Image quality in diagnostic radiology

This chapter provides a theoretical background about image quality in diagnostic radiology. Digital image representation and also image quality evaluation methods are here discussed. An overview of methods for quality evaluation of diagnostic imaging procedures is provided. Digital image representation and primary physical image quality parameters are also discussed, including objective image quality measurements and observer performance methods.

Are physical measures good indicators of image quality at low dose levels? A pilot study

Purpose: To evaluate if physical measures of noise predict image quality at high and low noise levels. Method: Twenty-four images were acquired on a DR system using a Pehamed DIGRAD phantom at three kVp settings (60, 70 and 81) across a range of mAs values. The image acquisition setup consisted of 14 cm of PMMA slabs with the phantom placed in the middle at 120 cm SID. Signal-to-noise ratio (SNR) and Contrast-tonoise ratio (CNR) were calculated for each of the images using ImageJ software and 14 observers performed image scoring. Images were scored according to the observer`s evaluation of objects visualized within the phantom. Results: The R2 values of the non-linear relationship between objective visibility score and CNR (60kVp R2 = 0.902; 70Kvp R2 = 0.913; 80kVp R2 = 0.757) demonstrate a better fit for all 3 kVp settings than the linear R2 values. As CNR increases for all kVp settings the Object Visibility also increases. The largest increase for SNR at low exposure values (up to 2 mGy) is observed at 60kVp, when compared with 70 or 81kVp.CNR response to exposure is similar. Pearson r was calculated to assess the correlation between Score, OV, SNR and CNR. None of the correlations reached a level of statistical significance (p>0.01). Conclusion: For object visibility and SNR, tube potential variations may play a role in object visibility. Higher energy X-ray beam settings give lower SNR but higher object visibility. Object visibility and CNR at all three tube potentials are similar, resulting in a strong positive relationship between CNR and object visibility score. At low doses the impact of radiographic noise does not have a strong influence on object visibility scores because in noisy images objects could still be identified.

Are physical measures good indicators of clinical image quality at low dose levels? A pilot study

Background - For dose reduction actions, the principle of “image quality as good as possible” to “image quality as good as needed” requires to know whether the physical measures and visual image quality relate. Visual evaluation and objective physical measures of image quality can appear to be different. If there is no noticeable effect on the visual image quality with a low dose but there is a objective physical measure impact, then the overall dose may be reduced without compromising the diagnostic image quality. Low dose imaging can be used for certain types of observations, e.g. thoracic scoliosis, control after metal implantation for osteosynthesis, reviewing pneumonia and tuberculosis. Aim of the study - To determine whether physical measures of noise predict visual (clinical) image quality at low dose levels.

A non-pixel image reader for continuous image detection based on tandem heterostructures

An optically addressed read-write sensor based on two stacked p-i-n heterojunctions is analyzed. The device is a two terminal image sensing structure. The charge packets are injected optically into the p-i-n writer and confined at the illuminated regions changing locally the electrical field profile across the p-i-n reader. An optical scanner is used for charge readout. The design allows a continuous readout without the need for pixel-level patterning. The role of light pattern and scanner wavelengths on the readout parameters is analyzed. The optical-to-electrical transfer characteristics show high quantum efficiency, broad spectral response, and reciprocity between light and image signal. A numerical simulation supports the imaging process. A black and white image is acquired with a resolution around 20 mum showing the potentiality of these devices for imaging applications.

A two terminal optical signal and image processing p-i-n/p-i-n image and colour sensor

A two terminal optically addressed image processing device based on two stacked sensing/switching p-i-n a-SiC:H diodes is presented. The charge packets are injected optically into the p-i-n sensing photodiode and confined at the illuminated regions changing locally the electrical field profile across the p-i-n switching diode. A red scanner is used for charge readout. The various design parameters and addressing architecture trade-offs are discussed. The influence on the transfer functions of an a-SiC:H sensing absorber optimized for red transmittance and blue collection or of a floating anode in between is analysed. Results show that the thin a-SiC:H sensing absorber confines the readout to the switching diode and filters the light allowing full colour detection at two appropriated voltages. When the floating anode is used the spectral response broadens, allowing B&W image recognition with improved light-to-dark sensitivity. A physical model supports the image and colour recognition process.

Enhanced short wavelength response in laser-scanned-photodiode image sensor using an a-SiC : H/a-Si : H tandem structure

We report in this paper the recent advances we obtained in optimizing a color image sensor based on the laser-scanned-photodiode (LSP) technique. A novel device structure based on a a-SiC:H/a-Si:H pin/pin tandem structure has been tested for a proper color separation process that takes advantage on the different filtering properties due to the different light penetration depth at different wavelengths a-SM and a-SiC:H. While the green and the red images give, in comparison with previous tested structures, a weak response, this structure shows a very good recognition of blue color under reverse bias, leaving a good margin for future device optimization in order to achieve a complete and satisfactory RGB image mapping. Experimental results about the spectral collection efficiency are presented and discussed from the point of view of the color sensor applications. The physics behind the device functioning is explained by recurring to a numerical simulation of the internal electrical configuration of the device.

