Factors affecting

Radiographic Image Quality

J. Anthony Seibert, Ph.D.

University of California, Davis Medical Center
Sacramento, California
 Image Quality

• Image quality is an indicator of the relevance

of information presented in the image to the
task we seek to accomplish using the image

• Considered in terms of portrayal of

– Normal anatomy
– Depiction of potential pathology

• Not necessarily the “same” in all images

• A constraining factor is radiation dose

 Image Quality (IQ) in Radiography

• Which has  IQ?

• Which has  dose?

• Which is ALARA?

• More important for

PEDIATRIC imaging
1000 speed 350 speed
equivalent equivalent
 Introduction

• Goals of medical imaging

“Good” Image Quality at “Reduced” Dose
• Medical imaging is challenging
• Digital systems have changed the paradigm
• Image processing is extremely important
• Desired endpoint:
Optimized Image Quality at Minimized Dose

ALARA
Image acquisition, display, & interpretation

X-rays Patient Detector Computer PACS Human

kVp Size Efficiency Digitization Data delivery Radiologist
mAs Restraints Resolution Preprocessing Data display Physician
Tube filtration Exam type Scatter grid Postprocessing Data storage Experience
Collimation ESE, dose DQE Configuration Workflow Condition
Acquisition to Interpretation: Image Quality
• Image quality is an indicator of the relevance
of information presented in the image to the
task we seek to accomplish using the image

• Considered in terms of portrayal of

– Normal anatomy
– Depiction of potential pathology

• Not necessarily the “same” in all images

• A constraining factor is radiation dose

 Sensitivity of Patient to Radiation
Radiation Induced Cancer Lifetime Risk From
1 Sv Whole Body Dose
15

Attributable Life-Time Risk

All Ages: 5%
10
1st Decade: 15%

% per Sv
Population
2nd Decade: 8% averages
Female
Middle Age 1 - 2 % 5 Male

Child ~10 X Sensitive Females

Males
0
0 50 100
Age at Time of Exposure
 Pediatric vs Adult Imaging Challenges

Large Adult

Adult

5 year

1 year

Neonate
5 cm

1 HVL @ 70 KVP
 Detector

• Screen-film
– Fixed speed
– Chemical processing
– Image quality optimization inflexible
• Digital detector
– Variable speed
– Electronic processing
– Image quality optimization flexible
 Image Quality

• Screen-film radiography
– IQ “built in” to the characteristics of the film
– Film is acquisition, display and archive medium
– Dose is determined by screen-film speed

• Digital radiography
– IQ dependent on Signal to Noise Ratio (SNR)
– Separation of acquisition, display, and archive
– Dose is variable and dependent on required SNR
 Conventional screen/film detector
1. Acquisition, Display, Archiving

Transmitted x-rays
Exposed film Film processor
through patient

Developer Fixer Wash Dry

Gray Scale
encoded on
Film Intensifying Screens film
x-rays  light
 Digital X-ray Detector 2. Display
Digital Pixel Digital to Analog
1. Acquisition Matrix Conversion

Transmitted x-rays
through patient

Digital
processing
Analog to Digital
Conversion

Charge X-ray converter

collection x-rays  electrons
device
3. Archiving
X-ray absorption Efficiency: CsI, BaFBr, Gd2O2S, a -Se
100
90 CsI: 175 mg/cm2
% Absorption Fraction

80
70 Gd2O2S: 120 mg/cm2
60
50
BaFBr: 100 mg/cm2
40
30
20
a-Se, 500 mm
10
0
10 20 30 40 50 60 70 80 90 100 110 120 130 140
Energy (keV)
 Signal Capture / Display:
Indirect vs. Direct Signal Acquisition
Indirect capture -- Indirect Display

Screen-film CR

Gd2O2S
Intensifying BaFBr
Screens Storage
Phosphor
Film
Laser
Chemical
Electronic
(Film) Processing
Processing

Photostimulated
Film Digitization
Luminescence
And Digitization
Line Spread
Function
 Signal Capture / Display:
Indirect vs. Direct Signal Acquisition

