Physical image properties of a complementary metal-oxide-semiconductor imager for mammography systems.

We acquired a direct-type flat panel detector (FPD) developed for mammography systems and investigated its physical image properties, as its characteristics may affect future mammography in the clinic. The pixel size of the detector is 50 µm, the smallest size used in clinical mammography. Amorphous selenium (a-Se) film is used in direct-type FPDs. Due to its inferior temperature properties, the temperature of the imaging room should be set to approximately 25 °C. A novel a-Se film with superior heat resistance has been developed by the HAMAMATSU photonics KK Electron Tube Division that is suitable for high electric field driving. However, the associated trade-offs in image properties are unknown. The purposes of the current study were to investigate whether the detector maintains a high image quality in the presence of a high electric field, and to evaluate the image properties. The signal readout mechanism incorporates a complementary metal-oxide-semiconductor with superior noise properties. We measured the input-output characteristics, resolution, noise properties, and detection quantum efficiency, and investigated the effects of the exposure of the a-Se film to different applied voltages under standard mammography conditions prescribed by the International Electrotechnical Commission. The resolution and noise properties associated with the direct-type FPD were not affected by differences in applied voltage. The CMOS imager had a higher resolution than conventional systems with an equivalent pixel size. It also had a high detective quantum efficiency value. Thus, this detector may be useful in mammography.

Evaluation of Deformable Image Registration for Three-Dimensional Temporal Subtraction of Chest Computed Tomography Images.

PURPOSE: To perform lung image registration for reducing misregistration artifacts on three-dimensional (3D) temporal subtraction of chest computed tomography (CT) images, in order to enhance temporal changes in lung lesions and evaluate these changes after deformable image registration (DIR). METHODS: In 10 cases, mutual information (MI) lung mask affine mapping combined with cross-correlation (CC) lung diffeomorphic mapping was used to implement lung volume registration. With advanced normalization tools (ANTs), we used greedy symmetric normalization (greedy SyN) as a transformation model, which involved MI-CC-SyN implementation. The resulting displacement fields were applied to warp the previous (moving) image, which was subsequently subtracted from the current (fixed) image to obtain the lung subtraction image. RESULTS: The average minimum and maximum log-Jacobians were 0.31 and 3.74, respectively. When considering 3D landmark distance, the root-mean-square error changed from an average of 20.82 mm for Pfixed to Pmoving to 0.5 mm for Pwarped to Pfixed. Clear shadows were observed as enhanced lung nodules and lesions in subtraction images. The lesion shadows showed lesion shrinkage changes over time. Lesion tissue morphology was maintained after DIR. CONCLUSIONS: DIR (greedy SyN) effectively and accurately enhanced temporal changes in chest CT images and decreased misregistration artifacts in temporal subtraction images.

Optimizing the reconstruction filter in cone-beam CT to improve periodontal ligament space visualization: An in vitro study.

PURPOSE: Evaluation of alveolar bone is important in the diagnosis of dental diseases. The periodontal ligament space is difficult to clearly depict in cone-beam computed tomography images because the reconstruction filter conditions during image processing cause image blurring, resulting in decreased spatial resolution. We examined different reconstruction filters to assess their ability to improve spatial resolution and allow for a clearer visualization of the periodontal ligament space. MATERIALS AND METHODS: Cone-beam computed tomography projections of 2 skull phantoms were reconstructed using 6 reconstruction conditions and then compared using the Thurstone paired comparison method. Physical evaluations, including the modulation transfer function and the Wiener spectrum, as well as an assessment of space visibility, were undertaken using experimental phantoms. RESULTS: Image reconstruction using a modified Shepp-Logan filter resulted in better sensory, physical, and quantitative evaluations. The reconstruction conditions substantially improved the spatial resolution and visualization of the periodontal ligament space. The difference in sensitivity was obtained by altering the reconstruction filter. CONCLUSION: Modifying the characteristics of a reconstruction filter can generate significant improvement in assessments of the periodontal ligament space. A high-frequency enhancement filter improves the visualization of thin structures and will be useful when accurate assessment of the periodontal ligament space is necessary.

Difficult tracheal intubation in a patient with maternal uniparental disomy 14.

