Expanding generalized contrast-to-noise ratio into a clinically relevant measure of lesion detectability by considering size and spatial resolution.

Purpose: Early image quality metrics were often designed with clinicians in mind, and ideal metrics would correlate with the subjective opinion of practitioners. Over time, adaptive beamformers and other post-processing methods have become more common, and these newer methods often violate assumptions of earlier image quality metrics, invalidating the meaning of those metrics. The result is that beamformers may "manipulate" metrics without producing more clinical information.

Approach: In this work, Smith et al.'s signal-to-noise ratio (SNR) metric for lesion detectability is considered, and a more robust version, here called generalized SNR (gSNR), is proposed that uses generalized contrast-to-noise ratio (gCNR) as a core. It is analytically shown that for Rayleigh distributed data, gCNR is a function of Smith et al.'s $C_{\psi }$ (and therefore can be used as a substitution). More robust methods for estimating the resolution cell size are considered. Simulated lesions are included to verify the equations and demonstrate behavior, and it is shown to apply equally well to in vivo data.

Results: gSNR is shown to be equivalent to SNR for delay-and-sum (DAS) beamformed data, as intended. However, it is shown to be more robust against transformations and report lesion detectability more accurately for non-Rayleigh distributed data. In the simulation included, the SNR of DAS was $4.4\pm 0.8$ , and minimum variance (MV) was $6.4\pm 1.9$ , but the gSNR of DAS was $4.5\pm 0.9$ , and MV was $3.0\pm 0.9$ , which agrees with the subjective assessment of the image. Likewise, the ${\mathrm{DAS}}^2$ transformation (which is clinically identical to DAS) had an incorrect SNR of $9.4\pm 1.0$ and a correct gSNR of $4.4\pm 0.9$ . Similar results are shown in vivo.

Conclusions: Using gCNR as a component to estimate gSNR creates a robust measure of lesion detectability. Like SNR, gSNR can be compared with the Rose criterion and may better correlate with clinical assessments of image quality for modern beamformers.