Contrast-detail phantom study for x-ray spectrum optimization regarding chest radiography using a cesium iodide-amorphous silicon flat-panel detector

RATIONALE AND OBJECTIVES: The purpose of this study evaluating a cesium iodide-amorphous silicon-based flat-panel detector was to optimize the x-ray spectrum for chest radiography combining excellent contrast-detail visibility with reduced patient exposure. MATERIALS AND METHODS: A Lucite plate with 36 drilled holes of varying diameter and depth was used as contrast-detail phantom. For 3 scatter body thicknesses (7.5 cm, 12.5 cm, 21.5 cm Lucite) images were obtained at 113 kVp, 117 kVp, and 125 kVp with additional copper filter of 0.2 and 0.3 mm, respectively. For each setting, radiographs acquired with 125 kVp and no copper filter were taken as standard of reference. On soft-copy displays, 3 observers blinded to the exposure technique evaluated the detectability of each aperture in each image according to a 5-point scale. The number of points given to all 36 holes per image was added. The scores of images acquired with filtration were compared with the standard images by means of a multivariate analysis of variance. Radiation burden was approximated by referring to the entrance dose and calculated using Monte Carlo method. RESULTS: All 6 evaluated x-ray spectra resulted in a statistically equivalent contrast-detail performance when compared with the standard of reference. The combination 125 kVp with 0.3 mm copper was most favorable in terms of dose reduction (approximately 33%). CONCLUSION: Within the constraints of the presented contrast-detail phantom study simulating chest radiography, the CsI/a-Si system enables an addition of up to 0.3 mm copper filtration without the need for compensatory reduction of the tube voltage for providing constant image quality. Beam filtration reduces radiation burden by about 33%.     

Alternative X-ray filters for an intra-oral digital radiographic system

Objective

The aim of this study was to evaluate the effect of the modulation of the radiation spectrum with the use of alternative X-ray filters in the quality of intra-oral digital images from storage phosphor plates.

Methods

The radiographic exposures were performed in a GE 1000 X-ray machine (General Electric Co., Milwaukee, WI), operating at 65 kVp, 10 mA, 40 cm focus receptor distance using three different exposure times: 0.05 s, 0.16 s and 0.35 s. The control filter (GC) was 100% aluminium (Al) with a thickness of 1.5 mm. The tested filters were: G1, 97% Al and 3% copper (Cu) with 1.47 mm thickness; G2, 96% Al and 4% Cu with 1.53 mm thickness; G3, 95% Al and 5% zinc (Zn) with 1.56 mm thickness; G4, 98% Al and 2% Zn with 1.5 mm thickness; and G5, 95% Cu and 5% Zn with 1.6 mm thickness. For formation of the image, a 12-step Al wedge (each step with increments of 1 mm in thickness) was radiographed 10 times. Pixel values measured in digital images were converted into optical density (OD).

Results

All replicates showed OD with high reproducibility (r > 0.95) for all exposure times and tested filters. In comparison between filters, statistically significant differences in density (p < 0.05) were observed. The OD curve of the G5 filter in all exposure times and G3 filter in an exposure time of 0.05 s showed changes in shape (p < 0.05).

Conclusions

Excluding the G5 filter, all others tested filters can be used as a substitute for GC without losses in image quality.     

基于蒙特卡罗和CT数据体素模型的双能X射线吸收法腰椎骨密度成像参数优化

目的 研究双能X射线吸收法（DXA）腰椎成像过程并优化成像参数,为提高双能X射线骨密度仪的成像质量提供理论依据。方法 采用蒙特卡罗方法,构建基于计算机断层扫描数据（CT）的体素模型,利用模拟产生的高低能X射线能谱,分别照射体素模型腰椎部位得到骨密度图像,计算每幅图像的品质因数（FOM）。根据FOM大小优化高低能管电压组合、过滤铜片厚度以及入射粒子数比值。结果 FOM在管电压组合为75与200 kVp达到最低值1.59×10^-2。当过滤铜片厚度由0 mm增加至3 mm时,FOM数值从6.30×10^-2下降到1.87×10^-2,且下降趋势逐渐变缓。随着低能与高能的入射粒子数比从1∶3增加到19∶1,FOM先降低后升高,在3∶1时达到最低值1.40×10^-2。结论 低能管电压为70~85 kVp,高能管电压为160~200 kVp,产生高能能谱时额外添加过滤铜片厚度0.3 mm,入射粒子数比值（低能/高能）为1~5时,能在获得较好的DXA腰椎图像质量的同时使患者受到较小的辐射剂量。     

