Objective

The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures.

Materials and methods

An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT.

Results

In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities.

Conclusions

Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.

Background The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator. Purpose To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting. Material and Methods Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow. Results In group A, the mean total dose-length product (DLP) was 41.2 +/- 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 +/- 22.0 mGy*cm), corresponding to a mean dose reduction of 84% (P<0.001). The mean CTDIvol for the control scans were 1.88 +/- 0.09 mGy and 13.16 +/- 0.40 mGy for groups A and B, respectively (P < 0.001). The success rate in group A was 91.2% and 87.9% in group B (P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found. Conclusion We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.

In recent decades, developments in detectors for X-ray imaging have improved dose efficiency. This has been accomplished with for example, structured scintillators such as columnar CsI, or with direct detectors where the X rays are converted to electric charge carriers in a semiconductor. Scattered radiation remains a major noise source, and fairly inefficient anti-scatter grids are still a gold standard. Hence, any future development should include improved scatter rejection. In recent years, photon-counting detectors have generated significant interest by several companies as well as academic research groups. This method eliminates electronic noise, which is an advantage in low-dose applications. Moreover, energy-sensitive photon-counting detectors allow for further improvements by optimising the signal-to-quantum-noise ratio, anatomical background subtraction or quantitative analysis of object constituents. This paper reviews state-of-the-art photon-counting detectors, scatter control and their application in diagnostic X-ray medical imaging. In particular, spectral imaging with photon-counting detectors, pitfalls such as charge sharing and high rates and various proposals for mitigation are discussed.

An X-ray sensor (1) having an active detector region including a plurality of detector diodes (2) arranged on a surface region (3) of the X-ray sensor (1), a junction termination (4) surrounding the surface area (3) including the plurality of detector diodes (2), the junction termination (4) including a guard (5) arranged closest to the end of the surface region (3), a field stop (6) arranged outside the guard (2) and a number N of field limiting rings, FLRs (7) arranged between the guard (5) and the field stop (6), wherein each of the FLRs (7) are placed at positions selected so that distances between different FLRs (7) and between the guard and the first FLR lie within an effective area, the effective area being bounded by the lines α=(10+1.3×(n−1)) μm and β=(5+1.05×(n−1)) μm.

Disclosed is an x-ray sensor having an active detector region including a plurality of detector diodes at a first side of the sensor, and with placement of the junction termination at a second opposite side of the sensor. Normally, this implies that the junction termination is moved from the top side where the active detector area is located to the bottom side of the sensor, allowing for full utilization of the active detector area at the top side with detector diodes to the very edge of the sensor.  

There is provided an x-ray sensor (21) comprising an active detector region including a plurality of detector diodes (22) at a first side of the sensor, and a common junction termination (23) at a second opposite side of the sensor. Normally, this implies that the junction termination (23) is moved from the top side where the active detector area is located to the bottom side of the sensor, allowing for full utilization of the active detector area at the top side with detector diodes to the very edge of the sensor.  

In the 1970s, it was determined that screening mammography is an efficient tool in fighting the increasing number of women dying from breast cancer, and many countries have established screening programs since then. Mammography systems have improved substantially over the years with one of the major advances being the transition from x-ray film to digital x-ray detectors. Following this development, the number of women dying from breast cancer has decreased, but there is still much room for improvement. One technology that is changing the breast imaging landscape is breast tomosynthesis; tomographic imaging with in-plane resolution similar to that of mammography, albeit limited height resolution. Breast tomosynthesis is commonly implemented with flat-panel detectors, but line detectors in a slit-scanning geometry can also be used. The latter configuration allows for more complex detector technologies, such as spectral photon-counting detectors that enable single-shot spectral imaging. The combination of spectral imaging and tomosynthesis opens up for a range of new applications, but the slit scanning geometry, which differs substantially from that of flat-panel tomosynthesis systems, and the factors affecting image quality have not been well understood. This thesis aims at filling this gap. Image quality and the parameters that influence image quality in spectral photon-counting slit-scanning breast tomosynthesis are characterized and analyzed using cascaded-systems modelling and linear image quality metrics. In addition, the thesis goes into characterizing the x-ray properties of breast tissue, an important input parameter for accurate material decomposition of in-vivo tissue. Material decomposition with spectral imaging opens up a range of applications, such as accurate measurement of volumetric breast density and spectral lesion characterization for decision support as part of mammography screening, and contrast-enhanced K-edge imaging for diagnostics. Tomosynthesis combined with material decomposition has the potential to improve these methods further by, for instance, separating lesions or regions of interest from surrounding fibro-glandular tissue in quantitative 3D maps of breast tissue.

Purpose: It has been shown that breast tomosynthesis may improve sensitivity and specificity compared to two-dimensional mammography, resulting in increased detection-rate of cancers or lowered call-back rates. The purpose of this study is to characterize a spectral photon-counting multislit breast tomosynthesis system that is able to do single-scan spectral imaging with multiple collimated x-ray beams. The system differs in many aspects compared to conventional tomosynthesis using energyintegrating flat-panel detectors. Methods: The investigated system was a prototype consisting of a dual-threshold photon-counting detector with 21 collimated line detectors scanning across the compressed breast. A review of the system is done in terms of detector, acquisition geometry, and reconstruction methods. Three reconstruction methods were used, simple back-projection, filtered back-projection and an iterative algebraic reconstruction technique. The image quality was evaluated by measuring the modulation transfer-function (MTF), normalized noise-power spectrum, detective quantum-efficiency (DQE), and artifact spread-function (ASF) on reconstructed spectral tomosynthesis images for a total-energy bin (defined by a low-energy threshold calibrated to remove electronic noise) and for a high-energy bin (with a threshold calibrated to split the spectrum in roughly equal parts). Acquisition was performed using a 29 kVp W/Al x-ray spectrum at a 0.24 mGy exposure. Results: The difference in MTF between the two energy bins was negligible, that is, there was no energy dependence on resolution. The MTF dropped to 50% at 1.5 lp/mm to 2.3 lp/mm in the scan direction and 2.4 lp/mm to 3.3 lp/mm in the slit direction, depending on the reconstruction method. The full width at half maximum of the ASF was found to range from 13.8 mm to 18.0 mm for the different reconstruction methods. The zero-frequency DQE of the system was found to be 0.72. The fraction of counts in the high-energy bin was measured to be 59% of the total detected spectrum. Scantimes ranged from 4 s to 16.5 s depending on voltage and current settings. Conclusions: The characterized system generates spectral tomosynthesis images with a dual-energy photon-counting detector. Measurements show a high DQE, enabling high image quality at a low dose, which is beneficial for low-dose applications such as screening. The single-scan spectral images open up for applications such as quantitative material decomposition and contrast-enhanced tomosynthesis. 

