Dynamic stress myocardial CT perfusion (CTP), a functional imaging modality that is proven highly valuable for evaluating myocardial ischemia, is one of the most challenging CT examinations being carried out in practice. The implementation varies among current CT systems on the image acquisition mode, the dose management, as well as the strategy to combine myocardial CTP with coronary CT angiography (CCTA), which may result in a large difference in the efficiency of the clinical workflow. Following the so-called “one-stop-shop” concept, a new genuine protocol has been implemented by using a 320-row CT imaging system, with rapid volumetric image acquisition in axial mode, adaptive temporal sampling rate, CCTA extracted from the boosted arterial phases within the CTP, and the deep learning algorithms ensuring the reconstructed image quality. This paper describes the imaging protocol and the associated technical parameters in detail and compares this protocol to those reported previously in the literature.
Purpose: The relevance of presampling modulation transfer function (MTF) measurements in digital mammography (DM) quality control (QC) is examined. Two studies are presented: a case study on the impact of a reduction in MTF on the technical image quality score and analysis of the robustness of routine QC MTF measurements.
Approach: In the first study, two needle computed radiography (CR) plates with identical sensitivities were used with differences in the 50% point of the MTF (fMTF0.5) larger than the limiting value in the European guidelines (>10 % change between successive measurements). Technical image quality was assessed via threshold gold thickness of the CDMAM phantom and threshold microcalcification diameter of the L1 structured phantom. For the second study, presampling MTF results from 595 half-yearly QC tests of 55 DM systems (16 types, six manufacturers) were analyzed for changes from the baseline value and changes in fMTF0.5 between successive tests.
Results: A reduction of 20% in fMTF0.5 of the two CR plates was observed. There was a tendency to a lower score for task-based metrics, but none were significant. Averaging over 55 systems, the absolute relative change in fMTF0.5 between consecutive tests (with 95% confidence interval) was 3% (2.5% to 3.4%). Analysis of the maximum relative change from baseline revealed changes of up to −10 % for one a-Se based system and −15 % for a group of CsI-based systems.
Conclusions: A limit of 10% is a relevant action level for investigation. If exceeded, then the impact on performance has to be verified with extra metrics.
KEYWORDS: Visualization, Digital breast tomosynthesis, Modulation transfer functions, Optical spheres, Aluminum, Breast imaging, Image processing, 3D modeling, Photovoltaics, Polymethylmethacrylate
Purpose: The impact of system parameters on signal detectability can be studied with simulation platforms. We describe the steps taken to verify and confirm the accuracy of a local platform developed for the use in virtual clinical trials.
Approach: The platform simulates specific targets into existing two-dimensional full-field digital mammography and digital breast tomosynthesis images acquired on a Siemens Inspiration system. There are three steps: (1) creation of voxel models or analytical objects; (2) generation of a realistic object template with accurate resolution, scatter, and noise properties; and (3) insertion and reconstruction. Four objects were simulated: a 0.5-mm aluminium (Al) sphere and a 0.2-mm-thick Al sheet in a PMMA stack, a 0.8-mm steel edge and a three-dimensional mass model in a structured background phantom. Simulated results were compared to acquired data.
Results: Peak contrast and signal difference-to-noise ratio (SDNR) were in close agreement (<5 % error) for both sphere and sheet. The similarity of pixel value profiles for sphere and sheet in the xy direction and the artifact spread function for real and simulated spheres confirmed accurate geometric modeling. Absolute and relative average deviation between modulation transfer function measured from a real and simulated edges showed accurate sharpness modelling for spatial frequencies up to the Nyquist frequency. Real and simulated objects could not be differentiated visually.
Conclusions: The results indicate that this simulation framework is a strong candidate for use in virtual clinical studies.
Purpose: The aim of this study was to implement, validate and apply a tool for the assessment of the MTF and NPS of dental CBCT scanners using up-to-date measurement methods. Methods: The MTF was calculated using the circular edge method, and the NPS as the 2D Fourier transform of homogeneous background ROIs. The validation framework has been set-up as follows: images with known MTF/NPS are simulated, and from these images the MTF/NPS was calculated and the results compared. The influence of the phantom dimensions and the CNR on the MTF/NPS accuracy has been studied for a 10x10 cm2 system FOV and corresponding voxel size of 0.25 mm3. For the practical measurements, two specific phantoms have been designed, based on the simulated results. Results: For the MTF the minimum number of slices needed to achieve an error of at most 5 % has been studied as a function of the CNR of the phantom rod insert (26 mm diameter). For the NPS, the number of 128x128 ROIs needed to achieve an error of at most 5 % have been determined. Measurement results on two different dental CBCT scanners for a selection of imaging conditions are presented. Conclusion: The simulation results provide guidelines for proper use of the developed tool to obtain accurate MTF and NPS measurements in practice. From the actual measurements it can be concluded that sometimes more information about system design parameters from the manufacturer is needed in order to explain the results with absolute certainty.
