Current challenges of full field digital mammography

Full field digital mammography (FFDM) has advantages over screen-film mammography (SFM), but some important challenges remain. The first challenge is related to the specific characteristics of FFDM. It remains unclear, which shape and limiting values of the modulation transfer function have the most influence on the performance of a detector, such as the effect of the image display on the overall image quality and the effect of processing on cancer detection. In order to assess the image quality of FFDM, we have set up a scoring system. The second challenge is related to screening mammography: is the quality of an image the same when it is viewed on different monitors and with different processing algorithms? Is Computer Aided Diagnosis necessary in a screening environment? In FFDM, the effect of different detectors, processing and display possibilities on the image and on cancer detection are not clearly investigated.     

Quality assurance of computed and digital radiography systems

Computed radiography (CR) and digital radiography (DR) are replacing traditional film screen radiography as hospitals move towards digital imaging and picture archiving and communication systems (PACS). Both IPEM and KCARE have recently published quality assurance and acceptance testing guidelines for DR. In this paper, the performance of a range of CR and DR systems is compared. Six different manufacturers are included. Particular attention is paid to the performance of the systems under automatic exposure control (AEC). The patient is simulated using a range of thicknesses of tissue equivalent material. Image quality assessment was based on detector assessment protocols and includes pixel value measures as well as subjective assessment using Leeds Test Objects. The protocols for detector assessment cover a broad range of tests and in general detectors (whether DR or CR) performed satisfactorily. The chief limitation in performing these tests was that not all systems provided ready access to pixel values. Subjective tests include the use of the Leeds TO20. As part of this work, suggested reference values are provided to calculate the TO20 image quality factor. One consequence of moving from film screen to digital technologies is that the dynamic range of digital detectors is much wider, and increased exposures are no longer evident from changes in image quality. As such, AEC is a key parameter for CR and DR. Dose was measured using a standard phantom as a basic means of comparing systems. In order to assess the AEC performance, exit doses were also measured while varying phantom thickness. Signal-to-noise ratios (SNRs) were calculated on a number of systems where pixel values were available. SNR was affected by the selection of acquisition protocol. Comparisons between different technologies and collation of data will help refine acceptance thresholds and contribute to optimising dose and image quality.     

Image quality measurements and metrics in full field digital mammography: an overview

This paper gives an overview of test procedures developed to assess the performance of full field digital mammography systems. We make a distinction between tests of the individual components of the imaging chain and global system tests. Most tests are not yet fully standardised. Where possible, we illustrate the test methodologies on a selenium flat-panel system.     

Clinical image quality criteria for full field digital mammography: a first practical application

In order to quantify the clinical quality of full-field digital mammography, a set of image quality parameters is developed. The set consisted of 12 image quality criteria and 8 physical characteristics of the image. The first set interrogates the visibility of anatomical structures and typical characteristics of a digital image, such as noise and saturation of dark and white areas. The second set of criteria evaluates contrast, sharpness and confidence with the representation of masses, microcalcifications and the image. The use of these criteria is reported in a retrospective study, in which the impact of dose on the radiological quality of digital mammograms is evaluated. Fifty patients acquired in a low-dose mode were retrieved and compared with 50 patients acquired in a dose mode that was set 41% higher. The dose affects, more than expected, contrast and sharpness of the image, whereas the visibility of the anatomical structures remains unchanged. With these parameters, quantification of the image quality is possible; however, because of subjectivity of the parameters, only intra-observer comparison and evaluation of the individual parameters rather than the overall results are advised. Together with physical tests of image quality, critical radiological evaluation of the quality should be included in the acceptance process of digital mammography.     

