Comparison of sensitivity characteristics between GAFCHROMIC LD-V1 and GAFCHROMIC XR-QA2 in mammographic dosimetry

In recent years, radiochromic films have begun to be used for dosimetry in mammography; however, the most sensitive GAFCHROMIC XR-QA2 (XR-QA2) film is no longer available owing to its discontinuation. In this study, we evaluated the sensitivity characteristics of GAFCHROMIC LD-V1 (LD-V1) as an alternative to XR-QA2 in the field of mammography, at a low dose and low energy. Our results show that the average ratio of the concentration change of LD-V1 divided by the concentration change of XR-QA2 at each absorbed dose was 53.7%, indicating the sensitivity of LD-V1 to be approximately half of XR-QA2. In addition, the linearity of the concentration change is sufficient even within a dose range of 0.59-14.52 mGy, which is lower than the manufacturer's recommended dose range. Therefore, the LD-V1 is capable of accurate dose assessment even with a low dose and the low level of energy used in mammography.

Dosimetry using a radiochromic film and a mammography phantom

Mammography is one of the most effective diagnostic methods for the early detection of breast cancer; however, it poses the risk of radiation exposure. To date, mammography dosimetry has been performed according to the mean glandular dose; however, the actual exposure in the breast has not been assessed. Here, we have measured dose distributions and depth doses using both radiochromic films and mammographic phantoms, and a three-dimensional intra-mammary dose assessment was conducted. The absorbed dose distribution at the surface was markedly higher on the chest wall side but lower on the nipple side. The absorbed doses in the depth direction exponentially decreased. The glandular tissue near the surface may be irradiated with an absorbed dose of 7.0 mGy or higher. Since LD-V1 could be placed inside the phantom, the absorbed dose inside the breast could also be evaluated in three dimensions.

Development of a three-dimensional dose evaluation method for computed tomography

During a single scan using computed tomography, an X-ray tube orbits along a 360°-circular path around the patient. A scan obtained using the half-cylindrical type phantoms with a radiochromic film sandwiched in between reveals a pixel value map illustrating the two-dimensional (2D) dose distribution. A three-dimensional (3D) dose distribution can be obtained with a 360° rotation of the 2D dose map. This study evaluates the concept and methodology of creating a 3D dose map to develop a phantom with a radiochromic film for obtaining the 3D dose distribution. The coronal and axial plane dose distributions were also evaluated. A single scan computed tomography image obtained using a half-cylindrical type of acrylic phantom with a sandwiched radiochromic film was studied. The diameters of the phantoms were 10 and 16 cm, and their lengths were 30 cm. A 2D image of the XR-QA2 film was obtained using an image scanner and image processing software. A red channel image was used to obtain the 3D dose distribution using a computing platform. A pseudo color was applied to the red channel image from which cross-sectional color images were obtained. Half of the cross-sectional pixel data were rotated by 360° to generate the data for each axial plane. The image created was saved, and a 3D pixel value map was constructed. The dose measurement procedure for the 3D dose distribution was developed using half-cylindrical acrylic phantoms with a radiochromic film.

Ultrasonographic Evaluation of Large-Bowel Obstruction With Fecal Impaction: A Case Report

Traditionally, large bowel obstruction (LBO) can be due to a neoplasm, most often colorectal cancer. Also, fecal impaction (FI) is a common disease, which occurs in a variety of ages and is significantly increased in the elderly. This case report is of LBO caused by FI, in which ultrasonography (US) proved to be useful for diagnosis and follow-up. A 60-year-old female had abdominal pain after taking a laxative as part of bowel preparation for colonoscopy. The US diagnostic findings were a marked dilation of the bowel, due to watery stool, in the ascending colon, and a clear FI, in the descending colon. Computed tomography showed similar findings to the US. There was a large amount of defecation after treatment and US demonstrated an improvement in the ileus. Ten days after admission, a colonoscopy revealed no stenosis or tumor, as a cause for the ileus.

THREE-DIMENSIONAL DOSIMETRY OF MAMMOGRAPHY USING A BLOCK CUBE BREAST PHANTOM AND RADIOCHROMIC FILM

This study developed a phantom with a shape similar to that of the breast and use GAFCHROMIC films that can be placed inside the phantom to measure the detailed breast dose distribution in mammography. GAFCHROMIC EBT3 was placed on the block cube breast phantom and irradiated with a mammography device to measure the absorbed dose distribution inside the phantom in the horizontal and depth directions. The dose distribution in the horizontal plane was the highest in the centre on the chest wall side, and it decreased in a fan shape. Along the depth of the phantom, the doses absorbed across the entire cross-section were 16.15 mGy at the surface and 7.51, 3.25 and 1.68 mGy at depths of 10, 20 and 30 mm, respectively. Compared with the mean glandular dose, the proposed method can measure breast dose distributions in greater detail and is applicable to various breast shapes.

