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BACKGROUND: Global shortages of iodinated contrast media (ICM) during COVID-19 pandemic forced the imaging community to use ICM more strategically in CT exams. PURPOSE: The purpose of this work is to provide a quantitative framework for preserving iodine CNR while reducing ICM dosage by either lowering kV in single-energy CT (SECT) or using lower energy virtual monochromatic images (VMI) from dual-energy CT (DECT) in a phantom study. MATERIALS AND METHODS: In SECT study, phantoms with effective diameters of 9.7, 15.9, 21.1, and 28.5 cm were scanned on SECT scanners of two different manufacturers at a range of tube voltages. Statistical based iterative reconstruction and deep learning reconstruction were used. In DECT study, phantoms with effective diameters of 20, 29.5, 34.6, and 39.7 cm were scanned on DECT scanners from three different manufacturers. VMIs were created from 40 to 140 keV. ICM reduction by lowering kV levels for SECT or switching from SECT to DECT was calculated based on the linear relationship between iodine CNR and its concentration under different scanning conditions. RESULTS: On SECT scanner A, while matching CNR at 120 kV, ICM reductions of 21%, 58%, and 72% were achieved at 100, 80, and 70 kV, respectively. On SECT scanner B, 27% and 80% ICM reduction was obtained at 80 and 100 kV. On the Fast-kV switch DECT, with CNR matched at 120 kV, ICM reductions were 35%, 30%, 23%, and 15% with VMIs at 40, 50, 60, and 68 keV, respectively. On the dual-source DECT, ICM reductions were 52%, 48%, 42%, 33%, and 22% with VMIs at 40, 50, 60, 70, and 80 keV. On the dual-layer DECT, ICM reductions were 74%, 62%, 45%, and 22% with VMIs at 40, 50, 60, and 70 keV. CONCLUSIONS: Our work provided a quantitative baseline for other institutions to further optimize their scanning protocols to reduce the use of ICM.

Purpose: We differentiated calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones using micro and clinical computerized tomography images. Materials and Methods: A total of 22 calcium oxalate monohydrate and 15 calcium oxalate dihydrate human kidney stones were scanned using a commercial micro-computerized tomography scanner with a pixel size of 7 to 23 μm. Under an institutional review board approved protocol, image data on 10 calcium oxalate monohydrate and 9 calcium oxalate dihydrate stones greater than 5 mm were retrieved from a total of 80 patients who underwent clinical dual energy computerized tomography for clinical indications and had stones available for infrared spectroscopic compositional analysis. Micro and clinical computerized tomography images were processed using in-house software, which quantified stone surface morphology with curvature based calculations. A shape index was generated as a quantitative shape metric to differentiate calcium oxalate monohydrate from calcium oxalate dihydrate stones. Statistical tests were used to test the performance of the shape index. Results: On micro-computerized tomography images the shape index of calcium oxalate monohydrate and calcium oxalate dihydrate stones significantly differed (ROC curve AUC 0.92, p <0.0001). At the optimal cutoff sensitivity was 0.93 and specificity was 0.91. On clinical computerized tomography images a significant morphological difference was also detected (p = 0.007). AUC, sensitivity and specificity were 0.90, 1 and 0.73, respectively. Conclusions: On micro and clinical computerized tomography images a morphological difference was detectable in calcium oxalate monohydrate and calcium oxalate dihydrate stones larger than 5 mm. The shape index is a highly promising method that can distinguish calcium oxalate monohydrate and calcium oxalate dihydrate stones with reasonable accuracy. [ABSTRACT FROM AUTHOR]

