INSTITUTE OF PHYSICS PUBLISHING Phys. Med. Biol.

47 (2002) R123R166

PHYSICS IN MEDICINE AND BIOLOGY PII: S0031-9155(02)24746-6

TOPICAL REVIEW

The physics of computed radiography

J A Rowlands
Sunnybrook and Womens College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5

Received 23 July 2002 Published 20 November 2002 Online at stacks.iop.org/PMB/47/R123 Abstract Cassette-based computed radiography (CR) systems have continued to evolve in parallel with integrated, instant readout digital radiography (DR) systems. The image quality of present day CR systems is approaching its theoretical limits but is signicantly inferior to DR. Further improvements in CR image quality require improved concepts. The aim of this review is to identify the fundamental limitations in CR performance. This will provide a background for the development of new approaches to improve photostimulable phosphor CR systems. It will also guide research in designing better CR systems to possibly compete with DR systems in terms of image quality parameters such as detective quantum efciency and yet maintain CR convenience in being portable and more economical.

1. Introduction Present day computed radiography (CR) is based on the use of photostimulable phosphors, which are also known as storage phosphors (Sonoda et al 1983). They are commercially the most successful detectors for digital radiography. The phosphors used are most often in the barium uorohalide family (Barnes 1993) in powder form and deposited onto a substrate to form an imaging plate or screen. X-ray absorption mechanisms are identical to those of conventional phosphor screens used with lm. They differ in that the useful optical signal is not derived from the light emitted in prompt response to the incident radiation, but rather from subsequent emission when the latent image, consisting of trapped charge, is optically stimulated and released from metastable traps. This triggers a process called photostimulated luminescence (PSL) resulting in the emission of shorter wavelength (blue) light in an amount proportional to the original x-ray irradiation. In CR, an imaging plate (IP) containing the storage phosphor is positioned in a light-tight enclosure, exposed to the x-ray image and then read out by raster scanning with a laser to release the PSL. The blue PSL light is collected with a light guide and detected with a photomultiplier tube (PMT). The PMT signal is digitized to form the image on a point-by-point basis (Fujita et al 1989). The broad acceptance of CR has been due to its large dynamic range, digital nature, easy portability and uniqueness rather than its intrinsic image quality. CR systems have improved in the almost 20 years that they have been available. They are now technological and engineering
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marvels, but have been unable to transcend their inherent image quality weaknesses. CR based on the use of storage phosphor screens in a cassette is seen to be complementary to rather than directly competitive with integrated readout digital radiography (DR) systems. There are numerous possible approaches to DR (Yaffe and Rowlands 1997) but to date the most successful are at panel systems based on active matrix arrays (Rowlands and Yorkston 2000). Flat panels are very close to being perfect in terms of quantitative measures of the efciency in which the x-ray aerial image is transformed to a digital image. In this regard DR has far outstripped the present ability of CR. Thus even to equal the image quality obtainable with screenlm and to match DR, change is needed in the basic approach to CR. Several very promising new approaches suggest that CR can rise to the challenge presented by at panel based DR systems. 1.1. Historical background The fundamental innovation in the development of CR was by Kodak (Luckey 1975) who conceived the storage of an x-ray image in a phosphor screen. It required signicant technical steps and conceptualization of the application by Fuji (Kotera et al 1980) to produce the rst medical x-ray images. Fuji, the main developer of CR in the eighties, used BaFBr:Eu2+ phosphor and a cassette-based approach. During this time, Agfa and Kodak performed research and development on the same method but were constrained from commercialization by patent issues and ambivalence due to the fear of damaging their installed base of screenlm, respectively. In this era the storage effect was also being observed in screenlm applications where it caused the unwanted effect of print through, i.e. a ghost image of a prior exposure to the screen that appears on a subsequent lm exposed in the same cassette. The storage effect is related to the phenomenon of thermally induced luminescence of irradiated materials, i.e. thermoluminescence. Both photoluminescence and thermoluminescence have a long history that can be traced back to 1603 (McKeever 1985, Kato 1994, Seibert 1997) and forward to present day applications in medicine (e.g. radiation dosimetry), biology (e.g. readout of radioactively tagged electrophoresis gels) and elsewhere (e.g. archaeological dating). 1.2. Outline of review There have been two previous comprehensive reviews of CR science and technology (Kato 1994, Seibert 1997). A recent text (Beutel et al 2000) though not specically targeting CR is highly relevant. A new review is timely because the science and technology of existing systems have plateaued and new concepts are being actively investigated. In the present review the fundamental operation of photostimulable phosphors is rst outlined. Then the two components of present day CR systems, the screens (or imaging plates) and the most commonly used reader type (ying spot), are described. The combination of a CR plate and reader forming a fully functioning CR system follows. From this the limitations of present day CR systems are extracted and novel, new approaches are identied. The current capabilities of clinical systems are described and potential areas of improvement are identied. 2. Photostimulable phosphors 2.1. Operation of photostimulable phosphors The following sections will outline the types of photostimulable phosphors used in CR. The physical phenomena arising in conventional phosphors and the new phenomena unique to photostimulable phosphors will be discussed.

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2.1.1. Types of photostimulable phosphors. The photostimulable phosphor rst used for CR was BaFBr:Eu2+. Its crystal structure is non-cubic, i.e. a layered structure that gives rise to phosphor grains with a plate-like rather than the more desirable cubic morphology (Blasse and Grabmaier 1994). BaFBr:Eu2+ is a good storage phosphor in that it can store a latent image for a long time, e.g. the latent image 8 h after irradiation will still be 75% of its original size (Kato 1994). The family of phosphors BaFX:Eu2+ where X can be any of the halogens Cl, Br or I (or an arbitrary mixture of them) have been studied extensively. The decay time after photostimulation of all these phosphors is now known to be approximately the same (0.7 s) and so they can all be used in CR. In earlier literature there was a long decay noted for BaFCl:Eu2+ which can now be eliminated. In recent years most manufacturers have used BaFBr0.85I0.15:Eu2+ not for the marginal increase in x-ray absorption compared to BaFBr:Eu2+, but rather for the better optical match of the wavelength of maximum stimulation of the phosphor to diode lasers. Recently Konica has utilized pure BaFI:Eu2+ in commercial systems (Nakano et al 2002) where the change in absorption is signicant. RbBr:Tl+ is cubic and has the advantage that it can be made into a needle-structured layer. By guiding the light to the surface, even a thick layer can achieve high resolution. However it has the disadvantage of a rapid (tens of seconds) loss of the latent image that makes it unsuitable for cassette-based systems (Nakazawa et al 1990). Konica has used this material in integrated readers where the CR plate can be rapidly read out in situ immediately after the termination of the exposure. CsBr:Eu2+ is also cubic, can be made in the needle structure, has a stable latent image and can be photostimulated. Agfa has proposed using this material in both cassette-based and integrated readers (Leblans et al 2001). The spectrum of light emitted by an efcient phosphor is controlled by a dilute (<1 atomic%) impurity called an activator. Such activated phosphors have a characteristic line spectrum caused by the isolated atom in the host or matrix. In BaFX phosphors used in CR the activator is Eu2+, which substitutes for Ba in the crystal lattice. Additionally in a photostimulable phosphor there should be effective electron and hole traps at every activator site so that the maximum number of x-ray induced excitations can be trapped. The detailed mechanism of PSL is still controversial (Blasse and Grabmaier 1994, Seibert 1997) and probably differs between specic photostimulable phosphors. The importance of having an appropriate phosphor manufactured in a reproducible manner cannot be overstated. The interested reader is referred to Blasse and Grabmaier (1994) as an introductory and accessible source on the physics, chemistry and manufacture of both conventional and photostimulable phosphors. We will rst review the operation of conventional phosphors before developing the additional concepts necessary for the understanding of photostimuable phosphors. 2.1.2. Operation of conventional (non-photostimulable) phosphors. A key concept in phosphors is the exciton, a hydrogen-like pseudo-atom consisting of a bound electron and hole as shown in gure 1. The exciton is a neutral entity that can form in crystalline insulators after radiation has created ionization. The exciton can move freely within the crystal since in the band structure representation shown in gure 1(a), the electron is in the conduction band of the crystal, the hole is in the valence band and their mutual attraction creates a localized minimum preventing the exciton from ionizing. In this manner the exciton drifts until it is trapped. Trapping of the exciton at an activator site is a prelude to the recombination of the electronhole pair (ehp) and the release of the characteristic radiation of the activator (e.g. Eu2+). If the electron and hole were separated after creation as in a semiconductor, they would have to diffuse separately to the same activation centre before they could recombine in order for light to be emitted. This is a highly unlikely event. Thus conditions favourable for

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Figure 1. The storage of energy and the subsequent generation of light of energy EF in photostimulable phosphors. (a) Band structure representation of a bound electronhole pair or exciton. (b) The energy levels at which an electronhole can be trapped at a PSL complex.

exciton formation and subsequent stability are desirable and probably essential for an efcient phosphor. The efciency of a phosphor for x-ray irradiation is conventionally dened as the ratio of the emitted light energy to the energy of the x-rays absorbed. Typically the best phosphors have an efciency 1020% (Blasse and Grabmaier 1994). For our purposes, it is more useful to dene a different quantity, the number of light photons released per unit of energy absorbed in the phosphor or more commonly its reciprocalthe average energy W, which must be absorbed to release a single light photon. Thus stated, the correspondence between phosphors and semiconductors for x-ray detection becomes apparent. In either case, the rst step in conversion of absorbed energy is to create ehps by the internal photoelectric effect where an electron is excited from the valence band to the conduction band leaving behind a hole. The minimum energy required to create an ehp is the band gap energy Eg. However, as shown by Shockley, this is an absolute minimum. When further considerations such as the randomness of the energy left to each electron (energy less than Eg carried by an electron or hole is useless to create further ionization) and the requirements of conservation of both energy and momentum are included, the average value should satisfy W > Eg. In fact W 3 Eg . (1) This behaviour has been shown to apply to practically all semiconductors, photoconductors andat sufciently high eldsinsulators (Klein 1968). It therefore represents the fundamental limiting energy requirement for ehp production in the solid state. However, in conventional phosphors there is one further stage before light can be emitted, the ehps must be allowed to recombine with the emission of radiation. This process can be made to approach 100% efciency by incorporating appropriate activators, which form luminescent recombination centres. Thus equation (1) also applies to activated phosphors and can be used to establish an approximate value for the lower limit of W on any phosphor once Eg is known. 2.1.3. Mechanisms of trapping and photostimulation. In photostimulated phosphors there are several more stages in the conversion of incident energy to light than in a conventional phosphor. Each stage causes further inefciency and therefore an increase in W. In table 1 the physical properties of several important conventional and photostimulable phosphors including W and wavelength of the light emitted by the activator have been listed and represent an update of the classic table given by Arnold (1979). A notable feature is that the

Topical Review Table 1. Physical properties of conventional and photostimulable phosphors. EK (keV) 50.2 37.4 37.4 37.4/33.2 37.4/33.2 36/33.2 36 15.2/13.4

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Phosphor Gd2O2S:Tb3+ BaFCl:Eu2+ BaFBr:Eu2+ BaFBr0.85I0.15:Eu2+ BaFI:Eu2+ CsI:Tl+ CsBr:Eu2+ RbBr:Tl+

Z 64 56 56 56/53 56/53 55/53 55 37/35

G Light Spectrum for Eg Density W (photons/ Decay time emission stimulation (eV) (g cm3) (eV) 50 keV) (s) peak (nm) (nm) (8) 8.3 (8) (8) 6.2 7.3 7.34 4.56 5.1 (5.1) (5.6) 4.52 4.45 3.35 20 2500 25 2000 360 140 360 140 20 2500 250 200 3 0.7 0.7 0.7 0.6 0.98 0.7 0.35 550 390 390 390 405 550 440 433 na 500600 500650 550700 550700 na 685 735

