Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures

PURPOSE

Increasing in number and complexity, interventional neuroradiology (INR) procedures are becoming an important source of radiation exposure for patients. In accordance with the ALARA principle, radiation exposure during INR procedures should be curtailed as much as possible while reaching successful treatment outcomes. Moreover, the extent of radiation exposure should be one outcome measure used to assess new technologies and procedural efficacy, and training programs should include techniques for exposure limitation. This study provides a methodology and preliminary data to assess radiation exposure during different INR procedure types.

MATERIALS AND METHODS

All patients undergoing endovascular procedures in two biplanar dedicated neuroangiography suites at a major academic medical center were monitored according to procedure type, pathological indication, fluoroscopy time and machine-generated patient dose estimates between April 2006 and July 2008.

RESULTS

1678 patients underwent cerebral arteriography during the study period. Women (62.1%) accounted for the majority of patients, but men (38.9%) were more likely to undergo an interventional procedure than women (32.8%). Diagnostic studies accounted for 64.9% of procedures. Variable exposures were found between diagnostic and interventional procedures. Exposure differed depending on indications for the procedure and procedure type.

CONCLUSION

Radiation exposure is an increasingly important consideration in the development of minimally invasive neurological procedures including cerebral angiography and INR. The type of procedure and lesion type allow the practitioner to estimate radiation exposure. Such information informs the clinical decision making process. Normative data should be collected and used for comparison purposes as one measure of technical and procedural success.

A comparative study of thoracic radiation doses from 64-slice cardiac CT

The goal of this study was to measure radiation doses for 64-slice cardiac CT angiography studies and to study the dose-savings features of these CT scanners. This was done using various phantoms. These radiation doses were compared with those from typical helical body CT scans, fluoroscopy cardiac catheterization studies and mammography examinations. Radiation measurements were made with a CT ionization detector and a solid state dosimeter. A GE 64-slice Lightspeed VCT and a Siemens Somatom Sensation 64 CT were used to scan a standard 32 cm acrylic phantom and an anthropomorphic phantom. Data were collected in axial and various gated cardiac helical modes. Organ doses and the effective doses were calculated from the measurements. In gated CT cardiac mode with the 32 cm acrylic phantom, the measured radiation doses per study were generally three to seven times greater than those from typical body helical CT examinations; the range depended upon selectable scan parameters. With the anatomical phantom, the surface doses in the anteroposterior (AP) plane were typically 20-60% higher than those measured using the 32 cm phantom. The lateral surface doses were -4% to +15%. These results can be attributed to the shorter AP dimension and the air in the lungs. The CT skin entrance radiation doses were 80-90% less than diagnostic cardiac catheterization studies, and organ doses were similar. Because 64-slice cardiac gated CT uses pitches equal to 0.20-0.27 and high mAs values, the patient radiation doses are appreciably higher than in routine body CT examinations. The female breast, which could receive a radiation dose 10-30 times that received from mammography screening, is an organ of particular concern.

Comparison of computed radiography and film/screen combination using a contrast-detail phantom

The purpose of this work is to compare computed radiography (Kodak CR 400) and film/screen combination (Speed 400) systems in regards of patient dose, technique settings, and contrast-detail detectability. A special contrast-detail phantom with drilled holes of varying diameter (detail) and varying depth (contrast) was utilized. Various thicknesses of the Lucite sheets were utilized to simulate scattering tissues. Images of the phantom were acquired using a range of 60-120 kVp for film/screen and CR with a conventional x-ray tube and then for CR with additional 2 mm aluminum added filtration to the x-ray beam. The patient entrance skin dose was measured while maintaining 1.6 o.d. for film/screen images and 1900 Exposure Index for CR images. CR phantom images were displayed on the diagnostic workstation for soft copy reading as well as printed on films for hard copy reading on viewbox. Four physicists evaluated the images by scoring the threshold target depth along the row of the same target diameter. Detection ratio was calculated by counting the number of detectable targets divided by the total number of targets in the phantom. The overall score was related to the patient entrance skin dose, kVp, and the thickness of the scattering material. The patient entrance skin dose was reduced as the additional aluminum filter was added to the x-ray beam. Our findings suggested using a higher kVp setting and additional added filtration would reduce the patient entrance skin dose without compromising the contrast-detail detectability, which was compensated by the contrast manipulation on soft-copy display workstations.

