Image information content and patient exposure

Technical evaluation of a prototype ratio 29:1 grid for adult patient cardiovascular angiography imaging conditions

The purpose of this work was to assess technical performance of a prototype high-ratio (r29), 80 line cm^-1grid for imaging conditions which mimic those for adult cardiovascular angiography. The standard equipment r15, 80 line cm^-1grid was used as a reference. Plastic Water^®LR phantoms with thickness in the range 20-44 cm were used to simulate adult patient attenuation and scatter. Grids were tested using x-ray field of view 20 and 25 cm and x-ray source to detector distance (SID) 107 and 120 cm. The primary transmission fraction (T_P) was measured using both narrow beam geometry and a lead beam stop (BS) technique. Scatter transmission (T_S) was measured with the lead BS technique. The quantum signal to noise ratio improvement factor (K_SNR) was used to describe relative grid performance. The experimental conditions required revised theory to assess grid performance. Theory to account for the detector glare and underestimation of scatter intensity by the lead BS method was developed. Also, novelK_SNRtheory was developed to allow direct comparison of two grids operated at different SID. MeanT_Pwas modestly lower for the r29 versus r15 grid (0.69 versus 0.75). When tested under equivalent scatter condition, T_Sof the r29 grid was approximately ½ that of the r15 grid (0.18 versus 0.34).K_SNRof the r29 grid at SID 120 cm compared to the r15 grid at SID 107 cm increased linearly with phantom thickness (range 1.0 to ∼1.16). Findings of this work indicate that the r29 grid used at SID 120 cm is expected to provide improved image quality (or reduced patient radiation dose) when compared to the r15 grid used at SID 107 cm for adult cardiovascular patients and that the potential benefit of the r29 grid increases with patient thickness >20 cm.

Information Capacity of Positron Emission Tomography Scanners

Background: The aim of the present study was to assess the upper information content bound of positron emission tomography (PET) images, by means of the information capacity (IC). Methods: The Geant4 Application for the Tomographic Emission (GATE) Monte Carlo (MC) package was used, and reconstructed images were obtained by using the software for tomographic image reconstruction (STIR). The case study for the assessment of the information content was the General Electric (GE) Discovery-ST PET scanner. A thin-film plane source aluminum (Al) foil, coated with a thin layer of silica and with a 18F-fludeoxyglucose (FDG) bath distribution of 1 MBq was used. The influence of the (a) maximum likelihood estimation-ordered subsets-maximum a posteriori probability-one step late (MLE-OS-MAP-OSL) algorithm, using various subsets (1 to 21) and iterations (1 to 20) and (b) different scintillating crystals on PET scanner’s performance, was examined. The study was focused on the noise equivalent quanta (NEQ) and on the single index IC. Images of configurations by using different crystals were obtained after the commonly used 2-dimensional filtered back projection (FBP2D), 3-dimensional filtered back projection re-projection (FPB3DRP) and the (MLE)-OS-MAP-OSL algorithms. Results: Results shown that the images obtained with one subset and various iterations provided maximum NEQ values, however with a steep drop-off after 0.045 cycles/mm. The single index IC data were maximized for the range of 8–20 iterations and three subsets. The PET scanner configuration incorporating lutetium orthoaluminate perovskite (LuAP) crystals provided the highest NEQ values in 2D FBP for spatial frequencies higher than 0.028 cycles/mm. Bismuth germanium oxide (BGO) shows clear dominance against all other examined crystals across the spatial frequency range, in both 3D FBP and OS-MAP-OSL. The particular PET scanner provided optimum IC values using FBP3DRP and BGO crystals (2.4829 bits/mm2). Conclusions: The upper bound of the image information content of PET scanners can be fully characterized and further improved by investigating the imaging chain components through MC methods.

Niobium Filters for Dose Reduction in Pediatric Radiology

The performance of a niobium filter, with K-edge at 19 keV, and a copper filter have been studied concerning absorbed dose, image quality and tube loading. Absorbed doses were measured with TLD. To evaluate image quality a perspex phantom with image quality test objects was used. In comparison with a conventional filter made of copper no significant advantage was obtained with the niobium filter.

Ideal-observer detectability in photon-counting differential phase-contrast imaging using a linear-systems approach

PURPOSE

To provide a cascaded-systems framework based on the noise-power spectrum (NPS), modulation transfer function (MTF), and noise-equivalent number of quanta (NEQ) for quantitative evaluation of differential phase-contrast imaging (Talbot interferometry) in relation to conventional absorption contrast under equal-dose, equal-geometry, and, to some extent, equal-photon-economy constraints. The focus is a geometry for photon-counting mammography.

METHODS

Phase-contrast imaging is a promising technology that may emerge as an alternative or adjunct to conventional absorption contrast. In particular, phase contrast may increase the signal-difference-to-noise ratio compared to absorption contrast because the difference in phase shift between soft-tissue structures is often substantially larger than the absorption difference. We have developed a comprehensive cascaded-systems framework to investigate Talbot interferometry, which is a technique for differential phase-contrast imaging. Analytical expressions for the MTF and NPS were derived to calculate the NEQ and a task-specific ideal-observer detectability index under assumptions of linearity and shift invariance. Talbot interferometry was compared to absorption contrast at equal dose, and using either a plane wave or a spherical wave in a conceivable mammography geometry. The impact of source size and spectrum bandwidth was included in the framework, and the trade-off with photon economy was investigated in some detail. Wave-propagation simulations were used to verify the analytical expressions and to generate example images.

RESULTS

Talbot interferometry inherently detects the differential of the phase, which led to a maximum in NEQ at high spatial frequencies, whereas the absorption-contrast NEQ decreased monotonically with frequency. Further, phase contrast detects differences in density rather than atomic number, and the optimal imaging energy was found to be a factor of 1.7 higher than for absorption contrast. Talbot interferometry with a plane wave increased detectability for 0.1-mm tumor and glandular structures by a factor of 3-4 at equal dose, whereas absorption contrast was the preferred method for structures larger than ∼0.5 mm. Microcalcifications are small, but differ from soft tissue in atomic number more than density, which is favored by absorption contrast, and Talbot interferometry was barely beneficial at all within the resolution limit of the system. Further, Talbot interferometry favored detection of "sharp" as opposed to "smooth" structures, and discrimination tasks by about 50% compared to detection tasks. The technique was relatively insensitive to spectrum bandwidth, whereas the projected source size was more important. If equal photon economy was added as a restriction, phase-contrast efficiency was reduced so that the benefit for detection tasks almost vanished compared to absorption contrast, but discrimination tasks were still improved close to a factor of 2 at the resolution limit.

CONCLUSIONS

Cascaded-systems analysis enables comprehensive and intuitive evaluation of phase-contrast efficiency in relation to absorption contrast under requirements of equal dose, equal geometry, and equal photon economy. The benefit of Talbot interferometry was highly dependent on task, in particular detection versus discrimination tasks, and target size, shape, and material. Requiring equal photon economy weakened the benefit of Talbot interferometry in mammography.

