Anthropomorphic breast phantoms for assessing ultrasonic imaging system performance and for training ultrasonographers: part II

Three prototype anthropomorphic breast phantoms are discussed. The phantoms were constructed using ultrasonically tissue-mimicking materials; these materials mimic various tissue parenchymae in terms of attenuation, speed of sound, density, and scatter level. Realistic artifacts related to refraction and reflection at interfaces between different simulated parenchymae are produced. The phantoms represent premenopausal breasts, and they complement one another. Two of them represent the dense breasts of women under 30 years of age, and one represents that of a woman between 35 and 40 years of age. Of the former two, one produces what is apparently above-average refraction effects in the region of the peripheral fat layer; the other produces more typical refraction effects. Simulated tumors, cysts, and calcifications of various sizes are suspended in the glandular regions. Such phantoms are valuable for use in developmental testing of state-of-the-art ultrasound machines, quality assurance testing of clinical machines, and training of sonographers in breast imaging.     

Boron-11 imaging with a three-dimensional reconstruction method.

A three-dimensional projection reconstruction technique is described for imaging boron-11 distributions, with potential application to boron neutron capture therapy. The method samples a spherical volume of k space uniformly to obtain a 32 x 32 x 32 matrix with voxel size of 0.42 cm3. A signal-to-noise ratio (S/N) of 3 was obtained in 8.5 minutes in a phantom containing 75 micrograms/mL of boron in borocaptate sodium (BSH). Images were obtained in a dog after cessation of an intravenous infusion of BSH and again 30 minutes later, with a maximum boron S/N of about 12. Boron levels in the brain dropped about 6%-8% and were more diffusely distributed on the images obtained 30 minutes after BSH infusion.     

Visualizing three-dimensional flow with simulated streamlines and three-dimensional phase-contrast MR imaging.

Three-dimensional (3D) velocity maps acquired with 3D phase-contrast magnetic resonance (MR) imaging contain information regarding complex motions that occur during imaging. A technique called simulated streamlines, which facilitates the display and comprehension of these velocity data, is presented. Single or multiple seed points may be identified within blood vessels of interest and tracked through the velocity field. The resulting trajectories are combined with a 3D MR angiogram and displayed with 3D volume visualization software. Mathematical analysis highlights potential applications and pitfalls of the technique, which was implemented both in phantoms and in vivo with excellent results. For example, single streamlines reveal helical flow patterns in aneurysms, and multiple streamlines seeded in the common carotid artery reveal branch filling-time relationships and slow filling of the carotid bulb. The technique is helpful in understanding these complex flow patterns.     

Effective Dose of CT- and Fluoroscopy-Guided Perineural/Epidural Injections of the Lumbar Spine: A Comparative Study

The objective of this study was to compare the effective radiation dose of perineural and epidural injections of the lumbar spine under computed tomography (CT) or fluoroscopic guidance with respect to dose-reduced protocols. We assessed the radiation dose with an Alderson Rando phantom at the lumbar segment L4/5 using 29 thermoluminescence dosimeters. Based on our clinical experience, 4–10 CT scans and 1-min fluoroscopy are appropriate. Effective doses were calculated for CT for a routine lumbar spine protocol and for maximum dose reduction; as well as for fluoroscopy in a continuous and a pulsed mode (3–15 pulses/s). Effective doses under CT guidance were 1.51 mSv for 4 scans and 3.53 mSv for 10 scans using a standard protocol and 0.22 mSv and 0.43 mSv for the low-dose protocol. In continuous mode, the effective doses ranged from 0.43 to 1.25 mSv for 1–3 min of fluoroscopy. Using 1 min of pulsed fluoroscopy, the effective dose was less than 0.1 mSv for 3 pulses/s. A consequent low-dose CT protocol reduces the effective dose compared to a standard lumbar spine protocol by more than 85%. The latter dose might be expected when applying about 1 min of continuous fluoroscopy for guidance. A pulsed mode further reduces the effective dose of fluoroscopy by 80–90%.     

