Youcef El-Mohri

Empirical and theoretical investigation of the noise performance of indirect detection, active matrix flat‐panel imagers (AMFPIs) for diagnostic radiology

Noise properties of active matrix, flat-panel imagers under conditions relevant to diagnostic radiology are investigated. These studies focus on imagers based upon arrays with pixels incorporating a discrete photodiode coupled to a thin-film transistor, both fabricated from hydrogenated amorphous silicon. These optically sensitive arrays are operated with an overlying x-ray converter to allow indirect detection of incident x rays. External electronics, including gate driver circuits and preamplification circuits, are also required to operate the arrays. A theoretical model describing the signal and noise transfer properties of the imagers under conditions relevant to diagnostic radiography, fluoroscopy, and mammography is developed. This frequency-dependent model is based upon a cascaded systems analysis wherein the imager is conceptually divided into a series of stages having intrinsic gain and spreading properties. Predictions from the model are compared with x-ray sensitivity and noise measurements obtained from individual pixels from an imager with a pixel format of 1536 x 1920 pixels at a pixel pitch of 127 microns. The model is shown to be in excellent agreement with measurements obtained with diagnostic x rays using various phosphor screens. The model is used to explore the potential performance of existing and hypothetical imagers for application in radiography, fluoroscopy, and mammography as a function of exposure, additive noise, and fill factor. These theoretical predictions suggest that imagers of this general design incorporating a CsI: Tl intensifying screen can be optimized to provide detective quantum efficiency (DQE) superior to existing screen-film and storage phosphor systems for general radiography and mammography. For fluoroscopy, the model predicts that with further optimization of a-Si:H imagers, DQE performance approaching that of the best x-ray image intensifier systems may be possible. The results of this analysis suggest strategies for future improvements of this imaging technology.

Signal, noise power spectrum, and detective quantum efficiency of indirect-detection flat-panel imagers for diagnostic radiology

The performance of an indirect-detection, active matrix flat-panel imager (FPI) at diagnostic energies is reported in terms of measured and theoretical signal size, noise power spectrum (NPS), and detective quantum efficiency (DQE). Based upon a 1536 x 1920 pixel, 127 microns pitch array of a-Si:H thin-film transistors and photodiodes, the FPI was developed as a prototype for examination of the potential of flat-panel technology in diagnostic x-ray imaging. The signal size per unit exposure (x-ray sensitivity) was measured for the FPI incorporating five commercially available Gd2O2S:Tb converting screens at energies 70-120 kVp. One-dimensional and two-dimensional NPS and DQE were measured for the FPI incorporating three such converters and as a function of the incident exposure. The measurements support the hypothesis that FPIs have significant potential for application in diagnostic radiology. A cascaded systems model that has shown good agreement with measured individual pixel signal and noise properties is employed to describe the performance of various FPI designs and configurations under a variety of diagnostic imaging conditions. Theoretical x-ray sensitivity, NPS, and DQE are compared to empirical results, and good agreement is observed in each case. The model is used to describe the potential performance of FPIs incorporating a recently developed, enhanced array that is commercially available and has been proposed for testing and application in diagnostic radiography and fluoroscopy. Under conditions corresponding to chest radiography, the analysis suggests that such systems can potentially meet or even exceed the DQE performance of existing technology, such as screen-film and storage phosphor systems; however, under conditions corresponding to general fluoroscopy, the typical exposure per frame is such that the DQE is limited by the total system gain and additive electronic noise. The cascaded systems analysis provides a valuable means of identifying the limiting stages of the imaging system, a tool for system optimization, and a guide for developing strategies of FPI design for various imaging applications.

Strategies to improve the signal and noise performance of active matrix, flat-panel imagers for diagnostic x-ray applications.

A theoretical investigation of factors limiting the detective quantum efficiency (DQE) of active matrix flat-panel imagers (AMFPIs), and of methods to overcome these limitations, is reported. At the higher exposure levels associated with radiography, the present generation of AMFPIs is capable of exhibiting DQE performance equivalent, or superior, to that of existing film-screen and computed radiography systems. However, at exposure levels commonly encountered in fluoroscopy, AMFPIs exhibit significantly reduced DQE and this problem is accentuated at higher spatial frequencies. The problem applies both to AMFPIs that rely on indirect detection as well as direct detection of the incident radiation. This reduced performance derives from the relatively large magnitude of the square of the total additive noise compared to the system gain for existing AMFPIs. In order to circumvent these restrictions, a variety of strategies to decrease additive noise and enhance system gain are proposed. Additive noise could be reduced through improved preamplifier, pixel and array design, including the incorporation of compensation lines to sample external line noise. System gain could be enhanced through the use of continuous photodiodes, pixel amplifiers, or higher gain x-ray converters such as lead iodide. The feasibility of these and other strategies is discussed and potential improvements to DQE performance are quantified through a theoretical investigation of a variety of hypothetical 200 microm pitch designs. At low exposures, such improvements could greatly increase the magnitude of the low spatial frequency component of the DQE, rendering it practically independent of exposure while simultaneously reducing the falloff in DQE at higher spatial frequencies. Furthermore, such noise reduction and gain enhancement could lead to the development of AMFPIs with high DQE performance which are capable of providing both high resolution radiographic images, at approximately 100 microm pixel resolution, as well as variable resolution fluoroscopic images at 30 fps.

