PURPOSE: To establish the reliability of anthropometric and dual energy X-ray absorptiometry(DXA) techniques used to assess percent body fat (% BF)in female athletes; to establish limits for detecting the smallest real change in % BF associated with anthropometric and DXA testing;to evaluate the validity of commonly used % BF prediction equations recommended by national certification programs along with equations derived from Multicompartment (MC), and DXA, in female athletes; and to create a new DXA based regression equation for elite female athletes. METHODS:Female athletes aged 17-31 were recruited into the study and participated in the establishment of anthropometric reliability (N=20), DXA reliability (N=32), and /or skinfold validity (N=95) testing. Anthropometric testing consisted of measurements of skinfolds,circumferences, and breadths. DXA measurements were conducted using a GE Lunar Prodigy DXA which served as the criterion measure (% BF DXA). RESULTS: Excellent reliability for both anthropometric sum5 skinfolds (ICC= .997, %TEM=0.9 %) and DXA (ICC =.996, CV =1.13% BF) techniques allows for detection of smallest real differences of 2.2 mm and 721g in summed skinfolds (sum5) and fat mass respectively. The DXA based equation of Ball et al.(2004) displayed the greatest validity of existing equations R=.874, total error (TE) 2.9% BF, and Bland Altman Limits of Agreement -4.7to 6.5 % BF. The newly created regression equation demonstrated a non-linear characteristic and displayed similar predictive ability R= .840, TE 3.0%BF, and Bland Altman Limits of Agreement of -6.1to 6.1 % BF. CONCLUSIONS: Anthropometric equations derived from various criteria yielded dissimilar results. Long utilized popular equations advocated in national accreditation schemes (ACSM, CSEP) show considerable bias compared to modern values obtained by current DXA technology. A new regression equation was created for female Canadian athletes 17-31yrs of age using skinfolds taught in the Canadian national professional certification program (CSEP).

PURPOSE: To establish the reliability of anthropometric and dual energy X-ray absorptiometry(DXA) techniques used to assess percent body fat (% BF)in female athletes; to establish limits for detecting the smallest real change in % BF associated with anthropometric and DXA testing;to evaluate the validity of commonly used % BF prediction equations recommended by national certification programs along with equations derived from Multicompartment (MC), and DXA, in female athletes; and to create a new DXA based regression equation for elite female athletes. METHODS:Female athletes aged 17-31 were recruited into the study and participated in the establishment of anthropometric reliability (N=20), DXA reliability (N=32), and /or skinfold validity (N=95) testing. Anthropometric testing consisted of measurements of skinfolds,circumferences, and breadths. DXA measurements were conducted using a GE Lunar Prodigy DXA which served as the criterion measure (% BF DXA). RESULTS: Excellent reliability for both anthropometric sum5 skinfolds (ICC= .997, %TEM=0.9 %) and DXA (ICC =.996, CV =1.13% BF) techniques allows for detection of smallest real differences of 2.2 mm and 721g in summed skinfolds (sum5) and fat mass respectively. The DXA based equation of Ball et al.(2004) displayed the greatest validity of existing equations R=.874, total error (TE) 2.9% BF, and Bland Altman Limits of Agreement -4.7to 6.5 % BF. The newly created regression equation demonstrated a non-linear characteristic and displayed similar predictive ability R= .840, TE 3.0%BF, and Bland Altman Limits of Agreement of -6.1to 6.1 % BF. CONCLUSIONS: Anthropometric equations derived from various criteria yielded dissimilar results. Long utilized popular equations advocated in national accreditation schemes (ACSM, CSEP) show considerable bias compared to modern values obtained by current DXA technology. A new regression equation was created for female Canadian athletes 17-31yrs of age using skinfolds taught in the Canadian national professional certification program (CSEP).

