Biomedical subjects
A R Cowen
Publications and source records attributed to A R Cowen.
Technical report: Initial experiences with an experimental solid-state universal digital X-ray image detector.
This paper presents a brief technical evaluation and first review of clinical experiences with an experimental direct digital X-ray image detector designed to support both dynamic and snap-shot imaging. Derivatives of this type of image detector can potentially fulfil the majority of the fluoroscopic and radiographic imaging requirements of clinical radiology departments, and initial results suggest that imaging systems using the new technology will provide a high quality dose-efficient solution to the search for a universal digital X-ray image detector.
Physical imaging performance of a compact computed radiography acquisition device.
A comprehensive investigation of the physical imaging performance of a Philips AC3 computed radiography system using fifth-generation image plate technology has been undertaken. Measurements include characteristic response, modulation transfer function (MTF) and Wiener spectra (WS) for standard and high resolution image plates sampled at 10 pixels/mm. These results were used to calculate noise equivalent quanta (NEQ) and detective quantum efficiency (DQE) spectral descriptions of system performance. Luminescence noise and x-ray quantum noise components were separated. From an estimate of the luminescence noise power, the average system gain was calculated and results show a substantial improvement over earlier generations of computed radiography systems for standard image plates.
A comprehensive physical image quality evaluation of a selenium based digital x-ray imaging system for thorax radiography.
A selenium based digital x-ray system dedicated to chest radiography has been installed by the UK Department of Health's Medical Devices Agency at Leeds General Infirmary, UK, to undergo a comprehensive evaluation, including the physical image quality. The underlying characteristics which define the overall image quality of a system are the following: sensitometric response, modulation transfer function, and noise power spectrum. These have been measured objectively on preprocessed digital data acquired under relevant radiographic conditions. The image data is further processed prior to hard copy display. The displayed image quality may only be measured subjectively; threshold contrast detail detectability is such a measure which can be related to the objective measures of image quality. The objective imaging characteristics suggest that Thoravision has a significant advantage over conventional radiography imaging systems. However, subjective measures have demonstrated that the image processing can have a significant effect on the perceived image quality. Thoravision has the potential to deliver a significantly improved image quality to clinicians with no increase in radiation exposure to the patient, or image quality may be maintained with a reduction in radiation exposure. Digital image processing is central to the efficiency with which it achieves this.
A comparison of the physical imaging properties of Fuji ST-V, ST-VA, and ST-VN computed radiography image plates.
The physical imaging performance of ST-V, ST-VA, and ST-VN computed radiography image plates, read with a Philips AC3 acquisition system, was investigated at 70 kVp with 0.5 mm of copper beam filtration for four different entrance air kerma values: 0.5, 2.6, 26, and 260 micro Gy. Measurements included characteristic response, presampling-modulation transfer function, and Wiener spectrum analysis for (18 x 24) cm2 image plates, sampled at 10 pixels/mm. These results were used to calculate DQE spectral descriptions of system performance. ST-VN image plates exhibited a slightly superior DQE performance for the two lower entrance air kerma values investigated.
Reporting requirements for skeletal digital radiography: comparison of soft-copy and hard-copy presentation.
PURPOSE: To assess diagnostic performance and reader preference when reporting results from digital hard-copy and two soft-copy formats of skeletal digital radiography. MATERIALS AND METHODS: The data comprised hand radiographs of patients undergoing renal dialysis. Normal hand radiographs obtained in trauma patients were assessed as control images. One hundred fifteen images acquired with a photostimulable-phosphor computed radiography system were analyzed. Image selection and initial assessment were by consensus of two experienced radiologists, who graded the radiographic changes of hyperparathyroidism with the Ritz scoring system. The images were then presented to four readers in three formats: hard-copy output and soft-copy presentations at 2K2 and 1K2 resolutions. These readers scored pathologic change and image preference. The results were analyzed with the receiver operating characteristic technique. RESULTS: There was a significant improvement in diagnostic performance for both soft-copy formats relative to the hard-copy format (P < .001). No significant difference in diagnostic performance was found between the two soft-copy formats. There was a significant preference for both soft-copy formats relative to the hard-copy format (P < .01), with the 2K2 soft-copy images preferred to the 1K2 images (P < .01). CONCLUSION: Soft-copy reporting can provide superior diagnostic performance even for images viewed at a modest (1K2) resolution. The lack of difference between the two soft-copy formats has important economic implications with respect to departmental hardware requirements.
Death, dying and grieving. Dealing with personal and work-related tragedies.
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Direct digital mammography image acquisition.
