Combination Ipsilateral Lobar and Segmental Radioembolization Using Glass Yttrium-90 Microspheres for Treatment of Multifocal Hepatic Malignancies.

Eight patients with primary (n = 6) and metastatic (n = 2) disease of the liver underwent yttrium-90 radioembolization with glass microspheres using a combination of segmental and ipsilateral lobar approach to treat multifocal tumors containing a single dominant tumor. The superselective dose was administered to the dominant tumor, whereas lobar infusion was used for smaller tumors. Assuming uniform distribution, median dose to the segment with dominant tumor was 412.3 Gy and to the remaining lobe was 117.5 Gy. No instances of radiation-induced liver disease occurred. Combined segmental and ipsilateral lobar radioembolization is a well-tolerated procedure to treat unilateral multifocal hepatic tumors including a single dominant tumor.

AAPM medical physics practice guideline 6.a.: Performance characteristics of radiation dose index monitoring systems.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: •Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. •Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Pulmonary nodules with ground-glass opacity can be reliably measured with low-dose techniques regardless of iterative reconstruction: results of a phantom study.

OBJECTIVE: Pulmonary nodules of ground-glass opacity represent one imaging manifestation of a slow-growing variant of lung cancer. The objective of this phantom study was to quantify the effect of the radiation dose used for the examination (volume CT dose index [CTDI(vol)]), type of reconstruction algorithm, and choice of postreconstruction enhancement algorithms on the measurement error when assessing the volume of simulated lung nodules with CT, focusing on two radiodensity levels. MATERIALS AND METHODS: Twelve synthetic nodules of two radiodensities (-630 and -10 HU), three shapes (spherical, lobulated, and spiculated), and two sizes (nominal diameters of 5 and 10 mm) were inserted into an anthropomorphic chest phantom and scanned with techniques varying in CTDI(vol) (from subscreening dose [0.8 mGy] to diagnostic levels [6.5 mGy]), reconstruction algorithms (iterative reconstruction and filtered back projection), and different postreconstruction enhancement algorithms. Nodule volume was measured from the resulting reconstructed CT images with a matched filter estimator. RESULTS: No significant over- or underestimation of nodule volume was observed across individual variables, with low percentage error overall (-1.4%) and for individual variables (range, -3.4% to 0.4%). The magnitude of percentage error was also low (overall average percentage error < 6% and SD values < 4.5%) and for individual variables (absolute percentage error range 3.3-5.6%). No clinically significant differences were observed between different levels of CTDI(vol), use of iterative reconstruction algorithms, or use of different postreconstruction enhancement algorithms. CONCLUSION: These results indicate that, if validated for other measurement tools and scanners, lung nodule volume measurements from scans acquired and reconstructed with significantly different acquisition and reconstruction techniques can be reliably compared.

Fetal MRI Analysis of Corpus Callosal Abnormalities: Classification, and Associated Anomalies.

BACKGROUND: Corpus callosal abnormalities (CCA) are midline developmental brain malformations and are usually associated with a wide spectrum of other neurological and non-neurological abnormalities. The study aims to highlight the diagnostic role of fetal MRI to characterize heterogeneous corpus callosal abnormalities using the latest classification system. It also helps to identify associated anomalies, which have prognostic implications for the postnatal outcome. METHODS: In this study, retrospective data from antenatal women who underwent fetal MRI between January 2014 and July 2023 at Rush University Medical Center were evaluated for CCA and classified based on structural morphology. Patients were further assessed for associated neurological and non-neurological anomalies. RESULTS: The most frequent class of CCA was complete agenesis (79.1%), followed by hypoplasia (12.5%), dysplasia (4.2%), and hypoplasia with dysplasia (4.2%). Among them, 17% had isolated CCA, while the majority (83%) had complex forms of CCA associated with other CNS and non-CNS anomalies. Out of the complex CCA cases, 58% were associated with other CNS anomalies, while 8% were associated with non-CNS anomalies. 17% of cases had both. CONCLUSION: The use of fetal MRI is valuable in the classification of abnormalities of the corpus callosum after the confirmation of a suspected diagnosis on prenatal ultrasound. This technique is an invaluable method for distinguishing between isolated and complex forms of CCA, especially in cases of apparent isolated CCA. The use of diffusion-weighted imaging or diffusion tensor imaging in fetal neuroimaging is expected to provide further insights into white matter abnormalities in fetuses diagnosed with CCA in the future.