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Η υπολογιστική τομογραφία διπλής ενέργειας είναι μια σύγχρονη και συνεχώς εξελισσόμενη τεχνική, η οποία ενισχύει την διαφοροποίηση υλικών, βασιζόμενη στις φασματικές τους ιδιότητες. Φασματική απεικόνιση στην υπολογιστική τομογραφία απαιτεί τη χρήση δυο διαφορετικών ενεργειακών φασμάτων, και μπορεί να διαχωρίσει υλικά τα οποία διαφέρουν σημαντικά στον ατομικό τους αριθμό. Για το λόγο αυτό το ιώδιο (Ζ=53), το οποίο χρησιμοποιείται ως σκιαγραφική ουσία, καθώς και το οστό και οι ασβεστώσεις, τα οποία περιέχουν ασβέστιο (Ζ=20) σε μεγάλο ποσοστό, μπορούν να είναι διακριτά από τα υπόλοιπα στοιχεία τα οποία αποτελούν το ανθρώπινο σώμα, όπως υδρογόνο (Ζ=1), οξυγόνο (Ζ=8), άνθρακα (Ζ=6) και άζωτο (Ζ=7), τα οποία είναι υλικά χαμηλού ατομικού αριθμού. Αυτή τη στιγμή υπάρχουν τρεις διαφορετικές τεχνολογίες υπολογιστικής τομογραφίας διπλής ενεργείας. Ο τομογράφος με ανιχνευτή δυο στρωμάτων, ο οποίος χρησιμοποίει μια λυχνία ακτίνων Χ και ένα ανιχνευτή με δύο στρώματα σπινθηρισμού τοποθετημένα το ένα πάνω στο άλλο. Το πάνω στρώμα απορροφά τα μεγαλύτερο μέρος φωτονίων χαμηλής ενέργειας, ενώ το κάτω τα εναπομείναντα φωτόνια υψηλής ενέργειας, κάνοντας λήψη δυο σειρών δεδομένων διαφορετικών ενεργειών ταυτόχρονα. Η δεύτερη τεχνολογική προσέγγιση είναι μέσω ταχύτατης εναλλαγής της τάσης της λυχνίας. Με αυτό τον τρόπο γίνεται λήψη δυο σειρών δεδομένων διαφορετικών ενεργειών, μεταβάλλοντας τη τάση της λυχνίας από χαμηλή σε υψηλή μέσα σε μια μόνο περιστροφή. Τέλος ο τρίτος υπολογιστικός τομογράφος διπλής ενεργείας, ο οποίος χρησιμοποιείται και σε αυτή τη μελέτη, είναι ο τομογράφος δύο λυχνιών, οποίος αποτελείται από δυο λυχνίες ακτίνων Χ και δυο ανιχνευτές. Οι δύο λυχνίες μπορούν να λειτουργήσουν σε διαφορετικά kV ανεξάρτητα η μία από την άλλη, λαμβάνοντας δύο σειρές δεδομένων διαφορετικών ενεργειών ταυτόχρονα. Όταν ο υπολογιστικός τομογράφος δυο λυχνιών χρησιμοποιείται για λήψη εικόνων διπλής ενέργειας, η μια λυχνία λειτουργεί στα 80 kV και η άλλη στα 140 kV. Σε αυτή τη μελέτη εξετάστηκε η συμπεριφορά σε δύο ενέργειες μέσω μια σειράς πειραμάτων, υλικών όπως, πολυμερών ισοδύναμων με μαλακούς ιστούς και οστό, καθώς επίσης, συγκεντρώσεων ιωδίου και ασβεστίου. Χρησιμοποιήθηκαν δυο πρωτόκολλα λήψεων, ένα μιας ενέργειας με λήψεις στα 80, 100, 120, και 140 kV, καθώς και ένα πρωτόκολλο διπλής ενέργειας. Στα πειράματα που πραγματοποιήθηκαν μετρήθηκαν οι αριθμοί CT των υλικών, ο θόρυβος, η αντίθεση και ο λόγος αντίθεσης προς θόρυβο. Επίσης έγινε σύγκριση ως προς τα παραπάνω χαρακτηριστικά ποιότητα εικόνας με βάση τους παραπάνω δείκτες μεταξύ της συμβατικής 120 kV εικόνας και της ανακατασκευασμένης διπλής ενέργειας “virtual 120” kV. Η λεγόμενη “virtual 120” kV, μια αναμεμιγμένη εικόνα, κατασκευασμένη από δυο σειρές δεδομένων διαφορετικών ενεργειών, με γραμμικό συνδυασμό . Επιπλέον διερευνήθηκαν και συγκρίθηκαν ως προς τη ποιότητα εικόνας όλοι οι πιθανοί συνδυασμοί των δυο σειρών δεδομένων ενέργειας. Τα αποτελέσματα έδειξαν ότι μόνο υλικά