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Felchle H, Brunner V, Groll T, Walther CN, Nefzger SM, Zaurito AE, Silva MG, Gissibl J, Topping GJ, Lansink Rotgerink L, Saur D, Steiger K, Combs SE, Tschurtschenthaler M, Fischer JC. Novel Tumor Organoid-Based Mouse Model to Study Image Guided Radiation Therapy of Rectal Cancer After Noninvasive and Precise Endoscopic Implantation. Int J Radiat Oncol Biol Phys 2024; 118:1094-1104. [PMID: 37875245 DOI: 10.1016/j.ijrobp.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Preoperative (neoadjuvant) radiation therapy (RT) is an essential part of multimodal rectal cancer therapy. Recently, total neoadjuvant therapy (TNT), which combines simultaneous radiochemotherapy with additional courses of chemotherapy, has emerged as an effective approach. TNT achieves a pathologic complete remission in approximately 30% of resected patients, opening avenues for treatment strategies that avoid radical organ resection. Furthermore, recent studies have demonstrated that anti-programmed cell death protein 1 immunotherapy can induce clinical complete responses in patients with specific genetic alterations. There is significant potential to enhance outcomes through intensifying, personalizing, and de-escalating treatment approaches. However, the heterogeneous response rates to RT or TNT and strategies to sensitize patients without specific genetic changes to immunotherapy remain poorly understood. METHODS AND MATERIALS We developed a novel orthotopic mouse model of rectal cancer based on precisely defined endoscopic injections of tumor organoids that reflect tumor heterogeneity. Subsequently, we employed endoscopic- and computed tomography-guided RT and validated rectal tumor growth and response rates to therapy using small-animal magnetic resonance imaging and endoscopic follow-up. RESULTS Rectal tumor formation was successfully induced in all mice after 2 organoid injections. Clinically relevant RT regimens with 5 × 5 Gy significantly delayed clinical signs of tumor progression and significantly improved survival. Consistent with human disease, rectal tumor progression correlated with the development of liver and lung metastases. Notably, long-term survivors after RT showed no evidence of tumor recurrence, as demonstrated by in vivo radiologic tumor staging and histopathologic examination. CONCLUSIONS Our novel mouse model combines orthotopic tumor growth via noninvasive and precise rectal organoid injection and small-animal RT. This model holds significant promise for investigating the effect of tumor cell-intrinsic aspects, genetic alterations of the host, and exogenous factors (eg, nutrition or microbiota) on RT outcomes. Furthermore, it allows for the exploration of combination therapies involving chemotherapy, immunotherapy, or novel targeted therapies.
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Affiliation(s)
- Hannah Felchle
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Valentina Brunner
- Translational Cancer Research and Institute of Experimental Cancer Therapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Tanja Groll
- Comparative Experimental Pathology, School of Medicine, Technical University of Munich, Munich, Germany; Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Caroline N Walther
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophie M Nefzger
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Antonio E Zaurito
- Translational Cancer Research and Institute of Experimental Cancer Therapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Miguel G Silva
- Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany; Institute of Molecular Oncology and Functional Genomics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Julia Gissibl
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Geoffrey J Topping
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Laura Lansink Rotgerink
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dieter Saur
- Translational Cancer Research and Institute of Experimental Cancer Therapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Steiger
- Comparative Experimental Pathology, School of Medicine, Technical University of Munich, Munich, Germany; Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Zentrum München, Institute of Radiation Medicine, Neuherberg, Germany
| | - Markus Tschurtschenthaler
- Translational Cancer Research and Institute of Experimental Cancer Therapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Julius C Fischer
- Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
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Guo P, Zhang L, Lu J, Zhang H, Zhu X, Wu C, Zhan X, Yin H, Wang Z, Xu Y, Wang Z. Grating-based x-ray dark-field CT for lung cancer diagnosis in mice. Eur Radiol Exp 2024; 8:12. [PMID: 38270720 PMCID: PMC10810771 DOI: 10.1186/s41747-023-00399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/20/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The low absorption of x-rays in lung tissue and the poor resolution of conventional computed tomography (CT) limits its use to detect lung disease. However, x-ray dark-field imaging can sense the scattered x-rays deflected by the structures being imaged. This technique can facilitate the detection of small alveolar lesions that would be difficult to detect with conventional CT. Therefore, it may provide an alternative imaging modality to diagnose lung disease at an early stage. METHODS Eight mice were inoculated with lung cancers simultaneously. Each time two mice were scanned using a grating-based dark-field CT on days 4, 8, 12, and 16 after the introduction of the cancer cells. The detectability index was calculated between nodules and healthy parenchyma for both attenuation and dark-field modalities. High-resolution micro-CT and pathological examinations were used to crosscheck and validate our results. Paired t-test was used for comparing the ability of dark-field and attenuation modalities in pulmonary nodule detection. RESULTS The nodules were shown as a signal decrease in the dark-field modality and a signal increase in the attenuation modality. The number of nodules increased from day 8 to day 16, indicating disease progression. The detectability indices of dark-field modality were higher than those of attenuation modality (p = 0.025). CONCLUSIONS Compared with the standard attenuation CT, the dark-field CT improved the detection of lung nodules. RELEVANCE STATEMENT Dark-field CT has a higher detectability index than conventional attenuation CT in lung nodule detection. This technique could improve the early diagnosis of lung cancer. KEY POINTS • Lung cancer progression was observed using x-ray dark-field CT. • Dark-field modality complements with attenuation modality in lung nodule detection. • Dark-field modality showed a detectability index higher than that attenuation in nodule detection.
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Affiliation(s)
- Peiyuan Guo
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Beijing, China
- Institute for Precision Medicine, Tsinghua University, Beijing, China
| | - Li Zhang
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Beijing, China
- Institute for Precision Medicine, Tsinghua University, Beijing, China
| | - Jincheng Lu
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Beijing, China
- Institute for Precision Medicine, Tsinghua University, Beijing, China
| | - Huitao Zhang
- School of Mathematical Sciences, Capital Normal University, Beijing, China
| | - Xiaohua Zhu
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Beijing, China
| | - Chengpeng Wu
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Beijing, China
| | - Xiangwen Zhan
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) and Comparative Medicine Center, Peking Union Medical College (PUMC), Beijing, China
| | - Hongxia Yin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhentian Wang
- Department of Engineering Physics, Tsinghua University, Beijing, China.
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Beijing, China.
- Institute for Precision Medicine, Tsinghua University, Beijing, China.
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Lin LP, Tan MTT. Biosensors for the detection of lung cancer biomarkers: A review on biomarkers, transducing techniques and recent graphene-based implementations. Biosens Bioelectron 2023; 237:115492. [PMID: 37421797 DOI: 10.1016/j.bios.2023.115492] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
Lung cancer remains the leading cause of cancer-related death. In addition to chest X-rays and computerised tomography, the detection of cancer biomarkers serves as an emerging diagnostic tool for lung cancer. This review explores biomarkers including the rat sarcoma gene, the tumour protein 53 gene, the epidermal growth factor receptor, the neuron-specific enolase, the cytokeratin-19 fragment 21-1 and carcinoembryonic antigen as potential indicators of lung cancer. Biosensors, which utilise various transduction techniques, present a promising solution for the detection of lung cancer biomarkers. Therefore, this review also explores the working principles and recent implementations of transducers in the detection of lung cancer biomarkers. The transducing techniques explored include optical techniques, electrochemical techniques and mass-based techniques for detecting biomarkers and cancer-related volatile organic compounds. Graphene has outstanding properties in terms of charge transfer, surface area, thermal conductivity and optical characteristics, on top of allowing easy incorporation of other nanomaterials. Exploiting the collective merits of both graphene and biosensor is an emerging trend, as evidenced by the growing number of studies on graphene-based biosensors for the detection of lung cancer biomarkers. This work provides a comprehensive review of these studies, including information on modification schemes, nanomaterials, amplification strategies, real sample applications, and sensor performance. The paper concludes with a discussion of the challenges and future outlook of lung cancer biosensors, including scalable graphene synthesis, multi-biomarker detection, portability, miniaturisation, financial support, and commercialisation.
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Affiliation(s)
- Lih Poh Lin
- Faculty of Engineering and Technology, Tunku Abdul Rahman University of Management and Technology, 53300, Kuala Lumpur, Malaysia; Centre for Multimodal Signal Processing, Tunku Abdul Rahman University of Management and Technology, 53300, Kuala Lumpur, Malaysia
| | - Michelle Tien Tien Tan
- Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Semenyih, Malaysia.
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Kattau M, Willer K, Noichl W, Urban T, Frank M, De Marco F, Schick R, Koehler T, Maack HI, Renger B, Renz M, Sauter A, Leonhardt Y, Fingerle A, Makowski M, Pfeiffer D, Pfeiffer F. X-ray dark-field chest radiography: a reader study to evaluate the diagnostic quality of attenuation chest X-rays from a dual-contrast scanning prototype. Eur Radiol 2023; 33:5549-5556. [PMID: 36806571 PMCID: PMC10326144 DOI: 10.1007/s00330-023-09477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/09/2022] [Accepted: 01/23/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To compare the visibility of anatomical structures and overall quality of the attenuation images obtained with a dark-field X-ray radiography prototype with those from a commercial radiography system. METHODS Each of the 65 patients recruited for this study obtained a thorax radiograph at the prototype and a reference radiograph at the commercial system. Five radiologists independently assessed the visibility of anatomical structures, the level of motion artifacts, and the overall image quality of all attenuation images on a five-point scale, with 5 points being the highest rating. The average scores were compared between the two image types. The differences were evaluated using an area under the curve (AUC) based z-test with a significance level of p ≤ 0.05. To assess the variability among the images, the distributions of the average scores per image were compared between the systems. RESULTS The overall image quality was rated high for both devices, 4.2 for the prototype and 4.6 for the commercial system. The rating scores varied only slightly between both image types, especially for structures relevant to lung assessment, where the images from the commercial system were graded slightly higher. The differences were statistically significant for all criteria except for the bronchial structures, the cardiophrenic recess, and the carina. CONCLUSIONS The attenuation images acquired with the prototype were assigned a high diagnostic quality despite a lower resolution and the presence of motion artifacts. Thus, the attenuation-based radiographs from the prototype can be used for diagnosis, eliminating the need for an additional conventional radiograph. KEY POINTS • Despite a low tube voltage (70 kVp) and comparably long acquisition time, the attenuation images from the dark-field chest radiography system achieved diagnostic quality for lung assessment. • Commercial chest radiographs obtained a mean rating score regarding their diagnostic quality of 4.6 out of 5, and the grating-based images had a slightly lower mean rating score of 4.2 out of 5. • The difference in rating scores for anatomical structures relevant to lung assessment is below 5%.
