The presence of metal-artifacts in CT imaging can obscure relevant anatomy and interfere with disease diagnosis. The cause and occurrence of metal-artifacts are primarily due to beam hardening, scatter, partial volume and photon starvation; however, the contribution to the artifacts from each of them depends on the type of hardware. A comparison of CT images obtained with different metallic hardware in various applications, along with acquisition and reconstruction parameters, helps understand methods for reducing or overcoming such artifacts. In this work, a metal beam hardening correction (BHC) and a projection-completion based metal artifact reduction (MAR) algorithms were developed, and applied on phantom and clinical CT scans with various metallic implants. Stainless-steel and Titanium were used to model and correct for metal beam hardening effect. In the MAR algorithm, the corrupted projection samples are replaced by the combination of original projections and in-painted data obtained by forward projecting a prior image. The data included spine fixation screws, hip-implants, dental-filling, and body extremity fixations, covering range of clinically used metal implants. Comparison of BHC and MAR on different metallic implants was used to characterize dominant source of the artifacts, and conceivable methods to overcome those. Results of the study indicate that beam hardening could be a dominant source of artifact in many spine and extremity fixations, whereas dental and hip implants could be dominant source of photon starvation. The BHC algorithm could significantly improve image quality in CT scans with metallic screws, whereas MAR algorithm could alleviate artifacts in hip-implants and dentalfillings.
Non-linear iterative reconstruction (IR) algorithms have shown promising improvements in image quality at reduced
dose levels. However, IR images sometimes may be perceived as having different image noise texture than traditional
filtered back projection (FBP) reconstruction. Standard linear-systems-based image quality evaluation metrics are
limited in characterizing such textural differences and non-linear image-quality vs. dose trade-off behavior, hence
limited in predicting potential impact of such texture differences in diagnostic task. In an attempt to objectively
characterize and measure dose dependent image noise texture and statistical properties of IR and FBP images, we have
investigated higher order moments and Haralicks Gray Level Co-occurrence Matrices (GLCM) based texture features on
phantom images reconstructed by an iterative and a traditional FBP method. In this study, the first 4 central order
moments, and multiple texture features from Haralick GLCM in 4 directions at 6 different ROI sizes and four dose levels
were computed. For resolution, noise and texture trade-off analysis, spatial frequency domain NPS and contrastdependent
MTF were also computed. Preliminary results of the study indicate that higher order moments, along with
spatial domain measures of energy, contrast, correlation, homogeneity, and entropy consistently capture the textural
differences between FBP and IR as dose changes. These metrics may be useful in describing the perceptual differences
in randomness, coarseness, contrast, and smoothness of images reconstructed by non-linear algorithms.
Today lowering patient radiation dose while maintaining image quality in Computed Tomography has become a very
active research field. Various iterative reconstruction algorithms have been designed to improve/maintain image quality
for low dose patient scans. Typically radiation dose variation will result in detectability variation for low contrast
objects. This paper assesses the low contrast detectability performance of the images acquired at different dose levels
and obtained using different image generation algorithms via two-alterative forced choice human observer method.
Filtered backprojection and iterative reconstruction algorithms were used in the study. Results showed that for the
objects and scan protocol used, the iterative algorithm employed in this study has similar low contrast detectability
performance compared to filtered backprojection algorithm at a 4 times lower dose level. It also demonstrated that well
controlled human observer study is feasible to assess the image quality of a CT system.
Dual energy computed tomography offers unique diagnostic value by enabling access to material density, effective
atomic number, and energy specific spectral characteristics, which remained indeterminate with conventional kVp
imaging. Gemstone Spectral Imaging (GSI) is one of the dual energy methods based on fast kVp switching between two
x-ray spectra, 80 kVp and 140 kVp nominal, in adjacent projections. The purpose of this study was to compare relative
dose between GSI monochromatic and conventional kVp imaging for equivalent image noise characteristics. A spatialfrequency
domain noise power spectrum (NPS) was used as a more complete noise descriptor for the comparison of the
two image types. Uniform 20cm water phantom images from GSI and conventional 120 kVp scans were used for NPS
calculation. In addition, a low contrast imaging study of the two image types with equivalent noise characteristics was
conducted for contrast-to-noise-ratio (CNR) and low contrast detectability (LCD) in the Catphan600® phantom. From
three GSI presets ranging from medium to low dose, we observed that conventional 120kVp scan requires ~ 7% -
18% increase in dose to match the noise characteristics in optimal noise GSI monochromatic image; and that the 65 keV
monochromatic image CNR for a 0.5% contrast object is 22% higher compared to corresponding 120 kVp scan. Optimal
use of the two energy spectra within GSI results in reduced noise and improved CNR in the monochromatic images,
indicating the potential for use of this image type in routine clinical applications.
