Detector or system? Extending the concept of detective quantum efficiency to characterize the performance of digital radiographic imaging systems

Effect of anti-scatter grids on the image improvement factor in digital radiography for various phantom thicknesses and irradiation fields

Digital radiography (DR) is used to acquire digital images with a consistent image brightness under different exposures and in the presence of various anti-scatter grids. This study effectively evaluates the image improvement factor and the conventional physical imaging properties, such as grid selectivity, contrast improvement ratio, and grid exposure factor. Various grids and acrylic phantoms of thicknesses 20 cm and 12 cm were used in this evaluation to simulate the pelvis and lumbar spine, and the cervical spine, respectively. Applied irradiation fields were adjusted according to the simulated body parts. Eight grids (four at 40 cm-1 strip frequency with grid ratios of 6:1, 8:1, 10:1, and 12:1, and four at 60 cm-1 strip frequency with grid ratios of 8:1, 10:1, 12:1, and 14:1) were used in this study. The grid selectivity, contrast improvement ratio, and grid exposure factor increased with higher grid ratios. At a constant grid ratio, these three parameters exhibited higher values at lower strip frequency (40 cm-1) than at higher strip frequency (60 cm-1). The change in the image improvement factor of the simulated cervical spine with respect to the grid was smaller than those of the simulated pelvis and lumbar spine. Our results suggested that the image improvement factor is a useful index for selecting grids according to object thickness at a constant exposure in DR systems.

Usefulness of copper filters in digital chest radiography based on the relationship between effective detective quantum efficiency and deep learning-based segmentation accuracy of the tumor area

This study aimed to determine the optimal radiographic conditions for detecting lesions on digital chest radiographs using an indirect conversion flat-panel detector with a copper (Cu) filter. First, we calculated the effective detective quantum efficiency (DQE) by considering clinical conditions to evaluate the image quality. We then measured the segmentation accuracy using a U-net convolutional network to verify the effectiveness of the Cu filter. We obtained images of simulated lung tumors using 10-mm acrylic spheres positioned at the right lung apex and left middle lung of an adult chest phantom. The Dice coefficient was calculated as the similarity between the output and learning images to evaluate the accuracy of tumor area segmentation using U-net. Our results showed that effective DQE was higher in the following order up to the spatial frequency of 2 cycles/mm: 120 kV + no Cu, 120 kV + Cu 0.1 mm, and 120 kV + Cu 0.2 mm. The segmented region was similar to the true region for mass-area extraction in the left middle lobe. The lesion segmentation in the upper right lobe with 120 kV + no Cu and 120 kV + Cu 0.1 mm was less successful. However, adding a Cu filter yielded reproducible images with high Dice coefficients, regardless of the tumor location. We confirmed that adding a Cu filter decreases the X-ray absorption efficiency while improving the signal-to-noise ratio (SNR). Furthermore, artificial intelligence accurately segments low-contrast lesions.

Comparison of Non-Uniform Image Quality Caused by Anode Heel Effect between Two Digital Radiographic Systems Using a Circular Step-Wedge Phantom and Mutual Information

The purpose of this study was to compare non-uniform image quality caused by the anode heel effect between two radiographic systems using a circular step-wedge (CSW) phantom and the normalized mutual information (nMI) metric. Ten repeated radiographic images of the CSW and contrast-detail resolution (CDR) phantoms were acquired from two digital radiographic systems with 16- and 12-degree anode angles, respectively, using various kVp and mAs. To compare non-uniform image quality, the CDR phantom was physically rotated at different orientations, and the directional nMI metrics were calculated from the CSW images. The directional visible ratio (VR) metrics were calculated from the CDR images. Analysis of variance (ANOVA) was performed to understand whether the nMI metric significantly changed with kVp, mAs, and orientations with Bonferroni correction. Mann-Whitney's U test was performed to compare the metrics between the two systems. Contrary to the VR metrics, the nMI metrics significantly changed with orientations in both radiographic systems. In addition, the system with the 12-degree anode angle exhibited less uniform image quality compared to the system with the 16-degree anode angle. A CSW phantom using the directional nMI metric can be significantly helpful to compare non-uniform image quality between two digital radiographic systems.

