Index of content:
Volume 43, Issue 10, October 2016
43(2016); http://dx.doi.org/10.1118/1.4959548View Description Hide Description
- THERAPEUTIC INTERVENTIONS
- Research Articles
43(2016); http://dx.doi.org/10.1118/1.4961743View Description Hide DescriptionPurpose:
The development of MR-guided high dose rate (HDR) brachytherapy is under investigation due to the excellent tumor and organs at risk visualization of MRI. However, MR-based localization of needles (including catheters or tubes) has inherently a low update rate and the required image interpretation can be hampered by signal voids arising from blood vessels or calcifications limiting the precision of the needle guidance and reconstruction. In this paper, a new needle tracking prototype is investigated using fiber Bragg gratings (FBG)-based sensing: this prototype involves a MR-compatible stylet composed of three optic fibers with nine sets of embedded FBG sensors each. This stylet can be inserted into brachytherapy needles and allows a fast measurement of the needle deflection. This study aims to assess the potential of FBG-based sensing for real-time needle (including catheter or tube) tracking during MR-guided intervention.Methods:
First, the MR compatibility of FBG-based sensing and its accuracy was evaluated. Different known needle deflections were measured using FBG-based sensing during simultaneous MR-imaging. Then, a needle tracking procedure using FBG-based sensing was proposed. This procedure involved a MR-based calibration of the FBG-based system performed prior to the interventional procedure. The needle tracking system was assessed in an experiment with a moving phantom during MR imaging. The FBG-based system was quantified by comparing the gold-standard shapes, the shape manually segmented on MRI and the FBG-based measurements.Results:
The evaluation of the MR compatibility of FBG-based sensing and its accuracy shows that the needle deflection could be measured with an accuracy of 0.27 mm on average. Besides, the FBG-based measurements were comparable to the uncertainty of MR-based measurements estimated at half the voxel size in the MR image. Finally, the mean(standard deviation) Euclidean distance between MR- and FBG-based needle position measurements was equal to 0.79 mm(0.37 mm). The update rate and latency of the FBG-based needle position measurement were 100 and 300 ms, respectively.Conclusions:
The FBG-based needle tracking procedure proposed in this paper is able to determine the position of the complete needle, under MR-imaging, with better accuracy and precision, higher update rate, and lower latency compared to current MR-based needle localization methods. This system would be eligible for MR-guided brachytherapy, in particular, for an improved needle guidance and reconstruction.
Towards 3D printed multifunctional immobilization for proton therapy: Initial materials characterization43(2016); http://dx.doi.org/10.1118/1.4962033View Description Hide DescriptionPurpose:
3D printing technology is investigated for the purpose of patient immobilization during proton therapy. It potentially enables a merge of patient immobilization, bolus range shifting, and other functions into one single patient-specific structure. In this first step, a set of 3D printed materials is characterized in detail, in terms of structural and radiological properties, elemental composition, directional dependence, and structural changes induced by radiation damage. These data will serve as inputs for the design of 3D printed immobilization structure prototypes.Methods:
Using four different 3D printing techniques, in total eight materials were subjected to testing. Samples with a nominal dimension of 20 × 20 × 80 mm3 were 3D printed. The geometrical printing accuracy of each test sample was measured with a dial gage. To assess the mechanical response of the samples, standardized compression tests were performed to determine the Young’s modulus. To investigate the effect of radiation on the mechanical response, the mechanical tests were performed both prior and after the administration of clinically relevant dose levels (70 Gy), multiplied with a safety factor of 1.4. Dual energy computed tomography (DECT) methods were used to calculate the relative electron density to water ρe, the effective atomic number Z eff, and the proton stopping power ratio (SPR) to water SPR. In order to validate the DECT based calculation of radiological properties, beam measurements were performed on the 3D printed samples as well. Photon irradiations were performed to measure the photon linear attenuation coefficients, while proton irradiations were performed to measure the proton range shift of the samples. The directional dependence of these properties was investigated by performing the irradiations for different orientations of the samples.Results:
The printed test objects showed reduced geometric printing accuracy for 2 materials (deviation > 0.25 mm). Compression tests yielded Young’s moduli ranging from 0.6 to 2940 MPa. No deterioration in the mechanical response was observed after exposure of the samples to 100 Gy in a therapeutic MV photon beam. The DECT-based characterization yielded Z eff ranging from 5.91 to 10.43. The SPR and ρe both ranged from 0.6 to 1.22. The measured photon attenuation coefficients at clinical energies scaled linearly with ρe. Good agreement was seen between the DECT estimated SPR and the measured range shift, except for the higher Z eff. As opposed to the photon attenuation, the proton range shifting appeared to be printing orientation dependent for certain materials.Conclusions:
In this study, the first step toward 3D printed, multifunctional immobilization was performed, by going through a candidate clinical workflow for the first time: from the material printing to DECT characterization with a verification through beam measurements. Besides a proof of concept for beam modification, the mechanical response of printed materials was also investigated to assess their capabilities for positioning functionality. For the studied set of printing techniques and materials, a wide variety of mechanical and radiological properties can be selected from for the intended purpose. Moreover the elaborated hybrid DECT methods aid in performing in-house quality assurance of 3D printed components, as these methods enable the estimation of the radiological properties relevant for use in radiation therapy.
