Volume 42, Issue 3, March 2015
Index of content:
42(2015); http://dx.doi.org/10.1118/1.4903900View Description Hide Description
- RADIATION THERAPY PHYSICS
Clinical evaluation of the iterative metal artifact reduction algorithm for CT simulation in radiotherapy42(2015); http://dx.doi.org/10.1118/1.4906245View Description Hide DescriptionPurpose:
To clinically evaluate an iterative metal artifact reduction (IMAR) algorithm prototype in the radiation oncology clinic setting by testing for accuracy in CT number retrieval, relative dosimetric changes in regions affected by artifacts, and improvements in anatomical and shape conspicuity of corrected images.Methods:
A phantom with known material inserts was scanned in the presence/absence of metal with different configurations of placement and sizes. The relative change in CT numbers from the reference data (CT with no metal) was analyzed. The CT studies were also used for dosimetric tests where dose distributions from both photon and proton beams were calculated. Dose differences and gamma analysis were calculated to quantify the relative changes between doses calculated on the different CT studies. Data from eight patients (all different treatment sites) were also used to quantify the differences between dose distributions before and after correction with IMAR, with no reference standard. A ranking experiment was also conducted to analyze the relative confidence of physicians delineating anatomy in the near vicinity of the metal implants.Results:
IMAR corrected images proved to accurately retrieve CT numbers in the phantom study, independent of metal insert configuration, size of the metal, and acquisition energy. For plastic water, the mean difference between corrected images and reference images was −1.3 HU across all scenarios (N = 37) with a 90% confidence interval of [−2.4, −0.2] HU. While deviations were relatively higher in images with more metal content, IMAR was able to effectively correct the CT numbers independent of the quantity of metal. Residual errors in the CT numbers as well as some induced by the correction algorithm were found in the IMAR corrected images. However, the dose distributions calculated on IMAR corrected images were closer to the reference data in phantom studies. Relative spatial difference in the dose distributions in the regions affected by the metal artifacts was also observed in patient data. However, in absence of a reference ground truth (CT set without metal inserts), these differences should not be interpreted as improvement/deterioration of the accuracy of calculated dose. With limited data presented, it was observed that proton dosimetry was affected more than photons as expected. Physicians were significantly more confident contouring anatomy in the regions affected by artifacts. While site specific preferences were detected, all indicated that they would consistently use IMAR corrected images.Conclusions:
IMAR correction algorithm could be readily implemented in an existing clinical workflow upon commercial release. While residual errors still exist in IMAR corrected images, these images present with better overall conspicuity of the patient/phantom geometry and offer more accurate CT numbers for improved local dosimetry. The variety of different scenarios included herein attest to the utility of the evaluated IMAR for a wide range of radiotherapy clinical scenarios.
Measurements of isocenter path characteristics of the gantry rotation axis with a smartphone application42(2015); http://dx.doi.org/10.1118/1.4906248View Description Hide DescriptionPurpose:
For stereotactic radiosurgery, the AAPM Report No. 54 [AAPM Task Group 42 (AAPM, 1995)] requires the overall stability of the isocenter (couch, gantry, and collimator) to be within a 1 mm radius. In reality, a rotating system has no rigid axis and thus no isocenter point which is fixed in space. As a consequence, the isocenter concept is reviewed here. It is the aim to develop a measurement method following the revised definitions.Methods:
The mechanical isocenter is defined here by the point which rotates on the shortest path in the room coordinate system. The path is labeled as “isocenter path.” Its center of gravity is assumed to be the mechanical isocenter. Following this definition, an image-based and radiation-free measurement method was developed. Multiple marker pairs in a plane perpendicular to the assumed gantry rotation axis of a linear accelerator are imaged with a smartphone application from several rotation angles. Each marker pair represents an independent measuring system. The room coordinates of the isocenter path and the mechanical isocenter are calculated based on the marker coordinates. The presented measurement method is by this means strictly focused on the mechanical isocenter.Results:
The measurement result is available virtually immediately following completion of measurement. When 12 independent measurement systems are evaluated, the standard deviations of the isocenter path points and mechanical isocenter coordinates are 0.02 and 0.002 mm, respectively.Conclusions:
The measurement is highly accurate, time efficient, and simple to adapt. It is therefore suitable for regular checks of the mechanical isocenter characteristics of the gantry and collimator rotation axis. When the isocenter path is reproducible and its extent is in the range of the needed geometrical accuracy, it should be taken into account in the planning process. This is especially true for stereotactic treatments and radiosurgery.
