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Objective: Mammography, today's standard imaging approach, has deficits with respect to the superimposition of anatomical structures. Dedicated CT of the breast so far indicated that it can provide superior soft-tissue imaging, but that it still has significant limitations with respect to spatial resolution and dose. We have assessed novel dedicated breast CT technology.Methods: Based on simulations and measurements we developed novel technology which uses direct-conversion CdTe material and photon-counting electronics with 100 μm detector element size for close to 100% dose efficiency. We assessed the potential for the imaging of microcalcifications of 100 to 200 μm diameter and soft-tissue lesions of 1 to 5 mm diameter by simulations at dose levels between 1 and 6 mGy.Results: Microcalcifications of 150 μm and soft-tissue lesions of 2 mm diameter were found to be clearly detectable at an average glandular dose of 3 mGy. Separate displays are required for high-resolution microcalcification and for low-resolution soft-tissue analysis. Total CT data acquisition time will be below 10 s.Conclusion: Dedicated breast CT may eventually provide comprehensive diagnostic assessment of microcalcifications and soft-tissue structures at dose levels equivalent to or below those of two-view screening mammography. [ABSTRACT FROM AUTHOR]

Some of the major interests in medical physics over the last few years have concerned the technical advances in Computed Tomography and high field Magnetic Resonance Imaging. This review discusses the introduction of Dual Source CT and explains how it can not only offer faster data acquisition but also operate with lower radiation doses. This provides enormous benefits for all patients, but for cardiac and pediatric examinations in particular. The advances in MRI at 7 T esla are also impressive, with better signal to noise; cardiac and musculoskeletal applications are discussed; technical improvements are work-in-progress for other applications. [ABSTRACT FROM AUTHOR]

We evaluated the potential for reduction of dose to the female breast in computed tomography (CT) of the thorax by using three different techniques: bismuth shielding, partial CT scanning and tube-current modulation (TCM). Measurements and simulations of dose and image quality were performed for a 64-slice CT system using a semi-anthropomorphic thorax phantom with breasts added. Three-dimensional dose distributions were calculated by Monte Carlo (MC) methods. Noise was determined by measurements and simulations. Bismuth shielding resulted in a dose reduction of about 50% for the breast, noise increased up to 40% and image quality was impaired by artifacts. In partial CT scans, not irradiating the breasts directly, dose to the breasts was reduced typically by 50%. To sustain a constant noise level, an increase of irradiation in the anteroposterior position resulted in a higher dose to the spine. Reduction of dose to the breasts of about 10% was achieved with TCM; distribution of noise was homogeneous and image quality uniform. Reduction of dose to the female breast was achieved by using all adapted CT methods. Bismuth shielding may compromise image quality, increase noise level and introduce streak artifacts. Partial and TCM examinations reduced dose to the breast without influencing image quality. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) imaging of the heart, most prominently coronary CT angiography, is currently subject to intense interest and is increasingly incorporated into clinical decision-making. In spite of tremendous progress in CT technology over the past decade, the limited temporal resolution has remained one of the most severe problems, especially for cardiac imaging. The novel design concept of dual-source CT (DSCT) allows for an effective scan time of 83 ms independent of heart rate. While large trials are still missing, initial studies have shown improved image quality, especially for visualizing the coronary arteries and detecting coronary artery stenoses. Further investigations have shown that routine beta blockade to lower the heart rate is not necessary to reliably achieve diagnostic image quality. Other applications that may particularly benefit from increased temporal resolution are the analysis of ventricular function and of the cardiac valves. Dose issues which are of interest for cardiac CT in general are discussed in some detail, including a quantitative analysis of dose values and three-dimensional dose distributions. Various strategies to lower radiation exposure are available today, and DSCT offers specific potential for this. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate accuracy and procedure times of electromagnetic tracking (EMT) in a robotic arm mounted flat panel setting using phantom and animal cadaveric models.Methods and Materials: A robotic arm mounted flat panel (RMFP) was used in combination with EMT to perform anthropomorphic phantom (n = 90) and ex vivo pig based punctures (n = 120) of lumbar facet joints (FJ, n = 120) and intervertebral discs (IVD, n = 90). Procedure accuracies and times were assessed and evaluated.Results: FJ punctures were carried out with a spatial accuracy of 0.8 ± 0.9 mm (phantom) and 0.6 ± 0.8 mm (ex vivo) respectively. While IVD punctures showed puncture deviations of 0.6 ± 1.2 mm (phantom) and 0.5 ± 0.6 mm (ex vivo), direct and angulated phantom based punctures had accuracies of 0.8 ± 0.9 mm and 1.0 ± 1.3 mm. Planning took longer for ex vivo IVD punctures compared to phantom model interventions (39.3 ± 17.3 s vs. 20.8 ± 5.0 s, p = 0.001) and for angulated vs. direct phantom FJ punctures (19.7 ± 5.1 s vs. 28.6 ± 7.8 s, p < 0.001). Puncture times were longer for ex vivo procedures when compared to phantom model procedures in both FJ (37.9 ± 9.0 s vs. 23.6 ± 7.2 s, p = 0.001) and IVD punctures (43.9 ± 16.1 s vs. 31.1 ± 6.4 s, p = 0.026).Conclusion: The combination of RMFP with EMT provides an accurate method of navigation for spinal interventions such as facet joint punctures and intervertebral disc punctures. [ABSTRACT FROM AUTHOR]