BACKGROUND: Maternal uniparental disomy 14 (UPD(14)mat) is an imprinting disorder. It is a rare disease, but there is the possibility that more undiagnosed patients might exist because the clinical features of UPD(14)mat resemble those of the Prader-Willi syndrome or other congenital diseases. We performed anesthetic management for an 8-year-old girl with UPD(14)mat. CASE PRESENTATIONS: She was admitted to undergo correction surgery due to symptomatic scoliosis. Preoperative examination revealed that she had a restricted mouth opening and retrognathia, as well as some typical characteristics of UPD(14)mat, such as small hands, growth retardation, and precocious puberty. We induced general anesthesia using sevoflurane without any problems. However, the tracheal intubation was difficult because of the restricted mouth opening. We used the McGRATHR MAC videolaryngoscope to overcome this problem. CONCLUSIONS: We speculate that the craniofacial deformity in case of UPD(14)mat patients may lead to difficulty in tracheal intubation.

Overall noise characteristics of reduced images on liquid crystal display and advantages of independent subpixel driving technology.

PURPOSE: During soft-copy diagnoses, medical images with a large number of matrices often need to display reduced images on liquid crystal displays (LCDs) because of the spatial resolution limitation of LCDs. A new technology, known as independent subpixel driving (ISD), was recently applied to clinical uses aiming to improve the spatial resolution. The authors' study demonstrates the overall noise characteristics of images displayed on a LCD at various display magnifications, with and without ISD application. METHODS: Measurements of the overall noise power spectra (NPS) of x-ray images displayed on LCD were performed at varying display magnifications, with and without ISD. The NPS of displayed images in several display situations were also simulated based on hypothetical noise factors. RESULTS: The measured and simulated NPS showed that noise characteristics worsened when the display magnification was reduced, due to aliasing errors. The overall noise characteristics were attributed to luminance-value fluctuation converted from pixel values, image-interpolation effects, inherent noise, and blurring of the LCD. ISD improved the noise characteristics because it suppressed noise increments by aliasing errors. CONCLUSIONS: ISD affected the noise-characteristic advantages of reduced images displayed on LCDs, particularly at low frequencies.

Phantom-based comparison of conventional versus phase-contrast mammography for LCD soft-copy diagnosis.

PURPOSE: Liquid crystal display (LCD) of mammograms provides soft-copy results that differ in conventional and phase contrast mammography (PCM). PCM potentially offers the highest quality of sharpness and graininess, an edge emphasis effect on the object, and the highest image resolution. However, when the image is displayed on an LCD, the resolution depends on the pixel pitch and the PCM image data must be diminished. We investigated the observed effect on spatial resolution and contrast when conventional or phase contrast mammograms are viewed on an LCD. METHODS: Using the tissue-equivalent phantom (Model 1011A), a conventional mammogram and a magnification radiography image were obtained with a PCM system. This phantom contains simulated fibers, microcalcifications, and masses. The PCM image was reduced 1/1.75 to render it consistent with life size mammography using the nearest neighbor, bilinear, and bicubic interpolation methods. The images were displayed on a five million (5M)-pixel LCD with 100 % magnification. Ten mammography technicians observed the reduction images displayed on LCDs and reported their results. RESULTS: In the detectability of the microcalcifications, there was no significant difference between conventional mammograms and reduced PCM images. Regarding fibers and masses, detectability using reduced images was higher than those of conventional images. The detectability using images reduced by the nearest-neighbor method was lower than those of images reduced by two other interpolation methods. Bilinear interpolation was affected by the smoothing effect, while CNR was increased. In addition, since the noise of PCM image was reduced by an air gap effect, high detectability of key image features was found. CONCLUSIONS: Soft-copy display of phase-contrast mammograms is feasible with LCDs, while detectability of fibers and masses was best with bilinear interpolation and use of an air gap.

Computerized scheme for evaluating mammographic phantom images.

PURPOSE: The authors developed a computer algorithm to automatically evaluate images of the American College of Radiology (ACR) mammography accreditation phantom. METHODS: The developed algorithm consist of the edge detection of wax insert, nonuniformity correction of background, and correction for magnification and also calculate the cross-correlation coefficient by image matching technique. The algorithm additionally evaluates target shape for fibers, target contrast for speck groups, and target circularity for masses. To obtain an ideal template image without noise and spatial resolution loss, the wax insert containing the embedded test pattern was extracted from the phantom and radiographed. Two template images and ten test phantom images were prepared for this study. The results of evaluation using the algorithm outputs were compared with the averaged results of observer studies by six skilled observers. RESULTS: In comparing the results from the algorithm outputs with the results of observers, the authors found that the computer outputs were well correlated with the evaluations by observers, and they indicate the quality of the phantom image. The correlation coefficients between results of observer studies and two outputs of computer algorithm, i.e., the cross-correlation coefficient by template matching and indices of target shape for fibers, were 0.89 (95% confidence interval, 0.82-0.93; hereinafter the same) and 0.85 (0.76-0.91). The correlation coefficients between observer's results and two outputs: the cross-correlation coefficient and indices of target contrast for speck groups, were 0.83 (0.79-0.86) and 0.85 (0.81-0.88) and between observer's results and two outputs: the cross-correlation coefficient and indices of target circularity for masses, were 0.90 (0.84-0.94) and 0.87 (0.77-0.92). CONCLUSIONS: Image evaluation using the ACR phantom is indispensable in quality control of a mammography system. The proposed algorithm is useful for quality control and image evaluation of mammography units.

