Volume-of-interest (VOI) imaging in C-arm flat-detector CT for high image quality at reduced dose

Deep-Interior: A new pathway to interior tomographic image reconstruction via a weighted backprojection and deep learning

BACKGROUND

In recent years, deep learning strategies have been combined with either the filtered backprojection or iterative methods or the direct projection-to-image by deep learning only to reconstruct images. Some of these methods can be applied to address the interior reconstruction problems for centered regions of interest (ROIs) with fixed sizes. Developing a method to enable interior tomography with arbitrarily located ROIs with nearly arbitrary ROI sizes inside a scanning field of view (FOV) remains an open question.

PURPOSE

To develop a new pathway to enable interior tomographic reconstruction for arbitrarily located ROIs with arbitrary sizes using a single trained deep neural network model.

METHODS

The method consists of two steps. First, an analytical weighted backprojection reconstruction algorithm was developed to perform domain transform from divergent fan-beam projection data to an intermediate image feature space,B ( x ⃗ ) $B(\vec{x})$ , for an arbitrary size ROI at an arbitrary location inside the FOV. Second, a supervised learning technique was developed to train a deep neural network architecture to perform deconvolution to obtain the true imagef ( x ⃗ ) $f(\vec{x})$ from the new feature spaceB ( x ⃗ ) $B(\vec{x})$ . This two-step method is referred to as Deep-Interior for convenience. Both numerical simulations and experimental studies were performed to validate the proposed Deep-Interior method.

RESULTS

The results showed that ROIs as small as a diameter of 5 cm could be accurately reconstructed (similarity index 0.985 ± 0.018 on internal testing data and 0.940 ± 0.025 on external testing data) at arbitrary locations within an imaging object covering a wide variety of anatomical structures of different body parts. Besides, ROIs of arbitrary size can be reconstructed by stitching small ROIs without additional training.

CONCLUSION

The developed Deep-Interior framework can enable interior tomographic reconstruction from divergent fan-beam projections for short-scan and super-short-scan acquisitions for small ROIs (with a diameter larger than 5 cm) at an arbitrary location inside the scanning FOV with high quantitative reconstruction accuracy.

Clinical Micro-CT Empowered by Interior Tomography, Robotic Scanning, and Deep Learning

While micro-CT systems are instrumental in preclinical research, clinical micro-CT imaging has long been desired with cochlear implantation as a primary application. The structural details of the cochlear implant and the temporal bone require a significantly higher image resolution than that (about 0.2 mm) provided by current medical CT scanners. In this paper, we propose a clinical micro-CT (CMCT) system design integrating conventional spiral cone-beam CT, contemporary interior tomography, deep learning techniques, and the technologies of a micro-focus X-ray source, a photon-counting detector (PCD), and robotic arms for ultrahigh-resolution localized tomography of a freely-selected volume of interest (VOI) at a minimized radiation dose level. The whole system consists of a standard CT scanner for a clinical CT exam and VOI specification, and a robotic micro-CT scanner for a local scan of high spatial and spectral resolution at minimized radiation dose. The prior information from the global scan is also fully utilized for background compensation of the local scan data for accurate and stable VOI reconstruction. Our results and analysis show that the proposed hybrid reconstruction algorithm delivers accurate high-resolution local reconstruction, and is insensitive to the misalignment of the isocenter position, initial view angle and scale mismatch in the data/image registration. These findings demonstrate the feasibility of our system design. We envision that deep learning techniques can be leveraged for optimized imaging performance. With high-resolution imaging, high dose efficiency and low system cost synergistically, our proposed CMCT system has great promise in temporal bone imaging as well as various other clinical applications.

Volume-of-interest imaging with dynamic fluence modulation using multiple aperture devices

Volume-of-interest (VOI) imaging is a strategy in computed tomography (CT) that restricts x-ray fluence to particular anatomical targets via dynamic beam modulation. This permits dose reduction while retaining image quality within the VOI. VOI-CT implementation has been challenged, in part, by a lack of hardware solutions for tailoring the incident fluence to the patient and anatomical site, as well as difficulties involving interior tomography reconstruction of truncated projection data. We propose a general VOI-CT imaging framework using multiple aperture devices (MADs), an emerging beam filtration scheme based on two binary x-ray filters. Location of the VOI is prescribed using two scout views at anterior-posterior (AP) and lateral perspectives. Based on a calibration of achievable fluence field patterns, MAD motion trajectories were designed using an optimization objective that seeks to maximize the relative fluence in the VOI subject to minimum fluence constraints. A modified penalized-likelihood method is developed for reconstruction of heavily truncated data using the full-field scout views to help solve the interior tomography problem. Physical experiments were conducted to show the feasibility of noncentered and elliptical VOI in two applications-spine and lung imaging. Improved dose utilization and retained image quality are validated with respect to standard full-field protocols. We observe that the contrast-to-noise ratio (CNR) is 40% higher compared with low-dose full-field scans at the same dose. The total dose reduction is 50% for equivalent image quality (CNR) within the VOI.

Known-component 3D image reconstruction for improved intraoperative imaging in spine surgery: A clinical pilot study

PURPOSE

Intraoperative imaging plays an increased role in support of surgical guidance and quality assurance for interventional approaches. However, image quality sufficient to detect complications and provide quantitative assessment of the surgical product is often confounded by image noise and artifacts. In this work, we translated a three-dimensional model-based image reconstruction (referred to as "Known-Component Reconstruction," KC-Recon) for the first time to clinical studies with the aim of resolving both limitations.

METHODS

KC-Recon builds upon a penalized weighted least-squares (PWLS) method by incorporating models of surgical instrumentation ("known components") within a joint image registration-reconstruction process to improve image quality. Under IRB approval, a clinical pilot study was conducted with 17 spine surgery patients imaged under informed consent using the O-arm cone-beam CT system (Medtronic, Littleton MA) before and after spinal instrumentation. Volumetric images were generated for each patient using KC-Recon in comparison to conventional filtered backprojection (FBP). Imaging performance prior to instrumentation ("preinstrumentation") was evaluated in terms of soft-tissue contrast-to-noise ratio (CNR) and spatial resolution. The quality of images obtained after the instrumentation ("postinstrumentation") was assessed by quantifying the magnitude of metal artifacts (blooming and streaks) arising from pedicle screws. The potential low-dose advantages of the algorithm were tested by simulating low-dose data (down to one-tenth of the dose of standard protocols) from images acquired at normal dose.

