Physics of Computed Radiography (CR)

Computed Radiography ...is the generic term applie d to an ima ging

Overview system comprised of:
Acceptance Testing
Quality Control Photostimulable Storage Phosphor
to a cqu ire the x-ray pr ojection image

J. Anthony Seibert, Ph .D. CR Reader

University o f Califo rnia, Davis to extract th e el ectronic late nt image
Medical Ce nter , Sacramento
Digital electronics
AAP M 1999 An nual Meeti ng, Nashvil le to convert the signals to digital form

CR Detector Computed Radiography “reader”

• Photostimulable Storage Phosphor (PSP) Information panel

• BaFBr compound, Eu activated

Phosphor Plate Cas sette Holder

Plate stacker

RIS interface CR reader interface

CR Image acquisition
Download patient demographic data; select image processing algorithms
1. X-ray Exposure
5. Computed
Patient
unexposed Radiograph

PSP 2. 3. 4.
detector Image Image Image
Reader Scaling Record
X-ray
system exposed
re-usable
phosphor
plate

1
 ID terminal: select anatomy-specific exam Bar-code reader: identify exposed cassette

Film laser printer

CR CR Networking
Reader
• DICOM
– Digital Imaging COmmunications in Medicine
– Provides open architecture solutions for modality
interfaces, storage/retrieval, and print functions

Dicom
• Technologist QC Workstation
• Modality Worklist Input
• Processed image output

CR - QC Workstation Soft-cop y review

CR vendors CR Trends

• Fuji ........ (GE, Siemens, Philips, others ) • Lower system costs

• Agfa ........ (Toshiba) • Smaller footprint

• Kodak • High throughput sy stems

• Konica • Low throughput systems “Table-top” units

• Lumisys • Integrated QC workstations for images

• Others • DICOM output

2
 Conventional film/screen detector Digital x-ray detector 2. Display
1. A cqu isition, Display, Ar chiving Digital Pixel D ig ital to An al og
C on ve rsio n
1. A cqu isition Matrix
Transmitted x-rays
Transmitted x-rays
through patient
through patient
Film processing:
Digital
light to optical density processing
An al og to Di gi tal
C on ve rsio n
Gray Scale
encoded on X-ray converter
Charge
Intensifying film
Film collection x-rays → electrons
Screens device
x-rays → light 3. A rchi ving

PSP Latent Image Formation Stimulation and Emission Spectra

Electrons trapped in proportion to x-rays absorbed Stimu latio n BaFBr: Eu2+ Emi ssion
1.0
Di od e
Conduction band He Ne
68 0 nm
τtunneling
=
Relative intensity

τ =recombination
ph on on 63 3 nm

e- Laser
e- F/ F +
0.5
PSL stimulation 8.3 eV
3.0 eV τ =Eu 2.0 eV

Eu3+ / Eu 2+
e- Valence band
0.0
80 0 70 0 60 0 50 0 40 0 30 0 λ (n m)
Incident x-rays F centers proportional to
incident x-ray intensity 1.5 1.75 2 2.5 3 4 Ene rgy (eV)

Photostimulated Luminescence CR: Latent Image Readout

Referen ce f-θ
detector le ns Cyli ndrica l mi rror
Incident Laser Beam
Light guide
PSL Lase r Li ght cha nnel ing gu ide
Source
Signal
Output Signal
PMT Polyg onal
Mirror
ADC
PMT
Protective Layer Laser beam:
Photostimulated
Exposed Luminescence Sca n direction
Light To i mage
Imaging Scattering
Phosphor Layer
proce sso r
Plate
Las er Light Spr ead
Plat e translation:
"Effective " read out di amete r Base Support Sub-scan direction

3
 Phosphor Plate Cycle
PSP
Base support
x-ray exposure
Sub -scan Direction
Plate translation plate exposure:
create latent image
reuse
laser beam scan
Typic al resolution:
35 x 43 cm -- 2.5 lp/mm plate readout:
24 x 30 cm -- 3.3 lp/mm extract latent image
18 x 24 cm -- 5.0 lp/mm light erasure

plate erasure:
Scan Direction remove residuals
Laser beam deflection

Characteristic Curve:
CR Image Manipulation
response of screen/film and CR

• Image pre-processing
4 10 ,0 00

Rel ative intensi ty of PSL

– Find the pertinent image information Film -screen
Film Optical D ensity

CR pla te
– Scale the data to appropriate range (40 0 spe ed)
1,00 0
3

Ove rexposed
• Contrast enhancement 2 10 0
– Anatomy specific grayscale manipulation Corre ctly expo se d
1 10
Und erexpose d
• Spatial frequency enhancement 0 1
0.01 0.1 1 10 10 0 Exp osure , mR

