Journal of Imaging

Research

16 pages, 2833 KiB

Open AccessArticle

Evolution of Lung Disease Studied by Computed Tomography in Adults with Cystic Fibrosis Treated with Elexacaftor/Tezacaftor/Ivacaftor

by Susana Hernández-Muñiz, Paloma Caballero, Adrián Peláez, Marta Solís-García, Carmen de Benavides, Javier Collada, Ignacio Díaz-Lorenzo, Cristina Zorzo, Rosa Mar Gómez-Punter and Rosa María Girón

J. Imaging 2025, 11(4), 124; https://doi.org/10.3390/jimaging11040124 - 21 Apr 2025

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Abstract

Elexacaftor–tezacaftor–ivacaftor (ETI) has shown clinical and spirometric benefits in cystic fibrosis (CF). CT remains a vital tool for diagnosing and monitoring structural lung disease. This study aimed to assess the evolution of lung disease, as evaluated through CT, in adults with CF after [...] Read more.

Elexacaftor–tezacaftor–ivacaftor (ETI) has shown clinical and spirometric benefits in cystic fibrosis (CF). CT remains a vital tool for diagnosing and monitoring structural lung disease. This study aimed to assess the evolution of lung disease, as evaluated through CT, in adults with CF after at least one year of ETI treatment. This ambispective observational analysis assessed lung CT scans performed before initiating ETI and after at least one year of treatment, using the modified Bhalla scoring system. For those patients with an earlier CT scan, a pre-treatment phase analysis was performed. Epidemiological, clinical, and functional parameters were evaluated. Results: Sixty-two patients were included (35 males, median age 30.4 ± 7.87 years). After at least one year of ETI, significant improvements were observed in the global CT Bhalla score (12.2 ± 2.8 vs. 14.0 ± 2.8), peribronchial thickening (1.4 ± 0.6 vs. 1.0 ± 0.4), and mucus plugging (1.6 ± 0.7 vs. 0.8 ± 0.6) (p < 0.001). Spirometry parameters increased significantly: the percentage of the predicted forced expiratory volume in the first second (ppFEV₁) increased from 66.5 ± 19.8 to 77.0 ± 20.4 (p = 0.005) and forced vital capacity (ppFVC) from 80.6 ± 16.4 to 91.6 ± 14.1 (p < 0.001). Additionally, body mass index showed a significant increase. A moderate correlation was found between the Bhalla score and spirometry results. In the pre-treatment phase (n = 52), mucus plugging demonstrated a significant worsening, whereas global CT score, other subscores, and spirometry did not change significantly. Conclusions: In adults with CF, after at least one year of ETI, a significant improvement in structural lung disease was achieved, as reflected by the CT Bhalla score. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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11 pages, 1088 KiB

Open AccessArticle

Evaluating Super-Resolution Models in Biomedical Imaging: Applications and Performance in Segmentation and Classification

by Mario Amoros, Manuel Curado and Jose F. Vicent

J. Imaging 2025, 11(4), 104; https://doi.org/10.3390/jimaging11040104 - 29 Mar 2025

Viewed by 365

Abstract

Super-resolution (SR) techniques have gained traction in biomedical imaging for their ability to enhance image quality. However, it remains unclear whether these improvements translate into better performance in clinical tasks. In this study, we provide a comprehensive evaluation of state-of-the-art SR models—including CNN- [...] Read more.

Super-resolution (SR) techniques have gained traction in biomedical imaging for their ability to enhance image quality. However, it remains unclear whether these improvements translate into better performance in clinical tasks. In this study, we provide a comprehensive evaluation of state-of-the-art SR models—including CNN- and Transformer-based architectures—by assessing not only visual quality metrics (PSNR and SSIM) but also their downstream impact on segmentation and classification performance for lung CT scans. Using U-Net and ResNet architectures, we quantify how SR influences diagnostic tasks across different datasets, and we evaluate model generalization in cross-domain settings. Our findings show that advanced SR models such as SwinIR preserve diagnostic features effectively and, when appropriately applied, can enhance or maintain clinical performance even in low-resolution contexts. This work bridges the gap between image quality enhancement and practical clinical utility, providing actionable insights for integrating SR into real-world biomedical imaging workflows. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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12 pages, 926 KiB

Open AccessArticle

Establishing Diagnostic Reference Levels for Mammography Digital Breast Tomosynthesis, Contrast Enhance, Implants, Spot Compression, Magnification and Stereotactic Biopsy in Dubai Health Sector

by Entesar Z. Dalah, Maryam K. Alkaabi, Nisha A. Antony and Hashim M. Al-Awadhi

J. Imaging 2025, 11(3), 79; https://doi.org/10.3390/jimaging11030079 - 7 Mar 2025

Viewed by 537

Abstract

The aim of this patient dose review is to establish a thorough diagnostic reference level (DRL) system. This entails calculating a DRL value for each possible image technique/view considered to perform a diagnostic mammogram in our practice. Diagnostic mammographies from a total of [...] Read more.

