Effects of different virtual monoenergetic CT image data on chest wall post-processing "unfolded ribs" and proposal of an algorithm improvement.

PURPOSE: To find out if the use of different virtual monoenergetic data sets enabled by DECT technology might have a negative impact on post-processing applications, specifically in case of the "unfolded ribs" algorithm. Metal or beam hardening artifacts are suspected to generate image artifacts and thus reduce diagnostic accuracy. This paper tries to find out how the generation of "unfolded rib" CT image reformates is influenced by different virtual monoenergetic CT images and looks for possible improvement of the post-processing tool. MATERIAL AND METHODS: Between March 2021 and April 2021, thin-slice dual-energy CT image data of the chest were used creating "unfolded rib" reformates. The same data sets were analyzed in three steps: first the gold standard with the original algorithm on mixed image data sets followed by the original algorithm on different keV levels (40-120 keV) and finally using a modified algorithm which in the first step used segmentation based on mixed image data sets, followed by segmentation based on different keV levels. Image quality (presence of artifacts), lesion and fracture detectability were assessed for all series. RESULTS: Both, the original and the modified algorithm resulted in more artifact-free image data sets compared to the gold standard. The modified algorithm resulted in significantly more artifact-free image data sets at the keV-edges (40-120 keV) compared the original algorithm. Especially "black artifacts" and pseudo-lesions, potentially inducing false positive findings, could be reduced in all keV level with the modified algorithm. Detection of focal sclerotic, lytic or mixed (k = 0.990-1.000) lesions was very good for all keV levels. The Fleiss-kappa test for detection of fresh and old rib fractures was ≥ 0.997. CONCLUSION: The use of different virtual monoenergetic keVs for the "unfolded rib" algorithm is generating different artifacts. Segmentation-based artifacts could be eliminated by the proposed new algorithm, showing the best results at 70-80 keV.

Empirical cupping correction for CT scanners with primary modulation (ECCP).

PURPOSE: X-ray CT measures the attenuation of polychromatic x-rays through an object. The raw data acquired, which are the negative logarithm of the relative x-ray intensity behind the patient, must undergo water precorrection to linearize the measurement and to convert them into line integrals that are ready for reconstruction. The function to linearize the measured projection data depends on the detected spectrum of the ray. This spectrum may vary as a function of the detector position, e.g., in cases where the heel effect becomes relevant, where a bow-tie filter introduces channel-dependent beam hardening, or where a primary modulator is used to modulate the primary intensity of the spectrum. METHODS: The authors propose a new approach that allows to handle these effects in a highly convenient way. Their new empirical cupping correction for primary modulation (ECCP) corrects for artifacts, such as cupping artifacts or ring artifacts, which are induced by nonlinearities in the projection data due to spatially varying pre- or postfiltration of the x-rays. To do so, ECCP requires only a simple scan of a homogeneous phantom of nearly arbitrary shape. Based on this information, coefficients of a polynomial series are calculated and stored for later use. RESULTS: Physical measurements demonstrate the quality of the precorrection that can be achieved using ECCP to remove the cupping artifacts and to obtain well-calibrated CT values even in cases of strong primary modulation. A combination of ECCP with analytical techniques yielding a hybrid cupping correction method is possible and allows for channel-dependent correction functions. CONCLUSION: The proposed ECCP method is a very effective and easy to incorporate approach that compensates for even strong detector channel-dependent changes of the detected spectrum. © 2011 American Association of Physicists in Medicine.

Genauigkeit und Reproduzierbarkeit eines Software-Prototypen zur halbautomatischen computergestützten Volumetrie der soliden und subsoliden Komponenten von teilsoliden Lungenrundherden.

