Effective dose efficiency: an application-specific metric of quality and dose for digital radiography.

The detective quantum efficiency (DQE) and the effective DQE (eDQE) are relevant metrics of image quality for digital radiography detectors and systems, respectively. The current study further extends the eDQE methodology to technique optimization using a new metric of the effective dose efficiency (eDE), reflecting both the image quality as well as the effective dose (ED) attributes of the imaging system. Using phantoms representing pediatric, adult and large adult body habitus, image quality measurements were made at 80, 100, 120 and 140 kVp using the standard eDQE protocol and exposures. ED was computed using Monte Carlo methods. The eDE was then computed as a ratio of image quality to ED for each of the phantom/spectral conditions. The eDQE and eDE results showed the same trends across tube potential with 80 kVp yielding the highest values and 120 kVp yielding the lowest. The eDE results for the pediatric phantom were markedly lower than the results for the adult phantom at spatial frequencies lower than 1.2-1.7 mm(-1), primarily due to a correspondingly higher value of ED per entrance exposure. The relative performance for the adult and large adult phantoms was generally comparable but affected by kVps. The eDE results for the large adult configuration were lower than the eDE results for the adult phantom, across all spatial frequencies (120 and 140 kVp) and at spatial frequencies greater than 1.0 mm(-1) (80 and 100 kVp). Demonstrated for chest radiography, the eDE shows promise as an application-specific metric of imaging performance, reflective of body habitus and radiographic technique, with utility for radiography protocol assessment and optimization.

A technique optimization protocol and the potential for dose reduction in digital mammography.

Digital mammography requires revisiting techniques that have been optimized for prior screen/film mammography systems. The objective of the study was to determine optimized radiographic technique for a digital mammography system and demonstrate the potential for dose reduction in comparison to the clinically established techniques based on screen- film. An objective figure of merit (FOM) was employed to evaluate a direct-conversion amorphous selenium (a-Se) FFDM system (Siemens Mammomat Novation(DR), Siemens AG Medical Solutions, Erlangen, Germany) and was derived from the quotient of the squared signal-difference-to-noise ratio to mean glandular dose, for various combinations of technique factors and breast phantom configurations including kilovoltage settings (23-35 kVp), target/filter combinations (Mo-Mo and W-Rh), breast-equivalent plastic in various thicknesses (2-8 cm) and densities (100% adipose, 50% adipose/50% glandular, and 100% glandular), and simulated mass and calcification lesions. When using a W-Rh spectrum, the optimized FOM results for the simulated mass and calcification lesions showed highly consistent trends with kVp for each combination of breast density and thickness. The optimized kVp ranged from 26 kVp for 2 cm 100% adipose breasts to 30 kVp for 8 cm 100% glandular breasts. The use of the optimized W-Rh technique compared to standard Mo-Mo techniques provided dose savings ranging from 9% for 2 cm thick, 100% adipose breasts, to 63% for 6 cm thick, 100% glandular breasts, and for breasts with a 50% adipose/50% glandular composition, from 12% for 2 cm thick breasts up to 57% for 8 cm thick breasts.

Effective DQE (eDQE) and speed of digital radiographic systems: an experimental methodology.

Prior studies on performance evaluation of digital radiographic systems have primarily focused on the assessment of the detector performance alone. However, the clinical performance of such systems is also substantially impacted by magnification, focal spot blur, the presence of scattered radiation, and the presence of an antiscatter grid. The purpose of this study is to evaluate an experimental methodology to assess the performance of a digital radiographic system, including those attributes, and to propose a new metric, effective detective quantum efficiency (eDQE), a candidate for defining the efficiency or speed of digital radiographic imaging systems. The study employed a geometric phantom simulating the attenuation and scatter properties of the adult human thorax and a representative indirect flat-panel-based clinical digital radiographic imaging system. The noise power spectrum (NPS) was derived from images of the phantom acquired at three exposure levels spanning the operating range of the clinical system. The modulation transfer function (MTF) was measured using an edge device positioned at the surface of the phantom, facing the x-ray source. Scatter measurements were made using a beam stop technique. The eDQE was then computed from these measurements, along with measures of phantom attenuation and x-ray flux. The MTF results showed notable impact from the focal spot blur, while the NPS depicted a large component of structured noise resulting from use of an antiscatter grid. The eDQE was found to be an order of magnitude lower than the conventional DQE. At 120 kVp, eDQE(0) was in the 8%-9% range, fivefold lower than DQE(0) at the same technique. The eDQE method yielded reproducible estimates of the system performance in a clinically relevant context by quantifying the inherent speed of the system, that is, the actual signal to noise ratio that would be measured under clinical operating conditions.

Detector or system? Extending the concept of detective quantum efficiency to characterize the performance of digital radiographic imaging systems.

