Volume 37, Issue 12, December 2010
- medical physics letters
- vision 20/20
- radiation therapy physics
- radiation imaging physics
- radiation measurement physics
- magnetic resonance physics
- nuclear medicine physics
- ultrasound physics
- thermotherapy physics
- anatomy and physiology
- radiation protection physics
- books and publications
Index of content:
Co-60 tomotherapy is the treatment modality of choice for developing countries in transition toward IMRT37(2010); http://dx.doi.org/10.1118/1.3481358View Description Hide Description
- MEDICAL PHYSICS LETTERS
37(2010); http://dx.doi.org/10.1118/1.3512796View Description Hide DescriptionPurpose:
The cardiovascular system (CVS) regulation can be studied from acentral viewpoint, through heart rate variability (HRV) data, and from a peripheral viewpoint, through laser Doppler flowmetry (LDF) signals. Both the central and peripheral CVSs are regulated by several interacting mechanisms, each having its own temporal scale. The central CVS has been the subject of many multiscale studies. By contrast, these studies at the level of the peripheral CVS are very recent. Among the multiscale studies performed on the central CVS data, multiscale entropy has been proven to give interesting physiological information for diagnostic purposes. However, no multiscale entropyanalysis has been performed on LDF signals. The authors’ goal is therefore to propose a first multiscale entropy study of LDF data recorded in healthy subjects.Methods:
The LDF signals recorded in the forearm of seven healthy subjects are processed. Their period sampling is, and coarse-graining scales from to are studied. Also, for validation, the algorithm is first tested on synthetic signals of known theoretical multiscale entropy.Results:
The results reveal nonmonotonic evolution of the multiscale entropy of LDF signals, with a maximum at small scales around and a minimum at longer scales around , singling out in this way two distinctive scales where the LDF signals undergo specific changes from high to low complexity. This also marks a strong contrast with the HRV signals that usually display a monotonic increase in the evolution of the multiscale entropy.Conclusions:
Multiscale entropy of LDF signals in healthy subjects shows variation with scales. Moreover, as the variation pattern observed appears similar for all the tested signals, multiscale entropy could potentially be a useful stationary signature for LDF signals, which otherwise are probe-position and subject dependent. Further work could now be conducted to evaluate possible diagnostic purposes of the multiscale entropy of LDF signals.
- VISION 20/20
37(2010); http://dx.doi.org/10.1118/1.3515456View Description Hide Description
The use of small animal models in basic and preclinical sciences constitutes an integral part of testing new pharmaceutical agents prior to commercial translation to clinical practice. Whole-body small animal imaging is a particularly elegant and cost-effective experimental platform for the timely validation and commercialization of novel agents from the bench to the bedside. Biomedical imaging is now listed along with genomics, proteomics, and metabolomics as an integral part of biological and medical sciences. Miniaturized versions of clinical diagnostic modalities, including but not limited to microcomputed tomography, micromagnetic resonance tomography, microsingle-photon-emission tomography, micropositron-emission tomography, optical imaging, digital angiography, and ultrasound, have all greatly improved our investigative abilities to longitudinally study various experimental models of human disease in mice and rodents. After an exhaustive literature search, the authors present a concise and critical review of in vivo small animal imaging, focusing on currently available modalities as well as emerging imaging technologies on one side and molecularly targeted contrast agents on the other. Aforementioned scientific topics are analyzed in the context of cancer angiogenesis and innovative antiangiogenic strategies under-the-way to the clinic. Proposed hybrid approaches for diagnosis and targeted site-specific therapy are highlighted to offer an intriguing glimpse of the future.
- RADIATION THERAPY PHYSICS
37(2010); http://dx.doi.org/10.1118/1.3511516View Description Hide DescriptionPurpose:
Target tracking using dynamic multileaf collimator (DMLC) is a promising approach for intrafraction motion management in radiation therapy. The purpose of this work is to develop a DMLC tracking algorithm capable of delivering volumetric-modulated arc therapy (VMAT) to the targets that experience two-dimensional (2D) rigid motion in the beam’s eye view.Methods:
The problem of VMAT delivery to moving targets is formulated as a control problem with constraints. The relationships between gantry speed, gantry acceleration,MLC leaf-velocity, dose rate, and target motion are derived. An iterative search algorithm is developed to find numerical solutions for efficient delivery of a specific VMAT plan to the moving target using 2D DMLC tracking. The delivery of five VMAT lung plans is simulated. The planned and delivered fluence maps in the target-reference frame are calculated and compared.Results:
The simulation demonstrates that the 2D tracking algorithm is capable of delivering the VMAT plan to a moving target fast and accurately without violating the machine constraints and the integrity of the treatment plan. The average delivery time is only 29 s longer than that of no-tracking delivery, 101 versus 72 s, respectively. The fluence maps are normalized to 200 MU and the average root-mean-square error between the desired and the delivered fluence is 2.1 MU, compared to 14.8 MU for no-tracking and 3.6 MU for one-dimensional tracking.Conclusions:
A locally optimal MLC tracking algorithm for VMAT delivery is proposed, aiming at shortest delivery time while maintaining treatment plan invariant. The inconsequential increase of treatment time due to DMLC tracking is clinically desirable, which makes VMAT with DMLC tracking attractive in treating moving tumors.