The aim of this patient dose review is to establish a thorough diagnostic reference level (DRL) system. This entails calculating a DRL value for each possible image technique/view considered to perform a diagnostic mammogram in our practice. Diagnostic mammographies from a total of 1191 patients who underwent a diagnostic mammogram study in our designated diagnostic mammography center were collected and retrospectively analyzed. The DRL representing our health sector was set as the median of the mean glandular dose (MGD) for each possible image technique/view, including the 2D standard bilateral craniocaudal (LCC/RCC) and mediolateral oblique (LMLO/RMLO), the 2D bilateral spot compression CC and MLO (RSCC/LSCC and RSMLO/LSMLO), the 2D bilateral spot compression with magnification (RMSCC/LMSCC and RMSMLO/LMSMLO), the 3D digital breast tomosynthesis CC and MLO (RCC/LCC and RMLO/LMLO), the 2D bilateral implant CC and MLO (RIMCC/LIMCC and RIMMLO/LIMMLO), the 2D bilateral contrast enhanced CC and MLO (RCECC/LCECC and RCEMLO/LCEMLO) and the 2D bilateral stereotactic biopsy guided CC (SBRCC/SBLCC). This patient dose review revealed that the highest MGD was associated with the 2D bilateral spot compression with magnification (MSCC/MSMLO) image view. For the compressed breast thickness (CBT) group 60–69 mm, the median and 75th percentile of the MGD values obtained were MSCC: 3.35 and 3.96, MSMLO: 4.14 and 5.25 mGy respectively. Obvious MGD variations were witnessed across the different possible views even for the same CBT group. Our results are in line with the published DRLs when using same statistical quantity and CBT group. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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13 pages, 3005 KiB

Open AccessArticle

Evaluation of Radiation Dose and Image Quality in Clinical Routine Protocols from Three Different CT Scanners

by Thawatchai Prabsattroo, Jiranthanin Phaorod, Piyaphat Tathuwan, Khanitta Tongluan, Puengjai Punikhom, Tongjit Maharantawong and Waraporn Sudchai

J. Imaging 2025, 11(3), 70; https://doi.org/10.3390/jimaging11030070 - 25 Feb 2025

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Abstract

Computed tomography examination plays a vital role in imaging and its use has rapidly increased in radiology diagnosis. This study aimed to assess radiation doses of routine CT protocols of the brain, chest, and abdomen in three different CT scanners, together with a [...] Read more.

Computed tomography examination plays a vital role in imaging and its use has rapidly increased in radiology diagnosis. This study aimed to assess radiation doses of routine CT protocols of the brain, chest, and abdomen in three different CT scanners, together with a qualitative image quality assessment. Methods: A picture archiving and communication system (PACS) and Radimetrics software version 3.4.2 retrospectively collected patients’ radiation doses. Radiation doses were recorded as the CTDI_vol, dose length product, and effective dose. CT images were acquired using the Catphan700 phantom to evaluate image quality. Results: The findings revealed that median values for the CTDI_vol and DLP across the brain, chest, and abdomen protocols were lower than the national and international DRLs. Effective doses for brain, chest, and abdomen protocols were also below the median value of R. Smith-Bindman. Neusoft achieved higher spatial frequencies in brain protocols, while Siemens outperformed others in chest protocols. Neusoft consistently exhibited superior high-contrast resolution. Siemens and Neusoft outperformed low-contrast detectability, while Siemens also outperformed the contrast-to-noise ratio. In addition, Siemens had the lowest image noise in brain protocols and high uniformity in chest and abdomen protocols. Neusoft showed the lowest noise in chest and abdomen protocols and high uniformity in the brain protocol. The noise power spectrum revealed that Philips had the highest noise magnitude with different noise textures across protocols and scanners. Conclusions: This study provides a comprehensive evaluation of radiation doses and image quality for three different CT scanners using standard clinical protocols. Almost all CT protocols exhibited radiation doses below the DRLs and demonstrated varying image qualities across each protocol and scanner. Selecting the right CT scanner for each protocol is essential to ensure that the CT images exhibit the best quality among a wide range of CT machines. The MTF, HCR, LCD, CNR, NPS, noise, and uniformity are suitable parameters for evaluating and monitoring image quality. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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17 pages, 2650 KiB

