Clinical usefulness of digital radiography in the gastrointestinal tract: Efficacy of magnification method

We assessed the performance capabilities of image intensifier digital radiography (II DR) in the detection of minute lesions in patients with early stomach cancer. The DR system was a prototype II DR system developed by Toshiba Corp (Tokyo, Japan). This system was able to acquire images with a 1,024-× 1,024-pixel matrix and 13 bits. Radiography was performed using a 0.3-mm tube focus. For the detectability of early stomach cancer, DR was judged to be superior to conventional screen-film system (CFSS) (DR superior, 55.7%; CFSS superior, 22.6%). In depicting the characteristics of the surface of the lesion, DR was also judged to be superior to CFSS (DR superior, 56.6%; CFSS superior, 17.0%). The II DR system used in this study was able to achieve almost the same spatial resolution as conventional radiography using the magnification method. It was also able to visualize subtle findings of early gastric cancer more clearly by the use of postprocessing. In addition, II DR has the advantages of reducing the patient exposure dose and permitting the acquisition of real-time images.     

Investigation of basic imaging properties in digital radiography. 5. Characteristic curves of II-TV digital systems

A simple method was devised to determine the characteristic curve of image intensifier (II)-TV digital imaging systems, which relates the output pixel value to the input relative x-ray intensity. To provide a wide range of x-ray intensities incident on the II, we used an aluminum stepwedge consisting of nine steps with thickness increments of 6.3 mm, together with an 0.81-mm-thick copper plate. The x-ray field was narrowly collimated to the area occupied by the stepwedge in order to reduce the effect of veiling glare. The relative x-ray intensities transmitted through each step of the stepwedge were determined by using screen-film systems. The gradient curve of the system was derived from the slope of the characteristic curve. Results obtained with a Siemens Digitron 2 system showed that its characteristic and gradient curves depended upon the matrix size used, but did not change with the II field size. The validity of the characteristic curve was demonstrated by measurement of iodine attenuation curves obtained with the II-TV digital system at different exposure levels.     

Investigation of basic imaging properties in digital radiography. 6. MTFs of II-TV digital imaging systems

We devised a new, simple technique for measuring the modulation transfer function (MTF) of a digital imaging system by using an image of an angulated slit. With this technique, the "presampling" analog MTF, which includes the geometric unsharpness, the detector unsharpness, and the unsharpness of the sampling aperture, can be measured even beyond the Nyquist frequency. A single-frame image of a slightly angulated slit was employed in order to obtain Fourier transforms of line spread functions at different alignments. The presampling MTF was determined by averaging the two Fourier transforms which we obtained from two extreme alignments (center and shifted) of the slit relative to the sampling coordinate. The presampling MTFs of our digital subtraction angiographic system were determined in two orthogonal directions for three different image-intensifier modes.     

Investigation of basic imaging properties in digital radiography 10. Structure mottle of II-TV digital imaging systems

Single-frame images obtained with image intensifier (II)-TV digital systems contain a large amount of structure mottle. In the present study, we examined several II-TV digital systems by use of Wiener spectral analysis and noted considerable variation of the structure mottle over the wide spatial frequency range. We found that the structure mottle in these systems may originate in the input phosphor, the output phosphor, and/or the electronic components, and that the Wiener spectra of structure mottle seem to depend on the specific combination of these components. The results of observer performance studies indicated that structure mottle can significantly decrease the detection of low-contrast objects in a single-frame image when the exposure incident on the II is greater than approximately 0.1 mR. In addition, we showed that the structure mottle can be removed by subtraction of a uniformly exposed mask. This simple procedure will improve the quality of radiologic images obtained with II-TV digital systems. Note, however, that the structure mottle is largely eliminated by subtraction in digital subtraction angiography (DSA) images.     

Investigation of basic imaging properties in digital radiography. 7. Noise Wiener spectra of II-TV digital imaging systems

We used Wiener spectral analysis in order to investigate the different noise sources and the effects of various parameters such as pixel size, image intensifier (II) field size, and exposure level on the noise in an II-TV digital system. The digital Wiener spectra in terms of relative x-ray intensity were determined directly from the digital noise data in terms of pixel values, by use of the characteristic curve of the imaging system. From averaged, subtracted, and/or combination images, the amount of structure mottle relative to the amount of quantum mottle was estimated. We found that a substantial amount of structure mottle was included in our II-TV digital subtraction angiography system, whereas the electronic noise of the TV system was quite small relative to the quantum and structure mottle. The effects of time jitter on the noise in single-frame images (consisting of multiple video frames) and in subtracted and averaged images were also investigated.     

