Dose reduction remains an important goal in interventional x-ray. We propose an image quality (IQ) measure called the visibility overshoot index. Given a patient image and a specified clinical task, the index quantifies the maximum acceptable dose reduction. The dose control system can then use this information to deliver the minimum dose necessary for detection of clinical signals, reducing unnecessary radiation exposure. We developed an experimental visual model to estimate signal detectability as a function of image features such as noise and signal contrast. The model is used to find a feature’s threshold–the maximum change in noise or signal contrast where signal detectability remains possible. An automated algorithm measures the magnitudes of these features on a frame. Visibility overshoot is expressed in terms of the image features: the noise overshoot and contrast overshoot indices are the ratio of the threshold to measured noise/contrast. The indices demonstrate good agreement with detector dose, channelized hotelling observer results, and clinicians’ judgments. In our study of a cylindrical object phantom acquired at seven dose levels, we found that the noise overshoot index is linearly related to the square root of detector dose and the CHO detectability index, with Pearson correlation 0.995–1.0 for signals 1-4 mm diameter. For interventional cardiology and neurology sequences acquired at standard and 25–30% dose, the index and clinicians rank IQ similarly. Results on the phantom suggest at least 15% dose reduction could be achieved in fluoroscopy mode. Our patient-specific IQ approach could bring additional dose savings to clinical practice.
This present collaborative research, undertaken in two different hemispheres, in an effort to address the challenge of early structural and sub-surface assessment of heritage marble architectures, like the Taj Mahal, using two complementary non-contact, non-invasive imaging techniques in the THz spectral range. In our previous work, it was already demonstrated that the complementary techniques of broadband Terahertz Time Domain Imaging (THz-TDI) and microRaman spectroscopy are successful in probing volume and surface damage in marble with Pietra-dura work. In the present work, the unique combination of THz-TDI and highly sensitive THz-Laser Feedback Interferometry (THz-LFI) have been explored to study sub-surface damage and irregularities of marble structures with Pietra-dura motif. These optical techniques hold immense possibility in large-scale architectural restoration projects as they collectively provide accurate structural depth profile up to several inches into the volume of the marble including the strain generated within the structure leading to potential cracks.
This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a cardiac interventional x-ray system with state-of-the-art image enhancement and x-ray optimization, compared to the current generation x-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each x-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose (p≪0.001) were found for the new system with no significant change in fluoroscopy duration (p=0.2); procedure DAP reduced by 64%, fluoroscopy DAP by 51%, and “cine” acquisition DAP by 76%. The image quality of 15 patient angiograms from each x-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analyzed using a two-sample t-test. Image quality was reduced by 9% (p≪0.01) for the new x-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new x-ray system compared to the current generation system.
Cardiologists use x-ray image sequences of the moving heart acquired in real-time to diagnose and treat cardiac patients. The amount of radiation used is proportional to image quality; however, exposure to radiation is damaging to patients and personnel. The amount by which radiation dose can be reduced without compromising patient care was determined. For five patient image sequences, increments of computer-generated quantum noise (white + colored) were added to the images, frame by frame using pixel-to-pixel addition, to simulate corresponding increments of dose reduction. The noise adding software was calibrated for settings used in cardiac procedures, and validated using standard objective and subjective image quality measurements. The degraded images were viewed next to corresponding original (not degraded) images in a two-alternative-forced-choice staircase psychophysics experiment. Seven cardiologists and five radiographers selected their preferred image based on visualization of the coronary arteries. The point of subjective equality, i.e., level of degradation where the observer could not perceive a difference between the original and degraded images, was calculated; for all patients the median was 33%±15% dose reduction. This demonstrates that a 33%±15% increase in image noise is feasible without being perceived, indicating potential for 33%±15% dose reduction without compromising patient care.
Modern cardiac x-ray imaging systems regulate their radiation output based on the thickness of the patient to maintain an acceptable signal at the input of the x-ray detector. This approach does not account for the context of the examination or the content of the image displayed. We have developed a machine vision algorithm that detects iodine-filled blood vessels and fits an idealized vessel model with the key parameters of contrast, diameter, and linear attenuation coefficient. The spatio-temporal distribution of the linear attenuation coefficient samples, when appropriately arranged, can be described by a simple linear relationship, despite the complexity of scene information. The algorithm was tested on static anthropomorphic chest phantom images under different radiographic factors and 60 dynamic clinical image sequences. It was found to be robust and sensitive to changes in vessel contrast resulting from variations in system parameters. The machine vision algorithm has the potential of extracting real-time context sensitive information that may be used for augmenting existing dose control strategies.
