Comparison of an amorphous silicon/cesium iodide flat-panel digital chest radiography system with screen/film and computed radiography systems--a contrast-detail phantom study

Computed chest radiography for total body irradiation: image quality and clinical feasibility

Objective.In myeloablative total body irradiation (TBI), lung shielding blocks are used to reduce the dose to the lungs and hence decrease the risk of radiation pneumonitis. Some centers are still using mega-Volt (MV) imaging with dedicated silver halide-based films during simulation and treatment for lung delineation and position verification. However, the availability of these films has recently become an issue. This study examines the clinical performance of a computed radiography (CR) solution in comparison to radiographic films and potential improvement of image quality by filtering and post-processing.Approach.We compared BaFBrI-based CR plates to radiographic films. First, images of an aluminum block were analyzed to assess filter impact on scatter reduction. Secondly, a dedicated image quality phantom was used to assess signal linearity, signal-to-noise ratio (SNR), contrast and spatial resolution. Ultimately, a clinical performance study involving two impartial observers was conducted on an anthropomorphic chest phantom, employing visual grading analysis (VGA). Various filter materials and positions as well as post-processing were examined, and the workflow between CR and film was compared.Main results.CR images exhibited high SNR and linearity but demonstrated lower spatial and contrast resolution when compared to film. However, filtering improved contrast resolution and SNR, while positioning filters inside the cassette additionally enhanced sharpness. Image processing improved VGA scores, while additional filtering also resulted in higher spine visibility scores. CR shortened TBI simulation by over 10 minutes for one patient, alongside a dose reduction by order of 0.1 Gy.Significance.This study highlights potential advantages of shifting from conventional radiographic film to CR for TBI. Overall, CR with the incorporation of processing and filtering proves to be suitable for TBI chest imaging. When compared to radiographic film, CR offers advantages such as reduced simulation time and dose delivery, re-usability of image plates and digital workflow integration.

Effect of beam quality and readout direction in the edge profile on the modulation transfer function of photostimulable phosphor systems via the edge method

Purpose: The objective of this study was to investigate the effects of (i) the difference in the beam qualities on the presampled modulation transfer function (MTF) using the edge method and (ii) the readout direction of the edge profile for the photostimulable phosphor (PSP) system. Approach: The International Electrotechnical Commission (IEC) defined a technique using the "radiation qualities based on a phantom made up of an aluminum added filter" (RQA). A general radiographic system with a tube voltage of 50 kV and 9.7 mm of additional aluminum filtration was used to conform the x-ray to the IEC-specified beam quality definition RQA3. Additionally, we employed two different beams with tube voltages of 60 and 70 kV using a dental x-ray unit. The MTF was measured in the readout direction from low-to-high exposure regions and vice versa with respect to the scanning and subscanning directions of the PSP system. Results: The difference in the 50%MTF value for all directions between 60 and 70 kV averaged less than 0.05 . The 50%MTF of RQA3 was on average 0.2 lower than the value for 60 kV for each direction. For all beam qualities, no difference was observed between the MTFs measured in the readout direction from the low-to-high exposure regions and vice versa. Conclusions: The MTFs, measured using the dental x-ray unit, were unaffected by the tube voltage, and they were slightly higher than those measured using the RQA3. Furthermore, the MTF was unaffected by the differences in the readout directions of the edge profile.

Evaluation of the image quality and dose reduction in digital radiography with an advanced spatial noise reduction algorithm in pediatric patients

OBJECTIVES

To evaluate whether the advanced spatial noise reduction (ASNR) algorithm installed in a digital radiography system generates acceptable images at a lower dose than a conventional denoising algorithm in pediatric patients.

METHODS

Nine sets of 30 images of pediatric patients, classified under three protocols and three age groups, were retrospectively selected. Different levels of low-dose image sets of these 270 images were generated by a noise simulation tool after validation testing using phantoms. Each image set was obtained with both the ASNR and conventional algorithm, and grouped randomly and blinded. Three experienced pediatric radiologists were asked to pick the "image with optimum dose" among images of different dose levels with an ALARA (as low as reasonably achievable) perspective. Dose reduction rates for each protocol and age group were calculated, and entrance skin exposure (ESE) was calculated using the values of kVp and mAs, assuming a standard body depth for each age group.

RESULTS

With the ASNR algorithm, estimated dose reduction rates were highest for abdominal radiographs (45.0%, 27.3%, and 24.3% in infants, children, and adolescents, respectively, p < 0.001). The mean dose reductions for all age groups in the abdominal, chest, and skull radiographs were 32.8%, 12.9%, and 23.2%, respectively (p < 0.001). Average of the calculated ESE was lower with the ASNR algorithm than with the conventional algorithm group (p < 0.001).

CONCLUSIONS

The ASNR algorithm facilitated optimization of image quality with a higher reduction in radiation dose than the conventional algorithm, making it more acceptable for use in pediatric patients.

KEY POINTS

•ASNR algorithm in DR system improves image quality via enhanced contrast and noise removal by estimating actual noise distribution based on a multi-scale noise covariance and frequency processing. •Noise simulation tool (NST) generating images of different dose levels can be used for evaluation of the optimum dose without unnecessary additional radiation exposure to pediatric patients. •Retrospective clinical study using NST showed that the ASNR algorithm enabled a higher reduction in radiation dose than the conventional algorithm in pediatric patients.

Introduction of a New Parameter for Evaluation of Digital Radiography System Performance

Background

The aim of this study was to compare the image quality and radiation doses in various digital radiography systems using contrast-detail radiography (CDRAD) phantom.