RESULTS

Preinstrumentation images (at normal clinical dose and matched resolution) exhibited an average 24.0% increase in soft-tissue CNR with KC-Recon compared to FBP (N = 16, P = 0.02), improving visualization of paraspinal muscles, major vessels, and other soft-tissues about the spine and abdomen. For a total of 72 screws in postinstrumentation images, KC-Recon yielded a significant reduction in metal artifacts: 66.3% reduction in overestimation of screw shaft width due to blooming (P < 0.0001) and reduction in streaks at the screw tip (65.8% increase in attenuation accuracy, P < 0.0001), enabling clearer depiction of the screw within the pedicle and vertebral body for an assessment of breach. Depending on the imaging task, dose reduction up to an order of magnitude appeared feasible while maintaining soft-tissue visibility and metal artifact reduction.

CONCLUSIONS

KC-Recon offers a promising means to improve visualization in the presence of surgical instrumentation and reduce patient dose in image-guided procedures. The improved soft-tissue visibility could facilitate the use of cone-beam CT to soft-tissue surgeries, and the ability to precisely quantify and visualize instrument placement could provide a valuable check against complications in the operating room (cf., postoperative CT).

Volume-of-interest Imaging Using Multiple Aperture Devices

Volume-of-interest (VOI) imaging is a promising strategy for dose reduction in computed tomography (CT) while retaining image quality. However, implementation of VOI-CT has been challenged by the lack of adequate hardware and the interior tomography reconstruction problem. Multiple aperture devices (MAD) are a novel filtration scheme that can achieve x-ray fluence field modulation in a compact design with small translations. In this work, we propose a general approach for VOI imaging using MADs. MAD trajectories are designed to dynamically tailor the fluence for prescribed VOI. A penalized-likelihood reconstruction algorithm is proposed for fully truncated projections extended with scout views. Physical experiments were conducted to verify the feasibility for non-centered elliptic VOIs. Image quality and dose were estimated and compared with standard fullfield protocols. The ability of MAD-based VOI imaging to retain high image quality while significantly decreasing the total dose is demonstrated, suggesting the potential for dose reduction in clinical CT applications.

Image quality and dose characteristics for an O-arm intraoperative imaging system with model-based image reconstruction

PURPOSE

To assess the imaging performance and radiation dose characteristics of the O-arm CBCT imaging system (Medtronic Inc., Littleton MA) and demonstrate the potential for improved image quality and reduced dose via model-based image reconstruction (MBIR).

METHODS

Two main studies were performed to investigate previously unreported characteristics of the O-arm system. First is an investigation of dose and 3D image quality achieved with filtered back-projection (FBP) - including enhancements in geometric calibration, handling of lateral truncation and detector saturation, and incorporation of an isotropic apodization filter. Second is implementation of an MBIR algorithm based on Huber-penalized likelihood estimation (PLH) and investigation of image quality improvement at reduced dose. Each study involved measurements in quantitative phantoms as a basis for analysis of contrast-to-noise ratio and spatial resolution as well as imaging of a human cadaver to test the findings under realistic imaging conditions.

RESULTS

View-dependent calibration of system geometry improved the accuracy of reconstruction as quantified by the full-width at half maximum of the point-spread function - from 0.80 to 0.65 mm - and yielded subtle but perceptible improvement in high-contrast detail of bone (e.g., temporal bone). Standard technique protocols for the head and body imparted absorbed dose of 16 and 18 mGy, respectively. For low-to-medium contrast (<100 HU) imaging at fixed spatial resolution (1.3 mm edge-spread function) and fixed dose (6.7 mGy), PLH improved CNR over FBP by +48% in the head and +35% in the body. Evaluation at different dose levels demonstrated 30% increase in CNR at 62% of the dose in the head and 90% increase in CNR at 50% dose in the body.

CONCLUSIONS

A variety of improvements in FBP implementation (geometric calibration, truncation and saturation effects, and isotropic apodization) offer the potential for improved image quality and reduced radiation dose on the O-arm system. Further gains are possible with MBIR, including improved soft-tissue visualization, low-dose imaging protocols, and extension to methods that naturally incorporate prior information of patient anatomy and/or surgical instrumentation.

Optimization of a secondary VOI protocol for lung imaging in a clinical CT scanner

We present a solution to meet an unmet clinical need of an in-situ "close look" at a pulmonary nodule or at the margins of a pulmonary cyst revealed by a primary (screening) chest CT while the patient is still in the scanner. We first evaluated options available on current whole-body CT scanners for high resolution screening scans, including ROI reconstruction of the primary scan data and HRCT, but found them to have insufficient SNR in lung tissue or discontinuous slice coverage. Within the capabilities of current clinical CT systems, we opted for the solution of a secondary, volume-of-interest (VOI) protocol where the radiation dose is focused into a short-beam axial scan at the z position of interest, combined with a small-FOV reconstruction at the xy position of interest. The objective of this work was to design a VOI protocol that is optimized for targeted lung imaging in a clinical whole-body CT system. Using a chest phantom containing a lung-mimicking foam insert with a simulated cyst, we identified the appropriate scan mode and optimized both the scan and recon parameters. The VOI protocol yielded 3.2 times the texture amplitude-to-noise ratio in the lung-mimicking foam when compared to the standard chest CT, and 8.4 times the texture difference between the lung mimicking and reference foams. It improved details of the wall of the simulated cyst and better resolution in a line-pair insert. The Effective Dose of the secondary VOI protocol was 42% on average and up to 100% in the worst-case scenario of VOI positioning relative to the standard chest CT. The optimized protocol will be used to obtain detailed CT textures of pulmonary lesions, which are biomarkers for the type and stage of lung diseases.

