In radiation treatment planning (RTP), CT reconstruction that combats projection truncation artifacts induced by the patient being positioned partially outside the scan field-of-view (FOV) needs to maintain high geometric and Hounsfield Unit (HU) accuracy outside the scan FOV. A new image reconstruction method has been proposed for clinical helical CT simulation scans. This method generates support images using the Discrete Algebraic Reconstruction Technique to accurately estimate patient contours outside the scan FOV and then uses support images to guide the projection extension. The proposed method improved geometric accuracy in objects outside the scan FOV compared to a more conventional method and kept the geometric distortion within 5 mm under very severe truncation. It also demonstrated HU accuracy in objects outside the scan FOV within 2.5% for a variety of soft tissues and 15% for bone tissues on a typical electron density phantom. Images of three radiotherapy patient cases reconstructed with the proposed method exhibited clearly defined, naturally looking patient contours, including the recovery of skinfold outside the scan FOV. The proposed method shows the potential for providing clinically desirable extended FOV images for a variety of patient setups in RTP.
Purpose: Prior-image-based reconstruction (PIBR) is a powerful tool for low-dose CT, however, the nonlinear behavior of such approaches are generally difficult to predict and control. Similarly, traditional image quality metrics do not capture potential biases exhibited in PIBR images. In this work, we identify a new bias metric and construct an analytical framework for prospectively predicting and controlling the relationship between prior image regularization strength and this bias in a reliable and quantitative fashion. Methods: Bias associated with prior image regularization in PIBR can be described as the fraction of actual contrast change (between the prior image and current anatomy) that appears in the reconstruction. Using local approximation of the nonlinear PIBR objective, we develop an analytical relationship between local regularization, fractional contrast reconstructed, and true contrast change. This analytic tool allows prediction bias properties in a reconstructed PIBR image and includes the dependencies on the data acquisition, patient anatomy and change, and reconstruction parameters. Predictions are leveraged to provide reliable and repeatable image properties for varying data fidelity in simulation and physical cadaver experiments. Results: The proposed analytical approach permits accurate prediction of reconstructed contrast relative to a gold standard based on exhaustive search based on numerous iterative reconstructions. The framework is used to control regularization parameters to enforce consistent change reconstructions over varying fluence levels and varying numbers of projection angles – enabling bias properties that are less location- and acquisition-dependent. Conclusions: While PIBR methods have demonstrated a substantial ability for dose reduction, image properties associated with those images have been difficult to express and quantify using traditional metrics. The novel framework presented in this work not only quantifies this bias in an intuitive fashion, but it gives a way to predict and control the bias. Reliable and predictable reconstruction methods are a requirement for clinical imaging systems and the proposed framework is an important step translating PIBR methods to clinical application.
Many clinical scenarios involve the presence of metal objects in the CT scan field-of-view. Metal objects tend to cause severe artifacts in CT images such as shading, streaks, and a loss of tissue visibility adjacent to metal components, which is often the region-of-interest in imaging. Many existing methods depend on synthesized projections and classification of in-vivo materials whose results can sometimes be subject to error and miss details, while other methods require additional information such as an accurate model of metal component prior to reconstruction. Deep learning approaches have advanced rapidly in recent years and achieved tremendous success in many fields. In this work, we develop a deep residual learning framework that trains a deep convolution neural network to detect and correct for metal artifacts from image content. Training sets are generated from simulation that incorporates modeling of physical processes related to metal artifacts. Testing scenarios included the presence of a surgical screw within the transaxial plane and two rod implants in the craniocaudal direction. The proposed network trained by polychromatic simulation data demonstrates the capability to largely reduce or, in some cases, almost entirely remove metal artifacts caused by beam hardening effects. The proposed method also showed largely reduced metal artifacts on data collected from a multi-slice CT system. These findings suggest deep residual learning enabled methods present a new type of promising approaches for reducing metal artifacts and support further development of the method in more clinically realistic scenarios.
Purpose: To improve the timely detection and treatment of intracranial hemorrhage or ischemic stroke, recent efforts include the development of cone-beam CT (CBCT) systems for perfusion imaging and new approaches to estimate perfusion parameters despite slow rotation speeds compared to multi-detector CT (MDCT) systems. This work describes development of a brain perfusion CBCT method using a reconstruction of difference (RoD) approach to enable perfusion imaging on a newly developed CBCT head scanner prototype. Methods: A new reconstruction approach using RoD with a penalized-likelihood framework was developed to image the temporal dynamics of vascular enhancement. A digital perfusion simulation was developed to give a realistic representation of brain anatomy, artifacts, noise, scanner characteristics, and hemo-dynamic properties. This simulation includes a digital brain phantom, time-attenuation curves and noise parameters, a novel forward projection method for improved computational efficiency, and perfusion parameter calculation. Results: Our results show the feasibility of estimating perfusion parameters from a set of images reconstructed from slow scans, sparse data sets, and arc length scans as short as 60 degrees. The RoD framework significantly reduces noise and time-varying artifacts from inconsistent projections. Proper regularization and the use of overlapping reconstructed arcs can potentially further decrease bias and increase temporal resolution, respectively. Conclusions: A digital brain perfusion simulation with RoD imaging approach has been developed and supports the feasibility of using a CBCT head scanner for perfusion imaging. Future work will include testing with data acquired using a 3D-printed perfusion phantom currently and translation to preclinical and clinical studies.
