Advanced Monte Carlo simulations of emission tomography imaging systems with GATE.

Built on top of the Geant4 toolkit, GATE is collaboratively developed for more than 15 years to design Monte Carlo simulations of nuclear-based imaging systems. It is, in particular, used by researchers and industrials to design, optimize, understand and create innovative emission tomography systems. In this paper, we reviewed the recent developments that have been proposed to simulate modern detectors and provide a comprehensive report on imaging systems that have been simulated and evaluated in GATE. Additionally, some methodological developments that are not specific for imaging but that can improve detector modeling and provide computation time gains, such as Variance Reduction Techniques and Artificial Intelligence integration, are described and discussed.

Scatter Correction Based on GPU-Accelerated Full Monte Carlo Simulation for Brain PET/MRI.

Accurate scatter correction is essential for qualitative and quantitative PET imaging. Until now, scatter correction based on Monte Carlo simulation (MCS) has been recognized as the most accurate method of scatter correction for PET. However, the major disadvantage of MCS is its long computational time, which makes it unfeasible for clinical usage. Meanwhile, single scatter simulation (SSS) is the most widely used method for scatter correction. Nevertheless, SSS has the disadvantage of limited robustness for dynamic measurements and for the measurement of large objects. In this work, a newly developed implementation of MCS using graphics processing unit (GPU) acceleration is employed, allowing full MCS-based scatter correction in clinical 3D brain PET imaging. Starting from the generation of annihilation photons to their detection in the simulated PET scanner, all relevant physical interactions and transport phenomena of the photons were simulated on GPUs. This resulted in an expected distribution of scattered events, which was subsequently used to correct the measured emission data. The accuracy of the approach was validated with simulations using GATE (Geant4 Application for Tomography Emission), and its performance was compared to SSS. The comparison of the computation time between a GPU and a single-threaded CPU showed an acceleration factor of 776 for a voxelized brain phantom study. The speedup of the MCS implemented on the GPU represents a major step toward the application of the more accurate MCS-based scatter correction for PET imaging in clinical routine.

Resolution modeling in projection space using a factorized multi-block detector response function for PET image reconstruction.

Positron emission tomography (PET) images usually suffer from limited resolution and statistical uncertainties. However, a technique known as resolution modeling (RM) can be used to improve image quality by accurately modeling the system's detection process within the iterative reconstruction. In this study, we present an accurate RM method in projection space based on a simulated multi-block detector response function (DRF) and evaluate it on the Siemens hybrid MR-BrainPET system. The DRF is obtained using GATE simulations that consider nearly all the possible annihilation photons from the field-of-view (FOV). Intrinsically, the multi-block DRF allows the block crosstalk to be modeled. The RM blurring kernel is further generated by factorizing the blurring matrix of one line-of-response (LOR) into two independent detector responses, which can then be addressed with the DRF. Such a kernel is shift-variant in 4D projection space without any distance or angle compression, and is integrated into the image reconstruction for the BrainPET insert with single instruction multiple data (SIMD) and multi-thread support. Evaluation of simulations and measured data demonstrate that the reconstruction with RM yields significantly improved resolutions and reduced mean squared error (MSE) values at different locations of the FOV, compared with reconstruction without RM. Furthermore, the shift-variant RM kernel models the varying blurring intensity for different LORs due to the depth-of-interaction (DOI) dependencies, thus avoiding severe edge artifacts in the images. Additionally, compared to RM in single-block mode, the multi-block mode shows significantly improved resolution and edge recovery at locations beyond 10 cm from the center of BrainPET insert in the transverse plane. However, the differences have been observed to be low for patient data between single-block and multi-block mode RM, due to the brain size and location as well as the geometry of the BrainPET insert. In conclusion, the RM method proposed in this study can yield better reconstructed images in terms of resolution and MSE value, compared to conventional reconstruction without RM.

PET attenuation correction for rigid MR Tx/Rx coils from 176Lu background activity.