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Affiliation(s)
- Margarete Kattau
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany.
| | - Konstantin Willer
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
| | - Theresa Urban
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Manuela Frank
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Fabio De Marco
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
| | - Rafael Schick
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Thomas Koehler
- Philips Research, 22335, Hamburg, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | | | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Martin Renz
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Yannik Leonhardt
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Alexander Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Marcus Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Munich Institute of Biomedical Engineering & School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675, Munich, Germany
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How YY, Paganin DM, Morgan KS. On the quantification of sample microstructure using single-exposure x-ray dark-field imaging via a single-grid setup. Sci Rep 2023; 13:11001. [PMID: 37419926 DOI: 10.1038/s41598-023-37334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
The size of the smallest detectable sample feature in an x-ray imaging system is usually restricted by the spatial resolution of the system. This limitation can now be overcome using the diffusive dark-field signal, which is generated by unresolved phase effects or the ultra-small-angle x-ray scattering from unresolved sample microstructures. A quantitative measure of this dark-field signal can be useful in revealing the microstructure size or material for medical diagnosis, security screening and materials science. Recently, we derived a new method to quantify the diffusive dark-field signal in terms of a scattering angle using a single-exposure grid-based approach. In this manuscript, we look at the problem of quantifying the sample microstructure size from this single-exposure dark-field signal. We do this by quantifying the diffusive dark-field signal produced by 5 different sizes of polystyrene microspheres, ranging from 1.0 to 10.8 µm, to investigate how the strength of the extracted dark-field signal changes with the sample microstructure size, [Formula: see text]. We also explore the feasibility of performing single-exposure dark-field imaging with a simple equation for the optimal propagation distance, given microstructure with a specific size and thickness, and show consistency between this model and experimental data. Our theoretical model predicts that the dark-field scattering angle is inversely proportional to [Formula: see text], which is also consistent with our experimental data.
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Affiliation(s)
- Ying Ying How
- School of Physics and Astronomy, Monash University, Clayton, VIC, 3800, Australia.
| | - David M Paganin
- School of Physics and Astronomy, Monash University, Clayton, VIC, 3800, Australia
| | - Kaye S Morgan
- School of Physics and Astronomy, Monash University, Clayton, VIC, 3800, Australia
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Viermetz M, Gustschin N, Schmid C, Haeusele J, Noel PB, Proksa R, Loscher S, Koehler T, Pfeiffer F. Technical Design Considerations of a Human-Scale Talbot-Lau Interferometer for Dark-Field CT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:220-232. [PMID: 36112565 DOI: 10.1109/tmi.2022.3207579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Computed tomography (CT) as an important clinical diagnostics method can profit from extension with dark-field imaging, as it is currently restricted to X-rays' attenuation contrast only. Dark-field imaging allows access to more tissue properties, such as micro-structural texture or porosity. The up-scaling process to clinical scale is complex because several design constraints must be considered. The two most important ones are that the finest grating is limited by current manufacturing technology to a [Formula: see text] period and that the interferometer should fit into the CT gantry with minimal modifications only. In this work we discuss why an inverse interferometer and a triangular G1 profile are advantageous and make a compact and sensitive interferometer implementation feasible. Our evaluation of the triangular grating profile reveals a deviation in the interference pattern compared to standard grating profiles, which must be considered in the subsequent data processing. An analysis of the grating orientation demonstrates that currently only a vertical layout can be combined with cylindrical bending of the gratings. We also provide an in-depth discussion, including a new simulation approach, of the impact of the extended X-ray source spot which can lead to large performance loss and present supporting experimental results. This analysis reveals a vastly increased sensitivity to geometry and grating period deviations, which must be considered early in the system design process.
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Low-density foreign body detection in food products using single-shot grid-based dark-field X-ray imaging. J FOOD ENG 2022. [DOI: 10.1016/j.jfoodeng.2022.111189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dark-field chest X-ray imaging for the assessment of COVID-19-pneumonia. COMMUNICATIONS MEDICINE 2022; 2:147. [PMID: 36411311 PMCID: PMC9678896 DOI: 10.1038/s43856-022-00215-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Currently, alternative medical imaging methods for the assessment of pulmonary involvement in patients infected with COVID-19 are sought that combine a higher sensitivity than conventional (attenuation-based) chest radiography with a lower radiation dose than CT imaging. Methods Sixty patients with COVID-19-associated lung changes in a CT scan and 40 subjects without pathologic lung changes visible in the CT scan were included (in total, 100, 59 male, mean age 58 ± 14 years). All patients gave written informed consent. We employed a clinical setup for grating-based dark-field chest radiography, obtaining both a dark-field and a conventional attenuation image in one image acquisition. Attenuation images alone, dark-field images alone, and both displayed simultaneously were assessed for the presence of COVID-19-associated lung changes on a scale from 1 to 6 (1 = surely not, 6 = surely) by four blinded radiologists. Statistical analysis was performed by evaluation of the area under the receiver–operator-characteristics curves (AUC) using Obuchowski’s method with a 0.05 level of significance. Results We show that dark-field imaging has a higher sensitivity for COVID-19-pneumonia than attenuation-based imaging and that the combination of both is superior to one imaging modality alone. Furthermore, a quantitative image analysis shows a significant reduction of dark-field signals for COVID-19-patients. Conclusions Dark-field imaging complements and improves conventional radiography for the visualisation and detection of COVID-19-pneumonia. Computed tomography (CT) imaging uses X-rays to obtain images of the inside of the body. It is used to look at lung damage in patients with COVID-19. However, CT imaging exposes the patient to a considerable amount of radiation. As radiation exposure can lead to the development of cancer, exposure should be minimised. Conventional plain X-ray imaging uses lower amounts of radiation but lacks sensitivity. We used dark-field chest X-ray imaging, which also uses low amounts of radiation, to assess the lungs of patients with COVID-19. Radiologists identified pneumonia in patients more easily from dark-field images than from usual plain X-ray images. We anticipate dark-field X-ray imaging will be useful to follow-up patients suspected of having lung damage. Frank, Gassert et al. use dark-field chest X-ray imaging to assess COVID-19-pneumonia. Dark-field imaging has a higher sensitivity for COVID-19-pneumonia than attenuation-based imaging and provides an ultralow dose alternative to computed tomography imaging for that purpose.
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Dark-field chest x-ray imaging: first experience in patients with alpha1-antitrypsin deficiency. Eur Radiol Exp 2022; 6:9. [PMID: 35229244 PMCID: PMC8885951 DOI: 10.1186/s41747-022-00263-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Spirometry and conventional chest x-ray have limitations in investigating early emphysema, while computed tomography, the reference imaging method in this context, is not part of routine patient care due to its higher radiation dose. In this work, we investigated a novel low-dose imaging modality, dark-field chest x-ray, for the evaluation of emphysema in patients with alpha1-antitrypsin deficiency.
Methods
By exploiting wave properties of x-rays for contrast formation, dark-field chest x-ray visualises the structural integrity of the alveoli, represented by a high signal over the lungs in the dark-field image. We investigated four patients with alpha1-antitrypsin deficiency with a novel dark-field x-ray prototype and simultaneous conventional chest x-ray. The extent of pulmonary function impairment was assessed by pulmonary function measurement and regional emphysema distribution was compared with CT in one patient.
Results
We show that dark-field chest x-ray visualises the extent of pulmonary emphysema displaying severity and regional differences. Areas with low dark-field signal correlate with emphysematous changes detected by computed tomography using a threshold of -950 Hounsfield units. The airway parameters obtained by whole-body plethysmography and single breath diffusing capacity of the lungs for carbon monoxide demonstrated typical changes of advanced emphysema.
Conclusions
Dark-field chest x-ray directly visualised the severity and regional distribution of pulmonary emphysema compared to conventional chest x-ray in patients with alpha1-antitrypsin deficiency. Due to the ultra-low radiation dose in comparison to computed tomography, dark-field chest x-ray could be beneficial for long-term follow-up in these patients.
