Investigation of combined kV/MV CBCT imaging with a high-DQE MV detector.

PURPOSE: Combined kV-MV cone-beam tomography (CBCT) imaging has been proposed for two potentially important image-guided radiotherapy applications: (a) scan time reduction (STR) and (b) metal artifact reduction (MAR). However, the feasibility of these techniques has been in question due to the low detective quantum efficiencies (DQEs) of commercially available electronic portal imagers (EPIDs). The goal of the work was to test whether a prototype high DQE MV detector can be used to generate acceptable quality pretreatment CBCT images at acceptable dose levels. METHODS: 6MV and 100 kVp projection data were acquired on a Truebeam system (Varian, Palo Alto, CA). The MV data were acquired using a prototype EPID containing two scintillators (a) a standard copper-gadolinium oxysulfide (Cu-GOS) screen having a zero-frequency DQE (DQE(0)) value of 1.4%, and (b) a prototype-focused cadmium tungstate (CWO) pixelated "strip" with a DQE(0) = 22%. The kV data were acquired using the standard onboard imager (DQE(0) = 70%). The angular spacing of the MV projections was 0.81° and the source output was 0.03 MU/projection while the kV projections were acquired with an angular spacing of 0.4° at 0.3 mAs/projection. Image quality was evaluated using (a) an 18-cm diameter electron density phantom (CIRS, Norfolk, VA) with nine contrast inserts and (b) the resolution section of the 20-cm diameter Catphan phantom (The Phantom Laboratory, Greenwich, NY). For the MAR studies, two opposing CIRS phantom inserts were replaced by steel rods. The reconstruction methods were based on combining MV and kV data into one sinogram. The MAR reconstruction utilized mostly kV raw data with only those rays corrupted by metal requiring replacement with MV data (total absorbed dose = 0.7 cGy). For the STR study, projections from partially overlapping 105°kV and MV acquisitions were combined to create a complete dataset that could have been acquired in 18 sec (absorbed dose = 2.5 cGy). MV-only (4.3 cGy) and kV-only (0.3 cGy) images were also reconstructed. RESULTS: The average signal-to-noise ratio (SNR) of the inserts in the MV-only CWO and GOS CIRS phantom images were 0.62× and 0.12× the SNR of the inserts in kV-only image, respectively. The limiting spatial resolutions in the MV-only GOS, MV-only CWO, and kV-only Catphan images were 3, 6, and 8 lp/cm, respectively. In the combined kV/CWO STR reconstruction, all contrast inserts were visible while only two were detectable in the kV/Cu-GOS image due to high levels of noise (average SNRs of kV/CWO and kV/GOS inserts were 0.97× and 0.18× the SNR of the kV-only inserts, respectively). In the kV-MV MAR reconstructions, streaking artifacts were substantially reduced with all inserts becoming clearly visible in the kV/CWO image while only two were visible in the kV/Cu-GOS image (average SNRs of the kV/CWO and kV/Cu-GOS CIRS with metal inserts were 0.94× and 0.35× the SNRs of the kV-only CIRS without metal inserts). CONCLUSIONS: We have demonstrated that a high-DQE MV detector can be applied to generating high-quality combined kV-MV images for SRT and MAR. Clinically acceptable doses were utilized.

Motion compensation for cone-beam CT using Fourier consistency conditions.

In cone-beam CT, involuntary patient motion and inaccurate or irreproducible scanner motion substantially degrades image quality. To avoid artifacts this motion needs to be estimated and compensated during image reconstruction. In previous work we showed that Fourier consistency conditions (FCC) can be used in fan-beam CT to estimate motion in the sinogram domain. This work extends the FCC to [Formula: see text] cone-beam CT. We derive an efficient cost function to compensate for [Formula: see text] motion using [Formula: see text] detector translations. The extended FCC method have been tested with five translational motion patterns, using a challenging numerical phantom. We evaluated the root-mean-square-error and the structural-similarity-index between motion corrected and motion-free reconstructions. Additionally, we computed the mean-absolute-difference (MAD) between the estimated and the ground-truth motion. The practical applicability of the method is demonstrated by application to respiratory motion estimation in rotational angiography, but also to motion correction for weight-bearing imaging of knees. Where the latter makes use of a specifically modified FCC version which is robust to axial truncation. The results show a great reduction of motion artifacts. Accurate estimation results were achieved with a maximum MAD value of 708 µm and 1184 µm for motion along the vertical and horizontal detector direction, respectively. The image quality of reconstructions obtained with the proposed method is close to that of motion corrected reconstructions based on the ground-truth motion. Simulations using noise-free and noisy data demonstrate that FCC are robust to noise. Even high-frequency motion was accurately estimated leading to a considerable reduction of streaking artifacts. The method is purely image-based and therefore independent of any auxiliary data.