One challenge for PET-MR hybrid imaging is the correction for attenuation of the 511 keV annihilation radiation by the required RF transmit and/or RF receive coils. Although there are strategies for building PET transparent Tx/Rx coils, such optimised coils still cause significant attenuation of the annihilation radiation leading to artefacts and biases in the reconstructed activity concentrations. We present a straightforward method to measure the attenuation of Tx/Rx coils in simultaneous MR-PET imaging based on the natural 176Lu background contained in the scintillator of the PET detector without the requirement of an external CT scanner or PET scanner with transmission source. The method was evaluated on a prototype 3T MR-BrainPET produced by Siemens Healthcare GmbH, both with phantom studies and with true emission images from patient/volunteer examinations. Furthermore, the count rate stability of the PET scanner and the x-ray properties of the Tx/Rx head coil were investigated. Even without energy extrapolation from the two dominant γ energies of 176Lu to 511 keV, the presented method for attenuation correction, based on the measurement of 176Lu background attenuation, shows slightly better performance than the coil attenuation correction currently used. The coil attenuation correction currently used is based on an external transmission scan with rotating 68Ge sources acquired on a Siemens ECAT HR + PET scanner. However, the main advantage of the presented approach is its straightforwardness and ready availability without the need for additional accessories.

Prediction of Alzheimer's Dementia in Patients with Amnestic Mild Cognitive Impairment in Clinical Routine: Incremental Value of Biomarkers of Neurodegeneration and Brain Amyloidosis Added Stepwise to Cognitive Status.

The aim of this study was to evaluate the incremental benefit of biomarkers for prediction of Alzheimer's disease dementia (ADD) in patients with mild cognitive impairment (MCI) when added stepwise in the order of their collection in clinical routine. The model started with cognitive status characterized by the ADAS-13 score. Hippocampus volume (HV), cerebrospinal fluid (CSF) phospho-tau (pTau), and the FDG t-sum score in an AD meta-region-of-interest were compared as neurodegeneration markers. CSF-Aß1-42 was used as amyloidosis marker. The incremental prognostic benefit from these markers was assessed by stepwise Kaplan-Meier survival analysis in 402 ADNI MCI subjects. Predefined cutoffs were used to dichotomize patients as 'negative' or 'positive' for AD characteristic alteration with respect to each marker. Among the neurodegeneration markers, CSF-pTau provided the best incremental risk stratification when added to ADAS-13. FDG PET outperformed HV only in MCI subjects with relatively preserved cognition. Adding CSF-Aß provided further risk stratification in pTau-positive subjects, independent of their cognitive status. Stepwise integration of biomarkers allows stepwise refinement of risk estimates for MCI-to-ADD progression. Incremental benefit strongly depends on the patient's status according to the preceding diagnostic steps. The stepwise Kaplan-Meier curves might be useful to optimize diagnostic workflow in individual patients.

Mental speed is associated with the shape irregularity of white matter MRI hyperintensity load.

Brain MRI white matter hyperintensities (WMHs) are common in elderly subjects. Their impact on cognition, however, appears highly variable. Complementing conventional scoring of WMH load (volume and location) by quantitative characterization of the shape irregularity of WMHs might improve the understanding of the relationship between WMH load and cognitive performance. Here we propose the "confluency sum score" (COSU) as a marker of the total shape irregularity of WMHs in the brain. The study included two independent patient samples: 87 cognitively impaired geriatric inpatients from a prospective neuroimaging study (iDSS) and 198 subjects from the National Alzheimer's Coordinating Center (NACC) database (132 with, 66 w/o cognitive impairment). After automatic segmentation and clustering of the WMHs on FLAIR (LST toolbox, SPM8), the confluency of the i-th contiguous WMH cluster was computed as confluencyi = [1/(36π)∙surfacei3/volumei2]1/3-1. The COSU was obtained by summing the confluency over all WMH clusters. COSU was tested for correlation with CERAD-plus subscores. Correlation analysis was restricted to subjects with at least moderate WMH load (≥ 13.5 ml; iDSS / NACC: n = 52 / 80). In the iDSS sample, among the 12 CERAD-plus subtests the trail making test A (TMT-A) was most strongly correlated with the COSU (Spearman rho = -0.345, p = 0.027). TMT-A performance was not associated with total WMH volume (rho = 0.147, p = 0.358). This finding was confirmed in the NACC sample (rho = -0.261, p = 0.023 versus rho = -0.040, p = 0.732). Cognitive performance in specific domains including mental speed and fluid abilities seems to be more strongly associated with the shape irregularity of white matter MRI hyperintensities than with their volume.

