PurposeWe aim to investigate the localization, visibility, and measurement of lung nodules in digital chest tomosynthesis (DTS).ApproachComputed tomography (CT), maximum intensity projections (CT-MIP) (transaxial versus coronal orientation), and computer-aided detection (CAD) were used as location reference, and inter- and intra-observer agreement regarding lung nodule size was assessed. Five radiologists analyzed DTS and CT images from 24 participants with lung nodules≥100 mm3, focusing on lung nodule localization, visibility, and measurement on DTS. Visual grading was used to compare if coronal or transaxial CT-MIP better facilitated the localization of lung nodules in DTS.ResultsThe majority of the lung nodules (79%) were rated as visible in DTS, although less clearly in comparison with CT. Coronal CT-MIP was the preferred orientation in the task of locating nodules on DTS. On DTS, area-based lung nodule size estimates resulted in significantly less measurement variability when compared with nodule size estimated based on mean diameter (mD) (p<0.05). Also, on DTS, area-based lung nodule size estimates were more accurate (SEE=38.7 mm3) than lung nodule size estimates based on mean diameter (SEE=42.7 mm3).ConclusionsCoronal CT-MIP images are superior to transaxial CT-MIP images in facilitating lung nodule localization in DTS. Most nodules≥100 mm3 found on CT can be visualized, correctly localized, and measured in DTS, and area-based measurement may be the key to more precise and less variable nodule measurements on DTS.
PurposeChest tomosynthesis (CTS) has a relatively longer acquisition time compared with chest X-ray, which may increase the risk of motion artifacts in the reconstructed images. Motion artifacts induced by breathing motion adversely impact the image quality. This study aims to reduce these artifacts by excluding projection images identified with breathing motion prior to the reconstruction of section images and to assess if motion compensation improves overall image quality.ApproachIn this study, 2969 CTS examinations were analyzed to identify examinations where breathing motion has occurred using a method based on localizing the diaphragm border in each of the projection images. A trajectory over diaphragm positions was estimated from a second-order polynomial curve fit, and projection images where the diaphragm border deviated from the trajectory were removed before reconstruction. The image quality between motion-compensated and uncompensated examinations was evaluated using the image quality criteria for anatomical structures and image artifacts in a visual grading characteristic (VGC) study. The resulting rating data were statistically analyzed using the software VGC analyzer.ResultsA total of 58 examinations were included in this study with breathing motion occurring either at the beginning or end (n=17) or throughout the entire acquisition (n=41). In general, no significant difference in image quality or presence of motion artifacts was shown between the motion-compensated and uncompensated examinations. However, motion compensation significantly improved the image quality and reduced the motion artifacts in cases where motion occurred at the beginning or end. In examinations where motion occurred throughout the acquisition, motion compensation led to a significant increase in ripple artifacts and noise.ConclusionsCompensation for respiratory motion in CTS by excluding projection images may improve the image quality if the motion occurs mainly at the beginning or end of the examination. However, the disadvantages of excluding projections may outweigh the benefits of motion compensation.
PurposeWe developed a method to visualize the image distortion induced by nonlinear noise reduction algorithms in computed tomography (CT) systems.ApproachNonlinear distortion was defined as the induced residual when testing a reconstruction algorithm by the criteria for a linear system. Two types of images were developed: a nonlinear distortion of an object (NLDobject) image and a nonlinear distortion of noise (NLDnoise) image to visualize the nonlinear distortion induced by an algorithm. Calculation of the images requires access to the sinogram data, which is seldomly fully provided. Hence, an approximation of the NLDobject image was estimated. Using simulated CT acquisitions, four noise levels were added onto forward projected sinograms of a typical CT image; these were noise reduced using a median filter with the simultaneous iterative reconstruction technique or a total variation filter with the conjugate gradient least-squares algorithm. The linear reconstruction technique filtered back-projection was also analyzed for comparison.ResultsStructures in the NLDobject image indicated contrast and resolution reduction of the nonlinear denoising. Although the approximated NLDobject image represented the original NLDobject image well, it had a higher random uncertainty. The NLDnoise image for the median filter indicated both stochastic variations and structures reminding of the object while for the total variation filter only stochastic variations were indicated.ConclusionsThe developed images visualize nonlinear distortions of denoising algorithms. The object may be distorted by the noise and vice versa. Analyzing the distortion correlated to the object is more critical than analyzing a distortion of stochastic variations. The absence of nonlinear distortion may measure the robustness of the denoising algorithm.
