Volume 41, Issue 10, October 2014
Index of content:
41(2014); http://dx.doi.org/10.1118/1.4885996View Description Hide Description
- RADIATION THERAPY PHYSICS
Design and experimental testing of air slab caps which convert commercial electron diodes into dual purpose, correction-free diodes for small field dosimetry41(2014); http://dx.doi.org/10.1118/1.4894728View Description Hide DescriptionPurpose:
Two diodes which do not require correction factors for small field relative output measurements are designed and validated using experimental methodology. This was achieved by adding an air layer above the active volume of the diode detectors, which canceled out the increase in response of the diodes in small fields relative to standard field sizes.Methods:
Due to the increased density of silicon and other components within a diode, additional electrons are created. In very small fields, a very small air gap acts as an effective filter of electrons with a high angle of incidence. The aim was to design a diode that balanced these perturbations to give a response similar to a water-only geometry. Three thicknesses of air were placed at the proximal end of a PTW 60017 electron diode (PTWe) using an adjustable “air cap”. A set of output ratios ( ) for square field sizes of side length down to 5 mm was measured using each air thickness and compared to measured using an IBA stereotactic field diode (SFD). was transferred from the SFD to the PTWe diode and plotted as a function of air gap thickness for each field size. This enabled the optimal air gap thickness to be obtained by observing which thickness of air was required such that was equal to 1.00 at all field sizes. A similar procedure was used to find the optimal air thickness required to make a modified Sun Nuclear EDGE detector (EDGEe) which is “correction-free” in small field relative dosimetry. In addition, the feasibility of experimentally transferring values from the SFD to unknown diodes was tested by comparing the experimentally transferred values for unmodified PTWe and EDGEe diodes to Monte Carlo simulated values.Results:
1.0 mm of air was required to make the PTWe diode correction-free. This modified diode (PTWeair) produced output factors equivalent to those in water at all field sizes (5–50 mm). The optimal air thickness required for the EDGEe diode was found to be 0.6 mm. The modified diode (EDGEeair) produced output factors equivalent to those in water, except at field sizes of 8 and 10 mm where it measured approximately 2% greater than the relative dose to water. The experimentally calculated for both the PTWe and the EDGEe diodes (without air) matched Monte Carlo simulated results, thus proving that it is feasible to transfer from one commercially available detector to another using experimental methods and the recommended experimental setup.Conclusions:
It is possible to create a diode which does not require corrections for small field output factor measurements. This has been performed and verified experimentally. The ability of a detector to be “correction-free” depends strongly on its design and composition. A nonwater-equivalent detector can only be “correction-free” if competing perturbations of the beam cancel out at all field sizes. This should not be confused with true water equivalency of a detector.
A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization41(2014); http://dx.doi.org/10.1118/1.4894710View Description Hide DescriptionPurpose:
To investigate the use of a system using electromagnetic tracking (EMT), post-processing and an error-detection algorithm for detecting errors and resolving uncertainties in high-dose-rate brachytherapy catheter digitization for treatment planning.Methods:
EMT was used to localize 15 catheters inserted into a phantom using a stepwise acquisition technique. Five distinct acquisition experiments were performed. Noise associated with the acquisition was calculated. The dwell location configuration was extracted from the EMT data. A CT scan of the phantom was performed, and five distinct catheter digitization sessions were performed. No a priori registration of the CT scan coordinate system with the EMT coordinate system was performed. CT-based digitization was automatically extracted from the brachytherapy plan DICOM files (CT), and rigid registration was performed between EMT and CT dwell positions. EMT registration error was characterized in terms of the mean and maximum distance between corresponding EMT and CT dwell positions per catheter. An algorithm for error detection and identification was presented. Three types of errors were systematically simulated: swap of two catheter numbers, partial swap of catheter number identification for parts of the catheters (mix), and catheter-tip shift. Error-detection sensitivity (number of simulated scenarios correctly identified as containing an error/number of simulated scenarios containing an error) and specificity (number of scenarios correctly identified as not containing errors/number of correct scenarios) were calculated. Catheter identification sensitivity (number of catheters correctly identified as erroneous across all scenarios/number of erroneous catheters across all scenarios) and specificity (number of catheters correctly identified as correct across all scenarios/number of correct catheters across all scenarios) were calculated. The mean detected and identified shift was calculated.Results:
The maximum noise ±1 standard deviation associated with the EMT acquisitions was 1.0 ± 0.1 mm, and the mean noise was 0.6 ± 0.1 mm. Registration of all the EMT and CT dwell positions was associated with a mean catheter error of 0.6 ± 0.2 mm, a maximum catheter error of 0.9 ± 0.4 mm, a mean dwell error of 1.0 ± 0.3 mm, and a maximum dwell error of 1.3 ± 0.7 mm. Error detection and catheter identification sensitivity and specificity of 100% were observed for swap, mix and shift (≥2.6 mm for error detection; ≥2.7 mm for catheter identification) errors. A mean detected shift of 1.8 ± 0.4 mm and a mean identified shift of 1.9 ± 0.4 mm were observed.Conclusions:
Registration of the EMT dwell positions to the CT dwell positions was possible with a residual mean error per catheter of 0.6 ± 0.2 mm and a maximum error for any dwell of 1.3 ± 0.7 mm. These low residual registration errors show that quality assurance of the general characteristics of the catheters and of possible errors affecting one specific dwell position is possible. The sensitivity and specificity of the catheter digitization verification algorithm was 100% for swap and mix errors and for shifts ≥2.6 mm. On average, shifts ≥1.8 mm were detected, and shifts ≥1.9 mm were detected and identified.
