ESTIMATION OF PEDIATRIC DOSE DESCRIPTORS ADAPTED TO INDIVIDUAL SPECIFIC SIZE FROM CT EXAMINATIONS.

Clinical challenges in pediatrics dose estimation by the displayed computed tomography (CT) dose indices may lead to inaccuracy, and thus size-specific dose estimate (SSDE) is introduced for better-personalized dose estimation. This study aims to estimate pediatric dose adapted to specific size. This retrospective study involved pediatric population aged 0-12 y. SSDE was derived from scanner reported volume CT dose index (CTDIvol), based on individual effective diameter (Deff) with corresponding size correction factors. The correlations of Deff with other associated factors such as age, exposure setting, CTDIvol and SSDE were also studied. The average Deff of Malaysian pediatric was smaller than reference phantom size (confidence interval, CI = 0.28, mean = 14.79) and (CI = 0.51, mean = 16.33) for head and abdomen, respectively. These have led to underestimation of pediatric dose as SSDE was higher than displayed CTDIvol. The percentage differences were statistically significant (p < .001) ranged from 0 to 17% and 37 to 60% for head and abdominal CT, respectively. In conclusion, the clinical implementation of SSDE in pediatric CT imaging is highly relevant to reduce radiation risk.

Effect of Low-Dose MDCT and Iterative Reconstruction on Trabecular Bone Microstructure Assessment.

We investigated the effects of low-dose multi detector computed tomography (MDCT) in combination with statistical iterative reconstruction algorithms on trabecular bone microstructure parameters. Twelve donated vertebrae were scanned with the routine radiation exposure used in our department (standard-dose) and a low-dose protocol. Reconstructions were performed with filtered backprojection (FBP) and maximum-likelihood based statistical iterative reconstruction (SIR). Trabecular bone microstructure parameters were assessed and statistically compared for each reconstruction. Moreover, fracture loads of the vertebrae were biomechanically determined and correlated to the assessed microstructure parameters. Trabecular bone microstructure parameters based on low-dose MDCT and SIR significantly correlated with vertebral bone strength. There was no significant difference between microstructure parameters calculated on low-dose SIR and standard-dose FBP images. However, the results revealed a strong dependency on the regularization strength applied during SIR. It was observed that stronger regularization might corrupt the microstructure analysis, because the trabecular structure is a very small detail that might get lost during the regularization process. As a consequence, the introduction of SIR for trabecular bone microstructure analysis requires a specific optimization of the regularization parameters. Moreover, in comparison to other approaches, superior noise-resolution trade-offs can be found with the proposed methods.

Reduction of metal artifact in single photon-counting computed tomography by spectral-driven iterative reconstruction technique.

PURPOSE: The exciting prospect of Spectral CT (SCT) using photon-counting detectors (PCD) will lead to new techniques in computed tomography (CT) that take advantage of the additional spectral information provided. We introduce a method to reduce metal artifact in X-ray tomography by incorporating knowledge obtained from SCT into a statistical iterative reconstruction scheme. We call our method Spectral-driven Iterative Reconstruction (SPIR). METHOD: The proposed algorithm consists of two main components: material decomposition and penalized maximum likelihood iterative reconstruction. In this study, the spectral data acquisitions with an energy-resolving PCD were simulated using a Monte-Carlo simulator based on EGSnrc C++ class library. A jaw phantom with a dental implant made of gold was used as an object in this study. A total of three dental implant shapes were simulated separately to test the influence of prior knowledge on the overall performance of the algorithm. The generated projection data was first decomposed into three basis functions: photoelectric absorption, Compton scattering and attenuation of gold. A pseudo-monochromatic sinogram was calculated and used as input in the reconstruction, while the spatial information of the gold implant was used as a prior. The results from the algorithm were assessed and benchmarked with state-of-the-art reconstruction methods. RESULTS: Decomposition results illustrate that gold implant of any shape can be distinguished from other components of the phantom. Additionally, the result from the penalized maximum likelihood iterative reconstruction shows that artifacts are significantly reduced in SPIR reconstructed slices in comparison to other known techniques, while at the same time details around the implant are preserved. Quantitatively, the SPIR algorithm best reflects the true attenuation value in comparison to other algorithms. CONCLUSION: It is demonstrated that the combination of the additional information from Spectral CT and statistical reconstruction can significantly improve image quality, especially streaking artifacts caused by the presence of materials with high atomic numbers.

