Flat-panel Detector System Research Articles

A Cone-Beam Volume CT Using a 3D Angiography System with a Flat Panel Detector of Direct Conversion Type: Usefulness for Superselective Intra-arterial Chemotherapy for Head and Neck Tumors

The development of flat panel detectors (FPDs) has made cone-beam CT feasible for practical use in a clinical setting. Our purpose was to assess the usefulness of cone-beam CT using the FPD in conjunction with conventional digital subtraction angiography (DSA) for performing superselective intra-arterial chemotherapy for head and neck tumors. Twenty-three consecutive patients (43 feeding arteries) were prospectively examined. All of the patients underwent intra-arterial rotational angiography using an FPD system, and the cone-beam CT was reconstructed from the volume dataset. Two radiologists evaluated the quality of the cone-beam CT and then evaluated whether the additional information provided by the cone-beam CT was useful for the interventional procedures. In 41 (95%) of 43 arteries, the extent of contrast material perfusion was sufficiently visualized on cone-beam CT. In 20 (47%) of 43 arteries, the DSA plus cone-beam CT was superior to the DSA alone regarding the precise understanding of vascular territory of each artery. This information was helpful for predicting the drug delivery for superselective intra-arterial chemotherapy, especially in deeply invasive tumors with multiple feeding arteries. In superselective intra-arterial chemotherapy for head and neck tumors, cone-beam CT with FPD provides useful additional information, which allows interventional radiologists to determine the feeders, as well as the dose of antitumor agent for each feeder.

Detectability of Regional Lung Ventilation with Flat-panel Detector-based Dynamic Radiography

This study was performed to investigate the ability of breathing chest radiography using flat-panel detector (FPD) to quantify relative local ventilation. Dynamic chest radiographs during respiration were obtained using a modified FPD system. Imaging was performed in three different positions, ie, standing and right and left decubitus positions, to change the distribution of local ventilation. We measured the average pixel value in the local lung area. Subsequently, the interframe differences, as well as difference values between maximum inspiratory and expiratory phases, were calculated. The results were visualized as images in the form of a color display to show more or less x-ray translucency. Temporal changes and spatial distribution of the results were then compared to lung physiology. In the results, the average pixel value in each lung was associated with respiratory phase. In all positions, respiratory changes of pixel value in the lower area were greater than those in the upper area (P < 0.01), which was the same tendency as the regional differences in ventilation determined by respiratory physiology. In addition, in the decubitus position, it was observed that areas with large respiratory changes in pixel value moved up in the vertical direction during expiration, which was considered to be airway closure. In conclusion, breathing chest radiography using FPD was shown to be capable of quantifying relative ventilation in local lung area and detecting regional differences in ventilation and timing of airway closure. This method is expected to be useful as a new diagnostic imaging modality for evaluating relative local ventilation.

フラットパネルディテクタを用いたデュアルエネルギーサブトラクション法におけるびまん性肺疾患の検出能の評価

We investigated and evaluated the detection of simulated lesions in various interstitial lung diseases using the dual-energy subtraction radiography method and flat-panel detector (FPD) images. We obtained a FPD system (GE Revolution XR/d), and employed dual-energy 60 kV and 130 kV exposure techniques. Three types of lung lesions, namely, micro-nodule, ground-glass, and honeycomb patterns were simulated with interstitial lung disease on a chest phantom. Chest images with and without simulated lesions were exposed and compared with standard images and subtraction images. We carried out evaluations with and without subtraction images and performed the analysis by using receiver operating characteristic (ROC) analysis of detection. Results showed that the detection of interstitial lung diseases was significantly improved by the use of subtraction images. The area under the ROC curve (AUC) values of micro-nodule images obtained with and without subtraction images were 0.768 and 0.963, ground-glass images 0.670 and 0.917, and honeycomb images 0.768 and 0.996, respectively. A significant difference of p<0.05 was accepted. The use of dual-energy subtraction radiography with a FPD improved diagnostic accuracy in detecting cases of multiple interstitial lung diseases and was considered useful.

