Volume 39, Issue 9, September 2012
Index of content:
Here, the authors explore the feasibility of discriminating cancer patients from healthy controls by serum RNA detection based on surface-enhanced Raman spectroscopy (SERS) and multivariate analysis.Methods:
MgSO4-aggregated silver nanoparticles (Ag NP) as the SERS-active substrate presented strong SERS signals to RNA.SERS measurements were performed on two groups of serum RNA samples: one group from patients (n = 31) with gastric cancer and the other group from healthy volunteers (n = 34).Results:
Tentative assignments of the Raman bands in the normalized SERSspectra demonstrated that there are differential expressions of circulating RNA between the gastric cancer group and the control group. Principal component analysis (PCA) combined with linear discriminate analysis(LDA) was introduced to differentiate gastric cancer from normal and achieved sensitivity of 100% and specificity of 94.1%.Conclusions:
This exploratory study demonstrated potential for developing serum RNASERSanalysis into a useful clinical tool for noninvasive screening and detection of cancer.
39(2012); http://dx.doi.org/10.1118/1.3694117View Description Hide Description
- VISION 20/20
39(2012); http://dx.doi.org/10.1118/1.4747343View Description Hide Description
Recent developments in image-guidance and device navigation, along with emerging robotic technologies, are rapidly transforming the landscape of interventional radiology (IR). Future state-of-the-art IR procedures may include real-time three-dimensional imaging that is capable of visualizing the target organ, interventional tools, and surrounding anatomy with high spatial and temporal resolution. Remote device actuation is becoming a reality with the introduction of novel magnetic-field enabled instruments and remote robotic steering systems. Robots offer several degrees of freedom and unprecedented accuracy, stability, and dexterity during device navigation, propulsion, and actuation. Optimization of tracking and navigation of interventional tools inside the human body will be critical in converting IR suites into the minimally invasive operating theaters of the future with increased safety and unsurpassed therapeutic efficacy. In the not too distant future, individual image guidance modalities and device tracking methods could merge into autonomous, multimodality, multiparametric platforms that offer real-time data of anatomy, morphology, function, and metabolism along with on-the-fly computational modeling and remote robotic actuation. The authors provide a concise overview of the latest developments in image guidance and device navigation, while critically envisioning what the future might hold for 2020 IR procedures.
- RADIATION THERAPY PHYSICS
Incorporation of treatment plan spatial and temporal dose patterns into a prostate intrafractional motion management strategy39(2012); http://dx.doi.org/10.1118/1.4742846View Description Hide DescriptionPurpose:
Periodic MV/KV radiographs taken during volumetric modulated arc therapy (VMAT) for hypofractionated treatment provide guidance in intrafractional motion management. The choice of imaging frequency and timing are key components in delivering the desired dose while reducing associated overhead such as imagingdose, preparation, and processing time. In this project the authors propose a paradigm with imaging timing and frequency based on the spatial and temporal dose patterns of the treatment plan.Methods:
A number of control points are used in treatment planning to model VMAT delivery. For each control point, the sensitivity of individual target or organ-at-risk dose to motion can be calculated as the summation of dose degradations given the organ displacements along a number of possible motion directions. Instead of acquiring radiographs at uniform time intervals, MV/KV image pairs are acquired indexed to motion sensitivity. Five prostate patients treated via hypofractionated VMAT are included in this study. Intrafractional prostate motion traces from the database of an electromagnetic tracking system are used to retrospectively simulate the VMAT delivery and motion management. During VMAT delivery simulation patient position is corrected based on the radiographic findings via couch movement if target deviation violates a patient-specific 3D threshold. The violation rate calculated as the percentage of traces failing the clinical dose objectives after motion correction is used to evaluate the efficacy of this approach.Results:
Imaging indexed to a 10 s equitime interval and correcting patient position accordingly reduces the violation rate to 19.5% with intervention from 44.5% without intervention. Imaging indexed to the motion sensitivity further reduces the violation rate to 12.1% with the same number of images. To achieve the same 5% violation rate, the imaging incidence can be reduced by 40% by imaging indexed to motion sensitivity instead of time.Conclusions:
The simulation results suggest that image scheduling according to the characteristics of the treatment plan can improve the efficiency of intrafractional motion management. Using such a technique, the accuracy of delivered dose during image-guided hypofractionated VMAT treatment can be improved.
