Ultrasonic diagnostic instruments.

The underlying physical principles and current limitations of diagnostic ultrasonic instruments are reviewed. Recently developed ultrasonic imaging devices using pulsed-reflected ultrasound are discussed in detail. These instruments transmit short trains of 1.5- to 10-megahertz sound. Echoes reflected from tissue are converted to electrical signals, which are presented on a display device to outline the contour of tissues and organs within the body. The physical resolution of the system is dependent on several design factors in addition to the transmitted sound frequencies. A resolution volume of approximately 1.5 by 3 by 4 millimeters is achieved optimally with commercially available systems operating at 2.25 megahertz. The various instrument designs are described in the context of clinical usage. Because the sound is diffracted, refracted, and reflected, tghe imaging considerations are different from those of x-ray imaging. Diagnostic devices based on the Doppler principle are distinguished from pulsed-reflected ultrasonic instruments.

Noise performance of a precision pulsed electromagnet power supply for magnetic resonance imaging.

Prepolarized magnetic resonance imaging (PMRI) uses two pulsed electromagnets to achieve high-field image quality with the benefits of low-field data acquisition. The principal challenge with all resistive MRI systems is the implementation of a highly precise magnet current supply. The noise current through the magnet is fundamentally limited by the current transducer used to provide feedback and the voltage reference used to generate the demand signal. Field instability in the main field magnet can both corrupt the received data and degrade the robustness of Carr¿Purcell¿Meiboom¿Gill (CPMG) echo trains, which are paramount to efficient imaging in PMRI. In this work, we present the magnet control system that achieved sufficient field stability for PMRI at $0.5/0.13$ T, identify the dominant sources of noise in the control system, examine the imaging artifacts that can occur if the field stability is insufficient, and identify how the design can be improved for better field stability, should it be required for future implementations of PMRI.

Rapid evaluation of left ventricular volume and mass without breath-holding using real-time interactive cardiac magnetic resonance imaging system.

OBJECTIVES: The purpose of this study was to validate cardiac measurements derived from real-time cardiac magnetic resonance imaging (MRI) as compared with well-validated conventional cine MRI. BACKGROUND: Although cardiac MRI provides accurate assessment of left ventricular (LV) volume and mass, most techniques have been relatively slow and required electrocardiogram (ECG) gating over many heart beats. A newly developed real-time MRI system allows continuous real-time dynamic acquisition and display without cardiac gating or breath-holding. METHODS: Fourteen healthy volunteers and nine patients with heart failure underwent real-time and cine MRI in the standard short-axis orientation with a 1.5T MRI scanner. Nonbreath-holding cine MRI was performed with ECG gating and respiratory compensation. Left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV), ejection fraction (EF) and LV mass calculated from the images obtained by real-time MRI were compared to those obtained by cine MRI. RESULTS: The total study time including localization for real-time MRI was significantly shorter than cine MRI (8.6 +/- 2.3 vs. 24.7 +/- 3.5 min, p < 0.001). Both imaging techniques yielded good quality images allowing cardiac measurements. The measurements of LVEDV, LVESV, EF and LV mass obtained with real-time MRI showed close correlation with those obtained with cine MRI (LVEDV: r = 0.985, p < 0.001; LVESV: r = 0.994, p < 0.001; EF: r = 0.975, p < 0.001; LV mass: r = 0.977, p < 0.001). CONCLUSIONS: Real-time MRI provides accurate measurements of LV volume and mass in a time-efficient manner with respect to image acquisition.

Spiral magnetic resonance coronary angiography with rapid real-time localization.

