Accreditation application Form EBAMP
General information(obligatory)Module Number / MPE 07
Institution Name / Royal Surrey County Hospital
Institution Address / Egerton Road, Guildford, GU2 7XX, UK
Event Title / Optimisation of X-ray imaging using standard and innovative techniques
(Online only course)
Type of event / O Congress
O Conference
O Workshop
O Seminar
X Course
Minimum level of education
in Medical Physics that
participants should
have already achieved:
EQF level / X 7
O 8
Date / 15th June to 8th October 2017 (online)
9 to 11th October 2017 (Webcasting)
12th October to 13thDecember 2017 (Face to face content and Post course assignment)
Venue(s) / NA (online only)
Event Description(obligatory)
Total hours of learning activity / 80
Language of activity / English
Abstract / The course will cover the measurement of image quality using standard test measurements and more advanced quantitative measurements such as detective quantum efficiency (DQE). The challenge of translating the industry IEC standard into a practical measurement undertaken in a clinical environment will be covered. The course will show how these measurements relate to the type of detector and the final clinical image quality. These quantitative measurements will be used to examine the image quality of clinical images and to show how to simulate clinical images as part of an optimisation project. To optimise a system, it is important to understand the clinical task that is undertaken and the consequences of inadequate image quality. The students will learn about the balance between image quality and risk due to the radiation exposure and the various strategies for optimisation studies that can be undertaken including using physics measurements and observer studies. Training will be received in the methodologies for observer studies, include data analysis using ROC and FROC techniques.
Learning Outcomes / MPE07.01Discuss in detail image quality metrics such as modulation transfer function (MTF) and Detective quantum efficiency (DQE).
MPE07.02Evaluate the performance of a detector using quantitative techniques such as MTF and DQE.
MPE07.03Discuss how the results of quantitative measurements may affect image quality of a system.
MPE07.04Take responsibility for improving the quality of radiological examinations.
MPE07.05Undertake research on the optimisation of clinical systems.
MPE07.06Implement the results of an optimisation study in a clinical department.
MPE07.07Design and implement an optimisation study using clinical images.
MPE07.08Discuss the methods for observer studies such as AFC, ROC, FROC and explain the strengths and weaknesses of each method.
MPE07.09Discuss the role of MPE in the ensuring the image quality in a radiology department.
Name and professional status of the lecturers (Including qualifications) / Dr Alistair Mackenzie PhD: Module leader
Prof Ken Young PhD: Module leader
Prof David Dance PhD
Dr Lucy Warren PhD
Dr Andria Hadjipanteli PhD
Dr. Mark Halling-Brown PhD
Dr Mishal Patel PhD
Dr Craig Moore PhD
Dr Lisanne Khoo
Course data (Optional)
Participant Assessment / Open book exam on Quantitative measurements 2 hours
Post course: Preparation of a plan for an optimization study relevant to their work
The range of evaluation grades are:
not evaluated
fail (less than 50% mark)
pass (50%–64%)
merit (65%–79%)
distinction (80%–100%).
Course Duration and Type / The online course can be up to 6 months
Course component / Estimated time (hours) for every component
Online lectures, seminars, tutorials, fora / The online component will be spread over a period of approximately three months and would require approximately 60 hours of reading and effort by the participants. The online phase will be mostly asynchronous so that participants would not need to take time off their clinical duties and there will not be a problem with time zones. If any synchronous learning is required this would be in the evening or weekend.
Participants will be required to contribute to the discussion fora. Participants will have the opportunity to video conferences with the lecturers.
There will be further 20 hours of materialfollwoing the face to face course.
Online compulsory reading
Face-to-face lectures, seminars, tutorials, fora / 0
Face-to-face technical demonstrations / 0
Face-to-face laboratory/clinical exercises / 0
Total participant effort time / 0
Assessment preparation time / 4 hours
Assessment time / 2 hours for exam;
~8 hours for optimization study plan
Pre-Requisites For Course Participation (Optional)
Minimum entry qualifications, training and years of experience of prospective participant / EQF Level 6 in Physics (BSc Physics or equivalent)
EQF Level 7 in Medical Physics (MSc Medical Physics or equivalent)
2 year equivalent clinical training in D&IR for clinical Medical Physicists
2 year equivalent Industry/Radiation Authority experience for Industry/Radiation Authority personnel.
