Optimizing image quality and dose for digital radiography of distal pediatric extremities using the contrast-to-noise ratio.

PURPOSE: To investigate the influence of X-ray tube voltage and filtration on image quality in terms of contrast-to-noise ratio (CNR) and dose for digital radiography of distal pediatric extremities and to determine conditions that give the best balance of CNR and patient dose. MATERIALS AND METHODS: In a phantom study simulating the absorption properties of distal extremities, the CNR and the related patient dose were determined as a function of tube voltage in the range 40 - 66 kV, both with and without additional filtration of 0.1 mm Cu/1 mm Al. The measured CNR was used as an indicator of image quality, while the mean absorbed dose (MAD) - determined by a combination of measurement and simulation - was used as an indicator of the patient dose. RESULTS: The most favorable relation of CNR and dose was found for the lowest tube voltage investigated (40 kV) without additional filtration. Compared to a situation with 50 kV or 60 kV, the mean absorbed dose could be lowered by 24 % and 50 %, respectively, while keeping the image quality (CNR) at the same level. CONCLUSION: For digital radiography of distal pediatric extremities, further CNR and dose optimization appears to be possible using lower tube voltages. Further clinical investigation of the suggested parameters is necessary.

[Balance of required dose and image quality in digital radiography]. / Abwägen von Dosisbedarf und Bildqualität in der digitalen Radiographie.

Projection radiography is in an advanced stage of progressive transition from conventional screen-film imaging to digital image acquisition modalities. The radiographic technique, including examination parameters such as tube voltage, tube current and filtration has frequently been adopted from screen-film technology. Digital systems, however, are characterized by their flexibility as the dose can be reduced at the expense of image quality and vice versa. The imaging parameters need to be individually optimized according to the best performance of a system. The traditional means of dose adjustment, such as positioning and collimation, are as valid for digital techniques as they were for conventional techniques. Digital techniques increasingly offer options for dose reduction. At the same time there is a risk to accidentally substantially increase patient dose due to the lack of visual control. Therefore, the implementation of dose indicators and dose monitoring is mandatory for digital radiography. The use of image quality classes according to the dose requirements of given clinical indications are a further step towards modern radiation protection.

Influence of cassette type on the DQE of CR systems.

In our recent paper by Monnin et al. [Med. Phys. 33, 411-420 (2006)], an objective analysis of the relative performance of a computed radiography (CR) system using both standard single-side (ST-VI) and prototype dual-side read (ST-BD) plates was reported. The presampled modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) for the systems were determined at three different beam qualities representative of paediatric chest radiography, at an entrance detector air kerma of 5 microGy. Experiments demonstrated that, compared to the standard single-side read system, the MTF for the dual-side read system was slightly reduced, but a significant decrease in image noise resulted in a marked increase in DQE (+40%) in the low spatial frequency range. However, the DQE improvement for the ST-BD plate decreased with increasing spatial frequency, and, at spatial frequencies above 2.2 mm(-1), the DQE of the dual-side read system was lower than that of the single-side one.

An image quality comparison of standard and dual-side read CR systems for pediatric radiology.

An objective analysis of image quality parameters was performed for a computed radiography (CR) system using both standard single-side and prototype dual-side read plates. The pre-sampled modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) for the systems were determined at three different beam qualities representative of pediatric chest radiography, at an entrance detector air kerma of 5 microGy. The NPS and DQE measurements were realized under clinically relevant x-ray spectra for pediatric radiology, including x-ray scatter radiations. Compared to the standard single-side read system, the MTF for the dual-side read system is reduced, but this is offset by a significant decrease in image noise, resulting in a marked increase in DQE (+40%) in the low spatial frequency range. Thus, for the same image quality, the new technology permits the CR system to be used at a reduced dose level.

Management of pediatric radiation dose using Philips digital radiography.

Digital radiography systems based on flat-panel detectors have been introduced into clinical practice in the past few years. The high detective quantum efficiency of these detectors allows the radiation dose to be reduced while maintaining image quality, an issue particularly significant for pediatric radiography. Another important aspect for dose optimization and monitoring is the integration of the detector into a computer-controlled x-ray examination system. This enables full control and complete reporting of all dose-relevant exposure parameters, including the determination of the exposure indicator and the patient dose (kerma-area product). In this paper the implementation of these principles in the Philips Digital Diagnost DR system is described and their relevance for pediatric applications is discussed.

[Spatial resolution of digital systems: is the visual determination with a lead bar pattern meaningful?]. / Ortsauflösung digitaler Aufnahmesysteme: Ist die visuelle Bestimmung mittels Strichraster sinnvoll?

The factors influencing the spatial resolution of digital detectors are discussed and demonstrated on simulated bar pattern images. Lead bar patterns are often used in quality control procedures to test the spatial resolution of image detectors. In digital imaging systems the pixelization of the detector interferes with the periodic bar pattern and makes it difficult to determine the resolution limit. Bar pattern images seem to have only limited value for characterizing the imaging performance of digital detector systems.

Digital radiography with a large-scale electronic flat-panel detector vs. screen-film radiography: observer preference in clinical skeletal diagnostics.

