Use of 3-D digital subtraction rotational angiography during cardiac catheterization of infants and adults with congenital heart diseases.

OBJECTIVE: To compare image quality, radiation and contrast doses required to obtain 3D-Digital subtraction rotational angiography (3D-DSRA) with 3D-Digital rotational angiography (3D-DRA) in infants (children ≤ 2 years of age) and adults with congenital heart diseases (ACHD). BACKGROUND: 3D-DRA can be performed with radiation doses comparable to bi-plane cine-angiography. However, 3D-DRA in infants requires a large contrast volume. The resolution of 3D-DRA performed in ACHD patients is limited by their soft tissue density. We hypothesized that the use of 3D-DSRA could help alleviate these concerns. METHODS: Radiation (DAP) and contrast doses required to obtain 3D-DSRA was compared with 3D-DRA in 15 age-, size-, and intervention-matched infants and 15 ACHD patients. The diagnostic quality and utility of these two modalities were scored by 4 qualified independent observers. RESULTS: Both in infants and adults, the median contrast volume for 3D-DSRA was lower than 3D-DRA (0.98 vs. 1.81 mL/kg; P < 0.001 and 0.92 vs. 1.4 mL/kg; P < 0.001, respectively) with an increased DAP (median: 188 vs. 128 cGy cm2 ; P = 0.068 and 659 vs. 427 cGy cm2 ; P = 0.045, respectively). The diagnostic quality and utility scores for rotational-angiography, and 3D-reconstruction were superior for 3D-DSRA (score = 94 vs. 80%, P = 0.03 and 90 vs.79%, P = 0.01, respectively) and equivalent for multi-planar-reformation and 3D-roadmapping in ACHD patients compared with 3D-DRA. All scores for both modalities were equivalent for infants. CONCLUSIONS: 3D-DSRA can be acquired using lower contrast volume with a mildly higher radiation dose than 3D-DRA in infants and ACHD patients. The diagnostic quality and utility scores for 3D-DSRA were higher in ACHD patients and equivalent for infants compared with 3D-DRA.

Clinical evaluation of a radio-protective cream for the hands of the pediatric interventional cardiologist.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of UltraBLOX™ radiation attenuating hand cream during lengthy cardiac catheterization procedures in children. BACKGROUND: The hands of interventional cardiologists receive high doses of radiation due to their proximity to the X-ray beam. Radiation attenuating gloves have about a 26% attenuation rate, but reduce dexterity and tactile sensation. The UltraBLOX™ cream is a new FDA-approved X-ray attenuating cream that can be applied to the operator's hands for radio-protection. METHODS: Two nanoDot™ dosimeters were secured side by side on the dorsum of the operator's (n = 2) left hand close to the wrist. One dosimeter and the rest of the hand were covered with 0.2 mm layer of the cream. The other dosimeter was unshielded. Procedures were performed using 110 kVp fluoroscopy at 15 pulses/sec. The measurements were categorized into four groups dependent on the duration of the procedure. The patients in all four groups were well matched for age and size. RESULTS: Procedural and cumulative hand radiation doses were higher with longer procedural duration. The overall % attenuation by the cream was 39.7% (28.6-51.5) and was unaffected by the length of the procedure (median: 40.9% at 30 min and 41.4% at 180 min; P = 0.66) or the dose of radiation. The kappa statistic for interobserver agreement for good tactile sensitivity was 0.82. CONCLUSIONS: UltraBLOX™ cream provides a new option for radio-protection for the hands of interventional cardiologists without impairing tactile sensitivity. There was no decrease in attenuation up to 180 min. © 2016 Wiley Periodicals, Inc.

AAPM Task Group Report 238: 3D C-arms with volumetric imaging capability.