Radiation doses during CT fluoroscopy

CT fluoroscopy (CTF) is a relatively new imaging modality that is particularly useful for performing complex biopsy procedures. Despite the obvious benefits, the potential exists to deliver considerable radiation doses to both the patients and medical staff. The purpose of our study was to quantify the radiation levels based upon typical clinical procedures. To assess the potential radiation risks, the patient radiation doses via the CT dose index (CTDI) method were measured during CTF for a GE Pro-Speed CT scanner using standardized head and body phantoms and a CT ionization chamber. The measurements were performed for a variety of kVp, mA, and slice thickness settings. To determine patient radiation doses, the CT kVp, mA, and total CTF scan times were recorded for various biopsy procedures. To determine the radiation doses to the hands of the radiologists, a radiation survey meter was used to measure the scattered radiation from standard phantoms. The effectiveness of various types of leaded gloves and shields were also determined. The measured CTDI values ranged from 20.4 cGy min(-1) to 63.1 cGy min(-1) of CTF. For a group of 78 patients, the clinically utilized imaging times varied from 13.0 to 407 s with an mean time of 96.6 s +/- 78.9 s (1 standard deviation). The scattered x-ray radiation at the position of the radiologists hands performing the biopsy procedures was measured to be 0.6 to 1.5 mGy min(-1). The thin leaded gloves provided a relatively minimal reduction in the scattered radiation to the hands between 11% and 44% dependent upon the kVp and the type of glove. However, floor mounted radiation shields reduced the scattered radiation levels to the body by 94% to 99%. In comparison to standard x-ray fluoroscopy, CTF employs much higher radiation dose rates due to the higher kVp, mA, and rotating geometry. It is important to minimize the radiation dose to patients and staff by limiting the imaging times, employing lower mA settings, and using appropriate radiation protection measures.

Proposition: a pregnant resident physician should be excused from training rotations such as angiography and nuclear medicine because of the potential exposure of the fetus

It has been reasonably well documented that a pregnant resident physician can assume radiology rotations, including higher-exposure rotations such as angiography and nuclear medicine, without exposing the fetus to radiation levels that exceed national and international guidelines. Hence, many medical physicists support the contention that rotations should not be altered because a resident is pregnant. On the other hand, many if not most physicists subscribe to the ALARA (as low as reasonably achievable) principle, especially in cases of fetal exposure where increased radiation susceptibility is combined with an inability to decide for one-self. In addition, altered rotations usually can be accommodated by swapping rotations with other residents, with the pregnant resident taking high exposure rotations after delivery of the child. Policies on this issue vary among institutions, possibly because medical physicists have not come to closure on the issue. This issue of Point/Counterpoint is directed toward that objective.

Monthly monitoring program on DryView laser imager: one year experience on five Imation units

Dry-processing film systems have become popular particularly in a network environment. This is mainly due to its ability to produce high quality images without wet chemistry processing. In this paper we describe a monthly monitoring program on five Model 8700 DryView Laser Imagers in our institution. A SMPTE pattern is generated via DryView Laser Imager software. The 100% patch is used for checking the base-plus-fog of the Imager. The 40% patch is used as the speed index. The optical density difference between patches 10% and 70% is used as the contrast index. These numbers are plotted for testing system consistency. In addition, the SMPTE pattern is examined to verify the sharpness of the bar patterns and the visibility of subtle contrasts-95% inset in the 100% patch and a 5% inset in the 0% patch. The clinical films are checked for processor artifacts, such as residuals from the drum. Stability of the dry processors has also been studied using three strips per day obtained at three different times of the day over a period of ten consecutive working days. The coefficient of variation is 0.05 for the speed index and 0.04 for the contrast index. The monthly monitoring program has been carried out in our institution since January 1997. The problems found by this monthly monitoring program assess the necessity of routine QC for DryView Laser Imagers. The instability of the post-processing dry silver films, and, consequently, the film handling requirements, are also discussed.

CT scans through metal scanning technique versus hardware composition

OBJECTIVE

Streak artifact on CT scans of metal containing areas has been a long standing problem. Although several artifact reducing methods have been used to improve image quality, most have been limited by requiring specialized equipment or lengthy complex calculations that are not automated. Others have shown that increasing the beam energy results in increased thickness of metal that may be imaged by CT without severe image degradation. We have studied the image quality of bone surrounding metal both with titanium and cobalt-chrome prostheses using various scanning techniques.