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Abstract
X-ray computed tomography (CT) is one of the most commonly used diagnostic three-dimensional imaging modalities today. Conventionally, this noninvasive technique generates contrast by measuring the X-ray attenuation properties of different tissues. Considering the wave nature of X-rays, complementary contrast can be achieved by further measuring their small-angle scattering (dark-field) properties. This provides additional valuable diagnostic information on otherwise unresolved tissue microstructure. In our work, we have translated this wave-optical mechanism from the optical bench to a human-sized prototype CT system. This involved the integration of an interferometer into a clinical CT gantry and overcoming several associated challenges regarding vibrations, continuous gantry rotation, and large field of view. This development puts complementary X-ray contrast within reach for real-word medical applications. X-ray computed tomography (CT) is one of the most commonly used three-dimensional medical imaging modalities today. It has been refined over several decades, with the most recent innovations including dual-energy and spectral photon-counting technologies. Nevertheless, it has been discovered that wave-optical contrast mechanisms—beyond the presently used X-ray attenuation—offer the potential of complementary information, particularly on otherwise unresolved tissue microstructure. One such approach is dark-field imaging, which has recently been introduced and already demonstrated significantly improved radiological benefit in small-animal models, especially for lung diseases. Until now, however, dark-field CT could not yet be translated to the human scale and has been restricted to benchtop and small-animal systems, with scan durations of several minutes or more. This is mainly because the adaption and upscaling to the mechanical complexity, speed, and size of a human CT scanner so far remained an unsolved challenge. Here, we now report the successful integration of a Talbot–Lau interferometer into a clinical CT gantry and present dark-field CT results of a human-sized anthropomorphic body phantom, reconstructed from a single rotation scan performed in 1 s. Moreover, we present our key hardware and software solutions to the previously unsolved roadblocks, which so far have kept dark-field CT from being translated from the optical bench into a rapidly rotating CT gantry, with all its associated challenges like vibrations, continuous rotation, and large field of view. This development enables clinical dark-field CT studies with human patients in the near future.
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Urban T, Gassert FT, Frank M, Willer K, Noichl W, Buchberger P, Schick RC, Koehler T, Bodden JH, Fingerle AA, Sauter AP, Makowski MR, Pfeiffer F, Pfeiffer D. Qualitative and Quantitative Assessment of Emphysema Using Dark-Field Chest Radiography. Radiology 2022; 303:119-127. [PMID: 35014904 DOI: 10.1148/radiol.212025] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Dark-field chest radiography allows for assessment of lung alveolar structure by exploiting wave optical properties of x-rays. Purpose To evaluate the qualitative and quantitative features of dark-field chest radiography in participants with pulmonary emphysema as compared with those in healthy control subjects. Materials and Methods In this prospective study conducted from October 2018 to October 2020, participants aged at least 18 years who underwent clinically indicated chest CT were screened for participation. Inclusion criteria were an ability to consent to the procedure and stand upright without help. Exclusion criteria were pregnancy, serious medical conditions, and any lung condition besides emphysema that was visible on CT images. Participants were examined with a clinical dark-field chest radiography prototype that simultaneously acquired both attenuation-based radiographs and dark-field chest radiographs. Dark-field coefficients were tested for correlation with each participant's CT-based emphysema index using the Spearman correlation test. Dark-field coefficients of adjacent groups in the semiquantitative Fleischner Society emphysema grading system were compared using a Wilcoxon Mann-Whitney U test. The capability of the dark-field coefficient to enable detection of emphysema was evaluated with receiver operating characteristics curve analysis. Results A total of 83 participants (mean age, 65 years ± 12 [standard deviation]; 52 men) were studied. When compared with images from healthy participants, dark-field chest radiographs in participants with emphysema had a lower and inhomogeneous dark-field signal intensity. The locations of focal signal intensity loss on dark-field images corresponded well with emphysematous areas found on CT images. The dark-field coefficient was negatively correlated with the quantitative CT-based emphysema index (r = -0.54, P < .001). Participants with Fleischner Society grades of mild, moderate, confluent, or advanced destructive emphysema exhibited a lower dark-field coefficient than those without emphysema (eg, 1.3 m-1 ± 0.6 for participants with confluent or advanced destructive emphysema vs 2.6 m-1 ± 0.4 for participants without emphysema; P < .001). The area under the receiver operating characteristic curve for detection of mild emphysema was 0.79. Conclusion Pulmonary emphysema leads to reduced signal intensity on dark-field chest radiographs, showing the technique has potential as a diagnostic tool in the assessment of lung diseases. © RSNA, 2022 See also the editorial by Hatabu and Madore in this issue.
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Affiliation(s)
- Theresa Urban
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Florian T Gassert
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Manuela Frank
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Konstantin Willer
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Wolfgang Noichl
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Philipp Buchberger
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Rafael C Schick
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Thomas Koehler
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Jannis H Bodden
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Alexander A Fingerle
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Andreas P Sauter
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Marcus R Makowski
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Franz Pfeiffer
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
| | - Daniela Pfeiffer
- From the Department of Physics, School of Natural Sciences, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Munich Institute of Biomedical Engineering, Technical University of Munich, Boltzmannstr 11, 85748 85748 Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.C.S., F.P.); Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (T.U., F.T.G., M.F., K.W., R.C.S., J.H.B., A.A.F., A.P.S., M.R.M., F.P., D.P.); Institute for Advanced Study, Technical University of Munich, Garching, Germany (T.K., F.P., D.P.); and Philips Research, Hamburg, Germany (T.K.)
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Gassert FT, Urban T, Frank M, Willer K, Noichl W, Buchberger P, Schick R, Koehler T, von Berg J, Fingerle AA, Sauter AP, Makowski MR, Pfeiffer D, Pfeiffer F. X-ray Dark-Field Chest Imaging: Qualitative and Quantitative Results in Healthy Humans. Radiology 2021; 301:389-395. [PMID: 34427464 DOI: 10.1148/radiol.2021210963] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background X-ray dark-field radiography takes advantage of the wave properties of x-rays, with a relatively high signal in the lungs due to the many air-tissue interfaces in the alveoli. Purpose To describe the qualitative and quantitative characteristics of x-ray dark-field images in healthy human subjects. Materials and Methods Between October 2018 and January 2020, patients of legal age who underwent chest CT as part of their diagnostic work-up were screened for study participation. Inclusion criteria were a normal chest CT scan, the ability to consent, and the ability to stand upright without help. Exclusion criteria were pregnancy, serious medical conditions, and changes in the lung tissue, such as those due to cancer, pleural effusion, atelectasis, emphysema, infiltrates, ground-glass opacities, or pneumothorax. Images of study participants were obtained by using a clinical x-ray dark-field prototype, recently constructed and commissioned at the authors' institution, to simultaneously acquire both attenuation-based and dark-field thorax radiographs. Each subject's total dark-field signal was correlated with his or her lung volume, and the dark-field coefficient was correlated with age, sex, weight, and height. Results Overall, 40 subjects were included in this study (average age, 62 years ± 13 [standard deviation]; 26 men, 14 women). Normal human lungs have high signal, while the surrounding osseous structures and soft tissue have very low and no signal, respectively. The average dark-field signal was 2.5 m-1 ± 0.4 of examined lung tissue. There was a correlation between the total dark-field signal and the lung volume (r = 0.61, P < .001). No difference was found between men and women (P = .78). Also, age (r = -0.18, P = .26), weight (r = 0.24, P = .13), and height (r = 0.01, P = .96) did not influence dark-field signal. Conclusion This study introduces qualitative and quantitative values for x-ray dark-field imaging in healthy human subjects. The quantitative x-ray dark-field coefficient is independent from demographic subject parameters, emphasizing its potential in diagnostic assessment of the lung. ©RSNA, 2021 See also the editorial by Hatabu and Madore in this issue.
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Affiliation(s)
- Florian T Gassert
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Theresa Urban
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Manuela Frank
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Konstantin Willer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Wolfgang Noichl
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Philipp Buchberger
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Rafael Schick
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Thomas Koehler
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Jens von Berg
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Alexander A Fingerle
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Andreas P Sauter
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Marcus R Makowski
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Daniela Pfeiffer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Franz Pfeiffer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
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Willer K, Fingerle AA, Noichl W, De Marco F, Frank M, Urban T, Schick R, Gustschin A, Gleich B, Herzen J, Koehler T, Yaroshenko A, Pralow T, Zimmermann GS, Renger B, Sauter AP, Pfeiffer D, Makowski MR, Rummeny EJ, Grenier PA, Pfeiffer F. X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study. LANCET DIGITAL HEALTH 2021; 3:e733-e744. [PMID: 34711378 PMCID: PMC8565798 DOI: 10.1016/s2589-7500(21)00146-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD). METHODS In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)-which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmography) were performed for every patient and for a subgroup of patients the measurement of diffusion capacity was performed. Individual patient datasets were statistically evaluated using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison. FINDINGS Between October, 2018 and December, 2019 we enrolled 77 patients. Compared with CT-based parameters (quantitative emphysema ρ=-0·27, p=0·089 and visual emphysema ρ=-0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with lung diffusion capacity in the evaluated cohort. Emphysema assessment based on dark-field chest x-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance than conventional clinical tests characterising emphysema. Pair-wise comparison of corresponding test parameters between adjacent visual emphysema severity groups (CT-based, reference standard) showed higher effect sizes. The mean effect size over the group comparisons (absent-trace, trace-mild, mild-moderate, and moderate-confluent or advanced destructive visual emphysema grades) for the COPD assessment test score is 0·21, for forced expiratory volume in 1 s (FEV1)/functional vital capacity is 0·25, for FEV1% of predicted is 0·23, for residual volume % of predicted is 0·24, for CT emphysema index is 0·35, for dark-field signal homogeneity within lungs is 0·38, for dark-field signal texture within lungs is 0·38, and for dark-field-based emphysema severity is 0·42. INTERPRETATION X-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema in patients with COPD because this technique provides relevant information representing the structural condition of lung parenchyma. This technique might offer a low radiation dose alternative to CT in COPD and potentially other lung disorders. FUNDING European Research Council, Deutsche Forschungsgemeinschaft, Royal Philips, and Karlsruhe Nano Micro Facility.
