On the potential of ROI imaging in x-ray CT - A comparison of novel dynamic beam attenuators with current technology.

PURPOSE: In this work, we explore the potential of region-of-interest (ROI) imaging in x-ray computed tomography (CT). Using two dynamic beam attenuator (DBA) concepts for fluence field modulation (FFM) previously developed, we investigate and evaluate the potential dose savings in comparison with current FFM technology. METHODS: ROI imaging is a special application of FFM where the bulk of x-ray radiation is propagated toward a certain anatomical target (ROI), specified by the imaging task, while the surrounding tissue is spared from radiation. We introduce a criterion suitable to quantitatively describe the balance between image quality inside an ROI and total radiation dose with respect to a given ROI imaging task. It accounts for the mean image variance at the ROI and the effective patient dose calculated from Monte Carlo simulations. The criterion is further used to compile task-specific DBA trajectories determining the primary x-ray fluence, and eventually used for comparing different FFM techniques, namely the sheet-based dynamic beam attenuator (sbDBA), the z-aligned sbDBA (z-sbDBA), and an adjustable static operation mode of the z-sbDBA. Furthermore, two static bowtie filters and the influence of tube current modulation (TCM) are included in the comparison. RESULTS: Our findings demonstrate by simulations that the presented trajectory optimization method determines reasonable DBA trajectories. The influence of TCM is strongly depending on the imaging task. The narrow bowtie filter allows for dose reductions of about 10% compared to the regular bowtie filter in the considered ROI imaging tasks. The DBAs are shown to realize substantially larger dose reductions. In our cardiac imaging scenario, the DBAs can reduce the effective dose by about 30% (z-sbDBA) or 60% (sbDBA). We can further verify that the noise characteristics are not adversely affected by the DBAs. CONCLUSION: Our research demonstrates that ROI imaging using the presented DBA concepts is a promising technique toward a more patient- and task-specific CT imaging requiring lower radiation dose. Both the sbDBA and the z-sbDBA are potential technical solutions for realizing ROI imaging in x-ray CT.

Technical Note: Sheet-based dynamic beam attenuator - A novel concept for dynamic fluence field modulation in x-ray CT.

PURPOSE: It has been a long-standing wish in computed tomography (CT) to compensate the emitted x-ray beam intensity for the patient's changing attenuation during the rotation of a CT data acquisition. The patient attenuation changes both spatially, along the fan beam angle, and temporally, between different projections. By modifying the pre-patient x-ray intensity profile according to the attenuation properties of the given object, image noise can be homogenized and dose can be delivered where it is really needed. Current state-of-the-art bowtie filters are not capable of changing attenuation profiles during the CT data acquisition. In our work, we present the sheet-based dynamic beam attenuator (sbDBA), a novel technical concept enabling dynamic shaping of the transmission profile. METHODS: The sbDBA consists of an array of closely spaced, highly attenuating metal sheets, focused toward the focal spot. Intensity modulation can be achieved by controlled defocusing of the array such that the attenuation of the x-ray fan beam depends on the fan angle. The sbDBA concept was evaluated in Monte-Carlo (MC) simulations regarding its spectral and scattering properties. A prototype of the sbDBA was installed in a clinical CT scanner and measurements evaluating the feasibility and the performance of the sbDBA concept were carried out. RESULTS: Experimental measurements on a CT scanner demonstrate the ability of the sbDBA to produce an attenuation profile that can be changed in width and location. Furthermore, the sbDBA shows constant transmission properties at various tube voltages. A small effect of the flying focal spot (FFS) position on the transmission profile can be observed. MC simulations confirm the essential properties of the sbDBA: In contrast to conventional bowtie filters, the sbDBA has almost no impact on the energy spectrum of the beam and there is negligible scatter emission toward the patient. CONCLUSIONS: A new concept for dynamic beam attenuation has been presented and its ability to dynamically shape the transmission profile has successfully been demonstrated. Advantages compared to regular bowtie filters including the lack of filter-induced beam hardening and scatter have been confirmed. The novel concept of a DBA paves the way toward region of interest (ROI) imaging and further reductions in patient dose.

