Johns Hopkins University
Jeffrey H. Siewerdsen, Douglas J. Moseley, Shane Burch, Stuart K. Bisland, Arjen Bogaards, Brian C. Wilson, David A. Jaffray
In: Medical Physics, 32 (1), pp. 241-254, 2005, ISSN: 0094-2405.
A mobile isocentric C-arm (Siemens PowerMobil) has been modified in our laboratory to include a large area flat-panel detector (in place of the x-ray image intensifier), providing multi-mode fluoroscopy and cone-beam computed tomography (CT) imaging capability. This platform represents a promising technology for minimally invasive, image-guided surgical procedures where precision in the placement of interventional tools with respect to bony and soft-tissue structures is critical. The image quality and performance in surgical guidance was investigated in pre-clinical evaluation in image-guided spinal surgery. The control, acquisition, and reconstruction system are described. The reproducibility of geometric calibration, essential to achieving high three-dimensional (3D) image quality, is tested over extended time scales (7 months) and across a broad range in C-arm angulation (up to 45 degrees), quantifying the effect of improper calibration on spatial resolution, soft-tissue visibility, and image artifacts. Phantom studies were performed to investigate the precision of 3D localization (viz., fiber optic probes within a vertebral body) and effect of lateral projection truncation (limited field of view) on soft-tissue detectability in image reconstructions. Pre-clinical investigation was undertaken in a specific spinal procedure (photodynamic therapy of spinal metastases) in five animal subjects (pigs). In each procedure, placement of fiber optic catheters in two vertebrae (L1 and L2) was guided by fluoroscopy and cone-beam CT. Experience across five procedures is reported, focusing on 3D image quality, the effects of respiratory motion, limited field of view, reconstruction filter, and imaging dose. Overall, the intraoperative cone-beam CT images were sufficient for guidance of needles and catheters with respect to bony anatomy and improved surgical performance and confidence through 3D visualization and verification of transpedicular trajectories and tool placement. Future investigation includes improvement in image quality, particularly regarding x-ray scatter, motion artifacts and field of view, and integration with optical tracking and navigation systems.
J Webster Stayman and Jeffrey A Fessler
In: IEEE transactions on medical imaging, 23 (12), pp. 154315-56, 2004, ISSN: 0278-0062.
Resolution and covariance predictors have been derived previously for penalized-likelihood estimators. These predictors can provide accurate approximations to the local resolution properties and covariance functions for tomographic systems given a good estimate of the mean measurements. Although these predictors may be evaluated iteratively, circulant approximations are often made for practical computation times. However, when numerous evaluations are made repeatedly (as in penalty design or calculation of variance images), these predictors still require large amounts of computing time. In Stayman and Fessler (2000), we discussed methods for precomputing a large portion of the predictor for shift-invariant system geometries. In this paper, we generalize the efficient procedure discussed in Stayman and Fessler (2000) to shift-variant single photon emission computed tomography (SPECT) systems. This generalization relies on a new attenuation approximation and several observations on the symmetries in SPECT systems. These new general procedures apply to both two-dimensional and fully three-dimensional (3-D) SPECT models, that may be either precomputed and stored, or written in procedural form. We demonstrate the high accuracy of the predictions based on these methods using a simulated anthropomorphic phantom and fully 3-D SPECT system. The evaluation of these predictors requires significantly less computation time than traditional prediction techniques, once the system geometry specific precomputations have been made.
Jeffrey H. Siewerdsen, Douglas J. Moseley, Babak Bakhtiar, Samuel Richard, David A. Jaffray
In: Medical Physics, 31 (12), pp. 3506-3520, 2004, ISSN: 0094-2405.