Geometry and energy constrained projection extension

BACKGROUND

In clinical computed tomography (CT) applications, when a patient is obese or improperly positioned, the final tomographic scan is often partially truncated. Images directly reconstructed by the conventional reconstruction algorithms suffer from severe cupping and direct current bias artifacts. Moreover, the current methods for projection extension have limitations that preclude incorporation from clinical workflows, such as prohibitive computational time for iterative reconstruction, extra radiation dose, hardware modification, etc.METHOD:In this study, we first established a geometrical constraint and estimated the patient habitus using a modified scout configuration. Then, we established an energy constraint using the integral invariance of fan-beam projections. Two constraints were extracted from the existing CT scan process with minimal modification to the clinical workflows. Finally, we developed a novel dual-constraint based optimization model that can be rapidly solved for projection extrapolation and accurate local reconstruction.

RESULTS

Both numerical phantom and realistic patient image simulations were performed, and the results confirmed the effectiveness of our proposed approach.

CONCLUSION

We establish a dual-constraint-based optimization model and correspondingly develop an accurate extrapolation method for partially truncated projections. The proposed method can be readily integrated into the clinical workflow and efficiently solved by using a one-dimensional optimization algorithm. Moreover, it is robust for noisy cases with various truncations and can be further accelerated by GPU based parallel computing.

Dual-rotation C-arm cone-beam computed tomography to increase low-contrast detection

PURPOSE

This paper investigates the capabilities of a dual-rotation C-arm cone-beam computed tomography (CBCT) framework to improve non-contrast-enhanced low-contrast detection for full volume or volume-of-interest (VOI) brain imaging.

METHOD

The idea is to associate two C-arm short-scan rotational acquisitions (spins): one over the full detector field of view (FOV) at low dose, and one collimated to deliver a higher dose to the central densest parts of the head. The angular sampling performed by each spin is allowed to vary in terms of number of views and angular positions. Collimated data is truncated and does not contain measurement of the incoming X-ray intensities in air (air calibration). When targeting full volume reconstruction, the method is intended to act as a virtual bow-tie. When targeting VOI imaging, the method is intended to provide the minimum full detector FOV data that sufficiently corrects for truncation artifacts. A single dedicated iterative algorithm is described that handles all proposed sampling configurations despite truncation and absence of air calibration.

RESULTS

Full volume reconstruction of dual-rotation simulations and phantom acquisitions are shown to have increased low-contrast detection for less dose, with respect to a single-rotation acquisition. High CNR values were obtained on 1% inserts of the Catphan® 515 module in 0.94 mm thick slices. Image quality for VOI imaging was preserved from truncation artifacts even with less than 10 non-truncated views, without using the sparsity a priori common to such context.

CONCLUSION

A flexible dual-rotation acquisition and reconstruction framework is proposed that has the potential to improve low-contrast detection in clinical C-arm brain soft-tissue imaging.

How Low Can We Go in Radiation Dose for the Data-Completion Scan on a Research Whole-Body Photon-Counting Computed Tomography System

PURPOSE

A research photon-counting computed tomography (CT) system that consists of an energy-integrating detector (EID) and a photon-counting detector (PCD) was installed in our laboratory. The scanning fields of view of the EID and PCD at the isocenter are 500 and 275 mm, respectively. When objects are larger than the PCD scanning field of view, a data-completion scan (DCS) using the EID subsystem is needed to avoid truncation artifacts in PCD images. The goals of this work were to (1) find the impact of a DCS on noise of PCD images and (2) determine the lowest possible dose for a DCS such that truncation artifacts are negligible in PCD images.

METHODS

First, 2 semianthropomorphic abdomen phantoms were scanned on the PCD subsystem. For each PCD scan, we acquired 1 DCS with the maximum effective mAs and 5 with lower effective mAs values. The PCD image reconstructed using the maximum effective mAs was considered as the reference image, and those using the lower effective mAs as the test images. The PCD image reconstructed without a DCS was considered the baseline image. Each PCD image was assessed in terms of noise and CT number uniformity; the results were compared among the baseline, test, and reference images. Finally, the impact of a DCS on PCD image quality was qualitatively assessed for other body regions using an anthropomorphic torso phantom.

RESULTS

The DCS had a negligible impact on the noise magnitude in the PCD images. The PCD images with the minimum available dose (CTDIvol < 2 mGy) showed greatly enhanced CT number uniformity compared with the baseline images without noticeable truncation artifacts. Further increasing the effective mAs of a DCS did not yield noticeable improvement in CT number uniformity.

CONCLUSIONS

A DCS using the minimum available dose had negligible effect on image noise and was sufficient to maintain satisfactory CT number uniformity for the PCD scans.

Augmented laminography, a correlative 3D imaging method for revealing the inner structure of compressed fossils

Non-destructive imaging techniques can be extremely useful tools for the investigation and the assessment of palaeontological objects, as mechanical preparation of rare and valuable fossils is precluded in most cases. However, palaeontologists are often faced with the problem of choosing a method among a wide range of available techniques. In this case study, we employ x-ray computed tomography (CT) and computed laminography (CL) to study the first fossil xiphosuran from the Muschelkalk (Middle Triassic) of the Netherlands. The fossil is embedded in micritic limestone, with the taxonomically important dorsal shield invisible, and only the outline of its ventral part traceable. We demonstrate the complementarity of CT and CL which offers an excellent option to visualize characteristic diagnostic features. We introduce augmented laminography to correlate complementary information of the two methods in Fourier space, allowing to combine their advantages and finally providing increased anatomical information about the fossil. This method of augmented laminography enabled us to identify the xiphosuran as a representative of the genus Limulitella.

Computed tomography and patient risk: Facts, perceptions and uncertainties

Since its introduction in the 1970s, computed tomography (CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses.

Half-Fan-Based Intensity-Weighted Region-of-Interest Imaging for Low-Dose Cone-Beam CT in Image-Guided Radiation Therapy

Objectives

With the increased use of computed tomography (CT) in clinics, dose reduction is the most important feature people seek when considering new CT techniques or applications. We developed an intensity-weighted region-of-interest (IWROI) imaging method in an exact half-fan geometry to reduce the imaging radiation dose to patients in cone-beam CT (CBCT) for image-guided radiation therapy (IGRT). While dose reduction is highly desirable, preserving the high-quality images of the ROI is also important for target localization in IGRT.

