Prospective Estimation of Radiation Dose and Image Quality for Optimized CT Performance

X-ray computed tomography (CT) is a non-invasive medical imaging technique that generates cross-sectional images by acquiring attenuation-based projection measurements at multiple angles. Since its first introduction in the 1970s, substantial technical improvements have led to the expanding use of CT in clinical examinations. CT has become an indispensable imaging modality for the diagnosis of a wide array of diseases in both pediatric and adult populations [1, 2]. Currently, approximately 272 million CT examinations are performed annually worldwide, with nearly 85 million of these in the United States alone [3]. Although this trend has decelerated in recent years, CT usage is still expected to increase mainly due to advanced technologies such as multi-energy [4], photon counting [5], and cone-beam CT [6].

Despite the significant clinical benefits, concerns have been raised regarding the population-based radiation dose associated with CT examinations [7]. From 1980 to 2006, the effective dose from medical diagnostic procedures rose six-fold, with CT contributing to almost half of the total dose from medical exposure [8]. For each patient, the risk associated with a single CT examination is likely to be minimal. However, the relatively large population-based radiation level has led to enormous efforts among the community to manage and optimize the CT dose.

As promoted by the international campaigns Image Gently and Image Wisely, exposure to CT radiation should be appropriate and safe [9, 10]. It is thus a responsibility to optimize the amount of radiation dose for CT examinations. The key for dose optimization is to determine the minimum amount of radiation dose that achieves the targeted image quality [11]. Based on such principle, dose optimization would significantly benefit from effective metrics to characterize radiation dose and image quality for a CT exam. Moreover, if accurate predictions of the radiation dose and image quality were possible before the initiation of the exam, it would be feasible to personalize it by adjusting the scanning parameters to achieve a desired level of image quality. The purpose of this thesis is to design and validate models to quantify patient-specific radiation dose prospectively and task-based image quality. The dual aim of the study is to implement the theoretical models into clinical practice by developing an organ-based dose monitoring system and an image-based noise addition software for protocol optimization.

More specifically, Chapter 3 aims to develop an organ dose-prediction method for CT examinations of the body under constant tube current condition. The study effectively modeled the anatomical diversity and complexity using a large number of patient models with representative age, size, and gender distribution. The dependence of organ dose coefficients on patient size and scanner models was further evaluated. Distinct from prior work, these studies use the largest number of patient models to date with representative age, weight percentile, and body mass index (BMI) range.

With effective quantification of organ dose under constant tube current condition, Chapter 4 aims to extend the organ dose prediction system to tube current modulated (TCM) CT examinations. The prediction, applied to chest and abdominopelvic exams, was achieved by combining a convolution-based estimation technique that quantifies the radiation field, a TCM scheme that emulates modulation profiles from major CT vendors, and a library of computational phantoms with representative sizes, ages, and genders. The prospective quantification model is validated by comparing the predicted organ dose with the dose estimated based on Monte Carlo simulations with TCM function explicitly modeled.

Chapter 5 aims to implement the organ dose-estimation framework in clinical practice to develop an organ dose-monitoring program based on a commercial software (Dose Watch, GE Healthcare, Waukesha, WI). In the first phase of the study we focused on body CT examinations, and so the patient’s major body landmark information was extracted from the patient scout image in order to match clinical patients against a computational phantom in the library. The organ dose coefficients were estimated based on CT protocol and patient size as reported in Chapter 3. The exam CTDIvol, DLP, and TCM profiles were extracted and used to quantify the radiation field using the convolution technique proposed in Chapter 4.

With effective methods to predict and monitor organ dose, Chapters 6 aims to develop and validate improved measurement techniques for image quality assessment. Chapter 6 outlines the method that was developed to assess and predict quantum noise in clinical body CT images. Compared with previous phantom-based studies, this study accurately assessed the quantum noise in clinical images and further validated the correspondence between phantom-based measurements and the expected clinical image quality as a function of patient size and scanner attributes.

Chapter 7 aims to develop a practical strategy to generate hybrid CT images and assess the impact of dose reduction on diagnostic confidence for the diagnosis of acute pancreatitis. The general strategy is (1) to simulate synthetic CT images at multiple reduced-dose levels from clinical datasets using an image-based noise addition technique; (2) to develop quantitative and observer-based methods to validate the realism of simulated low-dose images; (3) to perform multi-reader observer studies on the low-dose image series to assess the impact of dose reduction on the diagnostic confidence for multiple diagnostic tasks; and (4) to determine the dose operating point for clinical CT examinations based on the minimum diagnostic performance to achieve protocol optimization.