Phantomless patient-specific TomoTherapy QA via delivery performance monitoring and a secondary Monte Carlo dose calculation41(2014); http://dx.doi.org/10.1118/1.4894721View Description Hide DescriptionPurpose:
To describe the validation and implementation of a novel quality assurance (QA) system for TomoTherapy using a Monte Carlo (MC)-based secondary dose calculation and CT detector-based multileaf collimator (MLC) leaf opening time measurement QA verification. This system is capable of detecting plan transfer and delivery errors and evaluating the dosimetric impact of those errors.Methods:
The authors’ QA process, MCLogQA, utilizes an independent pretreatment MC secondary dose calculation and postdelivery TomoTherapy exit detector-based MLC sinogram comparison and log file examination to confirm accurate dose calculation, accurate dose delivery, and to verify machine performance. MC radiation transport simulations are performed to estimate patient dose utilizing prestored treatment machine-specific phase-space information, the patient’s planning CT, and MLC sinogram data. Sinogram data are generated from both the treatment planning system (MC_TPS) and from beam delivery log files (MC_Log). TomoTherapy treatment planning dose (D TPS) is compared with D MC_TPS and D MC_Log via dose–volume metrics and mean region of interest dose statistics. For validation, in-phantom ionization chamber dose measurements (D IC) for ten sample patient plans are compared with the computed values.Results:
Dose comparisons to in-phantom ion chamber measurements validate the capability of the MCLogQA method to detect delivery errors. D MC_Log agreed with D IC within 1%, while D TPS values varied by 2%–5% compared to D IC. The authors demonstrated that TomoTherapy treatments can be vulnerable to MLC deviations and interfraction output variations during treatment delivery. Interfractional Linac output variations for each patient were approximately 2% and average output was 1%–1.5% below the gold standard. While average MLC leaf opening time error from patient to patient varied from −0.6% to 1.6%, the MLC leaf errors varied little between fractions for the same patient plan, excluding one patient.Conclusions:
MCLogQA is a new TomoTherapy QA process that validates the planned dose before delivery and analyzes the delivered dose using the treatment exit detector and log file data. The MCLogQA procedure is an effective and efficient alternative to traditional phantom-based TomoTherapy plan-specific QA because it allows for comprehensive 3D dose verification, accounts for tissue heterogeneity, uses patient CT density tables, reduces total QA time, and provides for a comprehensive QA methodology for each treatment fraction.
Quantifying the effect of seed orientation in postplanning dosimetry of low-dose-rate prostate brachytherapy41(2014); http://dx.doi.org/10.1118/1.4895012View Description Hide DescriptionPurpose:
Radioactive seed orientations are usually ignored in clinical brachytherapy dosimetry for prostate implants. Associated with the anisotropic dose distribution of seeds, these orientations could cause dose differences between the planning configurations and the clinical postplanning dosimetry. This study will quantify the impact of seed orientation on the dosimetry.Methods:
3D seed positions and θ and φ polar angles were obtained using five independent fluoroscopic images for 287 patients. Five dose calculation methods are compared: TG43-1D (1), TG43-2D parallel to implant axis (2) and with orientations (3), Monte Carlo (MC) simulations parallel (4), and MC simulations with orientations (5). GEANT4 v4.9.6 MC simulations were made in 1 mm3 voxelized geometries based on the DICOM-RT information. Materials were assigned using thresholds based on the HU number, as recommended in TG186 reports. Seed voxels are overridden with prostatic materials and the layered mass geometry [Enger et al., Phys. Med. Biol. 57(19), 6269–6277 (2012)] allows subsequent placement of the source geometry. 500 million histories were used per patient. 3D dose and DVHs for each structure were calculated.Results:
The various seed orientations do not result in statistically significant differences on the dose metrics for the clinical target volume (CTV) or the urethra, based on the Student t-test p-value. Difference as low as −0.238% and 0.059% has been seen on the CTV D90, respectively, for the MC and the TG43. The difference between parallel and oriented calculations for the organs at risk (OARs) can differ by 2% on average.Conclusions:
Based on the results from this study, seed orientations have no significant impact of CTV and urethra dose metrics but can affect OARs that are external to the CTV.