Fast, automatic, and accurate catheter reconstruction in HDR brachytherapy using an electromagnetic 3D tracking system42(2015); http://dx.doi.org/10.1118/1.4908011View Description Hide DescriptionPurpose:
In high dose rate brachytherapy (HDR-B), current catheter reconstruction protocols are relatively slow and error prone. The purpose of this technical note is to evaluate the accuracy and the robustness of an electromagnetic (EM) tracking system for automated and real-time catheter reconstruction.Methods:
For this preclinical study, a total of ten catheters were inserted in gelatin phantoms with different trajectories. Catheters were reconstructed using a 18G biopsy needle, used as an EM stylet and equipped with a miniaturized sensor, and the second generation Aurora ® Planar Field Generator from Northern Digital Inc. The Aurora EM system provides position and orientation value with precisions of 0.7 mm and 0.2°, respectively. Phantoms were also scanned using a μ CT (GE Healthcare) and Philips Big Bore clinical computed tomography (CT) system with a spatial resolution of 89 μm and 2 mm, respectively. Reconstructions using the EM stylet were compared to μ CT and CT. To assess the robustness of the EM reconstruction, five catheters were reconstructed twice and compared.Results:
Reconstruction time for one catheter was 10 s, leading to a total reconstruction time inferior to 3 min for a typical 17-catheter implant. When compared to the μ CT, the mean EM tip identification error was 0.69 ± 0.29 mm while the CT error was 1.08 ± 0.67 mm. The mean 3D distance error was found to be 0.66 ± 0.33 mm and 1.08 ± 0.72 mm for the EM and CT, respectively. EM 3D catheter trajectories were found to be more accurate. A maximum difference of less than 0.6 mm was found between successive EM reconstructions.Conclusions:
The EM reconstruction was found to be more accurate and precise than the conventional methods used for catheter reconstruction in HDR-B. This approach can be applied to any type of catheters and applicators.
Comparison between target margins derived from 4DCT scans and real-time tumor motion tracking: Insights from lung tumor patients treated with robotic radiosurgery42(2015); http://dx.doi.org/10.1118/1.4907956View Description Hide DescriptionPurpose:
A unique capability of the CyberKnife system is dynamic target tracking. However, not all patients are eligible for this approach. Rather, their tumors are tracked statically using the vertebral column for alignment. When using static tracking, the internal target volume (ITV) is delineated on the four-dimensional (4D) CT scan and an additional margin is added to account for setup uncertainty [planning target volume (PTV)]. Treatment margins are difficult to estimate due to unpredictable variations in tumor motion and respiratory pattern during the course of treatment. The inability to track the target and detect changes in respiratory characteristics might result in geographic misses and local tumor recurrences. The purpose of this study is to develop a method to evaluate the adequacy of ITV-to-PTV margins for patients treated in this manner.Methods:
Data from 24 patients with lesions in the upper lobe (n = 12), middle lobe (n = 3), and lower lobe (n = 9) were included in this study. Each patient was treated with dynamic tracking and underwent 4DCT scanning at the time of simulation. Data including the 3D coordinates of the target over the course of treatment were extracted from the treatment log files and used to determine actual target motion in the superior–inferior (S–I), anterior–posterior (A–P), and left–right (L–R) directions. Different approaches were used to calculate anisotropic and isotropic margins, assuming that the tumor moves as a rigid body. Anisotropic margins were calculated by separating target motion in the three anatomical directions, and a uniform margin was calculated by shifting the gross tumor volume contours in the 3D space and by computing the percentage of overlap with the PTV. The analysis was validated by means of a theoretical formulation.Results:
The three methods provided consistent results. A uniform margin of 4.5 mm around the ITV was necessary to assure 95% target coverage for 95% of the fractions included in the analysis. In the case of anisotropic margins, the expansion required in the S–I direction was larger (8.1 mm) than those in the L–R (4.9 mm) and A–P (4.5 mm) directions. This margin accounts for variations of target position within the same treatment fraction.Conclusions:
The use of bony alignment for CyberKnife lung stereotactic body radiation therapy requires careful considerations, in terms of the potential for increased toxicity or local miss. Our method could be used by other centers to determine the adequacy of ITV-to-PTV margins for their patients.
42(2015); http://dx.doi.org/10.1118/1.4907965View Description Hide DescriptionPurpose:
To introduce a method to model the 3D dose distribution of laterally asymmetric proton beamlets resulting from collimation. The model enables rapid beamlet calculation for spot scanning (SS) delivery using a novel penumbra-reducing dynamic collimation system (DCS) with two pairs of trimmers oriented perpendicular to each other.Methods:
Trimmed beamlet dose distributions in water were simulated with MCNPX and the collimating effects noted in the simulations were validated by experimental measurement. The simulated beamlets were modeled analytically using integral depth dose curves along with an asymmetric Gaussian function to represent fluence in the beam’s eye view (BEV). The BEV parameters consisted of Gaussian standard deviations (sigmas) along each primary axis (σ x1,σ x2,σ y1,σ y2) together with the spatial location of the maximum dose (μx ,μy ). Percent depth dose variation with trimmer position was accounted for with a depth-dependent correction function. Beamlet growth with depth was accounted for by combining the in-air divergence with Hong’s fit of the Highland approximation along each axis in the BEV.Results:
The beamlet model showed excellent agreement with the Monte Carlo simulation data used as a benchmark. The overall passing rate for a 3D gamma test with 3%/3 mm passing criteria was 96.1% between the analytical model and Monte Carlo data in an example treatment plan.Conclusions:
The analytical model is capable of accurately representing individual asymmetric beamlets resulting from use of the DCS. This method enables integration of the DCS into a treatment planning system to perform dose computation in patient datasets. The method could be generalized for use with any SS collimation system in which blades, leaves, or trimmers are used to laterally sharpen beamlets.