Minimizing dose during fluoroscopic tracking through geometric performance feedback

PURPOSE

There is a growing concern regarding the dose delivered during x-ray fluoroscopy guided procedures, particularly in interventional cardiology and neuroradiology, and in real-time tumor tracking radiotherapy and radiosurgery. Many of these procedures involve long treatment times, and as such, there is cause for concern regarding the dose delivered and the associated radiation related risks. An insufficient dose, however, may convey less geometric information, which may lead to inaccuracy and imprecision in intervention placement. The purpose of this study is to investigate a method for achieving the required tracking uncertainty for a given interventional procedure using minimal dose.

METHODS

A simple model is used to demonstrate that a relationship exists between imaging dose and tracking uncertainty. A feedback framework is introduced that exploits this relationship to modulate the tube current (and hence the dose) in order to maintain the required uncertainty for a given interventional procedure. This framework is evaluated in the context of a fiducial tracking problem associated with image-guided radiotherapy in the lung. A particle filter algorithm is used to robustly track the fiducial as it traverses through regions of high and low quantum noise. Published motion models are incorporated in a tracking test suite to evaluate the dose-localization performance trade-offs.

RESULTS

It is shown that using this framework, the entrance surface exposure can be reduced by up to 28.6% when feedback is employed to operate at a geometric tracking uncertainty of 0.3 mm.

CONCLUSIONS

The analysis reveals a potentially powerful technique for dynamic optimization of fluoroscopic imaging parameters to control the applied dose by exploiting the trade-off between tracking uncertainty and x-ray exposure per frame.

Quantification of vasa vasorum density in multi-slice computed tomographic coronary angiograms: role of computed tomographic image voxel size

OBJECTIVE

This study is motivated by the possibility of using computed tomography (CT) to detect early coronary atherosclerosis by the increased CT values within the arterial wall resulting from vasa vasorum proliferation.

METHODS

Coronary arteries (n = 5) with early atherosclerotic changes were injected with Microfil and scanned (micro-CT). Noise was added to the CT projection data sets (to represent the radiation exposure of current clinical CT scanners) and then reconstructed to generate 3-dimensional images at different voxel sizes.

RESULTS

Higher CT values were detected because of contrast agent in vasa vasorum if voxel size was less than (150 microm)(3). Contrast in the main lumen increased the CT values dramatically at voxels greater than (100 microm)(3), whereas CT values of the same specimen without contrast in the main lumen remained constant.

CONCLUSIONS

Voxel sizes less than (200 microm)(3) are needed to quantitate arterial wall opacification due to vasa vasorum proliferation.

Energy filtering with X-ray lenses: optimization for photon-counting mammography

Chromatic properties of the multi-prism and prism-array X-ray lenses (MPL and PAL) can potentially be utilized for efficient energy filtering and dose reduction in mammography. The line-shaped foci of the lenses are optimal for coupling to photon-counting silicon strip detectors in a scanning system. A theoretical model was developed and used to investigate the benefit of two lenses compared with an absorption-filtered reference system. The dose reduction of the MPL filter was approximately 15% compared with the reference system at matching scan time, and the spatial resolution was higher. The dose of the PAL-filtered system was found to be approximately 20% lower than for the reference system at equal scan time and resolution, and only approximately 20% higher than for a monochromatic beam. An investigation of some practical issues remains, including the feasibility of brilliant-enough X-ray sources and manufacturing of a polymer PAL.

A low-absorption x-ray energy filter for small-scale applications

We present an experimental and theoretical evaluation of an x-ray energy filter based on the chromatic properties of a prism-array lens (PAL). It is intended for small-scale applications such as medical imaging. The PAL approximates a Fresnel lens and allows for high efficiency compared to filters based on ordinary refractive lenses, however at the cost of a lower energy resolution. Geometrical optics was found to provide a good approximation for the performance of a flawless lens, but a field-propagation model was used for quantitative predictions. The model predicted a 0.29 E/E energy resolution and an intensity gain of 6.5 for a silicon PAL at 23.5 keV. Measurements with an x-ray tube showed good agreement with the model in energy resolution and peak energy, but a blurred focal line contributed to a 29% gain reduction. We believe the blurring to be caused mainly by lens imperfections, in particular at the periphery of the lens.

Analysis of image quality for real-time target tracking using simultaneous kV-MV imaging

Real-time tracking can provide high accuracy localization for a moving target and minimize the effect of motion. Simultaneous kV-MV imaging has been proposed as a real-time tracking technique by utilizing the existing kV on-board imager (OBI) and the MV electronic portal device (EPID) mounted on the linear accelerator. The orthogonal pair of kV-MV images acquired simultaneously can provide 3-D localization in real-time. However, the kV and MV beams cross shooting the target interfere with each other with beam scattering, which affects the quality of images. The success of this modality heavily relies on the image quality, especially the visibility of the target, which was investigated in this study. The kV and MV images were acquired for a gold implant marker that was used as a surrogate of the target and placed in an IMRT thorax phantom, a dynamic phantom, and a pelvis phantom to test the image quality in different situations. Contrast-to-noise ration (CNR) was used to quantitatively describe the visibility of the target in the image. CNR can be obtained by statistical calculation from image processing and physics analysis with ion chamber measurement. The difference is described by contrast detection efficiency (CDE). By comparing the ratio (R) of CNR with and without the MV beam on, the MV beam scatter was found to have dramatically reduced the target visibility in the kV images (R=0.47), which was supported by an independent physics analysis that treats beam scatter as a noise. In contrast, the kV scatter effect on the MV images was minor (R=0.93). The effect of tumor motion was visible but tolerable for the target tracking purpose. CNR varied with different tumor sites and was lower for the pelvis than the thorax. Different kV imaging parameters such as kVp, mAs, and exposure time ms were tested for different cases. Considering a threshold of 1.0 CNR as a measure for the target visibility, a range of CNR from 1.3 to 4.2 was reached with appropriate tuning of those imaging parameters. This study has shown that CNR is a key parameter that can be used for assessing the visibility of the target in digital imaging and the quality of kV/MV images. It has also been shown that reasonable target visibility can be obtained using simultaneous kV-MV imaging for real-time target tracking.