Purpose: Prompt, reliable detection of intracranial hemorrhage (ICH) is essential for treatment of stroke and traumatic brain injury, and would benefit from availability of imaging directly at the point-of-care. This work reports the performance evaluation of a clinical prototype of a cone-beam CT (CBCT) system for ICH imaging and introduces novel algorithms for model-based reconstruction with compensation for data truncation and patient motion.
Methods: The tradeoffs in dose and image quality were investigated as a function of analytical (FBP) and model-based iterative reconstruction (PWLS) algorithm parameters using phantoms with ICH-mimicking inserts. Image quality in clinical applications was evaluated in a human cadaver imaged with simulated ICH. Objects outside of the field of view (FOV), such as the head-holder, were found to introduce challenging truncation artifacts in PWLS that were mitigated with a novel multi-resolution reconstruction strategy. Following phantom and cadaver studies, the scanner was translated to a clinical pilot study. Initial clinical experience indicates the presence of motion in some patient scans, and an image-based motion estimation method that does not require fiducial tracking or prior patient information was implemented and evaluated.
Results: The weighted CTDI for a nominal scan technique was 22.8 mGy. The high-resolution FBP reconstruction protocol achieved < 0.9 mm full width at half maximum (FWHM) of the point spread function (PSF). The PWLS soft-tissue reconstruction showed <1.2 mm PSF FWHM and lower noise than FBP at the same resolution. Effects of truncation in PWLS were mitigated with the multi-resolution approach, resulting in 60% reduction in root mean squared error compared to conventional PWLS. Cadaver images showed clear visualization of anatomical landmarks (ventricles and sulci), and ICH was conspicuous. The motion compensation method was shown in clinical studies to restore visibility of fine bone structures, such as the subtle fracture, cranial sutures, and the cochlea as well as subtle low-contrast structures in the brain parenchyma.
Conclusion: The imaging performance of the prototype suggests sufficient quality for ICH imaging and motivates continued clinical studies to assess the diagnosis utility of the CBCT system in realistic clinical scenarios at the point of care.
Intracranial hemorrhage (ICH) is associated with pathologies such as hemorrhagic stroke and traumatic brain injury. Multi-detector CT is the current front-line imaging modality for detecting ICH (fresh blood contrast 40-80 HU, down to 1 mm). Flat-panel detector (FPD) cone-beam CT (CBCT) offers a potential alternative with a smaller scanner footprint, greater portability, and lower cost potentially well suited to deployment at the point of care outside standard diagnostic radiology and emergency room settings. Previous studies have suggested reliable detection of ICH down to 3 mm in CBCT using high-fidelity artifact correction and penalized weighted least-squared (PWLS) image reconstruction with a post-artifact-correction noise model. However, ICH reconstructed by traditional image regularization exhibits nonuniform spatial resolution and noise due to interaction between the statistical weights and regularization, which potentially degrades the detectability of ICH. In this work, we propose three regularization methods designed to overcome these challenges. The first two compute spatially varying certainty for uniform spatial resolution and noise, respectively. The third computes spatially varying regularization strength to achieve uniform "detectability," combining both spatial resolution and noise in a manner analogous to a delta-function detection task. Experiments were conducted on a CBCT test-bench, and image quality was evaluated for simulated ICH in different regions of an anthropomorphic head. The first two methods improved the uniformity in spatial resolution and noise compared to traditional regularization. The third exhibited the highest uniformity in detectability among all methods and best overall image quality. The proposed regularization provides a valuable means to achieve uniform image quality in CBCT of ICH and is being incorporated in a CBCT prototype for ICH imaging.
Purpose: Prompt and reliable detection of intracranial hemorrhage (ICH) has substantial clinical impact in diagnosis
and treatment of stroke and traumatic brain injury. This paper describes the design, development, and preliminary
performance characterization of a dedicated cone-beam CT (CBCT) head scanner prototype for imaging of acute
ICH.
Methods: A task-based image quality model was used to analyze the detectability index as a function of system
configuration, and hardware design was guided by the results of this model-based optimization. A robust artifact
correction pipeline was developed using GPU-accelerated Monte Carlo (MC) scatter simulation, beam hardening
corrections, detector veiling glare, and lag deconvolution. An iterative penalized weighted least-squares (PWLS)
reconstruction framework with weights adjusted for artifact-corrected projections was developed. Various bowtie
filters were investigated for potential dose and image quality benefits, with a MC-based tool providing estimates of
spatial dose distribution.
