A compact system for intraoperative specimen imaging based on edge illumination x-ray phase contrast

Innovations in dedicated PET instrumentation: from the operating room to specimen imaging

This review casts a spotlight on intraoperative positron emission tomography (PET) scanners and the distinctive challenges they confront. Specifically, these systems contend with the necessity of partial coverage geometry, essential for ensuring adequate access to the patient. This inherently leans them towards limited-angle PET imaging, bringing along its array of reconstruction and geometrical sensitivity challenges. Compounding this, the need for real-time imaging in navigation systems mandates rapid acquisition and reconstruction times. For these systems, the emphasis is on dependable PET image reconstruction (without significant artefacts) while rapid processing takes precedence over the spatial resolution of the system. In contrast, specimen PET imagers are unburdened by the geometrical sensitivity challenges, thanks to their ability to leverage full coverage PET imaging geometries. For these devices, the focus shifts: high spatial resolution imaging takes precedence over rapid image reconstruction. This review concurrently probes into the technical complexities of both intraoperative and specimen PET imaging, shedding light on their recent designs, inherent challenges, and technological advancements.

T staging esophageal tumors with x rays

With histopathology results typically taking several days, the ability to stage tumors during interventions could provide a step change in various cancer interventions. X-ray technology has advanced significantly in recent years with the introduction of phase-based imaging methods. These have been adapted for use in standard labs rather than specialized facilities such as synchrotrons, and approaches that enable fast 3D scans with conventional x-ray sources have been developed. This opens the possibility to produce 3D images with enhanced soft tissue contrast at a level of detail comparable to histopathology, in times sufficiently short to be compatible with use during surgical interventions. In this paper we discuss the application of one such approach to human esophagi obtained from esophagectomy interventions. We demonstrate that the image quality is sufficiently high to enable tumor T staging based on the x-ray datasets alone. Alongside detection of involved margins with potentially life-saving implications, staging tumors intra-operatively has the potential to change patient pathways, facilitating optimization of therapeutic interventions during the procedure itself. Besides a prospective intra-operative use, the availability of high-quality 3D images of entire esophageal tumors can support histopathological characterization, from enabling "right slice first time" approaches to understanding the histopathology in the full 3D context of the surrounding tumor environment.

Edge-illumination spectral phase-contrast tomography

Following the rapid, but independent, diffusion of x-ray spectral and phase-contrast systems, this work demonstrates the first combination of spectral and phase-contrast computed tomography (CT) obtained by using the edge-illumination technique and a CdTe small-pixel (62μm) spectral detector. A theoretical model is introduced, starting from a standard attenuation-based spectral decomposition and leading to spectral phase-contrast material decomposition. Each step of the model is followed by quantification of accuracy and sensitivity on experimental data of a test phantom containing different solutions with known concentrations. An example of a micro CT application (20μm voxel size) on an iodine-perfusedex vivomurine model is reported. The work demonstrates that spectral-phase contrast combines the advantages of spectral imaging, i.e. high-Zmaterial discrimination capability, and phase-contrast imaging, i.e. soft tissue sensitivity, yielding simultaneously mass density maps of water, calcium, and iodine with an accuracy of 1.1%, 3.5%, and 1.9% (root mean square errors), respectively. Results also show a 9-fold increase in the signal-to-noise ratio of the water channel when compared to standard spectral decomposition. The application to the murine model revealed the potential of the technique in the simultaneous 3D visualization of soft tissue, bone, and vasculature. While being implemented by using a broad spectrum (pink beam) at a synchrotron radiation facility (Elettra, Trieste, Italy), the proposed experimental setup can be readily translated to compact laboratory systems including conventional x-ray tubes.

Femtosecond multimodal imaging with a laser-driven X-ray source

Laser-plasma accelerators are compact linear accelerators based on the interaction of high-power lasers with plasma to form accelerating structures up to 1000 times smaller than standard radiofrequency cavities, and they come with an embedded X-ray source, namely betatron source, with unique properties: small source size and femtosecond pulse duration. A still unexplored possibility to exploit the betatron source comes from combining it with imaging methods able to encode multiple information like transmission and phase into a single-shot acquisition approach. In this work, we combine edge illumination-beam tracking (EI-BT) with a betatron X-ray source and present the demonstration of multimodal imaging (transmission, refraction, and scattering) with a compact light source down to the femtosecond timescale. The advantage of EI-BT is that it allows multimodal X-ray imaging technique, granting access to transmission, refraction and scattering signals from standard low-coherence laboratory X-ray sources in a single shot.