Mammography is a branch of radiology which could benefit greatly from the assimilation of digital imaging technologies. Computerized enhancement techniques could be used to ensure optimum presentation of all clinical images. Beyond this it will facilitate powerful new clinical resources such as computer-assisted diagnosis, tele-mammography, plus digital image management and archiving. An essential precursor to all these advances is the availability of appropriate direct digital mammography (DDM) image-acquisition system(s) to capture high-quality breast X-ray image data at the outset. The only practical DDM image-acquisition system currently available is (photo-stimulable phosphor) computed radiography. Modern computed mammography (CM) uses similar radiation doses to the patient and produces equivalent, albeit different, image quality to screen-film mammography. Computed mammography offers superior rendition of the skin edge and sub-cutaneous tissue and dense parenchyma, while ensuring equivalent micro-calcification detectability. Meanwhile, a variety of new technical approaches to DDM are under active investigation and/or development which promise to supercede film-based mammography. These new (second generation) DDM technologies promise the radiologist superior image quality combined with significant dose savings compared with contemporary imaging systems. In this review we describe and compare the physical and clinical characteristics of CM and the various emerging DDM image-acquisition technologies.
Visibility of microcalcifications in computed and screen-film mammography.
Due to the clinically and technically demanding nature of breast x-ray imaging, mammography still remains one of the few essentially film-based radiological imaging techniques in modern medical imaging. There are a range of possible benefits available if a practical and economical direct digital imaging technique can be introduced to routine clinical practice. There has been much debate regarding the minimum specification required for direct digital acquisition. One such direct digital system available is computed radiography (CR), which has a modest specification when compared with modern screen-film mammography (SFM) systems. This paper details two psychophysical studies in which the detection of simulated microcalcifications with CR has been directly compared to that with SFM. The first study found that under scatter-free conditions the minimum detectable size of microcalcification was approximately 130 microns for both SFM and CR. The second study found that SFM had a 4.6% higher probability of observers being able to correctly identify the shape of 350 microns diameter test details; there was no significant difference for-either larger or smaller test details. From the results of these studies it has been demonstrated that the modest specification of CR, in terms of limiting resolution, does not translate into a dramatic difference in the perception of details at the limit of detectability. When judging the imaging performance of a system it is more important to compare the signal-to-noise ratio transfer spectrum characteristics, rather than simply the modulation transfer function.
Bee-ware! Los Angeles EMTs, paramedics and fire fighters are preparing to do battle with the Africanized honeybee.
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A comparison of the threshold detail detectability of a screen-film combination and computed radiology under conditions relevant to high-kVp chest radiography.
There is conflicting evidence regarding the viability of photostimulable phosphor computed radiology (CR) when used with high x-ray beam energies. In this study a standard screen-film combination was compared with CR using identical exposure conditions, which simulated those of a high-energy chest examination. The comparison was made using a psychophysical technique in which the threshold contrast detail detectability is assessed by human observers. Threshold contrast determination is an efficient way with which to assess the overall image quality. The CR images were processed and displayed using two independent image processing algorithms and hard-copy formats. The results showed, at the 5% level of statistical significance, that there was no difference in the overall image quality between any of the modalities being compared. It may be concluded therefore that CR is a potentially viable option for use in high-energy radiography of the chest.
Update on the recommended viewing protocol for FAXIL threshold contrast detail detectability test objects used in television fluoroscopy.
The significance of varying the viewing conditions that may affect the perceived threshold contrast of X-ray television fluoroscopy systems has been investigated. Factors investigated include the ambient room lighting and the viewing distance. The purpose of this study is to find the optimum viewing protocol with which to measure the threshold detection index. This is a particular problem when trying to compare the image quality of television fluoroscopy systems in different input field sizes. The results show that the viewing distance makes a significant difference to the perceived threshold contrast, whereas the ambient light conditions make no significant difference. Experienced observers were found to be capable of finding the optimum viewing distance for detecting details of each size, in effect using a flexible viewing distance. This allows the results from different field sizes to be normalized to account for both the magnification and the entrance air kerma rate differences, which in turn allow for a direct comparison of performance in different field sizes.
Improved image quality utilizing dual plate computed radiography.
A method of improving image quality in computed radiography (CR) using dual plate exposure has been developed. Two CR image plates are used to increase the fraction of X-ray quanta absorbed from the beam. Spatial registration and combination of images from the two plates leads to an image with improved signal-to-noise ratio characteristics. A cross correlation technique is used to register spatially the images from the front and rear plates. The modulation transfer function and noise power spectrum were measured for the single plate and combined dual plate images. Results indicate a potential increase of approximately 60% in the detective quantum efficiency (DQE) of the dual plate combined image compared with the single plate image. The improvement of DQE at high spatial frequencies is dependent on the accuracy of the registration of the two images. The actual improvement in imaging performance was measured using a contrast detail test piece. A computerized method was used to measure the imaged detail signal-to-noise ratio of the details of different dimension. Results indicate an improvement of 21% in the signal-to-noise ratio of the details imaged with the dual plate arrangement compared with the single plate. This indicates that this technique can result in a significant increase in image quality for the same exposure level. Alternatively this technique could allow reduction in exposure while maintaining the same image quality achievable with the single plate system.