Increase of pitch in spiral CT decreases data acquisition time; dual-source CT (DSCT) systems provide improved temporal resolution. We evaluated the combination of these two features. Measurements were performed using a commercial DSCT system equipped with prototype software allowing pitch factors from p = 0.35 to 3.0. We measured slice sensitivity profiles as a function of pitch to assess spatial resolution in the z-direction and the contrast of structures moved periodically to measure temporal resolution. Additionally we derived modulation transfer functions to provide objective parameters; both spatial and temporal resolution were essentially unchanged even at high pitch. CT of the cardiac region of three pigs was performed at p = 3.0. In vivo CT images confirmed good image quality; direct comparison with standard low-pitch phase-correlated CT image datasets showed no significant difference. For a normalized z-axis acquisition of 12 cm, the corresponding effective dose value was 2.0 mSv for the high-pitch CT protocol. We conclude that spiral DSCT imaging with a pitch of 3.0 can provide unimpaired image quality with respect to spatial and temporal resolution. Applications to cardiac and thoracic imaging with effective dose below 1 mSv are possible. [ABSTRACT FROM AUTHOR]

Image quality in pulmonary CT imaging is commonly degraded by cardiac motion artifacts. Phase-correlated image reconstruction algorithms known from cardiac imaging can reduce motion artifacts but increase image noise and conventionally require a concurrently acquired ECG signal for synchronization. Techniques are presented to overcome these limitations. Based on standard and phase-correlated images that are reconstructed using a raw data-derived synchronization signal, image-merging and temporal-filtering techniques are proposed that combine the input images automatically or interactively. The performance of the approaches is evaluated in patient and phantom datasets. In the automatic approach, areas of strong motion and static areas were well detected, providing an optimal combination of standard and phase-correlated images with no visible border between the merged regions. Image noise in the non-moving regions was reduced to the noise level of the standard reconstruction. The application of the interactive filtering allowed for an optimal adaptation of image noise and motion artifacts. Noise content after interactive filtering decreased with increasing temporal filter width used. We conclude that a combination of our motion-free merging approach and a dedicated interactive filtering procedure can highly improve pulmonary imaging with respect to motion artifacts and image noise. [ABSTRACT FROM AUTHOR]

The aim of the study was to test the reliability of intracerebral haemorrhage (ICH) detection with C-arm-mounted flat-detector computed tomography (FD-CT) in the angio suite as compared to multislice CT (MSCT). In this study 44 patients with 45 ICH were included. All patients were investigated with MSCT and FD-CT during angiographic evaluation. As a control group we included 16 patients without ICH. In each haematoma we assessed volumetric data of the ICH and counted the numbers of ICH-positive slices. Using interobserver ratings, we additionally investigated the potential of FD-CT to serve as a diagnostic tool to detect ICH. In FD-CT three haematomas were not detected because of motion and beam-hardening artefacts in the region close to the skull base. The r value for the degree of interobserver agreement for the number of slices was 0.95 for MSCT and 0.94 for FD-CT. Measurements of the area and the calculated volume of the ICH showed high inter- and intraobserver agreement. Our results indicate that FD-CT is a helpful tool in the daily emergency management of ICH patients as detection of ICH was found to be nearly as reliable as in MSCT. Limitations of this technology are motion and beam-hardening artefacts that may mask small haematomas located in the posterior fossa or the skull base. [ABSTRACT FROM AUTHOR]

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 multidetector CT is discussed. [ABSTRACT FROM AUTHOR]

Estimating the dose delivered to the patient in X-ray computed tomography (CT) examinations is not a trivial task. Monte Carlo (MC) methods appear to be the method of choice to assess the 3D dose distribution. The purpose of this work was to extend an existing MC-based tool to account for arbitrary scanners and scan protocols such as multi-slice CT (MSCT) scanners and to validate the tool in homogeneous and heterogeneous phantoms. The tool was validated by measurements on MSCT scanners for different scan protocols under known conditions. Quantitative CT Dose Index (CTDI) measurements were performed in cylindrical CTDI phantoms and in anthropomorphic thorax phantoms of various sizes; dose profiles were measured with thermoluminescent dosimeters (TLD) in the CTDI phantoms and compared with the computed dose profiles. The in-plane dose distributions were simulated and compared with TLD measurements in an Alderson-Rando phantom. The calculated dose values were generally within 10% of measurements for all phantoms and all investigated conditions. Three-dimensional dose distributions can be accurately calculated with the MC tool for arbitrary scanners and protocols including tube current modulation schemes. The use of the tool has meanwhile also been extended to further scanners and to flat-detector CT. [ABSTRACT FROM AUTHOR]