Video techniques for on-line portal imaging

The application of on-line portal imaging techniques to the verification of treatment precision is reviewed. The design parameters for a video portal imaging system are described, and the optimization of image quality is discussed with particular emphasis on photon noise. On-line images are presented for a head phantom imaged on a 4 MV linac, and compared with a conventional portal film. The relative advantages of an on-line system are compared with conventional portal film analysis.     

Performance evaluation of computed tomography with equivalent resolution images

A method of evaluating the performance of computed tomography (CT) with equivalent resolution images was investigated. Generally, in performance evaluations of CT, the resolution property is measured by the wire method, and the noise property is measured from noise images of a cylindrical water phantom. The signal-to-noise ratio (SNR) is then calculated for the integrated evaluation. Our proposed method enabled perceptual integrated evaluation by using equivalent resolution images created with frequency processing. The frequency-processing factor was calculated from the ratio of the modulation transfer factors of two models of CT, and the image of one of the two was processed by the factor. Because these processed images have resolution equivalent to images of the other CT, the perceptual evaluation with noise images becomes effective. In this investigation, images of a water phantom and a middle contrast resolution phantom were employed. Perceptual comparison of the amount of noise with equivalent resolution images could be performed easily, and effective performance evaluation was achieved. Therefore, our proposed method is useful for noise property and performance evaluation of CT.     

Evaluation of CRT images of digitized film angiographs

X-ray sheet film images of the test chart, the vascular phantom and angiography were digitized at sampling pitch of 0.2 mm and 0.15 mm using film digitizer TFR-01 (Toshiba) and transferred to a device for image storage and display system with 1635-line display monitor (TDF-500AS, Toshiba). Comparison of image qualities between film- and CRT-images was performed in fundamental and clinical studies. Resolution of the test chart image of conventional radiography was worse on CRT than on the original film, although it was improved when film image was digitized at resolution of 0.15 mm/pixel in comparison with that at resolution of 0.2 mm/pixel. Moiré stripes which occurred due to interference were found on CRT images taken using a grid technique. On CRT images of X-ray sheet film using direct magnification technique moiré stripes were not produced because of non grid technique, and the resolution approached that of the original film. In the study using vascular phantom, the optimal image on CRT could be obtained by various image processing procedures, and image quality on CRT with resolution of 0.15 mm approached that of original film. In case of direct magnification CRT images were superior to film images. Subtraction image of the vascular phantom at resolution of 0.2 mm/pixel was obtained on CRT and compared with film subtraction image. On conventional subtraction CRT image moiré stripes impaired the image quality in comparison with the film subtraction. However, magnification subtraction image of the vascular phantom on CRT was superior to the film subtraction. The results obtained in the test chart studies and phantom studies were also confirmed in clinical studies using various kind of angiograms. In addition, ROC study using clinical angiograms showed no significant statistical differences between the original film and CRT image even with 0.2 mm matrix size. Angiographic image on CRT at resolution of 0.15 mm/pixel or less is available for clinical use in place of conventional film image.     

Digital radiography of scoliosis with a scanning method: initial evaluation

PURPOSE: To evaluate the radiation dose, image quality, and Cobb angle measurements obtained with a digital scanning method of scoliosis radiography. MATERIALS AND METHODS: Multiple images were reconstructed into one image at a workstation. A low-dose alternative was to use digital pulsed fluoroscopy. Dose measurements were performed with thermoluminescent dosimeters in an Alderson phantom. At the same time, kerma area-product values were recorded. A Monte Carlo dose calculation also was performed. Image quality was evaluated with a contrast-detail phantom and visual grading system. Angle measurements were evaluated with an angle phantom and measurements obtained on patient images. RESULTS: The effective radiation dose was 0.087 mSv for screen-film imaging, 0.16 mSv for digital exposure imaging, and 0.017 mSv for digital fluoroscopy; the corresponding kerma area-product values were 0.43, 0.87, and 0.097 Gy. cm(2), respectively. The image quality of the digital exposure and screen-film images was about equal at visual grading, whereas fluoroscopy had lower image quality. The angle phantom had lower angle values with digital fluoroscopy, although the difference in measured angles was less than 0.5 degrees. The patient images showed no difference in angles. CONCLUSION: The described digital scanning method has acceptable image quality and adequate accuracy in angle measurements. The radiation dose required for digital exposure imaging is higher than that required for screen-film imaging, but that required for digital fluoroscopy is much lower.     

