Scholars@Duke
Francesco Ria

Francesco Ria

Assistant Professor of Radiology
Radiology
francesco.ria@duke.edu
Department of Radiology, Durham, NC 27710
Department of Radiology, Durham, NC 27710

Selected Publications

Proceedings Virtual Imaging Trials in Medicine 2024.

Journal Article ArXiv · May 8, 2024 This submission comprises the proceedings of the 1st Virtual Imaging Trials in Medicine conference, organized by Duke University on April 22-24, 2024. The listed authors serve as the program directors for this conference. The VITM conference is a pioneerin ... Open Access Link to item Cite

Technology Characterization Through Diverse Evaluation Methodologies: Application to Thoracic Imaging in Photon-Counting Computed Tomography.

Journal Article J Comput Assist Tomogr · April 15, 2024 OBJECTIVE: Different methods can be used to condition imaging systems for clinical use. The purpose of this study was to assess how these methods complement one another in evaluating a system for clinical integration of an emerging technology, photon-count ... Full text Open Access Link to item Cite

Myelography Using Energy-Integrating Detector CT Versus Photon-Counting Detector CT for Detection of CSF-Venous Fistulas in Patients With Spontaneous Intracranial Hypotension.

Journal Article AJR Am J Roentgenol · April 2024 BACKGROUND. CSF-venous fistulas (CVFs), which are an increasingly recognized cause of spontaneous intracranial hypotension (SIH), are often diminutive in size and exceedingly difficult to detect by conventional imaging. OBJECTIVE. This purpose of this stud ... Full text Open Access Link to item Cite

Characterizing imaging radiation risk in a population of 8918 patients with recurrent imaging for a better effective dose.

Journal Article Sci Rep · March 14, 2024 An updated extension of effective dose was recently introduced, namely relative effective dose ( E r ), incorporating age and sex factors. In this study we extended E r application to a population of about 9000 patients who underwent multiple CT imaging ... Full text Open Access Link to item Cite

Performance assessment of photon counting versus energy integrated CT: concordance of in vivo and phantom measurements

Conference Progress in Biomedical Optics and Imaging - Proceedings of SPIE · January 1, 2024 Photon-counting CT (PCCT) and energy-integrating CT (EICT) system offer differing image quality attributes, but it is uncertain if such attributes manifest themselves differently across phantom vs patients. This study investigated if image quality assessme ... Full text Cite

Development and Clinical Evaluation of a Contrast Optimizer for Contrast-Enhanced CT Imaging of the Liver

Journal Article Journal of Computer Assisted Tomography · January 1, 2024 Objective Patient characteristics, iodine injection, and scanning parameters can impact the quality and consistency of contrast enhancement of hepatic parenchyma in CT imaging. Improving the consistency and adequacy of contrast enhancement can enhance diag ... Full text Open Access Cite

Comparison of photon-counting and energy-integrating detector CT systems for the characterization of cystic renal lesions on virtual noncontrast imaging

Conference · November 26, 2023 Purpose: The purpose of this study is to compare the absolute CT attenuation errors of cystic renal lesions and abdominal organs on virtual noncontrast images (VNC) between photon-counting (PCCT) and energy-integrating (EID) detector CT systems. Methods a ... Open Access Cite

Comparison of photon-counting and energy-integrating detector CT systems for the characterization of cystic renal lesions on virtual noncontrast imaging

Conference · November 26, 2023 Purpose: The purpose of this study is to compare the absolute CT attenuation errors of cystic renal lesions and abdominal organs on virtual noncontrast images (VNC) between photon-counting (PCCT) and energy-integrating (EID) detector CT systems. Methods a ... Open Access Cite

Comparison of image quality of abdominal CT examinations and virtual noncontrast images between photon-counting and energy-integrating detector CT

Conference · November 26, 2023 Purpose: To compare image quality of portal venous phase (PVP) abdominal CT examinations and virtual non-contrast (VNC) images between photon-counting CT (PCCT) and energy-integratingDetector CT (EID). Methods and Materials: In this HIPAA compliant, IRB-a ... Open Access Cite

Comparison of image quality of abdominal CT examinations and virtual noncontrast images between photon-counting and energy-integrating detector CT

Conference · November 26, 2023 Purpose: To compare image quality of portal venous phase (PVP) abdominal CT examinations and virtual non-contrast (VNC) images between photon-counting CT (PCCT) and energy-integratingDetector CT (EID). Methods and Materials: In this HIPAA compliant, IRB-a ... Open Access Cite

Clinical and radiation risk across one million patients in Computed Tomography: influence of age, size, and race

Conference · November 26, 2023 Purpose. We recently developed a mathematical model to balance radiation risk and clinical risk, namely the risk of misdiagnosis due to insufficient image quality. In this work, we applied this model to a population of one million CT imaging cases to evalu ... Open Access Cite

Image quality of photon counting and energy integrating chest CT - Prospective head-to-head comparison on same patients.