Purpose: For the purpose of size-specific dose estimation, information regarding patient attenuation is required. The purpose of this work is to describe a method for measuring patient attenuation and expressing the results in terms of a water cylinder, with cross sectional area Aw, which would absorb the same average dose as the irradiated patient. The ability to calculate Aw directly from the CT image was validated with Monte Carlo simulations and an analytical model. Methods: A series of virtual cylinders were created with diameters ranging from 10 to 40 cm and lengths of 40 cm. The cylinders were given an atomic number equal to that of water; the density of the cylinders was varied from 0.26 to 1.2 g/cm3. The average dose to the cylinders from an axial scan at the longitudinal center position was calculated using Monte Carlo simulation and an analytical model. The relationship between phantom cross sectional area and calculated dose was determined for each density value to determine the dependence of Aw on object attenuation. In addition, Aw was estimated from the virtual CT images based on two derived models expressing the potential dependence of Aw on object attenuation, one model assuming a linear dependence and the other assuming a quadratic dependence. Model results were compared with those from the Monte Carlo simulation and the analytical dose calculation approach. Virtual thorax and abdomen phantoms of adult and pediatric sizes were created, and Aw was estimated using geometrical size parameters or the derived models. The accuracy of each approach for estimating Aw was determined by comparing the average dose to the virtual phantom calculated using Monte Carlo simulation to the average dose to a water equivalent phantom of cross sectional area Aw. Results: In the absence of a bowtie filter, both the Monte Carlo simulation and analytical model showed that (Aw/A) had a quadratic dependence on (μ/μw). However, including a bowtie filter in the Monte Carlo simulation altered the relationship, such that Aw/A was linearly dependent on μ/μw. Using this relationship, the dose absorbed by a water cylinder of area Aw agreed with the dose absorbed by adult and pediatric, thorax and abdomen phantoms to within 6% (mean difference = 0.5 ± 4.8%). Estimates of Aw (or the water equivalent diameter Dw) using only anterior-posterior and lateral phantom dimensions led to dose estimates that agreed with Monte Carlo-derived dose values within 3% and 6% for the abdomen adult and pediatric phantoms, respectively. However, because of density differences between lung and tissue, larger differences in dose relative to Monte Carlo-derived values were observed in the thorax adult and pediatric phantoms (15% and 11%, respectively) when only geometrical parameters were used to estimate Dw. Conclusions: Patient attenuation can be quantified in terms of the diameter of a water cylinder that absorbs same average dose as the irradiated cross section of the patient. The linear dependence of Aw on object attenuation makes it straightforward to calculate Aw from a CT image on most operator consoles or clinical workstations. [ABSTRACT FROM AUTHOR]

Purpose: To estimate attenuation using cross sectional CT images and scanned projection radiograph (SPR) images in a series of thorax and abdomen phantoms. Methods: Attenuation was quantified in terms of a water cylinder with cross sectional area of Aw from both the CT and SPR images of abdomen and thorax phantoms, where Aw is the area of a water cylinder that would absorb the same dose as the specified phantom. SPR and axial CT images were acquired using a dual-source CT scanner operated at 120 kV in single-source mode. To use the SPR image for estimating Aw, the pixel values of a SPR image were calibrated to physical water attenuation using a series of water phantoms. Aw and the corresponding diameter Dw were calculated using the derived attenuation-based methods (from either CT or SPR image). Aw was also calculated using only geometrical dimensions of the phantoms (anterior-posterior and lateral dimensions or cross sectional area). Results: For abdomen phantoms, the geometry-based and attenuation-based methods gave similar results for Dw. Using only geometric parameters, an overestimation of Dw ranging from 4.3% to 21.5% was found for thorax phantoms. Results for Dw using the CT image and SPR based methods agreed with each other within 4% on average in both thorax and abdomen phantoms. Conclusions: Either the cross sectional CT or SPR images can be used to estimate patient attenuation in CT. Both are more accurate than use of only geometrical information for the task of quantifying patient attenuation. The SPR based method requires calibration of SPR pixel values to physical water attenuation and this calibration would be best performed by the scanner manufacturer. [ABSTRACT FROM AUTHOR]