Interventional dual-energy imaging-Feasibility of rapid kV-switching on a C-arm CT system.

PURPOSE: In the last years, dual-energy CT imaging has shown clinical value, thanks to its ability to differentiate materials based on their atomic number and to exploit different properties of images acquired at two different energies. C-arm CT systems are used to guide procedures in the interventional suite. Until now, there are no commercially available systems that employ dual-energy material decomposition. This paper explores the feasibility of implementing a fast kV-switching technique on a clinically available angiographic system for acquiring dual-energy C-arm CT images. METHODS: As an initial proof of concept, a fast kV-switching approach was implemented on an angiographic C-arm system and the peak tube voltage during 3D rotational scans was measured. The tube voltage measurements during fast kV-switching scans were compared to corresponding measurements on kV-constant scans. Additionally, to prove stability of the requested exposure parameters, the accuracy of the delivered tube current and pulse width were also recorded and compared. In a first phantom experiment, the voxel intensity values of the individual tube voltage components of the fast kV-switching scans were compared to their corresponding kV-constant scans. The same phantom was used for a simple material decomposition between different iodine concentrations and pure water using a fast kV-switching protocol of 81 and 125 kV. In the last experiment, the same kV-switching protocol as in the phantom scan was used in an in vivo pig study to demonstrate the clinical feasibility. RESULTS: During rapid kV-switching acquisitions, the measured tube voltage of the x-ray tube during fast switching scans has an absolute deviation of 0.23 ± 0.13 kV compared to the measured tube voltage produced during kV-constant acquisitions. The stability of the peak tube voltage over different scan requests was about 0.10 kV for the low and 0.46 for the high energy kV-switching scans and less than 0.1 kV for kV-constant scans, indicating slightly lower stability for kV-switching scans. The tube current resulted in a relative deviation of -1.6% for the low and 6.6% overestimation for the high tube voltage of the kV-switching scans compared to the kV-constant scans. The pulse width showed no deviation for the longer pulse width and only minor deviations (0.02 ± 0.02 ms) for the shorter pulse widths compared to the kV-constant scans. The phantom experiment using different iodine concentrations showed an accurate correlation (R2 > 0.99) between the extracted intensity values in the kV-switching and kV-constant reconstructed volumes, and allows for an automatic differentiation between contrast concentration down to 10% (350 mg/ml iodine) and pure water under low-noise conditions. Preliminary results of iodine and soft tissue separation showed also promising results in the first in vivo pig study. CONCLUSIONS: The feasibility of dual-energy imaging using a fast kV-switching method on an angiographic C-arm CT system was investigated. Direct measurements of beam quality in the x-ray field demonstrate the stability of the kV-switching method. Phantom and in vivo experiments showed that images did not deviate from those of corresponding kV-constant scans. All performed experiments confirmed the capability of performing fast kV-switching scans on a clinically available C-arm CT system. More complex material decomposition tasks and postprocessing steps will be part of future investigations.

Marker-free motion correction in weight-bearing cone-beam CT of the knee joint.

PURPOSE: To allow for a purely image-based motion estimation and compensation in weight-bearing cone-beam computed tomography of the knee joint. METHODS: Weight-bearing imaging of the knee joint in a standing position poses additional requirements for the image reconstruction algorithm. In contrast to supine scans, patient motion needs to be estimated and compensated. The authors propose a method that is based on 2D/3D registration of left and right femur and tibia segmented from a prior, motion-free reconstruction acquired in supine position. Each segmented bone is first roughly aligned to the motion-corrupted reconstruction of a scan in standing or squatting position. Subsequently, a rigid 2D/3D registration is performed for each bone to each of K projection images, estimating 6 × 4 × K motion parameters. The motion of individual bones is combined into global motion fields using thin-plate-spline extrapolation. These can be incorporated into a motion-compensated reconstruction in the backprojection step. The authors performed visual and quantitative comparisons between a state-of-the-art marker-based (MB) method and two variants of the proposed method using gradient correlation (GC) and normalized gradient information (NGI) as similarity measure for the 2D/3D registration. RESULTS: The authors evaluated their method on four acquisitions under different squatting positions of the same patient. All methods showed substantial improvement in image quality compared to the uncorrected reconstructions. Compared to NGI and MB, the GC method showed increased streaking artifacts due to misregistrations in lateral projection images. NGI and MB showed comparable image quality at the bone regions. Because the markers are attached to the skin, the MB method performed better at the surface of the legs where the authors observed slight streaking of the NGI and GC methods. For a quantitative evaluation, the authors computed the universal quality index (UQI) for all bone regions with respect to the motion-free reconstruction. The authors quantitative evaluation over regions around the bones yielded a mean UQI of 18.4 for no correction, 53.3 and 56.1 for the proposed method using GC and NGI, respectively, and 53.7 for the MB reference approach. In contrast to the authors registration-based corrections, the MB reference method caused slight nonrigid deformations at bone outlines when compared to a motion-free reference scan. CONCLUSIONS: The authors showed that their method based on the NGI similarity measure yields reconstruction quality close to the MB reference method. In contrast to the MB method, the proposed method does not require any preparation prior to the examination which will improve the clinical workflow and patient comfort. Further, the authors found that the MB method causes small, nonrigid deformations at the bone outline which indicates that markers may not accurately reflect the internal motion close to the knee joint. Therefore, the authors believe that the proposed method is a promising alternative to MB motion management.