Chapter 8 concludes the thesis with a summary of accomplished work and a discussion about future research.

L'image principale de profil, symbole de l'individu connecté

Depuis le début du XXIe siècle, un type particulier d’images a envahi l’espace public constitué par Internet : il s’agit des images principales de profil, ces images que les utilisateurs de sites de réseaux sociaux choisissent pour les représenter auprès des autres individus connectés. Comme le plus souvent il s’agit d’une image du corps de celui ou celle qui s’affiche ainsi, il est intéressant de s’intéresser à cette pratique en la rattachant à des pratiques plus anciennes. Dans un premier temps, cette étude présente donc une perspective socio-historique en notant la ressemblance de la pratique de l’image principale de profil avec celle de l’autoportrait et du portrait commandé. Cela permet de remarquer plusieurs points de rupture ou d’inflexion dans l’usage de ce type d’images, mais aussi d’en dégager les usages sociaux typiques. Ensuite, l’observation d’un lieu particulier d’Internet permet de tirer les conclusions suivantes : si l’usage principal de ces images est facile à expliquer, elles servent à symboliser une présence dans des lieux non accessibles aux corps sensibles, ces images montrent toujours des éléments qui permettent de déduire une position sociale et elles sont fondamentalement identiques aux images produites avant Internet. Ensuite, l’étude de ces images montre qu’il y a un véritable continuum dans la manière de dévoiler son intimité qui permet d’affirmer que la frontière entre public et privé n’existe pas sur Internet. Finalement, ces images montrent une absence de canon quant à leur production et une multiplicité des façons de se mettre en scène qui laissent à penser qu’elles sont devenues des symboles à part entière dans la communication qui peut s’établir entre des étrangers sur Internet.

Good practices and inclusive Art at the University: the image of the Artist/Teacher and Innovative Pedagogies

The aim of art, as transformer of the individual, has numerous sides which give the human beings a sense of enhancement and growth. It is considered by university the need for our students to take part of this process of social transformation in which they feel the need of helping the community when its members are at risk of social exclusion. Art is considered to be a means, a tool and a purpose for an artis-pedagogue to be used as a guide for the renewal. And the university is also considered as a focus of commitment by means of the development of good practices as well as adopting an open and innovative attitude to any changes aimed at living harmoniously within a more just society.

L'image principale de profil, symbole de l'individu connecté

Depuis le début du XXIe siècle, un type particulier d’images a envahi l’espace public constitué par Internet : il s’agit des images principales de profil, ces images que les utilisateurs de sites de réseaux sociaux choisissent pour les représenter auprès des autres individus connectés. Comme le plus souvent il s’agit d’une image du corps de celui ou celle qui s’affiche ainsi, il est intéressant de s’intéresser à cette pratique en la rattachant à des pratiques plus anciennes. Dans un premier temps, cette étude présente donc une perspective socio-historique en notant la ressemblance de la pratique de l’image principale de profil avec celle de l’autoportrait et du portrait commandé. Cela permet de remarquer plusieurs points de rupture ou d’inflexion dans l’usage de ce type d’images, mais aussi d’en dégager les usages sociaux typiques. Ensuite, l’observation d’un lieu particulier d’Internet permet de tirer les conclusions suivantes : si l’usage principal de ces images est facile à expliquer, elles servent à symboliser une présence dans des lieux non accessibles aux corps sensibles, ces images montrent toujours des éléments qui permettent de déduire une position sociale et elles sont fondamentalement identiques aux images produites avant Internet. Ensuite, l’étude de ces images montre qu’il y a un véritable continuum dans la manière de dévoiler son intimité qui permet d’affirmer que la frontière entre public et privé n’existe pas sur Internet. Finalement, ces images montrent une absence de canon quant à leur production et une multiplicité des façons de se mettre en scène qui laissent à penser qu’elles sont devenues des symboles à part entière dans la communication qui peut s’établir entre des étrangers sur Internet.

