This study is an initial investigation into methods to harmonize quantitative imaging (QI) feature values across CT scanners based on image quality metrics. To assess the impact of harmonization on QI features, we: (1) scanned an image quality assessment phantom on three scanners over a wide range of acquisition and reconstruction conditions; (2) from those scans, assessed image quality for each scanner at each acquisition and reconstruction condition; (3) from these assessments, identified a set of parameters for each scanner that yielded similar image quality values (“harmonized condition”); (4) scanned a second phantom with texture (i.e., local variations in attenuation) under the same set of conditions; and (5) extracted QI features and compared values between non-harmonized and harmonized image quality conditions. Quantitative image quality assessments provided contrast to noise ratio (CNR) and modulation transfer function frequency at 50% (MTF f50) values for each scanner and each condition used. A set of harmonized conditions was identified across three CT scanners based on the similarity of CNR and MTF f50. To provide a comparison, several non-harmonized condition sets were identified. From the texture phantom, the standard deviation of the QI feature values (intensity mean and variance, GLCM autocorrelation and cluster tendency, GLDM high and low gray level emphasis) across the three CT systems decreased between 72.8% and 81.1% between the unharmonized and harmonized groups (with exception of intensity mean which showed little difference across scanners). These initial results suggest that selecting protocols that produce similar quantitative image quality metric values across different CT systems can reduce the variance of QI feature values across those systems.
KEYWORDS: Denoising, Education and training, Quantum noise, Quantum correlations, Breast, Data modeling, Systems modeling, Signal attenuation, Performance modeling, Computed tomography
Cone-beam breast CT (bCT) provides volumetric images of the uncompressed breast but present higher noise than 2D mammography. Deep Learning (DL) denoising with supervised training has shown successful CBCT noise reduction but requires matched low-dose and high-dose images. Self-supervised training removes that requirement but often assume locally independent noise. This work studies the impact of bCT noise correlation on self-supervised denoising methods. The self-supervised training strategies included two blind spot methods – Noise2Self, enforcing local similarity with independent image noise; and Noise2Sim, enforcing image similarity in presence of correlated noise – and two Noisier2Noise approaches: i) noise injection in the image domain; and, ii) noise injection in projection domain with a model of noise correlation. Self-supervised training was performed on bCT images generated from 150 voxelized models with a high-fidelity forward projector, including models of the x-ray spectrum, polychromatic attenuation, and detector signal and noise propagation. Denoised images were assessed with respect to high-dose references and supervised denoising, using RMSE, SSIM, and noise power spectrum (NPS). Noise2Sim and Noisier2Noise with noise injection in the projection domain showed good performance in presence of correlated noise, achieving RMSE of 0.21 and 0.18 (SSIM of 0.9 and 0.94), respectively, compared to RMSE of 0.17 (SSIM of 0.93) for supervised training. The independent noise assumption in Noise2Self and Noisier2Noise with image domain noise injection resulted in significantly diminished performance, yielding RMSE of 0.23 and 0.37 (SSIM of 0.86 and 0.84). The NPS measurements revealed a shift towards low frequency components for Noise2Sim, arising from blurring of tissue boundaries and residual image transfer induced by the masking of dissimilar regions in the loss function. Noisier2Noise showed a frequency distribution of noise closer to the high-dose reference. Such performance was slightly degraded for non-matched noise injection models inducing shorter correlation kernels than the nominal detector noise correlation, but models inducing longer correlation showed negligible impact in the denoising results. Self-supervised denoising in presence of correlated noise was proved feasible. Among the evaluated models, Noisier2Noise strategies with projection domain noise injection showed denoising performance comparable to supervised training and noise spectral distribution comparable to high-dose bCT.
Purpose: To demonstrate the utility of high-resolution micro-computed tomography (μCT) for determining ground-truth size and shape properties of calcium grains for evaluation of detection performance in breast CT (bCT).
Approach: Calcium carbonate grains (∼200 μm) were suspended in 1% agar solution to emulate microcalcifications (μCalcs) within a fibroglandular tissue background. Ground-truth imaging was performed on a commercial μCT scanner and was used for assessing calcium-grain size and shape, and for generating μCalc signal profiles. Calcium grains were placed within a realistic breast-shaped phantom and imaged on a prototype bCT system at 3- and 6-mGy mean glandular dose (MGD) levels, and the non-prewhitening detectability was assessed. Additionally, the μCT-derived signal profiles were used in conjunction with the bCT system characterization (MTF and NPS) to obtain predictions of bCT detectability.