Purpose: Digital breast tomosynthesis (DBT) is an emerging tool for breast-cancer screening and diagnostics. The purpose of this study is to present a second-generation photon-counting slitscanning DBT system and compare it to the first-generation system in terms of geometry and image quality. The study presents the first image-quality measurements on the second-generation system. Method: The geometry of the new system is based on a combined rotational and linear motion, in contrast to a purely rotational scan motion in the first generation. In addition, the calibration routines have been updated. Image quality was measured in the center of the image field in terms of in-slice modulation transfer function (MTF), artifact spread function (ASF), and in-slice detective quantum efficiency (DQE). Images were acquired using a W/Al 29 kVp spectrum at 13 mAs with 2 mm Al additional filtration and reconstructed using simple back-projection. Result: The in-slice 50% MTF was improved in the chest-mammilla direction, going from 3.2 to 3.5 lp/mm, and the zero-frequency DQE increased from 0.71 to 0.77. The MTF and ASF were otherwise found to be on par for the two systems. The new system has reduced in-slice variation of the tomographic angle. Conclusions: The new geometry is less curved, which reduces in-slice tomographic-angle variation, and increases the maximum compression height, making the system accessible for a larger population. The improvements in MTF and DQE were attributed to the updated calibration procedures. We conclude that the second-generation system maintains the key features of the photon-counting system while maintaining or improving image quality and improving the maximum compression height. 

Spectral imaging is the acquisition of multiple images of an object at different energy spectra. In mammography, dual-energy imaging (spectral imaging with two energy levels) has been investigated for several applications, in particular material decomposition, which allows for quantitative analysis of breast composition and quantitative contrast-enhanced imaging. Material decomposition with dual-energy imaging is based on the assumption that there are two dominant photon interaction effects that determine linear attenuation: the photoelectric effect and Compton scattering. This assumption limits the number of basis materials, i.e. the number of materials that are possible to differentiate between, to two. However, Rayleigh scattering may account for more than 10% of the linear attenuation in the mammography energy range. In this work, we show that a modified version of a scanning multi-slit spectral photon-counting mammography system is able to acquire three images at different spectra and can be used for triple-energy imaging. We further show that triple-energy imaging in combination with the efficient scatter rejection of the system enables measurement of Rayleigh scattering, which adds an additional energy dependency to the linear attenuation and enables material decomposition with three basis materials. Three available basis materials have the potential to improve virtually all applications of spectral imaging.

X-ray characteristics of body tissues are of crucial importance for developing and optimizing x-ray imaging techniques, in particular for dosimetry and spectral imaging applications. For breast imaging, the most important tissues are fibro-glandular, adipose and skin tissue. Some work has and is being done to better characterize these tissue types, in particular fibro-glandular and adipose tissue. In the case of breast skin, several recent studies have been published on the average skin thickness, but with regards to x-ray attenuation, the only published data, to the knowledge of the authors, is the elemental composition analysis of Hammerstein et al (1979 Radiology 130 485-91). This work presents an overview of breast skin thickness studies and a measurement of the effective atomic number (Z(eff)) of breast skin using spectral mammography. Z(eff), which together with the density forms the attenuation, is used to validate the work by Hammerstein et al, and the dependence of clinical parameters on Z(eff) is explored. Measurements were conducted on the skin edge of spectral mammograms using clinical data from a screening population (n = 709). The weighted average of breast skin thickness reported in studies between 1997 and 2013 was found to be 1.56 +/- 0.28 mm. Mean Z(eff) was found to be 7.365 (95% CI: 7.364,7.366) for normal breast skin and 7.441 (95% CI: 7.440,7.442) for the nipple and areola. Z(eff) of normal breast skin is in agreement with Hammerstein et al, despite the different methods and larger sample size used. A small but significant increase in Z(eff) was found with age, but the increase is too small to be relevant for most applications. We conclude that normal breast skin is well described by a 1.56 mm skin layer and the elemental composition presented by Hammerstein et al (1979 Radiology 130 485-91) and recommend using these characteristics when modelling breast skin.

Tomosynthesis is emerging as a next generation technology in mammography. Combined with photon-counting detectors with the ability for energy discrimination, a novel modality is enabled - spectral tomosynthesis. Further advantages of photon-counting detectors in the context of tomosynthesis include elimination of electronic noise, efficient scatter rejection (in some geometries) and no lag. Fourier-based linear-systems analysis is a well-established method for optimizing image quality in two-dimensional x-ray systems. The method has been successfully adapted to three-dimensional imaging, including tomosynthesis, but several areas need further investigation. This study focuses on two such areas: 1) Adaption of the methodology to photon-counting detectors, and 2) violation of the shift-invariance and stationarity assumptions in non-cylindrical geometries. We have developed a Fourier-based framework to study the image quality in a photon-counting tomosynthesis system, assuming locally linear, stationary, and shift-invariant system response. The framework includes a cascaded-systems model to propagate the modulation-transfer function (MTF) and noise-power spectrum (NPS) through the system. The model was validated by measurements of the MTF and NPS. High degrees of non-shift invariance and non-stationarity were observed, in particular for the depth resolution as the angle of incidence relative the reconstruction plane varied throughout the imaging volume. The largest effects on image quality in a given point in space were caused by interpolation from the inherent coordinate system of the x-rays to the coordinate system that was used for reconstruction. This study is part of our efforts to fully characterize the spectral tomosynthesis system, we intend to extend the model further to include the detective-quantum efficiency, observer modelling, and spectral effects.