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Affiliation(s)
- Konstantin Willer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Noichl
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Theresa Urban
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Rafael Schick
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alex Gustschin
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Thomas Koehler
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Philips Research Hamburg, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC Hamburg, Hamburg, Germany
| | - Gregor S Zimmermann
- Department of Cardiology, Angiology, and Pneumology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, Paris, France
| | - Franz Pfeiffer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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14
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Burkhardt R, Gora T, Fingerle AA, Sauter AP, Meurer F, Gassert FT, Dobiasch S, Schilling D, Feuchtinger A, Walch AK, Multhoff G, Herzen J, Noël PB, Rummeny EJ, Combs SE, Schmid TE, Pfeiffer F, Wilkens JJ. In-vivo X-ray dark-field computed tomography for the detection of radiation-induced lung damage in mice. Phys Imaging Radiat Oncol 2021; 20:11-16. [PMID: 34611553 PMCID: PMC8476771 DOI: 10.1016/j.phro.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Abstract
Radiation-induced lung damage was observed using X-ray dark-field tomography. In this pre-clinical study, mouse lungs were irradiated and subsequently imaged. We report increased sensitivity of X-ray dark-field tomography over absorption-based tomography.
Background and Purpose Radiotherapy of thoracic tumours can lead to side effects in the lung, which may benefit from early diagnosis. We investigated the potential of X-ray dark-field computed tomography by a proof-of-principle murine study in a clinically relevant radiotherapeutic setting aiming at the detection of radiation-induced lung damage. Material and Methods Six mice were irradiated with 20 Gy to the entire right lung. Together with five unirradiated control mice, they were imaged using computed tomography with absorption and dark-field contrast before and 16 weeks post irradiation. Mean pixel values for the right and left lung were calculated for both contrasts, and the right-to-left-ratio R of these means was compared. Radiologists also assessed the tomograms acquired 16 weeks post irradiation. Sensitivity, specificity, inter- and intra-reader accuracy were evaluated. Results In absorption contrast the group-average of R showed no increase in the control group and increased by 7% (p = 0.005) in the irradiated group. In dark-field contrast, it increased by 2% in the control group and by 14% (p = 0.005) in the irradiated group. Specificity was 100% for both contrasts but sensitivity was almost four times higher using dark-field tomography. Two cases were missed by absorption tomography but were detected by dark-field tomography. Conclusions The applicability of X-ray dark-field computed tomography for the detection of radiation-induced lung damage was demonstrated in a pre-clinical mouse model. The presented results illustrate the differences between dark-field and absorption contrast and show that dark-field tomography could be advantageous in future clinical settings.
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Affiliation(s)
- Rico Burkhardt
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Physics Department, Technical University of Munich, Garching, Germany
| | - Thomas Gora
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Feuchtinger
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Axel K Walch
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,TranslaTUM, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Julia Herzen
- Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Physics Department, Technical University of Munich, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
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15
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Scholz J, Roiser N, Braig EM, Petrich C, Birnbacher L, Andrejewski J, Kimm MA, Sauter A, Busse M, Korbel R, Herzen J, Pfeiffer D. X-ray dark-field radiography for in situ gout diagnosis by means of an ex vivo animal study. Sci Rep 2021; 11:19021. [PMID: 34561476 PMCID: PMC8463704 DOI: 10.1038/s41598-021-98151-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/01/2021] [Indexed: 12/27/2022] Open
Abstract
Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate (MSU) crystals in peripheral joints and tissue. Detection of MSU crystals is essential for definitive diagnosis, however the gold standard is an invasive process which is rarely utilized. In fact, most patients are diagnosed or even misdiagnosed based on manifested clinical signs, as indicated by the unchanged premature mortality among gout patients over the past decade, although effective treatment is now available. An alternative, non-invasive approach for the detection of MSU crystals is X-ray dark-field radiography. In our work, we demonstrate that dark-field X-ray radiography can detect naturally developed gout in animals with high diagnostic sensitivity and specificity based on the in situ measurement of MSU crystals. With the results of this study as a potential basis for further research, we believe that X-ray dark-field radiography has the potential to substantially improve gout diagnostics.
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Affiliation(s)
- Josef Scholz
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck Str. 1, 85748, Garching, Germany.
| | - Nathalie Roiser
- Clinic for Birds, Small Mammals, Reptiles and Omamental Fish, Centre for Clinical Veterinary Medicine, LMU Munich, 85764, Oberschleißheim, Germany
| | - Eva-Maria Braig
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck Str. 1, 85748, Garching, Germany
| | - Christian Petrich
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck Str. 1, 85748, Garching, Germany
| | - Lorenz Birnbacher
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck Str. 1, 85748, Garching, Germany
| | - Melanie A Kimm
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Madleen Busse
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck Str. 1, 85748, Garching, Germany
| | - Rüdiger Korbel
- Clinic for Birds, Small Mammals, Reptiles and Omamental Fish, Centre for Clinical Veterinary Medicine, LMU Munich, 85764, Oberschleißheim, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck Str. 1, 85748, Garching, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
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16
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Massimi L, Partridge T, Astolfo A, Endrizzi M, Hagen CK, Munro PRT, Bate D, Olivo A. Optimization of multipoint phase retrieval in edge illumination X-ray imaging: A theoretical and experimental analysis. Med Phys 2021; 48:5884-5896. [PMID: 34387879 DOI: 10.1002/mp.15162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/11/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this work, an analytical model describing the noise in the retrieved three contrast channels, transmission, refraction, and ultra small-angle scattering, obtained with edge illumination X-ray phase-based imaging system is presented and compared to experimental data. METHODS In EI, images acquired at different displacements of the presample mask (i.e., different illumination levels referred to as points on the "illumination curve"), followed by pixel-wise curve fitting, are exploited to quantitatively retrieve the three contrast channels. Therefore, the noise in the final image will depend on the error associated with the fitting process. We use a model based on the derivation of the standard error on fitted parameters, which relies on the calculation of the covariance matrix, to estimate the noise and the cross-channel correlation as a function of the position of the sampling points. In particular, we investigated the most common cases of 3 and 5 sampling points. In addition, simulations have been used to better understand the role of the integration time for each sampling point. Finally, the model is validated by comparison with the experimental data acquired with an edge illumination setup based on a tungsten rotating anode X-ray source and a photon counting detector. RESULTS We found a good match between the predictions of the model and the experimental data. In particular, for the investigated cases, an arrangement of the sampling points leading to minimum noise and cross-channel correlation can be found. Simulations revealed that, given a fixed overall scanning time, its distribution into the smallest possible number of sampling points needed for phase retrieval leads to minimum noise thanks to higher statistics per point. CONCLUSIONS This work presents an analytical model describing the noise in the various contrast channels retrieved in edge illumination as a function of the illumination curve sampling. In particular, an optimal sampling scheme leading to minimum noise has been determined for the case where 3 or 5 sampling points are used, which represent two of the most common acquisition schemes. In addition, the correlation between noise in the different channels and the role of the number of points and exposure time have been also investigated. In general, our results suggest a series of procedures that should be followed in order to optimize the experimental acquisitions.
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Affiliation(s)
- Lorenzo Massimi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tom Partridge
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Alberto Astolfo
- Nikon X-Tek Systems Ltd., Tring Business Centre, Tring, Hertfordshire, UK
| | - Marco Endrizzi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Charlotte K Hagen
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Peter R T Munro
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - David Bate
- Nikon X-Tek Systems Ltd., Tring Business Centre, Tring, Hertfordshire, UK
| | - Alessandro Olivo
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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17
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High-resolution multicontrast tomography with an X-ray microarray anode-structured target source. Proc Natl Acad Sci U S A 2021; 118:2103126118. [PMID: 34140413 PMCID: PMC8237686 DOI: 10.1073/pnas.2103126118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Talbot–Lau interferometry (TLI) holds remarkable potential for multicontrast X-ray imaging but suffers from technical challenges associated with microfabrication and limited efficiency. We tackle the frontier challenges in this field by developing a microarray anode–structured target source with a built-in structured illumination scheme. Our development facilitates high-resolution and high-sensitivity TLI imaging without the absorption source grating. We demonstrate the tri-contrast tomography capability with a Drum fish tooth specimen and separate the biological features with different combinations of physical properties. Our approach not only addresses the long-standing challenges in the field of X-ray TLI phase-contrast imaging but also features a compact setup that can potentially be made broadly available to academia research and industrial applications. Multicontrast X-ray imaging with high resolution and sensitivity using Talbot–Lau interferometry (TLI) offers unique imaging capabilities that are important to a wide range of applications, including the study of morphological features with different physical properties in biological specimens. The conventional X-ray TLI approach relies on an absorption grating to create an array of micrometer-sized X-ray sources, posing numerous limitations, including technical challenges associated with grating fabrication for high-energy operations. We overcome these limitations by developing a TLI system with a microarray anode–structured target (MAAST) source. The MAAST features an array of precisely controlled microstructured metal inserts embedded in a diamond substrate. Using this TLI system, tomography of a Drum fish tooth with high resolution and tri-contrast (absorption, phase, and scattering) reveals useful complementary structural information that is inaccessible otherwise. The results highlight the exceptional capability of high-resolution multicontrast X-ray tomography empowered by the MAAST-based TLI method in biomedical applications.
