• Imaging Science in Dentistry
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• v.53 no.1
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• pp.69-75
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• 2023

Purpose: Maxillofacial trauma predominantly affects young adults between 20 and 40 years of age. Although radioprotection is a legal requirement, the significant potential of dose reduction in computed tomography (CT) is still underused in the clinical routine. The objective of this study was to evaluate whether maxillofacial fractures can be reliably detected and classified using ultra-low-dose CT. Materials and Methods: CT images of 123 clinical cases with maxillofacial fractures were classified by two readers using the AOCOIAC software and compared with the corresponding results from post-treatment images. In group 1, consisting of 97 patients with isolated facial trauma, pre-treatment CT images at different dose levels (volumetric computed tomography dose index: ultra-low dose, 2.6 mGy; low dose, <10 mGy; and regular dose, <20 mGy) were compared with post-treatment cone-beam computed tomography (CBCT). In group 2, consisting of 31 patients with complex midface fractures, pre-treatment shock room CT images were compared with post-treatment CT at different dose levels or CBCT. All images were presented in random order and classified by 2 readers blinded to the clinical results. All cases with an unequal classification were re-evaluated. Results: In both groups, ultra-low-dose CT had no clinically relevant effect on fracture classification. Fourteen cases in group 2 showed minor differences in the classification code, which were no longer obvious after comparing the images directly to each other. Conclusion: Ultra-low-dose CT images allowed the correct diagnosis and classification of maxillofacial fractures. These results might lead to a substantial reconsideration of current reference dose levels.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.127-133
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• 2014

Purpose: Low dose of PET/CT is important because of Patient's X-ray exposure. The aim of this study was to evaluate the effectiveness of low-dose PET/ CT image through the CTAC and QAC of patient study and phantom study. Materials and Methods: We used the discovery 710 PET/CT (GE). We used the NEMA IEC body phantom for evaluating the PET data corrected by ultra-low dose CT attenuation correction method and NU2-94 phantom for uniformity. After injection of 70.78 MBq and 22.2 MBq of 18 F-FDG were done to each of phantom, PET/CT scans were obtained. PET data were reconstructed by using of CTAC of which dose was for the diagnosis CT and Q. AC of which was only for attenuation correction. Quantitative analysis was performed by use of horizontal profile and vertical profile. Reference data which were corrected by CTAC were compared to PET data which was corrected by the ultra-low dose. The relative error was assessed. Patients with over weighted and normal weight also underwent a PET/CT scans according to low dose protocol and standard dose protocol. Relative error and signal to noise ratio of SUV were analyzed. Results: In the results of phantom test, phantom PET data were corrected by CTAC and Q.AC and they were compared each other. The relative error of Q.AC profile was been calculated, and it was shown in graph. In patient studies, PET data for overweight patient and normal weight patient were reconstructed by CTAC and Q.AC under routine dose and ultra-low dose. When routine dose was used, the relative error was small. When high dose was used, the result of overweight patient was effectively corrected by Q.AC. Conclusion: In phantom study, CTAC method with 80 kVp and 10 mA was resulted in bead hardening artifact. PET data corrected by ultra- low dose CTAC was not quantified, but those by the same dose were quantified properly. In patients' cases, PET data of over weighted patient could be quantified by Q.AC method. Its relative difference was not significant. Q.AC method was proper attenuation correction method when ultra-low dose was used. As a result, it is expected that Q.AC is a good method in order to reduce patient's exposure dose.

• Korean Journal of Artificial Intelligence
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• v.9 no.2
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• pp.1-5
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• 2021

Although CT has an advantage in describing the three-dimensional anatomical structure of the human body, it also has a disadvantage in that high doses are exposed to the patient. Recently, a deep learning-based image reconstruction method has been used to reduce patient dose. The purpose of this study is to analyze the dose reduction and image quality improvement of deep learning-based reconstruction (DLR) on the adult's chest CT examination. Adult lung phantom was used for image acquisition and analysis. Lung phantom was scanned at ultra-low-dose (ULD), low-dose (LD), and standard dose (SD) modes, and images were reconstructed using FBP (Filtered back projection), IR (Iterative reconstruction), DLR (Deep learning reconstruction) algorithms. Image quality variations with respect to varying imaging doses were evaluated using noise and SNR. At ULD mode, the noise of the DLR image was reduced by 62.42% compared to the FBP image, and at SD mode, the SNR of the DLR image was increased by 159.60% compared to the SNR of the FBP image. Based on this study, it is anticipated that the DLR will not only substantially reduce the chest CT dose but also drastic improvement of the image quality.