The reduction in radiation dose for intra-oral radiographs by the use of thin K-edge filters

The aim of this investigation was to reduce the radiation dose to patients undergoing intra-oral dental radiography by using thin K-edge filters in addition to the existing aluminum filter. The subject was a head phantom (a human skull embedded in tissue-equivalent material), which was exposed to X rays over a range of tube voltages (50-90 kVp) for each of the four filter systems. These were 2.7 mm aluminium alone (the existing total filtration) or with added 0.1 mm erbium, 0.1 mm yttrium or 0.05 mm niobium. The radiation dose was measured at four selected sites along the primary beam. These were the entrance skin dose, the exit skin dose and intra-orally both in front and behind the dental film packet. The exposure times and radiation doses required to produce an equivalent density (degree of blackening) on a radiograph of an upper molar tooth were determined. Within the usual diagnostic range of 60-80 kV the use of the thin K-edge filter resulted in a doubling of the exposure time (owing to the additional attenuation of the added filters). However, the skin dose and the total dose imparted to the patient were significantly reduced.     

The effect of thin K-edge filters on radiation dose in dental radiography.

The use of thin K-edge filters has been found to reduce considerably the radiation dose in intra-oral radiography. The aim of this study was to investigate the effect of filtration on the skin entrance dose and several sites (representing organs or areas of interest within the head) along the central beam axis, at other points within the primary beam and at two points just outside the primary beam. The subject was a sliced head phantom (a human skull embedded in tissue-equivalent material) which was exposed to X rays from a conventional dental X-ray unit in the range of tube voltage 55-85 kVp for each of four filter systems. These were 2.7 mm of aluminium alone (the existing total filtration) or with an added 0.1 mm erbium, 0.1 mm yttrium or 0.05 mm niobium metal foils. Measurements of radiation dose were made using thermoluminescent dosemeters (TLD rods) and were adjusted to simulate the exposure resulting from a typical dental radiograph of a maxillary molar. The results suggest that the use of thin K-edge filters significantly reduces the entrance skin dose and to a certain extent reduces the total dose imparted to the head. However, the dose to the ipsilateral orbit at higher tube voltages may be increased.     

Chest radiography: optimization of X-ray spectrum for cesium iodide-amorphous silicon flat-panel detector

PURPOSE: To ascertain the optimum x-ray spectrum for chest radiography with a cesium iodide-amorphous silicon flat-panel detector. MATERIALS AND METHODS: End points for optimization included the ratio of tissue contrast to bone contrast and a figure of merit (FOM) equal to the square of the signal-to-noise ratio of tissue divided by incident exposure to the patient. Studies were conducted with both computer spectrum modeling and experimental measurement in narrow-beam and full-field exposure conditions for four tissue thicknesses (8-32 cm). Three parameters that affect spectra were considered: the atomic number (Z) of filter material (Z = 13, 26, 29, 42, 50, 56, 64, 74, and 82), kilovoltage (from 50 to 150 kVp), and filter thickness (from 0.25 to 2.00 half-value layer [HVL]). RESULTS: Computer modeling and narrow-beam experimental data showed similar trends for the full range of parameters evaluated. Spectrum model results showed that copper filtration at 120 kVp or more was optimum for FOM. The ratio of contrasts showed a trend to be higher with higher kilovoltage and only a minor variation with filter material. Full-field experimental results, which reflect the added contribution of x-ray scatter, differed in magnitude but not trends from the narrow-beam data in all cases except the ratio of contrasts in the mediastinum. CONCLUSION: The best performance overall, including both FOM and ratio of contrasts, was at 120 kVp with 1-HVL copper filtration (0.2 mm). With this beam spectrum and an increase in tube output (ie, milliampere seconds) of about 50%, a chest radiograph can be obtained with image quality approximately equal to that with a conventional spectrum but with about 25% less patient exposure.     

A phantom approach to find the optimal technical parameters for plain chest radiography

A simple approach based on phantom measurements is proposed in this study to find the filtration, tube potential and antiscatter device that are optimal in respect of patient dose and image quality, at constant film-screen combination, film processing and viewing conditions. An original quasi-anthropomorphic chest phantom was exposed with 18 different beam qualities and three antiscatter devices. The entrance surface dose, organ doses and effective dose were estimated for each radiograph. The image quality was compared using two objective quality indexes, a contrast index and a scatter fraction, as well as two subjective indexes, a low contrast visualization index and a high contrast visualization index. It was found that for this X-ray unit, routinely using a 7:1 antiscatter grid, the optimal imaging technique is added filtration of 0.1 mm Cu+1 mm Al at a tube potential 100 kVp. Using a 25 cm air gap instead of the grid allows the tube potential to be increased to the upper limit of 120 kVp for this unit. The entrance surface dose of 0.075 mGy at 120 kVp with an air gap is less than half the value of the same quantity with a grid at 100 kVp and is significantly below the European reference level of 0.3 mGy. This phantom method, comprising both objective measurements and subjective estimation, is suitable for dose-image quality optimization in a clinical environment.     

