LECTURE 02:

DESCRIPTION OF THE IAEA

METHODOLOGY FOR RADIOGRAPHIC
REMOTE QC
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NOTE TO READER
• The IAEA publication ‘Diagnostic Radiology Physics: A Handbook for Teachers and Students’ (International
Atomic Energy Agency (IAEA), Diagnostic Radiology Physics, Non-serial Publications, 2014) contains basic
information on radiography and mammography, instrumentation, image quality/image perception, dosimetry etc.
• Additional training material, in the form of PowerPoint presentations, has been developed for each chapter of the
handbook and are uploaded at the IAEA Human Health Campus (
Human Health Campus - Diagnostic Radiology Physics: A Handbook for Teachers and Students (iaea.org). They
are designed, as an additional training tool to assist in the better presentation of the content of information in the
Handbook.
• The current training material is not designed to replace the existing PowerPoints. It builds upon these
presentations in order to deepen knowledge in the specific topics reviewed in the new publication “International
Atomic Energy Agency (IAEA), Implementation of a Remote and Automated Quality Control Programme for
Radiography and Mammography Equipment, Human Health Series No. 39, IAEA, Vienna 2021”.
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LEARNING OBJECTIVES
• By the end of this presentation, you should be able to:
•explain the concept and rationale behind the Remote QC Programme

•describe the radiographic phantom

•set up the radiographic phantom and perform the imaging of the radiographic phantom

•perform image quality analysis using ATIA

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OUTLINE
• Concept and rationale behind Remote QC Program
• Description of the radiographic phantom
• Positioning and imaging the radiographic phantom
• ATIA image quality analysis
• Signal-to-noise ratio (SNR)
• Signal-difference-to-noise ratio (SDNR)
• Detectability Index (d’)
• Modulation Transfer Function (MTF)
• Normalized Noise Power Spectrum (NNPS)
• Virtual Transfer Function (VTF)
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THE CONCEPT OF REMOTE QC

• The IAEA developed an entire program for Remote

QC of radiographic and mammographic system
• A remote automated quality control program that
provides quantitative image analysis to facilitate
remote QC applications which can promote SDNR insert

collection of data to ensure consistency in MTF insert

Radiology.

Source: author
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THE CONCEPT OF REMOTE QC

• The Remote QC program includes
• Instructions to build a low-cost
phantom
• Image acquisition procedures and
instructions
• Analysis of the image using the
Automated Tool for Image Analysis
(ATIA) software

Source: author
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THE CONCEPT OF REMOTE QC

• To facilitate remote, reliable QC programs, that require a minimum
equipment, as well as human and financial resources. The analysis
system will inform the responsible CQMP if any measured value is out
of limits or if a worrisome trend is developing.
• To promote collection of data in a uniform harmonized manner allowing
for comparison and benchmarking, to ensure consistency
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THE CONCEPT OF REMOTE QC

• The phantom is very simple and relatively inexpensive, as it requires
materials which can be purchased and manufactured locally.
• The tool is user-independent and can be used quickly.
• Frequent quality control testing promotes a culture of quality in imaging.
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THE RADIOGRAPHIC PHANTOM

• Described in detail in IAEA Human Health Series 39
• Target plate: 28 cm x 28 cm of PMMA; 5 mm thick
• MTF insert, 5 cm x 5 cm copper plate; 2 mm thick
• Placed at an angle of 2-5 degrees with respect to straight edges of PMMA
target plate
• SDNR insert: 1 cm x 1 cm aluminum plate; 4 mm thick
• Quality or purity of metal inserts not important
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DIMENSIONS OF THE
RADIOGRAPHIC PHANTOM

Source: IAEA HH Series 39

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TIPS FOR MANUFACTURING THE

RADIOGRAPHIC PHANTOM
• Care and professional assistance (workshop) is required to create sharp edges on the
Cu insert to allow proper evaluation of the MTF.
• The vertical edge of the MTF insert should be positioned at an angle of 1-5 degrees
and close to the central axis of the phantom.
• Inserts can be glued carefully on the PMMA plate of 5 mm.
• The uniform phantom of 2 mm Cu can also be utilized separately to obtain
uniformity images, so care is required to avoid scratches.
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TIPS FOR MANUFACTURING THE

RADIOGRAPHIC PHANTOM
• The phantom blueprint (Radiography_Blueprint.pdf) should be printed in A3-size paper
(IAEA HH Series 39)
• This can be used as a guide for the correct placement of the Cu and Al inserts, both in terms
of proper size, positioning and angulation.
• Unlike the case of commissioning and acceptance testing, the purity of the inserts (Al, Cu) is
not of primary importance.
• It should be verified (under radiographic imaging prior to assembly of the phantom) that all
elements have the necessary uniformity to ensure proper image uniformity, so care is
required to avoid scratches.
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THE RADIOGRAPHIC PHANTOM

