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Ehsan Samei

Publications and source records attributed to Ehsan Samei.

34 records · Page 2Linked to original sources

Toward clinically relevant standardization of image quality.

In recent years, notable progress has been made on standardization of medical image presentations in the definition and implementation of the Digital Imaging and Communications in Medicine (DICOM) Grayscale Standard Display Function (GSDF). In parallel, the American Association of Physicists in Medicine (AAPM) Task Group 18 has provided much needed guidelines and tools for visual and quantitative assessment of medical display quality. In spite of these advances, however, there are still notable gaps in the effectiveness of DICOM GSDF to assure consistent and high-quality display of medical images. In additions the degree of correlation between display technical data and diagnostic usability and performance of displays remains unclear. This article proposes three specific steps that DICOM, AAPM, and ACR may collectively take to bridge the gap between technical performance and clinical use: (1) DICOM does not provide means and acceptance criteria to evaluate the conformance of a display device to GSDF or to address other image quality characteristics. DICOM can expand beyond luminance response, extending the measurable, quantifiable elements of TG18 such as reflection and resolution. (2) In a large picture archiving and communication system (PACS) installation, it is critical to continually track the appropriate use and performance of multiple display devices. DICOM may help with this task by adding a Device Service Class to the standard to provide for communication and control of image quality parameters between applications and devices, (3) The question of clinical significance of image quality metrics has rarely been addressed by prior efforts. In cooperation with AAPM, the American College of Radiology (ACR), and the Society for Computer Applications in Radiology (SCAR), DICOM may help to initiate research that will determine the clinical consequence of variations in image quality metrics (eg, GSDF conformance) and to define what constitutes image quality from a diagnostic perspective. Implementation of these three initiatives may further the reach and impact of DICOM toward quality medicine.

Data Display↗

Simulation study of a quasi-monochromatic beam for x-ray computed mammotomography.

The purpose of this simulation study was to evaluate the feasibility, benefits, and potential operating parameters of a quasi-monochromatic beam from a tungsten-target x-ray source yielding projection images. The application is intended for newly developed cone beam computed mammotomography (CmT) of an uncompressed breast. The value of a near monochromatic x-ray source for a fully 3D CmT application is the expected improved ability to separate tissues with very small differences in attenuation coefficients. The quasi-monochromatic beam is expected to yield enhanced tomographic image quality along with a low dose, equal to or less than that of dual view x-ray mammography. X-ray spectra were generated with a validated projection x-ray simulation tool (XSpect) for a range of tungsten tube potentials (40-100 kVp), filter materials (Z=51-65), and filter thicknesses (10th to 1000th value layer determined at 60 kVp). The breast was modeled from ICRU-44 breast tissue specifications, and a breast lesion was modeled as a 0.5 cm thick mass. The detector was modeled as a digital flat-panel detector with a 0.06 cm thick CsI x-ray absorption layer. Computed figures of merit (FOMs) included the ratio of mean beam energy post-breast to pre-breast and the ratio of lesion contrasts for edge-located and center-located lesions as indices of breast beam hardening, and SNR2/exposure and SNR2/dose as indices of exposure and dose efficiencies. The impact of optimization of these FOMs on lesion contrast is also examined. For all simulated filter materials at each given attenuation thickness [10th, 100th, 500th, 1000th value layers (VLs)], the mean and standard deviation of the pre-breast spectral full-width at tenth-maximum (FWTM) were 16.1 +/- 2.4, 10.3 +/- 2.2, 7.3 +/- 1.4, and 6.5 +/- 1.5 keV, respectively. The change in beam width at the tenth maximum from pre-breast to post-breast spectra ranged from 4.7 to 1.1 keV, for the thinnest and thickest filters, respectively. The higher Z filters (Z=57-63) produced a quasi-monochromatic beam that allowed the widest tube potential operating range (50-70 kVp) while maintaining minimal beam hardening and maximal SNR2/exposure and SNR2/dose, and providing a contrast greater than that obtained in the unfiltered case. Figures of merit improved with increasing filter thickness, with diminishing returns beyond the 500th value layer attenuation level. Operating parameters required to produce optimal spectra, while keeping exposures equal to that of dual view mammography, are within the capability of the commercial x-ray tube proposed for our experimental study, indicating that use of these highly attenuating filters is viable. Additional simulations comparing Mo/Mo, Mo/Rh, and W/Rh target/filter combinations indicate that they exhibit significantly lower SNR2/exposure than the present approach, precluding them from being used for computed mammotomography, while maintaining dose limitations and obtaining sufficient SNR. Beam hardening was also much higher in the existing techniques (17%-42%) than for our technique (2%). Simulations demonstrate that this quasi-monochromatic x-ray technique may enhance tissue separation for a newly developed cone beam computed mammotomography application for an uncompressed breast.