A comparison of the respiratory signals acquired by different respiratory monitoring systems used in respiratory gated radiotherapy37(2010); http://dx.doi.org/10.1118/1.3512798View Description Hide DescriptionPurpose:
Respiratory monitoring systems are used to detect the respiratory phase of patients during the planning and administration of respiratory gated radiotherapy by using four-dimensional computed tomography (4DCT) or 4D positron-emission tomography/CT (4DPET/CT) and the linear accelerator(linac), respectively. Generally, identical respiratory monitoring systems are used for 4DCT, 4DPET/CT, and linac. However, different systems are sometimes used in combination because the accessibility of the respiratory monitoring systems may differ by manufacturer. The combined use of different respiratory monitoring systems in phase-based gating is of concern because the differences in the timing of tags (end-respiration signals algorithmically determined by the respiratory monitoring system), defined by the two systems, may result in phase differences. The purpose of this study is to estimate this difference and evaluate its effect on 4DCT data.Methods:
Ten patients (seven men and three women) with a median age of 75 yr (range: 57–84 yr) were treated by gated stereotactic body radiation therapy between April and December 2009. Two types of respiratory monitoring systems—RPM (Varian Medical Systems) and AZ-733V (Anzai MEDICAL)—were placed on the abdominal surface of the patients, and the respiratory signals were acquired by both systems. The relationship between the amplitude peak and the tag obtained by each respiratory system was analyzed for each patient. Further, the 4DCT images were reconstructed by using the signals obtained from both the RPM and the AZ-733V systems, and the tumor volumes and the tumor centroid positions in the craniocaudal plane were analyzed for each patient.Results:
The correlation factor between the respiratory signals from the RPM system and AZ-733V system was 0.990 (range: 0.940–0.994). The amplitude peak of the RPM system corresponded well with that of the AZ-733V system. The deviation of the phase difference for all the patients ranged from to . In the case of some patients, differences were noted between the two systems in the estimation of the tumor centroid position and tumor shape.Conclusions:
The estimation of the position of the tumor centroid and tumor shape may vary with the use of different respiratory monitoring systems. This implies that it is preferable to use the same respiratory monitoring system with 4DCT, 4DPET-CT, and linac.
A novel off-axis scanning method for an enlarged ellipse cone-beam computed tomography field of view37(2010); http://dx.doi.org/10.1118/1.3514130View Description Hide DescriptionPurpose:
Current on-board imaging systems commonly used by modern linear accelerators(LINACs) have a limited field of view (FOV) for a cone-beam CT(CBCT) scan, which is typically less than 50 cm. Consequently, truncation artifacts often occur for large patients. The goal of this work is to investigate a novel method to increase the FOV for current on-board CBCT systems.Methods:
When a large patient is scanned with CBCT, any region outside the FOV is only partially sampled within a short range of projection angles, and at other angles no x-ray beams may pass through that region. To increase the sampling rate for the region outside the FOV, we have designed a new source trajectory by shifting the center of rotation during a CBCT scan. This resulted in a reduced sampling rate at the central area and increased sampling rate at the edges. The tradeoff led to a more balanced sampling for an enlarged FOV. An iterative algorithm was also developed to reconstruct the CTimage under the new sampling scheme using a compressed sensing technique.Results:
The method was validated by numerical simulations mimicking a Varian Trilogy CBCT system, and it was found that artifact-free images could be obtained with the FOV as large as 80 cm.Conclusions:
The new CT scanning trajectory can be easily realized under current clinical setup with little modification of the control system, and this can be useful for treating obese patients.