PURPOSE: To develop an experimental method for measuring the effective detective quantum efficiency (eDQE) of digital radiographic imaging systems and evaluate its use in select imaging systems. MATERIALS AND METHODS: A geometric phantom emulating the attenuation and scatter properties of the adult human thorax was employed to assess eight imaging systems in a total of nine configurations. The noise power spectrum (NPS) was derived from images of the phantom acquired at three exposure levels spanning the operating range of the system. The modulation transfer function (MTF) was measured by using an edge device positioned at the anterior surface of the phantom. Scatter measurements were made by using a beam-stop technique. All measurements, including those of phantom attenuation and estimates of x-ray flux, were used to compute the eDQE. RESULTS: The MTF results showed notable degradation owing to focal spot blur. Scatter fractions ranged between 11% and 56%, depending on the system. The eDQE(0) results ranged from 1%-17%, indicating a reduction of up to one order of magnitude and different rank ordering and performance among systems, compared with that implied in reported conventional detective quantum efficiency results from the same systems. CONCLUSION: The eDQE method was easy to implement, yielded reproducible results, and provided a meaningful reflection of system performance by quantifying image quality in a clinically relevant context. The difference in the magnitude of the measured eDQE and the ideal eDQE of 100% provides a great opportunity for improving the image quality of radiographic and mammographic systems while reducing patient dose.

Optimization of exposure parameters in full field digital mammography.

Optimization of exposure parameters (target, filter, and kVp) in digital mammography necessitates maximization of the image signal-to-noise ratio (SNR), while simultaneously minimizing patient dose. The goal of this study is to compare, for each of the major commercially available full field digital mammography (FFDM) systems, the impact of the selection of technique factors on image SNR and radiation dose for a range of breast thickness and tissue types. This phantom study is an update of a previous investigation and includes measurements on recent versions of two of the FFDM systems discussed in that article, as well as on three FFDM systems not available at that time. The five commercial FFDM systems tested, the Senographe 2000D from GE Healthcare, the Mammomat Novation DR from Siemens, the Selenia from Hologic, the Fischer Senoscan, and Fuji's 5000MA used with a Lorad M-IV mammography unit, are located at five different university test sites. Performance was assessed using all available x-ray target and filter combinations and nine different phantom types (three compressed thicknesses and three tissue composition types). Each phantom type was also imaged using the automatic exposure control (AEC) of each system to identify the exposure parameters used under automated image acquisition. The figure of merit (FOM) used to compare technique factors is the ratio of the square of the image SNR to the mean glandular dose. The results show that, for a given target/filter combination, in general FOM is a slowly changing function of kVp, with stronger dependence on the choice of target/filter combination. In all cases the FOM was a decreasing function of kVp at the top of the available range of kVp settings, indicating that higher tube voltages would produce no further performance improvement. For a given phantom type, the exposure parameter set resulting in the highest FOM value was system specific, depending on both the set of available target/filter combinations, and on the receptor type. In most cases, the AECs of the FFDM systems successfully identified exposure parameters resulting in FOM values near the maximum ones, however, there were several examples where AEC performance could be improved.

A comparative contrast-detail study of five medical displays.

The objective of this study was to compare the contrast-detail performance of five different commercial liquid crystal displays (LCDs) to other LCD and cathode-ray tube (CRT) displays for medical applications. A contrast-detail phantom, supplemented with 5 in. of acrylic, was imaged on a commercial digital radiographic system using techniques comparable to chest radiography. The phantom design enabled observer evaluation by a four-alternative forced choice paradigm. The acquired images were independently scored by five observers on five medical display devices: a 5 megapixel monochrome LCD, a 3 megapixel monochrome LCD, a 9 megapixel color LCD, a 5 megapixel monochrome CRT, and a mammographic-grade monochrome CRT. The data were analyzed using the method suggested by the manufacturer based on a nearest neighbor correction technique. They were further analyzed using a logistic regression response model with a natural threshold using an overall chi-square test for display type followed by pairwise comparisons for individual display performance. The differences between the display devices were small. The standard analysis of the results based on the manufacturer-recommended method did not yield any statistically discernible trend among displays. The logistic regression analysis, however, indicated that the 5 megapixel monochrome LCD was statistically significantly (p <0.0001) superior to the others, followed by the 3 megapixel monochrome LCD (p<0.0001). The three other displays exhibited lower but generally similar performance characteristics. The findings suggest that 5 and 3 megapixel monochrome LCDs provide comparable but subtly superior contrast detectability than other tested displays, with the former performing slightly better in the detection of subtle and fine details.

Assessment of detective quantum efficiency: intercomparison of a recently introduced international standard with prior methods.

