Threshold contrast detail detectability measurement of the fluoroscopic image quality of a dynamic solid-state digital x-ray image detector

Hysterosalpingography using a flat panel unit: evaluation and optimization of ovarian radiation dose

PURPOSE

The aim of the present study was the evaluation and optimization of radiation dose to the ovaries (D) in hysterosalpingography (HSG).

METHODS

The study included a phantom study and a clinical one. In the phantom study, we evaluated imaging results for different geometrical setups and irradiation conditions. In the clinical study, 34 women were assigned into three different fluoroscopy modes and D was estimated with direct cervical TLD measurements.

RESULTS

In the phantom study, we used a source-to-image-distance (SID) of 110 cm and a field diagonal of 48 cm, and thus decreased air KERMA rate (KR) by 19% and 70%, respectively, for beam filtration: 4 mm Al and 0.9 mm Cu (Low dose). The least radiation exposure was accomplished by using the 3.75 pps fluoroscopy mode in conjunction with beam filtration: Low dose. In the clinical study, D normalized to 50 s of fluoroscopy time with a 3.75 pps fluoroscopy mode reached a value of 0.45 ± 0.04 mGy. Observers' evaluation of diagnostic image quality did not significantly differ for the three different modes of acquisition that were compared.

CONCLUSIONS

Digital spot radiographs could be omitted in modern flat panel systems during HSG. Fluoroscopy image acquisitions in a modern flat panel unit at 3.75 pps and a beam filtration of 4 mm Al and 0.9 mm Cu demonstrate acceptable image quality with an average D equal to 0.45 mGy. This value is lower compared to the studied literature. For these reasons, the proposed method may be recommended for routine HSG examination in order to limit radiation exposure to the ovaries.

The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography

Dynamic, flat-panel, solid-state, x-ray image detectors for use in digital fluoroscopy and fluorography emerged at the turn of the millennium. This new generation of dynamic detectors utilize a thin layer of x-ray absorptive material superimposed upon an electronic active matrix array fabricated in a film of hydrogenated amorphous silicon (a-Si:H). Dynamic solid-state detectors come in two basic designs, the indirect-conversion (x-ray scintillator based) and the direct-conversion (x-ray photoconductor based). This review explains the underlying principles and enabling technologies associated with these detector designs, and evaluates their physical imaging characteristics, comparing their performance against the long established x-ray image intensifier television (TV) system. Solid-state detectors afford a number of physical imaging benefits compared with the latter. These include zero geometrical distortion and vignetting, immunity from blooming at exposure highlights and negligible contrast loss (due to internal scatter). They also exhibit a wider dynamic range and maintain higher spatial resolution when imaging over larger fields of view. The detective quantum efficiency of indirect-conversion, dynamic, solid-state detectors is superior to that of both x-ray image intensifier TV systems and direct-conversion detectors. Dynamic solid-state detectors are playing a burgeoning role in fluoroscopy-guided diagnosis and intervention, leading to the displacement of x-ray image intensifier TV-based systems. Future trends in dynamic, solid-state, digital fluoroscopy detectors are also briefly considered. These include the growth in associated three-dimensional (3D) visualization techniques and potential improvements in dynamic detector design.

Characterization of Detector Scintillator Effect on Interventional Device Visualization in X-ray Fluoroscopy

Flat panel detectors have a large number of parameters that affect fluoroscopy image quality. Scintillator thickness is very important and can be readily changed in fabrication. With increasing thickness, there is a degradation of MTF with spatial blurring but improved conversion efficiency. This design trade-off should be optimized for visualization. Using quantitative experimental and techniques, we simulated three detector models, including a direct detector and two indirect detectors with different scintillator thickness and investigated their effects on visualization of stent and guidewire. Detection performance was improved with the increasing scintillator thickness, especially at low exposure. With an idealized MTF, a direct detector performed fared better for stent detection as compared to guide wire detection.