Investigation of four-dimensional (4D) Monte Carlo dose calculation in real-time tumor tracking stereotatic body radiotherapy for lung cancers39(2012); http://dx.doi.org/10.1118/1.4739249View Description Hide DescriptionPurpose:
To investigate the dosimetric variations and radiobiological impacts as a consequence of delivering treatment plans of 3D nature in 4D manner based on the 4D Monte Carlo treatment planning framework implemented on Cyberknife.Methods:
Dose distributions were optimized on reference 3D images at end of exhale phase of a 4DCT dataset for 25 lungcancer patients treated with 60 Gy/3Fx or 48 Gy/4Fx. Deformable image registrations between individual 3DCT images to the reference 3DCT image in the 4DCT study were performed to interpolate doses calculated on multiple anatomical geometries back on to the reference geometry to compose a 4D dose distribution that included the tracking beam motion and organ deformation. The 3D and 4D dose distributions that were initially calculated with the equivalent path-length (EPL) algorithm (3DEPLdose and 4DEPLdose) were recalculated with the Monte Carlo algorithm (3DMCdose and 4DMCdose).Dosimetric variations of V60Gy/48Gy and D99 of GTV, mean doses to the lung and the heart and maximum dose (D1) of the spinal cord as a consequence of tracking beam motion in deforming anatomy,dose calculation algorithm, and both were quantified by the relative change from 4DMC to 3DMCdoses, from 4DMC to 4DEPLdoses, and from 4DMC to 3DEPLdoses, respectively.Results:
Comparing 4DMC to 3DEPL plans, V60Gy / 48Gy and D99 of GTV decreased considerably by 13 ± 22% (mean ± 1SD) and 9.2 ± 5.5 Gy but changes of normal tissuedoses were not more than 0.5 Gy on average. The generalized equivalent uniform dose (gEUD) and tumor control probability (TCP) were reduced by 14.3 ± 8.8 Gy and 7.5 ± 5.2%, and normal tissue complication probability (NTCP) for myelopathy and pericarditis were close to zero and NTCP for radiation pneumonitis was reduced by 2.5% ± 4.1%. Comparing 4DMC to 4DEPL plans found decreased V60Gy/48Gy and D99 by 12.3% ± 21.6% and 7.3 ± 5.3 Gy, the normal tissuesdoses by 0.5 Gy on average, gEUD and TCP by 13.0 ± 8.6 Gy and 7.1% ± 5.1%. Comparing 4DMC to 3DMCdoses, V60Gy/48Gy and D99 of GTV was reduced by 5.2% ± 8.8% and 2.6 ± 3.3 Gy, and normal tissues hardly changed from 4DMC to 3DMCdoses. The corresponding decreases of gEUD and TCP were 2.8 ± 4.0 Gy and 1.6 ± 2.4%.Conclusions:
The large discrepancy between original 3DEPL plan and benchmarking 4DMC plan is predominately due to dose calculation algorithms as the tracking beam motion and organ deformation hardly influenced doses of normal tissues and moderately decreased V60Gy/48Gy and D99 of GTV. It is worth to make a thoughtful weight of the benefits of full 4DMCdose calculation and consider 3DMCdose calculation as a compromise of 4DMCdose calculation considering the multifold computation time.
Determination of the beam quality index of high-energy photon beams under nonstandard reference conditions39(2012); http://dx.doi.org/10.1118/1.4745565View Description Hide DescriptionPurpose:
At some modern radiotherapy machines it is not possible to achieve reference conditions for the measurement of beam quality indices used in dosimetry codes of practice, such as IAEA TRS-398 and AAPM TG-51. This work aims at providing self-consistent and simpler expressions and more accurate fits for a limited range of beams of interest than have been proposed previously for deriving these beam quality indices from measurements.Methods:
The starting point is a formula proposed by Sauer [Med. Phys.36, 4168–4172 (2009)] for deriving the beam quality index used in IAEA TRS-398, TPR 20,10, from a measurement of the tissue phantom ratio at depths of 20 cm and 10 cm in water for an s × s cm2 (equivalent) square field, TPR 20,10(s). First, a self-consistent version of this formula is established followed by a simpler version by making a linear approximation. A similar approach is proposed to derive the beam quality index used in AAPM TG-51, %dd(10)X, from a measurement of PDD 10(s), the percentage depth dose at 10 cm for a square field with size s. All models were fitted to subsets of relevant data from BJR supplement 25.Results:
The linear models forTPR 20,10(s) and exponential models for PDD 10(s) as a function of the (equivalent) square field size can reproduce the beam quality within 0.3% and beam quality correction factors within 0.05% for square field sizes ranging from 4 cm to 12 cm and nominal photon energies from 4 MV to 12 MV. For higher energy beams the errors are only slightly worse but for %dd(10)X, an additional uncertainty component has to be considered for the electron contamination correction.Conclusions:
The models proposed here can be used in practical recommendations for the dosimetry of small and nonstandard fields.