Image artefact propagation in motion estimation and reconstruction in interventional cardiac C-arm CT.

The acquisition of data for cardiac imaging using a C-arm computed tomography system requires several seconds and multiple heartbeats. Hence, incorporation of motion correction in the reconstruction step may improve the resulting image quality. Cardiac motion can be estimated by deformable three-dimensional (3D)/3D registration performed on initial 3D images of different heart phases. This motion information can be used for a motion-compensated reconstruction allowing the use of all acquired data for image reconstruction. However, the result of the registration procedure and hence the estimated deformations are influenced by the quality of the initial 3D images. In this paper, the sensitivity of the 3D/3D registration step to the image quality of the initial images is studied. Different reconstruction algorithms are evaluated for a recently proposed cardiac C-arm CT acquisition protocol. The initial 3D images are all based on retrospective electrocardiogram (ECG)-gated data. ECG-gating of data from a single C-arm rotation provides only a few projections per heart phase for image reconstruction. This view sparsity leads to prominent streak artefacts and a poor signal to noise ratio. Five different initial image reconstructions are evaluated: (1) cone beam filtered-backprojection (FDK), (2) cone beam filtered-backprojection and an additional bilateral filter (FFDK), (3) removal of the shadow of dense objects (catheter, pacing electrode, etc) before reconstruction with a cone beam filtered-backprojection (cathFDK), (4) removal of the shadow of dense objects before reconstruction with a cone beam filtered-backprojection and a bilateral filter (cathFFDK). The last method (5) is an iterative few-view reconstruction (FV), the prior image constrained compressed sensing combined with the improved total variation algorithm. All reconstructions are investigated with respect to the final motion-compensated reconstruction quality. The algorithms were tested on a mathematical phantom data set with and without a catheter and on two porcine models using qualitative and quantitative measures. The quantitative results of the phantom experiments show that if no dense object is present within the scan field of view, the quality of the FDK initial images is sufficient for motion estimation via 3D/3D registration. When a catheter or pacing electrode is present, the shadow of these objects needs to be removed before the initial image reconstruction. An additional bilateral filter shows no major improvement with respect to the final motion-compensated reconstruction quality. The results with respect to image quality of the cathFDK, cathFFDK and FV images are comparable. In conclusion, in terms of computational complexity, the algorithm of choice is the cathFDK algorithm.

In vitro evaluation of the imaging accuracy of C-arm conebeam CT in cerebral perfusion imaging.

PURPOSE: The authors have developed a method to enable cerebral perfusion CT imaging using C-arm based conebeam CT (CBCT). This allows intraprocedural monitoring of brain perfusion during treatment of stroke. Briefly, the technique consists of acquiring multiple scans (each scan comprised of six sweeps) acquired at different time delays with respect to the start of the x-ray contrast agent injection. The projections are then reconstructed into angular blocks and interpolated at desired time points. The authors have previously demonstrated its feasibility in vivo using an animal model. In this paper, the authors describe an in vitro technique to evaluate the accuracy of their method for measuring the relevant temporal signals. METHODS: The authors' evaluation method is based on the concept that any temporal signal can be represented by a Fourier series of weighted sinusoids. A sinusoidal phantom was developed by varying the concentration of iodine as successive steps of a sine wave. Each step corresponding to a different dilution of iodine contrast solution contained in partitions along a cylinder. By translating the phantom along the axis at different velocities, sinusoidal signals at different frequencies were generated. Using their image acquisition and reconstruction algorithm, these sinusoidal signals were imaged with a C-arm system and the 3D volumes were reconstructed. The average value in a slice was plotted as a function of time. The phantom was also imaged using a clinical CT system with 0.5 s rotation. C-arm CBCT results using 6, 3, 2, and 1 scan sequences were compared to those obtained using CT. Data were compared for linear velocities of the phantom ranging from 0.6 to 1 cm∕s. This covers the temporal frequencies up to 0.16 Hz corresponding to a frequency range within which 99% of the spectral energy for all temporal signals in cerebral perfusion imaging is contained. RESULTS: The errors in measurement of temporal frequencies are mostly below 2% for all multiscan sequences. For single scan sequences, the errors increase sharply beyond 0.10 Hz. The amplitude errors increase with frequency and with decrease in the number of scans used. CONCLUSIONS: Our multiscan perfusion CT approach allows low errors in signal frequency measurement. Increasing the number of scans reduces the amplitude errors. A two-scan sequence appears to offer the best compromise between accuracy and the associated total x-ray and iodine dose.