KEYWORDS: Digital breast tomosynthesis, Molybdenum, Particles, 3D modeling, Visualization, Breast, 3D image processing, Target detection, Reconstruction algorithms, Mammography
We compare the reproducibility of the human observers and a channelized Hotelling observer (CHO), when reading digital breast tomosynthesis (DBT) images of a physical phantom containing a breast simulating structured background and calcification clusters at three dose levels. The phantom is scanned 217 times on a Siemens Inspiration DBT system. Volumes of interest, with and without the calcification targets, are extracted and the human observers’ percentage of correct (PC) scores is evaluated using a four-alternative forced choice method. A two-layer CHO is developed using the human observer results. The first layer consists of a localizing CHO that identifies the most conspicuous calcifications using two Laguerre–Gauss channels. Then a CHO with eight Gabor channels estimates the PC score for the calcification cluster. Observer reproducibility is estimated by bootstrapping, and the standard deviation (SD) is used as a figure of merit. The CHO closely approximated the human observer results for all the three dose levels with a correlation of >0.97. For the larger calcification cluster sizes, both observers have similar reproducibility, whereas the CHO is more reproducible for the smaller calcifications, with a maximum of 5.5 SD against 13.1 SD for the human observers. The developed CHO is a good candidate for automated reading of the calcification clusters of the structured phantom, with better reproducibility than the human readers for small calcifications.
This work examined the impact of the presampling Modulation Transfer Function (MTF) on detectability of lesion-like targets in digital mammography. Two needle CR plates (CR1 and CR2) with different MTF curves but identical detector response (sensitivity) were selected. The plates were characterized by MTF, normalized noise power spectrum (NNPS) and detective quantum efficiency (DQE). Three image quality phantoms were applied to study the impact of the difference in MTF: first, the CDMAM contrast-detail phantom to give gold thickness threshold (T); second, a 3D structured phantom with lesion models (calcifications and masses), evaluated via a 4-alternative forced-choice study to give threshold diameter (dtr) and third, a detectability index (d') from a 50 mm PMMA flat field image and an 0.2 mm Al contrast square. MTF coefficient of variation was ~1%, averaged up to 5 mm-1. At 5 mm-1, a significant 24% reduction in MTF was observed. The lower MTF caused a 12% reduction in NNPS for CR2 compared to CR1 (at detector air kerma 117 μGy). At 5 mm-1, there was a drop in DQE of 34% for CR2 compared to CR1. For the test objects, there was a trend to lower detectability for CR2 (lower MTF) for all but one parameter, however none of the changes were significant. The MTF is a sensitive and easily applied means of tracking changes in sharpness before these changes are uncovered using lesion simulating objects in test objects.
KEYWORDS: Digital breast tomosynthesis, 3D modeling, Target detection, 3D image processing, Imaging systems, Polymethylmethacrylate, Breast, Systems modeling, Breast imaging, Digital mammography
The purpose of this study is comparing the detection performance in 2D full field digital mammography (FFDM) and digital breast tomosynthesis (DBT) using a structured phantom with inserted target objects. The phantom consists of a semi-cylindrical PMMA container, filled with water and PMMA spheres of different diameters. Microcalcifications and 3D printed masses (spiculated and non-spiculated) were inserted. The phantom was imaged ten times in both modes of five systems, using automatic exposure control (AEC) and at half and double the AEC dose. Five readers evaluated target detectability in a four-alternative forced-choice study. The percentage of correct responses (PC) was assessed based on 10 trials of each reader for each object type, size, imaging modality and dose level. Additionally, detection threshold diameters at 62.5 PC were assessed via non-linear regression fitting of the psychometric curve. Evaluation of target detection in FFDM showed that spiculated masses were better detected compared to non-spiculated masses. In DBT, detection of both mass types increased significantly (p=0.0001) compared to FFDM. Microcalcification detection thresholds ranged between 110 and 118 μm and were similar for the five systems in FFDM while larger variations (106-158 μm) were found in DBT. Mass detection was independent of dose in FFDM while weak dependence was seen for DBT. Microcalcification detection increased with increasing dose for both modalities. The phantom was able to show detectability differences between FFDM and DBT mode for five commercial systems in line with the findings from clinical trials. We suggest to use the phantom for task-based assessment methods for acceptance and commissioning testing of DBT systems.