USE OF ULTRAVIOLET RAY PRE-IRRADIATION TO IMPROVE THE ACCURACY OF LOW-DOSE MEASUREMENTS OF THE CT USING A GAFCHROMIC RTQA2 FILM

The purpose of this study is to develop a method for use at extremely low-dose ranges and to decrease the uncertainty outside the recommended range of Gafchromic RTQA2 (RTQA2). By this method, the CT dose including the scattered radiation region can be grasped. The base density was increased by ultraviolet (UV)-ray preirradiation. RTQA2 was irradiated with UV-A rays for 26 and 40 h. Subsequently, RTQA2 was exposed to 2, 4, 6, 8, 10, 25, 50, 75, 100, 150, 200 and 250 mGy X-rays using a segmentation method. Calibration curves with and without UV-A irradiation were compared. The calibration curve with 40-h UV-A ray irradiation was the most linear, and a steeper slope area was not observed. The uncertainty in the calibration curve was reduced (p < 0.05). UV-A ray irradiation is an effective method for treating RTQA2; the accuracy in the extremely low-dose range of RTQA2 was improved.

THE CONCEPT OF X-RAY CT DOSE EVALUATION METHOD USING RADIOCHROMIC FILM AND FILM-FOLDING PHANTOM

In this paper, we propose a novel radiochromic film (RCF)-based computed tomography (CT) dosimetry method, which is different from the method based on CT dose index. RCF dosimetry using Gafchromic QA2 films was performed using two lengths of film-folding phantoms. The phantom was exposed to X-ray CT through a single scan, while the RCF was sandwiched between the phantoms. We analysed the dose profile curve in two directions to investigate the dose distribution. We observed a difference in the dose distribution as the phantom size changed. Our results contradict with the results of previous studies such as Monte Carlo simulation or direct measurement. The ability to visually evaluate 2D dose distributions is an advantage of RCF dosimetry over other methods. This research investigated the ability of 2D X-ray CT dose evaluation using RCF and film-folding phantom.

Effective Dose Display System in Gastric Cancer X-ray Screening

Purpose

The purpose of this study is to build a system for effective dose display immediately after the gastric cancer X-ray screening.

Materials and Methods

The regression equation of effective dose and dose area product (DAP) was introduced from the data of 500 persons including DAP and effective dose calculated using program for X-ray Monte Carlo.

Results

The effective dose was 5.39 mSv of median, 1.18 mSv of minimum, and 38.38 mSv of maximum. The regression equation was Y=0.354+0.0003772X (Y: effective dose, mSv, X: DAP, mGy cm²). Using the regression equation, the effective dose can be estimated from DAP and displayed just after the individual screening.

Conclusions

"Effective dose display system" was constructed to display effective dose immediately after gastric cancer X-ray screening. This system is on the way to be reformed by improving the regression equation on larger data.

Intensities of Incident and Transmitted Ultraviolet-A Rays through Gafchromic Films

Gafchromic films have been applied to X-ray dosimetry in diagnostic radiology. To correct nonuniformity errors in Gafchromic films, X-rays in the double-exposure technique can be replaced with ultraviolet (UV)-A rays. Intensities of the incident and transmitted UV-A rays were measured. However, it is unclear whether the chemical color change of Gafchromic films affects the UV-A transmission intensity. Gafchromic EBT3 films were suitable to be used in this study because non-UV protection layers are present on both sides of the film. The film is placed between UV-A ray light-emitting diodes and a probe of a UV meter. Gafchromic EBT3 films were irradiated by UV-A rays for up to 60 min. Data for analysis were obtained in the subsequent 60 min. Images from before and after UV-A irradiation were subtracted. When using 375 nm UV-A, the mean ± standard deviation (SD) of the pixel values in the subtracted image was remarkably high (11,194.15 ± 586.63). However, the UV-A transmissivity remained constant throughout the 60 min irradiation period. The mean ± SD UV-A transmission intensity was 184.48 ± 0.50 μm/cm². Our findings demonstrate that color density changes in Gafchromic EBT3 films do not affect their UV-A transmission. Therefore, Gafchromic films were irradiated by UV-A rays as a preexposure.

Effective energy measurement using radiochromic film: application of a mobile scanner

The effective energy calculated using the half-value layer (HVL) is an important parameter for quality assurance (QA) and quality control (QC). However constant monitoring has not been performed because measurements using an ionization chamber (IC) are time-consuming and complicated. To solve these problems, a method using radiochromic film (GAFCHROMIC EBT2 dosimetry film (GAF-EBT2) with slight energy dependency errors), a mobile scanner and step-shaped aluminum (SSAl) filter is developed. The results of the method using a mobile scanner were compared with those of the recommended method using an IC in order to evaluate its applicability. The difference ratios of the effective energies by each method using a mobile scanner with GAF-EBT2 were less than 5% compared with results of an IC. It is considered that this method offers a simple means of determining HVL for QA and QC consistently and quickly without the need for an IC dosimeter.

Accuracy assessment methods of tissue marker clip placement after 11-gauge vacuum-assisted stereotactic breast biopsy: comparison of measurements using direct and conventional methods

BACKGROUND

The objective of the study was to compare direct measurement with a conventional method for evaluation of clip placement in stereotactic vacuum-assisted breast biopsy (ST-VAB) and to evaluate the accuracy of clip placement using the direct method.

