The effect of spatial noise-reduction filtering on human observer detection of stationary cylinders mimicking arteries, catheters, and guide wires in x-ray fluoroscopy was investigated in both single image frames and image sequences. Ideal edge-preserving spatial filtering was simulated by filtering of the noise before addition of the target cylinder. This allowed us to separate the effect of edge blurring from those of noise reduction and spatial noise correlation. We used three different center-weighted averagers that reduced pixel noise variance by factors of 0.75, 0.50, and 0.25. As compared with no filtering, the effect of filtering on detection in single images was statistically insignificant. This indicated an adverse effect of spatial noise correlation on detection that countered the effect of noise reduction. By comparison, spatial filtering significantly improved detection in image sequences and yielded potential x-ray dose savings of 26–34%. Comparison of results with two observer models suggested that human observers have an improved detection efficiency in spatially filtered image sequences as compared with white-noise sequences. Pixel noise reduction, a measure commonly used to assess filter performance, overestimated the effect of filtering on detection and was not a good indicator of image quality. We conclude that edge-preserving spatial filtering is more effective in sequences than in single images and that such filtering can be used to improve image quality in noisy image sequences such as x-ray fluoroscopy.
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