PURPOSE: To test the accuracy and reproducibility of a software prototype for semi-automated computer-aided volumetry (CAV) of part-solid pulmonary nodules (PSN) with separate segmentation of the solid part. MATERIALS AND METHODS: 66 PSNs were retrospectively identified in 34 thin-slice unenhanced chest CTs of 19 patients. CAV was performed by two medical students. Manual volumetry (MV) was carried out by two radiology residents. The reference standard was determined by an experienced radiologist in consensus with one of the residents. Visual assessment of CAV accuracy was performed. Measurement variability between CAV/MV and the reference standard as a measure of accuracy, CAV inter- and intra-rater variability as well as CAV intrascan variability between two recontruction kernels was determined via the Bland-Altman method and intraclass correlation coefficients (ICC). RESULTS: Subjectively assessed accuracy of CAV/MV was 77 %/79 %-80 % for the solid part and 67 %/73 %-76 % for the entire nodule. Measurement variability between CAV and the reference standard ranged from -151-117 % for the solid part and -106-54 % for the entire nodule. Interrater variability was -16-16 % for the solid part (ICC 0.998) and -102-65 % for the entire nodule (ICC 0.880). Intra-rater variability was -70-49 % for the solid part (ICC 0.992) and -111-31 % for the entire nodule (ICC 0.929). Intrascan variability between the smooth and the sharp reconstruction kernel was -45-39 % for the solid part and -21-46 % for the entire nodule. CONCLUSION: Although the software prototype delivered satisfactory results when segmentation is evaluated subjectively, quantitative statistical analysis revealed room for improvement especially regarding the segmentation accuracy of the solid part and the reproducibility of measurements of the nodule's subsolid margins. KEY POINTS: · Assessed visually CAV delivers similar accuracy compared to manual volumetry. · Accuracy of CAV was higher for the entire nodule. · Reproducibility was better for the solid part. · Variability between the kernels was higher for the solid part.

Empirical binary tomography calibration (EBTC) for the precorrection of beam hardening and scatter for flat panel CT.

PURPOSE: Scatter and beam hardening are prominent artifacts in x-ray CT. Currently, there is no precorrection method that inherently accounts for tube voltage modulation and shaped prefiltration. METHODS: A method for self-calibration based on binary tomography of homogeneous objects, which was proposed by B. Li et al. ["A novel beam hardening correction method for computed tomography," in Proceedings of the IEEE/ICME International Conference on Complex Medical Engineering CME 2007, pp. 891-895, 23-27 May 2007], has been generalized in order to use this information to preprocess scans of other, nonbinary objects, e.g., to reduce artifacts in medical CT applications. Further on, the method was extended to handle scatter besides beam hardening and to allow for detector pixel-specific and ray-specific precorrections. This implies that the empirical binary tomography calibration (EBTC) technique is sensitive to spectral effects as they are induced by the heel effect, by shaped prefiltration, or by scanners with tube voltage modulation. The presented method models the beam hardening correction by using a rational function, while the scatter component is modeled using the pep model of B. Ohnesorge et al. ["Efficient object scatter correction algorithm for third and fourth generation CT scanners," Eur. Radiol. 9(3), 563-569 (1999)]. A smoothness constraint is applied to the parameter space to regularize the underdetermined system of nonlinear equations. The parameters determined are then used to precorrect CT scans. RESULTS: EBTC was evaluated using simulated data of a flat panel cone-beam CT scanner with tube voltage modulation and bow-tie prefiltration and using real data of a flat panel cone-beam CT scanner. In simulation studies, where the ground truth is known, the authors' correction model proved to be highly accurate and was able to reduce beam hardening by 97% and scatter by about 75%. Reconstructions of measured data showed significantly less artifacts than the standard reconstruction. CONCLUSIONS: EBTC appears to be an efficient algorithm to precorrect CT raw data for beam hardening and scatter and it can account for ray-dependent spectral variations as they occur due to the heel effect, due to shaped prefiltration, or due to variations in tube voltage.

Can a Novel Deep Neural Network Improve the Computer-Aided Detection of Solid Pulmonary Nodules and the Rate of False-Positive Findings in Comparison to an Established Machine Learning Computer-Aided Detection?

