Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology

An estimated 4-5 million CT scans are performed in the USA every year to investigate nephrourological diseases such as urinary stones and renal masses. Despite the clinical benefits of CT imaging, concerns remain regarding the potential risks associated with exposure to ionizing radiation. To assess the potential risk of harmful biological effects from exposure to ionizing radiation, understanding the mechanisms by which radiation damage and repair occur is essential. Although radiation level and cancer risk follow a linear association at high doses, no strong relationship is apparent below 100 mSv, the doses used in diagnostic imaging. Furthermore, the small theoretical increase in risk of cancer incidence must be considered in the context of the clinical benefit derived from a medically indicated CT and the likelihood of cancer occurrence in the general population. Elimination of unnecessary imaging is the most important method to reduce imaging-related radiation; however, technical aspects of medically justified imaging should also be optimized, such that the required diagnostic information is retained while minimizing the dose of radiation. Despite intensive study, evidence to prove an increased cancer risk associated with radiation doses below ~100 mSv is lacking; however, concerns about ionizing radiation in medical imaging remain and can affect patient care. Overall, the principles of justification and optimization must remain the basis of clinical decision-making regarding the use of ionizing radiation in medicine

Noise reduction in computed tomography images using an anisotropic bilateral filter

En este trabajo se propone el uso de un filtro bilateral anisotrópico (FBA) para reducir el ruido en imágenes de tomografía computarizada. El FBA fue implementado en una versión tridimensional que permite ajustar los parámetros del filtro dependiendo de la resolución de las imágenes en cada uno de los ejes. La utilidad del FBA se demostró con un fantoma estándar, que se escaneó, inicialmente, utilizando una dosis de radiación referencia de 240 mAs, y, seguidamente, con dosis del 50 % y 25% de la de referencia. Asimismo, se procesaron y analizaron dos casos clínicos correspondientes a una tomografía abdominal y otra de tórax, ambas utilizando una inyección intravenosa de medio de contraste. Se encontró que el FBA permite mantener una mejor relación entre el ruido, la resolución espacial y la detectabilidad de bajos contrastes, cuando se le compara con el método tradicional de retroproyección filtrada que utilizan los escáneres de tomografía clínicos. Los resultados del fantoma, sugieren que es posible reducir las dosis de radiación hasta en un 50% sin afectar la resolución espacial o la detectabilidad de bajos contrastes, cuando se le compara con la dosis de referencia. Los estudios clínicos, revelaron que el FBA puede disminuir el ruido de las imágenes y aún garantizar una calidad adecuada para el diagnóstico. Estudios clínicos prospectivos, son necesarios para demostrar que la disminución del ruido puede permitir una reducción significativa de las dosis de radiación.This work proposes the use of an anisotropic bilateral filter (ABF) to reduce the noise in computed tomography images. The FBA is implemented in the tridimensional space, allowing the adjustment of filter parameters depending on the image resolution in each axis. The utility of the FBA was demonstrated using a standard image quality phantom which was scanned using a 240 mAs reference dose, and subsequently with 50 % and 25 % of the reference dose. Additionally, two clinical cases were processed, corresponding to routine clinical, intravenous contrast-enhanced abdomen and thorax scans. The phantom study found that the FBA keeps a better tradeoff between noise, spatial resolution, and low contrast detectability, when it is compared to traditional filtered backprojection reconstructions, routinely employed by current computed tomography scanners. Hence, results in the phantom suggest it is possible to reduce radiation dose by at least 50% without affecting spatial resolution or low contrast detectability. The clinical studies revealed that the FBA can decrease image noise and still provide enough information for adequate diagnosis. Prospective clinical studies are necessary to demonstrate whether or not the observed noise reduction would allow a significant decrease in radiation dose

