A-Si:H/CsI(Tl) flat-panel versus computed radiography for chest imaging applications: image quality metrics measurement

Amorphous silicon (a-Si:H) flat-panel (FP) imaging systems have recently become commercially available for both chest and mammographic imaging applications. It has been shown that this new detector technology offers better image quality and various operational advantages over the computed radiography (CR) which to date has been the most widely implemented and used digital radiography technique. However, most image quality measurements reported on flat-panel systems have been performed on prototype systems in laboratories while those for CR systems were typically independently performed and reported on in separate studies. To directly compare the two technologies, we have measured the image properties for a commercial amorphous silicon/cesium iodide [a-Si:H/CsI(Tl)] flat-panel based digital chest system and a commercial CR system under clinical imaging conditions. In this paper, measurements of image quality metrics, including the modulation transfer functions (MTFs), noise power spectra (NPSs), and detective quantum efficiencies (DQEs), for the FP and CR systems are presented and compared. Methods and issues related to these measurements are discussed. The results show that the flat-panel system has slightly lower MTF but significantly higher DQEs than the CR system. The DQEs of the flat-panel system were found to increase with the exposure while those of the CR system decrease slightly with the exposure.     

Prototype Medical Image Management System (MIMS) at the University of Pennsylvania: Software Design Considerations

A 10 Mbits/second fiber-optic network for the transmission of chest x-ray images has been designed and implemented at our Hospital. Images are acquired with a high-resolution laser scanner. The viewing consoles display images at spatial resolutions of either 512 square or 1024 square. User interfaces have been designed to simplify the digitization and display processes. The applications level networking software and all the image processing software has been developed in-house. The system is now serving a 11-bed critical care facility on a day-to-day basis. This paper will focus on the software design issues. The software will be presented from a systems perspective. The importance of the user in the design process will be stressed and exemplified. The role of intelligent, rule-based software will be demonstrated. Selected clinical results will be discussed. Copyright © 1987 by the International Society for Optical Imaging. Proc SPIE 767:793–800, 1987. Reprinted with permission.     

System for digital acquisition of gastrointestinal images

Previous theoretical work and clinical experience with digital acquisition of fluoroscopic images have identified several problems which needed to be solved. These are: image resolution; blurring due to patient motion, combined with long exposure times; and excessive x-ray quantum mottle levels. We will show that application of pulsed progressive readout (PPR) methods to the TV camera solves these problems. By permitting a high-intensity x-ray pulse to be delivered, all motion is stopped and quantum mottle is reduced to acceptable levels. It will be shown that 1024 x 1024 digital matrices provide adequate resolution and 8-bit digitization is sufficient to permit the same quality as is used in conventional 100-mm photofluorography. User acceptance can be made easier by incorporation of existing photofluorographic controls (with which the radiologist is already familiar) to acquire the digital images. It is possible to interface PPR video systems using existing 100-mm exposure circuits without much modification and the resulting system can be regarded as a digital 100-mm camera.     

Critical comparison of 31 commercially available digital slide systems in pathology

Advances in new technologies for complete slide digitization in pathology have allowed the appearance of a wide spectrum of technologic solutions for whole-slide scanning, which have been classified into motorized microscopes and scanners. This article describes technical aspects of 31 different digital microscopy systems. The most relevant characteristics of the scanning devices are described, including the cameras used, the speed of digitization, and the image quality. Other aspects, such as the file format, the compression techniques, and the solutions for visualization of digital slides, (including diagnosis-aided tools) are also considered. Most of the systems evaluated allow a high-resolution digitization of the whole slide within about 1 hour using a x40 objective. The image quality of the current virtual microscopy systems is suitable for clinical, educational, and research purposes. The efficient use of digital microscopy by means of image analysis systems can offer important benefits to pathology departments.     

