2D antiscatter grid and scatter sampling based CBCT method for online dose calculations during CBCT guided radiation therapy of pelvis.

BACKGROUND: Online dose calculations before the delivery of radiation treatments have applications in dose delivery verification, online adaptation of treatment plans, and simulation-free treatment planning. While dose calculations by directly utilizing CBCT images are desired, dosimetric accuracy can be compromised due to relatively lower HU accuracy in CBCT images. PURPOSE: In this work, we propose a novel CBCT imaging pipeline to enhance the accuracy of CBCT-based dose calculations in the pelvis region. Our approach aims to improve the HU accuracy in CBCT images, thereby improving the overall accuracy of CBCT-based dose calculations prior to radiation treatment delivery. METHODS: An in-house developed quantitative CBCT pipeline was implemented to address the CBCT raw data contamination problem. The pipeline combines algorithmic data correction strategies and 2D antiscatter grid-based scatter rejection to achieve high CT number accuracy. To evaluate the effect of the quantitative CBCT pipeline on CBCT-based dose calculations, phantoms mimicking pelvis anatomy were scanned using a linac-mounted CBCT system, and a gold standard multidetector CT used for treatment planning (pCT). A total of 20 intensity-modulated treatment plans were generated for five targets, using 6 and 10 MV flattening filter-free beams, and utilizing small and large pelvis phantom images. For each treatment plan, four different dose calculations were performed using pCT images and three CBCT imaging configurations: quantitative CBCT, clinical CBCT protocol, and a high-performance 1D antiscatter grid (1D ASG). Subsequently, dosimetric accuracy was evaluated for both targets and organs at risk as a function of patient size, target location, beam energy, and CBCT imaging configuration. RESULTS: When compared to the gold-standard pCT, dosimetric errors in quantitative CBCT-based dose calculations were not significant across all phantom sizes, beam energies, and treatment sites. The largest error observed was 0.6% among all dose volume histogram metrics and evaluated dose calculations. In contrast, dosimetric errors reached up to 7% and 97% in clinical CBCT and high-performance ASG CBCT-based treatment plans, respectively. The largest dosimetric errors were observed in bony targets in the large phantom treated with 6 MV beams. The trends of dosimetric errors in organs at risk were similar to those observed in the targets. CONCLUSIONS: The proposed quantitative CBCT pipeline has the potential to provide comparable dose calculation accuracy to the gold-standard planning CT in photon radiation therapy for the abdomen and pelvis. These robust dose calculations could eliminate the need for density overrides in CBCT images and enable direct utilization of CBCT images for dose delivery monitoring or online treatment plan adaptations before the delivery of radiation treatments.

A 2D antiscatter grid and scatter sampling based CBCT method for online dose calculations during CBCT guided radiation therapy of pelvis.

Online dose calculations before radiation treatment have applications in dose delivery verification, plan adaptation, and treatment planning. We propose a novel CBCT imaging pipeline to enhance accuracy. Our approach aims to improve HU accuracy in CBCT images for more precise dose calculations. A quantitative CBCT pipeline was implemented, combining data correction strategies and scatter rejection, achieving high CT number accuracy. We evaluated the pipeline's effect using pelvis anatomy phantoms and found that dosimetric errors in quantitative CBCT-based dose calculations were minimal. In contrast, clinical CBCT and high-performance ASG CBCT-based plans showed significant errors. The proposed quantitative CBCT pipeline offers comparable dose calculation accuracy to the gold-standard planning CT, eliminating the need for density overrides and enabling precise dose delivery monitoring or online plan adaptations in radiation therapy.

A unified scatter rejection and correction method for cone beam computed tomography.