METHODS

Accuracy of clip placement was assessed by measuring the distance from a residual calcification of a targeted calcification clustered to a clip on a mammogram after ST-VAB. Distances in the craniocaudal (CC) and mediolateral oblique (MLO) views were measured in 28 subjects with mammograms recorded twice or more after ST-VAB. The difference in the distance between the first and second measurements was defined as the reproducibility and was compared with that from a conventional method using a mask system with overlap of transparent film on the mammogram. The 3D clip-to-calcification distance was measured using the direct method in 71 subjects.

RESULTS

The reproducibility of the direct method was higher than that of the conventional method in CC and MLO views (P = 0.002, P < 0.001). The median 3D clip-to-calcification distance was 2.8 mm, with an interquartile range of 2.0-4.8 mm and a range of 1.1-36.3 mm.

CONCLUSION

The direct method used in this study was more accurate than the conventional method, and gave a median 3D distance of 2.8 mm between the calcification and clip.

Simplified method for creating a density-absorbed dose calibration curve for the low dose range from Gafchromic EBT3 film

Radiochromic film dosimeters have a disadvantage in comparison with an ionization chamber in that the dosimetry process is time-consuming for creating a density-absorbed dose calibration curve. The purpose of this study was the development of a simplified method of creating a density-absorbed dose calibration curve from radiochromic film within a short time. This simplified method was performed using Gafchromic EBT3 film with a low energy dependence and step-shaped Al filter. The simplified method was compared with the standard method. The density-absorbed dose calibration curves created using the simplified and standard methods exhibited approximately similar straight lines, and the gradients of the density-absorbed dose calibration curves were −32.336 and −33.746, respectively. The simplified method can obtain calibration curves within a much shorter time compared to the standard method. It is considered that the simplified method for EBT3 film offers a more time-efficient means of determining the density-absorbed dose calibration curve within a low absorbed dose range such as the diagnostic range.

Correction of nonuniformity error of Gafchromic EBT2 and EBT3

This study investigates an X‐ray dose measurement method for computed tomography using Gafchromic films. Nonuniformity of the active layer is a major problem in Gafchromic films. In radiotherapy, nonuniformity error is reduced by applying the double‐exposure technique, but this is impractical in diagnostic radiology because of the heel effect. Therefore, we propose replacing the X‐rays in the double‐exposure technique with ultraviolet (UV)‐A irradiation of Gafchromic EBT2 and EBT3. To improve the reproducibility of the scan position, Gafchromic EBT2 and EBT3 films were attached to a 3‐mm‐thick acrylic plate. The samples were then irradiated with a 10 W UV‐A fluorescent lamp placed at a distance of 72 cm for 30, 60, and 90 minutes. The profile curves were evaluated along the long and short axes of the film center, and the standard deviations of the pixel values were calculated over large areas of the films. Paired t‐test was performed. UV‐A irradiation exerted a significant effect on Gafchromic EBT2 (paired t‐test; p=0.0275) but not on EBT3 (paired t‐test; p=0.2785). Similarly, the homogeneity was improved in Gafchromic EBT2 but not in EBT3. Therefore, the double‐exposure technique under UV‐A irradiation is suitable only for EBT2 films.

PACS number(s): 87.53 Bn

Relationship between Bone Mineral Density and Body Composition Estimated by Dual-Energy X-ray Absorptiometry: Comparison between Groups Aged 20-39 and 40-59 Years

Bone mineral density (BMD) is affected by lean body mass and body weight to various degrees in the course of aging. The attempt of this study is to determine the optimal time to begin prevention of osteoporosis. In this study, female hospital employees aged 20-59 years were divided into 2 age groups, 20-39 years and 40-59 years based on age at peak BMD, and the relations of total BMD, subtotal BMD and lumbar spine BMD to lean body mass and body weight were examined in both groups. Subtotal BMD was calculated by subtracting head BMD from total BMD along with whole body measurement. While persistent positive correlations were found among all factors in the 20-39-year-old group, subtotal BMD and lumbar spine BMD were positively correlated to lean body mass in the 40-59-year-old group. Thus, lean body mass and body weight appeared to exert a profound influence on subtotal BMD in those aged 20-39 years, but lean body mass in those aged 40-59 years. Lean body mass appears to provide the best prediction of subsequent development of osteoporosis.

Comparing three UV wavelengths for pre-exposing Gafchromic EBT2 and EBT3 films

Gafchromic films are used for X‐ray dose measurements during diagnostic examinations and have begun to be used for three‐dimensional X‐ray dose measurements using the high‐resolution characteristics of Gafchromic films for computed tomography. However, the problem of unevenness in Gafchromic film active layers needs to be resolved. Double exposures using X‐rays are performed during therapeutic radiology, although this is difficult for a diagnostic examination because of a heel effect. Thus, it has been suggested that ultraviolet (UV) radiation be used as a substitute for X‐rays. However, the appropriate UV wavelength has not been determined. Thus, we conducted this study to decide an appropriate UV wavelength. UV peak wavelengths of 245 nm (UV‐A), 310 nm (UV‐B), and 365 nm (UV‐C) were used to irradiate EBT2 and EBT3 films. Each UV wavelength was irradiated for 5, 15, 30, and 60 min, and irradiation was then repeated every 60 min up to 360 min. Gafchromic films were scanned after every irradiation using a flatbed scanner. Images were split into RGB images, and red images were analyzed using ImageJ, version 1.44, image analysis software. A region of interest (ROI) one‐half inch in diameter was placed in the center of subtracted Gafchromic film images, and UV irradiation times were plotted against mean pixel values. There were reactions in the front and back of Gafchromic EBT3 and the back of Gafchromic EBT2 with UV‐A and UV‐B. However, UV‐C resulted in some reactions in both sides of Gafchromic EBT2 and EBT3. The UV‐A and UV‐B wavelengths should be used.