胸片计算机辅助检测的研究进展

随着医学影像数字化的发展,对影像的智能化理解成为一种必然趋势,计算机辅助检测（computer-aided detection,CAD）系统已经成为了医学影像学研究的热点之一,并逐步进入了医学临床应用,这对于提高诊断准确率、减少漏诊有着非常积极的作用。文章在介绍CAD系统基本概念的基础上,重点阐述了CAD系统在胸片疾病诊断中的基本工作流程,包括病灶区域增强、肺区分割、可疑区域选择、病灶筛选和病灶特征的进一步分析,以及CAD系统在肺部结节检测、肺间质性病变检测、利用时间减影检测间期病理变化等方面的应用,并讨论了其发展趋势。     

Image optimization in a computed-radiography/photostimulable-phosphor system

Photostimulable phosphor imaging is an exciting new technology that has several advantages over film/screen radiography, the most important of which is the linearity of the photostimulable phosphor system over a wide exposure latitude. The photostimulable phosphor image is digital, and as such, provides options of how the image is viewed by radiologists. This report discusses the various image-processing parameters available for a photostimulable phosphor system and describes a rational approach for selecting these parameters in portable chest radiography. As photostimulable phosphor imaging becomes more widely implemented, an understanding of the processing parameters will facilitate the production of images that take full advantage of the benefits of these systems.     

Thick-section histometry of porous hydroxyapatite implants using backscattered electron imaging

A histometry system has been developed to measure bone ingrowth into porous hydroxyapatite implants utilizing the backscattered electron image of thick sections. The system consists of a scanning electron microscope (SEM) with backscattered electron detector, digital beam controller, minicomputer based image digitization, and microcomputer based image processing, point counting, and lineal analysis. The SEM backscattered electron imaging mode yields high tissue contrast and sharp tissue boundaries, substantially reducing the lost cap and projection effect errors of thick sections. High-resolution digitization of the image substantially reduces the standard error of the estimates. By using the digitized image the tedious process of filtering artifacts and recording actual point counts, intersections, and intercept lengths is delegated to computer software. Performance of this system in a recent study demonstrated substantial ease of operator use and speed of measurement. In the absence of a digital beam controller an inexpensive video digitizer circuit board may be used to digitize photographic prints of the SEM images. The combination of increased accuracy, precision, operator ease, and speed suggests that this system can be useful for soft tissue-bone-implant histometry.     

Performance characteristics of a real-time digital x-ray fluoroscopic system using an intensified charge injection device camera and CsI:Na crystal

A digital x-ray photoelectronic imaging system has been constructed using an optically flat 152-mm-diam, 2.5-mm-thick CsI:Na scintillating crystal. X-ray images formed by the scintillator are viewed by a single microchannel plate intensified charge injection device (ICID) camera and digitized at a real-time rate by a computerized frame-grabbing system. Video images are recorded and selected image frames are subjected to image processing and analysis schemes. Parameters governing the performance characteristics of the system are determined accordingly. For a 152-mm field size at the crystal plane, a spatial resolution limit of 1.50 +/- 0.10 1p/mm (1 sigma) measured at the 4% level of the modulation transfer function of the system has been obtained. This result is consistent with the measurements of the full width at half-maximum of the line spread function which is found to be 645 +/- 35 microns (1 sigma). Similarly, the intrinsic resolution of the CsI:Na scintillator only was found to be 6.5 +/- 0.5 1p/mm (1 sigma). Contrast ratio measurements, which are mainly determined by the quality of phosphor, have indicated a value of 12.1 +/- 0.6, whereas minimum visible details are observed at radiation exposure rates of 100 microR/s. This limit has been reduced to 10 microR/s using the single-scan integrating option provided by the ICID camera. A maximum contrast resolution of 1% corresponding to 100 statistically significant meaningful gray levels is achieved at a maximum exposure rate of 1000 microR/s. Consequently, although the imaging capability of the present system compares favorably with that of conventional x-ray video-fluoroscopic systems, a better performance may be achieved by using a higher resolution cooled dual-microchannel intensified CID camera in conjunction with a thinner CsI:Na crystal and a real-time digital image processing subsystem.     

Schemes for the optimization of chest radiography using a computer model of the patient and x-ray imaging system.

