Use of medical imaging continues to increase, making the largest contribution to the exposure of populations from artificial sources of radiation worldwide. The principle of optimisation of protection is that \'the likelihood of incurring exposures, the number of people exposed, and the magnitude of their individual doses should all be kept as low as reasonably achievable (ALARA), taking into account economic and societal factors\'. Optimisation for medical imaging involves more than ALARA - it requires keeping individual patient exposures to the minimum necessary to achieve the required medical objectives. In other words, the type, number, and quality of images must be adequate to obtain the information needed for diagnosis or intervention. Dose reductions for imaging or x-ray-image-guided procedures should not be used if they degrade image quality to the point where the images are inadequate for the clinical purpose. The move to digital imaging has provided versatile acquisition, post-processing, and presentation options, and enabled wide and often immediate availability of image information. However, because images are adjusted for optimal viewing, the appearance may not give any indication if the dose is higher than necessary. Nevertheless, digital images provide opportunities for further optimisation, and allow the application of artificial intelligence methods.Optimisation of radiological protection for digital radiology (radiography, fluoroscopy, and computed tomography) involves selection and installation of equipment, design and construction of facilities, choice of optimal equipment settings, day-to-day methods of operation, quality control programmes, and ensuring that all personnel receive proper initial and career-long training. The radiation dose levels that patients receive also have implications for doses to staff. As new imaging equipment incorporates more options to improve performance, it becomes more complex and less easily understood, so operators have to be given more extensive training. Ongoing monitoring, review, and analysis of performance is required that feeds back into the improvement and development of imaging protocols. Several different aspects relating to optimisation of protection that need to be developed are set out in this publication. The first is collaboration between radiologists/other radiological medical practitioners, radiographers/medical radiation technologists, and medical physicists, each of whom have key skills that can only contribute to the process effectively when individuals work together as a core team. The second is appropriate methodology and technology, with the knowledge and expertise required to use each effectively. The third relates to organisational processes which ensure that required tasks, such as equipment performance tests, patient dose surveys, and review of protocols, are carried out. There is wide variation in equipment, funding, and expertise around the world, and the majority of facilities do not have all the tools, professional teams, and expertise to fully embrace all the possibilities for optimisation. Therefore, this publication sets out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally: Level D - preliminary; Level C - basic; Level B - intermediate; and Level A - advanced. Guidance from professional societies can be invaluable in helping users to evaluate systems and aid in adoption of best practice. Examples of systems and activities that should be in place to achieve the different levels are set out. Imaging facilities can then evaluate the arrangements they already have, and use this publication to guide decisions about the next actions to be taken in optimising their imaging services.

OBJECTIVE: Accurate measurements of trabecular bone microarchitecture are required for a proper assessment of bone fragility. Photon-counting detector CT (PCD-CT) has different technical properties than conventional CT, resulting in higher resolution and thereby potentially enabling in-vivo measurement of trabecular microarchitecture. The purpose of this study was to quantify trabecular bone microarchitectural parameters with PCD-CT at varying radiation doses and compare this to µCT as gold standard.
METHODS: Both distal radii, distal tibiae, femoral heads, and two vertebrae were dissected from one human. All specimens were scanned ex-vivo on a PCD-CT system (slice increment 0.1 mm; pixel size 0.1042-0.127 mm) and a µCT system (isotropic voxel size 49-68.4 µm). The radiation doses of the PCD-CT scans were varied from 2.5 to 120 mGy based on the volume CT dose index (CTDIvol32). For the PCD-CT scans, contrast-to-noise ratio and trabecular sharpness were calculated and compared between radiation doses. µCT and PCD-CT scans were registered. The trabecular bone was then segmented from all PCD-CT and µCT scans and split into cubes with 6-mm edge length. For each cube, bone volume over total volume, trabecular thickness, trabecular number, and trabecular heterogeneity were calculated and compared between corresponding PCD-CT and µCT cubes.
RESULTS: With increasing dose, contrast-to-noise ratio and trabecular sharpness values increased for the PCD-CT images. Already at the lowest dose, high correlations between the trabecular microarchitectural parameters between µCT and PCD-CT were found (R2 = 0.55-0.95), which improved with increasing radiation dose (R2 = 0.76-0.96 at 20 mGy).
CONCLUSIONS: PCD-CT can be used to quantify trabecular bone microarchitecture, with accuracy comparable to µCT and at clinically relevant radiation doses.

