Bo Zhao

Image artifacts in digital breast tomosynthesis: investigation of the effects of system geometry and reconstruction parameters using a linear system approach.

Digital breast tomosynthesis (DBT) is a three-dimensional (3D) x-ray imaging modality that reconstructs image slices parallel to the detector plane. Image acquisition is performed using a limited angular range (less than 50 degrees) and a limited number of projection views (less than 50 views). Due to incomplete data sampling, image artifacts are unavoidable in DBT. In this preliminary study, the image artifacts in DBT were investigated systematically using a linear system approximation. A cascaded linear system model of DBT was developed to calculate the 3D presampling modulation transfer function (MTF) with different image acquisition geometries and reconstruction filters using a filtered backprojection (FBP) algorithm. A thin, slanted tungsten (W) wire was used to measure the presampling MTF of the DBT system in the cross-sectional plane defined by the thickness (z-) and tube travel (x-) directions. The measurement was in excellent agreement with the calculation using the model. A small steel bead was used to calculate the artifact spread function (ASF) of the DBT system. The ASF was correlated with the convolution of the two-dimensional (2D) point spread function (PSF) of the system and the object function of the bead. The results showed that the cascaded linear system model can be used to predict the magnitude of image artifacts of small, high-contrast objects with different image acquisition geometry and reconstruction filters.

A computer simulation platform for the optimization of a breast tomosynthesis system

In breast tomosynthesis there is a compromise between resolution, noise, and acquisition speed for a given glandular dose. The purpose of the present work is to develop a simulation platform to investigate the potential imaging performance for the many possible tomosynthesis system configurations. The simulation platform was used to investigate the dependence of image blur and signal difference to noise ratio (SDNR) for several different tomosynthesis acquisition configurations. Simulated projections of a slanted thin tungsten wire placed in different object planes were modified according to the detectors modulation transfer function (MTF), with or without pixel binning. In addition, the focal spot blur (FSB), which depends on the location of the wire, the system geometry, the source-detector movement speed, and the exposure time, was also incorporated into the projections. Both expectation maximization (EM) and filtered back projection (FBP) based algorithms were used for 3D image reconstruction. The in-plane MTF was calculated from the reconstructed image of the wire. To evaluate the noise performance, simulated noiseless projections of calcification and tumor in uniform breast tissue were modified with the noise power spectrum (NPS) calculated from a cascaded linear system model for the detector for a given x-ray dose. The SDNR of the reconstructed images was calculated with different tomosynthesis configurations, e.g., pixel binning, view number, and angular range. Our results showed that for a source-to-imager distance (SID) of 66 cm, pixel binning (2 x 2) caused more degradation to the in-plane MTF than the blur caused by the moving focal spot and reconstruction. The in-depth resolution can be improved by increasing the angular range.

Three-dimensional linear system analysis for breast tomosynthesis

The optimization of digital breast tomosynthesis (DBT) geometry and reconstruction is crucial for the clinical translation of this exciting new imaging technique. In the present work, the authors developed a three-dimensional (3D) cascaded linear system model for DBT to investigate the effects of detector performance, imaging geometry, and image reconstruction algorithm on the reconstructed image quality. The characteristics of a prototype DBT system equipped with an amorphous selenium flat-panel detector and filtered backprojection reconstruction were used as an example in the implementation of the linear system model. The propagation of signal and noise in the frequency domain was divided into six cascaded stages incorporating the detector performance, imaging geometry, and reconstruction filters. The reconstructed tomosynthesis imaging quality was characterized by spatial frequency dependent presampling modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) in 3D. The results showed that both MTF and NPS were affected by the angular range of the tomosynthesis scan and the reconstruction filters. For image planes parallel to the detector (in-plane), MTF at low frequencies was improved with increase in angular range. The shape of the NPS was affected by the reconstruction filters. Noise aliasing in 3D could be introduced by insufficient voxel sampling, especially in the z (slice-thickness) direction where the sampling distance (slice thickness) could be more than ten times that for in-plane images. Aliasing increases the noise at high frequencies, which causes degradation in DQE. Application of a reconstruction filter that limits the frequency components beyond the Nyquist frequency in the z direction, referred to as the slice thickness filter, eliminates noise aliasing and improves 3D DQE. The focal spot blur, which arises from continuous tube travel during tomosynthesis acquisition, could degrade DQE significantly because it introduces correlation in signal only, not NPS.