Evaluation and testing of computed radiography systems

The implementation of film replacement digital radiographic imaging systems throughout Europe is now gathering momentum. Such systems create the foundations for totally digital departments of radiology, since radiographic examinations constitute the most prevalent modality. Although this type of development will lead to improvements in the delivery and management of radiological service, such widespread implementation of new technology must be carefully monitored. The implementation of effective QA tests on installation, at periodic intervals and as part of a routine programme will aid this process. This paper presents the results of commissioning tests undertaken on a number of computed radiography imaging systems provided by different manufacturers. The aim of these tests was not only to provide baseline performance measurements against which subsequent measurements can be compared but also to explore any differences in performance, which might exist between different units. Results of measurements will be presented for (1) monitor and laser printer set-up; (2) imaging plates, including sensitivity, consistency and uniformity; (3) resolution and contrast detectability; and (4) signal and noise performance. Results from the latter are analysed in relationship with both system and quantum noise components.     

Image segmentation using multiresolution wavelet analysis and expectation-maximization (EM) algorithm for digital mammography

This article presents a novel algorithm for image segmentation via the use of the multiresolution wavelet analysis and the expectation maximization (EM) algorithm. The development of a multiresolution wavelet feature extraction scheme is based on the Gaussian Markov random field (GMRF) assumption in mammographic image modeling. Mammographic images are hierarchically decomposed into different resolutions. In general, larger breast lesions are characterized by coarser resolutions, whereas higher resolutions show finer and more detailed anatomical structures. These hierarchical variations in the anatomical features displayed by multiresolution decomposition are further quantified through the application of the Gaussian Markov random field. Because of its uniqueness in locality, adaptive features based on the nonstationary assumption of GMRF are defined for each pixel of the mammogram. Fibroadenomas are then segmented via the fuzzy C-means algorithm using these localized features. Subsequently, the segmentation results are further enhanced via the introduction of a maximum a posteriori (MAP) segmentation estimation scheme based on the Bayesian learning paradigm. Gibbs priors or Gibbs random fields have also been incorporated into the learning scheme of the present research with very effective outcomes. In this article, the EM algorithm for MAP estimation is formulated. The EM algorithm provides an iterative and computationally simple algorithm based on the incomplete data concept. © 1997 John Wiley & Sons, Inc. Int J Imaging Syst Technol, 8, 491–504, 1997     

Single-shot full resolution region-of-interest (ROI) reconstruction in image plane digital holographic microscopy

We describe a numerical processing technique that allows single-shot region-of-interest (ROI) reconstruction in image plane digital holographic microscopy with full pixel resolution. The ROI reconstruction is modelled as an optimization problem where the cost function to be minimized consists of an L2-norm squared data fitting term and a modified Huber penalty term that are minimized alternately in an adaptive fashion. The technique can provide full pixel resolution complex-valued images of the selected ROI which is not possible to achieve with the commonly used Fourier transform method. The technique can facilitate holographic reconstruction of individual cells of interest from a large field-of-view digital holographic microscopy data. The complementary phase information in addition to the usual absorption information already available in the form of bright field microscopy can make the methodology attractive to the biomedical user community.     

Chest radiography: a comparison of image quality and effective dose using four digital systems

Image quality (IQ) and effective dose for chest radiography was compared for four digital imaging systems that used three different detector technologies: a-Si/TFT flat-panel detector (FPD), scanning-slot/charge-coupled device (CCD) and photostimuable phosphor (PSP). On each system a phantom was exposed at 125 kV(p) for automatic exposure control (AEC) and 2, 4 and 8 Gy receptor dose using identical geometrical conditions. All images were scored as softcopy images by three observers. The effective dose was calculated for each exposure condition. For AEC, superior IQ was observed for the GE FPD compared with all the other systems, which showed similar IQ performance. For all systems the entrance surface dose associated with AEC was within the European recommendations but variations in the effective dose were observed between the four systems. For identical receptor dose levels superior IQ was observed with the FPDs. Thorascan was noted for its low effective dose and Agfa CR was associated with the highest effective dose. FPD systems showed a better overall performance, followed by the CCD and PSP systems.     