PACS number(s): 87.53 Bn

Ultraviolet exposure of Gafchromic XR-RV3 and XR-SP2 films

Gafchromic film has been used for X-ray dose measurement in diagnostic examinations. Their use has been initiated for three-dimensional X-ray dose measurement by using the high-resolution characteristics of Gafchromic films in computed tomography. However, it is necessary to solve the problem of nonuniform thickness in the active layers of Gafchromic films. A double exposure technique using X-rays is performed in therapeutic radiology; it is difficult to use in a diagnostic examination because of the heel effect. Therefore, it is suggested that ultraviolet (UV) rays be substituted for X-rays. However, the appropriate UV wavelength is unknown. In this study, we aimed to determine which UV wavelengths are effective to expose Gafchromic XR-RV3 and XR-SP2. UV lamps with peak wavelengths of 245 nm, 310 nm, and 365 nm were used. The three UV wavelengths were used to irradiate Gafchromic XR-RV3 and XR-SP2 films for 60 min, and irradiation was repeated every 60 min for 600 min thereafter. Films were scanned after each irradiation period on a flatbed scanner. The images were split into their red-green-blue components, and red images were stored using ImageJ version 1.44o image analysis software. Regions of interest (ROI), 0.5 inches in diameter, were placed at the centers of the subtracted Gafchromic film images, and graphs of UV irradiation duration and mean pixel values were plotted. There were reactions to UV-A on both Gafchromic XR-RV3 and XR-SP2; those to UV-B were moderate. However, UV-C demonstrated few reactions with Gafchromic XR-RV3 and XR-SP2. From these results, irradiation with UV-A may be able to correct nonuniformity errors. Uniform UV-A irradiation of Gafchromic films with large areas is possible, and UV rays can be used as a substitute for X-rays in the double exposure technique.

Effectiveness of the new injection program 'saline test injection mode' for use power injector in pediatric contrast CT

To improve the safety of the use of a power injector for pediatric contrast CT, we newly developed a saline test injection mode for a power injector and investigated its usefulness. We used an injection route and investigated the relationship of the injection pressure to the injection rate of saline and the contrast medium. From this relationship, we investigated it was possible to estimate the change of pressure injection of contrast medium from the pressure change of saline injection. The correlation between the saline test injection pressure and the contrast medium injection pressure was investigated in 64 clinical cases. The detection rate of side effects from the saline test injection was investigated in 473 patients. Regarding the correlation between the injection rate and pressure for both saline and contrast, the pressure rose as the rate increased. The contrast medium injection pressure could be estimated from the correlation observed with saline. The clinical data were obtained had a relationship similar to that with phantom data. The detection rate of side effects from the saline test injection was 4.4% in the clinical cases. In these cases, examinations were completed by re-establishing an injection route or administering hypnotics. Our results suggest that contrast medium pressure can be estimated from a saline test injection, thus aiding in prediction of the risk of injection abnormality. Reactions to injections could be observed in the present study, facilitating the prevention of examination failure. Countermeasures can be taken against the cause of the reaction, and the examination can be performed after confirming the absence of a reaction to injection. Therefore, a saline test injection may be useful in pediatric contrast CT.

Evaluation of GAFCHROMIC EBT2 dosimetry for the low dose range using a flat-bed scanner with the reflection mode

Recently developed radiochromic films can easily be used to measure absorbed doses because they do not need development processing and indicate a density change that depends on the absorbed dose. However, in GAFCHROMIC EBT2 dosimetry (GAF-EBT2) as a radiochromic film, the precision of the measurement was compromised, because of non-uniformity problems caused by image acquisition using a flat-bed scanner with a transmission mode. The purpose of this study was to improve the precision of the measurement using a flat-bed scanner with a reflection mode at the low absorbed dose dynamic range of GAF-EBT2. The calibration curves of the absorbed dose versus the film density for GAF-EBT2 were provided. X-rays were exposed in the range between ~0 and 120 mGy in increments of about 12 mGy. The results of the method using a flat-bed scanner with the transmission mode were compared with those of the method using the same scanner with the reflection mode. The results should that the determination coefficients (r (2) ) for the straight-line approximation of the calibration curve using the reflection mode were higher than 0.99, and the gradient using the reflection mode was about twice that of the one using the transmission mode. The non-uniformity error that is produced by a flat-bed scanner with the transmission mode setting could be almost eliminated by converting from the transmission mode to the reflection mode. In light of these findings, the method using a flat-bed scanner with the reflection mode (only using uniform white paper) improved the precision of the measurement for the low absorbed dose range.

