Selecting the tube current when using iterative reconstruction is challenging due to the varying relationship between contrast, noise, spatial resolution, and dose across different algorithms. This study proposes a task-based automated exposure control (AEC) method using a generalized detectability index (d'gen). The proposed method leverages existing AEC methods that are based on a prescribed noise level. The generalized d'gen metric is calculated using look-up tables of task-based modulation transfer function and noise power spectrum. Look-up tables were generated by scanning a 20-cmdiameter American College of Radiology (ACR) phantom and reconstructing with a reference reconstruction algorithm and four levels of an in-house iterative reconstruction algorithm (IR1-4). This study tested the validity of the assumption that the look-up tables can be approximated as being independent of dose level. Preliminary feasibility of the proposed d'gen-AEC method to provide a desired image quality level for different iterative reconstruction algorithms was evaluated for the ACR phantom. The image quality ((d'gen) resulting from the proposed d'gen-AEC method was 3.8 (IR1), 3.9 (IR2), 3.9 (IR3), 3.8 (IR4) compared to the desired d'gen of 3.9 for the reference image. For comparison, images acquired to match the noise standard deviation of the reference image demonstrated reduced image quality (d'gen). of 3.3 for IR1, 3.0 for IR2, 2.5 for IR3, and 1.8 for IR4). For all four iterative reconstruction methods, the d'gen-AEC method resulted in consistent image quality in terms of detectability index at lower dose than the reference scan. The results provide preliminary evidence that the proposed d'gen-AEC can provide consistent image quality across different iterative reconstruction approaches.
This study experimentally evaluated the effect of window width (WW) and window level (WL) on the task based detectability index (d’). Window-level transformation is frequently performed on CT images to improve visualization in clinical arena. Numerous model observers and metrics have been used to assess CT image quality. However, objective assessment is typically performed on the reconstructed CT image without considering the WW and WL settings used by the reader. In this study, the ACR CT phantom was scanned at 120 kV and 90 mAs and images were reconstructed using filtered backprojection. The bone and acrylic contrast objects from module one of the ACR phantom were selected for calculating the effect of the WW/WL on the detectability index (d’). The d’ for each object at 90 mAs was calculated for a range of WW and WL values. The results demonstrated that the d’ values were affected by the WW and WL settings. For example, WL setting of 20 HU and window width of 150 HU resulted in a 35% decrease in d’ compared to that of the untransformed image. A WL of 20 and WW of 1400 resulted in a 33% decrease in the d’ value for the high contrast object. The investigated WW and WL settings did not improve d’ for any of the investigated objects when reconstructed with the standard kernel. The results suggest that d’ is affected by the WW/WL settings. However, because d’ does not model the contrast adaptation of the human visual system, it may not represent the change in perceived image quality with window-level transformation.
This study investigated a fractal dimension algorithm for noise texture quantification in CT images. Quantifying noise in CT images is important for assessing image quality. Noise is typically quantified by calculating noise standard deviation and noise power spectrum (NPS). Different reconstruction kernels and iterative reconstruction approaches affect both the noise magnitude and noise texture. The shape of the NPS can be used as a noise texture descriptor. However, the NPS requires numerous images for calculation and is a vector quantity. This study proposes the metric of fractal dimension to quantify noise texture, because fractal dimension is a single scalar metric calculated from a small number of images. Fractal dimension measures the complexity of a pattern. In this study, the ACR CT phantom was scanned and images were reconstructed using filtered back-projection with three reconstruction kernels: bone, soft and standard. Regions of interest were extracted from the uniform section of the phantom for NPS and fractal dimension calculation. The results demonstrated a mean fractal dimension of 1.86 for soft kernel, 1.92 for standard kernel, and 2.16 for bone kernel. Increasing fractal dimension corresponded to shift in the NPS towards higher spatial frequencies and grainier noise appearance. Stable fractal dimension was calculated from two ROI’s compared to more than 250 ROI’s used for NPS calculation. The scalar fractal dimension metric may be a useful noise texture descriptor for evaluating or optimizing reconstruction algorithms.
This study quantitatively evaluated the performance of the exponential transformation of the free-response operating characteristic curve (EFROC) metric, with the Channelized Hotelling Observer (CHO) as a reference. The CHO has been used for image quality assessment of reconstruction algorithms and imaging systems and often it is applied to study the signal-location-known cases. The CHO also requires a large set of images to estimate the covariance matrix. In terms of clinical applications, this assumption and requirement may be unrealistic. The newly developed location-unknown EFROC detectability metric is estimated from the confidence scores reported by a model observer. Unlike the CHO, EFROC does not require a channelization step and is a non-parametric detectability metric. There are few quantitative studies available on application of the EFROC metric, most of which are based on simulation data. This study investigated the EFROC metric using experimental CT data. A phantom with four low contrast objects: 3mm (14 HU), 5mm (7HU), 7mm (5 HU) and 10 mm (3 HU) was scanned at dose levels ranging from 25 mAs to 270 mAs and reconstructed using filtered backprojection. The area under the curve values for CHO (AUC) and EFROC (AFE) were plotted with respect to different dose levels. The number of images required to estimate the non-parametric AFE metric was calculated for varying tasks and found to be less than the number of images required for parametric CHO estimation. The AFE metric was found to be more sensitive to changes in dose than the CHO metric. This increased sensitivity and the assumption of unknown signal location may be useful for investigating and optimizing CT imaging methods. Future work is required to validate the AFE metric against human observers.