Indirect Capture -- Direct Display Direct Capture -- Direct Display

CCD a-Si TFT array a-Se TFT array

Electrode
Gd2O2S CsI Dielectric
Intensifying scintillator layer +-
Screens Columnar
crystals a-Se
Lens or photoconductor
fiberoptic taper
Photodiode Electrode
CCD collector collector
a-Si TFT Array a-Si TFT array
Captured light
to electrons to
digital signal
 Analog versus Digital
Spatial Resolution
Exposure Latitude

Detector
Element,
Sampling Film

Signal output
“DEL” Digital
Pitch

MTF of pixel aperture (DEL)

1
0.9
100 mm
0.8
0.7
200 mm
Modulation

0.6
0.5 100:1
1000 mm
0.4
0.3 10000:1
0.2
0.1
0
0 1 2 3 4 5 6 7 8 9 10 11 Log relative exposure
Frequency (lp/mm)
 Digital Detectors
• Sampling and quantization (noise sources)

• Detector pre-processing (correct imperfections)

• Image post-processing (enhance image contrast)

 Analog to Digital Conversion:
Digitization

• Sampling: measuring the analog signal at

discrete spatial positions
– @ 2x frequency of video bandwidth

• Quantization: converting the amplitude of the

sampled signal into a digital number
– Determined by the number of ADC bits
 Sampling

• Signal averaging within detector element (del)

area = x  y

• Cutoff sampling frequency = 1 / x

• Nyquist frequency = 1 / 2x

• Minimum resolvable object size (mm)

= 1 / (2  Nyquist frequency)
 Sampling: discrete spatial measurement
infinite bits, 3 samples / line

Input

Sampling aperture Sampling points relative error

infinite bits, 7 samples / line

Input

relative error
Sampling aperture Sampling points
 Aliasing: Insufficient sampling

Pixel Sampling

Low frequency

> 2 samples/ cycle

High frequency

Assigned (aliased) frequency < 2 samples/ cycle

 Aliasing effects:
Input signal frequency, f > Nyquist frequency, fN

input f = 1.5 fN input f = 2.0 fN

output f = 0.5 fN output f = 1.0 fN

 How important is aliasing?
• High frequency noise lowers DQE(f) in the clinically
useful frequency range

• Stationary anti-scatter grids

• Image size reduction can cause aliasing

– Sub-sampling retains high frequencies, violating Nyquist limit
 Grid issues: Aliasing
• Sampling the image information
in an array of columns and rows Grid
can result in line pairing, Sampled
particularly with lower frequency detector
grids positioned slightly obliquely
to the array. This beating pattern
artifact is caused by insufficient
sampling.

• RECOMMENDATIONS
– Use high frequency stationary
grids or moving grids.
– Orient grids perpendicular to CR
laser scan direction or DR
readout (row) direction.
 Resolution and image blur
• Sources of blur
– Light spread in phosphor
– Geometric blurring: magnification / focal spot
– Averaging of signal within discrete detector element

Thick Screen: Thin Screen: Structured Phosphor:

 Good Absorption  Poor Absorption  Good Absorption
 Poor Resolution  Good Resolution  Good Resolution

Internal
LSF reflection
 Sampling and spatial resolution

1000 samples 500 samples 250 samples 125 samples

 Quantization: conversion to digital number
2 bits (4 discrete levels) and infinite sampling
3

input signal ramp quantized output relative error

3 bits (8 discrete levels) and infinite sampling

7
6
5
4
3
2
1
0

input signal ramp quantized output relative error

 Quantization Effects
Quantization noise causes “contouring”

Typical bit depths for CR/DR: 10 – 14 bits

8 bits 4 bits 3 bits 2 bits

“Contouring” is a problem in areas slowly varying in contrast.

 Dynamic range considerations

• Maximum usable signal determined by:

– Saturation of detector
– Analog to digital converter (ADC)

• Minimum usable signal determined by:

– Number of bits in ADC
– Quantum noise
– System noise bits graylevels
– Electronics 8 256
10 1024
12 4096
14 16384
Image acquisition and display Outside
images

Acquisition Post-processing
Pre-processing Display ?
Uncorrected Corrected “For display” Image
“Raw” “Raw” enhanced comparisons

X-ray system Enhancement:

- Spectrum - Equalization
- Detector - Contrast/Detail

Dead pixels Hard/Soft Copy

Column/line defects Perceptual linearization
Shading/flat-fielding VOI LUT -- DICOM GSDF
Signal amplification Hanging / Viewing
 Signal to Noise Ratio (SNR)

