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Urban T, Sauter AP, Frank M, Willer K, Noichl W, Bast H, Schick R, Herzen J, Koehler T, Gassert FT, Bodden JH, Fingerle AA, Gleich B, Renger B, Makowski MR, Pfeiffer F, Pfeiffer D. Dark-Field Chest Radiography Outperforms Conventional Chest Radiography for the Diagnosis and Staging of Pulmonary Emphysema. Invest Radiol 2023; 58:775-781. [PMID: 37276130 PMCID: PMC10581407 DOI: 10.1097/rli.0000000000000989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Dark-field chest radiography (dfCXR) has recently reached clinical trials. Here we compare dfCXR to conventional radiography for the detection and staging of pulmonary emphysema. MATERIALS AND METHODS Subjects were included after a medically indicated computed tomography (CT) scan, showing either no lung impairments or different stages of emphysema. To establish a ground truth, all CT scans were assessed by 3 radiologists assigning emphysema severity scores based on the Fleischner Society classification scheme.Participants were imaged at a commercial chest radiography device and at a prototype for dfCXR, yielding both attenuation-based and dark-field images. Three radiologists blinded to CT score independently assessed images from both devices for presence and severity of emphysema (no, mild, moderate, severe).Statistical analysis included evaluation of receiver operating characteristic curves and pairwise comparison of adjacent Fleischner groups using an area under the curve (AUC)-based z test with a significance level of 0.05. RESULTS A total of 88 participants (54 men) with a mean age of 64 ± 12 years were included. Compared with conventional images (AUC = 0.73), readers were better able to identify emphysema with images from the dark-field prototype (AUC = 0.85, P = 0.005). Although ratings of adjacent emphysema severity groups with conventional radiographs differed only for trace and mild emphysema, ratings based on images from the dark-field prototype were different for trace and mild, mild and moderate, and moderate and confluent emphysema. CONCLUSIONS Dark-field chest radiography is superior to conventional chest radiography for emphysema diagnosis and staging, indicating the technique's potential as a low-dose diagnostic tool for emphysema assessment.
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Di Fazio N, Scopetti M, Delogu G, Morena D, Santurro A, Cipolloni L, Serviddio G, Papi L, Frati P, Turillazzi E, Fineschi V. Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital. Diagnostics (Basel) 2023; 13:3361. [PMID: 37958256 PMCID: PMC10650777 DOI: 10.3390/diagnostics13213361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Luigi Papi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Emanuela Turillazzi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
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Blykers BK, Organista C, Kagias M, Marone F, Stampanoni M, Boone MN, Cnudde V, Aelterman J. Exploration of the X-ray Dark-Field Signal in Mineral Building Materials. J Imaging 2022; 8:jimaging8100282. [PMID: 36286376 PMCID: PMC9604867 DOI: 10.3390/jimaging8100282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
Mineral building materials suffer from weathering processes such as salt efflorescence, freeze-thaw cycling, and microbial colonization. All of these processes are linked to water (liquid and vapor) in the pore space. The degree of damage following these processes is heavily influenced by pore space properties such as porosity, pore size distribution, and pore connectivity. X-ray computed micro-tomography (µCT) has proven to be a valuable tool to non-destructively investigate the pore space of stone samples in 3D. However, a trade-off between the resolution and field-of-view often impedes reliable conclusions on the material's properties. X-ray dark-field imaging (DFI) is based on the scattering of X-rays by sub-voxel-sized features, and as such, provides information on the sample complementary to that obtained using conventional µCT. In this manuscript, we apply X-ray dark-field tomography for the first time on four mineral building materials (quartzite, fired clay brick, fired clay roof tile, and carbonated mineral building material), and investigate which information the dark-field signal entails on the sub-resolution space of the sample. Dark-field tomography at multiple length scale sensitivities was performed at the TOMCAT beamline of the Swiss Light Source (Villigen, Switzerland) using a Talbot grating interferometer. The complementary information of the dark-field modality is most clear in the fired clay brick and roof tile; quartz grains that are almost indistinguishable in the conventional µCT scan are clearly visible in the dark-field owing to their low dark-field signal (homogenous sub-voxel structure), whereas the microporous bulk mass has a high dark-field signal. Large (resolved) pores on the other hand, which are clearly visible in the absorption dataset, are almost invisible in the dark-field modality because they are overprinted with dark-field signal originating from the bulk mass. The experiments also showed how the dark-field signal from a feature depends on the length scale sensitivity, which is set by moving the sample with respect to the grating interferometer.
