Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy

Purpose. To perform a systematic review of the radiation dose and diagnostic accuracy of prospective versus retrospective ECG-gated multislice CT coronary angiography. Materials and methods. A search of Pubmed/Medline and Sciencedirect databases for English literature was performed to identify studies comparing prospective and retrospective ECG-gated multislice CT angiography in the diagnosis of coronary artery disease. Effective dose, dose length product, image quality and diagnostic value were compared between two groups of studies.Results. 22 studies were included for analysis. The mean effective dose of prospective ECG-gated scans was 4.5 mSv (95% CI: 3.6, 5.3 mSv), which is significantly lower than that of retrospective scans, which is 13.8 mSv (95% CI: 11.5, 16.0 mSv) (p < 0.001). The mean dose length product was 225 mGy cm (95% CI: 188, 262 mGy cm) and 822 mGy cm (95% CI: 630, 1013 mGy cm) for the prospective and retrospective ECG-gated scans, respectively, indicating a statistically significant difference between these two protocols (p < 0.0001). The mean sensitivity and specificity of multislice CT angiography in the diagnosis of coronary artery disease was 97.7% (95% CI: 93.7%, 100%) and 92.1% (95% CI: 87.2%, 97%) for prospective ECG-gated scans; 95.2% (95% CI: 91%, 99.5%) and 94.4% (95% CI: 88.5%, 100%) for retrospective ECG-gated scans, respectively, with no significant difference for sensitivity but significant difference for specificity (p = 0.047). Conclusion. Multislice CT coronary angiography with prospective ECG-gating leads to a significant reduction of radiation dose when compared to that of retrospective ECG-gating, while offering comparable image quality and diagnostic value

A Comparison of JPEG and Wavelet Compression Applied to CT Images

A study of image compression is becoming more important since an uncompressed image requires a large amount of storage space and high transmission bandwidth. This paper focuses on the quantitative comparison of lossy compression methods applied to a variety of 8-bit Computed Tomography (CT) images. Joint Photographic Experts Group UPEG) and Wavelet compression algorithms were used on a set of CT images, namely brain, chest, and abdomen. These algorithms were applied to each image to achieve maximum compression ratio (CR). Each compressed image was then decompressed and quantitative analysis was performed to compare each compressed-then-decompressed image with its corresponding original image. The Wavelet Compression Engine (standard edition 2.5), and ]pEG Wizard (Version 1.1.7) were used in this study. The statistical indices computed were mean square error (MSE) , signal-to-noise ratio (SNR) and peak signal-to-noise ratio (PSNR). Our results show that Wavelet compression yields better compression quality compared with ]pEG for higher compression. From the numerical values obtained we observe that the PSNR for chest and abdomen images is equal to 24 dB for compression ratio up to 31:1 by using ]pEG and 18 dB for compression ratio up to 33:1 by using wavelet. For brain image the PSNR is equal to 26 to 30 dB for compression ratio between 40 to 125:1 by using ]pEG, whereas by using wavelet the PSNR is equal to 22 to 34 dB for compression ratio between 52 to 240:1. The degree of compression was also found dependent on the anatomic structure and the complexity of the CT images

Coronary CT angiography: How should physicians use it wisely and when do physicians request it appropriately?

Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice

A comparative study of image compression between JPEG and wavelet

Image compression is fundamental to the efficient and cost-effective use of digital medical imaging technology and applications. Wavelet transform techniques currently provide the most promising approach to high-quality image compression, which is essential for teleradiology and Picture Archiving and Communication System (PACS). In this study wavelet compression was applied to compress and decompress a digitized chest x-ray image at various compression ratios. The Wavelet Compression Engine (standard edition 2.5) was used in this study. This was then compared with the formal compression standard “Joint Photographic Expert Group” JPEG, using JPEG Wizard (standard edition 1.3.7). Currently there is no standard set of criteria for the clinical acceptability of compression ratio. Thus, histogram analysis, maximum absolute error (MAE), mean square error (MSE), root mean square error (RMSE), signal to noise ratio (SNR), and peak signal to noise ratio (PSNR) were used as a set of criteria to determine the ‘acceptability’ of image compression. The wavelet algorithm was found to have generally lower average error matrices and higher peak signal to noise ratios. Wavelet methods have been shown to have no significant differences in diagnostic accuracy for compression ratios of up to 30:1. Visual comparison was also made between the original image and compressed image to ascertain if there is any significant image degradation. Using wavelet algorithm, a very high compression ratio of up to 600:1 was achieved

Introducing molecular biology to medical physicists

Molecular biology helps us understand how genetic information is converted to functional proteins, how proteins interact through complex networks to determine the fate and function of a cell and how mutations lead to diseases. In the era of molecular medicine and ommissionin medicine, medical physicists need to acquire basic knowledge of molecular biology in order to communicate and collaborate with clinical and life science colleagues. This article documents our experience in introducing molecular biology as an academic module in a regional training course for educators held in Kuala Lumpur, Nov 2019. The module consists of didactic lectures, simulation, group exercises, etc. From the positive feedbacks that we received, the participants benefited from the exposure and we plan to produce some learning materials for future courses

Trend and impact of international collaboration in clinical medicine papers published in Malaysia