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18
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X-ray Dark-Field Radiography: Potential for Visualization of Monosodium Urate Deposition. Invest Radiol 2021; 55:494-498. [PMID: 32251019 DOI: 10.1097/rli.0000000000000671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the potential of x-ray dark-field radiography for the noninvasive detection of monosodium urate (MSU) crystals as a novel diagnostic tool for gout. MATERIALS AND METHODS Contrast-to-noise ratios of MSU crystals in conventional radiography and dark-field radiography have been compared in a proof of principle measurement. Monosodium urate crystals have been injected into mouse legs in an ex vivo experimental gout setup. Three radiologists independently evaluated the images for the occurrence of crystal deposits in a blinded study for attenuation images only, dark-field images only, and with both images available for a comprehensive diagnosis. All imaging experiments have been performed at an experimental x-ray dark-field setup with a 3-grating interferometer, a rotating anode tube (50 kVp), and a photon-counting detector (effective pixel size, 166 μm). RESULTS X-ray dark-field radiography provided a strong signal increase for MSU crystals in a physiological buffer solution compared with conventional attenuation radiography with a contrast-to-noise ratio increase from 0.8 to 19.3. Based on conventional attenuation images only, the reader study revealed insufficient diagnostic performance (sensitivity, 11%; specificity, 92%) with poor interrater agreement (Cohen's coefficient κ = 0.031). Based on dark-field images, the sensitivity increased to 100%, specificity remained at 92%, and the interrater agreement increased to κ = 0.904. Combined diagnosis based on both image modalities maximized both sensitivity and specificity to 100% with absolute interrater agreement (κ = 1.000). CONCLUSIONS X-ray dark-field radiography enables the detection of MSU crystals in a mouse-based gout model. The simultaneous avaliability of a conventional attenuation image together with the dark-field image provides excellent detection rates of gout deposits with high specificity.
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19
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Andrejewski J, De Marco F, Willer K, Noichl W, Gustschin A, Koehler T, Meyer P, Kriner F, Fischer F, Braun C, Fingerle AA, Herzen J, Pfeiffer F, Pfeiffer D. Whole-body x-ray dark-field radiography of a human cadaver. Eur Radiol Exp 2021; 5:6. [PMID: 33495889 PMCID: PMC7835263 DOI: 10.1186/s41747-020-00201-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Grating-based x-ray dark-field and phase-contrast imaging allow extracting information about refraction and small-angle scatter, beyond conventional attenuation. A step towards clinical translation has recently been achieved, allowing further investigation on humans. METHODS After the ethics committee approval, we scanned the full body of a human cadaver in anterior-posterior orientation. Six measurements were stitched together to form the whole-body image. All radiographs were taken at a three-grating large-object x-ray dark-field scanner, each lasting about 40 s. Signal intensities of different anatomical regions were assessed. The magnitude of visibility reduction caused by beam hardening instead of small-angle scatter was analysed using different phantom materials. Maximal effective dose was 0.3 mSv for the abdomen. RESULTS Combined attenuation and dark-field radiography are technically possible throughout a whole human body. High signal levels were found in several bony structures, foreign materials, and the lung. Signal levels were 0.25 ± 0.13 (mean ± standard deviation) for the lungs, 0.08 ± 0.06 for the bones, 0.023 ± 0.019 for soft tissue, and 0.30 ± 0.02 for an antibiotic bead chain. We found that phantom materials, which do not produce small-angle scatter, can generate a strong visibility reduction signal. CONCLUSION We acquired a whole-body x-ray dark-field radiograph of a human body in few minutes with an effective dose in a clinical acceptable range. Our findings suggest that the observed visibility reduction in the bone and metal is dominated by beam hardening and that the true dark-field signal in the lung is therefore much higher than that of the bone.
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Affiliation(s)
- Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Alex Gustschin
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | | | - Pascal Meyer
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Fabian Kriner
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Florian Fischer
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Christian Braun
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
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20
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Burkhardt R, Gora T, Fingerle AA, Sauter AP, Meurer F, Umkehrer S, von Teuffenbach M, Kampfer S, Schilling D, Feuchtinger A, Walch AK, Rummeny E, Combs SE, Schmid TE, Pfeiffer F, Wilkens JJ, Herzen J. Early detection of radiation-induced lung damage with X-ray dark-field radiography in mice. Eur Radiol 2020; 31:4175-4183. [PMID: 33211140 PMCID: PMC8128748 DOI: 10.1007/s00330-020-07459-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/12/2020] [Accepted: 11/03/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Assessing the advantage of x-ray dark-field contrast over x-ray transmission contrast in radiography for the detection of developing radiation-induced lung damage in mice. METHODS Two groups of female C57BL/6 mice (irradiated and control) were imaged obtaining both contrasts monthly for 28 weeks post irradiation. Six mice received 20 Gy of irradiation to the entire right lung sparing the left lung. The control group of six mice was not irradiated. A total of 88 radiographs of both contrasts were evaluated for both groups based on average values for two regions of interest, covering (irradiated) right lung and healthy left lung. The ratio of these average values, R, was distinguished between healthy and damaged lungs for both contrasts. The time-point when deviations of R from healthy lung exceeded 3σ was determined and compared among contrasts. The Wilcoxon-Mann-Whitney test was used to test against the null hypothesis that there is no difference between both groups. A selection of 32 radiographs was assessed by radiologists. Sensitivity and specificity were determined in order to compare the diagnostic potential of both contrasts. Inter-reader and intra-reader accuracy were rated with Cohen's kappa. RESULTS Radiation-induced morphological changes of lung tissue caused deviations from the control group that were measured on average 10 weeks earlier with x-ray dark-field contrast than with x-ray transmission contrast. Sensitivity, specificity, and accuracy doubled using dark-field radiography. CONCLUSION X-ray dark-field radiography detects morphological changes of lung tissue associated with radiation-induced damage earlier than transmission radiography in a pre-clinical mouse model. KEY POINTS • Significant deviations from healthy lung due to irradiation were measured after 16 weeks with x-ray dark-field radiography (p = 0.004). • Significant deviations occur on average 10 weeks earlier for x-ray dark-field radiography in comparison to x-ray transmission radiography. • Sensitivity and specificity doubled when using x-ray dark-field radiography instead of x-ray transmission radiography.
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Affiliation(s)
- Rico Burkhardt
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany. .,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany. .,Physics Department, Technical University of Munich, Garching, Germany.
| | - Thomas Gora
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephan Umkehrer
- Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
| | | | - Severin Kampfer
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Feuchtinger
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Axel K Walch
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
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21
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Karaarslan A, Kasim FBH, Karaarslan N, Ates O. A study on legal and medical dimensions of radiation exposure in neurosurgery clinics in Turkish practice. Surg Neurol Int 2020; 11:397. [PMID: 33274112 PMCID: PMC7708964 DOI: 10.25259/sni_703_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background:
In the present study, the first aim was to address the detrimental effects of the fluoroscopy procedure performed by physicians and other health-care professionals in neurosurgery clinics, then to examine precautions that should be taken to avoid harmful effects of radiation and radioactive substances during this process. The second aim was to handle the rights provided for health-care professionals exposed to the radiation in workplaces.
Methods:
A standardized questionnaire was used for a multicenter survey. Volunteer, intellectual, and cooperative participants (n = 41) were randomly chosen. The survey was prepared considering reports drawn up by the International Atomic Energy Agency. The questions concerning safe and effective fluoroscopy procedure were asked to the participants. The answers received were statistically evaluated. The alpha significance value was accepted as 0.05.
Results:
Two neurosurgeons only knew the legal rights that they might possess due to the exposure to the radiation or radioactive substances.
Conclusion:
The survey conducted among the health-care professionals revealed the insufficiency of knowledge about the protection from the radiation exposure or radioactive substances in workplaces. Furthermore, both health-care professionals working in radiology clinics, and those in neurosurgery and other clinics who are likely to be exposed to the radiation or radioactive substances have the rights afforded by the law.
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Affiliation(s)
| | - Fatma Bahar Hacioğlu Kasim
- Department of Radiology, Republic of Turkey, Ministry of Health, State Hospital, Clinics of Radiology, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital and Spine Center, Clinics of Neurosurgery, Istanbul, Turkey
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22
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Kwan AC, Pourmorteza A, Stutman D, Bluemke DA, Lima JAC. Next-Generation Hardware Advances in CT: Cardiac Applications. Radiology 2020; 298:3-17. [PMID: 33201793 DOI: 10.1148/radiol.2020192791] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Impending major hardware advances in cardiac CT include three areas: ultra-high-resolution (UHR) CT, photon-counting CT, and phase-contrast CT. Cardiac CT is a particularly demanding CT application that requires a high degree of temporal resolution, spatial resolution, and soft-tissue contrast in a moving structure. In this review, cardiac CT is used to highlight the strengths of these technical advances. UHR CT improves visualization of calcified and stented vessels but may result in increased noise and radiation exposure. Photon-counting CT uses multiple photon energies to reduce artifacts, improve contrast resolution, and perform material decomposition. Finally, phase-contrast CT uses x-ray refraction properties to improve spatial and soft-tissue contrast. This review describes these hardware advances in CT and their relevance to cardiovascular imaging.
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Affiliation(s)
- Alan C Kwan
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - Amir Pourmorteza
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - Dan Stutman
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - David A Bluemke
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - João A C Lima
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
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23
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Umkehrer S, Morrone C, Dinkel J, Aigner L, Reiser MF, Herzen J, Yildirim AÖ, Pfeiffer F, Hellbach K. A proof-of principal study using phase-contrast imaging for the detection of large airway pathologies after lung transplantation. Sci Rep 2020; 10:18444. [PMID: 33116193 PMCID: PMC7595203 DOI: 10.1038/s41598-020-75185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022] Open
Abstract
In this study we aim to evaluate the assessment of bronchial pathologies in a murine model of lung transplantation with grating-based X-ray interferometry in vivo. Imaging was performed using a dedicated grating-based small-animal X-ray dark-field and phase-contrast scanner. While the contrast modality of the dark-field signal already showed several promising applications for diagnosing various types of pulmonary diseases, the phase-shifting contrast mechanism of the phase contrast has not yet been evaluated in vivo. For this purpose, qualitative analysis of phase-contrast images was performed and revealed pathologies due to previous lung transplantation, such as unilateral bronchial stenosis or bronchial truncation. Dependent lung parenchyma showed a strong loss in dark-field and absorption signal intensity, possibly caused by several post transplantational pathologies such as atelectasis, pleural effusion, or pulmonary infiltrates. With this study, we are able to show that bronchial pathologies can be visualized in vivo using conventional X-ray imaging when phase-contrast information is analysed. Absorption and dark-field images can be used to quantify the severity of lack of ventilation in the affected lung.