Methods

An intensity-weighting (IW) filter made of copper was mounted in place of a bowtie filter on the X-ray tube unit of an on-board imager (OBI) system such that the filter can substantially reduce radiation exposure to the outer ROI. In addition to mounting the IW filter, the lead-blade collimation of the OBI was adjusted to produce an exact half-fan scanning geometry for a further reduction of the radiation dose. The chord-based rebinned backprojection-filtration (BPF) algorithm in circular CBCT was implemented for image reconstruction, and a humanoid pelvis phantom was used for the IWROI imaging experiment.

Results

The IWROI image of the phantom was successfully reconstructed after beam-quality correction, and it was registered to the reference image within an acceptable level of tolerance. Dosimetric measurements revealed that the dose is reduced by approximately 61% in the inner ROI and by 73% in the outer ROI compared to the conventional bowtie filter-based half-fan scan.

Conclusions

The IWROI method substantially reduces the imaging radiation dose and provides reconstructed images with an acceptable level of quality for patient setup and target localization. The proposed half-fan-based IWROI imaging technique can add a valuable option to CBCT in IGRT applications.

Effect of Low-Dose MDCT and Iterative Reconstruction on Trabecular Bone Microstructure Assessment

We investigated the effects of low-dose multi detector computed tomography (MDCT) in combination with statistical iterative reconstruction algorithms on trabecular bone microstructure parameters. Twelve donated vertebrae were scanned with the routine radiation exposure used in our department (standard-dose) and a low-dose protocol. Reconstructions were performed with filtered backprojection (FBP) and maximum-likelihood based statistical iterative reconstruction (SIR). Trabecular bone microstructure parameters were assessed and statistically compared for each reconstruction. Moreover, fracture loads of the vertebrae were biomechanically determined and correlated to the assessed microstructure parameters. Trabecular bone microstructure parameters based on low-dose MDCT and SIR significantly correlated with vertebral bone strength. There was no significant difference between microstructure parameters calculated on low-dose SIR and standard-dose FBP images. However, the results revealed a strong dependency on the regularization strength applied during SIR. It was observed that stronger regularization might corrupt the microstructure analysis, because the trabecular structure is a very small detail that might get lost during the regularization process. As a consequence, the introduction of SIR for trabecular bone microstructure analysis requires a specific optimization of the regularization parameters. Moreover, in comparison to other approaches, superior noise-resolution trade-offs can be found with the proposed methods.

Kinect-Based Correction of Overexposure Artifacts in Knee Imaging with C-Arm CT Systems

Objective. To demonstrate a novel approach of compensating overexposure artifacts in CT scans of the knees without attaching any supporting appliances to the patient. C-Arm CT systems offer the opportunity to perform weight-bearing knee scans on standing patients to diagnose diseases like osteoarthritis. However, one serious issue is overexposure of the detector in regions close to the patella, which can not be tackled with common techniques. Methods. A Kinect camera is used to algorithmically remove overexposure artifacts close to the knee surface. Overexposed near-surface knee regions are corrected by extrapolating the absorption values from more reliable projection data. To achieve this, we develop a cross-calibration procedure to transform surface points from the Kinect to CT voxel coordinates. Results. Artifacts at both knee phantoms are reduced significantly in the reconstructed data and a major part of the truncated regions is restored. Conclusion. The results emphasize the feasibility of the proposed approach. The accuracy of the cross-calibration procedure can be increased to further improve correction results. Significance. The correction method can be extended to a multi-Kinect setup for use in real-world scenarios. Using depth cameras does not require prior scans and offers the possibility of a temporally synchronized correction of overexposure artifacts. To achieve this, we develop a cross-calibration procedure to transform surface points from the Kinect to CT voxel coordinates.

Interior tomographic imaging of mouse heart in a carbon nanotube micro-CT

BACKGROUND

The relatively high radiation dose from micro-CT is a cause for concern in preclinical research involving animal subjects. Interior region-of-interest (ROI) imaging was proposed for dose reduction, but has not been experimentally applied in micro-CT.

OBJECTIVE

Our aim is to implement interior ROI imaging in a carbon nanotube (CNT) x-ray source based micro-CT, and present the ROI image quality and radiation dose reduction for interior cardiac micro-CT imaging of a mouse heart in situ.

METHODS

An aperture collimator was mounted at the source-side to induce a small-sized cone beam (10 mm width) at the isocenter. Interior in situ micro-CT scans were conducted on a mouse carcass and several micro-CT phantoms. A GPU-accelerated hybrid iterative reconstruction algorithm was employed for volumetric image reconstruction. Radiation dose was measured for the same system operated at the interior and global micro-CT modes.

RESULTS

Visual inspection demonstrated comparable image quality between two scan modes. Quantitative evaluation demonstrated high structural similarity index (up to 0.9614) with improved contrast-noise-ratio (CNR) on interior micro-CT mode. Interior micro-CT mode yielded significant reduction (up to 83.9%) for dose length product (DLP).

CONCLUSIONS

This work demonstrates the applicability of using CNT x-ray source based interior micro-CT for preclinical imaging with significantly reduced radiation dose.

Collimation and Image Quality of C-Arm Computed Tomography: Potential of Radiation Dose Reduction While Maintaining Equal Image Quality

OBJECTIVES

The aim of this study was to assess the potential for radiation dose reduction in collimated C-arm computed tomography (CACT) while maintaining the image quality of the full field of view (FFOV) acquisition.

MATERIAL AND METHODS

A whole-body anthropomorphic phantom representing a 70-kg male was used in this study. The upper abdomen of the phantom was imaged using an angiographic system (Artis Zeego Q; Siemens Healthcare, Germany) with either the standard detector radiation dose level (RDL; D100, 360 nGy) or 14 experimental reduced RDLs ranging from 95% (D95, 342 nGy) to 30% D100 (D30, 108 nGy). Either the FFOV (craniocaudal coverage, 18 cm) or a collimated field of view (CFOV; craniocaudal coverage, 6 cm) was applied. The organ dose was measured using thermoluminescence detector dosimetry, and the mean effective dose was computed according to the recommendations by the International Commission on Radiological Protection Publication 103. To compare the CFOV and the FFOV data sets, image quality was assessed in terms of high- and low-contrast resolution by calculating the modulation transfer function using the wire method as well as the image noise, signal-to-noise ratio, and contrast-to-noise ratio using a low-contrast insert placed in the upper abdomen (Δ50 HU).