An automated closed-loop dose control system balances the radiation dose delivered to patients and the quality of images produced in cardiac x-ray imaging systems. Using computer simulations, this study compared two designs of automatic x-ray dose control in terms of the radiation dose and quality of images produced. The first design, commonly in x-ray systems today, maintained a constant dose rate at the image receptor. The second design maintained a constant image quality in the output images. A computer model represented patients as a polymethylmetacrylate phantom (which has similar x-ray attenuation to soft tissue), containing a detail representative of an artery filled with contrast medium. The model predicted the entrance surface dose to the phantom and contrast to noise ratio of the detail as an index of image quality. Results showed that for the constant dose control system, phantom dose increased substantially with phantom size (x5 increase between 20 cm and 30 cm thick phantom), yet the image quality decreased by 43% for the same thicknesses. For the constant quality control, phantom dose increased at a greater rate with phantom thickness (>x10 increase between 20 cm and 30 cm phantom). Image quality based dose control could tailor the x-ray output to just achieve the quality required, which would reduce dose to patients where the current dose control produces images of too high quality. However, maintaining higher levels of image quality for large patients would result in a significant dose increase over current practice.
This work presents a methodology to optimize the selection of multiple parameter levels of an image acquisition, degradation, or post-processing process applied to stimuli intended to be used in a subjective image or video quality assessment (QA) study. It is known that processing parameters (e.g. compression bit-rate) or technical quality measures (e.g. peak signal-to-noise ratio, PSNR) are often non-linearly related to human quality judgment, and the model of either relationship may not be known in advance. Using these approaches to select parameter levels may lead to an inaccurate estimate of the relationship between the parameter and subjective quality judgments – the system’s quality model. To overcome this, we propose a method for modeling the relationship between parameter levels and perceived quality distances using a paired comparison parameter selection procedure in which subjects judge the perceived similarity in quality. Our goal is to enable the selection of evenly sampled parameter levels within the considered quality range for use in a subjective QA study. This approach is tested on two applications: (1) selection of compression levels for laparoscopic surgery video QA study, and (2) selection of dose levels for an interventional X-ray QA study. Subjective scores, obtained from the follow-up single stimulus QA experiments conducted with expert subjects who evaluated the selected bit-rates and dose levels, were roughly equidistant in the perceptual quality space - as intended. These results suggest that a similarity judgment task can help select parameter values corresponding to desired subjective quality levels.
The purpose of this work is to report on a machine vision approach for the automated measurement of x-ray image contrast of coronary arteries filled with iodine contrast media during interventional cardiac procedures. A machine vision algorithm was developed that creates a binary mask of the principal vessels of the coronary artery tree by thresholding a standard deviation map of the direction image of the cardiac scene derived using a Frangi filter. Using the mask, average contrast is calculated by fitting a Gaussian model to the greyscale profile orthogonal to the vessel centre line at a number of points along the vessel. The algorithm was applied to sections of single image frames from 30 left and 30 right coronary artery image sequences from different patients. Manual measurements of average contrast were also performed on the same images. A Bland-Altman analysis indicates good agreement between the two methods with 95% confidence intervals -0.046 to +0.048 with a mean bias of 0.001. The machine vision algorithm has the potential of providing real-time context sensitive information so that radiographic imaging control parameters could be adjusted on the basis of clinically relevant image content.
Dynamic X-ray imaging systems are used for interventional cardiac procedures to treat coronary heart disease. X-ray settings are controlled automatically by specially-designed X-ray dose control mechanisms whose role is to ensure an adequate level of image quality is maintained with an acceptable radiation dose to the patient. Current commonplace dose control designs quantify image quality by performing a simple technical measurement directly from the image. However, the utility of cardiac X-ray images is in their interpretation by a cardiologist during an interventional procedure, rather than in a technical measurement. With the long term goal of devising a clinically-relevant image quality metric for an intelligent dose control system, we aim to investigate the relationship of image noise with clinical professionals’ perception of dynamic image sequences.
Computer-generated noise was added, in incremental amounts, to angiograms of five different patients selected to represent the range of adult cardiac patient sizes. A two alternative forced choice staircase experiment was used to determine the amount of noise which can be added to a patient image sequences without changing image quality as perceived by clinical professionals. Twenty-five viewing sessions (five for each patient) were completed by thirteen observers. Results demonstrated scope to increase the noise of cardiac X-ray images by up to 21% ± 8% before it is noticeable by clinical professionals. This indicates a potential for 21% radiation dose reduction since X-ray image noise and radiation dose are directly related; this would be beneficial to both patients and personnel.
