Feasibility study of a novel portable digital radiography system modified for fluoroscopy in the neonatal intensive care unit.

BACKGROUND: A portable radiographic system capable of fluoroscopic imaging in the neonatal intensive care unit (NICU) potentially benefits critically ill neonates by eliminating the need to transport them to a fluoroscopy suite. OBJECTIVE: To evaluate whether a portable bedside fluoroscopy system in the NICU can deliver comparable image quality at a similar dose rate to a standard system in a fluoroscopy suite. MATERIALS AND METHODS: In phase A, 20 patients <3 years of age and scheduled to undergo upper gastrointestinal series (upper GI) or voiding cystourethrograms (VCUG) in the radiology fluoroscopy suite were recruited to evaluate a portable fluoroscopic unit. A modified portable radiographic system with a cassette-sized detector and an in-room fluoroscopy system were sequentially used in the same examination. Four radiologists compared the image quality of 20 images from each system using the Radlex score (1-4) for five image quality attributes. The radiation dose rates for the portable and in-suite systems were collected. In phase B, fluoroscopy studies were performed in 5 neonates in the NICU and compared to the 20 previous neonatal studies performed in the department. Clinical workflow, examination time, fluoroscopy time, scattered radiation dose and patient radiation dose were evaluated. RESULTS: In phase A, average dose rates for in-room and portable systems were equivalent, (0.322 mGy/min and 0.320 mGy/min, respectively). Reader-averaged Radlex scores for in-room and portable systems were statistically significantly greater (P<0.05) for all attributes on the portable system except for image contrast. In phase B, scattered radiation from the average fluoroscopy time (26 s) was equivalent to the scattered radiation of 2.6 portable neonatal chest radiographs. Procedure time and diagnostic quality were deemed equivalent. The average dose rate in the NICU with the portable system was 0.21 mGy/min compared to 0.29 mGy/min for the in-room system. CONCLUSION: The portable fluoroscopy unit is capable of providing comparable image quality at equivalent dose levels to an in-room system for neonates with minimal risks to the staff and other patients in the NICU.

Expression of the prospective mesoderm genes twist, snail, and mef2 in penaeid shrimp.

In penaeid shrimp, mesoderm forms from two sources: naupliar mesoderm founder cells, which invaginate during gastrulation, and posterior mesodermal stem cells called mesoteloblasts, which undergo characteristic teloblastic divisions. The primordial mesoteloblast descends from the ventral mesendoblast, which arrests in cell division at the 32-cell stage and ingresses with its sister dorsal mesendoblast prior to naupliar mesoderm invagination. The naupliar mesoderm forms the muscles of the naupliar appendages (first and second antennae and mandibles), while the mesoteloblasts form the mesoderm, including the muscles, of subsequently formed posterior segments. To better understand the mechanism of mesoderm and muscle formation in penaeid shrimp, twist, snail, and mef2 cDNAs were identified from transcriptomes of Penaeus vannamei, P. japonicus, P. chinensis, and P. monodon. A single Twist ortholog was found, with strong inferred amino acid conservation across all three species. Multiple Snail protein variants were detected, which clustered in a phylogenetic tree with other decapod crustacean Snail sequences. Two closely-related mef2 variants were found in P. vannamei. The developmental mRNA expression of these genes was studied by qPCR in P. vannamei embryos, larvae, and postlarvae. Expression of Pv-twist and Pv-snail began during the limb bud stage and continued through larval stages to the postlarva. Surprisingly, Pv-mef2 expression was found in all stages from the zygote to the postlarva, with the highest expression in the limb bud and protozoeal stages. The results add comparative data on the development of anterior and posterior mesoderm in malacostracan crustaceans, and should stimulate further studies on mesoderm and muscle development in penaeid shrimp.

Slow and sustained nitric oxide releasing compounds inhibit multipotent vascular stem cell proliferation and differentiation without causing cell death.

