Characterization of a prototype tabletop x-ray CT breast imaging system

OA158] Noise equivalent number of quanta (NEQ): A tool for choosing the optimal reconstruction algorithm in computed tomography (CT)

For cone-beam computed tomography (CBCT) systems, we propose a sphere phantom based method to estimate the full three-dimensional (3D) modulation transfer function (MTF). The FDK reconstruction of CBCT system in a local region was modeled by a triple convolution operator. Afterward, we calculated the directional projections of ideal and reconstructed sphere phantoms into a two-dimensional (2D) plane for multiple views. To estimate the projected 3D point spread function (PSF), we applied the 2D Richardson-Lucy deconvolution with Tikhonov-Miller (RL-TM). After estimating the projected 3D PSF from multiple views, the full 3D PSF was estimated by performing filtered backprojection. Then, the full 3D MTF was calculated by taking the modulus of the Fourier transform of the estimated 3D PSF. To validate the proposed method, we reconstructed sphere phantoms from simulation and experiment data. We simulated ideal 3D MTFs and compared them with the estimated 3D MTFs along the -, -, and -directions. The full-width at half-maximum (FWHM) and full-width at tenth-maximum (FWTM) values were compared between ideal and estimated 3D MTFs. The estimated 3D MTFs from both the simulation and experiment results show qualitative similarity in their shapes with the ideal 3D MTFs; FWHM and FWTM results quantitatively show that the proposed method provides reliable estimation performance. In particular, the estimated 3D MTF in a missing cone region was correctly matched with the corresponding ideal 3D MTF. In this work, we proposed a full 3D MTF estimation method for CBCT systems. Based on the results, we believe that the proposed method can be used to evaluate the spatial resolution performance of CBCT systems.

Quality assurance in computed tomography (CT) is commonly performed with the Fourier-based modulation transfer function (MTF) and the noise variance, while more recently the noise power spectrum (NPS) has increased in popularity. The Fourier-based methods make assumptions such as shift-invariance and cyclostationarity. These assumptions are violated in real clinical systems and consequently are expected to result in systematic errors. A spatial approach, based on the object transfer matrix (T) and the covariance matrix (K) theory, does not require these assumptions and can provide a more general description of the imaging system. In this paper, the authors present an experimental methodology and data treatment for quality assessment of a lab cone-beam CT system by comparing the spatial with the Fourier approach in 2D reconstructed slices. In order to have control over all experimental parameters and image reconstruction, a bench-top flat-panel-based cone-beam CT scanner and a cylindrical water-filled poly(methyl methacrylate) (PMMA) phantom were used for the noise measurements. An aluminum foil inserted in the water phantom enabled the estimation of the line response function (LRF) with a limited number of assumptions. The authors evaluated the spatial blur, the noise and the signal-to-noise ratio (SNR) using the spatial approach as well as the Fourier-based approach. In order to evaluate the degree of noise nonstationarity of their cone-beam CT system, the authors evaluated both the local and global CT noise properties and compared them using both approaches. For the laboratory cone-beam CT, the location-dependent noise evaluation showed that in addition to the noise variance, the NPS and covariance eigenvector symmetry depend on the location in the image. The estimated signal transfer was similar for both approaches. Unlike the Fourier approach which uses the same exponential wave function basis for both MTF and NPS, the eigenvectors of T and K were significantly different. By using the eigenvectors of the noise and object transfer to characterize the system, the spatial approach provides additional information to the Fourier approach and is therefore an important tool for a thorough understanding of a CT system.