OBJECTIVE: Photon-counting x-ray detectors (PCDs) can produce dual-energy (DE) x-ray images of lung cancer in a single x-ray exposure. This study quantifies the dependence of contrast-to-noise ratio (CNR) on tube voltage, energy threshold and patient thickness in single exposure, DE, bone-suppressed thoracic imaging with PCDs, and elucidates how the processes inherent in x-ray detection by PCDs contribute to CNR degradation. Approach: We modeled the DE CNR for five theoretical PCDs, ranging from an ideal PCD that detects every photon in the correct energy bin and rejects scatter, to a non-ideal PCD that suffers from charge-sharing and electronic noise, and detects scatter. Model predictions were compared with experimental data from images acquired using a CdTe PCD. The imaging phantom simulated attenuation, scatter and contrast in lung nodule imaging. We quantified CNR improvements achievable with anti-correlated noise reduction (ACNR) and measured the range of exposure rates where pulse pile-up is negligible. Main Results: At the optimal energy thresholds, the modeled CNR with and without ACNR was within 10% of the experimental CNR. CNR improvements with ACNR were approximately five-fold. CNR increased <20% when increasing the tube voltage from 90 kV to 130 kV. Optimal energy thresholds ranged from 50 keV to 70 keV across all tube voltages and patient thicknesses with and without ACNR. Charge sharing and scatter had the largest effect on CNR, degrading it by ∼30% and ∼15% respectively. Dead-time losses were less than 5%. Significance: We (1) employed analytical and computational models to assess the impact of different factors on CNR in single-exposure DE imaging with PCDs, (2) evaluated the accuracy of these models in predicting experimental trends, and (3) quantified improvements in CNR achievable through ACNR. To the best of our knowledge, this study represents the first systematic investigation of single-exposure DE imaging of lung nodules with PCDs. .

OBJECTIVE: Image quality in positron emission tomography (PET) is influenced by positron range. In this work, the effect of the magnetic field of a PET/MR Siemens Biograph mMR 3T on the quality of PET images was studied.
METHODS: Experimental measurements were conducted using18F and68Ga-filled phantoms to quantify image uniformity, recovery coefficients (RCs), spill-over ratios and percent contrast for spherical lesions. Tissue-equivalent phantoms (lung inhale and exhale, adipose, water, trabecular and cortical bone) were used together with a line source to quantify the impact of the magnetic field on the reconstructed PET images. A comparative analysis was made with images obtained with a PET/CT Biograph Vision 600, using the same radionuclides and phantoms.
RESULTS: Higher RCs values were obtained when the image quality phantom was filled with68Ga and scanned with the PET/MR system compared to those obtained with the PET/CT scanner. Hot spheres in the lesion detectability phantom, appear contracted in the transverse direction in the PET/MR system, an effect more evident for68Ga compared to18F, but no elongation in the direction parallel to the magnetic field was observed. In the PET/CT scanner, radial profiles taken from axial slices of line sources, show longer distribution tails extending beyond 20 mm when filled with68Ga and placed inside lung-inhale tissue. In the PET/MR scanner the radial profiles of all materials collapsed into a single distribution with tails extending no more than 10 mm in the direction perpendicular to the magnetic field.
CONCLUSIONS: Positron range depends on positron energy and material density in which they traverse. The results show an evident improvement in image quality in the transaxial direction only, particularly in phantoms filled with68Ga when using a PET/MR system as opposed to images acquired in the PET/CT system due to the presence of the magnetic field.

Camera-based object detection is integral to advanced driver assistance systems (ADAS) and autonomous vehicle research, and RGB cameras remain indispensable for their spatial resolution and color information. This study investigates exposure time optimization for such cameras, considering image quality in dynamic ADAS scenarios. Exposure time, the period during which the camera sensor is exposed to light, directly influences the amount of information captured. In dynamic scenarios, such as those encountered in typical driving scenarios, optimizing exposure time becomes challenging due to the inherent trade-off between Signal-to-Noise Ratio (SNR) and motion blur, i.e., extending exposure time to maximize information capture increases SNR, but also increases the risk of motion blur and overexposure, particularly in low-light conditions where objects may not be fully illuminated. The study introduces a comprehensive methodology for exposure time optimization under various lighting conditions, examining its impact on image quality and computer vision performance. Traditional image quality metrics show a poor correlation with computer vision performance, highlighting the need for newer metrics that demonstrate improved correlation. The research presented in this paper offers guidance into the enhancement of single-exposure camera-based systems for automotive applications. By addressing the balance between exposure time, image quality, and computer vision performance, the findings provide a road map for optimizing camera settings for ADAS and autonomous driving technologies, contributing to safety and performance advancements in the automotive landscape.

Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This pilot study evaluates the feasibility and effectiveness of the International Atomic Energy Agency (IAEA)\'s remote and automated quality control (QC) methodology, which has been tested in multiple imaging centers. Methods: The data, collected between April and December 2022, included 47 longitudinal data sets from 22 digital radiographic units. Participants submitted metadata on the radiography setup, exposure parameters, and imaging modes. The database comprised 968 exposures, each representing multiple image quality parameters and metadata of image acquisition parameters. Python scripts were developed to collate, analyze, and visualize image quality data. Results: The pilot survey identified several critical issues affecting the future implementation of the IAEA method, as follows: (1) difficulty in accessing raw images due to manufacturer restrictions, (2) variability in IQ parameters even among identical X-ray systems and image acquisitions, (3) inconsistencies in phantom construction affecting IQ values, (4) vendor-dependent DICOM tag reporting, and (5) large variability in SNR values compared to other IQ metrics, making SNR less reliable for image quality assessment. Conclusions: Cross-comparisons among radiography systems must be taken with cautious because of the dependence on phantom construction and acquisition mode variations. Awareness of these factors will generate reliable and standardized quality control programs, which are crucial for accurate and fair evaluations, especially in high-frequency chest imaging.

OBJECTIVE: Magnetic resonance (MR) images free of artefacts are of pivotal importance for MR-guided ion radiotherapy. This study investigates MR image quality for simultaneous irradiation in an experimental setup using phantom imaging as well as in-vivo imaging. Observed artefacts are described within the study and their cause is investigated with the goal to find conclusions and solutions for potential future hybrid devices. Approach: An open magnetic resonance scanner with a field strength of 0.25 T has been installed in front of an ion beamline. Simultaneous MRI and irradiation using raster scanning were performed to analyze image quality in dedicated phantoms. Magnetic field measurements were performed to assist the explanation of observed artifacts. In addition, in-vivo images were acquired by operating the magnets for beam scanning without transporting a beam. Main Results: The additional frequency component within the isocenter caused by the fringe field of the horizontal beam scanning magnet correlates with the amplitude and frequency of the scanning magnet steering and can cause ghosting artifacts in the images. These are amplified with high currents and fast operating of the scanning magnet. Applying a real-time capable pulse sequence in-vivo revealed no ghosting artifacts despite a continuously changing current pattern and a clinical treatment plan activation scheme, suggesting that the use of fast imaging is beneficial for the aim of creating high quality in-beam MR images. This result suggests, that the influence of the scanning magnets on the MR acquisition might be of negligible importance and does not need further measures like extensive magnetic shielding of the scanning magnets. Significance: Our study delimited artefacts observed in MR images acquired during simultaneous raster scanning ion beam irradiation. The application of a fast pulse sequence showed no image artefacts and holds the potential that online MR imaging in future hybrid devices might be feasible. .