υψηλού ενεργού ατομικού αριθμού, όπως το οστό και οι υψηλές συγκεντρώσεις ιωδίου 17, 25 και 35 mg/ml, καθώς και ασβεστίου 200, 250 και 300 mg/ml, είχαν ενισχυμένη αντίθεση στα 80 kV. Αξίζει να σημειωθεί ότι για μικρές συγκεντρώσεις ,όπως 1.25, 2.5, 3.5 mg/ml και 45, 83 mg/ml ιωδίου και ασβεστίου αντιστοίχως, η αντίθεση έχει συμπεριφορά μαλακού ιστού. Αντίθετα η τιμή του λόγου αντίθεσης προς θόρυβο δεν είναι όσο υψηλή είναι η τιμή της αντίθεσης. Τα επίπεδα θορύβου της εικόνας στα 80 kV είναι τόσο υψηλά, με αποτέλεσμα οι τιμές του λόγου αντίθεσης προς θόρυβο για όλα τα υλικά υψηλού ατομικού αριθμού να είναι χαμηλότερες στα 80 kV, συγκρινόμενες με τις αντίστοιχες τιμές στις υπόλοιπες τάσεις, παρά το γεγονός ότι η τιμή της αντίθεσης είναι πολύ υψηλή στα 80 kV. Όσο αναφορά τη σύγκριση της 120 kV εικόνας με την λεγόμενη “virtual 120” kV, τα αποτελέσματα των πειραμάτων έδειξαν ότι οι τιμές αντίθεσης του οστού, καθώς επίσης και των συγκεντρώσεων ιωδίου και ασβεστίου, ήταν ισοδύναμες, αλλά η τιμή του λόγου αντίθεσης προς θόρυβο της “virtual 120” kV εικόνας ήταν αρκετά χαμηλότερη σε σχέση με την 120 kV εικόνα. Τέλος το τρίτο πείραμα έδειξε ότι η τιμή της αντίθεσης αυξάνεται όσο αυξάνεται το ποσοστό της 80 kV πληροφορίας στη μεικτή εικόνα, ενώ ο λόγος αντίθεσης προς θόρυβο έχει ένα εύρος συνδυασμών που είναι υψηλός. Συγκεκραμένα οι γραμμικοί συνδυασμοί οι όποιοι είχαν τη μεγαλύτερη τιμή αντιθέσεις προς θόρυβο ήταν οι συντελεστές της 80 kV πληροφορίας από 0.4 έως 0.7. / Dual Energy Computed Tomography (DECT) is an evolving technique, which enhances material differentiation benefiting from the spectral properties of the materials. Spectral CT imaging requires the use of two different energy spectra, and it can distinguish elements, which differ considerably in atomic number. Therefore iodine (Z=53) which is used as contrast agent in CT scans, bone and plaque calcifications which contain calcium (Z=20), can be distinguished from other elements of which the human body consists, such as hydrogen (Z=1), oxygen (Z=8), carbon (Z=6) and nitrogen (Z=7), which are low atomic number elements. Currently there are three technical approaches of dual energy computed tomography. The dual layer detector system, which uses a single x-ray source and a detector with two scintillation layers one on top of one another. The top layer absorbs most of the low energy photons, while the bottom one the remaining high energy photons, acquiring two energy datasets simultaneously. The second technology of dual energy imaging is via fast kVp switching, which acquires two different energy spectra, alternating on a view by view basis between low and high kVp in a single rotation. Finally the third dual energy imaging technique, used in this study, is via the dual source CT system, which contains two x-ray tubes and two detectors. The two tubes can be operated independently at different kV. The dual source CT when it is used for dual energy scan is operated 80 kV/140 kV. Thus two dual energy datasets