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The use of Monte Carlo simulations in diagnostic medical imaging research is widespread due to its flexibility and ability to estimate quantities that are challenging to measure empirically. However, any new Monte Carlo simulation code needs to be validated before it can be used reliably. The type and degree of validation required depends on the goals of the research project, but, typically, such validation involves either comparison of simulation results to physical measurements or to previously published results obtained with established Monte Carlo codes. The former is complicated due to nuances of experimental conditions and uncertainty, while the latter is challenging due to typical graphical presentation and lack of simulation details in previous publications. In addition, entering the field of Monte Carlo simulations in general involves a steep learning curve. It is not a simple task to learn how to program and interpret a Monte Carlo simulation, even when using one of the publicly available code packages. This Task Group report provides a common reference for benchmarking Monte Carlo simulations across a range of Monte Carlo codes and simulation scenarios. In the report, all simulation conditions are provided for six different Monte Carlo simulation cases that involve common x-ray based imaging research areas. The results obtained for the six cases using four publicly available Monte Carlo software packages are included in tabular form. In addition to a full description of all simulation conditions and results, a discussion and comparison of results among the Monte Carlo packages and the lessons learned during the compilation of these results are included. This abridged version of the report includes only an introductory description of the six cases and a brief example of the results of one of the cases. This work provides an investigator the necessary information to benchmark his/her Monte Carlo simulation software against the reference cases included here before performing his/her own novel research. In addition, an investigator entering the field of Monte Carlo simulations can use these descriptions and results as a self-teaching tool to ensure that he/she is able to perform a specific simulation correctly. Finally, educators can assign these cases as learning projects as part of course objectives or training programs.

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PURPOSE: The purpose of this work is to evaluate the performance of the image acquisition chain of clinical full field digital mammography (FFDM) systems by quantifying their image quality, and how well the desired information is captured by the images. METHODS: The authors present a practical methodology to evaluate FFDM using the task specific system-model-based Fourier Hotelling observer (SMFHO) signal to noise ratio (SNR), which evaluates the signal and noise transfer characteristics of FFDM systems in the presence of a uniform polymethyl methacrylate phantom that models the attenuation of a 6 cm thick 20/80 breast (20% glandular/80% adipose). The authors model the system performance using the generalized modulation transfer function, which accounts for scatter blur and focal spot unsharpness, and the generalized noise power spectrum, both estimated with the phantom placed in the field of view. Using the system model, the authors were able to estimate system detectability for a series of simulated disk signals with various diameters and thicknesses, quantified by a SMFHO SNR map. Contrast-detail (CD) curves were generated from the SNR map and adjusted using an estimate of the human observer efficiency, without performing time-consuming human reader studies. Using the SMFHO method the authors compared two FFDM systems, the GE Senographe DS and Hologic Selenia FFDM systems, which use indirect and direct detectors, respectively. RESULTS: Even though the two FFDM systems have different resolutions, noise properties, detector technologies, and antiscatter grids, the authors found no significant difference between them in terms of detectability for a given signal detection task. The authors also compared the performance between the two image acquisition modes (fine view and standard) of the GE Senographe DS system, and concluded that there is no significant difference when evaluated by the SMFHO. The estimated human observer efficiency was 30 ± 5% when compared to the SMFHO. The results showed good agreement when compared to other model observers as well as previously published human observer data. CONCLUSIONS: This method generates CD curves from the SMFHO SNR that can be used as figures of merit for evaluating the image acquisition performance of clinical FFDM systems. It provides a way of creating an empirical model of the FFDM system that accounts for patient scatter, focal spot unsharpness, and detector blur. With the use of simulated signals, this method can predict system performance for a signal known exactly/background known exactly detection task with a limited number of images, therefore, it can be readily applied in a clinical environment.