BACKGROUND: Transthoracic echocardiography (TTE) is the primary tool for assessing left ventricular (LV) function in cardiogenic shock (CS). However, inadequate image quality often hinders it. In this retrospective study, we investigated factors associated with LV image quality in patients admitted to the intensive care unit (ICU) with ischemic CS.
RESULTS: Two critical care physicians accredited in echocardiography independently reviewed the TTEs of 100 patients admitted to our tertiary cardiac ICU with ST-elevation myocardial infarction complicated by CS between October 2016 and September 2019. Endocardial border definition (EBD) was graded for each myocardial segment of the apical 4-chamber and 2-chamber views using a conventional scoring system (1 = good, 2 = suboptimal, 3 = poor, and 4 = not possible). The biplane EBD index (EBDi) was calculated by averaging all segments from both views. An average EBDi of both observers was correlated with clinical and echocardiographic parameters. The median age was 62 years [54, 73], and 78% were males. LV ejection fraction and cardiac index (CI) medians were 29% [20, 35] and 1.93 l/min/m2 [1.40, 2.51], respectively. The median biplane EBDi was nearly suboptimal (1.833 [1.542, 2.083]). There was no correlation between EBDi and age, sex, or body mass index. However, biplane EBDi demonstrated statistically significant correlations with PaO2 (r2 = 0.066, p = 0.01), mean arterial pressure (MAP, r2 = 0.055, p = 0.03), CI (r2 = 0.105, p < 0.01), tricuspid annulus systolic velocity (RV S\', r2 = 0.092, p = 0.01), and tricuspid regurge maximum velocity (TR Vmax, r2 = 0.067, p = 0.01). In a multivariate model, only CI correlated independently with EBDi (r2 = 0.105, p < 0.01). The biplane EBDi predicted CI (area under the curve (AUC) 0.70, p = 0.001) with good sensitivity (71%) and reasonable specificity (61%).
CONCLUSIONS: The study suggests that in patients admitted to the ICU with ischemic CS, LV image quality by TTE deteriorates with the severity of shock, as indicated by CI.

Purpose. Virtual Grid (VG) is an image processing technique designed to address scattered radiation from radiographic systems without a physical grid. It aims to eliminate artifacts caused by grid misalignment and enhance radiographic workflow efficiency. We intend to evaluate image quality between Virtual Grid and grid-based radiographic systems across various patient thicknesses.Methods. A Fujifilm Virtual Grid and GE AMX-4 portable radiographic system was used. Image quality was assessed using MTF, NPS, LCR, and CNR. MTF calculations employed an edge-device method with a 0.1 mmCu sheet. For NPS evaluation, uniform images were acquired with multiple 30 × 30 cm solid water blocks (2 cm thick), overlaid in 2 cm increments to simulate patient sizes from 2cm to 40 cm. LCR and CNR were evaluated using a CIRS test plate with 9-hole depths for a hole diameter of 0.375\'. The test object was placed on top of the detector then water blocks, while maintaining the same SID, beam quality, and exposure between the units. Visual assessments were conducted by four readers, quantifying perceived hole numbers. The weighted Cohen\'s Kappa and Welch\'s T-test were utilized for statistical analysis.Results. At 80% MTF, VG exhibited high contrast resolution of 1.1 l p/mm compared to 1.2 l p/mm for the grid system. VG demonstrated lower noise levels across all frequencies for equivalent patient thicknesses. Welch\'s T-test indicated no significant differences in LCR (P = 0.31) and CNR (P = 0.34) between the systems. However, qualitative observation demonstrated VG\'s better low contrast response for patient sizes ≥10 cm. The average weighted Cohen\'s Kappa value was 0.78.Conclusion. This work indicates the Virtual Grid technology can effectively mitigate scattered radiation to improve granularity and low-contrast resolution in an image compared to a grid system. Furthermore, it can potentially reduce patient dose.

X-ray imaging results in inhomogeneous irradiation of the detector and distortion of structures in the periphery of the image; yet the spatial dependency of tomosynthesis image-quality metrics has not been extensively investigated. In this study, we use virtual clinical trials to quantify the spatial dependency of lesion detectability in our lab\'s next-generation tomosynthesis (NGT) system. Two geometries were analyzed: a conventional geometry with mediolateral source motion, and a NGT geometry with T-shaped motion. Breast parenchymal texture was simulated using an open-source library with Perlin noise using 400 random seeds and three breast densities. Spherical mass lesions were inserted in the central slice of the phantoms using the voxel additive method. Image acquisition was simulated using in-house ray-tracing software and simple backprojection was performed using commercial reconstruction software. Lesion detectability with Channelized Hotelling Observers (CHOs) was analyzed using receiver operating characteristic curves to measure the detectability index (d\') at 154 unique locations for the lesions. We also divided images into three non-overlapping regions (differing in terms of distance from the chest wall). At the 0.05 level of significance, there was a statistically significant difference between the geometries in terms of d\' in one of the three regions, with the T geometry offering superior detectability. Examining all 154 lesion locations, the T geometry was found to offer lower spread (standard deviation) in d\' values throughout the image area, and superior d\' at 83 of 154 locations (53.9%). In summary, the T geometry enables superior lesion detection and mitigates anisotropies.