Orlhac
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
| | - Pia Akl
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
- HCL, Radiologie du Groupement Hospitalier Est, Hôpital Femme Mère Enfant, Unité Fonctionnelle: Imagerie de la Femme, 3 Quai des Célestins, 69002, Lyon, France
- Institut Curie, Service de Radiodiagnostic, 26 rue d'Ulm, 75005, Paris, France
| | - Fahad Khalid
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
| | - Christophe Nioche
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
| | - Irène Buvat
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
| | - Caroline Malhaire
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
- Institut Curie, Service de Radiodiagnostic, 26 rue d'Ulm, 75005, Paris, France
| | - Frédérique Frouin
- Inserm, Institut Curie,Université Paris-Saclay, Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Centre de Recherche de l'Institut Curie, Bât 101B rue Henri Becquerel, 91401, Orsay, France
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Ligero M, Jordi-Ollero O, Bernatowicz K, Garcia-Ruiz A, Delgado-Muñoz E, Leiva D, Mast R, Suarez C, Sala-Llonch R, Calvo N, Escobar M, Navarro-Martin A, Villacampa G, Dienstmann R, Perez-Lopez R. Minimizing acquisition-related radiomics variability by image resampling and batch effect correction to allow for large-scale data analysis. Eur Radiol 2021; 31:1460-70. [PMID: 32909055 DOI: 10.1007/s00330-020-07174-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/23/2020] [Accepted: 08/10/2020] [Indexed: 01/20/2023]
Abstract
Objective To identify CT-acquisition parameters accounting for radiomics variability and to develop a post-acquisition CT-image correction method to reduce variability and improve radiomics classification in both phantom and clinical applications. Methods CT-acquisition protocols were prospectively tested in a phantom. The multi-centric retrospective clinical study included CT scans of patients with colorectal/renal cancer liver metastases. Ninety-three radiomics features of first order and texture were extracted. Intraclass correlation coefficients (ICCs) between CT-acquisition protocols were evaluated to define sources of variability. Voxel size, ComBat, and singular value decomposition (SVD) compensation methods were explored for reducing the radiomics variability. The number of robust features was compared before and after correction using two-proportion z test. The radiomics classification accuracy (K-means purity) was assessed before and after ComBat- and SVD-based correction. Results Fifty-three acquisition protocols in 13 tissue densities were analyzed. Ninety-seven liver metastases from 43 patients with CT from two vendors were included. Pixel size, reconstruction slice spacing, convolution kernel, and acquisition slice thickness are relevant sources of radiomics variability with a percentage of robust features lower than 80%. Resampling to isometric voxels increased the number of robust features when images were acquired with different pixel sizes (p < 0.05). SVD-based for thickness correction and ComBat correction for thickness and combined thickness–kernel increased the number of reproducible features (p < 0.05). ComBat showed the highest improvement of radiomics-based classification in both the phantom and clinical applications (K-means purity 65.98 vs 73.20). Conclusion CT-image post-acquisition processing and radiomics normalization by means of batch effect correction allow for standardization of large-scale data analysis and improve the classification accuracy. Key Points • The voxel size (accounting for the pixel size and slice spacing), slice thickness, and convolution kernel are relevant sources of CT-radiomics variability. • Voxel size resampling increased the mean percentage of robust CT-radiomics features from 59.50 to 89.25% when comparing CT scans acquired with different pixel sizes and from 71.62 to 82.58% when the scans were acquired with different slice spacings. • ComBat batch effect correction reduced the CT-radiomics variability secondary to the slice thickness and convolution kernel, improving the capacity of CT-radiomics to differentiate tissues (in the phantom application) and the primary tumor type from liver metastases (in the clinical application). Electronic supplementary material The online version of this article (10.1007/s00330-020-07174-0) contains supplementary material, which is available to authorized users.