43(2016); http://dx.doi.org/10.1118/1.4962030View Description Hide DescriptionPurpose:
Conventional step-and-shoot intensity modulated radiation therapy leaf sequencing methods, where a nonhomogeneous fluence map is converted to a set of apertures and associated intensities, assume that target fluence is stratified into a fixed number of discrete levels and/or aperture leaf positions are restricted to a discrete set of locations. These assumptions induce a deviation from the planned fluence map and/or reduce the feasible region of potential plans, respectively. A continuous leaf optimization (CLO) framework is developed as a postprocessing methodology to improve upon conventional leaf sequencing so that the resulting plan avoids these two main drawbacks.Methods:
The CLO model directly represents leaf positions and aperture intensities with continuous variables with the goal of reproducing some target fluence profile. Fluence through leaf edges is modeled using the error function, and continuous fluence is approximated using a 0.1 mm discretization across the aperture opening. Conventional leaf sequencing methods provide feasible solutions to the CLO model, and a first-order descent algorithm is used to converge onto a locally optimal solution.Results:
As a proof-of-concept, the authors test this framework on 1D (single leaf pair) fluence maps. The CLO model was applied to conventional leaf sequencing and direct aperture optimization solutions. Consistent improvements to existing leaf sequencing methods were found when tested on 232 generated instances of potential target fluence. In addition to improvements in matching the target fluence, the CLO model was able to keep MUs at similar values to the initial conventional sequence.Conclusions:
The CLO model can improve upon existing leaf sequencing methods by avoiding the restrictions of fluence stratification and discretized leaf positions. This study lays the foundation for future models and solution methodologies that can incorporate continuous leaf positions explicitly into the treatment planning model.
Investigating deformable image registration and scatter correction for CBCT-based dose calculation in adaptive IMPT43(2016); http://dx.doi.org/10.1118/1.4962933View Description Hide DescriptionPurpose:
This work aims at investigating intensity corrected cone-beam x-ray computed tomography (CBCT) images for accurate dose calculation in adaptive intensity modulated proton therapy (IMPT) for prostate and head and neck (H&N) cancer. A deformable image registration (DIR)-based method and a scatter correction approach using the image data obtained from DIR as prior are characterized and compared on the basis of the same clinical patient cohort for the first time.Methods:
Planning CT (pCT) and daily CBCT data (reconstructed images and measured projections) of four H&N and four prostate cancer patients have been considered in this study. A previously validated Morphons algorithm was used for DIR of the planning CT to the current CBCT image, yielding a so-called virtual CT (vCT). For the first time, this approach was translated from H&N to prostate cancer cases in the scope of proton therapy. The warped pCT images were also used as prior for scatter correction of the CBCT projections for both tumor sites. Single field uniform dose and IMPT (only for H&N cases) treatment plans have been generated with a research version of a commercial planning system. Dose calculations on vCT and scatter corrected CBCT (CBCT cor) were compared by means of the proton range and a gamma-index analysis. For the H&N cases, an additional diagnostic replanning CT (rpCT) acquired within three days of the CBCT served as additional reference. For the prostate patients, a comprehensive contour comparison of CBCT and vCT, using a trained physician’s delineation, was performed.Results:
A high agreement of vCT and CBCT cor was found in terms of the proton range and gamma-index analysis. For all patients and indications between 95% and 100% of the proton dose profiles in beam’s eye view showed a range agreement of better than 3 mm. The pass rate in a (2%,2 mm) gamma-comparison was between 96% and 100%. For H&N patients, an equivalent agreement of vCT and CBCT cor to the reference rpCT was observed. However, for the prostate cases, an insufficient accuracy of the vCT contours retrieved from DIR was found, while the CBCT cor contours showed very high agreement to the contours delineated on the raw CBCT.Conclusions:
For H&N patients, no considerable differences of vCT and CBCT cor were found. For prostate cases, despite the high dosimetric agreement, the DIR yields incorrect contours, probably due to the more pronounced anatomical changes in the abdomen and the reduced soft-tissue contrast in the CBCT. Using the vCT as prior, these inaccuracies can be overcome and images suitable for accurate delineation and dose calculation in CBCT-based adaptive IMPT can be retrieved from scatter correction of the CBCT projections.