RESULTS

Collimated imaging (CFOV) covering 33% of the FFOV led to an increase in the x-ray tube output of 152% for CFOV (D100; FFOV, 95.5 mGy; CFOV, 147.7 mGy) to maintain the detector dose. The mean effective dose of D100 was 6.0 mSv (male) and 6.2 mSv (female) for the FFOV and 3.7 mSv (male) and 4.1 mSv (female) for the CFOV. High-contrast resolution was comparable for all acquisition protocols (mean 10% modulation transfer function ± 95% confidence interval; FFOV, 8.8 ± 0.1 line pairs/cm; CFOV, 8.8 ± 0.1 line pairs/cm). Low-contrast resolution was superior for the CFOV compared with that for the FFOV for each RDL (D100; image noise: FFOV, 34 ± 2 HU; CFOV, 22 ± 1 HU; contrast-to-noise ratio: FFOV, 1.3 ± 0.2; CFOV, 1.8 ± 0.3). Low-contrast resolution of the standard (D100) FFOV acquisition was achieved for the CFOV at 84% D100 of the FFOV and 54% D100 of the CFOV. Therefore, collimation up to 33% of the FFOV combined with the lower detector dose allows overall reduction of a patient's radiation exposure to 33% × 84% = 28% compared with FFOV acquisition. In the upper abdomen, this results in a nearly 50% reduction of the mean effective radiation dose (male, 2.0 mSv; female, 2.2 mSv) without loss of image quality compared with the standard FFOV acquisition.

CONCLUSIONS

Craniocaudal collimation in CACT should be used whenever possible to increase the image quality and reduce the patient's overall radiation exposure. Therefore, new smart acquisition protocols are required for collimated CACT to improve the trade-off between radiation exposure and image quality requirements considering the collimation used.

Low-Dose Volume-of-Interest C-Arm CT Imaging of Intracranial Stents and Flow Diverters

BACKGROUND AND PURPOSE

Volume-of-interest C-arm CT is a novel technique for imaging of intracranial high-contrast objects. We performed this study to evaluate the potential diagnostic value and radiation dose reduction of this technique for imaging of intracranial stents and flow diverters.

MATERIALS AND METHODS

Twenty-seven patients were imaged with a VOI C-arm CT scan following treatment with a flow diverter or stent-assisted coiling. The radiation dose-area product was recorded for VOI scans. For comparison, the dose-area product from 30 previously acquired consecutive full-view DynaCTs was used. Thermoluminescence dosimetry by using 35 evenly distributed thermoluminescence dosimeters in an anthropomorphic head phantom was also performed by using both conventional full field and VOI acquisitions. Three observers were presented with VOI images for assessment of the potential diagnostic value.

RESULTS

The dose-area product measurements showed an exposure reduction of 85% compared with the full field acquisitions used for comparison. The thermoluminescence dosimetry evaluations also showed a considerable dose reduction of 79.8% throughout the volume. For most of the evaluated cases, the observers thought that diagnostically useful information was provided by the VOI images (α = .810). Visualization of device details, such as the extent of opening, positioning, wall apposition, and aneurysm coverage, was judged of good diagnostic quality for most cases (88.9%-92.6%).

CONCLUSIONS

In this study, VOI C-arm CT provided high-quality diagnostic images of intracranial stents and flow diverters at a dramatic reduction of radiation exposure. Image content was thought to add useful information. It is a promising method to assess device status during procedures and at follow-up.

Patient-bounded extrapolation using low-dose priors for volume-of-interest imaging in C-arm CT

PURPOSE

Three-dimensional (3D) volume-of-interest (VOI) imaging with C-arm systems provides anatomical information in a predefined 3D target region at a considerably low x-ray dose. However, VOI imaging involves laterally truncated projections from which conventional reconstruction algorithms generally yield images with severe truncation artifacts. Heuristic based extrapolation methods, e.g., water cylinder extrapolation, typically rely on techniques that complete the truncated data by means of a continuity assumption and thus appear to be ad-hoc. It is our goal to improve the image quality of VOI imaging by exploiting existing patient-specific prior information in the workflow.

METHODS

A necessary initial step prior to a 3D acquisition is to isocenter the patient with respect to the target to be scanned. To this end, low-dose fluoroscopic x-ray acquisitions are usually applied from anterior-posterior (AP) and medio-lateral (ML) views. Based on this, the patient is isocentered by repositioning the table. In this work, we present a patient-bounded extrapolation method that makes use of these noncollimated fluoroscopic images to improve image quality in 3D VOI reconstruction. The algorithm first extracts the 2D patient contours from the noncollimated AP and ML fluoroscopic images. These 2D contours are then combined to estimate a volumetric model of the patient. Forward-projecting the shape of the model at the eventually acquired C-arm rotation views gives the patient boundary information in the projection domain. In this manner, we are in the position to substantially improve image quality by enforcing the extrapolated line profiles to end at the known patient boundaries, derived from the 3D shape model estimate.

RESULTS

The proposed method was evaluated on eight clinical datasets with different degrees of truncation. The proposed algorithm achieved a relative root mean square error (rRMSE) of about 1.0% with respect to the reference reconstruction on nontruncated data, even in the presence of severe truncation, compared to a rRMSE of 8.0% when applying a state-of-the-art heuristic extrapolation technique.

CONCLUSIONS

The method we proposed in this paper leads to a major improvement in image quality for 3D C-arm based VOI imaging. It involves no additional radiation when using fluoroscopic images that are acquired during the patient isocentering process. The model estimation can be readily integrated into the existing interventional workflow without additional hardware.