Do flat detector cardiac X-ray systems convey advantages over image-intensifier-based systems? Study comparing X-ray dose and image quality

The recent introduction of "flat-panel detector" (FD)-based cardiac catheterisation laboratories should offer improvements in image quality and/or dose efficiency over X-ray systems of conventional design. We compared three X-ray systems, one image-intensifier (II)-based system (system A), and two FD-based designs (systems B and C), assessing their image quality and dose efficiency. Phantom measurements were performed to assess dose rates in fluoroscopy and cine acquisition. Phantom dose rates were broadly similar for all systems, with all systems classified as offering "low" dose rates in fluoroscopy on standard phantoms. Patient X-ray dose rate and subjective image quality was assessed for 90 patients. Dose area product (DAP) rates were similar for all systems, except system C, which had a lower DAP rate in fluoroscopy. In terms of subjective image quality, the order of preference was (best to worst): system C, system A, system B. This study indicates that the use of an FD detector does not infer an automatic improvement in image quality or dose efficiency over II based designs. Specification and configuration of all of the components in the X-ray system contribute to the dose levels used and image quality achieved.

Flat-panel detectors: how much better are they?

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

Factors That Influence Radiation Dose in Percutaneous Coronary Intervention

AIM

To explore the factors that may influence the radiation dose imparted to the patient in PCI, and investigate whether the use of the latest digital X-ray system based on FP detector technology can have an impact on dose.

MATERIALS AND METHOD

Demographic and clinical data such as number of lesions treated, number of stents placed, grade of tortuosity, and stage of occlusion, as well as use of double wire and double balloon technique, ostial stenting or bifurcation stenting, and presence of major complications were recorded, together with radiation parameters.

RESULTS

The factors that increased patient radiation dose were (1) patient gender, as men exhibited higher doses than women; (2) complex lesion; (3) increasing number of stents; (4) position of stent; (5) grade of tortuosity; and (6) stage of occlusion. The FP digital system appeared to be settled in a lower-dose rate for fluoroscopy (a factor of 6) and higher for dose per frame in cine (a factor of 3) in comparison with the image intensifier (II) system. There was a marked reduction of DAP when the FP technology was introduced.

CONCLUSION

More extensive studies should be performed in the future so as to further investigate the influence of the FP detector in IC.

Image analysis methods for diffuse optical tomography

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

Comparison of a CCD and a flat-panel digital system in an Interventional Cardiology Laboratory

We evaluated the performances of angiographic units equipped with a flat-panel (FP) detector and image intensifier (II) charge-coupled device (CCD) in the Interventional Cardiology (IC) Department. Entrance dose rate and dose per image, along with the dose at the II level were measured using 2 mm copper sheets to simulate a patient. Image quality (IQ) was evaluated using a phantom. Doses increased with fluoroscopy level changing from low to high. FP presented higher doses than CCD. Periodic measurements showed differences of up to 35%. Low mode IQ did not significantly differ from normal and high mode for both systems. Low fluoroscopy mode was decided to be used routinely. Both X-ray systems performed within international recommendations for conventional systems with the exception of higher cine radiation doses and II dose rates, stressing the fact that more studies are required to investigate whether dose levels should be adjusted.

Quantitative image quality evaluation of pixel-binning in a flat-panel detector for x-ray fluoroscopy

X-ray fluoroscopy places stringent design requirements on new flat-panel (FP) detectors, requiring both low-noise electronics and high data transfer rates. Pixel-binning, wherein data from more that one detector pixel are collected simultaneously, not only lowers the data transfer rate but also increases x-ray counts and pixel signal-to-noise ratio (SNR). In this study, we quantitatively assessed image quality of image sequences from four acquisition methods; no-binning and three types of binning; in synthetic images using a clinically relevant task of detecting an extended guidewire in a four-alternative forced-choice paradigm. Binning methods were conventional data-line (D) and gate-line (G) binning, and a novel method in which alternate frames in an image sequence used D and G binning. Two detector orientations placed the data lines either parallel or perpendicular to the guide wire. At a low exposure of 0.6 microR (1.548 x 10(-10) C/kg) per frame, irrespective of detector orientation, D binning with its reduced electronic noise was significantly (p<0.1) better than the other acquisition methods. On average, alternate binning performed better than G binning. At a higher exposure of 4.0 microR (10.32 x 10(-10) C/kg) per frame, with data lines parallel to the guidewire, detection with D binning was significantly (p<0.1) better than G binning. However, with data lines perpendicular to the guidewire, G binning was significantly (p<0.1) better than D binning because the partial area effect was reduced. Alternate binning was the best binning method when results were averaged over both orientations, and it was as good as the best binning method at either orientation. In addition, at low and high exposures, alternate binning gave a temporally fused image with a smooth guidewire, an important image quality feature not assessed in a detection experiment. While at high exposure, detection with no binning was as good, or better, than the best binning method, it might be impractical at fluoroscopy imaging rates. A computational observer model based on signal detection theory successfully fit data and was used to predict effects of similar acquisition methods. Results from this study suggest the use of exposure-dependent detector binning in fluoroscopy that switches between D binning and alternate binning at low and high exposures, respectively.