The in-plane modulation transfer function (MTF) for multi-slice computed tomography (CT) can be found by scanning a phantom with cylindrical contrast inserts and making use of the circular edges presented in reconstructed axial images. Pixel data across the edge are used to establish an edge spread function, which is then used to obtain the line spread function and finally the MTF. A crucial step in this approach is to accurately locate the centroid of the circular region. Since the ESF is usually established in subpixel scale, slight deviation of the centroid may result in large errors. It has been a common practice to apply a preset threshold and calculate the center of mass in the binary output on each individual slice. It has also been suggested to locate the centroid on each slice by maximizing the sum of pixel values lying under a predefined template. In this paper, we propose a new algorithm based on registering the entire cylindrical object in 3D space. In a test on a high-noise low-contrast edge, both the threshold and the maximization algorithm showed scattered distribution of centroids across consecutive slices, resulting in underestimation of the MTF up to 10% at intermediate frequencies. In comparison, the method based on 3D registration has been found more robust to noise and the centroid locations are more consistent in the longitudinal direction. It is therefore recommended to use the proposed algorithm for centroid determination in evaluating the MTF with a circular edge in CT images.
Aim: Since dose reduction techniques such as tube current modulation may impact noise and consequently the performance that can be achieved with CT images, it is important to establish quality monitoring. We have studied whether it would be possible and relevant to implement an (automatical) procedure to retrieve and possibly alert for patients with relatively high noise levels in CT in comparison to similar cases. Proper alerting would make clinical quality supervision more efficient. Material and methods: Two homogeneous phantoms consisting of different diameters were scanned following a routine CT thorax protocol on a Siemens SOMATOM Force scanner and noise power spectra were calculated for the different phantom sizes. Next, forty-four patients, scanned with the same CT thorax protocol and reconstructed with a hard kernel (lung) and soft kernel (liver), were retrieved from PACS. Noise power spectra (NPS) were calculated for regions in the lung and liver, and evaluated over different frequency ranges. We hypothesized that the high frequency part correlates better with dose than the low frequency part that is determined by anatomical noise. Therefore we focused on the correlation of high frequency noise and dose versus patient size. Water equivalent diameters (WED) were calculated as a metric of patient size. Additionally, all patients were rated subjectively by an experienced thorax radiologist for their overall image quality and presence of diagnostically acceptable noise. Statistical correlations and outliers were investigated. Results: While the correlations between NPS and dose and patient size were not significant for the lung, a positive correlation of NPS measured in the liver with CTDIvol and WED was found (e.g. R2 = 0.31 for NPS(high frequencies) versus WED). The combined visualization of NPS at high frequencies, WED and CTDIvol showed some interesting outliers, however they did not receive lower image quality ratings. Conclusions: This work described how the Siemens SOMATOM Force scanner balances patient size, dose and image noise for a routine CT thorax protocol. However, since the outliers in both dose and (high frequency) noise levels still result in adequate to very good image quality scores, it is suggested that (straightforward) dose outlier based alerting should be the first task in dose-quality surveys on the particular scanner.
KEYWORDS: Sensors, Signal to noise ratio, Imaging systems, Digital breast tomosynthesis, Image quality, Image processing, Modulation transfer functions, Breast
Digital breast tomosynthesis (DBT) is a relatively new diagnostic imaging modality for women. Currently, various models
of DBT systems are available on the market and the number of installations is rapidly increasing. EUREF, the European
Reference Organization for Quality Assured Breast Screening and Diagnostic Services, has proposed a preliminary
Guideline - protocol for the quality control of the physical and technical aspects of digital breast tomosynthesis systems,
with an ultimate aim of providing limiting values guaranteeing proper performance for different applications of DBT. In
this work, we introduce an adaptive toolkit developed in accordance with this guideline to facilitate the process of image
quality evaluation in DBT performance test. This toolkit implements robust algorithms to quantify various technical
parameters of DBT images and provides a convenient user interface in practice. Each test is built into a separate module
with configurations set corresponding to the European guideline, which can be easily adapted to different settings and
extended with additional tests. This toolkit largely improves the efficiency for image quality evaluation of DBT. It is also
going to evolve with the development of protocols in quality control of DBT systems.