Niobium/aluminum filters reduce patient exposure.

Reducing patient exposure while maintaining image quality is key to radiographers. In a comparison study of different filters, the authors found that a combined niobium/aluminum filter provides substantial reduction of entrance skin exposure with fairly small increases in tube loading and little loss of image contrast.     

Reducing radiation exposure from survey CT scans

OBJECTIVE: The purpose of this study was to focus attention on the technique factors commonly used in survey CT scans (e.g., scout, topogram, or pilot scans) to measure the radiation exposure from typical survey CT scans, to compare their exposure to that of typical chest radiographs, and to explore methods for radiation exposure reduction. MATERIALS AND METHODS: The default survey CT scans on 21 CT scanners, representing three different vendors and 11 different models, were investigated. Exposure measurements were obtained with an ion chamber at isocenter and adjusted to be consistent with standard chest radiographic exposure measurement methods (single posterior-anterior projection). These entrance exposures were compared with those of typical chest radiographs, for which the mean for average-sized adults is 16 mR (4.1 x 10(-6) C/kg). RESULTS: The entrance exposures of the default survey CT scans ranged from 3.2 to 74.7 mR (0.8 to 19.3 x 10(-6) C/kg), which is equivalent to approximately 0.2 to 4.7 chest radiographs. By changing the default scan parameters from 120 kVp to 80 kVp and the tube position from 0 degrees (tube above table) to 180 degrees (tube below table), the entrance exposure for the survey CT scan was reduced to less than that of one chest radiograph for all CT scanners. CONCLUSION: For institutions at which the interpreting radiologists do not rely heavily on the appearance of the survey CT image, we recommend adjusting the technique parameters (kilovoltage and X-ray tube position) to decrease radiation exposure, especially for vulnerable patient populations such as children and young women.     

Spectral dependence of glandular tissue dose in screen-film mammography

The average glandular tissue dose in mammography is generally determined from published tables with knowledge of the breast entrance skin exposure, x-ray tube target material, beam quality (half-value layer [HVL]), breast thickness, and breast composition. Using a carefully designed and experimentally validated Monte Carlo simulation, the authors found that average glandular dose also depends on x-ray tube voltage and, to a lesser extent, on x-ray tube voltage waveform. For currently employed molybdenum target-molybdenum filter source assemblies, a difference in dose of 10% or more is possible in estimating the average glandular dose obtained with different x-ray tube voltages but with the same HVL. Presented are normalized average glandular tissue doses in units of radiation absorbed dose per unit entrance skin exposure for different tube voltages and tube voltage waveforms as well as for different breast thicknesses and compositions and beam filtrations.     

Evaluating the use of higher kVp and copper filtration as a dose optimisation tool in digital planar radiography

IntroductionTo identify the potential of beam hardening techniques, specifically the use of higher kilo voltage (kV) and copper (Cu) filtration, to optimise digital planar radiographic projections. The study assessed the suitability of such techniques in radiation dose reductions while maintaining diagnostic image quality for four common radiographic projections: antero-posterior (AP) abdomen, AP-knee, AP-lumbar spine, and lateral lumbar spine.MethodsAnthropomorphic phantom radiographs were obtained at varying kVp (standard kVp, +10 kVp, and +20 kVp) and varying Cu filtration thickness (0 mm, 0.1 mm, and 0.2 mm Cu). The Dose Area Product (DAP), mAs and time (s) were recorded as an indication of the emitted radiation dose. Image quality was assessed objectively via Contrast-Noise-Ratio (CNR) calculations and subjectively via Visual Grading Analysis (VGA) performed by radiographers and radiologists.ResultsOptimised exposure protocols were established for the AP-abdomen (100 kVp with 0.2 mm Cu), AP-knee (85 kVp, and 0.1 mm Cu), AP-lumbar spine (110 kVp and 0.2 mm Cu), and lateral lumbar spine (110 kVp and 0.2 mm Cu). This strategy resulted in respective DAP reductions of 71.98%, 62.50%, 64.51% and 71.85%. While CNR values decreased as beam hardening techniques were applied, VGA demonstrated either a lack of statistical variation or improved image quality between the standard and the optimised exposure protocols.ConclusionsDAP reductions without compromising image quality can be achieved through beam hardening for the AP-abdomen, AP-knee, AP-lumbar spine, and lateral lumbar spine projections.Implications for practiceBeam hardening techniques should be considered as an optimisation strategy in medical imaging departments. Research into the applicability of this strategy for other radiographic projections is recommended.     

