Image quality assessment and medical physics evaluation of different portable dental X-ray units

Introduction: Recently developed portable dental X-ray units increase the mobility of the forensic odontologists and allow more efficient X-ray work in a disaster field, especially when used in combination with digital sensors. This type of machines might also have potential for application in remote areas, military and humanitarian missions, dental care of patients with mobility limitation, as well as imaging in operating rooms. Objective: To evaluate radiographic image quality acquired by three portable X-ray devices in combination with four image receptors and to evaluate their medical physics parameters. Materials and methods: Images of five samples consisting of four teeth and one formalin-fixed mandible were acquired by one conventional wall-mounted X-ray unit, MinRay (R) 60/70 kVp, used as a clinical standard, and three portable dental X-ray devices: AnyRay (R) 60 kVp, Nomad (R) 60 kVp and Rextar (R) 70 kVp, in combination with a phosphor image plate (PSP), a CCD, or a CMOS sensor. Three observers evaluated images for standard image quality besides forensic diagnostic quality on a 4-point rating scale. Furthermore, all machines underwent tests for occupational as well as patient dosimetry. Results: Statistical analysis showed good quality imaging for all system, with the combination of Nomad (R) and PSP yielding the best score. A significant difference in image quality between the combination of the four X-ray devices and four sensors was established (p < 0.05). For patient safety, the exposure rate was determined and exit dose rates for MinRay (R) at 60 kVp, MinRay (R) at 70 kVp, AnyRay (R), Nomad (R) and Rextar (R) were 3.4 mGy/s, 4.5 mGy/s, 13.5 mGy/s, 3.8 mGy/s and 2.6 mGy/s respectively. The kVp of the AnyRay (R) system was the most stable, with a ripple of 3.7%. Short-term variations in the tube output of all the devices were less than 10%. AnyRay (R) presented higher estimated effective dose than other machines. Occupational dosimetry showed doses at the operator`s hand being lowest with protective shielding (Nomad (R): 0.1 mu Gy). It was also low while using remote control (distance > 1 m: Rextar (R) < 0.2 mu Gy, MinRay (R) < 0.1 mu Gy). Conclusions: The present study demonstrated the feasibility of three portable X-ray systems to be used for specific indications, based on acceptable image quality and sufficient accuracy of the machines and following the standard guidelines for radiation hygiene. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation

INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.

Introducing mapping standards in the quality assessment of buildings extracted from very high resolution satellite imagery

Many municipal activities require updated large-scale maps that include both topographic and thematic information. For this purpose, the efficient use of very high spatial resolution (VHR) satellite imagery suggests the development of approaches that enable a timely discrimination, counting and delineation of urban elements according to legal technical specifications and quality standards. Therefore, the nature of this data source and expanding range of applications calls for objective methods and quantitative metrics to assess the quality of the extracted information which go beyond traditional thematic accuracy alone. The present work concerns the development and testing of a new approach for using technical mapping standards in the quality assessment of buildings automatically extracted from VHR satellite imagery. Feature extraction software was employed to map buildings present in a pansharpened QuickBird image of Lisbon. Quality assessment was exhaustive and involved comparisons of extracted features against a reference data set, introducing cartographic constraints from scales 1:1000, 1:5000, and 1:10,000. The spatial data quality elements subject to evaluation were: thematic (attribute) accuracy, completeness, and geometric quality assessed based on planimetric deviation from the reference map. Tests were developed and metrics analyzed considering thresholds and standards for the large mapping scales most frequently used by municipalities. Results show that values for completeness varied with mapping scales and were only slightly superior for scale 1:10,000. Concerning the geometric quality, a large percentage of extracted features met the strict topographic standards of planimetric deviation for scale 1:10,000, while no buildings were compliant with the specification for scale 1:1000.