MRI quality control: six imagers studied using eleven unified image quality parameters

Quality control of the magnetic resonance imagers of different vendors in the clinical environment is non-harmonised, and comparing the performance is difficult. The purpose of this study was to develop and apply a harmonised long-term quality control protocol for the six imagers in our organisation in order to assure that they fulfil the same basic image quality requirements. The same Eurospin phantom set and identical imaging parameters were used with each imager. Values of 11 comparable parameters describing the image quality were measured. Automatic image analysis software was developed to objectively analyse the images. The results proved that the imagers were operating at a performance level adequate for clinical imaging. Some deficiencies were detected in image uniformity and geometry. The automated analysis of the Eurospin phantom images was successful. The measurements were successfully repeated after 2 weeks on one imager and after half a year on all imagers. As an objective way of examining the image quality, this kind of comparable and objective quality control of different imagers is considered as an essential step towards harmonisation of the clinical MRI studies through a large hospital organisation.     

Comparison of velocity-encoded MR imaging and fluid dynamic modeling of steady and disturbed flow.

The contrast of flow-encoded magnetic resonance (MR) images obtained in vivo and the accuracy of velocity measurements are complicated by the presence of complex flow states. The effects of complex flow states on MR flow-encoded images were studied and quantitative flow information was obtained with an MR phase-subtraction technique. Regions of complex flow, including flow stagnation and separation and laminar flow, could be clearly identified on the phase images. The MR imaging velocity measurements were validated by comparison with numerical simulation results for three-dimensional velocity distributions. The velocity MR images and the profiles obtained from the simulation generally agreed well for flow rates of 660 and 1,680 mL/min. This agreement lends support to both the fluid dynamic model and the physical basis of the phase imaging technique and establishes the validity of flow-encoded phase imaging as an in vivo flow quantitation method, especially under low Reynolds number flow conditions.     

Ultra-low-dose coronary artery calcium screening using multislice CT with retrospective ECG gating

The aim of this study was to reduce radiation exposure in multislice CT (MSCT) coronary artery calcium screening using different tube settings, and to determinate its impact on the detection and quantification of coronary artery calcification. Forty-eight patients underwent routine MSCT coronary artery calcium scoring (Somatom VolumeZoom, Siemens, Forchheim, Germany) with retrospective ECG-gated data acquisition. Scanning was performed with a 4×2.5-mm collimation. In each patient data acquisition was performed twice using tube settings of 120 kVp with 133 mAs (protocol 1) and of 80 kVp with 300 mAs (protocol 2). Together with the 80-kVp protocol additional online ECG-related tube current modulation (ECG pulsing) was used. Three-millimeter overlapping slices (increment 1.5 mm) were calculated for each data set. Semi-automated calcium quantification was performed calculating absolute Ca-hydroxylapatite mass. In addition to patient examinations, the radiation exposure for both protocols was evaluated using computed tomography dose index (CTDI) phantom measurements. Protocol 2 showed a significantly lower patient radiation exposure than protocol 1 (0.72 vs 2.04 mSv; p<0.0001). The CTDI phantom measurements revealed a 65% reduction of radiation dose. Calcium scoring results of both protocols showed a high correlation (r=0.99; p<0.0001) for absolute Ca-Hydroxylapatite mass measurements. Using 80-kVp protocols patient radiation exposure can be significantly reduced in MSCT coronary artery calcium screening without affecting the detection and quantification of coronary artery calcification; therefore, this technique should be used with retrospective ECG-gated cardiac CT examinations in patients with regular sinus rhythm.     

MR angiography with a cardiac-phase--specific acquisition window.

