IMAGE QUALITY AND POTENTIAL DOSE REDUCTION USING ADVANCED MODELED ITERATIVE RECONSTRUCTION (ADMIRE) IN ABDOMINAL CT - A REVIEW

Traditional filtered back projection (FBP) reconstruction methods have served the computed tomography (CT) community well for over 40 years. With the increased use of CT during the last decades, efforts to minimise patient exposure, while maintaining sufficient or improved image quality, have led to the development of model-based iterative reconstruction (MBIR) algorithms from several vendors. The usefulness of the advanced modeled iterative reconstruction (ADMIRE) (Siemens Healthineers) MBIR in abdominal CT is reviewed and its noise suppression and/or dose reduction possibilities explored. Quantitative and qualitative methods with phantom and human subjects were used. Assessment of the quality of phantom images will not always correlate positively with those of patient images, particularly at the higher strength of the ADMIRE algorithm. With few exceptions, ADMIRE Strength 3 typically allows for substantial noise reduction compared to FBP and hence to significant (≈30%) patient dose reductions. The size of the dose reductions depends on the diagnostic task.

ACCURATE KAP METER CALIBRATION AS A PREREQUISITE FOR OPTIMISATION IN PROJECTION RADIOGRAPHY

Modern X-ray units register the air kerma-area product, PKA, with a built-in KAP meter. Some KAP meters show an energy-dependent bias comparable with the maximum uncertainty articulated by the IEC (25 %), adversely affecting dose-optimisation processes. To correct for the bias, a reference KAP meter calibrated at a standards laboratory and two calibration methods described here can be used to achieve an uncertainty of <7 % as recommended by IAEA. A computational model of the reference KAP meter is used to calculate beam quality correction factors for transfer of the calibration coefficient at the standards laboratory, Q0, to any beam quality, Q, in the clinic. Alternatively, beam quality corrections are measured with an energy-independent dosemeter via a reference beam quality in the clinic, Q1, to beam quality, Q Biases up to 35 % of built-in KAP meter readings were noted. Energy-dependent calibration factors are needed for unbiased PKA Accurate KAP meter calibration as a prerequisite for optimisation in projection radiography.

AUTOMATIC SEGMENTATION OF PELVIS FOR BRACHYTHERAPY OF PROSTATE

Advanced model-based iterative reconstruction algorithms in quantitative computed tomography (CT) perform automatic segmentation of tissues to estimate material properties of the imaged object. Compared with conventional methods, these algorithms may improve quality of reconstructed images and accuracy of radiation treatment planning. Automatic segmentation of tissues is, however, a difficult task. The aim of this work was to develop and evaluate an algorithm that automatically segments tissues in CT images of the male pelvis. The newly developed algorithm (MK2014) combines histogram matching, thresholding, region growing, deformable model and atlas-based registration techniques for the segmentation of bones, adipose tissue, prostate and muscles in CT images. Visual inspection of segmented images showed that the algorithm performed well for the five analysed images. The tissues were identified and outlined with accuracy sufficient for the dual-energy iterative reconstruction algorithm whose aim is to improve the accuracy of radiation treatment planning in brachytherapy of the prostate.

ASSESSING THE USEFULNESS OF THE QUASI-IDEAL OBSERVER FOR QUALITY CONTROL IN FLUOROSCOPY

The aim of this work was to evaluate the reliability of the square of the signal-to-noise ratio rate, [Formula: see text], as a precise measurement for quality control test in a digital fluoroscopy system. The quasi-ideal model observer was used to measure [Formula: see text] The dose rate, pulse rate and field of view were varied, and their effect on dose efficiency, defined as [Formula: see text], was evaluated (where [Formula: see text] is the air kerma-area product rate). Measurements were repeated to assess reproducibility. The relative standard deviation in [Formula: see text] over seven consecutive measurements was 5 %. No significant variation in [Formula: see text] was observed across different pulse rates (10-30 pulses s(-1)). The low-dose-rate setting had a superior dose efficiency compared with the medium- and high-dose-rate settings. A smaller field of view resulted in higher dose efficiency.The results show that [Formula: see text] measurements offer the high precision required in quality control constancy tests.