SU-D-218-03: Resonant Frequency of Rotating Anode X-Ray Tubes.

PURPOSE: To evaluate a new rotating anode X-ray tube from the resonant frequency point of view for stable and safe operation, and to validate a finite element model for insight into X-ray tube rotor dynamics and vibration. METHODS: The 3-dimensional FEM model of the X-ray tube motor has been developed using ANSYS and COMSOL. The resultant resonant frequency from the FEM simulation is substantiated by experiments. During deceleration of the X-ray tube, an accelerometer and a corresponding amplifier send the time domain vibration response to a spectrum analyzer which generates the power spectrum. In the frequency domain analysis, a peak signifies large vibrations at that frequency. To corroborate the FEM model, the resonant frequency of the motor assembly without the anode attached was also measured. Lastly, a rough estimate of the resonant frequency can also be observed in angular speed curves which are obtained utilizing a quadrature position sensor. RESULTS: The first mode resonance is expected at 20.3 Hz from the FEM simulation. This result matches closely with the peak at 22.2 Hz in the power spectrum and the location of the abrupt decreasing acceleration (slope) in the speed curve at 22 Hz. Without the anode, the FEM simulation result of 35.1 Hz is equal to the first peak at 35.1 Hz, and the angular acceleration is suddenly reduced at 34.4 Hz. CONCLUSIONS: For image-guided interventional procedures using a hybrid system, the X-ray tube should create flux at various times requiring repeatedacceleration and deceleration of the motor. Hence it is ideal that the resonant frequency is higher than operational speed, although alternatively the motor could accelerate through the resonant frequency quickly. Design improvements to modify the location of resonance of our motor assemblyare underway using the verified FEM model. NIH R01 EB007626, Richard M. Lucas Foundation.

SU-E-I-80: Optimizing Scanning-Beam Digital X-Ray Tomosynthesis of the Lungs.

PURPOSE: We propose to optimize the geometry of the Scanning-Beam Digital Tomography system (SBDX) for application to lung tumor biopsies, thereby providing real-time 3D tomographic reconstructions for target verification. The unique geometry of the system requires trade-offs between patient dose, imaging field of view and tomosynthesis angle. METHODS: We used PCXMC, a Monte Carlo simulation software package, to determine the dose to organs of interest as well as the Average body dose and Effective Dose (both ICRP 60 and 103) for source to detector distances (SDDs) between 90cm and 150cm. To facilitate modeling our system, a modified version of PCXMC was created. We also used matlab to evaluate the possible tomosynthetic angles that Result across the field of view for the same SDDs. RESULTS: To maximize the tomosynthesis angle while leaving space for the patient, an SDD of between 90cm and 110cm is appropriate. At SDD 100cm, patient centered at 40 cm from the detector, operated in fluoro mode, the SBDX system delivers ∼0.38x the dose of a normal mobile fluoroscopy system operating at 30 fps. Because of the inverse geometry of the system, the dose to the patient goes up as the patient gets closer to the detector. Tomosynthetic angles up to 15 degrees over a 5-cm field-of-view can be achieved for this geometry. The patient must be placed within 45cm of the detector in order to achieve the benefits from reduced SDD and increased tomosynthetic angle. CONCLUSIONS: The dose-rate for our optimized geometry is acceptable, although higher dose rates for improved nodule visualization may be required. Additional dose optimization steps include modifying the scanning beam pattern to optimize for tomosynthetic image acquisition. Overall dose during the biopsy procedure will likely decrease since nodule targeting will be improved and the overall number of biopsies required will be reduced. This work has received funding from NIH grant R21 HL098683, as well as from the Lucas Foundation.

TU-E-BRA-05: Reverse Geometry Imaging with MV Detector for Improved Image Resolution.