Modeling the DQE(f) of photon-counting detectors: impact of the pixel sensitivity profile.

PURPOSE: To find comprehensive equations for the frequency-dependent MTF and DQE of photon counting detectors including the effect that the combination of crosstalk with an energy threshold is changing the pixel sensitivity profile and to compare the results with measurements. METHODS: The framework of probability-generating functions (PGF) is used to find a simple method to derive the MTF and the DQE directly from a Monte-Carlo model of the detection process. RESULTS: In combination with realistic model parameters for the detector, the method is used to predict the MTF and the DQE for different pixel sizes and thresholds. Particularly for small pixels, the modification of the sensitivity profile due to crosstalk substantially affects the frequency dependence of both quantities. CONCLUSION: The phenomenon of the pixel sensitivity profile, i.e. the fact that the choice of the threshold is affecting the detector sharpness, may play a substantial role in exploiting the full potential of photon counting detectors. The model compares well with measurements: with only two model parameters, the model can predict the MTF(f) and the DQE(f) for a wide range of thresholds.

Spatio-energetic cross-talk in photon counting detectors: Numerical detector model (PcTK) and workflow for CT image quality assessment.

PURPOSE: The interpixel cross-talk of energy-sensitive photon counting x-ray detectors (PCDs) has been studied and an analytical model (version 2.1) has been developed for double-counting between neighboring pixels due to charge sharing and K-shell fluorescence x-ray emission followed by its reabsorption (Taguchi K, et al., Medical Physics 2016;43(12):6386-6404). While the model version 2.1 simulated the spectral degradation well, it had the following problems that has been found to be significant recently: (1) The spectrum is inaccurate with smaller pixel sizes; (2) the charge cloud size must be smaller than the pixel size; (3) the model underestimates the spectrum/counts for 10-40 keV; and (4) the model version 2.1 cannot handlen-tuple-counting withn > 2 (i.e., triple-counting or higher). These problems are inherent to the design of the model version 2.1; therefore, we developed a new model and addressed these problems in this study. METHODS: We propose a new PCD cross-talk model (version 3.2; Pc TK for "photon counting toolkit") that is based on a completely different design concept from the previous version. It uses a numerical approach and starts with a 2-D model of charge sharing (as opposed to an analytical approach and a 1-D model with version 2.1) and addresses all of the four problems. The model takes the following factors into account: (1) shift-variant electron density of the charge cloud (Gaussian-distributed), (2) detection efficiency, (3) interactions between photons and PCDs via photoelectric effect, and (4) electronic noise. Correlated noisy PCD data can be generated using either a multivariate normal random number generator or a Poisson random number generator. The effect of the two parameters, the effective charge cloud diameter (d0 ) and pixel size (dpix ), was studied and results were compared with Monte Carlo simulations and the previous model version 2.1. Finally, a script for the workflow for CT image quality assessment has been developed, which started with a few material density images, generated material-specific sinogram (line integrals) data, noisy PCD data with spectral distortion using the model version 3.2, and reconstructed PCD- CT images for four energy windows. RESULTS: The model version 3.2 addressed all of the four problems listed above. The spectra withdpix  = 56-113 µm agreed with that of Medipix3 detector withdpix  = 55-110 µm without charge summing mode qualitatively. The counts for 10-40 keV were larger than the previous model (version 2.1) and agreed with MC simulations very well (root-mean-square difference values with model version 3.2 were decreased to 16%-67% of the values with version 2.1). There were many non-zero off-diagonal elements withn-tuple-counting withn > 2 in the normalized covariance matrix of 3 × 3 neighboring pixels. Reconstructed images showed biases and artifacts attributed to the spectral distortion due to the charge sharing and fluorescence x rays. CONCLUSION: We have developed a new PCD model for spatio-energetic cross-talk and correlation between PCD pixels. The workflow demonstrated the utility of the model for general or task-specific image quality assessments for the PCD- CT.Note: The program (Pc TK) and the workflow scripts have been made available to academic researchers. Interested readers should visit the website (pctk.jhu.edu) or contact the corresponding author.

