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1.  Detector system comparison using relative CNR for specific imaging tasks related to neuro-endovascular image-guided interventions (neuro-EIGIs) 
Neuro-EIGIs require visualization of very small endovascular devices and small vessels. A Microangiographic Fluoroscope (MAF) x-ray detector was developed to improve on the standard flat panel detector’s (FPD’s) ability to visualize small objects during neuro-EIGIs. To compare the performance of FPD and MAF imaging systems, specific imaging tasks related to those encountered during neuro-EIGIs were used to assess contrast to noise ratio (CNR) of different objects. A bar phantom and a stent were placed at a fixed distance from the x-ray focal spot to mimic a clinical imaging geometry and both objects were imaged by each detector system. Imaging was done without anti-scatter grids and using the same conditions for each system including: the same x-ray beam quality, collimator position, source to imager distance (SID), and source to object distance (SOD). For each object, relative contrasts were found for both imaging systems using the peak and trough signals. The relative noise was found using mean background signal and background noise for varying detector exposures. Next, the CNRs were found for these values for each object imaged and for each imaging system used. A relative CNR metric is defined and used to compare detector imaging performance. The MAF utilizes a temporal filter to reduce the overall image noise. The effects of using this filter with the MAF while imaging the clinical object’s CNRs are reported. The relative CNR for the detectors demonstrated that the MAF has superior CNRs for most objects and exposures investigated for this specific imaging task.
doi:10.1117/12.2042332
PMCID: PMC4187362  PMID: 25301999
MAF; ROI; CNR; image metrics; fluoroscopy; angiography; x-ray imaging; neurovascular interventions
2.  Experimental and theoretical performance analysis for a CMOS-based high resolution image detector 
Increasing complexity of endovascular interventional procedures requires superior x-ray imaging quality. Present state-of-the-art x-ray imaging detectors may not be adequate due to their inherent noise and resolution limitations. With recent developments, CMOS based detectors are presenting an option to fulfill the need for better image quality. For this work, a new CMOS detector has been analyzed experimentally and theoretically in terms of sensitivity, MTF and DQE.
The detector (Dexela Model 1207, Perkin-Elmer Co., London, UK) features 14-bit image acquisition, a CsI phosphor, 75 µm pixels and an active area of 12 cm × 7 cm with over 30 fps frame rate. This detector has two modes of operations with two different full-well capacities: high and low sensitivity. The sensitivity and instrumentation noise equivalent exposure (INEE) were calculated for both modes. The detector modulation-transfer function (MTF), noise-power spectra (NPS) and detective quantum efficiency (DQE) were measured using an RQA5 spectrum. For the theoretical performance evaluation, a linear cascade model with an added aliasing stage was used.
The detector showed excellent linearity in both modes. The sensitivity and the INEE of the detector were found to be 31.55 DN/µR and 0.55 µR in high sensitivity mode, while they were 9.87 DN/µR and 2.77 µR in low sensitivity mode. The theoretical and experimental values for the MTF and DQE showed close agreement with good DQE even at fluoroscopic exposure levels.
In summary, the Dexela detector's imaging performance in terms of sensitivity, linear system metrics, and INEE demonstrates that it can overcome the noise and resolution limitations of present state-of-the-art x-ray detectors.
doi:10.1117/12.2043053
PMCID: PMC4187383  PMID: 25300571
Linear Cascade Model; DQE; MTF; Aliasing; CMOS; X-Ray Imager
3.  Effect of injection technique on temporal parametric imaging derived from digital subtraction angiography in patient specific phantoms 
Parametric imaging maps (PIM’s) derived from digital subtraction angiography (DSA) for the cerebral arterial flow assessment in clinical settings have been proposed, but experiments have yet to determine the reliability of such studies. For this study, we have observed the effects of different injection techniques on PIM’s. A flow circuit set to physiologic conditions was created using an internal carotid artery phantom. PIM’s were derived for two catheter positions, two different contrast bolus injection volumes (5ml and 10 ml), and four injection rates (5, 10, 15 and 20 ml/s). Using a gamma variate fitting approach, we derived PIM’s for mean-transit-time (MTT), time-to-peak (TTP) and bolus-arrivaltime (BAT). For the same injection rates, a larger bolus resulted in an increased MTT and TTP, while a faster injection rate resulted in a shorter MTT, TTP, and BAT. In addition, the position of the catheter tip within the vasculature directly affected the PIM. The experiment showed that the PIM is strongly correlated with the injection conditions, and, therefore, they have to be interpreted with caution. PIM images must be taken from the same patient to be able to be meaningfully compared. These comparisons can include pre- and post-treatment images taken immediately before and after an interventional procedure or simultaneous arterial flow comparisons through the left and right cerebral hemispheres. Due to the strong correlation between PIM and injection conditions, this study indicates that this assessment method should be used only to compare flow changes before and after treatment within the same patient using the same injection conditions.