Relative dosimetry using active matrix flat-panel imager (AMFPI) technology

The first examination of the use of active matrix flat-panel arrays for dosimetry in radiotherapy is reported. Such arrays are under widespread development for diagnostic and radiotherapy imaging. In the current study, an array consisting of 512 x 512 pixels with a pixel pitch of 508 microm giving an area of 26 x 26 cm2 has been used. Each pixel consists of a light sensitive amorphous silicon (a-Si:H) photodiode coupled to an a-Si:H thin-film transistor. Data was obtained from the array using a dedicated electronics system allowing real-time data acquisition. In order to examine the potential of such arrays as quality assurance devices for radiotherapy beams, field profile data at photon energies of 6 and 15 MV were obtained as a function of field size and thickness of overlying absorbing material (solid water). Two detection configurations using the array were considered: a configuration (similar to the imaging configuration) in which an overlying phosphor screen is used to convert incident radiation to visible light photons which are detected by the photodiodes; and a configuration without the screen where radiation is directly sensed by the photodiodes. Compared to relative dosimetry data obtained with an ion chamber, data taken using the former configuration exhibited significant differences whereas data obtained using the latter configuration was generally found to be in close agreement. Basic signal properties, which are pertinent to dosimetry, have been investigated through measurements of individual pixel response for fluoroscopic and radiographic array operation. For signal levels acquired within the first 25% of pixel charge capacity, the degree of linear response with dose was found to be better than 99%. The independence of signal on dose rate was demonstrated by means of stability of pixel response over the range of dose rates allowed by the radiation source (80-400 MU/min). Finally, excellent long-term stability in pixel response, extending over a 2 month period, was observed.

Empirical investigation of the signal performance of a high-resolution, indirect detection, active matrix flat-panel imager (AMFPI) for fluoroscopic and radiographic operation

Signal properties of the first large-area, high resolution, active matrix, flat-panel imager are reported. The imager is based on an array of 1536 x 1920 pixels with a pixel-to-pixel pitch of 127 microns. Each pixel consists of a discrete amorphous silicon n-i-p photodiode coupled to an amorphous silicon thin-film transistor. The imager detects incident x rays indirectly by means of an intensifying screen placed over the array. External acquisition electronics send control signals to the array and process analog imaging signals from the pixels. Considerations for operation of the imager in both fluoroscopic and radiographic modes are detailed and empirical signal performance data are presented with an emphasis on exploring similarities and differences between the two modes. Measurements which characterize the performance of the imager were performed as a function of operational parameters in the absence or presence of illumination from a light-emitting diode or x rays. These measurements include characterization of the drift and magnitude of the pixel dark signal, the size of the pixel switching transient, the temporal behavior of pixel sampling and the implied maximum frame rate, the dependence of relative pixel efficiency and pixel response on photodiode reverse bias voltage and operational mode, the degree of linearity of pixel response, and the trapping and release of charge from metastable states in the photodiodes. In addition, X-ray sensitivity as a function of energy for a variety of phosphor screens for both fluoroscopic and radiographic operation is reported. Example images of a line-pair pattern and an anthropomorphic phantom in each mode are presented along with a radiographic image of a human hand. General and specific improvements in imager design are described and anticipated developments are discussed. This represents the first systematic investigation of the operation and properties in both radiographic and fluoroscopic modes of an imager incorporating such an array.

