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TU-G-BRB-01: Topic Introduction: Do We Need Clinical Trials in Particle Therapy and How Can Medical Physics Support Them?

Proton therapy, in particular, and ion therapy, just beginning, are becoming an increasing focus of attention in clinical radiation oncology and medical physics. Both modalities have been criticized of lacking convincing evidence from randomized trials proving their efficacy, justifying the higher costs involved in these therapies. This session will provide an overview of the current status of clinical trials in proton therapy, including recent developments in ion therapy. As alluded to in the introductory talk by Dr. Schulte, opinions are diverging widely as to the usefulness and need for clinical trials in particle therapy and the challenge of equipoise. The lectures will highlight some of the challenges that surround clinical trials in particle therapy. One, presented by Dr. Choy from UT Southwestern, is that new technology and even different types of particles such as helium and carbon ions are introduced into this environment, increasing the phase space of clinical variables. The other is the issue of medical physics quality assurance with physical phantoms, presented by Mrs. Taylor from IROC Houston, which is more challenging because 3D and 4D image guidance and active delivery techniques are in relatively early stages of development. The role of digital phantoms in developing clinical treatment planning protocols and as a QA tool will also be highlighted by Dr. Lee from NCI. The symposium will be rounded off by a panel discussion among the Symposium speakers, arguing pro or con the need and readiness for clinical trials in proton and ion therapy. Learning Objectives: To get an update on the current status of clinical trials allowing or mandating proton therapy. Learn about the status of planned clinical trials in the U.S. and worldwide involving ion therapy. Discuss the challenges in the design and QA of clinical trials in particle therapy. Learn about existing and future physical and computational anthropomorphic phantoms for charged particle clinical trial development and support. Research reported in this presentation is supported by the National Cancer Institute of the National; Institutes of Health under Award Number P20CA183640.

60 APPLIED LIFE SCIENCES↗

TU-G-BRB-02: Clinical Trials in Particle Therapy - Open Questions

Proton therapy, in particular, and ion therapy, just beginning, are becoming an increasing focus of attention in clinical radiation oncology and medical physics. Both modalities have been criticized of lacking convincing evidence from randomized trials proving their efficacy, justifying the higher costs involved in these therapies. This session will provide an overview of the current status of clinical trials in proton therapy, including recent developments in ion therapy. As alluded to in the introductory talk by Dr. Schulte, opinions are diverging widely as to the usefulness and need for clinical trials in particle therapy and the challenge of equipoise. The lectures will highlight some of the challenges that surround clinical trials in particle therapy. One, presented by Dr. Choy from UT Southwestern, is that new technology and even different types of particles such as helium and carbon ions are introduced into this environment, increasing the phase space of clinical variables. The other is the issue of medical physics quality assurance with physical phantoms, presented by Mrs. Taylor from IROC Houston, which is more challenging because 3D and 4D image guidance and active delivery techniques are in relatively early stages of development. The role of digital phantoms in developing clinical treatment planning protocols and as a QA tool will also be highlighted by Dr. Lee from NCI. The symposium will be rounded off by a panel discussion among the Symposium speakers, arguing pro or con the need and readiness for clinical trials in proton and ion therapy. Learning Objectives: To get an update on the current status of clinical trials allowing or mandating proton therapy. Learn about the status of planned clinical trials in the U.S. and worldwide involving ion therapy. Discuss the challenges in the design and QA of clinical trials in particle therapy. Learn about existing and future physical and computational anthropomorphic phantoms for charged particle clinical trial development and support. Research reported in this presentation is supported by the National Cancer Institute of the National; Institutes of Health under Award Number P20CA183640.