The influence of antiscatter x-ray grids on image quality in cone-beam computed tomography (CT) is evaluated through broad experimental investigation for various anatomical sites (head and body), scatter conditions (scatter-to-primary ratio (SPR) ranging from approximately 10% to 150%), patient dose, and spatial resolution in three-dimensional reconstructions. Studies involved linear grids in combination with a flat-panel imager on a system for kilovoltage cone-beam CT imaging and guidance of radiation therapy. Grids were found to be effective in reducing x-ray scatter "cupping" artifacts, with heavier grids providing increased image uniformity. The system was highly robust against ring artifacts that might arise in CT reconstructions as a result of gridline shadows in the projection data. The influence of grids on soft-tissue detectability was evaluated quantitatively in terms of absolute contrast, voxel noise, and contrast-to-noise ratio (CNR) in cone-beam CT reconstructions of 16 cm "head" and 32 cm "body" cylindrical phantoms. Imaging performance was investigated qualitatively in observer preference tests based on patient images (pelvis, abdomen, and head-and-neck sites) acquired with and without antiscatter grids. The results suggest that although grids reduce scatter artifacts and improve subject contrast, there is little strong motivation for the use of grids in cone-beam CT in terms of CNR and overall image quality under most circumstances. The results highlight the tradeoffs in contrast and noise imparted by grids, showing improved image quality with grids only under specific conditions of high x-ray scatter (SPR> 100%), high imaging dose (Dcenter> 2 cGy), and low spatial resolution (voxel size > or = 1 mm).
J H Siewerdsen, A M Waese, D J Moseley, S Richard, D A Jaffray
In: Medical Physics, 31 (11), pp. 3057-3067, 2004, ISSN: 0094-2405.
A set of computational tools are presented that allow convenient calculation of x-ray spectra, selection of elemental and compound filters, and calculation of beam quality characteristics, such as half-value layer, mR/mAs, and fluence per unit exposure. The TASMIP model of Boone and Seibert is adapted to a library of high-level language (Matlab) functions and shown to agree with experimental measurements across a wide range of kVp and beam filtration. Modeling of beam filtration is facilitated by a convenient, extensible database of mass and mass-energy attenuation coefficients compiled from the National Institute of Standards and Technology. The functions and database were integrated in a graphical user interface and made available online at http:// www.aip.org/epaps/epaps.html. The functionality of the toolset and potential for investigation of imaging system optimization was illustrated in theoretical calculations of imaging performance across a broad range of kVp, filter material type, and filter thickness for direct and indirect-detection flat-panel imagers. The calculations reveal a number of nontrivial effects in the energy response of such detectors that may not have been guessed from simple K-edge filter techniques, and point to a variety of compelling hypotheses regarding choice of beam filtration that warrant future investigation.
Auke Pieter Colijn, Wojciech Zbijewski, Alexander Sasov, Freek J. Beekman
In: Physics in Medicine & Biology, 49 (18), pp. 4321-4333, 2004, ISSN: 0031-9155.
We describe a newly developed, accelerated Monte Carlo simulator of a small animal micro-CT scanner. Transmission measurements using aluminium slabs are employed to estimate the spectrum of the x-ray source. The simulator incorporating this spectrum is validated with micro-CT scans of physical water phantoms of various diameters, some containing stainless steel and Teflon rods. Good agreement is found between simulated and real data: normalized error of simulated projections, as compared to the real ones, is typically smaller than 0.05. Also the reconstructions obtained from simulated and real data are found to be similar. Thereafter, effects of scatter are studied using a voxelized software phantom representing a rat body. It is shown that the scatter fraction can reach tens of per cents in specific areas of the body and therefore scatter can significantly affect quantitative accuracy in small animal CT imaging.
J Webster Stayman and Jeffrey A Fessler
In: IEEE transactions on medical imaging, 23 (3), pp. 269-284, 2004, ISSN: 0278-0062.
Imaging systems that form estimates using a statistical approach generally yield images with nonuniform resolution properties. That is, the reconstructed images possess resolution properties marked by space-variant and/or anisotropic responses. We have previously developed a space-variant penalty for penalized-likelihood (PL) reconstruction that yields nearly uniform resolution properties. We demonstrated how to calculate this penalty efficiently and apply it to an idealized positron emission tomography (PET) system whose geometric response is space-invariant. In this paper, we demonstrate the efficient calculation and application of this penalty to space-variant systems. (The method is most appropriate when the system matrix has been precalculated.) We apply the penalty to a large field of view PET system where crystal penetration effects make the geometric response space-variant, and to a two-dimensional single photon emission computed tomography system whose detector responses are modeled by a depth-dependent Gaussian with linearly varying full-width at half-maximum. We perform a simulation study comparing reconstructions using our proposed PL approach with other reconstruction methods and demonstrate the relative resolution uniformity, and discuss tradeoffs among estimators that yield nearly uniform resolution. We observe similar noise performance for the PL and post-smoothed maximum-likelihood (ML) approaches with carefully matched resolution, so choosing one estimator over another should be made on other factors like computational complexity and convergence rates of the iterative reconstruction. Additionally, because the postsmoothed ML and the proposed PL approach can outperform one another in terms of resolution uniformity depending on the desired reconstruction resolution, we present and discuss a hybrid approach adopting both a penalty and post-smoothing.
