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At least 73 records · Page 4

Automated registration of multispectral MR vessel wall images of the carotid artery

Purpose: Atherosclerosis is the primary cause of heart disease and stroke. The detailed assessment of atherosclerosis of the carotid artery requires high resolution imaging of the vessel wall using multiple MR sequences with different contrast weightings. These images allow manual or automated classification of plaque components inside the vessel wall. Automated classification requires all sequences to be in alignment, which is hampered by patient motion. In clinical practice, correction of this motion is performed manually. Previous studies applied automated image registration to correct for motion using only nondeformable transformation models and did not perform a detailed quantitative validation. The purpose of this study is to develop an automated accurate 3D registration method, and to extensively validate this method on a large set of patient data. In addition, the authors quantified patient motion during scanning to investigate the need for correction. Methods: MR imaging studies (1.5T, dedicated carotid surface coil, Philips) from 55 TIA/stroke patients with ipsilateral <70% carotid artery stenosis were randomly selected from a larger cohort. Five MR pulse sequences were acquired around the carotid bifurcation, each containing nine transverse slices: T1-weighted turbo field echo, time of flight, T2-weighted turbo spin-echo, and pre- and postcontrast T1-weighted turbo spin-echo images (T1W TSE). The images were manually segmented by delineating the lumen contour in each vessel wall sequence and were manually aligned by applying throughplane and inplane translations to the images. To find the optimal automatic image registration method, different masks, choice of the fixed image, different types of the mutual information image similarity metric, and transformation models including 3D deformable transformation models, were evaluated. Evaluation of the automatic registration results was performed by comparing the lumen segmentations of the fixed image and moving image after registration. Results: The average required manual translation per image slice was 1.33 mm. Translations were larger as the patient was longer inside the scanner. Manual alignment took 187.5 s per patient resulting in a mean surface distance of 0.271 ± 0.127 mm. After minimal user interaction to generate the mask in the fixed image, the remaining sequences are automatically registered with a computation time of 52.0 s per patient. The optimal registration strategy used a circular mask with a diameter of 10 mm, a 3D B-spline transformation model with a control point spacing of 15 mm, mutual information as image similarity metric, and the precontrast T1W TSE as fixed image. A mean surface distance of 0.288 ± 0.128 mm was obtained with these settings, which is very close to the accuracy of the manual alignment procedure. The exact registration parameters and software were made publicly available. Conclusions: An automated registration method was developed and optimized, only needing two mouse clicks to mark the start and end point of the artery. Validation on a large group of patients showed that automated image registration has similar accuracy as the manual alignment procedure, substantially reducing the amount of user interactions needed, and is multiple times faster. In conclusion, the authors believe that the proposed automated method can replace the current manual procedure, thereby reducing the time to analyze the images.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Validating and improving CT ventilation imaging by correlating with ventilation 4D-PET/CT using {sup 68}Ga-labeled nanoparticles

Purpose: CT ventilation imaging is a novel functional lung imaging modality based on deformable image registration. The authors present the first validation study of CT ventilation using positron emission tomography with{sup 68}Ga-labeled nanoparticles (PET-Galligas). The authors quantify this agreement for different CT ventilation metrics and PET reconstruction parameters. Methods: PET-Galligas ventilation scans were acquired for 12 lung cancer patients using a four-dimensional (4D) PET/CT scanner. CT ventilation images were then produced by applying B-spline deformable image registration between the respiratory correlated phases of the 4D-CT. The authors test four ventilation metrics, two existing and two modified. The two existing metrics model mechanical ventilation (alveolar air-flow) based on Hounsfield unit (HU) change (V{sub HU}) or Jacobian determinant of deformation (V{sub Jac}). The two modified metrics incorporate a voxel-wise tissue-density scaling (ρV{sub HU} and ρV{sub Jac}) and were hypothesized to better model the physiological ventilation. In order to assess the impact of PET image quality, comparisons were performed using both standard and respiratory-gated PET images with the former exhibiting better signal. Different median filtering kernels (σ{sub m} = 0 or 3 mm) were also applied to all images. As in previous studies, similarity metrics included the Spearman correlation coefficient r within the segmented lung volumes, and Dice coefficient d{sub 20} for the (0 − 20)th functional percentile volumes. Results: The best agreement between CT and PET ventilation was obtained comparing standard PET images to the density-scaled HU metric (ρV{sub HU}) with σ{sub m} = 3 mm. This leads to correlation values in the ranges 0.22 ⩽ r ⩽ 0.76 and 0.38 ⩽ d{sub 20} ⩽ 0.68, with r{sup ¯}=0.42±0.16 and d{sup ¯}{sub 20}=0.52±0.09 averaged over the 12 patients. Compared to Jacobian-based metrics, HU-based metrics lead to statistically significant improvements in r{sup ¯} and d{sup ¯}{sub 20} (p < 0.05), with density scaled metrics also showing higher r{sup ¯} than for unscaled versions (p < 0.02). r{sup ¯} and d{sup ¯}{sub 20} were also sensitive to image quality, with statistically significant improvements using standard (as opposed to gated) PET images and with application of median filtering. Conclusions: The use of modified CT ventilation metrics, in conjunction with PET-Galligas and careful application of image filtering has resulted in improved correlation compared to earlier studies using nuclear medicine ventilation. However, CT ventilation and PET-Galligas do not always provide the same functional information. The authors have demonstrated that the agreement can improve for CT ventilation metrics incorporating a tissue density scaling, and also with increasing PET image quality. CT ventilation imaging has clear potential for imaging regional air volume change in the lung, and further development is warranted.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A dual-view digital tomosynthesis imaging technique for improved chest imaging

