New approaches to Quality Assurance inmedicalimaging

Dr. Hugo de las Heras Gala Dr. Hugo de las Heras Gala Division of Radiological Devices Division of Radiological Devices US Food and Drug Administration US Food and Drug Administration

Munich,Germany,58October2010

ThistalkintroducesnewapproachestoQA andanopinionaboutitsfuture
Future ofQA

= g1 g 2 g
PresentofQA ImageQA Training

Dose QA

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

EverytechnologyneedsQualityAssurancechecks
Indiagnosticradiology,QAensures sufficientlyhighimagequality followingtheALARA principlefordose

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Dose andIQ mustbemeasuredandbalanced

Detectorsensitivity Contamination(NM) Countrates(NM) Malfunctionofdevices(Xray) Noise Resolution Artifacts

Dose

Image quality

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

DoseQA
Dose
Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Everymodalityhasitsowndosemeasures
Nuclear Medicine: Activity
Dose

Fluoroscopy: Peak skin dose Reference air Kerma Kerma-Area Product Fluoro time CT: CT dose index Dose-length product

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Newapproachesfocusoneffectivedose and skindose

1. Organ and effective dose E Comparisons among modalities 2. Entrance and peak skin dose skin-dose maps, prediction of deterministic effects
Dose
Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

1.Effectivedose allowsintercomparisons
Dose

Tools: Whole-body phantoms, simulations and handbooks Values are the same for any modality.

Current approach: flexible whole body phantoms with OSL detectors and handbook of organ and effective doses for each modality
Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

2.Skindose isrelatedtodeterministiceffects
Dose

Tools: Radiochromic film, densitometer, scanner Easy, cheap and available in every clinic Allows comparisons between x-ray modalities May allow validation of dose maps

Current approach: Relate dose measures to entrance skin dose, and enforce dose-map feature in CT and fluoroscopy.
Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

ImageQA
IQ

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Measuresforimagequalityarethesameforall modalities
Noise: Historically, SNR through standard deviation. Now, SNR through Noise power spectrum (NPS) Resolution: Historically, bar patterns and other structures Now, Modulation Transfer Function (MTF) Artifacts: Wide variety that do depend on each modality (out of scope) The current trend is to use mathematical (model) observers that simulate human perception and avoid all of the methods above IQ

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Atestobjectforcontrast,resolution,noiseand artifactstogether(quick,subjectiveQA)
IQ

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Thestandarddeviationdoesnotaccountfor structuresinthenoise
IQ

Quantum noise

Structure noise

Original

Same standard deviation

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Becausethestandarddeviationisjusttheintegralof theNoisePowerSpectrum
NPS1 IQ

1
NPS2

1 = 2

Brunner et al: proposal to IEC

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

ThefutureofQA

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

ThenewestapproachusesneitherNPSnorMTF
IQ object Imaging system display FourierMethods likeMTFandNPSrelyontwoassumptions: Thesystemisshiftinvariant (mostlyfalsebutacceptable) Thesystemislinear (mostlytruebutfalseinsomenewtechnologies) Solutions: 1.Usehumanobservers tovisuallydetermineIQ 2.Substitutehumansbymathematicalobservers

ROC plots

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

ThenewestapproachusesneitherNPSnorMTF
Diseased cases

ROC curve: plot of hits vs. false alarms

TPF, sensitivity (Se)

Test result

Threshold
Non-diseased cases

FPF, 1-specificity (Sp) Test result

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Diseased cases

Non-diseased cases

2
e nc a l in e

TPF, sensitivity

ch

Level of Technology

2
FPF, 1-specificity Degree of overlap Ability to discriminate between 2 conditions

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Howcanmodelobservers alsodoROCanalysis?
Animageisrepresentedasavectorg,andalesion init(suchasatumor)iscalledasignal Weobtainalotofimagesanddefine: Background+signal:=g1 Backgroundonly:=g2 IQ

g1
Thesignalis

g1 g 2
= g1 g 2 g
Training

g2

Ourobserverisanumber foreachimageg : If >threshold ,wedecidesignalpresent If <threshold ,wedecidesignalabsent

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

ROCismuchcheaperwithmodelobservers!
Diseased cases TPF, sensitivity (Se)

ROC curve: plot of hits vs. false alarms

Test result

Threshold
Non-diseased cases

FPF, 1-specificity (Sp)

Test result

Faster,cheaperandnoreadervariability

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Insummary,QA/QCismovingtowardsbetter simulationofhumanproperties
Attentiontowardsionizingradiationdose hasincreasedinthepastfewyears QA/QCregardingdoseismovingtowards effectivedose andentranceskindose

QA/QCregardingimagequalityis Advocatingagainsttheuseof EnforcingtheuseofMTF andNPS Improvingobservermodels Questions?

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

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Training

Imageandslidesources(thankyou!)
E.Guibelalde,UniversidadComplutense,Madrid(Spain) K.Myers,FDA,SilverSpring(USA) keeme.com,monrol.com nervoussystemdiseases.com ggii.com.ph mesotheliomasos.com blog.al.com weather.gov
Disclaimer: this talk did not undergo formal internal clearance at US FDA.

J.A.PattonHistoryandprinciplesof hybridimaging Gammex.com chihlien.com.tw IAEA(InternationalAtomicEnergyAgency)

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Backupslides

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010

A typical bar pattern to determine resolution in line-pairs / mm

Contrast, resolution, noise and artifacts together for quick QC

Inthefuture,ModelObserversmaygenerateROC plotsjustlikehumans
IQ Receiver Operating Characteristic Analysis basedon humanobservers: Manyimages Manydoctorsortrainedpeople Alotoftedioustime Disadvantages: Readervariability Expensive basedon modelobservers: Manyimages Apowerfulcomputer

Disadvantages: Mathematicalcomplexity

Dr.HugodelasHerasGala NewapproachestoQA 3rdMADEIRATConImaginginNuclearMedicine 58October2010