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Affiliation(s)
- Benjamin K. Blykers
- Pore-Scale Processes in Geomaterials Research Group (PProGRess), Department of Geology, Ghent University, 9000 Ghent, Belgium
- Ghent University Centre for X-ray Tomography (UGCT), 9000 Ghent, Belgium
- Correspondence:
| | - Caori Organista
- Ghent University Centre for X-ray Tomography (UGCT), 9000 Ghent, Belgium
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Institute for Biomedical Engineering, University and ETH Zürich, 8092 Zürich, Switzerland
- Department of Physics and Astronomy, Ghent University, 9000 Ghent, Belgium
| | - Matias Kagias
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Division of Engineering and Applied Science, California Institute of Technology, Pasadena, CA 91125, USA
| | - Federica Marone
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Marco Stampanoni
- Swiss Light Source, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Institute for Biomedical Engineering, University and ETH Zürich, 8092 Zürich, Switzerland
| | - Matthieu N. Boone
- Ghent University Centre for X-ray Tomography (UGCT), 9000 Ghent, Belgium
- Department of Physics and Astronomy, Ghent University, 9000 Ghent, Belgium
| | - Veerle Cnudde
- Pore-Scale Processes in Geomaterials Research Group (PProGRess), Department of Geology, Ghent University, 9000 Ghent, Belgium
- Ghent University Centre for X-ray Tomography (UGCT), 9000 Ghent, Belgium
- Environmental Hydrogeology, Department of Earth Sciences, Utrecht University, 3584 Utrecht, The Netherlands
| | - Jan Aelterman
- Ghent University Centre for X-ray Tomography (UGCT), 9000 Ghent, Belgium
- Department of Physics and Astronomy, Ghent University, 9000 Ghent, Belgium
- Image Processing and Interpretation, TELIN Department, Ghent University, 9000 Ghent, Belgium
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Dark-field chest x-ray imaging: first experience in patients with alpha1-antitrypsin deficiency. Eur Radiol Exp 2022; 6:9. [PMID: 35229244 PMCID: PMC8885951 DOI: 10.1186/s41747-022-00263-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Spirometry and conventional chest x-ray have limitations in investigating early emphysema, while computed tomography, the reference imaging method in this context, is not part of routine patient care due to its higher radiation dose. In this work, we investigated a novel low-dose imaging modality, dark-field chest x-ray, for the evaluation of emphysema in patients with alpha1-antitrypsin deficiency.
Methods
By exploiting wave properties of x-rays for contrast formation, dark-field chest x-ray visualises the structural integrity of the alveoli, represented by a high signal over the lungs in the dark-field image. We investigated four patients with alpha1-antitrypsin deficiency with a novel dark-field x-ray prototype and simultaneous conventional chest x-ray. The extent of pulmonary function impairment was assessed by pulmonary function measurement and regional emphysema distribution was compared with CT in one patient.
Results
We show that dark-field chest x-ray visualises the extent of pulmonary emphysema displaying severity and regional differences. Areas with low dark-field signal correlate with emphysematous changes detected by computed tomography using a threshold of -950 Hounsfield units. The airway parameters obtained by whole-body plethysmography and single breath diffusing capacity of the lungs for carbon monoxide demonstrated typical changes of advanced emphysema.
Conclusions
Dark-field chest x-ray directly visualised the severity and regional distribution of pulmonary emphysema compared to conventional chest x-ray in patients with alpha1-antitrypsin deficiency. Due to the ultra-low radiation dose in comparison to computed tomography, dark-field chest x-ray could be beneficial for long-term follow-up in these patients.
