781

Digital Subtraction
Angiography: Overview of
Technical Principles
Donald P. Harringto&
Lawrence M. Boxt
Philip D. Murray
Received June 8, 1 982; accepted after revision
July 12, 1982.
1 All authors: Department of Radiology, Harvard
Medical School, Brigham and W omens Hospital,
75 Francis St., Boston, MA 021 i 5. Address re-
print requests to D. P. Harrington.
AJR 1 39:781 -786, October 1982
o36i-8o3x/ 82/1394-0781 $00.00
American Roentgen Ray Society
The rapid development of equipment for digital subtraction angiography (DSA) has
created a new diagnostic imaging method, the limits of which have not been scientifi-
cally determined. Yet through aggressive marketing, the technique is already beginning
to permeate radiologic practice. The radiologist requires technical understanding of
the instrumentation for informed judgment on clinical applications. DSA depends on
the mating of high-resolution image-intensifier and television technology with comput-
erized information manipulation and storage. In this overview, the individual compo-
nents of the system are analyzed, from the generator to the image intensifier to the
television system to the associated computer. By examining the role of each compo-
nent, the current limitations and the areas of possible future development of DSA can
be understood. This provides a basis for dealing with current technology and for
evaluating the rapid technological changes that will occur over the next few years.
Digital subtraction angiognaphy (DSA) is an emerging technology that has
many characteristics in common with the development of the CT scanner during
the i 970s. Like CT scanning, DSA is a computer-assisted technique, integrating
digital data collection and computer processing to produce a medical image. A
further similarity is simultaneous development and marketing of equipment. In 5
years, CT evolved through four generations of scanners with profound changes
between the first and last generation, each of which was vigorously marketed. It
is reasonable to assume that DSA will also evolve significantly oven the next
several years, making selection of current equipment more difficult because of
concerns for premature technological obsolescence.
The theoretical basis of DSA also presents difficulties. Computer technology
and its associated jargon are one source. W hile the computer underlies CT
scanning, its operation does not need the active direction of the user. This is not
the case with DSA where image processing and a variety of viewing modes are
under user control.
A second cause for difficulty in evaluating DSA equipment is the need for a
component-by-component evaluation of the whole imaging chain. To achieve
optimum low-contrast visualization, the principal advantage of DSA, all links in
the imaging chain must be individually evaluated and optimized. In evaluating
individual components, four factors, contrast sensitivity, x-ray exposure, temporal
resolution, and spatial resolution, must each be considered for an understanding
of current and future DSA equipment.
This report defines the concepts that underlie the development of DSA and
evaluates each component in the imaging chain. Figure 1 provides a schematic
representation of the components of a composite DSA system. An attempt is
made to define some of the jargon associated with the computer technology and
to offer a background for evaluation of specific equipment and the possibilities
of further improvement.
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782 HARRINGTON ET AL. AJR:139, October 1982
Basic Principles of Digital Subtraction Angiography
DSA is part of the larger phenomenon known as digital
radiology. For DSA, the televised fluoroscopic image is
converted point-by-point to digital data. These data are then
manipulated in two operations [1 -5]. The first is the process
of image subtraction, also known as temporal or time sub-
traction. For this process, an image (the mask) obtained
before arrival of contrast material at the area of interest, is
placed into one of two digital memories. Then one or more
subsequent images are obtained after arrival of a contrast
bolus and placed into a second digital memory. The mask
image is digitally subtracted from the succeeding contrast
image, with the result that contrast-filled structures are
rendered visible free of background detail.
The second operation occurs after subtraction and is
expansion of the dynamic range of the subtracted image
which results in enhancement of the final image. This is
necessary because the range of contrast within the initial
subtracted image is very small. Subtraction and enhance-
ment are performed in real time, which means that the
processing of data is sufficiently rapid that the results are
available in time to influence the clinical examination. The
speed and apparent simplicity of computerized subtraction
are two major advantages of DSA over standard film sub-
traction angiography.
Several further steps are a routine part of the process.
Amplification of the output of the image intensifier is one.