Evaluation of Pulmonary Function Using Breathing Chest Radiography With a Dynamic Flat Panel Detector

Dynamic flat panel detectors (FPD) permit acquisition of distortion-free radiographs with a large field of view and high image quality. The present study was performed to evaluate pulmonary function using breathing chest radiography with a dynamic FPD. We report primary results of a clinical study and computer algorithm for quantifying and visualizing relative local pulmonary airflow. Dynamic chest radiographs of 18 subjects (1 emphysema, 2 asthma, 4 interstitial pneumonia, 1 pulmonary nodule, and 10 normal controls) were obtained during respiration using an FPD system. We measured respiratory changes in distance from the lung apex to the diaphragm (DLD) and pixel values in each lung area. Subsequently, the interframe differences (D-frame) and difference values between maximum inspiratory and expiratory phases (D-max) were calculated. D-max in each lung represents relative vital capacity (VC) and regional D-frames represent pulmonary airflow in each local area. D-frames were superimposed on dynamic chest radiographs in the form of color display (fusion images). The results obtained using our methods were compared with findings on computed tomography (CT) images and pulmonary functional test (PFT), which were examined before inclusion in the study. In normal subjects, the D-frames were distributed symmetrically in both lungs throughout all respiratory phases. However, subjects with pulmonary diseases showed D-frame distribution patterns that differed from the normal pattern. In subjects with air trapping, there were some areas with D-frames near zero indicated as colorless areas on fusion images. These areas also corresponded to the areas showing air trapping on computed tomography images. In asthma, obstructive abnormality was indicated by areas continuously showing D-frame near zero in the upper lung. Patients with interstitial pneumonia commonly showed fusion images with an uneven color distribution accompanied by increased D-frames in the area identified as normal on computed tomography images. Furthermore, measurement of DLD was very effective for evaluating diaphragmatic kinetics. This is a rapid and simple method for evaluation of respiratory kinetics for pulmonary diseases, which can reveal abnormalities in diaphragmatic kinetics and regional lung ventilation. Furthermore, quantification and visualization of respiratory kinetics is useful as an aid in interpreting dynamic chest radiographs.

Evaluation of the quality of CT-like images obtained using a commercial flat panel detector system

PurposeThe development of flat panel detector technology has resulted in renewed interest in the possibility of generating CT-like images from rotational angiographic acquisitions. At least two commercial products now use cone beam reconstruction software in conjunction with flat panel detectors to produce such images. The purpose of the work presented here is to report on image quality obtained from one such system in objective and subjective terms and to compare it with the quality of images obtained from a modern multi-detector CT scanner.MethodThe Image quality was assessed using a CATPHAN 500 model and an AAPM CT Performance Phantom model. Image noise, CT number accuracy, CT number consistency, Low Contrast Resolution, surface dose and Modulation Transfer Function were assessed for the flat panel detector and compared with results obtained from a 4 slice CT scanner.ResultsAs expected image quality obtained from the CT scanner was much better than from the flat panel detector. Low contrast resolution was much worse and the surface dose was higher for the flat panel detector than the CT scanner. There was an inaccuracy in CT number determination and the noise was greater by a factor of two or three. Limiting resolution was better on images from the CT scanner.ConclusionThe poor low contrast resolution from flat panel detector was expected given the expected resolution of ±10 Hounsfield Units. These systems should not be considered as diagnostic CT scanners. However, the remaining performance figures indicate that the CT-like images obtained from this type of equipment are of sufficient quality for at least some clinical applications, such as detection of brain haemorrhages in the vascular suite.

Image Quality and Radiation Dose on Digital Chest Imaging: Comparison of Amorphous Silicon and Amorphous Selenium Flat-Panel Systems

