1. Stephen Balter, PhD, Columbia University Medical Center, New York, NY, 10021, US
    2009 AAPM Annual Meeting
    For more information about the American Association of Physicists in Medicine, visit aapm.org/

    Radiation usage during fluoroscopically guided interventions can be high enough to warrant
    careful dosimetry and patient management. Basic compliance with the usual set of local
    regulatory requirements is sufficient for patient safety in the interventional environments. For
    example, modern systems meeting all current regulatory dose restrictions are capable of
    delivering table-top air kerma rates exceeding 200 mGy/min for normal mode fluoroscopy and
    1,500 mGy/min for cinefluorography.
    Clinical dosimetry during each complex intervention is facilitated by dosimetric instrumentation
    built into the fluoroscopic system. The Society of Interventional Radiology has published a
    standard of practice recommending dosimetry for all interventional procedures. In 2008, the ACR
    published a technical standard for the use of radiation in fluoroscopic procedures. A DICOM
    Structured Report for detailed reporting of radiation usage in interventional fluoroscopy has been
    defined, tested and is currently being deployed in clinical systems. The Joint Commission has
    included fluoroscopic procedures with skin doses exceeding 15 Gy in its list of sentinel events;
    with the implicit challenge to facilities that they can prove the absence of such occurrences.
    This course reviews technical elements for a program of patient fluoroscopic radiation safety.
    ICRU diagnostic dosimetric quantities and their fluoroscopic extensions
    Construction, dosimetric features, and performance characteristics of modern
    fluoroscopes
    Extended QA protocols for compliance measurements, system characterization and
    clinical dosimetry.
    Dose recording and reporting, including DICOM-DOSE
    The Joint Commission fluoroscopy sentinel event.
    Educational objectives
    1) Understand dosimetric concepts relating to interventional fluoroscopy
    2) Characterize the dosimetric features and performance of a modern fluoroscope
    3) Be able to set up a clinical dose recording and reporting policy that will meet clinical
    and JC requirements.

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  2. 51st AAPM Annual Meeting
    Aaron Fenster, PhD, Robarts Research Institute, London, ON, N6A 5K8, CANADA
    For more information about the American Association of Physicists in Medicine, visit aapm.org/

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  3. 51st AAPM Annual Meeting
    Michael A. Speidel, University of Wisconsin-Madison, Madison, WI, 53705, US
    For more information about the American Association of Physicists in Medicine, visit aapm.org/

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  4. 51st AAPM Annual Meeting
    Michael Markl, University Hospital Freiburg, Germany
    For more information about the American Association of Physicists in Medicine, visit aapm.org/


    AbstractID: 11950 Title: FunctionalCardiovascular MRI: Assessment, Visualization and
    Quantification of 3D Blood Flow Characteristics
    Magnetic Resonance Imaging (MRI) techniques provide a non-invasive method for the highly
    accurate anatomic depiction of the heart and vessels. Most MR-sequences demonstrate more
    or less significant sensitivity to flow and motion, which can lead to artifacts in many
    applications. The intrinsic motion sensitivity of MRI can, however, also be used to image
    vessels like in phase contrast (PC) MR-angiography or to quantify blood flow and motion of
    tissue. Such techniques offer the unique possibility to acquire spatially registered functional
    information simultaneously with the morphological data within a single experiment.
    Characterizations of the dynamic components of blood flow and cardiovascular function
    provide insight into normal and pathological physiology and have made considerable progress
    in recent years
    To synchronize flow or motion sensitive measurements with periodic tissue motion or
    pulsatile flow, data acquisition is typically gated to the cardiac cycle and time resolved
    (CINE) anatomical images are collected to depict the dynamics of tissue motion and blood
    flow during the cardiac cycle. Visualization and quantification of blood flow and tissue
    motion using PC MRI has been widely used in a number of applications. In addition to
    analyzing tissue motion such as left ventricular function, time-resolved 2D PC MRI
    techniques have proven to be useful tools for the assessment of blood flow within the
    cardiovascularsystem.
    Moreover, 3D spatial encoding offers the possibility of isotropic high spatial resolution and
    thus the ability to measure and visualize the temporal evolution of complex flow and motion
    patterns in a 3D-volume. In this context, ECG synchronized and respiration controlled flow
    sensitive 3D MRI using 3-directional velocity encoding (also termed 'flow sensitive 4D MRI')
    can be employed to detect and visualize global and local blood flow characteristicsin targeted
    vascular regions (aorta, cranial arteries, carotid arteries, etc.). For the analysis and
    visualization of complex, three-directional blood flow within a 3D volume, various
    visualization tools, including 2D vector-fields, 3D streamlines and particle traces, have been
    reported. In addition more advanced data quantification strategies of directly measured (e.g.
    flow rates) or derived parameters(e.g. pressure difference maps, wallsheerstress, pulse wave
    velocity, etc.) are promising as new clinical markersfor the characterization of cardiovascular
    disease.
    Thislecture will provide an overview of the MRimaging principles and advanced acquisition
    methods, data processing, flow visualization and quantification strategies, and clinical
    applications of flow sensitive MRI imaging.
    Educational Objectives:
    1. Understand the basic and advanced methodsforflow measurements using MRI
    2. Understand techniquesfor 3D flow visualization and quantification of blood flow and
    derived parameters
    3. Understand the issuesrelated to clinical applications of flow-sensitive MRI

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  5. 51st AAPM Annual Meeting
    Ewald Roessl, Philips Research Europe - Hamburg, 22335, GERMANY
    For more information about the American Association of Physicists in Medicine, visit aapm.org/

    AbstractID: 11929 Title: Energy-sensitive, photon-counting computed
    tomography: opportunities and technological challenges.
    Recent advances in the development of direct-conversion, energy-sensitive x-ray detectors stimulate research in the domain of preclinical
    and clinical photon-counting x-ray computed tomography (CT). The ability to quantify the energy of individual X-ray photons
    allows for novel approaches to improve the soft tissue differentiation, material decomposition and labeling techniques, the suppression
    of beam-hardening artifacts as well as the potential reduction of radiation dose. Moreover, spectral data acquisition enables the
    selective and quantitative imaging of certain contrast media on top of the conventional anatomy, by tuning an energy threshold in the
    detector system to the K-edge discontinuity of the contrast generating element in the agent.
    The present lecture will provide an overview of both, the opportunities and the technological challenges arising in the context of
    clinical, energy-resolved, photon-counting CT. Some examples of potential future applications will be given together with the most
    challenging technical difficulties encountered in the use of photon counting detectors in CT. The problem of counting photons at the
    high flux conditions of clinical CT will be discussed as well as the degradation of energy resolution by effects like pulse-pileup or
    charge sharing.
    All authors are employees of Philips Research.
    Educational Objectives:
    1. To understand the physical basics of photon counting detectors and the implications on their use in x-ray computed
    tomography
    2. To learn about a possible future application of energy-sensitive CT in connection with the identification and quantification
    of contrast-agents by means of the K-edge discontinuity in the attenuation.
    3. To obtain an overview of the technological challenges to be overcome in order to realize photon-counting CT in clinical
    practice.

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2009 AAPM Annual Meeting

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