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Dr. Ed Nickoloff, Columbia


University
FLAT PANEL FLUOROSCOPY
ACCEPTANCE TESTING AND
QUALITY CONTROL
EDWARD L. NICKOLOFF
DEPARTMENT OF RADIOLOGY
COLUMBIA UNIVERSITY &
NEW YORK PRESBYTERIAN HOSPITAL
NEW YORK, NEW YORK
by
Dr. Ed Nickoloff, Columbia
University
ACCEPTANCE TESTING GOALS
COMPARISON OF MEASURED IMAGE
QUALITY TO MANUFACTURERS SPECS
ITEMS NOT ROUTINELY TESTED
MECHANICAL SYSTEMS
LASER CAMERAS
ARCHIVEAL STORAGE DEVICES
ELECTRICAL SAFETY
REGULATORY COMPLIANCE
RECOMMENDATIONS TO STAFF
RADIATION DOSE CHARTS
Dr. Ed Nickoloff, Columbia
University
ACCEPTANCE TESTING GOALS
PRIOR TO 1st CLINICAL USAGE
VERIFY PURCHASE ORDER
CHECK ARCHITECTURAL DESIGN & FLOW
EVALUATE RADIATION SHIELDING,
SCATTER LEVELS & RADIATION
PROTECTION
MOST COMPREHENSIVE TESTING
MAKE REPAIRS & ADJUSTMENTS
UNDERSTAND ABC OPERATION
ESTABLISH BASELINE VALUES FOR QC
Dr. Ed Nickoloff, Columbia
University
ROUTINE QC TESTING
LIMITED NUMBER SPOT CHECKS
INTENDED TO IDENTIFY DEGRADATIONS
OR CHANGES
ENSURE PATIENT & STAFF RADIATION
SAFETY
FOLLOW-UP TO REPAIRS & UPGRADES
NEEDED FOR REGULATORY COMPLIANCE
SOME TEST SIMILAR TO ACCEPTANCE
FEWER PARAMETERS EVALUATED
COMPARED TO BASELINE VALUES
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Dr. Ed Nickoloff, Columbia
University
THE FIELD of VIEW
(FoV) GAME?
Dr. Ed Nickoloff, Columbia
University
12
15
16 17
20 20
25
SIEMENS
FoV (cm)
GE
FoV (cm)
GE measures horizontal & vertical.
Siemens measures diagonal.
Dr. Ed Nickoloff, Columbia
University
ARTIFACTS & IMAGE
UNIFORMITY
Dr. Ed Nickoloff, Columbia
University
NON-UNIFORMITIES
IMAGE INTENSIFIERS + TV
VIGNETTING, DISTORTION, PHOSPHOR
BURNS, DIRT, SATURATION, GRID
PROBLEMS
FLAT PANEL DETECTORS
BAD DETECTORS, NON-UNIFORM GAIN,
CALIBRATION ERRORS, DIRT,
SATURATION, GRID PROBLEMS,
PHYSICAL DAMAGE, SOFTWARE
PROBLEMS, IMAGE PERSISTENCE
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Dr. Ed Nickoloff, Columbia
University
SPATIAL RESOLUTION
ASSESSMENTS
Dr. Ed Nickoloff, Columbia
University
SYSTEM SPATIAL RESOLUTION
DEPENDS UPON GEOMETRICAL MAG
( M ), FOCAL SPOT ( f )& INHERENT IMAGE
RECEPTOR RESOLUTION (
ir
)
LESS THAN THE LOWEST OF:
M x
ir
M / [ (M - 1) x f ]
AT LOW M,
ir
DOMINATES
AT HIGH M, FOCAL SPOT BLUR
DOMINATES
Dr. Ed Nickoloff, Columbia
University
CAVEATS OF SPATIAL
RESOLUTION
MEASUREMENTS
Dr. Ed Nickoloff, Columbia
University
SUMMARY OF BAR
PATTERN PLACEMENT
PARTIAL PIXEL SHIFT EITHER VERTICAL
OR HORIZONTAL CAN ALTER MEASURED
RESOLUTION
RESOLUTION BEST = 1 / [ 2 x PIXEL SIZE]
OR, ZERO FOR 50% PIXEL SHIFT
OR, ANYWHERE IN BETWEEN
45 DEGREE ALIGNMENT OF BAR PATTERN
INCREASES SPACING BY 1.41 xs
PARTIAL PIXEL SHIFT STILL A PROBLEM