This amplification may occur before or after digitization of
the data and may be fixed or selectable, depending on the
individual system. Choices for amplification include linear
and logarithmic modes. In the former, the unsubtracted
signal is amplified linearly, independent of its numerical
value. This is appropriate if there is uniform tissue density
in the field, such as in abdominal imaging. Logarithmic
amplification, in which amplification of the input signal is in
proportion to the signals strength, provides images of opa-
cified blood vessels unaffected by overlying high- and low-
density structures. This is the technique used in carotid-
vertebral imaging and represents the most common form of
image amplification. Square-root amplification is an expeni-
mental form being investigated at the University of Arizona.
After amplification, the image must be converted from its
analogue form to a digital form. The analogue image, which
is a representation (or analogue) of a fixed quantity by
means of a physical variable, such as shades of gray in the
radiographic film or the brightness of the image intensifier,
must be converted to the digital form in which a discrete
value, rather than a continuous variable, represents the x-
rays exiting an object. The digital signal is more accurately
and easily transmitted than an analogue signal, and the well
defined digital data make computer manipulation a relatively
simple task. It is much easier to perform image processing
on digital data than on analogue data.
This process of digitization is performed by an analogue-
to-digital converter (A/D converter), the efficiency of which
can be defined by the rate of digitization or conversion time
and intensity resolution or depth of digitization. This device
assigns the output signals of the television camera, specific
IMAGE PROCESSOR ADVANCED IMAGESTORAGE
Fig. 1 -Flow of information in generalized digital subtraction system.
Display console contains TV monitors for display of unprocessed images
from TV chain on left or processed images from image storage. Control
functions include x-ray generator settings and choice of images for manipu-
lation. Image manipulation can be simple subtraction/enhancement per-
formed by the image processor/computer or more complex procedures,
such as signal filtration or edge enhancement performed by advanced
image processor/computer. Different systems allocate these functions to
different hardware in different configurations. Current systems transfer pro-
cessed images to either analogue or digital short-term storage module.
Images stored in analogue system can be redigitized and further processed
or archived on disk or tape. Images stored in digital form can be directly
reprocessed or archived.
discrete digital values. The rate of digitization is in micro-
seconds for all systems. The depth of digitization (or exact-
ness of the assigned value) is important because it is related
to the number of shades of gray that can be displayed; the
greater the depth of digitization, the larger number of shades
of gray become available for the final image. Commercially
available A/D converters provide 256 gray (28 or 8 bits) to
1 ,024 gray (210 or 1 0 bits) levels. The latest commercial
entry on the market claims selective 4,096 gray levels (212
or 1 2 bits) for each discrete point in the image. The A/D
conversion process influences the ultimate resolution of the
system in that noise may be introduced by this process,
affecting image quality. At the depth of digitization de-
scnibed, there is no significant limitation to image quality in
the present DSA systems, but noise may be significant when
quantification of the image data is attempted. The concept
of noise in the DSA system will be discussed subsequently.
It is at this point after digitization that the image is entered
into one of the two memories and the subtraction and
enhancement are performed.
DSA may be performed in several different modes. Serial
imaging, the most common mode, is used where image
acquisition rates can be relatively low (from one to eight
images per second). This mode allows for the greatest
degree of flexibility in image acquisition and may be
achieved with a short-pulsed x-ray exposure or by a longer
exposure with variable addition and averaging of individual
television frames. The difference between these methods
will also be discussed later. A second mode, the continuous
or dynamic mode, uses an acquisition rate of 30 fnames/
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AJR:139, October 1982 DIGITAL SUBTRACTION ANGIOGRAPHY 783
The modern cesium-iodide image intensifier is one of the
strongest links in the DSA image chain, but the character-
sec with resultant shorter x-ray exposure times, decreased
photon flux per image, and decreased resolution in com-
panison to the serial mode. This mode is used for rapidly
changing dynamic processes, such as occur in cardiac
imaging. In both modes, a precontrast image is used as the
mask, followed by contrast injection. W ith a third imaging
mode, termed the time-interval-difference mode, a rate of
30 frames/sec is used, but the subtraction is performed
between each successive image rather than from a single
first image (i.e. , frame 2 minus frame 1 , frame 3 minus frame
2, and so on). This mode which displays the differences
between the two successive images has not been fully
explored and it is not available from all manufacturers.
Variations in the way data are handled between different
manufacturers become evident after the subtraction and
enhancement process. The images formed must either be
further processed for viewing and other manipulation or be
stored. This choice introduces several major considerations.
