Digital tomosynthesis of hand joints for arthritis assessment.

The two principal forms of hand arthritis, rheumatoid arthritis (RA) and osteoarthritis (OA) have large clinical and economic costs. Radiography has been shown to be a useful tool to assess the condition of the disease. A hand radiograph, however, is a two-dimensional projection of a three-dimensional object. In this report we present the results of a study that applied digital tomosynthesis to hand radiography in order to extract three-dimensional outcome measures that should be more sensitive to arthritis progression. The study was performed using simulated projection radiographs created using micro computed tomography (microCT) and a set of five dry-bone hand skeletons. These simulated projection images were then reconstructed into tomographic slices using the matrix inversion tomosynthesis (MITS) algorithm. The accuracy of the tomosynthesis reconstruction was evaluated by comparing the reconstructed images to a gold standard created using the microCT data. A parameter from image registration science, normalized mutual information, provided a quantifiable figure of merit. This study examined the effects of source displacement, number of reconstructed planes, number of acquisitions, noise added to the gray scale images, and errors in the location of a fiducial marker. We also optimized the reconstruction as a function of two variables k and alpha, that controlled the mixing of MITS with conventional shift-and-add tomosynthesis. A study using hand delineated joint margins demonstrated that MITS images provided a better measurement of average joint space width. We found good agreement between the MITS slices and the true planes. Both joint margins and trabecular structure were visible and the reconstructed slices showed additional structures not visible with the standard projection image. Using hand-delineated joint margins we compared the average joint space width of the gold standard slices to the MITS and projection images. A root-mean square deviation (RMSD), calculated for this comparison, gave RMSDproj = 0.18 mm and RMSDMITS = 0.14 mm for the projection and MITS images, respectively. We have demonstrated the potential of digital tomosynthesis for imaging of the hand to assess arthritic changes. We have also developed a methodology that can be used to optimize the technique and have studied the issues that will control the feasibility of clinical implementation.

Imaging characteristics of an amorphous silicon flat-panel detector for digital chest radiography.

PURPOSE: To evaluate the imaging characteristics of an amorphous silicon flat-panel detector (FPD) for digital chest radiography. MATERIALS AND METHODS: The 41 x 41-cm digital FPD is constructed on a single monolithic glass substrate with a structured cesium iodide scintillator layer and an amorphous silicon thin-film transistor array for image readout. Basic imaging characteristics of the FPD and associated image processing system were assessed on acquired images, including linearity, repeatability, uniformity of response, modulation transfer function (MTF), noise power spectrum, detective quantum efficiency (DQE), contrast sensitivity, and scatter content. Results with the FPD system were compared to those with a storage phosphor computed radiography (CR) system. RESULTS: Images obtained with the FPD demonstrated excellent uniformity, repeatability, and linearity, as well as MTF and DQE that were superior to those with the storage phosphor CR system. The contrast and scatter content of images acquired with the FPD were equivalent to those acquired with the storage phosphor system. CONCLUSION: The FPD provides radiographic images with excellent inherent physical image quality.

Performance characteristics of a Kodak computed radiography system.

The performance characteristics of a photostimulable phosphor based computed radiographic (CR) system were studied. The modulation transfer function (MTF), noise power spectra (NPS), and detective quantum efficiency (DQE) of the Kodak Digital Science computed radiography (CR) system (Eastman Kodak Co.-model 400) were measured and compared to previously published results of a Fuji based CR system (Philips Medical Systems-PCR model 7000). To maximize comparability, the same measurement techniques and analysis methods were used. The DQE at four exposure levels (30, 3, 0.3, 0.03 mR) and two plate types (standard and high resolution) were calculated from the NPS and MTF measurements. The NPS was determined from two-dimensional Fourier analysis of uniformly exposed plates. The presampling MTF was determined from the Fourier transform (FT) of the system's finely sampled line spread function (LSF) as produced by a narrow slit. A comparison of the slit type ("beveled edge" versus "straight edge") and its effect on the resulting MTF measurements was also performed. The results show that both systems are comparable in resolution performance. The noise power studies indicated a higher level of noise for the Kodak images (approximately 20% at the low exposure levels and 40%-70% at higher exposure levels). Within the clinically relevant exposure range (0.3-3 mR), the resulting DQE for the Kodak plates ranged between 20%-50% lower than for the corresponding Fuji plates. Measurements of the presampling MTF with the two slit types have shown that a correction factor can be applied to compensate for transmission through the relief edges.