Automatic Localization of the Pons and Vermis on Fetal Brain MR Imaging Using a U-Net Deep Learning Model.

BACKGROUND AND PURPOSE: An MRI of the fetus can enhance the identification of perinatal developmental disorders, which improves the accuracy of ultrasound. Manual MRI measurements require training, time, and intra-variability concerns. Pediatric neuroradiologists are also in short supply. Our purpose was developing a deep learning model and pipeline for automatically identifying anatomic landmarks on the pons and vermis in fetal brain MR imaging and suggesting suitable images for measuring the pons and vermis. MATERIALS AND METHODS: We retrospectively used 55 pregnant patients who underwent fetal brain MR imaging with a HASTE protocol. Pediatric neuroradiologists selected them for landmark annotation on sagittal single-shot T2-weighted images, and the clinically reliable method was used as the criterion standard for the measurement of the pons and vermis. A U-Net-based deep learning model was developed to automatically identify fetal brain anatomic landmarks, including the 2 anterior-posterior landmarks of the pons and 2 anterior-posterior and 2 superior-inferior landmarks of the vermis. Four-fold cross-validation was performed to test the accuracy of the model using randomly divided and sorted gestational age-divided data sets. A confidence score of model prediction was generated for each testing case. RESULTS: Overall, 85% of the testing results showed a ≥90% confidence, with a mean error of <2.22 mm, providing overall better estimation results with fewer errors and higher confidence scores. The anterior and posterior pons and anterior vermis showed better estimation (which means fewer errors in landmark localization) and accuracy and a higher confidence level than other landmarks. We also developed a graphic user interface for clinical use. CONCLUSIONS: This deep learning-facilitated pipeline practically shortens the time spent on selecting good-quality fetal brain images and performing anatomic measurements for radiologists.

Review of deep learning and artificial intelligence models in fetal brain magnetic resonance imaging.

Central nervous system abnormalities in fetuses are fairly common, happening in 0.1% to 0.2% of live births and in 3% to 6% of stillbirths. So initial detection and categorization of fetal Brain abnormalities are critical. Manually detecting and segmenting fetal brain magnetic resonance imaging (MRI) could be time-consuming, and susceptible to interpreter experience. Artificial intelligence (AI) algorithms and machine learning approaches have a high potential for assisting in the early detection of these problems, improving the diagnosis process and follow-up procedures. The use of AI and machine learning techniques in fetal brain MRI was the subject of this narrative review paper. Using AI, anatomic fetal brain MRI processing has investigated models to predict specific landmarks and segmentation automatically. All gestation age weeks (17-38 wk) and different AI models (mainly Convolutional Neural Network and U-Net) have been used. Some models' accuracy achieved 95% and more. AI could help preprocess and post-process fetal images and reconstruct images. Also, AI can be used for gestational age prediction (with one-week accuracy), fetal brain extraction, fetal brain segmentation, and placenta detection. Some fetal brain linear measurements, such as Cerebral and Bone Biparietal Diameter, have been suggested. Classification of brain pathology was studied using diagonal quadratic discriminates analysis, K-nearest neighbor, random forest, naive Bayes, and radial basis function neural network classifiers. Deep learning methods will become more powerful as more large-scale, labeled datasets become available. Having shared fetal brain MRI datasets is crucial because there aren not many fetal brain pictures available. Also, physicians should be aware of AI's function in fetal brain MRI, particularly neuroradiologists, general radiologists, and perinatologists.

Automatic Ventriculomegaly Detection in Fetal Brain MRI: A Step-by-Step Deep Learning Model for Novel 2D-3D Linear Measurements.

