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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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Gassert FT, Frank M, De Marco F, Willer K, Urban T, Herzen J, Fingerle AA, Sauter AP, Makowski MR, Kriner F, Fischer F, Braun C, Pfeiffer F, Pfeiffer D. Assessment of Inflation in a Human Cadaveric Lung with Dark-Field Chest Radiography. Radiol Cardiothorac Imaging 2022; 4:e220093. [PMID: 36601456 PMCID: PMC9806722 DOI: 10.1148/ryct.220093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 12/16/2022]
Abstract
Dark-field chest radiography signal intensity appeared to correlate with inflation status in a cadaveric lung.
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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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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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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 Digit 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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [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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6
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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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7
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Abstract
Over the last 10 years, new techniques to administer surfactant have been promoted, based on their presumed lesser invasiveness and they have been generally called LISA (less invasive surfactant administration). We believe that the clinical potential of LISA techniques is currently overestimated. LISA lacks biological and pathophysiological background justifying its potential benefits. Moreover, LISA has been investigated in clinical trials without previous translational data and these trials are affected by significant flaws. The available data from these trials only allow to conclude that LISA is better than prolonged, unrestricted invasive ventilation with loosely described parameters, a mode of respiratory support that should be anyway avoided in preterm infants. We urge the conduction of high-quality studies to understand how to choose and titrate analgesia/sedation and optimize surfactant administration in preterm neonates. We offer a comprehensive, evidence-based review of the clinical data on LISA, their biases and the lack of physiopathology background.
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8
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Sanchez-Cano C, Alvarez-Puebla RA, Abendroth JM, Beck T, Blick R, Cao Y, Caruso F, Chakraborty I, Chapman HN, Chen C, Cohen BE, Conceição ALC, Cormode DP, Cui D, Dawson KA, Falkenberg G, Fan C, Feliu N, Gao M, Gargioni E, Glüer CC, Grüner F, Hassan M, Hu Y, Huang Y, Huber S, Huse N, Kang Y, Khademhosseini A, Keller TF, Körnig C, Kotov NA, Koziej D, Liang XJ, Liu B, Liu S, Liu Y, Liu Z, Liz-Marzán LM, Ma X, Machicote A, Maison W, Mancuso AP, Megahed S, Nickel B, Otto F, Palencia C, Pascarelli S, Pearson A, Peñate-Medina O, Qi B, Rädler J, Richardson JJ, Rosenhahn A, Rothkamm K, Rübhausen M, Sanyal MK, Schaak RE, Schlemmer HP, Schmidt M, Schmutzler O, Schotten T, Schulz F, Sood AK, Spiers KM, Staufer T, Stemer DM, Stierle A, Sun X, Tsakanova G, Weiss PS, Weller H, Westermeier F, Xu M, Yan H, Zeng Y, Zhao Y, Zhao Y, Zhu D, Zhu Y, Parak WJ. X-ray-Based Techniques to Study the Nano-Bio Interface. ACS NANO 2021; 15:3754-3807. [PMID: 33650433 PMCID: PMC7992135 DOI: 10.1021/acsnano.0c09563] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 05/03/2023]
Abstract
X-ray-based analytics are routinely applied in many fields, including physics, chemistry, materials science, and engineering. The full potential of such techniques in the life sciences and medicine, however, has not yet been fully exploited. We highlight current and upcoming advances in this direction. We describe different X-ray-based methodologies (including those performed at synchrotron light sources and X-ray free-electron lasers) and their potentials for application to investigate the nano-bio interface. The discussion is predominantly guided by asking how such methods could better help to understand and to improve nanoparticle-based drug delivery, though the concepts also apply to nano-bio interactions in general. We discuss current limitations and how they might be overcome, particularly for future use in vivo.