Coverage-based treatment planning to accommodate deformable organ variations in prostate cancer treatment41(2014); http://dx.doi.org/10.1118/1.4894701View Description Hide DescriptionPurpose:
To compare two coverage-based planning (CP) techniques with standard fixed margin-based planning (FM), considering the dosimetric impact of interfraction deformable organ motion exclusively for high-risk prostate treatments.Methods:
Nineteen prostate cancer patients with 8–13 prostate CT images of each patient were used to model patient-specific interfraction deformable organ changes. The model was based on the principal component analysis (PCA) method and was used to predict the patient geometries for virtual treatment course simulation. For each patient, an IMRT plan using zero margin on target structures, prostate (CTVprostate) and seminal vesicles (CTVSV), were created, then evaluated by simulating 1000 30-fraction virtual treatment courses. Each fraction was prostate centroid aligned. Patients whose D 98 failed to achieve 95% coverage probability objective D 98,95 ≥ 78 Gy (CTVprostate) or D 98,95 ≥ 66 Gy (CTVSV) were replanned using planning techniques: (1) FM (PTVprostate = CTVprostate + 5 mm, PTVSV = CTVSV + 8 mm), (2) CP OM which optimized uniform PTV margins for CTVprostate and CTVSV to meet the coverage probability objective, and (3) CPCOP which directly optimized coverage probability objectives for all structures of interest. These plans were intercompared by computing probabilistic metrics, including 5% and 95% percentile DVHs (pDVH) and TCP/NTCP distributions.Results:
All patients were replanned using FM and two CP techniques. The selected margins used in FM failed to ensure target coverage for 8/19 patients. Twelve CP OM plans and seven CPCOP plans were favored over the other plans by achieving desirable D 98,95 while sparing more normal tissues.Conclusions:
Coverage-based treatment planning techniques can produce better plans than FM, while relative advantages of CP OM and CPCOP are patient-specific.
41(2014); http://dx.doi.org/10.1118/1.4895016View Description Hide DescriptionPurpose:
The Vero4DRT has a maximum field size of 150.0 × 150.0 mm. The purpose of the present study was to develop expanded-field irradiation techniques using the unique gimbaled x-ray head of the Vero4DRT and to evaluate the dosimetric characteristics thereof.Methods:
Two techniques were developed. One features gimbal swing irradiation and multiple static segments consisting of four separate fields exhibiting 2.39° gimbal rotation around two orthogonal axes. The central beam axis for each piecewise-field is shifted 40 mm from the isocenters of the left–right (LR) and superior–inferior (SI) directions, and, thus, the irradiation field size is expanded to 230.8 × 230.8 mm. Adjacent regions were created at the isocenter (a center-adjacent expandedfield) and 20 mm from the isocenter (an off-adjacent expandedfield). The field gaps or overlaps of combined piecewise-fields were established by adjustment of gimbal rotation and movement of the multileaf collimator (MLC). Another technique features dynamic segment irradiation in which the beam is delivered while rotating the gimbal. The dose profile is controlled by a combination of gimbal swing motion and opening and closing of the MLC. This enabled the authors to expand the irradiation field on the LR axis because the direction of MLC motion is parallel to that axis. A field 220.6 × 150.0 mm in dimensions was configured and examined. To evaluate the dosimetric characteristics of the expandedfields, films inserted into water-equivalent phantoms at depths of 50, 100, and 150 mm were irradiated and field sizes, penumbrae, flatness, and symmetry analyzed. In addition, the expanded-field irradiation techniques were applied to intensity-modulated radiation therapy (IMRT). A head-and-neck IMRT field, created using a conventional Linac (the Varian Clinac iX), was reproduced employing an expanded-field of the Vero4DRT. The simulated dose distribution for the expanded-IMRT field was compared to the measured dose distribution.Results:
The field sizes, penumbrae, flatness, and symmetry of the center- and off-adjacent expanded-fields were 230.2–232.1 mm, 6.8–10.7 mm, 2.3%–5.1%, and −0.5% to −0.4%, respectively, at a depth of 100 mm. Similarly, the field sizes, penumbrae, flatness, and symmetry of dynamic segment irradiation on the LR axis were 219.2 mm, 6.0–6.2 mm, 3.4%, and −0.1%, respectively, at a depth of 100 mm. In the area of expanded-IMRT dose distribution, the passing rate of 5% dose difference was 85.8% between measurements and simulation, and the 3%/3 mm gamma passing rate was 96.4%.Conclusions:
Expanded-field irradiation techniques were developed using a gimbaled x-ray head. The techniques effectively extend target areas, as required when whole-breast irradiation or head-and-neck IMRT is contemplated.
Motion management during IMAT treatment of mobile lung tumors—A comparison of MLC tracking and gated delivery41(2014); http://dx.doi.org/10.1118/1.4896024View Description Hide DescriptionPurpose:
To compare real-time dynamic multileaf collimator (MLC) tracking, respiratory amplitude and phase gating, and no compensation for intrafraction motion management during intensity modulated arc therapy (IMAT).Methods:
Motion management with MLC tracking and gating was evaluated for four lung cancer patients. The IMAT plans were delivered to a dosimetric phantom mounted onto a 3D motion phantom performing patient-specific lung tumor motion. The MLC tracking system was guided by an optical system that used stereoscopic infrared (IR) cameras and five spherical reflecting markers attached to the dosimetric phantom. The gated delivery used a duty cycle of 35% and collected position data using an IR camera and two reflecting markers attached to a marker block.Results:
The average gamma index failure rate (2% and 2 mm criteria) was <0.01% with amplitude gating for all patients, and <0.1% with phase gating and <3.7% with MLC tracking for three of the four patients. One of the patients had an average failure rate of 15.1% with phase gating and 18.3% with MLC tracking. With no motion compensation, the average gamma index failure rate ranged from 7.1% to 46.9% for the different patients. Evaluation of the dosimetric error contributions showed that the gated delivery mainly had errors in target localization, while MLC tracking also had contributions from MLC leaf fitting and leaf adjustment. The average treatment time was about three times longer with gating compared to delivery with MLC tracking (that did not prolong the treatment time) or no motion compensation. For two of the patients, the different motion compensation techniques allowed for approximately the same margin reduction but for two of the patients, gating enabled a larger reduction of the margins than MLC tracking.Conclusions:
Both gating and MLC tracking reduced the effects of the target movements, although the gated delivery showed a better dosimetric accuracy and enabled a larger reduction of the margins in some cases. MLC tracking did not prolong the treatment time compared to delivery with no motion compensation while gating had a considerably longer delivery time. In a clinical setting, the optical monitoring of the patients breathing would have to be correlated to the internal movements of the tumor.