New Software for DQE Calculation in Digital Mammography Compliant with IEC 62220–1-2

Significant improvements in mammography systems have been achieved with the introduction of active matrix flat-panel digital detectors. The advent of this technology also makes it possible to implement computational methods for quantitative image analysis. This study describes new software created to perform detective quantum efficiency (DQE) calculations fully compliant with the IEC 62220–1-2 standard. Python-based software was developed that contains modules to calculate inverse conversion function, modulation transfer function (MTF), noise power spectrum (NPS), and DQE itself. A graphical user interface (GUI) and further add-ons make this software more user-friendly. Results are immediately displayed diagrammatically, and complete output data are exported to a .csv file. The code is available freely, as a compiled, executable file (.exe). The program was successfully tested using DICOM images obtained from mammography units from different manufacturers. This study also includes validation of the new software, based on comparisons of results obtained for the same set of data with two other, freely available programs.

Quantitative Image Quality Metrics of the Low-Dose 2D/3D Slot Scanner Compared to Two Conventional Digital Radiography X-ray Imaging Systems

The aim of this study was to determine the quantitative image quality metrics of the low-dose 2D/3D EOS slot scanner X-ray imaging system (LDSS) compared with conventional digital radiography (DR) X-ray imaging systems. The effective detective quantum efficiency (eDQE) and effective noise quantum equivalent (eNEQ) were measured using chest and knee protocols.

METHODS

A Nationwide Evaluation of X-ray Trends (NEXT) of a chest adult phantom and a PolyMethylmethacrylate (PMMA) phantom were used for the chest and knee protocols, respectively. Quantitative image quality metrics, including effective normalised noise power spectrum (eNNPS), effective modulation transfer function (eMTF), eDQE and eNEQ of the LDSS and DR imaging systems were assessed and compared.

RESULTS

In the chest acquisition, the LDSS imaging system achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.044). For the knee acquisition, the LDSS imaging system also achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.002). However, there was no significant difference in eNEQ and eDQE between DR systems 1 and 2 at lower and higher spatial frequencies (0.10 < p < 1.00) for either chest or knee protocols.

CONCLUSION

The LDSS imaging system performed well compared to the DR systems. Thus, we have demonstrated that the LDSS imaging system has the potential to be used for clinical diagnostic purposes.

Determination of DQE as a quantitative assessment of detectors in digital mammography: Measurements and calculation in practice

Introduction: Advances in digital detector technology and methods of image presentation in digital mammography now offer the possibility of implementing mathematical assessment methods to quantitative image analysis. The aim of this work was to develop new software to simplify the application of the existing international standard for DQE in digital mammography and show in detail how it can be applied, using a Siemens Mammomat Inspiration as a model.

Material and methods: Consistent with the IEC standard a 2 mm Al filter at the tube exit and images in DICOM format as raw data, without applying any additional post-processing were used. Measurements were performed for W/Rh anode/filter combination and different tube voltage values (26 ÷ 34 kV) without any anti-scatter grid. To verify new software doses ranging from 20-600 µGy were used in measurements. Exposure (air kerma) was measured using a calibrated radiation meter (Piranha Black 457, RTI Electronics AB, Sweden). MTF was determined, using an edge test device constructed specifically for this work.

Results: It has been demonstrated that with the new software the DQE can be measured with the accuracy required by the international standard IEC 62220-1-2. DQE has been presented as a function of spatial frequency for W/Rh anode/filter combination and different tube voltage.

Conclusions: New software was used successfully to analyze image quality parameters for the Siemens Mammomat Inspiration detector. This was done on the basis of an internationally accepted methodology. In the next step, mammographs with different detector types can be compared.