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Ledda RE, Silva M, McMichael N, Sartorio C, Branchi C, Milanese G, Nayak SM, Sverzellati N. The diagnostic value of grey-scale inversion technique in chest radiography. Radiol Med 2022; 127:294-304. [PMID: 35041136 PMCID: PMC8960630 DOI: 10.1007/s11547-022-01453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/03/2022] [Indexed: 12/01/2022]
Abstract
Purpose We investigated whether the additional use of grey-scale inversion technique improves the interpretation of eight chest abnormalities, in terms of diagnostic performance and interobserver variability. Material and methods A total of 507 patients who underwent a chest computed tomography (CT) examination and a chest radiography (CXR) within 24 h were enrolled. CT was the standard of reference. Images were retrospectively reviewed for the presence of atelectasis, consolidation, interstitial abnormality, nodule, mass, pleural effusion, pneumothorax and rib fractures. Four CXR reading settings, involving 3 readers were organized: only standard; only inverted; standard followed by inverted; and inverted followed by standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, assessed with the area under the curve (AUC), and their 95% confidence interval were calculated for each reader and setting. Interobserver agreement was tested by Cohen’s K test with quadratic weights (Kw) and its 95%CI.
Results CXR sensitivity % for any finding was 35.1 (95% CI: 33 to 37) for setting 1, 35.9 (95% CI: 33 to 37), for setting 2, 32.59 (95% CI: 30 to 34) for setting 3, and 35.56 (95% CI: 33 to 37) for setting 4; specificity % 93.78 (95% CI: 91 to 95), 93.92 (95% CI: 91 to 95), 94.43 (95% CI: 92 to 96), 93.86 (95% CI: 91 to 95); PPV % 56.22 (95% CI: 54.2 to 58.2), 56.49 (95% CI: 54.5 to 58.5), 57.15 (95% CI: 55 to 59), 56.75 (95% CI: 54 to 58); NPV % 85.66 (95% CI: 83 to 87), 85.74 (95% CI: 83 to 87), 85.29 (95% CI: 83 to 87), 85.73 (95% CI: 83 to 87); AUC values 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67), 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67); Kw values 0.42 (95% CI: 0.4 to 0.44), 0.40 (95% CI: 0.38 to 0.42), 0.42 (95% CI: 0.4 to 0.44), 0.41 (95% CI: 0.39 to 0.43) for settings 1, 2, 3 and 4, respectively.
Conclusions No significant advantages were observed in the use of grey-scale inversion technique neither over standard display mode nor in combination at the detection of eight chest abnormalities. Supplementary Information The online version contains supplementary material available at 10.1007/s11547-022-01453-0.
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Affiliation(s)
- Roberta Eufrasia Ledda
- Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | - Mario Silva
- Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | - Nicole McMichael
- Department of Radiology Diagnostics, Skåne University Hospital of Malmö, Malmö, Sweden
| | - Carlotta Sartorio
- Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | - Cristina Branchi
- Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy.
| | - Sundeep M Nayak
- Department of Radiology, Kaiser Permanente Northern California, San Leandro, CA, USA
| | - Nicola Sverzellati
- Department of Medicine and Surgery, University of Parma, Scienze Radiologiche, University Hospital of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
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Gassert FT, Urban T, Frank M, Willer K, Noichl W, Buchberger P, Schick R, Koehler T, von Berg J, Fingerle AA, Sauter AP, Makowski MR, Pfeiffer D, Pfeiffer F. X-ray Dark-Field Chest Imaging: Qualitative and Quantitative Results in Healthy Humans. Radiology 2021; 301:389-395. [PMID: 34427464 DOI: 10.1148/radiol.2021210963] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background X-ray dark-field radiography takes advantage of the wave properties of x-rays, with a relatively high signal in the lungs due to the many air-tissue interfaces in the alveoli. Purpose To describe the qualitative and quantitative characteristics of x-ray dark-field images in healthy human subjects. Materials and Methods Between October 2018 and January 2020, patients of legal age who underwent chest CT as part of their diagnostic work-up were screened for study participation. Inclusion criteria were a normal chest CT scan, the ability to consent, and the ability to stand upright without help. Exclusion criteria were pregnancy, serious medical conditions, and changes in the lung tissue, such as those due to cancer, pleural effusion, atelectasis, emphysema, infiltrates, ground-glass opacities, or pneumothorax. Images of study participants were obtained by using a clinical x-ray dark-field prototype, recently constructed and commissioned at the authors' institution, to simultaneously acquire both attenuation-based and dark-field thorax radiographs. Each subject's total dark-field signal was correlated with his or her lung volume, and the dark-field coefficient was correlated with age, sex, weight, and height. Results Overall, 40 subjects were included in this study (average age, 62 years ± 13 [standard deviation]; 26 men, 14 women). Normal human lungs have high signal, while the surrounding osseous structures and soft tissue have very low and no signal, respectively. The average dark-field signal was 2.5 m-1 ± 0.4 of examined lung tissue. There was a correlation between the total dark-field signal and the lung volume (r = 0.61, P < .001). No difference was found between men and women (P = .78). Also, age (r = -0.18, P = .26), weight (r = 0.24, P = .13), and height (r = 0.01, P = .96) did not influence dark-field signal. Conclusion This study introduces qualitative and quantitative values for x-ray dark-field imaging in healthy human subjects. The quantitative x-ray dark-field coefficient is independent from demographic subject parameters, emphasizing its potential in diagnostic assessment of the lung. ©RSNA, 2021 See also the editorial by Hatabu and Madore in this issue.