Results: Estimated detectability of the calcium grains on the bCT system ranged from 2.5 to 10.6 for 3 mGy and from 3.8 to 15.3 for 6 mGy with large fractions of the grains meeting the Rose criterion for visibility. Segmentation of μCT images based on morphological operations produced accurate results in terms of segmentation boundaries and segmented region size. A regression model linking bCT detectability to μCalc parameters indicated significant effects of μCalc size and vertical position within the breast phantom. Detectability using μCT-derived detection templates and bCT statistical properties (MTF and NPS) were in good correspondence with those measured directly from bCT (R2 > 0.88).
Conclusions: Parameters derived from μCT ground-truth data were shown to produce useful characterizations of detectability when compared to estimates derived directly from bCT. Signal profiles derived from μCT imaging can be used in conjunction with measured or hypothesized statistical properties to evaluate the performance of a system, or system component, that may not currently be available.
Purpose: A computer-aided diagnosis (CADx) system for breast masses is proposed, which incorporates both handcrafted and convolutional radiomic features embedded into a single deep learning model.
Approach: The model combines handcrafted and convolutional radiomic signatures into a multi-view architecture, which retrieves three-dimensional (3D) image information by simultaneously processing multiple two-dimensional mass patches extracted along different planes through the 3D mass volume. Each patch is processed by a stream composed of two concatenated parallel branches: a multi-layer perceptron fed with automatically extracted handcrafted radiomic features, and a convolutional neural network, for which discriminant features are learned from the input patches. All streams are then concatenated together into a final architecture, where all network weights are shared and the learning occurs simultaneously for each stream and branch. The CADx system was developed and tested for diagnosis of breast masses (N = 284) using image datasets acquired with independent dedicated breast computed tomography systems from two different institutions. The diagnostic classification performance of the CADx system was compared against other machine and deep learning architectures adopting handcrafted and convolutional approaches, and three board-certified breast radiologists.
Results: On a test set of 82 masses (45 benign, 37 malignant), the proposed CADx system performed better than all other model architectures evaluated, with an increase in the area under the receiver operating characteristics curve (AUC) of 0.05 ± 0.02, and achieving a final AUC of 0.947, outperforming the three radiologists (AUC = 0.814 − 0.902).
Conclusions: In conclusion, the system demonstrated its potential usefulness in breast cancer diagnosis by improving mass malignancy assessment.
KEYWORDS: Breast, Monte Carlo methods, Sensors, Tissues, Digital breast tomosynthesis, Clinical trials, X-rays, 3D image processing, X-ray imaging, Breast imaging
In silico reproductions of clinical exams represent an alternative strategy in the research and development of medical devices, which permit to avoid issues and costs related to clinical trials on patient population. In this work, we present a platform for virtual clinical trials in 2D and 3D x-ray breast imaging. The platform, developed by the medical physics team at University of Naples, Italy, permits to simulate digital mammography (DM), digital breast tomosynthesis (DBT) and CT dedicated to the breast (BCT) examinations. It relies on Monte Carlo simulations based on Geant4 toolkit and adopts digital models of patients derived from high-resolution 3D clinical breast images acquired at UC Davis, USA. Uncompressed digital breast models for BCT exam simulations were produced by means of a tissue classification algorithm; the compressed digital breast models for simulating DM and DBT are derived by the uncompressed ones via a simulated tissue compression. For a selected exam, specifications and digital patient, the platform computes breast image projections and glandular dose maps within the organ. Energy integrating a well as photon counting and spectral imaging detection scheme have been simulated. The current version of the software uses the Geant4 standard physics list Option4 and simulates and tracks <105 photons/s, when run on a 16-core CPU at 3.0 GHz. The developed platform will be an invaluable tool for R and D of apparatuses, and it will permit the access to clinical-like data to a broad research community. Digital patient exposures with the available phantom dataset will be possible for the same patient-derived phantom in uncompressed or compressed format, in DM, DBT and BCT modalities.