Evaluation of Non-Uniform Image Quality Caused by Anode Heel Effect in Digital Radiography Using Mutual Information

Anode heel effects are known to cause non-uniform image quality, but no method has been proposed to evaluate the non-uniform image quality caused by the heel effect. Therefore, the purpose of this study was to evaluate non-uniform image quality in digital radiographs using a novel circular step-wedge (CSW) phantom and normalized mutual information (nMI). All X-ray images were acquired from a digital radiography system equipped with a CsI flat panel detector. A new acrylic CSW phantom was imaged ten times at various kVp and mAs to evaluate overall and non-uniform image quality with nMI metrics. For comparisons, a conventional contrast-detail resolution phantom was imaged ten times at identical exposure parameters to evaluate overall image quality with visible ratio (VR) metrics, and the phantom was placed in different orientations to assess non-uniform image quality. In addition, heel effect correction (HEC) was executed to elucidate the impact of its effect on image quality. The results showed that both nMI and VR metrics significantly changed with kVp and mAs, and had a significant positive correlation. The positive correlation is suggestive that the nMI metrics have a similar performance to the VR metrics in assessing the overall image quality of digital radiographs. The nMI metrics significantly changed with orientations and also significantly increased after HEC in the anode direction. However, the VR metrics did not change significantly with orientations or with HEC. The results indicate that the nMI metrics were more sensitive than the VR metrics with regards to non-uniform image quality caused by the anode heel effect. In conclusion, the proposed nMI metrics with a CSW phantom outperformed the conventional VR metrics in detecting non-uniform image quality caused by the heel effect, and thus are suitable for quantitatively evaluating non-uniform image quality in digital radiographs with and without HEC.

Physical characterization of a novel wireless DRX Plus 3543C using both a carbon nano tube (CNT) mobile x-ray system and a traditional x-ray system

This work aims to characterize the novel DRX Plus 3543C detector in terms of detective quantum efficiency (DQE) using both a mobile x-ray system called Carestream DRX Revolution Nano and a traditional x-ray system (Carestream DRX Evolution). We used the commercial system DRX Revolution Nano, equipped with a new x-ray source based on CNT technology and field emission (FE) as the electron emitter (cathode). An innovative aspect of this device is its intrinsic selection of the focal spot size. We tested the system using three IEC-specified beam qualities (RQA3, 5 and 7) in terms of modulation transfer function (MTF), normalized noise power spectra (NNPS) and DQE as defined in the IEC 62220-1-1:2015. We compared the results obtained using DRX Revolution Nano and DRX Evolution with correlation and with Bland-Altman plots to study their agreement. RQA3 MTF is slightly lower than the RQA5 and 7 curves between 0.5 and 2.5 cycles mm^-1. We measured MTF values of about 0.6 at 1 lp mm^-1 and about 0.28 lp mm^-1 at 2 lp mm^-1. The NNPS curves show a decreasing trend with the energy regarding the DRX Revolution Nano. On the other hand, the DRX Evolution NNPS curve at RQA3 is greater than the one at RQA5, but the one at RQA5 is less than the one at RQA7. The DQE(0) ranged between about 0.82 (DRX Evolution at RQA3) and 0.54 (DRX Evolution at RQA7). As expected, the squared Pearson's correlation coefficients between the two x-ray tubes were always in an optimal agreement, and Bland-Altman plots confirmed a substantial equivalence between the two physical characterizations of the wireless detector. In conclusion, we can show that the dynamic focal selection of the system equipped with CNT does not play a substantial role in image quality compared to a traditional system in terms of physical characterisation of the detector in our measurement conditions.

Measurement of effective detective quantum efficiency for a photon counting scanning mammography system and comparison with two flat panel full-field digital mammography systems

