RADIOLOGICAL IMAGING METHOD

Abstract

A radiological imaging method including 2 radiation sources with imaging directions orthogonal to each other, performing vertical scanning of a standing patient along a vertical scanning direction, wherein radiological method includes at least one operating mode in which: a frontal scout view is made so as to identify a specific bone(s) localization within the frontal scout view, driving current intensity modulation of the frontal radiation source, depending on patient thickness and on the identified specific bone(s) localization along the vertical scanning direction, is performed automatically, so as to improve a compromise between: lowering the global radiation dose received by a patient during the vertical scanning, while keeping at a sufficient level the local image contrasts of the identified specific bone(s) localization at different imaging positions along the vertical scanning direction, for the frontal image.

Claims

1-27. (canceled)

28. A radiological imaging method comprising: 2 radiation sources with imaging directions orthogonal to each other, one frontal radiation source and one lateral radiation source, sliding vertically so as to perform vertical scanning of a standing patient along a vertical scanning direction, wherein said radiological method comprises at least one operating mode in which: a frontal scout view is made by performing a preliminary vertical scanning of a standing patient along said vertical scanning direction by said frontal radiation source, said frontal scout view is processed to identify a specific bone(s) localization within said frontal scout view, a driving current intensity of at least said frontal radiation source is modulated along said vertical scanning direction, depending on patient thickness and on said identified specific bone(s) localization along said vertical scanning direction, with no modulation of driving voltage intensity of said frontal radiation source along said vertical scanning direction, said driving current intensity modulation of said frontal radiation source is performed automatically, so as to improve a compromise between: lowering the global radiation dose received by a patient during said vertical scanning, while keeping at a sufficient level the local image contrasts of said identified specific bone(s) localization at different imaging positions along said vertical scanning direction, for the frontal image.

29. A radiological imaging method comprising: 2 radiation sources with imaging directions orthogonal to each other, one frontal radiation source and one lateral radiation source, sliding vertically so as to perform vertical scanning of a standing patient along a vertical scanning direction, wherein said radiological method comprises at least one operating mode in which: a lateral scout view is made by performing a preliminary vertical scanning of a standing patient along said vertical scanning direction by said lateral radiation source, said lateral scout view is processed to identify a specific bone(s) localization within said lateral scout view, a driving current intensity of at least said lateral radiation source is modulated along said vertical scanning direction, depending on patient thickness and on said identified specific bone(s) localization along said vertical scanning direction, with no modulation of driving voltage intensity of said lateral radiation source along said vertical scanning direction, said driving current intensity modulation of said lateral radiation source is performed automatically, so as to improve a compromise between: lowering the global radiation dose received by a patient during said vertical scanning, while keeping at a sufficient level the local image contrasts of said identified specific bone(s) localization at different imaging positions along said vertical scanning direction, for the lateral image.

30. A radiological imaging method comprising: 2 radiation sources with imaging directions orthogonal to each other, one frontal radiation source and one lateral radiation source, sliding vertically so as to perform vertical scanning of a standing patient along a vertical scanning direction, wherein said radiological method comprises at least one operating mode in which: frontal and lateral scout views are made by performing a preliminary vertical scanning of a standing patient along said vertical scanning direction by said frontal and lateral radiation sources, said frontal and lateral scout views are processed to identify a specific bone(s) localization within both said frontal and lateral scout views, driving current intensities of both said frontal and lateral radiation sources are modulated along said vertical scanning direction, depending on patient thickness and on said identified specific bone(s) localization along said vertical scanning direction, with no modulation of driving voltage intensities of either frontal or lateral radiation sources along said vertical scanning direction, said driving current intensity modulation of said frontal radiation source, as well as said driving current intensity modulation of said lateral radiation source, are all performed simultaneously, preferably synchronously, and automatically, so as to improve a compromise between: lowering the global radiation dose received by a patient during said vertical scanning, while keeping at a sufficient level the local image contrasts of said identified specific bone(s) localization at different imaging positions along said vertical scanning direction, for the frontal image and for the lateral image.

31. The radiological imaging method according to claim 28, wherein said driving current intensity modulation(s) of said frontal radiation source is or are performed also so as to reach a value of signal to noise ratio which is constant and common to most of said imaging positions along said vertical scanning direction, preferably to all said imaging positions along said vertical scanning direction, for said frontal image and/or for said lateral image, but which can take two different values respectively for frontal image and for lateral image.

32. The radiological imaging method according to claim 31, wherein, for each of said frontal and/or lateral images, said signal to noise ratio value is constant and predetermined for each different patient organ to be imaged.

