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Article ; Online: Development of pediatric CT protocols for specific scanners: why bother?

Cody, Dianna D

2014 Volume 44 Suppl 3, Page(s) 489–491

Abstract: When determining a strategy for pediatric CT scanning, clinical staff can either elect to adjust routine adult-protocol parameter settings on a case-by-case basis or rely on pre-set pediatric protocol parameters. The advantages of the latter approach are ...

Abstract	When determining a strategy for pediatric CT scanning, clinical staff can either elect to adjust routine adult-protocol parameter settings on a case-by-case basis or rely on pre-set pediatric protocol parameters. The advantages of the latter approach are the topic of this manuscript. This paper outlines specific options to consider, including the need for regular protocol review.
MeSH term(s)	Algorithms ; Child ; Equipment Failure Analysis/instrumentation ; Equipment Failure Analysis/standards ; Guideline Adherence ; Humans ; Patient-Centered Care/standards ; Pediatrics/standards ; Practice Guidelines as Topic ; Radiation Dosage ; Radiology/standards ; Radiometry/instrumentation ; Radiometry/standards ; Reference Values ; Tomography, X-Ray Computed/instrumentation ; Tomography, X-Ray Computed/standards ; United States
Language	English
Publishing date	2014-10-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-014-3136-4
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Article ; Online: Management of auto exposure control during pediatric computed tomography.

Cody, Dianna D

Pediatric radiology

2014 Volume 44 Suppl 3, Page(s) 427–430

Abstract: Automatic exposure control (AEC) is particularly well-suited for pediatric CT scanning. However the importance of the localizer scan portion of exams that relies on AEC is frequently underestimated. This paper explains in detail several crucial aspects ... ...

Abstract	Automatic exposure control (AEC) is particularly well-suited for pediatric CT scanning. However the importance of the localizer scan portion of exams that relies on AEC is frequently underestimated. This paper explains in detail several crucial aspects of the localizer and their effect on the subsequent cross-sectional (axial or helical) image acquisition. The paper also covers general suggestions regarding AEC influence on the cross-sectional images. AEC systems on CT scanners are becoming more complex; using them effectively in the setting of pediatric CT requires careful selection of scan parameters.
MeSH term(s)	Child ; Equipment Design ; Equipment Failure Analysis ; Humans ; Image Enhancement/instrumentation ; Image Enhancement/methods ; Patient Positioning/instrumentation ; Patient Positioning/methods ; Pediatrics/instrumentation ; Pediatrics/methods ; Radiation Dosage ; Radiation Protection/instrumentation ; Radiation Protection/methods ; Radiometry/instrumentation ; Radiometry/methods ; Tomography, X-Ray Computed/instrumentation ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2014-10-11
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-014-3140-8
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Article ; Online: A comparison of breast and lung doses from chest CT scans using organ-based tube current modulation (OBTCM) vs. Automatic tube current modulation (ATCM).

Layman, Rick R / Hardy, Anthony J / Kim, Hyun J / Chou, Ei Ne / Bostani, Maryam / Cagnon, Chris / Cody, Dianna / McNitt-Gray, Michael

Journal of applied clinical medical physics

2021 Volume 22, Issue 5, Page(s) 97–109

Abstract: ... as water equivalent diameter (D: Results: Mean dose reduction from OBTCM in nD: Conclusions: One ...

Abstract	Purpose: The purpose of this work was to estimate and compare breast and lung doses of chest CT scans using organ-based tube current modulation (OBTCM) to those from conventional, attenuation-based automatic tube current modulation (ATCM) across a range of patient sizes. Methods: Thirty-four patients (17 females, 17 males) who underwent clinically indicated CT chest/abdomen/pelvis (CAP) examinations employing OBTCM were collected from two multi-detector row CT scanners. Patient size metric was assessed as water equivalent diameter (D Results: Mean dose reduction from OBTCM in nD Conclusions: One specific manufacturer's OBTCM was analyzed. OBTCM was observed to significantly decrease normalized breast relative to a modeled version of that same manufacturer's ATCM scheme. However, significant dose savings were not observed in lung dose over all. Results from this study support the use of OBTCM chest protocols for females only.
MeSH term(s)	Breast/diagnostic imaging ; Female ; Humans ; Lung/diagnostic imaging ; Male ; Monte Carlo Method ; Phantoms, Imaging ; Radiation Dosage ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.13198
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Article ; Online: AAPM Medical Physics Practice Guideline 1.b: CT protocol management and review practice guideline.

Cody, Dianna D / Dillon, Chad M / Fisher, Tyler S / Liu, Xinming / McNitt-Gray, Michael F / Patel, Vikas

Journal of applied clinical medical physics

2021 Volume 22, Issue 6, Page(s) 4–10

Abstract: The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8000 members and is the ... ...