PURPOSE: Thick pixilated scintillators can offer significant improvements in quantum efficiency over phosphor screen megavoltage (MV) detectors. However spatial resolution can be compromised due to the spreading of light across pixels within septa. Of particular interest are the lower energy x-ray photons and associated light photons that produce higher image contrast but are stopped near the scintillator entrance surface. They suffer the most scattering in the scintillator prior to detection in the photodiodes. Reversing the detector geometry, so that the incident x-ray beam passes through the photodiode array into the scintillator, allows the light to scatter less prior to detection. This also reduces the Swank noise since now higher and lower energy x-ray photons tend to produce similar electronic signals. In this work, we present simulations and measurements of detector MTF for the conventional/forward and reverse geometries to demonstrate this phenomenon. METHODS: A tabletop system consisting of a Varian CX1 1MeV linear accelerator and a modified Varian Paxscan4030 with the readout electronics moved away from the incident the beam was used. A special holder was used to press a 2.5W×5.0L×2.0Hcm3 pixellated Cesium Iodide (CsI:Tl) scintillator array on to the detector glass. The CsI array had a pitch of 0.784mm with plastic septa between pixels and the photodiode array pitch was 0.192 mm. The MTF in the forward and reverse geometries was measured using a 0.5mm thick Tantalum slanted edge. Geant4-based Monte Carlo simulations were performed for comparison. RESULTS: The measured and simulated MTFs matched to within 3.4(±3.7)% in the forward and 4.4(±1.5)% in reverse geometries. The reverse geometry MTF was higher than the forward geometry MTF at all spatial frequencies and doubled to .25 at 0.3lp/mm. CONCLUSIONS: A novel method of improving the image resolution at MV energies was demonstrated. The improvements should be more pronounced with increased scintillator thickness. Funding support provided by NIH (grant number NIH R01 CA138426).

SU-E-I-22: Metal Artifact Correction Using KV and Selective MV Imaging.

PURPOSE: To improve the image quality of radiotherapy planning CTs for patients with metal implants or fillings by completing the missing kV projection data with selectively acquired MV data that does not suffer from photon starvation. Using both imaging systems that are available on current radiotherapy devices, streaking artifacts are avoided and the soft tissue contrast is restored, even in areas where the kV photons do not contribute any information. This enables a better delineation of structures of interest in planning CT images for patients with metal objects. METHODS: An algorithm for combining kV and MV projection data from the two on-board imagers of a radiotherapy device is presented in this work. It only requires selective MV imaging with the high energy X-rays being collimated onto the metal implants, ensuring that the patient dose does not increase significantly. The algorithm can cope with non-identical geometries of the two imagers and is based on stitching together kV and MV sinograms by estimating a ratio between them. A numerical head phantom with two dental fillings and two soft tissue patterns was used to quantitatively evaluate the proposed hybrid reconstruction algorithm. A structural similarity index (SSIM) with respect to the ground truth data was computed for two ROIs. Realistic, polychromatic spectra were used for both imagers with 120 keV(p) and 6 MeV(p). The patient dose was limited to about 6 cGy for both acquisitions combined. RESULTS: The reconstruction results yield visually as well as objectively better results (SSIM=74.8%) than a simple sinogram interpolation of the kV data (SSIM=69.7%) or a reconstruction from the original data (SSIM=17.9%). CONCLUSIONS: We have successfully implemented a new reconstruction method for hybrid kV-MV cone beam CT reconstruction that enables a better planning of radiotherapy treatments for patients with metal implants without compromising their safety. This work was funded by NIH grant 1R01CA138426-01A1.

WE-G-217BCD-05: Fiducial Marker-Based Motion Compensation for the Acquisition of 3D Knee Geometry Under Weight-Bearing Conditions Using a C-Arm CT Scanner.

PURPOSE: Imaging the knee under realistic load-bearing conditions can be carried out in a horizontal plane using a C-arm CT scanner. Human subjects can be scanned in a standing position and acquired data successfully reconstructed. However, reconstructing this data is a challenge due to significant artifacts that are induced due to involuntary motion. Here, we propose motion correction methods in 2D and 3D. METHODS: Four volunteers were scanned for 8 seconds while squatting with ∼30 degree flexion. Eight tantalum fiducial markers suitably attached around the knee were used to track motion. The marker position in each projection was semi- automatically detected. Each marker's static 3D position, which served as a reference to correct temporal motion, was estimated by triangulating each marker's 2D position from 248 projections using known projection matrices. Motion was corrected in 3 ways: 1) 2D projection shifting based on the mean position of markers, 2) 2D projection warping using approximate thin- plate splines, 3) 3D rigid body warping. RESULTS: The original reconstruction was severely motion-corrupted which made it impossible to distinguish the boundaries of bones. Reconstruction with projection shifting and warping in 2D improved visualization of edges of soft tissue as well as bone. A simple numerical metric of residual bead deviation from static position was reduced from 3.2mm to 0.4mm. The 2D-based methods are inherently limited in that they cannot fully accommodate different 3D movements at different depths from the X-ray source. Reconstruction with 3D warping shows clearer edges and less streak artifact than the 2D methods. CONCLUSIONS: The proposed three motion correction methods effectively reduced motion-induced artifacts in the reconstruction and are therefore suitable for weight-bearing scanning. Future work includes scanning patients in standing position after contrast injection for evaluating the soft tissue structure and constructing 3D finite element models for the estimation of joint cartilage stress. This study was supported by Center for Biomedical Imaging at Stanford, by Siemens AG, Healthcare Sector, and by the Lucas Foundation at Stanford. The concepts and contents proposed here are based on research and are not commercially available.

