EP4346608A1 - X-ray imaging system and method - Google Patents

Abstract

Improved reconstruction methods for quantitative 3D imaging is based on using simplified system matrix and datasets of little scatter interference in fast and or low radiation tomographic image acquisition and reconstruction, some using time continuity and spatial continuity. This method incorporates within tomographic imaging, scatter removal and or spectral imaging. Reconstruction using spectral measurements, may be able to separate each substance from the rest. And high resolution 3D reconstruction may perform on only selected substance, for instance, the rest of the ROI, or other tissues or components may be calculated as one known attenuation value from material decomposition image processing. Ultralow radiation 2D and 3D quantitative x ray imaging, with less than 1% SPR, or less than 5% SPR, at for example,10% to >99% reduction of radiation dosage but providing image visibility similar or equivalent or better than conventional general x ray images with antiscatter grid as the scatter removal device or using software or combination of both. This may be achieved by multiplying the intensity of each pixel by a factor or adjusting the intensity level of each pixel by a quantitative factor. The adjustment may be pixel dependent or independent of each others.

Description

X-RAY IMAGING SYSTEM AND METHOD

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

[0001] This application claims benefit of U.S. Provisional Patent Application

No. 63/193,598, filed on May 27, 2021; U.S. Provisional Patent Application No. 63/212,664, filed on June 20, 2021; U.S. Provisional Patent Application No. 63/218,181, filed on July 2, 2021; U.S. Provisional Patent Application No. 63/228,161, filed on August 2, 2021; U.S. Provisional Patent Application No. 63/230,834, filed on August 9, 2021; U.S. Provisional Patent Application 63/233,206, filed August 14, 2021;U.S. Provisional Patent Application No.63/235,582, filed on August 20, 2021; U.S. Provisional Patent Application No.63/247,318, filed on September 23, 2021; 63/250,240, filed on September 30, 2021; U.S. Provisional Patent Application No. 63/279,136, filed on November 14, 2021.

FIELD

[0002] This application is related to X-ray imaging systems and related technology for Medical and non-Medical Applications such as diagnosis, monitoring, surveillance, image guidance, identification and characterization in medicine, drug discovery and life science research, non-destructive testing (NDT), field inspection, characterization of minerals and security, digital content for entertainment, commerce, social media and marketing, input data for AI based analysis,

BACKGROUND

[0003] Traditional CT imaging in particular qCT allows better quantification of density in a volume containing one or more substances, such as densities for different tissues in a human body, than for example DXA.

[0004] However, traditional CT reconstruction as well as reconstruction of Tomosynthesis, or Inverse Geometry Scanning Fluoroscope (IGSF) or Cone Beam CT (CBCT) are time consuming and often are not able to generate data to quantify density accurately or consistently to better than 5%, which is typically higher than the density variation between tissues or different materials/substances in a Volume of Interest (VOI).

[0005] Traditional spectral CT reconstruction algorithms, which typically are based on photon counting or energy sensitive detectors are also limited in many aspects of quantification of various substances due to scatter interference and artifacts due to complex system design and motion required for a complete reconstruction and are typically a closed system in reconstruction in terms of incorporating dataset from measurements of other detectors different than the CT detectors in the toroid design. Iterative algorithms slow down the process and not accurate due to the assumption of all voxels are contributing to the deviation between measured and reconstructed model simulated projections.

[0006] A system which allow integration of at least two modalities or more modalities or an All-in-one x-ray system of prior art typically is a C ARM or tomosynthesis system of CBCT, to combine with General X-ray System and typically is only used in the setting of intervention guidance. Complete replacement of CT and densitometer has not been achieved with these all-in-one system. Discrepancies between modalities may have contributed to high radiological error and limitation in the use of AI due to lack of standard and or integrated imaging method and apparatus. [0007] AI analysis typically are using images with SPR much higher than 10% or at least 5%. As a result, the accuracy and precision is limited in scope and or may generate false negative or false positive in medicine and or inconsistencies within and across varies modalities, x-ray imaging systems by the same and or different x-ray system manufacturers

BACKGROUND OF THE INVENTION

Previously, image acquisition and reconstructions in a CT system is generally an enclosed system for example, only detectors assembled in the imaging gantry when measured together, are programed to reconstruct. The measurements from prior measurements generally are using the same set of detectors. Or a preexisting measurement result which are in a separate system are used to analyze the Region of Interest. This type of reconstructed is suitable for a closed system, such as a traditional CT or tomosynthesis system.

AI used with x ray imaging system does not use density and other physical properties such as movement, fluidic dynamics, concentration changes within a spatial constraint or energy disturbed properties , such as energy sensitivity, chemical properties and elasticity as data input in a training material or detection information.

In prior art, qCT provides better bone density measurement however, the radiation level is much higher than that of conventional bone densitometer such as Dexa using linear x ray detectors.

Reconstruction of CT typically use sinogram and assuming rotation more than 10 or 15 degree and or 60 degree which increases the complexity of imaging systems, typically require complex iteration methods

Segmentation typically do not rely on material decomposed data or density information derived from CT and or spectral imaging, especially for imaging of large dimensions and human imaging.

Tomographic imaging system such as traditional CT and or traditional Tomosynthesis system are typically bulky and hard to transport

Typically a reference sensor is needed to measure and estimate x ray input intensity of VOI imaging, which makes it complex

SUMMARY

The x-ray imaging system and apparatus disclosed herein improves and expands on disclosures in reference international patent applications (“PCT Applications”) including International Patent Application Nos. PCT/US2019/044226, PCT/US2019/014391 and PCT/US2019/022820 and PCT/US2020/062426. At least a portion of the hardware and software aforementioned included as what is called the x ray imaging system, tomography system, or spectral imaging system or tomosynthesis system or spectral tomography system and or spectral imaging and methods. One or more configurations from aforementioned PCTs and their improved versions and configurations are used in the present closure.

In one configuration, A x-ray imaging system comprising from front to back, source, detector, optionally a sample holder, and or scatter removal devices such as beam blocker array or beam selector, single, or double or triple detectors or more are used which stack together or measure the same VOI from different angles, or spatial location relative to at least one voxel within VOI

In one configuration, elements and aspects of aforementioned PCTs may be combined here with new content as a complete system or sub modules in a kit or software modules of a complete software application. Such element or kit component in hardware and or software may be combined with any x ray imaging system to improve speed, resolution, foot print, diagnostic value, save time and reduce radiation level and artifacts in imaging and quantitative measurements and for be used by AI to train or analyze to diagnose, monitor, track, inspect, 3D render and test in medical, non medical, security and research applications.

In one configuration, improved reconstruction methods for quantitative 3D imaging is based on using simplified system matrix and datasets of little scatter interference in fast and low radiation tomographic image acquisition and reconstruction some using time continuity and spatial continuity. This method may enable potential fast adoption of x ray imaging systems with capabilities for tomographic imaging, scatter removal and or spectral imaging to for example material decompose and separating substance images.

Rapid and low cost payment and transaction methods for X ray Imaging Procedures and purchase of equipment or kits may involve the use of digital bank and or digital wallet, some deposited with cryptocurrency are used for payment and reimbursement transactions involved in subscription and or pay per procedure

Density measurement, thickness measurement, interface region of two materials

In one configuration, at least one thin beam projected through the VOI, where density measurement is to be done for the tissue, or substance or component of interest. The projected region on the detector is approximately at least one pixel or more. Two or multiple beams which are distributed or have distance apart from each other may be used to illuminate the VOI, all at the same time or at different time points. Each beam may be generated by the field of view of a collimator. Or multiple beam or structural illumination of thin beams may be generated by a collimator placed between patient of the source, which has one or more x ray transmission regions, distributed across from the x ray beam cross section. Dual or multiple energy measurements may be derived. Inverse functional response equation system look up may be used to derive the attenuation value of the component or substance. The thickness may be calculated or measured by x ray at different angles of projections. The final calculation of density is derived from attenuation value at dual or multiple energies and corresponding density value of each component or substance. For example, if a VOI or the component of interest or a tissue volume is relatively homogeneous, such as LI of lumbar spine, the average value of the density derived from all beams may be calculated.

In one configuration, the density may be derived from tomography measurement.

Bone densitometer, using the x ray tomography method with low radiation level and low resolution, for example, 0.5 cm as the resolution desired in the z direction, or a dimension which may be smaller than thickness of bone in the z direction, for example, parallel to the center axis. For a human having 20 cm thickness, only 20 / 0.5 = 40 projection needed for bone density measurement. If the area of interest is restricted in the xy direction, for example a 1cm or size of xy dimension of lumbar spine or smaller are used as the dimension of xy cone beam diameter or slight bigger or slight smaller, approximately 40 projections, each are 0.5cm apart from the most adjacent point, the entire area of travel may be less than approximately 20 cm²

In one configuration, the total data points in area of travel to be at least equal or less than 5 x 8 data points. The distance between data points to be approximately the desired resolution in the z direction.

In one configuration, the angle of a x ray emitting position to the isocenter of the region of interest compared to the original center axis and or relative position of the x ray emitting position to the isocenter of the region of interest may be less than 10 or 11 degrees. In some cases, it may be less than 5 degrees.

In one configuration, less than 20 or less than 10 or less than 40 projections of a region of interest such as lumbar spine, with x ray beam diameter to be approximately the same or less than that of lumbar spine, may be sufficient for accurate density measurement. In one configuration, for density measurement, the number of projections or Number of x ray emitting positions relative to the VOI are approximately quantatitatively related to the value of thickness of the Volume of Interest Tv and or Cz which is the dimensions of the component of interest along the third axis, or in some cases, number of of projections and or x ray emitting positions relative to the VOI is directly proportional to Tv divided by Cz, or approximately equal to thickness of VOI divided by Cz/2 with Cz or Cz/2 being the distance between x ray emitting positions where x ray measurements are taken.

In one configuration, for density measurement with accuracy better or comparable to that of qCT, or CT, less than 10 projection images are taken or less than 20 projections or less than 30 or 40 projections may be taken at various x ray emitting positions. And x ray radiation locations where the measurements are taken are less than 2 cm² or less than 4 cm² or less than 5 cm ² or less than 6 cm² or less than 10 cm²

In one configuration, for densitometer measurements, x ray emitting locations for each projection is traveling in less than the total thickness along the Z or third access which is Cz cm³

In one configuration, the region of interest of lumbar spine may identified by taking a full view x ray first. The tomography x ray source position and its volume integral through the Volume of Interest may be saved in a table or database. Reconstruction involves a step to look up the system matrix of each projection from the table and or derive on the fly based on the projection geometry.

In one configuration, similar method may be used for assessing density of component or composite matter, if the mass or dimension of the matter may be estimated. Restricted xy direction ROI and step size is estimated to be smaller than the dimension in the z direction or third axis perpendicular to the detector coordinates and or third axis of the matter and or the material.

In one configuration, there may be at least one unit of step size dimension along the dimension of the matter or component in the z direction or along the third dimension relative to the 2D, coordinates, for example, typically 2D coordinates may be described by the 2D coordinate of the detector. The density of the matter may be derived. If the voxel situated within the component or the matter is derived and the density is approximately the value of expected of the matter, and in the spatial location of the matter, then not only the density may be used for accurate determination of the density of the matter, or the material or the component of interest, it may also be used to identify the matter, or the material or the component. The thickness of the component may be derived as well if it is not known already along the third axis in some cases. For example, if one or more voxels are of the similar density, the thickness of the material may be derived by adding the dimensions of voxels sharing similar density values along the dimension in the z direction or third axis and or dimension of the VOI to derive the true thickness of the matter or substance.

In one configuration, conventionally, generally the interface region of the two materials or two tissues may be resolved by increasing the resolution of CT measurement to have fine definition along the z. However here is disclosed a method where with low radiation, higher speed, low resolution tomography of selected regions may be used to achieve similar or better results.

In one configuration, low resolution image or low resolution tomography of selected regions of one or more within a region of interest, or the entire region of interest, combined with density measurement, and or spectral imaging method to derive high resolution measurement at the region where two materials meet, for example between bone and soft tissue. Low resolution, typically for example, is described as having lesser resolution than a typical CT along the third axis, or third dimension,

In one configuration, If the material decomposition is done in 2D configuration without tomographic reconstruction, or in line projection in one pixel or small number of pixel to allow the attenuation value of one component or composite material or a material to be derived on a pixel basis, , or the total attenuation value or radiographic density of the material or the component or the composite material or substance may be derived then the thickness of the material, or the component or the composite material may be derived based on the density and or optical and or radiographic density measurement from the low resolution tomographic imaging method.

In one configuration, segmentation is performed based on the material decomposition results, as one or more substances may exist in one segment and or such a segment may be comprised of combination of substances, in some cases, with an approximate ratio between the substances, and or with a range of ratios between two or more substances. For example, substance 1: substance : 2 = 0.5 to 1, or substance 1: substance 2 : substance 3 = 0.5 to 1: 1.2 to 3 meaning substance 1 to substance 2 ratio is between 0.5 to 1 and substance 2 to substance 3 ratio is between 1.2 to 3. In one configuration, thickness measurement of a particular material may be derived from density measurement from a tomographic method combined with at least a dual or multiple energy measurements and material decomposition method.

In one configuration, Segmentation or separation of tissues may be derived with low resolution low projection tomography with less radiation and faster speed to achieve equivalent or better result than high resolution CT or tomography method.

In one configuration, typically in conventional CT, segmentation is done after image reconstruction of the entire VOI. In the present disclosure, the segmentation may be done on a normalized pixel basis. The entire VOI does not need to be reconstructed, only selected region can be reconstructed and in some cases, reconstructed fully to enable segmentation. Spatial position of the segmented tissue or thickness of segmented sections along a beam path, for examples if there are more than one sections of the same tissues along the beam path, can be derived after tomographic reconstruction.

In prior art, Density measurements and or relative density information may be measured in qCT or densitometer using linear detectors such as in DXA. However, the exact density of the substance and composite substances and or tissue may not be accurately measured due to 1) thickness variation of the VOI along each beam path, which affects the radiodensity or optical density derived from the measurements. 2) qCT has high noise and or scatter interference therefore absolute and or density value is typically not easily derived from the CT measurements although variation and change of the density may be derived over time. 3) typically linear detector based measurements are believed not to be as accurate as qCT. And 4) both modalities are slow.

In one configuration, due to the inverse energy response system established for derivation of density information and measurements at dual or multiple energy levels, the absolute density values can therefore be obtained. For instance, It is to be expected that method using tomographic imaging method in the present disclosure and or in the aforementioned PCTs are more accurate than or at least equivalent traditional CT. In addition, regardless of patient size, the density values derived may be more accurate than prior CT and DXA methods.

And the present densitometer is faster than qCT and or DXA where the patient has to be scanned across the spine. In one configuration, segmentation and or separation of bone or soft tissue or calcification regions, or microcalcification regions, and or separation of implant or catheters and or foreign objects or surgical probes, biopsy probes and surgical tools, from the background, in a beam path, or 2D image measured by a 2D detector as well in space, such as multiple dimension or approximately complete tomography, in 3D, may be achieved by using number of projections in the range of less than between 1/100* to 1/1000* projection measurements and or less than 1/1000* or less than 1/100* or less than 1/50*, or 1/40*, or 1/30*, or 1/20*, or 1/10 th or less than 1/5* or anything in between those levels, compared to the projections numbers of a typical CT for similar or equivalent or better results in resolving regions with two or more matters or for separating different tissues or components or materials at the interface regions. The number of projections may be dependent upon or quantitatively related to the size of the material or the size of component along the z, Cz, and or the desired resolution to achieve desired density measurements along the third dimension of the VOI, which is typically parallel the center axis between the x ray source and the detector.

In one configuration, the segmentation and or material decomposition may be done on a normalized pixel by pixel basis.

In one configuration, density, optical density or relative density, measurement and or derivation and or linear attenuation coefficient value of a unit or units belonging to and contained in a component, or subunit or subunits of a unit contained in a component or substance may be applied to all of its volume if the substance or the component is relatively homogenous and slow varying.

Especially for certain applications, such as tracking applications, the density derived for a small dimension or volume can be interpolated or applied to the rest of the approximately same substance, or material or composites.

Establishment of Energy Response Function System at near or approximately the same thickness level as for imaged subject.

Due to the effect of scatter on the measurements, SNR, and or due to thickness of certain samples, the exposure level below detector saturation level may not be sufficient to quantitatively or effectively measure a thickness sample. For example, not enough photons are emitted to reach the detector to describe variability of different thick samples. In this case, the establishment of energy response function system by using interpolation plot, may require data points to be measured at the thickness similar to the VOI. At least one or at least two or more data points measured at thickness level of the known substances or combination of known substance similar to the thickness of the VOI.

In one configuration, the thickness of the VOI is measured by the user, or by a sensor and or given and or predetermined. The inversion of the energy response function from spectral measurements which has a dependence of thickness value of VOI and energy response function system established for the approximate thickness level and or within a certain thickness level of VOI. The inversion generates at least one image of at least one substance within VOI.

In one configuration, a phantom comprised of similar materials with regions of varied densities of each material and or combination of materials or substances, in some cases, with varied feature sizes, are placed in the illumination beam path of VOI between the source and the detector.

In 2D spectral imaging and or material decomposition measurements using dual or multiple energies, material decomposition, the separation of tissues may be performed using inverse energy response function system, the separation of material in phantom may serve as a quality verification tool to ensure that the proper separation has been completed given that the density and material composition in the phantom is known. The attenuation value of the phantom material and or each substances separated from the background can be subtracted from the material decomposed image to give rise to the measurement or data containing only relevant information to VOI.

Variation of the present value and to the value measured some other time may be compared to monitor changes in VOI.

Energy response function system established by the interpolated plot based on data points generated by measurements, image processed data and or reconstructed data of the phantom within a volumetric unit, can be used to derive the approximate density value and or linear attenuation coefficient and or the relative density value of voxels within VOI using inversion of the energy response function system.

Averaging of Primary Signals to derive low noise images

In one configuration, in order to avoid saturation of detector due to scatter, the input intensity of the x ray source may be adjusted to be small enough to avoid saturation, but if there is a thick VOI, the signal measured may not be accurate enough due to photon starvation or quantum photon randomness. Multiple exposures may be done to increase exposure level to collect enough photons for better representation of the imaged results. The resultant measurements can be stacked together. The projection measurements or its derivatives such as primary images or scatter images or derived attenuation values may be added together, and in some cases, averaged to generate an image with average value of at least two images, which can be used down the line for one or more of the following methods: the resultant image is to be analyzed and or processed such as primary images after scatter removal and or to be used as the source of data for reconstruction.

In one configuration, image settings which generates X ray input can be set at approximately just below those which generates x ray measurement level at approximately just below the saturation level of the detector, without the VOI in between the x ray detector and source.

In one configuration, x ray imaging setting to generate x ray input can be set so that the x ray irradiated can be used to generate image intensity less than the saturation level.

Exposure level for Generating Sufficient Primary X-ray Measurement for Imaging and Quantitative Analysis such as spectral imaging and tomographic imaging

The exposure level will need to be at a level which sufficiently produce primary x rays so that the input x ray radiation entering the VOI, cause two major photon events, 1) scatter x ray, 2) Primary x ray will produce sufficient primary x rays to be measured on the detector so that there basically is no photon starvation, but also enough photons are collected to describe the accurate attenuation value of VOI.

32 bit or more dynamic range may be sufficient in which exposure level of the one frame radiation level at the same or below the detector saturation level may be sufficient to produce primary x ray signals coming out of VOI to have sufficient information for quantity analysis for AI, or density measurement and other statistically meaningful data.

One method is to take a number of measurements of the sample, each with increasing exposure time, measure primary x ray signal and scatter signal

Using a thin beam. At certain point, with increasing of input signal, there is corresponding ratio of scatter level and corresponding primary x ray level for a specific VOI. To derive the ratio of the two, may be critical for derivation of input x ray efficiency of generating primary x rays to be detected on the detector.

To derive the true input primary which produces the primary

To reduce the effect of scatter on SNR or on the final presentation, especially for samples which are highly scattering and or sample regions which produces measurements with high percentage of scatter.

In one configuration, x ray sources with settings of varied intensity or a field emitter based x ray source may be used to modulate x ray intensity for two or more selected regions of interest, based on the thickness of the region. Each region may be illuminated with modulated intensity at different times.

The appropriate radiation level is selected for calculation of input primary which produces enough photons to pass through VOI and to generate detected signals higher than the noise level of the detector and producing consistent output signals for the same VOI.

The input x ray radiation may needed to be much higher than the saturation level of the detector if the imaged subject is thick. The amount of radiation or input x ray intensity may be adjusted based on thickness measurement, for example by an optical sensor and or a first x ray image of the region of interest.

Material decomposition Improved

In prior methods, an interpolated plot inverse response function system as established may be used for multiple energy or dual energy for material decomposition

In addition, distributed rare substances, or at least one additional substance may be differentiated based on material decomposition of at least two substances using at least two energies. This may be done by identifying collocated regions of the same substances, extract data from the collocated regions to characterize the additional substance.

This can be further extended to substance which are spatially distributed significantly in various area of volume of interest.

For example, if two or more substances collocate in the same volumetric unit, whose attenuation value and or density and or linear attenuation coefficient can be derived from 3D reconstruction. In one configuration, when 3D tomography is performed, such a substance may be identified, therefore attenuation value pertaining to the additional substance within the approximately same volumetric unit may be extracted without using a third energy if 3D tomography measurements may be used to assess the density or attenuation value of the voxel containing only of the additional substance, for example, by subtracting the values ( in density, attenuation value and or linear attenuation coefficient ) contributed by material decomposed substances from the total density value and or linear attenuation coefficient and or the attenuation value.

In one configuration, the density information of at least one of the substances have been measured and or given. Therefore number of energy levels used to interrogate the voxel or volumetric unit containing two or more substances can be one level or two levels less than number of substances.

DETAILS OF DRAWINGS

Fig. 1. Illustrates the use of a Gap strip gsl and gs 2, in a tomography system for covering up the track of the mover. It generally comprised of soft material. A conveyer belt like mechanism cycles the cover so that there is limited or none wrinkled look, but at the same time be able to cover the entire opening and the part or most or complete part of the track where the payload and translation stage moves hardware such as a x ray tube, collimator and sensors are moved to and from below the structure. The opening faces the user

Fig. 2. Flow diagram of imaging reconstruction for mapping of 3D and or spatial distribution of a substance in a volume of interest in an object.

Fig. 3 is a configuration of the imaging device in the present disclosure or one possible orientation of the imaging device relative to the room or the user/patient

Multiple purpose hanging from the ceiling. Or having a motorized arm with a base. Or with or without hardware modification, orient with 90 degrees or with the ends of motor or the patient facing the floor and bolted on to the floor. Use of x ray tomography device or x ray imaging device means to rotate or reorientate, for example with a motorized arm or with a ceiling connector.

Various fixtures such as for support of skull, head may be inserted in the middle.

In one configuration, fixtures for support for mammography, may be inserted in the middle.

X-ray tube and detector may be placed close together with the pillar or the supporting arm as in Fig 2 may be adjustable in height.

Alternatively, a rail may be installed on the ceiling and a motor and a x ray tube assembly may be attached.

And or the ceiling attachment may be connected to the pillar through a motorized arm to move or orient the a portion of or the whole structure.

At least one detector can be either in the lower gantry, and at least one source in the upper gantry or at least one detector in upper gantry and source in lower gantry respectively. And in this configuration, can be rotated accordingly.

Accessory hardware mechanical means or fixture many be used to stalized or attach the system to the ceiling and or side wall of a room or ceiling or internal side of a mobile device ceiling or side walls for imaging applications

In configuration, the pillar is on the ground, the source and or detector are moved up and down.

Generator and other accessories, such as electronics may be placed in the base structure 106.

Fig. 4. One configuration of placement of Beam blocker array plate 100 sandwiched in between two detectors, detector 22 and detector 29 in an X-ray Imaging Device of the present disclosure.

Antiscatter grid Grid 1, may be movable, may be optional, it may be placed between the patient and beam blocker array 100 or between the patient and the x ray source.

Antiscatter Gridl, may be placed between detector 29 and the object 2.

In one configuration, there is just one detector, detector, without detector 29. The antiscatter grid Grid 1 is placed between the patient and the x ray source or between the patient and the beam blocker array. Measurement of patient table or object support table and the cover surface is taken into account and calculated in calibration and or in imaging procedures.

Data and measurement effects of the table and object support table and or the cover surface for the detector gantry can be removed in image processing.

Fig. 5. In one configuration, in the image acquisition and reconstruction method for multiple dimensional and 3D imaging, only selected regions in an xy full view is selected for tomographic image acquisition and reconstruction.

Along a third dimension, Z coordinate of 2A, a portion of the complete z coordinate display, for example, with annotation, or digital density information, or z coordinate digital reading, or presentation of identified material, or varied visual presentation in color or gradient of color, or selective digital display of analysis results, extracted point to 7D data or image presentation or selection of region of interest for selective reconstruction and or User Interface presentation.

In one configuration, to enable better presentation of voxels embedded in each layer along the z direction, the method described above and an example is used for fast image and information presentation.

Time tracked information display may be displayed based on selected axis or plane or 3D element of interest or may be displayed based on selected component or substance. With at least a lower resolution background information displayed or reconstructed selectively or displayed.

Selecting of a point or a region of VOI, can be done by a computer input device, a joy stick or mouse, or touch pad, or via text through user interface. Or by filter process for density and other parameters available for each voxel and or component of interest or composite material or a micro or macro environment for processing or reconstruction or analysis and or presentation

DETAILED SPECIFICATION

In tomographic imaging systems, .uTomo or nMatrix, n²Matrix or up to n⁶Matrix method, where x ray source move in one axis or linearly, or in two dimension or up to 6 dimensions such as defined as xyz, pitch, yaw and roll, x ray images can be reconstructed in 7 dimensions, the 7^th dimension being time.

In a customizable personalized CT system - m3 -personalized 3D imaging system based on imaging and tomography systems described here and in aforementioned PCTs, in PCTs aforementioned, where x ray emitting position moves in at least one or two dimensions relative to the volume of interest in an object and or the detector, the number of projections measured from varied xray emitting position relative to ROI and or step size between relative x ray emitting positions relative to VOI can be related quantitatively to the resolution of reconstructed 3D image along the approximately third dimension. The third dimension can be approximately perpendicular to the detector plane and or virtual plane for projection images, transposed from the xy plane where the measurement of detector takes place.

In one configuration of image acquisition for 3D tomographic image, in a minimized step size of approximately Xc to provide projection measurements of VOI to achieve approximately resolution Xc along the z. The movement is only less than 2 degrees or 1 degree or 5 degrees or less than 3cm squared or less than 5 cm squared or 9cm squared or 25 cm squared in a 2D dimension or 1cm cubed or 2cm cubed in order to approximately reconstruct the 3D image of the VOI and or anything in between.

Various combination of detectors and or x ray tubes or x ray sources may be used to collect data, reconstruct and interrogate voxels within volume of interest to generate additional parameters or data for characterization, or quantification, or identification and or later for presentation.

In one configuration, if moving linearly or one dimension, the total distance traveled may be the same as the total thickness of the ROI to be resolved, or the total distance traveled by the source or the ROI may be the same as the total thickness of component or individual substances or unknown regions to be resolved.

The thickness measurement may be defined as the thickness along the axis which is parallel to the center axis connecting the x ray source emitting position and the detector.

In one configuration, such a multiple dimensional measurement system may be used for material decomposition to separate at least one substance and or for density measurements, with spatial resolution and or with time resolution. In one configuration, spectral imaging may be used for improved material decomposition and or better and or more accurate density measurements, this may be achieved by using dual or multiple energy x ray imaging combined with tomographic imaging described.

In one configuration, such an apparatus and method of measurements and tomographic imaging system may be combined with another imaging system configuration, for example, existing system configurations such as a ceiling mounted x ray system and or O-arm or O ring and or helical imaging geometry, to provide ease of access to a part or the entire VOI or field of view or a varied orientation of imaging source and detector pair, and better visibility and or flexibility of spatial configuration to provide better imaging angle. Measurements or datapoints from any x ray position may be used in tomographic reconstruction and or spectral imaging for improved material decomposition and or better density measurements.

In one configuration, the degrees described here is the total angle describing the relative movement of x ray emitting position to the ROI, for example, the center axis connecting a x ray source emitting position to the detector, for example relative to the center of the ROI, or passing through the center of ROI, relative to the center axis of ROI which is perpendicular to the detector.

In one configuration of the imaging methods, such as moving x ray emission position for projection measurement of VOI in a least one direction in a 6D space, ( X Y Z, pitch yaw roll), relative to VOI, the emitting position may move, for example linearly or rotate or both. in one figuration, the distance between each projection may be Xc, if Xc is approximately resolution desired by the imaging, and the total projection number is approximately equivalent to thickness divided by Xc in order to reconstruct a 3D image which has approximately Xc resolution along the Z or the third axis perpendicular to an 2D projection image or virtual image plane or the detector plane.

The method and Apparatus of Moving X-ray Source Position or X-ray Emitting Position

In one configuration, in multiple dimensional imaging and or large field of view imaging, the following methods may be used to modulate the position of the x ray radiation for one or more x ray measurement or x ray projections.

To move the emitting position of each projection, or emitting position of the x ray radiation relative to the VOI, the following methods may be used The source has a number of stationary emitting positions

The emitting position may be moved by electromagnetic means

The emitting position or the x ray tube, may be moved by a mover, energy driven.

The emitting position of x ray source, may be moved by at least one electrostatic means

The emitting position of x ray radiation, may be moved by at least one electron beam deflector or electron beam steerer

The emitting position of x ray radiation, may be moved by at least one x ray beam steerer

The emitting position of x ray radiation may be adjusted by electronic means such as in a field emitter x ray source, by turning on and off regions of field emitters, to adjust for the position of the x ray emission.

Optical or laser or ultrasound energy based electron beam or x ray beam steerer.

Or the emitting position may be moved by combining at least two of the above methods.

Combining two methods or using two movers or steerers may remove constraints of each method or moving or steering device which may impact image quality or stability of image acquisition system. For example, To allow the area of x ray irradiation to be expanded or reduced to adjusted in a larger range at the same time, allow precision to be achieved regarding x ray emission spatial position. Or such combinations may allow stability and improve image quality by continuous operation at one setting of one device while using another device to accommodate and achieve the desired setting of image acquisition.

In one configuration, such combination may allow the adjustment of field of view while image acquisition to be more flexible and finer tuned. For example, One mover may provide image acquisition at larger than Xc distance between x ray irradiation positions, but a second mover or steerer may adjust the x ray irradiation position at the position needed to achieve the desired Xc for a selected region of VOI, therefore reduce number of total projections

In one configuration, the method of having x ray radiation from more than two positions may be accomplished by

Having one mover moving at a steady speed, and another mover to adjust the electron beam target position on the anode, For example, a mover such as an mechanical mover to move the x ray source or the anode target or the electron beam emitting location, while using electron beam deflector to move the electron beam

The electron deflector may keep the electron beam at one position while the mover moves the x ray source or at least anode target at approximately acceleration or velocity. So that the x ray radiation may be made to be emitting from approximately one or more emitting position.

In one configuration, x ray may be irradiation from one spatial position relative to the VOI, as the x ray tube moves with a mover, the electron beam steerer may be able to keep the x ray irradiating from the said position as the x ray tube moves.

The result may be that the x ray may be irradiated from the said position longer and have longer exposure time as x ray tube or the anode moves, and or as the cathode moves.

In one configuration, the x ray emitting position relative to the VOI may be adjusted for increasing or decreasing exposure time or x ray irradiation time at the said position by at least combination of two movers, or combination of at least two different movers and or electron beam steerers.

In one configuration, the x ray emitting position may be tuned by an electron beam steerer or x ray beam steerer.

In one configuration, other Scatter removal methods may be used to remove scatter other than beam absorber particle or beam selector methods.

In one configuration, for example, using primary modulator or time of flight source and or detector are used for scatter separation from the primary image.

In one configuration, for example, if the x ray emitting position is moved to a position which is close to a desired spatial location, the same or a different deflector or a electron beam deflector or a mover or x ray beam steer, or a mover may be able to move to approximately the desired spatial position relative to the VOI, or at least closer to the said location.

In one configuration, if a mechanical mover only moves at certain step size, limiting spatial position where the x ray irradiation position may be at, a second mover, or electron steer or x ray steer may be used to move to the additional positions. For example, if a mechanical mover can only move in 33 or 44 um intervals instead of 40 um, the x ray steerer or the electron beam steerer may be able to adjust the position to 40um step size as desired by the application.

In one configuration, for example, as one mechanical mover moves the x ray cathode or x ray emitting position, or x ray away from a spatial location for x ray emission, a deflector may be used to steer the electron beam so that the x ray beam irradiation may be able to stay at the said position.

In one configuration, the second steering or moving system or method may allow for precise adjustment of x ray emission location and or precise adjustment of exposure time at the said location or overall exposure time.

In one configuration, for example, x ray may be continuous irradiated, the electron beam steerer may steer the x ray irradiation or electron beam to a different location such as an x ray attenuator so that the VOI is not irradiated even if the x ray generator is on and continue to generate electron beams. For example, on the anode target there is a region which only absorbs electron beam or deflects the beam to a different location, x ray generated but does not go through the path illuminating the VOI.

In one configuration, X ray steerer or electron beam steerer or mover may allow the adjustment of on and off illumination on the VOI as x ray beam or electron beam continues to emit. This allows adjustment of the precise dosage level or exposure level on the VOI separated from the x ray emission or electron emission state, thereby allow the flexibility, and fine tuning of the device previously not possible.

In one configuration, for example x ray emission may be always on or electron beam generation may be on continuously while x ray tube is in motion and as soon as the x ray tube is in position or close to the position desired, the x ray beam generated irradiates the VOI. In another words, VOI is being selectively illuminated from a desired spatial position or spatial positions using combination of methods as the x ray emission or electron beam emission continuously to be on.

Number of projections for imaging processing and tomography reconstruction & Missing Data Replacement

In one configuration, the least total number of projections and or the least number of x ray emitting positions are quantitative related to at least H max and or Xc , in some cases,

Hmax / Xc where Xc is approximately resolution desired in the z direction or along the thickness direction, or the third dimension perpendicular to approximately the projection measurement plane on the detector and or reconstruction projection image plane or virtual projection image plane, where Hmax the thickness or maximum thickness of VOI in the field of view or VOI.

In one configuration, the position between x ray irradiation position relative to VOI can be adjusted to generate 3D reconstructed models with approximately the resolution desired in the third axis.

In one configuration, if the distance between the most adjacent x ray irradiation positions is less than the resolution desired, more number of projections may be required.

In one configuration, if there are other factors which affects number of data points derived from the x ray projection measurements, such as x ray optics and other means blocking a certain portion of x ray passing the VOI or the x ray exiting VOI , reaching the detector or when x ray is collected by the regions in between x ray detector cells and or the projection lands in regions of x ray pixel which the signal sensitivity is significant different or less than the active region of the x ray cell, such as middle of the cell. Image data required for multiple dimensional and or tomographic image reconstruction using the aforementioned method may be lost due to for example, geometry configuration for image measurements, therefore, additional projections from the same or different spatial location, of approximately the same or similar regions of VOI, may be measured additionally to establish additional linear equations or additional measurements and or additional datapoints to make up for the data lost in order for an image reconstruction or a complete 3D or spectral imaging processing for VOI. .

In one configuration, to make up missing data, detector or detectors may be moved or the VOI may be moved relative to the x ray source, so that previous missing data from the projection path signal not detector or omitted in reconstruction algorithms may be made up.

The beam blocker array may be moved to at least one different position or x ray imaging geometry configuration may be varied in order to provide the measurements to replace the missing data. In one configuration, spectral measurements improve material decomposition and or 3D reconstruction by providing improved estimate of the density of at least one substance in the VOI. Scatter is removed in the projected image by using spatial domain scatter removal method by using Beam Stopper arrays ( or beam blocker arrays) or beam selector arrays, both may be movable and or both may be sandwiched in between two detectors to achieve Scatter to primary ration at less than 1% or less than 5%. Low scatter projection primary measurements of VOI are needed in some instances to measure density and other quantifiable properties of VOI and the substances within.

In some instances, two or more detectors and corresponding x ray emitting positions or x ray tubes may be used, either the set of detector and x ray emitting positions may move independently with each other, or the set of x ray detector and x ray tube are moving relatively different from the other sets. Due to the projection geometry calculation and spatial matrix setup, measurements from the set of detector and source are merged with that of the others and reconstruction is based on the data measurement from a variety of settings for spectral measurements, tomography measurements, and image processing of VOI may be performed on the combined measurement dataset collocated on a pixel by pixel basis and or voxel by voxel basis.

In one configuration, correlating the measurements from two or more detectors on pixels by pixel basis based on voxel spatial location in the VOI relative to the x ray emitting position and detector pixel locations receiving the projected signal from the voxel, derived from spatial system matrix, reconstruction algorithms may be based on the data derived or measurements from two or more detectors, moved by the same or different movers, or emitting position steered by different means.

In one configuration, for example, a spectral imaging of a ROI selected from a object, due to the 3D tomography, may be guided by the calculation of projected geometry based on the x ray tomographic image, to align the x ray emitting position at the center axis of detector and cone beam to be directly above the ROI. The reconstruction algorithms of the spectral measurements if it is desired to be multiple dimensional use measurements for the ROI from the 3D tomographic measurements of the prior measurements, in the reconstruction algorithms and method as part of the data input, for either deterministic method or analytical method. And spectral measurements of an object which guides the alignment of subsequent x ray emitting position and detector alignment for the measurements used to reconstruct a 3D image, may be used in the 3D reconstruction. And distributed 3D measurements of one or more ROI regions of an object as well as background image of the object in one or more ROIs may be used as a geometric and spatial reference for derivation of positioning of a selected internal VOI. For example, in dynamic imaging, characteristics of fluidic dynamics or cardiac movement may be derived in a 3D reconstruction assisted with measurements of the region around it but custom image acquisition and reconstruction of internal VOI relative to the background or a reference ROI may save time in image acquisition and reconstruction and reduce radiation exposure.

In one configuration, the present measurements and system configuration described in this disclosure and aforementioned PCTs allow for the incorporation of system configurations of multiple hardware which may be the same or different from each other in terms of a number critical parameters such as pixel size, image acquisition speed, spectral sensitivity and measurements from one or multiple set of hardware and mix match of detectors and x ray sources. While the principle of the reconstruction algorithms used for CT or tomosynthesis system may be retained, such as ART, monte carlo simulation, density analysis, variations and adaptation of such methods may be used, the incorporation of multiple detectors, and or their corresponding x ray sources or emitting positions may be customized to be used on a case by case basis and therefore the need to reconstruct or piece together necessary information to reach an accurate assessment of a voxel or an ROI, in an application specific manner. For example, measured data from a low resolution detector may be used for that of high resolution tomography. A different or the same x ray source may travel in the same 2d area for example, the first positions of the first x ray source traveled, but in smaller step size, and the first position where the first x ray source travel may not be revisited again as the measurements have already been done.

In one configuration, the total x ray beam emitting area or volume and x ray emitting positions may be a combination of step sizes, distances between projection emitting locations. The x ray emitting sequence may be implemented to be one acquisition process, so all combination of step sizes are traveled and emitted from or different step sizes can be implemented separately. In reconstruction, there maybe two image acquisition process in sequence, one is from the first process and the other is from the image acquired for the second x ray source.

The measured data from both detectors are used to reconstruct a multiple dimensional or 3D image if necessary. Due to motion artifacts of the object, there may be slight aberrations and artifacts but some of measurements may be useful. Motion artifacts can be removed using post processing methods. Selected regions where the measurements from both detectors are combined to perform reconstruct motion artifacts corrected and processed image may be used.

In one configuration, the image reconstruction may be done separately as well and to compare and evaluate ROI from both type of constructions may bring insight to ROI.

Radiation Exposure

In one configuration, to reduce radiation dosage received on a patient and reduce motion artifacts, the method is to minimize measurement, for example, in number of measurements, such as minimize the number of projected path in ROI, minimize each beam size, or total field of view of the projection volume, and as well as number of images projections taken, which can be down to one or two projection image, and minimize number of emitting positions, for example, in some cases, only one emitting position is sufficient, and the utilization of structured illumination, x ray thin beam with distributed locations and or only one x ray thin beam measurements needed to track a component or substance measurement in 6D spatial volume.

Prior art, CT image is taken. And a sparsity measurement method is predetermined, only selected number of projections images out of the total number of projections used in the original reconstruction are made to reconstruct a sparse reconstruction. Sufficient project images are needed to reconstruct a sparse 3D image.

In prior art, dual energy measurements are done, however, dual energy estimation is with scatter, not accurate, or done with digital subtraction method, or using database correlating the measurements with density or attenuation value which is not sufficiently accurate due to multiple energy or broad band spectrum of the source.

The present disclosure describes a system which allows both CT and densitometer and material decomposition method. This is different from CT or densitometer. One Configuration of 3D reconstruction may include the following:

In one configuration, Surgical guidance of 6D surgical path planning based on 3D or 7D ( 6D with time as the 7^th dimension) gated images taken, real time 3D vessel map or 6D surgical path, or simulated path to guide surgeon or robot to navigate.

Typically bone registration data , or tissue surface data is used for determination marker spatial relationship relative to a substance or component of interest. In one configuration, any two or three points within the tissue of the interest, or substance of the interest of volume of interest may be used as a reference point for navigation purposes. The distance and relative position between the tissue of interest or clot and or catheter probe may be determined by specific spatial dimension and orientation distance between those points and at least one point on another component. The direct link between these points simplifies the navigation process as without reconstruction, knowing the approximate volume distribution and reconstruction of the component is sufficient to orient the components relative to each other. Or such reconstruction may be done once for one component and such dimensions are preexisting. As long as the relationship between dimensions or spatial distribution between the two components can be correslated to these selected points, it is sufficient to track these positions and approximate the component orientation due to preexisting data of the component, instead of the reconstruct the entire component.

Such a configuration may reduces the speed and or optimize performance of the acquisition needed for image acquisition and reconstruction. Each point described may be one voxel, or it could be grouped voxel or it could be a number of voxels with a distributed spatial pattern, and such a point could be a column of voxels from the top layer of vol to the bottom layer, or it could be embedded within the VOI.

For example, in tracking purposes or monitoring, such a method may be used reduce speed by reducing image acquisition time and or time required for reconstruction.

In one configuration, surface points may be determined from the reconstructed image.

In one configuration An approximately volumetric distribution in any approximate shape may be used. And any point in the volume of interest of the component may be used as a reference or any point with a relative fixed spatial position to the volume of interest of component may be used. In the blood vessel road map, distinct road map may be derived based on the relative relationship between the catheter probe, center of vessel, and the diameter of the vessel may be used to calculate possible path to determine if the diameter is sufficient for the catheter to pass through.

In one configuration, 3 D reconstruction is based on selective detector regions.

In one configuration, 3D reconstruction is based on distributed small regions S of VOI projection measurement regions on the detector.

For example such a region S may be created by a collimator, with holes, where the x ray beam can pass through, such a collimator can be placed between the x ray tube and the patient or between the patient and the detector.

Such a region S may be selected from the total projection image, either randomly or by a criteria. At least two of such regions can be reconstructed sequentially or parallel, to build a time dependent 3D image. At least one voxel column may be projected on to the the detector or at least measurement on one pixel in the S region can be used for 3D reconstruction.

The benefit of such a method is to be able to select and choose each beam path or each detector region using digital program , without having to have a preset path. Therefore the size of voxel cylinder and its spatial location may be adjusted continuously throughout the monitoring and tracking process. This leaves flexibility and speed and accuracy.

In one configuration, at least one portion and or at least one component or one part of the catheter is comprising microstructure, of microstructure, and in some examples of certain frequency. Varied portion or various component of the catheter may be differentiated by the frequency of the microstructure in x ray measurements from other portions of the VOI. Such microstructure may serve as a marker or barcode for a portion of, or a component of or the whole selected VOI. .

The benefit of such a design is for rapid identification of spatial location and or orientation of the catheter or a portion of the catheter relative to other markers and or other portion of the catheter and or compared to the background and or relative to a selected VOI and subregion of VOI.

The rapid identification of the portion of the catheter may allow selective reconstruction of at least one column of selected VOI or catheter to be reconstructed, instead of reconstruction of the entire FOV with the projection image of VOI. This may also allow optimization of selection to ensure faster position and feedback and steering and or navigation of the catheter and or at least one portion of the catheter.

In one configuration, at least one portion of the beam blocker may comprised of microstructure of certain frequency. Such a microstructure may be a bar bode or marker for a particular beam blocker to differentiate it from the others and or simply to position such beam blocker relative to the background or a marker within the FOV and or VOI.

In one configuration, at least one or more portion of beam blocker comprising microstructure of certain frequency, the x ray tube and detector may be positioned or aligned spatially using at least one or more such beam blocker. Each beam blocker may be the same or different from each other. The size of beam blocker may be from sub millimeter to 10 cm in diameter. In some cases, it can be sphere shaped to ensure consistent measurements as x ray emitting moves relative to the VOI and beam blocker array.

In one configuration, Fourier Transform is used to extract frequency element of x ray measurement for identification and separation.

Beam blocker mage or beam absorber particle image and projection measurement of beam blocker or beam absorber can be identified and or replaced and or manipulated in the frequency domain.

3D reconstruction can use at least one partition method for reconstruction.

3D reconstruction can use at least one partition method for reconstruction and such partition can be iterative.

In one configuration, first image is reconstructed as a complete image for tracking. The present disclosure presents a method where without the first image, the VOI and internal components are diagnosed and tracked without having to wait for high resolution image from the beginning. Sequential or 3D images of VOL or selected regions of VOI taken at different time may be used to reconstruct a high resolution 3D image of VOI. of the same VOI,

Reconstruction from distributed location of the detector or low resolution 3D image may be taken as the first 3D image.

And at least one additional 3D image of the same or different resolution is reconstructed at a different time, At least two 3D image acquired or reconstructed at different or the same time, may provide higher resolution 3D image for the VOI and at the same time provide tracking information of a selected VOI region or a component inside.

Such selection of distrubted region or field of view may be done digitally or using a hardware such as a collimator.

For example, low resolution CT perfusion images may be used to reconstruct a high resolution CTA image by combining voxel information from sequential CT images.

The benefit of doing so, for example is to speed up time to treatment by combining at least two procedures into one. For example, CTP with CTA so that time to skin puncture or time to recanalization may be minimized and the operation time can be minimized.

For example, for a VOI 64 x 64 x 64 in volume, the size of small voxel column can be as small as 1 x 1, and the total number of partition can be 64 x 64.

Or the small voxel column can be 2 x 2 x 64, or 2 x 1 x 64, the number of partitioned voxel column therefore 1024.

Or partition can be looped at least two times or be iterative, for example a secondary column partition of 2 x 2 x 64 may be used to partition each 16 x 16 x 64, and 16 of l6 x l6 x 64 partition may be combined to a final 64 x 64 x 64 volume.

The benefit of the looped or iterative approach is that the user or the digital program can determine if a certain sub column needs to be reconstructed, or prioritized so that the speed of reconstruction is faster for some regions than others based on the requirement of the user, or the application. Criterial can be set ahead of time for making decisions during the reconstruction process or during the image acquisition process.

The benefit of such partition is that if the number of voxels need to be resolved in the z direction is large, then two or more partition process may be utilized to reduce system matrix for faster calculation and improvement of calculation condition.

The partitioned volumes may be reconstructed from measurements at different times or at the same image acquisition session.

The volume of predicable change may be marked as different at each time interval, the rest may be resolved or resolved with highest resolution over time. The guidance is optimization of both image acquisition and reconstruction and radiation level of the same or different tissue.

If Non Contrast CT is possible prior to CTP, significant amount of image acquisition and reconstruction may be eliminated as it would be clear where the LVO might be, regions outside of the LVO may be spared from high resolution imaging and regions close to LVO may be reconstructed with higher resolution.

Predetermined x ray emitting position for each projection image, and combine all of the positions to give rise to high resolution image of the VOL Selective reconstruction or image acquisition at certain set of position to determine dynamic characteristics of one or two component, for example, the catheter movement or addition of a component such as insertion of catheter or addition of contrast agents.

Determine the volume distribution where the dynamic state may take place or modification may take place prior to imaging, for example, estimate the density or possible changes or spatial location of such volume distribution over time, and predetermine x ray imaging emitting positions prior to image acquisition and reconstruction region. Or certain information and decision are derived in real time by a preset criterial or with AI.

Alternatively, the volume regions of VOI which are static over a period of time during dynamic changes of one or more regions of the VOI, or one or more component, the x ray tube imaging position for each projection may be planned so that the total area and or the total projection and or the distance between adjacent positions may be used to reconstruct a higher resolution 3D image.

For example, if image reconstruction using at least every other or every third x ray tube emitting position during reconstruction, and reconstruct with the alternate set of x ray emitting positions, or a third set of x ray emitting positions, or more, the reconstructed images can be two low resolution x ray image sufficient describing the VOI and a high resolution x ray from the total x ray emitting position. The low resolution may be used for tracking and the high resolution may be used for characteristics of static region.

There are cases, where high resolution image may not be derived for example, if a region is not dynamic but slow changing at a predicable rate, for example the parenchyma region, immediate outside the hemorrhaged volume, only x ray projection images within a selected time window can be used for reconstruction for that region.

Therefore the location of x ray emitting positions for each reconstruction and the time window where the projection image from these x ray emitting positions can be used can be optimized for accuracy and precision.

Spatial distribution of selected VOI region for reconstruction and or for image acquisition can be determined prior to image acquisition or during the image acquisition. And the FOV can be determined by selected volume of reconstruction and or in presentation or display.

This method typically can be used in surgical planning.

One configuration of 3D reconstruction may use at least one low resolution 3D reconstruction method

One configuration for 3D reconstruction is the following:

For example, to reconstruct m x n x p where m, n, p are number of voxel layers in x, y, z direction

Reconstruction of smaller number of layers first in the Z direction, or reconstruction with low resolution, smaller number of layers first, for example reconstruct L < P layers.

For example, L =p/2 or p/3 or p/4 or . p/1

If the final resolution desired is Xc, if reconstruct , for example, L = p/4, the resolution in the first reconstruction is p/4 layers, and resolution is Xi = 4Xc in the Z direction.

The distance between most adjacent projection position or emission position of x ray source for low resolution Xi reconstruction is therefore 4Xc.

One of the reasons to reconstruction a low resolution in the Z direction is to reduce ill condition and large matrix problem.

By resolving low resolution 3D reconstruction of the same VOI, additional information or constraints or optimization condition may be placed on the unknow, or addition linear equations may be provided for different voxel combinations. As a result, there could be less solutions or limited solutions for one single unknown voxel or reduced possibility of combinations.

Such low resolution 3D reconstruction may take place at least once prior to the final 3D reconstruction at Xc with P layers.

Such a low resolution 3D reconstruction may be iterative at least once prior to the final 3D reconstruction at Xc with P layers.

In one configuration, the adjustment or location or movement of the emission position and projection image x ray emission position for the complete 3D reconstruction may be preplanned. For example, in the spatial position of x ray source or x ray emitting position for the high resolution 3D reconstruction, where x ray emitting position is Xc distance apart, the spatial location of the x ray emitting position where a projection image originated may be in the same or similar plane or may in the plane approximately parallel to the traveling area of the x ray emitting position of low resolution 3D reconstruction, or such traveling spatial location is in close proximity with each other, the traveling path of the x ray source emitting location for 3D reconstruction for at least low and high resolution 3D reconstruction may be combined. The reason for recombined spatial locations of x ray emitting location may be to shorten traveling time for x ray emitting position if the x ray emitting position to be moved. Another reason could be to limit the number of new unknown voxels outside of VOI to be measured, for example in the region next to VOI, but not within VOI, voxels adjacent or right next to the VOI, may be on the same projection path which include voxels from VOI.

In one configuration, the projection images of the x ray source or x ray emitting positions for high resolution 3D reconstruction are in the same approximate regions of the detector or having similar or approximately same projection volume from x ray emitting positions of projection images used for in low resolution 3D of the VOI.

The Xc, can be approximately less than one pixel on the detector or more than one pixel, the distance between x ray emitting positions to allow reconstruction for both low resolution or high resolution 3D reconstruction may be less one pixel or to multiples of Xc. Xc may be in the dimensions of multiples whole integers of a pixel , or may be in the dimensions of less than one pixel, or may be any where between one pixel to multiple integers multiples of one pixel or Xc may be in between integer multiples of a pixel. In one configuration, In 3D reconstruction, the x ray projection source position may be selected from the total emitting positions based on low resolution or high resolution 3D reconstruction. The projection sequence of x ray emitting positions or the x ray emitting position movement sequence or movement pattern or spatial travel distance may be designed to minimize total x ray acquisition time or x ray electromagnetic steering time or the time required for mover to move the x ray source.

In one configuration, x ray source or x ray emitting position may be of varied intervals, but may have complete set of x ray emitting positions for projections to be collected for 3D reconstruction.

For example, during 3D reconstruction of 3D image with Xc resolution in Z or the third dimension or the axis only those projections from x ray emitting locations which are Xc apart are selected. However, the x ray emitting position may be set with Xc/2 intervals, so that there may be addition projections to be used to for example:

Create new projection path with new combinations of voxels in the projection path to from new linear equations to solve. Such additional projection or linear equations may be used in cases, where there is missing data to be collected for example, if beam blocker blocks a number of primary x rays, additional projections than P or approximately minimal projection numbers and at least minimal number of projection x ray emitting locations may be taken.

Create new projection path to resolve newly introduced unknown voxels due to Create new project path with new combination of voxels in the projection path so that missing data due to detector pixel regions where signals are not read properly, such as between pixels or outside of active regions in a pixel or outside of a region in the pixel where the measurement signal or signal response is most optimized or representative of the pixel signal response. For example, in cases, where 50% or 60% or 67 % of the region inside a pixel may be used to collect most signals in a pixel, the x ray projection lands on regions of the pixel where the signal response of the pixel is significantly different, or less than the center region of the pixel.

To make up data missing due to use of collimator or other x ray optics or x ray system parts or system configuration. Total set of x ray emitting positions for both low resolution and high resolutions and any other additional projection emitting positions , if moved by a mover, may travel through the most efficient or optimized travel path. 3D reconstruction or image processing relevant methods may select a number of projections from selected positions at a time from the total collected projection image or from the projection images from the complete set of x ray emitting positions.

For example, if the resolution desired in the z direction is Xc, if approximately Sc x Xc number of pixels are read and combined or averaged or integrated, when x ray emitting positions are at least Sc x Xc apart, a being the scaler to lower resolution of 3D reconstruction. The resolved scaled Voxel, Vsc, have dimension along z in the dimension of Xa x Xb x Xc x Sc , where Xa, is the resolution along the x axis, Xb, y axis and Xc, z axis. The highest number of Sc is the numbers of units of Xc along the z direction, or P. generally Sc may be between 2 and p. Dimensions of Xc could be between greater than 0 , less than 1 pixel to multiples of pixels, and everything in between.

Resolving voxel reading Vsc comprising Xc x Sc x Xa x Xb will reduce number of unknowns in the volume of interest and provide more linear equations for the same VOI. Resolved voxel value may provide constraints or optimized conditions for resolving voxels with resolution of Xc along.

As the x ray emitting position moving away from the original position or first projection position, for projections used in low resolution image reconstruction, the additional introduced unknowns outside of the VOI may be sufficiently small that extended region of detectors outside of the first projection detecting region is also small such that only small number of pixels in the extended regions of detector are to be read beyond the first detector region measuring the projection image of VOI.

For example, as the x ray source move in the y direction by the distance equivalent to the dimension of one pixel,

In one configuration, if the x ray emitting position is sufficient distant from the VOI and from the detector, the number of voxels outside of VOI may be very limited in quantity due to the fact that as the x ray source moves to new locations for x ray projection, or x ray projections taken from new x ray emitting positions, for example, such positions are at least Xc apart. If such a Xc is in the dimension of one pixel. Projections taken of VOI at a new location which is Xc apart from its ajacent x ray emitting position, the newly introduced unknow voxels in the region outside of VOI may now be in the new projection path where at least one voxel from VOI is involved. The detector region which collects measurements of such new projection line collect signals which are lands on just a fraction of Xc within a pixel or a fraction of pixel offset from the projection of the most adjacent projection from the most adjacent x ray emitting position. And when total number of projections, at least P number are measured, instead of square root of P , or a calculated number relating to P in one dimension to up to six dimensions in P, only one or two or a few extra pixels are extended along at least one axises. As a result, sometimes, the new ly introduced unknown voxels are very limited in numbers, may be ignored. In this case, projection emitting positions for calculation, image processing and or 3D reconstruction in low resolution or high resolution, may be placed in only partially overlapping regions or may not overlap at all.

In one configuration, the extension of the measurement region of detector during projection acquisition while the x ray emitting position changes, may be at least one or more pixels.

For example, the extension could at least one pixel row and additional one pixel column in the opposite direction of x ray emitting position as compared to the emitting position before.

In one figuration, if the x ray emitting position is in a xy area region centered in the center axis of the cone beam whose projection image is approximately center of all projection images.

In one configuration, the dimension of one side of a pixel on the detector is less than half size of the Xc in dimension. For situations where the images are to be captured with resolution similar to Xc, at least two or more pixels are read and their signals are processed, such as averaged to obtain the appropriate measurement, corresponding to a projection path landing on a region of size .

In one configuration, the VOI is partitioned into more than 2 smaller regions, for example a 256 x 256 x 256 VOI, partitioned small region unit may be 4 x 4 x 256 ( x, y, z respectively) the reconstruction of smaller regions from measurements of corresponding detector region which are on the projection path of voxels within the selected volume or region of VOI, may be parallel processed after the projection images of VOI has been acquired for 3D reconstructions. In this case, approximately 4096 units of 4 x 4 x 256 columns are reconstructed.

In one configuration, the attenuation value of each voxel can be between 0 and 1. And additional constraints and optimization condition may be applied.

3D reconstruction using spectral measurements at SPR < 1% or less than 5% or less than 10%

Based on the theory that density of tissue, for example, bone , throughout a human body is slow varying, the density of a tissue at one voxel location may be similar to those in the regions around it.

In one configuration, at least one pixel within ROI or within selected region containing substance of interest, dual or multiple energy measurement, determine attenuation value, provisional density value, iterative algorithms as in reconstruction to determine the thickness and therefore density of the substance of interest.

Upon on determining the density value of the substance at one location, use the density value in the rest of ROI for each projection measurements on each pixel region which is the result of passing through substance of interest with estimated provisional density to determine thickness of each substance.

In one configuration, 3D reconstruction starts with the provisional thickness value and density of the substance of interest. And perform iterative algorithms as in CT or iterative process in other modalities, until the simulated value on each pixel converge with that of the measured value.

In some cases two or more such pixel positions may be selected to increase number of projection measurement locations, for example, such pixel positions may be spatially distributed throughout the ROI, or may be aggregated in a region selected by the user or determined by the spatial location and or spatial distribution of the substance of interest, or substances of interest.

In some cases, dual energy or multiple energy measurements may be done in the selected pixels. In some cases, a ID line measurements or 2D measurements may be done at one energy, and a second or third energy or more energy measurements may be done at the selected pixel regions. The ID or 2D measurements or 2D image may be done to provide a spatial reference.

In another example, two or more ID and or 2D and or 2D images of the first energy measurements may be done of the selected region of ROI at the same time, but distributed from each other.

In one configuration, Reconstruction or material decomposition may be done in distributed fashion throughout the ROI in a parallel fashion. First for derivation of first set of density value and thickness value of two or more selected regions. Until eventually all of the pixels are derived. There is not interpolation but rather providing of provisional density value of each substance in the regions immediately adjacent to the regions measured by the pixels of whose value the material decomposition and or reconstruction image processing have been performed on for substances of interest.

Line or volume integral method may be used for reconstruction. In volume integral method, 3D poly tope that arises from intersecting a pyramidal cone-beam with voxels in VOI. The polytope may be subdivided into a set of subvoxels, so the proportion or the percentage value of a particular voxel in the beam path can be derived, a weight factor may be used.

In some example, if the volume of polytope does not pass the center of voxel, it is a 0, if it passes, it can be assigned a 1 value.

In addition to on the fly calculations of intersection of voxels and x ray beams, a look up table may be established for varied dimensions of region of interest, varied dimensions of voxels and or varied location of x ray emitting positions, and or varied x ray emitting positions of first positions as well as second positions to speed up the reconstruction method.

In one configuration, combination of look up table and on the fly calculations may be performed to optimize speed.

A GPU-Accelerated Multivoxel Update Scheme for Iterative Coordinate Descent (ICD) Optimization in

In one configuration, 3D Reconstruction In one configuration, a Look-Up Table-Based Ray Integration Framework may be used for reconstruction

Reconstruction Method Involves,

1. Establish a table which there are a number of combinations of imaging settings comprising varied thickness, x ray source location, and varied resolution along the z and varied detector location relative to the x ray source.

2. Select region of interest,

3. using time of flight sensor or an non radiation sensor to measure thickness, or height map or user input thickness or input measured thickness, or an estimation of thickness based on body built, size for example, infant, pediatric, small, medium, large, extra large, ultra large.

4. fine tune or verify by x ray measurement, of at least single energy level measurement, or dual or multiple energies or alternatively, the x ray measurement is set at low exposure level for the estimated body size, the measurement may be repeated at least one or more times.

Or alternatively, step 3 may be omitted.

In one configuration, the measurements may be averaged, for example or added together, or stacked.

In one configuration, the measurements may be averaged, for example, to reduce noise, such as random noise.

In one configuration, the measurements may be stacked, for example, to avoid photon starvation

In one configuration, the measurements may be averaged and stacked with two or more exposure levels.

In one configuration, the measurement to be repeated based on the analysis of the first x ray measurement.

In one configuration, the measurement is set to be 50% equal or less than the minimum required exposure for the estimated or approximate thickness. based on the thickness of the sample, look up in a table or database, volume integral, or x ray beam volume intersection with the voxel of specified dimensions, the said dimensions are the resolution desired.

If the detector plane relative to the x ray tube is different than the data stored in the table or database, derive a virtual plane of the detector based on the relative x ray detector location, relative to the x ray source, compared to that stored in the database, while all the other parameters values stay the same.

5. Move x ray emitting position to first positions and in some cases, second positions in the line path, or the same area or volume traveled, each step size, that of the resolution desired of z. in some cases, such geometry may be relaxed based on the application requirements. For high resolution images, scatter to primary ratio may be less than 5 % or less than 1%, or for low resolution images, scatter may be higher, 10% or 20%. Scatter may be removed using methods in the aforementioned PCT if scatter interference reduces 3D reconstruction image quality or performance.

6. Reconstruct based on the value of volume integral and path for reconstruction were looked up from the table

7. Present reconstructed 3D image or extracted or synthesized 2D or multiple dimensional image.

Reconstruction of 3D images may be achieved by area-based ray integration using summed area tables and regression models.

In one configuration, number 3 and 4 or number 4 may be used in single energy x ray or single energy x ray 2D or spectral 2D or tomosynthesis imaging method to configure the exposure level needed for an imaging procedure from one x ray source radiation position.

In one configuration, such exposure setting may be done in real time.

Once it is adjusted and at least once for the given FOV in VOI, such a setting may be used for in the entire image acquisition process needed for a tomographic reconstruction of VOI within FOV.

6D is defined as x, y, z, pitch, yaw, roll.

3D is defined as x, y, z. In one configuration, the segmentation is based on density, or density range. For example, in brain imaging, white matter and grey matter separation is based on density difference.

In one configuration, the separation of white matter and grey matter may be based on dual energy or multiple energy decomposition.

In one configuration, the segmentation may be based on the ratio of at least one substance to another or more substances, , for example, the protein to lipid ration, in white matter compared to that grey matter, may be different. Such ratio of substances could be substances located in one location comprising one or more voxels or a volume of interest.

In one configuration, after segmentation, and identification of one material or characterization of one material which may be comprised of at least two substances, material decomposition using spectral imaging may be used, such as using a look up table and or inverse energy function response function, and or thickness, the separated substances or the image of each substance may be displayed, certain markers, such as white matter hyperintensity, may be more visible now that the two materials, grey matter and white matter are separated and or the lipid and protein are separated. The white matter hyperintensity may appear more in one substance, such as lipid than protein, therefore more visible.

Micro calcification, in one configuration, may be separated by using dual or multiple energies.

Microcalcification, in one configuration, may be separated from lipid or protein component or white matter or grey matter as a distributed rare component, DRC, as defined in the aforementioned PCTs.

In one configuration, method for spectral imaging - tracking of at least one component

Such method of segmentation or evaluation of ratios of substances may be used to identify a substance, or diagnose or track or characterize a material or a substance of interest.

Performing Single Energy or Spectral - 3D imaging, material decomposition

Performing spectral imaging at one of first or 2^nd positions

For the same position, obtain attenuation value of different component in the ROI

Compared with the first images or first projection images or material decomposed images for each component due to dual or multiple energy measurement if every component or substance has a different attenuation value, if density does not change, perform multiple point measurements on each component or substance. Such a measurements, for example , the spatial location of measurements and energy level may be predetermined. For example, if it is a catheter or a portion of catheter. Its total spatial volume and distribution is well characterized. For the selected ROI within the catheter, a number of measurements maybe close to each other or distributed from each other may be used to spatially position the component or a portion of catheter, The rest of catheter spatial distribution may be derived through simulation.

If density does change, a selected roi involving estimated spatial distribution of the substance may be illuminated and measured, such as a blood vessel, with contrast agents. The concentration of the contrast agents may change over time. Since the tissue external to the blood vessel either stays static or monitored due to material decomposition, and tracking as described in 1), the spatial orientation and the location of blood vessel may be derived due to tissue around it, thereful the concentration of the contrast within the blood vessel may be drived especially if the thickness of blood vessel and attenuation value of the contrast agents measured by each normalized pixel are known.

Other examples:

The object or ROI has moved in the 6D space.

The central axis has shifted or iso center of ROI has moved.

If however only one component or substance has varied from the first image, the object has not moved, ROI may not have moved, at least one substance has moved and number of projections is the thickness of substance divided by the resolution desired.

If the substance of interest over time is distributed spatially differently, or where the substance of interest is spatially is changing in terms of composition or chemical make up, for example, become absent, or adding more materials, such as growth of stem cell which is tagged by a contrast agent recognized by for example, an antibody or nanobody or synthetic antibody, or for example, excretion of cations into an extracellular matrix region such as in the case of arthritis, or calcium distribution in a ROI, and or growth of blood vessels or capillaries over time within one or more tissue regions, a high resolution 3 D may be needed to be performed for the region. Considering there maybe one or more substances or one or more layers of substance or substances may stay constant or slow varying, the 6d spatial distribution of such a substance or substances may stay the same while the interface region with substances of the interest and substances of interest may vary, therefore 3D reconstruction or material decomposition processing may be performed for such a substance or substances.

In one configuration, the number of projections may be much less than total thickness of the object in the region of ROI / Xc, but rather the unknown region contains approximately the interface regions of substances of interest with the background or rest of object and what is internal to substances of interest. The total number of projections needed is therefore approximately thickness of unknown region divided by Xc, Xc being the resolution desired in the z axis perpendicular to the detector.

In one configuration, alternatively, depends on attenuation value and or the thickness of the substance measured at two or more positions on detector, for example, two position separate from each other, the orientation of the substance or the component may be determined.

In one configuration, one source may generate one or at least two projection path, received by the same detector or a different detector measurements on each detector, may give rise to determination of the substance position.

Alternatively, at least two source or two emitting position - detector pair, each generating at least one projection thin path, may also work.

Spectral x ray imaging reconstruction - selective reconstruction of individual material or substance

In dual or multiple energy material decomposition. Attenuation value of each material is decomposed and at least one substance is separated from the rest.

In one configuration, for image reconstruction, after material decomposition, at each emitting position, the contribution of each substance which has been separated at due to dual and multiple energy measurements, is known, therefore for 3D reconstruction, if only 3D resolution of one substances is needed, then the number of projection will be the thickness of the substances divided by the resolution desired for the substance.

In one configuration, for example, in bone fracture diagnosis, may be only bone image in high resolution is needed for diagnosis, therefore, at each emitting position, if dual energy imaging or multiple energy imaging is performed, the attenuation value of any tissue or composite tissue other than bone may be separated out, therefore may be accounted for as at least one known segment in the projection path.