VERIFICATION OF INDICATED SKIN ENTRANCE AIR KERMA FOR CARDIAC X-RAY-GUIDED INTERVENTION USING GAFCHROMIC FILM

The aim of this work was to verify the indicated maximum entrance surface air kerma (ESAK) using a GE Innova IGS 520 imaging system during cardiac interventional procedures. Gafchromic XR RV3 films were used for the patient measurements to monitor the maximum ESAK. The films were scanned and calibrated to measure maximum ESAK. Thermoluminescent dosemeters were used to measure the backscatter factor from an anthropomorphic thorax phantom. The measured backscatter factor, 1.53, was in good agreement with Monte Carlo simulations but higher than the one used by the imaging system, 1.20. The median of the ratio between indicated maximum ESAK and measured maximum ESAK was 0.68. In this work, the indicated maximum ESAK by the imaging system's dose map model underestimates the measured maximum ESAK by 32 %. The threshold ESAK for follow-up procedures for patient with skin dose in excess of 2 Gy will be reduced to 1.4 Gy.

PARALLELISATION OF THE MODEL-BASED ITERATIVE RECONSTRUCTION ALGORITHM DIRA

New paradigms for parallel programming have been devised to simplify software development on multi-core processors and many-core graphical processing units (GPU). Despite their obvious benefits, the parallelisation of existing computer programs is not an easy task. In this work, the use of the Open Multiprocessing (OpenMP) and Open Computing Language (OpenCL) frameworks is considered for the parallelisation of the model-based iterative reconstruction algorithm DIRA with the aim to significantly shorten the code's execution time. Selected routines were parallelised using OpenMP and OpenCL libraries; some routines were converted from MATLAB to C and optimised. Parallelisation of the code with the OpenMP was easy and resulted in an overall speedup of 15 on a 16-core computer. Parallelisation with OpenCL was more difficult owing to differences between the central processing unit and GPU architectures. The resulting speedup was substantially lower than the theoretical peak performance of the GPU; the cause was explained.

In-situ calibration of clinical built-in KAP meters with traceability to a primary standard using a reference KAP meter

The air kerma-area product (KAP) is used for settings of diagnostic reference levels. The International Atomic Energy Agency (IAEA) recommends that doses in diagnostic radiology (including the KAP values) be estimated with an accuracy of at least ± 7% (k = 2). Industry standards defined by the International Electrotechnical Commission (IEC) specify that the uncertainty of KAP meter measurements should be less than ± 25% (k = 2). Medical physicists willing to comply with the IAEA's recommendation need to apply correction factors to KAP values reported by x-ray units. The aim of this work is to present and evaluate a calibration method for built-in KAP meters on clinical x-ray units. The method is based on (i) a tandem calibration method, which uses a reference KAP meter calibrated to measure the incident radiation, (ii) measurements using an energy-independent ionization chamber to correct for the energy dependence of the reference KAP meter, and (iii) Monte Carlo simulations of the beam quality correction factors that correct for differences between beam qualities at a standard laboratory and the clinic. The method was applied to the KAP meter in a Siemens Aristos FX plus unit. It was found that values reported by the built-in KAP meter differed from the more accurate values measured by the reference KAP meter by more than 25% for high tube voltages (more than 140 kV) and heavily filtered beams (0.3 mm Cu). Associated uncertainties were too high to claim that the IEC's limit of 25% was exceeded. Nevertheless the differences were high enough to justify the need for a more accurate calibration of built-in KAP meters.

Quantifying the potential for dose reduction with visual grading regression

Objectives To propose a method to study the effect of exposure settings on image quality and to estimate the potential for dose reduction when introducing dose-reducing measures. Methods Using the framework of visual grading regression (VGR), a log(mAs) term is included in the ordinal logistic regression equation, so that the effect of reducing the dose can be quantitatively related to the effect of adding post-processing. In the ordinal logistic regression, patient and observer identity are treated as random effects using generalised linear latent and mixed models. The potential dose reduction is then estimated from the regression coefficients. The method was applied in a single-image study of coronary CT angiography (CTA) to evaluate two-dimensional (2D) adaptive filters, and in an image-pair study of abdominal CT to evaluate 2D and three-dimensional (3D) adaptive filters. Results For five image quality criteria in coronary CTA, dose reductions of 16-26% were predicted when adding 2D filtering. Using five image quality criteria for abdominal CT, it was estimated that 2D filtering permits doses were reduced by 32-41%, and 3D filtering by 42-51%. Conclusions VGR including a log(mAs) term can be used for predictions of potential dose reduction that may be useful for guiding researchers in designing subsequent studies evaluating diagnostic value. With appropriate statistical analysis, it is possible to obtain direct numerical estimates of the dose-reducing potential of novel acquisition, reconstruction or post-processing techniques.

