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Purpose: We investigated the feasibility of dual-energy (DE) detection of bone marrow edema (BME) using a dedicated extremity cone-beam CT (CBCT) with a unique three-source x-ray unit. The sources can be operated at different energies to enable single-scan DE acquisitions. However, they are arranged parallel to the axis of rotation, resulting in incomplete sampling and precluding the application of DE projection-domain decompositions (PDD) for beam-hardening reduction. Therefore, we propose a novel combination of a model-based “one-step” DE two-material decomposition followed by a constrained image-domain change-of-basis to obtain virtual non-calcium (VNCa) images for BME detection.
Methods: DE projections were obtained using an “alternating-kV” protocol by operating the peripheral two sources of the CBCT system at low-energy (60 kV, 0.105 mAs/frame) and the central source at high-energy (100 kV, 0.028 mAs/frame), for a total of 600 frames over 216° of gantry rotation. Projections were processed with detector lag, glare and fast Monte Carlo (MC)-based iterative scatter corrections. Model-based material decomposition (MBMD) was then implemented to obtain aluminum (Al) and polyethylene (PE) volume fraction images with minimal beam-hardening. Statistical ray weights in MBMD were modified to account for regions with highly oblique sampling by the peripheral sources. To generate the VNCa maps, image-domain decomposition (IDD) constrained by the volume conservation principle (VCP) was performed to convert the Al and PE MBMD images into volume fractions of water, fat and cortical bone. Accuracy of BME detection was evaluated using physical phantom data acquired on the multi-source extremity CBCT scanner.
Results: The proposed framework estimated the volume of BME with ~10% error. The MC-based scatter corrections and the modified MBMD ray weights were essential to achieve such performance – the error without MC scatter corrections was <30%, whereas the uniformity of estimated VNCa images was 3x improved using the modified weights compared to the conventional weights.
Conclusions: The proposed DE decomposition framework was able to overcome challenges of high scatter and incomplete sampling to achieve BME detection on a CBCT system with axially-distributed x-ray sources.
Volume-of-interest (VOI) imaging is a strategy in computed tomography (CT) that restricts x-ray fluence to particular anatomical targets via dynamic beam modulation. This permits dose reduction while retaining image quality within the VOI. VOI-CT implementation has been challenged, in part, by a lack of hardware solutions for tailoring the incident fluence to the patient and anatomical site, as well as difficulties involving interior tomography reconstruction of truncated projection data. We propose a general VOI-CT imaging framework using multiple aperture devices (MADs), an emerging beam filtration scheme based on two binary x-ray filters. Location of the VOI is prescribed using two scout views at anterior–posterior (AP) and lateral perspectives. Based on a calibration of achievable fluence field patterns, MAD motion trajectories were designed using an optimization objective that seeks to maximize the relative fluence in the VOI subject to minimum fluence constraints. A modified penalized-likelihood method is developed for reconstruction of heavily truncated data using the full-field scout views to help solve the interior tomography problem. Physical experiments were conducted to show the feasibility of noncentered and elliptical VOI in two applications—spine and lung imaging. Improved dose utilization and retained image quality are validated with respect to standard full-field protocols. We observe that the contrast-to-noise ratio (CNR) is 40% higher compared with low-dose full-field scans at the same dose. The total dose reduction is 50% for equivalent image quality (CNR) within the VOI.
Methods. Two novel methodologies predicate the work: (1) Known-Component Registration (KC-Reg) for 3D localization of the patient and interventional devices from 2D radiographs; and (2) Penalized-Likelihood reconstruction (PLH) for improved 3D image quality and dose reduction. A thorough assessment of geometric stability, dosimetry, and image quality was performed to define algorithm parameters for imaging and guidance protocols. Laboratory studies included: evaluation of KC-Reg in localization of spine screws delivered in cadaver; and PLH performance in contrast, noise, and resolution in phantoms/cadaver compared to filtered backprojection (FBP).
Results. KC-Reg was shown to successfully register screw implants within ~1 mm based on as few as 3 radiographs. PLH was shown to improve soft-tissue visibility (61% improvement in CNR) compared to FBP at matched resolution. Cadaver studies verified the selection of algorithm parameters and the methods were successfully translated to clinical studies under an IRB protocol.
Conclusions. Model-based registration and reconstruction approaches were shown to reduce dose and provide improved visualization of anatomy and surgical instrumentation. Immediate future work will focus on further integration of KC-Reg and PLH for Known-Component Reconstruction (KC-Recon) to provide high-quality intraoperative imaging in the presence of dense instrumentation.
