X-ray fluoroscopy spatio-temporal filtering with object detection

Robust learning-based X-ray image denoising - potential pitfalls, their analysis and solutions

PURPOSE

Since guidance based on X-ray imaging is an integral part of interventional procedures, continuous efforts are taken towards reducing the exposure of patients and clinical staff to ionizing radiation. Even though a reduction in the X-ray dose may lower associated radiation risks, it is likely to impair the quality of the acquired images, potentially making it more difficult for physicians to carry out their procedures.

METHOD

We present a robust learning-based denoising strategy involving model- based simulations of low-dose X-ray images during the training phase. The method also utilizes a data-driven normalization step - based on an X-ray imaging model - to stabilize the mixed signal-dependent noise associated with X-ray images. We thoroughly analyze the method's sensitivity to a mismatch in dose levels used for training and application. We also study the impact of differing noise models used when training for low and very low-dose X-ray images on the denoising results.

RESULTS

A quantitative and qualitative analysis based on acquired phantom and clinical data has shown that the proposed learning-based strategy is stable across different dose levels and yields excellent denoising results, if an accurate noise model is applied. We also found that there can be severe artifacts when the noise characteristics of the training images are significantly different from those in the actual images to be processed. This problem can be especially acute at very low dose levels. During a thorough analysis of our experimental results, we further discovered that viewing the results from the perspective of denoising via thresholding of sub-band co efficients can be very beneficial to get a better understanding of the proposed learning-based denoising strategy.

CONCLUSION

The proposed learning-based denoising strategy provides scope for significant X-ray dose reduction without the loss of important image information if the characteristics of noise is accurately accounted for during the training ph.

Toward a priori noise characterization for real-time edge-aware denoising in fluoroscopic devices

BACKGROUND

Low-dose X-ray images have become increasingly popular in the last decades, due to the need to guarantee the lowest reasonable patient's exposure. Dose reduction causes a substantial increase of quantum noise, which needs to be suitably suppressed. In particular, real-time denoising is required to support common interventional fluoroscopy procedures. The knowledge of noise statistics provides precious information that helps to improve denoising performances, thus making noise estimation a crucial task for effective denoising strategies. Noise statistics depend on different factors, but are mainly influenced by the X-ray tube settings, which may vary even within the same procedure. This complicates real-time denoising, because noise estimation should be repeated after any changes in tube settings, which would be hardly feasible in practice. This work investigates the feasibility of an a priori characterization of noise for a single fluoroscopic device, which would obviate the need for inferring noise statics prior to each new images acquisition. The noise estimation algorithm used in this study was tested in silico to assess its accuracy and reliability. Then, real sequences were acquired by imaging two different X-ray phantoms via a commercial fluoroscopic device at various X-ray tube settings. Finally, noise estimation was performed to assess the matching of noise statistics inferred from two different sequences, acquired independently in the same operating conditions.

RESULTS

The noise estimation algorithm proved capable of retrieving noise statistics, regardless of the particular imaged scene, also achieving good results even by using only 10 frames (mean percentage error lower than 2%). The tests performed on the real fluoroscopic sequences confirmed that the estimated noise statistics are independent of the particular informational content of the scene from which they have been inferred, as they turned out to be consistent in sequences of the two different phantoms acquired independently with the same X-ray tube settings.

CONCLUSIONS

The encouraging results suggest that an a priori characterization of noise for a single fluoroscopic device is feasible and could improve the actual implementation of real-time denoising strategies that take advantage of noise statistics to improve the trade-off between noise reduction and details preservation.

Real-time algorithm for Poissonian noise reduction in low-dose fluoroscopy: performance evaluation

BACKGROUND

Quantum noise intrinsically limits the quality of fluoroscopic images. The lower is the X-ray dose the higher is the noise. Fluoroscopy video processing can enhance image quality and allows further patient's dose lowering. This study aims to assess the performances achieved by a Noise Variance Conditioned Average (NVCA) spatio-temporal filter for real-time denoising of fluoroscopic sequences. The filter is specifically designed for quantum noise suppression and edge preservation. It is an average filter that excludes neighborhood pixel values exceeding noise statistic limits, by means of a threshold which depends on the local noise standard deviation, to preserve the image spatial resolution. The performances were evaluated in terms of contrast-to-noise-ratio (CNR) increment, image blurring (full width of the half maximum of the line spread function) and computational time. The NVCA filter performances were compared to those achieved by simple moving average filters and the state-of-the-art video denoising block matching-4D (VBM4D) algorithm. The influence of the NVCA filter size and threshold on the final image quality was evaluated too.

RESULTS

For NVCA filter mask size of 5 × 5 × 5 pixels (the third dimension represents the temporal extent of the filter) and a threshold level equal to 2 times the local noise standard deviation, the NVCA filter achieved a 10% increase of the CNR with respect to the unfiltered sequence, while the VBM4D achieved a 14% increase. In the case of NVCA, the edge blurring did not depend on the speed of the moving objects; on the other hand, the spatial resolution worsened of about 2.2 times by doubling the objects speed with VBM4D. The NVCA mask size and the local noise-threshold level are critical for final image quality. The computational time of the NVCA filter was found to be just few percentages of that required for the VBM4D filter.

CONCLUSIONS

The NVCA filter obtained a better image quality compared to simple moving average filters, and a lower but comparable quality when compared with the VBM4D filter. The NVCA filter showed to preserve edge sharpness, in particular in the case of moving objects (performing even better than VBM4D). The simplicity of the NVCA filter and its low computational burden make this filter suitable for real-time video processing and its hardware implementation is ready to be included in future fluoroscopy devices, offering further lowering of patient's X-ray dose.