In this study, we developed an automated workflow using a deep learning model (DL) to measure the lateral ventricle linearly in fetal brain MRI, which are subsequently classified into normal or ventriculomegaly, defined as a diameter wider than 10 mm at the level of the thalamus and choroid plexus. To accomplish this, we first trained a UNet-based deep learning model to segment the brain of a fetus into seven different tissue categories using a public dataset (FeTA 2022) consisting of fetal T2-weighted images. Then, an automatic workflow was developed to perform lateral ventricle measurement at the level of the thalamus and choroid plexus. The test dataset included 22 cases of normal and abnormal T2-weighted fetal brain MRIs. Measurements performed by our AI model were compared with manual measurements performed by a general radiologist and a neuroradiologist. The AI model correctly classified 95% of fetal brain MRI cases into normal or ventriculomegaly. It could measure the lateral ventricle diameter in 95% of cases with less than a 1.7 mm error. The average difference between measurements was 0.90 mm in AI vs. general radiologists and 0.82 mm in AI vs. neuroradiologists, which are comparable to the difference between the two radiologists, 0.51 mm. In addition, the AI model also enabled the researchers to create 3D-reconstructed images, which better represent real anatomy than 2D images. When a manual measurement is performed, it could also provide both the right and left ventricles in just one cut, instead of two. The measurement difference between the general radiologist and the algorithm (p = 0.9827), and between the neuroradiologist and the algorithm (p = 0.2378), was not statistically significant. In contrast, the difference between general radiologists vs. neuroradiologists was statistically significant (p = 0.0043). To the best of our knowledge, this is the first study that performs 2D linear measurement of ventriculomegaly with a 3D model based on an artificial intelligence approach. The paper presents a step-by-step approach for designing an AI model based on several radiological criteria. Overall, this study showed that AI can automatically calculate the lateral ventricle in fetal brain MRIs and accurately classify them as abnormal or normal.

AAPM Task Group Report 238: 3D C-arms with volumetric imaging capability.

This report reviews the image acquisition and reconstruction characteristics of C-arm Cone Beam Computed Tomography (C-arm CBCT) systems and provides guidance on quality control of C-arm systems with this volumetric imaging capability. The concepts of 3D image reconstruction, geometric calibration, image quality, and dosimetry covered in this report are also pertinent to CBCT for Image-Guided Radiation Therapy (IGRT). However, IGRT systems introduce a number of additional considerations, such as geometric alignment of the imaging at treatment isocenter, which are beyond the scope of the charge to the task group and the report. Section 1 provides an introduction to C-arm CBCT systems and reviews a variety of clinical applications. Section 2 briefly presents nomenclature specific or unique to these systems. A short review of C-arm fluoroscopy quality control (QC) in relation to 3D C-arm imaging is given in Section 3. Section 4 discusses system calibration, including geometric calibration and uniformity calibration. A review of the unique approaches and challenges to 3D reconstruction of data sets acquired by C-arm CBCT systems is give in Section 5. Sections 6 and 7 go in greater depth to address the performance assessment of C-arm CBCT units. First, Section 6 describes testing approaches and phantoms that may be used to evaluate image quality (spatial resolution and image noise and artifacts) and identifies several factors that affect image quality. Section 7 describes both free-in-air and in-phantom approaches to evaluating radiation dose indices. The methodologies described for assessing image quality and radiation dose may be used for annual constancy assessment and comparisons among different systems to help medical physicists determine when a system is not operating as expected. Baseline measurements taken either at installation or after a full preventative maintenance service call can also provide valuable data to help determine whether the performance of the system is acceptable. Collecting image quality and radiation dose data on existing phantoms used for CT image quality and radiation dose assessment, or on newly developed phantoms, will inform the development of performance criteria and standards. Phantom images are also useful for identifying and evaluating artifacts. In particular, comparing baseline data with those from current phantom images can reveal the need for system calibration before image artifacts are detected in clinical practice. Examples of artifacts are provided in Sections 4, 5, and 6.

Motion artifacts reduction in brain MRI by means of a deep residual network with densely connected multi-resolution blocks (DRN-DCMB).