doi:10.1117/12.2041347
PMCID: PMC4187403  PMID: 25302010
Parametric Imaging Maps; DSA; Mean Transit Time; Time to Peak; MTT
4.  Challenges and limitations of patient-specific vascular phantom fabrication using 3D Polyjet printing 
Additive manufacturing (3D printing) technology offers a great opportunity towards development of patient-specific vascular anatomic models, for medical device testing and physiological condition evaluation. However, the development process is not yet well established and there are various limitations depending on the printing materials, the technology and the printer resolution. Patient-specific neuro-vascular anatomy was acquired from computed tomography angiography and rotational digital subtraction angiography (DSA). The volumes were imported into a Vitrea 3D workstation (Vital Images Inc.) and the vascular lumen of various vessels and pathologies were segmented using a “marching cubes” algorithm. The results were exported as Stereo Lithographic (STL) files and were further processed by smoothing, trimming, and wall extrusion (to add a custom wall to the model). The models were printed using a Polyjet printer, Eden 260V (Objet-Stratasys). To verify the phantom geometry accuracy, the phantom was reimaged using rotational DSA, and the new data was compared with the initial patient data. The most challenging part of the phantom manufacturing was removal of support material. This aspect could be a serious hurdle in building very tortuous phantoms or small vessels. The accuracy of the printed models was very good: distance analysis showed average differences of 120 μm between the patient and the phantom reconstructed volume dimensions. Most errors were due to residual support material left in the lumen of the phantom. Despite the post-printing challenges experienced during the support cleaning, this technology could be a tremendous benefit to medical research such as in device development and testing.
doi:10.1117/12.2042266
PMCID: PMC4188370  PMID: 25300886
Vascular phantoms; 3D printing; additive manufacturing; patient specific phantoms; CT; Cone-Beam CT
5.  Scatter reduction for high resolution image detectors with a region of interest attenuator 
Compton scatter is the main interaction of x-rays with objects undergoing radiographic and fluoroscopic imaging procedures. Such scatter is responsible for reducing image signal to noise ratio which can negatively impact object detection especially for low contrast objects. To reduce scatter, possible methods are smaller fields-of-view, larger air gaps and the use of an anti-scatter grid. Smaller fields of view may not be acceptable and scanned-beam radiography is not practical for real-time imaging. Air gaps can increase geometric unsharpness and thus degrade image resolution. Deployment of an anti-scatter grid is not well suited for high resolution imagers due to the unavailability of high line density grids needed to prevent grid-line artifacts. However, region of interest (ROI) imaging can be used not only for dose reduction but also for scatter reduction in the ROI. The ROI region receives unattenuated x-rays while the peripheral region receives x-rays reduced in intensity by an ROI attenuator. The scatter within the ROI part of the image originates from both the unattenuated ROI and the attenuated peripheral region. The scatter contribution from the periphery is reduced in intensity because of the reduced primary x-rays in that region and the scatter fraction in the ROI is thus reduced. In this study, the scatter fraction for various kVp’s, air-gaps and field sizes was measured for a uniform head equivalent phantom. The scatter fraction in the ROI was calculated using a derived scatter fraction formula, which was validated with experimental measurements. It is shown that use of a ROI attenuator can be an effective way to reduce both scatter and patient dose while maintaining the superior image quality of high resolution detectors.
doi:10.1117/12.2043061
PMCID: PMC4188397  PMID: 25302000
Region of Interest; Scatter; ROI Attenuator; Digital Imaging
6.  Focal spot measurements using a digital flat panel detector 
Focal spot size is one of the crucial factors that affect the image quality of any x-ray imaging system. It is, therefore, important to measure the focal spot size accurately. In the past, pinhole and slit measurements of x-ray focal spots were obtained using direct exposure film. At present, digital detectors are replacing film in medical imaging so that, although focal spot measurements can be made quickly with such detectors, one must be careful to account for the generally poorer spatial resolution of the detector and the limited usable magnification. For this study, the focal spots of a diagnostic x-ray tube were measured with a 10-μm pinhole using a 194-μm pixel flat panel detector (FPD). The two-dimensional MTF, measured with the Noise Response (NR) Method was used for the correction for the detector blurring. The resulting focal spot sizes based on the FWTM (Full Width at Tenth Maxima) were compared with those obtained with a very high resolution detector with 8-μm pixels. This study demonstrates the possible effect of detector blurring on the focal spot size measurements with digital detectors with poor resolution and the improvement obtained by deconvolution. Additionally, using the NR method for measuring the two-dimensional MTF, any non-isotropies in detector resolution can be accurately corrected for, enabling routine measurement of non-isotropic x-ray focal spots. This work presents a simple, accurate and quick quality assurance procedure for measurements of both digital detector properties and x-ray focal spot size and distribution in modern x-ray imaging systems.
doi:10.1117/12.2043057
PMCID: PMC4188439  PMID: 25302004
focal spot measurement; Noise Response method; pinhole camera; flat panel detector; Focal Spot
7.  Improved-Resolution, Real-Time Skin-Dose Mapping for Interventional Fluoroscopic Procedures 
Proceedings of SPIE  2014;9033(903340):10.1117/12.2042519.