Vision 20/20: increased image resolution versus reduced radiation exposure

This is a review of methods, currently and potentially, available for significantly reducing x-ray exposure in medical x-ray imaging. It is stimulated by the radiation exposure implications of the growing use of helical scanning, multislice, x-ray computed tomography for screening, such as for coronary artery atherosclerosis and cancer of the colon and lungs. Screening requires high-throughput imaging with high spatial and contrast resolution to meet the need for high sensitivity and specificity of detection and classification of specific imaged features. To achieve this goal beyond what is currently available with x-ray imaging methods requires increased x-ray exposure, which increases the risk of tissue damage and ultimately cancer development. These consequences limit the utility of current x-ray imaging in screening of at-risk subjects who have not yet developed the clinical symptoms of disease. Current methods for reducing x-ray exposure in x-ray imaging, mostly achieved by increasing sensitivity and specificity of the x-ray detection process, may still have potential for an up-to-tenfold decrease. This could be sufficient for doubling the spatial resolution of x-ray CT while maintaining the current x-ray exposure levels. However, a spatial resolution four times what is currently available might be needed to adequately meet the needs for screening. Consequently, for the proposed need to increase spatial resolution, an additional order of magnitude of reduction of x-ray exposure would be needed just to keep the radiation exposure at current levels. This is conceivably achievable if refraction, rather than the currently used attenuation, of x rays is used to generate the images. Existing methods that have potential for imaging the consequences of refracted x ray in a clinical setting are (1) by imaging the edge enhancement that occurs at the interfaces between adjacent tissues of different refractive indices, or (2) by imaging the changes in interference patterns resulting from moving grids which alter the refraction of x rays, that have passed through the body, in a predictable fashion, and (3) theoretically, by an image generated from the change in time-of-flight of x-ray photons passing through the body. Imaging phase shift or change in time-of-flight, rather than attenuation, of x-ray photons through tissues presents formidable technological problems for whole-body 3D imaging. However, if achievable in a routine clinical setting, these approaches have the potential for greatly expanding the use of x-ray imaging for screening. This overview examines the increased contrast resolution and reduced radiation exposure that might be achievable by the above-mentioned methods.

Experimental evaluation of fiber-interspaced antiscatter grids for large patient imaging with digital x-ray systems

Radiographic imaging of large patients is compromised by x-ray scatter. Optimization of digital x-ray imaging systems used for projection radiography requires the use of the best possible antiscatter grid. The performance of antiscatter grids used in conjunction with digital x-ray imaging systems can be characterized through measurement of the signal-to-noise ratio (SNR) improvement factor (K(SNR)). The SNR improvement factor of several linear, focused antiscatter grids was determined from measurements of the fundamental primary and scatter transmission fraction measurements of the grids as well as the inherent scatter-to-primary ratio (SPR) of the x-ray beam and scatter phantom. The inherent SPR and scatter transmission fraction was measured using a graduated lead beam stop method. The K(SNR) of eight grids with line rates (N) in the range 40 to 80 cm(-1) and ratios (r) in the range 8:1 to 15:1 was measured. All of the grids had fiber interspace material and carbon-fiber covers. The scatter phantom used was Solid Water(R) with thickness 10 to 50 cm, and a 30 x 30 cm(2) field of view was used. All measurements were acquired using a 104 kVp x-ray beam. The SPR of the non-grid imaging condition ranged from 2.55 for the 10 cm phantom to 25.9 for the 50 cm phantom. The scatter transmission fractions ranged from a low of 0.083 for the N50 r15 grid to a high of 0.22 for the N40 r8 grid and the primary transmission fractions ranged from a low of 0.69 for the N80 r15 grid to 0.76 for the N40 r8 grid. The SNR improvement factors ranged from 1.2 for the 10 cm phantom and N40 r8 grid to 2.09 for the 50 cm phantom and the best performing N50 r15, N44 r15 and N40 r14 grids.

Pediatric interventional radiography equipment: safety considerations

This paper discusses pediatric image quality and radiation dose considerations in state-of-the-art fluoroscopic imaging equipment. Although most fluoroscopes are capable of automatically providing good image quality on infants, toddlers, and small children, excessive radiation dose levels can result from design deficiencies of the imaging device or inappropriate configuration of the equipment's capabilities when imaging small body parts. Important design features and setup choices at installation and during the clinical use of the imaging device can improve image quality and reduce radiation exposure levels in pediatric patients. Pediatric radiologists and cardiologists, with the help of medical physicists, need to understand the issues involved in creating good image quality at reasonable pediatric patient doses. The control of radiographic technique factors by the generator of the imaging device must provide a large dynamic range of mAs values per exposure pulse during both fluoroscopy and image recording as a function of patient girth, which is the thickness of the patient in the posterior-anterior projection at the umbilicus (less than 10 cm to greater than 30 cm). The range of pulse widths must be limited to less than 10 ms in children to properly freeze patient motion. Variable rate pulsed fluoroscopy can be leveraged to reduce radiation dose to the patient and improve image quality. Three focal spots with nominal sizes of 0.3 mm to 1 mm are necessary on the pediatric unit. A second, lateral imaging plane might be necessary because of the child's limited tolerance of contrast medium. Spectral and spatial beam shaping can improve image quality while reducing the radiation dose. Finally, the level of entrance exposure to the image receptor of the fluoroscope as a function of operator choices, of added filter thickness, of selected pulse rate, of the selected field-of-view and of the patient girth all must be addressed at installation.

Micro-computed tomography of the lungs and pulmonary-vascular system

Three-dimensional imaging of the intact lung and its vasculature is essential if the hierarchical and volumetric aspects of its structures and functions are to be quantitated. Although this is possible with clinical multislice helical CT scanners, the spatial resolution does not scale down adequately for small rodents for which cubic voxel dimensions of 50-100 microm are required. Micro-computed tomography (micro-CT) provides the necessary spatial resolution of 3D images of the intact thoracic contents. Micro-CT can provide higher resolution so that basic micro-architectural structures, such as alveoli, can be individually visualized and quantitated. Dynamic events, such as the respiratory and cardiac cycles, can be imaged at multiple time points throughout a representative cycle by coordinating the scan sequence (i.e., gating) to the cycle phase of a sequence of cycles. Fusion of the micro-CT image data with other image data, such as micro-SPECT or histology, can enhance the information content beyond the mainly structural information provided by micro-CT. Conventional attenuation-based X-ray imaging can involve significant X-ray exposures at high spatial resolutions, and this could affect the phenotype (e.g., via interstitial fibrosis) and genotype (e.g., via mutation), so its use in longitudinal studies using micro-CT may be limited in some cases. However, because of recent developments in which the phase shift or refraction of X-rays rather than attenuation is used, the X-ray exposure may be significantly reduced.

AEC for scanning digital mammography based on variation of scan velocity

A theoretical evaluation of nonuniform x-ray field distributions in mammography was conducted. An automatic exposure control (AEC) is proposed for a scanning full field digital mammography system. It uses information from the leading part of the detector to vary the scan velocity dynamically, thus creating a nonuniform x-ray field in the scan direction. Nonuniform radiation fields were also created by numerically optimizing the scan velocity profile to each breast's transmission distribution, with constraints on velocity and acceleration. The goal of the proposed AEC is to produce constant pixel signal-to-noise ratio throughout the image. The target pixel SNR for each image could be set based on the breast thickness, breast composition, and the beam quality as to achieve the same contrast-to-noise ratio between images for structures of interest. The results are quantified in terms of reduction in entrance surface air kerma (ESAK) and scan time relative to a uniform x-ray field. The theoretical evaluation was performed on a set of 266 mammograms. The performance of the different methods to create nonuniform fields decreased with increased detector width, from 18% to 11% in terms of ESAK reduction and from 30% to 25% in terms of scan time reduction for the proposed AEC and detector widths from 10 to 60 mm. Some correlation was found between compressed breast thickness and the projected breast area onto the image field. This translated into an increase of the ESAK and decrease of the scan time reduction with breast thickness. Ideally a nonuniform field in two dimensions could reduce the entrance dose by 39% on average, whereas a field nonuniform in only the scanning dimension ideally yields a 20% reduction. A benefit with the proposed AEC is that the risk of underexposing the densest region of the breast can be virtually eliminated.