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This study presents an analytical model for the edge spread function (ESF) of a clinical CT system that allows reliable fits of noisy ESF data. The model was used for the calculation of the material-specific transfer function TF and an estimation of the signal transfer and the signal-to-noise ratio (SNR) in 2D. Images of the Catphan phantom were acquired with a clinical Siemens Somatom Sensation Cardiac 64 CT scanner combining four different x-ray tube outputs (40, 150, 250 and 350 mAs) with four different reconstruction filters, which covered the range from very smooth (B10s) to very sharp (B70s). The images of the high- and mid-contrast cylinders of the phantom's 'Geometry and Sensitometry' module (air, Teflon, Delrin and PMP) were used to sample material-specific ESF curves. The ESF curves were fitted with the analytical model we developed based on a linear combination of Boltzmann and Gaussian functions. The analytical model of the ESF was used to obtain the Fourier-based material-specific transfer function TF, as well as the spatial-domain point spread function (PSF). TF was subsequently used to estimate the signal transfer, which was compared to the actual reconstructed image of a 3.0 mm diameter Teflon pin. The noise power spectrum (NPS) was calculated from images of a uniform water phantom under the same technique parameters. The task-specific SNR was calculated for all technique parameters from the model-based TF, the measured NPS and simulated 3 mm diameter disc signals modeling the aforementioned materials. Bootstrapping was performed to estimate the standard deviation of the TF and the SNR. The analytical model we developed accurately captured the features of the CT ESF data. The coefficient of determination R(2), a metric that describes the goodness of the fit, had a median value of 0.9995, and decreased for low tube output, low contrast and the sharp reconstruction filter. Our analysis showed that ESF, PSF and TF depended not only on the reconstruction filter, but also on the tube output and the material of the cylinders. For B40s and B70s, the TF of Delrin was significantly higher than the TF of other materials in the frequency range of 0.4-0.9 mm(-1). The estimated signal transfer agreed well with the actual reconstructed image of the Teflon pin. For the technique parameters we used the SNR values ranged between [64, 320], [64, 281], [37, 137] and [33, 117] for air, Teflon, Delrin and PMP respectively. While for high-contrast materials the smoothest reconstruction filter resulted in the highest SNR, for mid-contrast materials the standard filter gave the best results. The presented approach provides an accurate, analytical description of the material-specific ESF, PSF and TF as well as an estimate of the signal transfer. The transfer function TF together with the NPS and simulated signals allow the calculation of a task-specific SNR.

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PURPOSE: The authors compared the performance of five protocols intended to reduce dose to the breast during computed tomography (CT) coronary angiography scans using a model observer unknown-location signal-detectability metric. METHODS: The authors simulated CT images of an anthropomorphic female thorax phantom for a 120 kV reference protocol and five "dose reduction" protocols intended to reduce dose to the breast: 120 kV partial angle (posteriorly centered), 120 kV tube-current modulated (TCM), 120 kV with shielded breasts, 80 kV, and 80 kV partial angle (posteriorly centered). Two image quality tasks were investigated: the detection and localization of 4-mm, 3.25 mg/ml and 1-mm, 6.0 mg/ml iodine contrast signals randomly located in the heart region. For each protocol, the authors plotted the signal detectability, as quantified by the area under the exponentially transformed free response characteristic curve estimator (ÂFE), as well as noise and contrast-to-noise ratio (CNR) versus breast and lung dose. In addition, the authors quantified each protocol's dose performance as the percent difference in dose relative to the reference protocol achieved while maintaining equivalent ÂFE. RESULTS: For the 4-mm signal-size task, the 80 kV full scan and 80 kV partial angle protocols decreased dose to the breast (80.5% and 85.3%, respectively) and lung (80.5% and 76.7%, respectively) with ÂFE=0.96, but also resulted in an approximate three-fold increase in image noise. The 120 kV partial protocol reduced dose to the breast (17.6%) at the expense of increased lung dose (25.3%). The TCM algorithm decreased dose to the breast (6.0%) and lung (10.4%). Breast shielding increased breast dose (67.8%) and lung dose (103.4%). The 80 kV and 80 kV partial protocols demonstrated greater dose reductions for the 4-mm task than for the 1-mm task, and the shielded protocol showed a larger increase in dose for the 4-mm task than for the 1-mm task. In general, the CNR curves indicate a similar relative ranking of protocol performance as the corresponding ÂFE curves, however, the CNR metric overestimated the performance of the shielded protocol for both tasks, leading to corresponding underestimates in the relative dose increases compared to those obtained when using the ÂFE metric. CONCLUSIONS: The 80 kV and 80 kV partial angle protocols demonstrated the greatest reduction to breast and lung dose, however, the subsequent increase in image noise may be deemed clinically unacceptable. Tube output for these protocols can be adjusted to achieve a more desirable noise level with lesser breast dose savings. Breast shielding increased breast and lung dose when maintaining equivalent ÂFE. The results demonstrated that comparisons of dose performance depend on both the image quality metric and the specific task, and that CNR may not be a reliable metric of signal detectability.