33. The radiological imaging method according to claim 31, wherein: for a frontal image of a patient spine, said standard signal to noise ratio value corresponds to a number of X-ray photons received per detector pixel comprised between 50 and 70, the radiological imaging method operator preferably having the possibility to deviate, via a manual command, from this standard value by at least + or −20%, more preferably by at least + or −50%, and/or for a lateral image of a patient spine, said standard signal to noise ratio value corresponds to a number of X-ray photons received per detector pixel comprised between 20 and 40, the radiological imaging method operator preferably having the possibility to deviate, via a manual command, from this standard value by at least + or −20%, more preferably by at least + or −50%.

34. The radiological imaging method according to claim 28, wherein said frontal and/or lateral image, after having undergone at least a first step of current intensity modulation, is normalized by homogenization of regions located just outside patient body contours, in order to get rid of image artifacts coming from said driving current intensity modulation.

35. The radiological imaging method according to claim 34, wherein said frontal and/or lateral image, after having been normalized, undergoes a contrast enhancement step.

36. The radiological imaging method according to claim 28, wherein said identified specific bone(s) localization excludes metallic parts, if any, as for example metallic prosthesis of part of skeleton of patient body or as for example metallic protections put in place on patient body before performing said radiological imaging method.

37. The radiological imaging method according to claim 28, wherein said current intensity modulation is maximized so as to also maximize said vertical scanning speed at a constant value.

38. The radiological imaging method according to claim 28, wherein said operating mode can be either switched on or switched off manually by a radiological imaging method operator.

39. The radiological imaging method according to claim 28, wherein said current intensity modulation(s) rate do(es) not go beyond a predetermined threshold of 5 mA per millisecond, preferably a predetermined threshold of 2 mA per millisecond, more preferably a predetermined threshold of 1 mA per millisecond.

40. The radiological imaging method according to claim 28, wherein said current intensity modulation(s) at least range(s) from 20 mA to 300 mA, and preferably from 10 mA to 400 mA.

41. The radiological imaging method according to claim 28, wherein said fixed voltage intensity is selected within a range from 50 kV to 120 kV.

42. The radiological imaging method according to claim 28, wherein said vertical scanning speed value at least range(s) from 8 cm/second to 20 cm/second, and preferably from 4 cm/second to 30 cm/second.

43. The radiological imaging method according to claim 28, wherein each of said frontal and/or lateral scout view(s) is made by performing a preliminary vertical scanning of a standing patient along a vertical scanning direction with a reduced global radiation dose as compared to each of said frontal and lateral images, before making each of said frontal and lateral images.

44. The radiological imaging method according to claim 43, wherein said reduced global radiation is less than 10% of said global radiation dose, preferably less than 5% of said global radiation dose.

45. The radiological imaging method according to claim 28, wherein pixels in said scout view are gathered together, preferably by zones of N×N pixels, more preferably by zones of at least 10×10 pixels, to make imaged zones.

46. The radiological imaging method according to claim 28, wherein said images or said imaged zones are processed to identify salient points which in turn are used to compute said thickness profile and to identify said specific bone(s) localization of a standing patient along said vertical scanning direction.

47. The radiological imaging method according to claim 28, wherein said images or said imaged zones are processed by a neural network to compute said thickness profile and to identify said specific bone(s) localization of a standing patient along said vertical scanning direction.

48. The radiological imaging method according to claim 28, wherein said 2 radiation sources slide vertically so as to perform vertical scanning of a pelvis or of rachis or of a spine or of a full body of a standing patient along a vertical scanning direction.

49. The radiological imaging method according to claim 28, wherein 2 radiation detectors are respectively associated with said 2 radiations sources, said 2 radiation detectors being 2 Photon Counting Detectors (PCD) each being associated to an automatic image processing function balancing automatically image density whatever radiation dose received on the sensitive surface of said radiation detector to enhance image contrast.

50. The radiological imaging method according to claim 28, wherein 2 radiation detectors are respectively associated with said 2 radiations sources, said 2 radiation detectors being 2 multi-energy counting detectors, preferably being 2 Energy Resolved Photon Counting Detectors (ERPCD).

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0074] FIG. 1 shows an example of a part of the radiological imaging method according to an embodiment of the invention, dealing with computing driving current intensity modulation of radiation source.

[0075] FIG. 2 shows an example of a specific bones localization, here a patient full body including a spine continued by pelvis and leg, via salient points detection.

[0076] FIG. 3 shows an example of a corresponding parameter which is a median signal patch value as a function of the vertical position along the height of the patient expressed in millimeters.

[0077] FIG. 4 shows an example of a corresponding thickness profile expressed in millimeters as a function of the vertical position along the height of the patient expressed in millimeters.

[0078] FIG. 5 shows an example of constant voltages expressed in kilovolts as a function of a patient equivalent thickness expressed in centimeters, respectively for the frontal image and for the lateral image.

