Real-time 3D reconstruction of guidewires and stents using two update X-ray projections in a rotating imaging setup.

BACKGROUND: Vascular diseases are often treated minimally invasively. The interventional material (stents, guidewires, etc.) used during such percutaneous interventions are visualized by some form of image guidance. Today, this image guidance is usually provided by 2D X-ray fluoroscopy, that is, a live 2D image. 3D X-ray fluoroscopy, that is, a live 3D image, could accelerate existing and enable new interventions. However, existing algorithms for the 3D reconstruction of interventional material require either too many X-ray projections and therefore dose, or are only capable of reconstructing single, curvilinear structures. PURPOSE: Using only two new X-ray projections per 3D reconstruction, we aim to reconstruct more complex arrangements of interventional material than was previously possible. METHODS: This is achieved by improving a previously presented deep learning-based reconstruction pipeline, which assumes that the X-ray images are acquired by a continuously rotating biplane system, in two ways: (a) separation of the reconstruction of different object types, (b) motion compensation using spatial transformer networks. RESULTS: Our pipeline achieves submillimeter accuracy on measured data of a stent and two guidewires inside an anthropomorphic phantom with respiratory motion. In an ablation study, we find that the aforementioned algorithmic changes improve our two figures of merit by 75 % (1.76 mm → 0.44 mm) and 59 % (1.15 mm → 0.47 mm) respectively. A comparison of our measured dose area product (DAP) rate to DAP rates of 2D fluoroscopy indicates a roughly similar dose burden. CONCLUSIONS: This dose efficiency combined with the ability to reconstruct complex arrangements of interventional material makes the presented algorithm a promising candidate to enable 3D fluoroscopy.

Deep learning-based forward and cross-scatter correction in dual-source CT.

PURPOSE: Dual-source computed tomography (DSCT) uses two source-detector pairs offset by about 90°. In addition to the well-known forward scatter, a special issue in DSCT is cross-scattered radiation from X-ray tube A detected in the detector of system B and vice versa. This effect can lead to artifacts and reduction of the contrast-to-noise ratio of the images. The purpose of this work is to present and evaluate different deep learning-based methods for scatter correction in DSCT. METHODS: We present different neural network-based methods for forward and cross-scatter correction in DSCT. These deep scatter estimation (DSE) methods mainly differ in the input and output information that is provided for training and inference and in whether they operate on two-dimensional (2D) or on three-dimensional (3D) data. The networks are trained and validated with scatter distributions obtained by our in-house Monte Carlo simulation. The simulated geometry is adapted to a realistic clinical setup. RESULTS: All DSE approaches reduce scatter-induced artifacts and lead to superior results than the measurement-based scatter correction. Forward scatter, under the presence of cross-scatter, is best estimated either by our network that uses the current projection and a couple of neighboring views (fDSE 2D few views) or by our 3D network that processes all projections simultaneously (fDSE 3D). Cross-scatter, under the presence of forward scatter, is best estimated using xSSE XDSE 2D, with xSSE referring to a quick single scatter estimate of cross scatter, or by xDSE 3D that uses all projections simultaneously. By using our proposed networks, the total scatter error in dual could be reduced from about 18 HU to approximately 3 HU. CONCLUSIONS: Deep learning-based scatter correction can reduce scatter artifacts in DSCT. To achieve more accurate cross-scatter estimations, the use of a cross-scatter approximation improves the results. Also, the ability to leverage across different projection angles improves the precision of the algorithm.

Real-time scatter estimation for medical CT using the deep scatter estimation: Method and robustness analysis with respect to different anatomies, dose levels, tube voltages, and data truncation.

PURPOSE: X-ray scattering leads to CT images with a reduced contrast, inaccurate CT values as well as streak and cupping artifacts. Therefore, scatter correction is crucial to maintain the diagnostic value of CT and CBCT examinations. However, existing approaches are not able to combine both high accuracy and high computational performance. Therefore, we propose the deep scatter estimation (DSE): a deep convolutional neural network to derive highly accurate scatter estimates in real time. METHODS: Gold standard scatter estimation approaches rely on dedicated Monte Carlo (MC) photon transport codes. However, being computationally expensive, MC methods cannot be used routinely. To enable real-time scatter correction with similar accuracy, DSE uses a deep convolutional neural network that is trained to predict MC scatter estimates based on the acquired projection data. Here, the potential of DSE is demonstrated using simulations of CBCT head, thorax, and abdomen scans as well as measurements at an experimental table-top CBCT. Two conventional computationally efficient scatter estimation approaches were implemented as reference: a kernel-based scatter estimation (KSE) and the hybrid scatter estimation (HSE). RESULTS: The simulation study demonstrates that DSE generalizes well to varying tube voltages, varying noise levels as well as varying anatomical regions as long as they are appropriately represented within the training data. In any case the deviation of the scatter estimates from the ground truth MC scatter distribution is less than 1.8% while it is between 6.2% and 293.3% for HSE and between 11.2% and 20.5% for KSE. To evaluate the performance for real data, measurements of an anthropomorphic head phantom were performed. Errors were quantified by a comparison to a slit scan reconstruction. Here, the deviation is 278 HU (no correction), 123 HU (KSE), 65 HU (HSE), and 6 HU (DSE), respectively. CONCLUSIONS: The DSE clearly outperforms conventional scatter estimation approaches in terms of accuracy. DSE is nearly as accurate as Monte Carlo simulations but is superior in terms of speed (≈10 ms/projection) by orders of magnitude.