Methods

The image quality and radiation dose for seven different digital radiography systems were compared using the CDRAD phantom. Incident air kerma (IAK) values were measured for certain exposure settings in all digital radiography systems. The images from the CDRAD phantom were evaluated by three observers. The results were displayed in the form of a contrast-detail (CD) curve. In addition, the inverse image quality figure (IQFinv)-to-IAK ratios were used for quantitative comparison of different digital radiography system performance.

Results

Results of this study showed that the CD curves cannot be suitable criterion for determining the performance of digital radiography systems. For this reason, IQFinv-to-radiation dose (IAK) ratios in a fixed radiation condition were used. The highest performance in terms of producing high-quality images and low radiation dose was related to X-ray unit 1 and the lowest performance was for X-ray unit 5.

Conclusion

The ratio of IQFinv to IAK for performance evaluation of digital radiography systems is an innovation of this study. A digital radiography system with a higher IQFinv-to-IAK ratio is associated with lower patient dose and better image quality. Therefore, it is recommended to equip the new imaging centers with the systems that have higher IQFinv-to-IAK ratios.

A novel method for comparing radiation dose and image quality, between and within different x-ray units in a series of hospitals

OBJECTIVES

To develop a novel method for comparing radiation dose and image quality (IQ) to evaluate adult chest x-ray (CXR) imaging among several hospitals.

METHODS

CDRAD 2.0 phantom was used to acquire images in eight hospitals (17 digital x-ray units) using local adult CXR protocols. IQ was represented by image quality figure inverse (IQF_inv), measured using CDRAD analyser software. Signal to noise ratio, contrast to noise ratio and conspicuity index were calculated as additional measures of IQ. Incident air kerma (IAK) was measured using a solid-state dosimeter for each acquisition. Figure of merit (FOM) was calculated to provide a single estimation of IQ and radiation dose.

RESULTS

IQ, radiation dose and FOM varied considerably between hospitals and x-ray units. For IQF_inv, the mean (range) between and within the hospitals were 1.42 (0.83-2.18) and 1.87 (1.52-2.18), respectively. For IAK, the mean (range) between and within the hospitals were 93.56 (17.26-239.15) μGy and 180.85 (122.58-239.15) μGy, respectively. For FOM, the mean (range) between and within hospitals were 0.05 (0.01-0.14) and 0.03 (0.02-0.05), respectively.

CONCLUSIONS

The suggested method for comparing IQ and dose using FOM concept along with the new proposed FOM, is a valid, reliable and effective approach for monitoring and comparing IQ and dose between and within hospitals. It is also can be beneficial for the optimisation of x-ray units in clinical practice. Further optimisation for the hospitals/x-ray units with low FOM are required to minimise radiation dose without degrading IQ.

An investigation into the validity of utilising the CDRAD 2.0 phantom for optimisation studies in digital radiography

OBJECTIVES

To determine if a relationship exists between low contrast detail (LCD) detectability using the CDRAD 2.0 phantom, visual measures of image quality (IQ) and simulated lesion visibility (LV) when performing digital chest radiography (CXR).

METHODS

Using a range of acquisition parameters, a CDRAD 2.0 phantom was used to acquire a set of images with different levels of image quality. LCD detectability using the CDRAD 2.0 phantom, represented by an image quality figure inverse (IQF_inv) metric, was determined using the phantom analyser software. A Lungman chest phantom was loaded with two simulated lesions, of different sizes/placed in different locations, and was imaged using the same acquisition factors as the CDRAD 2.0 phantom. A relative visual grading analysis (VGA) was used by seven observers for IQ and LV evaluation of the Lungman images. Correlations between IQF_inv, IQ and LV were investigated.

RESULTS

Pearson's correlation demonstrated a strong positive correlation (r = 0.91; p < 0.001) between the IQ and the IQF_inv. Spearman's correlation showed a good positive correlation (r = 0.79; p < 0.001) and (r = 0.68; p < 0.001) between the IQF_inv and the LV for the first lesion (left upper lobe) and the second lesion (right middle lobe), respectively.

CONCLUSIONS

From results presented in this study, the automated evaluation of LCD detectability using CDRAD 2.0 phantom is likely to be a suitable option for IQ and LV evaluation in digital CXR optimisation studies. Advances in knowledge: This research establishes the potential of the CDRAD 2.0 phantom in digital CXR optimisation studies.

Morphologically controlled synthesis of ionic cesium iodide colloidal nanocrystals and electron beam-induced transformations

Colloidal nanocrystals (NCs) have become an important group of novel materials with applications in various fields such as lighting, medicine, and optoelectronic devices. Compared to common semiconductor NCs (e.g., CdSe, CdS, PbS) with covalent bonds and metal NCs (e.g., Au, Ag, Pt) with metallic bonds, the synthesis of colloidal NCs with ionic bonds has rarely been explored, possibly due to their high solubility in polar solvents. In this work, we demonstrate a wet chemical synthesis route to prepare ionic cesium iodide (CsI) colloidal NCs, and they can be controllably made into different morphologies with good uniformity, including nanospheres, hexagonal nanoplates and nanocubes. The degradation of CsI NCs during transmission electron microscopy (TEM) has been investigated, revealing their sensitivity to high energy electron beam irradiation. The as-prepared CsI NCs exhibit strong absorption bands peaking at 275–280 nm, which should be ascribed to the presence of F-centers inside the band gap of CsI NCs. This study provides an efficient way to achieve controllable synthesis of high-quality CsI NCs that may find promising applications as advanced nanoscintillators in medical imaging, particle physics, position emission tomography and other various fields.

Morphologically controlled synthesis of cesium iodide colloidal nanocrystals.