[0079] FIG. 6 shows an example of a current modulation expressed in milliamps as a function of a patient equivalent thickness expressed in centimeters, respectively for the frontal image and for the lateral image.

[0080] FIG. 7 shows an example of obtained numbers of X-ray photons per detector pixel (representative of signal to noise ratios) as a function of a patient equivalent thickness expressed in centimeters, respectively for the frontal image and for the lateral image.

[0081] FIG. 8 shows an example of radiation dose received by patient in ρGy (microgray), as a function of a patient equivalent thickness expressed in centimeters, respectively for the frontal image and for the lateral image.

[0082] FIG. 9 shows an example of a filtered frontal scout view, after salient points detection step, but before salient points filtering step.

[0083] FIG. 10 shows an example of a filtered frontal scout view, after salient points detection step and after salient points filtering step.

[0084] FIG. 11 shows an example of a filtered lateral scout view, after salient points detection step, but before salient points filtering step.

[0085] FIG. 12 shows an example of a filtered lateral scout view, after salient points detection step and after salient points filtering step.

[0086] FIG. 13 shows an example of a filtered frontal scout view, after deep neural network detection step.

[0087] FIG. 14 shows an example of a filtered lateral scout view, after deep neural network detection step.

[0088] FIG. 15 shows an example of lateral image, of constant driving current intensity and of constant driving voltage intensity, in a constant current and voltage mode.

[0089] FIG. 16 shows an example of lateral image, of modulated driving current intensity and of constant driving voltage intensity, in a modulated current and constant voltage mode.

[0090] FIG. 17 shows an example of final lateral image as displayed to the radiologist.

DETAILED DESCRIPTION OF THE INVENTION

[0091] The present invention aims at providing a solution to provide an AEC system to a scanning stereo-radiographic system, this AEC being compliant to the IEC 62494-1. This AEC system is designed to be used in the scanning stereo-radiographic system described in the applications PCT/IB2016/000273 and PCT/IB2017/000986, incorporated by reference and owned by same applicant EOS-Imaging.

[0092] In a preferred embodiment, the two detectors of this scanning stereo-radiographic system are multi-energy counting detectors, also known as Energy Resolved Photon Counting Detector (ERPCD) with at least 2 energy bins. In another embodiment, the two detectors of this scanning stereo-radiographic system are mono-energy counting detectors also known as Photon Counting Detector (PCD).

[0093] The use of the photon counting detector, in multi-energy or in mono-energy is advantageous compared to the gaseous detector for two main reasons. The first reason is the fact that the signal of the ERPCD or PCD is linear with the incoming flux and is directly equal to the number of detected photons while the signal of the gaseous detector was strongly nonlinear, and this non-linearity was rather complex to model to correct it with precision. In the ERPCD and PCD a non-linear behavior still exists at high flux called the pile-up effect, but this pile-up effect can be well modeled and corrected by the image calibration software. The second reason is the fact that the ERPCD and PCD have a very stable behavior and sensitivity without the need of a new calibration during months and are not sensible to a room temperature variation, where the gaseous detector was far to be as stable and needed a daily calibration, and its behavior and sensitivity could also vary in a few minutes according to a change of room temperature. The stability of the PCD and ERPCD and the photon counting functionality enable to use directly the counting signal of incident photon in the detector to evaluate the Exposure Index and the Signal to Noise Ratio. The Signal to Noise Ratio is directly equal to the root mean square of the signal. Other kinds of energy integration detector, as the gaseous one for example, do not present this advantage and need to precise calibration to evaluate the SNR, and thus the Exposure Index.

[0094] The radiological imaging method according to embodiments of the invention is based on the use of a scout view, in mono-energy (ERPCD or PCD). As one goal of this scanning radiography system is dedicated to bones imaging for orthopedics, the scout view in that case is analyzed to find precisely the axial skeletal or bones of the selected protocol. But for some other applications, a soft tissue organ protocol as for instance the lung could be selected, and in that case the scout view is analyzed to find the organ.

[0095] The relevant ROI for the diagnosis according to the definition of IEC 62494-1 is defined by the union of a set of circular sub ROI also called ‘patch’ of approximately the size of a vertebrae (4-5 cm diameter), which are placed on the set of characteristics detected points or landmarks on the scout view according to a protocol specific search of bones or organs. This search of characteristics points can be embodied with two different methods: a specific salient point search algorithm or using a trained pose detection Deep Neural Network.

[0096] Then the equivalent thickness of the patient is evaluated in each patch, and some protocol of specific selection rules provides a vertical vector of equivalent thickness according to the Z (vertical) position in the patient. The equivalent thickness is evaluated in mono material PMMA [Poly (methyl methacrylate)] equivalent when mono-energy scout view is used.