METHODS

In a double blind fashion, 28 radiology residents and attendings were surveyed as to the best technique for imaging bone detail surrounding metal. A series of images was arranged of an implanted titanium prosthesis, a cobalt-chrome prosthesis and a pelvis repaired with stainless steel pelvic reconstruction plates. Scans were performed using three techniques: 120 kVp, 170 mA, 2 s, 360 degrees rotation, 140 kVp, 140 mA, 3 s, 360 degrees rotation, 140 kVp, 140 mA, 4 s, 420 degrees rotation.

RESULTS

Titanium was superior to cobalt-chrome (p < .0001 Wilcoxon Signed Rank Test). No advantage was noted for higher kVp or increased scan arc of 420 degrees compared to the standard 360 degrees.

CONCLUSION

Titanium allows improved bone detail surround the metal than CT cobalt-chrome. We have found no advantage to using either high kVp or a 420 degrees scan arc to improve the image quality of bone surrounded by metal.

Value of the coronal plane in MRI of internal derangement of the knee

Sagittal images usually receive the most scrutiny in the magnetic resonance evaluation of meniscal and anterior cruciate ligament tears. We assessed the relative contribution of the coronal view. All knee magnetic resonance examinations performed over a 2-year period that had surgical confirmation were reviewed with respect to the presence of meniscal and anterior cruciate ligament tears. The appearance of an attenuated but uninterrupted anterior cruciate ligament was also evaluated. The coronal and sagittal plane images were evaluated separately. The study included 68 medial menisci, 67 lateral menisci, and 71 anterior cruciate ligaments. The coronal view is especially useful in the evaluation of the lateral meniscus. An anterior cruciate ligament that appears attennated but uninterrupted should be considered intact. The anterior cruciate ligament may be evaluated on the coronal view. The coronal view should be regarded as similar to the lateral chest radiograph, which supplements, but does not replace, the frontal chest radiograph.

Factors affecting x-ray spectra

The x-ray spectrum is defined as the energy distribution of the radiation produced in an x-ray exposure. The x-ray spectrum has a major impact on image quality and radiation dose delivered to patients. The authors explored the effects of three key factors on x-ray spectra: generator type, peak tube potential, and filtration. Different generator types are characterized by the amount of ripple in the kilovoltage waveform. Those with high (100%) ripple such as single-phase units produce less penetrating radiation than units with low (4%) ripple such as three-phase, 12-pulse generators. As peak tube potential increases, the half-value layer increases nearly linearly; radiation output increases by approximately the square of the tube potential. Filtration materials with atomic numbers less than 42, such as aluminum, titanium, copper, and niobium, produce similar spectra, with only slight variations in efficiency. Although aluminum has the lowest efficiency, this may be compensated for by increasing milliampere seconds. Filtration in addition to the inherent filtration provided by the tube reduces both skin surface dose and average depth-dose, with the optimal amount being approximately 2-3 mm or less of aluminum-equivalent material.

Radiographic detail and variation of the nominal focal spot size: the "focal effect"

It is not generally appreciated that there is a gradation of the focal spot size from the anode to cathode end of an x-ray field that can dramatically affect radiographic detail from one end of a radiograph to the other. The authors name this gradation the "focal effect." Gradations in radiation intensity and focal spot size were measured from anode end to cathode end of a 14 x 17-inch field and were visually demonstrated with lymphangiograms and line-pair patterns. The degradation in spatial resolution along the anode-cathode axis was found to be as much as 75%, depending on the orientation of the patient with respect to the x-ray tube. Radiographic detail is, therefore, significantly improved (even when the large focal spot is used) by exploiting the focal effect and placing the body part requiring the best radiographic detail at the anode end of the table.

