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Many facets of an image acquisition workflow leave a digital footprint, making workflow analysis amenable to an informatics-based solution. This paper describes a detailed framework for analyzing workflow and uses acute stroke response timeliness in CT as a practical demonstration. We review methods for accessing the digital footprints resulting from common technologist/device interactions. This overview lays a foundation for obtaining data for workflow analysis. We demonstrate the method by analyzing CT imaging efficiency in the setting of acute stroke. We successfully used digital footprints of CT technologists to analyze their workflow. We presented an overview of other digital footprints including but not limited to contrast administration, patient positioning, billing, reformat creation, and scheduling. A framework for analyzing image acquisition workflow was presented. This framework is transferable to any modality, as the key steps of image acquisition, image reconstruction, image post processing, and image transfer to PACS are common to any imaging modality in diagnostic radiology.

The trend of increasing cervical spine multidirectional computed tomography (MDCT) imaging of pediatric trauma patients is characteristic of the overall dramatic increase in computed tomography utilization in the United States. The purpose of this study is to compare the amount of radiation a pediatric trauma patient absorbs to the thyroid from plain radiographs and MDCT of the cervical spine and to express risk by calculation of theoretical thyroid cancer induction.A retrospective evaluation of pediatric trauma patients admitted from October 1, 2004, to October 31, 2009, was performed at an academic, Level I trauma center. Inclusion criteria were Level I/II trauma patients, cervical spine imaging performed at our institution, and age18 years. Absorbed thyroid radiation was calculated for patients receiving plain radiographs or MDCT. Thyroid cancer risk was calculated using the 2006 Biological Effects on Ionizing Radiation VII report.Six hundred seventeen patients met inclusion criteria: 224 received cervical spine radiographs and 393 received cervical spine MDCT. The mean thyroid radiation absorbed from radiographs was 0.90 mGy for males and 0.96 mGy for females compared with 63.6 mGy (males) and 64.2 mGy (females) receiving MDCT (p0.001). The median excess relative risk of thyroid cancer induction from one cervical spine MDCT in males was 13.0% and females was 25.0%, compared with 0.24% (males) and 0.51% (females) for radiographs (p0.001).The significant difference in radiation that MDCT delivers to the pediatric trauma patient when compared with plain radiographs should temper routine use of computed tomography in pediatric cervical spine clearance algorithms.

Polycapillary x-ray optics provide an innovative new way to control x-ray beams. Placing these optics after the object to be imaged provides very efficient rejection of Compton scatter, while allowing image magnification without loss of resolution, image demagnification, or image shaping to match with digital detectors. Measured scatter rejection optics had primary transmissions greater than 50% and scatter transmission of less than 1%. For a 5-cm thick Lucite phantom, this resulted in a contrast enhancement of nearly a factor of two at 20 keV and three at 40 keV. The magnification from the tapered capillary optics improved the MTF at all frequencies out to 1.8 times the original system resolution. Increases below the system resolution are most important because clinically relevant structures generally occupy lower spatial frequencies. Alternatively, placing a collimating optic and diffracting crystal before the patient provides sufficient monochromatic beam intensity for medical imaging. Contrast, resolution, and intensity measurements were performed with both high and low angular acceptance crystals. At 8 keV, contrast enhancement was a factor of 5 relative to the polychromatic case, in good agreement with theoretical values. At 17.5 keV, monochromatic subject contrast was more than a factor of 2 times greater than the conventional polychromatic contrast. An additional factor of two increase in contrast, for a total factor of four, is expected from the removal of scatter in a large beam clinical system. The measured angular resolution after the crystal was 0.4 mrad for a silicon crystal.

The implementation of presentation of grouped procedures (PGP) integration profile, as described in the Integrating the Healthcare Enterprise (IHE) Technical Framework, on computed tomography (CT) and magnetic resonance (MR) scanners as well as the picture archiving communication system (PACS) addresses the problem faced by many institutions in which there are multiple-requested procedures performed in one acquisition. It is a solution that, just like the initial implementation of PACS, requires substantial modification to workflow. Implementation of PGP not only speeds access to relevant images for the requested procedure, it reduces network traffic and is less demanding on workstation hardware because of the smaller data sets transmitted. These workflow issues show that PGP implementation is not complete when the vendors install the necessary hardware and software modifications. This report discusses the workflow modifications and the barriers to implementing the PGP solution.