Technical note: dual compression mammography using computed radiography.
On mammography most malignant growths may be seen as a tethered mass or architectural distortion. Benign lesions such as cysts and fibroadenomas have no focal tethering and are usually well circumscribed. Computed radiography (CR) is a direct digital system which may be used for mammography. One of the main advantages of CR is its wide exposure latitude allowing images to be acquired at lower exposures than required for film-screen systems. A technique was developed, utilizing the exposure latitude of CR, to acquire two mammograms of the same breast at two slightly different compressions, but using approximately the same exposure as a single film-screen mammogram. These images were then "animated" on a computer allowing the fibrous septa movement to be visualized. The movement of the fibrous septa in the presence of an abnormality was used to help confirm whether a lesion was benign or malignant. This technique may have clinical application in classifying architectural distortions and masses which are ultrasonically benign but later found to be malignant. Microcalcifications cannot be used as a diagnostic indicator with this technique because of the increased noise associated with the lower exposures. The increased noise did not affect the visualization of masses.
In a bind. A lawsuit forces L.A. medics and police to reexamine their policy on applying restraints.
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A clinical comparison between conventional and digital mammography utilizing computed radiography.
Previous work utilizing a specially designed mammographic test object has indicated that the image quality of computed radiography (CR) approaches that of a conventional film-screen technique of equivalent radiographic speed. In an attempt to correlate these results with the clinical situation a subjective rating study of the primary physical parameters of noise, sharpness, and contrast has been conducted. Using a randomized viewing sequence two radiologists experienced in mammography were asked to score these parameters utilizing a 5 point scale. A total of 138 images was used, 62% containing no abnormalities and 38% containing either microcalcifications, masses or both. Additionally, the observers scored their confidence of correct classification, and these results were then used to construct receiver operating characteristic (ROC) curves. The subjective rating of the physical parameters results produced similar results to those obtained using the test object, with CR images providing greater contrast than film. The resolution of CR, however, was lower than for film. Overall the noise levels were similar for both modalities, but the digital images occasionally contained high levels of dust artefacts. In one case these artefacts were mistaken for a cluster of microcalcifications. The test object results and the parameter rating results indicate that CR approaches the performance of film-screen images. Statistically the ROC curves produced indicate CR images to be comparable to the film-screen combination. This may be because the increased contrast compensates for resolution limitations and these findings correlate with our clinical experience.
Physical evaluation of computed radiography as a mammographic X-ray imaging system.
The physical imaging properties of a computed radiography (CR) system operating under mammographic exposure conditions have been measured. These measurements include modulation transfer function (MTF), sensitometric response and noise power spectrum (NPS). These figures were used to derive signal-to-noise ratio (SNR) descriptors of the system performance. The same measures were derived for a mammographic film-screen system. The SNR properties of the CR system indicate superior low frequency performance over a wider dynamic range than the film-screen system. The spatial frequency dependent SNR properties of the CR system are, however, limited. The results of a psychophysical test support the results obtained from physical measurements. These results indicate that despite its limited sharpness, details of dimensions relevant to diagnosis in mammography (circular details 0.25 mm diameter to represent microcalcifications and 3 mm diameter to represent small masses) are reproduced using CR with SNRs which are at least comparable with those of a mammographic film-screen system.
Earthquake.
On January 25, 1 week after the most devastating earthquake in Los Angeles history, the Southern California Hospital Council released the following status report: 928 patients evacuated from damaged hospitals. 805 beds available (136 critical, 669 noncritical). 7,757 patients treated/released from EDs. 1,496 patients treated/admitted to hospitals. 61 dead. 9,309 casualties. Where do we go from here? We are still waiting for the "big one." We'll do our best to be ready when Mother Nature shakes, rattles and rolls. The efforts of Los Angeles City Fire Chief Donald O. Manning cannot be overstated. He maintained department command of this major disaster and is directly responsible for implementing the fire department's Disaster Preparedness Division in 1987. Through the chief's leadership and ability to forecast consequences, the city of Los Angeles was better prepared than ever to cope with this horrendous earthquake. We also pay tribute to the men and women who are out there each day, where "the rubber meets the road."