The purpose of this study was to extend previous work to detect migration of total wrist arthroplasty non-invasively, and with greater accuracy. Two human cadaverous arms, each with a cemented total wrist implant, were used in this study. In one of the arms, 1 mm tantalum balls were implanted, six in the carpal bones and five in the radius. Five CT scans of each arm were acquired, changing the position of the arm each time to mimic different positions patients might take on repeated examinations. Registration of CT volume data sets was performed using an extensively validated, 3D semi-automatic volume fusion tool in which co-homologous point pairs (landmarks) are chosen on each volume to be registered. Three sets of ten cases each were obtained by placing landmarks on 1) bone only (using only arm one), 2) tantalum implants only, and 3) bone and tantalum implants (both using only arm two). The accuracy of the match was assessed visually in 2D and 3D, and numerically by calculating the distance difference between the actual position of the transformed landmarks and their ideal position (i.e., the reference landmark positions). All cases were matched visually within one width of cortical bone and numerically within one half CT voxel (0.32 mm, p = 0.05). This method matched only the bone/arm and not the prosthetic component per se, thus making it possible to detect prosthetic movement and wear. This method was clinically used for one patient with pain. Loosening of the carpal prosthetic component was accurately detected and this was confirmed at surgery.
Purpose: Improve tumor localization in In-111 ProstaScint SPECT scans through improved reconstruction and identification/removal of non-specific blood pool volumes using simultaneously acquired Tc-99m tagged red blood cell (RBC) SPECT scans.
Methods: We chose 30 patients with a history of prostate cancer who had undergone CT/MR and simultaneous Tc-99m RBC/In-111 ProstaScint SPECT scans due to rising PSA. To estimate the impact of reconstruction methods on anatomic definition and artifacts, SPECT volume data sets were reconstructed using ordered set-expectation maximization (OS-EM) with varying numbers of iterations and subsets, and these were compared against each other and against standard filtered back projection (FBP) reconstruction. Non-blood pool bladder activity in the Tc-99m scans was suppressed prior to subtraction from the In-111 scans by using an averaging algorithm within an ellipsoid volume encompassing the bladder. Outside the ellipsoid volume, Tc-99m voxel values were subtracted from the corresponding In-111 voxels after normalization of the data sets based on peak activity within the descending aorta.
Results: OS-EM reconstruction using 3 iterations and 45 subsets showed improved representation of anatomy compared with FBP. Bladder suppression reduced artifacts in the prostate bed. The subtraction method reduced the blood pool signal, confirmed visually by superimposition with matched CT/MR scans. Preliminary results using the Coefficient of Variation (CV) and a Student's t-test, show that the superimposition landmark distance differences are significantly different after subtraction.
Conclusions: OS-EM reconstruction together with bladder suppression and subtraction of the blood pool may help improve the specificity of ProstaScint SPECT interpretation and increase its utility in radiation therapy treatment planning.
KEYWORDS: Single photon emission computed tomography, Image registration, Visualization, Liver, 3D metrology, Data modeling, Computed tomography, 3D displays, Brain, 3D image processing
The purpose of this work was to evaluate three volumetric registration methods in terms of technique, user-friendliness and time requirements. CT and SPECT data from 11 patients were interactively registered using: a 3D method involving only affine transformation; a mixed 3D - 2D non-affine (warping) method; and a 3D non-affine (warping) method. In the first method representative isosurfaces are generated from the anatomical images. Registration proceeds through translation, rotation, and scaling in all three space variables. Resulting isosurfaces are fused and quantitative measurements are possible. In the second method, the 3D volumes are rendered co-planar by performing an oblique projection. Corresponding landmark pairs are chosen on matching axial slice sets. A polynomial warp is then applied. This method has undergone extensive validation and was used to evaluate the results. The third method employs visualization tools. The data model allows images to be localized within two separate volumes. Landmarks are chosen on separate slices. Polynomial warping coefficients are generated and data points from one volume are moved to the corresponding new positions. The two landmark methods were the least time consuming (10 to 30 minutes from start to finish), but did demand a good knowledge of anatomy. The affine method was tedious and required a fair understanding of 3D geometry.
All retrospective image registration methods have attached to them some intrinsic estimate of registration error. However, this estimate of accuracy may not always be a good indicator of the distance between actual and estimated positions of targets within the cranial cavity. This paper describes a project whose principal goal is to use a prospective method based on fiducial markers as a 'gold standard' to perform an objective, blinded evaluation of the accuracy of several retrospective image-to-image registration techniques. Image volumes of three modalities -- CT, MR, and PET -- were taken of patients undergoing neurosurgery at Vanderbilt University Medical Center. These volumes had all traces of the fiducial markers removed, and were provided to project collaborators outside Vanderbilt, who then performed retrospective registrations on the volumes, calculating transformations from CT to MR and/or from PET to MR, and communicated their transformations to Vanderbilt where the accuracy of each registration was evaluated. In this evaluation the accuracy is measured at multiple 'regions of interest,' i.e. areas in the brain which would commonly be areas of neurological interest. A region is defined in the MR image and its centroid C is determined. Then the prospective registration is used to obtain the corresponding point C' in CT or PET. To this point the retrospective registration is then applied, producing C' in MR. Statistics are gathered on the target registration error (TRE), which is the disparity between the original point C and its corresponding point C'. A second goal of the project is to evaluate the importance of correcting geometrical distortion in MR images, by comparing the retrospective TRE in the rectified images, i.e., those which have had the distortion correction applied, with that of the same images before rectification. This paper presents preliminary results of this study along with a brief description of each registration technique and an estimate of both preparation and execution time needed to perform the registration .