Portal Verification Using the KODAK ACR 2000 RT Storage Phosphor Plate System and EC® Films

BACKGROUND AND PURPOSE: The suitability of the storage phosphor plate system ACR 2000 RT (Eastman Kodak Corp., Rochester, MN, USA), that is destined for portal verification as well as for portal simulation imaging in radiotherapy, had to be proven by the comparison with a highly sensitive verification film. MATERIAL AND METHODS: The comparison included portal verification images of different regions (head and neck, thorax, abdomen, and pelvis) irradiated with 6- and 15-MV photons and electrons. Each portal verification image was done at the storage screen and the EC film as well, using the EC-L cassettes (both: Eastman Kodak Corp., Rochester, MN, USA) for both systems. The soft-tissue and bony contrast and the brightness were evaluated and compared in a ranking of the two compared images. Different phantoms were irradiated to investigate the high- and low-contrast resolution. To account for quality assurance application, the short-time exposure of the unpacked and irradiated storage screen by green and red room lasers was also investigated. RESULTS: In general, the quality of the processed ACR images was slightly higher than that of the films, mostly due to cases of an insufficient exposure to the film. The storage screen was able to verify electron portals even for low electron energies with only minor photon contamination. The laser lines were sharply and clearly visible on the ACR images. CONCLUSION: The ACR system may replace the film without any noticeable decrease in image quality thereby reducing processing time and saving the costs of films and avoiding incorrect exposures.     

Evaluation of radiographs developed by a new ultrarapid film processing system

The image quality of radiographs developed by a new ultrarapid processor was evaluated to determine if faster processing causes degradation in the image. The processor used was the Konica Super-Rapid SRX-501 model. Two films designed for this processor (Konica MGH-SR and MGL-SR) were processed in 45 sec and were compared with standard rapid processing in 90 sec of corresponding conventional films (Kodak TMG and OC). Rare-earth screens (Kodak Lanex Regular and Lanex Medium) used with the new and conventional films interleaved during angiographic studies or for phantom images were assessed for image quality. The basic imaging properties of the screen-film systems were examined by measuring (1) Hurter and Driffield curves, (2) modulation transfer functions by using the slit method, and (3) noise Wiener spectra. Subjective clinical assessment showed that the images obtained with ultrarapid processing were acceptable, with increased contrast and graininess. Hurter and Driffield curve measurements confirmed higher gradients. Modulation transfer function measurements were the same as for the conventional films. Noise Wiener spectrum measurements showed a 10% increase in noise for MGH-SR vs TMG film and a 30% increase for MGL-SR vs OC film. We conclude that acceptable image quality can be obtained using ultrarapid processing, with processing time approximately 60% that of conventional rapid processing. Potential applications include all areas in which rapid availability of the radiograph for interpretation is important. Although the processor studied was the first of its kind available, our evaluation indicates that the technology is available for a new class of ultrarapid processors.     

Contrast improvement in a new radiotherapy imaging system

PURPOSE: The aim of this paper is to compare the EC-L Kodak system for radiation therapy beam localization with a conventional one that could be daily employed in a radiotherapy department. BACKGROUND: The main purpose of portal images is to verify the treatment volume in actual clinical conditions. Low contrast is the main constraint affecting portal film image. METHODS: Kodak proposes a new imaging system (film and cassette) characterized by contrast enhancement as imaging standard for radiotherapy. The evaluation of system contrast was carried out by using a step-wedge consisting in 4 60 x 60 mm plexiglas steps and an anthropomorphic phantom. Portal films were exposed to a 6 MV photon beam by a linear accelerator (Varian Clinac 1800) with a 250 x 340 mm field size at the 1000 mm source film distance. The 2 imaging system performances were evaluated analyzing the image optical density. RESULTS: The use of the Kodak system results in a real contrast improvement, so it is satisfactory to describe the field placement as to the region of interest. CONCLUSIONS: The most critical characteristic attaining this method regards low contrast, i. e. the small optical density difference existing between different anatomical regions on the film. Since radiographic techniques can significantly influence quality of portal films, the adequate choice of film and screen combination, as well as the exposure technique is particularly useful in a radiotherapy quality assurance program.     

Image quality parameters for the production standard Eliav PORTpro portal imaging device

Measurements of the high contrast spatial resolution and contrast-to-noise ratio of the production standard Eliav "PORTpro" portal imaging system have been made using a commercially available quality assurance phantom. The spatial resolution of the images is comparable with published data for other commercial systems, but somewhat lower than that published previously for the prototype of this system. These data may be of use to those involved in the selection, commissioning or quality assurance testing of electronic portal imaging systems.     

Effects of optimization and image processing in digital chest radiography: an ROC study with an anthropomorphic phantom.