Journal Article Eur J Radiol · September 2023 PURPOSE: To prospectively compare the image quality of high-resolution, low-dose photon-counting detector CT (PCD-CT) with standard energy-integrating-detector CT (EID) on the same patients. METHOD: IRB-approved, prospective study; patients received same-d ... Full text Open Access Link to item Cite

Development and Testing of a Clinical Tool to Predict and Optimize Liver Contrast-Enhanced CT Imaging

Conference https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/mp.16525 · July 23, 2023 Achieving consistent and sufficient hepatic parenchyma contrast enhancement (HPCE) level can improve diagnostic performance and reduce enhancement variability; this raises the baseline image quality and optimize injection practices, both carries economic a ... Full text Open Access Link to item Cite

Accuracy of Noise Magnitude Measurements from Patient CT Images

Conference https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/mp.16525 · July 23, 2023 Purpose Noise magnitude is a main CT image quality indicator. In vivo measurements emerged as a patient-specific methodology to assess and qualify CT noise, yet methods to do so vary. Current noise measurement methods in soft tissues and air surrounding t ... Full text Open Access Link to item Cite

Making CT Dose Monitoring Meaningful: Augmenting Dose with Imaging Quality.

Journal Article Tomography · April 7, 2023 Due to the concerns about radiation dose associated with medical imaging, radiation dose monitoring systems (RDMSs) are now utilized by many radiology providers to collect, process, analyze, and manage radiation dose-related information. Currently, most co ... Full text Open Access Link to item Cite

Comparative Assessment of the Absorbed Doses Resulted from Occupational Exposure and Computed Tomography

Journal Article Medical Radiology and Radiation Safety · January 1, 2023 A comparative assessment of the absorbed doses resulted from computed tomography (CT) examinations, and the dose resulted from occupational external gamma exposure of the “Mayak” workers was carried out. The patients’ diagnostic radiation dose was reconstr ... Full text Open Access Cite

A patient-informed approach to predict iodinated-contrast media enhancement in the liver.

Journal Article Eur J Radiol · November 2022 OBJECTIVE: To devise a patient-informed time series model that predicts liver contrast enhancement, by integrating clinical data and pharmacokinetics models, and to assess its feasibility to improve enhancement consistency in contrast-enhanced liver CT sca ... Full text Open Access Link to item Cite

Dose coefficients for organ dosimetry in tomosynthesis imaging of adults and pediatrics across diverse protocols.

Journal Article Med Phys · August 2022 PURPOSE: The gold-standard method for estimation of patient-specific organ doses in digital tomosynthesis (DT) requires protocol-specific Monte Carlo (MC) simulations of radiation transport in anatomically accurate computational phantoms. Although accurate ... Full text Open Access Link to item Cite

Organ doses and cancer risk assessment in patients exposed to high doses from recurrent CT exams.

Journal Article Eur J Radiol · April 2022 PURPOSE: To estimate cumulative organ doses and age- and gender-stratified cancer mortality risks in patients undergoing recurrent computed tomography (CT) exams. METHODS: Cohorts of patients who received cumulative effective dose ≥ 100 mSv were stratified ... Full text Open Access Link to item Cite

Statement of the Italian Association of Medical Physics (AIFM) task group on radiation dose monitoring systems.