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PURPOSE: The purpose of this study was to develop a database for estimating organ dose in a voxelized patient model for coronary angiography and brain perfusion CT acquisitions with any spectra and angular tube current modulation setting. The database enables organ dose estimation for existing and novel acquisition techniques without requiring Monte Carlo simulations. METHODS: The study simulated transport of monoenergetic photons between 5 and 150 keV for 1000 projections over 360° through anthropomorphic voxelized female chest and head (0° and 30° tilt) phantoms and standard head and body CTDI dosimetry cylinders. The simulations resulted in tables of normalized dose deposition for several radiosensitive organs quantifying the organ dose per emitted photon for each incident photon energy and projection angle for coronary angiography and brain perfusion acquisitions. The values in a table can be multiplied by an incident spectrum and number of photons at each projection angle and then summed across all energies and angles to estimate total organ dose. Scanner-specific organ dose may be approximated by normalizing the database-estimated organ dose by the database-estimated CTDI(vol) and multiplying by a physical CTDI(vol) measurement. Two examples are provided demonstrating how to use the tables to estimate relative organ dose. In the first, the change in breast and lung dose during coronary angiography CT scans is calculated for reduced kVp, angular tube current modulation, and partial angle scanning protocols relative to a reference protocol. In the second example, the change in dose to the eye lens is calculated for a brain perfusion CT acquisition in which the gantry is tilted 30° relative to a nontilted scan. RESULTS: Our database provides tables of normalized dose deposition for several radiosensitive organs irradiated during coronary angiography and brain perfusion CT scans. Validation results indicate total organ doses calculated using our database are within 1% of those calculated using Monte Carlo simulations with the same geometry and scan parameters for all organs except red bone marrow (within 6%), and within 23% of published estimates for different voxelized phantoms. Results from the example of using the database to estimate organ dose for coronary angiography CT acquisitions show 2.1%, 1.1%, and -32% change in breast dose and 2.1%, -0.74%, and 4.7% change in lung dose for reduced kVp, tube current modulated, and partial angle protocols, respectively, relative to the reference protocol. Results show -19.2% difference in dose to eye lens for a tilted scan relative to a nontilted scan. The reported relative changes in organ doses are presented without quantification of image quality and are for the sole purpose of demonstrating the use of the proposed database. CONCLUSIONS: The proposed database and calculation method enable the estimation of organ dose for coronary angiography and brain perfusion CT scans utilizing any spectral shape and angular tube current modulation scheme by taking advantage of the precalculated Monte Carlo simulation results. The database can be used in conjunction with image quality studies to develop optimized acquisition techniques and may be particularly beneficial for optimizing dual kVp acquisitions for which numerous kV, mA, and filtration combinations may be investigated.