20 00 0 20 00 20 0 20 2 Sen sitivi ty (S)

Finding the Image Location Collimation area(s) determined

Collimation
• Image recognition phase Border
– collimation (Agfa)
– EDR (Fuji)
– segmentation (Kodak)

• Finding collimation borders and edges

4
 Processing the Image Histogram analysis

• Contrast enhancement
• Frequenc y distribution of pixel values within a
– MUSIC A (Agfa)
defined area in the image
– Gradation (Fuji)
– Tonescaling (Kodak)
• Shape is anatomy specific
• Define dynamic range (histogram analysis)
• Sets minimum and maximum “useful” pixel values
• Transform to anatomy specific contrast

Histogram Distribution Data conversion Grayscale transformation

Collimated Exposure into digital number Input to outpu t dig ita l number
Open
area area 1,000
Anatomy

Output dig ital number

102 800
Re la ti ve PSL
Frequency

101 600
100 400
10-1 200

10-1 100 101 102 103 0 511 1023 0 200 600 1,000
Pixel value Exp osure input Raw Digital Outp ut Raw Input d igital numbe r
Useful signal Histogram
mi n max
The shape is dependent on radiographic study,
1. Find the 2. Scale to 3. Create film
positioning and technique signal range look-alike

Histogram: pediatric image

to 9 368 to 8 323
800
Frequency

600

400

200

0
0 200 400 600 800 100 0 Di gital valu e

Pre-processed no
Useful image range for anatomy Contrast enhanced
window/level

5
 Data conversion for overexposure Data conversion for wide latitude
Exposure into digital number Exposure into digital number
Re du ce gai n Incre ase gr adi ent

1 02 1 02
Re la ti ve PSL

Rel ative PSL

1 01 1 01
1 00 1 00
1 0- 1 1 0- 1

Exposure 10 -1 10 0 10 1 10 2 10 3 0 51 1 10 23 Exposure
in put in put 10 -1 10 0 10 1 10 2 10 3 0 51 1 10 23
Ra w Di gital Ou tp ut Ra w Di gital Ou tp ut
high kVp
overexposure (sca led a nd l og am pli fi ed) (sca led a nd l og am pli fi ed)
min max (w ide latitude)
min max

Screen-F ilm Computed Radiography

Underexposed Overexposed Underexposed Overexposed

Screen- Film CR
80 kVp, 18 mAs 80 kVp, 18 mAs 80 kVp, 18 mAs

400 speed screen - film L=4, wide latitude

6
 CR: Contrast Enhancement
Look-up-table transformation
1,000
Output digital number

M L E A
800
Fuji System
600 Example LUTs
400

200

0
0 200 400 600 800 1,000

Input digital number “Raw data” “Contrast Enhanc ed”

Spatial Frequency Processing CR: Image manipulation

• “Edge Enhancement”

Soli d: orig inal resp onse Di fference : Edge Enh anced:

Dash : l ow pass fi ltered Ori gin al - filtered Di fference + Origin al
Response

Sum

lo w hi gh lo w hi gh lo w hi gh

Spatial frequency
“Black Bone” “Edge Enhanced”

CR: Dual Energy Imaging CR: Dual Energy Imaging

Low Energy Image High Energy Image “Tissue only” Image “Bone only” Image

7
 Image Performance Measures CR: Spatial Resolution
• Pho sph or p late sizes: impact on resolution
• Spatial res olution
– Dependent on IP size
– Less than corresponding speed screen-film

• Contrast sensitivity
– Dependent on exposure and SNR

• Exposure
35x43 (14x17) 24x30 (10x12) 18x24 (8x10)
– Variable speed detector
0.2 mm pixels 0.14 mm pixels 0.1 mm pixels

High Contrast (Spatial) Resolution MTF Curves

18 x 24 cm 35 x 43 cm
1.0

0.8 Pre-sampled MT F
Screen-film
Scan
0.6
MTF

Subscan
Hi res CR
0.4 Sampled MT F:
Standard CR Standard CR
0.2 2K x 2K matrix
35 x 43 cm
0
2 4 6 8 10
Spatial F requency (lp/mm)