At the Department of Medical Physics at the University of Wisconsin-Madison, research on dual energy chest imaging including the algorithm and patient studies is done using a Pixar image processor computer. In the project described here, a study was made of which low-cost system is able to replace the Pixar and provide high-speed dual energy image processing. The dual energy algorithm was analyzed and the user and system requirements were obtained. A single workstation (e.g. Sun Sparc Station 2) does not provide enough processing power. Therefore accelerator boards for the workstation were reviewed. A prototype system was developed, using an i860-based accelerator board, i.e. the CSPI SuperCard-1, in a Sun 3/150 host computer. Bare computer time for the dual energy algorithm was reduced from 25 min using the Pixar image computer to less than three minutes using the SuperCard-1 processor board. >

K-edge energy subtraction radiography is a method for detecting the presence of iodinated contrast material by subtracting two digital radiographs produced by X-ray beams with energies above and below the iodine K edge. We performed a feasibility study on the application of K-edge energy digital subtraction arthrography (KEDSA) to painful hip prostheses. During arthrography, loosening of the prosthesis is implied if contrast material is seen dissecting around the prosthesis, an often difficult detection task because of adjacent prosthesis metal or cement. In conventional arthrography a preliminary mask image is thus used from which films obtained after injection of iodinated contrast material are subtracted. Movement by the patient during this process may preclude subsequent subtraction. With KEDSA, since multiple image pairs may be obtained after the injection of contrast material, the problem of patient motion is virtually eliminated. A conventional X-ray tube operating between 55 and 65 kVp was alternately filtered by iodine and cerium filters to produce the KEDSA images. The apparatus was capable of producing a subtracted image within 3 sec. The technique was applied to phantoms and to six patients immediately after hip arthrography that had been positive for prosthesis loosening. Although of lower spatial resolution, the KEDSA images were, in all cases, positive for loosening in a pattern consistent with the conventional arthrographic images. KEDSA was shown to be successful in detecting extraarticular contrast material. During a single study, subtraction in various imaging planes as well as postexercise subtraction imaging can be accomplished-techniques not heretofore possible in routine subtraction arthrography.

A frequently cited reason for not using commercial off-the-shelf (COTS) hardware in picture archiving and communications systems (PACS) is lack of capacity, reliability, and scalability. This report describes the evaluation the scalability of COTS hardware in a clinical PACS by migrating from an active server-passive backup server environment to an active-active cluster server arrangement.

The benefits and pitfalls of implementing a Java-based system to distribute results and images to referring physicians are addressed. The basic requirements for and barriers to implementing this system in a non-picture archiving and communication system (PACS) environment will also be discussed. The majority of radiology information systems (RIS) and hospital information systems (HIS) currently only distribute the text data for radiology examinations. This is generally adequate for low-acuity exams in a relatively healthy patient; however, many clinicians prefer to review images so they can correlate the reported findings with the image data, as well as review the exam themselves. A web-based solution eliminates the need for specialized review software and/or hardware at each review site. In addition, there is no need for support personnel to travel to each site to set up and upgrade software.

We evaluated a single-exposure, phosphor-plate, dual-energy imaging device that produces, in addition to conventional chest radiographs, both tissue- and bone-selective images. Our purpose was to determine whether dual-energy radiography was more accurate than routine chest radiography for detection and characterization of pulmonary nodules.Two hundred patients undergoing chest CT were asked to volunteer to have dual-energy and conventional chest radiographs obtained immediately before or after their CT scan. Radiographs from a subset of 50 of these patients with 116 CT-detected nodules and 10 patients with normal findings on CT scans of the chest were presented to the observers for the nodule detection study. Similarly, radiographs from a subset of 29 patients with 20 calcified and 20 uncalcified nodules were presented to five observers to determine nodule calcification. Dual-energy images were produced by filtering the X-ray tube output with a gadolinium sheet while using a multiple phosphor plate receptor. A dual-energy triad of images consisting of a conventional image, a tissue-selective image, and a bone-selective image were produced. The conventional chest radiographs and dual-energy image sets were presented to observers in random order. Data from a free response receiver operating curve and a receiver operating curve were generated for nodule detection and characterization, respectively.By using the dual-energy images, all five observers improved their ability to diagnose pulmonary nodules (p = .0005) and to characterize nodules as calcified (p = .005).By eliminating rib shadows with tissue-selective images and enhancing calcified structures with bone-selective images, dual-energy chest radiography improved the ability of all observers, regardless of expertise, to detect and characterize pulmonary nodules.