Variation of for the small-field dosimetric parameters percentage depth dose, tissue-maximum ratio, and off-axis ratio41(2014); http://dx.doi.org/10.1118/1.4895978View Description Hide DescriptionPurpose:
Evaluate the ability of different dosimeters to correctly measure the dosimetric parameters percentage depth dose (PDD), tissue-maximum ratio (TMR), and off-axis ratio (OAR) in water for small fields.Methods:
Monte Carlo (MC) simulations were used to estimate the variation of for several types of microdetectors as a function of depth and distance from the central axis for PDD, TMR, and OAR measurements. The variation of enables one to evaluate the ability of a detector to reproduce the PDD, TMR, and OAR in water and consequently determine whether it is necessary to apply correction factors. The correctness of the simulations was verified by assessing the ratios between the PDDs and OARs of 5- and 25-mm circular collimators used with a linear accelerator measured with two different types of dosimeters (the PTW 60012 diode and PTW PinPoint 31014 microchamber) and the PDDs and the OARs measured with the Exradin W1 plastic scintillator detector (PSD) and comparing those ratios with the corresponding ratios predicted by the MC simulations.Results:
MC simulations reproduced results with acceptable accuracy compared to the experimental results; therefore, MC simulations can be used to successfully predict the behavior of different dosimeters in small fields. The Exradin W1 PSD was the only dosimeter that reproduced the PDDs, TMRs, and OARs in water with high accuracy. With the exception of the EDGE diode, the stereotactic diodes reproduced the PDDs and the TMRs in water with a systematic error of less than 2% at depths of up to 25 cm; however, they produced OAR values that were significantly different from those in water, especially in the tail region (lower than 20% in some cases). The microchambers could be used for PDD measurements for fields greater than those produced using a 10-mm collimator. However, with the detector stem parallel to the beam axis, the microchambers could be used for TMR measurements for all field sizes. The microchambers could not be used for OAR measurements for small fields.Conclusions:
Compared with MC simulation, the Exradin W1 PSD can reproduce the PDDs, TMRs, and OARs in water with a high degree of accuracy; thus, the correction used for converting dose is very close to unity. The stereotactic diode is a viable alternative because it shows an acceptable systematic error in the measurement of PDDs and TMRs and a significant underestimation in only the tail region of the OAR measurements, where the dose is low and differences in dose may not be therapeutically meaningful.
- RADIATION IMAGING PHYSICS
41(2014); http://dx.doi.org/10.1118/1.4894724View Description Hide DescriptionPurpose:
To investigate the feasibility of an accurate measurement of water, lipid, and protein composition of breast tissue using a photon-counting spectral computed tomography (CT) with spectral distortion corrections.Methods:
Thirty-eight postmortem breasts were imaged with a cadmium-zinc-telluride-based photon-counting spectral CT system at 100 kV. The energy-resolving capability of the photon-counting detector was used to separate photons into low and high energy bins with a splitting energy of 42 keV. The estimated mean glandular dose for each breast ranged from 1.8 to 2.2 mGy. Two spectral distortion correction techniques were implemented, respectively, on the raw images to correct the nonlinear detector response due to pulse pileup and charge-sharing artifacts. Dual energy decomposition was then used to characterize each breast in terms of water, lipid, and protein content. In the meantime, the breasts were chemically decomposed into their respective water, lipid, and protein components to provide a gold standard for comparison with dual energy decomposition results.Results:
The accuracy of the tissue compositional measurement with spectral CT was determined by comparing to the reference standard from chemical analysis. The averaged root-mean-square error in percentage composition was reduced from 15.5% to 2.8% after spectral distortion corrections.Conclusions:
The results indicate that spectral CT can be used to quantify the water, lipid, and protein content in breast tissue. The accuracy of the compositional analysis depends on the applied spectral distortion correction technique.
