Variation assessment of deformable registration in stereotactic radiosurgery.

INTRODUCTION: The regular functions of CT-MRI registration include delineation of targets and organs-at-risk (OARs) in radiosurgery planning. The question of whether deformable image registration (DIR) could be applied to stereotactic radiosurgery (SRS) in its place remains a subject of debate. METHODS: This study collected data regarding 16 patients who had undergone single-fraction SRS treatment. All lesions were located close to the brainstem. CT and MRI two image sets were registered by both rigid image registration (RIR) and DIR algorithms. The contours of the OARs were drawn individually on the rigid and deformable CT-MRI image sets by qualified radiation oncologists and dosimetrists. The evaluation metrics included volume overlapping (VO), Dice similarity coefficient (DSC), and dose. The modified demons deformable algorithm (VARIAN SmartAdapt) was used for evaluation in this study. RESULTS: The mean range of VO for OARs was 0.84 ± 0.08, and DSC was 0.82 ± 0.07. The maximum average volume difference was at normal brain (17.18 ± 14.48 cm3) and the second highest was at brainstem (2.26 cm3 ± 1.18). Pearson correlation testing showed that all DIRs' OAR volumes were linearly and significantly correlated with RIRs' volume (0.679-0.992, two tailed, P << 0.001). The 100% dose was prescribed at gross tumor volume (GTV). The average maximum percent dose difference was observed in brainstem (26.54% ± 27.027), and the average mean dose difference has found at same organ (1.6% ± 1.66). CONCLUSION: The change in image-registration method definitely produces dose variance, and is significantly more what depending on the target location. The volume size of OARs, however, was not statistical significantly correlated with dose variance.

Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan.

Flatfoot (pes planus) is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA-MT5) angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI) registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA-MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot.

Autoradiographic and histopathological studies of boric acid-mediated BNCT in hepatic VX2 tumor-bearing rabbits: Specific boron retention and damage in tumor and tumor vessels.

Hepatoma is a malignant tumor that responds poorly to conventional therapies. Boron neutron capture therapy (BNCT) may provide a better way for hepatoma therapy. In this research, (10)B-enriched boric acid (BA, 99% (10)B) was used as the boron drug. A multifocal hepatic VX2 tumor-bearing rabbit model was used to study the mechanisms of BA-mediated BNCT. Autoradiography demonstrated that BA was selectively targeted to tumors and tumor vessels. Histopathological examination revealed the radiation damage to tumor-bearing liver was concentrated in the tumor regions during BNCT treatment. The selective killing of tumor cells and the destruction of the blood vessels in tumor masses may be responsible for the success of BA-mediated BNCT for liver tumors.

Both dopaminergic and adrenergic receptors in the brain are involved in the behavioural excitation induced by dibutyryl 3',5'-adenosine monophosphate and aminophylline in the rat.

Following administration of dibutyryl cyclic-AMP or aminophylline, but not vehicle solution, into the lateral cerebral ventricle of rats produced locomotor stimulation, head and body rearing, circling, (as indicated by an enhancement of gross movement), increased grooming, head swaying and scratching (as indicated by an enhancement of fine movement), tail elevation, piloerection and convulsion. The behavioural excitation produced by either dibutyryl cyclic-AMP or aminophylline was antagonized by pretreatment with intraventricular injection of either two alpha-adrenergic antagonists (phentolamine and yohimbine) or a dopaminergic antagonist (haloperidol), but not with either a beta-adrenergic antagonist (propranolol) or a narcotic antagonist (naloxone). In addition, direct administration of dibutyryl cyclic-AMP into either the anterior hypothalamus, the nucleus accumbens or the caudate-putamen complex of rats produced the same behavioural responses as those produced by the intraventricular injection. Again, the behavioural responses induced by intracerebral injection of dibutyryl cyclic-AMP was antagonized by pretreatment with either alpha-adrenergic antagonists or a dopaminergic antagonist. The present data indicate that both the dopaminergic and the adrenergic receptors in the brain are involved in the behavioural excitation induced by dibutyryl cyclic-AMP and aminophylline in the rat.

Evaluation of inherent gray-level dynamic range in a digital image using the runs test and join-count statistics.

The dynamic range of the gray level of a digital image is limited by the noise it contains. Two statistical methods called "runs test" and "join-count statistic" are used to measure the noise level in a digital image. A residual image is formed by subtracting an original image from its smoothed version. Theoretically, the noise level in the residual image should be identical to that in the original image. The noise level is determined by examining each bit plane of the residual image individually starting from the least significant bit up to the bit plane whose statistic does not show a random pattern. Images from three digital modalities: computerized tomography, magnetic resonance, and computed radiography are used to evaluate the gray-level dynamic range. Both methods are easy to implement and fast to perform.