This report reviews the image acquisition and reconstruction characteristics of C-arm Cone Beam Computed Tomography (C-arm CBCT) systems and provides guidance on quality control of C-arm systems with this volumetric imaging capability. The concepts of 3D image reconstruction, geometric calibration, image quality, and dosimetry covered in this report are also pertinent to CBCT for Image-Guided Radiation Therapy (IGRT). However, IGRT systems introduce a number of additional considerations, such as geometric alignment of the imaging at treatment isocenter, which are beyond the scope of the charge to the task group and the report. Section 1 provides an introduction to C-arm CBCT systems and reviews a variety of clinical applications. Section 2 briefly presents nomenclature specific or unique to these systems. A short review of C-arm fluoroscopy quality control (QC) in relation to 3D C-arm imaging is given in Section 3. Section 4 discusses system calibration, including geometric calibration and uniformity calibration. A review of the unique approaches and challenges to 3D reconstruction of data sets acquired by C-arm CBCT systems is give in Section 5. Sections 6 and 7 go in greater depth to address the performance assessment of C-arm CBCT units. First, Section 6 describes testing approaches and phantoms that may be used to evaluate image quality (spatial resolution and image noise and artifacts) and identifies several factors that affect image quality. Section 7 describes both free-in-air and in-phantom approaches to evaluating radiation dose indices. The methodologies described for assessing image quality and radiation dose may be used for annual constancy assessment and comparisons among different systems to help medical physicists determine when a system is not operating as expected. Baseline measurements taken either at installation or after a full preventative maintenance service call can also provide valuable data to help determine whether the performance of the system is acceptable. Collecting image quality and radiation dose data on existing phantoms used for CT image quality and radiation dose assessment, or on newly developed phantoms, will inform the development of performance criteria and standards. Phantom images are also useful for identifying and evaluating artifacts. In particular, comparing baseline data with those from current phantom images can reveal the need for system calibration before image artifacts are detected in clinical practice. Examples of artifacts are provided in Sections 4, 5, and 6.

AAPM Task Group Report 272: Comprehensive acceptance testing and evaluation of fluoroscopy imaging systems.

Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, whereas others do not, making acceptance testing a subjective and time-consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology and continues with general fluoroscopy and mobile C-arms. Finally, the appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail.

Accurate MTF measurement in digital radiography using noise response.

PURPOSE: The authors describe a new technique to determine the system presampled modulation transfer function (MTF) in digital radiography using only the detector noise response. METHODS: A cascaded-linear systems analysis was used to develop an exact relationship between the two-dimensional noise power spectrum (NPS) and the presampled MTF for a generalized detector system. This relationship was then utilized to determine the two-dimensional presampled MTF. For simplicity, aliasing of the correlated noise component of the NPS was assumed to be negligible. Accuracy of this method was investigated using simulated images from a simple detector model in which the "true" MTF was known exactly. Measurements were also performed on three detector technologies (an x-ray image intensifier, an indirect flat panel detector, and a solid state x-ray image intensifier), and the results were compared using the standard edge-response method. Flat-field and edge images were acquired and analyzed according to guidelines set forth by the International Electrotechnical Commission, using the RQA 5 spectrum. RESULTS: The presampled MTF determined using the noise-response method for the simulated detector system was in close agreement with the true MTF with an averaged percent difference of 0.3% and a maximum difference of 1.1% observed at the Nyquist frequency (fN). The edge-response method of the simulated detector system also showed very good agreement at lower spatial frequencies (less than 0.5 fN) with an averaged percent difference of 1.6% but showed significant discrepancies at higher spatial frequencies (greater than 0.5 fN) with an averaged percent difference of 17%. Discrepancies were in part a result of noise in the edge image and phasing errors. For all three detector systems, the MTFs obtained using the two methods were found to be in good agreement at spatial frequencies less than 0.5 fN with an averaged percent difference of 3.4%. Above 0.5 fN, differences increased to an average of 20%. Deviations of the experimental results largely followed the trend seen in the simulation results, suggesting that differences between the two methods could be explained as resulting from the inherent inaccuracies of the edge-response measurement technique used in this study. Aliasing of the correlated noise component was shown to have a minimal effect on the measured MTF for the three detectors studied. Systems with significant aliasing of the correlated noise component (e.g., a-Se based detectors) would likely require a more sophisticated fitting scheme to provide accurate results. CONCLUSIONS: Results indicate that the noise-response method, a simple technique, can be used to accurately measure the MTF of digital x-ray detectors, while alleviating the problems and inaccuracies associated with use of precision test objects, such as a slit or an edge.