60 APPLIED LIFE SCIENCES↗

TU-G-BRB-03: IROC Houston’s Proton Beam Validation for Clinical Trials

Proton therapy, in particular, and ion therapy, just beginning, are becoming an increasing focus of attention in clinical radiation oncology and medical physics. Both modalities have been criticized of lacking convincing evidence from randomized trials proving their efficacy, justifying the higher costs involved in these therapies. This session will provide an overview of the current status of clinical trials in proton therapy, including recent developments in ion therapy. As alluded to in the introductory talk by Dr. Schulte, opinions are diverging widely as to the usefulness and need for clinical trials in particle therapy and the challenge of equipoise. The lectures will highlight some of the challenges that surround clinical trials in particle therapy. One, presented by Dr. Choy from UT Southwestern, is that new technology and even different types of particles such as helium and carbon ions are introduced into this environment, increasing the phase space of clinical variables. The other is the issue of medical physics quality assurance with physical phantoms, presented by Mrs. Taylor from IROC Houston, which is more challenging because 3D and 4D image guidance and active delivery techniques are in relatively early stages of development. The role of digital phantoms in developing clinical treatment planning protocols and as a QA tool will also be highlighted by Dr. Lee from NCI. The symposium will be rounded off by a panel discussion among the Symposium speakers, arguing pro or con the need and readiness for clinical trials in proton and ion therapy. Learning Objectives: To get an update on the current status of clinical trials allowing or mandating proton therapy. Learn about the status of planned clinical trials in the U.S. and worldwide involving ion therapy. Discuss the challenges in the design and QA of clinical trials in particle therapy. Learn about existing and future physical and computational anthropomorphic phantoms for charged particle clinical trial development and support. Research reported in this presentation is supported by the National Cancer Institute of the National; Institutes of Health under Award Number P20CA183640.

60 APPLIED LIFE SCIENCES↗

TU-G-BRB-05: Panel Discussion: Clinical Trials in Proton and Ion Therapy - Are We Ready?

Proton therapy, in particular, and ion therapy, just beginning, are becoming an increasing focus of attention in clinical radiation oncology and medical physics. Both modalities have been criticized of lacking convincing evidence from randomized trials proving their efficacy, justifying the higher costs involved in these therapies. This session will provide an overview of the current status of clinical trials in proton therapy, including recent developments in ion therapy. As alluded to in the introductory talk by Dr. Schulte, opinions are diverging widely as to the usefulness and need for clinical trials in particle therapy and the challenge of equipoise. The lectures will highlight some of the challenges that surround clinical trials in particle therapy. One, presented by Dr. Choy from UT Southwestern, is that new technology and even different types of particles such as helium and carbon ions are introduced into this environment, increasing the phase space of clinical variables. The other is the issue of medical physics quality assurance with physical phantoms, presented by Mrs. Taylor from IROC Houston, which is more challenging because 3D and 4D image guidance and active delivery techniques are in relatively early stages of development. The role of digital phantoms in developing clinical treatment planning protocols and as a QA tool will also be highlighted by Dr. Lee from NCI. The symposium will be rounded off by a panel discussion among the Symposium speakers, arguing pro or con the need and readiness for clinical trials in proton and ion therapy. Learning Objectives: To get an update on the current status of clinical trials allowing or mandating proton therapy. Learn about the status of planned clinical trials in the U.S. and worldwide involving ion therapy. Discuss the challenges in the design and QA of clinical trials in particle therapy. Learn about existing and future physical and computational anthropomorphic phantoms for charged particle clinical trial development and support. Research reported in this presentation is supported by the National Cancer Institute of the National; Institutes of Health under Award Number P20CA183640.

60 APPLIED LIFE SCIENCES↗

TH-EF-207A-01: Respiratory Motion Correction in 4D-Multi Pinhole Small Animal SPECT

Purpose: Respiration causes lesion smearing, image blurring and quality degradation, affecting lesion contrast and the ability to define correct lesion size. The spatial resolution of current multi pinhole SPECT (MPHS) scanners is sub-millimeter. Therefore, the effect of motion is more noticeable in comparison to conventional SPECT scanner. Gated imaging aims to reduce motion artifacts. A major issue in gating is the lack of statistics and individual reconstructed frames are noisy. The increased noise in each frame, deteriorates the quantitative accuracy of the MPHS Images. The objective of this work, is to enhance the image quality in 4D-MPHS imaging, by 4D image reconstruction. Methods: The new algorithm requires deformation vector fields (DVFs) that are calculated by non-rigid Demons registration. The algorithm is based on the motion-incorporated version of ordered subset expectation maximization (OSEM) algorithm. This iterative algorithm is capable to make full use of all projections to reconstruct each individual frame. To evaluate the performance of the proposed algorithm a simulation study was conducted. A fast ray tracing method was used to generate MPHS projections of a 4D digital mouse phantom with a small tumor in liver in eight different respiratory phases. To evaluate the 4D-OSEM algorithm potential, tumor to liver activity ratio was compared with other image reconstruction methods including 3D-MPHS and post reconstruction registered with Demons-derived DVFs. Results: Image quality of 4D-MPHS is greatly improved by the 4D-OSEM algorithm. When all projections are used to reconstruct a 3D-MPHS, motion blurring artifacts are present, leading to overestimation of the tumor size and 24% tumor contrast underestimation. This error reduced to 16% and 10% for post reconstruction registration methods and 4D-OSEM respectively. Conclusion: 4D-OSEM method can be used for motion correction in 4D-MPHS. The statistics and quantification are improved since all projection data are combined together to update the image.

