V Patel

A practical exposure-equivalent metric for instrumentation noise in x-ray imaging systems

The performance of high-sensitivity x-ray imagers may be limited by additive instrumentation noise rather than by quantum noise when operated at the low exposure rates used in fluoroscopic procedures. The equipment-invasive instrumentation noise measures (in terms of electrons) are generally difficult to make and are potentially not as helpful in clinical practice as would be a direct radiological representation of such noise that may be determined in the field. In this work, we define a clinically relevant representation for instrumentation noise in terms of noise-equivalent detector entrance exposure, termed the instrumentation noise-equivalent exposure (INEE), which can be determined through experimental measurements of noise-variance or signal-to-noise ratio (SNR). The INEE was measured for various detectors, thus demonstrating its usefulness in terms of providing information about the effective operating range of the various detectors. A simulation study is presented to demonstrate the robustness of this metric against post-processing, and its dependence on inherent detector blur. These studies suggest that the INEE may be a practical gauge to determine and compare the range of quantum-limited performance for clinical x-ray detectors of different design, with the implication that detector performance at exposures below the INEE will be instrumentation-noise limited rather than quantum-noise limited.

The Solid-State X-Ray Image Intensifier (SSXII): An EMCCD- Based X-Ray Detector

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.

Rotational micro‐CT using a clinical C‐arm angiography gantry

Rotational angiography (RA) gantries are used routinely to acquire sequences of projection images of patients from which 3D renderings of vascular structures are generated using Feldkamp cone-beam reconstruction algorithms. However, these systems have limited resolution (<4 lp/mm). Micro-computed tomography (micro-CT) systems have better resolution (>10 lp/mm) but to date have relied either on rotating object imaging or small bore geometry for small animal imaging, and thus are not used for clinical imaging. The authors report here the development and use of a 3D rotational micro-angiography (RMA) system created by mounting a micro-angiographic fluoroscope (MAF) [35 microm pixel, resolution >10 microp/mm, field of view (FOV)=3.6 cm] on a standard clinical FPD-based RA gantry (Infinix, Model RTP12303J-G9E, Toshiba Medical Systems Corp., Tustin, CA). RA image sequences are obtained using the MAF and reconstructed. To eliminate artifacts due to image truncation, lower-dose (compared to MAF acquisition) full-FOV (FFOV) FPD RA sequences (194 microm pixel, FOV=20 cm) were also obtained to complete the missing data. The RA gantry was calibrated using a helical bead phantom. To ensure high-quality high-resolution reconstruction, the high-resolution images from the MAF were aligned spatially with the lower-dose FPD images, and the pixel values in the FPD image data were scaled to match those of the MAF. Images of a rabbit with a coronary stent placed in an artery in the Circle of Willis were obtained and reconstructed. The MAF images appear well aligned with the FPD images (average correlation coefficient before and after alignment: 0.65 and 0.97, respectively) Greater details without any visible truncation artifacts are seen in 3D RMA (MAF-FPD) images than in those of the FPD alone. The FWHM of line profiles of stent struts (100 microm diameter) are approximately 192+/-21 and 313+/-38 microm for the 3D RMA and FPD data, respectively. In addition, for the dual-acquisition 3D RMA, FFOV FPD data need not be of the highest quality, and thus may be acquired at lower dose compared to a standard FPD acquisition. These results indicate that this system could provide the basis for high resolution images of regions of interest in patients with a reduction in the integral dose compared to the standard FPD approach.

Progress in electron-multiplying CCD (EMCCD) based, high-resolution, high-sensitivity x-ray detector for fluoroscopy and radiography

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 EMCCDs 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.

Implementation of a high-sensitivity Micro-Angiographic Fluoroscope (HS-MAF) for in-vivo endovascular image guided interventions (EIGI) and region-of-interest computed tomography (ROI-CT)

New advances in catheter technology and remote actuation for minimally invasive procedures are continuously increasing the demand for better x-ray imaging technology. The new x-ray high-sensitivity Micro-Angiographic Fluoroscope (HS-MAF) detector offers high resolution and real-time image-guided capabilities which are unique when compared with commercially available detectors. This detector consists of a 300 μm CsI input phosphor coupled to a dual stage GEN2 micro-channel plate light image intensifier (LII), followed by minifying fiber-optic taper coupled to a CCD chip. The HS-MAF detector image array is 1024X1024 pixels, with a 12 bit depth capable of imaging at 30 frames per second. The detector has a round field of view with 4 cm diameter and 35 microns pixels. The LII has a large variable gain which allows usage of the detector at very low exposures characteristic of fluoroscopic ranges while maintaining very good image quality. The custom acquisition program allows real-time image display and data storage. We designed a set of in-vivo experimental interventions in which placement of specially designed endovascular stents were evaluated with the new detector and with a standard x-ray image intensifier (XII). Capabilities such fluoroscopy, angiography and ROI-CT reconstruction using rotational angiography data were implemented and verified. The images obtained during interventions under radiographic control with the HS-MAF detector were superior to those with the XII. In general, the device feature markers, the device structures, and the vessel geometry were better identified with the new detector. High-resolution detectors such as HS-MAF can vastly improve the accuracy of localization and tracking of devices such stents or catheters.