are acquired simultaneously. In this study the dual energy behavior of soft tissue equivalent materials, bone, iodine and calcium water solutions are examined through a series of experiments. Two acquisition protocols are used, a single energy at 80, 100, 120 and 140 kV, and a dual energy protocol. The CT numbers of these materials, as well as image noise, contrast and contrast to noise ratio are measured. Moreover comparison of these image quality features for standard single energy 120 kV image, which is the convention CT scan, and the “virtual 120” kV image is presented. The “virtual 120” kV is a blended image, reconstructed by the two dual energy datasets in a linear combination of In addition examination of all the possible linear combinations of the two dual energy datasets, and comparison in image quality, is presented. The results showed that only high Zeff materials had enhanced contrast at 80 kV, like bone, and the high iodine and calcium concentrations, such as 17, 25, and 35 mg/ml and 200, 250, and 300 mg/ml respectively. It is noteworthy that for small concentrations, such as 1.25, 2.5, 3.5 mg/ml and 45, 83 mg/ml of iodine and calcium respectively, contrast behavior is like the one of a soft tissue. Contrarily contrast to noise ratio is not as high as contrast at 80 kV. Image noise values at 80 kV are so high that CNR values for all high atomic number materials are lower at 80 kV compared to the ones of other voltages, despite the fact that contrast is very high at 80 kV. As it concerns the comparison of the single energy 120 kV image and the “virtual 120” kV, the results of the experiments showed that contrast values of bone, iodine and calcium concentrations, were equal, but contrast to noise ratio of the “virtual 120” was quite lower compared to the single energy 120 kV. Finally the third experiment showed that contrast values increase as the percentage of the 80 kV datasets increases in the blended image, while contrast to noise ratio has a range in which is higher. Specifically the linear combinations which had the highest CNR values were the ones with weighting factor of the 80 kV starting from 0.4 to 0.7.

Breast cancer screening and diagnosis in X-ray mammography rely on the detection and visualization of microcalcifications (μCs) and soft tissue masses. The early detection of breast cancer has been shown to decrease breast cancer mortality. The μCs are composed mainly of calcium with attenuation coefficients greater than that of soft tissue. The detection and visualization of μCs are relatively easy over a uniform tissue background, but limited by the ‘‘clutter’’ due to overlapping tissue background present on the mammogram. The clutter in tissue background arises from the structures of glandular tissue, vessels, and soft tissue masses in the breast. However, depending upon their size and location, the visualization of calcifications in mammograms may be limited by the superimposed anatomical structures even when the calcifications