An Update of VirtualDose Software Used for Assessing Patient Organ Doses from CT Examinations
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1 An Update of VirtualDose Software Used for Assessing Patient Organ Doses from CT Examinations Aiping Ding, X. George Xu Rensselaer Polytechnic Institute Troy, NY USA 1
2 Acknowledgements NIH/NIBIB (1R42EB010404) and NIH/NLM (R01LM009362) funding supports Dr Bob Liu at Massachusetts General Hospital Dr Wesley Bolch and Mr. Danny Long at University of Florida 2
3 Concern About CT Dose at The Highest Level Today Brenner and Hall, N Engl J Med NCRP. Report No. 160, Ionizing Radiation Exposure of the Population of the United States
4 Overuse for CT Scanning A single chest CT scan 350 standard chest X-rays 4
5 CT Dose Not That Small - 45 CT scans are used for Image-Guided Radiation Therapy (IGRT) Organ CT dose (Gy) Rectum 0.8 Prostate 0.6 Bladder 0.8 Left Femoral Head 1.82 Imaging doses (a total of 45 scans) from MDCT at 250 mas /scan A P Ding, J W Gu, X G Xu, Trofimov AV. Monte Carlo calculation of imaging doses from diagnostic multi-detector CT and kilovoltage cone beam CT as part of prostate cancer treatment plans. Med Phys. 37(12): ,
6 General Methodologies for CT Dose Estimation Using CTDI and DLP Physical Measurements Using Physical Phantoms Using Patient Models and Monte Carlo Simulations 6
7 Dosimetry Metrics on Current Commercial CT Scanners CT dose index (CTDI) and Dose Length Product (DLP) Patient gender/size specific dose information not available 7
8 CTDI/DLP and Patient Dose CTDI and DLP: Not the Same Thing - Standardized measures of the radiation output of a CT system - Not patient dose - No organ doses available It s better to use patient phantoms 8
9 Ways of Determining CT Organ Doses Physical measurement Dosimeter Physical phantom of patient CT modality Computational simulation Simulation tool (Monte Carlo) Computational model CT scanner model CT dose measurement CT dose simulation 9
10 Existing Software Packages Do not Meet the Needs ImPACT CT Dose CT-Expo ImpactDose
11 Motivation Increasing CT exposure becomes a national problem Accurate dosimetry tool needed Existing software outdated and crude CT dose-reporting mandatory (e. g., California) FDA public hearing recently on CT dose Our virtual patient technology, Monte Carlo modeling, and software engineering bring many opportunities 11
12 Methods: To Calculate Organ Doses from CT Exams Model patients or parts of patients Model CT scanner in detail Monte Carlo Methods/codes Simulate CT scans Calculate organ doses 12
13 Partial and Whole-Body Computational Patient Phantoms Partial patient model created from CT images Whole-body patient phantoms In-field organ doses only In-field organ doses Out-of-field organ doses Partial organ doses Averaged organ doses
14 Methods: Virtual Patients -Average Population UF pediatric phantoms - Lee (2010) (Lee, et al., Phys. Med. Biol, 2010) RPI adult male and female phantoms - Zhang (2009) (Zhang, et al., Phys. Med. Biol, 2009) RPI P3, P6 and P9 phantoms with gestation of 3, 6 and 9 months, respectively - Xu (2007) (Xu, et al., Phys. Med. Biol, 2007) 14
15 A New Set of Obese Phantoms Ding A, Mille M, Liu T, Caracappa PF, Xu XG. Extension of RPI-adult male and female computational phantoms to obese patients and a Monte Carlo study of the effect on CT imaging dose. Phys. Med. Biol. 57(9): , 2012 (FEATURE ARTICLE). Male Female Normal Weight OverWight Obese I Obese II Morbidly Obese 15
16 Methods: CT Scanner Modeling Detailed GE LightSpeed Pro 16 MDCT x-ray source and scan protocols modeled in MC codes Tube kvp, mas, pitch, and collimation CT setup with CTDI phantom Adjustment Factor used for different scanners (Caracappa et.al, AAPM 2010) TCM protocols included (Gu et.al, Phys. Med. Biol. 2009) 16
17 Methods: Monte Carlo code MCNPX (version 2.6.0) - Monte Carlo N-Particle Extended (MCNPX) code - Repeated structures format used for patient phantoms description - Cookie-cutter function used for defining fan beam - F6 tally card to score deposited energy 17
18 Methods: A Comprehensive Slice-byslice Organ Dose Database Axial scan simulations in MCNPX Contiguous scans from the top to the bottom of 27 phantoms CT technical parameters -4 different tube voltages: 80, 100, 120, and 140 kvp -4 different beam collimations: 1.25 mm, 5 mm, 10 mm and 20 mm -Using both the head and body bowtie filters 18
19 Methods: Effective Dose Calculations Effective Dose takes into account Absorbed Dose to specific organs Radio-sensitivity of each organ ICRP-103 and ICRP-60 E w H w w D T T T R T, R T T R w T = tissue weighting factor w R = radiation weighting coefficient (1 for photons) D T,R = average absorbed dose to tissue T 19
20 Methods: Software as a Service (SaaS) Web-based software as a service Not require setup CDs No needs for downloads, client-side configuration No other tedious deployment steps Suitable to develop a cross-platform application 20
21 Methods: Service-Orientated Architecture (SOA) A new software design architecture Essentially a collection of functions Flexible to manage Easy to upgrade /update frequently JSON (JavaScript Object Notation) interpret and response user request 21
22 Methods: Programming Languages and Tools Microsoft.NET Framework Programming Languages - HTML (Hypertext Markup Language) - JavaScript - JQuery - C# Microsoft Visual Studio 2010 Microsoft SQL Server
23 Results: VirtuaDose TM Graphical User Interface Computer Smartphone 23
24 User input parameters Patient Phantom type Standard scan protocols from a dropdown Combo box Type of scanner BTF type Collimation for the scanner Z-overscanning kvp for the scanner mas Pitch Results: VirtualDose TM Interactive Graphical User Interface CTDI w 24
25 Results: DICOM Processing Capability in VirtualDose TM Retrieve scan information in DICOM locally for patient CT dose reporting 25
26 Results: VirtualDose TM Rapid Archiving and Reporting Features 26
27 New $2.6 Million Grant from NIBIB to support GPU-based Monte Carlo Code Development Fast MC calculation speed Real-time CT dose calculation Less than 10 seconds 27
28 Conclusions Existing software fail to meet current and future needs for accurate and state-of-the-art CT dose reporting Our work shows several improvements Anatomically realistic children, adult, pregnant female, and obese patients Accurate CT source modeling DICOM process capability User-friendly GUI design Web-based service Clinical testing undergoing at MGH 28
29 29
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