Methods: Novel predictors for estimation of local spatial resolution and noise properties are developed for PL reconstruction that include a physical model for blur and correlated noise in flat-panel cone-beam CT (CBCT) acquisitions. Prospective predictions (e.g., without reconstruction) of local point spread function and and local noise power spectrum (NPS) model are applied, compared, and validated using a flat-panel CBCT test bench. Imaging conditions investigated include two acquisition strategies (an unmodulated X-ray technique and automatic exposure control) as well as varying regularization strength.
Results: Comparisons between prediction and physical measurements show excellent agreement for both spatial resolution and noise properties. In comparison, traditional prediction methods (that ignore blur/correlation found in flat-panel data) fail to capture important data characteristics and show significant mismatch.
Conclusion: Novel image property predictors permit prospective assessment of flat-panel CBCT using MBIR. Such predictors enable standard and task-based performance assessments, and are well-suited to evaluation, control, and optimization of the CT imaging chain (e.g., x-ray technique, reconstruction parameters, novel data acquisition methods, etc.) for improved imaging performance and/or dose utilization.
Methods: Important aspects of CBCT angiography were investigated, weighting tradeoffs among the magnitude of iodine enhancement (peak contrast), the degree of data consistency, and the degree of data sparsity. Simulation studies were performed across a range of CBCT half-scan acquisition speed ranging ~3 – 17 s. Experiments were conducted using a CBCT prototype and an anthropomorphic neurovascular phantom incorporating a vessel with contrast injection with a time-attenuation (TAC) injection giving low data consistency but high peak contrast. Images were reconstructed using filtered back-projection (FBP), penalized likelihood (PL), and the RoD algorithm. Data were evaluated in terms of root mean square error (RMSE) in image enhancement as well as overall image noise and artifact.
Results: Feasibility was demonstrated for 3D angiographic assessment in CBCT images acquired across a range of data consistency and sparsity. Compared to FBP, the RoD method reduced the RMSE in reconstructed images by 50.0% in simulation studies (fixed peak contrast; variable data consistency and sparsity). The improvement in RMSE compared to PL reconstruction was 28.8%. The phantom experiments investigated conditions of low data consistency, RoD provided a 15.6% reduction in RMSE compared to FBP and a 16.3% reduction compared to PL, showing the feasibility of RoD method for slow-rotating CBCT-A system.
Conclusions: Simulations and phantom experiments show the feasibility and improved performance of the RoD approach compared to FBP and PL reconstruction, enabling 3D neuro-angiography on a slowly rotating CBCT system (e.g., 17.1s for a half-scan). The algorithm is relatively robust against data sparsity and is sensitive in detecting low levels of contrast enhancement from the baseline (mask) scan. Tradeoffs among peak contrast, data consistency, and data sparsity are demonstrated clearly in each experiment and help to guide the development of optimal contrast injection protocols for future preclinical and clinical studies.
Methods: The prototype CMOS-based CBCT involves a DALSA Xineos3030 detector (99 μm pixels) with 400 μm-thick CsI scintillator and a compact 0.3 FS rotating anode x-ray source. We compare the performance of CMOS CBCT to an a- Si:H FPD scanner built on a similar gantry, but using a Varian PaxScan2530 detector with 0.137 mm pixels and a 0.5 FS stationary anode x-ray source. Experimental studies include measurements of Modulation Transfer Function (MTF) for the detectors and in 3D image reconstructions. Image quality in clinical scenarios is evaluated in scans of a cadaver ankle. Metrics of trabecular microarchitecture (BV/TV, Bone Volume/Total Volume, TbSp, Trabecular Spacing, and TbTh, trabecular thickness) are obtained in a human ulna using CMOS CBCT and a-Si:H FPD CBCT and compared to gold standard μCT.
Results: The CMOS detector achieves ~40% increase in the f20 value (frequency at which MTF reduces to 0.20) compared to the a-Si:H FPD. In the reconstruction domain, the FWHM of a 127 μm tungsten wire is also improved by ~40%. Reconstructions of a cadaveric ankle reveal enhanced modulation of trabecular structures with the CMOS detector and soft-tissue visibility that is similar to that of the a-Si:H FPD system. Correlations of the metrics of bone microarchitecture with gold-standard μCT are improved with CMOS CBCT: from 0.93 to 0.98 for BV/TV, from 0.49 to 0.74 for TbTh, and from 0.9 to 0.96 for TbSp.