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Dr. Ed Nickoloff, Columbia
University
MTF GRAPH & SPATIAL RESOLUTION LIMIT
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 0.5 1 1.5 2 2.5 3
SPATIAL FREQUENCY (LP/mm)
M
T
F
V
A
L
U
E
NO NOISE
5 %NOISE
IMAGE NOISE
Dr. Ed Nickoloff, Columbia
University
SUMMARY OF NOISE EFFECTS
AS IMAGE NOISE INCREASES THE
LIMITING HIGH CONSTRAST SPATIAL
RESOLUTION DECREASES
QUANTUM MOTTLE IS A KEY FACTOR IN
IMAGE NOISE
RECORD MODE (CINE) WILL HAVE LESS
QUANTUM MOTTLE THAN FLUORO MODE
WHICH MIGHT IMPROVE RESOLUTION
ABC DOSE MODES WILL INFLUENCE
RESULTS
Dr. Ed Nickoloff, Columbia
University
80 kVp X-RAY SPECTRA WITH DIFFERENT
COPPER FILTRATION
0.00E+00
1.00E+04
2.00E+04
3.00E+04
4.00E+04
5.00E+04
6.00E+04
7.00E+04
0 10 20 30 40 50 60 70 80
X-RAY ENERGY (keV)
#
X
-
R
A
Y
S
/
k
e
V
0 mm Cu 0.3 mm Cu 0.6 mm Cu 0.9 mm Cu
Dr. Ed Nickoloff, Columbia
University
EFFECTS OF FILTRATION AND kVp
UPON SPATIAL RESOLUTION
SOME NEW FLUORO UNITS USE
CONSIDEABLE FILTRATION IN X-RAY BEAM
HIGH kVp AND FILTRATION REDUCE
INHERENT CONTRAST OF BAR PATTERN
0.10 mm LEAD BAR PATTERN OR THICKER
WOULD BE BEST FOR SPATIAL
RESOLUTION
SCATTERED RADIATION IS MORE
PENETRATING & WILL AFFECT SHIELDING
OR ROOM & LEADED APPAREL
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Dr. Ed Nickoloff, Columbia
University
X-RAY BEAM QUALITY (HVL)
kVp & FILTER MAY
BE AUTOMATIC
HVL DEPENDS UPON
kVp, CONTOUR & X-
RAY FILTER
FILTER MAY BE
DIFFERENT IN
FLUORO & CINE`
TYP. HVL=3.5 - 9.0
mm @ 80 kVp & CAN
BE HIGHER
Dr. Ed Nickoloff, Columbia
University
HVL MINIMUM REGULATORY
HVL
min
> 3.50 (kVp/100) + 0.08
in mm aluminum
HVL MAXIMUM EMPIRICAL
HVL
max
< 4.0 to 9.0 mm Al @ 80 kVp
MODERN ANGIO ROOMS HAVE VARIABLE
FILTRATION WHICH CAN BE UP TO 0.9 mm Cu
IEC STANDARD (REGULATORY FOR IR??)
Dr. Ed Nickoloff, Columbia
University
COMPARISON OF HVL vs. ADDED FILTRATION
0
1
2
3
4
5
6
7
8
9
0 0.2 0.4 0.6 0.8 1
ADDED FILTRATION ( mm COPPER )
M
E
A
S
U
R
E
D
H
V
L
(
m
m
A
l
E
Q
.
)
SIEMENS GE
@80 kVp
Dr. Ed Nickoloff, Columbia
University
SPATIAL RESOLUTION AT
INPUT SURFACE OF IMAGE
RECEPTOR
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Dr. Ed Nickoloff, Columbia
University
COMPARISON OF INHERENT DETECTOR
SPATIAL RESOLUTION
2
2.2
2.4
2.6
2.8
3
3.2
3.4
3.6
3.8
10 12 14 16 18 20 22 24
FIELD-of-VIEW (LP/mm)
S
P
A
T
I
A
L
R
E
S
O
L
U
T
I
O
N
(
L
P
/
m
m
)
Axiom Artis I.I. Axiom Artis Flat Panel Innova Flat Panel
Dr. Ed Nickoloff, Columbia
University
SUMMARY ABOUT INHERENT
SPATIAL RESOLUTION
SPATIAL RESOLUTION OF IMAGE INTENSIFIER +
T.V. IMPROVES WITH SMALL FoVS
FLAT PANEL RESOLUTION DOES NOT INCREASE
WITH FoV CHANGES
SPATIAL RESOLUTION OF FLAT PANEL SYSTEMS
IS LESS THAN IMAGE INTENSIFIER PLUS T.V.