Individually optimized contrast-enhanced 4D-CT for radiotherapy simulation in pancreatic ductal adenocarcinoma43(2016); http://dx.doi.org/10.1118/1.4963213View Description Hide DescriptionPurpose:
To develop an individually optimized contrast-enhanced (CE) 4D-computed tomography (CT) for radiotherapy simulation in pancreatic ductal adenocarcinomas (PDA).Methods:
Ten PDA patients were enrolled. Each underwent three CT scans: a 4D-CT immediately following a CE 3D-CT and an individually optimized CE 4D-CT using test injection. Three physicians contoured the tumor and pancreatic tissues. Image quality scores, tumor volume, motion, tumor-to-pancreas contrast, and contrast-to-noise ratio (CNR) were compared in the three CTs. Interobserver variations were also evaluated in contouring the tumor using simultaneous truth and performance level estimation.Results:
Average image quality scores for CE 3D-CT and CE 4D-CT were comparable (4.0 and 3.8, respectively; P = 0.082), and both were significantly better than that for 4D-CT (2.6, P < 0.001). Tumor-to-pancreas contrast results were comparable in CE 3D-CT and CE 4D-CT (15.5 and 16.7 Hounsfield units (HU), respectively; P = 0.21), and the latter was significantly higher than in 4D-CT (9.2 HU, P = 0.001). Image noise in CE 3D-CT (12.5 HU) was significantly lower than in CE 4D-CT (22.1 HU, P = 0.013) and 4D-CT (19.4 HU, P = 0.009). CNRs were comparable in CE 3D-CT and CE 4D-CT (1.4 and 0.8, respectively; P = 0.42), and both were significantly better in 4D-CT (0.6, P = 0.008 and 0.014). Mean tumor volumes were significantly smaller in CE 3D-CT (29.8 cm3, P = 0.03) and CE 4D-CT (22.8 cm3, P = 0.01) than in 4D-CT (42.0 cm3). Mean tumor motion was comparable in 4D-CT and CE 4D-CT (7.2 and 6.2 mm, P = 0.17). Interobserver variations were comparable in CE 3D-CT and CE 4D-CT (Jaccard index 66.0% and 61.9%, respectively) and were worse for 4D-CT (55.6%) than CE 3D-CT.Conclusions:
CE 4D-CT demonstrated characteristics comparable to CE 3D-CT, with high potential for simultaneously delineating the tumor and quantifying tumor motion with a single scan.
43(2016); http://dx.doi.org/10.1118/1.4963212View Description Hide DescriptionPurpose:
Magnetic resonance imaging (MRI)-guided Co-60 provides daily and intrafractional MRI soft tissue imaging for improved target and critical organ tracking. To increase delivery efficiency, the system uses three Co-60 sources at 120° apart, allowing up to 600 cGy combined dose rate at isocenter. Despite the potential tripling in output, creating a delivery plan that uses all three sources is considerably unintuitive. Here, the authors computerize the triplet orientation optimization using column generation, an approach that was demonstrated effective in integrated beam orientation and fluence optimization for noncoplanar therapies. To achieve a better plan quality without increasing the treatment time, the authors then solve a fluence map optimization (FMO) problem while regularizing the fluence maps to reduce the number of deliverable MLC segments.Methods:
Three patients—one prostate, one lung, and one head and neck boost plan (H&NBoost)—were evaluated in this study. For each patient, the beamlet doses were calculated using Monte Carlo, under a 0.35 T magnetic field, for 180 equally spaced coplanar beams grouped into 60 triplets. The beamlet size is 1.05 × 0.5 cm determined by the MLC leaf thickness and step size. The triplets were selected using the column generation algorithm. The FMO problem was formulated using an L2-norm dose fidelity term and an L1-norm anisotropic total variation regularization term, which allows controlling the number of MLC segments, and hence the treatment time, with minimal degradation to the dose. The authors’ Fluence Regularization and Optimized Selection of Triplets (FROST) plans were compared against the clinical treatment plans (CLNs) produced by an experienced dosimetrist. PTV homogeneity, max dose, mean dose, D95, D98, and D99 were evaluated. OAR max and mean doses, as well as R50, defined as the ratio of the 50% isodose volume over the planning target volume were investigated.Results:
The mean PTV D95, D98, and D99 differ by +0.04%, +0.07%, and +0.25% of the prescription dose between planning methods. The mean PTV homogeneity was virtually same with values at 0.8788 (FROST) and 0.8812 (CLN). R50 decreased by 0.67 comparing FROST to CLN. On average, FROST reduced D max and D mean of OARs by 7.30% and 6.08% of the prescription dose, respectively. The manual CLN planning processes required numerous trial and error runs. The FROST plans on the other hand required minimal human intervention.Conclusions:
Efficient delivery of MRI-guided Co-60 therapy needs the output of multiple sources yet suffers from unintuitive and laborious manual beam selection processes. Computerized triplet orientation optimization improves both planning efficiency and plan dosimetry. The novel fluence map regularization provides additional controls over the number of MLC segments and treatment time.
- DIAGNOSTIC IMAGING (IONIZING AND NON-IONIZING)
- Research Articles
Patient-specific quantification of image quality: An automated method for measuring spatial resolution in clinical CT images43(2016); http://dx.doi.org/10.1118/1.4961984View Description Hide DescriptionPurpose:
To develop and validate an automated technique for evaluating the spatial resolution characteristics of clinical computed tomography (CT) images.Methods:
Twenty one chest and abdominopelvic clinical CT datasets were examined in this study. An algorithm was developed to extract a CT resolution index (RI) analogous to the modulation transfer function from clinical CT images by measuring the edge-spread function (ESF) across the patient’s skin. A polygon mesh of the air-skin boundary was created. The faces of the mesh were then used to measure the ESF across the air-skin interface. The ESF was differentiated to obtain the line-spread function (LSF), and the LSF was Fourier transformed to obtain the RI. The algorithm’s ability to detect the radial dependence of the RI was investigated. RIs measured with the proposed method were compared with a conventional phantom-based method across two reconstruction algorithms (FBP and iterative) using the spatial frequency at 50% RI, f 50, as the metric for comparison. Three reconstruction kernels were investigated for each reconstruction algorithm. Finally, an observer study was conducted to determine if observers could visually perceive the differences in the measured blurriness of images reconstructed with a given reconstruction method.Results:
RI measurements performed with the proposed technique exhibited the expected dependencies on the image reconstruction. The measured f 50 values increased with harder kernels for both FBP and iterative reconstruction. Furthermore, the proposed algorithm was able to detect the radial dependence of the RI. Patient-specific measurements of the RI were comparable to the phantom-based technique, but the patient data exhibited a large spread in the measured f 50, indicating that some datasets were blurrier than others even when the projection data were reconstructed with the same reconstruction algorithm and kernel. Results from the observer study substantiated this finding.Conclusions:
Clinically informed, patient-specific spatial resolution can be measured from clinical datasets. The method is sufficiently sensitive to reflect changes in spatial resolution due to different reconstruction parameters. The method can be applied to automatically assess the spatial resolution of patient images and quantify dependencies that may not be captured in phantom data.