PurposeThe aim of our study was to compare the image quality assessments of vascular anatomy between interventional radiographers and interventional radiologists using digital subtraction angiography (DSA) runs acquired during an interventional radiology procedure.ApproachVisual grading characteristics (VGC) analysis was used to assess image quality by comparing two groups of images, where one group consisted of procedures in which radiation dose was optimized (group A, n = 10) and one group where dose optimization was not performed (group B, n = 10). The radiation dose parameters were optimized based on theoretical and empirical evidence to achieve radiation dose reductions during uterine artery embolization procedures. The two observer groups comprised of interventional radiologists (n = 4) and interventional radiographers (n = 4). Each observer rated the image quality of 20 DSA runs using a five-point rating scale.ResultsThe VGC analysis produced an area under the VGC curve (AUCVGC) of 0.55 for interventional radiographers (P = 0.61) and AUCVGC of 0.52 for interventional radiologists (P = 0.83). The optimization of radiation dose parameters demonstrated a reduction in kerma-area product by 35% (P = 0.026, d = 0.5) and reference air kerma (Ka, r) by 43% (P = 0.042, d = 0.5) between group A and group B.ConclusionsVGC analysis indicated that the image quality assessments of interventional radiographers were comparable with interventional radiologists, where a reduction in radiation dose revealed no effect on both observer groups regarding their image quality assessment of vascular anatomy.
Visual grading characteristic (VGC) analysis was used to investigate the performance of interventional radiologists and interventional radiographers when assessing uterine artery embolisation (UAE) image quality. The observers rated the image quality of 20 randomised DSA (digital subtraction angiography) series using a five-point rating scale, which compared Group A (optimised UAE radiation dose; n = 50) with a reference Group B (control group; n = 50). VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.52 for interventional radiologists (P = 0.83) and 0.55 for interventional radiographers (P = 0.61). Radiation dose reduction had no effect on observer image quality assessments.
KEYWORDS: Chest, Radiology, Radiography, Monte Carlo methods, Medical imaging, Optical spheres, Chest imaging, Statistical analysis, Sensors, Software development
Chest tomosynthesis may be a suitable alternative to computed tomography for the clinical task of follow up of pulmonary nodules. The aim of the present study was to investigate the detection of pulmonary nodule growth suggestive of malignancy using chest tomosynthesis. Previous studies have indicated remained levels of detection of pulmonary nodules at dose levels corresponding to that of a conventional lateral radiograph, approximately 0.04 mSv, which motivated to perform the present study this dose level. Pairs of chest tomosynthesis image sets, where the image sets in each pair were acquired of the same patient at two separate occasions, were included in the study. Simulated nodules with original diameters of approximately 8 mm were inserted in the pairs of image sets, simulating situations where the nodule had remained stable in size or increased isotropically in size between the two different imaging occasions. Four different categories of nodule growth were included, corresponding to a volume increase of approximately 21 %, 68 %, 108 % and 250 %. All nodules were centered in the depth direction in the tomosynthesis images. All images were subjected to a simulated dose reduction, resulting in images corresponding to an effective dose of 0.04 mSv. Four observers were given the task of rating their confidence that the nodule was stable in size or not on a five-level rating scale. This was done both before any size measurements were made of the nodule as well as after measurements were performed. Using Receiver operating characteristic analysis, the rating data for the nodules that were stable in size was compared to the rating data for the nodules simulated to have increased in size. Statistically significant differences between the rating distributions for the stable nodules and all of the four nodule growth categories were found. For the three largest nodule growths, nearly perfect detection of nodule growth was seen. In conclusion, the present study indicates that during optimal imaging conditions and for nodules with diameters of approximately 8 mm that grow fairly symmetrically, chest tomosynthesis performed at a dose level corresponding to that of a lateral chest radiograph can, with high sensitivity, differentiate nodules stable in size from nodules growing at rates associated with fast growing malignant nodules.