39(2012); http://dx.doi.org/10.1118/1.4745566View Description Hide DescriptionPurpose:
To describe and mathematically validate the superiorization methodology, which is a recently developed heuristic approach to optimization, and to discuss its applicability to medical physics problem formulations that specify the desired solution (of physically given or otherwise obtained constraints) by an optimization criterion.Methods:
The superiorization methodology is presented as a heuristic solver for a large class of constrained optimization problems. The constraints come from the desire to produce a solution that is constraints-compatible, in the sense of meeting requirements provided by physically or otherwise obtained constraints. The underlying idea is that many iterative algorithms for finding such a solution are perturbation resilient in the sense that, even if certain kinds of changes are made at the end of each iterative step, the algorithm still produces a constraints-compatible solution. This property is exploited by using permitted changes to steer the algorithm to a solution that is not only constraints-compatible, but is also desirable according to a specified optimization criterion. The approach is very general, it is applicable to many iterative procedures and optimization criteria used in medical physics.Results:
The main practical contribution is a procedure for automatically producing from any given iterative algorithm its superiorized version, which will supply solutions that are superior according to a given optimization criterion. It is shown that if the original iterative algorithm satisfies certain mathematical conditions, then the output of its superiorized version is guaranteed to be as constraints-compatible as the output of the original algorithm, but it is superior to the latter according to the optimization criterion. This intuitive description is made precise in the paper and the stated claims are rigorously proved. Superiorization is illustrated on simulated computerized tomography data of a head cross section and, in spite of its generality, superiorization is shown to be competitive to an optimization algorithm that is specifically designed to minimize total variation.Conclusions:
The range of applicability of superiorization to constrained optimization problems is very large. Its major utility is in the automatic nature of producing a superiorization algorithm from an algorithm aimed at only constraints-compatibility; while nonheuristic (exact) approaches need to be redesigned for a new optimization criterion. Thus superiorization provides a quick route to algorithms for the practical solution of constrained optimization problems.
Four-dimensional dose distributions of step-and-shoot IMRT delivered with real-time tumor tracking for patients with irregular breathing: Constant dose rate vs dose rate regulation39(2012); http://dx.doi.org/10.1118/1.4745562View Description Hide DescriptionPurpose:
Dose-rate-regulated tracking (DRRT) is a tumor tracking strategy that programs the MLC to track the tumor under regular breathing and adapts to breathing irregularities during delivery using dose rate regulation. Constant-dose-rate tracking (CDRT) is a strategy that dynamically repositions the beam to account for intrafractional 3D target motion according to real-time information of target location obtained from an independent position monitoring system. The purpose of this study is to illustrate the differences in the effectiveness and delivery accuracy between these two tracking methods in the presence of breathing irregularities.Methods:
Step-and-shoot IMRT plans optimized at a reference phase were extended to remaining phases to generate 10-phased 4D-IMRT plans using segment aperture morphing (SAM) algorithm, where both tumor displacement and deformation were considered. A SAM-based 4D plan has been demonstrated to provide better plan quality than plans not considering target deformation. However, delivering such a plan requires preprogramming of the MLC aperture sequence. Deliveries of the 4D plans using DRRT and CDRT tracking approaches were simulated assuming the breathing period is either shorter or longer than the planning day, for 4 IMRT cases: two lung and two pancreatic cases with maximum GTV centroid motion greater than 1 cm were selected. In DRRT, dose rate was regulated to speed up or slow down delivery as needed such that each planned segment is delivered at the planned breathing phase. In CDRT, MLC is separately controlled to follow the tumor motion, but dose rate was kept constant. In addition to breathing period change, effect of breathing amplitude variation on target and critical tissue dose distribution is also evaluated.Results:
Delivery of preprogrammed 4D plans by the CDRT method resulted in an average of 5% increase in target dose and noticeable increase in organs at risk (OAR) dose when patient breathing is either 10% faster or slower than the planning day. In contrast, DRRT method showed less than 1% reduction in target dose and no noticeable change in OAR dose under the same breathing period irregularities. When ±20% variation of target motion amplitude was present as breathing irregularity, the two delivery methods show compatible plan quality if the dose distribution of CDRT delivery is renormalized.Conclusions:
Delivery of 4D-IMRT treatment plans, stemmed from 3D step-and-shoot IMRT and preprogrammed using SAM algorithm, is simulated for two dynamic MLC-based real-time tumor tracking strategies: with and without dose-rate regulation. Comparison of cumulative dose distribution indicates that the preprogrammed 4D plan is more accurately and efficiently conformed using the DRRT strategy, as it compensates the interplay between patient breathing irregularity and tracking delivery without compromising the segment-weight modulation.