60 APPLIED LIFE SCIENCES↗

Experimental evaluation of neural probe’s insertion induced injury based on digital image correlation method

Purpose: The application of neural probes in clinic has been challenged by probes’ short lifetime when implanted into brain tissue. The primary goal is to develop an evaluation system for testing brain tissue injury induced by neural probe’s insertion using microscope based digital image correlation method. Methods: A brain tissue phantom made of silicone rubber with speckle pattern on its surface was fabricated. To obtain the optimal speckle pattern, mean intensity gradient parameter was used for quality assessment. The designed testing system consists of three modules: (a) load module for simulating neural electrode implantation process; (b) data acquisition module to capture micrographs of speckle pattern and to obtain reactive forces during the insertion of the probe; (c) postprocessing module for extracting tissue deformation information from the captured speckle patterns. On the basis of the evaluation system, the effects of probe wedge angle, insertion speed, and probe streamline on insertion induced tissue injury were investigated. Results: The optimal quality speckle pattern can be attained by the following fabrication parameters: spin coating rate—1000 r/min, silicone rubber component A: silicone rubber component B: softener: graphite = 5 ml: 5 ml: 2 ml: 0.6 g. The probe wedge angle has a significant effect on tissue injury. Compared to wedge angle 40° and 20°, maximum principal strain of 60° wedge angle was increased by 40.3% and 87.5%, respectively; compared with a relatively higher speed (500 μm/s), the maximum principle strain within the tissue induced by slow insertion speed (100 μm/s) was increased by 14.3%; insertion force required by probe with convex streamline was smaller than the force of traditional probe. Based on the experimental results, a novel neural probe that has a rounded tip covered by a biodegradable silk protein coating with convex streamline was proposed, which has both lower insertion and micromotion induced tissue injury. Conclusions: The established evaluation system has provided a simulation environment for testing brain tissue injury produced by various insertion conditions. At the same time, it eliminates the adverse effect of biological factors on tissue deformation during the experiment, improving the repeatability of measurement results. As a result, the evaluation system will provide support on novel neural probe design that can reduce the acute tissue injury during the implantation of the probe.

61 RADIATION PROTECTION AND DOSIMETRY↗

Validation of a deformable image registration technique for cone beam CT-based dose verification

Purpose: As radiation therapy evolves toward more adaptive techniques, image guidance plays an increasingly important role, not only in patient setup but also in monitoring the delivered dose and adapting the treatment to patient changes. This study aimed to validate a method for evaluation of delivered intensity modulated radiotherapy (IMRT) dose based on multimodal deformable image registration (DIR) for prostate treatments. Methods: A pelvic phantom was scanned with CT and cone-beam computed tomography (CBCT). Both images were digitally deformed using two realistic patient-based deformation fields. The original CT was then registered to the deformed CBCT resulting in a secondary deformed CT. The registration quality was assessed as the ability of the DIR method to recover the artificially induced deformations. The primary and secondary deformed CT images as well as vector fields were compared to evaluate the efficacy of the registration method and it’s suitability to be used for dose calculation. PLASTIMATCH, a free and open source software was used for deformable image registration. A B-spline algorithm with optimized parameters was used to achieve the best registration quality. Geometric image evaluation was performed through voxel-based Hounsfield unit (HU) and vector field comparison. For dosimetric evaluation, IMRT treatment plans were created and optimized on the original CT image and recomputed on the two warped images to be compared. The dose volume histograms were compared for the warped structures that were identical in both warped images. This procedure was repeated for the phantom with full, half full, and empty bladder. Results: The results indicated mean HU differences of up to 120 between registered and ground-truth deformed CT images. However, when the CBCT intensities were calibrated using a region of interest (ROI)-based calibration curve, these differences were reduced by up to 60%. Similarly, the mean differences in average vector field lengths decreased from 10.1 to 2.5 mm when CBCT was calibrated prior to registration. The results showed no dependence on the level of bladder filling. In comparison with the dose calculated on the primary deformed CT, differences in mean dose averaged over all organs were 0.2% and 3.9% for dose calculated on the secondary deformed CT with and without CBCT calibration, respectively, and 0.5% for dose calculated directly on the calibrated CBCT, for the full-bladder scenario. Gamma analysis for the distance to agreement of 2 mm and 2% of prescribed dose indicated a pass rate of 100% for both cases involving calibrated CBCT and on average 86% without CBCT calibration. Conclusions: Using deformable registration on the planning CT images to evaluate the IMRT dose based on daily CBCTs was found feasible. The proposed method will provide an accurate dose distribution using planning CT and pretreatment CBCT data, avoiding the additional uncertainties introduced by CBCT inhomogeneity and artifacts. This is a necessary initial step toward future image-guided adaptive radiotherapy of the prostate.