A method for cardiac-phase-specific magnetic resonance (MR) angiography is presented. An electronics module permits incrementing of phase-encoding gradients and storage of incoming data only during a chosen portion of the cardiac cycle. Suppression of stationary material is maintained by delivering radio-frequency pulses at constant TR throughout the cycle. Imaging of a pulsatile flow phantom demonstrates that acquiring data only during systole substantially increases the signal intensity of flowing material. In addition, phase-encoding ghost artifacts are eliminated from the neighborhood of the vessel. Image acquisition time is minimized by acquiring only the low-frequency phase-encoding lines in the cardiac-phase-specific mode. In healthy volunteers, greatly improved MR angiograms of the lower extremities are obtained. Fat saturation and magnetization transfer further enhance vessel/background contrast. Acquiring data only during systole ensures rapid inflow for all phase-encoding lines, permitting a near-longitudinal section orientation without in-plane saturation. This substantially reduces total acquisition time relative to axial acquisition.     

Artifactual echoes in B-mode images due to multiple scattering

In B-mode images, echoes, which appear to arise from inherently anechoic regions due to scattering from neighbouring echogenic regions, can be considered artifactual. We have observed multiple scatter contributions to such artifactual echoes in images of plane boundaries between random scattering phantoms and anechoic regions. For the strongest scattering phantom studied, multiple scatter echoes were 3-9% of the average phantom signal using two sharply focused transducers, an annular array in pulse echo mode, and an annular array/cone hybrid. Multiple scatter was less than 5% for a conventional transducer. Echo amplitudes were also measured in normal excised human liver and breast tissue. It was estimated that artifactual echoes due to multiple scatter would be negligible in B-mode images of liver. However, for breast imaging, the level of artifactual echoes was estimated to be similar to that found for our strongest scattering phantom.     

不同附加滤过与管电压和管电流组合对小儿床边X射线摄影图像质量和辐射剂量的影响

目的 探讨小儿床边X射线摄影时,不同附加滤过与管电压、管电流组合条件对图像质量和辐射剂量的影响。方法 利用日本岛津无线平板移动数字化X射线摄影（DR）机和荷兰Artinis公司CDRAD 2.0体模,采用小儿床边日常工作的50 kV管电压、1.40 mAs管电流曝光,得到图像质量因子反数值（IQFInv）。再于移动DR机束光器开口处附加1 mm铝、2 mm铝、1+2 mm铝和0.3 mm铜4种滤过组合,并分别采用50、66、83、100 kV 4种管电压与不同的管电流组合对体模曝光。所有曝光后图像分析得到IQFInv值。采用Pearson相关及回归分析管电压、管电流对IQFInv值的影响,并且找到与日常工作图像质量IQFInv值相当的各附加滤过与管电压、管电流组合。采用瑞典RTI公司Barracuda诊断水平剂量仪,测量各滤过与管电压、管电流组合的入射体表剂量,每种组合测量20次。结果 各种滤过及管电压、管电流组合摄影条件图像质量比较,在测试范围内管电压与IQFInv值呈正相关（r=0.49,P<0.05）;管电流也与IQFInv值呈正相关（r=0.36,P<0.05）。随着附加滤过的增加,需要更大的管电流才能得到所需的图像质量。同时随着附加滤过的增加,各级管电压之间IQFInv值差距加大。各种滤过及管电压、管电流组合摄影条件下,采用附加滤过后入射体表剂量变化范围为（30.58±0.21）~（10.49±0.09）μGy。各组之间差异均有统计学意义（t=-15.306~514.585,P<0.05）。各种附加滤过均能有效减少入射体表剂量。同时随着滤过的增加和管电压的增加,入射体表剂量减少更为明显。但是超过83 kV管电压以后,各种附加滤过的入射体表剂量都呈上升趋势。结论 附加滤过是有效降低小儿床边X射线摄影入射体表剂量的方法。在保证图像质量的前提之下,高原子序数的附加滤过与次高千伏的管电压以及匹配的管电流组合是最优的小儿床边X射线摄影条件。