OBJECTIVE: Magnetic resonance imaging (MRI) acquisition is inherently sensitive to motion, and motion artifact reduction is essential for improving image quality in MRI. METHODS: We developed a deep residual network with densely connected multi-resolution blocks (DRN-DCMB) model to reduce the motion artifacts in T1 weighted (T1W) spin echo images acquired on different imaging planes before and after contrast injection. The DRN-DCMB network consisted of multiple multi-resolution blocks connected with dense connections in a feedforward manner. A single residual unit was used to connect the input and output of the entire network with one shortcut connection to predict a residual image (i.e. artifact image). The model was trained with five motion-free T1W image stacks (pre-contrast axial and sagittal, and post-contrast axial, coronal, and sagittal images) with simulated motion artifacts. RESULTS: In other 86 testing image stacks with simulated artifacts, our DRN-DCMB model outperformed other state-of-the-art deep learning models with significantly higher structural similarity index (SSIM) and improvement in signal-to-noise ratio (ISNR). The DRN-DCMB model was also applied to 121 testing image stacks appeared with various degrees of real motion artifacts. The acquired images and processed images by the DRN-DCMB model were randomly mixed, and image quality was blindly evaluated by a neuroradiologist. The DRN-DCMB model significantly improved the overall image quality, reduced the severity of the motion artifacts, and improved the image sharpness, while kept the image contrast. CONCLUSION: Our DRN-DCMB model provided an effective method for reducing motion artifacts and improving the overall clinical image quality of brain MRI.

Deep learning LI-RADS grading system based on contrast enhanced multiphase MRI for differentiation between LR-3 and LR-4/LR-5 liver tumors.

BACKGROUND: To develop a deep learning (DL) method based on multiphase, contrast-enhanced (CE) magnetic resonance imaging (MRI) to distinguish Liver Imaging Reporting and Data System (LI-RADS) grade 3 (LR-3) liver tumors from combined higher-grades 4 and 5 (LR-4/LR-5) tumors for hepatocellular carcinoma (HCC) diagnosis. METHODS: A total of 89 untreated LI-RADS-graded liver tumors (35 LR-3, 14 LR-4, and 40 LR-5) were identified based on the radiology MRI interpretation reports. Multiphase 3D T1-weighted gradient echo imaging was acquired at six time points: pre-contrast, four phases immediately post-contrast, and one hepatobiliary phase after intravenous injection of gadoxetate disodium. Image co-registration was performed across all phases on the center tumor slice to correct motion. A rectangular tumor box centered on the tumor area was drawn to extract subset tumor images for each imaging phase, which were used as the inputs to a convolutional neural network (CNN). The pre-trained AlexNet CNN model underwent transfer learning using liver MRI data for LI-RADS tumor grade classification. The output probability number closer to 1 or 0 indicated a higher possibility of being combined LR-4/LR-5 tumor or LR-3 tumor, respectively. Five-fold cross validation was used for training (60% dataset), validation (20%) and testing processes (20%). RESULTS: The DL CNN model for LI-RADS grading using inputs of multiphase liver MRI data acquired at three time points (pre-contrast, arterial, and washout phase) achieved a high accuracy of 0.90, sensitivity of 1.0, precision of 0.835, and AUC of 0.95 with reference to the expert human radiologist report. The CNN output of probability provided radiologists a confidence level of the model's grading for each liver lesion. CONCLUSIONS: An AlexNet CNN model for LI-RADS grading of liver lesions provided diagnostic performance comparable to radiologists and offered valuable clinical guidance for differentiating intermediate LR-3 liver lesions from more-likely malignant LR-4/LR-5 lesions in HCC diagnosis.

Radiation dose reduction in time-resolved CT angiography using highly constrained back projection reconstruction.

Recently dynamic, time-resolved three-dimensional computed tomography angiography (CTA) has been introduced to the neurological imaging community. However, the radiation dose delivered to patients in time-resolved CTA protocol is a high and potential risk associated with the ionizing radiation dose. Thus, minimizing the radiation dose is highly desirable for time-resolved CTA. In order to reduce the radiation dose delivered during dynamic, contrast-enhanced CT applications, we introduce here the CT formulation of HighlY constrained back PRojection (HYPR) imaging. We explore the radiation dose reduction approaches of both acquiring a reduced number of projections for each image and lowering the tube current used during acquisition. We then apply HYPR image reconstruction to produce image sets at a reduced patient dose and with low image noise. Numerical phantom experiments and retrospective analysis of in vivo canine studies are used to assess the accuracy and quality of HYPR reduced dose image sets and validate our approach. Experimental results demonstrated that a factor of 6-8 times radiation dose reduction is possible when the HYPR algorithm is applied to time-resolved CTA exams.

