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J H Siewerdsen

Publications and source records attributed to J H Siewerdsen.

At least 19 recordsLinked to original sources

A simple, direct method for x-ray scatter estimation and correction in digital radiography and cone-beam CT.

X-ray scatter poses a significant limitation to image quality in cone-beam CT (CBCT), resulting in contrast reduction, image artifacts, and lack of CT number accuracy. We report the performance of a simple scatter correction method in which scatter fluence is estimated directly in each projection from pixel values near the edge of the detector behind the collimator leaves. The algorithm operates on the simple assumption that signal in the collimator shadow is attributable to x-ray scatter, and the 2D scatter fluence is estimated by interpolating between pixel values measured along the top and bottom edges of the detector behind the collimator leaves. The resulting scatter fluence estimate is subtracted from each projection to yield an estimate of the primary-only images for CBCT reconstruction. Performance was investigated in phantom experiments on an experimental CBCT bench-top, and the effect on image quality was demonstrated in patient images (head, abdomen, and pelvis sites) obtained on a preclinical system for CBCT-guided radiation therapy. The algorithm provides significant reduction in scatter artifacts without compromise in contrast-to-noise ratio (CNR). For example, in a head phantom, cupping artifact was essentially eliminated, CT number accuracy was restored to within 3%, and CNR (breast-to-water) was improved by up to 50%. Similarly in a body phantom, cupping artifact was reduced by at least a factor of 2 without loss in CNR. Patient images demonstrate significantly increased uniformity, accuracy, and contrast, with an overall improvement in image quality in all sites investigated. Qualitative evaluation illustrates that soft-tissue structures that are otherwise undetectable are clearly delineated in scatter-corrected reconstructions. Since scatter is estimated directly in each projection, the algorithm is robust with respect to system geometry, patient size and heterogeneity, patient motion, etc. Operating without prior information, analytical modeling, or Monte Carlo, the technique is easily incorporated as a preprocessing step in CBCT reconstruction to provide significant scatter reduction.

Algorithms↗

Intraoperative cone-beam CT for guidance of head and neck surgery: Assessment of dose and image quality using a C-arm prototype.

Cone-beam computed tomography (CBCT) with a flat-panel detector represents a promising modality for intraoperative imaging in interventional procedures, demonstrating sub-mm three-dimensional (3D) spatial resolution and soft-tissue visibility. Measurements of patient dose and in-room exposure for CBCT-guided head and neck surgery are reported, and the 3D imaging performance as a function of dose and other acquisition/reconstruction parameters is investigated. Measurements were performed on a mobile isocentric C-arm (Siemens PowerMobil) modified in collaboration with Siemens Medical Solutions (Erlangen, Germany) to provide flat-panel CBCT. Imaging dose was measured in a custom-built 16 cm cylindrical head phantom at four positions (isocenter, anterior, posterior, and lateral) as a function of kVp (80-120 kVp) and C-arm trajectory ("tube-under" and "tube-over" half-rotation orbits). At 100 kVp, for example ("tube-under" orbit), the imaging dose was 0.059 (isocenter), 0.022 (anterior), 0.10 (posterior), and 0.056 (lateral) mGy/ mAs, with scans at approximately 50 and approximately 170 mAs typical for visualization of bony and soft-tissue structures, respectively. Dose to radiosensitive structures (viz., the eyes and thyroid) were considered in particular: significant dose sparing to the eyes (a factor of 5) was achieved using a "tube-under" (rather than "tube-over") half-rotation orbit; a thyroid shield (0.5 mm Pb-equivalent) gave moderate reduction in thyroid dose due to x-ray scatter outside the primary field of view. In-room exposure was measured at positions around the operating table and up to 2 m from isocenter. A typical CBCT scan (10 mGy to isocenter) gave in-air exposure ranging from 29 mR (0.26 mSv) at 35 cm from isocenter, to <0.5 mR (<0.005 mSv) at 2 m from isocenter. Three-dimensional (3D) image quality was assessed in CBCT reconstructions of an anthropomorphic head phantom containing contrast-detail spheres (11-103 HU; 1.6-12.7 mm) and a natural human skeleton. The contrast-to-noise ratio (CNR) was evaluated across a broad range of dose (0.6-23.3 mGy). CNR increased as the square root of dose, with excellent visualization of bony and soft-tissue structures achieved at approximately 3 mGy (0.10 mSv) and approximately 10 mGy (0.35 mSv), respectively. The prototype C-arm demonstrates CBCT image quality sufficient for guidance of head and neck procedures based on soft-tissue and bony anatomy at dose levels low enough for repeat intraoperative imaging, with total dose over the course of the procedure comparable to or less than the effective dose of a typical (2 mSv) diagnostic CT of the head.