Conventional phosphors, i.e. those used in screenlm combinations, are shown in normal type and the photostimulable phosphors in bold. Entries that are unknown are left blank or if an entry is inappropriate na is used. In some cases the value has been estimated by comparison with similar known materials, in this case the value is enclosed in parentheses. Z is the atomic number of the radiologically important, i.e. heavy element or elements, EK is K-absorption edge energy of the heavy elements, Eg is the energy gap of the host crystal in electron volts (eV), density is quoted for a single crystal, i.e. 100% packing factor, G = conversion gain (emitted light photons per 50 keV of absorbed x-ray energy). For the conventional phosphors this is the direct light emitted and for the photostimulable phosphors is the PSL light obtained when the trapped energy is fully stimulated and shown with an asterisk. Decay time constants are usually the same whether the light is given promptly on stimulation by x-rays or after stimulation of trapped charge by a laser since they are limited by characteristics of the same luminescence centre and not the trapping, and release mechanisms. Data were compiled from Arnold (1979), Blasse and Grabmaier (1994), Holl et al (1988), Leblans et al (2001), Schweizer (2001) and Sonoda et al (1983).

conversion gain for the photostimulable phosphors is an order of magnitude smaller than that for conventional phosphors. In a storage phosphor, excitons can be trapped without the emission of light. It is believed that if photostimulation is to occur later, the trapping must occur on sites spatially correlated with the activator. This is called the PSL complex shown in gure 1(b). The energy levels in the crystal are critical to effective storage phosphor operation. The energy difference between the electron traps and the conduction band edge must be small enough to allow stimulation with laser light, yet sufciently large to prevent signicant random thermal release of the charge carriers from the traps. In BaFBr:Eu2+ the image storage is due to: (i) electron trapping at positive ion (Br or F) vacancies, forming an F-centre, or (ii) hole trapping at an unidentied site (Blasse and Grabmaier 1994). An activated photostimulated luminescent site or PSL centre is therefore thought to be an arrangement of three spatially correlated components: an electron trap, a hole trap and the luminescent activation centre. The PSL emission spectrum has been correlated with an internal transition within the activator, Eu2+. The stimulation spectrum has been correlated with the absorption spectrum of the F-centre showing that the rst step in the stimulation process is excitation of the trapped electron. However, it is believed that a great inefciency arises because 80% of the electrons are trapped at F sites and 20% at Br sites but only the latter contribute to PSL (von Seggern et al 1988, Thoms et al 1991). It was rst thought that the hole was trapped on the activator site itself (Eu2+) thereby increasing the valency to Eu3+ (Takahashi et al 1984, 1985). However as there is no change in the electron spin resonance spectrum following x-ray irradiation, this trapping mechanism cannot be operative (Schweizer 2001). Thus the nature of the hole trap is in doubt and the details of the entire process are only known approximately. In the needle phosphor RbBr:Tl+ the luminescent centre is the Tl+ ion; the electron is trapped at a Br vacancy; and the hole is assumed to be trapped at a Tl+ ion (Blasse

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and Grabmaier 1994). Optical stimulation excites the electron, which recombines with the hole on the Tl+ yielding the PSL light. There are many other possible photostimulable phosphors but little is published relevant to their application in CR. Signicant studies have been made into large classes of materials (Shimada et al 1991). It is probable that there are more to be discovered and improvements to be made to already known phosphors. It is important to continue to better understand the operation of the storage phosphors so as to be in a position to improve their imaging properties. 2.2. X-ray properties of photostimulable phosphors The number of x-rays used limits the image quality since x-ray image noise arises from the random interactions of x-rays with the detector. The square of signal-to-noise ratio (SNR) at the input of a detector SNR2 in, i.e. the ultimate SNR which a perfect detector could achieve, is equal to the number of x-rays incident on the detector NI. At the output of the detector SNR2 out = Nd (the number of x-rays detected) for a detector that counts x-rays. The ratio of detected to incident x-rays is called the quantum efciency AQ. Thus for a photon counting detector SNR2 Nd out = = AQ . NI SNR2 in (2)

From equation (2) it is evident that AQ is the single most important determinant of the ultimate image quality possible from an x-ray detector. In gure 2, AQ is plotted against incident x-ray energy E for some common photostimulable phosphors. In gure 2(a) the AQ for BaFBr0.85I0.15:Eu2+ is plotted for phosphor loadings of 40 and 70 mg cm2 representing the typical values for a high resolution and standard IPs, respectively, used in CR (Kato 2002). In gure 2(b) the attenuation of BaFI:Eu2+ is shown for the same phosphor mass loadings and in gure 2(c) a more direct comparison of BaFBr0.85I0.15:Eu2+ and BaFI:Eu2+ layers of the same physical thickness of 200 m. It is seen that the K-edge is very pronounced and the total absorption is never very large but can be signicant in the energies just above the K-edge of Ba and/or I. The very large variation of AQ with energy, shown in the relatively thin layer of the powder phosphors, gives rise to an undesirably large absorption of scattered radiation relative to the primary (unscattered) radiation in these screens. This is a disadvantage (Tucker et al 1993 Shaw et al 1994 Yip et al 1996) compared to for example, Gd2O2S screens with a higher K-edge (Bogucki et al 1995, Floyd et al 1991). There is controversy in the literature as to whether the increase in the scatter to primary ratio in CR is due to the position of the K-edge or is correlated to the relatively poor absorption of CR screens (McLean and Gray 1996). Thus, in general, the SNR is increased in CR by reduction of scatter (Miettunen and Korhola 1991). In gure 2(d) AQ is shown for the needle-structured phosphors. In this case the absorption is (with the exception of RbBr) larger than in the powder phosphors and the increase in attenuation seen at the K-edge is less pronounced. 3. Screens and CR imaging plates (IPs) The design and physics of IPs are very similar in concept to conventional phosphor screens used with lm. Thus a brief review of the design and operation of conventional screens follows.

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Figure 2. X-ray attenuation curves for phosphors. (a) BaFBr0.85 I0.15:Eu2+ for 40 and 70 mg cm2. (b)BaFI:Eu2+ for 40 and 70 mg cm2. (c) Comparison of BaFBr:Eu2+ with BaFI:Eu2+ at the same phosphor layer thickness. (d) Comparison of the needle-structured phosphor RbBr, CsBr and CsI for the same 400 m thick layer (graphs courtesy of G DeCrescenzo).

3.1. Conventional phosphor screens The phosphor grains are highly scattering particles due to the high refractive index of phosphors compared to the plastic binder and air pockets within the screen. The scattering is sufcient in that the ow of photons can be considered diffusive and the layer turbid. This scattering limits the spreading of light from its point of origin to a lateral distance comparable to the phosphor layer thickness. Consequently, if high resolution is desired, a thin screen must be used also reducing AQ. While travelling within the phosphor, light will be spread by scatteringa random walk processthe amount of lateral diffusion being proportional to the path length required to escape the phosphor. The fraction of light escaping from the screen depends on: the bulk absorption of the screen, generally negligible for most screens unless a dye is intentionally added; and the boundary condition on the screen, primarily the nature of the backing, whether it is reective or absorptive. The boundary condition is used to adjust the light escape efciency as a function of depth of x-ray absorption. The blurring for x-rays in a given screen also depends on the depth of x-ray absorption. Thus the optical boundary conditions (and bulk absorption due to dye) can be optimized to appropriately weight the contribution from x-rays absorbed at different depths. Analytical models of light transport in phosphor screens have been developed to permit the calculation of screen resolution from their

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Figure 3. Manufacturing methods and structure of powder phosphor screens. (a) Doctor blade method for depositing a thick uniform layer of phosphor slurry on the moving web of backing material from a supply roll. (b) Overall structure of screen.

basic properties (Swank 1973). The models use parameters to represent the scattering length (usually the phosphor grain size but this can be increased by using a binder with a similar refractive index to the phosphor grains (Kato 1994)), the absorption length and the boundary conditions. The phosphor grain size is a critical design parameter for several reasons. First, there are factors related to the intrinsic luminescence properties. If the grains are too small, then the defects created on the outside of the grain, e.g. non-photostimulable electron or hole traps, may dominate the bulk properties of the material. Secondly, there are factors related to the diffusion of light through the screen. If the grains are too large, then non-uniformity of light output or structural noise will be more pronounced. Thirdly, a larger scattering length will reduce the resolution of the screen. Thus screens designed for a low-resolution task, e.g. chest, can use larger phosphor grains than a high-resolution, e.g. mammographic, task. Screens are usually designed to be 1020 phosphor grains thick. 3.2. Manufacture of IPs CR IPs are powder phosphor screens made with photostimulable phosphor. Phosphor grains are combined with a polymer binder and deposited on a substrate. The ratio of binder volume to phosphor volume in the mixture controls the fractional volume of the phosphor layer nally occupied by air pockets or voids. A solvent is used to liquefy the phosphor/binder mixture into slurry in preparation for deposition onto the exible but strong backing layer of the screen. The doctor blade controls the phosphor layer thickness deposited on the backing as shown in gure 3(a). The backing material is transported as a web below the doctor blade at a carefully controlled spacing. The doctor blade deposits the phosphor slurry onto the backing, and its edge establishes the thickness of the phosphor layer as shown in gure 3(b). The nal screen thickness will be less than the height of the blade due to shrinkage as the solvent is driven off during the subsequent drying process. Typically the binder is nitrocellulose, polyester, acrylic or polyurethane and the backing material is also a polymer, e.g. polyethylene terephthalate 200400 m thick (Kato 1994). The use of a black or white backing permits adjustments of the reectivity and absorptivity at the phosphor interface. In BaFBr0.85I0.15:Eu2+ IPs the typical phosphor grain size is 4 or 5 m (Kengyelics et al 1998a, Matsuda et al 1993) with a trend to yet smaller sizes as the ability to make smaller grains with good PSL properties improves. A recently introduced capability in the design of IPs is the possibility of having different optical boundary conditions for the laser (absorptive) and PSL light (reective) by use of

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analyser

Figure 4. Pulse height spectra in phosphor screens. Top row: measurement method. Bottom row: example pulse height spectra obtained under the conditions shown.

anti-halation backing layers (Gingold and Schaetzing 2001). The exposed phosphor surface and the back of the screen have additional protective layers. The purpose of both these layers is to protect the optical surface of the phosphor layer because during stacking and transport within the reader, the bottom surface rubs against the top of other IPs. 3.3. Gain-uctuation noise in photostimulable phosphor screens Ideally in a phosphor screen, the same amount of light would be given off from the absorption of every x-ray. However, in practice there are variations in the light emitted per x-ray, which gives rise to gain-uctuation noise. Such effects can be visualized by considering a pulse height spectrum PHS (Ginzburg and Dick 1993). This is a histogram of the number of events in which a specic number of light photons are given off after the absorption of a single monoenergetic x-ray (gure 4). Such a PHS may be measured experimentally for conventional phosphor screens (Drangova and Rowlands 1986) as shown in gure 4(a) or may be modelled (Fahrig et al 1995). The physics of the mechanisms giving rise to changes in the PHS is usually clear (Trauernicht and Van Metter 1988) and illustrative examples are given in gure 4(b)-(d). Furthermore, the effect of gain-uctuation noise on image quality can be calculated by use of the Swank factor, which is derived directly from the PHS (Swank 1973a). The underlying idea is that the gain-uctuations sensed by an energy-integrating detector will decrease SNRout compared to a counting detector. The generalization of the quantum efciency concept is recognized in the terminology as detective quantum efciency, which is used to understand the noise properties of an integrating detector. Thus the following relationship can be derived: SNR2 out = DQE. (3) SNR2 in This concept has been described fully by Swank (1973a) and can be further generalized to include effects that occur as a function of spatial frequency f. If we look rst at the large area effect, that is for f = 0, Swank showed that the added gain-uctuation noise could be expressed as a multiplicative factor now called the Swank factor, AS: (4) DQE(0) = AQ AS .