Effect of area x-ray beam equalization on image quality and dose in digital mammography

In mammography, thick or dense breast regions persistently suffer from reduced contrast-to-noise ratio (CNR) because of degraded contrast from large scatter intensities and relatively high noise. Area x-ray beam equalization can improve image quality by increasing the x-ray exposure to under-penetrated regions without increasing the exposure to other breast regions. Optimal equalization parameters with respect to image quality and patient dose were determined through computer simulations and validated with experimental observations on a step phantom and an anthropomorphic breast phantom. Three parameters important in equalization digital mammography were considered: attenuator material (Z = 13-92), beam energy (22-34 kVp) and equalization level. A Mo/Mo digital mammography system was used for image acquisition. A prototype 16 x 16 piston driven equalization system was used for preparing patient-specific equalization masks. Simulation studies showed that a molybdenum attenuator and an equalization level of 20 were optimal for improving contrast, CNR and figure of merit (FOM = CNR2/dose). Experimental measurements using these parameters showed significant improvements in contrast, CNR and FOM. Moreover, equalized images of a breast phantom showed improved image quality. These results indicate that area beam equalization can improve image quality in digital mammography.

Cardiac computed tomography imaging: a history and some future possibilities

Cardiac computed tomography (CT) is a special subset of CT, a subject about which much has been written in terms of the underlying concepts and mathematics and the sociologic impact. Cardiac CT has passed through three, chronologically overlapping, developmental stages and is now in its fourth stage of development. The first stage was fluoroscopy-based CT (1972-1995) stimulated by physiologic research needs, and the next was clinical CT-based exploration (1975-1980) of the potential of clinical CT in cardiology. This was followed by the electron beam CT-based stage (1980-present), which was the first CT approach applicable to clinical cardiology. Finally, volume-scanning CT imaging methods achieved with multislice scanning approaches of helical CT and by flat panel-based CT (1990-present), show great promise for clinically applicable CT of the cardiovascular system.

Fundamentals of image acquisition and processing in the digital era

OBJECTIVES

To review the historic context for digital imaging in dentistry and to outline the fundamental issues related to digital imaging modalities.

CONTEXT

Digital dental X-ray images can be achieved by scanning analog film radiographs (secondary capture), with photostimulable phosphors, or using solid-state detectors (e.g. charge-coupled device and complementary metal oxide semiconductor). There are four characteristics that are basic to all digital image detectors; namely, size of active area, signal-to-noise ratio, contrast resolution and the spatial resolution. To perceive structure in a radiographic image, there needs to be sufficient difference between contrasting densities. This primarily depends on the differences in the attenuation of the X-ray beam by adjacent tissues. It is also depends on the signal received; therefore, contrast tends to increase with increased exposure. Given adequate signal and sufficient differences in radiodensity, contrast will be sufficient to differentiate between adjacent structures, irrespective of the recording modality and processing used. Where contrast is not sufficient, digital images can sometimes be post-processed to disclose details that would otherwise go undetected. For example, cephalogram isodensity mapping can improve soft tissue detail.

CONCLUSIONS

It is concluded that it could be a further decade or two before three-dimensional digital imaging systems entirely replace two-dimensional analog films. Such systems need not only to produce prettier images, but also to provide a demonstrable evidence-based higher standard of care at a cost that is not economically prohibitive for the practitioner or society, and which allows efficient and effective workflow within the business of dental practice.

Quality assurance of a system for improved target localization and patient set-up that combines real-time infrared tracking and stereoscopic X-ray imaging

BACKGROUND AND PURPOSE

The aim of this study is to investigate the positional accuracy of a prototype X-ray imaging tool in combination with a real-time infrared tracking device allowing automated patient set-up in three dimensions.

MATERIAL AND METHODS

A prototype X-ray imaging tool has been integrated with a commercially released real-time infrared tracking device. The system, consisting of two X-ray tubes mounted to the ceiling and a centrally located amorphous silicon detector has been developed for automated patient positioning from outside the treatment room prior to treatment. Two major functions are supported: (a) automated fusion of the actual treatment images with digitally reconstructed radiographs (DRRs) representing the desired position; (b) matching of implanted radio opaque markers. Measurements of known translational (up to 30.0mm) and rotational (up to 4.0 degrees ) set-up errors in three dimensions as well as hidden target tests have been performed on anthropomorphic phantoms.

RESULTS

The system's accuracy can be represented with the mean three-dimensional displacement vector, which yielded 0.6mm (with an overall SD of 0.9mm) for the fusion of DRRs and X-ray images. Average deviations between known translational errors and calculations varied from -0.3 to 0.6mm with a standard deviation in the range of 0.6-1.2mm. The marker matching algorithm yielded a three-dimensional uncertainty of 0.3mm (overall SD: 0.4mm), with averages ranging from 0.0 to 0.3mm and a standard deviation in the range between 0.3 and 0.4mm.

CONCLUSIONS

The stereoscopic X-ray imaging device integrated with the real-time infrared tracking device represents a positioning tool allowing for the geometrical accuracy that is required for conformal radiation therapy of abdominal and pelvic lesions, within an acceptable time-frame.

Optimum momentum transfer arguments for x-ray forward scatter imaging

In our research program we have shown through modeling, related numerical calculations, and experimental measurements that there exists a potential use of scattered radiation for medical x-ray imaging. Each incident photon of wavelength lambda which scatters at a small angle theta with respect to its initial direction of travel has a change in momentum characterized by the photon momentum transfer argument x = lambda(-1) sin(theta/2). In this work, we show that in order to maximize the signal-to-noise ratio (SNR) obtained with scattered x rays, one must detect photons with specific x values. Using a photon counting detector to distinguish 2-cm-thick polymethyl methacrylate and nylon targets situated within a 15-cm-diam spherical water phantom with an 80 kV beam yields experimentally SNR/square root(K(air)c) = 12.8 +/- 0.2 (mJ/kg)(-1/2) when using the photons between x = 0.5 and 0.7 nm(-1). Here K(air)c is the air collision kerma and the average momentum transfer argument, x, is calculated by weighting x by the incident photon fluence distribution. The model predicts a value of SNR/square root(K(air)c) = 12.9 (mJ/kg)(-1/2). If we choose to form the signal with the range in x extended to be from 0.5 to 1.0 nm(-1) then, despite the detection of more scattered photons, experimentally SNR/square root(K(air)c) decreases by 38% to 7.9 +/- 0.3 (mJ/kg)(-1/2). The model predicts a value of 9.46 (mJ/kg)(-1/2). Results for energy integrating detectors are in general similar to those for photon counters, but there exist cases where a significant decrease in SNR can occur. For example, for measurements in air with the two plastics at theta = 3 degrees the SNR for an energy integrator was found to be 52% that of a photon counter. Numerical calculations predict that the effects of spectral blur can be significant when a narrow angular range is used for detection. Preliminary numerical predictions for breast tissues suggest a potential use of x-ray scatter in the field of mammography.