Investigation of basic imaging properties in digital radiography. I. Modulation transfer function

The effect of various digital parameters, such as the sampling aperture, sampling distance, and display aperture, on the modulation transfer function (MTF) of digital radiographic imaging systems was investigated by means of theoretical simulation studies. The MTFs were also determined experimentally to confirm the relationship used in the simulation studies. The results indicate that the overall MTF of a digital system cannot specify the resolution properties in the same way as can the MTFs of analog systems. The MTF of a digital system may include a "false" response due to aliasing, which could lead to an incorrect interpretation of the resolution properties. The magnitude of aliasing that will occur in a digitized signal depends on the sampling parameters chosen and on the frequency content of the radiologic object being imaged. Thus, the type of object to be detected as well as various digital parameters must be considered in the design and evaluation of digital imaging systems.     

Patient dose management in digital radiography

Purpose:

To present the experience in patient dose management and the development of an online audit tool for digital radiography.

Materials and methods:

Several tools have been developed to extract the information contained in the DICOM header of digital images, collect radiographic parameters, calculate patient entrance doses and other related parameters, and audit image quality.

Results:

The tool has been used for mammography, and includes images from over 25,000 patients, over 75,000 chest images, 100,000 computed radiography procedures and more than 1,000 interventional radiology procedures. Examples of calculation of skin dose distribution in interventional cardiology based upon information of DICOM header and the results of dosimetric parameters for cardiology procedures in 2006 are presented.

Conclusion:

Digital radiology has great advantages for imaging and patient dose management. Dose reports, QCONLINE systems and the MPPS DICOM service are good tools to optimise procedures and to manage patient dosimetry data. The implementation of the ongoing IEC-DICOM standard for patient dose structured reports will improve dose management in digital radiology.     

Impact of digital radiography on clinical workflow

It is commonly accepted that digital radiography (DR) improves workflow and patient throughput compared with traditional film radiography or computed radiography (CR). DR eliminates the film development step and the time to acquire the image from a CR reader. In addition, the wide dynamic range of DR is such that the technologist can perform the quality-control (QC) step directly at the modality in a few seconds, rather than having to transport the newly acquired image to a centralized QC station for review. Furthermore, additional workflow efficiencies can be achieved with DR by employing tight radiology information system (RIS) integration. In the DR imaging environment, this provides for patient demographic information to be automatically downloaded from the RIS to populate the DR Digital Imaging and Communications in Medicine (DICOM) image header. To learn more about this workflow efficiency improvement, we performed a comparative study of workflow steps under three different conditions: traditional film/screen x-ray, DR without RIS integration (ie, manual entry of patient demographics), and DR with RIS integration. This study was performed at the Cleveland Clinic Foundation (Cleveland, OH) using a newly acquired amorphous silicon flat-panel DR system from Canon Medical Systems (Irvine, CA). Our data show that DR without RIS results in substantial workflow savings over traditional film/screen practice. There is an additional 30% reduction in total examination time using DR with RIS integration.     

Angular resolution in magnification radiography and the observation of x-ray wave interaction signatures

High resolution x-ray imaging studies have demonstrated significant radiographic contrast enhancements that are attributed to wave interactions within the sample. This paper reviews diffraction and refraction in the context of medical radiography, describing signatures produced by each process and the necessary experimental conditions for observing them. The concept of angular resolution is introduced and applied to current x-ray source and detector configurations, testing their ability to record these features. It is difficult to record interference patterns arising from refractive phase shifts because their formation requires a mono-energetic beam. The refraction of x-rays across boundaries, as described by Snell's law, produces strong contrast enhancements when they are struck at close to the glancing incidence. Deflections are proportional to the change in electron density (at energies above the K-edge) and square root of the wavelength, so they can be observed with a poly-energetic beam. Diffraction can also be observed with white radiation, but produce fringes with far narrower separation under the same irradiation conditions. In both cases, the observation of wave interaction signatures requires a propagation distance between the sample and detector, and selection of an appropriate geometric magnification, which can be estimated using a simple model presented here.     