We have developed a dose-tracking system (DTS) that provides a real-time display of the skin-dose distribution on a 3D patient graphic during fluoroscopic procedures. Radiation dose to individual points on the skin is calculated using exposure and geometry parameters from the digital bus on a Toshiba C-arm unit. To accurately define the distribution of dose, it is necessary to use a high-resolution patient graphic consisting of a large number of elements. In the original DTS version, the patient graphics were obtained from a library of population body scans which consisted of larger-sized triangular elements resulting in poor congruence between the graphic points and the x-ray beam boundary. To improve the resolution without impacting real-time performance, the number of calculations must be reduced and so we created software-designed human models and modified the DTS to read the graphic as a list of vertices of the triangular elements such that common vertices of adjacent triangles are listed once. Dose is calculated for each vertex point once instead of the number of times that a given vertex appears in multiple triangles. By reformatting the graphic file, we were able to subdivide the triangular elements by a factor of 64 times with an increase in the file size of only 1.3 times. This allows a much greater number of smaller triangular elements and improves resolution of the patient graphic without compromising the real-time performance of the DTS and also gives a smoother graphic display for better visualization of the dose distribution.
doi:10.1117/12.2042519
PMCID: PMC4148722  PMID: 25177446
Interventional fluoroscopic procedures; dose tracking system; skin dose; fluoroscopy exposure; dose mapping
8.  Component Level Modular Design of a Solid State X-ray Image Intensifier for an M×N Array 
The Solid-State X-ray Image Intensifier (SSXII) is a novel dynamic x-ray imager, based on an array of electron-multiplying CCDs (EMCCDs), that can significantly improve performance compared to conventional x-ray image intensifiers (XIIs) and flat panel detectors (FPDs). To expand the field-of-view (FOV) of the SSXII detectors while maintaining high resolution, a scalable component level modular design is presented. Each module can be fit together with minimum dead-space and optically coupled to one contiguous x-ray converter plate. The electronics of each of the modules consists of a detachable head-board, on which is mounted the EMCCD, and a driver board. The size of the head-boards is minimized to ensure that the modules fit together properly. The driver boards connect with the head-boards via flat cables and are designed to be plugged into the main mother-board that contains an FPGA chip that generates the driving clock signals for the EMCCDs and analog-to-digital converter (ADC). At the front-end, a high speed ADC on each of the driver boards samples and digitizes the EMCCD analog output signal and an extensible modular digital multiplexer back-end is used to acquire and combine image data from multiple modules. The combined digital data is then transmitted to a PC via a standard Camera Link interface. Eventually, this modular design will be extended to a 3×3 or larger array to accomplish full clinical FOVs and enable the SSXII to replace conventional lower-resolution XIIs or FPDs.
doi:10.1109/NSSMIC.2010.5874284
PMCID: PMC3596890  PMID: 23505331
9.  Updates in the real-time Dose Tracking System (DTS) to improve the accuracy in calculating the radiation dose to the patients skin during fluoroscopic procedures 
We have developed a dose-tracking system (DTS) to manage the risk of deterministic skin effects to the patient during fluoroscopic image-guided interventional cardiac procedures. The DTS calculates the radiation dose to the patient’s skin in real-time by acquiring exposure parameters and imaging-system geometry from the digital bus on a Toshiba C-arm unit and displays the cumulative dose values as a color map on a 3D graphic of the patient for immediate feedback to the interventionalist. Several recent updates have been made to the software to improve its function and performance. Whereas the older system needed manual input of pulse rate for dose-rate calculation and used the CPU clock with its potential latency to monitor exposure duration, each x-ray pulse is now individually processed to determine the skin-dose increment and to automatically measure the pulse rate. We also added a correction for the table pad which was found to reduce the beam intensity to the patient for under-table projections by an additional 5–12% over that of the table alone at 80 kVp for the x-ray filters on the Toshiba system. Furthermore, mismatch between the DTS graphic and the patient skin can result in inaccuracies in dose calculation because of inaccurate inverse-square-distance calculation. Therefore, a means for quantitative adjustment of the patient-graphic-model position and a parameterized patient-graphic library have been developed to allow the graphic to more closely match the patient. These changes provide more accurate estimation of the skin-dose which is critical for managing patient radiation risk.