Wojciech Zbijewski and Freek J Beekman
In: Physics in medicine and biology, 49 (1), pp. 145-157, 2004, ISSN: 0031-9155.
For the purpose of obtaining x-ray tomographic images, statistical reconstruction (SR) provides a general framework with possible advantages over analytical algorithms such as filtered backprojection (FBP) in terms of flexibility, resolution, contrast and image noise. However, SR images may be seriously affected by some artefacts that are not present in FBP images. These artefacts appear as aliasing patterns and as severe overshoots in the areas of sharp intensity transitions ('edge artefacts'). We characterize this inherent property of iterative reconstructions and hypothesize how discretization errors during reconstruction contribute to the formation of the artefacts. An adequate solution to the problem is to perform the reconstructions on an image grid that is finer than that typically employed for FBP reconstruction, followed by a downsampling of the resulting image to a granularity normally used for display. Furthermore, it is shown that such a procedure is much more effective than post-filtering of the reconstructions. Resulting SR images have superior noise-resolution trade-off compared to FBP, which may facilitate dose reduction during CT examinations.
Wojciech Zbijewski and Freek J Beekman
In: Medical Physics, 31 (1), pp. 62-69, 2004, ISSN: 0094-2405.
Statistical reconstruction (SR) methods provide a general and flexible framework for obtaining tomographic images from projections. For several applications SR has been shown to outperform analytical algorithms in terms of resolution-noise trade-off achieved in the reconstructions. A disadvantage of SR is the long computational time required to obtain the reconstructions, in particular when large data sets characteristic for x-ray computer tomography (CT) are involved. As was shown recently, by combining statistical methods with block iterative acceleration schemes [e.g., like in the ordered subsets convex (OSC) algorithm], the reconstruction time for x-ray CT applications can be reduced by about two orders of magnitude. There are, however, some factors lengthening the reconstruction process that hamper both accelerated and standard statistical algorithms to similar degree. In this simulation study based on monoenergetic and scatter-free projection data, we demonstrate that one of these factors is the extremely high number of iterations needed to remove artifacts that can appear around high-contrast structures. We also show (using the OSC method) that these artifacts can be adequately suppressed if statistical reconstruction is initialized with images generated by means of Radon inversion algorithms like filtered back projection (FBP). This allows the reconstruction time to be shortened by even as much as one order of magnitude. Although the initialization of the statistical algorithm with FBP image introduces some additional noise into the first iteration of OSC reconstruction, the resolution-noise trade-off and the contrast-to-noise ratio of final images are not markedly compromised.
Mark Oldham, Jeffrey H Siewerdsen, Sai Kumar, John Wong, David A Jaffray
Optical-CT Gel-Dosimetry I: Basic Investigations Journal Article
In: Medical physics, 30 (4), pp. 623-634, 2003, ISSN: 0094-2405.
Comprehensive verification of the intricate dose distributions associated with advanced radiation treatments is now an immediate and substantial problem. The task is challenging using traditional dosimeters because of restrictions to point measurements (ion chambers, diodes, TLD, etc.) or planar measurements (film). In essence, rapid advances in the technology to deliver radiation treatments have not been paralleled by corresponding advances in the ability to verify these treatments. A potential solution has emerged in the form of water equivalent three dimensional (3D) gel-dosimetry. In this paper we present basic characterization and performance studies of a prototype optical-CT scanning system developed in our laboratory. An analysis of the potential role or scope of gel dosimetry, in relation to other dosimeters, and to verification across the spectrum of therapeutic techniques is also given. The characterization studies enabled the determination of nominal operating conditions for optical-CT scanning. "Finger" phantoms are introduced as a powerful and flexible tool for the investigation of optical-CT performance. The modulation-transfer function (MTF) of the system is determined to be better than 10% out to 1 mm(-1), confirming sub-mm imaging ability. System performance is demonstrated by the acquisition of a 1 x 1 x 1 mm3 dataset through the dose distribution delivered by an x-ray lens that focuses x rays in the energy range 40-80 KeV. This 3D measurement would be extremely difficult to achieve with other dosimetry techniques and highlights some of the strengths of gel dosimetry. Finally, an optical Monte Carlo model is introduced and shown to have potential to model light transport through gel-dosimetry systems, and to provide a tool for the study and optimization of optical-CT gel dosimetry. The model utilizes Mie scattering theory and requires knowledge of the variation of the particle size distribution with dose. The latter was determined here using the technique of dynamic-light-scattering.