42(2015); http://dx.doi.org/10.1118/1.4908208View Description Hide DescriptionPurpose:
To quantitatively investigate the effect of range shifter materials on single-spot characteristics of a proton pencil beam.Methods:
An analytic approximation for multiple Coulomb scattering (“differential Moliere” formula) was adopted to calculate spot sizes of proton spot scanning beams impinging on a range shifter. The calculations cover a range of delivery parameters: six range shifter materials (acrylonitrile butadiene styrene, Lexan, Lucite, polyethylene, polystyrene, and wax) and water as reference material, proton beam energies ranging from 75 to 200 MeV, range shifter thicknesses of 4.5 and 7.0 g/cm2, and range shifter positions from 5 to 50 cm. The analytic method was validated by comparing calculation results with the measurements reported in the literature.Results:
Relative to a water-equivalent reference, the spot size distal to a wax or polyethylene range shifter is 15% smaller, while the spot size distal to a range shifter made of Lexan or Lucite is about 6% smaller. The relative spot size variations are nearly independent of beam energy and range shifter thickness and decrease with smaller air gaps.Conclusions:
Among the six material investigated, wax and polyethylene are desirable range shifter materials when the spot size is kept small. Lexan and Lucite are the desirable range shifter materials when the scattering power is kept similar to water.
Investigating CT to CBCT image registration for head and neck proton therapy as a tool for daily dose recalculation42(2015); http://dx.doi.org/10.1118/1.4908223View Description Hide DescriptionPurpose:
Intensity modulated proton therapy (IMPT) of head and neck (H&N) cancer patients may be improved by plan adaptation. The decision to adapt the treatment plan based on a dose recalculation on the current anatomy requires a diagnostic quality computed tomography (CT) scan of the patient. As gantry-mounted cone beam CT (CBCT) scanners are currently being offered by vendors, they may offer daily or weekly updates of patient anatomy. CBCT image quality may not be sufficient for accurate proton dose calculation and it is likely necessary to perform CBCT CT number correction. In this work, the authors investigated deformable image registration (dir) of the planning CT (pCT) to the CBCT to generate a virtual CT (vCT) to be used for proton dose recalculation.Methods:
Datasets of six H&N cancer patients undergoing photon intensity modulated radiation therapy were used in this study to validate the vCT approach. Each dataset contained a CBCT acquired within 3 days of a replanning CT (rpCT), in addition to a pCT. The pCT and rpCT were delineated by a physician. A Morphons algorithm was employed in this work to perform dir of the pCT to CBCT following a rigid registration of the two images. The contours from the pCT were deformed using the vector field resulting from dir to yield a contoured vCT. The dir accuracy was evaluated with a scale invariant feature transform (SIFT) algorithm comparing automatically identified matching features between vCT and CBCT. The rpCT was used as reference for evaluation of the vCT. The vCT and rpCT CT numbers were converted to stopping power ratio and the water equivalent thickness (WET) was calculated. IMPT dose distributions from treatment plans optimized on the pCT were recalculated with a Monte Carlo algorithm on the rpCT and vCT for comparison in terms of gamma index, dose volume histogram (DVH) statistics as well as proton range. The dir generated contours on the vCT were compared to physician-drawn contours on the rpCT.Results:
The dir accuracy was better than 1.4 mm according to the SIFT evaluation. The mean WET differences between vCT (pCT) and rpCT were below 1 mm (2.6 mm). The amount of voxels passing 3%/3 mm gamma criteria were above 95% for the vCT vs rpCT. When using the rpCT contour set to derive DVH statistics from dose distributions calculated on the rpCT and vCT the differences, expressed in terms of 30 fractions of 2 Gy, were within [−4, 2 Gy] for parotid glands (D mean), spinal cord (D 2%), brainstem (D 2%), and CTV (D 95%). When using dir generated contours for the vCT, those differences ranged within [−8, 11 Gy].Conclusions:
In this work, the authors generated CBCT based stopping power distributions using dir of the pCT to a CBCT scan. dir accuracy was below 1.4 mm as evaluated by the SIFT algorithm. Dose distributions calculated on the vCT agreed well to those calculated on the rpCT when using gamma index evaluation as well as DVH statistics based on the same contours. The use of dir generated contours introduced variability in DVH statistics.
