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Willer K, Fingerle AA, Gromann LB, De Marco F, Herzen J, Achterhold K, Gleich B, Muenzel D, Scherer K, Renz M, Renger B, Kopp F, Kriner F, Fischer F, Braun C, Auweter S, Hellbach K, Reiser MF, Schroeter T, Mohr J, Yaroshenko A, Maack HI, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny EJ, Pfeiffer F, Noël PB. X-ray dark-field imaging of the human lung-A feasibility study on a deceased body. PLoS One 2018; 13:e0204565. [PMID: 30261038 PMCID: PMC6160109 DOI: 10.1371/journal.pone.0204565] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 09/11/2018] [Indexed: 12/24/2022] Open
Abstract
Disorders of the lungs such as chronic obstructive pulmonary disease (COPD) are a major cause of chronic morbidity and mortality and the third leading cause of death in the world. The absence of sensitive diagnostic tests for early disease stages of COPD results in under-diagnosis of this treatable disease in an estimated 60–85% of the patients. In recent years a grating-based approach to X-ray dark-field contrast imaging has shown to be very sensitive for the detection and quantification of pulmonary emphysema in small animal models. However, translation of this technique to imaging systems suitable for humans remains challenging and has not yet been reported. In this manuscript, we present the first X-ray dark-field images of in-situ human lungs in a deceased body, demonstrating the feasibility of X-ray dark-field chest radiography on a human scale. Results were correlated with findings of computed tomography imaging and autopsy. The performance of the experimental radiography setup allows acquisition of multi-contrast chest X-ray images within clinical boundary conditions, including radiation dose. Upcoming clinical studies will have to demonstrate that this technology has the potential to improve early diagnosis of COPD and pulmonary diseases in general.
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Affiliation(s)
- Konstantin Willer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alexander A. Fingerle
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas B. Gromann
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Klaus Achterhold
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniela Muenzel
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kai Scherer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Martin Renz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fabian Kriner
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Fischer
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Braun
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katharina Hellbach
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Schroeter
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | | | | | | | | | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | | | | | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Peter B. Noël
- Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Gromann LB, De Marco F, Willer K, Noël PB, Scherer K, Renger B, Gleich B, Achterhold K, Fingerle AA, Muenzel D, Auweter S, Hellbach K, Reiser M, Baehr A, Dmochewitz M, Schroeter TJ, Koch FJ, Meyer P, Kunka D, Mohr J, Yaroshenko A, Maack HI, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny EJ, Pfeiffer F, Herzen J. In-vivo X-ray Dark-Field Chest Radiography of a Pig. Sci Rep 2017; 7:4807. [PMID: 28684858 PMCID: PMC5500502 DOI: 10.1038/s41598-017-05101-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/25/2017] [Indexed: 12/12/2022] Open
Abstract
X-ray chest radiography is an inexpensive and broadly available tool for initial assessment of the lung in clinical routine, but typically lacks diagnostic sensitivity for detection of pulmonary diseases in their early stages. Recent X-ray dark-field (XDF) imaging studies on mice have shown significant improvements in imaging-based lung diagnostics. Especially in the case of early diagnosis of chronic obstructive pulmonary disease (COPD), XDF imaging clearly outperforms conventional radiography. However, a translation of this technique towards the investigation of larger mammals and finally humans has not yet been achieved. In this letter, we present the first in-vivo XDF full-field chest radiographs (32 × 35 cm2) of a living pig, acquired with clinically compatible parameters (40 s scan time, approx. 80 µSv dose). For imaging, we developed a novel high-energy XDF system that overcomes the limitations of currently established setups. Our XDF radiographs yield sufficiently high image quality to enable radiographic evaluation of the lungs. We consider this a milestone in the bench-to-bedside translation of XDF imaging and expect XDF imaging to become an invaluable tool in clinical practice, both as a general chest X-ray modality and as a dedicated tool for high-risk patients affected by smoking, industrial work and indoor cooking.
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Affiliation(s)
- Lukas B Gromann
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.
| | - Fabio De Marco
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Peter B Noël
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Kai Scherer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Bernhard Gleich
- Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Alexander A Fingerle
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Daniela Muenzel
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Katharina Hellbach
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, 81377, Munich, Germany
| | - Andrea Baehr
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig-Maximilian-University, 85764, Oberschleißheim, Germany
| | - Michaela Dmochewitz
- Institute of Molecular Animal Breeding and Biotechnology, Ludwig-Maximilian-University, 85764, Oberschleißheim, Germany
| | - Tobias J Schroeter
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Frieder J Koch
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Pascal Meyer
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Danays Kunka
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344, Eggenstein-Leopoldshafen, Germany
| | - Andre Yaroshenko
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | | | - Roland Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany
| | - Thomas Koehler
- Philips GmbH Innovative Technologies, Research Laboratories, 22335, Hamburg, Germany.,Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | | | - Karsten Rindt
- Philips Medical Systems DMC GmbH, 22335, Hamburg, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, 81675, München, Germany.,Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics & Institute of Medical Engineering, Technical University of Munich, 85748, Garching, Germany.