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PURPOSE: Quality assurance in computed tomography (CT) is commonly performed with the Fourier-based modulation transfer function (MTF) and the noise variance, while more recently the noise power spectrum (NPS) has increased in popularity. The Fourier-based methods make assumptions such as shift-invariance and cyclostationarity. These assumptions are violated in real clinical systems and consequently are expected to result in systematic errors. A spatial approach, based on the object transfer matrix (T) and the covariance matrix (K) theory, does not require these assumptions and can provide a more general description of the imaging system. In this paper, the authors present an experimental methodology and data treatment for quality assessment of a lab cone-beam CT system by comparing the spatial with the Fourier approach in 2D reconstructed slices. METHODS: In order to have control over all experimental parameters and image reconstruction, a bench-top flat-panel-based cone-beam CT scanner and a cylindrical water-filled poly(methyl methacrylate) (PMMA) phantom were used for the noise measurements. An aluminum foil inserted in the water phantom enabled the estimation of the line response function (LRF) with a limited number of assumptions. The authors evaluated the spatial blur, the noise and the signal-to-noise ratio (SNR) using the spatial approach as well as the Fourier-based approach. In order to evaluate the degree of noise nonstationarity of their cone-beam CT system, the authors evaluated both the local and global CT noise properties and compared them using both approaches. RESULTS: For the laboratory cone-beam CT, the location-dependent noise evaluation showed that in addition to the noise variance, the NPS and covariance eigenvector symmetry depend on the location in the image. The estimated signal transfer was similar for both approaches. Unlike the Fourier approach which uses the same exponential wave function basis for both MTF and NPS, the eigenvectors of T and K were significantly different. CONCLUSIONS: By using the eigenvectors of the noise and object transfer to characterize the system, the spatial approach provides additional information to the Fourier approach and is therefore an important tool for a thorough understanding of a CT system.

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Cardiovascular disease in general and coronary artery disease (CAD) in particular, are the leading cause of death worldwide. They are principally diagnosed using either invasive percutaneous transluminal coronary angiograms or non-invasive computed tomography angiograms (CTA). Minimally invasive therapies for CAD such as angioplasty and stenting are rendered under fluoroscopic guidance. Both invasive and non-invasive imaging modalities employ ionizing radiation and there is concern for deterministic and stochastic effects of radiation. Accurate simulation to optimize image quality with minimal radiation dose requires detailed, gender-specific anthropomorphic phantoms with anatomically correct heart and associated vasculature. Such phantoms are currently unavailable. This paper describes an open source heart phantom development platform based on a graphical user interface. Using this platform, we have developed seven high-resolution cardiac/coronary artery phantoms for imaging and dosimetry from seven high-quality CTA datasets. To extract a phantom from a coronary CTA, the relationship between the intensity distribution of the myocardium, the ventricles and the coronary arteries is identified via histogram analysis of the CTA images. By further refining the segmentation using anatomy-specific criteria such as vesselness, connectivity criteria required by the coronary tree and image operations such as active contours, we are able to capture excellent detail within our phantoms. For example, in one of the female heart phantoms, as many as 100 coronary artery branches could be identified. Triangular meshes are fitted to segmented high-resolution CTA data. We have also developed a visualization tool for adding stenotic lesions to the coronaries. The male and female heart phantoms generated so far have been cross-registered and entered in the mesh-based Virtual Family of phantoms with matched age/gender information. Any phantom in this family, along with user-defined stenoses, can be used to obtain clinically realistic projection images with the Monte Carlo code penMesh for optimizing imaging and dosimetry.

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We have developed a general-purpose Monte Carlo simulation code, called penMesh, that combines the accuracy of the radiation transport physics subroutines from PENELOPE and the flexibility of a geometry based on triangle meshes. While the geometric models implemented in most general-purpose codes--such as PENELOPE's quadric geometry--impose some limitations in the shape of the objects that can be simulated, triangle meshes can be used to describe any free-form (arbitrary) object. Triangle meshes are extensively used in computer-aided design and computer graphics. We took advantage of the sophisticated tools already developed in these fields, such as an octree structure and an efficient ray-triangle intersection algorithm, to significantly accelerate the triangle mesh ray-tracing. A detailed description of the new simulation code and its ray-tracing algorithm is provided in this paper. Furthermore, we show how it can be readily used in medical imaging applications thanks to the detailed anatomical phantoms already available. In particular, we present a whole body radiography simulation using a triangulated version of the anthropomorphic NCAT phantom. An example simulation of scatter fraction measurements using a standardized abdomen and lumbar spine phantom, and a benchmark of the triangle mesh and quadric geometries in the ray-tracing of a mathematical breast model, are also presented to show some of the capabilities of penMesh.