The implementation of this system provides a cost-effective and easy-to-use mechanism for verifying the receipt of radiology results. This provides the radiology department with assurance that their use of internet technologies is secure, effective, and reliable. Likewise, the approach outlined can be integrated into an enterprise-wide solution for the deployment of digital certificate technologies.

The analysis of hypothetical accidents of liquid metal cooled fast breeder reactors (LMFBR) shows that the reactor core can under certain circumtances undergo melting. The movement and freezing behavior of the molten core material are of primary importance for the subsequent course of the accident. To investigate the characteristics of freezing and crust formation of a melt penetrating into cold structure, a series of out-of-pile experiments was performed using a simple cylindrical geometry. In the experiments the molten fuel was simulated by a thermite melt that was formed by the reaction of iron oxide and aluminum and was forced into a freezing channel. The movement of the melt was observed by X-ray cinematography and on-line instrumentalation. Post-test examination supplied information about the distribution of the relocated material and the formation of the crusts. The tests were then analyzed with the multicomponent computer code BUCOGEL. The test results show that the freezing behavior of the thermite melt is comparable to that of a uranium oxide/stainless steel mixture as used in in-pile tests conducted in similar geometry. The results of the thermite tests are therefore regarded as suitable to validate the relocation and freezing modules of computer codes describing whole-core accidents.

Single-photon (I-125) absorptiometry was used to measure bone mineral content (BMC) of the distal third of the radius, and dual-photon absorptiometry (Gd-153) was used to measure total-body bone mineral (TBBM), as well as the BMC of major skeletal regions. Measurements were done in normal females, normal males, osteoporotic females, osteoporotic males, and renal patients. The BMC of the radius predicted TBBM well in normal subjects, but was less satisfactory in the patient groups. The spinal BMC was predicted with even lower accuracy from radius measurement. The error in predicting areal density (bone mass per unit projected skeletal area) of the lumbar and thoracic spine from the radius BMC divided by its width was smaller, but the regressions differed significantly among normals, osteoporotics, and renal patients. There was a preferential spinal osteopenia in the osteoporotic group and in about half of the renal patients. Bone measurements on the radius can indicate overall skeletal status in normal subjects and to a lesser degree in patients, but these radius measurements are inaccurate, even on the average, as an indicator of spinal state.

Recent studies have demonstrated that subjective assessment of the severity of coronary artery stenoses results in poor interobserver concordance and poor correlation with physiologic significance as determined by Doppler measurements of coronary flow reserve. Use of the coronary flow reserve as an integrated measure of the effect of stenosis geometry has been emphasized within the context of quantitative cinemetric analysis. The comparison of two parametric digital subtraction angiographic flow images obtained before and after hyperemic intervention has led to calculation of flow reserve values that correlate well with electromagnetic flowmeter data in dogs. By means of a similar model relating blood flow and image variables, single flow ratio images have been formed. These parametric images provide a two-dimensional display of the ratio of hyperemic flow to baseline flow. Linear temporal interpolation of data from a sequence of cardiac phase-matched subtraction images is used to improve the resolution of the displayed flow ratios. Summation of flow variables measured within the perfusion bed was used to calculate a value for the overall coronary flow reserve and to characterize the significance of isolated lesions in an open-chest canine preparation. A linear regression calculation relating parametric image flow ratio values to electromagnetic flowmeter measurements resulted in a linear fit of y = .96x - 0.19 with a correlation coefficient of .90. The direct visual representation of flow ratio distribution provided by the parametric imaging method may aid in the interpretation of multiple complex lesions as well as of single lesions.

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