Front-End Design for SiPM-Based Monolithic Neutron Double Scatter Imagers.

Neutron double scatter imaging exploits the kinematics of neutron elastic scattering to enable emission imaging of neutron sources. Due to the relatively low coincidence detection efficiency of fast neutrons in organic scintillator arrays, imaging efficiency for double scatter cameras can also be low. One method to realize significant gains in neutron coincidence detection efficiency is to develop neutron double scatter detectors which employ monolithic blocks of organic scintillator, instrumented with photosensor arrays on multiple faces to enable 3D position and multi-interaction time pickoff. Silicon photomultipliers (SiPMs) have several advantageous characteristics for this approach, including high photon detection efficiency (PDE), good single photon time resolution (SPTR), high gain that translates to single photon counting capabilities, and ability to be tiled into large arrays with high packing fraction and photosensitive area fill factor. However, they also have a tradeoff in high uncorrelated and correlated noise rates (dark counts from thermionic emissions and optical photon crosstalk generated during avalanche) which may complicate event positioning algorithms. We have evaluated the noise characteristics and SPTR of Hamamatsu S13360-6075 SiPMs with low noise, fast electronic readout for integration into a monolithic neutron scatter camera prototype. The sensors and electronic readout were implemented in a small-scale prototype detector in order to estimate expected noise performance for a monolithic neutron scatter camera and perform proof-of-concept measurements for scintillation photon counting and three-dimensional event positioning.

Advances in Nuclear Radiation Sensing: Enabling 3-D Gamma-Ray Vision.

The enormous advances in sensing and data processing technologies in combination with recent developments in nuclear radiation detection and imaging enable unprecedented and "smarter" ways to detect, map, and visualize nuclear radiation. The recently developed concept of three-dimensional (3-D) Scene-data fusion allows us now to "see" nuclear radiation in three dimensions, in real time, and specific to radionuclides. It is based on a multi-sensor instrument that is able to map a local scene and to fuse the scene data with nuclear radiation data in 3-D while the instrument is freely moving through the scene. This new concept is agnostic of the deployment platform and the specific radiation detection or imaging modality. We have demonstrated this 3-D Scene-data fusion concept in a range of configurations in locations, such as the Fukushima Prefecture in Japan or Chernobyl in Ukraine on unmanned and manned aerial and ground-based platforms. It provides new means in the detection, mapping, and visualization of radiological and nuclear materials relevant for the safe and secure operation of nuclear and radiological facilities or in the response to accidental or intentional releases of radioactive materials where a timely, accurate, and effective assessment is critical. In addition, the ability to visualize nuclear radiation in 3-D and in real time provides new means in the communication with public and facilitates to overcome one of the major public concerns of not being able to "see" nuclear radiation.

Left atrial shape predicts recurrence after atrial fibrillation catheter ablation.

INTRODUCTION: Multiple markers left atrium (LA) remodeling, including LA shape, correlate with outcomes in atrial fibrillation (AF). Catheter ablation is an important treatment of AF, but better tools are needed to determine which patients will benefit. In this study, we use particle-based modeling to quantitatively assess LA shape, and determine to what degree it predicts AF recurrence after catheter ablation. METHODS AND RESULTS: There were 254 patients enrolled in the DECAAF study who underwent cardiac magnetic resonance imaging of the LA prior to AF ablation and were followed for recurrence for up to 475 days. We performed particle-based shape modeling on each patient's LA shape. We selected shape parameters using the LASSO method and factor analysis, and then added them to a Cox regression model, which included multiple clinical parameters and LA fibrosis. We computed Harrell's C-statistic with and without shape in the model. We used the model to stratify patients into recurrence risk classes by both shape and shape and fibrosis combined. Three shape parameters were selected for inclusion. The C-statistic increased from 0.68 to 0.72 when shape was added to the model (P < 0.05). Visualized shapes showed that a more round LA shape with a shorter, more laterally rotated appendage was predictive of recurrence. CONCLUSION: LA shape is an independent predictor of recurrence after AF ablation. When combined with LA fibrosis, shape analysis using PBM may improve patient selection for ablation.

Durable lesion formation while avoiding esophageal injury during ablation of atrial fibrillation: Lessons learned from late gadolinium MR imaging.