Journal Article Insights Imaging · February 5, 2022 The evaluation of radiation burden in vivo is crucial in modern radiology as stated also in the European Directive 2013/59/Euratom-Basic Safety Standard. Although radiation dose monitoring can impact the justification and optimization of radiological proce ... Full text Open Access Link to item Cite

Comparing two different noise magnitude estimation methods in CT using virtual imaging trials

Conference Progress in Biomedical Optics and Imaging - Proceedings of SPIE · January 1, 2022 Several methods have been introduced over the years to measure CT image noise magnitudes in vivo applying different image segmentation strategies, HU thresholds, and regions of interests in which the noise is calculated. Therefore, it is impossible to dire ... Full text Open Access Cite

A mathematical framework to quantitatively balance clinical and radiation risk in Computed Tomography

Conference · December 1, 2021 Purpose: Risk in medical imaging is a combination of radiation risk and clinical risk, which is largely driven by the effective diagnosis. While radiation risk has traditionally been the main focus of Computed Tomography (CT) optimization, such a goal cann ... Open Access Cite

Organ-based and DLP-based effective dose as representations of radiation risk in a population of 8946 patients with cumulative effective dose greater than 100 mSv

Conference · December 1, 2021 Purpose. Recent studies have shown that it is not uncommon for a patient to undergo multiple CT exams resulting in high cumulative dose above 100 mSv, the radiation risk associated with which is not negligible. The purpose of this study was to compare the ... Open Access Cite

Deep learning classification of COVID-19 in chest radiographs: performance and influence of supplemental training.

Journal Article J Med Imaging (Bellingham) · November 2021 Purpose: Accurate classification of COVID-19 in chest radiographs is invaluable to hard-hit pandemic hot spots. Transfer learning techniques for images using well-known convolutional neural networks show promise in addressing this problem. These methods ca ... Full text Open Access Link to item Cite

Comparison of 12 surrogates to characterize CT radiation risk across a clinical population.

Journal Article Eur Radiol · September 2021 OBJECTIVES: Quantifying radiation burden is essential for justification, optimization, and personalization of CT procedures and can be characterized by a variety of risk surrogates inducing different radiological risk reflections. This study compared how t ... Full text Open Access Link to item Cite

Patient-Informed Organ Dose Estimation in Clinical CT: Implementation and Effective Dose Assessment in 1048 Clinical Patients.

Journal Article AJR Am J Roentgenol · March 2021 OBJECTIVE. The purpose of this study is to comprehensively implement a patient-informed organ dose monitoring framework for clinical CT and compare the effective dose (ED) according to the patient-informed organ dose with ED according to the dose-length pr ... Full text Open Access Link to item Cite

Classification of COVID-19 in chest radiographs: assessing the impact of imaging parameters using clinical and simulated images

Journal Article Proc. SPIE 11597, Medical Imaging 2021: Computer-Aided Diagnosis, 115970A · February 15, 2021 As computer-aided diagnostics develop to address new challenges in medical imaging, including emerging diseases such as COVID-19, the initial development is hampered by availability of imaging data. Deep learning algorithms are particularly notorious for p ... Full text Open Access Link to item Cite

Estimation of in vivo noise in clinical CT images: comparison and validation of three different methods against ensemble noise gold-standard

Journal Article Proc. SPIE 11595, Medical Imaging 2021: Physics of Medical Imaging, 115952P · February 15, 2021 Image quality estimation is crucial in modern CT with noise magnitude playing a key role. Several methods have been proposed to estimate noise surrogates in vivo. This study aimed to ascertain the accuracy of three different noise-magnitude estimation meth ... Open Access Link to item Cite

Justification of radiological procedures in COVID-19 pandemic based on radiation risk only

Conference · December 2, 2020 Purpose. Radiologic procedures are recommended based on benefit-to-risk justification. In X-ray imaging, while the benefit is often immediate for the patient, the associated radiation burden risk is a longer-term effect. Such a temporal gap can bias the ju ... Open Access Cite

Virtual Imaging Trials for Novel Coronavirus Disease (COVID-19)

Conference · December 2, 2020 PURPOSE Virtual imaging trial is a unique framework that can greatly facilitate the assessment and optimization of imaging, by emulating the experiments using representative models of patients and scanners. This study aimed to impalement and demonstrate a ... Cite

A database of 40 patient-based computational models for benchmarking organ dose estimates in CT.

Journal Article Med Phys · December 2020 PURPOSE: Patient radiation burden in computed tomography (CT) can best be characterized through risk estimates derived from organ doses. Organ doses can be estimated by Monte Carlo simulations of the CT procedures on computational phantoms assumed to emula ... Full text Open Access Link to item Cite

A comparison of COVID-19 and imaging radiation risk in clinical patient populations.

Journal Article J Radiol Prot · November 11, 2020 The outbreak of coronavirus SARS-COV2 affected more than 180 countries necessitating fast and accurate diagnostic tools. Reverse transcriptase polymerase chain reaction (RT-PCR) has been identified as a gold standard test with Chest CT and Chest Radiograph ... Full text Open Access Link to item Cite

Technical Note: Validation of TG 233 phantom methodology to characterize noise and dose in patient CT data.