An angle-dependent estimation of CT x-ray spectrum from rotational transmission measurements.

PURPOSE: Computed tomography (CT) performance as well as dose and image quality is directly affected by the x-ray spectrum. However, the current assessment approaches of the CT x-ray spectrum require costly measurement equipment and complicated operational procedures, and are often limited to the spectrum corresponding to the center of rotation. In order to address these limitations, the authors propose an angle-dependent estimation technique, where the incident spectra across a wide range of angular trajectories can be estimated accurately with only a single phantom and a single axial scan in the absence of the knowledge of the bowtie filter. METHODS: The proposed technique uses a uniform cylindrical phantom, made of ultra-high-molecular-weight polyethylene and positioned in an off-centered geometry. The projection data acquired with an axial scan have a twofold purpose. First, they serve as a reflection of the transmission measurements across different angular trajectories. Second, they are used to reconstruct the cross sectional image of the phantom, which is then utilized to compute the intersection length of each transmission measurement. With each CT detector element recording a range of transmission measurements for a single angular trajectory, the spectrum is estimated for that trajectory. A data conditioning procedure is used to combine information from hundreds of collected transmission measurements to accelerate the estimation speed, to reduce noise, and to improve estimation stability. The proposed spectral estimation technique was validated experimentally using a clinical scanner (Somatom Definition Flash, Siemens Healthcare, Germany) with spectra provided by the manufacturer serving as the comparison standard. Results obtained with the proposed technique were compared against those obtained from a second conventional transmission measurement technique with two materials (i.e., Cu and Al). After validation, the proposed technique was applied to measure spectra from the clinical system across a range of angular trajectories [-15°, 15°] and spectrum settings (80, 100, 120, 140 kVp). RESULTS: At 140 kVp, the proposed technique was comparable to the conventional technique in terms of the mean energy difference (MED, -0.29 keV) and the normalized root mean square difference (NRMSD, 0.84%) from the comparison standard compared to 0.64 keV and 1.56%, respectively, with the conventional technique. The average absolute MEDs and NRMSDs across kVp settings and angular trajectories were less than 0.61 keV and 3.41%, respectively, which indicates a high level of estimation accuracy and stability. CONCLUSIONS: An angle-dependent estimation technique of CT x-ray spectra from rotational transmission measurements was proposed. Compared with the conventional technique, the proposed method simplifies the measurement procedures and enables incident spectral estimation for a wide range of angular trajectories. The proposed technique is suitable for rigorous research objectives as well as routine clinical quality control procedures.

Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution: image reconstruction and assessment of image quality.

