Purpose: Timely detection of neurovascular pathology such as ischemic stroke is essential to effective treatment, and systems for cone-beam CT (CBCT) could provide CT angiography (CTA) assessment in a timely manner close to the point of care. CBCT systems suffer from slow rotation speed and readout speed, which leads to inconsistent or sparse dataset. This work describes a new reconstruction method using a reconstruction of difference (RoD) approach that is robust against such factors. <p> </p>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. <p> </p>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. <p> </p>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.
Purpose: A number of cone-beam CT (CBCT) applications demand increasingly compact system designs for smaller footprint and improved portability. Such compact geometries can be achieved via reduction of air gap and integration of novel, curved detectors; however, the increased x-ray scatter in presents a major challenge to soft-tissue image quality in such compact arrangements. This work investigates pre-patient modulation (bowtie filters) and antiscatter grids to mitigate such effects for compact geometries with curved detectors. Methods: The effects of bowtie filters on dose and x-ray scatter were investigated in a compact geometry (180 mm air gap), for three detector curvatures: Flat, Focused at source, and Compact focused at isocenter. Experiments used bowtie filters of varying curvature combined with antiscatter grids (GR: 8:1, 80 lpmm). Scatter was estimated via GPU-accelerated Monte Carlo simulation in an anthropomorphic head phantom. Primary fluence was estimated with a polychromatic Siddon projector. Realistic Poisson noise (total dose: 20 mGy) was added to the total signal. Scatter magnitude and distribution were evaluated in projection data, and CT image quality was assessed in PWLS reconstructions. Results were validated in physical experiments on an x-ray test-bench for CBCT. Results: Moderate bowties combined with grids reduced average scatter magnitude and SPR, reduced cupping from 90 to 5 HU, and yielded net benefit to CNR despite attenuation of primary fluence. Dose to sensitive organs (eye lens) was reduced by 27%. More aggressive bowties showed further potential for dose reduction (35%) but increased peripheral SPR and increased non-uniformity and artifacts at the periphery of the image. Curved detector geometry exhibited slightly improved uniformity but a slight reduction in CNR compared to conventional flat detector geometry. Conclusion: Highly portable, soft-tissue imaging, CBCT systems with very compact geometry and curved detectors appear feasible, despite elevated x-ray scatter, through combination of moderate pre-patient collimation and antiscatter grids.