The first is whether these images should now be converted
back into an analogue format or remain digital. Ideally an
all-digital system is preferable, but storage is limited to a few
images unless improved and highly expensive technology is
used. But if the images are converted back to the analogue
format for storage, the number of images is no longer a
problem. Another issue is what memory and computing
capacities are necessary for further processing and/or
quantification, and finally, how should the data be ultimately
stored? This sketch of basic principles can be usefully
amplified by evaluating each of the individual components
of the imaging chain [6, 7].
DSA System Components
X-ray Tube and Generator
Two components can be taken together, the x-ray tube
and generator. W hile a high photon flux is a necessity for
DSA, standard angiographic x-ray tubes and generators are
generally adequate to the task. One notable exception is the
0.3-mm-focal-spot magnification tube, which does not allow
sufficient photon flux for DSA. A compromise x-ray tube
might have 0.6 and 1 .2 mm dual focal spots. DSA is routinely
accomplished with the larger focal spot, since focal-spot
size is not a major factor in this relatively low-resolution
system [8].
As to the generator, a highly desirable feature is computer
control. Such a system allows rapid determination of expo-
sure factors, without multiple trial and error exposures which
waste time and radiation. In a computer-controlled system,
a first approximation of the exposure factors is based on
the size of the patient, the area of interest, and such factors
as the number of video frames to be integrated if frame
averaging is used. A particular amperage is then picked,
and a test exposure (or preferable fluonoscopic exposure)
is made with automatic computation of the final exposure
factors to provide for the proper light output from the image
intensifier. This is a critical factor, as the light range within
which the TV camera functions is quite narrow compared to
the output range of the intensifier.
Another advanced design is control of the photon flux at
the intensifier face in relation to the opacity of injected
contrast material. For example, in an elderly patient with
poor renal function, a high x-ray dose could be chosen in
order to reduce the contrast dose necessary for the study.
In other circumstances, larger contrast injections allow
lesser x-ray exposure.
X-ray exposure is a misunderstood factor in DSA. The
procedure is lauded as a relatively noninvasive angiographic
substitute, which is also said to be possible with lessen x-
ray exposure compared to standard angiography. In a pre-
viously published clinical series, entrance skin dose rates
varied from 1 30-1 80 mR [2] to 46-i 75 mR [9] per image.
Our own experience suggests that dose rates are higher,
200-700 mR pen image. Radiation requirements to the
intensifier face are i -2 mR pen image depending on the
manufacturer. If 2 mR is delivered to the intensifier, then at
a minimum the entrance skin dose would be in the range of
200 mrad (2 mGy) per image. Dose reduction is not gener-
ally a high priority item but can be realized with a better
understanding of x-ray dose vs. contrast sensitivity of the
system. This subject should be examined when one consid-
ens individual DSA units. It is also worth pointing out that the
expected tube life in the DSA system may be shorter than
for angiographic tubes because of the large demands for
high photon flux in all systems.
A future prospect is that DSA may be performed with
energy subtraction rather than temporal subtraction. Energy
subtraction, an alternative being tested in several centers,
is based on subtraction of images of different kilovoltage,
rather than in different time [i 0]. The advantage is that the
different kilovoltages can be programmed within millisec-
onds of each other, so that motion no longer introduces an
artifact. Current fluonoscopically based DSA units are incap-
able of energy subtraction although one manufacturer is
planning to provide such a system in the future. The circuitry
of the generator must be extensively altered for this tech-
nique.
An important purchasing consideration is whether DSA
units can be added to existing equipment. Some companies,
mainly full-range x-ray equipment manufacturers, sell their
DSA units only as a package with their x-ray equipment,
while other companies provide an add-on unit to already
standing equipment. One reason given for not mixing equip-
ment is the need for optimization of all links in the imaging
chain. For example, a 5-year-old image intensifier may not
meet the specifications of a new cesium-iodide image inten-
sifier. A further argument is that synchronization of the DSA
equipment and the x-ray generators is complicated, and
incompatibilities may exist between different manufacturers
generators. However, the continued success of add-on in-
stallations tends to deny that argument, but the controversy
continues along well defined parochial lines.
Im age Intensifiers
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784 HARRINGTON ET AL. AJR:139, October 1982
istics of these intensifiers are somewhat different from stan-
dand fluorographic intensifiers [1 1 , 1 2]. For DSA applica-
tions, the image intensifier must operate at a 1 -2 mR per
image exposure rate without loss of contrast or resolution.