A dual modality SPECT-CT prototype dedicated to uncompressed breast imaging (mammotomography) has been developed. The CT subsystem incorporates an ultra-thick K-edge filtration technique producing a quasi-monochromatic x-ray cone beam to optimize the dose efficiency for uncompressed breast tomography. We characterize the absorbed
dose to the breast under normal tomographic cone beam image acquisition protocols using both TLD measurements and
ionization chamber-calibrated radiochromic film. Geometric and anthropomorphic breast phantoms are filled with 1000mL of water and oil to simulate different breast compositions and varying object shapes having density bounds of 100% glandular and fatty breast compositions, respectively. Doses to the water filled geometric and anthropomorphic breast phantoms for a tomographic scan range from 1.3-7.3mGy and 1.7-6.3mGy, respectively, with a mean whole-breast dose of 4.5mGy for the water-filled anthropomorphic phantom. Measured dose distribution trends indicate lower doses in the center of the breast phantoms towards the chest wall along with higher doses near the peripheries and nipple regions. Measured doses to the oil-filled phantoms are consistently lower across all volume shapes (mean dose, 3.8mGy for the anthropomorphic breast). Results agree with Monte Carlo dose estimates generated for uncompressed breast
imaging and illustrate the advantages of using the novel K-edge filtered beam to minimize absorbed dose to the breast during fully-3D imaging.
In current dedicated breast computed tomography (mammotomography) systems, comfortable patient positioning on a
stationary bed restricts the practicable range of source-detector trajectories, thus compromising the system's ability to
adequately image the patient's anterior chest wall. This study examines the effect on detecting small, low-contrast
lesion-like-spheres using limited angle x-ray source-detector trajectories and trajectories that intentionally raise the
tomographic imaging system mid-acquisition. These modified acquisition paths may increase chest wall visualization,
simplify the design of the imaging system and increase patient comfort by allowing the design of an improved patient
bed. Thin walled balloons of various volumes filled with iodine act as surrogate high contrast lesions to initially
investigate the effect of these novel trajectories. Then, stacks of 5mm acrylic spheres regularly spaced in concentric
circles are placed in water to simulate a low contrast environment in a uniform scatter medium. 360° azimuthal scans are
acquired at various bed heights with contiguous projections subsequently removed to create limited angle acquisitions
from 240-360°. Projections from the different bed heights are interwoven to form trajectories that mimic discontinuously
raising the imaging system mid-acquisition. The resulting iteratively reconstructed volumes are evaluated with an
observer study. Initial images suggest that using limited angles and raising the system is possible while increasing the
observer's ability to visualize objects near the chest wall. Based on the results of this study, an improved patient bed to
facilitate chest wall imaging will be designed, and the feasibility of vertical system motion to increase imaged breast
volume explored.
A hybrid SPECT-CT system for dedicated 3D breast imaging (mammotomography) is currently under development. Each imaging system will be placed on top of a single rotation stage and moved in unison azimuthally, with the SPECT system additionally capable of polar and radial motions. In this initial prototype, the CT system will initially be positioned at a fixed polar tilt. Using a phantom with three tungsten wires, the MTF of the CT system was measured in 3D for different CT system tilts. A phantom with uniformly arranged 0.5cm diameter acrylic spheres was suspended in air in the CT field of view, and also placed at multiple locations and orientations inside an oil-filled breast phantom to evaluate the effect of CT system tilt on lesion visibility and distortion. Projection images were collected using various simple circular orbits with fixed polar tilts ranging between ±15°, and complex 3D saddle trajectories including combined polar and azimuthal motions at maximum polar tilt angles. Reconstructions were performed using an iterative reconstruction algorithm on 4x4 binned projection images with 0.508mm3 voxels. There was minor variation in the MTF in the imaged volume for the CT system at all trajectories, potentially due to the use of an iterative reconstruction algorithm. Results from the spherical cross phantoms indicated that there was more reconstruction inaccuracy and geometric distortion in the reconstructed slices with simple circular orbits with fixed tilt in contrast to complex 3D trajectories. Line profiles further showed a cupping artifact in planes farther away from the flat plane of the x-ray cone beam placed at different tilts. However, this cupping artifact was not seen for images acquired with complex 3D trajectories. This indicated that cupping artifacts can also be caused by undersampled cone beam data. These findings generally indicate that despite insufficient sampling with the cone beam imaging geometry, it is possible to place the CT system at a stationary polar tilt with the CT tube positioned upward such that a patient can be comfortably placed above the system and allow complete sampling near the top of the pendant, uncompressed breast and chest wall. However, a complex 3D trajectory allows for more complete sampling of the entire image volume.