Reducing the weight of the EC-L cassette

PURPOSE

To model the EC-L portal film cassette to understand how its weight could be reduced without compromising image quality.

METHODS AND MATERIALS

The BEAM99 Monte Carlo code was used to simulate a 6-MV X-ray beam impinging on a water phantom 15 or 40 cm thick and subsequently reaching image receptors of different designs. The image receptor model included the front cassette wall, lead or copper plates 0-1.2 g/cm(2) in thickness, a Lanex Fast screen pair, and the rear cassette wall. The signal generated in the phosphor screen from primary and scattered photons and charged particles was calculated for all image receptors and for both a water phantom and a water phantom plus bone object. Subject contract was calculated using the formalism of Motz and Danos, and the detective quantum efficiency was calculated using the formalism of Swank. Experimental cassettes with copper plate thicknesses of 0.5, 0.25, and 0.0 mm were used to image patients at several anatomic sites.

RESULTS

Multiple scatter, especially at large field sizes, generates a low-energy X-ray component that can overrespond in the image receptor. The lead plate is more effective in reducing this X-ray scatter component than the copper plate. Filtering of the X-ray beam by the patient hardens the X-ray spectrum of a 6-MV X-ray beam, reducing subject contrast for thick patients. The front wall of the cassette plays an important role in contributing to the signals generated in the image receptor when the thickness of the metal plate is reduced. Over a wide variety of field sizes and patient thicknesses, subject contrast and detective quantum efficiency are relatively independent of metal plate thickness.

CONCLUSIONS

The results suggest that a redesign of the EC-L cassette where the front wall of the cassette becomes part of the image receptor, and where the metal plate is changed to lead and the thickness reduced to 0.2 g/cm(2), would generate images of quality comparable to those of the existing EC-L cassette when used with a 6-MV X-ray beam. This change would reduce the weight of the EC-L cassette by 1040 g.

Vessel imaging by interferometric phase-contrast X-ray technique

BACKGROUND

Phase-contrast x-ray imaging using an x-ray interferometer has great potential to reveal the structures inside soft tissues, because the sensitivity of this method to hydrogen, carbon, nitrogen, and oxygen is approximately 1000 times higher than that of the absorption-contrast x-ray method. Imaging of vessels is very important to understand the vascular distribution of organs and tumors, so the possibility of selective angiography based on phase contrast is examined with a physiological material composed of low-atomic-number elements.

METHODS AND RESULTS

Phase-contrast x-ray imaging was performed with a synchrotron x-ray source. Differences in refractive index, ddelta, of physiological saline, lactated Ringer's solution, 5% glucose, artificial blood such as pyridoxylated hemoglobin-polyoxyethylene conjugate, and perfluorotributylamine were measured. Because the ddelta of physiological saline has highest contrast, it was used for the phase-contrast x-ray imaging of vessel, and this was compared with absorption-contrast x-ray images. Vessels >0.03 mm in diameter of excised liver from rats and a rabbit were revealed clearly in phase-contrast x-ray imaging, whereas the vessel could not be revealed at all by the absorption-contrast x-ray image. Absorption-contrast x-ray images with iodine microspheres depicted only portal veins >0.1 mm in diameter with nearly the same x-ray dose as the present phase-contrast x-ray imaging.

CONCLUSIONS

Phase-contrast x-ray imaging explored clear depiction of the vessels using physiological saline with small doses of x-rays.

Portal imaging

Portal imaging is the acquisition of images with a radiotherapy beam. Imaging theory suggests that the quality of portal images could be much higher if the efficiency of the imaging media in detecting radiation could be improved. Introduction of new media (films and electronic portal imaging devices) has confirmed this by markedly increasing the quality of portal images. Images from these devices can then be used to verify a patient's treatment. Geometric verification requires the portal image to be registered with a reference image. Dosimetric verification requires the portal imager to be calibrated for dose. This review gives a brief overview of the current areas of interest in portal imaging: imaging theory; imaging media, film and electronic portal imaging devices; image registration; and dosimetry using these devices.

Clinical use of electronic portal imaging: report of AAPM Radiation Therapy Committee Task Group 58

AAPM Task Group 58 was created to provide materials to help the medical physicist and colleagues succeed in the clinical implementation of electronic portal imaging devices (EPIDs) in radiation oncology. This complex technology has matured over the past decade and is capable of being integrated into routine practice. However, the difficulties encountered during the specification, installation, and implementation process can be overwhelming. TG58 was charged with providing sufficient information to allow the users to overcome these difficulties and put EPIDs into routine clinical practice. In answering the charge, this report provides; comprehensive information about the physics and technology of currently available EPID systems; a detailed discussion of the steps required for successful clinical implementation, based on accumulated experience; a review of software tools available and clinical use protocols to enhance EPID utilization; and specific quality assurance requirements for initial and continuing clinical use of the systems. Specific recommendations are summarized to assist the reader with successful implementation and continuing use of an EPID.

Assessing the information content of phosphor produced medical images: application to Zn2SiO4:Mn phosphor

In this study a method to assess the information content of medical images produced by phosphors is described. The optical signal emitted by the phosphor after X-ray excitation, the detective quantum efficiency (DQE), expressing the signal-to-noise ratio (SNR) transfer efficiency, and the information capacity were experimentally determined. The method was based on light flux and modulation transfer function (MTF) measurements and was used to assess the imaging performance of the Zn2SiO4:Mn phosphor. The latter was employed in the form of laboratory prepared phosphor layers (test screens). Results showed that high values for optical signal emission and DQE were obtained for medium thickness phosphor layers (56 and 89 mg/cm2) at 20 kVp X-ray tube voltage. The information capacity was found to decrease continuously with phosphor coating weight.

A radiographic and tomographic imaging system integrated into a medical linear accelerator for localization of bone and soft-tissue targets

PURPOSE

Dose escalation in conformal radiation therapy requires accurate field placement. Electronic portal imaging devices are used to verify field placement but are limited by the low subject contrast of bony anatomy at megavoltage (MV) energies, the large imaging dose, and the small size of the radiation fields. In this article, we describe the in-house modification of a medical linear accelerator to provide radiographic and tomographic localization of bone and soft-tissue targets in the reference frame of the accelerator. This system separates the verification of beam delivery (machine settings, field shaping) from patient and target localization.

