Technical Report

Digital Angio

Development of the DIGITEX Safire Cardiac System
Equipped with Direct-conversion Flat Panel Detector
Safire: Shimadzu Advanced Flat Imaging REceptor

Hidefumi Suzuki
Medical Systems Division, Shimadzu Corporation


1. Introduction

Doctor Roentgen, winner of the first Nobel Prize,
discovered X-rays in 1895. In 1896, the following year,
Shimadzu Corporation's founder Genzo Shimadzu Jr.
became the first person in Japan to succeed in capturing
X-ray images. Based on X-ray technology accumulated
over more than a century since the corporation was
founded, Shimadzu continues to pursue the development
of the most advanced technology in this field. Providing
diagnostic imaging equipment and systems to advanced
medical facilities and offering high added value and
reliability forms the basis of our research and
development activities.
Fig. 1 shows the basic concept behind the
development of Shimadzu's flat panel detector (FPD). If
we look at the history of X-rays, we can see that the
evolution of X-ray technology can be divided into two
general areas: still images and fluoroscopic (moving)
images. The development of still-image technology, of
course, is tied to the history of film-screen systems. Even
in this digital age, film imaging is used widely for
radiography and other purposes because of the high
image quality that it offers. The history of fluoroscopy
began with fluorescent screens. This was followed by the
historical development of the I.I. (image intensifier), and
now this technology is used widely in R/F and cardiac
systems in combination with CCD cameras and digital
image processing systems.
The way that the history of X-rays is intertwined with
that of detectors underlines the significance of
developments in detector technology. At Shimadzu, we
are well aware that progress in X-ray detector technology
can lead to advances in the whole field of X-ray
technology. We are currently pushing forward with the
development of FPD technology with the aim of unifying
the different types of detectors used to obtain still and
fluoroscopic images. An important point to note is that the
unification of detectors does not simply mean combining
the ability to perform still-image and moving-image
detection. In order to properly realize this aim, we must
achieve the important objective of bringing to moving
images a level of image quality at least as high as that
obtained with film.

2. X-ray Conversion Method for Moving-image FPD

Fig. 2 shows the X-ray conversion method for moving-
image FPD. With indirect-conversion FPD, X-rays are first
converted to light by a CsI phosphor, and then this light is
converted to electric signals by photodiodes. During the
2-stage conversion process, light is scattered and image
quality is reduced, making it impossible to obtain image
quality equal to or better than that obtained with film. This
conversion process and phosphor material are the same
as that used when combining an I.I. and a CCD camera
and so, of course, we can only hope for the same level of
quality attained with an I.I. With direct-conversion FPD,
X-rays are converted directly to electric signals by an
a-Se (amorphous selenium) film. This method, while
requiring an extremely high technical capability, is ideal
for obtaining high-quality images.
Fig. 3 is a graph showing the modulation transfer
function (MTF) for indirect-conversion FPD, direct-

Indirect-type FPD Direct-type FPD
X-ray X-ray
Storage
capacitance
Photodiode
Pixel electrode
Counter electrode
Storage
capacity
X-ray Light (phosphor)
Electric charge (photodiode)Electric signal
X-rayElectric signal (photoconductive effect)
Fig. 1 Shimadzu's FPD Development Concept Fig. 2 X-ray Conversion Method for Moving-image FPD
The Unification of Still-image and Fluoroscopic-image Detectors
Still images
Fluoroscopic
(moving) images
Discovery of
X-rays in 1895
Moving-image
flat panel detector
Film
Digitalization
Fluorescent
screen I.I.
Ideal detector that offers both the
high image quality of film imaging
and the sensitivity and moving-
image functionality of I.I.

Digital Angio
conversion FPD, film-screen, and the I.I. and CCD
camera combination. The horizontal axis represents the
spatial frequency and the vertical axis represents the
transmission rate of image information. The closer the
MTF is to 1.0, the more faithful the image is to the original.
As Fig. 3 clearly shows, direct-conversion FPD offer a
spatial resolution that surpasses that of film-screen. On
the other hand, indirect-conversion FPD offer only the
same level of image quality as the I.I. and CCD camera
combination.
In view of the above, we at Shimadzu believe that only
direct-conversion FPD can enable the unification of
still-image and fluoroscopic-image detectors, and that
they will provide a basis for the development of new
imaging technology and yield new clinical value. We set
ourselves the highly demanding technical challenge of
developing direct-conversion FPD. Next-generation
direct-conversion FPD will allow the unification of detector
technology and thereby change the course of X-ray
history.
Fig. 3 Comparison of MTF Curve for Different X-ray Detectors