WE-C-217BCD-02: Design of an MR Compatible Rotating Anode X-Ray Tube.

PURPOSE: To design a rotating anode X-ray tube capable of operating in strong magnetic field environments. This tube design can be used in 'close proximity" hybrid X-ray/MR system geometries where the imaging fields of view are separated by only ∼1.2 meters. METHODS: Existing rotating anode X-ray tube designs fail in strong magnetic field environments because the fields alter the electron trajectories in the tube and act as a brake on the induction motor, reducing the rotation speed of the anode. We propose an X- ray tube design that utilizes optimized resistive coils to shield a fraction of the MR fringe field. The remainder of the correction is performed using bias voltages on electrodes adjacent to the x-ray tube filament. Furthermore, we replace the induction motor with a novel motor design that is analogous to a three-phase brushed DC motor with the MR fringe field serving as the stator field. RESULTS: Space charge simulations of the electron optics show that the combined magnetostatic/electrostatic method can correct for a magnetic field strength of 152 mT with approximately 590 A/cm2 applied to the shielding coils and a 35 kV potential difference applied to the bias electrodes. A prototype of the motor design was machined and assembled. The performance of this prototype motor was evaluated at various magnetic field strengths, and was found to accelerate to the minimum operating speed of 3000 rpm in 10 seconds for an external field of 60 mT. CONCLUSIONS: The space charge simulations validate that the electron trajectories can be controlled using our combined approach. Testing of the motor prototype demonstrates that our design outperforms existing induction motors in strong magnetic field environments. Integrating this design with our modified flat panel detector will allow, for the first time, a "close proximity" hybrid system in which imaging performance is not compromised. NIH R01 EB007626 Richard M. Lucas Foundation Stanford Bio-X Fellowship.

WE-C-217BCD-08: Rapid Monte Carlo Simulations of DQE(f) of Scintillator-Based Detectors.

PURPOSE: Monte Carlo simulations of DQE(f) can greatly aid in the design of scintillator-based detectors by helping optimize key parameters including scintillator material and thickness, pixel size, surface finish, and septa reflectivity. However, the additional optical transport significantly increases simulation times, necessitating a large number of parallel processors to adequately explore the parameter space. To address this limitation, we have optimized the DQE(f) algorithm, reducing simulation times per design iteration to 10 minutes on a single CPU. METHODS: DQE(f) is proportional to the ratio, MTF(f)̂2 /NPS(f). The LSF-MTF simulation uses a slanted line source and is rapidly performed with relatively few gammas launched. However, the conventional NPS simulation for standard radiation exposure levels requires the acquisition of multiple flood fields (nRun), each requiring billions of input gamma photons (nGamma), many of which will scintillate, thereby producing thousands of optical photons (nOpt) per deposited MeV. The resulting execution time is proportional to the product nRun x nGamma x nOpt. In this investigation, we revisit the theoretical derivation of DQE(f), and reveal significant computation time savings through the optimization of nRun, nGamma, and nOpt. Using GEANT4, we determine optimal values for these three variables for a GOS scintillator-amorphous silicon portal imager. Both isotropic and Mie optical scattering processes were modeled. Simulation results were validated against the literature. RESULTS: We found that, depending on the radiative and optical attenuation properties of the scintillator, the NPS can be accurately computed using values for nGamma below 1000, and values for nOpt below 500/MeV. nRun should remain above 200. Using these parameters, typical computation times for a complete NPS ranged from 2-10 minutes on a single CPU. CONCLUSIONS: The number of launched particles and corresponding execution times for a DQE simulation can be dramatically reduced allowing for accurate computation with modest computer hardware. NIHRO1 CA138426. Several authors work for Varian Medical Systems.