Initial implementation of the conversion from the energy-subtracted CT number to electron density in tissue inhomogeneity corrections: An anthropomorphic phantom study of radiotherapy treatment planning42(2015); http://dx.doi.org/10.1118/1.4908207View Description Hide DescriptionPurpose:
To achieve accurate tissue inhomogeneity corrections in radiotherapy treatment planning, the authors had previously proposed a novel conversion of the energy-subtracted computed tomography (CT) number to an electron density (ΔHU–ρe conversion), which provides a single linear relationship between ΔHU and ρe over a wide range of ρe . The purpose of this study is to present an initial implementation of the ΔHU–ρe conversion method for a treatment planning system (TPS). In this paper, two example radiotherapy plans are used to evaluate the reliability of dose calculations in the ΔHU–ρe conversion method.Methods:
CT images were acquired using a clinical dual-source CT (DSCT) scanner operated in the dual-energy mode with two tube potential pairs and an additional tin (Sn) filter for the high-kV tube (80–140 kV/Sn and 100–140 kV/Sn). Single-energy CT using the same DSCT scanner was also performed at 120 kV to compare the ΔHU–ρe conversion method with a conventional conversion from a CT number to ρe (Hounsfield units, HU–ρe conversion). Lookup tables for ρe calibration were obtained from the CT image acquisitions for tissue substitutes in an electron density phantom (EDP). To investigate the beam-hardening effect on dosimetric uncertainties, two EDPs with different sizes (a body EDP and a head EDP) were used for the ρe calibration. Each acquired lookup table was applied to two radiotherapy plans designed using the XiO TPS with the superposition algorithm for an anthropomorphic phantom. The first radiotherapy plan was for an oral cavity tumor and the second was for a lung tumor.Results:
In both treatment plans, the performance of the ΔHU–ρe conversion was superior to that of the conventional HU–ρe conversion in terms of the reliability of dose calculations. Especially, for the oral tumor plan, which dealt with dentition and bony structures, treatment planning with the HU–ρe conversion exhibited apparent discrepancies between the dose distributions and dose–volume histograms (DVHs) of the body-EDP and head-EDP calibrations. In contrast, the dose distributions and DVHs of the body-EDP and head-EDP calibrations coincided with each other almost perfectly in the ΔHU–ρe conversion for 100–140 kV/Sn. The difference between the V 100’s (the mean planning target volume receiving 100% of the prescribed dose; a DVH parameter) of the body-EDP and head-EDP calibrations could be reduced to less than 1% using the ΔHU–ρe conversion, but exceeded 11% for the HU–ρe conversion.Conclusions:
The ΔHU–ρe conversion can be implemented for currently available TPS’s without any modifications or extensions. The ΔHU–ρe conversion appears to be a promising method for providing an accurate and reliable inhomogeneity correction in treatment planning for any ill-conditioned scans that include (i) the use of a calibration EDP that is nonequivalent to the patient’s body tissues, (ii) a mismatch between the size of the patient and the calibration EDP, or (iii) a large quantity of high-density and high-atomic-number tissue structures.
- RADIATION IMAGING PHYSICS
42(2015); http://dx.doi.org/10.1118/1.4906128View Description Hide DescriptionPurpose:
To develop objective functions for selecting multiple representative respiratory waveforms. A specific application considered is to reduce the number of swiping scans in a novel helical CT scan protocol to harvest efficiency and dose reduction benefit.Methods:
The authors consider a general class of potential objective functions consisting of weighted norms on pointwise profile differentials. The authors utilize the Lagrangian approach and derive proper conditions on the formulation based on first and second order optimality conditions. The derived objective functions are applied to clinically acquired respiratory trajectories for swipe subset selection to verify the validity and generality of the proposed rationale. An end-to-end 4DCT reconstruction comparison is performed using a swipe subset of data corresponding to 3 out of the full 25 waveforms to assess the consequence in image quality and dose.Results:
Their results show that maximizing the proposed objective function with the suggested parameters yields maximal spread of trajectories among the selected subset. 4DCT Reconstruction using the chosen subset of data indicates the potential for further dose reduction by about 5 to 10 folds without significant sacrifice in image quality. Experimental results also support further generalization to include slice prioritization.Conclusions:
The authors have derived a formulation that is both simple and general as a metric to quantify the spread of a set of respiratory trajectories, which can be used for subset selection with potential computation and dose reduction benefit when applied to a newly developed helical 4DCT scan protocol.
Image quality dependency on system configuration and tube voltage in chest tomosynthesis—A visual grading study using an anthropomorphic chest phantom42(2015); http://dx.doi.org/10.1118/1.4907963View Description Hide DescriptionPurpose:
To investigate the potential benefit of increasing the dose per projection image in chest tomosynthesis, performed at the current standard dose level, by reducing the angular range covered or the projection image density and to evaluate the influence of the tube voltage on the image quality.Methods:
An anthropomorphic chest phantom was imaged using nine different projection image configurations and ten different tube voltages with the GE VolumeRAD tomosynthesis system. The resulting image sets were representative of being acquired at the same total effective dose. This was achieved partly by applying a simulated dose reduction to the projection images due to restrictions concerning the tube load settings on the VolumeRAD system. Four observers were included in a visual grading study where the reconstructed tomosynthesis section images were rated according to a set of image quality criteria. Image quality was evaluated relative to the default configuration and default tube voltage on the VolumeRAD system.Results:
Overall, the image quality decreased with decreasing projection image density. Regarding angular range covered by the projection images, the image quality increased with decreasing angular range for two of the criteria, whereas for a criterion related to the depth resolution in the section images the reduced angular ranges resulted in inferior image quality as compared to the default configuration. The image quality showed little dependence on the tube voltage.Conclusions:
At the standard dose level of the VolumeRAD system, the potential benefits from increasing the dose per projection do not fully compensate for the negative effects resulting from a reduction in the number of projection images. Consequently, the default configuration consisting of 60 projection images acquired over 30° is a good alternative. The tube voltage used in tomosynthesis does not have a large impact on the image quality.
