How To Find The Best Hardware and Software To

DR system:
How to find the best hardware and software to

achieve minimum dose and optimal image quality
Radiographer, M.Sc. Health: Helle Precht & PhD: Oke Gerke
Denmark
RC 1414 - Paediatric imaging
Agenda
Canons indirect DR system:
DR hardware
Project focusing on scintilator sensitivity in paediatrics
Possibilities in software processing (Multi Frequency Processing)
Optimization
Project focusing on possibilities to grade dose and image quality in

relation to the type of the paediatric examination
Educating Tomorrows Professionals www.ucl.dk /conradint
Cooperation between:
DR hardware
DR Hardware
Connection to generator
Computer capacity
Connection to RIS/PACS systems
Touch screen
Diagnostic monitors
Detector
DR hardware
DR detector
Stationary/portable ~ Wireless
DQE and MTF
Pixel size and fill factor
Fig.: DR detector (Bushong, 2004)
Fill factor = Light sensitive area/detector area
Scintilator line spread function
GOS
CsI
Scintilator project
Project focusing on
scintilator and scoliosis
Background
Scoliosis pathology
Human radiation response in relation to patient age
Tissue weighting factor and contact shield
ALARA
Technique: high kV, airgap and stitching
GOS and CsI scintilator
Scintilator project
Hypothesis
A Canon detector with CSI scintilator will
produce acceptable image quality at a
scoliosis examination at lower dose than a
Canon detector with GOS scintilator
Scintilator project
Method
Theory supported by published articles, books and
information by Canon
Quantitative experimental design
Canons CXDI 50G and 50C detector
Human phantom (audit)
Dosimeter (DAP and ESD - Unfors)
Monte Carlo dose calculations
Statistics
Scintilator project
Results
200
350
180
300
160
250
120
200
REX
DAP mGy cm^2
140
100
150
80
60
100
40
50
20
0
0,5
0,6
0,8
1,2
0
1,6
DAP 1 GOS
2
0,5
2,5
3,2
0,6
0,8
mAs
DAP 2 GOS
4
1
DAP 1 CsI
6,3
1,2
10
1,6
12,5
2
16
2,5
20
3,2
25
4
6,3
10
12,5
16
20
25
mAs
DAP 2 CsI
REX 1 GOS
REX 2 GOS
REX 1 CsI
REX 2 CsI
Scintilator project
Analyzing image quality

Participants: three radiologists and three reporting radiographers
Every image was scored according to:
No.
Def.:
Too low SNR
Acceptable SNR
High SNR
Reduced spatial
Acceptable spatial
High spatial resolution
resolution
resolution
Image criteria not
Image criteria barely
Image criteria above
met
met
requirements
Scintilator project
Results
Radiographers
2
1
CsI
20
16
CsI
GOS
25
12,5
10
CsI
CsI
mAs
GOS
0,5
0,6
0,8
1
1,2
1,6
2
2,5
3,2
4
6,3
10
12,5
16
20
25
0,5
0,6
0,8
1
Number of score
1,2
1,6
2
2,5
3,2
4
6,3
Number of score
Radiologists
mAs
Scintilator project
Technical measurements of
sensitivity at different kV levels
CsI, CXDI 50C

GOS, CXDI 50G
Fig.: CsI and GOS scintilators signal reinforcement at different kV values.

Scintilator project
Conclusion
The REX value can be used as an objective indicator of image quality based on the
indication for the examination. Dose and scintilator amplification degree affect REX
value.
Based on the experiments the hypothesis is confirmed:
The CsI detector can at 2 mAs produce an acceptable image quality, where GOS does
not produce comparable image quality until 6,3 mAs. This confirms the theory about
the CsI detectors DQE and higher REX value compared to the GOS detector at all mAs
levels.
Scintilator project
Perspectives
Other DR products?
Technical phantom for more objective results
Use of other modalities - CT, MRI or UL?

