Structural heart disease (SHD) is a recently recognized subset of heart disease, and minimally invasive, transcatheter treatments for SHD rely heavily on guidance from multiple imaging modalities. Mentally integrating the information from these images can be challenging during procedures and can take up time and increase radiation exposure. This study used the free Unity graphics engine and tailored LabVIEW and Python algorithms, along with deep learning, to merge echocardiography, CT-derived 3D heart models, and fiber optic shape sensing data with fluoroscopic imaging. Tests were performed on a patient specific ballistic gel heart model. This is the first attempt at fusing the above four imaging modalities together and can pave the way for more advanced guidance techniques in the future.
A new Graphical User Interface (GUI) was developed using Laboratory Virtual Instrumentation Engineering Workbench
(LabVIEW) for a high-resolution, high-sensitivity Solid State X-ray Image Intensifier (SSXII), which is a new x-ray
detector for radiographic and fluoroscopic imaging, consisting of an array of Electron-Multiplying CCDs (EMCCDs)
each having a variable on-chip electron-multiplication gain of up to 2000x to reduce the effect of readout noise. To
enlarge the field-of-view (FOV), each EMCCD sensor is coupled to an x-ray phosphor through a fiberoptic taper. Two
EMCCD camera modules are used in our prototype to form a computer-controlled array; however, larger arrays are
under development. The new GUI provides patient registration, EMCCD module control, image acquisition, and patient
image review. Images from the array are stitched into a 2kx1k pixel image that can be acquired and saved at a rate of 17
Hz (faster with pixel binning). When reviewing the patient's data, the operator can select images from the patient's
directory tree listed by the GUI and cycle through the images using a slider bar. Commonly used camera parameters
including exposure time, trigger mode, and individual EMCCD gain can be easily adjusted using the GUI. The GUI is
designed to accommodate expansion of the EMCCD array to even larger FOVs with more modules. The high-resolution,
high-sensitivity EMCCD modular-array SSXII imager with the new user-friendly GUI should enable angiographers and
interventionalists to visualize smaller vessels and endovascular devices, helping them to make more accurate diagnoses
and to perform more precise image-guided interventions.
We evaluate a new method for measuring the presampled modulation transfer function (MTF) using the noise power
spectrum (NPS) obtained from a few flat-field images acquired at one exposure level. The NPS is the sum of structure,
quantum, and additive instrumentation noise, which are proportional to exposure squared, exposure, and a constant,
respectively, with the spatial-frequency dependence of the quantum noise depending partly on the detector MTF.
Cascaded linear-systems theory was used to derive an exact and generic relationship that was used to isolate noise terms
and enable determination of the MTF directly from the noise response, thereby circumventing the need for precision test
objects (slit, edge, etc.) as required by standard techniques. Isolation of the quantum NPS by fitting the total NPS versus
exposure obtained using 30 flat-field images each at six or more different exposure levels with a linear regression
provides highly accurate MTFs. A subset of these images from indirect digital detectors was used to investigate the
accuracy of measuring the MTF from 30 or fewer flat-field images obtained at a single exposure level. Analyzing as few
as two images acquired at a single exposure resulted in no observable systematic error. Increasing the number of images
analyzed resulted in an increase in accuracy. Fifteen images provided comparable accuracy with the most rigorous slope
approach, with less than 5% variability, suggesting additional image acquisitions may be unnecessary. Reducing the
number of images acquired for the noise response method further simplifies and facilitates routine MTF measurements.
We present a new method that enables the determination of the
two-dimensional MTF of digital radiography systems
using the noise response measured from flat-field images. Unlike commonly-used methods that measure the onedimensional
MTF, this new method does not require precision-made test-objects (slits/edges) or precise tool alignment.