37(2010); http://dx.doi.org/10.1118/1.3512792View Description Hide DescriptionPurpose:
Radiochromic film has become an important tool to assess complex dose distributions. In particular, EBT was accepted by the scientific community as a reference two-dimensional detector. Recently, Gafchromic EBT2 has replaced old film, providing new improvements in both accuracy and handling.Methods:
This work presents a dosimetric study of the new Gafchromic EBT2 using an Epson 10000XL flatbed scanner, also comparing the results with EBT film as reference when necessary. The most important filmcharacteristics have been studied, such as ambient light sensitivity, different possibilities of the three RGB color channels, postirradiation development, high dose behavior, exposition at temperatures similar to the human body, and dependence on orientation during the scanning process.Results:
The results obtained confirm a considerably lower sensitivity to ambient light of EBT2, as well as a fast stabilization of the film within 2 h. It has also been found that the green channel has a better behavior at high dose levels up to 35 Gy, in addition to good behavior of the red channel at doses below 10 Gy. Other features, such as temperature independence and scanning orientation dependence, have also been shown.Conclusions:
Gafchromic EBT2 can be used for clinical practice in the same way as the old EBT film. However, a much easier handling as the result of all new enhancements improves film behavior, expanding in this way the potential applications of radiochromic filmdosimetry.
Alanine/EPR dosimetry applied to the verification of a total body irradiation protocol and treatment planning dose calculation using a humanoid phantom37(2010); http://dx.doi.org/10.1118/1.3496355View Description Hide DescriptionPurpose:
To avoid complications in total body irradiation (TBI), it is important to achieve a homogeneous dose distribution throughout the body and to deliver a correct dose to the lung which is an organ at risk. The purpose of this work was to validate the TBI dose protocol and to check the accuracy of the 3D dose calculations of the treatment planning system.Methods:
Dosimetry based on alanine/electron paramagnetic resonance (EPR) was used to measure dose at numerous locations within an anthropomorphic phantom (Alderson®) that was irradiated in a clinical TBI beam setup. The alanine EPRdosimetry system was calibrated against water calorimetry in a Co-60 beam and the absorbed dose was determined by the use of “dose-normalized amplitudes” . The dose rate of the TBI beam was checked against a Farmer ionization chamber. The phantom measurements were compared to 3D dose calculations from a treatment planning system (Pinnacle®) modeled for standard dose calculations.Results:
Alanine dosimetry allowed accurate measurements which were in accordance with ionization chamber measurements. The combined relative standard measurement uncertainty in the Alderson phantom was. The humanoid phantom was irradiated to a reference dose of 10 Gy, limiting the lungdose to 7.5 Gy. The ratio of the average measured dose midplane in the craniocaudal direction to the reference dose was 1.001 with a spread of ±4.7% (1 sd). Dose to the lung was measured in 26 locations and found, in average, 1.8% lower than expected. Lungdose was homogeneous in the ventral-dorsal direction but a dose gradient of was observed in the craniocaudal direction midline within the lung lobe. 3D dose calculations (Pinnacle®) were found, in average, 2% lower compared to dose measurements on the body axis and 3% lower for the lungs.Conclusions:
The alanine/EPR dosimetry system allowed accurate dose measurements which enabled the authors to validate their TBI dose protocol. Dose calculations based on a collapsed cone convolution dose algorithm modeled for regular treatments are accurate within 3% and can further be improved when the algorithm is modeled for TBI.
Combining registration and active shape models for the automatic segmentation of the lymph node regions in head and neck CT images37(2010); http://dx.doi.org/10.1118/1.3515459View Description Hide DescriptionPurpose:
Intensity-modulated radiation therapy(IMRT) is the state of the art technique for head and neck cancertreatment. It requires precise delineation of the target to be treated and structures to be spared, which is currently done manually. The process is a time-consuming task of which the delineation of lymph node regions is often the longest step. Atlas-based delineation has been proposed as an alternative, but, in the authors’ experience, this approach is not accurate enough for routine clinical use. Here, the authors improve atlas-based segmentation results obtained for level II–IV lymph node regions using an active shape model (ASM) approach.Methods:
An average image volume was first created from a set of head and neck patient images with minimally enlarged nodes. The average image volume was then registered using affine, global, and local nonrigid transformations to the other volumes to establish a correspondence between surface points in the atlas and surface points in each of the other volumes. Once the correspondence was established, the ASMs were created for each node level. The models were then used to first constrain the results obtained with an atlas-based approach and then to iteratively refine the solution.Results:
The method was evaluated through a leave-one-out experiment. The ASM- and atlas-based segmentations were compared to manual delineations via the Dice similarity coefficient (DSC) for volume overlap and the Euclidean distance between manual and automatic 3D surfaces. The mean DSC value obtained with the ASM-based approach is 10.7% higher than with the atlas-based approach; the mean and median surface errors were decreased by 13.6% and 12.0%, respectively.Conclusions:
The ASM approach is effective in reducing segmentation errors in areas of low CT contrast where purely atlas-based methods are challenged. Statistical analysis shows that the improvements brought by this approach are significant.