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We quantify the variation in resolution due to anisotropy caused by oblique X-ray incidence in indirect flat-panel detectors for computed tomography breast imaging systems. We consider a geometry and detector type utilized in breast computed tomography (CT) systems currently being developed. Our methods rely on mantis, a combined X-ray, electron, and optical Monte Carlo transport open source code. The physics models are the most accurate available in general-purpose Monte Carlo packages in the diagnostic energy range. We consider maximum-obliquity angles of 10 ( degrees ) and 13 ( degrees ) at the centers of the 30 and 40 cm detector edges, respectively, and 16 ( degrees ) at the corner of the detector. Our results indicate that blur is asymmetric and that the resolution properties vary significantly with the angle (or location) of incidence. Our results suggest that the asymmetry can be as high as a factor of 2.6 between orthogonal directions. Anisotropy maps predicted by mantis provide an understanding of the effect that such variations have on the imaging system and allow more accurate modeling and optimization of breast CT systems. These maps of anisotropy across the detector could lead to improved reconstruction and help motivate physics-based strategies for computer detection of breast lesions.

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The H operator represents the deterministic performance of any imaging system. For a linear, digital imaging system, this system operator can be written in terms of a matrix, H, that describes the deterministic response of the system to a set of point objects. A singular value decomposition of this matrix results in a set of orthogonal functions (singular vectors) that form the system basis. A linear combination of these vectors completely describes the transfer of objects through the linear system, where the respective singular values associated with each singular vector describe the magnitude with which that contribution to the object is transferred through the system. This paper is focused on the measurement, analysis, and interpretation of the H matrix for digital x-ray detectors. A key ingredient in the measurement of the H matrix is the detector response to a single x ray (or infinitestimal x-ray beam). The authors have developed a method to estimate the 2D detector shift-variant, asymmetric ray response function (RRF) from multiple measured line response functions (LRFs) using a modified edge technique. The RRF measurements cover a range of x-ray incident angles from 0 degree (equivalent location at the detector center) to 30 degrees (equivalent location at the detector edge) for a standard radiographic or cone-beam CT geometric setup. To demonstrate the method, three beam qualities were tested using the inherent, Lu/Er, and Yb beam filtration. The authors show that measures using the LRF, derived from an edge measurement, underestimate the system's performance when compared with the H matrix derived using the RRF. Furthermore, the authors show that edge measurements must be performed at multiple directions in order to capture rotational asymmetries of the RRF. The authors interpret the results of the H matrix SVD and provide correlations with the familiar MTF methodology. Discussion is made about the benefits of the H matrix technique with regards to signal detection theory, and the characterization of shift-variant imaging systems.

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PURPOSE: Monte Carlo codes can simulate the transport of radiation within matter with high accuracy and can be used to study medical applications of ionising radiations. The aim of our work was to develop a Monte Carlo code capable of generating projection images of the human body. In order to obtain clinically realistic images a detailed anthropomorphic phantom was prepared. These two simulation tools are intended to study the multiple applications of imaging in radiotherapy, from image guided treatments to portal imaging. METHODS: We adapted the general-purpose code PENELOPE 2006 to simulate a radiation source, an ideal digital detector, and a realistic model of the patient anatomy. The anthropomorphic phantom was developed using computer-aided design tools, and is based on the NCAT phantom. The surface of each organ is modelled using a closed triangle mesh, and the full phantom contains 330 organs and more than 5 million triangles. A novel object-oriented geometry package, which includes an octree structure to sort the triangles, has been developed to use this complex geometry with PENELOPE. RESULTS: As an example of the capabilities of the new code, projection images of the human pelvis region were simulated. Radioactive seeds were included inside the phantom's prostate. Therefore, the resulting simulated images resemble what would be obtained in a clinical procedure to assess the positioning of the seeds in a prostate brachytherapy treatment. CONCLUSIONS: The new code can produce projection images of the human body that are comparable to those obtained by a real imaging system (within the limitations of the anatomical phantom and the detector model). The simulated images can be used to study and optimise an imaging task (i.e., maximise the object detectability, minimise the delivered dose, find the optimum beam energy, etc.). Since PENELOPE can simulate radiation from 50 eV to 1 GeV, the code can also be used to simulate radiotherapy treatments and portal imaging. Using the octree data structure, the new geometry model does not significantly increase the computing time when compared to the simulation of a much simpler quadric geometry. In conclusion, we have shown that it is feasible to use PENELOPE and a complex triangle mesh geometry to simulate real medical physics applications.