[0097] The vertical equivalent thickness vector is then used to process a characteristic thickness, which is a secured detection of most probable maximum thickness. The characteristic thickness and the equivalent vector thickness are then used to process the parameters of the scan to get an Exposure Index in each patch as close as possible to the Exposure Target.

[0098] The exposure parameters can be produced in a few different modes according to the choice of the operator: [0099] a first mode called ‘constant exposure mode’ provides simply the optimal constants kV, mA, filter and scan speed to use for the scan and will provide a Constant flux exposure control according to the definition of the IEC 60601-2-44; [0100] a second mode called ‘Flex Dose’ will process a scan speed, a selected filter and a vector of temporal modulation of the exposure along the vertical axis and will provide a Z axis exposure control according to the definition of the IEC 60601-2-44.

[0101] The “Flex Dose” is to be used with the voltage or tension (kV) being fixed and the current (mA) being modulated along the Z axis. The operating mode according to the invention is this second mode called “Flex dose”.

[0102] FIG. 1 shows an example of a part of the radiological imaging method according to an embodiment of the invention, dealing with computing driving current intensity modulation of radiation source.

[0103] The radiological imaging method according to embodiments of the invention includes a method to process the current intensity modulation of a radiation source along the vertical scanning direction. The FIG. 1 presents the functional block diagram of an example implementation using the salient points.

[0104] The following successive steps are performed: [0105] In a step 1, a scout view of the standing patient is acquired with reduced radiation dose. The Scout View is required in order to use the “Flex Dose” mode and is acquired with a 0.5 mm thickness copper filter and a very low dose. The patient dose ratio between this Scout View and the main shot is less than 10% for long axis and localized protocols. This step 1 of the method is the acquisition of a scout view at reduced dose by a vertical scanning along the patient. [0106] In a step 2, a post processing of the scout view is performed where pixels in the scout view are gathered together, preferably by zones of N×N pixels, for example by zones of at least 20×20 pixels, to make imaged zones with calibration and average binning. The Scout View was here acquired at such a low level of dose that a large binning 20×20 was applied to filter enough of the noise and get a higher level of confidence on the estimated thickness. This step 2 is the post processing of the scout view image, including the homogeneity correction using the gain calibration of the detector, and the use of a filter to improve the signal to noise ratio without introducing any bias to get a high level of confidence on the estimated thickness, for instance an average binning of 20×20 is well adapted. [0107] In a step 3, salient points are detected as will be explained in more detail with respect to FIGS. 9 to 12, where first points of higher radiation absorption are detected, and where then part of detected points are filtered out according to predetermined rules, in order to keep practically only the wished specific bones localization, for example the patient body spine, giving the salient points succession. A salient point detection algorithm developed to detect validated axial skeletal bones is applied on the binned image. The detected salient points are then selected differently in frontal and lateral images according to the patient orientation. The selected salient points mainly follow the axial skeletal composed of the lower limbs, the pelvis, the spine, the neck, and the head. A metal prosthesis or metal protection detection is also used to remove and to exclude the corresponding selected salient points in step 3 where metal detection is performed whereas in step 8 the outliers are just selected with respect to thickness. This step 3 is the detection of the specific bone(s) localization and rejection of metal parts in the scout view. As a matter of example, we use the description of the method using the salient points detection, but another implementation using a specific neural network can also be used. The salient points detection method used consists to search at a scale of a typical vertebrae size, which is around 5 cm diameter, to find a set of local maximum attenuation points in the scout view. The detected salient points are then selected differently in frontal and lateral images according to the patient orientation. The selected salient points mainly follow the axial skeletal composed of the lower limbs, the pelvis, the spine, the neck, and the head. There exists only one selected salient point at one Z altitude (at one Z position along vertical scanning direction) whereas there can be several different detected salient points at one Z altitude. The FIGS. 9 to 12 present respectively the salient points detection and selection on the frontal and lateral scout view of a patient. The FIGS. 9 and 11 present the detected salient points, and the FIGS. 10 and 12 present the selected salient points. The FIGS. 13 and 14 present an example of the skeletal detection using the neural network method, including a limited number of landmarks, applied on the same patient than for the FIGS. 9 to 12. As a matter of example, the limited number of landmarks presented in the FIGS. 13 and 14 correspond to the cervical vertebras C2 and C7, the thoracic vertebra T9, the sacrum, and on the lower limbs the left and right femoral head, ⅓ diaphysis, center of trochlea, distal tibia and proximal tibia. The selection of salient points method enables also to remove the points which are detected on metallic parts, including for example metallic prosthesis or metallic protections for breast, gonad ovary or other sensible parts of the body. The metallic parts can also be removed using the neural network method. [0108] In a step 4, from the salient points, a signal profile is obtained as a function of vertical position expressed in mm. This step 4 is the processing of signal profile along the vertical scanning of the patient. The median value of the signal of the scout view image is processed in each circular patch centered on selected salient points and is associated to the altitude z of the corresponding salient point in the vertical scanning referential. The patch size representing an area approximately equivalent to a vertebrae size which is around 5 cm diameter. The resulting signal profile function of z is sparse, and an interpolation and extrapolation of this sparse signal profile provides a complete vertical profile sampling of signal according to the vertical altitude z on the whole height of the required vertical scanning of the patient, including some bottom and top extension of scan area for optional selection by the operator. [0109] In a step 5, from preceding signal profile, a patient thickness profile is computed. Indeed, this step 5 is the processing of the thickness profile along the vertical scanning of the patient. The logarithm of the signal profile function of c is processed using a calibration second degree polynomial function to provide the corresponding PMMA thickness equivalent according to the equation 1:

[00001]$t=\{\begin{array}{c}{a\left[\ln \left(\frac{\mathrm{signal}}{\mathrm{mAs}}\right)\right]}^2+b\left[\ln \left(\frac{\mathrm{signal}}{\mathrm{mAs}}\right)\right]+c,\mathrm{if}\mathrm{signal}>0\\ \mathrm{MaxThickness},\mathrm{if}\mathrm{signal}=0\end{array}$

with mAs=mA.sub.scout view*time_per_line and MaxThickness=600 mm of PMMA. [0110] The coefficients a, b and c of the polynomial are processed using a calibration. [0111] In a step 6, optionally, new upper and/or lower scan limits can be manually selected by radiological imaging method operator. The operator can reduce or increase a little bit the height of the scan using a selection tool on the scout view images in the interface software. [0112] In a step 7, optionally, the patient thickness profile is cropped according to preceding new upper and/or lower scan limits. The processed thickness profile function of z is then cropped according to the operator selection of the upper and lower limits of the vertical scan along the patient. [0113] In a step 8, from preceding thickness profile, a characteristic patient thickness is computed, after filtering out outliers like metallic prosthesis or metallic protections has already be done in step 3. This step 8 is the processing of the characteristic thickness. Considering simply the maximum value of the thickness profile previously determined at the step 5 is not representative of patient's thickness when patient is sitting or with a leg on a support or with folded arms. To define a representative thickness of the patient, the derivative of the thickness profile is processed to define statistical parameters using the mean and standard deviation to remove outliers, and then the characteristic thickness is defined as the maximum thickness without considering the outliers. [0114] In a step 9, image acquisitions parameters are taken from a reference table, according both to specific bones localization, for instance precise position of the patient spine along vertical scanning direction, and to patient thickness variation along vertical scanning direction, i.e. along height of the patient. Indeed, the processed characteristic PMMA equivalent thickness and the selected protocol are used to obtain the image acquisition parameters (kV, filter, scan speed) according to a reference anatomical parameters table. The step 9 is the selection in a table of the image acquisitions parameters according to the processed characteristic thickness and to the selected protocol. The parameters set comprises for instance the signal target, and the reference kV. The reference kV, mA and speed could be used to acquire the images of the patients in case the operator choose to disable the modulation, but to keep the AEC, in that case, the scan speed and the constant value of current would be processed according to the signal target and to the characteristic thickness. The reference voltage (kV) is used to acquire the images of the patients with the current modulation with a constant voltage (kV). As a matter of example, the signal target for a spine exam are different for the frontal and the lateral images and are typically respectively around 60 photons/pixel for frontal view, and around 30 photons/pixel for lateral view. These values can be adjusted by the radiologist in a limited allowed range. [0115] In a step 10, depending on the chosen operating mode, either a constant value of current intensity, or preferably a variable modulation of current intensity along the vertical direction is chosen, as a function of both the precise position of the patient spine along vertical scanning direction and the patient thickness variation along vertical scanning direction, in order to reach a constant and common signal to noise ratio along vertical scanning direction. i.e. a constant target number of X-ray photons per detector pixel along vertical scanning direction, this constant target number of X-ray photons per detector pixel along vertical scanning direction having preferably a different value for frontal image, for example 60, and for lateral image, for example 30. The final step of the “Flex Dose” mode is the processing of the current (mA) modulation vector of the image along the patient body part to scan to fit the Exposure Index Target as close as possible in every patch of the ROL. A matrix was calibrated to establish the relationship between the measured signal values as a function of a set of voltage (kV) values and PMMA equivalent thicknesses. The algorithm used to determine the current (mA) performs 1D interpolation within this matrix. [0116] More precisely, in this step 10, depending on the chosen operating mode, a variable modulation of current intensity along the vertical direction are chosen, as a function of both the precise position of the patient spine along vertical scanning direction and the patient thickness variation along vertical scanning direction so as to get an equivalent patient thickness variation along vertical scanning direction (bones attenuate more radiation, therefore they equivalent to superior thicknesses than their real thicknesses, as compared to soft tissues), in order to reach a constant and common signal to noise ratio along vertical scanning direction, i.e. a constant target number of X-ray photons per detector pixel along vertical scanning direction, this constant target number of X-ray photons per detector pixel along vertical scanning direction having preferably a different value for frontal image, for example 60, and for lateral image, for example 30. [0117] The contrast is known to be better at low voltage (kV) but, the use of a low voltage (kV) is not efficient looking at the useful dose which provides some signal in the detector compared to the dose received in the thick parts of a body. The choice of a specific value of the voltage (kV) constant along the complete vertical scanning, when one or more voltage values are available (at least 3, and preferably exactly 3, of them are available), is guided by a compromise between a better contrast leading to a lower voltage (V) and a more efficient dose use leading to a higher voltage (kV). The thickness profile, and a 1D table representing the expected signal with respect to the chosen constant voltage value and to the thickness for a referenced current and scan speed is used to process the required current profile at the reference scan speed to reach the signal target. The current profile can be then adjusted proportionally to a specific scan speed. For instance, it is required to double the current profile to double the scan speed with respect to the reference scan speed. The source having a maximum output power, the maximum current profile allowed for a given scan speed can be deduced by the ratio of the maximum power and the chosen constant voltage value. The optimal scan speed is found looking at the higher allowed current profile. [0118] The final step of the “Flex Dose” mode is the processing of the of the current (mA) modulation vector of the image along the patient body part to scan to fit the Exposure Index Target as close as possible in every patch of the ROT. [0119] The voltage (kV) and current (mA) can be processed only as scalar values for the corresponding characteristic thickness in constant AEC mode, or as a current modulation vector in “Flex Dose” mode to optimize the X-ray flux according to the estimated thickness of the patient along the vertical scan. The “Flex Dose” mode enables an important dose reduction for long axis protocols compared to a constant current (mA) mode, which was based only on the maximum thickness of the patient. [0120] The overall target of “Flex Dose” mode is to reach a constant and repeatable signal level on the maximum thickness location of the patient's scanned area in constant mode, and moreover, to reach a constant and repeatable signal level all along the scanned axial skeletal of the patient and independently of the patient morphology and thickness for this mode.