Management status of computed radiography in Korean hospitals

Abstract

Although image quality control (QC) of digital system requires professionalism and information techniques, the real situation is that accurate image QC has not been carried out due to the lack of information and experienced operators in clinics. Therefore, in the present study, image QC was divided into representative medical images via computed radiography (CR), and a means of maintaining the optimal image quality in clinics is suggested. The QC state of 25 Korean hospitals equipped with CR was assessed by a questionnaire. Based on the answers, experiments were carried out by dividing the data into the CR. In the CR, the systemic QC of the imaging plate (IP) was examined by assessing the management of the IP with a questionnaire. The results in the CR part demonstrated the importance of systemic management and the establishment of standards, such as selection of the appropriate turnover cycle, based on the use of an IP and the management state determined by the questionnaire. This highlights the need to develop a company's own training program for the use of CR. There is little research data on methods of the image QC for CR equipment. Accordingly, equipment companies and operators should establish systemic QC methods through more studies.     

The use of a figure-of-merit (FOM) for optimisation in digital mammography: a literature review

The use of image quality parameters in digital mammography such as contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and detective quantum efficiency (DQE) has been widespread, with the intention of detector evaluation and/or quantitative evaluation of the system performance. These parameters are useful in ensuring adequate system performance when tests are done against international standards or guidelines. Parameters like CNR are relative quantities that lie within a range that is manufacturer and system dependent. The use of a figure-of-merit (FOM) is a relatively new concept as a tool in digital mammography permitting quantitative assessment in terms of image quality and patient dose. This review summarises the available evidence for the use and applicability of an FOM in digital mammography.     

Clinical aspects of quality criteria in digital radiography

In clinical radiological practice two main questions regarding image quality have to be looked at: Which degree of image quality is needed? and: How can this image quality be objective? Image quality requirements depend on size, density and contrast of the objects of interest and on the clinical question which has to be answered. In comparison to conventional radiography, the digital radiographic techniques offer additional features concerning optimisation of image quality and dose, like a wider dynamic range, digital fluoroscopic techniques and post-processing. Therefore it is necessary to define new quality criteria for these techniques. In the following, typical examples demonstrate the development of the 'Diagnostic Requirements for Digital Radiographic Procedures'. These examinations include projection radiographs with digital luminiscent radiography, fluoroscopic procedures with digital image intensifier radiography and angiographic procedures with digital subtraction angiography. The clinical question of a radiological examination also forms the background to optimisation strategies considering image quality and radiation dose.     

Application of European protocol in the evaluation of contrast-to-noise ratio and mean glandular dose for two digital mammography systems

The performance of two digital mammography systems, Agfa CR75 and CRMM3 computed radiography (CR) and IMS Giotto MD direct digital radiography (DR), was assessed by applying a method recommended in the European protocol for quality control in mammography screening. The contrast-to-noise ratio (CNR) and mean glandular dose (MGD) values were measured and contrast detail (CD) analysis was performed. The CNRs for system CR were 21.9, 12.9, 9.5, 8.8, 7.4, 5.5 and 4.4 for 2, 3, 4, 4.5, 5, 6 and 7-cm polymenthylmethacrylate (PMMA) thickness, respectively. The respective CNRs for system DR were 10.4, 8.8, 6.3, 7.3, 7.2, 6.4 and 6.54. For the same phantom thickness sequence, the MGDs were 0.7, 1.1, 1.3, 1.6, 1.9, 2.5 and 3.4 mGy for system CR, whereas they were 0.7, 1.2, 1.1, 1.3, 1.8, 3.5 and 3.9 mGy for system DR. The CNR and MGD results satisfactorily correlate with CD analysis results. The MGD values compare well with the values recommended in the European protocol. Despite being simple, CNR and MGD can provide an effective system for performance assessment and constancy checks for related optimisations.     

Bistatic atmospheric optoelectronic communication systems (field experiments)

Some results of field experiments on atmospheric optoelectronic communication carried out in spring-summer-fall period in 2013 are considered. Experiments were performed to estimate the possibility of test signal transfer through bistatic communication channels extending up to 17 km under conditions of cloudless and cloudy atmospheres at radiation wavelength of 510.6 nm.     