OBJECTIVE: The aim of this study was to compare the performance of 2 approved computer-aided detection (CAD) systems for detection of pulmonary solid nodules (PSNs) in an oncologic cohort. The first CAD system is based on a conventional machine learning approach (VD10F), and the other is based on a deep 3D convolutional neural network (CNN) CAD software (VD20A). METHODS AND MATERIALS: Nine hundred sixty-seven patients with a total of 2451 PSNs were retrospectively evaluated using the 2 different CAD systems. All patients had thin-slice chest computed tomography (0.6 mm) using 100 kV and 100 mAs and a high-resolution kernel (I50f). The CAD images generated by VD10F were transferred to the PACS for evaluation. The images generated by VD20A were evaluated using a Web browser-based viewer. Finally, a senior radiologist who was blinded for the CAD results examined the thin-slice images of every patient (ground truth). RESULTS: A total of 2451 PSNs were detected by the senior radiologist. CAD-VD10F detected 1401 true-positive, 143 false-negative, 565 false-positive (FP), and 342 true-negative PSNs, resulting in sensitivity of 90.7%, specificity of 37.7%, positive predictive value of 0.71, and negative predictive value of 0.70. CAD-VD20A detected 1381 true-positive, 163 false-negative, 337 FP, and 570 true-negative PSNs, resulting in sensitivity of 89.4%, specificity of 62.8%, positive predictive value of 0.80, and negative predictive value 0.77, respectively. The rate of FP per scan was 0.6 for CAD-VD10F and 0.3 for CAD-VD20A. CONCLUSIONS: The new deep learning-based CAD software (VD20A) shows similar sensitivity with the conventional CAD software (VD10F), but a significantly higher specificity.

An investigation of 4D cone-beam CT algorithms for slowly rotating scanners.

PURPOSE: To evaluate several algorithms for 4D cone-beam computed tomography (4D CBCT) with slow rotating devices. 4D CBCT is used to perform phase-correlated (PC) reconstructions of moving objects, such as breathing patients, for example. Such motion phase-dependent reconstructions are especially useful for updating treatment plans in radiation therapy. The treatment plan can be registered more precisely to the motion of the tumor and, in consequence, the irradiation margins for the treatment, the so-called planning target volume, can be reduced significantly METHODS: In the study, several algorithms were evaluated for kilovoltage cone-beam CT units attached to linear particle accelerators. The reconstruction algorithms were the conventional PC reconstruction, the McKinnon-Bates (MKB) algorithm, the prior image constrained compressed sensing (PICCS) approach, a total variation minimization (ASD-POCS) algorithm, and the auto-adaptive phase correlation (AAPC) algorithm. For each algorithm, the same motion-affected raw data were used, i.e., one simulated and one measured data set. The reconstruction results from the authors' implementation of these algorithms were evaluated regarding their noise and artifact levels, their residual motion blur, and their computational complexity and convergence. RESULTS: In general, it turned out that the residual motion blur was lowest in those algorithms which exclusively use data from a single motion phase. Algorithms using the image from the full data set as initialization or as a reference for the reconstruction were not capable of fully removing the motion blurring. The iterative algorithms, especially approaches based on total variation minimization, showed lower noise and artifact levels but were computationally complex. The conventional methods based on a single filtered backprojection were computationally inexpensive but suffered from higher noise and streak artifacts which limit the usability. In contrast, these methods showed to be less demanding and more predictable in their outcome than the total variation minimization based approaches. CONCLUSIONS: The reconstruction algorithms including at least one iterative step can reduce the 4 CBCT specific artifacts. Nevertheless, the algorithms that use the full data set, at least for initialization, such as MKB and PICCS in the authors' implementation, are only a trade-off and may not fully achieve the optimal temporal resolution. A predictable image quality as seen in conventional reconstruction methods, i.e., without total variation minimization, is a desirable property for reconstruction algorithms. Fast, iterative approaches such as the MKB can therefore be seen as a suitable tradeoff.

