Daniel R. Bednarek

Accurate characterization of image intensifier distortion

Image intensifier distortion due to photocathode curvature and electron optics is shown to be approximated by a simple two parameter odd-power polynomial. The accuracy of this fit was found to be far better than that of two other one parameter characterizations of distortion when applied to experimental data from four different model image intensifiers ranging in diameter from 9 to 14 in. The standard errors of the two parameters fits were less than 0.1 mm or 0.03% of the field of the IIs and were within the estimated measurement error.

Generalizing the MTF and DQE to include x-ray scatter and focal spot unsharpness: application to a new microangiographic system.

Detector characterization with modulation transfer function (MTF) and detective quantum efficiency (DQE) inadequately predicts image quality when the imaging system includes focal spot unsharpness and patient scatter. The concepts of MTF, noise power spectrum, noise equivalent quanta and DQE were referenced to the object plane and generalized to include the effect of geometric unsharpness due to the finite size of the focal spot and the effect of the spatial distribution and magnitude of x-ray scatter due to the patient. The generalized quantities provide performance characteristics that consider the complete imaging system, but reduce to a description of the detector properties without magnification or scatter. We have evaluated a new neurovascular angiography imaging system based on a region of interest (ROI) microangiographic detector using these generalized quantities. A uniform head-equivalent phantom was used as a filter and x-ray scatter source. This allowed the study of all properties of the detector under clinically relevant x-ray spectra and x-ray scatter conditions. Realistic focal spots (0.8 mm nominal), beam energies (60-100 kVp), and detector exposures (0.8-2.3 mR) were used, and the effects of different scatter fractions (0-0.62) resulting from changing the beam size (0-100 cm2) were investigated. The generalized MTF and DQE were found to have very little dependence on the tube voltage and the detector entrance exposure. Magnification, with the focal spot used, results in a large decrease of the generalized DQE at higher frequencies (about 100-fold at 10 cycles/mm), but a significantly smaller decrease at lower frequencies. Scatter on the other hand, causes a constant drop in the generalized DQE (factor of 3 for scatter fraction 0.3) for all frequencies. Our results show that there are tradeoffs in the choice of the different system parameters; therefore this methodology of studying the imaging system as a whole could provide guidance in system design.

Region of interest fluoroscopy.

In some medical imaging applications, it is necessary to visualize only the center of the field of view with optimal quality. For example, often in interventional radiographic procedures only the region directly adjacent to the catheter tip must be well seen. A new imaging approach which reduces the number of photons exposing the patient outside a region of interest (ROI), while allowing the photon fluence to be maintained or increased in the ROI, may make more optimal use of the total integral radiation dose to the patient as well as enable increased contrast and reduced artifacts in the ROI. A demonstration is given with an angiographic phantom, for an ROI which is less than 10% of the total field of view and where the periphery receives 6% of the ROI exposure. Contrast is improved about 30% in the ROI, and yet the images are adequate in the periphery for visualizing high contrast reference features while there is a reduction in total integral patient dose. Details of the technique are discussed along with requirements for clinical implementation.

Endovascular image-guided interventions (EIGIs)

Minimally invasive interventions are rapidly replacing invasive surgical procedures for the most prevalent human disease conditions. X-ray image-guided interventions carried out using the insertion and navigation of catheters through the vasculature are increasing in number and sophistication. In this article, we offer our vision for the future of this dynamic field of endovascular image-guided interventions in the form of predictions about (1) improvements in high-resolution detectors for more accurate guidance, (2) the implementation of high-resolution region of interest computed tomography for evaluation and planning, (3) the implementation of dose tracking systems to control patient radiation risk, (4) the development of increasingly sophisticated interventional devices, (5) the use of quantitative treatment planning with patient-specific computer fluid dynamic simulations, and (6) the new expanding role of the medical physicist. We discuss how we envision our predictions will come to fruition and result in the universal goal of improved patient care.