37(2010); http://dx.doi.org/10.1118/1.3515457View Description Hide DescriptionPurpose:
The curative potential of external beam radiation therapy is critically dependent on having the ability to accurately aim radiation beams at intended targets while avoiding surrounding healthy tissues. However, existing technologies are incapable of real-time, volumetric, soft-tissue imaging during radiation beam delivery, when accurate target tracking is most critical. The authors address this challenge in the development and evaluation of a novel, minimally interfering, telerobotic ultrasound (U.S.) imaging system that can be integrated with existing medicallinear accelerators(LINACs) for therapy guidance.Methods:
A customized human-safe robotic manipulator was designed and built to control the pressure and pitch of an abdominal U.S. transducer while avoiding LINAC gantry collisions. A haptic device was integrated to remotely control the robotic manipulator motion and U.S. image acquisition outside the LINAC room. The ability of the system to continuously maintain high quality prostate images was evaluated in volunteers over extended time periods. Treatment feasibility was assessed by comparing a clinically deployed prostate treatment plan to an alternative plan in which beam directions were restricted to sectors that did not interfere with the transabdominal U.S. transducer. To demonstrate imaging capability concurrent with delivery,robot performance and U.S. target tracking in a phantom were tested with a 15 MV radiation beam active.Results:
Remote image acquisition and maintenance of image quality with the haptic interface was successfully demonstrated over 10 min periods in representative treatment setups of volunteers. Furthermore, the robot’s ability to maintain a constant probe force and desired pitch angle was unaffected by the LINAC beam. For a representative prostate patient, the dose-volume histogram (DVH) for a plan with restricted sectors remained virtually identical to the DVH of a clinically deployed plan. With reduced margins, as would be enabled by real-time imaging, gross tumor volume coverage was identical while notable reductions of bladder and rectal volumes exposed to large doses were possible. The quality of U.S. images obtained during beam operation was not appreciably degraded by radiofrequency interference and 2D tracking of a phantom object in U.S. images obtained with the beam on/off yielded no significant differences.Conclusions:
Remotely controlled robotic U.S. imaging is feasible in the radiotherapy environment and for the first time may offer real-time volumetric soft-tissue guidance concurrent with radiotherapydelivery.
37(2010); http://dx.doi.org/10.1118/1.3517866View Description Hide DescriptionPurpose:
This article aims to introduce a novel algorithm for fast beam angle selection in intensity modulated radiotherapy(IMRT).Methods:
The algorithm models the optimization problem as a beam angle ranking problem and chooses suitable beam angles according to their rank. A new parameter called “beam intensity profile perturbation score (BIPPS)” is used for ranking the beam angles. The BIPPS-based beam angle ranking implicitly accounts for the dose-volume effects of the involved structures. A simulated phantom case with obvious optimal beam angles is used to verify the validity of the presented technique. In addition, the efficiency of the algorithm was examined in three clinical cases (prostate, pancreas, and head and neck) in terms of DVH and dose distribution. In all cases, the judgment of the algorithm’s efficiency was based on the comparison between plans with equidistant beams (equal-angle-plan) and plans with beams obtained using the algorithm (suitable-angle-plan).Results:
It is observed from the study that the beam angle ranking function over BIPPS instantly picks up a suitable set of beam angles for a specific case. It takes only about 15 min for choosing the suitable beam angles even for the most complicated cases. The DVHs and dose distributions confirm that the proposed algorithm can efficiently reduce the mean or maximum dose to OARs, while guaranteeing the target coverage and dose uniformity. On the average, about 17% reduction in the mean dose to critical organs, such as rectum, bladder, kidneys and parotids, is observed. Also, about 12% (averaged) reduction in the maximum dose to critical organs (spinal cord) is observed in the clinical cases presented in this study.Conclusions:
This study demonstrates that the algorithm can be effectively applied to IMRT scenarios to get fast and case specific beam angle configurations.