Dose and detectability improvements with high energy phase sensitive x-ray imaging in comparison to low energy conventional imaging

The objective of this study was to demonstrate the potential benefits of using high energy x-rays for phase sensitive breast imaging through a comparison with conventional mammography imaging. We compared images of a contrast-detail phantom acquired on a prototype phase sensitive x-ray imaging system with images acquired on a commercial flat panel digital mammography unit. The phase contrast images were acquired using a micro-focus x-ray source with a 50 µm focal spot at 120 kVp and 4.5 mAs, with a magnification factor of 2.46 and a 50 µm pixel pitch. A phase attenuation duality-based phase retrieval algorithm that requires only a single phase contrast image was applied. Conventional digital mammography images were acquired at 27 kVp, 131 mAs and 28 kVp, 54 mAs. For the same radiation dose, both the observer study and signal-to-noise ratio (SNR)/figure of merit comparisons indicated a large improvement by the phase retrieved image as compared to the clinical system for the larger disc sizes, but the improvement was not enough to detect the smallest discs. Compared to the double dose image acquired with the clinical system, the observer study also indicated that the phase retrieved image provided improved detection capabilities for all disc sizes except the smallest discs. Thus the SNR improvement provided by phase contrast imaging is not yet enough to offset the noise reduction provided by the clinical system at the doubled dose level. However, the potential demonstrated by this study for high energy phase sensitive x-ray imaging to improve lesion detection and reduce radiation dose in mammography warrants further investigation of this technique.

Reliability and validity of soft copy images based on flat-panel detector in pneumoconiosis classification: comparison with the analog radiographs

RATIONALE AND OBJECTIVES

The aim of this study was to evaluate the reliability and validity of soft copy images based on flat-panel detector of digital radiography (DR-FPD soft copy images) compared to analog radiographs (ARs) in pneumoconiosis classification and diagnosis.

MATERIALS AND METHODS

DR-FPD soft copy images and ARs from 349 subjects were independently read by four-experienced readers according to the International Labor Organization 2000 guidelines. DR-FPD soft copy images were used to obtain consensus reading (CR) by all readers as the gold standard. Reliability and validity were evaluated by a κ and receiver operating characteristic analysis, respectively.

RESULTS

In small opacity, overall interreader agreement of DR-FPD soft copy images was significantly higher than that of ARs, but it was not significantly different in large opacity and costophrenic angle obliteration. In small opacity, agreement of DR-FPD soft copy images with CR was significantly higher than that of ARs with CR. It was also higher than that of ARs with CR in pleural plaque and thickening. Receiver operating characteristic areas were not different significantly between DR-FPD soft copy images and ARs.

CONCLUSIONS

DR-FPD soft copy images showed accurate and reliable results in pneumoconiosis classification and diagnosis compared to ARs.

Optimizing imaging quality and radiation dose by the age-dependent setting of tube voltage in pediatric chest digital radiography

Objective

The quality and radiation dose of different tube voltage sets for chest digital radiography (DR) were compared in a series of pediatric age groups.

Materials and Methods

Forty-five hundred children aged 0-14 years (yr) were randomly divided into four groups according to the tube voltage protocols for chest DR: lower kilovoltage potential (kVp) (A), intermediate kVp (B), and higher kVp (C) groups, and the fixed high kVp group (controls). The results were analyzed among five different age groups (0-1 yr, 1-3 yr, 3-7 yr, 7-11 yr and 11-14 yr). The dose area product (DAP) and visual grading analysis score (VGAS) were determined and compared by using one-way analysis of variance.

Results

The mean DAP of protocol C was significantly lower as compared with protocols A, B and controls (p < 0.05). DAP was higher in protocol A than the controls (p <0.001), but it was not statistically significantly different between B and the controls (p = 0.976). Mean VGAS was lower in the controls than all three protocols (p < 0.001 for all). Mean VGAS did not differ between protocols A and B (p = 0.334), but was lower in protocol C than A (p = 0.008) and B (p = 0.049).

Conclusion

Protocol C (higher kVp) may help optimize the trade-off between radiation dose and image quality, and it may be acceptable for use in a pediatric age group from these results.

Optimisation of radiological protocols for chest imaging using computed radiography and flat-panel X-ray detectors

PURPOSE

Digital radiography technology has replaced conventional screen-film systems in many hospitals. Despite the different characteristics of new detector materials, frequently, the same radiological protocols previously optimised for screen film are still used with digital equipment without any critical review. This study addressed optimisation of exposure settings for chest examinations with digital systems, considering both image quality and patient dose.

MATERIALS AND METHODS

Images acquired with direct digital radiography equipment and a computed radiography system were analysed with specially developed commercial software with a four-alternative forced-choice method: the most promising protocols were then scored by two senior radiologists.

RESULTS

Digital technology offers a wide dynamic range and the ability to postprocess images, allowing use of lower tube potentials in chest examinations. The computed radiography system showed both better image quality and lower dose at lower energies (85 kVp and 95 kVp) than those currently used (125 kVp). Direct digital radiography equipment confirmed both its superior image quality and lower dose requirements compared with the storage phosphor plate system.

CONCLUSIONS

Generally, lowering tube potentials in chest examinations seems to allow better image quality/effective dose ratio when using digital equipment.