Investigation of basic imaging properties in digital radiography. 11. Multiple slit-beam imaging technique with image intensifier-TV digital system

We are developing a digital x-ray imaging system using a multiple slit assembly (MSA) and an image intensifier (II)-TV digital system. The advantage of this approach is that the scatter from an object and the veiling glare in the II-TV system can be reduced significantly while the x-ray utilization is maintained much better than that with a single slit-beam technique. The quality of reconstructed images is related to many parameters such as the slit width, the lead spacer, the number of image frames, and the reconstruction algorithm. In this study, reduction of scatter and veiling glare was measured quantitatively, and image artifacts were analyzed. It was found that the fraction of scatter and veiling glare can be reduced to approximately 0.01-0.1 by use of the MSA imaging technique, and that the magnitude of the fractions is strongly dependent upon the slit width and the lead spacer of the MSA used. The artifacts are caused by inaccuracies in the slit width, lead spacer, and scan motion, and by undersampling of image data. The overlap scanning technique was effective in reducing the magnitude of these artifacts in the reconstructed image.     

Investigation of basic imaging properties in digital radiography. 8. Detection of simulated low-contrast objects in digital subtraction angiographic images

We investigated the effects of imaging and display conditions on the detectability of low-contrast objects in digital subtraction angiographic (DSA) images. The test images were produced by superimposition of low-contrast objects on a uniform noisy background obtained with a DSA system. We employed 18-alternative forced-choice (18-AFC) experiments and predictions based on statistical decision theory to study the dependence of the threshold contrasts of the test objects on the object size, incident x-ray exposure, display window width, and display medium. The results indicated that the threshold contrast decreased with increasing object size, and that the detectability of an object of a given size increased with increasing incident x-ray exposure and decreasing width of the display window. We found that the signal-to-noise ratio (SNR) obtained from the perceived statistical decision theory model, which includes the observer's internal noise, can accurately predict the detectability of low-contrast objects in DSA images. The threshold SNR corresponding to 50% correct detection in the 18-AFC experiments had a constant value of 3.8, in agreement with results reported previously for screen-film systems. The theoretical model will be useful for prediction of the performance of a DSA system based on its physical characteristics, and for evaluation of the tradeoff between patient exposure and diagnostic accuracy for a given DSA unit.     

Evaluation of the imaging properties of two generations of a CCD-based system for digital chest radiography

Two generations of a CCD-based detector system with lens-based optical coupling for digital chest radiography were evaluated in terms of presampling MTF, NPS, NEQ, DQE, linearity in response, and SNR over the detector area. Measurements were performed over a wide exposure range and at several different beam qualities. Neither the presampling MTF nor the DQE showed any general strong beam quality dependence, whereas the NPS and NEQ did when compared at specific entrance air kerma values. The exposure dependency for the DQE was found to be considerable, with the detectors showing low DQE at low exposures, and higher DQE at higher exposures. It was found that the second generation has been substantially improved compared to its predecessor regarding all the relevant parameters. The DQE(0) at an entrance air kerma of 5 microGy increased from 9% to 15%, mainly due to a better system gain (including optical coupling efficiency and matching of the energy of the emitted light photons to the sensitivity of the CCD camera). The first generation of detectors was found to have problems with bad peripheral resolution [MTF(muN/2) <0.1]. This problem was nonexistent for the second generation for which uniform resolution has been obtained [MTF(muN/2)=0.3]. A theoretical calculation of the DQE of two model systems similar to the ones evaluated was also performed, and the results were comparable to the experimentally determined data at high exposures. The model shows that both systems suffer from low optical coupling efficiency due to the large demagnification used. The main conclusion is that although the second generation has been improved, there is still a problem with low system gain leading to relatively modest DQE values, especially at low exposures.     

Quality control of storage phosphor digital radiography systems

Quality control (QC) of storage phosphor devices is important in assuring that the image information entered into an Image management and communication (IMAC) system is sufficient for diagnosis. QC of storage phosphor digital radiography systems is complex because of the self-corrective nature of the image-processing software used in these machines. Currently, one must produce hard copy to perform adequate QC. Inspection of images with reject analysis and inspection of cassettes and imaging plates has helped us in our QC program. For those QC tests using control limits, the appropriate settings for these limits are unknown. Starting approximations are given. Recommended tests are described.     