37(2010); http://dx.doi.org/10.1118/1.3517837View Description Hide DescriptionPurpose:
To develop and implement a failure mode and effect analysis (FMEA)-based commissioning and quality assurance framework for dynamic multileaf collimator (DMLC) tumortracking systems.Methods:
A systematic failure mode and effect analysis was performed for a prototype real-time tumortracking system that uses implanted electromagnetic transponders for tumor position monitoring and a DMLC for real-time beam adaptation. A detailed process tree of DMLC tracking delivery was created and potential tracking-specific failure modes were identified. For each failure mode, a risk probability number (RPN) was calculated from the product of the probability of occurrence, the severity of effect, and the detectibility of the failure. Based on the insights obtained from the FMEA, commissioning and QA procedures were developed to check (i) the accuracy of coordinate system transformation, (ii) system latency, (iii) spatial and dosimetric delivery accuracy, (iv) delivery efficiency, and (v) accuracy and consistency of system response to error conditions. The frequency of testing for each failure mode was determined from the RPN value.Results:
Failures modes with were recommended to be tested monthly. Failure modes with were assigned to be tested during comprehensive evaluations, e.g., during commissioning, annual quality assurance, and after major software/hardware upgrades. System latency was determined to be . The system showed consistent and accurate response to erroneous conditions. Tracking accuracy was within 3%–3 mm gamma (100% pass rate) for sinusoidal as well as a wide variety of patient-derived respiratory motions. The total time taken for monthly QA was , while that taken for comprehensive testing was .Conclusions:
FMEA proved to be a powerful and flexible tool to develop and implement a quality management (QM) framework for DMLC tracking. The authors conclude that the use of FMEA-based QM ensures efficient allocation of clinical resources because the most critical failure modes receive the most attention. It is expected that the set of guidelines proposed here will serve as a living document that is updated with the accumulation of progressively more intrainstitutional and interinstitutional experience with DMLC tracking.
- RADIATION IMAGING PHYSICS
An iterative method for tomographic x-ray perfusion estimation in a decomposition model-based approach37(2010); http://dx.doi.org/10.1118/1.3495818View Description Hide DescriptionPurpose:
X-ray based tomographic blood perfusion imaging requires recovery of contrast time-attenuation-curves from dynamic projection data. When using slowly rotating imaging systems, this task is challenging due to nonsimultaneous projection acquisition. A dynamic reconstruction method is proposed that aims at compensating the lack of simultaneously acquired information by incorporating prior knowledge about the expected temporal contrast dynamics.Methods:
A decomposition model using temporal basis functions to approximate time-attenuation-curves is integrated into an iterative tomographic reconstruction method. The computationally efficient implementation of the proposed approach makes use of standard forward-projections and backprojections, as well as scalar products in image space. The critical issue of projection noise propagation is tackled by the application of regularization which is realized by the early stopping of iteration cycles and by the proper selection of smooth temporal basis functions. The performance of the proposed dynamic reconstruction approach is evaluated in a simulation study concerning various aspects: Noise propagation and regularization, specification of the temporal model, and type of acquisition mode.Results:
The evaluation based on dynamic phantom data indicates that tomographic recovery of contrast time-attenuation-curves in tissue can be achieved with an average range of accuracy of (with respect to dynamic peak attenuation) under ideal noise-free conditions. The relative estimation error for arterial time-attenuation-curves is in the range of 8%, which is due to faster contrast dynamics in the artery. In general, performance depends on the level of acquired information contained in the projection data, which is mainly influenced by the type of rotational acquisition mode; restrictions in angular range and speed can lead to limited accuracy. The analysis of propagated projection noise in a statistical bias-variance framework reveals relative noise levels in estimated time-attenuation-curves of 3%–4% in tissue regions and below 1% in vessels when using optimized settings for regularization. Here, the effect of noise suppression depends on the interrelation between the number of iteration cycles and the constraints imposed by the temporal decomposition model.Conclusions:
For usage with slowly rotating imaging systems, the presented model-based iterative dynamic reconstruction method is capable of recovering contrast time-attenuation-curves related to tissue perfusion. The proposed regularization framework is an effective means to limit the impact of projection noise, which is a factor dominating estimation accuracy in tissue regions.
37(2010); http://dx.doi.org/10.1118/1.3501883View Description Hide Description
Purpose: This work aimed to extend Fourier-based imaging metrics for modeling and predicting quantitative imaging performance. The new methodology was applied to the platform of breast tomosynthesis for investigating the influence of acquisition parameters (e.g., acquisition angle and dose) on quantitative imaging performance.
Methods: Two quantitative imaging tasks were considered: Area estimation and volume estimation of a 4 mm diameter spherical target. The maximum likelihood estimator yielded training data to generate a size estimation task function, which was combined with the MTF and NPS to predict estimation performance by computing an “estimability index” analogous to the detectability index. Estimation performance for the two tasks was computed as a function of acquisition angle and dose. The results were used for system optimization in terms of quantitation performance and further compared to the detectability index for the detection of the same spherical target.
Results: The estimability index computed with the size estimation tasks correlated well with precision measurements for area and volume estimation over a broad range of imaging conditions and provided a meaningful figure of merit for quantitative imaging performance and optimization. The results highlighted that optimal breast tomosynthesis acquisition parameters depend significantly on imaging task and dose. At nominal dose (1.5 mGy), mass detection was optimal at an acquisition angle of 85°, while area and volume estimation for the same mass were optimal at and 164° acquisition angles, respectively.