Digital breast tomosynthesis (DBT) is a 3D mammography technique that promises better visualization of low contrast lesions than conventional 2D mammography. A wide range of parameters influence the diagnostic information in DBT images and a systematic means of DBT system optimization is needed. The gold standard for image quality assessment is to perform a human observer experiment with experienced readers. Using human observers for optimization is time consuming and not feasible for the large parameter space of DBT. Our goal was to develop a model observer (MO) that can predict human reading performance for standard detection tasks of target objects within a structured phantom and subsequently apply it in a first comparative study. The phantom consists of an acrylic semi-cylindrical container with acrylic spheres of different sizes and the remaining space filled with water. Three types of lesions were included: 3D printed spiculated and non-spiculated mass lesions along with calcification groups. The images of the two mass lesion types were reconstructed with 3 different reconstruction methods (FBP, FBP with SRSAR, MLTRpr) and read by human readers. A Channelized Hotelling model observer was created for the non-spiculated lesion detection task using five Laguerre-Gauss channels, tuned for better performance. For the non-spiculated mass lesions a linear relation between the MO and human observer results was found, with correlation coefficients of 0.956 for standard FBP, 0.998 for FBP with SRSAR and 0.940 for MLTRpr. Both the MO and human observer percentage correct results for the spiculated masses were close to 100%, and showed no difference from each other for every reconstruction algorithm.
KEYWORDS: Radiology, Image analysis, Digital imaging, Surgery, Digital breast tomosynthesis, Medical imaging, Breast, Analytical research, Image quality, Computed tomography, Magnetic resonance imaging
Four-alternative forced choice (4AFC) test is a psychophysical method that can be adopted for observer performance evaluation in radiological studies. While the concept of this method is well established, difficulties to handle large image data, perform unbiased sampling, and keep track of the choice made by the observer have restricted its application in practice. In this work, we propose an easy-to-use software that can help perform 4AFC tests with DICOM images. The software suits for any experimental design that follows the 4AFC approach. It has a powerful image viewing system that favorably simulates the clinical reading environment. The graphical interface allows the observer to adjust various viewing parameters and perform the selection with very simple operations. The sampling process involved in 4AFC as well as the speed and accuracy of the choice made by the observer is precisely monitored in the background and can be easily exported for test analysis. The software has also a defensive mechanism for data management and operation control that minimizes the possibility of mistakes from user during the test. This software can largely facilitate the use of 4AFC approach in radiological observer studies and is expected to have widespread applicability.
The aim of this work was to investigate the influence of backscatter radiation from the orbital bone and the intraorbital fat on the eye lens dose in the dental CBCT energy range. To this end we conducted three different yet interrelated studies; A preliminary simulation study was conducted to examine the impact of a bony layer situated underneath a soft tissue layer on the amount of backscatter radiation. We compared the Percentage Depth Dose (PDD) curves in soft tissue with and without the bone layer and we estimated the depth in tissue where the decrease in backscatter caused by the presence of the bone is noticeable. In a supplementary study, an eye voxel phantom was designed with the DOSxyznrc code. Simulations were performed exposing the phantom at different x-ray energies sequentially in air, in fat tissue and in realistic anatomy with the incident beam perpendicular to the phantom. Finally, a virtual head phantom was implemented into a validated hybrid Monte Carlo (MC) framework to simulate a large Field of View protocol of a real CBCT scanner and examine the influence of scattered dose to the eye lens during the whole rotation of the paired tube-detector system. The results indicated an increase in the dose to the lens due to the fatty tissue in the surrounding anatomy. There is a noticeable dose reduction close to the bone-tissue interface which weakens with increasing distance from the interface, such that the impact of the orbital bone in the eye lens dose becomes small.
KEYWORDS: Monte Carlo methods, Fluctuations and noise, Computed tomography, Photons, Gold, Aluminum, Image filtering, Optical filters, X-rays, Signal attenuation
The bowtie filter is an essential element of computed tomography scanners. Implementation of this filter in a Monte Carlo dosimetry platform can be based on Turner’s method, which describes how to measure the filter thickness and relate the x-ray beam as a function of bowtie angle to the central beam. In that application, the beam hardening is accounted for by means of weighting factors that are associated to the photons according to their position (fan angle) and energy. We assessed an alternative approximation in which the photon spectrum is given a fan angle-dependent scaling factor. The aim of our investigation was to evaluate the effects on dose accuracy estimation when using the gold standard bowtie filter method versus a beam scaling approximation method. In particular, we wanted to assess the percentage dose differences between the two methods for several water thicknesses representative for different patients of different body mass index. The largest percentage differences were found for the thickest part of the bowtie filter and increased with patient size.
KEYWORDS: Monte Carlo methods, Fluctuations and noise, Aluminum, Signal attenuation, Gold, X-rays, Optical filters, Optical simulations, X-ray computed tomography, Scanners
Purpose: To estimate the consequences on dosimetric applications when a CT bowtie filter is modeled by means of
full beam hardening versus partial beam hardening.
Method: A model of source and filtration for a CT scanner as developed by Turner et. al. [1] was implemented.
Specific exposures were measured with the stationary CT X-ray tube in order to assess the equivalent thickness of Al
of the bowtie filter as a function of the fan angle. Using these thicknesses, the primary beam attenuation factors were
calculated from the energy dependent photon mass attenuation coefficients and used to include beam hardening in
the spectrum. This was compared to a potentially less computationally intensive approach, which accounts only
partially for beam hardening, by giving the photon spectrum a global (energy independent) fan angle specific
weighting factor.
Percentage differences between the two methods were quantified by calculating the dose in air after passing several
water equivalent thicknesses representative for patients having different BMI. Specifically, the maximum water
equivalent thickness of the lateral and anterior-posterior dimension and of the corresponding (half) effective diameter
were assessed.
Results: The largest percentage differences were found for the thickest part of the bowtie filter and they increased
with patient size. For a normal size patient they ranged from 5.5% at half effective diameter to 16.1% for the lateral
dimension; for the most obese patient they ranged from 7.7% to 19.3%, respectively. For a complete simulation of
one rotation of the x-ray tube, the proposed method was 12% faster than the complete simulation of the bowtie filter.
Conclusion: The need for simulating the beam hardening of the bow tie filter in Monte Carlo platforms for CT
dosimetry will depend on the required accuracy.
KEYWORDS: Monte Carlo methods, 3D image reconstruction, 3D image processing, Image registration, 3D modeling, Reconstruction algorithms, Image segmentation, Image quality, Image restoration, Tissues
Scatter remains a major cause of image artifacts in cone beam CT (CBCT). To correct the scatter for improved image reconstruction, the Monte Carlo simulation technique has been useful in estimating the scatter distribution. This technique, however, requires a 3D computational phantom of the patient, which is typically obtained from the reconstructed 3D image and is not fully available for CBCT scans with limited field of view. This study proposes a novel approach to restore the volume of the patient in such cases by use of a standard patient model and image registration techniques. As demonstrated for the 6 x 6 em oral CBCT scan, a full-field image of the model could be registered to the truncated patient image and was then successfully imported to Monte Carlo simulation for scatter estimation. Scatter correction was achieved by subtracting the Monte Carlo scatter data from the raw data on a projection-by-projection basis. Compared to the original data, the reconstructed image with scatter correction showed reduced streak artifacts and an improved contrast resolution of up to 15% between the soft and bony tissue. This approach exploits the low-frequency characteristic of the scatter distribution. The procedure could use more suitable models, and it could in a next step be further automated. It would then be an interesting candidate to improve image quality in practice.
KEYWORDS: 3D scanning, Computer simulations, Monte Carlo methods, Imaging systems, Image restoration, Reconstruction algorithms, Head, Polymethylmethacrylate, 3D modeling, Modulation transfer functions
The 'central artefact' is commonly seen in cone beam computed tomography (CBCT) images in case of an offset
scanning geometry. This study evaluates the hypothesis that such artefact is caused by the rotationally asymmetric
distribution of scatter. Predictions were examined by use of a hybrid simulation model in conjunction with a simple
experimental design. The model accounted for the entire imaging chain of CBCT and was parameterized according to
the Scanora 3D CBCT system (Soredex-PaloDEx, Finland). Computational cylinder phantoms of different cross-sections
and internal structures were simulated under various symmetric and asymmetric settings. The integrated commercial
software tool was employed for image reconstruction. Results confirmed that the scatter was the sole source for the
central artefact. It was also found that the artefact was particularly apparent with the algebraic iterative reconstruction.
The degree of asymmetry, by either the object's structure or eccentric placement, was much more influential than the
effect of the truncated imaging field of view. The findings have also been further proved with a computational
anatomical phantom of an adult human head. The computer simulation approach, as adopted in this study, is efficient
and has broad applications to CBCT.
A new set of conversion coefficients from kerma free-in-air to absorbed dose and to effective dose for external photon exposure with incident energies between 15 keV and 10 MeV under six standard irradiation geometries have been calculated using the Visible Chinese Human (VCH) computational model, which was developed on purpose of radiation dosimetry and protection. The whole-body voxelized geometry of VCH was mirrored from the high quality cryosectional photographic color images and was representative for the average physical characteristics of Chinese population. Dose discrepancies in comparison with other datasets are mainly due to anatomical differences. Detailed results from the VCH model are able to complement current dosimetric data in the realm of Radiology. The investigation on simulative particle transport and dosimetry calculation provides quantitative references for the study of anthropomorphic models.
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