A multiscale approach for the reconstruction of the fiber architecture of the human brain based on 3D-PLI.

Structural connectivity of the brain can be conceptionalized as a multiscale organization. The present study is built on 3D-Polarized Light Imaging (3D-PLI), a neuroimaging technique targeting the reconstruction of nerve fiber orientations and therefore contributing to the analysis of brain connectivity. Spatial orientations of the fibers are derived from birefringence measurements of unstained histological sections that are interpreted by means of a voxel-based analysis. This implies that a single fiber orientation vector is obtained for each voxel, which reflects the net effect of all comprised fibers. We have utilized two polarimetric setups providing an object space resolution of 1.3 µm/px (microscopic setup) and 64 µm/px (macroscopic setup) to carry out 3D-PLI and retrieve fiber orientations of the same tissue samples, but at complementary voxel sizes (i.e., scales). The present study identifies the main sources which cause a discrepancy of the measured fiber orientations observed when measuring the same sample with the two polarimetric systems. As such sources the differing optical resolutions and diverging retardances of the implemented waveplates were identified. A methodology was implemented that enables the compensation of measured different systems' responses to the same birefringent sample. This opens up new ways to conduct multiscale analysis in brains by means of 3D-PLI and to provide a reliable basis for the transition between different scales of the nerve fiber architecture.

Understanding fiber mixture by simulation in 3D Polarized Light Imaging.

3D Polarized Light Imaging (3D-PLI) is a neuroimaging technique that has opened up new avenues to study the complex architecture of nerve fibers in postmortem brains. The spatial orientations of the fibers are derived from birefringence measurements of unstained histological brain sections that are interpreted by a voxel-based analysis. This, however, implies that a single fiber orientation vector is obtained for each voxel and reflects the net effect of all comprised fibers. The mixture of various fiber orientations within an individual voxel is a priori not accessible by a standard 3D-PLI measurement. In order to better understand the effects of fiber mixture on the measured 3D-PLI signal and to improve the interpretation of real data, we have developed a simulation method referred to as SimPLI. By means of SimPLI, it is possible to reproduce the entire 3D-PLI analysis starting from synthetic fiber models in user-defined arrangements and ending with measurement-like tissue images. For the simulation, each synthetic fiber is considered as an optical retarder, i.e., multiple fibers within one voxel are described by multiple retarder elements. The investigation of different synthetic crossing fiber arrangements generated with SimPLI demonstrated that the derived fiber orientations are strongly influenced by the relative mixture of crossing fibers. In case of perpendicularly crossing fibers, for example, the derived fiber direction corresponds to the predominant fiber direction. The derived fiber inclination turned out to be not only influenced by myelin density but also systematically overestimated due to signal attenuation. Similar observations were made for synthetic models of optic chiasms of a human and a hooded seal which were opposed to experimental 3D-PLI data sets obtained from the chiasms of both species. Our study showed that SimPLI is a powerful method able to test hypotheses on the underlying fiber structure of brain tissue and, therefore, to improve the reliability of the extraction of nerve fiber orientations with 3D-PLI.

A review of the use and potential of the GATE Monte Carlo simulation code for radiation therapy and dosimetry applications.