Radiation Protocol for Three-Dimensional Rotational Angiography to Limit Procedural Radiation Exposure in the Pediatric Cardiac Catheterization Lab.

BACKGROUND: Three-dimensional rotational angiography (3DRA) offers more detailed anatomic information than 2D digital acquisition (2DDA). Concerns over potentially higher contrast and radiation doses have limited its routine use. OBJECTIVE: The primary objective of this study was to compare radiation doses required to obtain 3DRA using a customized low dose radiation protocol with 2DDA. The secondary objective was to compare total procedural radiation in pediatric cardiac catheterization procedures utilizing 3DRA to those that do not. STUDY DESIGN: Phantom studies were conducted to establish customized 3DRA protocols for radiation reduction. Comparison of 3DRA and non-3DRA procedures in age-, size- and diagnosis-matched controls was performed. Radiation doses were indexed to body surface area (BSA) to account for differing body habitus as validated from the phantom study. RESULTS: Study (n = 100) and control (n = 100) groups were matched for age (10.2 vs. 9.98 years; P = .239) and BSA (1.23 vs. 1.09 m2 ; P = .103). The dose area product (DAP) to acquire a 3DRA was similar to a 5 s, 15 frames/second 2DDA (278 vs. 241 cGy/cm2 ; P = .14). Despite the 3DRA group consisting of more complex interventions, no difference was found in the total procedural Air Kerma and DAP indexed to BSA (244 vs. 249 mGy/m2 ; P = .79 and 3348 vs. 3176 cGy/cm2 /m2 ; P = .48, respectively). The contrast volume to acquire a 3DRA compared to a 2DDA was greater (1.59 vs. 1.01 mL/kg; P < .001). However, no difference was found for the entire procedure (3.8 vs. 4 mL/kg, P = .494). This could have resulted from the need to obtain multiple 2DDAs to achieve the detail of a single 3DRA (11 vs. 7 per study; P < .001). CONCLUSIONS: When 3DRA, using the proposed protocols is employed, total procedural contrast and radiation doses are comparable with the sole use of biplane cine-angiograms. These protocols may allow for routine use of 3DRA for congenital cardiac catheterizations.

Measuring the presampled MTF from a reduced number of flat-field images using the Noise Response (NR) method.

We evaluate a new method for measuring the presampled modulation transfer function (MTF) using the noise power spectrum (NPS) obtained from a few flat-field images acquired at one exposure level. The NPS is the sum of structure, quantum, and additive instrumentation noise, which are proportional to exposure squared, exposure, and a constant, respectively, with the spatial-frequency dependence of the quantum noise depending partly on the detector MTF. Cascaded linear-systems theory was used to derive an exact and generic relationship that was used to isolate noise terms and enable determination of the MTF directly from the noise response, thereby circumventing the need for precision test objects (slit, edge, etc.) as required by standard techniques. Isolation of the quantum NPS by fitting the total NPS versus exposure obtained using 30 flat-field images each at six or more different exposure levels with a linear regression provides highly accurate MTFs. A subset of these images from indirect digital detectors was used to investigate the accuracy of measuring the MTF from 30 or fewer flat-field images obtained at a single exposure level. Analyzing as few as two images acquired at a single exposure resulted in no observable systematic error. Increasing the number of images analyzed resulted in an increase in accuracy. Fifteen images provided comparable accuracy with the most rigorous slope approach, with less than 5% variability, suggesting additional image acquisitions may be unnecessary. Reducing the number of images acquired for the noise response method further simplifies and facilitates routine MTF measurements.

Graphical User Interface for a Dual-Module EMCCD X-ray Detector Array.

