AAPM medical physics practice guideline 10.a.: Scope of practice for clinical medical physics.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline (MPPG) represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiation requires specific training, skills, and techniques as described in each document. As the review of the previous version of AAPM Professional Policy (PP)-17 (Scope of Practice) progressed, the writing group focused on one of the main goals: to have this document accepted by regulatory and accrediting bodies. After much discussion, it was decided that this goal would be better served through a MPPG. To further advance this goal, the text was updated to reflect the rationale and processes by which the activities in the scope of practice were identified and categorized. Lastly, the AAPM Professional Council believes that this document has benefitted from public comment which is part of the MPPG process but not the AAPM Professional Policy approval process. The following terms are used in the AAPM's MPPGs: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances

Quality care and safety know no borders

The public, governmental agencies, and payers expect medical professional organisations to develop practice guidelines and technical standards. The American College of Radiology proactively addresses these topics as well as other quality and safety interests including appropriateness criteria and accreditation. The College is also actively involved in development of a national radiology data base to collect data regarding quality and safety metrics in multiple areas. In addition, the College has developed RADPEER™, a simple, cost-effective process that allows peer review to be performed during the routine interpretation of current images. This paper discusses the efforts of the ACR in all of these areas

Mamografia digital: performance de equipamentos e prática clínica

Evolução tecnológica: ferramentas de otimização. Controlo da qualidade em mamografia digital. Prática clínica - Aspetos a melhorar: tecnologia e técnica

A review of mammographic positioning image quality criteria for the craniocaudal projection

Detection of breast cancer is reliant on optimal breast positioning and the production of quality images. Two projections, the mediolateral (MLO) and craniocaudal (CC), are routinely performed. Determination of successful positioning and inclusion of all breast tissue is achieved through meeting stated image quality criteria. For the CC view, current image quality criteria are inconsistent. Absence of reliable anatomical markers, other than the nipple, further contribute to difficulties in assessing the quality of CC views. The aim of this paper was to explore published international quality standards to identify and find the origin of any CC positioning criteria which might provide for quantitative assessment. The pectoralis major (pectoral) muscle was identified as a key posterior anatomical structure to establish optimum breast tissue inclusion on mammographic projections. It forms the first two of the three main CC metrics that are frequently reported 1. visualisation of the pectoral muscle, 2. measurement of the posterior nipple line (PNL) and 3. depiction of retroglandular fat. This literature review explores the origin of the three metrics, and discusses three key publications, spanning 1992 to 1994, on which subsequent image quality standards have been based. The evidence base to support published CC metrics is sometimes not specified and more often the same set of publications are cited, most often without critical evaluation. To conclude, there remains uncertainty if the metrics explored for the CC view support objective evaluation and reproducibility to confirm optimal breast positioning and quality images

Compresión Digital en Imágenes Médicas

Imaging technology has long played a principal role in the medical domain, and as such, its use is widespread in the diagnosis and treatment of numerous health conditions. Concurrently, new developments in imaging techniques and sensor technology make possible the acquisition of increasingly detailed images of several organs of the human body. This improvement is indeed advantageous for medical practitioners. However, it comes to a cost in the form of storage and telecommunication infrastructures needed to handle high-resolution images reliably. Ordinarily, digital compression is a mainstay in the efficient management of digital media, including still images and video. From a technical point of view, medical imaging could take full advantage of digital compression technology. However, nuances unique to medical data impose constraints to the application of digital compression in medical images. This paper presents an overview of digital compression in the context of still medical images, along with a brief discussion on related regulatory and legal implications.La Imagenología desempeña un papel protagónico en el campo médico, siendo su uso ampliamente generalizado en el diagnóstico y tratamiento de numerosos trastornos de la salud.Nuevos desarrollos en la adquisición de imágenes y en la tecnología de sensores hacen posible obtener imágenes más detalladas de varios órganos del cuerpo humano. Tal mejora es ciertamente ventajosa para la práctica médica, pero supone un encarecimiento de los recursos tecnológicos necesarios para manejar imágenes de alta resolución de manera confiable. Comúnmente, el manejo eficiente de medios digitales se apoya principalmente en la compresión digital. Desde un punto de vista técnico, las imágenes médicas podrían aprovechar las ventajas de la compresión digital. Sin embargo, peculiaridades de los datos médicos imponen restricciones a su uso. Este artículo presenta un vistazo a la compresión digital en el contexto de las imágenes médicas, y una breve discusión de los aspectos regulatorios y legales asociados a su uso

