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Evaluating Machine Learning-Based MRI Reconstruction Using Digital Image Quality Phantoms

Quantitative and objective evaluation tools are essential for assessing the performance of machine learning (ML)-based magnetic resonance imaging (MRI) reconstruction methods. However, the commonly used fidelity metrics, such as mean squared error (MSE), structural similarity (SSIM), and peak signal-to-noise ratio (PSNR), often fail to capture fundamental and clinically relevant MR image quality aspects. To address this, we propose evaluation of ML-based MRI reconstruction using digital image quality phantoms and automated evaluation methods. Our phantoms are based upon the American College of Radiology (ACR) large physical phantom but created in k-space to simulate their MR images, and they can vary in object size, signal-to-noise ratio, resolution, and image contrast. Our evaluation pipeline incorporates evaluation metrics of geometric accuracy, intensity uniformity, percentage ghosting, sharpness, signal-to-noise ratio, resolution, and low-contrast detectability. We demonstrate the utility of our proposed pipeline by assessing an example ML-based reconstruction model across various training and testing scenarios. The performance results indicate that training data acquired with a lower undersampling factor and coils of larger anatomical coverage yield a better performing model. The comprehensive and standardized pipeline introduced in this study can help to facilitate a better understanding of the performance and guide future development and advancement of ML-based reconstruction algorithms.

47 OTHER INSTRUMENTATION↗

Quantifying the impact of respiratory-gated 4D CT acquisition on thoracic image quality: A digital phantom study

Purpose: Prospective respiratory-gated 4D CT has been shown to reduce tumor image artifacts by up to 50% compared to conventional 4D CT. However, to date no studies have quantified the impact of gated 4D CT on normal lung tissue imaging, which is important in performing dose calculations based on accurate estimates of lung volume and structure. To determine the impact of gated 4D CT on thoracic image quality, the authors developed a novel simulation framework incorporating a realistic deformable digital phantom driven by patient tumor motion patterns. Based on this framework, the authors test the hypothesis that respiratory-gated 4D CT can significantly reduce lung imaging artifacts. Methods: Our simulation framework synchronizes the 4D extended cardiac torso (XCAT) phantom with tumor motion data in a quasi real-time fashion, allowing simulation of three 4D CT acquisition modes featuring different levels of respiratory feedback: (i) “conventional” 4D CT that uses a constant imaging and couch-shift frequency, (ii) “beam paused” 4D CT that interrupts imaging to avoid oversampling at a given couch position and respiratory phase, and (iii) “respiratory-gated” 4D CT that triggers acquisition only when the respiratory motion fulfills phase-specific displacement gating windows based on prescan breathing data. Our framework generates a set of ground truth comparators, representing the average XCAT anatomy during beam-on for each of ten respiratory phase bins. Based on this framework, the authors simulated conventional, beam-paused, and respiratory-gated 4D CT images using tumor motion patterns from seven lung cancer patients across 13 treatment fractions, with a simulated 5.5 cm{sup 3} spherical lesion. Normal lung tissue image quality was quantified by comparing simulated and ground truth images in terms of overall mean square error (MSE) intensity difference, threshold-based lung volume error, and fractional false positive/false negative rates. Results: Averaged across all simulations and phase bins, respiratory-gating reduced overall thoracic MSE by 46% compared to conventional 4D CT (p ∼ 10{sup −19}). Gating leads to small but significant (p < 0.02) reductions in lung volume errors (1.8%–1.4%), false positives (4.0%–2.6%), and false negatives (2.7%–1.3%). These percentage reductions correspond to gating reducing image artifacts by 24–90 cm{sup 3} of lung tissue. Similar to earlier studies, gating reduced patient image dose by up to 22%, but with scan time increased by up to 135%. Beam paused 4D CT did not significantly impact normal lung tissue image quality, but did yield similar dose reductions as for respiratory-gating, without the added cost in scanning time. Conclusions: For a typical 6 L lung, respiratory-gated 4D CT can reduce image artifacts affecting up to 90 cm{sup 3} of normal lung tissue compared to conventional acquisition. This image improvement could have important implications for dose calculations based on 4D CT. Where image quality is less critical, beam paused 4D CT is a simple strategy to reduce imaging dose without sacrificing acquisition time.