3. Shimadzu's Direct-conversion FPD (Safire)
and Systems Equipped with Safire

Fig. 4 shows the developmental target specifications for
Shimadzu's direct-conversion FPD (Safire). Fig. 5 shows
a cardiac system equipped with Safire, which began
clinical evaluation in March this year. Naturally, the target
modality varies with the field of vision. Shimadzu selected
the cardiac system as the first target as it makes good
use of the high image quality of the direct-conversion
FPD, and developed an FPD with a 9 9-inch field of
vision. This size is ideal for cardiac systems focusing on
the heart and for C-arms used in surgery. If we consider
the diagonal dimensions, we can see that this detector
offers a field of vision equivalent to that of the
conventional 12-inch I.I., and can be adapted for other
uses, such as head examinations using digital subtraction
angiography (DSA). Fig. 6 shows a comparison of the
spatial resolution charts for a direct-conversion FPD and
an I.I. and CCD camera combination. We can see that the
direct-conversion FPD achieves a resolution greater than
3 lp (lines pairs) per mm. Direct-conversion FPD offer not
only this kind of spatial resolution, but also superior
low-contrast resolution and so visibility for stents and
microcatheters, which are difficult to observe with
conventional I.I., is greatly improved. This also means
that examination time and consequently radiation
exposure can be reduced. Using the basic technology
developed with the 9 9-inch field of view, we will push
forward with the development of an FPD with a 17
17-inch field of view. It will be possible to use this FPD
with R/F systems, angiographic systems, and
radiographic systems to produce both still and
fluoroscopic images.
It is believed that next-generation direct-conversion
FPD will revolutionize medical imaging diagnosis.
Through adaptation to each type of X-ray system, they
offer the potential to reduce radiation exposure while
maintaining an image quality equivalent to that of film,
and to increase the efficiency of digital image storage and
telemedicine.

Field of view (inches)
9 9 17 17
Operation principle Direct conversion
Pixel pitch 150 m
X-ray conversion
material
a-Se
Frame rate 30 fps
Heart
Applications
C-arm for surgery
R/F, angiographic,
and radiographic
systems
Produces still and fluoroscopic images in all applications.
Fig. 4 Developmental Target Specifications for Shimadzu's
Direct-conversion FPD


Fig. 5 Cardiac System Equipped with Safire
(Model for Clinical Evaluation)
Modulation Transfer Function (MTF)
Direct-type FPD
Film-screen
Indirect-type FPD
I.I. (6-inch FOV)
+ CCD camera

Technical Report





















Fig. 6 Comparison of Spatial Resolution

4. Clinical Images Obtained Using System
Equipped with Safire

Fig. 7, 8, 9, and 10 show clinical images obtained using
Shimadzu's cardiac system equipped with Safire.

4.1. Clinical Image 1
(DA Image of Left Coronary Artery)
Fig. 7 shows a clinical image of the left coronary artery.
Using a wide dynamic range of the direct-conversion FPD
(Safire) makes it possible to clearly visualize the fine
blood vessels in the third and fourth branches of the
artery without being influenced by direct radiation from
the pulmonary area.














Fig. 7 Clinical Image 1
4.2 Clinical Image 2
(DA Image of Right Coronary Artery and Stent)
Fig. 8 shows a clinical image of the right coronary
artery. In the top-right part of the image, it is possible to
clearly visualize a stent implant along with its structure.












Fig. 8 Clinical Image 2


4.3 Clinical Image 3 (Pulsed DSA Image of Abdomen)
Fig. 9 shows a pulsed DSA image of the abdomen.
Clear visualization of even fine blood vessels is possible
across the entire 9-inch field of view without distortion.
This illustrates the ability of the direct-conversion FPD
(Safire) to allow the distortion-free visualization of the
inspected area across the entire field of view.













Fig. 9 Clinical Image 3


4.4 Clinical Image 4 (Pulsed DSA Image of Head)
Fig. 10 shows a pulsed DSA image of the head. It is
possible to clearly visualize the detailed structure of the
head's vascular system with the contrast medium flowing
from the arterial system to the venous system with time.



Direct-conversion FPD (Safire)
I.I. (6-inch FOV) + CCD camera

Digital Angio












Arterial System













Venous System

Fig. 10 Clinical Image 4






















5. Summary

This article has described Shimadzu's development of
a direct-conversion FPD (Safire), which was aimed at
bringing to moving images an image quality equal to or
greater than that achieved with film. We have also noted
how the effectiveness of a cardiac system equipped with
the direct-conversion FPD (Safire) has been clearly
demonstrated in clinical evaluation, and have proposed
that it will be the first in a new generation of cardiac
systems.
The direct-conversion FPD will give rise to new
developments in imaging technology and consequently
yield new clinical value. Shimadzu will continue to make
every effort to develop the most advanced technology, to
provide the latest diagnostic imaging equipment and
systems to advanced medical facilities, and to offer high
added value and reliability.
Finally, we would like to take this opportunity to thank
all the staff at the Kokura Memorial Hospital for their
cooperation with the clinical examination of this system
and for providing additional clinical images.


Bibliography

1) S. Adachi, et al: Noise Properties of a Se-Based Flat-Panel X-ray
Detector with CMOS Readout Integrated Circuits, Proc. SPIE4682,
pp.580-591, 2002.

2) P. R. Granfors, et al: Performance of a Flat Panel Cardiac Detector,
Proc. SPIE4320, pp.77-86, 2001.

3) R. E. Colbeth, et al: 40 30 cm Flat Panel Imager for Angiography,
R&F, and Cone-Beam CT Applications, Proc. SPIE4320, pp.94-102,
2001.

4) S. Adachi, S. Tokuda, et al: Development of Direct-conversion FPD
for Fluoroscopy (Moving-image) - Shimadzu Corporation, Innervision,
Vol.17 No.4, pp.47-51, April 2001.

5) S. Adachi, S. Yamada, et al: Shimadzu's Direct-conversion Flat Panel
Detector Enables Fluoroscopy with High-resolution and a High S/N
ratio, Monthly Journal of Medical Imaging and Information, Vol.34
No.2, pp.178-183, February 2002.

6) S. Adachi, H. Koyama, et al: Shimadzu's Next-generation Direct-
conversion Flat Panel Detector Supports Fluoroscopy, Monthly
Journal of Medical Imaging and Information, Vol.35 No.2, pp.140-143,
February 2003.