Are quantitative features of lung nodules reproducible at different CT acquisition and reconstruction parameters?

Consistency and duplicability in Computed Tomography (CT) output is essential to quantitative imaging for lung cancer detection and monitoring. This study of CT-detected lung nodules investigated the reproducibility of volume-, density-, and texture-based features (outcome variables) over routine ranges of radiation dose, reconstruction kernel, and slice thickness. CT raw data of 23 nodules were reconstructed using 320 acquisition/reconstruction conditions (combinations of 4 doses, 10 kernels, and 8 thicknesses). Scans at 12.5%, 25%, and 50% of protocol dose were simulated; reduced-dose and full-dose data were reconstructed using conventional filtered back-projection and iterative-reconstruction kernels at a range of thicknesses (0.6-5.0 mm). Full-dose/B50f kernel reconstructions underwent expert segmentation for reference Region-Of-Interest (ROI) and nodule volume per thickness; each ROI was applied to 40 corresponding images (combinations of 4 doses and 10 kernels). Typical texture analysis metrics (including 5 histogram features, 13 Gray Level Co-occurrence Matrix, 5 Run Length Matrix, 2 Neighboring Gray-Level Dependence Matrix, and 3 Neighborhood Gray-Tone Difference Matrix) were computed per ROI. Reconstruction conditions resulting in no significant change in volume, density, or texture metrics were identified as "compatible pairs" for a given outcome variable. Our results indicate that as thickness increases, volumetric reproducibility decreases, while reproducibility of histogram- and texture-based features across different acquisition and reconstruction parameters improves. To achieve concomitant reproducibility of volumetric and radiomic results across studies, balanced standardization of the imaging acquisition parameters is required.

Cone-beam CT image reconstruction with extended z range.

In circular cone-beam CT the Feldkamp [Feldkamp-Davis-Kress (FDK)] algorithm is the most prominent image reconstruction algorithm. For example, in radiation oncology images reconstructed with the Feldkamp algorithm are used for accurate patient positioning. The scan and reconstruction volumes are limited by the size of the flat panel detector. Flat panel detectors, however, are expensive and difficult to manufacture in large size. For numerous treatment techniques, extending this scan volume would be very beneficial. In most applications, data from 360 degrees or more are available. However, usually only those slices are reconstructed where each pixel is seen under the full 360 degree range. Yet for a 360 degree scan there are regions that are seen by less than 360 degrees, namely, those that lie further off the plane of the circular source trajectory. Performing a reconstruction also for those slices where all voxels are seen at least by 180 degrees will extend the z range and therefore increase the dose usage. In this work a new method is presented that reconstructs also those slices where some or all pixels receive less than 360 degrees but at least 180 degrees of the data. The procedure significantly increases the longitudinal range of the reconstructed volume. As opposed to the existing techniques, the proposed method does not necessitate any multiple convolutions or multiple backprojections, lending itself therefore for a very efficient implementation. To validate the abilities of the extended reconstruction, the authors performed an evaluation of the image quality by using simulated and measured CT data. The method shows good image quality on simulated phantom data as well as on clinical patient scans. Image noise and spatial resolution behave as expected. This means that the noise equals FDK values in the normal region and increases in the extended region due to reduced data redundancies. The extended Feldkamp demonstrates its ability to extend the reconstructable z range and appears to be useful in clinical practice.

Physics-based spectral compensation algorithm for x-ray CT with primary modulator.