Dental cone beam CT: A review

For the maxillofacial region, there are various indications that cannot be interpreted from 2D images and will benefit from multiplanar viewing. Dental cone beam CT (CBCT) utilises a cone- or pyramid-shaped X-ray beam using mostly flat-panel detectors for 3D image reconstruction with high spatial resolution. The vast increase in availability and amount of these CBCT devices offers many clinical benefits, and their ongoing development has potential to bring various new clinical applications for medical imaging. Additionally, there is also a need for high quality research and education. European guidelines promote the use of a medical physics expert for advice on radiation protection, patient dose optimisation, and equipment testing. In this review article, we perform a comparison of technical equipment based on manufacturer data, including scanner specific X-ray spectra, and describe issues concerning CBCT image reconstruction and image quality, and also address radiation dose issues, dosimetry, and optimisation. We also discuss clinical needs and what type of education users should have in order to operate CBCT systems safely. We will also take a look into the future and discuss the issues that still need to be solved.

Reconstructing cone-beam CT with spatially varying qualities for adaptive radiotherapy: a proof-of-principle study

With the aim of maximally reducing imaging dose while meeting requirements for adaptive radiation therapy (ART), we propose in this paper a new cone beam CT (CBCT) acquisition and reconstruction method that delivers images with a low noise level inside a region of interest (ROI) and a relatively high noise level outside the ROI. The acquired projection images include two groups: densely sampled projections at a low exposure with a large field of view (FOV) and sparsely sampled projections at a high exposure with a small FOV corresponding to the ROI. A new algorithm combining the conventional filtered back-projection algorithm and the tight-frame iterative reconstruction algorithm is also designed to reconstruct the CBCT based on these projection data. We have validated our method on a simulated head-and-neck (HN) patient case, a semi-real experiment conducted on a HN cancer patient under a full-fan scan mode, as well as a Catphan phantom under a half-fan scan mode. Relative root-mean-square errors (RRMSEs) of less than 3% for the entire image and ~1% within the ROI compared to the ground truth have been observed. These numbers demonstrate the ability of our proposed method to reconstruct high-quality images inside the ROI. As for the part outside ROI, although the images are relatively noisy, it can still provide sufficient information for radiation dose calculations in ART. Dose distributions calculated on our CBCT image and on a standard CBCT image are in agreement, with a mean relative difference of 0.082% inside the ROI and 0.038% outside the ROI. Compared with the standard clinical CBCT scheme, an imaging dose reduction of approximately 3-6 times inside the ROI was achieved, as well as an 8 times outside the ROI. Regarding computational efficiency, it takes 1-3 min to reconstruct a CBCT image depending on the number of projections used. These results indicate that the proposed method has the potential for application in ART.

Compensator models for fluence field modulated computed tomography

PURPOSE

Fluence field modulated computed tomography (FFMCT) presents a novel approach for acquiring CT images, whereby a patient model guides dynamically changing fluence patterns in an attempt to achieve task-based, user-prescribed, regional variations in image quality, while also controlling dose to the patient. This work aims to compare the relative effectiveness of FFMCT applied to different thoracic imaging tasks (routine diagnostic CT, lung cancer screening, and cardiac CT) when the modulator is subject to limiting constraints, such as might be present in realistic implementations.

METHODS

An image quality plan was defined for a simulated anthropomorphic chest slice, including regions of high and low image quality, for each of the thoracic imaging tasks. Modulated fluence patterns were generated using a simulated annealing optimization script, which attempts to achieve the image quality plan under a global dosimetric constraint. Optimization was repeated under different types of modulation constraints (e.g., fixed or gantry angle dependent patterns, continuous or comprised of discrete apertures) with the most limiting case being a fixed conventional bowtie filter. For each thoracic imaging task, an image quality map (IQMsd) representing the regionally varying standard deviation is predicted for each modulation method and compared to the prescribed image quality plan as well as against results from uniform fluence fields. Relative integral dose measures were also compared.

RESULTS

Each IQMsd resulting from FFMCT showed improved agreement with planned objectives compared to those from uniform fluence fields for all cases. Dynamically changing modulation patterns yielded better uniformity, improved image quality, and lower dose compared to fixed filter patterns with optimized tube current. For the latter fixed filter cases, the optimal choice of tube current modulation was found to depend heavily on the task. Average integral dose reduction compared to a uniform fluence field ranged from 10% using a bowtie filter to 40% or greater using an idealized modulator.

CONCLUSIONS

The results support that FFMCT may achieve regionally varying image quality distributions in good agreement with user-prescribed values, while limiting dose. The imposition of constraints inhibits dose reduction capacity and agreement with image quality plans but still yields significant improvement over what is afforded by conventional dose minimization techniques. These results suggest that FFMCT can be implemented effectively even when the modulator has limited modulation capabilities.

Experimental realization of fluence field modulated CT using digital beam attenuation

Tailoring CT scan acquisition parameters to individual patients is a topic of much research in the CT imaging community. It is now common place to find automatically adjusted tube current options for modern CT scanners. In addition, the use of beam shaping filters, commonly called bowtie filters, is available on most CT systems and allows for different body regions to receive different incident x-ray fluence distributions. However, no method currently exists which allows for the form of the incident x-ray fluence distribution to change as a function of the view angle. This study represents the first experimental realization of fluence field modulated CT (FFMCT) for a c-arm geometry CT scan. X-ray fluence modulation is accomplished using a digital beam attenuator (DBA). The device is composed of ten iron wedge pairs that modulate the thickness of iron, the x-rays must traverse before reaching a patient. Using this device, experimental data was taken using a Siemens Zeego c-arm scanner. Scans were performed on a cylindrical polyethylene phantom and on two different sections of an anthropomorphic phantom. The DBA was used to equalize the x-ray fluence striking the detector for each scan. Non DBA, or 'flat field' scans were also acquired of the same phantom objects for comparison. In addition, a scan was performed in which the DBA was used to enable volume of interest (VOI) imaging. In VOI, only a small sub-volume within a patient receives full dose and the rest of the patient receives a much lower dose. Data corrections unique to using a piece-wise constant modulator were also developed. The feasibility of FFMCT implemented using a DBA device has been demonstrated. Initial results suggest dose reductions of up to 3.6 times relative to 'flat field' CT. In addition to dose reduction, the DBA enables a large improvement in image noise uniformity and the ability to provide regionally enhanced signal to noise using VOI imaging techniques. The results presented in this paper take the field of FFMCT from the theoretical stage to that of possible clinical implementation. FFMCT, as shown in this paper, can reduce the patient dose while maintaining or improving image quality. In addition, the DBA has been experimentally shown to be well suited to implement entirely new imaging methods like photon counting and VOI imaging.