MATERIALS AND METHODS

A kilovoltage (kV) x-ray source is mounted on the drum assembly of an Elekta SL-20 medical linear accelerator, maintaining the same isocenter as the treatment beam with the central axis at 90 degrees to the treatment beam axis. The x-ray tube is powered by a high-frequency generator and can be retracted to the drum-face. Two CCD-based fluoroscopic imaging systems are mounted on the accelerator to collect MV and kV radiographic images. The system is also capable of cone-beam tomographic imaging at both MV and kV energies. The gain stages of the two imaging systems have been modeled to assess imaging performance. The contrast-resolution of the kV and MV systems was measured using a contrast-detail (C-D) phantom. The dosimetric advantage of using the kV imaging system over the MV system for the detection of bone-like objects is quantified for a specific imaging geometry using a C-D phantom. Accurate guidance of the treatment beam requires registration of the imaging and treatment coordinate systems. The mechanical characteristics of the treatment and imaging gantries are examined to determine a localizing precision assuming an unambiguous object. MV and kV radiographs of patients receiving radiation therapy are acquired to demonstrate the radiographic performance of the system. The tomographic performance is demonstrated on phantoms using both the MV and the kV imaging system, and the visibility of soft-tissue targets is assessed.

RESULTS AND DISCUSSION

Characterization of the gains in the two systems demonstrates that the MV system is x-ray quantum noise-limited at very low spatial frequencies; this is not the case for the kV system. The estimates of gain used in the model are validated by measurements of the total gain in each system. Contrast-detail measurements demonstrate that the MV system is capable of detecting subject contrasts of less than 0.1% (at 6 and 18 MV). A comparison of the kV and MV contrast-detail performance indicates that equivalent bony object detection can be achieved with the kV system at significantly lower doses (factors of 40 and 90 lower than for 6 and 18 MV, respectively). The tomographic performance of the system is promising; soft-tissue visibility is demonstrated at relatively low imaging doses (3 cGy) using four laboratory rats.

CONCLUSIONS

We have integrated a kV radiographic and tomographic imaging system with a medical linear accelerator to allow localization of bone and soft-tissue structures in the reference frame of the accelerator. Modeling and experiments have demonstrated the feasibility of acquiring high-quality radiographic and tomographic images at acceptable imaging doses. Full integration of the kV and MV imaging systems with the treatment machine will allow on-line radiographic and tomographic guidance of field placement.

Analysis of spectral blur effects in x-ray scatter imaging

Previous analysis in our research program investigating the potential use of scattered photons for medical x-ray imaging has been for monoenergetic beams. In practice, polyenergetic beams are almost always used due to their higher photon fluence rate. The effects of beam polychromaticity on x-ray scatter imaging are determined with the aid of our semianalytic model that images a target object against a background material of the same dimensions when both are situated within a water phantom. Our analysis involves four different photon beams with constant incident energy fluence: (1) a monoenergetic beam with photon energy E0, (2) a dual peak beam with two separate monoenergetic peaks of energies E1 and E2, (3) a clinical x-ray beam, and (4) a rectangular beam with uniform energy fluence between energies Emin and Emax. A comparison between the polyenergetic spectra is accomplished by matching the centroids and standard deviations of the dual peak and rectangular spectra to those of the clinical x-ray spectrum. For the task of imaging liver versus fat structures 1 cm thick in a 25-cm-diam spherical water phantom with the scattered photons between 2 degrees and 12 degrees, the predicted signal-to-noise ratio (SNR) obtained with a 100 kV beam is 87.5% of the SNR acquired with the optimum monoenergetic beam (SNRopt). The SNR for the corresponding dual peak beam is 84.4% of SNRopt and for the rectangular beam is 86.3%. Our analysis shows that monoenergetic x-ray beams are not necessary for x-ray scatter imaging.

The effect of the antiscatter grid on full-field digital mammography phantom images

Computer Analysis of Mammography Phantom Images (CAMPI) is a method for making quantitative measurements of image quality. This article reports on a recent application of this method to a prototype full-field digital mammography (FFDM) machine. Images of a modified ACR phantom were acquired on the General Electric Diagnostic Molybdenum Rhodium (GE-DMR) FFDM machine at a number of x-ray techniques, both with and without the scatter reduction grid. The techniques were chosen so that one had sets of grid and non-grid images with matched doses (200 mrads) and matched gray-scale values (1500). A third set was acquired at constant 26 kVp and varying mAs for both grid conditions. Analyses of the images yielded signal-to-noise-ratio (SNR), contrast and noise corresponding to each target object, and a non-uniformity measure. The results showed that under conditions of equal gray-scale value the grid images were markedly superior, albeit at higher doses than the non-grid images. Under constant dose conditions, the non-grid images were slightly superior in SNR (7%) but markedly less uniform (60%). Overall, the grid images had substantially greater contrast and superior image uniformity. These conclusions applied to the whole kVp range studied for the Mo-Mo target filter combination and 4 cm of breast equivalent material of average composition. These results suggest that use of the non-grid technique in digital mammography with the GE-DMR-FFDM unit, is presently not warranted. With improved uniformity correction procedure, this conclusion would change and one should be able to realize a 14% reduction in patient dose at the same SNR by using a non-grid technique.

A search for improved technique factors in paediatric fluoroscopy

A Monte Carlo computational model of a fluoroscopic imaging chain was used for deriving optimal technique factors for paediatric fluoroscopy. The optimal technique was defined as the one that minimizes the absorbed dose (or dose rate) in the patient with a constraint of constant image quality. Image quality was assessed for the task of detecting a detail in the image of a patient-simulating phantom, and was expressed in terms of the ideal observer's signal-to-noise ratio (SNR) for static images and in terms of the accumulating rate of the square of SNR for dynamic imaging. The entrance air kerma (or air kerma rate) and the mean absorbed dose (or dose rate) in the phantom quantified radiation detriment. The calculations were made for homogeneous phantoms simulating newborn, 3-, 10- and 15-year-old patients, barium and iodine contrast material details, several x-ray spectra, and for imaging with or without an antiscatter grid. The image receptor was modelled as a CsI x-ray image intensifier (XRII). For the task of detecting low- or moderate-contrast iodine details, the optimal spectrum can be obtained by using an x-ray tube potential near 50 kV and filtering the x-ray beam heavily. The optimal tube potential is near 60 kV for low- or moderate-contrast barium details, and 80-100 kV for high-contrast details. The low-potential spectra above require a high tube load, but this should be acceptable in paediatric fluoroscopy. A reasonable choice of filtration is the use of an additional 0.25 mm Cu, or a suitable K-edge filter. No increase in the optimal tube potential was found as phantom thickness increased. With the constraint of constant low-contrast detail detectability, the mean absorbed doses obtained with the above spectra are approximately 50% lower than those obtained with the reference conditions of 70 kV and 2.7 mm Al filter. For the smallest patient and x-ray field size, not using a grid was slightly more dose-efficient than using a grid, but when the patient size and field size were increased a fibre interspaced grid resulted in lower doses than imaging without a grid. For a 15-year-old patient the mean absorbed doses were up to 40% lower with this grid than without the grid.