60 APPLIED LIFE SCIENCES↗

TU-H-206-01: An Automated Approach for Identifying Geometric Distortions in Gamma Cameras

Purpose: To develop a clinically-deployable, automated process for detecting artifacts in routine nuclear medicine (NM) quality assurance (QA) bar phantom images. Methods: An artifact detection algorithm was created to analyze bar phantom images as part of an ongoing QA program. A low noise, high resolution reference image was acquired from an x-ray of the bar phantom with a Philips Digital Diagnost system utilizing image stitching. NM bar images, acquired for 5 million counts over a 512×512 matrix, were registered to the template image by maximizing mutual information (MI). The MI index was used as an initial test for artifacts; low values indicate an overall presence of distortions regardless of their spatial location. Images with low MI scores were further analyzed for bar linearity, periodicity, alignment, and compression to locate differences with respect to the template. Findings from each test were spatially correlated and locations failing multiple tests were flagged as potential artifacts requiring additional visual analysis. The algorithm was initially deployed for GE Discovery 670 and Infinia Hawkeye gamma cameras. Results: The algorithm successfully identified clinically relevant artifacts from both systems previously unnoticed by technologists performing the QA. Average MI indices for artifact-free images are 0.55. Images with MI indices < 0.50 have shown 100% sensitivity and specificity for artifact detection when compared with a thorough visual analysis. Correlation of geometric tests confirms the ability to spatially locate the most likely image regions containing an artifact regardless of initial phantom orientation. Conclusion: The algorithm shows the potential to detect gamma camera artifacts that may be missed by routine technologist inspections. Detection and subsequent correction of artifacts ensures maximum image quality and may help to identify failing hardware before it impacts clinical workflow. Going forward, the algorithm is being deployed to monitor data from all gamma cameras within our health system.

60 APPLIED LIFE SCIENCES↗

SU-D-BRF-03: Improvement of TomoTherapy Megavoltage Topogram Image Quality for Automatic Registration During Patient Localization

Purpose: To improve the quality of mega-voltage orthogonal scout images (MV topograms) for a fast and low-dose alternative technique for patient localization on the TomoTherapy HiART system. Methods: Digitally reconstructed radiographs (DRR) of anthropomorphic head and pelvis phantoms were synthesized from kVCT under TomoTherapy geometry (kV-DRR). Lateral (LAT) and anterior-posterior (AP) aligned topograms were acquired with couch speeds of 1cm/s, 2cm/s, and 3cm/s. The phantoms were rigidly translated in all spatial directions with known offsets in increments of 5mm, 10mm, and 15mm to simulate daily positioning errors. The contrast of the MV topograms was automatically adjusted based on the image intensity characteristics. A low-pass fast Fourier transform filter removed high-frequency noise and a Weiner filter reduced stochastic noise caused by scattered radiation to the detector array. An intensity-based image registration algorithm was used to register the MV topograms to a corresponding kV-DRR by minimizing the mean square error between corresponding pixel intensities. The registration accuracy was assessed by comparing the normalized cross correlation coefficients (NCC) between the registered topograms and the kV-DRR. The applied phantom offsets were determined by registering the MV topograms with the kV-DRR and recovering the spatial translation of the MV topograms. Results: The automatic registration technique provided millimeter accuracy and was robust for the deformed MV topograms for three tested couch speeds. The lowest average NCC for all AP and LAT MV topograms was 0.96 for the head phantom and 0.93 for the pelvis phantom. The offsets were recovered to within 1.6mm and 6.5mm for the processed and the original MV topograms respectively. Conclusion: Automatic registration of the processed MV topograms to a corresponding kV-DRR recovered simulated daily positioning errors that were accurate to the order of a millimeter. These results suggest the clinical use of MV topograms as a promising alternative to MVCT patient alignment.