Tomografía computarizada por rayos X: fundamentos y actualidad

Este artículo presenta una revisión de los fundamentos de la tomografía computarizada, empezando por un recuento de los inicios y progresos de esta técnica a través del tiempo, y continuando con una descripción de los principios físicos que rigen la producción de los rayos X. El artículo también discute las bases matemáticas para la reconstrucción de las imágenes a partir de proyecciones utilizando métodos analíticos o iterativos. En una sección independiente, se revisan los conceptos más importantes relacionados con los riesgos de la radiación ionizante y se discuten investigaciones recientes, algunas polémicas, acerca de los beneficios y riesgos asociados con la tomografía computarizada y cómo estos afectan los protocolos de adquisición de las imágenes. Finalmente, con base en los avances científicos y tendencias más recientes, el artículo propone las áreas que, presumiblemente, continuarán siendo el centro de atención de la tomografía computarizada de rayos X en los próximos años.This paper reviews the fundamentals of x-ray computed tomography. It starts by summarizing the early days of the technique and its evolution through time, as well as the physical principles of x-ray production. Subsequently, the mathematical principles of image reconstruction are discussed with emphasis in both analytical and iterative reconstruction methods. A complete section is dedicated to review the main concepts related with the risks of ionizing radiation, and discuss some of the most recent controversies about CT radiation and how those risks affect scanning protocols. Finally, based on the most recent advances and trends in CT, the paper discuss about those areas, which, presumably, will be the research focus of CT in the near future

Quantitative prediction of stone fragility from routine single and dual energy CT: proof of feasibility

Rationale and Objectives Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphological features from dual-energy CT images and assess their relationship to stone fragility. Materials and Methods Thirty-three calcified urinary stones were scanned with micro CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low-and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. Results The average stone volume was 300 mm3 (range 134–674 mm3). The average comminution time measured ex vivo was 32 s (range 7–115 s). Stone volume, dual-energy CT number ratio and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R2= 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R2 of 0.54. Conclusion Dual-energy CT number ratios, volume, and morphological metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy

Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed

Reducción del ruido en imágenes de tomografía computarizada usando un filtro bilateral anisotrópico

This work proposes the use of an anisotropic bilateral filter (ABF) to reduce the noise in computed tomography images. The FBA is implemented in the tridimensional space, allowing the adjustment of filter parameters depending on the image resolution in each axis. The utility of the FBA was demonstrated using a standard image quality phantom which was scanned using a 240 mAs reference dose, and subsequently with 50 % and 25 % of the reference dose. Additionally, two clinical cases were processed, corresponding to routine clinical, intravenous contrast-enhanced abdomen and thorax scans. The phantom study found that the FBA keeps a better tradeoff between noise, spatial resolution, and low contrast detectability, when it is compared to traditional filtered backprojection reconstructions, routinely employed by current computed tomography scanners. Hence, results in the phantom suggest it is possible to reduce radiation dose by at least 50% without affecting spatial resolution or low contrast detectability. The clinical studies revealed that the FBA can decrease image noise and still provide enough information for adequate diagnosis. Prospective clinical studies are necessary to demonstrate whether or not the observed noise reduction would allow a significant decrease in radiation dose.En este trabajo se propone el uso de un filtro bilateral anisotrópico (FBA) para reducir el ruido en imágenes de tomografía computarizada. El FBA fue implementado en una versión tridimensional que permite ajustar los parámetros del filtro dependiendo de la resolución de las imágenes en cada uno de los ejes. La utilidad del FBA se demostró con un fantoma estándar, que se escaneó, inicialmente, utilizando una dosis de radiación referencia de 240 mAs, y, seguidamente, con dosis del 50 % y 25% de la de referencia. Asimismo, se procesaron y analizaron dos casos clínicos correspondientes a una tomografía abdominal y otra de tórax, ambas utilizando una inyección intravenosa de medio de contraste. Se encontró que el FBA permite mantener una mejor relación entre el ruido, la resolución espacial y la detectabilidad de bajos contrastes, cuando se le compara con el método tradicional de retroproyección filtrada que utilizan los escáneres de tomografía clínicos. Los resultados del fantoma, sugieren que es posible reducir las dosis de radiación hasta en un 50% sin afectar la resolución espacial o la detectabilidad de bajos contrastes, cuando se le compara con la dosis de referencia. Los estudios clínicos, revelaron que el FBA puede disminuir el ruido de las imágenes y aún garantizar una calidad adecuada para el diagnóstico. Estudios clínicos prospectivos, son necesarios para demostrar que la disminución del ruido puede permitir una reducción significativa de las dosis de radiación

Dual-Energy CT for Evaluation of Intra- and Extracapsular Silicone Implant Rupture

Silicone implants are commonly used for both breast augmentation and breast reconstruction. With aging of the implant, the silicone envelope may become weak or may rupture. The technique of choice for evaluation of implant integrity is breast MRI; however this may be contraindicated in some patients or the cost may be prohibitive. Dual-energy CT allows determination of density and atomic number of tissue and can provide material composition information. We present a case of extracapsular implant rupture with MRI and dual-energy CT imaging and surgical correlation