Mammographic resolution: influence of focal spot intensity distribution and geometry

The influence of focal spot intensity distribution and geometry upon mammographic image quality were evaluated. The modulation transfer functions (MTF's) for eight different intensity distributions were determined and plotted in a manner to eliminate the effects of magnification and focal spot dimension. The results indicated that the total cross-sectional area is important for focal spots with uniform intensity distributions and equivalent diameters. For equivalent focal spot dimensions, intensity distributions with edge bands were shown to have less spatial resolution than uniform intensity distributions. Focal spots with greater intensities towards their centers provided better resolution than either uniform intensity distributions or distributions with edge bands for equivalent sizes. The type of intensity distribution was also shown to affect the accuracy of star pattern measurements of focal spot size; this method of measurement is only precise for a uniform square intensity distribution. Errors obtained with several other intensity distributions were tabulated. The variations of the effective focal spot size with position along the anode-cathode axis were shown to be of a factor of approximately two to three. The combined effects of geometric blur and film/screen blur were present for various heights above the cassette tray on several different mammographic systems.

A quality-control phantom for digitization of radiographs

Quality control is fundamental to the clinical application of digital radiography. A 14 x 17-in phantom radiograph was designed to test digital image quality by measurement of five parameters: high-contrast spatial resolution, low-contrast discrimination, linearity of gray-scale response, high-frequency noise, and geometric distortion. The phantom was used to evaluate the AT&T-Philips CommView picture archival and communications system (AT&T Bell Laboratories, West Long Branch, NJ; Philips Medical Systems, Shelton, CT). High-contrast resolution was found to be greater along the diagonal axis of the system than along either the horizontal or vertical axis. Problems with low-contrast discrimination and linearity of gray-scale response were identified. This phantom provides a simple tool for daily quality assurance testing and an objective standard for comparison of image quality between different digital radiography systems.

A predictive test for adverse reactions to contrast media. Preliminary results

In a prospective study, whole blood samples drawn from patients prior to their being injected with contrast media were incubated with zymosan to activate the complement cascade. The samples were tested for various analytes, including C3a, thromboxane B2 (TxB2), beta thromboglobulin and platelet factor 4 (PF4). Of 207 patients receiving contrast media, only eight experienced reactions, which were mild. Levels of the platelet constituents were generally elevated in these patients. Specificity and sensitivity were 89% and 83%, respectively, for the combined TxB2 and PF4 radioimmunoassay data. Using the Wilcoxon-Mann-Whitney rank sum test, both PF4 and TxB2 were collected with RCM reactions at the R less than .05 level. Although preliminary, the results suggest that RCM reactions are predictable by the in vitro test procedures described.

Bone mineral assessment: new dual-energy CT approach

Most clinical quantitative computed tomographic (CT) determinations of bone mineral content are hampered by inability to properly account for the various substances contained within the spongiosa (spongy bone). In general, the presence of adipose tissue lowers the CT numbers (Hounsfield units) and leads to underestimation of bone mineral content. Collagen matrix has the opposite effect. A new approach to obtaining data from postreconstruction dual-energy CT scans accounts for five principal constituents of the spongiosa. In addition to bone mineral values, the method also provides the adipose tissue concentration, calcium content, and density of the total trabecular space. Since calcium values are provided, the measurements can be compared with prereconstruction dual-energy data that are acquired simultaneously. A new solid-plastic calibration phantom was utilized in this study, and data were obtained from 26 subjects. Dual-energy data were correlated with single-energy measurements (r greater than .96), and calcium measurements were correlated with the bone mineral determinations (r = .97) in these 26 cases. All measurements of the various vertebral constituents agreed with published values.

Evaluation of a cinevideodensitometric method for measuring vessel dimensions from digitized angiograms

A cinevideodensitometric method for measuring the dimensions of small vessels by computer analysis of digitized cineangiograms was developed and validated in radiographic phantom models. With this method, which is based on full-width-at-half-maximum analysis of videodensitometric profile curves, the diameters of contrast-filled plexiglass cylinders ranging from 1.78 mm to 4.14 mm in diameter were measured to within 2% mean error. The theoretical basis for this method of cinevideodensitometric analysis is provided.

Prekallikrein activation, C1 esterase inhibitor, and factor XII as predictors of adverse reaction to contrast media. A prospective study

The susceptibility of 152 patients to idiosyncratic reactions resulting from the administration of radiographic contrast media was studied. The rate of activation of plasma prekallikrein was measured in samples taken from these patients before they received contrast agents. Kallikrein inhibitor and factor XII levels were also determined. The tests were of no value in selecting the ten patients who subsequently experienced mild reactions. However, the possibility remains that one or more of the tests may have predictive value for patients who experience moderate or severe reactions.