Atherosclerosis is the leading cause of cerebral and myocardial infarction. It is believed that neointimal growth common in the later stages of atherosclerosis is a result of vascular smooth muscle cell (SMC) de-differentiation in response to endothelial injury. However, the claims of the SMC de-differentiation theory have not been substantiated by monitoring the fate of mature SMCs in response to such injuries. A recent study suggests that atherosclerosis is a consequence of multipotent vascular stem cell (MVSC) differentiation. Nitric oxide (NO) is a well-known mediator against atherosclerosis, in part because of its inhibitory effect on SMC proliferation. Using three different NO-donors, we have investigated the effects of NO on MVSC proliferation. Results indicate that NO inhibits MVSC proliferation in a concentration dependent manner. A slow and sustained delivery of NO proved to inhibit proliferation without causing cell death. On the other hand, larger, single-burst NO concentrations, inhibits proliferation, with concurrent significant cell death. Furthermore, our results indicate that endogenously produced NO inhibits MVSC differentiation to mesenchymal-like stem cells (MSCs) and subsequently to SMC as well.

Emerging protein array technologies for proteomics.

Numerous efforts have been made to understand fundamental biology of diseases based on gene expression. However, the relationship between gene expression and onset of disease often remains obscure. The great advances in protein microarrays allow us to investigate this unclear question through protein profiles, which are regarded as more reliable than gene expressions to serve as the harbinger of disease onset or as the biomarker of disease treatment monitoring. The authors review two relatively new platforms of protein arrays, along with an introduction to the common basis of protein array technologies. Immobilization of proteins on the surface of arrays and neutralizing reactive areas after the immobilization are key practical issues in the field of protein array. One of the emerging protein array technologies is the magneto-nanosensor array, where giant magnetoresistive sensors are used to quantitatively measure the analytes of interest, which are labeled with magnetic nanoparticles. Similar to giant magnetoresistive sensors, several different ways of utilizing magnetic properties for biomolecular detection have been developed and are reviewed here. Another emerging protein array technology is nucleic acid programmable protein arrays, which have thousands of protein features directly expressed by nucleic acids on the array surface. The authors anticipate that these two emerging protein array platforms can be combined to produce synergistic benefits and open new applications in proteomics and clinical diagnostics.

Precision of iodine quantification in hepatic CT: effects of iterative reconstruction with various imaging parameters.

OBJECTIVE: The objective of this study was to evaluate the feasibility of using iterative reconstructions in hepatic CT to improve the precision of Hounsfield unit quantification, which is the degree to which repeated measurements under unchanged conditions provide consistent results. MATERIALS AND METHODS: An anthropomorphic liver phantom with iodinated lesions designed to simulate the enhancement of hypervascular tumors during the late hepatic arterial phase was imaged, and images were reconstructed with both filtered back projection (FBP) and iterative reconstructions, such as adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR). This protocol was further expanded into various dose levels, tube voltages, and slice thicknesses to investigate the effect of iterative reconstructions under all these conditions. The iodine concentrations of the lesions were quantified, with their precision calculated in terms of repeatability coefficient. RESULTS: ASIR reduced image noise by approximately 35%, and improved the quantitative precision by approximately 5%, compared with FBP. MBIR reduced noise by more than 65% and improved the precision by approximately 25% compared with the routine protocol. MBIR consistently showed better precision across a thinner slice thickness, lower tube voltage, and larger patient, achieving the target precision level at a dose lower (≥ 40%) than that of FBP. CONCLUSION: ASIR blended with 50% of FBP indicated a moderate gain in quantitative precision compared with FBP but could achieve more with a higher percentage. A higher gain was achieved by MBIR. These findings may be used to reduce the dose required for reliable quantification and may further serve as a basis for protocol optimization in terms of iodine quantification.

Towards task-based assessment of CT performance: system and object MTF across different reconstruction algorithms.