• Asian Spine Journal
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• v.12 no.6
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• pp.1010-1016
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• 2018

Study Design: Retrospective cohort study. Purpose: To report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2). Overview of Literature: The reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery. Methods: Consecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure. Results: Six consecutive ASD patients with a mean age of 62 years (28-72 years) were examined. Each patient received a total dose of 12 mg with an average dose of $0.69{\pm}0.2mg$ (0.42-1 mg) per single FF and $1.38{\pm}0.44mg$ (0.85-2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (${\kappa}=0.95$) and 100% vs. 100% IBF, respectively (${\kappa}=1$). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (${\kappa}=0.96$). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1-2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of $32.8{\pm}6.3$, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of $4.7{\pm}2.1$, and physical component summary improved by an average of $10.5{\pm}2.1$. Conclusions: To our knowledge, this is the first study to report a CT that defined 92%-98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.

• Korean Journal of Radiology
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• v.23 no.9
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• pp.854-865
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• 2022

Photon-counting detector (PCD) CT is a new CT technology utilizing a direct conversion X-ray detector, where incident X-ray photon energies are directly recorded as electronical signals. The design of the photon-counting detector itself facilitates improvements in spatial resolution (via smaller detector pixel design) and iodine signal (via count weighting) while still permitting multi-energy imaging. PCD-CT can eliminate electronic noise and reduce artifacts due to the use of energy thresholds. Improved dose efficiency is important for low dose CT and pediatric imaging. The ultra-high spatial resolution of PCD-CT design permits lower dose scanning for all body regions and is particularly helpful in identifying important imaging findings in thoracic and musculoskeletal CT. Improved iodine signal may be helpful for low contrast tasks in abdominal imaging. Virtual monoenergetic images and material classification will assist with numerous diagnostic tasks in abdominal, musculoskeletal, and cardiovascular imaging. Dual-source PCD-CT permits multi-energy CT images of the heart and coronary arteries at high temporal resolution. In this special review article, we review the clinical benefits of this technology across a wide variety of radiological subspecialties.

• Progress in Medical Physics
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• v.18 no.3
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• pp.134-138
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• 2007

The current PET/CT system with high quality CT images not only increases diagnostic value by providing anatomic localization, but also shortens the acquisition time for attenuation correction than primary PET system. All commercially available PET/CT system uses the CT scan for attenuation correction instead of the transmission scan using radioactive source such as $^{137}Cs,\;^{68}Ge$. However the CT scan may substantially increase the patient dose. The purpose of this study was to evaluate quality of PET images reconstructed by CT attenuation map using various tube currents. in this study, images were acquired for 3D Hoffman brain phantom and cylindrical phantom using GE DSTe PET/CT system. The emission data were acquired for 10 min using phantoms after injecting 44.03 MBq of $^{18}F-FDG$. The CT images for attenuation map were acquired by changing tube current from 10 mA to 95 mA with fixed exposure time of 8 sec and fixed tube voltage of 140 kVp. The PET images were reconstructed using these CT attenuation maps. Image quality of CT images was evaluated by measuring SD (standard deviation) of cylindrical phantom which was filled with water and $^{18}F-FDG$ solution. The PET images were evaluated by measuring the activity ratio between gray matter and white matter in Hoffman phantom images. SDs of CT images decrease by increasing tube current. When PET images were reconstructed using CT attenuation maps with various tube currents, the activity ratios between gray matter and white matter of PET images were almost same. These results indicated that the quality of the PET images using low dose CT data were comparable to the PET images using general dose CT data. Therefore, the use of low dose CT is recommended than the use of general dose CT, when the diagnostic high quality CT is not required. Further studies may need to be performed for other system, since this study is limited to the GE DSTe system used in this study.