A digital system for chest radiography based on a large image intensifier was compared to a conventional film-screen system. The digital system was optimized with regard to spatial and contrast resolution and dose. The images were digitally processed for contrast and edge enhancement. A simulated pneumothorax and two simulated nodules were positioned over the lungs and the mediastinum of an anthropomorphic phantom. Observer performance was evaluated with ROC analysis. Five observers assessed the processed digital images and the conventional full-size radiographs. The time spent viewing the full-size radiographs and the digital images was recorded. For the simulated pneumothorax, the results showed perfect performance for the full-size radiographs and detectability was high also for the processed digital images. No significant difference in the detectability of the simulated nodules was seen between the two imaging systems. The results for the digital images showed a significantly improved detectability for the nodules in the mediastinum as compared to a previous ROC study where no optimization and image processing was available. No significant difference in detectability was seen between the former and the present ROC study for small nodules in the lung. No difference was seen in the time spent assessing the conventional full-size radiographs and the digital images. The study indicates that processed digital images produced by a large image intensifier are equal in image quality to conventional full-size radiographs for low-contrast objects such as nodules.     

Real‐time MR thermometry for monitoring HIFU ablations of the liver

A high‐resolution and high‐speed pulse sequence is presented for monitoring high‐intensity focused ultrasound ablations in the liver in the presence of motion. The sequence utilizes polynomial‐order phase saturation bands to perform outer volume suppression, followed by spatial‐spectral excitation and three readout segmented echo‐planar imaging interleaves. Images are processed with referenceless thermometry to create temperature‐rise images every frame. The sequence and reconstruction were implemented in RTHawk and used to image stationary and moving sonications in a polyacrylamide gel phantom (62.4 acoustic W, 50 sec, 550 kHz). Temperature‐rise images were compared between moving and stationary experiments. Heating spots and corresponding temperature‐rise plots matched very well. The stationary sonication had a temperature standard deviation of 0.15° C compared to values of 0.28° C and 0.43° C measured for two manually moved sonications at different velocities. Moving the phantom (while not heating) with respect to the transducer did not cause false temperature rises, despite susceptibility changes. The system was tested on nonheated livers of five normal volunteers. The mean temperature rise was ? 0.05° C, with a standard deviation of 1.48° C. This standard deviation is acceptable for monitoring high‐intensity focused ultrasound ablations, suggesting real‐time imaging of moving high‐intensity focused ultrasound sonications can be clinically possible. Magn Reson Med, 2010. © 2009 Wiley‐Liss, Inc.     

Characterization of new portal film systems for radiotherapy verification.

Portal images are an important verification tool in radiotherapy. Their use has been limited by their poor image quality, which is due to the inherent lack of contrast at megavoltage energies. Recently CEA and Kodak have introduced new portal film-cassette systems with much improved contrast. We have determined the H-D curves for these systems and found the gamma (gamma) for the CEA system (8.5) to be larger than that for the Kodak EC-L system (6.3). The optimal doses were CEA TLF 1.2 cGy, CEA TVS 15.9 cGy and Kodak EC-L 1.5 cGy. We also obtained phantom images that were evaluated by 11 radiotherapists. They ranked the CEA B High Plus cassette with CEA TVS film the highest, followed by the Kodak EC-L system. Some clinical films of a lateral pelvis are also presented, to demonstrate the improvement in image quality with these new film systems as compared with conventional portal films.     

Development of a semi-automated superimposing image verification system using a template matching algorithm in radiotherapy

To analyze shifts in the isocenter of images, we developed a semi-automated superimposing image-verification system that is capable of automatically quantifying shifts in the isocenter through image analysis with a personal computer (PC). The accuracy and usefulness of this software were examined through a comparison of nine portal images with a simulation image and by comparing nine portal images with a DRR image, using a human pelvic phantom. The difference between the known magnitude of shift and the magnitude of shift detected with this method was analyzed as detection error. When the portal images were compared with the simulation image, the 95% confidence interval (95% CI) of detection errors (mean+/-SD) was 0.57+/-0.36 mm (95% CI: 0.49-0.65 mm). When the portal images were compared with the DRR image, the respective figures were 0.68+/-0.38 mm (95% CI: 0.59-0.77 mm). No significant difference was noted between these two categories of comparison (N.S). The absolute detection error (mean+/-SD) in all directions was 0.34+/-0.34 mm for the comparison of portal images with the simulation image and 0.41+/-0.36 mm for the comparison of portal images with the DRR image. This system seems to be appropriate for verification of the treatment field by improving the accuracy of radiotherapy as a method of computer-assisted landmark recognition during image comparison.     