SYSTEMS IN SMALL FoVS
SPATIAL RESOLUTION OF FLAT PANEL SYSTEMS
IS BETTER THAN IMAGE INTENSIFIER + T.V. IN
LARGE FoVS
Dr. Ed Nickoloff, Columbia
University
SUMMARY ABOUT INHERENT
SPATIAL RESOLUTION
FLAT PANEL RESOLUTION IS APPROX.
1 / [ 2 x PIXEL SIZE (mm)]
GE PIXEL = 200 T & SIEMENS PIXEL = 185 T
ESTIMATE SPATIAL RESOLUTION FLAT
PANELS
2.5 LP/mm & 2.7 LP/mm
CORRESPONDS TO MEASUREMENTS
ABC MODES, RADIATION DOSE, SOFTWARE
AND ANGULATION HAVE AN EFFECT
Dr. Ed Nickoloff, Columbia
University
SPATIAL RESOLUTION AT
DISTANCES AWAY FOR INPUT
SURFACE OF IMAGE
RECEPTOR
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Dr. Ed Nickoloff, Columbia
University
COMPARISON OF SPATIAL RESOLUTION IN MEDIUM
FoV ( I.I.= 17cm, SFPD=20cm & GEFPD=17cm)
2
2.2
2.4
2.6
2.8
3
3.2
3.4
3.6
0 5 10 15 20 25 30 35 40 45
DISTANCE FROM ENTRANCE (cm)
S
P
A
T
I
A
L
R
E
S
O
L
U
T
I
O
N
(
L
P
/
m
m
)
Axiom Artis I.I. Axiom Artis Flat Panel Innova Flat Panel
Calc Calc Calc
Dr. Ed Nickoloff, Columbia
University
COMPARISON OF SPATIAL RESOLUTION FOR SMALL
Fov (I.I. = 13 cm, SFPD = 16 cm & GEFPD = 13 cm)
2
2.2
2.4
2.6
2.8
3
3.2
3.4
3.6
3.8
4
0 5 10 15 20 25 30 35 40 45
DISTANCE FORM ENTRANCE (cm)
S
P
A
T
I
A
L
R
E
S
O
L
U
T
I
O
N
(
L
P
/
m
m
)
Axiom Artis I.I. Axiom Artis Flat Panel Innova Flat Panel
Calc I Calc S Calc G
Dr. Ed Nickoloff, Columbia
University
EFFECTS OF DISTANCE
ON SPATIAL RESOLUTION
DISPLACING THE PATTERN AWAY FROM
ENTRANCE SURFACE IMPROVES
RESOLUTION UP TO 20 25 cm
SID=100 cm USED MAG FACTOR ~ 1.30
FLUORO FOCAL SPOTS ~ 0.7 mm effective
LONGER DISTANCE RESULT IN FOCAL
SPOT BLUR DEGRADING RESOLUTION
FLAT PANEL SYSTEMS BETTER AT LARGE
FoVS & BOTH SYSTEMS TESTED SIMILAR
IMAGE INTENSIFIER SYSTEM BETTER AT
ALL SMALL FoVS
Dr. Ed Nickoloff, Columbia
University
FLUORO vs. CINE (RECORD
MODE) SPATIAL RESOLUTION
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Dr. Ed Nickoloff, Columbia
University
RESOLUTION COMPARISON OF FLUORO vs.
RECORD MODE FOR SIEMENS AXIOM ARTIS FLAT
PANEL
2
2.2
2.4
2.6
2.8
3
3.2
3.4
3.6
3.8
4
0 5 10 15 20 25 30 35 40
DISTANCE FORM INPUT SURFACE (cm)
M
E
A
S
U
R
E
D
S
P
A
T
I
A
L
R
E
S
O
L
U
T
I
O
N
(
L
P
?
m
m
)
FLUORO 16 cm Fov RECORD 16 cm FoV
Dr. Ed Nickoloff, Columbia
University
SUMMARY OF FLUORO vs CINE
SPATIAL RESOLUTION
FLAT PANEL UNITS AT INPUT SURFACE
RECORD MODE (CINE) USE MORE RADIATION
RECORD MODE HAS LESS Q.M.