Image quality and patient dose in computed tomography examinations in Greece

The purpose of this study is to evaluate image quality of various computed tomography (CT) scanners installed in Greece, as well as to investigate patient doses from common CT examinations. An image quality survey was performed in 44 CT scanners countrywide. The imaging performance of the systems was evaluated by measurements of certain parameters, such as image noise, spatial uniformity, high- and low-contrast resolution and slice thickness accuracy. Moreover, preliminary results of patient dose survey are presented. Concerning image quality, 80 % of the scanners were found to be in compliance with the national legislation and relative international guidelines for all the examined parameters. Weighted CT dose index and dose-length product values for chest and abdomen routine examinations were generally below the dose reference levels (DRLs) suggested by the European Commission. However, some scanners were found to deliver significantly higher doses than the suggested DRL for head routine examinations. Finally, differences in the performance among scanners of the same type and similar age were observed, pointing out the importance of frequent calibration, routine quality control and proper maintenance.     

Radon survey in Kalamata (Greece)

A national radon survey is still lacking for Greece. Some groups have carried out several more or less local or extended radon surveys and valuable experience has been gained. After the first preliminary survey carried out by our group, where 500 Kodak LR-115 etched track detectors were placed in Greek schools and dwellings for one year, indoor radon measurements were continued by placing the same number of detectors in a restricted area, covering the city of Kalamata (a medium size city with 60,000 inhabitants), situated in the south of Peloponnese. Although Kalamata was not of special radon interest, the local authorities insisted on knowing for their citizens' sake the level of this natural radiation. At first, the intention was to use a different method of organisation and distribution of the etched-track detectors from the previous one, attempting mainly to acquire more reliable results and to collect as many detectors as possible. Secondly, it was of great importance to test the statistics of the indoor radon concentrations for a rather small area, and thirdly, to estimate independently the annual absorbed dose by children, taking into account radon concentrations measured both in their home and at school. The set of detectors' readings (about 370), revealed, in general, lower values for Kalamata, compared to the ones found in the preliminary radon survey in Greece and almost all concentrations were found to be below the NRPB action level (200 Bq.m-3).     

Status and prospects of digital detector technology for CR and DR

Projection radiography is in the middle of the transition from conventional screen-film imaging to digital image acquisition modalities, mainly based on imaging plates (computed radiography, CR) and flat-panel detectors (direct radiography, DR). Cassette-based CR has been available for the past 20 y, and constitutes the major part of direct radiography installations in hospitals today. direct radiography systems based on large-area amorphous silicon active matrix arrays are commercially available for the last 5 y and exist basically in two different types: with scintillators or photoconductors as X-ray conversion material ('indirect' or 'direct' type). direct radiography systems allow for improved image quality and/or dose reduction due to their high detective quantum efficiency and enable faster workflow because of instant image availability. However, new technology developments are improving the performance for CR systems as well, rendering it competitive to direct radiography in many practical aspects. Therefore, it is assumed that the CR and direct radiography systems will coexist for many years to come. This paper reviews the digital detector technologies and the possible future directions of development.     

Comparative reject analysis in conventional film-screen and digital storage phosphor radiography

The purpose of this work was to gather information about the benefits in patient care caused by the introduction of digital radiography. In particular, the possibility of reducing the number of image repeats and thus unnecessary patient radiation was sought. Waste films of conventional radiography were collected--in digital radiography each image delete command at the post-processing workstation was documented. Rejected images were analysed retrospectively. The overall reject rate was 27.6% in the conventional and 2.3% in the digital department. While in the conventional department the main reason for rejection was 'exposure' and 'others' (i.e. problems related to film handling), the main reason in the digital environment was 'positioning'. Reject analysis yields representative data about the current performance of a radiology department. A marked reduction of repeated X rays and consequently reduced radiation exposure of the patient was clearly shown in this study comparing two differently working radiology departments. This is one of several benefits of digital radiography in patient care.     