Software optimization
Software processing
Pre - and post processing
Fig.: Process in production of image data (Canon Inc., 2008a).
Software processing
Automatic histogram adaptation
Fig.: Exposure recognition (Canon Inc., 2008b)
Software processing
LUT curves in Canons DR system
Bone#1
Bone#2
Chest
Standard
Inv Linear
Software processing
Index value: REX - ROI
ROI
Fig.: Basis for REX calculation (Canon Inc., 2001).
Software processing
Example using a human phantom
REX: 257
REX: 641
REX: 655
REX: 4747
Software processing
Guide for software optimization

Turn off all the functions of MLT(S)
Set LUT
Adjust ROI Contrast
Max. density region is dark
Min. density region is bright
Graininess needs to be reduced
Sharpness is not enough
Adjust Dynamic Range Dark Region
Adjust Dynamic Range Bright Region
Adjust Effect of Noise Reduction
Adjust Frequency Band
Adjust Effect of Edge Enhancement
Fig.: MLT(S) flow chart (Canon Inc., 2008a; Canon Inc., 2008b)
Software processing
Dynamic range
Bright region
Dark region
Fig.: Technical illustration of MLT(S) compression (Canon Inc., 2008a).
Software processing
Dynamic range, Dark region
20
Dynamic range, Bright region
20
Software processing
Contrast local and global
Fig.: Local and global contrast (Canon Inc., 2008a).
Software processing
Example using a CD Rad phantom
30
Software processing
30
Software processing
Frequencies
Fig.: The building and function of the laplacian pyramid (Vuylsteke, Schoeters, 1999).
Software processing
Edge enhancement
Fig.: Unsharp masking (Gonzales, Woods, 2008).
Software processing
Effect: 1
Frequency: 1
Effect: 20
Frequency: 7
Frequency: 4
Effect: 20
Software processing
Frequency: 1
Frequency: 7
Effect: 20
Effect: 1
Effect: 20
Frequency: 4
Software processing
Noise reduction
Fig.: The principle behind low pass filtration (Gonzales, Woods, 2008)
Software processing
10
Software processing
10
Software project
Project focusing on
software optimization
Background
Survey of optimization level with Canons European Application Group
New MLT(S) software new possibilities within Radiography?
Lack of research in Paediatric Radiography within the software optimization
Are we in accordance with national and international standards?
Do we use the full potential of DR systems?
Radiographers job description
Software project
Survey (Questionaire)
Implementation - dose
6
5
4
3
2
1
0
Cause of missing optimization

Number of answers
6
5
4
3
2
1
0
Number of answers
Number of answers
Implementation - image quality
8
7
6
5
4
3
2
1
0
Software project
Hypothesis
Hyp.1:
With Canon's new MLT(S) software one can maintain
optimal image quality at lower mAs in paediatric
examinations of the femur.
Hyp.2:
If the pathological focus at a femur examination is
changed from primary to follow-up examination of a
fracture, it is possible to reduce mAs more than the
achieved mAs value from hyp. 1 using MLT(S).
Software project
Optimization
Current practice
Adjust practice
and formulate
possible new
criteria for
good practice
Compare practice
with criteria for
good practice
Point out deviation
Fig.: Quality development as a dynamic process (Kjrgaard, 2001)

Software project
Optimization in Radiography
1.
Set of standards, always based on an

anatomical background
2.
Make sure that these live up to image quality

(diagnosis) and dose demand (reference dose)
3.
Optimize low performing practices
4.
Set/develop new standards
5.
Repeat
(European Commission, 1996a; Bth et al., 2005)
Software project
Which examination to start optimizing?

The following examinations should be given priority in
the optimization of paediatric examinations:
Acquisition leading to repeated radiation

Acquisition that gives high radiation dose
Acquisition involving radiation sensitive area
(ICRP, 2006; ICRP - annals of the ICRP, 2004).
Software project
As Low As Reasonable Achievable

(ALARA)
diagnostic
information
Dose saturation
dose
Threshold value for diagnostic information
Fig.: Dose draft on diagnostic information (Norrman, 2007)
Software project
Method
Theory supported by published articles,
books and information by Canon
Quantitative experimental design

Technical phantom (CD Rad)
Human phantom (VGA analysis)
mAs and software settings are variable
Monte Carlo dose calculations
Statistics
Software project
Phantoms
Technical CD Rad phantom with water absorption
Human lamb phantom
Software project
Technical parameters used

in the experiments
Fixed parameters:
60 kV
Total filtration: 4,2 mm Al
SID: 100 cm
LUT: Bone#1
Collimation: 42x42 cm and 26x13 cm
Variable parameters:
16-0,5 mAs
Software parameters
Software project
Software settings
Software processing
Contrast
Dynamic range, Dark Region
Settings
16
10
23
13
29
16
20
Noise reduction
10
Edge enhangement, frequency band
Edge enhancement, effect
10
Table: Applied MLT(S) parameters in CD Rad tests
Software project
Analysis of CD Rad images
Fig.: CD Rad analyser (Artinis, 2006)
Software project
Analysis of human phantom images:

1st hypothesis
1
VGA
Visualization of age appropriate trochanter, femoral head, medial and

lateral condyle and femur bone
Visualization of periarticular soft tissue level
Sharpness of the demarcation between cancellous bone and compact

bone
Sharpness of trabecular
Table: Image criteria on femur images (Bontrager, 2002; European Commission, 1996b)
-2
Clearly worse than the reference image
-1
A little worse than the reference image
Comparable with the reference image
+1
A little better than the reference image
+2
Clearly better than the reference image
Table: Relative VGA scale for scoring image quality (Almn, et al, 2000).
Software project
Analysis of human phantom images:

2nd hypothesis
VGA
Visualization of the fracture bone ends of the

femur and their position
Table: Image criteria for control exposure of femur AP.
Not visible
Poorly reproduced
Well reproduced
Very well reproduced
Table: Absolute VGA scale for scoring image quality (Almn, et al, 2000).
Software project
Results
S-4
S-10
2 mAs
Software project
Results
Radiologist
Not visible
Poorly
represented
Well
represented
Very well
represented
56 (46.67%) 56 (46.67%)
14 (11.67%)
78 (65%)
28 (23.33%)
1 (0.83%)
33 (27.5%)
86 (71.67%)
8 (6.66%)
Table: Frequency table on the radiologists score, number (%), of the image criteria
for each of the four scoring possibilities within the hypothesis.
Software project
Statistical results
Significant factors by 1th hypothesis:
mAs
dynamic range, dark region
frequency band
Significant factors by 2nd hypothesis:

mAs
dynamic range, dark region
frequency band
edge enhancement effect
Software project
Bias
1. During the CD Rad tests the use of two images at each adjustment of
MLT(S) parameters and dose was an absolute minimum, the
recommendation is six identical images.
2. Calculation of applied water phantom as an absorber to the CD Rad
phantom.
3. Use of a lamb phantom; the difference to human anatomy is natural.
4. Size and absorption of the human phantom was larger than femur of a
five-year old child.
5. Manually placing ROI and its influence on the REX value.
Software project
Conclusion
Distinction between optimal and diagnostic image quality.
Based on the experiments both hypothesis is confirmed:
Optimal image quality is obtained at a dose reduction of 70 % from 16 to 5 mAs with
MLT(S) optimized images. Specifically optimized images are approved at 2 mAs, but
the radiologists VGA scores are worse than the reference image (diagnostic image
quality). This reduction consists of 97 %.
In follow up exposures of femur fracture all the radiologists approved optimized