Biological effect of dose distortion by fiducial markers in spot-scanning proton therapy with a limited number of fields: A simulation study39(2012); http://dx.doi.org/10.1118/1.4745558View Description Hide DescriptionPurpose:
In accurate proton spot-scanning therapy, continuous target tracking by fluoroscopic x ray during irradiation is beneficial not only for respiratory moving tumors of lung and liver but also for relatively stationary tumors of prostate. Implanted gold markers have been used with great effect for positioning the target volume by a fluoroscopy, especially for the cases of liver and prostate with the targets surrounded by water-equivalent tissues. However, recent studies have revealed that gold markers can cause a significant underdose in proton therapy. This paper focuses on prostate cancer and explores the possibility that multiple-field irradiation improves the underdose effect by markers on tumor-control probability (TCP).Methods:
A Monte Carlo simulation was performed to evaluate the dose distortion effect. A spherical gold marker was placed at several characteristic points in a water phantom. The markers were with two different diameters of 2 and 1.5 mm, both visible on fluoroscopy. Three beam arrangements of single-field uniform dose (SFUD) were examined: one lateral field, two opposite lateral fields, and three fields (two opposite lateral fields + anterior field). The relative biological effectiveness (RBE) was set to 1.1 and a dose of 74 Gy (RBE) was delivered to the target of a typical prostate size in 37 fractions. The ratios of TCP to that without the marker (TCPr) were compared with the parameters of the marker sizes, number of fields, and marker positions. To take into account the dependence of biological parameters in TCP model, α/β values of 1.5, 3, and 10 Gy (RBE) were considered.Results:
It was found that the marker of 1.5 mm diameter does not affect the TCPs with all α/β values when two or more fields are used. On the other hand, if the marker diameter is 2 mm, more than two irradiation fields are required to suppress the decrease in TCP from TCPr by less than 3%. This is especially true when multiple (two or three) markers are used for alignment of a patient.Conclusions:
It is recommended that 1.5-mm markers be used to avoid the reduction of TCP as well as to spare the surrounding critical organs, as long as the markers are visible on x-ray fluoroscopy. When 2-mm markers are implanted, more than two fields should be used and the markers should not be placed close to the distal edge of any of the beams.
39(2012); http://dx.doi.org/10.1118/1.4745560View Description Hide DescriptionPurpose
: To segment fiber tracts in the limbic circuit and to assess their sensitivity to radiation therapy (RT).Methods:
Twelve patients with brain metastases who had received fractionated whole brainradiation therapy to 30 Gy or 37.5 Gy were included in the study. Diffusion weighted images were acquired pre-RT, at the end of RT, and 1-month post-RT. The fornix, corpus callosum, and cingulum were extracted from diffusion weighted images by combining fiber tracking and segmentation methods based upon characteristics of the fiber bundles. Cingulum was segmented by a seed-based tractography, fornix by a region of interests (ROI)-based tractography, and corpus callosum by a level-set segmentation algorithm. The radiation-induced longitudinal changes of diffusion indices of the structures were evaluated.Results:
Significant decreases were observed in the fractional anisotropy of the posterior part of the cingulum, fornix, and corpus callosum from pre-RT to end of RT by –14.0%, –12.5%, and –5.2%, respectively (p < 0.001), and from pre-RT to 1-month post-RT by –11.9%, –12.8%, and –6.4%, respectively (p < 0.001). Moreover, significant increases were observed in the mean diffusivity of the corpus callosum and the posterior part of the cingulum from pre-RT to end of RT by 6.8% and 6.5%, respectively, and from pre-RT to 1-month post-RT by 8.5% and 6.3%, respectively. The increase in the radial diffusivity primarily contributed to the significant decrease in the fractional anisotropy, indicating that demyelination is the predominant radiation effect on the white matter structures.Conclusions:
Our findings indicate that the fornix and the posterior part of the cingulum are significantly susceptible to radiation damage. We have developed robust computer-aided semiautomatic segmentation and fiber tracking tools to facilitate the ROI delineation of critical structures, which is important for assessment of radiation damage in a longitudinal fashion.
