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MEDICAL PHYSICS INTERNATIONAL Journal, vol.1, No.1, 2013EFFECTIVE PHYSICS EDUCATION FOR OPTIMIZING CT IMAGEQUALITY AND DOSE MANAGEMENT WITH OPEN ACCESS RESOURCESP. Sprawls 1 , P-A. T. Duong 21 Sprawls Educational Foundation and Emory University/Department of Radiology and Imaging Sciences, Montreat, USA2 Emory University/Department of Radiology and Imaging Sciences, Atlanta, USAAbstract: The most effective optimization of CT imagequality and related radiation dose management requires aclinical imaging staff with knowledge of the physicsprinciples that apply to the imaging process. This knowledgecan be developed through a combination of learningactivities, including classroom discussions, but a criticalrequirement is guided learning activities associated with theclinical imaging procedures. A program is described forincluding physics education within clinical activities,especially for trainees, and online open access resources areprovided to enhance the process.Keywords: Computed Tomography, PhysicsEducation, Image Quality, Radiation Dose Management.INTRODUCTIONComputed tomography (CT) is now one of the mosteffective and valuable imaging methods for medicaldiagnosis and guiding therapeutic procedures. With thecontinuing advances in technology there is the capabilityto produce images with characteristics that can beoptimized for a wide range of clinical purposes. Also,there is the need to manage the radiation dose for eachpatient and balance it with respect to the image qualityrequirements. This is achieved by adjusting the protocolfactors for each procedure. Developing an optimizedprotocol requires knowledge of the clinical requirements,the design and functional characteristics of theequipment, and especially the physical principles andphysics that is the foundation of the CT imaging process.There is a significant challenge in providing the medicalprofessionals who have responsibility for and whoconduct CT procedures with the appropriate knowledgeof physics that can be applied to enhance theeffectiveness and safety of CT. A model of acollaborative approach to providing this education, on aglobal basis, is described along with the online resourcesthat are open access and can be used in any CT program.Figure 1. The model of a program to provide physics educationto support clinical CT procedures.CONTROLLING THE CT PROCEDUREThere are two major factors that can be controlled ineach CT procedure as illustrated in Figure 1. One is thecharacteristics and quality of the image and the other isthe radiation dose delivered to the patient. The directcontrol of these by the medical staff is through theadjustment of the imaging protocol which is the complexcombination of quite a few individual protocol factors.A. Technology. The imaging capabilities and ability tomanage radiation dose that are available in a specificclinic depend on the design characteristics of the CTequipment. With the continuing development andinnovations there is generally the opportunity to producehigher quality images and to do it with a reducedradiation dose to the patient. However, this can only beachieved if the staff is capable of developing and usingprotocols that are optimized for each.B. Science. Physics is the fundamental science ofCT. The imaging process and the design of thetechnology are based on physics principles. That is theknowledge used by physicists and engineers in the46
MEDICAL PHYSICS INTERNATIONAL Journal, vol.1, No.1, 2013continuing development of CT technology. However, ofequal significance is the knowledge of physics requiredby the medical professionals who conduct imagingprocedures. This is the knowledge that must be appliedin the intelligent selection, adjustment, and optimizationof imaging protocols.management. This knowledge comes from physics andengineering study, typically at the graduate level, andpractical and applied experience.C. Medical Imaging Professionals: This is the team ofprofessionals who have responsibility for and conduct theCT imaging procedures. They include radiologists,trainees (residents and fellows), and technologists whooperate the equipment. They need a physics knowledgestructure that applies to their functions. It needs to givethem insight into and an understanding of the CT processwith which they can interact. To a great extent it needs tomake what is generally an “invisible world” visible sothat useful knowledge structures can be formed and used.VISUALIZATIONFigure 2. The major factors that determine image quality anddose to the patient.A major factor in providing effective medical physicseducation, especially for medical imaging professionals,is to enable them to visualize the imaging process andespecially the relationships among the variouscomponents and elements. This helps form mentalknowledge structures of the CT process that go beyondjust seeing the equipment and the images. Here we havetwo examples.PHYSICS KNOWLEDGE STRUCTURESKnowledge of physics is actually a mentalrepresentation of various components of the physicaluniverse, depending on the specific areas of study andexperience, medical physics being the one that is ourinterest at this time. Physics knowledge structures consistof a complex combination of elements including images,words, and mathematical quantities. The organization ofthese elements contributes to a higher level of knowledgein the form of principles, concepts, and the ability toanalyze conditions and apply the knowledge to innovateand produce solutions to a variety of questions orproblems.A. Appropriate Knowledge Structures. The physicsknowledge structure that is appropriate for an individualdepends on the work or functions that they are toperform. The knowledge structure needed by physicistsand engineers who develop CT technology, new methodsand procedures, and evaluate quality and performance isvery different from that needed by the medical imagingstaff conducting clinical procedures.B. Physicists and Engineers: They need a strongquantitative (mathematical) understanding of both thephysics and technology in order to innovate, develop, andanalyze new possibilities. This also applies to the clinicalmedical physicist who evaluates image quality, systemperformance, and plays a major role in radiation doseFigure 3. The three phases of the CT imaging process and themajor protocol factors associated with each.This visual provides a comprehensive view of the CTprocess and shows where it is possible to interact andcontrol the characteristics and quality of the images. Thisis the type of knowledge that cannot be conveyed bywords alone or mathematical equations.One of the most difficult topics for many to understandis the different quantities that are used to expressradiation dose, their relationships, and the factors thatcontrol them. That is all brought together in this onevisual.47
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