X-ray Absorption Efficiency Low Contrast Response: Leeds TO -16

1
Photon absorption fraction

BaFBr, 100 mg/cm²

0.8
Gd 2O2S, 120 mg/cm 2
0.6

0.4

0.2 BaFBr, 50 mg/cm²

0
0 20 40 60 80 100 120 140
Energy (keV) 3.5 mR 70 kVp 0.5 mR

8
 Image retake rates Other Repeated
Retake rate evaluation -- 1st half, 1992
12% Examinations with CR
Wrong exam
7 Screen-Fil m 5%
6 Motion
CR
Percent error

5 6% Positioning
4 Reprinting 46%

3 9%

2 Under exposure
10%
1
0 O verexposure
Jan Feb Mar Apr May Jun 12% Total # repeats = 1043
from Willis, RSNA 1996

Adu lt portable chest ca lcu lated exposures Adu lt portable chest ca lcu lated exposures
First half, 1994, 4572 exams Second half, 1994, 4661 exams
Target Target
expo sure expo sure
38.3% 5 3.9 % 7.8% rang e 23.1% 7 3.5 % 3.4% rang e
60 0 60 0
50 0 50 0
40 0 Q1
40 0
#exams

#exams

Q3
30 0 Q2 30 0 Q4
20 0 20 0
10 0 10 0
0 0
50 0

40 0

30 0

20 0

10 0

<50

50 0

40 0

30 0

10 0

<50
20 0
System speed (S #) System speed (S #)
Low Incident Exposure High Low Incident Exposure High

Guidelines for QC based on Exposure,

Apri l 1 - 17, 1996
Adul t Po rtabl e Ch est
typical adult exam
“Exposure Creep”
180 Sys tem s peed Indication
Number of examinations

160
140 • >1000 <0.2 mR • Underexposed: repeat
120
100
Grid tec hnique • 600 - 1000 0.3-0.2 mR • Underexposed: QC exception
80
60 without a grid • 300 - 600 1.0-0.3 mR • Underexposed: QC review
40
20 • 150 - 300 1.3-1.0 mR • Acceptable range
0
• 75 -150 1.3-2.7 mR • Overexposed: QC review
0

50 9 9

35 4 9

30 7 4

20 7 4

15 2 4

4
00

54

32

17

12

-7

• 50 - 74 4.0-2.7 mR • Overexposed: QC exception

-6

50
0-

0-

0-

0-

0-

0-

0-

0-
>1

0
60

40

25

10

Sensitivi ty number • <50 >4.0 mR • Overexposed: repeat

9
 Radiation Dose for CR New issues for the Medical Physicist:
Digital Projection Imaging
• Variable Speed Detector
• Differences between screen-film and PSP detectors
• Optimal dos e 2X higher than 400 speed screen/film
• Testing digital systems: vendor specific details
– Lower absorption efficiency • Indirect (CR) vs. direct (Flat-panel) detectors
– Quantum and electronic noise
• Exposure levels and SNR measurements
– Readout inefficiencies of latent image
• QC phantoms
• Anti-scatter grids needed • Soft-copy displays and workstations

Uniformity
Recommended acceptance tests
(Ta sk Group #10 -- AAPM)

498 508 537 480

• Physical Ins pection - Inventory
• Evaluation of image process ing parameters 490 513
• Imaging Plate Uniformity and Dark Noise
• Signal Response
– Linearity and Slope
– Calibration and Beam Quality
497 505 544 487
• Laser Beam Function

