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PURPOSE: To evaluate high contrast resolution of Model Based Iterative Reconstruction used with typical sinus examination acquisition parameters. METHODS: MBIR has recently become available as a recon option on a clinical scanner (Discovery HD750, GE Healthcare). In this work, we evaluate high contrast resolution for scan and reconstruction options that are available for sinus examinations. For this study we used our adult sinus CT protocol reconstructed with filtered back projection, and two alternative scans reconstructed with IR. Our conventional adult sinus CT protocol utilizes a high resolution scan mode which is not compatible with the scanner's IR recon option. The two additional scans are with high resolution option off, one with the head SFOV, and one with the body SFOV. Using IR and the head SFOV, reconstructed images have a 1024 × 1024 pixel matrix. Using IR and the body SFOV, reconstructed images have a 512 × 512 pixel matrix. Three evaluations of high contrast resolution are made for these images. A wire phantom is scanned for assessment of image modulation transfer function. The bar patterns of the ACR phantom are visually assessed for quality in both axial and coronal reformats. RESULTS: MTF curves show 50% values of 6.8, 7.5, and 7.7 lp/cm for Body IR 512 × 512, Head IR 1024 × 1024, and filtered back projection with HD Bone kernel. The 10% MFT curves for these reconstructions are 11.2, 11.9, and 12.1 lp/cm. Visual evaluation of the ACR phantom at 15 cm display field of view demonstrates resolution of the 10 lp/cm bar patterns for all reconstructions with better visualization of the axial versus coronal recons. CONCLUSIONS: MBIR reconstruction demonstrates high contrast resolution that is comparable with our conventional sinus examination.

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PURPOSE: To evaluate 12 x-ray image intensifier (XRII) digital spot systems. MATERIALS AND METHODS: Four objective tests were performed to assess XRII digital spots: entrance exposure, patient exposure, soft-copy gray scale, and pixel noise. Two additional tests were performed to assess high-contrast limiting resolution and threshold contrast detection. RESULTS: Digital spot XRII entrance exposures averaged 1 x 10(-7) C/kg (0.38 mR) for units with large fields of view (FOVs); mean entrance exposure in a medium-sized patient was 1. 25 x 10(-5) C/kg (48 mR). Luminance measurements of the table-side monitors provided a mean of 473 just-noticeable differences in gray scale with the room lights off. Mean resolution with a bar test pattern was measured as 1.5 line pairs per millimeter for systems with a 40-cm FOV. Measured pixel noise (in relative units) was 6-25. Mean threshold contrast with the lights off was 0.85%. CONCLUSION: Once input exposure is normalized for FOV and image matrix size, soft-copy assessment of limiting resolution with either low-contrast detection or, preferably, an off-line noise metric (pixel SD) provides objective measurements of digital spot image quality. With the lights on, 10 systems with room-light sensors had an 11% loss of gray scale. For systems without sensors, the loss was 33%.

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A clinical viewing system was integrated with the Mayo Clinic Scottsdale picture archiving and communication system (PACS) for providing images and the report as part of the electronic medical record (EMR). Key attributes of the viewer include a single user log-on, an integrated patient centric EMR image access for all ordered examinations, prefetching of the most recent prior examination of the same modality, and the ability to provide comparison of current and past exams at the same time on the display. Other functions included preset windows, measurement tools, and multiformat display. Images for the prior 12 months are stored on the clinical server and are viewable in less than a second. Images available on the desktop include all computed radiography (CR), chest, magnetic resonance images (MRI), computed tomography (CT), ultrasound (U/S), nuclear, angiographic, gastrointestinal (GI) digital spots, and portable C-arm digital spots. Ad hoc queries of examinations from PACS are possible for those patients whose image may not be on the clinical server, but whose images reside on the PACS archive (10TB). Clinician satisfaction was reported to be high, especially for those staff heavily dependent on timely access to images, as well as those having heavy film usage. The desktop viewer is used for resident access to images. It is also useful for teaching conferences with large-screen projection without film. We report on the measurements of functionality, reliability, and speed of image display with this application.

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Fifteen large-area, flat-panel displays used for clinical image review were evaluated for image quality and compared with 30 comparably sized cathode ray tube (CRT) monitors. Measurements were of image display patterns by Video Electronic Standards Association (VESA) and a commercial product. Field measurements were made of: maximum and minimum luminance, ambient lighting, characteristic curve (gamma), point shape and size, high-contrast resolution, uniformity, and distortion. Assessments were made of pixel defects, latent image patterns, ghosting artifacts, and viewing angle luminance. Also, a questionnaire was generated for users of the flat-panel and CRT units. Seventeen respondents indicated no preference for either flat panel or CRT. Results show these flat panels to have higher luminance (mean, 177.7 cd/m2); larger number of just noticeable differences (JNDs; n = 555), higher gamma, comparable uniformity, and warm-up time. CRTs had less angle viewing dependence and far fewer artifacts (ghosting and latent images). Our questionnaire showed active matrix liquid crystal displays (AMLCD) to be fully acceptable for clinical image viewing. Furthermore, the statistical results show that further testing for new AMLCDs of this type is unwarranted.