In chest tomosynthesis (TS) the most commonly used reconstruction methods are based on Filtered Back Projection (FBP) algorithms. Due to the limited angular range of x-ray projections, FBP reconstructed data is typically associated with a low spatial resolution in the out-of-plane dimension. Lung nodule measures that depend on depth information such as 3D shape and volume are therefore difficult to estimate. In this paper the relation between features from FBP reconstructed lung nodules and the true out-of-plane nodule elongation is investigated and a method for estimating the out-of-plane nodule elongation is proposed. In order to study these relations a number of steps that include simulation of spheroidal-shaped nodules, insertion into synthetic data volumes, construction of TS-projections and FBP-reconstruction were performed. In addition, the same procedure was used to simulate nodules and insert them into clinical chest TS projection data. The reconstructed nodule data was then investigated with respect to in-plane diameter, out-of-plane elongation, and attenuation coefficient. It was found that the voxel value in each nodule increased linearly with nodule elongation, for nodules with a constant attenuation coefficient. Similarly, the voxel value increased linearly with in-plane diameter. These observations indicate the possibility to predict the nodule elongation from the reconstructed voxel intensity values. Such a method would represent a quantitative approach to chest tomosynthesis that may be useful in future work on volume and growth rate estimation of lung nodules.
KEYWORDS: Fluoroscopy, Imaging systems, Stereoscopy, X-rays, 3D image processing, Image acquisition, 3D acquisition, Monte Carlo methods, Chest, X-ray imaging
Three-dimensional (3D) imaging with interventional fluoroscopy systems is today a common examination. The examination includes acquisition of two-dimensional projection images, used to reconstruct section images of the patient. The aim of the present study was to investigate the difference in resulting effective dose obtained using different levels of complexity in calculations of effective doses from these examinations. In the study the Siemens Artis Zeego interventional fluoroscopy system (Siemens Medical Solutions, Erlangen, Germany) was used. Images of anthropomorphic chest and pelvis phantoms were acquired. The exposure values obtained were used to calculate the resulting effective doses from the examinations, using the computer software PCXMC (STUK, Helsinki, Finland). The dose calculations were performed using three different methods: 1. using individual exposure values for each projection image, 2. using the mean tube voltage and the total DAP value, evenly distributed over the projection images, and 3. using the mean kV and the total DAP value, evenly distributed over smaller selection of projection images. The results revealed that the difference in resulting effective dose between the first two methods was smaller than 5%. When only a selection of projection images were used in the dose calculations the difference increased to over 10%. Given the uncertainties associated with the effective dose concept, the results indicate that dose calculations based on average exposure values distributed over a smaller selection of projection angles can provide reasonably accurate estimations of the radiation doses from 3D imaging using interventional fluoroscopy systems.
In the monitoring of progression of lung disease in patients with cystic fibrosis (CF), recurrent computed tomography (CT) examinations are often used. The relatively new imaging technique chest tomosynthesis (CTS) may be an interesting alternative in the follow-up of these patients due to its visualization of the chest in slices at radiation doses and costs significantly lower than is the case with CT. A first step towards introducing CTS imaging in the diagnostics of CF patients is to establish a scoring system appropriate for evaluating the severity of CF pulmonary disease based on findings in CTS images. Previously, several such CF scoring systems based on CT imaging have been published. The purpose of the present study was to develop a CF scoring system for CTS, by starting from an existing scoring system dedicated for CT images and making modifications regarded necessary to make it appropriate for use with CTS images. In order to determine any necessary changes, three thoracic radiologists independently used a scoring system dedicated for CT on both CT and CTS images from CF patients. The results of the scoring were jointly evaluated by all the observers, which lead to suggestions for changes to the scoring system. Suggested modifications include excluding the scoring of air trapping and doing the scoring of the findings in quadrants of the image instead of in each lung lobe.