Although standard methods are dependent upon data processing that can result in inaccuracies and inconsistencies, this
method based on the intrinsic noise response of the imager is highly accurate and less susceptible to such problems. A
cascaded-linear-systems analysis was used to derive an exact relationship between the noise power spectrum (NPS) and
the presampled MTF of a generalized detector system. The NPS was then used to determine the two-dimensional MTF
for three systems: a simulated detector in which the "true" MTF was known exactly, a commercial indirect flat-panel
detector (FPD), and a new solid-state x-ray image intensifier (SSXII). For the simulated detector, excellent agreement
was observed between the "true" MTF and that determined using the noise response method, with an averaged deviation
of 0.3%. The FPD MTF was shown to increase on the diagonals and was measured at 2.5 cycles/mm to be 0.086±0.007,
0.12±0.01, and 0.087±0.007 at 0, 45, and 90°, respectively. No statistically significant variation was observed for the
SSXII as a function of angle. Measuring the two-dimensional MTF should lead to more accurate characterization of the
detector resolution response, incorporating any potential non-isotropy which may result from the physical characteristics
of the sensor, including the active-area shape of the pixel array.
Due to the high-resolution needs of angiographic and interventional vascular imaging, a Micro-Angiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer which was attached to the C-arm of a clinical angiographic unit. The MAF detector
provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 μm-thick CsI phosphor, a dual stage micro-channel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a
scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 μm square pixels with 12 bit
depth. The Solid-State X-Ray Image Intensifier (SSXII) is an EMCCD (Electron Multiplying charge-coupled device)
based detector which provides an image matrix of 1k×1k 32 μm square pixels with 12 bit depth. The changer allows the
MAF or a SSXII region-of-interest (ROI) detector to be inserted in front of the standard flat-panel detector (FPD) when higher resolution is needed during angiographic or interventional vascular imaging procedures. The CAPIDS was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF or SSXII including: fluoroscopy, roadmapping, radiography,
and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular
image-guided interventions (EIGI) using prototype self-expanding asymmetric vascular stents (SAVS) in over 10 rabbit aneurysm creation and treatment experiments which have demonstrated the system's potential benefits for future clinical use.
KEYWORDS: Image filtering, Angiography, X-rays, Image quality, Signal to noise ratio, Signal attenuation, X-ray imaging, Data centers, Data acquisition, Physics
Rotational angiography (RA) is widely used clinically to obtain 3D data. In many procedures, e.g.,
neurovascular interventions, the imaged field of view (FOV) is much larger than the region of interest (ROI),
thereby subjecting the patient to unnecessary x-ray dose. To reduce the dose in these procedures, we have proposed
placing an x-ray attenuating filter with an open aperture (ROI) in the x-ray beam (called filtered region of interest
(FROI) RA. We have shown that this approach yields high quality data for centered objects of interest (OoIs). In
this study, we investigate the noise behavior of the FROI approach for off-center OoIs.
Using filter-specific attenuation and noise characteristics, simulated FROI projection images were generated.
The intensities in the peripheral region were equalized, and the 3D data reconstructed. For each reconstructed voxel,
the intersections with the full intensity beam (ROI) were determined for each projection, and noise properties were
evaluated. Off-center OoIs intersect the high intensity beam in more than 60% of the projections (ROI having 40%
FOV area), with intersection frequency increasing with increasing ROI area and OoI proximity to the central region.
The noise increases with distance from the central region up to a factor of two. Integral dose reductions range
between 40% and 85%, depending on ROI area and filter thickness.
Substantial dose reductions (40-85%) are achieved with less than a factor of two increase in noise for OoIs
peripheral to the central region, indicating the FROI approach might be an alternative for reducing dose during
standard procedures.
The new Solid State X-Ray Image Intensifier (SSXII) has the unique ability to operate in single photon counting (SPC)
mode, with improved resolution, as well as in traditional energy integrating (EI) mode. The SSXII utilizes an electron-multiplying
CCD (EMCCD), with an effective pixel size of 32μm, which enables variable signal amplification (up to a
factor of 2000) prior to digital readout, providing very
high-sensitivity capabilities. The presampled MTF was measured
in both imaging modes using the standard angulated-slit method. A measured detector entrance exposure of 24μR per
frame was used to provide approximately 0.8 interaction events per pixel in the 10μm-wide slit area. For demonstration
purposes, a simple thresholding technique was used to localize events in SPC mode and a number of such frames were
summed to provide an image with the same total exposure used for acquiring the EI image. The MTF for SPC mode,
using a threshold level of 15% of the maximum 12-bit signal and 95% of the expected events, and for EI mode (in
parentheses) was 0.67 (0.20), 0.37 (0.07), 0.20 (0.03), and 0.11 (0.01) at 2.5, 5, 7.5, and 10 cycles/mm, respectively.