Cassette based computed radiography systems have continued to evolve in parallel with integrated, instant readout digital radiography DR systems. The image quality of present day computed radiography systems is approaching its theoretical limits but is still significantly inferior to DR. Our overall aim is to identify the fundamental limitations in computed radiography performance. This will provide a basis for the development of new approaches to improve photostimulable phosphor based computed radiography systems based either on cassettes or integrated systems. In this fundamental work flare has been evaluated by use of the disk transfer function. It is found that there is a significant, previously unnoticed low frequency drop in the modulation transfer function. However, it is not yet fully resolved if the measured flare is due solely to scattering of light in the readout system or whether scattered x-rays in the imaging plate cassette enhance it. Further work is necessary to resolve this issue. The likely effect of flare on proposed new computed radiography methods is also explored.
Thierry Ducourant, David Couder, Thibaut Wirth, J. Trochet, Raoul Bastiaens, Tom Bruijns, Hans Luijendijk, Bernhard Sandkamp, Andrew Davies, Dominique Didier, Agustin Gonzalez, Sylvain Terraz, Daniel Ruefenacht
One of the most demanding applications in dynamic X-Ray imaging is Digital Subtraction Angiography (DSA). As opposed to other applications such as Radiography or Fluoroscopy, there has been so far limited attempts to introduce DSA with flat detector (FD) technology: Up to now, only part of the very demanding requirements could be taken into account. In order to enable an introduction of FD technology also in this area, a complete understanding of all physical phenomena related to the use of this technology in DSA is necessary. This knowledge can be used for detector design and performance optimization. Areas of research include fast switching between several detector operating modes (e.g. switching between fluoroscopy and high dose exposure modes and vice versa) and non stability during the DSA run e.g. due to differences in gain between subsequent images. Furthermore, effects of local and global X-Ray overexposure (due to direct radiation), which can cause temporal artifacts such as ghosting, may have a negative impact on the image quality. Pixel shift operations and image subtraction enhance the visibility of any artifact. The use of a refresh light plays an important role in the optimization process.
Both an 18x18 cm2 as well as a large area 30x40 cm2 flat panel detector are used for studying the various phenomena. Technical measurements were obtained using complex imaging sequences representing the most demanding application conditions.
Studies on subtraction test objects were performed and vascular applications have been carried out in order to confirm earlier findings. The basis for comparison of DSA is, still, the existing and mature IITV technology.
The results of this investigation show that the latest generation of dynamic flat detectors is capable of handling this kind of demanding application. Not only the risk areas and their solutions and points of attention will be addressed, but also the benefits of present FD technology with respect to state-of-the-art IITV technology regarding DSA will be discussed.
Tom Bruijns, Raoul Bastiaens, Bart Hoornaert, Eric von Reth, Falko Busse, Volker Heer, Thierry Ducourant, Arnold Cowen, Andrew Davies, Francois Terrier
The purpose of this research is to establish the technical and clinical image quality of a 30 X 40 cm2 dynamic flat detector (FD) compared to state-of-the-art IITV technology. A Trixell detector for vascular and RF applications is designed for a mixed use of fluoroscopy as well as exposure series and a range of radiographic applications. An RF system has been built which comprises both the FD as well as an IITV detector. This system enables a direct comparison of technical image quality measurements and patient images under exactly the same X-ray conditions. Image quality measurements comprise Detective Quantum Efficiency including transfer characteristics, Modulation Transfer Function, Noise Power Spectrum, lag, Low Frequency Drop and residual signals. Observation tests, using Threshold Contrast Detail Detectability (TCDD) techniques, are performed in order to confirm the results of the technical measurements. Results show a DQE (f) of the flat detector that is higher compared to IITV and above all constant over a wide dose range, the IITV DQE (f) drops at higher dose range due to fixed structure. Furthermore the Low Frequency Drop is substantially smaller in the FD-based system. The TCDD subjective tests show improved system performance in favor of the FD system.