PURPOSE: To prospectively evaluate the recently introduced international standard method for measurement of the detective quantum efficiency (DQE) of digital radiography systems, in comparison with representative prior methods. MATERIALS AND METHODS: A recently introduced international standard method (International Electrotechnical Commission [IEC] 62220-1, 2003) for DQE measurement and two previously described DQE evaluation methods were considered. In addition to an overall comparison, evaluations of the following method factors were performed: beam quality, beam-limiting devices (apertures or collimators), noise power spectrum (NPS) analysis algorithms and parameters (area, region of interest size, background detrending), and modulation transfer function (MTF) test devices and methods. RESULTS: Overall, at low to middle frequencies, the IEC method yielded DQE estimates that were 3.3% and 6.5% lower than the values yielded by the two previous methods. Averaged over the frequency range of 1.5-2.5 mm(-1), the DQE estimate derived by using the IEC method was 7.1% lower and 12.4% higher than the estimates derived by using the other two methods. Results obtained with the two previous DQE evaluation methods agreed well (within 2.0%) in the low- to middle-frequency range but diverged by up to 10% at higher frequencies. When the DQE method factors were evaluated separately, the largest percentage deviations in DQE were associated with (in order of decreasing influence) the MTF analysis method ( approximately 11%), the beam limitation (about 7%-10%), the beam quality ( approximately 9%), and the NPS analysis method ( approximately 3%). CONCLUSION: Comparison of DQE estimates obtained by using the recently introduced international standard technique with those obtained by using prior methods revealed that the overall measurement method can affect the DQE estimate by as much as 12%. Findings further suggest that both beam limitation achieved by means of internal collimation (rather than external apertures) and use of a radio-opaque edge MTF device yield a more accurate estimation of the DQE.

Intercomparison of methods for image quality characterization. I. Modulation transfer function.

The modulation transfer function (MTF) and the noise power spectrum (NPS) are widely recognized as the most relevant metrics of resolution and noise performance in radiographic imaging. These quantities have commonly been measured using various techniques, the specifics of which can have a bearing on the accuracy of the results. As a part of a study aimed at comparing the relative performance of different techniques, in this paper we report on a comparison of two established MTF measurement techniques: one using a slit test device [Dobbins et al., Med. Phys. 22, 1581-1593 (1995)] and another using a translucent edge test device [Samei et al., Med. Phys. 25, 102-113 (1998)], with one another and with a third technique using an opaque edge test device recommended by a new international standard (IEC 62220-1, 2003). The study further aimed to substantiate the influence of various acquisition and processing parameters on the estimated MTF. The slit test device was made of 2 mm thick Pb slabs with a 12.5 microm opening. The translucent edge test device was made of a laminated and polished Pt(0.9)Ir(0.1). alloy foil of 0.1 mm thickness. The opaque edge test device was made of a 2 mm thick W slab. All test devices were imaged on a representative indirect flat-panel digital radiographic system using three published beam qualities: 70 kV with 0.5 mm Cu filtration, 70 kV with 19 mm Al filtration, and 74 kV with 21 mm Al filtration (IEC-RQA5). The latter technique was also evaluated in conjunction with two external beam-limiting apertures (per IEC 62220-1), and with the tube collimator limiting the beam to the same area achieved with the apertures. The presampled MTFs were deduced from the acquired images by Fourier analysis techniques, and the results analyzed for relative values and the influence of impacting parameters. The findings indicated that the measurement technique has a notable impact on the resulting MTF estimate, with estimates from the overall IEC method 4.0% +/- 0.2% lower than that of Dobbins et al. and 0.7% +/- 0.4% higher than that of Samei et al. averaged over the zero to cutoff frequency range. Over the same frequency range, keeping beam quality and limitation constant, the average MTF estimate obtained with the edge techniques differed by up to 5.2% +/- 0.2% from that of the slit, with the opaque edge providing lower MTF estimates at lower frequencies than those obtained with the translucent edge or slit. The beam quality impacted the average estimated MTF by as much as 3.7% +/- 0.9% while the use of beam limiting devices alone increased the average estimated MTF by as much as 7.0% +/- 0.9%. While the slit method is inherently very sensitive to misalignment, both edge techniques were found to tolerate misalignments by as much as 6 cm. The results suggest the use of the opaque edge test device and the tube internal collimator for beam limitation in order to achieve an MTF result most reflective of the overall performance of the imaging system and least susceptible to misalignment and scattered radiation. Careful attention to influencing factors is warranted to achieve accurate results.

Intercomparison of methods for image quality characterization. II. Noise power spectrum.