X-ray computed tomography (CT) scatter correction using primary modulator has been continuously developed over the past years, with progress in improving the performance of scatter correction. In this work, we further advance the primary modulator technique towards practical applications where the spectral nonuniformity caused by the modulator continues to be a challenging problem. A physics-based spectral compensation algorithm is proposed to adaptively correct for the spectral nonuniformity, and hence to reduce the resultant ring artifacts on reconstructed CT images. First, an initial spectrum of the CT system without the primary modulator is modeled using an understanding of x-ray CT physics, and optimized by an expectation maximization method; then, the optimized estimation of the initial spectrum is utilized to adaptively calculate the effective modulator thickness from measured transmissions of the primary modulator at each detector element, leading to a set of new spectra that is able to capture the nonuniform spectral distribution of the primary modulator; finally, using the modulator-modeled spectrum, a beam hardening mapping function is generated and beam hardening correction is applied to CT projections. A CatPhan600 phantom and an anthropomorphic thorax phantom were scanned with three different primary modulators to evaluate the approach. For the Catphan phantom, the spectral compensation algorithm efficiently removes the ring (and band) artifacts that otherwise dominate the reconstructed CT image. For the three modulators with nominal copper thickness of 52.5, 105 and 210 [Formula: see text]m, our method reduces the CT number nonuniformity from 147.9, 436.2 and 696.4 Hounsfield units (HU) to 14.6, 26.2 and 13.6 HU, respectively, close to that of the reference image (i.e. 7.5 HU). For the thorax phantom, the ring artifacts are also suppressed significantly on the transaxial image; on the sagittal image, the alternating black-and-white patterns are largely removed, with the CT number nonuniformity being reduced from 282.0 HU to 38.5 HU.

A User Interface for Optimizing Radiologist Engagement in Image Data Curation for Artificial Intelligence.

PURPOSE: To delineate image data curation needs and describe a locally designed graphical user interface (GUI) to aid radiologists in image annotation for artificial intelligence (AI) applications in medical imaging. MATERIALS AND METHODS: GUI components support image analysis toolboxes, picture archiving and communication system integration, third-party applications, processing of scripting languages, and integration of deep learning libraries. For clinical AI applications, GUI components included two-dimensional segmentation and classification; three-dimensional segmentation and quantification; and three-dimensional segmentation, quantification, and classification. To assess radiologist engagement and performance efficiency associated with GUI-related capabilities, image annotation rate (studies per day) and speed (minutes per case) were evaluated in two clinical scenarios of varying complexity: hip fracture detection and coronary atherosclerotic plaque demarcation and stenosis grading. RESULTS: For hip fracture, 1050 radiographs were annotated over 7 days (150 studies per day; median speed: 10 seconds per study [interquartile range, 3-21 seconds per study]). A total of 294 coronary CT angiographic studies with 1843 arteries and branches were annotated for atherosclerotic plaque over 23 days (15.2 studies [80.1 vessels] per day; median speed: 6.08 minutes per study [interquartile range, 2.8-10.6 minutes per study] and 73 seconds per vessel [interquartile range, 20.9-155 seconds per vessel]). CONCLUSION: GUI-component compatibility with common image analysis tools facilitates radiologist engagement in image data curation, including image annotation, supporting AI application development and evolution for medical imaging. When complemented by other GUI elements, a continuous integrated workflow supporting formation of an agile deep neural network life cycle results.Supplemental material is available for this article.© RSNA, 2019.

Evaluation of Texture Analysis Parameter for Response Prediction in Patients with Hepatocellular Carcinoma Undergoing Drug-eluting Bead Transarterial Chemoembolization (DEB-TACE) Using Biphasic Contrast-enhanced CT Image Data: Correlation with Liver Perfusion CT.