60 APPLIED LIFE SCIENCES↗

SU-D-18C-01: A Novel 4D-MRI Technology Based On K-Space Retrospective Sorting

Purpose: Current 4D-MRI techniques lack sufficient temporal/spatial resolution and consistent tumor contrast. To overcome these limitations, this study presents the development and initial evaluation of an entirely new framework of 4D-MRI based on k-space retrospective sorting. Methods: An important challenge of the proposed technique is to determine the number of repeated scans(NR) required to obtain sufficient k-space data for 4D-MRI. To do that, simulations using 29 cancer patients' respiratory profiles were performed to derive the relationship between data acquisition completeness(Cp) and NR, also relationship between NR(Cp=95%) and the following factors: total slice(NS), respiratory phase bin length(Lb), frame rate(fr), resolution(R) and image acquisition starting-phase(P0). To evaluate our technique, a computer simulation study on a 4D digital human phantom (XCAT) were conducted with regular breathing (fr=0.5Hz; R=256×256). A 2D echo planer imaging(EPI) MRI sequence were assumed to acquire raw k-space data, with respiratory signal and acquisition time for each k-space data line recorded simultaneously. K-space data was re-sorted based on respiratory phases. To evaluate 4D-MRI image quality, tumor trajectories were measured and compared with the input signal. Mean relative amplitude difference(D) and cross-correlation coefficient(CC) are calculated. Finally, phase-sharing sliding window technique was applied to investigate the feasibility of generating ultra-fast 4D-MRI. Result: Cp increased with NR(Cp=100*[1-exp(-0.19*NR)], when NS=30, Lb=100%/6). NR(Cp=95%) was inversely-proportional to Lb (r=0.97), but independent of other factors. 4D-MRI on XCAT demonstrated highly accurate motion information (D=0.67%, CC=0.996) with much less artifacts than those on image-based sorting 4D-MRI. Ultra-fast 4D-MRI with an apparent temporal resolution of 10 frames/second was reconstructed using the phase-sharing sliding window technique. Conclusions: A novel 4D-MRI technology based on k-space sorting has been successfully developed and evaluated on the digital phantom. Framework established can be applied to a variety of MR sequences, showing great promises to develop the optimal 4D-MRI technique for many radiation therapy applications. NIH (1R21CA165384-01A1)

60 APPLIED LIFE SCIENCES↗

Segmentation-free empirical beam hardening correction for CT

Purpose: The polychromatic nature of the x-ray beams and their effects on the reconstructed image are often disregarded during standard image reconstruction. This leads to cupping and beam hardening artifacts inside the reconstructed volume. To correct for a general cupping, methods like water precorrection exist. They correct the hardening of the spectrum during the penetration of the measured object only for the major tissue class. In contrast, more complex artifacts like streaks between dense objects need other techniques of correction. If using only the information of one single energy scan, there are two types of corrections. The first one is a physical approach. Thereby, artifacts can be reproduced and corrected within the original reconstruction by using assumptions in a polychromatic forward projector. These assumptions could be the used spectrum, the detector response, the physical attenuation and scatter properties of the intersected materials. A second method is an empirical approach, which does not rely on much prior knowledge. This so-called empirical beam hardening correction (EBHC) and the previously mentioned physical-based technique are both relying on a segmentation of the present tissues inside the patient. The difficulty thereby is that beam hardening by itself, scatter, and other effects, which diminish the image quality also disturb the correct tissue classification and thereby reduce the accuracy of the two known classes of correction techniques. The herein proposed method works similar to the empirical beam hardening correction but does not require a tissue segmentation and therefore shows improvements on image data, which are highly degraded by noise and artifacts. Furthermore, the new algorithm is designed in a way that no additional calibration or parameter fitting is needed. Methods: To overcome the segmentation of tissues, the authors propose a histogram deformation of their primary reconstructed CT image. This step is essential for the proposed algorithm to be segmentation-free (sf). This deformation leads to a nonlinear accentuation of higher CT-values. The original volume and the gray value deformed volume are monochromatically forward projected. The two projection sets are then monomially combined and reconstructed to generate sets of basis volumes which are used for correction. This is done by maximization of the image flatness due to adding additionally a weighted sum of these basis images. sfEBHC is evaluated on polychromatic simulations, phantom measurements, and patient data. The raw data sets were acquired by a dual source spiral CT scanner, a digital volume tomograph, and a dual source micro CT. Different phantom and patient data were used to illustrate the performance and wide range of usability of sfEBHC across different scanning scenarios. The artifact correction capabilities are compared to EBHC. Results: All investigated cases show equal or improved image quality compared to the standard EBHC approach. The artifact correction is capable of correcting beam hardening artifacts for different scan parameters and scan scenarios. Conclusions: sfEBHC generates beam hardening-reduced images and is furthermore capable of dealing with images which are affected by high noise and strong artifacts. The algorithm can be used to recover structures which are hardly visible inside the beam hardening-affected regions.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Filtered-backprojection reconstruction for a cone-beam computed tomography scanner with independent source and detector rotations