Conclusions: These findings provide an initial validation that the Fourier-based metrics extended to estimation tasks can represent a meaningful metric and predictor of quantitative imaging performance. The optimization framework also revealed trade-off between anatomical noise and systemnoise in volumetric imagingsystems potentially identifying different optimal acquisition parameters than currently used in breast tomosynthesis and CT.
Comparison of radiation exposure and associated radiation-induced cancer risks from mammography and molecular imaging of the breasta)37(2010); http://dx.doi.org/10.1118/1.3512759View Description Hide DescriptionPurpose:
Recent studies have raised concerns about exposure to low-dose ionizing radiation from medical imaging procedures. Little has been published regarding the relative exposure and risks associated with breast imaging techniques such as breast specific gamma imaging (BSGI), molecular breast imaging (MBI), or positron emission mammography(PEM). The purpose of this article was to estimate and compare the risks of radiation-induced cancer from mammography and techniques such as PEM, BSGI, and MBI in a screening environment.Methods:
The authors used a common scheme for all estimates of cancer incidence and mortality based on the excess absolute risk model from the BEIR VII report. The lifetime attributable risk model was used to estimate the lifetime risk of radiation-induced breast cancer incidence and mortality. All estimates of cancer incidence and mortality were based on a population of 100 000 females followed from birth to age 80 and adjusted for the fraction that survives to various ages between 0 and 80. Assuming annual screening from ages 40 to 80 and from ages 50 to 80, the cumulative cancer incidence and mortality attributed to digital mammography, screen-film mammography, MBI, BSGI, and PEM was calculated. The corresponding cancer incidence and mortality from natural background radiation was calculated as a useful reference. Assuming a 15%–32% reduction in mortality from screening, the benefit/risk ratio for the different imaging modalities was evaluated.Results:
Using conventional doses of 925 MBq Tc-99m sestamibi for MBI and BSGI and 370 MBq F-18 FDG for PEM, the cumulative cancer incidence and mortality were found to be 15–30 times higher than digital mammography. The benefit/risk ratio for annual digital mammography was for both the 40–80 and 50–80 screening groups, but dropped to 3:1 for the 40–49 age group. If the primary use of MBI, BSGI, and PEM is in women with dense breast tissue, then the administered doses need to be in the range 75–150 MBq for Tc-99m sestamibi and 35 MBq–70 MBq for F-18 FDG in order to obtain benefit/risk ratios comparable to those of mammography in these age groups. These dose ranges should be achievable with enhancements to current technology while maintaining a reasonable examination time.Conclusions:
The results of the dose estimates in this study clearly indicate that if molecular imaging techniques are to be of value in screening for breast cancer, then the administered doses need to be substantially reduced to better match the effective doses of mammography.
Monte Carlo calculation of imaging doses from diagnostic multidetector CT and kilovoltage cone-beam CT as part of prostate cancer treatment plans37(2010); http://dx.doi.org/10.1118/1.3512791View Description Hide DescriptionPurpose:
To calculate imagingdoses to the rectum, bladder, and femoral heads as part of a prostate cancertreatment plans, assuming an image guided radiation therapy(IGRT) procedure involving either the multidetector CT (MDCT) or kilovoltage cone-beam CT (kV CBCT).Methods:
This study considered an IGRTtreatment plan for a prostate carcinoma patient involving 50.4 Gy from 28 initial fractions and a boost of 28.8 Gy from 16 fractions. A total of 45 CTimaging procedures, each involving a MDCT or a kV CBCT scan procedure, were carefully modeled using theMCNPX code version 2.5.0. The MDCT scanner model is based on the GE LightSpeed 16-MDCT scanner and the kV CBCTscanner model is based on the Varian On-Board Imager using parameters reported by the CT manufacturers and literatures. A patient-specific treatment planning CT data set was used to construct the phantom for the dose calculation. The target, organs-at-risk (OARs), and background voxels in the CT data set were categorized into six tissue types according to CT numbers for Monte Carlo calculations.Results:
For a total of 45 imaging procedures, it was found that the rectum received 78.4 and 76.7 cGy from MDCT and kV CBCT, respectively. The bladder received slightly greater doses of 82.4 and 77.9 cGy, while the femoral heads received much higher doses of 182.3 and 141.3 cGy from MDCT and kV CBCT, respectively. To investigate the impact of these imagingdoses on treatment planning, OAR doses from MDCT or kV CBCTimaging procedures were added to the corresponding dose matrix reported by the original treatment plans to construct dose volume histograms. It was found that after the imagingdose is added, the rectum volumes irradiated to 75 and 70 Gy increased from 13.9% and 21.2%, respectively, in the original plan to 14.8% and 21.8%. The bladder volumes receiving 80 Gy increased to 4.6% from 4.1% in the original plan and the volume receiving 75 Gy increased to 7.9% from 7.5%. All values remained within the tolerance levels:, for rectum and , for bladder. The irradiation of femoral heads was also acceptable with no volume receiving .Conclusions:
IGRT procedures can irradiate the OARs to an imagingdose level that is great enough to require careful evaluation and perhaps even adjustment of original treatment planning in order to still satisfy the dose constraints. This study only considered one patient CT because the CT x rays cover a relatively larger volume of the body and the dose distribution is considerably more uniform than those associated with the therapeutic beams. As a result, the dose to an organ from CTimagingdoses does not vary much from one patient to the other for the same CT settings. One factor that would potentially affect such CTdose level is the size of the patient body. More studies are needed to develop accurate and convenient methods of accounting for the imagingdoses as part of treatment planning.