Purpose: Digital tomosynthesis (DTS) has been shown to be useful for reducing the overlapping of abnormalities with anatomical structures at various depth levels along the posterior–anterior (PA) direction in chest radiography. However, DTS provides crude three-dimensional (3D) images that have poor resolution in the lateral view and can only be displayed with reasonable quality in the PA view. Furthermore, the spillover of high-contrast objects from off-fulcrum planes generates artifacts that may impede the diagnostic use of the DTS images. In this paper, the authors describe and demonstrate the use of a dual-view DTS technique to improve the accuracy of the reconstructed volume image data for more accurate rendition of the anatomy and slice images with improved resolution and reduced artifacts, thus allowing the 3D image data to be viewed in views other than the PA view. Methods: With the dual-view DTS technique, limited angle scans are performed and projection images are acquired in two orthogonal views: PA and lateral. The dual-view projection data are used together to reconstruct 3D images using the maximum likelihood expectation maximization iterative algorithm. In this study, projection images were simulated or experimentally acquired over 360° using the scanning geometry for cone beam computed tomography (CBCT). While all projections were used to reconstruct CBCT images, selected projections were extracted and used to reconstruct single- and dual-view DTS images for comparison with the CBCT images. For realistic demonstration and comparison, a digital chest phantom derived from clinical CT images was used for the simulation study. An anthropomorphic chest phantom was imaged for the experimental study. The resultant dual-view DTS images were visually compared with the single-view DTS images and CBCT images for the presence of image artifacts and accuracy of CT numbers and anatomy and quantitatively compared with root-mean-square-deviation (RMSD) values computed using the digital chest phantom or the CBCT images as the reference in the simulation and experimental study, respectively. High-contrast wires with vertical, oblique, and horizontal orientations in a PA view plane were also imaged to investigate the spatial resolutions and how the wire signals spread in the PA view and lateral view slice images. Results: Both the digital phantom images (simulated) and the anthropomorphic phantom images (experimentally generated) demonstrated that the dual-view DTS technique resulted in improved spatial resolution in the depth (PA) direction, more accurate representation of the anatomy, and significantly reduced artifacts. The RMSD values corroborate well with visual observations with substantially lower RMSD values measured for the dual-view DTS images as compared to those measured for the single-view DTS images. The imaging experiment with the high-contrast wires shows that while the vertical and oblique wires could be resolved in the lateral view in both single- and dual-view DTS images, the horizontal wire could only be resolved in the dual-view DTS images. This indicates that with single-view DTS, the wire signals spread liberally to off-fulcrum planes and generated wire shadow there. Conclusions: The authors have demonstrated both visually and quantitatively that the dual-view DTS technique can be used to achieve more accurate rendition of the anatomy and to obtain slice images with improved resolution and reduced artifacts as compared to the single-view DTS technique, thus allowing the 3D image data to be viewed in views other than the PA view. These advantages could make the dual-view DTS technique useful in situations where better separation of the objects-of-interest from the off-fulcrum structures or more accurate 3D rendition of the anatomy are required while a regular CT examination is undesirable due to radiation dose considerations.

60 APPLIED LIFE SCIENCES↗

Realistic simulation of reduced-dose CT with noise modeling and sinogram synthesis using DICOM CT images

Purpose: Reducing the patient dose while maintaining the diagnostic image quality during CT exams is the subject of a growing number of studies, in which simulations of reduced-dose CT with patient data have been used as an effective technique when exploring the potential of various dose reduction techniques. Difficulties in accessing raw sinogram data, however, have restricted the use of this technique to a limited number of institutions. Here, we present a novel reduced-dose CT simulation technique which provides realistic low-dose images without the requirement of raw sinogram data. Methods: Two key characteristics of CT systems, the noise equivalent quanta (NEQ) and the algorithmic modulation transfer function (MTF), were measured for various combinations of object attenuation and tube currents by analyzing the noise power spectrum (NPS) of CT images obtained with a set of phantoms. Those measurements were used to develop a comprehensive CT noise model covering the reduced x-ray photon flux, object attenuation, system noise, and bow-tie filter, which was then employed to generate a simulated noise sinogram for the reduced-dose condition with the use of a synthetic sinogram generated from a reference CT image. The simulated noise sinogram was filtered with the algorithmic MTF and back-projected to create a noise CT image, which was then added to the reference CT image, finally providing a simulated reduced-dose CT image. The simulation performance was evaluated in terms of the degree of NPS similarity, the noise magnitude, the bow-tie filter effect, and the streak noise pattern at photon starvation sites with the set of phantom images. Results: The simulation results showed good agreement with actual low-dose CT images in terms of their visual appearance and in a quantitative evaluation test. The magnitude and shape of the NPS curves of the simulated low-dose images agreed well with those of real low-dose images, showing discrepancies of less than +/−3.2% in terms of the noise power at the peak height and +/−1.2% in terms of the spatial frequency at the peak height. The magnitudes of the noise measured for 12 different combinations the phantom size, tube current, and reconstruction kernel for the simulated and real low-dose images were very similar, with differences of 0.1 to 4.7%. Thep value for a statistical testing of the difference in the noise magnitude ranged from 0.99 to 0.11, showing that there was no difference statistically between the noise magnitudes of the real and simulated low-dose images using our method. The strength and pattern of the streak noise in an anthropomorphic phantom was also consistent with expectations. Conclusions: A novel reduced-dose CT simulation technique was developed which uses only CT images while not requiring raw sinogram data. Our method can provide realistic simulation results under reduced-dose conditions both in terms of the noise magnitude and the textual appearance. This technique has the potential to promote clinical research for patient dose reductions.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Portal dosimetry for VMAT using integrated images obtained during treatment