PURPOSE: To investigate a measurement method for evaluating the resolution properties of CT imaging systems across reconstruction algorithms, dose, and contrast. METHODS: An algorithm was developed to extract the task-based modulation transfer function (MTF) from disk images generated from the rod inserts in the ACR phantom (model 464 Gammex, WI). These inserts are conventionally employed for HU accuracy assessment. The edge of the disk objects was analyzed to determine the edge-spread function, which was differentiated to yield the line-spread function and Fourier-transformed to generate the object-specific MTF for task-based assessment, denoted MTF(Task). The proposed MTF measurement method was validated against the conventional wire technique and further applied to measure the MTF of CT images reconstructed with an adaptive statistical iterative algorithm (ASIR) and a model-based iterative (MBIR) algorithm. Results were further compared to the standard filtered back projection (FBP) algorithm. Measurements were performed and compared across different doses and contrast levels to ascertain the MTF(Task) dependencies on those factors. RESULTS: For the FBP reconstructed images, the MTF(Task) measured with the inserts were the same as the MTF measured from the wire-based method. For the ASIR and MBIR data, the MTF(Task) using the high contrast insert was similar to the wire-based MTF and equal or superior to that of FBP. However, results for the MTF(Task) measured using the low-contrast inserts, the MTF(Task) for ASIR and MBIR data was lower than for the FBP, which was constant throughout all measurements. Similarly, as a function of mA, the MTF(Task) for ASIR and MBIR varied as a function of noise--with MTF(Task) being proportional to mA. Overall greater variability of MTF(Task) across dose and contrast was observed for MBIR than for ASIR. CONCLUSIONS: This approach provides a method for assessing the task-based MTF of a CT system using conventional and iterative reconstructions. Results demonstrated that the object-specific MTF can vary as a function of dose and contrast. The analysis highlighted the paradigm shift for iterative reconstructions when compared to FBP, where iterative reconstructions generally offer superior noise performance but with varying resolution as a function of dose and contrast. The MTF(Task) generated by this method is expected to provide a more comprehensive assessment of image resolution across different reconstruction algorithms and imaging tasks.

Perceived Safety of Learning Environment and Associated Anxiety Factors during COVID-19 in Ghana: Evidence from Physical Education Practical-Oriented Program.

The outbreak of COVID-19 led to the swift migration to alternate instructional delivery models and pedagogical practices in educational institutions. This study examined the perceived safety of the learning environment and associated anxiety factors among physical education students amidst COVID-19. Using a cross-sectional design, a sample of 638 students drawn purposively and conveniently from a public university in Ghana completed a self-developed questionnaire. Frequency counts, percentages, and ordered logistic regression were used to analyze the data. Findings of the study showed that students perceived the practical lesson environment as unsafe, with self-reported moderate to high levels of anxiety during their practical lessons. The ordered logistic regression results revealed that varied factors such as age, COVID-19 information platforms, certainty about personal safety, and adequacy of preparation to manage COVID-19 cases were associated with anxiety. The study concluded that an unsafe practical physical education learning environment increases the anxiety levels of students. Academic departments/units should provide periodic interventions (e.g., positive self-talk, mental rehearsal, cognitive restructuring) and counseling services for students amidst the ongoing pandemic to help moderate situational-specific anxiety. In addition, key to the management of students' anxiety is the provision of a safe and supportive school environment, including the provision of adequate personal protective equipment for practical lessons by school authorities.

COVID-19-Related Knowledge and Anxiety Response among Physical Education Teachers during Practical In-Person Lessons: Effects of Potential Moderators.

The COVID-19 pandemic has resulted in heightened anxiety levels among teachers, especially regarding PE teachers who are required to engage students in practical in-person or contact teaching lessons. Previous research showed that these levels of anxiety among PE teachers appeared to be explained by the interplay between COVID-19 knowledge, workplace safety perception, and educational qualification. This study assessed the relationship between COVID-19-related knowledge and anxiety response among PE teachers during such practical lessons while moderating the effects of workplace safety perception and educational qualification within the relationship. The study conveniently recruited 160 PE teachers to solicit responses through both online and printed questionnaires. Using correlation and linear regression analyses, the study revealed a significant negative relationship between COVID-19-related knowledge and anxiety response among PE teachers. The educational qualification of PE teachers did not significantly moderate the association between COVID-19-related knowledge and anxiety response. Workplace safety perception significantly moderated the association between COVID-19-related knowledge and anxiety response among PE teachers. The findings remind educational authorities about the essence of creating a positive and safe working environment conducive to academic work. Achieving this goal requires the provision of adequate COVID-19 management logistics (e.g., personal protective equipment, hand sanitizers) by educational authorities for PE teachers to maintain safety practices and optimal learning conditions.