Second in a two-part series comparing measurement techniques for the assessment of basic image quality metrics in digital radiography, in this paper we focus on the measurement of the image noise power spectrum (NPS). Three methods were considered: (1) a method published by Dobbins et al. [Med. Phys. 22, 1581-1593 (1995)], (2) a method published by Samei et al. [Med. Phys. 30, 608-622 (2003)], and (3) a new method sanctioned by the International Electrotechnical Commission (IEC 62220-1, 2003), developed as part of an international standard for the measurement of detective quantum efficiency. In addition to an overall comparison of the estimated NPS between the three techniques, the following factors were also evaluated for their effect on the measured NPS: horizontal versus vertical directional dependence, the use of beam-limiting apertures, beam spectrum, and computational methods of NPS analysis, including the region-of-interest (ROI) size and the method of ROI normalization. Of these factors, none was found to demonstrate a substantial impact on the amplitude of the NPS estimates (< or = 3.1% relative difference in NPS averaged over frequency, for each factor considered separately). Overall, the three methods agreed to within 1.6% +/- 0.8% when averaged over frequencies > 0.15 mm(-1).

Measurement of the detective quantum efficiency in digital detectors consistent with the IEC 62220-1 standard: practical considerations regarding the choice of filter material.

As part of a larger evaluation we attempted to measure the detective quantum efficiency (DQE) of an amorphous silicon flat-panel detector using the method described in the International Electrotechnical Commission standard 62220-1 published in October 2003. To achieve the radiographic beam conditions specified in the standard, we purchased scientific-grade ultrahigh purity aluminum (99.999% purity, type-11999 alloy) filters in thicknesses ranging from 0.1 through 10.0 mm from a well-known, specialty metals supplier. Qualitative evaluation of flat field images acquired at 71 kV (RQA5 beam quality) with 21 mm of ultrahigh purity aluminum filtration demonstrated a low frequency mottle that was reproducible and was not observed when the measurement was repeated at 74 kV (RQA5 beam quality) with 21 mm of lower-purity aluminum (99.0% purity, type-1100 alloy) filtration. This finding was ultimately attributed to the larger grain size (approximately 1-2 mm) of high purity aluminum metal, which is a well-known characteristic, particularly in thicknesses greater than 1 mm. The impact of this low frequency mottle is to significantly overestimate the noise power spectrum (NPS) at spatial frequencies < or = 0.2 mm(-1), which in turn would cause an underestimation of the DQE in this range. A subsequent evaluation of ultrahigh purity aluminum, purchased from a second source, suggests, that reduced grain size can be achieved by the process of annealing. Images acquired with this sample demonstrated vertical striated nonuniformities that are attributed to the manufacturing method and which do not appear to appreciably impact the NPS at spatial frequencies > or = 0.5 mm(-1), but do result in an asymmetry in the x- and y-NPS at spatial frequencies < or = 0.2 mm(-1). Our observations of markedly visible nonuniformities in images acquired with high purity aluminum filtration suggest that the uniformity of filter materials should be carefully evaluated and taken into consideration when measuring the DQE.

Measurement of the detective quantum efficiency in digital detectors consistent with the IEC 62220-1 standard: Practical considerations regarding the choice of filter material.

As part of a larger evaluation we attempted to measure the detective quantum efficiency (DQE) of an amorphous silicon flat-panel detector using the method described in the International Electrotechnical Commission standard 62220-1 published in October 2003. To achieve the radiographic beam conditions specified in the standard, we purchased scientific-grade ultrahigh purity aluminum (99.999% purity, type-11999 alloy) filters in thicknesses ranging from 0.1 through 10.0 mm from a well-known, specialty metals supplier. Qualitative evaluation of flat field images acquired at 71 kV (RQA5 beam quality) with 21 mm of ultrahigh purity aluminum filtration demonstrated a low frequency mottle that was reproducible and was not observed when the measurement was repeated at 74 kV (RQA5 beam quality) with 21 mm of lower-purity aluminum (99.0% purity, type-1100 alloy) filtration. This finding was ultimately attributed to the larger grain size (approximately 1-2 mm) of high purity aluminum metal, which is a well-known characteristic, particularly in thicknesses greater than 1 mm. The impact of this low frequency mottle is to significantly overestimate the noise power spectrum (NPS) at spatial frequencies ⩽0.2mm-1, which in turn would cause an underestimation of the DQE in this range. A subsequent evaluation of ultrahigh purity aluminum, purchased from a second source, suggests, that reduced grain size can be achieved by the process of annealing. Images acquired with this sample demonstrated vertical striated nonuniformities that are attributed to the manufacturing method and which do not appear to appreciably impact the NPS at spatial frequencies ⩾0.5mm-1, but do result in an asymmetry in the x- and y-NPS at spatial frequencies ⩽0.2mm-1. Our observations of markedly visible nonuniformities in images acquired with high purity aluminum filtration suggest that the uniformity of filter materials should be carefully evaluated and taken into consideration when measuring the DQE.