Purpose: Portal dosimetry provides an accurate and convenient means of verifying dose delivered to the patient. A simple method for carrying out portal dosimetry for volumetric modulated arc therapy (VMAT) is described, together with phantom measurements demonstrating the validity of the approach. Methods: Portal images were predicted by projecting dose in the isocentric plane through to the portal image plane, with exponential attenuation and convolution with a double-Gaussian scatter function. Appropriate parameters for the projection were selected by fitting the calculation model to portal images measured on an iViewGT portal imager (Elekta AB, Stockholm, Sweden) for a variety of phantom thicknesses and field sizes. This model was then used to predict the portal image resulting from each control point of a VMAT arc. Finally, all these control point images were summed to predict the overall integrated portal image for the whole arc. The calculated and measured integrated portal images were compared for three lung and three esophagus plans delivered to a thorax phantom, and three prostate plans delivered to a homogeneous phantom, using a gamma index for 3% and 3 mm. A 0.6 cm{sup 3} ionization chamber was used to verify the planned isocentric dose. The sensitivity of this method to errors in monitor units, field shaping, gantry angle, and phantom position was also evaluated by means of computer simulations. Results: The calculation model for portal dose prediction was able to accurately compute the portal images due to simple square fields delivered to solid water phantoms. The integrated images of VMAT treatments delivered to phantoms were also correctly predicted by the method. The proportion of the images with a gamma index of less than unity was 93.7% ± 3.0% (1SD) and the difference between isocenter dose calculated by the planning system and measured by the ionization chamber was 0.8% ± 1.0%. The method was highly sensitive to errors in monitor units and field shape, but less sensitive to errors in gantry angle or phantom position. Conclusions: This method of predicting integrated portal images provides a convenient means of verifying dose delivered using VMAT, with minimal image acquisition and data processing requirements.

61 RADIATION PROTECTION AND DOSIMETRY↗

Magnetoacoustic tomography with magnetic induction for high-resolution bioimepedance imaging through vector source reconstruction under the static field of MRI magnet

Purpose: Magnetoacoustic tomography with magnetic induction (MAT-MI) is an imaging modality to reconstruct the electrical conductivity of biological tissue based on the acoustic measurements of Lorentz force induced tissue vibration. This study presents the feasibility of the authors' new MAT-MI system and vector source imaging algorithm to perform a complete reconstruction of the conductivity distribution of real biological tissues with ultrasound spatial resolution. Methods: In the present study, using ultrasound beamformation, imaging point spread functions are designed to reconstruct the induced vector source in the object which is used to estimate the object conductivity distribution. Both numerical studies and phantom experiments are performed to demonstrate the merits of the proposed method. Also, through the numerical simulations, the full width half maximum of the imaging point spread function is calculated to estimate of the spatial resolution. The tissue phantom experiments are performed with a MAT-MI imaging system in the static field of a 9.4 T magnetic resonance imaging magnet. Results: The image reconstruction through vector beamformation in the numerical and experimental studies gives a reliable estimate of the conductivity distribution in the object with a ∼1.5 mm spatial resolution corresponding to the imaging system frequency of 500 kHz ultrasound. In addition, the experiment results suggest that MAT-MI under high static magnetic field environment is able to reconstruct images of tissue-mimicking gel phantoms and real tissue samples with reliable conductivity contrast. Conclusions: The results demonstrate that MAT-MI is able to image the electrical conductivity properties of biological tissues with better than 2 mm spatial resolution at 500 kHz, and the imaging with MAT-MI under a high static magnetic field environment is able to provide improved imaging contrast for biological tissue conductivity reconstruction.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

TH-CD-207A-08: Simulated Real-Time Image Guidance for Lung SBRT Patients Using Scatter Imaging