Increasing the threshold level resulted in a corresponding increase in the measured SPC MTF and a lower number of
detected events, indicating a tradeoff between resolution and count efficiency is required. The SSXII in SPC mode was
shown to provide substantial improvements in resolution relative to traditional EI mode, which should benefit
applications that have demanding spatial resolution requirements, such as mammography.
The MTF, NNPS, and DQE are standard linear system metrics used to characterize intrinsic detector performance.
To evaluate total system performance for actual clinical conditions, generalized linear system metrics (GMTF,
GNNPS and GDQE) that include the effect of the focal spot distribution, scattered radiation, and geometric
unsharpness are more meaningful and appropriate. In this study, a two-dimensional (2D) generalized linear system
analysis was carried out for a standard flat panel detector (FPD) (194-micron pixel pitch and 600-micron thick CsI)
and a newly-developed, high-resolution, micro-angiographic fluoroscope (MAF) (35-micron pixel pitch and 300-
micron thick CsI). Realistic clinical parameters and x-ray spectra were used. The 2D detector MTFs were calculated
using the new Noise Response method and slanted edge method and 2D focal spot distribution measurements were
done using a pin-hole assembly. The scatter fraction, generated for a uniform head equivalent phantom, was
measured and the scatter MTF was simulated with a theoretical model. Different magnifications and scatter fractions
were used to estimate the 2D GMTF, GNNPS and GDQE for both detectors. Results show spatial non-isotropy for
the 2D generalized metrics which provide a quantitative description of the performance of the complete imaging
system for both detectors. This generalized analysis demonstrated that the MAF and FPD have similar capabilities at
lower spatial frequencies, but that the MAF has superior performance over the FPD at higher frequencies even when
considering focal spot blurring and scatter. This 2D generalized performance analysis is a valuable tool to evaluate
total system capabilities and to enable optimized design for specific imaging tasks.
The SSXII is a novel x-ray imager designed to improve upon the performance limitations of conventional dynamic
radiographic/fluoroscopic imagers related to resolution,
charge-trapping, frame-rate, and instrumentation-noise. The
SSXII consists of a CsI:Tl phosphor coupled via a fiber-optic taper (FOT) to an electron-multiplying CCD (EMCCD).
To facilitate investigational studies, initial designs enable interchangeability of such imaging components. Measurements
of various component and configuration characteristics enable an optimization analysis with respect to overall detector
performance. Photon transfer was used to characterize the EMCCD performance including ADC sensitivity, read-noise,
full-well capacity and quantum efficiency. X-ray sensitivity was measured using RQA x-ray spectra. Imaging
components were analyzed in terms of their MTF and transmission efficiency. The EMCCD was measured to have a
very low effective read-noise of less than 1 electron rms at modest EMCCD gains, which is more than two orders-ofmagnitude
less than flat panel (FPD) and CMOS-based detectors. The variable signal amplification from 1 to 2000 times
enables selectable sensitivities ranging from 8.5 (168) to over 15k (300k) electrons per incident x-ray photon with
(without) a 4:1 FOT; these sensitivities could be readily increased with further component optimization. MTF and DQE
measurements indicate the SSXII performance is comparable to current state-of-the-art detectors at low spatial
frequencies and far exceeds them at higher spatial frequencies. The instrumentation noise equivalent exposure (INEE)
was measured to be less than 0.3 μR out to 10 cycles/mm, which is substantially better than FPDs. Component analysis
suggests that these improvements can be substantially increased with further detector optimization.
The objective performance evaluation metrics, termed Generalized Modulation Transfer Function (GMTF), Generalized
Noise Power Spectrum (GNPS), Generalized Noise Equivalent Quanta (GNEQ), and Generalized Detective Quantum
Efficiency (GDQE), have been developed to assess total
imaging-system performance by including the effects of
geometric unsharpness due to the finite size of the focal spot and scattered radiation in addition to the detector properties.