If there are multiple layers of the tissue interlacing with that of bone. During reconstruction, such spatial distribution may be accounted for already, in some cases, may not need to further investigate the attenuation of its voxel layer.

Therefore the total projection needed is therefore approximately equivalent to ( 2 x

Thickness of bone / Xc), if there are only dual energy is performed. However if there are three components or substances in the projection path, the amount of measurements is therefore approximately ( 3 x thickness / bone /Xc).

In one configuration, the substance of interest is thicker than the rest of other tissues, then the total amount of emitting position may be determined by the total thickness of the ROI.

In one configuration, reconstruction may also be done, for example using a selected energy for a portion of first positions or a projection images, so that the portion of projected images may be approximately sufficient to resolve unknowns in the corresponding tissue or substance which responses distinctly for the x ray attenuation than the rest of substance in the ROI. And a second level for another tissue, for another portion of first positions or another portion of projected images. And son.

The total number of projection image stays the same but the energy level is adjusted during 3D image acquisition.

In one configuration, reconstruction of at least a portion of VOI is based on measurements on the area of the detector immediately below VOI on the projection path or each measurement of segmented columns of VOI or of VOI for reconstruction is the detector region approximately below segmented column or VOI, variation of the center of said detector region is less than 0.5mm or less than 1mm, less than 5mm or less than 1cm or less than 2cm, or less than 5cm, or less than 10cm deviated than an original detector region or the original detector position for the measurement of the same VOI or each segmented VOI. therefore reducing complexity of reconstruction algorithms, and improve data acquisition speed, reducing amount of unknown voxels outside of VOI or said segmented column to measured the said detector region spatial position within a detector is substantially the same or similar or within a region of detector which is essentially the used for the 3D reconstruction. Typically for traditional CT or tomosynthesis or inverse geometry scanning fluoroscope, the reconstruction of any selected column such as lx 2 x height of the sample or lxl x height of the sample, the detector region collecting projection imaging for any one voxel is substantially different in spatial position during image acquisition for 3D reconstruction, is substantially different for the measurement of any one voxel , therefore for smaller volume of interest compared to a larger volume of interest or larger subject, the amount of radiation is typically larger than what is necessary in prior art configuration, or the total number of detector cells or pixels required to track and measure for 3D reconstruction are much larger in number, or the amount of unknowns which needs to be resolved for accurate and essentially 3D reconstruction of selected VOI are typically much more, therefore may take longer and cause ill condition more likely to occur.

Although it is one aspect of the present disclosure to include the improved reconstruction method for prior art projection geometry, which is include traditional ct, or tomosynthesis or IGSF, helical it is part of our disclosure to emphasis on the benefit of most optimized method which is the segmented column reconstruction method, where drastically smaller number of unknowns are resolved in reconstruction, in some cases, independently . Parallel processing can be achieved much more effectively combined with traditional parallel processing method. Traditional methods for increase speed and reduce matrix size and other optimization methods can for CT, tomosynthesis and IGSC and O-ring and other projection geometries, for electron microscope and or PET or for PET/CT or optical tomographic method in addition than what is described here and in the aforementioned PCTs and patents can be adopted to further performance

In one configuration, methods and system described in the present disclosure and aforementioned PCTs and patents, wherein density or relative attenuation value or relative linear attenuation coefficient within a volumetric unit derived quantitatively by said x ray measurement and reconstruction, differentiate tissues or substances or composites or component with density values within 1%, 2% or less than 5% or less than 10% of each other.

Filters

In one configuration, filters such as aluminum, copper and tin filters may be placed, between the x ray source and the patient, for example, placed in collimator and used selectively for reducing beam hardening effect and/or dose and and/or to optimize image quality at the interface between tissue and air. Or such filters may be used for adjusting the energy level of the x ray emitting source to optimize the imaging result for a particular substance, substance composite and molecular complexes or one or more coded aperture, or filter which transmissive of a range of energy levels peaking at k-edge of one or more substances in VOI.

Computing for image processing

In configuration, computation for image processing including the complete tasks or some of the tasks in preprocessing such as remove dark noise, flat field, gain, pixel consistency, dead pixel mapping, spurious noise filtering, normalization, scatter removal, material decomposition, attenuation value derivation for each substance or composite substances, 2D or 3D or multiple dimension, or up to 6D plus time, 7D reconstruction, post processing, such as removing geometric artifacts, segmentation, quantitative analysis of the data, AI assisted diagnostics, or any AI assisted reconstruction, tracking, monitoring, presentation, texture map, density information, parallel computing, cuda, annotation, or other CT or spectral imaging typical image processing methods and noise and artifacts removal methods, may take placed locally at the detector location, or take place at the microprocessor integrated with the hardware controller, or may take place at a desk top computer or a server, with a graphic microprocessor, GPU or parallel computing device, or being transferred via wired and wireless communication protocol, through one or more wireless or wired networks, such as cellular network , or satellite, or dedicated network or internet to a cloud server, or remote server or block chain for processing and computing. And the data collected at the completion of the tasks are send to a storage device and microprocessor where the patient information is kept for viewing, presentation and or further image processing and analysis.

A microprocessor at the location of image acquisition or image data source or image processing site, such as a PAC storage integrated system, may digitally determine or a user using such a microprocessor may determine and send command digitally to a digital program or software to set conditions to separate different tasks and in some cases, categorizes the tasks.

Typically, when a patient’s images are to be processed at a location different from image acquisition, the whole electronic medical record or patient information is transferred. This may be done, however there may be a problem of privacy.

In some instances, a portion or complete of tasks are transferred out of the original data site to a remote location for image processing, but patient private information may not be transferred except information about the computing or processing tasks and relevant data needed for image data processing.

In one configuration, such tasks may be tagged, or labeled or marked with identifier or identifiers which are different than patient Id or sensitive data from the patient. From example, the location of the x ray device where the imaging acquisition is taken, and or tagged with time the images are taken, and or based on. The identification of the data set is given by the time of which such data is set, therefore no patient sensitive information may be transferred off site or away from the image acquisition location, only tasks to be completed.

In addition, since the measurements are minimized, amount of information sent may be relatively small as well in most cases, so that communication does not become a time bottle neck. The tasks however may be completed faster when computing power in the cloud server or remote computing device are used.

Such tasks may be sent out when, for example, during an imaged guiding intervention procedure or during diagnostic and or during patient monitoring, or during pre surgical planning and during surgeries or clinical studies or post procedure analysis and processing.

Communication of such tasks intranet or external via internet or other digital network may or may not be encrypted.

The usage of the server, and computation access and or data and computation complexity level may be subscribed or based on per use case.

For example, a computation server may be installed within a hospital to serve multiple image acquisition systems, and or multiple image processing applications, stored in a location different from the image acquisition system such server may be subscribed or purchased.

Computation may be for application other than medical purposes. In one configuration, payment transaction may be based on a database kept either on the image acquisition system, or controller or at the server used for computation side. The database keeps track of and stores metered information regarding the amount of computing done for each imaging data source location, for example, each computing task is associated with a facility via an identifier which server provider may provide computing service to.

Computing service may be provided from outside of the hospital network, payment transaction may be performed based on usage tracked or metered by the server where the computer service is performed, or by the local computer to the image acquisition system.

Such metered information stored on the server or the image acquisition or image processing data side may be communicated electronically periodically to payment processing server, where the amount is of payment is calculated based on the usage.

Or a subscription fee may be associated and charged periodically through the payment system involving user interface, payment transaction, encryption, confirmation and communications involved in similar digital banking transactions.

Meta file for each image may contain image identifier, may contain configuration of system matrix, time label, DICOM tag, or reference to a 3D or spectral image reconstruction or meter which may indicate the count of the images, taken of the same object or ROI.

In one configuration, a tally of or count of the number of an imaging procedure of each category of imaging modalities, such as spectral imaging, tomography, general X ray or densitometer are recorded in the portal a user and or administrator and or maintenance staff or tech support can access. In some cases, such tally can be included in user information or user portal and or log file and can be retrieved and displayed in either admin panel in the software and or send through an intranet or internet or hospital communication channel to a server either for storage and record keeping and or for confirmation of service rendered and business intelligence analysis, and or sent to a customer site as an electronic invoice or directly feed into a communication method used by a customer such as hospital, clinics and imaging centers.

Establishment of minimum exposure needed for material decomposition and quantitative imaging In one configuration, one method to determine and or approximate minimum exposure needed for quantitative imaging and / or material decomposition includes one or more of the following methods:

Measure the material decomposed image for each substance, if the primary image of the measured value or a image with has 1% or less SPR or 5% or less SPR or 10 % or less is approximately equivalent to the simulated or calculated projection image or value on each pixel based on an analytical algorithms and/or based on Monte Carlo simulation, of the substance or composite tissue, the minimum exposure under which the measurement is done is sufficient.

Determine the minimum exposure which generates the measurements on the detector or projection image on the detector which has normalized measurements which has less than 1% SPR or less than 5% SPR, is approximately equivalent to the simulated or calculated projection image or value on each pixel based on an analytical algorithms and/or based on Monte Carlo simulation, of the substance or composite tissue.

Establish a plot based on measurements of attenuation value of a ROI with a number of exposures, each at a different value.

Based on the plot, at certain level of exposure or more, the attenuation value determined remains to be the same. As a result, a minimum exposure level may be obtained. A database may be established either by direct measurements and or interpolation of various samples of thickness and or components, for each organ, or region of organ or tissue or tissue composite. Or such minimum exposure value may be obtained from an existing database.

Determine normalized pixel value on the detector, if the minimum value of measured pixel value of x ray passing through any where of ROI is approximately, for example, 5-10% or 5% or between 0.5% to 10% of the total dynamic range of the detector or the saturation level of the detector, then the exposure may be sufficiently minimized. The measure value may be x ray measurements, a primary x ray image with less than 1% of SPR or less than 5% of SPR or less than 10% SPR.

Automated exposure control

In prior art , automated exposure control is generally based on the previous measurements. However the level of radiographic exposure is determined based on the present day diagnostic levels with antiscatter grid. Automatic Exposure Control may be set by using an established database, depending on the region of ROI or type of ROI and dimension of the ROI, the automatic exposure is set. An sensor such as Time of flight sensor may be used to measure such dimensions or cameras.

X ray measurements of the same or approximately same ROI, in some case, with image processing, such as noise removal, and other image processing techniques and / or scatter removed to be of less than 1% SPR or less than 5% of SPR or less than 10% of SPR may be used as a reference to determine the exposure level, for example, by simulation or calculation, where such exposure level will generate approximately a minimum pixel value of measurements of ROI, normalized and or with scatter removal, is 5% or 1% or 1% to 10% of the saturation level of the detector.

Time of flight sensor may be used to generate height map or thickness measurement of an area selected from a 2D image generated by a 2D camera. The height information or thickness of the selected region digital or visually, such as a height map or 3D surface view generated based on the height measurement or grey scale image of time of flight sensor may be displayed or layed on top of the 2D image, for example, layered over the region of interest from 2D. this may be used to replace a 3D camera with accurate measurement of 3D, as it is less expensive and may be more accurate in some cases of measurement.

Sensor such as time of flight sensor may be used to measure the thickness therefore the number of projections needed for 3d tomography.

In one configuration, an x ray image based on selected region of interest may be displayed in the camera view. Alternatively, the images of different modality may be displayed separately or colocated. Computer may indicate region of interest with a selection indicator, such as a box which shows the selected region on the camera image, and at the same top, the height map or grey scale image or key measurements of height map or thickness information or 3D surface model or measurements are displayed in a separate display region or on top of the camera image or image of the selected region in the camera capture image is replaced by the gray scale image or height map or thickness measurement or 3D information. Or the computer control may toggle back and forth between images captured by different modalities, camera, time of flight sensor, or x ray or other modalities such as optical imaging method or MRI or ultrasoound, for the region of interest. The background image could be image captured by any modality such as the camera or time of flight sensor or x ray image. In one configuration, the x-ray imaging is taken with the following steps, some steps are optional

• At least one Image taken by a camera / video, referenced as “First Image”

• The image is displayed on the computer display

• The user selects the region of interest using user interface offered such as on a computer and or a joystick or a computer input device or a handswitch

• Selected region can be converted into 2D or multiple dimension coordinates, for example in a system matrix,

• the ToF sensor or non radiation sensor such as optical sensor, is programmed to perform measurement of this region specified by these coordinates.

• The sensor scans the region, build the heightmap and sends taken image to the computer

• On the computer display, this heightmap image is displayed like another layer over first image and we place this heightmap image over the previously selected region of interest. Or alternatively, the height map image displaces the region of interest in the 2D image or the height map may be converted into a grey scale image, or a 3D surface model of the region of interest or there is an indicator on the 2D camera image or numerical display on the computer user interface at least the maximum and or minimum of thickness of VOI within field of view selected for ROI, or thickness range of the VOI

• An x ray is taken of the region of interest, is referenced as the first x ray image.

• In case additional images needed to be taken, for example, to adjust measured pixel value or intensity of x ray input for the selected region or to produce spectral imaging, or density measurement or material decomposition or multiple dimensional imaging may be performed based on the first x ray image,

• the user may select the region of interest based on the first x ray image or the computer program may select the ROI based on at least one or a set of criteria.

• Exposure settings may be adjusted, or exposure time may be adjusted or the number of images may be set , in some cases based on the first x-ray image so that additional images are taken to provide the data and information the application needs.

• In some cases, the exposure adjustment is not needed as the exposure is set based on the measurement of the time of light sensor.

Methods for scatter removal

In one configuration

With the beam absorption particle plate between the VOI and the detector, each plate one or more beam particle absorbing regions which attenuates x ray beams, in some cases, approximately 100%

For each x ray emitting position, the corresponding projection measurement of VOI, acquired by the detector, there may be at least two positions for the same beam absorption particle array ( also called “beam blocker “ array).

For example there may be a position A and position B, for the same beam absorption particle array for the same x ray emitting position or x ray source position. The x ray shadow area of projection measurement while the beam absorbing particles at position A on the detector ( the missing data information of VOI) may be replaced by the measurement or essentially primary x ray measurement of same detector region of a different projection while the shadow of the beam absorbing particles are at the position B location and the x ray source location or x ray emitting point location are at the same spatial location relative to the VOI and detector. And reverse may be done for shadow regions of beam absorber particle array. The resultant projection measurement at position A or Position B may be called “missing data gap replaced modified projection or primary image measurement” or simply modified projection or primary measurement at Position A or at Position B

The modified projection measurements at position A and position B may be added together on a pixel by pixel basis - each derived or measured value of each pixel location on the detector are added together, the total measured value can be directly used for presentation and or display, or the averaged value, in this case, total value on each pixel divided by two, may be used for further analysis or for the presentation of the generated image value.

In some cases, especially for highly quantitative measurements, more than two positions, such as 3 or more beam particle array positions may be used if multiple frames or multiple exposures or measurements are needed for the application, for example in reducing time for image processing and or reducing possibly total numbers of projections to be made or generated or measured.

In some cases, position A and B or C, or more, are not overlapping. Therefore the missing gap is different in each position.

In one configuration, for example, if a total of three different exposures or frames are needed, the beam particle absorber plate may be placed at position A, position B and Position C for each frame of projection measurement. The total stacked images or total averaged image will therefore have regions from data derived from two projection exposures, therefore only missing 1/3 of the total data compared to regions outside of beam particle absorber shadow areas on the detector for position A, B and C. the benefit of additional spatial locations is so that the measurement exposure time or sampling time can be increased for the missing data regions.

The number of projection measurements at position A, or B or C etc can be the same or varied depends on the requirement. However, it is preferred that equal number of projections at each position at taken to avoid photon starvation or improve data quality due to quantum photon randomness.

Improved method for quality assurance of Beam Blocker positions and their corresponding shadow areas on the detector for x ray measurements or tomographic imaging acquisition

One configuration of scatter removal method for general x ray or spectral imaging or densitometer or tomographic imaging:

For Scatter and Primary Separation and scatter Interpolation methods during the tomographic imaging process as the x ray emitting position moves for image acquisition

Without imaged subject , one configuration includes the following one or more steps.

Step a. • Take the first image for position A of the beam blocker positions at one x ray emitting position p in six dimensions, and a particular position in six dimensions for detector D and particular location in six dimensions for beam blocker plate B

• Find each beam blocker shadow area, and or center of the shadow area and total number of shadow area in the field of view covering volume of interest.

One configuration for the shadow finding or location of all scatter signal region method is one or more of the following:

One configuration: Using known geometry, spatial position in up to 6D or 7D x ray tube or emitting position, known position of detector, beam blocker array, spatial position and spatial distribution of each beam blocker, locate the simulated shadow region on the detector of each beam blocker at least one pixel, which has a beam path directly traced back to the x ray emitting position, with the beam blocker / beam absorber particle in the beam path. one configuration, o Using circle finders or shape finder algorithms to find predicable shape or pattern of the shadow on the detector

Another configuration for the shadow finding method is o Find regions which have signal levels below a certain threshold or within a certain range, with one or two or more pixels, or pixel region which approximate or slightly smaller than of predicated beam blocker or beam blocker shadow dimensions, which may have approximately lowest level signal compared to the surrounding the detector region, within field of view illuminated by the x-ray beam or selected by a beam restricting device between the x ray source and detector. o One configuration

Locate at least one detector region comprising at least one shadow area of beam blocker, which are determined due to the beam blocker attenuation - have predictable spacing between the shadow area or circle area or predicable shadow region based on the beam blocker design Calculate the rest of beam blocker shadow location and calculate the number of shadow location in the field of view and or center of the shadow area based on predetermined relative shadow locations in previous step. ( this step may be omitted in some cases)

In one configuration, the verification of the accuracy of shadow region of the beam blocker may be performed, as the spacing between the shadow regions have predicable range based on the beam blocker array design.

Step b. some of the steps and configurations are optional

In one configuration, imaged subject is placed between the source and detector

• Take the first image for position A of the beam blocker positions.

• Find each beam blocker shadow area, and or center of the shadow area.

One configuration, includes one or more the following configurations or steps:

Locate at least one detector region X comprising at least one shadow area of beam blocker, which are determined due to the beam blocker attenuation.

In one configuration, a test has been performed, that the shadow regions identified to have predictable approximate spacing between the shadow areas if more than one shadow areas are found.

The following configurations and methods or steps may be combined from one or two steps and some may be optional:

• Take a second image in the imaging procedure for position A of the beam blocker position

• Find shadow area or shadow areas in the detector region X comprising at least one shadow area of beam blocker, which are determined due to the beam blocker attenuation

• Find the corresponding shadow area based on data and derivation from the image and measurements in step a. due to the same beam blocker or beam blockers • Calculate the difference between the location of the shadow area due to the same beam blocker, or the shift of the shadow area of the same beam blocker on the detector Or, based on the relative location of the reference beam blocker shadow area and its corresponding shadow area in the image taken, and number of shadows within a given field of view, and approximated relative distance between shadow area, calculate the approximated location of the shadow area and approximate its corresponding center area or center region.

• Calculate or approximate the rest of beam blocker shadow location in the field of view and or center of the shadow areas based on predetermined relative shadow locations in previous Step a when there was not an imaged subject.

• Calculate and or approximate the rest of beam blocker shadow location in the field of view and or center of the shadow areas based on predetermined numerical approximation or numbers known to exist between distances and locations of the shadow regions

• Calculate or approximate the rest of beam blocker shadow location in the field of view and or center of the shadow areas based on predetermined numerical approximation or numbers of relative spatial positions known to exist between locations of the shadow regions

• Calculate and or approximate the rest of beam blocker shadow location in the field of view and or center of the shadow areas on the detector, taken into account spatial orientation of the beam blocker plate relative to the detector and or source,

• Approximation take into account of the shift of the x ray source calculated from the selected shadow area, determine the shift for the rest of shadow areas.

• The intensity of white image and or intensity of actual measurements are adjusted to provide consistency to proceed to the next step.

In one configuration, the location X is determined prior to the imaging of the subject.

In one configuration, the position of shadow areas are determined from image in the location X area.

In one configuration, shadow area of the rest of beam blocker are determined based on the shift from Step a image of the same shadow areas and or relative spatial positions to the shadow areas within location X, where X is identified as a portion of the complete beam blocker shadow position and has a relative specific spatial relationship to the rest of the shadow positions for the approximate x ray emitting position and or approximate beam blocker array position.

In one configuration, the determination of the shadow areas, could also be determined through calculation of x ray emitting position, relative to the shadow area, thereby determine the beam blocker position corresponding to the shadow region, or what is called, reference beam blocker or reference beam blockers if there are more than one beam blockers and their corresponding reference shadow areas are measured and calculated. As the shadow region shifts, if x ray emitting position is known and accurate, then the location of beam blocker corresponding to the shadow area can always be determined, and as the location of other beam blockers are fixed to the reference beam blockers.

In one configuration, computer software determines the field of view of the detector which is used to image the subject for example, the edge of the image may be determined, such as due to detector measurement, beyond a threshold, that is outside of the field of view.

Locate at least one region X at selected region or regions of the detector, for example the comer of detector within the field of view for the selected volume of interest

Find shadow areas in region X and or their corresponding beam blockers positions after each image taken

Alternatively, find shadow areas in the image and locate those shadow areas in region X

Determine the rest of shadow areas based on the predetermined geometry, such as fixed beam blocker positions relative to each other and their corresponding shadow areas and their relationship to that of reference beam blockers and their shadow areas and x ray emitting location in step a. and or the number of shadow areas within a distance or a region or the field of view.

After complete set of beam blocker positions and or complete set of scatter only regions approximately center region of shadow area) are determined, high resolution scatter image can be derived from scatter interpolation.

In one configuration, scatter Interpolation • Interpolate selected data point or data points in the shadow area, for example, approximately center region of the shadow area to derive high resolution scatter image

• If there are more images of additional exposures taken at the same location of x ray emitting positions and beam blocker positions, using the shadow position of beam blocker in the first image as the position of beam blocker each time for interpolation

• Each time when the beam blocker is moved, shadow area and or beam blocker positions will be determined again for the entire image using method described above in step a and b.

• region of beam blocker is to be determined again, and beam blocker shadow area is again to be determined for the entire plate

• interpolation based on the shadow region of the entire plate

• As the x ray emitting position is moved to a different position, the following process may happen a) repeat 1-9 or b) assume that position A and position B of beam blocker are assumed to be the same interpolate using the same position a and position b beam blocker position, but adjust the center position of the beam shadow for interpolation based on the position of the x ray emitting position; or c) assume that position A and position B of beam blocker are assumed to be the same interpolate using the same position a and position b beam blocker position, but do not adjust the center position of the beam shadow for interpolation based on the position of the x ray emitting position as x ray emitting position is very close to the one before, the center of beam blocker shadow therefore has little change, position change can be negligible; or d) using the method in c) for a number of x ray emitting positions, but adjust the center of beam blocker shadow area based on x ray emitting positions

In one configuration, a x ray image of the beam blocker at Position A may be taken prior to the subject being placed between the source and detector. And beam blocker shadow regions of position A of beam blockers are determined, separately. And center pixel or center region of the shadow areas are determined and used as the data point for interpolation to derive high resolution scatter image at position A In one configuration, same process is repeated for Position B or at other position of the beam blocker array.

In one configuration, as the x ray emitting position shifts, based on the geometry calculated, the shadow area of beam blocker at position A may be shifted and determined in the system matrix based on the geometry of the x ray tube and detector.

In one configuration, an optical sensor is placed near the actuator of the beam blocker to measure the location of the beam blocker.

For example, in one configuration, a laser and laser measurement device is used to sense the actuator location.

For an LED and a wide angle lens are used to sense the location of the actuator. For example, an led or retroreflector of led is placed on the side of actuator at a fixed location, as the actuator moves, the emitted or reflected light is captured by a wide angle negative lens or fish eye lens combined with or not combined with a waveguide. The location of collected signal spatially can be corelated with the location of the actuator. The precise location of the beam blocker plate can therefore determined.

Similarly to determine detector location without x ray radiation.. The side of the detector may be attached to a light source or a retroreflector and the a sensor placed directly in the line of sight or optics are placed in the line of sight steer the light emitted from the light source to the sensor.

Other type of optical based sensors may be used to detect the precise location of the detector and or the actuators attached to the beam blocker plate or the beam blocker plate.

For example, a sensor which signal gets interrupted when the actuators of detector and or beam blocker plate moves pass the sensor where the sensor ‘s placement is precisely at a known position. If the sensor sensing occurs with predicted timing or steps of movement of actuator, then it is verified that

Light design.

In one configuration, Light bars or light indicators may be placed or embedded on the x ray system, or integrated as part of the system for example at the top enclosure end in the middle, or on the control panel or at the base, behind the logo to light up the logo at the exterior.

The color can be one or more colors selected from the color chart. For example, green may be used for eco or less radiation, or branding, or blue for cooling effect, or pink may be used for girl, lady. The indicator can be one color or it can alternate and change to different colors based on the customer, for example, blue for boy, pink for a patient who is a girl etc. to make the machine more appealing by soothing the patient or calming or other therapeutic or meditating or mood adjusting for the patient. Or it can be multicolored for example, when spectral x ray is administered, designated color may be used to symbolize different wavelength.

LED may be used for the light indicator. Other light sources may be used alternatively.

In one configuration, light bar can be placed in the middle or edge of top enclosure.

Light bar can be used to enclose the control panel on the system or any where on the machine for aesthetic reasons or mood adjustment or informative purposes.

Presentation of extracted image data and or tomographic image

In one configuration

Images obtained by conventional general x ray imaging method, with 2D detector, combined with for example, an antiscatter grid, may require radiation exposure for example at 30m As to 40mAs, a typical setting for chest imaging, to achieve visualization presentation, familiar to users such a radiologist.

However, with the present scatter removal method, using distributed Beam Stopper array method, for example, between the detector and the patient, as described in the aforementioned PCTs or beam selector method between two layers of detectors, or time of flight detectors, or primary modulator based method, which may reduce scatter to less than 1% Scatter to Primary Ratio or less than 5% of Scatter to primary ratio, for instance, on a normalized pixel, the exposure or radiation level needed to acquire accurate measurement of attenuation value, or optical density or radiographic density and / or for dual or multiple energy material decomposition, to separate at least one substance, is much less, for example, less than 1% or less than 10% or less than 20% or less than 30% or less than 40% or less than 50% or less than 60% or less than 70% or less than 80% or less than 90% or less than in between 10% - 90% of what may be required to generate a conventional general x ray image obtained with either antiscattered grid or software which may be of diagnostic value.

In some cases, the presentation of the image at a low exposure level, for example 3mAs or 6 mAs in chest imaging or even less for other part, may be visually difficult for a user to see. In one configuration, exposure may be increased for better visualization after image processing and or reconstruction.

In some cases, increasing exposure for example by exposure time, or increase current or both, may saturate the detector, therefore affect the accuracy of the quantitative measurements, or affect the repeatability or post measurement image processing, for AI or density measurement.

A high dynamic range reference detector may be used to overcome such situation.

In one configuration, two or more images, such as the primary images with less than 1% scatter to primary ration or less than 5% or less than 10% of scatter to primary ratio, separate exposures of the same ROI may be used and/ or combined.

The x ray radiation level reaching the ROI and / or exposure level may be below the saturation level of the detector. When the resultant images has no or limited scatter interference, in some cases, the total added exposure level may be less than or substantially less than that of conventional x ray or radiographic image needed for a visual diagnosis by a user or AI diagnosis, for example, from 2/3 to 1/10*, ( two thirds to one tenth) or 2/3^rd to 1/1000, or 8/10 ( eight 10^th) to 1/1000.000 of the radiation level of a conventional x ray image.

In some cases, different regions of ROI may not be illuminated again as it is not area of interest, for example in a dual energy or triple energy or spectral imaging or tomosynthesis imaging, a first pulse may be a full view image and second or third pulse of a different energy level may illuminate smaller region of interest or may be lower resolution such as using a distributed illumination or structured illumination.

Distributed illumination or structure illumination of x ray thin beams may be achieved by a conventional x ray tube, for example, using a collimator or a variable target or a MAD filter or beam chopper or a filter, or a digital controlled field emitter x ray source with adjustable Field of View, or a monochromatic x ray source, for example, a monochromatic x ray radiation derived from a filter or generated by fluorescent x ray from a second target or x ray radiation from synchrotron radiation.

In one configuration, as the attenuation value is obtained, or optical density or radiodensity or attenuation density is obtained, a multiplication factor of more than 1 may be applied to the measured value and or intensity value and or Hounsfield value, so that total intensity value of each pixel is higher for visualization, however, AI, density and or post processing or image analysis take into account such a factor or omit such a factor for accurate image analysis, as such a multiplication factor is used for visualization purpose, for example, so that the intensity level is pleasing or is at the level which is familiar with that of a user, such as an radiologist.

In case of material decomposed 2D images for at least one substance using inversion of energy response function equation system as described, each separated substance Hounsfield value may be multiplied by a factor, for multiple components or multiple substances in a ROI, Hounsfield value of each substance or each component may be multiplied by a same or different factor and / or adjusted quantitatively on a pixel basis, and or on a detection region basis and or on at least one measurement of one or multiple pixels at least one time, for alternative presentation and/or alternative visualization.

Thereby an image of 2D may be presented with improved visual diagnostic value and /or human user friendliness, at the same time, allowing lower radiation exposure to the subject or ROI.

This may be named as multiplication factor presentation or “MFP” method may be applied to a 3D image or multiple dimensional image acquired with radiation reduction to less than 2/3 to less than 1/10,000,000 of conventional CT level.

MFP method may be used in point, or ID x ray measurements with radiation reduction to less than 2/3 to less than 1/10,000,000 of conventional radiographic and CT imaging level.

MFP method may be used in timed measurements, such as dynamic measurements with tracking or monitoring or fluidic dynamic methods.

Multiplication factor presentation or MFP may be combined with the use of various color which is either true to the nature color of the substance or a color selected to distinctly represent at least one substance or one ROI, different from the measured color value such as grey scale or RBG value.

Contrast Agents Presentation

In one configuration

Blood vessel space which is mapped out by the first multi dimensional reconstruction using contrast agents which is a substance differentiable by spectral imaging, may be used to derive concentration of contrast agents in the blood vessel over time as a constraint in a 3D reconstruction. Illustrated in Fig. 2 , one example of using such a reconstruction process is the following:

Acquiring data sets without contrast (a*),

Administer Contrast agents, Acquiring data with contrast (b) ,

Spectral Imaging (c),

Material Decomposition to separate out blood vessel image from the background

(d),

Image acquisition and tomographic Reconstruction (E) to position blood vessel against background or references, such as anatomic markers,

Derive blood flow relative to reference (F) against the background relative static substances

Display is controlled (g)to present images of blood vessel separately or against a reference or background.

In some cases, datasets without contrast may not be acquired prior to datasets with contrast agents

In some cases, contrast agent concentration presentation is amplified, in intensity presentation of selected color to indicate a clear blood vessel image.

In the prior art, contrast agents may be proposed to be reduced. However due to scatter, the x ray measurement is not uniform, there are highly saturated region due to absorption of bone, or other super absorber, such as a metal, as a result, if there is contrast agent spatially distributed in the projection path of a thick bone, the measurement contrast agent or the Prescence or quantification of contrast agents are interfered.

Using the spectral scatter removal method in the aforementioned methods in aforementioned PCT and this disclosure, including beam blocker array method, including beam selector method, including time of flight source and detector method, including frequency based primary modulator method, the scatter is removed to less than SPR < 1% or less than 5% for example, as the contrast agent is reduced, for example, at least to ,50% , <75% , or <90% , or <99 % , or <99.5%, the precise attenuation value or optical density due to contrast agents are measured, in a spectral measurements, or single energy point, ID or 2D, or in multiple dimensional imaging conditions. Microbubble Void Imaging

Microbubbles generated by ultrasound for example may be used in void imaging by x ray tomography or spectral imaging. Inter lumen mixing may be characterized using this technique. microbubble disruption at high ultrasound pressure was harnessed as a technique for injecting a negative indicator by creating a microbubble void within a microbubble-filled vessel.

In one configuration, A long burst of 5000 cycles at 2 MHz and a peak-negative pressure of 1.3 MPa was transmitted from the single-element unfocussed transducer to destroy the microbubbles within the intersection volume between the ultrasound field and the vessel lumen

Microbubble contrast agent In one configuration,

Using the formulation outlined by Sheeran et al. (20111. decafluorobutane microbubbles were prepared by the dissolution of l,2-dipalmitoyl-sn-glycero-3-phosphatidylcholine (DPPC),

1 ,2-dipalmitoyl-.s77-glycero-3-phosphatidylethanolamine-polyethyleneglycol-2000 (DPPE- PEG-2000) and l,2-dipalmitoyl-3-trimethylammonium propane (chloride salt, 16:0 TAP) in a molar ratio of 65:5:30 and total lipid concentrations of 0.75, 1.5 and 3 mg/mL. The excipient solution comprised propylene 15% glycol, 5% glycerol and 80% normal saline. Microbubbles were then generated via agitation of a 2-mL sealed vial containing 1.5 mL of the resulting solution using a shaker for 60 s.

The microbubble solution generated was sized and counted according to Sennoga et al.

(2012) and had a concentration of about 5 x 10⁹ microbubbles/ml, with the average size at 1 pm. In this study, microbubbles were diluted in outgassed water (Mulvana et al. 2012) to a concentration of 2 x 10⁵ microbubbles/mL.

Void creation by bubble destruction

In one configuration, microbubble disruption at high ultrasound pressure was harnessed as a technique for injecting a negative indicator by creating a microbubble void within a microbubble-filled vessel. A long burst of 5000 cycles at 2 MHz and a peak-negative pressure of 1.3 MPa was transmitted from the single-element unfocussed transducer to destroy the microbubbles within the intersection volume between the ultrasound field and the vessel lumen. This level of ultrasound transmission is well within the Food and Drug Administration (FDA) safety limit (FDA 2008).

Missing data may be due to grid space between active pixel area in a detector in some cases, interpolation may be used to fill up the missing data gap. In some cases, additional images may be need to be taken to fill in the data gap. For example by moving the x ray emitting position in the same area the first positions of the radiation emitting positions, only in positions different from the first positions, or second positions where the emitting positions may be center at regions in between the first positions.

In one configuration, one or more markers, which may be placed in one or more distributed location, may attenuates x ray differently than the background, in some cases, perturb x ray distinctly and or differently than the rest of VOI, achieved through distribution through space, atomic z and or density, may be used to characterize relative distance and or 2D - 6D position of anatomic markers in VOI. Such a marker may be used to collocate the patient anatomic markers as the patient moves, for example, when patient rotates in order to improve accessibility for procedures or reduce radiation exposure or for better visibility, for example, reduce number of tissue types in an VOI.

The marker may be measured by x ray and or may be sensitive to optical measurements, such as it has reflective surface, and can be measured by an one or more optical sensors placed externally to the patient. One or more optical sensors may be placed on the patient, which may capture retroflectors or LED positioned in the line of the sight of the sensor to precisely position the patient 6D location. Such a device may be used to collocate multiple measurements where the VOI may be rotated and or there may be motion by VOI which affects x ray measurements and artifacts may be generated.

. The system substantially unifies the coordinate systems of the patient, optical position sensing device and or imaging systems

Presentation of a point or line or structural illuminated measurements of ROI

In one configuration, representation of point measurements such as material decomposed measurements to represent individual substances, or composite substances, may be displayed against a 2D or 3D background, based on the spatial location of the ROI illuminated which result in the point or ID or structural illuminated projection measurements.

Such spatial location may be derived from the determination of the movement of x ray source, or x ray emitting position, and /or focal spot size, field of view, relative to the ROI, and / or relative to the detector.

Such spatial positioning of ROI illuminated region may be determined by measurements prior to the subject or ROI placed in between the source and the detector.

In one configuration, Mobile Medical Imaging incorporating present disclosure and aforementioned PCT and patent disclosure

Typically, x ray tomography systems, such as conventional CT is bulky, therefore difficult to be moved around due to its dimensions.

In one configuration, the tomography system described is compact, small enough to fit through a standard room door.

Mobile system described in the past, autonomous mobile device

Flexibility - that the system can be taken apart and assembled in less than 5 minutes. Various detectors may be used and mounted in a per need basis. The source emitting position mover or the beam steering device may be permanently mounted with the source or detachable. Various sources may be placed in the same mounting location. Such sources may be detached prior to moving to avoid major impact. And such a source or sources may be kept in a case during transportation.

The navigation, and drivable device and transport device is detachable. Thereby can standalone and used to transport other tomography system.

Once the destination is reached, such a device is detached from the x ray system, as the mobile portion comprising the drive device, or the transport device and the navigation device is not permanently installed to save space. In some cases, part of which are connected permanently.

In some cases, the whole part of mobile device is connected and integrated with the apparatus. Tomography system may be equipped with a pulling electric motor, which is driven by a user pressing a button or using a control stick.

Such a tomography system may be collapsible into a more compact form for easy and safe transportation to avoid damages and causing damages to the surroundings during transportation.

In one configuration, a mobile X-ray tomography apparatus, capable of taking 2D and or spectral imaging and measurements, for imaging guidance, point of care diagnosis, diagnosis, 3d fluoro, comprising an apparatus body comprising one or more of the following items: x ray generator, computer acquisition, processing and viewing device, an X-ray source or an x ray source mount where an x ray source may be detached or attached and an X-ray detector mounted thereon or an detector mount where x ray detector may be detached and reattached upon reaching the destination, associated power supplier, controllers, said apparatus body may be connected to a mobile body comprising one or more of a drive device and a transport device;

In one configuration, the mobile body may be permanently attached to the apparatus body or may be detachable. Computer for image acquisition and or a display system may be part of the apparatus.

In some cases, the mobile body has container location which has one or more slots for the detector or detectors, and container location for the x ray source or x ray sources.

One or more element of the mobile body in some instances are permanently connected to the apparatus body, for example the transport device.

In one configuration, an instruction receiving device is connected through a physical connector to the apparatus body, is detachable, the instruction receiving device being configured to receive an instruction configured to be entered therein as an input, and configured to instruct the mobile body to transport the apparatus body to reach a designated position; a navigation device removably mounted on the apparatus body, to which the instruction receiving device sends the instruction, the navigation device including a detection device comprising an optical detection and distance-measuring sensor, the optical detection and distance-measuring sensor being mounted so as to face a region in front of the apparatus body in a direction of travel thereof, the optical detection and distance-measuring sensor being configured to emit a series of coded laser pulses at intervals of a predetermined angle in a plane in space so as to detect, in real time, the environment of the mobile X-ray examination apparatus, wherein said navigation device is configured to create an environment map of an environment of the mobile X-ray e amination apparatus, and to determine a current position of the apparatus body according to a detected environment profile information; said navigation device being further configured to calculate a movement trajectory of the apparatus body according to the environment map, the current position, and the designated position received from the instruction receiving device; and a central control device situated on the apparatus body, wherein said navigation device is configured to send an electronic designation of the calculated movement trajectory to said central control device, wherein said central control device is configured to operate said drive device that in turn drives said transport device of the apparatus body to follow the calculated movement trajectory so as to reach the designated position, and wherein the navigation device is connected, when mounted on the apparatus body, to the central control device via an interface that provides connections to power the navigation device and to enable communications between the navigation device and the central control device.

The integration of a portable tomography system with an ambulance, as a portable CT. may be battery operated or may be powered by the electrical vehicle or the engine. The exterior of the CT should be connected via mechanical method and or hardware. For example, a rail tracks on ambulance for the wheels of the portable CT. and or rail racks for the upper structure for the x ray tube on the roof of the ambulance.

Locking mechanisms to lock the wheels of the x ray system and or the x ray source and related hardware and or the mover for the x ray source in place.

In one configuration, a stationary x ray system may be installed inside the vehicle, as a part of the construction, for example to the ceiling and to the floor of the vehicle. And there may be support connections to connect the structural support of the x ray system to either the floor and or at least one side of the vehicle. And the x ray source may be attached to a robotic arm which may have one or more joints, which allow flexibility in direction as well as flexibility in distance and movement in dimensions the movement may be manually controlled or motorized. In addition, electromagnetic steerer may move the x ray emitting position for tomography and or a mover to move in at least one axis of 6D dimension for, for example, tomography and or increase field of view of the tomography, for example to perform tomography in two ROI which may be separate from each other spatially in the xy plane parallel to the detector.

In one configuration, such an x ray system inside an ambulance can be a whole body tomography system.

In one configuration, flexible hardware implementations

In one configuration, as the ROI is further determined, the field of view may be adjusted by collimator, MAD filter and or adjusted internally by the field emitter x ray source where the angle of emission is adjusted to fullfill the demand of field of view.

As the field emitter source may also be adjusted to emit structural illumination such as only a certain regions of emitter is emitted, thereby generating a narrow beam. Sequential generation of narrow beam or simultaneous narrow beam distributed from each other may be generated to measure a VOI to track or interrogate, for example, with multiple energy x ray.

In one configuration, the focal spot size may be adjusted by the x ray source for example field emitter x ray source depends on the application demand and resolution demand in xy or multiple dimensions.

Beam particle stopper plate may be moved for spectral imaging or tomography or may stay stationary.

In one configuration, the data gap may be interpolated from adjacent regions, for example, for visual presentation purpose, and or when accuracy requirements or precision requirements are not very high but in general to make up for the data gap due to beam particle stoppers, the beam particle stopper may be moved, and or imaging in other energy level while the beam particle stoppers are in a position different from those which caused the said data gap, and or as the x ray emitting position moves, the region of ROI, which are illuminated by the primary blocked by the said beam particle stopper position to cause said data gap, may not be in the same position relative to the emitting position of the source, therefore the primary x ray from the emitting position may pass through the said ROI region and reaching the detector instead of blocked by the x ray emitting position. Therefore additional projection images may need to be done than what is required for x ray tomography in order to make up for the missing data. In addition, in cases, where sparse data is sufficient for evaluation of a certain multiple dimensional imaging application, wider angle projection combined with scatter removal to access better visual position of a ROI may be done rather than getting a high spatial resolution tomography and high spectral resolution image, it may be less radiation less time required to take at least one projection imaging to estimate the thickness and or access visually an internal ROI from for example 90 degree angle than before, and a low resolution projection and or less number of projections may be needed in order to assess, identify and characterize the ROI. Therefore a combined trajectory may be preferred in some cases.

In one configuration, reconstruction of adjusted resolution may be done on one tissue and a different type of reconstruction such as a different resolution may be done on a different tissue. For example, if a tumor is estimated to be embedded only in selected one or more tissues, only high resolution 2D or 3D images need to be reconstructed for those tissue only.

The other tissues may be estimated by the nature of slow variation or AI method to derive the three dimensional and or spectral data.

For the selected region where distinct information may provide evidence or trace of information for characterization to derive from or for identification to derive from or for diagnosis to derive from , additional measurements or projections may be performed to interrogated the selected tissues.

Going further, on the other hand, measurement of one or more relevant substance or component or ROI in varied settings of resolution in spectral or spatial domain, or in the time domain, may be done in order to derive information may be used to derive information which reveal negative presence or absence of a certain substance or component or a tissue or a marker.

Reconstruction may be based on system matrix or a non system matrix approach in which each voxel is tracked and labeled based on each projection line and its attenuation value may be derived.

In one configuration, prior trajectory geometry are designed either to accommodate multiple applications by different users, therefore providing flexibility of multiple degrees and multiple coordinates. And the user may put in any projection geometry using the software. The example, are use of various applications of tomosynthesis of large angles. In one configuration, the system matrix set up here are simplified and specific for one system, therefore providing only limited number of degree of freedoms for the specific application only.

In one configuration, for a large field of view whole body imaging, only one coordinate of three degree of freedom is needed to represent both 2D or 3D translation of x ray source as well as translation of detector or detectors in 2D or 3D translation mode. The same coordinate may be used in tomography reconstruction of a ROI, when the emitting position is moving in the x y plane and or moving in only one axis and or when moving in 3D in for example, translation direction.

Additional coordinate or coordinates may be added for example to represent x ray detector and or x ray source rotation. These coordinates may be needed because of the alignment of the source and or detector may not be deviated from the theoretical position where the program or the user sets at, the user can either align the hardware perfectly or use digital method to track the rotation and or misalignment of the detector and the emitting position.

The data is then used in calculation of preprocessing, or post processing to correlate data, or to make image processing and or in reconstruction algorithms.

A virtual detector position, relative to the x ray emitting position may be generated in which the x ray detection plane is perpendicular to the center axis of the cone beam or center axis of a set of distributed thin beam. And the measurements may be converted to the measurements at a translational and or a rotation placement , which is where the actual detector is placed at to illustrates the actual geometry.

The virtual detector position relative to the actual detector position is determined by a number of means, including sensors, such as time of flight sensors, or cameras or at least point detectors and or x ray exposures and or x ray exposure plus reference objects with which measurements may give rise to the accurate determination of virtual detector spatial position information.

In one configuration, In case of iterative algorithms are used, and or simulation are used, such deviation from the theoretical configuration or ideal positions may be taken into account when simulated data such as projection data are generated.

In addition for imperfection of beam geometry, and the correction of, the algorithms may make use of a measurement such as white field measurement and or during measurement of a subject, with or without a reference marker or reference object to determine quality of cone beam as well as its position in 6D.

In one configuration, measurements may vary, depends on the x ray source, due to the variation of spectral or multiple x ray radiation characteristics and or source design. The differences may be characterized prior to the measurements of the ROI so that the differences may be accounted for in each reconstruction or spectral imaging calculation. This may be done by deduction based on characterized beam behavior and measurement at a specific location of the cone beam

In one configuration, using sensor or time of flight sensor to measure the total thickness. And based on the attenuation value of each tissue, the thickness and density can be estimated for each tissue

Using a sensor, such as a time of flight sensor or optical sensor, the thickness of ROI may be derived. The thickness of the ROI may be used such that in the material decomposition method, where on inverse energy function system using interpolated plot is established via the data points derived from measurement of known samples with known density with similar thickness range of the ROI. For example, if the thickness is 5cm, a number of known samples with similar density as with thickness varies for example from 2 - 5 cm, may be measured individually and or in a composite material similar to the ROI, to establish an interpolated plot at dual or multiple energies. And given the thickness of ROI at 5cm, such a plot is used to be accurately deduce the attenuation value of each of decomposed material within the ROI. If a large pool of measured value is obtained. Based on the thickness of ROI, an interpolated plot or energy response function system may be generated specifically for the thickness range, in order to derive more accurate or precise results of material decomposition for the ROI.

Integrated audio and or camera/ video systems

In one configuration, Integrated audio and or camera/video may assist patient positioning within the x ray system for imaging, or may assist user such as medical tech and patient communication while the patient and medical tech are not in the same room. And or in situations where remote monitoring and imaging are required from a location adjacent to room housing the imaging system or from a room remote from the room housing the imaging system. For example, in consideration of social distancing or when the patient is highly contagious, limited contact or no direct contact is needed during the imaging procedure. Speaker and audio system as well as camera system and visual system may be used at the patient side.

And speaker, audio, camera and visual system may be used the user side, which may be in a different room.

Such a system may be integrated with the x ray system for example, the speaker is positioned In one configuration, a imaging system comprising:

Optionally a table; the table may be placed on top of the gantry b

A gantry A containing detector or detectors for receiving radiation. The gantry surface may be used as a surface and structure for patient. a gantry A containing the x ray radiation source is above said table;

A side gantry C containing structural support, for example, on the side of table, for supporting the radiation source and or connecting the radiation source with Gantry A where the detectors are.

Structure Design for Functional Use - loading of patient and compactness and storage of the electronics.

One configuration of the build of the system is to leave a gap between the support pillar and base gantry.

Among many benefits, having a connecting bridge to allow electric wiring and control of the stage from the pillar, at the same time, allowing a patient table, such as a surgical table or patient bed to be placed directly below the x ray source and base gantry without having to move the patient off the table.

One configuration is to have the base gantry directly connected to the support pillar so that the patient can be load onto the patient table above the base gantry where the detectors and assemblies are held.

Gantry A, B , or C may be integrated. a photo or x ray detector mounted on a gantry B or gantry C for performing imaging of a radiation field emanating from a patient lying on said table or the surface of gantry A optionally a display screen mounted within said system so that it can be viewed by said patient; the display screen may display images of the patient or optical camera images of the patient and or images of the user controlling the x ray imaging system, or phycian.

At least one camera may be mounted on gantry C or Gantry B for visualization of the patient.

Camera can be controlled by a controller at the side of gantry via a microprocessor or at a desk top display side or at the user side remotely. an audio speaker provided with said system, for example, via connection with a controller or a computing system, such that sound emanating therefrom may be heard by said patient; a media player connected communicably to said video screen by a first channel and to said audio speaker by a second channel; wherein said first channel comprises further a standard interface mounted on said gantry A, or B or C and interposed between said media player and said video screen; and wherein a patient may listen to the sound from the audio speaker and optionally view said video screen while undergoing said imaging or before imaging procedure or after imaging procedure

In one configuration, the patient may have a microphone on site, which integrated with a microprocessor via communication channel and digitized audio be streamed through a network through an software or digital method, and displayed on a media player in a remote location. User, the physician or the imaging tech may have the same set of set up, audio speaker, microphone, and in some instances visual display to visualize the patient and patient position on the x ray table.

The audio speaker may also be used for audio alerts such as radiation active and any error conditions. The video camera may be used to assist in alignment of x-ray tube over the subject and region of interest, by the user. The audio and or video system may also allows for remote monitoring or positioning of the patient by verbal and visual presentation and communication between the patient and the user such as a x ray tech or a surgeon.

In one configuration, Time of flight Method is used

Typically, using time of flight sensor, and or x ray source may remove the separate primary with scatter to less than 5% or less than 1%, combined with n to n6 matrix method described in the aforementioned PCTs and one configuration one configuration, it allows for quantitative 3D and or spectral imaging in a short time.

In one configuration, time of flight method may be combined with and/ or utilized in single energy imaging, spectral imaging, tomosynthesis, with multiple source, or multiple location of the source spanning in a range greater than 5 degrees, or 10 degrees, or 5cm or 10 cm for sparse reconstruction or combined with conventional CT and or helical or any other trajectories which allows for a complete reconstruction

In some cases, amount of exposure may not be enough due to a single pulse, for example, when in the ps or faster range.

Measurement of two or more pulses from the same emitting position and/or travel in the same projection path through VOI may be combined to give a total primary x ray measurement which may be characterized using spectral, tomosynthesis and CT and multiple dimensional imaging apparatus and method.

When combined with a full field x ray measurements, characterization of ROI and or components internal to ROI in space and / or in time and or in spectral domain, may all be achieved. Scattered x ray signals which has a time delay would be separated out in the time domain from primary x ray.

For example, as the user or the computer program determines ROI for time of flight measurement, from at least one x ray emitting position, an x ray pulse is emitted from time of flight x ray source, illuminating ROI or a portion of ROI, the corresponding detector is synchronized to capture and separate primary x ray and scatter x ray. At one additional x ray pulse is generated, so that primary x ray and scattered x ray is measured and categorized. In some cases, the scatter x ray is not measured, only primary x ray is measured by timing the measurement capturing time window of the detector. Any x ray signal outside of the time of arrival for the primary x ray is not processed selectively.

The primary measurement from two or more pulses are combined to produce primary x ray measurement for further processing.

A time of detector may be used to capture x ray signals from multiple emitting positions at the same time. For example, if each x ray emitting position illuminates the ROI at the same time, however from different emitting positions,

In one configuration, Thickness measured by an external sensor or estimated by x ray measurement, or estimated by the user and select a size based on visually assessed approximate value.

In one configuration, In addition to the total thickness, AI may be used to determine or a database may be used to store information on the type and estimated amount of substance or substances ROI may have, from optical measurements, or x ray measurements, exposure level may be approximated based on such values or information. And the thickness or proportion of each substance or composite substances within the ROI may be estimated, for example using material decomposition, such as dual energy or multiple energy x ray measurements. Exposure levels on the subsequent measurements on the same ROI or selected region or regions of ROI for either material decomposition or multiple dimensional measurements or tracking or monitoring may be approximated.

In one configuration, the x ray imaging system may be used to guide Robotics

In one configuration, surgical guidance of robots may be accomplished by X ray measurements combined with optical based motion tracking to better locate surgical tools.

Obtaining imaging data of a VOI of object using an imaging device

Display the image data of the VOI on a display screen

Tracking with a motion tracking device couple to the imaging device, a position and orientation of surgical instrument.

Optical based motion tracking may deploy distance to 6D tracking by deploy one or more optical sensor assembly, including a retroflector. The optical sensor assembly may have a negative lens or fish eye lens and waveguide and 2D sensor down stream from the waveguide. The negative lens and the waveguide and the sensor assembly may be monolithic.

And the optical sensor assembly may be mounted to a movable device, which can be tracked by optical means by the following method: two or more LED emitters may be used external to the movable device, optical sensing assembly may be mounted on the movable device.

Supporting an end effector relative to the patient with a robotic arm coupled to the imaging device

Modifying at least a portion of the image data displayed on the display screen in response to a change in the position and orientable of the movable effector and the end effector with respect to a position of the patient.

Wherein x ray imaging data indicates the position and orientation of the end effector of the robotic arm.

X ray measurements may be combined with inertia based surgical tracking.

X ray system may be combined with one or more 6D optical input device, for tracking of surgical instrument in minimum invasive intervention procedures.

Surgical Robotics Guidance

In one configuration, the system is designed to display medical device,

In one configuration, the system comprises a virtual window system that creates a visual coherency between the image of the patient and his or her anatomy and the patient by aligning the image of the patient anatomy on the display to the patient and presenting the image to the user that feels as if the user is looking directly into the patient through the display. The invention is designed to also display medical devices, such as a minimally invasive tool. The system substantially unifies the coordinate systems of the patient, the medical device, the display, and the physician's hands. The invention creates a visual coherency between the motion of the medical device in the image and the motion of the physician's hands manipulating the device. This method also creates a visual coherency between the motion of the image in the display and of that display.

In one configuration, the system includes the capability to display an image of a patient anatomy on a moveable display, said system comprising: a display screen configured to be moved and aligned with target regions on an exterior of a patient's body; a processor configured to receive data representing the patient's anatomy relative to the movement of an intervention or biopsy device such as a catheter or a portion of a catheter or implant for intervention procedures and data representing a position of the display screen in real time, wherein the processor is configured to deliver to the display screen a real-time image representing the catheter or a portion of catheter or an implant navigating in the patient anatomy in accordance with a first spatial relationship between a position of the intervention device and its navigation path in patient and a position of the display screen in real time, the image being updated in real time in response to movement of the display screen in accordance with the first spatial relationship; and means on the display screen allowing a user to establish a second spatial relationship between the position of catheter which is trackable by the x ray imaging device in 6D relative to the patient's anatomy, the position of the display screen in real time, wherein subsequent movement of the display updates in real-time the image on the display in accordance with said second spatial relationship.

The display may be a virtual reality display.

The surgical tools connected to a surgical effector or a catheter with one or more portion of it having 6D attenuation variations so that it or a portion of it can be tracked in 6d by x ray imaging.

In one configuration, a first control signal is generated to control an intervention device. The first control signal is send to or a microprocessor or send to a microprocessor and or directly to a user or be connected to an intervention device or robotics arm. In response to the first control signal, a first valve in the robotic surgical instrument or the intervention device is opened to flow a first fluid over a surgical site. The valve may control the fluid to be delivered through a lumen of a catheter. The opening is at the tip of intervention device. generating a second control signal to control the robotic surgical instrument or an intervention device, coupling the second control signal into the robotic surgical instrument; and or inform an user or an microprocessor to inform an user and in response, opening a second valve in the robotic surgical instrument to flow a second fluid over the surgical site in response to the second control signal. And cascade of 3^rd or more control signals and manipulated the same way.

Minimal Invasive Device Design for improved x ray guided intervention

In one configuration, a system for use in treating a carotid arterycan include the following components: an arterial access device adapted to be introduced into a common carotid artery the arterial access device having a lumen that extends from a distal opening at a distal region of the arterial access device to a proximal opening at a proximal region of the arterial access device, the lumen configured for receiving retrograde blood flow through the distal opening from the common carotid artery; and a shunt having an internal shunt lumen fluidly connected to the lumen of the arterial access device at a location between the distal and proximal openings of the arterial access device. The internal shunt lumen can provide a pathway for blood to flow out of the internal lumen of the arterial access device at a location between the distal and proximal openings of the arterial access device; and said first occlusive member can be located on said catheter.

One configuration further includes methods and systems for establishing retrograde carotid arterial blood flow, systems for cleaning and vacuum system of debris from intervention operations, and a method for positioning a bifurcated graft across a distended region of a main vessel adjacent a bifurcation of the main vessel into an ipsilateral vessel and a contralateral vessel. The method can include the following steps: introducing a catheter pre-packaged with a bifurcated graft therein into the ipsilateral vessel and then into the main vessel to a point beyond the distended region, the bifurcated graft having a tubular main portion branching into two tubular extensions at a bifurcation point, namely, an ipsilateral extension and a contralateral extension; deploying the bifurcated graft from within the catheter so that the tubular main portion contacts the walls of the main vessel at a point beyond the distended region and the tubular extensions are located within the distended region and pointing toward respective ipsilateral and contralateral vessels; delivering a flexible guidewire through the ipsilateral vessel and ipsilateral extension and causing it to deflect around the bifurcation point into the contralateral extension and then into contralateral vessel; deploying a tubular contralateral graft through the contralateral vessel using the flexible guidewire; engaging a first end of the contralateral graft with the contralateral extension; engaging a second end of the contralateral graft with the contralateral vessel; deploying a tubular ipsilateral graft through the ipsilateral vessel; engaging a first end of the ipsilateral graft with the ipsilateral extension; and engaging a second end of the ipsilateral graft with the ipsilateral vessel.

The step of deploying the contralateral graft can include: a. using the flexible guidewire as a locator within the contralateral extension of the bifurcated graft to deliver a stiff guidewire into the contralateral extension from the contralateral vessel; and b. passing the contralateral graft over the stiff guidewire into the contralateral extension.

A bifurcated graft assembly for bridging a distended region of a main vessel adjacent a bifurcation of the main vessel into two branching vessels can include the following: a. a bifurcated graft having a tubular main portion branching into two tubular extensions at a bifurcation point, the bifurcated graft including a bifurcated graft body reinforced with a plurality of separate and spaced apart wires in the main portion and tubular extensions each of which has a generally closed sinusoidal shape, at least one wire at the ends of each of the tubular extensions is self-expanding, a first wire being located adjacent to the end of the main portion of the bifurcated graft body such that alternate apices of the first wire projects beyond at least part of the end; and b. at least one tubular graft sized to connect between one of the tubular extensions of the bifurcated graft and the respective branching vessel, the tubular graft having a graft body reinforced with wires, wherein a wire in a first end of the tubular graft is balloon-expandable, the first end of the tubular graft being overlapped within and being capable of outward expansion into frictional engagement with the end of the tubular extension to form the graft assembly.

A prosthetic mitral valve assembly can include a radially-expandable stent including a lower portion sized for deployment between leaflets of a native mitral valve and an upper portion having a flared end. The upper portion is sized for deployment within the annulus of the mitral valve and the flared end is configured to extend above the annulus. The stent is formed with a substantially D-shape cross-section for conforming to the native mitral valve. The D-shape cross-section includes a substantially straight portion for extending along an anterior side of the native mitral valve and a substantially curved portion for extending along a posterior side of the native mitral valve. The assembly can further include a valve portion formed of pericardial tissue and mounted within an interior portion of the stent for occluding blood flow in one direction.

An active annuloplasty ring holder can have a template that can be folded or pivoted to the side allowing the template to align longitudinally with the handle and enter the patient's chest through a small incision. The holder may include a mechanism to remotely detach sutures fastening the ring to the holder, thereby detaching the ring while avoiding the risk associated with introducing a scalpel into the operating field. A detachment mechanism may include a movable pin actuated by a pull wire that releases a plurality of holding sutures, or a hot wire, knives, or pull wire that severs the sutures. The holder may have a built-in light source for better visualization of the ring inside the heart. The holder may also have an optical mechanisms of visualizing the inside of the heart from the proximal end of the handle.

One or more components or portion of the above described minimum invasive devices containing one or multiple regions may be made of materials with the same or varied attenuation properties, so that the movement and process of procedure may be controlled with visual and measurement based feedback related to the artery and other parts of body.

Visual and x-ray measurement based feedback system disclosed herein may be used for the following non-limiting examples and any other medical device, such as surgical devices described herein:

SUTURE CLIP DEPLOYMENT DEVICES;

SYSTEM AND METHOD FOR CRIMPING A PROSTHETIC VALVE;

FORCE-BASED HEART VALVE SIZER;

METHODS OF IMPLANT OF A HEART VALVE WITH A CONVERTIBLE SEWING RING; and

FLEXIBLE ANNULOPLASTY RING.

A catheter-based material removal device includes an elongated tube having a distal material removal tip thereon. The material removal tip includes a one- or two-piece housing affixed to the tube, and a rotating member therein. The rotating member includes a screw thread for coarsely chopping material received within the housing and an outwardly projecting flange for finely chopping the material. The housing includes at least one shearing member located axially adjacent the outwardly projecting flange. The shearing member has a relatively small circumferential size and a shearing edge that removes any material buildup on the axially- facing surface of the flange. Two shearing members may be provided, one each on both the proximal and distal sides of the flange. There may be three flanges restrained within a groove formed with the housing.

Multiple lumen catheter can have a soft tip. A multiple lumen access device can be used for providing a single entry port into the human body for selectively introducing medical implements therethrough and for providing simultaneous auxiliary access into the body. The multiple lumen access device includes a multi-lumen sheath which may have an outer tube and structure defining a device lumen located therein. The inner structure may be an inner wall or inner tube. The outer tube and inner structure are located so as to define at least one auxiliary lumen. Some embodiments include flexible inner walls which can be flexed between relaxed and expanded/contracted positions wherein the relative cross-sectional areas of the device lumen and auxiliary lumens are varied. The access device further includes a valve which provides sealing of the device lumen. The valve may be provided in a lumen junction housing or separate from the housing either permanently or removably connected with the device lumen.

A system can sense a characteristic of fluid flowing to or from the body of a human or a conduit having a first end adapted to be outside the body, a second end adapted to be received within the body, and a flow passage through which fluid can flow between the first and second ends. There may be a probe including a sensor for sensing a characteristic of the fluid or a liquid dispensing device in the lumen of the flow passage having an internal lumen which fit into the flow passage and be reasonably sized so that one or more contrast agents may be released into the flow passage. The direction of the flow and speed may be tracked by taking measurements at one or more time interval. And second or third contrast agents may be administered in order to track sequence and directions and speed of the flow. The probe is mounted on the conduit with the sensor in the flow passage. The sensor is isolated from the fluid flowing in the flow passage.

Examples of Configurations of 3D Reconstruction

In one configuration,

3D reconstruction method solving multiple linear equations, for example, for a volume of ROI, with volume of m x n x p, for example, in dimensions of X x Y x Z, , total number of voxels may be approximately m x n x p, where m, n, or p describes dimensions of ROI in units of voxels along, each of X, Y , Z coordinates for example, in a ROI with total number voxels of 64 x 64 x 64 = 262144, if 64 is approximately the dimensions in units of voxels in the X direction within ROI, coordinate value along the x direction, and approximately is the coordinate value along the y direction. 64 x 64 approximately describes the xy plane in which the ROI is enclosed in, in some cases are parallel to the detector; z is the thickness along the center axis, may be perpendicular to the detector plane, in this example, may be approximately 64, total number of variables may be 262144 variables needs to be resolved. For example, resolve approximately 4096 linear equations involving 262144 variables. In 3D volume of VOI projected image, as the x ray emitting position moves relative to the object or the detector, additional unknown voxels may be added to the total number of unknow voxels need to be resolved.

For example, in the instance when the x ray emitting position moves relative to the subject, and or detector, in the xy plane, one pixel pitch at each step in an area of c², the total unknown linear equation at each projecting involving voxels in the ROI may still be m x n, additional pixels on the detectors used to make the measurements of projected image may be c² + (m+n) c. However, each time as x ray emitting position moves, not all of such pixels are used in measurements or in the solving of linear equations. As x ray emitting position moves away from the original position, additional pixels are to be used on the detector for the measurement of projected image involving voxels inside of the ROI, therefore the measurements from such pixels are used for in the solving of the linear equations.

The total additional unknown voxels may be calculated. For example, if the top layer of the ROI is in the middle point from the source to detector, and the x ray emitting position of the original position passing through the middle axis of the ROI, and if the x ray emitting position moves in the xy plane, for example, in approximately c² or c²-l steps, each step is approximately pixel pitch in dimension, if each voxel is approximately described as Xa x Xb x Xc where Xa, Xb and Xc are dimensions of the voxel in the X, Y, Z coordinates, in this example, Xa = Xb = Xc , and Xa is approximately equivalent to the pixel pitch of the detector, then, the total unknown voxels introduced may then be approximately described as

½ x c²x m + ½ c² x n = ½ x c² x (m + n) Equation (1)

In some cases, Xa, or Xb or Xc may not be equivalent in dimensions, nor Xa, or Xb or Xc may not be the same size as the pixel pitch of the detector. Or the top layer closest to the source or the x ray emitting position may not be the middle point between the emitting position and the detector. The number of unknown voxels therefore may be adjusted accordingly.

In one example, each voxel of ROI illuminated by X ray and projected onto the detector, is correlated with at least one pixel on the detector as x ray source moves, or relative position of the object and source changes, the correlation is tracked and new measurements are performed.

Each voxel in ROI contributes to the projection image or measurements on the detector. Such process may be tracked by labeling both the voxel as well the detector pixels.

Projected measurements or projection images may be related weighted voxel attenuation density.

Projected geometry of an x-ray system representing approximately three degrees of freedom in a system matrix disclosed herein may be sufficient for multiple dimension reconstruction or 3D reconstruction.

Projection geometry of a system matrix designed for tomographic reconstruction, comprising additional coordinates or vectors formed to represent additional degrees of freedoms to describe relative spatial position and movement of one or more components.

3D reconstruction by solving linear equations may take a long time. Using Simultaneous Algebraic Reconstruction Technique, it may still take a long time. Using simultaneous updating method, SIRT, may take long time. Methods to improve the speed of reconstruction may include one or more of the following methods

• using texture mapping hardware, such as 2-D texture mapping hardware with microprocessors,

• Using texture mapping hardware, such as 2D texture mapping hardware, and /or extend the precision of a given frame buffer using color channels, or using methods to increase the resolution of the framebuffer.

• parallel processing, CUDA

• parallel processing, by section off longitudinally along the center axis direction ROI into two or more volumes, each with less linear equations.

• Reduce field of view, or size of volume based on previously known information or data, or user selection, dual or multiple energy analysis, or low resolution 3D information or imaging results of other modalities, such as endoscope, spectroscopy, thermo, mri, ultrasound, or photoacoustic, electromedical, optical imaging, or user selection or digital program selection based on preset criteria, or AI analyzed results or AI methods and or deep machine learning.

• Randomized iterative method for solving a consistent system of linear equations may be used to improve the speed of reconstruction using Algebraic methods.

Reconstruction with fast speed may be achieved using the above methods with minimally a general purpose CPU or with GPU.

One method of tomographic reconstruction, may use the method of solving many simultaneous linear equations. One equation can be written for each measurement. A particular sample in a particle profile is the sum of a particular group of pixels in the image to calculate unknown variables ( the image pixel values), there must be independent equations, and there therefore m x n measurements or n squared measurements. The final image has reduced noise and artifacts. Since the ROI is dramatically reduced, therefore it is possible for using n² matrix or n⁶ matrix where the emitting position moves in at least 2 axis of the 6D space for illuminate the VOI.

When VOI is obtained by various methods, such as spectal 2D material decomposition, 3D tomography and spectral 3D and or other sensors, volume of interest is fairly restricted, therefore suitable for the reconstruction.

In addition, due to the SPR is less than 1% or less than 5%, the acquired images prior to reconstruction is highly quantitative, therefore enable solving simultaneous linear equation.

In one configuration, the method of tomographic reconstruction may use iterative techniques to calculate the final image in small steps. There are several variations of this method: the Algebraic Reconstruction Technique (ART), Simultaneous Iterative Reconstruction Technique (SIRT), and Iterative Least Squares Technique (ILST). The difference between these methods is how the successive corrections are made: ray-by-ray, pixel-by-pixel, or simultaneously correcting the entire data set, respectively. As an example of these techniques, we will look at ART.