An evaluation of field total petroleum hydrocarbon (TPH) systems

An evaluation of several field kits and petroleum hydrocarbon measuring systems was conducted. The field kits were the immunoassay based EnviroGard petroleum fuels in soil test kit (EnviroGard, Millipore Canada, Mississauga, Ont., Canada), the turbidimetric based PetroFlag hydrocarbon test kit for soil (Dexsil, Hamden, CT, USA), a DR/2000 field kit (Hach Company, Loveland CO, USA) employing colorimetric test procedures and a total organic carbon (TOC) analysis instrument (Dohrmann Division, Rosemount Analytical Inc., Santa Clara, CA, USA) using oxidation principles. These procedures were compared to the traditional technique of extraction of the petroleum hydrocarbons using trichlorotrifluoroethane (Freon 113) as the solvent and subsequent infrared (IR) analysis using a portable fixed wavelength analyzer (Buck Scientific, East Norwalk, CT, USA).The EnviroGard kit was affected by the sample matrix. The soil type and the presence or lack thereof specific chemical components affected the capability to detect the petroleum hydrocarbon concentration. The PetroFlag soil test kit tended to generate results higher than the accepted concentration. The IR method was better capable of producing results similar to the expected concentration values of the prepared samples.Results indicate that the total organic carbon analysis technique evaluated is best suited for samples containing dissolved hydrocarbons in water and is not a preferred procedure for water samples containing dispersed or floating oil. At low concentrations of 10ppm and less, the TOC method and IR method have concentration values within a few parts-per-million (ppm) of each other, however, an examination of the trends in the results for all samples shows no similarity. This would indicate that the traditional extraction and infrared method and the total organic carbon method are not measuring the same parameter.Finally, the colorimetric field kit was capable of quantifying the concentration of oil in water samples within limits. The results from the oil-in-water method built into the unit at the factory were not comparable with analysis carried out by the infrared technique. With specific methods for each oil incorporated into the spectrophotometer, the comparability of data increased significantly. Results generated by the kit are dependent upon the color and amount of the oil in the sample. The kit is best suited for dark colored oils and the water samples with concentrations in the range of 10 to 85ppm by weight.     

Doses under automatic exposure control (AEC) for direct digital radiographic (DDR) X-ray systems

Current guidelines quote tolerances for automatic exposure control (AEC) device performance for X-ray systems as 'Baseline ± X %'. However, in the situation where a baseline figure has not yet been achieved, as in the case of commissioning assessments, this tolerance is not relevant. The purpose of this work is to provide mean doses for direct digital radiography (DDR) X-ray system, operating in AEC, against which comparisons can be made. Dose measurements have been recorded under AEC operation on 29 DDR detectors from three different manufacturers. Two different testing protocols were examined: (1) water equivalent phantoms in front of the DDR detector and (2) aluminium block at the tube head. The average patient exit dose, using the aluminium block was 4.6 μGy with the antiscatter grid in place and 4.0 μGy with the grid removed. Using the water phantoms, the average dose was measured at 17.1 μGy with the antiscatter grid in place and 5.4 μGy with grid removed. Based on these results, it is clear that different testing configurations significantly impact on the measured dose.     

Nodule detection in digital chest radiography: effect of system noise

Apart from the image content that is the reproduction of anatomy and possible lesions, an X-ray image also contains system noise due to the limited number of photons and other internal noise sources in the system (image plate artefacts, electronic noise, etc.). The aim of this study was to determine the extent to which the system noise influences the detection of subtle lung nodules in five different regions of the chest. This was done by conducting a receiver operating characteristic (ROC) study with five observers on two different sets of images; clinical chest X-ray images and images of a LucAl phantom at similar dose levels found in the different regions of the chest. In both image types, mathematically simulated nodules (with a full-width-at-fifth-maximum of 10 mm) were added to the images at varying contrast levels. As a measure of the influence of system noise on the detection of subtle lung nodules, the ratio between the contrast needed to obtain an area under the ROC curve of 0.80 in the system noise images to that needed in the clinical images was used. The contrast ratio between system noise images and clinical images ranged from approximately 0.02 (in the hilar region) to 0.18 (in the lower mediastinal region). The maximum difference in contrast needed for the corresponding system noise images, collected at the lowest and the highest dose represented in the anatomical image, was a factor of 2. These results indicate that probably no region in a chest X-ray image is limited by the number of quanta to the detector for the detection of 10 mm lung nodules when a radiation dose corresponding to a system with speed class 200 (leading to a detector dose of approximately 9 muGy behind the parenchyma) is used.