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Affiliation(s)
- Stephan Umkehrer
- Chair of Biomedical Physics, Physics Department & Munich School of BioEngineering, Technical University of Munich (TUM), Garching, Germany.
| | - Carmela Morrone
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians University Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, Neuherberg, Germany
| | - Laura Aigner
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Maximilian F Reiser
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, Neuherberg, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Physics Department & Munich School of BioEngineering, Technical University of Munich (TUM), Garching, Germany
| | - Ali Ö Yildirim
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Physics Department & Munich School of BioEngineering, Technical University of Munich (TUM), Garching, Germany.,Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katharina Hellbach
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Ruprecht-Karls-University Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
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24
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Exploring potential of different X-ray imaging methods for early-stage lung cancer detection. RADIATION DETECTION TECHNOLOGY AND METHODS 2020. [DOI: 10.1007/s41605-020-00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Zan G, Vine DJ, Yun W, Lewis SJY, Wang Q, Wang G. Quantitative analysis of a micro array anode structured target for hard x-ray grating interferometry. Phys Med Biol 2020; 65:035008. [PMID: 31874460 PMCID: PMC7067380 DOI: 10.1088/1361-6560/ab6578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Talbot-Lau interferometry (TLI) provides additional contrast modes for x-ray imaging that are complementary to conventional absorption radiography. TLI is particularly interesting because it is one of the few practical methods for realizing phase contrast with x-rays that is compatible with large-spot high power x-ray sources. A novel micro array anode structured target (MAAST) x-ray source offers several advantages for TLI over the conventional combination of an extended x-ray source coupled with an absorption grating including higher flux and larger field of view, and these advantages become more pronounced for x-ray energies in excess of 30 keV. A Monte Carlo simulation was performed to determine the optimal parameters for a MAAST source for use with TLI. It was found that the both spatial distribution of x-ray production and the number of x-ray produced in the MAAST have a strong dependence on the incidence angle of the electron beam.
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Affiliation(s)
- Guibin Zan
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei 230029, People's Republic of China. Sigray, Inc. 5750 Imhoff Drive, Concord, CA 94520, United States of America. Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, United States of America
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26
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Abstract
Since their discovery by Wilhelm Conrad Röntgen in 1895, X-rays have become the most widely available, typically fastest, and usually most cost-effective medical imaging modality today. From the early radiographic approaches using X-ray films as detectors, the portfolio of medical X-ray imaging devices developed into a large range of dedicated instrumentation for various applications. While X-ray imaging has come a long way, there are some physical properties of X-rays, which have not yet been fully exploited, and which may offer quite some room for further enhancements of current X-ray imaging equipment. Firstly, X-ray imaging today is mainly black and white, despite the fact that X-ray generators actually create a full spectrum of X-ray energies, and that the interactions of X-rays that occur within the human body are not the same for all energies and every material. Exploiting these spectral dependencies allows to not only obtain a black and white CT image, but also to obtain more molecularly specific information, which is relevant particularly in oncological precision radiology. The second aspect of X-rays, and so far in radiology mainly neglected and unused, is the physical fact that X-rays can also be interpreted in the wave picture, and not only as presently been done in the particle picture. If interpreted as waves, X-rays-just like visible light-experience a phase shift in matter, and this-if exploited correctly-can produce a new class of X-ray images, which then depict the wave interactions of X-rays with matter, rather than only the attenuating properties, as done until now.
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27
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Gradl R, Dierolf M, Yang L, Hehn L, Günther B, Möller W, Kutschke D, Stoeger T, Gleich B, Achterhold K, Donnelley M, Pfeiffer F, Schmid O, Morgan KS. Visualizing treatment delivery and deposition in mouse lungs using in vivo x-ray imaging. J Control Release 2019; 307:282-291. [DOI: 10.1016/j.jconrel.2019.06.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 01/17/2023]
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28
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Zan G, Vine DJ, Spink RI, Yun W, Wang Q, Wang G. Design optimization of a periodic microstructured array anode for hard x-ray grating interferometry. Phys Med Biol 2019; 64:145011. [PMID: 31163408 DOI: 10.1088/1361-6560/ab26ce] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Talbot-Lau grating interferometer (TLGI) has great advantages in x-ray imaging contrasts, especially for low-Z materials, over conventional absorption contrast. A microstructured array anode target (MAAT) source offers significantly higher imaging throughput than the combination of an extended x-ray source paired with an absorption grating (also known as source grating). The performance of the MAAT source can be optimized with respect to the areal density, dimensions, and choice of material for the microstructured metal inserts (MMI) and the substrate in which they are embedded. In this paper, we analyze the x-ray generation efficiency per incident electron, relative fraction of x-rays generated by MMI and substrate, x-ray spectrum, and angular distribution via Monte Carlo simulation. Based on the simulation results, the optimal parameters are obtained for a MAAT with incident electron energies from 30 keV to 120 keV. The corresponding temperature distribution within the MAAT is also simulated for the optimal set of the parameters via finite element analysis. As demonstrated by the thermal analysis data, the maximum allowable electron-beam power loading was derived that allows a stable operation of the transmission MAAT.
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Affiliation(s)
- Guibin Zan
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei 230029, People's Republic of China. Sigray, Inc. 5750 Imhoff Drive, Concord, CA 94520, United States of America. Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, United States of America
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29
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Imaging features in post-mortem x-ray dark-field chest radiographs and correlation with conventional x-ray and CT. Eur Radiol Exp 2019; 3:25. [PMID: 31292790 PMCID: PMC6620231 DOI: 10.1186/s41747-019-0104-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/29/2019] [Indexed: 02/01/2023] Open
Abstract
Background Although x-ray dark-field imaging has been intensively investigated for lung imaging in different animal models, there is very limited data about imaging features in the human lungs. Therefore, in this work, a reader study on nine post-mortem human chest x-ray dark-field radiographs was performed to evaluate dark-field signal strength in the lungs, intraobserver and interobserver agreement, and image quality and to correlate with findings of conventional x-ray and CT. Methods In this prospective work, chest x-ray dark-field radiography with a tube voltage of 70 kVp was performed post-mortem on nine humans (3 females, 6 males, age range 52–88 years). Visual quantification of dark-field and transmission signals in the lungs was performed by three radiologists. Results were compared to findings on conventional x-rays and 256-slice computed tomography. Image quality was evaluated. For ordinal data, median, range, and dot plots with medians and 95% confidence intervals are presented; intraobserver and interobserver agreement were determined using weighted Cohen κ. Results Dark-field signal grading showed significant differences between upper and middle (p = 0.004–0.016, readers 1–3) as well as upper and lower zones (p = 0.004–0.016, readers 1–2). Median transmission grading was indifferent between all lung regions. Intraobserver and interobserver agreements were substantial to almost perfect for grading of both dark-field (κ = 0.793–0.971 and κ = 0.828–0.893) and transmission images (κ = 0.790–0.918 and κ = 0.700–0.772). Pulmonary infiltrates correlated with areas of reduced dark-field signal. Image quality was rated good for dark-field images. Conclusions Chest x-ray dark-field images provide information of the lungs complementary to conventional x-ray and allow reliable visual quantification of dark-field signal strength. Electronic supplementary material The online version of this article (10.1186/s41747-019-0104-7) contains supplementary material, which is available to authorized users.
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30
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Abstract
The X-ray dark-field signal can be measured with a grating-based Talbot-Lau interferometer. It measures small angle scattering of micrometer-sized oriented structures. Interestingly, the signal is a function not only of the material, but also of the relative orientation of the sample, the X-ray beam direction, and the direction of the interferometer sensitivity. This property is very interesting for potential tomographically reconstructing structures below the imaging resolution. However, tomographic reconstruction itself is a substantial challenge. A key step of the reconstruction algorithm is the inversion of a forward projection model. In this work, we propose a very general 3-D projection model. We derive the projection model under the assumption that the observed scatter distribution has a Gaussian shape. We theoretically show the consistency of our model with existing, more constrained 2-D models. Furthermore, we experimentally show the compatibility of our model with simulations and real dark-field measurements. We believe that this 3-D projection model is an important step towards more flexible trajectories and, by extension, dark-field imaging protocols that are much better applicable in practice.