A fast dual-energy computational method using isotransmission lines and table lookup.

An efficient method has been developed to speed up the computational time required for tissue separation after the dual-energy scan in computerized tomography and digital radiography. This method consists of two steps. First, an isotransmission line method is used to replace the iterative algorithm for solving the two nonlinear equations, which is computationally noisy and sensitive. Second, two tables, one for the aluminum component and the other for the plastic component, are derived from calibration data in order to replace calculation by a table lookup. Results from this method are compared with the conventional method.

New stereotactic technique for percutaneous thermocoagulation upper thoracic ganglionectomy in cases of palmar hyperhidrosis.

To perform unilateral or bilateral upper thoracic ganglionectomy, we established a three-dimensional system of coordinates for T2 and T3 ganglia. For this purpose, the spatial relations were represented by drawings obtained from 50 Chinese cadavers. A simple stereotactic frame was constructed as an aid in performing the procedure. Then, according to the established three-dimensional system of coordinates, percutaneous thermocoagulation of both T2 and T3 ganglia was performed on 10 patients (20 sides) with palmar hyperhidrosis, under local anesthesia and fluoroscopic guidance at the posteroanterior projection. Excellent relief of abnormal sweating in 19 of the 20 hands was achieved. Partial relief was obtained in the remaining hand. No complication was observed in our patients. The technique has been proved to be safe, effective, and simpler than other methods now in use.

Spinal intramedullary pseudocyst. Case report.

The authors describe a case of a spinal intramedullary pseudocyst at T-1 that did not communicate with the surrounding spaces. The cystic wall was composed of dense connective tissue without epithelial or neoplastic cells. The patient's condition improved dramatically after surgical removal of the cyst. The literature on spinal intramedullary cystic lesions is reviewed and the etiology of pseudocysts is discussed. This case is believed to be the first in which a pseudocyst has been demonstrated within the spinal cord.

Comparison of chi-square and join-count methods for evaluating digital image data.

The significance of each bit of the pixel in digital image data from various radiological modalities is tested to determine the contrast resolution. Two statistical methods, join-count statistic and chi-square goodness of fit test, are used to perform the test. Join-count statistic is used to measure the spatial coherence among pixels, while the chi-square test is used to determine if the bit data are randomly distributed. A residual image is formed by subtracting an original image from its smoothed version. The contrast revolution is determined by applying both statistics on each bit plane of the residual image starting from the least significant bit up to the bit plane whose statistic does not show a random pattern. Images from three digital modalities, computerized tomography, magnetic resonance, and computed radiography, are used to evaluate the gray-level dynamic range. Both methods are easy to implement and fast to perform.

Assessment of noise in a digital image using the join-count statistic and the Moran test.

We assume that the data bits of a pixel in digital images can be divided into signal and noise bits. The signal bits occupy the most significant part of the pixel and the noise bits the least significant part. The signal part of each pixel are correlated while the noise parts are uncorrelated. Two statistical methods, the Moran test and the join-count statistic, are used to examine the noise parts. Images from three digital modalities--computerized tomography, magnetic resonance and computed radiography--are used for the evaluation of the noise bits. A residual image is formed by subtracting the original image from its smoothed version. The noise level in the residual image is then identical to that in the original image. Both statistical tests are then performed on the bit planes of the residual image. The results show that most digital images contain only 8-9 bits of correlated information. Both methods are easy to implement and fast to perform.

Shape-based grey-level image interpolation.

The three-dimensional (3D) object data obtained from a CT scanner usually have unequal sampling frequencies in the x-, y- and z-directions. Generally, the 3D data are first interpolated between slices to obtain isotropic resolution, reconstructed, then operated on using object extraction and display algorithms. The traditional grey-level interpolation introduces a layer of intermediate substance and is not suitable for objects that are very different from the opposite background. The shape-based interpolation method transfers a pixel location to a parameter related to the object shape and the interpolation is performed on that parameter. This process is able to achieve a better interpolation but its application is limited to binary images only. In this paper, we present an improved shape-based interpolation method for grey-level images. The new method uses a polygon to approximate the object shape and performs the interpolation using polygon vertices as references. The binary images representing the shape of the object were first generated via image segmentation on the source images. The target object binary image was then created using regular shape-based interpolation. The polygon enclosing the object for each slice can be generated from the shape of that slice. We determined the relative location in the source slices of each pixel inside the target polygon using the vertices of a polygon as the reference. The target slice grey-level was interpolated from the corresponding source image pixels. The image quality of this interpolation method is better and the mean squared difference is smaller than with traditional grey-level interpolation.