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Affiliation(s)
- Carlos Sanchez-Cano
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramon 182, 20014 Donostia San Sebastián, Spain
| | - Ramon A. Alvarez-Puebla
- Universitat
Rovira i Virgili, 43007 Tarragona, Spain
- ICREA, Passeig Lluís
Companys 23, 08010 Barcelona, Spain
| | - John M. Abendroth
- Department
of Materials Science and Engineering, Stanford
University, Stanford, California 94305, United States
| | - Tobias Beck
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Robert Blick
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Yuan Cao
- Department
of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
- Biointerfaces
Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Frank Caruso
- ARC
Centre of Excellence in Convergent Bio-Nano Science and Technology
and the Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Indranath Chakraborty
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Henry N. Chapman
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Centre
for Ultrafast Imaging, Universität
Hamburg, 22761 Hamburg, Germany
- Deutsches
Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Chunying Chen
- National
Center for Nanoscience and Technology (NCNST), 100190 Beijing China
| | - Bruce E. Cohen
- The
Molecular Foundry and Division of Molecular Biophysics and Integrated
Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | | | - David P. Cormode
- Radiology
Department, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Daxiang Cui
- School
of Chemistry and Chemical Engineering, Frontiers Science Center for
Transformative Molecules and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | | | - Gerald Falkenberg
- Deutsches
Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Chunhai Fan
- School
of Chemistry and Chemical Engineering, Frontiers Science Center for
Transformative Molecules and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Neus Feliu
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- CAN, Fraunhofer Institut, 20146 Hamburg, Germany
| | - Mingyuan Gao
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Elisabetta Gargioni
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Claus-C. Glüer
- Section
Biomedical Imaging, Department of Radiology and Neuroradiology, University Medical Clinic Schleswig-Holstein and Christian-Albrechts-University
Kiel, 24105 Kiel, Germany
| | - Florian Grüner
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Universität
Hamburg and Center for Free-Electron Laser Science, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - Moustapha Hassan
- Karolinska University Hospital, Huddinge, and Karolinska
Institutet, 17177 Stockholm, Sweden
| | - Yong Hu
- College of Engineering and Applied Sciences, Nanjing University, Nanjing 210093, China
| | - Yalan Huang
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Samuel Huber
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nils Huse
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Yanan Kang
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90049, United States
| | - Thomas F. Keller
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Deutsches
Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Christian Körnig
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Universität
Hamburg and Center for Free-Electron Laser Science, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - Nicholas A. Kotov
- Department
of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
- Biointerfaces
Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
- Michigan
Institute for Translational Nanotechnology (MITRAN), Ypsilanti, Michigan 48198, United States
| | - Dorota Koziej
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Xing-Jie Liang
- National
Center for Nanoscience and Technology (NCNST), 100190 Beijing China
| | - Beibei Liu
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology,
Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085 China
| | - Yang Liu
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Ziyao Liu
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Luis M. Liz-Marzán
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramon 182, 20014 Donostia San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, 48013 Bilbao, Spain
- Centro de Investigación Biomédica
en Red de Bioingeniería,
Biomateriales y Nanomedicina (CIBER-BBN), Paseo de Miramon 182, 20014 Donostia-San Sebastián, Spain
| | - Xiaowei Ma
- National
Center for Nanoscience and Technology (NCNST), 100190 Beijing China
| | - Andres Machicote
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Wolfgang Maison
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Adrian P. Mancuso
- European XFEL, 22869 Schenefeld, Germany
- Department of Chemistry and Physics, La
Trobe Institute for Molecular
Science, La Trobe University, Melbourne 3086, Victoria, Australia
| | - Saad Megahed
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Bert Nickel
- Sektion Physik, Ludwig Maximilians Universität
München, 80539 München, Germany
| | - Ferdinand Otto
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Cristina Palencia
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | | | - Arwen Pearson
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Oula Peñate-Medina
- Section
Biomedical Imaging, Department of Radiology and Neuroradiology, University Medical Clinic Schleswig-Holstein and Christian-Albrechts-University
Kiel, 24105 Kiel, Germany
| | - Bing Qi
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Joachim Rädler
- Sektion Physik, Ludwig Maximilians Universität