Evaluation of the imaging properties of an amorphous selenium-based flat panel detector for digital fluoroscopy

The imaging performance of an amorphous selenium (a-Se) flat-panel detector for digital fluoroscopy was experimentally evaluated using the spatial frequency dependent modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). These parameters were investigated at beam qualities and exposures within the range typical of gastrointestinal fluoroscopic imaging (approximately 0.1 - 10 microR, 75 kV). The investigation does not take into consideration the detector cover, which in clinical use will lower the DQE measured here by its percent attenuation. The MTF was found to be less than the expected aperture response and the NPS was not white which together indicate presampling blurring. The cause of this blurring was attributed to charge trapping at the interface between two different layers of the a-Se. The effect on the DQE was also consistent with presampling blur, which reduces the aliasing in the NPS and thereby reduces the spatial frequency dependence of the DQE. (The DQE was independent of spatial frequency from 0.12 to 0.73 mm(-1) due to antialiasing of the NPS.) Moreover, the first zero of the measured MTF and the aperture response appeared at the same spatial frequency (6.66 mm(-1) for a pixel of 150 microm). Hence, the geometric fill factor (77%) was increased to an effective fill factor of 99 +/- 1%. A large scale ( approximately 32 pixels) correlation in the noise due to the configuration of the readout electronics caused increased noise power in the gate line NPS at low spatial frequency (< 0.1 mm(-1)). The DQE (f = 0) was exposure independent over a large range of exposures but became exposure dependent at low exposures due to the electronic noise.

Integration of digital fluoroscopy with CT-based radiation therapy planning of lung tumors

Radiation dose escalation may be a means to increase the local control rate of inoperable lung tumors. Treatment plans involve the creation of a uniform planning target volume (PTV) to ensure proper coverage despite patient breathing and setup error. This may lead to unnecessary radiation of normal tissue in shallow breathers or target underdosing for patients with excess internal motion. Therefore, the nature of tumor motion for each patient should be measured in 3D, something that cannot be done with CT alone. We have developed a method that acquires 2D real-time fluoroscopic images (loops) and coregisters them with 2D digitally reconstructed radiographs (DRR) formed from the CT scan. The limitations of CT to encompass motion can be overcome by merging the two modalities together. The accuracy of the coregistration method is tested with a stationary grid of radio-opaque markers at various spatial positions. The in-plane (at-depth) displacement between markers on the fluoroscopic image versus the DRR varies with position across the image due to slight misalignments between the x-ray source used in fluoroscopy and the virtual source used for the DRR relative to the test object. At clinically relevant positions, the maximum, measured in-plane displacement, is 1.1 mm. The method is applied to the thorax of an anthropomorphic phantom and a good fit is observed between the appearances of the bony anatomical structures on the coregistered image. Finally, a series of motion measurements are carried out on two oscillating cylindrical objects. The degree of motion as measured by fluoroscopy is accurate to within 1.0 mm, whereas the DRR is inconsistent in predicting motion. The coregistration of fluoroscopic loops with the DRR shows at what point within the oscillation the DRR fails to encompass motion. For any treatment site involving target motion, this real-time imaging is a useful asset in the planning stage.