S. N. Swetadri Vasan

Design considerations for a new, high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS).

The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.

EMCCD-based high resolution dynamic x-ray detector for neurovascular interventions

We have designed and developed from the discrete component level a high resolution dynamic detector for neurovascular interventions. The heart of the detector is a 1024 × 1024 pixel electron multiplying charge coupled device (EMCCD) with a pixel size of 13 × 13 μm2, bonded to a fiber optic plate (FOP), and optically coupled to a 350 μm micro-columnar CsI(TI) scintillator via a 3.3:1 fiber optic taper (FOT). The detector provides x-ray images of 9 cycles/mm resolution at 15 frames/sec and real time live video at 30 frames/sec with binning at a lower resolution, both independent of gain applied to EMCCD, as needed for region-of-interest (ROI) image guidance during neurovascular interventions.

Spatially different, real-time temporal filtering and dose reduction for dynamic image guidance during neurovascular interventions

Fluoroscopic systems have excellent temporal resolution, but are relatively noisy. In this paper we present a recursive temporal filter with different weights (lag) for different user selected regions of interest (ROI) to assist the neurointerventionalist during an image guided catheter procedure. The filter has been implemented on a Graphics Processor (GPU), enabling its usage for fast frame rates such as during fluoroscopy. We first demonstrate the use of this GPU-implemented rapid temporal filtering technique during an endovascular image guided intervention with normal fluoroscopy. Next we demonstrate its use in combination with ROI fluoroscopy where the exposure is substantially reduced in the peripheral region outside the ROI, which is then software-matched in brightness and filtered using the differential temporal filter. This enables patient dose savings along with improved image quality.

Dose reduction in fluoroscopic interventions using a combination of a region of interest (ROI) x-ray attenuator and spatially different, temporally variable temporal filtering

A novel dose reduction technique for fluoroscopic interventions involving a combination of a material x-ray region of interest (ROI) attenuator and spatially different, temporally variable ROI temporal recursive filter, was used to guide the catheter to the ROI in three live animal studies, two involving rabbits and one involving a sheep. In the two rabbit studies presented , a catheter was guided to the entrance of the carotid artery. With the added ROI attenuator the image under the high attenuation region is very noisy. By using temporal filtering with a filter weight of 0.6 on previous frames, the noise is reduced. In the sheep study the catheter was guided to the descending aorta of the animal. The sheep offered a relatively higher attenuation to the incident x-rays and thus a higher temporal filter weight of 0.8 on previous frames was used during the procedure to reduce the noise to levels acceptable by the interventionalist. The image sequences from both studies show that significant dose reduction of 5-6 times can be achieved with acceptable image quality outside the ROI by using the above mentioned technique. Even though the temporal filter weighting outside the ROI is higher, the consequent lag does not prevent perception of catheter movement.

Workflow for the use of a high-resolution image detector in endovascular interventional procedures

Endovascular image-guided intervention (EIGI) has become the primary interventional therapy for the most widespread vascular diseases. These procedures involve the insertion of a catheter into the femoral artery, which is then threaded under fluoroscopic guidance to the site of the pathology to be treated. Flat Panel Detectors (FPDs) are normally used for EIGIs; however, once the catheter is guided to the pathological site, high-resolution imaging capabilities can be used for accurately guiding a successful endovascular treatment. The Micro-Angiographic Fluoroscope (MAF) detector provides needed high-resolution, high-sensitivity, and real-time imaging capabilities. An experimental MAF enabled with a Control, Acquisition, Processing, Image Display and Storage (CAPIDS) system was installed and aligned on a detector changer attached to the C-arm of a clinical angiographic unit. The CAPIDS system 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 including: fluoroscopy, roadmap, radiography, and digital-subtraction-angiography (DSA). Using the automatic controls, the MAF detector can be moved to the deployed position, in front of a standard FPD, whenever higher resolution is needed during angiographic or interventional vascular imaging procedures. To minimize any possible negative impact to image guidance with the two detector systems, it is essential to have a well-designed workflow that enables smooth deployment of the MAF at critical stages of clinical procedures. For the ultimate success of this new imaging capability, a clear understanding of the workflow design is essential. This presentation provides a detailed description and demonstration of such a workflow design.

Image acquisition, geometric correction and display of images from a 2x2 x-ray detector array based on electron multiplying charge coupled device (EMCCD) technology

A high resolution (up to 11.2 lp/mm) x-ray detector with larger field of view (8.5 cm x 8.5 cm) has been developed. The detector is a 2 x 2 array of individual imaging modules based on EMCCD technology. Each module outputs a frame of size 1088 x 1037 pixels, each 12 bits. The frames from the 4 modules are acquired into the processing computer using one of two techniques. The first uses 2 CameraLink communication channels with each carrying information from two modules, the second uses a application specific custom integrated circuits, the Multiple Module Multiplexer Integrated Circuit (MMMIC), 3 of which are used to multiplex the data from 4 modules into one CameraLink channel. Once the data is acquired using either of the above mentioned techniques, it is decoded in the graphics processing unit (GPU) to form one single frame of size 2176 x 2074 pixels each 16 bits. Each imaging module uses a fiber optic taper coupled to the EMCCD sensor. To correct for mechanical misalignment between the sensors and the fiber optic tapers and produce a single seamless image, the images in each module may be rotated and translated slightly in the x-y plane with respect to each other. To evaluate the detector acquisition and correction techniques, an aneurysm model was placed over an anthropomorphic head phantom and a coil was guided into the aneurysm under fluoroscopic guidance using the detector array. Image sequences before and after correction are presented which show near-seamless boundary matching and are well suited for fluoroscopic imaging.