The image quality (IQ) of imaging systems must be sufficiently high for image‐guided radiation therapy (IGRT). Hence, users should implement a quality assurance program to maintain IQ. In our routine IQ tests of the kV cone‐beam CT system (Elekta XVI), image noise was quantified by noise standard deviation (NSD), which was the standard deviation of CT numbers measured in a small area in an image of an IQ test phantom (Catphan), and the high spatial resolution (HSR) was evaluated by the number of line‐pairs (LPN) visually recognizable in the image. We also measured the image uniformity, the low contrast resolution, and the distances of two points for geometrical accuracy. For this study, we did an additional evaluation of the XVI data for 12 monthly IQ tests by using noise power spectrum (NPS) for noise, modulation transfer function (MTF) for HSR, and CT number‐to‐density relationship. NPS was obtained by applying Fourier analysis in a small area on the uniformity test section of Catphan. The MTF analysis was performed by applying the Droege‐Morin (D‐M) method to the line‐pair bar regions in the phantom. The CT number‐to‐density relationship was obtained for insert materials in the low‐contrast test section of the phantom. All the quantities showed a noticeable change over the one‐year period. Especially the noise level improved significantly after a repair of the imager. NPS was more sensitive to the IQ change than NSD. MTF could provide more quantitative and objective evaluation of HSR. The CT number was very different from the expected CT number, but the CT number‐to‐density curves were constant within 5% except for two months. Since the D‐M method is easy to implement, we recommend using MTF instead of LPN even for routine QA. The IQ of the imaging systems was constantly changing; hence, IQ tests should be periodically performed. Additionally, we found the importance of IQ tests after every service work, including detector calibration as well as preventive maintenance.PACS number(s): 87.56Da, 87.57.C‐, 87.57.N‐, 8757.Q‐

Two main spatial frequency and quantitative calculations and measurements am, used to study the imaging system of three industrial digital radiography (IDR) modules for non-destructive testing (NDT), namely complementary metal oxide semiconductor (CMOS) flat-panel digital detector with 50 mu m pixel pitch, computed radiography (CR) with phosphor imaging plate with 25 mu m pixel pitch and laser-type film digitiser with 50 mu m pixel pitch. The modulation transfer function (MTF) and noise power spectrum (NPS) measurement and calculations were adapted on order to evaluate the image quality of IDR images. The MTF has been used to characterise the resolution properties of analogue and digital X-ray imaging systems and measure image deterioration due to optical factors, such as diffusion of image forming radiation. The NPS is used in determining noise in images produced and the choices of normalisation of the NPS vary slightly from researcher to researcher, but the underlying methodology is consistent. In order to easily compare these two measurements and calculations, the integral of up to the system Nyquist frequency was used as the final image quality quantitative evaluation. For the MTF measurement and calculation, four regions of interest (ROI) were, defined to portray the randomness in performing real testing. The four ROI are then compared with each other. For the NPS measurement and calculation, ten ROI were defined, scattered and averaged to have overall noise estimation. From the measurements and calculations which were done, the averaged MTF at 20% modulation for the laser-type film digitiser system is 6.55 cycles/mm, CR modulated 4.48 and CMOS modulated 2.83 cycles/mm. For NPS measurement and calculation, the result obtained in decreasing order is laser-type film digitiser, CMOS and CR. The laser-type film digitiser system modulates the best transfer function at 20% but does not have the lowest NPS. The lowest and stable NPS is the CR system but it has the lowest modulating capability at 20%. The study shows that in order to perform NDT by using the evaluated modules, the user must know the true capability, of the system and how, it is designed for specific application and discontinuity detection.

Our work is to investigate and understand the factors affecting the imaging performance of amorphous selenium (a-Se) flat-panel detectors for digital mammography. Both theoretical and experimental methods were developed to investigate the spatial frequency dependent detective quantum efficiency [DQE(f)] of a-Se flat-panel detectors for digital mammography. Since the k-edge of a-Se is 12.66 keV and within the energy range of a mammographic spectrum, a cascaded linear system model was developed which takes into account the effect of k-fluorescence on the modulation transfer function (MTF), noise power spectrum (NPS) and DQE(f) of the detector. This model was used to understand the performance of a prototype detector with 85 mm pixel size. The presampling MTF, NPS and DQE(f) of the prototype were measured, and compared to the theoretical calculation by the model. The calculation showed that k-fluorescence reduces the MTF by 15% at the Nyquist frequency (f<SUB>NY</SUB>) of the prototype detector, and the NPS at f<SUB>NY</SUB> was reduced to 82% of that at zero spatial frequency. Because of the decrease in both MTF and NPS at high spatial frequencies, k-fluorescence only has a small degradation effect on DQE(f) for mammography. The measurement of presampling MTF of the prototype detector revealed an additional source of blurring, which was attributed to the blocking layer at the interface between a-Se and the active matrix. This introduced high frequency drop in both presampling MTF and NPS, and reduced aliasing in the NPS. As a result, the DQE(f) of the prototype detector at f<SUB>NY</SUB> approaches 50% of that at zero spatial frequency.