Implementation of a large-scale picture archiving and communication system.

This paper describes the implementation of a large-scale picture archiving and communication system (PACS) in a clinical environment. The system consists of a PACS infrastructure, composed of a PACS controller, a database management system, communication networks, and optical disk archive. It connects to three MR units, four CT scanners, three computed radiography systems, and two laser film digitizers. Seven display stations are on line 24 h/day, 7 days/wk in genitourinary radiology (2K), pediatric radiology in-patient (1K and 2K) and outpatient (2K), neuroradiology (2K), pediatric ICU (1K), coronary care unit (1K), and one laser film printing station. The PACS is integrated with the hospital information system and the radiology information system. The system has been in operation since February 1992. We have integrated this PACS as a clinical component in daily radiology practice. It archives an average of 2.0-gigabyte image data per workday. A 3-mo system performance of various components are tabulated. The deployment of this large-scale PACS signifies a milestone in our PACS research and development effort. Radiologists, fellows, residents, and clinicians use it for case review, conferences, and occasionally for primary diagnosis. With this large-scale PACS in place, it will allow us to investigate the two critical issues raised when PACS research first started 10 yrs ago: system performance and cost effectiveness between a digital-based and a film-based system.

Localization of the sympathetic postganglionic neurons innervating cardiac coronary artery with horseradish peroxidase in monkeys.

Localization of the sympathetic postganglionic neurons innervating the cardiac coronary arteries in monkeys was investigated by using retrograde axonal transport of horseradish peroxidase (HRP). HRP was applied to the main trunk of the left and right coronary arteries, and to the terminal branches of the ventral and dorsal descending vessels of the left and right coronary arteries, respectively. The animals were sacrificed 84-96 hours later and perfused via the left ventricle. The paravertebral sympathetic ganglia from the superior cervical, middle cervical and stellate ganglia to the T9 ganglia, and nodose ganglia were removed and processed for HRP identification. After HRP was applied into the main trunk of the right coronary artery, and into the main trunk and the terminal branches of the descending vessels of the left coronary artery, the HRP-labeled sympathetic neurons were localized predominantly in the right superior cervical ganglion, and next in the left superior cervical ganglia. However, labeled cells were found in the stellate ganglia bilaterally. After HRP applications to the terminal branches of the dorsal descending vessels of the right coronary artery, HRP-labeled cells were mainly present in the left superior cervical ganglion and next in the right superior cervical ganglion. Some labeled cells were found in the middle cervical and stellate ganglia. No labeled cell was found in ganglia below the second thoracic ganglia on either side in these four groups.

Effects of stellate ganglionectomy on the cat cardiovascular function.

The effects of stellate ganglionectomy on cardiovascular function were assessed in pentobarbital-anesthetized cats. A right stellectomy produced much more profound bradycardiac effects than a left stellectomy. This finding demonstrated that the stellate ganglion exerted a lateralized influence on heart beat in the cat. The cardiovascular response of intact cats to phase 4 (overshoot) of the Valsalva-like maneuver (VM) was reflex bradycardia. In response to VM, however, reflex bradycardia was completely abolished by a right or bilateral stellectomy, or by pretreatment with propranolol, but not by a left stellectomy alone or with phentolamine. The data indicated that the right stellate ganglion in cats makes a major contribution to cardiovascular control, especially over reflex bradycardia mechanisms.

Simple empirical formula for predicting range variation of central-axis parameters in small electron fields.

The depth of central-axis percent dose Rx (except R100) and practical range, Rp, for small field electron beams can be calculated by the proposed empirical formula: Rx = Rxo x [1 - (1 - r/Rpo)m], where Rxo and Rpo are the broad beam percentage dose depth and practical range respectively; r is the small field cutout side when it is less than the maximum lateral scatter equivalent range, and m is the exponent term relative to the decreasing curvature. Five electron beams from a Varian CL-2100CD linear accelerator were used to verify this formula. The difference between measured and calculated depth dose range is within +/- 1 mm when cutout side reduced to 2 x 2 cm2. This formula offers a simple and time-saving method to quickly determine the useful treatment percentage dose depth of small field electron beams.

Improvements on a patient-specific dose estimation system in nuclear medicine examination.