Purpose: We propose a method to improve the accuracy of volume estimation of kidney stones from computerized tomography images. Materials and Methods: The proposed method consisted of 2 steps. A threshold equal to the average of the computerized tomography number of the object and the background was first applied to determine full width at half maximum volume. Correction factors were then applied, which were precalculated based on a model of a sphere and a 3-dimensional Gaussian point spread function. The point spread function was measured in a computerized tomography scanner to represent the response of the scanner to a point-like object. Method accuracy was validated using 6 small cylindrical phantoms with 2 volumes of 21.87 and 99.9 mm3, and 3 attenuations, respectively, and 76 kidney stones with a volume range of 6.3 to 317.4 mm3. Volumes estimated by the proposed method were compared with full width at half maximum volumes. Results: The proposed method was significantly more accurate than full width at half maximum volume (p <0.0001). The magnitude of improvement depended on stone volume with smaller stones benefiting more from the method. For kidney stones 10 to 20 mm3 in volume the average improvement in accuracy was the greatest at 19.6%. Conclusions: The proposed method achieved significantly improved accuracy compared with threshold methods. This may lead to more accurate stone management. [Copyright &y& Elsevier]

Dual-energy computed tomography (DECT) allows one to obtain both density and atomic number and thus can provide information about material composition of scanned objects. In this paper, we extend a basis material decomposition method for high energy X-ray DECT used in cargo inspection. It differs from conventional DECT reconstruction methods by pair-production effect coming into play in the reconstruction. The pair-production does not happen for DECT in low energy level (lower than 1 MeV). The decomposition error of the basis material model and its applicability in the high-energy level are analyzed in this paper. A reconstruction method based on this model is proposed to reconstruct both the atomic number Z and the electron density \rhoe images for a high-energy DECT. The method is validated by a numerical simulation and a practical experiment on a cargo inspection system. Results show that the proposed reconstruction method is strongly grounded on physics and feasible for high-energy DECT in material discrimination, especially for cargo inspections. The advantages and limitations of the high-energy DECT, as well as possible improvements for future work are discussed in this paper. [ABSTRACT FROM AUTHOR]

Purpose: In diagnostic CT imaging, multiple important applications depend on the knowledge of the x-ray spectrum, including Monte Carlo dose calculations and dual-energy material decomposition analysis. Due to the high photon flux involved, it is difficult to directly measure spectra from the x-ray tube of a CT scanner. One potential method for indirect measurement involves estimating the spectrum from transmission measurements. The expectation maximization (EM) method is an accurate and robust method to solve this problem. In this article, this method was evaluated in a commercial CT scanner. Methods: Two step-wedges (polycarbonate and aluminum) were used to produce different attenuation levels. Transmission measurements were performed on the scanner and the measured data from the scanner were exported to an external computer to calculate the spectra. The EM method was applied to solve the equations that represent the attenuation processes of polychromatic x-ray photons. Estimated spectra were compared to the spectra simulated using a software provided by the manufacturer of the scanner. To test the accuracy of the spectra, a verification experiment was performed using a phantom containing different depths of water. The measured transmission data were compared to the transmission values calculated using the estimated spectra. Results: Spectra of 80, 100, 120, and 140 kVp from a dual-source CT scanner were estimated. The estimated and simulated spectra were well matched. The differences of mean energies were less than 1 keV. In the verification experiment, the measured and calculated transmission values were in excellent agreement. Conclusions: Spectrum estimation using transmission data and the EM method is a quantitatively accurate and robust technique to estimate the spectrum of a CT system. This method could benefit studies relying on accurate knowledge of the x-ray spectra from CT scanner. [ABSTRACT FROM AUTHOR]

Abstract: An X-ray cargo inspection system with few-view projection imaging is developed for detecting contraband in air containers. This paper describes this developing inspection system, including its configuration and the process of inspection using three imaging modalities: digital radiography (DR), few view imaging and computed tomography (CT). The few-view imaging can provide 3D images with much faster scanning speed than CT and do great help to quickly locate suspicious cargo in a container. An algorithm to reconstruct tomographic images from severely sparse projection data of few-view imaging is discussed. A cooperative work manner of the three modalities is presented to make the inspection more convenient and effective. Numerous experiments of performance tests and modality comparison are performed on our system for inspecting air containers. Results demonstrate the effectiveness of our methods and implementation of few-view imaging in practical inspection systems. [Copyright &y& Elsevier]