60 APPLIED LIFE SCIENCES↗

SU-E-J-158: Audiovisual Biofeedback Reduces Image Artefacts in 4DCT: A Digital Phantom Study

Purpose: Irregular breathing motion has a deleterious impact on 4DCT image quality. The breathing guidance system: audiovisual biofeedback (AVB) is designed to improve breathing regularity, however, its impact on 4DCT image quality has yet to be quantified. The purpose of this study was to quantify the impact of AVB on thoracic 4DCT image quality by utilizing the digital eXtended Cardiac Torso (XCAT) phantom driven by lung tumor motion patterns. Methods: 2D tumor motion obtained from 4 lung cancer patients under two breathing conditions (i) without breathing guidance (free breathing), and (ii) with guidance (AVB). There were two breathing sessions, yielding 8 tumor motion traces. This tumor motion was synchronized with the XCAT phantom to simulate 4DCT acquisitions under two acquisition modes: (1) cine mode, and (2) prospective respiratory-gated mode. Motion regularity was quantified by the root mean square error (RMSE) of displacement. The number of artefacts was visually assessed for each 4DCT and summed up for each breathing condition. Inter-session anatomic reproducibility was quantified by the mean absolute difference (MAD) between the Session 1 4DCT and Session 2 4DCT. Results: AVB improved tumor motion regularity by 30%. In cine mode, the number of artefacts was reduced from 61 in free breathing to 40 with AVB, in addition to AVB reducing the MAD by 34%. In gated mode, the number of artefacts was reduced from 63 in free breathing to 51 with AVB, in addition to AVB reducing the MAD by 23%. Conclusion: This was the first study to compare the impact of breathing guidance on 4DCT image quality compared to free breathing, with AVB reducing the amount of artefacts present in 4DCT images in addition to improving inter-session anatomic reproducibility. Results thus far suggest that breathing guidance interventions could have implications for improving radiotherapy treatment planning and interfraction reproducibility.

60 APPLIED LIFE SCIENCES↗

SU-E-I-94: Automated Image Quality Assessment of Radiographic Systems Using An Anthropomorphic Phantom

Purpose: In a large, academic medical center, consistent radiographic imaging performance is difficult to routinely monitor and maintain, especially for a fleet consisting of multiple vendors, models, software versions, and numerous imaging protocols. Thus, an automated image quality control methodology has been implemented using routine image quality assessment with a physical, stylized anthropomorphic chest phantom. Methods: The “Duke” Phantom (Digital Phantom 07-646, Supertech, Elkhart, IN) was imaged twice on each of 13 radiographic units from a variety of vendors at 13 primary care clinics. The first acquisition used the clinical PA chest protocol to acquire the post-processed “FOR PRESENTATION” image. The second image was acquired without an antiscatter grid followed by collection of the “FOR PROCESSING” image. Manual CNR measurements were made from the largest and thickest contrast-detail inserts in the lung, heart, and abdominal regions of the phantom in each image. An automated image registration algorithm was used to estimate the CNR of the same insert using similar ROIs. Automated measurements were then compared to the manual measurements. Results: Automatic and manual CNR measurements obtained from “FOR PRESENTATION” images had average percent differences of 0.42%±5.18%, −3.44%±4.85%, and 1.04%±3.15% in the lung, heart, and abdominal regions, respectively; measurements obtained from “FOR PROCESSING” images had average percent differences of -0.63%±6.66%, −0.97%±3.92%, and −0.53%±4.18%, respectively. The maximum absolute difference in CNR was 15.78%, 10.89%, and 8.73% in the respective regions. In addition to CNR assessment of the largest and thickest contrast-detail inserts, the automated method also provided CNR estimates for all 75 contrast-detail inserts in each phantom image. Conclusion: Automated analysis of a radiographic phantom has been shown to be a fast, robust, and objective means for assessing radiographic image quality. The method reduces the burden of manual measurements and provides a means by which to monitor and compare radiographic system performance.