43(2016); http://dx.doi.org/10.1118/1.4962032View Description Hide DescriptionPurpose:
In many clinical MRI scenarios, existing imaging information can be used to significantly shorten acquisition time or to improve Signal to Noise Ratio (SNR). In this paper the authors present a framework, referred to as FASTMER, for fast MRI by exploiting a reference image.Methods:
The proposed approach utilizes the possible similarity of the reference image to the acquired image, which exists in many clinical MRI imaging scenarios. Examples include similarity between adjacent slices in high resolution MRI, similarity between various contrasts in the same scan and similarity between different scans of the same patient. To account for the fact that the reference image may exhibit low similarity with the acquired image the authors develop an iterative weighted reconstruction approach, which tunes the weights according to the degree of similarity.Results:
Experimental results demonstrate the performance of the method in three different clinical MRI scenarios: The first example demonstrates SNR improvement in high resolution brain MRI, the second scenario exploits similarity between T2-weighted and fluid-attenuated inversion recovery (FLAIR) for fast FLAIR scanning and the last application utilizes similarity between baseline and follow-up scans for fast follow-up acquisition. The results show that FASTMER outperforms image reconstruction of existing state-of-the-art methods.Conclusions:
The authors present a framework for fast MRI by exploiting a reference image. Recovery is based on an iterative algorithm that supports cases in which similarity to the reference scan is not guaranteed. This extends the applicability of the FASTMER to different MRI scanning scenarios. Thanks to the existence of reference images in various clinical imaging tasks, the proposed framework can play a major role in improving reconstruction in many MR applications.
43(2016); http://dx.doi.org/10.1118/1.4959998View Description Hide DescriptionPurpose:
Current approaches using deformable vector field (DVF) for motion-compensated 4D-cone beam CT (CBCT) reconstruction typically utilize an isotropically smoothed DVF between different respiration phases. Such isotropically smoothed DVF does not work well if sliding motion exists between neighboring organs. This study investigated an anisotropic motion modeling scheme by extracting organ boundary local motions (e.g., sliding) and incorporated them into 4D-CBCT reconstruction to optimize the motion modeling and reconstruction methods.Methods:
Initially, a modified simultaneous algebraic reconstruction technique (mSART) was applied to reconstruct high quality reference phase CBCT using all phase projections. The initial DVFs were precalculated and subsequently updated to achieve the optimized solution. During the DVF update, sliding motion estimation was performed by matching the measured projections to the forward projection of the deformed reference phase CBCT. In this process, each moving organ boundary was first segmented. The normal vectors of the boundary DVF were then extracted and incorporated for further DVF optimization. The regularization term in the objective function adaptively regularizes the DVF by (1) isotopically smoothing the DVF within each organ; (2) smoothing the DVF at boundary along the normal direction; and (3) leaving the tangent direction of boundary DVF unsmoothed (i.e., allowing for sliding motion). A nonlinear conjugate gradient optimizer was used. The algorithm was validated on a digital cubic tube phantom with sliding motion, nonuniform rotational B-spline based cardiac-torso (NCAT) phantom, and two anonymized patient data. The relative reconstruction error (RE), the motion trajectory’s root mean square error (RMSE) together with its maximum error (MaxE), and the Dice coefficient of the lung boundary were calculated to evaluate the algorithm performance.Results:
For the cubic tube and NCAT phantom tests, the REs are 10.2% and 7.4% with sliding motion compensation, compared to 13.4% and 8.9% without sliding modeling. The motion trajectory’s RMSE and MaxE for NCAT phantom tests are 0.5 and 0.8 mm with sliding motion constraint compared to 3.5 and 7.3 mm without sliding motion modeling. The Dice coefficients for both NCAT phantom and the patients show a consistent trend that sliding motion constraint achieves better similarity for segmented lung boundary compared with the ground truth or patient reference.Conclusions:
A sliding motion-compensated 4D-CBCT reconstruction and the motion modeling scheme was developed. Both phantom and patient study demonstrated the improved accuracy and motion modeling accuracy in reconstructed 4D-CBCT.
