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Belikhin MA, Chernyaev AP, Pryanichnikov AA. High-speed bioimpedance-based gating system for radiotherapy: Prototype and proof of principle. J Appl Clin Med Phys 2024:e14491. [PMID: 39194180 DOI: 10.1002/acm2.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 08/29/2024] Open
Abstract
PURPOSE To investigate a novel bioimpedance-based respiratory gating system (BRGS) designed for external beam radiotherapy and to evaluate its technical characteristics in comparison with existing similar systems. MATERIALS AND METHODS The BRGS was tested on three healthy volunteers in free breathing and breath-hold patterns under laboratory conditions. Its parameters, including the time delay (TD) between the actual impedance change and the gating signal, temperature drift, root mean square (RMS) noise, and signal-to-noise ratio (SNR), were measured and analyzed. RESULTS The gate-on TD and the gate-off TD were found to be 9.0 ± 2.0 ms [mean ± standard deviation (M ± SD)] and 7.2 ± 1.3 ms, respectively. The temperature drift of the BRGS output signal was 0.02 Ω after 30 min of operation. RMS noise averaged 0.14 ± 0.05 Ω (M ± SD) for all subjects and varied from 0.08 to 0.20 Ω with repeated measurements. A significant difference in SNR (p < 0.001) was observed between subjects, ranging from 4 to 15. CONCLUSION The evaluated bioimpedance-based gating system showed a high performance in real-time respiratory monitoring and may potentially be used as an external surrogate guidance for respiratory-gated external beam radiotherapy. Direct comparison with commercially available systems, 4D correlation studies, and expansion of the patient sample are goals for future preclinical studies.
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Affiliation(s)
| | | | - Alexander A Pryanichnikov
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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de Oliveira RS, Moll-Bernardes R, de Brito AX, Pinheiro MVT, de Almeida SA, da Silva Gomes NL, de Oliveira Terzi FV, Moreira OC, Xavier SS, Rosado-de-Castro PH, de Sousa AS. Use of PET/CT to detect myocardial inflammation and the risk of malignant arrhythmia in chronic Chagas disease. J Nucl Cardiol 2023; 30:2702-2711. [PMID: 37605061 DOI: 10.1007/s12350-023-03350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Chagas heart disease (CHD) is characterized by progressive myocardial inflammation associated with myocardial fibrosis and segmental abnormalities that may lead to malignant ventricular arrhythmia and sudden cardiac death. This arrhythmia might be related to the persistence of parasitemia or inflammation in the myocardium in late-stage CHD. Positron emission tomography/computed tomography (PET/CT) has been used to detect myocardial inflammation in non-ischemic cardiomyopathies, such as sarcoidosis, and might be useful for risk prediction in patients with CHD. METHODS AND RESULTS Twenty-four outpatients with chronic CHD were enrolled in this prospective cross-sectional study between May 2019 and March 2022. The patients were divided into two groups: those with sustained ventricular tachycardia and/or aborted sudden cardiac death who required implantable cardioverter-defibrillators, and those with the same stages of CHD and no complex ventricular arrhythmia. Patients underwent 18F-fluorodeoxyglucose (18F-FDG) and 68Ga-DOTATOC PET/CT, and blood samples were collected for qualitative parasite assessment by polymerase chain reaction. Although similar proportions of patients with and without complex ventricular arrhythmia showed 18F-FDG and 68Ga-DOTATOC uptake, 68Ga-DOTATOC corrected SUVmax was higher in patients with complex arrhythmia (3.4 vs 1.7; P = .046), suggesting that inflammation could be associated with the presence of malignant arrhythmia in the late stages of CHD. We also detected Trypanosoma cruzi in both groups, with a nonsignificant trend of increased parasitemia in the group with malignant arrhythmia (66.7% vs 33.3%). CONCLUSION 18F-FDG and 68Ga-DOTATOC uptake on PET/CT may be useful for the detection of myocardial inflammation in patients with Chagas cardiomyopathy, and 68Ga-DOTATOC uptake may be associated with the presence of malignant arrhythmia, with potential therapeutic implications.
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Affiliation(s)
- Renée Sarmento de Oliveira
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Internal Medicine Department, Rio de Janeiro Federal State University, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | - Sergio Salles Xavier
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Kortelainen MJ, Koivumäki TM, Vauhkonen MJ, Hedman MK, Kärkkäinen STJ, Niño Quintero J, Hakulinen MA. Respiratory motion reduction with a dual gating approach in myocardial perfusion SPECT: Effect on left ventricular functional parameters. J Nucl Cardiol 2018; 25:1633-1641. [PMID: 28303474 DOI: 10.1007/s12350-017-0844-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Respiratory motion (RM) complicates the analysis of myocardial perfusion (MP) single-photon emission computed tomography (SPECT) images. The effects of RM on left ventricular (LV) functional variables have not been thoroughly investigated. METHODS AND RESULTS Thoracic electrical bioimpedance and electrocardiographic signals were recorded from eighteen patients undergoing the rest phase of a 1-day stress/rest cardiac-gated MP-SPECT examination. The signals and list-mode emission data were retrospectively processed to yield standard cardiac- and dual-gated (respiratory and cardiac gating) image sets applying a novel algorithm. LV volume, MP, shape index (SI), wall motion (WM), wall thickening (WT), and phase analysis parameters were measured with Quantitative Perfusion SPECT/Quantitative Gated SPECT software (Cedars-Sinai Medical Center). Image quality was evaluated by three experienced physicians. Dual gating increased LV volume (77.1 ± 26.8 vs 79.8 ± 27.6 mL, P = .006) and decreased SI (0.57 ± 0.05 vs 0.56 ± 0.05, P = .036) and global WT (39.0 ± 11.8% vs 36.9 ± 9.4%, P = .034) compared to cardiac gating, but did not significantly alter perfusion, WM or phase analysis parameters or image quality (P > .05). CONCLUSIONS RM reduction has an effect on LV volume, shape, and WT parameters. RM exerts no significant effect on phase analysis parameters.