doi:10.1117/12.2007706
PMCID: PMC4013095  PMID: 24817801
Interventional fluoroscopic procedures; dose tracking system; skin dose; fluoroscopy; dose mapping
10.  Improved contrast and spatial resolution with Single Photon Counting (SPC) for an area x-ray imager, the newly developed high-resolution Micro-Angiographic Fluoroscopic (MAF) detector 
Although in radiological imaging, the prevailing mode of acquisition is the integration of the energy deposited by all x-rays absorbed in the imaging detector, much improvement in image spatial and contrast resolution could be achieved if each individual x-ray photon were detected and counted separately. In this work we compare the conventional energy integration (EI) mode with the new single photon counting (SPC) mode for a recently developed high-resolution Micro-Angiographic Fluoroscopic (MAF) detector, which is uniquely capable of both modes of operation. The MAF has 1024×1024 pixels of 35 microns effective size and is capable of real-time imaging at 30 fps. The large variable gain of its light image intensifier (LII) provides quantum limited operation with essentially no additive instrumentation noise and enables the MAF to operate in both EI and the very sensitive low-exposure SPC modes. We used high LII gain with very low exposure (<1 x-ray photon/pixel) per frame for SPC mode and higher exposure per frame with lower gain for EI mode. Multiple signal-thresholded frames were summed in SPC mode to provide an integrated frame with the same total exposure as EI mode. A heavily K-edge filtered x-ray beam (average energy of 31 keV) was used to provide a nearly monochromatic spectrum. The MTF measured using a standard slit method showed a dramatic improvement for the SPC mode over the EI mode at all frequencies. Images of a line pair phantom also showed improved spatial resolution with 12 lp/mm visible in SPC mode compared to only 8 lp/mm in EI mode. In SPC mode, images of human distal and middle phalanges showed the trabecular structures of the bone with far better contrast and detail. These improvements with the SPC mode should be advantageous for clinical applications where high resolution and/or high contrast are essential such as in mammography and extremity imaging as well as for dual modality applications, which combine nuclear medicine and x-ray imaging using a single detector.
doi:10.1109/NSSMIC.2009.5401587
PMCID: PMC3991167  PMID: 24748764
11.  Region-of-Interest Micro-Angiographic Fluoroscope Detector Used in Aneurysm and Artery Stenosis Diagnoses and Treatment 
Proceedings of SPIE  2012;8313:10.1117/12.910771.
Due to the need for high-resolution angiographic and interventional vascular imaging, a Micro-Angiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer, which was attached to the C-arm of a clinical angiographic unit at a local hospital. The MAF detector provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 µm-thick CsI phosphor, a dual stage micro-channel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 µm effective square pixels with 12 bit depth. The changer allows the MAF region-of-interest (ROI) detector to be inserted in front of the Image Intensifier (II) when higher resolution is needed during angiographic or interventional vascular imaging procedures, e.g. endovascular stent deployment. The CAPIDS was developed and implemented using Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF including: fluoroscopy, roadmapping, radiography, and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular image-guided interventions (EIGI) for diagnosing and treating artery stenoses and aneurysms using self-expanding endovascular stents and coils in fifteen patient cases, which have demonstrated benefits of using the ROI detector. The visualization of the fine detail of the endovascular devices and the vessels generally gave the clinicians confidence on performing neurovascular interventions and in some instances contributed to improved interventions.
doi:10.1117/12.910771
PMCID: PMC3877313  PMID: 24386538
Neuro-imaging; neuro-endovascular image-guided interventions; x-ray imaging; fluoroscopic detector; high-resolution imaging
12.  Graphical User Interface for a Dual-Module EMCCD X-ray Detector Array 
A new Graphical User Interface (GUI) was developed using Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) for a high-resolution, high-sensitivity Solid State X-ray Image Intensifier (SSXII), which is a new x-ray detector for radiographic and fluoroscopic imaging, consisting of an array of Electron-Multiplying CCDs (EMCCDs) each having a variable on-chip electron-multiplication gain of up to 2000× to reduce the effect of readout noise. To enlarge the field-of-view (FOV), each EMCCD sensor is coupled to an x-ray phosphor through a fiberoptic taper. Two EMCCD camera modules are used in our prototype to form a computer-controlled array; however, larger arrays are under development. The new GUI provides patient registration, EMCCD module control, image acquisition, and patient image review. Images from the array are stitched into a 2k×1k pixel image that can be acquired and saved at a rate of 17 Hz (faster with pixel binning). When reviewing the patient's data, the operator can select images from the patient's directory tree listed by the GUI and cycle through the images using a slider bar. Commonly used camera parameters including exposure time, trigger mode, and individual EMCCD gain can be easily adjusted using the GUI. The GUI is designed to accommodate expansion of the EMCCD array to even larger FOVs with more modules. The high-resolution, high-sensitivity EMCCD modular-array SSXII imager with the new user-friendly GUI should enable angiographers and interventionalists to visualize smaller vessels and endovascular devices, helping them to make more accurate diagnoses and to perform more precise image-guided interventions.