43(2016); http://dx.doi.org/10.1118/1.4962469View Description Hide DescriptionPurpose:
In dual-isotope (Tc-99m/In-111) small-animal single-photon emission computed tomography (SPECT), quantitative accuracy of Tc-99m activity measurements is degraded due to the detection of Compton-scattered photons in the Tc-99m photopeak window, which originate from the In-111 emissions (cross talk) and from the Tc-99m emission (self-scatter). The standard triple-energy window (TEW) estimates the total scatter (self-scatter and cross talk) using one scatter window on either side of the Tc-99m photopeak window, but the estimate is biased due to the presence of unscattered photons in the scatter windows. The authors present a modified TEW method to correct for total scatter that compensates for this bias and evaluate the method in phantoms and in vivo.Methods:
The number of unscattered Tc-99m and In-111 photons present in each scatter-window projection is estimated based on the number of photons detected in the photopeak of each isotope, using the isotope-dependent energy resolution of the detector. The camera-head-specific energy resolutions for the 140 keV Tc-99m and 171 keV In-111 emissions were determined experimentally by separately sampling the energy spectra of each isotope. Each sampled spectrum was fit with a Linear + Gaussian function. The fitted Gaussian functions were integrated across each energy window to determine the proportion of unscattered photons from each emission detected in the scatter windows. The method was first tested and compared to the standard TEW in phantoms containing Tc-99m:In-111 activity ratios between 0.15 and 6.90. True activities were determined using a dose calibrator, and SPECT activities were estimated from CT-attenuation-corrected images with and without scatter-correction. The method was then tested in vivo in six rats using In-111-liposome and Tc-99m-tetrofosmin to generate cross talk in the area of the myocardium. The myocardium was manually segmented using the SPECT and CT images, and partial-volume correction was performed using a template-based approach. The rat heart was counted in a well-counter to determine the true activity.Results:
In the phantoms without correction for Compton-scatter, Tc-99m activity quantification errors as high as 85% were observed. The standard TEW method quantified Tc-99m activity with an average accuracy of −9.0% ± 0.7%, while the modified TEW was accurate within 5% of truth in phantoms with Tc-99m:In-111 activity ratios ≥0.52. Without scatter-correction, In-111 activity was quantified with an average accuracy of 4.1%, and there was no dependence of accuracy on the activity ratio. In rat myocardia, uncorrected images were overestimated by an average of 23% ± 5%, and the standard TEW had an accuracy of −13.8% ± 1.6%, while the modified TEW yielded an accuracy of −4.0% ± 1.6%.Conclusions:
Cross talk and self-scatter were shown to produce quantification errors in phantoms as well as in vivo. The standard TEW provided inaccurate results due to the inclusion of unscattered photons in the scatter windows. The modified TEW improved the scatter estimate and reduced the quantification errors in phantoms and in vivo.
Polyvinyl chloride as a multimodal tissue-mimicking material with tuned mechanical and medical imaging properties43(2016); http://dx.doi.org/10.1118/1.4962649View Description Hide DescriptionPurpose:
The mechanical and imaging properties of polyvinyl chloride (PVC) can be adjusted to meet the needs of researchers as a tissue-mimicking material. For instance, the hardness can be adjusted by changing the ratio of softener to PVC polymer, mineral oil can be added for lubrication in needle insertion, and glass beads can be added to scatter acoustic energy similar to biological tissue. Through this research, the authors sought to develop a regression model to design formulations of PVC with targeted mechanical and multimodal medical imaging properties.Methods:
The design of experiment was conducted by varying three factors—(1) the ratio of softener to PVC polymer, (2) the mass fraction of mineral oil, and (3) the mass fraction of glass beads—and measuring the mechanical properties (elastic modulus, hardness, viscoelastic relaxation time constant, and needle insertion friction force) and the medical imaging properties [speed of sound, acoustic attenuation coefficient, magnetic resonance imaging time constants T 1 and T 2, and the transmittance of the visible light at wavelengths of 695 nm (T λ695) and 532 nm (T λ532)] on twelve soft PVC samples. A regression model was built to describe the relationship between the mechanical and medical imaging properties and the values of the three composition factors of PVC. The model was validated by testing the properties of a PVC sample with a formulation distinct from the twelve samples.Results:
The tested soft PVC had elastic moduli from 6 to 45 kPa, hardnesses from 5 to 50 Shore OOO-S, viscoelastic stress relaxation time constants from 114.1 to 191.9 s, friction forces of 18 gauge needle insertion from 0.005 to 0.086 N/mm, speeds of sound from 1393 to 1407 m/s, acoustic attenuation coefficients from 0.38 to 0.61 (dB/cm)/MHz, T 1 relaxation times from 426.3 to 450.2 ms, T 2 relaxation times from 21.5 to 28.4 ms, T λ695 from 46.8% to 92.6%, and T λ532 from 41.1% to 86.3%. Statistically significant factors of each property were identified. The regression model relating the mechanical and medical imaging properties and their corresponding significant factors had a good fit. The validation tests showed a small discrepancy between the model predicted values and experimental data (all less than 5% except the needle insertion friction force).Conclusions:
The regression model developed in this paper can be used to design soft PVC with targeted mechanical and medical imaging properties.