Purpose: To develop a comprehensive Monte Carlo-based model for the acquisition of scatter images of patient anatomy in real-time, during lung SBRT treatment. Methods: During SBRT treatment, images of patient anatomy can be acquired from scattered radiation. To rigorously examine the utility of scatter images for image guidance, a model is developed using MCNP code to simulate scatter images of phantoms and lung cancer patients. The model is validated by comparing experimental and simulated images of phantoms of different complexity. The differentiation between tissue types is investigated by imaging objects of known compositions (water, lung, and bone equivalent). A lung tumor phantom, simulating materials and geometry encountered during lung SBRT treatments, is used to investigate image noise properties for various quantities of delivered radiation (monitor units(MU)). Patient scatter images are simulated using the validated simulation model. 4DCT patient data is converted to an MCNP input geometry accounting for different tissue composition and densities. Lung tumor phantom images acquired with decreasing imaging time (decreasing MU) are used to model the expected noise amplitude in patient scatter images, producing realistic simulated patient scatter images with varying temporal resolution. Results: Image intensity in simulated and experimental scatter images of tissue equivalent objects (water, lung, bone) match within the uncertainty (∼3%). Lung tumor phantom images agree as well. Specifically, tumor-to-lung contrast matches within the uncertainty. The addition of random noise approximating quantum noise in experimental images to simulated patient images shows that scatter images of lung tumors can provide images in as fast as 0.5 seconds with CNR∼2.7. Conclusions: A scatter imaging simulation model is developed and validated using experimental phantom scatter images. Following validation, lung cancer patient scatter images are simulated. These simulated patient images demonstrate the clinical utility of scatter imaging for real-time tumor tracking during lung SBRT.

60 APPLIED LIFE SCIENCES↗

Prediction of standard-dose brain PET image by using MRI and low-dose brain [{sup 18}F]FDG PET images

Purpose: Positron emission tomography (PET) is a nuclear medical imaging technology that produces 3D images reflecting tissue metabolic activity in human body. PET has been widely used in various clinical applications, such as in diagnosis of brain disorders. High-quality PET images play an essential role in diagnosing brain diseases/disorders. In practice, in order to obtain high-quality PET images, a standard-dose radionuclide (tracer) needs to be used and injected into a living body. As a result, it will inevitably increase the patient’s exposure to radiation. One solution to solve this problem is predicting standard-dose PET images using low-dose PET images. As yet, no previous studies with this approach have been reported. Accordingly, in this paper, the authors propose a regression forest based framework for predicting a standard-dose brain [{sup 18}F]FDG PET image by using a low-dose brain [{sup 18}F]FDG PET image and its corresponding magnetic resonance imaging (MRI) image. Methods: The authors employ a regression forest for predicting the standard-dose brain [{sup 18}F]FDG PET image by low-dose brain [{sup 18}F]FDG PET and MRI images. Specifically, the proposed method consists of two main steps. First, based on the segmented brain tissues (i.e., cerebrospinal fluid, gray matter, and white matter) in the MRI image, the authors extract features for each patch in the brain image from both low-dose PET and MRI images to build tissue-specific models that can be used to initially predict standard-dose brain [{sup 18}F]FDG PET images. Second, an iterative refinement strategy, via estimating the predicted image difference, is used to further improve the prediction accuracy. Results: The authors evaluated their algorithm on a brain dataset, consisting of 11 subjects with MRI, low-dose PET, and standard-dose PET images, using leave-one-out cross-validations. The proposed algorithm gives promising results with well-estimated standard-dose brain [{sup 18}F]FDG PET image and substantially enhanced image quality of low-dose brain [{sup 18}F]FDG PET image. Conclusions: In this paper, the authors propose a framework to generate standard-dose brain [{sup 18}F]FDG PET image using low-dose brain [{sup 18}F]FDG PET and MRI images. Both the visual and quantitative results indicate that the standard-dose brain [{sup 18}F]FDG PET can be well-predicted using MRI and low-dose brain [{sup 18}F]FDG PET.

60 APPLIED LIFE SCIENCES↗

SU-F-J-114: On-Treatment Imagereconstruction Using Transit Images of Treatment Beams Through Patient and Thosethrough Planning CT Images

Purpose: To reconstruct patient images at the time of radiation delivery using measured transit images of treatment beams through patient and calculated transit images through planning CT images. Methods: We hypothesize that the ratio of the measured transit images to the calculated images may provide changed amounts of the patient image between times of planning CT and treatment. To test, we have devised lung phantoms with a tumor object (3-cm diameter) placed at iso-center (simulating planning CT) and off-center by 1 cm (simulating treatment). CT images of the two phantoms were acquired; the image of the off-centered phantom, unavailable clinically, represents the reference on-treatment image in the image quality of planning CT. Cine-transit images through the two phantoms were also acquired in EPID from a non-modulated 6 MV beam when the gantry was rotated 360 degrees; the image through the centered phantom simulates calculated image. While the current study is a feasibility study, in reality our computational EPID model can be applicable in providing accurate transit image from MC simulation. Changed MV HU values were reconstructed from the ratio between two EPID projection data, converted to KV HU values, and added to the planning CT, thereby reconstructing the on-treatment image of the patient limited to the irradiated region of the phantom. Results: The reconstructed image was compared with the reference image. Except for local HU differences>200 as a maximum, excellent agreement was found. The average difference across the entire image was 16.2 HU. Conclusion: We have demonstrated the feasibility of a method of reconstructing on-treatment images of a patient using EPID image and planning CT images. Further studies will include resolving the local HU differences and investigation on the dosimetry impact of the reconstructed image.