Objective. To enable practical interferometry-based phase contrast CT using standard incoherent x-ray sources, we propose an imaging system where the analyzer grating is replaced by a high-resolution detector. Since there is no need to perform multiple exposures (with the analyzer grating at different positions) at each scan angle, this scheme is compatible with continuous-rotation CT apparatus, and has the potential to reduce patient radiation dose and patient motion artifacts. Approach. Grating-based x-ray interferometry is a well-studied technique for imaging soft tissues and highly scattering objects embedded in such tissues. In addition to the traditional x-ray absorption-based image, this technique allows reconstruction of the object phase and small-angle scattering information. When using conventional incoherent, polychromatic, hard x-ray tubes as sources, three gratings are usually employed. To sufficiently resolve the pattern generated in these interferometers with contemporary x-ray detectors, an analyzer grating is used, and consequently multiple images need to be acquired for each view angle. This adds complexity to the imaging system, slows image acquisition and thus increases sensitivity to patient motion, and is not dose efficient. By simulating image formation based on wave propagation, and proposing a novel phase retrieval algorithm based on a virtual grating, we assess the potential of a analyzer-grating-free system to overcome these limitations. Main results. We demonstrate that the removal of the analyzer-grating can produce equal image contrast-to-noise ratio at reduced dose (by a factor of 5), without prolonging scan duration. Significance. By demonstrating that an analyzer-free CT system, in conjuction with an efficient phase retrieval algorithm, can overcome the prohibitive dose and workflow penalties associated grating-stepping, an alternative path towards realizing clinical inteferometric CT appears possible.

Beam-hardening-free synthetic images with absolute CT numbers that radiologists are used to can be constructed from spectral CT data by forming 'dichromatic' images after basis decomposition. The CT numbers are accurate for all tissues and the method does not require additional reconstruction. This method prevents radiologists from having to relearn new rules-of-thumb regarding absolute CT numbers for various organs and conditions as conventional CT is replaced by spectral CT. Displaying the synthetic Hounsfield unit images side-by-side with images reconstructed for optimal detectability for a certain task can ease the transition from conventional to spectral CT.

Purpose: To develop a framework for taking the spatial frequency composition of an imaging taskinto account when determining optimal bin weight factors for photon counting energy sensitivex-ray systems. A second purpose of the investigation is to evaluate the possible improvement comparedto using pixel based weights.Methods: The Fourier based approach of imaging performance and detectability index d0 is appliedto pulse height discriminating photon counting systems. The dependency of d0 on the bin weightfactors is made explicit, taking into account both differences in signal and noise transfer characteristicsacross bins and the spatial frequency dependency of interbin correlations from reabsorbedscatter. Using a simplified model of a specific silicon detector, d0 values for a high and a low frequencyimaging task are determined for optimal weights and compared to pixel based weights.Results: The method successfully identifies bins where a large point spread function degradesdetection of high spatial frequency targets. The method is also successful in determining how todownweigh highly correlated bins. Quantitative predictions for the simplified silicon detectormodel indicate that improvements in the detectability index when applying task-based weightsinstead of pixel based weights are small for high frequency targets, but could be in excess of 10%for low frequency tasks where scatter-induced correlation otherwise degrade detectability.Conclusions: The proposed method makes the spatial frequency dependency of complex correlationstructures between bins and their effect on the system detective quantum efficiency easier toanalyze and allows optimizing bin weights for given imaging tasks. A potential increase in detectabilityof double digit percents in silicon detector systems operated at typical CT energies (100kVp) merits further evaluation on a real system. The method is noted to be of higher relevancefor silicon detectors than for cadmium (zink) telluride detectors.

Purpose: To determine the intrinsic dimensionality of linear attenuation coefficients (LACs) from XCOM for elements with low atomic number (Z = 1-20) at diagnostic x-ray energies (25-120 keV). H-0(q), the hypothesis that the space of LACs is spanned by q bases, is tested for various q-values. Methods: Principal component analysis is first applied and the LACs are projected onto the first q principal component bases. The residuals of the model values vs XCOM data are determined for all energies and atomic numbers. Heteroscedasticity invalidates the prerequisite of i.i.d. errors necessary for bootstrapping residuals. Instead wild bootstrap is applied, which, by not mixing residuals, allows the effect of the non-i.i.d residuals to be reflected in the result. Credible regions for the eigenvalues of the correlation matrix for the bootstrapped LAC data are determined. If subsequent credible regions for the eigenvalues overlap, the corresponding principal component is not considered to represent true data structure but noise. If this happens for eigenvalues l and l + 1, for any l <= q, H-0(q) is rejected. Results: The largest value of q for which H-0(q) is nonrejectable at the 5%-level is q = 4. This indicates that the statistically significant intrinsic dimensionality of low-Z XCOM data at diagnostic energies is four. Conclusions: The method presented allows determination of the statistically significant dimensionality of any noisy linear subspace. Knowledge of such significant dimensionality is of interest for any method making assumptions on intrinsic dimensionality and evaluating results on noisy reference data. For LACs, knowledge of the low-Z dimensionality might be relevant when parametrization schemes are tuned to XCOM data. For x-ray imaging techniques based on the basis decomposition method (Alvarez and Macovski, Phys. Med. Biol. 21, 733-744, 1976), an underlying dimensionality of two is commonly assigned to the LAC of human tissue at diagnostic energies. The finding of a higher statistically significant dimensionality thus raises the question whether a higher assumed model dimensionality (now feasible with the advent of multibin x-ray systems) might also be practically relevant, i.e., if better tissue characterization results can be obtained.

We show how the spectral imaging framework should be modified to account for a high fraction of Compton interactions in low Z detector materials such as silicon. Using this framework, where deposited energies differ from actual photon energies, we compare the performance of a silicon strip detector, including the influence of scatter inside the detector and charge sharing but disregarding signal pileup, with an ideal energy integrating detector. We show that although the detection efficiency for silicon rapidly drops for the acceleration voltages encountered in clinical computed tomography practice, silicon detectors could perform on a par with ideal energy integrating detectors for routine imaging tasks. The use of spectrally sensitive detectors opens up the possibility for decomposition techniques such as k-edge imaging, and we show that the proposed modification of the spectral imaging framework is beneficial for such imaging tasks.

The current invention applies to photon counting silicon x-ray detectors with energy discriminating capabilities and applications in x-ray imaging systems. The overall image quality produced by such a system is improved by the presented novel methods for optimally using the energy information in Compton events and making selective use of counts induced from charges collected in neighboring pixels. The pile-up problem during high-flux imaging regimes is reduced by a novel method for signal reset, which improves the count efficiency by reducing the risk of losing event due to signal pile-up in the read out electronics chain.