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Affiliation(s)
- Matti J Kortelainen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | | | - Marko J Vauhkonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Marja K Hedman
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Mikko A Hakulinen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Jafari Tadi M, Teuho J, Lehtonen E, Saraste A, Pänkäälä M, Koivisto T, Teräs M. A novel dual gating approach using joint inertial sensors: implications for cardiac PET imaging. Phys Med Biol 2017; 62:8080-8101. [PMID: 28880843 DOI: 10.1088/1361-6560/aa8b09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Positron emission tomography (PET) is a non-invasive imaging technique which may be considered as the state of art for the examination of cardiac inflammation due to atherosclerosis. A fundamental limitation of PET is that cardiac and respiratory motions reduce the quality of the achieved images. Current approaches for motion compensation involve gating the PET data based on the timing of quiescent periods of cardiac and respiratory cycles. In this study, we present a novel gating method called microelectromechanical (MEMS) dual gating which relies on joint non-electrical sensors, i.e. tri-axial accelerometer and gyroscope. This approach can be used for optimized selection of quiescent phases of cardiac and respiratory cycles. Cardiomechanical activity according to echocardiography observations was investigated to confirm whether this dual sensor solution can provide accurate trigger timings for cardiac gating. Additionally, longitudinal chest motions originating from breathing were measured by accelerometric- and gyroscopic-derived respiratory (ADR and GDR) tracking. The ADR and GDR signals were evaluated against Varian real-time position management (RPM) signals in terms of amplitude and phase. Accordingly, high linear correlation and agreement were achieved between the reference electrocardiography, RPM, and measured MEMS signals. We also performed a Ge-68 phantom study to evaluate possible metal artifacts caused by the integrated read-out electronics including mechanical sensors and semiconductors. The reconstructed phantom images did not reveal any image artifacts. Thus, it was concluded that MEMS-driven dual gating can be used in PET studies without an effect on the quantitative or visual accuracy of the PET images. Finally, the applicability of MEMS dual gating for cardiac PET imaging was investigated with two atherosclerosis patients. Dual gated PET images were successfully reconstructed using only MEMS signals and both qualitative and quantitative assessments revealed encouraging results that warrant further investigation of this method.
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Affiliation(s)
- Mojtaba Jafari Tadi
- Turku PET Center, University of Turku, Finland. Department of Future Technologies, University of Turku, Finland
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Kesner AL, Chung JH, Lind KE, Kwak JJ, Lynch D, Burckhardt D, Koo PJ. Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET. Radiology 2016; 281:239-48. [PMID: 27027335 DOI: 10.1148/radiol.2016152105] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the performance of hardware- and software-gating technologies in terms of qualitative and quantitative characteristics of respiratory motion in positron emission tomography (PET) imaging. Materials and Methods Between 2010 and 2013, 219 fluorine 18 fluorodeoxyglucose PET examinations were performed in 116 patients for assessment of pulmonary nodules. All patients provided informed consent in this institutional review board-approved study. Acquisitions were reconstructed as respiratory-gated images by using hardware-derived respiratory triggers and software-derived signal (via an automated postprocessing method). Asymmetry was evaluated in the joint distribution of reader preference, and linear mixed models were used to evaluate differences in outcomes according to gating type. Results In blind reviews of reconstructed gated images, software was selected as superior 16.9% of the time (111 of 657 image sets; 95% confidence interval [CI]: 14.0%, 19.8%), and hardware was selected as superior 6.2% of the time (41 of 657 image sets; 95% CI: 4.4%, 8.1%). Of the image sets, 76.9% (505 of 657; 95% CI: 73.6%, 80.1%) were judged as having indistinguishable motion quality. Quantitative analysis demonstrated that the two gating strategies exhibited similar performance, and the performance of both was significantly different from that of nongated images. The mean increase ± standard deviation in lesion maximum standardized uptake value was 42.2% ± 38.9 between nongated and software-gated images, and lesion full width at half maximum values decreased by 9.9% ± 9.6. Conclusion Compared with vendor-supplied respiratory-gating hardware methods, software gating performed favorably, both qualitatively and quantitatively. Fully automated gating is a feasible approach to motion correction of PET images. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Adam Leon Kesner
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
| | - Jonathan Hero Chung
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
| | - Kimberly Erin Lind
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
| | - Jennifer Jihyang Kwak
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
| | - David Lynch
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
| | - Darrell Burckhardt
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
| | - Phillip Jahhyung Koo
- From the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado School of Medicine, 12700 E 19th Ave, Box C-278, Aurora, CO 80045 (A.L.K., K.E.L., J.J.K., P.J.K.); Department of Radiology, National Jewish Health, Denver, Colo (J.H.C., D.L.); and Siemens, Hoffman Estates, Ill (D.B.)
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