Signal-to-noise ratio improvements using anti-scatter grids with different object thicknesses and tube voltages

13301乙第65号博士（保健学）金沢大学博士論文本文Ful

Enhancing Representation in Radiography-Reports Foundation Model: A Granular Alignment Algorithm Using Masked Contrastive Learning

Recently, multi-modal vision-language foundation models have gained significant attention in the medical field. While these models offer great opportunities, they still face a number of challenges, such as the requirement for fine-grained knowledge understanding in computer-aided diagnosis and capability of utilizing very limited or no task-specific labeled data in real-world clinical applications. In this study, we present MaCo, a novel multi-modal medical foundation model that explores masked contrastive learning to achieve granular alignment and zero-shot learning for a variety of medical imaging tasks. MaCo incorporates a correlation weighting mechanism to adjust the correlation between masked image patches and their corresponding reports, thereby enhancing the representation learning capabilities. We evaluate MaCo on six well-known open-source X-ray datasets, and the experimental results show it outperforms seven state-of-the-art approaches for classification, segmentation, and zero-shot phase grounding, demonstrating its great potential to promote a wide range of medical image analysis tasks

Requisitos técnicos de um sistema de informação de determinação de parâmetros de exposição radiológicos : para radiografias do tórax e da coluna lombar

A evolução tecnológica dos sistemas de radiologia digital possibilita a diminuição da exposição dos pacientes à radiação. No entanto, se as potencialidades dos mesmos não forem usadas de forma adequada, podem originar exposições elevadas, desnecessárias nos pacientes. De modo a diminuir o erro humano do Técnico de Radiologia na seleção de parâmetros de exposição e a adequar a exposição radiológica do paciente criou-se um Sistema de Informação (SI) que realiza uma estimativa da dose de radiação, na realização de radiografias da coluna lombar, nas incidências de frente e de perfil, e de radiografias do tórax, na incidência postero-anterior (PA), realizadas seguindo as recomendações. A metodologia adotada para a realização deste trabalho teve como base as quatro primeiras fases do Modelo em Cascata. Inicialmente, foi necessário efetuar uma recolha de informação relativa aos parâmetros de exposição utilizados na realização de radiografias da coluna lombar e do tórax, face à antropometria de cada paciente. Esta recolha possibilitou estimar valores de referência de dose de radiação, que serviram de base para a definição dos requisitos técnicos e desenho do SI a desenvolver. De modo a testar o desenho do sistema foi efetuada uma avaliação do mesmo com base num questionário efetuado a sete Técnicos de Radiologia com cerca de 10 anos de experiência profissional e com Mestrado. Os resultados obtidos nesta avaliação permitem considerar que o desenho do SI cumpre os requisitos pré-definidos, estando reunidas todas as condições necessárias do mesmo para a passagem, num trabalho futuro, às restantes fases do Modelo em Cascata de forma a tornar o SI operacional