Quantifying the potential for dose reduction with visual grading regression

OBJECTIVES

To propose a method to study the effect of exposure settings on image quality and to estimate the potential for dose reduction when introducing dose-reducing measures.

METHODS

Using the framework of visual grading regression (VGR), a log(mAs) term is included in the ordinal logistic regression equation, so that the effect of reducing the dose can be quantitatively related to the effect of adding post-processing. In the ordinal logistic regression, patient and observer identity are treated as random effects using generalised linear latent and mixed models. The potential dose reduction is then estimated from the regression coefficients. The method was applied in a single-image study of coronary CT angiography (CTA) to evaluate two-dimensional (2D) adaptive filters, and in an image-pair study of abdominal CT to evaluate 2D and three-dimensional (3D) adaptive filters.

RESULTS

For five image quality criteria in coronary CTA, dose reductions of 16-26% were predicted when adding 2D filtering. Using five image quality criteria for abdominal CT, it was estimated that 2D filtering permits doses were reduced by 32-41%, and 3D filtering by 42-51%.

CONCLUSIONS

VGR including a log(mAs) term can be used for predictions of potential dose reduction that may be useful for guiding researchers in designing subsequent studies evaluating diagnostic value. With appropriate statistical analysis, it is possible to obtain direct numerical estimates of the dose-reducing potential of novel acquisition, reconstruction or post-processing techniques.

Bedside monitoring of CBF with xenon-CT and a mobile scanner: a novel method in neurointensive care

Combining previously independently established techniques our objective was to develop and evaluate a method for bedside qualitative assessment of cerebral blood flow in neurointensive care (NICU) patients. The CT-protocol was optimized using phantoms and comparing a mobile CT-scanner (Tomoscan-M, Philips) with two stationary CT scanners. Thirty-two per cent xenon was delivered with standard equipment (Enhancer 3000). Mean cortical flow in volunteers was 48 ml/min/100 g, with the mean vascular territorial flow varying between 45 and 66 ml/min/100 g. The potential clinical usefulness was illustrated in three patients with vasospasm following subarachnoid haemorrhage. Our conclusion is that quantitative bedside measurements of CBF can be repeatedly performed in an easy and safe way in a standard NICU-setting, using xenon-inhalation and a mobile CT-scanner. The method is useful for the decision-making, and is a good example of how the quality of multi-modality monitoring in the NICU can be developed and further diversified.

Breast dosimetry using high-resolution voxel phantoms

A computer model of X-ray mammography has been developed, which uses quasi-realistic high-resolution voxel phantoms to simulate the breast. The phantoms have 400 microm voxels and simulate the three-dimensional distributions of adipose and fibro-glandular tissues, Cooper's ligaments, ducts and skin and allow the estimation of dose to individual tissues. Calculations of the incident air kerma to mean glandular dose conversion factor, g, were made using a Mo/Mo spectrum at 28 kV for eight phantoms in the thickness range 40-80 mm and of varying glandularity. The values differed from standard tabulations used for breast dosimetry by up to 43%, because of the different spatial distribution of glandular tissue within the breast. To study this further, additional voxel phantoms were constructed, which gave variations of between 9 and 59% compared with standard values. For accurate breast dosimetry, it is therefore very important to take the distribution of glandular tissues into account.

Calculation of the properties of digital mammograms using a computer simulation

A Monte Carlo computer model of mammography has been developed to study and optimise the performance of digital mammographic systems. The program uses high-resolution voxel phantoms to model the breast, which simulate the adipose and fibroglandular tissues, Cooper's ligaments, ducts and skin in three dimensions. The model calculates the dose to each tissue, and also the quantities such as energy imparted to image pixels, noise per image pixel and scatter-to-primary (S/P) ratios. It allows studies of the dependence of image properties on breast structure and on position within the image. The program has been calibrated by calculating and measuring the pixel values and noise for a digital mammographic system. The thicknesses of two components of this system were unknown, and were adjusted to obtain a good agreement between measurement and calculation. The utility of the program is demonstrated with the calculations of the variation of the S/P ratio with and without a grid, and of the image contrast across the image of a 50-mm-thick breast phantom.