• Determines detectability of an object

• The signal is derived from the x-ray quanta
• The noise is from a variety of sources:
– X-ray quantum statistics
– Electronic noise
– Fixed pattern noise
– Sampling noise (aliasing)
– Anatomical noise

• System pre and post processing are crucial

 Pre-Processing
Two major steps correct and adjust for:

1. Detector / x-ray system flaws

– Pixel defects
– Sensitivity variations
– Offset gain variations
– X-ray beam variations (e.g., heel effect)

2. Wide detector dynamic range

– Identify image location
– Scale image data
– Optimize quantization levels for “post-processing”
 Pre-processing schemes

• 1-dimensional shading correction

– Computed Radiography (CR)
– Linear CCD

• 2-dimensional flat-field correction

– Area CCD, CMOS
– TFT arrays
Shading correction techniques: 1-D data
Apply offset correction to uniform exposures, n averages:

IO (x)  I(x) i - O(x) i ; i  1, n

Create normalized shading correction array:

IO Global average
Sh(x)  x
IO (x) Average row data
Implement shading correction (line by line):

C(x)  I(x) - O(x)   Sh(x)

 1-D shading correction Pre-processing

Response Corrected response

Scan Direction

Low noise, inverted, normalized correction trace

 2-D flat-field correction

• Non-functioning components:
– Dead pixels in columns and/or rows

• Intensity variations:
– Uneven phosphor coating
– Optical coupling (vignetting, barrel distortion)
– Converter sensitivity

• Variation in offset and gain of sub-panels

• Variation in black-level correction

 Uncorrected flat-panel image
Background
signal

+,-
column defects
row defects

pixel defects
Sub-panel offset gain variation
 Flat-field techniques: 2D image
(fixed detector)

Apply offset and average of <n> uniform exposures:

IO (x, y)  I(x, y)i - O(x, y)i ; i  1, n

Create normalized flat-field correction matrix:

IO Global average
FF(x, y) 
IO (x, y)

Implement flat-field correction on acquired image:

C(x, y)  I(x, y) - O(x, y)   FF(x, y)

 2-D Flat-field correction
Pre-processing

Raw, Raw Correction “mask” Raw Processed

Background variations Avg, inverted background Pre-processed image Contrast, resolution

Column, line defects Column, line, pixel repair Image pixel value to enhancement; proprietary
“Del” dropouts Normalized values exposure relationship? processing
Preprocessing, Step 2: find / scale image

Shift and Subtract Collimation

Border
Create / analyze Histogram Distribution
Collimated Direct
area x-ray
Frequency Anatomy area

Pixel value
Useful signal

The shape is dependent on radiographic study,

positioning and technique
 Data conversion Grayscale transformation
Exposure into digital number Input to output digital number
1,000

Output digital number

102 800
Relative PSL

101 600
100 400
10-1 200

10-1 100 101 102 103 0 511 1023 0

200 600 1,000
Exposure input Raw Digital Output Raw Input digital number
Histogram
min max

1. Find the 2. Scale to 3. Create film

signal range look-alike
 Histogram: pediatric image
to 9368 to 8323
800
Frequency

600

400

200

0
0 200 400 600 800 1000 Digital value

Useful image range for anatomy

Pre-processed Scaled and inverted:
“raw” image “For Processing” image
 Data conversion for overexposure
Exposure into digital number
Reduce overall gain

102
Relative PSL

101
100
10-1

Exposure
input 10-1 100 101 102 103 0 511 1023
Raw Digital Output

overexposure (scaled and log amplified)

min max
Screen – Film

Identical exposure

Digital
 Data conversion for wide latitude
Exposure into digital number: less kV dependence
Change gradient
(auto mode)
102
Relative PSL

101
100
10-1

Exposure
input 10-1 100 101 102 103 0 511 1023
Raw Digital Output
low kVp
(broad histogram) (scaled and log amplified)
min max
 Contrast Enhancement

• Optimize image contrast via non-linear

transformation curves

• Unprocessed images: “subject contrast”

• Proprietary processing:
– “Gradation processing” (Fuji)
– “Tone scaling” (Kodak)
– “MUSICA” (Agfa)
– …….. And others by the various manufacturers
 Look-up-table transformation
1,000
M L
Output digital number
E A
800