Digital radiography in urography

The clinical utility was evaluated of a computed radiographic system in urography. The system (FCR 101, Philips Medical Systems, Inc., Shelton, CT) is based on a photo-stimulatable phosphor screen (imaging plate) for X-ray image detection and storage. The X-ray information recorded on the imaging plate is converted into digital from and processed by means of a computer. After processing is completed, the digitized image is reversed back to analogic signals, which modulate the intensity of a laser beam scanning the image on a single-emulsion film (Fuji CR 633). Two hundred IVP's were obtained in four groups, of 50 patients each, with normal azotemic values by rapid infusion of a low osmolality contrast medium (iopamidol 150 mgI/ml). While conventional radiographs were performed on the first group of patients with the injection of 0.6 gI/kg body weight of contrast medium, digital examinations were carried out, in the remaining three groups, with the injection of 0.6, 0.3 and 0.12 gI/kg, respectively. The digital images were processed with the "Abdomen-routine" program. A specific algorithm was implemented in order to reduce the excessive contrast resolution of the bladder, which is due to the characteristics of the nonionic contrast medium and enhanced by the reading program. The image details were evaluated by two observers and then statistically analyzed with nonparametric tests. Statistical analysis did not show any difference in the quality of digital and screen-film images. Image processing improved some inadequate images, by reducing the contrast resolution of the bladder, and allowed a better detection of some details. Low doses (0.3 gI/kg) of a low osmolality (150 mgI/kg) contrast medium were enough to obtain good images. Another biological advantage was obtained by a consistent radiation dose reduction (about 40%).     

Portal imaging

Portal imaging is the acquisition of images with a radiotherapy beam. Imaging theory suggests that the quality of portal images could be much higher if the efficiency of the imaging media in detecting radiation could be improved. Introduction of new media (films and electronic portal imaging devices) has confirmed this by markedly increasing the quality of portal images. Images from these devices can then be used to verify a patient's treatment. Geometric verification requires the portal image to be registered with a reference image. Dosimetric verification requires the portal imager to be calibrated for dose. This review gives a brief overview of the current areas of interest in portal imaging: imaging theory; imaging media, film and electronic portal imaging devices; image registration; and dosimetry using these devices.     

A quality control test of the image obtained with electronic portal imaging devices]

INTRODUCTION: A quality control of the digital image obtained from two electronic portal imaging devices is discussed. The devices are used to verify the radiotherapic treatment setup by comparing online images of the irradiated volume with those of the simulation devices. MATERIAL AND METHODS: Both iView and Target View devices, respectively installed on a dual energy SLi Precise Elekta and Saturne 42 Ge linear accelerators, consist of highly efficient phosphor screen and high quality videocamera, controlled by a workstation, able to generate digital portal images from few cGy doses. A phantom and software package are used to assess the spatial resolution and signal to noise ratio, and to compare tha data obtained. Spatial resolution and signal to noise ratio of both systems were studied as a function of energy, gantry angle and image acquisition parameters. RESULTS: The mean spatial resolutions obtained from the first 30 measurements were 0,265+/-0,012 and 0,220+/-0,010 lp/mm respectively for 6 and 18 MV of Saturne 42 (Target View) and 0,241+/-0,006 and 0,239+/-0,005 lp/mm for 4 and 6 MV of SLi (iView). Spatial resolution decreases as a function of energy, meanwhile there are no significant statistical differences as regards of the acquisition parameters; signal to noise ratio, instead, increases with integration time. Different values of the spatial resolution as a function of gantry angle are due to changes in the screen-camera distance and flexing of the detector housing. The quality control test is performed every 15 days by the technicians of our Radiotherapy Department. We set the reject level of spatial resolution and signal to noise ratio to be three standard deviations below the mean value obtained during the initial EPID characterization: if the measures fall below these values preventative maintenance is scheduled. CONCLUSIONS: The efficacy of the use electronic portal imaging devices for visualizing and quantifying the relative positions of anatomical structures within the radiation field depends on the image quality. It is therefore essential to devise quality control tests for the devices themselves, to guarantee an optimal level of system performance in a fast and efficient manner.     