The role of context in image annotation and recommendation

With the rise of smart phones, lifelogging devices (e.g. Google Glass) and popularity of image sharing websites (e.g. Flickr), users are capturing and sharing every aspect of their life online producing a wealth of visual content. Of these uploaded images, the majority are poorly annotated or exist in complete semantic isolation making the process of building retrieval systems difficult as one must firstly understand the meaning of an image in order to retrieve it. To alleviate this problem, many image sharing websites offer manual annotation tools which allow the user to “tag” their photos, however, these techniques are laborious and as a result have been poorly adopted; Sigurbjörnsson and van Zwol (2008) showed that 64% of images uploaded to Flickr are annotated with < 4 tags. Due to this, an entire body of research has focused on the automatic annotation of images (Hanbury, 2008; Smeulders et al., 2000; Zhang et al., 2012a) where one attempts to bridge the semantic gap between an image���s appearance and meaning e.g. the objects present. Despite two decades of research the semantic gap still largely exists and as a result automatic annotation models often offer unsatisfactory performance for industrial implementation. Further, these techniques can only annotate what they see, thus ignoring the “bigger picture” surrounding an image (e.g. its location, the event, the people present etc). Much work has therefore focused on building photo tag recommendation (PTR) methods which aid the user in the annotation process by suggesting tags related to those already present. These works have mainly focused on computing relationships between tags based on historical images e.g. that NY and timessquare co-exist in many images and are therefore highly correlated. However, tags are inherently noisy, sparse and ill-defined often resulting in poor PTR accuracy e.g. does NY refer to New York or New Year? This thesis proposes the exploitation of an image���s context which, unlike textual evidences, is always present, in order to alleviate this ambiguity in the tag recommendation process. Specifically we exploit the “what, who, where, when and how” of the image capture process in order to complement textual evidences in various photo tag recommendation and retrieval scenarios. In part II, we combine text, content-based (e.g. # of faces present) and contextual (e.g. day-of-the-week taken) signals for tag recommendation purposes, achieving up to a 75% improvement to precision@5 in comparison to a text-only TF-IDF baseline. We then consider external knowledge sources (i.e. Wikipedia & Twitter) as an alternative to (slower moving) Flickr in order to build recommendation models on, showing that similar accuracy could be achieved on these faster moving, yet entirely textual, datasets. In part II, we also highlight the merits of diversifying tag recommendation lists before discussing at length various problems with existing automatic image annotation and photo tag recommendation evaluation collections. In part III, we propose three new image retrieval scenarios, namely “visual event summarisation”, “image popularity prediction” and “lifelog summarisation”. In the first scenario, we attempt to produce a rank of relevant and diverse images for various news events by (i) removing irrelevant images such memes and visual duplicates (ii) before semantically clustering images based on the tweets in which they were originally posted. Using this approach, we were able to achieve over 50% precision for images in the top 5 ranks. In the second retrieval scenario, we show that by combining contextual and content-based features from images, we are able to predict if it will become “popular” (or not) with 74% accuracy, using an SVM classifier. Finally, in chapter 9 we employ blur detection and perceptual-hash clustering in order to remove noisy images from lifelogs, before combining visual and geo-temporal signals in order to capture a user’s “key moments” within their day. We believe that the results of this thesis show an important step towards building effective image retrieval models when there lacks sufficient textual content (i.e. a cold start).

Malséance : la mort et l'image dans le (méta)théâtre de Samuel Beckett et de Jean Genet

Both ludic and macabre, the theatrical works of Samuel Beckett and Jean Genet are a paradox to behold. Indeed, as this thesis seeks to illustrate, despite their vastly differing aesthetics, at the core of each playwright’s stage productions is a tension between the characters’ yearning for silence and invisibility, and the continual creation of an often humorous, chaotic, exaggerated or theatrical image that depicts this very longing. Seeking an impossible intersection between their image and their death, they are trapped in a double bind that guarantees aesthetic failure. In order to grasp the close, yet delicate, relationship between the image of death and the death of the image, as presented in the plays of Beckett and Genet, we will explore how the characters’ creative processes deflate the very images — both visual and auditory — that they create. More specifically, we will examine how mimesis both liberates and confines the characters; while the symbolic realm provides the only means of self-representation, it is also a source of profound alienation and powerlessness, for it never adequately conveys meaning. Thus, body, gesture, language and voice are each the site of simultaneous and ceaseless reappearance and disappearance, for which death remains the only (aporetic) cure. Struggling against theatrical form, which demands the actors’ and the audience’s physical presence, both playwrights make shrewd use of metatheatre to slowly empty the stage and thereby suggest the impending, yet impossible, erasure of their characters.