Assessing the validity of digital health literacy instrument for secondary school students in Ghana: The polychoric factor analytic approach.

The emergence of the coronavirus pandemic resulted in the heightened need for digital health literacy among the youth of school-going age. Despite the relevance of digital health literacy among the general public (including students), it appears the measurement of digital health literacy is still a challenge among researchers. Recently, Dadackinski and colleagues adapted existing digital health literacy measures to fit the COVID-19 situation. Since this development, the instrument has been widely used with few validation studies with none in Africa and specifically, in Ghana. The purpose of the study was to assess the validity of the digital health literacy instrument (DHLI) for secondary school students in Ghana using the polychoric factor analysis. We sampled 1,392 students from secondary schools in Ghana. The digital health literacy instrument was administered to the respondents, thereof. The study confirmed the four latent structure of the DHLI. Further, sufficient validity evidence was found regarding the construct validity of the DHLI. The findings from the study support the validity of the DHLI and its utility within the Ghanaian context. With the growing need for digital health literacy among younger people globally, the DHLI provides sufficient grounds for scaling them based on their level of literacy. There is a need for the instrument to be adapted and re-validated in Ghana and among different populations to widen its reproducibility.

Perceived threat mediates the relationship between psychosis proneness and aggressive behavior.

Psychotic symptoms are associated with aggressive tendencies, but this relationship is both complex and imperfect. In contrast to psychotic disorders, little is known about aggressive behavior and sub-clinical psychotic symptoms (e.g., "psychosis proneness"), which are relatively common in the general population. Threat/control-override (TCO), which is the propensity to overestimate the likelihood that an outside agent will (1) inflict harm (threat) or (2) control one's behaviors (control-override), has been associated with aggression in both psychiatric and community samples. The purpose of this study was to determine if psychosis proneness is related to aggression, and if one or both aspects of TCO mediate this relationship. We hypothesized that the propensity to overestimate threat would mediate this relationship, but control-override would not. Sixty men and sixty women (mean age=20.00 years, sd=3.00) with no history of psychotic disorder completed measures assessing psychosis proneness, threat control/override, aggressive history, aggressive ideation, and aggressive behavior. Three structural equation models were tested: (1) Threat and control-override modeled as separate mediating variables, (2) TCO as a unitary mediating latent construct, and (3) TCO considered as part of a psychosis proneness latent variable. Results indicated that psychosis proneness is positively related to aggression and that the best model fit was obtained when threat and control-override were modeled as separate variables, with mediation through threat alone. The utility of TCO for explaining the relation between psychosis spectrum symptoms and aggression is discussed.

A Clinicopathological Study of 236 Cystic Ovarian Lesions at Jos University Teaching Hospital, Jos, Nigeria.

Background: Cystic ovarian lesions are defined by an ovarian fluid containing space limited by a membrane. The exact prevalence of the disease is unknown. A proper diagnosis is imperative for the choice of appropriate therapy. The objective of this study is to establish the different histological variants of ovarian cysts diagnosed at the Histopathology Department of Jos University Teaching Hospital between January 1, 2000, and December 31, 2019. Methodology: This is a descriptive study of consecutive cases of ovarian cysts at the Jos University Teaching Hospital, Jos, Nigeria between January 1, 2000, and December 31, 2019. Demographic and histopathologic data were collated from patients' request forms and duplicate copies of histology reports of all histologically diagnosed cases of ovarian cysts at the Histopathology Department during the study period. Result: A total of 236cases of cystic ovarian lesions were seen during the period of the study. Benign and malignant cases constituted 226(95.76%) and 10(4.24%) cases respectively. Corpus luteum cyst was the commonest histological type accounting for 28.33% of cases. Lesions located on the right ovary were 145(61.44%), while those on the left were 95(40.25%). The commonest symptom was abdominal pain. The age range was 4-70years, with a mean, median and mode of 35.02+11.9 years, 33.0 years, and 35.0 years respectively. Conclusion: The vast majority of ovarian cysts in our environment are benign, and commonly occurs in women during their reproductive age. Abdominal pain is the commonest presentation and cysts of the ovary occur more on the right.

Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm--initial clinical experience.

PURPOSE: To investigate whether an adaptive statistical iterative reconstruction (ASIR) algorithm improves the image quality at low-tube-voltage (80-kVp), high-tube-current (675-mA) multidetector abdominal computed tomography (CT) during the late hepatic arterial phase. MATERIALS AND METHODS: This prospective, single-center HIPAA-compliant study was institutional review board approved. Informed patient consent was obtained. Ten patients (six men, four women; mean age, 63 years; age range, 51-77 years) known or suspected to have hypervascular liver tumors underwent dual-energy 64-section multidetector CT. High- and low-tube-voltage CT images were acquired sequentially during the late hepatic arterial phase of contrast enhancement. Standard convolution FBP was used to reconstruct 140-kVp (protocol A) and 80-kVp (protocol B) image sets, and ASIR (protocol C) was used to reconstruct 80-kVp image sets. The mean image noise; contrast-to-noise ratio (CNR) relative to muscle for the aorta, liver, and pancreas; and effective dose with each protocol were assessed. A figure of merit (FOM) was computed to normalize the image noise and CNR for each protocol to effective dose. Repeated-measures analysis of variance with Bonferroni adjustment for multiple comparisons was used to compare differences in mean CNR, image noise, and corresponding FOM among the three protocols. The noise power spectra generated from a custom phantom with each protocol were also compared. RESULTS: When image noise was normalized to effective dose, protocol C, as compared with protocols A (P = .0002) and B (P = .0001), yielded an approximately twofold reduction in noise. When the CNR was normalized to effective dose, protocol C yielded significantly higher CNRs for the aorta, liver, and pancreas than did protocol A (P = .0001 for all comparisons) and a significantly higher CNR for the liver than did protocol B (P = .003). Mean effective doses were 17.5 mSv +/- 0.6 (standard error) with protocol A and 5.1 mSv +/- 0.3 with protocols B and C. Compared with protocols A and B, protocol C yielded a small but quantifiable noise reduction across the entire spectrum of spatial frequencies. CONCLUSION: Compared with standard FBP reconstruction, an ASIR algorithm improves image quality and has the potential to decrease radiation dose at low-tube-voltage, high-tube-current multidetector abdominal CT during the late hepatic arterial phase.

Quantitative imaging in breast tomosynthesis and CT: comparison of detection and estimation task performance.

PURPOSE: This work investigates a framework for modeling volumetric breast imaging to compare detection and estimation task performance and optimize quantitative breast imaging. METHODS: Volumetric reconstructions of a breast phantom, which incorporated electronic, quantum, and anatomical noise with embedded spherical lesions, were simulated over a range of acquisition angles varying from 4 degrees to 204 degrees with a constant total acquisition dose of 1.5 mGy. A maximum likelihood estimator was derived in terms of the noise power spectrum, which yielded figures of merit for quantitative imaging performance in terms of accuracy and precision. These metrics were computed for estimation of lesion area, volume, and location. Estimation task performance was optimized as a function of acquisition angle and compared to the performance of a more conventional lesion detection task. RESULTS: Results revealed tradeoffs between electronic, quantum, and anatomical noise. The detection of a 4 mm sphere was optimal at an acquisition angle of 84 degrees, where reconstructed images using a smaller acquisition angle exhibited increased anatomical noise and reconstructed images using a larger acquisition angle exhibited increased quantum and electronic noise. For all estimation tasks, accuracy was found to be fairly constant as a function acquisition angle indicating adequate system calibration, whereas a more significant dependence on acquisition angle was observed for precision performance. Precision for the 2D area estimation task was optimal at approximately 104 degrees, while precision of the 3D volume estimation task was optimal at larger angles (approximately 124 degrees). Precision for the localization task showed orientation dependence where localization was significantly inferior in the depth direction. Overall, precision for localization was optimal at larger angles (i.e., > 125 degrees) compared to the size estimation tasks. Results suggested that for quantitative imaging tasks, the acquisition angle should be larger than currently used in conventional breast tomosynthesis for lesion detection. CONCLUSIONS: Analysis of quantitative imaging performance using Fourier-based metrics highlights the difference between estimation and detection task in volumetric breast imaging and provides a meaningful framework for optimizing the performance of breast imaging systems for quantitative imaging applications.