Experimental validation of a three-dimensional linear system model for breast tomosynthesis

A three-dimensional (3D) linear model for digital breast tomosynthesis (DBT) was developed to investigate the effects of different imaging system parameters on the reconstructed image quality. In the present work, experimental validation of the model was performed on a prototype DBT system equipped with an amorphous selenium (a-Se) digital mammography detector and filtered back-projection (FBP) reconstruction methods. The detector can be operated in either full resolution with 85 microm pixel size or 2 x 1 pixel binning mode to reduce acquisition time. Twenty-five projection images were acquired with a nominal angular range of +/- 20 degrees. The images were reconstructed using a slice thickness of 1 mm with 0.085 x 0.085 mm in-plane pixel dimension. The imaging performance was characterized by spatial frequency-dependent parameters including a 3D noise power spectrum (NPS) and in-plane modulation transfer function (MTF). Scatter-free uniform x-ray images were acquired at four different exposure levels for noise analysis. An aluminum (Al) edge phantom with 0.2 mm thickness was imaged to measure the in-plane presampling MTF. The measured in-plane MTF and 3D NPS were both in good agreement with the model. The dependence of DBT image quality on reconstruction filters was investigated. It was found that the slice thickness (ST) filter, a Hanning window to limit the high-frequency components in the slice thickness direction, reduces noise aliasing and improves 3D DQE. An ACR phantom was imaged to investigate the effects of angular range and detector operational modes on reconstructed image quality. It was found that increasing the angular range improves the MTF at low frequencies, resulting in better detection of large-area, low-contrast mass lesions in the phantom. There is a trade-off between noise and resolution for pixel binning and full resolution modes, and the choice of detector mode will depend on radiation dose and the targeted lesion.

Imaging performance of an amorphous selenium digital mammography detector in a breast tomosynthesis system.

In breast tomosynthesis a rapid sequence of N images is acquired when the x-ray tube sweeps through different angular views with respect to the breast. Since the total dose to the breast is kept the same as that in regular mammography, the exposure used for each image of tomosynthesis is 1/N. The low dose and high frame rate pose a tremendous challenge to the imaging performance of digital mammography detectors. The purpose of the present work is to investigate the detector performance in different operational modes designed for tomosynthesis acquisition, e.g., binning or full resolution readout, the range of view angles, and the number of views N. A prototype breast tomosynthesis system with a nominal angular range of +/-25 degrees was used in our investigation. The system was equipped with an amorphous selenium (a-Se) full field digital mammography detector with pixel size of 85 microm. The detector can be read out in full resolution or 2 x 1 binning (binning in the tube travel direction). The focal spot blur due to continuous tube travel was measured for different acquisition geometries, and it was found that pixel binning, instead of focal spot blur, dominates the detector modulation transfer function (MTF). The noise power spectrum (NPS) and detective quantum efficiency (DQE) of the detector were measured with the exposure range of 0.4-6 mR, which is relevant to the low dose used in tomosynthesis. It was found that DQE at 0.4 mR is only 20% less than that at highest exposure for both detector readout modes. The detector temporal performance was categorized as lag and ghosting, both of which were measured as a function of x-ray exposure. The first frame lags were 8% and 4%, respectively, for binning and full resolution mode. Ghosting is negligible and independent of the frame rate. The results showed that the detector performance is x-ray quantum noise limited at the low exposures used in each view of tomosynthesis, and the temporal performance at high frame rate (up to 2 frames per second) is adequate for tomosynthesis.

Optimization of detector operation and imaging geometry for breast tomosynthesis

In breast tomosynthesis there are tradeoffs between resolution, noise and acquisition speed for a given glandular dose. The purpose of the present work is to investigate the dependence of tomosynthesis imaging performance on system configuration, which includes detector operational modes and image acquisition geometry. A prototype Siemens breast tomosynthesis system with maximum angular range of +/- 25 degrees was used in our investigation. The system was equipped with an amorphous selenium (a-Se) full field digital mammography detector with pixel size of 85µm. The detector can be read out with full resolution or 2x1 binning (binning in the tube travel direction), which increases the image readout rate and decreases the degradation effect of electronic noise. The total number of views can be varied from 11 to 49, and filtered back projection (FBP) method was used to reconstruct the tomosynthesis images. We investigated the effects of detector operational modes (binning) and imaging geometry (view angle and number) on temporal performance and spatial resolution of the projection images. The focal spot blur due to continuous tube travel was measured for different acquisition geometry, and its effect on in-plane presampling modulation transfer function (MTF) was compared to that due to pixel binning. A three-dimensional cascaded linear system model was developed for tomosynthesis to predict the 3D MTF, NPS and DQE. The results were compared with experimental measurements, and reasonable agreement was achieved. The understanding of the relationship between the 3D and projection image quality will lead to optimization of the x-ray spectrum, imaging geometry and reconstruction filters for digital breast tomosynthesis.

Temporal performance of amorphous selenium mammography detectors.