Dose-Response Relationship, Radiation↗

An innovative phantom for quantitative and qualitative investigation of advanced x-ray imaging technologies.

Development, characterization, and quality assurance of advanced x-ray imaging technologies require phantoms that are quantitative and well suited to such modalities. This note reports on the design, construction, and use of an innovative phantom developed for advanced imaging technologies (e.g., multi-detector CT and the numerous applications of flat-panel detectors in dual-energy imaging, tomosynthesis, and cone-beam CT) in diagnostic and image-guided procedures. The design addresses shortcomings of existing phantoms by incorporating criteria satisfied by no other single phantom: (1) inserts are fully 3D--spherically symmetric rather than cylindrical; (2) modules are quantitative, presenting objects of known size and contrast for quality assurance and image quality investigation; (3) features are incorporated in ideal and semi-realistic (anthropomorphic) contexts; and (4) the phantom allows devices to be inserted and manipulated in an accessible module (right lung). The phantom consists of five primary modules: (1) head, featuring contrast-detail spheres approximate to brain lesions; (2) left lung, featuring contrast-detail spheres approximate to lung modules; (3) right lung, an accessible hull in which devices may be placed and manipulated; (4) liver, featuring contrast-detail spheres approximate to metastases; and (5) abdomen/pelvis, featuring simulated kidneys, colon, rectum, bladder, and prostate. The phantom represents a two-fold evolution in design philosophy--from 2D (cylindrically symmetric) to fully 3D, and from exclusively qualitative or quantitative to a design accommodating quantitative study within an anatomical context. It has proven a valuable tool in investigations throughout our institution, including low-dose CT, dual-energy radiography, and cone-beam CT for image-guided radiation therapy and surgery.

Brain Neoplasms↗

Investigation of C-arm cone-beam CT-guided surgery of the frontal recess.

OBJECTIVE/HYPOTHESIS: A cone-beam CT (CBCT) imaging system based on a mobile C-arm (Siemens PowerMobil) incorporating a high-performance flat-panel detector (Varian PaxScan) has been developed in our laboratory. We hypothesize that intraoperative C-arm CBCT provides image quality and guidance performance sufficient to assist surgical approach to the frontal recess. STUDY DESIGN: A preclinical prospective study was conducted using six cadaver heads to assess the performance characteristics and the potential clinical utility of this imaging system. METHODS: The mobile C-arm was employed for intraoperative CBCT guidance of the endoscopic approach to twelve frontal recesses. RESULTS: The imaging system is capable of sub-mm 3D spatial resolution with bone and soft-tissue visibility and a field of view sufficient for guidance of head and neck surgery. The system can generate intraoperative, volumetric CT images rapidly with an acceptably low radiation exposure to the patient and with image quality sufficient for most surgical tasks. Moreover, the system is portable and compatible with the surgical setup, providing excellent access to the patient. Finally, the accuracy of the system is not bound to a registration process. CONCLUSIONS: The ability to create updated images as surgery progresses introduces the concept of 'near-real-time' CT guidance for head and neck surgery. We found that the use of CBCT increased surgical confidence in accessing the frontal recess, resolved ambiguities with anatomical variations, and provided valuable teaching information to surgeons in training in both preoperative planning and correlation between tri-planar CT scans and intraoperative endoscopic findings.

Cadaver↗

Volume CT with a flat-panel detector on a mobile, isocentric C-arm: pre-clinical investigation in guidance of minimally invasive surgery.

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.

Algorithms↗

Generalized DQE analysis of radiographic and dual-energy imaging using flat-panel detectors.

Analysis of detective quantum efficiency (DQE) is an important component of the investigation of imaging performance for flat-panel detectors (FPDs). Conventional descriptions of DQE are limited, however, in that they take no account of anatomical noise (i.e., image fluctuations caused by overlying anatomy), even though such noise can be the most significant limitation to detectability, often outweighing quantum or electronic noise. We incorporate anatomical noise in experimental and theoretical descriptions of the "generalized DQE" by including a spatial-frequency-dependent noise-power term, S(B), corresponding to background anatomical fluctuations. Cascaded systems analysis (CSA) of the generalized DQE reveals tradeoffs between anatomical noise and the factors that govern quantum noise. We extend such analysis to dual-energy (DE) imaging, in which the overlying anatomical structure is selectively removed in image reconstructions by combining projections acquired at low and high kVp. The effectiveness of DE imaging in removing anatomical noise is quantified by measurement of S(B) in an anthropomorphic phantom. Combining the generalized DQE with an idealized task function to yield the detectability index, we show that anatomical noise dramatically influences task-based performance, system design, and optimization. For the case of radiography, the analysis resolves a fundamental and illustrative quandary: The effect of kVp on imaging performance, which is poorly described by conventional DQE analysis but is clarified by consideration of the generalized DQE. For the case of DE imaging, extension of a generalized CSA methodology reveals a potentially powerful guide to system optimization through the optimal selection of the tissue cancellation parameter. Generalized task-based analysis for DE imaging shows an improvement in the detectability index by more than a factor of 2 compared to conventional radiography for idealized detection tasks.