The relationship between theoretical descriptions of imaging performance (Fourier-based) and the
performance of real human observers was investigated for detection tasks in multi-slice CT. The detectability
index for the Fisher-Hotelling model observer and non-prewhitening model observer (with and without
internal noise and eye filter) was computed using: 1) the measured modulation transfer function (MTF) and
noise-power spectrum (NPS) for CT; and 2) a Fourier description of imaging task. Based upon CT images of
human patients with added simulated lesions, human observer performance was assessed via an observer
study in terms of the area under the ROC curve (Az). The degree to which the detectability index correlated
with human observer performance was investigated and results for the non-prewhitening model observer with
internal noise and eye filter (NPWE) were found to agree best with human performance over a broad range of
imaging conditions. Results provided initial validation that CT image acquisition and reconstruction
parameters can be optimized for observer performance rather than system performance (i.e., contrast-to-noise
ratio, MTF, and NPS). The NPWE model was further applied for the comparison of FBP with a novel modelbased
iterative reconstruction algorithm to assess its potential for dose reduction.
Dual-energy CT has attracted much attention in recent years. Most recently, a fast-kVp switching
(FKS) dual-energy method has been presented with clinical and phantom results to demonstrate
its efficacy. The purpose of our study was to quantitatively compare the CTDIW of FKS and
routine CT exams under the body and head conditions. For a fair comparison, the low contrast
detectability (LCD) was matched before measuring dose. In FKS protocols, an x-ray generator
switch rapidly between 140kVp and 80kVp in adjacent views, and the effective tube current is
around 600mA. In addition to the tube voltage and current, the flux ratio between high and low
kVp is optimized by asymmetric sampling of 35%-65%. The head and body protocols further
differ by the gantry speed (0.9sec/1.0sec) and type of bowtie filter (head/body). For baseline
single-energy, we followed the IEC standard head and body protocols (120kV, 1sec, 5mm) but
iteratively adjusted the tube current (mA) in order to match the LCD. CTDIW was measured
using either a 16 cm (for head scanning) or a 32 cm (for body scanning) PMMA phantom of at
least 14 cm in length. The LCD was measured using the water section of Catphan 600. To make
the study repeatable, the automated statistical LCD measurement tool available on GE Discovery
CT750 scanner was used in this work. The mean CTDIW for the head and body single-energy
acquisitions were 57.5mGy and 29.2mGy, respectively. The LCD was measured at 0.45% and
0.42% (slice thickness=5mm, object size=3mm, central 4 images), respectively. The average
CTDIW for FKS head and body scans was 70.4mGy and 33.4mGy, respectively, at the optimal
monochromatic energy of 65 keV. The corresponding LCD was measured at 0.45% and 0.43%,
respectively. This demonstrates that, with matching LCD, CTDIW of FKS is comparable to that
of routine CT exams under head and body conditions.
The objective performance evaluation metrics, termed Generalized Modulation Transfer Function (GMTF), Generalized
Noise Power Spectrum (GNPS), Generalized Noise Equivalent Quanta (GNEQ), and Generalized Detective Quantum
Efficiency (GDQE), have been developed to assess total
imaging-system performance by including the effects of
geometric unsharpness due to the finite size of the focal spot and scattered radiation in addition to the detector properties.
These metrics were used to evaluate the performance of the HSMAF, a custom-built, high-resolution, real-time-acquisition
detector with 35-μm pixels, in simulated neurovascular angiographic conditions using a uniform head-equivalent
phantom. The HSMAF consists of a 300-μm-thick CsI(Tl) scintillator coupled to a 4 cm diameter, variable-gain,
Gen2 light image intensifier with dual-stage microchannel plate, followed by direct fiber-optic coupling to a 30-fps
CCD camera, and is capable of both fluoroscopy and angiography. Effects of focal-spot size, geometric magnification,
irradiation field-of-view, and air-gap between the phantom and the detector were evaluated. The resulting plots of GMTF
and GDQE showed that geometric blurring is the more dominant image degradation factor at high spatial frequencies,
whereas scatter dominates at low spatial frequencies. For the standard image-geometry and scatter conditions used here,
the HSMAF maintains substantial system imaging capabilities (GDQE>5%) at frequencies above 4 cycles/mm where
conventional detectors cannot operate. The loss in image SNR due to scatter or focal-spot unsharpness could be
compensated by increasing the exposure by a factor of 2 to 3. This generalized evaluation method may be used to more
realistically evaluate and compare total system performance leading to improved system designs.