Disclosed is a calibration phantom for an x-ray imaging system having an x-ray source and an x-ray detector. The calibration phantom includes a combination of geometric objects of at least three different types and/or compositions including: a first object located in the middle, including a first material; a plurality of second objects arranged around the periphery of the first object, at least a subset of the second objects including a second material different than the first material, wherein the first object is relatively larger than the second objects; a plurality of third objects arranged around the periphery of the first object and/or around the periphery of at least a subset of the second objects, at least a subset of the third objects including a third material different than the first material and the second material, wherein the third objects are relatively smaller than the second objects.

An x-ray imaging apparatus includes an x-ray source and detector with multiple detector elements. The source and detector are on a support that rotates around a subject, enabling projections at different view angles. The apparatus operates the x-ray source in switched kVp mode for alternately applying different voltages, including lower and higher voltages, during rotation to enable lower-energy and higher-energy exposures over the projections, providing for lower-energy projections and higher-energy projections. The x-ray detector is a photon-counting multi-bin detector allocating photon counts to multiple energy bins, and the apparatus selects counts from at least a subset of the bins to provide corresponding photon count information for both lower- and higher-energy projections. The apparatus performs material basis decomposition for some of the lower-energy projections and higher-energy projections and/or for some combinations of at least one lower-energy projection and at least one higher-energy projection, based on the corresponding photon count information.

This paper presents a dual-energy imaging technique optimized for contrast-enhanced mammography using a photon counting detector. Each photon pulse is processed separately in the detector and the addition of an electronic threshold near the middle of the energy range of the x-ray spectrum allows discrimination of high and low energy photons. This effectively makes the detector energy sensitive, and allows the acquisition of high- and low-energy images simultaneously. These high- and low-energy images can be combined to dual-energy images where the anatomical clutter has been suppressed. By setting the electronic threshold close to 33.2 keV (the k-edge of iodine) the system is optimized for dual-energy contrast-enhanced imaging of breast tumors. Compared to other approaches, this method not only eliminates the need for separate exposures that might lead to motion artifacts, it also eliminates the otherwise deteriorating overlap between high- and low-energy spectra. We present phantom dual-energy images acquired on a prototype system to illustrate that the technique is already operational, albeit in its infancy. We also present a theoretical estimation of the potential gain in tumor signal-difference-to-noise ratio when using this electronic spectrum-splitting method as opposed to acquiring the high- and low-energy images separately with double exposures with separate x-ray spectra. Assuming ideal energy sensitive photon counting detectors, we arrive at the conclusion that the signal-difference-to-noise ratio could be increased by 145% at constant dose. We also illustrate our results on synthetic images.

We compare the theoretical limits of iodine quantification for the photon counting multibin and dual energy technologies. Dual energy systems by necessity have to make prior assumptions in order to quantify iodine. We explicitly allow the multibin system to make the same assumptions and also allow them to be wrong. We isolate the effect of technology from imperfections and implementation issues by assuming both technologies to be ideal, i.e., without scattered radiation, unity detection efficiency and perfect energy response functions, and by applying the Cramer-Rao lower bound methodology to assess the quantification accuracy. When priors are wrong the maximum likelihood estimates will be biased and the mean square error of the quantification error is a more appropriate figure of merit. The evaluation assumes identical X-ray spectra for both methodologies and for that reason a sensitivity analysis is performed with regard to the assumed X-ray spectrum. We show that when iodine is quantified over regions of interest larger than 6 cm, multibin systems benefit by independent estimation of three basis functions. For smaller regions of interest multibin systems can increase quantification accuracy by making the same prior assumptions as dual energy systems.

Material basis decomposition in the sinogram domain requires accurate knowledge of the forward model in spectral computed tomography (CT). Misspecifications over a certain limit will result in biased estimates and make quantum limited (where statistical noise dominates) quantitative CT difficult. We present a method whereby users can determine the degree of allowed misspecification error in a spectral CT forward model and still have quantification errors that are limited by the inherent statistical uncertainty. For a particular silicon detector based spectral CT system, we conclude that threshold determination is the most critical factor and that the bin edges need to be known to within 0.15 keV in order to be able to perform quantum limited material basis decomposition. The method as such is general to all multibin systems.

Material basis decomposition in the sinogram domain requires accurate knowledge of the forward model in spectral CT. Misspecifications over a certain limit will result in biased estimates and make quantum limited quantitative CT difficult. We present a method whereby users can determine the degree of allowed misspecification error in a spectral CT forward model, and still have quantification errors that are quantum limited.

The effect of temperature variation on pulse height determination accuracy is determined for a photon counting multibin silicon detector developed for spectral CT. Theoretical predictions of the temperature coefficient of the gain and offset are similar to values derived from synchrotron radiation measurements in a temperature controlled environment. By means of statistical modeling, we conclude that temperature changes affect all channels equally and with separate effects on gain and threshold offset. The combined effect of a 1 degrees C temperature increase is to decrease the detected energy by 0.1 keV for events depositing 30 keV. For the electronic noise, no statistically significant temperature effect was discernible in the data set, although theory predicts a weak dependence. The method is applicable to all x-ray detectors operating in pulse mode.

This article presents a Monte Carlo simulation of the detector energy response in the presence of pileup in a segmented silicon microstrip detector designed for high flux spectral computed tomography with sub-millimeter pixel size. Currents induced on the collection electrode of a pixel segment are explicitly modeled and signals emanating from events in neighboring pixels are superimposed together with electronic noise before the entire pulse train is processed by a model of the readout electronics to obtain the detector energy response function. The article shows how the lower threshold and the time constant of the electronic filters need to be set in order to minimize the detrimental influence of cross talk from neighboring pixel segments, an issue that is aggravated by the sub-millimeter pixel size and the proposed segmented detector design. (C) 2010 Elsevier B.V. All rights reserved.