41(2014); http://dx.doi.org/10.1118/1.4894726View Description Hide DescriptionPurpose:
The authors have recently developed a novel 4D-MRI technique for imaging organ respiratory motion employing cine acquisition in the axial plane and using body area (BA) as a respiratory surrogate. A potential disadvantage associated with axial image acquisition is the space-dependent phase shift in the superior–inferior (SI) direction, i.e., different axial slice positions reach the respiratory peak at different respiratory phases. Since respiratory motion occurs mostly in the SI and anterior–posterior (AP) directions, sagittal image acquisition, which embeds motion information in these two directions, is expected to be more robust and less affected by phase-shift than axial image acquisition. This study aims to develop and evaluate a 4D-MRI technique using sagittal image acquisition.Methods:
The authors evaluated axial BA and sagittal BA using both 4D-CT images (11 cancer patients) and cine MR images (6 healthy volunteers and 1 cancer patient) by comparing their corresponding space-dependent phase-shift in the SI direction and in the lateral direction , respectively. To evaluate sagittal BA 4D-MRI method, a motion phantom study and a digital phantom study were performed. Additionally, six patients who had cancer(s) in the liver were prospectively enrolled in this study. For each patient, multislice sagittal MR images were acquired for 4D-MRI reconstruction. 4D retrospective sorting was performed based on respiratory phases. Single-slice cine MRI was also acquired in the axial, coronal, and sagittal planes across the tumor center from which tumor motion trajectories in the SI, AP, and medial–lateral (ML) directions were extracted and used as references from comparison. All MR images were acquired in a 1.5 T scanner using a steady-state precession sequence (frame rate ∼ 3 frames/s).Results:
4D-CT scans showed that was significantly greater than (p-value: 0.012); the median phase-shift was 16.9% and 7.7%, respectively. Body surface motion measurement from axial and sagittal MR cines also showed was significantly greater than . The median and was 11.0% and 9.2% (p-value = 0.008), respectively. Tumor motion trajectories from 4D-MRI matched with those from single-slice cine MRI: the mean (±SD) absolute differences in tumor motion amplitude between the two were 1.5 ± 1.6 mm, 2.1 ± 1.9 mm, and 1.1 ± 1.0 mm in the SI, ML, and AP directions from this patient study.Conclusions:
Space-dependent phase shift is less problematic for sagittal acquisition than for axial acquisition. 4D-MRI using sagittal acquisition was successfully carried out in patients with hepatic tumors.
41(2014); http://dx.doi.org/10.1118/1.4894812View Description Hide DescriptionPurpose:
Survival for high-grade gliomas is poor, at least partly explained by intratumoral heterogeneity contributing to treatment resistance. Radiological evaluation of treatment response is in most cases limited to assessment of tumor size months after the initiation of therapy. Diffusion-weighted magnetic resonance imaging (MRI) and its estimate of the apparent diffusion coefficient (ADC) has been widely investigated, as it reflects tumor cellularity and proliferation. The aim of this study was to investigate texture analysis of ADC images in conjunction with multivariate image analysis as a means for identification of pretreatment imaging biomarkers.Methods:
Twenty-three consecutive high-grade glioma patients were treated with radiotherapy (2 Gy/60 Gy) with concomitant and adjuvant temozolomide. ADC maps and T1-weighted anatomical images with and without contrast enhancement were collected prior to treatment, and (residual) tumor contrast enhancement was delineated. A gray-level co-occurrence matrix analysis was performed on the ADC maps in a cuboid encapsulating the tumor in coronal, sagittal, and transversal planes, giving a total of 60 textural descriptors for each tumor. In addition, similar examinations and analyses were performed at day 1, week 2, and week 6 into treatment. Principal component analysis (PCA) was applied to reduce dimensionality of the data, and the five largest components (scores) were used in subsequent analyses. MRI assessment three months after completion of radiochemotherapy was used for classifying tumor progression or regression.Results:
The score scatter plots revealed that the first, third, and fifth components of the pretreatment examinations exhibited a pattern that strongly correlated to survival. Two groups could be identified: one with a median survival after diagnosis of 1099 days and one with 345 days, p = 0.0001.Conclusions:
By combining PCA and texture analysis, ADC texture characteristics were identified, which seems to hold pretreatment prognostic information, independent of known prognostic factors such as age, stage, and surgical procedure. These findings encourage further studies with a larger patient cohort.
High-resolution three-dimensional visualization of the rat spinal cord microvasculature by synchrotron radiation micro-CT41(2014); http://dx.doi.org/10.1118/1.4894704View Description Hide DescriptionPurpose:
Understanding the three-dimensional (3D) morphology of the spinal cord microvasculature has been limited by the lack of an effective high-resolution imaging technique. In this study, synchrotron radiation microcomputed tomography (SRµCT), a novel imaging technique based on absorption imaging, was evaluated with regard to the detection of the 3D morphology of the rat spinal cord microvasculature.Methods:
Ten Sprague-Dawley rats were used in this ex vivo study. After contrast agent perfusion, their spinal cords were isolated and scanned using conventional x-rays, conventional micro-CT (CµCT), and SRµCT.Results:
Based on contrast agent perfusion, the microvasculature of the rat spinal cord was clearly visualized for the first time ex vivo in 3D by means of SRµCT scanning. Compared to conventional imaging techniques, SRµCT achieved higher resolution 3D vascular imaging, with the smallest vessel that could be distinguished approximately 7.4 μm in diameter. Additionally, a 3D pseudocolored image of the spinal cord microvasculature was generated in a single session of SRµCT imaging, which was conducive to detailed observation of the vessel morphology.Conclusions:
The results of this study indicated that SRµCT scanning could provide higher resolution images of the vascular network of the spinal cord. This modality also has the potential to serve as a powerful imaging tool for the investigation of morphology changes in the 3D angioarchitecture of the neurovasculature in preclinical research.
