Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Medical Biophysics


Ian Cunningham


Digital subtraction angiography (DSA) is an x-ray-based imaging method widely used for diagnosis and treatment of patients with vascular disease. This technique uses subtraction of images acquired before and after injection of an iodinated contrast agent to generate iodine-specific images. While it is extremely successful at imaging structures that are near-stationary over a period of several seconds, motion artifacts can result in poor image quality with uncooperative patients and DSA is rarely used for coronary applications.

Alternative methods of generating iodine-specific images with reduced motion artifacts might exploit the energy-dependence of x-ray attenuation in a patient. This could be performed either by aquiring two or more post-injection images at different x-ray energies or from an analysis of the spectral shape of the transmitted spectrum. The first method, which we call energy-subtraction angiography (ESA), was introduced as a dual-energy alternative to DSA over two decades ago but technological limitations of the time resulted in poor image quality. The second potential method, energy-resolved angiography (ERA), requires energy-resolving photon-counting (EPC) x-ray detectors that are under development in a number of laboratories.

The goals of this thesis were to: 1) develop a method of comparing image quality in terms of signal-to-noise ratio (SNR) obtained using ESA and ERA with DSA assuming ideal instrumentation for each; 2) develop a method of describing performance and image quality that can be obtained in practice with photon-counting detectors, and; 3) assess the potential of ESA and ERA by comparing the available iodine SNR with that of DSA including the effects of non-ideal detector performance.

It is shown that using ideal instrumentation both ESA and ERA can provide iodine-specific images with SNR equal to that of DSA. However, stochastic x-ray interaction and detection processes will degrade SNR obtained with ERA and ESA to a larger extent than DSA. Energy-resolved angiography will achieve near-ideal performance only with low detector electronic noise levels, high collection efficiency of secondary quanta liberated in the detector, and low Compton cross sections. It is concluded that, when these conditions are satsified, ESA and ERA can provide iodine SNR within 25% of that of DSA for the same patient entrance exposure, and therefore may provide alternatives to DSA in situations where motion artifacts are expected to result in compromised DSA procedures, such as in coronary applications. This could have important applications for subtraction imaging of the coronary arteries in the near future.