Assumed previous KSCs for the course from the “Inventory of Learning Outcomes for the MPE in Europe” (Annex I of the “European Guidelines on the MPE”)
Generic Skills / Generic Skills Required at EQF level 7
KSC as a Physical Scient / All Knowledge learning outcomes to EQF level 7
KSC as a Healthcare Professional / All Knowledge learning outcomes to EQF level 7
KSC in Clinical Medical Radiological and other Medical Devices and Protection from Ionising Radiation and other Physical Agents: / All Knowledge learning outcomes to EQF level 7
The Skills and Competences included in the IAEA document ‘Clinical Training of Medical Physicists Specializing in Diagnostic Radiology’ (IAEA Training Course Series, 47, 2010) to EQF level 7.
KSC Specific for the Course’s Medical Physics Specialty / none
Course content: Aim and summary learning outcomes (Optional)
Course aim / This module aims to help the future MPE (Diagnostic Radiology) acquire the knowledge, skills and competences necessary to exercise a leadership role within the profession in his own country and in Europe in the field of diagnostic radiology.The scope of this course is to give in-depth knowledge of the methodologies available for optimisation of planar imaging systems in general radiography and mammography. The optimisation techniques discussed will not only use standard test object measurements of image quality, but will also include advanced quantitative measurements and how to use these methods in the simulation of images.
Summary learning outcomes
Course content: Target KSC to be developed to course’s EQF level (Optional)
Primary KSCs targeted in this Course / K2. List the common imaging modalities (general projection x-ray imaging (DDR, CR and film-screen where this is still valid), chest systems, mammography, dental systems (intra-oral, OPG, cephalometric systems), mobile, flat panel / image intensifier fluoroscopes including C-arms, interventional systems, tomosynthesis, paediatric systems, radiostereometric (RSA) systems, stereotactic systems, dual energy X-ray absorptionmetry (DXA), axial and helical mode CT, cone-beam CT, MRI, ultrasound) and explain their function as instruments for the measurement, mapping and imaging of the spatial distribution of different physical variables within the human body. Each imaging modality/dedicated device has its utility in the various applications of medical imaging i.e., diagnosis, population screening, patient monitoring, intervention and specialised use such as paediatric.
K4. Explain in detail the principles of image quality measurement: linear systems theory, types of contrast (subject, image and display), unsharpness (LSR, PSF, LSF, MTF), lag, noise (including sources, noise power spectra, effect of lag on noise, noise propagation in image subtraction), SNR (including Rose model, Wagner’s taxonomy, CNR, relation to dose, NEQ, DQE.
K6. Describe and explain at an advanced level the following: temporal / frequency domain representation of signals, Fourier transform, statistical description of signals, power spectral density, autocorrelation function, sampled (discrete) signals, delta function and its Fourier transform, Fourier transform of a periodic discrete signal (DFT), the FFT, the effects of finite sample intervals, linear processors, impulse response, convolution integral and theorem, various types of filters used in the processing of medical signals.
K14. For each imaging modality, explain the relationship between target image quality outcomes and imaging device performance indicators.
K17. Explain the meaning and the concepts of sensitivity and specificity in medical imaging.
K22. For each imaging modality, explain device design variables which impact device performance indicators (e.g., focal spot size in the case of x-ray imaging).
K23. For each imaging modality, list and explain user controlled variables/settings and their impact on image quality/diagnostic efficacy and patient risk.
K24. For each imaging modality, explain strengths and limitations and their impact on image quality / diagnostic efficacy (including any artefacts).
K26. For each imaging modality, describe and explain differences in device design and their effects on image quality and patient safety for dedicated devices (e.g., mammography, dental systems for projection x-ray imaging).