have adequate contrast-to-noise ratio (CNR). Dual-energy subtraction imaging techniques offer an alternative approach to the detection and visualization of μCs. With this technique, high- and low-energy images are separately acquired and ‘‘subtracted’’ from each other in a weighted fashion to cancel out the cluttered tissue structure so as to decrease the obscurity from overlapping tissue structures. In this study, computer simulations were developed in order to compute SNR as a function of various imaging parameters (X-ray spectra, μC size, breast thickness, and total exposure- 2 different cases) in Dual Energy Calcification images. Emphasis was placed on the monochromatization of the X-ray spectra with the use of K-edge filtering technique. Also, simulations provided values for various quality parameters of the spectra. Optimization was based on maximization of SNRtc while reducing total entrance exposure of the breast or Coefficient of Variation of the incident photons (CVIinc). / Ο καρκίνος του μαστού, ο οποίος είναι μια κοινή αιτία θανάτου μεταξύ των γυναικών του πληθυσμού, μπορεί να εκδηλωθεί μέσω μικροαποτιτανώσεων. Στη μαστογραφία, η ιατρική διάγνωση (συμπεριλαμβανομένων των τεχνικών ελέγχου) βασίζεται στην ανίχνευση και απεικόνιση αυτών των μικροαποτιτανώσεων (μCs) ή/ και της μάζας των μαλακών ιστών. Η έγκαιρη ανίχνευση του καρκίνου έχει αποδειχθεί ότι μειώνει τη θνησιμότητα λόγω καρκίνου του μαστού. Οι μCs αποτελούνται κυρίως από ασβέστιο (Ca), με αποτέλεσμα τη μεγαλύτερη εξασθένηση της ακτινοβολίας σε σχέση με τον μαλακό ιστό. Η ανίχνευση και η απεικόνιση των μικροαποτιτανώσεων είναι σχετικά εύκολη για έναν ομοιόμορφο μαστό. Ωστόσο, η απεικόνιση περιορίζεται από την ανομοιομορφία του υγιούς επικείμενου ιστού, που προκύπτει από τον αδενώδη ιστό, τις φλέβες και τους μαλακούς ιστούς στο μαστό. Ανάλογα με το βαθμό της ανομοιομορφίας, την αντίθεση των μCs, και τον τρόπο της επικάλυψης του ιστού, μπορεί να είναι δύσκολο να εντοπιστεί μια μικροαποτιτάνωση, παρόλο που ενδέχεται να υπάρχει επαρκής λόγος αντίθεσης προς θόρυβο (CNR). Η απεικόνιση με αφαιρετική τεχνική διπλής ενέργειας προσφέρει μια εναλλακτική προσέγγιση για την ανίχνευση και απεικόνιση των μCs. Με την τεχνική αυτή, αποκτώνται ξεχωριστά εικόνες υψηλής και χαμηλής ενέργειας και στη συνέχεια αφαιρείται η μια από την άλλη, με σκοπό να μειωθεί η ασάφεια από τις επικαλυπτόμενες δομές του ιστού. Στη παρούσα μελέτη, αναπτύχθηκε αλγόριθμος προσομοίωσης για τον υπολογισμό του SNR για διάφορους παράγοντες απεικόνισης (φάσματα ακτίνων-Χ, μέγεθος αποτιτάνωσης, πάχος μαστού και συνθήκες έκθεσης). Έμφαση δόθηκε στη τροποποίηση των φασμάτων ακτίνων-Χ ώστε να αποκτηθούν όσο το δυνατόν πιο «μονοχρωματικά» φάσματα με τη χρήση της τεχνικής K-edge. Η επιλογή των βέλτιστων φασμάτων υψηλής και χαμηλής ενέργειας βασίστηκε στην αύξηση του SNRtc με ταυτόχρονη μείωση της έκθεσης εισόδου στην επιφάνεια του μαστού ή τη μείωση του συντελεστή διακύμανσης των προσπιπτόντων φωτονίων στην είσοδο του μαστού (CVIinc).