A spiral high-resolution coronary artery imaging sequence (SH) interfaced with real-time localization system (RT) has been developed. A clinical study of 40 patients suspected of coronary artery disease (CAD) was conducted. Segmented k-space acquisition techniques have dominated magnetic resonance coronary angiography (MRCA) over the last decade. Although a recent multicenter trial using this technique demonstrated encouraging results, the technique was hampered by low specificity. Spiral k-space acquisition had demonstrated several advantages for MRCA. Therefore, a first clinical trial implementing spiral high-resolution coronary imaging sequence with real-time localization (SH-RT) was performed.A clinical study of 40 patients suspected of CAD undergoing X-ray angiography was conducted to analyze the clinical reliability of this novel imaging system. The SH-RT had been designed to exploit the unique capability of two imaging sequences. The RT allowed a rapid localization of the coronary arteries. Then SH achieved multislice acquisition during a short breath-hold with submillimeter resolution. The MRCA data were analyzed for scan time, anatomic coverage, image quality, and accuracy in detecting CAD. In 40 subjects, SH achieved 0.7 to 0.9 mm resolution with 14-heartbeat breath-holds. Excellent or good image quality was achieved in 78% (263/337) of the coronary segments. Blinded consensus reading among three observers generated sensitivity of 76% and specificity of 91% in the detection of CAD compared with X-ray angiography. The MRCA imaging sequence implementing a novel spiral k-space acquisition technique enabled rapid and reliable imaging of the CAD in submillimeter resolution with short breath-holds.

New real-time interactive cardiac magnetic resonance imaging system complements echocardiography.

OBJECTIVES: We conducted an initial clinical trial of a newly developed cardiac magnetic resonance imaging (CMRI) system. We evaluated left ventricular (LV) function in 85 patients to compare the clinical utility of the CMRI system with echocardiography, the current noninvasive gold standard. BACKGROUND: Conventional CMRI systems require cardiac-gating and respiratory compensation to synthesize a single image from data acquired over multiple cardiac cycles. In contrast, the new CMRI system allows continuous real-time dynamic acquisition and display of any scan plane at 16 images/s without the need for cardiac gating or breath-holding. METHODS: A conventional 1.5T Signa MRI Scanner (GE, Milwaukee, Wisconsin) was modified by the addition of an interactive workstation and a bus adapter. The new CMRI system underwent clinical trial by testing its ability to evaluate global and regional LV function. The first group (A) consisted of 31 patients with acceptable echocardiography image quality. The second group (B) consisted of 31 patients with suboptimal echocardiography image quality. The third group (C) consisted of 29 patients with severe lung disease or congenital cardiac malformation who frequently have suboptimal echo study. Two independent observers scored wall motion and image quality using the standard 16-segment model and rank-order analysis. RESULTS: CMRI evaluation was complete in less than 15 min. In group A, no significant difference was found between ECHO and CMRI studies (p = NS). In group B, adequate visualization of wall segments was obtained 38% of the time using ECHO and 97% of the time using CMRI (p < 0.0001). When grouped into coronary segments, adequate visualization of at least one segment occurred in 18 of 30 patients (60%) with ECHO and in all 30 patients (100%) with CMRI (p < 0.0001). In group C, adequate visualization of the wall segments was obtained in 58% (CI 0.53-0.62) of the time using echocardiography and 99.7% (CI 0.99-1.0) of the time using CMRI (p < 0.0001). CONCLUSIONS: The new CMRI system provides clinically reliable evaluation of LV function and complements suboptimal echocardiography. In comparison with the conventional CMRI, the new CMRI system significantly reduces scan time, patient discomfort and associated cost.

Clinical application of Compton and photo-electric reconstruction in computed tomography: preliminary results.

Although computed tomography has demonstrated some promise in the direction of quantative radiology, valuable information related to the varying response of tissues to x-rays of different energy is still not utilized on a routine basis. Advancements in a method proposed by Alvarez and Macovski for decomposing dual-spectra CT projection data into its material-dependent Compton and photo-electric components are described. Results are presented to demonstrate that such a separation can be performed. Reconstructed images of separated Compton and photo-electric data obtained from clinical scans are shown. With the improvements described, the Compton images begin to approach the quality of conventional reconstructions with evidence of improved polychromatic correction. The photo-electric data, while separable, suffers from unacceptable noise level. Analysis of this difficulty is presented, with recommendations for future improvement by careful selection of the effective energy of the low energy spectrum. The encouraging results suggest that this technique warrants continued development and evaluation.