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Thus the correction term AS converts the DQE of a device used as a counting detector to that for an integrating detector. The Swank factor can, to a useful approximation, be subdivided into further multiplicative components with the common feature that they are all ideally unity but in practice are usually less than unity by only a small factor. We will now examine these components of AS. When an x-ray spectrum is used, the screen reacts to x-rays with a different energy by giving off a different amount of light. The correction term for a broad x-ray spectrum is called AXED (x-ray energy distribution). Its value depends both on the spectrum and the absorption of the screen and is modest with AXED 0.9. There are ongoing discussions to redene DQE(0) for radiographic and uoroscopic detectors so as to exclude this effect. The current literature still includes it. Further variations of light output from the screen from x-ray to x-ray arise from two effects shown in gure 4(d): (i) K-uorescence occurs when an x-ray of energy E above the K-edge of a material in the screen may give off a K-uorescent x-ray of energy EK and the K-photon may escape (resulting in a PHS output with a total energy per x-ray of EEK) or be reabsorbed (the PHS output has a total energy per x-ray of E ). The effect on gainuctuation noise arising from K-escape and reabsorption is called AAED (absorbed energy distribution). Values for commonly used radiographic phosphors have been tabulated (Swank 1973a, Rowlands and Yorkston 2000) and calculated by Monte Carlo methods (Chan and Doi 1984, Boone et al 1999). The AAED including K-reabsorption is unity for E below the K-edges, i.e. there is no effect on noise, but AAED drops considerably for E > K-edge. The smaller the total absorption in the screen, the greater K-escape above the K-edge and so the smaller is AAED. Due to the relatively low AQ in powder phosphor screens AAED 0.7 is reached at energies just above the K-edge. It then slowly increases back to unity with increase in energy. Averaged over the whole x-ray spectrum AAED is 0.750.85 for powder phosphor screens and in needle phosphor screens, with a smaller K-escape fraction, AAED 0.90.95. (ii) The effects due to the interactions of the depth of absorption of the x-ray and the optical boundary conditions (e.g. for a screen with an absorptive backing the amount of light emitted for an x-ray depends on whether it is absorbed near the output face of the screen {full light emitted} or the back of the screen near the absorber {no light emitted}). This gives rise to the correction factor AOPD (optical pulse distribution). For screens with a reective backing the PHS is quite narrow showing that the amount of light collected from each x-ray is independent of the depth of x-ray absorption. Thus AOPD 1. However for a black backing or a bulk dye the light collected is highly dependent on the depth of x-ray absorption resulting in an exponential PHS and AOPD 0.5. For a practical system it is also necessary to consider contributions to DQE(0) from structural noise Astruct. This understanding of conventional screens can be applied to CR IPs. There are two additional important effects: (i) the fraction of the trapped charge latent image released by the simulating light, i.e. the discharge fraction F, depends nonlinearly, on the stimulating light intensity (Lubinsky et al 1987). Therefore AOPD depends on F. For example, in IPs with absorptive (black) backing AOPD 0.5 at low F, i.e. F < 0.1, but AOPD 1 as F 1 where all depths of the IP are completely discharged. (ii) The number of photoelectrons emitted from the photocathode of the PMT per x-ray absorbed in the IP is relatively small so that secondary quantum noise (specically called luminescence noise in the context of CR) represented by the parameter ASQ also plays a role in the total DQE(0). Other sources of noise, which will be ignored here because they can be generally reduced to insignicant values, include stimulating laser noise, multiplicative gain noise in the electronic amplier and quantization noise. Especially note that amplier dark noise, which can be a dominant factor degrading DQE in DR systems (e.g. at panel detectors, Rowlands and

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Figure 5. Screen opticsthe path of laser light entering and scattering within the phosphor layer and the same for the resulting PSL emission depending on the optical boundary conditions dened by the backing layer. The small graphs represent the depth distribution of laser light IL and escape probability IPSL for stimulated PSL generated at a given depth d in the IP. First for transport of laser light into the IP for (a) reective, (b) absorptive backing layers and for transport of the PSL out of the IP, (c) reective and (d) absorptive backing layers. Full lines represent the situation where there is no bulk absorption of light in the phosphor layer and the dashed lines are for the situation with a signicant amount of bulk light absorption.

Yorkston (2000)), has no role in CR due to the essentially zero dark current of the PMT used as the rst stage amplier. In summary, the product of all the individual factors modies the detective quantum efciency and thus DQE(0) = AQ AXED AAED AOPD (F )AStruct ASQ . 3.4. Resolution of photostimulable phosphor screens Using a ying spot scanner, resolution is not dependent on the scattering of the PSL but rather on the scattering of the stimulating laser light. The light transport properties are shown for both PSL and laser light in gure 5. The boundary conditions for the penetration of the stimulating laser light and escape of PSL will be examined separately. In gures 5(a) and (b) the spreading of the laser light is illustrated from its point of incidence on the front surface of the screen to the back. The spreading is less if the backing absorbs rather than reects the laser light. X-rays absorbed closer to the surface of the IP will have better resolution than those absorbed at greater depths and the resolution is worse for an IP of greater thickness. In order to understand the efciency with which the latent image is read out as a function of depth d in the screen, it is necessary to know the amount of stimulating light reaching each (5)

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Figure 6. Comparison of the geometry and orientation of screens used in different radiographic imaging systems. The backing layer denes the optical boundary condition and in most cases is highly reecting but can, in some cases be absorbing. In (a) orientation of mammographic screen with x-rays incident on light emitting surface and (b) illustrating similar geometry and screen thickness for computed radiography are shown. Note the x-ray attenuation curve showing the relatively larger absorption of x-rays at the incidence surface. In (c) the arrangement for at panel imagers used in DR is shown, where the absorption is at the less favourable back surface of the screen, far from the readout active matrix. (d) Shows that for screenlm with dual screens one of the screens is in the front screen orientation and the other in the back screen.

layer. The quantity IL is dened as the total intensity of the laser light at d independent lateral spread of the laser and is shown in gure 5. If, as is often the case, the bulk absorption of light in the IP can be neglected, then for reective backing IL is essentially independent of d. (There is, extraordinarily, a smaller intensity of laser light close to the incident face than deeper within the phosphor layer. This arises because the laser light is trapped in the IP by multiple scattering and it can more readily escape close to the surface.) In marked contrast, for an absorptive backing IL drops linearly from the front surface to almost zero at the back. Bulk absorption, which may be intentionally created by the incorporation of dye to absorb the laser light preferentially. The effect of the dye absorber on IL is shown by the dotted lines on the graphs in gure 5. The efciency of escape of PSL, IPSL, has the same general nature as IL, i.e. constant for a reective backing and linearly dependent on the distance from the backing for an absorptive backing (gures 5(c) and (d)). The PSL is more blurred from x-rays at the back than the front of the IP. (The PSL blurring has no effect on resolution if the ying spot readout method is used.) Note that the paths of most optical quanta will be the shortest and hence blurring least if the read out is performed at the x-ray entrance side of the phosphor as is normal in CR (gure 6(b)) and single screenlm as used in mammography (gure 6(a)) but not in at panel DR imagers (gure 6(c)) or conventional dual screen screenlm (gure 6(d)). This provides a much-needed advantage to CR over at panel imagers. It also is the explanation of the surprising, but little remarked fact that CR is far more universal than other imaging systems. A single type of CR plate (standard resolution) is usable for all imaging tasks except mammography, which is to be compared to three types of screenlm in general use for radiography (high resolution, general purpose and high speed).

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Figure 7. Overall concept of CR readout systems. (a) Cassette-based requiring carrying cassette back and forth between the x-ray and readout systems. (An important component in practical application not shown in the diagram is a stacker needed to buffer the demand on the system.) (b) Integrated readout systems requiring no operator intervention in the exposure readout cycle.

4. CR readersying spot scanner Present day CR systems are of two general types: (i) cassette-based systems as shown in gure 7(a) where the IP is enclosed in a light-tight cassette for the x-ray exposure, and subsequently moved by hand to the readout system; (ii) integrated readout systems, shown

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in gure 7(b) where the IPs are captive within the readout system, re-circulated and reused without handling. Both types use a ying spot readout system, i.e. a laser spot is scanned with a mirror over the exposed IP in a point-by-point raster pattern. The ying spot scanner is not the only possible approach but is common in commercially available medical CR systems and will therefore be described in detail. 4.1. Gaussian optics of laser beam For mirror scanning, highly collimated beams produced by lasers are essential. A circular beam with a Gaussian intensity in cross section is desirable and this can be accomplished using heliumneon gas lasers or solid-state laser diodes (Kengyelics et al 1998b). Gas lasers naturally have a circular Gaussian form if operated in their fundamental transverse mode (TEM00). Astigmatic lenses are needed with solid-state lasers due to their highly elliptical beam shape. With either kind of laser, once a circular Gaussian beam has been obtained, its cross-sectional diameter can be modied using a laser beam expander. However, the beam cannot be collimated to a parallel beam of the small size required at the IP as such a beam will have a large inherent divergence caused by diffraction. A larger diameter, less divergent beam must be used and focused to a small spot at the image plane. The diameter of the collimated Gaussian beam Wl where it enters the focusing lens of focal length f is related to the focused Gaussian spot size Wf by the relationship (Siegman 1986) Wl Wf = f /. (6) From equation (6) it can be seen that the smaller the focal spot required, the larger the beam diameter before entering the lens. For CR, f = 50 cm for a eld-of-view of 35 cm. Applying equation (6) for the desired Wf = 100 m (diameter measured at the 1/e2 intensity points (Siebert 1997)), then Wl 1 mm. This is a useful beam size, often encountered in laboratory lasers, as a 1 mm beam does not diverge signicantly over a distance of a few metres. 4.2. Laser types The advantages of solid-state laser diodes compared to continuous gas lasers are: (i) the output intensity of a solid-state laser can be controlled electrically; Note that gas lasers, e.g. HeNe with wavelength = 633 nm, need an additional external device such as an electro-optical or electro-acoustical modulator; (ii) The solid-state diodes used in CR ( = 680 nm) are more compact, energy efcient, and have a longer operational lifetime than gas lasers. They do not, however, have as good a match to the optical stimulation requirements of BaFBr:Eu2+. This necessitated using both a greater laser power and a redesign of the phosphor (replacing Br by Br0.85I0.15, Matsuda et al (1993)). 4.3. Readout rate limits In designing a readout system one must know the required readout rate. The plate throughput of medical scanners is 30110 plates per hour (Seibert1997), which is adequate for the workload of a typical clinic. The engineering limit on the transport and stacking of IPs is a component of the total readout time. There is also a fundamental limit related to the characteristics of the photostimulable phosphor, i.e. the intrinsic decay time of the luminescence centre (Eu2+ in the case of BaFX). PSL from a previously stimulated region will continue to glow. This decays with a time constant, which is characteristic of the activator and the host lattice. For BaFBr0.85I0.15:Eu2+, the time constant is 0.7 s (table 1). If scanning were performed too

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Figure 8. The nonlinear, stimulation energy dependence of PSL (a) measured by uniform irradiation of complete imaging plate (Kato 1994) and (b) measured for a single pixel in scanning mode (Arakawa et al 2000). In both graphs the full line is an exponential t to the discharge curve, which can be seen not to be quite exact. It can, under certain circumstances, be represented by a power law.

quickly, the PSL signal from one pixel would not be completely decayed before the PSL from the next was initiated. Consequently, it would bleed into the next pixel and cause spatial blurring. To avoid this, several time constants should elapse between the readout of one pixel and the next, i.e. usually 5 time constants (1/e5 < 1% lag) resulting in 4 s per pixel. Thus with 2000 2000 pixels the shortest readout time would be 16 s. Fuji AC-3 readers take 30 s to readout an array of this size (Fetterly and Hangiandreou 2000). Another practical limitation on readout time is the laser power available. The PSL output with stimulating laser irradiance is shown in gure 8 for BaFBr0.85I0.15:Eu2+ (a) for the complete plate irradiated uniformly and (b) for an individual pixel. Note that since the PSL output saturates, i.e. the IP is within 10% of complete discharge, with laser input of 2 J m2, there is no need to use more light. The energy deposited by a 30 mW laser spread uniformly over the whole area of a typical IP (0.33 m 0.33 m 0.1 m2) is 0.3 J m2 s1. Thus it will take 2/0.3 7 s to discharge the IP by 90%, i.e. F = 90%. In practice, therefore, the characteristic phosphor decay time provides the limit on readout time in ying spot scanners. 4.4. Beam scanning The diode laser beam is sent through several subsystems before reaching the CR plate as shown in gure 9(a). The laser beam is divided (not necessarily equally) into two with a beam splitter such as a partially silvered mirror. The main beam passes to the scanning system; the side beam is sent to a photodiode used to monitor, and with feedback, stabilizes the laser output intensity. The laser focusing lens is generally of the F/ design. It has three further functions: (i) to make the focal plane at so that focus is uniform across the IP, (ii) to convert the constant angular motion of the scan mirror into a constant linear speed at the image plane so that the pixel spacing is constant and (iii) to move the entrance aperture of the lens, i.e. locus dening region where any ray within the angle of acceptance will be imaged by the lens, signicantly out from the body of the lens so that the rapidly scanning mirror has space to