37(2010); http://dx.doi.org/10.1118/1.3512794View Description Hide DescriptionPurpose:
Energy-resolved x-ray imaging has the potential to improve contrast-to-noise ratio by measuring the energy of each interacting photon and applying optimal weighting factors. The success of energy-resolving photon-counting (EPC) detectors relies on the ability of an x-ray detector to accurately measure the energy of each interacting photon. However, the escape of characteristic emissions and Compton scatter degrades spectral information. This article makes the theoretical connection between accuracy and imprecision in energy measurements with the x-ray Swank factor for, Si, CdZnTe, and -based detectors.Methods:
For a detector that implements adaptive binning to sum all elements in which x-ray energy is deposited for a single interaction, energy imprecision is shown to depend on the Swank factor for a large element with x rays incident at the center. The response function for each converter material is determined using Monte Carlo methods and used to determine energy accuracy, Swank factor, and relative energy imprecision in photon-energy measurements.Results:
For each material, at energies below the respective K edges, accuracy is close to unity and imprecision is only a few percent. Above the K-edge energies, characteristic emission results in a drop in accuracy and precision that depends on escape probability. In Si, and to some extent, Compton-scatter escape also degrades energy precision with increasing energy. The influence of converter thickness on energy accuracy and imprecision is modest for low-Z materials but becomes important when using high-Z materials at energies greater than the K-edge energies.Conclusions:
Accuracy and precision in energy measurements by EPC detectors are determined largely by the energy-dependent x-ray Swank factor. Modest decreases in the Swank factor (5%–15%) result in large increases in relative imprecision (30%–40%).
37(2010); http://dx.doi.org/10.1118/1.3515460View Description Hide DescriptionPurpose:
To demonstrate the feasibility of reconstructing a cone-beam CT(CBCT)image by deformably altering a prior fan-beam CT (FBCT) image such that it matches the anatomy portrayed in the CBCT projection data set.Methods:
A prior FBCT image of the patient is assumed to be available as a source image. A CBCT projection data set is obtained and used as a target image set. A parametrized deformation model is applied to the source FBCT image, digitally reconstructedradiographs(DRRs) that emulate the CBCT projection image geometry are calculated and compared to the target CBCT projection data, and the deformation model parameters are adjusted iteratively until the DRRs optimally match the CBCT projection data set. The resulting deformed FBCT image is hypothesized to be an accurate representation of the patient’s anatomyimaged by the CBCT system. The process is demonstrated via numerical simulation. A known deformation is applied to a prior FBCT image and used to create a synthetic set of CBCT target projections. The iterative projection matching process is then applied to reconstruct the deformation represented in the synthetic target projections; the reconstructed deformation is then compared to the known deformation. The sensitivity of the process to the number of projections and the DRR/CBCT projection mismatch is explored by systematically adding noise to and perturbing the contrast of the target projections relative to the iterated source DRRs and by reducing the number of projections.Results:
When there is no noise or contrast mismatch in the CBCT projection images, a set of 64 projections allows the known deformed CTimage to be reconstructed to within a nRMS error of 1% and the known deformation to within a nRMS error of 7%. A CTimage nRMS error of less than 4% is maintained at noise levels up to 3% of the mean projection intensity, at which the deformation error is 13%. At 1% noise level, the number of projections can be reduced to 8 while maintaining CTimage and deformation errors of less than 4% and 13%, respectively. The method is sensitive to contrast mismatch between the simulated projections and the target projections when the soft-tissue contrast in the projections is low.Conclusions:
By using prior knowledge available in a FBCT image, the authors show that a CBCTimage can be iteratively reconstructed from a comparatively small number of projection images, thus saving acquisition time and reducing imagingdose. This will enable more frequent daily imaging during radiation therapy. Because the process preserves the CT numbers of the FBCT image, the resulting 3D image intensities will be more accurate than a CBCTimagereconstructed via conventional backprojection methods. Reconstruction errors are insensitive to noise at levels beyond what would typically be found in CBCT projection data, but are sensitive to contrast mismatch errors between the CBCT projection data and the DRRs.