Assessing task performance in FFDM, DBT, and synthetic mammography using uniform and anthropomorphic physical phantoms43(2016); http://dx.doi.org/10.1118/1.4962475View Description Hide DescriptionPurpose:
The purpose of this study is to quantify the differences in detectability between full field digital mammography (FFDM), digital breast tomosynthesis (DBT), and synthetic mammography (SM) for challenging, low contrast signals, in the context of both a uniform and an anthropomorphic, textured phantom.Methods:
Images of the phantoms were acquired using a Hologic Selenia Dimensions system. Images were taken at 50%, 100%, and 200% of the dose delivered under automatic exposure control (AEC). Low-contrast disks, created using an inkjet printer with iodine-doped ink, were inserted into the phantom. The disks varied in diameter from 210 to 630 μm, and in local contrast from 1.1% to 2.8% in regular increments. Human observers located the disks in a 4 alternative forced choice experiment. Proportion correct (PC) was computed as the number of correct localizations out of the total number of tries.Results:
Overall, scores from FFDM and DBT were consistently greater than scores from SM. At an exposure corresponding to the AEC setting, mean PC scores for the largest disks with the uniform phantom were 0.80 for FFDM, 0.83 for DBT, and 0.66 for SM, with the same rank ordering at other doses. Scores were similar but lower for the nonuniform background. At an exposure twice the AEC setting, however, the difference between uniform and nonuniform scores was most pronounced for DBT alone. Differences between scores for FFDM and SM were statistically significant, while those between FFDM and DBT were not. Scores were used to compute the minimum contrast level needed to reach 62.5% detection rate. The minimum contrast for SM was 36%–81% higher compared to FFDM or DBT, in either background.Conclusions:
This study shows that an anthropomorphic phantom and lesions inserts may be used to conduct a reader study. Detectability was significantly lower for synthetic mammography than for FFDM or DBT, for all conditions. Additionally, observer performance was consistently lower for the anthropomorphic phantom, indicating the greater challenge due to anatomical background. Because of this, it may be important to use realistic phantoms in observer studies in order to draw conclusions that are more clinically relevant.
43(2016); http://dx.doi.org/10.1118/1.4962930View Description Hide DescriptionPurpose:
To investigate the relationship between the k-space sampling patterns used for compressed sensing MR spectroscopic imaging (CS-MRSI) and the modulation transfer function (MTF) of the metabolite maps. This relationship may allow the desired frequency content of the metabolite maps to be quantitatively tailored when designing an undersampling pattern.Methods:
Simulations of a phantom were used to calculate the MTF of Nyquist sampled (NS) 32 × 32 MRSI, and four-times undersampled CS-MRSI reconstructions. The dependence of the CS-MTF on the k-space sampling pattern was evaluated for three sets of k-space sampling patterns generated using different probability distribution functions (PDFs). CS-MTFs were also evaluated for three more sets of patterns generated using a modified algorithm where the sampling ratios are constrained to adhere to PDFs.Results:
Strong visual correlation as well as high R 2 was found between the MTF of CS-MRSI and the product of the frequency-dependant sampling ratio and the NS 32 × 32 MTF. Also, PDF-constrained sampling patterns led to higher reproducibility of the CS-MTF, and stronger correlations to the above-mentioned product.Conclusions:
The relationship established in this work provides the user with a theoretical solution for the MTF of CS MRSI that is both predictable and customizable to the user’s needs.
Development of a PET/OMRI combined system for simultaneous imaging of positron and free radical probes for small animals43(2016); http://dx.doi.org/10.1118/1.4963215View Description Hide DescriptionPurpose:
Positron emission tomography (PET) has high sensitivity for imaging radioactive tracer distributions in subjects. However, it is not possible to image free radical distribution in a subject by PET. Since free radicals are quite reactive, they are related to many diseases, including but not limited to cancer, inflammation, strokes, and heart disease. The Overhauser enhanced magnetic resonance imaging (OMRI) is so far the only method that images free radical distribution in vivo. By combining PET and OMRI, a new hybrid imaging modality might be developed that can simultaneously image the radioactive tracer and free radical distributions. For this purpose, the authors developed a PET/OMRI combined system for small animals.Methods:
The developed PET/OMRI system used an optical fiber-based PET system combined with a permanent magnet-based OMRI system. The optical fiber-based PET system uses flexible optical fiber bundles. Eight optical fiber-based block detectors were arranged in a 56 mm diameter ring to form a PET system. The LGSO blocks were located inside the field-of-view (FOV) of the OMRI, and the position sensitive photomultiplier tubes were positioned behind the OMRI to minimize the interference between the PET and the OMRI. The OMRI system used a 0.0165 T permanent magnet. The system has an electron spin resonance coil to enhance the MRI signal using the Overhauser effect to image the free radical in the FOV of the PET/OMRI system.Results:
The spatial resolution and sensitivity of the optical fiber-based PET system were 1.2 mm FWHM and 1.2% at the central FOV, respectively. The OMRI system imaged the distribution of a nitroxyl radical (NXR) solution. The interference between PET and OMRI was small. Simultaneous imaging of the positron radiotracer and the NXR solution was successfully conducted with the developed PET/OMRI system for phantom and small animal studies.Conclusions:
The authors developed a PET/OMRI combined system with the potential to provide interesting new results in molecular imaging research, such as in vivo molecular and free radical distributions.