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Figure 9. Flying spot CR readout scanner. (a) Scanner components also showing the graph of direct output of PMT response to a step in intensity on the IP, (b) processing stages, (c) response curves of processing stages and (d) typical form of output signal as it passes through the processing stages.

operate. Either a rotating polygonal mirror driven by a synchronous motor or an oscillating at mirror driven by a galvanometer can perform the scanning function. The advantage of the rotating polygon mirror is that the transition from one facet to the next performs the yback, i.e. retrace which occurs at the end of one line as the beam rapidly returns to the start of the next line. This maintains a high laser duty cycle, i.e. the fraction of the time the laser is actually reading out the IP. In contrast, a galvanometer has to be driven in an oscillatory manner by a sawtooth signal and after yback takes a xed time to return to stable operation. Its duty cycle is therefore lower than a polygon and at high line rates, the duty cycle decreases even further. Thus the polygon is used for faster scanning speeds but it has two disadvantages which lead to periodic errors that appear as banding artefacts in the subscan direction. (i) The reective

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properties of its facets may each differ slightly, which requires a further correction to the laser output (Matsuda et al 1993). (ii) Unintentional scanning of the beam perpendicular to the scan direction results in an effect called cross-scan error, caused by slight angular shifts between facets. This can be corrected passively using a pair of cylindrical optics (Matsuda et al 1993). CR, as in any destructive readout, is very sensitive to cross-scan error. If the beam moves one way, there will be reduced signal as it rereads already partially discharged regions of the IP and in the other way, it will steal signal from the next line. Control of cross-scan error to <1 m is required (Matsuda et al 1993). Any uncorrected periodic error leads to banding with a period equal to the number of facets on the polygon (Kengyelics et al 1998b). The scan mirror repetitively scans a line and retraces the laser beam thus dening the scan direction. During retrace the laser beam is turned off and restarted just before it is expected to reach the active area of the IP. The laser beam positioning with respect to the previously read out pixels is accomplished with a line start detector, i.e. a photodiode near to the starting point of the scanning. The linear motion of the plate in the subscan direction combined with the laser scan creates a raster pattern that is read out progressively. 4.5. Collection of PSLlight guide The light guide is located as close as feasible to the IP to efciently collect the blue PSL as shown in gure 10. Using the physical process of total internal reection, the light guide transfers the PSL to the photomultiplier (PMT). To be efcient, careful design of the light guide is needed. Any light reaching the guide entrance must be accepted at an angle appropriate for total internal reection within the guide. Made of a transparent plastic such as acrylic, the conditions for total internal reection only occur if the guide is bent gently, i.e. on a large radius. It cannot perform demagnication, as light would escape from the sides. The light guide shape changes from a lineto match the laser scan line at the IP, to an annulusto match the circular shape of the input window of the PMT (Tanaka et al 1984). A more compact system using laser cuts to the acrylic has also been shown (Matsuda et al 1993). Care has to be exercised to prevent laser light scattering or reecting from the light guide onto the IP where it would discharge another part of the image creating are (gure 10(c)), i.e. a low frequency drop in the modulation transfer function. A related effect can occur in the top layer of the IP where unwanted reections can produce halation (gure 10(d)). Thus the top layer thickness has been reduced to 3 m (Ogawa et al 1995). A conductive layer is also incorporated in the IP structure to prevent build up of static electricity. 4.6. Signal processing The processing of the stimulated PSL signal from the IP is shown in gure 9. In gure 9(b) are the processing modules, in (c) their function and in (d) examples of the waveform at corresponding points in the processing cycle. The rst processing step is logarithmic amplication, which reduces the dynamic range prior to digitization and prepares the data for better visualization on a monitor. The second processing step is to temporally lter the signal. This has several important functions: to correlate the signal prior to digitization so as to optimally match the analogue signal to the digitization sample rate fd. This also prevents aliasing of noise and reduces or eliminates xed pattern noise of an x-ray grid oriented with the grid lines perpendicular to the scan direction. An ideal lter would be a low pass lter f to satisfy the sampling theorem. with a sharp cutoff at fc = 1 2 d The third processing step is digitization (Kato 1994). The digitization rate is relatively slow, e.g. 4 s per pixel, therefore an a/d (analogue to digital converter) operating at a

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Figure 10. Details of light collection system (a) in normal operation, (b) details of Fuji ST-V structure, (c) generation of are by reection of laser light from the face of the light guide back onto the IP where PSL can be stimulated at a point remote from the original incident point of laser and (d) generation of halation by reection of light within the 3 m protective layer. This layer has been reduced to the point where halation is insignicant.

frequency fd = 250 000 samples per second is required. How can we establish an adequate digitization dynamic range? The upper limit is the highest exposure to which the IP can be exposed or the raw x-ray beam (air kerma 1000 Gy). The lower limit is related to the noise at the lowest exposure level encountered. For a/d quantization noise to be insignicant (Dolazza and Poulo 1984) the least signicant bit has to be equal to or less than the noise at the lowest exposure level. The lowest exposure required may be assumed to be 1/10 of the mean. The mean exposure level to which IPs are exposed is 3 Gy, which, for a 200 m square pixel (assuming a quantum efciency of 0.5), is 1200 x-rays per pixel (2 1016 x-rays Gy1 m2 0.5 3 106 Gy (2 104 m)2). One tenth of this is 120 x-rays with a noise of (120)1/2 11 x-rays (0.03 Gy). This is a raw dynamic range of 1000/0.03 = 33 000 15 bits. In the earliest commercial CR readers an 8-bit a/d was used. Two methods were required for the large raw dynamic range to be adequately digitized. The rst used a preread cycle to scan the laser across the image at a greatly reduced power. This allowed a determination of the actual image content and the PMT gain was adjusted to match that content (Seibert 1997, Kengyelics et al 1998b). The second method added a logarithmic

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Figure 11. Quantum accounting diagram for several different radiographic imaging systems namely the ying spot CR system, line scanner CR system and at panel DR system.

converter to process the signal from the PMT before it entered the a/d as shown in gure 9. This further reduced the effective dynamic range of the signal (Dolazza and Poulo 1984) and the number of bits required. Currently, analogue logarithmic processing or square root processing (Dolazza and Poulo 1984) is used to reduce the dynamic range of the signal before digitization by a 12-bit a/d. Alternatively if logarithmic processing is performed digitally, i.e. after the a/d, using look-up tables, then a 16-bit a/d will be necessary. The prescan approach has been eliminated due to the ready availability of high bit depth converters and the ability of handling large amounts of digital data, which was far from trivial in the early eighties when CR systems were introduced. Finally a shading correction is applied to allow for the varying light collection efciency of the light guide as a function of the laser position along the line. This is a one-dimensional correction as every line is the same. 4.7. Isolation of PSL from laser light To permit the PSL signal to be isolated from the laser light, the phosphors chosen for CR can be stimulated with laser light with a different wavelength from the PSL light. Is there a problem in isolating these two sources of light, both of which will enter the light guide and reach the PMT? Laser power used in CR is 30 mW (Matsuda et al 1993, Seibert 1997, Leblans et al 2001) or 2 1017 red light photons/s (assuming 2 eV per red light photon). At this power and the 4 s dwell time per pixel derived earlier, there are 8 1011 red light photons incident on each pixel. The stimulated light output from the IP for a single fully absorbed 50 keV x-ray is 70 blue PSL photons (gure 11). Thus the ability to detect 120 x-rays, i.e. lowest exposure level dened above at which signal needs to be measured1/10 mean exposure, will require the detection of 8000 blue photons in the presence of 8 1011 red photons. Therefore the

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Figure 12. Propagation of noise in CR systems illustrating the contribution of noise from secondary quantum statistics. The effect on image quality by changing g is investigated. In the upper row a representation of the image of a single x-ray photon is illustrated. With g = 1000 each x-ray has enough secondary quanta that its image is smooth and representative of the characteristic blurring of the systems. As g decreases, each x-ray has fewer light photons representing it resulting in a rougher appearance. The corresponding Wiener noise power spectra for the same g values are shown in the lower part of the gure.

ratio of stimulating red to PSL blue photons at the surface of the IP at the worst case of the minimum x-ray exposure is 108 or eight orders of magnitude! The rst approach used to separate these light photons depends on the PMT. A typical transparent bialkali photocathode has a quantum efciency of 25% in the blue and 0.1% in the red. The second approach is the lter, which still needs to selectively remove ve orders of magnitude brighter light in the red while efciently passing light in the blue if interference with the output of the PMT from the laser light is to be avoided. 4.8. Quantum accounting diagram The maximum signal to noise ratio (SNR) of any imaging system occurs where the x-rays are absorbed. If the SNR of the imaging system is essentially determined here, the system is said to be x-ray quantum noise limited in its performance. Inevitably the SNR is reduced as the signal passes through the system. It is possible to make high image quality x-ray detectors because of the large intrinsic conversion gain as the x-ray energy, e.g. 50 keV, is converted to many secondary particles, e.g. 3 eV photons. It is important that the detector maintains a large number of quanta representing each x-ray if secondary quantum noise is to be minimized. A quantum accounting diagram aids in locating the secondary quantum sink. Figure 11 illustrates the propagation of quanta through the CR conversion stages. Each 50 keV x-ray interacting in the detector produces 2000 ehp. However, only a small fraction (1/15) of these ehps are trapped in a manner that permits them to be laser photostimulable and produce PSL. Of these, only half are actually stimulated, i.e. discharge fraction F = 0.5, and PSL photons emitted. For an IP with a reective backing we assume all of these PSL photons escape from the IP. However only 1/3 can be collected by the light guide and brought to the face of the PMT where 1/4 release photoelectrons. Taking into account all these factors an absorbed x-ray is represented on average by 5.5 e, i.e. the system gain g = 5.5 electrons per 50 keV x-ray (2000 1/15 1 2 1/3 1/4). Fortunately, the PMT can efciently and adequately amplify 5.5 electrons such that no signicant further noise is added. The noise inherent in the few electrons representing a single x-ray is the weakest noise link in the CR system and is the secondary quantum sink. For comparison, in the quantum accounting diagram for at panel DR (gure 11) g equals 1000. In gure 12 the effect on image quality by changing