Measurements and evaluation of proximal femoral bone mineral density with dual energy X-ray absorptiometry

Proximal femoral bone mineral density (BMD) can be measured by dual energy X-ray absorptiometry method in the neck, trochanter, intertrochanter, total and Ward's triangle area. Ward's triangle area of the proximal femur is a smaller area to measure than the others, and the position varies, depending on the status of inner rotation of the target leg. In this study, the measurements of the proximal femoral BMD in women were carried out on the neck, trochanter, intertrochanter, total and Ward's triangle area with the, subjects' legs turned 15 degrees toward the inside. The Ward's BMD were measured using Ward's cognitive method, in which the measured BMD were compared among age groups of 50-59, 60-69, 70-79 and 80-89 to determine whether this process could reveal decreased femoral BMD in elderly women. The correlation between BMD and age was tested using the Pearson correlation coefficient. In all measured parts, the BMD of women age 50-59 were significantly higher than those of women age 80-89. The correlations between BMD and age were negative in all measured parts, and the most negative correlation was between age and Ward's BMD. The study using Ward's cognitive method showed an inverse correlation between Ward's BMD and age in women.

Diagnostic validity of high-density barium sulfate in gastric cancer screening: follow-up of screenees by record linkage with the Osaka Cancer Registry

Background

The use of high-density barium sulfate was recommended by the Japan Society of Gastroenterological Cancer Screening (JSGCS) in 2004. We evaluated the diagnostic validity of gastric cancer screening that used high-density barium sulfate.

Methods

The study subjects were 171 833 residents of Osaka, Japan who underwent gastric cancer screening tests at the Osaka Cancer Prevention and Detection Center during the period from 1 January 2000 through 31 December 2001. Screening was conducted using either high-density barium sulfate (n = 48 336) or moderate-density barium sulfate (n = 123 497). The subjects were followed up and their medical records were linked to those of the Osaka Cancer Registry through 31 December 2002. The results of follow-up during 1 year were defined as the gold standard, and test performance values were calculated.

Results

The sensitivity and specificity of the screening test using moderate-density barium sulfate were 92.3% and 91.0%, respectively, while the sensitivity and specificity of the high-density barium test were 91.8% and 91.4%, respectively. The results of area under receiver-operating-characteristic (ROC) curve analysis revealed no significant difference between the 2 screening tests.

Conclusions

Screening tests using high- and moderate-density barium sulfate had similar validity, as determined by sensitivity, specificity, and ROC curve analysis.

Half-value layer measurement: simple process method using radiochromic film

Although the half-value layer (HVL) is one of the important parameters for QA and QC, constant monitoring has not been performed because the measurements using an ionization chamber (IC) are time-consuming and complicated. To solve these problems, the use of radiochromic film (GAFCHROMIC XR TYPE R: GAF-R) with step-shaped aluminum (Al) filters, referred to herein as the simple process method, has been developed. The measurement X-ray tube voltages were 120 kV, 100 kV, and 80 kV. The Al filter area, the full exposure area, and the unexposed area were set on the GAF-R so as to obtain correct data. The HVL was evaluated using the density attenuation ratio. The HVLs obtained using the GAF-R and an 1C dosimeter were compared. HVLs with X-ray tube voltages of 120 kV, 100 kV, and 80 kV using the GAF-R were 4.10 mm, 3.55 mm and 2.97 mm, respectively. The difference ratios of the HVLs using the GAF-R and the IC were 1.2%, 7.6%, and 10.0%, respectively. The HVL at 120 kV can be routinely and quickly measured using the simple process method. Therefore, an IC dosimeter is not needed for HVL measurements for QA and QC. However, the HVL measurements of low energy (100 kV and 80 kV) need attention.

Film-reading ability of radiographers in detecting gastric cancer during screening using X-ray examination

PURPOSE

The aim of this study was to evaluate the film-reading ability of radiographers in detecting gastric cancer during screening X-ray examinations.

MATERIALS AND METHODS

A test set of 100 patients (50 negative and 50 positive; mean age 62 years, range 33-78 years) given a stomach X-ray examination were selected from those who underwent gastric cancer screening in Osaka, Japan, between 2000 and 2003. Eleven radiographers and four radiologists scored the test set on a five-point scale. A receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was defined as a measure of film-reading ability to detect cancer.

RESULTS

No significant difference (two-tailed P = 0.962, Welch's t-test) was observed between averaged AUC values from radiographers (0.76, range 0.85-0.62) and radiologists (0.75, range 0.86-0.62).

CONCLUSION

Film-reading ability of radiographers in detecting gastric cancer during screening X-ray examinations was not significantly different from that of radiologists. Our results suggest that radiographers can assist radiologists to detect gastric cancer during screening.

High resolution T2 weighted liver MR imaging using functional residual capacity breath-hold with a 1.0-Tesla scanner

PURPOSE

During acquisition of rapid high resolution (HR) T2 weighted (T2W) liver magnetic resonance (MR) images using a 1.0-Tesla (T) scanner, the liver is segmented into odd and even sections that are acquired at two different times using the multi-breath-hold (MBH) strategy. Misalignment between the two breath-hold (B-H) images may result in the occurrence of a blind area and a decrease in diagnostic accuracy. Here, a functional residual capacity (FRC) B-H method was developed to overcome this problem.