KEYWORDS: Calibration, Eye, LCDs, Contrast sensitivity, Signal to noise ratio, Display technology, Visibility, Light emitting diodes, LED displays, Medical imaging
Calibration of medical review displays according to the part 14 Grayscale Standard Display Function (GSDF) is
important in order to obtain consistency in displayed image quality since display technology and viewing conditions may
vary substantially. Unfortunately, the purpose of the GSDF calibration is best suited for low luminance range conditions
but is not optimal when using modern displays with a high luminance range. Low contrast objects will then obtain a
greater visibility in mid-gray areas compared to similar objects in bright or dark regions. In this study, low contrast
sinusoidal patterns were displayed on a high luminance range monitor under realistic viewing conditions. In order to
simulate the viewing of an x-ray image with both dark and bright regions displayed simultaneously, the luminance of the
patterns ranged from 2 to 600 cd/m2 while the observers were always adapted to the logarithmic average of 35 cd/m2.
The results show a clear relationship between the patterns deviation from the adaptation luminance level and the
necessary contrast required to detect the pattern. The results also indicate the potential for an improvement in the lowcontrast
detectability over a large luminance range by adjusting the GSDF for the limited eye adaptation.
The primary aim of the present work was to analyze the effects of varying scatter-to-primary ratios on the appearance of
simulated nodules in chest tomosynthesis section images. Monte Carlo simulations of the chest tomosynthesis system
GE Definium 8000 VolumeRAD (GE Healthcare, Chalfont St. Giles, UK) were used to investigate the variation of
scatter-to-primary ratios between different angular projections. The simulations were based on a voxel phantom created
from CT images of an anthropomorphic chest phantom. An artificial nodule was inserted at 80 different positions in the
simulated phantom images, using five different approaches for the scatter-to-primary ratios in the insertion process. One
approach included individual determination of the scatter-to primary-ratio for each projection image and nodule location,
while the other four approaches were using mean value, median value and zero degree projection value of the scatter-toprimary
ratios at each nodule position as well as using a constant scatter-to-primary ratio of 0.5 for all nodule positions.
The results indicate that the scatter-to-primary ratios vary up to a factor of 10 between the different angular
tomosynthesis projections (±15°). However, the error in the resulting nodule contrast introduced by not taking all
variations into account is in general smaller than 10 %.
In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of section
images of the chest, resulting in a reduction of disturbing anatomy at a moderate increase in radiation dose compared to
chest radiography. In a previous study, we investigated the effects of learning with feedback on the detection of
pulmonary nodules in chest tomosynthesis. Six observers with varying degrees of experience of chest tomosynthesis
analyzed tomosynthesis cases for presence of pulmonary nodules. The cases were analyzed before and after learning with
feedback. Multidetector computed tomography (MDCT) was used as reference. The differences in performance between
the two readings were calculated using the jackknife alternative free-response receiver operating characteristics
(JAFROC-2) as primary measure of detectability. Significant differences between the readings were found only for
observers inexperienced in chest tomosynthesis. The purpose of the present study was to extend the statistical analysis of
the results of the previous study, including JAFROC-1 analysis and FROC curves in the analysis. The results are
consistent with the results of the previous study and, furthermore, JAFROC-1 gave lower p-values than JAFROC-2 for
the observers who improved their performance after learning with feedback.
Chest tomosynthesis has recently been introduced to healthcare as a low-dose alternative to CT or as a tool for improved
diagnostics in chest radiography with only a modest increase in radiation dose to the patient. However, no detailed
description of the dosimetry for this type of examination has been presented. The aim of this work was therefore to
investigate the dosimetry of chest tomosynthesis. The chest tomosynthesis examination was assumed to be performed
using a stationary detector and a vertically moving x-ray tube, exposing the patient from different angles. The Monte
Carlo based computer software PCXMC was used to determine the effective dose delivered to a standard-sized patient
from various angles using different assumptions of the distribution of the effective dose over the different projections.
The obtained conversion factors between input dose measures and effective dose for chest tomosynthesis for different
angular intervals were then compared with the horizontal projection. The results indicate that the error introduced by
using conversion factors for the PA projection in chest radiography for estimating the effective dose of chest
tomosynthesis is small for normally sized patients, especially if a conversion factor between KAP and effective dose is
used.