Results: The initial prototype will feature a source-detector distance of 1000 mm and source-axis distance of 550
mm, a 43x43 cm2 flat panel detector, and a 15° rotating anode x-ray source with 15 kW power and 0.6 focal spot
size. Artifact correction reduced image nonuniformity by ~250 HU, and PWLS reconstruction with modified
weights improved the contrast to noise ratio by 20%. Inclusion of a bowtie filter can potentially reduce dose by 50%
and improve CNR by 25%.
Conclusions: A dedicated CBCT system capable of imaging millimeter-scale acute ICH was designed. Preliminary
findings support feasibility of point-of-care applications in TBI and stroke imaging, with clinical studies beginning
on a prototype.
Traumatic brain injury (TBI) is a major cause of death and disability. The current front-line imaging modality for TBI detection is CT, which reliably detects intracranial hemorrhage (fresh blood contrast 30-50 HU, size down to 1 mm) in non-contrast-enhanced exams. Compared to CT, flat-panel detector (FPD) cone-beam CT (CBCT) systems offer lower cost, greater portability, and smaller footprint suitable for point-of-care deployment. We are developing FPD-CBCT to facilitate TBI detection at the point-of-care such as in emergent, ambulance, sports, and military applications. However, current FPD-CBCT systems generally face challenges in low-contrast, soft-tissue imaging. Model-based reconstruction can improve image quality in soft-tissue imaging compared to conventional filtered back-projection (FBP) by leveraging high-fidelity forward model and sophisticated regularization. In FPD-CBCT TBI imaging, measurement noise characteristics undergo substantial change following artifact correction, resulting in non-negligible noise amplification. In this work, we extend the penalized weighted least-squares (PWLS) image reconstruction to include the two dominant artifact corrections (scatter and beam hardening) in FPD-CBCT TBI imaging by correctly modeling the variance change following each correction. Experiments were performed on a CBCT test-bench using an anthropomorphic phantom emulating intra-parenchymal hemorrhage in acute TBI, and the proposed method demonstrated an improvement in blood-brain contrast-to-noise ratio (CNR = 14.2) compared to FBP (CNR = 9.6) and PWLS using conventional weights (CNR = 11.6) at fixed spatial resolution (1 mm edge-spread width at the target contrast). The results support the hypothesis that FPD-CBCT can fulfill the image quality requirements for reliable TBI detection, using high-fidelity artifact correction and statistical reconstruction with accurate post-artifact-correction noise models.
Nearly all reconstruction methods are controlled through various parameter selections. Traditionally, such parameters are used to specify a particular noise and resolution trade-off in the reconstructed image volumes. The introduction of reconstruction methods that incorporate prior image information has demonstrated dramatic improvements in dose utilization and image quality, but has complicated the selection of reconstruction parameters including those associated with balancing information used from prior images with that of the measurement data. While a noise-resolution tradeoff still exists, other potentially detrimental effects are possible with poor prior image parameter values including the possible introduction of false features and the failure to incorporate sufficient prior information to gain any improvements. Traditional parameter selection methods such as heuristics based on similar imaging scenarios are subject to error and suboptimal solutions while exhaustive searches can involve a large number of time-consuming iterative reconstructions. We propose a novel approach that prospectively determines optimal prior image regularization strength to accurately admit specific anatomical changes without performing full iterative reconstructions. This approach leverages analytical approximations to the implicitly defined prior image-based reconstruction solution and predictive metrics used to estimate imaging performance. The proposed method is investigated in phantom experiments and the shift-variance and data-dependence of optimal prior strength is explored. Optimal regularization based on the predictive approach is shown to agree well with traditional exhaustive reconstruction searches, while yielding substantial reductions in computation time. This suggests great potential of the proposed methodology in allowing for prospective patient-, data-, and change-specific customization of prior-image penalty strength to ensure accurate reconstruction of specific anatomical changes.
Nonlinear partial volume (NLPV) effects can be significant for objects with large attenuation differences and fine detail
structures near the spatial resolution limits of a tomographic system. This is particularly true for small metal devices like
cochlear implants. While traditional model-based approaches might alleviate these artifacts through very fine sampling
of the image volume and subsampling of rays to each detector element, such solutions can be extremely burdensome in
terms of memory and computational requirements. The work presented in this paper leverages the model-based approach
called “known-component reconstruction” (KCR) where prior knowledge of a surgical device is integrated into the estimation.
In KCR, the parameterization of the object separates the volume into an unknown background anatomy and a
known component with unknown registration. Thus, one can model projections of an implant at very high spatial resolution
while limiting the spatial resolution of the anatomy - in effect, modeling NLPV effects where they are most significant.
We present modifications of the KCR approach that can be used to largely eliminate NLPV artifacts, and demonstrate
the efficacy of the modified technique (with improved image quality and accurate implant position estimates) for
the cochlear implant imaging scenario.
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