We model the effect of signal pile-up on the energy resolution of a photon counting silicon detector designed for high flux spectral CT with sub-millimeter pixel size. Various design parameters, such as bias voltage, lower threshold level for discarding of electronic noise and the entire electronic read out chain are modeled and realistic parameter settings are determined. We explicitly model the currents induced on the collection electrodes of a pixel and superimpose signals emanating from events in neighboring pixels, either due to charge sharing or signals induced during charge collection. Electronic noise is added to the pulse train before feeding it through a model of the read out electronics where the pulse height spectrum is saved to yield the detector energy response function. The main result of this study is that a lower threshold of 5 keV and a rather long time constant of the shaping filter (tau(0) = 30 ns) are needed to discard induced pulses from events in neighboring pixels. These induction currents occur even if no charge is being deposited in the analyzed pixel from the event in the neighboring pixel. There is also only a limited gain in energy resolution by increasing the bias voltage to 1000 V from 600 V. We show that with these settings the resulting energy resolution, as measured by the FWHM/E of the photo peak, is 5% at 70 keV.

Purpose: Current photon-counting computed tomography detectors are limited to a pixel size of around 0.3 to 0.5 mm due to excessive charge sharing degrading the dose efficiency and energy resolution as the pixels become smaller. In this work, we present measurements of a prototype photon-counting detector that leverages the charge sharing to reach a theoretical sub-pixel resolution in the order of 1 μm. The goal of the study is to validate our Monte-Carlo simulation using measurements, enabling further development. Approach: We measure the channel response at the MAX IV Lab, in the DanMAX beamline, with a 35 keV photon beam, and compare the measurements with a 2D Monte Carlo simulation combined with a charge transport model. Only a few channels on the prototype are connected to keep the number of wire bonds low. Results: The measurements agree generally well with the simulations with the beam close to the electrodes but diverge as the beam is moved further away. The induced charge cloud signals also seem to increase linearly as the beam is moved away from the electrodes. Conclusions: The agreement between measurements and simulations indicates that the Monte-Carlo simulation can accurately model the channel response of the detector with the photon interactions close to the electrodes, which indicates that the unconnected electrodes introduce unwanted effects that need to be further explored. With the same Monte-Carlo simulation previously indicating a resolution of around 1 μm with similar geometry, the results are promising that an ultra-high resolution detector is not far in the future.

Purpose: To validate the SpekPy software toolkit that has been developed to estimate the spectra emitted fromtungsten anode X-ray tubes. The model underlying the toolkit introduces improvements upon a well-knownsemi-empirical model of X-ray emission.Materials and methods: Using the same theoretical framework as the widely-used SpekCalc software, new electronpenetration data was simulated using the Monte Carlo (MC) method, alternative bremsstrahlung crosssectionswere applied, L-line characteristic emissions were included, and improvements to numerical methodsimplemented. The SpekPy toolkit was developed with the Python programming language. The toolkit was validatedagainst other popular X-ray spectrum models (50 to 120 kVp), X-ray spectra estimated with MC (30 to150 kVp) as well as reference half value layers (HVL) associated with numerous radiation qualities from standardlaboratories (20 to 300 kVp).Results: The toolkit can be used to estimate X-ray spectra that agree with other popular X-ray spectrum modelsfor typical configurations in diagnostic radiology as well as with MC spectra over a wider range of conditions.The improvements over SpekCalc are most evident at lower incident electron energies for lightly and moderatelyfiltered radiation qualities. Using the toolkit, estimations of the HVL over a large range of standard radiationqualities closely match reference values.Conclusions: A toolkit to estimate X-ray spectra has been developed and extensively validated for central-axisspectra. This toolkit can provide those working in Medical Physics and beyond with a powerful and user-friendlyway of estimating spectra from X-ray tubes.

X-ray Computed Tomography (CT) is a highly utilized tool in diagnos- tic radiology. CT provides radiologists with unobstructed views of patient anatomy. However, image quality in CT is highly dependent on the imaging task, scan technique, beam quality and radiation dose. The size of the patient must be considered and the radiation dose must be subsequently adapted to achieve consistent image quality. As CT is a modality that utilizes radia- tion to generate images, the purpose of this thesis was to explore tools and methodologies that can be utilized to optimize image quality with respect to radiation dose.

In Paper I, fundamental image quality metrics were modeled whereby the effect of radiation dose/beam quality on these metrics could be estimated. The applications of these models were demonstrated by estimating the de- tectability of low contrast details across different radiation doses/beam qual- ities using a mathematical model observer.

Dose indices are reported by CT scanners to indicate the level of radiation that has been utilized during a scan. As the level of radiation dose is a central aspect in optimization work, methods were deployed to verify the accuracy of CT dose indices for wide beam CT scanners in Paper II.

CT scanners employ so called Automatic Tube Current Modulation (ATCM) to adapt the level of radiation dose to obtain consistent image quality across varying sized patients. In Paper III, a comprehensive study was executed to better understand the complex nature of ATCM as it relates to different vendor implementations as ATCM plays a central role in the optimization of CT scans.

As the beam quality used during an examination has a central role for both dosimetry and image quality, a toolkit was developed that can be used to model x-ray spectra emerging from an x-ray tube in Paper IV. The toolkit underwent a rigorous validation and has since been made available online.

In conclusion, this thesis has resulted in a number of methods and utilities that can help unfold the complex relationship between image quality and radiation dose on a practical level in CT.

Purpose: To investigate two methods of approximating the Modulation Transfer Function (MTF) and Noise Power Spectrum (NPS) in computed tomography (CT) for a range of scan parameters, from limited image acquisitions. Methods: The two methods consist of 1) using a linear systems approach to approximate the NPS for different filtered backprojection (FBP) kernels with a filter function derived from the kernel ratio of determined MTFs and 2) using an empirical fitted model to approximate the MTF and NPS. In both cases a scaling function accounts for variations in mAs and kV. The two methods of approximating the MTF/ NPS are further investigated by comparing image quality figure of merits (FOM) d' and AUC calculated using approximations of the MTF/NPS and MTF/NPS that have been determined for different mAs/kV levels and reconstruction kernels. Results: The greatest RMSE for NPS approximated for a range of mAs/kVp/convolution kernels using both methods and compared to determined NPS was 0.05 of the peak value. The RMSE for FOM with the kernel ratio method were at most 0.1 for d' and 0.01 for the AUC. Using the empirical model method, the RMSE for FOM were at most 0.02 for d' and 0.001 for the AUC. Conclusions: The two methods proposed in this paper can provide a convenient way of approximating the MTF and NPS for use in, among other things, mathematical observer studies. Both methods require a relatively small number of direct determinations of NPS from scan acquisitions to model the NPS/MTF for arbitrary mAs and kV.