To start the ART algorithm, all the pixels in the image array are set to some arbitrary value. An iterative procedure is then used to gradually change the image array to correspond to the profiles. An iteration cycle consists of looping through each of the measured data points. For each measured value, the following question is asked: how can the pixel values in the array be changed to make them consistent with this particular measurement ? In other words, the measured sample is compared with the sum of the image pixels along the ray pointing to the sample. If the ray sum is lower than the measured sample, all the pixels along the ray are increased in value. Likewise, if the ray sum is higher than the measured sample, all of the pixel values along the ray are decreased. After the first complete iteration cycle, there will still be an error between the ray sums and the measured values. This is because the changes made for any one measurement disrupts all the previous corrections made. The idea is that the errors become smaller with repeated iterations until the image converges to the proper solution.

Another configuration reconstruction method may be used is an example of DSP, such as filtered backprojection.

An individual sample is backprojected by setting all the image pixels along the ray pointing to the sample to the same value. In less technical terms, a backprojection is formed by smearing each view back through the image in the direction it was originally acquired.

The final backprojected image is then taken as the sum of all the backprojected views

Filtered backprojection may be used as a technique to correct the blurring encountered in simple backprojection. each view is filtered before the backprojection to counteract the blurring PSF. That is, each of the one-dimensional views is convolved with a one dimensional filter kernel to create a set of filtered views. These filtered views are then backprojected to provide the reconstructed image, a close approximation to the "correct" image.

One reconstruction method may be a Fourier reconstruction. In the spatial domain, tomographic reconstruction involves the relationship between a two-dimensional image and its set of one-dimensional views. By taking the two-dimensional Fourier transform of the image and the one-dimensional Fourier transform of each of its views, the problem can be examined in the frequency domain.

One example of fourier domain reconstruction is the following, In the spatial domain, each view is found by integrating the image along rays at a particular angle. In the frequency domain, the image spectrum is represented in this illustration by a two-dimensional grid. Fourier reconstruction of a tomographic image may require three steps. First, the one dimensional FFT is taken of each view. Second, these view spectra are used to calculate the two-dimensional frequency spectrum of the image, as outlined by the Fourier slice theorem. Since the view spectra are arranged radially, and the correct image spectrum is arranged rectangularly, an interpolation routine is needed to make the conversion. Third, the inverse FFT is taken of the image spectrum to obtain the reconstructed image.

In one configuration, an apparatus, comprising: processing circuitry configured to obtain projection data representing an intensity of radiation having illuminated VOI and exited out of VOI of an object detected at a plurality of detectors or the ratio of such intensity over the radiation entering VOI, in some cases, derived from the ratio of from radiation detected in the first detectors and radiation detected at a reference detector, generating the first data sets and a second dataset.

First data sets comprising data generated by at least one detector,

At least a second data set comprise data generated by the same first detectors or a second detectors, the projection data may be from a different radiation emitting position, or different energy level, different exposure or different system configuration. more data set comprising data generated by the same first detectors, or the same second detectors or additional detectors.

In one configuration, a second radiation source may be a first radiation source, or the same radiation source which may have different emitting position or different emitting positions, and or different focal spot size and or different field of view due to an field of view or beam restricting device, such as MADs , referred to as m

Multiple aperture devices (MADs) , sequential binary filters that can provide a wide range of fluence patterns, may be placed between the source and the object, and adjusted dynamically with relatively small motions to select VOI, some of which may be off axis. or collimators.

The second radiation source may be a different radiation source than the first radiation source but travel in the same area of the first emitting positions of the first radiation source where the radiation emitted may be of a different focal size, and or different energy level and or speed of pulse generation. wherein the plurality of detectors and or x ray sources includes the first detectors may have a different detector configuration than the second detectors, or 3^rd or more detectors, wherein the respective detector configurations of the first detectors and second detectors, third or more detectors are respectively determined by a detector type The projection geometry and of pixel elements arranged within the respective first detectors and second detectors, and reconstruct a combined image using the plurality of datasets, wherein each dataset of the plurality of datasets corresponds to a respective system-matrix equation representing respective projection geometries corresponding to the plurality of datasets,

Each dataset of the plurality of datasets may corresponds to approximately the same or similar system matrix equation or a different system matrix equation representing respective projection geometries corresponding to the plurality of datasets, and the image is reconstructed using one of the following methods, using

1. the same system matrix for a plurality of datasets comprising data with scatter to primary ration less than 1% or less than 5%, for example, by either low scatter VOI, or using time of flight primary measurement by removal of scatter in the time domain, or scatter removal method comprising primary x ray image derived from subtraction of high resolution scatter derived from interpolation of low resolution scatter image, using ART or its derivative algorithms to reconstruct, in some cases, iterative methods are used as well.

2. different system matrices for a plurality of datasets, at least one modified- a dual variable, and using a splitting based subproblem method.

3. Same system matrix for a plurality of datasets, at least one modified-dual variable and using a splitting based subproblem method. Subproblem may be performed on the datasets separated by time of data generation.

Use of at least one more addition dataset may be extended using the same method.

Controller for the medical imaging system

In one configuration, the controller is further configured to determine from a defined geometry using a first system matrix comprising at least one coordinate with at least three degrees of freedom.

In one configuration, the controller is further configured to execute a material decomposition to generate a spatial distribution and position model for at least one material . wherein the controller is further configured to generate a material decomposition model based on 2D dual energy or multiple energy material decomposed measurements of the VOI from x- ray emitted at one or both of the first or second emitting positions. The method further comprising a second data set including measurements of a reference detector.

The system , wherein the reference detector is placed in an x-ray beam path. the first data set and the second dataset are used to train AI algorithms for reconstruction and determining said VOI for data acquisition.

In one configuration, the method wherein an x-ray exposure level is approximated by an automatic exposure method and apparatus, the time of flight detector, and/or a reference detector

1. , wherein each system matrix has at least one vector 3 coordinates, each coordinate with three degrees of freedom.

2. The method of any of items 0-00, wherein a density information of at least one substance of interest or composite substance of interest is derived from the at least one 2D projected image of the VOI, or at least one 2D projection measurement at selected pixels at one or dual or multiple energy levels on a normalized pixel basis.

In one configuration, a radiation diagnosis apparatus comprising: reconstructing circuitry configured to reconstruct three-dimensional substance distribution, substance such as contrast agent or microcalcification or a portion of or a whole part of an implant or surgical tool or a catheter tip, distributed rare components in a time series from a group of acquired 2D images and or point to ID measurements acquired in presence of the substance by at least one imaging system from directions in a range that makes it possible to reconstruct three-dimensional images of a ROI of an object, or determine relative spatial position in 6D to a reference ROI or a component internal or external to the object by performing a reconstruction process that is based on at least on one of the following method

1. reconstruction method in some cases, iterative plus a filter threshold approximately similar to that of the estimated substance concentration or related density in the VOI

2. on normalized pixel basis, perform at least one dual energy or multiple energy material decomposition based on an inversion of an established energy response function equation system to solve the nonlinear energy response function , and/or Distributed Rare Component method, perform reconstruction using density information derived from material decomposition. The material decomposition may involve establishment of an energy response function system with an interpolation step where spectral measurement of known materials with various combination of density and thickness are correlated, and interpolate to form a plot to include a total number of variables in density and thickness possible. The total possible number of variables in each substance which may be limited by the total number of dynamic range allowed by the detector pixel for representing each substance and or composite material with two or more substances.

Spectral imaging using photon counting detectors and or energy sensitive detectors, in comes cases, combined with a broadband source, may be used for material decomposition during 3D reconstruction

Spectral imaging using tunable wavelength plus detector may be used for material decomposition to be combined with 3D reconstruction

Spectral imaging using k-edge methods may be used with 3D reconstruction.

In some cases, spatial continuity or temporal continuity of the density of the substance is used as a constraint condition for reconstruction.

An image processing apparatus, comprising:

At least one acquisition unit configured to image a Volume of Interest of an object and reconstruct three-dimensional data and or 3D image; an image formation unit configured to form a first image and a second image according to a first image generation condition and a second image generation condition, based on the acquired data; a generating unit configured to generate positional and distance relationship information expressing a positional relationship between the first image and the second image, based on the acquired data; a controller configured to cause a display to display information expressing the positional and distance relationship, based on the positional relationship information·

A x ray imaging apparatus comprising: setting circuitry configured to obtain position information with respect to a landmark of an object in a first image generated by performing a first image acquisition on the VOI in an object and to set an imaging condition or an imaging setting to be used during a second imaging acquisition by using the obtained position information, the position information being determined on a basis of at least first image and expressed in an image taking system used during the first image; and image generating circuitry configured to generate a second image by performing the second measurements based on the imaging condition.

3d Reconstruction Volume Integration and Subunits of A Voxel

In one configuration, Exact Volume Integration Method may be used. The intersected volume aij, may be computed as the following, a voxel, vj , is projected to a (flat) detector to find detector cells that interact with the voxel. For each cell, ci , a pyramid- like shape of a beam can be designed with four-planes that connect the x-ray source to the four-edges of the cell. Then, the intersected volume between the voxel and the beam is equal to the volume of the voxel clipped by the four-planes. We used the Sutherland-Hodgman clipping algorithm [6] which works by extending each plane of the convex shape of the beam in turn and selecting only vertices from the subject polygon, vj , that are on the visible side.

In one configuration, to approximate the intersected volume, aij , would be counting the number of sub- voxels of known volume within the intersected volume. The approach is inspired by an approximation of the area underneath a curve, also known as a Riemann sum where the area is divided into a number of rectangles (or trapezoids) and approximated by the sum of all the rectangles. Similarly, a voxel, vj , is first divided into N 3 of sub-voxels whose side length is 1/N of the voxel’s side. Then, the intersected volume is approximated by counting the number of sub- voxels whose central points are inside the beam. Figure 2(a) shows a brief explanation of this approach with the case that N is 4 (in 2D for simplicity). In this example, the volume is approximated by 6 · d where 6 is the number of rectangles whose central points (red dots) lie inside of the beam (green area) and d is the area of a small rectangle. Recursive sub-division approach In this approach, instead of having a fixed number of sub- voxels per voxel as in the Riemann sum approach, we recursively divide it into N sub-voxels when the current cube is intersecting with the beam. Suppose that each time a voxel is divided into N sub- voxels. Each sub- voxel will be evaluated if it intersects with a beam or not. If it intersects, the sub- voxel will be divided into another N sub-voxels. This process will be recursively enacted until a pre-defined number of sub-divisions has been reached. The final volume is computes by counting the number of the smallest size of sub-voxels that pass the intersection test. This process is described in Figure 2(b) for the 2D case when N is 2 and there are two sub-divisions. In this example, the volume is approximated as 9 · d where 9 is the number of rectangles at the finest levels that are determined as the one having overlap region between the beam (green area) and tangent circle to the rectangle, and d is area of a rectangle at the finest level.

The intersection test is performed by setting the criterion of non- intersection cases. There are four cases when a voxel (or a sub-voxel) does not overlap with a beam, designed by four planes with inward direction of normal vector.

1. If du (dd ) is negative distance and its magnitude is larger than the half side of the cube, the beam is passing below (above) of the cube.

2. If dl (dr ) is negative distance and its magnitude is larger than the half side of the cube, the beam is passing right (left) of the cube. Here dx is a signed distance from the center of the sub-voxel to a plane, x, and the subscripts {u, d, l, r} are short-hand for the location of a plane as {up, down, left, right}. If any geometry configuration between a sub- voxel and a beam violates one of the non-overlap criteria, we perform another sub-division for the (sub-)voxel or count the voxel as part of the intersected volume, if it reaches the pre defined number of sub-divisions.

In one configuration, the central points of all N ³ sub- voxels obtained as in Riemann sum approach are projected onto the detector. a cell sensitivity kernel may be described by a zero mean Gaussian distribution. In one instance, the variance of the cell sensitivity kernel is determined to have the side length of a cell as its FWHM. In one configuration, the density value at each sub-voxel is obtained by using (tri-) linear interpolation and the projected values are scattered over nearby cells according to their sensitivities.

In one configuration, if a subunit is considered a part of a particular voxel, the voxel can be considered relatively uniform in its density distribution. The density value of the subunit may be interpolated into its surrounding subunits.

Another configuration of a 3D reconstruction based on volume integration method may include the following

Based on the location of the detector 22, to source 12, and individual detector pixel Dxy relative to the VOI, each ray beam radiated from the x ray source may be be collected on a corresponding pixel on the detector after passing through a number of voxels of a VOI in between the source and the detector the said voxels may be identified based on its relative geometric position to the source, to the pixel on the detector pixel Dxy. For each voxel in the beam path, there are a number of subunits, for example, 1000 subunits are used to represent substantially a portion or the complete volume of a voxel Vox ijk.

Based on a reference point in the subunits, such as a center point of the subunit, it is determined from the line connecting the source to reference point of the subunit, an intersection with the detector plane. The intersection point may be on the said pixel location, and the subunit is counted as 1, or if the said line lands on the border of the pixel location or it may be outside of the said pixel area, the subunit is then counted as 0. After all of the spatial position of subunits are evaluated against the said pixel, Dxy the total number of “1” s will be used to determine the portion of the said Voxelijk in the ray beam path which projects on to the pixel Dxy.

In one example, the subunits of each Voxel in the VOI are evaluated based the ray beam radiating from the source, and its corresponding detector pixel or pixel region is identified. The ray beam tracing the pixel or pixel region back to the source may comprise a number of such projecting lines connecting source, subunit in a voxel and the pixel or the pixel region. Each subunit therefore its corresponding pixel on the detector is tracked and counted, until the entire VOI has been evaluated. In one configuration, a cell sensitivity kernel described by a zero mean Gaussian distribution. For example, the variance of the cell sensitivity kernel can be determined to have the side length of a cell as its FWHM.

In addition, when the subunits of the voxel interact with the ray beam, but the ray traced to the detector from the x-ray radiation source, lands in a subregion outside of full width half maximum or outside of the more sensitive part of pixel, such subunits may not be counted as “1”, as the sensitivity of the pixel in the said sub region, may not contribute enough or at all to the measurement of the pixel. Such data loss may be recovered by additional projections passing through the same subunits or voxel. Or alternatively, since the portion of such subunits of the voxel is relatively small, therefore may be neglected.

The results may be used to establish the linear equations to resolve for the unknow voxel values.

Since for each ray beam, connect the pixel to a subunit or a voxel, or a number of voxels, in some case, may be there may be a large number of voxels in total which the ray beam illuminates. The total number of voxels may exceed the number of voxel layers as there may be more than one voxel in each layer intersect the ray beam. As a result, there may be large number of elements in the system matrix established for solving the unknown voxels. And such a matrix may be sparse comprised of many zeros, or voxels which do not interact with the a ray beam under investigation.

Such sparse matrix may be converted into a lesser sparse matrix for faster computation and data processing.

In one configuration of Reconstruction

Using analytic techniques, in which the reconstruction problem is attacked using mathematical analysis. Both the projections and the reconstruction area are divided into pixels, and a numerical approximation of the true mathematical technique is introduced.

The algebraic techniques assume a discretized problem, and solve the reconstruction problem in a completely different way. In the algebraic approach, the reconstruction problem is represented by a system of linear equations. The variables (unknowns) are the pixels of the reconstruction area, and the right hand side of the equations is the projection data. A system of linear equations with n unknowns and m equations looks like a nXi + anX2 + ····+ ainXn — bi a2iXi + a22X2 + ...+ a2_nX_n = b2 a_mlXl + <lm2X2 +... + a_mnXn — b_m where the xj’s (j=l,.. ,n) represent the image, and the bi’s (i=l,...,m) represent the projection data. Using matrix notation, the linear system can be written more succinctly as

Ax=b, where c=(ci···c_h)^t and b=(bi---b_m)^T. T may be the transpose operator, x and b are column vectors. All pixels of the reconstruction area may be listed in a single column vector x, and all data points of the projections are a single column vector b. m x n matrix A specifies what the relation between the scanned object and the projections is. In other words, it is the mathematical representation of the scanner with which the projections were taken. Each row of the matrix (each equation) may describes a single projection ray, since it exactly describes the list of pixels that are hit by that ray. Each ray will only meet a very small percentage of the pixels, since it crosses the reconstruction area in a straight line. Hence, the matrix A may be sparse (a large percentage of its elements is zero).

Another way of solving Ax=b is the Moore-Penrose pseudoinverse A⁺. The solution is then simply x⁺=A⁺b.

In another method, the algebraic reconstruction problem may be solved using iterative techniques. These may start from a certain initial guess of the solution, and then repeatedly apply an update step, till the solution is “good enough” according to some criterion. Most, but not all, of these iterative methods (mathematically) converge to a solution. Examples of iterative algorithms are SIRT and PD ART.

Ax=b, where x represents the image, b represents the projections, and A represents the scanning process

A system like the one shown Ax=b, is typically solved by minimizing some norm ||Ax-b||, the difference between the product of calculated image and image acquisition process or method and the measured projection image. The SIRT algorithm is one of many methods for doing that.

Example of how SIRT is implemented is the following

If A represents the action of the scanner, may also be known as the forward projection. Each row of A contains the coefficients of an equation that corresponds to a single ray. It describes how the pixels are combined into ray sums. The transposed matrix, A^T back projects the projection images onto the reconstruction area. Given a ray sum, it describes which pixels are hit by that ray.

SIRT alternates forward and back projections. Its update equation is x(^t+1)=_X(t)+_CAT_R(_b— _Ax(t)), where C and R are diagonal matrices that contain the inverse of the sum of the columns and rows of the system matrix. These matrices compensate for the number of rays that hit each pixel and the number of pixels that are hit by each ray.

Iterations start with x⁽⁰⁾=0. The update equation then does the following things.

The current reconstruction x^® is forward projected: Ax^®.

The result is subtracted from the original projections: b-Ax^®·

This difference is then back projected. In essence this is done by multiplying with A^T, but weighted with C and R.

This results in the correction factor CA^TR(b-Ax(t)).

The correction factor is then added to the current reconstruction, and the whole process is repeated from step 1.

GPU-accelerated implementation of the same code may increase the speed of reconstruction. Implementation

Example below is an implementation, if matrix A is known.

% Input: sparse system matrix A, data b.

% Output: SIRT reconstruction x. x = zeros(d * d, 1);

[rows cols] = size(A);

C = sparse(l : cols, 1 : cols, 1 ./ sum(A));

R = sparse(l : rows, 1 : rows, 1 ./ sum(A'));

CATR = C * A’ * R; for i = 1 : 100 x = x + CATR * (b - A * x); end

And different sections of ROI may be divided into multiple sections, such as subsets of total volume, and parallel computed.

In one configuration, there is an initial guess and in the repeated step of the iterative steps, a solution may use attenuation value derived for each tissue or each substance or two or more composite substances, and or density values, and or thickness values derived by x ray measurements, such as single energy, or spectral measurements, or a different sensor or predetermined value, or a preexisting database or looked up in a database or an inverse energy response equation system.

In one configuration, low Radiation Tracking Method to track using ultra low radiation method and volume integral method includes at least some of the following Scatter removal using interpolation method can provide high resolution scatter image and high resolution primary image, often needed in diagnostic settings. However, such image processing for high resolution imaging may come at a cost of time required for tracking high speed event. One configuration, scatter removal is achieved by combining scatter removal method to achieve SPR < 1% and SPR < 5% and SPR < 10% with a antiscatter grid. Such a combination may decrease the exposure required even more high resolution primary x ray imaging with scatter removal to less than 1% SPR or SPR with that of image acquired without scatter removal or with an antiscatter grid in real time.

And such a antiscatter grid may move or shaken during image acquisition

In one configuration, as illustrated in Fig. 4. Beam blocker array plate 100 sandwiched in between two detectors, detector 22 and detector 29,

In one configuration, detector 29 may not optional

In one configuration, Table 1, a sample holder or patient table may be placed between the patient and the detector assembly

In one configuration, the beam blocker array 100 may be placed between the source 12 and the patient 2.

In one configuration, a antiscatter grid, Grid 1 may be placed between detector 22 and patient.

In one configuration, Antiscatter grid Gridl may be optional.

The tracking method may be done by using a point, linear detector or 2D detector combined with a full view detector which is capable of high resolution primary imaging with SPR less than 1% or less than 5% or less than 10%, or such detector may be combined with a antiscatter grid to provide tracking capabilities without image processing based scatter removal. Both scatter removal and real time imaging without scatter removal may be used in one imaging procedure.

Tomographic imaging may be acquired prior to the tracking or monitoring procedure, or it may done prior to the imaging procedure.

When a linear detector is used, the SPR is relatively low or may be less than 1%, such a detector may be used in between the VOI and the full view detector or behind the full view detector.

During a tracking session, for example, in tracking a catheter, low resolution fluoroscope may be used to provide a full view, and positioning of the VOI relative to the source and the full view detector. Intermittently, a high resolution primary image may be derived, with the scatter removal method.

3D fluoro where the 3D images are reconstructed continuously, and sometimes with a time interval and displayed intermittently. Contrast agents injected with for example certain flow rate, are used with system to provide capabilities such as CT angiogram using the present disclosure.

In one configuration, tracking of distances between different tissues of various density such as nerve tissues and blood vessels can be achieved with or with out contrast label using tomographic imaging and or spectral imaging to material decompose based on density difference and derive spatial distribution and distances and dimensions between different tissue types, for diagnosis and tracking.

Warning or alert signals may be given when a probe or surgical tool or catheter tip is too close to the nerve or blood vessels or other type of tissues for safety and surgical guidance purpose.

For fast speed tracking of a catheter for example, volume integral method can be used to trace a series of voxels and subunits in a ray corresponding to a detector pixel or a pixel region. In regions without catheter movement, in two or more detector pixel regions, measurements of a series of voxels which known spatial positions, may lead to the derivation of exact position of the VOI in 6D space. Such measurements may be gated.

In one configuration, using volume integral and the position of the x ray source, and a known position of VOI is determined. Simulation of projection image, with VOI with known composition, and known x ray source location and detector location, may be performed. If the measured data at a number of positions are a match with the simulated data in the corresponding positions for the VOI, then the spatial location of the VOI can be determined. In one configuration, if the spatial position of an VOI is known, and VOI is known, in terms of its material composition and dimensions, if one or more materials or component with a certain spatial distribution inside the VOI moves, such as a catheter or a RF ablation transducer probe, and or if there is a change in spatial distribution, and such change can be monitored over time, such as contrast labeled blood flow, in and near heart valve, the dynamic movement and orientation of said component, said material may be monitored with fast frame rate with high resolution primary image.

In some cases, material decomposition using measured data at distributed locations can be used to precisely determine the position and distribution of a substance or component.

In one configuration, measurements outside of the field of view of the substance or the said component may be used to position VOI. However, the tracking measurement is done with the large detectors, but the precise position of the catheter or the implant may be done with a second detector, such as a small 2D detectors, in some cases, may be capable of 3D imaging or a linear detectors in some cases, measuring only primary images, a motor may move the detector to track the movement of the catheter. A 3D imaging may be performed on the small detector or the linear detector which may comprise of multiple row detector cells, precisely track the catheter but at the same time,

In one configuration, interpolation of measured dual energy detector data to establish a plot at dual and multiple energies and using inverse look up of the established energy response function system, has been used in densitometry, but limited to only small samples. As the material or VOI gets thicker, significant amount of primary x ray may be lost due to the generation of scatter. The plot established by the multiple energy measurement and inverse energy response function is therefore not useful or accurate anymore in some cases. Due to this reason, such a method has not found its way to clinics.

In one configuration, such a method may be improved by establishing the energy response function at measurement data points where the thickness of the VOI is relatively close to each other. For example, within um, or within 1mm, or within 1 cm or within single digit cm or within 10cm or with 15cm. if a number of data points of certain thickness range are used to establish the energy response function system, then the material decomposition method may be more accurate. For example, such an improved method may be used for densitometer of thick samples.

In one configuration, K edge measurements , for example, by using a kedge filter, and spectral imaging with point to 2D detectors or one or more multiple energy photon sensitive detectors may also be used here.

And such method may be combined with tomographic measurements to further increase accuracy of densitometer.

In one configuration, when densitometer or spectral imaging is used, combined with use of antiscatter grid, and beam stop array based scatter removal, , the placement of an implant can be precisely monitored and accurately guided.

Use of cone beam CT with antiscatter grid and scatter removal device such as beam stop array have been done before, however, due to the mechanical limitation and spatial limitation and performance limitation such implementation in clinics are limited.

In one configuration, using the tomography method in the aforementioned PCTs and one configuration, combined with antiscatter grid, and beam stop array scatter removal method, and material decomposition method, fast and accurate real time tracking and monitoring can be accomplished. In some cases, tomography may not even needed during the procedure. In one configuration, surgery may be planned with precision with a roadmap predeterimined to optimize speed and reduce safety risk by spatial positioning of surgical tools in is designed to avoid or be too close to regions where sensitive tissues such as nerve In one configuration, simulated projection image of the VOI at various source and detector location may be compared with 2D, ID or point measured data to determine the orientation and spatial location of VOI or component or substance internal to the VOI. Each of the hardware component or imaging processing involved may be optional depends on the application requirement. catheter may be tracked with high speed during a surgery.

Antiscatter grid may be optional, however the use of it may improve SNR. And in addition it allows real time 2D imaging with sufficient scatter removal for visual guidance. Combination of antiscatter grid and beam stop array plate, enable even lower radiation than either one of the method. As the imaging procedure is relatively long, such reduction on a repeated basis is therefore useful in drastic reduction of radiation overall.

Reconstruction based optical measurements

In one configuration, a computer-supported method for reconstructing an image of a three- dimensional subject surface comprising the steps of: supplying at least two line illumination of a position with reflected object on the surface of a three-dimensional subject, capture reflected optical signal in at least two sensors, connected to an evaluation controller or computer. said projections being offset from each other by difference angles in space; in said evaluation computer allocating to each of said surface elements a position designation designating a position of the sensor surface element in the illuminated surface of the object, and in each illumination, a sensor element data value; and in said evaluation computer, allocating binary volume data values, dependent on the respective position designations and data values of a plurality of said elements on the sensor, each is spatially sensitive, for a plurality of positions on the surface of the object having respective positions in space, for generating a three-dimensional image of said subject from a totality of said volume elements.

In one configuration of 3D reconstruction method, For a set of voxels in the ROI or VOI in a particular beam path, there may be parameter or parameters and criterium or criteria set to determine or define which voxel or voxel in a particular spatial location which the beam path may touch up or passing through is considered to be in the beam path or not or if the beam pass through the voxel. For example, one criterium may be whether the beamlet of certain size, pass through the center of the voxel. If yes, then it is 1, meaning that the beam pass through the voxel, and its contribution of attenuation, or weighing factor in attenuation contribution is 1, this voxel is taken into account in linear equation calculation as a whole pixel. And if it does not, then the weighing factor for the voxel which contributes to the attenuation of the beam is considered zero.

Radiation Level in Tompograhic Imaging

To limit radiation level, one configuration is to limit number of projections acquired.

In one configuration, a computer-supported method for reconstructing an image of a three- dimensional subject comprising the steps of: supplying at least two axis 2-dimensional projections of a three-dimensional subject, onto a projection surface composed of surface elements, to an evaluation computer, each projection being offset from each other by difference angles in a rotational plane or translational plane ; in said evaluation computer allocating to each of said surface elements a position designation designating a position of the surface element in the projection surface, and in each projection, a surface data value; and in said evaluation computer, allocating binary volume data values, dependent on the respective position designations and surface data values of a plurality of said surface elements, for a plurality of volume elements having respective positions in space, for generating a three-dimensional image of said subject from a totality of said volume elements.

A method of reconstruction, where each step size can be approximately equivalent to or quantitatively related to the resolution desired for the axis parallel to the center axis describing the shortest distance from the detector to the x-ray source.

A method as itemed wherein the step of supplying at least three two-dimensional projections to said evaluation computer comprises supplying said at least three two-dimensional projections with said difference angles being less than 2° or less than 3 degrees or less than 5 degrees, or less than 10 degrees or less than 15 degrees.

Scatter removal using antiscatter grid and combined with spatial domain based scatter removal method.

To increase Signal to noise ratio, the antiscatter grid may be used with spatial domain based scatter removal method to achieve removal of scatter to less than 1% of primary or less than 5% of the primary, at the same time, may allow for higher primary x ray dynamic range or Signal to noise ratio for the signals collected by the x ray detector.

To achieve spectral domain scatter removal to reach SPR of less than 1%, in some cases, thickness of lead strip may be adjusted or grid comprising of two or more substances with varied atomic z number. In some case, such is not needed as the beam particle absorber array plate is also used.

As illustrated in Fig 5,

From front to back, x ray source, 12, subject 2 or the ROI , beam particle absorber array plate 100, with a number of beam attenuating particles distributed in the beam path, to block primary x ray from reaching the detector in distributed spatial locations, antiscatter grid, Grid 1, detector 22.

In one configuration, scatter removal is achieved by combining scatter removal method to achieve SPR < 1% and SPR < 5% and SPR < 10% with a antiscatter grid. Such a combination may decrease the exposure required even more high resolution primary x ray imaging with scatter removal to less than 1% SPR or SPR with that of image acquired without scatter removal or with an antiscatter grid in real time.

And such a antiscatter grid may move or shaken during image acquisition

In one configuration, as illustrated in Fig 5. Beam blocker array plate 100 sandwiched in between two detectors, detector 22 and detector 29,

In one configuration, detector 29 may not optional

In one configuration, Table 1, a sample holder or patient table may be placed between the patient and the detector assembly In one configuration, the beam blocker array 100 may be placed between the source 12 and the patient 2.

In one configuration, a antiscatter grid, Grid 1 may be placed between detector 22 and patient.

In one configuration, a Gridl may be placed between detector 29 and the patient.

In one configuration, Antiscatter grid Gridl may be optional.

In some cases, the antiscatter grid, or bucky grid may be movable during the exposure. in some cases, the beam particle absorber array plate 100 or beam blocker array plate 100 is movable by an actuator.

In some cases, filters are added down stream of x ray source but upstream of the ROI.

In some cases, detector 22 is a dual detector assembly of dual energy x ray layer.

In some cases, detector 22 is a dual detector assembly, with a beam selector layer 16, sandwiched in the middle of the two detectors.

In some cases, detector 22 is a dual detector assembly, with a beam particle absorber plate 100 , sandwiched in the middle of the two detectors.

All of spatial domain scatter removal apparatus and methods and those described in one configuration have been described in aforementioned PCTs may be included here, with the improvement of adding an antiscatter grid 900 down stream from ROI.

Antiscatter grid 900 may be placed between the beam absorber array plate 100 and the detector or antiscatter grid 900 may be placed in upstream of the beam absorber array plate but down stream from the ROI.

Antiscatter grid may be placed upstream of the front detector of a dual detector assembly.

In tomography applications, when x ray source move, the antiscatter grid may be moved during the 3D image acquisition to ensure alignment of the source with the antiscatter grid for optimized scatter removal. A sample table for holding the ROI or the subject, for example, x ray transparent patient table, may be used between ROI and the rest of hardware, such as beam particle absorber plate 100, and or the antiscatter grid, and the detector or detectors.

After a image is acquired, post imaging processing include removing noise, scatter, gain correction, dark current and other typical post imaging processing method to ensure accuracy of the quantitative data, based on Lambert-Beer Law, the attenuation value of antiscatter grid given the measured x ray signal on the detector can be calculated based on the thickness of the grid and attenuation value and or coefficient of various substances which make up the grid, The adjusted x ray signal level ( for example, intensity or the radiographic density, or optical density) which is the x ray signal level exiting out of the ROI but before entering the antiscatter grid, can therefore be derived.

Similarly using lambert-beer law, the x ray signal entering the sample holder can be calculated from x ray signal level or derived optical density measurement of the x ray exiting out of the sample holder, and known thickness and known attenuation value or optical density or linear attenuation coefficient of the sample holder, where the input x ray is the x ray signal entering the sample holder and out put the x ray signal coming out the sample holder

After the removal of the effect of antiscatter grid and or sample table, the resultant value can thereby be used for image processing analysis using material decomposition

In one configuration, a number of beam particle absorbers may be distributed or interspersed within the antiscatter grid in a x y plane parallel to the detector. For example, such a device may be used upstream of the detector or detects or detector assemblies. This may be useful for tracking applications especially for when the resolution of the images are not critical. For example, the missing data gap generated by the attenuation of the beam particle absorbers are not critical in determining the spatial location and or position of a catheter or an implant.

The missing data gap may be filled by interpolation from the pixel value of adjacent regions to allow visually pleasing presentation to the viewer.

Automatic Exposure Setup In prior art, generally x ray images are taken at high radiation levels, and then adjusted to reduce radiation based on the signal capture on the detector, for example for the prior measurements.

In one configuration, Methods may be used here on low SPR images, or material decomposed images or SPR <1% or < 2%, or < 3% or < 4% or < 5% images, of single energy, dual energy or multiple energy, or spectral images to increase exposure or increase times of exposure so that there is sufficient exposure totaled for the measurement to derive attenuation density or optical density or radiolographic density or density of the substance or composite substances.

Using time of flight, or x ray imaging or measurements, or sensor, or other imaging modalities to derive thickness, generate settings for exposures, however, the settings may be incorrect due to unknow factors of samples. Exposure may be repeated or time of exposure may be adjusted provide enough photons for attenuation density or optical density or radiographic density or density or thickness measurements, through single energy, spectral imaging, material decomposition and tomography methods in x ray.

In one configuration, sensitivity of x ray measurements and accuracy of x ray measurements may be affected by the noise of the detector. For example, at extreme low level of exposure, for example, 1/30* of the general x ray measurement setting used by a typical radiographic system or fluoroscope today, there may be enough photons to reach detector to provide sufficient measurements for derivation of the attenuation values, or optical density or radiolographic density or density or mass attenuation coefficient may be able to derived from a measurement. However if the detector has high noise level, due to for example, dark current, or white noise or other issues, the exposure may be increased so that the captured signal is sufficient above the noise level to provide accurate measurements.

When the detector, such as cooled detector have low noise level, in addition to sensitivity level, photocounting detector, much lower radiation exposure may be sufficient to provide sufficient measurements for density or optical density or mass coefficient measurements.

There may or may not be a multiplication factor in order to for the presentation of the measurement to be visually meaning or visible for the user. 3D or 2D Imaging and its application in fluoroscope

In one configuration, X ray radiation profile over a field of view may be characterized, by one or multiple detectors. A reference detector may be used in the beam path, for example, down stream from the source and upstream of VOI, may be used to monitor dynamically or in real time the x ray emitted intensity coming out the x ray tube, such as the anode target.

In CT or digital tomosynthesis, or C - arm or O-ring or other projection geometry to acquire necessary number of projection measurements in order to reconstruct multiple dimensional images, or material decomposed images for image guidance or diagnostic modality such as PET and CT, of prior art, generally since x ray source and detector are synchronized in movement, therefore measured signal in each pixel of the detector may change when x ray radiation emitted changes. In an ideal situation, a noise corrected and normalized pixel may change its measurement value when the x ray source emits different amount of radiation with each exposure setting and may vary due to inconsistency of emitted x ray radiation coming out of the tube. However additional changes may contribute to the measured value of a specific pixel, for example, the position of the x ray emitting position in 6D. For example, in situations when x ray emitting position moves independently from the detector in multiple dimension tomography, the value measured by the pixel is affected by the location of the x ray emitting position, such as in a cone beam, with a field of view large enough that the further away the pixel is from the pixel or pixel region where the center axis of x ray cone beam, the more variation there may be, compared to the pixel region right next to or directly measuring the center axis projection line from the source. And / or the level variance may be different for each wavelength or energy level of the x ray.

In order for accurate analysis of quantitative data which may be used for image processing, as the x ray source or emitting position moves, the resultant variance of signal level on each pixel of the detector due to its related position to the projected beam path it measures relative to the x ray emitting position in 6D space, and / or relative position to the center axis of the x ray beam may be taken into account. The characterization of such variance may be done at a time separate from the actual measurement of VOI. Such variance level may be taken into account prior to image processing, analysis, spectral image using energy sensitive detectors or spectral imaging using monochromatic source or spectral imaging using inverse energy response function system method, densitometry, spectroscopy and /or multiple dimension reconstruction. In one configuration, for any measurements at a unique x ray emitting position, images or measurements may be taken at various x ray emitting positions prior to and after taking images of VOI. Such that x ray radiation input characterization is characterized at each location of x ray emitting position relative to the detector.

Spectral fluoroscope is not widely adopted due to the fact in the past, the spectral images using large flat panel detectors have scatter therefore affecting accuracy and complete material decomposition. And antiscatter grid is still used in single energy fluoroscope systems.

Radiation reduction in fluoroscope systems is marginal, due to for example, adoption of imaging procedures or other minor adjustment. Fluoroscope with radiation exposure of less than half of the current clinical setting per image captured while maintaining sufficient resolution or equivalent resolution and or provide comparable clinical value or image guidance has not been typically possible.

Even though it may be general knowledge that reducing scatter or using time of flight x ray imaging method or primary x ray modulation method to reduce scatter in the past may reduce radiation level, but dramatic reduction such as to less than half or less than 1/3 or less than ¼ or less than 1/5* or less than l/6^th or less than l/7^th or less than l/8^th, or less than 1/9*, or less than 1/10*, or less than 1/15* or less than 1/20*, of the clinical settings has not been reported.

In addition, typically reported methods are difficult to implement in practical settings due to various technical challenges, for example, availability of x ray source or detector in large format in time of flight x ray method, or beam hardening in primary x ray modulation method or in patient specific primary x ray method using collimator.

Especially given the real time monitoring requirements in monitoring or image guidance, such as in a fluoroscope, deficiency of other scatter removal method and material decomposition method are even more pronounced. Described in one configuration and aforementioned PCTs, x ray system with spectral imaging capability, for example, with dual or multiple energy sensitive detector systems, or with inverse energy response function system method for material decomposition, with a SPR approximately < 1% or less than 5%, or less than 4%, or less than 3% or less than 2% and, in some instances with tomography capability may be used in a fluoroscope format, with radiation shields, in some instances, optically see through with human eyes and other related hardware used similar to fluoroscope system.

In one configuration using 2D fluoroscope: Single Energy or Spectral Fluoroscope or x ray imaging may to track or intervention guide or monitor for example, post treatment and post op condition

In one configuration, radiation exposure level can be carefully and precisely controller to be less than 1/30*, or less than 1/20* or less than 1/25*, or less than 15* or less than 10* of present fluoroscopy procedures, or less than 1/5* or less than l/3^rd or less than ½ of the current exposure level using scatter removal method to reach < 1% SPR or less than 4% SPR, or less than 5% SPR, in some instance, using material decomposition method to separate tissue, contrast agents, implant, catheter and surgical tools and or probes, or diseased tissues.

Radiation exposure level may be reduced to less than 1/30*, or less than 1/20* or less than 1/25*, or less than 15* or less than 1/10* , or less than 1/5*, or less than 1/4* or less than l/3^rd or less than ½ or less than 70% or less than 60% or less than 80% or less than 90% of present fluoroscopy procedures using scatter removal method to reach < 1% SPR or less than 4% SPR, or less than 5% SPR.

Such reduction may be implemented per image captured. Such reduction in radiation may be for the same resolution and or for the same ROI or VOI.

Ultralow radiation tomographic fluoroscope or spectral tomography fluoroscope may be reconstructed based on using such low radiation settings for each 2D, ID or point measurements taken.

In one configuration, tomosynthesis methods may be based on images measured with ultralow radiation settings as described.

Such ultralow radiation exposure based x ray measurements may be used in tomography, or tomosynthesis or any geometric trajectory used in x ray imaging to reduce radiation exposure in each point, ID or 2D measurement and therefore dramatically reduce total radiation exposure in a specific imaging method, for example, digital tomosynthesis in mammography, or in O ring imaging method, or in helical imaging method.

The tomography methods and apparatus of using n or n² to n⁶ CT method, by using a xy mover of the x ray emitting position, for example, adding an electromagnetic steerer, or a mechanical mover, or adding scatter removal apparatus, such as beam selector, or beam particle absorber, array or beam stopper array, or Beam Stopper array, with or without a moving mechanism or moving apparatus. In some cases, such Beam Stopper array or beam particle absorber array, may be placed in between the patient or ROI and the detector and movable with a mover, such as a motorized actuator. 2D images of the ROI, and material decomposed ROI, and or 3D images of the ROI may be displayed at different times or simultaneously on one or multiple displays. And selected slices of sagittal, coronal, axial view of ROI, may be displayed separately or simultaneously.

In one configuration, minimum invasive surgeries or robotics surgeries, one or more selected substance or components such as tissues or catheters or implant, or blood vessels, or nerve tissue or simulated substance image, derived from sparse measurements or point, or ID measurements may be selectively presented using various presentation method, such as intensity adjustment, or color representation, displayed against other substances or the rest of ROI. Resolution or intensity relativity or color choices may be related or independently selected and used.

In one configuration, continuous mode at, for example at 0- 10mA, images at single energy, dual energy or triple energy or multiple energy are taken, for example, at less thanlms or less than 5ms or less than 10ms or less than 20 ms to provide enough exposure for scatter removal or material decomposition method.

In one configuration, the fluoroscope settings can be adjusted to reduce exposure and increase speed of user feedback: for example, if exposure level setting is at 100mA fluoroscope pulsed level, less than 1ms or less than 2ms or less than 3ms or less than 4ms or less than 5ms or less than 10ms or less than 15ms or less than 20ms or less than 25 ms or less than 30 ms or less than 50 ms or less than 100ms or less than 150ms or less than 200ms or at a fraction of exposure setting for a typical fluoroscopy pulsed measurements. Or at exposure level between l/100^th and 90% of the current pulsed fluoroscopy level, to achieve SPR of less than 1% or SPR of less than 5% and or material decomposition to obtain attenuation value or density value or attenuation density or radiographic density or optical density of each substance or composite substances or combined substances with approximately similar or better resolution.

For repeated measurements of the same ROI, for example in fluoroscope or material decomposition measurements or multiple dimension imaging or spectral multiple dimension imaging, in some instances, at least one or more or one or more set of initial measurements may be done, such as each measurement at each energy is done at exposure level similar or slightly less than that of typical clinical exposure level, however, subsequently, additional measurements for tracking or for additional measurements at different geometry or x ray emitting positions of the same ROI, may be done at lower exposure level, such that sufficient photons reaches detector to measure and derive attenuation value and or density of each tissue, or imaging and presentation of images with <1% SPR or < 5% SPR.

The intensity level of lower exposure level measurements may be adjusted , for example, multiple by a factor, to achieve the intensity level familiar to the user such as radiologists or for other VR applications for the same ROI.

The goal of going through the method, measuring both at high exposure level and lower exposure level may be to ensure that intensity presentation is not misleading or arbitrary.

Such method is to ensure accuracy and consistency of the measurement or intensity presentation which is familiar to radiologists without creating artifacts which may be misleading in fluoroscope tracking and visualization and diagnostic applications.

CT or 3D fluoroscope or 2D fluoroscope or imaging for tracking or monitoring and surveillance

Method for realistic or qualitative presentation of quantitative measurements. Some of the measurements are done at exposure value significantly less than typical settings used in clinics or for live animal imaging.

The exposure level of each projection image used for tomography reconstruction and or material decomposition can be anywhere between l/30^th to 90% of a typical CT or tomosynthesis or spectral imaging setting for each projection image or measurement.

In one configuration, there may be one or more projection image or one or more set of projection images done at one or multiple energies at one x ray emitting position may be done at the level sufficient for photon collection for scatter separation and or material decomposition to derive accurate and consistent attenuation value or density of each tissue and or produce images of <1% SPR or < 5% SPR. in some instances, the setting of current and exposure time may be similar to a typical CT or tomosynthesis projection image setting, or at a level approximately equivalent or below the saturation level of the detector.

In one configuration,, user or computer program may determine the appropriate exposure level for sufficient signal display presentation based on one or more images done.

In one configuration, minimum exposure level may be determined based on the first x ray measurement so that enough exposure is provided for measurements so that the exposure level is sufficient for material decomposition, or scatter removal to derive the accurate attenuation value or density of substances in the ROI.

Such minimum exposure level may be preselected.

In one configuration,, the quantitative factor relating the two exposure levels may be derived. A criterium or a preset criteria may be used to determine the quantitative factor. Or a preset value for the quantitative factor may be used.

As measurements may be repeated at approximately minimal exposure level or a low exposure level in between the minimum exposure level and a typical exposure setting acceptable to the user. The quantitative factor may be used to in multiplication to bring the intensity level to one that is desired by the user. The total images are then combined together to provide images to be presented at an intensity level qualitative similar to those familiar with CT or tomosynthesis projection images or fluoroscopy images.

In one configuration, and intensity difference between the setting and those measurements done at minimal exposure level sufficient for material decomposition, or scatter removal to derive the accurate attenuation value or density of substances in the ROI. Each separated tissue may be displayed by multiplying with an adjustable factor which is the quantitative factor determine relating the difference in exposure level between typical clinical setting and visualization measurements and the lowered exposure measurements. Such a presentation may reduce any artifact may rise due to multiplication, as the reference level of presentation intensity has been measured and used here to do the presentation and the multiplification factor are consistent or intensity level is consistent and or the qualitative presentation are deemed suitable in all calculations, reconstructions, image processing of projection measurements and their presentations. Artifacts, misleading information quantitative or qualitative, or visual misrepresentation may then be avoided.

Continuous mode of Fluoroscope

In one configuration, while the fluoroscope is in continuous mode in 2D fluoroscope, x ray detector may be timed to collect exposure as soon as the x ray emitting position is at a spatial location to image ROI, for example, when the mover moves the x ray source emitting position or electromagnetic steerer steers the x ray emitting position to a position preferred by the user and digital program, generally such a movement is for multiple dimensional reconstruction, or in movement of x ray source and or detector to position to image an ROI within its field of view. The detector may be timed to stop collecting exposure at a time set by the user or the digital program. Or the mover may move the x ray emitting position to a different location, after dwelling at the spatial location for a period of time, which may be preset or determined in real time, The movement of the x ray emitting position signals to the detector to stop acquiring images. Or the detector is signaled in real time by the user and digital program after a period of time collecting the signal to stop until the x ray emitting position reaches its new location. A second exposure may be acquired.

Fluoroscope:

In one configuration, the source and detector distance may be variable, for example, approximately at 45cm distance or approximately less than 36 cm distance, or great than 45 cm to up to 1.6meters.

The source and detector distance may be fixed.

Fiduciary markers may be used in the same way as in fluoroscope of prior art or may be omitted.

In one configuration, such a system may be with or without wheels for portability within operating room or within a clinic or within a hospital.

The x ray system may be designed or configured to meet the requirements of system, performance and fda or other regulatory agency in the US or outside US.

The emitting source attached to the mover or the x ray emitting device steered by a steerer, with or with out x ray optics or optics for manipulating x ray radiation, may be moved independently by one moving device, the same moving device may move the detector or multiple detectors, in some instances, attached to the scatter removal apparatus, one movement. For example, a C arm may have a motion system attached to a gantry or supporting apparatus which holds both the x ray source and detector in relatively fixed position. However the detector or detectors related or attached modules may move independently from the x ray source and related modules, as in a design where the source is moved by a mover, which is attached to a gantry. And the detector or the detector assembly or detector related modules such as scatter removal apparatus may be moved by a different mover, which is attached to the same gantry or a different gantry.

The total angle of movement for the line passing through x ray emitting position connecting to the center of ROI, and reaching detector may be in less than five degrees, or less than four degrees, compared to its original location, for a complete tomography reconstruction.

The total angle of movement for the line passing through x ray emitting position connecting to the center of ROI, and reaching detector may be in less than 15 degrees, or less than 14 degrees, or less than 13 degrees, or less than 12 degrees or less than 11 degrees, or less than ten degrees, or less than 9 degrees, or less than 8 degrees, or less than 7 degrees, or less than 6 degrees or less than 5 degrees, or less than 4 degrees or less than 3 degrees, or less than 2 degrees, compared to its original location, for a complete tomography reconstruction.

The degree total angle of x ray emitting position to the center of ROI may increase as the distance between the source and detector decrease for the same thickness of ROI.

Filling of data replacement using beam particle absorber array plate

In one configuration, when at least two images taken of the same ROI, each with an array of x ray absorbing particles positioned at positions different from another.

The missing data of one image at the shadowed area of the beam absorbing particles may be filled in from the projection measurements without beam absorbing particles blocking the primary x ray.

However due to the fact that sometimes, one image may have different intensity than the other, or different x ray input intensity and or output intensity than the other at the shadowed area, sometimes, it is not a direct replacement or filling in of the data on the same detector positions of first image in the shadow area with that of projection measurements from the second measurements in the same regions. A direct replacement would result in uneven regions of intensity representing replacement data. To alleviate this issue, one or more of following methods may be used.

In one configuration, comparison of regions of measurements between two images, for example, close to and or around the shadowed region, derive the ratio of intensity between two images. And adjust intensity of replacement data, from one image to match that of the image with the shadowed regions replace, for example by multiplication of an factor which is approximately the intensity ratio between the two images. The modified two images may be combined to have a better display image.

In one configuration, material decompose into each tissue displays, at least one tissue from each image with the shadowed region. Since the material decomposed tissue attention value is approximately the same for the same ROI, and its representation would then be the same for the data derived from either images with different beam absorbing shadow area. The shadow area of one image may then be replaced by the value of same pixel location of the other image.

In one configuration, derive attenuation value of each projection image involving VOI by using a measured white image at the same x ray emitting position and similar configurations and image setting without the imaged subject in some cases, reconfigure or readjust the primary image derived from white image intensity based on the variation of the primary image outside the projected area containing VOI information so that the intensity of adjusted primary image from the white image is similar in intensity as the input primary x ray intensity for the projection image of the VOI. Derive the attenuation value of the VOI, for example using formular based on on murphy’s law. Replace missing data from shadow regions of one image comprised of attenuation values with image of attenuation due to the same VOI but with different shadow regions due to varied beam blocker array positions.

In one configuration, make sure all white images and adjust primary image from imaged subjection projection images to have the same x ray input as the white image primary image.

In one configuration, How to verify and adjust x ray input intensity for each projection image in tomographic and or spectral imaging. - using primary image or a portion of scatter image - average the pixel value of a selected region of the same spatial location, compare selected region pixel value of each image.

X ray input intensity level - Adjustment and methods between different projection measurements

Image Intensity or Pixel Value Adjustment for example,

• White Image and or Imaged Subject Image with variable beam blocker array positions at, two or more beam blocker array positions, for example, position A and position B or more, and for approximately the same or similar x -ray emitting positions,

• Or for images taken at x ray emitting positions within a certain area or region or volume, such as less than 1mm, or between 1mm to 1cm or between 1cm to 10cm variation in x ray emitting positions in at least one dimension.

• Or within a certain orientation, such as within a certain small angle in pitch, yaw and roll

White Image Intensity Adjustment and or VOI imaging with different beam blocker array position may include some or all of the steps below for image processing involved in scatter removal and or spectral imaging and or tomographic imaging.

Variation between Position A and Position B - look for area not in the shadow - primary image of the white image ,

-Identify one or more pixels in the shadow regions of beam blocker array, low resolution scatter image.

-Interpolate to give rise to high resolution scatter image

-Subtract from the measured image to give rise to the Primary Image derived from image taken at beam blocker position A Pa, and that at Position B, Pb

-average the entire image or a portion of image, or one or more, for example, 4 selected regions, for example, each image separate with each other and can be in between shadow regions locations of Position A and Position B) , at selected spatial locations, derive a Average Pixel Value of the selected region for position A image, compare to that at position B image at those same spatial locations,

-If there is a difference, for example, the difference is more than 0.05% or more than 0.01% of the total, or between 0.00001% to 0.01%, or any variation value of significance which can impact the consistency and or determined intensity level of an image in visualization, image processing and tomographic reconstruction and or spectral imaging the pixel values of image for VOI and or within field of view can to be adjusted. -Same x ray emitting position, can be able to adjust intensity of images based on the average pixel value of the selected region.

-Pixel A or pixel A averaged / Pixel B or pixel B averaged =~ Rab, adjust Intensity measurement at Image position B for each pixel by multiplying Rab.

For image processing to derive final image, without beam blocker shadow position

- swap circle shadow regions at position A with image at position B or other images.

- Then average the final image at position A and Position B, or stack them on a pixel by pixel basis.

For tomographic imaging, remove data acquired in the shadow regions, or label as null, use images from the same x ray emitting position, but different beam blocker position, or images from a different x ray emitting position, having the x ray projected illumination passing through voxel regions which has been in the beam illumination path blocked by beam blocker array at the position A. of any of the positions to measured sufficient times for resolving each voxel or voxel regions or voxel volumes.

In some cases, a different energy image of the same voxel regions may be used to derive voxel value or attenuation value or intensity value.

Compare white image produced by projections produced by adjacent x ray emitting positions

- selected region average value - projection image adjusted for the variation in position.

In one example a reference white image intensity level is set where all the other white images are adjusted to have approximately the same value of intensity.

In case of imaged subject image, a reference imaged subject image - typically a primary image, is used for comparison of regions or average pixel value of a region in two images,

In one configuration, such regions are the entire image or a region or a portion of the detector region within a field of view.

In some configuration, to select the regions used for comparison of intensity level, the ratios between adjacent pixels or pixels in certain proximity are calculated, compared to each other within one image and the relational information between pixels of a selected region or multiple regions are compared to those of a second image, those with minimized variations are selected for intensity comparison and calculation of pixels or pixel regions in the selected regions.

In one case, for example, whenever there are multiple variations due to external disturbances, such as addition of contrast agents, internal variations, such as breathing, or movements, certain regions of imaged areas have large variations from one exposure to the next, and certain regions may not have any significant variations or have small variation due to the fact that they are body parts or regions of imaged subject are approximately the same or relatively similar between the two or more frames or exposures.

In some cases, Such regions can be selected to do intensity comparison.

In some cases, it is predetermined that certain regions of VOI are used for intensity comparison

In one configuration, regions external to the VOI may be used as intensity comparisons In some cases, the x ray intensity or variation between exposure is carefully modulated and is known

In some cases, material decomposed data of a marker, for example one or two marker with defined density and or defined dimensions and or defined x ray attenuation value in one or more pixels or one or more normalized pixels can be used to assess variation in intensity level of pixels or pixel regions in relatively the same or approximately spatial locations. The marker, can be an internal marker, such as a selected region of bone, or it can an external marker, for example a reference marker with x ray measurement value and or attenuation value or properties to be differentiable, for example a metal, and or bone like material.

In one configuration, the derived attenuation value from a measured pixel value can be adjusted accordingly, directly, of pixel value from measurement. For example, if the region of primary image intensity varied by a ratio R12 for example, if PI / P2 is approximately R12, P2 level can be adjusted by multiply by a number approximately = R12 or the attenuation value ATT2 derived from P2 may be adjusted approximately by a quantity, for example, 1/R12

In one configuration, a reference sensor placed between the x ray source and the patient may be used for measure x ray input intensity or intensity level variation between images taken at various positions of x ray emission and or beam blocker array position.

Imaged subject image or VOI image: adjustment of intensity level of primary x ray image of VOI , for varied x ray emitting position within a certain region or volume and or rotational angle in pitch, yaw and roll.

In one configuration, Using primary x ray image variation between processed image from Position A and Position B and or additional position of beam blocker array, in some cases, such images has been adjusted within the set to have similar or equal intensity level. Using the examples of beam blocker having two different positions during image acquisition,- look for area not in the shadow area which selected primary image of the white image , average a selected region with a specific spatial location, derive a Average Pixel Value of the selected region, compare, if the difference is between 0.000001% to 0.01% or 0.001 to 0.1% or 0.1% or more, adjust the intensity value to the reference image value which is intensity level of one of the primary images. Set a selected image as the reference image, which all other images are to be adjusted against.

Image taken within the similar condition, , for example, with the same xray emitting position or similar x ray emitting positions, however different beam blocker array positions can be adjusted as described above using either a portion, or selected region and or the entire primary x ray image comparison , for example, measured pixel value, or normalized pixel value.

For Images from different x ray emitting positions of the same VOI, however close to each other, with approximately the same beam blocker array position, and or varied beam blocker positions,

A portion of, or selection region or regions of, or the entire Scatter image such as average pixel value calculated, can be used to compare from one image to another, for example, with the same image settings of kv, ma and ms. A reference image can be selected to compare to, and the rest of images can be adjusted.

In one configuration, using scatter x ray image

Determine and adjust primary image of the projection image of VOI, based on scatter image intensity difference between most adjacent x ray emitting positions.

Between x-ray emitting position, find the most adjacent x ray emitting positions, compare and derive the approximately ratio S12 between average pixel value of scatter image at the selected region or regions of approximately the same spatial position or spatial positions of their projected images of VOI generated at x ray emitting position 1 and x ray emitting position 2.

1) adjust intensity of primary image based on the difference for example based on ratio of average pixel value of images or selected region images. In one configuration, if needed, set one primary as the reference image which all other primary image are adjusted against,

In one configuration, adjust intensity of primary image on a pixel by pixel basis based on the difference and or ratio between the scatter image to the first reference scatter image, in some cases, at selected regions.

For example, if there are multiple scatter images, for example, 3 at three different position x ray emitting position, the adjustment is using the first image or first scatter image or primary image can be used as the reference for the image, or scatter image, or primary image. The scatter image intensity level difference can be calculated based on those from two most adjacent x ray emitting positions or among those whose x ray emitting positions are close and generating approximately the same scatter image if given the same x ray input radiation. The adjustment level for primary x ray compared to the reference x ray image can be cumulative and or multipliable over a number of positions, especially if x ray radiation from those positions generates scatter x ray image which are not approximately the same anymore.

In one configuration, for ensuring comparable or consistent projection measurement, for example for replacement of data in the shadow area of the beam blockers on the detector, the same method may be used for adjusting image intensity of the original image or replacement projection data to ensure relative attenuation level and or intensity level of the transmitted signal on the detector on a pixel by pixel or pixel region by pixel region basis.

Attenuation Value Derivation correlate primary image of white image with primary image of the VOI image white images are adjusted to as if they have the same x ray input intensity value Wc at all x ray emitting positions. imaged subject or VOI image are adjusted as if they all have the approximately same x ray input intensity value Wvoi of a selected VOI image which is used as a reference image, where Wvoi / Wc = V where V is a constant, for each set of Wc and Woi at all x ray emitting positions.

Attenuation can there be approximately derived based on Wc and measured value, as, if there is a variation between the input for the white image and input for the VOI image, the variation is the same for all projection measurements, the reconstruction results can be valid approximately, but could be provide voxel values which when compared to actual voxel value, there is a factor which is consistent in all projection paths, but since all voxels have the same difference factor, the relative attenuation values between voxels are approximately the same compared to those generated by the actual white image or actual x ray input intensity value is known and used for attenuation value calculation.

Replacement of Missing Data in Tomography and X-ray Imaging

In one configuration, examples of methods to replace missing data in the shadow region of beam particle absorber in the beam particle absorber array scatter removal apparatus and method

System matrix or line or volume integral for scatter removal to identify the pixel or pixel region in the end point of the beam path, along the thickest part of the beam particle absorber, as it is estimated that it contains only scatter only signals. The pixel value can be interpolated. However average value of the pixel region may be applied to the pixel region that is more than just a pixel in the center of the beam path. The pixel region may be comprised of two or more pixels, but no more than the shadow of the beam particle absorber plate, ideally with the beam path of estimated pixel region where the corresponding beam path from the source is blocked by the beam particle stopper due to the thickness of beam absorber particles is high enough so that the estimated b primary x ray blocked is more than 99% or 99.9% or 99.99% or better of the intensity of the beam reaching the beam particle stopper along the said beam path

In the method to remove scatter and then replace the missing data due to blocked beam by the beam particle absorber, the following steps may be included

Using method of material decomposition through inverse energy response system method, for example, in a dual energy method,

- remove scatter at one position of beam particle absorber array plate, for example, position A for both energies, high energy level, for example, 250kV, 150 KV - 250kV, or 100 KV to 150 Kev, separately at low energy level, for example, 65-100 Kv, 20kvto 65kv - remove scatter at a different position of beam particle absorber array plate, for example, position B for both energies, high energy level, for example, 150 KeV, or between 100 KeV and 150 Kev, separately at low energy level, for example, 65-100 Kev

The different positions of the beam particle stopper array plate result in for example, non overlapping shadow regions on the detector.

To compensating for missing data information from attenuation of beam particle stopper array, the following method may be used:

Optional A calculate the radiographic density for each of the four images the equation or calculate the ratio between output intensity Io and input intensity I_ton a pixel by pixel basis.

D - tog Equation (A) where Io is the measured output image, or I_t is input intensity, sometimes, it may be the measured pixel value in the same pixel location in the white image at the same exposure setting may be used when the x ray source radiation level is quantitively relatable or similar or the same between exposures.

• in some cases, the alternative method to derive I_t, is to use the reference photodiode or detector to derive from measured intensity and location of the reference detector, the estimated pixel value of each pixel on the detector used to measure VOI.

• in some cases, a background pixel value of at least one pixel which directly measures the input intensity without the VOI in between, may be measured on the same detector but away from the x ray beam path illuminate VOI. as the result of methods described in Option A, the variation in the array image data or its derivation due to the contribution of the input intensity is removed. Pixel values in the regions corresponding to the shadow area of beam attenuation by each of the beam particle absorber on the beam particle absorber arrays location of the radiographic density image array resulted from position A is then replaced by a radiographic density image array of the same exposure and in some instance of the same VOI, but with the beam particle array plate or each of beam particle absorber at a position B. Position B is different than position A in that the shadow area of beam particle absorber array plate produced by each beam particle absorber may not overlap with that of each beam particle absorber at Position B.

Option B - use the data from dual energy or spectral images to material decompose, derive image for each substance, such as a bone image and a soft tissue image, each with an image at position A and an image at Position B. Since the material decomposed image is the essentially radiographic density image of individual tissues at position A and position B, the shadow area can then be replaced by the corresponding regions.

The variation of image value on a pixel by pixel basis due to variation in input intensity is therefore removed.

Either radiographic density or the ratio of output to input intensity on a pixel by pixel basis, may be used in multiple dimensional image reconstruction as the input projection value. And in iterative methods, the simulated value or derivation of simulated value may be expressed in approximately the same format so that the difference between the two may be calculated directly without variation in values contributed by varied input intensity, which may be produced by separate exposures along the same beam path.

In cases, where x ray input intensity or radiation may be consistent, quantitative relatable or predictable from one exposure to another, fluctuation in input intensity between separate exposures with the same setting may be minimized, for example, with 1% , or within 0.5%, or within 0.1% or within 0.05 % or with 0.01% or less, and in particular variation within one energy level or one discrete wavelength, measured intensity values by the detector may be used as the projection data directly in scatter removal, material decomposition, spectral imaging, multiple dimensional imaging, tomosynthesis, and 3D tomography and other image processing procedures and methods.

In one configuration, missing data from the shadow area may be set as missing, or no linear equations were established during reconstruction, therefore the linear equations do not exist for those data points. In order for complete reconstruction, addition projections may be needed at additional x ray emitting positions, for example, additional projections when x ray emitting position is at a position where its projection path through one or more voxels that is the in the projection path of the missing primary x rays due to beam particle absorber elements. Additional such projections may pass through other voxels until each of the voxels in the missing projection path is illuminated by at least one different x ray beam path in a different exposure. This combines with projection image set which are estimated enough to resolve all of the voxels in the VOI if the beam particle absorbers are not blocking primary beams to cause missing data in reconstruction.

In one configuration, the missing data from the shadow area may be set as missing, or no linear equations were established involving the unknown voxels in the beam path passing through the attenuation elements of beam particle absorber plate. X ray emitting position may be moved further away from the area of x ray emitting position which result in the first set of projection images captured. The first set is captured so that if there was no missing data due to the attenuating elements from the beam particle absorber plate, the image set is sufficient for a complete reconstruction of 3D image of the VOI.

In one configuration, the second x ray emitting positions may be an area of x ray emitting positions, each emitting position generates x ray radiation which passing through the voxels of VOI which are in the path of primary x rays blocked during the capture of first set of projection image.

In one configuration, the primary x rays emitted from the x ray source in the second positions, blocked by the attenuation elements of the beam particle stopper array plate may pass through voxels or voxel positions in VOI which are different than the voxels or voxel positions of VOI which are in the beam path of primary x ray emitted from the x ray source in the first x ray emitting positions, attenuated completed by the beam particle absorber array plate.

Either x ray source moves away from the first positions to a location constraints by said conditions of primary x ray path. Or a second x ray source may be used the number of projection image in the image set generated by x ray moving in the second positions, or a x ray source array set which second positions are locations of each array element which generates x ray. Number of second positions is determined by the size of voxel layer along the z direction which perpendicular to detector and the source movement plane. In some cases, the number of second set of projection images may be as many as that of first image set or significantly less base on the distance and angle between the first positions and second positions. The second source, or source array or the source illuminating in second position, may have a collimator placed downstream from the second source but upstream of VOI. The collimator may have distributed transmissive regions to allow primary x rays to illuminate regions, or VOI slices or voxels which are in the paths of primary x rays blocked in the acquisition of the first set of images. Such primary x rays transmitted from collimator may not be blocked by the attenuating elements of beam particle stopper array plate before reaching the detector if the transmitted beam is small in cross sections, it is therefore possible that there is not a high SPR value in the second imaging positions, therefore scatter removal may not be needed before the capture projection image data or their derivation may be used for imaging processing, and or image reconstruction.

The images generated by the second set of emission positions by a second source may be same or may of different energies or of varied frequencies, or different phase, or different exposure settings or radiated with characteristics of varied values in x ray imaging parameters, than that of the first image sets. In that case the image capture by the same detector or different detector corresponding to each of the source may take place in the same time domain or approximately at the same time.

For some generators of fluoroscope, the continuous mode only emit small amount of current, for example, at 10mA, the source may be in a continuous mode as the x ray emitting position changes from one position to another. The detector is synchronized with the location of x ray emitting position being at the preferred location where image is to be taken for image reconstruction and or image processing so that x ray detector starts to collect the image or exposure signal at the preferred location. After enough exposure signal is collected at the preferred location, x ray detector either deactivated or timed to take an image at a later time. X ray radiation is either off for a small period of time or continuous until the detector is ready to take another image again.

In one configuration, for an exposure to be effective generating a signal on the detector after passing through a sample, the total amount of radiation exposure needed may be 10m As, therefore the x ray emission may be set to be continuous and the detector activates and be set to collect exposure in a period of one second until 10m As signal is collected, then the detector is off, until the x ray emission position is moved to a new location for another image, at which time, the detector is on again to initiate the signal collection process, therefore may be synchronized with the location or spatial location of the x ray emitting position.

3D reconstruction method

In one configuration, instead of using system matrix, the projection image may be related using a method describing the geometry of projection image as the x ray emitting position moves relative to the ROI, and the pixel position on the detector each beam of the projection measurement may be accounted for by an angle from the vertical axis of x ray radiation source, and / or the projected location corresponding to the beam line. If the x ray emitting position moves in a xy grid area, then the grid may be described by xy coordinates of each point on the grid area compared to a reference location. Each beam line is tracked by a number which may also have an x y coordinates to indicate its spatial position to the center line of the x ray tube.

In one configuration, at least one tensor may be used to relate a projection beam to its corresponding position in the detector and at least one additional projection beam of the x ray source or x ray beam generated from the x ray emitting position to its corresponding pixel or pixel positions on the detector.

In one configuration, at least one vector may be used to describe the beam affected area on the ROI and /or the imaged object.

In some instance, at least one matrix may be used to describe each voxel in the ROI and its projection path involving other voxels and resultant projection measurements on its corresponding pixel or pixel region on the detector or detectors.

In one configuration, a sub matrix may be used to describe a subset of linear equations for solving a subset number of variables.

In one configuration, Kaczmarz method may be used for reconstruction. Various modifications or derivatives of this method may be used to improve the speed of reconstruction or of the convergence of solutions. In one configuration, each equation of the linear system can be interpreted as a hyperplane, and the solution of the consistent system can be interpreted as the point of intersection of these hyperplanes. The search for an approximate solution by the Kaczmarz algorithm is carried out in the directions perpendicular to these hyperplanes.

In one configuration, a randomized version of this algorithm may be used, and estimates its rate of convergence may be estimated. One of the purposes of the randomization of projection method to provide the speed of convergence regardless of the number of equations in the system. The block Kaczmarz modification was developed with the study of the convergence of the random projection algorithms. From the geometric point of view, the projection may be not made onto the hyperplane, but on intersection of several hyperplanes.

In one configuration, the block algorithm implementation is related with the least squares solution of an underdetermined system of linear algebraic equations in each iteration. This problem may be solved using the MoorenPenrose pseudo-inverse. This is equivalent to solving a system of equations with a generalized arrowhead matrix

Another variation of kaczmarz may be used in which a modified Kaczmarz algorithm for solving systems of linear equations in a distributed environment, i.e. the equations within the system are distributed over multiple nodes within a network.

In one configuration, randomized coordinate descent (CD) for solving the full-rank overdetermined linear least-squares may be used.

In one configuration, a first CD ( coordinate descent) may be used first to compute the residual and then standard Kaczmarz on the resulting consistent system is used.

In one configuration, enhancement of the Kaczmarz algorithm with projection adjustment may be used.

In one configuration, relaxed greedy randomized Kaczmarz methods for solving large sparse linear systems may be used. In one configuration, an Iterative Hard Thresholding Algorithm based on Sparse Randomized Kaczmarz Method for Compressed Sensing may be used.

In one configuration, one randomized iterative method for solving a consistent system of linear equations may be used.

In one configuration , the iterative method for solving a consistent system of linear equations may include the randomized Kaczmarz algorithm, randomized coordinate descent, randomized Gaussian descent and randomized Newton method. Block versions or versions with importance sampling of all these methods may be used.

The method is shown to enjoy exponential rate decay (in expectation) - also known as linear convergence, under very mild conditions on the way randomness enters the algorithm. Another row projection method for solving structured linear systems on parallel computer for image reconstruction is cimmino’s method, which may also be used.

Identification and Quantification of one or more Embedded Component of Interest, ECOI, such as Microcalcification, Blood Vessel, Nerve or Cation++ rich or Negative Contrast Labeled Regions, Contrast Labeled Regions, Plaster Cast, and or identifiable region which can be separated from the rest of the background from an x ray measurement, diseased region, a tissue and or a region of tissue or object, a region of composite material or absence of an component of interest

In some cases, the microcalcification represents any of the above material and substance.

In one configuration, A embedded component or material or substance such as microcalcification imaging method: 3D imaging reconstruction system which include tomosynthetic image reconstruction system and method and or inverse geometry scanning imaging method and or 3D imaging method described in the disclosure and aforementioned PCTs and other 3D or tomographic imaging method comprising the steps of:

-Identify and isolate regions of potential microcalcification, from projection measurements, or image and or derived separated tissue image using dual or multiple energy methods, in some cases, involve DRC method described in aforementioned PCTs, distributed rear component method.

-acquire and reconstructing a 3D intermediate image from a plurality of point or ID or 2D or 3D or combination of measurements and images in point to multiple dimensions respectively obtained from a plurality of digital point to 3D projection and reconstructed images respectively acquired from different x-ray emitting positions relative to VOI in a subject in a translation movement range, and or limited angle range such as less than 1 degree, and or 1- 5 degree, and or 5-10 degree and or between 10-15 degrees, and or between 15-60 degrees or between 60- 180 degrees.

-in one configuration, the acquisition may be selectively, the approximately the selected regions which may contribute to the potential microcalcification projection image regions are illuminated and or are prioritized in reconstruction.

-Remove scatter if scatter is expected to be significant using beam particle stopper array, beam stopper array or beam selector, and or movable version of such device and or interpolation method and or time of flight scatter separation, primary modulator frequency domain scatter separation method to less than 1% SPR or less than 5% SPR, or less than 10% SPR, in one configuration, with or without subjecting said projection images to noise filtering;

-material separate microcalcium regions contained in the respective reconstructed image and electronically marking microcalcium voxels respectively associated with said microcalcium regions;

-in one configuration, selecting at least one of said slice images as at least one subject slice image relevant to said microcalcium region; in one configuration

-in one configuration, quantify the said microcalification region or material of interest or ECOI in terms of attenuation value, and or optical density and or density, and or total volume in the material separated volume.

- in one configuration, forward projecting the microcalcification voxels in the segmented microcalcification region of the at least one subject slice image, and marking microcalcification pixels associated with the microcalcification voxels in the 2D projection images;

-Display the said images and display the quantified values associated with at least one microcalcification location, in some cases, along with the spatial distribution parameters.

-In one configuration, generating noise-filtered 2D projection images by subjecting the microcalcification pixels of the 2D projection images to adaptive noise filtering, wherein no noise filtering or noise filtering leading to a noise reduction that is reduced relative to remaining image regions is implemented;

-In one configuration, generating a final tomosynthetic, or Inverse Geometry Scanning Imaging Method and or tomographic imaging method described in this disclosure and aforementioned PCTs x-ray image from the noise-filtered 2D projection images.

-In one configuration dual energy or multiple energy projection imaging and measurements may be performed, the voxels or regions or slice which containing microcalcifications may be material separated to provide information of proportion of substances and materials relative to each other or each of other materials or the background substances.

In one configuration, to further characterize region of interest containing microcalcification. Structural illumination comprising two or more x ray illumination beams with defined field of view can be performed. If there are distributed regions of macrocalcification or x ray beam with restricted field of view by electronic control, such as in a field emitter x ray source or by collimator or MAD filter is used to illuminate only microcalcification voxels.

-In one configuration, multiple dimensional image acquisition and or multiple dimensional or 3D reconstruction may be performed on a VOI directly with or without at least one single energy projection measurement.

- in one configuration, selected reconstruction and image processing with varied parameters may be performed to further zoom in the details of microcalcification and or its surrounding volumes or regions. For example, higher resolution reconstruction, and or dual or multiple energy imaging to separate substances and derive relative quantitative relationship in terms of amount or density concentration in one or multiple volume of interests. -In one configuration nose filters or adaptive noise filters or edge filters may be performed after forward projection to the microcalcification region while no filtering or no noise filtering leading to a noise reduction that is reduced relative to remaining image regions is implemented.

-in one configuration, a approximately complete 3D image with defined resolution along the third dimension relative to the detector or multiple dimensional x ray image from the noise filter 2D projection images is generated.

In one configuration, image processing may be performed such as Denoise, gain, dead pixel, pixel consistency and normalization.

In one configuraiton, the measurement of reference sensor may be performed to derive input intensity of x ray measurements.

In one configuration, dual energy or multiple energy 2D measurements may be used to identify provisional region of microcalcification prior to a 3D reconstruction. Provisional Region of ECOI may be selected which can be designated as may containing calcification may be 3D reconstructed selectively using regions of projection images or measurements containing projection images of provision regions of ECOI.

In one configuration, dual energy and multiple energy 3D reconstruction and measurements of the provisional region of ECOI may be performed to provide quantitative analysis of the Provision Region of ECOI.

In one configuration, inverse energy response function system may be used, where depending on the thickness of the VOI, and thickness of components as part of VOI, materials and substances are separated in 2D as well as within each volumetric unit of interest with the imaged subject.

In one configuration, methods concerning identification, quantification and multiple dimension, from 2D - 7D ( xyz, pitch yaw and roll and time) reconstruction of VOI comprising Metal or Synthetic Material Configurations for Imaging Metal and or other absorbing material in catheter or an implant which comprising one or more substances overlapping each other, such as sheath or lumen

In one configuration, If the approximate density and or thickness and or spatial distribution of catheter and or probe and or implant and or its internal component are known

In one configuration, a method for determining a three-dimensional reconstruction of an examination object, include steps of:

Scatter can be removed if SPR is significant to SPR <1%, or SPR <5% or 5%-10% using stationary and or movable beam selector, beam absorber particle arrays or beam blocker arrays and time of flight source and detector and or primary modulator based scatter removal methods.

Multiple and 3d TOMOGRAPHIC IMAGING using the present disclosure and aforementioned PCTs, tomosynthesis and inverse scanning geometry fluoroscope and other tomographic imaging methods from point to 3D images or measurements of the VOI containing the metal part.

In one configuration, dual energy or multiple energy 2D and or 3D imaging are performed to Identify the region of measurements which containing the metal in the projection images.

In one configuration, identify the slice and or spatial location of volume containing the metal region

In one configuration, derive the total thickness of the metal object along each projection line corresponding to each pixel which received project line passing through the metal using inverse energy response function system to solve metal and or other substances absorbs differently than the background.

In one configuration, the identification and characterization of metal location and spatial distribution is through dual or multiple energy imaging involving DRC, distributed random components, where such components are displayed and located in the material separated image of substance such as soft tissue, lean tissue or fat, where the image is slow varying except due to presence of metal, or other synthetic or foreign objects within VOI Given that the density is known of the metal and or the attenuation property is known, the volume of the metal region and or spatial distribution of the metal can be derived.

In one configuration, defining edge zones of the provisional metal areas in the original projection images;

In one configuration, selecting edge points from the edge zones;

In one configuration, mapping the provisional metal are into the original projection images to create a plurality of corresponding provisional metal area; if the are multiple metal area or multiple layers of metal or other absorbing material, based on preexisting data, approximately determine the edge zones of each material or substance Determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of the examination object, approximate density or volume of metal or substance and related information to forward project and approximate relative spatial position and or distribution in the projected image and or in the 3D reconstructed image;

In one configuration, mapping the provisional metal volume into the original projection images to create a plurality of corresponding provisional metal volume;

In one configuration, determining modified projection images and compared to the original projection images, if a threshold target or approximate variance value has been reached, store the 3D volumetric data and proceed to the next stage for data presentation or processing relevant to the current method and application. If not, proceed to the following steps:

In one configuration, alternatively derive the total attenuation value based on the resolved value of each voxel or voxel regions including the metal region in the beam bath, if the total value is approximately the same as the derived value from the projection measurement of the beam path, or with below a variance value set as a approximate threshold, the projection image containing the metal portion in the VOI can then be presented against the background and or imaged processed and or positioned against the background and or markers such as anatomic markers and or external markers, and or labeled.

In one configuration, the following steps may be used to reconstruct VOI containing metal volume, it may include iterative steps or the iterative steps may be omitted depends on the results of the first reconstruction, -Determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of the examination object, approximately determine the approximate density or volume of metal or substance and related information;

-Segmenting or material separate the provisional three-dimensional reconstruction and in some cases with dual or more energy measurements and material decomposition to determine a provisional metal volume and its spatial distribution and position in multiple dimensional space; mapping the provisional metal volume into the original projection images to create a plurality of corresponding provisional metal volume;

-Determine the spatial position of the metal volume and or on a pixel basis -determining modified projection images by modifying data values of the 3D volume data derived from the last iteration or reconstruction, in locations of the provisional metal volume as a function of data values of the selected edge points;

-calculating differential images based on the original projection images and or the corresponding modified projection images and or density and volume of substance and or composite substance;

-segmenting the differential images to determine definitive metal areas;

-Determine modified projection images from the definitive metal areas; and -determining the three-dimensional reconstruction by incorporating contribution from the material density and volume data from the definitive metal area and or data to the corresponding modified projection images.

-Compare to the original projection data.

Dual or more energy CT may be performed at each source and corresponding detector position, and material decomposition may be performed and correct for each projection line geometry corresponding to a pixel or a pixel region.

Same iterative steps may be repeated or may be omitted depending on if a predetermined variance value from the original dataset is reached.

In one configuration, the value of modification may be limited to one or more voxels instead of all the voxels in the beam path where the variance above the threshold is detected. If there is high frequency voxel values or voxels with values significantly different from its surrounding areas, when slowing variance values are expected or predetermined relative values are expected, the voxel regions where such signal exists may be replaced with values interpolated from its surrounding regions or simulated values, and forward projection is performed again to assess the variance value from the modified projection and the original measured value or data derived from the original projection value.

In one configuration, the original volume and or the original spatial distribution of metal attained from the first reconstruction may be sufficiently close to the actual data that there is no need for reconstruction for areas other than selected regions. Or the regions with high variance such as above threshold values, may be derived from its adjacent neighbors where such variance values are relatively small. Such interpolation can occur in both metal and non metal area. Forward projection and or summation of attenuation values can be used to reevaluate the modified reconstructed value and or projected image to until such variance is minimized below threshold

Such a method can be used on metal, or microcalcification or any tissue or non tissue component or substances.

In one configuration, to identify and track a component in VOI, such as metal or an object differentiable by x-ray measurements, without knowing the density and or dimension and or the spatial distribution of of such component, in a human body or an imaged subject:

Dual energy imaging - identify the edge zone of the metal

In one configuration, using dual energy or multiple energy to separate background materials, such as using dual energy to separate bone and soft tissue.

The part of the metal exist in the VOI will show up in bone image, and as well as soft tissue image.

As the soft tissue and or the bone tissue are slow varying, the edge of metal or the metal portion will therefore have a sharp and distinct measurement from its adjacent materials, therefore can be identified.

In one configuration, single energy imaging is sufficient to identify the edge zone In one configuration, three dimensional tomography identify the edge zone as well

Determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of the examination object, the approximate metal density and volume and spatial position in the projected image;

In one configuration, identification of the metal at distributed locations using spectral imaging using x ray spectral thin beams and or using 2D spectral imaging In one configuration, determine approximate density value

In one configuration, defining edge zones of the provisional metal areas in the original projection images; selecting edge points from the edge zones; in one configuration, Determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of the examination object, the approximate metal density and volume and spatial position in the projected image; in one configuration, Segmenting the provisional three-dimensional reconstruction to determine a provisional metal volume; mapping the provisional metal volume into the original projection images to create a plurality of corresponding provisional metal areas; in one configuration, determine the spatial position of the metal volume related to other anatomic markers

In one configuration, determining modified projection images by modifying data values of the original projection images assigned to locations in the provisional metal areas as a function of data values of the selected edge points; calculating differential images based on the original projection images and the corresponding modified projection images; segmenting the differential images to determine definitive metal areas; subtracting the definitive metal areas from the differential images; and determining the three-dimensional reconstruction by adding the subtracted differential images to the corresponding modified projection images. In one configuration Method for generating or quantify metal based on reconstructed density values,

Dual energy or multiple energy imaging or single energy imaging In one configuration, Identify edge zone of the metal area

In one configuration, material decompose to metal and the rest of VOI in the subject in which A plurality of projections of an object is generated by means of X-ray technology, - a tomographic data set is reconstructed from the multitude of x-ray images, typically projected from a region less than 1 degree and or between 1 - 5 degree, and or between 5-10 degree and or between 10 - 15 degree, relative to the VOI and or relative to at least a portion of source to detector or x ray emitting position to detector center axis for at least a portion of projections and or relative to source to detector center axis for approximately all or most of projections. . in one configuration, the voxel value are verified and corrected if it is different from its adjacent voxels. in one configuration, Projection image and reconstruction of a metallic area in the VOI and in turn the metal volume in the tomographic data set is identified by means of segmentation and or material separation based on density value or a range of density value or radiographic density value and or voxel value for each voxel.

In one configuration, each projection image either has low SPR level and or Scatter is removed using beam blocker, beam selector, time of flight x ray source and or detector.

In one configuration, in implant and surgical/intervention guidance, Preplanning after 3D image acquisition and reconstruction of the original volume, or VOI for the surgery, which can be called first tomographic image.

Determine and plan for surgical map and navigation of catheter and or surgical probe and tool and or catheter guided energy treatment spatial distribution and entry angle.

For implant, energy treatment and or biopsy, surgery, determine the 7D spatial distribution of the probe or virtual space for surgery or intervention or biopsy relative to treated tissue or relative to at least one or more anatomic marker or reference markers. Live measurements of VOI, for example, the probe and implant in point to 2D and reconstructed 3D to 7D image provides the feedback of alignment and misalignment of the measurement relative to the anatomic marker and reference marker

Navigation guidance of the catheter and surgical tool or biopsy probe and or radiotherapy orientation is adjusted in ID to 6D to improve alignment. The final alignment is when the probe or implant is precisely placed in the preplanned volume, and in some cases, relative to anatomic or reference marker.

In one configuration, the analysis of post alignment physiological characteristics is performed such as blood flow direction and or other physiological state are measured to verify results. Specific tests and verification methods used in real time post surgery may be developed and utilized to verify the final position prior to the end of intervention and treatment.

In spine treatment, may be the alignment angle between different bone types and or bone structures.

In one configuration, nerve and or blood vessel distribution are mapped relative to anatomic markers either as part of navigation path, or as a part to be kept at a distance larger than a threshold set by the user and or a digital program.

As the distance between nerve and or blood vessel and or a tissue is in proximity which can cause safety issue, an alarm or sound may be generated to alert the operator and physicians when the distance is assessed to be shorter than a threshold value.

In one configuration, 3D reconstruction algorithms, there typically iterative method and correction method to ensure the fidelity of the reconstructed image.

In one configuration, no iterative method is needed after the first reconstruction or limited number of iteration may be performed. The error of voxel value detected can either be automatically corrected based on a set of criteria, for example, reconstruction in the approximate region which is critical and or important for the intervention or treatment, for example, where the movement of the catheter tip and or the region of pathology or treatment would be, two or more reconstruction algorithms may be used. If there are inconsistencies between the resultant reconstruction value, if it is critical for guidance, such values are compared to the adjacent or voxel values in proximity, if they are quite different, an interpolated value from the voxel values for voxel in proximity of the voxel in question can be generated.

In one configuration, the resultant voxel value reconstructed from the live measurement may be generated compared to the voxel value from a measurement before the image guidance, such as during surgical planning and can be replaced with a value closer to the correct value based on prior measurements and or prior reconstructed value.

In one configuration, reconstruction can be approximately minimized to regions of variable which is relatively critical for assessing the 7d or 6d spatial location of the catheter relative to the object and or anatomic markers, as the value of rest of the object can be obtained from the either prior measurements during surgical planning and or during the surgical guidance.

The guidance system may contain at least one computer, display or hand or foot pedal or switch.

In the software and or in the software UI, the time interval between approximately at least one or more of the following methods during one procedure can be used : complete 3D imaging and or sometimes spectral imaging and or spectral 3D and or limited region 3D, and or 2D imaging and or ID imaging and or point imaging and or structural illuminated imaging of VOI can be adjusted

In the software and or in the software user interface, the time interval between approximately at least one or more of the following methods during one procedure can be selected and used complete 3D imaging and or sometimes spectral imaging and or spectral 3D and or limited region 3D, and or 2D imaging and or ID imaging and or point imaging and or structural illuminated imaging of VOI can be adjusted

Such method may be used during the surgical procedure as a part of navigational guidance tool. Or for monitoring of a previously imaged VOI, and or for rapid diagnostics. In one configuration, an image acquisition system and or a reconstruction algorithms and or image processing method or algorithms may be stored and integrated together in at least one computer. Images stored in the computer can be image processed and reconstructed. However such programs and or algorithms for image processing, such as scatter removal, and or relative image intensity assessment from one exposure to the next, and pixel value and relevant data adjustment based on factors such as relative image intensities and relative x ray input intensity, can be a separate program, its function can be performed in one computer, near the image acquisition system, or in the remote operator’s room, or in cloud and or in a remote server. And the reconstruction algorithms can also be store in the same or a different location such as cloud or a separate computer and remote server.

In one configuration, imaging processing and or image reconstruction and or image analysis software such as material separation and segmentation may be performed in the same location or in cloud or on block chain and or in a remote server.

In one configuration, the image processing can be done parallel, for example all in cloud and or in local computer and or remote server, or there may be redundant image processing running parallel and or in series so is reconstruction in a separate software, to ensure accuracy and verification and speed.

In one configuration, a certain portion of the images may be processed in one location and the rest of images may be processed in another location, the combined results are used together for prognosis, diagnosis, surgical guidance, post - monitoring and surveying.

Raw images without scatter removal acquired may be export out of the local position and reconstructed in locations and servers and computer different than the computer used for image acquisition. Both raw images and or the image processed images such as generated scatter and or primary images and or the final beam blocker shadow swapped images and or image averaging processed images can be exported out of the imaging system a user may use the imaging processing and reconstruction tools on the local computer and or within the facility, or a different imaging processing and or reconstruction algorithms can be used for image processing such as scatter removal, intensity adjustment, pixel value adjustment, averaging, stacking of signals and material decomposition, segmentation, and reconstruction.

In one configuration, such images and or image processed results and or reconstructed images may be analyzed further for surgical planning using a software. Such a software may image process the data files, or images acquired, and or image processed images in one or more stages of image processing, and or reconstructed image. The analysis such as for neurosurgery or implant or for spine or cardiovascular surgeries, may include function and features such as measurement tool, additional annotation of anatomic markers, surgery mapping and reconciliation of surgical planning and live and or real time surgery guidance images.

Given that the images have less scatter to primary ratio, such as less than 1% or less than 5% or between 1-5% or between 0-10%, information such as precise spatial distribution, and or dimensions and or density improve over CT or 2D fluoro to be achieve precision of guidance in space as good as 1% or as good as up to 5%, or as good as up to 10% and or anything in between. Dimensions, relative spatial position and identification of various parts of the same tissue for example, from reference markers and or anatomic markers or temporal markers may be achieved with higher accuracy, to 1% and or up to 5% and or up to 10% may be achieved, or achieved in shorter time frame than before when CT, or c arm, or cone beam CT and or digital tomosynthesis or 2D fluoro are used.

In one configuration, the images are display in a grey scale designated by the range of density or voxel value generated in the 3D image reconstructed. Relative ratio of voxel value within VOI can be less than 1 or equal to 1 if the highest voxel value is set to 1.

However to relate the reconstructed 3D image to absolute density information may require establishment of a database using known materials similar to actual material and or using actual material which has a quantitative relationship with known material in physical characteristics and or in x ray measurement based quantitative value at single or multiple energies in one or multiple dimensional images or measurements, which may vary with thickness. This provides the basis for correlating measurements and or reconstructed value of voxel in VOI at varied thickness to actual density values or attenuation values using tomographic imaging and or spectral imaging and or spectral CT of VOI the present disclosure and or prior PCTs and or all of chao’s disclosure.

In one configuration , a quantitative relationship of the detector used for measurement of the unknow or VOI of the image object may be established with a highly repeatable and accurate reference sensor. And the reference sensor may server as the standard by which each detectors can be measured against and or quantitatively related to and the measurement of the standard established the reference for properties which can be measured with varied thickness, material, density and dynamic characteristics and relative substance ratio and or segmentation, and or material decomposition and or point to 7D distribution and characterization.

In one configuration, all images are labeled with relevant information in dicom file or meta file to be used as a reference and or for image processing and or for reconstruction.

Such image files may be stored in local drives of the image acquisition system and or a server linked to image acquisition system or transported out to a pac system and or to a database with or with our pac infrastructure for digital storage.

Such images may be time stamped

A set of data file relating an imaging procedure including images and or related data files and or patient information, and or facility or image acquisition information and or software name and version for generating image processed images and or reconstructed images and or AI software, may be stored locally in one or more computer or servers for storage and or for accessing by radiologist or programs for further analysis. Analysis of at least one or more images, locally and or in a separate location and or server by radiologist, surgeons and or AI algorithms and in sequence and or in time in imaging procedures and in some cases, against surgical planning data and algorithms, may used for improve surgical planning algorithms and or to improve AI algorithms and for optimizing and or improve operating time and or patient outcome.

At least a portion of the image data or a set of image data in an image procedure and or in a number of imaging procedures over time for example for the same patient and or for two or more or a set of patients to draw conclusions about the patient condition, and or to provide statistically meaningful data and or quantitative information and or qualitative information to generate new results and or facts regarding the patient and or for a least two or more patients.

Blockchain may be used to link with at least one image of the entire study series, or a portion of or over a long period of time to monitor variations and changes for clinical significance. In one configuration, the number of x ray emitting positions and or number of projections may be quantitatively related to the dimension of the implant or a portion of the implant.

In one configuration, the number of x ray emitting position and or number of projections may be quantitatively related to the approximate dimension of the implant oriented in the VOI approximately vertical to the detector, and or related to the approximate dimension of at least one internal object or at last one reference marker with specified dimension and with a relative spatial distribution and or relationship to the implant.

In one configuration, images or data files from other modalities such as MRI, optical imaging, electromechanical or electrochemical or invitro pathology analysis and or biopsied sample characterizing a region of VOI and derived data and facts can be combined with one or more images and or data files obtained using x ray measurements, for example, those generates or raw images obtained with scatter to primary ratio less than 1% or less than 5% or less than 10% for surgical/ intervention and treatment planning, prognosis, diagnosis, post intervention monitoring, surveillance.

Alignment and reconciliation of real time intervention probes and tools with existing planned surgical map, in some cases, angiograms, can be achieved faster and more accurate using the 2D or material decomposed or spectral imaging combined with CT or 3D imaging and or fluoroscope and or 3D fluoro, CT perfusion, multiple phase CT using the present disclosure and or disclosed methods and apparatus in the aforementioned PCTs and chao’s disclosure.

In one configuration, the user can select resolution from the software interface which is suitable for different parameter configuration of 3D imaging throughout the intervention procedure and or different parameter configurations, such as varied or a selected resolution for different procedures, exposure setting, mA and or imaging and or x ray filter for varied imaged subject and or for tracking or monitoring and or identifying of at least one object which can be placed internal to the imaged subject, such as surgical tools, or implant and or parts used in energy based surgeries.

In one configuration, resolution can be adjusted, For example from single digital um to cm as the resolution. In one configuration, both in intervention and or treatment planning and or navigation planning and post monitoring, the dimension of the implant and or intervention volume within VOI and or dimension of a part , or a portion of intervention device, such as surgical probe, and or biopsy probe and tool tips, may be quantitatively related to the resolution of the 3D image, for example, determines the number of x ray emitting positions and or number of projection images need to be taken for an approximately complete 3D image.

In one configuration, the interval between 3D fluoro or 3D image generation may be adjusted.

In one configuration, the interval may be a fixed number or generation of 3D images and display is continuous.

In one configuration, the interval between 3D images can be longer such as during one stage of intervention navigation, and in other stage such as during energy treatment or during ablation, the interval can be shortened. And or in one configuration, spectral imaging in 2D and 3D may be used during the treatment, and may be applied during a specific stage of the intervention.

The user or operator of the x ray system may adjust such parameter using software by entering information prior to the intervention.

In one configuration, the operator may use a switch or physical switch or software input to trigger 3D image generation during the intervention

In one configuration, combination of both timing methods can be used.

In one configuration, only a selected component is tracked and displayed over existing background and or a portion of images acquired and reconstructed earlier.

In one configuration, use of AI is applied for image processing for diagnosis, prognosis and post op monitoring and surgical planning and or for reconstruction, and or for inspection, identification and quantification

In one configuration, an AI method includes: A storage unit for storing the trained model,

A processing unit that performs detection and or tracking processing based on the learned model,

Including,

The trained model is

Based on the teaching data annotated indicating the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity within at least one Volume Of Interest (VOI) of the object, with respect to the learning image captured so that the VOI whose the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity are not displayed in the image is within the field of view, A learned model that has been learned to output the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity of the VOI in the learning image,

The processing unit is in one configuration, by performing the detection and or tracking process on the detection and or tracking measurements captured so that the volume of interest is within the angle of view, the detection information indicating the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity, identification, determination, characterization of the VOI and substances within it and or the object is output, and the detection information is used as the detection image. An information processing system characterized by being displayed on a display unit in a superimposed manner. The information processing system is an annotation. For example, by giving a flag to a pixel determined as a pixel belong to a characterized region part of VOI in the learning image.

-A detection process of receiving an input of the detection image to the neural network and detecting an object is performed, and detection information indicating the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity within at least one Volume Of Interest (VOI) of the object, in the detection image is superimposed on the detection image and displayed on the display unit. A trained model that makes a computer work,

The neural network is

An input layer for inputting data,

An intermediate layer that performs arithmetic processing on data input through the input layer;

In one configuration, an output layer that outputs data based on the calculation result output from the intermediate layer,

Equipped with The trained model is

Based on the teacher data annotated indicating the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity within at least one Volume Of Interest (VOI) of the object, with respect to the learning image captured so that the object whose physical and chemical properties such as distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity within Volume Of Interest (VOI) of the object are not displayed in the image is within the angle of view, A learned model, which is learned so as to output the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity within Volume Of Interest (VOI) of the object in the learning image.

In one configuration, an information processing method for performing detection processing based on a learned model,

The trained model is

Based on the teacher data annotated indicating the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity within at least one Volume Of Interest (VOI) of the object, with respect to the learning image captured so that the object whose clear position and shape are not displayed in the image is within the angle of view, A learned model that has been learned to output the position shape of the object in the learning image,

By performing the detection process based on the learned model for the detection image captured so that the target VOI is within the angle of view, the detection information indicating the distribution in the space domain, density, movement, fluidic dynamics, chemistry properties, energy disturbed properties, elasticity of the target VOI is output,

An information processing method, characterized in that the detection information is superimposed on the detection image and displayed on a display unit.

In one configuration, the measured raw data is labeled with configuration of the system and hardware, and parameters can be used for image processing and or reconstruction, in some cases, database may be included for reconstruction and or spectral imaging and or material decomposition.

In one configuration, metal Detection and Reconstruction of VOI containing Metal and similar type of object

In one configuration, A method for determining a three-dimensional reconstruction of an examination object comprising metal, such as implant, surgical probes, and or biopsy probes include steps of: performing dual energy imaging, wherein the scatter is removed, for example, if SPR > 1% to achieve SPR <1%, or SPR <5%, or between 5%-10%, the dual energy imaging comprising performing material decomposition to derive a total thickness of the object along each projection line corresponding to each pixel which received a project line passing through the metal using inverse energy response function system to solve metal from other substances that are absorbed differently than the metal; defining edge zones of provisional metal areas in the projection images obtained from the dual energy imaging; or as in one configuration, using DRC, distributed rare component method may be used to separate metal from the background information or image. selecting edge points from the edge zones; mapping the provisional metal areas into the original projection images to create a plurality of corresponding provisional metal areas;

Optionally in response to there being multiple metal areas or multiple layers of metal or other absorbing material, based on preexisting data, approximately determining the edge zones of each material or substance; determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of the examination object with provisional density or volume of the metal or substance and related information to approximate a relative spatial position and/or distribution in the projection image and/or in the 3D reconstruction; in one configuration, selected region in Volume of Interested containing metal of interest is reconstructed selectively, and or selected region in VOI containing a reference marker may also be selectively reconstructed. mapping the provisional metal volume into the original projection images to create a plurality of corresponding provisional metal volume, determining modified projection images and comparing the modified projection images to the original projection images; and if a threshold target or approximate variance value has been reached, storing the 3D volumetric data and proceeding to a next stage for data presentation or processing relevant to an application of the method.

In one configuration, the method of one item above, wherein one or more of the following steps may be iterative, for example, determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of the examination object, and determining the approximate density or volume of metal or substance and related information to approximate a relative spatial position and/or distribution in the projection image and/or in the 3D reconstruction; segmenting the provisional three-dimensional reconstruction to determine a provisional metal volume; mapping the provisional metal volume into the original projection images to create a plurality of corresponding provisional metal volume; determine the spatial position of the metal volume and/or on a pixel basis; in one configuration, determining modified projection images by using data values of the 3D volume data derived from the last reconstruction, in locations of the provisional metal volume as a function of data values of the selected edge points; calculating differential images based on the original projection images and/or the corresponding modified projection images and/or density and volume of substance and/or composite substance;

If the differential images are constructed of values close to a threshold near zero value, and or the percentage of data on differential images are greater than a certain threshold is smaller than a predetermined threshold,

Reconstruction is completed. Further image processing the reconstruction data can be performed based on application needs. For example, for some applications, reconstruction done is sufficient for tracking applications where a metal object is tracked by 3D reconstruction, for example, if the differential images are due to values in the metal volume regions.

For example, for some applications, reconstruction done is sufficient for identification of the component of interest, such as the metal, quantification of the metal volume and positioning of the metal, and or for evaluation of region of interest in areas of importance, such as a legion or microcalcification region, when the differential values are contributed by the region is not in proximity of metal, or legion and or microcalcification, or a component of interest.

In one configuration, the image process continues as

For example,

Modify the differential image area so that overall it is slow varying as the rest of the region for example, if the differential image area are due to regions outside of the metal area determine modified projection images from the definitive metal areas; determining the three-dimensional reconstruction based on the new values in one configuration comparing the three-dimensional reconstruction to the original projection data.

In one configuration, no further processing is needed.

In one configuration, the method of an item above, wherein the iterative steps is repeated or omitted depending on whether a predetermined variance value from the original dataset is reached.

In one configuration, the method of any of items above, further comprising performing dual or more energy CT at each source and corresponding detector position, and performing and correcting material decomposition for each projection line geometry corresponding to a pixel or a pixel region.

In configuration, the method of any of items above, wherein the method is performed knowing the density of the metal object and spatial distribution of the metal. For example, for some applications, reconstruction done is sufficient for tracking applications where a metal object is tracked by 3D reconstruction, for example, if the differential images are due to values in the metal volume regions, can therefore be eliminated based on predetermined value and or relative value of the metal physical properties.

In one configuration, a method of identifying spatial distribution of a metal without knowing a density of the metal using dual or multiple energy imaging, the method comprising at least one or more of the steps: defining spatial distribution of the provisional metal areas in at least one of the original projection images on a normalized pixel basis by spectral imaging and material decomposition based on projection images with less than 1% or less than 5% SPR. estimating attenuation value of the metal determining a provisional three-dimensional reconstruction of the examination object based on a plurality of two-dimensional original projection images of VOI containing metal in the examination object, segmenting the provisional three-dimensional reconstruction to determine a provisional metal volumetric spatial distribution and location; in one configuration, estimating the density of the metal mapping the provisional metal volume into the original projection images to create a plurality of corresponding provisional metal areas; determining modified projection images by modifying data values of the original projection images assigned to locations in the provisional metal volumes as a function of data values of the selected spatial positions; calculating differential images based on the original projection images and the corresponding modified projection images; segmenting the differential images to determine regions contributing to regions of differential values greater than a certain threshold; in one configuration, if the contributing region is outside of the metal volume and or the regions have pixel area greater than a certain threshold is typically not in the region of component of interest, ignore the variance and display the final results with smooth interpolated value determining the three-dimensional reconstruction or image by using the modified value In one configuration, the method of item above, further comprising obtaining a 3D image data set from a plurality of 2D image data sets obtained using an X-ray image acquisition device freed from tracks of at least one metal object imaged in at least part of the 2D image data sets, wherein the obtaining is based on the dual or multiple energy 2D projection imaging of the VOI containing the metal object,

In one configuration, the method of items above, further comprising deriving a metal attenuation value linearly in the direction of the projection and its approximate distribution in the spatial domain is derived.

In one configuration, the method of any of items above, further comprising increasing the exposure level to accommodate for the metal attenuation in the image compared to VOI imaging without metal.. VOI can be tissue or semiconductor material.

In one configuration, the method of any of items above, further comprising interpolating the area with metal with regions around it.

In one configuration, the method of item above, wherein , if fat and lean tissue are separated, each of the fat and lean tissue is interpolated into the region where the metal is expected to be so that the interpolated region is slow varying throughout the region. In one configuration, the method of item above, further comprising reconstructing a 3D image data set obtained from the 2D image data sets and sometimes, also based on predetermined density information and thickness of the metal from the measurement and the rest of tissue,

In one configuration, the method of item above, wherein the 3D image data set is obtained from the 2D image data sets reconstructed from the data set containing interpolated tissue value

In one configuration, the method of item above, further comprising the step to compare the two methods

In one configuration, the method of item above, further comprising generating a preprocessed 3D image data set, wherein in the preprocessing an interpolation of data values takes place to determine at least one or a plurality of substitute data values for the selected voxels in the preprocessed 3D image data record, such that from the substitute data values, dependent data values of the preprocessed 3D image data set, a value of an objective function is determined, and iteratively changing the substitute data values until the value of the objective function meets a predetermined criterion.

An x-ray system configured to perform the method of any of items above, comprising a detector that detects X-rays transmitted through a subject with a detector and collects projection data based on the detection result.

In one configuration, the system of any of items above, comprising a computer or microprocessor or controller for acquiring position information of one or more X-ray superabsorber in the subject.

In one configuration, the system of item above, wherein the X-ray super absorber is a metal object.

In one configuration, the system of any of items above, comprising a deriving unit for deriving information on the transmission path of the X-ray according to the processing effect of the metal artifact reduction processing on the X-ray high absorber based on the positional information of the X-ray high absorber.

In one configuration, the system of items above, wherein the derivation unit derives information on a transmission path of the X-ray so as to reduce the metal artifact in a region of interest of image data reconstructed from the projection data in the metal artifact reduction processing.

In one configuration, tompgrahic methods comprises of one or more steps of the following, not in a fixe order: image acquisition, scatter removal, 3D reconstruction, segment the metal volume, present or display the metal image with the rest of VOI in the background and or precisely present spatial location in 6D and 7D relative to the background is a display.

In one configuration, spectral tomographic imaging comprises of one or more steps of the following, not a fixe order: image acquisition at dual or multiple energy levels, spectral imaging, scatter removal, material separation, 3D image reconstruction display metal portion against the background, and or separate metal image and display in 2D format as a individual image and or display metal image in a 2D format against the background, graphic presentation to indicate it is embedded and arrows on the front of the image where metal is embedded, the software with a volumetric transport image over lay the VOI and or images from other background tissues, indicating where the metal using for example computer arrow display overlaying the VOi and can be based on metal spatial distribution on a pixel by pixel basis

In one configuration, a low resolution 3D tomographic imaging is performed to position the metal volume, the image reconstructed can then be segmented to position the metal area in VOI and determine metal area, or edge of the metal area on projection images. High resolution reconstruction is selected on the region containing the metal volume and precise position of the metal can be derived.

Exposure Level Control in one configuration, the method of item above, wherein an x-ray exposure level is approximated by an automatic exposure method and apparatus, and or the time of flight detector, or a non radiation sensor and/or a reference detector, or a first x ray measurement. In some cases, when multiple exposure frames are needed to accumulate enough signal level needed for the VOI, the first frame is sufficient to determine the number of exposures or frames needed for better image data for visualization and or image processing and or analysis.

In one configuration, non radiating sensor such as optical sensor such as time of flight sensor or a camera can be used to to assess surface position of ROI or the object and or thickness of VOI, or for example in a whole body imaging, to assess the starting point of 2D imaging and distance from ROI, for example top layer of ROI, calculate thickness, and exposure needed and or where to move x ray source and detector to have the VOI in field of view.

The field of view for tomographic imaging may be selected based on an x ray image taken of VOI.

In one configuration, single energy or multiple energy X ray images include 2D and or tomographic images and or densitometer measurements and analysis are taken of the ROI, and used to determine selected ROI regions for 3D imaging.

X ray imaging of ROI to determine and or estimate approximate thickness of ROI. The method of any of items above, wherein the method is configured to be combined with another movement trajectory, tube rotating angle, or detector angle to either expand a field of view of an x-ray emitting beam volume or to combine projected images, and/or to expand flexibility of movement due to pre-existing application requirements.

In one configuration, the method of item above, wherein the requirement leads to movements comprises angular and or translational movement of the subject or movement of the VOI.

In one configuration, the method of any of items above, wherein each movement is configured to introduce a new projection path for each voxel of the VOI.

In one configuration, the method of any of items above, wherein the x-ray is emitted from the same location or a different emitting location.

In one configuration, the method of any of items above, wherein the x-ray system comprises more than one source, each source capable of tomography.

In one configuration, the method of item above, wherein the more than one source are configured to be used and represented in the same system matrix, each source having a plurality of emitting positions or are configured to move to generate projecting images of the VOI, wherein the projected images are combined with other images to reconstruct the 3D image of the VOI.

In one configuration, the method of item above, wherein each source is configured to project projected images of at least one portion of VOI, and a 3D reconstruction is derived from two or more set of projected images, each set produced by at least each source.

In one configuration, the method of item above, wherein each system matrix has at least one vector 3 coordinates, each coordinate with three degrees of freedom.

The method of item above, wherein the same system matrix includes different sources, the measured data being combined to establish a more accurate provisional 3D reconstruction.

The method of any of items above, wherein the 3D reconstructed image comprises the VOI, which is determined through earlier 3D reconstruction of different resolution, or energy level or spectral imaging or single energy image or 3D reconstruction at at least one or more different x ray emitting positions.

The method of any of items above, wherein a density information of at least one substance of interest or composite substance of interest is derived from the at least one 2D projected image of the VOI, or at least one 2D projection measurement at selected pixels at one or dual or multiple energy levels on a normalized pixel basis. The method of item above, wherein the projected image is imaged processed with a scatter removal method involving interpolation in the spatial domain and/or using a movable Beam Stopper array and/or stacked detector method with a Beam Stopper array or movable beam selector.

In one configuration, the method of item above, wherein the density information derived for at least one substance of interest or composite substance of interest is in reconstruction of the 3D image where single or dual or multiple energy measurements are used.

In one configuration, the method of items above, the density information of each substance or composites of substances is quantitatively related and or derived from the dimension or the size of voxel or voxel regions and or through inverse look up of energy response function system established through known materials, in some cases, similar to the VOI and or actual materials in the VOI

In one configuration, the method of any of items above, wherein a final 3D reconstruction is used to determine the values of each voxel in the VOI.

In one configuration, the method of any of items above, wherein the x-ray system is mounted upright.

In one configuration, the method of item above, wherein the x-ray system is mounted in an C arm or U arm.

In one configuration, the method of any of items above, wherein the projected images are located at a different VOI on the subject at the same time or at a different time, the combined 3D reconstructed image resulting in a 3D image with a larger volume.

In one configuration, the method of items above, wherein the total x-ray emitting position angle from source to VOI or isocenter of VOI relative to the center axis and or the first position center axis is less than 10 degrees or, less than 5 degrees, or less than 4 degrees or less than 3 degrees or less than 2 degrees or less than 1 degree.

In one configuration, to determine thickness of VOI

Thickness of VOI can be derived approximately derived by a x ray measurement, exposure measurement especially when input intensity is given, can be used to calculate the thickness of the sample given that the materials and or density of selected region of VOI is approximately known. Sensor can be used to derive source to detector distance and related information, approximately such as a point of care setting when the detector assembly is put between a patient’s back and a bed and or in a setting where during assembly and or maintenance and quality verification, source to detector distance and or source to object table or patient table can be determined. .

3D reconstruction

In one configuration, dual energy or multiple energy measurements is used at each x-ray emitting position to for quantitative analysis of VOI, for example, derive the density and or attenuation value, and or linear attenuation coefficient for each material or substance and or characterize a voxel or a voxel region or VOI or to separate regions, segment voxels and materials or substances from background or other substances within VOI.

The threshold and or filter and or constraint can provide image analysis and reconstruction data which are improved for tissue, metal or contrast separation.

In one configuration, in forward back projection calculation, the attenuation value and/or density value derived from dual energy material method using inverse energy response function look-up are used. A reference detector or sensor can be used to measure the actual input of the x-ray emitted prior to its passing through the VOI. This leads to more precise derivation of density and/or attenuation value of each voxel.

In one example, dual energy or multiple energy measurement is performed at one x-ray emitting position, the first emitting position while a reference sensor may also be used. Derivation of the thickness and density of each material is based on the ratio of the output to input x-ray measurements relative to the ROI. The approximate values of attenuation are then used in the weighted forward back project FBP method to be combined with a Monte Carlo simulation, taking into consideration that scatter is less than 5% of the primary or less than 1% of the primary. The relative thickness and attenuation value may be simulated for other x-ray emitting positions based on the measurements from the first x-ray emitting position.

In one example, dual energy or multiple energy measurement is performed at two or more x-ray emitting position distributed in the ID or 2D or up to 6D area traveled by the x- ray emitting position for the acquisition of a tomography image while a reference sensor may also be used. Derivation of the thickness and density of each material is based on the ratio of the output to input x-ray measurements relative to the ROI. The approximate values of attenuation are then used in the weighted forward back project FBP method to be combined with a Monte Carlo simulation, taking into consideration that scatter is less than 5% of the primary or less than 1% of the primary. The relative thickness and attenuation value may be simulated for other x-ray emitting positions based on the measurements from the first x-ray emitting position.

To improve structural fidelity and noise suppression, AI may be combined with reconstruction. For instance, extracting information from prior measurements, incorporating density and other material property measurements can be used as parameters in deep machine learning to train the software to denoise and reconstruct faster and more accurate than without AI.

Imaging with reduced resolution can be performed by limiting the illuminated area using a collimator or by adjusting or rotating the target of the anode and/or increase sparsity of the measurements to achieve reduction of radiation and/or improve image reconstruction.

In one configuration, the iterative method may be is used to reduce noise and or correct errors and or improve reconstruction results in the image reconstruction.

In one configuration, 3D- 7D ( including temporal dimension) and/or densitometry and/or spectral tomography reconstruction

Based on the disclosure herein, 3D reconstruction based on primary images or images with Scatter to Primary Ratio of less than 1% or between 1% and 5% or between 1% - 10%.

In one configuration, reconstruction algorithms may be accomplished by reconstruction techniques or derived method or derivative of reconstruction techniques typically used for conventional CT or spectral CT systems and or algorithms used for solving multiple variable linear equations, in some cases, with constraints and or in some cases converting negative variables, especially those relatively close to zero to zeros.

In one configuration, there are typically a number of methods involved in the reconstruction,

Object Modeling: The models can be divided into two categories: discrete model and analytical model. Analytical model utilizes two-dimensional or three-dimensional analytical functions to describe objects, such as Shepp-Logan phantom. In the discrete model, the object is discretized by different basis functions like pixel, voxel, and blob.

Scan trajectory: in one configuration, the source moves in a xy plane, parallel to the detector. The projection geometry may be defined by three degree of freedom. There may be one coordinate that describes the spatial coordinate of the source, and/or the object and/or the detector. The center ray offset may be defined as U0 and VO.

In one configuration, projection/backprojection model: Projection is an operator that computes the projection of an object model. The projection of a ray is the sum of the points in the object along this ray. Back projection is the adjoint of projection. It assigns the projection of a ray to each point in this ray.

In analytical object model, for each ray, the projection can be simulated by the following steps: (1) According to the expressions of the ray and each regular region with constant value, calculating the intersection length of the ray and each region. (2) Getting the projection of the ray passing through each region by multiplying the length by region value. (3) Summing these projections to get the projection of this ray. When an object is expressed with discrete model, for instance, pixel model, the following models may be used to describe the projection/backprojection: pixel driven, ray driven, distance driven, area model, etc. For more realistic models, noise and scatter may be considered.

In one configuration, scatter may not need to be considered when SPR is less than 1 %.

Image.

In one configuration, reconstruction algorithms can include analytic reconstruction algorithms and iterative reconstruction algorithms. In analytic algorithms, filters and back- projectors can be included.

In one configuration, the iterative algorithms can include forward projection, error correction, back-projection, and updating the image data.

In one configuration, analytic algorithms: For example, FBP algorithm and/or Rho- filtered layergram reconstruction method.

In one configuration. Iterative algorithms· Tn general, iterative reconstruction scheme can include a projection model and a backprojection of the error in projection domain. Iterative reconstruction algorithms can have advantages in reducing image noise and various artifacts and or fixing reconstruction errors in computation.

In one configuration, algebraic reconstruction technique (ART) can update the reconstructed results ray by ray while simultaneous iterative reconstruction technique (SIRT) and simultaneous ART (SART) Ordered subset (OS) -based methods can update the reconstructed results one subset by one subset.

P-SART, paralleled reconstruction of selected vertical section of the SART method, there the derivative of SART or extracted version of SART, where reconstruction algorithms are applied a selected data set containing projection measurements contained in a selected region within a vertical sections of the VOI

The subset definition may be a conventional CT subset definition, or defined using a new method or algorithms.

The vertical section may be selected based on analysis of an x ray measurement taken of VOI, or multiple measurements such as spectral and or tomographic and or based on predetermined data. For example, a region of reconstruction selected of suspicious cancer region may be performed. The region selected may be a part of VOI containing the entire cancer region or at a part of VOI containing at least a portion of the cancer region.

In one configuration, when the idea of ordered subset is applied to SIRT and SART, it leads to OS-SIRT and OS-SART.

Each of these ART-like iterative reconstruction algorithms can be seen as a specific case of general Landweber scheme.

In one configuration, based on the parameter estimation theory, statistical iterative reconstruction algorithms can be used in denoising. Some statistical methods, like maximum likelihood expectation-maximization (MLEM) algorithm can be used. Expectation maximization (EM) method can be used for parameter estimation. Ordered subset EM (OSEM) algorithms can be used to increase the rate of convergence. EMAP, a maximum a posteriori probability (MAP) algorithm based on modified EM algorithm, can be used because the algorithm has a faster convergence rate and smoother image quality.

In one configuration, the image reconstruction algorithm can be based on an optimization model.

In one configuration, the iterative image reconstruction algorithm can be based on an optimization model.

In one configuration, some statistical methods, for example, weighted least-squares (WLS) algorithm that considers second order statistical properties, can be based on least squares principle.

In the family of least squares algorithms, methods based on iterative coordinate descent (ICD) may be used in image reconstruction. Iterated conditional modes (ICM) method is essentially an ICD algorithm. It has some important advantages. For example, ICM can add robust results to OSL algorithm (one-step-late, based on Gibbs prior, is unstable when the smoothing parameter getting larger) . In the optimization model, the objective functions can be solved by quadratic optimization techniques. Conjugate gradient least squares (CGLS) algorithm is one of the quadratic optimization techniques. It has advantages in convergence rate, simplicity and potential for parallelization, compared to general gradient-based methods. Steepest descent methods also belong to quadratic optimization techniques. The projection onto steepest descent (POSD) algorithm is a steepest descent algorithm that is projection controlled and the extensive POSD algorithms have better robustness. Gradient ascent (GA) is a gradient- based optimization algorithm that can be used in imaging processing. Fast iterative shrinkage thresholding algorithm (FISTA) can be used for inverse problem that is attractive due to computational simplicity and a global rate of convergence .

In configuration, regularization methods may be used to find solutions to the optimization models for ill-posed problems.

In one configuration, total variation (TV) minimization is a regularization method that has advantages of preserving the sharp edges and denoising. Soft threshold filtering algorithm can also be applied to limited angle reconstruction . The projection onto convex sets (POCS) can used to find an intersection of several well defined closed convex sets as a solution. Alternating direction method of multipliers (ADMM) can be applied to the distributed convex optimization of large-scale problems .

In one configuration, Image quality metrics, such as Mean squared error (MSE) and mean square deviation (MSD) can be used for describing the difference between the estimator and what is estimated. Similarly, root-MSE (RMSE) and root-MSD (RMSD) may be also used for evaluating the quality of reconstruction images.

In one configuration, signal-to-noise ratio (SNR) can be used as a physical measure of the sensitivity of an imaging system. The signal amplitude of each pixel is the amount in which patch of the image is elevated, relative to the mean background signal. SNR represents the integrated signal over a region of interest (ROI). Structural similarity (SSIM) is an index for measuring the similarity between two images. Mean structural similarity (MSSIM) is an average of the SSIM used to measure the similarity between two images in terms of brightness, contrast, and structure. Pearson correlation coefficient is to measure the linear correlation between two images. Universal quality index (UQI) is used to evaluate the similarity between the reconstructed image of the ROI and or the phantom image. The value of UQI ranges from 0 to 1. If the UQI value is closer to 1, the reconstruction image is closer to the real image.

Typical reconstruction consideration factors for instance, can include one or more of the following:

Projection data pre-processing model may be used in for example: (A) Denoise, (B) Dead pixel correction, (C) Detector consistency correction, (D) Artifact correction, (E) Beam hardening correction, (F) FOV correction, (G) Phase retrieval, (H) Flat field correction; Backprojection model: (A) Pixel driven, (B) Ray driven, (C) Strip model, (D) GPU support;

Projection geometry: Planar-detector; xy plane trajectory projection geometry may be defined by the coordinate of the source, the detector center, and the principal axis of the detector plane (typically horizontal and vertical, specified as two 3D vectors). The magnitude of each vector corresponds to the pixel value of every detector.

Projection model: (A) Analytical method, (B) Pixel driven, (C) Ray driven, (D) Strip model; (E) GPU support; (F) Noise simulation, (G) Scattering simulation, (H) Artifacts simulation;

Backprojection model: (A) Pixel driven, (B) Ray driven, (C) Strip model, (D) GPU support;

Post-processing: (A) Denoise, (B) Threshold segmentation, (C) 3D cutting, (D) CT number, (E) Quantitative analysis, (F) Artifacts removal;

Special function: (A) Quarter pixel offset, (B) Simulating polychromatic X-ray, (C) Support arbitrary scanning axis, (D) Scattering correction, (E) Respiratory motion correction,

(F) Leverage nonlinear interval data acquisition, (G) Limited angle problem;

Methods include features other than CT: (A) PET reconstruction, (B) SPECT reconstruction, (C) MRI reconstruction;

Methods include Image quality metrics: (A) Standardized root mean square distance measurement, (B) Normalized average absolute distance measure, (C) the worst case distance measure over a 2 x 2 pixel area, (D) Structure accuracy, (E) Pointwise accuracy, (F) Hit-ratio,

(G) Pearson correlation coefficient, (H) RMSE, (I) MSSIM, (J) UQI.

Reconstruction algorithms: Analytical algorithms (FBP, FDK, etc.), Iterative algorithms, etc.;

Software environment which can include: Operation system (Windows, Linux), Compiling languages (C#, C, C++, MATLAB, Python, etc. Java ), GUI (Graphical User Interface), mobile operating system, android operating systems, apple operating systems, software structure.

In one configuration, a ray-driven and strip model for computing projection data, can include one or more of the following projection operators:

(1) “line”: Calculate the length of the ray through a pixel as the contribution;

(2) “linear”: Linear interpolation is performed between the two nearest voxels of the ray and the column/row intersection as the contribution of the column/row to the ray; (3) “strip”: The area surrounded by two adjacent rays passing through a pixel is calculated as the contribution of the pixel.

(4) volume integral, the volume enclosed by sides whose projection line lands on the border of the pixel or at least a portion of the pixel, such as the full length half maximum guassian distribution region of the pixel region.

(5) volume integral, the volume of voxels, whose value and weighted contribution to the signal on at least a portion and or the active regions or the whole of the pixels in a selected pixel region. Such pixel region is projected measurement region of the volume integral from the VOI.

In one configuration, three-dimensional reconstruction algorithms may include SART, OS-SART, SIRT, CGLS.

In one configuration, Filters in analytical reconstruction algorithms can include ram- lak, shepp-logan, cosine, hamming, hann, tukey, lanczos, triangular, gaussian, barlett-hann, blackman, nuttall, blackman-harris, blackman-nuttall, flat-top, kaiser, parzen.

In one configuration, Discrete algebraic reconstruction technique (DART) can segment the reconstructed image by setting a threshold. DART may be applied to dense nanoparticles segmentation problem.

In one configuration, geometry can be described for each projection image by nine degrees of freedom in total: 3 coordinates for the position of the punctual source, 3 coordinates for the flat panel position and 3 angles for the flat panel orientation. Gaussian noise simulation may be used. Filters for denoising can include conditional median image filter, average out of ROI image filter, TV denoising image filter, conjugate gradient image filters, Laplace filters and additive Gaussian noise filter. FDK and SART reconstruction methods may be used. Respiratory motion correction may be taken into account. Gated measurements may be done for gated tomography reconstruction.

In one configuration, 3D GPU Algorithms such as SIRT3D_CUDA, CGLS3D_CUDA or Monte Carlo based techniques or hybrid of the techniques used in both reconstruction models may be used. The techniques included may be iterative reconstruction, analytical reconstruction, deterministic reconstruction, filtered back projection, expectation maximization, SART, TV-based projection, Group Based sparse representation modeling with ART. For example, in a hybrid system, the initial image is generated by analytical methods (raw data domain), and iterative methods are focused to optimize image characteristics, for example, noise, in the image domain. In another pairing, an iterative algorithm can be directly implemented into the reconstruction process to focus on image improvements of an initial image estimate that is generated by an analytical method.

In one configuration, in a spectral X-ray nonlinear image reconstruction, the data measured by different energy levels can be used to reconstruct the three-dimensional entity. It mainly solves two problems: material decomposition problem and CT image reconstruction problem. The regularized weighted least squares Gauss-Newton algorithm (RWLS-GN) can be implemented to provide several different regularization methods to process. The algorithm may be less sensitive to noise and improved contrast-to-noise ratio.

In one configuration, end to end computer aided reconstruction and diagnosis may be useful in faster image reconstruction. However, the conventional CT has scatter to primary ratio higher than 5% and in some cases, more than 20%, such as in spectral CT. AI therefore may not be useful if trained by different CT models or by different companies. In one configuration, either due to scatter removal, such as less than 1% or less than 5% or less than 10% SPR, or low scatter level of ROI, the measurements of primary x-ray images are typically more consistent and quantitative from machine to machine if the same energy level are used than conventional CT. Approximately Input x-ray emitted from the x-ray tube and or simulated x ray input intensity or derived x ray input intensity and output x-ray intensity detected on the detector are used in derivation of final reconstruction value. Therefore, AI, or deep learning techniques may be useful for training for reconstruction, such as the denoising step of the reconstruction, and in some cases, combined with analysis of tomography images.

In one configuration, the tomography reconstruction may have two version of reconstruction method in the same software, One version allows for training for AI based reconstruction, and/or incorporate the use of density data and/or other x-ray measurable property information and/or information collected by other methods. The comparison may reveal additional information useful for radiologists.

Another example is the general model of CT imaging,

G= Au,

Where A the system matrix which may include M x N X P, which may include P row of total number of projections, M X N are total number of measurement pixels.

In some cases, the total number of measured pixels may be expanded to include additional unknown voxel volume outside of the volume of interest but within the illumination path of the cone beam, and the newly introduced unknown voxels as x-ray emitting position moves. The total number of measured pixels may increase in each step of movement. In one configuration, even though the unknown voxels may be increased as x-ray cone beam moves, due to the increased number of measured pixels larger than m x n, the number of projected images may not need to change in order to resolve the unknown voxels.

In one configuration, G denotes the measured projection data or the density value derived from the projection data, for example, by referencing an inverse energy response function equation system. A reconstruction model SART may be used to derive vector u from the projection data G and system matrix A,

With a single energy and/or multiple energy measurement, the air sac can be identified and determined by setting a low attenuation value threshold and or linear attenuation coefficient when solving m x n x p linear equations. Matrix M x n x p describes the dimension of ROI in the 3D volumetric region in the X, Y and Z spatial coordinates respectively.

With dual or multiple energy measurements of a ROI and/or input intensity measurement from a second detector, the density and thickness may be derived for each component or substance, from the measurement of the x-ray beam passing through such component or composite of multiple components arriving at one or more pixel or pixels.

Dual or multiple energy measurements may be achieved by measuring x-ray pulses of varies energy levels after passing through VOI at different times, sequentially using a point or ID or 2D detector.

Dual or multiple energy measurement may be accomplished by using an x-ray source that may generate two or more energy peaks in one pulse, and using a detector assembly with stacked detectors, each with a different energy level, or a detector with repeating units of multiple regions in each pixel. Each region may have a different energy bin than its neighbor in the same pixel region. One benefit of this configuration is to increase data acquisition time for measuring dual or multiple energy signals.

Scatter removal of such detector may be done through collecting low resolution scatter at each energy bin region, interpolating to the corresponding regions of each pixel to achieve high resolution scatter for each energy level.

From the density measurement, the microprocessor can set measurement of one tissue at 1 and the rest at 0, and derive the attenuation value or density of each voxel correlating with its spatial location using aforementioned reconstruction methods by solving m x n x p linear equations. Matrix M x n x p describes the dimension of ROI in the 3D volumetric region in the X, Y and Z spatial coordinates respectively. In one configuration, summation methods, or convolution method, or the Fourier methods or series expansion methods may be used for reconstruction.

In one configuration, Algebraic Reconstruction Techniques (ART) can be used for solving three dimensional reconstruction from x-ray projection. This is a deconvolution problem of a particular type: an estimate of a function in a higher dimensional space is deconvolved from its experimentally measured projections to a lower dimensional space. X- ray image represents the project of the three dimensional distribution of x-ray densities within the body onto a two-dimensional plane. A finite number of such x-ray measurements in 2D or ID or distributed regions on a detector, allows reconstruction of an estimate of the original 3- D densities. Here, density refers to optical density.

In a typical ART algorithms, each projected density is a thrown back across the higher dimensional from whence it came, with repeated correction to bring each projection of the estimate into agreement with the corresponding measured projections.

In order to use ART algorithms, the representation of space in digital computers may need to be considered. In digital computer, it is necessary to represent continuous space in a discrete fashion. ART algorithms are formulated in terms of a particular kind of basis set: one which divides the reconstruction space into a finite number of non overlapping elements or subregions. The unknown density distribution is approximated by the values assigned to each element using the reconstruction algorithm.

Assume that the unknown density function is identically zero outside a finite region . The reconstruction space R can be divided into non overlapping elements. This division can optionally be as fine as possible. The minimum fineness of the division of r is linked to the computer representation of the projections to the lower dimensional space.

It is assumed that each projection is of a finite extent, and divided into non overlapping elements. The maximum size of the projection elements can be dictated by the presumed spatial resolution in the projection. This resolution can be determined by the physics of the radiation used. A spacing can be used between elements which is half of the presumed resolution. Finer division may be warranted if one is attempting to achieve superresolution by deconvoluting the spread function.

Let Pj, j = 1,..., n, represent all the projection elements of the available projections taken together. For each projected element Rj there is a corresponding subregion Sj, in R, of which Pj the projection. The exact shape of Sj depends on the paths of the radiation through R. Sj is referred to as the passage for radiation falling on Pj. The radiation has traversed the object through the passage Si. In this one example, the radiation travels in a parallel ray at the angle and the ray width is chosen so that one centroid is encountered per row of elements Ri by Sk, except for the last row. If this edge effect is ignored, then ci would be identically 1. For a given square Ri, Uij = 1 if its centroid is in the shaded region Si, = 0 if not.

Let r represent a point in R and f(r) our unknown density function. Then

J f(r) dr « Pj j = 1 ...m (a) where Pj is the experimental measurement of the j th projection element of f(r). The approximation sign (~) indicates that the measurement process is not perfect. Equation are the fundamental equations from which all reconstruction methods for determining f(r) begin. .

The passage Sj through R has no necessary geometric relationship to the elements of R. Let Ri be the ith element R. The region Sj P Ri may be defined as the intersection of passage Sj with the reconstruction element Ri. This can result in the equation (a) as j=l,...,m (b)

One goal is to obtain an approximation for the unknown function f(r) by assigning an estimate fi of its value to each region Ri. The best estimate would result when fi is the average value of f(r) over the subregion Ri,

The ideal outcome may not be attained due to limitations on the amount and quality of data as well as the reconstruction algorithms themselves.

Since it is unknown how the function f(r) varies within the element Ri, its value in Sj P Ri is unknown. However, it may be assumed that if fi is the average value of f(r) over Ri, then the integral of f(r) over Sj P Ri may be estimated by the geometric fraction. Wij

Multiply by fi:

J f(r) dr w Wij fi i=l,....,n; j=l,...m (e)

By this further approximation, equation (b) or the projected image measurement become a set of simultaneous linear equations in the unknows fi.

Pj « åf=iWij fi j = l,...m (f)

Although the above set of equations look like an ordinary set of linear equations, they are distinguished by a number of features.

1) The matrix { Wij } is quite sparse, since from the geometry of projection s Ri = 0 (the null set), for most pairs ( i,j). as it is from the geometry of projections, ( the null set), That is , only a relatively few of the Wij are nonzero, and each passage Sj encounters only a relatively few of the Ri.

2) The size of the matrix { Wij } can be enormous. In typical applications n starts at 2500 and n can easily reach 10^L6. In some cases, n = 10^L9. The number of projection elements m ranges from 500 to 10^L5 and 10^L7 in corresponding cases. Thus the matrix size nm ranges from 750,000 to 10^L11 or 10^L16.

3) The equations are originally highly underdetermined, that is, i.e. m«n.

4) The rank of the matrix { Wij } is unknown.

5) The matrix { Wij } is none negative since Wij >=0.

6) The data values Pj are ordinarily non-negative.

7) The unknown function /(r) is ordinarily assumed to be nonnegative, so that one desires a solution for which fi >0.

8) The errors in the data may cause the equations to be inconsistent.

9) Statistical effects of noise in the data may need be analyzed, if possible.

10) The approximation by which equation (f) was derived at may introduce systematic errors, which may need to be analyzed. Efficient representation of space

Because of the enormity of the matrix {Wij }, the size of the reconstruction problem may need to be reduced similar to most CT algorithms.

The shape of the passage Sj does not enter into the formation of the reconstruction problem in terms of Equation . However, in the case of projections obtained from radiation transmitted through the region R, each passage Sj is a ray or a beam since it goes more or less in a straight line. If R is a convex region of the d-dimensional space (divided into n elements Ri, all of which have the same size), then the eman distance across R will be approximately n 1/d (where the unit of length is the linear dimension of each Ri). The centroids within Sj should be distributed along its length in order to accurately represent the density distribution along Sj. For those rays Sj which roughly coincide with a diameter of R, it is required that Nj > nl/d, which sets a more stringent requirement on the coarseness of the division of R.

In one configuration, the original ART Algorithm is used in 3D reconstruction. the algorithm does not need to iterative or it can be iterative,

In one configuration, the iterative process is started with all reconstruction elements set to a constant . In each iteration the difference between the actual data for a projection element and the sum of the reconstruction elements representing it ( equation t) is calculated . The correction is evenly divided amongst the (Nj) reconstruction elements () and added to them. If the correction is negative, the calculated density for a reconstruction element may become negative, and be set to zero ( max operator, guaranteeing f >=0). Each projection element is considered in turn (j=l+modmq). The calculation is repeated a number of cycles (K) for the whole set of projection elements until reasonable convergence is attained.

The staring value can be chosen to be identically zero. If one orders the projection elements Pj such that all of those from one projection come before those of the next, then will be the same in either case after the index j has gone through the first projection PI.

Alternatively, one may use a rough algorithm such as summation method to produce starting values.

If each projection Pk, k = 1....k forms a partition of R, then there are exactly k terms in each summation. The advantage of such an initial estimate is that the sequence in q, should converge more rapidly when is near the final results. However with underdetermined equation 20, any distortions introduced by such an initial estimate may be retained.

Convergence criteria

To determine when an iterative algorithm has converged to a solution which is optimal according to some criterion. Various criteria for convergence have been devised.

Three measures for the convergence of the proposed as the following: , the discrepancy between the measured and calculated projection element.

The nonuniformity or variance And entropy the absolute values obtained for this criteria were greater than necessary, in some cases. . Which now is formulated and were later spell out . the divergence of ART with inconsistent data is nevertheless real. Therefore the computation may be stopped before divergence begins. The minimum value of is found to coincided within one iteration with the stopping criterion.

Variation of art algorithm may be applied.

There may be variations of ART which may be used.

For example, generalized ART

A generalized ART algorithm A as any iterative function which finds new values for the reconstruction elements intersecting a passage from their old values:

The sum of the new reconstruction elements should be closer to the value of the projection element.

Multiplicative ART is another configuration of ART reconstruction Algorithms.

The choice between additive ART and multiplicative ART depends on the physics of radiation used for transmitted radiation, the form of the reconstructed object can be independent of an additive constant. Such a constant may result from variable exposure in an x-ray, or an intervening filter except for the nonlinearity of the max operator, independence from an additive constant is accomplished by additive ART.

The solving of linear equation m x n x p, may be dependent up the weighted constant or coefficient for each voxel, based on its location within VOI and relative the source the detector. For each pixel which measures the x-ray emitted from the x-ray source passing through VOI, there are a number of variables that may equate or approximate the number of voxel layers within ROI which the x-ray transverses, with each variable representing a coefficient or constant weighted multiplied by the voxel density. If only a portion of the voxel is involved, a percentage of the voxel and/or a fixed number of subunits in each voxel would add another multiplying factor of weighted variable. The summation of finite elements gives rise to the total density of voxels along the beam path. If x-ray passing VOI projected onto a pixel of the detector measures and produces another variable, a matrix modeling method may be use to decipher the value of density in each voxel.