Monte Carlo simulation of a mammographic test phantom

A test phantom, including a wide range of mammographic tissue equivalent materials and test details, was imaged on a digital mammographic system. In order to quantify the effect of scatter on the contrast obtained for the test details, calculations of the scatter-to-primary ratio (S/P) have been made using a Monte Carlo simulation of the digital mammographic imaging chain, grid and test phantom. The results show that the S/P values corresponding to the imaging conditions used were in the range 0.084-0.126. Calculated and measured pixel values in different regions of the image were compared as a validation of the model and showed excellent agreement. The results indicate the potential of Monte Carlo methods in the image quality-patient dose process optimisation, especially in the assessment of imaging conditions not available on standard mammographic units.

Influence of the characteristic curve on the clinical image quality of lumbar spine and chest radiographs

The "European Guidelines on Quality Criteria for Diagnostic Radiographic Images" do not address the choice of the film characteristic (H&D) curve, which is an important parameter for the description of a radiographic screen-film system. The image contrast of clinical lumbar spine and chest radiographs was altered by digital image processing techniques, simulating images with different H&D curves, both steeper and flatter than the original. The manipulated images were printed on film for evaluation. Seven experienced radiologists evaluated the clinical image quality by analysing the fulfilment of the European Image Criteria (ICS) and by visual grading analysis (VGA) of in total 224 lumbar spine and 360 chest images. A parallel study of the effect of the H&D curve has also been made using a theoretical model. The contrast (DeltaOD) of relevant anatomical details was calculated, using a Monte Carlo simulation-model of the complete imaging system including a 3D voxel phantom of a patient. Correlations between the calculated contrast and the radiologists' assessment by VGA were sought. The results of the radiologists' assessment show that the quality in selected regions of lumbar spine and chest images can be significantly improved by the use of films with a steeper H&D curve compared with the standard latitude film. Significant (p<0.05) correlations were found between the VGA results and the calculations of the contrast of transverse processes and trabecular details in the lumbar spine vertebrae, and with the contrast of blood vessels in the retrocardiac area of the chest.

A study and optimization of lumbar spine X-ray imaging systems

A Monte Carlo program has been developed that incorporates a voxel phantom of an adult patient in a model of the complete X-ray imaging system, including the anti-scatter grid and screen-film receptor. This allows the realistic estimation of patient dose and the corresponding image (optical density map) for a wide range of equipment configurations. This paper focuses on the application of the program to lumbar spine anteroposterior and lateral screen-film examinations. The program has been applied to study the variation of physical image quality measures and effective dose for changing system parameters such as tube voltage, grid design and screen-film system speed. These variations form the basis for optimization of these system parameters. In our approach to optimization, the best systems are those that can match (or come close to) the calculated image quality measure of systems preferred in a recent European clinical trial, but with lower patient dose. The largest dose savings found were 21% for a 400 speed class system with a grid having a strip density of 40 cm(-1) and a grid ratio of 16. A further dose saving of 13% was possible when a 600 speed class system was employed. The best systems found from the optimization correspond to those recommended by the European Commission guidelines on image quality criteria for diagnostic radiographic images.

Schemes for the optimization of chest radiography using a computer model of the patient and x-ray imaging system

A computer program has been developed to model chest radiography. It incorporates a voxel phantom of an adult and includes antiscatter grid, radiographic screen, and film. Image quality is quantified by calculating the contrast (deltaOD) and the ideal observer signal-to-noise ratio (SNR(I)) for a number of relevant anatomical details at various positions in the anatomy. Detector noise and system unsharpness are modeled and their influence on image quality is considered. A measure of useful dynamic range is computed and defined as the fraction of the image that is reproduced at an optical density such that the film gradient exceeds a preset value. The effective dose is used as a measure of the radiation risk for the patient. A novel approach to patient dose and image quality optimization has been developed and implemented. It is based on a reference system acknowledged to yield acceptable image quality in a clinical trial. Two optimizations schemes have been studied, the first including the contrast of vessels as measure of image quality and the second scheme using also the signal-to-noise ratio of calcifications. Both schemes make use of our measure of useful dynamic range as a key quantity. A large variety of imaging conditions was simulated by varying the tube voltage, antiscatter device, screen-film system, and maximum optical density in the computed image. It was found that the optical density is crucial in screen-film chest radiography. Significant dose savings (30%-50%) can be accomplished without sacrificing image quality by using low-atomic-number grids with a low grid ratio or an air gap and more sensitive screen-film system. Dose-efficient configurations proposed by the model agree well with the example of good radiographic technique suggested by the European Commission.