Purpose: The weighted CT dose index (CTDIw) has been extended for a nominal total collimation width (nT) greater than 40 mm and relies on measurements of CTDfree air. The purpose of this work was to compare three methods of measuring CTDIfree air and subsequent calculations of CTDIw to investigate their clinical appropriateness. Methods: The CTDIfree air, for multiple nTs up to 160 mm, was calculated from (1) high-resolution air kerma profiles from a step-and-shoot translation of a liquid ionization chamber (LIC) (considered to be a dosimetric reference), (2) pencil ionization chamber (PIC) measurements at multiple contiguous positions, and (3) air kerma profiles obtained through the continuous translation of a solid-state detector. The resulting CTDIfree air was used to calculate the CTDIw, per the extended formalism, and compared. Results: The LIC indicated that a 40 mm nT should not be excluded from the extension of the CTDIw formalism. The solid-state detector differed by as much as 8% compared to the LIC. The PIC was the most straightforward method and gave equivalent results to the LIC. Conclusions: The CTDIw calculated with the latest CTDI formalism will differ most for 160 mm nTs (e.g., whole-organ perfusion or coronary CT angiography) compared to the previous CTDI formalism. Inaccuracies in the measurement of CTDIfree air will subsequently manifest themselves as erroneous calculations of the CTDIw, for nTs greater than 40 mm, with the latest CTDI formalism. The PIC was found to be the most clinically feasible method and was validated against the LIC.

It has previously been shown that 2D spectral mammography can be used to discriminate between (likely benign) cystic and (potentially malignant) solid lesions in order to reduce unnecessary recalls in mammography. One limitation of the technique is, however, that the composition of overlapping tissue needs to be interpolated from a region surrounding the lesion. The purpose of this investigation was to demonstrate that lesion characterization can be done with spectral tomosynthesis, and to investigate whether the 3D information available in tomosynthesis can reduce the uncertainty from the interpolation of surrounding tissue. A phantom experiment was designed to simulate a cyst and a tumor, where the tumor was overlaid with a structure that made it mimic a cyst. In 2D, the two targets appeared similar in composition, whereas spectral tomosynthesis revealed the exact compositional difference. However, the loss of discrimination signal due to spread from the plane of interest was of the same strength as the reduction of anatomical noise. Results from a preliminary investigation on clinical tomosynthesis images of solid lesions yielded results that were consistent with the phantom experiments, but were still to some extent inconclusive. We conclude that lesion characterization is feasible in spectral tomosynthesis, but more data, as well as refinement of the calibration and discrimination algorithms, are needed to draw final conclusions about the benefit compared to 2D.

The lens contains sawtooth-shaped grooves (103, 104) located between the two ends of the lens in at least two surfaces. A refractive device for x-rays comprises a low Z-material part (101) with one end (105) for receiving x-rays from an x-ray source, and an opposite end (106) for these x-rays to exit from. The device also includes a number of essentially sawtooth-shaped grooves located between the two ends in at least two surfaces. The grooves are arranged so that x-rays entering the device will have to pass through them as they travel between the two ends of the device, after which they are focused to a refraction point. Independent claims are also included for (a) a lens containing this refractive device, (b) an x-ray system for two-dimensional focusing of x-rays and including at least two of these lenses, each x-ray beam intersecting the two lenses one after the other, and at least one lens being rotated about an optical axis relative to the other lens, (c) a method for two-dimensional focusing using these lenses, (d) a method for obtaining a bimodal energy distribution from an x-ray source using this lens, (e) a method for making a refractive x-ray lens with a sawtooth profile by engraving the profiles in a substrate, processing an original piece and using the original to press grooves into a suitable material.

The present invention refers to a refractive arrangement for X-rays, and specially to a lens comprising: a member of low-Z material, said member of low-Z material having a first end adapted to receive x-rays emitted from an x-ray source and a second end from which emerge said x-rays received at said first end. It further comprises a plurality of substantially saw-tooth formed grooves disposed between said first and second ends, said plurality of grooves oriented such that said x-rays which are received at said first end, pass through said member of low-Z material and said plurality of grooves, and emerge from said second end, are refracted to a focal point.

Purpose: Beam-quality optimization in digital mammography traditionally considers detection of a target obscured by quantum noise in a homogeneous background. This does not correspond well to the clinical imaging task because real mammographic images contain a complex superposition of anatomical structures, resulting in anatomical noise that may dominate over quantum noise. The purpose of this paper is to assess the influence on optimal beam quality in mammography when anatomical noise is taken into account. Methods: The detectability of microcalcifications and masses was quantified using a theoretical ideal-observer model that included quantum noise as well as anatomical noise and a simplified model of a photon-counting mammography system. The outcome was experimentally verified using two types of simulated tissue phantoms. Results: The theoretical model showed that the detectability of tumors and microcalcifications behaves differently with respect to beam quality and dose. The results for small microcalcifications were similar to what traditional optimization methods yield, which is to be expected because quantum noise dominates over anatomical noise at high spatial frequencies. For larger tumors, however, low-frequency anatomical noise was the limiting factor. Because anatomical structure noise has similar energy dependence as tumor contrast, the optimal x-ray energy was found to be higher and the useful energy region was wider than traditional methods suggest. A simplified scalar model was able to capture this behavior using a fitted noise mixing parameter. The phantom measurements confirmed these theoretical results. Conclusions: It was shown that since quantum noise constitutes only a small fraction of the noise, the dose could be reduced substantially without sacrificing tumor detectability. Furthermore, when anatomical noise is included, the tube voltage can be increased well beyond what is conventionally considered optimal and used clinically, without loss of image quality. However, no such conclusions can be drawn for the more complex mammographic imaging task as a whole. (C) 2014 American Association of Physicists in Medicine.