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g is investigated. With g = 1000 each x-ray has enough secondary quanta that its image is smooth and representative of the characteristic blurring of the systems. As g decreases, each x-ray has fewer photons resulting in a rougher appearance. The resulting noise power spectrum is shown in the lower part of gure 12. As g decreases the noise of the secondary quanta NPSSQ approaches, and in the case where g = 1, equals the noise from the x-rays NPSX. This has a deleterious effect on both DQE(0) and as f increases, DQE( f ). Secondary quantum noise is evident in optically coupled x-ray image devices (Yaffe and Rowlands 1997), especially where optical demagnication is signicant. It has been investigated in the context of phosphor screens coupled to CCDs using tapered bre optics (Maidment and Yaffe 1994). The situation is also analogous to the use of lm in screenlm (Nishikawa and Yaffe 1990). Film has an optical DQE(0) 1% (Dainty and Shaw 1974) leading to g 20, which is comparable to g for CR. What options are available to increase g in CR? 4.9. Possible sources of improvement in conversion gain in ying spot CR systems In gure 11, the sources of loss in g are highlighted. BaFX:Eu2+ has been developed to produce the maximum possible PSL output and practically may have reached a limit. However, it does not appear to violate any conservation laws to expect that a signicant fraction of losses seen within the phosphor (failure to trap ehps, non-photostimulable sites) could be eliminated. Using previously established data leads to a theoretically possible increase in g by 15. By careful analysis it may be possible to elucidate the exact mechanism of operation of the phosphor, reduce the losses and improve the gain. The next stage is the light collection system. The theoretical limit would collect all the emitted light resulting in an increase in g 3. Means for accomplishing this could include reading from the side of the IP opposite to that of the laser and increasing the light guide efciency by placing it in contact with the IP (Arakawa et al 1999, 2000). The PMT has an optical quantum efciency of only 25% since it relies on the external photoelectric effect, i.e. an electron is given enough energy to eject it from a solid and into the vacuum. In theory, solid-state devices can approach an optical quantum efciency of 100% because of the internal photoelectric effect where an electron is transferred from the valence band to the empty conduction band within the solid. This potential four times increase in optical quantum efciency would help to reduce the secondary quantum noise characteristic of CR. However, if a large area photodiode replaced the PMT, then both the electronic noise from the capacitance of the diode (14 cm2 50 pF cm2) and the uctuations in the dark current (>14 5 nA cm2) would each yield an electronic noise Ne > 5000 e rms. For this to be equal to the x-ray noise from NX x-rays, we have the relationship Ne = g (NX)0.5. Our example is then 5000 = 5.5 (NX)0.5, i.e. NX 106 x-rays/pixel, which corresponds to 4 mGy incident air kerma. Thus a ying spot CR system using a silicon photodiode would not be quantum noise limited below 4 mGy (three orders of magnitude larger than the typical incident air kerma of 3 Gy used in CR) incident on the IP! Thus, PMTs continue to be used because: (i) the gain achieved by impact ionization using a cascaded series of 10 dynodes, each with an adjustable gain up to 4, yields an overall gain of a million. This gain is essentially noiseless. Unlike an electronic amplier, there are no parasitic capacitances and the inherent gain uctuations are insignicant. (ii) The dark current Id is negligible even for a very large active area (14 cm2) required in mapping the input of the light guide (35 cm 4 mm). Id < 1000 e cm2 s1 or 0.06 electrons from the 14 cm2 area of the photocathode during the pixel integration time of 4 s. Thus the electronic noise and dark current uctuations, from a practical-sized PMT, are insignicant compared to the 60 e (11 x-rays g = 5.5) noise that corresponds to the lowest signal encountered in CR. Thus for a ying spot scanner, g cannot be expected to be increased signicantly in the near future.

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Figure 13. Linear response of IP to x-ray exposure. (a) CR reader output measured at PMT in arbitrary units (AU) plotted against irradiation to IP expressed in air kerma. This curve shows the linear inputoutput relationship over more than four orders of magnitude (Bootstrapped from three individual plots from Kato 1994). (b) CR reader output in CR Reader unit plotted against the logarithm of x-ray kerma, i.e. exposure, showing a straight line t which demonstrates a linear relationship between the PSL output and air kerma (Kengyelics et al 1998b) for four combinations of reader and IP parameters (latitude parameter L and IP type ST or HR).

4.10. Readout linearity Figure 13(a) shows the native characteristic curve, i.e. a plot of PMT signal output before logarithmic compression, of a CR reader. The author constructed this composite graph by bootstrapping data from several individual curves (Kato 1994) to show the overall dynamic range of the system. The exposure sensitivity of the CR plate is shown to be linearly proportional to exposure from 0.11000 Gy (a dynamic range of 104). This curve must be linear (or linearizeable) for MTF, NPS and thus DQE to be dened. However, the linearity of the characteristic curve, although necessary, is not a sufcient condition. The creation of PSL depends nonlinearly on the stimulation light intensity as can be seen by referring back to gure 8. If the system is to satisfy the requirements for linear analysis, three further conditions must be satised. The rst condition for effective linearity is that the laser light intensity must be kept constant during the readout scanning process to maintain the discharge fraction F of the IP at a constant level. This is because both the spatial resolution of CR systems (gure 14) and the x-ray to charge conversion gain g, and hence the secondary quantum noise, depends on F. The second condition (satised automatically for photostimulable phosphors in current use) is that the discharge process must be very inefcient. This ensures that F is independent of the latent image. If the discharge process were more efcient, then an effect similar to adjacency in lm could occur leading to a complete breakdown of linear analysis. This is an edge enhancement that arises close to a high-contrast sharp edge during development (Dainty and Shaw 1974). In both lm development and IP readout such effects arise from the latent image using up the developer or laser light, respectively. The third condition is that any nonlinear processing applied to the signal from the PMT, e.g. the logarithmic compression, be reversed.

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Figure 14. Phosphor blunting is illustrated by (a) a plot of MTF plotted for three different laser power intensities to the IP and corresponding relative discharge of plate obtained from gure 8 (Arakawa et al 2000) and (b) schematic illustration of origin of phosphor blunting.

Thus although the readout process is intrinsically nonlinear, the linear parameters dening spatial resolution (modulation transfer function (MTF)), spatial noise (Wiener noise power spectrum (NPS)) and the spatial frequency dependent detective quantum efciency DQE( f ) can nevertheless be dened for CR systems in current use (with a possible exception to be discussed later). Note that the values of MTF, NPS and DQE will be different for the same reader and IP if factors affecting F are changed. Furthermore, the optimization procedure by which the scan parameters are obtained is a nonlinear process. 4.11. Plate reconditioning A residual latent charge image remains on the CR plate after readout. Erasure of the image using a high intensity light source must be performed before the plate is reused. This is accomplished using a high-pressure sodium or uorescent lamp (Siebert 1997). The erasure time depends on the brightness of the lamp and the level of erasure required. The level of erasure achieved also depends on the prior x-ray exposure and F. The erasure rate is enhanced if the initial erasure is performed with a light spectrum including ultraviolet followed by a spectrum with the UV ltered out (Matsuda et al 1993). This is probably due to the creation of trapped charge by UV irradiation. Erasure times are 1020 s for the Fuji AC-3 and 50 s for the Lumisys ACR-2000 readers (Fetterly and Hangiandreou 2000). In practice, unless exposed to an excessive x-ray irradiation (such as during a quality control procedure), the previous latent image is effectively removed during a single erase cycle. It is possible to accumulate an image on the CR plate due to natural radioactivity and cosmic radiation. Therefore, before clinical use the IPs should pass through a further erasure cycle if they have been in storage for more than a day (Seibert 1997). 5. Conguration and operation of CR systems After the image has been acquired digitally, it has to be processed and manipulated before it can be displayed effectively and a diagnosis made. Processing for CR images is specic for each different application (Vuylsteke et al 1997). The system conguration, how the components parameters are chosen and the CR system performance will now be described.

R146 Table 2. Imaging plate parameters and derivation of AS. Phosphor layer mass loading (mg cm2) 70d 40d Phosphor layer thickness (m) 230c 140e Phosphor packing factor 0.60 0.56 System gain (e/x-ray) 16.6b 4.0b

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IP type ST-Va HR-Va

AQ 0.43 0.31

DQE(0) E<1 (Gy) 0.30 0.14

AS 0.70 0.45

Two categories of IP are shown, ST (standard resolution) and HR (high resolution) all read out in an AC3 reader under the x-ray conditions of 75 kVp (W) with 1.5 mm added Cu ltration. Data in a given row were obtained from the reference given in the rst column unless otherwise noted. AS is obtained by dividing DQE(0) by AQ. a Kengyelics et al (1998). b Estimated from NPS in the original paper by Hillen et al (1987) method. c Ogawa et al (1995). d Kato (2002). e Measured by author.

5.1. System parameters The most signicant system choice is not in the readout system but in what it reads outthe IP or screen. The amount of blurring and the effectiveness of the IP in absorbing radiation are dened by the thickness of the phosphor layer and its optical parameters (scattering length and absorption length for light photons and the boundary conditions). Fuji IPs are available in standard resolution (ST) and high resolution (HR) followed by a generation number expressed as a Roman numeral. The standard resolution plate is intended for all general radiographic applications while the HR plate is intended specically for mammography. A reective layer is used in Fuji ST-V plates (Ogawa et al 1995), which reects only blue (PSL) lightit is absorptive for the red laser light (Kato 2002) as shown in gure 10(b). The phosphor layer including binder is 230 m thick. In contrast HR-V has a black backing, i.e. absorbs both red and blue light, and has bulk absorptive dye specically for the red laser light (Kato 2002). The measured x-ray absorption of Fuji IPs under well-dened x-ray spectral conditions have been given for ST-V and HR-V (Kengyelics et al 1998b). This could be used for an independent determination of phosphor loadings from knowledge of attenuation coefcients and modelling of x-ray spectra (Tucker et al 1990). A summary of the phosphor mass loadings and other parameters for the IPs mentioned above is given in table 2. When the phosphor layer thickness is known, an estimate of the phosphor packing factor can be made. The literature suggests that, in general, maximum packing factors of 60% can be achieved (Vosburgh et al 1977) but precise values depend signicantly on the morphology of the phosphor, the distribution of grain sizes and other factors and requirements such as exibility of the IP (Kengyelics et al 1998a). Measurements of the physical thickness of the phosphor layer are also important for the understanding of the MTF. The laser spot size, from the point of view of maximum resolution, should be as small as possible (Kato 1994). An 100 m 1/e2 diameter at the focal plane is in common use. 5.2. Operational parameters The pixel separation is solely a function of the reader. Most cassette-based readers are capable of scanning at various different pixel sizes with 200 m pixels (Nyquist frequency fNY = 2.5 lp/mm) or 100 m pixels ( fNY = 5 lp/mm) for general purposes with ST. In earlier mammographic readers using HR IPs 100 m pixels ( fNY = 5 lp/mm) were used but in more

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recent readers 50 m pixels ( fNY = 10 lp/mm) have been used. In earlier readers the scanning pitch was changed depending on the IP type. In recent readers the readout may occur at a ner pitch than required and digital rebinning of the data used. In practice, the pixel size is chosen so as not to be the limiting factor on the MTF. The discharge fraction F depends on the laser energy incident per unit area of the IP. As a system parameter, F depends on three factors: the plate size, the time to scan the complete plate and the laser power (corrected by the duty cycle of the scanner). F may also depend on other factors such as: contrast and density settings of the reader, and whether an ST or HR plate is being read. It could also depend on the IP generation and other factors controlled by the CR reader based on information from the bar code specic to the individual IP. This is an area that merits further investigation. F can, in principle, be established by rereading [IR2 = F(1 F)k] a uniformly irradiated IP that has been read out once [IR1 = Fk] with the erasure cycle bypassed. Then, F = 1 IR2/IR1. In practice, F 50% (Leblans et al 2001) represents a trade off between decreased secondary quantum noise and increased blurring as F is increased. However, systematic measurements of F and correlation with image quality for different designs of IPs and readers are lacking. 5.3. System performance The CR system, though not strictly linear, satises most conditions for linear analysis. Thus meaningful values for MTF, NPS and DQE can be measured in the conventional manner with the proviso that the measurements cannot be identied with the IP alone but are a function of the type and mode of reader and F must be constant. 5.3.1. System response. The characteristic curve of a CR reader at the output of the PMT is shown in gure 13(a) plotted on a loglog graph where it shows a slope of unity demonstrating linear response over many orders of magnitude. However, the logarithmic response of the amplier modies the characteristic of the complete CR system. The resulting curve is shown in gure 13(b). The logarithmic response has to be removed for linear analysis. The fact that a straight line can be tted through the data shows that the logarithmic amplier is accurate and that any signal offsets have been removed precisely before logarithmic processing. 5.3.2. Modulation transfer function. The MTF is the single most critical determinant of the spatial frequency dependence of the DQE. Conventionally, measurements of detector MTF correct for the size of the x-ray source (focal spot unsharpness) and the nite slit size. It should be measured at a point in the CR system where the MTF has had no articial edge enhancement or other image processing. This is the native MTF. MTF measurement on digital systems is usually based on the method of over-sampling using a slanted edge or slit (Fujita et al 1992, Beutel et al 2000). This approach eliminates aliasing arising from the limited sampling inherent in practical digital systems (Dobbins 1995) and is called the presampling MTF. There are specic problems related to measurement of MTF in CR systems due to their dependence on F (Lubinsky et al 1986) shown in gure 14. MTF is reduced as F increases, which we call phosphor blunting. In gure 14(b) the mechanism is explained in terms of the same Gaussian intensity prole used to discharge an IP to different F. The increase in full width at half maximum along with the distortion of the shape of the discharge is shown. The saturation and widening of the curves arises from the nonlinear nature of photostimulation shown in gure 8. Another potentially opposite effect, called beam sharpening improves the MTF as F increases and is shown in gure 15. In (a) the raster is dened along with the position of the laser beam at the instant of interest,

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Figure 15. Outline of the principle of destructive reading of CR plates and the origin of laser beam sharpening. Note that, for clarity, blurring arising from scattering in the screen has been neglected in this diagram (black represents 100% and white 0%).