München, 80539 München, Germany
| | - Joseph J. Richardson
- ARC
Centre of Excellence in Convergent Bio-Nano Science and Technology
and the Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Axel Rosenhahn
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Kai Rothkamm
- Department
of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Michael Rübhausen
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | | | - Raymond E. Schaak
- Department of Chemistry, Department of Chemical Engineering,
and
Materials Research Institute, The Pennsylvania
State University, University Park, Pensylvania 16802, United States
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer
Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Marius Schmidt
- Department of Physics, University
of Wisconsin-Milwaukee, 3135 N. Maryland Avenue, Milwaukee, Wisconsin 53211, United States
| | - Oliver Schmutzler
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Universität
Hamburg and Center for Free-Electron Laser Science, Luruper Chaussee 149, 22761 Hamburg, Germany
| | | | - Florian Schulz
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - A. K. Sood
- Department of Physics, Indian Institute
of Science, Bangalore 560012, India
| | - Kathryn M. Spiers
- Deutsches
Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Theresa Staufer
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Universität
Hamburg and Center for Free-Electron Laser Science, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - Dominik M. Stemer
- California NanoSystems Institute, University
of California, Los Angeles, Los Angeles, California 90095, United States
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Andreas Stierle
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Deutsches
Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Xing Sun
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- Molecular Science and Biomedicine Laboratory (MBL) State
Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry
and Chemical Engineering, Hunan University, Changsha 410082, P.R. China
| | - Gohar Tsakanova
- Institute of Molecular Biology of National
Academy of Sciences of
Republic of Armenia, 7 Hasratyan str., 0014 Yerevan, Armenia
- CANDLE Synchrotron Research Institute, 31 Acharyan str., 0040 Yerevan, Armenia
| | - Paul S. Weiss
- California NanoSystems Institute, University
of California, Los Angeles, Los Angeles, California 90095, United States
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department
of Chemistry and Biochemistry, University
of California, Los Angeles, Los Angeles, California 90095, United States
- Department of Bioengineering, University
of California, Los Angeles, Los Angeles, California 90095, United States
| | - Horst Weller
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- CAN, Fraunhofer Institut, 20146 Hamburg, Germany
| | - Fabian Westermeier
- Deutsches
Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Ming Xu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology,
Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085 China
| | - Huijie Yan
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Yuan Zeng
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Ying Zhao
- Karolinska University Hospital, Huddinge, and Karolinska
Institutet, 17177 Stockholm, Sweden
| | - Yuliang Zhao
- National
Center for Nanoscience and Technology (NCNST), 100190 Beijing China
| | - Dingcheng Zhu
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
| | - Ying Zhu
- Bioimaging Center, Shanghai Synchrotron Radiation Facility,
Zhangjiang Laboratory, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China
- Division of Physical Biology, CAS Key Laboratory
of Interfacial
Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China
| | - Wolfgang J. Parak
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramon 182, 20014 Donostia San Sebastián, Spain
- Mathematics,
Informatics, and Natural Sciences (MIN) Faculty, University of Hamburg, 20354 Hamburg, Germany
- School
of Chemistry and Chemical Engineering, Frontiers Science Center for
Transformative Molecules and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
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9
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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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10
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Kitchen MJ, Buckley GA, Kerr LT, Lee KL, Uesugi K, Yagi N, Hooper SB. Emphysema quantified: mapping regional airway dimensions using 2D phase contrast X-ray imaging. BIOMEDICAL OPTICS EXPRESS 2020; 11:4176-4190. [PMID: 32923035 PMCID: PMC7449757 DOI: 10.1364/boe.390587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
We have developed an analyser-based phase contrast X-ray imaging technique to measure the mean length scale of pores or particles that cannot be resolved directly by the system. By combining attenuation, phase and ultra-small angle X-ray scattering information, the technique was capable of measuring differences in airway dimension between lungs of healthy mice and those with mild and severe emphysema. Our measurements of airway dimensions from 2D images showed a 1:1 relationship to the actual airway dimensions measured using micro-CT. Using 80 images, the sensitivity and specificity were measured to be 0.80 and 0.89, respectively, with the area under the ROC curve close to ideal at 0.96. Reducing the number of images to 11 slightly decreased the sensitivity to 0.75 and the ROC curve area to 0.90, whilst the specificity remained high at 0.89.