A hybrid SPECT-CT system for dedicated 3D breast cancer imaging (mammotomography) is in development. Using
complex 3D imaging acquisition trajectories, the versatile integrated system will be capable of contouring and imaging
an uncompressed breast suspended in a 3D volume located below a radio-opaque patient bed, providing co-registered
volumetric anatomical and functional information. This study examines tradeoffs involved in the design of the patient
bed to satisfy concomitant and competing technical and ergonomic requirements specific to this imaging paradigm. The
complementary source-detector arrangement of the CT system is geometrically more restrictive than that of the single
detector SPECT system. Additionally, the compact dimensions and size of the CT system components (primarily the x-ray
tube) are key constraints on the bed design and so the focus is concentrated there. Using computer-aided design
software, several design geometry options are examined to simultaneously consider and optimize the following
parameters: image magnification, imaged breast volume, azimuthal imaging span, and patient comfort. Several CT
system source to image distances are examined (55-80cm), as well as axial patient tilt up to 35°. An optimal patient bed
design for a completely under-bed hybrid imaging system was determined. A 60cm SID, magnification factor of ~1.5,
and patient bed angled at ~15° provided the optimal dimensions. Additional bed dimensions allow the CT projection
beam to nearly entirely image the chest wall, however at the cost of reduced angular sampling for CT. Acquired x-ray
mammotomographic image data is used to assess the feasibility of this reduced angle acquisition approach.
Patient positioning on a bed is an integral part of accurate imaging for dedicated 3D breast imaging. For both dedicated
breast SPECT (single photon emission computed tomography) and breast CT (computed tomography or computed
mammotomography, CmT) which are under development in our lab, maximum access to the breast in the imaging
system's field of view is required to obtain the largest imaged breast volume. Accurate bed positioning will be necessary
as it may be integrated with a guided biopsy apparatus. Thus, a patient bed with flexible 3D positioning capability is
being integrated into the various independent and hybrid 3D imaging systems. The customized bed has both manual and
computer controlled positioning capability, and the accuracy and reproducibility of the system are being characterized.
Computer controlled positioning and feedback provide seemingly reproducible results. However, gross movements may
vary in their accuracy to the given input position. While linear with slopes near 1.0 and intercepts near 0.0cm, lateral
(Y) movement translates less than the input amount, while axial (X) movement translates farther than the input amount.
Vertical (Z) directional movement follows a quadratic shift with a small dc component with or without added weight on
the table. A variety of patient imaging conditions along with x-ray image data are evaluated to demonstrate the
reproducibility of positioning accuracy. Individual directional repositioning accuracy is found to be better than multiple,
combined directional repositioning accuracy. Imaging results indicate a reproducibility (error) of less than 1mm, which
may be suitable for SPECT imaging but perhaps not for higher resolution dedicated breast CT. However, for the
independent SPECT system, bed motion is not necessary because the detector's line of sight can already acquire data at
the chest wall.
A dual modality SPECT/CT computed mammotomography (CmT) system for dedicated functional/structural breast
imaging is under development. In simultaneous, dual-modality imaging, contamination of the transmission (x-ray) image
by emission photons from the uncompressed, pendant breast and torso is an important consideration in the design of
hybrid imaging hardware. The lack of a collimator on the transmission image detector implies increased geometric
efficiency of primary and scattered emission photons from the breast and neighboring torso region that potentially
increase transmission image noise. This study investigates the nature and extent of this cross contamination. Projection
and tomographic x-ray images are obtained with and without emission activity in a realistic anthropomorphic torso and
various breast phantoms, and also with and without lead shielding on the torso for a variety of x-ray exposure times.
Results for emission-source contamination of transmission images are quantified in terms of a mean and standard
deviation of regions of interest. There was an observed trend of increased contamination with increasing emission
radioactivity in the projection images when the x-ray detector was located immediately beneath the torso phantom, but
no discernible effect when the detector was lateral to (and beneath) the torso. Torso shielding mitigated this
contamination somewhat. Indeed, in reconstructed CmT data, there was both a decrease in SNR and concomitant
decrease in mean attenuation coefficient with increasing emission radioactivity contamination. These results are
consistent with the expected increased noise due to a uniform emission irradiation of the detector and hence the resulting
apparent increase in detected x-ray transmission events (which yield a lower reconstructed attenuation coefficient value).