• Radiation Oncology Journal
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• v.27 no.1
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• pp.42-48
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• 2009

Purpose: The introduction of image guided radiation therapy/four-dimensional radiation therapy (IGRT/4DRT) potentially increases the accumulated dose to patients from imaging and verification processes as compared to conventional practice. It is therefore essential to investigate the level of the imaging dose to patients when IGRT/4DRT devices are installed. The imaging dose level was monitored and was compared with the use of pre-IGRT practice. Materials and Methods: A four-dimensional CT (4DCT) unit (GE, Ultra Light Speed 16), a simulator (Varian Acuity) and Varian IX unit with an on-board imager (OBI) and cone beam CT (CBCT) were installed. The surface doses to a RANDO phantom (The Phantom Laboratory, Salem, NY USA) were measured with the newly installed devices and with pre-existing devices including a single slice CT scanner (GE, Light Speed), a simulator (Varian Ximatron) and L-gram linear accelerator (Varian, 2100C Linac). The surface doses were measured using thermo luminescent dosimeters (TLDs) at eight sites-the brain, eye, thyroid, chest, abdomen, ovary, prostate and pelvis. Results: Compared to imaging with the use of single slice non-gated CT, the use of 4DCT imaging increased the dose to the chest and abdomen approximately ten-fold ($1.74{\pm}0.34$ cGy versus $23.23{\pm}3.67$cGy). Imaging doses with the use of the Acuity simulator were smaller than doses with the use of the Ximatron simulator, which were $0.91{\pm}0.89$ cGy versus $6.77{\pm}3.56$ cGy, respectively. The dose with the use of the electronic portal imaging device (EPID; Varian IX unit) was approximately 50% of the dose with the use of the L-gram linear accelerator ($1.83{\pm}0.36$ cGy versus $3.80{\pm}1.67$ cGy). The dose from the OBI for fluoroscopy and low-dose mode CBCT were $0.97{\pm}0.34$ cGy and $2.3{\pm}0.67$ cGy, respectively. Conclusion: The use of 4DCT is the major source of an increase of the radiation (imaging) dose to patients. OBI and CBCT doses were small, but the accumulated dose associated with everyday verification need to be considered.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.131-136
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• 2013

Purpose: Quantitative comparative evaluation of the difference in eye lens absorbed dose when measured by MVCT and kV-CBCT, though such a dose was not included in the original IMRT treatment plan for the nasopharyngeal cancer patient. Materials and Methods: We used CT (Lightspeed Ultra 16, General Electric, USA) against an Anderson rando phantom (Alderson Research Laboratories Inc, USA) and established the plan for tomotherapy treatment (Tomotherapy, Inc, USA) and linear accelerator treatment (Pinnacle 8.0, Philips Medicle System) for the achieved CT images on the same condition with the nasopharyngeal cancer patient treatment plan. Then, align the ther-moluminescence dosimeter (TLD100 Harshaw, USA) with the eye lens, shot the lens with Tomotherapy MVCT under 3 conditions (Fine, Normal, and Coarse), and shot both lenses with kV-CBCT under 2 conditions (Low Dose Head and Standard Dose Head) 3 times each. Results: When we analyzed the eye lens absorbed dose according to MVCT and kV-CBCT images by using both Tomotherapy and Pinacle 8.0, we achieved the following result; According to Tomotherapy MVCT, RT 0.8257 cGy in the Coarse mode, LT 0.8137 cGy, RT 1.089 cGy and LT 1.188 cGy in the Normal mode, and RT 2.154 cGy and LT 2.082 cGy in the Fine mode. According to Pinacle 8.0 kV-CBCT, RT 0.2875 cGy and LT 0.1676 cGy in the Standard Dose mode and RT 0.1648 cGy and LT 0.1212 cGy in the Low-Dose mode. In short, the MVCT result was significantly different from that of kV-CBCT, up to 20 times. Conclusion: We think kV-CBCT is more effective for reducing the amount of radiation which a patient is receiving during intensity modulated radiation treatment for other purposes than treatment than MVCT, when we consider the absorbed dose only from the viewpoint of image-guided radiation therapy. Besides, we understood the amount of radiation is too sensitive to the shooting condition, even when we use the same equipment.

• Hip & pelvis
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• v.36 no.1
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• pp.26-36
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• 2024

Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.