Jeffrey H. Siewerdsen, Ian A. Cunningham, David A. Jaffray
In: Medical Physics, 29 (11), pp. 2655-2671, 2002, ISSN: 0094-2405.
A methodological framework for experimental analysis of the noise-power spectrum (NPS) of multidimensional images is presented that employs well-known properties of the n-dimensional (nD) Fourier transform. The approach is generalized to n dimensions, reducing to familiar cases for n = 1 (e.g., time series) and n = 2 (e.g., projection radiography) and demonstrated experimentally for two cases in which n = 3 (viz., using an active matrix flat-panel imager for x-ray fluoroscopy and cone-beam CT to form three-dimensional (3D) images in spatiotemporal and volumetric domains, respectively). The relationship between fully nD NPS analysis and various techniques for analyzing a "central slice" of the NPS is formulated in a manner that is directly applicable to measured nD data, highlights the effects of correlation, and renders issues of NPS normalization transparent. The spatiotemporal NPS of fluoroscopic images is analyzed under varying conditions of temporal correlation (image lag) to investigate the degree to which the NPS is reduced by such correlation. For first-frame image lag of approximately 5-8%, the NPS is reduced by approximately 20% compared to the lag-free case. A simple model is presented that results in an approximate rule of thumb for computing the effect of image lag on NPS under conditions of spatiotemporal separability. The volumetric NPS of cone-beam CT images is analyzed under varying conditions of spatial correlation, controlled by adjustment of the reconstruction filter. The volumetric NPS is found to be highly asymmetric, exhibiting a ramp characteristic in transverse planes (typical of filtered back-rojection) and a band-limited characteristic in the longitudinal direction (resulting from low-pass characteristics of the imager). Such asymmetry could have implications regarding the detectability of structures visualized in transverse versus sagittal or coronal planes. In all cases, appreciation of the full dimensionality of the image data is essential to obtaining meaningful NPS results. The framework may be applied to NPS analysis of image data of arbitrary dimensionality provided the system satisfies conditions of NPS existence.
David A. Jaffray, Jeffrey H. Siewerdsen, John W. Wong, Alvaro A. Martinez
In: International Journal of Radiation Oncology, Biology, Physics, 53 (5), pp. 1337-1349, 2002, ISSN: 0360-3016.
PURPOSE: Geometric uncertainties in the process of radiation planning and delivery constrain dose escalation and induce normal tissue complications. An imaging system has been developed to generate high-resolution, soft-tissue images of the patient at the time of treatment for the purpose of guiding therapy and reducing such uncertainties. The performance of the imaging system is evaluated and the application to image-guided radiation therapy is discussed.
METHODS AND MATERIALS: A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography (CT) has been integrated with a medical linear accelerator. Kilovoltage X-rays are generated by a conventional X-ray tube mounted on a retractable arm at 90 degrees to the treatment source. A 41 x 41 cm(2) flat-panel X-ray detector is mounted opposite the kV tube. The entire imaging system operates under computer control, with a single application providing calibration, image acquisition, processing, and cone-beam CT reconstruction. Cone-beam CT imaging involves acquiring multiple kV radiographs as the gantry rotates through 360 degrees of rotation. A filtered back-projection algorithm is employed to reconstruct the volumetric images. Geometric nonidealities in the rotation of the gantry system are measured and corrected during reconstruction. Qualitative evaluation of imaging performance is performed using an anthropomorphic head phantom and a coronal contrast phantom. The influence of geometric nonidealities is examined.
