Index of content:
Volume 41, Issue 1, January 2014
CT ventilation imaging is a novel functional lung imaging modality based on deformable image registration. The authors present the first validation study of CT ventilation using positron emission tomography with68Ga-labeled nanoparticles (PET-Galligas). The authors quantify this agreement for different CT ventilation metrics and PET reconstruction parameters.Methods:
PET-Galligas ventilation scans were acquired for 12 lung cancer patients using a four-dimensional (4D) PET/CT scanner. CT ventilation images were then produced by applying B-spline deformable image registration between the respiratory correlated phases of the 4D-CT. The authors test four ventilation metrics, two existing and two modified. The two existing metrics model mechanical ventilation (alveolar air-flow) based on Hounsfield unit (HU) change (V HU) or Jacobian determinant of deformation (V Jac). The two modified metrics incorporate a voxel-wise tissue-density scaling (ρV HU and ρV Jac) and were hypothesized to better model the physiological ventilation. In order to assess the impact of PET image quality, comparisons were performed using both standard and respiratory-gated PET images with the former exhibiting better signal. Different median filtering kernels (σm = 0 or 3 mm) were also applied to all images. As in previous studies, similarity metrics included the Spearman correlation coefficient r within the segmented lung volumes, and Dice coefficient d 20 for the (0 − 20)th functional percentile volumes.Results:
The best agreement between CT and PET ventilation was obtained comparing standard PET images to the density-scaled HU metric (ρV HU) with σ m = 3 mm. This leads to correlation values in the ranges 0.22 ⩽ r ⩽ 0.76 and 0.38 ⩽ d 20 ⩽ 0.68, with and averaged over the 12 patients. Compared to Jacobian-based metrics, HU-based metrics lead to statistically significant improvements in and (p < 0.05), with density scaled metrics also showing higher than for unscaled versions (p < 0.02). and were also sensitive to image quality, with statistically significant improvements using standard (as opposed to gated) PET images and with application of median filtering.Conclusions:
The use of modified CT ventilation metrics, in conjunction with PET-Galligas and careful application of image filtering has resulted in improved correlation compared to earlier studies using nuclear medicine ventilation. However, CT ventilation and PET-Galligas do not always provide the same functional information. The authors have demonstrated that the agreement can improve for CT ventilation metrics incorporating a tissue density scaling, and also with increasing PET image quality. CT ventilation imaging has clear potential for imaging regional air volume change in the lung, and further development is warranted.
- REVIEW ARTICLE (Online only)
41(2014); http://dx.doi.org/10.1118/1.4835495View Description Hide Description
The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic.