The use of dynamic phantoms in interventional radiology

An investigation of flat panel equipment variables on image quality with a dedicated cardiac phantom

Image quality (IQ) evaluation plays a key role in the process of optimization of new x-ray systems. Ideally, this process should be supported by real clinical images, but ethical issues and differences in anatomy and pathology of patients make it impossible. Phantom studies might overcome these issues. This paper presents the IQ evaluation of 30 cineangiographic films acquired with a cardiac flat panel system. The phantom used simulates the anatomy of the heart and allows the circulation of contrast agent boluses through coronary arteries. Variables investigated with influence on IQ and radiation dose are: tube potential, detector dose, added Copper filters, dynamic density optimization (DDO) and viewing angle. The IQ evaluation consisted of scoring 4 simulated calcified lesions located on different coronary artery segments in terms of degree of visualization. Eight cardiologists rated the lesions using a five-point scale ((1) lesion not visible to (5) very good visibility). Radiation doses associated to the angiograms are expressed in terms of incident air kerma (IAK) and effective dose that has been calculated with PCXMX software (STUK, Finland) from the exposure settings assuming a standard sized patient of 70 Kg. Mean IQ scores ranged from 1.68 to 4.88. The highest IQ scores were obtained for the angiograms acquired with tube potential 80 kVp, no added Cu filters, DDO 60%, RAO and LAO views and the highest entrance detector dose that has been used in the present study, namely 0.17 microGy/im. Radiation doses (IAK approximately 40 mGy and effective dose of 1 mSv) were estimated for angiograms acquired at 15 frames s(-1), detector field-of-view 20 cm, and a length of 5 s. The following parameters improved the IQ factor significantly: a change in tube potential from 96 to 80 kVp, detector dose from 0.10 microGy/im to 0.17 microGy/im, the absence of Copper filtration. DDO variable which is a post-processing parameter should be carefully evaluated because it alters the quality of the images independently of radiation exposure settings. The SAM anthropomorphic phantom has the advantage of visualization of stenotic lesions during the injection of a contrast agent and using an anatomical background. In the future, this phantom could potentially bridge the gap between physics tests and the clinical reality in the catheterization laboratory.

A virtual reality simulator for remote interventional radiology: concept and prototype design

We present a virtual reality simulator to realize interventional radiology (IR) procedures remotely. The simulator contains two subsystems: one at the local site and the other at the remote site. At the local site, the interventional radiologist interacts with a three-dimensional (3-D) vascular model extracted from the patient's data and inserts IR devices through the Motion Tracking Box (MTB), which converts physical motion (translation and rotation) of IR devices into digital signal. This signal is transferred to the Actuator Box (AB) at the remote site that drives the IR devices in the patient. The status of the IR devices is subsequently fed back to the local site and displayed on the vascular model. To prove the concept, the prototype developed employs a physical angiography phantom (mimicking the patient) and its corresponding 3-D digital model. A magnetic tracking system provides information about positioning of the IR devices in the phantom. The initial results are encouraging. The AB controlled remotely drives IR devices with resolution of 0.00288 mm/step in translation and 0.079 deg/step in rotation.

Anatomy changes in radiotherapy detected using portal imaging

BACKGROUND AND PURPOSE

Localisation images normally acquired to verify patient positioning also contain information about the patient's internal anatomy. The aim of this study was to investigate the anatomical changes observed in localisation images and examples of dosimetric consequences.

PATIENTS AND METHODS

Localisation images were obtained weekly prior to radiotherapy with an electronic portal imaging device (EPID). A series of 'difference images' was created by subtracting the first localisation image from that of subsequent fractions. Images from 81 lung, 40 head and neck and 34 prostate cancer patients were classified according to the changes observed. Changes were considered relevant if the average pixel value over an area of at least 1cm(2) differed by more than 5%, to allow for variations in linac output and EPID signal. Two patients were selected to illustrate the dosimetric effects of relevant changes. Their plans were re-calculated with repeat CT scans acquired after 4 weeks of treatment and compared with the difference images of the corresponding days.

RESULTS

Progressive changes were detected for 57% of lung and 37% of head and neck cancer patients studied. Random changes were observed in 37% of lung, 28% of head and neck and 82% of prostate cancer patients. For a lung case, an increase of 10.0% in EPID dose due to tumour shrinkage corresponded to an increase of 9.8% in mean lung dose. Gas pockets in the rectum region of the prostate case increased the EPID dose by 6.3%, and resulted in a decrease of the minimum dose to the planning target volume of 26.4%.

CONCLUSIONS

Difference images are an efficient means of qualitatively detecting anatomical changes for various treatment sites in clinical practice. They can be used to identify changes for a particular patient, to indicate if the dose delivered to the patient would differ from planning and to detect if there is a need for re-planning.

Quantification of motion unsharpness in digital fluoroscopy

The objectives of this work were first to develop a convenient method to quantify persistence in digital fluoroscopy systems, then to quantify the effect of variable temporal averaging on the detection of moving low-contrast test details within digital fluoroscopic and pulsed fluoroscopic images. The results were analysed to clarify the relationship between the optimum persistence required to see the lowest contrast for circular test details for a range of diameters and their speed of movement. The optimum persistence values obtained are compared with the limited data available on speeds of movement of patient organs during fluoroscopy. It is tentatively concluded that for imaging the abdomen, the optimum imaging system persistence time constant is approximately 0.15 s. For the much greater speeds associated with cardiac motion, no additional frame averaging is necessary, i.e. just the persistence provided by the observer's visual system appears to be optimal for small objects.

Optimization of variable temporal averaging in digital fluoroscopy

In modern X-ray fluoroscopy systems, the amount of temporal averaging (i.e. persistence) applied to the image is often user selectable. The objective of this work is to quantify the effect of variable temporal averaging on the detection of low contrast test objects moving at a range of known speeds within the digital fluoroscopic image. An image intensifier system with a short-persistence television camera was used to record image sequences of a moving threshold contrast-detail diameter test object onto broadcast-standard U-matic videotape. The image sequences were replayed through an image processing system allowing different amounts of temporal averaging to be applied. The test images were scored by an experienced observer. The temporal averaging time constants produced by the added image processing were measured using a method based on noise correlation. Results are presented showing the trends of threshold contrast with test detail diameter and movement speed. The optimum value of temporal averaging time constant is presented as a function of detail diameter for a range of speeds. By comparison with the limited information available in the literature on organ movement, it is tentatively concluded that for the organ movement speeds expected in the abdomen, the optimum imaging system persistence time constant should be approximately 0.15 s. For the much greater speeds associated with cardiac motion no additional frame averaging, i.e. just the persistence provided by the observer's visual system, appears to be optimal.