Intravenous angiography using scanned projection radiography: preliminary investigation of a new method.

The use of digital subtraction techniques combined with fluoroscopy has rekindled interest in arteriography using intranvenous injections of contrast media. A new method is proposed for intravenous angiography in which an x-ray source and xenon detector array from a computed tomographic (CT) scanner are used to scan a region of interest to produce projection image. In order to provide adequate visualization of small concentrations of iodine in blood vessels, a subtraction scheme is used to remove the contribution from overlapping soft tissue and bone. Initial experiments with a temporal subtraction algorithm on phantoms have demonstrated the ability to image simulated blood vessels of 1.7-mm diameter containing dilute diatrizoate with an iodine concentration of 3.7 mg/cc, at an exposure of less than 100 mR. Vascular structures 5-8 mm in diameter have been imaged in dogs with iodine concentrations of less than 37 mg/cc using temporal subtraction. Principal advantages of the method over other film or fluoroscopic subtraction techniques are: 1) wide dynamic range an low noise of the (CT) detectors, providing excellent iodine sensitivity; 2) high scatter rejection; and 3) efficient utilization of x-ray dose.

Applications of time-varying gradients in existing magnetic resonance imaging systems.

This paper describes several applications of magnetic resonance imaging (MRI) with time-varying gradients within the framework of existing imaging systems. An alternative form of slice selection is shown where a time-varying gradient is used, during the reception interval, to isolate the slice of interest (the reconstruction of the slice itself is treated by the conventional techniques). This system allows for precise control of the slice, thinner slices (less than 1 mm) and the ability to select multiple, closely packed slices using a single imaging sequence. All this is done by postprocessing so the slice(s) of interest can be selected after the measurements have been completed. It is also shown how time-varying gradients can be used to generate the signals required for conventional projection-reconstruction and two-dimensional Fourier transform techniques (yet achieving higher resolution and using a resonant gradient system). In addition to cross-sectional imaging, this same approach provides a simple system for projection imaging of the entire volume. All of these techniques constitute a good starting point for the exploitation of time-varying gradients for fast, high-resolution MRI with existing imaging systems.

Vessel imaging using dual-energy tomosynthesis.

A method has been developed that combines dual-energy subtraction and tomosynthesis for vessel imaging in intravenous angiography. This paper describes the procedure for doing tomosynthesis on a fan-beam rotational-motion system and gives the point responses of the imaging system. Phantom studies show that dual-energy tomosynthesis improves the visualization of desired vessels lying on a selected plane. The results may be feasible for some applications such as clinical diagnosis of coronary artery diseases.

Information and artifact in computed tomography image statistics.

In conventional computed tomography images only the average CT number, which is a first-order statistical parameter, is used to characterize the tissues by giving an estimate of tissue density. Second order statistical parameters such as the signal variance and cross-correlation function have also been used to obtain additional information to discriminate between certain tissues and lesions. However, the contribution of quantum noise to the signal variance and cross-correlation function creates, for the conventional CT patient dose, a background signal often larger than the signal containing the information about tissue structure. The misleading information, called "artifacts", in second-order image statistics caused by quantum noise, is studied.

Dual-energy x-ray projection imaging: two sampling schemes for the correction of scattered radiation.