A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study

BACKGROUND AND PURPOSE

The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system.

MATERIALS AND METHODS

Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber.

RESULTS

A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; P < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060-0.3571).

CONCLUSIONS

Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.

Quantitative image quality analysis of a nonlinear spatio-temporal filter

Digital temporal and spatial filtering of fluoroscopic image sequences can be used to improve the quality of images acquired at low X-ray exposure. In this study, we characterized a nonlinear edge preserving, spatio-temporal noise reduction filter, the bidirectional multistage (BMS) median filter of Arce (1991). To assess image quality, signal detection and discrimination experiments were performed on stationary targets using a four-alternative forced-choice paradigm. A measure of detectability, d', was obtained for filtered and unfiltered noisy image sequences at different signal amplitudes. Filtering gave statistically significant, average d' improvements of 20% (detection) and 31% (discrimination). A nonprewhitening detection model modified to include the human spatio-temporal visual system contrast-sensitivity underestimated enhancement, predicting an improvement of 6%. Pixel noise standard deviation, a commonly applied image quality measure, greatly overestimated effectiveness giving 67% improvement in d'. We conclude that human testing is required to evaluate the filter effectiveness and that human perception models must be improved to account for the spatio-temporal filtering of image sequences.

Detection improvement in spatially filtered x-ray fluoroscopy image sequences

The effect of spatial noise-reduction filtering on human observer detection of stationary cylinders mimicking arteries, catheters, and guide wires in x-ray fluoroscopy was investigated in both single image frames and image sequences. Ideal edge-preserving spatial filtering was simulated by filtering of the noise before addition of the target cylinder. This allowed us to separate the effect of edge blurring from those of noise reduction and spatial noise correlation. We used three different center-weighted averagers that reduced pixel noise variance by factors of 0.75, 0.50, and 0.25. As compared with no filtering, the effect of filtering on detection in single images was statistically insignificant. This indicated an adverse effect of spatial noise correlation on detection that countered the effect of noise reduction. By comparison, spatial filtering significantly improved detection in image sequences and yielded potential x-ray dose savings of 26-34%. Comparison of results with two observer models suggested that human observers have an improved detection efficiency in spatially filtered image sequences as compared with white-noise sequences. Pixel noise reduction, a measure commonly used to assess filter performance, overestimated the effect of filtering on detection and was not a good indicator of image quality. We conclude that edge-preserving spatial filtering is more effective in sequences than in single images and that such filtering can be used to improve image quality in noisy image sequences such as x-ray fluoroscopy.

Perception of temporally filtered X-ray fluoroscopy images

For noisy X-ray fluoroscopy image sequences we quantitatively evaluated image quality after digital temporal filtering to reduce noise. Using an experimental paradigm called a reference/test adaptive forced-choice method we compared detectability of stationary low-contrast disks in filtered and unfiltered, computer-generated image sequences. In the first experiment, a low-pass first-order recursive filter used in X-ray fluoroscopy was found to be much less effective at enhancing detectability than predicted from the reduction of display noise variance, a common measurement of filter effectiveness. Detectability was reasonably predicted by a nonprewhitening human-observer model (NPW-HVS) that included an independently determined human temporal-contrast-sensitivity function. In another experiment, designed to test models over a range of temporal frequencies, we used paired high-pass and low-pass temporal filters that both reduced noise variance by 25%. The high-pass filter was artificially applied to the noise only and greatly improved detectability, while the low-pass filter had little effect. The human-observer model quantitatively described the measurements, but classical prewhitening and nonprewhitening signal detectors did not. As compared to the nonprewhitening, spatio-temporal matched filter, human-observer efficiency was low and variable at 2.1%, 2.9%, and 0.06% for 60 frames of unfiltered low-pass and high-pass noise, respectively. As compared to this detector, humans were not very effective at combining information across frames. On the other hand, signal to noise ratios (SNR's) from the human-observer model were comparable to human performance, and efficiencies were reasonably constant at 40%, 52%, and 32%, respectively. We conclude that it is imperative to include human-observer models and experiments in the analysis of noise-reduction filtering of noisy image sequences, such as X-ray fluoroscopy.

Detection of moving objects in pulsed-x-ray fluoroscopy

We investigated the detectability of moving, low-contrast objects in white-noise image sequences. The computer-generated, cylindrical phantoms mimicked arteries, catheters, and guide wires in medical, x-ray fluoroscopy image sequences at 16 acquisitions/s (pulsed-16) or 32 acquisitions/s (pulsed-32). We measured detectability by using a reference-test, adaptive forced-choice method whereby reference and test presentations were alternated during an experimental session to minimize effects of subject attention and accuracy criteria. In the case of the largest cylinder (diameter 0.48 deg), the highest speed (5.86 deg/s) increased absolute detectability by approximately 42% compared with that in the stationary case. With the smallest cylinder (diameter 0.023 deg), this motion decreased detectability by approximately 51%. The dose savings of pulsed-16 was approximately 18% of that for pulsed-32, with relatively little effect of velocity or object size. In general, subjects took slightly longer to respond in the case of low-acquisition fluoroscopy. Detectability data were modeled with a nonprewhitening matched filter that included a physiological, spatiotemporal contrast sensitivity function and a suboptimal, spatiotemporal signal template with time-limited memory.