RESULTS: Images of the head phantom were acquired and illustrate the submillimeter spatial resolution that is achieved with the cone-beam approach. High-resolution sagittal and coronal views demonstrate nearly isotropic spatial resolution. Flex corrections on the order of 0.2 cm were required to compensate gravity-induced flex in the support arms of the source and detector, as well as slight axial movements of the entire gantry structure. Images reconstructed without flex correction suffered from loss of detail, misregistration, and streak artifacts. Reconstructions of the contrast phantom demonstrate the soft-tissue imaging capability of the system. A contrast of 47 Hounsfield units was easily detected in a 0.1-cm-thick reconstruction for an imaging exposure of 1.2 R (in-air, in absence of phantom). The comparison with a conventional CT scan of the phantom further demonstrates the spatial resolution advantages of the cone-beam CT approach.
CONCLUSIONS: A kV cone-beam CT imaging system based on a large-area, flat-panel detector has been successfully adapted to a medical linear accelerator. The system is capable of producing images of soft tissue with excellent spatial resolution at acceptable imaging doses. Integration of this technology with the medical accelerator will result in an ideal platform for high-precision, image-guided radiation therapy.
Burkhard A. Groh, Jeffrey H. Siewerdsen, Doug G. Drake, John W. Wong, David A. Jaffray
In: Medical Physics, 29 (6), pp. 967-975, 2002, ISSN: 0094-2405.
The use of cone-beam computed tomography (CBCT) has been proposed for guiding the delivery of radiation therapy, and investigators have examined the use of both kilovoltage (kV) and megavoltage (MV) x-ray beams in the development of such CBCT systems. In this paper, the inherent contrast and signal-to-noise ratio (SNR) performance for a variety of existing and hypothetical detectors for CBCT are investigated analytically as a function of imaging dose and object size. Theoretical predictions are compared to the results of experimental investigations employing largearea flat-panel imagers (FPIs) at kV and MV energies. Measurements were performed on two different FPI-based CBCT systems: a bench-top prototype incorporating an FPI and kV x-ray source (100 kVp x rays), and a system incorporating an FPI mounted on the gantry of a medical linear accelerator (6 MV x rays). The SNR in volume reconstructions was measured as a function of dose and found to agree reasonably with theoretical predictions. These results confirm the theoretically predicted advantages of employing kV energy x rays in imaging soft-tissue structures found in the human body. While MV CBCT may provide a valuable means of correcting 3D setup errors and may offer an advantage in terms of simplicity of mechanical integration with a linear accelerator (e.g., implementation in place of a portal imager), kV CBCT offers significant performance advantages in terms of image contrast and SNR per unit dose for visualization of soft-tissue structures. The relatively poor SNR performance at MV energies is primarily a result of the low x-ray quantum efficiencies (approximately a few percent or less) that are currently achieved with FPIs at high energies. Furthermore, kV CBCT with an FPI offers the potential of combined volumetric and radiographic/fluoroscopic imaging using the same device.
J H Siewerdsen, D A Jaffray
In: Medical Physics, 28 (2), pp. 220-231, 2001, ISSN: 0094-2405.
A system for cone-beam computed tomography (CBCT) based on a flat-panel imager (FPI) is used to examine the magnitude and effects of x-ray scatter in FPI-CBCT volume reconstructions. The system is being developed for application in image-guided therapies and has previously demonstrated spatial resolution and soft-tissue visibility comparable or superior to a conventional CT scanner under conditions of low x-ray scatter. For larger objects consistent with imaging of human anatomy (e.g., the pelvis) and for increased cone angle (i.e., larger volumetric reconstructions), however, the effects of x-ray scatter become significant. The magnitude of x-ray scatter with which the FPI-CBCT system must contend is quantified in terms of the scatter-to-primary energy fluence ratio (SPR) and scatter intensity profiles in the detector plane, each measured as a function of object size and cone angle. For large objects and cone angles (e.g., a pelvis imaged with a cone angle of 6 degrees), SPR in excess of 100% is observed. Associated with such levels of x-ray scatter are cup and streak artifacts as well as reduced accuracy in reconstruction values, quantified herein across a range of SPR consistent with the clinical setting. The effect of x-ray scatter on the contrast, noise, and contrast-to-noise ratio (CNR) in FPI-CBCT reconstructions was measured as a function of SPR and compared to predictions of a simple analytical model. The results quantify the degree to which elevated SPR degrades the CNR. For example, FPI-CBCT images of a breast-equivalent insert in water were degraded in CNR by nearly a factor of 2 for SPR ranging from approximately 2% to 120%. The analytical model for CNR provides a quantitative understanding of the relationship between CNR, dose, and spatial resolution and allows knowledgeable selection of the acquisition and reconstruction parameters that, for a given SPR, are required to restore the CNR to values achieved under conditions of low x-ray scatter. For example, for SPR = 100%, the CNR in FPI-CBCT images can be fully restored by: (1) increasing the dose by a factor of 4 (at full spatial resolution); (2) increasing dose and slice thickness by a factor of 2; or (3) increasing slice thickness by a factor of 4 (with no increase in dose). Other reconstruction parameters, such as transaxial resolution length and reconstruction filter, can be similarly adjusted to achieve CNR equal to that obtained in the scatter-free case.