(b) shows the form of the x-ray latent image of a letter A stamped from an otherwise opaque lead sheet, the three rows show, (c) the exhaustion image or map of the discharge fraction of the image that represents the remaining potential for image readout, (d) the exhaustion image multiplied by the original latent image, i.e. the total remaining latent image at this instant in the readout procedure and (e) the image read out to the computer. The readout discharge fraction (dependent on the laser energy per pixel) in the range 0100% are shown in the columns. In (f ) where the laser beam size is doubled laser beam sharpening can occur if F is large. Beam sharpening arises from the interaction of only the leading edges of the readout beam with the remaining latent image resulting in better MTF at high F than at low. Operating the reader in manual mode permits the control of F (Kengyelics et al 1998b). The components of MTF for CR consist of (Ogawa et al 1995): (i) x-ray effects such as scattering and uorescence reabsorption MTFx-ray, (ii) blurring within the IP MTFIP, (iii) the spatial response of the reader, including the laser spot size MTFlaser and, if the system scans at a ne pitch then synthesizing a coarser pitch by averaging the pixel pitch and line pitch creates MTFAverage( f ), and (iv) the response of the electronic temporal lter used for antialiasing (gure 9) at the temporal frequency , Rtemporal( ) = MTFelec( f ) where = fv and v is the scan speed (pixels per second pixel size) introduced to eliminate aliasing and reduce noise. Combining these components and assuming that linear system analysis applies, then MTFR = MTFx-ray MTFIP MTFlaser MTFaverage MTFelec . (7)

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Figure 16. Modulation transfer functions for Fuji ST-V and HR-V IPs measured in the same readout system (Fuji AC3) for: (a) scan and subscan directions (Kengyelics et al 1998b) and (b) MTF( f ) in subscan direction is replotted on Swanks universal curve, i.e. against f T where T is the phosphor layer thickness from table 2 (ST-V is 230 m and HR-V is 140 m) showing overlap of graphs. Note a correction to the data was applied prior to scaling, the MTF for a 100 m laser spot size was divided into the measured MTFs for both IPs.

Figure 16(a) shows the measured MTF for Fuji ST-V and HR-V IP in both scan and subscan directions (Kengyelics et al 1998b). For each IP type, MTF is similar in both and, in particular, the MTF is signicant at the Nyquist frequency in the scan direction. This is unexpected, as the purpose of the temporal lter is to reduce the MTF at the Nyquist frequency to zero in the scan direction. In the authors opinion, this occurs because the anti-aliasing lter is after the logarithmic amplier (Ogawa et al 1995). The temporal lter operates in the logarithmic domain, not the linear domain, leading to nonlinearity. Further evidence for nonlinearity is that the MTF of a Fuji 5000 system measured using several different methods yields radically different results (Fetterly et al 2002). In this case an MTF cannot be dened for the lter, and thus a system MTF does not exist. The lter response can be seen clearly in the noise power spectrum (see section 5.3.3). Fortunately these arguments do not apply to the MTF in the subscan direction, which therefore is a true MTF of the system. In the subscan direction the behaviour of the MTF in terms of the components in equation (7) is as follows. The laser spot size provides an almost negligible contribution to MTF, the temporal lter is not relevant and the MTFs shown are taken without averaging. The only signicant MTF factors are the x-ray interactions and laser scattering in the IP. It is enlightening to apply Swanks (1973) scaling analysis to compare the MTFs of IPs of differing thicknesses. From table 2 the ST-V IP thickness is almost twice that for HR-V. After correcting for the laser spot size and pixel sizes, the MTFs can be rescaled onto the same graph by plotting MTF as a function of the dimensionless quantity f T. In gure 16, the curves for ST-V and HR-V superimpose precisely on Swanks universal curve, indicating that for practical purposes the optical designs of these IPs are identical at the values of F set by the reader. In conclusion, the MTF of IPs is similar to the expectation for any scattering screen. Caution is advised since some readers do not operate linearly in the scan direction and in this case, a meaningful MTF can only be dened in the subscan direction. 5.3.3. Noise power spectra. The NNPS (NPS normalized to signal) for the same IPs as above are plotted in gure 17(a) in the scan and subscan directions. The presence of the

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(a) Normalized Noise Power Spectrum (mm )

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0.1 0 1 2 3 4 5 1

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Figure 17. (a) Normalized noise power spectra for both Fuji ST-V and HR-V obtained with an AC3 reader (Kengyelics et al 1998b). The data are plotted in both the scan and subscan directions. The scan direction shows a marked drop at high spatial frequencies that is directly attributable to the temporal anti-aliasing lter shown conceptually in gure 9. The form of the lter can be estimated by dividing the NNPS (scan) by NNPS (subscan) and the result is shown in (b) where it can be seen that the lter is the same for both ST-V and HR-V as might have been expected since the common element is the AC3 scanner where the lter is present.

temporal lter is clearly seen in the scan direction. Dividing the NPS in the scan direction by that in the subscan direction and taking the square root (gure 17(b)) produces the lter response. The lter for both IPs measured on the same reader under the same scan conditions is the same. It can be tted as a sixth-order Butterworth lter with a 3 dB point at 3.35 lp/mm and a drop, by a factor of ten, at f/fc = 0.5 which is the Nyquist frequency (5 lp/mm). This lter is therefore acting as a perfect anti-aliasing lter in the NPS measurements. It seems inconsistent to plot the lter function here since the system, based on our analysis of MTF, is nonlinear. However, an explanation is now feasible. During measurement of NPS, the image is uniform with small variations due to noise. Thus the system will mimic a linear response, as will any characteristic over a small enough excursion. However, the MTF situation is exactly opposite. The range of values is very large, i.e. 0 when far from the position of the image of the slit to a very signicant value at the centre of the slit. Under these circumstances the nonlinearities will be worst. Therefore the function shown in gure 17(b) is the true small signal response of the system corresponding to the actual electronic circuit and measurements of NNPS are valid in both the scan and subscan directions. 5.3.4. Detective quantum efciency. How do we judge what is a good DQE? First, there is an important quantity called DQE(0) the detective quantum efciency at (or close to) f = 0. Next there is the change, always a drop, of DQE as the spatial frequency increases. This is the shape of the DQE or DQE( f )/DQE(0). The best DQE starts at unity and stays constant at unity to the largest frequency of interest. However, for a sampled system, the DQE is not dened above the Nyquist frequency fNY(half the sampling frequency). In practice DQE(0) and DQE( f )/DQE(0) are intertwined and cannot be selected independently. DQE is calculated from the MTF, NNPS and exposure to the system in terms of the mean number of x-ray

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Figure 18. Illustration of the role of structure noise in the detective quantum efciency of CR. (a) DQE( f ) plotted as a function of exposure for an example IP/reader system (Fuji ST-II/901) (Dobbins et al 1995). Note that the highest value of DQE is for the lowest exposure level due to the decrease in x-ray noise as a function of exposure while structural noise remains constant. (b) DQE( f ) plotted against exposure at two different spatial frequencies as shown in the diagram. The air kerma at which DQE drops by a factor of 2 is illustrated.

photons incident per unit area DQE(f ) =

using the expression:

MTF2 . (8) NNPS Structural noise is a fact of life for both the CR and screenlm systems. In DR systems it is normal to correct for structural noise or xed pattern noise. However, CR systems based on ying spot scanners lack the precise geometrical alignment for such corrections to be successful. Structural noise NNPSStruct manifests itself at high exposures since it is independent of exposure while NNPSX decreases linearly with exposure. Figure 18 shows DQE( f ) for Fuji ST-II/901 IP/reader combination plotted against f for several exposure values (Dobbins et al 1995). In this system quantum noise is dominant up to an exposure of 1020 Gy (depending on spatial frequency) as seen in gure 18(b). This is adequate immunity to structural noise for most medical uses of CR and has been achieved by incremental improvements (Dobbins et al 1995, Ogawa et al 1995). Our discussion on DQE will now focus on experimental values obtained at low exposures where the effect of structural noise can be ignored. There is no evidence in a loss of DQE as exposure decreaseseven at 0.3 Gy exposure (corresponding to approximately 1/10 of the mean exposure used in CR) and therefore there cannot be any signicant contribution to the overall NPS from digitization noise indicating that the number of a/d bits is adequate. In gure 19 an analysis of the effect of secondary quantum noise on DQE( f ) is shown. In gure 19(a) the normalized measured noise power spectrum (NNPSmeas) is plotted as a function of spatial frequency. From the attening of NNPSmeas at high spatial frequency, the spatial frequency independent secondary quantum noise NNPSSQ can be identied. Using NNPSmeas, the DQE is calculated. Kengyelics et al (1998) have shown that this DQE is for g = 14. Simply rescaling the values of NNPSSQ is equivalent to changing g. This has been performed for g values of interest and the resulting values of DQE are plotted in gure 19(b). Changing g has an effect on DQE especially at high f. When g is decreased, DQE( f ) drops

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Figure 19. Extraction of secondary quantum noise and calculation of optical coupling gain g. (a) Plots of NNPS( f ) in the subscan direction (where the effect of the temporal lter can be ignored) and at low exposure (where structural noise can be ignored) for Fuji ST-V IP and AC3 reader (Kengyelics et al 1998b). The fractional drop between the NNPS at f = 0 (due to both x-ray noise NNPSX and secondary quantum noise NNPSSQ) and f very large (where NNPSSQ is the only noise) is approximately equal to g and more precisely g/AS + 1. In (b) DQE( f ) for the same IP and system is shown. A large part of the drop in DQE with increasing f is due to the increasing importance of NNPSSC. This can be emphasized by estimating the value of DQE( f ) at other g simply by changing the amount of frequency-independent NNPSSC.

Table 3. Contributions to the Swank factor in Fuji imaging plates readout in the AC3 reader. Calculation of AOPD from measured AS from table 2 and estimated AXED, AAED and ASQ as explained in text. IP type ST-V HR-V AS 0.70 0.45 AXED 0.90 AAED 0.85 ASQ 0.95 0.86 AOPD 0.91 0.64

precipitously. If g is increased then DQE( f ) increases, but only to a point. For g = 1000, secondary quantum noise is negligible and any further increase in g makes no signicant improvement in DQE( f ). DQE still decreases rapidly as f is increased. This is due to the Lubberts (1968) effect where the MTF for the ith layer MTFi is a function of the depth of absorption of the x-ray. If the same MTFi was valid for all depths, then the DQE would be independent of f, i.e. DQE proportional to MTFi2 NPSi with NPS proportional to MTFi2. However, in the case of depth-dependent MTFi, the total MTF is a weighted sum of MTFi. Similarly, the NPS is a weighted sum of NPSi each of which is proportional to MTFi2 at the corresponding depths. Since the Schwartz inequality states that the square of sums is always larger (equal only for the case of one layer) than the sum of squares, DQE( f )/DQE(0) is always less than unity and decreases as f increases. This accounts for the drop in DQE seen even when secondary quantum noise is negligible, i.e. g = 1000. The value of DQE(0) can be expressed as components, primarily the quantum efciency, but also affected by several other correction terms (equation (5)). An analysis of these terms has been performed for ST-V and HR-V IPs and the results are shown in table 3.