A simple method to retrospectively estimate patient dose-area product for chest tomosynthesis examinations performed using VolumeRAD41(2014); http://dx.doi.org/10.1118/1.4895002View Description Hide DescriptionPurpose:
The purpose of the present work was to develop and validate a method of retrospectively estimating the dose-area product (DAP) of a chest tomosynthesis examination performed using the VolumeRAD system (GE Healthcare, Chalfont St. Giles, UK) from digital imaging and communications in medicine (DICOM) data available in the scout image.Methods:
DICOM data were retrieved for 20 patients undergoing chest tomosynthesis using VolumeRAD. Using information about how the exposure parameters for the tomosynthesis examination are determined by the scout image, a correction factor for the adjustment in field size with projection angle was determined. The correction factor was used to estimate the DAP for 20 additional chest tomosynthesis examinations from DICOM data available in the scout images, which was compared with the actual DAP registered for the projection radiographs acquired during the tomosynthesis examination.Results:
A field size correction factor of 0.935 was determined. Applying the developed method using this factor, the average difference between the estimated DAP and the actual DAP was 0.2%, with a standard deviation of 0.8%. However, the difference was not normally distributed and the maximum error was only 1.0%. The validity and reliability of the presented method were thus very high.Conclusions:
A method to estimate the DAP of a chest tomosynthesis examination performed using the VolumeRAD system from DICOM data in the scout image was developed and validated. As the scout image normally is the only image connected to the tomosynthesis examination stored in the picture archiving and communication system (PACS) containing dose data, the method may be of value for retrospectively estimating patient dose in clinical use of chest tomosynthesis.
Improving x-ray fluorescence signal for benchtop polychromatic cone-beam x-ray fluorescence computed tomography by incident x-ray spectrum optimization: A Monte Carlo study41(2014); http://dx.doi.org/10.1118/1.4895004View Description Hide DescriptionPurpose:
To develop an accurate and comprehensive Monte Carlo (MC) model of an experimental benchtop polychromatic cone-beam x-ray fluorescence computed tomography (XFCT) setup and apply this MC model to optimize incident x-ray spectrum for improving production/detection of x-ray fluorescence photons from gold nanoparticles (GNPs).Methods:
A detailed MC model, based on an experimental XFCT system, was created using the Monte Carlo N-Particle (MCNP) transport code. The model was validated by comparing MC results including x-ray fluorescence (XRF) and scatter photon spectra with measured data obtained under identical conditions using 105 kVp cone-beam x-rays filtered by either 1 mm of lead (Pb) or 0.9 mm of tin (Sn). After validation, the model was used to investigate the effects of additional filtration of the incident beam with Pb and Sn. Supplementary incident x-ray spectra, representing heavier filtration (Pb: 2 and 3 mm; Sn: 1, 2, and 3 mm) were computationally generated and used with the model to obtain XRF/scatter spectra. Quasimonochromatic incident x-ray spectra (81, 85, 90, 95, and 100 keV with 10 keV full width at half maximum) were also investigated to determine the ideal energy for distinguishing gold XRF signal from the scatter background. Fluorescence signal-to-dose ratio (FSDR) and fluorescence-normalized scan time (FNST) were used as metrics to assess results.Results:
Calculated XRF/scatter spectra for 1-mm Pb and 0.9-mm Sn filters matched (r ≥ 0.996) experimental measurements. Calculated spectra representing additional filtration for both filter materials showed that the spectral hardening improved the FSDR at the expense of requiring a much longer FNST. In general, using Sn instead of Pb, at a given filter thickness, allowed an increase of up to 20% in FSDR, more prominent gold XRF peaks, and up to an order of magnitude decrease in FNST. Simulations using quasimonochromatic spectra suggested that increasing source x-ray energy, in the investigated range of 81–100 keV, increased the FSDR up to a factor of 20, compared to 1 mm Pb, and further facilitated separation of gold XRF peaks from the scatter background.Conclusions:
A detailed MC model of an experimental benchtop XFCT system has been developed and validated. In exemplary calculations to illustrate the usefulness of this model, it was shown that potential use of quasimonochromatic spectra or judicious choice of filter material/thickness to tailor the spectrum of a polychromatic x-ray source can significantly improve the performance of benchtop XFCT, while considering trade-offs between FSDR and FNST. As demonstrated, the current MC model is a reliable and powerful computational tool that can greatly expedite the further development of a benchtop XFCT system for routine preclinical molecular imaging with GNPs and other metal probes.