Total number of variables Rv relating to variables along the projection path within VOI gives rise to the measurements on the corresponding region or corresponding pixel. Total number of pixels is approximately mxn. Therefore there may be m x n number of linear equation. Each equation has equal or less than a total number of element within Rv + 1.

As x-ray emitting position moves, for example, each pixel or pixel region of m x n region on detector gets updated with a new set of voxels or elements in the pathway. Cramer’ s rule, for example, can be used to solve for the unknown voxels in the matrix. If the x-ray emitting position moves P times, then the total number of linear equations is m x n x p and the total number of unknowns are m x n x p. Each unknown has a unique solution. There may be approximation made for one or more unknown voxels outside of VOI as X-ray emitting position moves and x-ray illumination of VOI projects through these unknown voxels, so no additional linear equations are needed. However, additional measurements, as x-ray moves again in the area of emitting positions, may be made to include new linear equations to resolve the newly introduced unknown outside of VOI.

In one configuration, iteration method is not needed, or is less than 2 times, in some configuration, the iteration is less than 3 times.

In one configuration, correction method after the first 3D reconstruction includes estimated new values is given to selected voxel region of VOI in the beam path, and no verification is needed if certain parts or segments or certain material is known in density and spatial distribution and 6 D positioning relative to one or more reference markers.

Spectral information is analyzed through reconstruction models in spectral systems. The variation arises from the dependence of the energy of bremsstrahlung radiation on angle, and on the contribution of absorption of photons as they exit the anode. X-ray source models with off-axis spectral information may be used. In some instances, when the region of interest is small and when the x-ray center axis is centered in the region of interest, for example, when a mover moves the x-ray emitting position directly above the region of interest, such reconstruction model may or may not be needed with a spectral system. In addition, if the spectral radiation characteristics are well characterized for the x-ray tube for the off axis locations, in some cases, such characterization are done in real time, with a detector placed between the x-ray emitting position and the subject, using the energy response equation system and inverse energy response equation system look up function. Such reconstruction model specific for a spectral system may or may not be needed.

In one configuration, reconstruction model for spectral CT can include:

1. Running Monte Carlo simulation.

2. Extracting the data from phase space files. And

3. Applying the regression on the Monte Carlo extracted data and mapping dependency of coefficients of regression using an independent variable order polynomial to get the final model.

However, with x-ray tube having a larger FOV, off axis radiation has a different characteristic spectrally than radiation close to the center axis. This would lead to inconsistencies and reduction in accuracy when x-ray tubes are moved in large angles for 3D reconstruction. In one configuration, due to the fact that there are only small movements of the x-ray emitting position relative to the subject, such as in < 1 cm or <2cm or <3cm in each dimensions or moving in an area of less than 4cm squared or 9 cm squared, or 1 cm squared, the distortion due to spectral radiation variance off axis of the x-ray tube center axis is minimized. The reconstruction model can be sufficient to reconstruct a complete 3D image x- ray

In one configuration one configuration, minimization of region of interest for tomography measurement, therefore a reduction of the Field of view for tomographic measurements may lead to reduced distortion due to off axis spectral variance.

In one configuration, field of view may be less than 10 x 10 cm squared, or less than 5 cm squared, or less than 4 cm squared, or less than 3cm squared, or less than 2cm squared or less than 1 cm squared.

In one configuration, for some small field of view, the SPR may be less than 1 % without the scatter removal method.

For 3D reconstruction of one configuration, using nMatrix to n7 matrix method involving the x ray emitting position moving in at least one axis or up to 6 axis, both voxel- and ray-driven methods may be used. The voxel-driven reprojector follows the algorithm for backprojection, using a P-matrix. The ray-driven reprojector is derived by extracting from the P-matrix the equation of the line joining a detector-pixel and the X-ray source position. This reprojector can be modified to a ray-driven backprojector. When the geometry is specified explicitly in terms of the physical parameters of the imaging system, the projection matrices can be constructed. The algorithms may be used in image reconstruction, visualization and volume rendering.

In one configuration, Reconstruction of 3D imaging of a volume of Interest may be based on the derivation of density of unknown voxels, for each projection with 2D image on a detector, The reconstruction volume VOI is a Cartesian lattice of size Nx x Ny x Nz specified in terms of a reference point VO and an array of index vectors i = [i, j, k]T. T may denote transposition. Dc, Ay, Dz, are the grid spacing in the X-, Y-, Z- directions, respectively. The 3- D coordinates of a lattice-point I in V are the elements of the vector

Vi= VO + [ i Dc j Ay kAz]

A mathematical model to represent each voxel at arbitrary points within the volume may be created for spatially locating a specific voxel and solving for its density information based on the projected images. For example, a superposition of scaled and/or shifted version s of local basis functions may be used.

In this disclosure, for example, the Volume of interest ( VOI) is a 3-D array of voxels of size Am, Dh, Dr, bounded by six planes. A plane is represented by the equation

Where X is a point on the place, normal to the plane, and c is perpendicular to the plane.

A homogenous coordinate system can represent perspective projection and as well as rigid body transformations. Tilde can be used to identify quantities in the homogenous coordinate system and superscript + to distinguish normalized homogeneous coordinates. A normalized homogenous coordinates of a point v are given by . the vector can be expanded as

In one configuration, when grid spacing is not the same along all the axes, or non cubic grids are involved, for example, when Xa, Xb are not the same as Xc, scaling transformation may be used.

The process of gathering a projection of a 3-D object can include positioning the x-ray source - detector combination around the object, passing a cone beam X-rays through the object, and collecting the attenuated X-ray image at the detector. Synthetic projection of a digital object involves a simulation of this process mathematically and can include two parts. The first geometric part can involve a rigid body transformation of the object followed by a geometric projection of the voxels or a tracing of the rays over a cone beam geometry. The second part can involve an approximation to the X-ray integral and a digital object involves a simulation of this process mathematically.

VDR involves mapping every lattice point in the volume of interest onto the detector plane, followed by updating the values of the projection over a neighborhood of the projected pint. Let kl and k2 be the row and column number of the grid points on the detector, the procedure for computing VDR from a source point s onto the detector plane can include the following steps:

1. For every lattice point vG V, compute its geometric projection P

2. Identify a set Np of integer neighbors or P and update the values of projection I (kl,k2) over Np as follows

3. I (kl, k2) = I (kl, k2) + w kl, k2 f (j, j, k) (kl, k2) Np

Where wkl, k2 is the weight associated with the contribution to a neighboring point (kl,k2). f (I,j,k) is the grey value of the 3D object. The coordinates of the detector grid pints are given by g= [kl u k2 v]T. gi , I = 1,..., T and are the grid points within Np.

Each time x-ray emitting position moves relative the ROI, the rigid body undergoes perspective transformation to denote and position the x-ray source, its projection line and the lattice point in the ROI and the pixel on the detector to receive the projection line. For simplicity, assuming the source moves by 1 pixel pitch each time in the xy plane compared to previous position, the location of the source or perspective mapping on the normal x-ray source position is described as Pn. Transformation of the two coordinates of the point on the detector plane at a perpendicular distance can be 1 as both detector and the object may not move. The perspective mapping in the normal x-ray source position is repeated as many times as the x-ray emitting position moves.

Pn describes the perspective mapping in the normal x-ray source position. T3 is the rigid body transformation involving movement of the subject relative to the x-ray source and detector pair. In this case, T3 is not changed.

For each voxel in the reconstruction Volume V, the equation for projection changes a number of times. U and V are the 2-D coordinates of the projection of the point v onto the detector plane.

Each v may be related to the spatial location of the source and the location of center axis of the x-ray source on the detector plan by the angle of the projection of P’ relative to the center axis of the x-ray source.. The density of each voxel within V can be derived by taking measurements of the projection of the point V at different x-ray source location. RDR is the weighted sum of the values of the voxels that lie in the path of a specified ray as it passes through a volume of interest. For every detector pixel, the computation of RDR can include the following steps:

Find the entry and exit points of the ray joining the source point s and detector pixel with the VOI. Compute the ray-sum. A specification of world coordinates of the source and detector points in 3-D may be needed.

The ray sum may be computed using parametric representation of the ray. This is facilitated by finding the interaction of the ray with the set of planes that define the boundaries of the voxel in the volume. Determining the points of intersections of the ray with a set of parallel planes is a simple problem can be carried out increments. One proceeds in a ray-tracing fashion after determining the lattice point and parameters pertaining to the entry point voxel. The ray sum is computed as the weighted sum of voxel values at the indexes along the ray path where the weights are given by ray lengths through the respective voxels. Repeat the above procedures for all the rays specified by the row and column numbers of the detector pixels. This forms one set of project rays coming from an x-ray source emitting location. A number of sets of projection rays and associated projections and each voxel in V in the illumination path may be characterized by the spatial location relative to the detector pixel and the source associated with each projection rays in a projection geometry ( specified by P for example).

Matrix would need to be decomposed to resolve the unknown pixels as the total number of images captured by the detector approximately equal or greater than number of voxel layers of V along the center axis of the x-ray source using ART (algebraic reconstruction techniques and/or monte carlo simulations). The VOI can be further simplified to include two different materials, for example, bone and everything else.

When such tomography measurements may not be required, in some instances, less number of images may be taken to construct multiple dimensional image with data gap such as in tomosynthesis methods, or combination of each of the abovementioned methods may be combined with other non-rotational tomography methods, tomosynthesis methods and spectral imaging methods, such as used with k edge and other imaging processing method based on the disclosure herein.

For example, in surgical tracking, imaged objects or components in a subject may be defined by their multiple dimension footprints as well as their material properties in terms of density and chemical elemental compositions and other parameters. A detector measurement of each component to be tracked, which may include a single substance or multiple substances may be correlated to density using energy response function equation system, and may be combined with dimension information of the components and relative spatial location of components to reference objects and components or anatomic marker or markers, therefore providing the information needed to calculate the orientation and spatial location of the component or components, for example, in situations where only one or two components in the same project path moves. Material properties can be used to compute the attenuation coefficients for each energy in the incident beam spectrum based on the corresponding photon cross-section provided by a preexisting database, such as a XCOM database from the National Institute of Standards and Technology (NIST), or by the multiple energy material decomposition method described in one configuration. As noted above, the multiple energy material decomposition method can be established with primarily primary x-ray measurements, for example, using the scatter removal method, to reduce scatter to primary ratio to less than 1%, and/or using primary x-ray thin beams to illuminate the known samples. The multiple energy material decomposition method can include two or more steps of dual energy material decomposition system where an energy response function system is established by measurements of dual energy detector of the known materials with varied known density and thickness, and interpolation of such measurements and density and thickness relationship to extensive varied values of density and thickness of the same or similar materials. Inversion of the energy response function systems provides the density information of individual materials or individual components in the composite materials.

One configuration of 3D Reconstruction

Between the interface of the one or multiple substances

As the attenuation value of tissues such as bone and soft tissue are slow varying, the bulk of one tissue may be estimated to have a relatively slow varying value. Therefore low resolution 3D imaging may be sufficient to interrogate the 3D make up or voxels embedded in each tissue.

For tissue interface regions, and or abnormal regions, for example, or for regions with mixture of multiple substances, to resolve unnkown voxels in these selected regions or volumes, x ray emitting positions may move relatively to the ROI in finer steps, in the area or the volume of the first positions, than the voxel size of the low resolution 3D image of the ROI, the total number of movement may be determined by estimated volume of the selected regions. The estimated volume may be based on prior measurements or looked up from a database or determined by a user.

One configuration of Reconstruction Image or data acquired using configuration of the present disclosure and aforementioned PCTs in 3D, CT and Spectral CT 3d reconstruction, complete CT reconstruction and/or Tomosynthesis , can be used to reconstruct 3D by using any one or more of the following methods. Some of these methods can be used directly or their derivatives can be used in the reconstruction of Spectral CT, CT or tomosynthesis and approximately complete CT. Some of these methods can be derivatives of reconstruction methods used in Spectral CT, CT or tomosynthesis, electron tomography, and other imaging modalities including MRI, microscope, optical imaging, electron microscope. a GPU-based CT reconstruction method contains a wide variety of iterative algorithms.

• MATLAB and/or Python libraries for high-performance x-ray absorption tomographic reconstruction.

• Example of implementations of projection and backprojection operations on GPUs (including multi-GPUs), with a interface using higher level languages to facilitate the development of new methods.

• geometry may include Cone Beam, Parallel Beam, Digital Tomosynthesis, C-arm CT, or tomography configuration described in the present closure. Geometric parameters may be defined per projection or per scan.

Additional Examples of reconstruction algorithms such as: o Filtered backprojection (FBP,FDK) and variations (different filters, Parker weights, ...) o Iterative algorithms

□ Gradient-based algorithms (SART, OS-SART, SIRT) with multiple tuning parameters (Nesterov acceleration, initialization, parameter reduction, etc.)

□ Krylov subspace algorithms (CGFS)

□ Statistical reconstruction (MFEM)

□ Total variation regularization based algorithms: FISTA-based (SART-TV) and POCS-based (ASD-POCS, OS-ASD-POCS, B-ASD-POCS-b, PCSD, AwPCSD, Aw- ASD-POCS)

• TV denoising for 3D images

• image loading functionality

• plotting functions, and

• Image quality metrics. Previously in CT reconstruction, Model based Iterative Reconstruction, projection images are acquired in a rotational projectory as in a convetional CT, contoure are generated based on the tomography construction which is described as the following

Method for the reconstruction of result image data (EBD) of an examination subject from measurement data (MD) obtained during a relative rotational movement between a radiation source of an X-ray image recording system and the e amination subject, comprising the following steps: - reconstructing (SI) initial image data (IBD) from the measured data, - deriving (S5) contour data (KD) from the initial image data , - calculating (S4) contour Significance data (KSD) from the measurement data and / or the initial image data, and - calculating (S6) the result image data (EBD) using the contour data and the contour significance data.

One configuration discloses method for reconstruction where contour data and or initial value of voxel and or the material decomposed image data, and spatial position and distribution of each decomposed substance are derived by, and VOI for image reconstruction are derived from:

Example of a geometric model used in the tomography reconstruction method will now be described.

In projection based CT, the following calculation may be used which is based on the measured data

G = A m

For CT scanner images, in some case, the tomography system described may be programmed to operate to obtain the images in order to present images in formats similar to images provided by conventional CT scanner or digital tomosynthesis, or sliced tomography. The presentation may be done by selecting row and/or columns in ROI to present which would result in a sliced view as in a conventional CT image.

Geometric matrix A can be divided into phantom-based methods and phantom-less methods according to whether a customized or universal phantom is used in the process of geometric calibration. In phantom-based methods, to estimate geo-metric parameters , a calibration phantom including certain numbers of markers may be used to acquire projections.

Some or all of the following factors may be typically used in CT or tomosynthesis, in order to establish a geometric configuration in mathematical terms to reconstruct multiple dimensional image based on the measurements:

Specify several important parameters of the multiple dimensional imaging system for image reconstruction ( uO, vO) The coordinates of the orthogonal projection of an X-ray focal spot on the detector plane.

SID, the source to detector distance, ip the rotational angle of the detector plane along its normal vector Q, the rotational angle of the detector plan along the v = vO axis; ( Xs, Ys, Zs), the coordinates of the source uO, vO coordinates of the sources’ projections on the detector.

The parameters are determined using formula below.

A , the Projection matrix is a 3 x 4 matrix that relates the mapping of a point (x, y, z) in object coordinates to its projection ( u, v) on a two-dimensional detector defined using homogeneous coordinates

[ Ax, Ay, Az, A ] T = [ au, av, a]T

(A)

Where a is an arbitrary scaling factor or a distance weighting factor. The projection matrix A can be factorized as:

A = K [S/t] = P

(B)

Where K is a 3 x 3 upper triangular matrix or intrinsic matrix, S is a 3 x 3 rotation matrix, and t is a 3 x 1 translation vector,

Where uO and vO are the coordinates of the intersection point associated with the center of x-ray and the detector, and Pu and Pv are the pixel height and width of the detector. The parameter S can be further represented using three Euler angles or a unitary quaternion. where three Euler angles h,, , Q represent the orientation of the detector plane along the x, y and z axes in the object coordinate system, respectively, (unihdegree). In formula (B), the parameter t is t = [tx, ty, tz]T (E)

The translation vector t includes three elements, Where tx, ty, and tz denote the distance in shift between the object and source coordinate Systems.

With the known matrices P, K, and S, the geometric parameters can be extracted and uO and vO can be expressed as follows:

U0 = K13, VO = K23

(F) where uO and vO are the central ray offsets, and K13 and K23 are the elements of the intrinsic matrix K.

The parameter source to object distance ( SID) is

SID = KllPu = K22Pv

(G)

Pu can be equal to Pv in some case, and can be designated as l

The rotation angles of the detector are

(H)

The source position is or o = [ Ox, Oy,Oz, 1]T

(I)

Where Ox, Oy or Oz are the coordinate of the source.

Where t is tx = A 34 ty = (A24-K23A34)/K22 tz = (A14-tl3A34-K2A12)/Kl 1

(J)

Where SCQ is

(K)

Where t and S may be combined to describe translation movement of x-ray emitting position relative to the object and/or rotational movement, and optionally accompanied by the detector movement.

In some cases, such movement in each step is minimized to approximately the pixel pitch of the detector and/or approximately the resolution of one axis may be used to describe volume of interest. The axis of the x-ray emitting source and/or the relative movement of the x-ray emitting location to the object may not be substantially changed. t may be transformed to a spatial location, in approximate distance or in approximately equivalent distance by an angular movement that is either 0 or integer multiples of resolution required by the third axis, or optionally smaller than a pixel pitch movement, or less than the resolution required by the third axis, or the resolution along the thickness of the object, or the resolution in the axis perpendicular to the detector, or more than resolution required by the third axis.

In some cases, when only x-ray emitting position moves relative to the object or the detector, S, the rotational matrix may be omitted. The geometric matrix approximately describing the spatial position and/or orientation and/or dimensions of volume of interest, the object, the x-ray emitting location and the detector transformation used to describe projection spatial configuration is then A = K [1/t]

(H) t may be transformed to a spatial location, approximately either 0 or integer multiples of resolution required by the third axis, or optionally smaller than a pixel pitch movement, or less than the resolution required by the third axis, or the resolution along the thickness of the object, or the resolution in the axis perpendicular to the detector, or more than resolution required by the third axis.

In one example, where x-ray emitting position moves in the xy plane, perpendicular to the detector, each time, each of axis, or in both coordinates or axis,

Tx = tx + Xc or Tx = Tx + iXc, where i is the number of source steps from the original position in the x direction. Tx, may be transformed to a spatial location, approximately either 0 or integer multiples of resolution required by the third axis, or optionally smaller than a pixel pitch movement, or less than the resolution required by the third axis, or more than resolution required by the third axis And in each move, there is at least one coordinate movement. In a preferred case, there are movements of the source in at least two coordinates.

One example method may be used to further improve the calculation accuracy of the projection matrix P, which is a nonlinear least-squares method to iteratively minimize the square distance between one or more measured marker coordinates (pi, vi) and their reprojected coordinates ( pi (P), vi(P) ). The markers may be placed on or in a phantom at one or multiple spatial locations. The reprojected coordinates of the markers in the calibration phantom can be calculated by Eq (A). The projection matrix P is adjusted to minimize the square distance between ( mί -mί (P)) and ( vi - vi (P)) to obtain the optimized P. The algorithms that may be used is the Levenberg-Marquardt algorithms and the objective function was as follows:

(I)

Where ui and vi are measured marker coordinates, ui(P) and vi(P) are reprojected marker coordinates using the projection matrix approach, and N is the number of markers in the object.

The initial guess of the projection matrix P can be calculated by using the direct linear transformation (DLT) algorithm in Eq (A) and (B).

1. Material decomposed images of different substances based on Spectral 1D-2D imaging method using measurement with the first data set generated by first detector, or first detectors and or at least one first source

2. A multiple dimensional or 3D reconstructed image by using tomographic or spectral tomographic method of one configuration and aforementioned PCTs using measurements with 1% SPR or less than 5% SPR, a measurement with the a first detector or first detectors and or a first source or first sources, in some cases, the reconstructed image is generated from moving emitting position in a 2D plane and reconstruct from the projected images using a system matrix comprising at least one coordinate of three degree of freedom, reconstruction may be done in the space domain or in the frequency domain or in the time domain.

3. Prior measurements of a different imaging procedure and or

4. Prior measurements from a different or hybrid modality or

5. Coutour is given or saved in a database.

A second data set for reconstruction is generated by the second measurements of projection at first detectors and or the same source, or a different source, or different detectors, in some cases, the emitting positions of the second source and measurement location of the second detector relative to the VOI is approximately similar to that of the first measurements. Re construction is done using the same system matrix.

If there are different materials or components with one or more substances to be tracked, vectors are formed to model the spatial distribution and location and orientation of the component relatie to the isocenter of the projection beam, and the center axis of the component, parallel to the center axis of VOI, may be used in reconstruction, or additional coordinate with three angular freedom may be used, for example to track a component to move in 6D space. A second data set for reconstruction is generated by the second measurements of projection at first detectors and or the same source, or a different source, or different detectors, in some cases, the emitting positions of the second source and measurement location of the second detector relative to the VOI is approximately different from that of the first measurements. Reconstruction is done using the different system matrix.

Previously inverse fourier transform reconstruction involves

Reconstruction from a series of projection views in which the source revolves around an object to be imaged such that an acquisition system for acquiring from the detector elements x-ray attenuation data corresponding to each beam at each of the projection views; and an image reconstructor that receives the x-ray attenuation data from the acquisition system and performs the following steps to reconstruct an image: (a) backprojecting the x-ray attenuation data for each beam to form an array of data points therealong, (b) weighting each backprojected data point by a weighting factor w(t), where r is the distance between the backprojected data point and a source location of the divergent beams to form weighted backprojected data points, (c) Fourier transforming and processing an array of data which includes the weighted backprojected data points to form an acquired k-space data set; (d) aligning the acquired k-space data set with a reference k-space, and (e) reconstructing an image from the referenced k-space data by performing an inverse Fourier transformation thereon. Or using vector method for reconstruction based on trajectory different than rotation, such as in a radiation therapy linear accelerator type of x ray source.

Presently a system matrix used may have three degree of freedom, and Fourier space reconstruction.

In cases there are one or more components internal to VOI which moves independently relative to each other and relative to VOI, in a real time 3D reconstruction to track a component in 6 D, an angular coordinate of three degree of freedom may be added. However if the component only moves in the XYZ space but no rotation, then the same system matrix may still be used without adding additional coordinate. convert the projection images into a non-spatial domain, the projection image, generated using the projection beam having the plurality of rays, being converted into the non-spatial domain based on system matrix with one coordinate with at least three degree of freedom; reconstruct a three-dimensional image from at least the projection image in the non-spatial domain; and convert the reconstructed three-dimensional image from the non-spatial domain to the spatial domain.

To combine linear accelerator trajectory, vector may still be used and or an coordinate using rotational coordinate may be combined with tomographic coordinates described in the disclosure.

In one configuration, reconstruction methods, typically use one or more of the following methods:

Object model: (A) Analytical model, (B) Discrete model: (Bl) Pixel, (B2)

Voxel, (B3) Blob;

Projection geometry: projection geometry may be defined by the coordinate of the source, the detector center, and the principal axis of the detector plane (typically horizontal and vertical, specified as two 3D vectors). The magnitude of each vector corresponds to the pixel value of every detector. Another implementation may include description of each projection image by nine degrees of freedom in total: 3 coordinates for the position of the source, 3 coordinates for the flat panel position and 3 angles for the flat panel orientation. For example, generally, the existing x-ray tomography or tomosynthesis or C arm, or U arm or other general x-ray systems simply move in x y z axis due to requirement of the application, but in much larger distances, for example, more than 5 cm in x y z and more that 2 or 5 degrees in total rotational angle for the center axis of x-ray beam, and generally, in cone beam or fan beam or parallel beam, or line beam. Typically, the movement of x-ray systems and its components affecting imaging projection geometry may have the following movement trajectory characteristics: (A) Circle trajectory, (B) Helical trajectory, (C) Arbitrary trajectory; (D) Curved-detector, (E) Line-detector, (F) Multi-row curved-detector, (G) Planar-detector; (H) 2D plane - source , for example, as in M3 Personalized CT configuration with flat panel detector; (I) Dual Axis rotational. The m3 nmatrix or n2 matrix method disclosed herein may include the movement characteristics, which may be typically represented as the following: (a) 3D volume, or three degree of freedom, xyz, - Source only, in M3 Personalized CT configuration with flat panel detector, total number of projection is approximately thickness / Xc; (b) 6D, six degree of freedom- as in M3 Personalized CT configuration with flat panel detector; (c) 9 degree of freedom, source - six degree of freedom of source, including 3 degree of freedom for both source and detector, plus detector, additional three degree of freedom, using M3 personalized CT configuration; (d) the source may be in one degree of freedom, however in Xc step size, Xc being the resolution desired in the z axis perpendicular to the detector, and total number of projection should be the thickness along the z divided by Xc, in another words, the emitting would travel in approximately total distance of the thickness for a complete 3D reconstruction at resolution Xc along the Z direction (e) combination of each of (a), (b), (c), (d) with each of (A) through (I)

For instance, the projection geometry may be minimally defined by three degree of freedom, or three coordinates, which describes the coordinate of the source, the detector center and the principal axis of the detector plane in methods where only x -ray emitting position or the detector or the object moves in a xy plane relative to the subject and / or the detector there may be another two coordinates, u and v, to describe the projection from the source to a specific voxel and to the detector. There may be uO and vO, each describing the x-ray source center axis offset.

For instance, the projection geometry may be defined by total of six degree of freedom, to accommodate the movement of source in rotational coordinates and in some instances, the detector in rotational coordinates, but in pairs.

VOI selection model may include: (A) regionalization of a 2D map of a projection image of a ROI or the object; (B) category each region for spectral imaging, single energy, dual energy or multiple energy in 2D at one source emitting position; (C) further categorize subregions for spectral imaging based on anatomic marker and selected criteria; (D) select subregions for tomography with low resolution; ( E) select subregions for tomography with high resolution; (F) select subregions for tomography with high speed acquisition; (G) prioritization based on selection of VOI and assignment based on identification and separation of independent processes and codependent processes during acquisition and reconstruction for parallel computer processing.

Projection model may include: (A) Analytical method, (B) Pixel driven, (C) Ray driven, (D) Strip model; (E) GPU support; (F)Noise removal using software, (G) Scattering removal, in some cases, this step is eliminated, (H) Artifacts simulation; (I) 2D Spectral at one position, combined with each of (A) through (H); (J) 3D spectral using each of (A ) through (H) and combined.

Projection data pre-processing model: (A) Denoise, (B) Dead pixel correction, (C) Detector consistency correction, (D) Artifact correction, (E) Beam hardening correction, (F) FOV correction, (G) Phase retrieval, (H) Flat field correction.

Backprojection model: (A) Pixel driven, (B) Ray driven, (C) Strip model, (D) volume integral, (E) GPU support. Operations of reconstructing may include Fourier inverse transformation, filtering backprojection. Example filters can include Shepp-Logan, sine, Hamming, Hanning, Cosine, Triangle and Bandlimit.

Filters in analytical reconstruction algorithms may include ram-lak, shepp-logan, cosine, hamming, hann, tukey, lanczos, triangular, gaussian, barlett-hann, blackman, nuttall, blackman-harris, blackman- nuttall, flat- top, kaiser, parzen. Discrete algebraic reconstruction technique (DART) may be used to segment the reconstructed image by setting a threshold. DART may be applied to dense nanoparticles segmentation problem.

Methods for B-spline based image registration with regularization may be used to encourage the deformation to be invertible (diffeomorphic).

In one configuration of 3D reconstruction

Each ray path tracing from a pixel or a region of detector back to x ray source emitting location may have different magnification factor for its integral volume passing through VOI from one voxel layer to next along the z axis. Total of the rays in one exposure of x ray radiation in each projection image may be needed to be accounted for for each pixel position of the detector or for selected pixel region of the detector or unit pixel regions comprising two or more pixels. Each ray may have an angle relative to each other or to the center axis of the x ray cone beam relative to the detector each Voxel may have a number of subunits. The number of subunits per voxel which are part of the integral volume of a particular x ray path traceable to a pixel or unit pixel region, may account for a 0-100% of the total number of subunits in each voxel. Such proportion may be used to describe the weighted factor for the voxel which may may be used to comprise the system matrix of the projection image. The attenuation of the respective ray beam passing through the aforementioned subunit portion of the particular voxel. For example, there may be 1000 subunits in a voxel, however, if there are 400 subunits of this voxel intersects with a particular ray, such voxel or our unknown variable, would have a weighing factor or weighted factor of 40% or 0.4 represented in the system matrix for reconstruction.

For each voxel, there may be 1 to more weighing factors for 1 or more different ray paths in the voxel layer passing through this voxel. For each ray path, there can be 1 or more voxels in the same voxel layer which intersect with the said ray path.

In some cases, instead of tracking voxel layers, each voxel in the VOI may be described with a weighing factor relative to one or more ray paths.

Total number of unknown voxels to be resolved are the voxels in the VOI. the number of projections are approximately determined by the thickness of the VOI, or the thickest part of VOI, divided by the resolution desired in the z axis perpendicular to the detector. The resolution is set by the digital program or input by a user. The field of view in the xy direction is selected by a digital program or the user.

The reconstruction may be limited to a region smaller than a field of view once images are acquired for reconstruction.

In one configuration, reconstruction may be extended to PET, SPECT, MRI to collocate anatomic markers and allow reconstruction for multiple modality imaging of an object.

In one configuration, the reconstruction method may be simplified or be a derivative of CT or tomosynthesis reconstruction algorithms, or reconstruction of other modalities such as electron microscope of prior art to reduce or eliminate some of the artifacts, noise, variables, steps, and/or may minimize calculation complexity due to the reduction of necessary number of coordinates to describe the total number of degree of movement freedom for the x-ray system, and/or each of the components minimize computation time required, enable prioritization and/or parallel computing at the same time may increase accuracy and precision of data reconstruction, eliminate or minimize steps of the iterative algorithms for a complete 3D reconstruction or sparse tomography reconstruction by using apparatus and methods, including:

Measurement and/or derivation of primary x-ray signals with SPR less than 1% or 5%, or less than 10% SPR such as using scatter removal methods including hardware and software to separate primary and scatter x-ray signal in the spatial domain or frequency domain or time domain. In some cases, interpolation of scatter data is used to derive the high resolution scatter image or data, in order to derive the x-ray image including essentially primary x-ray signal with 1% or less SPR or 5% or less SPR.

Spectral Imaging Methods: (A) Use a broad band x-ray with one or more energy peaks and flat panel or 2 D detector in system configuration. Combined with spectral imaging / x-ray tomography method to approximately derive attenuation coefficient, or optical density or density for each material or composite material and/or each voxel, or sub voxel volume. For example, using inverse energy response function equation system and/or interpolated plot method to solve spectral imaging energy response function to obtain density data and/or optical density data of substances in VOI, based on the energy response function equation system established with measurements and interpolation or an existing database, typically may be as precise as in a pixel by pixel basis, but may be in larger detection region ; (B) using a spectral CT system including a broadband x-ray source, for example, paired with one or more energy sensitive detector, some may contain pixels and/or subunits in a pixel, each collecting photons with selected energy threshold. The same energy response function system, interpolation plot and solving method used in (A) may be used to approximately derive density and/or optical density of the material and/or estimate each of the voxel value; (C)using conventional spectral CT method, for example, with broadband x-ray source, such as with two or more energy peaks or quasimonochromatic or monochromatic x-ray source paired with an energy sensitive detector, which may contain pixels, each including subunits, each collecting photons with selected energy threshold. Based on the measurements, a database or a pre existing database can be looked up to provide the approximate density or optical density information for each or composite materials in the VOI.

In one configuration, optimization and customization of acquisition and reconstruction procedures can significantly reduce radiation level and improve precision and accuracy of reconstruction and quantitative analysis. During one imaging procedure, VOI and its subregion selection can be defined for multiple energy imaging, dual energy or single energy measurement and therefore reconstruction of spectral 2D or and/or tomography from the measured data at the specific subregion. Depending on the substances within a sub region of ROI, multiple energy or dual energy or single energy method as well as specific energy levels can be selected during acquisition as well during reconstruction. For example, subregion with bone and soft tissue including heart and blood vessels may be imaged with more than two energies. And subregions with soft tissue only and heart, may be imaged with dual energy only. Tomography method can be adjusted accordingly. Hardware via collimator or digitally controlled x-ray tube emission can allow spatially selection, and/or selection of x-ray sources and/or movement of x-ray sources, or selection of collimator filters or collimator field of view. Selection may also be made for subregion for high resolution or low resolution image acquisition and/or reconstruction. Selection may be done through detector image acquisition and processing. Subregion during acquisition may be achieved by digitally controlled electron emission reaching the anode for x-ray generation, for example, with a digital switchable generator, field emission x-ray tube, or cold cathode. Each subregion or collective subregion illumination of single or dual or multiple energy can be controlled spatially by digital control field emitters. For example, only two subregions of VOI is to be imaged with dual energy and the rest single energy the field emitter x-ray tube controller or a microprocessor may determine the corresponding spatial location of anode, therefore field emitter position, corresponding with the detector pixel regions which measures each of the subregions. Only the two subregions may be illuminated with second energy level. And the tomography image based on the dual energy measurements therefore may be reconstructed for each of the subregions separately. And the tomography image for the rest of VOI can be reconstructed on a single energy measurement.

In one configuration, two or more x-ray sources may be used for example, a conventional x-ray tube may be used for a subregion and a field emitter x-ray source may be used for another subregion, or one or more field emitter x-ray sources may be used to illuminate a portion of the subregion which the conventional x-ray source may be able to illuminate. The benefit of having such an arrangement is to customize and limit radiation exposure to selected subregions in VOI and/or to limit movement required of each source within the field of view of VOI in the study if the source is already situated such that its field of view already covers selected subregions of VOI. For example in a field of view 43cm x 43 cm, two or more x-ray source may be placed separately spatially, distributed on a 2D plane or 3D space facing the VOI. Each source may have a field of view covering the entire VOI or a subregion of the VOI. Each source may be programmable to illuminate the entire field of view or smaller field of view by for example, selecting subsets of field emitters to illuminate a smaller field of view or steering using electromagnetic or electrooptical mechanisms electrons to emitting x-ray in selected regions of anode.

In one configuration, spectral tomography may include image acquisition at one energy level to allow complete 3D reconstruction and image acquisition at a second or more energy levels at one or more distributed and selected locations of first positions of x-ray emission to allow for derivation of density values for fast and accurate reconstruction. Alternatively, the image acquisition at second or more energy levels at selected subset of first positions for sparsed and compression imaging method reconstruction at multiple energies may be performed to improve accuracy and precision and reduce reconstruction time and reduced radiation level. Projection geometry may be simplified to be defined as two coordinates, each with three degree of freedom instead of three coordinates commonly used in conventional CT reconstruction. In one implementation where only x-ray source is moving in a 2D plane relative to the object for tomography image acquisition, coordinate may be defined for source, and for center axis of the detector and the source passing through VOI and the system may prioritize selected portion or portions in ROI for reconstruction during data and measurement acquisition.

Use of two or more x-ray source or two or more x-ray emitting positions, their corresponding detector or detectors for tomography as well spectral imaging may be described using the same coordinate or same coordinate systems, for 3 degree of freedom or 6 degree of freedom or 9 degree of freedom defined by the system configuration.

Enable parallel processing during data and measurement acquisition within secondary VOI layers or VOI2nd.

In one configuration, post reconstruction, processing methods such as (A) Denoise, (B) Threshold segmentation, (C) 3D cutting, (D) CT number, (E) Quantitative analysis, (F) Artifacts removal may be used on per need basis.

Threshold segmentation may be done prior to reconstruction as well. And quantitative analysis may also be done prior to reconstruction as well as post reconstruction. Artifact removal may be minimized due to the accuracy and precision of raw data. Denoise may not needed in some cases, or use in a limited sense, as the scatter is no longer an element of interference prior to reconstruction process.

Function may be performed to improve reconstruction, including : (A) Quarter pixel offset, (B) Simulating polychromatic X-ray, (C) Support arbitrary scanning axis, (D) Scattering correction, in case where SPR is greater than 10%, or SPR is less than 5% and greater than 1% (E) Respiratory motion correction may be performed to further clean up the data if needed. As the speed of tomography is increased especially for a small field of view, the motion correction may not be needed. (F) Leverage nonlinear interval data acquisition.

Image quality matrices may be presented for the reconstruction data using, for example, Standardized root mean square distance measurement, Normalized average absolute distance measure, the worst case distance measure over a 2 x 2 pixel area, Structure accuracy, Pointwise accuracy, Hit-ratio, Pearson correlation coefficient, RMSE, MSSIM, UQI.

One configuration of 3D Reconstruction In one configuration, a method of reconstructing a 3D image of a VOI of an object using an x-ray system, the x-ray system comprising at least one x-ray source and at least one detector, the method comprising: translating and/or rotating the at least one x-ray source and/or one or more of the plurality of detectors; correlating projection measurements with various positions of the at least one x-ray source and at least one detector using a system matrix, wherein each system matrix is described by at least one coordinate with at least three degrees of freedom in x y z translation. wherein for at least a one 2D projection image, the at least one x-ray source is configured to emit beams illuminating at least a majority of or approximately an entirety of the VOI so that for each voxel within the VOI, there is new projection path reaching one of the plurality of detectors, and wherein there are m x n projection paths approximately, with each movement between the emitting positions, the movement being approximately a resolution desired in along an axial axis connecting an x-ray tube of the at least one x-ray source and the at least one detector passing through the VOI, so that the new projection path is different from a remainder of the m x n projection path by at least approximately one voxel or each voxel within VOI has a projection path differ than other path by at leat approximately one voxel.

The method of item above, wherein a total number of projections is approximated by a thickness of the VOI.

The method of item above, wherein a total number of projections and or x ray emitting positions are approximated by a geometry measurement of a sensor, a camera or an x-ray image exposure value, or a time of flight sensor, the approximation comprising: determining at least a distance from a top of the subject containing the VOI to the at least one source, and subtracting the distance from the top of the subject to the at least one x-ray source from a source-to-detector distance (“SID”); and deriving the thickness of VOI, which comprising steps of subtracting sample holder, or object support table down stream from the object, away from the said source

In one configuration, calibration of x ray tube and detector, and 3D reconstruction system calibration In addition to a round phantom, phantom shape and dimensions may vary.

In one configuration, for a example a phantom with laddered 3D shape containing in various components, for example metal, or wire or different types of tissue layers or tissue types may be used. Phantom may be square. And the phantom may be small in xy, compared to traditional phantom. And there may be a mover to move the phantom to various locations on the detector or various spatial locations relative to the x ray tube, or the x ray tube may be moved relative to phantom in order to calibrate the x ray 3D tomography system.

To align x ray tube and detector, the beam absorber plate with distributed attenuating regions may be used, Ideally such attenuating region may be O.lum to 10mm in dimension. Such attenuation regions may be any shape, but may be shaped as a ball, or has gradient edge. Such plate may be a 2D plate or a 3D volumetric plate. The location of the attenuating regions may be measured in 2D projection or 3D reconstructed.

In some cases, there are measurements and or database or look up table established for ideal x ray tube and detector alignment, for example, x ray cone beam center axis is perpendicular approximately to detector plane, and in some cases, lands in the center of detector. Such spatial location may be measured based on the measurement of beam absorber plate and or various spatial locations of the attenuation regions, or its corresponding projection image on the detector. Measurements may be done during calibration and if deviates from the original location or one or more predetermined spatial locations, the relative spatial location of the detector to the x ray tube may be derived.

3D reconstruction of the beam particle absorber plate at one or more positions relative to the x ray source in 2D or ID or 3D spatial dimensions, may also be used to calibrate and quality assess x ray tube and detector relative alignment.

Digital differential analyzer and or branchless formulation of a Joseph-type interpolating ray-casting algorithm for the computation of X-ray projections

In one configuration, a number of other devices may be used to reduce the size of the reconstruction problem or increase its computation speed,

For instance, the number of projections can be minimized consistent with the desired resolution in the reconstruction space.

The skillful use of machine language will also reduce computing time. The innermost loop of the iterative algorithms, such as ART, may be written in machine language and repeated in consecutive memory locations. This stack of instructions is then entered at the appropriate point so that the number remaining is exactly the number needed for a given projection element. A stack makes it unnecessary to increment an index, which can save computing time for the ART algorithm.

Special purpose computers may be considered. Optical or electronic analog or hybrid devices may be even greater speeds.

In one configuration, method concerning contrast agents

In case of microorganism recognition and binding, in vivo or in vitro or ex vivo or synthetic organ on a chip, or molecular studies or cellular studies, the microorganism binding or interaction or function site receptor or receptors may be linked and conjugated to X-ray contrast agents, or molecular complexes of contrast agents or conjugations of x-ray contrast agents.

In one example, of covid-19, two distinct functional domains of the S protein, termed SI and S2, both of which are necessary for a coronavirus to successfully enter a cell, interact with functional domains or epitopes of one or more receptors on the human cell membrane. S 1 is responsible for the first stages of viral entry, and contains the receptor binding domain. S2 acts in the later-stage fusion of the cell and viral membranes. In order for fusion to take place, the S protein needs to be cleaved by proteases found in the cell. This cleavage is generally mediated by furin, a protein convertase.

The S glycoprotein of SARs-Cov-2 can interact with the cell surface receptor angiotensin I converting enzyme 2 (ACE2). The SI subunit, which contains the receptor binding domain, makes contact with ACE2 which is facilitated by furin cleavage.

A linker as described above may be used to link LI, the domain of ACE2 and/or L2 that of Furin which interacts with the S 1 and/or L3 that of human cell which contacts S2 for the infiltration of the virus into the cell, and/or L4. In addition natural or synthetic nucleic acid sequences or synthetic nucleic acid mimics which bind through specific complementarity to RNA of the COVID-19 virus may be in the same molecular complex or bind to each of LI, L2 or L3 or combination of at least two of the epitopes. Each of LI. L2, 13, 14 or combination of one or more L1-L4, may be linked to an x-ray contrast agent. Using deep mutagenesis, variants of ACE2 may be used as they may have increased binding capability to the receptor binding domain of S protein.

Contrast agents linked to the unmutated or mutated version of ASE2 or Furin, or both, or its soluble versions may serve as a molecular diagnostic or characterization or identification marker for x-ray imaging, especially for the x-ray imaging described here and aforementioned PCTs and patents.

For instance, a soluble ACE2 (sACE2) in which part of or all portion of S2 non interacting or binding sites such as the neck and transmembrane domains, are removed , is sufficient for binding S and neutralizing infection. Derivatives of ACE2, or furin or other parts of human cells, such as peptide derivatives of these molecules which covid-19 binds may also serve as a target for the virus to bind. The x-ray contrast may be functionalized with these molecules and sites to attract vims binding and/or help visualize them through x-ray analysis.

Genetic engineering of contrast agents can be used.

For example, cells can be incubated with a subsaturating dilution of medium containing the Receptor Binding Domain of SARS-CoV-2 fused C-terminally to proteins or synthetic or natural nucleic acid-based oligos which have high affinity for x-ray contrast labels, for example cations++, zinc, calcium or gold particles or particles made of tantalum. Using a microscope, a high throughput imaging device, a digital pathology system, optical tweezer, a flow cytometer or cell sorter or microfluidic chip based cell sorter system can be combined with x- ray system described herein, as the imaging modality. Levels of bound RBD- Protein or oligo plus X-ray contrast may be correlated with surface expression levels of myc-tagged ACE2 with a different x-ray contrast agent, which may be measured by dual or multiple energy x-ray imaging system. Additional fusions of other proteins, such as fusion of sACE2 to the Fc region of human immunoglobulin can provide an avidity boost while recruiting immune effector functions and increasing serum stability that may be tagged with an x-ray contrast agent.

Presentation of x-ray images and of the individual substances and composites inside a subject, sometimes termed as corresponding components and composites may be achieved through the use of CT presentation algorithms. Attenuation values are expressed, according to a linear density scale, as “Hounsfield units” (HU). In the Hounsfield scale, water is arbitrarily assigned a value of 0 HU. All other CT values are computed according to

HU = 1000 x (ptissue - (m H2o)/ (m H2o. in which m is the linear attenuation coefficient.

The HU values for each pixel (which reflect the electron density of the imaged tissue at a given location) are converted into a digital image by assigning a gray-scale intensity to each value — the higher the number, the brighter the pixel intensity. For example, because fat is less dense than water, with an HU value in the -30 to -70 range, fat always appears darker than water in CT images. In the presentation of contrast agents, such as calcium in labeling of blood vessels and other tissues, for example, if calcium is detector in the blood vessel due to administration of the injectable contrast agents calcium chloride, the measured amount may be increased or modified artificially by the computer and/or a digital program or the user to achieve better visualization against the background, or it may be represented in a different color than the grey scale intensity.

Hardware Structure and Function Consideration

In one configuration, the quantitative x-ray system involving scatter removal system capable of removing scatter down to SPR of less than 1% or 5% or 10%, using for example frequency domain method involving primary modulators and or beam blocker arrays, and or time of flight sensors and or beam selectors may have a dome top, or circular top structure, elliptical shape or orbit shape or an elongated track shape to ensure coverage of the travel of the x-ray source which may include x-ray tube, its housing and optionally a collimator.

In all figures of x-ray upper body design, the x-ray tube housing and enclosure may be shrunk to a much smaller dimension, size of a nanotube x-ray. Collimator may be eliminated in some design.

In some designs x-ray upper body may be much smaller, as in a portable system, where there is no need to move in xy direction in large travel distances. The dimensions at the bottom can be much smaller and compact, such as in a C arm, or U arm, without the bottom part to hold the detector. The detector may be placed at various locations by the user, to receive x-ray passing through the patient, and may not be motorized. Alternatively, a mover can move independently one or more detectors in and out of the area where the detector can receive the x-ray cone beam exiting out of the ROI after illuminating the patient or ROI independently .

Lights for aesthetic reasons or for lighting up the patient or region of interest may be installed in the periphery of the bottom of the enclosure for the translation stage to move x-ray source and related assembled. It may be installed in multiple locations at or near the outer edge of the bottom of the enclosure facing the patient or the x-ray table. Alternatively, an operating room light fixture may be embedded into the x-ray system overhang, or attached to the top of the x-ray system, with the illuminating side facing the patient.

The camera or video or TOF may be installed adjacent to the x-ray tube housing or attached to the tube housing or the collimator. In one configuration, two photon and multiphoton of x-rav measurements to further increase resolution of x ray imaging

Two photon or multiphoton system can be used where pulses of x-ray, or generally ultrafast ultrafast x-ray photon beams are generated where photon 1 from the time of flight source is delayed by the ROI or the subject and photon 2 from the source is not delayed. The two photons can be measured at a fixed distance from the source. For example after going through a beam splitter, photon 1 is transmitted, photon 2 is reflected. Both photons are measured after exiting the beam splitter. The time delayed is used to measure the thickness of the object.

In one configuration, A detector may be displayed upstream of ROI and or down downstream of X ray emitting position, or outside of the VOI , which can serve as a reference sensor to measure intensity of input x ray radiation prior entering ROI.

Such a configuration may allow monitoring of x-ray tube stability, or comparing and monitoring differences between x-ray exposures or to measure x-ray beam input intensity prior to reaching ROI for quantitative measurements where repeated exposures are needed to measure a region of interest.

For example, if a small detector, r2, may measure one or more regions of x-ray beam emitted prior to x-ray beam illuminating the subject. The x-ray input intensity or exposure reaching the subject may be derived. For example, if each time at different locations of the x- ray emitting position, x-ray input intensity is measured by r2, the reference detector may be used to derive in real time x-ray illuminating the region of interest even if r 22 is not in the beam path of ROI. When the subject is not in the beam path, r2 and detector 22 measure x-ray beam at different spatial locations of the input beam. In some cases, a third detector may be used to correlate measurements of r2 to that of the detector 22 or establish a quantitative relationship between the measurements on r2 and that of 22 for the same exposure to characterize x-ray emission characteristics at different spatial regions relative to each other.

In quantitative imaging, when measurements at each exposure are measured, and calculated against each other, for example, in material decomposition and/or 3D imaging reconstruction, reference measurements of the x-ray beam ensure that the input x-ray beam is determined or derived or measured, prior to illuminate the region of interest. Accurate x-ray beam input intensity measurements may ensure the derivation of density information and 3 D reconstruction. The reference detector r 22 may also have regions or repeating regions of one or more energy sensitive detecting elements.

In one configuration, sensor is downstream from x-ray source, upstream from the imaged subject to measure x-ray intensity. sensor f22 between x-ray source and the imaged subject monitors and/or controls emission of the x-ray beam 32 from source 12 to pass through to illuminate region of interest ROI_32 and project the image of ROI on to detector 22.

Such a sensor may be placed in between the shutter of collimator and the x-ray emitting area or anywhere outside of ROI, in the x-ray beam path.

In one configuration, such an sensor may be an event detector responsive to the input photons. An event detector preferably includes a photosensitive element for converting received photons into electrical signals and a thresholding circuit for comparing the photoinduced electrical signals to a preset threshold value. The pixels in the image sensor remain in a non-integrating reset state if the electrical signal in the event detector is below the threshold. The image sensor is switched into an integrating state (that is, activated) if the electrical signal in the event detector is above the threshold. This provides an autonomous triggering mechanism for an imaging system.

In one configuration, automatic exposure control may be built the function of the detector to automatically terminate exposure and or send an alert or warning to the UI for the user and or patient when a preset threshold level of radiation has been detected. Or any of exposure control and or notification may be based on accumulated amount of exposure. Termination may be include one or more of the following activities:

-trigger the generator to switch off and/or to a different energy level and/or a different mode depends on the event or activity determined real time or predetermined following the termination.

-turn off the detector 22, for example, close the shutter of the detector down stream of the ROI from the source.

-detector f22 to turn off, for example, the shutter of the detector f22 to close

-Triggering of a master digital switch or master clock which synchronizes the hardware and software activities of the imaging system, for example, it may drive the mover to move the x-ray tube or detector or both to a different location.

In addition to ensure or minimize the exposure required to measure the ROI, the automatic exposure control method and apparatus may ensure an input x-ray beam intensity which may be uniform or quantifiable over the imaging process. And the attenuation value and or linear attenuation coefficient and or relevant value of the ROI or each of voxel may be determined consequently.

In one configuration, such an automatic exposure control may be used to control and measure quantification of measurement at different energy levels. Knowing precisely the input value of x-ray beam and measured detector value of projected x-ray beam passed through ROI, deriving attenuating properties of the ROI, thereby will be able to correlate to the interpolated plot or the inverse energy response function equation system.

The detector or the detectors which are used to measure projected x-ray beam exiting out of the subject or ROI, may also measure and determine for the next measurement the approximately what exposure is needed to achieve similar measurement level and may minimize the radiation level at the same time.

When the approximate exposure for measurement of a subject or a ROI is estimated, from , for example, measurement of an external sensor, such as a camera or Time of flight sensor, or measurement of the ROI at an earlier time by detector 22 or related detector assembly of the subject, the detector f22 may be preset to turn off or trigger other events at the measurement level derived from, for example, the measurement of f22 taking place at the same time as the measurement of ROI by detector 22 at an earlier time. f22 may have a corresponding exposure value which is approximately determined or set due to derivations from the measurement or measurements of the ROI by the external sensor, for example a time of flight sensor or one or more imaging sensors or cameras.

In one configuration, correlation may be achieved by carefully controlling the input x- ray beam intensity and energy profile so that it is approximately similar to the input x-ray beam intensity which generates measurements of the materials at various energies for calibration or establishment of the interpolated plot or the inverse energy response function equation system by the detector or detectors.

In one configuration, the accuracy of the sensors, f22 or detector 22 may be adjusted by adjusting gain and other noise removal methods. Additional methods, such as using a photodiode or a sensor or a reference camera or sensor, or a reference, rp002 to correlate and adjust the measurement at each pixel for f22 and/or detector 22 with that of the reference camera, may be used periodically to calibrate and/or measure f22 and detector 22 or any camera or sensor which may be used in the x-ray imaging system, to ensure accuracy of measurements and correlation between measurements of each detector used in the x-ray imaging system as well as the x-ray imaging system used to establish the interpolation plot, and other x-ray imaging systems. In the calibration or measurements relative to the reference, rp002, the sensors used in the x-ray system may have a relative quantitative relationship compared to others and as well as the reference.

In one configuration, the photodiode or sensor or the reference camera rp 002 used may be able to be calibrated periodically

In one configuration, for example, when f22 or detectors can have low noise, or the measurement precision or accuracy is not critical for the application, such correlation and measurement against the reference may be not needed.

In one configuration, such a reference, rp 002 may be used as a service tool or quality tool at the manufacturing site or after the x-ray system is deployed into the field.

Such a reference camera or photodiode rp002 may be used to ensure if the calibration or establishment of the energy response function equation system or the measurements used for generation of the interpolated plot are made on x-ray systems, including x-ray tube, detectors different than those of the specific x-ray system used to measurement the subject or ROI in actual measurements.

In one configuration, a standard r9001 against which the reference rp 002 is measured, may be kept against a universal standard of photon measurement sensor or a system. The standard r9001 could be optical or x-ray, and may be defined as a standard, similar to a temperature standard at NIST or a time standard.

In one configuration, the reference and standard can ensure the standardization of the measurement within one x-ray system and/or across all x-ray imaging systems.

Examples of optical and x-ray standard used can include the following:

Internal reference sensor f22 and detector 22 and reference or reference sensor rp 002 or the standard r9001 and other standards or standard sensors which standard r9001 or f22 or rp 002 may be measured and/or calibrated against may include or include photon counting detectors, photodiodes, sensors, or photon multiplier tubes or avalanche photon diode detector, gated sensors or sensors of x-ray or sensors of optical ray or electrical signal converted from x-ray.

In one configuration, x-ray source used in the x-ray imaging system may be also characterized and normalized using similar detectors and standards.

Detectors, sensors and/or X-ray Sources in the x-ray imaging systems or the reference sensors and standards may be calibrated and/or characterized using materials of known spectral signatures.

Calibration and/or measurements and/or characterization of the detectors and/or x-ray sources may be done locally at the x-ray imaging system or remotely. The system or the x-ray source or the detector may be calibrated in spectral domain as well as spatial domain to obtain the expected spectra from the standards.

Each pixel of the x-ray detector may be measured and/or calibrated or characterized and normalized with an x-ray point source or a spectral source or a standardized cone beam source with known characteristics in space, time, and/or spectral domain. Detector system linearity, presampled modulation transfer function (MTF), Wiener spectrum (WS), noise equivalent quanta (NEQ), and power spectrum may be characterized with or without a standard, such as a material or materials of known spectral signatures.

Cross-sectional intensity of the x-ray source may be characterized, measured, by a single pixel photon counter in spectroscopy mode or a sensor or a ID or 2D sensor. Uniformity of x-ray in time, spectral and spatial domain can be characterized. X-ray intensity in terms of either gray (Gy) or photon flux at the source output window for the x-ray source can be made. The Beam quality of cross section can be characterized.

An X-ray beam can be characterized by its intensity, wavelength spread, divergence, cross-section size, homogeneity and shape. Quantifying the quality of an X-ray beam generated by a source is used for establishing or selection of normalization methods or derivation of deviation of the source beam profile with the source used to establish the interpolation plot or the energy response function equation system. The quantities that are typically used are flux, flux density, brightness and brilliance, all within a 0.1% bandwidth represented by a wavelength range, Dl, centred around a specific wavelength l. That is, Dl is equal to 1/1000 of l. These properties are distinct for an x-ray source and one thus may take into consideration one or more or all of these properties when comparing X-ray beam characteristics between one used in a specific x-ray imaging system or that used in one imaging system used to generate the energy response function equation and interpolation plot.

The x-ray source may be characterized, for example, by a sensor, such as a photodiode, PMT, photon counting detector or diode, Avalanche Photo Diode, or an image camera at various energy level and wavelengths.

Characterizing Spectral Response of x-ray sample standards at different power levels will now be explained.

Spectral signatures using a material or multiple materials of known density and thickness may be collected from x-ray or light levels that range from low to high on the power source dial setting with equal increments. The purpose of the measurements may include one or more of the following: Characterize spectral variation at the same pixel location at different power source levels with energy peaks at one or more energy levels, which are selected for measurements of ROI. The power source levels may be the exposure levels selected for measurements. In case of the x-ray system using automatic exposure control, such power levels and/or power level range can be preselected, for example, based on the thickness of the sample or a first measurement of the ROI in the subject.

Characterize the spectral shifts at different power levels for each pixel.

Characterize noise levels in spectral measurement from each pixel.

Noise levels are characterized at one or more energy levels which are selected for measurements of ROI.

An external x-ray source with stable output over time (<0.1% variability) over time may be used.

One or more standards as described above may be used. For example, tissue simulating phantoms or materials may be used at one or more levels of thickness and/or at least one or more known density. The number of standards used may vary. The number of measurements may be smaller than what is used to calibrate and establish an interpolated plot. For example, 3 different thickness of one or more materials may be used. In a triple energy system, for example, a total of 9 samples are used if there are three distinct materials in the ROI. Total measurement may be 9+9+9 = 27 instead of 400-500 measurements as in some cases needed in the interpolation plot.

The information may be used in data normalization, characterize energy response for the x-ray system, for example, a spectral x-ray tomography system with a source and a detector or detectors set, system calibration, and/or to quantitatively correlate each pixel of two or more different x-ray systems, for example, a spectral x-ray system used to measure ROI with a spectral x-ray system standard, which may be used to measure one or more material standards at data points that are used in an interpolation to establish an energy response function equation or a plot at various energies.

Deviation of source and x-ray detector from the source and detector of standard x-ray system used to measure known materials and samples to establish the interpolated plot and energy response function equation system may be taken into account for the establishment of the inverse energy functional response equation. The detector of one x-ray system used to measure ROI of the subject may have measurements of an unknown ROI, and use inverse energy response function equation, which is based on data points adjusted from measurements of the x-ray system standard using the deviation between the x-ray source and detector pair used in the x-ray system standard.

In one configuration, reference Detector will now be explained. In one configuration, Sensor is in Collimator to monitor x-ray exposure for the purpose of assessing input x-ray beam intensity emitted from source 12 or exposure prior to reaching the imaged subject 2.

In one configuration, Sensor r2 between the x-ray source 12 and upstream of the subject 2 and collimator shutter s2 or aperture, a2, may be used to measure x-ray exposure at one or more locations different from the x-ray beam passing through the shutter aperture a2. For example, one or more x-ray detectors may be placed in the positions within the outer perimeters of the field of view of the x-ray beam but not in the beam path which passes through the aperture, a2, of the collimator shutter g22. In the even there is not a collimator, the x-ray detector or detectors would be placed in the outer rim of the x-ray cone beam, so that x -ray is measured before reaching the imaged subject.

In one configuration, optics or x-ray optics such as beam splitter may be placed in the x-ray path prior to reaching the imaged subject so that portion of x-ray passes through the subject and reaches at least one detector. A portion of the x-ray generated is redirected to a separate or second detector by a grating system, or beam splitter, to be measured. The intensity or exposure captured by the second detector may be used to derive the value of the exposure illuminating the subject or VOI of the subject, especially if the exposure in either direction is characterized prior to the measurements. In some cases, pixel by pixel or pixel region by pixel region correlation of the first detector 22 to the second detector, or the reference detector, R2, may be determined prior to imaging of the subject.

In one configuration, an X-ray detection device f22 can provide an output signal, the value of which can be used to determine the radiation received at a selected region of an object, such as a patient. The device f22 can include a transmitter for being energized by X-rays, said transmitter producing radiation of a wavelength different from that of said X-rays, said transmitter aligned with X-ray detector 22 to be exposed, and wherein said transmitter is of substantially the same cross-sectional area as said X-ray detector, a detector for detecting said radiation wherein said detector is substantially transparent to incident X-ray radiation, and a sensor connected to said detector, said sensor generating an output signal related to said radiation, the value of said output signal can be used to determine the x-ray radiation received at said transmitter to provide X-ray exposure output readings at one or more selected locations of a patient's body. The x-ray detection device f22 may have a fiber optic element. In one configuration, Beam Chopper is used in the beam path between x ray source and the detector and or between x ray source and the imaged subject

For example, one configuration of the chopper is described in “A New High-Speed Beam Chopper for Time-Resolved X-Ray Studies” J. Synchrotron Rad (2000) 7, ppl-4, and incorporated herein by reference.

In one configuration, a high-speed x-ray beam chopper can be phase-locked to the temporal structure of a timer or temporal structure of x-ray emitting position mover or the electromagnetic or magnetic steering device for steering electron beams of x-ray source to position the x-ray emitting location. This chopper can be used in time resolved measurements of various phenomena.

In one configuration, an x-ray beam chopper may be used for generating fast 2D image acquisition at various x-ray emitting positions for multiple dimensional x-ray imaging reconstruction or for generation of multiple spectral images for example, such as when the target of the field emitter or electron emitter has regions of varied materials for generation of x-ray energies of different levels.

In one configuration, an x-ray beam chopper can include a motor controller that accepts the frequency of the x-ray emitting device or the generator and that can be the master clock of the device, or of the controller of the electron steering device or the motion system which moves the x-ray emitting device. This allows the beam chopper rotation speed to be synchronized to the motion of the x-ray source mover or electron steering device. By this synchronization, any portion of x-ray emitted can be positioned within the beam chopper transmission-time window.

In one configuration, the beam chopper can have a high level of rotor speed regulation. The rotor disk can have a plurality of polished facets equally spaced around its circumference. An optical encoder reflects an optical beam from these facets and feeds the frequency to a speed control circuit in electrical communication with the motor controller board. The feedback to the driver circuit can regulate the rotor speed.

In one configuration,, with appropriate modification or specification of the chopper motor rpm speed, the chopper can be adaptable to x-ray sources. Generally, to facilitate phase locking of the rotation frequency of the chopper to the x-ray emitting device or the external trigger such as motion systems to move the x-ray source or the electron beam steerer to move the x-ray emitting position, and also to have the maximum duty cycle, the x-ray imaging or x- ray measurement frequency to the beam chopper rotation frequency should be the smallest possible integer consistent with the maximum beam chopper speed available. Both x-ray source and x-ray beam chopper system can move synchronized in position and time.

In one configuration, beam chopper can additionally allow for finer focal spot size. A rotational beam chopping apparatus can include a helical shutter for an electron beam system that is employed in x-ray imaging system. The beam chopping apparatus can allow for variability in both velocity of the beam chopper rotation and/or frequency of x-ray measurements, and the beam focal spot size by modifying the physical characteristics or geometry of the beam chopper apparatus. The present specification also discloses a beam chopping apparatus which moves to synchronize with the x-ray emitting position to provide a vertical moving beam spot with substantially constant size and adjustable x-ray pulse width to allow for illumination of ROI with faster frame rate than the x-ray emitting device. This can be achievable by a constant or a tapered opening or transmissive channel, thereby producing an x-ray emitting cone beam with smaller focal spot at the same time as the tapered transmissive channel is synchronized with the location of center of x-ray cone beam due to the movement of the x-ray emitting position and the rotational speed of the helical shutter. Such a beam chop can be of light weight. And the rotation of the helical shutter can be in either direction to achieve the compactness of the beam chopper. The helical shutter may be driven by an actuator.

Such a beam chopper may be placed between the x-ray emitting device and a collimator, or downstream from a collimator related to the ROI.

The transmissive channel alignment with the x-ray emitting cone beam center axis may be synchronized by locking the rotational frequency or speed with the master clock of mover or beam steerer of the x-ray emitting device. A reference optical sensor with a light source may be used to ensure and adjust the frequency of the rotation. Such a device may be designed with a reflective surface within the beam chopper device and optical light transmissive channels interlaced with the transmissive channels for the x-ray beam.

In one configuration, the movement of the x-ray emitting location can be independent of the movement of beam chopper. As the x-ray emitting position movement varies, the location of the beam chopper can vary as well while the rotation of the chopper can be locked with the master clock of the motion system, which moves the x-ray emitting position. Chopper rotation frequency, which determines the period of transmission of the x-ray beam through each of the x-ray transmissive channels, can determine the pulse width therefore exposure time. In some cases, a collimator may not be needed. In some cases, a collimator is placed or attached to the x-ray tube housing or supporting structure downstream from the chopper to further select ROI. In one configuration, one or more beams or one or more thin beams may be generated by a beam chopper so that a different region of VOI may be imaged during an imaging procedure to track or monitor a portion of VOI, such as a component contained in a VOI.

In one configuration, motorized beam chopper may be further modified to have x ray attenuation regions, and or collimation and or beam restricting and or structural illumination and or filter regions, x ray optics regions and or any material or means which can provide energy, amplitude, frequency and spatial signal modulation and or x ray transmissive regions, to provide a mechanism for steering or modulating and manipulating x ray beam at various times and or at various spatial locations and or at various frequencies relative to the VOI.

In one configuration, x ray beam chopper may be used jointly with other means of x ray steering, collimation, modulation and spatial and or frequency modulation to optimize x ray perturbation of VOI under different imaging conditions.

Such a method can be used in any x ray imaging applications, for example, medical, industrial, security and research to extend flexibility and lower the cost of system configuration.

Optical measurement acquisition and visual presentation

In one configuration, x ray imaging system, tomographic system and or spectral tomographic systems may be combined with other modalities for better information and result extraction and combined intelligence derivation of the imaged subject for a number of applications which can include medical, nonmedical, entertainment, research and industrial or any applications which either x ray or optical system can independently serving.

In one configuration, sensor may be used to determine the approximate exterior color, or shade or visual property of items reachable by line of sight of LED, laser or any light source or ambient light, such as the imaged object surface, external surface, and or external surface of ROI, which in turn may present such color in image presentation along with volumetric presentation of the ROI after tomography image is acquired.

A user may click an visual presentation of the object with external presentation, or right click or have an input signal given to the digital program, a 3D image may be pop up over the existing display with or without detailed annotation or the 3D image may be presented as an replacement of the existing external image, or additional digital, data or visual presentation typical in 3D, 2D , or multiple dimensional presentation in graphics or visual and quantitative presentation in CT, optical or other relevant modalities such as densitometers, may be used Sensor may be used with AI applications, such as deep learning, to guide imaging, tracking and monitoring of ROI along with using x-ray imaging systems of one configuration in the aforementioned PCTs and this disclosure

Such sensors may be mounted near the x-ray source, or anywhere in the x-ray system. Sensors may also be placed separately from the core x-ray imaging system.

For example, a catheter may be tracked by selectively image different portions of VOI which containing a portion or the whole catheter and or the probe attached to it or one or more portion of an intervention device or probe. The color or visual presentation of the catheter and or the patient and or relevant objects during the procedure may already be obtained prior to the imaging procedure. In configuration, the color or visual or graphic presentation of the catheter and the rest of probe or surgical tool may be obtained in real time and presented during the imaging procedure.

In one configuration, an optical sensor and or time of flight sensor are attached to the x ray tube assembly.

One configuration of Exposure Control

Automatic exposure control of prior art involving take one exposure and adjusting exposure level based on prior measurement.

In one configuration, a sensor such as time of flight sensor measures the height map and thereby the thickness of the subject, an exposure level is set based on a predetermined database, for example, based on the spatial location of the ROI within the Subject, or the approximate make up of the ROI, or the type of ROI, a recommended exposure level may be looked up or calculated. For example, the thickest part of the ROI , such as that of brain, may be calculated, and the exposure level is thereby selected and set based on a derived value or look up value in an existing database for brain tissue types, and previous recommended exposure level with the measured thickness

One configuration of whole Body Imaging or Large Field of View Imaging

In one configuration, the x ray source assembly may be moved in at least one axis by a mover. And the x ray detector may be moved in parallel with the x ray source by a mover. X ray source and detector may be moved independently of each other, however, the source and detector may be aligned by at least one pair of movers which move similarly to each other, and or parallel to each other but separated spatially.

In one configuration, the following imaging steps are used

Using camera to define field of view. This may be optional

Using time of flight sensor to measure height map, and or thickness of the VOI or the whole body.

Determine size of whole body or VOI

Apply a pre-existing digital grid on the VOI or the whole body, in one configuration, each grid segment indicates approximate region of one body part, for example head, chest, extremities, thighs or joints or feet or based on thickness range, or thickness threshold and size of various thickness, or height range, the VOI or the whole body is segmented by a digital grid, with each grid segment containing voi of similar thickness and or defined proximity. Or AI may be used to recognize the body parts based on non radiation sensor such as a camera and or time of flight sensor view.

The user may adjust the boundary and or the size of each grid segment for each prelabeled body parts.

Image settings may be determined by one of more of the values, such as thickness, body part, at least one x ray measurement of a grid unit.

Each grid segment of VOI may be imaged with one or more same or similar image settings such as number of projections, kV, mA, exposure time.

The beam restricting device such as collimator may be used to image at least a portion of or the entire grid segment.

In prior art, the thickness of VOI is measured by a sensor, such as a camera or time of flight sensor to determine only exposure level. In one configuration, thickness measurement is not only to determine exposure level, but also the number of projections to be made for reconstruction of multiple dimensional images. in one configuration, the senor such as time of flight sensor is also used to determine the size of the patient, or VOI, by constructing height map and determining from the height map, the VOI the beginning and end of VOI, for example, head or toe, so further x-ray imaging decision can be made regarding image settings, locations of starting position and finish location for extending field of view sufficient enough for x ray imaging. Prexisting imaging plan may be already stored in the computer, depends of the imaged object estimated size, the user or the computer can decide the starting point or homing positions of the x ray tube which can be and or can be selected from one or a number of choices, and field of view of each exposure may be and may be selected from one or a number of choices.

The image procedure settings for complete acquisition may be dependent upon estimated or measured patient size, the user or a digital program can position the patient or the imaged object at a predetermined approximate position, the image acquisition setting geometry and or sequence of acquisition spatial location and or a predermined geometry may be used and stored in the database, and or determined prior to or in real time of the imaging procedure.

Tomographic imaging geometry is predetermined and selected and x ray emitting position selected based on thickness of the patient and or thickness of the component of interest and or VOI and or the imaging modality choice and in some cases, the field of view and geometry of image acquisition may be dependent on camera measurements or TOF measurement and or x ray measurement.

In some cases, such measurement is used with AI to identify body parts for x ray measurement such as for setting values for the imaging parameters such as kV, mA and or exposure time.

In one configuration: Method to align 2D and or multiple dimensional images

Geometric artifacts may result in inaccurate representation of the anatomy and yield unreliable morphological measurements, including the size and volume of the organs or tumors, or affect the assessment of functional quantities. Lack of registration between anatomical and functional images may limit or lead to false results in tomographic image or material decomposed image measurements performed on the basis of region of interest defined on anatomic images. It may also comprise the quality of image.

Because of limited field of view of the source and that of detector, whole body x-ray imaging and or tomography acquired in separate image segments. Depending on the acquisitions, these consist of either 2D projection image and or three dimensional volume reconstructed image. These images may be combined in to whole body image. Each of the image may be called here an image station. Image stations may suffer from inter-station intensity variations, which have to be corrected in order to obtain a homogenous whole body image. In one configuration, quantitative imaging, and or dual or multiple energy imaging with material decomposition, may reconstruct and attenuation density or optical density or radiographic density of one or more simulated path or measured path of one or more beam lines may provide sufficient information inter- station alignment.

In one configuration, Image stations may be acquired to including overlapping regions of ROI, for example, predefined length between neighboring segments.

In one configuration, mosaicking of the whole-body image stations and aligning them to their multi-modal corresponding image using image registration include methods such as

Geometric artifacts may result in inaccurate representations of the anatomy and yield unreliable morphological measurements, including the size and volume of organs or tumours, or affect the assessment of functional quantities, such as the global apparent diffusion coefficient (ADC) Moreover, the lack of registration between anatomical and functional images may limit or lead to false results in DWI parameters measurements performed on the basis of region of interest defined on anatomical images.

Scale, rotate, perform other multiple-D transformations, and align images may be matched by intensity correlation, feature matching, or control point mapping, or anatomic marker matching in optical imaging methods, which may be applied to the x ray images and imaging stations of one or more ROI.

In one configuration, Optical density, or attenuation value or radiographic density on at least two pixels of the same projection line may align two projection images. The distance and spatial relationship with a reference object or reference marker may serve as a method to align projected images or reconstructed images which may or may not have overlapping regions.

In one configuration a system matrix with a coordinate with at least three degree of freedom may be used to track source and detector position and relative spatial relationship with the ROI or two or more ROIs, the relative spatial relationship of projection image is therefore derived in a large field of view. In this case, The align-ment of neighboring DWI segments is not explicitly considered in the registration metric. Instead it is assumed that registration of DWI stations onto the whole-body anatomical reference will lead to DWI with high image continuity In one configuration, at least one ROI or voxel in tissue or anatomic marker or organ may serve as a reference point for alignment.

Or the system matrix, detector, ROI and source emitting position

In whole body imaging, For example, an ROI in Pelvis region may serve as a reference.

In one configuration a spatially referenced image may be specified by the image data and its associated spatial referencing object RA or ROI. a spatially referenced image specified by the image data B and its associated spatial referencing object or a spatial referencing ROI.

In case of 2D images, relative position of x ray emitting position, the anatomic marker and or detector position and reference image of the ROI, and relative position of the ROI may be related in a system matrix including source, detector and the ROI. Or two system matrix describing at least relative spatial location of x ray source, or detector and or ROI and transformation function to describe relative relationship from one to another.

Optical density and measured and derived thickness information and or attenuation density or attenuation value of material decomposed region or at least one substance along a beam, for example, derived from spectral imaging, such as using inverse energy response function system based on less than 1% or less than 5% SPR projected images may provide sufficient information for adjustment for alignment, for example if there is an overlapping region.

Relative spatial positions or distance to a reference object or anatomic marker either internal or external of ROI may provide enough information for 2D image to be mosaic stitched together or aligned and placed in a 3D or 6D space.

In one configuration attenuation density, or optical density or radiographic density and density may be derived or simulated based on the assumption of the slow varying nature of one substance or composite substances and derived thickness values of a predicted projection path or a simulated projection path.

In some cases, voxels do not need to be resolved in multiple dimensions in order for the estimation of attenuation density or attenuation value of a predicated beam path through VOI. Similar in the alignment of multiple dimensional image, same approach may be applied. The precise simulated beam path may be aligned based on attenuation value or attenuation density or radiographic density.

Such simulated beam path or projected path may be related to the VOI through at least one geometric system matrix describing source emitting position, VOI and or projected image on the detector.

In one configuration Image registration is typically performed in a pairwise manner, where the aim is to find the transform that aligns the moving image to the fixed or reference image.

Aligning multiple images of the same VOI may be achieved by sequentially applying pairwise registration to a chosen reference image.

In one configuration, groupwise, approach, can be used, in which a set of n images, Fi, are simultaneously aligned, by jointly optimizing n spatial transformation. Since an infinite amount of solutions to the set of n images may exist, an extra constraint can be introduced. The constraint minimizes the total image deformation of the set of images, which effectively maps them to a mean reference space.

In one configuration, the rigid image transformation model can be used, for example, it is defined as a transformation of image coordinates form a fixed image domain to a moving image considering six degrees of freedom, consists of three translating parameters and three rotation angles.

In one configuration, imaging procedure or method in dissimilar metrics

Due to different modalities, 2D vs 3D vs material decomposed substance images, the choice of alignment method may be determined by the limitation of what the image or measurements can provide out of the image stations. For example, if one of the two images of ROI with predefined overlapping regions, if only single energy x ray image is available, then single energy x ray images may be used to align. If spectral images are made in one image station and 3D in another, with overlapping regions, then simulated spectral images, or material decomposed image or segmented image maybe used from 3D image and multiple energy material decomposed 2D image of the overlapping region may be used to align. If 3D images are acquired, one or more beam line simulated or projected image through the VOI may be determined based on the beam path from both images, and aligned so that the rest of the images may be aligned. Or segmented image from 3D, such as segmented tissue image may be served as the ROI for the analysis of beam path alignment.

In one configuration, whole body image formation may include one or more of the following methods:

Image station are sequentially aligned using a reference station, for example, pelvis, forming a whole body image. Obtained whole body image is deformably aligned using mutual information to the corresponding anatomical reference. Simultaneous optimization of all image station position ( groupwise approach) followed by deformable registration to an anatomical reference.

Direct deformable registration of image station onto a single energy whole body anatomical reference or spectral whole body anatomical reference or material decomposed whole body anatomical reference or 3D and or its segmented image anatomical reference using a sequential pairwise approach between the image station segment and the whole body image.

Image stations are directly and deformably registered to one or more of the following measurements: a single energy anatomical image, spectral images or 3D images

Mosaicking of the whole body image, which may include at least one of the following images: 2D, spectral 2D or 3D or spectral 3D with simultaneous deformable alignment to a single energy whole body 2D anatomical image or spectral 2D image.

Whole body image may be mosaising together using rigid body part, such as bone image or bone attenuation value or radiographic density as a reference. For example pelvis bone tissue attenuation value as a geometric or spatial reference. For example dual energy images or image stations are taken. Material decomposed bone images are matched based on simulated or measured attenuation value of selected projection path at least one or more pixel locations of the detector.

The corresponding soft tissue and or the rest of body tissue images may be aligned using the bone images as a reference. And image of individual tissues or composite tissues may be combined into one based on the bone image location relative to the tissue. Image station comprised of either spectral images and or segmented 3D image may also produce bone measurements or density as well as thickness information, which may serve as reference for registration the spatial location of other tissues throughout the body.

Motion artifacts may affect the location of the bone but the bone itself may be rigid enough that the spatial position and distribution of the bone is optimally aligned to allow a reasonable whole body image construction.

A typical method may contain one or more of the following steps:

1. take at least a dual energy image of the whole body, - each image set of dual energy, is called image station of each body segment

2. derive bone attenuation values, align images based on bone attenuation value and or simulated bone images based on the projection line of the overlapping region.

3. select the corresponding soft tissue image corresponding to the bone image using the same x ray emitting position

4. apply to the whole body image

5. optimize images based on set criteria (minimize deformation variances due to motion artifacts relative to a reference image), or determine a reference image to be used.

Move to image an object based on selected ROI by a user or a digital program a system matrix may be created, with x y z axis which describes spatially the location of x ray emitting position and the Volume of Interest and the detector and relative relationship between the projection image, one particular projection line, each voxel, and the detector. once an image or a set of images are taken of the VOI, the user pick ROI on the projected image, based on the reconstructed image or the project image or image sets or fact or facts derived from the image or image set.

In one configuration, the corresponding VOI position in the object is calculated using the center point of the ROI as the center axis projecting location which connecting the source and the detector. The x ray source and the detector move to the xy location of the center point of the ROI, and the collimator is adjusted to the corresponding size based on the projection image area selected for the selected ROI. In one configuration, 2D/3D Real Time Fluoroscope with adjustable height structure or pilar or telescoping beam structure for varied source to detector distance.

The source and associated tomography enabling hardware and or mover to move source for tomography and or large field of view imaging may move up for example, for when not in use, or use in diagnostics mode, moves down when in use as a fluoroscope.

Automatic exposure control is used in CT and tomosynthesis in image acquisition as the different projection angles, may introduce new regions of material to be in the projection path, or VOI thickness in the projection path significantly are different from one to the next, thereby requiring adjustment of exposure levels frequently or from one to the next in order to get the 2D images with quality sufficiently good for reconstruction of tomography images or multiple dimensional images.

For a volume of interest, with defined spatial location and thickness and dimension and material composition, using methods of one configuration and for the aforementioned PCT for tomography or approximately complete tomography or tomosynthesis reconstruction, the projection images are essentially same region of interest with similar thickness and material, thereby, for reconstruction of multiple dimensional image of VOI, only one x ray image or at least only one x ray image with optical sensor measurement of thickness combined are minimally required to derive the minimal dosage required for each projection image of VOI. Thereby it reduces computation time and energy requirement for multiple dimensional x ray imaging over time.

For dual or multiple energy projection images of VOI for tomography or multiple dimension reconstruction purposes, an optical sensor measurement and or one x ray image may also be sufficient for derivation of minimum exposure required at each energy.

In another words for multiple energy or single energy 2D or multiple dimensional or tomography imaging based on reconstruction of 2D or ID or point measurement of projections through a VOI, exposure control can be based on one optical sensor measurement, such as a 3D height map by a 3D camera or a time of flight sensor and or only one first image.

In one configuration, adjustment of x ray exposure is done once during the x ray acquisition step for tomographic image or multiple dimensional image In one configuration, adjustment of x ray exposure is more than once during the x ray acquisition step for tomographic image or multiple dimensional image.

Only one x ray image taken of ROI is needed for determining the exposure level. Exposure level may be adjusted multiple times, if different selected areas of ROI is imaged. For example, if ROI is large, within the ROI, there may be two or more regions which are distinct from each other. The exposure level may be adjusted if a selected region needed to be imaged for tomography vs the entire ROI, as the selected region may have less thickness compared to the entire ROI, or the selected area may have components or substances which have a less density than the most dense region of the ROI. But the same first image may be used for analysis of the selected region to determine the exposure level.

This is possible due to the fact that with the aforementioned PCT and one configuration, the x ray projections are taken within area where the x ray emitting position are relatively close to each other, for example distance between each emitting position may be the size of the resolution along the z and the total emitting positions are located in 2D or 3D space, therefore can be in mm or cm range. And the thickest part of volume of interest which may be used to determine the exposure level, may be the same for most projections required for the reconstruction of the tomography and or multiple dimension image.

In one configuration, Method for exposure adjustment

Optical sensor or non radiation sensor to measure thickness, sometimes to set 1^st exposure level, the exposure level may be a single exposure or multiple exposure added or averaged signal used as the image for reconstruction.

In some cases, scatter removal method is used to remove scatter, such as use beam particle absorber plate or Beam Stopper array plate.

Exposure time at each projection position is controlled or adjusted or un changed based on first x ray image taken of the VOI.

In one configuration, Beam Stopper Array Plate Configuration and Method may be the following Beam Stopper array plate 100 or the beam absorber particle plate 100 may be fixed on a detector by a clamp. In some cases, alignment pins may be used to ensure the positioning of the Beam Stopper array is similar relative to the detector each time it is replaced or displaced.

While in the prior art, Beam Stopper array may be moved into another position so that at least two projections are taken at same x ray source emitting position so that the missing projection data or primary signal from one Beam Stopper position may be provided by the primary signal derived projection taken in another Beam Stopper position where now the primary signal is captured.

Also in prior art, there may be one projection taken by the detector which is with Beam Stopper array, and the second image taken without the Beam Stopper array. The second image is to used to generate a primary image by subtracting the high resolution scatter image derived from the first projection image.

Both implementations are different from the following description of a different implementation which is an improvement of method, some may be used for scatter removal suitable for tomography applications by possibly reducing time and movement required during image acquisition in order to reconstruct a complete tomography or multiple dimensional image or in tomosynthesis.

In some cases, the Beam Stopper array may be smaller than the detector for example ½ of the detector a mover, for example, at least one axis mover may move the Beam Stopper array to be in front of the different regions of the detector a defined region, a high resolution scatter as a result of interpolation from scatter signal in Beam Stopper shadow region taken at a position 1, may be used to remove scatter for projections taken of VOI in the define region without Beam Stopper array in between the VOI and the detector. The x ray source can be in the same or a different location. Or the x ray source emitting position can be in the same position 1 or at a location sufficiently close to 1 , within a certain area.

Such a Beam Stopper array can be implemented such that the mover can move a plate, approximately size of the detector, only a portion of the plate is populated with Beam Stopper array. Either by rotation or by linear movement, the portion of the plate with the Beam Stopper array is moved to be in front of a different region of detector, or the portion of the plate with the Beam Stopper array can be completely taken out from between the detector and the volume of interest after at least one image has been taken with the Beam Stopper array in between the detector and the VOI. In tomography where the x ray source emitting position moves in small distances way from its original position, or the x ray source emitting position moves in a small xy plane area or 6D space, As, the scatter measurement may be the approximately the same. Therefore one high resolution scatter image derived from any one of the x ray source emitting position may be used as the scatter image to derive the primary image from projection images from all x ray source emitting positions within the same space As.

For example in tomography or tomosynthesis or multiple dimensional imaging, if total of P projections are to taken within a xy plane or within a 6D space, of traveling area for x ray source emitting positions, in distributed positions, a x ray projection images may be taken with a full view Beam Stopper array in between the detector and source at a number of x ray source emitting positions T, each of the position within T is referred to as small t, t or each of the x ray source position generates a high resolution scatter image for each t, there are more than one x ray source emitting positions which generates the same or similar high resolution scatter image for the same VOI. If the total number of the projection is P, P/T is the number of x ray source emitting positions which have the same or similar scatter image under the same exposure settings, for approximately the same VOI.

After the images are taken with Beam Stopper array, the Beam Stopper array are removed by the mover, the projection images are taken without Beam Stopper array in between the detector and the VOI. Tomography image is reconstructed based on the 2D images of primary image derived from measured projection image subtracting the high resolution scatter image each measured projection image has a corresponding high resolution scatter image which is derived from measurement taken when Beam Stopper array are between the detector and ROI, and the x ray source emitting positions of the measured projection images with and with Beam Stopper array are sufficiently close or within a certain 6D space or 3D space or 2D area or ID distance.

Beam Stopper array may comprised of Beam Stopper s are distributed sparsely. There are selected projection region DS taken in between the shadow areas are sufficient distant from the scatter only or the Beam Stopper shadow region of the detector, that the high resolution scatter image generated from interpolation SO due to the Beam Stopper array shadow area are different from the high resolution scatter image DSS, DSP is the primary image of the selected region DS of the VOI. The composite image DS is the combined signal of the resolution scatter image DSS and the primary image DSP. As X ray projection images are taken. The Beam Stopper array may be moved to a different position, a new selected projection region DS ‘ now exist. The Beam Stopper array may be move sufficient positions so that all region of detector now has at least corresponding high resolution x ray scatter measurement for at least one position of x ray source emitting position for each of the defined space where the x ray source emitting position may travel to for a complete tomography or multiple dimensional or tomosynthesis reconstruction.

In another example, the scatter interpolation may take time for image processing. To improve image processing time, and faster availability of primary image for reconstruction, therefore improve 3D reconstruction time, high resolution scatter image generated at each Beam Stopper position may be used for a different Beam Stopper position if the x ray source emitting position are the same or the x ray source emitting positions are close enough with each or within a certain defined spatial dimension.

In another example, at least one interpolation process is done for projection images from x ray source emitting position in a defined region where it is estimated that high resolution scatter image for each of x ray source emitting position with the same exposure setting, for the same VOI, is the same or approximately the same for two or more exposures at one or more x ray source emitting positions. Different Beam Stopper array shadow regions from one or more exposures at one or more x ray source emitting positions may be used as data points in one interpolation step to derive high resolution scatter image, which is subtracted from the composition image of each projection to derive the high resolution primary image.

The number of Beam Stopper arrays units in each Beam Stopper array is widely distributed, one or more of the following may take place the Beam Stopper array attenuation particles may move at the same pace or faster or move at the same or a longer distance than the x ray source emitting position. The shadow area of the Beam Stopper array taken at sufficiently different positions from two or more exposure or frame image may be used for interpolation to derive a high resolution scatter image, which may be the same or approximately the same for projection image taken at two or more x ray source emitting positions which are sufficiently close to each other. The high resolution scatter image for each x ray source emitting position of the same VOI may be the same or similar. Missing data or missing primary measurement of one Beam Stopper array position BBij may be replaced or completed by one or more weighted projection measurements from at least one or more Beam Stopper positions different from BBji. Sometimes, partial missing projection data needed for reconstruction may be extracted from restored or obtained from at least one or combination of two or more projection measurements at two or more Beam Stopper positions different from the BB position BBij. These Beam Stopper positions other than BBij may be partially overlapping with the Beam Stopper array position BBij or completely non overlapping.

For 2D imaging, especially when there are two or more exposures of the same VOI, with X- ray source emitting position staying at the same spatial position, and if the exposures have the same or similar setting if there are two or more Beam Stopper Array Positions, the scatter only measurements from multiple exposures, at various locations on the detector, may be combined together as the data points used for interpolation to derive high resolution scatter image, which can be used in derivation of high resolution primary image for each exposure by subtracting the high resolution scatter image from the composite image measured for each exposure. In another words, interpolation or derivation of high resolution scatter image may be done at least once, using data points measured from at Beam Stopper array shadow regions of at least one Beam Stopper array position. Missing data may be filled in by the high primary image of the missing data region of a different projection, or a weighted average from two or more projection images of the same missing data region, if none of the projection images have the same missing data region.

The minimal number of Beam Stopper array unit per unit area is inversely proportional to the number of exposures needed to derive a high resolution primary image of VOI with a certain exposure settings, if the Beam Stopper array plate is moved from position to position to eliminate the missing data gap due to absorption of the Beam Stopper array. For example, if 500 Beam Stopper units are minimally needed to derive high resolution scatter image in order to derive a high primary image in a 20cm x 20cm detector, if there are two exposures, and two sets of Beam Stopper array locations, then only 250 Beam Stopper units may be needed and they may be more sparsely distributed than the 500 Beam Stopper units. If there are four exposures, then only 125 Beam Stopper units are needed for each exposure. A mover is to move the Beam Stopper array plate relative to the VOI and / or the source between exposures. All Beam Stopper array units position and their shadow regions may be distributed from each other within each exposure or among all exposures. At least one interpolation may be needed to derive the high resolution scatter image from shadow regions of all 500 Beam Stopper units from one or more exposures. The final high resolution primary image derives from combined or averaged value of primary image from each exposure.

In one example, as x ray source emitting position moves within a defined area, the Beam Stopper array 100 may move too, in one axis or in two axis. Scatter only measurement under shadow areas from at least one Beam Stopper position may be interpolated, used as the high resolution scatter image alternatively scatter only measured under the Beam Stopper shadow area in two or more position of Beam Stopper array may be combined and or scatter only measurements under the Beam Stopper shadow area in two or more positions of x ray source emitting position may all be combined and interpolated at least once to generate a high resolution scatter image, which can be subtracted from projection images from each of the x ray source emitting positions to generate primary x ray image for that position.

In some cases, the Beam Stopper array is moved in xy plane or two axis of 3D space or at least one axis of the 3D plane.

Beam Stopper array plate is moved so that scatter value of additional regions of detector image of VOI can be derived.

Beam Stopper array plate can have sparsely distributed attenuation regions so that each projection image only has limited regions which has missing data gaps of the VOI due to the attenuation regions of Beam Stopper array plate. Due to varied location of Beam Stopper array plate, the final density of the Beam Stopper array shadow regions of detector or the scatter only regions, can be dense enough to generate a high resolution scatter image at each part of the detector. So that a high resolution primary image may be derived from a projection image by subtracting the high resolution scatter image. And in some example, at least one, or only one scatter interpolation needs to be done for different positions of x ray source emitting location or for different location of Beam Stopper array plate.

Using tomography method described in one configuration and aforementioned PCTs, in some cases, projection image with BSA may need to be taken only once given the position of x ray source emitting location when the projection is taken is only a small angle or small area within a ID or 2D area or 3D or up to 6D volume. Using tomography method described in one configuration and aforementioned PCTs, in some cases, projection image with BSA may need to be taken only twice given the position of x ray source emitting location when the projection is taken is only a small angle or small area within a ID or 2D area or 3D or up to 6D volume.

Using tomography method described in one configuration and aforementioned PCTs, in some cases, projection image with BSA may need to be taken three times or less, or four times or less, to up to six times or less given the position of x ray source emitting location when the projection is taken is only a small angle or small area within a ID or 2D area or 3D or up to 6D volume.

The rest of projection images are taken without BSA.

Or alternatively, if a sufficient number of BSA particles are moved throughout the tomography image acquisition, the total scatter image is acquired by using the total shadow regions due to the movement of the BSA during projection acquisition process. The total shadow regions of BSA may be used to interpolate high resolution scatter image for the projection images needed for the complete tomography image, or a fraction of the total projection images needed for the complete tomography image. In latter case, one or more sets of BSA movement or BSA positions may be needed for additional projections needed for a tomography reconstruction.

In another words, one or two or less than three times, less than four times, or less than five times or less than six times of image processing involving interpolation of scatter signals in the shadow regions to derive high resolution scatter image is used for scatter correction of a tomography image.

The BSA plate may be a fraction the size of detector, or have Beam Blocker particles sparsely distributed across a 2D region plate approximately the same size as the detector.

“Beam Stopper Array Plate” is the same as the “beam particle stopper array” or “beam blocker array” or “Beam particle stopper array”, or “beam absorber particle array” or short “BB” or “BT” or “BSA”

In one configuration, Radioscope or fluoroscope acquisition mixed with radiographic image acquisition method includes the following method to display fluoroscope intermixed with radiographic images. Traditional fluoro images may be performed at exposure levels which are very low compared to radiographic images.

Fluoroscopy display may be intermittently replaced with radiographic images, such as processed with scatter removal to SPR < 1% or < 5% or less than 10%, for example, using spatial domain scatter removal methods, such as using Beam Stopper array plate at two or more positions, using beam selector and two detectors. Dual or multiple energy material decomposed images may also be displayed. Continuously acquired exposure may be stacked or averaged to provide the raw image with sufficient photon information for image processing. The radiographic images which may be resultant of higher exposure measurements than radioscope or fluoroscope. Radiographic images may be derived from fluoroscope images by stacking or averaging. Radiographic images may be used for tomographic reconstruction. The display may display fluoroscope images, processed radiographic images with scatter removed to scatter removal to SPR < 1% or < 5% or less than 10%, material decomposed images with dual or multiple energies and or tomographic or multiple dimensional images reconstructed from radiographic images simultaneously or at pre arranged time intervals or sequences.

Radioscope images may be displayed with material decomposed images in the same image, having a bigger region of interest displayed while the material decomposed region is a selected portion of the ROI.

Similarly, tomography or multiple dimensional images may be display on top of the radioscope images, and in some cases, only a selected portion of VOI are reconstructed.

Or different radioscope images, radiographic images and multiple dimensional images and tomographic images may be displayed separately in different locations on a display device.

Appropriate shielding of transparent material may be used for physicians and surgeons and hospital staff to be protected but be able to perform intervention procedures on patient. For example, a shielding material maybe used to be enclosed on the sides but with access ports to allow the physician with shielding covered regions to extend arms and hands to the position of the patient lying on a patient table.

In one configuration of Artificial Intelligence

Current technology of artificial intelligence may have limited values or parameters to work with. In addition, due to CT or general x-ray system or fluoro system of prior art system construction, scatter is an barrier to derive measurement data which is of quantitative in nature. And due to different detector size in CT and lack of spectral imaging in CT for human clinic, the AI algorithms developed and trained with CT of a certain manufacturers may not be useful for other systems of the same manufacturer or other manufacturers.

In one configuration, the x-ray system is built with reduced interference and noise possible, therefore allowing the following features, each being independent or combined with others to provide high accuracy, high performance, high speed x-ray imaging and measurement capabilities.

• Lowest interference and noise per pixel possible if preferred

• High resolution, or highest resolution if preferred

• High speed, or highest speed if preferred

• Selected region or selected distributed region

• Selected wavelengths or energy level or levels, with or without highest energy resolution, either discrete energy levels or broadband.

With methods and apparatus described above and purpose described above, artificial intelligence, including machine learning, deep machine learning, neuron network systems and methods may analyze or make use of the following to train an AI algorithm: presence and absence of one or more marker, substance, dynamic movements and interaction between subjects and components in a subject or external components and external subjects, spatial and temporal data and kinetic and interaction data acquired in the process of tracking and monitoring dynamic or static state or movements of the subjects and/or components internal or external to a region of interest in the subject or external to the subject. The input for the analysis and fact derivation in AI may include x-ray measurements and/or may be combined with other user input and other type of measurements and/or digital or analog input.

Annotations or labels and quantified values of different regions or segments or ROI or VOI of images and measurements may be used with the measurements and images in this disclosure and that from references, or other data sources as the input data for AI analysis.

AI can be for analysis, identification, diagnosis, prognosis, prediction of outcome and/or treatment outcome, image guidance, treatment / therapeutic guidance and post monitoring and surveillance and tracking in clinics as well as nondestructive testing, research, security applications,

Image, measurements, dataset of such measurements, and associated data and facts drawn from data or datasets based on the measurements of one configuration can be used in Data analysis, Linear Method, Artificial Intelligence, Neural Network, Machine Learning, Deep Machine Learning, deep neural network and/or as training materials of such computing device and/or software based methods.

Based on the measurements and data and image measured based on the disclosures described in this disclosure, PCTs including PCT/US2019/022820, PCT/US2019/014391, PCT/US 2019/044226 and patents in Chao’s disclosure, US patent 6173034, 6134297, 6052433, 5771269, 5648997, and any patents drived from prior mentioned PCTs, the entirety of each of which being incorporated herein by reference and being considered part of the specification, systems, methods and algorithms of artificial intelligence, neural network, and machines learning can be applied.

In image and measurement recognition and component and/or target and/or region of interest recognition and characterization, x-ray measurable properties characterization, identification, characterization, tracking, image guidance, may be improved by AI, neural network, and/or machine learning.

In drug screening, AI can select one or more molecular probe or lead candidates which fit one or more criteria based on measurements on in vitro sample, fixed, live sample, tissue samples, samples in microfluidics chips, growth cultures, petri dishes and, exo vivo samples, and live samples of small animal, microorganisms, organisms and humans.

In digital pathology, AI can draw facts and conclusions based on results of measurements with one or more criteria of samples.

The system may be programmed to have various settings or modes, for simulating or optimizing one or more steps in the imaging process, including data acquisition to provide data or images to be similar or just like that of each of conventional imaging methods, although image acquisition, processing and presentation methods may vary, compared to CT scanners. The resultant images, however, may be a synthesized or presented to be substantially the same or similar to that of image modality known to users or for better relating to a modality, such as MRI, PET, SPECT or optical imaging, or Ultrasound, and photoacoustic methods. One benefit of such functionality, for example, is for comparison of historical image data or measurements, or preferences of user as medical training in the past has been based on CT scanners. Additionally, the images can be used for large scale data collection and comparison. The images acquired by other X-ray machines may be used to compare with images acquired by that described in one configuration to derive at deterministic results, for public epidemiology, or diagnosis or prognosis, to predict disease progression, disease outcome, treatment outcome, monitoring or surveillance, with or without AI. A method for reconstructing a 3D image of an object from incomplete cone beam projection data can include: determining values representing planar integrals on a plurality of planes containing a reference axis in Radon space from the cone beam projection data; scanning the object to obtain object boundary information for each of the plurality of planes containing the reference axis; on each of the planes in Radon space containing the reference axis, employing a 2D CT reconstruction procedure to calculate a 2D projection image of the object on the plane; in one configuration, iteratively correcting the 2D projection image on each of the planes in Radon space containing the reference axis by transforming the image back and forth between 2D projection image space and Radon space, correcting in 2D projection image space by a priori information on the object including for example, material decomposed data at one or dual energies, or information from each pixel or adjacent pixels, or compressed data or complete preexisting data, and correcting in Radon space by the planar integrals; and reconstructing the 3D image of the object projection by projection by employing for each projection a 2D CT reconstruction procedure on the corrected 2D projection images in the plane of each synthesized slice to calculate a 2D and/or 3D image of the object. 2D, multiple dimensional image, ID and measurements, and material decomposed data representation and/or CT slices may be extracted from the reconstructed image.

In one configuration, Reconstruction of 2d or 3D or multiple dimensional Image up to 6 D and/or in time, such as 7D using AI or deep learning or without AI in conventional imaging methods may have various algorithms and configurations to speed up reconstruction process in AI and increase accuracy. However, when scatter is present at 5% or more of primary, and/or material is not decomposed, the time it takes to reconstruct is considerably longer and the reconstructed image has more noise and artifacts related to geometric movement, which may reduce the accuracy, especially in tomography reconstruction and/or material decomposed image reconstruction.

In one configuration, Reconstruction algorithms may utilize AI and deep learning algorithms and or without using AI according to one configuration can reduce exposure, radiation level, and/or measurement acquisition time and/or reconstruction time.

This method of reconstructing an image or a data set used in diagnosis, image guidance or intervention, or planning, or post procedure monitoring, tracking or inspection or testing can include: performing at least one algorithm step on a raw data set or an intermediate data set of one or more data types, such as, a reconstruction method including at least one or more of following types of measurements and/or data types: material decomposed data and/or low scatter to primary ratio data such as less than 1% SPR or less than 5% SPR and/or scatter removed data and/or single energy, dual energy or spectral measurements of point, and/or ID and/or 2D measurements and/or structural illuminated measurements, such as distributed point, ID, 2D measurements at multiple region of interest locations, and/or one or more regions of sparse measurement positions, and/or tomography data preexisting measurements of physical properties using mechanical mechanisms and/or sensors, for example, presented in CAD, simulated and/or interpolated x-ray measurements based on the preexisting measurements of physical properties impacting x-ray measurement, such as dimensions, and/or 6d orientation of VOI, and/or, density and thickness preexisting information which allows synthesis of tomography information of one or more substances, and/or one or more materials and/or one or more regions of interest images and/or measurements of modalities other than x-ray parameters such as density, thickness, dimension of at least one component, composite, materials, substances derived from measurements and preexisting information existing database and references data measured to enable inverse derivation or look up from one or more energy function response equation systems. compressed data set, and sparse data points or measurements sufficient to identify, characterize and determine a component, or substance or a VOI.

In one configuration, the reconstruction of a data set or an image may further use AI, which may include at least one algorithm including a deep learning algorithm.

The method may perform at least one algorithm including: performing at least one conventional, non-deep-learning algorithm on one or more types of data set or measurements or images of material decomposed data and/or low scatter to primary ratio data such as less than 1% SPR or less than 5% SPR and/or scatter removed data and/or single energy, dual energy or spectral measurements of point, and/or ID and/or 2D measurements and/or structural illuminated measurements, such as distributed point, ID, 2D measurements at multiple region of interest locations, and/or one or more regions of sparse measurement positions, and/or tomography data preexisting measurements of physical properties using mechanical mechanisms and/or sensors preexisting information which allows synthesis of tomography information of one or more substances, and/or one or more materials and/or one or more regions of interest images and/or measurements of modalities other than x-ray parameters such as density, thickness, dimension of at least one component, composite, materials, substances derived from measurements and preexisting information existing database and references data measured to enable inverse derivation or look up from one or more energy function response equation systems.

-compressed data set, and sparsed data points or measurements, which is sufficient to identify, characterize and determine a component, or substance or a VOI. any of the above data to obtain an intermediate data set of an initial data or reconstructed image; and optionally, one or more steps to interactively derive tomography images.

In one configuration, reconstruction using AI and deep learning algorithms including performing a deep learning algorithm on the intermediate data set to obtain the final reconstructed image.

The method performs at least one algorithm that can include performing a deep learning algorithm directly on the raw data set described above to obtain the final reconstructed image. In one configuration, iterative CT reconstruction method can use multi-modal edge information.

In one configuration, a method for reconstructing a 3D image of an object from incomplete cone beam projection data can include: determining values representing planar integrals on a plurality of planes containing a reference axis in Radon space from the cone beam projection data; scanning the object to obtain object boundary information for each of the plurality of planes containing the reference axis; on each of the planes in Radon space containing the reference axis, employing a 2D CT reconstruction procedure to calculate a 2D projection image of the object on the plane;

In one configuration, iterative correction may not be needed.

In one configuration iteratively correcting the 2D projection image on each of the planes in Radon space containing the reference axis by transforming the image back and forth between 2D projection image space and Radon space, correcting in 2D projection image space by a priori information on the object including for example, material decomposed data at one or dual energies, or information from each pixel or adjacent pixels, or compressed data or complete preexisting data, and correcting in Radon space by the planar integrals; and reconstructing the 3D image of the object projection by projection by employing for each projection a 2D CT reconstruction procedure on the corrected 2D projection images in the plane of each synthesized slice to calculate a 2D and/or 3D image of the object. 2D, multiple dimensional image, ID and measurements, and material decomposed data representation and/or CT slices may be extracted from the reconstructed image.

The apparatus of item wherein the images are scatter removed to less than 1% SPR or less than 5% SPR or less than 10% SPR or no scatter removal is neccary when spr is already less than 1% or 5% or 10%, , avoiding a need to consider scatter in simulation. The apparatus of any of above items, wherein a distance moved by an x-ray source from a first position to a second position is less than 5 cm, or /or less than 2 cm squared or less than 5 cm squared or less than 1cm squared and less than 4 cm squared or less than 3 cm squared and/or less than 3 cm squared from the first positions.

The apparatus of items above, wherein x-ray emitted at the second position is configured to travel in the same volume or 6D spatial position as x-ray from the first position. The apparatus of any of the above item, wherein the x-ray source is field emitting to emit x-ray at the same spatial position as the x-ray filament tube or other type of x-ray source, or the various type of source or its modulated version with same or different parameters including focal spot size, energy level, frame rate, and/or geometry, or manipulated by different x-ray optics or steered by different mechanisms may be used, wherein a same spatial matrix, a modified dual or multiple variable method, or a split subproblem method is used.

The apparatus of any of the above items, wherein an optical method is used in conjunction with the present x-ray systems, using the system matrix.

The apparatus of it wherein vectors are used in the system matrix.

The apparatus of any of item above wherein the controller is configured to use dual energy or multiple energy x-ray to determine an approximate area and distribution in the projected image on a pixel by pixel basis.

The apparatus of any of above items wherein the data sets are used to reconstruct a 3D image.

The apparatus of any of above items, wherein the controller is configured to segment or material out the material volume and space distribution, and/or perform material decomposition.

The apparatus of any of the above items, wherein the controller is configured to determine the ROI before and/or after reconstruction for further spectral imaging.

The apparatus of any above item, wherein the system matrix comprises at least one coordinate with three degrees of freedom.

The apparatus of any above items, wherein the controller is configured to combine movement of source and/or detector with that of a tomography system.

The apparatus of any above itemes, wherein the controller is configured to perform Contrast Agent decomposition.

-The apparatus of any of above items, wherein the controller is configured to perform dual energy or multiple energy decomposition to distinguish an X-ray absorbing material.

-The apparatus of any of above items, wherein the x-ray absorbing material comprises: a metal or plaster cast mixed with barium, a catheter and/or implant with one or more materials and/or having lumen and sheath made of different x-ray absorbing properties or atomic z, or made with distributed x-ray absorbent material at certain spatial locations interlaced with x-ray transparent material, sufficient to determine its spatial distribution compared to the background and other segments in the same catheter or implant, or including well- characterized x-ray absorption properties on a pixel basis, sufficient to differentiate one segment to another segment A plaster cast, a blood vessel, a contrast labeled blood vessel, microcalcification, and/or contrast- agent labeled molecules.

The apparatus of any of above items, wherein the controller is configured to denoiseusing AI software trained to remove noise.

The apparatus of any of above items, wherein the controller is configured to use data generated in training of an AI algorithms for reconstruction.

The apparatus of any of above items, wherein the apparatus is part of a tomography device.

The apparatus of above items, wherein the subject is loaded on a table or bed which is x-ray transmissive, the table or bed being placed on top of a detector gantry of the tomography device.

The apparatus of above time, wherein a patient is configured to lay on a surface of a detector gantry, which is transparent to x-ray.

The apparatus of any of above items, wherein the device or a portion thereof is portable by connecting to an autonomous driving device to be transported inside a clinic or to remote location outside the hospital.

The apparatus of any of above items, wherein the device is less than dimensions of an opening of a standard door.

The apparatus of any of the above items, wherein the device is used as a point of care device, and/or used in a patient’ s room.

The apparatus of any of items above, wherein the device comprises a detector module that is movable and can be placed in between the patient’ s bed and the patient. The apparatus of any of above items wherein the controller is configured to perform material decomposition using Beam Stopper reconstruction method.

The apparatus of item above, wherein the Beam Stopper reconstruction methods comprises filling a data gap from an image taken at the same x-ray emitting position and with a different Beam Stopper array position where primary x-rays are blocked. The apparatus of any items above, wherein the Beam Stopper reconstruction methods comprises filling a the data gap during the reconstruction process, each projection path which is missed from the Beam Stopper being described as having no data input, therefore requiring extra projection data to be generated from the same x-ray emitting position or using sparse data 3D reconstruction algorithms.

The apparatus of any of items above, wherein the material decomposition is performed for metal and/or other absorbing material in a catheter or an implant comprising one or more substances overlapping each other, if the controller knows the approximate density and/or thickness of the catheter or implant.

In one configuration, Regenerative Energy & Regenerative Power Supply is used.

In one configuration, a regenerative power supply connected to the x ray generator may be used to store and regenerate energy for generating energy or electricity which is used to hit x ray tube to generate x ray.

For example, the regenerative power supply may be connected to the generator, when generator runs, a portion of energy is supplied to the regenerative power supply. And in some cases, such a regenerative power supply would power up selectively and provide electricity to reach the x ray tube to generate x ray.

Switches may be used to connect the x ray tube selectively with the regenerative power supply or the x ray generator depends on the requirement of the measurements, or by predetermined parameter.

In one configuration, Phantom and Target to Test for Lidar, used in X-ray imaging In one configuration, Time of flight sensor, or Lidar may be used to measure height map of ROI or thickness of the sample, for either exposure setting or for estimation of number of projections needed for 3D tomography.

Current fluoroscope or densitometer or digital x ray phantoms generally has similar thickness across, or has the similar or same depth in the z direction ( for example, along the axis perpendicular to the x ray detector. )

In order to quality control and ensure performance, There may be additional test targets made to ensure measurement accuracy.

Traditional method and hardware generally have complex features and measurement standard which are not needed in the context of x ray imaging in one configuration, a phantom suitable for lidar quality assurance for height mapping is therefore needed.

In one configuration, the phantom may be made of polymer to ensure light weight ness and low cost, but any material which a spatial shape which may have defined shapes may be used. The size of the phantom may have a depth and xy dimension similar to ROI measured by x ray system. Or the phantom may have any dimensions. There may be steps of different height, for example, difference between variability in height or thickness may be the resolution of the lidar. Or the surface of the phantom closest to the lidar source may be curved, instead of having step shape. When the dimension of the phantom is known, for example, height at each xy position, the thickness measurement or the height measurement by the lidar may be compared to known dimensions the phantom for accuracy checking. If below a certain tolerance, the lidar needs to be serviced or repaired or calibrated. If the xy dimensions are not measured to be accurate within a tolerance, the lidar system may be service. If the lidar head can not scan or measure within a certain time frame or to the selected angle or angles specified, the lidar needs to be serviced.

The phantom may also have a slice along the z direction of a material which has a 3D dimension, may have various height and thickness along the z. A motor may be used to move such a phantom so that lidar scanning angle, speed, resolution, along the z may be measured as the phantom being moved to the field of view tested.

The lidar may be moved relative to the phantom to test scan angle, measurement speed, and resolution along the z. In one configuration, phantom to test scatter removal

In one configuration, using beam selector as specified in aforementioned PCTs, derived patents and or this disclosure to verify scatter removal amount relative to the primary x ray.

Beam selector has regions where x ray attenuation occurs, and distributed holes for x ray transmission. The attenuation may be approximately complete to ensure blockage of primary and scatter x ray landing in regions outside of the hole area. The depth of the material or the choice of the material may be a mixed material, for example, metal material of two or more types, each may absorb x ray strongly or almost completely at certain energy level of x ray beam. The mixed material or combination of materials with thickness along the z, therefore ensure the x ray attenuation at all energy levels. Or the attenuation may be achieved by one material with a certain thickness. Distributed within the x ray attenuation material, are the holes for x ray transmission. Each hole is aligned so that its spatial orientation is to allow primary x ray to pass through to the detector below , And only limited scatter within a certain critical angle can pass through the hole to reach the detector.

An x ray measurement of a ROI, takes place as x ray irradiated from the source, pass through the ROI and reach the beam selector, some of which is attenuated completely approximately, some, mainly of primary x ray, passes through the hole to reach the detector and approximately or greater than 99.999% of scatter x ray may be filtered by the x ray attenuation region.

Such a phantom is made to quality inspect other scatter removal method. For example for a known sample with a region of ROI, for example an ROI of a test phantom, given an input x ray intensity, the output may be predicated by the well characterized sample, or the phantom. For example, if the measurement of the ROI of the test phantom may be determined for a given intensity, the attenuation value of the ROI or optical density of ROI can therefore be obtained. The x ray system under quality inspection may image ROI of the test phantom, The scatter removal property of the system may be tested by using the system to measure ROI of the phantom with or without the beam selector between the ROI and the detector. In the case of beam absorber and one detector are used in the system for scatter removal, the beam selector is to be placed on top of the detector after the beam absorber array plate 100, is removed from the top of the detector. The ROI measurement is compared between measurements using beam selector and the measurement using beam absorber plate. In one configuration, beam blocker array or beam absorber plate, verification for scatter removal level can be one of the following:

In one configuration, where beam absorber plate is used between two detectors for scatter removal on both detectors. The beam selector may be directly put on the front detector beam absorber plate for measurement of ROI and compare for results of scatter removal.

In one configuration, when the beam selector may be smaller than the detector, pixel measurement on the region outside of the beam selector, and passing through the phantom or the ROI, may be used to derive the input x ray level. It is to be noted that there may be a quantitative relationship between the x ray measurement due to x ray passing through the hole and the pixel measurement outside of the beam selector. Based on the placement of the tube, and x ray irradiated from the x ray tube, its spatial position relative to the hole and regions outside of the beam selector, there may be variations without a sample placed in the beam projection path. Partly it is due to variation of spatial distribution of x ray beam from its center axis, different x ray wavelength or energy level will have different intensity map depends on the spatial location relative to the tube or center axis. Partly due to the fact that there may be slight scatter from the beam selector itself which result in a deviation for the x ray measurement resulted only from primary x ray and in some cases, some scatter x ray of ROI in the beam path passing through hole reaching the detector. Since the deviation is sufficiently small in its quantitative contribution to the measurement, in some cases, it can be ignored. However in some cases, such a measurement due to the scatter of the beam selector, may be accounted for and or removed from the measurement to derive measurements coming from only x ray interaction with ROI in the beam path.

One configuration of assessment of white image intensity or x ray input intensity variability

The method to evaluate x ray input intensity to ROI is important as it is important in quantitative measurement, that the input intensity is known. In addition, for consistency of measurements in serial measurements such as spectral imaging and or tomography or tomosynthesis, it is important to know quantitative differences between one exposure to the next x ray input intensity as well out x ray measurement of ROI. Sometimes, a white image is taken prior or after the measurement of the sample at similar settings to determine the input x ray intensity, such a measurement may be sufficient in some cases. However in some cases, a photodiode with one or multiple arrays may be placed between the sample and the x ray tube or between the sample and the collimator. The sensor or the photodide may be mechanically attached to the output surface of the collimator, facing the sample, so that as the shutter opens, the sensor measures input x ray intensity, at one or more pixel positions. The sensor may be in the beam path reaching ROI, or may be placed in a region outside of the field of view of ROI. An actuator may be attached to the collimator to move the sensor in the xy direction based on the adjust of field of view of the collimator. Or the sensor may be at a fixed position. And the x ray measurement will account for the attenuation of the sensor.

One configuration of method is to identify regions of detector from the first measurement, where at least one region may be used for assessment of input variability by averaging pixel values of the region. For example, if the selected region measures a region which may be slow various from pixel to pixel measurement, such an averaging value may be used from exposure to exposure to evaluate x ray input intensity variation between exposures.

In one configuration, such a region or regions which may be used for assessment may be preselected.

In one configuration, in tomography method disclosed in aforementioned PCTs and or its derived patents and aforementioned patents and this disclosure, as the x ray emitting position moves, the selected region of the detector measures the output of the x ray passing through the ROI, but since the selected region of the ROI at each exposure is approximately similar due to the fact that the distance or the traveling area of the x ray emitting position is very small, in some cases, and in the case of the regions of ROI measured between different exposures at varied x ray emitting locations at selected regions of detectors differs slight. As ROI region is dominated by slow varying soft tissue or slow varying bone tissue measurement, the averaged measurement of same pixel region of the detector, for example, average pixel value and or measurement and or attenuation value of a region with 10 or 100 pixels may vary a very small amount from one exposure to the next if the x ray input intensity is similar or differ by a large amount if the x ray input intensity is different by a large amount, and therefore may be used as a method for assessing variability of x ray input intensity from one exposure to the next. Two or more such regions may be used to further validate amount of differences. And the input x ray intensity corresponding to the rest of detector regions, may be derived based on the difference of input x ray intensity corresponding to selected region.

In one configuration of tomographic or spectral or spectral tomographic imaging In one configuration, method of addition of an element or parts for imaging including

Elements and aspects of aforementioned PCTs may be combined here with new content as a complete system or sub modules in a kit or software modules of a complete software application. Such element or kit component in hardware and or software may be combined with any x ray imaging system to improve speed, resolution, foot print, diagnostic value, save time and reduce radiation level and artifacts in imaging and quantitative measurements and for be used by AI to train or analyze to diagnose, monitor, track, inspect and test in medical, ndt, security and research applications.

In one configuration, steering or moving of x ray emitting position relative to the imaged subject:

In tomographic imaging systems, .uTomo or nMatrix, n²Matrix or up to n⁶Matrix method, where x ray source move in one axis or linearly, or in two dimension or up to 6 dimensions.

In a customizable personalized CT system - m3 -personalized 3D imaging system based on imaging and tomography systems described here and in aforementioned PCTs, W02019183002A2 and wo/2020/028422, where x ray emitting position moves in at least two dimensions relative to the volume of interest in an object and or the detector in a minimized step size of Xc to provide projection measurements of VOI to achieve resolution Xc along the z. The movement is only less than 2 degrees or 1 degree or 5 degrees or less than 3cm squared or less than 5 cm squared or 9cm squared or 25 cm squared in a 2D dimension or lcm cubed or 2cm cubed in order to completely reconstruct the 3D image of the VOI. If moving linearly or one dimension, the total distance traveled may be the same as the total thickness of the ROI to be resolved, or the total distance traveled by the source or the ROI may be the same as the total thickness of component or individual substances or unknown regions to be resolved. The thickness measurement may be defined as the thickness along the axis which is parallel to the center axis connecting the x ray source emitting position and the detector.

The degrees described here is the total angle describing the relative movement of x ray emitting position to the ROI, for example, the center axis connecting a x ray source emitting position to the detector, for example relative to the center of the ROI, or passing through the center of ROI, relative to the center axis of ROI which is perpendicular to the detector. In nMatrix, the emitting position may travel in one dimension, for example linearly, the distance between each projection may be Xc, if Xc is approximately resolution desired by the imaging, and the total projection number is approximately equivalent to thickness divided by Xc in order to reconstruct a 3D image which has approximately Xc resolution along the Z.

To move the emitting position of each projection relative to the VOI, the following methods may be used

The source has a number of stationary emitting positions

The emitting position may be moved by electromagnetic and or electrostatic and or electrooptical or acoustic or optical or energy based means

The emitting position or the x ray tube, may be moved by a mover, energy driven.

Or the emitting position may be moved by combining at least two of the above methods

Or any of the moving methods or apparatus combined combined with one or more Or the imaged subject can be moved by one or two methods or means of moving.

Or combination of at least two methods which is capable of steering or moving the emitting position of x ray source and or the imaged subject.

In one configuration, Method and apparatus for scatter removal

Methods used in the past to reduce scatter to less than 1% or less than 2% or less than 5% or 10% of the primary, or SPR may be using time of flight source and detector pair, or one example can be one of the following in prior art.

Beam Stop Array has been described in “ Apparatus and method for x-ray scatter reduction and correction for fan beam CT and cone beam volume CT”

US Patent Number, US6618466B1, where the beam stop array is used with a cone beam CT configuration.

In, Liu et al described , "An accurate scatter measurement and correction technique for cone beam breast CT imaging using scanning sampled measurement (SSM)technique," Proc. SPIE 6142, Medical Imaging 2006: Physics of Medical Imaging, 614234 (2 March 2006) : https://doi.org/10.1117/12.656655

It is a cone beam CT configuration. And in the PCT#US2019/044226. X ray radiation source moves in a 3D volume in very small steps, each is approximately resolution desired in the z axis. Beam particle absorber plates similar to Beam Stop Array are used for remove scatter, when the Beam particle absorber plates are moved during imaging process, and data gaps are filled from primary images taken of the same VOI at the same x ray radiation source location or when the beam particle absorber plates are not in the x ray beam path, only x ray image is taken with missing data gap. Primary x ray is derived by subtract the composite image taken with the x ray source position at the same location with the high resolution scatter image from the projection image taken with beam absorber plate in the beam path.

In one configuration, Antiscatter grid may be added to improve SNR.

Methods are improved to remove scatter both in 2D format as for as for tomography or multiple dimensional imaging.

In addition, exposure level of the projection images may be adjusted, by only taking one image of the VOI, and or using a time of flight sensor to measure height map along the z. measuring once the height map is sufficient both for setting the exposure level, but also for determining the number of projections needed. The exposure level can be confirmed by the first x ray image of the ROI.

And the selected VOI for tomography or further imaging can be selected automatically or by the user manually based on the first projection image.

In one configuration, If even smaller VOI, or secondary VOI is identified for further interrogation with different imaging settings, or imaging method, such as higher resolution 3D or spectral imaging or densitometry, the exposure level may be adjusted based on the selected region for the secondary VOI of first x ray image taken

One configuration of a method for imaging a VOI to improve image quality, the method comprising at least one or more the following steps and apparatus ( the sequence of the steps can be rearranged):

(a) providing a source of imaging radiation, a beam filter, an antiscatter grid, which is optional, a detector for the imaging radiation, an air gap between the object and the detector and a beam stop array; (b) moving the x ray radiation position relative to the object in steps, each step is Xc, the resolution along the Z axis;

(c) total area or total distance or total volume travel is approximately the thickness of the VOI.

(d) taking at least one image of VOI at at least one x ray radiation position to obtain VOI of scatter distribution, interpolate to derive a high resolution scatter image

(e) taking a second sequence of images of the object at the same and or different projection angles by using the source and the detector without the beam stop array, the second sequence of images comprising N images, N³N';

(f) performing an interpolation on at least one image of VOI measured with BSA to obtain at least one high resolution scatter image, and

(g) obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration, A method for imaging a VOI, the improved method comprising:

(a) providing a source of imaging radiation, a beam compensation filter which is optional, or filter which is optional, may be used to reduce beam hardening, an antiscatter grid, which is optional, a detector for the imaging radiation, an air gap between the object and the detector and a motorized beam stop array;

(b) moving the x ray radiation position relative to the object in steps, each step is Xc, the resolution along the Z axis;

(c) total area or total distance or total volume travel is approximately the thickness of the VOI.

(c) taking at least one image of VOI at at least one x ray radiation position to obtain VOI of scatter distribution, interpolate to derive a high resolution scatter image

(d) taking a second sequence of images of the object at the same and or different projection angles by using the source and the detector with the beam stop array at at least a different position,

(e) performing an interpolation using at least one image of VOI measured with BSA to obtain at least one high resolution scatter image, and (f) obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

(g) eliminate the missing data gap of derived primary image at a x ray irradiation position due to BSA at one position with corresponding primary image from a different BSA position.

One configuration, of a system for imaging an object while correcting for scatter, the system comprising: a source of imaging radiation; a beam compensation filter, which is optional, an antiscatter grid; ( optional) a detector for the imaging radiation, the detector being so located as to leave an air gap between the object and the detector; a beam stop array for being placed, at selected times, in a path of the imaging radiation between the source and the detector; or the beam stop array may be moved to different positions between projections. a structural support for at least one source and its assembly and at least one detector and associated hardware, and at least one mover to move the source relative to VOI and at least one mover to move at least one detector a control device for controlling the movers, the source and the detector,

(i) controlling the source and at least one detector to be aligned, the radiation position moves in at least one axis of 6D dimension relative to the detector, relative to the VOI, while taking a first sequence of images of the VOI at selected different projection positions by using the source, the detector and the beam stop array, the first sequence of images comprising N' images;

(ii) controlling the source and at least one detector to be aligned, the radiation position moves in at least one axis of 6D dimension relative to the detector, relative to the VOI, while taking a first sequence of images of the VOI at selected different projection positions by using the source, the detector and the beam stop array, the first sequence of images comprising N images;, N³N'; and the x ray radiation positions for set of projection images travel in the same dimension. an image processing device, receiving an output of the detector, for: (iii) performing interpolation on the first sequence of images of the VOI to obtain a sequence of scatter images, the sequence of scatter images comprising N images, each corresponding to one of the N images of the second sequence of images; and

(iv) obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration, A system for imaging an object while correcting for scatter, the system comprising: a source of imaging radiation; a beam compensation filter; which is optional, or a filter to reduce beam hardening, which is optional too. an antiscatter grid; which is optional a detector for the imaging radiation, the detector being so located as to leave an air gap between the object and the detector; a beam stop array for being placed, at selected times, in a path of the imaging radiation between the source and the detector; a structural support for at least one source and its assembly and at least one detector and associated hardware, and at least one mover to move the source relative to VOI and at least one mover to move at least one detector

In one configuration, a control device for controlling the movers, the source and the detector,

(i) controlling the source and at least one detector to be aligned, the radiation position moves in at least one axis of 6D dimension relative to the detector, relative to the VOI, while taking a first sequence of images of the VOI at selected different projection positions by using the source, the detector and the beam stop array, the first sequence of images comprising N' images;

(ii) controlling the source and at least one detector to be aligned, the radiation position moves in at least one axis of 6D dimension relative to the detector, relative to the VOI, while taking a first sequence of images of the VOI at selected different projection positions by using the source, the detector and the beam stop array at a different position, position B, the second sequence of images comprising N images;, N=N'; and the x ray radiation positions for set of projection images travel in the same dimension. In one configuration, methods of scatter reduction, an image processing device, receiving an output of the detector, for:

(i) performing interpolation on the first sequence of images of the VOI to obtain a sequence of scatter images, the sequence of scatter images comprising N’ images, each corresponding to one of the N images of the second sequence of images; and

(ii) obtaining a sequence of primary images, the sequence of primary images comprising N’ images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration, performing interpolation on the second sequence of images of the VOI to obtain a sequence of scatter images, the sequence of scatter images comprising N images, obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N’ images of the first sequence of the images, and a corresponding one of the N images of the sequence of scatter images.

The missing data gap in primary image of N images can be replaced by the corresponding N’ primary image in the same location of the missing data gap due to the BSA and vice versa.

In eon configuration, total set of images may be more than that of first and second sequence. In one configuration, the total number can be 3 or 4, or more.

In one configuration, the interpolation is done with shadow regions of detector from two or more projection images, each taken at a unique BSA array location, acquired at x ray radiation positions which are the same and or within a define dimension spatially.

In one configuration, Method to improve signal level or image quality

For thick samples, when the exposure level of a single frame is limited, and the signal level after attenuation is low, or when there are not enough photons captured on the detector after x ray exits the VOI and captured on the detector, the projection images taken at various BSA locations and acquired at approximately the same x ray radiation position may be added together or averaged to improve image quality and image intensity. Additional frames of projection images may also be acquired at the same x ray radiation position with BSA at the same or different positions.

In one configuration, a method for imaging an object while correcting for scatter, the method comprising:

(a) providing a source of imaging radiation, a detector for the imaging radiation, and a beam stop array;

(b) taking a first sequence of images of the object by using the source, the detector and the beam stop array, the first sequence of images comprising N' images;

(c) taking a second sequence of images of the object by using the source and the detector without the beam stop array, the second sequence of images comprising N images, N>N';

(d) performing a spatial interpolation on the first sequence of images of the object to obtain a sequence of scatter sample images;

(e) performing an angular interpolation on the sequence of scatter sample images to obtain a sequence of scatter images, the sequence of scatter images comprising N images, each corresponding to one of the N images of the second sequence of images; and

(f) obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration,

Example of a system for imaging an object while correcting for scatter, the system comprising:

At least one source of imaging radiation; the radiation position may be moved by at least one mover.

At least two assemblies for detection comprising One detector and its a beam stop array, which can be optional; and a mover for moving the detector and beam stop array a mover for moving BSA is the BSA is movable. a support structure on which the source and the detector are mounted; a control device for controlling the movers, the source and the detector for: (i) taking a first sequence of projection images of VOI by moving the source, the detector and the beam stop array, the first sequence of images comprising N' images; and

(ii) taking a second sequence of images of the object by using the source and the detector without the beam stop array, the second sequence of images comprising N images, N>N'; and N + N’ is approximately the thickness of the VOI along the center axis of x ray radiation, perpendicular to the detector divided by the desired resolution. an image processing device, receiving an output of the detector, for:

(i) performing a spatial interpolation on the first sequence of images of the object to obtain a sequence of scatter sample images;

(iii) performing an angular interpolation on the sequence of scatter sample images to obtain a sequence of scatter images, the sequence of scatter images comprising N images, each corresponding to one of the N images of the second sequence of images; and

(iii) obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration, example of a system for imaging an VOI while correcting for scatter, the system comprising:

At least one source of imaging radiation; the radiation position may be moved by at least one mover.

At least two assemblies for detection comprising One detector and its a beam stop array, which can be optional; and a mover for moving the detector and beam stop array a mover for moving BSA is the BSA is movable. a support structure on which the source and the detector are mounted; a control device for controlling the movers, the source and the detector for:

(i) taking a first sequence of projection images of VOI by moving the source, the detector and the beam stop array, the first sequence of images comprising N' images; and

(ii) taking a second sequence of images of the object by using the source and the detector without the beam stop array, the second sequence of images comprising N images, N>N'; and N + N’ is approximately the thickness of the VOI along the center axis of x ray radiation, perpendicular to the detector divided by the desired resolution. an image processing device, receiving an output of the detector, for:

(i) performing a spatial interpolation on the first sequence of images of the object to obtain a sequence of scatter sample images;

(iii) performing an angular interpolation on the sequence of scatter sample images to obtain a sequence of scatter images, the sequence of scatter images comprising N images, each corresponding to one of the N images of the second sequence of images; and (iii) obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration of a system for imaging an object while correcting for scatter, the system comprising: a source of imaging radiation; a beam compensation filter; an antiscatter grid; which is optional a detector for the imaging radiation, the detector being so located as to leave an air gap between the object and the detector; a beam stop array for being placed, at selected times, in a path of the imaging radiation between the source and the detector; a structural support for at least one source and its assembly and at least one detector and associated hardware, and at least one mover to move the source relative to VOI and at least one mover to move at least one detector a control device for controlling the movers, the source and the detector,

(i) controlling the source and at least one detector to be aligned, the radiation position moves in at least one axis of 6D dimension relative to the detector, relative to the VOI, while taking a first sequence of images of the VOI at selected different projection positions by using the source, the detector and the beam stop array, the first sequence of images comprising N' images;

(ii) controlling the source and at least one detector to be aligned, the radiation position moves in at least one axis of 6D dimension relative to the detector, relative to the VOI, while taking a first sequence of images of the VOI at selected different projection positions by using the source, the detector and the beam stop array at a different position, position B, the second sequence of images comprising N images;, N=N'; and the x ray radiation positions for set of projection images travel in the same dimension an image processing device, receiving an output of the detector, for:

(i) performing interpolation on the first sequence of images of the VOI to obtain a sequence of scatter images, the sequence of scatter images comprising N’ images, each corresponding to one of the N images of the second sequence of images; and

(ii) obtaining a sequence of primary images, the sequence of primary images comprising N’ images, each formed in accordance with a corresponding one of the N images of the second sequence of images and a corresponding one of the N images of the sequence of scatter images.

In one configuration, performing interpolation on the second sequence of images of the VOI to obtain a sequence of scatter images, the sequence of scatter images comprising N images, obtaining a sequence of primary images, the sequence of primary images comprising N images, each formed in accordance with a corresponding one of the N’ images of the first sequence of the images, and a corresponding one of the N images of the sequence of scatter images.

The missing data gap in primary image of N images can be replaced by the corresponding N’ primary image in the same location of the missing data gap due to the BSA and vice versa.

In one configuration, the total set of images may be more than that of first and second sequence. In one configuration, the total number can be 3 or 4, or more.

In one configuration, the interpolation is done with shadow regions of detector from two or more projection images, each taken at a unique BSA array location, acquired at x ray radiation positions which are the same and or within a define dimension spatially.

In US patent US10835199B2, for 3D imaging, 35199B2 an optical-based in situ real time geometry calibration device to determine a spatial position and orientation of the x-ray source and the detector relative to the object in real time; and an image processing system configured to reconstruct a 3D structure of the object from the individual 2D x-ray projection images and associated imaging geometry parameters;

In one configuration , the orientation of the source and detector is already determined or preset by the digital program or the user, or during a calibration step prior to the real time imaging of VOI, in another words independent of the in situ optical sensor measurement.

In one configuration, the optical sensor does determine the spatial location of VOI, therefore the spatial position of the x ray tube and detector, as the x ray tube and detector are directed to move and to have the field of view of VOI for x ray beam irradiation and measurement.

The x ray tube and detector may move independently. the optical sensor or a different optical sensor with a geometry relationship to the first sensor may be used to measure and estimate number of projection images needed by determine the height map of the VOI in at least one axis perpendicular to the detector or the along the center axis of the x ray tube. in some cases, there may be an optical sensor to determine and identify a primary VOI for 2D imaging, spatial position for the x ray tube relative to the the primary VOI, and the detector may be automatically aligned with the x ray tube.

However, for 3D imaging, x ray imaging instead of optical sensor may be used to determine spatially position of x ray tube and the detector.

For example, at least one x ray image may be taken of a primary VOI to determine the spatial position of the x ray tube and detector for 3D or tomographic imaging by identifying a secondary VOI.

IF after imaging of tomography, an even smaller voi contained by the original Voi is selected, the same height map may be used, but only the corresponding selected region, x ray exposure can be adjusted either by the height map data or the x ray image, of the selected VOI.

One configuration of Density measurement, thickness measurement, interface region of two materials, segmentation In one configuration, segmentation may be based on material decomposed results or single, dual energy and multiple energy measurements and tomographic imaging based on one or more criteria involving data measured or simulated and or derived .

In one configuration, at least one thin beam projected through the VOI, where density measurement is to be done for the tissue, or substance or component of interest. The projected region on the detector is approximately at least one pixel or more.

Two or multiple beams which are distributed or have distance apart from each other may be used to illuminate the VOI, all at the same time or at different time points. Each beam may be generated by the field of view of a collimator. Or multiple beam or structural illumination of thin beams may be generated by a collimator placed between patient of the source, which has one or more x ray transmission regions, distributed across from the x ray beam cross section. Dual or multiple energy measurements may be derived. Inverse functional response equation system look up may be used to derive the attenuation value of the component or substance. The thickness may be calculated or measured by x ray at different angles of projections. The final calculation of density is derived from attenuation value at dual or multiple energies and corresponding density value of each component or substance. For example, if a VOI or the component of interest or a tissue volume is relatively homogeneous, such as LI of lumbar spine, the average value of the density derived from all beams may be calculated.

Or the density may be derived from tomography measurement.

Bone densitometer, using the x ray tomography method with low radiation level and low resolution, for example, 0.5 cm as the resolution desired in the z direction, or a dimension which may be smaller than thickness of bone in the z direction, for example, parallel to the center axis. For a human having 20 cm thickness, only 20 / 0.5 = 40 projection needed for bone density measurement. If the area of interest is restricted in the xy direction, for example a 1cm or size of xy dimension of lumbar spine or smaller are used as the dimension of xy cone beam diameter or slight bigger or slight smaller, approximately 40 projections, each are 0.5cm apart from the most adjacent point, the entire area of travel may be less than approximately 20 cm²

Or total data points in area of travel to be at least equal or less than 5 x 8 data points. The distance between data points to be approximately the desired resolution in the z direction. The angle of a x ray emitting position to the isocenter of the region of interest compared to the original relative position of the x ray emitting position to the isocenter of the region of interest may be less than 10 or 11 degrees. In some cases, it may be less than 5 degrees.

Less than 20 or less than 10 or less than 40 projections of a region of interest such as lumbar spine, with x ray beam diameter to be approximately the same or less than that of lumbar spine, may be sufficient for accurate density measurement.

For density measurement, it may be that the number of projections are approximately thickness of the Volume of Interest divided by Cz, which is the dimension of the component along the Z. or approximately equal to thickness of VOI divided by Cz/2 with Cz or Cz/2 being the distance between x ray emitting positions where x ray measurements are taken.