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Speech recognition reporting for chest examinations was introduced and tightly integrated with a Radiology Information System (RIS) and a Picture Archiving and Communications System (PACS). A feature of this integration was the unique one-to-one coupling of the workstation displayed case and the reporting via speech recognition for that and only that particular examination and patient. The utility of the resulting, wholly integrated electronic environment was then compared with that of the previous analog chest unit and dedicated wet processor, with reporting of hard copy examinations by direct dictation to a typist. Improvements in quality of service in comparison to the previous work environment include (1) immediate release of the patient, (2) decreased rate of repeat radiographs, (3) improved image quality, (4) decreased time for the examination to be available for interpretation, (5) automatic hanging of current and previous images, (6) ad-hoc availability of images, (7) capability of the radiologist to immediately review and correct the transcribed report, (8) decreased time for clinicians to view results, and (9) increased capacity of examinations per room.

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Mayo Clinic Scottsdale (MCS) is a busy outpatient facility (150,000 examinations per year) connected via asynchronous transfer mode (ATM; OC-3 155 MB/s) to a new Mayo Clinic Hospital (178 beds) located more than 12 miles distant. A primary care facility staffed by radiology lies roughly halfway between the hospital and clinic connected to both. Installed at each of the three locations is a high-speed star topology image network providing direct fiber connection (160 MB/s) from the local image storage unit (ISU) to the local radiology and clinical workstations. The clinic has 22 workstations in its star, the hospital has 13, and the primary care practice has two. In response to Mayo's request for a seamless service among the three locations, the vendor (GE Medical Systems, Milwaukee, WI) provided enhanced connectivity capability in a two-step process. First, a transfer gateway (TGW) was installed, tested, and implemented to provide the needed communication of the examinations generated at the three sites. Any examinations generated at either the hospital or the primary care facility (specified as the remote stars) automatically transfer their images to the ISU at the clinic. Permanent storage (Kodak optical jukebox, Rochester, NY) is only connected to the hub (Clinic) star. Thus, the hub ISU is provided with a copy of all examinations, while the two remote ISUs maintain local exams. Prefetching from the archive is intelligently accomplished during the off hours only to the hub star, thus providing the remote stars with network dependent access to comparison images. Image transfer is possible via remote log-on. The second step was the installation of an image transfer server (ITS) to replace the slower Digital Imaging and Communications in Medicine (DICOM)-based TGW, and a central higher performance database to replace the multiple database environment. This topology provides an enterprise view of the images at the three locations, while maintaining the high-speed performance of the local star connection to what is now called the short-term storage (STS). Performance was measured and 25 chest examinations (17 MB each) transferred in just over 4 minutes. Integration of the radiology information management system (RIMS) was modified to provide location-specific report and examination interfaces, thereby allowing local filtering of the worklist to remote and near real-time consultation, and remote examination monitoring of modalities are addressed with this technologic approach. The installation of the single database ITS environment has occurred for testing prior to implementation.

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A blood-mimicking flow phantom was used to evaluate the precision of velocity measurements acquired using 25 pulsed Doppler ultrasonographic units from four vendors. Measurements were made at four constant flow rates (12 to 50 cm/s peak velocity). The average standard deviation values of the peak and time-averaged velocities among all units and all flow rates were found to be 7 and 9% of the mean, respectively, while the corresponding values for a subgroup of 20 identical units were 5 and 8%. Considered in conjunction with other published data, this suggests that units should be calibrated to an institutional standard at the time of acceptance testing.

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The American Association of Physicists in Medicine, Committee on Training of Radiologists conducted a survey of radiation oncologists requesting information regarding their radiation oncology physics training. General questions were asked of the oncologist regarding their radiation oncology practice such as number of oncologists, number of new patients treated, and the size and type of facility in which the practice is located. The oncologist also responded to questions regarding their educational background. The survey requested the radiation oncologists to answer questions regarding the adequacy and importance of their training in specific areas of radiation physics. The responders indicated that the importance of most physics topics in their clinical practice corresponded to the level of their understanding. The survey indicated that for most radiation oncologists their physics instruction was an important and interesting part of their residency program.

