The knowledge of the relationship that links radiation dose and image quality is a prerequisite to any optimization of medical diagnostic radiology. Image quality depends, on the one hand, on the physical parameters such as contrast, resolution, and noise, and on the other hand, on characteristics of the observer that assesses the image. While the role of contrast and resolution is precisely defined and recognized, the influence of image noise is not yet fully understood. Its measurement is often based on imaging uniform test objects, even though real images contain anatomical backgrounds whose statistical nature is much different from test objects used to assess system noise. The goal of this study was to demonstrate the importance of variations in background anatomy by quantifying its effect on a series of detection tasks. Several types of mammographic backgrounds and signals were examined by psychophysical experiments in a two-alternative forced-choice detection task. According to hypotheses concerning the strategy used by the human observers, their signal to noise ratio was determined. This variable was also computed for a mathematical model based on the statistical decision theory. By comparing theoretical model and experimental results, the way that anatomical structure is perceived has been analyzed. Experiments showed that the observer's behavior was highly dependent upon both system noise and the anatomical background. The anatomy partly acts as a signal recognizable as such and partly as a pure noise that disturbs the detection process. This dual nature of the anatomy is quantified. It is shown that its effect varies according to its amplitude and the profile of the object being detected. The importance of the noisy part of the anatomy is, in some situations, much greater than the system noise. Hence, reducing the system noise by increasing the dose will not improve task performance. This observation indicates that the tradeoff between dose and image quality might be optimized by accepting a higher system noise. This could lead to a better resolution, more contrast, or less dose.

A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm 2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.

The aim was to propose a strategy for finding reasonable compromises between image noise and dose as a function of patient weight. Weighted CT dose index (CTDI w ) was measured on a multidetector-row CT unit using CTDI test objects of 16, 24 and 32 cm in diameter at 80, 100, 120 and 140 kV. These test objects were then scanned in helical mode using a wide range of tube currents and voltages with a reconstructed slice thickness of 5 mm. For each set of acquisition parameter image noise was measured and the Rose model observer was used to test two strategies for proposing a reasonable compromise between dose and lowcontrast detection performance: (1) the use of a unique noise level for all test object diameters, and (2) the use of a unique dose efficacy level defined as the noise reduction per unit dose. Published data were used to define four weight classes and an acquisition protocol was proposed for each class. The protocols have been applied in clinical routine for more than one year. CTDI vol values of 6.7, 9.4, 15.9 and 24.5 mGy were proposed for the following weight classes: 2.5-5, 5-15, 15-30 and 30-50 kg with image noise levels in the range of 10-15 HU. The proposed method allows patient dose and image noise to be controlled in such a way that dose reduction does not impair the detection of low-contrast lesions. The proposed values correspond to highquality images and can be reduced if only high-contrast organs are assessed.

Multi-detector CT is less effective than single-detector CT in detection of small low-contrast objects if sections thinner than 5 mm are used. Results for single- and multi-detector CT were similar for sections 5 mm or thicker.

A suitable quantity for evaluating the image quality in mammography is the smallest visible size of an object. This quantity, called the image quality index (IQI), can be derived from the basic image parameters: contrast, MTF, Wiener spectrum. Several evaluation methods of the IQI, all based on statistical decision theory, have been considered. An experimental visibility test using simulated microcalcifications has been performed in order to compare the results obtained with different IQI models. A previous approach, based on simplifying assumptions, yields a good correlation with the visibility test but fails to predict the actual size of the visible objects. Improved models have been derived for an ideal observer and for a 'quasi-ideal' one with perfect or with realistic visual characteristics. The experimental visual results are well modelled by the IQI method, provided that a suitable threshold signal-to-noise ratio is used for each of these models.

Switzerland has recorded the level of activity of 90Sr in the milk teeth of children from different regions of the country since the first atomic explosions in the atmosphere. Activity peaked at 0.421 Bq g-1 Ca at the beginning of the sixties, coinciding with the detonation of many large nuclear devices. Following the Nuclear Test Ban Treaty that ended atmospheric nuclear weapon tests, a steady and significant decrease in 90Sr activity in milk teeth has been observed-down to a value of 0.03 Bq g-1 Ca for children born in 1994. The apparent half-life of 90Sr in milk teeth is 9.8+/-3 years. With the exception of the period from 1962 to 1964, there is no correlation between the activity in the teeth of children born in a given year and the year of extraction. Between 1953 and 1992, the milk teeth of children born in Zürich county showed 16% less activity than teeth from children born in Vaud county. Dairy consumption habits might be responsible for this trend. The effect of the 90Sr deposition from Chernobyl is barely measurable in milk teeth, and no effect is seen from the five Swiss nuclear reactors. This paper emphasizes the necessity of a very high purity chemical separation of 90Sr or 90Y to determine 90Sr activity in milk teeth or other samples.

The detection process used in a commercial dose calibrator was modeled using the GEANT 3 Monte Carlo code. Dose calibrator efficiency for gamma and beta emitters, and the response to monoenergetic photons and electrons was calculated. The model shows that beta emitters below 2.5 MeV deposit energy indirectly in the detector through bremsstrahlung produced in the chamber wall or in the source itself. Higher energy beta emitters (E > 2.5 MeV) deposit energy directly in the chamber sensitive volume, and dose calibrator sensitivity increases abruptly for these radionuclides. The Monte Carlo calculations were compared with gamma and beta emitter measurements. The calculations show that the variation in dose calibrator efficiency with measuring conditions (source volume, container diameter, container wall thickness and material, position of the source within the calibrator) is relatively small and can be considered insignificant for routine measurement applications. However, dose calibrator efficiency depends strongly on the inner-wall thickness of the detector.

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