Effective detective quantum efficiency (eDQE) describes the resolution and noise properties of an imaging system along with scatter and primary transmission, all measured under clinically appropriate conditions. Effective dose efficiency (eDE) is the eDQE normalised to mean glandular dose and has been proposed as a useful metric for the optimisation of clinical imaging systems. The aim of this study was to develop a methodology for measuring eDQE and eDE on a Philips microdose mammography (MDM) L30 photon counting scanning system, and to compare performance with two conventional flat panel systems. A custom made lead-blocker was manufactured to enable the accurate determination of dose measurements, and modulation transfer functions were determined free-in-air at heights of 2, 4 and 6 cm above the breast support platform. eDQE were calculated for a Philips MDM L30, Hologic Dimensions and Siemens Inspiration digital mammography system for 2, 4 and 6 cm thick poly(methyl methacrylate) (PMMA). The beam qualities (target/filter and kilovoltage) assessed were those selected by the automatic exposure control, and anti-scatter grids were used where available. Measurements of eDQE demonstrate significant differences in performance between the slit- and scan-directions for the photon counting imaging system. MTF has been shown to be the limiting factor in the scan-direction, which results in a rapid fall in eDQE at mid-to-high spatial frequencies. A comparison with two flat panel mammography systems demonstrates that this may limit image quality for small details, such as micro-calcifications, which correlates with a more conventional image quality assessment with the CDMAM phantom. eDE has shown the scanning photon counting system offers superior performance for low spatial frequencies, which will be important for the detection of large low contrast masses. Both eDQE and eDE are proposed as useful metrics that should enable optimisation of the Philips MDM L30.

CHARACTERISING THE EOS SLOT-SCANNING SYSTEM WITH THE EFFECTIVE DETECTIVE QUANTUM EFFICIENCY

As opposed to the standard detective quantum efficiency (DQE), effective DQE (eDQE) is a figure of merit that allows comparing the performances of imaging systems in the presence of scatter rejection devices. The geometry of the EOS™ slot-scanning system is such that the detector is self-collimated and rejects scattered radiation. In this study, the EOS system was characterised using the eDQE in imaging conditions similar to those used in clinical practice: with phantoms of different widths placed in the X-ray beam, for various incident air kerma and tube voltages corresponding to the phantom thickness. Scatter fractions in EOS images were extremely low, around 2 % for all configurations. Maximum eDQE values spanned 9-14.8 % for a large range of air kerma at the detector plane from 0.01 to 1.34 µGy. These figures were obtained with non-optimised EOS setting but still over-performed most of the maximum eDQEs recently assessed for various computed radiology and digital radiology systems with antiscatter grids.

Benchmarking the performance of fixed-image receptor digital radiography systems. Part 2: system performance metric

This is part two of a two-part study in benchmarking system performance of fixed digital radiographic systems. The study compares the system performance of seven fixed digital radiography systems based on quantitative metrics like modulation transfer function (sMTF), normalised noise power spectrum (sNNPS), detective quantum efficiency (sDQE) and entrance surface air kerma (ESAK). It was found that the most efficient image receptors (greatest sDQE) were not necessarily operating at the lowest ESAK. In part one of this study, sMTF is shown to depend on system configuration while sNNPS is shown to be relatively consistent across systems. Systems are ranked on their signal-to-noise ratio efficiency (sDQE) and their ESAK. Systems using the same equipment configuration do not necessarily have the same system performance. This implies radiographic practice at the site will have an impact on the overall system performance. In general, systems are more dose efficient at low dose settings.

Benchmarking the performance of fixed-image receptor digital radiographic systems part 1: a novel method for image quality analysis

This is the first part of a two-part study in benchmarking the performance of fixed digital radiographic general X-ray systems. This paper concentrates on reporting findings related to quantitative analysis techniques used to establish comparative image quality metrics. A systematic technical comparison of the evaluated systems is presented in part two of this study. A novel quantitative image quality analysis method is presented with technical considerations addressed for peer review. The novel method was applied to seven general radiographic systems with four different makes of radiographic image receptor (12 image receptors in total). For the System Modulation Transfer Function (sMTF), the use of grid was found to reduce veiling glare and decrease roll-off. The major contributor in sMTF degradation was found to be focal spot blurring. For the System Normalised Noise Power Spectrum (sNNPS), it was found that all systems examined had similar sNNPS responses. A mathematical model is presented to explain how the use of stationary grid may cause a difference between horizontal and vertical sNNPS responses.

Quality-controlled dose-reduction of pelvic X-ray examinations in infants with hip dysplasia

BACKGROUND

Digital plain radiography (DR) examinations of the pelvis are frequently performed in infants with hip dysplasia.