Investigation of dose reduction in neonatal radiography using specially designed phantoms and LiF:Mg,Cu,P TLDs

Many departments still do not use recommended radiographic parameters to X-ray neonates. Direct, accurate dose measurements of individual examinations may assist a department in justifying technique modifications that provide a substantial dose reduction without a significant loss of image quality. The aim of this study was to investigate dose reduction techniques for neonates in the intensive care unit. Alterations in beam energy (kVp and filtration) and collimation were investigated using specially designed phantoms mimicking a 700 g and 2000 g neonate, and ultrasensitive LiF:Mg,Cu,P thermoluminescence dosimeters (TLDs). Differences in entrance surface dose (ESD) and dose at depth (3 cm or 5 cm) were compared for two, overlapping fields centred individually on the chest and abdomen (Technique 1) and one large chest-abdomen field (Technique 2 or babygram). The large phantom was irradiated at 54 kVp, 60 kVp and 70 kVp without additional filtration and at 66 kVp and 70 kVp with a rare-earth hafnium filter. Focus-film distance (FFD) and mAs were adjusted to maintain optical density (OD) on each radiograph. The baseline dose at 54 kVp and 100 cm FFD was (46+/-2) micro Gy. Increasing the tube potential from 54 kVp to 70 kVp without additional filtration reduced the ESD by 27%. However, the addition of a 0.05 mm hafnium filter at 66 kVp further reduced the radiation dose by 13%, to produce an ESD of (28+/-2) micro Gy. All contrast details were observable at 66 kVp with hafnium filtration. Technique 1 may lead to an increase in effective dose due to field overlap, which diverges at depth, and increased scatter at the periphery of the fields.     

Investigation of optimum X-ray beam tube voltage and filtration for chest radiography with a computed radiography system

The purpose of this study was to determine the optimum tube voltage and amount of added copper (Cu) filtration for processed chest radiographs obtained with an Agfa 75.0 Computed Radiography (CR) system. The contrast-to-noise ratio (CNR) was measured in the lung, heart/spine and diaphragm compartments of a validated chest phantom using various tube voltages and amounts of Cu filtration. The CNR was derived as a function of air kerma at the CR plate and with the effective dose. As rib contrast can interfere with detection of nodules in chest radiography, a tissue-to-rib ratio (TRR) was derived to investigate which tube voltages suppress the contrast of rib. Although processing algorithms affect the signal and noise in a way that is hard to predict, we found that, for a given set of processing parameters, the CNR was related to the plate air kerma and effective dose in a logarithmic manner (all R(2) >or=0.97). For imaging of the lung region, a low voltage (60 kVp) produced the highest CNR, whereas a high voltage (125 kVp) produced the highest TRR. In the heart/spine region, 80-125 kVp produced the highest CNR, while in the diaphragm region 60-90 kVp produced the highest CNR. For chest radiography with this CR system, the optimal tube voltage depends upon the region of interest. Of the filters tested, a 0.1 mm Cu thickness was found to provide a statistically significant increase in the CNR in the diaphragm region with tube potentials of 60 kVp and 80 kVp, without affecting the CNR in the other anatomical compartments.     

Study of image quality (contrast) and reduction of patient dose by using heavy metal filters

We studied image quality (contrast) and patient dose reduction using heavy metal filters in lumbar spine and abdomen x-ray examination. Heavy metal filters used in this study are gadolinium, holmium and ytterbium and these combinations. These filters have k-absorption edge in the range from 50 to 70 keV. Image quality and patient dose in 70-90 kV tube voltage with heavy metal filters were compared with 80 kV tube voltage without filter. Image quality was improved in four percent and patient dose could be reduced by 30%. However, tube loading increased from 1.6 to 2.2 times. It was found that the best filter choices gave better image and reduced patient dose compared to without filter.     