When single photon emission computer aided tomography (SPECT) is performed, planar projection views are taken at a series of stepping angles covering the entire arc around the patient. These projection views are identical to planar gamma camera images, except that they are generally taken with a shorter acquisition time. The projection views are reconstructed to create transaxial SPECT images via backprojection techniques. We attempted the following studies to show that opposing SPECT projection views could yield the same correct quantitative information as the planar gamma camera images. Planar and SPECT images were used from patients who had received 0.135 MBq (5 mCi) of In-111-methyl benzyl DTPA BrE- 3 monoclonal antibodies. An In-111 filled flat flood source was utilized to acquire transmission images on the planar gamma camera in order to generate an attenuation map of the patient in the anterior/posterior plane. A camera calibration factor was obtained using a source of known activity. The activity of the liver was determined from abdominal planar images using regions of interest (ROIs) drawn around the liver on opposing anterior and posterior views. Similarly, the activity of the liver was determined from the opposing SPECT projection images which showed the anterior and posterior views. The same attenuation map was used for the correction of both the planar images and SPECT projection views. A cylindrical plastic phantom containing spherical plastic balls was used to validate that this technique accurately measured the activity contained in selected ROIs. Planar and SPECT images were taken of the phantom with each ball containing 6.8 kBq (250 (mu) Ci) of Tc- 99m. A Tc-99m filled flat flood source was utilized to acquire transmission images on the planar gamma camera, and a source of known activity was used to obtain a camera calibration. Using a similar method to that used on the liver images, the activity of the balls was determined from the planar images and the SPECT projection views. Liver activities calculated from SPECT projection views matched the activities calculated from the planar images within 20% error. The activities for each ball in the phantom, calculated from SPECT projection views, matched the activity calculated from the planar images within 5% error, and matched the known activity in each ball within 10% error. The data indicates that despite their short acquisition times, the SPECT projection views may be used to quantify the activity from ROIs, without a significant increase in error associated with activity measurement.
SPECT is a powerful clinical tool. However, the low spatial resolution and ill-defined boundaries associated with SPECT require special consideration in visualization. Quantitative geometric and magnitude information are areas of particular usefulness in evaluating disease states. In this paper, we describe a set of practical 3D visualization tools to display and analyze SPECT data, and present interactive methods to measure (1) the relative position, size and shape of regions of interest and (2) the magnitude and distribution of radioactive count information. Interactive pick tools allow users to extract values at selected points, distance between points, or value profiles along selected line segments. In the three-dimensional reconstruction, transparent and opaque isosurfaces are formed simultaneously at specified activity levels, and the volume enclosed by the opaque surface is displayed. The utility of these tools is demonstrated with two types of patient studies: those using tumor-avid agents to identify active tumor in the chest and abdomen, and those used for evaluating the volume of perfused myocardium.
In this paper we present interactive visualization procedures for registration of SPECT and CT images based on landmarks. Because of the poor anatomic detail available in many SPECT images, registration of SPECT images with other modalities often requires the use of external markers. These markers may correspond to anatomic structures identifiable in the other modality image. In this work, we present a method to nonrigidly register SPECT and CT images based on automatic marker localization and interactive anatomic localization using 3D surface renderings of skin. The images are registered in 3D by fitting low order polynomials which are constrained to be near rigid. The method developed here exploits 3D information to attain greater accuracy and reduces the amount of time needed for expert interaction.
KEYWORDS: 3D image processing, Algorithm development, Visualization, 3D modeling, Image processing, Binary data, Systems modeling, Skull, 3D metrology, Medical imaging
Three-dimensional (3D) medical imaging deals with the visualization, manipulation, and measuring of objects in 3D medical images. So far, research efforts have concentrated primarily on visualization, using well-developed methods from computer graphics. Very little has been achieved in developing techniques for manipulating medical objects, or for extracting quantitative measurements from them beyond volume calculation (by counting voxels), and computing distances and angles between manually located surface points. A major reason for the slow pace in the development of manipulation and quantification methods lies with the limitations of current algorithms for constructing surfaces from 3D solid objects. We show that current surface construction algorithms either (a) do not construct valid surface descriptions of solid objects or (b) produce surface representations that are not particularly suitable for anything other than visualization. We present ALLIGATOR, a new surface construction algorithm that produces valid, topologically connected surface representations of solid objects. We have developed a modeling system based on the surface representations created by ALLIGATOR that is suitable for developing algorithms to visualize, manipulate, and quantify 3D medical objects. Using this modeling system we have developed a method for efficiently computing principle curvatures and directions on surfaces. These measurements form the basis for a new metric system being developed for morphometrics. The modeling system is also being used in the development of systems for quantitative pre-surgical planning and surgical augmentation.
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