Abstract	The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: (a) Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. (b) Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
MeSH term(s)	Cytarabine ; Health Physics ; Humans ; Radiation Oncology ; Societies ; Tomography, X-Ray Computed ; United States
Chemical Substances	Cytarabine (04079A1RDZ)
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.13193
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Article ; Online: Partial arc beam filtration: a novel approach to reducing CT breast radiation dose.

Mathieu, Kelsey B / Cody, Dianna D

AJR. American journal of roentgenology

2013 Volume 200, Issue 3, Page(s) 601–607

Abstract: Objective: We sought to assess the effectiveness of a novel CT radiation dose reduction strategy in which filtration was added at the x-ray tube output port between the x-ray beam and the breast area of three sizes of anthropomorphic phantoms.: ... ...

Abstract	Objective: We sought to assess the effectiveness of a novel CT radiation dose reduction strategy in which filtration was added at the x-ray tube output port between the x-ray beam and the breast area of three sizes of anthropomorphic phantoms. Materials and methods: To evaluate the dose-reduction potential of partial arc x-ray beam filtration, copper foil filtration or lead foil filtration was placed over CT scanners' covers when scanning anthropomorphic phantoms representative of a 5-year-old child, a 10-year-old child, and an adult female. Dose reduction was calculated as the percentage difference between the mean entrance radiation dose (on the phantoms' surfaces at locations representing the sternum and left breast) in unshielded scans compared with the mean dose in scans shielded by copper or lead foil. We also compared the CT numbers and noise sampled in regions representing the lung and the soft tissues near the sternum, left breast, and spine in CT images of the phantoms during unshielded scans relative to acquisitions shielded by copper or lead foil. Results: Entrance dose at the sternum and left breast in the three anthropomorphic phantoms was reduced by 28-66% and 54-79% when using copper or lead foil filtration, respectively. However, copper foil filtration affected the CT numbers and noise in the CT images less than the lead foil filtration did (8.2% vs 32% mean increase in noise). Conclusion: By incorporating partial arc beam filtration into CT scanners, substantial dose reductions may be achieved with a minimal increase in image noise.
MeSH term(s)	Adult ; Breast ; Child ; Child, Preschool ; Equipment Design ; Equipment Failure Analysis ; Female ; Filtration/instrumentation ; Humans ; Male ; Phantoms, Imaging ; Radiation Dosage ; Radiation Protection/instrumentation ; Radiation Protection/methods ; Tomography, X-Ray Computed/instrumentation ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2013-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	82076-3
ISSN	1546-3141 ; 0361-803X ; 0092-5381
ISSN (online)	1546-3141
ISSN	0361-803X ; 0092-5381
DOI	10.2214/AJR.12.8771
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Article ; Online: Development of a dual-energy computed tomography quality control program: Characterization of scanner response and definition of relevant parameters for a fast-kVp switching dual-energy computed tomography system.

Nute, Jessica L / Jacobsen, Megan C / Stefan, Wolfgang / Wei, Wei / Cody, Dianna D

Medical physics

2018 Volume 45, Issue 4, Page(s) 1444–1458

Abstract: Purpose: A prototype QC phantom system and analysis process were developed to characterize the spectral capabilities of a fast kV-switching dual-energy computed tomography (DECT) scanner. This work addresses the current lack of quantitative oversight ... ...

Abstract	Purpose: A prototype QC phantom system and analysis process were developed to characterize the spectral capabilities of a fast kV-switching dual-energy computed tomography (DECT) scanner. This work addresses the current lack of quantitative oversight for this technology, with the goal of identifying relevant scan parameters and test metrics instrumental to the development of a dual-energy quality control (DEQC). Methods: A prototype elliptical phantom (effective diameter: 35 cm) was designed with multiple material inserts for DECT imaging. Inserts included tissue equivalent and material rods (including iodine and calcium at varying concentrations). The phantom was scanned on a fast kV-switching DECT system using 16 dual-energy acquisitions (CTDIvol range: 10.3-62 mGy) with varying pitch, rotation time, and tube current. The circular head phantom (22 cm diameter) was scanned using a similar protocol (12 acquisitions; CTDIvol range: 36.7-132.6 mGy). All acquisitions were reconstructed at 50, 70, 110, and 140 keV and using a water-iodine material basis pair. The images were evaluated for iodine quantification accuracy, stability of monoenergetic reconstruction CT number, noise, and positional constancy. Variance component analysis was used to identify technique parameters that drove deviations in test metrics. Variances were compared to thresholds derived from manufacturer tolerances to determine technique parameters that had a nominally significant effect on test metrics. Results: Iodine quantification error was largely unaffected by any of the technique parameters investigated. Monoenergetic HU stability was found to be affected by mAs, with a threshold under which spectral separation was unsuccessful, diminishing the utility of DECT imaging. Noise was found to be affected by CTDIvol in the DEQC body phantom, and CTDIvol and mA in the DEQC head phantom. Positional constancy was found to be affected by mAs in the DEQC body phantom and mA in the DEQC head phantom. Conclusion: A streamlined scan protocol was developed to further investigate the effects of CTDIvol and rotation time while limiting data collection to the DEQC body phantom. Further data collection will be pursued to determine baseline values and statistically based failure thresholds for the validation of long-term DECT scanner performance.
MeSH term(s)	Phantoms, Imaging ; Quality Control ; Signal-To-Noise Ratio ; Time Factors ; Tomography, X-Ray Computed/instrumentation
Language	English
Publishing date	2018-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.12812
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Article ; Online: The impact of x-ray tube stabilization on localized radiation dose in axial CT scans: initial results in CTDI phantoms.