Journal Article Med Phys · April 2020 PURPOSE: Phantoms are useful tools in diagnostic CT, but practical limitations reduce phantoms to being only a limited patient surrogate. Furthermore, a phantom with a single cross sectional area cannot be used to evaluate scanner performance in modern CT ... Full text Open Access Link to item Cite

Patient-Informed and Physiology-Based Modelling of Hepatic Contrast Dynamics in Contrast-Enhanced CT Imaging

Journal Article · March 16, 2020 PURPOSE Iodinated contrast agents are commonly used in CT imaging to enhance tissue contrast. Consistency in contrast enhancement (CE) is critical in radiological diagnosis. Contrast material circulation in individual patients is affected by factors such a ... Open Access Cite

Modeling Patient-Informed Liver Contrast Perfusion in Contrast-enhanced Computed Tomography.

Journal Article J Comput Assist Tomogr · 2020 OBJECTIVE: To determine the correlation between patient attributes and contrast enhancement in liver parenchyma and demonstrate the potential for patient-informed prediction and optimization of contrast enhancement in liver imaging. METHODS: The study incl ... Full text Open Access Link to item Cite

CT Practice Monitoring

Chapter · December 16, 2019 This book is an ideal resource for practitioners of CT applications in medicine, including physicians, trainees, engineers, and scientists. This book offers a comprehensive and topical depiction of advances in CT imaging. ... Link to item Cite

Total risk index: a mathematical model for decision making based on clinical and radiation risk assessment in CT

Conference · December 4, 2019 Purpose. Radiological risk is a combination of radiation and clinical risk (likelihood of not delivering a proper diagnosis), which together may be characterized as a total risk index (TRI). While many strategies have been developed to ascertain radiation ... Open Access Cite

Expanding the Concept of Diagnostic Reference Levels to Noise and Dose Reference Levels in CT.

Journal Article AJR Am J Roentgenol · October 2019 OBJECTIVE. Diagnostic reference levels were developed as guidance for radiation dose in medical imaging and, by inference, diagnostic quality. The objective of this work was to expand the concept of diagnostic reference levels to explicitly include noise o ... Full text Open Access Link to item Cite

Characterization of Radiation Risk across a Clinical CT Patient Population: Comparison across 12 Risks Metrics

Conference · November 27, 2018 PURPOSE Ascertaining radiological procedure radiation burden is essential for justification, optimization, and personalization of the procedure. While the exact radiation risk for an individual exam is unknowable, various risk-related figures have been use ... Cite

Effective Dose for Computed Tomography in Large, Clinical Populations

Conference · November 27, 2018 PURPOSE Effective dose can efficiently integrate multiple organ dose values into a singular scalar value of radiation dose. The effective dose can also be calculated using dose length product (DLP) to effective dose conversion coefficients. The purpose of ... Cite

A Data-Centric Strategy for Developing CT Dose and Noise Reference Levels from Clinical Patient Populations

Conference · November 27, 2018 PURPOSE To develop a data-centric strategy solution for developing CT dose and noise reference levels across large clinical patient populations and in CT scanners. METHOD AND MATERIALS This IRB-exempt study evaluated CT abdominopelvic (AP)-related examin ... Cite

CT Resolution, Noise, and Dose Reference Levels Across a Multi-Center Patient Population

Conference · November 26, 2018 PURPOSE The diagnostic reference level (DRL) is useful as a first-order tool to compare radiation exposures of one's imaging clinic against those of one's peers in computed tomography. Ria et al. have advocated for the addition of a Noise Reference Level ( ... Cite

A Novel Methodology for Automated Image Quality Assessment of Pediatric CT

Conference · November 25, 2018 PURPOSE To develop an effective and automated methodology for patient-specific image quality assessment of clinical pediatric body CT examinations. METHOD AND MATERIALS This IRB approved study evaluated 816 clinically performed (6/14-11/17), contrast-enh ... Cite

Beyond the DRL: Applying Automated Quality Metrics to Assess Pediatric CT Program Liver Lesion Detection Performance

Conference · November 25, 2018 PURPOSE To apply an automated program for evaluating pediatric body CT study quality which utilizes metrics of dose and image quality for optimization of liver lesion detection. METHOD AND MATERIALS With IRB approval, 880 clinical contrast-enhanced abdom ... Cite