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The object of this study was to determine the sensitivity of magnetic resonance (MR) for imaging intracranial lesions with heavily T2-weighted images compared with that of computed tomographic (CT) and T1-weighted images. Fifty-five patients with known intracranial pathology consisting of primary neurogenic tumors, brain infarcts, demyelinating disease, and metastases were studied by MR and CT. Patients were studied with either 0.6 or 1.5 T systems with T1- and T2-weighted radiofrequency pulse sequences. The heavily T2-weighted images were found to be superior to the T1-weighted images in terms of sensitivity, with 168 lesions found versus 86 by CT and 104 by T1-weighted imaging.

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Most magnetic resonance imaging has used body orthogonal axes with the Z axis placed along the length of the body and the X and Y axes at right angles to the body. This orientation is not optimum for the heart; visualization of sections along the short and long cardiac axes would best define cardiac structural detail and functional status. The new orientation was accomplished by selection of electronic angulation of the magnetic fields for each subject rather than by attempting to approximate the cardiac axes by altering the position of the patient. This technique improved visualization of comparative wall segments, valvular structures, and the true four-chamber view of the heart, and also gave the best visualization of the pericardium. In addition, more accurate estimates of chamber size and myocardial mass can be made from the short-axis orientation, since the sections are orthogonal to the myocardium.

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Magnetic resonance imaging (MRI) of the prostate was accomplished in 10 patients who subsequently had surgical exploration for histologic confirmation and tumor staging. Eight patients were found to have carcinoma of the prostate. Two patients had malignancies of the urinary bladder and were treated with radical resection of the bladder and prostate. The prostatic glands in the latter two patients were free of tumor. One gland was entirely normal; the other had extensive acute and chronic prostatitis. Two resected prostates with carcinoma and one normal prostate were available for in vitro MRI in a clinical magnetic resonance unit. The MRI finding of prostatic carcinoma was heterogeneous signal patterns, seen best on T2-weighted studies. A similar pattern was identified in the gland with acute and chronic prostatitis. There was a homogeneous MRI signal pattern of the normal prostate gland examined in vitro. In two instances, the MRI studies were accurate for the identification of tumor spread to the seminal vesicles, not diagnosed at the time of surgical resection. Microscopic metastatic disease of the lymph nodes in four patients was not identified by MRI.

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Sixty-five patients were examined with magnetic resonance imaging (MR) to determine what combination of operator-selectable controls would result in a thorough examination of the intervertebral disks. There were 20 normal subjects, 8 with degenerative lumbar disk disease, 27 with both degeneration and herniation, 5 with stenosis of the spinal canal, and 5 with disk space infection. T2 was significantly longer in the normal nucleus pulposus than in the degenerated disk. Based on plots of in vivo signal intensity vs. repetition time (TR) for various echo times (TE), a sagittal 30-msec. TE and a 0.25-sec. TR were used for anatomical delineation and rapid localization, while sagittal and/or axial 120-msec. TE/3-sec. TR images were used to evaluate the cerebrospinal fluid and disk. Comparison with radiographs, high-resolution CT scans, and myelograms showed that MR was the most sensitive for identification of degeneration and disk space infection, separating the normal nucleus pulposus from the annulus and degenerated disk. Herniation, stenosis of the canal, and scarring can be identified as accurately with MR as with CT or myelography.

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The addition of a magnetic resonance (MR) unit to a hospital radiology environmental poses many unique considerations. Large magnetic fields present health and safety considerations as well as a hostile environment for data recorded magnetically. Radio-frequency shielding is necessary to eliminate a source of background signal that interferes with patient examinations. Magnetic shielding may be necessary in some instances to prevent low-level magnetic field exposure of persons with artificial cardiac pacemakers. Superconducting magnets are heavy and large and may give off large amounts of helium which can temporarily replace the air in the magnet room. Possible solutions to these environmental requirements are presented.

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Seventy-two patients were examined to determine the clinical potential for magnetic resonance imaging (MRI) of the spine. MRI using different pulse sequences was compared with plain radiography, high-resolution computed tomography, and myelography. There were 35 normal patients; pathologic conditions studied included canal stenosis, herniated disk, metastatic tumor, neurofibroma, trauma, Chiari malformation, syringomyelia, arteriovenous malformation, and rheumatoid arthritis. MRI provided sharply defined anatomic delineation and tissue characterization. It was diagnostic in syringomyelia and Chiari malformation and was useful in the evaluation of trauma and spinal canal block from any cause. MRI was sensitive to degenerative disk disease and infection. The spin-echo technique, with three pulse sequence variations, seems very promising. A short echo time (TE) produces the best signal-to-noise ratio and spatial resolution. Lengthening the TE enhances differentiation of various tissues by their signal intensity, while the combined increase of TE and recovery time (TR) produces selective enhancement of the cerebrospinal fluid signal intensity.

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