OBJECTIVE

The purpose was to reduce the radiation dose and to determine objective quality control criteria to ensure accurate assessment. This seems feasible because of higher quantum efficiency of DR and easy assessable anatomical structures for most orthopaedic measurements.

MATERIALS AND METHODS

Institutional review board approval was obtained. In this prospective randomized study, 264 patients underwent X-ray examination of the pelvis with standard and reduced dose. The evaluation of the plain-radiographs was conducted using the following criteria: acetabular and center edge angle, closing of the epiphyseal plates and maturation of the femoral head. Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score of 3 or more points or more than 2 criteria with 2 points, the radiograph was scored as "not assessable". The statistical analysis was conducted as non-inferiority-trial.

RESULTS

Five (1.9%) examined X-rays were scored as not assessable. There was no statistical inferiority between the examinations with standard (4.57 μSv) or reduced dose (3.06 μSv). Also, the individual evaluation of the defined criteria was dose-independent.

CONCLUSION

The adequate evaluation of hip dysplasia in children and young adults on pelvic radiographs is possible with reduced radiation dose, by simple using an exposure class of 800 instead of 400.

Performance evaluation of two computed radiography systems and patient dose in pelvic examination

This study was carried out to evaluate the performance of two computed radiography (CR) units. These evaluations became necessary following the introduction of CR systems in Sudan. Evaluation of the CR systems was performed using physical image quality parameters: signal transfer property, modulation transfer function, normalised noise power spectrum, detective quantum efficiency and the subjective contrast detail detectability. Patient dose was measured in terms of entrance surface air kerma estimated from tube output and exposure factors for 100 patients who had undergone pelvic X-ray examinations. Fuji computed radiography velocity system with columnar screen dose results was much lower than those using CR975 system with granular screen. Patient doses delivered by both systems were within the international diagnostic reference levels.

Quality-controlled dose reduction of full-leg radiography in patients with knee malalignment

OBJECTIVE

Digital plain radiographs of the full leg are frequently performed examinations of children and young adults. Thus, the objective of this work was to reduce the radiation exposure dependent on specific indications, and to determine objective quality-control criteria to ensure accurate assessment.

MATERIALS AND METHODS

Institutional review board approval and informed consent of all participants were obtained. In this prospective, randomized controlled, blinded, two-armed single-center study, 288 evaluable patients underwent plain radiography of the full leg with standard and reduced doses. The evaluation of the plain radiographs was conducted using the following criteria: mechanical axis, leg length, and maturation of the epiphyseal plate. Two blinded radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score of 3 or more points or all criteria with 2 points, the radiograph was scored as "not assessable". The study was designed as a non-inferiority trial.

RESULTS

Eleven (3.8%) examined X-rays were scored as not assessable. The rate of non-assessable radiographs with 33% reduced dose was significantly not inferior to the rate of non-assessable radiographs with standard dose. The evaluation of the quality criteria was dose independent.

CONCLUSIONS

Full-leg plain radiography in patients with knee malalignment can be performed at 33% reduced dose without loss of relevant diagnostic information.

Evaluation of clinical full field digital mammography with the task specific system-model-based Fourier Hotelling observer (SMFHO) SNR

PURPOSE

The purpose of this work is to evaluate the performance of the image acquisition chain of clinical full field digital mammography (FFDM) systems by quantifying their image quality, and how well the desired information is captured by the images.

METHODS

The authors present a practical methodology to evaluate FFDM using the task specific system-model-based Fourier Hotelling observer (SMFHO) signal to noise ratio (SNR), which evaluates the signal and noise transfer characteristics of FFDM systems in the presence of a uniform polymethyl methacrylate phantom that models the attenuation of a 6 cm thick 20/80 breast (20% glandular/80% adipose). The authors model the system performance using the generalized modulation transfer function, which accounts for scatter blur and focal spot unsharpness, and the generalized noise power spectrum, both estimated with the phantom placed in the field of view. Using the system model, the authors were able to estimate system detectability for a series of simulated disk signals with various diameters and thicknesses, quantified by a SMFHO SNR map. Contrast-detail (CD) curves were generated from the SNR map and adjusted using an estimate of the human observer efficiency, without performing time-consuming human reader studies. Using the SMFHO method the authors compared two FFDM systems, the GE Senographe DS and Hologic Selenia FFDM systems, which use indirect and direct detectors, respectively.