INTRODUCTION: Adequate catheter/atrial tissue contact is critical for lesion formation during radiofrequency (RF) ablation of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) is a unique tool for the evaluation of lesion formation and detection of acute esophageal injury. METHODS: LGE-MRIs were obtained prior, within 24 hours of, and at 115 ± 62 days after first AF ablation in 36 patients. The Visitag module of CARTO3 was used to collect contact force (CF) and duration from a CF sensing ablation catheter for each registered ablation point. The minimum CF resulting in permanent lesions was determined. Esophageal enhancement detected by acute LGE-MRI was classified as mild, moderate, and severe. The CF resulting in esophageal enhancement was determined. RESULTS: A total of 4,642 registered ablation tags at 50 W power were analyzed. The mean RF duration (5.9 ± 3.7 vs. 5.6 ± 3.2 seconds, P < 0.05), CF (11.5 ± 5.6 vs. 10.9 ± 5.4 g, P < 0.001), and force time integral (FTI) (67.3 ± 54.5 vs. 62.2 ± 52.7 gs, P < 0.01) were significantly higher between ablation tags with and without associated LGE-MRI detected scar. The mean CF (15.7 ± 6.1 vs. 12.6 ± 5.9 g, P < 0.05, n  =  17 patients) in areas of esophageal enhancement was greater than areas without. CONCLUSION: Left atrial short duration ablation lesions with a CF greater than 12 g are more likely to be associated with permanent lesion formation. Ablating on top of the esophagus, CF less than 15 g would help minimize esophageal wall injury.

Scintillation and cherenkov photon counting detectors with analog silicon photomultipliers for TOF-PET.

Objective.Standard signal processing approaches for scintillation detectors in positron emission tomography (PET) derive accurate estimates for 511 keV photon time of interaction and energy imparted to the detection media from aggregate characteristics of electronic pulse shapes. The ultimate realization of a scintillation detector for PET is one that provides a unique timestamp and position for each detected scintillation photon. Detectors with these capabilities enable advanced concepts for three-dimensional (3D) position and time of interaction estimation with methods that exploit the spatiotemporal arrival time kinetics of individual scintillation photons.Approach.In this work, we show that taking into consideration the temporal photon emission density of a scintillator, the channel density of an analog silicon photomultiplier (SiPM) array, and employing fast electronic readout with digital signal processing, a detector that counts and timestamps scintillation photons can be realized. To demonstrate this approach, a prototype detector was constructed, comprising multichannel electronic readout for a bismuth germanate (BGO) scintillator coupled to an SiPM array.Main Results.In proof-of-concept measurements with this detector, we were able to count and provide unique timestamps for 66% of all optical photons, where the remaining 34% (two-or-more-photon pulses) are also independently counted, but each photon bunch shares a common timestamp. We show this detector concept can implement 3D positioning of 511 keV photon interactions and thereby enable corrections for time of interaction estimators. The detector achieved 17.6% energy resolution at 511 keV and 237 ± 10 ps full-width-at-half-maximum coincidence time resolution (CTR) (fast spectral component) versus a reference detector. We outline the methodology, readout, and approach for achieving this detector capability in first-ever, proof-of-concept measurements for scintillation photon counting detector with analog silicon photomultipliers.Significance.The presented detector concept is a promising design for large area, high sensitivity TOF-PET detector modules that can implement advanced event positioning and time of interaction estimators, which could push state-of-the-art performance.

Tetris-inspired detector with neural network for radiation mapping.

Radiation mapping has attracted widespread research attention and increased public concerns on environmental monitoring. Regarding materials and their configurations, radiation detectors have been developed to identify the position and strength of the radioactive sources. However, due to the complex mechanisms of radiation-matter interaction and data limitation, high-performance and low-cost radiation mapping is still challenging. Here, we present a radiation mapping framework using Tetris-inspired detector pixels. Applying inter-pixel padding for enhancing contrast between pixels and neural networks trained with Monte Carlo (MC) simulation data, a detector with as few as four pixels can achieve high-resolution directional prediction. A moving detector with Maximum a Posteriori (MAP) further achieved radiation position localization. Field testing with a simple detector has verified the capability of the MAP method for source localization. Our framework offers an avenue for high-quality radiation mapping with simple detector configurations and is anticipated to be deployed for real-world radiation detection.

Low power implementation of high frequency SiPM readout for Cherenkov and scintillation detectors in TOF-PET.