ViewDEX (Viewer for Digital Evaluation of X-ray images) is a Java-based DICOM-compatible software tool for
observer performance studies that can be used to display medical images with simultaneous registration of the observer's
response. The current release, ViewDEX 2.0 is a development of ViewDEX 1.0, which was released in 2007. Both
versions are designed to run in a Java environment and do not require any special installation. For example, the program
can be located on a memory stick or stand alone hard drive and be run from there. ViewDEX is managed and configured
by editing property files, which are plain text files where users, tasks (questions, definitions, etc.) and functionality
(WW/WL, PAN, ZOOM, etc.) are defined. ViewDEX reads all common DICOM image formats and the images can be
stored in any location connected to the computer. ViewDEX 2.0 is designed so that the user in a simple way can alter if
the questions presented to the observers are related to localization or not, enabling e.g. free-response ROC, standard
ROC and visual grading studies, as well as combinations of these, to be conducted in a fast and efficient way. The
software can also be used for bench marking and for educational purposes. The results from each observer are saved in a
log file, which can be exported for further analysis. The software is freely available for non-commercial purposes.
Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using
these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest
radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest
tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest
radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response
receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary
nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total
number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest
tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The
JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest
radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged
JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference
between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the
tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability
due to additional clinical experience of tomosynthesis.
The purpose of this study was to investigate the effect of dose on lesion detection and characterization in breast
tomosynthesis (BT), using human breast specimens. Images of 27 lesions in breast specimens were acquired on a BT
prototype based on a Mammomat Novation (Siemens) full-field digital mammography (FFDM) system. Two detector
modes - binned (2×1 in the scan direction) and full resolution - and four BT exposure levels - approximately 2×, 1.5×,
1×, and 0.5× the total mAs at the same beam quality as used in a single FFDM view with a Mammomat Novation unit
under automatic exposure control (AEC) conditions - were examined. The exposure for all BT scans was equally
divided among 25 projections. An enhanced filtered back projection reconstruction method was applied with a constant
filter setting. A human observer performance study was conducted in which the observers were forced to select the
minimum (threshold) exposure level at which each lesion could be both detected and characterized for assessment of
recall or not in a screening situation. The median threshold exposure level for all observers and all lesions corresponded
to approximately 1×, which is half the exposure of what we currently use for BT. A substantial variation in exposure
thresholds was noticed for different lesion types. For low contrast lesions with diffuse borders, an exposure threshold of
approximately 2× was required, whereas for spiculated high contrast lesions and lesions with well defined borders, the
exposure threshold was lower than 0.5×. The use of binned mode had no statistically significant impact on observer
performance compared to full resolution mode. There was no substantial difference between the modes for the detection
and characterization of the lesion types.
The DICOM part 14 grayscale standard display function provides one way of harmonizing image appearance under different monitor luminance settings. This function is based on ideal observer conditions where the eye is always adapted to the target luminance and thereby also at peak contrast sensitivity. Clinical workstations are however often
exposed to variations in ambient light due to a sub-optimal reading room light environment. Also, clinical images are inhomogeneous and low-contrast patterns must be detected even at luminance levels that differ from the eye adaptation level. All deviations from ideal luminance conditions cause the observer to detect patterns with reduced eye sensitivity but the magnitude of this reduction is unclear. The purpose of this paper was to quantify the effect different luminance settings have on the contrast threshold. A method to display well-defined sinusoidal low-contrast test patterns on an
LCD has previously been developed and was used in this study. The observers were exposed to light from three
different areas: 1) A small sinusoidal test pattern. 2) The remaining of the display surface. 3) Ambient light from outside
the display area covering most of the observer's field of view. By adjusting the luminance from each of these three
areas, two major effects could be quantified. The first effect was similar to Barten's f-factor where the target luminance
differs from the observer's adaptation level while the second effect concerned the influence of areas outside the display
surface. When a luminance range of 1-350 cd/m2 was used, the contrast needed to detect a dark object in a gray
surrounding was almost doubled compared to a dark object in a dark surrounding. Ambient light from outside the
display area has a moderate effect on the contrast threshold, except for the combination of high ambient light and dark
objects where the contrast threshold increased considerably.