For density measurement with accuracy better or comparable to that of qCT, or CT, less than 10 projection images are taken or less than 20 projections or less than 30 or 40 projections may be taken at various x ray emitting positions. And x ray radiation locations where the measurements are taken are less than 2 cm² or less than 4 cm² or less than 5 cm ² or less than 6 cm² or less than 10 cm ²

Or for densitometer measurements, x ray emitting locations for each projection is traveling in less than the total thickness along the Z which is Cz cm³

The region of interest of lumbar spine may identified by taking a full view x ray first. The tomography x ray source position and its volume integral through the Volume of Interest may be saved in a table or database. Reconstruction involves a step to look up the system matrix of each projection from the table and or derive on the fly based on the projection geometry.

Similar method may be used for assessing density of component or composite matter, if the mass or dimension of the matter may be estimated. Restricted xy direction ROI and step size is estimated to be smaller than the dimension in the z director of the matter, or there may be at least one unit of step size dimension along the dimension of the matter or component in the z direction. The density of the matter may be derived. If the voxel situated within the component or the matter is derived and the density is approximately the value of expected of the matter, and in the spatial location of the matter, then not only the density may be used for accurate determination of the density of the matter, or the material or the component of interest, it may also be used to identify the matter, or the material or the component. The thickness of the component may be derived as well if it is not known already. For example, if one or more voxels are of the similar density, the thickness of the material may be derived by adding the voxel dimension along the z to derive the true thickness of the matter.

Conventionally, generally the interface region of the two materials or two tissues may be resolved by increasing the resolution of CT measurement to have fine definition along the z. However here is disclosed a method where with low radiation, higher speed, low resolution tomography of selected regions may be used to achieve similar or better results.

In one configuration, Low resolution image or low resolution tomography of selected regions of one or more within a region of interest, or the entire region of interest, combined with density measurement, and or spectral imaging method to derive high resolution measurement at the region where two materials meet, for example between bone and soft tissue.

In one configuration, If the material decomposition in 2D, or in line projection in one pixel or small number of pixel to allow the attenuation value of one component or composite material or a material to be derived on a pixel basis, , or the total attenuation value or radiographic density of the material or the component or the composite material or substance may be derived then the thickness of the material, or the component or the composite material may be derived based on the density and or optical and or radiographic density measurement from the low resolution measurement.

Thickness measurement of a particular material may be derived from density measurement combined with at least a dual or multiple energy measurements.

Segmentation or material decomposition of tissues may be derived with low resolution low projection tomography with less radiation and faster speed to achieve equivalent or better result than high resolution CT or tomography method.

For example, segmentation of bone or soft tissue or calcification regions, or microcalcification regions, and or separation of implant or catheters from the background, in a line path, or 2D as well spatially such as multiple dimension or approximately complete tomography may be achieved by using number of projections in the range of less than or less than 1/100* or less than l/50^th, or 1/40*, 1/30*, 1/20*, or 1/10 th or less than 1/5* or less than of CT for similar or equivalent or better results in resolving regions with two or more matters or for separating different tissues or components or materials at the interface regions. The number of projections may be dependent upon the size of the material or the size of component along the z, Cz, or the desired resolution along the z of the VOI. In one configuration, The segmentation may be done on a pixel by pixel or voxel by voxel basis.

Density measurement of a unit of a component, or subunit of a component or substance may be applied to all of its volume if the substance or the component is relatively homogenous.

Segmentation may be the same as material decomposed results, however, segmentation may also be based on spatial separation. Segmentation may be based on a number of x ray measurement properties, such as density, within a density range, separate based on approximate density range, and or proportion of different materials within a volume and or x ray imaged pattern in density, dynamic properties, spatial locations, properties exhibited under energy perturbation, or digital software and or user imposed criterial and or AI derived criterial and or dimension, and or shape, and or any physiological or chemical differences and properties in time, frequency, chemistry, spatial characteristics in interaction with a reference marker or against the rest of VOI or another component of interest.

Averaging of Primary Signals

In order to avoid saturation due to scatter, the input intensity of the x ray source may be adjusted to be small enough to avoid saturation, but if there is thick VOI, the signal measured may not be accurate enough due to photon starvation or quantum photon randomness. Multiple exposures may be done to increase exposure level to collect enough photons for better representation of the imaged results. The resultant measurements can be stacked together or added together.

In one configuration, the measurements may be added together and then an average value is to be derived. Averaging the measurement may reduce the random noise.

In the case of projection image with using position A of beam stopper array and position B and more location of beam stopper array, each beam stopper array shadow area or approximately beam stopper shadow area collected by the detector may be replaced by projection image of another exposure. This projection image may have distributed regions of beam stopper shadow area due to beam stopper array movement.

In one configuration, these exposures may have similar or approximately the same exposure level or x ray radiation input level entering into volume of interest. In one configuration, these exposures may be taken at the same or approximately same x ray radiation location.

In one configuration, these exposures may be taken at x ray radiation location in proximity of each other in 6D space.

In one configuration, the derived high resolution scatter image may shift in space location based on where x ray emitting location is for the projection image to derive the primary image from the composite image. For example, if only one resolution scatter image is captured for one x ray radiation location, but it is used as the original image to derive high resolution scatter image, for a number of x ray radiation emitting locations, for example, when the x ray radiation emitting locations are approximately in the same area of defined size or same volume or 6D space, and the dimensions of such spatial regions may be small, for within cm range or one degree or two or less than cm cubed in volume or even less. In order to compute high resolution primary image for a x ray radiation source location where the scatter image is not derived from, the high resolution scatter image may shift in position to match the projection image x ray radiation source spatial location.

Due to the effect of scatter on the measurements, SNR, and or due to thickness of certain samples, the exposure level below detector saturation level may not be sufficient to quantitatively or effectively measure a thickness sample. For example, not enough photons are emitted to reach the detector to describe variability of different thick samples. In this case, the establishment of energy response function system by using interpolation plot, may require data points to be measured at the thickness similar to the VOI. Two or more data points measured at thickness level of the known substances or combination of known substance similar to the thickness of the VOI.

The exposure level will need to be at a level which sufficiently produce primary x rays so that the input x ray radiation entering the VOI, cause two major photon events, 1) scatter x ray, 2) Primary x ray will produce sufficient primary x rays to be measured on the detector so that there is not only photon starvation, but also enough photons are collected to describe the accurate attenuation value of VOI.

32 bit or more dynamic range may be sufficient in which exposure level of the one frame radiation level at the same or below the detector saturation level may be sufficient to produce primary x ray signals coming out of VOI to have sufficient grey scale variations or data depth for resolving density or optical density variability of voxels, quantity analysis for AI, or density measurement and other statistically meaningful data.

One method is to take as many measurements of the sample, with increasing exposure rate, measure primary x ray signal and scatter signal

Using a thin beam. At certain point, with increasing of input signal, there is corresponding scatter measurements and corresponding primary x ray measurements. To derive the ratio of the two, may be critical for derivation of input x ray efficiency.

In one configuration, as thickness is varied, record input primary which produces the primary x ray signal measured on the detector,

In one configuration, AI algorithms may be used and trained at varied thickness levels for different patient, to derive measured primary level, the input x ray level. The result may be used to calculate or estimate the proportion of primary x ray which turns into scatter, the proportion of x ray captured by the detector and the input x ray radiation, or the absorbed x ray at various thickness level, body compositions, in some cases, variations in atomic z level, or composition or molecular makeup.

In one configuration, AI algorithms may be used and trained at varied thickness levels for different simulated substances, such as simulated tissues or composite tissues, and / or known substances such as aluminum or lucite, similar to those in VOI or similar or approximately same to VOI of patients, to derive measured primary level, the input x ray level. The result may be used to calculate or estimate the proportion of primary x ray which turns into scatter, the proportion of x ray captured by the detector and the input x ray radiation, or the absorbed x ray at various thickness level, body compositions, in some cases, variations in atomic z level, or composition or molecular makeup.

To reduce the effect of scatter on SNR or on the final presentation, especially for samples which are highly scattering and or sample regions which produces measurements with high percentage of scatter.

X ray sources of varied intensity or a field emitter based x ray source may be used to modulate x ray intensity for two or more selected regions of interest, based on the region thickness. Each region may be illuminated with modulated intensity at different times. The input x ray radiation may be much higher than the saturation level of the detector if the sample is thickness. The amount of radiation or input x ray intensity may be adjusted based on thickness measurement, for example by an optical sensor and or a first x ray image of the region of interest.

In one configuration, Material decomposition Improved

An interpolated plot inverse response function system as established may be used for multiple energy or dual energy for material decomposition

In addition, distributed rare substances, or at least one additional substance may be differentiated based on material decomposition of at least two substances using at least two energies. This may be done by identifying collocated regions of the same substances, extract data from the collocated regions to characterize the additional substance.

This can be further extended to substance which are spatially distributed significantly in various area of volume of interest.

When 3D tomography is performed, such a substance may be identified, therefore attenuation value pertaining to the additional substance may be extracted without using a third energy if 3D tomography measurements may be used to assess the density or attenuation value of the voxel containing only of the additional substance.

Or the density information of the other substances are measured and or given

Structural support and function for x -ray imaging system

Although traditional x ray system, tomosynthesis system and CT systems configuration such as general x ray, c arm, or U arm, ceiling x ray source mount may be used and compatible with the x ray imaging system described here and in the aforementioned PCT, here we describe a configuration of structural support, for improved accessibility, better stability and compactness,

Due to the fact that there may be two or more detectors, and in some cases, with Beam Particle Stopper Plate, a lower gantry with multiple motors and actuators, for moving beam particle stopper plate, having a wagon like lower image gantry with enough space to contain required hardware and provide accessibility needed for the patient and the user. The patient support may be separate from the cover surface for the image gantry or it may be the same or right above it. Alternatively a surgical table or patient table, which may be portable, can fit onto the image gantry. The patient can already be on the table, before being pushed to the imaging system. Or the patient can be loaded on to the imaging gantry in the x ray exam room.

The upper imaging overhang to move and support x ray tube and assembly is designed such that the path of all motion areas are out of way from the patient and operator to ensure safety. And there is additional space for attaching additional x ray sources and associated mover and hardware. For example, there may be two or more x ray sources such as hot filament source, field emitter source, low energy source, high energy source, or a flat panel field emitter pixelated source, all on the same system, hanging from the upper gantry. Given that there may be space between the detector and source similar or larger than that in a CT gantry, and it is open structure, additional sources may be simply attached on to the upper gantry, in the same motor for the first source or have its separate motor hanging from the upper gantry or hanging from a different support structure. Each x ray source may be moving in and out of the alignment with the field of view on the VOI depends on the instruction from a digital program or manually by the user.

In one configuration, the system may include, x ray imaging, fluoroscope, 3D fluoroscope and tomography, tomosynthesis and densitometer.

Such a all in one system will be accessible through a subscription program, where the customer can pay subscription fee via a digital currency processing method. The subscription fee may be adjusted based on the volume of images taken which can be monitored by a digital timer which is capable of recording the total number of imaging procedures or studies on one or more x ray imaging systems at one or multiple sites over a period of time such as quarterly, monthly or yearly. The subscription fee may be automatically adjusted based on the volume recorded. Or the digital timer program may include functionalities to digitally notify the company, either by email or by messages through network or by a database accessible by both the customer and the provider of the subscription service via dicom protocol. Or such timer information may be queried by the RIS or pac system periodically. For Beam Particle Stopper Array, use of tungsten ball as the Beam Particle in the beam particle array plate. Previously lead ball led to incomplete blocking of primary x ray. However, use of metal balls, such as tungsten ball or mixed alloy - such as lead, tungsten, zinc - can block x ray close to 100% at single, dual or multiple energy levels. Various dimensions or gradient in attenuation, such as a metal or multilayer metal, or with microstructures in three dimensions with the time of light sensors. And with x ray radiation to verify for x ray tube and detector calibration combined with beam stopper array.

In one configuration, Method of Quality Assurance

Time of flight sensor, optical sensor or camera, beam stop array and patient table and the image gantry or image support where the detectors are held. One or more regions of the image gantry and the support structure may be used to verify the performance of the time of the flight sensor. For example, at least one or multiples frames of measurements are done. When multiple frames are taken, the values of measurements may be average. One of the reasons which to average the measurements is to reduce the random noise of the time of flight sensor and increase the accuracy.

The surface area of the gantry facing the source and time of flight sensor or optical or non radiation sensor or camera.

For example, at least a portion of the surface of the gantry covering the detector movement area, such as at least one comer with at least one side to be measured by time of flight sensor or the optical sensor. This measurement is to verify time of flight sensor accuracy. Verification may be done by the comparison to a previous measurement by the same sensor after the sensor has been calibrated, and or a measurement by a laser range finder.

In one configuration, two or more area or regions of the surface of the gantry, are to be measured and compared to a previous measurement.

In one configuration, one or more portion of the surface area or a mechanical means comprising a microstructure with markers or at least a portion containing 3D profile or gradient of depths for example, with features in dimensions of the accuracy of the optical sensor, or time of flight sensor measurement. Such mechanical means may be permanently attached or glued or a part of the surface of the gantry.

And one or more targets each with one or more markers which may be measured by the optical sensor for verification of performance. Such target may be part of the surface of the gantry or may be attached to the surface gantry.

When there is a patient table used, mechanical means such one or more rails may be installed on the floor where the imaging gantry is positioned, at a position which to set the placement of the table to be positioned for patient imaging. For example, such a position may be used to optimize the imaging condition for the patient, for example to center the table in the center of travel range of xy motorized stages which are used to move the x ray source assembly which may comprise of x ray source, beam limiting device, such as a collimator, filter or other components such as one or more optical sensors.

There may be one or more mechanical devices such as a flap or interlock which is attached to a portion of the image gantry, such as the portion which contains the image detector or detectors. Such attachment may have mechanical means to lock the patient table in place. Such a mechanical device may be used to secure the patient table which may be x ray transparent or x ray lucent, into the imaged position. The patient may climb into the table from each of the sides of the table. In one configuration, the patient is already on the patient table and is rolled into the gantry to be in between the x ray tube and the detector.

In configuration the surface of the image gantry, which may hold the detector and beam stopper array or detectors and in some cases motorized stages if there are any, may be x ray translucent, and support the patient.

In one configuration, To qualify Camera:

Normal ambient lighting. Markers on the patient table or the surface of the image gantry, below the surface, one or more detectors are placed.

The device under test (DUT), in this case, may be the camera or the optical sensor, is placed in front of an illuminated chart with different markers and patterns on it. An image is then taken with the DUT, and software algorithms analyze the position and shape of the markers, and extract the performance parameters of the camera module.

One configuration of Densitometer involving thickness and 3D reconstruction

As given a certain x ray input value, enter into a VOI, in a projection path, as the VOI along the projection beam path, increases in thickness, primary x ray projecting through the VOI and landing on the detector become less and less.

The factor plays into the primary x ray getting less and less may be one or more of the following More and more primary x ray are absorbed, in this case, the measurement on the detector directly correlates with material composition and absorption and the thickness of the VOI

More and more primary x ray are scattered, in this case, it is less obvious or difficult to quantitatively correlates measured on the detector with another variable, for example, primary x ray may also be less due to the varied density of the VOI in addition to the thickness, or the varied scattering effect.

In order to improve the reconstruction of the 3D tomography or for improved spectral imaging and material decomposition, or density measurement, the thickness of the VOI may need to be taken into consideration.

For example, for certain thickness range, the spectral measurements, establishing energy response function system, interpolate to generate a plot, data points measured may be be at the same or approximately the same thickness.

In one configuration, energy response function system is established for a certain range of thickness, such as increment of 1 cm, or 2 cm or 5 cm or 10 cm to up to 100cm or more in thickness. Optical sensors may measure the thickness of VOI, to determine which set of data range is to be used for inverse energy function response system look up.

At least one or more data points may be taken at each thickness level.

And at least one or more energy level measurements are done for the thickness level similar to approximately the same as the VOI, for example with aluminum, or aluminum combined with lucite or other substances which may be similar to the substance in the VOI, for example, fat or lean soft tissue, or a contrast agent. Or the blood vessel like material.

In one configuration, real substance, such as real tissue or tissues or simulated tissues may be measured to correlate the measurements with aluminum so that the measurements in aluminum may be quantitative related with the real substance to be measured.

In one configuration, real patient measurement is to establish the energy response function system data point.

In one configuration, in deep machine learning, in convolution neuron network and AI algorithms training, two or more patients of a certain thickness are measured, in some cases, density is derived based on for example, spectral measurements and material decomposition, such as inverse function response system derived from interpolated plot derived from, dual energy, or multiple energy measurements, or using photon energy sensitive detectors. AI algorithms are trained at each of multiple thickness levels combined with thickness correlated density data. In addition to shape, pattern, anatomic parts.

In one configuration, 3D reconstruction using AI method, may incorporate such thickness dependent density measurements to train.

In one configuration, such density measurement and or thickness dependent density derivation, using method such as inverse response function system, may be combined with other commonly used AI methods for reconstruction and or post 3D reconstruction or post material decomposition analysis based on spectral imaging in 2D and or 3D for diagnosis, tracking and monitoring applications.

In one configuration, such thickness dependent AI training, or 3D reconstruction or material decomposition, or density measurement for each substance material decomposed and 3D segmented, are performed with VOI which has low scatter interference, or performed with projection or measurements with scatter removal or separation methods in the aforementioned PCTs and their derived patents and aforementioned patents and in this disclosure, for example: image analysis and processing methods, such as thickness dependent density measurements and or 3D reconstruction or material decomposition based on spectral measurements and or diagnosis based on analysis of such measurements and 3D images or derived segmented 3D images, are performed when scatter are removed so that SPR is less 1% or SPR is less than 5%, by using time of flight x ray source and detector, or using beam stopper array, or a movable beam stopper array, or using a beam selector or movable beam selector or a primary modulator.

In some cases aforementioned scatter removal method may be combined with antiscatter grid.

In one configuration, 3D reconstruction may not be iterative

In one configuration, Density measurement in assessing lesions or fracture. Low resolution 3D image, for example, using binning method to measure x ray projection image. Spectral imaging may be performed to material decompose.

Identify approximate lesion position in the 2D, or spectral or low resolution 3D image. Density measurements are performed in regions where there are healthy tissues as a reference.

Density measurements may be performed in regions may be close to the lesion. And density measurements may be performed in the region of lesion or fracture to assess the difference.

3D reconstructed or extracted from measurements of the healthy region surrounding the lesion area are compared to the lesion area, or the area which close proximity to the lesion area.

The difference between the measurements may be used to assess the diseased condition or for diagnosis.

Spectral measurements and or spectral 3D may be used to further assess tissues in the lesion and tissue surrounding the lesion area, for example, by 3D segmentation and analysis of each voxel within the lesion area or by using contrast agents.

In one configuration, the detector is noise corrected. For example for flat field or white noise correction. However due to uniformity of x ray source, for example, depending on the distance from center of x ray cone beam center axis, the distribution of x ray intensity radiated from the emitting position may be different from wavelength to wavelength or from energy level to energy level, , if FOV of VOI is not in the center of the x ray detector, the x ray tube will need to be aligned to FOV. And the correction done with x ray tube in the center of detector may not be applicable if the x ray center axis is now aligned with a different part of detector.

In one configuration, x ray detector can be segmented or partitioned so that each segment or each partition is noise corrected with a source which has essentially a field of view small enough that all beam projection signals are approximately uniform.

In one configuration, x ray detector can be noise corrected with x ray source or x ray emitting position aligned at different regions of the detector. And depending on where the x ray tube is aligned on the detector during a measurement of VOI, the correction data with the x ray tube or x ray radiation emitting location at essentially the same or similar location can be used to correct the measurements. In one configuration, Partition of VOI for Spectral Imaging, Densitometry and Tomography and multiple dimension measurement and reconstruction

For an imaged subject with varied thickness, the subject may be partitioned into regions, each region with a thickness range, The thickness may be measured by the user or an optical sensor such as time of flight sensor. Not only exposure level is estimated, but also the number of projections needed may be estimated for each of the partitions.

Generally the setting of exposure is to not to produce saturated regions in the detector while imaging VOI. In order to meet this requirement and to optimize uniformity at 2D and 3D imaging, the exposure of each projection image is set to be approximately just slight below the saturation level of the detector.

In SPR < 1% or less than 5% or less than 10%, such an exposure level may produce uniform projection measurement for a typical human imaging.

In one configuration, to reduce random noise, multiple exposures may be captured and averaged.

In one configuration, when thickness value is high, exposure level which is at approximately saturation level of the detector, there is not enough or no photons produced. The digital program or the user may increase exposure level to the appropriate level suitable for producing sufficient primary x ray signal for diagnosis or inspection or tracking or for spectral imaging with material decomposition or for tomography. The digital program may automate the partition method.

In one configuration, When measure a VOI, thickness of VOI may vary. Thickness may affect one or more of the following parameters

Number of projections Exposure level

Exposure settings such as kV, mA Scatter to Primary Ratio - SPR

In one configuration, for densitometer and or material decomposition measurement and methods, and or for spectral imaging and or multiple dimension or tomography imaging, the VOI is partitioned in the xy plane into portion of similar thickness, for measurements and subsequent image processing. For example, the neck area and the head area may be reconstructed separately, or the chest area may be reconstructed separately from extremity portion of the body. And the extremity may be partitioned into different portions so that for example the shoulder and arm joint area may be measured and processed differently than the hand region where the thickness is much less.

For material decomposition, the total thickness of the VOI determines which interpolated plot is used as various measurements at dual or multiple energies are interpolated for varied thickness within a certain range. Such interpolated plot may be specified for a certain thickness range. For example, two or more measurements may be made within a certain range, for example, in mm or cm or up to 10cm in thickness of the known substance. And one or more measurements of the same thickness of real tissue corresponding to each of known substance, or similar to the known substance in attenuation coefficient, may be measured and correlated to the known substance.

The interpolated plot for the known substance, such as aluminum or lucite may be adjusted accordingly based on the quantitative relationship for the real tissue plot, for example for the bone and soft tissue.

For each of various thickness level, there can be a interpolated plot for dual energy, or multiple energies. Dual energy material decomposition, and or iterative dual energy material decomposition for multiple energy measurements or dual energy material decomposition for distributed rare component as described in aforementioned PCTs may be applied, or multiple energy measurements for DRC identified and separation using iterative dual energy method may be used. Or linearization methods for material decomposition may be used

One configuration has improved from the previous disclosure in that thickness interpolation plot is generated for each thickness range. And the optical density and or linear attenuation coefficient may vary based on the total thickness of VOI for the same substance, or same material or material composites and or the measurement of the same density.

One configuration For varied thickness, known or actual material of varied densities and or varied thickness measurements may be used to establish a database for single energy, dual energy, multiple energy measurements , inverse energy response function may be performed to derive not only material decomposition based on spectral imaging or spectral tomographic imaging but also for single energy tomographic imaging and reconstruction and density derivation. In measurements taken for reconstruction of single, dual and multiple energy tomography images, thickness may be taken into account as well. For example, Single Energy measurement of various thickness range and varied density range for chest imaging or composite material similar to chest images may be taken of known material similar to what is in the unknown imaged subject and or actual material which is approximately same or similar to the content to the unknowns in the imaged subjects

One configuration At various thickness, and or varied density, given a measurement at single energy or dual energy or multiple energy measurement, there may be non linearity at thickness level beyond a certain range, within a certain thickness level, linearity may still apply the corresponding density and its quantitative relationship with the measurement at single or dual or multiple may be different from that at varied thickness range of VOI and or component of interest. Linear attenuation coefficient at varied thickness levels, Energy response function system or tomographic imaging system therefore need to be established relative to the relevant thickness level for the measured VOI or imaged subject, density level of the unknown can therefore be derived.

For example at a thickness level of 30cm for a VOI, the measurement at single energy or the ratio of output to input intensity or radiographic density of each voxel may be different when the total thickness of VOI is at 20 cm. even though if the VOXEL is similar or exactly the same in physical density. The reason for that may be that significant amount of primary has turned into scatter, therefore result in lesser primary measurement, not due to absorption but due to loss of primary due to scatter. Therefore the linear attenuation coefficient and or attenuation value for the same voxel dimension and or material density which is approximately correct for one thickness may not be exactly the same when the voi is thicker.

Within a thickness range, such radiographic density may be consistently varying, however, when the thickness of VOI are different beyond a thickness range, such radiography density quantitative relationship with input and or the measured detector value of the VOI of similar material or approximately the same material may change quantitatively for a voxel with the same or similar density and or the same or similar dimension with the VOI.

Deep machine learning, AI algorithms training may train at patient of various thickness, measured radiographic density at single energy, or dual energy and multiple energy levels. Deep machine learning, AI algorithms training may train with VOI of various thickness levels, measured radiographic density at single energy, or dual energy and multiple energy levels with similar or essentially the same material and composite material, to the VOI.

Deep machine learning, or AI algorithms and or Convoluted Neuron Network training may train with human tissues, human body parts at each thickness levels, measured radiographic density at single energy, or dual energy and multiple energy levels or spectral imaging with similar or essentially the same material and/or composite material of a VOI, at one or more density levels similar or approximately the same to the VOIs of at least one patient, for image processing methods including material decomposition, reconstruction, densitometry and diagnosis and image guidance.

Low resolution in the xy direction and low exposure level, for point to 2D x ray measurements, such as 1/20, or 1/20* or 1/10*, or 1/30*, or 1/40* or down to 1/100* , or sometimes less than that of exposure level needed for diagnosis or visualization needed for clinical diagnosis standard may be used in the reconstruction or diagnosis or tracking of an internal component to a VOI. For example, tracking of catheter or placement of an implant.

For example, down to the single digit ms or sub microsecond or us level of exposure level x ray measurements and or low resolution x ray measurements for example, from binned measurements may be taken of the VOI and its internal components. Although the signal is too weak for diagnosis but sufficient for tracking. A simulated projection image of a 3D from reconstruction of x ray measurements or simulated from CT, optical imaging, MRI or other modalities, may be used to compare with the projected image to track and monitor VOI, and its internal components in space position and space distribution.

In one configuration, reduction of speed and exposure can be achieved by structured illumination.

In one configuration Structured illumination generated by thin beams may be generated by multiple x ray sources or a source with multiple x ray radiation location, x ray beam radiated from each radiation emitting location, distributed spatially through the VOI, reach detector to produce projected measurements to be compared to a simulated projection image of a 3D from reconstruction of x ray measurements or simulated from CT, optical imaging, MRI or other modalities at distributed locations of projection path of each of the x ray radiation source. In one configuration, this x-ray imaging system may have radiographic, fluoroscope, spectral x ray, spectral CT, densitometer of one or more segment, and or one or more material , whole body tomography and x ray and may allow the patient to sit, lie down, stand or move while standing, for example for spine, or stand facing 90 degrees from tube or the detector plane. The same configuration may allow or allow a fixture to support patient body parts or position patient body parts for better imaging orientation. For example, for dental imaging, a chin rest or for head imaging and head support, or for mammography, a support or compressing plates for breasts. Or for example a whole body support to allow the patient to face slight slanted downward so that detector and the x ray tube assembly are placed on either side of VOI, or the breasts of the patient for better visualization. Such as configuration is to allow imaging modality such as a mammogram exam. Such a fixture may have foot stand where the patient to stand slightly slanted, and a body rest, so that the patient may lean against the body rest and face downward with a slight angle and the breasts may be compressed or placed between two mechanical plates to allow better positioning of the VOI of breasts or mammogram exam.

In one configuration, structure and function of an x ray imaging system

For example, as illustrated in figure 1 , the lower gantry, may have an enclosure portion which encloses the the support structure, which can support detectors, which may be moved by movers placed or attached to the support structure. And the pilar support structure can be used to hold electronics and generator and control boxes, And the pillar support can attach to the top gantry, which can be attached to the motion system to hold the x ray tube assembly and or additional optical sensor or sensors and beam restricting device.

The design is such that the detector and x ray tube assembly can be moved independently, and there may be space to add additional detectors in the lower gantry or the base, or additional space for adding additional x ray source and moving one or more x-ray sources in and out of the field of the view.

There may be a power replay to switch at least two or more active components on and off.

In one configuration, the upper image gantry or the arm may have the grip grove,, it may allow the upper gantry to have the clearance needed so that there is enough light coming through for the patient or operator or the physician to work on the patient. In one configuration, the entire x ray system may rotate to an orientation where the the structure support structure is above a standing object, for example, a patient. And the arm attached to the x ray tube assembly and the mover which moves the x ray tube assembly in the vertical position approximately ; the base, is orientated such hat the detector or detectors can move vertically approximatelycan. The end or ends of the arm and the base closest to the ground may have a support the weight of the entire imaging system or imaging gantry or have a end device attached to the end to interface or touch the floor.

In this configuration, the image gantry may have the same or approximately the same design but serve multiple purpose by having different orientation can serve in varied orientations to image a patient in various positions.

For example, a patient may be standing or a patient who may move while standing, For example in image the patient for flexion extension, the patient may move while the x ray images are taken.

And the same image gantry may be in a different orientation for patient to sit down or lying down either on the lower image gantry or on a surgical table placed in between the patient and lower image gantry.

In one configuration, the example of the imaging device as described before is illustrated in Fig 2 and Fig 3 with different orientation

And fig 3 may be inverted. So that top is bottom and bottom is top, and a patient holder may be placed in between.

Fig. 3 may be a different orientation or configuration of the imaging device described in aforementioned PCTs.

The patient table is either as in a surgical table .or a surgical table with an opening in at least one end, so that the base 22 and 109 may be inserted between the table.

With flexibility in orientation, will enable multiple purpose use of the imaging device. And various fixtures for support and or orient patient body part, such as head, limbs, breasts or a portion or entire object or patient may be used for improved comfort and improved access for better images. The device may also be stable during while one or more components in motion in any one configuration illustrated. In one configuration, Imaging gantry or imaging arm may be defined as a bridge-like overhead structure with a platform supporting devices such as x ray tube, collimator, and other sensors and wires.

In one configuration, relative x ray emitting position travel in the same region relative to VOI to get a high resolution image

Less than qCT projections, emitting within less movement area than tomosynthesis and or having less projections than both for densitometer measurement which is equivalent or more accurate than qCT and more accurate than DXA.

One configuration of x ray image display

Display of at one selected substance or component, in a background of rest of the VOI or in a low resolution of the background image of the rest of the VOI.

Selected VOI or component internal to VOI and in the projection path, or a segmented image over a background, which can be low resolution.

In one configuration, as the reconstruction continues, the resolution of display becomes higher.

In corona or sagittal or axial display, or any selected perspective, as the mouse or input selected region is selected visually with a digital grid, or with a mouse hovered over, or with a digital coordinate selection, the details of the selected area is display in either 3D, or 2D, or ID.

For example, while in a corona view, it is a two D display, however, if the mouse points at a location with x y coordinate, a display of the path, for example, perpendicular to the point in the xy plane or the region or volume with the coordinate of xy and a portion or all of z is selected or display and or having analytical data presented or calculated in the background and presented.

One configuration of Display of X-ray images

This is a different method than pior art when the x ray images are display in sagittal, corona, and axial presentation.

In one configuration As the mouse then hover over a region of the secondary display, additional details may be displayed either in a digital format, or for example annotation, or description such as density and other relevant parameters, or a high definition visual details.

In one configuration

Z coordinate of 2A, a portion of the complete z coordinate display, for example, with annotation, or digital density information, or z coordinate reading, or identified material, or visual presentation, or analysis results, or selective reconstruction.

Z coordinate of 2A, a portion of the complete z coordinate display, for example, with annotation, or digital density information, or z coordinate reading, or identified material, or visual presentation, or analysis results, or selective reconstruction. The unit measure of z coordinate for example. Can be selected as measurement unit, such as um range, or mm range or cm range.

In one configuration

As the user or the digital program selected a region of interest or element of the interest, a display detail may be a selected x y plane at the selected z level, or it could be a higher resolution and or display setting of multiple dimension or n multiple dimensional view, or detail of ID or 2D view in at least one dimensions of 6D view , such as x y z pitch yaw or roll

In one configuration

Or dimensions of a selected component of composite material or a substance may be the unit measurement of the z axis or any of the other axis.

In one configuration, in the image acquisition and reconstruction method for multiple dimensional and 3D imaging, only selected regions in an xy full view is selected for tomographic image acquisition and reconstruction. To enable better presentation of voxels embedded in each layer along the z direction, the method described above and an example as illustrated in Fig. 5 may be useful for fast image and information presentation.

In one configuration Time tracked information display may be displayed based on selected axis or plane or 3D element of interest or may be displayed based on selected component or substance. With at least a lower resolution background information displayed or reconstructed selectively or displayed.

One configuration of portable device

In one configuration, some aspects of the present disclosure include quantitative Spectral Xray

2D/3D/Tomography using multiple axis matrix image acquisition and reconstruction with less than 1% or less than 5% SPR or less than 10% SPR using beam blocker array plate and or beam selector and or time of flight sensor or frequency domain scatter removal, capable of real time 2D and/or 3D and/or 6D fluoroscopy and dimension measurement uses the following techniques:

- Fast primary X-ray Image measurements enabled by scatter removal to less than 10% or 5% SPR or less than 1% SPR using one pulse image acquisition process.

- Use of Beam Particle Stopper Array to remove scatter in a two detector or one detector configuration to one or two exposures. Spectral Imaging enabled by Energy Response Function Equation System establishment and solving nonlinear energy response equation system by inverse look up table enable better guidance and/or monitoring of intervention procedures and treatment levels.

In one configuration, Portable Device based on the aforementioned x-ray system, enabled by autonomous driving mechanisms. High throughput device enabled by spatial configuration of the x-ray tomography system enables high throughput monitoring of activities and lives of live animals in their nature environment. AI enabled x-ray tomography image acquisition and tomography reconstruction and analysis speed up imaging process and improve precision and personalization. Standardization Methods and scatter removal methods above to in one configuration, fast Tomography and highly quantitative 3D image and/or Spectral 3D reconstruction enabled by almost complete scatter removal at less than 1% SPR or less than 5% SPR, material decomposition from spectral Imaging and/or density measurement, simplified system matrix, which result in dramatical improvements in model based iterative reconstruction, fourier transform based reconstruction and or material decomposition, and or imaging processing, reconstructions based on Analytical and or Deterministic, iterative algorithms, SART, SIRT techniques, ray tracing method, monte carlo simulation methods and enablement of image reconstruction of ROI and its individual components despite the complexity involved in expanded hardware configurations, intervention device design, and related chemistry and contrast agents. Determination of ROI before, during and after both image acquisition and reconstruction. Differential presentation of overlapping substances in 2D and/or 3D format, amplification of dynamic range, intensity, selective color presentation and enhanced contrast representation of selected substances separately from or against the background images of other substances. Contrast agents, suitable for the spectral 2D and 3D tomography, may be made less toxic by using dramatically lesser amount, for example, 2x to IO,OOOc less, by using quantitative imaging method in point, structural,

ID- 7D imaging. Design of intervention devices to be better controlled and visualized and enable dramatic improvement and adoption of quantitative data analysis and AI analysis and recontruction of tomographic images, or more specifically, quantitative personalized x-ray imaging / tomography system, the implementation of high resolution (sub micro range), and/or high sensitivity, great than 10-3 molar, and/or high spectral resolution (multiple energy ), and/or less than one second per 3D image acquisition and/or less than Is reconstruction, in human clinics. in one configuration of x-ray system and or spectral imaging system and or tomographic imaging system and or quantitative x ray imaging system with scatter to primary ration less than 1% or 5% or 10%., portable or not portable, the total number P of the needed X-ray emitting locations is approximately quantitatively related to number of units of Xc, resolution along the third axis, typically perpendicular to the xy detector axis and or a virtual xy axis, which position can be quantitative related to the x ray emitting position and or x-ray detector position which is described by a xy plane.

In one configuration, the needed X-ray emitting locations may be arranged in a linear axis or 2D plane to minimize the movement and number of newly introduced unknowns during the imaging process. For example, to move linearly, 20 cm is required to resolve unknown voxels in the VOI, but at the same time, more unknowns will be introduced in the imaging process due to the illumination of regions outside of VOI when the X-ray cone beam moves. However, if the X-ray emitting position is moved in the xy dimension, the total illuminated volume may be minimized, the total movement angle can be less than one degree if the source to detector distance (SID) =1 meter. As a consequence, the number of unknown voxels outside the VOI are dramatically reduced.

For example, only an area of 20 x 20 mm^A2 is required to resolve unknowns in the complete 3D volumetric region if the desired resolution is 0.5mm.] in one configuration, 3D x-ray imaging system disclosed herein can include the x-ray emitting positions being moved relative to the subject in at least two axis, or two dimensions, for example in each of the six degrees of freedom, x y z roll, yaw, pitch, in reduced and/or minimized number of steps. Each step approximately is one pixel pitch of the detector resolution needed in the z direction, The movement can be effected by, for example, magnetic or electron lens or mechanical or motorized, or electromagnetic methods, which may be included in or attached to each of the x-ray sources.

In one configuration, when the x-ray source may move in one direction, for example linearly in x, y, z, pixel by pixel, or the x-ray source may be moved in angular fashion space, each time, different x-ray projection paths across the subject are introduced. The system disclosed herein can at the same time minimize the amount of new unknowns introduced, or at least reduce number of unknown voxels in the projection paths as much as possible. Such projection based geometry calculation may be used for 3 D image reconstruction.

In one configuration, x ray source move relative to the subject in at least one axis of 6 D. this may apply when the material is relatively thin.

Implementation of submicron resolution in human clincs

Better than 10 ^L (-3) molar or 2x to 10,000 x contrast or more than 99. 999% reduction in contrast level, or From 99.99% to 99.999999% reduction in contrast level.

Same source or different sources can be at the same spatial location so that the beam from each source may travel in the same projection path.

In a configuration, said system can be configured to fit through a standard door, the plurality of detectors configure to be placed between a patient and a patient bed, surgical table, or imaging table. In a configuration, the device can be less than dimensions of an opening of a standard door.

A tomographic system can be configured or made compact to fit through a standard door.

A whole body tomographic system can be configured or made compact enough to fit through a standard door.

In a configuration, the system can further comprise a first system matrix configured to integrate one or more of the x-ray sources and one or more of the plurality of detectors.

In a configuration, the apparatus can comprise a 3rd or more detectors, wherein the respective detector configurations of the first detectors and second detectors, and the third or more detectors are determined by a detector type.

Additional comments: At one on detector and one source may be sufficient for generating images needed for an approximate complete tomographic image or sufficient to produce approximately complete data for reconstruction.

Prior art, CT has multiple sources, travel on the same path, however require rotation. And there is a limitation of number of sources and detector pair , being placed due to the restricted spatial arrangement. And limitation of spatial location where the source and detector can go.

There is also prior art of taking a full view and then a CT, however not taking 3D of the VOI or selected VOI using different set of detectors of various configurations and types, therefore limit the type of the data can be provided.

For example, a detector with um resolution may be used with a detector with 100 um resolution and a first detector may have 150 um resolution.

Having the flexibility of placing various sources, detector, same kind or different in and out of the FOV of the VOI or a selected portion of VOI, and to provide complete tomography is a flexibility only offered by the tomographic method. Tomosynthesis with limited projections and wide angle can not provide the flexibility and reconfiguration transition speed offered in this configuration.

Additional x ray source and detector may be added over time to increase functionality or features of an existing system, the modular configuration. CT is a closed system, can not easily adding another source or detector.

Tomosynthesis is also limited as moving multiple sources in large angles takes time and takes room.

And generally the multiple sources are used for reconstruction of the same 3D model of the VOI. Or in another words, the projection images made by all of the sources are used to make essentially one 3D image. Or all the sources are needed or required in order to provide projection images required for a 3D image.

In one configuration, each of the sources may be sufficient to make all the projections needed for an essentially complete 3D model or multiple dimensional image.

This one configuration offers the most compactness and speed and lowest radiation level. In a space limited hospital or lab or clinic, such configuration provides the most economical value.

In a configuration, the different detector can comprise at least one detector placed upstream or downstream or at the same spatial location of the first detector from which the first data set was acquired or at the approximately the same spatial location of the first detector.

In a configuration, the denoising process can be selectively done on a substance or the VOI.

In one configuration, selective denoising which can include white noise calibration.

In a configuration, the selective data acquisition can be based on a reconstruction result of first data set, or a selected VOI, wherein the reconstruction is prioritized for the selected VOI.

Generally, in conventional CT, complete data acquisition. Can not adjust and determine during image acquisition. Using the tomographic method described here and in aforementioned PCT, a selective reconstruction of a selected portion of VOI, may adjust image acquisition settings such as high or low resolution, kV, speed, mA, based on a predetermined decision tree or algorithms or trained AI algorithms stored the microprocessor. In one configuration, method of reconstructing a 3D image of a VOI of an object using an x- ray system, the x-ray system comprising at least one x-ray source and at least one detector. The method can comprise translating and/or rotating the at least one x-ray source and/or one or more of the plurality of detectors; correlating projection measurements with various positions of the at least one x-ray source and at least one detector using a system matrix, wherein for at least a one 2D projection image, the at least one x-ray source can be configured to emit beams illuminating at least a majority of or approximately an entirety of the VOI so that for each voxel within the VOI, there can be new projection path reaching one of the plurality of detectors, and wherein there can be m x n projection paths approximately, with each movement between the emitting positions, the movement being approximately a resolution desired in along an axial axis connecting an x-ray tube of the at least one x-ray source and the at least one detector passing through the VOI, so that the new projection path can be different from a remainder of the m x n projection path by at least approximately one voxel, or each voxel within VOI can have a projection path differ than other path by at least approximately one voxel.

In one configuration, an x-ray system may include the x-ray source(s) and its corresponding detector(s) which may both move in one or multiple dimensions, optionally synchronized. Alternatively, the detector or source may stay stationary, and the VOI or imaged subject may move. Alternatively, the source may move independently of the corresponding detector the x ray source move to the VOI or x ray emitting position moves relative to VOI at least one axis out of 6D space, defined as x, y, z, pitch, yaw, roll.

In a configuration, the total rotational x-ray emitting position angle from the center axis by less than 5 degrees or, less than 4 degrees, or less than 3 degrees or less than 3 degrees or less than 2 degrees or less than 1 degree.

The center axis is the x ray beam center connecting the emitting position passing through VOI and reaching the detector, in some cases, at approximately vertical or 90 degree angle.

Shift of the center axis by a distance. Or shifting of the x ray emitting position to the first center axis position a projection measurement was made in the imaging process or the image acquisition procedure for tomographic image reconstruction.

In a configuration, the x-ray system can comprise more than one source, each source is capable of tomography.

In one configuration , each source can be a source sufficient to produce an approximately complete tomographic image

In a configuration, x-ray emitted at the second position can be configured to travel in the same volume or 6D spatial position as x-ray from the first position.

In a configuration, the subject can be loaded on a table or bed which is x-ray transmissive, the table or bed being placed on top of a detector gantry of the tomography device.

In a configuration, a patient can be configured to lay on a surface of a detector gantry, which is transparent to x-ray.

In one configuration the subject or the patient can be preloaded on to a surface and or support, such as an x ray transmissive table, and the surface and or support can then be placed in the x ray beam path for x ray imaging or tomographic imaging or densitometer measurement.

In a configuration, the beam particle stopper reconstruction methods can comprise filling a data gap from an image taken at the same x-ray emitting position and with a different beam particle stopper array position where primary x-rays are blocked.

In a configuration, the beam particle stopper reconstruction methods can comprise filling a the data gap during the reconstruction process, each projection path which is missed from the beam particle stopper being described as having no data input, therefore requiring extra projection data to be generated from the same x-ray emitting position or using sparse data 3D reconstruction algorithms.

In one configuration beam particle stopper plate may be placed between the patient and the source or any where between the source and the detector. two or more sources, or x ray emitting positions in one source may be used in projecting images for at least one multiple dimension image.

In one configuration, tomographic imaging method include at least the 3D method described in the aforementioned PCT and in this disclosure. And it can include other tomographic method or spectral imaging method.

In one configuration, the theoretical basis of tomographic geometry,

“nMatrix” to “n²Matrix” up to n⁷matrix or can be used interchangeably, where x ray emitting position can be linear or up to 6D and plus temporal variation, with each X-ray emitting position, such as Position 1 or Position 2, a unique set of X-ray illuminated paths differentiated based on the spatial positions of the voxels (highlighted in black) in each path in the VOI are measured by the corresponding pixels on the detector 20. As the distance between the X-ray emitting positions is as small as Xc, if the total area traveled 16 on a 2D plane is at least equal to the depth of the VOI, the total movement angle in 2D area 16 relative to the original position can be less than 1 degree, and this way the number of unknown voxels introduced outside of VOI due to the movement of X-ray emitting position is minimized. Resolution achievable theoretically can be as high as single digit micron meter in XYZ dimensions, achievable using commercially available detectors. 3D image acquisition can take less than one second to achieve resolution similar to, or greater than that of a CT slice.

In one configuration, in human or large object imaging, resolution can be as high as single um or sub micron. And the resolution may be around lOOum, or down to 1mm as in conventional CT. accommodation of both may need the selection of ROI or VOI in each situations to be suitable for the resolution desired, in terms of imaging speed and radiation level. Therefore the imaging setting or projection image setting in spatial position, may be selected for each desired resolution.

In one configuration, compressed and/or sparse imaging method may be used, where the total number of images acquired is less than NTT, or where each 2D image is lower in resolution than that of Xc, the desired resolution in Z, or the step size is significantly larger than Xc.

In the compressed and sparse imaging method, x-ray source only moves in one axis, relative to the object. Newly introduced unknown in the region out of the ROI, Voi, is proportionally larger compared to the number of voxels in the ROI, especially in each x-ray beam path.

In one configuration, compared to compressed and sparse measurement based method, and the method only selected region of interest are measured in a CT measurements, the differences may include, less robotic movement, less radiation.

In one configuration, such a set of measurements may be different from current measurement methods where a compressed and sparse imaging method is used in place of high resolution CT image, which was reconstructed once prior to the imaging process. The differences include at least one of the following method:

- The number of measurements and/or measurement steps are much less than compressed and sparse image set as a CT image or a sliced CT image does not need to reconstructed in order to identify or characterize the ROI.

- Measurement of material decomposition at a pixel level may be used to identify a ROI in the present disclosure.

- Characterization and identification of ROI may be done prior to reconstruction in the present disclosure whereas reconstruction needs to be done before a ROI is sufficiently characterized.

- Quantitative measurements such as density values are used in identification, characterization and determination of ROI and/or in the deep learning process which is not used in the current CT method relating to sparse and compressed imaging method.

- In the sparse tomography method, the entire VOI is illuminated in each projection image, and the total number of projection may be reduced. In the present disclosure, each project measurement may be just one point or ID or distributed 2D images in the selected region of VOI, and the total number of projections may be reduced depending on the application requirements. In some cases, the number of projection images is reduced to such a level that the images themselves may not directly result in tomography reconstruction, and additional data independent of the measurement data may be used in tomography reconstruction if needed, thereby providing a method to reduce exposure and/or time for image acquisition or reconstruction significantly. - The radiation level is significantly less in the present disclosure due to much less complex geometry configuration, optimized measurement steps, as reduced projection numbers are needed in tomography and optimization of procedures, which may include measurements of different types, and/or dimensions and/or varied spatial locations within a VOI.

In one configuration,

Prior methods developed for image reconnections of CT and tomosynthesis for compressed and/or sparsed imaging conditions may still be used. Compressed and/or sparsed imaging method may be used, where the total number of images acquired is less than NTT, or where each 2D image is lower in resolution than that of Xc, the desired resolution in Z, or

In one configuration, the step size is significantly larger or larger than Xc.

In one configuration, in the compressed and sparse imaging method, x-ray source only moves in one axis, relative to the object. Newly introduced unknown in the region out of the ROI, Voi, is proportionally larger compared to the number of voxels in the ROI, especially in each x-ray beam path.

In one configuration, the x-ray imaging method and apparatus, based on the methods in this disclosure for normalization, calibration, correlation between x-ray systems, scatter removed to less than 1% Scatter to primary ratio ( SPR), in some cases, and as well as 3D tomography and/or spectral imaging in point ID, 2D to 3D and to 6 D in time domain, may generate a standardized imaging systems across multiple x-ray imaging systems. The measurement of selected sample standards correlate the x-ray system used to measure ROI in a subject to an x-ray imaging system standards. Images generated by the method and apparatus in this disclosure may be used to train AI algorithms, especially an AI method including the use of density, time and other critical quantitative measurements in addition to visual parameters such as shape and pattern, to identify, characterize, monitor and track and select a region of interest or a subject for diagnosis, inspection, image guided a surgery or a medical procedures, and/or delivery of therapeutic treatments.

Artificial intelligence based on the x-ray imaging may be used more widely, adopting the disclosed set of standardization methods. In one configuration, AI - at least one axis movement tomography, AI training with images of SPR less than 1% or less than 5%

In one configuration, for some applications, for tomography or a near complete tomography using BPSP for x-ray scatter removal to less than 1% or less than 5% SPR x-ray attenuation may only be measured once at one x-ray emitting location and at one position of the BPSP. The total number of projection 2D images that need to be acquired to reconstruct a complete 3D image may be denoted by Tj . The missing data may be complemented by interpolation or extraction of measured data at other BPSP positions. The total number of projection 2D images that need to be acquired to reconstruct a complete 3D image with no or little missing data may be approximately >2Tj. The missing data due to use of the BPSP may be complemented by moving BPSP to a different position where x-ray is attenuated at a different location of the projection image on the detector at the same x-ray emitting location, or by moving BPSP to a different position as well as moving the x-ray emitting location. In the latter cases, the total number of x-ray measurements may be increased for tomography but typically no more than 2 x Tj , which is equal to the total measurements at each BPSP position for an approximately completely reconstructed tomography image. For example, if there are 4 possible different positions of BPSP, at each position, the attenuated primary x-ray in each position does not overlap with any of the other positions. If three x-ray images are taken at 3 of the 4 positions, at each position, there are Tj/3 images taken. In that case, the total number of images that need to be acquired to reconstruct a complete tomography of a VOI, with no or virtually no data gap, is approximately ((4 * Tj )/3). The 4th set of projections may be taken with x-ray emitting position travel in the same 2d area that is traveled by the first 3 sets of projection. The 4th set of projections may be taken with xray emitting position at a different emitting position than those of the first three sets. This 4th set of projections may be used to resolve the new unknown voxels introduced outside of the ROI as the x-ray emitting position moves in the first three set of projections.

In one configuration, missing data by tomography, more projections to have missing data regions or unresolved voxel region be in a project path in additional projection images to make up for the missing data.

111 In one configuration, at two exposures are added together to form a new image and or provide sufficient intensity needed for presentation.

In one configuration, a beam particle stopper may also be designed of materials that enable attenuation of at least two or more energy levels, for example, at 99.99%.

In one configuration,

Reconstruction method may include Monte Carlo simulation or simulation methods used to do x-ray projection simulation and modeling, which may, in some example, be combined with setting the voxel value to zero or one for a range of attenuation values, and correlate the value in each Voxel unit to what is measured on the detector respectively.

In one configuration, solving linear equations to derive voxel values, no iterative process needed as there is no scatter, precise attenuation value of voxels can be derived.

For each thickness level, the optical density of the voxel with the same composition may be different which results in the final projection value given a certain input intensity.

In one configuration, a database or energy response function system is to be established for measurements at single energy at various thickness of substances and combination of substances with SPR to be less than 1% or less than 5%. Inverse look up function is to be performed to derive the thickness value at a given attenuation value for a certain thickness or thickness range. Multiple data points may be taken to establish a plot for various density value at the thickness.

If there are multiple components. Multiple combination of each component is used. The measurement is interpolated corresponding to variation in density at a certain thickness.

Such an energy response function system inverse look up is performed depends on the thickness of the projection path and known estimated composition of the material. As at certain thickness, the attenuation value of a voxel of same composition may be different depends on the thickness

In one configuration, Dynamic range of the detector will need to have 32 bit or more to resolve unknown voxels of various density.

Material decomposition may take place at each voxel level after 3D reconstruction. For n energy levels, for example, when it is equivalent or greater than dual energy level, additional substances or composite may be differentiated using dual energy decomposition, or iterative dual energy decomposition, n’ is the number of substances decomposed n’ may be greater or equal to 3. Or n’ >n.

Material or substance information in spatially adjacent voxels without the extra substance may be used as a reference for attenuation values at dual or multiple energies.

For example when a contrast agents has a spatial distribution of 1-p voxels, in a cluster. For example, in one single voxel layer. Dual energy decomposition will separate each voxel on the layer to at least two substances or two separate material components. Each material may filled up each voxel except in voxels where only contrast agents are present, where the voxel or attenuation value may be drastically different from adjacent voxels.

In the aforementioned patents and PCTs and this disclosure, where dual or more energy levels are used, such DRC, may be separated in a 2D projection image, or it may also be extracted from selected image comprising of attenuation values of each voxel in the selected layer or slice. In this way, the concentration or spatial distribution of the contrast agents can be precisely determined.

In one configuration, Permeability may be measured and assessed to characterize and identify markers.

In one configuration Prior to an intervention procedure, such as RF ablation of a cardiac tissue or renal tissue, a portion of tissue, a portion of the ROI, may have a specific permeability characteristic that may be modified and different when a treatment and procedure has been performed in the ROI. Contrast agents or labeled substances may be injected, aspirate or absorbed in a portion or complete region of ROI with permeability characteristics which may differentiate from surrounding tissue. This device combined with the contrast agents may be used for image guidance of the intervention procedure to monitor therapeutic treatment during the intervention procedure. Diagnosis, or monitoring of ablated regions with minimized toxicity may be preferred in some intervention procedures to better monitor intervention process and outcome. For example, in cardiac ablation, liquid with contrast agents may be aspirated into ablated region during procedure, and the ablated regions would have a different permeability such as pattern of permeability or speed of permeability of ablated region that is different from healthy or unablated region. This may guide the effectiveness of the treatment, adjust treatment level, reduce time required for the procedure and/or limit damage to the surround tissues during the procedure.

In one configuration, a method for image acquisition and 3D tomography and determine density of voxel in the ROI include one of the following:

-2D material decomposition at dual or more energy or single energy

-Measure difference between before injection of contrast agents and after to determine region of ablation

-Measure the distribution of contrast agents over time in the VOI to determine affected region volume and extend of ablation

-Adjust or terminate ablation procedure accordingly.

-Catheter or an implant such as a stent or heart valve or surgical tool tip interacting with the tissue, or exterior of non contact probe or contact probe for biopsy or energy treatment may be designed to have different regions, each with the same or varied material properties such as density, or thickness or both or atomic z, or combination of materials, with specific patterns or shapes and geometric configuration measurable by xray. For example, different material of varied atomic z may be placed in positions to be measured by the x-ray and differentiated, so that the orientation and spatial location of the different regions and the implant or the object may be determined based on relative spatial locations and distances from each other.

In one configuration, an intervention device, such as a biopsy probe, robot surgical probe or tool tip, a catheter, an implant, temperature probe, ultrasound probe, pressure sensor, energy transducer, may have portions of its device attenuation X-ray at different levels or or have an internal component(s) such as a lumen, a guide wire, or valve driven liquid handling tube, or its sheath having different X-ray attenuation properties than the rest of the device. This integrated design of intervention design combined with x ray imaging or tomography system may allow selected portion of intervention device to be moved, controlled and monitored, in some cases with feedback from a x-ray measurement .

In one configuration, there may be one or more regions on the implant or the probe 2000. For example, Region A of the implant may be made of material or synthetic material with certain measurement profile at one or more energies of x-ray. Region B may be made of a different or the same material. The lumen of the catheter 3000 and the sheath of the catheter 3001 may have differential x ray measurement properties, move independent of A or B of the implant 2000.

In one configuration, Distance and relative spatial orientation of A and B may be measured to determine the orientation of the implant 2000 spatially or used to monitor the movement of A relative to movement or state of region B for a user to better control the implant or for the user to monitor the dynamic spatial changes of A or B independent of each other or A relative B and vice versa, and/or A relative to other anatomic markers or reference component or reference location in the subject where A and B and the implant is placed in.

In one configuration some cases, the material in region A may be segmented by different density, which may be different at different spatial locations.

In one configuration, the method to identify and track over time implant with specific design for radiology

Implant or catheter spatial positioning in 6D relative to a portion or a marker in VOI

The implant or the component to be position may comprise at least one x ray sensitive features, such as variation densities along the component, or two or more substances with various x ray sensitivity measurable in the system or quantifiable by the current system, or dimensions, or shape or repeated patterns

-at least one X ray image- full view 2 D image acquisition of a VOI

-Identify location of catheter or the component to be tracked - select field of view for a region of VOI, VOIc containing catheter and component

-Determine the thickness of the selected region of VOI , VOIc or the maximum thickness of selected region of VOI, VOIc by non radiation sensor measurement such as using time of flight sensor or measurement by user manually or other commonly used tools.

- Determine or adjust the exposure level based on either optical sensor measurement or x ray measurement or both, for projection images and or optionally image settings -Determine number of projections

-Spectral imaging

- or low resolution tomographic imaging

- or low resolution spectral tomographic imaging -with the resolution of Xc being the dimension of smaller feature in the radiosensitive marker on the catheter - such as shape or repeated pattern.

- segmentation and or material decomposition and or Extract information on spatial distribution of the component or each of components if the catheter or the probe comprising multiple components relative to a selected anatomic marker, or a reference marker, such as the iso center of the VOI.

In one configuration of 3D reconstruction

Isocenter of the VOI is the spatial center of VOI, which can be approximately the center of x ray beam volume, for example, center axis of cone beam or parallel beam or fan from source, to the voxel at the center of VOI and to the detector.

For example,

Isocenter of VOI can be the center of VOI, where the x ray source center axis can project through and reach detector, for example, in a perpendicular path. When the first x ray projection is taken, there is a first center axis position. The center axis of each x ray emitting position may shift as the x ray emitting position shifts but could continue to be parallel to the first center axis position. The shifted distance in total in acquisition of an x ray togramphic image of a voi may be less than 2cm ^L2 or less than 4 cm ^L2 or less than 1cm ^L2. Or less than 0.5mm ^L2 depending on the resolution desired or the thickness of VOI or the thickness of the selected region of VOI, VOIc.

In one configuration, full view x ray image may be taken periodically to select a new isocenter as the catheter or implant moves.

Tracking may be accomplished by repeated of measurement and image processing steps.

The number of projections used may be many times less than that of a conventional portable CT in order for a complete tomographic reconstruction and 3 d or 6D positioning of the component, such as implant or catheter. As generally hundreds of images or a large number of projections are acquired to track with reasonable precision in space. In this configuration, radiation is reduced due to field of view restriction and also the speed can be improved and radiation much reduced compared to O ring CT and conventional CT.

Loading of patient and movement of patient will be less of a factor due to limited number of measurements which allow shortest image acquisition time and faster reconstruction.

At least one input device may be used to manually control the x ray tube movement or x ray tube and detector pair movement. The input device can be a mouse, a joy stick or a membrane control unit.

In some cases, more than 1-5 degree may be used for imaging. 1-10 degrees may be used in imaging when precision, accuracy, or minimization of radiation or imaging time or complexity is not a performance priority. A sufficient number of projections may be made to achieve a resolution along Z which can be predetermined. The difference from tomosynthesis is that the total projection number may be sufficient for a complete tomographic reconstruction. Or the low resolution tomographic image has less than 1% or 5% SPR in some instances using tomographic methods in the aforementioned configurations Spectral imaging analysis may still be performed for extracted slice.

In one configuration, degrees separation here refers to the degree of difference between the further travel angle or distance of the x ray emitting position in tomographic image acquisition to the center axis of x ray source to detector passing through VOI, isocenter where the first x ray measurement for the tomographic reconstruction is taken.

The degree separation here may also refers to the widest angle between x ray emitting positions in the image acquisition needed for an approximately complete tomographic reconstruction.

In one configuration, image acquisition and display for improved x-ray imaging

In one configuration, the zoom in and zoom out is achieved by one of the following: an x ray source of different focal size ; and or detector of various pixel pitch size ; and or moving the source or the x ray emitting positions in varied size of step size between x ray radiation emitting positions in multiple dimensional imaging process or tomographic imaging process.

In one configuration, methods for determine variation and or percentage of variation of x ray input intensity or the variation of intensity level entering into the VOI or the imaged subject before being attenuated by the VOI and collected by the detector can be the derivation of scatter x ray of the projection measurement. .

In one configuration, at least a portion of scatter X-ray Image separated from the primary imaging and evaluated for intensity level, can be used to determine the input x ray intensity level and or variation of input x ray intensity level in for example, multiple exposure or multiple frame imaging, spectral imaging, or densitometry or multiple dimensional or CT measurements.

The determine of the level can be useful in determining attention value of the imaged subject or VOI, or for the 3D or multiple dimension x ray image reconstruction in which x ray projection images or measurement may be adjusted due to measurement of scattered x ray compared to previous x ray image levels.

In methods where in the tomographic method, the travel path or area of volume or 6d space of x ray emitting position relative to the VOI or the subject as described in aforementioned PCTs are limited to a few cm or mm or um range, scattered x ray images derived from each projection image of VOI may be similar to each other, for example, due to proximity of the travel area of the source or VOI, or the average intensity of scattered image from each projection image should be the same approximately, or similar or the same or the scattered x ray image may be variable based on the variability of the input x ray intensity. Or a least a portion of scatter x ray measurement at a selected location may be used to assess variability or proportion of variability of scatter x ray relative to scattered x ray image may be the same or similar to the variability or proportion of variability of input x ray or input x ray measurements.

In one configuration, the scatter x ray image or a portion of scatter x ray imaging of at least one or more selected regions derived from a projection image or projection measurement of a given VOI can be summed up or averaged for determination of variation of x ray input intensity levels of the said projection image or measurement. In one configuration, in two d imaging, to remove scatter, the beam blocker array method can be used in which beam blocker array may be moved so that the data missing from beam blocker array can be replaced by data acquired from another exposure.

In one configuration, the shadow area generated by the beam blockers on the beam blocker array from x ray projection image, or measurements of voxel regions blocked by the beam blockers can be replaced by data or image or measurement from a different projection image or projection path where the projection image of the voxel regions which was blocked in the earlier measurement VOI has now in the x ray illumination beam path transmitted through VOI and reaching the detector.

In one configuration, various configurations of Patient Table Design

In one configuration, the table on top of the detector assembly can be motorized from one side of the enclosure. In one configuration, motorized part for motorize the table or table top can be xy, the side of the table that is longest, for example, if the y axis is longer, then if along the x axis, the motors are located. There could be less motorized motion and power needed to motorize the table. The benefit of such design is such that it is easier to move. The weight of patient or VOI may be evenly distributed on the side of the motorized part.

Previously, the motorized part are generally placed on the shorter side of the table due to c arm design, which has a shorter length in the direction where the table motor can sit, However, given the detector enclosure assembly being long along the y axis.

The motorized table may be adjusted in the z axis to position the patient properly for optimized image angle.

Locking mechanisms can be provided to fix the table to a selected position which is longer than the rest, , with table length along

In one configuration, Contrast agents are designed to further improve functionality and visualization and specificity of analysis

One configuration of contrast agents are microstructure which has frequency elements which can be separated and or bar coded with features and or properties which can be differentiated or separated in the frequency domain from the background. For example, different microstructure or microstructure with specific frequency and phase may be built into the contrast agents. A substance or composite substance with the same or similar atomic z can have a number of variations based on the microstructure the substance or substances made into. Imaging using such contrast simplifies image process and or can be used in the study of multiplexed system, where a VOI may have a number of affinities or a number of epitopes where a contrast agent conjugated with a antibody or a molecule such as DNA can recognize. Colocation studies of multiple labels may use this method. And superresolution imaging using this label may use this method.

Contrast agents with combination of various molecules, for example comprised of one or more units of protein, calcium, nucleic lipid and water content, constructed into repeating units or with a certain frequency, which can be constructed as part of contrast agents. Each type of molecules may be mixed with other molecules to form a attenuation property or density property which result in a variation or an element which can be detectable by the x ray measurement. For example, molecule may be folded in way to include water component or lipid component so that its density is different. The signature of the portion of molecule or the molecule complex can be density as well as ratio of multiple components distinguishable by x ray measurement in the time domain as well as in the frequency domain. Such information may be combined with spatial information to allow identification and quantification.

In one configuration, such a molecule construct may be made as a contrast from a test tube, or may be genetically engineered and made in real time in vivo. Or such as contrast agent or state of a contrast may be made by enzymatic activities. For example, if calcium is embedded in the molecule, which is made while in vivo, but released in the location of enzymatic activities by abundance, then that is a calcium marker.

Genetically programmed and engineered and produced molecule sequence where the sequence is made of molecules subunits with varied affinity for various components, such as calcium, water, lipid, therefore introduce a microstructure unit comprising repeating units of various component, which has conformation in ID or 2D, or 3D or 4D or 5D or 6D which is defined as x, y, z, pitch, yaw, roll. Such a molecule complex, or a portion of it, can be used as a marker or contrast agent. The frequency marker can be comprised of molecule or subunits of molecules comprised of one or more substances, or each subunit can be a combination of substances, and the ratio or ratios of which can serve as an element in a unit which contains the frequency information.

For example, either in absence of or in presence such a molecule or molecule complex, or a portion of, or change in conformation of such a marker, or a charge in state, or a change in composition of such as marker, certain molecular activity or target can be detected. The molecular can be a linear structure or 2D structure such as a sheet structure or multiple dimensional, detectable by x ray measurement and or optical measurement method.

One configuration of these contrast agents can be used for diagnostic purpose, by being part of complexes which include such contrast unit. The protein containing portion of the molecule or molecule complex can be the therapeutic portion, and or can be served as a part of a complex which can be used for differentiation from the rest of VOI or background in r x ray measurements.

Such molecules can separated in the frequency domain, if it has its its frequency signature or bar code compared to other molecules in the VOI.

Fourier transform or inverse Fourier transform may be used to derive frequency element, and or identify frequency signature. And data pertaining to unique frequency signal can be processed, or manipulated or separated from the rest of frequency data in the selected VOI region.

Frequency characteristics and or frequency signature of the marker or contrast agents may be one frequency or comprised of multiple frequencies.

In one configuration, Single Snapshot Multiple-frequency Demodulation and or Spatial Frequency Domain

Imaging (SFDI) traditionally are operating in the optical spectrum, in visible and NIR.

In one configuration, Reflected light are demodulated into evaluate sample.

And two layer or one layer information on the sample are collected.

In one configuration, x ray signal from x ray source are generated and modulated into a ac and dc component using primary modulator and or micro deformable mirror or ultrasound. In one configuration, Separation of microcalcification, distributed rare component, or diseased tissue regions, implant, foreign object or energy perturbed regions, or characterization of energy perturbed regions during a period of time of tracking, catheter or probe or surgical tools, can utilize the method described here:

ID or 2D or 3D Spectral Imaging based Material Decomposition for materials such as microcalcification Separation

ID or 2D or 3D Spectral Imaging based Material Decomposition for materials such as Microcalcification Separation

In one configuration, when x ray projection measurement involves microcalcification, bone and soft tissue all in one projection path or projection line.

In one configuration, improved dual energy method

In one configuration, dual energy imaging at high energy and low energy, material decomposition based on inversion energy function response function established based on interpolation of dual energy measurement, bone, soft tissue at each energy level with scatter to primary ration at less than 1%.

Identify regions of bone image which has sharp varying attenuation properties while the region around it has slow varying properties.

Sharp varying attenuation may be detected with either density variation or high frequency signal component.

Slow varying properties may be detected with slowing varying measurement or signal level or low frequency component signal.

In one configuration Identification region of soft tissue which as sharp varying attenuation properties while the region around it has slow varying properties

There are regions of microcalcification residing on the soft tissue which does not have bone in the projection path, therefore isolated from bone region, which can be determined.

There are also regions of microcalcification sits on the border of the bone and soft tissue, where the variation in measurements in soft tissue corresponds to the location of microcalcification, where the microcalcification may be residing with a portion of it with projection image of bone in the projection path, and another portion not having bone in the projection path. The portion of variation in density, or high frequency signal of bone measurement or bone image to the adjacent tissue such as bone, is consistent with variation, or high frequency signal, in soft tissue measurement, then the variation is defined as microcalcification. And the region next to it spatially next to the slow varying bone structure is then microcalcification.