39(2012); http://dx.doi.org/10.1118/1.4742848View Description Hide DescriptionPurpose:
Intensity modulated radiation therapy (IMRT) has gained popularity in the treatment of cancers. Manual evaluation of IMRT plans for head-and-neck cancers has been especially challenging necessitating efficient and objective assessment tools. In this work, the authors address this issue by developing a personalized conformity index (CI) for comparison of IMRT plans for head-and-neck cancers and evaluating its plan quality discerning power in comparison with other widely used CIs.Methods:
A two-dimensional CI with dose and distance incorporated (CI DD ) was developed using the MATLAB program language, to quantify the planning target volume (PTV) coverage. Valuable information contained in the digital imaging and communication in medicine (DICOM) RT objects were harvested for computation of each of the CI DD components. Apart from the dose penalty factor, a distance-based exponential function was employed by varying the penalty weight associated with the location of cold spots within the PTV. With the goal of deriving a customized penalty factor, the distances between individual pixel and its nearest PTV boundary was found. Using the exponential function, the impact of distance penalty was substantially larger for cold spots closer to the PTV centroid but petered out quickly wherever they were situated in the vicinity of PTV border. In order to evaluate the CI DD scoring system, three CT image data sets of nasopharyngeal carcinoma (NPC) patients were collected. Ten IMRT plans with degrading qualities were generated from each dataset and were ranked based on CI DD and other existing indices. The coefficient of variance was calculated for each dataset to compare the degree of variation.Results:
The CI DD scoring system that considered spatial importance of each voxel within the PTV was successfully developed. The results demonstrated that the CI DD including four discrete factors could provide accurate rankings of plan quality by examining the relative importance of each cold spot within the PTVs. Apart from the dose penalty factor, a distance-based exponential function was employed taking the specific tumor geometry into account. Compared with other commonly used CIs, the CI DD resulted in the largest coefficient of variance among the ten IMRT plans for each dataset, indicating that its discerning power was the best among the CIs being compared.Conclusions:
The CI DD scoring system was successfully developed to incorporate patient-specific spatial dose information and provide a geometry-based physical index for comparison of IMRT plans for head-and-neck cancers. By taking individual tumor geometry into account, the superiority of CI DD in plan discerning power was demonstrated. The use of CI DD could provide an effective means of benchmarking performance, reducing treatment plan variability, and advancing the quality of current IMRT planning.
- RADIATION IMAGING PHYSICS
Ideal-observer detectability in photon-counting differential phase-contrast imaging using a linear-systems approach39(2012); http://dx.doi.org/10.1118/1.4739195View Description Hide DescriptionPurpose:
To provide a cascaded-systems framework based on the noise-power spectrum (NPS), modulation transfer function(MTF), and noise-equivalent number of quanta (NEQ) for quantitative evaluation of differential phase-contrast imaging (Talbot interferometry) in relation to conventional absorption contrast under equal-dose, equal-geometry, and, to some extent, equal-photon-economy constraints. The focus is a geometry for photon-counting mammography.Methods:
Phase-contrast imaging is a promising technology that may emerge as an alternative or adjunct to conventional absorption contrast. In particular, phase contrast may increase the signal-difference-to-noise ratio compared to absorption contrast because the difference in phase shift between soft-tissue structures is often substantially larger than the absorption difference. We have developed a comprehensive cascaded-systems framework to investigate Talbot interferometry, which is a technique for differential phase-contrast imaging. Analytical expressions for the MTF and NPS were derived to calculate the NEQ and a task-specific ideal-observer detectability index under assumptions of linearity and shift invariance. Talbot interferometry was compared to absorption contrast at equal dose, and using either a plane wave or a spherical wave in a conceivable mammography geometry. The impact of source size and spectrum bandwidth was included in the framework, and the trade-off with photon economy was investigated in some detail. Wave-propagation simulations were used to verify the analytical expressions and to generate example images.Results:
Talbot interferometry inherently detects the differential of the phase, which led to a maximum in NEQ at high spatial frequencies, whereas the absorption-contrast NEQ decreased monotonically with frequency. Further, phase contrast detects differences in density rather than atomic number, and the optimal imaging energy was found to be a factor of 1.7 higher than for absorption contrast. Talbot interferometry with a plane wave increased detectability for 0.1-mm tumor and glandular structures by a factor of 3–4 at equal dose, whereas absorption contrast was the preferred method for structures larger than ∼0.5 mm. Microcalcifications are small, but differ from soft tissue in atomic number more than density, which is favored by absorption contrast, and Talbot interferometry was barely beneficial at all within the resolution limit of the system. Further, Talbot interferometry favored detection of “sharp” as opposed to “smooth” structures, and discrimination tasks by about 50% compared to detection tasks. The technique was relatively insensitive to spectrum bandwidth, whereas the projected source size was more important. If equal photon economy was added as a restriction, phase-contrast efficiency was reduced so that the benefit for detection tasks almost vanished compared to absorption contrast, but discrimination tasks were still improved close to a factor of 2 at the resolution limit.Conclusions:
Cascaded-systems analysis enables comprehensive and intuitive evaluation of phase-contrast efficiency in relation to absorption contrast under requirements of equal dose, equal geometry, and equal photon economy. The benefit of Talbot interferometry was highly dependent on task, in particular detection versus discrimination tasks, and target size, shape, and material. Requiring equal photon economy weakened the benefit of Talbot interferometry in mammography.
A database for estimating organ dose for coronary angiography and brain perfusion CT scans for arbitrary spectra and angular tube current modulation39(2012); http://dx.doi.org/10.1118/1.4739243View Description Hide DescriptionPurpose:
The purpose of this study was to develop a database for estimating organ dose in a voxelized patient model for coronary angiography and brain perfusion CT acquisitions with any spectra and angular tube current modulation setting. The database enables organ dose estimation for existing and novel acquisition techniques without requiring Monte Carlo simulations.Methods:
The study simulated transport of monoenergetic photons between 5 and 150 keV for 1000 projections over 360° through anthropomorphic voxelized female chest and head (0° and 30° tilt) phantoms and standard head and body CTDI dosimetry cylinders. The simulations resulted in tables of normalized dose deposition for several radiosensitive organs quantifying the organ dose per emitted photon for each incident photon energy and projection angle for coronary angiography and brain perfusion acquisitions. The values in a table can be multiplied by an incident spectrum and number of photons at each projection angle and then summed across all energies and angles to estimate total organ dose. Scanner-specific organ dose may be approximated by normalizing the database-estimated organ dose by the database-estimated CTDI vol and multiplying by a physical CTDI vol measurement. Two examples are provided demonstrating how to use the tables to estimate relative organ dose. In the first, the change in breast and lung dose during coronary angiography CT scans is calculated for reduced kVp, angular tube current modulation, and partial angle scanning protocols relative to a reference protocol. In the second example, the change in dose to the eye lens is calculated for a brain perfusion CT acquisition in which the gantry is tilted 30° relative to a nontilted scan.Results:
Our database provides tables of normalized dose deposition for several radiosensitive organs irradiated during coronary angiography and brain perfusion CT scans. Validation results indicate total organ doses calculated using our database are within 1% of those calculated using Monte Carlo simulations with the same geometry and scan parameters for all organs except red bone marrow (within 6%), and within 23% of published estimates for different voxelized phantoms. Results from the example of using the database to estimate organ dose for coronary angiography CT acquisitions show 2.1%, 1.1%, and −32% change in breast dose and 2.1%, −0.74%, and 4.7% change in lung dose for reduced kVp, tube current modulated, and partial angle protocols, respectively, relative to the reference protocol. Results show −19.2% difference in dose to eye lens for a tilted scan relative to a nontilted scan. The reported relative changes in organ doses are presented without quantification of image quality and are for the sole purpose of demonstrating the use of the proposed database.Conclusions:
The proposed database and calculation method enable the estimation of organ dose for coronary angiography and brain perfusion CT scans utilizing any spectral shape and angular tube current modulation scheme by taking advantage of the precalculated Monte Carlo simulation results. The database can be used in conjunction with image quality studies to develop optimized acquisition techniques and may be particularly beneficial for optimizing dual kVp acquisitions for which numerous kV, mA, and filtration combinations may be investigated.
39(2012); http://dx.doi.org/10.1118/1.4742070View Description Hide DescriptionPurpose:
Radiation dose from CT examination depends on the position relative to the irradiated region in the longitudinal direction. The objective of this work is to present a mechanism for calculating dose at any point on a line parallel to the axis of rotation.Methods:
In a medium that is uniform in the z direction, the cumulative dose at the midpointD L (0) of the irradiated length (L) increases with Luntil the equilibrium dose (D eq) is reached. Using the approach to equilibrium function, H(L) = D L (0)/D eq, the authors formulated equations for calculating dose at an arbitrary point on an axial line.Results:
Dose calculation examples are presented for multidetector CT (MDCT) and micro-CT.Conclusions:
The new equations are suited for any functional form ofH(L), and can be used for dose evaluations in MDCT, micro-CT, cone-beam CT, and other cases with media that are approximately uniform along the z direction.
39(2012); http://dx.doi.org/10.1118/1.4742052View Description Hide DescriptionPurpose:
Common electronic portal imaging devices (EPIDs) contain a 1.0 mm copper conversion plate to increase detection efficiency of a therapeutic megavoltage spectrum. When used in imaging with a photon beam generated with a low atomic number (Z) target, the conversion plate attenuates a substantial proportion of photons in the diagnostic range, thereby reducing the achievable image quality. In this work, we measure directly dependence on low-Z target image quality as a function of copper plate thickness, for both planar imaging and cone beam computed tomography (CBCT).Methods:
Monte Carlo modeling was used to quantify changes to the diagnostic spectrum and detector response for low-Z target beams generated with either 2.35 or 7.00 MeV electrons incident on a carbon target. Planar contrast-to-noise ratio (CNR) and spatial resolution measurements were made as a function of copper thickness. CNR measurements were made for CBCT imaging as a function of dose both with and without the copper plate present in the EPID.Results:
The presence of copper in the EPID decreased the diagnostic photon population by up to 20% and suppressed the peak detector response (dose deposited in the scintillator) at 60 keV by a factor of 6.4. Planar CNR was increased by a factor ranging from 1.4 to 4.0, depending on the material imaged, with no copper present compared to a standard 1.0 mm thickness. Planar spatial resolution was only slightly degraded with increasing copper thickness. Increases in CBCT image CNR ranged from a factor of 1.3–2.1 with the copper plate removed.Conclusions:
It is possible to increase the proportion of photons in the diagnostic energy range (25 keV–150 keV) reaching the phosphor screen by as much as 20% when removing the copper conversion plate. This results in significant increases of planar and CBCT image CNR. Consequently, we suggest that the copper conversion plate be removed from the EPID when used for low-Z target planar or CBCT imaging.
