Computerized fluoroscopy techniques for intravenous study of cardiac chamber dynamics.

A computerized fluoroscopy system which was recently developed in our laboratories permits image contrast increases of 8-16 relative to conventional image intensifer fluoroscopy and permits study of canine and human ventricular wall motion using peripheral intravenous injections. Two time-dependent image subtraction algorithms are illustrated in connection with observation of artificially infarcted dog hearts. The first algorithm produces a display analogous to direct ventriculography using catheterization. The second displays regions of dyskinetic motion as anomalous image grey shades.

Intravenous video arteriography of the intracranial vasculature: early experience.

A computerized fluoroscopic apparatus developed by members of the University of Wisconsin Medical Physics Section was used for 12 months to perform intravenous video arteriography. In previous papers, the apparatus was described and its use was illustrated for performing time subtraction intravenous video arteriography of the extracranial carotid arteries, the arteries of the abdomen and extremities, as well as angiocardiography. In this report, the use and current limitations of this technique for evaluation of the intracranial vasculature are described and illustrated.

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.

A regional convolution kernel algorithm for scatter correction in dual-energy images: comparison to single-kernel algorithms.

Single kernel scatter correction algorithms are based on the model that the scatter field can be predicted by convolution of the primary intensity (Iprim) with a spatially invariant scatter point-spread function (PSF). Practical limitations (Iprim unknown) suggest the substitution of the total detected intensity (Idet) for Iprim as the source image in the convolution. In regions of high scatter fraction (SF), Idet is a poor approximation of Iprim, thereby causing an overestimation of scatter originating in the region. This contributes to errors in estimating detected scatter in the mediastinum and neighboring regions. A technique using a regionally variable point-spread function that significantly reduces RMS error in estimation of the primary image as compared to the single PSF method is investigated. The regionally variable convolution method employs a larger PSF in the mediastinum and a smaller PSF in the lungs to reduce the error in estimating the scatter throughout the image. The method to allow for patient differences has also been expanded and various implementations of these methods have been compared. Results show that the dual-kernel algorithm is always more effective than an equivalent single-kernel algorithm. The dual-kernel algorithm using a predicted scatter fraction curve gives an overall RMS error in the primary of as low as 20.8% which is equivalent to 8.7% RMS error in the scatter. The dual-kernel method using a predicted scatter fraction curve approaches the accuracy of the single-kernel method using patient specific scatter measurements. Because using individual scatter measurements is a less desirable method for clinical use, we feel that the dual-kernel algorithm which uses two regions specific convolution kernels and a variable scatter fraction curve is the preferable method.

Optimal x-ray spectra for screen-film mammography.

Theoretical and experimental techniques have been used to study optimal x-ray for screen-film mammography. A simple model of mammographic imaging predicts optimum x-ray energies which are significantly higher than the K-characteristic energies of Mo. A subjective comparison of x-ray spectra from Mo-anode and W-anode tubes indicates that spectra produced by a W-anode tube filtered with materials of atomic number just above that of Mo are more suitable for screen-film mammography than spectra produced by the Mo-anode/Mo-filter system. The imaging performance of K-edge filtered, W-anode tube spectra was compared to the performance of Mo-anode spectra using phantom measurements and mastectomy specimen radiography. It was shown that optimal W-anode spectra can produce equal contrast with an exposure reduction of a factor of two to three, a dose reduction of a factor of two, and equal or reducing tube loading, compared to Mo-anode spectra. A computer simulation was carried out to extend the initial, monoenergetic theory to the case of real, polychromatic sources. The effects of varying filter material and thickness, tube operating potential, and breast thickness were all studied. Since W-anode x-ray tubes are considered to be better for Xerox mammography than Mo-anode tubes, this study has shown that both Xerox and screen-film techniques can be performed optimally with a single, properly designed, W-anode x-ray tube.

Three-beam K-edge imaging of iodine using differences between fluoroscopic video images: experimental results.