Noninvasive x-ray tube current measurement

A clamp-on current probe utilizing the Hall effect was used to determine x-ray tube current. This noninvasive technique was compared to two other methods of mA measurement: the Machlett Dynalyzer and the mR/mAs linearity method. Three diagnostic x-ray units were used in the comparison; two modern three-phase rooms and one 25 year old single-phase room. The Dynalyzer and current probe measurements agreed to within +/- 3% and showed mA miscalibration at several technique settings. The mR/mAs linearity method failed to detect any miscalibration. One disadvantage of using the current probe is its susceptibility to electronic noise when making measurements of tube current below 100 mA. These results justify the use of the current probe in routine quality control calibration checks.

Effect of coronary stenotic lesions on regional myocardial blood flow at rest

To determine the effect of atherosclerotic coronary lesions on myocardial blood flow in patients at rest, regional myocardial blood flow was measured distal to stenotic lesions in 29 patients with isolated proximal lesions of the left anterior descending artery. Severity of coronary stenosis was measured by computer-assisted cinevideodensitometric analysis of digitized coronary arteriograms. Regional myocardial blood flow was measured from the clearance rate of intracoronary 133Xe injected into the left main coronary artery and recorded with a multicrystal scintillation camera. In 21 patients with stenotic lesions ranging from 19% to 84% area reduction, distal regional myocardial blood flow was normal. In all eight patients with reduced regional myocardial blood flow distal to left anterior descending lesions, the minimum area of each stenotic lesion was less 0.80 mm2 (mean 0.34 +/- 0.2 mm2), minimum calculated diameter was less than 1 mm (mean 0.59 +/- 0.3 mm), and percent stenosis, based on the reduction in cross-sectional area, was greater than 85% (mean 94 +/- 4%). For all patients, distal flow, expressed as a fraction of normal flow, correlated with the lesion cross-sectional area (r = .84), minimum luminal diameter (r = .84), and percent area stenosis (r = -.70). Thus, resting myocardial blood flow distal to stenotic lesions of the proximal coronary arteries remains normal until the degree of narrowing is severe. The dimensions observed for critical coronary stenotic lesions correlate well with theoretical predictions based on fluid mechanics and with experimental preparations in laboratory animals.

Radionuclide administration to nursing mothers: mathematically derived guidelines

We determined a formula to establish objective guidelines for the administration of radionuclides to nursing mothers. The formula is based on the maximum permissible dose to the infant's critical organ, serial measurements of breast milk activity, milk volume, and dose to the critical organ per microcurie in milk. Using worst-case assumptions, we believe that cessation of nursing for 24 hours after administration of technetium labeled radiopharmaceuticals is sufficient for safety. Longer-lived agents require greater delays. Iodine-123 radiopharmaceuticals are preferable to iodine-131 agents and should always be used when studying the unblocked thyroid.

A simplified approach for modulation transfer function determinations in computed tomography

In order to determine the modulation transfer functions (MTF's) for x-ray computed tomography (CT) scanners, a measurement must be performed to obtain either the point spread function (PSF) or the line spread function (LSF). Thereafter, the usual procedure is to interpolate between the measured points and to determine the Fourier transforms numerically in order to obtain the MTF. Since this must usually be done many times to evaluate various reconstruction kernels and scan modalities, the process is tedious. Fortunately, it can be greatly simplified by utilizing a mathematical function to describe the PSF or LSF. Measured data for five CT scanners indicates that the PSF can usually be described by a Gaussian function. Hence, the MTF can be written in a generalized form eliminating the necessity of performing Fourier transformations each time. The MTF is determined directly from a single performance characteristic related to the full width at half maximum. The accuracy of the approach is compared with detailed MTF calculations for five CT scanners and it is shown to agree favorably with this data.

Normal thermographic standards for the cervical spine and upper extremities

Although thermography has been used for a variety of abnormal conditions, extensive data on large, relatively asymptomatic populations has heretofore not been available. More specifically, no data deal with the upper extremities and, more particularly, no analyses are based on simultaneous thermograms of the posterior neck and shoulders. The current study undertook this task. The results confirm the existence of thermal symmetry in the overwhelming majority of 100 normal relatively asymptomatic, actively employed factory workers. Conversely, if persistent, statistically significant thermal asymmetry exists, as outlined and correlates with patient symptomatology, an organic basis for it should be sought.