A new Graphical User Interface (GUI) was developed using Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) for a high-resolution, high-sensitivity Solid State X-ray Image Intensifier (SSXII), which is a new x-ray detector for radiographic and fluoroscopic imaging, consisting of an array of Electron-Multiplying CCDs (EMCCDs) each having a variable on-chip electron-multiplication gain of up to 2000× to reduce the effect of readout noise. To enlarge the field-of-view (FOV), each EMCCD sensor is coupled to an x-ray phosphor through a fiberoptic taper. Two EMCCD camera modules are used in our prototype to form a computer-controlled array; however, larger arrays are under development. The new GUI provides patient registration, EMCCD module control, image acquisition, and patient image review. Images from the array are stitched into a 2k×1k pixel image that can be acquired and saved at a rate of 17 Hz (faster with pixel binning). When reviewing the patient's data, the operator can select images from the patient's directory tree listed by the GUI and cycle through the images using a slider bar. Commonly used camera parameters including exposure time, trigger mode, and individual EMCCD gain can be easily adjusted using the GUI. The GUI is designed to accommodate expansion of the EMCCD array to even larger FOVs with more modules. The high-resolution, high-sensitivity EMCCD modular-array SSXII imager with the new user-friendly GUI should enable angiographers and interventionalists to visualize smaller vessels and endovascular devices, helping them to make more accurate diagnoses and to perform more precise image-guided interventions.

A method for the determination of the two-dimensional MTF of digital radiography systems using only the noise response.

We present a new method that enables the determination of the two-dimensional MTF of digital radiography systems using the noise response measured from flat-field images. Unlike commonly-used methods that measure the one-dimensional MTF, this new method does not require precision-made test-objects (slits/edges) or precise tool alignment. Although standard methods are dependent upon data processing that can result in inaccuracies and inconsistencies, this method based on the intrinsic noise response of the imager is highly accurate and less susceptible to such problems. A cascaded-linear-systems analysis was used to derive an exact relationship between the noise power spectrum (NPS) and the presampled MTF of a generalized detector system. The NPS was then used to determine the two-dimensional MTF for three systems: a simulated detector in which the "true" MTF was known exactly, a commercial indirect flat-panel detector (FPD), and a new solid-state x-ray image intensifier (SSXII). For the simulated detector, excellent agreement was observed between the "true" MTF and that determined using the noise response method, with an averaged deviation of 0.3%. The FPD MTF was shown to increase on the diagonals and was measured at 2.5 cycles/mm to be 0.086±0.007, 0.12±0.01, and 0.087±0.007 at 0, 45, and 90°, respectively. No statistically significant variation was observed for the SSXII as a function of angle. Measuring the two-dimensional MTF should lead to more accurate characterization of the detector resolution response, incorporating any potential non-isotropy which may result from the physical characteristics of the sensor, including the active-area shape of the pixel array.

The Solid State X-ray Image Intensifier (SSXII) in Single Photon Counting (SPC) mode.

The new Solid State X-Ray Image Intensifier (SSXII) has the unique ability to operate in single photon counting (SPC) mode, with improved resolution, as well as in traditional energy integrating (EI) mode. The SSXII utilizes an electron-multiplying CCD (EMCCD), with an effective pixel size of 32µm, which enables variable signal amplification (up to a factor of 2000) prior to digital readout, providing very high-sensitivity capabilities. The presampled MTF was measured in both imaging modes using the standard angulated-slit method. A measured detector entrance exposure of 24µR per frame was used to provide approximately 0.8 interaction events per pixel in the 10µm-wide slit area. For demonstration purposes, a simple thresholding technique was used to localize events in SPC mode and a number of such frames were summed to provide an image with the same total exposure used for acquiring the EI image. The MTF for SPC mode, using a threshold level of 15% of the maximum 12-bit signal and 95% of the expected events, and for EI mode (in parentheses) was 0.67 (0.20), 0.37 (0.07), 0.20 (0.03), and 0.11 (0.01) at 2.5, 5, 7.5, and 10 cycles/mm, respectively. Increasing the threshold level resulted in a corresponding increase in the measured SPC MTF and a lower number of detected events, indicating a tradeoff between resolution and count efficiency is required. The SSXII in SPC mode was shown to provide substantial improvements in resolution relative to traditional EI mode, which should benefit applications that have demanding spatial resolution requirements, such as mammography.

Performance Trade-Off Analysis Comparing Different Front-End Configurations for a Digital X-ray Imager.