42(2015); http://dx.doi.org/10.1118/1.4907964View Description Hide DescriptionPurpose:
Surgical retained foreign objects (RFOs) have significant morbidity and mortality. They are associated with approximately $1.5 × 109 annually in preventable medical costs. The detection accuracy of radiographs for RFOs is a mediocre 59%. The authors address the RFO problem with two complementary technologies: a three-dimensional (3D) gossypiboma micro tag, the μTag that improves the visibility of RFOs on radiographs, and a computer aided detection (CAD) system that detects the μTag. It is desirable for the CAD system to operate in a high specificity mode in the operating room (OR) and function as a first reader for the surgeon. This allows for fast point of care results and seamless workflow integration. The CAD system can also operate in a high sensitivity mode as a second reader for the radiologist to ensure the highest possible detection accuracy.Methods:
The 3D geometry of the μTag produces a similar two dimensional (2D) depiction on radiographs regardless of its orientation in the human body and ensures accurate detection by a radiologist and the CAD. The authors created a data set of 1800 cadaver images with the 3D μTag and other common man-made surgical objects positioned randomly. A total of 1061 cadaver images contained a single μTag and the remaining 739 were without μTag. A radiologist marked the location of the μTag using an in-house developed graphical user interface. The data set was partitioned into three independent subsets: a training set, a validation set, and a test set, consisting of 540, 560, and 700 images, respectively. A CAD system with modules that included preprocessing μTag enhancement, labeling, segmentation, feature analysis, classification, and detection was developed. The CAD system was developed using the training and the validation sets.Results:
On the training set, the CAD achieved 81.5% sensitivity with 0.014 false positives (FPs) per image in a high specificity mode for the surgeons in the OR and 96.1% sensitivity with 0.81 FPs per image in a high sensitivity mode for the radiologists. On the independent test set, the CAD achieved 79.5% sensitivity with 0.003 FPs per image in a high specificity mode for the surgeons and 90.2% sensitivity with 0.23 FPs per image in a high sensitivity mode for the radiologists.Conclusions:
To the best of the authors’ knowledge, this is the first time a 3D μTag is used to produce a recognizable, substantially similar 2D projection on radiographs regardless of orientation in space. It is the first time a CAD system is used to search for man-made objects over anatomic background. The CAD system for the μTags achieved reasonable performance in both the high specificity and the high sensitivity modes.
42(2015); http://dx.doi.org/10.1118/1.4907971View Description Hide DescriptionPurpose:
Active matrix flat panel imagers (AMFPI) have limited performance in low dose applications due to the electronic noise of the thin film transistor (TFT) array. A uniform layer of avalanche amorphous selenium (a-Se) called high gain avalanche rushing photoconductor (HARP) allows for signal amplification prior to readout from the TFT array, largely eliminating the effects of the electronic noise. The authors report preliminary avalanche gain measurements from the first HARP structure developed for direct deposition onto a TFT array.Methods:
The HARP structure is fabricated on a glass substrate in the form of p-i-n, i.e., the electron blocking layer (p) followed by an intrinsic (i) a-Se layer and finally the hole blocking layer (n). All deposition procedures are scalable to large area detectors. Integrated charge is measured from pulsed optical excitation incident on the top electrode (as would in an indirect AMFPI) under continuous high voltage bias. Avalanche gain measurements were obtained from samples fabricated simultaneously at different locations in the evaporator to evaluate performance uniformity across large area.Results:
An avalanche gain of up to 80 was obtained, which showed field dependence consistent with previous measurements from n-i-p HARP structures established for vacuum tubes. Measurements from multiple samples demonstrate the spatial uniformity of performance using large area deposition methods. Finally, the results were highly reproducible during the time course of the entire study.Conclusions:
We present promising avalanche gain measurement results from a novel HARP structure that can be deposited onto a TFT array. This is a crucial step toward the practical feasibility of AMFPI with avalanche gain, enabling quantum noise limited performance down to a single x-ray photon per pixel.
42(2015); http://dx.doi.org/10.1118/1.4907961View Description Hide DescriptionPurpose:
Accurate detection of pulmonary nodules remains a technical challenge in computer-aided diagnosis systems because some nodules may adhere to the blood vessels or the lung wall, which have low contrast compared to the surrounding tissues. In this paper, the analysis of typical shape features of candidate nodules based on a shape constraint Chan–Vese (CV) model combined with calculation of the number of blood branches adhered to nodule candidates is proposed to reduce false positive (FP) nodules from candidate nodules.Methods:
The proposed scheme consists of three major stages: (1) Segmentation of lung parenchyma from computed tomography images. (2) Extraction of candidate nodules. (3) Reduction of FP nodules. A gray level enhancement combined with a spherical shape enhancement filter is introduced to extract the candidate nodules and their sphere-like contour regions. FPs are removed by analysis of the typical shape features of nodule candidates based on the CV model using spherical constraint and by investigating the number of blood branches adhered to the candidate nodules. The constrained shapes of CV model are automatically achieved from the extracted candidate nodules.Results:
The detection performance was evaluated on 127 nodules of 103 cases including three types of challenging nodules, which are juxta-pleural nodules, juxta-vascular nodules, and ground glass opacity nodules. The free-receiver operating characteristic (FROC) curve shows that the proposed method is able to detect 88% of all the nodules in the data set with 4 FPs per case.Conclusions:
Evaluation shows that the authors’ method is feasible and effective for detection of three types of nodules in this study.