Reporting of methodologic information on trial registries for quality assessment: a study of trial records retrieved from the WHO search portal

Background: Although randomized clinical trials (RCTs) are considered the gold standard of evidence, their reporting is often suboptimal. Trial registries have the potential to contribute important methodologic information for critical appraisal of study results. Methods and Findings: The objective of the study was to evaluate the reporting of key methodologic study characteristics in trial registries. We identified a random sample (n = 265) of actively recruiting RCTs using the World Health Organization International Clinical Trials Registry Platform (ICTRP) search portal in 2008. We assessed the reporting of relevant domains from the Cochrane Collaboration’s ‘Risk of bias’ tool and other key methodological aspects. Our primary outcomes were the proportion of registry records with adequate reporting of random sequence generation, allocation concealment, blinding, and trial outcomes. Two reviewers independently assessed each record. Weighted overall proportions in the ICTRP search portal for adequate reporting of sequence generation, allocation concealment, blinding (including and excluding open label RCT) and primary outcomes were 5.7% (95% CI 3.0–8.4%), 1.4% (0–2.8%), 41% (35–47%), 8.4% (4.1–13%), and 66% (60–72%), respectively. The proportion of adequately reported RCTs was higher for registries that used specific methodological fields for describing methods of randomization and allocation concealment compared to registries that did not. Concerning other key methodological aspects, weighted overall proportions of RCTs with adequately reported items were as follows: eligibility criteria (81%), secondary outcomes (46%), harm (5%) follow-up duration (62%), description of the interventions (53%) and sample size calculation (1%). Conclusions: Trial registries currently contain limited methodologic information about registered RCTs. In order to permit adequate critical appraisal of trial results reported in journals and registries, trial registries should consider requesting details on key RCT methods to complement journal publications. Full protocols remain the most comprehensive source of methodologic information and should be made publicly available.

Hydrologic and Water Quality Assessment of Miller Run: A Study of Bucknell University’s Impact

Human development causes degradation of stream ecosystems due to impacts on channel morphology, hydrology, and water quality. Urbanization, the second leading cause of stream impairment, increases the amount of impervious surface cover, thus reducing infiltration and increasing surface runoff of precipitation, which ultimately affects stream hydrologic process and aquatic biodiversity. The main objective of this study was to assess the overall health of Miller Run, a small tributary of the Bull Run and Susquehanna River watersheds, through an integrative hydrologic and water quality approach in order to determine the degree of Bucknell University’s impact on the stream. Hydrologic conditions, including stage and discharge, and water quality conditions, including total suspended solids, ion, nutrient, and dissolved metal concentrations, specific conductivity, pH, and temperature, were measured and evaluated at two sampling sites (upstream and downstream of Bucknell’s main campus) during various rain events from September 2007 to March 2008. The primary focus of the stream analysis was based on one main rain event on 26 February 2008. The results provided evidence that Miller Run is impacted by Bucknell’s campus. From a hydrologic perspective, the stream’s hydrograph showed the exact opposite pattern of what would be expected from a ‘normal’ stream. Miller run had a flashier downstream hydrograph and a broader upstream hydrograph, which was more than likely due to the increased amount of impervious surface cover throughout the downstream half of the watershed. From a water quality perspective, sediment loads increased at a faster rate and were significantly higher downstream compared to upstream. These elevated sediment concentrations were probably the combined result of sediment runoff from upstream and downstream construction sites that were being developed over the course of the study. Sodium, chloride, and potassium concentrations, in addition to specific conductivity, also significantly increased downstream of Bucknell’s campus due to the runoff of road salts. Calcium and magnesium concentrations did not appear to be impacted by urbanization, although they did demonstrate a significant dilution effect downstream. The downstream site was not directly affected by elevated nitrate concentrations; however, soluble reactive phosphorus concentrations tended to increase downstream and ammonium concentrations significantly peaked partway through the rain event downstream. These patterns suggest that Miller Run may be impacted by nutrient runoff from the golf course, athletic fields, and/or fertilizers applications on the main campus. Dissolved manganese and iron concentrations also appeared to slightly increase downstream, demonstrating the affect of urban runoff from roads and parking lots. pH and temperature both decreased farther downstream, but neither showed a significant impact of urbanization. More studies are necessary to determine how Miller Run responds to changes in season, climate, precipitation intensity, and land-use. This study represents the base-line analysis of Miller Run’s current hydrologic and water quality conditions; based on these initial findings, Bucknell should strongly consider modifications to improve storm water management practices and to reduce the campus’s overall impact on the stream in order to enhance and preserve the integrity of its natural water resources.