Quantifying quality: correlation phantom and clinical scan CT noise levels to contruct a Quality Reference Level

Conference · November 26, 2017 Conclusion This study represents a proof of concept method to develop and refine a Noise Reference Level for a given protocol and scanner. This represents a first step in establishing an automated Performance Reference Level for a given scan protocol that ... Cite

Organ Dose Estimation in CT through Voxelized Phantoms and Monte Carlo Methods: Impact of Wrong Patient-Phantom Matching

Conference · November 26, 2017 PURPOSE The aim of this study was to assess the impact on organ dose estimation for Body CT examinations when the patient is matched to the wrong virtual phantom. METHODS AND MATERIALS Patient-specific organ dosimetry is estimated using a Monte Carlo fram ... Cite

Awareness of medical radiation exposure among patients: A patient survey as a first step for effective communication of ionizing radiation risks.

Journal Article Phys Med · November 2017 INTRODUCTION: The European Directive 2013/59/EURATOM requires patient radiation dose information to be included in the medical report of radiological procedures. To provide effective communication to the patient, it is necessary to first assess the patient ... Full text Open Access Link to item Cite

Image noise and dose performance across a clinical population: Patient size adaptation as a metric of CT performance.

Journal Article Med Phys · June 2017 PURPOSE: Modern CT systems adjust X-ray flux accommodating for patient size to achieve certain image noise values. The effectiveness of this adaptation is an important aspect of CT performance and should ideally be characterized in the context of real pati ... Full text Open Access Link to item Cite

Organ Dose Estimation for CT Localizer Images

Conference MEDICAL PHYSICS · June 1, 2017 Link to item Cite

Dose Manager: New Solutions for Old Issues

Conference MEDICAL PHYSICS · June 1, 2017 Link to item Cite

Adaptability index: quantifying CT tube current modulation performance from dose and quality informatics

Journal Article Proc. SPIE 10132, Medical Imaging 2017: Physics of Medical Imaging, 101322N (March 9, 2017) · March 9, 2017 The balance between risk and benefit in modern CT scanners is governed by the automatic adaptation mechanisms that adjust x-ray flux for accommodating patient size to achieve certain image noise values. The effectiveness of this adaptation is an important ... Full text Open Access Link to item Cite

SU-F-I-48: Variability in CT Scanning Over-Range Across Clinical Operation.

Conference Med Phys · June 2016 PURPOSE: Inconsistency in the scan range for a given protocol can be a source of variability in patient dose. The purpose of this study was to determine the variability in the over-scan length in clinical CT operation for chest and abdominopelvic (A&P) pro ... Full text Link to item Cite

Monte Carlo-corrected GTV dose prescription on lung tumors treated with Cyberknife: A possible recipe

Conference Physica medica European Journal of Medical Physics · February 18, 2016 Link to item Cite

Application of the EUREF protocol for acceptance test of three digital breast tomosynthesis systems

Conference Physica Medica: International Journal of Medical Physics · February 18, 2016 Link to item Cite

CT Scan Dosimetric Parameters Routine Monitoring: First Results of Radiation Dose Optimization Strategies Promptly Provided by a Multidisciplinary Team

Conference · November 29, 2015 CONCLUSION Radiation dose reduction, while saving image quality could be easily implemented with this approach. Furthermore, the availability of a dosimetric data archive provides immediate feedbacks, related to the implemented optimization strategies. Ba ... Open Access Link to item Cite

STEREOTACTIC BODY RADIOTHERAPY FOR PROSTATE CANCER

Conference ANTICANCER RESEARCH · June 1, 2015 Link to item Cite

Study for the definition of the frequency for routine analytical control in radiolabelling process

Conference EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING · October 1, 2014 Open Access Link to item Cite

Risk assessment and economic impact analysis of the implementation of new European legislation on radiopharmaceuticals in Italy: the case of the new monograph chapter Compounding of Radiopharmaceuticals (PHARMEUROPA, Vol. 23, No. 4, October 2011).

Journal Article Curr Radiopharm · December 2013 An assessment of the new monograph chapter Compounding of Radiopharmaceuticals has been conducted on the basis of the first period of implementation of Italian legislation on Good Radiopharmaceuticals Practice (NBP) in the preparation of radiopharmaceutica ... Full text Open Access Link to item Cite

Laws versus Quality scheme: an opportunity to improve

Conference EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING · October 1, 2013 Link to item Cite