A computer program has been developed to model chest radiography. It incorporates a voxel phantom of an adult and includes antiscatter grid, radiographic screen, and film. Image quality is quantified by calculating the contrast (deltaOD) and the ideal observer signal-to-noise ratio (SNR(I)) for a number of relevant anatomical details at various positions in the anatomy. Detector noise and system unsharpness are modeled and their influence on image quality is considered. A measure of useful dynamic range is computed and defined as the fraction of the image that is reproduced at an optical density such that the film gradient exceeds a preset value. The effective dose is used as a measure of the radiation risk for the patient. A novel approach to patient dose and image quality optimization has been developed and implemented. It is based on a reference system acknowledged to yield acceptable image quality in a clinical trial. Two optimizations schemes have been studied, the first including the contrast of vessels as measure of image quality and the second scheme using also the signal-to-noise ratio of calcifications. Both schemes make use of our measure of useful dynamic range as a key quantity. A large variety of imaging conditions was simulated by varying the tube voltage, antiscatter device, screen-film system, and maximum optical density in the computed image. It was found that the optical density is crucial in screen-film chest radiography. Significant dose savings (30%-50%) can be accomplished without sacrificing image quality by using low-atomic-number grids with a low grid ratio or an air gap and more sensitive screen-film system. Dose-efficient configurations proposed by the model agree well with the example of good radiographic technique suggested by the European Commission.     

What's "unstable" in unstable angina?

The role of emotional distress (e.g., anger, depression, and anxiety) in anginal chest discomfort (ACD) may have been underestimated. The authors review the empirical studies in this area, which are inconsistent with the standard theory on the ischemia-angina relationship; summarize the substantial evidence indicating a strong and consistent cross-sectional/prospective epidemiological association of emotional distress and ischemia/ACD; review the distress-targeted, interventional evidence confirming a causal relationship (i.e., reduced chest discomfort and health system utilization), thus confirming clinical utility of such interventions; and explore the possible mechanisms that might account for the relationship between emotional distress and chest discomfort. Substantial clinical benefit may be achieved by aggressively detecting and treating emotional distress in ACD patients.     

Effectiveness of an e-Learning Platform for Image Interpretation Education of Medical Staff and Students

Medical staff must be able to perform accurate initial interpretations of radiography to prevent diagnostic errors. Education in medical image interpretation is an ongoing need that is addressed by text-based and e-learning platforms. The effectiveness of these methods has been previously reported. Here, we describe the effectiveness of an e-learning platform used for medical image interpretation education. Ten third-year medical students without previous experience in chest radiography interpretation were provided with e-learning instructions. Accuracy of diagnosis using chest radiography was provided before and after e-learning education. We measured detection accuracy for two image groups: nodular shadow and ground-glass shadow. We also distributed the e-learning system to the two groups and analyzed the effectiveness of education for both types of image shadow. The mean correct answer rate after the 2-week e-learning period increased from 34.5 to 72.7%. Diagnosis of the ground glass shadow improved significantly more than that of the mass shadow. Education using the e-leaning platform is effective for interpretation of chest radiography results. E-learning is particularly effective for the interpretation of chest radiography images containing ground glass shadow.     

Comparison of the quality of temporal subtraction images obtained with manual and automated methods of digital chest radiography

The authors have been developing a fully automated temporal subtraction scheme to assist radiologists in the detection of interval changes in digital chest radiographs. The temporal subtraction image is obtained by subtraction of a previous image from a current image. The authors' automated method includes not only image shift and rotation techniques but also a nonlinear geometric warping technique for reduction of misregistration artifacts in the subtraction image. However, a manual subtraction method that can be carried out only with image shift and rotation has been employed as a common clinical technique in angiography, and it might be clinically acceptable for detection of interval changes on chest radiographs as well. Therefore, the authors applied both the manual and automated temporal subtraction techniques to 181 digital chest radiographs, and compared the quality of the subtraction images obtained with the two methods. The numbers of clinically acceptable subtraction images were 147 (81.2%) and 176 (97.2%) for the manual and automated subtraction methods, respectively. The image quality of 148 (81.8%) subtraction images was improved by use of the automated method in comparison with the subtraction images obtained with the manual method. These results indicate that the automated method with the nonlinear warping technique can significantly reduce misregistration artifacts in comparison with the manual method. Therefore, the authors believe that the automated subtraction method is more useful for the detection of interval changes in digital chest radiographs.     

Automated complete slide digitization: a medium for simultaneous viewing by multiple pathologists.