Purpose: A new cone-beam CT scanner for image-guided radiotherapy (IGRT) can independently rotate the source and the detector along circular trajectories. Existing reconstruction algorithms are not suitable for this scanning geometry. The authors propose and evaluate a three-dimensional (3D) filtered-backprojection reconstruction for this situation. Methods: The source and the detector trajectories are tuned to image a field-of-view (FOV) that is offset with respect to the center-of-rotation. The new reconstruction formula is derived from the Feldkamp algorithm and results in a similar three-step algorithm: projection weighting, ramp filtering, and weighted backprojection. Simulations of a Shepp Logan digital phantom were used to evaluate the new algorithm with a 10 cm-offset FOV. A real cone-beam CT image with an 8.5 cm-offset FOV was also obtained from projections of an anthropomorphic head phantom. Results: The quality of the cone-beam CT images reconstructed using the new algorithm was similar to those using the Feldkamp algorithm which is used in conventional cone-beam CT. The real image of the head phantom exhibited comparable image quality to that of existing systems. Conclusions: The authors have proposed a 3D filtered-backprojection reconstruction for scanners with independent source and detector rotations that is practical and effective. This algorithm forms the basis for exploiting the scanner’s unique capabilities in IGRT protocols.

60 APPLIED LIFE SCIENCES↗

Effect of optical digitizer selection on the application accuracy of a surgical localization system-a quantitative comparison between the OPTOTRAK and flashpoint tracking systems

Application accuracy is a crucial factor for stereotactic surgical localization systems, in which space digitization camera systems are one of the most critical components. In this study we compared the effect of the OPTOTRAK 3020 space digitization system and the FlashPoint Model 3000 and 5000 3D digitizer systems on the application accuracy for interactive localization of intracranial lesions. A phantom was mounted with several implantable frameless markers which were randomly distributed on its surface. The target point was digitized and the coordinates were recorded and compared with reference points. The differences from the reference points represented the deviation from the "true point." The root mean square (RMS) was calculated to show the differences, and a paired t-test was used to analyze the results. The results with the phantom showed that, for 1-mm sections of CT scans, the RMS was 0.76 +/- 0. 54 mm for the OPTOTRAK system, 1.23 +/- 0.53 mm for the FlashPoint Model 3000 3D digitizer system, and 1.00 +/- 0.42 mm for the FlashPoint Model 5000 system. These preliminary results showed that there is no significant difference between the three tracking systems, and, from the quality point of view, they can all be used for image-guided surgery procedures. Copyright 1999 Wiley-Liss, Inc.

Non-NASA Center↗

Four dimensional magnetic resonance imaging with retrospective k-space reordering: A feasibility study

Purpose: Current four dimensional magnetic resonance imaging (4D-MRI) techniques lack sufficient temporal/spatial resolution and consistent tumor contrast. To overcome these limitations, this study presents the development and initial evaluation of a new strategy for 4D-MRI which is based on retrospective k-space reordering. Methods: We simulated a k-space reordered 4D-MRI on a 4D digital extended cardiac-torso (XCAT) human phantom. A 2D echo planar imaging MRI sequence [frame rate (F) = 0.448 Hz; image resolution (R) = 256 × 256; number of k-space segments (N{sub KS}) = 4] with sequential image acquisition mode was assumed for the simulation. Image quality of the simulated “4D-MRI” acquired from the XCAT phantom was qualitatively evaluated, and tumor motion trajectories were compared to input signals. In particular, mean absolute amplitude differences (D) and cross correlation coefficients (CC) were calculated. Furthermore, to evaluate the data sufficient condition for the new 4D-MRI technique, a comprehensive simulation study was performed using 30 cancer patients’ respiratory profiles to study the relationships between data completeness (C{sub p}) and a number of impacting factors: the number of repeated scans (N{sub R}), number of slices (N{sub S}), number of respiratory phase bins (N{sub P}), N{sub KS}, F, R, and initial respiratory phase at image acquisition (P{sub 0}). As a proof-of-concept, we implemented the proposed k-space reordering 4D-MRI technique on a T2-weighted fast spin echo MR sequence and tested it on a healthy volunteer. Results: The simulated 4D-MRI acquired from the XCAT phantom matched closely to the original XCAT images. Tumor motion trajectories measured from the simulated 4D-MRI matched well with input signals (D = 0.83 and 0.83 mm, and CC = 0.998 and 0.992 in superior–inferior and anterior–posterior directions, respectively). The relationship between C{sub p} and N{sub R} was found best represented by an exponential function (C{sub P}=100(1−e{sup −0.18N{sub R}}), when N{sub S} = 30, N{sub P} = 6). At a C{sub P} value of 95%, the relative error in tumor volume was 0.66%, indicating that N{sub R} at a C{sub P} value of 95% (N{sub R,95%}) is sufficient. It was found that N{sub R,95%} is approximately linearly proportional to N{sub P} (r = 0.99), and nearly independent of all other factors. The 4D-MRI images of the healthy volunteer clearly demonstrated respiratory motion in the diaphragm region with minimal motion induced noise or aliasing. Conclusions: It is feasible to generate respiratory correlated 4D-MRI by retrospectively reordering k-space based on respiratory phase. This new technology may lead to the next generation 4D-MRI with high spatiotemporal resolution and optimal tumor contrast, holding great promises to improve the motion management in radiotherapy of mobile cancers.