To determine clinical image quality in radiography, visual grading of the reproduction of important anatomical
landmarks is often used. The rating data from the observers in a visual grading study with multiple scale steps is ordinal,
meaning that non-parametric rank-invariant statistical methods are required. However, many visual grading methods
incorrectly use parametric statistical methods. This work describes how the methodology developed in receiver operating
characteristics (ROC) analysis for characterising the difference in the observer's response to the signal and no-signal
distributions can be applied to visual grading data for characterising the difference in perceived image quality between
two systems. The method is termed visual grading characteristics (VGC) analysis. In a VGC study, the task of the
observer is to rate her confidence about the fulfilment of image quality criteria. Using ROC software, the given ratings
for the two systems are then used to determine the VGC curve, which describes the relationship between the proportions
of fulfilled image criteria for the two compared systems for all possible decision thresholds. As a single measure of the
difference in image quality between the two compared systems, the area under the VGC curve can be used.
Observer performance studies are time-consuming tasks, both for the participating observers and for the scientists
collecting and analyzing the data. A possible way to optimize such studies is to perform the study in a completely digital
environment. A software tool - ViewDEX (Viewer for Digital Evaluation of X-ray images) - has been developed in Java,
enabling it to function on almost any computer. ViewDEX is a DICOM-compatible software tool that can be used to
display medical images with simultaneous registration of the observer's response. ViewDEX is designed so that the user
in a simple way can alter the types of questions and images presented to the observers, enabling ROC, MAFC and visual
grading studies to be conducted in a fast and efficient way. The software can also be used for bench marking and for
educational purposes. The results from each observer are saved in a log file, which can be exported for further analysis.
The software is freely available for non-commercial purposes.
The purpose of this study was to determine how image quality in breast tomosynthesis (BT) is affected when acquisition
modes are varied, using human breast specimens containing malignant tumors and/or microcalcifications. Images of
thirty-one breast lumpectomy and mastectomy specimens were acquired on a BT prototype based on a Mammomat
Novation (Siemens) full-field digital mammography system. BT image acquisitions of the same specimens were
performed varying the number of projections, angular range, and detector signal collection mode (binned and nonbinned
in the scan direction). An enhanced filtered back projection reconstruction method was applied with constant
settings of spectral and slice thickness filters. The quality of these images was evaluated via relative visual grading
analysis (VGA) human observer performance experiments using image quality criteria. Results from the relative VGA
study indicate that image quality increases with number of projections and angular range. A binned detector collecting
mode results in less noise, but reduced resolution of structures. Human breast specimens seem to be suitable for
comparing image sets in BT with image quality criteria.
The purpose of this work was to evaluate and compare the visibility of tumors in digital mammography (DM) and breast tomosynthesis (BT) images. Images of the same women were acquired on both a DM system (Mammomat Novation, Siemens) and a BT prototype system adapted from the same type of DM system. Simulated 3D tumors (average dimension: 8.4 mm x 6.6 mm x 5 mm) were projected and added to each DM image as well as each BT projection image prior to 3D reconstruction. The same beam quality and approximately the same total absorbed dose were used for each breast image acquisition on both systems. Two simulated tumors were added to each of thirty breast scans, yielding sixty cases. A series of 4-alternative forced choice (4-AFC) human observer performance experiments were conducted in order to determine what projected tumor signal intensity in the DM images would be needed to achieve the same detectability as in the reconstructed BT images. Nine observers participated. For the BT experiment, when the tumor signal intensity on the central projection was 0.010 the mean percent of correct responses (PC) was measured to be 81.5%, which converted to a detectability index value (d') of 1.96. For the DM experiments, the same detectability was achieved at a signal intensity determined to be 0.038. Equivalent tumor detection in BT images were thus achieved at around four times less projected signal intensity than in DM images, indicating that the use of BT may lead to earlier detection of breast cancer.