High definition video quality assessment metric built upon full reference ratios

Métrica de calidad de video de alta definición construida a partir de ratios de referencia completa. La medida de calidad de video, en inglés Visual Quality Assessment (VQA), es uno de los mayores retos por solucionar en el entorno multimedia. La calidad de vídeo tiene un impacto altísimo en la percepción del usuario final (consumidor) de los servicios sustentados en la provisión de contenidos multimedia y, por tanto, factor clave en la valoración del nuevo paradigma denominado Calidad de la Experiencia, en inglés Quality of Experience (QoE). Los modelos de medida de calidad de vídeo se pueden agrupar en varias ramas según la base técnica que sustenta el sistema de medida, destacando en importancia los que emplean modelos psicovisuales orientados a reproducir las características del sistema visual humano, en inglés Human Visual System, del que toman sus siglas HVS, y los que, por el contrario, optan por una aproximación ingenieril en la que el cálculo de calidad está basado en la extracción de parámetros intrínsecos de la imagen y su comparación. A pesar de los avances recogidos en este campo en los últimos años, la investigación en métricas de calidad de vídeo, tanto en presencia de referencia (los modelos denominados de referencia completa), como en presencia de parte de ella (modelos de referencia reducida) e incluso los que trabajan en ausencia de la misma (denominados sin referencia), tiene un amplio camino de mejora y objetivos por alcanzar. Dentro de ellos, la medida de señales de alta definición, especialmente las utilizadas en las primeras etapas de la cadena de valor que son de muy alta calidad, son de especial interés por su influencia en la calidad final del servicio y no existen modelos fiables de medida en la actualidad. Esta tesis doctoral presenta un modelo de medida de calidad de referencia completa que hemos llamado PARMENIA (PArallel Ratios MEtric from iNtrInsic features Analysis), basado en la ponderación de cuatro ratios de calidad calculados a partir de características intrínsecas de la imagen. Son: El Ratio de Fidelidad, calculado mediante el gradiente morfológico o gradiente de Beucher. El Ratio de Similitud Visual, calculado mediante los puntos visualmente significativos de la imagen a través de filtrados locales de contraste. El Ratio de Nitidez, que procede de la extracción del estadístico de textura de Haralick contraste. El Ratio de Complejidad, obtenido de la definición de homogeneidad del conjunto de estadísticos de textura de Haralick PARMENIA presenta como novedad la utilización de la morfología matemática y estadísticos de Haralick como base de una métrica de medida de calidad, pues esas técnicas han estado tradicionalmente más ligadas a la teledetección y la segmentación de objetos. Además, la aproximación de la métrica como un conjunto ponderado de ratios es igualmente novedosa debido a que se alimenta de modelos de similitud estructural y otros más clásicos, basados en la perceptibilidad del error generado por la degradación de la señal asociada a la compresión. PARMENIA presenta resultados con una altísima correlación con las valoraciones MOS procedentes de las pruebas subjetivas a usuarios que se han realizado para la validación de la misma. El corpus de trabajo seleccionado procede de conjuntos de secuencias validados internacionalmente, de modo que los resultados aportados sean de la máxima calidad y el máximo rigor posible. La metodología de trabajo seguida ha consistido en la generación de un conjunto de secuencias de prueba de distintas calidades a través de la codificación con distintos escalones de cuantificación, la obtención de las valoraciones subjetivas de las mismas a través de pruebas subjetivas de calidad (basadas en la recomendación de la Unión Internacional de Telecomunicaciones BT.500), y la validación mediante el cálculo de la correlación de PARMENIA con estos valores subjetivos, cuantificada a través del coeficiente de correlación de Pearson. Una vez realizada la validación de los ratios y optimizada su influencia en la medida final y su alta correlación con la percepción, se ha realizado una segunda revisión sobre secuencias del hdtv test dataset 1 del Grupo de Expertos de Calidad de Vídeo (VQEG, Video Quality Expert Group) mostrando los resultados obtenidos sus claras ventajas. Abstract Visual Quality Assessment has been so far one of the most intriguing challenges on the media environment. Progressive evolution towards higher resolutions while increasing the quality needed (e.g. high definition and better image quality) aims to redefine models for quality measuring. Given the growing interest in multimedia services delivery, perceptual quality measurement has become a very active area of research. First, in this work, a classification of objective video quality metrics based on their underlying methodologies and approaches for measuring video quality has been introduced to sum up the state of the art. Then, this doctoral thesis describes an enhanced solution for full reference objective quality measurement based on mathematical morphology, texture features and visual similarity information that provides a normalized metric that we have called PARMENIA (PArallel Ratios MEtric from iNtrInsic features Analysis), with a high correlated MOS score. The PARMENIA metric is based on the pooling of different quality ratios that are obtained from three different approaches: Beucher’s gradient, local contrast filtering, and contrast and homogeneity Haralick’s texture features. The metric performance is excellent, and improves the current state of the art by providing a wide dynamic range that make easier to discriminate between very close quality coded sequences, especially for very high bit rates whose quality, currently, is transparent for quality metrics. PARMENIA introduces a degree of novelty against other working metrics: on the one hand, exploits the structural information variation to build the metric’s kernel, but complements the measure with texture information and a ratio of visual meaningful points that is closer to typical error sensitivity based approaches. We would like to point out that PARMENIA approach is the only metric built upon full reference ratios, and using mathematical morphology and texture features (typically used in segmentation) for quality assessment. On the other hand, it gets results with a wide dynamic range that allows measuring the quality of high definition sequences from bit rates of hundreds of Megabits (Mbps) down to typical distribution rates (5-6 Mbps), even streaming rates (1- 2 Mbps). Thus, a direct correlation between PARMENIA and MOS scores are easily constructed. PARMENIA may further enhance the number of available choices in objective quality measurement, especially for very high quality HD materials. All this results come from validation that has been achieved through internationally validated datasets on which subjective tests based on ITU-T BT.500 methodology have been carried out. Pearson correlation coefficient has been calculated to verify the accuracy of PARMENIA and its reliability.