PURPOSE: Scattered radiation is a major cause of image quality degradation in flat panel detector-based cone beam CT (CBCT). While recently introduced 2D antiscatter grids reject the majority of scatter fluence, the small percentage of scatter fluence still transmitted to the detector remains a major challenge for implementation of quantitative imaging techniques such as dual energy imaging in CBCT. Additionally, this residual scatter is also a major source of grid-induced artifacts, which impedes implementation of 2D grids in CBCT. We therefore present a new method to achieve both robust scatter rejection and residual scatter correction using a 2D antiscatter grid; in doing so, we expand the role of 2D grids from mere scatter rejection devices to scatter measurement devices. METHOD: In our method, the radiopaque septa of the 2D grid emulate a micro array of beam-stops placed on the detector which introduce spatially periodic septal shadows. By selecting sufficiently thin grid septa, the primary intensity can be reduced while preserving the uniformity of scatter intensity. This enables us to correlate the modulated pixel signal intensity in septal shadows with local scatter intensity. Our method then exploits this correlation to measure and remove residual scatter intensity from projections. No assumptions are made about the object being imaged. We refer to this as Grid-based Scatter Sampling (GSS). In this work, we evaluate the principle of signal modulation with grid septa, the accuracy of scatter estimates, and the effect of the GSS method on image quality using simulations and measurements. We also implement the GSS method experimentally using a 2D grid prototype. RESULTS: Our results demonstrate that the GSS method increased CT number accuracy and reduced image artifacts associated with scatter. With 2D grid and residual scatter correction, HU nonuniformity was reduced from 65 HU to 30 HU in pelvis sized phantoms, and HU variations due to change in phantom size were reduced from 59 HU to 20 HU, when compared to use of only a 2D grid. With residual scatter correction via GSS method, grid-induced ring artifacts were suppressed, leading to a 41% reduction in noise. The shape of the modulation transfer function (MTF) was preserved before and after suppression of ring artifacts. CONCLUSIONS: Our grid-based scatter sampling method enables utilization of a 2D grid as a scatter measurement and correction device. This method significantly improves quantitative accuracy in CBCT, further reducing the image quality gap between CBCT and multi-detector CT. By correcting residual scatter with the proposed method, grid-induced line artifacts in projections and associated ring artifacts in CBCT images were also suppressed with no compromise of spatial resolution.

Risk factors for postpartum depression in Chinese women: A cross-sectional study at 6 weeks postpartum.

OBJECTIVE: Postpartum depression (PPD) has received increasing attention due to its harmful impacts and high incidence. PPD is affected by physiological and psychological factors, but the conclusions are not uniform at present, so this study explored the risk factors of postpartum depressive symptoms (PPDS) in Chinese population. METHODS: A total of 397 women attending the obstetric department of the First Affiliated Hospital of Wenzhou Medical University participated in the questionnaire survey, mainly through a cross sectional study. At 6 weeks postpartum, the Edinburgh Postpartum Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess PPDS and sleep quality, respectively. RESULTS: The incidence of probable PPDS in our study population was 14.6% at 6 weeks postpartum. Women with blood group A had an almost 3-fold greater risk of PPDS than those with blood group B (OR [95% CI], 2.99 [1.43-6.28], p = 0.004). After adjusting for potential confounding variables, the blood group A phenotype was significantly more prevalent in women with PPDS compared to blood group B (OR [95% CI], 2.65 [1.23-5.70], p = 0.01). CONCLUSIONS: Compared to women with blood groups B, AB or O, women with blood group A had high odds of PPDS. If this result can be demonstrated and replicated in other populations, blood group A may be a useful predictor of risk for PPDS in Chinese postpartum women.

Simultaneous scatter rejection and correction method using 2D antiscatter grids for CBCT.

While two-dimensional antiscatter grids (2D grid) reduce scatter intensity substantially in Cone Beam Computed Tomography (CBCT), a small fraction of scattered radiation is transmitted through the 2D grid to the detector. Residual scatter limits the accuracy of CT numbers and interferes with the correction of grid's septal shadows, or footprint, in projections. If grid's septal shadows are not adequately suppressed in projections, it will lead to ring artifacts in CBCT images. In this work, we present a new method to correct residual scatter transmitted through the grid by employing the 2D grid itself as a residual scatter measurement device. Our method, referred as grid-based scatter sampling (GSS), exploits the spatial modulation of primary x-ray fluence by 2D grid's septal shadows. The shape of the signal modulation pattern varies as a function of residual scatter intensity registered by detector pixels. Such a variation in signal pattern was employed to measure residual scatter intensity in each projection, and subsequently, residual scatter was subtracted from each projection. To validate the GSS method, CBCT imaging experiments were conducted using a 2D antiscatter grid prototype in a linac mounted CBCT system. The effect of GSS method on the ring artifact reduction was quantified by measuring noise in CBCT images. In addition, the nonuniformity of Hounsfield Units (HU) and HU accuracy was measured in both head and pelvis-sized phantoms. In qualitative evaluations, GSS method successfully reduced ring artifacts caused by 2D grid's footprint. Image noise reduced by 23% due to reduction of ring artifacts. HU nonuniformity in water-equivalent sections was reduced from 20 HU to 10 HU, and streak artifacts between high density inserts were reduced. The phantom size dependent variations in HU was also reduced after application of GSS method. Without GSS method, HU of density inserts reduced by 9% on the average when phantom size was increased from head to pelvis. With GSS method, HU values reduced only by 5% under the same conditions. In summary, GSS method complements the 2D grid's scatter suppression performance, by correcting the scatter transmitted through the grid. This approach does not require additional scatter-measurement hardware, such as beam-stop arrays, since the grid itself is employed as the scatter measurement device. By suppressing residual scatter in projections, our proposed method successfully reduced artifacts caused by 2D grid's footprint, and further improved CT number accuracy.