State-of-the-art (SoA) electronic readout for silicon photomultiplier (SiPM)-based scintillation detectors that demonstrate experimental limits in achievable coincidence time resolution (CTR) leverage low noise, high frequency signal processing to facilitate a single photon time response that is near the limit of the SiPMs architecture. This readout strategy can optimally exploit fast luminescence and prompt photon populations, and promising measurements show detector concepts employing this readout can greatly advance PET detector CTR, relative to SoA in clinical systems. However, the technique employs power hungry components which make the electronics chain impractical for channel-dense time-of-flight (TOF)-PET detectors. We have developed and tested a low noise and high frequency readout circuit which is performant at low power and consists of discrete elements with small footprints, making it feasible for integration into TOF-PET detector prototypes. A 3 × 3 mm2Broadcom SiPM with this readout chain exhibited sub-100 ps single photon time resolution at 10 mW of power consumption, with a relatively minor performance degradation to 120 ± 2 ps FWHM at 5 mW. CTR measurements with 3 × 3 × 20 mm3LYSO and fast LGSO scintillators demonstrated 127 ± 3 ps and 113 ± 2 ps FWHM at optimal power operation and 133 ± 2 ps and 121 ± 3 ps CTR at 5 mW. BGO crystals 3 × 3 × 20 mm3in size show 271 ± 5 ps FWHM CTR (1174 ± 14 ps full-width-at-tenth-maximum (FWTM)) at optimal power dissipation and 289 ± 8 ps (1296 ± 33 ps FWTM) at 5 mW. The compact and low power readout topology that achieves this performance thereby offers a platform to greatly advance PET system CTR and also opportunities to provide high performance TOF-PET at reduced material cost.

Investigation of Electronic Signal Processing Chains for a Prototype TOF-PET System With 100-ps Coincidence Time Resolution.

We have evaluated CTR performance of four different mixed-signal front-end electronic readout configurations with the goal to achieve 100 picoseconds (ps) coincidence time resolution (CTR). The proposed TOF-PET detector elements are based on two 3 × 3 × 10 mm3 "fast LGSO" crystal segments, side-coupled to linear arrays of 3 × 3 mm2 silicon photomultipliers (SiPMs), to form a total crystal length of 20 mm. We studied multiple configurations and components for the front-end readout: 1) high speed radio frequency (RF) amplifiers; 2) an ASIC-based discriminator; 3) combination of RF amplifier, balun transformer, and discriminator ASIC; and 4) combination of balun transformer, and discriminator ASIC. Using two 3 × 3 × 10 mm3 fast LGSO crystals side coupled to a linear array of three SiPMs, coincidence data were experimentally acquired for each readout configuration in combination with a low jitter field programmable gate array (FPGA)-based time to digital converter (TDC). After evaluating timing performance of the three readout schemes, the best CTR value of 99.4 ± 1.9 ps FWHM was achieved for configuration (3), which is more than 20 ps better than the results achieved using configurations (1) and (2).

High-resolution time-of-flight PET detector with 100 ps coincidence time resolution using a side-coupled phoswich configuration.

Photon time-of-flight (TOF) capability in positron emission tomography (PET) enables reconstructed image signal-to-noise ratio (SNR) improvement. With the coincidence time resolution (CTR) of 100 picosecond (ps), a five-fold SNR improvement can be achieved with a 40 cm diameter imaging subject, relative to a system without TOF capability. This 100 ps CTR can be achieved for aclinically relevantdetector design (crystal element length ≥20 mm with reasonably high crystal packing fraction) using a side-readout PET detector configuration that enables 511 keV photon interaction depth-independent light collection efficiency and lower variance in scintillation photon transit time to the silicon photomultiplier (SiPM). In this study, we propose a new concept of TOF-PET detector to achieve high (<2 mm) resolution, using a 'side-coupled phoswich' configuration, where two crystals with different decay times (τd) are coupled in a side-readout configuration to a common row of photosensors. The proposed design was validated and optimized with GATE Monte Carlo simulation studies to determine an efficient detector design. Based on the simulation results, a proof-of-concept side-coupled phoswich detector design was developed comprising two LSO crystals with the size of 1.9 × 1.9 × 10 mm3with decay times of 34.39 and 43.07 ns, respectively. The phoswich crystals were side-coupled to the same three 4 × 4 mm2SiPMs and detector performances were evaluated. As a result of the experimental evaluation, the side-coupled phoswich configuration achieved CTR of 107 ± 3 ps, energy resolution of 10.5% ± 1.21% at 511 keV and >95% accuracy in identifying interactions in the two adjacent 1.9 × 1.9 × 10 mm3crystal elements using the time-over-threshold technique. Based on our results, we can achieve excellent spatial and energy resolution in addition to ∼100 ps CTR with this novel detector design.