Demographics on Fuji CR output CR Parameter Settings

Ex po su re m e nu c ode
Fu ji CR reader system
R ea d out (ED R) m ode Anatomical region GA GT GC GS RN RT RE
A - Auto m a tic
Gener al ch est (LAT) 1.0 B 1.6 -0.2 4.0 R 0.2
S - S e m i-a utom a t ic
F - Fix e d
Gener al ch est (PA) 0.6 D 1.6 -0.5 4.0 R 0.2
Port Chest GRID 0.8 F 1.8 -0.0 5 4.0 T 0.2
Top
U CD MC RA DIO LO G Y 00 A 0200 Port Chest NO GRI D 1.0 D 1.6 -0.1 5 4.0 R 0.5
of
film Peds chest NICU/PICU 1.1 D 1.6 -0.2 3.0 R 0.5
Film Imag e Finger 0.9 O 0.6 0.3 5.0 T 0.5
Wrist 0.8 O 0.6 0.2 5.0 T 0.5
D ATE For earm 0.8 O 0.6 0.3 5.0 T 0.5
PO R TAB LE C HE ST Tim e Plaste r cast (ar m) 0.8 O 0.6 0.4 5.0 T 0.5
0 3 .3 1 .1 9 95
L 2 .0 S 2 5 0 C *1 .6 , *1 .0 Elbo w* 0.8 O 0.6 0.4 7.0 T 1.0
Pa tie nt Ide ntific a tion 1 1 :4 5 B ottom
G 1 .0 E # 1 .0 -- 0 .2 0 R 0 .3 Upper Ribs* 0.8 O 1.6 0.0 5.0 R 1.0
of
A 054 # 9 5 0 3 3 10 5 4
2 /3 R film Pelvis* 0.9 O 0.6 0.2 6.0 T 1.0
Pelvis por table 0.9 O 0.6 0.2 4.0 T 0.5
Tib/F bi 0.9 N 0.6 0.25 5.0 F 0.5
L = La tit ude (us e ful r an ge of e x pos ur es in o rde rs of m a gnitude )
S = S e ns itiv ity (v a lue inv e rs e ly re la te d to inc ide nt e x pos ur e )
Foo t 0.8 O 0.6 0.3 5.0 T 0.5
Foo t* 1.2 N 0.6 -0.0 5 7.0 T 0.5
C = De ns ity / c ontr a s t s e tting m od ific a tions
G = Film ga m m a c ur ve s e tt ings (c ontr a st e nha nc e m e nt pa r am et e rs ) Os Calcis 0.8 O 0.6 0.4 5.0 F 1.0
No te : the a s s oc ia te d le tte r s in dic a te the LU T ty pe Foo t cast 0.8 O 0.6 0.5 5.0 F 0.5
C-spine 1.1 F 0.6 0.5 5.0 P 0.5
R = Fre que nc y pr oc e s sin g (s pa tia l a nd e dge e nh an c em en t pa ra m e te r s )
A = Num be r of film s s inc e la s t re bo ot of s y s te m
T- sp n
i e 0.8 F 1.8 -0.0 5 4.0 T 0.2
Swimme rs 1.2 J 0.9 0.3 5.0 T 0.5
2 /3 = Im a ge re duc t ion fa c tor ( 6 7 % of a c tua l s iz e in this c a s e ) Lumba r spine 1.0 N 0.9 0.4 5.0 T 1.0
R= m
I a ge re v e rs a l indic a tor Breast specimen 2.5 D 0.6 0.35 9.0 P 1.0

10
 Da te: 7/1 0/98 Lo ca tio n: UCDM C, ACC, 3
M ed ci al Phy si ci st: Antho ny Sei be rt, Ph.D. Sy ste m Ide ntif i ca tio n: CRu ni t 3

UC Da vi s Me dica l C ente r
CR R eader and Screens Recommended acceptance tests
Sig na l Resp on se: Calib r atio n a nd Beam Qu ality
(Ta sk Group #10 -- AAPM)
No te: Use mAs va u
l es to pro vid e a n ap pro xi ma te ex po su re of 1 mR to th e IP.

Men u = TEST Ex po su re Co n ditio ns

IP T yp e: ST 1 4x 17
IP SN:
Su bMenu = A ve 2. 0
L = 2 , E D R = se mi
Foc al sp ot
1. 2 m m
Tim e del ay
~2m n i
S ID (c m)
140
SMD (cm)
1 30
• High Contrast Resolution
k Vp De p en d en cy
k Vp F li trati on m As mR -mete r mR -IP S S 1
( mR ) OD NA • Noise / Low-Contrast Response
60 1 A /l 0 .5 Cu 15 . 00 1 . 06 0 .9 1 1 21 .0 0 11 0. 5 9 1 .4 1 NA
80 1 A /l 0 .5 Cu 4 .5 1 . 06 0 .9 1 1 08 .0 0 98 .7 1 1 .3 8 NA
11 5 1 A /l 0 .5 Cu 1. 13 1 . 14 0 .9 8 1 15 .0 0
Ma xi mu m Dif f eren ce :
11 3. 0 4
14 .3 3
1 .4 5
0 .0 7
NA
NA • Distortion
F i l trati o n D e pe n d en cy
k Vp F li trati on m As m R-me ter mR -IP S S 1
( mR ) OD NA
80
80
n on e
1 A /l 0 .5 Cu
0. 50
4. 50
0 . 96
1 . 06
0 .8 3
0 .9 1
1 87 .0 0
1 08 .0 0
15 4. 7 9
98 .7 1
1 .4 0
1 .3 8
NA
NA
• Erasure Thoroughness
80 1A /l 2 .5 Cu 60 . 00 0 . 99 0 .8 5 1 24 .0 0 10 5. 8 5 1 .4 0 NA
Ma xi mu m Dif f eren ce : 56 .0 8 0 .0 2 NA
• Anti-aliasing
12 0. 00 180 0. 0
160 .0 0
10 0. 00
8 0. 00
140 0. 0
120 .0 0 • Positioning and collimation errors
R es po ns e