Despite the emission contamination in both projection and reconstructed images, the contamination is uncorrelated, and
indeed no reconstruction artifacts were observed under the various measured conditions. This indicates that a simple
contamination correction may be possible to the projection data prior to reconstruction.
A compact, dual modality computed mammotomography (CmT) and single photon emission computed tomography
(SPECT) system for dedicated 3D breast imaging is in development. The CmT component utilizes novel, heavy K-edge
filtration to practicably narrow the energy spectrum of the cone-shaped x-ray beam incident on the patient's pendant,
uncompressed breast. This quasi-monochromatic beam in CmT is expected to improve discrimination of tissue with
very similar attenuation coefficients while restraining dose levels to below that of existing dual view mammography.
Our previous extensive simulation studies showed the optimal energy range that provides maximum dose efficiency for
a 50/50 adipose/glandular breast is in the 35-40keV range. This current study aims to experimentally validate previous
simulation results. Here, experimental pre-breast and post-breast collimated x-ray beam spectral measurements are
made under tube operating voltages between 40-100kVp using filter materials from Z=13-74, with K-edge values
spanning that of Ce (K=40.4keV), and using different attenuating thicknesses of filter material, approximately
equivalent to the 200th and 500th attenuating value layer (VL) thickness. Ce-filtered post breast spectra for 8cm to 18cm
breasts are measured for a range of breast adipose/glandular compositions. Evaluated figures of merit include mean
beam energy, spectral full-width at tenth-maximum, beam hardening and dose for the range of breast sizes.
Measurements are shown to corroborate the simulations, and both indicate that for a given dose a 200th VL of Ce
filtration may have the most optimal performance in the dedicated mammotomography paradigm.
Our effort to implement a volumetric x-ray computed mammotomography (CmT) system dedicated to imaging breast disease comprises: demonstrated development of a quasi-monochromatic x-ray beam providing minimal dose and other optimal imaging figures of merit; new development of a compact, variable field-of-view, fully-3D acquisition gantry with a digital flat-panel detector facilitating more nearly complete sampling of frequency space and the physical breast volume; incorporation of iterative ordered-subsets transmission (OSTR) image reconstruction allowing modeling of the system matrix. Here, we describe the prototype 3D gantry and demonstrate initial system performance. Data collected on the prototype gantry demonstrate the feasibility of using OSTR with realistic reconstruction times. The gantry consists of a rotating W-anode x-ray tube using ultra-thick K-edge filtration, and an ~20x25cm2 digital flat-panel detector located at <60cm SID. This source/detector combination can be shifted laterally changing the location of the central ray relative to the system center-of-rotation, hence changing the effective imaging field-of-view, and is mounted on a goniometric cradle allowing <50° polar tilt, then on a 360° azimuthal rotation stage. Combined, these stages provide for positioning flexibility in a banded region about a sphere, facilitating simple circle-plus-arc-like trajectories, as well as considerably more complex 3D trajectories. Complex orbits are necessary to avoid physical hindrances from the patient while acquiring the largest imaging volume of the breast. The system capabilities are demonstrated with fully-3D reconstructed images of geometric sampling and resolution phantoms, a fabricated breast phantom containing internal features of interest, and a cadaveric breast specimen. This compact prototype provides flexibility in dedicated, fully-3D CmT imaging of healthy and diseased breasts.
With the development of several classes of dedicated emission and transmission imaging technologies utilizing ionizing radiation for improved breast cancer detection and in vivo characterization, it is extremely useful to have available anthropomorphic breast phantoms in a variety of shapes, sizes and malleability prior to clinical imaging.
These anthropomorphic phantoms can be used to evaluate the implemented imaging approaches given a known quantity, the phantom, and to evaluate the variability of the measurement due to the imaging system chain. Thus, we have developed a set of fillable and incompressible breast phantoms ranging in volume from 240 to 1730mL with nipple-to-chest distances from 3.8 to 12cm. These phantoms are mountable and exchangeable on either a uniform chest plate or anthropomorphic torso phantom containing tissue equivalent bones and surface tissue. Another fillable ~700mL breast phantom with solid anterior chest plate is intentionally compressible, and can be used for direct comparisons between standard planar imaging approaches using mild-to-severe compression, partially compressed tomosynthesis, and uncompressed computed mammotomography applications. These phantoms can be filled with various fluids (water and oil based liquids) to vary the fatty tissue background composition. Shaped cellulose sponges with two cell densities are fabricated and can be added to the breasts to simulate connective tissue. Additionally,
microcalcifications can be simulated by peppering slits in the sponges with oyster shell fragments. These phantoms have a utility in helping to evaluate clinical imaging paradigms with known input object parameters using basic imaging characterization, in an effort to further evaluate contemporary and next generation imaging tools. They may additionally provide a means to collect known data samples for task based optimization studies.
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