Utility of digital radiography for the screening of pneumoconiosis as compared to analog radiography: radiation dose, image quality, and pneumoconiosis classification

The purpose of this study was to compare digital radiography (DR) and analog radiography (AR) for the screening of pneumoconiosis with respect to radiation dose, image quality, and pneumoconiosis classification. DR was performed on 50 subjects who were enrolled for an examination of pneumoconiosis (Digital Diagnost™, Philips, Netherlands), and AR (MXO-15B, Toshiba, Japan) was performed the same day after the study was approved by the Institutional Review Board and written informed consent was obtained from all subjects. Entrance surface doses (ESDs) of DR and AR were measured using a glass dosimeter attached to a Rando human phantom (Alderson Co., U.S.) under exposure conditions commonly used in clinical practice in Korea. Visibilities on all images were evaluated using a 5-point scale by four chest radiologists using a modified form of the European Chest Guidelines (EUR 16260). All the images were classified using the ILO's guidelines by referencing standard analog radiographs. ESDs of DR were significantly lower than those of AR (0.15 mGy vs. 0.21 mGy, p < 0.05). All anatomic structures were significantly more visible by DR images (p < 0.0001), especially the left main bronchus, ribs, and thoracic spine. Body mass index did not correlate with anatomic structure visibility by DR (r = -0.029, p = 0.842) or AR images (r = -0.076, p = 0.602). Overall intra- and inter-reader agreements for DR images were significantly higher than for AR images. DR offers improved image quality with a significant reduction of up to 23.6% in radiation dose and more accurate pneumoconiosis classification than AR.

Correlation of contrast-detail analysis and clinical image quality assessment in chest radiography with a human cadaver study

PURPOSE

To determine the correlation between the clinical and physical image quality of chest images by using cadavers embalmed with the Thiel technique and a contrast-detail phantom.

MATERIALS AND METHODS

The use of human cadavers fulfilled the requirements of the institutional ethics committee. Clinical image quality was assessed by using three human cadavers embalmed with the Thiel technique, which results in excellent preservation of the flexibility and plasticity of organs and tissues. As a result, lungs can be inflated during image acquisition to simulate the pulmonary anatomy seen on a chest radiograph. Both contrast-detail phantom images and chest images of the Thiel-embalmed bodies were acquired with an amorphous silicon flat-panel detector. Tube voltage (70, 81, 90, 100, 113, 125 kVp), copper filtration (0.1, 0.2, 0.3 mm Cu), and exposure settings (200, 280, 400, 560, 800 speed class) were altered to simulate different quality levels. Four experienced radiologists assessed the image quality by using a visual grading analysis (VGA) technique based on European Quality Criteria for Chest Radiology. The phantom images were scored manually and automatically with use of dedicated software, both resulting in an inverse image quality figure (IQF). Spearman rank correlations between inverse IQFs and VGA scores were calculated.

RESULTS

A statistically significant correlation (r = 0.80, P < .01) was observed between the VGA scores and the manually obtained inverse IQFs. Comparison of the VGA scores and the automated evaluated phantom images showed an even better correlation (r = 0.92, P < .001).

CONCLUSION

The results support the value of contrast-detail phantom analysis for evaluating clinical image quality in chest radiography.

Development of standard digital images for pneumoconiosis

We developed the standard digital images (SDIs) to be used in the classification and recognition of pneumoconiosis. From July 3, 2006 through August 31, 2007, 531 retired male workers exposed to inorganic dust were examined by digital (DR) and analog radiography (AR) on the same day, after being approved by our institutional review board and obtaining informed consent from all participants. All images were twice classified according to the International Labour Office (ILO) 2000 guidelines with reference to ILO standard analog radiographs (SARs) by four chest radiologists. After consensus reading on 349 digital images matched with the first selected analog images, 120 digital images were selected as the SDIs that considered the distribution of pneumoconiosis findings. Images with profusion category 0/1, 1, 2, and 3 were 12, 50, 40, and 15, respectively, and a large opacity were in 43 images (A = 20, B = 22, C = 1). Among pleural abnormality, costophrenic angle obliteration, pleural plaque and thickening were in 11 (9.2%), 31 (25.8%), and 9 (7.5%) images, respectively. Twenty-one of 29 symbols were present except cp, ef, ho, id, me, pa, ra, and rp. A set of 120 SDIs had more various pneumoconiosis findings than ILO SARs that were developed from adequate methods. It can be used as digital reference images for the recognition and classification of pneumoconiosis.

Quality control measurements for digital x-ray detectors

This paper describes a digital radiography (DR) quality control protocol for DR detectors from the forthcoming report from the Institute of Physics and Engineering in Medicine (IPEM). The protocol was applied to a group of six identical caesium iodide (CsI) digital x-ray detectors to assess reproducibility of methods, while four further detectors were assessed to examine the wider applicability. Twelve images with minimal spatial frequency processing are required, from which the detector response, lag, modulation transfer function (MTF), normalized noise power spectrum (NNPS) and threshold contrast-detail (c-d) detectability are calculated. The x-ray spectrum used was 70 kV and 1 mm added copper filtration, with a target detector air kerma of 2.5 µGy for the NNPS and c-d results. In order to compare detector performance with previous imaging technology, c-d data from four screen/film systems were also acquired, at a target optical density of 1.5 and an average detector air kerma of 2.56 µGy. The DR detector images were typically acquired in 20 min, with a further 45 min required for image transfer and analysis. The average spatial frequency for the 50% point of the MTF for six identical detectors was 1.29 mm(-1) ± 0.05 (3.9% coefficient of variation (cov)). The air kerma set for the six systems was 2.57 µGy ± 0.13 (5.0% cov) and the NNPS at this air kerma was 1.42 × 10(-5) mm(2) (6.5% cov). The detective quantum efficiency (DQE) measured for the six identical detectors was 0.60 at 0.5 mm(-1), with a maximum cov of 10% at 2.9 mm(-1), while the average DQE was 0.56 at 0.5 mm(-1) for three CsI detectors from three different manufacturers. Comparable c-d performance was found for these detectors (5.9% cov) with an average threshold contrast of 0.46% for 11 mm circular discs. The average threshold contrast for the S/F systems was 0.70% at 11 mm, indicating superior imaging performance for the digital systems. The protocol was found to be quick, reproducible and gave an in-depth assessment of performance for a range of digital x-ray detectors.