Demonstration of correlations between clinical and physical image quality measures in chest and lumbar spine screen-film radiography

The ability to predict clinical image quality from physical measures is useful for optimization in diagnostic radiology. In this work, clinical and physical assessments of image quality are compared and correlations between the two are derived. Clinical assessment has been made by a group of expert radiologists who evaluated fulfillment of the European image criteria for chest and lumbar spine radiography using two scoring methods: image criteria score (ICS) and visual grading analysis score (VGAS). Physical image quality measures were calculated using a Monte Carlo simulation model of the complete imaging system. This model includes a voxelized male anatomy and was used to calculate contrast and signal-to-noise ratio of various important anatomical details and measures of dynamic range. Correlations between the physical image quality measures on the one hand and the ICS and VGAS on the other were sought. 16 chest and 4 lumbar spine imaging system configurations were compared in frontal projection. A statistically significant correlation with clinical image quality was found in chest posteroanterior radiography for the contrast of blood vessels in the retrocardiac area and a measure of useful dynamic range. In lumbar spine anteroposterior radiography, a similar significant correlation with clinical image quality was found between the contrast and signal-to-noise ratio of the trabecular structures in the L1-L5 vertebrae. The significant correlation shows that clinical image quality can, at least in some cases, be predicted from appropriate measures of physical image quality.

Influence of anode/filter material and tube potential on contrast, signal-to-noise ratio and average absorbed dose in mammography: a Monte Carlo study

The comparative performance of mammographic X-ray systems that use different anode/filter combinations has been assessed for screen-film and digital imaging. Monte Carlo techniques have been used to calculate average glandular dose as well as contrast and signal-to-noise ratio for imaging two test details. Five anode/filter combinations have been studied to establish the potential for dose saving or image quality improvement. For screen-film mammography, it was found that little benefit is gained by changing from a standard 28 kV molybdenum/molybdenum spectrum for breasts up to 6 cm thick. For thicker breasts, where the tube potential for the standard technique might be increased, 20% improvement in contrast can be achieved without dose penalty using molybdenum/rhodium or rhodium/rhodium spectra, whereas dose savings of more than 50% can be attained whilst maintaining contrast using tungsten/rhodium or rhodium/aluminium spectra. In digital mammography, a molybdenum/molybdenum spectrum delivers the lowest dose for a 2 cm breast, but gives the highest dose for thicker breasts. Tungsten/rhodium or rhodium/aluminium spectra provide the lowest doses at greater thicknesses. It is concluded that for screen-film mammography, molybdenum/molybdenum is the spectrum of choice for all but the thickest or most glandular breasts. In digital mammography, an alternative spectrum is preferable for breasts thicker than 2 cm.

Sensitivity of coefficients for converting entrance surface dose and kerma-area product to effective dose and energy imparted to the patient

We investigate the sensitivity of the conversions from entrance surface dose (ESD) or kerma-area product (KAP) to effective dose (E) or to energy imparted to the patient (epsilon) to the likely variations in tube potential, field size, patient size and sex which occur in clinical work. As part of a factorial design study for chest and lumbar spine examinations, the tube potentials were varied to be +/-10% of the typical values for the examinations while field sizes and the positions of the field centres were varied to be representative of values drawn from measurements on patient images. Variation over sex and patient size was based on anthropomorphic phantoms representing males and females of ages 15 years (small adult) and 21 years (reference adult). All the conversion coefficients were estimated using a mathematical phantom programmed with the Monte Carlo code EGS4 for all factor combinations and analysed statistically to derive factor effects. In general, the factors studied behaved independently in the sense that interaction of the physical factors generally gave no more than a 5% variation in a conversion coefficient. Taken together, variation of patient size, sex, field size and field position can lead to significant variation of E/KAP by up to a factor of 2, of E/ESD by up to a factor of 3, of epsilon/KAP by a factor of 1.3 and of epsilon/ESD by up to a factor of 2. While KAP is preferred to determine epsilon, the results show no strong preference of KAP over ESD in determining E. The mean absorbed dose D in the patient obtained by dividing epsilon (determined using KAP) by the patient's mass was found to be the most robust measure of E.