The imaging performance of a recently developed digital flat-panel detector system was compared with conventional screen-film imaging in an observer preference study. In total, 34 image pairs of various regions of the skeleton were obtained in 24 patients; 30 image pairs were included in the study. The conventional images were acquired with 250- and 400-speed screen-film combinations, using the standard technique of our department. Within hours, the digital images were obtained using identical exposure parameters. The digital system employed a large-area (43x43 cm) flat-panel detector based on amorphous silicon (Trixell Pixium 4600), integrated in a Bucky table. Six radiologists independently evaluated the image pairs with respect to image latitude, soft tissue rendition, rendition of the periosteal and enosteal border of cortical bone, rendition of cancellous bone and the visibility of potentially present pathological changes, using a subjective five-point scale. The digital images were rated significantly (p=0.001) better than the screen-film images with respect to soft tissue rendition and image latitude. Also the rendition of the cancellous bone and the periosteal and enosteal border of the cortical bone was rated significantly (p=0.05) better for the flat-panel detector. The visibility of pathological lesions was equivalent; only large-area sclerotic lesions (n=2) were seen superiorly on screen-film images. The new digital flat-panel detector based on amorphous silicon appears to be at least equivalent to conventional screen-film combinations for skeletal examinations, and in most respects even superior.

Comparison of low-contrast detail perception on storage phosphor radiographs and digital flat panel detector images.

A contrast detail analysis was performed to compare perception of low-contrast details on X-ray images derived from digital storage phosphor radiography and from a flat panel detector system based on a cesium iodide/amorphous silicon matrix. The CDRAD 2.0 phantom was used to perform a comparative contrast detail analysis of a clinical storage phosphor radiography system and an indirect type digital flat panel detector unit. Images were acquired at exposure levels comparable to film speeds of 50/100/200/400 and 800. Four observers evaluated a total of 50 films with respect to the threshold contrast for each detail size. The numbers of correctly identified objects were determined for all image subsets. The overall results show that low-contrast detail perception with digital flat panel detector images is better than with state of the art storage phosphor screens. This is especially true for the low-exposure setting, where a nearly 10% higher correct observation ratio is reached. Given its high detective quantum efficiency the digital flat panel technology based on the cesium iodide scintillator/amorphous silicon matrix is best suited for detection of low-contrast detail structures, which shows its high potential for clinical imaging.

Selenium radiography versus storage phosphor and conventional radiography in the detection of simulated chest lesions.

PURPOSE: To compare selenium detectors with three conventional and digital detector systems for the detection of simulated pulmonary lesions. MATERIALS AND METHODS: Templates containing nodules, linear structures, and micronodular opacities were superimposed over an anthropomorphic chest phantom. The authors compared lesion detection with use of storage phosphor radiography (250 speed), selenium radiography (250 speed) with an antiscatter grid, selenium radiography (450 speed) without an antiscatter grid, an asymmetric screen-film system (400 speed), and a conventional screen-film system (250 speed). Detection performance of 10 radiologists was compared by using a multireader-multicase receiver operating characteristic analysis of variance. RESULTS: For the detection of nodules, no statistically significant differences between imaging modes were seen. For the detection of micronodules and linear lesions, both selenium techniques were superior to all other modes (P < .05). In addition, the asymmetric screen-film radiographs were inferior (P < .05) to the conventional screen-film radiographs and to storage phosphor radiographs for the detection of micronodules. CONCLUSION: The selenium detector improves detection of simulated fine linear and low-contrast micronodular details and appears to be superior to other detector systems for chest radiography.

[Quality assurance in roentgen diagnosis. Comparison of constancy test methods according to DIN and IEC and practical consequences in Germany]. / Qualitätssicherung in der Röntgendiagnostik. Vergleich der Konstanzprüfmethoden gemäss DIN und IEC und praktische Konsequenzen in Deutschland.

Since 1987 constancy tests for X-ray imaging equipment are required by the German Röntgenordinance and are performed according to the DIN 6868 standards. On an international level, standards for these tests have been developed by the IEC (International Electrotechnical Commission, IEC 1223 series); however, these standards have so far not been applied in nation-wide quality programmes in any country. Typical aspects of both, DIN and IEC standards, are demonstrated for direct radiography and indirect radioscopy and indirect radiography as examples. DIN standards optimise test procedures for minimum effort and cost efficiency designed for execution even in small hospitals and practices by the users. For each type of x-ray equipment tests are performed with only one universal test device, which is precisely specified and independent of local conditions. Oplimisation is misation is missing for IEC test procedures; they are designed for more performance characteristics and need for each x-ray equipment more individual test devices, which are mostly open for local choice and need a considerably higher effort in respect of time consumption and test films compared to DIN. Adoption of the IEC standards for the constancy tests in Germany would involve considerable financial and organisational effort which is probably not counterbalanced by an increased benefit.

Digital chest imaging with a selenium detector: comparison with conventional radiography for visualization of specific anatomic regions of the chest.