[0121] FIG. 2 shows an example of a specific bones localization, here a patient full body including a spine continued by pelvis and leg, via salient points detection. The FIG. 2 presents a typical example of selected salient points on a lateral scout view.

[0122] The succession of circles follows the patient spine in a globally vertical direction. This succession of salient points SP is spotted on the lateral image of a patient body. This patient body lateral image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0123] FIG. 3 shows an example of a corresponding parameter P which is a median signal patch value as a function of the vertical position Z along the height of the patient expressed in millimeters. The FIG. 3 presents the corresponding fully sampled signal profile along the vertical scanning of the patient. The selected salient points are indicated in FIG. 2 on the lateral scout view by circular dots which represent the circular patch which is around 5 cm diameter.

[0124] FIG. 4 shows an example of a corresponding thickness profile th expressed in millimeters as a function of the vertical position Z along the height of the patient expressed in millimeters. The FIG. 4 presents the characteristic thickness determination on the lateral profile presented in the FIG. 2.

[0125] The patient thickness profile is plotted on FIG. 4. The patient thickness th, expressed in mm, is represented as a function of the vertical position Z, also expressed in mm.

[0126] The FIGS. 5 and 6 present a simulation of the standard relation of the voltage (kV) and current (mA) according to the equivalent PMMA thickness for the full spine protocol in “Flex Dose” mode, for the characteristic thicknesses 225 mm in frontal and 335 mm in lateral measured for the anthropomorphic phantom of the FIGS. 15, 16 and 17 taken as an example.

[0127] FIG. 5 shows an example of constant voltages V expressed in kilovolts as a function of a patient equivalent thickness th expressed in centimeters, respectively for the frontal image and for the lateral image. These constant voltages can be chosen dependent on the characteristic thicknesses measures in the frontal and lateral scout views.

[0128] For the frontal curve F, voltage constant value has been selected at 90 kV (corresponding to a characteristic thickness of 225 mm measured in the frontal scout view of the anthropomorphic phantom) and is independent on the characteristic patient thicknesses ranging from about 10 cm to about 50 cm.