Developments in telepathology robotic systems have evolved the concept of a 'virtual microscope' handling 'digital slides'. Slide digitization is a method of archiving salient histological features in numerical (digital) form. The value and potential of this have begun to be recognized by several international centres. Automated complete slide digitization has application at all levels of clinical practice and will benefit undergraduate, postgraduate, and continuing education. Unfortunately, as the volume of potential data on a histological slide represents a significant problem in terms of digitization, storage, and subsequent manipulation, the reality of virtual microscopy to date has comprised limited views at inadequate resolution. This paper outlines a system refined in the authors' laboratory, which employs a combination of enhanced hardware, image capture, and processing techniques designed for telepathology. The system is able to scan an entire slide at high magnification and create a library of such slides that may exist on an internet server or be distributed on removable media (such as CD-ROM or DVD). A digital slide allows image data manipulation at a level not possible with conventional light microscopy. Combinations of multiple users, multiple magnifications, annotations, and addition of ancillary textual and visual data are now possible. This demonstrates that with increased sophistication, the applications of telepathology technology need not be confined to second opinion, but can be extended on a wider front.     

Image quality of digital chest X-rays: wet versus dry laser printers

The aim of this study was to compare the image quality of digital chest x-rays (Thoravision) obtained with 2 "wet" laser imagers of different matrix sizes and a "dry" system. Fifty chest x-rays in 2 planes were printed out in normal (100%) and reduced (61%) format using 3 different systems: 2 "wet" laser imagers (Agfa Matrix LR 3300, 4256 x 5174 pixels, 315 dpi; Agfa Scopix LR 5200, 8512 x 10348 pixels, 630 dpi), and one "dry" system (Agfa Drystar 3000,4352 x 5295 pixels, 330 dpi). All tests yielded normal findings. Anonymous images were evaluated by 4 independent reviewers on record forms rating the detectability of predefined anatomic structures. When the image quality of diagnosis-relevant, anatomic structures was evaluated on digital chest x-rays reproduced in normal and reduced format, the wet laser imagers did not show significant advantages over the dry system, Agfa Drystar 3000. The Agfa Drystar 3000 system is a feasible alternative for reproducing digital images, particularly for decentralized archives.     

Phototimer setup for CR imaging

A study was performed to investigate the feasibility of using the standard deviation (sigma) of the pixel values in a computed radiography (CR) image and a measure of the median incident exposure on the imaging plate (IP) as parameters for setting up phototimers in a CR system. Slabs of Lucite 4-, 6-, and 8-in.-thick were imaged with a CR system at 70, 90, and 125 kVp at various mA s values both with grid and without grid. Incident IP exposures were measured with an ionization chamber. Images were analyzed on a workstation. The sigma's in the "flat field" images were found to be approximately related to the mean incident exposure E by the relationship: sigma is proportional to E(-1/2), indicating the quantum-noise-limited operation of the system. Derived relationships between the reading sensitivity of the (IP) reader (S number) and sigma can be used to obtain images with a specific noise level. At our institution, where a 400 speed screen-film system is used for general radiography and 200 speed for chest radiography, radiologists generally find CR image quality acceptable when sigma < or = 11 (S< or =400) for general radiography (50-90 kVp), and sigma < or =8 (S< or =200) for chest radiography (125 kVp). However, factors other than the amount of x-ray quanta that form the useful image, such as the image processing mode and the amount of collimation, may affect both the sensitivity value and the image quality.     

Maximizing film contrast for scanning equalization radiography

The results of a numerical simulation indicate that scanning equalization radiography (SER) provides the opportunity to use film/screen combinations of significantly higher contrast than currently practical in conventional chest radiography. These calculations which attempt to maximize overall image contrast while minimizing areas of over and under exposure demonstrate that optimum film gradient varies inversely with scanning beam area. Furthermore, we show that in an SER system which we have optimized for chest imaging that the peak film gamma gradient can be increased from that typical of conventional films (3.0-3.5) to approximately 7 with advantage.     

Integration of Temporal Subtraction and Nodule Detection System for Digital Chest Radiographs into Picture Archiving and Communication System (PACS): Four-year Experience

Since May 2002, temporal subtraction and nodule detection systems for digital chest radiographs have been integrated into our hospital’s picture archiving and communication systems (PACS). Image data of digital chest radiographs were stored in PACS with the digital image and communication in medicine (DICOM) protocol. Temporal subtraction and nodule detection images were produced automatically in an exclusive server and delivered with current and previous images to the work stations. The problems that we faced and the solutions that we arrived at were analyzed. We encountered four major problems. The first problem, as a result of the storage of the original images’ data with the upside-down, reverse, or lying-down positioning on portable chest radiographs, was solved by postponing the original data storage for 30 min. The second problem, the variable matrix sizes of chest radiographs obtained with flat-panel detectors (FPDs), was solved by improving the computer algorithm to produce consistent temporal subtraction images. The third problem, the production of temporal subtraction images of low quality, could not be solved fundamentally when the original images were obtained with different modalities. The fourth problem, an excessive false-positive rate on the nodule detection system, was solved by adjusting this system to chest radiographs obtained in our hospital. Integration of the temporal subtraction and nodule detection system into our hospital’s PACS was customized successfully; this experience may be helpful to other hospitals.     