WE-C-217BCD-11: Coupled Radiative and Optical Geant4 Simulation of MV EPIDs Based on Thick Pixelated Scintillating Crystals.

PURPOSE: One way to greatly reduce the incidence of metal artifacts produced in kilovoltage (kV) CT images is by using megavoltage (MV) photons that penetrate high-Z objects, thus providing a measurable signal. For do se-efficient imaging, a high detective quantum efficiency (DQE) MV detector is desired. This study validates the coupled radiation and optical Geant4 simulation results against experimental data from various prototype pixelated scintillator MV detectors and determines the essential optical parameters which control the detector performance. METHODS: Experimental data obtained with a 6MV radiation source from 8 different detectors was considered. The detectors used CsI, CdW and BGO as scintillating crystals and polystyrene septal wall material. Accurate Geant4 models of the detectors were implemented and coupled radiation and optical simulations were performed. The unknown optical properties of the models were determined by minimizing the difference between the modulation transfer functions (MTF) of the simulated data obtained with the slanted slit technique and the experimental MTFs. With the set of optical properties fixed, further simulation validation was performed against the experimental normalized noise power spectrum (NNPS(f)) and the experimental DQE(f) curves for each detector. All the simulations were performed on a computer cluster deployed on the Amazon EC2 platform. RESULTS: The optimal values for the free optical parameters are 10%, 95% and 90% for the top surface reflectivity, the crystal-sept a surface reflectivity, and the Lambertian component contribution to the reflected beam from the crystal-septa interface respectively. The absolute difference between experimental and simulated data was below 10% for all the data sets. CONCLUSIONS: To our knowledge this study is the first to present a full optical and radiative DQE(f) model using Geant4 that shows an excellent match with experimental data. The model indicates that improved performance can be obtained using more specular septa which are optically opaque. Support: NIH-T32-CA09695, NIH-1R01CA138426 NIH T32-CA09695, NIH R01- CA138426, Several authors work for Varian Medical Systems.

Cerebral CT perfusion using an interventional C-arm imaging system: cerebral blood flow measurements.

BACKGROUND AND PURPOSE: CTP imaging in the interventional suite could reduce delays to the start of image-guided interventions and help determine the treatment progress and end point. However, C-arms rotate slower than clinical CT scanners, making CTP challenging. We developed a cerebral CTP protocol for C-arm CBCT and evaluated it in an animal study. MATERIALS AND METHODS: Five anesthetized swine were imaged by using C-arm CBCT and conventional CT. The C-arm rotates in 4.3 seconds plus a 1.25-second turnaround, compared with 0.5 seconds for clinical CT. Each C-arm scan had 6 continuous bidirectional sweeps. Multiple scans each with a different delay to the start of an aortic arch iodinated contrast injection and a novel image reconstruction algorithm were used to increase temporal resolution. Three different scan sets (consisting of 6, 3, or 2 scans) and 3 injection protocols (3-mL/s 100%, 3-mL/s 67%, and 6-mL/s 50% contrast concentration) were studied. CBF maps for each scan set and injection were generated. The concordance and Pearson correlation coefficients (ρ and r) were calculated to determine the injection providing the best match between the following: the left and right hemispheres, and CT and C-arm CBCT. RESULTS: The highest ρ and r values (both 0.92) for the left and right hemispheres were obtained by using the 6-mL 50% iodinated contrast concentration injection. The same injection gave the best match for CT and C-arm CBCT for the 6-scan set (ρ = 0.77, r = 0.89). Some of the 3-scan and 2-scan protocols provided matches similar to those in CT. CONCLUSIONS: This study demonstrated that C-arm CBCT can produce CBF maps that correlate well with those from CTP.

Experimental study of intracranial hematoma detection with flat panel detector C-arm CT.

BACKGROUND AND PURPOSE: Intracranial hemorrhage is a commonly acknowledged complication of interventional neuroradiology procedures, and the ability to image hemorrhage at the time of the procedure would be very beneficial. A new C-arm system with 3D functionality extends the capability of C-arm imaging to include soft-tissue applications by facilitating the detection of low-contrast objects. We evaluated its ability to detect small intracranial hematomas in a swine model. MATERIALS AND METHODS: Intracranial hematomas were created in 7 swine by autologous blood injection of various hematocrits (19%-37%) and volumes (1.5-5 mL). Four animals received intravascular contrast before obtaining autologous blood (group 1), and 3 did not (group 2). We scanned each animal by using the C-arm CT system, acquiring more than 500 images during a 20-second rotation through more than 200 degrees . Multiplanar reformatted images with isotropic resolution were reconstructed on the workstation by using product truncation, scatter, beam-hardening, and ring-artifact correction algorithms. The brains were harvested and sliced for hematoma measurement and compared with imaging findings. RESULTS: Five intracranial hematomas were created in group 1 animals, and all were visualized. Six were created in group 2, and 3 were visualized. One nonvisualized hematoma was not confirmed at necropsy. All the others in both groups were confirmed. In group 1 (with contrast), small hematomas were detectable even when the hematocrit was 19%-20%. In group 2 (without contrast) C-arm CT was able to detect small hematomas (<1.0 cm(2)) created with hematocrits of 29%-37%. The area of hematoma measured from the C-arm CT data was, on average, within 15% of the area measured from harvested brain. CONCLUSIONS: The image quality obtained with this implementation of C-arm CT was sufficient to detect experimentally created small intracranial hematomas. This capability should provide earlier detection of hemorrhagic complications that may occur during neurointerventional procedures.

