Fluence field modulated (FFM) CT allows for improvements in image quality and dose reduction. To date, only one-dimensional modulators have been proposed, as the extension to two-dimensional (2-D) modulation is difficult with solid-metal attenuation-based fluence field modulated designs. This work proposes to use liquid and gas to attenuate the x-ray beam, as unlike solids, these materials can be arranged allowing for 2-D fluence modulation. The thickness of liquid and the pressure for a given path length of gas were determined that provided the same attenuation as 30 cm of soft tissue at 80, 100, 120, and 140 kV. Liquid iodine, zinc chloride, cerium chloride, erbium oxide, iron oxide, and gadolinium chloride were studied. Gaseous xenon, uranium hexafluoride, tungsten hexafluoride, and nickel tetracarbonyl were also studied. Additionally, we performed a proof-of-concept experiment using a 96 cell array in which the liquid thickness in each cell was adjusted manually. Liquid thickness varied as a function of kV and chemical composition, with erbium oxide allowing for the smallest thickness. For the gases, tungsten hexaflouride required the smallest pressure to compensate for 30 cm of soft tissue. The 96 cell iodine attenuator allowed for a reduction in both dynamic range to the detector and scatter-to-primary ratio. For both liquids and gases, when k-edges were located within the diagnostic energy range used for imaging, the mean beam energy exhibited the smallest change with compensation amount. The thickness of liquids and the gas pressure seem logistically implementable within the space constraints of C-arm-based cone beam CT (CBCT) and diagnostic CT systems. The gas pressures also seem logistically implementable within the space and tube loading constraints of CBCT and diagnostic CT systems.
Purpose: The multi-leaf collimator (MLC) assembly present on TomoTherapy (Accuray, Madison WI) radiation therapy (RT) and mega voltage CT machines is well suited to perform fluence field modulated CT (FFMCT). In addition, there is a demand in the RT environment for FFMCT imaging techniques, specifically volume of interest (VOI) imaging. Methods: A clinical TomoTherapy machine was programmed to deliver 30% imaging dose outside predefined VOIs. Four different size ROIs were placed at varying distances from isocenter. Projections intersecting the VOI received "full dose" while those not intersecting the VOI received 30% of the dose (i.e. the incident fluence for non VOI projections was 30% of the incident fluence for projections intersecting the VOI). Additional scans without fluence field modulation were acquired at "full" and 30% dose. The noise (pixel standard deviation) was measured inside the VOI region and compared between the three scans. Results: The VOI-FFMCT technique produced an image noise 1.09, 1.05, 1.05, and 1.21 times higher than the "full dose" scan for ROI sizes of 10 cm, 13 cm, 10 cm, and 6 cm respectively within the VOI region. Conclusions: Noise levels can be almost unchanged within clinically relevant VOIs sizes for RT applications while the integral imaging dose to the patient can be decreased, and/or the image quality in RT can be dramatically increased with no change in dose relative to non-FFMCT RT imaging. The ability to shift dose away from regions unimportant for clinical evaluation in order to improve image quality or reduce imaging dose has been demonstrated. This paper demonstrates that FFMCT can be performed using the MLC on a clinical TomoTherapy machine for the first time.
In Computed Tomographic (CT) image reconstruction for 4 dimensional digital subtraction angiography (4D-DSA), loss of vessel contrast has been observed behind highly attenuating anatomy, such as large contrast filled aneurysms. Although this typically occurs only in a limited range of projection angles, the observed contrast time course can be altered. In this work we propose an algorithm to correct for highly attenuating anatomy within the fill projection data, i.e. aneurysms. The algorithm uses a 3D-SA volume to create a correction volume that is multiplied by the 4D-DSA volume in order to correct for signal dropout within the 4D-DSA volume. The algorithm was designed to correct for highly attenuating material in the fill volume only, however with alterations to a single step of the algorithm, artifacts due to highly attenuating materials in the mask volume (i.e. dental implants) can be mitigated as well. We successfully applied our algorithm to a case of vessel dropout due to the presence of a large attenuating aneurysm. The performance was qualified visually as the affected vessel no longer dropped out on corrected 4D-DSA time frames. The correction was quantified by plotting the signal intensity along the vessel. Our analysis demonstrated our correction does not alter vessel signal values outside of the vessel dropout region but does increase the vessel values within the dropout region as expected. We have demonstrated that this correction algorithm acts to correct vessel dropout in areas with highly attenuating materials.
Fluence field modulated CT allows for improvements in image quality and dose reduction. To date, only 1-D modulators have been proposed, the extension to 2-D modulation is difficult with solid-metal attenuation-based modulators. This work proposes to use liquids and gas to attenuate the x-ray beam which can be arrayed allowing for 2-D fluence modulation. The thickness of liquid and the pressure for a given path length of gas were determined that provided the same attenuation as 30 cm of soft tissue at 80, 100, 120, and 140 kV. Gaseous Xenon and liquid Iodine, Zinc Chloride, and Cerium Chloride were studied. Additionally, we performed some proof-of-concept experiments in which (1) a single cell of liquid was connected to a reservoir which allowed the liquid thickness to be modulated and (2) a 96 cell array was constructed in which the liquid thickness in each cell was adjusted manually. Liquid thickness varied as a function of kV and chemical composition, with Zinc Chloride allowing for the smallest thickness; 1.8, 2.25, 3, and 3.6 cm compensated for 30 cm of soft tissue at 80, 100, 120, and 140 kV respectively. The 96 cell Iodine attenuator allowed for a reduction in both dynamic range to the detector and scatter to primary ratio. Successful modulation of a single cell was performed at 0, 90, and 130 degrees using a simple piston/actuator. The thickness of liquids and the Xenon gas pressure seem logistically implementable within the constraints of CBCT and diagnostic CT systems.
When performing Computed Tomographic (CT) image reconstruction on digital subtraction angiography (DSA)
projections, loss of vessel contrast has been observed behind highly attenuating anatomy, such as dental implants
and large contrast filled aneurysms. Because this typically occurs only in a limited range of projection angles, the
observed contrast time course can potentially be altered. In this work, we have developed a model for acquiring
DSA projections that models both the polychromatic nature of the x-ray spectrum and the x-ray scattering
interactions to investigate this problem. In our simulation framework, scatter and beam hardening contributions to
vessel dropout can be analyzed separately. We constructed digital phantoms with large clearly defined regions
containing iodine contrast, bone, soft issue, titanium (dental implants) or combinations of these materials. As the
regions containing the materials were large and rectangular, when the phantoms were forward projected, the
projections contained uniform regions of interest (ROI) and enabled accurate vessel dropout analysis. Two phantom
models were used, one to model the case of a vessel behind a large contrast filled aneurysm and the other to model a
vessel behind a dental implant. Cases in which both beam hardening and scatter were turned off, only scatter was
turned on, only beam hardening was turned on, and both scatter and beam hardening were turned on, were simulated
for both phantom models. The analysis of this data showed that the contrast degradation is primarily due to scatter.
When analyzing the aneurysm case, 90.25% of the vessel contrast was lost in the polychromatic scatter image,
however only 50.5% of the vessel contrast was lost in the beam hardening only image. When analyzing the teeth
case, 44.2% of the vessel contrast was lost in the polychromatic scatter image and only 26.2% of the vessel contrast
was lost in the beam hardening only image.