Purpose: For brain CT perfusion it is well established that 80 kVp is optimal. Although neuro‐CT angiography is somewhat similar, emphasis is on the detection of aneurysms and related vascular pathologies throughout the brain. Thus it is necessary to visualize small and large blood vessels with contrast material, as well as form multi‐planar views and 3D images, so image quality and noise in addition to contrast are important for thin slices. A study was initiated to determine the optimal kVp for neuro‐CTA. Methods: A customized version of a commercial head phantom (CIRS 007TE‐27 medium adult head CT dose phantom) was purchased to facilitate quantitative measurements with iodinated contrast material, contrast for white and gray matter, and to maintain the ability to perform dosimetry. The customization consisted of adding four 25 mm holes, 35 mm from the center arranged at 45 degree angles from the center, with solid rods equivalent with brain, white, and gray matter, as well as four fillable vials were included for study of contrast agents. Dosimetry measurements were carried out with standard pencil chamber and with 0.6 cc ionization chamber. For study of the optimal kVp for a head CTA, the vials were filled with four different concentrations of contrast, approximating low to medium concentrations that would be expected in such a study. The standard CTA protocol was followed, 64 × 0.625, pitch 0.53, rotation speed 0.5 second, and CTDIvol was kept constant for each kVp. Results: The best contrast was observed at 80 kVp; however, in order to achieve noise in CTA low enough to be clinically useful there may be issues with tube current capability for a clinical technique. Clinical investigation is underway. Conclusions: The best balance of contrast and noise currently possible will be achieved at 100 kVp in a clinical scan.
The effect of CT scanner geometry on spatial resolution, contrast sensitivity, and patient dose are considered and used to determine the limiting factor or factors for a particular scanner. To this end analytical expressions for the components of the system modulation transfer function (MTF) are identified, and a Geometrical Figure of Merit is introduced based on the information capacity per rad. This formalism is used to compare four commercial CT units representing the main types presently in use. Improvements in scanner geometry are suggested which will improve this Figure of Merit for a given design. A new geometry, which would be relatively inexpensive to manufacture, is introduced and considered in the context of the formalism presented. Such a geometry utilizing state of the art components is shown to be superior to present and improved versions of CT scanners currently available.
PURPOSE: To compare the accuracy with which simulated solitary pulmonary nodules can be identified on digital images of the chest that are unprocessed, processed with adaptive spatial filtering, or processed with global filtering. MATERIALS AND METHODS: Six experienced chest radiologists evaluated 408 test radiographs (136 from each of the three types, half with simulated nodules) and judged whether a nodule was present. Data from the 2,448 observations were evaluated by means of a receiver operating characteristic curve with location methods. RESULTS: Accuracy was significantly better with the adaptive filter technique than with the global technique (P < .05), and it was better with adaptive filtering than with no processing in the detection of pulmonary nodules in the mediastinal-subdiaphragmatic areas (P < .05). No significant difference was found between no processing and global filtering. CONCLUSION: Adaptive filtration is superior to global filtration in the identification of solitary pulmonary nodules and is superior to no processing in nodules projected over the radiopaque areas of the thorax on digital images.
Metastatic calcification of the lung and heart can cause severe cardiopulmonary compromise and death. Although it is found in most end-stage renal disease patients at autopsy, it is only rarely detected during life. Using a prototype dual-energy digital chest radiographic unit, we measured calcium content (mg/cm2) over the lung and heart in 32 hemodialysis patients. Pulmonary calcium content was significantly greater in these patients than in sex-matched control subjects (men, 230 +/- 43 [mean +/- standard error] vs 166 +/- 7, p less than .05; women, 168 +/- 19 vs 110 +/- 7.5, p less than .001). Abnormal values were detected by dual-energy radiography in 44% of patients (vs 9% of patients studied by conventional radiography). Cardiac calcium content was also significantly greater in the hemodialysis patients than in the control subjects (259 +/- 14 vs 184 +/- 8, p less than .05). Metastatic calcification was significantly correlated with elevated phosphate and calcium-phosphate product levels. Patients with significantly elevated pulmonary calcium content had evidence of restrictive lung disease by functional testing. There was an inverse correlation between elevated cardiac calcium content and ejection fraction. We conclude that dual-energy digital radiography allows premortem diagnosis of metastatic visceral calcification and is more sensitive than current techniques.
The methodology employed to calculate radiographic signal-to-noise ratio (SNR) for the commonly used disk-shaped test object is reviewed. Although the "matched" aperture yields the maximum SNR, its shape is difficult to achieve experimentally. On the other hand, a circular aperture having the same size as the object is much simpler to realize. We have performed a numerical analysis of the SNRs obtained with matched and circular apertures for two screen/film systems (a mammographic and a general purpose combination) for a range of test-object sizes. We find that for object sizes greater than 0.5 mm in diameter, there is a less than 4% difference between the SNRs obtained with the two apertures. The shapes of some of the matched apertures are also presented. We conclude that the SNR determined with the circular aperture is a simpler and more useful determinant of system performance for the screen/film combinations studied.
Two methods of dual‐photon absorptiometry (DPA) utilizing an x‐ray tube instead of a radionuclide source have recently been introduced. In one method kVp switching is employed and two transmitted intensities at each pixel are determined. In the other method, K ‐edge filtration combined with a single kVp spectrum is used, but photons in two energy windows are counted. We present a theoretical analysis of the two methods, focusing on a figure of merit which is essentially the exposure efficiency (the precision for a given entrance exposure) and tube loading. We also compare their exposure efficiencies to theoretical limits that no DPA system can exceed. Our study indicates that the K ‐edge‐filtered method is more exposure efficient by about a factor of 2. The switched‐kVp method requires less heat units per scan by about a factor of 3. A hybrid K ‐edge switched‐kVp method is suggested which achieves the same exposure efficiency as the K ‐edge‐filtered method at lesser tube loading. Our theoretical model is based on published x‐ray spectra and attenuation coefficients and is in good agreement with other simulation work. It is of interest that a point source of Gd‐153 would be even more exposure efficient, achieving about 90% of the theoretical limit. However, in practice, the Gd source is of finite size and limited strength, and consequently the radionuclide method cannot achieve as good a precision as either x‐ray method in similar scan times.