Chapter 13 Differentiation and the European Central Bank

As the guardian of the euro, the European Central Bank (ECB) oversees a prime example of differentiated integration. Against the backdrop of the multiple crises of the euro’s second decade, this contribution asks how the ECB has dealt with differentiation. It analyses both the historical development of the ECB’s relationship with euro outsiders – discerning between ‘old’ opt-outs and ‘new’ accession countries in the context of EU enlargement – and how differentiation affects ECB policymaking across its various tasks. Specifically, we analyze three logics of ‘deepening’ and ‘widening’: (1) Is the ECB encouraging euro membership among the ‘outs’? (2) Does it seek to reduce the impact of differentiation by keeping the ‘outs’ on board as much as possible? (3) Or does the ECB further cement differentiation by excluding the ‘outs’ from decision-making or deepening integration among the ‘ins’ only? We find that, in the past, the ECB has been hesitant to support ‘more Europe’. When the sovereign debt crisis posed a potentially existential threat, however, the ECB started adopting a more proactive role through both monetary policies and discursive acts. The COVID-19 crisis appears to confirm that the ECB has shed its narrow technocratic focus in order to provide political leadership in the EU. Yet, in our view, this does not suggest that the ECB is a competence maximizer ‘hardwired’ to ever closer union. Rather, the evidence suggests that it merely accepted greater powers and a deepening of integration to avert the threat of (differentiated) disintegration

Using a NPWE model observer to assess suitable image quality for a digital mammography quality assurance programme

A method of objectively determining imaging performance for a mammography quality assurance programme for digital systems was developed. The method is based on the assessment of the visibility of a spherical microcalcification of 0.2 mm using a quasi-ideal observer model. It requires the assessment of the spatial resolution (modulation transfer function) and the noise power spectra of the systems. The contrast is measured using a 0.2-mm thick Al sheet and Polymethylmethacrylate (PMMA) blocks. The minimal image quality was defined as that giving a target contrast-to-noise ratio (CNR) of 5.4. Several evaluations of this objective method for evaluating image quality in mammography quality assurance programmes have been considered on computed radiography (CR) and digital radiography (DR) mammography systems. The measurement gives a threshold CNR necessary to reach the minimum standard image quality required with regards to the visibility of a 0.2-mm microcalcification. This method may replace the CDMAM image evaluation and simplify the threshold contrast visibility test used in mammography qualit

Computed tomography commissioning programmes: how to obtain a reliable MTF with an automatic approach?

The purpose of this study was to assess the spatial resolution of a computed tomography (CT) scanner with an automatic approach developed for routine quality controls when varying CT parameters. The methods available to assess the modulation transfer functions (MTF) with the automatic approach were Droege's and the bead point source (BPS) methods. These MTFs were compared with presampled ones obtained using Boone's method. The results show that Droege's method is not accurate in the low-frequency range, whereas the BPS method is highly sensitive to image noise. While both methods are well adapted to routine stability controls, it was shown that they are not able to provide absolute measurements. On the other hand, Boone's method, which is robust with respect to aliasing, more resilient to noise and provides absolute measurements, satisfies the commissioning requirements perfectly. Thus, Boone's method combined with a modified Catphan 600 phantom could be a good solution to assess CT spatial resolution in the different CT plane

A strategy to qualify the performance of radiographic monitors

The purpose of this work was to compare standard desktop display systems with dedicated medical display systems. The set of image tests proposed by the American Association of Physicists in Medicine (AAPM TG18) was used to assess a Philips 107S desktop display system and a Siemens medical display. Three observers performed the subjective assessment, in a non-concerted manner. The objective assessment was performed using a CCD camera according to the AAPM TG18 procedure. The results clearly demonstrate the inadequacy of standard desktop display systems in the framework of diagnostic radiology. Moreover, a good correlation between the subjective and objective assessment methods was obtaine

Assessment of radiographic screen-film systems: a comparison between the use of a microdensitometer and a drum film digitiser

A high-end drum film digitiser (Tango, Germany) and a calibrated linear microdensitometer developed by PTB were used to assess the modulation transfer function (MTF) and the noise power spectra (NPS) of 3 mammographic screen film systems at optical density levels of 0.8, 1.5 and 2.5. The use of a drum scanner to assess MTF and NPS data appears to be adequate but requires an appropriate characterisation of the scanner to verify its internal noise level and its MTF. It is further necessary to calibrate the scanner output in terms of visual diffuse optical densities. Processing of two-dimensional digital data of grating images need to be more strictly defined for accurate MTF measurements of screen-film systems. Nevertheless, even now it seems to be feasible to use commercially available high-end and well calibrated scanners to assess screen film systems. This is especially important for quality assurance purposes because important parameters of screen film systems such like MTF and NPS can now be determined without using sophisticated microdensitometers which are not commercially availabl

Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients

The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times mor

Fluoroscopy-guided procedures in cardiology: is patient exposure being reduced over time?

The number of fluoroscopy-guided procedures in cardiology is increasing over time and it is appropriate to wonder whether technological progress or change of techniques is influencing patient exposure. The aim of this study is to examine whether patient dose has been decreasing over the years. Patient dose data of more than 7700 procedures were collected from two cardiology centres. A steady increase in the patient dose over the years was observed in both the centres for the two cardiological procedures included in this study. Significant increase in dose was also observed after the installation of a flat-panel detector. The increasing use of radial access may lead to an increase in the patient exposure. The monitoring of dose data over time showed a considerable increase in the patient exposure over time. Actions have to be taken towards dose reduction in both the centre

Derivation of an observer model adapted to irregular signals based on convolution channels.

Anthropomorphic model observers are mathe- matical algorithms which are applied to images with the ultimate goal of predicting human signal detection and classification accuracy across varieties of backgrounds, image acquisitions and display conditions. A limitation of current channelized model observers is their inability to handle irregularly-shaped signals, which are common in clinical images, without a high number of directional channels. Here, we derive a new linear model observer based on convolution channels which we refer to as the "Filtered Channel observer" (FCO), as an extension of the channelized Hotelling observer (CHO) and the nonprewhitening with an eye filter (NPWE) observer. In analogy to the CHO, this linear model observer can take the form of a single template with an external noise term. To compare with human observers, we tested signals with irregular and asymmetrical shapes spanning the size of lesions down to those of microcalfications in 4-AFC breast tomosynthesis detection tasks, with three different contrasts for each case. Whereas humans uniformly outperformed conventional CHOs, the FCO observer outperformed humans for every signal with only one exception. Additive internal noise in the models allowed us to degrade model performance and match human performance. We could not match all the human performances with a model with a single internal noise component for all signal shape, size and contrast conditions. This suggests that either the internal noise might vary across signals or that the model cannot entirely capture the human detection strategy. However, the FCO model offers an efficient way to apprehend human observer performance for a non-symmetric signal