This is higher than for conventional fluoroscopy or even
cinefluoroscopy. This operation level alone can lead to
abnormalities such as pulse-charge defocusing or saturation
of the output phosphor in standard image intensifiers [6].
A second aspect of the intensifier operation is that at high
radiation levels, there is a correspondingly high gain or light
level which adversely affects the TV camera, and appropni-
ate variable filtration or aperture control is necessary for
proper light-level control [6]. This control is also necessary
to allow variability in the photon flux to the image intensifier
face as mentioned above.
The cesium-iodide image intensifier is the standard for
production DSA units, but state-of-the-art image intensifiers,
such as the Thompson CSF 96 intensifier and the Philips
1 4-inch (36 cm) intensifier, are proposed for future DSA
units. Further modifications will include thicker image phos-
phors in order to better control and use the light output [6].
The size of the image intensifier is also an important
factor, especially for demonstrating large vascular areas, as
in the extremities. Large intensifiers, such as the Philips 14-
inch (36 cm), offer superior contrast resolution capabilities,
but have the disadvantages of decrease in spatial resolution
due to the fixed matrix size of the image processor and the
considerable increase in cost.
Television System
The TV system serves to convert the optical image of the
image intensifier to an electronic signal that will be digitized.
Many believe this limits the overall resolution of the system,
and most manufacturers agree that the television compo-
nent of the DSA system must be state-of-the-art. Newly
developed video tubes, such as the Amperex 45-XQ ( frogs
head plumbicon), as incorporated into a Sierra Scientific
camera, and the lead oxide Videcon tube are examples [1,
2]. Concepts of noise and signal-to-noise ratio in TV systems
need special consideration.
Noise is anything that obscures a signal that is being
measured. In the context of the DSA system, it can be
caused by another electrical signal (interference) which
originates primarily from the TV camera, by some physical
process such as the quantum noise which originates from a
limitation in the number of x-rays per image, and from the
digitization noise which reflects the uncertainty associated
with quantizing the video signal into a finite number of digital
levels [8]. Signal-to-noise ratio (SNR) is the ratio of the
signal voltage to the noise voltage (100:1 , 1000:1 , etc.).
The SNR of a standard radiographic system is roughly
1 00:1 , while the standard fluoroscopic system raises this to
200:1 . These systems have poor low-contrast detectability
(low-contrast sensitivity). CT has an SNR of 2000:1 and,
like DSA, has high contrast sensitivity. In any ideal radio-
graphic system, the SNR should be limited by the quantum
statistics of the photon flux and not the components of the
system. Since the TV system is an important source of noise
for DSA, one method for improving the entire system is to
achieve the highest possible signal-to-noise ratio for the TV
link, which is obtained with state-of-the-art television sys-
tems.
W ork by Mistretta et al. [4, 5] in W isconsin indicates that
a standard plumbicon television system will give a 500:1
SNR and the newer frogs head plumbicon, 800:1 , and
they have suggested an alternative method for improving
the SNR of the imaging chain, which is known as signal
averaging. In this technique, a series of serially acquired
television frames are averaged ; that is, one collects a
sum of repetitive analogue signals and an average signal
is derived. This technique can provide an SNR of 1200:1
[4]. The disadvantages of this technique are that motion
artifacts may be introduced as the number of averaged
frames is increased, and that the need for long exposure
times increases the radiation exposure to the patient. Such
an averaging technique also demands a high-quality televi-
sion system with low lag and good image stability.
A second alternative is termed the snapshot mode [1],
which incorporates a slow-scan video technique where the
image is stored on the target of the TV pick-up tube and
then read out and digitized. This method is limited by the
need for a progressive TV readout where the entire video
frame, consisting of 525 lines per field is read out progres-
sively rather than the standard interlaced system where two
fields of 262.5 lines are alternatively placed on the video
frame. A further advantage of this latter system is economy
of radiation exposure in both dose and time, which de-
creases the chance for motion artifact. The disadvantage of
the snapshot method is that it will not serve for rapid
acquisition of images.
One limitation of most current television systems is that
they are formatted to 525 television raster lines. This is not
a limiting factor to resolution, however, if the matrix size
remains at 51 2 x 51 2. Manufacturers are introducing new
high-resolution television systems which will incorporate
1 ,000-raster-line (on more) television cameras and monitors.