RESULTS

Even though the two FFDM systems have different resolutions, noise properties, detector technologies, and antiscatter grids, the authors found no significant difference between them in terms of detectability for a given signal detection task. The authors also compared the performance between the two image acquisition modes (fine view and standard) of the GE Senographe DS system, and concluded that there is no significant difference when evaluated by the SMFHO. The estimated human observer efficiency was 30 ± 5% when compared to the SMFHO. The results showed good agreement when compared to other model observers as well as previously published human observer data.

CONCLUSIONS

This method generates CD curves from the SMFHO SNR that can be used as figures of merit for evaluating the image acquisition performance of clinical FFDM systems. It provides a way of creating an empirical model of the FFDM system that accounts for patient scatter, focal spot unsharpness, and detector blur. With the use of simulated signals, this method can predict system performance for a signal known exactly/background known exactly detection task with a limited number of images, therefore, it can be readily applied in a clinical environment.

Effective detective quantum efficiency for two mammography systems: measurement and comparison against established metrics

PURPOSE

The aim of this paper was to illustrate the value of the new metric effective detective quantum efficiency (eDQE) in relation to more established measures in the optimization process of two digital mammography systems. The following metrics were included for comparison against eDQE: detective quantum efficiency (DQE) of the detector, signal difference to noise ratio (SdNR), and detectability index (d') calculated using a standard nonprewhitened observer with eye filter.

METHODS

The two systems investigated were the Siemens MAMMOMAT Inspiration and the Hologic Selenia Dimensions. The presampling modulation transfer function (MTF) required for the eDQE was measured using two geometries: a geometry containing scattered radiation and a low scatter geometry. The eDQE, SdNR, and d' were measured for poly(methyl methacrylate) (PMMA) thicknesses of 20, 40, 60, and 70 mm, with and without the antiscatter grid and for a selection of clinically relevant target/filter (T/F) combinations. Figures of merit (FOMs) were then formed from SdNR and d' using the mean glandular dose as the factor to express detriment. Detector DQE was measured at energies covering the range of typical clinically used spectra.

RESULTS

The MTF measured in the presence of scattered radiation showed a large drop at low spatial frequency compared to the low scatter method and led to a corresponding reduction in eDQE. The eDQE for the Siemens system at 1 mm(-1) ranged between 0.15 and 0.27, depending on T/F and grid setting. For the Hologic system, eDQE at 1 mm(-1) varied from 0.15 to 0.32, again depending on T/F and grid setting. The eDQE results for both systems showed that the grid increased the system efficiency for PMMA thicknesses of 40 mm and above but showed only small sensitivity to T/F setting. While results of the SdNR and d' based FOMs confirmed the eDQE grid position results, they were also more specific in terms of T/F selection. For the Siemens system at 20 mm PMMA, the FOMs indicated Mo/Mo (grid out) as optimal while W/Rh (grid in) was the optimal configuration at 40, 60, and 70 mm PMMA. For the Hologic, the FOMs pointed to W/Rh (grid in) at 20 and 40 mm of PMMA while W/Ag (grid in) gave the highest FOM at 60 and 70 mm PMMA. Finally, DQE at 1 mm(-1) averaged for the four beam qualities studied was 0.44 ± 0.02 and 0.55 ± 0.03 for the Siemens and Hologic detectors, respectively, indicating only a small influence of energy on detector DQE.

CONCLUSIONS

Both the DQE and eDQE data showed only a small sensitivity to T/F setting for these two systems. The eDQE showed clear preferences in terms of scatter reduction, being highest for the grid-in geometry for PMMA thicknesses of 40 mm and above. The SdNR and d' based figures of merit, which contain additional weighting for contrast and dose, pointed to specific T/F settings for both systems.