In an earlier article we discussed the rationale for using differences between video images in three-beam selective iodine K-edge imaging. Rather than combining three initial images Li linearly to yield the final image k1L1 + k2L2 + k3L3, differences between the Li were first generated and then combined either to linear or quadratic order. This approach was motivated by the desire to suppress the large multiplicative biases of fluoroscopic imaging and justified by theoretically proving that k1 + k2 + k3 is approximately equal to 0. In this paper we discuss the instrumentation and experimental results obtained from this difference-based technique. A specially-constructed apparatus is described which automatically selects the optimum combination coefficients and combines the difference images up to quadratic order at realtime video rates. Three methods for generating K-edge subtraction images are compared: the former approach in which the Li are linearly combined and combination of differences to linear and quadratic order. In imaging phantoms in which the iodine distribution is known, the resultant subtraction images from all three methods appear similar. Inspection of signal sizes shows that the quadratic difference-based approach provides superior bone and tissue residual suppression by about a factor of 2. In imaging phantoms in which the iodine distribution is unknown, incomplete suppression of x-ray scatter and image intensifier veiling glare prevent a quantitative comparison of performance of the three algorithms. An experiment verification is provided of the theorem which states that k1 + k2 + k3 is approximately equal to 0.

A hybrid computerized fluoroscopy technique for noninvasive cardiovascular imaging.

The excellent linearity of digital image storage and retrieval permits hybrid analog-digital subtraction to extend the spatial resolution of two previously developed algorithms which employed entirely digital apparatus. A low resolution, time-integrated preinjection digital mask image is reconverted to analog form and subtracted from live analog video images of iodine administered by peripheral intravenous injection to produce a high resolution display of the cardiovascular system with contrast ten times greater than conventional fluoroscopy. Preliminary studies in dogs are compared with images obtained with our digital subtraction algorithms.

Conventional chest radiography vs dual-energy computed radiography in the detection and characterization of pulmonary nodules.

OBJECTIVE: We evaluated a single-exposure, phosphor-plate, dual-energy imaging device that produces, in addition to conventional chest radiographs, both tissue- and bone-selective images. Our purpose was to determine whether dual-energy radiography was more accurate than routine chest radiography for detection and characterization of pulmonary nodules. SUBJECTS AND METHODS: Two hundred patients undergoing chest CT were asked to volunteer to have dual-energy and conventional chest radiographs obtained immediately before or after their CT scan. Radiographs from a subset of 50 of these patients with 116 CT-detected nodules and 10 patients with normal findings on CT scans of the chest were presented to the observers for the nodule detection study. Similarly, radiographs from a subset of 29 patients with 20 calcified and 20 uncalcified nodules were presented to five observers to determine nodule calcification. Dual-energy images were produced by filtering the X-ray tube output with a gadolinium sheet while using a multiple phosphor plate receptor. A dual-energy triad of images consisting of a conventional image, a tissue-selective image, and a bone-selective image were produced. The conventional chest radiographs and dual-energy image sets were presented to observers in random order. Data from a free response receiver operating curve and a receiver operating curve were generated for nodule detection and characterization, respectively. RESULTS: By using the dual-energy images, all five observers improved their ability to diagnose pulmonary nodules (p = .0005) and to characterize nodules as calcified (p = .005). CONCLUSION: By eliminating rib shadows with tissue-selective images and enhancing calcified structures with bone-selective images, dual-energy chest radiography improved the ability of all observers, regardless of expertise, to detect and characterize pulmonary nodules.

Digital subtraction angiography: principles and pitfalls of image improvement techniques.

The technology of imaging methods in digital subtraction angiography (DSA) is discussed in detail. Areas covered include function of the video camera in both interlaced and sequential scan modes, digitization by the analog-to-digital converter, logarithmic signal processing, dose rates, and acquisition of images using frame integration and pulsed-sequential techniques. Also discussed are various methods of improving image content and quality by both hardware and software modifications. These include the development of larger image intensifiers, larger matrices, video camera improvements, reregistration, hybrid subtraction, matched filtering, recursive filtering, DSA tomography, and edge enhancement.