OBJECTIVE: The purpose of this study was to compare a new digital chest radiography system that uses amorphous selenium as the X-ray detector with conventional radiography for the visualization of various anatomic regions of the chest as a first phase of testing image quality. MATERIALS AND METHODS: Six observers analyzed pairs of posteroanterior chest radiographs of 40 patients. One radiograph in each pair was obtained with a conventional chest film changer, and the other was obtained with the digital selenium chest radiography system. Each observer rated the visibility and the radiographic quality of 12 different anatomic regions. RESULTS: The observers rated visualization obtained with the digital system as better than that obtained with the conventional system in four regions (right lower lobe, upper lobes, ribs, and soft tissue), as better than or equal to that obtained with the conventional system in four regions (retrocardiac, retrodiaphragmatic, hilum, and upper mediastinum), and as equal to that obtained with the conventional system in four regions (horizontal fissure, carina, azygoesophageal recess, and thoracic spine). Some observers had a strong preference for the digital images, whereas others showed no preference. The conventional system was not ranked high for any region (2880 observations, p < .01, sign test). CONCLUSION: The digital selenium chest radiography system performs well in a clinical setting, providing visualization of anatomic structures that is better than or at least equal to that provided by standard screen-film images.

Image quality of a digital chest radiography system based on a selenium detector.

A digital chest radiography system has been developed, with a detector based on the photoelectric properties of amorphous selenium. The selenium layer is deposited on a cylindrical aluminium drum, large enough to cover the full field of view for chest imaging. The electrostatic charge image which is formed on the selenium surface after x-ray exposure is read out by electrometer probes using fast drum rotation. For a physical evaluation of the attainable image quality, the characteristic curve, the modulation transfer function, and the noise spectra were measured. From these measurements, the signal-to-noise properties of the detector in terms of detective quantum efficiency (DQE) and noise equivalent quanta (NEQ) were derived. The results show that the selenium-based detector has a wide dynamic range and a significantly better DQE than screen-film and storage phosphor systems for spatial frequencies below the Nyquist limit (2.7 lp/mm). As a consequence, the detectability of small, low-contrast details is considerably improved.

Grids or air gaps for scatter reduction in digital radiography: a model calculation.

The relative advantages of grids and air gaps for scatter reduction in a digital radiography system were investigated using a theoretical model. In this model the properties of the scatter reduction device are described by primary transmission and selectivity. The signal-to-noise (SNR) improvement factor for fixed exposure to the patient was used as a performance indicator. The results show that the SNR improvement depends strongly on the local scatter fraction; for all practical configurations, however, it stays below a factor of 2. For high scatter fractions, an air gap of 20 cm has about the same effect on SNR improvement as a highly selective grid; for low and medium scatter conditions the air gap performs better than any grid. Additive system noise reduces the SNR improvement factor compared to the case with quantum noise only, the reduction being more pronounced for the grids than for the air gap. The results suggest that the use of an air gap instead of a grid is advantageous in digital radiography systems.

X-ray diffraction measurements of some plastic materials and body tissues.

X-ray diffraction allows the investigation of the atomic or molecular structure of materials. The combination of diffractometry with computerized tomography enables spatially resolved imaging of the diffraction properties of extended objects as described in more detail in a companion article [Harding et al., Med. Phys. 14, 515 (1987)]. We present measured diffraction patterns of some plastics and several biological materials, which allow further optimization of our method and the selection of suitable application areas.

X-ray diffraction computed tomography.

Coherent scattering of x-ray photons leads to the phenomenon of x-ray diffraction, which is widely used for determining atomic structure in materials science. A technique [x-ray diffraction computed tomography (CT)] is described, analogous to conventional CT, in which the x-ray diffraction properties of a stack of two-dimensional object sections may be imaged. The technique has been investigated using a first generation (single pencil beam) CT scanner to measure small angle coherent scatter, in addition to the customary transmitted radiation. Diffraction data from a standard CT performance phantom obtained with this new technique and with an x-ray diffractometer are compared. The agreement is satisfactory bearing in mind the poor momentum resolution of our apparatus. The dose and sensitivity of x-ray diffraction CT are compared with those of conventional transmission CT. Diffraction patterns of some biological tissues and plastics presented in a companion paper indicate the potential of x-ray diffraction CT for tissue discrimination and material characterization. Finally, possibilities for refinement of the technique by improving the momentum resolution are discussed.

Coherent scatter in radiographic imaging: a Monte Carlo simulation study.

The significance of coherently scattered radiation in radiographic imaging is investigated using the Monte Carlo simulation technique. Recent data on the form factor of liquid water, which take into account intermolecular interference effects, have been used for the calculation of the coherent differential cross section. The spatial distribution of scattered radiation in the detection plane was calculated separately for coherent and incoherent single and multiple scattering. In the pencil beam geometry, it is found that coherent scattering leaving the object, is almost exclusively single scattering, is concentrated near but not exactly at the transmitted primary beam and dominates over multiple incoherent scattering in this region even for thick objects and polyenergetic radiation. Some consequences concerning the performance of grids, the choice of phantom materials and a new imaging method are given.