Experimental demonstration and optimization of X-ray StaticCodeCT

As the use of X-ray computed tomography (CT) grows in medical diagnosis, so does the concern for the harm a radiation dose can cause and the biological risks it represents. StaticCodeCT is a new low-dose imaging architecture that uses a single-static coded aperture (CA) in a CT gantry. It exploits the highly correlated data in the projection domain to estimate the unobserved measurements on the detector. We previously analyzed the StaticCodeCT system by emulating the effect of the coded mask on experimental CT data. In contrast, this manuscript presents test-bed reconstructions using an experimental cone-beam X-ray CT system with a CA holder. We analyzed the reconstruction quality using three different techniques to manufacture the CAs: metal additive manufacturing, cold casting, and ceramic additive manufacturing. Furthermore, we propose an optimization method to design the CA pattern based on the algorithm developed for the measurement estimation. The obtained results point to the possibility of the real deployment of StaticCodeCT systems in practice.

Evaluation of a metal artifact reduction algorithm and an adaptive image noise optimization filter in the estimation of peri-implant fenestration defects using cone beam computed tomography: an in-vitro study

OBJECTIVE

The aim of this study is to assess the effects of metal artifact reduction (MAR) and adaptive image noise enhancer (AINO) in CBCT imaging on the detection accuracy of artificially created fenestration defects in proximity to titanium and zirconium implants in sheep jaw.

METHODS

Six zirconium and 10 titanium implants were planted on mandibular jaws of three sheep, and artificial defects were created. All images were obtained with a standard voxel size (0.150 mm³) and with 4 scan modes: (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO during CBCT scanning. A total of 60 CBCT scans were produced.

RESULTS

For all types of implants, intra- and inter-observer kappa values were the highest for MAR filter. The scan mode of with MAR filter was found to have the highest area under the curve (AUC), whereas the scan mode of without both MAR and AINO filters was found to have the lowest AUC values with statistical significance (p ≤ 0.05). Titanium implants were found to have higher AUC values than zirconium (p ≤ 0.05).

CONCLUSION

Both MAR module and AINO filters enhance the accuracy of the detection of peri-implant fenestrations; however, the use of MAR filter solely can be recommended for detection of peri-implant fenestrations.

StaticCodeCT: single coded aperture tensorial X-ray CT

Coded aperture X-ray CT (CAXCT) is a new low-dose imaging technology that promises far-reaching benefits in industrial and clinical applications. It places various coded apertures (CA) at a time in front of the X-ray source to partially block the radiation. The ill-posed inverse reconstruction problem is then solved using l1-norm-based iterative reconstruction methods. Unfortunately, to attain high-quality reconstructions, the CA patterns must change in concert with the view-angles making the implementation impractical. This paper proposes a simple yet radically different approach to CAXCT, which is coined StaticCodeCT, that uses a single-static CA in the CT gantry, thus making the imaging system amenable for practical implementations. Rather than using conventional compressed sensing algorithms for recovery, we introduce a new reconstruction framework for StaticCodeCT. Namely, we synthesize the missing measurements using low-rank tensor completion principles that exploit the multi-dimensional data correlation and low-rank nature of a 3-way tensor formed by stacking the 2D coded CT projections. Then, we use the FDK algorithm to recover the 3D object. Computational experiments using experimental projection measurements exhibit up to 10% gains in the normalized root mean square distance of the reconstruction using the proposed method compared with those attained by alternative low-dose systems.

A unified scatter rejection and correction method for cone beam computed tomography

PURPOSE

Scattered radiation is a major cause of image quality degradation in flat panel detector-based cone beam CT (CBCT). While recently introduced 2D antiscatter grids reject the majority of scatter fluence, the small percentage of scatter fluence still transmitted to the detector remains a major challenge for implementation of quantitative imaging techniques such as dual energy imaging in CBCT. Additionally, this residual scatter is also a major source of grid-induced artifacts, which impedes implementation of 2D grids in CBCT. We therefore present a new method to achieve both robust scatter rejection and residual scatter correction using a 2D antiscatter grid; in doing so, we expand the role of 2D grids from mere scatter rejection devices to scatter measurement devices.

METHOD

In our method, the radiopaque septa of the 2D grid emulate a micro array of beam-stops placed on the detector which introduce spatially periodic septal shadows. By selecting sufficiently thin grid septa, the primary intensity can be reduced while preserving the uniformity of scatter intensity. This enables us to correlate the modulated pixel signal intensity in septal shadows with local scatter intensity. Our method then exploits this correlation to measure and remove residual scatter intensity from projections. No assumptions are made about the object being imaged. We refer to this as Grid-based Scatter Sampling (GSS). In this work, we evaluate the principle of signal modulation with grid septa, the accuracy of scatter estimates, and the effect of the GSS method on image quality using simulations and measurements. We also implement the GSS method experimentally using a 2D grid prototype.

RESULTS

Our results demonstrate that the GSS method increased CT number accuracy and reduced image artifacts associated with scatter. With 2D grid and residual scatter correction, HU nonuniformity was reduced from 65 HU to 30 HU in pelvis sized phantoms, and HU variations due to change in phantom size were reduced from 59 HU to 20 HU, when compared to use of only a 2D grid. With residual scatter correction via GSS method, grid-induced ring artifacts were suppressed, leading to a 41% reduction in noise. The shape of the modulation transfer function (MTF) was preserved before and after suppression of ring artifacts.

CONCLUSIONS

Our grid-based scatter sampling method enables utilization of a 2D grid as a scatter measurement and correction device. This method significantly improves quantitative accuracy in CBCT, further reducing the image quality gap between CBCT and multi-detector CT. By correcting residual scatter with the proposed method, grid-induced line artifacts in projections and associated ring artifacts in CBCT images were also suppressed with no compromise of spatial resolution.

Artificial intelligence in radiotherapy: a technological review

Radiation therapy (RT) is widely used to treat cancer. Technological advances in RT have occurred in the past 30 years. These advances, such as three-dimensional image guidance, intensity modulation, and robotics, created challenges and opportunities for the next breakthrough, in which artificial intelligence (AI) will possibly play important roles. AI will replace certain repetitive and labor-intensive tasks and improve the accuracy and consistency of others, particularly those with increased complexity because of technological advances. The improvement in efficiency and consistency is important to manage the increasing cancer patient burden to the society. Furthermore, AI may provide new functionalities that facilitate satisfactory RT. The functionalities include superior images for real-time intervention and adaptive and personalized RT. AI may effectively synthesize and analyze big data for such purposes. This review describes the RT workflow and identifies areas, including imaging, treatment planning, quality assurance, and outcome prediction, that benefit from AI. This review primarily focuses on deep-learning techniques, although conventional machine-learning techniques are also mentioned.

Evaluation of a metal artifact reduction algorithm and an optimization filter in the estimation of peri-implant dehiscence defects by using cone beam computed tomography: an in-vitro study

OBJECTIVES

The aim of this study was to assess the effect of a metal artifact reduction (MAR) algorithm and the adaptive image noise optimizer (AINO) optimization filter in the detection of peri-implant dehiscences with cone beam computed tomography (CBCT).

STUDY DESIGN

Nine implants (3 zirconium, 3 titanium, and 3 zirconium-titanium) were placed in 3 sheep heads. Dehiscences were created on the buccal and lingual/palatal surfaces. A total of 9 defects and 9 controls with no defects were evaluated by 3 observers. Each sheep head was scanned 5 times with 4 scan modes; (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO. Receiver operating characteristic analysis and weighted kappa coefficients were used to calculate diagnostic efficacy and intra- and interobserver agreements for each implant type and scan mode.

RESULTS

For all implant types, dehiscences were most accurately detected when both MAR and AINO were applied (P ≤ .045). Detection of dehiscences was more accurate with titanium implants (P ≤ .040). There were no significant differences in agreement among and between the observers.

CONCLUSIONS

The use of both MAR and AINO enhanced the detection accuracy of artificially created dehiscences in proximity to implants. Their combined use is recommended for detecting peri-implant dehiscences.

Optimization of the geometry and speed of a moving blocker system for cone-beam computed tomography scatter correction

PURPOSE

X-ray scatter is a significant barrier to image quality improvements in cone-beam computed tomography (CBCT). A moving blocker-based strategy was previously proposed to simultaneously estimate scatter and reconstruct the complete volume within the field of view (FOV) from a single CBCT scan. A blocker consisting of lead stripes is inserted between the X-ray source and the imaging object, and moves back and forth along the rotation axis during gantry rotation. While promising results were obtained in our previous studies, the geometric design and moving speed of the blocker were set empirically. The goal of this work is to optimize the geometry and speed of the moving block system.

METHODS

Performance of the blocker was examined through Monte Carlo (MC) simulation and experimental studies with various geometry designs and moving speeds. All hypothetical designs employed an anthropomorphic pelvic phantom. The scatter estimation accuracy was quantified by using lead stripes ranging from 5 to 100 pixels on the detector plane. An iterative reconstruction based on total variation minimization was used to reconstruct CBCT images from unblocked projection data after scatter correction. The reconstructed image was evaluated under various combinations of lead strip width and interspace (ranging from 10 to 60 pixels) and different moving speed (ranging from 1 to 30 pixels per projection).

RESULTS

MC simulation showed that the scatter estimation error varied from 0.8% to 5.8%. Phantom experiment showed that CT number error in the reconstructed CBCT images varied from 13 to 35. Highest reconstruction accuracy was achieved when the strip width was 20 pixels and interspace was 60 pixels and the moving speed was 15 pixels per projection.

CONCLUSIONS

Scatter estimation can be achieved in a large range of lead strip width and interspace combinations. The moving speed does not have a very strong effect on reconstruction result if it is above 5 pixels per projection. Geometry design of the blocker affected image reconstruction accuracy more. The optimal geometry of the blocker has a strip width of 20 pixels and an interspace three times the strip width, which means 25% detector is covered by the blocker, while the optimal moving speed is 15 pixels per projection.

Early Changes in Serial CBCT-Measured Parotid Gland Biomarkers Predict Chronic Xerostomia After Head and Neck Radiation Therapy

PURPOSE

To determine whether serial cone beam computed tomography (CBCT) images taken during head and neck radiation therapy (HNR) can improve chronic xerostomia prediction.

METHODS AND MATERIALS

In a retrospective analysis, parotid glands (PGs) were delineated on daily kV CBCT images using deformable image registration for 119 HNR patients (60 or 70 Gy in 2 Gy fractions over 6 or 7 weeks). Deformable image registration accuracy for a subset of deformed contours was quantified using the Dice similarity coefficient and mean distance to agreement in comparison with manually drawn contours. Average weekly changes in CBCT-measured mean Hounsfield unit intensity and volume were calculated for each PG relative to week 1. Dose-volume histogram statistics were extracted from each plan, and interactions among dose, volume, and intensity were investigated. Univariable analysis and penalized logistic regression were used to analyze association with observer-rated xerostomia at 1 year after HNR. Models including CBCT delta imaging features were compared with clinical and dose-volume histogram-only models using area under the receiver operating characteristic curve (AUC) for grade ≥1 and grade ≥2 xerostomia prediction.

RESULTS

All patients experienced end-treatment PG volume reduction with mean (range) ipsilateral and contralateral PG shrinkage of 19.6% (0.9%-58.4%) and 17.7% (4.4%-56.3%), respectively. Midtreatment volume change was highly correlated with mean PG dose (r = -0.318, P < 1e^-6). Incidence of grade ≥1 and grade ≥2 xerostomia was 65% and 16%, respectively. For grade ≥1 xerostomia prediction, the delta-imaging model had an AUC of 0.719 (95% confidence interval [CI], 0.603-0.830), compared with 0.709 (95% CI, 0.603-0.815) for the dose/clinical model. For grade ≥2 xerostomia prediction, the dose/clinical model had an AUC of 0.692 (95% CI, 0.615-0.770), and the addition of contralateral PG changes modestly improved predictive performance, with an AUC of 0.776 (0.643-0.912).

CONCLUSIONS

The rate of CBCT-measured PG image feature changes improves prediction over dose alone for chronic xerostomia prediction. Analysis of CBCT images acquired for treatment positioning may provide an inexpensive monitoring system to support toxicity-reducing adaptive radiation therapy.

4D cone-beam computed tomography (CBCT) using a moving blocker for simultaneous radiation dose reduction and scatter correction

Four-dimensional (4D) x-ray cone-beam computed tomography (CBCT) is important for a precise radiation therapy for lung cancer. Due to the repeated use and 4D acquisition over a course of radiotherapy, the radiation dose becomes a concern. Meanwhile, the scatter contamination in CBCT deteriorates image quality for treatment tasks. In this work, we propose the use of a moving blocker (MB) during the 4D CBCT acquisition ('4D MB') and to combine motion-compensated reconstruction to address these two issues simultaneously. In 4D MB CBCT, the moving blocker reduces the x-ray flux passing through the patient and collects the scatter information in the blocked region at the same time. The scatter signal is estimated from the blocked region for correction. Even though the number of projection views and projection data in each view are not complete for conventional reconstruction, 4D reconstruction with a total-variation (TV) constraint and a motion-compensated temporal constraint can utilize both spatial gradient sparsity and temporal correlations among different phases to overcome the missing data problem. The feasibility simulation studies using the 4D NCAT phantom showed that 4D MB with motion-compensated reconstruction with 1/3 imaging dose reduction could produce satisfactory images and achieve 37% improvement on structural similarity (SSIM) index and 55% improvement on root mean square error (RMSE), compared to 4D reconstruction at the regular imaging dose without scatter correction. For the same 4D MB data, 4D reconstruction outperformed 3D TV reconstruction by 28% on SSIM and 34% on RMSE. A study of synthetic patient data also demonstrated the potential of 4D MB to reduce the radiation dose by 1/3 without compromising the image quality. This work paves the way for more comprehensive studies to investigate the dose reduction limit offered by this novel 4D MB method using physical phantom experiments and real patient data based on clinical relevant metrics.

Estimating 4D-CBCT from prior information and extremely limited angle projections using structural PCA and weighted free-form deformation for lung radiotherapy

PURPOSE

To investigate the feasibility of using structural-based principal component analysis (PCA) motion-modeling and weighted free-form deformation to estimate on-board 4D-CBCT using prior information and extremely limited angle projections for potential 4D target verification of lung radiotherapy.

METHODS

A technique for lung 4D-CBCT reconstruction has been previously developed using a deformation field map (DFM)-based strategy. In the previous method, each phase of the 4D-CBCT was generated by deforming a prior CT volume. The DFM was solved by a motion model extracted by a global PCA and free-form deformation (GMM-FD) technique, using a data fidelity constraint and deformation energy minimization. In this study, a new structural PCA method was developed to build a structural motion model (SMM) by accounting for potential relative motion pattern changes between different anatomical structures from simulation to treatment. The motion model extracted from planning 4DCT was divided into two structures: tumor and body excluding tumor, and the parameters of both structures were optimized together. Weighted free-form deformation (WFD) was employed afterwards to introduce flexibility in adjusting the weightings of different structures in the data fidelity constraint based on clinical interests. XCAT (computerized patient model) simulation with a 30 mm diameter lesion was simulated with various anatomical and respiratory changes from planning 4D-CT to on-board volume to evaluate the method. The estimation accuracy was evaluated by the volume percent difference (VPD)/center-of-mass-shift (COMS) between lesions in the estimated and "ground-truth" on-board 4D-CBCT. Different on-board projection acquisition scenarios and projection noise levels were simulated to investigate their effects on the estimation accuracy. The method was also evaluated against three lung patients.

RESULTS

The SMM-WFD method achieved substantially better accuracy than the GMM-FD method for CBCT estimation using extremely small scan angles or projections. Using orthogonal 15° scanning angles, the VPD/COMS were 3.47 ± 2.94% and 0.23 ± 0.22 mm for SMM-WFD and 25.23 ± 19.01% and 2.58 ± 2.54 mm for GMM-FD among all eight XCAT scenarios. Compared to GMM-FD, SMM-WFD was more robust against reduction of the scanning angles down to orthogonal 10° with VPD/COMS of 6.21 ± 5.61% and 0.39 ± 0.49 mm, and more robust against reduction of projection numbers down to only 8 projections in total for both orthogonal-view 30° and orthogonal-view 15° scan angles. SMM-WFD method was also more robust than the GMM-FD method against increasing levels of noise in the projection images. Additionally, the SMM-WFD technique provided better tumor estimation for all three lung patients compared to the GMM-FD technique.

CONCLUSION

Compared to the GMM-FD technique, the SMM-WFD technique can substantially improve the 4D-CBCT estimation accuracy using extremely small scan angles and low number of projections to provide fast low dose 4D target verification.

Reducing scan angle using adaptive prior knowledge for a limited-angle intrafraction verification (LIVE) system for conformal arc radiotherapy

The purpose of this study is to develop an adaptive prior knowledge guided image estimation technique to reduce the scan angle needed in the limited-angle intrafraction verification (LIVE) system for 4D-CBCT reconstruction. The LIVE system has been previously developed to reconstruct 4D volumetric images on-the-fly during arc treatment for intrafraction target verification and dose calculation. In this study, we developed an adaptive constrained free-form deformation reconstruction technique in LIVE to further reduce the scanning angle needed to reconstruct the 4D-CBCT images for faster intrafraction verification. This technique uses free form deformation with energy minimization to deform prior images to estimate 4D-CBCT based on kV-MV projections acquired in extremely limited angle (orthogonal 3°) during the treatment. Note that the prior images are adaptively updated using the latest CBCT images reconstructed by LIVE during treatment to utilize the continuity of the respiratory motion. The 4D digital extended-cardiac-torso (XCAT) phantom and a CIRS 008A dynamic thoracic phantom were used to evaluate the effectiveness of this technique. The reconstruction accuracy of the technique was evaluated by calculating both the center-of-mass-shift (COMS) and 3D volume-percentage-difference (VPD) of the tumor in reconstructed images and the true on-board images. The performance of the technique was also assessed with varied breathing signals against scanning angle, lesion size, lesion location, projection sampling interval, and scanning direction. In the XCAT study, using orthogonal-view of 3° kV and portal MV projections, this technique achieved an average tumor COMS/VPD of 0.4  ±  0.1 mm/5.5  ±  2.2%, 0.6  ±  0.3 mm/7.2  ±  2.8%, 0.5  ±  0.2 mm/7.1  ±  2.6%, 0.6  ±  0.2 mm/8.3  ±  2.4%, for baseline drift, amplitude variation, phase shift, and patient breathing signal variation, respectively. In the CIRS phantom study, this technique achieved an average tumor COMS/VPD of 0.7  ±  0.1 mm/7.5  ±  1.3% for a 3 cm lesion and 0.6  ±  0.2 mm/11.4  ±  1.5% for a 2 cm lesion in the baseline drift case. The average tumor COMS/VPD were 0.5  ±  0.2 mm/10.8  ±  1.4%, 0.4  ±  0.3 mm/7.3  ±  2.9%, 0.4  ±  0.2 mm/7.4  ±  2.5%, 0.4  ±  0.2 mm/7.3  ±  2.8% for the four real patient breathing signals, respectively. Results demonstrated that the adaptive prior knowledge guided image estimation technique with LIVE system is robust against scanning angle, lesion size, location and scanning direction. It can estimate on-board images accurately with as little as 6 projections in orthogonal-view 3° angle. In conclusion, adaptive prior knowledge guided image reconstruction technique accurately estimates 4D-CBCT images using extremely-limited angle and projections. This technique greatly improves the efficiency and accuracy of LIVE system for ultrafast 4D intrafraction verification of lung SBRT treatments.

X-ray scatter correction for multi-source interior computed tomography

PURPOSE

The schemes of multi-source interior computed tomography (CT) have shown promise for ultra-fast, organ-oriented, and low-dose dynamic imaging. Besides forward scattering, x-ray cross scattering from multiple x-ray sources activated simultaneously can further degrade image quality. Here, we investigate the overall x-ray scattering artifact in a recently proposed multi-source interior CT architecture, and present two methods for scatter correction.

METHODS

Compared to single-source global CT, scattering in multi-source interior CT architecture is affected by two new factors: cross scattering from simultaneously activated multiple x-ray sources and region-of-interest (ROI) oriented interior CT mode. The scatter artifact in the multi-source interior CT architecture was evaluated through both numerical simulation and physical experimentation, and compared to that from conventional single-source global CT. Monte Carlo simulation was conducted with a modified numerical CATphan^® 600 phantom. Physical experiments were performed in an in-house developed CT imaging platform with a custom-built phantom. The simulation and experiments were carried out on the single-source CT architecture and the multi-source CT architecture, respectively in the global CT mode and the interior CT mode for comparison. To correct the scattering artifact, two new methods were presented. The first is a beam-stopper-array (BSA)-based method, which enables an online correction of forward scattering and cross scattering simultaneously. The second is a source-trigger-sequence (STS)-based method dedicated to cross-scatter correction. It enables on-the-fly measurements of the cross scattering signals at a few pre-selected views. The CT image quality was quantitatively evaluated in terms of contrast-to-noise ratio (CNR) and CT number deviation before and after the scatter correction.

RESULTS

X-ray cross scattering degraded image quality in both the simulation and experiments. Before the scatter correction, the multi-source interior CT mode yielded a reduction of CNR at the ROIs by up to 68.5% and 50.7% in the simulation and experiments, respectively. The stationary BSA-based method significantly improved CNR and CT number accuracy in the images from multi-source interior CT mode, by reducing the negative effects from both forward scattering and cross scattering. The STS-based method enabled multi-source interior CT mode to provide comparable image quality to that with the single-source interior CT mode, by correcting the artifact from cross scattering. The remaining forward scattering artifact can be corrected with the fast adaptive scatter kernel superposition (FASKS) technique. With the proposed scatter correction methods, the CT number error at the ROIs was reduced to less than 37 HU in both simulation and experiments, respectively.

CONCLUSIONS

Cross scattering, in addition to forward scattering, can cause significant image quality degradation in the multi-source interior CT architecture. However, image quality can be significantly improved with the proposed scatter correction methods.

Correction of Bowtie-Filter Normalization and Crescent Artifacts for a Clinical CBCT System

PURPOSE

To present our experiences in understanding and minimizing bowtie-filter crescent artifacts and bowtie-filter normalization artifacts in a clinical cone beam computed tomography system.

METHODS

Bowtie-filter position and profile variations during gantry rotation were studied. Two previously proposed strategies (A and B) were applied to the clinical cone beam computed tomography system to correct bowtie-filter crescent artifacts. Physical calibration and analytical approaches were used to minimize the norm phantom misalignment and to correct for bowtie-filter normalization artifacts. A combined procedure to reduce bowtie-filter crescent artifacts and bowtie-filter normalization artifacts was proposed and tested on a norm phantom, CatPhan, and a patient and evaluated using standard deviation of Hounsfield unit along a sampling line.

RESULTS

The bowtie-filter exhibited not only a translational shift but also an amplitude variation in its projection profile during gantry rotation. Strategy B was better than strategy A slightly in minimizing bowtie-filter crescent artifacts, possibly because it corrected the amplitude variation, suggesting that the amplitude variation plays a role in bowtie-filter crescent artifacts. The physical calibration largely reduced the misalignment-induced bowtie-filter normalization artifacts, and the analytical approach further reduced bowtie-filter normalization artifacts. The combined procedure minimized both bowtie-filter crescent artifacts and bowtie-filter normalization artifacts, with Hounsfield unit standard deviation being 63.2, 45.0, 35.0, and 18.8 Hounsfield unit for the best correction approaches of none, bowtie-filter crescent artifacts, bowtie-filter normalization artifacts, and bowtie-filter normalization artifacts + bowtie-filter crescent artifacts, respectively. The combined procedure also demonstrated reduction of bowtie-filter crescent artifacts and bowtie-filter normalization artifacts in a CatPhan and a patient.

CONCLUSION

We have developed a step-by-step procedure that can be directly used in clinical cone beam computed tomography systems to minimize both bowtie-filter crescent artifacts and bowtie-filter normalization artifacts.

An interprojection sensor fusion approach to estimate blocked projection signal in synchronized moving grid-based CBCT system

PURPOSE

A preobject grid can reduce and correct scatter in cone beam computed tomography (CBCT). However, half of the signal in each projection is blocked by the grid. A synchronized moving grid (SMOG) has been proposed to acquire two complimentary projections at each gantry position and merge them into one complete projection. That approach, however, suffers from increased scanning time and the technical difficulty of accurately merging the two projections per gantry angle. Herein, the authors present a new SMOG approach which acquires a single projection per gantry angle, with complimentary grid patterns for any two adjacent projections, and use an interprojection sensor fusion (IPSF) technique to estimate the blocked signal in each projection. The method may have the additional benefit of reduced imaging dose due to the grid blocking half of the incident radiation.

METHODS

The IPSF considers multiple paired observations from two adjacent gantry angles as approximations of the blocked signal and uses a weighted least square regression of these observations to finally determine the blocked signal. The method was first tested with a simulated SMOG on a head phantom. The signal to noise ratio (SNR), which represents the difference of the recovered CBCT image to the original image without the SMOG, was used to evaluate the ability of the IPSF in recovering the missing signal. The IPSF approach was then tested using a Catphan phantom on a prototype SMOG assembly installed in a bench top CBCT system.

RESULTS

In the simulated SMOG experiment, the SNRs were increased from 15.1 and 12.7 dB to 35.6 and 28.9 dB comparing with a conventional interpolation method (inpainting method) for a projection and the reconstructed 3D image, respectively, suggesting that IPSF successfully recovered most of blocked signal. In the prototype SMOG experiment, the authors have successfully reconstructed a CBCT image using the IPSF-SMOG approach. The detailed geometric features in the Catphan phantom were mostly recovered according to visual evaluation. The scatter related artifacts, such as cupping artifacts, were almost completely removed.

CONCLUSIONS

The IPSF-SMOG is promising in reducing scatter artifacts and improving image quality while reducing radiation dose.

Validation of a deformable image registration technique for cone beam CT-based dose verification

PURPOSE

As radiation therapy evolves toward more adaptive techniques, image guidance plays an increasingly important role, not only in patient setup but also in monitoring the delivered dose and adapting the treatment to patient changes. This study aimed to validate a method for evaluation of delivered intensity modulated radiotherapy (IMRT) dose based on multimodal deformable image registration (dir) for prostate treatments.

METHODS

A pelvic phantom was scanned with CT and cone-beam computed tomography (CBCT). Both images were digitally deformed using two realistic patient-based deformation fields. The original CT was then registered to the deformed CBCT resulting in a secondary deformed CT. The registration quality was assessed as the ability of the dir method to recover the artificially induced deformations. The primary and secondary deformed CT images as well as vector fields were compared to evaluate the efficacy of the registration method and it's suitability to be used for dose calculation. plastimatch, a free and open source software was used for deformable image registration. A B-spline algorithm with optimized parameters was used to achieve the best registration quality. Geometric image evaluation was performed through voxel-based Hounsfield unit (HU) and vector field comparison. For dosimetric evaluation, IMRT treatment plans were created and optimized on the original CT image and recomputed on the two warped images to be compared. The dose volume histograms were compared for the warped structures that were identical in both warped images. This procedure was repeated for the phantom with full, half full, and empty bladder.

RESULTS

The results indicated mean HU differences of up to 120 between registered and ground-truth deformed CT images. However, when the CBCT intensities were calibrated using a region of interest (ROI)-based calibration curve, these differences were reduced by up to 60%. Similarly, the mean differences in average vector field lengths decreased from 10.1 to 2.5 mm when CBCT was calibrated prior to registration. The results showed no dependence on the level of bladder filling. In comparison with the dose calculated on the primary deformed CT, differences in mean dose averaged over all organs were 0.2% and 3.9% for dose calculated on the secondary deformed CT with and without CBCT calibration, respectively, and 0.5% for dose calculated directly on the calibrated CBCT, for the full-bladder scenario. Gamma analysis for the distance to agreement of 2 mm and 2% of prescribed dose indicated a pass rate of 100% for both cases involving calibrated CBCT and on average 86% without CBCT calibration.

CONCLUSIONS

Using deformable registration on the planning CT images to evaluate the IMRT dose based on daily CBCTs was found feasible. The proposed method will provide an accurate dose distribution using planning CT and pretreatment CBCT data, avoiding the additional uncertainties introduced by CBCT inhomogeneity and artifacts. This is a necessary initial step toward future image-guided adaptive radiotherapy of the prostate.

A moving blocker-based strategy for simultaneous megavoltage and kilovoltage scatter correction in cone-beam computed tomography image acquired during volumetric modulated arc therapy

PURPOSE

To evaluate a moving blocker-based approach in estimating and correcting megavoltage (MV) and kilovoltage (kV) scatter contamination in kV cone-beam computed tomography (CBCT) acquired during volumetric modulated arc therapy (VMAT).

METHODS AND MATERIALS

During the concurrent CBCT/VMAT acquisition, a physical attenuator (i.e., "blocker") consisting of equally spaced lead strips was mounted and moved constantly between the CBCT source and patient. Both kV and MV scatter signals were estimated from the blocked region of the imaging panel, and interpolated into the unblocked region. A scatter corrected CBCT was then reconstructed from the unblocked projections after scatter subtraction using an iterative image reconstruction algorithm based on constraint optimization. Experimental studies were performed on a Catphan® phantom and an anthropomorphic pelvis phantom to demonstrate the feasibility of using a moving blocker for kV-MV scatter correction.

RESULTS

Scatter induced cupping artifacts were substantially reduced in the moving blocker corrected CBCT images. Quantitatively, the root mean square error of Hounsfield units (HU) in seven density inserts of the Catphan phantom was reduced from 395 to 40.

CONCLUSIONS

The proposed moving blocker strategy greatly improves the image quality of CBCT acquired with concurrent VMAT by reducing the kV-MV scatter induced HU inaccuracy and cupping artifacts.

Scatter Reduction and Correction for Dual-Source Cone-Beam CT Using Prepatient Grids

PURPOSE

Scatter significantly limits the application of the dual-source cone-beam computed tomography by inducing scatter artifacts and degrading contrast-to-noise ratio, Hounsfield-unit accuracy, and image uniformity. Although our previously developed interleaved acquisition mode addressed the cross scatter between the 2 X-ray sources, it doubles the scanning time and doesn't address the forward scatter issue. This study aims to develop a prepatient grid system to address both forward scatter and cross scatter in the dual-source cone-beam computed tomography.

METHODS

Grids attached to both X-ray sources provide physical scatter reduction during the image acquisition. Image data were measured in the unblocked region, while both forward scatter and cross scatter were measured in the blocked region of the projection for postscan scatter correction. Complementary projections were acquired with grids at complementary locations and were merged to form complete projections for reconstruction. Experiments were conducted with different phantom sizes, grid blocking ratios, image acquisition modes, and reconstruction algorithms to investigate their effects on the scatter reduction and correction. The image quality improvement by the prepatient grids was evaluated both qualitatively through the artifact reduction and quantitatively through contrast-to-noise ratio, Hounsfield-unit accuracy, and uniformity using a CATphan 504 phantom.

RESULTS

Scatter artifacts were reduced by scatter reduction and were removed by scatter correction method. Contrast-to-noise ratio, Hounsfield-unit accuracy, and image uniformity were improved substantially. The simultaneous acquisition mode achieved comparable contrast-to-noise ratio as the interleaved and sequential modes after scatter reduction and correction. Higher grid blocking ratio and smaller phantom size led to higher contrast-to-noise ratio for the simultaneous mode. The iterative reconstruction with total variation regularization was more effective than the Feldkamp, Davis, and Kress method in reducing noise caused by the scatter correction to enhance contrast-to-noise ratio.

CONCLUSION

The prepatient grid system is effective in removing the scatter effects in the simultaneous acquisition mode of the dual-source cone-beam computed tomography, which is useful for scanning time reduction or dual energy imaging.

A moving blocker system for cone-beam computed tomography scatter correction

PURPOSE

Scatter contamination in cone-beam computed tomography (CBCT) degrades the image quality by introducing shading artifacts. A moving-blocker-based approach has been proposed to simultaneously estimate scatter and reconstruct the complete volume within field of view (FOV) from a single CBCT scan. Promising results were obtained from our simulation studies. In this work, the authors demonstrated experimentally the effectiveness of the moving-blocker-based scatter correction approach by implementing a moving blocker system on a LINAC on-board kV CBCT imaging system.

METHODS

A physical attenuator (i.e., "blocker") consisting of equal spaced lead strips was mounted on a linear actuator. A step motor connected to the actuator drove the blocker to move back and forth along gantry rotation axis during the CBCT acquisition. Scatter signal was estimated from the blocked region of imaging panel, and interpolated into the unblocked region. A statistics-based iterative image reconstruction algorithm was used to reconstruct CBCT images from unblocked projections after the scatter signal was subtracted. Experimental studies were performed on a Catphan phantom and an anthropomorphic pelvis phantom to evaluate performance of the moving blocker system.

RESULTS

The scatter-induced shading artifacts were substantially reduced in the images acquired with the moving blocker system. CT number error in selected regions of interest reduced from 318 to 17 and from 239 to 10 for the Catphan phantom and pelvis phantom, respectively.

CONCLUSIONS

The authors demonstrated experimentally that the moving blocker system can successfully estimate the scatter signal in projection data and obtain complete volumetric information within the FOV using a single scan.

An Inter-Projection Interpolation (IPI) Approach with Geometric Model Restriction to Reduce Image Dose in Cone Beam CT (CBCT)

Cone beam computed tomography (CBCT) imaging is a key step in image guided radiation therapy (IGRT) to improve tumor targeting. The quality and imaging dose of CBCT are two important factors. However, X-ray scatter in the large cone beam field usually induces image artifacts and degrades the image quality for CBCT. A synchronized moving grid (SMOG) approach has recently been proposed to resolve this issue and shows great promise. However, the SMOG technique requires two projections in the same gantry angle to obtain full information due to signal blockage by the grid. This study aims to develop an inter-projection interpolation (IPI) method to estimate the blocked image information. This approach will require only one projection in each gantry angle, thus reducing the scan time and patient dose. IPI is also potentially suitable for sparse-view CBCT reconstruction to reduce the imaging dose. To be compared with other state-of-the-art spatial interpolation (called inpainting) methods in terms of signal-to-noise ratio (SNR) on a Catphan and head phantoms, IPI increases SNR from 15.3dB and 12.7dB to 29.0dB and 28.1dB, respectively. The SNR of IPI on sparse-view CBCT reconstruction can achieve from 28dB to 17dB for undersample projection sets with gantry angle interval varying from 1 to 3 degrees for both phantoms.

Assessment of buccal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode

OBJECTIVES

To investigate the accuracy of cone beam CT (CBCT) images obtained with and without artefact reduction (AR) in detecting simulated buccal peri-implant and buccal periodontal defects.

METHODS

42 implants inserted into edentulous mandibles, and 38 teeth present in dry mandibles were used. Simulated buccal peri-implant defects (n = 22) and buccal periodontal defects (n = 22) were prepared. 20 implants and 18 teeth without simulated defects were the control group. Images of the mandibles were obtained using a Planmeca ProMax(®) 3D Max CBCT unit (Planmeca Oy, Helsinki, Finland). Image reconstructions were prepared without and with low, medium and high AR modes. Images were viewed randomly by six observers twice for the presence of defects. Kappa coefficient was calculated. F2_LD_F1 design for non-parametric analysis of longitudinal data was used. Area under curves (AUCs) were calculated for each observer. Significance level was taken as α = 0.05.

RESULTS

Intraobserver kappa ranged from 0.140 to 0.792 for peri-implant and from 0.189 to 1.0 for periodontal defects. All factors were statistically significant (p < 0.001), except for image mode and implant brand. Pairwise interactions were found between periodontal defects and peri-implant defects (p < 0.001), observers (p < 0.001), observer and image mode (p < 0.001), defect model and observer (p < 0.001) and defect model, image mode and observer (p = 0.04). AUC values ranged from 0.39 to 0.52 for peri-implant and from 0.45 to 0.71 for periodontal defects. Higher AUC values were found for periodontal defects than for peri-implant defects.

CONCLUSIONS

Buccal peri-implant defects were more difficult to detect than buccal periodontal defects. No difference was found among CBCT images obtained with and without AR modes.

Intraoperative Cone-Beam Computed Tomography and Multi-Slice Computed Tomography in Temporal Bone Imaging for Surgical Treatment

Objective

Conventional computed tomography (CT) imaging is the standard imaging technique for temporal bone diseases, whereas cone-beam CT (CBCT) imaging is a very fast imaging tool with a significant less radiation dose compared with conventional CT. We hypothesize that a system for intraoperative cone-beam CT provides comparable image quality to diagnostic CT for identifying temporal bone anatomical landmarks in cadaveric specimens.

Study Design

Cross-sectional study.

Setting

University tertiary care facility.

Subjects and Methods

Twenty cadaveric temporal bones were affixed into a head phantom and scanned with both a prototype cone-beam CT C-arm and multislice helical CT. Imaging performance was evaluated by 3 otologic surgeons and 1 head and neck radiologist. Participants were presented images in a randomized order and completed landmark identification questionnaires covering 21 structures.

Results

CBCT and multislice CT have comparable performance in identifying temporal structures. Three otologic surgeons indicated that CBCT provided statistically equivalent performance for 19 of 21 landmarks, with CBCT superior to CT for the chorda tympani and inferior for the crura of the stapes. Subgroup analysis showed that CBCT performed superiorly for temporal bone structures compared with CT. The radiologist rated CBCT and CT as statistically equivalent for 18 of 21 landmarks, with CT superior to CBCT for the crura of stapes, chorda tympani, and sigmoid sinus.

Conclusion

CBCT provides comparable image quality to conventional CT for temporal bone anatomical sites in cadaveric specimens. Clinical applications of low-dose CBCT imaging in surgical planning, intraoperative guidance, and postoperative assessment are promising but require further investigation.