60 APPLIED LIFE SCIENCES↗

SU-G-IeP3-09: Investigating the Interplay of Antiscatter Grids with Modern Detectors and Image Processing in Digital Radiography

Purpose: To use phantom and simulation experiments to relate technique factors, patient size and antiscatter grid use to image quality in portable digital radiography (DR), in light of advancements in detector design and image processing. Methods: Image contrast-to-noise ratio (CNR) on a portable DR system (MobileDaRt Evolution, Shimadzu) was measured by imaging four aluminum inserts of varying thickness, superimposed on a Lucite slab phantom using a pediatric abdominal protocol. Three thicknesses of Lucite were used: 6.1cm, 12cm, and 18.2cm, with both 55 and 65 kVp beams. The mAs was set so that detector entrance exposure (DEE) was matched between kVp values. Each technique and phantom was used with and without an antiscatter grid (focused linear grid embedded in aluminum with an 8:1 ratio). The CNR-improvement-factor was then used to determine the thickness- and technique-dependent appropriateness of grid use. Finally, the same experiment was performed via Monte Carlo simulation, integrating incident energy fluence at each detector pixel, so that effects of detector design and image processing could be isolated from physical factors upstream of the detector. Results: The physical phantom experiment demonstrated a clear improvement for the lower tube voltage (55kVp), along with substantial CNR benefits with grid use for 12–18cm phantoms. Neither trend was evident with Monte Carlo, suggesting that suboptimal quantum-detection-efficiency and automated grid-removal could explain trends in kVp and grid use, respectively. Conclusion: Physical experiments demonstrate marked improvement in CNR when using a grid for phantoms of 12 and 18cm Lucite thickness (above ∼10cm soft-tissue equivalent). This benefit is likely due to image processing, as this result was not seen with Monte Carlo. The impact of image processing on image resolution should also be investigated, and the CNR benefit of low kVp and grid use should be weighed against the increased exposure time necessary to achieve adequate DEE.

60 APPLIED LIFE SCIENCES↗

TH-E-17A-06: Anatomical-Adaptive Compressed Sensing (AACS) Reconstruction for Thoracic 4-Dimensional Cone-Beam CT

Purpose: The Feldkamp-Davis-Kress (FDK) algorithm currently used for clinical thoracic 4-dimensional (4D) cone-beam CT (CBCT) reconstruction suffers from noise and streaking artifacts due to projection under-sampling. Compressed sensing theory enables reconstruction of under-sampled datasets via total-variation (TV) minimization, but TV-minimization algorithms such as adaptive-steepest-descent-projection-onto-convex-sets (ASD-POCS) often converge slowly and are prone to over-smoothing anatomical details. These disadvantages can be overcome by incorporating general anatomical knowledge via anatomy segmentation. Based on this concept, we have developed an anatomical-adaptive compressed sensing (AACS) algorithm for thoracic 4D-CBCT reconstruction. Methods: AACS is based on the ASD-POCS framework, where each iteration consists of a TV-minimization step and a data fidelity constraint step. Prior to every AACS iteration, four major thoracic anatomical structures - soft tissue, lungs, bony anatomy, and pulmonary details - were segmented from the updated solution image. Based on the segmentation, an anatomical-adaptive weighting was applied to the TV-minimization step, so that TV-minimization was enhanced at noisy/streaky regions and suppressed at anatomical structures of interest. The image quality and convergence speed of AACS was compared to conventional ASD-POCS using an XCAT digital phantom and a patient scan. Results: For the XCAT phantom, the AACS image represented the ground truth better than the ASD-POCS image, giving a higher structural similarity index (0.93 vs. 0.84) and lower absolute difference (1.1*10{sup 4} vs. 1.4*10{sup 4}). For the patient case, while both algorithms resulted in much less noise and streaking than FDK, the AACS image showed considerably better contrast and sharpness of the vessels, tumor, and fiducial marker than the ASD-POCS image. In addition, AACS converged over 50% faster than ASD-POCS in both cases. Conclusions: The proposed AACS algorithm was shown to reconstruct thoracic 4D-CBCT images more accurately and with faster convergence compared to ASD-POCS. The superior image quality and rapid convergence makes AACS promising for future clinical use.

