REVEAL TECHNOLOGY

Technology Overview 

 

Traditional X-ray imaging creates a map of X-ray attenuation, but ignores useful information encoded in the energy of the transmitted photons. Reveal™ retains this information by performing spectral decomposition of the X-ray beam. This additional energy information enables selective removal of anatomical background, enhancing detectability of anatomies of interest. Reveal™ achieves this thanks to its unique triple stacked layer design, allowing for easy integration, high quantum efficiency, and the removal of motion artifacts.

Original research 

 

Maurino,S. Ghanbarzadeh, S. Ghaffari, B. Iheanacho, K. S. Karim, Study of a Single-Shot Dual-Energy Flat Panel Detector with High Detective Quantum Efficiency”, Radiological Society of North America 2019 Scientific Assembly and Annual Meeting, December 2019. 

 

Maurino,S. Ghanbarzadeh, S. Ghaffari, K. S. Karim, and othersNovel multi-energy x-ray detector allows for simultaneous single-shot acquisition of digital radiography and tissue-subtracted images”, European Congress of Radiology, 2019. 

 

Maurino,S. Ghanbarzadeh, S. Ghaffari, T. Zhang, I. Cunningham, K. S. Karim, Evaluation of A Novel Stacked Triple-Layer Flat-Panel X-Ray Detector for Dual-Energy and Digital Radiography Imaging,” Medical Physics, June 2018. 

 

Maurino, A.Badano, I. Cunningham, K.S. Karim, “Theoretical and Monte Carlo optimization of a stacked three-layer flat-panel x-ray imager for applications in multi-spectral diagnostic medical imaging,” in SPIE Medical Imaging (Physics of Medical Imaging), Proc. SPIE 9783, San Diego USA, March 2016.

 

Allec, S.Abbaszadeh, C.C. Scott, K.S. Karim, J. Lewin, “Evaluating noise reduction techniques while considering anatomical noise in dual-energy contrast-enhanced mammography,” Medical Physics, March 2013. 

 

Allec, S.Abbaszadeh, C. Scott, J. Lewin, K.S. Karim, “Including the effect of motion artifacts in noise and performance analysis of dual-energy contrast-enhanced mammography,” Journal of Physics in Medicine and Biology, Vol. 57, December 2012. 

 

Allec, S.Abbaszadeh, A. Fleck, O. Tousignant, K.S. Karim, “K-edge imaging using dual-layer large area flat panel imagers,” IEEE Transactions on Nuclear Science, October 2012 

 

Allec, S.Abbaszadeh, K.S. Karim, “Single layer and dual layer contrast-enhanced mammography using amorphous selenium flat panel detectors,” Journal of Physics in Medicine and Biology, Vol. 56, pp. 5903-5923, August 2011. 

Dual-energy Q&A 

Q. How is Bone Suppression (BS) Different from Dual Energy Subtraction (DES)?

A. DES is better than BS because it is physics based and enables detection and identification of materials (e.g. soft tissue vs calcification). DES works on all clinical images with multiple views (e.g. PA, lateral, oblique). On the other hand, BS is a software algorithm that is limited to a specific disease and view (e.g. nodule detection in a chest PA view).  See the following publication for a comparison between BS and DES.

 

Li, Feng, Roger Engelmann, Lorenzo L. Pesce, Kunio Doi, Charles E. Metz, and Heber MacMahon. “Small lung cancers: improved detection by use of bone suppression imaging—comparison with dual-energy subtraction chest radiography.” Radiology 261, no. 3 (2011): 937-949. 

 

Q. What are the different applications that DES can be used for?

A. DES has been used for pneumonia, lung nodule detection, catheter identification, calcified coronaries, and finding unknown masses in the Emergency Room. See below for some relevant publications.

 

Pneumonia:   

Martini, Katharina, Marco Baessler, Stephan Baumueller, and Thomas Frauenfelder. “Diagnostic accuracy and added value of dual-energy subtraction radiography compared to standard conventional radiography using computed tomography as standard of reference.” PloS one 12, no. 3 (2017): e0174285. 

               

Calcified Coronaries: 

Ansari-Gilani, Kianoush, Yasmeen K. Tandon, David W. Jordan, Leslie Ciancibello, David L. Wilson, and Robert C. Gilkeson. “Dual-energy Subtraction Chest Radiography: Application in Cardiovascular Imaging.” Journal of Thoracic Imaging 35, no. 3 (2020): W75-W81. 

 

Lung nodule detection: 

Kuhlman, Janet E., Jannette Collins, Gregory N. Brooks, Donald R. Yandow, and Lynn S. Broderick. “Dual-energy subtraction chest radiography: what to look for beyond calcified nodules.” Radiographics 26, no. 1 (2006): 79-92. 

 

Catheter identification: 

Kuhlman, Janet E., Jannette Collins, Gregory N. Brooks, Donald R. Yandow, and Lynn S. Broderick. “Dual-energy subtraction chest radiography: what to look for beyond calcified nodules.” Radiographics 26, no. 1 (2006): 79-92. 

 

Finding unknown masses: 

Kuhlman, Janet E., Jannette Collins, Gregory N. Brooks, Donald R. Yandow, and Lynn S. Broderick. “Dual-energy subtraction chest radiography: what to look for beyond calcified nodules.” Radiographics 26, no. 1 (2006): 79-92. 

 

Q. Is there a health economic analysis available for any of the applications?

A. See comprehensive analysis for pneumonia (including community acquired pneumonia) in the USA below.  Since DES improves the sensitivity of chest X-rays in detecting pneumonia, DES can help reduce some of the $9.5B in costs pneumonia imposes on US hospitals today.

 

Divino, Victoria, Jennifer Schranz, Maureen Early, Hemal Shah, Miao Jiang, and Mitch DeKoven. “The annual economic burden among patients hospitalized for community-acquired pneumonia (CAP): a retrospective US cohort study.” Current Medical Research and Opinion 36, no. 1 (2020): 151-160. 

 

Long, Brit, Drew Long, and Alex Koyfman. “Emergency medicine evaluation of community-acquired pneumonia: history, examination, imaging and laboratory assessment, and risk scores.” The Journal of Emergency Medicine 53, no. 5 (2017): 642-652.