X-ray phase-contrast microtomography of soft tissues using a compact laboratory system with two-directional sensitivity

X-ray microtomography is a nondestructive, three-dimensional inspection technique applied across a vast range of fields and disciplines, ranging from research to industrial, encompassing engineering, biology, and medical research. Phase-contrast imaging extends the domain of application of x-ray microtomography to classes of samples that exhibit weak attenuation, thus appearing with poor contrast in standard x-ray imaging. Notable examples are low-atomic-number materials, like carbon-fiber composites, soft matter, and biological soft tissues. We report on a compact and cost-effective system for x-ray phase-contrast microtomography. The system features high sensitivity to phase gradients and high resolution, requires a low-power sealed x-ray tube, a single optical element, and fits in a small footprint. It is compatible with standard x-ray detector technologies: in our experiments, we have observed that single-photon counting offered higher angular sensitivity, whereas flat panels provided a larger field of view. The system is benchmarked against known-material phantoms, and its potential for soft-tissue three-dimensional imaging is demonstrated on small-animal organs: a piglet esophagus and a rat heart. We believe that the simplicity of the setup we are proposing, combined with its robustness and sensitivity, will facilitate accessing quantitative x-ray phase-contrast microtomography as a research tool across disciplines, including tissue engineering, materials science, and nondestructive testing in general.

PEPI Lab: a flexible compact multi-modal setup for X-ray phase-contrast and spectral imaging

This paper presents a new flexible compact multi-modal imaging setup referred to as PEPI (Photon-counting Edge-illumination Phase-contrast imaging) Lab, which is based on the edge-illumination (EI) technique and a chromatic detector. The system enables both X-ray phase-contrast (XPCI) and spectral (XSI) imaging of samples on the centimeter scale. This work conceptually follows all the stages in its realization, from the design to the first imaging results. The setup can be operated in four different modes, i.e. photon-counting/conventional, spectral, double-mask EI, and single-mask EI, whereby the switch to any modality is fast, software controlled, and does not require any hardware modification or lengthy re-alignment procedures. The system specifications, ranging from the X-ray tube features to the mask material and aspect ratio, have been quantitatively studied and optimized through a dedicated Geant4 simulation platform, guiding the choice of the instrumentation. The realization of the imaging setup, both in terms of hardware and control software, is detailed and discussed with a focus on practical/experimental aspects. Flexibility and compactness (66 cm source-to-detector distance in EI) are ensured by dedicated motion stages, whereas spectral capabilities are enabled by the Pixirad-1/Pixie-III detector in combination with a tungsten anode X-ray source operating in the range 40-100 kVp. The stability of the system, when operated in EI, has been verified, and drifts leading to mask misalignment of less than 1 [Formula: see text]m have been measured over a period of 54 h. The first imaging results, one for each modality, demonstrate that the system fulfills its design requirements. Specifically, XSI tomographic images of an iodine-based phantom demonstrate the system's quantitativeness and sensibility to concentrations in the order of a few mg/ml. Planar XPCI images of a carpenter bee specimen, both in single and double-mask modes, demonstrate that refraction sensitivity (below 0.6 [Formula: see text]rad in double-mask mode) is comparable with other XPCI systems based on microfocus sources. Phase CT capabilities have also been tested on a dedicated plastic phantom, where the phase channel yielded a 15-fold higher signal-to-noise ratio with respect to attenuation.

The choice of an autocorrelation length in dark-field lung imaging

Respiratory diseases are one of the most common causes of death, and their early detection is crucial for prompt treatment. X-ray dark-field radiography (XDFR) is a promising tool to image objects with unresolved micro-structures such as lungs. Using Talbot-Lau XDFR, we imaged inflated porcine lungs together with Polymethylmethacrylat (PMMA) microspheres (in air) of diameter sizes between 20 and 500 [Formula: see text] over an autocorrelation range of 0.8-5.2 [Formula: see text]. The results indicate that the dark-field extinction coefficient of porcine lungs is similar to that of densely-packed PMMA spheres with diameter of [Formula: see text], which is approximately the mean alveolar structure size. We evaluated that, in our case, the autocorrelation length would have to be limited to [Formula: see text] in order to image [Formula: see text]-thick lung tissue without critical visibility reduction (signal saturation). We identify the autocorrelation length to be the critical parameter of an interferometer that allows to avoid signal saturation in clinical lung dark-field imaging.

