Assessment and optimisation of digital radiography systems for clinical use.
Digital imaging has long been available in radiology in the form of computed tomography (CT) magnetic resonance imaging (MRI) and ultrasound. Initially the transition to general radiography was slow and fragmented but in the last 10 15 years in particular, huge investment by the manufacturers, greater and cheaper computing power, inexpensive digital storage and high bandwidth data transfer networks have lead to an enormous increase in the number of digital radiography systems in the UK. There are a number of competing digital radiography (DR) technologies, the most common are computer radiography (CR) systems followed by indirect digital radiography (IDR) systems. To ensure and maintain diagnostic quality and effectiveness in the radiology department appropriate methods are required to evaluate and optimise the performance of DR systems. Current semi quantitative test object based methods routinely used to examine DR performance suffer known short comings, mainly due to the subjective nature of the test results and difficulty in maintaining a constant decision threshold among observers with time. Objective image quality based measurements of noise power spectra (NPS) and modulation transfer function (MTF) are the 'gold standard' for assessing image quality. Advantages these metrics afford are due to their objective nature, the comprehensive noise analysis they permit and in the fact that they have been reported to be relatively more sensitive to changes in detector performance. The advent of DR systems and access to digital image data has opened up new opportunities in applying such measurements to routine quality control and this project initially focuses on obtaining NPS and MTF results for 12 IDR systems in routine clinical use. Appropriate automatic exposure control (AEC) device calibration and a reproducible measurement method are key to optimising X ray equipment for digital radiography. The uses of various parameters to calibrate AEC devices specifically for DR were explored in the next part of the project and calibration methods recommended. Practical advice on dosemeter selection, measurement technique and phantoms were also given. A model was developed as part of the project to simulate CNR to optimise beam quality for chest radiography with an IDR system. The values were simulated for a chest phantom and adjusted to describe the performance of the system by inputting data on phosphor sensitivity, the signal transfer function (STF) the scatter removal method and the automatic exposure control (AEC) responses. The simulated values showed good agreement with empirical data measured from images of the phantom and so provide validation of the calculation methodology. It was then possible to apply the calculation technique to imaging of tissues to investigate optimisation of exposure parameters. The behaviour of a range of imaging phosphors in terms of energy response and variation in CNR with tube potential and various filtration options were investigated. Optimum exposure factors were presented in terms of kV mAs regulation curves and the large dose savings achieved using additional metal filters were emphasised. Optimum tube potentials for imaging a simulated lesion in patient equivalent thicknesses of water ranging from 5 40 cm thick for example were: 90 110kVp for CsI (IDR) 80 100kVp for Gd2O2S (screen /film) and 65 85kVp for BaFBrI. Plots of CNR values allowed useful conclusions regarding the expected clinical operation of the various DR phosphors. For example 80 90 kVp was appropriate for maintaining image quality over an entire chest radiograph in CR whereas higher tube potentials of 100 110 kVp were indicated for the CsI IDR system. Better image quality is achievable for pelvic radiographs at lower tube potentials for the majority of detectors however, for gadolinium oxysulphide 70 80 kVp gives the best image quality. The relative phosphor sensitivity and energy response with tube potential were also calculated for a range of DR phosphors. Caesium iodide image receptors were significantly more sensitive than the other systems. The percentage relative sensitivities of the image receptors averaged over the diagnostic kV range were used to provide a method of indicating what the likely clinically operational dose levels would be, for example results suggested 1.8 uGy for CsI (IDR) 2.8 uGy for Gd2O2S (Screen/film) and 3.8 uGy for BaFBrI (CR) The efficiency of scatter reduction methods for DR using a range of grids and air gaps were also reviewed. The performance of various scatter reduction methods: 17/70; 15/80; 8/40 Pb grids and 15 cm and 20 cm air gaps were evaluated in terms of the improvement in CNR they afford, using two different models. The first, simpler model assumed quantum noise only and a photon counting detector. The second model incorporated quantum noise and system noise for a specific CsI detector and assumed the detector was energy integrating. Both models allowed the same general conclusions and suggest improved performance for air gaps over grids for medium to low scatter factors and both models suggest the best choice of grid for digital systems is the 15/80 grid, achieving comparable or better performance than air gaps for high scatter factors. The development, analysis and discussion of AEC calibration, CNR value, phosphor energy response, and scatter reduction methods are then brought together to form a practical step by step recipe that may be followed to optimise digital technology for clinical use. Finally, CNR results suggest the addition of 0.2 mm of copper filtration will have a negligible effect on image quality in DR. A comprehensive study examining the effect of copper filtration on image quality was performed using receiver operator characteristic (ROC) methodology to include observer performance in the analysis. A total of 3,600 observations from 80 radiographs and 3 observers were analysed to provide a confidence interval of 95% in detecting differences in image quality. There was no statistical difference found when 0.2 mm copper filtration was used and the benefit of the dose saving promote it as a valuable optimisation tool.