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Using data obtained at low x-ray exposure has eliminated structural noise. ASQ, which arises from the secondary quantum noise, has been calculated from the formula ASQ = (NPStotal NPSSQ)/NPStotal. From table 3 the estimated values of AOPD (0.6 for HR-V with black backing; 0.9 for ST-V with reective backing for PSL) are consistent with the known design of the modern IPs and when is assumed that the reader has been set at a readout depth F 0.5 or more. Systematic measurements of the spatial frequency dependent parameters: modulation transfer function MTF, Wiener noise power spectrum NPS and detective quantum efciency DQE( f ), have been performed for several generations of Fuji CR systems (Hillen et al 1987, Dobbins et al 1995, Kengyelics et al 1998b, Samei and Flynn 2002) and IPs (Kengyelics et al 1998a). A gradual improvement in CR IP and reader technology is evident and due to incremental improvements in several independent factors (Ogawa et al 1995). Other readers and IPs have also been investigated: Kodak (Bradford et al 1999), Lumisys (Fetterly and Hangiandreou et al 2000), inter-comparisons of all the former systems with Agfa (Samei and Flynn 2002) and Fuji IPs with Konica IP on the same Konica reader (Nakano et al 2002). General rules for the evaluation of systems have been proposed (Samei et al 2001). Super high-resolution systems have been evaluated (Flynn and Samei 1999, Kengyelics et al 1998a). The kVp dependence of DQE has also been investigated (Fetterly and Hangiandreou 2001). The difference between the DQE( f ) of ST-V and HR-V IPs is summarized in gure 20(a). The DQE(0) of ST-V is approximately twice that of HR-V which can be expected due to the almost doubling of phosphor loadings (table 2). The DQE( f ) at high frequency is higher for HR, at least if the reader is optimized. This is similar to conventional screenlm combinations shown in gure 20(b). The DQE( f ) of CR systems is lower than a perfect system could accomplish but can be completely understood from the limitation of the scattering phosphors and the CR readers. 5.4. First principles calculations of imaging properties It would be advantageous in the design and optimization of CR systems to have a complete analytical model describing the readout of a CR plate. Such a model has been developed (Lubinsky et al 1986, Korn et al 1986, Lubinsky et al 1987). In their model, the latent image is read, point-by-point, in the IP as the laser beam traces out the raster for all depths in the phosphor layer. The blurring of the laser readout light is modelled using analytical approaches developed by Kubella and Munk (Kortum 1969) and Swank (1973). The model has so far had only limited application (to a prototype IP design). It describes an inherently nonlinear process containing aspects of nonlinear discharge of the latent image and destructive scanning in two dimensions. To analyse needle-structured phosphors the modelling will have to be extended. This work has commenced in the context of XRIIs (Hillen et al 1991) and at-panel detectors (Rowlands and Yorkston 2000). Considerable further work is needed before making a practical, rst principles, calculation of MTF, NPS and DQE for arbitrary designs of CR systems. Once complete, this work should create a rm foundation for the optimization of the CR system design. 5.5. How close are powder phosphor CR systems to fundamental limits? Current CR systems are not optimal for image quality, but are practical and exible. The best photostimulable phosphor, BaFX:Eu2+ has an atomic number and density less than the best conventional phosphors (table 1) and has a gain lower than theoretically possible. However,

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Figure 20. (a) DQE comparisons between Fuji ST-V and HR-V with AC3 reader (Kengyelics et al 1998b) and HR-V with 7000 reader (Dobbins et al 1995). The concept of using HR-V for general radiography is that a loss of DQE(0) due to reduced absorption of IP permits reduced thickness of phosphor layer, which permits better MTF that will allow DQE to be maintained above DQE for ST-V at high enough spatial frequencies. However, this is true only for one of the two IP/reader combinations shown here. A further requirement is that g must be kept large as well. The values of g are shown on the plotted lines (obtained from Kengyelics et al (1998) and, for HR-V 7000 reader, estimated by the author using the procedure described in the text). (b) Classic DQE as a function of the thickness diagram (Sandrik and Wagner 1982) for conventional screenlm systems showing crossing of DQE curves due to thickness, absorption and MTF tradeoff. Note that Hi-Plus is approximately twice the CaWO4 phosphor loading of Par.

unless a new higher density photostimulable phosphor and a means to increase the conversion gain are discovered, the powder phosphor approach combined with the ying spot reader is close to a physical limit. Thus a radical new approach is required. 6. Concepts for improved CR What new approaches are available which might improve on conventional powder phosphors CR used with a ying spot scanner? Several possibilities will be examined and estimates made of possible improvements. 6.1. Dual-sided readout The concept of dual-sided readout is shown in gure 21 (Arakawa et al 1999, 2000). The substrate of the double-sided IP (DS IP) is made transparent. The advantages are twofold: (i) the IP construction is simpler, there is no need to make a special anti-halation layer, (ii) the admixture of the top and bottom light outputs is digital and so can be optimized at each frequency. The potential improvement in DQE is not yet known as dual-sided readout systems have not been compared directly with optimized single-sided readout systems. The estimate for DQE improvement is of the order of a factor of 2060% depending on the application. 6.2. Needle-structured phosphors Figure 22(a) shows conceptually the image quality improvements using needle-structured phosphors. Laser light is guided from the surface to the point of x-ray interaction and

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Figure 21. Two-sided readout system with two light collection systems and a single laser (Arakawa et al 1999, 2000). (a) Concept, (b) IP structure, (c) laser light penetration plotted as a function of the depth of phosphor and (d) PSL escape efciency to top and bottom PMTs.

Figure 22. Properties of needle-structured phosphors imaging plates. (a) Optical properties of the IP showing forward-directed PSL light emission and distribution of laser light reection and scattering and (b) read-out method to ensure the collection of the majority of the forward-directed PSL light while eliminating the direct reection of the laser.

PSL is guided back to the surface by a structure similar to a bre optic plate. Blue light emitting CsI:Na (Stevels and Schrama-dePaw 1974) was developed in a needle-structured form for use in XRIIs (Vosburgh et al 1977). More recently green emitting structured CsI:Tl has been developed (Nagarkar et al 1998) for digital radiographic systems using silicon detectors (Yaffe and Rowlands 1997), e.g. indirect conversion at-panel imagers (Rowlands and Yorkston 2000). The layers of CsI are made by evaporation in a vacuum under carefully controlled conditions such that the material crystallizes into long needleshaped crystals, perpendicular to the substrate. The size of the crystals is 110 m in diameter. Subsequently, heat is used to crack the crystals along their long boundaries to separate them into columns. Ideally the columns would be the full thickness of the layer and 50 m in diameter, i.e. considerably larger than the individual crystals but less than a typical pixel size, separated by cracks several wavelengths thick, e.g. 1 m, to prevent transmission of the evanescent ray between columns. Alternatively, special substrates can create crystal growth in a preferential manner so that spontaneously cracking occurs during the evaporation process (Jing et al 1992). The control of these processes is very difcult.

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The precise preparation approaches are trade secrets. Probably various methods are used so different imaging properties may result. For CR there are two image quality advantages of a structured IP compared to a powder IP made using the same phosphor. First, the effective density of a structured phosphor is almost doubled, as the screen (except for minor losses due to cracking) is 100% phosphor compared to the 60% packing factor in a powder phosphor (table 2). Secondly, the blurring in a structured phosphor of a given thickness is empirically the same as for a powder phosphor screen of half that thickness (Rowlands and Yorkston 2000). Thus a needle phosphor screen can have an increase in mass loading by a factor of four compared to a powder screen made from the same phosphor and yet maintain similar spatial resolution. A chest system has been developed using a 300 m layer of RbBr:Tl+ (Nakazawa et al 1990). It is encapsulated to protect the hygroscopic phosphor from fading due to humidity damage. A favourable phosphor microstructure was achieved using special substrates prepared by ame deposition of polymers. The readout of IPs made with structured phosphors requires a different approach than for powder phosphors. It must take into account the highly specular reections from the phosphor surface and the forward directionality of the emitted PSL light as shown in gure 22(a). The readout approach in gure 22(b) was developed to give the laser light a large angle of incidence. This permits the acceptance of the forward-directed PSL and avoids acceptance of the reected laser beam (Shimada et al 1991, Isoda et al 2001, Schaetzing et al 2002). Recent developments in needle phosphors have used a 500 m layer of CsBr:Eu2+ (Leblans et al 2001). These show much better DQE( f ) than is possible with BaFX:Eu2+and approach that possible with at-panel DR systems. 6.3. Line scanning readers In a line scanning reader, a bar is moved across the plate (or the plate may be moved under the scanner bar) to facilitate the readout of a complete line or lines (gure 23). An array of light emitting diodes (or lasers) and lenses create a nely focused line of stimulating (red) light on the surface of the IP. The resulting PSL is focused onto a silicon photodiode array. Photodiodes can be used in this application because each photodiode can be very small (e.g. 0.1 mm in the scan direction by 1 mm in the subscan direction) yielding a very low electronic noise that does not overwhelm the PSL signal. Line scanning readers have several advantages over ying spot scanners. Reading out a complete line potentially speeds up the readout process so that a complete line can be read out in the time it would take a ying spot scanner to read a pixel. This could, in principle, result in a three order of magnitude increase in readout rate, but to achieve this would also require a corresponding increase in laser power. Line scanning readers also offer fundamental image quality advantages; improvement in the system gain g, shown in gure 11 is the primary one. Two effects contribute to the improvement in g: (i) the collection of photons can be improved by having the image sensor closer to the irradiated area of the plate; (ii) the conversion efciency of light to charge in the photodiode, is potentially 4 times greater than a PMT. Together these two effects could increase g by an order of magnitude which would have a very signicant impact on DQE as seen in gure 19(b). Another image quality advantage is that the readout process is similar to that of at-panel imagers and thus resolution depends on the PSL spreading, not the laser beam spreading (only for the subscan direction of single line readers). Therefore nonlinearities that cause phosphor blunting (gure 14) do not occur in the scan direction for either type of reader but do remain in the subscan direction for single line scanners (Isoda et al 2001).

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Figure 23. Schematic of the line scanner that permits readout from an entire row (or rows) of the image at a time. (a) Detailed cross section of a reection mode scan head in the cross scan direction and (b) transmission mode. (c) Overall concept of the scanner where the plate is moved while a line (slit scan) or bar (slot scan) of stimulating red light is projected onto the IP and the emitted PSL is collected by the lens array and focused on the linear photodiode array or multiline CCD. Note that the MTF is controlled by the laser spread in the subscan direction and by the spread of the PSL in the scan direction. The multiline CCD has the capability of scanning the latent charge image across the CCD plane in the subscan direction (such devices are known as time domain integration (TDI) CCDs) simultaneously and in synchronization with the mechanical scanning of the IP.