Radiological images are today mostly displayed on monitors, but much is still unknown regarding the interaction between monitor and viewer. Issues like monitor luminance range, calibration, contrast resolution and luminance distribution need to be addressed further. To perform vision research of high validity to the radiologists, test images should be presented on medical displays. One of the problems has been how to display low contrast patterns in a strictly controlled way. This paper demonstrates how to generate test patterns close to the detection limit on a medical grade display using subpixel modulation. Patterns are generated with both 8-bit and 10-bit monitor input. With this technique, up to 7162 luminance levels can be displayed and the average separation is approximately 0.08 of a JND (Just Noticeable Difference) on a display with a luminance range between 1 and 400 cd/m2. These patterns were used in a 2AFC detection task and the detection threshold was found to be 0.75 ± 0.02 of a JND when the adaptation level was the same as the target luminance (20 cd/m2). This is a reasonable result considering that the magnitude of a JND is based on the method of adjustment rather than on a detection task. When test patterns with a different luminance than the adaptation level (20 cd/m2) were displayed, the detection thresholds were 1.11 and 1.06 of a JND for target luminance values 1.8 and 350 cd/m2, respectively.
Purpose: To determine how image quality linked to tumor detection is affected by reducing the absorbed dose to 50% and 30% of the clinical levels represented by an average glandular dose (AGD) level of 1.3 mGy for a standard breast according to European guidelines. Materials and methods: 90 normal, unprocessed images were acquired from the screening department using a full-field digital mammography (FFDM) unit Mammomat Novation (Siemens). Into 40 of these, one to three simulated tumors were inserted per image at various positions. These tumors represented irregular-shaped malignant masses. Dose reduction was simulated in all 90 images by adding simulated quantum noise to represent images acquired at 50% and 30% of the original dose, resulting in 270 images, which were subsequently processed for final display. Four radiologists participated in a free-response receiver operating characteristics (FROC) study in which they searched for and marked suspicious positions of the masses as well as rated their degree of suspicion of occurrence on a one to four scale. Using the jackknife FROC (JAFROC) method, a score between 0 and 1 (where 1 represents best performance), referred to as a figure-of-merit (FOM), was calculated for each dose level. Results: The FOM was 0.73, 0.70, and 0.68 for the 100%, 50% and 30% dose levels, respectively. Using Analysis of the Variance (ANOVA) to test for statistically significant differences between any two of the three FOMs revealed that they were not statistically distinguishable (p-value of 0.26). Conclusion: For the masses used in this experiment, there was no significant change in detection by increasing quantum noise, thus indicating a potential for dose reduction.
The aim of this work was to investigate and quantify the effects of system noise, nodule location, anatomical noise and anatomical background on the detection of lung nodules in different regions of the chest x-ray. Simulated lung nodules of diameter 10 mm but with varying detail contrast were randomly positioned in four different kinds of images: 1) clinical images collected with a 200 speed CR system, 2) images containing only system noise (including quantum noise) at the same level as the clinical images, 3) clinical images with removed anatomical noise, 4) artificial images with similar power spectrum as the clinical images but random phase spectrum. An ROC study was conducted with 5 observers. The detail contrast needed to obtain an Az of 0.80, C0.8, was used as measure of detectability. Five different regions of the chest x-ray were investigated separately. The C0.8 of the system noise images ranged from only 2% (the hilar regions) to 20% (the lateral pulmonary regions) of those of the clinical images. Compared with the original clinical images, the C0.8 was 16% lower for the de-noised clinical images and 71% higher for the random phase images, respectively, averaged over all five regions. In conclusion, regarding the detection of lung nodules with a diameter of 10 mm, the system noise is of minor importance at clinically relevant dose levels. The removal of anatomical noise and other noise sources uncorrelated from image to image leads to somewhat better detection, but the major component disturbing the detection is the overlapping of recognizable structures, which are, however, the main aspect of an x-ray image.
The purpose of this work was to study how the pixel size of digital detectors can affect shape determination of microcalcifications in mammography. Screen-film mammograms containing microcalcifications clinically proven to be indicative of malignancy were digitised at 100 lines/mm using a high-resolution Tango drum scanner. Forty microcalcifications were selected to cover an appropriate range of sizes, shapes and contrasts typically found of malignant cases. Based on the measured MTF and NPS of the combined screen-film and scanner system, these digitised images were filtered to simulate images acquired with a square sampling pixel size of 10 μm x 10 μm and a fill factor of one. To simulate images acquired with larger pixel sizes, these finely sampled images were re-binned to yield a range of effective pixel sizes from 20 μm up to 140 μm. An alternative forced-choice (AFC) observer experiment was conducted with eleven observers for this set of digitised microcalcifications to determine how pixel size affects the ability to discriminate shape. It was found that observer score increased with decreasing pixel size down to 60 μm (p<0.01), at which point no significant advantage was obtained by using smaller pixel sizes due to the excessive relative noise-per-pixel. The relative gain in shape discrimination ability at smaller pixel sizes was larger for microcalcifications that were smaller than 500 μm and circular.