Current flat-panel detectors either directly convert x-ray energy to electronic charge or use indirect conversion with an intermediate optical process. The purpose of this work was to compare direct and indirect detectors in terms of their modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). Measurements were made on three flat-panel detectors, Philips Digital Diagnost, GE Revolution XQ/i, and Hologic Direct-Ray DR1000 using the IEC-defined RQA5 (approximately 75 kVp, 21 mm Al) and RQA9 (approximately 120 kVp, 40 mm Al) radiographic techniques. The presampled MTF of the systems was measured using an edge method (Samei et al., Med Phys 25:102, 1998). The NPS of the systems was determined for a range of exposure levels by 2D Fourier analysis of uniformly exposed radiographs (Flynn and Samei, Med Phys 26:1612, 1999). The ideal signal-to-noise ratio per exposure for each system was estimated using a semi-empirical x-ray model. The DQE, reported only at the RQA5 technique, was assessed from the measured MTF, NPS, exposure, and the ideal signal-to-noise ratio. For the direct system, the MTF was found to be significantly higher than that for the indirect systems and very close to an ideal function associated with the detector pixel size. The NPS for the direct system was found to be constant in relation to frequency. The DQE results reflected expected differences based on the absorption efficiency of the different detector materials. Using RQA5 and 0.3 mR exposure, the measured DQE values at spatial frequencies of 0.15 mm-1 and 2.5 mm-1 were 64% and 14% for the XQ/i system and 35% and 19% for DR-1000. Using RQA5 and the averages at all exposures, the corresponding values were 58% and 13% for the XQ/i system and 36% and 19% for DR-1000.

To validate a normal-resolution (NR) simulation (NRsim) algorithm that uses high-resolution (HR) or super-high resolution (SHR) acquisitions on a commercial HR computed tomography (CT) scanner by comparing image quality between NRsim-generated images and actual NR images. NRsim is intended to allow direct comparison between normal-resolution CT and HR/SHR reconstructions in clinical investigations, without repeating exams. The Aquilion Precision CT (Canon Medical Systems Corporation) HR CT scanner has three resolution modes resulting from detector binning in the channel (x-y) and row (z) directions. For NR, each detector element is 0.5mm×0.5mm along the channel and row directions, 0.25mm×0.5mm for HR, and 0.25mm×0.25mm for SHR. The NRsim algorithm simulates NR acquisitions from HR or SHR acquisitions (termed NRHR and NRSHR , respectively) by downsampling the pre-log raw data in the channel direction for the HR acquisitions and in the channel and row direction for the SHR acquisition. The downsampled data are then reconstructed using the same process as NR. The axial modulation transfer function (MTF), slice sensitivity profile (SSP), and CT number accuracy were measured using the Catphan 600 phantom, and the three-dimensional noise power spectrum (NPS) was measured in water-equivalent phantoms for standard protocols across a range of size-specific dose estimates (SSDE): head (6.2-29.8mGy), lung (2.2-18.2mGy), and body (5.6-19.4mGy). The MTF and NPS measurements were combined to estimate low-contrast detectability (LCD) using a non-prewhitening model observer with an eye filter for a 5-mm disk with 10HU contrast. All metrics were compared for NR, NRHR , and NRSHR images reconstructed using filtered back projection (FBP) and an iterative reconstruction algorithm (AIDR3D). We chose a 15% error threshold as a reasonable definition of success for NRsim when compared against actual NR based on published studies showing that a just-noticeable difference in image noise level for human observers is typically <15%. The axial MTF and SSPs for NRsim were in good agreement with NR demonstrated by a maximum difference of 5.1% for the MTF at 10% and 50% across materials (air, Teflon, LDPE, and polystyrene) and a maximum SSP difference of 2.2%. Noise magnitude differences were within 15% across the SSDE levels with the exception of below 4.5mGy for the lung protocol with FBP. The relative RMSE of normalized NPS comparisons were all <15%. Differences in CT numbers for NRsim reconstructions were within 2HU of NR. LCD for NRsim was within 15% of NR with the exception of NRSHR for the lung protocol SSDE levels below 3.7mGy with FBP. NRsim, an algorithm for simulating NR acquisitions using HR and SHR raw data, was introduced and shown to generate images with spatial resolution, noise, HU accuracy, and LCD largely equivalent to scans acquired using an actual NR acquisition. At SSDE levels below ~5mGy for the lung protocol, differences in noise magnitude and LCD for NRSHR were >15% which defines a region where NRsim degrades due to contributions from electronic noise.