Stomach and duodenum: radiographic magnification using computed radiography (CR)

We performed direct radiographic magnification (X3) using a 0.1-mm microfocal tube and computed radiography (CR) in air-barium double-contrast studies of the stomach and duodenum. To eliminate blurring of the image due to motion, we used the maximum kilovolt peak rate possible (102 kVp), the maximum milliampere second rate possible (64 mAs), the shortest possible exposure time (0.1 second), and a horizontal x-ray beam. With the patients in the supine position, CR provided the wide image reproduction range required to obtain satisfactory radiographs. Image processing in the CR system produced radiographs with increased radiographic contrast and enhanced edge definition of anatomic borders or pathologic processes. The duodenal villi were clearly visible in 45% of the cases.     

Patient-specific region-of-interest fluoroscopy device for X-ray dose reduction

A region-of-interest (ROI) fluoroscopy device that provides an automatically generated ROI filter with an arbitrary shape, as well as digitally compensated images, was built and evaluated. ROI filters were generated by using a deformable attenuation material. Images were compensated by using a compensation ratio and a running average interpolation method. Image compensation parameters were predicted on the basis of the x-ray tube potential used. The image quality with and without an ROI filter was evaluated. This ROI fluoroscopic technique was shown to substantially reduce patient and operator radiation exposure without degrading image quality within the ROI.     

Optimization of tube potential-filter combinations for film-screen mammography: a contrast detail phantom study

This study evaluated how tube potential-filter combinations [with a molybdenum (Mo) anode and either an Mo or a rhodium (Rh) filter] influence image quality and radiation dose to breasts of different thicknesses in film-screen mammography using a new mammography phantom (CDMAM Phantom Type 3.4). A 28-kVp/Mo tube potential-filter combination is recommended for a breast (phantom) thickness of 40 mm or less, 28 kVp/Rh for a breast (phantom) thickness of 60 mm or less, and 30 kVp/Rh for a breast (phantom) thickness greater than 60 mm.     

Detector for dual-energy digital radiography

A detection scheme is described that allows one to accomplish dual-energy scanned projection digital radiography without switching the x-ray tube voltage. The method employs a high/low atomic number detector sandwich that simultaneously separates the x-ray beam transmitted by the patient into low and high energy components. To test the method, the response of a scanning linear array of energy-sensitive detectors was simulated, and bone and soft tissue images of an anthropomorphic chest phantom were obtained at 140 kVp. These were compared with similar images obtained by switching the x-ray tube voltage from 80 kVp to a heavily filtered 140 kVp. For comparable entrance skin exposures, the dual-energy detector images required a lower tube load and resulted in higher noise levels. The latter is attributable to the fact that the separation in energy between the high and low energy components is smaller with the dual-energy detector than with the voltage switching technique, and to misregistration problems associated with the simulation methodology. A detector design is also discussed that would result in improved energy separation and lower noise levels. In view of this possibility and the tube loading advantage, the method looks promising for digital scanned projection radiography.     

Chest radiography with a flat-panel detector: image quality with dose reduction after copper filtration

PURPOSE: To compare image quality and estimated dose for chest radiographs obtained by using a cesium iodide-amorphous silicon flat-panel detector at fixed tube voltage and detector entrance dose with and without additional 0.3-mm copper filtration. MATERIALS AND METHODS: The study was approved by the institutional ethics committee. All prospectively enrolled patients signed the written consent form. Chest radiographs in two projections were acquired at 125-kVp tube voltage and 2.5-microGy detector entrance dose. The experimental group (38 patients) was imaged with 0.3-mm copper filtration; the control group (38 patients) was imaged without copper filtration. An additional 12 patients were imaged with and without copper filtration and served as paired subject-controls. Three readers blinded to group and clinical data independently evaluated the radiographs for image quality on a digital display system. Twelve variables (six for each radiographic projection) were assigned scores on a seven-point ordinal scale. Scores between experimental and control groups were compared: Logistic regression analysis and Mann-Whitney U test were used for unpaired patients; and Wilcoxon and McNemar test, for paired patients. In all, 72 comparisons were determined (36 [12 variables x three readers] for unpaired patients and 36 for paired patients). In a phantom study, radiation burden of experimental protocol was compared with that of control protocol by using Monte Carlo calculations. RESULTS: For 70 of 72 comparisons, digital radiographs obtained with copper filtration were of similar image quality as radiographs obtained without copper filtration (P = .123 to P > .99). For two of 72 comparisons, one observer judged the experimental protocol superior to the control protocol (P = .043, P = .046). Patient dose reduction estimated with Monte Carlo calculations was 31%. Use of copper filtration increased exposure times by 48% for posteroanterior views and by 34% for lateral views. CONCLUSION: Subjectively equivalent chest radiographic image quality was found with estimated 30% dose reduction after addition of 0.3-mm copper filtration with flat-panel cesium iodide-amorphous silicon technology.