60 APPLIED LIFE SCIENCES↗

Image quality comparison between single energy and dual energy CT protocols for hepatic imaging

Purpose: Multi-detector computed tomography (MDCT) enables volumetric scans in a single breath hold and is clinically useful for hepatic imaging. For simple tasks, conventional single energy (SE) computed tomography (CT) images acquired at the optimal tube potential are known to have better quality than dual energy (DE) blended images. However, liver imaging is complex and often requires imaging of both structures containing iodinated contrast media, where atomic number differences are the primary contrast mechanism, and other structures, where density differences are the primary contrast mechanism. Hence it is conceivable that the broad spectrum used in a dual energy acquisition may be an advantage. In this work we are interested in comparing these two imaging strategies at equal-dose and more complex settings. Methods: We developed numerical anthropomorphic phantoms to mimic realistic clinical CT scans for medium size and large size patients. MDCT images based on the defined phantoms were simulated using various SE and DE protocols at pre- and post-contrast stages. For SE CT, images from 60 kVp through 140 with 10 kVp steps were considered; for DE CT, both 80/140 and 100/140 kVp scans were simulated and linearly blended at the optimal weights. To make a fair comparison, the mAs of each scan was adjusted to match the reference radiation dose (120 kVp, 200 mAs for medium size patients and 140 kVp, 400 mAs for large size patients). Contrast-to-noise ratio (CNR) of liver against other soft tissues was used to evaluate and compare the SE and DE protocols, and multiple pre- and post-contrasted liver-tissue pairs were used to define a composite CNR. To help validate the simulation results, we conducted a small clinical study. Eighty-five 120 kVp images and 81 blended 80/140 kVp images were collected and compared through both quantitative image quality analysis and an observer study. Results: In the simulation study, we found that the CNR of pre-contrast SE image mostly increased with increasing kVp while for post-contrast imaging 90 kVp or lower yielded higher CNR images, depending on the differential iodine concentration of each tissue. Similar trends were seen in DE blended CNR and those from SE protocols. In the presence of differential iodine concentration (i.e., post-contrast), the CNR curves maximize at lower kVps (80–120), with the peak shifted rightward for larger patients. The combined pre- and post-contrast composite CNR study demonstrated that an optimal SE protocol has better performance than blended DE images, and the optimal tube potential for SE scan is around 90 kVp for a medium size patients and between 90 and 120 kVp for large size patients (although low kVp imaging requires high x-ray tube power to avoid photon starvation). Also, a tin filter added to the high kVp beam is not only beneficial for material decomposition but it improves the CNR of the DE blended images as well. The dose adjusted CNR of the clinical images also showed the same trend and radiologists favored the SE scans over blended DE images. Conclusions: Our simulation showed that an optimized SE protocol produces up to 5% higher CNR for a range of clinical tasks. The clinical study also suggested 120 kVp SE scans have better image quality than blended DE images. Hence, blended DE images do not have a fundamental CNR advantage over optimized SE images.

60 APPLIED LIFE SCIENCES↗

SU-F-J-26: Performance of 2.5MV Portal Imaging in Comparison with KV X-Ray and 6MV and Flattening-Filter-Free 6MV Portal Imaging

Purpose: To assess image quality and imaging dose of 2.5MV electronic portal imaging in comparison to kV imaging and 6MV and Flattening-Filter-Free 6MV (6MVFFF) portal imaging using a DMI imager. Methods: Quantitative assessment of image quality was performed with Leeds and Las Vegas test phantoms in conjunction with qualitative evaluation of clinical patient images for kV imaging and 2.5MV, 6MV and 6MVFFF portal imaging. High and low contrast resolutions were evaluated and imaging doses were measured using these x-rays. Phantom test was performed both in air and in solid water. Clinical patient portal images were also reviewed and qualitatively assessed for these three imaging MV energies. Results: Among the 28 objects in Las Vegas phantom, 16, 17 and 26 of them were resolved using Low Dose technique and 18, 22 and 26 were resolved using High Quality technique with 6MV, 6MVFFF and 2.5MV, respectively. The number of Leeds low contrast objects resolved by 6MV, 6MFFFF and 2.5MV was 6, 15 and 18 with Low Dose technique and 14, 17 and 18 with High Quality technique, respectively. When the test phantoms were embedded in 20cm thick solid water, the results were noticeably affected, but the performance of 2.5MV was still substantially better than 6MV and 6MVFFF. Imaging dose with 2.5MV measured at 10 cm depth was about half of that with 6MV or 6MVFFF. Clinical patient portal images were reviewed and qualitatively assessed for different sites including brain, head-and-neck, chest and pelvis. 2.5MV imaging provided more details and substantially higher contrast. Conclusion: While portal imaging with 6MVFFF provides noticeably better image quality than that with 6MV, the performance of 2.5MV portal imaging is substantially better than both 6MV and 6MVFFF in terms of high and low contrast resolutions as well as lower imaging dose. 2.5MV imaging provides near kV imaging quality.