43(2016); http://dx.doi.org/10.1118/1.4963218View Description Hide DescriptionPurpose:
Although current computed tomography (CT) systems can scan the head in a very short time, patient motion sometimes still induces artifacts. If motion occurs, one has to repeat the scan; to avoid motion, sedation or anesthesia is sometimes applied.Methods:
The authors propose a method to iteratively estimate and compensate this motion during the reconstruction. In every iteration, the rigid motion was estimated view-by-view and then used to update the system matrix. A multiresolution scheme was used to speed up the convergence of this joint estimation of the image and the motion of the subject. A final iterative reconstruction was performed with the last motion estimate.Results:
The method was evaluated on simulations, patient scans, and a phantom study. The quality of the reconstructed images was improved substantially after the compensation. In simulation and phantom studies, root-mean-square error was reduced and mean structural similarity was increased. In the patient studies, most of the motion blurring in the reconstructed images disappeared after the compensation.Conclusions:
The proposed method effectively eliminated motion-induced artifacts in head CT scans. Since only measured raw data are needed for the motion estimation and compensation, the proposed method can be applied retrospectively to clinical helical CT scans affected by motion.
Technical assessment of a prototype cone-beam CT system for imaging of acute intracranial hemorrhage43(2016); http://dx.doi.org/10.1118/1.4963220View Description Hide DescriptionPurpose:
A cone-beam CT scanner has been developed for detection and monitoring of traumatic brain injury and acute intracranial hemorrhage (ICH) at the point of care. This work presents a technical assessment of imaging performance and dose for the scanner in phantom and cadaver studies as a prerequisite to clinical translation.Methods:
The scanner incorporates a compact, rotating-anode x-ray source and a flat-panel detector (43 × 43 cm2) on a mobile U-arm gantry with source-axis distance = 550 mm and source-detector distance = 1000 mm. Central and peripheral doses were measured in 16 cm diameter CTDI phantoms using a 0.6 cm3 Farmer ionization chamber for various scan techniques and as a function of longitudinal position, including out of field. Spatial resolution, contrast, noise, and image uniformity were assessed in quantitative and anthropomorphic head phantoms. Two reconstruction protocols were evaluated, including filtered backprojection (FBP) for high-resolution bone imaging and penalized weighted least squares (PWLS) reconstruction for low-contrast soft tissue (ICH) visualization. A fresh cadaver was imaged with and without simulated ICH using the scanner as well as a diagnostic multidetector CT (MDCT) scanner using a standard head protocol. Images were interpreted by a fellowship-trained neuroradiologist for imaging tasks of ICH detection, gray-white-CSF differentiation, detection of midline shift, and fracture detection.Results:
The nominal scan protocol involved 720 projections acquired over a 360° orbit at 100 kV and 216 mAs, giving a dose (weighted CTDI) of 22.8 mGy (∼1.2 mSv effective dose). Out-of-field dose decreased to <10% within 6 cm of the field edge (approximate to the thyroid position). Image uniformity demonstrated <1% variation between the edge of the field (near the cranium) and center of the image. The high-resolution FBP reconstruction protocol showed ∼0.9 mm point spread function (PSF) full-width at half-maximum (FWHM). The smooth PWLS reconstruction protocol yielded ∼1.2 mm PSF FWHM and contrast-to-noise ratio exceeding 5.7 in ∼50 HU spherical ICH, resulting in conspicuous depiction of ICH down to ∼2 mm (the smallest diameter investigated). Cadaver images demonstrated good differentiation of brain and CSF (sufficient, but inferior to MDCT, recognizing that the CBCT dose was one-third that of MDCT), excellent visualization of cranial sutures and fracture (potentially superior to MDCT), clear detection of midline shift, and conspicuous detection of ICH.Conclusions:
Technical assessment of the prototype demonstrates dose characteristics and imaging performance consistent with point-of-care detection and monitoring of head injury—most notably, conspicuous detection of ICH—and supports translation of the system to clinical studies.