Left ventricular volume: physical basis for attenuation corrections in radionuclide determinations

Absolute left ventricular volume has been calculated from gated blood pool studies by estimating an attenuation correction for left ventricular counts. We studied the physical basis of these corrections by evaluating x-ray photon attenuation from CT scans of the thorax (10 second scans, no gating). CT numbers were converted to linear attenuation coefficients (LACs) at 140 keV, and LACs from the center of the left ventricle or esophagus to the chest wall (40 degrees left anterior oblique position) were determined in 12 patients of various body habitus. The mean LACs were virtually identical (0.13 cm-1 +/- 0.02 cm-1 SD), but were less than the LAC of water (0.15 cm-1). However, the esophagus was 66% further from the chest wall than the center of the left ventricle. These results suggest that conventional methods overestimate attenuation and show that LAC variability between individuals can be large. Better methods of attenuation correction may improve count-based estimates of left ventricular volume.

A radioimmunoassay for total captopril in human serum or plasma samples

A radioimmunoassay for the measurement of total captopril in serum and heparinized plasma has been developed. Prior to the assay, serum or heparinized plasma samples are subjected to tri-n-butyl-phosphine reduction followed by N-ethylmaleimide (NEM) derivatization. The assay utilizes in-house NEM-captopril antibody, [125I]NEM-captopril radiolabel and human serum standards. Satisfactory zero binding and sensitivity are obtained after 3 h of incubation at room temperature. Separation of the antibody-bound and free radiolabeled antigen is achieved by employing a polyethylene glycol solution. The assay was shown to have excellent parallelism, recovery, and precision. Cross-reactivities with potentially interfering substances were low.

Interference in immunoassay

With the proliferation of immunoassays used in the clinical laboratory, we have come to realize that there are many factors which can interfere with these assays. Some of these, like exogenous radioactivity, will only interfere with one type of immunoassay--the radioimmunoassay. Other interferences will affect all types of immunoassays, although perhaps to differing degrees. This article will survey some of the more common types of interfering substances which may affect immunoassays, including tube types, serum factors, and the interferences which are specifically due to the type of label used in the assay.

The role of 99mTc pertechnetate uptake in the evaluation of thyroid function

To investigate the usefulness of the 20 min 99mTc-pertechnetate uptake test, the records of 246 consecutive patients were reviewed. Of these, 192 patients (151 females, 41 males; 10 weeks to 78 years) had at least one year clinical follow-up or a confirmed diagnosis by biopsy or surgery and were included in our study. In these patients, the 99mTc pertechnetate uptake and hormonal values (T3 resin uptake, T4 RIA, T-index) were obtained. These results were then compared to the clinical diagnosis at the time of the uptake and one year later. All patients received an i.v. injection of 5 mCi of 99mTc pertechnetate. Imaging was performed using a pinhole collimator and a scintillation camera interfaced to a computer. Regions of interest for the thyroid and the background were used to calculate the 20 min 99mTc pertechnetate uptake as a percentage of the injected dose. 99mTc uptake and hormonal values were confirmatory in 158 patients (82.3%): 138 were euthyroid, 18 were hyperthyroid and 2 were hypothyroid. In 29 other patients (15.1%) the pertechnetate uptake provided useful additional information and helped to identify Hashimoto's thyroiditis (8 patients); thyroid suppression by exogenous iodide, steroids or T4 (7 patients); overtreated hyperthyroidism (1 patient); persistent hyperthyroidism (5 patients); different stages of Grave's disease (4 patients); and toxic nodular goiter (4 patients). The 99mTc uptake was misleading in 5 euthyroid patients (2.6%). We have found the 99mTc pertechnetate uptake a useful adjunct to measurement of hormonal levels in patients with suspected thyroid disease.

Human platelets labeled with In-111 8-hydroxyquinoline: kinetics, distribution, and estimates of radiation dose