A rapid and automatic image registration algorithm with subpixel accuracy.

A number of digital imaging techniques in medicine require the combination of multiple images. Using these techniques, it is essential that the images be adequately aligned and registered prior to addition, subtraction, or any other combination of the images. This paper describes an alignment routine developed to register an image of a fixed object containing a global offset error, rotation error, and magnification error relative to a second image. The described routine uses sparsely sampled regional correlation in a novel way to reduce computation time and avoid the use of markers and human interaction. The result is a fast, robust, and automatic alignment algorithm, with accuracy better than about 0.2 pixel in a test with clinical computed radiography images.

Plate scatter correction for improved performance in dual-energy imaging.

We have developed a method for correcting for the scatter produced by the computed radiography plates in single-shot dual-energy imaging. In our technique, which uses a series of four computed radiography plates (the middle two plates act as a filter), the back plate can have scatter fractions as high as 30% due to the scatter from the first three plates. We use the deconvolution method to correct for this scatter, as the scatter medium is uniform and isotropic with a constant air gap. The ratio of the modulation transfer function (MTF) of a standard computed radiography plate to that of a dual-energy plate gives us the correction factor we need to scale the Fourier transforms of our images, thus compensating for the reduced response of the system due to scatter. We also investigated the effect of having an air gap between the back dual-energy plate and the first three plates. Our measurements show that this degrades the signal-to-noise response of the back plate slightly at low spatial frequencies. We also used independent scatter fraction measurements to verify the validity of our MTF measurements. Applying the correction to a back plate image improves the fine detail contrast by approximately 30%.

DQE(f) of four generations of computed radiography acquisition devices.

Measurements were made of the MTF(f), NPS(f), and DQE(f) of four generations of computed radiography (CR) imaging plates and three generations of CR image readers. The MTF generally showed only a minor change between generations of plates and readers, but the DQE(f) has improved substantially from a very early plate/reader combination to a more recent one. The DQE in the more recent plate/reader combination is 1.3X greater at low frequencies and about 3X greater at high frequencies than the much earlier versions. Thus there has been substantial improvement in the imaging performance obtainable with CR since some of the early observer studies which indicated poorer performance with CR than with screen-film.

Effects of undersampling on the proper interpretation of modulation transfer function, noise power spectra, and noise equivalent quanta of digital imaging systems.

The proper understanding of modulation transfer function (MTF), noise power spectra (NPS), and noise equivalent quanta (NEQ) in digital systems is significantly hampered when the systems are undersampled. Undersampling leads to three significant complications: (1) MTF and NPS do not behave as transfer amplitude and variance, respectively, of a single sinusoid, (2) the response of a digital system to a delta function is not spatially invariant and therefore does not fulfill certain technical requirements of classical analysis, and (3) NEQ loses its common meaning as maximum available SNR2 (signal-to-noise) at a particular frequency. These three complications cause the comparisons of MTF and NEQ between undersampled digital systems to depend on the frequency content of the images being evaluated. A tutorial of MTF, NPS, and NEQ concepts for digital systems is presented, along with a complete theoretical treatment of the above-mentioned complications from undersampling.

Variable compensation chest radiography performed with a computed radiography system: design considerations and initial clinical experience.

The authors describe a variable compensation (VC) technique in which an x-ray equalizer and a computed radiography system are used. The VC technique allows retrospective alteration of equalized chest appearance with maintenance of improved signal-to-noise ratio in dense regions. Two imaging plates are used: one upstream of the patient to record the incident beam profile and one down-stream to record the equalized image. Subtraction of a weighted version of the upstream image from the down-stream image permits alteration of the appearance of the VC image, from the extremes of stimulated-unequalized to highly equalized. VC image appearance was optimized with a real-time workstation. The quality of VC images obtained in 33 patients was evaluated by three chest radiologists. Mediastinal appearance was better on VC equalized images than on conventional screen-film images. The stimulation of the appearance of a conventional radiograph with VC proved useful in interpretation of lung appearances on equalized radiographs.

Digital chest radiography with photostimulable storage phosphors: signal-to-noise ratio as a function of kilovoltage with matched exposure risk.