Additionally, for example, spatial distribution, spatial frequency , density of the region with and without the calcification may be used for evaluation. As density of bone is in general different from that of microcalcification.

Spatial distribution characteristic of bone is different from that of spatial distribution characteristic of microcalcification as well.

In one configuration measurements may be analyzed in the non space domain.

In one configuration, fourier transform of spatial frequency may be used to analyze the measurement.

Factors taken into consideration, spatial profile, relative proximity, spatial location, relative position in soft tissue, bone, and other reference marker, density, slow varying or abrupt high frequency changes can all be taken into account in analysis.

In one configuration, multiple energy method.

One configuration is to use three energies, to separate Bone, soft tissue, lean and fat tissue using inversion energy function system equation.

In general, tissue specific characteristic of microcalcification can be characterized before hand. For example, microcalcification may tend to reside in lean tissue.

If the bone image contains calcification portion and there are regions of abrupt changes in soft tissue or lean tissue in the same region where bone has abrupted changes, and if lean tissue image has more abrupt changes, therefore high frequency signals, or changes, then microcalcification can be determined and quantified.

Other than characterization of microcalcification in the above method, or other components such as distributed rare component, or diseased tissue regions, implant, foreign object or energy perturbed regions, or characterization of energy perturbed regions during a period of time of tracking, catheter or probe or surgical tool tips, can all be separated based on the above methods. In one configuration ID - 3D images may be extracted from reconstructed 3D images, which can be in CT orientation, such as corona, sagittal and axial orientation, or in all 6 D orientation for analysis.

Such analysis method may be combined with AI method, which requires training on actual diagnostic or image guidance, prognostic images of multiple patients to analyze or formulate results used for diagnosis, intervention, treatment or drug development studies and medical device studies, prognosis and post intervention and treatment monitoring

Such analysis method may be based on images with SPR less 1% or SPR less than 5%.

In one configuration Such analysis method may be used to improve existing AI method accuracy.

Such analysis method may be used independently with out trained AI algorithms to form diagnostic or prognosis or intervention guidance opinion and or formulate additional analysis parameters for medical or industrial applications for analysis and inspection.

Such results may be used for accurate diagnosis comparable or better than that of AI or radiologist assessment.

In one configuration, the identified region may contain varying proportion of substances, such as cations, lipid or water or protein or metal or other x ray differentiable substances, such as ca++, oxygenated or deoxygenated molecules, molecular complexes with distinct x ray measurement signature in spatial domain, frequency domain.

For example, white matter and grey matter in brain is different in lipid and protein ratio. Due to variation is for example, variation in density and also in ratio of different molecular component, and spatial distribution, the two matters can be separated volumetrically. And diseased or component of interest in the regions of interest can be analyzed based on one or more the following parameters

• Density

• Material decomposed based on dual or multiple energy in point, or ID or 2D or 3D, the ratio of decomposed materials

• Spatial distribution of each substance and or composite substances

• Spatial frequency of one or more molecules or substances, or molecular complexes or each tissues • Relative quantification values of each of the above and its surrounding tissues and molecules

• Relative values of spatial profiles with one or more tissue, or molecule or molecule complexes

• Relative frequency profiles of one or more substances, molecules and its surrounding tissue and molecules.

Such analysis may be based on point, ID, 2D or 3D extracted data regions in any orientation.

Changes of such parameters and values can recorded and tracked and characterized over time.

Absence and Presence of any of the component, and parameters can be recorded and tracked as well.

For example, in a stroke location, large vascular occlusion, there may be a number of component in the localized spot where the occlusion occurs,

In one configuration, The parameters which may matter for analysis can be one or more of the following

• Location of the occlusion, for example, it needs to be determined that the data region of interest is in the blood vessel.

• Characterization of there the blood vessel is, which part of brain

• How big is the suspected region

• Composition of the suspected region - proportion and which component

• Where is the suspected region- spatial profile to adjacent tissues or one or more segments in the brain

• Spatial frequency profile in all directions and or in sliced images in ID, 2D or 3D

• Density of various component and or of the region or of the volume.

Which are relevant markers for diagnosis, prognosis and image guidance for intervention.

Similarly in diagnosis of a tumor or arthritis or kidney stone or energy perturbed region, for monitoring the progression of tissue changes or physiological changes, such as permeability of contrast agents, one or more factors may be measured and analyzed.

Diagnosis, alert and quantitative imaging allows reduction of work flow time by earlier alert capabilities during and post imaging procedures and having the patient stays in the x ray machine for diagnosis, treatment and or intervention. The method described here to for improvement of work flow in medical imaging, treatment and intervention of illnesses:

In one configuration, the imaging modality measures the patient, send information to pac and diagnostics tools are used to analyze and determine the condition of the patient and radiologist or AI based software will interpret, and treatment and intervention procedures are administered based on the results.

The intervention and treatment are given based on the analysis post imaging.

The method described here may be post imaging procedure or during image acquisition and processing procedure, to accelerate work flow

The patient is placed on a patient table, and under going imaging procedures One or more imaging procedures are made.

During the imaging procedure, certain parameters are measured and processed.

When one or more criteria are met in one or multiple procedures, some of the criterial may be captured during an imaging procedure, before the procedure is over, if there are a certain thresholds are met due to measurement, alert msg or signals managed by software is sent out to the radiologist or relevant intervention and treatment staff to get ready to administer treatment either by a sound and or by electronic msg to medical record and pac or other relevant database or software. Such a patient may be prioritized over other patients in the diagnosis /medical treatment / intervention during work flow using software.

As additional information is captured to solidify the diagnosis either by the software installed in the imaging station or somewhere where the images and measurements can be analyzed by software or radiologist, the intervention and treatment medical professionals are already prepared to deliver treatment and or intervention.

Such medical staff may be onsite, in the clinic or the hospital where the imaging procedure is performed or they could be some where different, at a different clinic or remote location. Medicine and IV can be given to the patient while the patient is on the x ray exam table. And intervention may be performed on the patient while the patient stays in the same x ray machine without having to be moved to a different x ray machine for exam or intervention procedures.

In one configuration, a system described as above can be used for industrial applications, such as security. Inspections, and failure analysis, field inspection. In one configuration, Computer Input Control can be improved,

In one configuration ,A handhold device for the of control x ray imaging - general x ray and CT. Such a device may be wirelessly or wired to be connected to the generator or a microprocessor in the image gantry or connected to the microprocessor at the work station where there is a computer for image processing and or display. a hand held device described here which can be used to activate x ray imaging procedures using input functions such as press and expose, or to start, pause and resume may be used as a stand alone or integrated with other functions for convenient control for x-ray imaging procedures for 2d and or for tomosynthesis, or spectral imaging or tomography imaging procedures. In some cases, imaging or measurement of other modalities may be integrated in the same procedure, such as optical measurements, camera, time of flight sensor.

In one configuration, Low radiation bone densitometry using low resolution tomography

In one configuration Partition of VOI based on thickness for spectral imaging, densitometry and tomography

Scatter x ray image can be used to derive the variation of x ray input intensity from projection image to projection image at different times. At least a portion of Scatter x ray image may be used for assessment of variation of x ray input intensity from projection to projection of the same VOI from at least one or more x ray emitting positions within a spatial volume or an area or a linear path of x ray emitting positions.

In SFDI, the incident spatially modulated light comprises a DC component, an AC component, modulated at a specific frequency f. The collection of the spatially-modulated light is demodulated on the detector after the x ray passing through VOI, to obtain the modulation transfer function (MTF). SFDI utilizes a demodulation technique referred to as the three- phase method and requires three images Io₀ , 1120₀ , 1240₀ acquired at different phase delays (0, 2p/3, and 4p/3) to compute MTF (the ratio of IAC and I ₍o₎AC) at one spatial frequency.

Similarly, In SFDI_X, the incident spatially modulated light comprises a DC component, an AC component, modulated at a specific frequency f. The collection of the spatially- modulated x ray is demodulated on the detector after the x ray passing through VOI, to obtain the modulation transfer function (MTF). SFDI_X, may utilizes a demodulation technique, a three-phase method, and three images acquired at different phase delays to compute MTF at one spatial frequency.

In one configuration, x ray projection image or extracted Id or 2d or 3D image or space domain frequency pattern of at least one selected VOI volume out of the VOI , 3D x ray tomographic image reconstruction may have MTF at at least one spatial frequency.

Single snapshot multiple frequency demodulation (SSMD) method can extract multiple modulation transfer functions from a single structured light image containing multiple components of different spatial modulation frequencies. In x ray tomography imaging using the present disclosure and aforementioned PCTs, at least one voxel layer or at least ID extracted line of voxel within VOI may have multiple components of different spatial modulation frequencies. Single snap shot multiple frequency demodulation method can extract multiple MTFs.

Photoncounting detectors may be used to capture signals at different wavelength. And using flat panel detectors, frequency analysis and derivation method, such as Fourier transform to derive frequency components.

In one configuration, primary frequency modulators may be used with varying modulators moved in and out of the selected VOI field of view, to provide spectral modulation for spatial frequency domain imaging.

In one configuration, multiple energy imaging combined with inverse energy system function to derive density information of each substance in each voxel, spatial frequency domain information may be derived for each substance for each voxel layer or ID, 2D or 3D layer in any of 6D orientation in the 3D VOI, can be served as a way to determine concentration of each substance in a designated volume.

In one configuration, field emitter based nanotube may be used to modulate amplitude and phase of emitted x ray, at the selected field emitter region.

In one configuration, X-ray-frequency modulation via periodic switching of an external magnetic field, the diffraction of an X-ray beam on an ultrasonic wave propagating at the surface of a crystal gives rise to diffraction satellites whose temporal structure is correlated to the one of the ultrasonic wave In one configuration, x-ray beam may also be modulated by a microwave frequency modulator.

Spatial domain frequency signature of a molecule may be combined with the density measurement to identify a molecule and quantify the molecule in a ID, 2D or 3D volume extracted from 3D volume reconstructed of VOI. Density of each substance or molecule in a voxel may be derived from spectral imaging combined with 3D reconstruction or spectral 3D imaging.

2D or 3D imaging may be used to identify the molecule, using a look up table involving single or multiple energies at thickness range similar to VOI being imaged.

Frequency signature is registered.

Either density or frequency or both may be used to identify the molecule or substance.

Additional information regarding density and frequency of other substances in the presence of the specified molecule may be used for identification

Or proportion of various substances may be used to identify a tissue.

In one configuration, thickness level is used for identification of the substance or material composite.

In one configuration, a look up table may be used for tissue identification.

After the molecule is identified, quantification of the substances maybe derived.

Substances, or at least one molecule or molecular complexes comprising multiple molecules, or tissues are identified and characterized by density and spatial frequency in at least ID to 3D dimensions out of 3D volumetric image of the VOI.

Adjustable resolution for 3D imaging in the z direction in one system.

Separation of microcalcification, with bone and soft tissue present on the same projection path, by inversion energy function system equation.

In one configuration, Scatter removal method can be improved

Improved identification and positioning of beam blocker shadow location for more precise scatter image determination Reduction of work flow time - all in one system to consolidate different stages of diagnosis, treatment and intervention.

In one configuration, Density measurement can be varied to varied precision and accuracy.

In one configuration, segmentation based on varied density levels or tissue types with density variation at different locations.

Scatter to primary ratio can be various levels based on the scatter removal method, whether if it is spatial domain based, spectral and spatial domain based ( such as beam blockers or beam selector using attenuation material which can attenuate substantially, or close to 100%)

In one configuration, density based measurements, for example, when scatter to primary ration is less than 1%, or between 1-2% or between 2-3% or between 3-4% or between 4-5%, or higher than 5%, correspondingly, tomography and spectral imaging based method can provide measurements and or processed imaging measurements to have, for example: density and / or optical density based measurements can be as accurate as 1%, or between 1- 2%, or between 2-3%, or between 3% - 4%, or between 4% to 5%.

And the density and or optical density based segmentation can be less than 1%, or between 1- 2%, or between 2-3% , or between 3-5%, or between 4-5%.

And the substances ratio and or substance of varied density ration within a volume of interest, as small as one voxel, can be as accurate or precise as to better than 1%, or between 1-2% or between 2-3% or between 3-4% or between 4-5% or >5% or more.

In one configuration, due to scatter removal process, reconstruction accuracy can be much improved

In one configuration, scatter to primary ratio can be less than 1 %, or between 1-2%, or between 2-3%, or between 3-4% or between 4-5%, or more than 5%, therefore enabling precise density derivation for identification of markers and or substances or tissues and or component of interest and or quantification of volumes and or segmentation, in some cases, take into individual component thickness, segment thickness total VOI thickness and varied substances in the x ray beam path In one configuration, by using one or more movers together and or one or more types of movers or steering device, and or one or more type of x ray sources, and or using electrooptics or other means to focusing the x ray emitting position or using parallel beams, or fan beams or combined with cone beams or various geometry of beams, and or other x ray optics, and or one or more detectors, adjustment of resolutions can be achieved, for example:

In one configuration, to make reconstruction of 2D projection images into 3D, the distance with x ray emitting position, and or the movement between x ray emitting positions can be less than lOOnm, or between lOOnm to 500nm, or between 500nm to lum, or between lum to lOum, or between llum to lOOum, or between 100 um - 200um or between 200um to 500um or between 500 to 1mm, or between 500 to be in the mm range. such variation of spatial resolutions of at least one or more subsets can exit in one machine.

Presently only one machine can have limited resolution variation, for example, resolution may be within +/- 50%. Using methods described the aforementioned PCTs and patent disclosures and the present disclosures, the variation of resolution achieved can be better than two times, or better than three times, or better than four times, or better than five times, or between 10 - 100,000,000 times better.

This can be achieved in a station object by using various combination of x ray sources, or x ray emitting point, or in combinations with x ray optics or in combination with various detectors of resolution and speed.

In an live object, the resolution increases, the speed of image acquisition needs to be increased as well.

In one configuration, variation of spatial frequency resolutions of at least one or more subsets can exit in one machine, subsets are the following

Such as 1-3 times better; or 1-10 times better, Or, 1-100 times better, Or 1 to 1000 times better

Or 1 to 10,000 times better, Or 1 to 100,000 times better, Or 1 to 1000.000 times better

Or 1 to 10,000,000 times better, Or 1- 100,000,000 times better, Or 1- 1000,000,000 times better On configuration of 3D acquisition, involve one or more below steps, some steps are optional:

1. image acquisition for multiple dimension reconstruction, user select field of view for 3D reconstruction, or using a first x ray image or spectral imaging to determine field of view for reconstruction. The number of projections is approximately or at least approximately thickness of voi divided by approximately resolution along the z desired by

Set exposure level at least once during imaging acquisition, or Set exposure level once or Set exposure level less than three times. Based on the first x ray image.

2. In one configuration of 3D reconstruction,

-using line integral or volume integral to derive intersection of x ray beam and the VOI, connecting x ray source to detector taken into account subvoxel value and in some cases, gaussian distribution

-using conventional ct technique such as Algebraic Reconstruct Technique or analytical technics or deterministic techniques to solve for unknown voxel value. To reduce ill condition, reduce number of unknows by limit the size of the reconstruction unit comprising of unknown voxels, for example, partition cross sections xy of the VOI, to smaller unit, for example two partitions or more to reconstruct, xy cross section can be as small as 2xlor 1 x 1. Reconstruct each partition,

- parallel processing each partition.

-In one configuration, no iteration is needed, In some cases, iteration is needed if noise level is high

4..for thick samples or high resolution reconstruction, low resolution 3D image of the same VOI may be done, for example, with >2Xc as the resolution along the z to reduce number of voxels with similar value.

As the source to VOI and detector distance is far, the newly introduced voxels are relatively small in number

And to resolve the additionally introduced unknowns, no additional projections may be needed, simply extend the dimensions of detector regions to have more rows or columns of detectors to measured projected image outside of the VOI. In one configuration, payment and Transaction Method of the x-ray system and or aforementioned x rav system including for example. 2D. 3D. spectral imaging. 4D to 7D imaging

X ray Imaging record keeping and payment process apparatus and methods An imaging taking apparatus including the following methods and apparatus One or more microprocessors

Wired or wireless communication device and protocol and software process Cloud, server or hardware storage locally or remotely

Microprocessor containing Method for recording number of images, or number of procedures, which may be acquired, processed or not processed, extracted, selected, and or each may be traced to a reimbursement code existed, or may be created in the future.

Microprocessor may containing one or more database, or database structure to store and categorize each image based on one or more criteria, such as studies, or type of studies, or images, type of images, procedure utilizing images, or measurements related to a procedure, or extracted image from measurements and reconstructed images, extracted data from measurements and reconstructed images.

Microprocessor may be associated with a software, or algorithm using to label or time stamp an image,

Time: time stamp each image taken, either 2D or 3D, or more multiple dimensional, such as attach a DICOM label or adding a time label, store in a database which is stored in a microprocessor

Identification of the image or image set: for example, each image is labeled with at least the name and or a description of the subject or the region of interest, or at least a unique identification number or binary identification number, or all of the aforementioned id information.

• Recording number of images taken per subject based on DICOM labels or unique identifier for each imaging process or each imaging session or each study or treatment or diagnostic or monitoring or therapeutic planning, or research project or tracking period. • Recording and tally number of images taken and or processed for each x ray system including the computer, the x ray hardware and the software; a memory storage unit, electronically store one or more documents, each has reports or up to date records of number of images taken during a time frame such as a day or a month or a year or since the system has been in use; the report or the document can be accessed by either physically accessing the computer and its associated x ray imaging system or the electronic memory storage unit remotely via internet or intranet or direct physical access for example a memory stick or security key capable of storing and process digital information; a computer is programmed to generate a report based on the document, store electronically, and periodically automatically sends the report to the predetermined recipient via email or hardcopy or other electronic means for example, stored on a server, password protected, accessible for the predetermined recipient who can access by login to access the record by using a password either at the x ray system location, and or at a remote location.

The apparatuses disclosed herein can include a storage and/or a database as illustrated in Figure 8, which stores images produced by the apparatuses disclosed herein and/or using the imaging methods disclosed herein. Each image or a dataset including images and/or data can be associated with a time label at time t = tO, tl, t2, the units of the time may be in seconds, or minutes, or hours, months or years, or any range from sub-seconds to years. Such time label can be associated with the time at which the image or data is acquired. Each image or dataset may or may not be acquired at the same facility. The time sensitive database may store images of the subject from one or more locations or facilities or different imaging sites, such as location 1 or 2 or 3 in Figure 8, which may be linked with unstructured and structured data other than x-ray images relating to or of the subject with the same identifier or related identifier. Such data may be labeled with a time label at time t = tO, tl, t2... . Such database may contain unstructured and structured data relating to a fact extracted from the data and/or the images and/or associated with a specific time. Such a system allows for tracking and monitoring of the images of the same region of interest of the subject overtime.

The apparatuses disclosed herein can generate time sensitive scatter removed x-ray images and their post-processed images, for example, after material decomposition. Such images can be labeled with a time specifier, generally the time of when the images are taken. Such images and related image set taken of a subject spatial and/or temporally may be labeled with a time stamp and/or a unique identifier to associate with a specific time for each image or image set, and an identifier associated with the subject. One or more facts may be extracted from such database, including time sensitive data.

The label and database system described above may incorporate any features of DICOM labels, including but not limited to a custom DICOM (Digital Imaging and Communications in Medicine) label. In some instances, such a label with specific time and an unique identifier may be made with a second ID, for example, a social security number of the subject (that is, a human patient), which is relatively permanent, or an identifier chosen by the subject. Such identifiers can be integrated with a random number to generate an encryption. The identifier may be one fact relating to the subject or one set of two or more facts relating to the subject. The identifier may be a second fact or a second key about the subject or a set of two or more facts or numbers assigned to or chosen by the subject, so that the first identifier or first set of identifiers may not be made public, or may be hidden when accessing the image or the image set of subject. The second key or second identifiers can include additional security measures of using a second identifier, which may enable retrieving of images and/or linking continuity of images of a particular subject without having to access private information. The second identifier may be a number or a method of access such as a physical key or an apparatus such as cell phone.

The database may not contain private information of the subject, but rather a key assigned to the subject or chosen by the subject or associated with the subject, such as, unique identifier for the subject, which may be social security number in the US. The subject and/or designated entities can have access to confirm or further validate the permission to access. Different combinations of second identifiers may be used together to increase the security of access. The database may include some or the complete private information relevant to the subject. In the case where there is no private information or partial private information, an encryption or access or tracking methods is used to ensure continuity of the image data and other data relating to the subject over time. One or more of the following methods may be used, such as random number mixing with a secondary key; a second access apparatus, remote and/or on-site; and/or a second access component from the same apparatus. The secondary key may be of long term and non-changing nature, such as a social security number. The second access apparatus may be a physical key or wireless or wired apparatus may be used on site. Alternatively or additionally, an apparatus can be used remotely if there is Internet or Intranet communication to the database. The database system can therefore enable linking, retrieving, and/or storing image data continuously and/or intermittently over time for a subject. For example, to diagnose, treat, and/or post-therapeutic monitor a disease or health state of a patient, such a system allows for accessing and evaluating images of the patient over time.

The database may containing a record how many images are taken from one or multiple locations during a specific time frame. The calculation of how many images or measurement or facts derived from the measurements or images at one time or over time may be taken in real time as new measurements or images are taken or over time, from a fact and data storing database which may containing a tally or record or actual data. The calculated tally or data may be stored in a database in a local microprocessor as part of the x-ray imaging acquisition system or a part of image display system with graphic cards and display or a central database to include record of other types including patient electronic record, history, diagnosis and personal information, or the database may be used to tally the number of categorize images or measurements or facts derived from the measurements

For example, the database may be constructed to collect digitally from one or more, or several image acquisition systems with at least one microprocessor. The database may be stored locally in an image acquisition system, the database may be stored in microprocessor in a separate location or in a server, or in a cloud storage device. The number of images taken per one specific imaging acquisition system or for at least one image acquisition system from one facility may be recorded in real time or over a period of time.

A payment apparatus and method associated images taken or studies and patient including the images taken or the number of images taken may exist based on per image taken, based on subscription or based on an upfront payment made, in addition to pay per image at a less amount.

Generally, CT system or a general x-ray system or spectral imaging system are sold as capital equipment. Given that the costs of good sold of the apparatus and methods described here may be in the general radiology level, due to less complexity and less robotics required, the hospitals or clinics which previously could not afford a CT system, can now afford to purchase a unit. In order to make it more accessible for patients and physicians who are interested in using it, a new business model or payment process may be used, for example:

A membership based fee, or a subscription purchase for using the whole system or parts of or some of the apparatus and methods, hardware and software used described for x-ray imaging, measurement or analysis, or for improving x ray imaging systems described in the aforementioned PCTs and patents derived from PCTs and this disclosure.

An automated payment process using checking or saving account or a credit card or scheduled wire transfer or direct deposit from a bank account may be done for the regular payments

For example, a customer may pay a yearly or monthly flat fee for a number of images or a number procedures involving imaging guidance using x-ray imaging and measurement. There are various levels of subscription and levels of payment corresponding to likely volumes or use of system. When the usage is higher than what was expected. The customer, such as a clinic or urgent care or surgical center, may be notified through the software via an email or a msg. The buyer then may use a payment of choice, for example, use online payment process to pay for the additional amount for the month or upgrade the subscription level to a higher level. And included in the subscription, there may be services on hardware and software and free updates. There may be no upfront payment or a small flat fee in the beginning, paid through electronically or by a check. The electronic payment is done through electronically online or through a check or wired transfer or direct deposit each month.

An example of how the database, or calculated number of images or measurements or the facts extracted from measurements, sometimes, and or categorized data derived from or based on images and measurements can be provided for a pay per procedure method or pay per image or a set of images or purchase an analysis or image processing service. Where the clinic or the hospital pays or compensate the seller of the device or the seller of the imaging service a cash or cash equivalent compensation.

The service is listed on the internet or web store or mobile app based store, or market place.

An example of how the image acquisition, viewing and measurement presentation and related or derived data may be provided in a bundled service along with other products and services.

A user may purchase of the imaging service and products on internet or by one or a few clicks on internet, similar to purchase a book but only here to purchase an imaging or diagnostic or analysis service or product. The purchase can also be done via mobile phone or mobile phone app or web based app. The result of the purchase triggers a software to send a message to the warehouse of the seller or seller associated partners and installation service providers of the seller and or its associated partner. A electronic msg generated by a software is to be sent over the internet and or telephone call is made to the buyer to confirm the sale and or arrange for installation.

One or more imaging system and or related viewer, and storage and communication hardware and software may be installed at the preferred or buyer designated site. Such a system may be stand alone or connected via cloud and intranet or local network.

The present methods and apparatus may be purchased and sold on the internet or via mobile platform using digital methods, for example, using only one click to purchase, or two or more clicks to purchase. The purchase methods may be using currency, or blockchain or cryptocurrency, or credit card, or bank account, or other acceptable methods by both the purchaser and the seller.

Payment may be made in crypto currency and or seller and buyer agreed upon currency or the exchange of goods and services which are equivalent, online via mobile or internet or controlled network means.

For upgrade or renewal of services, or adding a new imaging and diagnostics and procedural service, a user may login to the seller’s website, and make a payment. Or such a payment portal may be directly linked with the user’s purchasing network. Different tier of services may be listed, optimized service models may be suggested based the user ‘s usage history, or preference.

The suggested model may be based on a list of questionnaires which provided by the software, either online or via a workstation application. The user can select from a multiple choices question or provide answers in numbers or words or phrases, automated software and or assisted from a partner or representative online or in person may assist in answering the questions. The user or purchasing may choose to skip one or more questions presented by the software.

Entire purchase process and or transaction may be encrypted or performed in a secured portal.

Direct deposit or fund transfer may be used. And for prequalified buyer, the payment transaction may be delayed for a term specified by the seller, this process may be managed by the software. The seller may be the manufacturer or a customer or partner or both of a manufacturer which provides the imaging service.

The seller may provide B to B as well as B to C product and services via digital bank and or digital wallet service.

B to B, business to business, for example, from the seller, for example, to a hospital or a clinic, not only for subscription but also for purchase of the equipment and or for using images after image acquisition for image processing or for methods, software, hardware for extracting analyzing and storing and commercialization of the x ray measurements.

B to C, business to consumer, for example, from the provider of imaging service or diagnostic service to a patient or an individual person and or from the provider of instrument, via the clinics or hospitals, and or imaging service provider, for example, by installing an imaging unit onsite of a customer or partner such as clinics and or hospital, and or directly offer imaging services to an individual person who is also a patient of the clinic or hospital. not only for subscription or purchase of one or more images or series of images in imaging procedures but also for purchase of the equipment and or for using images after image acquisition for image processing or for methods, software, hardware for extracting analyzing and storing and commercialization of the x ray measurements.

Typically, a payment hub may be used to process payment transactions. The payment hub may generate interchange revenue share from electronic payment due to the amount of fees needed to be paid in additional to the merchant bank. The fees and related charges are typically paid in large amount, by the customer - hospitals /clinics / healthcare organizations / imaging centers - to the transaction handling merchant bank to cover handling costs, fraud and bad debt costs and the risk involved in approving the payment. In addition, for large dollar amount transactions, the time required for each transaction may be long due to a lengthy process.

To reduce the cost and time required and increase efficiency of financial transaction in purchasing an x ray imaging subscription service, or x ray imaging system or x ray imaging service, the seller of the x ray imaging system and or related product and services may partner with a bank or digital wallet service. The seller of the imaging service or equipment may become a digital bank, by provide a digital bank and or e- wallet or digital wallet software platform and or related financial services to customers. The digital bank status may be achieved through a banking license or a E-money license or a license of a third party which a license as a service model.

The digital bank which allows a customer to sign up with a user name and password, and or telephone number or email and or tax id, and or social security number or other identifier information to have a bank account.

The seller of x ray imaging device and related product and services may provide a digital wallet, or e-wallet, which allows the customer store money on an electronic device, or remotely on a server, creating Digital wallet, e-Wallet, or digital account via a software on mobile phone, a mobile wallet or desk top , or a wireless device or an online interface. The digital bank account and or the digital wallet which may be connected with one or more bank accounts and credit cards, support a number of features such as switching between bank accounts and credit cards, and or allow deposit or storage of currency, transfers, payment transactions.

The software platform methods for digital bank may include the front end, comprising a thin presentation layer of information, for example, a mobile app, the app or the web portal which allows username and password input and sign in and registration and related information, Developer portal the back end comprising a product layer where sits the core banking system, client data and other back-offices related processes.

The middle-ware comprising an intermediary layer orchestrating information between the front end and the back end and API layer. The middle ware may contain a sub-layer, called the API layer enabling all connections to external / 3^rd party applications which may enrich the service offering, other financial and product service providers, or accounting software \. The middle ware may also contain customer accounts, loans, payments, market place, digital onboarding, payment networks, cards and card management

The platform may allow for decoupling distribution channels, products and customer / client data, all connected by APIs enabling resilience to future changes.

A compliance software may be used to monitor serious potential risks. An intelligent customer support tools such as ERP or CRM software may be used to optimize channel management. Through email campaigns, video chat, social media features. In one configuration, digital bank accounts and or digital wallets allow the user to make payments using mobile phone by using near field communication ( NFC) if NFC is equipped on such mobile phones, finger print and or iris scanner or biometrics may be used to ensure total security.

Using cloud based technology, such as Optical / QR code generated by customer’s hardware device or mobile gadget or sellers or partners of seller ‘s sales outlet. The customer ‘s gadget or hardware device may operate online or offline. Offline examples are such as barcode reader or card reader can read such a gadget to process payment.

Digital online delivery technology are encrypted software applications where payment are made through internet.

SMS based payment, where the account is managed using SMS commands ( to confirm payment); the payment sometimes can be made with out internet access, the customer may inform a representative of service provider, which is the seller, or a partner of the seller, about the phone number and payment confirmation code.

Such transaction and transaction record may be used with a delivery technology, operate in one of the following type of networks: designed exclusively for the network of the seller or the manufacturer, or the network of the seller’s partner in banking and payment transactions, such a network may support a market place, providing a number of products or services including subscription of x ray imaging device, related product and services, subscription of cloud computing services for image processing, viewing, and storage services, PAC services, medical record storage services, diagnostic services and teleradiology services. Or such a network may be dedicated exclusively for the imaging services or pay per scan or per procedure services and or subscription services of imaging equipment and or purchasing of imaging equipment

Half closed type, where the customer can use the digital wallet apps when visiting a hospital or clinic or imaging center where there is an agreement between the hospital / clinic / imaging center and the digital banking or digital wallet service provider who is the partner of the seller and or manufacturer of the x ray imaging system and related product and services.

Integrated type where the purchasing network or healthcare vendor payment program of the hospital / clinic / imaging center or imaging service providers are integrated with the digital bank network of the seller and or manufacturers of the equipment and related product services, and or subscription services and or pay per procedure or scan services. The portal interfaces with customer and or seller’s existing accounting systems, aligning supply chain processes and automating payment processes. Payment hub may be used to creates automated payment strategy through optimization of supplier payment types ( card, ACH, check, specialty), while providing an opportunity for monthly revenue share. The payment hub may start with a single consolidated payment file, may facilitates payment and corresponding details including email remittance, and a reconciliation report is generated. However, now, since the supplier or the seller of the imaging product or imaging service provider may be the bank or have integrated with the financial network of a bank which handles the payment transaction and related financial processing requests, the payment transaction cost involved may be reduced dramatically. The amount of transaction and payment handling fee therefore may be reduced significantly. The seller may charge little or approximately zero for the transaction from the purchasing party, therefore there is not a need for record keeping of merchant bank’s transaction fee from customer side.

Digital bank allows the customer to have an IB AN to receive payments or make direct payment to the seller or the digital bank, which could be the bank as well.

Digital wallet may be an encrypted app runs on online, or mobile device and or kiosk. Digital wallet may allow customer to store and deposit prepaid “cash” in a variety of currencies such as US Dollars, Euros, crypto currency, such as Bitcoin, Ethereum and other crypto currencies in the digital wallet, and one may even be able to pay with them in certain places.

Bitcoin is being stored in the blockchain network. The digital wallet may contain private and public keys and makes it possible to work with them. Example of digital wallets serves as cryptocurrency wallets such as desk top wallets, hardware wallets which use a hardware data storage device, online digital wallets, mobile digital wallets. The digital wallet or digital currency or the digital bank account user may have two or more following components software component ensures security and strong data encryption information component, containing a database comprising business customer data ( name, bank account details, payment options, address) profile of the customer comprising contact information, type of imaging equipment and or device and product and services subscription services) information component, containing a database comprising a personal data user data ( name, card details, payment options and so on),

Information component may be connected to a network connected to containing a database with a medical record database for the patient comprising prescriptions and or other relevant information regarding imaging services and or medical record.

Various level of imaging products and or associated medical related product and services, may be available to purchase directly from the digital wallet through or digital bank account.

The customer selects a digital payment system, via software interface on a desk top or smart phone or an online kiosk. The digital payment system may be pre-paid and password- protected account for storing the currency for any future online transaction. It is to this account, the user or customer can connect payment cards.

The benefit of the seller provide digital bank services are to lower the transaction cost, improve business efficiency and transaction speed for the customers to purchase product and services, such as x ray imaging device, and related images and or subscriptions for imaging services.

Comes with the subscription or pay for procedure method via transaction handling through digital bank and or digital wallet, is a online questionnaire prior to imaging procedure or after the imaging procedure given to the patient, either in the image acquisition software or image viewer that which allows the patient to assign access rules for their medical data, for example, the opt in to store their x ray imaging data, or a portion of the imaging data and in some cases, medical record or part of the medical record in a server or blockchain managed and or maintained and sometimes owned by the provider of the imaging subscription service or pay per procedure or per image service. The block chain technology and as well as the seller or service provider allows patients to assign access rules for their medical data, for example, permitting specific researchers to access parts their data for a fixed period of time. In some instances, tag information, not the medical data itself may be stored in data blocks. And the actual medical data including x ray measurements and images may be stored in an off-chain storage, in a relational database, managed by either the hospital or the seller depends on the access rule set by the patient.

The on-chain data can store metadata about this off-chain data, together with pointers to where the actual data resides, and hash codes that may be used to verify the integrity of the off-chain data. The technology can also be used for identify and access control, in other words as a mechanism to control access privileges to this data stored off-chain.AI may be used for customer service. , transaction details are recorded as digital evidence onto blockchain.

Big data is used to do precision underwriting.

Open banking may be used in certain part of the digital banking and digit wallet transaction process.

A customer may download the digital wallet application, or access on line web portal, purchase digital currency through or transfer from a financial network, stored in the wallet the digital currency and then make payment and perform other digital wallet featured financial transactions as a stand-alone app or through the web portal.

A method for reducing transaction cost and improving transaction speed for payment of subscription x-ray imaging services, x ray imaging system, related products and services, said payment occurring within a financial network, said network including a payment processing process based on a financial processing request automated to be send out at a predefined time period during a time interval, for example , first of a month.

The payment processing software looks up a database created to look up the customer information, track the level of subscription services the customer has signed up, look up the total number of images or procedures during the subscription period a periodic payment is to be made for, compare the subscription level to the total number images or imaging procedures taken by one or more x ray imaging systems installed at one or more imaging sites of the customer, match the subscription level and the payment level, process the payment and send an email report of the payment, total number of images or procedures taken, generate revenue sharing information if there is any based on reimbursement codes, any difference if there is any between the subscription level and or payment level and actual total number of images taken in the payment period.

The total number images taken may be tallied by the image acquisition system, stored in a database in a local microprocessor, send via network to the payment processing software by the imaging product and service provider via an automated email, or by an administrator or by a x ray technician on a periodic basis. The local microprocessor may be at the x-ray detector controlling unit location or at the work station for image processing, which may also be connected to the display hardware and other control units such as membrane controller for controlling the x ray system via push buttons, or a touch screen controlling display or a computer with a monitor with desk top software app. A user may be able to access the computer or the microprocessor by a desktop app, which contains password authentication method to access the computer. The computer may contain the image acquisition or viewing software which also contains the database storing information on total number of images taken. The user may also be able to access the database by using a hardware authentication method, a physical key.

The payment processing app function and related software may compare the tally of number of images or procedures in the database, and subscription level, and generate automated email or phone text messages to inform the customer of the result of comparison and amount paid, a bill for additional charges for the additional images not covered by the subscription.

The customer will then pay for the difference via the same payment network or login the system to pick a higher level subscription service for the next payment period.

If the customer does neither, the payment processing app may apply the additional images not paid though subscription to the tally for the next period in the database. Same process will go on for a predefined number of times.

A customer service representative may be sent a report of warning that if such process goes on without being corrected by the customer. Such a customer service representative may determine an appropriate response to said warning in accordance with predefined policies and procedures.

When the customer decides to have one or more addons and or retrofit modules, such a new hardware addon, such as an retrofit imaging module comprising new x ray sources or additional detectors, or devices such as intervention devices, and or reagents, such as contrast agents, or related reagents, and or AI services and or radiology services, and or upgrade of software services with image processing, maintenance, cloud service, block chain integration, image presentation, additional technical services, radiology technician services, additional training, the subscription level may be modified.

Each of the service items and purchase items may be stored in a database, sometimes with encryption,

The customer makes a selection of each of the add on, either before or after login into the bank account or the web portal or digital wallet with the market place listing these items and select into cart, and put in promotion and discount code, and hit confirm to make a purchase. The banking app may indicate there is not enough fund in the account or processing based on typical online transaction procedures. The customer may see a customized item designed specifically for its account in the cart once it has login.

The customized item may be a negotiated customized item specific for the customer.

The front end user interface may have different design and information for business customers and or individual persons.

With individual person, the customer may need to put in prescription details, or the subscription details may already feed through the doctor’ s prescription network to reach the imaging service outlet. The insurance and related information pertaining to the patient, may be write into the portal by the patient swiping a registration machine or by a representative at the imaging service outlet or a nurse or an administrative staff for patient registration , which could be the imaging room at a clinic or hospital or imaging center. Or an imaging service may be ordered by a physician at a clinic or the hospital, due to a diagnosis, or a procedure.

The imaging procedure reimbursement related information such as patient information and imaging procedure information and or related prescription are then send directly via apps designed for in network and or out of network reimbursement processes or to a responsible party such as a hospital or clinics via the preferred processing network to further processing as soon as an imaging procedure has been performed on the patient.

The follow on process to get the imaging service provider and or its customers of subscription or personal account reimbursed may be similar to what is commonly adopted. Which may include Ensure a payee account meet the criteria for receiving funds for payment of medical services; providing a patient database including patient identifiers for patients who are eligible to receive payment for medical services from the payor; storing a procedure price database correlating at least one medical procedure with at least one medical procedure payment price; comparing a patient identification presented by the patient to the patient eligibility data in the patient database to determine if the patient is eligible for reimbursement; providing the imaging or medical procedure involving the patient if the patient is eligible; and electronically receiving a sum equivalent to procedure price from the payor account when the payor account confirms a portion of the entire reimbursement amount to the payee account when the procedure is complete.

A plurality of imaging devices each generating a data set representing an examination of an object disposed within the imaging area of each imaging device;

At least one collaborative processing center for processing the data set into the target image representation remote from the imaging device;

An information transfer path for transferring the data set from the imaging device to the joint processing center and transferring the image representation from the joint processing center to a display console;

The imaging procedures are tallied at the collaborative processing center and or send to payment processing portal of the provider of the imaging service.

Receiving patient information from a hospital;

Storing information about the patient and converting the information of the patient; Transmitting the converted patient's information to another hospital and storing the transmission related information;

Posting a medical opinion about a patient from another hospital on a web server;

PACS system method for remote and remote control characterized in that it comprises the step of notifying the medical opinions to the hospital.

A registered subscriber capable of registering a medical image, a receiving subscriber capable of receiving a medical image, and a server device for centrally managing the medical image are connected via a network, and the server device is connected to the registered subscriber. Registering the medical image sent from the database in the database and distributing the medical image to the receiving subscriber.

A method for management of X-ray imaging facilities and services comprising the steps of: installing at least a part of a digital X-ray imaging facility; generating digital images corresponding to X-ray exposures; metering the number of X-ray exposures produced by said digital X-ray imaging facility; and Transfer to the metered number of X-ray exposures to a central processing server for one or more imaging facilities if there is a central processing server,

Number recorded on the meters corresponding to each imaging procedure and x ray exposure is stored in a databased, and transferred or accessed via encrypted secure means to imaging service provider via an established network or via an electronic communication method, such as email and web portal.

Billing method is to retrieve the metered number, compare the number of x ray images taken and the imaging procedures involving x ray images, with the subscription level. If there is a match, no action is taken, a x ray image meter report is generated in a predefined time period and send to the customer.

Due to the fact that the seller and imaging service provider may be in charge of the payment processing and software platform involved, there is a much lower transaction cost per transaction, thereby lower the cost for healthcare overall.

An image handling method, comprising: providing at least one imaging device interfaced to at least one remote hub station; collecting at least one hardcopy image set to obtain a corresponding digital image signal set; assigning a unique identification signal to each of the digital image signal sets, the unique identification including imaging location identification and x ray system configuration and imaging setting such as exposure time and linked studies embedded within an encrypted data structure; and retrieving the digital image signal set from a remote terminal via associating the unique identification signal with the digital image set signal.

What has been described is a fast and cost effective digital payment method for purchasing x ray imaging system, for the subscription of x ray imaging service and for pay-per-procedure and or pay -per- image services by integrating x ray imaging market place with a secure and compliant digital bank and digital wallet system at little or no cost to customers or for the provider of imaging services for the payment transaction fee. Terms

Material decomposition is defined as separating materials based using spectral imaging method, such as using inverse energy response function system and or using measured data with thickness range, as data points to interpolate to establish a energy response function system and using inverse function to look up the corresponding attenuation value or density value.

Segmentation may be defined to include material composition and separation, but segmentation may also include segmentation based on parameters and values defined by the user, which may or may not be based on x ray measurement alone, or using a number of quantitative and or qualitative parameters to categorize one portion of 3D image from another, or categorize or organize measured data based on parameters and range value or threshold set by the user and or digital program and or AI trained algorithms or used to train AI.

Inverse Single, Dual, Multiple Energy Response Function System is defined as inverse look up of multiple energy response function system established by measurements at varied data point or sampling points where the thickness and or densities of one or multiple substances or composites are varied from those in other data points in the interested thickness range of VOI at, single, two or more energy levels and the interpolated plot of these data points provides additional data points where there is a unique direct relationship between measured data at single, dual and multiple energy levels and the thickness and or density of known materials and or combination of known materials or known substances.

In one configuration The number of sample points can be determined by how close the interpolated data is to actual measured data given the same or similar thickness, and makeup or composition of VOI. In one configuration, the number of sample points is selected so that the measured data resulted from looking up system is close to the actual measurements when same or similar image settings are applied and same or similar thickness of VOi and thickness of each substances and composites contained in the VOI, by < 0.1% difference, or <0.05 % difference, or by 0.1-0.5% , or 0.6- 1% and or 1-2% or 2-5%. Component

“Component” or “material” or “substance” is referred to an element which can be measured by x ray and differentiated from the background. Examples of component is a component of an intervention device, such as fluid conduit, contrast agents, metal, or bone or tissue, or a part of heart or blood vessel.

Although this disclosure has been described in the context of certain embodiments and examples, it will be understood by those skilled in the art that the disclosure extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and obvious modifications and equivalents thereof. In addition, while several variations of the embodiments of the disclosure have been shown and described in detail, other modifications, which are within the scope of this disclosure, will be readily apparent to those of skill in the art. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the disclosure. For example, features described above in connection with one embodiment can be used with a different embodiment described herein and the combination still fall within the scope of the disclosure. It should be understood that various features and aspects of the disclosed embodiments can be combined with, or substituted for, one another in order to form varying modes of the embodiments of the disclosure. Thus, it is intended that the scope of the disclosure herein should not be limited by the particular embodiments described above. Accordingly, unless otherwise stated, or unless clearly incompatible, each embodiment of this disclosure may include, additional to its essential features described herein, one or more features as described herein from each other embodiment of the disclosure disclosed herein.

Features, materials, characteristics, or groups described in conjunction with a particular aspect, embodiment, or example are to be understood to be applicable to any other aspect, embodiment or example described in this section or elsewhere in this specification unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and/or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and/or steps are mutually exclusive. The protection is not restricted to the details of any foregoing embodiments. The protection extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.

Furthermore, certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations, one or more features from a claimed combination can, in some cases, be excised from the combination, and the combination may be claimed as a subcombination or variation of a subcombination.

Moreover, while operations may be depicted in the drawings or described in the specification in a particular order, such operations need not be performed in the particular order shown or in sequential order, or that all operations be performed, to achieve desirable results. Other operations that are not depicted or described can be incorporated in the example methods and processes. For example, one or more additional operations can be performed before, after, simultaneously, or between any of the described operations. Further, the operations may be rearranged or reordered in other implementations. Those skilled in the art will appreciate that in some embodiments, the actual steps taken in the processes illustrated and/or disclosed may differ from those shown in the figures. Depending on the embodiment, certain of the steps described above may be removed, others may be added. Furthermore, the features and attributes of the specific embodiments disclosed above may be combined in different ways to form additional embodiments, all of which fall within the scope of the present disclosure. Also, the separation of various system components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products.

For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. Not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. Conditional language used herein, such as, among others, “can,” “could,” “might,” “may,” “e.g.,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements and/or steps. Thus, such conditional language is not generally intended to imply that features, elements and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without other input or prompting, whether these features, elements and/or steps are included or are to be performed in any particular embodiment. The terms “comprising,” “including,” “having,” and the like are synonymous and are used inclusively, in an open-ended fashion, and do not exclude additional elements, features, acts, operations, and so forth. Also, the term “or” is used in its inclusive sense (and not in its exclusive sense) so that when used, for example, to connect a list of elements, the term “or” means one, some, or all of the elements in the list.

Conjunctive language such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply that certain embodiments require the presence of at least one of X, at least one of Y, and at least one of Z.

Language of degree used herein, such as the terms “approximately,” “about,” “generally,” and “substantially” as used herein represent a value, amount, or characteristic close to the stated value, amount, or characteristic that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, “generally,” and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount. As another example, in certain embodiments, the terms “generally parallel” and “substantially parallel” refer to a value, amount, or characteristic that departs from exactly parallel by less than or equal to 15 degrees, 10 degrees, 5 degrees, 3 degrees, 1 degree, 0.1 degree, or otherwise.

Any methods disclosed herein need not be performed in the order recited. The methods disclosed herein include certain actions taken by a practitioner; however, they can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as “illuminating a subject” include “instructing illumination of a subject.”

All of the methods and tasks described herein may be performed and fully automated by a computer system. The computer system may, in some cases, include multiple distinct computers or computing apparatuses (e.g., physical servers, workstations, storage arrays, cloud computing resources, etc.) that communicate and interoperate over a network to perform the described functions. Each such computing apparatus typically includes a processor (or multiple processors) that executes program instructions or modules stored in a memory or other non- transitory computer-readable storage medium or apparatus (e.g., solid state storage apparatuses, disk drives, etc.). The various functions disclosed herein may be embodied in such program instructions, and/or may be implemented in application-specific circuitry (e.g., ASICs or FPGAs) of the computer system. Where the computer system includes multiple computing apparatuses, these apparatuses may, but need not, be co-located. The results of the disclosed methods and tasks may be persistently stored by transforming physical storage apparatuses, such as solid state memory chips and/or magnetic disks, into a different state. In some embodiments, the computer system may be a cloud-based computing system whose processing resources are shared by multiple distinct business entities or other users.

The scope of the present disclosure is not intended to be limited by the specific disclosures of preferred embodiments in this section or elsewhere in this specification, and may be defined by claims as presented in this section or elsewhere in this specification or as presented in the future. The language of the claims is to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive.

Claims

WHAT IS CLAIMED IS:

1. An X-ray image measurement system, comprising at least one x-ray source comprising at least one x-ray emitting position generate at least two separate exposures to produce at least two separate measurements on at least one detector either

Take an average pixel value Pavg of at least one selected region from the said measurements, or of derived scatter and or of primary image from the measurements of at least one region of detector with a defined spatial distribution and or defined coordinates on the detector for each exposure

The defined coordinates and or spatial distribution are similar or the same or shifted,

Or

The define coordinates and or spatial distribution are similar or the same or shifted if the x -ray tube or emitting position relative to the detector have shifted its positions between the two exposures, the amount of shift can be approximately equivalent or less than the amount of shift the x ray emitting position relative to the detector have shifted ; the direction of shift can be the same or similar or opposite

Adjust the pixel value of at last one pixel up to all the pixels in at least one measurement, and or in at least one scatter image, and or in at least one primary image generated by at least one exposure out of at least two exposures based on the average pixel value Pavg

2. Claim 1, wherein the said adjustment is quantitatively related to the Pavg

3. Claim 1, wherein the said adjustment is approximated by one or more of the following steps

Approximate the ratio R12 between said images generated by one exposure, which is used a reference exposure, to those corresponding images generated by at least one exposure by dividing average pixel value derived from those measurements generated by a first exposure Pavgl by the average pixel value Pavg2 of the corresponding images or measurements due to the second exposure Or ratio R12 of average pixel value of images acquired by at least one x ray reference detector, corresponding to at least one detector placed between source the imaged subject, or sensor placed in the beam path but outside of x ray beam volume illuminating VOI x ray reference detector acquires each exposure at the same time as said detector. or ratio R12 of the average pixel value of images derived from measurements by a portion of said detector is relatively distant from the portion of detector collecting at least one projection image of VOI.

4. Claim 1, said adjustment is done through

Multiplication of the Ratio R12 with the pixel value of each pixel on the image derived from or corresponding direct measurements, and or scatter image and or primary image of the second exposure or more exposure, to generate at least one image and or an image dataset comprising at least processed measurement or image, at least one processed primary and or at least one processed scatter image.

5. Claim 1, said measurement is a white image and or white image with beam blocker array

6. Claim 1, said exposure generates said measurement or said scatter image and or said primary image, of a volume of interest placed between at least one the source and at least one detector.

7. Claim 1, said exposures are generated at similar or the same x ray energy level by at least one x ray emitting position or at least one x ray source

8. Claim 1, said image processing of said measurements include method to remove scatter, or separate scatter image from primary image

9. Claim 1, said image processing method involve beam blocker array, said region for derivation of said average pixel value is between beam blocker shadows.

10. Claim 1, wherein said image process method is reconstruction of 1D-7D images, or spectral imaging, and or material decomposition and or densitometry, and or density determination of one or more substances and or a volumetric unit or fluoroscope or quantativie analysis, including relative spatial positioning, interaction of components, recognition of shape, dimension, spatial distribution, relative proportion of substances, identification, tracking, quantification, segmentation, dynamic characterization, or analysis in AI algorithms or training AI algorithms

11. Claim 1 wherein in said adjustment , the said measurements, or said scatter image or said primary images are generated by stacking and or averaging of at least two separate measurements from two separate exposures.

12. Claim 1, wherein said primary images or said measurements have a scatter to primary ration of less than 1% or less than 5% or less than 10%,

13. claim 1, wherein said adjustment is conditional provided that the measurements or scatter or primary images and their counter parts generated by at least one exposure are different by more than a threshold.

14. Claim 1, wherein adjustment of at least one primary image generated by at least one exposure relative to at least one said primary image generated by at least one exposure of a different beam blocker array position, of no beam blocker array swap the missing data region of one primary image with those generated from another exposure at a different beam blocker array position or with no beam blocker

15. Claim 1, wherein said exposures are taken at approximately the same X -ray emitting position relative to the imaged object or relative to said detector

16. Claim 1, wherein said exposure are taken at approximately different x ray emitting position relative to the said detector or relative to the imaged subject

17. Claim 1, wherein said x ray emitting position relative to the detector is approximately different but within a defined distance in the mm range or less than 1 cm or 1cm, or less than 2cm or less than 3cm or less than 4 cm or between 4-5cm and the energy level is the approximately the same

18. Claim 1, the said adjustment are performed on pixels of measurements or said images generated by more than one exposure measurements relative to at least one said measurement, or at least one primary image or at least one said scatter image

19. Claim 1, wherein said adjustment is used in obtaining separate image for at least one substance in a VOI, in one or more following steps: establishing energy response function system of single, dual or multiple energy response function system imaging VOI with one or more substance

20. Claim 1, wherein

The images derived from additional exposure can then be compared, derive a ratio between the calibration image and actual image measurements so that the second and or third exposure and or more exposures can be adjusted for future image processing afterwards. Claim 1, wherein generate x ray radiation of single, or dual or multiple energy levels

21. Claim 1, wherein x-ray source generate x ray radiation of single, or dual or multiple energy levels

22. Claim 1 , said x ray image measurement system comprising

Said x ray source or said x ray emitting position relative to VOI is moved by at least one type of mover or steered by at least one type of steer or at least one type of mover and at least one type of steerer, in at least one dimension

23. Claim 1, at each said x -ray emitting position relative to the VOI x-ray radiation generated illuminates at least one projection path through at least a portion of VOI with variation in at least a portion of one voxel to produce at least one image of at least a portion of VOI, compared to the image of VOI from other x-ray emitting position relative to the VOI

24. Claim 1, wherein said scatter x ray or said primary image are generated in in the time domain, by using time of flight x ray sensor and x ray source or in the frequency domain, by using primary modulator or in the space domain, by using beam blocker array or x-ray beam selector, placed between the x ray source and detector

24 claim 1, said image or said measurement are used to reconstruct 3D image

25 claim 1, two or more said x ray emitting positions relative to VOI in travel in ID to 6D space radiate x ray to illuminate at least a portion of VOI to generate measurements to produce at least one data set to reconstruct a 3D image of VOI 26, claim 1, said image or said measurement from varied said x-ray emitting position relative to VOI are used to reconstruct 3D image

27. claim 1, said image or said measurement from varied said x-ray emitting position relative to VOI are used to reconstruct 3D image

Distance between two different x ray emitting positions to VOI is quantitatively related to a resolution Xc in the third dimension of VOI

28. claim 1, said x ray emitting position relative to VOI travels in at least one dimension in ID or 2D, or 3D, or 4D, or 5 D or 6D or 7D space, x ray measurements or said primary image generated from said emitting position

Reconstruct at least one ID - 7D image of at least a portion of VOI via at least one algorithms used in reconstruction of CT, tomosynthesis, Inverse geometry scanning fluoroscope, or their derivatives and related methods.

29. claim 1, wherein said x ray emitting position relative to VOI travels in at least one dimension in ID or 2D, or 3D, or 4D, or 5 D or 6D or 7D space, x ray measurements or said primary image generated from said emitting position

Reconstruct at least one ID - 7D image of at least a portion of VOI via at least one reconstruction algorithms selected from ART or art type or Monte Carlo , analytical or discrete model

30. claim 1, wherein said x ray emitting position relative to VOI travels in at least one dimension in ID or 2D, or 3D, or 4D, or 5 D or 6D or 7D space, x ray measurements or said primary image generated from said emitting position reconstruct at least one ID - 7D image of at least a portion of VOI via a selection of projection model base on line, pixel, blob, volume integral, or a selection of object model Analytical model, Discrete model, Pixel, Voxel, Blob, or through the use of a look up table or use a line, or strip, or volume integral, or pixel method

31. claim 1 , wherein wherein said x ray emitting position relative to VOI travels in at least one dimension in ID or 2D, or 3D, or 4D, or 5 D or 6D or 7D space, x ray measurements or said primary image generated from said emitting position reconstruct at least one ID - 7D image of at least a portion of VOI via partition of at least one column along a third dimension, said column is at least 1x2 in two dimensions

32. claim 1, wherein wherein said x ray emitting position relative to VOI travels in at least one dimension in ID or 2D, or 3D, or 4D, or 5 D or 6D or 7D space, x ray measurements or said primary image generated from said emitting position reconstruct at least one 3D image of at least a portion of VOI via at least one partition configuration, producing at least two or more columns, each said column is at least approximately lxl or 1x2 area sectional in the xy dimensions parallel to the detector or parallel to a virtual detector layer, said virtual detector is quantitative related to the detector layer in spatial location or corresponding pixel value third axis of column is perpendicular to a virtual detector plane or the detector plane 33. claim 1, wherein reconstruction of at least a portion of VOI is based on measurements on the area of the detector immediately below VOI on the projection path or each measurement of partitioned columns of VOI or of VOI for reconstruction is the detector region approximately below segmented column or VOI, variation of the center of said detector region is less than 0.5mm or less than 1mm, less than 5mm or less than 1cm or less than 2cm, or less than 5cm, or less than 10cm deviated than an original detector region or the original detector position for the measurement of the same VOI or each partitioned VOI. the said detector region spatial position within a detector is substantially the same or similar or within a region of detector which is essentially the used for the 3D reconstruction. Reconstruction of each partitioned column is based on below each column of VOI generated by partition

Partition configuration is made by the user or by automated digital algorithms, wherein partition is based on prior measurement of single energy, spectral image, 3D image to select partition configuration for example, faster and improved reconstruction or for application needs

The user use user interface in text or numerical input or graphic selection and input on the prior measurement to define each segmentation dimension and partition configurations said columns is parallel and then stitched together based on relative spatial positions or

Reconstruction of said columns is sequential, and then stitched together based on relative spatial positions

In case where the VOI moves or rotates, the reconstruction The spatial position of measurements pertaining to VOI or specific voxel or voxel region to be reconstructions shift on the detector

Or a virtual detector plane is configured where the relative pixel positions are fixed and dimension of the plane is fixed, and it is detector cell or pixels spatially correlates with each pixels in the detector region which collects measurement of VOI as the VOI moves.

Or voxel tracing method is used where the detector pixel or pixel regions collecting measurements of projection path involving a particular voxel is tracked based on the movement of VOI in 7d. make use of region of detector which is shifted spatially translates the spatial location of the region of detector collecting measurements of specific selected voxel or voxel regions in VOI or measurements of specific partitioned column to a virtual detector region

33. Method for 3D reconstruction

Projection measurements or derived primary image generated from at least one x ray emitting position of at least one x ray source by at least one detector of a image subject X ray emitting position travels relative to the VOI in at least one dimension in a 7D space Reconstruct at least a portion of VOI via at least one partition configuration, producing at least two or more columns, each said column is at least approximately lxl or 1x2 area sectional in the xy dimensions parallel to the detector or parallel to a virtual detector layer, said virtual detector is quantitative related to the detector layer in spatial location or corresponding pixel value third axis of column is perpendicular to a virtual detector plane or the detector plane, said third dimension is approximately equivalent to the thickness of VOI or a defined partition a substance within the VOI

34. Claim 33, wherein

Said measurement of partitioned columns of VOI or of VOI is the detector region approximately below the partitioned column or VOI, variation of the center of said detector region is less than 0.5mm or less than 1mm, less than 5mm or less than 1cm or less than 2cm, or less than 5cm, or less than 10cm deviated than an original detector region or the original detector position for the measurement of the same VOI or each segmented VOI.

36. Claim 33, wherein reconstruction, wherein VOI is partitioned into one or more volumetric regions comprising at least two voxels or columns along the third dimension, or along the approximate direction of beam paths of the x ray.

37 reconstruction in claim 33 each column may be at least in dimensions of 1 x 1 or 1 x2 in the xy direction and similar dimension in the third axis as the dimension of VOI in the third axis,

39 reconstruction in claim 33, wherein Each column may independently reconstructed

40 reconstruction in claim 33, wherein reconstructed columns stitched together based on relative spatial locations after reconstruction

41 reconstruction in 33, wherein partitioned reconstruction along the third dimension may occur and or selected field of interested may be reconstructed first or prioritized, or reconstructed simultaneously or parallel processed , may be stitched together afterwards or digitally label the spatial location of each segment or each partitions in VOI for display

42 reconstruction in claim 13, parallel processing is used to further speed up the reconstruction method.

43 reconstruction in claim 33, scatter is removed in the time domain, such with a time of flight sensor and source, frequency domain, such with a primary modulator and or spatial domain such as with beam selector or beam blocker array.

44 tomographic imaging method in claim 33, said primary image is generated, wherein material for attenuation of beam selector and beam blocker array can attenuate x ray beam of the system better than approximately 99%, or 99.9% or 99.99%

45 method in claim 33, wherein material for attenuation is mixed metal alloy or tungsten 46. claim 33, a least a portion of beam path related x ray source to detector passing through VOI are generated within less than 1 degree of source to VOI relative location

47 reconstruction in claim 33, wherein thickness of VOI is measured or assessed by the user or given for spectral imaging for material decompose or determining exposure or projection number or number of x ray emitting position

48 reconstruction in claim 33, at least one x ray emitting position of at least one x ray source generates single, dual or multiple energy x ray

48. reconstruction in claim 33, said measurement level or said primary image pixel value is adjusted based on variation or ratio of average pixel value of at least one region on the detector in approximately the same spatial location from said measurement or said derived image from a separate exposure.

49. reconstruction in claim 33, said primary image is generated by a movable beam blocker array and interpolation

50. reconstruction in claim 33, said primary image is generated by identification of the location of beam blocker array shadow in each measurement in the field of view

55. reconstruction in claim 33, said measurement level or said primary image pixel value is adjusted based on variation or ratio of average pixel value of at least one region on the detector in approximately the same spatial location from said measurement or said derived image from a separate exposure if said variation is beyond a predetermined threshold.

56. claim 33, wherein density of one or more substance of at least one thickness is derived through inversion of energy response function system established for at least one thickness range, where x-ray attenuation value and its corresponding at least one density levels or at least two density levels or more thickness levels for substance or at least two or more substance or composite materials

57. claim 33, wherein said x ray measurement system are calibrated by a phantom comprising at least one substance in a volumetric unit and or certain materials or substance, or composite or mixed material of certain ratio, at one or more thickness level for each material or having at least one thickness level or more thickness level for the whole phantom, the corresponding attenuation energy response function system at single, dual energy or multiple energy levels, stored in a database.

58. claim 33, wherein a sensor a sensor is used to measure the thickness of VOI, therefore determine the attenuation value for certain energy level by looking up a energy response function system database established by using a phantom containing known materials and or substances, at at least one or more thickness levels or at least one or more density levels the input x ray intensity can be determined.

57 claim 33, said reconstruction generates density values and attenuation values of at least one or more substance or at least one or more composite materials or mixture of materials, relative proportion between substances and mixture of materials in a volumetric unit, derived partly from an inversion of energy response function of at least one phantom, Said phantom comprising

At least two or one substances with known density at at least six thickness levels or more or at least six density level or more and placed at predetermined approximate spatial location or an approximate spatial location relative to x-ray tube or the detector, with each substance has a defined spatial distribution in 3D, relative spatial position to each other in 6D, which generates corresponding attenuation value for at least single x ray energy level or at least dual energy level or at least multiple energy level each certain thickness level

Said thickness level is similar or quantitative related to or derived from the VOI to be measured

Said substance in said phantom is similar or the same approximately or derivatives of substance in VOI to be measured

58 said reconstruction method in claim 3, a phantom is placed between x-ray measurement and detector, is comprised of at least two substance similar to substances in VOI to be measured, with feature sizes within micrometer, or between micronmeter to millimeter, or millimeter to centimeter, or centimeter

59, said reconstruction method in claim 33, a phantom is used to identify and quantify substance, wherein said phantom with voxels or at least one volumetric unit comprised - at least one or more of simulated tissues comprising brain tissues, lung tissues, soft tissues of various kind, bone tissues of various kind, metal material, synthetic material, contrast, and or aluminum and or Lucite, Tumor tissue, cations, circulation markers, perfusion markers, oxygenated, deoxygenated complexes, including hemoglobin molecules, and complexes each tissue with at least one density level, each located in its predefined spatial location and spatial distribution within the phantom.

60, claim 30, a phantom is used to establish energy response function for the x ray measurement system, calibration and establishment of an database periodically, every three years, or two years, or 3-15 years, or every 1 year or every l-12months or every day or every week or every 1-5 weeks. 61, claims 33, a phantom is used to establish energy response function system for inversion look up , said phantom is placed between the x ray source and detector,

62 in claim 33, wherein such a phantom can be purchased separate from a vendor or furnished with each x ray system by the x ray imaging service provider or by the manufacture or x ray imaging device or by seller of the x ray imaging device 63, claim 33, said x ray emitting position relative to VOI, wherein the use of at least one mover, or at least two movers or at least one steerer, or one mover and one steerer such as an electomagentic or electrostatic steer may be combined 64 , in claim 33 , wherein at least one or more hardware assembly and software is a part of a kit system or retrofit system

65. in claim 33, wherein at least a portion or a complete system in a mobile design or portable within a clinic and can be transported

66. in claim 33 , wherein at least a portion or the whole system can be transported through a standard door.

67. claim 33, wherein varied functional structure where the generator, source, at least one source, at least an approximately whole body system where there is a pillar for support, lower gantry for detector and cover, upper gantry for at least one source and motion system for moving the x ray emitting position for tomographic and general x ray imaging,

68. in claim 33, wherein such structure can be oriented 90 degrees rotation in either direction

69. in claim 33, wherein application of said x ray system and method is for medical medical or non medical use

70. in claim 33, wherein data derived from measurements and processed data can be sent to cloud, stored in a database, or stored in a hard drive, or disk or portable storage device for data transfer and further analysis.

71. claim 33, said primary image is generated from scatter removal of using movable beam blocker array during tomographic imaging acquisition, the missing data is replaced by a measurement at the same or a different x ray emitting position relative to the VOI during reconstruction

72. claim 33 density or attenuation measurement based on the adjustment of resolution or distance between x ray emitting positions, generates at least equivalent or more accurate density measurement with the total projection measurement number or the total x-ray emitting position relative to VOI to be less than 1%, or 5% or 10% or 20% or 30% of a typical number of projections for tomographic imaging or qCT.

73. claim 33, reconstruction wherein spatial frequency of at least one substance and or composites in 1-7D with dimensions, patterns, shapes, density, dynamic properties, repeated patterns and frequencies, and or ratio of substances can be derived and analyzed to further characterize, quantify, identify a substance, or materials and or composite, a segment and or VOI.

74. claim 33, density measurement or relative attenuation value or relative linear attenuation coefficient is achieved at within an accuracy or precision level of 1%, 2% and 3% or 4% or 5%.

75. claim 33, material decomposition or density measurement or segmentation based on said method generates data or measurements provides data or measurement accuracy and resolution, speed, sensitivity better than or replacing existing imaging procedures comprising angiograms, traditional CT perfusion, or traditional CT with contrast, PET/CT, MRI or in vivo optical methods or tomosynthesis imaging

76. claim 33, density measurement or relative attenuation value or relative linear attenuation coefficient is achieved at within an accuracy or precision level of 1%, 2% and 3% or 4% or 5%.

77. claim 33, material decomposition or density measurement or segmentation based on said method generates data or measurements provides data or measurement accuracy and resolution, speed, sensitivity better than imaging procedures comprising angiograms, CT perfusion, or CT with contrast, PET/CT, MRI and optical methods, which eliminate the use of contrast agents or substantially reduce the quantity of contrast agents used in said procedures

78. claim 33, density or relative attenuation value or relative linear attenuation coefficient within a volumetric unit derived quantitatively by said x ray measurement and reconstruction, generate relative substance ratio

78. claim 33, wherein density or relative attenuation value or relative linear attenuation coefficient within a volumetric unit derived quantitatively by said x ray measurement and reconstruction, differentiate tissues or substances or composites or component with density values or attenuation values or linear attentuation coefficient within 1%, 2% or less than 5% or less than 10% of each other

79. claim 33, wherein density or relative attenuation value or relative linear attenuation coefficient within a volumetric unit derived quantitatively by said x ray measurement and reconstruction, grey matter / white matter, spatial frequency, hyperintensity, microlesion, tumor, blood vessel, circulation markers, diseased tissue, interaction between molecular complexes

80. a payment method for purchases or services of an x-ray measurement system generate multiple dimension images, wherein a report of number of imaging procedures, images, can be presented to the user or administrative user and or subscription service provider, or vendor.

81. claim 80 said system or imaging services is purchase based on per unit device or subscription, pay per image, per imaging procedure,

82. claim 80, wherein the method is to generate invoice to be paid against online based on metered use volume or unit price, use digital payment method or automatic payment using including digital wallet, bank account, credit card, cryptocurrency, centralized currency, via ach, wiring, online check and bill pay, methods typically used in digital payment through a secure online login