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Affiliation(s)
- Marcus J. Kitchen
- School of Physics and Astronomy, Monash
University, Clayton, Victoria, 3800, Australia
| | - Genevieve A. Buckley
- School of Physics and Astronomy, Monash
University, Clayton, Victoria, 3800, Australia
| | | | - Katie L. Lee
- School of Physics and Astronomy, Monash
University, Clayton, Victoria, 3800, Australia
| | - Kentaro Uesugi
- The Ritchie Centre, MIMR-PHI Institute of
Medical Research and the Department of Obstetrics and Gynaecology,
Monash University, Clayton, Victoria, 3168, Australia
| | - Naoto Yagi
- The Ritchie Centre, MIMR-PHI Institute of
Medical Research and the Department of Obstetrics and Gynaecology,
Monash University, Clayton, Victoria, 3168, Australia
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11
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Gie AG, Salaets T, Vignero J, Regin Y, Vanoirbeek J, Deprest J, Toelen J. Intermittent CPAP limits hyperoxia-induced lung damage in a rabbit model of bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2020; 318:L976-L987. [PMID: 32186390 DOI: 10.1152/ajplung.00465.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A significant proportion of preterm infants develop bronchopulmonary dysplasia (BPD) leading to poor lifelong respiratory health. Limited treatment options exist with continuous positive airway pressure (CPAP) ventilation being one of the few associated with diminished BPD. However, little is known about the effect of the distending pressure of CPAP on the developing lung exposed to hyperoxia. We aimed to identify the functional and structural effects of CPAP in a preterm hyperoxia rabbit model of BPD. Premature rabbit pups were randomized to normoxia, hyperoxia (≥95% O2), or hyperoxia plus 4 h daily CPAP [fraction of inspired oxygen (FiO2) 0.95, 5 cmH2O]. On day 7 postdelivery we performed invasive pressure-volume- and forced oscillation-based pulmonary function tests, before lung harvest for histological evaluation. Alveolar and vascular morphology, airway smooth muscle content, respiratory epithelium height, extracellular matrix components, and inflammatory cytokine expression were quantified. Hyperoxia-reared pups had restrictive lungs: alveolar walls were thickened, with the lung parenchymal tissue, collagen content, and airway smooth muscle content increased. In addition, peripheral pulmonary artery wall thickness was increased. CPAP increased alveolar recruitment and limited the structural effect of hyperoxia on the respiratory epithelium and pulmonary arteries. Additionally, CPAP improved lung function, mitigating hyperoxia-associated changes to respiratory system resistance, tissue damping, and tissue elastance. Hyperoxia disrupted functional and structural lung development. Daily intermittent CPAP limited hyperoxia-associated decreased lung function and attenuated structural changes to pulmonary arteries and respiratory epithelium while having no structural alveolar consequences. The mechanism by which CPAP has these beneficial effects needs further investigation.
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Affiliation(s)
- Andre George Gie
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Thomas Salaets
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Janne Vignero
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Yannick Regin
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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12
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Katz I, Milet A, Chalopin M, Farjot G. Numerical analysis of mechanical ventilation using high concentration medical gas mixtures in newborns. Med Gas Res 2019; 9:213-220. [PMID: 31898606 PMCID: PMC7802424 DOI: 10.4103/2045-9912.273959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/02/2019] [Accepted: 07/23/2019] [Indexed: 11/05/2022] Open
Abstract
When administered in relatively high concentrations the mechanical properties of inhaled gas can become significantly different from air. This fact has implications in mechanical ventilation where adequate respiration and injury to the lungs or respiratory muscles can worsen morbidity and mortality. Here we use an engineering pressure loss model to analyze the administration of medical gas mixtures in newborns. The model is used to determine the pressure distribution along the gas flow path. Numerical experiments comparing medical gas mixtures with helium, nitrous oxide, argon, xenon, and medical air as a control, with and without an endotracheal tube obstruction were performed. The engineering pressure loss model was incorporated into a model of mechanical ventilation during pressure control mode, a ventilator mode that is often used for neonates. Results are presented in the form of Rohrer equations relating pressure loss to flow rate for each gas mixture with and without obstruction. These equations were incorporated into a model for mechanical ventilation resulting in pressure, flow rate, and volume curves for the inhalation-exhalation cycle. In terms of accuracy, published values of airway resistance range from 50 to 150 cmH2O/L per second for a normal 3 kg infant. With air, the current results are 55 to 80 cmH2O/L per second for 0.3 to 5 L/min. It is shown that density through inertial pressure losses has a greater influence on airway resistance than viscosity in spite of relatively low flow rates and small airway dimensions of newborns. The results indicate that the high-density xenon mixture can be problematic during mechanical ventilation. On the other hand, low density heliox (a mixture of helium and oxygen) provides a wider margin of safety for mechanical ventilation than the other gas mixtures. The argon or nitrous oxide mixtures considered are only slightly different from air in terms of mechanical ventilation performance.