Thirty images with added simulated pathological lesions at two different dose levels (100% and 10% dose) were evaluated with the free-response forced error experiment by nine experienced radiologists. The simulated pathological lesions present in the images were classified according to four different parameters: the position within the lumbar spine, possibility to perform a symmetrical (left-right) comparison, the lesion contrast, and the complexity of the surrounding background where the lesion was situated. The detectability of each lesion was calculated as the fraction of radiologists who successfully detected the lesion before a false positive error was made. The influence of each of the four parameters on lesion detectability was investigated. The results of the study show that the influence of lesion contrast is the most important factor for detectability. Since the dose level had a limited effect on detectability, large dose savings can be made without reducing the detectability of pathological lesions in lumbar spine radiography.
To evaluate the image quality of clinical radiographs with two different methods, and to find correlations between the two methods.
Based on fifteen lumbar spine radiographs, two new sets of images were created. A hybrid image set was created by adding two distributions of artificial lesions to each original image. The image quality parameters spatial resolution and noise were manipulated and a total of 210 hybrid images were created. A set of 105 disease-free images was created by applying the same combinations of spatial resolution and noise to the original images. The hybrid images were evaluated with the free-response forced error experiment (FFE) and the normal images with visual grading analysis (VGA) by nine experienced radiologists. The VGA study showed that images with low noise are preferred over images with higher noise levels. The alteration of the MTF had a limited influence on the VGA score. For the FFE study the visibility of the lesions was independent of the spatial resolution and the noise level. In this study we found no correlation between the two methods, probably because the detectability of the artificial lesions was not influenced by the manipulations of noise level and resolution. Hence, the detection of lesions in lumbar spine radiography may not be a quantum-noise limited task. The results show the strength of the VGA technique in terms of detecting small changes in the two image quality parameters. The method is more robust and has a higher statistical power than the ROC related method and could therefore, in some cases, be more suitable for use in optimization studies.
In digital radiography, radial asymmetry may be present. The use of a one-dimensional representation of the resolution properties can therefore be questioned. Although measurements are often done in two orthogonal directions, there may be a need for a more detailed description. A method of measuring the two-dimensional presampling modulation transfer function (MTF) has therefore been developed. A finely sampled 'disk spread function' is obtained by imaging an aperture mask, consisting of N2 circular holes arranged in an NxN manner in an opaque material, in such a way that each hole is positioned at a different phase relative to the sampling coordinates of the detector system. This spread function is resampled, extrapolated, Fourier transformed, and finally corrected for the finite hole size in order to obtain the presampling MTF. The method was tested on a computed radiography (CR) system through measurements with a prototype mask, consisting of 100 holes of radius 0.2 mm drilled in a lead alloy. The results were compared with measurements using the slit method, and were found to be consistent. Problems associated with the method, e.g. errors due to incorrect alignment of the holes in the aperture mask with the beam, and limitations due to the finite hole size, are discussed.
KEYWORDS: Modulation transfer functions, Sensors, Modulation, Signal processing, Optical transfer functions, Spatial frequencies, Signal detection, Photons, Electrons, Selenium
The effects of the design of a radiographic system on the modulation transfer function (MTF) are studied with a specially developed computer program. The program simulates a digital radiographic system by using three parameters: sampling distance, sampling aperture, and the spread of the signal in the detector due to the interaction processes of the incoming photons. The signal spread is approximated by Gaussian distributions. The influence of the three parameters is studied on the presampling MTF and on the two extreme cases of the digital MTF: the maximum MTF and the minimum MTF. From theoretical data on the interaction processes, the resolution properties of an amorphous selenium flat-panel detector are simulated. The program is also used to simulate a measurement of the presampling MTF with the slit method, and the effect of the slit width on the measured presampling MTF is examined.
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