60 APPLIED LIFE SCIENCES↗

WE-G-207-04: Non-Local Total-Variation (NLTV) Combined with Reweighted L1-Norm for Compressed Sensing Based CT Reconstruction

Purpose: Compressed sensing (CS) has been used for CT (4DCT/CBCT) reconstruction with few projections to reduce dose of radiation. Total-variation (TV) in L1-minimization (min.) with local information is the prevalent technique in CS, while it can be prone to noise. To address the problem, this work proposes to apply a new image processing technique, called non-local TV (NLTV), to CS based CT reconstruction, and incorporate reweighted L1-norm into it for more precise reconstruction. Methods: TV minimizes intensity variations by considering two local neighboring voxels, which can be prone to noise, possibly damaging the reconstructed CT image. NLTV, contrarily, utilizes more global information by computing a weight function of current voxel relative to surrounding search area. In fact, it might be challenging to obtain an optimal solution due to difficulty in defining the weight function with appropriate parameters. Introducing reweighted L1-min., designed for approximation to ideal L0-min., can reduce the dependence on defining the weight function, therefore improving accuracy of the solution. This work implemented the NLTV combined with reweighted L1-min. by Split Bregman Iterative method. For evaluation, a noisy digital phantom and a pelvic CT images are employed to compare the quality of images reconstructed by TV, NLTV and reweighted NLTV. Results: In both cases, conventional and reweighted NLTV outperform TV min. in signal-to-noise ratio (SNR) and root-mean squared errors of the reconstructed images. Relative to conventional NLTV, NLTV with reweighted L1-norm was able to slightly improve SNR, while greatly increasing the contrast between tissues due to additional iterative reweighting process. Conclusion: NLTV min. can provide more precise compressed sensing based CT image reconstruction by incorporating the reweighted L1-norm, while maintaining greater robustness to the noise effect than TV min.

60 APPLIED LIFE SCIENCES↗

WE-D-303-01: Development and Application of Digital Human Phantoms

Modern medical physics deals with complex problems such as 4D radiation therapy and imaging quality optimization. Such problems involve a large number of radiological parameters, and anatomical and physiological breathing patterns. A major challenge is how to develop, test, evaluate and compare various new imaging and treatment techniques, which often involves testing over a large range of radiological parameters as well as varying patient anatomies and motions. It would be extremely challenging, if not impossible, both ethically and practically, to test every combination of parameters and every task on every type of patient under clinical conditions. Computer-based simulation using computational phantoms offers a practical technique with which to evaluate, optimize, and compare imaging technologies and methods. Within simulation, the computerized phantom provides a virtual model of the patient’s anatomy and physiology. Imaging data can be generated from it as if it was a live patient using accurate models of the physics of the imaging and treatment process. With sophisticated simulation algorithms, it is possible to perform virtual experiments entirely on the computer. By serving as virtual patients, computational phantoms hold great promise in solving some of the most complex problems in modern medical physics. In this proposed symposium, we will present the history and recent developments of computational phantom models, share experiences in their application to advanced imaging and radiation applications, and discuss their promises and limitations. Learning Objectives: Understand the need and requirements of computational phantoms in medical physics research Discuss the developments and applications of computational phantoms Know the promises and limitations of computational phantoms in solving complex problems.

60 APPLIED LIFE SCIENCES↗

SU-E-I-45: Feasibility for Using Iodine Quantification to Assist Diagnosis in Dual Energy Contrast-Enhanced Digital Mammography

Purpose: The objective of this study is to develop quantitative calibration between image quality indexes and iodine concentration with dual-energy (DE) contrast-enhanced digital mammography (CEDM) techniques and further serve as the assistance for diagnosis. Methods: Custom-made acrylic phantom with dimensions of 24×30 cm{sup 2} simulated breast thickness from 2 to 6 cm was used in the calibration. The phantom contained matrix of four times four holes of 3 mm deep with a diameter of 15 mm for filling contrast agent with area density ranged from 0.1 to 10 mg/cm{sup 2}. All the image acquisitions were performed on a full-field digital mammography system (Senographe Essential, GE) with dual energy acquisitions. Mean pixel value (MPV), and contrast-to-noise ratio (CNR) were used for evaluating the relationship between image quality indexes and iodine concentration. Iodine map and CNR map could further be constructed with these calibration curves applied pixel by pixel utilized MATLAB software. Minimum iodine concentration could also be calculated with the visibility threshold of CNR=5 according the Rose model. Results: When evaluating the DE subtraction images, MPV increased linearly as the iodine concentration increased with all the phantom thickness surveyed (R{sup 2} between 0.989 and 0.992). Lesions with increased iodine uptake could thus be enhanced in the color-encoded iodine maps, and the mean iodine concentration could be obtained through the ROI measurements. As for investigating CNR performance, linear relationships were also shown between the iodine concentration and CNR (R{sup 2} between 0.983 and 0.990). Minimum iodine area density of 1.45, 1.73, 1.80, 1.73 and 1.72 mg/cm{sup 2} for phantom thickness of 2, 3, 4, 5, 6 cm were calculated based on Rose’s visualization criteria. Conclusion: Quantitative calibration between image quality indexes and iodine concentrations may further serving as the assistance for analyzing contrast enhancement for patient participating the dual energy CEDM procedures.