Study of optical reflectors for a 100ps coincidence time resolution TOF-PET detector design.

Positron Emission Tomography (PET) reconstructed image signal-to-noise ratio (SNR) can be improved by including the 511 keV photon pair coincidence time-of-flight (TOF) information. The degree of SNR improvement from this TOF capability depends on the coincidence time resolution (CTR) of the PET system, which is essentially the variation in photon arrival time differences over all coincident photon pairs detected for a point positron source placed at the system center. The CTR is determined by several factors including the intrinsic properties of the scintillation crystals and photodetectors, crystal-to-photodetector coupling configurations, reflective materials, and the electronic readout configuration scheme. The goal of the present work is to build a novel TOF-PET system with 100 picoseconds (ps) CTR, which provides an additional factor of 1.5-2.0 improvement in reconstructed image SNR compared to state-of-the-art TOF-PET systems which achieve 225-400 ps CTR. A critical parameter to understand is the optical reflector's influence on scintillation light collection and transit time variations to the photodetector. To study the effects of the reflector covering the scintillation crystal element on CTR, we have tested the performance of four different reflector materials: Enhanced Specular Reflector (ESR) -coupled with air or optical grease to the scintillator; Teflon tape; BaSO4paint alone or mixed with epoxy; and TiO2paint. For the experimental set-up, we made use of 3 × 3 × 10 mm3fast-LGSO:Ce scintillation crystal elements coupled to an array of silicon photomultipliers (SiPMs) using a novel 'side-readout' configuration that has proven to have lower variations in scintillation light collection efficiency and transit time to the photodetector.Results: show CTR values of 102.0 ± 0.8, 100.2 ± 1.2, 97.3 ± 1.8 and 95.0 ± 1.0 ps full-width-half-maximum (FWHM) with non-calibrated energy resolutions of 10.2 ± 1.8, 9.9 ± 1.2, 7.9 ± 1.2, and 8.6 ± 1.7% FWHM for the Teflon, ESR (without grease), BaSO4(without epoxy) and TiO2paint treatments, respectively.

Statistical shape analysis of the left atrial appendage predicts stroke in atrial fibrillation.

The shape of the left atrium (LA) and left atrial appendage (LAA) have been shown to predict stroke in patients with atrial fibrillation (AF). Prior studies rely on qualitative assessment of shape, which limits reproducibility and clinical utility. Statistical shape analysis (SSA) allows for quantitative assessment of shape. We use this method to assess the shape of the LA and LAA and predict stroke in patients with AF. From a database of AF patients who had previously undergone MRI of the LA, we identified 43 patients with AF who subsequently had an ischemic stroke. We also identified a cohort of 201 controls with AF who did not have a stroke after the MRI. We performed SSA of the LA and LAA shape to quantify the shape of these structures. We found three of the candidate LAA shape parameters to be predictive of stroke, while none of the LA shape parameters predicted stroke. When the three predictive LAA shape parameters were added to a logistic regression model that included the CHA2DS2-VASc score, the area under the ROC curve increased from 0.640 to 0.778 (p = .003). The shape of the LA and LAA can be assessed quantitatively using SSA. LAA shape predicts stroke in AF patients, while LA shape does not. Additionally, LAA shape predicts stroke independent of CHA2DS2-VASc score. SSA for assessment of LAA shape may improve stroke risk stratification and clinical decision making for AF patients.

Scalable electronic readout design for a 100 ps coincidence time resolution TOF-PET system.

We have developed a scalable detector readout design for a 100 ps coincidence time resolution (CTR) time of flight (TOF) positron emission tomography (PET) detector technology. The basic scintillation detectors studied in this paper are based on 2 × 4 arrays of 3 × 3 × 10 mm3'fast-LGSO:Ce' scintillation crystals side-coupled to 6 × 4 arrays of 3 × 3 mm2silicon photomultipliers (SiPMs). We employed a novel mixed-signal front-end electronic configuration and a low timing jitter Field Programming Gate Array-based time to digital converter for data acquisition. Using a22Na point source, >10 000 coincidence events were experimentally acquired for several SiPM bias voltages, leading edge time-pickoff thresholds, and timing channels. CTR of 102.03 ± 1.9 ps full-width-at-half-maximum (FWHM) was achieved using single 3 × 3 × 10 mm3'fast-LGSO' crystal elements, wrapped in Teflon tape and side coupled to a linear array of 3 SiPMs. In addition, the measured average CTR was 113.4 ± 0.7 ps for the side-coupled 2 × 4 crystal array. The readout architecture presented in this work is designed to be scalable to large area module detectors with a goal to create the first TOF-PET system with 100 ps FWHM CTR.