600
Fuji System
400 Example LUTs

200

0
0 200 400 600 800 1,000

Input digital number

 Types of image output:
Contrast
Raw Unprocessed Enhanced

“Pre-processed” “For processing” “For presentation”

No scaling CAD Proprietary
No flatfield VOI LUT Limited variability
 VOI LUT: a flexible approach

• Value Of Interest Look-Up-Table (DICOM)

• Adjustment of contrast, brightness with non-linear
LUT adjustment
• Provides for manipulation of raw data
(“For Processing” images)
• Universal support (modalities, PACS) not available
• Future universal image processing workstation?
 DICOM VOI LUT
• Configure CR/DX modality to send specific VOI LUT
– Eliminates “burned-in” LUT and potential information loss

• PACS must be able to use and vary VOI LUT

Adjustable VOI LUT 4095

0
Raw image histogram values P - values

From Mike Flynn, Ph.D.

 Spatial Frequency Processing
“Edge Enhancement”

Solid:
MTF:
Edge original response
original
Enhanced:
Difference: response
Dash: low- pass
Difference
Original filtered
+filtered
Original
Response

Original Blurred
Response

Sum

low
low
lowlow high
high
high
high
Spatial frequency
Difference Edge enhanced
 Multi-band Frequency Processing

Non-linear Non-linear Non-linear Non-linear

weighting weighting weighting weighting

Optimize sub- “Multi frequency”

band weighting enhanced image
Standard Processing Multi-frequency Processing

Compliments of Keith Strauss, Boston Childrens Hospital

 Quantitative measures of Quality
• SNR: Average value / Std Dev of background

• CNR:  Attenuation / Std Dev of background

– Contrast: tissue differences, tissue/bone differences

– Subject contrast: X-ray energy

• Detection: CNR of 3 to 5
– Size (diameter); image processing
SNR and CNR

Background
420.3 3.3

Object
411.8 3.3

420.3
SNR = = 127.4
3.3

420.3 - 411.8
CNR = = 2.6
3.3
 Noise Sources
• Incomplete x-ray absorption: 
• Secondary quantum noise: quantum sink
– # secondary quanta  incident quanta
• Spatial gain variation (flat-field)
• Aliasing (insufficient sampling)
• Swank Factor
– Different x-ray photons produce variable signal
• Lubberts Effect
– Different x-ray photons produce variable PSF’s
• Additive system noise
– electronic, quantization, shot, etc.
 Visual Detection of Object
• SNR (CNR) is dependent on # x-ray quanta
• Detection is determined by CNR and object size

Signal  N0g g = gain

 = efficiency
Variance,  q2  N0g ( g 2   g2 )
1
SNR = N0 η
2

1   g2 g 2
k is threshold detection CNR = 3 to 5
k = SNR  d  C
(circular object of diameter d and contrast C)
 Limiting spatial
resolution

Low dose

High dose
Contrast-Detail Phantom Image
Limiting contrast
resolution
Low Contrast Response: Leeds TO-16

3.5 mR (30.6 mGy) 70 kVp 0.5 mR (4.4 mGy)

10 mAs 20 mAs
50 mAs 100 mAs
 What determines necessary dose?

• Patient thickness
• X-ray technique; GRID or NO GRID
• Detector absorption AND conversion efficiency
• Detector electronic and stationary noise
• Detector Detective Quantum Efficiency (DQE)
• Required SNR / CNR of examination
• Pre and post processing algorithms
• Display and viewing conditions
Detective Quantum Efficiency (DQE)
2
SNR out MTF(f )2
DQE(f ) = 
SNR in NPSN ( f )  q
2

• A measure of the information transfer

efficiency of a detector system

• Dependent on:
– Absorption efficiency
– Conversion efficiency
– Spatial resolution (MTF)
– Conversion noise and electronic noise
– Detector variable gain and pattern noise
 “Pre-sampled” MTF
1.0
0.9
0.8 a-Selenium: 0.13 mm

0.7
Modulation

0.6
0.5 CsI-TFT: 0.20 mm
0.4
CR: 0.05 mm Screen-film
0.3
0.2
0.1
CR: 0.10 mm
0.0
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
Frequency (lp/mm)
 Noise Power Spectrum
• Noise transfer characteristics of detector
• Analyze sub-images, Fourier Transform, average
– (IEC 62220-1 standard, AAPM Task Group on NPS)