J Webster Stayman and Jeffrey A Fessler
In: IEEE transactions on medical imaging, 19 (6), pp. 601-615, 2000, ISSN: 0278-0062.
Traditional space-invariant regularization methods in tomographic image reconstruction using penalized-likelihood estimators produce images with nonuniform spatial resolution properties. The local point spread functions that quantify the smoothing properties of such estimators are space-variant, asymmetric, and object-dependent even for space-invariant imaging systems. We propose a new quadratic regularization scheme for tomographic imaging systems that yields increased spatial uniformity and is motivated by the least-squares fitting of a parameterized local impulse response to a desired global response. We have developed computationally efficient methods for PET systems with shift-invariant geometric responses. We demonstrate the increased spatial uniformity of this new method versus conventional quadratic regularization schemes in simulated PET thorax scans.
D A Jaffray, J H Siewerdsen
In: Medical physics, 27 (6), pp. 1311-1323, 2000, ISSN: 0094-2405.
The development and performance of a system for x-ray cone-beam computed tomography (CBCT) using an indirect-detection flat-panel imager (FPI) is presented. Developed as a bench-top prototype for initial investigation of FPI-based CBCT for bone and soft-tissue localization in radiotherapy, the system provides fully three-dimensional volumetric image data from projections acquired during a single rotation. The system employs a 512 x 512 active matrix of a-Si:H thin-film transistors and photodiodes in combination with a luminescent phosphor. Tomographic imaging performance is quantified in terms of response uniformity, response linearity, voxel noise, noise-power spectrum (NPS), and modulation transfer function (MTF), each in comparison to the performance measured on a conventional CT scanner. For the geometry employed and the objects considered, response is uniform to within 2% and linear within 1%. Voxel noise, at a level of approximately 20 HU, is comparable to the conventional CT scanner. NPS and MTF results highlight the frequency-dependent transfer characteristics, confirming that the CBCT system can provide high spatial resolution and does not suffer greatly from additive noise levels. For larger objects and/or low exposures, additive noise levels must be reduced to maintain high performance. Imaging studies of a low-contrast phantom and a small animal (a euthanized rat) qualitatively demonstrate excellent soft-tissue visibility and high spatial resolution. Image quality appears comparable or superior to that of the conventional scanner. These quantitative and qualitative results clearly demonstrate the potential of CBCT systems based upon flat-panel imagers. Advances in FPI technology (e.g., improved x-ray converters and enhanced electronics) are anticipated to allow high-performance FPI-based CBCT for medical imaging. General and specific requirements of kilovoltage CBCT systems are discussed, and the applicability of FPI-based CBCT systems to tomographic localization and image-guidance for radiotherapy is considered.
Larry E. Antonuk, Kyung-Wook Jee, Youcef El-Mohri, Manat Maolinbay, Sani Nassif, Xin Rong, Qihua Zhao, Jeffrey H. Siewerdsen, Robert A. Street, Khooshbu S. Shah
In: Medical Physics, 27 (2), pp. 289-306, 2000, ISSN: 0094-2405.
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.
Jeffrey H Siewerdsen, D A Jaffray
In: Medical Physics, 26 (12), pp. 2635-2647, 1999, ISSN: 0094-2405.