A comparison of material decomposition techniques for dual-energy CT colonography.

In recent years, dual-energy computed tomography (DECT) has been widely used in the clinical routine due to improved diagnostics capability from additional spectral information. One promising application for DECT is CT colonography (CTC) in combination with computer-aided diagnosis (CAD) for detection of lesions and polyps. While CAD has demonstrated in the past that it is able to detect small polyps, its performance is highly dependent on the quality of the input data. The presence of artifacts such as beam-hardening and noise in ultra-low-dose CTC may severely degrade detection performances of small polyps. In this work, we investigate and compare virtual monochromatic images, generated by image-based decomposition and projection-based decomposition, with respect to CAD performance. In the image-based method, reconstructed images are firstly decomposed into water and iodine before the virtual monochromatic images are calculated. On the contrary, in the projection-based method, the projection data are first decomposed before calculation of virtual monochromatic projection and reconstruction. Both material decomposition methods are evaluated with regards to the accuracy of iodine detection. Further, the performance of the virtual monochromatic images is qualitatively and quantitatively assessed. Preliminary results show that the projection-based method does not only have a more accurate detection of iodine, but also delivers virtual monochromatic images with reduced beam hardening artifacts in comparison with the image-based method. With regards to the CAD performance, the projection-based method yields an improved detection performance of polyps in comparison with that of the image-based method.

A Monte Carlo software bench for simulation of spectral k-edge CT imaging: Initial results.

PURPOSE: Spectral Computed Tomography (SCT) systems equipped with photon counting detectors (PCD) are clinically desired, since such systems provide not only additional diagnostic information but also radiation dose reductions by a factor of two or more. The current unavailability of clinical PCDs makes a simulation of such systems necessary. METHODS: In this paper, we present a Monte Carlo-based simulation of a SCT equipped with a PCD. The aim of this development is to facilitate research on potential clinical applications. Our MC simulator takes into account scattering interactions within the scanned object and has the ability to simulate scans with and without scatter and a wide variety of imaging parameters. To demonstrate the usefulness of such a MC simulator for development of SCT applications, a phantom with contrast targets covering a wide range of clinically significant iodine concentrations is simulated. With those simulations the impact of scatter and exposure on image quality and material decomposition results is investigated. RESULTS: Our results illustrate that scatter radiation plays a significant role in visual as well as quantitative results. Scatter radiation can reduce the accuracy of contrast agent concentration by up to 15%. CONCLUSIONS: We present a reliable and robust software bench for simulation of SCTs equipped with PCDs.

Synovitis in patients with early inflammatory arthritis monitored with quantitative analysis of dynamic contrast-enhanced optical imaging and MR imaging.

PURPOSE: To evaluate quantitative perfusion measurements of dynamic indocyanine green (ICG)-enhanced optical imaging for monitoring synovitis in the hands of patients with inflammatory arthritis compared with dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and clinical outcome. MATERIALS AND METHODS: This study was approved by the ethics committee at the institution. Individual joints (n = 840) in the hands and wrists of 28 patients (14 women; mean age, 53.3 years) with inflammatory arthritis were examined at three different time points: before start of therapy and 12 and 24 weeks after start of therapy or therapy escalation. Treatment response was assessed by using clinical measures (simple disease activity index [SDAI]), ICG-enhanced optical imaging, and DCE MR imaging. Dynamic images were obtained for optical imaging and DCE MR imaging. The rate of early enhancement (REE) of the perfusion curves of each joint was calculated by using in-house developed software. Correlation coefficients were estimated to evaluate the associations of changes of imaging parameters and SDAI change. RESULTS: Quantitative perfusion measurements with optical imaging and MR imaging correctly identified patients who responded (n = 18) and did not respond to therapy (n = 10), as determined by SDAI. The difference of REE after 24 weeks of treatment compared with baseline in responders was significantly reduced in optical imaging and MR imaging (optical imaging: mean, -21.5%; MR imaging: mean, -41.0%; P < .001 for both), while in nonresponders it was increased (optical imaging: mean, 10.8%; P = .075; MR imaging: mean, 8.7%; P = .03). The REE of optical imaging significantly correlated with MR imaging (ρ = 0.80; P < .001) and SDAI (ρ = 0.61; P < .001). CONCLUSION: Quantitative analysis of contrast-enhanced optical imaging allows for potential therapeutic monitoring of synovitis in patients with inflammatory arthritis.