In addition to the familiar problems of reduced contrast and signal-to-noise ratio (SNR) in the single energy case, dual-energy subtractions in the presence of scattered radiation suffer further degradations from: (1) artifacts due to nonuniform subtraction of scatter, and (2) a serious deterioration of the signal of interest. To determine the expected performance of scatter correcting schemes, we simulated energy subtractions performed in the presence of scatter. We discuss scatter's detrimental effects on contrast and SNR in these simulations and the expected improvements from scatter corrections to within 5% to 10%. We introduce two sampling schemes for the correction of scatter. Each scheme requires two measurements, and each involves placing an x-ray opaque sampling grid between the source and the object. In the first method, the grid is an array of lead disks present only during one measurement. Using these samples we generate an estimate of the scatter field and then subtract it from the second measurement yielding a scatter corrected image. In the second method, the grid is an array of lead strips present during both measurements but displaced between measurements by one-half of a strip spacing to completely sample the image. From the two measurements we generate an image to be corrected, an estimate of the scatter field, and a scatter corrected image. In phantom studies implemented on a digital fluoroscopy system, we observed for single energy images of blood vessel phantoms improved contrast and field uniformity. For scatter corrected selective material cancellations in human phantoms we observed improved contrast and significant reduction in artifacts. In both cases we observed no significant loss in SNR. These results facilitate the implementation of efficient large area detectors for dual-energy imaging.

Two interpolating filters for scatter estimation.

We have previously reported on a dual-measurement sample-and-estimate technique for scatter correction. In this paper, we present a scatter-correction technique that uses the previous sampling scheme but a different method of estimation. To provide samples of the scatter directly, an array of small, uniformly spaced lead disks is placed immediately before the object during only the first measurement. Interpolating from these samples we form an estimate of the scatter. We subtract this estimate from the second measurement to form a scatter-corrected image. Previously, we used least-squares interpolation to estimate the scatter. Because the samples are uniformly spaced, classical sampling theory motivated the investigation of interpolating filters for scatter estimation. To form the scatter image, we convolved the sample set with two different interpolating filters--a sinc function from classical sampling theory and a jinc function because the scatter function is radially symmetric. Using phantoms as objects, we applied both filters for scatter correction in vessel imaging and energy-subtraction imaging. Initial corrected images contained an artifact attributed to aliasing. We modified the filter widths to reduce the aliasing. Although improvements in image quality were measured and the artifact was less pronounced, the artifact was still present. We present the phantom results obtained with this class of filters and discuss methods for its improved performance.

Noise analysis in isolation of iodine using three energies.

The Poisson noise inherent in multispectral x-ray imaging systems is formulated to give the SNR under a limited exposure constraint. The SNR value is maximized with respect to the exposure partition among different x-ray energies. The study shows how to choose suitable spectra and the dose weights. The robustness of these dose weights is also demonstrated for systems of varying bone and tissue contents.

Fast minimum variance estimator for limited angle CT image reconstruction.

Many applications of diagnostic cross sectional imaging require that images be reconstructed from a limited number of projections (limited angle). Convolution back projection has been unsuitable in these applications. Methods for reconstruction based on stochastic estimation theory, such as the minimum variance estimator, use a discrete linear measurement model and are suitable for limited angle reconstruction. Unfortunately, the computational requirements of these methods have precluded their use. In this paper, starting from the general minimum variance estimator x = RxyRyy-1y, a computationally efficient (fast) estimator is derived for limited angle reconstruction by choosing Rxy and Ryy in the simplest way consistent with the geometric considerations of data acquisition. Minimum variance has in the past been precluded from use by the large amount of computation required to compute Ryy-1. With the fast estimator, the computation is avoided because Ryy has a particular form that allows factorization of the matrix into a product of matrices, each of which is easily inverted. A demonstration of the estimator for the reconstruction of sharp peaks is provided. Image quality is similar to that obtained with other methods.

Noise reduction methods for hybrid subtraction.

In digital subtraction angiography, hybrid subtraction provides selective vessel images free of soft-tissue motion artifacts but with a lower signal-to-noise ratio (SNR) than temporal subtraction images. An image processing method called measurement-dependent filtering has been developed to enhance the SNR of hybrid images without losing resolution or selectivity. Linear combinations of four images consisting of a pre- and postcontrast dual-energy measurement pair form both the hybrid image and a lower noise but less selective vessel image. The noise-reduced image is derived by combining the low-frequency components of the hybrid image with the high-frequency components of the lower noise image in a variety of ways. The results of the filtering method, when tested on both phantom and clinical data, display images with about the same degree of conspicuity as the hybrid image and a SNR approaching that of the temporal image.