Performance of indirect digital x-ray imagers is typically limited by the front-end components. Present x-ray-to-light converting phosphors significantly reduce detector resolution due to stochastic blurring and k-fluorescent x-ray reabsorption. Thinner phosphors improve resolution at the cost of lowering quantum detection efficiency (QDE) and increasing Swank noise. Magnifying fiber optic tapers (FOTs) are commonly used to increase the field-of-view of small sensor imagers, such as CMOS, CCD, or electron-multiplying CCD (EMCCD) based detectors, which results in a reduction in detector sensitivity and further reduces the MTF. We investigate performance trade-offs for different front-end configurations coupled to an EMCCD sensor with 8 µm pixels. Six different columnar structured CsI(Tl) scintillators with thicknesses of 100, 200, 350, 500, and 1000 µm type high-light (HL) and a 350 µm type high-resolution (HR) (Hamamatsu) and four different FOTs with magnification ratios (M) of 1, 2.5, 3.3, and 4 were studied using the RQA5 x-ray spectrum. The relative signal of the different scintillators largely followed the relative QDE, indicating their light output per absorbed x-ray was similar, with the type HR CsI emitting 57% of the type HL. The efficiency of the FOTs was inversely proportional to M(2) with the M = 1 FOT transmitting 87% of the incident light. At 5 (10) cycles/mm, the CsI MTF was 0.38 (0.22), 0.33 (0.17), 0.37 (0.19), 0.23 (0.09), 0.19 (0.08), and 0.09 (0.03) for the 100, 200, 350HR, 350, 500, and 1000 µm CsI, respectively and the FOT MTF was 0.89 (0.84), 0.80 (0.72), 0.70 (0.60), and 0.69 (0.37) for M = 1, 2.5, 3.3, and 4, respectively. The 1000, 500, and 350HR µm CsI had the highest DQE for low, medium, and high spatial frequency ranges of 0 to 1.6, 1.6 to 4.5, and 4.5 to 10 cycles/mm, respectively. Larger FOT M resulted in a reduction in DQE. Quantifying performance of different front-end configurations will enable optimal selection of components for task-specific designs.

Progress in the Development of a new Angiography Suite including the High Resolution Micro-Angiographic Fluoroscope (MAF), a Control, Acquisition, Processing, and Image Display System (CAPIDS), and a New Detector Changer Integrated into a Commercial C-Arm Angiography Unit to Enable Clinical Use.

Due to the high-resolution needs of angiographic and interventional vascular imaging, a Micro-Angiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer which was attached to the C-arm of a clinical angiographic unit. The MAF detector provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 µm-thick CsI phosphor, a dual stage micro-channel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 µm square pixels with 12 bit depth. The Solid-State X-Ray Image Intensifier (SSXII) is an EMCCD (Electron Multiplying charge-coupled device) based detector which provides an image matrix of 1k×1k 32 µm square pixels with 12 bit depth. The changer allows the MAF or a SSXII region-of-interest (ROI) detector to be inserted in front of the standard flat-panel detector (FPD) when higher resolution is needed during angiographic or interventional vascular imaging procedures. The CAPIDS was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF or SSXII including: fluoroscopy, roadmapping, radiography, and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular image-guided interventions (EIGI) using prototype self-expanding asymmetric vascular stents (SAVS) in over 10 rabbit aneurysm creation and treatment experiments which have demonstrated the system's potential benefits for future clinical use.

Generalized two-dimensional (2D) linear system analysis metrics (GMTF, GDQE) for digital radiography systems including the effect of focal spot, magnification, scatter, and detector characteristics.

The MTF, NNPS, and DQE are standard linear system metrics used to characterize intrinsic detector performance. To evaluate total system performance for actual clinical conditions, generalized linear system metrics (GMTF, GNNPS and GDQE) that include the effect of the focal spot distribution, scattered radiation, and geometric unsharpness are more meaningful and appropriate. In this study, a two-dimensional (2D) generalized linear system analysis was carried out for a standard flat panel detector (FPD) (194-micron pixel pitch and 600-micron thick CsI) and a newly-developed, high-resolution, micro-angiographic fluoroscope (MAF) (35-micron pixel pitch and 300-micron thick CsI). Realistic clinical parameters and x-ray spectra were used. The 2D detector MTFs were calculated using the new Noise Response method and slanted edge method and 2D focal spot distribution measurements were done using a pin-hole assembly. The scatter fraction, generated for a uniform head equivalent phantom, was measured and the scatter MTF was simulated with a theoretical model. Different magnifications and scatter fractions were used to estimate the 2D GMTF, GNNPS and GDQE for both detectors. Results show spatial non-isotropy for the 2D generalized metrics which provide a quantitative description of the performance of the complete imaging system for both detectors. This generalized analysis demonstrated that the MAF and FPD have similar capabilities at lower spatial frequencies, but that the MAF has superior performance over the FPD at higher frequencies even when considering focal spot blurring and scatter. This 2D generalized performance analysis is a valuable tool to evaluate total system capabilities and to enable optimized design for specific imaging tasks.