Towards clinical application of a Laplace operator-based region of interest reconstruction algorithm in C-arm CT

It is known that a reduction of the field-of-view in 3-D X-ray imaging is proportional to a reduction in radiation dose. The resulting truncation, however, is incompatible with conventional reconstruction algorithms. Recently, a novel method for region of interest reconstruction that uses neither prior knowledge nor extrapolation has been published, named approximated truncation robust algorithm for computed tomography (ATRACT). It is based on a decomposition of the standard ramp filter into a 2-D Laplace filtering and a 2-D Radon-based residual filtering step. In this paper, we present two variants of the original ATRACT. One is based on expressing the residual filter as an efficient 2-D convolution with an analytically derived kernel. The second variant is to apply ATRACT in 1-D to further reduce computational complexity. The proposed algorithms were evaluated by using a reconstruction benchmark, as well as two clinical data sets. The results are encouraging since the proposed algorithms achieve a speed-up factor of up to 245 compared to the 2-D Radon-based ATRACT. Reconstructions of high accuracy are obtained, e.g., even real-data reconstruction in the presence of severe truncation achieve a relative root mean square error of as little as 0.92% with respect to nontruncated data.

The meaning of interior tomography

The classic imaging geometry for computed tomography is for the collection of un-truncated projections and the reconstruction of a global image, with the Fourier transform as the theoretical foundation that is intrinsically non-local. Recently, interior tomography research has led to theoretically exact relationships between localities in the projection and image spaces and practically promising reconstruction algorithms. Initially, interior tomography was developed for x-ray computed tomography. Then, it was elevated to have the status of a general imaging principle. Finally, a novel framework known as 'omni-tomography' is being developed for a grand fusion of multiple imaging modalities, allowing tomographic synchrony of diversified features.

Approximate truncation robust computed tomography--ATRACT

We present an approximate truncation robust algorithm to compute tomographic images (ATRACT). This algorithm targets at reconstructing volumetric images from cone-beam projections in scenarios where these projections are highly truncated in each dimension. It thus facilitates reconstructions of small subvolumes of interest, without involving prior knowledge about the object. Our method is readily applicable to medical C-arm imaging, where it may contribute to new clinical workflows together with a considerable reduction of x-ray dose. We give a detailed derivation of ATRACT that starts from the conventional Feldkamp filtered-backprojection algorithm and that involves, as one component, a novel original formula for the inversion of the two-dimensional Radon transform. Discretization and numerical implementation are discussed and reconstruction results from both, simulated projections and first clinical data sets are presented.

Volume-of-interest imaging of the inner ear in a human temporal bone specimen using a robot- driven C-arm flat panel detector CT system

VOI imaging can provide higher image quality at a reduced dose for a subregion. In this study with a robot-driven C-arm FDCT system, the goals were proof of feasibility for inner ear imaging, higher flexibility during data acquisition, and easier processing during reconstruction. First a low-dose OV scan was acquired allowing an orientation and enabling the selection of the VOI. The C-arm was then moved by the robotic system without a need for patient movement and the VOI was scanned with adapted parameters. Uncompromised artifact-free image quality was achieved by the 2-scan approach and the dose was reduced by 80%-90% in comparison with conventional MSCT and FPCT scans.

Achieving routine submillisievert CT scanning: report from the summit on management of radiation dose in CT

This Special Report presents the consensus of the Summit on Management of Radiation Dose in Computed Tomography (CT) (held in February 2011), which brought together participants from academia, clinical practice, industry, and regulatory and funding agencies to identify the steps required to reduce the effective dose from routine CT examinations to less than 1 mSv. The most promising technologies and methods discussed at the summit include innovations and developments in x-ray sources; detectors; and image reconstruction, noise reduction, and postprocessing algorithms. Access to raw projection data and standard data sets for algorithm validation and optimization is a clear need, as is the need for new, clinically relevant metrics of image quality and diagnostic performance. Current commercially available techniques such as automatic exposure control, optimization of tube potential, beam-shaping filters, and dynamic z-axis collimators are important, and education to successfully implement these methods routinely is critically needed. Other methods that are just becoming widely available, such as iterative reconstruction, noise reduction, and postprocessing algorithms, will also have an important role. Together, these existing techniques can reduce dose by a factor of two to four. Technical advances that show considerable promise for additional dose reduction but are several years or more from commercial availability include compressed sensing, volume of interest and interior tomography techniques, and photon-counting detectors. This report offers a strategic roadmap for the CT user and research and manufacturer communities toward routinely achieving effective doses of less than 1 mSv, which is well below the average annual dose from naturally occurring sources of radiation.

Time-resolved cardiac interventional cone-beam CT reconstruction from fully truncated projections using the prior image constrained compressed sensing (PICCS) algorithm

C-arm cone-beam CT could replace preoperative multi-detector CT scans in the cardiac interventional setting. However, cardiac gating results in view angle undersampling and the small size of the detector results in projection data truncation. These problems are incompatible with conventional tomographic reconstruction algorithms. In this paper, the prior image constrained compressed sensing (PICCS) reconstruction method was adapted to solve these issues. The performance of the proposed method was compared to that of FDK, FDK with extrapolated projection data (E-FDK), and total variation-based compressed sensing. A canine projection dataset acquired using a clinical C-arm imaging system supplied realistic cardiac motion and anatomy for this evaluation. Three different levels of truncation were simulated. The relative root mean squared error and the universal image quality index were used to quantify the reconstruction accuracy. Three main conclusions were reached. (1) The adapted version of the PICCS algorithm offered the highest image quality and reconstruction accuracy. (2) No meaningful variation in performance was observed when the amount of truncation was changed. (3) This study showed evidence that accurate interior tomography with an undersampled acquisition is possible for realistic objects if a prior image with minimal artifacts is available.

High resolution dual detector volume-of-interest cone beam breast CT--Demonstration with a bench top system

PURPOSE

In this study, we used a small field high resolution detector in conjunction with a full field flat panel detector to implement and investigate the dual detector volume-of-interest (VOI) cone beam breast computed tomography (CBCT) technique on a bench-top system. The potential of using this technique to image small calcifications without increasing the overall dose to the breast was demonstrated. Significant reduction of scatter components in the high resolution projection image data of the VOI was also shown.