Direct Conversion X-ray Detector with Micron-Scale Pixel Pitch for Edge-Illumination and Propagation-Based X-ray Phase-Contrast Imaging

In this work, we investigate the potential of employing a direct conversion integration mode X-ray detector with micron-scale pixels in two different X-ray phase-contrast imaging (XPCi) configurations, propagation-based (PB) and edge illumination (EI). Both PB-XPCi and EI-XPCi implementations are evaluated through a wave optics model-numerically simulated in MATLAB-and are compared based on their contrast, edge-enhancement, visibility, and dose efficiency characteristics. The EI-XPCi configuration, in general, demonstrates higher performance compared to PB-XPCi, considering a setup with the same X-ray source and detector. However, absorption masks quality (thickness of X-ray absorption material) and environmental vibration effect are two potential challenges for EI-XPCi employing a detector with micron-scale pixels. Simulation results confirm that the behavior of an EI-XPCi system employing a high-resolution detector is susceptible to its absorption masks thickness and misalignment. This work demonstrates the potential and feasibility of employing a high-resolution direct conversion detector for phase-contrast imaging applications where higher dose efficiency, higher contrast images, and a more compact imaging system are of interest.

Volumetric High-Resolution X-Ray Phase-Contrast Virtual Histology of Breast Specimens With a Compact Laboratory System

The assessment of margin involvement is a fundamental task in breast conserving surgery to prevent recurrences and reoperations. It is usually performed through histology, which makes the process time consuming and can prevent the complete volumetric analysis of large specimens. X-ray phase contrast tomography combines high resolution, sufficient penetration depth and high soft tissue contrast, and can therefore provide a potential solution to this problem. In this work, we used a high-resolution implementation of the edge illumination X-ray phase contrast tomography based on "pixel-skipping" X-ray masks and sample dithering, to provide high definition virtual slices of breast specimens. The scanner was originally designed for intra-operative applications in which short scanning times were prioritised over spatial resolution; however, thanks to the versatility of edge illumination, high-resolution capabilities can be obtained with the same system simply by swapping x-ray masks without this imposing a reduction in the available field of view. This makes possible an improved visibility of fine tissue strands, enabling a direct comparison of selected CT slices with histology, and providing a tool to identify suspect features in large specimens before slicing. Combined with our previous results on fast specimen scanning, this works paves the way for the design of a multi-resolution EI scanner providing intra-operative capabilities as well as serving as a digital pathology system.

Monitoring tissue engineered constructs and protocols with laboratory-based x-ray phase contrast tomography

Tissue engineering (TE) aims to generate bioengineered constructs which can offer a surgical treatment for many conditions involving tissue or organ loss. Construct generation must be guided by suitable assessment tools. However, most current tools (e.g. histology) are destructive, which restricts evaluation to a single-2D anatomical plane, and has no potential for assessing constructs prior to or following their implantation. An alternative can be provided by laboratory-based x-ray phase contrast computed tomography (PC-CT), which enables the extraction of 3D density maps of an organ's anatomy. In this work, we developed a semi-automated image processing pipeline dedicated to the analysis of PC-CT slices of oesophageal constructs. Visual and quantitative (density and morphological) information is extracted on a volumetric basis, enabling a comprehensive evaluation of the regenerated constructs. We believe the presented tools can enable the successful regeneration of patient-specific oesophagus, and bring comparable benefit to a wide range of TE applications. STATEMENT OF SIGNIFICANCE: Phase contrast computed tomography (PC-CT) is an imaging modality which generates high resolution volumetric density maps of biological tissue. In this work, we demonstrate the use of PC-CT as a new tool for guiding the progression of an oesophageal tissue engineering (TE) protocol. Specifically, we developed a semi-automated image-processing pipeline which analyses the oesophageal PC-CT slices, extracting visual and quantitative (density and morphological) information. This information was proven key for performing a comprehensive evaluation of the regenerated constructs, and cannot be obtained through existing assessment tools primarily due to their destructive nature (e.g. histology). This work paves the way for using PC-CT in a wide range of TE applications which can be pivotal for unlocking the potential of this field.

Edge-illumination x-ray phase-contrast imaging

Although early demonstration dates back to the mid-sixties, x-ray phase-contrast imaging (XPCI) became hugely popular in the mid-90s, thanks to the advent of 3rd generation synchrotron facilities. Its ability to reveal object features that had so far been considered invisible to x-rays immediately suggested great potential for applications across the life and the physical sciences, and an increasing number of groups worldwide started experimenting with it. At that time, it looked like a synchrotron facility was strictly necessary to perform XPCI with some degree of efficiency-the only alternative being micro-focal sources, the limited flux of which imposed excessively long exposure times. However, new approaches emerged in the mid-00s that overcame this limitation, and allowed XPCI implementations with conventional, non-micro-focal x-ray sources. One of these approaches showing particular promise for 'real-world' applications is edge-illumination XPCI: this article describes the key steps in its evolution in the context of contemporary developments in XPCI research, and presents its current state-of-the-art, especially in terms of transition towards practical applications.