Effective DQE (eDQE) for monoscopic and stereoscopic chest radiography imaging systems with the incorporation of anatomical noise

PURPOSE

Stereoscopic chest biplane correlation imaging (stereo∕BCI) has been proposed as an alternative modality to single view chest x-ray (CXR). The metrics effective modulation transfer function (eMTF), effective normalized noise power spectrum (eNNPS), and effective detective quantum efficiency (eDQE) have been proposed as clinically relevant metrics for assessing clinical system performance taking into consideration the magnification and scatter effects. This study compared the metrics eMTF, eNNPS, eDQE, and detectability index for stereo∕BCI and single view CXR under isodose conditions at two magnifications for two anthropomorphic phantoms of differing sizes.

METHODS

Measurements for the eMTF were taken for two phantom sizes with an opaque edge test device using established techniques. The eNNPS was measured at two isodose conditions for two phantoms using established techniques. The scatter was measured for two phantoms using an established beam stop method. All measurements were also taken at two different magnifications with two phantoms. A geometrical phantom was used for comparison with prior results for CXR although the results for an anatomy free phantom are not expected to vary for BCI.

RESULTS

Stereo∕BCI resulted in improved metrics compared to single view CXR. Results indicated that magnification can potentially improve the detection performance primarily due to the air gap which reduced scatter by ∼20%. For both phantoms, at isodose, eDQE(0) for stereo∕BCI was ∼100 times higher than that for CXR. Magnification at isodose improved eDQE(0) by ∼10 times for stereo∕BCI. Increasing the dose did not improve eDQE. The detectability index for stereo∕BCI was ∼100 times better than single view CXR for all conditions. The detectability index was also not improved with increased dose.

CONCLUSIONS

The findings indicate that stereo∕BCI with magnification may improve detectability of subtle lung nodules compared to single view CXR. Results were improved with magnification for the smaller phantom but not for the larger phantom. The effective DQE and the detectability index did not improve with increasing dose.

Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system

OBJECTIVE

The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system.

METHODS

The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson's correlation coefficient.

RESULTS

Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, p<0.033) and eDE (R=0.77, p<0.008) were observed.

CONCLUSION

Medical physics experts may use the physical image quality metrics described here in quality assurance programmes and optimisation studies with a degree of confidence that they reflect the clinical image quality in chest CR images acquired without an antiscatter grid.

ADVANCES IN KNOWLEDGE

A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography.

Effects of breast thickness and lesion location on resolution in digital magnification mammography

This study aimed to examine the resolution effects of breast thickness and lesion location in magnification mammography by evaluating generalized modulation transfer function (GMTF) including the effect of focal spot, effective pixel size, and the scatter. Polymethyl methacrylate (PMMA) thicknesses ranging from 10 to 40 mm were placed on a standard supporting platform that was positioned to achieve magnification factors ranging from 1.2 to 2.0. As the magnification increased, the focal spot MTF degraded, while the detector MTF improved. The GMTF depended on the trade-off between the focal spot size and effective pixel size. Breast thickness and lesion location had little effect on the resolution at high frequencies. The resolution of small focal spot did improve slightly with increasing PMMA thickness for magnification factors less than 1.8. In contrast, system resolution decreased with increasing PMMA thickness for magnification factors greater than 1.8 since focal spot blur begins to dominate spatial resolution. In particular, breast thickness had a large effect on the resolution at lower frequencies. A low-frequency drop effect increased with increasing PMMA thickness because of the increase in scatter fraction. Hence, the effect of compressed breast thickness should be considered for the standard magnification factor of 1.8 that is most commonly used in clinical practice. Our results should provide insights for determining optimum magnification in clinical application of digital mammography, and our approaches can be extended to a wide diversity of radiological imaging systems.

The basics and implementation of digital mammography

Current day digital mammography acquisition units have already been shown to be equal or better than screen film systems for the detection and classification of breast lesions. The optimal multimodality breast imaging diagnostic workstations and connectivity to existing picture and archiving communication systems and information systems is still a work in progress, but with more and more facilities transitioning to digital imaging it is only a matter of time until these hurdles are overcome.