Rapid-scan coherence signals in X-band EPR spectra of semiquinones with small hyperfine splittings.

Rapid-scan EPR signals for semiquinones with very-small well-resolved hyperfine splittings exhibit coherence signals at a time after passing through the EPR line that is proportional to the reciprocal of the hyperfine splitting. Such coherences are a general phenomenon due to constructive interference of the responses to transient excitation of spins by rapid scan of the magnetic field across equally spaced spin packets. Examples are shown for 2,3,5,6-tetramethoxy-1,4-benzosemiquinone with aH=46 mG for 12 protons and for 2,5-di-t-butyl-1,4-benzosemiquinone with aH=59 mG for 18 protons.

Field-stepped direct detection electron paramagnetic resonance.

The widest scan that had been demonstrated previously for rapid scan EPR was a 155G sinusoidal scan. As the scan width increases, the voltage requirement across the resonating capacitor and scan coils increases dramatically and the background signal induced by the rapidly changing field increases. An alternate approach is needed to achieve wider scans. A field-stepped direct detection EPR method that is based on rapid-scan technology is now reported, and scan widths up to 6200G have been demonstrated. A linear scan frequency of 5.12kHz was generated with the scan driver described previously. The field was stepped at intervals of 0.01 to 1G, depending on the linewidths in the spectra. At each field data for triangular scans with widths up to 11.5G were acquired. Data from the triangular scans were combined by matching DC offsets for overlapping regions of successive scans. This approach has the following advantages relative to CW, several of which are similar to the advantages of rapid scan. (i) In CW if the modulation amplitude is too large, the signal is broadened. In direct detection field modulation is not used. (ii) In CW the small modulation amplitude detects only a small fraction of the signal amplitude. In direct detection each scan detects a larger fraction of the signal, which improves the signal-to-noise ratio. (iii) If the scan rate is fast enough to cause rapid scan oscillations, the slow scan spectrum can be recovered by deconvolution after the combination of segments. (iv) The data are acquired with quadrature detection, which permits phase correction in the post processing. (v) In the direct detection method the signal typically is oversampled in the field direction. The number of points to be averaged, thereby improving the signal-to-noise ratio, is determined in post processing based on the desired field resolution. A degased lithium phthalocyanine sample was used to demonstrate that the linear deconvolution procedure can be employed with field-stepped direct detection EPR signals. Field-stepped direct detection EPR spectra were obtained for Cu(2+) doped in Ni(diethyldithiocarbamate)2, Cu(2+) doped in Zn tetratolylporphyrin, perdeuterated tempone in sucrose octaacetate, vanadyl ion doped in a parasubstituted Zn tetratolylporphyrin, Mn(2+) impurity in CaO, and an oriented crystal of Mn(2+) doped in Mg(acetylacetonate)2(H2O)2.

X-Band Rapid-Scan Electron Paramagnetic Resonance of Radiation-Induced Defects in Tooth Enamel.

X-band rapid-scan electron paramagnetic resonance (EPR) spectra from tooth enamel samples irradiated with doses of 0.5, 1 and 10 Gy had substantially improved signal-to-noise relative to conventional continuous wave EPR. The radiation-induced signal in a 60 mg of a tooth enamel sample irradiated with a 0.5 Gy dose was readily characterized in spectra recorded with 34 min data acquisition times. The coefficient of variance of the calculated dose for a 1 Gy irradiated sample, based on simulation of the first-derivative spectra for three replicates as the sum of native and radiation-induced signals, was 3.9% for continuous wave and 0.4% for rapid scan.

Multiharmonic electron paramagnetic resonance for extended samples with both narrow and broad lines.