METHODS

With the regular flat panel based CBCT technique, exposures were made at 80 kVp to generate an air kerma of 6 mGys at the isocenter. With the dual detector VOI CBCT technique, a high resolution small field CMOS detector was used to scan a cylindrical VOI (2.5 cm in diameter and height, 4.5 cm off-center) with collimated x-rays at four times of regular exposure level. A flat panel detector was used for full field scan with low x-ray exposures at half of the regular exposure level. The low exposure full field image data were used to fill in the truncated space in the VOI scan data and generate a complete projection image set. The Feldkamp-Davis-Kress (FDK) filtered backprojection algorithm was used to reconstruct high resolution images for the VOI. Two scanning techniques, one breast centered and the other VOI centered, were implemented and investigated. Paraffin cylinders with embedded thin aluminum (Al) wires were imaged and used in conjunction with optically stimulated luminescence (OSL) dose measurements to demonstrate the ability of this technique to image small calcifications without increasing the mean glandular dose (MGD).

RESULTS

Using exposures that produce an air kerma of 6 mGys at the isocenter, the regular CBCT technique was able to resolve the cross-sections of Al wires as thin as 254 μm in diameter in the phantom. For the specific VOI studied, by increasing the exposure level by a factor of 4 for the VOI scan and reducing the exposure level by a factor of 2 for the full filed scan, the dual-detector CBCT technique was able to resolve the cross-sections of Al wires as thin as 152 μm in diameter. The CNR evaluated for the entire Al wire cross-section was found to be improved from 5.5 in regular CBCT to 14.4 and 16.8 with the breast centered and VOI centered scanning techniques, respectively. Even inside VOI center, the VOI scan resulted in significant dose saving with the dose reduced by a factor of 1.6 at the VOI center. Dose saving outside the VOI was substantial with the dose reduced by a factor of 7.3 and 7.8 at the breast center for the breast centered and VOI centered scans, respectively, when compared to full field scan at the same exposure level. The differences between the two dual detector techniques in terms of dose saving and scatter reduction were small with VOI scan at 4× exposure level and full field scan at 0.5 × exposure level. The MGDs were only 94% of that from the regular CBCT scan.

CONCLUSIONS

For the specific VOI studied, the dual detector VOI CBCT technique has the potential to provide high quality images inside the VOI with MGD similar to or even lower than that of full field breast CBCT. It was also found that our results were compromised by the use of inadequate detectors for the VOI scan. An appropriately selected detector would better optimize the image quality improvement that can be achieved with the VOI CBCT technique.

Feasibility of flat panel angiographic CT after intravenous contrast agent application in the postoperative evaluation of patients with clipped aneurysms

BACKGROUND AND PURPOSE

Important findings, such as aneurysm remnants or major arterial occlusion, can be detected on intra- or postoperative angiography after surgical clipping of intracranial aneurysms. The purpose of this study was to evaluate the feasibility of IV-ACT for the postoperative detection of residual aneurysms and parent vessel patency compared with IA-DSA, which was selected as the standard reference method.

MATERIALS AND METHODS

Twenty-two patients with 27 aneurysms treated by surgical clipping were examined by using both IA-DSA and IV-ACT. Both diagnostic procedures were performed on an FPD-equipped angiography system. Postprocessing of IV-ACT acquisitions was performed on a dedicated workstation producing multiplanar reformations and maximum intensity projections of the clip region and other intracranial arteries. Three interventional neuroradiologists independently evaluated both procedures.

RESULTS

A residual aneurysm was delineated in 10 cases with IA-DSA. Sufficient opacification of the intracranial vessels was assigned in 26 IV-ACT cases. Due to metal artifacts, IV-ACT images were tagged as "not diagnostic" on 8 occasions. In the other 19 aneurysms, a residual aneurysm was delineated in 6 cases-all 6 being true-positive compared with IA-DSA-and was excluded in the remaining 13 cases-all true-negative. Even small aneurysm remnants with a diameter of 1.5 mm were detected with IV-ACT.

CONCLUSIONS

Currently IV-ACT cannot be recommended as a routine tool for postoperative evaluation of clipped aneurysms due to metal artifacts in 30% of the examinations. These artifacts appear with multiple normal-sized or large clips. In patients with single or multiple small clips, IV-ACT can reliably show aneurysm remnants.

Comparison of extended field-of-view reconstructions in C-arm flat-detector CT using patient size, shape or attenuation information

In C-arm-based flat-detector computed tomography (FDCT) it frequently happens that the patient exceeds the scan field of view (SFOV) in the transaxial direction because of the limited detector size. This results in data truncation and CT image artefacts. In this work three truncation correction approaches for extended field-of-view (EFOV) reconstructions have been implemented and evaluated. An FDCT-based method estimates the patient size and shape from the truncated projections by fitting an elliptical model to the raw data in order to apply an extrapolation. In a camera-based approach the patient is sampled with an optical tracking system and this information is used to apply an extrapolation. In a CT-based method the projections are completed by artificial projection data obtained from the CT data acquired in an earlier exam. For all methods the extended projections are filtered and backprojected with a standard Feldkamp-type algorithm. Quantitative evaluations have been performed by simulations of voxelized phantoms on the basis of the root mean square deviation and a quality factor Q (Q = 1 represents the ideal correction). Measurements with a C-arm FDCT system have been used to validate the simulations and to investigate the practical applicability using anthropomorphic phantoms which caused truncation in all projections. The proposed approaches enlarged the FOV to cover wider patient cross-sections. Thus, image quality inside and outside the SFOV has been improved. Best results have been obtained using the CT-based method, followed by the camera-based and the FDCT-based truncation correction. For simulations, quality factors up to 0.98 have been achieved. Truncation-induced cupping artefacts have been reduced, e.g., from 218% to less than 1% for the measurements. The proposed truncation correction approaches for EFOV reconstructions are an effective way to ensure accurate CT values inside the SFOV and to recover peripheral information outside the SFOV.