doi:10.1117/12.877588
PMCID: PMC3865244  PMID: 24357902
Image Guided Interventions; Graphical User Interface; Solid State X-ray Image Intensifier (SSXII); Electron-Multiplying CCD (EMCCD); Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW); System
13.  Significance of Including Field Non-Uniformities Such as the Heel Effect and Beam Scatter in the Determination of the Skin Dose Distribution during Interventional Fluoroscopic Procedures 
The current version of the real-time skin-dose-tracking system (DTS) we have developed assumes the exposure is contained within the collimated beam and is uniform except for inverse-square variation. This study investigates the significance of factors that contribute to beam non-uniformity such as the heel effect and backscatter from the patient to areas of the skin inside and outside the collimated beam. Dose-calibrated Gafchromic film (XR-RV3, ISP) was placed in the beam in the plane of the patient table at a position 15 cm tube-side of isocenter on a Toshiba Infinix C-Arm system. Separate exposures were made with the film in contact with a block of 20-cm solid water providing backscatter and with the film suspended in air without backscatter, both with and without the table in the beam. The film was scanned to obtain dose profiles and comparison of the profiles for the various conditions allowed a determination of field non-uniformity and backscatter contribution. With the solid-water phantom and with the collimator opened completely for the 20-cm mode, the dose profile decreased by about 40% on the anode side of the field. Backscatter falloff at the beam edge was about 10% from the center and extra-beam backscatter decreased slowly with distance from the field, being about 3% of the beam maximum at 6 cm from the edge. Determination of the magnitude of these factors will allow them to be included in the skin-dose-distribution calculation and should provide a more accurate determination of peak-skin dose for the DTS.
doi:10.1117/12.911528
PMCID: PMC3865277  PMID: 24357908
Interventional fluoroscopic procedures; Dose tracking system; Gafchromic film (XR-RV3; ISP); Skin dose; Backscatter; Heel effect
14.  Evaluation of embolic deflection device using optical particle tracking 
Trans-aortic valve replacement is a new endovascular procedure which has started to be used routinely in cardiac interventional suites. During such procedures a stent-like device containing new aortic valves is placed over the damaged ones, possibly causing calcifications to be dislodged and released in arteries leading to stroke. To prevent such events, new devices are being developed to provide distal protection to the brain supplying arteries. Currently there is a need to evaluate such device efficacy in a repeatable manner. We are proposing and investigating such a method based on particle optical tracking. We simulated such protective devices using two porous screens (150 and 200 μm pore size) which were placed in an arterial bifurcation phantom connected to a clinically relevant flow loop. A mask was acquired and gold embolic particles (100–300μm) were injected at a steady rate using a motorized injector. Optical images with 2 ms exposure were acquired at 30 fps. Images were subtracted, thresholded and filtered using a 5×5 median filter. ROI's were drawn over the main and bifurcating arteries and a particle counting algorithm was used to estimate particle flow rates in each artery for each run. The unprotected and the two protected cases were evaluated. Before filter placement, the particle flow rate was 60 and 40 %, respectively, of the main artery. After the filter placement, the particle flow rate in the protected branch was 4% and 8% of the particle flow rate in the main artery. We present a method to assess the efficacy of such devices using an optical particle tracking and counting technique.
doi:10.1117/12.2004319
PMCID: PMC3864933  PMID: 24353394
embolic deflection device; optical particle tracking; Trans-aortic valve replacement
15.  Design considerations for a new, high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS) 
The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50–1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.
doi:10.1117/12.2006430
PMCID: PMC3864963  PMID: 24353389
MAF; CMOS; ROI; fluoroscopy; angiography; x-ray imaging; detector design; neurovascular interventions
16.  Theoretical performance analysis for CMOS based high resolution detectors 
High resolution imaging capabilities are essential for accurately guiding successful endovascular interventional procedures. Present x-ray imaging detectors are not always adequate due to their inherent limitations. The newly-developed high-resolution micro-angiographic fluoroscope (MAF-CCD) detector has demonstrated excellent clinical image quality; however, further improvement in performance and physical design may be possible using CMOS sensors. We have thus calculated the theoretical performance of two proposed CMOS detectors which may be used as a successor to the MAF.
The proposed detectors have a 300 μm thick HL-type CsI phosphor, a 50 μm-pixel CMOS sensor with and without a variable gain light image intensifier (LII), and are designated MAF-CMOS-LII and MAF-CMOS, respectively. For the performance evaluation, linear cascade modeling was used. The detector imaging chains were divided into individual stages characterized by one of the basic processes (quantum gain, binomial selection, stochastic and deterministic blurring, additive noise). Ranges of readout noise and exposure were used to calculate the detectors’ MTF and DQE.