39(2012); http://dx.doi.org/10.1118/1.4742053View Description Hide DescriptionPurpose:
The use of time-resolved four-dimensional computed tomography (4D-CT) in radiotherapy requires strict quality assurance to ensure the accuracy of motion management protocols. The aim of this work was to design and test a phantom capable of large amplitude motion for use in 4D-CT, with particular interest in small lesions typical for stereotactic body radiotherapy.Methods:
The phantom of “see-saw” design is light weight, capable of including various sample materials and compatible with several surrogate marker signal acquisition systems. It is constructed of polymethylmethacrylate (Perspex) and its movement is controlled via a dc motor and drive wheel. It was tested using two CTscanners with different 4D acquisition methods: the Philips Brilliance Big Bore CT (helical scan, pressure belt) and a General Electric Discovery STE PET/CT (axial scan, infrared marker). Amplitudes ranging from 1.5 to 6.0 cm and frequencies of up to 40 cycles per minute were used to study the effect of motion on image quality. Maximum intensity projections (MIPs), as well as average intensity projections (AIPs) of moving objects were investigated and their quality dependence on the number of phase reconstruction bins assessed.Results:
CT number discrepancies between moving and stationary objects were found to have no systematic dependence on amplitude, frequency, or specific interphase variability. MIP-delineated amplitudes of motion were found to match physical phantom amplitudes to within 2 mm for all motion scenarios tested. Objects undergoing large amplitude motions (>3.0 cm) were shown to cause artefacts in MIP and AIP projections when ten phase bins were assigned. This problem can be mitigated by increasing the number of phase bins in a 4D-CT scan.Conclusions:
The phantom was found to be a suitable tool for evaluating the image quality of 4D-CT motion management technology, as well as providing a quality assurance tool for intercenter/intervendor testing of commercial 4D-CT systems. When imaging objects with large amplitudes, the completeness criterion described here indicates the number of phase bins required to prevent missing data in MIPs and AIPs. This is most relevant for small lesions undergoing large motions.
39(2012); http://dx.doi.org/10.1118/1.4739506View Description Hide DescriptionPurpose:
The authors propose a novel method for misalignment estimation of micro-CT scanners using an adaptive genetic algorithm.Methods:
The proposed algorithm is able to estimate the rotational geometry, the direction vector of table movement and the displacement between different imaging threads of a dual source or even multisource scanner. The calibration procedure does not rely on dedicated calibration phantoms and a sequence scan of a single metal bead is sufficient to geometrically calibrate the whole imaging system for spiral, sequential, and circular scan protocols. Dual source spiral and sequential scan protocols in micro-computed tomography result in projection data that—besides the source and detector positions and orientations—also require a precise knowledge of the table direction vector to be reconstructed properly. If those geometric parameters are not known accurately severe artifacts and a loss in spatial resolution appear in the reconstructed images as long as no geometry calibration is performed. The table direction vector is further required to ensure that consecutive volumes of a sequence scan can be stitched together and to allow the reconstruction of spiral data at all.Results:
The algorithm's performance is evaluated using simulations of a micro-CT system with known geometry and misalignment. To assess the quality of the algorithm in a real world scenario the calibration of a micro-CT scanner is performed and several reconstructions with and without geometry estimation are presented.Conclusions:
The results indicate that the algorithm successfully estimates all geometry parameters, misalignment artifacts in the reconstructed volumes vanish, and the spatial resolution is increased as can be shown by the evaluation of modulation transfer function measurements.
39(2012); http://dx.doi.org/10.1118/1.4742850View Description Hide DescriptionPurpose:
A breast dedicated positron emission tomography(PET)scanner has been developed based on monolithic LYSO crystals coupled to position sensitive photomultiplier tubes (PSPMTs). In this study, we describe the design of the PET system and report on its performance evaluation.Methods:
MAMMI is a breast PETscanner based on monolithic LYSO crystals. It consists of 12 compact modules with a transaxial field of view (FOV) of 170 mm in diameter and 40 mm axial FOV that translates to cover up to 170 mm. The patient lies down in a prone position that facilitates maximum breast elongation. Quantitative performance analysis of the calculated method for the attenuation correction specifically developed for MAMMI, and based on PETimage segmentation, has also been conducted in this evaluation. In order to fully determine the MAMMI prototype's performance, we have adapted the measurements suggested for National Electrical Manufacturers Association (NEMA) NU 2-2007 and NU 4-2008 protocol tests, as they are defined for whole-body and small animal PETscanners, respectively.Results:
Spatial resolutions of 1.6, 1.8, and 1.9 mm were measured in the axial, radial, and tangential directions, respectively. A scatter fraction of 20.8% was obtained and the maximum NEC was determined to be 25 kcps at 44 MBq. The average sensitivity of the system was observed to be 1% for an energy window of (250 keV–750 keV) and a maximum absolute sensitivity of 1.8% was measured at the FOV center.Conclusions:
The overall performance of the MAMMI reported on this evaluation quantifies its ability to produce high quality PETimages.Spatial resolution values below 3 mm were measured in most of the FOV. Only the radial component of spatial resolution exceeds the 3 mm at radial positions larger than 60 mm. This study emphasizes the need for standardized testing methodologies for dedicated breast PET systems similar to NEMA standards for whole-body and small animal PETscanners.