PURPOSE: To present the theory for image reconstruction of a high-pitch, high-temporal-resolution spiral scan mode for dual-source CT (DSCT) and evaluate its image quality and dose. METHODS: With the use of two x-ray sources and two data acquisition systems, spiral CT exams having a nominal temporal resolution per image of up to one-quarter of the gantry rotation time can be acquired using pitch values up to 3.2. The scan field of view (SFOV) for this mode, however, is limited to the SFOV of the second detector as a maximum, depending on the pitch. Spatial and low contrast resolution, image uniformity and noise, CT number accuracy and linearity, and radiation dose were assessed using the ACR CT accreditation phantom, a 30 cm diameter cylindrical water phantom or a 32 cm diameter cylindrical PMMA CTDI phantom. Slice sensitivity profiles (SSPs) were measured for different nominal slice thicknesses, and an anthropomorphic phantom was used to assess image artifacts. Results were compared between single-source scans at pitch = 1.0 and dual-source scans at pitch = 3.2. In addition, image quality and temporal resolution of an ECG-triggered version of the DSCT high-pitch spiral scan mode were evaluated with a moving coronary artery phantom, and radiation dose was assessed in comparison with other existing cardiac scan techniques. RESULTS: No significant differences in quantitative measures of image quality were found between single-source scans at pitch = 1.0 and dual-source scans at pitch = 3.2 for spatial and low contrast resolution, CT number accuracy and linearity, SSPs, image uniformity, and noise. The pitch value (1.6 pitch 3.2) had only a minor impact on radiation dose and image noise when the effective tube current time product (mA s/pitch) was kept constant. However, while not severe, artifacts were found to be more prevalent for the dual-source pitch = 3.2 scan mode when structures varied markedly along the z axis, particularly for head scans. Images of the moving coronary artery phantom acquired with the ECG-triggered high-pitch scan mode were visually free from motion artifacts at heart rates of 60 and 70 bpm. However, image quality started to deteriorate for higher heart rates. At equivalent image quality, the ECG-triggered high-pitch scan mode demonstrated lower radiation dose than other cardiac scan techniques on the same DSCT equipment (25% and 60% dose reduction compared to ECG-triggered sequential step-and-shoot and ECG-gated spiral with x-ray pulsing). CONCLUSIONS: A high-pitch (up to pitch = 3.2), high-temporal-resolution (up to 75 ms) dual-source CT scan mode produced equivalent image quality relative to single-source scans using a more typical pitch value (pitch = 1.0). The resultant reduction in the overall acquisition time may offer clinical advantage for cardiovascular, trauma, and pediatric CT applications. In addition, ECG-triggered high-pitch scanning may be useful as an alternative to ECG-triggered sequential scanning for patients with low to moderate heart rates up to 70 bpm, with the potential to scan the heart within one heart beat at reduced radiation dose.

Technical principles of dual source CT.

During the past years, multi-detector row CT (MDCT) has evolved into clinical practice with a rapid increase of the number of detector slices. Today's 64 slice CT systems allow whole-body examinations with sub-millimeter resolution in short scan times. As an alternative to adding even more detector slices, we describe the system concept and design of a CT scanner with two X-ray tubes and two detectors (mounted on a CT gantry with a mechanical offset of 90 degrees) that has the potential to overcome limitations of conventional MDCT systems, such as temporal resolution for cardiac imaging. A dual source CT (DSCT) scanner provides temporal resolution equivalent to a quarter of the gantry rotation time, independent of the patient's heart rate (83 ms at 0.33 s rotation time). In addition to the benefits for cardiac scanning, it allows to go beyond conventional CT imaging by obtaining dual energy information if the two tubes are operated at different voltages. Furthermore, we discuss how both acquisition systems can be used to add the power reserve of two X-ray tubes for long scan ranges and obese patients. Finally, future advances of DSCT are highlighted.

First performance evaluation of a dual-source CT (DSCT) system.

We present a performance evaluation of a recently introduced dual-source computed tomography (DSCT) system equipped with two X-ray tubes and two corresponding detectors, mounted onto the rotating gantry with an angular offset of 90 degrees . We introduce the system concept and derive its consequences and potential benefits for electrocardiograph [corrected] (ECG)-controlled cardiac CT and for general radiology applications. We evaluate both temporal and spatial resolution by means of phantom scans. We present first patient scans to illustrate the performance of DSCT for ECG-gated cardiac imaging, and we demonstrate first results using a dual-energy acquisition mode. Using ECG-gated single-segment reconstruction, the DSCT system provides 83 ms temporal resolution independent of the patient's heart rate for coronary CT angiography (CTA) and evaluation of basic functional parameters. With dual-segment reconstruction, the mean temporal resolution is 60 ms (minimum temporal resolution 42 ms) for advanced functional evaluation. The z-flying focal spot technique implemented in the evaluated DSCT system allows 0.4 mm cylinders to be resolved at all heart rates. First clinical experience shows a considerably increased robustness for the imaging of patients with high heart rates. As a potential application of the dual-energy acquisition mode, the automatic separation of bones and iodine-filled vessels is demonstrated.