Research collaboration is the way forward in order to improve quality and impact of its research findings. International research collaboration has resulted in international co-authorship in scientific communications and publications. This study highlights the collaborating research and authorship trend in clinical medicine in Malaysia from 2001 to 2010. Malaysian-based author affiliation in the Web of Science (Science Citation Index Expanded) and clinical medicine journals (n = 999) and articles (n = 3951) as of 30th Oct 2011 were downloaded. Types of document analyzed were articles and reviews, and impact factors (IF) in the 2010 Journal Citation Report Science Edition were taken to access the quality of the articles. The number of publications in clinical medicine increased from 4.5 % (n = 178) in 2001 to 23.9 % (n = 944) in 2010. The top three contributors in the subject categories are Pharmacology and Pharmacy (13.9 %), General and Internal Medicine (13.6 %) and Tropical Medicine (7.3 %). By journal tier system: Tier 1 (18.7 %, n = 738), Tier 2 (22.5 %, n = 888), Tier 3 (29.6 %, n = 1170), Tier 4 (27.2 %, n = 1074), and journals without IF (2.1 %, n = 81). University of Malaya was the most productive. Local collaborators accounted for 60.3 % and international collaborations 39.7 %. Articles with international collaborations appeared in journals with higher journal IFs than those without international collaboration. They were also cited more significantly than articles without international collaborations. Citations, impact factor and journal tiers were significantly associated with international collaboration in Malaysia’s clinical medicine publications. Malaysia has achieved a significant number of ISI publications in clinical medicine participation in international collaboration

Development of a Tissue Equivalent Gelatine Phantom for Accuracy Verification of Tissue Elasticity Measurement Using Shear Wave Elastography Ultrasound

Background Shearwave elastography ultrasound (SWE) has been increasing used in the recent decade to quantify tissue stiffness and viscoelastic properties correlate to a disease condition. Aims This study aimed to develop a low cost and reproducible gelatine phantom to verify the accuracy of tissue elasticity measurement using shear wave elastography (SWE). The effect of lesion’s size, stiffness and depth from the surface on the tissue elasticity measurement were also investigated. Methods A breast tissue-equivalent phantom embedded with spherical inclusions of different sizes, stiffness and depth from surface was constructed using gelatine. The elasticity of the spherical inclusions was determined using a commercial SWE system and compared to the elasticity determined using a high precision electromechanical microtester (gold standard for elasticity measurements). Results Statistically significant difference (p < 0.05) was found between the elasticity measured using SWE and electromechanical microtester, whereby the SWE overestimated the tissue elasticity by a mean value of 22.8 ± 15.0 kPa. The size and depth of the spherical inclusions have not imposed any effect on the elasticity measured by SWE, but the depth of shear wave detection was found limited to 8 cm from the surface. Conclusion The gelatine phantom constructed in this study could be used to verify the accuracy of the elasticity measured using SWE. The tissue elasticity measured by the SWE appeared to be overestimated compared to the gold standard. Further research would need to be carried out to determine the offset from the SWE measurement and to account for these differences

Evaluation of organ dose and image quality metrics of pediatric CT Chest-Abdomen-Pelvis (CAP) examination: an anthropomorphic phantom study

The aim of this study is to investigate the impact of CT acquisition parameter setting on organ dose and its influence on image quality metrics in pediatric phantom during CT examination. The study was performed on 64-slice multidetector CT scanner (MDCT) Siemens Definition AS (Siemens Sector Healthcare, Forchheim, Germany) using various CT CAP protocols (P1–P9). Tube potential for P1, P2, and P3 protocols were fixed at 100 kVp while P4, P5, and P6 were fixed at 80 kVp with used of various reference noise values. P7, P8, and P9 were the modification of P1 with changes on slice collimation, pitch factor, and tube current modulation (TCM), respectively. TLD-100 chips were inserted into the phantom slab number 7, 9, 10, 12, 13, and 14 to represent thyroid, lung, liver, stomach, gonads, and skin, respectively. The image quality metrics, signal to noise ratio (SNR) and contrast to noise ratio (CNR) values were obtained from the CT console. As a result, this study indicates a potential reduction in the absorbed dose up to 20% to 50% along with reducing tube voltage, tube current, and increasing the slice collimation. There is no significant difference (p > 0.05) observed between the protocols and image metrics

Robust radiogenomics approach to the identification of EGFR mutations among patients with NSCLC from three different countries using topologically invariant Betti numbers

Abstract Objectives: To propose a novel robust radiogenomics approach to the identification of epidermal growth factor receptor (EGFR) mutations among patients with non-small cell lung cancer (NSCLC) using Betti numbers (BNs). Materials and methods: Contrast enhanced computed tomography (CT) images of 194 multi-racial NSCLC patients (79 EGFR mutants and 115 wildtypes) were collected from three different countries using 5 manufacturers' scanners with a variety of scanning parameters. Ninety-nine cases obtained from the University of Malaya Medical Centre (UMMC) in Malaysia were used for training and validation procedures. Forty-one cases collected from the Kyushu University Hospital (KUH) in Japan and fifty-four cases obtained from The Cancer Imaging Archive (TCIA) in America were used for a test procedure. Radiomic features were obtained from BN maps, which represent topologically invariant heterogeneous characteristics of lung cancer on CT images, by applying histogram- and texture-based feature computations. A BN-based signature was determined using support vector machine (SVM) models with the best combination of features that maximized a robustness index (RI) which defined a higher total area under receiver operating characteristics curves (AUCs) and lower difference of AUCs between the training and the validation. The SVM model was built using the signature and optimized in a five-fold cross validation. The BN-based model was compared to conventional original image (OI)- and wavelet-decomposition (WD)-based models with respect to the RI between the validation and the test. Results: The BN-based model showed a higher RI of 1.51 compared with the models based on the OI (RI: 1.33) and the WD (RI: 1.29). Conclusion: The proposed model showed higher robustness than the conventional models in the identification of EGFR mutations among NSCLC patients. The results suggested the robustness of the BN-based approach against variations in image scanner/scanning parameters