In this paper, the authors' review the applicability of the open-source GATE Monte Carlo simulation platform based on the GEANT4 toolkit for radiation therapy and dosimetry applications. The many applications of GATE for state-of-the-art radiotherapy simulations are described including external beam radiotherapy, brachytherapy, intraoperative radiotherapy, hadrontherapy, molecular radiotherapy, and in vivo dose monitoring. Investigations that have been performed using GEANT4 only are also mentioned to illustrate the potential of GATE. The very practical feature of GATE making it easy to model both a treatment and an imaging acquisition within the same framework is emphasized. The computational times associated with several applications are provided to illustrate the practical feasibility of the simulations using current computing facilities.

Model-based verification of a non-linear separation scheme for ballistocardiography.

The current rise in popularity of ballisto-cardiography-related research has led to the development of new sensor concepts and recording methods. Measuring the ballistocardiogram using bed mounted pressure sensors opens up new possibilities for home monitoring applications. The signals measured with these sensors contain a mixture of cardiac and respiratory components, which can be used for detection of comorbidities of heart failure like apnea or arrhythmia. However, the separation of the cardiac and respiratory components has proven to be difficult, since there is significant overlap in the spectra of both components. In this paper, an algorithm for the separation task is presented, which can overcome the problem of overlapping spectra. Additionally, a model has been developed for the generation of artificial ballistocardiograms, which are used to analyze the separation performance. Furthermore, the algorithm is tested on preliminary data from a clinical study.

Does PET/MR in human brain imaging provide optimal co-registration? A critical reflection.

The introduction of hybrid positron emission/magnetic resonance tomography (PET/MR) in diagnostic clinical imaging was a major step in the evolution of ever-more sophisticated imaging systems combining two strategies formerly regarded as technically incompatible in a single device. The advent of PET/MR opened up many new avenues in clinical and research environments, mainly by providing multi-modality images obtained during a single examination. Ideally, simultaneous data acquisition with hybrid PET/MR should warrant exact image co-registration of all multi-modality image volumes provided by both systems. This assumes that there is negligible mutual electronic, technical and logistical interference on the respective simultaneous measurements. Recently, such hybrid dedicated head and whole-body systems were successfully applied in an increasing number of cases. When employed for brain imaging, PET/MR has the potential to provide high-resolution multi-modality datasets. However, it also demands careful consideration of the multitude of features offered, as well as the limitations. There are open issues that have to be considered, such as the handling of patient motion during extended periods of data acquisition, optimized sampling of derived images to ease the visual interpretation and quantitative evaluation of co-registered images. This paper will briefly summarize the current status of PET/MR within the framework of developments for image co-registration and discuss current limitations and future perspectives.

EduGATE - basic examples for educative purpose using the GATE simulation platform.

EduGATE is a collection of basic examples to introduce students to the fundamental physical aspects of medical imaging devices. It is based on the GATE platform, which has received a wide acceptance in the field of simulating medical imaging devices including SPECT, PET, CT and also applications in radiation therapy. GATE can be configured by commands, which are, for the sake of simplicity, listed in a collection of one or more macro files to set up phantoms, multiple types of sources, detection device, and acquisition parameters. The aim of the EduGATE is to use all these helpful features of GATE to provide insights into the physics of medical imaging by means of a collection of very basic and simple GATE macros in connection with analysis programs based on ROOT, a framework for data processing. A graphical user interface to define a configuration is also included.

Automatic identification of gray and white matter components in polarized light imaging.

Polarized light imaging (PLI) enables the visualization of fiber tracts with high spatial resolution in microtome sections of postmortem brains. Vectors of the fiber orientation defined by inclination and direction angles can directly be derived from the optical signals employed by PLI analysis. The polarization state of light propagating through a rotating polarimeter is varied in such a way that the detected signal of each spatial unit describes a sinusoidal signal. Noise, light scatter and filter inhomogeneities, however, interfere with the original sinusoidal PLI signals, which in turn have direct impact on the accuracy of subsequent fiber tracking. Recently we showed that the primary sinusoidal signals can effectively be restored after noise and artifact rejection utilizing independent component analysis (ICA). In particular, regions with weak intensities are greatly enhanced after ICA based artifact rejection and signal restoration. Here, we propose a user independent way of identifying the components of interest after decomposition; i.e., components that are related to gray and white matter. Depending on the size of the postmortem brain and the section thickness, the number of independent component maps can easily be in the range of a few ten thousand components for one brain. Therefore, we developed an automatic and, more importantly, user independent way of extracting the signal of interest. The automatic identification of gray and white matter components is based on the evaluation of the statistical properties of the so-called feature vectors of each individual component map, which, in the ideal case, shows a sinusoidal waveform. Our method enables large-scale analysis (i.e., the analysis of thousands of whole brain sections) of nerve fiber orientations in the human brain using polarized light imaging.