The Worldhood of the Cinematic Image

A close analysis of the specifically cinematographic procedure in Akira Kurosawa’s ‘Dream’ Crows reveals it as an articulated and insightful philosophical statement, endowed with general relevance concerning ‘natural’ perception, phenomenological Erlebnis, mechanical image and aesthetic rapture. The antagonism between the Benjaminian lineage of a mechanical irreducibility of the cinematic image to anthropocentric categories, and the Cartesian tradition of a film-philosophy still relying on the equally irreducible structure of the intentional act, be it the one of a deeply embodied and enworlded counsciousness, in accounting for the essential structure of film and spectator (and their relation), i.e., the antagonism between the decentering primacy of the image and the self-centered primacy of perception, cannot be settled through a simple Phenomenological shift from occularcentric, intentional counsciousness to its embodyment ‘in-the-world’ as yet another carrier of intentionality. Still it remains to be explained what is it in the mechanical image that is able to so deeply affect the human flesh, and conversely, to what features in the human bodily experience is its mechanical other, the fascinating image, so successfuly adressing? It should be expected from the anti-Cartesianism of both the early and the late Merleau-Ponty the textual support for an approach to the essential condition of passivity in movie watching, that would be convergent with Benjamin. The Chapter ‘Le sentir’, in Phénoménologie de la perception, will offer us the proper guide to elucidate what we are already perceiving and conceiving in Kurosawa’s film, where the ex-static phenomenological body of the aesthetical contemplator ‘enters the frame’ like the Benjaminian surgeon enters the body and like the painter - and always already like our deepest level of ‘sensing’, previously to any act of cousciousness - ‘just looses himself in the scene before him’. The Polichinello secret of cinema watching is nonetheless too evident to be seen, and that is where Phenomenological description and reduction are still required.

Intermittent Fasting Induces Hypothalamic Modifications Resulting In Low Feeding Efficiency, Low Body Mass And Overeating.

Intermittent fasting (IF) is an often-used intervention to decrease body mass. In male Sprague-Dawley rats, 24 hour cycles of IF result in light caloric restriction, reduced body mass gain, and significant decreases in the efficiency of energy conversion. Here, we study the metabolic effects of IF in order to uncover mechanisms involved in this lower energy conversion efficiency. After 3 weeks, IF animals displayed overeating during fed periods and lower body mass, accompanied by alterations in energy-related tissue mass. The lower efficiency of energy use was not due to uncoupling of muscle mitochondria. Enhanced lipid oxidation was observed during fasting days, whereas fed days were accompanied by higher metabolic rates. Furthermore, an increased expression of orexigenic neurotransmitters AGRP and NPY in the hypothalamus of IF animals was found, even on feeding days, which could explain the overeating pattern. Together, these effects provide a mechanistic explanation for the lower efficiency of energy conversion observed. Overall, we find that IF promotes changes in hypothalamic function that explain differences in body mass and caloric intake.

Exploratory Study Of The Effect Of Lifestyle Counselling On Bone Mineral Density And Body Composition In Users Of The Contraceptive Depot-medroxyprogesterone Acetate.

To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits. An exploratory study in which women aged 18 to 40 years participated: 29 new DMPA users and 25 new non-hormonal contraceptive users. All participants were advised on healthy lifestyle habits: sun exposure, walking and calcium intake. BMD and BC were assessed at baseline and 12 months later. Statistical analysis included the Mann-Whitney test or Student's t-test followed by multiple linear regression analysis. Compared to the controls, DMPA users had lower BMD at vertebrae L1 and L4 after 12 months of use. They also had a mean increase of 2 kg in total fat mass and an increase of 2.2% in body fat compared to the non-hormonal contraceptive users. BMD loss at L1 was less pronounced in DMPA users with a calcium intake ≥ 1 g/day compared to DMPA users with a lower calcium intake. DMPA use was apparently associated with lower BMD and an increase in fat mass at 12 months of use. Calcium intake ≥ 1 g/day attenuates BMD loss in DMPA users. Counselling on healthy lifestyle habits failed to achieve its aims.

Growth And Body Composition In Brazilian Female Rhythmic Gymnastics Athletes.

The aim was to analyse the physical growth and body composition of rhythmic gymnastics athletes relative to their level of somatic maturation. This was a cross-sectional study of 136 athletes on 23 teams from Brazil. Mass, standing height and sitting height were measured. Fat-free and fat masses, body fat percentages and ages of the predicted peak height velocity (PHV) were calculated. The z scores for mass were negative during all ages according to both WHO and Brazilian references, and that for standing height were also negative for all ages according to WHO reference but only until 12 years old according to Brazilian reference. The mean age of the predicted PHV was 12.1 years. The mean mass, standing and sitting heights, body fat percentage, fat-free mass and fat mass increased significantly until 4 to 5 years after the age of the PHV. Menarche was reached in only 26% of these athletes and mean age was 13.2 years. The mass was below the national reference standards, and the standing height was below only for the international reference, but they also had late recovery of mass and standing height during puberty. In conclusion, these athletes had a potential to gain mass and standing height several years after PHV, indicating late maturation.