Automatic 3DTV Quality Assessment Based On Depth Perception Analysis

Quality assessment is a key factor for stereoscopic 3D video content as some observers are affected by visual discomfort in the eye when viewing 3D video, especially when combining positive and negative parallax with fast motion. In this paper, we propose techniques to assess objective quality related to motion and depth maps, which facilitate depth perception analysis. Subjective tests were carried out in order to understand the source of the problem. Motion is an important feature affecting 3D experience but also often the cause of visual discomfort. The automatic algorithm developed tries to quantify the impact on viewer experience when common cases of discomfort occur, such as high-motion sequences, scene changes with abrupt parallax changes, or complete absence of stereoscopy, with a goal of preventing the viewer from having a bad stereoscopic experience.

A quality assessment system for fresh fruits in hypermarkets and fruit trading centres.

When the fresh fruit reaches the final markets from the suppliers, its quality is not always as good as it should, either because it has been mishandled during transportation or because it lacks an adequate quality control at the producer level, before being shipped. This is why it is necessary for the final markets to establish their own quality assessment system if they want to ensure to their customers the quality they want to sell. In this work, a system to control fruit quality at the last level of the distribution channel has been designed. The system combines rapid control techniques with laboratory equipment and statistical sampling protocols, to obtain a dynamic, objective process, which can substitute advantageously the quality control inspections carried out visually by human experts at the reception platform of most hypermarkets. Portable measuring equipment have been chosen (firmness tester, temperature and humidity sensors...) as well as easy-to-use laboratory equipment (texturometer, colorimeter, refractometer..,) combining them to control the most important fruit quality parameters (firmness, colour, sugars, acids). A complete computer network has been designed to control all the processes and store the collected data in real time, and to perform the computations. The sampling methods have been also defined to guarantee the confidence of the results. Some of the advantages of a quality assessment system as the proposed one are: the minimisation of human subjectivity, the ability to use modern measuring techniques, and the possibility of using it also as a supplier's quality control system. It can be also a way to clarify the quality limits of fruits among members of the commercial channel, as well as the first step in the standardisation of quality control procedures.