The MAF-CMOS showed slightly better MTF than the MAF-CMOS-LII, but the MAF-CMOS-LII showed far better DQE, especially for lower exposures.
The proposed detectors can have improved MTF and DQE compared with the present high resolution MAF detector. The performance of the MAF-CMOS is excellent for the angiography exposure range; however it is limited at fluoroscopic levels due to additive instrumentation noise. The MAF-CMOS-LII, having the advantage of the variable LII gain, can overcome the noise limitation and hence may perform exceptionally for the full range of required exposures; however, it is more complex and hence more expensive.
doi:10.1117/12.2006217
PMCID: PMC3864964  PMID: 24353390
MTF; DQE; CMOS; MAF; Linear Cascade Model; interventional imaging; x-ray image detector
17.  Use of a graphics processing unit (GPU) to facilitate real-time 3D graphic presentation of the patient skin-dose distribution during fluoroscopic interventional procedures 
Proceedings of SPIE  2012;8313:831343-.
We have developed a dose-tracking system (DTS) that calculates the radiation dose to the patient’s skin in real-time by acquiring exposure parameters and imaging-system-geometry from the digital bus on a Toshiba Infinix C-arm unit. The cumulative dose values are then displayed as a color map on an OpenGL-based 3D graphic of the patient for immediate feedback to the interventionalist. Determination of those elements on the surface of the patient 3D-graphic that intersect the beam and calculation of the dose for these elements in real time demands fast computation. Reducing the size of the elements results in more computation load on the computer processor and therefore a tradeoff occurs between the resolution of the patient graphic and the real-time performance of the DTS. The speed of the DTS for calculating dose to the skin is limited by the central processing unit (CPU) and can be improved by using the parallel processing power of a graphics processing unit (GPU). Here, we compare the performance speed of GPU-based DTS software to that of the current CPU-based software as a function of the resolution of the patient graphics. Results show a tremendous improvement in speed using the GPU. While an increase in the spatial resolution of the patient graphics resulted in slowing down the computational speed of the DTS on the CPU, the speed of the GPU-based DTS was hardly affected. This GPU-based DTS can be a powerful tool for providing accurate, real-time feedback about patient skin-dose to physicians while performing interventional procedures.
doi:10.1117/12.911344
PMCID: PMC3766975  PMID: 24027616
skin dose; dosimetry; fluoroscopic dose; dose tracking; real-time dosimetry; fluoroscopic interventional procedures; GPU
18.  Investigation of metrics to assess vascular flow modifications for diverter device designs using hydrodynamics and angiographic studies 
Proceedings of SPIE  2012;8317:83170F-.
Intracranial aneurysm treatment with flow diverters (FD) is a new minimally invasive approach, recently approved for use in human patients. Attempts to correlate the flow reduction observed in angiograms with a parameter related to the FD structure have not been totally successful. To find the proper parameter, we investigated four porous-media flow models. The models describing the relation between the pressure drop and flow velocity that are investigated include the capillary theory linear model (CTLM), the drag force linear model (DFLM), the simple quadratic model (SQM) and the modified quadratic model (MQM). Proportionality parameters are referred to as permeability for the linear models and resistance for the quadratic ones. A two stage experiment was performed. First, we verified flow model validity by placing six different stainless-steel meshes, resembling FD structures, in known flow conditions. The best flow model was used for the second stage, where six different FD’s were inserted in aneurysm phantoms and flow modification was estimated using angiographically derived time density curves (TDC). Finally, TDC peak variation was compared with the FD parameter. Model validity experiments indicated errors of: 70% for the linear models, 26% for the SQM and 7% for the MQM. The resistance calculated according to the MQM model correlated well with the contrast flow reduction. Results indicate that resistance calculated according to MQM is appropriate to characterize the FD and could explain the flow modification observed in angiograms.
doi:10.1117/12.915675
PMCID: PMC3767005  PMID: 24027624
flow diverter; digital subtraction angiography; aneurysms; flow resistance; permeability
19.  New head equivalent phantom for task and image performance evaluation representative for neurovascular procedures occurring in the Circle of Willis 
Proceedings of SPIE  2012;8313:83130Q-.