The Modulation Transfer Function (MTF) of any system is the frequency response to a delta signal. This response is degraded by several factors such as the inherent veiling glare of the detector and the focal spot size among others. Consequently, the MTF has been one of the physical characteristics that are commonly used to quantitatively measure the physical performance of a system. In this article, the MTF of two flat panel detectors (FPD) and of two Cone Beam CT systems is evaluated. First, the MTF of PaxScan 2520 and of PaxScan 4030CB is evaluated. One of the standard techniques to evaluate the MTF of a FPD is by using an edge of a metal with high atomic number. For instance, it has been suggested by IEC 62220-1 to use an opaque edge to evaluate the MTF of a FPD. Yet, it was found that different metals yield slightly different MTF. In this study, the effects on the MTF evaluation of different metals and exposure parameters was studied and analyzed. First, the MTF was evaluated using different kVps and exposures levels. Second, the MTF was evaluated using aluminum edges of different thickness. Third, the MTF was evaluated using the following four different metals: Aluminum, Copper, Steel and Lead. Finally, the MTF obtained previously were compared to the MTF obtained by using a pinhole. In the second part of this study, the MTF of two systems using these two FPDs were also evaluated using different wires, filters and acquisition modes. The preliminary results demonstrate that the MTF is independent of kVp and exposure level. Yet, it is dependent on the material used to evaluate it.

Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide. Early detection of breast cancer using high-quality mammography is essential for improving prognosis and treatment outcomes. Digital breast tomosynthesis with synthesized two-dimensional mammography (SM) reduces dose and tissue overlap; however, its comprehensive physical evaluations remain limited. This study quantitatively compared the image quality of conventional digital mammography (DM) and SM acquired using the AMULET Innovality System. Polymethyl methacrylate, American College of Radiology, and contrast-detail (CD) mammography phantoms were imaged 10 times in both DM and SM modes. Image quality metrics, including signal-to-noise ratio (SNR) maps, noise power spectrum (NPS), contrast-to-noise ratio (CNR), modulation transfer function (MTF), and CD curves, were evaluated. DM demonstrated higher SNR uniformity and suppressed low- and high-frequency noise, and the CNR values were 1.3-2 times greater than those of SM across all object sizes. MTF analysis showed superior resolution in DM (MTF(f50), 4.0 cycles/mm) compared with that of the SM (2.5 cycles/mm). CD curve analysis confirmed the better detectability of fine structures in DM, with values of 134.9 for DM and 56.7 for SM. Quantitative phantom-based evaluation demonstrated that DM showed superior performance to SM in several physical image quality metrics, including SNR uniformity, noise characteristics, spatial resolution, and contrast-detail detectability. These findings indicate systematic differences in physical image quality between DM and SM; however, further observer and clinical studies are required to clarify how these differences translate to diagnostic performance in clinical practice.

Purpose:Reducing patient dose while maintaining (or even improving) image quality is one of the foremost goals in CT imaging. To this end, we consider the feasibility of optimizing CT scan protocols in conjunction with the application of different beam‐hardening filtrations and assess this augmentation through noise‐power spectrum (NPS) and detector quantum efficiency (DQE) analysis.Methods:American College of Radiology (ACR) and Catphan phantoms (The Phantom Laboratory) were scanned with a 64 slice CT scanner when additional filtration of thickness and composition (e.g., copper, nickel, tantalum, titanium, and tungsten) had been applied. A MATLAB‐based code was employed to calculate the image of noise NPS. The Catphan Image Owl software suite was then used to compute the modulated transfer function (MTF) responses of the scanner. The DQE for each additional filter, including the inherent filtration, was then computed from these values. Finally, CT dose index (CTDIvol) values were obtained for each applied filtration through the use of a 100 mm pencil ionization chamber and CT dose phantom.Results:NPS, MTF, and DQE values were computed for each applied filtration and compared to the reference case of inherent beam‐hardening filtration only. Results showed that the NPS values were reduced between 5 and 12% compared to inherent filtration case. Additionally, CTDIvol values were reduced between 15 and 27% depending on the composition of filtration applied. However, no noticeable changes in image contrast‐to‐noise ratios were noted.Conclusion:The reduction in the quanta noise section of the NPS profile found in this phantom‐based study is encouraging. The reduction in both noise and dose through the application of beam‐hardening filters is reflected in our phantom image quality. However, further investigation is needed to ascertain the applicability of this approach to reducing patient dose while maintaining diagnostically acceptable image qualities in a clinical setting.