NAMA3DS1-COSPAD1: Subjective video quality assessment database on coding conditions introducing freely available high quality 3D stereoscopic sequences

Research in stereoscopic 3D coding, transmission and subjective assessment methodology depends largely on the availability of source content that can be used in cross-lab evaluations. While several studies have already been presented using proprietary content, comparisons between the studies are difficult since discrepant contents are used. Therefore in this paper, a freely available dataset of high quality Full-HD stereoscopic sequences shot with a semiprofessional 3D camera is introduced in detail. The content was designed to be suited for usage in a wide variety of applications, including high quality studies. A set of depth maps was calculated from the stereoscopic pair. As an application example, a subjective assessment has been performed using coding and spatial degradations. The Absolute Category Rating with Hidden Reference method was used. The observers were instructed to vote on video quality only. Results of this experiment are also freely available and will be presented in this paper as a first step towards objective video quality measurement for 3DTV.

Subjective quality assessment of an adaptive video streaming model

With the recent increased popularity and high usage of HTTP Adaptive Streaming (HAS) techniques, various studies have been carried out in this area which generally focused on the technical enhancement of HAS technology and applications. However, a lack of common HAS standard led to multiple proprietary approaches which have been developed by major Internet companies. In the emerging MPEG-DASH standard the packagings of the video content and HTTP syntax have been standardized; but all the details of the adaptation behavior are left to the client implementation. Nevertheless, to design an adaptation algorithm which optimizes the viewing experience of the enduser, the multimedia service providers need to know about the Quality of Experience (QoE) of different adaptation schemes. Taking this into account, the objective of this experiment was to study the QoE of a HAS-based video broadcast model. The experiment has been carried out through a subjective study of the end user response to various possible clients’ behavior for changing the video quality taking different QoE-influence factors into account. The experimental conclusions have made a good insight into the QoE of different adaptation schemes which can be exploited by HAS clients for designing the adaptation algorithms.

Insertion of impairments in test video sequences for quality assessment based on psychovisual characteristics

Assessing video quality is a complex task. While most pixel-based metrics do not present enough correlation between objective and subjective results, algorithms need to correspond to human perception when analyzing quality in a video sequence. For analyzing the perceived quality derived from concrete video artifacts in determined region of interest we present a novel methodology for generating test sequences which allow the analysis of impact of each individual distortion. Through results obtained after subjective assessment it is possible to create psychovisual models based on weighting pixels belonging to different regions of interest distributed by color, position, motion or content. Interesting results are obtained in subjective assessment which demonstrates the necessity of new metrics adapted to human visual system.

Retinal image quality assessment through a visual similarity index

Retinal image quality is commonly analyzed through parameters inherited from instrumental optics. These parameters are defined for ‘good optics’ so they are hard to translate into visual quality metrics. Instead of using point or artificial functions, we propose a quality index that takes into account properties of natural images. These images usually show strong local correlations that help to interpret the image. Our aim is to derive an objective index that quantifies the quality of vision by taking into account the local structure of the scene, instead of focusing on a particular aberration. As we show, this index highly correlates with visual acuity and allows inter-comparison of natural images around the retina. The usefulness of the index is proven through the analysis of real eyes before and after undergoing corneal surgery, which usually are hard to analyze with standard metrics.