Diagnostic Reference Levels for digital mammography in Australia

Aims: In 3 phases, this thesis explores: radiation doses delivered to women during mammography, methods to estimate mean glandular dose (MGD), and the use of mammographic breast density (MBD) in MGD calculations. Firstly, it examines Diagnostic reference levels (DRLs) for digital mammography in Australia, with novel focus on the use of compressed breast thickness (CBT) and detector technologies as a guide when determining patient derived DRLs. Secondly, it analyses the agreement between Organ Dose estimated by different digital mammography units and calculated MGD for clinical data. Thirdly, it explores the novel use of MBD in MGD calculations, suggesting a new dose estimation called the actual glandular dose (AGD), and compares MGD to AGD. Methods: DICOM headers were extracted from 52405 anonymised mammograms using 3rd party software. Exposure and QA information were utilised to calculate MGD using 3 methods. LIBRA software was used to estimate MBD for 31097 mammograms. Median, 75th and 95th percentiles were calculated across MGDs obtained for all included data and according to 9 CBT ranges, average population CBT, and for 3 detector technologies. The significance of the differences, correlations, and agreement between MGDs for different CBT ranges, calculation methods, and different density estimation methods were analysed. Conclusions: This thesis have recommended DRLs for mammography in Australia, it shows that MGD is dependent upon CBT and detector technology, hence DRLs were presented as a table for different CBTs and detectors. The work also shows that Organ Doses reported by vendors vary from that calculated using established methodologies. Data produced also show that the use of MGD calculated using standardised glandularities underestimates dose at lower CBTs compared to AGD by up to 10%, hence, underestimating radiation risk. Finally, AGD was proposed; it considers differences in breast composition for individualised radiation-induced risk assessment

Processing digital radiographs : a survey in how different processing affects the assessment of stifle radiographs in dogs and cats