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We describe the anisotropy in imaging performance caused by oblique x-ray incidence in indirect detectors for breast tomosynthesis based on columnar scintillator screens. We use MANTIS, a freely available combined x-ray, electron, and optical Monte Carlo transport package which models the indirect detection processes in columnar screens, interaction by interaction. The code has been previously validated against published optical distributions. In this article, initial validation results are provided concerning the blur for particular designs of phosphor screens for which some details with respect to the columnar geometry are available from scanning electron microscopy. The polyenergetic x-ray spectrum utilized comes from a database of experimental data for three different anode/filter/kVp combinations: Mo/Mo at 28 kVp, Rh/Rh at 28 kVp, and W/Al at 42 kVp. The x-ray spectra were then filtered with breast tissue (3, 4, and 6 cm thickness), compression paddle, and support base, according to the oblique paths determined by the incidence angle. The composition of the breast tissue was 50%/50% adipose/glandular tissue mass ratio. Results are reported on the pulse-height statistics of the light output and on spatial blur, expressed as the response of the detector to a pencil beam with a certain incidence angle. Results suggest that the response is nonsymmetrical and that the resolution properties of a tomosynthesis system vary significantly with the angle of x-ray incidence. In contrast, it is found that the noise due to the variability in the number of light photons detected per primary x-ray interaction changes only a few percent. The anisotropy in the response is not less in screens with absorptive backings while the noise introduced by variations in the depth-dependent light output and optical transport is larger. The results suggest that anisotropic imaging performance across the detector area can be incorporated into reconstruction algorithms for improving the image quality of breast tomosynthesis. This study also demonstrates that the assessment of image quality of breast tomosynthesis systems requires a more complete description of the detector response beyond local, center measurements of resolution and noise that assume some degree of symmetry in the detector performance.

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We report on the variability in imaging system performance due to oblique x-ray incidence, and the associated transport of quanta (both x rays and optical photons) through the phosphor, in columnar indirect digital detectors. The analysis uses MANTIS, a combined x-ray, electron, and optical Monte Carlo transport code freely available. We describe the main features of the simulation method and provide some validation of the phosphor screen models considered in this work. We report x-ray and electron three-dimensional energy deposition distributions and point-response functions (PRFs), including optical spread in columnar phosphor screens of thickness 100 and 500 microm, for 19, 39, 59, and 79 keV monoenergetic x-ray beams incident at 0 degrees, 10 degrees, and 15 degrees. In addition, we present pulse-height spectra for the same phosphor thickness, x-ray energies, and angles of incidence. Our results suggest that the PRF due to the phosphor blur is highly nonsymmetrical, and that the resolution properties of a columnar screen in a tomographic, or tomosynthetic imaging system varies significantly with the angle of x-ray incidence. Moreover, we find that the noise due to the variability in the number of light photons detected per primary x-ray interaction, summarized in the information or Swank factor, is somewhat independent of thickness and incidence angle of the x-ray beam. Our results also suggest that the anisotropy in the PRF is not less in screens with absorptive backings, while the noise introduced by variations in the gain and optical transport is larger. Predictions from MANTIS, after additional validation, can provide the needed understanding of the extent of such variations, and eventually, lead to the incorporation of the changes in imaging performance with incidence angle into the reconstruction algorithms for volumetric x-ray imaging systems.