Mathieu, Kelsey B / McNitt-Gray, Michael F / Cody, Dianna D

Physics in medicine and biology

2016 Volume 61, Issue 20, Page(s) 7363–7376

Abstract: Rise, fall, and stabilization of the x-ray tube output occur immediately before and after data acquisition on some computed tomography (CT) scanners and are believed to contribute additional dose to anatomy facing the x-ray tube when it powers on or off. ...

Abstract	Rise, fall, and stabilization of the x-ray tube output occur immediately before and after data acquisition on some computed tomography (CT) scanners and are believed to contribute additional dose to anatomy facing the x-ray tube when it powers on or off. In this study, we characterized the dose penalty caused by additional radiation exposure during the rise, stabilization, and/or fall time (referred to as overscanning). A 32 cm CT dose-index (CTDI) phantom was scanned on three CT scanners: GE Healthcare LightSpeed VCT, GE Healthcare Discovery CT750 HD, and Siemens Somatom Definition Flash. Radiation exposure was detected for various x-ray tube start acquisition angles using a 10 cm pencil ionization chamber placed in the peripheral chamber hole at the phantom's 12 o'clock position. Scan rotation time, ionization chamber location, phantom diameter, and phantom centering were varied to quantify their effects on the dose penalty caused by overscanning. For 1 s single, axial rotations, CTDI at the 12 o'clock chamber position (CTDI
MeSH term(s)	Algorithms ; Humans ; Image Processing, Computer-Assisted ; Phantoms, Imaging ; Radiation Dosage ; Tomography Scanners, X-Ray Computed ; Tomography, X-Ray Computed/instrumentation
Language	English
Publishing date	2016-10-21
Publishing country	England
Document type	Journal Article
ZDB-ID	208857-5
ISSN	1361-6560 ; 0031-9155
ISSN (online)	1361-6560
ISSN	0031-9155
DOI	10.1088/0031-9155/61/20/7363
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Article ; Online: CT protocol review and optimization.

Kofler, James M / Cody, Dianna D / Morin, Richard L

Journal of the American College of Radiology : JACR

2014 Volume 11, Issue 3, Page(s) 267–270

Abstract: To reduce the radiation dose associated with CT scans, much attention is focused on CT protocol review and improvement. In fact, annual protocol reviews will soon be required for ACR CT accreditation. A major challenge in the protocol review process is ... ...

Abstract	To reduce the radiation dose associated with CT scans, much attention is focused on CT protocol review and improvement. In fact, annual protocol reviews will soon be required for ACR CT accreditation. A major challenge in the protocol review process is determining whether a current protocol is optimal and deciding what steps to take to improve it. In this paper, the authors describe methods for pinpointing deficiencies in CT protocols and provide a systematic approach for optimizing them. Emphasis is placed on a team approach, with a team consisting of at least one radiologist, one physicist, and one technologist. This core team completes a critical review of all aspects of a CT protocol and carefully evaluates proposed improvements. Changes to protocols are implemented only with consensus of the core team, with consideration of all aspects of the CT examination, including image quality, radiation dose, patient care and safety, and workflow.
MeSH term(s)	Practice Guidelines as Topic ; Radiation Protection/standards ; Radiographic Image Enhancement/standards ; Radiology/standards ; Tomography, X-Ray Computed/standards ; United States
Language	English
Publishing date	2014-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2274861-1
ISSN	1558-349X ; 1546-1440
ISSN (online)	1558-349X
ISSN	1546-1440
DOI	10.1016/j.jacr.2013.10.013
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Article ; Online: Dual-Energy CT: Lower Limits of Iodine Detection and Quantification.