Optical Demonstration of a Medical Imaging System with an EMCCD-Sensor Array for Use in a High Resolution Dynamic X-ray Imager.

Use of an extensible array of Electron Multiplying CCDs (EMCCDs) in medical x-ray imager applications was demonstrated for the first time. The large variable electronic-gain (up to 2000) and small pixel size of EMCCDs provide effective suppression of readout noise compared to signal, as well as high resolution, enabling the development of an x-ray detector with far superior performance compared to conventional x-ray image intensifiers and flat panel detectors. We are developing arrays of EMCCDs to overcome their limited field of view (FOV). In this work we report on an array of two EMCCD sensors running simultaneously at a high frame rate and optically focused on a mammogram film showing calcified ducts. The work was conducted on an optical table with a pulsed LED bar used to provide a uniform diffuse light onto the film to simulate x-ray projection images. The system can be selected to run at up to 17.5 frames per second or even higher frame rate with binning. Integration time for the sensors can be adjusted from 1 ms to 1000 ms. Twelve-bit correlated double sampling AD converters were used to digitize the images, which were acquired by a National Instruments dual-channel Camera Link PC board in real time. A user-friendly interface was programmed using LabVIEW to save and display 2K × 1K pixel matrix digital images. The demonstration tiles a 2 × 1 array to acquire increased-FOV stationary images taken at different gains and fluoroscopic-like videos recorded by scanning the mammogram simultaneously with both sensors. The results show high resolution and high dynamic range images stitched together with minimal adjustments needed. The EMCCD array design allows for expansion to an M×N array for arbitrarily larger FOV, yet with high resolution and large dynamic range maintained.

Component Level Modular Design of a Solid State X-ray Image Intensifier for an M×N Array.

The Solid-State X-ray Image Intensifier (SSXII) is a novel dynamic x-ray imager, based on an array of electron-multiplying CCDs (EMCCDs), that can significantly improve performance compared to conventional x-ray image intensifiers (XIIs) and flat panel detectors (FPDs). To expand the field-of-view (FOV) of the SSXII detectors while maintaining high resolution, a scalable component level modular design is presented. Each module can be fit together with minimum dead-space and optically coupled to one contiguous x-ray converter plate. The electronics of each of the modules consists of a detachable head-board, on which is mounted the EMCCD, and a driver board. The size of the head-boards is minimized to ensure that the modules fit together properly. The driver boards connect with the head-boards via flat cables and are designed to be plugged into the main mother-board that contains an FPGA chip that generates the driving clock signals for the EMCCDs and analog-to-digital converter (ADC). At the front-end, a high speed ADC on each of the driver boards samples and digitizes the EMCCD analog output signal and an extensible modular digital multiplexer back-end is used to acquire and combine image data from multiple modules. The combined digital data is then transmitted to a PC via a standard Camera Link interface. Eventually, this modular design will be extended to a 3×3 or larger array to accomplish full clinical FOVs and enable the SSXII to replace conventional lower-resolution XIIs or FPDs.

Quantum Performance Analysis of an EMCCD-based X-ray Detector Using Photon Transfer Technique.