Measuring interfraction and intrafraction lung function changes during radiation therapy using four-dimensional cone beam CT ventilation imaging42(2015); http://dx.doi.org/10.1118/1.4907991View Description Hide DescriptionPurpose:
Adaptive ventilation guided radiation therapy could minimize the irradiation of healthy lung based on repeat lung ventilation imaging (VI) during treatment. However the efficacy of adaptive ventilation guidance requires that interfraction (e.g., week-to-week), ventilation changes are not washed out by intrafraction (e.g., pre- and postfraction) changes, for example, due to patient breathing variability. The authors hypothesize that patients undergoing lung cancer radiation therapy exhibit larger interfraction ventilation changes compared to intrafraction function changes. To test this, the authors perform the first comparison of interfraction and intrafraction lung VI pairs using four-dimensional cone beam CT ventilation imaging (4D-CBCT VI), a novel technique for functional lung imaging.Methods:
The authors analyzed a total of 215 4D-CBCT scans acquired for 19 locally advanced non-small cell lung cancer (LA-NSCLC) patients over 4–6 weeks of radiation therapy. This set of 215 scans was sorted into 56 interfraction pairs (including first day scans and each of treatment weeks 2, 4, and 6) and 78 intrafraction pairs (including pre/postfraction scans on the same-day), with some scans appearing in both sets. VIs were obtained from the Jacobian determinant of the transform between the 4D-CBCT end-exhale and end-inhale images after deformable image registration. All VIs were deformably registered to their corresponding planning CT and normalized to account for differences in breathing effort, thus facilitating image comparison in terms of (i) voxelwise Spearman correlations, (ii) mean image differences, and (iii) gamma pass rates for all interfraction and intrafraction VI pairs. For the side of the lung ipsilateral to the tumor, we applied two-sided t-tests to determine whether interfraction VI pairs were more different than intrafraction VI pairs.Results:
The (mean ± standard deviation) Spearman correlation for interfraction VI pairs was , which was significantly lower than for intrafraction pairs ( , p = 0.0002). Conversely, mean absolute ventilation differences were larger for interfraction pairs than for intrafraction pairs, with and , respectively (p < 10−15). Applying a gamma analysis with ventilation/distance tolerance of 25%/10 mm, we observed mean pass rate of (69% ± 20%) for interfraction VIs, which was significantly lower compared to intrafraction pairs (80% ± 15%, with p ∼ 0.0003). Compared to the first day scans, all patients experienced at least one subsequent change in median ipsilateral ventilation ≥10%. Patients experienced both positive and negative ventilation changes throughout treatment, with the maximum change occurring at different weeks for different patients.Conclusions:
The authors’ data support the hypothesis that interfraction ventilation changes are larger than intrafraction ventilation changes for LA-NSCLC patients over a course of conventional lung cancer radiation therapy. Longitudinal ventilation changes are observed to be highly patient-dependent, supporting a possible role for adaptive ventilation guidance based on repeat 4D-CBCT VIs. We anticipate that future improvement of 4D-CBCT image reconstruction algorithms will improve the capability of 4D-CBCT VI to resolve interfraction ventilation changes.
42(2015); http://dx.doi.org/10.1118/1.4907968View Description Hide DescriptionPurpose:
With the goal of producing a less computationally intensive alternative to fully iterative penalized-likelihood image reconstruction, our group has explored the use of penalized-likelihood sinogram restoration for transmission tomography. Previously, we have exclusively used a quadratic penalty in our restoration objective function. However, a quadratic penalty does not excel at preserving edges while reducing noise. Here, we derive a restoration update equation for nonquadratic penalties. Additionally, we perform a feasibility study to extend our sinogram restoration method to a helical cone-beam geometry and clinical data.Methods:
A restoration update equation for nonquadratic penalties is derived using separable parabolic surrogates (SPS). A method for calculating sinogram degradation coefficients for a helical cone-beam geometry is proposed. Using simulated data, sinogram restorations are performed using both a quadratic penalty and the edge-preserving Huber penalty. After sinogram restoration, Fourier-based analytical methods are used to obtain reconstructions, and resolution-noise trade-offs are investigated. For the fan-beam geometry, a comparison is made to image-domain SPS reconstruction using the Huber penalty. The effects of varying object size and contrast are also investigated. For the helical cone-beam geometry, we investigate the effect of helical pitch (axial movement/rotation). Huber-penalty sinogram restoration is performed on 3D clinical data, and the reconstructed images are compared to those generated with no restoration.Results:
We find that by applying the edge-preserving Huber penalty to our sinogram restoration methods, the reconstructed image has a better resolution-noise relationship than an image produced using a quadratic penalty in the sinogram restoration. However, we find that this relatively straightforward approach to edge preservation in the sinogram domain is affected by the physical size of imaged objects in addition to the contrast across the edge. This presents some disadvantages of this method relative to image-domain edge-preserving methods, although the computational burden of the sinogram-domain approach is much lower. For a helical cone-beam geometry, we found applying sinogram restoration in 3D was reasonable and that pitch did not make a significant difference in the general effect of sinogram restoration. The application of Huber-penalty sinogram restoration to clinical data resulted in a reconstruction with less noise while retaining resolution.Conclusions:
Sinogram restoration with the Huber penalty is able to provide better resolution-noise performance than restoration with a quadratic penalty. Additionally, sinogram restoration with the Huber penalty is feasible for helical cone-beam CT and can be applied to clinical data.