Modeling the performance characteristics of computed radiography (CR) systems

Computed radiography (CR) using storage phosphors is widely used in digital radiography and mammography. A cascaded linear systems approach wherein several parameter values were estimated using Monte Carlo methods was used to model the image formation process of a single-side read ;;flying spot'' CR system using a granular phosphor. Objective image quality metrics such as modulation transfer function and detective quantum efficiency were determined using this model and show good agreement with published empirical data. A model such as that addressed in this work could allow for improved understanding of the effect of storage phosphor physical properties and CR reader parameters on objective image quality metrics for existing and evolving CR systems.

Detectability of lung nodules using flat panel detector with dual energy subtraction by two shot method: Evaluation by ROC method

The aim of this study was to evaluate the effectiveness of dual-exposure dual energy subtraction technique in flat-panel chest radiography for lung nodules detection. Chest radiographs were acquired in 100 patients (57 men and 43 women; mean age, 60.2 years; range, 18-89 years) using a flat-panel digital chest system. These images were evaluated by seven radiologists. A continuous rating scale of 0-100 was used to represent each observer's confidence level regarding the presence or absence of lung nodules. Observer performance for detection of lung nodules with subtraction images was tested by using receiver operating characteristic (ROC) analysis of individual and averaged reader data. The average area under the ROC curve (Az value) significantly increased with subtraction images (Az=0.79 in standard radiographs versus Az=0.84 with subtraction images, p<0.05). In conclusion, the two-exposure dual-energy subtraction chest radiography significantly would improve detection of lung nodules.

Advances in Digital Radiography: Physical Principles and System Overview

During the past two decades, digital radiography has supplanted screen-film radiography in many radiology departments. Today, manufacturers provide a variety of digital imaging solutions based on various detector and readout technologies. Digital detectors allow implementation of a fully digital picture archiving and communication system, in which images are stored digitally and are available anytime. Image distribution in hospitals can now be achieved electronically by means of web-based technology with no risk of losing images. Other advantages of digital radiography include higher patient throughput, increased dose efficiency, and the greater dynamic range of digital detectors with possible reduction of radiation exposure to the patient. The future of radiography will be digital, and it behooves radiologists to be familiar with the technical principles, image quality criteria, and radiation exposure issues associated with the various digital radiography systems that are currently available.

Image quality and radiation dose on digital chest imaging: comparison of amorphous silicon and amorphous selenium flat-panel systems

OBJECTIVE

The aim of this study was to compare the image quality and radiation dose in chest imaging using an amorphous silicon flat-panel detector system and an amorphous selenium flat-panel detector system. In addition, the low-contrast performance of both systems with standard and low radiation doses was compared.

MATERIALS AND METHODS

In two groups of 100 patients each, digital chest radiographs were acquired with either an amorphous silicon or an amorphous selenium flat-panel system. The effective dose of the examination was measured using thermoluminescent dosimeters placed in an anthropomorphic Rando phantom. The image quality of the digital chest radiographs was assessed by five experienced radiologists using the European Guidelines on Quality Criteria for Diagnostic Radiographic Images. In addition, a contrast-detail phantom study was set up to assess the low-contrast performance of both systems at different radiation dose levels. Differences between the two groups were tested for significance using the two-tailed Mann-Whitney test.

RESULTS

The amorphous silicon flat-panel system allowed an important and significant reduction in effective dose in comparison with the amorphous selenium flat-panel system (p < 0.0001) for both the posteroanterior and lateral views. In addition, clinical image quality analysis showed that the dose reduction was not detrimental to image quality. Compared with the amorphous selenium flat-panel detector system, the amorphous silicon flat-panel detector system performed significantly better in the low-contrast phantom study, with phantom entrance dose values of up to 135 muGy.

CONCLUSION

Chest radiographs can be acquired with a significantly lower patient radiation dose using an amorphous silicon flat-panel system than using an amorphous selenium flat-panel system, thereby producing images that are equal or even superior in quality to those of the amorphous selenium flat-panel detector system.

Flat-panel detectors: how much better are they?

Interventional and fluoroscopic imaging procedures for pediatric patients are becoming more prevalent because of the less-invasive nature of these procedures compared to alternatives such as surgery. Flat-panel X-ray detectors (FPD) for fluoroscopy are a new technology alternative to the image intensifier/TV (II/TV) digital system that has been in use for more than two decades. Two major FPD technologies have been implemented, based on indirect conversion of X-rays to light (using an X-ray scintillator) and then to proportional charge (using a photodiode), or direct conversion of X-rays into charge (using a semiconductor material) for signal acquisition and digitization. These detectors have proved very successful for high-exposure interventional procedures but lack the image quality of the II/TV system at the lowest exposure levels common in fluoroscopy. The benefits for FPD image quality include lack of geometric distortion, little or no veiling glare, a uniform response across the field-of-view, and improved ergonomics with better patient access. Better detective quantum efficiency indicates the possibility of reducing the patient dose in accordance with ALARA principles. However, first-generation FPD devices have been implemented with less than adequate acquisition flexibility (e.g., lack of tableside controls/information, inability to easily change protocols) and the presence of residual signals from previous exposures, and additional cost of equipment and long-term maintenance have been serious impediments to purchase and implementation. Technological advances of second generation and future hybrid FPD systems should solve many current issues. The answer to the question "how much better are they?" is "significantly better", and they are certainly worth consideration for replacement or new implementation of an imaging suite for pediatric fluoroscopy.