Initial performance evaluation of an indirect-detection, active matrix flat-panel imager (AMFPI) prototype for megavoltage imaging

PURPOSE The development of the first prototype active matrix flat-panel imager (AMFPI) capable of radiographic and fluoroscopic megavoltage operation is reported. The signal and noise performance of individual pixels is empirically quantified. Results of an observer-dependent study of imaging performance, using a contrast-detail phantom, are detailed and radiographic patient images are shown. Finally, a theoretical investigation of the zero-frequency detective quantum efficiency (DQE) performance of such imagers, using a cascaded systems formalism, is presented. METHODS AND MATERIALS The imager is based on a 508-microm pitch, 26 x 26 cm2 array which detects radiation indirectly via an overlying copper plate + phosphor screen converter. RESULTS Due to its excellent optical coupling, the imager exhibits sensitivity superior to that of video-based systems. With an approximately 133 mg/cm2 Gd2O2S:Tb screen the system is x-ray quantum-noise-limited down to approximately 0.3 cGy, conservatively, and extensions of this behavior to even lower doses by means of reduced additive electronic noise is predicted. The observer-dependent study indicates performance superior to that of conventional radiotherapy film while the patient images demonstrate good image quality at 1 to 4 MU. The theoretical studies suggest that, with a 133 mg/cm2 Gd2O2S:Tb screen, the system would provide DQE performance equivalent to that of video-based systems and that almost a factor of two improvement in DQE is achievable through the incorporation of a 400 mg/cm2 screen. CONCLUSION The reported prototype imager is the first megavoltage AMFPI having performance characteristics consistent with practical clinical operation. The superior contrast-detail sensitivity of the imager allows the capture of high-quality 6- and 15-MV images at minimal dose. Moreover, significant performance improvements, including extension of the operational range up to full portal doses, appear feasible. Such capabilities could be of considerable practical benefit in patient localization and verification.

Determination of the detective quantum efficiency of a prototype, megavoltage indirect detection, active matrix flat‐panel imager

After years of aggressive development, active matrix flat-panel imagers (AMFPIs) have recently become commercially available for radiotherapy imaging. In this paper we report on a comprehensive evaluation of the signal and noise performance of a large-area prototype AMFPI specifically developed for this application. The imager is based on an array of 512 x 512 pixels incorporating amorphous silicon photodiodes and thin-film transistors offering a 26 x 26 cm2 active area at a pixel pitch of 508 microm. This indirect detection array was coupled to various x-ray converters consisting of a commercial phosphor screen (Lanex Fast B, Lanex Regular, or Lanex Fine) and a 1 mm thick copper plate. Performance of the imager in terms of measured sensitivity, modulation transfer function (MTF), noise power spectra (NPS), and detective quantum efficiency (DQE) is reported at beam energies of 6 and 15 MV and at doses of 1 and 2 monitor units (MU). In addition, calculations of system performance (NPS, DQE) based on cascaded-system formalism were reported and compared to empirical results. In these calculations, the Swank factor and spatial energy distributions of secondary electrons within the converter were modeled by means of EGS4 Monte Carlo simulations. Measured MTFs of the system show a weak dependence on screen type (i.e., thickness), which is partially due to the spreading of secondary radiation. Measured DQE was found to be independent of dose for the Fast B screen, implying that the imager is input-quantum-limited at 1 MU, even at an extended source-to-detector distance of 200 cm. The maximum DQE obtained is around 1%--a limit imposed by the low detection efficiency of the converter. For thinner phosphor screens, the DQE is lower due to their lower detection efficiencies. Finally, for the Fast B screen, good agreement between calculated and measured DQE was observed.

Segmented crystalline scintillators: An initial investigation of high quantum efficiency detectors for megavoltage x‐ray imaging

Electronic portal imaging devices (EPIDs) based on indirect detection, active matrix flat panel imagers (AMFPIs) have become the technology of choice for geometric verification of patient localization and dose delivery in external beam radiotherapy. However, current AMFPI EPIDs, which are based on powdered-phosphor screens, make use of only approximately 2% of the incident radiation, thus severely limiting their imaging performance as quantified by the detective quantum efficiency (DQE) (approximately 1%, compared to approximately 75% for kilovoltage AMFPIs). With the rapidly increasing adoption of image-guided techniques in virtually every aspect of radiotherapy, there exist strong incentives to develop high-DQE megavoltage x-ray imagers, capable of providing soft-tissue contrast at very low doses in megavoltage tomographic and, potentially, projection imaging. In this work we present a systematic theoretical and preliminary empirical evaluation of a promising, high-quantum-efficiency, megavoltage x-ray detector design based on a two-dimensional matrix of thick, optically isolated, crystalline scintillator elements. The detector is coupled with an indirect detection-based active matrix array, with the center-to-center spacing of the crystalline elements chosen to match the pitch of the underlying array pixels. Such a design enables the utilization of a significantly larger fraction of the incident radiation (up to 80% for a 6 MV beam), through increases in the thickness of the crystalline elements, without loss of spatial resolution due to the spread of optical photons. Radiation damage studies were performed on test samples of two candidate scintillator materials, CsI(Tl) and BGO, under conditions relevant to radiotherapy imaging. A detailed Monte Carlo-based study was performed in order to examine the signal, spatial spreading, and noise properties of the absorbed energy for several segmented detector configurations. Parameters studied included scintillator material, septal wall material, detector thickness, and the thickness of the septal walls. The results of the Monte Carlo simulations were used to estimate the upper limits of the modulation transfer function, noise power spectrum and the DQE for a select number of configurations. An exploratory, small-area prototype segmented detector was fabricated by infusing crystalline CsI(Tl) in a 2 mm thick tungsten matrix, and the signal response was measured under radiotherapy imaging conditions. Results from the radiation damage studies showed that both CsI(Tl) and BGO exhibited less than approximately 15% reduction in light output after 2500 cGy equivalent dose. The prototype CsI(Tl) segmented detector exhibited high uniformity, but a lower-than-expected magnitude of signal response. Finally, results from Monte Carlo studies strongly indicate that high scintillator-fill-factor configurations, incorporating high-density scintillator and septal wall materials, could achieve up to 50 times higher DQE compared to current AMFPI EPIDs.