Micro‐angiography for neuro‐vascular imaging. II. Cascade model analysis

A micro-angiographic detector was designed and its performance was previously tested to evaluate its feasibility as an improvement over current x-ray detectors for neuro-interventional imaging. The detector was shown to have a modulation transfer function value of about 2% at the Nyquist frequency of 10 cycles/mm and a zero frequency detective quantum efficiency [DQE(0)] value of about 55%. An assessment of the system was required to evaluate whether the current system was performing at its full potential and to determine if any of its components could be optimized to further improve the output. For the purpose, in this study, the parallel cascade theory was used to analyze the performance of the detector under neuro-angiographic conditions by studying the output at the various stages in the imaging chain. A simple model for the spread of light in the CsI(Tl) entrance phosphor was developed and the resolution degradation due to K-fluorescence absorption was calculated. The total gain of the system was found to result in 21 e(-) (rms) detected at the charge coupled device per absorbed x-ray photon. The gain and the spread of quanta in the imaging chain were used to calculate theoretically the DQE using the parallel cascade model. The results of the model-based calculations matched fairly well with the experimental data previously obtained. This model was then used to optimize the phosphor thickness for the detector. The results showed that the area under the DQE curve had a maximum value at 150 microm of CsI(Tl), though when weighted by the squared signal in frequency space of a 100-microm-diam iodinated vessel, the integral DQE reached a maximum at 250 microm of CsI(Tl). Further, possible locations for gain increase in the imaging chain were determined, and the output of the improved system was simulated. Thus a theoretical analysis for the micro-angiographic detector was performed to better assess its potential.

Region of Interest (ROI) Computed Tomography

High-resolution computed tomography (CT) reconstructions currently require either full field of view (FOV) exposure, resulting in high dose, or region of interest (ROI) exposure, resulting in artifacts. To obtain high-resolution 3D reconstruction of an ROI with minimal artifiacts, we have developed a method involving a non-uniform ROI beam filter to reduce dose outside the ROI while acquiring the ROI at a higher dose. High-resolution, high-dose full-field projections ofa phontom were obtained. ROIs in the images were selected and the low-dose data outside the ROI were simulated by adding various levels of noise to the projection data corresponding to a dose of 1/16 and 1/256 of the original dose. For an ROI of 30% FOV, artifacts in the reconstructed ROI were minimal for both dose reduction levels. For an ROI of 10% FOV, artifacts remained minimal only for the 1/16th dose case. The effect of the presence of a high contrast object outside the ROI was also studied. We found that the intensity of the artifacts increases with the contrast of the object, its size, and its distance from the axis of rotation. CT using an ROI filter provides a way to reconstruct an ROI with reduced integral dose and yet with minimal artifacts and improved spatial resolution.

Challenges and limitations of patient-specific vascular phantom fabrication using 3D Polyjet printing

Additive manufacturing (3D printing) technology offers a great opportunity towards development of patient-specific vascular anatomic models, for medical device testing and physiological condition evaluation. However, the development process is not yet well established and there are various limitations depending on the printing materials, the technology and the printer resolution. Patient-specific neuro-vascular anatomy was acquired from computed tomography angiography and rotational digital subtraction angiography (DSA). The volumes were imported into a Vitrea 3D workstation (Vital Images Inc.) and the vascular lumen of various vessels and pathologies were segmented using a “marching cubes” algorithm. The results were exported as Stereo Lithographic (STL) files and were further processed by smoothing, trimming, and wall extrusion (to add a custom wall to the model). The models were printed using a Polyjet printer, Eden 260V (Objet-Stratasys). To verify the phantom geometry accuracy, the phantom was reimaged using rotational DSA, and the new data was compared with the initial patient data. The most challenging part of the phantom manufacturing was removal of support material. This aspect could be a serious hurdle in building very tortuous phantoms or small vessels. The accuracy of the printed models was very good: distance analysis showed average differences of 120 μm between the patient and the phantom reconstructed volume dimensions. Most errors were due to residual support material left in the lumen of the phantom. Despite the post-printing challenges experienced during the support cleaning, this technology could be a tremendous benefit to medical research such as in device development and testing.