We aim to compare the imaging performance of a cone-beam CT (CBCT) imaging system with noncircular scan protocols (sine-on-sphere) to a conventional circular orbit. A biplane C-arm system (ARTIS Icono; Siemens Healthineers) capable of circular and noncircular CBCT acquisition was used, with the latter orbit (sine-on-sphere, "Sine Spin") executing a sinusoidal motion with tilt amplitude over the half-scan orbit. A test phantom was used for the characterization of image uniformity, noise, noise-power spectrum (NPS), spatial resolution [modulation transfer function (MTF) in axial and oblique directions], and cone-beam artifacts. Findings were interpreted using an anthropomorphic head phantom with respect to pertinent tasks in skull base neurosurgery. The noncircular scan protocol exhibited several advantages associated with improved 3D sampling-evident in the NPS as filling of the null cone about the spatial frequency axis and reduction of cone-beam artifacts. The region of support at the longitudinal extrema was reduced from 16 to at a radial distance of 6.5cm. Circular and noncircular orbits exhibited nearly identical image uniformity and quantum noise, demonstrating cupping of and overall noise of . Although both the radially averaged axial MTF ( ) and 45deg oblique MTF ( ) were lower for the noncircular orbit compared with the circular orbit at the default full reconstruction field of view (FOV), there was no difference in spatial resolution for the medium reconstruction FOV (smaller voxel size). Differences in the perceptual image quality for the anthropomorphic phantom reinforced the objective, quantitative findings, including reduced beam-hardening and cone-beam artifacts about structures of interest in the skull base. Image quality differences between circular and noncircular CBCT orbits were quantitatively evaluated on a clinical system in the context of neurosurgery. The primary performance advantage for the noncircular orbit was the improved sampling and elimination of cone-beam artifacts.

Background/Objectives: In digital radiography imaging, dual-layer flat-panel detectors (DFDs), in which two flat-panel detector layers are stacked with a minimal distance between the layers and appropriate alignment, are commonly used in material decompositions as dual-energy applications with a single x-ray exposure. DFDs also enable more efficient use of incident photons, resulting in x-ray images with improved noise power spectrum (NPS) and detection quantum efficiency (DQE) performances as single-energy applications. Purpose: Although the development of DFD systems for material decomposition applications is actively underway, there is a lack of research on whether single-energy applications of DFD can achieve better performance than the single-layer case. In this paper, we experimentally observe the DFD performance in terms of the modulation transfer function (MTF), NPS, and DQE with discussions. Methods: Using prototypes of DFD, we experimentally measure the MTF, NPS, and DQE of the convex combination of the images acquired from the upper and lower detector layers of DFD. To optimize DFD performance, a two-step image registration is performed, where subpixel registration based on the maximum amplitude response to the transform based on the Fourier shift theorem and an affine transformation using cubic interpolation are adopted. The DFD performance is analyzed and discussed through extensive experiments for various scintillator thicknesses, x-ray beam conditions, and incident doses. Results: Under the RQA 9 beam conditions of 2.7 μGy dose, the DFD with the upper and lower scintillator thicknesses of 0.5 mm could achieve a zero-frequency DQE of 75%, compared to 56% when using a single-layer detector. This implies that the DFD using 75 % of the incident dose of a single-layer detector can provide the same signal-to-noise ratio as a single-layer detector. Conclusions: In single-energy radiography imaging, DFD can provide better NPS and DQE performances than the case of the single-layer detector, especially at relatively high x-ray energies, which enables low-dose imaging.