The aim of this study was to compare the image quality and radiation dose in chest imaging using an amorphous silicon flat-panel detector system and an amorphous selenium flat-panel detector system. In addition, the low-contrast performance of both systems with standard and low radiation doses was compared. In two groups of 100 patients each, digital chest radiographs were acquired with either an amorphous silicon or an amorphous selenium flat-panel system. The effective dose of the examination was measured using thermoluminescent dosimeters placed in an anthropomorphic Rando phantom. The image quality of the digital chest radiographs was assessed by five experienced radiologists using the European Guidelines on Quality Criteria for Diagnostic Radiographic Images. In addition, a contrast-detail phantom study was set up to assess the low-contrast performance of both systems at different radiation dose levels. Differences between the two groups were tested for significance using the two-tailed Mann-Whitney test. The amorphous silicon flat-panel system allowed an important and significant reduction in effective dose in comparison with the amorphous selenium flat-panel system (p < 0.0001) for both the posteroanterior and lateral views. In addition, clinical image quality analysis showed that the dose reduction was not detrimental to image quality. Compared with the amorphous selenium flat-panel detector system, the amorphous silicon flat-panel detector system performed significantly better in the low-contrast phantom study, with phantom entrance dose values of up to 135 muGy. Chest radiographs can be acquired with a significantly lower patient radiation dose using an amorphous silicon flat-panel system than using an amorphous selenium flat-panel system, thereby producing images that are equal or even superior in quality to those of the amorphous selenium flat-panel detector system.

Comparison of Different Radiography Systems in an Experimental Study for Detection of Forearm Fractures and Evaluation of the M??ller-AO and Frykman Classification for Distal Radius Fractures

We sought to compare the diagnostic performance of screen-film radiography, storage-phosphor radiography, and a flat-panel detector system in detecting forearm fractures and to classify distal radius fractures according to the Müller-AO and Frykman classifications compared with the true extent, depicted by anatomic preparation. A total of 71 cadaver arms were fractured in a material testing machine creating different fractures of the radius and ulna as well as of the carpal bones. Radiographs of the complete forearm were evaluated by 3 radiologists, and anatomic preparation was used as standard of reference in a receiver operating curve analysis. The highest diagnostic performance was obtained for the detection of distal radius fractures with area under the receiver operating curve (AUC) values of 0.959 for screen-film radiography, 0.966 for storage-phosphor radiography, and 0.971 for the flat-panel detector system (P > 0.05). Exact classification was slightly better for the Frykman (kappa values of 0.457-0.478) compared with the Müller-AO classification (kappa values of 0.404-0.447), but agreement can be considered as moderate for both classifications. The 3 imaging systems showed a comparable diagnostic performance in detecting forearm fractures. A high diagnostic performance was demonstrated for distal radius fractures and conventional radiography can be routinely performed for fracture detection. However, compared with anatomic preparation, depiction of the true extent of distal radius fractures was limited and the severity of distal radius fractures tends to be underestimated.

Computer-Aided Nodule Detection on Digital Chest Radiography: Validation Test on Consecutive T1 Cases of Resectable Lung Cancer

To evaluate the usefulness of a commercially available computer-assisted diagnosis (CAD) system on operable T1 cases of lung cancer by use of digital chest radiography equipment. Fifty consecutive patients underwent surgery for primary lung cancer, and 50 normal cases were selected. All cancer cases were histopathologically confirmed T1 cases. All normal individuals were selected on the basis of chest computed tomography (CT) confirmation and were matched with cancer cases in terms of age and gender distributions. All chest radiographs were obtained with one computed radiography or two flat-panel detector systems. Eight radiologists (four chest radiologists and four residents) participated in observer tests and interpreted soft copy images by using an exclusive display system without and with CAD output. When radiologists diagnosed cases as positives, the locations of lesions were recorded on hard copies. The observers' performance was evaluated by receiver operating characteristic analysis. The overall detectability of lung cancer cases with CAD system was 74% (37/50), and the false-positive rate was 2.28 (114/50) false positives per case for normal cases. The mean A(z) value increased significantly from 0.896 without CAD output to 0.923 with CAD output (P = 0.018). The main cause of the improvement in performance is attributable to changes from false negatives without CAD to true positives with CAD (19/31, 61%). Moreover, improvement in the location of the tumor was observed in 1.5 cases, on average, for radiology residents. This CAD system for digital chest radiographs is useful in assisting radiologists in the detection of early resectable lung cancer.