One of the issues in (alpha) -Si:H X-ray detectors is signal to noise ratio for low dose fluoroscopic applications. An optimized sensitivity of the X-ray detection system together with low and isotropic system noise characteristics are primary pre-conditions needed for maximum image quality. However, in spite of high DQE numbers of this Flat Detector technology in radiological and fluoroscopic application areas, a SNR for low dose fluoroscopy is found, which is inferior to that found with Image Intensifier-TV based systems. The problem area is a small dose range, producing gray levels just above absolute dark. Except for the dark level, these levels can (dependent on the application area) contain clinically relevant information. Since scatter affects the darker parts of the relevant image areas there will be noise in those areas, caused by X-ray quantum statistics and readout noise. The objective of the simulations is to investigate the influence of the various system noise components on the image quality. A level of system noise can be found where the subjective image quality is mainly determined by the X-ray quantum statistics and where the readout noise does not necessarily have to be invisible in totally dark parts. The simulation concerns a threshold contrast detail detectability (TCDD) observation test, where observers score discs of various diameter and absorption in an image sequence (being a fixed scene of the test object with (temporal) X-ray noise and system noise). The dynamic sequence is based upon total simulation, i.e. the test object as well as the X-ray noise and the system noise components were simulated. To verify the simulations also an image sequence was acquired on a Flat Detector system. The observations are done at various dose levels, with and without post processing to obtain noise reduction like it is used in clinical practice for this kind of system. The sequences are observed on a medical CRT display.
Advanced technical investigations, including DQE measurements and threshold contrast detail-detectability experiments, have been performed in order to demonstrate the superior image quality of an experimental flat dynamic X-ray image detector (FDXD) system. The dose efficiencies throughout a range of dose levels used in fluoroscopic and radiographic applications have been measured and are presented. Together with the results of a range of clinical patient examinations, the results of the technical investigations fully confirm earlier expectations in terms of increased image quality and improved dose efficiency with respect to current imaging modalities. Several mixed applications performed with the FDXD system are presented including those where subtraction techniques were used. The dynamic aspects of the FDXD system are discussed in detail. In the fluoroscopic mode, images have been acquired with a dose-rate as low as 5 nGy per image using a frame rate of approx. 25 fps. Low dose fluoroscopic images will be presented and it will be confirmed that low readout noise of the detection system facilitates the clinical acceptability of the images, even without applying any noise reduction algorithms. Post-processing algorithms for exposures will also be discussed. It can be concluded that the results of the technical measurements, together with the clinical examinations, prove that in areas regarding dose efficiency and image quality, this new detector technology is superior to the current X-ray modalities in many aspects.
This paper presents results of an image quality evaluation performed on a prototype DirectRay system (Sterling Diagnostic Imaging, Direct Radiography Corp.) operating in a UK radiology department. Physical imaging characteristics measured included characteristic (sensitometric) response, square-wave response function, Wiener spectrum and detective quantum efficiency (DQE). In addition, subjective image quality was assessed using a calibrated threshold contrast detail detectability (TCDD) test object. Results produced by the DirectRay system were compared with those achieved by a modern photo-stimulable computed radiography (CR) system. DirectRay and CR systems exhibit similarly wide exposure dynamic ranges, but in practice exploit this property in differing ways. Measured values of DQE(0) for the DirectRay system were found to be higher compared to those obtained for CR, for the majority of the exposure range examined. These results were confirmed subjectively by TCDD test-object analysis. No evidence of a 'memory artifact' phenomenon was found.
We are currently in an era of active development of the digital X-ray imaging detectors that will serve the radiological communities in the new millennium. The rigorous comparative physical evaluations of such devices are therefore becoming increasingly important from both the technical and clinical perspectives. The authors have been actively involved in the evaluation of a clinical demonstration version of a flat-panel dynamic digital X-ray image detector (or FDXD). Results of objective physical evaluation of this device have been presented elsewhere at this conference. The imaging performance of FDXD under radiographic exposure conditions have been previously reported, and in this paper a psychophysical evaluation of the FDXD detector operating under continuous fluoroscopic conditions is presented. The evaluation technique employed was the threshold contrast detail detectability (TCDD) technique, which enables image quality to be measured on devices operating in the clinical environment. This approach addresses image quality in the context of both the image acquisition and display processes, and uses human observers to measure performance. The Leeds test objects TO[10] and TO[10+] were used to obtain comparative measurements of performance on the FDXD and two digital spot fluorography (DSF) systems, one utilizing a Plumbicon camera and the other a state of the art CCD camera. Measurements were taken at a range of detector entrance exposure rates, namely 6, 12, 25 and 50 (mu) R/s. In order to facilitate comparisons between the systems, all fluoroscopic image processing such as noise reduction algorithms, were disabled during the experiments. At the highest dose rate FDXD significantly outperformed the DSF comparison systems in the TCDD comparisons. At 25 and 12 (mu) R/s all three-systems performed in an equivalent manner and at the lowest exposure rate FDXD was inferior to the two DSF systems. At standard fluoroscopic exposures, FDXD performed in an equivalent manner to the DSF systems for the TCDD comparisons. This would suggest that FDXD would therefore perform adequately in a clinical fluoroscopic environment and our initial clinical experiences support this. Noise reduction processing of the fluoroscopic data acquired on FDXD was also found to further improve TCDD performance for FDXD. FDXD therefore combines acceptable fluoroscopic performance with excellent radiographic (snap shot) imaging fidelity, allowing the possibility of a universal x-ray detector to be developed, based on FDXD's technology. It is also envisaged that fluoroscopic performance will be improved by the development of digital image enhancement techniques specifically tailored to the characteristics of the FDXD detector.