MR angiography and dynamic flow evaluation of the portal venous system

We studied the value of MR angiographic techniques in imaging the portal venous system. Projection angiograms were created by postprocessing a series of two-dimensional, flow-compensated gradient-echo images. Flow velocity was determined by a bolus-tracking method with radiofrequency tagging and multiple data readout periods. Each image was acquired during a breath-hold. MR angiography was applied to six normal subjects and four patients with abnormal hemodynamics in the portal venous system. Flow velocity determined by MR was correlated with the results of duplex sonography. The main portal vein and intrahepatic branches were shown in all cases. Portosystemic collaterals were identified in all patients with portal hypertension. In normal subjects, peak flow velocities (17.9 +/- 2.8 cm/sec) on MR correlated well with values determined by duplex sonography (17.5 +/- 2.2 cm/sec) (r = .846, p less than .04). Reversed portal blood flow was shown in two patients. One patient with portal vein thrombosis had no evidence of flow by MR angiography. Our results indicate that MR angiography can provide a three-dimensional display of normal and abnormal vascular anatomy as well as functional information in the portal venous system.     

Fluoroscopy: recording of fluoroscopic images and automatic exposure control.

Some means of recording images is a necessary part of most fluoroscopic systems. Several methods are available for recording images during fluoroscopy. Screen-film recording methods such as use of spot film devices and automatic film changers provide high-spatial-resolution images. Recording images by using the image intensifier (fluorography) provides film or digital images at relatively lower doses but with poorer spatial resolution. Digitally recorded images have better contrast resolution than analog images but lower spatial resolution and represent a compromise between dose and image quality. Motion picture (cine fluorographic) recording requires extremely high dose rates compared with those of lower-resolution videotape recording of motion. Recording systems in fluoroscopy require automatic exposure control for optimum image quality. The same feedback system used to control fluorographic exposures can be used to control exposure rates during fluoroscopy as well. Automatic brightness control maintains intensifier exposure rates on the basis of subject thickness by adjusting various technique factors. The type of control mechanism depends on the imaging task and the complexity (age and cost) of the equipment. The operator can choose between better image quality (higher contrast) or lower radiation dose.     

Flow effects in multislice, spin-echo magnetic resonance imaging. Model, experimental verification, and clinical examples

Flowing blood is responsible for a number of complex effects on clinical magnetic resonance (MR) images. To help elucidate these effects, a computer model of a conventional multislice spin-echo pulse sequence was developed. Using TR, TE, and direction of slice acquisition, the model calculates and plots a profile of MR signal intensity vs. z-axis velocity. The model predicts complex profiles with multiple segments of MR signal loss depending on TR, TE, direction of flow, sequence and timing of slice excitation, and slice location relative to adjacent slices. Model predictions were verified by imaging a bulk-flow phantom, consisting of a rotating cylinder filled with a manganese chloride solution with T1 = 840 msec and characterized by a velocity-gradient resolution of 0.23 cm/sec/pixel. In conventional spin-echo MRI of medium and large vessels using body coils, in which the velocity gradients exceed 2-5 cm/sec/pixel, most of the flow artifacts are averaged and are difficult to appreciate. However, bright crescents or rings of MR signal occasionally are seen in the inferior vena cava and portal vein, which the model is invoked to explain. The bulk-flow phantom will find use as a tool for calibrating flow-sensitive pulse sequences when these become widely available.     

Application of digital image processing for the generation of voxels phantoms for Monte Carlo simulation

This paper presents the application of a computational methodology for optimizing the conversion of medical tomographic images in voxel anthropomorphic models for simulation of radiation transport using the MCNP code. A computational system was developed for digital image processing that compresses the information from the DICOM medical image before it is converted to the Scan2MCNP software input file for optimization of the image data. In order to validate the computational methodology, a radiosurgery treatment simulation was performed using the Alderson Rando phantom and the acquisition of DICOM images was performed. The simulation results were compared with data obtained with the BrainLab planning system. The comparison showed good agreement for three orthogonal treatment beams of (60)Co gamma radiation. The percentage differences were 3.07%, 0.77% and 6.15% for axial, coronal and sagital projections, respectively.     

New chest imaging techniques: a comparison of five analogue and digital methods

In recent years new analogue and digital techniques have become available for chest imaging. This study compares conventional film/screen, asymmetric film/screen (InSight), equalization (Amber), storage phosphor and digital image intensifier techniques by phantom exposures and patient examinations. The quality of chest images of 43 patients was classified by seven observers in four different hospitals. According to the results of phantom measurements and a previous study, digital image intensifier radiography was excluded from the patient examinations because of its low image quality. The Amber system had the best image quality. Images of the storage phosphor system were of good quality in both mediastinal and peripheral fields of the chest. Compared to conventional film/screen, the asymmetric film/screen (InSight) was graded higher in the mediastinal field, but lower in the peripheral field. Correspondence to: H. P. Busch