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Affiliation(s)
- Ira Katz
- Medical Research & Development, Healthcare World Business Line, Air Liquide Santé International, Paris Innovation Campus, Les Loges-en-Josas, France
| | - Aude Milet
- Medical Research & Development, Healthcare World Business Line, Air Liquide Santé International, Paris Innovation Campus, Les Loges-en-Josas, France
| | - Matthieu Chalopin
- Medical Research & Development, Healthcare World Business Line, Air Liquide Santé International, Paris Innovation Campus, Les Loges-en-Josas, France
| | - Géraldine Farjot
- Medical Research & Development, Healthcare World Business Line, Air Liquide Santé International, Paris Innovation Campus, Les Loges-en-Josas, France
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13
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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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14
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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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15
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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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16
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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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17
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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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18
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Wang Z, Ren K, Shi X, Liu D, Wu Z, Gao K. Technical Note: Single-shot phase retrieval method for synchrotron-based high-energy x-ray grating interferometry. Med Phys 2019; 46:1317-1322. [DOI: 10.1002/mp.13399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/20/2018] [Accepted: 01/18/2019] [Indexed: 01/31/2023] Open
Affiliation(s)
- Zhili Wang
- School of Electronic Science & Applied Physics; Hefei University of Technology; Hefei 230009 China
- Beijing Advanced Innovation Center for Imaging Technology; Capital Normal University; Beijing 100048 People's Republic of China
| | - Kun Ren
- School of Electronic Science & Applied Physics; Hefei University of Technology; Hefei 230009 China
| | - Xiaomin Shi
- School of Electronic Science & Applied Physics; Hefei University of Technology; Hefei 230009 China
| | - Dalin Liu
- School of Electronic Science & Applied Physics; Hefei University of Technology; Hefei 230009 China
| | - Zhao Wu
- National Synchrotron Radiation Laboratory University of Science and Technology of China; 230029 Hefei China
| | - Kun Gao
- National Synchrotron Radiation Laboratory University of Science and Technology of China; 230029 Hefei China
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19
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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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20
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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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X-Ray Dark-field Imaging to Depict Acute Lung Inflammation in Mice. Sci Rep 2018; 8:2096. [PMID: 29391514 PMCID: PMC5794739 DOI: 10.1038/s41598-018-20193-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 01/15/2018] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to evaluate the feasibility of early stage imaging of acute lung inflammation in mice using grating-based X-ray dark-field imaging in vivo. Acute lung inflammation was induced in mice by orotracheal instillation of porcine pancreatic elastase. Control mice received orotracheal instillation of PBS. Mice were imaged immediately before and 1 day after the application of elastase or PBS to assess acute changes in pulmonary structure due to lung inflammation. Subsequently, 6 mice from each group were sacrificed and their lungs were lavaged and explanted for histological analysis. A further 7, 14 and 21 days later the remaining mice were imaged again. All images were acquired with a prototype grating-based small-animal scanner to generate dark-field and transmission radiographs. Lavage confirmed that mice in the experimental group had developed acute lung inflammation one day after administration of elastase. Acute lung inflammation was visible as a striking decrease in signal intensity of the pulmonary parenchyma on dark-field images at day 1. Quantitative analysis confirmed that dark-field signal intensity at day 1 was significantly lower than signal intensities measured at the remaining timepoints, confirming that acute lung inflammation can be depicted in vivo with dark-field radiography.
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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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25
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Abstract
Unlike conventional x-ray attenuation one of the advantages of phase contrast x-ray imaging is its capability of extracting useful physical properties of the sample. In particular the possibility to obtain information from small angle scattering about unresolvable structures with sub-pixel resolution sensitivity has drawn attention for both medical and material science applications. We report on a novel algorithm for the analyzer based x-ray phase contrast imaging modality, which allows the robust separation of absorption, refraction and scattering effects from three measured x-ray images. This analytical approach is based on a simple Gaussian description of the analyzer transmission function and this method is capable of retrieving refraction and small angle scattering angles in the full angular range typical of biological samples. After a validation of the algorithm with a simulation code, which demonstrated the potential of this highly sensitive method, we have applied this theoretical framework to experimental data on a phantom and biological tissues obtained with synchrotron radiation. Owing to its extended angular acceptance range the algorithm allows precise assessment of local scattering distributions at biocompatible radiation doses, which in turn might yield a quantitative characterization tool with sufficient structural sensitivity on a submicron length scale.