60 APPLIED LIFE SCIENCES↗

WE-DE-207A-02: Advances in Cone Beam CT Anatomical and Functional Imaging in Angio-Suite to Enable One-Stop-Shop Stroke Imaging Workflow

1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures. Along with development of catheters, embolic materials, pushable coils and the GDC coils there was simultaneous development and improvement of 2D DSA image quality and the introduction of 3D DSA. Together, these advances resulted in an enormous expansion in the scope and numbers of minimally invasive endovascular procedures. The introduction of flat detectors for c-arm angiographic systems in 2002 provided the possibility of the angiographic suite becoming not just a location for vascular imaging where physiological assessments might also be performed. Over the last decade algorithmic and hardware advances have been sufficient to now realize this potential in clinical practice. The selection of patients for endovascular treatments is enhanced by this dual capability. Along with these advances has been a steady reduction in the radiation exposure required so that today, vascular and soft tissue images may be obtained with equal or in many cases less radiation exposure than is the case for comparable images obtained with multi-detector CT. Learning Objectives: To understand the full capabilities of today’s angiographic suite To understand how c-arm cone beam CT soft tissue imaging can be used for assessments of devices, blood flow and perfusion. Advances in real-time x-ray neuro-endovascular image guidance Stephen Rudin - Reacting to the demands on real-time image guidance for ever finer neurovascular interventions, great improvements in imaging chains are being pursued. For the highest spatial and temporal resolution, x-ray guidance with fluoroscopy and angiography although dominant are still being vastly improved. New detectors such as the Micro-Angiographic Fluoroscope (MAF) and x-ray source designs that enable higher outputs while maintaining small focal spots will be highlighted along with new methods for minimizing the radiation dose to patients. Additionally, new platforms for training and device testing that include patient-specific 3D printed vascular phantoms and new metrics such as generalized relative object detectability for objectively inter-comparing systems will be discussed. This will improve the opportunity for better evaluation of these technological advances which should contribute to the safety and efficacy of image guided minimally invasive neuro-endovascular procedures. Learning Objectives: To understand the operation of new x-ray imaging chain components such as detectors and sources To be informed about the latest testing methods, with 3D printed vascular phantoms, and new evaluation metrics for advanced imaging in x-ray image guided neurovascular interventions Advances in cone beam CT anatomical and functional imaging in angio-suite to enable one-stop-shop stroke imaging workflow Guang-Hong Chen - The introduction of flat-panel detector based cone-beam CT in clinical angiographic imaging systems enabled treating physicians to obtain three-dimensional anatomic roadmaps for bony structure, soft brain tissue, and vasculatures for treatment planning and efficacy checking after the procedures. However, much improvement is needed to reduce image artifacts, reduce radiation dose, and add potential functional imaging capability to provide four-dimensional dynamic information of vasculature and brain perfusion. In this presentation, some of the new techniques developed to address radiation dose issues, image artifact reduction and brain perfusion using C-arm cone-beam CT imaging system will be introduced for the audience. Learning Objectives: To understand the clinical need of one-stop-shop stroke imaging workflow To understand to technical challenges in cone beam CT perfusion To understand the potential technical solutions to enable one-stop-shop imaging workflow Recent advances in devices used in neuro--interventions Mattew Gounis - Over the past two decades, there has been explosive development of medical devices that have revolutionized the endovascular treatment of cerebrovascular diseases. There is now Level 1, Class A evidence that intra-arterial, mechanical thrombectomy in acute ischemic stroke is superior to medical management; and similarly that minimally invasive, endovascular repair of ruptured brain aneurysms is superior to surgical treatment. Stent-retrievers are now standard of care for emergent large vessel occlusions causing a stroke, with a number of patients need to treat for good clinical outcomes as low as 4. Recent technologies such as flow diverters and disrupters, intracranial self-expanding stents, flexible large bore catheters that can reach vessels beyond the circle of Willis, stent-retrievers, and super-compliant balloons are the result of successful miniaturization of design features and novel manufacturing technologies capable of building these devices. This is a rapidly evolving field, and the device technology enabling such advancements will be reviewed. Importantly, image-guidance technology has not kept pace in neurointervention and the ability to adequately characterize these devices in vivo remains a significant opportunity. Learning Objectives: A survey of devices used in neurointerventions, their materials and essential design characteristics Funding support received from NIH and DOD; Funding support received from GE Healthcare; Funding support received from Siemens AX; Patent royalties received from GE Healthcare; G. Chen, Funding received from NIH; funding received from DOD; funding received from GE Healthcare; funding received from Siemens AX.; M. Gounis, consultant for Codman Neurovascular and Stryker Neurovascular; Holds stock in InNeuroCo Inc, research grants: NIH, Medtronic Neurovascular, Microvention/Terumo, Cerevasc LLC, Gentuity, Codman Neurovascular, Philips Healthcare, Stryker Neurovascular, Tay Sachs Foundation, and InNeuroCo Inc.; S. Rudin, Supported in part by NIH Grant R01EB002873 and the Toshiba Medical System Corp.

