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Biomedical subjects

B J McParland

Publications and source records attributed to B J McParland.

At least 19 recordsLinked to original sources

A comparison of two mammography film-screen combinations designed for standard-cycle processing.

This paper presents comparisons of the Kodak Min-R 2000 mammography film-screen combination designed for standard-cycle processing with that of the older Min-RM/Min-R combination. Comparisons were performed in terms of characteristic curves and relative image quality. The Min-R 2000 combination had a speed of 1.7 relative to the Min-RM/Min-R combination to yield an optical density of 1.25; the maximum gradients of the characteristic curves for the two combinations were 4.6 and 2.7, respectively. Image quality was evaluated in a breast detail phantom study. It was demonstrated that image qualities of the film-screen combinations were comparable.

Female

A study of patient radiation doses in interventional radiological procedures.

Patient radiation doses received during interventional radiological procedures can be significant. To aid in the establishment of reference dose levels, a patient dose survey has been conducted of such procedures. A total of 288 non-coronary procedures (177 classified as diagnostic and 111 as therapeutic) were accrued into the study. For each procedure, the fluoroscopy screening time and the fluoroscopic and digital radiographic dose-area products were recorded in a computer database. For example, median dose-area product values (due to fluoroscopy and digital radiography combined) of 24.2, 27.9, 69.6 and 74.7 Gy cm2 were obtained for nephrostomy, biliary stent removal/insertion, cerebral angiography and percutaneous transhepatic cholangiography procedures. While the effective dose is not an accurate measure of patient risk, it is convenient for comparing the radiological risks associated with various procedures. Effective doses were estimated from the total dose-area products. The respective median estimated effective dose values for the four procedures noted above were 3.9, 4.5, 7.0 and 12.0 mSv. While an infrequently performed procedure at this institution (n = 4 during this survey), the transjugular intrahepatic portosystemic shunt (TIPS) procedure had the greatest median dose-area product and effective dose values: 347 Gy cm2 and 55.5 mSv, respectively. Excluding the extreme case of TIPS, it was found that among commonly-performed procedures, those that are categorized as therapeutic do not necessarily present a statistically significant greater radiation risk than those which are diagnostic. Comparisons between dose-area product values obtained from this study are made with data from other interventional radiology patient dose surveys and reasons for some differences noted are discussed.

Angiography

Optimizing optical density of a Kodak mammography film-screen combination with standard-cycle processing.

The optimization of optical density in film-screen mammography is crucial in attaining good image quality. While a target range for film optical density of 1.4-1.8 has been recommended for centres participating in the National Health Service Breast Screening Programme (NHSBSP), past investigations have shown that combinations of mammography film and screen and processor conditions can have various optimum densities, some of which are outside this recommended range. The optimum optical density of the film/screen/processor conditions combination used at our institution (the Kodak MIN-RM/MIN-R combination designed for standard-cycle processing) was evaluated using a breast detail phantom study. It was found that the optimum optical density was 1.25 OD. We recommend that an individual institution determines the optimum optical density for the film-screen combination it uses and the processing conditions specific to it.

Mammography

Entrance skin dose estimates derived from dose-area product measurements in interventional radiological procedures.

Patient skin doses resulting from interventional radiological procedures have the potential to exceed threshold doses for deterministic effects such as erythema and epilation. If the irradiation geometry is known, the entrance skin dose can be estimated from the measured dose-area product. For each of 10 non-coronary interventional procedures, a nominal geometry was identified. From a previous survey of patient dose-area products, the entrance skin doses were estimated under the assumption that all procedures were performed with the nominal geometry specific to it. An analysis of the uncertainties in these doses caused by realistic deviations from the nominal geometry was also performed and it was shown that the estimated entrance skin dose values are at least to within 40%, and generally to within about 30%, of those actually received. For example, the median estimated entrance skin doses for the posteroanterior and lateral projections of cerebral angiography were 100 and 110 mGy. respectively, and for hepatic angiography 425 mGy. The largest entrance skin dose estimate for a single projection was for the angiography component of a CT arterial portography procedure at 670 mGy. Comparisons between entrance skin dose estimates obtained from this study are made with data from other interventional radiology patient dose surveys.