Platelets from nine normal male subjects were labeled with In-111 8-hydroxyquinoline (In-111 oxine) in the presence of plasma in either "closed" blood transfer packs or in "open" test tubes. The mean labeling efficiencies in these two systems were 27 and 53%, respectively. Mean survival time of In-111-labeled autologous platelets was 8.76 days, with a standard deviation of 1.05 according to the maximum-likelihood estimate of the gamma-function model. The initial recovery of In-111 platelets in the circulation was 57% with a standard deviation of 11%. The distribution of In-111 platelets in liver and spleen was quantitated by anterior, posterior, and transmission gamma-camera imaging. During the first 30 min, 38% of the injected dose accumulated in the spleen, 13% in the liver. No significant increase in In-111 radioactivity was observed in either of the two organs over a 3-9-day period. The bone marrow was an additional site of In-111 accumulation. The spleen was the critical organ with respect to radiation dose. The splenic dose was estimated to be 34 rad/mCi In-111 platelets, that of the liver 2.1 rad/mCi. With the injection of 100-150 microCi of In-111-labeled platelets in normal subjects, giving a splenic radiation of 5 rad, a complete 10-day survival study can be performed and uptake of In-111 in different organs can be measured quantitatively for at least 3-4 days.

Temporal resolution requirements for left ventricular time-activity curves

To investigate framing rate requirements for left ventricular (LV) time-activity curves, ECG-synchronized blood pool studies of 33 patients were compared to independent techniques for evaluation of LV function. There were no significant differences in LV ejection fractions determined using different framing rates. Systolic time intervals calculated from 64- and 32-point curves were similar and correlated well with those obtained by standard methods (r = 0.81, p less than 0.001). Results from 16-point curves were worse (p less than 0.02). There were no differences between peak ejection and filling rates obtained with 64- and 32-point curves compared to angiography, but the rates calculated using 16-point curves were significantly slower (p less than 0.05). The findings suggest that LV time-activity curves acquired at 16 frames per RR interval do not provide optimum quantification of LV function indexes other than the ejection fraction.

Blood gastrin levels in hyperthyroidism

Serum gastrin concentrations were measured in 22 untreated and 10 treated thyrotoxic patients. In contrast to similar studies carried out in Japan, serum gastrin levels were normal in hyperthyroid subjects. The mean value in hyperthyroid subjects (94.8 +/- 34.5 pg/ml) was higher than that in the treated patients (73.6 +/- 33.2 pg/ml), but the difference was not significant (P greater than 0.05).

A study of age-dependent changes in thyroid function tests in adults

Total serum thyroxine (T4), triiodothyronine (T3), T3 resin uptake (T3U), thyrotrophin (TSH), and reverse T3 (rT3) were measured in 209 healthy adults 20--89 yr old. Mean T4 values for men were stable throughout life, but in females under age 60, T4 values were significantly higher than in older women. Values for T3U in males were significantly higher than in females throughout all decades, although females had a significant increase in T3U after age 60. TSH values increased significantly in females over age 60. Throughout all decades, males had stable TSH levels that were slightly higher than the female results before age 60 and lower thereafter. Mean serum T3 declined similarly for both sexes with increasing age, although not to the extent previously reported. Men had significantly higher mean rT3 values over all decades than females, although female rT3 levels decreased after age 50 whereas males maintained stable values. The physiologic reasons for these findings may be due to sex-related changes in binding proteins and alterations in metabolic clearance rates, production, and degradation of these hormones with increasing age.

A comparison of five methods for monitoring the precision of automated x-ray film processors

Five different methods for preparing sensitometric strips used to monitor the precision of automated film processors are compared. A method for determining the sensitivity of each system to processor variations is presented; the observed statistical variability is multiplied by the system response to temperature or chemical changes. Pre-exposed sensitometric strips required the use of accurate densitometers and stringent control limits to be effective. X-ray exposed sensitometric strips demonstrated large variations in the x-ray output (2 omega approximately equal to 8.0%) over a period of one month. Some light sensitometers were capable of detecting +/- 1.0 degrees F (+/- 0.6 degrees C) variations in developer temperature in the processor and/or about 10.0 ml of chemical contamination in the processor. Nevertheless, even the light sensitometers were susceptible to problems, e.g. film emulsion selection, line voltage variations, and latent image fading. Advantages and disadvantages of the various sensitometric methods are discussed.

Tc-99m human serum albumin: a suitable agent for plasma volume measurements in man

In 16 patients we have carried out simultaneous plasma-volume measurements with human serum albumins tagged with Tc-99m (Tc-99m HSA) and I-131 (I-131 HSA). The correlation coefficient was 0.987. Tc-99m HSA, prepared from kits that predictably yield high labeling efficiency (and thereby negligible amounts of TCO4-), is clearly a superior agent for repeat plasma volume determinations, because of its shorter half-life and the reduced radiation dose to the subject.