An ideal-observer model is applied to optimize the design of an X-ray tube intended for use in a multi-slit scanning photon-counting mammography system. The design is such that the anode and the heel effect are reversed and the projected focal spot is smallest at the chest wall. Using linear systems theory, detectability and dose efficiency for a 0.1-mm disk are calculated for different focal spot sizes and anode angles. It is shown that the image acquisition time can be reduced by about 25% with spatial resolution and dose efficiency improved near the chest wall and worsened further away. The image quality is significantly more homogeneous than for the conventional anode orientation, both with respect to noise and detectability of a small object. With the tube rotated 90^°, dose efficiency can be improved by 20% for a fixed image acquisition time. 

Two digital mammography systems, one based on scanning photon counting silicon detectors and the other on storage phosphor plates (CR), have been compared in terms of image quality and dose. Sets of images of a contrast-detail phantom (CDMAM3.4) were acquired for each system and dose level. The images were evaluated in the disc diameter range 0.16-1 mm using a computer program (CDcom) and the results were fitted to a psychometric curve for each disc diameter. The contrast-detail curve was summarized into one single figure of merit, the image quality index, and the dose efficiency was calculated. The errors of the calculated parameters were assessed using statistical analysis. It was found that the scanning photon-counting system can achieve the same image quality as the storage phosphor plate (CR) system at 30-38% of the average glandular dose.

The goal in medical x-ray imaging is to obtain the image quality requiredfor a given detection task, while ensuring that the patient dose is kept as lowas reasonably achievable. The two most common strategies for dose reductionare: optimizing incident x-ray beams and utilizing energy informationof transmitted beams with new detector techniques (spectral imaging). Inthis thesis, dose optimization schemes were investigated in two x-ray imagingsystems: digital mammography and computed tomography (CT).

In digital mammography, the usefulness of anti-scatter grids was investigatedas a function of breast thickness with varying geometries and experimentalconditions. The general conclusion is that keeping the grid is optimalfor breasts thicker than 5 cm, whereas the dose can be reduced without a gridfor thinner breasts.

A photon-counting silicon-strip detector developed for spectral mammographywas characterized using synchrotron radiation. Energy resolution, ΔE/E_in, was measured to vary between 0.11-0.23 in the energy range 15-40 keV, which is better than the energy resolution of 0.12-0.35 measured inthe state-of-the-art photon-counting mammography system. Pulse pileup hasshown little effect on energy resolution.

In CT, the performance of a segmented silicon-strip detector developedfor spectral CT was evaluated and a theoretical comparison was made withthe state-of-the-art CT detector for some clinically relevant imaging tasks.The results indicate that the proposed photon-counting silicon CT detector issuperior to the state-of-the-art CT detector, especially for high-contrast andhigh-resolution imaging tasks.

The beam quality was optimized for the proposed photon-counting spectralCT detector in two head imaging cases: non-enhanced imaging and Kedgeimaging. For non-enhanced imaging, a 120-kVp spectrum filtered by 2half value layer (HVL) copper (Z = 29) provides the best performance. Wheniodine is used in K-edge imaging, the optimal filter is 2 HVL iodine (Z = 53)and the optimal kVps are 60-75 kVp. In the case of gadolinium imaging, theradiation dose can be minimized at 120 kVp filtered by 2 HVL thulium (Z =69).

We have evaluated a silicon-strip detector with a 0.18-mu m CMOS application specific integrated circuits (ASIC) containing 160 channels for use in photon-counting digital mammography. Measurements were performed at the Elettra light source using monochromatic X-ray beams with different energies and intensities. Energy resolution, Delta E/E-in, was measured to vary between 0.10 and 0.23 in the energy range of 15-40 keV. Pulse pileup has shown little effect on energy resolution.

The grids used in digital mammography to reduce scattered radiation from the breast are not perfect and lead to partial absorption of primary radiation at the same time as not all of the scattered radiation is absorbed. It has therefore lately been suggested to remove the grids and correct for effects of scattered radiation by post-processing the images. In this paper, we investigated the dose reduction that might be achieved if the gird were to be removed. Dose reduction is determined as a function of PMMA thickness by comparing the contrast-to-noise ratios (CNRs) of images acquired with and without grid at a constant exposure. We used a theoretical model validated with Monte Carlo simulations and phantom studies. To evaluate the CNR, we applied aluminum filters of two different sizes, 4x8 cm2 and 1x1 cm 2. When the large Al filter was used, the resulting CNR value for the grid-less images was overestimated as a result of a difference in amount of scattered radiation in the background region and of the region covered by the filter, a difference that could be eliminated by selecting a region of interest close to the edge of the filter. The optimal CNR when the PMMA thickness was above about 4 cm was obtained with a grid, whereas removing the grid leaded to a dose saving in thinner PMMAs. The results suggest not removing grids in breast cancer screening.

We are developing a photon-counting spectral CT detector with small pixel size of 0.40.5 mm2, o ering a potentialadvantage for better visualization of small structures in pediatric patients. The purpose of this study is to determinethe patient size dependent scanning parameters (kVp and mAs) for pediatric CT in two imaging cases: adipose imagingand iodinated blood imaging.Cylindrical soft-tissue phantoms of diameters between 10-25 cm were used to mimic patients of di erent ages from 0-15 y. For adipose imaging, a 5-mm-diameter adipose sphere was assumed as an imaging target, while an iodinated bloodsphere of 1 mm in diameter was assumed in the case of iodinated imaging. By applying the geometry of a commercial CTscanner (GE LightSpeed VCT), simulations were carried out to calculate the detectability index,d02, with tube potentialsvarying from 40 to 140 kVp. The optimal kVp for each phantom in each imaging case was determined such that the dose-normalized detectability index,d02=dose, is maximized. With the assumption that image quality in pediatric imagingis required the same as in typical adult imaging, the value of mAs at optimal kVp for each phantom was selected toachieve a reference detectability index that was obtained by scanning an adult phantom (30 cm in diameter) in a typicaladult CT procedure (120 kVp and 200 mAs) using a modeled energy-integrating system.For adipose imaging, the optimal kVps are 50, 60, 80, and 120 kVp, respectively, for phantoms of 10, 15, 20, and25-cm in diameter. The corresponding mAs values required to achieve the reference detectability index are only 9%,23%, 24%, and 54% of the mAs that is used for adult patients at 120 kVp, for 10, 15, 20, and 25-cm-diameter phantoms,respectively. In the case of iodinated imaging, a tube potential of 60 kVp was found optimal for all phantoms investigated,and the mAs values required to achieve the reference detectability index are 2%, 9%, 37%, and 109% of the adult mAs.The results also indicate that with the use of respective optimal kVps, the photon-counting spectral system o ers up to30% higherd02=dose than the modeled energy-integrating system for adipose imaging, and 70% for iodinated imaging.