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Detector characterization with modulation transfer function (MTF) and detective quantum efficiency (DQE) inadequately predicts image quality when the imaging system includes focal spot unsharpness and patient scatter. The concepts of MTF, noise power spectrum, noise equivalent quanta and DQE were referenced to the object plane and generalized to include the effect of geometric unsharpness due to the finite size of the focal spot and the effect of the spatial distribution and magnitude of x-ray scatter due to the patient. The generalized quantities provide performance characteristics that consider the complete imaging system, but reduce to a description of the detector properties without magnification or scatter. We have evaluated a new neurovascular angiography imaging system based on a region of interest (ROI) microangiographic detector using these generalized quantities. A uniform head-equivalent phantom was used as a filter and x-ray scatter source. This allowed the study of all properties of the detector under clinically relevant x-ray spectra and x-ray scatter conditions. Realistic focal spots (0.8 mm nominal), beam energies (60-100 kVp), and detector exposures (0.8-2.3 mR) were used, and the effects of different scatter fractions (0-0.62) resulting from changing the beam size (0-100 cm2) were investigated. The generalized MTF and DQE were found to have very little dependence on the tube voltage and the detector entrance exposure. Magnification, with the focal spot used, results in a large decrease of the generalized DQE at higher frequencies (about 100-fold at 10 cycles/mm), but a significantly smaller decrease at lower frequencies. Scatter on the other hand, causes a constant drop in the generalized DQE (factor of 3 for scatter fraction 0.3) for all frequencies. Our results show that there are tradeoffs in the choice of the different system parameters; therefore this methodology of studying the imaging system as a whole could provide guidance in system design.

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Standard objective parameters such as MTF, NPS, NEQ and DQE do not reflect complete system performance, because they do not account for geometric unsharpness due to finite focal spot size and scatter due to the patient. The inclusion of these factors led to the generalization of the objective quantities, termed GMTF, GNNPS, GNEQ and GDQE defined at the object plane. In this study, a commercial x-ray image intensifier (II) is evaluated under this generalized approach and compared with a high-resolution, ROI microangiographic system previously developed and evaluated by our group. The study was performed using clinically relevant spectra and simulated conditions for neurovascular angiography specific for each system. A head-equivalent phantom was used, and images were acquired from 60 to 100 kVp. A source to image distance of 100 cm (75 cm for the microangiographic system) and a focal spot of 0.6 mm were used. Effects of varying the irradiation field-size, the air-gaps, and the magnifications (1.1 to 1.3) were compared. A detailed comparison of all of the generalized parameters is presented for the two systems. The detector MTF for the microangiographic system is in general better than that for the II system. For the total x-ray imaging system, the GMTF and GDQE for the II are better at low spatial frequencies, whereas the microangiographic system performs substantially better at higher spatial frequencies. This generalized approach can be used to more realistically evaluate and compare total system performance leading to improved system designs tailored to the imaging task.

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Under certain assumptions the detectability of the ideal observer can be defined as the integral of the system Noise Equivalent Quanta multiplied by the squared object spatial frequency distribution. Using the detector Noise-Equivalent-Quanta (NEQ(D)) for the calculation of detectability inadequately describes the performance of an x-ray imaging system because it does not take into account the effects of patient scatter and geometric unsharpness. As a result, the ideal detectability index is overestimated, and hence the efficiency of the human observer in detecting objects is underestimated. We define a Generalized-NEQ (GNEQ) for an x-ray system referenced at the object plane that incorporates the scatter fraction, the spatial distributions of scatter and focal spot, the detector MTF(D), and the detector Normalized-Noise-Power-Spectrum (NNPS(D)). This GNEQ was used in the definition of the ideal detectability for the evaluation of the human observer efficiency during a two Alternative Forced Choice (2-AFC) experiment, and was compared with the case where only the NEQ(D) was used in the detectability calculations. The 2-AFC experiment involved the detection of images of polyethylene tubes (diameters between 100-300 µm) filled with iodine contrast (concentrations between 0-120 mg/cm(3)) placed onto a uniform head equivalent phantom placed near the surface of a microangiographic detector (43 µm pixel size). The resulting efficiency of the human observer without regarding the effects of scatter and geometric unsharpness was 30%. When these effects were considered the efficiency was increased to 70%. The ideal observer with the GNEQ can be a simple optimization method of a complete imaging system.