Classification of ambiguous nerve fiber orientations in 3D polarized light imaging.

3D polarized light imaging (3D-PLI) has been shown to measure the orientation of nerve fibers in post mortem human brains at ultra high resolution. The 3D orientation in each voxel is obtained as a pair of angles, the direction angle and the inclination angle with unknown sign. The sign ambiguity is a major problem for the correct interpretation of fiber orientation. Measurements from a tiltable specimen stage, that are highly sensitive to noise, extract information, which allows drawing conclusions about the true inclination sign. In order to reduce noise, we propose a global classification of the inclination sign, which combines measurements with spatial coherence constraints. The problem is formulated as a second order Markov random field and solved efficiently with graph cuts. We evaluate our approach on synthetic and human brain data. The results of global optimization are compared to independent pixel classification with subsequent edge-preserving smoothing.

GATE based Monte Carlo simulation of planar scintigraphy to estimate the nodular dose in radioiodine therapy for autonomous thyroid adenoma.

The recommended target dose in radioiodine therapy of solitary hyperfunctioning thyroid nodules is 300-400Gy and therefore higher than in other radiotherapies. This is due to the fact that an unknown, yet significant portion of the activity is stored in extranodular areas but is neglected in the calculatory dosimetry. We investigate the feasibility of determining the ratio of nodular and extranodular activity concentrations (uptakes) from post-therapeutically acquired planar scintigrams with Monte Carlo simulations in GATE. The geometry of a gamma camera with a high energy collimator was emulated in GATE (Version 5). A geometrical thyroid-neck phantom (GP) and the ICRP reference voxel phantoms "Adult Female" (AF, 16ml thyroid) and "Adult Male" (AM, 19ml thyroid) were used as source regions. Nodules of 1ml and 3ml volume were placed in the phantoms. For each phantom and each nodule 200 scintigraphic acquisitions were simulated. Uptake ratios of nodule and rest of thyroid ranging from 1 to 20 could be created by summation. Quantitative image analysis was performed by investigating the number of simulated counts in regions of interest (ROIs). ROIs were created by perpendicular projection of the phantom onto the camera plane to avoid a user dependant bias. The ratio of count densities in ROIs over the nodule and over the contralateral lobe, which should be least affected by nodular activity, was taken to be the best available measure for the uptake ratios. However, the predefined uptake ratios are underestimated by these count density ratios: For an uptake ratio of 20 the count ratios range from 4.5 (AF, 1ml nodule) to 15.3 (AM, 3ml nodule). Furthermore, the contralateral ROI is more strongly affected by nodular activity than expected: For an uptake ratio of 20 between nodule and rest of thyroid up to 29% of total counts in the ROI over the contralateral lobe are caused by decays in the nodule (AF 3 ml). In the case of the 1ml nodules this effect is smaller: 9-11% (AF) respectively 7-8% (AM). For each phantom, the dependency of count density ratios upon uptake ratios can be modeled well by both linear and quadratic regression (quadratic: r(2)>0.99), yielding sets of parameters which in reverse allow the computation of uptake ratios (and thus dose) from count density ratios. A single regression model obtained by fitting the data of all simulations simultaneously did not provide satisfactory results except for GP, while underestimating the true uptake ratios in AF and overestimating them in AM. The scintigraphic count density ratios depend upon the uptake ratios between nodule and rest of thyroid, upon their volumes, and their respective position in a non-trivial way. Further investigations are required to derive a comprehensive rule to calculate the uptake or dose ratios based on post-therapeutic scintigraphy.