Quantitative breast tomosynthesis: from detectability to estimability.

PURPOSE: This work aimed to extend Fourier-based imaging metrics for modeling and predicting quantitative imaging performance. The new methodology was applied to the platform of breast tomosynthesis for investigating the influence of acquisition parameters (e.g., acquisition angle and dose) on quantitative imaging performance. METHODS: Two quantitative imaging tasks were considered: Area estimation and volume estimation of a 4 mm diameter spherical target. The maximum likelihood estimator yielded training data to generate a size estimation task function, which was combined with the MTF and NPS to predict estimation performance by computing an "estimability index" analogous to the detectability index. Estimation performance for the two tasks was computed as a function of acquisition angle and dose. The results were used for system optimization in terms of quantitation performance and further compared to the detectability index for the detection of the same spherical target. RESULTS: The estimability index computed with the size estimation tasks correlated well with precision measurements for area and volume estimation over a broad range of imaging conditions and provided a meaningful figure of merit for quantitative imaging performance and optimization. The results highlighted that optimal breast tomosynthesis acquisition parameters depend significantly on imaging task and dose. At nominal dose (1.5 mGy), mass detection was optimal at an acquisition angle of 85 degrees, while area and volume estimation for the same mass were optimal at approximately 125 degrees and 164 degrees acquisition angles, respectively. CONCLUSIONS: These findings provide an initial validation that the Fourier-based metrics extended to estimation tasks can represent a meaningful metric and predictor of quantitative imaging performance. The optimization framework also revealed trade-off between anatomical noise and system noise in volumetric imaging systems potentially identifying different optimal acquisition parameters than currently used in breast tomosynthesis and CT.

Laboratory Turnaround Time of Surgical Biopsies at a Histopathology Service in Nigeria.

INTRODUCTION: Laboratory turnaround time is defined as the time between the receipt of a sample in the laboratory and when the report is ready for collection/dispatch. It is a critical component of the quality assurance of a laboratory and has been identified as a key performance indicator of laboratory performance. This study is aimed at evaluating the turnround time in the histopathology unit of our center and comparing the findings with that of similar studies. METHODOLOGY: This was a prospective descriptive study of the first 500 consecutive samples of surgical biopsies submitted for analyses at the Histopathology Department of the Jos University Teaching Hospital. The samples were tracked from the reception desk, where they are submitted to the dispatch point where the results are collected by clients. The grossing time (T1), processing time (T2), reporting time (T3), and the transcription time (T4) were recorded for each sample. The data obtained were analyzed using SPSS software and presented as simple frequencies and percentages. RESULTS: The mean laboratory turnaround time was 7.5 + 9.7 days with a range of 3-18 days. As much as 20.8% of reports were ready for dispatch by day 3 and 100% by day 18. Overall, the grossing time (T1), processing time (T2), reporting time (T3), and transcription (T4) time consumed 17.5%, 35.5%, 27.7%, and 19.3% of the total time spent, respectively. CONCLUSION: We recommend the development of practicable targets for the histopathology laboratories as regards timeliness. This should be regularly evaluated to ensure compliance and improvement of service quality in this regard.

Impact of Colorized Display of Mammograms on Lesion Detection.