Phantom equivalents of different human anatomical parts are routinely used for imaging system evaluation or dose calculations. The various recommendations on the generic phantom structure given by organizations such as the AAPM, are not always accurate when evaluating a very specific task. When we compared the AAPM head phantom containing 3 mm of aluminum to actual neuro-endovascular image guided interventions (neuro-EIGI) occurring in the Circle of Willis, we found that the system automatic exposure rate control (AERC) significantly underestimated the x-ray parameter selection. To build a more accurate phantom for neuro-EIGI, we reevaluated the amount of aluminum which must be included in the phantom. Human skulls were imaged at different angles, using various angiographic exposures, at kV’s relevant to neuro-angiography. An aluminum step wedge was also imaged under identical conditions, and a correlation between the gray values of the imaged skulls and those of the aluminum step thicknesses was established. The average equivalent aluminum thickness for the skull samples for frontal projections in the Circle of Willis region was found to be about 13 mm. The results showed no significant changes in the average equivalent aluminum thickness with kV or mAs variation. When a uniform phantom using 13 mm aluminum and 15 cm acrylic was compared with an anthropomorphic head phantom the x-ray parameters selected by the AERC system were practically identical. These new findings indicate that for this specific task, the amount of aluminum included in the head equivalent must be increased substantially from 3 mm to a value of 13 mm.
doi:10.1117/12.911351
PMCID: PMC3767006  PMID: 24027618
Head equivalent phantom; uniform phantom; Circle of Willis; fluoroscopy; digital subtracted angiography
20.  Optical Demonstration of a Medical Imaging System with an EMCCD-Sensor Array for Use in a High Resolution Dynamic X-ray Imager 
Use of an extensible array of Electron Multiplying CCDs (EMCCDs) in medical x-ray imager applications was demonstrated for the first time. The large variable electronic-gain (up to 2000) and small pixel size of EMCCDs provide effective suppression of readout noise compared to signal, as well as high resolution, enabling the development of an x-ray detector with far superior performance compared to conventional x-ray image intensifiers and flat panel detectors. We are developing arrays of EMCCDs to overcome their limited field of view (FOV). In this work we report on an array of two EMCCD sensors running simultaneously at a high frame rate and optically focused on a mammogram film showing calcified ducts. The work was conducted on an optical table with a pulsed LED bar used to provide a uniform diffuse light onto the film to simulate x-ray projection images. The system can be selected to run at up to 17.5 frames per second or even higher frame rate with binning. Integration time for the sensors can be adjusted from 1 ms to 1000 ms. Twelve-bit correlated double sampling AD converters were used to digitize the images, which were acquired by a National Instruments dual-channel Camera Link PC board in real time. A user-friendly interface was programmed using LabVIEW to save and display 2K × 1K pixel matrix digital images. The demonstration tiles a 2 × 1 array to acquire increased-FOV stationary images taken at different gains and fluoroscopic-like videos recorded by scanning the mammogram simultaneously with both sensors. The results show high resolution and high dynamic range images stitched together with minimal adjustments needed. The EMCCD array design allows for expansion to an M×N array for arbitrarily larger FOV, yet with high resolution and large dynamic range maintained.
doi:10.1109/NSSMIC.2010.5874260
PMCID: PMC3596892  PMID: 23505330
21.  Overcoming x-ray tube small focal spot output limitations for high-resolution region of interest imaging 
Proceedings of SPIE  2012;8313:831358.
We investigate methods to increase x-ray tube output to enable improved quantum image quality with a higher generalized-NEQ (GNEQ) while maintaining a small focal-spot size for the new high-resolution Micro-angiographic Fluoroscope (MAF) Region of Interest (ROI) imaging system. Rather than using a larger focal spot to increase tube-loading capacity with degraded resolution, we evaluated separately or in combination three methods to increase tube output: 1) reducing the anode angle and lengthening the filament to maintain a constant effective small focal-spot size, 2) using the standard medium focal spot viewed from a direction on the anode side of the field and 3) increasing the frame rate (frames/second) in combination with temporal filter. The GNEQ was compared for the MAF for the small focal-spot at the central axis, and for the medium focal-spot with a higher output on the anode side as well as for the small focal spot with different temporal recursive filtering weights. A net output increase of about 4.0 times could be achieved with a 2-degree anode angle (without the added filtration) and a 4 times longer filament compared to that of the standard 8-degree target. The GNEQ was also increased for the medium focal-spot due to its higher output capacity and for the temporally filtered higher frame rate. Thus higher tube output, while maintaining a small effective focal-spot, should be achievable using one or more of the three methods described with only small modifications of standard x-ray tube geometry.
doi:10.1117/12.910791
PMCID: PMC3419545  PMID: 22905312
NEQ; Focal spot; GNEQ; ROI; MAF; EIGI; MTF; NNPS; X-ray tube; CNR
22.  Evaluation of intracranial aneurysm coil embolization in phantoms and patients using a high-resolution Microangiographic Fluoroscope (MAF) 
Proceedings of SPIE  2012;8313:831316.