A new photoconductor imaging system for digital radiography

Amorphous selenium is a material often used in the x-ray imaging system. The main application is in xeroradiography where the structure of the sensor is a layer of selenium on a conductive substrate. The signal is a charge density on the surface which is revealed by a toner or by electrostatic probe for digitalization. In the system described here, the sensor structure is different for the sensor is covered by an electrode, a thin layer of metal, which gives another interface. The reading system needs the scanning of a light beam and the resolution power depends on the size of the beam. It is easier to scan a light beam than electrostatic probes so a more compact system can be realized. In the process, there are two phases: the storage and the reading. The time spent between the two phases reduces the quality of the image, and an in situ reading system, integrated to the radiographic machine will be, for this reason, more efficient. Also, the sensor needs good memory effect. One has investigated different sensors based on a structure of a thin photoconductive layer between two electrodes to find a memory effect. We have already seen this phenomena in the Bi12 SiO20 (B. Richard, "Contribution à l'étude d'un procédé d'imagerie radiologique utilisant le photoconducteur BO12 SiO20," Ph.D. thesis, Paris, 1987). In amorphous selenium with some dopants and some type of metallic contact, the memory effect is important enough to realize a system. With 2 X 2 cm samples, a complete x-ray digital imaging system has been built.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dual-energy digital mammography utilizing stimulated phosphor computed radiography

Dual-energy subtraction is a radiographic technique for the acquisition of a material selective image by the weighted subtraction of low- and high-energy digital X-ray images. This is achieved by exploiting the energy dependence of the X-ray attenuation components in the image. This can allow the removal of background morphology to enhance the presentation of otherwise obscured details. The detection of microcalcifications in a mammogram by dual-energy techniques has previously been investigated. These investigations indicated that, using dual-energy techniques, small microcalcifications could be extracted from the background breast morphology with sufficient signal to noise ratio (SNR) to be full visualized. The authors present the extension of a theoretical dual-energy model to incorporate practical considerations and then compare the results with experimentally derived data using a commercially available computed radiography system. In particular the extended model now takes into account the energy dependent detective quantum efficiency of a system. This is thought to be a major factor in reducing the efficiency of dual-energy mammography. The theoretical model predicts that dual-exposure dual-energy mammography, utilizing HRIII image plates, could not provide a detail SNR of five for calcifications smaller than 470 mu m. The experimental results verify this and indicate that dual-energy subtraction mammography, utilizing computed radiography, is currently not a viable technique for the detection of clinically significant microcalcifications. Further advances in X-ray image detector efficiency will be required if the full potential of this technique is to be achieved.     

Calibrating automatic exposure control devices for digital radiography

The energy responses of digital radiography detectors differ from those of screen-film systems. To provide a consistent level of image quality at different tube potentials automatic exposure control (AEC) devices must be calibrated to suit the energy response of the image receptor with which they are intended for use. AEC calibration for digital radiography systems requires an alternative parameter to optical density, ideally one related to the quality of a digital image. Energy responses of computed radiography (CR) and indirect digital radiography (IDR) image receptors have been calculated, and compared with those for screen-film systems. Practical assessments of the relative sensitivities of a CR detector made using the detector dose indicator (DDI), pixel value and signal-to-noise ratio showed similar variations with tube potential. The DDI has been used to determine the correct kV compensation curve required to calibrate the AECs for the loss in detector sensitivity with tube potential. AECs are set up relative to a predetermined air kerma incident on the detector at 80 kV for CR and IDR systems using this curve and the method used is described. Factors influencing the calibration of AECs for digital radiography including techniques, types of phantom and contributions from scatter are reviewed, and practical methods recommended for use.     

直接数字化X线摄影在腰椎侧位影像中的应用价值

目的 探讨直接数字化X线摄影( direct digitized radiography, DDR)在腰椎侧位影像中的应用价值.方法 随机抽取81例患者的DDR腰椎侧位影像,使用图像后处理方法中多级图像对比增益法,又称"交响乐"功能(multi-scale image contrast amplification, MUSICA)进行后处理,同时取另81例患者进行普通X线摄影,由放射科经验丰富的医生、技师各2名对所有的腰椎侧位影像进行分析,采用常规影像质量评价指标评价两组的影像质量.结果 (1)DDR腰椎侧位影像质量影像评分为13.00,普通X线影像评分为8.96,经非参数检验的配对符号秩和检验,依赖负秩计算的统计量(Z＝-7.88,P＜0.01),两组差异有统计学意义,DDR腰椎侧位组明显优于普通平片组;(2)81例中DDR腰椎图像显示满意率为92.6%(75/81), 普通X线平片显示满意率为61.7%(50/81) ,两者差异有统计学意义(χ2 = 21.89, P＜0.01). 结论 与普通X线影像相比,DDR影像能更好的显示下部腰椎椎体、附件及周围软组织,可获得良好的图像,有利于放射诊断工作.