60 APPLIED LIFE SCIENCES↗

A four‐alternative forced choice (4AFC) methodology for evaluating microcalcification detection in clinical full‐field digital mammography (FFDM) and digital breast tomosynthesis (DBT) systems using an inkjet‐printed anthropomorphic phantom

Purpose The advent of three‐dimensional breast imaging systems such as digital breast tomosynthesis (DBT) has great promise for improving the detection and diagnosis of breast cancer. With these new technologies comes an essential need for testing methods to assess the resultant image quality. Although randomized clinical trials are the gold standard for assessing image quality, phantom‐based studies can provide a simpler and less burdensome approach. In this work, a complete framework is presented for task‐based evaluation of microcalcification (MCs) detection performance for DBT imaging systems. Methods The framework consists of three parts. The first part is a realistic anthropomorphic physical breast phantom created through inkjet printing, with parchment paper and iodine‐doped ink. The second is a method for inserting realistic MCs fabricated from calcium hydroxyapatite. The reproducibility and stability of the phantom materials were investigated through multiple samples of parchment and ink over 6 months. The final part is an analysis using a four‐alternative forced choice (4AFC) reader study. To demonstrate the framework, a task‐based 4AFC study was conducted using a clinical system to compare performance from DBT, synthetic mammography (SM), and full‐field digital mammography (FFDM). Nine human observers read images containing MC clusters imaged with all three modalities and tried to correctly locate the MCs. The proportion correct (PC) was measured as the number of correctly detected clusters out of all trials. Results Overall, readers scored the highest with FFDM, (PC = 0.95 ± 0.03) then DBT (0.85 ± 0.04), and finally SM (0.44 ± 0.06). For the parchment and ink samples, the linear attenuation properties were very stable over 6 months. In addition, little difference was found between the various parchment and ink samples, indicating good reproducibility. Conclusions This framework presents a promising methodology for evaluating diagnostic task performance of clinical breast DBT systems.

Ikejimba, Lynda C.↗

SU-E-J-02: 4D Digital Tomosynthesis Based On Algebraic Image Reconstruction and Total-Variation Minimization for the Improvement of Image Quality

Purpose: In this paper, we implemented the four-dimensional (4D) digital tomosynthesis (DTS) imaging based on algebraic image reconstruction technique and total-variation minimization method in order to compensate the undersampled projection data and improve the image quality. Methods: The projection data were acquired as supposed the cone-beam computed tomography system in linear accelerator by the Monte Carlo simulation and the in-house 4D digital phantom generation program. We performed 4D DTS based upon simultaneous algebraic reconstruction technique (SART) among the iterative image reconstruction technique and total-variation minimization method (TVMM). To verify the effectiveness of this reconstruction algorithm, we performed systematic simulation studies to investigate the imaging performance. Results: The 4D DTS algorithm based upon the SART and TVMM seems to give better results than that based upon the existing method, or filtered-backprojection. Conclusion: The advanced image reconstruction algorithm for the 4D DTS would be useful to validate each intra-fraction motion during radiation therapy. In addition, it will be possible to give advantage to real-time imaging for the adaptive radiation therapy. This research was supported by Leading Foreign Research Institute Recruitment Program (Grant No.2009-00420) and Basic Atomic Energy Research Institute (BAERI); (Grant No. 2009-0078390) through the National Research Foundation of Korea(NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP)

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-F-J-183: Interior Region-Of-Interest Tomography by Using Inverse Geometry System