OBJECTIVE: To assess the effect of the colorized display of digital mammograms on observer detection of subtle breast lesions. METHODS: Three separate observer studies compared detection performance using grayscale versus color display of 1) low-contrast mass-like objects in a standardized mammography phantom; 2) simulated microcalcifications in a background of normal breast parenchyma; and 3) standard-of-care clinical digital mammograms with subtle calcifications and masses. Colorization of the images was done by displaying each image pixel in blue, green, and red hues, or gray, maintaining DICOM-calibrated luminance scale and consistent luminance range. For the simulated calcifications and clinical mammogram studies, comparison of detection rates was computed using McNemar's test for paired differences. RESULTS: For the phantom study, mass-like object detection was significantly better using a green colormap than grayscale (73.3% vs 70.8%, P = .009), with no significant improvement using blue or red colormaps (72.6% and 72.5%, respectively). For simulated microcalcifications, no significant difference was noted in detection using the green colormap, as compared with grayscale. For clinical digital screening mammograms, no significant difference was noted between gray and green colormaps for detection of microcalcifications. Green color display, however, resulted in decreased sensitivity for detection of subtle masses (63% vs 69%, P = .03). CONCLUSION: Although modest improvement was demonstrated for a detection task using colorized display of a standard mammography phantom, no significant improvement was demonstrated using a color display for a simulated clinical detection task, and actual clinical performance was worse for colorized display of mammograms in comparison to standard grayscale display.

Comparison of model and human observer performance for detection and discrimination tasks using dual-energy x-ray images.

Model observer performance, computed theoretically using cascaded systems analysis (CSA), was compared to the performance of human observers in detection and discrimination tasks. Dual-energy (DE) imaging provided a wide range of acquisition and decomposition parameters for which observer performance could be predicted and measured. This work combined previously derived observer models (e.g., Fisher-Hotelling and non-prewhitening) with CSA modeling of the DE image noise-equivalent quanta (NEQ) and imaging task (e.g., sphere detection, shape discrimination, and texture discrimination) to yield theoretical predictions of detectability index (d') and area under the receiver operating characteristic (Az). Theoretical predictions were compared to human observer performance assessed using 9-alternative forced-choice tests to yield measurement of Az as a function of DE image acquisition parameters (viz., allocation of dose between the low- and high-energy images) and decomposition technique [viz., three DE image decomposition algorithms: standard log subtraction (SLS), simple-smoothing of the high-energy image (SSH), and anti-correlated noise reduction (ACNR)]. Results showed good agreement between theory and measurements over a broad range of imaging conditions. The incorporation of an eye filter and internal noise in the observer models demonstrated improved correspondence with human observer performance. Optimal acquisition and decomposition parameters were shown to depend on the imaging task; for example, ACNR and SSH yielded the greatest performance in the detection of soft-tissue and bony lesions, respectively. This study provides encouraging evidence that Fourier-based modeling of NEQ computed via CSA and imaging task provides a good approximation to human observer performance for simple imaging tasks, helping to bridge the gap between Fourier metrics of detector performance (e.g., NEQ) and human observer performance.

Cascaded systems analysis of noise reduction algorithms in dual-energy imaging.

An important aspect of dual-energy (DE) x-ray image decomposition is the incorporation of noise reduction techniques to mitigate the amplification of quantum noise. This article extends cascaded systems analysis of imaging performance to DE imaging systems incorporating linear noise reduction algorithms. A general analytical formulation of linear DE decomposition is derived, with weighted log subtraction and several previously reported noise reduction algorithms emerging as special cases. The DE image noise-power spectrum (NPS) and modulation transfer function (MTF) demonstrate that noise reduction algorithms impart significant, nontrivial effects on the spatial-frequency-dependent transfer characteristics which do not cancel out of the noise-equivalent quanta (NEQ). Theoretical predictions were validated in comparison to the measured NPS and MTF. The resulting NEQ was integrated with spatial-frequency-dependent task functions to yield the detectability index, d', for evaluation of DE imaging performance using different decomposition algorithms. For a 3 mm lung nodule detection task, the detectability index varied from d' < 1 (i.e., nodule barely visible) in the absence of noise reduction to d' > 2.5 (i.e., nodule clearly visible) for "anti-correlated noise reduction" (ACNR) or "simple-smoothing of the high-energy image" (SSH) algorithms applied to soft-tissue or bone-only decompositions, respectively. Optimal dose allocation (A*, the fraction of total dose delivered in the low-energy projection) was also found to depend on the choice of noise reduction technique. At fixed total dose, multi-function optimization suggested a significant increase in optimal dose allocation from A* = 0.32 for conventional log subtraction to A* = 0.79 for ACNR and SSH in soft-tissue and bone-only decompositions, respectively. Cascaded systems analysis extended to the general formulation of DE image decomposition provided an objective means of investigating DE imaging performance across a broad range of acquisition and decomposition algorithms in a manner that accounts for the spatial-frequency-dependent imaging task.