Breast↗

Impact of resolution and noise characteristics of digital radiographic detectors on the detectability of lung nodules.

One of the unanswered questions in digital radiography is the connection between physical image quality metrics and clinical detection performance. In this paper, we examine the impact of two physical metrics, resolution and noise, on the detectability of nodules in a pulmonary background for specific digital radiographic detectors. A detection experiment was performed on a simulated image set using anatomical backgrounds from a high-quality lung radiograph and three different simulated nodule sizes (2-3.5 mm). The resolution and noise of the resulting images were modified using existing routines to simulate a selenium-based and a cesium iodide-based flat-panel detector at comparable exposures. A location-known-exactly (LKE) observer performance experiment was performed in which four experienced chest radiologists and three physicists specializing in chest radiology scored the images. The data from the observer experiment were analyzed by receiver operating characteristic (ROC) methodology. The detectability, as measured by the parameter Az, was higher for the selenium detector than the cesium iodide detector for all nodule sizes by an average of 8.5%. For one nodule size (2.75 mm), the difference between detectors was statistically significant (p < 0.01). The findings indicate that for the particular task studied, the superior resolution performance of the selenium-based detector provided better detectability of subtle lung nodules even though the images had greater noise than images obtained with the cesium iodide detector.

Biophysical Phenomena↗

Assessment of flat panel LCD primary class display performance based on AAPM TG 18 acceptance protocol.

The image display is an important component of the Picture Archiving and Communication System (PACS) and of digital imaging in general. In this paper, we assess the display performance of 32 different flat panel LCD devices, in terms of their reflection, luminance response, luminance uniformity, resolution, noise, veiling glare and color uniformity included in the tentative guidelines of the AAPM TG18 document version 8.1. We also report on the angular dependencies of luminance and contrast, which constitute one of the miscellaneous tests. The tools used included a telescopic photometer, which was also used as a colorimeter, an illuminance meter, light sources for the reflection assessment, light-blocking devices, and digital TG18 test patterns. The luminance ratio (LR), maximum luminance difference (ALmax) and deviation of contrast response with respect to that of DICOM GSDF were 379.2+/-61.0, 1.6+/-1.1%, and 4.84+/-0.58%, respectively. The maximum luminance nonuniformity was 9.2+/-3.9% for the 10% luminance of the TG18-UNL10 test pattern. In the luminance-based resolution test, the percent luminance difference (deltaL) at the center was 0.78+/-0.42%. In all cases of noise testing, the rectangular target in each square in the three quadrants was visible, as were all 15 targets, except for the smallest one, in each corner pattern and the center pattern. The glare ratio (GR) was 2350+/-1460. The average color uniformity parameter, delta(u',v'), across the display area of each display device was 0.002+/-0.001. Nevertheless, not all of the color uniformity parameters of the display devices associated with a workstation met the acceptance criteria. For 7 selected flat panel displays, the mean specular and diffuse reflection coefficients were 0.0061+/-0.0010 and 0.0017+/-0.0005 cd/m2 per lux, respectively. All of the test results conformed to the criteria recommended by AAPM TG18, indicating that the displays were fully acceptable for diagnostic image interpretation. The maximum viewing angle conforming to the DICOM 3.14 standard luminance responses with a 10% tolerance was found to be approximately 50 degrees in both directions along the vertical axis, 10 degrees in the upper direction and 20 degrees in the lower direction along the horizontal axis, and 20 degrees in the upper direction and 10 degrees in the lower direction along the diagonal axis. Therefore, a radiologist should interpret a displayed image by considering the physical characteristics of the narrow viewing angle of the AMLCD displays. The acceptance testing protocol described herein demonstrates the successful clinical implementation of the guidelines for the viewing conditions of medical displays, and if implemented with a QC program, can be used to determine when LCD devices used for diagnostic interpretation need to be upgraded.