Free-moving Quantitative Gamma-ray Imaging.

The ability to map and estimate the activity of radiological source distributions in unknown three-dimensional environments has applications in the prevention and response to radiological accidents or threats as well as the enforcement and verification of international nuclear non-proliferation agreements. Such a capability requires well-characterized detector response functions, accurate time-dependent detector position and orientation data, a digitized representation of the surrounding 3D environment, and appropriate image reconstruction and uncertainty quantification methods. We have previously demonstrated 3D mapping of gamma-ray emitters with free-moving detector systems on a relative intensity scale using a technique called Scene Data Fusion (SDF). Here we characterize the detector response of a multi-element gamma-ray imaging system using experimentally benchmarked Monte Carlo simulations and perform 3D mapping on an absolute intensity scale. We present experimental reconstruction results from hand-carried and airborne measurements with point-like and distributed sources in known configurations, demonstrating quantitative SDF in complex 3D environments.

An Image-based Approach for 3D Left Atrium Functional Measurements.

There is growing interest in the assessment of function of the left atrium (LA) in patients with atrial fibrillation (AF). Existing methods of LA functional measurement only quantify a limited subset of the functional parameters from a single or biplane CINE-MRI scan through the LA. Here, we propose an image-based method for comprehensive evaluation of the function of the entire LA in 3D. 4D LA images were reconstructed from a series of CINE image stack covering the whole LA with small or no gap between thin slices. A segmentation from a high-resolution Magnetic Resonance Angiography (MRA) was registered and propagated through pairwise deformable registrations covering the cardiac cycle. Volume, LA ejection fraction and surface strain were computed for each timepoint and registered to Late Gadolinium Enhancement (LGE) scans for each of 52 patient scans. A correlation coefficient of -0.11 was calculated between LGE and strain, indicating that fibrotic tissue correlates with reduced elasticity.

Experimental validation of a coincidence time resolution metric including depth-of-interaction bias for TOF-PET.

Depth-of-interaction (DOI) variability of annihilation photons is known to be a source of coincidence time resolution (CTR) degradation for fast time-of-flight-positron emission tomography detectors. An analytical model was recently proposed to explicitly include the DOI time bias separately from variance-related statistical factors, such as scintillation photon emission and photosensor jitter, in the CTR evaluation. In the present work, an experimental validation of this new model is provided. An unconventional signal readout configuration was used to magnify the DOI bias with 20 mm long LYSO:Ce crystals. In a head-to-head orientation of the crystals, simulations performed using the metric with DOI bias exhibited a much better agreement (within 21 ps) with the experimentally measured CTR of 413 ± 8 ps full-width at half maximum, whereas simulations without DOI bias underestimated the CTR by 138 ps. The metric including DOI bias was shown to also be effective at predicting the CTR of the head-to-head setup (without DOI information) using data from a DOI-collimated experimental setup (with partial DOI information). With the development of new low-variance ultra-fast detectors, the DOI timing blur will become increasingly important and will need to be taken into account in analytical predictions and in some experimental measurements through the proposed metric.

Deformable multisurface segmentation of the spine for orthopedic surgery planning and simulation.

Purpose: We describe a shape-aware multisurface simplex deformable model for the segmentation of healthy as well as pathological lumbar spine in medical image data. Approach: This model provides an accurate and robust segmentation scheme for the identification of intervertebral disc pathologies to enable the minimally supervised planning and patient-specific simulation of spine surgery, in a manner that combines multisurface and shape statistics-based variants of the deformable simplex model. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user assistance is allowed to disable the prior shape influence during deformation. Results: Results demonstrate validation against user-assisted expert segmentation, showing excellent boundary agreement and prevention of spatial overlap between neighboring surfaces. This section also plots the characteristics of the statistical shape model, such as compactness, generalizability and specificity, as a function of the number of modes used to represent the family of shapes. Final results demonstrate a proof-of-concept deformation application based on the open-source surgery simulation Simulation Open Framework Architecture toolkit. Conclusions: To summarize, we present a deformable multisurface model that embeds a shape statistics force, with applications to surgery planning and simulation.