A novel approach to the human connectome: ultra-high resolution mapping of fiber tracts in the brain.

Signal transmission between different brain regions requires connecting fiber tracts, the structural basis of the human connectome. In contrast to animal brains, where a multitude of tract tracing methods can be used, magnetic resonance (MR)-based diffusion imaging is presently the only promising approach to study fiber tracts between specific human brain regions. However, this procedure has various inherent restrictions caused by its relatively low spatial resolution. Here, we introduce 3D-polarized light imaging (3D-PLI) to map the three-dimensional course of fiber tracts in the human brain with a resolution at a submillimeter scale based on a voxel size of 100 µm isotropic or less. 3D-PLI demonstrates nerve fibers by utilizing their intrinsic birefringence of myelin sheaths surrounding axons. This optical method enables the demonstration of 3D fiber orientations in serial microtome sections of entire human brains. Examples for the feasibility of this novel approach are given here. 3D-PLI enables the study of brain regions of intense fiber crossing in unprecedented detail, and provides an independent evaluation of fiber tracts derived from diffusion imaging data.

High-resolution fiber tract reconstruction in the human brain by means of three-dimensional polarized light imaging.

Functional interactions between different brain regions require connecting fiber tracts, the structural basis of the human connectome. To assemble a comprehensive structural understanding of neural network elements from the microscopic to the macroscopic dimensions, a multimodal and multiscale approach has to be envisaged. However, the integration of results from complementary neuroimaging techniques poses a particular challenge. In this paper, we describe a steadily evolving neuroimaging technique referred to as three-dimensional polarized light imaging (3D-PLI). It is based on the birefringence of the myelin sheaths surrounding axons, and enables the high-resolution analysis of myelinated axons constituting the fiber tracts. 3D-PLI provides the mapping of spatial fiber architecture in the postmortem human brain at a sub-millimeter resolution, i.e., at the mesoscale. The fundamental data structure gained by 3D-PLI is a comprehensive 3D vector field description of fibers and fiber tract orientations - the basis for subsequent tractography. To demonstrate how 3D-PLI can contribute to unravel and assemble the human connectome, a multiscale approach with the same technology was pursued. Two complementary state-of-the-art polarimeters providing different sampling grids (pixel sizes of 100 and 1.6 µm) were used. To exemplarily highlight the potential of this approach, fiber orientation maps and 3D fiber models were reconstructed in selected regions of the brain (e.g., Corpus callosum, Internal capsule, Pons). The results demonstrate that 3D-PLI is an ideal tool to serve as an interface between the microscopic and macroscopic levels of organization of the human connectome.

Towards ultra-high resolution fibre tract mapping of the human brain - registration of polarised light images and reorientation of fibre vectors.

Polarised light imaging (PLI) utilises the birefringence of the myelin sheaths in order to visualise the orientation of nerve fibres in microtome sections of adult human post-mortem brains at ultra-high spatial resolution. The preparation of post-mortem brains for PLI involves fixation, freezing and cutting into 100-mum-thick sections. Hence, geometrical distortions of histological sections are inevitable and have to be removed for 3D reconstruction and subsequent fibre tracking. We here present a processing pipeline for 3D reconstruction of these sections using PLI derived multimodal images of post-mortem brains. Blockface images of the brains were obtained during cutting; they serve as reference data for alignment and elimination of distortion artefacts. In addition to the spatial image transformation, fibre orientation vectors were reoriented using the transformation fields, which consider both affine and subsequent non-linear registration. The application of this registration and reorientation approach results in a smooth fibre vector field, which reflects brain morphology. PLI combined with 3D reconstruction and fibre tracking is a powerful tool for human brain mapping. It can also serve as an independent method for evaluating in vivo fibre tractography.