RATIONALE AND OBJECTIVES: This study aimed to evaluate the potential role of computed tomography texture analysis (CTTA) of arterial and portal-venous enhancement phase image data for prediction and accurate assessment of response of hepatocellular carcinoma undergoing drug-eluting bead transarterial chemoembolization (TACE) by comparison to liver perfusion CT (PCT). MATERIALS AND METHODS: Twenty-eight patients (27 male; mean age 67.2 ± 10.4) with 56 hepatocellular carcinoma-typical liver lesions were included. Arterial and portal-venous phase CT data obtained before and after TACE with a mean time of 39.93 ± 62.21 days between examinations were analyzed. TACE was performed within 48 hours after first contrast-enhanced CT. CTTA software was a prototype. CTTA analysis was performed blinded (for results) by two observers separately. Combined results of modified Response Evaluation Criteria In Solid Tumors (mRECIST) and PCT of the liver were used as the standard of reference. Time to progression was additionally assessed for all patients. CTTA parameters included heterogeneity, intensity, average, deviation, skewness, and entropy of co-occurrence. Each parameter was compared to those of PCT (blood flow [BF], blood volume, arterial liver perfusion [ALP], portal-venous perfusion, and hepatic perfusion index) measured before and after TACE. RESULTS: mRECIST + PCT yielded 28.6% complete response (CR), 42.8% partial response, and 28.6% stable disease. Significant correlations were registered in the arterial phase in CR between changes in mean heterogeneity and BF (P = .004, r = -0.815), blood volume (P = .002, r = -0.851), and ALP (P = .002, r = -0.851), respectively. In the partial response group, changes in mean heterogeneity correlated with changes in ALP (P = .003) and to a lesser degree with hepatic perfusion index (P = .027) in the arterial phase. In the stable disease group, BF correlated with entropy of nonuniformity (P = .010). In the portal-venous phase, no statistically significant correlations were registered in all groups. Receiver operating characteristic analysis of CTTA parameters yielded predictive cutoff values for CR in the arterial contrast-enhanced CT phase for uniformity of skewness (sensitivity: 90.0%; specificity: 45.8%), and in the portal-venous phase for uniformity of heterogeneity (sensitivity: 92.3%; specificity: 81.8%). CONCLUSIONS: Significant correlations exist between CTTA parameters and those derived from PCT both in the pre- and the post-TACE settings, and some of them have predictive value for TACE midterm outcome.

Differences in Texture Analysis Parameters Between Active Alveolitis and Lung Fibrosis in Chest CT of Patients with Systemic Sclerosis: A Feasibility Study.

RATIONALE AND OBJECTIVES: This study aimed to determine the diagnostic aid of computed tomography (CT) features for the differentiation of active alveolitis and fibrosis using a CT texture analysis (CTTA) prototype and CT densitometry in patients with systemic sclerosis (SSc) using ancillary high-resolution computed tomography (HRCT) features and their longitudinal course as standard of reference. MATERIALS AND METHODS: We retrospectively analyzed thin-slice noncontrast chest CT image data of 43 patients with SSc (18 men, mean age 51.55 ± 15.52 years; range 23-71 years). All of them had repeated noncontrast enhanced HRCT of the lung. Classification into active alveolitis or fibrosis was done on HRCT based on classical HRCT findings (active alveolitis [19; 44.2%] and fibrosis [24; 55.8%]) and their course at midterm. Results were compared to pulmonary functional tests and were followed up by CT. Ground glass opacity was considered suggestive of alveolitis, whereas coarse reticulation with parenchymal distortion, traction bronchiectasis, and honeycombing were assigned to fibrosis. RESULTS: Statistically significant differences in CTTA were found for first-order textural features (mean intensity, average, deviation, skewness) and second-order statistics (entropy of co-occurrence matrix, mean number of nonuniformity (NGLDM), entropy of NGLDM, entropy of heterogeneity, intensity, and average). Cut-off value for the prediction of fibrosis at baseline was significant for entropy of intensity (P value < .001) and for mean deviation (P value < .001), and for prediction of alveolitis was significant for uniformity of intensity (P value < .001) and for NGLDM (P value < .001). At pulmonary functional tests, forced expiratory volume in 1 second and single-breath diffusion capacity for carbon monoxide were significantly lower in fibrosis than in alveolitis 2.03 ± 0.78 vs. 2.61 ± 0.83, P < .016 and 4.51 ± 1.61 vs. 6.04 ± 1.75, P < .009, respectively. Differences in CT densitometry between alveolitis and fibrosis were not significant. CONCLUSIONS: CTTA parameters are significantly different in active alveolitis vs. fibrosis in patients with SSc and may be helpful for differentiation of these two entities.