Angiography

Radiology in the neonatal intensive care unit: dose reduction and image quality.

This paper describes a prospective study of the diagnostic radiation doses received in a neonatal intensive care unit (NICU) for a representative radiological technique used at our institution for a number of years and a "low dose" technique similar to that recommended by the Commission of the European Communities (CEC). A 400 speed film-screen combination was used in both techniques. A total of 363 anteroposterior (AP) chest and abdominal films of 77 neonates were accrued. For each radiograph, the entrance skin dose (FSD), energy imparted (EI) and mean whole body dose were determined. For a neonatal AP chest, there was an 18% reduction in the mean ESD per radiograph from 20.0 muGy for the representative technique to 16.4 muGy for the low dose technique (p < 0.0005). The reduction in the mean EI per radiograph values for the two techniques from 7.9 muJ to 7.1 muJ (10%) was statistically significant at the p < 0.017 level, after compensating for the difference in mean field dimensions between the two patient cohorts. The mean whole body dose per radiograph reduction from 4.4 to 3.5 muGy (20%) was statistically significant at the p < 0.0028 level. It was determined that the ESD and EI could be fitted by an exponential function in the equivalent patient diameter, a single parameter indicative of neonate size. Absolute excess childhood cancer mortality risk per film was estimated using risk factors derived for fetal exposures. A "worst case" absolute excess mortality risk per chest radiograph was estimated to be 1.40 x 10(-7) for the conventional technique and was further reduced to 1.11 x 10(-7) for the low dose technique. A blind comparison of patient-matched film pairs for each technique was performed by three radiologists using criteria similar to those specified by the CEC. No statistically significant difference in clinical image quality was found between the two techniques.

Analysis of Variance

Digital portal image registration by sequential anatomical matchpoint and image correlations for real-time continuous field alignment verification.

Detection of radiotherapy field misalignments with electronic portal imaging devices requires the precise initial registration of the digital portal image with a reference image indicating the prescribed field alignment. Moreover, for real-time continuous detection this registration must be performed rapidly--arguably within 250 ms. The quality of this registration is sensitive to the ability of the user to accurately identify corresponding anatomical landmarks in the image pair. To improve the accuracy of the registration and, ultimately, that of the field misalignment measurement, we have developed a sequential digital portal image registration method using both user-identified anatomical matchpoints and image information. A first pass generates registration parameters from user-provided matchpoint coordinates and explicitly accounts for the uncertainty in matchpoint identification. The second pass uses both the initial registration parameters and image information to further improve the registration quality by maximizing cross correlations between segments of the image pair. As this registration method does not use massive matrix/vector computations common to other algorithms, it is inherently faster and well-suited for real-time field placement error detection. On a platform representative of those controlling many commercial electronic portal imaging devices (486 CPU), this algorithm registers portal images in times of less than 6 ms per matchpoint with errors of less than 2% in magnification, 0.5 degree in in-plane rotation, and less than 1 pixel dimension in in-plane translation. As the algorithm assumes a rigid-body geometry, it is sensitive to out-of-plane rotations. A quantitative analysis of this algorithm is presented, indicates its accuracy, and describes its sensitivity to out-of-plane rotations.

Algorithms

A fluoroscopy credentialling programme for orthopaedic surgeons.

We have developed a teaching programme for non-radiologists who use fluoroscopy, which includes techniques for reducing the radiation received by the patient and the surgeon during orthopaedic procedures. The techniques resolve around the radiation protection concepts of time, distance and shielding. The programme has been very successful in reducing the total fluoroscopy times of orthopaedic surgeons; in our institute, durations have been reduced to about 10% of those before the training started. We review the aims and content of our programme.

Education, Medical, Continuing

The effect of a dynamic wedge in the medial tangential field upon the contralateral breast dose.