Image and color recognition using amorphous silicon p-i-n photodiodes

Large area hydrogenated amorphous silicon single and stacked p-i-n structures with low conductivity doped layers are proposed as monochrome and color image sensors. The layers of the structures are based on amorphous silicon alloys (a-Si(x)C(1-x):H). The current-voltage characteristics and the spectral sensitivity under different bias conditions are analyzed. The output characteristics are evaluated under different read-out voltages and scanner wavelengths. To extract information on image shape, intensity and color, a modulated light beam scans the sensor active area at three appropriate bias voltages and the photoresponse in each scanning position ("sub-pixel") is recorded. The investigation of the sensor output under different scanner wavelengths and varying electrical bias reveals that the response can be tuned, thus enabling color separation. The operation of the sensor is exemplified and supported by a numerical simulation.

Large area image sensing structures based on a-SiC : H: a dynamic characterization

In recent works large area hydrogenated amorphous silicon p-i-n structures with low conductivity doped layers were proposed as single element image sensors. The working principle of this type of sensor is based on the modulation, by the local illumination conditions, of the photocurrent generated by a light beam scanning the active area of the device. In order to evaluate the sensor capabilities is necessary to perform a response time characterization. This work focuses on the transient response of such sensor and on the influence of the carbon contents of the doped layers. In order to evaluate the response time a set of devices with different percentage of carbon incorporation in the doped layers is analyzed by measuring the scanner-induced photocurrent under different bias conditions.

Laser scanned photodiodes (LSP) for Image sensing

An optimized ZnO:Al/a-pin SixCl1-x:H/Al configuration for the laser scanned photodiode (LSP) imaging detector is proposed. The LSP utilizes light induced depletion layers as detector and a laser beam for readout. The effect of the sensing element structure, cell configuration and light source flux are investigated and correlated with the sensor output characteristics. Experimental data reveal that the large optical gap and the low conductivity of the doped a-SixC1-x:H layers are responsible by an induced inversion layer at the illuminated interfaces which blocks the carrier collection. These insulator-like layers act as MIS gates preventing image smearing. The physical background of the LSP is discussed.

Laser scanned photodiodes (LSPs) for image sensing

An optimized ZnO:Al/a-pin SixC1-x:H/Al configuration for the laser scanned photodiode (LSP) imaging detector is proposed and the read-out parameters improved. The effect of the sensing element structure, cell configuration and light source flux are investigated and correlated with the sensor output characteristics. Data reveals that for sensors with wide band gap doped layers an increase on the image signal optimized to the blue is achieved with a dynamic range of two orders of magnitude, a responsivity of 6 mA W-1 and a sensitivity of 17 muW cm(-2) at 530 nm. The main output characteristics such as image responsivity, resolution, linearity and dynamic range were analyzed under reverse, forward and short circuit modes. The results show that the sensor performance can be optimized in short circuit mode. A trade-off between the scan time and the required resolution is needed since the spot size limits the resolution due to the cross-talk between dark and illuminated regions leading to blurring effects.

Novel structure for large area image sensing

This work presents preliminary results in the study of a novel structure for a laser scanned photodiode (LSP) type of image sensor. In order to increase the signal output, a stacked p-i-n-p-i-n structure with an intermediate light-blocking layer is used. The image and the scanning beam are incident through opposite sides of the sensor and their absorption is kept in separate junctions by an intermediate light-blocking layer. As in the usual LSP structure the scanning beam-induced photocurrent is dependent on the local illumination conditions of the image. The main difference between the two structures arises from the fact that in this new structure the image and the scanner have different optical paths leading to an increase in the photocurrent when the scanning beam is incident on a region illuminated on the image side of the sensor, while a decreasing in the photocurrent was observed in the single junction LSP. The results show that the structure can be successfully used as an image sensor even though some optimization is needed to enhance the performance of the device.

Image quality of myocardial perfusion-gated studies: effect of ingestion of different fat content in the reduction of extra-myocardial abdominal signal

Myocardial perfusion-gated-SPECT (MP-gated-SPECT) imaging often shows radiotracer uptake in abdominal organs. This accumulation interferes frequently with qualitative and quantitative assessment of the infero-septal region of myocardium. The objective of this study is to evaluate the effect of ingestion of different fat content on the reduction of extra-myocardial uptake and to improve MP-gated-SPECT image quality. In this study, 150 patients (65 ^ 18 years) who were referred for MP-gated-SPECT underwent a 1-day-protocol including imaging after stress (physical or pharmacological) and resting conditions. All patients gave written informed consent. Patients were subdivided into five groups: GI, GII, GIII, GIV and GV. In the first four groups, patients ate two chocolate bars with different fat content. Patients in GV – control group (CG) – had just water. Uptake indices (UI) of myocardium (M)/liver(L) and M/stomach–proximal bowel(S) revealed lower UI of M/S at rest in all groups. Both stress and rest studies using different food intake indicate that patients who ate chocolate with different fat content showed better UI of M/L than the CG. The UI of M/L and M/S of groups obtained under physical stress are clearly superior to that of groups obtained under pharmacological stress. These differences are only significant in patients who ate high-fat chocolate or drank water. The analysis of all stress studies together (GI, GII, GIII and GIV) in comparison with CG shows higher mean ranks of UI of M/L for those who ate high-fat chocolate. After pharmacological stress, the mean ranks of UI of M/L were higher for patients who ate high- and low-fat chocolate. In conclusion, eating food with fat content after radiotracer injection increases, respectively, the UI of M/L after stress and rest in MP-gated-SPECT studies. It is, therefore, recommended that patients eat a chocolate bar after radiotracer injection and before image acquisition.