Intracranial aneurysm (IA) embolization using Gugliemi Detachable Coils (GDC) under x-ray fluoroscopic guidance is one of the most important neuro-vascular interventions. Coil deposition accuracy is key and could benefit substantially from higher resolution imagers such as the micro-angiographic fluoroscope (MAF). The effect of MAF guidance improvement over the use of standard Flat Panels (FP) is challenging to assess for such a complex procedure. We propose and investigate a new metric, inter-frame cross-correlation sensitivity (CCS), to compare detector performance for such procedures. Pixel (P) and histogram (H) CCS’s were calculated as one minus the cross-correlation coefficients between pixel values and histograms for the region of interest at successive procedure steps. IA treatment using GDC’s was simulated using an anthropomorphic head phantom which includes an aneurysm. GDC’s were deposited in steps of 3 cm and the procedure was imaged with a FP and the MAF. To measure sensitivity to detect progress of the procedure by change in images of successive steps, an ROI was selected over the aneurysm location and pixel-value and histogram changes were calculated after each step. For the FP, after 4 steps, the H and P CCSs between successive steps were practically zero, indicating that there were no significant changes in the observed images. For the MAF, H and P CCSs were greater than zero even after 10 steps (30 cm GDC), indicating observable changes. Further, the proposed quantification method was applied for evaluation of seven patients imaged using the MAF, yielding similar results (H and P CCSs greater than zero after the last GDC deposition). The proposed metric indicates that the MAF can offer better guidance during such procedures.
doi:10.1117/12.911333
PMCID: PMC3419595  PMID: 22905313
Intracranial aneurysms; microangiographic fluoroscope; MAF; coil embolization; cross-correlation sensitivity
23.  Image Geometric Corrections for a New EMCCD-based Dual Modular X-ray Imager 
An EMCCD-based dual modular x-ray imager was recently designed and developed from the component level, providing a high dynamic range of 53 dB and an effective pixel size of 26 μm for angiography and fluoroscopy. The unique 2×1 array design efficiently increased the clinical field of view, and also can be readily expanded to an M×N array implementation. Due to the alignment mismatches between the EMCCD sensors and the fiber optic tapers in each module, the output images or video sequences result in a misaligned 2048×1024 digital display if uncorrected. In this paper, we present a method for correcting display registration using a custom-designed two layer printed circuit board. This board was designed with grid lines to serve as the calibration pattern, and provides an accurate reference and sufficient contrast to enable proper display registration. Results show an accurate and fine stitching of the two outputs from the two modules.
doi:10.1109/IEMBS.2011.6090726
PMCID: PMC3411313  PMID: 22254882
24.  Spatially Different, Real-Time Temporal Filtering and Dose Reduction for Dynamic Image Guidance during Neurovascular Interventions 
Conference Proceedings  2011;2011:6192-6195.
Fluoroscopic systems have excellent temporal resolution, but are relatively noisy. In this paper we present a recursive temporal filter with different weights (lag) for different user selected regions of interest (ROI) to assist the neurointerventionalist during an image guided catheter procedure. The filter has been implemented on a Graphics Processor (GPU), enabling its usage for fast frame rates such as during fluoroscopy.
We first demonstrate the use of this GPU-implemented rapid temporal filtering technique during an endovascular image guided intervention with normal fluoroscopy. Next we demonstrate its use in combination with ROI fluoroscopy where the exposure is substantially reduced in the peripheral region outside the ROI, which is then software-matched in brightness and filtered using the differential temporal filter. This enables patient dose savings along with improved image quality.
doi:10.1109/IEMBS.2011.6091529
PMCID: PMC3401071  PMID: 22255753
25.  Angiographic analysis of blood flow modification in cerebral aneurysm models with a new asymmetric stent 
We have built new asymmetric stents for minimally invasive endovascular treatment of cerebral aneurysms. Each asymmetric stent consists of a commercial stent with a micro-welded circular mesh patch. The blood flow modification in aneurysm-vessel phantoms due to these stents was evaluated using x-ray angiographic analysis. However, the density difference between the radiographic contrast and the blood gives rise to a gravity effect, which was evaluated using an initial optical dye-dilution experiment. For the radiographic evaluations, curved-vessel phantoms instead of simple straight side-wall aneurysm phantoms were used in the characterization of meshes/stents. Six phantoms (one untreated, one treated with a commercial stent, and four treated with different asymmetric stents) with similar morphologies were used for comparison. We calculated time-density curves of the aneurysm region and then calculated the peak value (Pk) and washout rate (1/τ) after analytical curve fitting. Flow patterns in the angiograms showed reduction of vortex flow and slow washout in the dense mesh patch treated aneurysms. The meshes reduced Pk down to 21% and 1/τ down to 12% of the values for the untreated case. In summary, new asymmetric stents were constructed and their evaluation demonstrates that they may be useful in the endovascular treatment of aneurysms.
doi:10.1117/12.535347
PMCID: PMC3163448  PMID: 21886414
aneurysm; cerebral aneurysm; angiography; time-density; blood flow; flow evaluation; flow modification; stent; asymmetric stent; interventional neuroradiology

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