42(2015); http://dx.doi.org/10.1118/1.4908210View Description Hide DescriptionPurpose:
Radiomics, which is the high-throughput extraction and analysis of quantitative image features, has been shown to have considerable potential to quantify the tumor phenotype. However, at present, a lack of software infrastructure has impeded the development of radiomics and its applications. Therefore, the authors developed the imaging biomarker explorer (ibex), an open infrastructure software platform that flexibly supports common radiomics workflow tasks such as multimodality image data import and review, development of feature extraction algorithms, model validation, and consistent data sharing among multiple institutions.Methods:
The ibex software package was developed using the matlab and c/c++ programming languages. The software architecture deploys the modern model-view-controller, unit testing, and function handle programming concepts to isolate each quantitative imaging analysis task, to validate if their relevant data and algorithms are fit for use, and to plug in new modules. On one hand, ibex is self-contained and ready to use: it has implemented common data importers, common image filters, and common feature extraction algorithms. On the other hand, ibex provides an integrated development environment on top of matlab and c/c++, so users are not limited to its built-in functions. In the ibex developer studio, users can plug in, debug, and test new algorithms, extending ibex’s functionality. ibex also supports quality assurance for data and feature algorithms: image data, regions of interest, and feature algorithm-related data can be reviewed, validated, and/or modified. More importantly, two key elements in collaborative workflows, the consistency of data sharing and the reproducibility of calculation result, are embedded in the ibex workflow: image data, feature algorithms, and model validation including newly developed ones from different users can be easily and consistently shared so that results can be more easily reproduced between institutions.Results:
Researchers with a variety of technical skill levels, including radiation oncologists, physicists, and computer scientists, have found the ibex software to be intuitive, powerful, and easy to use. ibex can be run at any computer with the windows operating system and 1GB RAM. The authors fully validated the implementation of all importers, preprocessing algorithms, and feature extraction algorithms. Windows version 1.0 beta of stand-alone ibex and ibex’s source code can be downloaded.Conclusions:
The authors successfully implemented ibex, an open infrastructure software platform that streamlines common radiomics workflow tasks. Its transparency, flexibility, and portability can greatly accelerate the pace of radiomics research and pave the way toward successful clinical translation.
42(2015); http://dx.doi.org/10.1118/1.4908002View Description Hide DescriptionPurpose:
To design bowtie filters with improved properties for dedicated breast CT to improve image quality and reduce dose to the patient.Methods:
The authors present three different bowtie filters designed for a cylindrical 14-cm diameter phantom with a uniform composition of 40/60 breast tissue, which vary in their design objectives and performance improvements. Bowtie design #1 is based on single material spectral matching and produces nearly uniform spectral shape for radiation incident upon the detector. Bowtie design #2 uses the idea of basis material decomposition to produce the same spectral shape and intensity at the detector, using two different materials. Bowtie design #3 eliminates the beam hardening effect in the reconstructed image by adjusting the bowtie filter thickness so that the effective attenuation coefficient for every ray is the same. All three designs are obtained using analytical computational methods and linear attenuation coefficients. Thus, the designs do not take into account the effects of scatter. The authors considered this to be a reasonable approach to the filter design problem since the use of Monte Carlo methods would have been computationally intensive. The filter profiles for a cone-angle of 0° were used for the entire length of each filter because the differences between those profiles and the correct cone-beam profiles for the cone angles in our system are very small, and the constant profiles allowed construction of the filters with the facilities available to us. For evaluation of the filters, we used Monte Carlo simulation techniques and the full cone-beam geometry. Images were generated with and without each bowtie filter to analyze the effect on dose distribution, noise uniformity, and contrast-to-noise ratio (CNR) homogeneity. Line profiles through the reconstructed images generated from the simulated projection images were also used as validation for the filter designs.Results:
Examples of the three designs are presented. Initial verification of performance of the designs was done using analytical computations of HVL, intensity, and effective attenuation coefficient behind the phantom as a function of fan-angle with a cone-angle of 0°. The performance of the designs depends only weakly on incident spectrum and tissue composition. For all designs, the dynamic range requirement on the detector was reduced compared to the no-bowtie-filter case. Further verification of the filter designs was achieved through analysis of reconstructed images from simulations. Simulation data also showed that the use of our bowtie filters can reduce peripheral dose to the breast by 61% and provide uniform noise and CNR distributions. The bowtie filter design concepts validated in this work were then used to create a computational realization of a 3D anthropomorphic bowtie filter capable of achieving a constant effective attenuation coefficient behind the entire field-of-view of an anthropomorphic breast phantom.Conclusions:
Three different bowtie filter designs that vary in performance improvements were described and evaluated using computational and simulation techniques. Results indicate that the designs are robust against variations in breast diameter, breast composition, and tube voltage, and that the use of these filters can reduce patient dose and improve image quality compared to the no-bowtie-filter case.