Model and performance of a no-reference quality assessment metric for video streaming

Video streaming via Transmission Control Protocol (TCP) networks has become a popular and highly demanded service, but its quality assessment in both objective and subjective terms has not been properly addressed. In this paper, based on statistical analysis a full analytic model of a no-reference objective metric, namely pause intensity (PI), for video quality assessment is presented. The model characterizes the video playout buffer behavior in connection with the network performance (throughput) and the video playout rate. This allows for instant quality measurement and control without requiring a reference video. PI specifically addresses the need for assessing the quality issue in terms of the continuity in the playout of TCP streaming videos, which cannot be properly measured by other objective metrics such as peak signal-to-noise-ratio, structural similarity, and buffer underrun or pause frequency. The performance of the analytical model is rigidly verified by simulation results and subjective tests using a range of video clips. It is demonstrated that PI is closely correlated with viewers' opinion scores regardless of the vastly different composition of individual elements, such as pause duration and pause frequency which jointly constitute this new quality metric. It is also shown that the correlation performance of PI is consistent and content independent. © 2013 IEEE.

Pause intensity:a no-reference quality assessment metric for video streaming in TCP networks

In this paper a full analytic model for pause intensity (PI), a no-reference metric for video quality assessment, is presented. The model is built upon the video play out buffer behavior at the client side and also encompasses the characteristics of a TCP network. Video streaming via TCP produces impairments in play continuity, which are not typically reflected in current objective metrics such as PSNR and SSIM. Recently the buffer under run frequency/probability has been used to characterize the buffer behavior and as a measurement for performance optimization. But we show, using subjective testing, that under run frequency cannot reflect the viewers' quality of experience for TCP based streaming. We also demonstrate that PI is a comprehensive metric made up of a combination of phenomena observed in the play out buffer. The analytical model in this work is verified with simulations carried out on ns-2, showing that the two results are closely matched. The effectiveness of the PI metric has also been proved by subjective testing on a range of video clips, where PI values exhibit a good correlation with the viewers' opinion scores. © 2012 IEEE.

Advanced Techniques for Image Quality Assessment of Modern X-ray Computed Tomography Systems

X-ray computed tomography (CT) imaging constitutes one of the most widely used diagnostic tools in radiology today with nearly 85 million CT examinations performed in the U.S in 2011. CT imparts a relatively high amount of radiation dose to the patient compared to other x-ray imaging modalities and as a result of this fact, coupled with its popularity, CT is currently the single largest source of medical radiation exposure to the U.S. population. For this reason, there is a critical need to optimize CT examinations such that the dose is minimized while the quality of the CT images is not degraded. This optimization can be difficult to achieve due to the relationship between dose and image quality. All things being held equal, reducing the dose degrades image quality and can impact the diagnostic value of the CT examination.

A recent push from the medical and scientific community towards using lower doses has spawned new dose reduction technologies such as automatic exposure control (i.e., tube current modulation) and iterative reconstruction algorithms. In theory, these technologies could allow for scanning at reduced doses while maintaining the image quality of the exam at an acceptable level. Therefore, there is a scientific need to establish the dose reduction potential of these new technologies in an objective and rigorous manner. Establishing these dose reduction potentials requires precise and clinically relevant metrics of CT image quality, as well as practical and efficient methodologies to measure such metrics on real CT systems. The currently established methodologies for assessing CT image quality are not appropriate to assess modern CT scanners that have implemented those aforementioned dose reduction technologies.

Thus the purpose of this doctoral project was to develop, assess, and implement new phantoms, image quality metrics, analysis techniques, and modeling tools that are appropriate for image quality assessment of modern clinical CT systems. The project developed image quality assessment methods in the context of three distinct paradigms, (a) uniform phantoms, (b) textured phantoms, and (c) clinical images.

The work in this dissertation used the “task-based” definition of image quality. That is, image quality was broadly defined as the effectiveness by which an image can be used for its intended task. Under this definition, any assessment of image quality requires three components: (1) A well defined imaging task (e.g., detection of subtle lesions), (2) an “observer” to perform the task (e.g., a radiologists or a detection algorithm), and (3) a way to measure the observer’s performance in completing the task at hand (e.g., detection sensitivity/specificity).

First, this task-based image quality paradigm was implemented using a novel multi-sized phantom platform (with uniform background) developed specifically to assess modern CT systems (Mercury Phantom, v3.0, Duke University). A comprehensive evaluation was performed on a state-of-the-art CT system (SOMATOM Definition Force, Siemens Healthcare) in terms of noise, resolution, and detectability as a function of patient size, dose, tube energy (i.e., kVp), automatic exposure control, and reconstruction algorithm (i.e., Filtered Back-Projection– FPB vs Advanced Modeled Iterative Reconstruction– ADMIRE). A mathematical observer model (i.e., computer detection algorithm) was implemented and used as the basis of image quality comparisons. It was found that image quality increased with increasing dose and decreasing phantom size. The CT system exhibited nonlinear noise and resolution properties, especially at very low-doses, large phantom sizes, and for low-contrast objects. Objective image quality metrics generally increased with increasing dose and ADMIRE strength, and with decreasing phantom size. The ADMIRE algorithm could offer comparable image quality at reduced doses or improved image quality at the same dose (increase in detectability index by up to 163% depending on iterative strength). The use of automatic exposure control resulted in more consistent image quality with changing phantom size.

Based on those results, the dose reduction potential of ADMIRE was further assessed specifically for the task of detecting small (<=6 mm) low-contrast (<=20 HU) lesions. A new low-contrast detectability phantom (with uniform background) was designed and fabricated using a multi-material 3D printer. The phantom was imaged at multiple dose levels and images were reconstructed with FBP and ADMIRE. Human perception experiments were performed to measure the detection accuracy from FBP and ADMIRE images. It was found that ADMIRE had equivalent performance to FBP at 56% less dose.

Using the same image data as the previous study, a number of different mathematical observer models were implemented to assess which models would result in image quality metrics that best correlated with human detection performance. The models included naïve simple metrics of image quality such as contrast-to-noise ratio (CNR) and more sophisticated observer models such as the non-prewhitening matched filter observer model family and the channelized Hotelling observer model family. It was found that non-prewhitening matched filter observers and the channelized Hotelling observers both correlated strongly with human performance. Conversely, CNR was found to not correlate strongly with human performance, especially when comparing different reconstruction algorithms.

The uniform background phantoms used in the previous studies provided a good first-order approximation of image quality. However, due to their simplicity and due to the complexity of iterative reconstruction algorithms, it is possible that such phantoms are not fully adequate to assess the clinical impact of iterative algorithms because patient images obviously do not have smooth uniform backgrounds. To test this hypothesis, two textured phantoms (classified as gross texture and fine texture) and a uniform phantom of similar size were built and imaged on a SOMATOM Flash scanner (Siemens Healthcare). Images were reconstructed using FBP and a Sinogram Affirmed Iterative Reconstruction (SAFIRE). Using an image subtraction technique, quantum noise was measured in all images of each phantom. It was found that in FBP, the noise was independent of the background (textured vs uniform). However, for SAFIRE, noise increased by up to 44% in the textured phantoms compared to the uniform phantom. As a result, the noise reduction from SAFIRE was found to be up to 66% in the uniform phantom but as low as 29% in the textured phantoms. Based on this result, it clear that further investigation was needed into to understand the impact that background texture has on image quality when iterative reconstruction algorithms are used.

To further investigate this phenomenon with more realistic textures, two anthropomorphic textured phantoms were designed to mimic lung vasculature and fatty soft tissue texture. The phantoms (along with a corresponding uniform phantom) were fabricated with a multi-material 3D printer and imaged on the SOMATOM Flash scanner. Scans were repeated a total of 50 times in order to get ensemble statistics of the noise. A novel method of estimating the noise power spectrum (NPS) from irregularly shaped ROIs was developed. It was found that SAFIRE images had highly locally non-stationary noise patterns with pixels near edges having higher noise than pixels in more uniform regions. Compared to FBP, SAFIRE images had 60% less noise on average in uniform regions for edge pixels, noise was between 20% higher and 40% lower. The noise texture (i.e., NPS) was also highly dependent on the background texture for SAFIRE. Therefore, it was concluded that quantum noise properties in the uniform phantoms are not representative of those in patients for iterative reconstruction algorithms and texture should be considered when assessing image quality of iterative algorithms.