Biochemical, Anthropometric And Body Composition Indicators As Predictors Of Hepatic Steatosis In Obese Adolescents.

To describe the prevalence of hepatic steatosis and to assess the performance of biochemical, anthropometric and body composition indicators for hepatic steatosis in obese teenagers. Cross-sectional study including 79 adolecents aged from ten to 18 years old. Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right kidney cortex. The insulin resistance was determined by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric and body composition indicators consisted of body mass index, body fat percentage, abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid profile and hepatic enzymes, such as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also evaluated. In order to assess the performance of these indicators in the diagnosis of hepatic steatosis in teenagers, a ROC curve analysis was applied. Hepatic steatosis was found in 20% of the patients and insulin resistance, in 29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting hepatic steatosis, with a cutoff of 1.06 times above the reference value for gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric indicators, the body fat percentage, the lipid profile, the glycemia and the aspartate aminotransferase did not present significant associations. Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be submitted to abdominal ultrasound examination due to the increased chance of having hepatic steatosis.

Effects Of Programmed Physical Activity On Body Composition In Post-pubertal Schoolchildren.

To assess body composition modifications in post-pubertal schoolchildren after practice of a physical activity program during one school year. The sample consisted of 386 students aged between 15 and 17 years and divided into two groups: the study group (SG) comprised 195 students and the control group (CG), 191. The SG was submitted to a physical activity program and the CG attended conventional physical education classes. Body composition was assessed using body mass index (BMI), percentage of body fat (%BF), fat mass (FM), and lean mass (LM). A positive effect of the physical activity program on body composition in the SG (p<0.001) was observed, as well as on the interaction time x group in all the variables analyzed in both genders. A reduction in %BF (mean of differences = -5.58%) and waist circumference (-2.33cm), as well as an increase in LM (+2.05kg) were observed in the SG for both genders, whereas the opposite was observed in the CG. The practice of programmed physical activity promotes significant reduction of body fat in post-pubertal schoolchildren.

Photoelastic And Finite Element Analyses Of Occlusal Loads In Mandibular Body.

This study proposed to evaluate the mandibular biomechanics in the posterior dentition based on experimental and computational analyses. The analyses were performed on a model of human mandible, which was modeled by epoxy resin for photoelastic analysis and by computer-aided design for finite element analysis. To standardize the evaluation, specific areas were determined at the lateral surface of mandibular body. The photoelastic analysis was configured through a vertical load on the first upper molar and fixed support at the ramus of mandible. The same configuration was used in the computer simulation. Force magnitudes of 50, 100, 150, and 200 N were applied to evaluate the bone stress. The stress results presented similar distribution in both analyses, with the more intense stress being at retromolar area and oblique line and alveolar process at molar level. This study presented the similarity of results in the experimental and computational analyses and, thus, showed the high importance of morphology biomechanical characterization at posterior dentition.

Analysis Of The Fluorescence Of Body Fluids On Different Surfaces And Times.

The use of screening techniques, such as an alternative light source (ALS), is important for finding biological evidence at a crime scene. The objective of this study was to evaluate whether biological fluid (blood, semen, saliva, and urine) deposited on different surfaces changes as a function of the age of the sample. Stains were illuminated with a Megamaxx™ ALS System and photographed with a Canon EOS Utility™ camera. Adobe Photoshop™ was utilized to prepare photographs for analysis, and then ImageJ™ was used to record the brightness values of pixels in the images. Data were submitted to analysis of variance using a generalized linear mixed model with two fixed effects (surface and fluid). Time was treated as a random effect (through repeated measures) with a first-order autoregressive covariance structure. Means of significant effects were compared by the Tukey test. The fluorescence of the analyzed biological material varied depending on the age of the sample. Fluorescence was lower when the samples were moist. Fluorescence remained constant when the sample was dry, up to the maximum period analyzed (60 days), independent of the substrate on which the fluid was deposited, showing the novelty of this study. Therefore, the forensic expert can detect biological fluids at the crime scene using an ALS even several days after a crime has occurred.

Comparison Between Automated And Microscopic Analysis In Body Fluids Cytology.

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