Purpose: The inverse geometry computed tomography (IGCT) composed of multiple source and small size detector has several merits such as reduction of scatter effect and large volumetric imaging within one rotation without cone-beam artifact, compared to conventional cone-beam computed tomography (CBCT). By using this multi-source characteristics, we intend to present a selective and multiple interior region-of-interest (ROI) imaging method by using a designed source on-off sequence of IGCT. Methods: All of the IGCT sources are operated one by one sequentially, and each projection in the shape of narrow cone-beam covers its own partial volume of full field of view (FOV) determined from system geometry. Thus, through controlling multi source operation, limited irradiation within ROI is possible and selective radon space data for ROI imaging can be acquired without additional X-ray filtration. With this feature, we designed a source on-off sequence for multi ROI-IGCT imaging, and projections of ROI-IGCT were generated by using the on-off sequence. Multi ROI-IGCT images were reconstructed by using filtered back-projection algorithm. All these imaging process of our study has been performed by utilizing digital phantom and patient CT data. ROI-IGCT images of the phantom were compared to CBCT image and the phantom data for the image quality evaluation. Results: Image quality of ROI-IGCT was comparable to that of CBCT. However, the distal axial-plane from the FOV center, large cone-angle region, ROI-IGCT showed uniform image quality without significant cone-beam artifact contrary to CBCT. Conclusion: ROI-IGCT showed comparable image quality and has the capability to provide multi ROI image within a rotation. Projection of ROI-IGCT is performed by selective irradiation, hence unnecessary imaging dose to non-interest region can be reduced. In this regard, it seems to be useful for diagnostic or image guidance purpose in radiotherapy such as low dose target localization and patient alignment. This research was supported by the Mid-career Researcher Program through NRF funded by the Ministry of Science, ICT & Future Planning of Korea (NRF-2014R1A2A1A10050270) and by the Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (No. 2013M2A2A7038291)

60 APPLIED LIFE SCIENCES↗

Cardiac motion correction based on partial angle reconstructed images in x-ray CT

Purpose: Cardiac x-ray CT imaging is still challenging due to heart motion, which cannot be ignored even with the current rotation speed of the equipment. In response, many algorithms have been developed to compensate remaining motion artifacts by estimating the motion using projection data or reconstructed images. In these algorithms, accurate motion estimation is critical to the compensated image quality. In addition, since the scan range is directly related to the radiation dose, it is preferable to minimize the scan range in motion estimation. In this paper, the authors propose a novel motion estimation and compensation algorithm using a sinogram with a rotation angle of less than 360°. The algorithm estimates the motion of the whole heart area using two opposite 3D partial angle reconstructed (PAR) images and compensates the motion in the reconstruction process. Methods: A CT system scans the thoracic area including the heart over an angular range of 180° + α + β, where α and β denote the detector fan angle and an additional partial angle, respectively. The obtained cone-beam projection data are converted into cone-parallel geometry via row-wise fan-to-parallel rebinning. Two conjugate 3D PAR images, whose center projection angles are separated by 180°, are then reconstructed with an angular range of β, which is considerably smaller than a short scan range of 180° + α. Although these images include limited view angle artifacts that disturb accurate motion estimation, they have considerably better temporal resolution than a short scan image. Hence, after preprocessing these artifacts, the authors estimate a motion model during a half rotation for a whole field of view via nonrigid registration between the images. Finally, motion-compensated image reconstruction is performed at a target phase by incorporating the estimated motion model. The target phase is selected as that corresponding to a view angle that is orthogonal to the center view angles of two conjugate PAR images. To evaluate the proposed algorithm, digital XCAT and physical dynamic cardiac phantom datasets are used. The XCAT phantom datasets were generated with heart rates of 70 and 100 bpm, respectively, by assuming a system rotation time of 300 ms. A physical dynamic cardiac phantom was scanned using a slowly rotating XCT system so that the effective heart rate will be 70 bpm for a system rotation speed of 300 ms. Results: In the XCAT phantom experiment, motion-compensated 3D images obtained from the proposed algorithm show coronary arteries with fewer motion artifacts for all phases. Moreover, object boundaries contaminated by motion are well restored. Even though object positions and boundary shapes are still somewhat different from the ground truth in some cases, the authors see that visibilities of coronary arteries are improved noticeably and motion artifacts are reduced considerably. The physical phantom study also shows that the visual quality of motion-compensated images is greatly improved. Conclusions: The authors propose a novel PAR image-based cardiac motion estimation and compensation algorithm. The algorithm requires an angular scan range of less than 360°. The excellent performance of the proposed algorithm is illustrated by using digital XCAT and physical dynamic cardiac phantom datasets.