images at 0,5 mAs corresponding to a dose reduction of 92 %.
Because of the factual bias of the project it might generally be possible to reduce dose
even further, as the lamb phantom absorbs more radiation than a five year old child.
Software project
Perspectives
New version of the MLT(S) software.
The complexity of software optimization demonstrates the necessity of more educated
radiographers with a view to handle development and implementation of such practices.
Future software could incorporate processing combinations designed for representing a given
pathology optimally with the lowest possible dose.
In the future examine possibilities of the software in several organs, pathologies and patient
groups a manual on software optimization will be developed as well as a database on applied
radiographic techniques and software settings for all Europe.
In order to disseminate the achieved knowledge two articles will be written for publication in
Paediatric Radiology.
References
Almn, A., Tingberg, A., Mattsson, S. et al. (2000); The influence of different technique factors on
image quality of lumbar spine radiographs as evaluated by established CEC image criteria, The British
Journal of Radiology, vol. 73, pp. 1192-99.
Artinis (2006); Manual Contrast-Detail Phantom, Artinis CD Rad type 2.0.
Bth, M., Hkansson, M. et al. (2005); A conceptual optimisation strategy for radiography in a digital
environment, Radioation Protection Dosimetry, vol. 114 pp. 230-35.
Bontrager, K.L. (2002); Textbook of Radiographic Positioning and Related Anatomi, 4 th edn, Bontrager
Publising, Phoenix.
Canon Inc.(2001); X-ray Digital Camera CXDI Series, Technical guide Image Processing, Japan.
Canon Inc. (2008a); CXDI Image Processing Software MLT(S) Users Manual, Japan.
Canon Inc. (2008b); Multiobjective Frequency Processing Function manual MLT(S) Edition, Japan.
European Comission (1996a); European guidelines on quality criteria for diagnostic radiographic
images, Luxemburg.
European Commission (1996b); European guidelines on quality criteria for diagnostic radiographic
images in paediatrics, Luxemburg.
Gonzales, R.C. & Woods, R.E. (2008); Digital Image Processing, 3 rd edn, Pearson, Prentice Hall.
ICRP (2006); Recommendations of the International Comission on Radiological Protection.
ICRP annals of the ICRP (2004); Guest Editiorial Managing patient dose in digital radiology, vol.
34, pp. 1-73.
Kjrgaard, J. (2001); Kvalitetsudvikling i sundhedsvsenet, 1 st edn, 3 rd oplag, Munksgaard, DK.
Norrman, E. (2007); Optimisation of radiographic imaging by means of factorial experiments
Doctoral Dissertation, rebro studies in Phisics 3, rebro University, Sweden.
Vallgrda, S. & Koch, L. (2007); Forskningsmetoder i folkesundhedsvidenskab, 3 rd edn, Munksgaard,
Copenhagen.
Vuylsteke, P. & Schoeters, E. (1999); Image Processing in Computer Radiography. Vol. 16 pp 87-101.
Questions?
Denmark
Thanks for your attention
E-mail: hepr@ucl.dk

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DR system:

How to find the best hardware and software to

RC 1414 - Paediatric imaging

Project focusing on scintilator sensitivity in paediatrics

Possibilities in software processing (Multi Frequency Processing)

Project focusing on possibilities to grade dose and image quality in

Educating Tomorrows Professionals www.ucl.dk /conradint

Educating Tomorrows Professionals www.ucl.dk /conradint

Connection to RIS/PACS systems

Educating Tomorrows Professionals www.ucl.dk /conradint

DQE and MTF

Pixel size and fill factor

Fig.: DR detector (Bushong, 2004)

Fill factor = Light sensitive area/detector area

Scintilator line spread function

Educating Tomorrows Professionals www.ucl.dk /conradint

Educating Tomorrows Professionals www.ucl.dk /conradint

Educating Tomorrows Professionals www.ucl.dk /conradint

Educating Tomorrows Professionals www.ucl.dk /conradint

DAP mGy cm^2

Educating Tomorrows Professionals www.ucl.dk /conradint

Analyzing image quality

Too low SNR

High spatial resolution

Image criteria not

Image criteria barely

Image criteria above

Educating Tomorrows Professionals www.ucl.dk /conradint

Educating Tomorrows Professionals www.ucl.dk /conradint

CsI, CXDI 50C

Fig.: CsI and GOS scintilators signal reinforcement at different kV values.

Educating Tomorrows Professionals www.ucl.dk /conradint

Use of other modalities - CT, MRI or UL?

Educating Tomorrows Professionals www.ucl.dk /conradint

Pre - and post processing

Fig.: Process in production of image data (Canon Inc., 2008a).

Educating Tomorrows Professionals www.ucl.dk /conradint

Automatic histogram adaptation

Fig.: Exposure recognition (Canon Inc., 2008b)

Educating Tomorrows Professionals www.ucl.dk /conradint

LUT curves in Canons DR system

Educating Tomorrows Professionals www.ucl.dk /conradint

Index value: REX - ROI

Fig.: Basis for REX calculation (Canon Inc., 2001).

Educating Tomorrows Professionals www.ucl.dk /conradint

Example using a human phantom

Educating Tomorrows Professionals www.ucl.dk /conradint

Guide for software optimization

Max. density region is dark

Min. density region is bright

Graininess needs to be reduced

Sharpness is not enough

Adjust Dynamic Range Dark Region

Adjust Dynamic Range Bright Region

Adjust Effect of Noise Reduction

Adjust Frequency Band

Adjust Effect of Edge Enhancement

Fig.: Technical illustration of MLT(S) compression (Canon Inc., 2008a).

Educating Tomorrows Professionals www.ucl.dk /conradint

Example using a human phantom

Dynamic range, Dark region

Dynamic range, Bright region

Educating Tomorrows Professionals www.ucl.dk /conradint