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.

The use of carbon fibre material in radiographic cassettes: estimation of the dose and contrast advantages

A Monte Carlo simulation has been used to estimate the dose and contrast advantages of replacing radiographic cassette fronts fabricated from aluminium with cassette fronts fabricated from low atomic number material (carbon fibre). The simulation used a realistic imaging geometry and calculations were made both with and without an anti-scatter grid. Account was taken of the scatter generated in the cassette front and the effect of beam hardening on primary contrast. Dose and contrast were evaluated for a range of cassette front thicknesses and tube potentials (60-150 kV) as well as for four examinations representative of situations with varying amounts of scatter. The results with an anti-scatter grid show a clear dose and contrast advantage in all cases when an aluminium cassette front is replaced with a low attenuation cassette front. The contrast advantage is dependent upon the examination and is generally greater for imaging bony structures than for imaging soft tissue. If a 1.74 mm aluminium cassette front is compared with a 1.1 mm carbon fibre cassette front, then the dose advantages are 16%, 9%, 8% and 6% and the contrast advantages are 10%, 7%, 4% and 5% for the AP paediatric pelvis examination at 60 kV, the anteroposterior (AP) lumbar spine examination at 80 kV, the lateral lumbar spine examination at 100 kV and the posteroanterior (PA) chest examination at 150 kV, respectively. The results without an anti-scatter grid show an increased dose advantage when a low attenuation cassette front is used, but the contrast advantage is small and in some situations negative.

Transmission ionization chambers for measurements of air collision kerma integrated over beam area. Factors limiting the accuracy of calibration

Kerma-area product meters (KAP meters) are frequently used in diagnostic radiology to measure the integral of air-collision kerma over an area A (integral of A Kc,air dA) perpendicular to the x-ray beam. In this work, a precise method for calibrating a KAP meter to measure integral of A Kc,air dA is described and calibration factors determined for a broad range of tube potentials (40-200 kV). The integral is determined using a large number of TL dosimeters spread over and outside the nominal field area defined as the area within 50% of maximum Kc,air. The method is compared to a simplified calibration method which approximates the integral by multiplying the kerma in the centre of the field by the nominal field area Anom. While the calibration factor using the precise method is independent of field area and distance from the source, that using the simplified method depends on both. This can be accounted for by field inhomogeneities caused by the heel effect, extrafocal radiation and scattered radiation from the KAP meter. The deviations between the calibration factors were as large as +/- 15% for collimator apertures of 5-100 cm2 and distances from the source of 50-160 cm. The uncertainty in the calibration factor using the precise method was carefully evaluated and the expanded relative uncertainty estimated to be +/- 3% with a confidence level of 95%.

The physical performance of different x-ray contrast agents: calculations using a Monte Carlo model of the imaging chain

A Monte Carlo computational model of the imaging chain has been used to investigate the performance of x-ray contrast agents with atomic number, Z, 53 < or = Z < or = 90 with respect to physical image quality descriptors (contrast and signal to noise ratio, SNR) and patient mean absorbed dose. Contrast agents of equal molar concentrations were used within a water slab (simulating the patient). The imaging conditions were chosen to represent adult and paediatric examinations. For all tube potentials studied (40-140 kV), the contrast agents with the highest atomic numbers (bismuth and thorium) gave the highest contrast. In analogue screen-film imaging, several other contrast agents could produce a higher image contrast than iodine in a limited range of tube potentials. This advantage could alternatively be effected as a reduced amount of administered contrast agent, or as a reduced mean absorbed dose in the patient. In digital imaging, a lower mean absorbed dose for a constant SNR than that with iodine can be achieved for ranges of tube potentials and contrast agents. Bismuth and thorium yield a lower dose than iodine at all studied tube potentials. Gadolinium and erbium could alternatively be used at a broad range of tube potentials above 90 kV with a dose penalty of only 5-20%.

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.