60 APPLIED LIFE SCIENCES↗

SU-E-I-04: A Mammography Phantom to Measure Mean Glandular Dose and Image Quality

Purpose: To evaluate mean glandular dose (MGD) and image quality in a selection of mammography systems using a novel phantom based on thermoluminescent dosemeters and the ACR wax insert. Methods: The phantom consists of two acrylic, 19 cm diameter, 4.5 cm thick, semicircular modules, used in sequence. The image quality module contains the ACR insert and is used to obtain a quality control image under automatic exposure conditions. The dosimetric module carries 15 TLD-100 chips, some under Al foils, to determine air kerma and half-value-layer. TL readings take place at our laboratory under controlled conditions. Calibration was performed using an ionization chamber and a Senographe 2000D unit for a variety of beam qualities, from 24 to 40 kV, Mo and Rh anodes and filters. Phantom MGD values agree, on the average, within 3% with ionization chamber data, and their precision is better than 10% (k=1). Results: MGD and image quality have been evaluated in a selection of mammography units currently used in Mexican health services. The sample includes analogic (screen/film), flexible digital (CR), and full-field digital image receptors. The highest MDG are associated to the CR technology. The most common image quality failure is due to artifacts (dust, intensifying screen scratches, and processor marks for film/screen, laser reader defects for CR). Conclusion: The developed phantom permits the MGD measurement without the need of a calibrated ionization chamber at the mammography site and can be used by a technician without the presence of a medical physicist. The results indicate the urgent need to establish quality control programs for mammography.

07 ISOTOPE AND RADIATION SOURCES↗

TU-G-BRB-04: Digital Phantoms for Developing Protocols in Particle Therapy

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↗

A virtual trial framework for quantifying the detectability of masses in breast tomosynthesis projection data

Purpose: Digital breast tomosynthesis (DBT) is a promising breast cancer screening tool that has already begun making inroads into clinical practice. However, there is ongoing debate over how to quantitatively evaluate and optimize these systems, because different definitions of image quality can lead to different optimal design strategies. Powerful and accurate tools are desired to extend our understanding of DBT system optimization and validate published design principles. Methods: The authors developed a virtual trial framework for task-specific DBT assessment that uses digital phantoms, open-source x-ray transport codes, and a projection-space, spatial-domain observer model for quantitative system evaluation. The authors considered evaluation of reconstruction algorithms as a separate problem and focused on the information content in the raw, unfiltered projection images. Specifically, the authors investigated the effects of scan angle and number of angular projections on detectability of a small (3 mm diameter) signal embedded in randomly-varying anatomical backgrounds. Detectability was measured by the area under the receiver-operating characteristic curve (AUC). Experiments were repeated for three test cases where the detectability-limiting factor was anatomical variability, quantum noise, or electronic noise. The authors also juxtaposed the virtual trial framework with other published studies to illustrate its advantages and disadvantages. Results: The large number of variables in a virtual DBT study make it difficult to directly compare different authors' results, so each result must be interpreted within the context of the specific virtual trial framework. The following results apply to 25% density phantoms with 5.15 cm compressed thickness and 500 {mu}m{sup 3} voxels (larger 500 {mu}m{sup 2} detector pixels were used to avoid voxel-edge artifacts): 1. For raw, unfiltered projection images in the anatomical-variability-limited regime, AUC appeared to remain constant or increase slightly with scan angle. 2. In the same regime, when the authors fixed the scan angle, AUC increased asymptotically with the number of projections. The threshold number of projections for asymptotic AUC performance depended on the scan angle. In the quantum- and electronic-noise dominant regimes, AUC behaviors as a function of scan angle and number of projections sometimes differed from the anatomy-limited regime. For example, with a fixed scan angle, AUC generally decreased with the number of projections in the electronic-noise dominant regime. These results are intended to demonstrate the capabilities of the virtual trial framework, not to be used as optimization rules for DBT. Conclusions: The authors have demonstrated a novel simulation framework and tools for evaluating DBT systems in an objective, task-specific manner. This framework facilitates further investigation of image quality tradeoffs in DBT.

60 APPLIED LIFE SCIENCES↗

TU-G-BRB-00: Clinical Trials in Proton and Particle Therapy

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-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↗