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Affiliation(s)
- Florian T Gassert
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Theresa Urban
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Manuela Frank
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Konstantin Willer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Wolfgang Noichl
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Philipp Buchberger
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Rafael Schick
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Thomas Koehler
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Jens von Berg
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Alexander A Fingerle
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Andreas P Sauter
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Marcus R Makowski
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Daniela Pfeiffer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
| | - Franz Pfeiffer
- From the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany (F.T.G., A.A.F., A.P.S., M.R.M., D.P., F.P.); Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany (T.U., M.F., K.W., W.N., P.B., R.S., F.P.); and Philips Research, Hamburg, Germany (T.K., J.v.B.)
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Willer K, Fingerle AA, Noichl W, De Marco F, Frank M, Urban T, Schick R, Gustschin A, Gleich B, Herzen J, Koehler T, Yaroshenko A, Pralow T, Zimmermann GS, Renger B, Sauter AP, Pfeiffer D, Makowski MR, Rummeny EJ, Grenier PA, Pfeiffer F. X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study. LANCET DIGITAL HEALTH 2021; 3:e733-e744. [PMID: 34711378 PMCID: PMC8565798 DOI: 10.1016/s2589-7500(21)00146-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD). METHODS In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)-which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmography) were performed for every patient and for a subgroup of patients the measurement of diffusion capacity was performed. Individual patient datasets were statistically evaluated using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison. FINDINGS Between October, 2018 and December, 2019 we enrolled 77 patients. Compared with CT-based parameters (quantitative emphysema ρ=-0·27, p=0·089 and visual emphysema ρ=-0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with lung diffusion capacity in the evaluated cohort. Emphysema assessment based on dark-field chest x-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance than conventional clinical tests characterising emphysema. Pair-wise comparison of corresponding test parameters between adjacent visual emphysema severity groups (CT-based, reference standard) showed higher effect sizes. The mean effect size over the group comparisons (absent-trace, trace-mild, mild-moderate, and moderate-confluent or advanced destructive visual emphysema grades) for the COPD assessment test score is 0·21, for forced expiratory volume in 1 s (FEV1)/functional vital capacity is 0·25, for FEV1% of predicted is 0·23, for residual volume % of predicted is 0·24, for CT emphysema index is 0·35, for dark-field signal homogeneity within lungs is 0·38, for dark-field signal texture within lungs is 0·38, and for dark-field-based emphysema severity is 0·42. INTERPRETATION X-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema in patients with COPD because this technique provides relevant information representing the structural condition of lung parenchyma. This technique might offer a low radiation dose alternative to CT in COPD and potentially other lung disorders. FUNDING European Research Council, Deutsche Forschungsgemeinschaft, Royal Philips, and Karlsruhe Nano Micro Facility.