A technique of scatter and glare correction for videodensitometric studies in digital subtraction videoangiography.

The logarithmic amplification of video signals and the availability of data in digital form make digital subtraction videoangiography a suitable tool for videodensitometric estimation of physiological quantities. A system for this purpose was implemented with a digital video image processor. However, it was found that the radiation scattering and veiling glare present in the image-intensified video must be removed to make meaningful quantitations. An algorithm to make such a correction was developed and is presented. With this correction, the videodensitometry system was calibrated with phantoms and used to measure the left ventricular ejection fraction of a canine heart.

A truly hybrid interventional MR/X-ray system: feasibility demonstration.

A system enabling both x-ray fluoroscopy and MRI in a single exam, without requiring patient repositioning, would be a powerful tool for image-guided interventions. We studied the technical issues related to acquisition of x-ray images inside an open MRI system (GE Signa SP). The system includes a flat-panel x-ray detector (GE Medical Systems) placed under the patient bed, a fixed-anode x-ray tube overhead with the anode-cathode axis aligned with the main magnetic field and a high-frequency x-ray generator (Lunar Corp.). New challenges investigated related to: 1) deflection and defocusing of the electron beam of the x-ray tube; 2) proper functioning of the flat panel; 3) effects on B0 field homogeneity; and 4) additional RF noise in the MR images. We have acquired high-quality x-ray and MR images without repositioning the object using our hybrid system, which demonstrates the feasibility of this new configuration. Further work is required to ensure that the highest possible image quality is achieved with both MR and x-ray modalities.

Single-exposure dual-energy computed radiography: improved detection and processing.

Recent reports have emphasized the potential for dual-energy computed radiographic applications. An improved method for single-exposure material-selective imaging with a photostimulable phosphor computed radiography system was investigated. The essential elements of the technique are (a) prefiltration with gadolinium, which divides the incident broad-beam x-ray spectrum into low-energy and high-energy peaks; (b) a cassette consisting of four photostimulable phosphor plates that record images of increasing mean energies, with a computed energy separation of 23 keV from the front to the rear plate; (c) spatially dependent scatter and beam-hardening corrections; and (d) a noise-reduction algorithm based on noise correlations between bone-selective and soft-tissue-selective dual-energy images. These elements result in improved material cancellation and signal-to-noise ratio throughout the image.

Digital video subtraction angiography for evaluation of peripheral vascular disease.

Digital video subtraction angiography (DVSA) has been employed to study a variety of peripheral vascular problems, using equipment developed at the University of Wisconsin. The technique is relatively simple and safe and has good patient acceptance. Experience indicates that in selected patients it is a satisfactory alternative to standard arteriography for screening and for definitive evaluation and on occasion may yield information not obtainable with conventional methods. It can aid in the performance of transluminal angioplasty and is suitable for serial evaluation of atherosclerotic vessels and bypass grafts.

Computerized fluoroscopy: digital subtraction for intravenous angiocardiography and arteriography.

Computerized fluoroscopy is a system comprising on-line digital time and energy subtraction algorithms designed to isolate and enhance the iodine signal from image intensified fluoroscopy. The apparatus is described and its use for time subtraction intravenous arteriography of the carotid, abdominal, extremely arteries, as well as the heart, is illustrated. Vascular diseases such as stenoses, obstruction, emboli, ulcerative plaques, and aneurysms are readily demonstrated. The technique has a potential for evaluating cardiac motion and the patency of coronary artery bypass grafts. The method appears to be a safe and less expensive alternative to catheter arteriography and angiocardiography in certain instances.

Clinical applications of computerized fluoroscopy: the extracranial carotid arteries.

Preliminary results obtained with a new computerized fluoroscopic apparatus in examination of the extracranial carotid arteries are described. All patients had clinical signs of symptoms of extracranial occlusive vascular disease. In most cases, image quality was sufficient to display patency of the internal carotid arteries, with excellent correlation between intravenous and conventional angiography. While the new technique is not totally noninvasive, it does eliminate many of the risks and costs of conventional arteriography.