60 APPLIED LIFE SCIENCES↗

Prospective Evaluation of Dual-Energy Imaging in Patients Undergoing Image Guided Radiation Therapy for Lung Cancer: Initial Clinical Results

Purpose: A prospective feasibility study was conducted to investigate the utility of dual-energy (DE) imaging compared to conventional x-ray imaging for patients undergoing kV-based image guided radiation therapy (IGRT) for lung cancer. Methods and Materials: An institutional review board-approved feasibility study enrolled patients with lung cancer undergoing IGRT and was initiated in September 2011. During daily setup, 2 sequential respiration-gated x-ray images were obtained using an on-board imager. Imaging was composed of 1 standard x-ray image at 120 kVp (1 mAs) and a second image obtained at 60 kVp (4 mAs). Weighted logarithmic subtraction of the 2 images was performed offline to create a soft tissue-selective DE image. Conventional and DE images were evaluated by measuring relative contrast and contrast-to-noise ratios (CNR) and also by comparing spatial localization, using both approaches. Imaging dose was assessed using a calibrated ion chamber. Results: To date, 10 patients with stage IA to IIIA lung cancer were enrolled and 57 DE images were analyzed. DE subtraction resulted in complete suppression of overlying bone in all 57 DE images, with an average improvement in relative contrast of 4.7 ± 3.3 over that of 120 kVp x-ray images (P<.0002). The improvement in relative contrast with DE imaging was seen for both smaller (gross tumor volume [GTV] ≤5 cc) and larger tumors (GTV >5 cc), with average relative contrast improvement ratios of 3.4 ± 4.1 and 5.4 ± 3.6, respectively. Moreover, the GTV was reliably localized in 95% of the DE images versus 74% of the single energy (SE images, (P=.004). Mean skin dose per DE image set was 0.44 ± 0.03 mGy versus 0.43 ± 0.03 mGy, using conventional kV imaging parameters. Conclusions: Initial results of this feasibility study suggest that DE thoracic imaging may enhance tumor localization in lung cancer patients receiving kV-based IGRT without increasing imaging dose.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

CBCT with specification of imaging dose and CNR by anatomical volume of interest

Purpose: A novel method has been developed for volume of interest (VOI) cone-beam CT (CBCT) imaging using a 2.35 MV/Carbon target linac imaging beam line combined with dynamic multileaf collimator sequences. Methods: The authors demonstrate the concept of acquisition of multiple, separate imaging volumes, where volumes can be either completely separated or nested, and are associated with predetermined imaging dose and contrast-to-noise ratio (CNR) characteristics. Two individual MLC sequences were established in the planning system (Eclipse, Varian Medical) to collimate the beam according to a defined inner VOI (e.g., containing a target volume under image guidance) and an outer VOI (e.g., including surrounding landmarks or organs-at-risk). MLC sequences were interleaved as a function of gantry angle to produce a reconstructed CBCT image with nested VOIs. By controlling the ratio of inner-to-outer ratio of MLC segments (and thus Monitor Units) during acquisition, the relative dose and CNR in the two volumes can be controlled. Inner-to-outer ratios of 2:1 to 6:1 were examined. Results: The concept was explored using an anatomical head phantom to assess image quality. A geometric phantom was used to quantify absolute dose and CNR values for the various sequences. The authors found that the dose in the outer VOI decreased by a functional relationship dependent on the inner-to-outer sequence ratio, while the CNR varied by the square root of dose, as expected. Conclusions: In this study the authors demonstrate flexibility in VOI CBCT by tailoring the imaging dose and CNR distribution in separate volumes within the patient anatomy. This would allow for high quality imaging of a target volume for alignment purposes, with simultaneous low dose imaging of the surrounding anatomy (e.g., for coregistration)

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Technical Note: Image filtering to make computer-aided detection robust to image reconstruction kernel choice in lung cancer CT screening

Purpose: In lung cancer computed tomography (CT) screening, the performance of a computer-aided detection (CAD) system depends on the selection of the image reconstruction kernel. To reduce this dependence on reconstruction kernels, the authors propose a novel application of an image filtering method previously proposed by their group. Methods: The proposed filtering process uses the ratio of modulation transfer functions (MTFs) of two reconstruction kernels as a filtering function in the spatial-frequency domain. This method is referred to as MTF{sub ratio} filtering. Test image data were obtained from CT screening scans of 67 subjects who each had one nodule. Images were reconstructed using two kernels: f{sub STD} (for standard lung imaging) and f{sub SHARP} (for sharp edge-enhancement lung imaging). The MTF{sub ratio} filtering was implemented using the MTFs measured for those kernels and was applied to the reconstructed f{sub SHARP} images to obtain images that were similar to the f{sub STD} images. A mean filter and a median filter were applied (separately) for comparison. All reconstructed and filtered images were processed using their prototype CAD system. Results: The MTF{sub ratio} filtered images showed excellent agreement with the f{sub STD} images. The standard deviation for the difference between these images was very small, ∼6.0 Hounsfield units (HU). However, the mean and median filtered images showed larger differences of ∼48.1 and ∼57.9 HU from the f{sub STD} images, respectively. The free-response receiver operating characteristic (FROC) curve for the f{sub SHARP} images indicated poorer performance compared with the FROC curve for the f{sub STD} images. The FROC curve for the MTF{sub ratio} filtered images was equivalent to the curve for the f{sub STD} images. However, this similarity was not achieved by using the mean filter or median filter. Conclusions: The accuracy of MTF{sub ratio} image filtering was verified and the method was demonstrated to be effective for reducing the kernel dependence of CAD performance.