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Affiliation(s)
- Konstantin Willer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Noichl
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Theresa Urban
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Rafael Schick
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alex Gustschin
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Thomas Koehler
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Philips Research Hamburg, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC Hamburg, Hamburg, Germany
| | - Gregor S Zimmermann
- Department of Cardiology, Angiology, and Pneumology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, Paris, France
| | - Franz Pfeiffer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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8
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Ram S, Han MK. X-ray dark field imaging: a tool for early diagnosis of emphysema in chronic obstructive pulmonary disease? LANCET DIGITAL HEALTH 2021; 3:e691-e692. [PMID: 34711374 DOI: 10.1016/s2589-7500(21)00230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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9
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Burkhardt R, Gora T, Fingerle AA, Sauter AP, Meurer F, Gassert FT, Dobiasch S, Schilling D, Feuchtinger A, Walch AK, Multhoff G, Herzen J, Noël PB, Rummeny EJ, Combs SE, Schmid TE, Pfeiffer F, Wilkens JJ. In-vivo X-ray dark-field computed tomography for the detection of radiation-induced lung damage in mice. Phys Imaging Radiat Oncol 2021; 20:11-16. [PMID: 34611553 PMCID: PMC8476771 DOI: 10.1016/j.phro.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Abstract
Radiation-induced lung damage was observed using X-ray dark-field tomography. In this pre-clinical study, mouse lungs were irradiated and subsequently imaged. We report increased sensitivity of X-ray dark-field tomography over absorption-based tomography.
Background and Purpose Radiotherapy of thoracic tumours can lead to side effects in the lung, which may benefit from early diagnosis. We investigated the potential of X-ray dark-field computed tomography by a proof-of-principle murine study in a clinically relevant radiotherapeutic setting aiming at the detection of radiation-induced lung damage. Material and Methods Six mice were irradiated with 20 Gy to the entire right lung. Together with five unirradiated control mice, they were imaged using computed tomography with absorption and dark-field contrast before and 16 weeks post irradiation. Mean pixel values for the right and left lung were calculated for both contrasts, and the right-to-left-ratio R of these means was compared. Radiologists also assessed the tomograms acquired 16 weeks post irradiation. Sensitivity, specificity, inter- and intra-reader accuracy were evaluated. Results In absorption contrast the group-average of R showed no increase in the control group and increased by 7% (p = 0.005) in the irradiated group. In dark-field contrast, it increased by 2% in the control group and by 14% (p = 0.005) in the irradiated group. Specificity was 100% for both contrasts but sensitivity was almost four times higher using dark-field tomography. Two cases were missed by absorption tomography but were detected by dark-field tomography. Conclusions The applicability of X-ray dark-field computed tomography for the detection of radiation-induced lung damage was demonstrated in a pre-clinical mouse model. The presented results illustrate the differences between dark-field and absorption contrast and show that dark-field tomography could be advantageous in future clinical settings.
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Affiliation(s)
- Rico Burkhardt
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Physics Department, Technical University of Munich, Garching, Germany
| | - Thomas Gora
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Feuchtinger
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Axel K Walch
- Abteilung Analytische Pathologie, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,TranslaTUM, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Julia Herzen
- Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Physics Department, Technical University of Munich, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany.,Munich School of BioEngineering (MSB), Technical University of Munich, Garching, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Munich, Germany.,Physics Department, Technical University of Munich, Garching, Germany.,Chair of Biomedical Physics, Technical University of Munich, Garching, Germany
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10
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Sauter AP, Andrejewski J, Frank M, Willer K, Herzen J, Meurer F, Fingerle AA, Makowski MR, Pfeiffer F, Pfeiffer D. Correlation of image quality parameters with tube voltage in X-ray dark-field chest radiography: a phantom study. Sci Rep 2021; 11:14130. [PMID: 34239040 PMCID: PMC8266828 DOI: 10.1038/s41598-021-93716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022] Open
Abstract
Grating-based X-ray dark-field imaging is a novel imaging modality with enormous technical progress during the last years. It enables the detection of microstructure impairment as in the healthy lung a strong dark-field signal is present due to the high number of air-tissue interfaces. Using the experience from setups for animal imaging, first studies with a human cadaver could be performed recently. Subsequently, the first dark-field scanner for in-vivo chest imaging of humans was developed. In the current study, the optimal tube voltage for dark-field radiography of the thorax in this setup was examined using an anthropomorphic chest phantom. Tube voltages of 50–125 kVp were used while maintaining a constant dose-area-product. The resulting dark-field and attenuation radiographs were evaluated in a reader study as well as objectively in terms of contrast-to-noise ratio and signal strength. We found that the optimum tube voltage for dark-field imaging is 70 kVp as here the most favorable combination of image quality, signal strength, and sharpness is present. At this voltage, a high image quality was perceived in the reader study also for attenuation radiographs, which should be sufficient for routine imaging. The results of this study are fundamental for upcoming patient studies with living humans.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Markus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.,Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