A photostimulable storage phosphor (PSP) digital radiography system was evaluated regarding the signal-to-noise ratio (S/N) on chest images acquired at differing peak kilovoltage settings but with matched risk from radiation exposure. Images of two chest phantoms were acquired by using bedside (portable) imaging equipment at tube voltages ranging from 60 to 120 kV. Exposure factors were set so that the effective dose equivalent, a risk estimator weighted for various organs, was approximately equal in all exposures. The S/N in the lung-equivalent regions was found to be slightly higher (maximum, 15%) in the low-energy exposures, while the S/N values in the mediastinum- and subdiaphragm-equivalent regions were approximately equal at all kilovoltage settings. The absence of a high sensitivity of S/N to kilovoltage in risk-matched PSP images should enable institutions to select x-ray beam quality on the basis of other imaging criteria.

Direct digitization of optical images using a photostimulable phosphor system.

The authors describe a method for directly digitizing optical images with a photostimulable phosphor (PSP) system. A PSP plate is initially charged with an exposure to a uniform x-ray field, and is then exposed to an optical image which discharges the plate in relation to the amount of incident light. Two applications were investigated: a contact-print technique for digitizing film radiographs, and a projection technique for digitizing transparent objects such as histology slides. Spatial uniformity was found to be adequate, and linearity of optical density response was excellent from 0.0-2.9 o.d. after look-up table correction. Spatial frequency response was degraded with the optical technique relative to the x-ray imaging properties of the plates, but was restorable by Fourier filtering. Image noise following spatial enhancement was satisfactory at intermediate to high optical densities using a high-resolution PSP plate, but was somewhat degraded at low densities.

Threshold perception performance with computed and screen-film radiography: implications for chest radiography.

Images of a phantom obtained with computed radiography and standard screen-film imaging were compared to evaluate observer threshold perception performance with a modified contrast-detail technique. Optimum exposure necessary for performance with the imaging plate technique to match that with screen-film techniques was determined, as was comparative performance with variation in kilovoltages, plate type, spatial enhancement, and hard-copy interpolation method. It was found that computed radiography necessitates about 75%-100% more exposure than screen-film radiography to optimally match performance with Ortho-C film with Lanex regular or medium screens (Eastman Kodak, Rochester, NY) for detection of objects 0.05-2.0 cm in diameter. However, only minimal loss of detection performance (approximately 10% overall) was experienced if standard screen-film exposures were used with computed radiography. Little change in observer performance was found with variation in plate type, spatial enhancement, or method of hard-copy interpolation. However, perception performance with computed radiographic images was better at lower kilovoltages.

Single-exposure conventional and computed radiography image acquisition.

A technique for simultaneously acquiring a conventional film-screen radiographic image and a digital computed radiography (CR) image with a single x-ray exposure is described. Measurements of image contrast, spatial resolution, and signal-to-noise ratios demonstrate that a modified film cassette in which the first intensifier screen has been replaced with a CR imaging plate permits dual-image, single-exposure imaging with only nominal degradation in film and CR image quality relative to the two standard image counterparts. This technique may be used to acquire matched image pairs for research or as a way to provide full-size conventional film images in the clinical environment, while retaining the advantages offered by computed radiography systems.

Scatter fractions in AMBER imaging.

Images of two phantoms were obtained with use of an advanced multiple-beam equalization radiography system, and scatter fractions were estimated with use of a photostimulable phosphor imaging system. Scatter fractions in the equalized images were lower in the mediastinum-equivalent areas and higher in the lung-equivalent areas, relative to images that were conventionally acquired with use of an antiscatter grid. The differences are attributed to a reduction in incident exposure in the lungs and the presence of cross-scatter between lung and mediastinal regions.

Quantitative radiographic imaging using a photostimulable phosphor system.

We have evaluated a photostimulable phosphor x-ray imaging system [Philips Computed Radiography (PCR) system] for use in quantification of x-ray exposure in diagnostic radiography. An exponential function was fitted to data yielding quantitative x-ray exposure values as a function of digital pixel values. We investigated several factors that affect the accuracy of exposure measurement using the PCR including repeatability, background noise as a function of time delay between plate erasure and use, sensitivity variation between different plates, nonuniformity of sensitivity within a plate, decay of the latent image between time of exposure and readout (observed as a change in sensitivity), and the accuracy with which the (exponential) calibration function yields exposure values as a function of digital pixel values. The calibration was performed over the exposure range from 5.1 X 10(-9) to 2.0 X 10(-5) C/kg (0.02-75 mR). The accuracy of exposure measurements made with a single imaging plate is between 1.6% and 4.2%. If measurements from several plates are involved, the uncertainty in the final measurement will be between 5% and 5.9%.

Variable compensation technique for digital radiography of the chest.