Megavoltage imaging with a large-area, flat-panel, amorphous silicon imager

PURPOSE The creation of the first large-area, amorphous silicon megavoltage imager is reported. The imager is an engineering prototype built to serve as a stepping stone toward the creation of a future clinical prototype. The engineering prototype is described and various images demonstrating its properties are shown including the first reported patient image acquired with such an amorphous silicon imaging device. Specific limitations in the engineering prototype are reviewed and potential advantages of future, more optimized imagers of this type are presented. METHODS AND MATERIALS The imager is based on a two-dimensional, pixelated array containing amorphous silicon field-effect transistors and photodiode sensors which are deposited on a thin glass substrate. The array has a 512 x 560-pixel format and a pixel pitch of 450 microns giving an imaging area of approximately 23 x 25 cm2. The array is used in conjunction with an overlying metal plate/phosphor screen converter as well as an electronic acquisition system. Images were acquired fluoroscopically using a megavoltage treatment machine. RESULTS Array and digitized film images of a variety of anthropomorphic phantoms and of a human subject are presented and compared. The information content of the array images generally appears to be at least as great as that of the digitized film images. CONCLUSION Despite a variety of severe limitations in the engineering prototype, including many array defects, a relatively slow and noisy acquisition system, and the lack of a means to generate images in a radiographic manner, the prototype nevertheless generated clinically useful information. The general properties of these amorphous silicon arrays, along with the quality of the images provided by the engineering prototype, strongly suggest that such arrays could eventually form the basis of a new imaging technology for radiotherapy localization and verification. The development of a clinically useful prototype offering high-quality images, ultimately with an approximately 52 x 52-cm2 detection surface, is anticipated.

Additive noise properties of active matrix flat-panel imagers

A detailed theoretical and empirical investigation of additive noise for indirect detection, active matrix flat-panel imagers (AMFPIs) has been performed. Such imagers comprise a pixelated array, incorporating photodiodes and thin-film transistors (TFTs), and an associated electronic acquisition system. A theoretical model of additive noise, defined as the noise of an imaging system in the absence of radiation, has been developed. This model is based upon an equivalent-noise-circuit representation of an AMFPI. The model contains a number of uncorrelated noise components which have been designated as pixel noise, data line thermal noise, externally coupled noise, preamplifier noise and digitization noise. Pixel noise is further divided into the following components: TFT thermal noise, shot and 1/f noise associated with the TFT and photodiode leakage currents, and TFT transient noise. Measurements of various additive noise components were carried out on a prototype imaging system based on a 508 microm pitch, 26 x 26 cm2 array. Other measurements were performed in the absence of the array, involving discrete components connected to the preamplifier input. Overall, model predictions of total additive noise as well as of pixel, preamplifier, and data line thermal noise components were in agreement with results of their measured counterparts. For the imaging system examined, the model predicts that pixel noise is dominated by shot and 1/f noise components of the photodiode and TFT at frame times above approximately 1 s. As frame time decreases, pixel noise is increasingly dominated by TFT thermal noise. Under these conditions, the reasonable degree of agreement observed between measurements and model predictions provides strong evidence that the role of TFT thermal noise has been properly incorporated into the model. Finally, the role of the resistance and capacitance of array data lines in the model was investigated using discrete component circuits at the preamplifier input. Measurements of preamplifier noise and data line thermal noise components as a function of input capacitance and resistance were found to be in reasonable agreement with model predictions.