Re spon se

6 0. 00 100 .0 0
80 .0 0
4 0. 00

2 0. 00
60 0. 0
40 .0 0 • Throughput
S (1mR) 20 .0 0 S (1mR )
0. 00 0.0 0
50 70 90 110 13 0 n one 1 A /l 0. 5 Cu 1Al / 2. 5Cu
kV p Fi l trati on

Date: 7/10/98 Location: UCDM C, A CC, 3

Medical P hysicist: A nthony S eibert, P h.D. Syst em Identification: CR unit 3

UC Da vis Me dic al Cente r

C R R eader and Screens
In sp ection Resu lts Su mmary

Acceptable
1. Physica l Inspe ction - In vento ry Ye s
2. Imag ing Pla te Unif orm ity a nd Dar k No ise Ye s
3. Sig nal Respo nse: L inea rity and Slo pe Ye s
4. Sig nal Respo nse: C ali bra tion and Be am Qu ality Ye s
5. Laser Be am Fun ction Ye s
6. Hig h-C ontr ast R esolu tion Ye s
7. Noi se /Low -Co ntr ast Re sp onse Ye s
8. Disto rtio n Ye s
9. Era su re Thor ou ghne ss Y es*
10. Ant i-A liasing Ye s
11. Posit ionin g an d C olli mati on E rr ors Ye s
12. Thr oug hput Ye s

Com men ts:

10 mAs 20 mAs Sprea dsheet from Ehsan Samei, Ph.D ., Med ical Un iversity o f South Caroli na

Quality Control Periodic Quality Control

Three levels of system performance for quality control and • Daily (technologist)
system maintenance – General inspection
– Film processor / Laser printer
1. Routine: Technologist level
– Erase imaging plates
- no radiation measurements
– Verify digital interfaces and network transmission
2. Full inspection: Physicist level
- radiation measurements; non-invasive adjustments • Weekly (technologist)
– Verify CRT calibration
3. System adjustment: Vendor service level – Test phantom images
- hardware and software maintenance – System cleanliness

11
 Periodic Quality Control Periodic Quality Control

• Monthly (Technologist) • Semi-Annually / Annually (Physicist)

– Evaluate image quality

– Film processor maintenance (if any)
– Acceptance tests to re-establish baseline values
– Inspect and clean image receptors
– Review
– Review film retake rate • patie nt expo sure tren ds
• retake activity
– QC review for “out-of-tolerance” issues • QC re co rds
• Service hi story

CR: Specifications CR: Clinical Considerations

• Phosphor plate throughput

• Sensitiv ity to scatter
• Spatial res olution
• Multiple images per phosphor plate?
• Contrast resolution and dynamic range
• Patient demographic data
• RIS-HIS-DICOM interfaces / compliance
• Image quality control
• Peripheral equipment; QC phantoms
• Input to PACS
• Service issues; plate longevity; warranties

Computed Radiography Experience Summary

• Flexibility is a double-edged sword • CR is currently the only readily available technology

– reduced retakes but higher under/over exposures
– variable speed (need to tailor exposure to exam)
– more difficult to correctly use
• Provides guidelines for new digital detectors
• Indicates the need for continuous training
for direc t digital acquisition of projection radiographs
• Experience with CR will provide a framework for
future digital detector implementation and QC
• Filmless radiology requires a lot more than just digital
acquisition devices -- a massive investment in PACS
and knowledgeable support personnel, including
MEDICAL PHYSICIST INPUT is necessary

12