In einer initialen Studie verglichen wir das XQi Revolution, welches auf indirektem CsI (Cäsium Iodit) /a: Si (amorphes Silizium) basiert mit einem direkten Digitalröntgengerät a: SE (amorphes Selen) an einem CDRAD-Phantom bei vier unterschiedlichen Eintrittsdosen und an einem TRG-Phantom bei zwei unterschiedlichen Eintrittsdosen. Mittels des berechneten Bildqualitätsfaktors des CDRAD-Phantoms konnten wir zeigen, daß das indirekte im Vergleich zum direkten System bei niedrigeren Dosen eine bessere Detailerkennungsrate aufweist. Ein positiver Trend läßt sich auch beim TRG-Phantom darstellen. In einer weiteren Studie untersuchten wir anhand von Patientenbildern die Bildqualität des Dual Energy Systems bei zwei unterschiedlichen Dosisniveaus, der Standarddosis sowie einer doppelten Dosis, was einem Speed-Äquivalent von 400/1000 bzw. 200/500 entspricht. Bei hoher Dosis konnten wir eine signifikante Reduktion des Rauschens im Knochen- und Weichteilbild feststellen, gleichzeitig nahmen die Störungen durch Bewegungsartefakte signifikant zu. Im Anschluß verglichen wir die Erkennbarkeit verkalkter Lungenpathologien im Standard P/A Bild mit zusätzlichem Einsatz von Dual Energy. Als Goldstandard erfolgte der sichere Nachweis der Pathologien im CT. Bei zusätzlichem Einsatz von Dual Energy konnten wir eine signifikante Steigerung der Sensitivität erkennen. Dieses Ergebnis wurde durch den Qualitätsfaktor, der die Bildeigenschaften kumulativ beschreibt, bestätigt. Weiterhin untersuchten wir analog die Erkennbarkeit von nichtverkalkten Lungenrundherden. Auch bei diesen Pathologien ließ sich ein positiver Trend der Sensitivität und Spezifität bei zusätzlichem Einsatz von Dual Energy erkennen. Zusätzlich stieg die durchschnittliche Entscheidungssicherheit der Gutachter signifikant an. Damit bietet die Dual Energy Subtraktionstechnik eine wertvolle Ergänzung in der Diagnostik verkalkter und nichtverkalkter Lungenpathologien eine wertvolle Ergänzung zum Standardröntgen. / First study assess and quantify the image quality at two dose levels for an amorphous Silicon (a:Si) Cesium Iodide (CsI) flat panel system compared with a direct amorphous Selenium (a:Se) digital radiography system. Image quality of a:Si flat panel digital radiography proved to be superior to a:Se drum digital radiography using low-dose settings. Second study assess the image quality of subtracted soft tissue and bone images of a CsIdetector-based dual-energy system for chest radiography at varying dose levels. Radiation dose did not significantly influence the perception of dual-energy image quality. Next study assess the value of dual-energy chest radiography obtained using a cesium iodide flat-panel detector in addition to standard posteroanterior chest radiography for the detection of calcified chest abnormalities. When dual-energy images were added, sensitivity increased significantly. Brunner and Langer’s test revealed a highly significant difference between posteroanterior chest radiography and dual-energy imaging in the detection of calcified chest abnormalities. Dual-energy images added to standard posteroanterior chest radiographs significantly improve the detection of calcified chest lesions. Last study compare the sensitivity and specificity of digital chest radiography alone with digital chest radiography combined with dual-energy chest radiography in the detection of small non-calcified pulmonary nodules. Standard and dual-energy radiographs were obtained with a flat-panel digital chest system. The increase of nodule detection overall as well as for different size categories was significant. The increase of the confidence level rating was also significant. Dual energy added to standard posteroanterior chest radiography significantly improves the sensitivity, specificity, and confidence in detection of small non-calcified pulmonary nodules. Dual-energy subtraction has the potential to become a future routine application in chest radiography.