Shaping X-ray spectra with filters in X-ray diagnostics

The influence on image contrast, tube load and patient mean absorbed dose of different ways of shaping diagnostic X-ray spectra by placing filters in the beam is derived fro two radiographic models (abdominal screen-film radiography and intra-oral, dental radiography) using a computational model. The filters are compared at either equal tube load (keeping tube potential constant) or equal contrast (adjusting the tube potential with the different filters), but always at equal energy imparted per unit area to the image receptor. Compared at equal tube load and relative to standard aluminum filtration, reductions in the mean absorbed dose in the patient of 15-25% can be achieved using filters of Cu, Ti, W and Au (increasing the tube load by 30-40% compared with standard aluminium filtration). However, contrast is also reduced by 7%. Compared at equal contrast, the dose reductions are smaller, about 10%. Filters of copper are generally recommended, as are filters of aluminium. The use of bandpass filters (K-edge filters) should be restricted to examinations where the need for substantial variation in tube potential from patient to patient is small. The benefit of using thicker filters than those commonly used today (increasing tube load by factors of 1.4-2.0 compared with no added filter) is small as the dose reduction is most rapid for small initial values of added filters, and the increase in tube load increases steadily with increasing filter thickness.

A Monte Carlo program for the calculation of contrast, noise and absorbed dose in diagnostic radiology

A Monte Carlo computer program has been developed for the simulation of X-ray photon transport in diagnostic X-ray examinations. The simulation takes account of the incident photon energy spectrum and includes a phantom (representing the patient), an anti-scatter grid and an image receptor. The primary objective for developing the program was to study and optimise the design of anti-scatter grids. The program estimates image quality in terms of contrast and signal-to-noise ratio, and radiation risk in terms of mean absorbed dose in the patient. It therefore serves as a tool for the optimisation of the radiographic procedure. A description is given of the program and the variance-reduction techniques used. The computational method was validated by comparison with measurements and other Monte Carlo simulations.

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

An optimization of anti-scatter grid design using Monte Carlo techniques in diagnostic radiology is presented. The criterion for optimization was to find the combinations of the grid parameters (lead strip width, grid ratio and strip density) and tube potential which result in the lowest mean absorbed dose in the patient at fixed image contrast. The optimization was performed in three irradiation geometries, representing different scattering conditions (paediatric examinations, and two adult lumbar spine examinations) and was restricted to grids using fibre materials in covers and interspaces. Grid designs currently available were studied, as were designs which use thinner strips (< 30 microns) and higher grid ratios (> 18). It was found that grids with widely different strip densities (strips cm-1) and grid ratios can have good performance provided that they are used with appropriate strip width and tube potential. With increasing amounts of scatter, the optimal grid requires thicker strips and higher grid ratios. Increasing the strip density and using thinner strips and higher grid ratios are generally required. Grids with low strip density (25 strips cm-1) were found to be less sensitive to alterations in strip width. Optimal grids for paediatric radiology require thinner strips (10-20 microns) than those in currently available grids. Grids on the market are best suited for examinations of the adult body in anteroposterior (AP) view. In the adult lateral view, representing the largest scattering volume, higher grid ratios (> 18) than those in existing grids would be optimal. Examples of good grid designs are given for each examination.

Monte Carlo study of grid performance in diagnostic radiology: factors which affect the selection of tube potential and grid ratio

A Monte Carlo computational model has been developed for the study of the performance of anti-scatter grids in diagnostic radiology. It is used here to estimate the scatter in the image plane from soft tissue phantoms (representing the patient) and to calculate image contrast and the mean absorbed dose in the phantom. Different scattering conditions, representative of various examinations, have been investigated: adult lumbar spine; small field radiography and fluoroscopy; adult chest and paediatric pelvis and chest. For each scattering condition, the combinations of tube potential and grid ratio have been found which, for a well designed grid, result in the lowest mean absorbed dose in the phantom for a fixed contrast level. In examinations which generate large amounts of scatter, the use of high grid ratios in combination with high tube potentials is favourable with regard to both mean absorbed dose in the phantom and tube charge. When less scatter is generated, either the grid ratio or the tube potential can be varied to achieve the desired contrast level. High grid ratios require shorter exposure times, but need careful alignment in the beam to prevent primary radiation cut-off. It is shown that the air gap technique can be used to reduce patient dose in examinations with small amounts of scatter, but in combinations with a lower tube potential than when a grid is used.