RECORD MORE IS A LITTLE BETTER
FLAT PANEL UNITS DISPLACED FROM INPUT
SURFACE
RECORD MODE HAS LARGER FOCAL SPOT &
MORE FOCAL SPOT BLUR
FOR FLAT PANEL UNITS FLUORO RESOLUTION
BETTER AT LARGE DISTANCES
GE FLAT PANEL PROBABLY USED SMALL FOCAL
SPOT IN RECORD
Dr. Ed Nickoloff, Columbia
University
SUMMARY OF FLUORO vs. CINE
SPATIAL RESOLUTION
FOR IMAGE INTENSIFIER UNITS WITH
DIGITIZED TV
FLUORO MAY BE 1023 LINE & CINE 512 LINES
FLUORO RESOLUTION IS MUCH BETTER THAN
CINE
FOR IMAGE INTENSIFIER UNITS WITH CINE
FILM
CINE IS BETTER THAN FLUORO AT I.I. BECAUSE
IT IS NOT LIMITED BY TV LINES & BANDPASS
AT DISTANCES, FOCAL SPOT BLUR DOMINATES
CINE FILM HAS BETTER RESOLUTION THAN
RECORD MODE ON FLAT PANEL SYSTEMS
Dr. Ed Nickoloff, Columbia
University
TEMPORAL RESOLUTION &
PERSISTANCE
6 WIRES 0.13 - 0.56
mm DIAMETER AT 30
RPM
FLUORO & CINE`/ DSA
STATIONARY vs.
ROTATING
WATER PHANTOM
SIMULATES PATIENT
ATTENUATION
2 - 3 SPOKES VISIBLE
MOVING
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Dr. Ed Nickoloff, Columbia
University
MEASUREMENTS OF
PATIENT ENTRANCE
RADIATION DOSES
Dr. Ed Nickoloff, Columbia
University
SID = 100 cm
T
FIXED 30 cm
TABLE
ATTENUATION
MATERIAL
I.I.
RADIATION
DETECTOR
X-RAY
TUBE
TYPICAL PATIENT RADIATION DOSES
Dr. Ed Nickoloff, Columbia
University
CINE DOSE RATES FOR DIFFERENT FoV's &
THICKNESS--- SIEMENS AXION ARTIS dBC
0.1
1
10
100
0 5 10 15 20 25
ACRYLIC THICKNESS (cm)
E
X
P
O
S
U
R
E
(R
/
M
IN
)
25 cm FoV 20 cm FoV 16 cm FoV
NORMAL, 15
FPS CINE
Dr. Ed Nickoloff, Columbia
University
SUMMARY OF PATIENT ENTRANCE
RADIATION EXPOSURE RATES
EACH VENDORS HAS MULTIPLE RADIATION
DOSE PROGRAMS!!!
GE HAS:
IQ+, IQ STAND., SMART IQ, RDL+, RDL STAND.
RANGE OF Max / Min = 3 or 4 : 1
LOW is about 50% of NORMAL
SIEMENS HAS:
MINUS = -50%; NORMAL; PLUS = +50%
FOR BOTH FLAT PANELS, EACH CINE
FRAME = 4 TO 10 FLUORO FRAMES
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Dr. Ed Nickoloff, Columbia
University
SUMMARY OF PATIENT ENTRANCE
RADIATION EXPOSURE RATES
USEFUL TO PLOT LN( EXPOSURE RATE)
VERSES THICKNESS
HVL FOR TISSUE 3.7 TO 4.4 cm
COMPARING 17 cm FoV, IN THE 15 25 cm
THICKNESS ACRYLIC:
SIEMENS FLAT PANEL = 2xs I.I. WITH
DIGITIZED TV FOR RECORD
GE FLAT PANEL (RDL+,NORMAL) ABOUT
SAME EXPOSURE RATES AS SIEMENS
FLAT PANEL IN FLUORO & LESS IN CINE
VARIOUS MODES ALLOW A LARGE RANGE
Dr. Ed Nickoloff, Columbia
University
ABC CONTROLS
Dr. Ed Nickoloff, Columbia
University
FLUORO ABC CONTROL OF FLAT PANEL SYSTEMS
50
60
70
80
90
100
110
0 5 10 15 20 25 30
THICKNESS ACRYLIC (cm)
T
U
B
E
P
O
T
E
N
T
I
A
L
(
k
V
p
)
GE INNOVA SIEMENS 0.9 mm Cu SIEMENS 0.6 mm Cu
SIEMENS 0.3 mm Cu SIEMENS 0.2 mmCu
Dr. Ed Nickoloff, Columbia
University
I.I. INPUT EXPOSURE RATES (IIIER)
IIIER IS HOW X-RAY
SERVICE ADJUSTS
RADIATION LEVELS
GRID REMOVED
FLUORO < 100 T R /
SEC*
CINE` < 20 T R /
FRAME*
DSA < 1000 T R /
FRAME*
* 9 INCH (23 cm) FoV
X-RAY
TUBE
I.I.