Implementation of digital multiplexing for high resolution x-ray detector arrays

We describe and demonstrate for the first time the use of the novel Multiple Module Multiplexer (MMMIC) [1] for a 2×2 array of new electron multiplying charge coupled device (EMCCD) based x-ray detectors [2]. It is highly desirable for x-ray imaging systems to have larger fields of view (FOV) extensible in two directions yet to still be capable of doing high resolution imaging over regions-of-interest (ROI). The MMMIC achieves these goals by acquiring and multiplexing data from an array of imaging modules thereby enabling a larger FOV, and at the same time allowing high resolution ROI imaging through selection of a subset of modules in the array. MMMIC also supports different binning modes. This paper describes how a specific two stage configuration connecting three identical MMMICs is used to acquire and multiplex data from a 2×2 array of EMCCD based detectors. The first stage contains two MMMICs wherein each MMMIC is getting data from two EMCCD detectors. The multiplexed data from these MMMICs is then forwarded to the second stage MMMIC in the similar fashion. The second stage that has only one MMMIC gives the final 12 bit multiplexed data from four modules. This data is then sent over a high speed Camera Link interface to the image processing computer. X-ray images taken through the 2×2 array of EMCCD based detectors using this two stage configuration of MMMICs are shown successfully demonstrating the concept.

Dose reduction technique using a combination of a region of interest (ROI) material x-ray attenuator and spatially different temporal filtering for fluoroscopic interventions

We demonstrate a novel approach for achieving patient dose savings during image-guided neurovascular interventions, involving a combination of a material x-ray region of interest (ROI) attenuator and a spatially different ROI temporal filtering technique. The part of the image under the attenuator is reduced in dose but noisy and less bright due to fewer x-ray quanta reaching the detector, as compared to the non-attenuating (or less attenuating) region. First the brightness is equalized throughout the image by post processing and then a temporal filter with higher weights is applied to the high attenuating region to reduce the noise, at the cost of increased lag; however, in the regions where less attenuation is present, a lower temporal weight is needed and is applied to preserve temporal resolution. A simulation of the technique is first presented on an actual image sequence obtained from an endovascular image guided interventional (EIGI) procedure. Then the actual implementation of the technique with a physical ROI attenuator is presented. Quantitative analysis including noise analysis and integral dose calculations are presented to validate the proposed technique.

Detector system comparison using relative CNR for specific imaging tasks related to neuro-endovascular image-guided interventions (neuro-EIGIs)

Neuro-EIGIs require visualization of very small endovascular devices and small vessels. A Microangiographic Fluoroscope (MAF) x-ray detector was developed to improve on the standard flat panel detector’s (FPD’s) ability to visualize small objects during neuro-EIGIs. To compare the performance of FPD and MAF imaging systems, specific imaging tasks related to those encountered during neuro-EIGIs were used to assess contrast to noise ratio (CNR) of different objects. A bar phantom and a stent were placed at a fixed distance from the x-ray focal spot to mimic a clinical imaging geometry and both objects were imaged by each detector system. Imaging was done without anti-scatter grids and using the same conditions for each system including: the same x-ray beam quality, collimator position, source to imager distance (SID), and source to object distance (SOD). For each object, relative contrasts were found for both imaging systems using the peak and trough signals. The relative noise was found using mean background signal and background noise for varying detector exposures. Next, the CNRs were found for these values for each object imaged and for each imaging system used. A relative CNR metric is defined and used to compare detector imaging performance. The MAF utilizes a temporal filter to reduce the overall image noise. The effects of using this filter with the MAF while imaging the clinical object’s CNRs are reported. The relative CNR for the detectors demonstrated that the MAF has superior CNRs for most objects and exposures investigated for this specific imaging task.

Intrinsic and total system performance evaluation for a newly developed Solid State X-ray Image Intensifier (SSXII) detector

The new Solid State X-ray Image Intensifier (SSXII) is a high-resolution, high-sensitivity, real-time region-ofinterest (ROI) x-ray imaging detector. Evaluations were made of both standard linear systems metrics (MTF, DQE) and total system performance with generalized linear systems metrics (GMTF, GDQE) including scatter and geometric un-sharpness for simulated clinical conditions. The SSXII is based on a 1k x 1k EMCCD sensor coupled to a 300 μm thick CsI(Tl) phosphor through a 2.88:1 fiber optic taper resulting in a 37 μm effective pixel size and an effective 3.7 cm x 3.7 cm square field-of-view (FOV). Standard methods were used to calculate MTF, NNPS and DQE. Generalized metrics were calculated and compared for three different magnifications (1.03, 1.11 and 1.2) and three different focal spots (0.3 mm, 0.5 mm and 0.8 mm) for a scatter fraction of 0.28. For an RQA5 spectrum, at 5 cycles/mm the MTF was found to be 0.06 and DQE was 0.04, while the DQE(0) was 0.60. Focal spot un-sharpness and scatter significantly degrades the GMTF and GDQE performance of the detector. A low frequency drop is caused by scatter and is almost independent of focal spot size and magnification. The degradation for middle range frequencies is caused by geometric un-sharpness and increases with focal spot size and magnification. This degradation was least in the case of the small focal spot and almost independent of magnification. In spite of this degradation, the high resolution SSXII with a small FOV may have a significant impact on ROI image-guided neuro-interventions since it demonstrates far better performance than standard current detectors.