Selection of anti-scatter grids for different imaging tasks: the advantage of low atomic number cover and interspace materials

A Monte Carlo computer program has been developed for the study of anti-scatter grids used in diagnostic radiology. The program estimates the scatter from soft tissue phantoms representative of either adult or paediatric examinations and uses dose increase, signal-to-noise ratio improvement and contrast improvement factors to study grid performance. It has been used to quantify the advantage of replacing grids with aluminium covers and interspaces by grids using materials of low atomic number for these components. Two approaches are used. First, the aluminium and low atomic number alternatives are compared for five grid ratios at fixed strip density and width and for tube potentials of 50, 70, 100 and 150 kV. Second, 44 commercially available grids are compared for three different imaging situations (lumbar spine, chest and paediatric). The results demonstrate that grids made with carbon fibre cover and cotton fibre interspace result in greater improvements in contrast and signal-to-noise ratio, and lower dose increase factors, than do grids made with aluminium. The dose reduction varies with irradiation conditions and is generally larger at lower tube potentials, higher grid ratios and lower strip densities. A typical reduction in mean absorbed dose in the patient is 30% in an adult lumbar spine (AP view) at 70 kV with a grid with 36 strips per centimetre and ratio 12.

Conversion factors between energy imparted to the patient and air collision kerma integrated over beam area in pediatric radiology

Conversion factors between the energy imparted to the patient in pediatric radiography and air collision kerma integrated over beam area are presented. The values have been derived from Monte Carlo calculations in soft tissue phantoms and extend results published earlier to cover children from early infancy to the age of 15 years. Variations related to phantom size as well as to focus-phantom distance, radiation field size, orientation of view (a.p., lateral), tube potential, and beam filtration are given. We show that the conversion factor increases with increasing half-value layer of the X-ray beam and the anterioposterior width of the simulated child. Increasing the focus-phantom distance increases the conversion factor, while increasing the field size decreases the factors due to more scattered radiation escaping laterally from the phantom.

Microbeam radiation therapy

It is proposed to carry out radiotherapy and radiosurgery for brain lesions by crossfiring an array of parallel, closely spaced microbeams of synchrotron-generated x rays several times through an isocentric target, each microbeam in the array having an approximately 25-microns-wide adjustable-height rectangular cross section. The following inferences from the known tissue sparing of 22-MeV deuteron microbeams in the mouse brain and the following exemplary Monte Carlo computations indicate that endothelial cells in the brain that are lethally irradiated by any microbeam in an array of adequately spaced microbeams outside an isocentric target will be replaced by endothelial cells regenerated from microscopically contiguous, minimally irradiated endothelium in intermicrobeam segments of brain vasculature. Endothelial regeneration will prevent necrosis of the nontargeted parenchymal tissue. However, neoplastic and/or nonneoplastic targeted tissues at the isocenter will be so severely depleted of potentially mitotic endothelial and parenchymal cells by multiple overlapping microbeams that necrosis will ensue. The Monte Carlo computations simulate microbeam irradiations of a 16-cm diameter, 16-cm-long cylindrical human head phantom using 50-, 100-, and 150-keV monochromatic x rays.

Influence of scattered radiation and tube potential on radiographic contrast: comparison of two different dental X-ray films

The fundamental concept in image quality of contrast has been analysed in terms of its elements; film, radiation and object contrast, and the theoretical formula to describe their interrelationship have been evaluated. Experiments were designed to investigate the dependence of radiographic contrast on the kV, the type of generator and dental film used (D and E speed). An ivory wedge was used as the object, both alone and within a polymethyl methacrylate phantom as scattering medium. Precise definition and control of the X-ray generators were achieved by means of measurements of the primary X-ray spectra using a Compton spectrometer. D speed was found to have higher film contrast than E speed when compared at the same optical density, due to its lower base and fog and lower level of saturation in these experiments. On the other hand, E speed was found to have wider latitude. The experimental object was reproduced with the highest radiographic contrast using D-speed film and, with a given type of generator, this increased when the kV was decreased. While no difference in scatter/primary ratios was observed using the two different films, a weak dependence on kV in the range from 36 to 77 kV was found and confirmed by Monte Carlo calculations. The results indicate that the D and E speed films used had equal energy absorption properties; the difference in radiographic performance is due to their different film characteristics. The importance of controlling the physical parameters (photon energy spectrum, base and fog and optical density level) when comparing image qualities is clearly demonstrated.