[0129] For the lateral curve L, voltage constant value has been selected at 120 kV (corresponding to a characteristic thickness of 335 mm measured in the frontal scout view of the anthropomorphic phantom) and is independent on the characteristic patient thicknesses ranging from about 10 cm to about 50 cm.

[0130] FIG. 6 shows an example of a current modulation I expressed in milliamps as a function of a patient equivalent thickness th expressed in centimeters, respectively for the frontal image and for the lateral image.

[0131] For the frontal curve F, current increases regularly from about 10 mA to about 400 mA, for equivalent patient thicknesses ranging from about 10 cm to about 30 cm, and then is kept constant at about 400 mA from about 30 cm to about 50 cm.

[0132] For the lateral curve L, current increases regularly from about 10 mA to about 400 mA, for equivalent patient thicknesses ranging from about 10 cm to about 37 cm, and then is kept constant at about 400 mA from about 37 cm to about 50 cm. Increase of F curve is steeper than increase of L curve.

[0133] FIG. 7 shows an example of obtained numbers S of X-ray photons per detector pixel (representative of signal to noise ratios) as a function of a patient equivalent thickness th expressed in centimeters respectively for the frontal image and for the lateral image.

[0134] For the frontal curve F, the number of X-ray photons per detector pixel is rather constant at about 60, for equivalent patient thicknesses ranging from about 15 cm to about 30 cm, and then decreases abruptly from about 60 to about 5, for equivalent patient thicknesses ranging from about 30 cm to about 40 cm, and continues to decrease more softly to tend toward zero, without reaching actually zero, from about 40 cm to about 50 cm. Below 15 cm, between 15 cm and 10 cm, this number increases abruptly to about 140.

[0135] For the lateral curve L, the number of X-ray photons per detector pixel is rather constant at about 27, for equivalent patient thicknesses ranging from about 20 cm to about 37 cm, and then decreases softly to tend toward zero, without reaching actually zero, for equivalent patient thicknesses ranging from about 40 cm to about 50 cm. Below 20 cm, between 20 cm and 10 cm, this number increases abruptly to about 250.

[0136] FIG. 8 shows an example of radiation dose D received by patient in ρGy, as a function of a patient equivalent thickness th expressed in centimeters respectively for the frontal image and for the lateral image.

[0137] For the frontal curve F, the radiation dose received by patient increases first slowly from about none to about 100 micrograys, for equivalent patient thicknesses ranging from about 10 cm to about 20 cm, then increases much more abruptly from about 100 micrograys to about 850 micrograys, for equivalent patient thicknesses ranging from about 20 cm to about 30 cm, and afterwards remains roughly constant at about 850 micrograys, for equivalent patient thicknesses ranging from about 30 cm to about 50 cm.

[0138] For the lateral curve L, the radiation dose received by patient increases first slowly from about none to about 130 micrograys, for equivalent patient thicknesses ranging from about 10 cm to about 25 cm, then increases much more abruptly from about 130 micrograys to about 1700 micrograys, for equivalent patient thicknesses ranging from about 25 cm to about 37 cm, and afterwards remains roughly constant at about 1700 micrograys, for equivalent patient thicknesses ranging from about 37 cm to about 50 cm. L curve increases more slowly than F curve in first phase of slow increase, but then L curve increases more rapidly than F curve in second phase of abrupt (or quick) increase.

[0139] On all FIGS. 9 to 16, the scale along horizontal and vertical axis are in mm, after scout view image has been binned (which means each zone of 20×20 original square pixels has been gathered in a new pixel), for scout view, frontal and lateral images taken after scout view having no such binning.

[0140] FIG. 9 to FIG. 12 show frontal and lateral images using a step of salient points detection, both before and after filtering in order to focus on the patient spine (or on the patient spine continued by one of his or her leg) and to exclude other bones, in order to enhance image contrast on the zone of interest which is here the patient spine.

[0141] This filtering step aims at selecting only salient points which are located most probably on axial skeleton, here on spine and on one leg continuing the spine.

[0142] FIG. 9 shows an example of a filtered frontal scout view, after salient points detection step, but before salient points filtering step. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0143] FIG. 10 shows an example of a filtered frontal scout view, after salient points detection step and after salient points filtering step. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0144] Bones 21 to 25 are spotted within patient 20. Patient 20 is plotted with respect to his or her height Z expressed in mm with respect to his or her width also expressed in mm.

[0145] Rules for frontal image filtering step are the following ones: [0146] For each Z (vertical position) value, the salient point with maximal thickness is chosen, [0147] Metal parts are excluded even if they correspond to a salient point with maximal thickness (metal parts correspond to very steep attenuation or absorption changes with their vicinity within patient body).