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31
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Sauter AP, Andrejewski J, De Marco F, Willer K, Gromann LB, Noichl W, Kriner F, Fischer F, Braun C, Koehler T, Meurer F, Fingerle AA, Pfeiffer D, Rummeny E, Herzen J, Pfeiffer F. Optimization of tube voltage in X-ray dark-field chest radiography. Sci Rep 2019; 9:8699. [PMID: 31213645 PMCID: PMC6582156 DOI: 10.1038/s41598-019-45256-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
Grating-based X-ray dark-field imaging is a novel imaging modality which has been refined during the last decade. It exploits the wave-like behaviour of X-radiation and can nowadays be implemented with existing X-ray tubes used in clinical applications. The method is based on the detection of small-angle X-ray scattering, which occurs e.g. at air-tissue-interfaces in the lung or bone-fat interfaces in spongy bone. In contrast to attenuation-based chest X-ray imaging, the optimal tube voltage for dark-field imaging of the thorax has not yet been examined. In this work, dark-field scans with tube voltages ranging from 60 to 120 kVp were performed on a deceased human body. We analyzed the resulting images with respect to subjective and objective image quality, and found that the optimum tube voltage for dark-field thorax imaging at the used setup is at rather low energies of around 60 to 70 kVp. Furthermore, we found that at these tube voltages, the transmission radiographs still exhibit sufficient image quality to correlate dark-field information. Therefore, this study may serve as an important guideline for the development of clinical dark-field chest X-ray imaging devices for future routine use.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany.
| | - Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Lukas B Gromann
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Fabian Kriner
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Florian Fischer
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Christian Braun
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
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32
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De Marco F, Willer K, Gromann LB, Andrejewski J, Hellbach K, Bähr A, Dmochewitz M, Koehler T, Maack HI, Pfeiffer F, Herzen J. Contrast-to-noise ratios and thickness-normalized, ventilation-dependent signal levels in dark-field and conventional in vivo thorax radiographs of two pigs. PLoS One 2019; 14:e0217858. [PMID: 31158251 PMCID: PMC6546243 DOI: 10.1371/journal.pone.0217858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 12/20/2022] Open
Abstract
Lung tissue causes significant small-angle X-ray scattering, which can be visualized with grating-based X-ray dark-field imaging. Structural lung diseases alter alveolar microstructure, which often causes a dark-field signal decrease. The imaging method provides benefits for diagnosis of such diseases in small-animal models, and was successfully used on porcine and human lungs in a fringe-scanning setup. Micro- and macroscopic changes occur in the lung during breathing, but their individual effects on the dark-field signal are unknown. However, this information is important for quantitative medical evaluation of dark-field thorax radiographs. To estimate the effect of these changes on the dark-field signal during a clinical examination, we acquired in vivo dark-field chest radiographs of two pigs at three ventilation pressures. Pigs were used due to the high degree of similarity between porcine and human lungs. To analyze lung expansion separately, we acquired CT scans of both pigs at comparable posture and ventilation pressures. Segmentation, masking, and forward-projection of the CT datasets yielded maps of lung thickness and logarithmic lung attenuation signal in registration with the dark-field radiographs. Upon correlating this data, we discovered approximately linear relationships between the logarithmic dark-field signal and both projected quantities for all scans. Increasing ventilation pressure strongly decreased dark-field extinction coefficients, whereas the ratio of lung dark-field and attenuation signal changed only slightly. Furthermore, we investigated ratios of dark-field and attenuation noise levels at realistic signal levels via calculations and phantom measurements. Dark-field contrast-to-noise ratio (CNR) per lung height was 5 to 10% of the same quantity in attenuation. We conclude that better CNR performance in the dark-field modality is typically due to greater anatomical noise in the conventional radiograph. Given the high physiological similarity of human and porcine lungs, the presented thickness-normalized, ventilation-dependent values allow estimation of dark-field activity of human lungs of variable size and inspiration, which facilitates the design of suitable clinical imaging setups.
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Affiliation(s)
- Fabio De Marco
- Chair of Biomedical Physics & School of BioMedical Engineering, Technical University of Munich, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics & School of BioMedical Engineering, Technical University of Munich, Garching, Germany
| | - Lukas B Gromann
- Chair of Biomedical Physics & School of BioMedical Engineering, Technical University of Munich, Garching, Germany
| | - Jana Andrejewski
- Chair of Biomedical Physics & School of BioMedical Engineering, Technical University of Munich, Garching, Germany
| | - Katharina Hellbach
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andrea Bähr
- Institute of Molecular Animal Breeding and Biotechnology, LMU Munich, Oberschleissheim, Germany
| | - Michaela Dmochewitz
- Institute of Molecular Animal Breeding and Biotechnology, LMU Munich, Oberschleissheim, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | | | - Franz Pfeiffer
- Chair of Biomedical Physics & School of BioMedical Engineering, Technical University of Munich, Garching, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics & School of BioMedical Engineering, Technical University of Munich, Garching, Germany
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33
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Ludwig V, Seifert M, Hauke C, Hellbach K, Horn F, Pelzer G, Radicke M, Rieger J, Sutter SM, Michel T, Anton G. Exploration of different x-ray Talbot-Lau setups for dark-field lung imaging examined in a porcine lung. Phys Med Biol 2019; 64:065013. [PMID: 30731447 DOI: 10.1088/1361-6560/ab051c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
X-ray dark-field imaging is a promising technique for lung diagnosis. Due to the alveolar structure of lung tissue, a higher contrast is obtained by the dark-field image compared to the attenuation image. Animal studies indicate an enhancement regarding the detection of lung diseases in early stages. In this publication, we focus on the influence of different Talbot-Lau interferometer specifications while maintaining the x-ray source, sample magnification and detector system. By imaging the same porcine lung with three different grating sets, we analyze the contrast-to-noise ratio of the obtained dark-field images with respect to visibility and correlation length. We demonstrate that relatively large grating periods of the phase and of the analyzer grating are sufficient for high quality lung imaging at reasonable dose levels.
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Affiliation(s)
- Veronika Ludwig
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nuremberg, 91058 Erlangen, Germany
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Li X, Chen Z, Zhang L, Zhu X, Wang S, Peng W. Quantitative characterization of ex vivo breast tissue via x-ray phase-contrast tomography. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:503-516. [PMID: 30958320 DOI: 10.3233/xst-180453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Grating-based X-ray phase-contrast imaging (GPCI) has received growing interests in recent years due to its high capability of visualizing soft tissue. Breast imaging is one of the most promising candidates for the first clinical application of this imaging modality. OBJECTIVE In this work, quantitative breast tissue characterization based on GPCI computed tomography (CT) is investigated with a laboratory X-ray tube through a comparison between attenuation-based CT images and phase-contrast CT images. METHODS The Hounsfield units (HU) scale was introduced to phase-contrast images due to its wide application in clinical medicine. In this work, instead of water, plastic cylinders composed of polyethylene terephthalate (PET) was treated as the calibration material. An alternative test-retest reliability (TRR) was presented to evaluate the repeatability of GPCI. Comparison between attenuation-based CT imaging and GPCI CT imaging was operated with the use of statistical analysis methods like histograms and receiver operating characteristic (ROC) curves. RESULTS The determined mean TRR related to cylinders is slightly larger in phase-contrast imaging (0.93) than that in attenuation-based imaging (0.89). With respect to distinguishing breast tissues, the AUC (area under curve) values of ROC curves of phase-contrast images are higher than that of attenuation-based images. CONCLUSIONS An ex vivo study of GPCI shows that it is a stable imaging modality for visualizing the breast tissue with good repeatability, and that it could be of potential for the diagnosis of breast cancer as well.
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Affiliation(s)
- Xinbin Li
- Department of Engineering Physics, Tsinghua University, Haidian District, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Haidian District, Beijing, China
| | - Zhiqiang Chen
- Department of Engineering Physics, Tsinghua University, Haidian District, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Haidian District, Beijing, China
| | - Li Zhang
- Department of Engineering Physics, Tsinghua University, Haidian District, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Haidian District, Beijing, China
| | - Xiaohua Zhu
- Department of Engineering Physics, Tsinghua University, Haidian District, Beijing, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University) of Ministry of Education, Haidian District, Beijing, China
| | - Shengping Wang
- Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, China
| | - Weijun Peng
- Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, China
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Wagner WL, Wuennemann F, Pacilé S, Albers J, Arfelli F, Dreossi D, Biederer J, Konietzke P, Stiller W, Wielpütz MO, Accardo A, Confalonieri M, Cova M, Lotz J, Alves F, Kauczor HU, Tromba G, Dullin C. Towards synchrotron phase-contrast lung imaging in patients - a proof-of-concept study on porcine lungs in a human-scale chest phantom. JOURNAL OF SYNCHROTRON RADIATION 2018; 25:1827-1832. [PMID: 30407195 DOI: 10.1107/s1600577518013401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/20/2018] [Indexed: 05/23/2023]
Abstract
In-line free propagation phase-contrast synchrotron tomography of the lungs has been shown to provide superior image quality compared with attenuation-based computed tomography (CT) in small-animal studies. The present study was performed to prove the applicability on a human-patient scale using a chest phantom with ventilated fresh porcine lungs. Local areas of interest were imaged with a pixel size of 100 µm, yielding a high-resolution depiction of anatomical hallmarks of healthy lungs and artificial lung nodules. Details like fine spiculations into surrounding alveolar spaces were shown on a micrometre scale. Minor differences in artificial lung nodule density were detected by phase retrieval. Since we only applied a fraction of the X-ray dose used for clinical high-resolution CT scans, it is believed that this approach may become applicable to the detailed assessment of focal lung lesions in patients in the future.
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Affiliation(s)
- Willi L Wagner
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Wuennemann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jonas Albers
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Fulvia Arfelli
- Department of Physics, University of Trieste and INFN, Trieste, Italy
| | | | - Jürgen Biederer
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philip Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | | | - Maria Cova
- Department of Radiology, University of Trieste, ASUITS, Trieste, Italy
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Frauke Alves
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Hans Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Vignero J, Marshall NW, Vande Velde G, Bliznakova K, Bosmans H. Translation from murine to human lung imaging using x-ray dark field radiography: A simulation study. PLoS One 2018; 13:e0206302. [PMID: 30372458 PMCID: PMC6205805 DOI: 10.1371/journal.pone.0206302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 02/01/2023] Open
Abstract
Recent studies on murine models have demonstrated the potential of dark field (DF) x-ray imaging for lung diseases. The alveolar microstructure causes small angle scattering, which is visualised in DF images. Whether DF imaging works for human lungs is not a priori guaranteed as human alveoli are larger and system settings for murine imaging will probably have to be adapted. This work examines the potential of translating DF imaging to human lungs. The DF contrast due to murine and human lung models was studied using numerical wave propagation simulations, where the lungs were modelled as a volume filled with spheres. Three sphere diameters were used: 39, 60 and 80 μm for the murine model and 200, 300 and 400 μm spheres for the human model. System settings applied for murine lung response modelling were taken from a prototype grating interferometry scanner used in murine lung experiments. The settings simulated for human lung imaging simulations combine the requirements for grating interferometry and conventional chest RX in terms of x-ray energy and pixel size. The DF signal in the simulated murine model was consistent with results from experimental DF data. The simulated linear diffusion coefficient for medium alveoli diameters was found to be (1.31±0.01)⋅10-11 mm-1, 120 times larger than those of human lung tissue ((1.09±0.01)⋅10-13 mm-1). However, as the human thorax is typically a factor 15 times larger than that of murine animals, the overall DF effect in human lungs remains substantial. At the largest lung thickness and for the DF setup simulated, human lungs have an estimated DF response of around 0.31 and murine lungs of 0.23. Dark field imaging can therefore be considered a promising modality for use in human lung imaging.