Multiharmonic electron paramagnetic resonance spectroscopy was demonstrated for two samples with both narrow and broad lines: (i) α,γ-Bisdiphenylene-ß-phenylallyl (BDPA) with ΔBpp of 0.85 G plus ultramarine blue with ΔBpp of 17 G, and (ii) a nitroxide radical immobilized in sucrose octaacetate. Modulation amplitudes up to 17 G at 41 kHz were generated with a rapid scan coil driver and Litz wire coils that provide uniform magnetic field sweeps over samples with heights of 5mm. Data were acquired with a 2-D experiment in the Xepr software through the transient signal path of a Bruker E500T and digitized in quadrature with a Bruker SpecJet II. Signals at the modulation frequency and its harmonics were calculated by digital phase-sensitive detection. The number of harmonics with signal intensity greater than noise increases as the ratio of the modulation amplitude to the narrowest peak increases. Spectra reconstructed by the multiharmonic method from data obtained with modulation amplitudes up to five times the peak-to-peak linewidths of the narrowest features have linewidths that are broadened by up to only about 10% relative to linewidths in spectra obtained at low modulation amplitudes. The signal-to-noise improves with increasing modulation amplitude up to the point where the modulation amplitude is slightly larger than the linewidth of the narrowest features. If this high a modulation amplitude had been used in conventional methodology the linewidth of the narrowest features would have been severely broadened. The multiharmonic reconstruction methodology means that the selection of the modulation amplitude that can be used without spectral distortion is no longer tightly tied to the linewidth of the narrowest line.

Improved sensitivity for imaging spin trapped hydroxyl radical at 250 MHz.

Radicals, including hydroxyl, superoxide, and nitric oxide, play key signaling roles in vivo. Reaction of these free radicals with a spin trap affords more stable paramagnetic nitroxides, but concentrations in vivo still are so low that detection by electron paramagnetic resonance (EPR) is challenging. Three innovative enabling technologies have been combined to substantially improve sensitivity for imaging spin-trapped radicals at 250 MHz. 1) Spin-trapped adducts of BMPO have lifetimes that are long enough to make imaging by EPR at 250 MHz feasible. 2) The signal-to-noise ratio of rapid-scan EPR is substantially higher than for conventional continuous-wave EPR. 3) An improved algorithm permits image reconstruction with a spectral dimension that encompasses the full 50 G spectrum of the BMPO-OH spin adduct without requiring the wide sweeps that would be needed for filtered backprojection. A 2D spectral-spatial image is shown for a phantom containing ca. 5 µM BMPO-OH.

Digitally generated excitation and near-baseband quadrature detection of rapid scan EPR signals.

The use of multiple synchronized outputs from an arbitrary waveform generator (AWG) provides the opportunity to perform EPR experiments differently than by conventional EPR. We report a method for reconstructing the quadrature EPR spectrum from periodic signals that are generated with sinusoidal magnetic field modulation such as continuous wave (CW), multiharmonic, or rapid scan experiments. The signal is down-converted to an intermediate frequency (IF) that is less than the field scan or field modulation frequency and then digitized in a single channel. This method permits use of a high-pass analog filter before digitization to remove the strong non-EPR signal at the IF, that might otherwise overwhelm the digitizer. The IF is the difference between two synchronized X-band outputs from a Tektronix AWG 70002A, one of which is for excitation and the other is the reference for down-conversion. To permit signal averaging, timing was selected to give an exact integer number of full cycles for each frequency. In the experiments reported here the IF was 5kHz and the scan frequency was 40kHz. To produce sinusoidal rapid scans with a scan frequency eight times IF, a third synchronized output generated a square wave that was converted to a sine wave. The timing of the data acquisition with a Bruker SpecJet II was synchronized by an external clock signal from the AWG. The baseband quadrature signal in the frequency domain was reconstructed. This approach has the advantages that (i) the non-EPR response at the carrier frequency is eliminated, (ii) both real and imaginary EPR signals are reconstructed from a single physical channel to produce an ideal quadrature signal, and (iii) signal bandwidth does not increase relative to baseband detection. Spectra were obtained by deconvolution of the reconstructed signals for solid BDPA (1,3-bisdiphenylene-2-phenylallyl) in air, 0.2mM trityl OX63 in water, 15N perdeuterated tempone, and a nitroxide with a 0.5G partially-resolved proton hyperfine splitting.

Rapid-scan EPR of immobilized nitroxides.

X-band electron paramagnetic resonance spectra of immobilized nitroxides were obtained by rapid scan at 293 K. Scan widths were 155 G with 13.4 kHz scan frequency for (14)N-perdeuterated tempone and for T4 lysozyme doubly spin labeled with an iodoacetamide spirocyclohexyl nitroxide and 100 G with 20.9 kHz scan frequency for (15)N-perdeuterated tempone. These wide scans were made possible by modifications to our rapid-scan driver, scan coils made of Litz wire, and the placement of highly conducting aluminum plates on the poles of a Bruker 10″ magnet to reduce resistive losses in the magnet pole faces. For the same data acquisition time, the signal-to-noise for the rapid-scan absorption spectra was about an order of magnitude higher than for continuous wave first-derivative spectra recorded with modulation amplitudes that do not broaden the lineshapes.