Quantitative assessment of nonsolid pulmonary nodule volume with computed tomography in a phantom study.

BACKGROUND: To assess the volumetric measurement of small (≤1 cm) nonsolid nodules with computed tomography (CT), focusing on the interaction of state of the art iterative reconstruction (IR) methods and dose with nodule densities, sizes, and shapes. METHODS: Twelve synthetic nodules [5 and 10 mm in diameter, densities of -800, -630 and -10 Hounsfield units (HU), spherical and spiculated shapes] were scanned within an anthropomorphic phantom. Dose [computed tomography scan dose index (CTDIvol)] ranged from standard (4.1 mGy) to below screening levels (0.3 mGy). Data was reconstructed using filtered back-projection and two state-of-the-art IR methods (adaptive and model-based). Measurements were extracted with a previously validated matched filter-based estimator. Analysis of accuracy and precision was based on evaluation of percent bias (PB) and the repeatability coefficient (RC) respectively. RESULTS: Density had the most important effect on measurement error followed by the interaction of density with nodule size. The nonsolid -630 HU nodules had high accuracy and precision at levels comparable to solid (-10 HU) nonsolid, regardless of reconstruction method and with CTDIvol as low as 0.6 mGy. PB was <5% and <11% for the 10- and 5-mm in nominal diameter -630 HU nodules respectively, and RC was <5% and <12% for the same nodules. For nonsolid -800 HU nodules, PB increased to <11% and <30% for the 10- and 5-mm nodules respectively, whereas RC increased slightly overall but varied widely across dose and reconstruction algorithms for the 5-mm nodules. Model-based IR improved measurement accuracy for the 5-mm, low-density (-800, -630 HU) nodules. For other nodules the effect of reconstruction method was small. Dose did not affect volumetric accuracy and only affected slightly the precision of 5-mm nonsolid nodules. CONCLUSIONS: Reasonable values of both accuracy and precision were achieved for volumetric measurements of all 10-mm nonsolid nodules, and for the 5-mm nodules with -630 HU or higher density, when derived from scans acquired with below screening dose levels as low as 0.6 mGy and regardless of reconstruction algorithm.

Detection of pulmonary embolism during pregnancy: comparing radiation doses of CTPA and pulmonary scintigraphy.

OBJECTIVE: In pregnant patients pulmonary embolism is a common occurrence with potentially devastating outcomes, necessitating timely imaging diagnosis. In every patient, especially in pregnant patients, radiation exposure is an important consideration while selecting the best imaging modality. MATERIALS AND METHODS: We performed a retrospective analysis comparing radiation doses of computed tomography pulmonary angiography (CTPA), perfusion scintigraphy, and perfusion/ventilation scintigraphy for suspected pulmonary embolism in 53 pregnant patients at our hospital between 2006 and 2012. Effective dose and breast-absorbed and uterus-absorbed doses for CTPA as well as effective dose and breast and fetus-absorbed doses for pulmonary scintigraphy were estimated using International Commission on Radiological Protection 103 weighting factors. RESULTS: For CTPA and perfusion scintigraphy, average doses were estimated as effective doses of 21 and 1.04 mSv, breast-absorbed doses of 44 and 0.28 mGy, and uterus-absorbed dose of 0.46 mGy and fetal-absorbed dose of 0.25 mGy, respectively. With inclusion of the ventilation component of pulmonary scintigraphy, doses increased to an effective dose of 1.29 mSv, a breast-absorbed dose of 0.37 mGy, and a fetal-absorbed dose of 0.40 mGy. CONCLUSION: Perfusion nuclear medicine study has a statistically significantly lower effective and breast-absorbed dose (P<0.0001) when compared with CTPA. Similarly, the fetal-absorbed dose for pulmonary scintigraphy has a statistically lower dose (P=0.0010) when compared with CTPA, even if the ventilation component of pulmonary scintigraphy is performed, although these values are so small that they are unlikely to be clinically significant.