This will improve the display of the image but will be most
useful only when larger matrices, such as 1 024 x 1024,
are incorporated into future image processing systems.
Im age Processor
The image processor is the heart of DSA because it is the
part of the system where subtraction and image enhance-
ment takes place. Two principal types have been developed.
The design concept put forth by Mistretta [1 3] at the Uni-
vensity of W isconsin was that a subtraction system should
be fast, easy to operate, and relatively inexpensive as com-
pared to standard film subtraction. The image processor
described by Mistretta is a hard-wined system, which means
that the subtraction circuits are fixed and not alterable or
programmable.
The design concept developed by Nudelman and col-
leagues at the University of Arizona (Ovitt et al. [1 1) calls for
a more complex system for subtraction and image enhance-
ment requiring considerable operator interaction with
choices to be made of types of amplifications and methods
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AJR:139, October 1982 DIGITAL SUBTRACTION ANGIOGRAPHY 785
of enhancement. In this more complicated system, program-
mable computer hardware (as opposed to Mistrettas non-
programmable subtraction circuits) control the system op-
eration. These systems are capable of handling patient
information and an array of alternative and more compli-
cated image manipulations (limited by the ability of program-
mers to write programs for them). A large number of addi-
tional algorithms are available as a part of some DSA units.
One such algorithm is for image-edge enhancement. This is
accomplished by increasing the contrast density in the
picture elements so that edges of areas where there is a
shift in contrast density are enhanced, thus making the
object more prominent. The application of such algorithms
are under active investigation, but the diagnostic value
beyond basic subtraction is still unknown.
Despite the increasing complexity of systems, subtraction
of the background still remains the most important function
of any DSA system. There are further options available for
image manipulation. An array processor is a device capable
of performing a series of image manipulations very rapidly.
One such manipulation is image reregistration, which shifts
the contrast image up on down in relation to the mask image
to compensate for motion between the mask and the con-
trast image. It is not unreasonable to suggest that the
greatest percentage of the image in DSA is due to the
subtraction process, while a further improvement is pro-
duced from contrast enhancement. Other manipulations of
the images, as previously described, have not yet had a
significant impact on the imaging process.
The matrix of the image processor (mentioned above)
needs further description. For our purpose, a matrix is a
rectangular array of picture elements (pixels). The size of
the matrix is defined by the number of pixels on a side. The
most common sizes in DSA are 256 x 256 and 51 2 x 512.
As the pixel is the smallest element in the picture, the
resolution of the system is defined by the pixel size. The
matrix size should also be considered in the context of the
image intensifier. If the field size is 6 inches (1 5 cm) in
diameter and the matrix size is 51 2 x 51 2, there are 3.3
pixels/mm (1 .6 line pairs/mm) or for a 9-inch-diam (23 cm)
field, 2.2 pixels/mm (1 .1 line pairs/mm). W ith a fixed matrix,
improved spatial resolution is achieved by decreasing the
field size. The loss in spatial resolution with increasing field
size is important in a system that is already deficient in
spatial resolution, as has been discussed with reference to
large-field intensifiers. Some users of large-field image in-
tensifiers have found that the loss of spatial resolution is
outweighed by the increased field size and contrast sensi-
tivity afforded by the advanced design of such intensifiers.
This points out that theoretical advantages and disadvan-
tages of any system or component should be carefully
evaluated in a clinical situation before conclusions about
utility or limitations are drawn. The same controversy will
arise when enlarged matrix sizes (e.g. , 1 024 x 1024)
become available. It is difficult to say whether the cost of
development and extra instrumentation needed (such as
extra memory and high-resolution TV system) will be offset
by the increased spatial resolution they may provide.
Data Transfer and Storage
The matrix size also defines the problem of data storage
and transfer. For example, a matrix size of 51 2 x 512
contains 262,1 44 bits of data on pieces of information for
storage in digital form. Data are conveniently quantified in
terms of bits and bytes (8 bits = 1 byte; 1 06 bytes = 1
megabyte). To double the matrix size from 51 2 x 51 2 to
1 024 x 1 024, one needs to quadruple the memory neces-
sary to store each image.