K27. Describe in detail x-ray projection and CT imaging devices for general projection x-ray imaging (DDR, CR and film-screen where this is still valid), chest systems, mammography (including tomosynthesis), dental systems (intra-oral, OPG, cephalometric systems), mobile, dual energy projection x-ray imaging, flat panel/image intensifier/mobile/over/under table fluoroscopes and C-arms, interventional systems, paediatric systems, radiostereometric (RSA) systems, stereotactic / biopsy systems (e.g., mammography), dual energy X-ray absorptionmetry (DXA), sequential/axial and helical mode CT, multidetector CT, dual source/energy CT, volumetric CT scanners, CT scanners for radiotherapy planning, CT fluoroscopy and cone-beam CT, including:
-physics principles, geometry, functioning, structure, strengths and limitations
-image reconstruction and automatic pre-processing
-image quality related performance indicators
-device design for image quality and patient/occupational dose optimization, including special features for dedicated systems
-user determined parameters and their manipulation for optimising image quality and patient dose
K28. Define and explain the effect of variation of the following performance indicators on image quality in projection x-ray imaging (spatial resolution, contrast resolution, contrast to noise ratio, point spread function, modulation transfer function, noise power spectrum, detective quantum efficiency, noise equivalent quanta).
K56. Explain the meaning of justification and optimization as applied to medical imaging practices.
Skills
S1. For each modality, operate imaging devices at the level necessary for give advice on optimization of imaging protocols, quality control, image quality manipulation, and carry out research when the available evidence for advice is not sufficient.
S2. For each modality predict the effect on image quality and diagnostic accuracy when changing scanning and reconstruction parameters.
S3. Manipulate acquisition parameters for all forms of projection x-ray imaging devices (e.g., kV, filtration, mAs, sensitivity (‘speed’), collimation, magnification, SID, SSD, frame rate, screening time, manual/AED modes, compression), explain the effect on image quality and relevant patient dose quantities (and occupational dose particularly when this is correlated with patient dose) and relevance to specific clinical studies.
S11. Use modelling and simulation software (e.g. Matlab, SimuLink) to solve problems in the processing of imaging data.
S21. Optimize patient radiation protection in high dose or high risk practices: interventional radiology, CT, health screening programmes, irradiation of children, neonates or the foetus, genetic predisposition for detrimental radiation effects.
S34. For each imaging modality, apply the theory of image formation for the analysis and optimization of clinical acquisition protocols.
S35. For each imaging modality, manipulate acquisition parameters (e.g., tube voltage, filtration, contour filters, tube current, exposure time, field size, magnification in projection x-ray imaging) to optimize image quality and patient dose.
S36. For each imaging modality, explain the effect of operator selectable parameters on image quality and hence clinical utility.
S39. Apply the theory of human image perception/observer performance to the optimization of image reading.
S40. For each imaging modality, evaluate image quality from psychophysical studies with human observers.
S41. For each imaging modality identify and correct causes of below target image quality and safety criteria.
Competencies
C1. Carry out or supervise as appropriate the measurement of physical quantities relevant to the effective, safe and economical use of medical devices / ionizing radiations and other physical agents in Diagnostic and Interventional Radiology.
C6. Take responsibility for statutory and institutional requirements for Medical Physics Services in Diagnostic and Interventional Radiology with respect to Patient Safety / Dose Optimization.
C7. Take responsibility for the protection of patients by optimization of practices, procedures and acquisition protocols.
C19. For each imaging modality, give advice regarding the adjustment of protocols to the needs of particular clients in studies which are complex, unusual, beyond-protocol and non-predictable.
Secondary KSCs targeted in this module / Knowledge
K8. Explain the principles and methods of image post-processing including knowledge based image analysis, pattern theory, deterministic image processing and feature enhancement, image segmentation, image registration and co-registration / fusion.
K10. For each imaging modality, define and explain in detail and quantitatively the physical property / properties of tissues which the device measures and images, including any variables impacting the value of these properties and associated tissue contrast (e.g., attenuation coefficient for CT which is dependent on beam energy/kV, tissue contrast in CT dependent on kV).
K11. For each imaging modality, list and explain sources of measurement inaccuracy, uncertainty and artefacts.
K13. For each imaging modality, list and define device performance indicators relevant to image quality outcomes (e.g., limiting spatial and contrast resolutions, SNR, geometric accuracy) including discussion of accuracy, precision and stability.