A técnica de mamografia por dupla energia tem se mostrado uma ferramenta eficiente para aumentar a visualização e detecção de microcalcificações, uma vez que permite, por meio da combinação de imagens obtidas com energias diferentes (baixa e alta energia), suprimir o ruído estrutural. Por outro lado, pesquisas recentes sugerem que esta técnica permite a obtenção de imagens quantitativas das espessuras de microcalcificações e frações glandulares presentes nos tecidos mamários. O presente trabalho tem como objetivo, o estudo e otimização de imagens quantitativas obtidas através da técnica de mamografia por dupla energia. Este estudo foi realizado por simulação computacional, utilizando o código PENELOPE (Penetrarion and Energy Loss of Positrons and Electrons), o qual foi adaptado para fornecer imagens mamográficas digitais e dados relevantes para o estudo da formação da imagem, bem como fornecer as grandezas dosimétricas de interesse nesta técnica. Para isto, a geometria de um típico exame clínico foi simulado,considerando desde o equipamento mamográfico digital (fonte, placa compressora, suporte e detector), até a mama (pele, gordura, tecidos glandulares e microcalcificações). A validação das adaptações ao código foi feita através da comparação entre os valores de razão espalhado-primário (SPR) e dose glandular normalizada (DgN) gerados neste trabalho, com aqueles presentes na literatura. Finalmente, todos os elementos da cadeia da formação de imagens quantitativas foram implementados e avaliados, consistindo de (i) um algoritmo de pré-processamento, que permite corrigir a contribuição do espalhamento nas imagens, com desempenho superior a 95%; (ii) um algoritmo de pós-processamento nas imagens combinadas (baixa e alta energia) que permite corrigir o aumento do ruído decorrente do pré-processamento e da combinação das imagens, com desempenho de 90%. Os resultados de otimização foram adquiridos para diversas características de mama (espessuras de 2 a 6 cm e frações glandulares entre 25 e 75%) e avaliados para diferentes tamanhos de calcificações. As combinações ótimas de energias (baixa;alta) para mamas com espessuras de 2, 4 e 6 cm foram (16;62), (19;56) e (22;56) keV, respectivamente. As combinações escolhidas como ótimas conseguiram estimar as espessuras das microcalcificações com exatidão superior a 92% e a fração glandular com exatidão superior a 95%. / The dual-energy mammography technique has proven to be an efficient tool to increase the visualization and detection of microcalcifications, since it allows, by combining images obtained with different energies (low and high energy), suppress the structural noise. Moreover, recent researches suggests that this technique would allow obtaining quantitative images of microcalcifications thicknesses or glandular fractions present in the breast tissues. This current work aims the study and optimization of quantitative images obtained through dual-energy mammography technique, and was carried out by computer simulation using the PENELOPE code (Penetrarion and Energy Loss of Positron and Electrons), wich was adapted to provide digital mammographic images, and relevant data used in the study of the formation of images and provide the dosimetric quantities of interest in this technique. For this, the model of a typical clinical examination was simulated, from considering the digital mammography equipment (source, compressing plate holder and detector), until the breast (skin, fat, glandular tissues and calcifications). The validation of code adaptation was evaluated by comparing the values of scatter-primary ratio (SPR) and normalized glandular dose (DgN) acquired in this work, with the data in the literature. Finally, all elements of the data chain of the quantitative images were implemented and evaluated, which consist of (i) a pre-processing algorithm that corrects the scattering contribution in the images, with a performance superior to 95%; (ii) a post-processing algorithm in the combined images (low and high energy) that allows to correct the increased noise from the pre-processing and from the combination of the images, with a performance of 90%. The optimization results were obtained for different breast characteristics and evaluated in different calcifications sizes. The optimum combinations of energies (low;high) for breasts with thicknesses of 2, 4 and 6 cm were (16;62), (19;56) and (22;56) keV , respectively. The combinations chosen as optimal was able to estimate the thickness of microcalcifications with an accuracy higher than 92% and the glandular fraction with an accuracy upper to 95% .