Intracranial 2D and 3D DSA with flat panel detector of the direct conversion type: initial experience

The purpose of this study was to compare the image quality of two-dimensional (2D) digital subtraction angiography (DSA) between a flat panel detector (FPD) of the direct conversion type with low radiation dose and a conventional image intensifier (I.I.)-TV system, and to assess 3D DSA with the FPD system in the depiction of intracranial vessels. Fifteen consecutive patients (five men, ten women; age range: 18-82 years; mean age: 55.5 years) were prospectively included in this study. All patients underwent 2D DSA with both the FPD and I.I.-TV system in one projection. The radiation doses during angiography were evaluated using a phantom. The 3D DSA images were created from the rotational DSA data with the FPD system. Two blinded radiologists independently evaluated 2D DSA with the FPD system and I.I.-TV system using a 5-point assessment scale (excellent to not visible) to assess the depiction of intracranial vessels. MIP and volume rendering (VR) images of 3D DSA with the FPD system were also evaluated using a 5-point scale (excellent to not visible). DSA and fluoroscopy dose measurements with the phantom showed a dose reduction of approximately 85% and 9% with the FPD system compared with the I.I.-TV system, respectively. For 2D DSA, the FPD system was significantly superior to the I.I.-TV system with respect to the visibility of the peripheral and perforating vessels (p<0.05). The peripheral and perforating vessels were also sufficiently visualized on MIP images of 3D DSA in all 15 cases. Our FPD system was found to be superior to the I.I.-TV system in visualizing small intracranial vessels combined with a significant reduction of radiation dose, and was able to create high-quality 3D DSA images on which high spatial resolution allowed precise visualization of small vessels such as perforating ones.

Computerized Methods for Determining Respiratory Phase on Dynamic Chest Radiographs Obtained by a Dynamic Flat-Panel Detector (FPD) System

Chest radiography using a dynamic flat-panel detector with a large field of view can provide sequential chest radiographs during respiration. These images provide information regarding respiratory kinetics, which is effective for diagnosis of pulmonary diseases. For valid analysis of respiratory kinetics in diagnosis of pulmonary diseases, it is crucial to determine the association between the kinetics and respiratory phase. We developed four methods to determine the respiratory phase based on image information associated with respiration and compared the results in dynamic chest radiographs of 37 subjects. Here, the properties of each method and future tasks are discussed. The method based on the change in size of the lung gave the most stable results, and that based on the change in distance from the lung apex to the diaphragm was the most promising method for determining the respiratory phase.

Digital Chest Radiography with an Amorphous Silicon Flat-Panel-Detector Versus a Storage-Phosphor System: Comparison of Soft-Copy Images

Department of Radiology and the Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Korea. This study was supported by research funds from the LISTEM Company. Received December 14, 2005 ; Accepted February 3, 2006 Address reprint requests to : Hyun Ju Lee, M.D., Seoul National University College of Medicine, 28 Yeongon-dong, Jongno-gu, Seoul 110-744, Korea. Tel. 82-2-2072-1861 Fax. 82-2-743-6385 E-mail: rosaceci@radiol.snu.ac.kr Purpose: We compared the soft-copy images produced by an amorphous silicon flatpanel-detector system with the images produced by a storage-phosphor radiography system for their ability to visualize anatomic regions of the chest. Materials and Methods: Two chest radiologists independently analyzed 234 posteroanterior chest radiographs obtained from 78 patients on high-resolution liquid crystal display monitors (2560×2048×8 bits). In each patient, one radiograph was obtained with a storage-phosphor system, and two radiographs were obtained via amorphous silicon flat-panel-detector radiography with and without spatial frequency filtering. After randomizing the 234 images, the interpreters rated the visibility and radiographic quality of 11 different anatomic regions. Each image was ranked on a five-point scale (1 = not visualized, 2 = poor visualization, 3 = fair visualization, 4 = good visualization, and 5 = excellent visualization). The statistical difference between each system was determined using the Wilcoxon’s signed rank test. Results: The visibility of three anatomic regions (hilum, heart border and ribs), as determined by the chest radiologist with 14 years experience (p<0.05) and the visibility of the thoracic spine, as determined by the chest radiologist with 8 years experience (p=0.036), on the amorphous silicon flat-panel-detector radiography prior to spatial frequency filtering were significantly superior to that on the storage-phosphor radiography. The visibility of 11 anatomic regions, as determined by the chest radiologist with 14 years experience (p<0.0001) and the visibility of five anatomic regions (unobscured lung, rib, proximal airway, thoracic spine and overall appearance), as determined by the chest radiologist with 8 years experience (p<0.05), on the amorphous silicon flat-panel-detector radiography after spatial frequency filtering were significantly superior to that on the storage-phosphor radiography. Conclusion: The amorphous silicon flat-panel-detector system depicted the anatomic structures on chest radiographs comparably or significantly better as compared to the storage-phosphor system. The superiority of the amorphous silicon flat-panel-detector system compared to the storage-phosphor system was more obvious after performing spatial frequency filtering.