60 APPLIED LIFE SCIENCES↗

Heel effect adaptive flat field correction of digital x-ray detectors

Purpose: Anode heel effect renders large-scale background nonuniformities in digital radiographs. Conventional offset/gain calibration is performed at mono source-to-image distance (SID), and disregards the SID-dependent characteristic of heel effect. It results in a residual nonuniform background in the corrected radiographs when the SID settings for calibration and correction differ. In this work, the authors develop a robust and efficient computational method for digital x-ray detector gain correction adapted to SID-variant heel effect, without resorting to physical filters, phantoms, complicated heel effect models, or multiple-SID calibration and interpolation.Methods: The authors present the Duo-SID projection correction method. In our approach, conventional offset/gain calibrations are performed only twice, at the minimum and maximum SIDs of the system in typical clinical use. A fast iterative separation algorithm is devised to extract the detector gain and basis heel patterns from the min/max SID calibrations. The resultant detector gain is independent of SID, while the basis heel patterns are parameterized by the min- and max-SID. The heel pattern at any SID is obtained from the min-SID basis heel pattern via projection imaging principles. The system gain desired at a specific acquisition SID is then constructed using the projected heel pattern and detector gain map.Results: The method was evaluated for flat field and anatomical phantom image corrections. It demonstrated promising improvements over interpolation and conventional gain calibration/correction methods, lowering their correction errors by approximately 70% and 80%, respectively. The separation algorithm was able to extract the detector gain and heel patterns with less than 2% error, and the Duo-SID corrected images showed perceptually appealing uniform background across the detector.Conclusions: The Duo-SID correction method has substantially improved on conventional offset/gain corrections for digital x-ray imaging in an SID-variant environment. The technique is relatively simple, and can be easily incorporated into multiple-point gain calibration/correction techniques. It offers a potentially valuable tool for preprocessing digital x-ray images to boost image quality of mammography, chest and cardiac radiography, as well as automated computer aided diagnostic radiology.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Evaluation of respiratory and cardiac motion correction schemes in dual gated PET/CT cardiac imaging

Purpose: Cardiac imaging suffers from both respiratory and cardiac motion. One of the proposed solutions involves double gated acquisitions. Although such an approach may lead to both respiratory and cardiac motion compensation there are issues associated with (a) the combination of data from cardiac and respiratory motion bins, and (b) poor statistical quality images as a result of using only part of the acquired data. The main objective of this work was to evaluate different schemes of combining binned data in order to identify the best strategy to reconstruct motion free cardiac images from dual gated positron emission tomography (PET) acquisitions. Methods: A digital phantom study as well as seven human studies were used in this evaluation. PET data were acquired in list mode (LM). A real-time position management system and an electrocardiogram device were used to provide the respiratory and cardiac motion triggers registered within the LM file. Acquired data were subsequently binned considering four and six cardiac gates, or the diastole only in combination with eight respiratory amplitude gates. PET images were corrected for attenuation, but no randoms nor scatter corrections were included. Reconstructed images from each of the bins considered above were subsequently used in combination with an affine or an elastic registration algorithm to derive transformation parameters allowing the combination of all acquired data in a particular position in the cardiac and respiratory cycles. Images were assessed in terms of signal-to-noise ratio (SNR), contrast, image profile, coefficient-of-variation (COV), and relative difference of the recovered activity concentration. Results: Regardless of the considered motion compensation strategy, the nonrigid motion model performed better than the affine model, leading to higher SNR and contrast combined with a lower COV. Nevertheless, when compensating for respiration only, no statistically significant differences were observed in the performance of the two motion models considered. Superior image SNR and contrast were seen using the affine respiratory motion model in combination with the diastole cardiac bin in comparison to the use of the whole cardiac cycle. In contrast, when simultaneously correcting for cardiac beating and respiration, the elastic respiratory motion model outperformed the affine model. In this context, four cardiac bins associated with eight respiratory amplitude bins seemed to be adequate. Conclusions: Considering the compensation of respiratory motion effects only, both affine and elastic based approaches led to an accurate resizing and positioning of the myocardium. The use of the diastolic phase combined with an affine model based respiratory motion correction may therefore be a simple approach leading to significant quality improvements in cardiac PET imaging. However, the best performance was obtained with the combined correction for both cardiac and respiratory movements considering all the dual-gated bins independently through the use of an elastic model based motion compensation.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