The authors describe a new technique, variable compensation (VC) radiography, for digital radiography of the chest. It permits retrospective adjustment of image display while maintaining improved mediastinal signal-to-noise ratio (S/N) from aggressive x-ray equalization. A fraction of a logarithmic image representing the profile of the beam intensity incident on the patient is subtracted from a logarithmic equalized image. VC images of a chest phantom were generated with various weightings of the beam-profile image. Edge artifacts were substantially reduced with a weighting of greater than 0.5 and eliminated with a weighting of 1.0. The S/N properties of VC images were measured with a series of plastic squares placed over various regions of the chest phantom. The S/N of the squares in the dense sub-diaphragm were improved twofold compared with the S/N on unequalized radiographs, whereas the S/N in the lung was reduced by 30%. Studies of a volunteer revealed the ability to render images with aggressive equalization (for improved mediastinal visualization) and images with the appearance of traditional chest radiographs.

Geometrical properties of a digital beam attenuator system.

A digital beam attenuator system has been developed to automatically generate patient-specific compensating filters for chest radiography. An initial low-dose test image is used to generate the attenuator, which is fabricated by overprinting multiple layers of a heavy-metal material onto a nonattenuating substrate. The attenuator is subsequently inserted into the x-ray beam for a final compensated radiograph. The effects of focal spot blurring and limited attenuator resolution result in the final compensated image containing only high-spatial frequency information. The frequency response of the process is not strictly describable by a modulation transfer function, but an approximation of the frequencies remaining in the compensated image is obtained for low-contrast conditions. It is found that a 4 X 4 blurring function on the original 64 X 64 test image is required for the attenuator to give appropriate compensated image appearance. A proposed attenuator printing scheme prints the attenuator in a 16 X 16 matrix, staggering successively printed layers to achieve the required 64 X 64 sampling with appropriate blurring. The resulting compensated image has good anatomical definition and contains a frequency response similar to that obtained by compensation techniques being investigated by Plewes and Sorenson.

Digital beam attenuator technique for compensated chest radiography.

The feasibility of producing patient-specific beam attenuators for chest radiography has been investigated using an anthropomorphic phantom and a human volunteer. A low-dose test exposure is digitized, processed, and used to print a small cerium filter, which is placed in the x-ray beam near the collimator. The final radiograph is recorded on film. The technique results in relatively uniform film exposure, so that structures in all regions of the chest are simultaneously displayed with optimal film contrast. The equalized exposure improves image quality in the normally underpenetrated regions and reduces the role of cross-scatter from the lungs. The image is analogous to optical or computer-processed unsharp masking techniques, but the processing is accomplished in the x-ray beam and results in an improved exposure distribution, giving advantages that cannot be achieved with image processing techniques alone.

A scanning-slit x-ray videoabsorptiometric technique for bone mineral measurement.

An x-ray videoabsorptiometric technique was developed for measurement of bone mineral content (BMC) in vivo. The principle utility of this technique is the precise measurement of commonly fractured bones, such as the femoral neck, that are difficult to measure by other techniques because of repositioning problems. Scanning slits reduce scattered radiation and improve linearity of measurements. Heavily filtered, high-kVp beams are used to minimize errors from beam hardening, and data renormalization is employed to compensate for spatial nonuniformities of the beam and detector. Linearity of measured BMC over the range 0.8 to 5 g/cm2 is very good (r = 0.998) and compares well to single- and dual-photon absorptiometry. A 1.6% change in measured BMC is observed for a 10% change (approximately 2 cm) in tissue thickness while a 10% change in marrow type causes a 0.6%-0.8% change in BMC. Manual repositioning of a femur phantom revealed a variation of 0.84% over ten measurements when femur values were referenced to standards. A computer repositioning algorithm provides much easier identification of the region for analysis and yields comparable variation (0.9%).

Work in progress: hybrid temporal-energy subtraction in digital fluoroscopy.

Initial clinical results using a digital fluoroscopic implementation of the combined time-energy ("hybrid") subtraction technique are described, with emphasis on carotid and renal imaging. Where patient motion artifacts are due to soft-tissue motion alone, hybrid subtraction can remove them. Due to the need for a finite separation time between high- and low-energy pairs, however, the present implementation of the hybrid technique is not completely immune to soft-tissue motion. The intrinsic signal-to-noise ratio of hybrid imaging is less than that of conventional temporal subtraction. However, since the low-energy temporal subtraction images are included in the hybrid data set, the diagnostic quality of the examination is not compromised.