A statistical, task-based evaluation method for three-dimensional x-ray breast imaging systems using variable-background phantoms37(2010); http://dx.doi.org/10.1118/1.3488910View Description Hide DescriptionPurpose:
For the last few years, development and optimization of three-dimensional (3D) x-ray breast imagingsystems, such as digital breast tomosynthesis (DBT) and computed tomography, have drawn much attention from the medical imaging community, either academia or industry. However, there is still much room for understanding how to best optimize and evaluate the devices over a large space of many different system parameters and geometries. Current evaluation methods, which work well for 2D systems, do not incorporate the depth information from the 3D imagingsystems. Therefore, it is critical to develop a statistically sound evaluation method to investigate the usefulness of inclusion of depth and background-variability information into the assessment and optimization of the 3D systems.Methods:
In this paper, we present a mathematical framework for a statistical assessment of planar and 3D x-ray breast imagingsystems. Our method is based on statistical decision theory, in particular, making use of the ideal linear observer called the Hotelling observer. We also present a physical phantom that consists of spheres of different sizes and materials for producing an ensemble of randomly varying backgrounds to be imaged for a given patient class. Lastly, we demonstrate our evaluation method in comparing laboratory mammography and three-angle DBT systems for signal detection tasks using the phantom’s projection data. We compare the variable phantom case to that of a phantom of the same dimensions filled with water, which we call the uniform phantom, based on the performance of the Hotelling observer as a function of signal size and intensity.Results:
Detectability trends calculated using the variable and uniform phantom methods are different from each other for both mammography and DBT systems.Conclusions:
Our results indicate that measuring the system’s detection performance with consideration of background variability may lead to differences in system performance estimates and comparisons. For the assessment of 3D systems, to accurately determine trade offs between image quality and radiation dose, it is critical to incorporate randomness arising from the imaging chain including background variability into system performance calculations.
Evaluation of a multi-atlas based method for segmentation of cardiac CTA data: a large-scale, multicenter, and multivendor study37(2010); http://dx.doi.org/10.1118/1.3512795View Description Hide DescriptionPurpose:
Computed tomography angiography (CTA) is increasingly used for the diagnosis of coronary artery disease (CAD). However, CTA is not commonly used for the assessment of ventricular and atrial function, although functional information extracted from CTA data is expected to improve the diagnostic value of the examination. In clinical practice, the extraction of ventricular and atrial functional information, such as stroke volume and ejection fraction, requires accurate delineation of cardiac chambers. In this paper, we investigated the accuracy and robustness of cardiac chamber delineation using a multiatlas based segmentation method on multicenter and multivendor CTA data.Methods:
A fully automatic multiatlas based method for segmenting the whole heart (i.e., the outer surface of the pericardium) and cardiac chambers from CTA data is presented and evaluated. In the segmentation approach, eight atlas images are registered to a new patient’s CTA scan. The eight corresponding manually labeled images are then propagated and combined using a per voxel majority voting procedure, to obtain a cardiac segmentation.Results:
The method was evaluated on a multicenter/multivendor database, consisting of (1) a set of 1380 Siemens scans from 795 patients and (2) a set of 60 multivendor scans (Siemens, Philips, and GE) from different patients, acquired in six different institutions worldwide. A leave-one-out 3D quantitative validation was carried out on the eight atlas images; we obtained a mean surface-to-surface error of and an average Dice coefficient of 0.93 was achieved. A 2D quantitative evaluation was performed on the 60 multivendor data sets. Here, we observed a mean surface-to-surface error of and an average Dice coefficient of 0.91 was achieved. In addition to this quantitative evaluation, a large-scale 2D and 3D qualitative evaluation was performed on 1380 and 140 images, respectively. Experts evaluated that 49% of the 1380 images were very accurately segmented (below 1 mm error) and that 29% were accurately segmented (error between 1 and 3 mm), which demonstrates the robustness of the presented method.Conclusions:
A fully automatic method for whole heart and cardiac chamber segmentation was presented and evaluated using multicenter/multivendor CTA data. The accuracy and robustness of the method were demonstrated by successfully applying the method to 1420 multicenter/multivendor data sets.