The Asymmetric Vascular Stent. Efficacy in a Rabbit Aneurysm Model

Background and Purpose— Development of hemodynamic modifying devices to treat intracranial aneurysms is an active area of research. The asymmetrical vascular stent (AVS), a stent containing a low-porosity patch, is such device. We evaluate AVS efficacy in an in vivo intracranial aneurysm model. Methods— We created 24 elastase rabbit model aneurysms: 13 treated with the AVS, 5 treated with standard coronary stents, and 6 untreated controls. Four weeks after treatment, aneurysms underwent follow-up angiography, cone-beam micro-CT, histological evaluation, and selective electron microscopy scanning. Results— Four rabbits died early in the study: 3 during AVS treatment and 1 control (secondary to intraprocedural vessel injury and an unrelated tumor, respectively). AVS-treated aneurysms exhibited very weak or no aneurysm flow immediately after treatment and no flow in all aneurysms at follow-up. Standard stent-treated aneurysms showed flow both after treatment (5/5) and at follow-up (3/5). All control aneurysms remained patent during the study. Micro-CT scans showed: 9 of 9 scanned AVS aneurysms were occluded, 6 of 9 AVS were ideally placed, and 3 of 9 low-porosity region partially covered the aneurysm neck; standard stent-treated aneurysms were 1 of 5 occluded, 2 of 5 patent, and 2 of 5 partially patent. Histology results demonstrated: for AVS-treated aneurysms, advanced thrombus organization in the (9/9); for standard stent-treated aneurysms, (1/4) no thrombus, (2/4) partially thrombosed, and (1/4) fully thrombosed; for control aneurysms (4/4), no thrombus. Conclusion— The use of AVS shows promise as a viable new therapeutic in intracranial aneurysm treatment. These data encourage further investigation and provide substantial support to the AVS concept.

Super-global distortion correction for a rotational C-arm x-ray image intensifier.

Image intensifier (II) distortion changes as a function of C-arm rotation angle because of changes in the orientation of the II with the earths or other stray magnetic fields. For cone-beam computed tomography (CT), distortion correction for all angles is essential. The new super-global distortion correction consists of a model to continuously correct II distortion not only at each location in the image but for every rotational angle of the C arm. Calibration bead images were acquired with a standard C arm in 9 in. II mode. The super-global (SG) model is obtained from the single-plane global correction of the selected calibration images with given sampling angle interval. The fifth-order single-plane global corrections yielded a residual rms error of 0.20 pixels, while the SG model yielded a rms error of 0.21 pixels, a negligibly small difference. We evaluated the accuracy dependence of the SG model on various factors, such as the single-plane global fitting order, SG order, and angular sampling interval. We found that a good SG model can be obtained using a sixth-order SG polynomial fit based on the fifth-order single-plane global correction, and that a 10 degrees sampling interval was sufficient. Thus, the SG model saves processing resources and storage space. The residual errors from the mechanical errors of the x-ray system were also investigated, and found comparable with the SG residual error. Additionally, a single-plane global correction was done in the cylindrical coordinate system, and physical information about pincushion distortion and S distortion were observed and analyzed; however, this method is not recommended due to a lack of calculational efficiency. In conclusion, the SG model provides an accurate, fast, and simple correction for rotational C-arm images, which may be used for cone-beam CT.

Evaluation of a CMOS Image Detector For Low Cost and Power Medical X-ray Imaging Applications

Recent developments in CMOS image detectors are changing the way digital imaging is performed for many applications. The replacement of charge coupled devices (CCDs), with CMOS detectors is a desirable paradigm shift that will depend on the ability to match the high performance characteristics of CCDs. Digital X-ray imaging applications (chest X-ray, mammography) would benefit greatly from this shift because CMOS detectors have the following inherent characteristics: (1) Low operating power (5 - 10 times lower than CCD/processing electronics). (2) Standard CMOS manufacturing process (CCD requires special manufacturing). (3) On-chip integration of analog/digital processing functions (difficult with CCD). (4) Low Cost (5 - 10 times lower cost than CCD). The achievement of both low cost and low power is highly desirable for portable applications as well as situations where large, expensive X-ray imaging machines are not feasible (small hospitals and clinics, emergency medical vehicles, remote sites). Achieving this goal using commercially available components would allow rapid development of such digital X-ray systems as compared with the development difficulties incurred through specialized direct detectors and systems. The focus of this paper is to evaluate a CMOS image detector for medical X-ray applications and to demonstrate the results obtained from a prototype CMOS digital X-ray camera. Results from the images collected from this optically-coupled camera are presented for a particular lens, X-ray conversion screen, and demagnification factor. Further, an overview of the overall power consumption and cost of a multi-sensor CMOS mosaic compared to its CCD counterpart are also reported.