Computer Graphics↗

Determination of the detective quantum efficiency of a digital x-ray detector: comparison of three evaluations using a common image data set.

The detective quantum efficiency (DQE) of an x-ray digital imaging detector was determined independently by the three participants of this study, using the same data set consisting of edge and flat field images. The aim was to assess the possible variation in DQE originating from established, but slightly different, data processing methods used by different groups. For the case evaluated in this study differences in DQE of up to +/-15% compared to the mean were found. The differences could be traced back mainly to differences in the modulation transfer function (MTF) and noise power spectrum (NPS) determination. Of special importance is the inclusion of a possible low-frequency drop in MTF and the proper handling of signal offsets for the determination of the NPS. When accounting for these factors the deviation between the evaluations reduced to approximately +/-5%. It is expected that the recently published standard on DQE determination will further reduce variations in the data evaluation and thus in the results of DQE measurements.

Computer Simulation↗

Fundamental imaging characteristics of a slot-scan digital chest radiographic system.

Our purpose in this study was to evaluate the fundamental image quality characteristics of a new slot-scan digital chest radiography system (ThoraScan, Delft Imaging Systems/Nucletron, Veenendaal, The Netherlands). The linearity of the system was measured over a wide exposure range at 90, 117, and 140 kVp with added Al filtration. System uniformity and reproducibility were established with an analysis of images from repeated exposures. The modulation transfer function (MTF) was evaluated using an established edge method. The noise power spectrum (NPS) and the detective quantum efficiency (DQE) of the system were evaluated at the three kilo-voltages over a range of exposures. Scatter fraction (SF) measurements were made using a posterior beam stop method and a geometrical chest phantom. The system demonstrated excellent linearity, but some structured nonuniformities. The 0.1 MTF values occurred between 3.3-3.5 mm(-1). The DQE(0.15) and DQE(2.5) were 0.21 and 0.07 at 90 kVp, 0.18 and 0.05 at 117 kVp, and 0.16 and 0.03 at 140 kVp, respectively. The system exhibited remarkably lower SFs compared to conventional full-field systems with anti-scatter grid, measuring 0.13 in the lungs and 0.43 in the mediastinum. The findings indicated that the slot-scan design provides marked scatter reduction leading to high effective DQE (DQEeff) of the system and reduced patient dose required to achieve high image quality.

Equipment Design↗

Subtle lung nodules: influence of local anatomic variations on detection.

PURPOSE: To assess the influence of local anatomic noise on the detection of subtle lung nodules depicted on chest radiographs. MATERIALS AND METHODS: Six 8 x 8-cm lung regions were extracted from digital chest radiographs obtained in healthy subjects. Simulated nodules emulating the radiographic characteristics of subtle tissue-equivalent lesions 3.2-6.4 mm in diameter (equivalent to 0.1-0.4 mm in contrast-diameter product [CD]) were added to the images. On multiple renditions of each image, nodules were inserted at slightly different locations within 6 mm of the center; this process allowed different local background patterns to overlie the nodules. An observer detection study involving 15 experienced radiologists was performed. The authors performed analysis of variance and pairwise t test analyses to determine variations in nodule detectability related to nodule location and size on each image. RESULTS: Results indicated a strong correlation between nodule size and observer detection score and significant variation in nodule detectability as a function of location. Changes in nodule position caused observer score variations that were equivalent to the variation caused by an up to 185% change in nodule CD (78% average over all six images), an up to 68% change in diameter (32% average), and an up to 28% change in area under the receiver operating characteristic curve (Az) (14% average). CONCLUSION: Local anatomic variations surrounding and overlying a subtle lung nodule on a chest radiograph that are created by the projection of anatomic features in the thorax, such as ribs and pulmonary vessels, can greatly influence the detection of nodules, altering the Az by as much as 28%.

Analysis of Variance↗

Evaluation of a flat panel digital radiographic system for low-dose portable imaging of neonates.