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.     

Improved image quality in digital mammography with image processing

PURPOSE: The effect of image processing, specifically Bayesian image estimation (BIE), on digital mammographic images is studied. BIE is an iterative, nonlinear statistical estimation technique that has previously been used in chest radiography to reduce image scatter content and improve the contrast-to-noise ratio (CNR). We adapt this technique to digital mammography and examine its effect. METHODS/MATERIALS: Images of the American College of Radiologists (ACR) breast phantom were acquired on a calibrated digital mammography system at a normal mammographic exposure both with and without a grid. An iterative Bayesian estimation algorithm was formulated and used to process the images acquired without a grid. Quantitative scatter fractions were measured and compared for the image acquired with the grid, the image acquired without the grid, and the image acquired without the grid and processed by the Bayesian algorithm. CNR values were also computed for the four visible masses in the ACR phantom before and after processing and compared to a grid. RESULTS: Initial images acquired without an antiscatter grid had scatter fractions of 0.46. Processing this image with BIE reduced the scatter content to under 0.04. In comparison, the image acquired with a grid had scatter of 0.19. BIE processing accounted for CNR improvements from 29% to 219% for the masses seen in the ACR phantom as compared to the unprocessed image. Visibility of the four masses in the phantom was improved. CONCLUSIONS: Bayesian image estimation can be used with digital mammography to reduce scatter fractions. This technique is very useful as it can reduce scatter content effectively without introducing any adverse effects, such as grid line aliasing. Bayesian processing can also increase image CNR, which may potentially increase the visualization of subtle masses. Preliminary work shows an improvement in CNR to values greater than that provided by a standard grid.     

Scatter rejection and low-contrast performance of a slot-scan digital chest radiography system with electronic aft-collimation: a chest phantom study

Anti-scatter grids have been widely used to reject scatter and increase the perceptibility of low-contrast object in chest radiography; however they also attenuate the primary x-rays, resulting in a substantial degradation of primary information. Compensation for this degradation requires the use of higher exposure technique hence higher dose to the patient. A more efficient approach to reject scatter is the slot-scan imaging technique which employs a narrow scanning x-ray fan beam in conjunction with a slit or slot shaped solid state detector or an area detector used with an aft-collimator. With this approach, scatter can be rejected effectively without the need to attenuate primary x-rays. This paper demonstrates an electronic aft-collimation method, referred to as the alternate line erasure and readout (ALER) technique, for implementing the slot-scan digital radiography with a modern flat-panel detector. With this technique, instead of first exposing the detector and then reading the image line by line, the image line on the leading edge of the scanning fan beam is reset to erase the scatter accumulated prior to the arrival of the fan beam x-rays, while the image line on the trailing edge of the scanning fan beam is read out to acquire the image signals following the fan-beam exposure. These reset and readout processes are alternated and repeated as the x-ray fan beam scans across the detector. An anthropomorphic chest phantom was imaged to evaluate the scatter rejection ability and the low-contrast performance for the ALER technique and compare them with those for the anti-scatter grid method in full-field chest imaging. With a projected beam width of 16 mm, the slot-scan/ALER technique resulted in an average reduction of the scatter-to-primary ratios by 81%, 84%, 82%, and 86% versus 65%, 73%, 74%, and 73% with the anti-scatter grid method in the lungs, mediastinum, retrocardium, and subdiaphragm, respectively. The average CNR for the slot-scan/ALER technique was found to improve by 135%, 133%, 176%, and 87% versus 15%, 15%, 38%, and -11% with the anti-scatter grid method in the mediastinum, retrocardium, subdiaphragm, and lungs, respectively. These results demonstrated that the slot-scan/ALER technique can be used to achieve equally effective scatter rejection but substantially higher low-contrast performance than the anti-scatter grid method.