A graphical user interface based on LabVIEW software was developed to enable clinical evaluation of a new High-Sensitivity Micro-Angio-Fluoroscopic (HSMAF) system for real-time acquisition, display and rapid frame transfer of
high-resolution region-of-interest images. The HSMAF detector consists of a CsI(Tl) phosphor, a light image intensifier
(LII), and a fiber-optic taper coupled to a progressive scan,
frame-transfer, charged-coupled device (CCD) camera which
provides real-time 12 bit, 1k × 1k images capable of greater than 10 lp/mm resolution. Images can be captured in
continuous or triggered mode, and the camera can be programmed by a computer using Camera Link serial
communication. A graphical user interface was developed to control the camera modes such as gain and pixel binning as
well as to acquire, store, display, and process the images. The program, written in LabVIEW, has the following
capabilities: camera initialization, synchronized image acquisition with the x-ray pulses, roadmap and digital subtraction
angiography acquisition (DSA), flat field correction, brightness and contrast control, last frame hold in fluoroscopy,
looped play-back of the acquired images in angiography, recursive temporal filtering and LII gain control. Frame rates
can be up to 30 fps in full-resolution mode. The user friendly implementation of the interface along with the high frame-rate
acquisition and display for this unique high-resolution detector should provide angiographers and interventionalists
with a new capability for visualizing details of small vessels and endovascular devices such as stents and hence enable
more accurate diagnoses and image guided interventions.
The solid-state x-ray image intensifier (SSXII) is an EMCCD-based x-ray detector designed to satisfy an increasing need
for high-resolution real-time images, while offering significant improvements over current flat panel detectors (FPDs)
and x-ray image intensifiers (XIIs). FPDs are replacing XIIs because they reduce/eliminate veiling glare, pincushion or s-shaped
distortions and are physically flat. However, FPDs suffer from excessive lag and ghosting and their performance
has been disappointing for low-exposure-per-frame procedures due to excessive instrumentation-noise. XIIs and FPDs
both have limited resolution capabilities of ~3 cycles/mm. To overcome these limitations a prototype SSXII module has
been developed, consisting of a 1k x 1k, 8 μm pixel EMCCD with a fiber-optic input window, which views a 350 μm
thick CsI(Tl) phosphor via a 4:1 magnifying fiber-optic-taper (FOT). Arrays of such modules will provide a larger field-of-
view. Detector MTF, DQE, and instrumentation-noise equivalent exposure (INEE) were measured to evaluate the
SSXIIs performance using a standard x-ray spectrum (IEC RQA5), allowing for comparison with current state-of-the-art
detectors. The MTF was 0.20 at 3 cycles/mm, comparable to standard detectors, and better than 0.05 up to 7 cycles/mm,
well beyond current capabilities. DQE curves indicate no degradation from high-angiographic to low-fluoroscopic
exposures (< 2% deviation in overall DQE from 1.3 mR to 2.7 μR), demonstrating negligible instrumentation-noise,
even with low input signal intensities. An INEE of < 0.2 μR was measured for the highest-resolution mode (32 μm
effective pixel size). Comparison images between detector technologies qualitatively demonstrate these improved
imaging capabilities provided by the SSXII.
New advances in catheter technology and remote actuation for minimally invasive procedures are continuously
increasing the demand for better x-ray imaging technology. The new x-ray high-sensitivity Micro-Angiographic
Fluoroscope (HS-MAF) detector offers high resolution and real-time image-guided capabilities which are unique when
compared with commercially available detectors. This detector consists of a 300 μm CsI input phosphor coupled to a
dual stage GEN2 micro-channel plate light image intensifier (LII), followed by minifying fiber-optic taper coupled to a
CCD chip. The HS-MAF detector image array is 1024X1024 pixels, with a 12 bit depth capable of imaging at 30 frames
per second. The detector has a round field of view with 4 cm diameter and 35 microns pixels. The LII has a large
variable gain which allows usage of the detector at very low exposures characteristic of fluoroscopic ranges while
maintaining very good image quality. The custom acquisition program allows real-time image display and data storage.