Analysis of image quality in digital chest imaging

An evaluation of the image quality of an amorphous silicon flat-panel detector system and a computed radiology system compared with a screen-film system was performed by means of contrast-detail phantom images. Hard and soft copy images were evaluated. Although patient dose at clinical settings was strongly decreased with the amorphous silicon system, the low-contrast visibility with this system was still significantly better than with the screen-film system. For the computed radiology system, low-contrast visibility was comparable to the screen-film system. Best results were obtained by soft copy reading at full resolution with adaptation of contrast and brightness. Changing tube voltage (102-133 kV), or additional filtration, did not significantly affect image quality. However, low-contrast visibility improved significantly with increasing exposure. It was clearly demonstrated that, in chest imaging, the amorphous silicon system has superior imaging characteristics compared to the screen-film and the computed radiology system.

Comparison of Eight Different Digital Chest Radiography Systems: Variation in Detection of Simulated Chest Disease

In a short period, a variety of technically different digital radiography chest systems have become available for clinical use. Our purpose was to assess the diagnostic performance of eight different digital radiography chest systems for detection of simulated chest disease under clinical conditions. Assessed were four different flat-panel detector systems, two different charge-coupled device systems, one selenium-coated drum, and one storage phosphor system. For each system, 10 chest images of an anthropomorphic chest phantom were obtained. Each image contained one to 12 simulated chest lesions. Eight radiologists performed soft-copy interpretations. Entrance dose was measured and effective dose calculated. A semi-parametric logistic regression model was used for statistical analysis. Statistically significant differences were found in the diagnostic performance of the eight digital chest systems (p = 0.01). Best performance was observed with the charge-coupled device system with slot-scan technology, yielding a sensitivity of 46% (132 of 288) lesions detected. The performance of three flat-panel detectors and the selenium-drum system was not significantly different from the slot-scan charge-coupled device system. Fewer lesions were detected with the storage phosphor system than with all other digital technologies, with a sensitivity of 34% (99 of 288) lesions detected, slot-scan charge-coupled device system versus storage phosphor system, p < 0.001. The effective dose varied among the digital systems. We found differences in diagnostic performance among the eight different digital chest systems. Differences in detection rates are predominantly explained by detector design.

Comparison of technical and anatomical noise in digital thorax X-ray images

Former studies by Hoeschen and Buhr indicated a higher total noise in a thorax image than expected from technical noise, i.e. quantum and detector noise. This difference results from the overlay of many small anatomical structures along the X-ray beam, which leads to a noise-like appearance without distinguishable structures in the projected image. A method is proposed to quantitatively determine this 'anatomical noise' component, which is not to be confused with the anatomical background (e.g. ribs). This specific anatomical noise pattern in a radiograph changes completely when the imaging geometry changes because different small anatomical structures contribute to the projected image. Therefore, two images are taken using slightly different exposure geometry, and a correlation analysis based on wavelet transforms allows to determining the uncorrelated noise components. Since the technical noise also differs from image to image, which makes it difficult to separate the anatomical noise, images of a lung phantom were produced on a low-sensitive industrial X-ray film using high-exposure levels. From these results, the anatomical noise level in real clinical thorax radiographs using realistic exposure levels is predicted using the general dose dependence described in the paper text and compared with the quantum and detector noise level of an indirect flat-panel detector system. For consistency testing, the same lung phantom was imaged with the same digital flat-panel detector and the total image noise including anatomical noise is determined. The results show that the relative portion of anatomical noise may exceed the technical noise level. Anatomical noise is an important contributor to the total image noise and, therefore, impedes the recognition of anatomical structures.