Contrast-detail analysis of three flat panel detectors for digital radiography

In this paper we performed a contrast detail analysis of three commercially available flat panel detectors, two based on the indirect detection mechanism (GE Revolution XQ/i, system A, and Trixell/Philips Pixium 4600, system B) and one based on the direct detection mechanism (Hologic DirectRay DR 1000, system C). The experiment was conducted using standard x-ray radiation quality and a widely used contrast-detail phantom. Images were evaluated using a four alternative forced choice paradigm on a diagnostic-quality softcopy monitor. At the low and intermediate exposures, systems A and B gave equivalent performances. At the high dose levels, system A performed better than system B in the entire range of target sizes, even though the pixel size of system A was about 40% larger than that of system B. At all the dose levels, the performances of the system C (direct system) were lower than those of system A and B (indirect systems). Theoretical analyses based on the Perception Statistical Model gave similar predicted SNRT values corresponding to an observer efficiency of about 0.08 for systems A and B and 0.05 for system C.

Image analysis methods for diffuse optical tomography

Three major analytical tools in imaging science are summarized and demonstrated relative to optical imaging in vivo. Standard resolution testing is optimal when infinite contrast is used and hardware evaluation is the goal. However, deep tissue imaging of absorption or fluorescent contrast agents in vivo often presents a different problem, which requires contrast-detail analysis. This analysis shows that the minimum detectable sizes are in the range of 1/10 the outer diameter, whereas minimum detectable contrast values are in the range of 10 to 20% relative to the continuous background values. This is estimated for objects being in the center of the domain being imaged, and as the heterogeneous region becomes closer to the surface, the lower limit on size and contrast can become arbitrarily low and more dictated by hardware specifications. Finally, if human observer detection of abnormalities in the images is the goal, as is standard in most radiological practice, receiver operating characteristic (ROC) curve and location receiver operating characteristic curve (LROC) are used. Each of these three major areas of image interpretation and analysis are reviewed in the context of medical imaging as well as how they are used to quantify the performance of diffuse optical imaging of tissue.

Image quality performance of liquid crystal display systems: influence of display resolution, magnification and window settings on contrast-detail detection

The aim of this study was to investigate the combined effects of liquid crystal display (LCD) resolution, image magnification and window/level adjustment on the low-contrast performance in soft-copy image interpretation in digital radiography and digital mammography. In addition, the effect of a new LCD noise reduction mechanism on the low-contrast detectability was studied. Digital radiographs and mammograms of two dedicated contrast-detail phantoms (CDRAD 2.0 and CDMAM 3.4) were scored on five LCD devices with varying resolutions (1-3- and 5-megapixel) and one dedicated 5-megapixel cathode ray tube monitor. Two 5-megapixel LCDs were included. The first one was a standard 5-megapixel LCD and the second had a new (Per Pixel Uniformity) noise reduction mechanism. A multi-variate analysis of variance revealed a significant influence of LCD resolution, image magnification and window/level adjustment on the image quality performance assessed with both the CDRAD 2.0 and the CDMAM 3.4 phantoms. The interactive adjustment of brightness and contrast of digital images did not affect the reading time, whereas magnification to full resolution resulted in a significantly slower soft-copy interpretation. For digital radiography applications, a 3-megapixel LCD is comparable with a 5-megapixel CRT monitor in terms of low-contrast performance as well as in reading time. The use of a 2-megapixel LCD is only warranted when radiographs are analysed in full resolution and when using the interactive window/level adjustment. In digital mammography, a 5-megapixel monitor should be the first choice. In addition, the new PPU noise reduction system in the 5-megapixel LCD devices provides significantly better results for mammography reading as compared to a standard 5-magapixel LCD or CRT. If a 3-megapixel LCD is used in mammography setting, a very time-consuming magnification of the digital mammograms would be necessary.

Direct detector radiography versus dual reading computed radiography: feasibility of dose reduction in chest radiography

The image quality of dual-reading computed radiography and dose-reduced direct radiography of the chest was compared in a clinical setting. The study group consisted of 50 patients that underwent three posteroanterior chest radiographs within minutes, one image obtained with a dual read-out computed radiography system (CR; Fuji 5501) at regular dose and two images with a flat panel direct detector unit (DR; Diagnost, Philips). The DR images were obtained with the same and with 50% of the dose used for the CR images. Images were evaluated in a blinded side-by-side comparison. Eight radiologists ranked the visually perceivable difference in image quality using a three-point scale. Then, three radiologists scored the visibility of anatomic landmarks in low and high attenuation areas and image noise. Statistical analysis was based on Friedman tests and Wilcoxon rank sum tests at a significance level of P<0.05. DR was judged superior to CR for the delineation of structures in high attenuation areas of the mediastinum even when obtained with 50% less dose (P<0.001). The visibility of most pulmonary structures was judged equivalent with both techniques, regardless of acquisition dose and speed level. Scores for image noise were lower for DR compared with CR, with the exception of DR obtained at a reduced dose. Thus, in this clinical preference study, DR was equivalent or even superior to the most modern dual read-out CR, even when obtained with 50% dose. A further dose reduction does not appear to be feasible for DR without significant loss of image quality.

Physical imaging properties and low-contrast performance of a newly developed flat-panel digital radiographic system

We investigated the clinical usefulness of a newly developed flat-panel detector (FPD) system by comparing its physical imaging properties and low-contrast detectability with those of a current FPD system. The newly developed CsI-based indirect FPD (Canon, CXDI-40C) and current Gd(2)O(2)S-based FPD (Canon CXDI-11) systems were used. Characteristic curves, resolution properties, radiographic noise, detective quantum efficiencies (DQEs) and low-contrast detectability for both systems were measured. The new FPD system showed considerably lower noise levels than those of the current FPD system. DQE (0) s of the new and current FPD systems were 75% and 35%, respectively. Observer performance tests of the contrast-detail (C-D) phantom indicated that the new FPD system can significantly improve low-contrast performance over that obtainable with the current FPD system under the same conditions of exposure. The new FPD system provided approximately 50% reduction in exposure while providing comparable detectability. The newly developed FPD system provides radiographic images with excellent inherent physical image quality and low-contrast performance.