A method for selective tissue and bone visualization using dual energy scanned projection radiography.

Information contained in the x-ray energy spectrum can be used to produce selective radiographic images of bone or soft tissue. A method has been devised to separate bone and soft tissue based upon differences in photoelectric absorption and Compton scattering using an appropriate combination of images obtained with radiographic exposures at 70 KVP and 140 KVP. Since photoelectric absorption is highly dependent upon atomic number, high atomic number materials such as calcium can be easily separated from water density substances. Using a prototype system for line-scanned radiography, selective subtraction of bone or soft-tissue has been implemented. Because this method uses a conventional broad-spectrum x-ray source, it was necessary to develop a nonlinear polynomial approximation to estimate tissue and bone thickness. The model was verified with phantom studies using water and aluminum. The application of this dual-energy bone and soft-tissue separation to chest radiography is demonstrated. This method allows accurate estimation of tissue and bone thickness and should find application to chest radiography for improved lesion detection and for bone mineral assessment.

Generalized image combinations in dual KVP digital radiography.

Dual energy basis decomposition techniques apply to single projection radiographic imaging. The high and low energy images are non-linearly transformed to generate two energy-independent images characterizing the integrated Compton/photoelectric attenuation components. Characteristic linear combinations of these two basis images identify unknown materials, cancel known materials, and generate synthesized monoenergetic images. The problems of intervening materials and material displacement are solved in general for a wide class of clinical imaging tasks. The basis projection angle identifies one from a family of energy selective imaging tasks, and such performance measures as the contrast enhancement factor (CEF) and signal to noise ratio (SNR) are expressed as functions of this angle. Algorithms for the decomposition of high and low energy measurements are compared and experimental images are included.

Selective projection imaging: applications to radiography and NMR.

Projection imaging has traditionally been plagued by intervening structures which limited the visibility of the desired regions. This problem was solved by the cross-sectional format of computerized tomography. This format, Manuscript received at 1982. however, exhibits relatively limited field of view, poor resolution and high dose. It is particularly unsuitable for the important problem of vessel imaging. In this paper we study selective projection imaging, a technique for isolating the desired structures in the projection format. In digital radiography, using temporal or energy subtraction, these techniques have shown excellent capability of imaging important structures. These techniques appear particularly applicable to NMR where, unlike the X-ray history, primarily cross-sectional images have been produced. In particular, because of its sensitivity to moving material, NMR appears ideally suited to vessel imaging. ntroduction.

Resolution and noise considerations in MRI systems with time-varying gradients.

The design and performance of spatial localization filters in an MR imaging system with time-varying gradients is presented. The system is based on recording measurements of the imaged volume-done in the presence of cosinusoidal gradients. A postprocessing scheme is shown which enables every point to be imaged from a single FID signal. Methods are shown which achieve a three-demensional localization with arbitrarily small sidelobes. Those localization filters are implemented without significant computational penalty. The signal-to-noise ratio (SNR) in the suggested imaging system is shown to be space-invariant (same SNR for each imaged point). We find a closed-form relation between the localization filter and the resulting noise. It is shown that the gain achieved by the localization filters highly exceeds the relatively small loss in SNR.

Inhomogeneity and multiple dimension considerations in magnetic resonance imaging with time-varying gradients.

The inhomogeneity of the main magnetic field is a significant factor limiting the performance and increasing the cost of commercial magnetic resonance imaging (MRI) and spectroscopy machines. This is particularly true where shielding is employed to limit fringing fields. In this paper, we investigate the performance of a recently introduced MRI technique using time-varying gradients in the presence of such inhomogeneity. It is shown that the time-varying gradient imaging system can accommodate considerable inhomogeneities (1000 ppm in typical imaging application). The problem of selection of the gradient frequencies for simultaneous multiple dimension imaging in the presence of inhomogeneity is formulated and solved.