Assessment of the dose reduction potential of a model-based iterative reconstruction algorithm using a task-based performance metrology.

PURPOSE: Different computed tomography (CT) reconstruction techniques offer different image quality attributes of resolution and noise, challenging the ability to compare their dose reduction potential against each other. The purpose of this study was to evaluate and compare the task-based imaging performance of CT systems to enable the assessment of the dose performance of a model-based iterative reconstruction (MBIR) to that of an adaptive statistical iterative reconstruction (ASIR) and a filtered back projection (FBP) technique. METHODS: The ACR CT phantom (model 464) was imaged across a wide range of mA setting on a 64-slice CT scanner (GE Discovery CT750 HD, Waukesha, WI). Based on previous work, the resolution was evaluated in terms of a task-based modulation transfer function (MTF) using a circular-edge technique and images from the contrast inserts located in the ACR phantom. Noise performance was assessed in terms of the noise-power spectrum (NPS) measured from the uniform section of the phantom. The task-based MTF and NPS were combined with a task function to yield a task-based estimate of imaging performance, the detectability index (d'). The detectability index was computed as a function of dose for two imaging tasks corresponding to the detection of a relatively small and a relatively large feature (1.5 and 25 mm, respectively). The performance of MBIR in terms of the d' was compared with that of ASIR and FBP to assess its dose reduction potential. RESULTS: Results indicated that MBIR exhibits a variability spatial resolution with respect to object contrast and noise while significantly reducing image noise. The NPS measurements for MBIR indicated a noise texture with a low-pass quality compared to the typical midpass noise found in FBP-based CT images. At comparable dose, the d' for MBIR was higher than those of FBP and ASIR by at least 61% and 19% for the small feature and the large feature tasks, respectively. Compared to FBP and ASIR, MBIR indicated a 46%-84% dose reduction potential, depending on task, without compromising the modeled detection performance. CONCLUSIONS: The presented methodology based on ACR phantom measurements extends current possibilities for the assessment of CT image quality under the complex resolution and noise characteristics exhibited with statistical and iterative reconstruction algorithms. The findings further suggest that MBIR can potentially make better use of the projections data to reduce CT dose by approximately a factor of 2. Alternatively, if the dose held unchanged, it can improve image quality by different levels for different tasks.

A Case for Wide-Angle Breast Tomosynthesis.

RATIONALES AND OBJECTIVES: Conventional mammography is largely limited by superimposed anatomy. Digital breast tomosynthesis (DBT) and computed tomography (CT) alleviate this limitation but with added out-of-plane artifacts or limited chest wall coverage. This article presents a wide-angle breast tomosynthesis (WBT), aimed to provide a practical solution to these limitations, and offers an initial study of its utility in comparison with DBT and CT using a singular evaluation platform. MATERIALS AND METHODS: Using an anthropomorphic virtual breast phantom, a Monte Carlo code modeled a breast imaging system for three modalities of DBT, WBT, and breast CT (44°, 99°, and 198° total angle range, respectively) at four breast compression levels, all at a constant mean glandular dose level of 1.5 mGy. Reconstructed volumes were generated using iterative reconstruction methods. Lesion detectability was estimated using contrast-to-noise ratio and a channelized Hotelling observer model in terms of the area under the receiver operating characteristic (AUC). RESULTS: Results showed improved detection with increased angular span and compression. The estimated AUCs for WBT were similar to that of CT. Comparative performance averaged over all thicknesses between CT and WBT was 4.3 ± 3.0%, whereas that between WBT and DBT was 5.6 ± 1.0%. At compression levels reflective of the modality (7-, 5-, and 4-cm thickness for CT, WBT, and DBT, respectively), WBT yielded an AUC comparable to CT (performance difference of 1.2%) but superior to DBT (performance difference of 5.5%). CONCLUSIONS: The proposed imaging modality showed significant advantages over conventional DBT. WBT exhibited superior imaging performance over DBT at lower compression levels, highlighting further potential for reduced breast compression.