We designed a set of in-vivo experimental interventions in which placement of specially designed endovascular stents
were evaluated with the new detector and with a standard x-ray image intensifier (XII). Capabilities such fluoroscopy,
angiography and ROI-CT reconstruction using rotational angiography data were implemented and verified. The images
obtained during interventions under radiographic control with the HS-MAF detector were superior to those with the XII.
In general, the device feature markers, the device structures, and the vessel geometry were better identified with the new
detector. High-resolution detectors such as HS-MAF can vastly improve the accuracy of localization and tracking of
devices such stents or catheters.
A new high-resolution, high-sensitivity, low-noise x-ray detector based on EMCCDs has been developed. The EMCCD detector module consists of a 1kx1k, 8μm pixel EMCCD camera coupled to a CsI(Tl) scintillating phosphor via a fiber optic taper (FOT). Multiple modules can be used to provide the desired field-of-view (FOV). The detector is capable of acquisitions over 30fps. The EMCCD's variable gain of up to 2000x for the pixel signal enables high sensitivity for fluoroscopic applications. With a 3:1 FOT, the detector can operate with a 144μm effective pixel size, comparable to current flat-panel detectors. Higher resolutions of 96 and 48μm pixel size can also be achieved with various binning modes. The detector MTFs and DQEs were calculated using a linear-systems analysis. The zero frequency DQE was calculated to be 59% at 74 kVp. The DQE for the 144μm pixel size was shown to exhibit quantum-noise limited behavior down to ~0.1μR using a conservative 30x gain. At this low exposure, gains above 30x showed limited improvements in DQE suggesting such increased gains may not be necessary. For operation down to 48µm pixel sizes, the detector instrumentation noise equivalent exposure (INEE), defined as the exposure where the instrumentation noise equals the quantum-noise, was <0.1μR for a 20x gain. This new technology may provide improvements over current flat-panel detectors for applications such as fluoroscopy and angiography requiring high frame rates, resolution, dynamic range and sensitivity while maintaining essentially no lag and very low INEE. Initial images from a prototype detector are also presented.
New cone-beam computed tomographic (CBCT) mammography system designs are presented where the detectors provide high spatial resolution, high sensitivity, low noise, wide dynamic range, negligible lag and high frame rates similar to features required for high performance fluoroscopy detectors. The x-ray detectors consist of a phosphor coupled by a fiber-optic taper to either a high gain image light amplifier (LA) then CCD camera or to an electron multiplying CCD. When a square-array of such detectors is used, a field-of-view (FOV) to 20 x 20 cm can be obtained where the images have pixel-resolution of 100 μm or better. To achieve practical CBCT mammography scan-times, 30 fps may be acquired with quantum limited (noise free) performance below 0.2 μR detector exposure per frame. Because of the flexible voltage controlled gain of the LA's and EMCCDs, large detector dynamic range is also achievable. Features of such detector systems with arrays of either generation 2 (Gen 2) or 3 (Gen 3) LAs optically coupled to CCD cameras or arrays of EMCCDs coupled directly are compared. Quantum accounting analysis is done for a variety of such designs where either the lowest number of information carriers off the LA photo-cathode or electrons released in the EMCCDs per x-ray absorbed in the phosphor are large enough to imply no quantum sink for the design. These new LA- or EMCCD-based systems could lead to vastly improved CBCT mammography, ROI-CT, or fluoroscopy performance compared to systems using flat panels.
Standard objective parameters such as MTF, NPS, NEQ and DQE do not reflect complete system performance, because they do not account for geometric unsharpness due to finite focal spot size and scatter due to the patient. The inclusion of these factors led to the generalization of the objective quantities, termed GMTF, GNNPS, GNEQ and GDQE defined at the object plane. In this study, a commercial x-ray image intensifier (II) is evaluated under this generalized approach and compared with a high-resolution, ROI microangiographic system previously developed and evaluated by our group. The study was performed using clinically relevant spectra and simulated conditions for neurovascular angiography specific for each system. A head-equivalent phantom was used, and images were acquired from 60 to 100 kVp. A source to image distance of 100 cm (75 cm for the microangiographic system) and a focal spot of 0.6 mm were used. Effects of varying the irradiation field-size, the air-gaps, and the magnifications (1.1 to 1.3) were compared. A detailed comparison of all of the generalized parameters is presented for the two systems. The detector MTF for the microangiographic system is in general better than that for the II system. For the total x-ray imaging system, the GMTF and GDQE for the II are better at low spatial frequencies, whereas the microangiographic system performs substantially better at higher spatial frequencies. This generalized approach can be used to more realistically evaluate and compare total system performance leading to improved system designs tailored to the imaging task.
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