• Attenuator plate: 10 cm x 10 cm (or as large as needed); 2 mm Cu plate
placed at exit port of collimator
• Before permanently gluing the metal inserts on the phantom, run several
test images to verify they are processable by the ATIA software
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THE RADIOGRAPHIC PHANTOM,

SDNR insert
MTF insert

Source: IAEA HH Series 39

Source: Author
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THE RADIOGRAPHIC PHANTOM

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POSITIONING OF THE PHANTOM

• Place phantom on DR detector or CR cassette (or on radiographic
system tabletop to monitor full system performance including antiscatter
grid)
• A positioning template (even on paper) may be helpful to secure
consistent phantom positioning
• SID = 100 cm
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POSITIONING OF THE PHANTOM

• If the “automasking” feature on CR or DR system cannot be easily
disabled, open collimators to extend field beyond margins of the
detector/cassette; otherwise, collimate to extend field just outside
margins of target plate
• Once positioning is done, place attenuator at bottom of collimator,
ensuring that the entire X ray field is being attenuated
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POSITIONING THE PHANTOM

Source: Author Detector collimation Phantom collimation

Source: Author
 19

POSITIONING THE RADIOGRAPHIC

PHANTOM
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IMAGING THE PHANTOM

• Although wear and tear over time is inevitable, a few things to keep in mind
• Avoid storing the phantom in areas which may get very hot during the day
• Target plate may lose flat shape
• Metal inserts may move or come unglued from the target plate
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IMAGING THE PHANTOM

• Avoid scratching the target plate
• ATIA software results are not generally affected by presence of minor scratches or
dust, but major damage or debris on the phantom will affect the results
• Although phantom orientation in the field does not impact results, consistent
orientation is recommended
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IMAGING THE PHANTOM

• Radiographic technique
• 80 kVp
• If AEC is available, select the center cell
• Use most typical average mA value
• If no AEC is available, or if testing DR detector alone, select appropriate manual technique
• Make an exposure
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IMAGING THE PHANTOM

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IMAGING THE PHANTOM

• As image becomes available in review station, make sure positioning and collimation were
done as required
• When in doubt, reposition or recollimate and reacquire image
• Observe image for possible artifacts and other unusual image appearance
• The remote QC publication suggests to modify window and level settings for this step
• Care must be taken, as windowing and leveling at review station in certain CR and DR
systems may result in file truncation, affecting the output image file
• Consult with service engineer!
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EXTRACTING OR UPLOADING
THE IMAGE
• Consult with service personnel as to how to
access/extract/upload the “raw” or “for processing”
version of the image
• Do not extract or upload the processed version of the
image; results will be incorrect
• Do not manually delete images from CR or DR
system in case you need to re-extract or upload; they
can be autodeleted later by the system itself

Source: Author
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SIGNAL-TO-NOISE RATIO (SNR)

• The pixel signal-to noise ratio (SNR) compares the signal level at a given location within the
image to a measure of the noise made at the same location
• The signal (S) is calculated as the mean pixel value (PV) from a region of interest (ROI).
The standard deviation from the same ROI is used as a very simple estimate of the noise (σ).
• SNR is the ratio of these two values:
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SIGNAL-TO-NOISE RATIO (SNR)

• For periodic testing, the ROI should
always have the same size and should be
located in the same position SNR and SDNR ROIs

• ROI should be of a size with a sufficient

number of pixels to ensure that a
repeatable value is obtained, but small
enough to avoid any heel effect

Source: Author
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SIGNAL-TO-NOISE RATIO (SNR)

• An ROI of 5 mm x 5 mm is sufficiently
large
SNR and SDNR ROIs
• The ROI should not include local artifacts
• In ATIA, the ROI has been placed in a
uniform area of the phantom. If the user
notes local artifacts in the ROI, the ROI
position should be moved away from the
artifact
Source: Author
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SIGNAL-TO-NOISE RATIO (SNR)