Performance of a static-anode/flat-panel x-ray fluoroscopy system in a diagnostic strength magnetic field: a truly hybrid x-ray/MR imaging system.

Minimally invasive procedures are increasing in variety and frequency, facilitated by advances in imaging technology. Our hybrid imaging system (GE Apollo flat panel, custom Brand x-ray static anode x-ray tube, GE Lunar high-frequency power supply and 0.5 T Signa SP) provides both x-ray and MR imaging capability to guide complex procedures without requiring motion of the patient between two distant gantries. The performance of the x-ray tube in this closely integrated system was evaluated by modeling and measuring both the response of the filament to an externally applied field and the behavior of the electron beam for field strengths and geometries of interest. The performance of the detector was assessed by measuring the slanted-edge modulation transfer function (MTF) and when placed at zero field and at 0.5 T. Measured resonant frequencies of filaments can be approximated using a modified vibrating beam model, and were at frequencies well below the 25 kHz frequency of our generator for our filament geometry. The amplitude of vibration was not sufficient to cause shorting of the filament during operation within the magnetic field. A simple model of electrons in uniform electric and magnetic fields can be used to estimate the deflection of the electron beam on the anode for the fields of interest between 0.2 and 0.5 T. The MTF measured at the detector and the DQE showed no significant difference inside and outside of the magnetic field. With the proper modifications, an x-ray system can be fully integrated with a MR system, with minimal loss of image quality. Any x-ray tube can be assessed for compatibility when placed at a particular location within the field using the models. We have also concluded that a-Si electronics are robust against magnetic fields. Detailed knowledge of the x-ray system installation is required to provide estimates of system operation.

First use of a truly-hybrid X-ray/MR imaging system for guidance of brain biopsy.

The use of a new hybrid imaging system for guidance of a brain biopsy is described. The system combines the strengths of MRI (soft-tissue contrast, arbitrary plane selection) with those of x-ray fluoroscopy (high-resolution real-time projection images, clear portrayal of bony structures) and allows switching between the imaging modalities without moving the patient. The biopsy was carried out using x-ray guidance for direction of the needle through the foramen ovale and MR guidance to target the soft-tissue lesion. Appropriate samples were acquired. The system could be particularly effective for guidance of those cases where motion, swelling, resection and other intra-operative anatomical changes cannot be accounted for using traditional stereotactic-based imaging approaches.

Clinical fluoroscopic fiducial-based registration of the vertebral body in spinal neuronavigation.

We present a system involving a computer-instrumented fluoroscope for the purpose of 3D navigation and guidance using pre-operative diagnostic scans as a reference. The goal of the project is to devise a computer-assisted tool that will improve the accuracy, reduce risk, minimize the invasiveness, and shorten the time it takes to perform a variety of neurosurgical and orthopedic procedures of the spine. For this purpose we propose an apparatus that will track surgical tools and localize them with respect to the patient's 3D anatomy and pre-operative 3D diagnostic scans using intraoperative fluoroscopy for in situ registration and embedded fiducials. Preliminary studies have found a fiducial registration error (FRE) of 1.41 mm and a Target Localization Error (TLE) of 0.48 mm. The resulting system leverages equipment already commonly available in the operating room (OR), providing an important new functionality that is free of many current limitations, while keeping costs contained.

Filtered backprojection for modifying the impulse response of circular tomosynthesis.

A filtering technique has been developed to modify the three-dimensional impulse response of circular motion tomosynthesis to allow the generation of images whose appearance is like those of some other imaging geometries. In particular, this technique can reconstruct images with a blurring function which is more homogeneous for off-focal plane objects than that from circular tomosynthesis. In this paper, we describe the filtering process, and demonstrate the ability to alter the impulse response in circular motion tomosynthesis from a ring to a disk. This filtering may be desirable because the blurred out-of-plane objects appear less structured.