Design of a noise-dependent shrinkage function in wavelet shrinkage of X-ray CT image.

PURPOSE: Many shrinkage functions have been introduced and applied for the wavelet shrinkage denoising of computed tomography (CT) images. However, these functions have problems in continuity of functions and cause "shrinkage artifacts". Therefore, we designed a new and smooth shrinkage function using noise distribution. METHODS: The proposed shrinkage function was designed under the following four conditions: (1) use of noise distribution, (2) shrunk coefficients having all ranges of amplitude, (3) function continuity, and (4) property of a function that is controllable by two parameters. The designed function was applied to phantom and chest CT images and denoising performance was compared with other functions. RESULTS: In the proposed method, edge and pixel values were maintained when compared with previous functions, the occurrence of shrinkage artifacts was smaller, and high- quality denoised images were obtained. CONCLUSIONS: The proposed shrinkage function is effective for low-dose noisy CT images when using accurately selected parameters.

Quantitative kinetic analysis of lung nodules using the temporal subtraction technique in dynamic chest radiographies performed with a flat panel detector.

Early detection and treatment of lung cancer is one of the most effective means of reducing cancer mortality, and to this end, chest X-ray radiography has been widely used as a screening method. A related technique based on the development of computer analysis and a flat panel detector (FPD) has enabled the functional evaluation of respiratory kinetics in the chest and is expected to be introduced into clinical practice in the near future. In this study, we developed a computer analysis algorithm to detect lung nodules and to evaluate quantitative kinetics. Breathing chest radiographs obtained by modified FPD and breath synchronization utilizing diaphragmatic analysis of vector movement were converted into four static images by sequential temporal subtraction processing, morphological enhancement processing, kinetic visualization processing, and lung region detection processing. An artificial neural network analyzed these density patterns to detect the true nodules and draw their kinetic tracks. Both the algorithm performance and the evaluation of clinical effectiveness of seven normal patients and simulated nodules showed sufficient detecting capability and kinetic imaging function without significant differences. Our technique can quantitatively evaluate the kinetic range of nodules and is effective in detecting a nodule on a breathing chest radiograph. Moreover, the application of this technique is expected to extend computer-aided diagnosis systems and facilitate the development of an automatic planning system for radiation therapy.

Investigation of physical image characteristics and phenomenon of edge enhancement by phase contrast using equipment typical for mammography.

A technique called phase contrast mammography (PCM) has only recently been applied in clinical examination. In this application, PCM images are acquired at a 1.75 x magnification using an x-ray tube for clinical use, and then reduced to the real size of the object by image processing. The images showed enhanced object edges; reportedly, this enhancement occurred because of the refraction of x rays through a cylindrical object. The authors measured the physical image characteristics of PCM to compare the image characteristics of PCM with those of conventional mammography. More specifically, they measured the object-edge-response characteristics and the noise characteristics in the spatial frequency domain. The results revealed that the edge-response characteristics of PCM outperformed those of conventional mammography. In addition, the characteristics changed with the object-placement conditions and the object shapes. The noise characteristics of PCM were better than those of conventional mammography. Subsequently, to verify why object edges were enhanced in PCM images, the authors simulated image profiles that would be obtained if the x rays were refracted and totally reflected by using not only a cylindrical substance but also a planar substance as the object. So, they confirmed that the object edges in PCM images were enhanced because x rays were refracted irrespective of the object shapes. Further, they found that the edge enhancements depended on the object shapes and positions. It was also proposed that the larger magnification than 1.75 in the commercialized system might be more suitable for PCM. Finally, the authors investigated phase-contrast effects to breast tissues by the simulation and demonstrated that PCM would be helpful in the diagnoses of mammography.