• SNR should be calculated in “raw” or “‘for processing” images. This presents a linear
response with respect to dose and corrected for the offset value
• Many DR systems have a linear response and have zero offset value
• More care is required for CR systems, which often present a logarithmic response or have a
power law relationship between pixel value and detector air kerma
• In the Remote QC program, the goal is to monitor the performance of a system over time as
part of a QC program, and thus this linearization is not needed
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SIGNAL-DIFFERENCE-TO-NOISE
RATIO (SDNR)
• The signal-difference-to-noise ratio (SDNR) is a simple measure of target
conspicuity that has been shown to correlate with more complex detectability
measures for circular objects in homogenous backgrounds
• Two ROIs are used:
• one positioned within the Al square
• one in the local background
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SIGNAL-DIFFERENCE-TO-NOISE
RATIO (SDNR)
• Mean pixel value from the ROI in the Al square (PVAl) and from ROI in the
background (PVbg) are measured
• The noise is taken to be the standard deviation (stdev) of the pixels within the
background ROI
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SIGNAL-DIFFERENCE-TO-NOISE
RATIO (SDNR)
• For periodic testing, the ROIs should always have
the same size and should be located in the same
position
• ROIs should be of a size with a sufficient number
of pixels to ensure that a repeatable value is
obtained, but small enough to avoid any heel
effect
• ROIs of 5 mm x 5 mm is sufficiently large and fit
well within the 10 mm x 10 mm Al insert

Source: Author
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SIGNAL-DIFFERENCE-TO-NOISE
RATIO (SDNR)
• ROIs should not include local artifacts
• In ATIA, the ROIs have been placed in the corresponding regions within
and outside the Al insert, respectively
• SDNR should be calculated in a “raw” or “for processing” images that presents a
linear response with respect to dose and corrected for the offset value
• Many DR systems have a linear response and have zero offset value
 34

SIGNAL-DIFFERENCE-TO-NOISE
RATIO (SDNR)
• More care is required for CR systems, which often present a logarithmic
response or have a power law relationship between pixel value and
detector air kerma
• In the Remote QC program, the goal is to monitor the performance of a
system over time as part of a QC programmme, and thus this
linearization is not needed
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DETECTABILITY INDEX (d’)

• Model observers are a mathematical means of estimating a measure of target
detectability from images as they overcome many of the drawbacks of human
detectability studies such as inter-reader variability
• A non prewhitening model observer with eye filter (NPWE),
• NPWE observers have been used to describe object detectability in contrast-detail
test objects, for both screen-film systems and for digital detectors
• The NPWE detectability index expresses the detectability of objects for some given
geometry, object size and shape and a measure of large area image contrast and is
calculated as follows:
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DETECTABILITY INDEX (d’)

• Where C is the measured contrast to estimate the contrast transfer in large areas and
is obtained from the Al insert in the phantom
• The 5 mm target plate results in an almost scatter-free image
• S is the Fourier transform of a disk-like object with radius R described by a first-
order Bessel function
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DETECTABILITY INDEX (d’)

• MTF is the presampling modulation transfer function
of the detector, measured using a version of the edge
method MTF ROIs
• Obtained from the machined straight edge of the 2°-4°
angled Cu insert with respect to the pixel matrix
• A finely sampled version of the edge spread function
(ESF) is formed from which the presampling MTF is
calculated, with a generation of the ESF from a ROI
positioned on the edge

Source: Author
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DETECTABILITY INDEX (d’)

• The NNPS (normalized noise power spectrum) was
estimated from a region of 512 x 512 pixels in a
homogeneous area of the phantom image. Half-
overlapping 256 x 256 pixel ROIs are then extracted
for 2D NPS calculation. In line with IEC guidelines
• VTF is the visual transfer function

• where u is the spatial frequency.

Source: Author
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DETECTABILITY INDEX (d’)

• d’ should be calculated in “raw” or “‘for processing” images. This presents a linear response
with respect to dose and corrected for the offset value
• Many DR systems have a linear response and have zero offset value
• More care is required for CR systems, which often present a logarithmic response or have a
power law relationship between pixel value and detector air kerma
• In the Remote QC program, the goal is to monitor the performance of a system over time as
part of a QC program, and thus this linearization is not needed
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END OF LECTURE 7
 BIBLIOGRAPHY 41

• International Atomic Energy Agency (IAEA), Implementation of a Remote and Automated

Quality Control Programme for Radiography and Mammography Equipment, Human Health
Series No. 39, IAEA, Vienna (2021).
• International Atomic Energy Agency (IAEA). Worldwide Implementation of Digital Imaging in
Radiology, Human Health Series No. 28, IAEA, Vienna (2015).
• International Atomic Energy Agency (IAEA). Dosimetry in Diagnostic Radiology: An
International Code of Practice, Technical Reports Series No. 457, IAEA, Vienna, 2007.
• International Atomic Energy Agency (IAEA). Roles and Responsibilities, and Education and
Training Requirements for Clinically Qualified Medical Physicists, Human Health Series No. 25,
IAEA, Vienna, 2013.
• International Atomic Energy Agency (IAEA), Radiation Protection of Patients (RPOP). Available
at: https://www.iaea.org/resources/rpop.
• International Atomic Energy Agency (IAEA), Diagnostic Radiology Physics, Non-serial
Publications, 2014