41(2014); http://dx.doi.org/10.1118/1.4894733View Description Hide DescriptionPurpose:
Photon counting detectors (PCDs) are an emerging technology with applications in spectral and low-dose radiographic and tomographic imaging. This paper develops an analytical model of PCD imaging performance, including the system gain, modulation transfer function (MTF), noise-power spectrum (NPS), and detective quantum efficiency (DQE).Methods:
A cascaded systems analysis model describing the propagation of quanta through the imaging chain was developed. The model was validated in comparison to the physical performance of a silicon-strip PCD implemented on an experimental imaging bench. The signal response, MTF, and NPS were measured and compared to theory as a function of exposure conditions (70 kVp, 1–7 mA), detector threshold, and readout mode (i.e., the option for coincidence detection). The model sheds new light on the dependence of spatial resolution, charge sharing, and additive noise effects on threshold selection and was used to investigate the factors governing PCD performance, including the fundamental advantages and limitations of PCDs in comparison to energy-integrating detectors (EIDs) in the linear regime for which pulse pileup can be ignored.Results:
The detector exhibited highly linear mean signal response across the system operating range and agreed well with theoretical prediction, as did the system MTF and NPS. The DQE analyzed as a function of kilovolt (peak), exposure, detector threshold, and readout mode revealed important considerations for system optimization. The model also demonstrated the important implications of false counts from both additive electronic noise and charge sharing and highlighted the system design and operational parameters that most affect detector performance in the presence of such factors: for example, increasing the detector threshold from 0 to 100 (arbitrary units of pulse height threshold roughly equivalent to 0.5 and 6 keV energy threshold, respectively), increased the f 50 (spatial-frequency at which the MTF falls to a value of 0.50) by ∼30% with corresponding improvement in DQE. The range in exposure and additive noise for which PCDs yield intrinsically higher DQE was quantified, showing performance advantages under conditions of very low-dose, high additive noise, and high fidelity rejection of coincident photons.Conclusions:
The model for PCD signal and noise performance agreed with measurements of detector signal, MTF, and NPS and provided a useful basis for understanding complex dependencies in PCD imaging performance and the potential advantages (and disadvantages) in comparison to EIDs as well as an important guide to task-based optimization in developing new PCD imaging systems.
A method for avoiding overlap of left and right lungs in shape model guided segmentation of lungs in CT volumes41(2014); http://dx.doi.org/10.1118/1.4894817View Description Hide DescriptionPurpose:
The automated correct segmentation of left and right lungs is a nontrivial problem, because the tissue layer between both lungs can be quite thin. In the case of lung segmentation with left and right lung models, overlapping segmentations can occur. In this paper, the authors address this issue and propose a solution for a model-based lung segmentation method.Methods:
The thin tissue layer between left and right lungs is detected by means of a classification approach and utilized to selectively modify the cost function of the lung segmentation method. The approach was evaluated on a diverse set of 212 CT scans of normal and diseased lungs. Performance was assessed by utilizing an independent reference standard and by means of comparison to the standard segmentation method without overlap avoidance.Results:
For cases where the standard approach produced overlapping segmentations, the proposed method significantly (p = 1.65 × 10−9) reduced the overlap by 97.13% on average (median: 99.96%). In addition, segmentation accuracy assessed with the Dice coefficient showed a statistically significant improvement (p = 7.5 × 10−5) and was 0.9845 ± 0.0111. For cases where the standard approach did not produce an overlap, performance of the proposed method was not found to be significantly different.Conclusions:
The proposed method improves the quality of the lung segmentations, which is important for subsequent quantitative analysis steps.
Evaluation of slice sensitivity profiles for helical and axial 4D-CT acquisitions on the Philips Brilliance CT Big Bore41(2014); http://dx.doi.org/10.1118/1.4895976View Description Hide DescriptionPurpose:
4D-CT can be performed using two acquisition modes. One employs a cine axial scan and the other acquires the data using a very low pitch helical acquisition. This study evaluates the longitudinal resolutions of each of these methods by creating slice sensitivity profiles (SSP).Methods:
An SSP phantom was scanned using both axial and helical scanning modes. The phantom was scanned at the center of the field of view (FOV) and at several points offset from the FOV center. For helical scans, the pitch was varied from 0.04 to 0.2. With the axial scans, the phantom position relative to the center of the detector ring was varied. All of these were performed using a 16 × 1.5 mm collimation.Results:
The SSP graphs were generated from these scanned datasets. The full width at half maximum (FWHM) of the graphs was used as the surrogate for longitudinal resolution. The results of these experiments demonstrated that axial scans have a slightly better resolution at CT isocenter (1.5 vs 1.8 mm). Helical mode scanning maintained this measurement for varying pitch factors and placement with the scan field. However, the resolution for axial scans degrades as the phantom is moved further from the center of the FOV and is positioned nearer to the edge of the detector rings.Conclusions:
When it is imperative to maintain uniform longitudinal resolution throughout the FOV, it is suggested that helical acquisition be utilized or the axial mode data be reconstructed to account for beam divergence. For axial scans, this will require either limiting the longitudinal extent of each cine axial acquisition and/or using a smaller reconstructed FOV.