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11
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Andrejewski J, De Marco F, Willer K, Noichl W, Gustschin A, Koehler T, Meyer P, Kriner F, Fischer F, Braun C, Fingerle AA, Herzen J, Pfeiffer F, Pfeiffer D. Whole-body x-ray dark-field radiography of a human cadaver. Eur Radiol Exp 2021; 5:6. [PMID: 33495889 PMCID: PMC7835263 DOI: 10.1186/s41747-020-00201-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Grating-based x-ray dark-field and phase-contrast imaging allow extracting information about refraction and small-angle scatter, beyond conventional attenuation. A step towards clinical translation has recently been achieved, allowing further investigation on humans. METHODS After the ethics committee approval, we scanned the full body of a human cadaver in anterior-posterior orientation. Six measurements were stitched together to form the whole-body image. All radiographs were taken at a three-grating large-object x-ray dark-field scanner, each lasting about 40 s. Signal intensities of different anatomical regions were assessed. The magnitude of visibility reduction caused by beam hardening instead of small-angle scatter was analysed using different phantom materials. Maximal effective dose was 0.3 mSv for the abdomen. RESULTS Combined attenuation and dark-field radiography are technically possible throughout a whole human body. High signal levels were found in several bony structures, foreign materials, and the lung. Signal levels were 0.25 ± 0.13 (mean ± standard deviation) for the lungs, 0.08 ± 0.06 for the bones, 0.023 ± 0.019 for soft tissue, and 0.30 ± 0.02 for an antibiotic bead chain. We found that phantom materials, which do not produce small-angle scatter, can generate a strong visibility reduction signal. CONCLUSION We acquired a whole-body x-ray dark-field radiograph of a human body in few minutes with an effective dose in a clinical acceptable range. Our findings suggest that the observed visibility reduction in the bone and metal is dominated by beam hardening and that the true dark-field signal in the lung is therefore much higher than that of the bone.
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Affiliation(s)
- Jana Andrejewski
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Alex Gustschin
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | | | - Pascal Meyer
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Fabian Kriner
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Florian Fischer
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Christian Braun
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
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12
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Gureyev TE, Paganin DM, Arhatari B, Taba ST, Lewis S, Brennan PC, Quiney HM. Dark-field signal extraction in propagation-based phase-contrast imaging. Phys Med Biol 2020; 65:215029. [PMID: 32756030 DOI: 10.1088/1361-6560/abac9d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A method for extracting the dark-field signal in propagation-based phase-contrast imaging is proposed. In the case of objects consisting predominantly of a single material, or several different materials with similar ratios of the real decrement to the imaginary part of the complex refractive index, the proposed method requires a single image for extraction of the dark-field signal in two-dimensional projection imaging. In the case of three-dimensional tomographic imaging, the method needs only one image to be collected at each projection angle. Initial examples using simulated and experimental data indicate that this method can improve visualization of small sharp features inside a larger object, e.g. the visualization of microcalcifications in propagation-based x-ray breast cancer imaging. It is suggested that the proposed approach may be useful in other forms of biomedical imaging, where it can help one to obtain additional small-angle scattering information without increasing the radiation dose to the sample.
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Affiliation(s)
- T E Gureyev
- School of Physics, The University of Melbourne, Parkville 3010, Australia. Faculty of Health Sciences, The University of Sydney, Lidcombe 2141, Australia. School of Physics and Astronomy, Monash University, Clayton 3800, Australia. School of Science and Technology, University of New England, Armidale 2351, Australia
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13
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Momose A. X-ray phase imaging reaching clinical uses. Phys Med 2020; 79:93-102. [PMID: 33212423 DOI: 10.1016/j.ejmp.2020.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 02/01/2023] Open
Abstract
X-ray phase imaging that uses the phenomena of X-ray refraction and scattering to generate image contrast has the potential to overcome the drawback of conventional X-ray radiography in observing biological soft tissues. After its dawn at synchrotron radiation facilities 30 years ago, the development of X-ray phase imaging is expanding to hospitals by grating-based phase-imaging approaches available with a conventional X-ray tube. In this review, after introducing the physical advantages and methodological details of X-ray phase imaging, recent trials of instrumentation in hospitals for diagnoses of rheumatoid arthritis and chronic obstructive pulmonary disease are introduced.