• Output is the noise power estimate as a function

of spatial frequency, NPS(f) in 2 dimensions
CR Image NPS

Scan Direction
Detective Quantum Efficiency, Radiography
0.8
CsI - TFT

0.6
DQE( f )

a-Se - TFT
0.4
CR “dual-side”
Screen-film
0.2
CCD
CR Conventional
0.0
0.0 0.5 1.0 1.5 2.0 2.5
Spatial Frequency (cycles/mm)
 Screen-Film
Flat-field pre-processing
MDACC: Chris Shaw, et al

Low contrast
aSi/CsI Flat-Panel
resolution

CR

125 kVp
2 mAs

Image quality depends on more than

quantum mottle!
Flat-field, absorption efficiency, scatter …
Digital Radiography: Radiation Exposure

• CR and DR tolerate poor radiographic technique

• Dose is dependent on DQE and “required” SNR

• Dose is roughly proportional to inverse of DQE

 Exposure issues

• Incident exposure can be “hidden”

• Low exposures have excessive image noise

• High exposures lead to saturation signal loss

• Technique complacency, instead of “just enough”

• Feedback is necessary!!
– S number, Exposure Index, LgM, f-number, other?
 Characteristic Curve:
Response of screen/film vs. digital detectors
5
Useless
4 10,000
Film-screen
Film Optical Density

(400 speed) Digital

Relative intensity
3 1,000
Overexposed
Useless
2 100
Correctly exposed
1 10
Underexposed
0 1
0.01 0.1 1 10 100 Exposure, mR

20000 2000 200 20 2 Sensitivity (S)

 How do manufacturers indicate
estimated exposure?
• Fuji: “S” – sensitivity number
• S  200 / Exposure (mR)

• Kodak: “Exposure Index” – EI

• EI  1000  log (Exposure [mR] ) + 2000

• Agfa: “lg M” – relative exposure database

• IDC: “f-number” – provides analogy to camera speed

• +1 = 2x exposure; +2 = 4x exposure

• DR: most systems currently do not have a feedback

signal… but use phototiming (AEC)
 CR / DR and dose efficiency
• CR ~ 2X more exposure than a 400 speed film ~200
equivalent speed

• DR system DQE(0) values vary substantially (20 - 80%)

• Dose efficiency related to DQE for given SNR

• Slot-scan systems most efficient (scatter rejection)

• NEED: Pre and post patient measurements

– kV and mAs, DAP, and detector exposure index
 CR/DR implementation

• Image Processing optimization

– Establish Contrast Scale
– Balance Edge Enhancement with perceived noise
– Multi-frequency Enhancement parameter
adjustments
– Determine DC offset (brightness) for display
monitors

• Verify image display conditions

– Soft copy and hard copy
 SMPTE pattern
(Society of Motion Picture and Television Engineers)

Pre Calibration Post Calibration (GSDF)

 GSDF calibration
Grayscale Standard Display Function: DICOM part 14

Pre-calibration

Post-calibration
 Viewing condition precautions

• Room illuminance
• Angular luminance variations of LCD’s
• Small, low quality Tech QC monitor

Too much room light!!

 Angular viewing dependence

• LCD Screens should be perpendicular to eye gaze

From Bottom

From Top
From Middle
 CR/DR implementation
• Uniformity for CR/DR images and Display
– Acceptance Testing
• Measurement of Performance
• Correction of Substandard Performance

– Calibration of CR/DR Response (presentation state)

– Calibration of Monitors
• Maximum brightness
• Look-up-Tables, DICOM GSDF, Part 14

– Periodic Quality Control

• Evaluation of resolution, contrast, artifacts
• Monitor technologist performance, exposure indices
 Summary

• Radiographic image quality

– Task dependent, and a function of acquisition and display
– Limited by dose to the patient

• Signal to noise ratio

– Ideally, system is quantum limited
– Noise sources are quantum, electronic, stationary

• Image processing
– Pre-processing to enhance detector performance
– Post-processing to enhance grayscale and image features

• The SYSTEM…. Is only as good as the weakest link