Electronics method to advance the coincidence time resolution with bismuth germanate.

Exploiting the moderate Cherenkov yield from 511 keV photoelectric interactions in bismuth germanate (BGO) scintillators enables one to achieve a level of coincidence time resolution (CTR) appropriate for time-of-flight positron emission tomography (TOF-PET). For this approach, owing to the low number of promptly emitted light photons, single photon time resolution (SPTR) can have a stronger influence on achievable CTR. We have previously shown readout techniques that reduce effective device capacitance of large area silicon photomultipliers (SiPMs) can yield improvements in single photon response shape that minimize the influence of electronic noise on SPTR. With these techniques, sub-100 ps FWHM SPTR can be achieved with [Formula: see text] mm2 FBK near-ultra-violet high density (NUV-HD) SiPMs. These sensors are also useful for detecting Cherenkov light due to relatively high photon detection efficiency for UV light. In this work, we measured CTR for BGO crystals coupled to FBK NUV-HD SiPMs with a passive bootstrapping readout circuit that effectively reduces the SiPM device capacitance. A range of CTR values between 200 [Formula: see text] 3 and 277 [Formula: see text] 7 ps FWHM were measured for 3 [Formula: see text] 3 [Formula: see text] 3 and 3 [Formula: see text] 3 [Formula: see text] 15 mm3 crystals, respectively. This readout technique provides a relatively simple approach to achieve state-of-the-art CTR performance using BGO crystals for TOF-PET.

Does Alignment in Statistical Shape Modeling of Left Atrium Appendage Impact Stroke Prediction?

Evidence suggests that the shape of left atrium appendages (LAA) is a primary indicator in predicting stroke for patients diagnosed with atrial fibrillation (AF). Statistical shape modeling tools used to represent (i.e., parameterize) the underlying LAA variability are of crucial importance to learn shape-based predictors of stroke. Most shape modeling techniques use some form of alignment either as a data pre-processing step or during the modeling step. However, the LAA is a joint anatomy along with left atrium (LA), and the relative position and alignment plays a crucial part in determining risk of stroke. In this paper, we explore different alignment strategies for statistical shape modeling and how each strategy affects the stroke prediction capability. This allows for identifying a unified approach of alignment while analyzing the LAA anatomy for stroke. Here, we study three different alignment strategies, (i) global alignment, (ii) global translational alignment and (iii) cluster based alignment. Our results show that alignment strategies that take into account LAA orientation, i.e., (ii), or the inherent natural clustering of the population under study, i.e., (iii), provide significant improvement over global alignment in both qualitative as well as quantitative measures.

Efficient Segmentation Pipeline Using Diffeomorphic Image Registration: A Validation Study.

Functional measurements of the left atrium (LA) in atrial fibrillation (AF) patients is limited to a single CINE slice midway through the LA. Nonetheless, a full 3D characterization of atrial functional measurements would provide more insights into LA function. But this improved modeling capacity comes at a price of requiring LA segmentation of each 3D time point,a time-consuming and expensive task that requires anatomy-specific expertise.We propose an efficient pipeline which requires ground truth segmentation of a single (or limited) CINE time point to accurately propagate it throughout the sequence. This method significantly saves human effort and enable better characterization of LA anatomy. From a gated cardiac CINE MRI sequence we select a single CINE time point with ground truth segmentation, and assuming cyclic motion, we register other images corresponding to all time points using diffeomorphic registration in ANTs. The diffeomorphic registration fields allow us to map a given anatomical shape (segmentation) to each CINE time point, facilitating the construction of a 4D shape model.

Interatrial Septum and Appendage Ostium in Atrial Fibrillation Patients: A Population Study.

Left atrial appendage (LAA) closure is performed in atrial fibrillation (AF) patients to help prevent stroke. LAA closure using an occlusion implant is performed under imaging guidance. However, occlusion can be a complicated process due to the highly variable and heterogeneous LAA shapes across patients. Patient-specific implant selection and insertion processes are keys to the success of the procedure, yet subjective in nature. A population study of the angle of entry at the interatrial septum relative to the appendage can assist in both catheter design and patient-specific implant choice. In our population study, we analyzed the inherent clusters of the angles that were obtained between the septum normal and the LAA ostium plane. The number of inherent angle clusters matched the LAA four morphological classifications reported in the literature. Further, our exploratory analysis revealed that the normal from the ostium plane does not intersect the septum in all the samples under study. The insights gained from this study can help assist in making objective decisions during LAA closure.