This study introduces a methodology for generating high resolution signal profiles of microcalcification (MC) grains for validating breast CT (bCT) systems. A physical MC phantom was constructed by suspending calcium carbonate grains in an agar solution emulating MCs in a fibroglandular tissue background. Additionally, small Teflon spheres (2.4 mm diameter) were embedded in the agar solution for the purpose of fiducial marking and assessment of segmentation accuracy. The MC phantom was imaged on a high resolution (34 μm) commercial small-bore μCT scanner at high dose, and the images were used as the gold-standard for assessing MC size and for generating high resolution signal profiles of each MC. High-dose bCT scans of the MC phantom suspended in-air were acquired using 1×1 binning mode (75 μm dexel pitch) by averaging three repeat scans to produce a single low-noise reconstruction of the MC phantom. The high resolution μCT volume data set was then registered with the corresponding bCT data set after correcting for the bCT system spatial resolution. Microcalcification signal profiles constructed using low-noise bCT images were found to be in good agreement with those generated using the μCT scanner with all differences <10% within the VOI surrounding each MC. The MC signal profiles were used as detection templates for a non-prewhitening-matched-filter model observer for scans acquired in a realistic breast phantom at 3, 6, and 9 mGy mean glandular dose. MC detectability using signal templates derived from bCT were shown to be in good agreement with those generated using μCT.
Retrospective kV x-ray 4DCT treatment planning for lung cancer MV linac treatment is becoming a standard-of-care for this widely used procedure for the largest cancer cause-of-death in the US. It currently provides the best estimate of a fixed-in-time but undulating and closed 3D "shell" to which a minimum curative-intent radiation dose should be delivered to provide the best estimated patient survival and the least morbidity, usually characterized by quantitative dose-volume-histograms (DVHs). Unfortunately this closed shell volume or internal target volume (ITV) currently has to be increased enough to enclose the full range of respiratory lesion motion (plus set-up etc. uncertainties) which cannot yet be accurately determined in real time during treatment delivery. With accurate motion-tracking, the planning target volume (PTV) or outer “shell” may be reduced by up to 40%. However there is no single 2D plane that precisely follows the reduced-PTV-volume’s 3D respiratory motion, currently best estimated by the retrospective hand contouring by a trained and experienced MD radiation oncology MD using the full 3D-time information of 4DCT. Once available, 3D motion tracking in real time has the potential to substantially decrease DVH doses to surrounding organs-at-risk (OARs), while maintaining or raising the curative-intent dose to the lesion itself. The assertion argued here is that, the 3D volume-rendered imaging of lung cancer lesion-trajectories in real-time from TumoTrak digital x-ray tomosythesis, has the potential to provide more accurate 3D motion tracking and improved dose delivery at lower cost than the real time, 2D single slice imaging of MRI-guided radiotherapy.
Field-emission x-ray source arrays have been studied for both tomosynthesis and CT applications, however these arrays tend to have limited output. We propose the use of multi-source x-ray arrays using thermionic cathodes, contained within a single vacuum housing. A prototype 3-source x-ray array has been fabricated and tested, and the utility of multi-x-ray-source arrays has been demonstrated using physical simulations in both tomosynthesis and in cone beam CT. The prototype x-ray tube made use of a cylindrical molybdenum anode, machined to have 3 specific focal tracks. Grid-controlled cathode assemblies were fabricated and aligned to each focal tract, and the individual x-ray focal spots were evaluated with a star pattern at 35 kV and 40 mA. The 3-source assembly was used to physically simulate tomosynthesis imaging geometry, and tomosynthesis images of a lemon were obtained. Physical simulations using a cone beam breast CT scanner were also performed, by vertically moving the single x-ray source into 5 different locations – simulating 5 different source positions. A new geometry for cone beam CT imaging is proposed, where each source of a multi-x-ray source array is individually collimated to eliminate rays involving large cone angles. This geometry also allows three sources to be simultaneously pulsed onto a single flat panel detector, achieving better duty cycle and view sampling in cone beam CT. A reconstruction algorithm was written to accommodate the different source positions, and phantoms designed to demonstrate cone beam artifacts were imaged. The tomosynthesis images illustrate appropriate depth resolution in the test object. Analysis of the CT data demonstrate marked improvement compared to one source. We conclude that multi-source x-ray arrays using thermionic cathodes will have important applications in medical imaging, especially breast tomosynthesis and cone beam computed tomography.