6.4. Transparent photostimulable phosphor screens Figure 24 shows the improvements possible using transparent phosphor screens. It is necessary to carefully dene a transparent CR IP. It is essentially transparent to the laser and PSL light but to function it must have some interactions with the stimulating light and be capable of absorbing a fraction of it. Perhaps unexpectedly, a transparent phosphor can be used with the ying spot CR readout method (though not single or multiple line scanners) to create a higher image resolution than with conventional scattering IPs or even needle-structured phosphors. The reason is shown in gure 24. The stimulating laser beam is passed directly through the transparent IP, interacting only with PSL centres and thus resolution is, in principle, dened by the unscattered laser beam diameter. However, there are major problems with this approach: (i) laser light which scatters from unintentional but inevitable defects on the surfaces of the IP, e.g. scratches and dust particles, reects within the transparent layer causing area low frequency drop in MTF. (ii) Since the laser passes straight through, without being delayed by scattering, a more powerful laser is required. No estimates of the increase in laser power appear in the literature but it must be several orders of magnitude. (iii) Unless the laser beam is incident normally on the IP, the light reected from the exit plane of the phosphor will traverse through the phosphor and so reach other points within the IP and cause blurring. Normal incidence can be achieved using a telecentric scan lens so that the laser beam always emerges parallel to the principal axis of the lens. (iv) It is much more difcult to collect the PSL light from a transparent than a scattering IPs, as much of the light can be trapped within the IP by total internal reection. A solution proposed by DeBoer and Luckey (1988) uses a powder phosphor in a binder whose refractive index matches that of the phosphor for red light making the IP transparent for the stimulating laser beam. The materials are chosen to have different refractive indices for the blue PSL. Thus the layer acts as a scattering phosphor for the PSL, which can be collected in the usual way. The transparent phosphor approach is appealing but

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Figure 24. Transparent plate CR system. (a) Showing principle of creation of high resolution image by readout of a transparent plate. (b) Showing origin of geometrical blurring due to the oblique incidence of x-rays at the edge of the eld of view of the image combined with the high resolution expectation for a transparent phosphor and the increased thickness permitted by the approach. The virtual pixel is the region readout by each position of the laser beam at which digitization is performed, and it can be seen that the path of the x-ray is different from the pixel. (c) The readout method shown uses a telecentric scan lens which, as well as acting as a scan lens with F/ characteristics also has the property of light emerging from the lens, is parallel to the principal axis of the lens and so is always incident normally on the plate/lens system. In addition this system has the feature of readout in the same direction that the x-rays were incident, thus ensuring elimination of geometric blurring independently of the thickness of the IP, i.e. the x-ray absorption path is parallel to the division line between virtual pixels.

not ideal. Considering the extremely high sensitivity to unwanted scattering events and the high laser power required, it is suggested that this system cannot easily be made practical. 6.5. Dual energy By obtaining two images at different x-ray energies and by appropriate manipulation, removal of the complex bony detail may be accomplished to aid in visualization of soft tissue abnormalities. This is possible because the attenuation of x-rays by matter is due to two independent processes, photoelectric absorption and Compton scattering, each of which have different energy dependences. At each energy, the corresponding attenuation coefcients have a constant ratio for any element in the periodic table. Therefore two images obtained at different energies can be re-expressed as a ratio of the quantity of one element (or an arbitrary mixture of elements) to another, e.g. bone to soft tissue. In early applications, two separate exposures were made at different kVps and captured using an x-ray image intensier XRII. In general, the farther apart the energies of the two imaging beams, the better the separation of the images and the lower the noise. In applying dual energy for general radiology, an XRII is impractical so screenlm or CR has been used. Two cassettes cannot be moved mechanically between exposures quickly enough to avoid patient motion artefacts. Thus the two exposure approach used with XRIIs is not practical. The solution proposed was the single cassette/single exposure approach in which two (Ishigaki et al 1988, Kido et al 1993, Takeo et al 1996) or more (Ergun et al 1990) IPs are exposed simultaneously. This eliminates patient movement and the dual energy effect is obtained by the preferential absorption of softer radiation in the front IP and harder in the back IP. The spectra of the two images can be further separated by interposing a beam-hardening lter between the front and back IPs, but with the disadvantage of loss of quantum efciency

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(Stewart and Huang 1990) and/or by using a stack of several IPs each subject to a slightly different effective energy (Ergun et al 1990). Despite considerable effort, simultaneous high quantum efciency and good spectral separation in these images could not be obtained. At the same exposure level much noisier bone/tissue separated images are obtained using the single rather than the dual exposure method. Alvarez (1996) solved the problem of a dual plate CR system with no moving parts yet achieving a high degree of spectral separation between the two images. He used the erasability of CR plates to establish a highly differentiated x-ray spectrum to be absorbed in each IP. First he made a high kVp exposure to create a latent image in both the front and back IPs. This image was erased from the front plate by ooding it with light. Once erased, the second low kVp image was made. Due to the combination of the softness of the beam and an intermediate beam-hardening lter, the second image was absorbed essentially only by the front IP. The image separation in mean spectral energy is much higher than with the single kVp approach. This leads to a signicant increase in SNR almost equivalent to an instant readout system such as a at-panel imager or XRII but at much lower cost. 6.6. Overcoming the thickness-resolution optimization problemmultiple plate readout The rst clinical CR images seen by the author were part of an RSNA scientic exhibit in the early eighties. A stack of seven thin CR plates exposed simultaneously in the same cassette provided the raw images. These were subsequently digitized and recombined into a single digital image. This approach yields an MTF( f ) of a very thin plate, has the quantum absorption of a plate seven times as thick and an excellent DQE( f ) at all relevant spatial frequencies. In practice, this multiple plate approach was not adopted outside Japan. Presumably there was difculty in registration (Shaw et al 1997) and lengthy time requirements. This concept of plate stacking has been rediscovered (Barnes 1993). Two ordinary IPs were loaded into the same cassette (Workman and Cowen 1995) and the images were matched by cross-correlation techniques and recombined. The improvement in x-ray absorption is <100% since the second IP can only absorb x-rays not already absorbed by the rst. Thus it is impressive that Shaw et al (1997) were able to show a 60% increase in DQE, i.e. an improvement of SNR of 30%. This approach has considerable merit as a means of overcoming the thickness blurring tradeoff in IPs. However, it needs a new concept to make the recombination of a considerable number of IPs a practical reality. 7. Clinical application of complete CR systems The rst issue in establishing a new imaging system is how it compares to previous systems (Cowen et al 1993). For x-ray systems, the important measurements are image quality and patient dose, the former being highly dependent on the latter. Computed radiography has been compared to the digitized lm from a lmscreen combination (Yoshimura et al 1993). Image quality is very difcult to compare across imaging systems because of their inherently different properties (Fuhrman et al 1988). An interesting technical concept is to expose the CR IP in the same cassette with a conventional screenlm system, thus obtaining a perfectly matched CR and screenlm image in the same exposure and without additional radiation (Chotas et al 1991, MacMahon et al 1991, Sanada et al 1991, Wilson and West 1993). Recent studies have used more conventional approaches (Cook et al 1994) and comparisons of CR against DR systems (Rong et al 2001). There is little agreement as to whether the image quality of CR is better, worse or the same as screenlm.

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In a digital system the exposure can be varied over a large range yet still deliver an optimally bright image with a correct mean intensity and tone scale. In practice, there is a very narrow margin where the image is subjectively equivalent to screenlm. This is the basis for the statement that twice the exposure is necessary for standard CR plates (Huda et al 1997, Seibert et al 1996) to achieve the image noise perception characteristic of commonly used 400 speed screenlm, i.e. 2.5 Gy mean exposure to obtain an optical density of 1 above base plus fog, since standard CR plates are considered to be 200 speed (5 Gy mean exposure). This is a very subjective criterion, based on systems with differing MTFs and noise behaviour but it is signicant as it represent a clinical consensus. New systems mean new artefacts. The form of these artefacts and the diseases they may camouage or imitate are well documented (Oestmann et al 1991, Solomon et al 1991, Cesar et al 2001). A primary criterion used by radiologists in comparing image quality in lms is the appearance of x-ray noise in the image or quantum mottle. Any visual signs of mottle make an image unacceptable. The blurring in CR, by reducing the x-ray bandwidth, effectively reduces the appearance of noise. The control of latitude (Chotas and Ravin 1992) is important and the digital nature of CR makes quantication of images possible (Floyd et al 1990). The specic clinical applications of CR will now be reviewed. 7.1. Portable Photostimulable phosphor systems are widely used for emergency and bedside radiography where the variable readout sensitivity allows for compensation for under- and overexposure problems. Portable chest radiography presents particular problems (Niklason et al 1993) especially in intensive care situations (Jennings et al 1992). In bedside applications accurate lining up a grid is impractical and thus scatter (Floyd et al 1992) is difcult to control. 7.2. General radiography For chest radiography, comparative studies of the threshold perception of CR compared to screenlm (Dobbins et al 1992, Launders and Cowen 1995), indirect conversion at-panel imagers (Rong et al 2001), and selenium-based systems (Bernhardt et al 1999) have been performed. Radiation dose requirements for adults (Marshall et al 1994) and paediatrics (Kogutt et al 1988, Huda et al 1996) have been investigated. Oda et al (1996) determined the optimal beam quality and Lo et al (1994) showed the advantages of correcting for scatter using a beam stop technique. A one-shot dual energy CR procedure (Ishigaki et al 1988) has been investigated for the detection of pulmonary nodules (Kido et al 1993) and has been compared with asymmetrical screenlm (Kelcz et al 1994). Further studies with variation of dose have been performed (Kimme-Smith et al 1995, 1996). For both adults (Murphey et al 1992) and children (Kottamasu et al 1997) musculoskeletal, extremities (Wilson et al 1991), hand (Swee et al 1997), cervical spine (Wilson et al 1994) and scoliosis (Jonsson et al 1995) have been identied as useful applications of CR. The combination of equalization with CR has also been investigated (de Rooy et al 1993, Dobbins et al 1993). The application of CR to radiographic magnication is obvious, since magnication requires increasing the distance between the detector and patient, and hence the IP from the x-ray source. Using screenlm with a xed radiographic speed requires additional radiation to the patient to obtain an adequately exposed image. CR works well at reduced dose so that the exposure can be based on the radiation requirement of the imaging task and not simply the

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technology (Nakano et al 1986, 1987). A similar argument can be used for the application of CR to phase contrast imaging where the need for very large patientimager distances combined with as small a magnication as possible (to avoid focal spot blurring) gives an additional freedom for optimization not available with screenlm (Ohara et al 2002). 7.3. Mammography Early CR mammography used a 100 m pixel and conventional HR IP (Higashida et al 1992, Cowen et al 1997b) with a mixed reception. Using a contrastdetail phantom specially designed for mammography (Jarlman et al 1991, Cowen et al 1992), study of the visibility of microcalcications (Cowen et al 1997a) and linear analysis (Workman et al 1994) demonstrated comparable performance to screenlm despite a poorer limiting resolution. These results were conrmed using a clinical ROC study (Brettle et al 1994). However, the introduction of at-panel DR systems with improved dose efciency and MTF (Cowen et al 1997b) have raised expectations. CR readers with 50 m pixel size and a two-sided readout mammographic system (Jouan 1999, Arakawa et al 2000) have shown improved results (Seibert et al 2002) and clinical trials of these systems have begun.

8. Concluding remarks Computed radiography, based on the use of photostimulable phosphor IPs, is a very practical approach for digital radiography. It has penetrated practically every niche in clinical radiography. Combined with a cassette, it can be used in conventional x-ray rooms. IPs can be conveniently produced in large areas. The readout time is comparable to the standard screenlm and thus must be regarded as acceptable. It is not instantaneous so there is no immediate image evaluation on acquisition as in DR. Unlike screenlm, the CR readout process requires no consumable items. As PACS (picture archiving and communication systems) become more widespread, there will be little if any need for lm for diagnosis or archiving. CR IPs have a linear response over a wide range of x-ray intensities, and are erased simply by exposure to a uniform stimulating light source. Systems based on the use of ying spot scanners and the BaFBr0.85I0.15:Eu2+ and BaFI:Eu2+ powder phosphor IPs have been highly developed and perfected to the limits of powder phosphor technology. Unfortunately physical limits prevent this mode of CR reaching ideal behaviour and the CR systems have a relatively poor resolution and DQE compared to DR systems such as at-panel imagers. Methods to improve CR performance are possible and need to be investigated. Study of needle phosphor IPs, dual-sided readout and linear scanners and possibly the use of transparent phosphors may allow these new methods to be competitive. The theoretical basis of CR does not yet permit the accurate prediction of image properties. CR seems poised to make an explosive leap forward. This should be taken as an opportunity and a challenge for medical physicists to contribute to the further development and understanding of this important modality.

Acknowledgment The National Cancer Institute of Canada (NCIC) nancially supports this work through a Terry Fox Program Project Grant Imaging for Cancer.

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