Increasing source to image distance for AP pelvis imaging: impact on radiation dose and image quality

Aim - A quantative primary study to determine whether increasing source to image distance (SID), with and without the use of automatic exposure control (AEC) for antero-posterior (AP) pelvis imaging, reduces dose whilst still producing an image of diagnostic quality. Methods - Using a computed radiography (CR) system, an anthropomorphic pelvic phantom was positioned for an AP examination using the table bucky. SID was initially set at 110 cm, with tube potential set at a constant 75 kVp, with two outer chambers selected and a fine focal spot of 0.6 mm. SID was then varied from 90 cm to 140 cm with two exposures made at each 5 cm interval, one using the AEC and another with a constant 16 mAs derived from the initial exposure. Effective dose (E) and entrance surface dose (ESD) were calculated for each acquisition. Seven experienced observers blindly graded image quality using a 5-point Likert scale and 2 Alternative Forced Choice software. Signal-to-Noise Ratio (SNR) was calculated for comparison. For each acquisition, femoral head diameter was also measured for magnification indication. Results - Results demonstrated that when increasing SID from 110 cm to 140 cm, both E and ESD reduced by 3.7% and 17.3% respectively when using AEC and 50.13% and 41.79% respectively, when the constant mAs was used. No significant statistical (T-test) difference (p = 0.967) between image quality was detected when increasing SID, with an intra-observer correlation of 0.77 (95% confidence level). SNR reduced slightly for both AEC (38%) and no AEC (36%) with increasing SID. Conclusion - For CR, increasing SID significantly reduces both E and ESD for AP pelvis imaging without adversely affecting image quality.

Comparison of inverse planning systems based on biological or physical factors: Pinnacle®, Corvus® and Monaco®

Radiotherapy (RT) is one of the most important approaches in the treatment of cancer and its performance can be improved in three different ways: through the optimization of the dose distribution, by the use of different irradiation techniques or through the study of radiobiological initiatives. The first is purely physical because is related to the physical dose distributiuon. The others are purely radiobiological because they increase the differential effect between the tumour and the health tissues. The Treatment Planning Systems (TPS) are used in RT to create dose distributions with the purpose to maximize the tumoral control and minimize the complications in the healthy tissues. The inverse planning uses dose optimization techniques that satisfy the criteria specified by the user, regarding the target and the organs at risk (OAR’s). The dose optimization is possible through the analysis of dose-volume histograms (DVH) and with the use of computed tomography, magnetic resonance and other digital image techniques.

OPTIMAX 2014 - Radiation dose and image quality optimisation in medical imaging

Medical imaging is a powerful diagnostic tool. Consequently, the number of medical images taken has increased vastly over the past few decades. The most common medical imaging techniques use X-radiation as the primary investigative tool. The main limitation of using X-radiation is associated with the risk of developing cancers. Alongside this, technology has advanced and more centres now use CT scanners; these can incur significant radiation burdens compared with traditional X-ray imaging systems. The net effect is that the population radiation burden is rising steadily. Risk arising from X-radiation for diagnostic medical purposes needs minimising and one way to achieve this is through reducing radiation dose whilst optimising image quality. All ages are affected by risk from X-radiation however the increasing population age highlights the elderly as a new group that may require consideration. Of greatest concern are paediatric patients: firstly they are more sensitive to radiation; secondly their younger age means that the potential detriment to this group is greater. Containment of radiation exposure falls to a number of professionals within medical fields, from those who request imaging to those who produce the image. These staff are supported in their radiation protection role by engineers, physicists and technicians. It is important to realise that radiation protection is currently a major European focus of interest and minimum competence levels in radiation protection for radiographers have been defined through the integrated activities of the EU consortium called MEDRAPET. The outcomes of this project have been used by the European Federation of Radiographer Societies to describe the European Qualifications Framework levels for radiographers in radiation protection. Though variations exist between European countries radiographers and nuclear medicine technologists are normally the professional groups who are responsible for exposing screening populations and patients to X-radiation. As part of their training they learn fundamental principles of radiation protection and theoretical and practical approaches to dose minimisation. However dose minimisation is complex – it is not simply about reducing X-radiation without taking into account major contextual factors. These factors relate to the real world of clinical imaging and include the need to measure clinical image quality and lesion visibility when applying X-radiation dose reduction strategies. This requires the use of validated psychological and physics techniques to measure clinical image quality and lesion perceptibility.