39(2012); http://dx.doi.org/10.1118/1.4742845View Description Hide DescriptionPurpose:
The purpose of this work was to develop and validate a computer-aided method for the 3D segmentation of lymph nodes in CT images. The proposed method can be utilized to facilitate applications like biopsy planning, image guided radiation treatment, or assessment of response to therapy.Methods:
An optimal surface finding based lymph node segmentation method was developed. Based on the approximate center point of a lymph node of interest, a graph is generated, which represents the local neighborhood around the lymph node at discrete locations (graph nodes). A cost function is calculated based on a weighted edge and region homogeneity term. By means of optimization, a surface-based segmentation of the lymph node is derived. In addition, an interactive segmentation refinement algorithm was developed, which allows the user to quickly correct segmentation errors, if needed. For assessment of segmentation accuracy, 111 lymph nodes of mediastinum, abdomen, head/neck, and axillary regions from 35 volumetric CT scans were utilized. For accuracy analysis, lymph nodes were divided into three test sets based on lymph node size and spatial resolution of the CT scan. The average lymph node size for test set I, II, and III was 1056, 1621, and 501 mm3, respectively. Spatial resolution of test set II was lower than for test sets I and III. To generate an independent reference standard for comparison, all 111 lymph nodes were segmented by an expert with a live wire approach.Results:
All test sets were segmented with the proposed approach. Out of the 111 lymph nodes, 40 cases (36%) required computer-aided refinement of initial segmentation results. The refinement typically required 10 s per lymph node. The mean and standard deviation of the Dice coefficient for final segmentations was 0.847 ± 0.061, 0.836 ± 0.058, and 0.809 ± 0.070 for test sets I, II, and II, respectively. The average signed surface distance error was 0.023 ± 0.171, 0.394 ± 0.189, and 0.001 ± 0.146 mm for test sets I, II, and II, respectively. The time required for locating the approximate center point of a target lymph node in a scan, generating an initial OSF segmentation, and refining the segmentation, if needed, is typically less than one minute.Conclusions:
Segmentation of lymph nodes in volumetric CT images is a challenging task due to partial volume effects, nearby strong edges, neighboring structures with similar intensity profiles and potentially inhomogeneous density of lymph nodes. The presented approach addresses many of these obstacles. In the majority of cases investigated, the initial segmentation method delivered results that did not require further processing. In addition, the computer-aided segmentation refinement framework was found to be effective in dealing with potentially occurring segmentation errors.
39(2012); http://dx.doi.org/10.1118/1.4742851View Description Hide DescriptionPurpose:
How do display settings and ambient lighting affect contrast detection thresholds for human observers? Can recalibrating a display for high ambient lighting improve object detection?Methods:
Contrast/detail (CD) threshold detection performance was measured for observers using four color displays with varying overall contrast (e.g., differing maximum luminance and ambient lighting conditions). Detailed mapping of contrast detection performance (for fixed object size) was tracked as a function of: display maximum luminance, ambient lighting changes (with and without recalibrating for the higher ambience), and the performance of radiologistsvs. nonradiologists.Results:
The initial phase was analyzed with a hierarchical linear model of observer performance using: background gray level, maximum display luminance, and radiologistvs. nonradiologist. The only statistically significant finding was a maximum luminance of 100 cd/m2 display performing worse than a baseline peak of 400 cd/m2. The second phase examined ambient lighting effects on detection thresholds. Background gray level and maximum display luminance were examined coupled with ambient lighting for: baseline at 30, 435 uncorrected, and 435 lx with display recalibration for the ambient conditions. Results showed ambient correction improved sensitivity for small background digital driving level, but not at higher luminance backgrounds.Conclusions:
For CD study, nonradiologist observers can be used without loss of applicability. Contrast detection thresholds improved significantly between displays with peak luminance from 100 cd/m2 to 200 cd/m2, but improvement beyond that was not statistically significant for contrast detection thresholds in a reading room environment. Applying a calibration correction at high ambience (435 lx) improved detection tasks primarily in the darker background regions.