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Sellerer T, Noël PB, Patino M, Parakh A, Ehn S, Zeiter S, Holz JA, Hammel J, Fingerle AA, Pfeiffer F, Maintz D, Rummeny EJ, Muenzel D, Sahani DV. Dual-energy CT: a phantom comparison of different platforms for abdominal imaging. Eur Radiol 2018; 28:2745-55. [PMID: 29404773 DOI: 10.1007/s00330-017-5238-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Evaluation of imaging performance across dual-energy CT (DECT) platforms, including dual-layer CT (DLCT), rapid-kVp-switching CT (KVSCT) and dual-source CT (DSCT). METHODS A semi-anthropomorphic abdomen phantom was imaged on these DECT systems. Scans were repeated three times for CTDIvol levels of 10 mGy, 20 mGy, 30 mGy and different fat-simulating extension rings. Over the available range of virtual-monoenergetic images (VMI), noise as well as quantitative accuracy of hounsfield units (HU) and iodine concentrations were evaluated. RESULTS For all VMI levels, HU values could be determined with high accuracy compared to theoretical values. For KVSCT and DSCT, a noise increase was observed towards lower VMI levels. A patient-size dependent increase in the uncertainty of quantitative iodine concentrations is observed for all platforms. For a medium patient size the iodine concentration root-mean-square deviation at 20 mGy is 0.17 mg/ml (DLCT), 0.30 mg/ml (KVSCT) and 0.77mg/ml (DSCT). CONCLUSION Noticeable performance differences are observed between investigated DECT systems. Iodine concentrations and VMI HUs are accurately determined across all DECT systems. KVSCT and DLCT deliver slightly more accurate iodine concentration values than DSCT for investigated scenarios. In DLCT, low-noise and high-image contrast at low VMI levels may help to increase diagnostic information in abdominal CT. KEY POINTS • Current dual-energy CT platforms provide accurate, reliable quantitative information. • Dual-energy CT cross-platform evaluation revealed noticeable performance differences between different systems. • Dual-layer CT offers constant noise levels over the complete energy range.
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de las Heras H, Torres R, Fernández-Soto JM, Vañó E. Objective criteria for acceptability and constancy tests of digital subtraction angiography. Phys Med 2015; 32:272-6. [PMID: 26522881 DOI: 10.1016/j.ejmp.2015.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Demonstrate an objective procedure to quantify image quality in digital subtraction angiography (DSA) and suggest thresholds for acceptability and constancy tests. METHODS Series of images were obtained in a DSA system simulating a small (paediatric) and a large patient using the dynamic phantom described in the IEC and DIN standards for acceptance tests of DSA equipment. Image quality was quantified using measurements of contrast-to-noise ratio (CNR). Overall scores combining the CNR of 10-100 mg/ml Iodine at a vascular diameter of 1-4 mm in a homogeneous background were defined. Phantom entrance surface air kerma (Ka,e) was measured with an ionisation chamber. RESULTS The visibility of a low-contrast vessel in DSA images has been identified with a CNR value of 0.50 ± 0.03. Despite using 14 times more Ka,e (8.85 vs 0.63 mGy/image), the protocol for large patients showed a decrease in the overall score CNRsum of 67% (4.21 ± 0.06 vs 2.10 ± 0.05). The uncertainty in the results of the objective method was below 5%. CONCLUSION Objective evaluation of DSA images using CNR is feasible with dedicated phantom measurements. An objective methodology has been suggested for acceptance tests compliant with the IEC/DIN standards. The defined overall scores can serve to fix a reproducible baseline for constancy tests, as well as to study the device stability within one acquisition series and compare different imaging protocols. This work provides aspects that have not been included in the recent European guidelines on Criteria for Acceptability of Medical Radiological Equipment.
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Affiliation(s)
- Hugo de las Heras
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), c. Profesor Martín Lagos, S/N, 28040 Madrid, Spain.
| | - Ricardo Torres
- Servicio de Radiofísica y Protección Radiológica. Hospital Universitario Río Hortega, c/ Dulzaina, 2, 47012 Valladolid, Spain
| | - José Miguel Fernández-Soto
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), c. Profesor Martín Lagos, S/N, 28040 Madrid, Spain; Departamento de Radiología, Facultad de Medicina, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
| | - Eliseo Vañó
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), c. Profesor Martín Lagos, S/N, 28040 Madrid, Spain; Departamento de Radiología, Facultad de Medicina, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
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