MATERIAL AND METHODS

Twenty-five volunteers were enrolled. The sagittal images were reconstructed from whole liver transverse images. When the B-H phases are different, misalignment may occur in the craniocaudal and anterior-posterior (AP) directions. In this study, misalignments of the abdominal wall were measured in the AP direction. The misalignment was compared between four B-H phases, maximum inspiration (MI), maximum expiration (ME), voluntary expiration (VE) and FRC using one-way repeated measures ANOVA. Differences between groups were compared using the t-test for multi-group comparisons. In addition, qualitative analysis of misalignment was performed between VE and FRC in 52 clinical patients and the chi(2) test was performed.

RESULTS

The misalignment widths of FRC, ME, MI and VE B-Hs were 2.7+/-3.8, 6.4+/-7.4, 9.1+/-8.4 and 6.0+/-6.7 mm, respectively. Misalignment of the liver position using FRC was significantly smaller than for the other B-H methods (p<0.05). Significant differences between the VE B-H and FRC B-H were also observed in the qualitative analysis (p<0.05).

CONCLUSION

The liver positions obtained when using FRC B-H were significantly more reproducible than when using the other B-H methods. The FRC B-H method resulted in a reduction in the blind area and an extension of the diagnostic area to the whole liver.

[Subtraction image for dynamic liver MRI using free breath-hold at functional residual capacity: a clinical trial]

PURPOSE

Dynamic liver MRI images have been obtained under expiration breath holding (BH). However, problems with obtaining reproducible liver positions often observed. This study investigated ways to improve the reproducibility of liver position on dynamic liver MRI.

MATERIALS AND METHODS

After giving informed consent, 60 patients (32 males and 28 females, ages 33-85, median age 69) were examined by liver dynamic MRI under two types of BH. The BH phases were voluntary expiration (VE) phase without any explanations and functional residual capacity (FRC) phase after careful explanation was provided. Plain images, arterial phase images, portal phase images and parenchymal phase images were obtained. For statistical evaluation of reproducibility, the area of the 2nd or 3rd images from top of the liver was measured in each phase using a threshold value of half maximum. Misregistration areas were calculated by finding the remainder of the liver area in the plain-arterial (Pl-A) phase, arterial-portal (A-Po) phase, plain-parenchymal (Pl-Pa) phase. Contingency table analysis was done due to the misregistration was occurred or not.

RESULTS

Misregistration of liver image on the VE and the FRC of three phase types were statistical significant on the Pl-A (p < 0.01), on the A-Po (p < 0.01) and on the Pl-Pa (p < 0.05), respectively.

CONCLUSION

The FRC phase following careful explanation of the BH provided significantly improved reproducibility of liver position on dynamic liver MRI. Therefore, precise subtraction images could be obtained for routine clinical examinations without slice matching.

Functional residual capacity breath hold for subtraction image of dynamic liver MRI

PURPOSE

In dynamic liver magnetic resonance imaging (MRI) studies, there are problems with misregistration when subtraction images are processed. For reduction of the misregistration, a functional residual capacity (FRC) phase breath-hold (FRC B-H) method was used.

MATERIAL AND METHODS

Sixty patients (32 males and 28 females, aged 33-85 years, median age 69 years) were examined. The subjects were chronologically categorized into two groups: a voluntary expiratory (VE) B-H group and a FRC B-H group. The blood-flow phase images were classified as plain, arterial, portal and parenchymal phases. To evaluate the reproducibility of liver positions between VE B-H and FRC B-H in each phase (between Plain and Arterial, Arterial and Portal, Plain and Parenchymal), the misregistration areas were compared on the top of the liver.

RESULTS

The misregistration area between Plain-Arterial, Arterial-Portal and Plain-Parenchymal in VE B-H was 731.0+/-1153.6, 1134.9+/-1357.2 and 628.4+/-844.5 (cm(2)), respectively. The misregistration area between each phase in FRC B-H was 386.4+/-874.9, 574.5+/-1086.1 and 279.8+/-551.2 (cm(2)), respectively. Using the Mann-Whitney U-test as quantitative analysis, the difference in misregistration areas between two groups was statistically significant (p<0.05). Differences in the qualitative analysis were also significant according to the chi(2) test (p<0.05).

CONCLUSION

The liver positions with FRC B-H were markedly more reproducible than those with VE B-H. To improve the registration accuracy of subtraction dynamic liver MRI, the FRC B-H should be used.

Sonographic examination of the appendix in acute infectious enteritis and acute appendicitis

PURPOSE

To use transabdominal sonography to determine the frequency of visualization of the adult normal appendix in patients with suspected acute infectious enteritis (AIE) compared with patients with acute appendicitis (AA) and a control group.

METHODS

A total of 296 patients divided into 3 different groups underwent sonographic examination, including 120 randomly selected asymptomatic patients, 91 consecutive patients with AIE, and 85 consecutive patients with AA. In the 3 groups, visualization rate, outer appendiceal diameter, presence or absence of inflamed periappendiceal fat, and location of the appendix were recorded.