SU-D-204-06: Dose and Image Quality Evaluation of a Low-Dose Slot-Scanning X-Ray System for Pediatric Orthopedic Studies

Purpose: Children in early teens with scoliosis require repeated radiographic exams over a number of years. The EOS (EOS imaging S.A., Paris, France) is a novel low-dose slot-scanning digital radiographic system designed to produce full-spine images of a free-standing patient. The radiation dose and image quality characteristics of the EOS were evaluated relative to those of a Computed Radiography (CR) system for scoliosis imaging. Methods: For dose evaluation, a full-torso anthropomorphic phantom was scanned five times using the default standard clinical protocols for both the EOS and a CR system, which include both posteroanterior and lateral full-spine views. Optically stimulated luminescent dosimeters (OSLDs), also known as nanoDots™ (Landauer, Inc., Glenwood, IL), were placed on the phantom’s surface to measure entrance skin dose. To assess image quality, MTF curves were generated from sampling the noise levels within the high-contrast regions of a line-pair phantom. Vertical and horizontal distortions were measured for the square line-pair phantom with the EOS system to evaluate the effects of geometric magnification and misalignment with the indicated imaging plane. Results: The entrance skin dose was measured to be 0.4 to 1.1 mGy for the EOS, and 0.7 to 3.6 mGy for the CR study. MTF comparison shows that CR greatly outperforms the EOS, despite both systems having a limiting resolution at 1.8 line-pairs per mm. Vertical distortion was unaffected by phantom positioning, because of the EOS slot-scanning geometry. Horizontal distortion increased linearly with miscentering distance. Conclusion: The EOS system resulted in approximately 70% lower radiation dose than CR for full-spine images. Image quality was found to be inferior to CR. Further investigation is required to see if EOS system is an acceptable modality for performing clinically diagnostic scoliosis examinations.

60 APPLIED LIFE SCIENCES↗

SU-E-J-27: Shifting Multiple EPID Imager Layers to Improve Image Quality and Resolution in MV CBCT

Purpose: Vertical stacking of four conventional EPID layers can improve DQE for MV-CBCT applications. We hypothesize that shifting each layer laterally by half a pixel relative to the layer above, will improve the contrast-to-noise ratio (CNR) and image resolution. Methods: For CNR assessment, a 20 cm diameter digital phantom with 8 inserts is created. The attenuation coefficient of the phantom is similar to lung at the average energy of a 6 MV photon beam. The inserts have attenuations 1, 2…8 times of lung. One of the inserts is close to soft tissue, resembling the case of a tumor in lung. For resolution assessment, a digital phantom featuring a bar pattern is created. The phantom has an attenuation coefficient similar to soft tissue and the bars have an attenuation coefficient of calcium sulfate. A 2 MeV photon beam is attenuated through these phantoms and hits each of the four stacked detector layers. Each successive layer is shifted by half a pixel in the x only, y only, and x and y (combined) directions, respectively. Blurring and statistical noise are added to the projections. Projections from one, two, three and four layers are used for reconstruction. CNR and image resolution are evaluated and compared. Results: When projections from multiple layers are combined for reconstruction, CNR increases with the number of layers involved. CNR in reconstructions from two, three and four layers are 1.4, 1.7 and 1.99 times that from one layer. The resolution from the shifted four layer detector is also improved from a single layer. In a comparison between one layer versus four layers in this preliminary study, the resolution from four shifted layers is at least 20% better. Conclusion: Layer-shifting in a stacked EPID imager design enhances resolution as well as CNR for half scan MV-CBCT. The project described was supported, in part, by a grant from Varian Medical Systems, Inc., and Award No. R01CA188446-01 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

60 APPLIED LIFE SCIENCES↗