[0148] When filtering has been performed within patient 20 frontal image: [0149] Only remain spine 21, left leg 23 and a small part of right leg 22. [0150] Whereas arms 24, shoulders 25 and most of right leg 22 have been filtered and thereby excluded.

[0151] FIG. 11 shows an example of a filtered lateral scout view, after salient points detection step, but before salient points filtering step. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0152] FIG. 12 shows an example of a filtered lateral scout view, after salient points detection step and after salient points filtering step. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0153] Bones 31 to 35 are spotted within patient 30. Patient 30 is plotted with respect to his or her height Z expressed in mm and with respect to his or her width also expressed in mm.

[0154] Rules for lateral image filtering step are the following ones: [0155] For each Z (vertical position) value, the salient point closest to patient back is chosen (corresponding here to the salient point the more on the right of the lateral image since patient is looking toward left side, but it would correspond to the salient point the more on the left of the lateral image if patient were looking toward right side). [0156] Metal parts are excluded even if they correspond to a salient point with maximal thickness (metal parts correspond to very steep attenuation or absorption changes with their vicinity within patient body), [0157] Still exclude some isolated salient points too close to the patient back, further than patient spine toward right side of lateral image, for example some isolated salient points lost in soft tissues zones like in buttocks or in flesh portion of back.

[0158] When filtering has been performed within patient 30 lateral image: [0159] Only remain spine 31 and left leg 32, [0160] Whereas arms 33 and 34, as well as jaws 35, have been filtered and thereby excluded.

[0161] Current intensity modulation may be calibrated.

[0162] A specific image, either frontal or lateral, may also be corrected:

[0163] A profile of driving current intensity modulation is calculated from the scout view.

[0164] Then an image is acquired with the calculated modulation profile.

[0165] Then, obtained image is corrected by calibration software homogenizing detector and correcting its non-linearity.

[0166] Then, use is made of the feedback measure file of the generator after radiation emission, in order to identify at each line j of taken image the value effectively sent by the generator of current mA (j) at this line j.

[0167] Then the image is normalized: signal of each line j of taken image is divided by mA (j).

[0168] FIG. 13 shows an example of a filtered frontal scout view, after deep neural network detection step. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0169] There is a patient 40 represented on a frontal image with landmarks 41 plotted by the deep neural network.

[0170] FIG. 14 shows an example of a filtered lateral scout view, after deep neural network detection step. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm.

[0171] There is a patient 50 represented on a lateral image with landmarks 51 plotted by the deep neural network.

[0172] FIG. 15 shows an example of lateral image, of constant driving current intensity and of constant driving voltage intensity, in a constant current and voltage mode. The FIG. 15 presents the lateral scan of an anthropomorphic phantom in the case of the modulation is disabled.

[0173] A patient 60 is represented on a lateral image. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm. There is a constant driving current intensity 61 all along the vertical scanning direction Z, for example at about 350 mA. There is a constant driving voltage intensity 62 all along the vertical scanning direction Z, for example at about 120 kV. Patient 60 lateral image is of average quality.

[0174] FIG. 16 shows an example of lateral image, of modulated driving current intensity and of constant driving voltage intensity, in a modulated current and constant voltage mode. The FIG. 16 presents the lateral scan of the anthropomorphic phantom in the case of the modulation is enabled but with a fixed voltage (kV).

[0175] A patient 70 is represented on a lateral image. This patient body image is plotted with respect to altitude Z (height along vertical scanning direction) as a function of the patient width, patient thickness th being perpendicular to plan of figure, both altitude and width w being expressed in mm. There is a driving current intensity modulation 71 all along the vertical scanning direction Z, for example varying between about 10 mA and about 350 mA. There is a constant driving voltage intensity 72 all along the vertical scanning direction Z, for example at about 120 kV. Patient 70 lateral image is of notably similar quality than patient 60 lateral image, but taken with a lower radiation dose and adjusted to get the right level of signal at each position along vertical scanning direction.

[0176] One can see in the image presented in the FIG. 16 compared to the one from the FIG. 15 that the blank or void part of the image outside the patient is modulated correspondingly to the modulation profile applied. The image is then corrected by the normalization with the excepted signal without attenuation to remove this modulation of the blank part in image, to avoid compromising the radiologist analysis of the image. The demodulated image follows then a standard contrast enhancement process before the presentation to the radiologist.

[0177] FIG. 17 shows an example of final lateral image as displayed to the radiologist. The FIG. 17 presents for instance the lateral scan image acquired with current modulation only including the demodulation and contrast enhancement processing as it is presented to the radiologist. This final lateral image is of good quality.

[0178] The invention has been described with reference to preferred embodiments. However, many variations are possible within the scope of the invention.