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Fingerle A, Willer K, Gromann L, de Marco F, Herzen J, Achterhold K, Gleich B, Münzel D, Scherer K, Renz M, Renger B, Kopp F, Kriner F, Fischer F, Braun C, Auweter S, Hellbach K, Reiser M, Schröter T, Mohr J, Yaroshenko A, Maack H, Pralow T, van der Heijden H, Proksa R, Koehler T, Wieberneit N, Rindt K, Rummeny E, Pfeiffer F, Noël P. Erste Ergebnisse der Dunkelfeld-Radiografie des menschlichen Thorax. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Fingerle
- Institut für diagnostische und interventionelle Radiologie, Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, München
| | - K Willer
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - L Gromann
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - F de Marco
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - J Herzen
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - K Achterhold
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - B Gleich
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - D Münzel
- Institut für diagnostische und interventionelle Radiologie, Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, München
| | - K Scherer
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Technische Universität München, Garching
| | - M Renz
- Institut für diagnostische und interventionelle Radiologie, Technische Universität München, München
| | - B Renger
- Institut für diagnostische und interventionelle Radiologie, Technische Universität München, München
| | - F Kopp
- Institut für diagnostische und interventionelle Radiologie, Technische Universität München, München
| | - F Kriner
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München
| | - F Fischer
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München
| | - C Braun
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München
| | - S Auweter
- Institut für klinische Radiologie, Ludwig-Maximilians-Universität München, München
| | - K Hellbach
- Institut für klinische Radiologie, Ludwig-Maximilians-Universität München, München
| | - M Reiser
- Institut für klinische Radiologie, Ludwig-Maximilians-Universität München, München
| | - T Schröter
- Karlsruher Institut für Technologie, Karlsruhe
| | - J Mohr
- Karlsruher Institut für Technologie, Karlsruhe
| | | | - H Maack
- Philips Medical Systems DMC GmbH, Hamburg
| | - T Pralow
- Philips Medical Systems DMC GmbH, Hamburg
| | | | - R Proksa
- Philips GmbH Innovative Technologies, Research Laboratories, Hamburg
| | - T Koehler
- Philips GmbH Innovative Technologies, Research Laboratories; Institute for Advanced Study, Technische Universität München, Hamburg
| | | | - K Rindt
- Philips Medical Systems DMC GmbH, Hamburg
| | - E Rummeny
- Institut für diagnostische und interventionelle Radiologie, Technische Universität München, München
| | - F Pfeiffer
- Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, Institut für diagnostische und interventionelle Radiologie, Institute for Advanced Study, Technische Universität München, Garching
| | - P Noël
- Institut für diagnostische und interventionelle Radiologie, Lehrstuhl für Biomedizinische Physik und Institut für Medizintechnik, München
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Erhard K, Kilburn-Toppin F, Willsher P, Moa E, Fredenberg E, Wieberneit N, Buelow T, Wallis MG. Characterization of Cystic Lesions by Spectral Mammography: Results of a Clinical Pilot Study. Invest Radiol 2016; 51:340-7. [PMID: 26741891 DOI: 10.1097/rli.0000000000000246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Round lesions are a common mammographic finding, which can contribute more than 20% of overall recalls at screening. Discrimination of cystic fluid from solid tissue by spectral x-ray imaging has been demonstrated in specimen experiments. This work translates these results into a clinical pilot study to investigate the feasibility of discriminating cystic from solid lesions using spectral mammography. MATERIALS AND METHODS Women undergoing mammography as part of their routine diagnostic workup were consented for analysis of spectral information obtained from a photon-counting mammography system. Images were analyzed retrospectively after diagnosis was confirmed with ultrasound and pathology. Well-defined solitary lesions were delineated independently by 3 expert radiologists. A breast lesion model is generated from the spectral mammography data using the energy-dependent x-ray attenuation of cyst fluid, carcinoma, and adipose and glandular tissue. From the breast lesion model, 2 spectral features are computed and combined in a 2-feature discrimination algorithm, which is evaluated in an analysis of the receiver operating characteristic curve for the task of identifying solid lesions ("positive result"). Expected outcomes on a screening population are extrapolated from this pilot study by cross-validation with bootstrapping using a 95% confidence interval (CI). RESULTS The 2-feature discrimination algorithm was evaluated on the set of 119 eligible lesions (62 solids, 57 cysts) of diameter greater than 10 mm. The area under the receiver operating characteristic curve (AUC) was 0.88 with a specificity of 61% at the 99% sensitivity level on average over all expert radiologists. Cross-validation with bootstrapping of the clinical data revealed an AUC of 0.89 (95% CI, 0.79-0.96) and a specificity of 56% (95% CI, 33%-78%) when operating the algorithm at the 99% sensitivity level. CONCLUSIONS Discriminating cystic from solid lesions with spectral mammography demonstrates promising results with the potential to reduce mammographic recalls. It is estimated that for each missed cancer at least 625 cystic lesions would have been correctly identified and hence would not have been needed to be recalled. Our results justify undertaking a larger reader study to refine the algorithm and determine clinically relevant thresholds to allow safe classification of cystic lesions by spectral mammography.
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Affiliation(s)
- Klaus Erhard
- From the *Philips Research Laboratories, Hamburg, Germany; †Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, United Kingdom; ‡Philips Health Systems, Mammography Solutions, Solna, Sweden; §Philips Medical Systems DMC GmbH, Hamburg, Germany; and ∥NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom
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Fredenberg E, Roessl E, Koehler T, van Stevendaal U, Schulze-Wenck I, Wieberneit N, Stampanoni M, Wang Z, Kubik-Huch RA, Hauser N, Lundqvist M, Danielsson M, Åslund M. Photon-counting spectral phase-contrast mammography. ACTA ACUST UNITED AC 2012. [DOI: 10.1117/12.910615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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