The purpose of this paper is to develop a patient-specific dose estimation system in nuclear medicine examination. A dose deposition routine to store the deposited energy of the photons during their flights was embedded in the widely used SimSET Monte Carlo code and a user-friendly interface for reading PET and CT images was developed. Dose calculated on ORNL phantom was used to validate the accuracy of this system. The ratios of S value for (99m)Tc, (18)F and (131)I computed by this system to those obtained with OLINDA for various organs were ranged from 0.93 to 1.18, which were comparable to that obtained from MCNPX2.6 code (0.88-1.22). Our system developed provides opportunity for tumor dose estimation which cannot be known from the MIRD. The radiation dose can provide useful information in the amount of radioisotopes to be administered in radioimmunotherapy.

Prediction of nodal metastasis in head and neck cancer using a 3T MRI ADC map.

BACKGROUND AND PURPOSE: The detection of cervical nodal metastases is important for the prognosis and treatment of head and neck tumors. The purpose of this study was to assess the ability of ADC values at 3T to distinguish malignant from benign lymph nodes. MATERIALS AND METHODS: From July 2009 to June 2010, twenty-two patients (21 men and 1 woman; mean age, 49.8±9.5 years; age range, 28-66 years) scheduled for surgical treatment of biopsy-proved head and neck cancer were prospectively and consecutively enrolled in this study. All patients were scanned on a 3T imaging unit (Verio) by using a 12-channel head coil combined with a 4-channel neck coil. Histologic findings were the reference standard for the diagnosis of lymph node metastasis. RESULTS: The ADC values derived from the signal intensity averaged across images obtained with b-values of 0 and 800 s/mm2 were 1.086±0.222×10(-3) mm2/s for benign lymph nodes and 0.705±0.118×10(-3) mm2/s for malignant lymph nodes (P<.0001). When an ADC value of 0.851×10(-3) mm2/s was used as a threshold value for differentiating benign from malignant lymph nodes, the best results were obtained with an accuracy of 91.0%, sensitivity of 91.3%, and specificity of 91.1%. CONCLUSIONS: The ADC value is a sensitive and specific parameter that can help to differentiate malignant from benign lymph nodes.

Development of an imaging-planning program for screen/film and computed radiography mammography for breasts with short chest wall to nipple distance.

OBJECTIVE: Imaging breasts with a short chest wall to nipple distance (CWND) using a traditional mammographic X-ray unit is a technical challenge for mammographers. The purpose of this study is the development of an imaging-planning program to assist in determination of imaging parameters of screen/film (SF) and computed radiography (CR) mammography for short CWND breasts. METHODS: A traditional mammographic X-ray unit (Mammomat 3000, Siemens, Munich, Germany) was employed. The imaging-planning program was developed by combining the compressed breast thickness correction, the equivalent polymethylmethacrylate thickness assessment for breasts and the tube loading (mAs) measurement. Both phantom exposures and a total of 597 exposures were used for examining the imaging-planning program. RESULTS: Results of the phantom study show that the tube loading rapidly decreased with the CWND when the automatic exposure control (AEC) detector was not fully covered by the phantom. For patient exposures with the AEC fully covered by breast tissue, the average fractional tube loadings, defined as the ratio of the predicted mAs using the imaging-planning program and mAs of the mammogram, were 1.10 and 1.07 for SF and CR mammograms, respectively. The predicted mAs values were comparable to the mAs values, as determined by the AEC. CONCLUSION: By applying the imaging-planning program in clinical practice, the experiential dependence of the mammographer for determination of the imaging parameters for short CWND breasts is minimised.

A method incorporating 4DCT data for evaluating the dosimetric effects of respiratory motion in single-arc IMAT.

This study introduces a method incorporating 4DCT data to determine the impact of respiratory motion in single-arc intensity-modulated arc therapy (IMAT). Simulation was done by re-warping the static dose distribution of all phases of a 4DCT image set with a 3D deformation map to reference CT images at end-inspiration and end-expiration. To calculate the dose received during respiration under IMAT, the control points were interpolated and re-distributed into separate IMAT plans corresponding to each respiratory phase. This study also investigated the role that plan complexity may play in the dosimetric impact of the respiratory motion in the delivery of IMAT. The dosimetric impact of organ motion was evaluated by analyzing the degradation of D(95,) D(50) and D(05) of the CTV and PTV. From the results shown for the patients in this study who had maximum organ motion displacement approximately 15 mm, the dosimetric impact is rather small. Therefore, our preliminary results suggest that respiratory motion of less than 1.5 cm may be ignored for both moderately and highly modulated IMAT, irrespective of the number of fractions. Specifically, highly modulated plans only increased the degradation of D(95) of the DVH curves for a single fraction by 2% in the CTV and 9% in the PTV compared to the expected value of the multi-fraction plan.