The basic problems with transfer and storage of data are
the time necessary to transfer large amounts of data and
the cost of storage. Until the introduction of CT scanning, x-
ray film storage was an acceptable mode for storage of all
radiographic images, but this is not the case for CT images
or DSA. In CT, the digital data are stored on magnetic tape
or magnetic disks. The average CT study will consist of
20-30 images, which requires 1 0 megabytes (about 1/3 mB/
image) to store. This is a large storage requirement. DSA is
similar. The DSA image processing is done in the computers
central processing unit (CPU) which allows for rapid pen-
formance of subtraction. But the CPU cannot be used for
storage of images. The processed images must be trans-
ferred to an auxiliary storage device. The rate of transfer of
data within the CPU is about 1 0 million bytes/sec, which
allows images obtained at 30 frames/sec to be subtracted
and enhanced. Transfer of the processed information to
storage is limited to about 500,000 bytes/sec. Thus, a 512
x 51 2 image contains so much information, that only two
images/sec can be transferred in digital form. To go faster
entails more advanced technology and expense. One solu-
tion that preserves the digital nature of this information is to
decrease the matrix size and therefore the amount of infon-
mation to be stored. Thus, at a 1 28 x 1 28 matrix, 30
frames/sec may be processed. The solution proposed by
Mistretta is to transfer images in an analogue form. In this
form, 512 x 512 matrix images can be acquired and pro-
cessed at 30 frames/sec without difficulty. The drawback
to this solution is that the images must be nedigitized for
further processing.
There are three further questions that must be addressed
concerning the storage and retrieval of images generated
by DSA systems. In what form will be data be stored? W hich
data will be stored? W hat storage devices will be used?
Conversion of data from digital to analogue causes im-
mediate loss of information content and subsequent degra-
dation of image quality. It is not clear, however, to what
extent this affects the diagnostic quality of the study. Fur-
thermore, conversion to analogue necessitates reconver-
sion to digital for later manipulation. Digital data can be
handled faster by DSA systems and is the basis for all
manipulation. Thus, it would be advantageous to keep all
stoned data in digital form. The present state of the technol-
ogy dictates, however, that analogue data storage is
cheaper and the only means for real-time, high-resolution,
high-frame-rate image acquisition. As digital technology ad-
vances, there will be greaten imperative to store all collected
data in the digital mode. Manufacturers of DSA systems are
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786 HARRINGTON ET AL. AJR:i39, October 1982
currently working to fulfill this imperative.
The question of which data to save is by no means a new
problem. Radiologists have always had this problem and
have yet to solve it. There exists a temptation to save all
data generated in a digital subtraction examination because
it appears to be less voluminous than a conventional film
examination. This, however, is misleading. The number of
images generated and processed by these electronic tech-
niques can be as many as hundreds per patient per exami-
nation, and this amount of data adds up quickly.
It is clear that unlimited space for electronic data storage
is no more available than for film storage. Thus, some
criteria for image selection must be developed. Should only
, diagnostic images be archived, all other image data
erased and lost forever? Is there any advantage to saving
only enhanced, as opposed to raw or unprocessed, im-
ages? Certainly there are more questions than answers.
Finally, a word about the image storage medium. Ana-
logue storage media (video magnetic tape and disk, and
film) theoretically limit the range of later reprocessing and
manipulating of archival data. For the present, video disk is
too expensive for large-scale image storage. This leaves
videotape or hard-copied film of CRT (cathode-ray-tube
video screen) images. The former is suboptimal; the latter
takes us back to the original problem of giving up electronic
information for analogue image. Most archived digital sub-
traction images are in the form of hard-copied film transpan-
encies of CRT images. This form of image storage is mad-
equate because it has been difficult to reliably reproduce
high-resolution CRT images on film. Although there are
theoretical reasons for optimism in its solution, this problem
has yet to be solved. A soon-to-be-available method of
digital image storage is the laser disk [14]. This technique
would provide permanent digital images stored in a random
access manner. It is analogous to a phonograph record, in
that one can select any spot on the disk to display. Magnetic
tape is a reasonably inexpensive means of digital data
storage, but has the drawbacks of being cumbersome (no
more than five or six patients images per 2,400 foot [732
m] reel) and necessitating sequential access to images. That
is, one image after another has to be passed until the
desired image data is reached. Until digital disks become
commercially available at reasonable cost, tape is probably
the best means of long-term digital data storage.
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