Open AccessArticle

Typical and Local Diagnostic Reference Levels for Chest and Abdomen Radiography Examinations in Dubai Health Sector

by Entesar Z. Dalah, Maitha M. Al Zarooni, Faryal Y. Binismail, Hashim A. Beevi, Mohammed Siraj and Subrahmanian Pottybindu

J. Imaging 2025, 11(1), 21; https://doi.org/10.3390/jimaging11010021 - 13 Jan 2025

Cited by 1 | Viewed by 895

Abstract

Chest and abdomen radiographs are the most common radiograph examinations conducted in the Dubai Health sector, with both involving exposure to several radiosensitive organs. Diagnostic reference levels (DRLs) are accepted as an effective safety, optimization, and auditing tool in clinical practice. The present [...] Read more.

Chest and abdomen radiographs are the most common radiograph examinations conducted in the Dubai Health sector, with both involving exposure to several radiosensitive organs. Diagnostic reference levels (DRLs) are accepted as an effective safety, optimization, and auditing tool in clinical practice. The present work aims to establish a comprehensive projection and weight-based structured DRL system that allows one to confidently highlight healthcare centers in need of urgent action. The data of a total of 5474 adult males and non-pregnant females who underwent chest and abdomen radiography examinations in five different healthcare centers were collected and retrospectively analyzed. The typical DRL (TDRL) for each healthcare center was established and defined per projection (chest: posterior–anterior (PA), anterior–posterior (AP) and lateral (LAT); abdomen: erect and supine) for a weight band (60–80 kg) and for the whole data (no weight band). Local DRL (LDRL) values were established per project for the selected radiograph for the whole data (no weight band) and the 60–80 kg population. Chest radiography data from 1755 (60–80 kg) images were used to build this comprehensive DRL system (PA: 1471, AP: 252, and LAT: 32). Similarly, 611 (60–80 kg) abdomen radiographs were used to establish a DRL system (erect: 286 and supine: 325). The LDRL values defined per chest and abdomen projection for the weight band group (60–80 kg) were as follows: chest—0.51 PA, 2.46 AP, and 2.13 LAT dGy·cm²; abdomen—8.08 for erect and 5.95 for supine dGy·cm². The LDRL defined per abdomen projection for the 60–80 kg weight band highlighted at least one healthcare center in need of optimization. Such a system is efficient, easy to use, and very effective clinically. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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10 pages, 2530 KiB

Open AccessCommunication

Quantitative Comparison of Color-Coded Parametric Imaging Technologies Based on Digital Subtraction and Digital Variance Angiography: A Retrospective Observational Study

by István Góg, Péter Sótonyi, Balázs Nemes, János P. Kiss, Krisztián Szigeti, Szabolcs Osváth and Marcell Gyánó

J. Imaging 2024, 10(10), 260; https://doi.org/10.3390/jimaging10100260 - 18 Oct 2024

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Abstract

The evaluation of hemodynamic conditions in critical limb-threatening ischemia (CLTI) patients is inevitable in endovascular interventions. In this study, the performance of color-coded digital subtraction angiography (ccDSA) and the recently developed color-coded digital variance angiography (ccDVA) was compared in the assessment of key [...] Read more.

The evaluation of hemodynamic conditions in critical limb-threatening ischemia (CLTI) patients is inevitable in endovascular interventions. In this study, the performance of color-coded digital subtraction angiography (ccDSA) and the recently developed color-coded digital variance angiography (ccDVA) was compared in the assessment of key time parameters in lower extremity interventions. The observational study included 19 CLTI patients who underwent peripheral vascular intervention at our institution in 2020. Pre- and post-dilatational images were retrospectively processed and analyzed by a commercially available ccDSA software (Kinepict Medical Imaging Tool 6.0.3; Kinepict Health Ltd., Budapest, Hungary) and by the recently developed ccDVA technology. Two protocols were applied using both a 4 and 7.5 frames per second acquisition rate. Time-to-peak (TTP) parameters were determined in four pre- and poststenotic regions of interest (ROI), and ccDVA values were compared to ccDSA read-outs. The ccDVA technology provided practically the same TTP values as ccDSA (r = 0.99, R² = 0.98, p < 0.0001). The correlation was extremely high independently of the applied protocol or the position of ROI; the r value was 0.99 (R² = 0.98, p < 0.0001) in all groups. A similar correlation was observed in the change in passage time (r = 0.98, R² = 0.96, p < 0.0001). The color-coded DVA technology can reproduce the same hemodynamic data as a commercially available DSA-based software; therefore, it has the potential to be an alternative decision-supporting tool in catheter labs. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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Review