Contrast-enhanced (CE) breast imaging involves the injection contrast agents (i.e., iodine) to increase conspicuity of malignant lesions. CE imaging may be used in conjunction with digital mammography (DM) or digital breast tomosynthesis (DBT) and has shown promise in improving diagnostic specificity. Both CE-DM and CE-DBT techniques require optimization as clinical diagnostic tools. Physical factors including x-ray spectra, subtraction technique, and the signal from iodine contrast, must be considered to provide the greatest object detectability and image quality. We developed a cascaded linear system model (CLSM) for the optimization of CE-DM and CE-DBT employing dual energy (DE) subtraction or temporal (TE) subtraction. We have previously developed a CLSM for DBT implemented with an a-Se flat panel imager (FPI) and filtered backprojection (FBP) reconstruction algorithm. The model is used to track image quality metrics - modulation transfer function (MTF) and noise power spectrum (NPS) - at each stage of the imaging chain. In this study, the CLSM is extended for CE breast imaging. The effect of x-ray spectrum (varied by changing tube potential and the filter) and DE and TE subtraction techniques on breast structural noise was measured was studied and included as a deterministic source of noise in the CLSM. From the two-dimensional (2D) and three-dimensional (3D) MTF and NPS, the ideal observer signal-to-noise ratio (SNR), also known as the detectability index (d'), may be calculated. Using d' as a FOM, we discuss the optimization of CE imaging for the task of iodinated contrast object detection within structured backgrounds. Increasing x-ray energy was determined to decrease the magnitude of structural noise and not its correlation. By performing DE subtraction, the magnitude of the structural noise was further reduced at the expense of increased stochastic (quantum and electronic) noise. TE subtraction exhibited essentially no residual structural noise at the expense of increased quantum noise, even over that of the DE case. For DE subtraction, optimization of dose weighting to the HE view (fh ) results in the minimization of quantum noise. Both subtraction weighting factor (wSub ) and the iodine contrast signal were dependent on the LE and HE x-ray spectra. To best detect a 5 mm Gaussian lesion with 5 mg/ml of iodine within a 4 cm thick breast, it was found that the high energy (HE) view should be acquired with a tube potential of 47 kVp (W/Ti spectrum) and the low energy (LE) view with a potential of 23 kVp (W/Rh spectrum). Due to the complete removal of structural noise, TE subtraction produced much higher d' than DE subtraction both as a function of mean glandular dose and iodine concentration. We have shown the effect of increasing x-ray energy as well as projection domain subtraction on breast structural noise. Further, we have exhibited the utility of the CLSM for DE and TE subtraction CE imaging in the optimization of imaging parameters such as x-ray energy, fh , and wSub as well as guiding the understanding of their effects on image contrast and noise.

To characterize the radiation dose and three-dimensional (3D) imaging performance of a recently developed mobile, isocentric C-arm equipped with a flat-panel detector (FPD) for intraoperative cone-beam computed tomography (CBCT) (Cios Spin 3D, Siemens Healthineers) and to identify potential improvements in 3D imaging protocols for pertinent imaging tasks. The C-arm features a 30×30cm2 FPD and isocentric gantry with computer-controlled motorization of rotation (0-195°), angulation (±220°), and height (0-45cm). Geometric calibration was assessed in terms of 9 degrees of freedom of the x-ray source and detector in CBCT scans, and the reproducibility of geometric calibration was evaluated. Standard and custom scan protocols were evaluated, with variation in the number of projections (100-400) and mAs per view (0.05-1.65mAs). Image reconstruction was based on 3D filtered backprojection using "smooth," "normal," and "sharp" reconstruction filters as well as a custom, two-dimensional 2D isotropic filter. Imaging performance was evaluated in terms of uniformity, gray value correspondence with Hounsfield units (HU), contrast, noise (noise-power spectrum, NPS), spatial resolution (modulation transfer function, MTF), and noise-equivalent quanta (NEQ). Performance tradeoffs among protocols were visualized in anthropomorphic phantoms for various anatomical sites and imaging tasks. Geometric calibration showed a high degree of reproducibility despite ~19mm gantry flex over a nominal semicircular orbit. The dose for a CBCT scan varied from ~0.8-4.7mGy for head protocols to ~6-38mGy for body protocols. The MTF was consistent with sub-mm spatial resolution, with f10 (frequency at which MTF=10%) equal to 0.64mm-1 , 1.0mm-1 , and 1.5mm-1 for smooth, standard, and sharp filters respectively. Implementation of a custom 2D isotropic filter improved CNR~50-60% for both head and body protocols and provided more isotropic resolution and noise characteristics. The NPS and NEQ quantified the 3D noise performance and provided a guide to protocol selection, confirmed in images of anthropomorphic phantoms. Alternative scan protocols were identified according to body site and task - for example, lower-dose body protocols (<3mGy) sufficient for visualization of bone structures. The studies provided objective assessment of the dose and 3D imaging performance of a new C-arm, offering an important basis for clinical deployment and a benchmark for quality assurance. Modifications to standard 3D imaging protocols were identified that may improve performance or reduce radiation dose for pertinent imaging tasks.