A Monte Carlo study of grid performance in diagnostic radiology: task-dependent optimization for digital imaging

A Monte Carlo computational model has been used to optimize grid design in digital radiography. The optimization strategy involved finding grid designs that, for a constant signal-to-noise ratio, resulted in the lowest mean absorbed dose in the patient. Different examinations were simulated to explore the dependence of the optimal scatter-rejection technique on the imaging situation. A large range of grid designs was studied, including grids with both aluminium and fibre interspaces and covers, and compared to a 20 cm air gap. The results show that the optimal tube potential in each examination does not depend strongly on the scatter-rejection technique. There is a significant dose reduction associated with the use of fibre-interspaced grids, particularly in paediatric radiography. The optimal grid ratio and strip width increase with increasing scattering volume. With increasing strip density, the optimal strip width decreases, and the optimal grid ratio increases. Optimal grid ratios are higher than those used today, particularly for grids with large strip density. It is, however, possible to identify grids of good performance for a range of strip densities and grid ratios provided the strip width is selected accordingly. The computational method has been validated by comparison with measurements with a caesium iodide image receptor.

Use of the concept of energy imparted in diagnostic radiology

The concept of energy imparted by ionizing radiation to the matter in a volume is analyzed and methods to determine the energy imparted epsilon to the patient are reviewed, in particular, determinations based on measurements of the air kerma integrated over beam area [the kerma-area-product (KAP)] and calculations needed to derive conversion factors epsilon/KAP. The energy imparted to the image receptor, epsilon rec, including the statistical aspects of the concept, and the effect of epsilon rec on image quality and patient dose are also analysed. Finally, use of the energy imparted to the patient as a risk indicator is discussed.

An investigation of the imaging characteristics of the Y2O2S:Eu3+ phosphor for application in X-ray detectors of digital mammography

Y2O2S:Eu laboratory prepared screens were evaluated as mammographic image receptors and were compared to similarly prepared screens of Gd2O2S:Tb and Y2O2S:Tb phosphor materials, often used in X-ray imaging detectors. The evaluation was performed by determining the Modulation Transfer Function (MTF) and the spatial frequency dependent Detective Quantum Efficiency (DQE). Y2O2S:Eu exhibited higher DQE values at low frequencies and given its good spectral matching with digital optical detectors, it may be appropriate for use in X-ray digital mammography.

A semianalytic model to investigate the potential applications of x-ray scatter imaging

Although x-ray scatter is generally regarded as a nuisance that reduces radiographic contrast (C) and the signal-to-noise ratio (SNR) in conventional images, many technologies have been devised to extract useful information from the scattered x rays. A systematic approach, however, for analyzing the potential applications of x-ray scatter imaging has been lacking. Therefore, we have formulated a simple but useful semianalytic model to investigate C and SNR in scatter images. Our model considers the imaging of a target object against a background material of the same dimensions when both are situated within a water phantom. We have selected biological materials (liver, fat, bone, muscle, blood, and brain matter) for which intermolecular form factors for coherent scattering were available. Analytic relationships between C and SNR were derived, and evaluated numerically as the target object thickness (0.01-40 mm) and photon energy (10-200 keV) were systematically varied. The fundamental limits of scatter imaging were assessed via calculations that assumed that all first-order scatter exiting the phantom, over 4 pi steradians, formed the signal. Calculations for a restricted detector solid angle were then performed. For the task of imaging white brain matter versus blood in a 15 cm thick water phantom, the maximum SNR, over all energies, for images based on the detection of all forward scatter within the angular range 2 degrees-12 degrees is greater than that of primary images for target object thicknesses < or = 23 mm. Use of the backscattered x rays within the range 158 degrees-178 degrees to image objects 3 cm below the surface of a 25 cm thick water phantom allows the liver to be distinguished from fat with a SNR superior to that of primary imaging when the objects are < or = 22 mm thick. Our analysis confirms the usefulness of scattered x rays, and provides simple methods for determining the regimes of medical interest in which x-ray scatter imaging could outperform conventional imaging.

Laser-based microfocused x-ray source for mammography: feasibility study

A laser-produced plasma (LPP) x-ray source with possible application in mammography was created by focusing a laser beam on a Mo target. A Table-Top-Terawatt (TTT) laser operating at 1 J energy per pulse was employed. A dual pulse technique was used. Maximum energy transfer (approximately 10%) from laser light to hot electrons was reached at a 150 ps delay between pulses and the conversion efficiency (hard x-ray yield/laser energy input) was approximately 2 x 10(-4). The created LPP x-ray source is characterized by a very small focal spot size (tens of microns), Gaussian brightness distribution, and a very short pulse duration (a few ps). The spectral distribution of the generated x rays was measured. Images of the focal spot, using a pinhole camera, and images of a resolution pattern and a mammographic phantom were obtained. The LPP focal spot modulation transfer function for different magnification factors was calculated. We have shown that the LPP source in conjunction with a spherically bent, high throughput, crystal monochromator in a fixed-exit Rowland circle configuration can be used to created a narrow band tunable mammography system. Tunability to a specific patient breast tissue thickness and density would allow one to significantly improve contrast and resolution (exceeding 20 lp/mm) while lowering the exposure up to 50% for thicker breasts. The prospects for the LPP x-ray source for mammographic application are discussed.

Advanced imaging methods

Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. New approaches for intra-oral radiography allow investigators to conduct densitometric assessments of dento-alveolar structures. Longitudinal changes in alveolar bone can be studied by computer-assisted image analysis programs. These techniques have been applied to dimensional analysis of the alveolar crest, detection of gain or loss of alveolar bone density, peri-implant bone healing, and caries detection. Dental applications of computed tomography (CT) include the detailed radiologic anatomy of alveolar processes, orofacial soft tissues and air spaces, and developmental defects. Image analysis software permits bone mass mineralization to be quantified by means of CT data. CT has also been used to study salivary gland disease, injuries of the facial skeleton, and dental implant treatment planning. Magnetic resonance imaging (MRI) has been used extensively in retrospective and prospective studies of internal derangements of the temporomandibular joint. Assessments based on MRI imaging of the salivary glands, paranasal sinuses, and cerebrovascular disease have also been reported. Magnetic resonance spectroscopy (MRS) has been applied to the study of skeletal muscle, tumors, and to monitor the healing of grafts. Nuclear imaging provides a sensitive technique for early detection of physiological changes in soft tissue and bone. It has been used in studies of periodontitis, osteomyelitis, oral and maxillofacial tumors, stress fractures, bone healing, temporomandibular joint, and blood flow. This article includes brief descriptions of the technical principles of each imaging modality, reviews their previous uses in oral biology research, and discusses potential future applications in research protocols.

Intraoral storage phosphor radiography for approximal caries detection and effect of image magnification: comparison with conventional radiography

OBJECTIVES

The aim of this study was first to test the newly developed storage phosphor (SP) system Digora for diagnostic accuracy of approximal caries detection with special emphasis on image magnification compared with conventional radiography, and second, to test whether the image surroundings could have an influence on observer performance.