Jump to: Research, Other

13 pages, 3641 KiB

Open AccessReview

Current Role of CT Pulmonary Angiography in Pulmonary Embolism: A State-of-the-Art Review

by Ignacio Diaz-Lorenzo, Alberto Alonso-Burgos, Alfonsa Friera Reyes, Ruben Eduardo Pacios Blanco, Maria del Carmen de Benavides Bernaldo de Quiros and Guillermo Gallardo Madueño

J. Imaging 2024, 10(12), 323; https://doi.org/10.3390/jimaging10120323 - 15 Dec 2024

Cited by 1 | Viewed by 1996

Abstract

The purpose of this study is to conduct a literature review on the current role of computed tomography pulmonary angiography (CTPA) in the diagnosis and prognosis of pulmonary embolism (PE). It addresses key topics such as the quantification of the thrombotic burden, its [...] Read more.

The purpose of this study is to conduct a literature review on the current role of computed tomography pulmonary angiography (CTPA) in the diagnosis and prognosis of pulmonary embolism (PE). It addresses key topics such as the quantification of the thrombotic burden, its role as a predictor of mortality, new diagnostic techniques that are available, the possibility of analyzing the thrombus composition to differentiate its evolutionary stage, and the applicability of artificial intelligence (AI) in PE through CTPA. The only finding from CTPA that has been validated as a prognostic factor so far is the right ventricle/left ventricle (RV/LV) diameter ratio being >1, which is associated with a 2.5-fold higher risk of all-cause mortality or adverse events, and a 5-fold higher risk of PE-related mortality. The increasing use of techniques such as dual-energy computed tomography allows for the more accurate diagnosis of perfusion defects, which may go undetected in conventional computed tomography, identifying up to 92% of these defects compared to 78% being detected by CTPA. Additionally, it is essential to explore the latest advances in the application of AI to CTPA, which are currently expanding and have demonstrated a 23% improvement in the detection of subsegmental emboli compared to manual interpretation. With deep image analysis, up to a 95% accuracy has been achieved in predicting PE severity based on the thrombus volume and perfusion deficits. These advancements over the past 10 years significantly contribute to early intervention strategies and, therefore, to the improvement of morbidity and mortality outcomes for these patients. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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Other

Jump to: Research, Review

13 pages, 1650 KiB

Open AccessTechnical Note

Pano-GAN: A Deep Generative Model for Panoramic Dental Radiographs

by Søren Pedersen, Sanyam Jain, Mikkel Chavez, Viktor Ladehoff, Bruna Neves de Freitas and Ruben Pauwels

J. Imaging 2025, 11(2), 41; https://doi.org/10.3390/jimaging11020041 - 2 Feb 2025

Viewed by 932

Abstract

This paper presents the development of a generative adversarial network (GAN) for the generation of synthetic dental panoramic radiographs. While this is an exploratory study, the ultimate aim is to address the scarcity of data in dental research and education. A deep convolutional [...] Read more.

This paper presents the development of a generative adversarial network (GAN) for the generation of synthetic dental panoramic radiographs. While this is an exploratory study, the ultimate aim is to address the scarcity of data in dental research and education. A deep convolutional GAN (DCGAN) with the Wasserstein loss and a gradient penalty (WGAN-GP) was trained on a dataset of 2322 radiographs of varying quality. The focus of this study was on the dentoalveolar part of the radiographs; other structures were cropped out. Significant data cleaning and preprocessing were conducted to standardize the input formats while maintaining anatomical variability. Four candidate models were identified by varying the critic iterations, number of features and the use of denoising prior to training. To assess the quality of the generated images, a clinical expert evaluated a set of generated synthetic radiographs using a ranking system based on visibility and realism, with scores ranging from 1 (very poor) to 5 (excellent). It was found that most generated radiographs showed moderate depictions of dentoalveolar anatomical structures, although they were considerably impaired by artifacts. The mean evaluation scores showed a trade-off between the model trained on non-denoised data, which showed the highest subjective quality for finer structures, such as the mandibular canal and trabecular bone, and one of the models trained on denoised data, which offered better overall image quality, especially in terms of clarity and sharpness and overall realism. These outcomes serve as a foundation for further research into GAN architectures for dental imaging applications. Full article

(This article belongs to the Special Issue Tools and Techniques for Improving Radiological Imaging Applications)

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