LabVIEW Graphical User Interface for a New High Sensitivity, High Resolution Micro-Angio-Fluoroscopic and ROI-CBCT System

A graphical user interface based on LabVIEW software was developed to enable clinical evaluation of a new High-Sensitivity Micro-Angio-Fluoroscopic (HSMAF) system for real-time acquisition, display and rapid frame transfer of high-resolution region-of-interest images. The HSMAF detector consists of a CsI(Tl) phosphor, a light image intensifier (LII), and a fiber-optic taper coupled to a progressive scan, frame-transfer, charged-coupled device (CCD) camera which provides real-time 12 bit, 1k × 1k images capable of greater than 10 lp/mm resolution. Images can be captured in continuous or triggered mode, and the camera can be programmed by a computer using Camera Link serial communication. A graphical user interface was developed to control the camera modes such as gain and pixel binning as well as to acquire, store, display, and process the images. The program, written in LabVIEW, has the following capabilities: camera initialization, synchronized image acquisition with the x-ray pulses, roadmap and digital subtraction angiography acquisition (DSA), flat field correction, brightness and contrast control, last frame hold in fluoroscopy, looped play-back of the acquired images in angiography, recursive temporal filtering and LII gain control. Frame rates can be up to 30 fps in full-resolution mode. The user friendly implementation of the interface along with the high frame-rate acquisition and display for this unique high-resolution detector should provide angiographers and interventionalists with a new capability for visualizing details of small vessels and endovascular devices such as stents and hence enable more accurate diagnoses and image guided interventions.

New microangiography system development providing improved small vessel imaging, increased contrast to noise ratios, and multi-view 3D reconstructions.

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.

Experimental comparison of cone beam CT (CBCT) reconstruction and multi-view reconstruction (MVR) for microangiography (MA) detector system

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.

SU‐FF‐I‐108: Effect of Point Spread Function, X‐Ray Quantum Noise, and Additive Instrumentation Noise On the Accuracy of the Angulated Slit Method for Determination of Pre‐Sampled Detector MTF

Purpose: To evaluate the accuracy of the angulated‐slit method for determining the detectorModulation Transfer Function(MTF) and thus, for the first time to determine the accuracy of the method for various physical circumstances. We quantify the difference between “true” MTFs and “measured” MTFs obtained using the angulated‐slit method. Method and Materials: A series of simulated slit images were initially generated without blur, with different slit‐widths, different slit‐angles relative to the detector matrix, and with and without Poisson distributed x‐ray quantum noise. We used the angled‐slit method to calculate the MTF and compared it with the “true” MTF (a sinc‐function given by the pixel aperture). We then introduced known Gaussian blur and additive instrumentation noise to simulate more realistic slit images. The MTFs “measured” with the slit method and the “true” MTFs were compared. Results: For the ideal slit without blur, there was an increased error in the measured MTF with increasing slit‐angle and slit‐width, with the greatest error at higher spatial frequencies. Larger slit widths and angles resulted in even greater deviations. Slit images simulated using Poisson distributed quanta, known Gaussian blur, and additive instrumentation noise, resulted in an overall increase in the MTF when compared with the “true” MTF, especially at higher spatial frequencies and increasing deviation with increasing width of the Gaussian blur (around 15% difference at 50% of the Nyquist for a PSF with 3 pixels FWHM and 1% additive noise). Conclusion: These results show the angulated‐slit method to be sensitive to slit‐angle and slit‐width. The presence of quantum noise, additive instrumentation noise and the width of the blur function are shown to severely affect the angled‐slit method accuracy, especially at higher spatial frequencies. Although the slit method provides accurate MTF values at low spatial frequencies, it overestimates the MTF at higher spatial frequencies. (Support: NIH‐R01EB002873)

MO‐D‐332‐07: Update On the Development of a New Dual Detector (Micro‐Angiographic Fluoroscope/Flat Panel) C‐Arm Mounted System for Endovascular Image Guided Interventions (EIGI)

Purpose: To develop a dual detector C‐arm unit, capable of high‐resolution microangiography and fluoroscopy, and Region‐of‐Interest Cone‐Beam CT (ROI‐CBCT). Method and Materials: The Microangiographic Fluoroscope (MAF) (1024×1024×12bits, 35μm pixels, 4 cm field‐of‐view, FOV) was attached with a specially designed holder to a standard C‐arm Flat‐Panel (FP) system. The MAF consists of a 300 μm CsI input phosphor coupled to a dual stage GEN2 micro‐channel plate light image intensifier (LII), followed by a minifying fiber‐optic taper coupled to a 30 fps CCDcamera. The LII has a large variable gain allowing usage for very low (fluoroscopic) exposures while maintaining very good image quality. The holder allows facile placing of the new detector into the FP FOV when use is required or parking when not. The source‐to‐image distance and the orientation of this detector are selected using the same controls as for the standard C‐arm unit. A special switch attached onto the holder allows automatic collimation of the x‐ray beam to the active area of the MAF. The new system was tested in multiple experiments involving phantoms and animals for reliability and capability to perform EIGI procedures and also for dual detector ROI‐CBCT. Results: The new system is being used routinely for EIGI fluoroscopic guidance and microangiography in our research lab. The design allows a variable SID between 69 and 104 cm. During rotational angiography and dual detector ROI‐CBCT, 194 projections are acquired, one every degree. Interventional devices such as endovascular stents placed in the animals and phantoms were reconstructed with great accuracy, and virtually without artifacts. Conclusion: Implementation of such a high‐resolution imager on a clinical system could bring substantial benefits for the treatment of cerebrovascular disease and also potentially increase the motivation to develop improved and more effective endovascular devices. (Funding: NIH Grants R01 EB002873, NS43924).