41(2014); http://dx.doi.org/10.1118/1.4895847View Description Hide DescriptionPurpose:
Patient-to-image registration is critical to providing surgeons with reliable guidance information in the application of image-guided neurosurgery systems. The conventional point-matching registration method, which is based on skin markers, requires expensive and time-consuming logistic support. Surface-matching registration with facial surface scans is an alternative method, but the registration accuracy is unstable and the error in the more posterior parts of the head is usually large because the scan range is limited. This study proposes a new surface-matching method using a portable 3D scanner to acquire a point cloud of the entire head to perform the patient-to-image registration.Methods:
A new method for transforming the scan points from the device space into the patient space without calibration and tracking was developed. Five positioning targets were attached on a reference star, and their coordinates in the patient space were measured prior. During registration, the authors moved the scanner around the head to scan its entire surface as well as the positioning targets, and the scanner generated a unique point cloud in the device space. The coordinates of the positioning targets in the device space were automatically detected by the scanner, and a spatial transformation from the device space to the patient space could be calculated by registering them to their coordinates in the patient space that had been measured prior. A three-step registration algorithm was then used to register the patient space to the image space. The authors evaluated their method on a rigid head phantom and an elastic head phantom to verify its practicality and to calculate the target registration error (TRE) in different regions of the head phantoms. The authors also conducted an experiment with a real patient’s data to test the feasibility of their method in the clinical environment.Results:
In the phantom experiments, the mean fiducial registration error between the device space and the patient space, the mean surface registration error, and the mean TRE of 15 targets on the surface of each phantom were 0.34 ± 0.01 mm and 0.33 ± 0.02 mm, 1.17 ± 0.02 mm and 1.34 ± 0.10 mm, and 1.06 ± 0.11 mm and 1.48 ± 0.21 mm, respectively. When grouping the targets according to their positions on the head, high accuracy was achieved in all parts of the head, and the TREs were similar across different regions. The authors compared their method with the current surface registration methods that use only a part of the facial surface on the elastic phantom, and the mean TRE of 15 targets was 1.48 ± 0.21 mm and 1.98 ± 0.53 mm, respectively. In a clinical experiment, the mean TRE of seven targets on the patient’s head surface was 1.92 ± 0.18 mm, which was sufficient to meet clinical requirements.Conclusions:
The proposed surface-matching registration method provides sufficient registration accuracy even in the posterior area of the head. The 3D point cloud of the entire head, including the facial surface and the back of the head, can be easily acquired using a portable 3D scanner. The scanner does not need to be calibrated prior or tracked by the optical tracking system during scanning.
Fiducial marker and marker-less soft-tissue detection using fast MV fluoroscopy on a new generation EPID: Investigating the influence of pulsing artifacts and artifact suppression techniques a)41(2014); http://dx.doi.org/10.1118/1.4896116View Description Hide DescriptionPurpose:
Because frame rates on current clinical available electronic portal imaging devices (EPID’s) are limited to 7.5 Hz, a new commercially available PerkinElmer EPID (XRD 1642 AP19) with a maximum frame rate of 30 Hz and a new scintillator (Kyokko PI200) with improved sensitivity (light output) for megavolt (MV) irradiation was evaluated. In this work, the influence of MV pulse artifacts and pulsing artifact suppression techniques on fiducial marker and marker-less detection of a lung lesion was investigated, because target localization is an important component of uncertainty in geometrical verification of real-time tumor tracking.Methods:
Visicoil™ markers with a diameter of 0.05 and 0.075 cm were used for MV marker tracking with a frame rate of, respectively, 7.5, 15, and 30 Hz. A 30 Hz readout of the detector was obtained by a 2 × 2 pixel binning, reducing spatial resolution. Static marker detection was conducted in function of increasing phantom thickness. Additionally, marker-less tracking was conducted and compared with the ground-truth fiducial marker motion. Performance of MV target detection was investigated by comparing the least-square sine wave fit of the detected marker positions with the predefined sine wave motion. For fiducial marker detection, a Laplacian-of-Gaussian enhancement was applied after which normalized cross correlation was used to find the most probable marker position. Marker-less detection was performed by using the scale and orientation adaptive mean shift tracking algorithm. For each MV fluoroscopy, a free running (FR-nF) (ignoring MV pulsing during readout) acquisition mode was compared with two acquisition modes intending to reduce MV pulsing artifacts, i.e., combined wavelet-FFT filtering (FR-wF) and electronic readout synchronized with respect to MV pulses.Results:
A 0.05 cm Visicoil marker resulted in an unacceptable root-mean square error (RMSE) > 0.2 cm with a maximum frame rate of 30 Hz during FR-nF readout. With a 30 Hz synchronized readout (S-nF) and during 15 Hz readout (independent of readout mode), RMSE was submillimeter for a static 0.05 cm Visicoil. A dynamic 0.05 cm Visicoil was not detectable on the XRD 1642 AP19, despite a fast synchronized readout. For a 0.075 cm Visicoil, deviations of sine wave motion were submillimeter (RMSE < 0.08 cm), independent of the acquisition mode (FR, S). For marker-less tumor detection, FR-nF images resulted in RMSE > 0.3 cm, while for MV fluoroscopy in S-mode RMSE < 0.1 cm for 15 Hz and RMSE < 0.16 cm for 30 Hz. Largest consistency in target localization was experienced during 15 Hz S-nF readout.Conclusions:
In general, marker contrast decreased in function of higher frame rates, which was detrimental for marker detection success. In this work, Visicoils with a thickness of 0.075 cm were showing best results for a 15 Hz frame rate, while non-MV compatible 0.05 cm Visicoil markers were not visible on the new EPID with improved sensitivity compared to EPID models based on a Kodak Lanex Fast scintillator. No noticeable influence of pulsing artifacts on the detection of a 0.075 cm Visicoil was observed, while a synchronized readout provided most reliable detection of a marker-less soft-tissue structure.