These metrics were used to evaluate the performance of the HSMAF, a custom-built, high-resolution, real-time-acquisition
detector with 35-μm pixels, in simulated neurovascular angiographic conditions using a uniform head-equivalent
phantom. The HSMAF consists of a 300-μm-thick CsI(Tl) scintillator coupled to a 4 cm diameter, variable-gain,
Gen2 light image intensifier with dual-stage microchannel plate, followed by direct fiber-optic coupling to a 30-fps
CCD camera, and is capable of both fluoroscopy and angiography. Effects of focal-spot size, geometric magnification,
irradiation field-of-view, and air-gap between the phantom and the detector were evaluated. The resulting plots of GMTF
and GDQE showed that geometric blurring is the more dominant image degradation factor at high spatial frequencies,
whereas scatter dominates at low spatial frequencies. For the standard image-geometry and scatter conditions used here,
the HSMAF maintains substantial system imaging capabilities (GDQE>5%) at frequencies above 4 cycles/mm where
conventional detectors cannot operate. The loss in image SNR due to scatter or focal-spot unsharpness could be
compensated by increasing the exposure by a factor of 2 to 3. This generalized evaluation method may be used to more
realistically evaluate and compare total system performance leading to improved system designs.
The solid-state x-ray image intensifier (SSXII) is an EMCCD-based x-ray detector designed to satisfy an increasing need
for high-resolution real-time images, while offering significant improvements over current flat panel detectors (FPDs)
and x-ray image intensifiers (XIIs). FPDs are replacing XIIs because they reduce/eliminate veiling glare, pincushion or s-shaped
distortions and are physically flat. However, FPDs suffer from excessive lag and ghosting and their performance
has been disappointing for low-exposure-per-frame procedures due to excessive instrumentation-noise. XIIs and FPDs
both have limited resolution capabilities of ~3 cycles/mm. To overcome these limitations a prototype SSXII module has
been developed, consisting of a 1k x 1k, 8 μm pixel EMCCD with a fiber-optic input window, which views a 350 μm
thick CsI(Tl) phosphor via a 4:1 magnifying fiber-optic-taper (FOT). Arrays of such modules will provide a larger field-of-
view. Detector MTF, DQE, and instrumentation-noise equivalent exposure (INEE) were measured to evaluate the
SSXIIs performance using a standard x-ray spectrum (IEC RQA5), allowing for comparison with current state-of-the-art
detectors. The MTF was 0.20 at 3 cycles/mm, comparable to standard detectors, and better than 0.05 up to 7 cycles/mm,
well beyond current capabilities. DQE curves indicate no degradation from high-angiographic to low-fluoroscopic
exposures (< 2% deviation in overall DQE from 1.3 mR to 2.7 μR), demonstrating negligible instrumentation-noise,
even with low input signal intensities. An INEE of < 0.2 μR was measured for the highest-resolution mode (32 μm
effective pixel size). Comparison images between detector technologies qualitatively demonstrate these improved
imaging capabilities provided by the SSXII.
A new high-resolution, high-sensitivity, low-noise x-ray detector based on EMCCDs has been developed. The EMCCD detector module consists of a 1kx1k, 8μm pixel EMCCD camera coupled to a CsI(Tl) scintillating phosphor via a fiber optic taper (FOT). Multiple modules can be used to provide the desired field-of-view (FOV). The detector is capable of acquisitions over 30fps. The EMCCD's variable gain of up to 2000x for the pixel signal enables high sensitivity for fluoroscopic applications. With a 3:1 FOT, the detector can operate with a 144μm effective pixel size, comparable to current flat-panel detectors. Higher resolutions of 96 and 48μm pixel size can also be achieved with various binning modes. The detector MTFs and DQEs were calculated using a linear-systems analysis. The zero frequency DQE was calculated to be 59% at 74 kVp. The DQE for the 144μm pixel size was shown to exhibit quantum-noise limited behavior down to ~0.1μR using a conservative 30x gain. At this low exposure, gains above 30x showed limited improvements in DQE suggesting such increased gains may not be necessary. For operation down to 48µm pixel sizes, the detector instrumentation noise equivalent exposure (INEE), defined as the exposure where the instrumentation noise equals the quantum-noise, was <0.1μR for a 20x gain. This new technology may provide improvements over current flat-panel detectors for applications such as fluoroscopy and angiography requiring high frame rates, resolution, dynamic range and sensitivity while maintaining essentially no lag and very low INEE. Initial images from a prototype detector are also presented.
New cone-beam computed tomographic (CBCT) mammography system designs are presented where the detectors provide high spatial resolution, high sensitivity, low noise, wide dynamic range, negligible lag and high frame rates similar to features required for high performance fluoroscopy detectors. The x-ray detectors consist of a phosphor coupled by a fiber-optic taper to either a high gain image light amplifier (LA) then CCD camera or to an electron multiplying CCD. When a square-array of such detectors is used, a field-of-view (FOV) to 20 x 20 cm can be obtained where the images have pixel-resolution of 100 μm or better. To achieve practical CBCT mammography scan-times, 30 fps may be acquired with quantum limited (noise free) performance below 0.2 μR detector exposure per frame. Because of the flexible voltage controlled gain of the LA's and EMCCDs, large detector dynamic range is also achievable. Features of such detector systems with arrays of either generation 2 (Gen 2) or 3 (Gen 3) LAs optically coupled to CCD cameras or arrays of EMCCDs coupled directly are compared. Quantum accounting analysis is done for a variety of such designs where either the lowest number of information carriers off the LA photo-cathode or electrons released in the EMCCDs per x-ray absorbed in the phosphor are large enough to imply no quantum sink for the design. These new LA- or EMCCD-based systems could lead to vastly improved CBCT mammography, ROI-CT, or fluoroscopy performance compared to systems using flat panels.
The new Multi-View Reconstruction (MVR) method for generating 3D vascular images was evaluated experimentally. The MVR method requires only a few digital subtraction angiographic (DSA) projections to reconstruct the 3D model of the vessel object compared to 180 or more projections for standard CBCT. Full micro-CBCT datasets of a contrast filled carotid vessel phantom were obtained using a Microangiography (MA) detector. From these datasets, a few projections were selected for use in the MVR technique. Similar projection views were also obtained using a standard x-ray image intensifier (II) system. A comparison of the 2D views of the MVRs (MA and II derived) with reference micro-CBCT data, demonstrated best agreement with the MA MVRs, especially at the curved part of the phantom. Additionally, the full 3D MVRs were compared with the full micro-CBCT 3D reconstruction resulting for the phantom with the smallest diameter (0.75 mm) vessel, in a mean centerline deviation from the micro-CBCT derived reconstructions of 29 μm for the MA MVR and 48 μm for the II MVR. The comparison implies that an MVR may be substituted for a full micro-CBCT scan for evaluating vessel segments with consequent substantial savings in patient exposure and contrast media injection yet without substantial loss in 3D image content. If a high resolution system with MA detector is used, the improved resolution could be well suited for endovascular image guided interventions where visualization of only a small field of view (FOV) is required.
A new microangiographic system (MA) integrated into a c-arm gantry has been developed allowing precise placement of a MA at the exact same angle as the standard x-ray image intensifier (II) with unchanged source and object position. The MA can also be arbitrarily moved about the object and easily moved into the field of view (FOV) in front of the lower resolution II when higher resolution angiographic sequences are needed. The benefits of this new system are illustrated in a neurovascular study, where a rabbit is injected with contrast media for varying oblique angles. Digital subtraction angiographic (DSA) images were obtained and compared using both the MA and II detectors for the same projection view. Vessels imaged with the MA appear sharper with smaller vessels visualized. Visualization of ~100 μm vessels was possible with the MA whereas not with the II. Further, the MA could better resolve vessel overlap. Contrast to noise ratios (CNR) were calculated for vessels of varying sizes for the MA versus the II and were found to be similar for large vessels, approximately double for medium vessels, and infinitely better for the smallest vessels. In addition, a 3D reconstruction of selected vessel segments was performed, using multiple (three) projections at oblique angles, for each detector. This new MA/II integrated system should lead to improved diagnosis and image guidance of neurovascular interventions by enabling initial guidance with the low resolution large FOV II combined with use of the high resolution MA during critical parts of diagnostic and interventional procedures.
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