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.

Vergleich von vier digitalen und einem konventionellen Röntgenaufnahmesystem für den Thorax mittels einer Patientenstudie mit nachfolgender Systemoptimierung

Using a patient study to prove the clinical relevance of a comparison of five different radiographic systems for the chest conducted with an anthropomorphic chest phantom. Depending on the results, it was tested whether the performance of a modern digital system with a transparent imaging plate can be improved by changing the post-processing of the image. Chest radiographs of patients were taken with a CsI/aSi-flat panel detector (FDR), transparent imaging plate (tDLR), selenium drum detector (DSR), conventional storage phosphor plate (DLR) and asymmetrical screen-film-system (aFFS), and compared using image criteria scoring (ICS) and visual grading analysis (VGA) for anatomical structures (modified criterions of the EUR 16 260 EN guidelines). After optimizing the post processing, the images of the tDLR-system were evaluated once more in a phantom ROC study and patient VGA study. The flat panel detector-system proved to meet best the anatomical image quality criteria, followed by DSR, tDLR, aFFS and DLR. The modified post processing of the tDLR-images resulted in a significantly better detection of simulated pathological lung-structures, but improved the perceptibility of anatomical structures only slightly. The results of the patient VGA study and the phantom ROC study are similar and considered valid. The new digital imaging systems with flat panel detector and transparent imaging plate provide the best image quality of the tested radiographic devices for chest imaging, assuming that all system components are attuned and optimized for the type of structure to be detected. Image processing is of primary importance for system optimization.

Physical Imaging Properties and Low-contrast Performance of a Newly Developed Flat-panel Digital Radiographic System

We investigated the clinical usefulness of a newly developed flat-panel detector (FPD) system by comparing its physical imaging properties and low-contrast detectability with those of a current FPD system. The newly developed CsI-based indirect FPD (Canon, CXDI-40C) and current Gd(2)O(2)S-based FPD (Canon CXDI-11) systems were used. Characteristic curves, resolution properties, radiographic noise, detective quantum efficiencies (DQEs) and low-contrast detectability for both systems were measured. The new FPD system showed considerably lower noise levels than those of the current FPD system. DQE (0) s of the new and current FPD systems were 75% and 35%, respectively. Observer performance tests of the contrast-detail (C-D) phantom indicated that the new FPD system can significantly improve low-contrast performance over that obtainable with the current FPD system under the same conditions of exposure. The new FPD system provided approximately 50% reduction in exposure while providing comparable detectability. The newly developed FPD system provides radiographic images with excellent inherent physical image quality and low-contrast performance.

RSNA2004 : Dual Energy Subtraction法は間質性肺疾患の診断精度を改善するか?(平成16年度後期国際研究集会派遣会員報告書, 学術交流委員会だより)

Purpose : The purpose of the study is to evaluate the detection of simulated interstitial lung lesions on dual energy subtraction radiography method using a flat panel detector. Methods : Images were obtained using a flat panel detector system on dual energy technique with the exposure of 60kV and 130kV. Three types of interstitial lung lesions; micro-nodule, ground-glass and honeycomb patterns were simulated by using a chest phantom. The ROC analysis was performed, and P-values<0.05 were considered to identify significant differences. Results : The area under the ROC curve Az values on standard vs subtraction methods were 0.768 vs 0.963, 0.670 vs 0.917 and 0.768 vs 0.996 on micro-nodule, ground-glass, and honeycomb patterns, respectively. Significant differences were observed on all patterns. Conclusion : Dual energy subtraction radiography method using flat panel detector is a promising tool in the detection of interstitial lung lesions with an improved diagnostic accuracy.

Examination of the Quality Control Program in Flat-Panel Detector System

Examination of the Quality Control Program in Flat-Panel Detector System

Effectiveness of Mobile Flat Panel Detector system

Effectiveness of Mobile Flat Panel Detector system