ATTENUATION
DETECTOR
NO GRID
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Dr. Ed Nickoloff, Columbia
University
SUMMARY OF INPUT
RADIATION TO DETECTORS
ALL SYSTEM MEET < 100 R/ sec
FLUORO & < 20 R / frame IN RECORD
FOR 23 cm FoV
GE HAS ABOUT SAME RAD LEVELS IN
15 pps & 30 pps FLUORO
IN LARGE FoVs LEVELS ABOUT SAME
FOR ALL TYPES OF FLUORO &
RECORD
THERE ARE DIFFERENCE BETWEEN
SETTINGS AND VENDORS
Dr. Ed Nickoloff, Columbia
University
CONTRAST RATIO (R
C
)
MEASURES
DEGRADATION DUE
TO LIGHT &
PHOTON SCATTER
CAN DEGRADE
VISIBILITY OF
SMALL VESSELS
USE LIGHT ON
MONITOR
R
C
> 60 : 1
Dr. Ed Nickoloff, Columbia
University
LOW CONTRAST IMAGING
STANDARD
PENETRAMETER
WITH LOW
CONTRAST HOLES
TOO EASY
kVp & FILTER
DEPENDENT
C-D PHANTOMS
USEFUL FOR
RELATIVE
MEASUREMENTS
Dr. Ed Nickoloff, Columbia
University
CONTRAST OF HOLES
C
0
= EXP [ - ( T) ]
VISIBILITY OF HOLES
C
0
* MTF ( ) = K / SNR
where (1 / 2D) < < (1 / D)
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Dr. Ed Nickoloff, Columbia
University
DATA FROM C-D PHANTOM
73% @
12 cm
62%@
12 cm
75% @
16 cm
62% @
16 cm
63% @
15 cm
57%@
15 cm
71.5% @
20 cm
62% @
20 cm
60% @
17 cm
60%@
17 cm
71% @
25 cm
62% @
25 cm
55% @
20 cm
55%@
20cm
CINE FLUOR. CINE FLUOR.
SIEMENS FPD GE FPD
Dr. Ed Nickoloff, Columbia
University
MONITOR CRITERIA
MONITORS MUST HAVE A BALANCED
GRAY SCALE
5% CONTRAST MUST BE VISIBLE
MINIMUM BRIGHTNESS (BLACK LEVEL)
<1 TO 2 nit (Cd / m
2
)
MAXIMUM BRIGHTNESS >400 TO 500 nit
NO DEFECT & DISTORTIONS
TINT OR COLOR DIFFERENCES
Dr. Ed Nickoloff, Columbia
University
OTHER PHYSICS TESTS
X-RAY EQUIPMENT TEST
kVp, WAVEFORM, HVL, mA LINEARITY,
FOCAL SPOT SIZE, ETC.
REGULATORY TESTS
MAX FLUORO EXPOSURE RATE,
COLLIMATION, SAFETY CHECKS, ETC.
MECHANICAL CHECKS
ISOCENTER, CENTRAL BEAM, MOTION,
ALIGNMENT, COLLISION SENSOR, ETC.
RADIATION PROTECTION SURVEY
Dr. Ed Nickoloff, Columbia
University
OTHER PHYSICS TEST
DAP METER ACCURACY
ARCHIVING & PACS TRANSMISSION
ELECTRICAL SAFETY
GROUNDING, POLARITY, EMERGENCY
POWER, CUT-OFF SWITCHES, ETC.
GRID EVALUATION
SID TRACKING
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Dr. Ed Nickoloff, Columbia
University
THE END!