The purpose of this study was to evaluate the clinical utility of an investigational flat-panel digital radiography system for low-dose portable neonatal imaging. Thirty image-pairs from neonatal intensive care unit patients were acquired with a commercial Computed Radiography system (Agfa, ADC 70), and with the investigational system (Varian, Paxscan 2520) at one-quarter of the exposure. The images were evaluated for conspicuity and localization of the endings of ancillary catheters and tubes in two observer performance experiments with three pediatric radiologists and three neonatologists serving as observers. The results indicated no statistically significant difference in diagnostic quality between the images from the investigational system and from CR. Given the investigational system's superior resolution and noise characteristics, observer results suggest that the high detective quantum efficiency of flat-panel digital radiography systems can be utilized to decrease the radiation dose/exposure to neonatal patients, although post-processing of the images remains to be optimized. The rapid availability of flat-panel images in portable imaging was found to be an added advantage for timely clinical decision-making.

Catheterization↗

An experimental comparison of detector performance for direct and indirect digital radiography systems.

Current flat-panel detectors either directly convert x-ray energy to electronic charge or use indirect conversion with an intermediate optical process. The purpose of this work was to compare direct and indirect detectors in terms of their modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). Measurements were made on three flat-panel detectors, Hologic Direct-Ray DR-1000 (DRC), GE Revolution XQ/i (XQ/i), and Philips Digital Diagnost (DiDi) using the IEC-defined RQA5 (approximately 74 kVp, 21 mm Al) and RQA9 (approximately 120 kVp, 40 mm Al) radiographic techniques. The presampled MTFs of the systems were measured using an edge method [Samei et al., Med. Phys. 25, 102 (1998)]. The NPS of the systems were determined for a range of exposure levels by two-dimensional (2D) Fourier analysis of uniformly exposed radiographs [Flynn and Samei, Med. Phys. 26, 1612 (1999)]. The DQEs were assessed from the measured MTF, NPS, exposure, and estimated ideal signal-to-noise ratios. For the direct system, the MTF was found to be significantly higher than that for the indirect systems and very close to an ideal function associated with the detector pixel size. The NPS for the direct system was found to be constant in relation to frequency. For the XQ/i and DRC systems, the DQE results reflected expected differences based on the absorption efficiency of the different detector materials. Using RQA5, the measured DQE values in the diagonal (and axial) direction(s) at spatial frequencies of 0.15 mm(-1) and 2.5 mm(-1) were 64% (64%) and 20% (15%) for the XQ/i system, and 38% (38%) and 20% (20%) for the DRC, respectively. The DQE results of the DiDi system were difficult to interpret due to additional preprocessing steps in that system.

Equipment Failure Analysis↗

Image quality in two phosphor-based flat panel digital radiographic detectors.

Two general types of phosphor screens are currently used in indirect digital radiographic systems: structured phosphor screens and turbid phosphor screens. The purpose of the study was to experimentally compare the image quality characteristics of two flat-panel digital radiography detectors with similar electronics and pixel sizes (0.127 mm), but otherwise equipped with the two types of screens (0.6-mm-thick structured CsI and Lanex Regular). The presampled modulation transfer functions (MTFs) of the detectors were assessed using an edge method. The noise power spectra (NPS) were measured by two-dimensional Fourier analysis of uniformly-exposed radiographs at 50-100 kVp with 19 mm added Al filtration. The detective quantum efficiencies (DQEs) were assessed from the MTF, the NPS, and estimates of the ideal signal-to-noise ratio. The MTF measures of the two detectors were generally similar above a spatial frequency of 2 mm(-1), with approximately 2.5 and approximately 3.8 mm(-1) spatial frequencies corresponding to 0.2 MTF and 0.1 MTF, respectively. Below 2 mm(-1), the MTF for the CsI-based detector was slightly higher by an average of 0.07. At 70 kVp, the measured DQE values in the diagonal (and axial) direction(s) at spatial frequencies of 0.15 mm(-1) and 2.5 mm(-1) were 78% (78%) and 26% (20%) for the CsI-based detector, and 20% (20%) and 7% (6%) for the Lanex-based detector, respectively. The comparative findings experimentally confirm that in indirect flat-panel detectors, structured phosphor screens provide a more favorable tradeoff between resolution and noise compared to turbid-phosphor screens, effectively increasing the detection efficiency of the detector without a negative impact on the detector's spatial resolution response.

Phosphorus↗

A method for modifying the image quality parameters of digital radiographic images.