A system for cone-beam computed tomography (CBCT) has been developed based upon the technology of active matrix flat-panel imagers (FPIs), and the system has demonstrated the potential for fully three-dimensional volumetric imaging with high spatial and contrast resolution. This paper investigates the effects of image lag (arising from charge trapping and release in the FPI pixels) upon CBCT reconstructions. Hypotheses were derived based upon a simple, geometrical/physical model, suggesting that image lag in the projection data results primarily in two artifacts: a spatial blurring artifact in the direction opposite to the direction of rotation (called a "comet") and a line artifact along the direction of the first few projections (called a "streak"). The hypotheses were tested by means of computer simulations and experimental measurements that yielded CBCT images of a simple cylindrical water phantom containing an attenuating rod of varying size and composition. The computer simulations generated projection images based upon analysis of the system geometry and a simple model of the FPI that allowed free adjustment of the image lag. Experimental measurements involved CBCT scans of the phantom under various conditions and modes of acquisition followed by examination of the resulting CBCT axial slices for lag artifacts. Measurements were performed as a function of exposure level, position and contrast of the rod, and for three modes of acquisition designed to isolate and/or minimize the two hypothesized artifacts. The results clearly illustrate the comet and streak artifacts, particularly in relation to high-contrast objects imaged at high exposure levels. The significance of such artifacts under clinical conditions is expected to be small, considering the magnitude of the effect relative to the morphology and composition of typical anatomy. The artifacts may become appreciable, however, in the presence of high-contrast objects, such as marker BBs, dental fillings, and metal prosthetics. A procedural method of reducing lag artifacts is demonstrated.
Jeffrey H. Siewerdsen, David A. Jaffray
In: Medical Physics, 26 (8), pp. 1624-1641, 1999, ISSN: 0094-2405.
Spatial and temporal imaging characteristics of an amorphous silicon flat-panel imager (FPI) were investigated in terms relevant to the application of such devices in cone-beam computed tomography (CBCT) and other x-ray imaging modalities, including general radiography, fluoroscopy, mammography, radiotherapy portal imaging, and nondestructive testing. Specifically, issues of image lag (including the magnitude, spatial uniformity, temporal-frequency characteristics, and dependence upon exposure and frame time) and long-term image persistence ("ghosts") were investigated. As part of the basic characterization of the FPI, pixel dark signal and noise (magnitude, temporal stability, and spatial uniformity) as well as radiation response (signal size, linearity, gain, and reciprocity) were also measured. Image lag was analyzed as a function of frame time and incident exposure. First-frame lag (i.e., the relative residual signal in the first frame following readout of an exposure) was approximately 2-10%, depending upon incident exposure and was spatially nonuniform to a slight degree across the FPI; second-, third-, and fourth-frame lag were approximately 0.7%, 0.4%, and 0.3%, respectively (at 25% sensor saturation). Image lag was also analyzed in terms of the temporal-frequency-dependent transfer function derived from the radiation response, allowing a quantitative description of system components contributing to lag. Finally, the contrast of objects as a function of time following an exposure was measured in order to examine long-term image persistence ("ghosts"). Ghosts were found to persist up to 30 min or longer, depending upon the exposure and frame time. Two means of reducing the apparent contrast of ghost images were tested: (i) rapid scanning of the FPI at maximum frame rate, and (ii) flood-field exposure of the FPI; neither was entirely satisfactory. These results pose important considerations for application of FPIs in CBCT as well as other x-ray imaging modalities. For example in CBCT, the magnitude of image lag is such that significant artifacts in tomographic reconstructions may result if strategies are not adopted either to reduce or correct the lag between successive projections (e.g., rapid scanning between projections or iterative correction algorithms, respectively). Similarly, long-term image persistence may necessitate frequent recalibration of offset corrections.
Youcef El-Mohri, Larry E. Antonuk, Jonathan Yorkston, Kyung-Wook Jee, Manat Maolinbay, K. L. Lam, Jeffrey H. Siewerdsen
In: Medical Physics, 26 (8), pp. 1530-1541, 1999, ISSN: 0094-2405.
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.
Larry E. Antonuk, Youcef El-Mohri, Weidong Huang, Kyung-Wook Jee, Jeffrey H. Siewerdsen, Manat Maolinbay, Victor E. Scarpine, Howard M. Sandler, John Yorkston
In: International Journal of Radiation Oncology, Biology, Physics, 42 (2), pp. 437-454, 1998, ISSN: 0360-3016.
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.