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Affiliation(s)
- Janne Vignero
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Nicholas W. Marshall
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | | | - Kristina Bliznakova
- Laboratory of Computer Simulations in Medicine, Technical University of Varna, Varna, Bulgaria
| | - Hilde Bosmans
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, UZ Leuven, Leuven, Belgium
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Bopp J, Ludwig V, Seifert M, Pelzer G, Maier A, Anton G, Riess C. Simulation study on X-ray phase contrast imaging with dual-phase gratings. Int J Comput Assist Radiol Surg 2018; 14:3-10. [PMID: 30349975 DOI: 10.1007/s11548-018-1872-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/10/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Two phase gratings in an X-ray grating interferometers can solve several technical challenges for clinical use of X-ray phase contrast. In this work, we adapt and evaluate this setup design to clinical X-ray sources and detectors in a simulation study. METHODS For a given set of gratings, we optimize the remaining parameter space of a dual-phase grating setup using a numerical wave front simulation. The simulation results are validated with experimentally obtained visibility measurements on a setup with a microfocus tube and a clinical X-ray detector. We then confirm by simulation that the Lau condition for the [Formula: see text] grating also holds for two phase gratings. Furthermore, we use a [Formula: see text] grating with a fixed period to search for periods of matching phase grating configurations. RESULTS Simulated and experimental visibilities agree very well. We show that the Lau condition for a dual-phase grating setup requires the interference patterns of the first phase grating to constructively overlay at the second phase grating. Furthermore, a total of three setup variants for given [Formula: see text] periods were designed with the simulation, resulting in visibilities between 4.5 and 9.1%. CONCLUSION Dual-phase gratings can be used and optimized for a medical X-ray source and detector. The obtained visibilities are somewhat lower than for other Talbot-Lau interferometers and are a tradeoff between setup length and spatial resolution (or additional phase stepping, respectively). However, these disadvantage appears minor compared to the overall better photon statistics, and the fact that dual-phase grating setups can be expected to scale to higher X-ray energies.
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Affiliation(s)
- Johannes Bopp
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-University Erlangen-Nuremberg, Martensstr. 3, 91058, Erlangen, Germany.
| | - Veronika Ludwig
- Erlangen Centre for Astroparticle Physics, Department of Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Erwin-Rommel-Str. 1, 91058, Erlangen, Germany
| | - Maria Seifert
- Erlangen Centre for Astroparticle Physics, Department of Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Erwin-Rommel-Str. 1, 91058, Erlangen, Germany
| | - Georg Pelzer
- Erlangen Centre for Astroparticle Physics, Department of Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Erwin-Rommel-Str. 1, 91058, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-University Erlangen-Nuremberg, Martensstr. 3, 91058, Erlangen, Germany
| | - Gisela Anton
- Erlangen Centre for Astroparticle Physics, Department of Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Erwin-Rommel-Str. 1, 91058, Erlangen, Germany
| | - Christian Riess
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-University Erlangen-Nuremberg, Martensstr. 3, 91058, Erlangen, Germany
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Willer K, Fingerle AA, Gromann LB, De Marco F, Herzen J, Achterhold K, Gleich B, Muenzel D, Scherer K, Renz M, Renger B, Kopp F, Kriner F, Fischer F, Braun C, Auweter S, Hellbach K, Reiser MF, Schroeter T, Mohr J, Yaroshenko A, Maack HI, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny EJ, Pfeiffer F, Noël PB. X-ray dark-field imaging of the human lung-A feasibility study on a deceased body. PLoS One 2018; 13:e0204565. [PMID: 30261038 PMCID: PMC6160109 DOI: 10.1371/journal.pone.0204565] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 09/11/2018] [Indexed: 12/24/2022] Open
Abstract
Disorders of the lungs such as chronic obstructive pulmonary disease (COPD) are a major cause of chronic morbidity and mortality and the third leading cause of death in the world. The absence of sensitive diagnostic tests for early disease stages of COPD results in under-diagnosis of this treatable disease in an estimated 60–85% of the patients. In recent years a grating-based approach to X-ray dark-field contrast imaging has shown to be very sensitive for the detection and quantification of pulmonary emphysema in small animal models. However, translation of this technique to imaging systems suitable for humans remains challenging and has not yet been reported. In this manuscript, we present the first X-ray dark-field images of in-situ human lungs in a deceased body, demonstrating the feasibility of X-ray dark-field chest radiography on a human scale. Results were correlated with findings of computed tomography imaging and autopsy. The performance of the experimental radiography setup allows acquisition of multi-contrast chest X-ray images within clinical boundary conditions, including radiation dose. Upcoming clinical studies will have to demonstrate that this technology has the potential to improve early diagnosis of COPD and pulmonary diseases in general.
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Affiliation(s)
- Konstantin Willer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alexander A. Fingerle
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas B. Gromann
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Klaus Achterhold
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniela Muenzel
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kai Scherer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Martin Renz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fabian Kriner
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Fischer
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Braun
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katharina Hellbach
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Schroeter
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | | | | | | | | | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | | | | | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Peter B. Noël
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Depiction of pneumothoraces in a large animal model using x-ray dark-field radiography. Sci Rep 2018; 8:2602. [PMID: 29422512 PMCID: PMC5805747 DOI: 10.1038/s41598-018-20985-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/29/2018] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to assess the diagnostic value of x-ray dark-field radiography to detect pneumothoraces in a pig model. Eight pigs were imaged with an experimental grating-based large-animal dark-field scanner before and after induction of a unilateral pneumothorax. Image contrast-to-noise ratios between lung tissue and the air-filled pleural cavity were quantified for transmission and dark-field radiograms. The projected area in the object plane of the inflated lung was measured in dark-field images to quantify the collapse of lung parenchyma due to a pneumothorax. Means and standard deviations for lung sizes and signal intensities from dark-field and transmission images were tested for statistical significance using Student's two-tailed t-test for paired samples. The contrast-to-noise ratio between the air-filled pleural space of lateral pneumothoraces and lung tissue was significantly higher in the dark-field (3.65 ± 0.9) than in the transmission images (1.13 ± 1.1; p = 0.002). In case of dorsally located pneumothoraces, a significant decrease (-20.5%; p > 0.0001) in the projected area of inflated lung parenchyma was found after a pneumothorax was induced. Therefore, the detection of pneumothoraces in x-ray dark-field radiography was facilitated compared to transmission imaging in a large animal model.
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Implementation of a Talbot-Lau interferometer in a clinical-like c-arm setup: A feasibility study. Sci Rep 2018; 8:2325. [PMID: 29396417 PMCID: PMC5797080 DOI: 10.1038/s41598-018-19482-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/02/2018] [Indexed: 02/07/2023] Open
Abstract
X-ray grating-based phase-contrast imaging has raised interest regarding a variety of potential clinical applications, whereas the method is feasible using a medical x-ray tube. Yet, the transition towards a clinical setup remains challenging due to the requirement of mechanical robustness of the interferometer and high demands applying to medical equipment in clinical use. We demonstrate the successful implementation of a Talbot-Lau interferometer in an interventional c-arm setup. The consequence of vibrations induced by the rotating anode of the tube is discussed and the prototype is shown to provide a visibility of 21.4% at a tube voltage of 60 kV despite the vibrations. Regarding clinical application, the prototype is mainly set back due to the limited size of the field of view covering an area of 17 mm × 46 mm. A c-arm offers the possibility to change the optical axis according to the requirements of the medical examination. We provide a method to correct for artifacts that result from the angulation of the c-arm. Finally, the images of a series of measurements with the c-arm in different angulated positions are shown. Thereby, it is sufficient to perform a single reference measurement in parking position that is valid for the complete series despite angulation.
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Pfeiffer F, Reiser M, Rummeny E. [X‑ray Phase Contrast : Principles, potential and advances in clinical translation]. Radiologe 2018; 58:218-225. [PMID: 29374312 DOI: 10.1007/s00117-018-0357-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
More than 100 years ago Max von Laue in Munich discovered that X‑rays can be interpreted not only as X‑ray quanta in a particle picture, but also show a wave character. This property has been used for a long time in basic research (e.g. in crystallography for determining the structure of proteins), but so far has had no application in medical imaging. In the last 10 years, however, very impressive technological progress could be made in preclinical research, which also makes the utilization of the wave character of X‑ray light possible for medical imaging. These novel radiography procedures, so-called phase-contrast and dark-field imaging, have a great potential for a pronounced improvement in X‑ray imaging and therefore, also the diagnosis of important diseases. This article describes the basic principles of these novel procedures, summarizes the preclinical research results already achieved exemplified by various organs and shows the potential for future clinical utilization in radiography and computed tomography.
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Affiliation(s)
- F Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Department Physik & Munich School of BioEngineering, Technische Universität München, München, Deutschland. .,Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - M Reiser
- Klinik und Poliklinik für Radiologie, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Deutschland
| | - E Rummeny
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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