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Horn F, Gelse K, Jabari S, Hauke C, Kaeppler S, Ludwig V, Meyer P, Michel T, Mohr J, Pelzer G, Rieger J, Riess C, Seifert M, Anton G. High-energy x-ray Talbot–Lau radiography of a human knee. ACTA ACUST UNITED AC 2017; 62:6729-6745. [DOI: 10.1088/1361-6560/aa7721] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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27
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Gromann LB, De Marco F, Willer K, Noël PB, Scherer K, Renger B, Gleich B, Achterhold K, Fingerle AA, Muenzel D, Auweter S, Hellbach K, Reiser M, Baehr A, Dmochewitz M, Schroeter TJ, Koch FJ, Meyer P, Kunka D, Mohr J, Yaroshenko A, Maack HI, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny EJ, Pfeiffer F, Herzen J. In-vivo X-ray Dark-Field Chest Radiography of a Pig. Sci Rep 2017; 7:4807. [PMID: 28684858 PMCID: PMC5500502 DOI: 10.1038/s41598-017-05101-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/25/2017] [Indexed: 12/12/2022] Open
Abstract
X-ray chest radiography is an inexpensive and broadly available tool for initial assessment of the lung in clinical routine, but typically lacks diagnostic sensitivity for detection of pulmonary diseases in their early stages. Recent X-ray dark-field (XDF) imaging studies on mice have shown significant improvements in imaging-based lung diagnostics. Especially in the case of early diagnosis of chronic obstructive pulmonary disease (COPD), XDF imaging clearly outperforms conventional radiography. However, a translation of this technique towards the investigation of larger mammals and finally humans has not yet been achieved. In this letter, we present the first in-vivo XDF full-field chest radiographs (32 × 35 cm2) of a living pig, acquired with clinically compatible parameters (40 s scan time, approx. 80 µSv dose). For imaging, we developed a novel high-energy XDF system that overcomes the limitations of currently established setups. Our XDF radiographs yield sufficiently high image quality to enable radiographic evaluation of the lungs. We consider this a milestone in the bench-to-bedside translation of XDF imaging and expect XDF imaging to become an invaluable tool in clinical practice, both as a general chest X-ray modality and as a dedicated tool for high-risk patients affected by smoking, industrial work and indoor cooking.
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Affiliation(s)
- Lukas B Gromann
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.
| | - Fabio De Marco
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Peter B Noël
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Kai Scherer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Bernhard Gleich
- Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Alexander A Fingerle
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Daniela Muenzel
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Katharina Hellbach
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Andrea Baehr
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig-Maximilian-University, 85764, Oberschleißheim, Germany
| | - Michaela Dmochewitz
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig-Maximilian-University, 85764, Oberschleißheim, Germany
| | - Tobias J Schroeter
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Frieder J Koch
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Pascal Meyer
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Danays Kunka
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Andre Yaroshenko
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | | | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany.,Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | | | - Karsten Rindt
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany.,Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.
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Scherer K, Yaroshenko A, Bölükbas DA, Gromann LB, Hellbach K, Meinel FG, Braunagel M, Berg JV, Eickelberg O, Reiser MF, Pfeiffer F, Meiners S, Herzen J. X-ray Dark-field Radiography - In-Vivo Diagnosis of Lung Cancer in Mice. Sci Rep 2017; 7:402. [PMID: 28341830 PMCID: PMC5428469 DOI: 10.1038/s41598-017-00489-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 02/28/2017] [Indexed: 02/01/2023] Open
Abstract
Accounting for about 1.5 million deaths annually, lung cancer is the prevailing cause of cancer deaths worldwide, mostly associated with long-term smoking effects. Numerous small-animal studies are performed currently in order to better understand the pathogenesis of the disease and to develop treatment strategies. Within this letter, we propose to exploit X-ray dark-field imaging as a novel diagnostic tool for the detection of lung cancer on projection radiographs. Here, we demonstrate in living mice bearing lung tumors, that X-ray dark-field radiography provides significantly improved lung tumor detection rates without increasing the number of false-positives, especially in the case of small and superimposed nodules, when compared to conventional absorption-based imaging. While this method still needs to be adapted to larger mammals and finally humans, the technique presented here can already serve as a valuable tool in evaluating novel lung cancer therapies, tested in mice and other small animal models.
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Affiliation(s)
- Kai Scherer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748, Garching, Germany.
| | - Andre Yaroshenko
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748, Garching, Germany
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | - Deniz Ali Bölükbas
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians University, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), 81377 Munich, Germany
| | - Lukas B Gromann
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748, Garching, Germany
| | - Katharina Hellbach
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, 81377, Munich, Germany
| | - Felix G Meinel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, 81377, Munich, Germany
| | - Margarita Braunagel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, 81377, Munich, Germany
| | - Jens von Berg
- Philips Research Laboratories, Philips Medical Systems, 22335, Hamburg, Germany
| | - Oliver Eickelberg
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians University, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), 81377 Munich, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, 81377, Munich, Germany
| | - Franz Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748, Garching, Germany
| | - Silke Meiners
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians University, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), 81377 Munich, Germany
| | - Julia Herzen
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748, Garching, Germany
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