60 APPLIED LIFE SCIENCES↗

SU-F-P-48: The Quantitative Evaluation and Comparison of Image Distortion and Loss of X-Ray Images Between Anti-Scattered Grid and Moire Compensation Processing in Digital Radiography

Purpose: To quantitatively analyze the influence image processing for Moire elimination has in digital radiography by comparing the image acquired from optimized anti-scattered grid only and the image acquired from software processing paired with misaligned low-frequency grid. Methods: Special phantom, which does not create scattered radiation, was used to acquire non-grid reference images and they were acquired without any grids. A set of images was acquired with optimized grid, aligned to pixel of a detector and other set of images was acquired with misaligned low-frequency grid paired with Moire elimination processing algorithm. X-ray technique used was based on consideration to Bucky factor derived from non-grid reference images. For evaluation, we analyze by comparing pixel intensity of acquired images with grids to that of reference images. Results: When compared to image acquired with optimized grid, images acquired with Moire elimination processing algorithm showed 10 to 50% lower mean contrast value of ROI. Severe distortion of images was found with when the object’s thickness was measured at 7 or less pixels. In this case, contrast value measured from images acquired with Moire elimination processing algorithm was under 30% of that taken from reference image. Conclusion: This study shows the potential risk of Moire compensation images in diagnosis. Images acquired with misaligned low-frequency grid results in Moire noise and Moire compensation processing algorithm used to remove this Moire noise actually caused an image distortion. As a result, fractures and/or calcifications which are presented in few pixels only may not be diagnosed properly. In future work, we plan to evaluate the images acquired without grid but based on 100% image processing and the potential risks it possesses.

60 APPLIED LIFE SCIENCES↗

Comparing deflection measurements of a magnetically steerable catheter using optical imaging and MRI

Purpose: Magnetic resonance imaging (MRI) is an emerging modality for interventional radiology, giving clinicians another tool for minimally invasive image-guided interventional procedures. Difficulties associated with endovascular catheter navigation using MRI guidance led to the development of a magnetically steerable catheter. The focus of this study was to mechanically characterize deflections of two different prototypes of the magnetically steerable catheterin vitro to better understand their efficacy. Methods: A mathematical model for deflection of the magnetically steerable catheter is formulated based on the principle that at equilibrium the mechanical and magnetic torques are equal to each other. Furthermore, two different image based methods for empirically measuring the catheter deflection angle are presented. The first, referred to as the absolute tip method, measures the angle of the line that is tangential to the catheter tip. The second, referred to the base to tip method, is an approximation that is used when it is not possible to measure the angle of the tangent line. Optical images of the catheter deflection are analyzed using the absolute tip method to quantitatively validate the predicted deflections from the mathematical model. Optical images of the catheter deflection are also analyzed using the base to tip method to quantitatively determine the differences between the absolute tip and base to tip methods. Finally, the optical images are compared to MR images using the base to tip method to determine the accuracy of measuring the catheter deflection using MR. Results: The optical catheter deflection angles measured for both catheter prototypes using the absolute tip method fit very well to the mathematical model (R{sup 2} = 0.91 and 0.86 for each prototype, respectively). It was found that the angles measured using the base to tip method were consistently smaller than those measured using the absolute tip method. The deflection angles measured using optical data did not demonstrate a significant difference from the angles measured using MR image data when compared using the base to tip method. Conclusions: This study validates the theoretical description of the magnetically steerable catheter, while also giving insight into different methods and modalities for measuring the deflection angles of the prototype catheters. These results can be used to mechanically model future iterations of the design. Quantifying the difference between the different methods for measuring catheter deflection will be important when making deflection measurements in future studies. Finally, MR images can be used to reliably measure deflection angles since there is no significant difference between the MR and optical measurements.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

An initial study on the estimation of time-varying volumetric treatment images and 3D tumor localization from single MV cine EPID images

Purpose: In this work the authors develop and investigate the feasibility of a method to estimate time-varying volumetric images from individual MV cine electronic portal image device (EPID) images. Methods: The authors adopt a two-step approach to time-varying volumetric image estimation from a single cine EPID image. In the first step, a patient-specific motion model is constructed from 4DCT. In the second step, parameters in the motion model are tuned according to the information in the EPID image. The patient-specific motion model is based on a compact representation of lung motion represented in displacement vector fields (DVFs). DVFs are calculated through deformable image registration (DIR) of a reference 4DCT phase image (typically peak-exhale) to a set of 4DCT images corresponding to different phases of a breathing cycle. The salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). PCA decouples the spatial and temporal components of the DVFs. Spatial information is represented in eigenvectors and the temporal information is represented by eigen-coefficients. To generate a new volumetric image, the eigen-coefficients are updated via cost function optimization based on digitally reconstructed radiographs and projection images. The updated eigen-coefficients are then multiplied with the eigenvectors to obtain updated DVFs that, in turn, give the volumetric image corresponding to the cine EPID image. Results: The algorithm was tested on (1) Eight digital eXtended CArdiac-Torso phantom datasets based on different irregular patient breathing patterns and (2) patient cine EPID images acquired during SBRT treatments. The root-mean-squared tumor localization error is (0.73 ± 0.63 mm) for the XCAT data and (0.90 ± 0.65 mm) for the patient data. Conclusions: The authors introduced a novel method of estimating volumetric time-varying images from single cine EPID images and a PCA-based lung motion model. This is the first method to estimate volumetric time-varying images from single MV cine EPID images, and has the potential to provide volumetric information with no additional imaging dose to the patient.

60 APPLIED LIFE SCIENCES↗