This study examines the potential of a multisource x-ray system to reduce cone beam artifacts in a dedicated breast CT acquisition geometry. A breast CT scanner (Doheny), built at our institution, was used to demonstrate the potential of multiple x-ray sources in a single x-ray tube housing. Both 3 focal spot and 5 focal spot thermionic systems were physically simulated in this study. The x-ray tube is mounted on a vertical actuator on the breast CT system gantry, allowing the single x-ray source to be positioned at different vertical locations in the field of view. Five acquisition geometries were used to acquire raw cone beam CT data with the x-ray source locations placed at 2 cm intervals. Data was collected using a 15-cm tall Defrise phantom. The individual acquisitions of raw CT data were reconstructed using filtered back projection, aligned and summed. The reconstructed CT volume data set using three sources and five sources were compared to that produced from a single source. Both multi-source datasets demonstrated less visible cone beam artifact, and the contrast clearly improved. The resolvable field of view in the vertical direction was extended by 50% when comparing the one source to the three source geometry and extended by 120% when comparing the one source to the five source geometry. This physical simulation of a multisource x-ray CT system successfully demonstrated that a reduction in cone beam CT artifacts could be achieved using a multi-source x-ray tube on a breast CT scanner.
Two simulated sets of digital tomosynthesis images of the lungs, each acquired at a 90 degree angle from the other,
with 19 projection images used for each set and SART iterative reconstructed, gives dual tomosynthesis slice image
quality approaching that of spiral CT, and with a data acquisition time that is 3% of that of cone beam CT. This fast
kV acquisition, should allow near real time tracking of lung tumors in patients receiving SBRT, based on a novel
TumoTrakTM multi-source X-ray tube design. Until this TumoTrakTM prototype is completed over the next year, its
projected performance was simulated from the DRR images created from a spiral CT data set from a lung cancer
patient. The resulting dual digital tomosynthesis reconstructed images of the lung tumor were exceptional and
approached that of the gold standard Feldkamp CT reconstruction of breath hold, diagnostic, spiral, multirow, CT
data. The relative dose at 46 mAs was less than 10% of what it would have been if the digital tomosynthesis had been
done at the 472 mAs of the CT data set. This is for a 0.77 fps imaging rate sufficient to resolve respiratory motion in
many free breathing patients during SBRT. Such image guidance could decrease the magnitudes of targeting error
margins by as much as 20 mm or more in the craniocaudal direction for lower lobe lesions while markedly reducing
dose to normal lung, heart and other critical structures. These initial results suggest a wide range of topics for future
work.
A Monte Carlo-based tungsten anode spectral model, conceptually similar to the previously-developed TASMIP model,
was developed. This new model provides essentially unfiltered x-ray spectra with better energy resolution and
significantly extends the range of tube potentials for available spectra. MCNPX was used to simulate x-ray spectra as a
function of tube potential for a conventional x-ray tube configuration with several anode compositions. Thirty five x-ray
spectra were simulated and used as the basis of interpolating a complete set of tungsten x-ray spectra (at 1 kV intervals)
from 20 to 640 kV. Additionally, Rh and Mo anode x-ray spectra were simulated from 20 to 60 kV. Cubic splines were
used to construct piecewise polynomials that interpolate the photon fluence per energy bin as a function of tube potential
for each anode material. The tungsten anode spectral model using interpolating cubic splines (TASMICS) generates
minimally-filtered (0.8 mm Be) x-ray spectra from 20 to 640 kV with 1 keV energy bins. The rhodium and molybdenum
anode spectral models (RASMICS and MASMICS, respectively) generate minimally-filtered x-ray spectra from 20 to 60
kV with 1 keV energy bins. TASMICS spectra showed no statistically significant differences when compared with the
empirical TASMIP model, the semi-empirical Birch and Marshall model, and a Monte Carlo spectrum reported in AAPM
TG 195. The RASMICS and MASMICS spectra showed no statistically significant differences when compared with
their counterpart RASMIP and MASMIP models. Spectra from the TASMICS, MASMICS, and RASMICS models are
available in spreadsheet format for interested users.
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