RESULTS

The visualization rates of the appendix were 49.2%, 70.3%, and 96.5% for the control, AIE, and AA groups, respectively (P < 0.05). The mean +/- SD outer appendiceal diameters for the 3 groups were 4.5 +/- 1.2 mm, 4.5 +/- 1.4 mm, and 7.9 +/- 2.0 mm, respectively. The difference between outer appendiceal diameter in the control and AIE groups was not statistically significant. Periappendiceal inflamed fat was detected in all AA cases, but in none of the AIE cases.

CONCLUSION

The appendix was visualized more often in patients with AIE than in the control group, although the outer appendiceal diameter of the AIE group was not significantly different from that of the normal appendix seen in the control group.

Sonographic visualization of the normal stomach: left lateral decubitus position

The aim of this study was to evaluate the usefulness of an imaging technique that takes into account the effect of posture change on the stomach in transabdominal ultrasonography (US). A total of 240 adult patients (healthy subjects) underwent gastric US. In all subjects, the lesser curvature of the stomach (LCS) and left liver were measured in two different positions [left lateral decubitus (LLD) and supine]. The maximal length of the LCS was defined as the measured range between the cardial orifice and the left liver tip. The anteroposterior length (L1) and maximal longitudinal length (L2) of the left liver were determined on epigastric longitudinal scans. The mean LCS in the supine and LLD positions was 90.2 +/- 34.7 and 124.4 +/- 44.4 mm, respectively. The mean L1 in the supine and LLD positions was 54.0 +/- 12.7 and 65.6 +/- 14.4 mm, respectively. The mean L2 in the supine and LLD positions was 84.3 +/- 18.5 and 107.0 +/- 25.8 mm, respectively. The results for the measured LCS, L1, and L2 differed significantly between the supine and LLD positions (P < 0.05). This study demonstrated that the LCS could be clearly visualized on longitudinal scanning in the LLD position. Therefore, this position may potentially be more useful for gastric US, even in view of the limitations of this approach.

[Examination of patient skin dose during abdominal interventional radiology using a GAF system]

Radiation-induced skin injury caused by interventional radiology(IVR)is a deterministic effect. If exposure dose exceeds threshold dose, injuries may occur. It therefore is important to understand the maximum exposure dose in skin. The purpose of this study was to determine the maximum exposure dose and its dose distribution. Moreover, to analyze the factors from measuring the absorbed dose in the incoming radiation side, a film-type dosimeter was used. When the measured results were determined in terms of the clinical aspect, fluoroscopic time(total time)in procedure, it ranged from 3.3 to 64.0 minutes, and DSA images obtained ranged from 8 to 280 images. Absorbed dose ranged from 0.3 to 6.0 Gy, with an average dose of 3.2 Gy. It thus exceeded 2 or 3 Gy, which was the threshold dose of temporary erythematic or depilation in 10 of 14 cases. The maximum dose was 6.0 Gy for a procedure of percutaneous transhepatic obliteration. The maximum exposure dose can be determined objectively by using a film-type dosimeter. It was also possible to grasp the overall dose distribution visually.

Sonographic appearance of the normal appendix in adults

OBJECTIVE

To evaluate the sonographic visualization of the normal adult appendix, a large series of sonographic images from consecutive asymptomatic patients was analyzed.

METHODS

A total of 788 consecutive adult patients (402 male and 386 female; median age +/- SD, 51.1 +/- 17.2 years; range, 16-91 years) were examined by appendiceal transabdominal sonography with tissue harmonic imaging. The detection rate, outer appendiceal diameter, intraluminal content, and location of the appendix were estimated. The overall normal appendix was separated into appendix-visualized and appendix-not-visualized groups, which were then examined for the relationship with abdominal wall thickness, body mass index (in kilograms per square meter), age, and sex.

RESULTS

The normal appendix was detected in 388 (49.2%) of 788 patients. The outer appendiceal diameter +/- SD was 4.27 +/- 1.2 mm (range, 1.0-11.1 mm). In 291 (75%) of the 388 patients, appendices could be depicted in the intra-luminal gas during sonography. The location of the appendix was classified according to the appendiceal tip, which was found to be abdominal in 37 (9.5%), pelvic in 291 (75%), retrocecal in 23 (6.0%), and a midline extension in 37 (9.5%). In both body mass index and abdominal wall thickness, significant differences were found between appendix-visualized and appendix-not-visualized cases (P < .05). There was no significant difference in age (P = .37) or sex (P = .23) between appendix-visualized and appendix-not-visualized cases.

CONCLUSIONS

The results show that the normal adult appendix can be revealed by sonographic visualization in a large series of asymptomatic patients.

Usefulness of a pulse oximeter for enhancing breath holding in hepatic subtraction angiography

This study examined the usefulness of a pulse oximeter in hepatic digital subtraction angiography (DSA) with oxygen administration for breath holding. Oxygen saturation and dissociation times were measured using a pulse oximeter. Twenty-eight patients inhaled oxygen at a rate of 3 liters/min through a nasal tube. Saturation times ranged from 0 to 140 seconds to achieve arterial oxygen-hemoglobin saturation of almost 100%. Dissociation times ranged from 0 to 600 seconds after oxygen termination.