Algorithms↗

Spektr: a computational tool for x-ray spectral analysis and imaging system optimization.

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.

Algorithms↗

The influence of antiscatter grids on soft-tissue detectability in cone-beam computed tomography with flat-panel detectors.

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).

Artifacts↗

A performance comparison of flat-panel imager-based MV and kV cone-beam CT.

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.

Dose-Response Relationship, Radiation↗

A framework for noise-power spectrum analysis of multidimensional images.

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.

Algorithms↗

Cone-beam computed tomography with a flat-panel imager: magnitude and effects of x-ray scatter.

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.

Biophysical Phenomena↗

High resolution gel-dosimetry by optical-CT and MR scanning.

The increased intricacy of Intensity-Modulated-Radiation-Therapy (IMRT) delivery has created the need for a high-resolution 3D-dosimetry (three-dimensional) system capable of measuring and verifying the complex delivery. Present clinical methods are inadequate being restricted to single points (e.g., ion-chambers) or to 2D planes (e.g., film), and are labor intensive. In this paper we show that gel-dosimetry in conjunction with optical-CT scanning can yield maps of dose that are of sufficient accuracy, resolution and precision to allow verification of complex radiosurgery deliveries, and by extension IMRT deliveries. The radiosurgery dose-distribution represents the most challenging case encountered in external beam therapy by virtue of the steep dose-gradients and high resolution of delivery. We characterize the stringent radiosurgery requirements by the RTAP (Resolution-Time-Accuracy-Precision) criteria defined as < or = 1 mm3 spatial resolution, < or = 1 hour imaging time, accurate to within 3%, and within -1% precision. The RTAP criteria is applied to an in-house laser-based optical-CT scanning system presented here, and evaluated using gel-flasks containing BANG3 gel. The same gel flasks were subsequently imaged using the MR imaging protocol recommended by the gel manufacturer, but modified to match as closely as possible the RTAP. The resulting dose-maps demonstrate the high precision (< 1.3% noise at high dose) achievable with optical CT scanning while preserving high spatial resolution (<1 mm3). Using the sequence above, the MR gel-dose maps were found to have poorer precision by a factor of 5, under the strict conditions of the RTAP. The optical CT gel-dosimetry system was further evaluated for the verification of a complex 3-isocenter radiosurgery delivery. In conclusion, this work demonstrates that gel-dosimetry and optical-CT scanning approach an important long-term goal of radiation dosimetry, as specified by the RTAP criteria, and have potential to impact the clinic by improving and facilitating clinical dose verification for the most complex external beam radiation treatments.

Calibration↗

Optimization of x-ray imaging geometry (with specific application to flat-panel cone-beam computed tomography).

A theoretical method is presented that allows identification of optimal x-ray imaging geometry, considering the effects of x-ray source distribution, imaging task, x-ray scatter, and imager detective quantum efficiency (DQE). Each of these factors is incorporated into the ICRU-recommended figure of merit for image quality, the detectability index, which is maximized to determine the optimal system configuration. Cascaded systems analysis of flat-panel imagers (FPIs) is extended to incorporate the effects of x-ray scatter directly in the DQE, showing that x-ray scatter degrades DQE as an additive noise source. Optimal magnification is computed for FPI configurations appropriate to (but not limited to) cone-beam computed tomography (CBCT). The sensitivity of the results is examined as a function of focal spot size, imaging task (e.g., ideal observer detection or discrimination tasks), x-ray scatter fraction, detector resolution, and additive noise. Nominal conditions for FPI-CBCT result in optimal magnification of approximately 1.4-1.6, depending primarily on the magnitude of the x-ray scatter fraction. The methodology is sufficiently general that examination of optimal geometry for other FPI applications (e.g., chest radiography, fluoroscopy, and mammography) is possible. The degree to which increased exposure can be used to compensate for x-ray scatter degradation is quantified.

Algorithms↗

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

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

Feasibility Studies↗

Cone-beam computed tomography with a flat-panel imager: initial performance characterization.

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.

Animals↗

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

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

Biophysical Phenomena↗

A ghost story: spatio-temporal response characteristics of an indirect-detection flat-panel imager.

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.

Biophysical Phenomena↗

Cone-beam computed tomography with a flat-panel imager: effects of image lag.

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.

Computer Simulation↗