A new computer simulation approach is presented that is capable of modeling several varieties of digital radiographic systems by their image quality characteristics. In this approach, the resolution and noise characteristics of ideal supersampled input images are modified according to input modulation transfer functions (MTFs) and noise power spectra (NPS). The modification process is separated into two routines-one for modification of the resolution and another for modification of the noise characteristics of the input image. The resolution modification routine blurs the input image by applying a frequency filter described by the input MTF. The resulting blurred image is then reduced to its final size to account for the sampling process of the digital system. The noise modification routine creates colored noise by filtering the frequency components of a white noise spectrum according to the input noise power. This noise is then applied to the image by a moving region of interest to account for variations in noise due to differences in attenuation. In order to evaluate the efficacy of the modification routines, additional routines were developed to assess the resolution and noise of digital images. The MTFs measured from the output images of the resolution modification routine were within 3% of the input MTF The NPS measured from the output images of the noise modification routine were within 2% of the input NPS. The findings indicate that the developed modification routines provide a good means of simulating the resolution and noise characteristics of digital radiographic systems for optimization or processing purposes.

Algorithms↗

Chest radiography: optimization of X-ray spectrum for cesium iodide-amorphous silicon flat-panel detector.

PURPOSE: To ascertain the optimum x-ray spectrum for chest radiography with a cesium iodide-amorphous silicon flat-panel detector. MATERIALS AND METHODS: End points for optimization included the ratio of tissue contrast to bone contrast and a figure of merit (FOM) equal to the square of the signal-to-noise ratio of tissue divided by incident exposure to the patient. Studies were conducted with both computer spectrum modeling and experimental measurement in narrow-beam and full-field exposure conditions for four tissue thicknesses (8-32 cm). Three parameters that affect spectra were considered: the atomic number (Z) of filter material (Z = 13, 26, 29, 42, 50, 56, 64, 74, and 82), kilovoltage (from 50 to 150 kVp), and filter thickness (from 0.25 to 2.00 half-value layer [HVL]). RESULTS: Computer modeling and narrow-beam experimental data showed similar trends for the full range of parameters evaluated. Spectrum model results showed that copper filtration at 120 kVp or more was optimum for FOM. The ratio of contrasts showed a trend to be higher with higher kilovoltage and only a minor variation with filter material. Full-field experimental results, which reflect the added contribution of x-ray scatter, differed in magnitude but not trends from the narrow-beam data in all cases except the ratio of contrasts in the mediastinum. CONCLUSION: The best performance overall, including both FOM and ratio of contrasts, was at 120 kVp with 1-HVL copper filtration (0.2 mm). With this beam spectrum and an increase in tube output (ie, milliampere seconds) of about 50%, a chest radiograph can be obtained with image quality approximately equal to that with a conventional spectrum but with about 25% less patient exposure.

Cesium↗

Sonography of fetal choroid plexus cysts: detection depends on cyst size and gestational age.

OBJECTIVE: To establish diagnostic criteria for the diagnosis of fetal choroid plexus cysts across gestation. METHODS: Prenatal sonographic images of 166 fetuses without choroid plexus cysts were prospectively collected from 13 weeks to term. Texture characteristics of the choroid plexus regions were analyzed to quantify changes as a function of gestational age. A set of 20 fetal sonographic images with choroid plexus cysts were used to create cyst prototypes (1.5-2.5 mm), which were randomly embedded into normal choroid plexus images from varying gestational ages. A test set of 544 images was created, which included 408 images with choroid plexus cysts and 136 images without choroid plexus cysts. Four observers following a blinded study design evaluated the presence of choroid plexus cysts in the images. The influence of cyst size and gestational age on the detection of cysts was measured with receiver operating characteristic analysis and analysis of variance. Observer agreement was characterized by agreement kappa statistics. RESULTS: Texture analysis indicated greater echo texture heterogeneity at earlier gestational ages. The receiver operating characteristic analysis showed a corresponding decrease in diagnostic accuracy for cyst detection at earlier gestational ages. The cyst detection threshold (area under the receiver operating characteristic curve, 0.8) was 2.4 mm (SE, 0.2 mm) for 13 to 21 weeks' gestation and decreased to 1.9 mm (SE, 0.17 mm) for 22 to 38 weeks' gestation. Average interobserver and intraobserver kappa statistics were 0.37 and 0.53, respectively. CONCLUSIONS: Because of the changing echo texture of the choroid plexus through gestation, choroid plexus cysts must be at least 2.5 mm in diameter for confident diagnosis before 22 weeks' gestation and at least 2 mm after 22 weeks.