- RADIATION MEASUREMENT PHYSICS
Characterizing energy dependence and count rate performance of a dual scintillator fiber-optic detector for computed tomography42(2015); http://dx.doi.org/10.1118/1.4906206View Description Hide DescriptionPurpose:
Kilovoltage (kV) x-rays pose a significant challenge for radiation dosimetry. In the kV energy range, even small differences in material composition can result in significant variations in the absorbed energy between soft tissue and the detector. In addition, the use of electronic systems in light detection has demonstrated measurement losses at high photon fluence rates incident to the detector. This study investigated the feasibility of using a novel dual scintillator detector and whether its response to changes in beam energy from scatter and hardening is readily quantified. The detector incorporates a tissue-equivalent plastic scintillator and a gadolinium oxysulfide scintillator, which has a higher sensitivity to scatter x-rays.Methods:
The detector was constructed by coupling two scintillators: (1) small cylindrical plastic scintillator, 500 μm in diameter and 2 mm in length, and (2) 100 micron sheet of gadolinium oxysulfide 500 μm in diameter, each to a 2 m long optical fiber, which acts as a light guide to transmit scintillation photons from the sensitive element to a photomultiplier tube. Count rate linearity data were obtained from a wide range of exposure rates delivered from a radiological x-ray tube by adjusting the tube current. The data were fitted to a nonparalyzable dead time model to characterize the time response. The true counting rate was related to the reference free air dose air rate measured with a 0.6 cm3 Radcal® thimble chamber as described in AAPM Report No. 111. Secondary electron and photon spectra were evaluated using Monte Carlo techniques to analyze ionization quenching and photon energy-absorption characteristics from free-in-air and in phantom measurements. The depth/energy dependence of the detector was characterized using a computed tomography dose index QA phantom consisting of nested adult head and body segments. The phantom provided up to 32 cm of acrylic with a compatible 0.6 cm3 calibrated ionization chamber to measure the reference air kerma.Results:
Each detector exhibited counting losses of 5% when irradiated at a dose rate of 26.3 mGy/s (Gadolinium) and 324.3 mGy/s (plastic). The dead time of the gadolinium oxysulfide detector was determined to be 48 ns, while the dead time of the plastic scintillating detector was unable to accurately be calculated due to poor counting statistics from low detected count rates. Noticeable depth/energy dependence was observed for the plastic scintillator for depths greater than 16 cm of acrylic that was not present for measurements using the gadolinium oxysulfide scintillator, leading us to believe that quenching may play a larger role in the depth dependence of the plastic scintillator than the incident x-ray energy spectrum. When properly corrected for dead time effects, the energy response of the gadolinium oxysulfide scintillator is consistent with the plastic scintillator. Using the integrated dual detector method was superior to each detector individually as the depth-dependent measure of dose was correctable to less than 8% between 100 and 135 kV.Conclusions:
The dual scintillator fiber-optic detector accommodates a methodology for energy dependent corrections of the plastic scintillator, improving the overall accuracy of the dosimeter across the range of diagnostic energies.
- MAGNETIC RESONANCE PHYSICS
Multiattribute probabilistic prostate elastic registration (MAPPER): Application to fusion of ultrasound and magnetic resonance imaging42(2015); http://dx.doi.org/10.1118/1.4905104View Description Hide DescriptionPurpose:
Transrectal ultrasound (TRUS)-guided needle biopsy is the current gold standard for prostate cancer diagnosis. However, up to 40% of prostate cancer lesions appears isoechoic on TRUS. Hence, TRUS-guided biopsy has a high false negative rate for prostate cancer diagnosis. Magnetic resonance imaging (MRI) is better able to distinguish prostate cancer from benign tissue. However, MRI-guided biopsy requires special equipment and training and a longer procedure time. MRI-TRUS fusion, where MRI is acquired preoperatively and then aligned to TRUS, allows for advantages of both modalities to be leveraged during biopsy. MRI-TRUS-guided biopsy increases the yield of cancer positive biopsies. In this work, the authors present multiattribute probabilistic postate elastic registration (MAPPER) to align prostate MRI and TRUS imagery.Methods:
MAPPER involves (1) segmenting the prostate on MRI, (2) calculating a multiattribute probabilistic map of prostate location on TRUS, and (3) maximizing overlap between the prostate segmentation on MRI and the multiattribute probabilistic map on TRUS, thereby driving registration of MRI onto TRUS. MAPPER represents a significant advancement over the current state-of-the-art as it requires no user interaction during the biopsy procedure by leveraging texture and spatial information to determine the prostate location on TRUS. Although MAPPER requires manual interaction to segment the prostate on MRI, this step is performed prior to biopsy and will not substantially increase biopsy procedure time.Results:
MAPPER was evaluated on 13 patient studies from two independent datasets—Dataset 1 has 6 studies acquired with a side-firing TRUS probe and a 1.5 T pelvic phased-array coil MRI; Dataset 2 has 7 studies acquired with a volumetric end-firing TRUS probe and a 3.0 T endorectal coil MRI. MAPPER has a root-mean-square error (RMSE) for expert selected fiducials of 3.36 ± 1.10 mm for Dataset 1 and 3.14 ± 0.75 mm for Dataset 2. State-of-the-art MRI-TRUS fusion methods report RMSE of 3.06–2.07 mm.Conclusions:
MAPPER aligns MRI and TRUS imagery without manual intervention ensuring efficient, reproducible registration. MAPPER has a similar RMSE to state-of-the-art methods that require manual intervention.