Evaluation of a software package for automated quality assessment of contrast detail images—comparison with subjective visual assessment

Contrast detail analysis is commonly used to assess image quality (IQ) associated with diagnostic imaging systems. Applications include routine assessment of equipment performance and optimization studies. Most frequently, the evaluation of contrast detail images involves human observers visually detecting the threshold contrast detail combinations in the image. However, the subjective nature of human perception and the variations in the decision threshold pose limits to the minimum image quality variations detectable with reliability. Objective methods of assessment of image quality such as automated scoring have the potential to overcome the above limitations. A software package (CDRAD analyser) developed for automated scoring of images produced with the CDRAD test object was evaluated. Its performance to assess absolute and relative IQ was compared with that of an average observer. Results show that the software does not mimic the absolute performance of the average observer. The software proved more sensitive and was able to detect smaller low-contrast variations. The observer's performance was superior to the software's in the detection of smaller details. Both scoring methods showed frequent agreement in the detection of image quality variations resulting from changes in kVp and KERMA(detector), which indicates the potential to use the software CDRAD analyser for assessment of relative IQ.

Flat-panel-detector chest radiography: effect of tube voltage on image quality

PURPOSE

To compare the visibility of anatomic structures in direct-detector chest radiographs acquired with different tube voltages at equal effective doses to the patient.

MATERIALS AND METHODS

The study protocol was approved by the institutional internal review board, and written informed consent was obtained from all patients. Posteroanterior chest radiographs of 48 consecutively selected patients were obtained at 90, 121, and 150 kVp by using a flat-panel-detector unit that was based on cesium iodide technology and automated exposure control. Monte Carlo simulations were used to verify that the effective dose for all kilovoltage settings was equal. Five radiologists subjectively and independently rated the delineation of anatomic structures on hard-copy images by using a five-point scale. They also ranked image quality in a blinded side-by-side comparison. Average ranking scores were compared by using one-way analysis of variance with repeated measures. Data were analyzed for the entire patient group and for two patient subgroups that were formed according to body mass index (BMI).

RESULTS

The visibility scores of most anatomic structures were significantly superior with the 90-kVp images (mean score, 3.11), followed by the 121-kVp (mean score, 2.95) and 150-kVp images (mean score, 2.80). Differences did not reach significance (P > .05) only for the delineation of the peripheral vessels, the heart contours, and the carina. This was also true for the subgroup of patients (n = 24) with a BMI greater than and the subgroup of patients (n = 24) with a BMI less than the mean BMI (26.9 kg/m(2)). At side-by-side comparison, the readers rated 90-kVp images as having superior image quality in the majority of image triplets; the percentage of 90-kVp images rated as "first choice" ranged from 60% (29 of 48 patients) to 90% (43 of 48 patients), with a median of 88% (42 of 48 patients), among the readers.

CONCLUSION

Delineation of most anatomic structures and overall image quality were ranked superior in digital radiographs acquired with lower kilovoltage at a constant effective patient dose.

Computed Radiography and Direct Radiography

PURPOSE

We sought to evaluate the performance of dual-readout and single-readout computed radiography compared with direct radiography for detecting subtle lung abnormalities with a standard and a low-dose technique.

MATERIALS AND METHODS

Posteroanterior radiographs of an anthropomorphic chest phantom were obtained with a single-readout storage phosphor radiography system (CRS, pixel size 200 microm), a dual-readout storage phosphor radiography system (CRD, pixel size 100 microm), and a direct detector (DR, pixel size 143 microm) at dose levels of 400 and 800 speed. Ten templates were superimposed to project 4 types of lesions over low- and high-attenuation areas, simulating nodules, micronodules, lines, and patchy opacities. Six radiologists evaluated 60 hard-copy images for the presence or absence of lesions. Statistical significance of differences was evaluated using receiver operating characteristic analysis and analysis of variance.

RESULTS

For both low- and high-attenuation areas, CRD (Az = 0.85 and 0.66) was superior to CRS (Az = 0.75 and 0.58) for overall performance and all lesion subtypes (P < 0.05). DR (Az = 0.87 and 0.67) performed slightly better than CRD, being significant only for the detection of micronodules. Acquisition dose significantly affected only the detection of lines and micronodules, whereas the detection of nodules and patchy opacities was not significantly different with reduced exposure, regardless of the system used.

CONCLUSION

The dual-readout CR system significantly outperformed the single-readout CR and almost equaled the performance of DR. Dose reduction was more critical for small-sized lesions (micronodules, lines) than for nodular or patchy opacifications and affected mainly the lesions in high attenuation areas.

A clinical evaluation of the image quality computer program, CoCIQ

To provide an objective way of measuring image quality, a computer program was designed that automatically analyzes the test images of a contrast-detail (CD) phantom. The program gives a quantified measurement of image quality by calculating an Image Quality Figure (IQF). The aim of this work was to evaluate the program and adjust it to clinical situations in order to find the detectable level where the program gives a reliable figure of the contrast resolution. The program was applied on a large variety of images with lumbar spine and urographic parameters, from very low to very high image qualities. It was shown that the computer program produces IQFs with small variations and there were a strong linear statistical relation between the computerized evaluation and the evaluation performed by human observers (R2= 0.98). This method offers a fast and easy way of conducting image quality evaluations.