Röntgen används dagligen i den veterinärmedicinska kliniken och är ett mycket användbart diagnostiskt verktyg. I dagsläget existerar röntgensystem där användaren har stora möjligheter att bearbeta den digitala röntgenbilden på olika sätt och på det viset skapa röntgenbilder med olika utseenden. Syftet med detta examensarbete var att undersöka hur olika bearbetningar av digitala röntgenbilder av knäleder hos hund och katt påverkar den upplevda bildkvalitén samt dess betydelse för den radiologiska diagnostiken. Studien har genomförts som en enkätstudie i samarbete med företaget Fujifilm som tillhandahåller det röntgensystem som använts i studien och enkäten skickades ut till kliniker som använder sig av deras röntgensystem. Till enkäten användes röntgenbilder på tio olika knäleder, fem friska och fem sjuka. Av dessa kom nio röntgenbilder från hundar och en från katt. Röntgenbilderna bearbetades på fyra olika sätt, vilket resulterade i totalt 40 bilder. Den första bearbetningen som användes (K) hade endast en ökning av mängden kantförstärkning, den andra (KM) hade mycket kantförstärkning samt en ändrad lutning på look-up table/LUT-kurvan, vilket gav en ökad gråskala och därmed ledde till att befintliga mjukdelar framträdde tydligare. I den tredje bearbetningen (G) användes en linjär LUT-kurva istället för en optimerad för skelettröntgen och den fjärde bearbetningen (O) var en subjektivt optimerad röntgenbild för att maximera möjligheten att kunna ställa en korrekt radiologisk diagnos. Den subjektiva bedömningen gjordes av författaren och handledarna. Målet med bearbetningarna var att de skulle skilja sig markant från varandra och att de korresponderande bearbetningarna för varje led skulle utgöra visuellt likvärdiga bilder. I enkäten skulle respondenterna skatta alla bilder utifrån dess diagnostiska kvalitét och huruvida leden hade osteofytära pålagringar eller ökad intraartikulär mjukdelstäthet. Totalt inkom 14 fullständigt ifyllda enkäter från respondenter med olika stor erfarenhet av bildavläsning, utifrån detta delades respondenterna upp i de mer erfarna och de mindre erfarna. I resultatet framkom att respondenterna rankade bearbetningarna i ordningen G, K, O, KM där G var sämst och KM bäst. I den mer erfarna gruppen var det ingen större skillnad mellan bearbetningarna G och K samt mellan O och KM, men annars var resultatet relativt överensstämmande oavsett om man såg till de två respondentgrupperna var för sig eller till alla respondenter sammantaget. När det kom till andelen korrekta diagnoser fanns en relativt stor skillnad i andelen korrekta diagnoser av osteofytära benpålagringar mellan bearbetning G och KM hos den mindre erfarna gruppen, där KM hade en större andel korrekta diagnoser. Utöver detta fanns ingen större skillnad mellan någon av bearbetningarna. Dock var andelen korrekta diagnoser av ökad intraartikulär mjukdelstäthet markant lägre för bearbetning KM än för övriga bearbetningar. Sammanfattningsvis kan konstateras att bearbetning KM rankades oväntat hög. Det kan även konstateras att de olika bearbetningarna inte ger någon övergripande skillnad i hur osteofytära benpålagringar bedöms. Det fanns en stor skillnad i hur avsaknaden av ökad intraartikulär mjukdelstäthet diagnosticeras i bearbetning KM, vilket tyder på att den bearbetningen är mindre lämplig att använda för detta jämfört med andra bearbetningar. För att kunna få mer säkra resultat behövs vidare forskning inom området.Radiographs are used daily in veterinary practice and are an especially useful diagnostic tool. Today there are several X-ray systems where the user has great opportunity to process the digital radiograph in different ways that result in radiographs with a variety of features. The purpose of this master’s thesis was to examine how different processing can affect the perceived image quality of digital stifle radiographs in dogs and cats, and the affect this has on how the image is evaluated. The study was implemented as a survey in cooperation with the company Fujifilm, which is the provider of the x-ray system that were used in the study and the survey was distributed to veterinary clinics using x-ray systems from this company. Radiographs of ten different stifles were used in the survey, five normal and five abnormal. Nine of the images were from dogs and one was from a cat. Images were processed in four different ways, which resulted in 40 images in total. The first processing that was used (K) only had an increase of edge enhancement. The second processing (KM) had a lot of edge enhancement and a steeper lookup table (LUT) -curve, which increased the visibility of the soft tissues due to an increased grayscale. In the third (G) a linear LUT-curve were used instead of one optimized for skeletal radiographs and the fourth (O) was a subjectively optimized radiograph with the goal to maximize the possibility to make a correct diagnosis. This optimized processing was performed by the author and the supervisors. The goal of the different processing wasto create four images for each joint that differed greatly from one another, and that the corresponding processing between joints should be visually equivalent to each other. In the survey the respondents were asked to rank each image based on their diagnostic quality and whether the joint had osteophytes or increased intraarticular soft tissue opacity. In total the survey resulted in 14 completed surveys from respondents with different amounts of experience in image evaluation. Based on this, the respondents were divided into two groups, those with more experience and those with less experience. The result showed that the respondents ranked the different image processing in the following order: G, K, O and KM. Where G was ranked lowest and KM highest. In the more experienced group, there were no large differences between G and K or between O and KM. Otherwise, the ranking was quite consistent despite whether the groups or all respondents were analyzed. For osteophyte diagnosis there was a large difference between G and KM in the less experienced group, where KM had a higher frequency of correct diagnosis. Apart from this, there were no large differences between the processing types and diagnosis of osteophytes. However, the frequency of correctly diagnosed lack of increased intraarticular soft tissue opacity in KM was a lot lower than the other types of processing. In conclusion, it can be stated that KM was ranked unexpectedly high by the respondents. It can also be concluded that there was no overall difference in the frequency of correctly diagnosed osteophytes between the different types of processing. However, there was a large difference in the frequency of correctly diagnosed lack of increased intraarticular soft tissue opacity in KM compared to the other processing, where KM had a lower frequency of correct diagnoses. The result suggests that KM is not as useful for the diagnosis of increased intraarticular soft tissue opacity as the other processing methods. Although, there is a need for further research to make more certain conclusions