Verification imaging using a computed radiography system for high-energy electron beam therapy

PURPOSE

The aim of this study was to examine a method to more conveniently acquire verification images. A computed radiography (CR) system was employed using a photostimulable phosphor plate and diagnostic cassette used for taking diagnostic X-ray photographs.

MATERIALS AND METHODS

Verification images were acquired using the diagnostic cassette and therapy cassette. Image processing parameters were adjusted to improve the image quality. Verification images were printed using optimum parameters, and 10 radiation technicians visually evaluated the images. The sign test was used, and image quality was evaluated using a two-sided test at a 5% level of significance. To assess its clinical value, a radiation oncologist evaluated patient verification images.

RESULTS

Verification image quality was improved by the adjustment of image processing parameters. As a result of the image quality evaluation, there were no significant differences between the two types of cassette (p>0.05). In most of the clinical cases (98%), the verification images were useful.

CONCLUSION

We found that good quality verification images were acquired by a CR system with a diagnostic cassette. This system is suitable for practical use to acquire daily verification images, and it is considered useful for maintaining quality assurance (QA) in high-energy electron beam therapy.

Beneficial effect of angiotensin-converting enzyme inhibitor on dilated cardiomyopathy induced by autoimmune mechanism against beta1-adrenoceptor

We have shown that a peptide corresponding to the sequence of the second extracellular loop of the human beta1-adrenoceptor (beta1-peptide) was able to induce an autoimmune cardiomyopathy in rabbits. In this study, we examined the effect of angiotensin-converting enzyme inhibitor (ACEI) on beta1-peptide-induced cardiomyopathy. Rabbits were divided into four groups: (1) control group (n= 6) receiving saline injection; (2) beta1-peptide group (n = 8) immunized with beta1-peptide; (3) ACEI group (n = 6), lisinopril (3 mg/day) given orally and receiving saline injection; and (4) ACEI + beta1-peptide group (n = 7), lisinopril (3 mg/day) given orally and immunized with beta1-peptide. Our results showed that, after 1 year, all rabbits in the beta1-peptide group had an increase in heart weight, wall thinning and dilatations of both ventricles as compared with rabbits in the ACEI + beta1-peptide group that had normal heart weight and shape. All rabbits in the beta1-peptide group exhibited multifocal degeneration and necrosis of myocardial cells with moderate infiltration of inflammatory cells. In the ACEI + beta1-peptide group, three rabbits showed focal degeneration and necrosis of myocardial cells accompanied by mononuclear cells. The lesions in this group were apparently less marked than those in the beta1-peptide group. In conclusion, ACEI protects the myocardium from injury induced by an autoimmune mechanism against beta1-adrenoceptor.

Light intensity distribution in the externally illuminated cylindrical photo-bioreactor and its application to hydrogen production by Rhodobacter capsulatus

The light distribution in the externally illuminated cylindrical photo-bioreactor for production of hydrogen by a photosynthetic bacterium Rhodobacter capsulatus ST-410 was estimated. The estimation was performed on the basis of the Matsuura and Smith's diffuse model [1]. In the diffuse model, the incident light rays are assumed to proceed in every direction and the local intensity is calculated as the sum of the intensities of light. Since Lambert-Beer's law, extensively used in photometry, was not useful for explaining the decrease in the intensity of light by the biomass, an empirical expression was used. The measurement of the intensities from every direction was conducted in an externally illuminated cylindrical photo-bioreactor having an inner diameter of 60mm and a working volume of 550ml. The obtained results confirmed our estimation. The light distribution was applied to estimate the hydrogen production by R. capsulatus ST-410 using the same photo-bioreactor. The overall hydrogen-production rate was successfully estimated.

Effects of Ethanolamine as a nitrogen source on hydrogen production by Rhodobacter capsulatus

Ethanolamine was examined as a nitrogen source in the production of hydrogen by Rhodobacter capsulatus ST-410, a hydrogenase-deficient mutant of the strain B-100. It was found that ethanolamine supports cell growth as the sole nitrogen source and permits a large amount of hydrogen evolution, detected at 138 micromol/ml-culture from 3.5 mM ethanolamine and 30 mM DL-malate. The amount corresponded to a stoichiometric yield of 77% and was close to that obtained from 7.0 mM L-glutamate and 30 mM DL-malate. The hydrogen evolution rate per unit biomass (cells) was higher than that with L-glutamate, and the cells grown with ethanolamine had higher nitrogenase activity than the cells grown with L-glutamate. In terms of bioconversion of cellulosic and hemicellulosic biomass to hydrogen, D-glucose, D-xylose, and D-cellobiose were tested as substrates. The results indicated that those sugars permit a large evolution of hydrogen through cultivation with ethanolamine as a nitrogen source. For instance, the cells grown with 3.5 mM ethanolamine evolved hydrogen of 289 micromol/ml-culture (80% yield) from 30 mM D-glucose under a controlled pH of 6.4 to 6.9.

Oxygen administration during hepatic DSA

The research presented in this article examined the role of oxygen in preventing diaphragmatic motion artifacts in delayed-phase hepatic digital subtraction angiography (DSA). The results demonstrate that administering oxygen to patients before the examination substantially reduces artifacts due to motion.