The elevated incidence of breast cancer following irradiation of breast tissue has led to concern over the magnitude of the scattered radiation received by the uninvolved contralateral breast during radiation therapy for a primary breast lesion and the risk of an induced contralateral breast cancer. Some linear accelerators use a single dynamic (or universal) wedge that is mounted within the treatment head at an extended distance from the patient. Because of the combined effects of distance and shielding, the contralateral breast dose due to a medial tangent containing a dynamic wedge is expected to be less than that containing a conventional wedge. This paper presents contralateral breast dose (CBD) measurements performed on an anthropomorphic phantom with breast prostheses irradiated with 6 MV X rays from a linear accelerator equipped with a dynamic wedge. Doses were measured at 15 points within the contralateral breast prosthesis with thermoluminescent dosimeters. It was found that the contralateral breast dose per unit target breast dose decreases with the perpendicular distance from the posterior edge of the medial tangent to the dose measurement point and increases with effective wedge angle by factors ranging up to 2.8, in agreement with data presented earlier for a water phantom geometry. This dose elevation showed no statistically significant dependence (p less than 0.05) upon the perpendicular distance from the beam edge. Comparisons with data in the literature show that the contralateral breast dose increase by a dynamic wedge is typically only about half of that reported for a conventional wedge for the same wedge angle and distance from the beam.

Breast

Methods of calculating the output factors of rectangular electron fields.

The dose output of a clinical electron beam exhibits a complex dependence upon field size, beam energy and collimation system design. A variety of methods have been developed in the past to calculate the output of an electron beam of arbitrary field dimensions. This paper describes three of these methods and indicates the advantages and disadvantages of each. Comparisons with measured data are also presented.

Algorithms

Practical considerations for electron therapy planning and preparation.

This Clinic recently commissioned its first electron beams for radiation therapy. Over the past twelve months at this institution, we have developed devices and techniques to obtain precise and reproducible electron therapy treatments. These devices and methods have been used in the treatment of irregularly shaped fields for areas of complex shape, or those adjacent to critical or radiosensitive tissues and areas where it has been cosmetically unsuitable for patients to carry treatment field markings. This paper describes the techniques used in six representative cases with due consideration to physics, dosimetry and practical aspects. Several recommendations result from our experiences here.

Electrons

Diagnostic value of Doppler ultrasound in the assessment of liver cirrhosis in children: histopathological correlation.

We have correlated flow abnormalities in the hepatic vasculature with histological findings in the liver to determine the accuracy of Doppler ultrasound in the diagnosis of liver cirrhosis in children. Eighteen children admitted for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Biopsy specimens showed established cirrhosis in 9 of 18, early cirrhosis in 5 of 18, and no cirrhosis in 4 of 18 children. Doppler studies were also performed on 20 control subjects. The portal vein velocity was decreased (p < 0.0005) and the arterio-portal velocity ratio was increased (p < 0.0005) in the established cirrhosis cohort relative to the controls. For the criteria of the established cirrhosis cohort, the sensitivities of the loss of the reverse flow component in the hepatic veins, the arterio-portal velocity ratio being greater than 3.0, the portal vein velocity being less than 20 cm/s, and the existence of focal flow acceleration in the hepatic veins were 100%, 78%, 67%, and 44%, respectively. The specificity of all these criteria was 100%. The indicators were not useful in the diagnosis of early cirrhosis.

Biopsy

A differential method for inhomogeneity correction on dose in a photon beam.

For a uniform slab of inhomogeneity in a supervoltage beam, correction factors can be calculated from the Batho equation. In this report, we present a method for calculating the effect of an annular inhomogeneity, concentric about the beam axis, upon the dose at a point on the axis and below the annulus. A derivation of the equation required in the calculation for supervoltage radiation is given. Results from measurements made in 60Co beams for polystyrene foam, cedar, and aluminum annuli, all having 3.0 x 2.0 cm2 in cross section but with different inside diameters, are compared with correction values calculated by the method. For situations where the annulus is just submerged in the phantom, measured and calculated values are in good agreement. For a general situation, two calculation types are proposed and the data show that in general the measured scatter perturbation lies between the calculated values of the two types. Application of our technique predicts a sign reversal in the scatter perturbation due to an inhomogeneity. This reversal has previously been observed and reported and is also demonstrated in our measurements.

Cobalt Radioisotopes