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Affiliation(s)
- Atsushi Momose
- Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan.
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14
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Umkehrer S, Morrone C, Dinkel J, Aigner L, Reiser MF, Herzen J, Yildirim AÖ, Pfeiffer F, Hellbach K. A proof-of principal study using phase-contrast imaging for the detection of large airway pathologies after lung transplantation. Sci Rep 2020; 10:18444. [PMID: 33116193 PMCID: PMC7595203 DOI: 10.1038/s41598-020-75185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022] Open
Abstract
In this study we aim to evaluate the assessment of bronchial pathologies in a murine model of lung transplantation with grating-based X-ray interferometry in vivo. Imaging was performed using a dedicated grating-based small-animal X-ray dark-field and phase-contrast scanner. While the contrast modality of the dark-field signal already showed several promising applications for diagnosing various types of pulmonary diseases, the phase-shifting contrast mechanism of the phase contrast has not yet been evaluated in vivo. For this purpose, qualitative analysis of phase-contrast images was performed and revealed pathologies due to previous lung transplantation, such as unilateral bronchial stenosis or bronchial truncation. Dependent lung parenchyma showed a strong loss in dark-field and absorption signal intensity, possibly caused by several post transplantational pathologies such as atelectasis, pleural effusion, or pulmonary infiltrates. With this study, we are able to show that bronchial pathologies can be visualized in vivo using conventional X-ray imaging when phase-contrast information is analysed. Absorption and dark-field images can be used to quantify the severity of lack of ventilation in the affected lung.
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Affiliation(s)
- Stephan Umkehrer
- Chair of Biomedical Physics, Physics Department & Munich School of BioEngineering, Technical University of Munich (TUM), Garching, Germany.
| | - Carmela Morrone
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians University Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, Neuherberg, Germany
| | - Laura Aigner
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Maximilian F Reiser
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, Neuherberg, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Physics Department & Munich School of BioEngineering, Technical University of Munich (TUM), Garching, Germany
| | - Ali Ö Yildirim
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians University Munich, Munich, Germany.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, Neuherberg, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Physics Department & Munich School of BioEngineering, Technical University of Munich (TUM), Garching, Germany.,Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katharina Hellbach
- Department of Radiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Ruprecht-Karls-University Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
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15
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Braig EM, Pfeiffer D, Willner M, Sellerer T, Taphorn K, Petrich C, Scholz J, Petzold L, Birnbacher L, Dierolf M, Pfeiffer F, Herzen J. Single spectrum three-material decomposition with grating-based x-ray phase-contrast CT. Phys Med Biol 2020; 65:185011. [PMID: 32460250 DOI: 10.1088/1361-6560/ab9704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Grating-based x-ray phase-contrast imaging provides three simultaneous image channels originating from a single image acquisition. While the phase signal provides direct access to the electron density in tomography, there is additional information on sub-resolutional structural information which is called dark-field signal in analogy to optical microscopy. The additional availability of the conventional attenuation image qualifies the method for implementation into existing diagnostic routines. The simultaneous access to the attenuation coefficient and the electron density allows for quantitative two-material discrimination as demonstrated lately for measurements at a quasi-monochromatic compact synchrotron source. Here, we investigate the transfer of the method to conventional polychromatic x-ray sources and the additional inclusion of the dark-field signal for three-material decomposition. We evaluate the future potential of grating-based x-ray phase-contrast CT for quantitative three-material discrimination for the specific case of early stroke diagnosis at conventional polychromatic x-ray sources. Compared to conventional CT, the method has the potential to discriminate coagulated blood directly from contrast agent extravasation within a single CT acquisition. Additionally, the dark-field information allows for the clear identification of hydroxyapatite clusters due to their micro-structure despite a similar attenuation as the applied contrast agent. This information on materials with sub-resolutional microstructures is considered to comprise advantages relevant for various pathologies.