The low electronic noise, high resolution, and good temporal performance of electron-multiplying CCDs (EMCCDs) are ideally suited for applications traditionally served by x-ray image intensifiers. In order to improve an expandable clinical detector's field-of-view and have full control of the system performance, we have successfully built a solid-state x-ray detector. The photon transfer technique was used to quantify the EMCCD quantum performance in terms of sensitivity (or camera gain constant, K), read noise (RN), full-well capacity (FW), and dynamic range (DR). Measured results show the system maintains a K of 11.3 ± 0.9 e(-)/DN at unit gain, with a read noise of 71.5±6.0 e(-)rms at gain 1, which decreases proportionally with higher gains. The full well capacity was measured to be 31.3±2.7 ke(-), providing a dynamic range of 52.8±0.7 dB using the chip manufacturer specified clocking scheme. Similar performance was measured with other commercial camera systems. The manufacturer data sheet indicates a dynamic range of 66 dB is plausible with improved read noise and full well capacity. Different clocking schemes are under investigation to assess their impact on improving performance towards idealized values. EMCCD driver clock voltage levels were adjusted individually to check the influence on quantum performance. The clocks work to transfer charge from the image area to readout amplifier through the storage area, horizontal and multiplication registers. Results indicate that the clock that contributes to lateral overflow drain bias is essential to the system performance in terms of dynamic range and full well capacity. The serial register clocks used for transporting charge stored in the pixels of the memory lines to the output amplifier had the largest effect on RN, while others had less of an impact. Initial adjustment of these clocks resulted in a variability of 16% in the performance of dynamic range, 38% in read noise and 56% in full well capacity. Quantifying the quantum performance provides valuable insight into overall performance and enables optimal adjustment of the clocking scheme. Further improvements are expected.

Component analysis of a new Solid State X-ray Image Intensifier (SSXII) using photon transfer and Instrumentation Noise Equivalent Exposure (INEE) measurements.

The SSXII is a novel x-ray imager designed to improve upon the performance limitations of conventional dynamic radiographic/fluoroscopic imagers related to resolution, charge-trapping, frame-rate, and instrumentation-noise. The SSXII consists of a CsI:Tl phosphor coupled via a fiber-optic taper (FOT) to an electron-multiplying CCD (EMCCD). To facilitate investigational studies, initial designs enable interchangeability of such imaging components. Measurements of various component and configuration characteristics enable an optimization analysis with respect to overall detector performance. Photon transfer was used to characterize the EMCCD performance including ADC sensitivity, read-noise, full-well capacity and quantum efficiency. X-ray sensitivity was measured using RQA x-ray spectra. Imaging components were analyzed in terms of their MTF and transmission efficiency. The EMCCD was measured to have a very low effective read-noise of less than 1 electron rms at modest EMCCD gains, which is more than two orders-of-magnitude less than flat panel (FPD) and CMOS-based detectors. The variable signal amplification from 1 to 2000 times enables selectable sensitivities ranging from 8.5 (168) to over 15k (300k) electrons per incident x-ray photon with (without) a 4:1 FOT; these sensitivities could be readily increased with further component optimization. MTF and DQE measurements indicate the SSXII performance is comparable to current state-of-the-art detectors at low spatial frequencies and far exceeds them at higher spatial frequencies. The instrumentation noise equivalent exposure (INEE) was measured to be less than 0.3 µR out to 10 cycles/mm, which is substantially better than FPDs. Component analysis suggests that these improvements can be substantially increased with further detector optimization.

Improved contrast and spatial resolution with Single Photon Counting (SPC) for an area x-ray imager, the newly developed high-resolution Micro-Angiographic Fluoroscopic (MAF) detector.

Although in radiological imaging, the prevailing mode of acquisition is the integration of the energy deposited by all x-rays absorbed in the imaging detector, much improvement in image spatial and contrast resolution could be achieved if each individual x-ray photon were detected and counted separately. In this work we compare the conventional energy integration (EI) mode with the new single photon counting (SPC) mode for a recently developed high-resolution Micro-Angiographic Fluoroscopic (MAF) detector, which is uniquely capable of both modes of operation. The MAF has 1024×1024 pixels of 35 microns effective size and is capable of real-time imaging at 30 fps. The large variable gain of its light image intensifier (LII) provides quantum limited operation with essentially no additive instrumentation noise and enables the MAF to operate in both EI and the very sensitive low-exposure SPC modes. We used high LII gain with very low exposure (<1 x-ray photon/pixel) per frame for SPC mode and higher exposure per frame with lower gain for EI mode. Multiple signal-thresholded frames were summed in SPC mode to provide an integrated frame with the same total exposure as EI mode. A heavily K-edge filtered x-ray beam (average energy of 31 keV) was used to provide a nearly monochromatic spectrum. The MTF measured using a standard slit method showed a dramatic improvement for the SPC mode over the EI mode at all frequencies. Images of a line pair phantom also showed improved spatial resolution with 12 lp/mm visible in SPC mode compared to only 8 lp/mm in EI mode. In SPC mode, images of human distal and middle phalanges showed the trabecular structures of the bone with far better contrast and detail. These improvements with the SPC mode should be advantageous for clinical applications where high resolution and/or high contrast are essential such as in mammography and extremity imaging as well as for dual modality applications, which combine nuclear medicine and x-ray imaging using a single detector.