Principles of Different X-ray Phase-Contrast Imaging: A Review

Numerous advances have been made in X-ray technology in recent years. X-ray imaging plays an important role in the nondestructive exploration of the internal structures of objects. However, the contrast of X-ray absorption images remains low, especially for materials with low atomic numbers, such as biological samples. X-ray phase-contrast images have an intrinsically higher contrast than absorption images. In this review, the principles, milestones, and recent progress of X-ray phase-contrast imaging methods are demonstrated. In addition, prospective applications are presented.

Detection of involved margins in breast specimens with X-ray phase-contrast computed tomography

Margins of wide local excisions in breast conserving surgery are tested through histology, which can delay results by days and lead to second operations. Detection of margin involvement intraoperatively would allow the removal of additional tissue during the same intervention. X-ray phase contrast imaging (XPCI) provides soft tissue sensitivity superior to conventional X-rays: we propose its use to detect margin involvement intraoperatively. We have developed a system that can perform phase-based computed tomography (CT) scans in minutes, used it to image 101 specimens approximately half of which contained neoplastic lesions, and compared results against those of a commercial system. Histological analysis was carried out on all specimens and used as the gold standard. XPCI-CT showed higher sensitivity (83%, 95% CI 69–92%) than conventional specimen imaging (32%, 95% CI 20–49%) for detection of lesions at margin, and comparable specificity (83%, 95% CI 70–92% vs 86%, 95% CI 73–93%). Within the limits of this study, in particular that specimens obtained from surplus tissue typically contain small lesions which makes detection more difficult for both methods, we believe it likely that the observed increase in sensitivity will lead to a comparable reduction in the number of re-operations.

Dark-field signal extraction in propagation-based phase-contrast imaging

A method for extracting the dark-field signal in propagation-based phase-contrast imaging is proposed. In the case of objects consisting predominantly of a single material, or several different materials with similar ratios of the real decrement to the imaginary part of the complex refractive index, the proposed method requires a single image for extraction of the dark-field signal in two-dimensional projection imaging. In the case of three-dimensional tomographic imaging, the method needs only one image to be collected at each projection angle. Initial examples using simulated and experimental data indicate that this method can improve visualization of small sharp features inside a larger object, e.g. the visualization of microcalcifications in propagation-based x-ray breast cancer imaging. It is suggested that the proposed approach may be useful in other forms of biomedical imaging, where it can help one to obtain additional small-angle scattering information without increasing the radiation dose to the sample.

Evaluation of a compact multicontrast and multiresolution X-ray phase contrast edge illumination system for small animal imaging

PURPOSE

In this work the performance of a compact multiresolution and multicontrast x-ray phase system based on edge illumination is investigated. It has been designed for small animal imaging and with a limited footprint for ease of deployment in laboratories.

METHODS

The presented edge illumination system is based on a compact microfocus tungsten x-ray source combined with a flat panel detector. The source has a maximum output of 10 W when the minimum spot size of about 15 μm is used. The system has an overall length of 70 cm. A new double sample mask design, obtained by arranging both skipped and nonskipped configurations on the same structure, provides dual resolution capability. To test the system, we carried out computed tomography (CT) scans of a plastic phantom with different source settings using both single-image and multi-image acquisition schemes at different spatial resolutions. In addition, CT scans of an ex-vivo mouse specimen were acquired at the best identified working conditions to demonstrate the application of the presented system to small animal imaging.

RESULTS

We found this system delivers good image quality, allowing for an efficient material separation and improving detail visibility in small animals thanks to the higher signal-to-noise ratio (SNR) of phase contrast with respect to conventional attenuation contrast. The system offers high versatility in terms of spatial resolution thanks to the double sample mask design integrated into a single scanner. The availability of both multi- and single-image acquisition schemes coupled with their dedicated retrieval algorithms, allows different working modes which can be selected based on user preference. Multi-image acquisition provides quantitative separation of the real and imaginary part of the refractive index, however, it requires a long scanning time. On the other hand, the single image approach delivers the best material separation and image quality at all the investigated source settings with a shorter scanning time but at the cost of quantitativeness. Finally, we also observed that the single image approach combined with a high-power x-ray source may result in a fast acquisition protocol compatible with in-vivo imaging.