K25. For each imaging modality, explain in detail acquisition protocols, pre-processing of image data, image reconstruction principles, post-processing of images.
K82. Describe the components/subsystems of medical devices in each imaging modality.
Skill
S9. Use specialised test tools e.g., contrast-detail test objects, to evaluate imaging systems.
S10. For each imaging modality elicit information from DICOM file headers.
S34. For each imaging modality, recognize normal anatomy as well as pathology in images to a level necessary for the clinical involvement role of the MPE.
Competencies
C18. Apply the theory of image formation to advise on the selection of the most appropriate imaging modality.
NEW KSCs which are NOT INCLUDED in the “Inventory of Learning Outcomes for the MPE in Europe”
Outline Teaching Plan (Optional)
Pre Course Phase / SECTION 1: Introductory Concepts (OPTIONAL)
Introduction to Module 7
Mathematical techniques
Fourier transforms: basic theory, how they are used in imaging (measurements and image processing
Image sampling. What is aliasing and how does it affect image quality
Describe DICOM standard
Detectors
Design of detectors (phosphor/TFT, photo-conductors, CR, Needle IP CR, photon counting detectors)
SECTION 2: Quantitative measurements
Set up for quantitative measurements
Beam qualities
Signal transfer properties
Radiographic factors and dose levels
Modulation transfer function (MTF)
Definition of MTF
Digital MTF
Supersampling of impulse function
Locating edge/slit in image
Data conditioning methods for ESF & LSF
Comparison of methods for calculating MTF
Two dimensional MTF
Expectation MTF
Noise power spectra (NPS)
Definition of NPS
Measurement and normalisation of NPS
Key points about images for NPS
Area of image to be used for NPS
Dealing with trends and discontinuities in sub-ROIs
Calculation and normalisation of NPS
Uncertainties of NPS
Potential issues with measurement of NPS
Noise equivalent quanta (NEQ) and Detective quantum efficiency (DQE)
Definition of NEQ
Definition of DQE
Calculation of NEQ and DQE
DQE: Results, use and meaning
Calculation of number of x-ray quanta
Practical measurements of MTF and NPS
Video demonstration of:
- Setting up IEC RQA standard
- Acquiring images for STP and NPS
- Acquiring images for MTF
Contributing factors affecting the MTF
MTFs associated with detector type
Sources of noise in the image
NPS associated with detector type
Sources of noise
Noise sources: aliasing
Overview of use of MTF and NPS in quality control
Comparison of DQE results
Compilation of a series of report and papers on:
Comparison of MTF, NPS and DQE for differnet technologies in general radiography and mammography
Concluding section
Group discussion: value of DQE as a measurement
Sample exam question
Description of optional practical on DQE
Summary of sub-module
SECTION 3: Optimisation techniques
Introduction
Describe module
Definition of optimisation
Methods for optimisation
Example of risk/benefit in mammogrphy
Involvement of all staff groups
Quantifying benefits from radiology
The radiologists’ task
The radiologist
Examining the clinical task
Measurement of image quality and dose
Quantitative measurements of image quality
Contrast detail
Definition effective Detective Quantum Efficiency (eDQE)
eDQE methodology
eDQE results
Software for calculating patient dose
Optimisation using image quality measurements
Dose selection in mammography and link to clinical task
Practical set up of automatic exposure controls (AEC)
Setting up AECs
Setting up an AEC for general radiography
Set up AEC for mammography
Mammography AEC set up: Worked example
Audit
Clinica audit
Diagnostic reference levels
Optimisation using real, phantom or simulated clinical images
Clinical or clinical-like images
Structured background phantoms
Use of anthropomorphic phantoms for optimisation
Mathematical models
Collection of clinical images
Using real tissue
Simulation of lesions: physical phantoms
Simulation of lesions: mathematical
Create projection images
Modification of clinical and simulated images
Observer study methodologies
Visual grading analysis
Visual grading characteristics
Alternative forced choice techniques
Analysis of AFC data
Studies simulating reporting process
ROC methodologies
FROC analysis
Significance testing (ROC / FROC)
Worked exampled of FROC study
Examples of Optimisation studies
Optimisation of paediatric extremities