Generalized Objective Performance Assessment of a New High-Sensitivity Microangiographic Fluoroscopic (HSMAF) Imaging System.

The objective performance evaluation metrics, termed Generalized Modulation Transfer Function (GMTF), Generalized Noise Power Spectrum (GNPS), Generalized Noise Equivalent Quanta (GNEQ), and Generalized Detective Quantum Efficiency (GDQE), have been developed to assess total imaging-system performance by including the effects of geometric unsharpness due to the finite size of the focal spot and scattered radiation in addition to the detector properties. These metrics were used to evaluate the performance of the HSMAF, a custom-built, high-resolution, real-time-acquisition detector with 35-mum pixels, in simulated neurovascular angiographic conditions using a uniform head-equivalent phantom. The HSMAF consists of a 300-mum-thick CsI(Tl) scintillator coupled to a 4 cm diameter, variable-gain, Gen2 light image intensifier with dual-stage microchannel plate, followed by direct fiber-optic coupling to a 30-fps CCD camera, and is capable of both fluoroscopy and angiography. Effects of focal-spot size, geometric magnification, irradiation field-of-view, and air-gap between the phantom and the detector were evaluated. The resulting plots of GMTF and GDQE showed that geometric blurring is the more dominant image degradation factor at high spatial frequencies, whereas scatter dominates at low spatial frequencies. For the standard image-geometry and scatter conditions used here, the HSMAF maintains substantial system imaging capabilities (GDQE>5%) at frequencies above 4 cycles/mm where conventional detectors cannot operate. The loss in image SNR due to scatter or focal-spot unsharpness could be compensated by increasing the exposure by a factor of 2 to 3. This generalized evaluation method may be used to more realistically evaluate and compare total system performance leading to improved system designs.

The Solid-State X-Ray Image Intensifier (SSXII): An EMCCD-Based X-Ray Detector.

The solid-state x-ray image intensifier (SSXII) is an EMCCD-based x-ray detector designed to satisfy an increasing need for high-resolution real-time images, while offering significant improvements over current flat panel detectors (FPDs) and x-ray image intensifiers (XIIs). FPDs are replacing XIIs because they reduce/eliminate veiling glare, pincushion or s-shaped distortions and are physically flat. However, FPDs suffer from excessive lag and ghosting and their performance has been disappointing for low-exposure-per-frame procedures due to excessive instrumentation-noise. XIIs and FPDs both have limited resolution capabilities of ~3 cycles/mm. To overcome these limitations a prototype SSXII module has been developed, consisting of a 1k x 1k, 8 mum pixel EMCCD with a fiber-optic input window, which views a 350 mum thick CsI(Tl) phosphor via a 4:1 magnifying fiber-optic-taper (FOT). Arrays of such modules will provide a larger field-of-view. Detector MTF, DQE, and instrumentation-noise equivalent exposure (INEE) were measured to evaluate the SSXIIs performance using a standard x-ray spectrum (IEC RQA5), allowing for comparison with current state-of-the-art detectors. The MTF was 0.20 at 3 cycles/mm, comparable to standard detectors, and better than 0.05 up to 7 cycles/mm, well beyond current capabilities. DQE curves indicate no degradation from high-angiographic to low-fluoroscopic exposures (< 2% deviation in overall DQE from 1.3 mR to 2.7 muR), demonstrating negligible instrumentation-noise, even with low input signal intensities. An INEE of < 0.2 muR was measured for the highest-resolution mode (32 mum effective pixel size). Comparison images between detector technologies qualitatively demonstrate these improved imaging capabilities provided by the SSXII.