- QUANTITATIVE IMAGING AND IMAGE PROCESSING
- Research Articles
Coronary artery analysis: Computer-assisted selection of best-quality segments in multiple-phase coronary CT angiography43(2016); http://dx.doi.org/10.1118/1.4961740View Description Hide DescriptionPurpose:
The authors are developing an automated method to identify the best-quality coronary arterial segment from multiple-phase coronary CT angiography (cCTA) acquisitions, which may be used by either interpreting physicians or computer-aided detection systems to optimally and efficiently utilize the diagnostic information available in multiple-phase cCTA for the detection of coronary artery disease.Methods:
After initialization with a manually identified seed point, each coronary artery tree is automatically extracted from multiple cCTA phases using our multiscale coronary artery response enhancement and 3D rolling balloon region growing vessel segmentation and tracking method. The coronary artery trees from multiple phases are then aligned by a global registration using an affine transformation with quadratic terms and nonlinear simplex optimization, followed by a local registration using a cubic B-spline method with fast localized optimization. The corresponding coronary arteries among the available phases are identified using a recursive coronary segment matching method. Each of the identified vessel segments is transformed by the curved planar reformation (CPR) method. Four features are extracted from each corresponding segment as quality indicators in the original computed tomography volume and the straightened CPR volume, and each quality indicator is used as a voting classifier for the arterial segment. A weighted voting ensemble (WVE) classifier is designed to combine the votes of the four voting classifiers for each corresponding segment. The segment with the highest WVE vote is then selected as the best-quality segment. In this study, the training and test sets consisted of 6 and 20 cCTA cases, respectively, each with 6 phases, containing a total of 156 cCTA volumes and 312 coronary artery trees. An observer preference study was also conducted with one expert cardiothoracic radiologist and four nonradiologist readers to visually rank vessel segment quality. The performance of our automated method was evaluated by comparing the automatically identified best-quality segments identified by the computer to those selected by the observers.Results:
For the 20 test cases, 254 groups of corresponding vessel segments were identified after multiple phase registration and recursive matching. The AI-BQ segments agreed with the radiologist’s top 2 ranked segments in 78.3% of the 254 groups (Cohen’s kappa 0.60), and with the 4 nonradiologist observers in 76.8%, 84.3%, 83.9%, and 85.8% of the 254 groups. In addition, 89.4% of the AI-BQ segments agreed with at least two observers’ top 2 rankings, and 96.5% agreed with at least one observer’s top 2 rankings. In comparison, agreement between the four observers’ top ranked segment and the radiologist’s top 2 ranked segments were 79.9%, 80.7%, 82.3%, and 76.8%, respectively, with kappa values ranging from 0.56 to 0.68.Conclusions:
The performance of our automated method for selecting the best-quality coronary segments from a multiple-phase cCTA acquisition was comparable to the selection made by human observers. This study demonstrates the potential usefulness of the automated method in clinical practice, enabling interpreting physicians to fully utilize the best available information in cCTA for diagnosis of coronary disease, without requiring manual search through the multiple phases and minimizing the variability in image phase selection for evaluation of coronary artery segments across the diversity of human readers with variations in expertise.
Use of regularized principal component analysis to model anatomical changes during head and neck radiation therapy for treatment adaptation and response assessment43(2016); http://dx.doi.org/10.1118/1.4961746View Description Hide DescriptionPurpose:
To develop standard (SPCA) and regularized (RPCA) principal component analysis models of anatomical changes from daily cone beam CTs (CBCTs) of head and neck (H&N) patients and assess their potential use in adaptive radiation therapy, and for extracting quantitative information for treatment response assessment.Methods:
Planning CT images of ten H&N patients were artificially deformed to create “digital phantom” images, which modeled systematic anatomical changes during radiation therapy. Artificial deformations closely mirrored patients’ actual deformations and were interpolated to generate 35 synthetic CBCTs, representing evolving anatomy over 35 fractions. Deformation vector fields (DVFs) were acquired between pCT and synthetic CBCTs (i.e., digital phantoms) and between pCT and clinical CBCTs. Patient-specific SPCA and RPCA models were built from these synthetic and clinical DVF sets. EigenDVFs (EDVFs) having the largest eigenvalues were hypothesized to capture the major anatomical deformations during treatment.Results:
Principal component analysis (PCA) models achieve variable results, depending on the size and location of anatomical change. Random changes prevent or degrade PCA’s ability to detect underlying systematic change. RPCA is able to detect smaller systematic changes against the background of random fraction-to-fraction changes and is therefore more successful than SPCA at capturing systematic changes early in treatment. SPCA models were less successful at modeling systematic changes in clinical patient images, which contain a wider range of random motion than synthetic CBCTs, while the regularized approach was able to extract major modes of motion.Conclusions:
Leading EDVFs from the both PCA approaches have the potential to capture systematic anatomical change during H&N radiotherapy when systematic changes are large enough with respect to random fraction-to-fraction changes. In all cases the RPCA approach appears to be more reliable at capturing systematic changes, enabling dosimetric consequences to be projected once trends are established early in a treatment course, or based on population models.
43(2016); http://dx.doi.org/10.1118/1.4961747View Description Hide DescriptionPurpose:
Accurate reconstruction of the dose delivered by 90Y microspheres using a postembolization PET scan would permit the establishment of more accurate dose–response relationships for treatment of hepatocellular carcinoma with 90Y. However, the quality of the PET data obtained is compromised by several factors, including poor count statistics and a very high random fraction. This work uses Monte Carlo simulations to investigate what impact factors other than low count statistics have on the quantification of 90Y PET.Methods:
PET acquisitions of two phantoms—a NEMA PET phantom and the NEMA IEC PET body phantom-containing either 90Y or 18F were simulated using gate. Simulated projections were created with subsets of the simulation data allowing the contributions of random, scatter, and LSO background to be independently evaluated. The simulated projections were reconstructed using the commercial software for the simulated scanner, and the quantitative accuracy of the reconstruction and the contrast recovery of the reconstructed images were evaluated.Results:
The quantitative accuracy of the 90Y reconstructions were not strongly influenced by the high random fraction present in the projection data, and the activity concentration was recovered to within 5% of the known value. The contrast recovery measured for simulated 90Y data was slightly poorer than that for simulated 18F data with similar count statistics. However, the degradation was not strongly linked to any particular factor. Using a more restricted energy range to reduce the random fraction in the projections had no significant effect.Conclusions:
Simulations of 90Y PET confirm that quantitative 90Y is achievable with the same approach as that used for 18F, and that there is likely very little margin for improvement by attempting to model aspects unique to 90Y, such as the much higher random fraction or the presence of bremsstrahlung in the singles data.