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Affiliation(s)
- Eva-Maria Braig
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, 85748 Garching, Germany
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Kimm MA, Willner M, Drecoll E, Herzen J, Noël PB, Rummeny EJ, Pfeiffer F, Fingerle AA. Grating-based phase-contrast CT (PCCT): histopathological correlation of human liver cirrhosis and hepatocellular carcinoma specimen. J Clin Pathol 2020; 73:483-487. [PMID: 31941652 DOI: 10.1136/jclinpath-2019-206380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/24/2023]
Abstract
AIMS To correlate signal intensities in grating-based phase-contrast CT (PCCT) images obtained at a synchrotron light source and a conventional X-ray source with tissue components in human liver cirrhosis and hepatocellular carcinoma (HCC) specimen. METHODS Study approval was obtained by the institutional review board. Human specimen of liver cirrhosis and HCC were imaged at experimental grating-based PCCT setups using either a synchrotron radiation source or a conventional X-ray tube. Tissue samples were sectioned and processed for H&E and Elastica van Gieson staining. PCCT and histological images were manually correlated. Depending on morphology and staining characteristics tissue components like fibrosis, HCC, inflammation, connective tissue and necrosis were differentiated and visually correlated with signal intensity in PCCT images using a 5-point Likert scale with normal liver parenchyma as a reference. RESULTS Grating-based PCCT images of human cirrhotic liver and HCC specimen showed high soft-tissue contrast allowing correlation with histopathological sections. Signal intensities were similar in both setups independent of the nature of the radiation source. Connective tissue and areas of haemorrhage displayed the highest signal intensities, fibrotic liver tissue the lowest. CONCLUSIONS Grating-based PCCT provides comparable results for the characterisation of human specimen of liver cirrhosis and HCC using either a synchrotron light source or a conventional X-ray tube. Due to its high soft-tissue contrast and its applicability to conventional X-ray tubes grating-based PCCT holds potential for preclinical research and virtual histology applications.
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Affiliation(s)
- Melanie A Kimm
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marian Willner
- Chair of Biomedical Physics, Department of Physics and Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Enken Drecoll
- Department of Pathology, School of Medicine & Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics and Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Paganin DM, Morgan KS. X-ray Fokker-Planck equation for paraxial imaging. Sci Rep 2019; 9:17537. [PMID: 31772186 PMCID: PMC6879762 DOI: 10.1038/s41598-019-52284-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/15/2019] [Indexed: 11/08/2022] Open
Abstract
The Fokker-Planck equation can be used in a partially-coherent imaging context to model the evolution of the intensity of a paraxial x-ray wave field with propagation. This forms a natural generalisation of the transport-of-intensity equation. The x-ray Fokker-Planck equation can simultaneously account for both propagation-based phase contrast, and the diffusive effects of sample-induced small-angle x-ray scattering, when forming an x-ray image of a thin sample. Two derivations are given for the Fokker-Planck equation associated with x-ray imaging, together with a Kramers-Moyal generalisation thereof. Both equations are underpinned by the concept of unresolved speckle due to unresolved sample micro-structure. These equations may be applied to the forward problem of modelling image formation in the presence of both coherent and diffusive energy transport. They may also be used to formulate associated inverse problems of retrieving the phase shifts due to a sample placed in an x-ray beam, together with the diffusive properties of the sample. The domain of applicability for the Fokker-Planck and Kramers-Moyal equations for paraxial imaging is at least as broad as that of the transport-of-intensity equation which they generalise, hence the technique is also expected to be useful for paraxial imaging using visible light, electrons and neutrons.
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Affiliation(s)
- David M Paganin
- School of Physics and Astronomy, Monash University, Clayton, Victoria, 3800, Australia.
| | - Kaye S Morgan
- School of Physics and Astronomy, Monash University, Clayton, Victoria, 3800, Australia
- Chair of Biomedical Physics, Department of Physics, Munich School of Bioengineering, and Institute of Advanced Study, Technische Universität München, 85748, Garching, Germany
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