Conclusion: Adoption of a CMOS detector in extremity CBCT improved spatial resolution and enhanced performance in metrics of bone microarchitecture compared to a conventional a-Si:H FPD. The results support development of clinical applications of CMOS CBCT in quantitative imaging of bone health.
Methods: We implemented a task-driven imaging framework to optimize orbit parameters that maximize detectability index d'. This framework utilizes a specified Fourier domain task function and an analytical model for system spatial resolution and noise. Two experiments were conducted to test the framework. First, a simple task was considered consisting of frequencies lying entirely on the fz-axis (e.g., discrimination of structures oriented parallel to the central axial plane), and a “circle + arc” orbit was incorporated into the framework as a means to improve sampling of these frequencies, and thereby increase task-based detectability. The orbit was implemented on a robotic C-arm (Artis Zeego, Siemens Healthcare). A second task considered visualization of a cochlear implant simulated within a head phantom, with spatial frequency response emphasizing high-frequency content in the (fy, fz) plane of the cochlea. An optimal orbit was computed using the task-driven framework, and the resulting image was compared to that for a circular orbit.
Results: For the fz-axis task, the circle + arc orbit was shown to increase d' by a factor of 1.20, with an improvement of 0.71 mm in a 3D edge-spread measurement for edges located far from the central plane and a decrease in streak artifacts compared to a circular orbit. For the cochlear implant task, the resulting orbit favored complementary views of high tilt angles in a 360° orbit, and d' was increased by a factor of 1.83.
Conclusions: This work shows that a prospective definition of imaging task can be used to optimize source-detector orbit and improve imaging performance. The method was implemented for execution of non-circular, task-driven orbits on a clinical robotic C-arm system. The framework is sufficiently general to include both acquisition parameters (e.g., orbit, kV, and mA selection) and reconstruction parameters (e.g., a spatially varying regularizer).
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.
Joint optimization of fluence field modulation and regularization in task-driven computed tomography
Methods: Experiments involved a cone-beam CT (CBCT) bench system, a robotic C-arm, and three phantoms. A robust 3D-2D registration process was used to compute the 9 degree of freedom (DOF) transformation between each projection and an existing 3D image by maximizing normalized gradient information with a digitally reconstructed radiograph (DRR) of the 3D volume. The quality of the resulting “self-calibration” was evaluated in terms of the agreement with an established calibration method using a BB phantom as well as image quality in the resulting CBCT reconstruction.
Results: The self-calibration yielded CBCT images without significant difference in spatial resolution from the standard (“true”) calibration methods (p-value >0.05 for all three phantoms), and the differences between CBCT images reconstructed using the “self” and “true” calibration methods were on the order of 10-3 mm-1. Maximum error in magnification was 3.2%, and back-projection ray placement was within 0.5 mm.
Conclusion: The proposed geometric “self” calibration provides a means for 3D imaging on general noncircular orbits in CBCT systems for which a geometric calibration is either not available or not reproducible. The method forms the basis of advanced “task-based” 3D imaging methods now in development for robotic C-arms.
Methods. Using fast, robust 3D-2D registration in combination with 3D models of known components (surgical devices), the 3D pose determination was solved to relate known components to 2D projection images and 3D preoperative CT in near-real-time. Exact and parametric models of the components were used as input to the algorithm to evaluate the effects of model fidelity. The proposed algorithm employs the covariance matrix adaptation evolution strategy (CMA-ES) to maximize gradient correlation (GC) between measured projections and simulated forward projections of components. Geometric accuracy was evaluated in a spine phantom in terms of target registration error at the tool tip (TREx), and angular deviation (TREΦ) from planned trajectory.
Results. Transpedicle surgical devices (probe tool and spine screws) were successfully guided with TREx<2 mm and TREΦ <0.5° given projection views separated by at least >30° (easily accommodated on a mobile C-arm). QA of the surgical product based on 3D-2D registration demonstrated the detection of pedicle screw breach with TREx<1 mm, demonstrating a trend of improved accuracy correlated to the fidelity of the component model employed.
Conclusions. 3D-2D registration combined with 3D models of known surgical components provides a novel method for near-real-time guidance and quality assurance using a mobile C-arm without external trackers or fiducial markers. Ongoing work includes determination of optimal views based on component shape and trajectory, improved robustness to anatomical deformation, and expanded preclinical testing in spine and intracranial surgeries.
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