Jacobsen, Megan C / Cressman, Erik N K / Tamm, Eric P / Baluya, Dodge L / Duan, Xinhui / Cody, Dianna D / Schellingerhout, Dawid / Layman, Rick R

Radiology

2019 Volume 292, Issue 2, Page(s) 414–419

Abstract: Background Assessments of the quantitative limitations among the six commercially available dual-energy (DE) CT acquisition schemes used by major CT manufacturers could aid researchers looking to use iodine quantification as an imaging biomarker. Purpose ...

Abstract	Background Assessments of the quantitative limitations among the six commercially available dual-energy (DE) CT acquisition schemes used by major CT manufacturers could aid researchers looking to use iodine quantification as an imaging biomarker. Purpose To determine the limits of detection and quantification of DE CT in phantoms by comparing rapid peak kilovoltage switching, dual-source, split-filter, and dual-layer detector systems in six different scanners. Materials and Methods Seven 50-mL iohexol solutions were used, with concentrations of 0.03-2.0 mg iodine per milliliter. The solutions and water sample were scanned five times each in two phantoms (small, 20-cm diameter; large, 30 × 40-cm diameter) with six DE CT systems and a total of 10 peak kilovoltage settings or combinations. Iodine maps were created, and the mean iodine signal in each sample was recorded. The limit of blank (LOB) was defined as the upper limit of the 95% confidence interval of the water sample. The limit of detection (LOD) was defined as the concentration with a 95% chance of having a signal above the LOB. The limit of quantification (LOQ) was defined as the lowest concentration where the coefficient of variation was less than 20%. Results The LOD range was 0.021-0.26 mg/mL in the small phantom and 0.026-0.55 mg/mL in the large phantom. The LOQ range was 0.07-0.50 mg/mL in the small phantom and 0.20-1.0 mg/mL in the large phantom. The dual-source and rapid peak kilovoltage switching systems had the lowest LODs, and the dual-layer detector systems had the highest LODs. Conclusion The iodine limit of detection using dual-energy CT systems varied with scanner and phantom size, but all systems depicted iodine in the small and large phantoms at or below 0.3 and 0.5 mg/mL, respectively, and enabled quantification at concentrations of 0.5 and 1.0 mg/mL, respectively. © RSNA, 2019
MeSH term(s)	Contrast Media ; Iodine ; Phantoms, Imaging ; Radiographic Image Enhancement/methods ; Radiography, Dual-Energy Scanned Projection/methods ; Reproducibility of Results ; Tomography, X-Ray Computed/methods
Chemical Substances	Contrast Media ; Iodine (9679TC07X4)
Language	English
Publishing date	2019-06-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiol.2019182870
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Article ; Online: "How to" incorporate dual-energy imaging into a high volume abdominal imaging practice.

Tamm, Eric P / Le, Ott / Liu, Xinming / Layman, Rick R / Cody, Dianna D / Bhosale, Priya R

Abdominal radiology (New York)

2017 Volume 42, Issue 3, Page(s) 688–701

Abstract: Dual-energy CT imaging has many potential uses in abdominal imaging. It also has unique requirements for protocol creation depending on the dual-energy scanning technique that is being utilized. It also generates several new types of images which can ... ...

Abstract	Dual-energy CT imaging has many potential uses in abdominal imaging. It also has unique requirements for protocol creation depending on the dual-energy scanning technique that is being utilized. It also generates several new types of images which can increase the complexity of image creation and image interpretation. The purpose of this article is to review, for rapid switching and dual-source dual-energy platforms, methods for creating dual-energy protocols, different approaches for efficiently creating dual-energy images, and an approach to navigating and using dual-energy images at the reading station all using the example of a pancreatic multiphasic protocol. It will also review the three most commonly used types of dual-energy images: "workhorse" 120kVp surrogate images (including blended polychromatic and 70 keV monochromatic), high contrast images (e.g., low energy monochromatic and iodine material decomposition images), and virtual unenhanced images. Recent developments, such as the ability to create automatically on the scanner the most common dual-energy images types, namely new "Mono+" images for the DSDECT (dual-source dual-energy CT) platform will also be addressed. Finally, an approach to image interpretation using automated "hanging protocols" will also be covered. Successful dual-energy implementation in a high volume practice requires careful attention to each of these steps of scanning, image creation, and image interpretation.
MeSH term(s)	Clinical Protocols ; Humans ; Radiography, Abdominal/methods ; Radiography, Dual-Energy Scanned Projection/methods ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2017-01-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2839786-1
ISSN	2366-0058 ; 2366-004X
ISSN (online)	2366-0058
ISSN	2366-004X
DOI	10.1007/s00261-016-1035-x
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