CT is a powerful method for noninvasive assessment of the lung. Advancements to CT technology have guided the high-resolution structural and functional assessment of lung diseases. This has helped make the transition from characterizing the severity of lung disease to novel phenotyping of disease subtypes. Chronic obstructive pulmonary disease (COPD) is a spectrum of inflammatory lung disease affecting lung parenchyma, airways, and the pulmonary and systemic vasculature. Quantitative CT-based measures have largely focused on quantifying the extent of airway and parenchymal damage with disease. Recently perfusion CT method has been used to assess the pulmonary vascular bed. This technique was used to demonstrate a vascular etiology of smoking-associated centriacinar emphysema (CAE), a subtype of the COPD spectrum. However, technical challenges have limited the transition of this CT method to clinical studies to assess pulmonary vascular physiology. In this thesis, we introduce dual energy CT-perfused blood volume (DECT-PBV) as a novel image-based biomarker to assess peripheral pulmonary vascular dysfunction. Using this technique, we show that smoking-associated pulmonary perfusion heterogeneity, a marker of abnormal blood flow is a reversible process, in the midst of smoking-associated lung inflammation, and not a product of advanced lung disease. We demonstrate, via regional PBV measures and structural measures of the central pulmonary vessels, that the reversibility of pulmonary perfusion heterogeneity is a direct result of increased peripheral (downstream) parenchymal perfusion. We validate our quantitative imaging approach in a unique cohort of early CAE-susceptible smokers using a pharmaceutical intervention to dilate the pulmonary parenchymal vascular bed. The validated DECT approach and our novel DECT imaging findings extend our characterization of the vascular phenotype in inflammatory lung disease and provide a framework for future quantitative imaging studies of the lung to assess early intervention targeted to pulmonary vessels.

This thesis presents techniques constructed to aid the radiologists in detecting breast cancer, the second largest cause of cancer deaths for western women. In the first part of the thesis, a computer-aided detection (CAD) system constructed for the detection of stellate lesions is presented. Different segmentation methods and an attempt to incorporate contra-lateral information are evaluated. In the second part, a new method for evaluating such CAD systems is presented based on constructing credible regions for the number of false positive marks per image at a certain desired target sensitivity. This method shows that the resulting regions are rather wide and this explains some of the difficulties encountered by other researchers when trying to compare CAD algorithms on different data sets. In this part an attempt to model the clinical use of CAD as a second look is also made and it shows that applying CAD in sequence to the radiologist in a routine manner, without duly altering the decision criterion of the radiologist, might very well result in suboptimal operating points. Finally, in the third part two dual-energy imaging methods optimized for contrast-enhanced imaging of breast tumors are presented. The first is based on applying an electronic threshold to a photon-counting digital detector to discriminate between high- and low-energy photons. This allows simultaneous acquisition of the high- and low-energy images. The second method is based on the geometry of a scanned multi-slit system and also allows single-shot contrast-enhanced dual-energy mammography by filtering the x-ray beam that reaches different detector lines differently. / QC 20100819

The purpose of this thesis project was to determine the precision error of dual-energy x-ray absorptiometry (DXA) derived bone mineral density (BMD) at regions of interest (ROI) that are clinically relevant to persons with spinal cord injury (SCI), and secondarily to compare the precision error between a group of persons who are able-bodied and a group of persons with chronic SCI. Over 2 visits, four DXA scans at sites of the distal femur, proximal tibia, and calcaneus were completed in 10 persons who are able-bodied and 10 persons with chronic SCI. Using forearm sub region analysis, we measured the BMD and calculated the precision error for a total of 7 ROI at these sites. Despite a lower BMD at every ROI in the group of persons with chronic SCI compared to the group of persons who are able-bodied (range, 33 – 56%), the relative precision error was similar between groups. However, there was a trend for greater precision error in persons with SCI at a whole bone ROI of the distal femur (RMS-CV of 8.40% vs. 5.63%) and a ROI of the posterior calcaneus body (RMS-CV of 3.52% vs. 1.78%) when compared to persons who are able-bodied. Further, the ROI of the posterior calcaneus body appeared to have a lower precision error in persons who are able-bodied (RMS-CV, 1.78%) than the distal femur and proximal tibia (RMS-CV range 3.26 – 5.63%). The results from this study suggest that the precision error of DXA derived BMD is similar between persons with SCI and persons who are able-bodied, and that the posterior calcaneus body may be a more precise site than the distal femur and proximal tibia.