Antiscatter grids are used in digital mammography to reduce the scattered radiation from the breast and improve image contrast. They are, however, imperfect and lead to partial absorption of primary radiation, as well as failing to absorb all scattered radiation. Nevertheless, the general consensus has been that antiscatter grids improve image quality for the majority of breast types and sizes. There is, however, inconsistency in the literature, and recent results show that a substantial image quality improvement can be achieved even for thick breasts if the grid is disposed of. The purpose of this study was to investigate if differences in the considered imaging task and experimental setup could explain the different outcomes. We estimated the dose reduction that can be achieved if the grid were to be removed as a function of breast thickness with varying geometries and experimental conditions. Image quality was quantified by the signal-difference-to-noise ratio (SDNR) measured using an aluminum (Al) filter on blocks of poly(methyl methacrylate) (PMMA), and images were acquired with and without grid at a constant exposure. We also used a theoretical model validated with Monte Carlo simulations. Both theoretically and experimentally, the main finding was that when a large [Formula: see text] Al filter was used, the SDNR values for the gridless images were overestimated up to 25% compared to the values for the small [Formula: see text] filter, and gridless imaging was superior for any PMMA thickness. For the small Al filter, gridless imaging was only superior for PMMAs thinner than 4cm. This discrepancy can be explained by a different sensitivity to and sampling of the angular scatter spread function, depending on the size of the contrast object. The experimental differences were eliminated either by using a smaller region of interest close to the edge of the large filter or by applying a technique of scatter correction by subtracting the estimated scatter image. These results explain the different conclusions reported in the literature and show the importance of the selection of measurement methods. Since the interesting structures in mammography are below the 1-cm scale, we advocate the use of smaller contrast objects for assessment of antiscatter grid performance.

Head computed tomography (CT) plays an important role in the comprehensive evaluation of acutestroke. Photon-counting spectral detectors, as promising candidates for use in the next generation of x-ray CTsystems, allow for assigning more weight to low-energy x-rays that generally contain more contrast information.Most importantly, the spectral information can be utilized to decompose the original set of energy-selectiveimages into several basis function images that are inherently free of beam-hardening artifacts, a potential ad-vantage for further improving the diagnosis accuracy. We are developing a photon-counting spectral detector forCT applications. The purpose of this work is to determine the optimal beam quality for material decomposition intwo head imaging cases: nonenhanced imaging and K-edge imaging. A cylindrical brain tissue of 16-cm diam-eter, coated by a 6-mm-thick bone layer and 2-mm-thick skin layer, was used as a head phantom. The imagingtarget was a 5-mm-thick blood vessel centered in the head phantom. In K-edge imaging, two contrast agents,iodine and gadolinium, with the same concentration (5mg∕mL) were studied. Three parameters that affect beamquality were evaluated: kVp settings (50 to 130 kVp), filter materials (Z¼13to 83), and filter thicknesses [0 to 2half-value layer (HVL)]. The image qualities resulting from the varying x-ray beams were compared in terms oftwo figures of merit (FOMs): squared signal-difference-to-noise ratio normalized by brain dose (SDNR2∕BD) andthat normalized by skin dose (SDNR2∕SD). For nonenhanced imaging, the results show that the use of the 120-kVp spectrum filtered by 2 HVL copper (Z¼29) provides the best performance in both FOMs. When iodine isused in K-edge imaging, the optimal filter is 2 HVL iodine (Z¼53) and the optimal kVps are 60 kVp in terms ofSDNR2∕BD and 75 kVp in terms of SDNR2∕SD. A tradeoff of 65 kVp was proposed to lower the potential riskof skin injuries if a relatively long exposure time is necessarily performed in the iodinated imaging. In the case ofgadolinium imaging, both SD and BD can be minimized at 120 kVp filtered with 2 HVL thulium (Z¼69). Theresults also indicate that with the same concentration and their respective optimal spectrum, the values ofSDNR2∕BD and SDNR2∕SD in gadolinium imaging are, respectively, around 3 and 10 times larger thanthose in iodine imaging. However, since gadolinium is used in much lower concentrations than iodine in theclinic, iodine may be a preferable candidate for K-edge imaging.

Photon-counting detectors are expected to bring a range of improvements to patient imaging with x-ray computed tomography (CT). One is higher spatial resolution. We demonstrate the resolution obtained using a commercial CT scanner where the original energy-integrating detector has been replaced by a single-slice, silicon-based, photon-counting detector. This prototype constitutes the first full-field-of-view silicon-based CT scanner capable of patient scanning. First, the pixel response function and focal spot profile are measured and, combining the two, the system modulation transfer function is calculated. Second, the prototype is used to scan a resolution phantom and a skull phantom. The resolution images are compared to images from a state-of-the-art CT scanner. The comparison shows that for the prototype 19 lp∕cm are detectable with the same clarity as 14 lp∕cm on the reference scanner at equal dose and reconstruction grid, with more line pairs visible with increasing dose and decreasing image pixel size. The high spatial resolution remains evident in the anatomy of the skull phantom and is comparable to that of other photon-counting CT prototypes present in the literature. We conclude that the deep silicon-based detector used in our study could provide improved spatial resolution in patient imaging without increasing the x-ray dose.

The superposition of anatomical structures often greatly impedes detectability in conventional mammography. Spectral imaging and tomosynthesis are two promising methods used for suppression of the anatomical background. The aim of this thesis is to compare and evaluate the benefits of tomosynthesis and spectral imaging, both in combination and separately. A computer model for signal and noise transfer in tomosynthesis was developed and combined with an existing model for spectral imaging. Measurements were performed to validate the models. An ideal-observer detectability index incorporating anatomical noise was used as a figure of merit to compare the different modalities. For detection of a contrast-enhanced tumor in a breast with high anatomical background, the optimum performance for spectral tomosynthesis was found at a tomo-angle of 10 degrees. The improvement was in the order of a factor 10 compared to non-energy-resolved tomosynthesis with the same angular extent. This was supported by clinical results.