Contrast-detail phantom scoring methodology

Published results of medical imaging studies which make use of contrast detail mammography (CDMAM) phantom images for analysis are difficult to compare since data are often not analyzed in the same way. In order to address this situation, the concept of ideal contrast detail curves is suggested. The ideal contrast detail curves are constructed based on the requirement of having the same product of the diameter and contrast (disk thickness) of the minimal correctly determined object for every row of the CDMAM phantom image. A correlation and comparison of five different quality parameters of the CDMAM phantom image determined for obtained ideal contrast detail curves is performed. The image quality parameters compared include: (1) contrast detail curve--a graph correlation between "minimal correct reading" diameter and disk thickness; (2) correct observation ratio--the ratio of the number of correctly identified objects to the actual total number of objects multiplied by 100; (3) image quality figure--the sum of the product of the diameter of the smallest scored object and its relative contrast; (4) figure-of-merit--the zero disk diameter value obtained from extrapolation of the contrast detail curve to the origin (e.g., zero disk diameter); and (5) k-factor--the product of the thickness and the diameter of the smallest correctly identified disks. The analysis carried out showed the existence of a nonlinear relationship between the above parameters, which means that use of different parameters of CDMAM image quality potentially can cause different conclusions about changes in image quality. Construction of the ideal contrast detail curves for CDMAM phantom is an attempt to determine the quantitative limits of the CDMAM phantom as employed for image quality evaluation. These limits are determined by the relationship between certain parameters of a digital mammography system and the set of the gold disks sizes in the CDMAM phantom. Recommendations are made on selections of CDMAM phantom regions which should be used for scoring at different image quality and which scoring methodology may be most appropriate. Special attention is also paid to the use of the CDMAM phantom for image quality assessment of digital mammography systems particularly in the vicinity of the Nyquist frequency.

Visibility of simulated microcalcifications-A hardcopy-based comparison of three mammographic systemsa)

Full-field digital mammography systems are currently available for clinical use. These digital systems offer improved image quality, flexible image processing, display, storage, retrieval, and transmission. These systems employ a variety of different x-ray detectors based on storage phosphors (in computed radiography), charge-coupled devices (CCDs), or amorphous silicon flat panels (FPs). The objective of this study is to compare three different types of mammographic detectors: screenfilm (SF) combination, a CsI-based FP detector, a CCD and x-ray phosphor-based detector for their performance in detection of simulated microcalcifications. Microcalcifications (MCs) were simulated with calcium carbonate grains of various sizes (90-355 microm). They were overlapped with a slab of simulated 50% adipose/50% glandular breast tissue for a uniform background or an anthropomorphic breast phantom for a tissue structure background. Images of the phantoms, acquired with and without magnification, were reviewed by mammographers, physicists, and students. A five-point confidence level rating was given for each MC reviewed. Average ratings from the mammographers were used to compare the performances of the three imaging systems, various MC size groups, and two magnification modes. The results indicate that with uniform background and no magnification, the FP system performed the best while the SF system did slightly better than the CCD system. With magnification added, all detection tasks were improved except for the smallest and largest one or two size groups. In particular, detection in the SF and CCD images was significantly improved over that in the FP images. With tissue structure background and no magnification, the FP system was outperformed by the SF and the CCD systems. With magnification added, the performance of the FP and the CCD systems was improved significantly. With this improvement, the SF and FP systems were outperformed by the CCD system.

Contrast-Detail Phantom Study for X-ray Spectrum Optimization Regarding Chest Radiography Using a Cesium Iodide-Amorphous Silicon Flat-Panel Detector

RATIONALE AND OBJECTIVES

The purpose of this study evaluating a cesium iodide-amorphous silicon-based flat-panel detector was to optimize the x-ray spectrum for chest radiography combining excellent contrast-detail visibility with reduced patient exposure.

MATERIALS AND METHODS

A Lucite plate with 36 drilled holes of varying diameter and depth was used as contrast-detail phantom. For 3 scatter body thicknesses (7.5 cm, 12.5 cm, 21.5 cm Lucite) images were obtained at 113 kVp, 117 kVp, and 125 kVp with additional copper filter of 0.2 and 0.3 mm, respectively. For each setting, radiographs acquired with 125 kVp and no copper filter were taken as standard of reference. On soft-copy displays, 3 observers blinded to the exposure technique evaluated the detectability of each aperture in each image according to a 5-point scale. The number of points given to all 36 holes per image was added. The scores of images acquired with filtration were compared with the standard images by means of a multivariate analysis of variance. Radiation burden was approximated by referring to the entrance dose and calculated using Monte Carlo method.

RESULTS

All 6 evaluated x-ray spectra resulted in a statistically equivalent contrast-detail performance when compared with the standard of reference. The combination 125 kVp with 0.3 mm copper was most favorable in terms of dose reduction (approximately 33%).

CONCLUSION

Within the constraints of the presented contrast-detail phantom study simulating chest radiography, the CsI/a-Si system enables an addition of up to 0.3 mm copper filtration without the need for compensatory reduction of the tube voltage for providing constant image quality. Beam filtration reduces radiation burden by about 33%.

[Full-field digital mammography with amorphous silicon-based flat- panel detector: physical imaging characteristics and signal detection]

The physical characteristics of a clinical amorphous silicon-based flat-panel imager for full-field digital mammography were investigated. Pre-sampled modulation transfer functions (MTF) were measured by using a slit method. Noise power spectra were determined for different input exposures by fast Fourier transform. The MTFs of full-field digital mammography systems showed significantly higher values than those of the computed radiography (CR) system. The full-field digital mammography system showed a lower noise level than that of the CR system under the same exposure conditions. Contrast detail analysis has been performed to compare the detectability of the full-field digital mammography system with that of the screen-film (Min-R 2000/Min-R 2000) system. The average contrast-detail curves of digital and film images were obtained from the results of observation. Image quality figures (IQF) were also calculated from the individual observer performance tests. The results indicated that the digital contrast-detail curves and IQF, on average, are superior to those of the screen-film system.