Adult↗

An experimental comparison of detector performance for computed radiography systems.

The intrinsic resolution, noise, and signal-to-noise transfer characteristics of five commercial digital computed radiography (CR) systems were compared using identical experimental methods. The reader/screen combinations evaluated were Agfa ADC-Compact/MD-10, Agfa ADC-Compact/MD-30, Agfa ADC-Solo/MD-10, Agfa ADC-Solo/MD-30, Lumisys CR-2000/MD-10, Fuji FCR-9501 (HQ)/ST-Va, Kodak CR-400/GP-25, and Kodak CR-400/HR. Measurements were made at 70 and 115 kVp with 19 mm added aluminum filtration. The presampled modulation transfer functions (MTFs) of the systems were measured using an edge method. The noise power spectra (NPS) were determined by 2D Fourier analysis of uniformly exposed radiographs. The frequency-dependent detective quantum efficiencies (DQEs) were computed from the MTF, NPS, exposure measurements, and computational estimates of the ideal signal-to-noise ratios. Using 70 kVp and 0.1-0.12 mm pixel sizes, spatial frequencies of 2.1, 2.0, 2.2, 1.9, 2.0, 2.0, 2.3, 2.3, and 3.5 cycles/mm were measured at 0.2 MTF for the eight reader/screen combinations, respectively. Using 70 kVp, 7.74 x 10(-8) C/kg (0.3 mR), and 0.1-0.12 mm pixel sizes, DQE(0.15) values of 20.3%, 22.9%, 24.6%, 28.6%, 22.2%, 30.0%, 29.5%, and 17.3% were obtained for the eight combinations, respectively. The corresponding values at 115 kVp were 15.9%, 18.5%, 21.5%, 21.8%, 15.3%, 23.1%, 22.3%, and 13.8%, respectively. The findings of the study demonstrate the pixel size, orientation, beam quality, screen, and reader dependencies of image quality in CR systems. The physical performance of the systems having standard-resolution screens demonstrated similar resolution performance but more notable variations in DQE. The one high-resolution screen tested had reduced DQE and increased MTF at high frequencies.

Evaluation Studies as Topic↗

AAPM/RSNA tutorial on equipment selection: PACS equipment overview: general guidelines for purchasing and acceptance testing of PACS equipment.

A picture archiving and communication system (PACS) is a comprehensive computer system that is responsible for the electronic storage and distribution of medical images in the medical enterprise. The system is highly integrated with digital acquisition and display devices and is often related closely to other medical information systems, such as the radiology information system or hospital information system. In the past few years, there has been continuous growth in clinical implementation of PACS to reduce costs and improve patient care, a trend that is expected to continue. However, a PACS is complex and costly to acquire, replace, maintain, and repair. To select a system that best meets their requirements, purchasers of PACS equipment need to be aware of the key characteristics and differing features of the various products. After the PACS has been installed, the user should perform technical and clinical acceptance testing to ensure that the system meets expectations.

Data Display↗

AAPM/RSNA physics tutorial for residents: technological and psychophysical considerations for digital mammographic displays.

Digital mammography is gradually replacing screen-film analog mammography, a transition driven by a desire to improve the efficiency and possibly the quality of the interpretation of mammograms. Digital mammography involves the use of electronic display devices to display the mammograms. Currently, two electronic technologies are used to display digital mammograms: the cathode-ray tube (CRT) and liquid crystal display (LCD). CRT and LCD devices have imaging characteristics markedly different from those of transilluminated film, which has conventionally been used to display analog mammograms. Consequently, the transition to digital mammography necessitates consideration of a number of psychophysical factors pertaining to effective display of mammograms. Some of these factors are related to specific performance characteristics of the display devices, whereas others are related to inherent characteristics of the human visual system. The main psychophysical factors that affect the interpretation of medical images are contrast, resolution, and noise. Optimal display of mammograms is achieved by taking these factors into consideration and by using time-efficient, intuitive, and reader-specific user interfaces. Because display devices are susceptible to variations in hardware and calibration and to degradation over time, acceptance testing and quality control testing are necessary to maintain an adequate level of display quality.

Artifacts↗