The issue of the spatial resolution required in order to present diagnostic quality digital images, especially for softcopy reporting, has received much attention over recent years. The aim of this study was to compare the diagnostic performance reporting from hardcopy and optimized softcopy image presentations. One-hundred-fifteen radiographs of the hand acquired on a photostimulable phosphor computed radiography (CR) system were chosen as the image material. The study group was taken from patients who demonstrated subtle erosions of the bone in the digits. The control group consisted of radiologically normal bands. The images were presented in three modes, the CR system's hardcopy output, and softcopy presentations at full and half spatial resolutions. Four consultant radiologists participated as observers. Results were analyzed using the receiver operating characteristic (ROC) technique, and showed a statistically significant improvement in observer performance for both softcopy formats, when compared to the hardcopy presentation. However, no significant difference in observer performance was found between the two softcopy presentations. We therefore conclude that, with appropriate attention to the processing and presentation of digital image data, softcopy reporting can, for most examinations, provide superior diagnostic performance, even for images viewed at modest (1 k2) resolutions.
The production of hardcopy output, of suitable quality for modern digital radiography systems, is generally performed using a laser imager exposing a silver-halide film. Until recently the use of technologies that do not require the 'wet' photographic processing of the film have been hampered by poor image quality. However the Polaroid Helios imager offers high imaging specification, without the environmental overheads, by utilizing a totally digital printing paradigm. The Helios system was evaluated in terms of its physical imaging properties, and a clinical trial was undertaken. The results, although preliminary in nature, indicate that the Helios imager does indeed offer a viable alternative to conventional laser imagers. This encourages us to carry out a full trial in clinical routine.
Photostimulable phosphor computed radiography (CR) is becoming an increasingly popular image acquisition system. The acceptability of this technique, both diagnostically, ergonomically and economically is highly influenced by the method by which the image data is presented to the user. Traditional CR systems utilize an 11' by 14' film hardcopy format, and can place two images per exposure onto this film, which does not correspond to sizes and presentations provided by conventional techniques. It is also the authors' experience that the image enhancement algorithms provided by traditional CR systems do not provide optimal image presentation. An alternative image enhancement algorithm was developed, along with a number of hardcopy formats, designed to match the requirements of the image reporting process. The new image enhancement algorithm, called dynamic range reduction (DRR), is designed to provide a single presentation per exposure, maintaining the appearance of a conventional radiograph, while optimizing the rendition of diagnostically relevant features within the image. The algorithm was developed on a Sun SPARCstation, but later ported to a Philips' EasyVisionRAD workstation. Print formats were developed on the EasyVision to improve the acceptability of the CR hardcopy. For example, for mammographic examinations, four mammograms (a cranio-caudal and medio-lateral view of each breast) are taken for each patient, with all images placed onto a single sheet of 14' by 17' film. The new composite format provides a more suitable image presentation for reporting, and is more economical to produce. It is the use of enhanced image processing and presentation which has enabled all mammography undertaken within the general infirmary to be performed using the CR/EasyVisionRAD DRR/3M 969 combination, without recourse to conventional film/screen mammography.
During 1990 The UK Department of Health installed two Photostimulable Phosphor Computed Radiography (PPCR) systems in the General Infirmary at Leeds with a view to evaluating the clinical and physical performance of the technology prior to its introduction into the NHS. An issue that came to light from the outset of the projects was the radiologists reservations about the influence of the standard PPCR computerized image processing on image quality and diagnostic performance. An investigation was set up by FAXIL to develop an algorithm to produce single format high quality PPCR images that would be easy to implement and allay the concerns of radiologists.
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