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Dye-dilution imaging sequences were performed and time-density curves were constructed in elastomer vessel aneurysm models to demonstrate the effectiveness of coils and an asymmetric stent in disrupting standard vortex flow. Compared with the use of coils, the use of stents led to marked flow modification, as seen with imaging sequences, and substantially slower inflow, as indicated by time-density curves, owing to the low-porosity region of the stent that covers the aneurysm orifice. These flow examination results indicate that potentially favorable flow modification features can be created by using the described asymmetric stent design, the use of which may lead to alternative methods of image-guided endovascular cerebral aneurysm therapy.

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We study the properties of a new microangiographic system, consisting of a Region of Interest (ROI) microangiographic detector, x-ray source, and patient. The study was performed under conditions intended for clinical procedures such as neurological diagnostic angiograms as well as treatments of intracranial aneurysms, and vessel-stenoses. The study was performed in two steps; first a uniform head equivalent phantom was used as a "filter". This allowed us to study the properties of the detector alone, under clinically relevant x-ray spectra. We report the detector MTF, NPS, NEQ, and DQE for beam energies ranging from 60-100kVp and for different detector entrance exposures. For the second step, the phantom was placed adjacent to the detector, allowing scatter to enter the detector and new measurements were obtained for the same beam energies and detector entrance exposures. Different radiation field sizes were studied, and the effects of different scatter amounts were investigated. The spatial distribution of scatter was studied using the edge-spread method and a generalized system MTF was obtained by combining the scatter MTF weighted by the scatter fraction with the detector MTF and focal spot unsharpness due to magnification. The NPS combined with the generalized MTF gave the generalized system NEQ and DQE. The generalized NEQ and the ideal object detectability were used to calculate the Dose Area Product to the patient for 75% object detection probability. This was used as a system optimization method.

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Minimally invasive image-guided neuro-vascular interventions require very high image-resolution and quality, specifically over regions-of-interest (ROI) crucial to the procedure. ROI imaging or micro-angiography, allows limited patient integral radiation dose while permitting rapid frame transfer of high-resolution images. The design and performance of a charge coupled device (CCD) based x-ray detector or micro-angiographic camera was assessed for neuro-vascular procedures. The detector consists of a 250-microm-thick CsI(Tl) phosphor fiber-optically coupled through a 1.8:1 taper to a CCD chip, with an effective image pixel size of 50 microm and a frame rate of 5 fps in the 2:1 pixel-binned mode. The characteristics of the camera including the modulation transfer function (MTF), the noise equivalent quanta, the detective quantum efficiency, observer studies, and the effect of geometric magnification were evaluated. The MTF was found to have nonzero (1.7%) value at the Nyquist frequency of 10 cycles/mm, while the DQE(0) had a value of approximately 55%. All values were measured using head equivalent attenuating material in the beam at 80 kVp. Human observer studies performed using the 2 Alternative Forced Choice method revealed that iodinated vessels with inner diameter of 100 microm and 2 cm in length can be seen with a confidence level greater than 75%. The observer studies included a comparison with ideal observer performance calculations based on the integral signal to noise ratio in the image. Probabilities of visualization of various objects of interest in a neuro-intervention, such as stents, were assessed. A geometric magnification of 1 was found to be best for imaging under neuro-angiographic conditions. The detector appeared to satisfy all the demands of neuro-angiography and showed promise as an improvement over existing angiographic detectors.

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