The move beyond just assessing noise properties in textured phantoms towards assessing detectability, a series of new phantoms were designed specifically to measure low-contrast detectability in the presence of background texture. The textures used were optimized to match the texture in the liver regions actual patient CT images using a genetic algorithm. The so called “Clustured Lumpy Background” texture synthesis framework was used to generate the modeled texture. Three textured phantoms and a corresponding uniform phantom were fabricated with a multi-material 3D printer and imaged on the SOMATOM Flash scanner. Images were reconstructed with FBP and SAFIRE and analyzed using a multi-slice channelized Hotelling observer to measure detectability and the dose reduction potential of SAFIRE based on the uniform and textured phantoms. It was found that at the same dose, the improvement in detectability from SAFIRE (compared to FBP) was higher when measured in a uniform phantom compared to textured phantoms.

The final trajectory of this project aimed at developing methods to mathematically model lesions, as a means to help assess image quality directly from patient images. The mathematical modeling framework is first presented. The models describe a lesion’s morphology in terms of size, shape, contrast, and edge profile as an analytical equation. The models can be voxelized and inserted into patient images to create so-called “hybrid” images. These hybrid images can then be used to assess detectability or estimability with the advantage that the ground truth of the lesion morphology and location is known exactly. Based on this framework, a series of liver lesions, lung nodules, and kidney stones were modeled based on images of real lesions. The lesion models were virtually inserted into patient images to create a database of hybrid images to go along with the original database of real lesion images. ROI images from each database were assessed by radiologists in a blinded fashion to determine the realism of the hybrid images. It was found that the radiologists could not readily distinguish between real and virtual lesion images (area under the ROC curve was 0.55). This study provided evidence that the proposed mathematical lesion modeling framework could produce reasonably realistic lesion images.

Based on that result, two studies were conducted which demonstrated the utility of the lesion models. The first study used the modeling framework as a measurement tool to determine how dose and reconstruction algorithm affected the quantitative analysis of liver lesions, lung nodules, and renal stones in terms of their size, shape, attenuation, edge profile, and texture features. The same database of real lesion images used in the previous study was used for this study. That database contained images of the same patient at 2 dose levels (50% and 100%) along with 3 reconstruction algorithms from a GE 750HD CT system (GE Healthcare). The algorithms in question were FBP, Adaptive Statistical Iterative Reconstruction (ASiR), and Model-Based Iterative Reconstruction (MBIR). A total of 23 quantitative features were extracted from the lesions under each condition. It was found that both dose and reconstruction algorithm had a statistically significant effect on the feature measurements. In particular, radiation dose affected five, three, and four of the 23 features (related to lesion size, conspicuity, and pixel-value distribution) for liver lesions, lung nodules, and renal stones, respectively. MBIR significantly affected 9, 11, and 15 of the 23 features (including size, attenuation, and texture features) for liver lesions, lung nodules, and renal stones, respectively. Lesion texture was not significantly affected by radiation dose.

The second study demonstrating the utility of the lesion modeling framework focused on assessing detectability of very low-contrast liver lesions in abdominal imaging. Specifically, detectability was assessed as a function of dose and reconstruction algorithm. As part of a parallel clinical trial, images from 21 patients were collected at 6 dose levels per patient on a SOMATOM Flash scanner. Subtle liver lesion models (contrast = -15 HU) were inserted into the raw projection data from the patient scans. The projections were then reconstructed with FBP and SAFIRE (strength 5). Also, lesion-less images were reconstructed. Noise, contrast, CNR, and detectability index of an observer model (non-prewhitening matched filter) were assessed. It was found that SAFIRE reduced noise by 52%, reduced contrast by 12%, increased CNR by 87%. and increased detectability index by 65% compared to FBP. Further, a 2AFC human perception experiment was performed to assess the dose reduction potential of SAFIRE, which was found to be 22% compared to the standard of care dose.

In conclusion, this dissertation provides to the scientific community a series of new methodologies, phantoms, analysis techniques, and modeling tools that can be used to rigorously assess image quality from modern CT systems. Specifically, methods to properly evaluate iterative reconstruction have been developed and are expected to aid in the safe clinical implementation of dose reduction technologies.