DESIGN

SP plates and Ektaspeed films were exposed simultaneously to 50 extracted premolars/molars, and the SP image files were transported to a different platform for processing. Ten observers rated 95 approximal surfaces for caries with four imaging modalities: (1) SP images at dental film size viewed with black surroundings, (2) magnified (x4) images viewed in the same manner, (3) magnified (x4) images viewed with text and graphics framing, and (4) films viewed on a light box. The observations were validated with microscopy. Diagnostic accuracy was calculated as the area beneath the receiver operating characteristic curve (AZ).

RESULTS

No significant differences were found between SP images and films. Magnified SP images with text and graphics demonstrated significantly higher AZ values than nonmagnified images both for enamel and dentin, and magnified images with black surroundings demonstrated similar results for dentin.

CONCLUSIONS

In this in vitro material the observer performance for approximal caries detection with SP images was comparable to that with Ektaspeed films. The magnified SP images generally showed a significantly higher diagnostic accuracy than the nonmagnified SP images.

Dual-beam imaging for online verification of radiotherapy field placement

PURPOSE

Due to the poor quality of megavoltage (MV) radiographs, detection and assessment of discrepancies in radiation field placement are difficult. Furthermore, the high imaging dose required to produce the megavoltage radiograph prohibits frequent image acquisition, particularly for those fields that require the use of an "open-field" exposure. For these small, or conformal, radiation fields, an alternate method of verifying field placement is required if the out-of-field dose is to be minimized. An open-field image acquired with a kilovoltage (kV) source would (a) deliver a very low patient dose, (b) increase the visibility of bony landmarks, and (c) simplify intercomparison of portal and prescription images. This article describes the development of a dual-beam imaging system that produces diagnostic quality "double-exposure" portal images for verifying radiation field placement.

METHODS AND MATERIALS

The dual-beam system consists of a kV x-ray tube mounted on the gantry of a medical linear accelerator. The kV beam shares the same isocenter (+/- 1 mm) as the treatment beam but is at 45 degrees to the central axis. Both the kilovoltage and megavoltage images are collected with a fluoroscopic imaging system that uses a low-noise CCD camera to accumulate the light emitted from a phosphor screen. Two 45 degrees mirrors are used to remove the CCD camera from the x-ray beam. The light integration on the CCD array is controlled by a mechanical shutter, allowing easy synchronization with the radiation exposures. The camera is shielded by a lead housing to reduce the number of x-rays reaching the CCD array. A conventional thickness phosphor screen is used for both the kV and MV exposures. In the dual-beam imaging procedure, an open-field kV radiograph is acquired with the patient in treatment position. Immediately following, a MV image is acquired with the beam-defining blocks in position. Summation of the two images produces an online double-exposure image. The anatomical information in either the kV or MV image can be emphasized by weighting the images appropriately. This system was used to acquire MV and kV images of both a contrast-detail phantom and a Rando head phantom. Dual-beam images were also acquired for a pituitary treatment, demonstrating the feasibility and usefulness of the dual-beam technique.

RESULTS

Analysis of the contrast-detail images produced with the MV and kV beams shows the expected advantage of using the kV x-ray beam. Images of a Rando head phantom confirm these results. A clinical demonstration of the dual-beam system for verifying the delivery of a pituitary field is shown. The quality of the dual-beam image is similar to the prescription (simulation) image, contains a larger anatomical region, and delivers a lower integral dose to the patient. In addition, the kV beam also enhances the visibility of small markers implanted in the prostate.

CONCLUSIONS

A dual-beam imaging system has been developed for the radiographic verification of small, conformal fields. This development demonstrates the advantages and feasibility of using a kV x-ray beam in combination with the treatment beam to improve the accuracy of detecting patient setup errors.

Technical note: digital radiographic pelvimetry--a novel, low dose, accurate technique

A technique is described for lateral pelvimetry which results in a lower radiation dose than that resulting from conventional film-screen pelvimetry and computed tomography (CT) pelvimetry. It uses digital radiographic imaging thereby closely matching conventional techniques yet additionally providing post-processing facilities including distance measurement and contrast adjustment. The digital technique was evaluated with an anthropomorphic phantom and compared with the conventional technique by measuring entrance surface doses on two groups of post-natal patients. Digital radiography gave radiation doses 10 times lower than those using conventional techniques.

Evaluation of image quality in fluoroscopy by measurements and Monte Carlo calculations

We have studied image quality in fluoroscopy, as related to the detectability of low-contrast iodine or acrylic (PMMA) details added to a homogeneous 20 cm thick PMMA phantom, by experimental measurements of the signal-to-noise ratio (SNR) and by Monte Carlo calculation. The agreement between the measured and calculated SNR at equal absorbed dose in the phantom showed that the imaging performance of x-ray image intensifier (XRII) based fluoroscopic systems is well understood and can be mainly accounted for by x-ray attenuation in the phantom and the detail, and by the interaction statistics of primary and secondary (scattered) x-ray quanta in the input phosphor of the XRII. The electronic noise sources in the video chain had only a small effect on the detectability of the details studied here. The optimal x-ray tube potential was 50-60 kV for detecting the low-contrast iodine detail in the phantom, and 70-100 kV for detecting the thin PMMA detail. For the task of detecting the iodine detail the use of a fibre-interspaced antiscatter grid improved the dose-to-information conversion efficiency of the imaging system by a factor of 2.2 as compared to imaging without the grid, and additional filtering of the x-ray beam by 0.25 mm Cu increased the efficiency by a factor of 1.6. Monte Carlo results were further used to estimate the potential of increasing the dose-to-information conversion efficiency by imaging system design changes. For the detection task of a static, low-contrast, low-spatial-frequency iodine contrast material detail embedded in a 20 cm thick soft-tissue phantom, the greatest contributions for further improvement could be achieved by improved antiscatter devices, x-ray spectrum modification, and by decreasing the absorption in the material layers in front of the CsI phosphor of the XRII. Contrary to this, no significant efficiency increase could be obtained by increasing the CsI phosphor coating thickness from the present value of 180 mg cm-2, or by changes in the video chain characteristics. The maximum potential of efficiency improvement is a factor of 6.3 when compared to the reference fluoroscopy system operated at 60 kV with 2.7 mm Al primary beam filtration, and a factor of 3.9 when compared to the reference system at 50 kV with the primary beam filtration added by 0.25 mm Cu.

A comparison of radiation dose in examination of the abdomen using different radiological imaging techniques

Typical radiation doses for abdominal examinations were determined for field sizes and entrance doses commonly selected on image intensifier based digital radiographic systems. In addition, measurements were also performed using conventional film-screen methods, a 100 mm camera combination and a phosphor storage computed radiography system. Both antero-posterior and postero-anterior projections were assessed. An anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosimeters was used to measure entrance surface doses. Organ equivalent doses, deduced using normalized organ dose data, were used to calculate effective dose and effective dose equivalent. A comparison of the imaging techniques on the basis of effective dose indicated that significant dose reductions (by approximately a factor of 3) may be expected if the abdomen is imaged using a postero-anterior rather than an antero-posterior projection for a given imaging system. If digital imaging systems are used instead of a conventional film-screen technique, patient effective dose for a given projection can be lower by at least a factor of 5.