We investigated temporal performance of amorphous selenium (a-Se) detectors specifically designed for mammographic imaging. Our goal is to quantify the inherent lag and ghosting of a-Se photoconductor as a function of imaging conditions. Two small area electroded a-Se samples, one positively and the other negatively biased on the entrance side of x rays, were used in the experiments. The study of lag and ghosting was performed by delivering a number of raw exposures as experienced in screening mammography to the samples at different electric field strength E(Se) while measuring the current through the a-Se sample. Ghosting at different operational conditions was quantified as the percentage x-ray sensitivity (x-ray generated photocurrent measured from the sample) reduction compared to before irradiation. Lag was determined by measuring the residual current of a-Se at a given time after the end of each x-ray exposure. Both lag and ghosting were measured as a function of E(Se) and cumulative exposure. The values of E(Se) used in our experiments ranged from 1 to 20 V/microm. It was found that ghosting increases with exposure and decreases with E(Se) for both samples because of the dominant effect of recombination between trapped electrons and x-ray generated holes. Lag on the other hand has different dependence on E(Se) and cumulative exposure. At E(Se) < or = 10 V/microm, the first frame lag for both samples changed slowly with cumulative exposure, with a range of 0.2%-1.7% for the positively biased sample and 0.5%-8% for the negatively biased sample. Overall the positively biased sample has better temporal performance than the negatively biased sample due to the lower density of trapped electrons. The impact of time interval between exposures on the temporal performance was also investigated. Recovery of ghosting with longer time interval was observed, which was attributed to the neutralization of trapped electrons by injected holes through dark current.

Statistical analysis of target motion in gated lung stereotactic body radiation therapy

An external surrogate-based respiratory gating technique is a useful method to reduce target margins for the treatment of a moving lung tumor. The success of this technique relies on a good correlation between the motion of the external markers and the internal tumor as well as the repeatability of the respiratory motion. In gated lung stereotactic body radiation therapy (SBRT), the treatment time for each fraction could exceed 30 min due to large fractional dose. Tumor motion may experience pattern changes such as baseline shift during such extended treatment time. The purpose of this study is to analyze tumor motion traces in actual treatment situations and to evaluate the effect of the target baseline shift in gated lung SBRT treatment. Real-time motion data for both the external markers and tumors from 51 lung SBRT treatments with Cyberknife Synchrony technology were analyzed in this study. The treatment time is typically greater than 30 min. The baseline shift was calculated with a rolling average window equivalent to ∼20 s and subtracted from that at the beginning. The magnitude of the baseline shift and its relationship with treatment time were investigated. Phase gating simulation was retrospectively performed on 12 carefully selected treatments with respiratory amplitude larger than 5 mm and regular phases. A customized gating window was defined for each individual treatment. It was found that the baseline shifts are specific to each patient and each fraction. Statistical analysis revealed that more than 69% treatments exhibited increased baseline shifts with the lapse of treatment time. The magnitude of the baseline shift could reach 5.3 mm during a 30 min treatment. Gating simulation showed that tumor excursion was caused mainly by the uncertainties in phase gating simulation and baseline shift, the latter being the primary factor. With a 5 mm gating window, 2 out of 12 treatments in the study group showed significant tumor excursion. Baseline shifts alone could cause up to 20% of tumor excursion outside the gating window. It is concluded that baseline shifts may increase with the treatment time and are more likely to act as a time-dependent systematic error. For phase-based gated lung SBRT, a baseline shift may be one of the major sources of targeting error during treatment.

Image-guided respiratory-gated lung stereotactic body radiotherapy: Which target definition is optimal?

In stereotactic body radiotherapy(SBRT), the respiratory tumor motion makes target definition very important to achieve optimal clinical results for treatment of early stage lungcancer. In this article, the authors quantitatively evaluated the influence of different target definition strategies on image-guided respiratory-gated SBRT for lungcancer. Twelve lungcancer patients with 4D CT estimated target motion of > 1 cm were selected for this retrospective study. An experienced physician contoured gross target volumes (GTVs) at each 4D CT phase for all patients. Three types of internal target volumes (ITVs) were generated based on the contoured GTVs:(1) ITV BH : GTV contoured on deep expiration breath-hold (BH) CT with an isotropic internal margin (IM) of 5 mm ; (2) ITV 50 : GTV contoured at the end-expiration (50%) phase with an isotropic IM of 5 mm ; (3) ITV GW : Composite volume of all GTVs within the gating window, defined as several phases around phase 50% with residual target motion of 5 mm . Planning target volumes (PTVs) were generated by adding 3 mm isotropic setup error margin to ITVs. Three treatment plans, namely, Plan BH , Plan 50 , and Plan GW , were created based on the three PTVs. Identical beam settings and planning constraints were used for all three plans for each patient. The prescription dose was 60 Gy in three fractions. The potential toxicities to the critical organs were quantified by mean lungdose (MLD), lung volume receiving > 20 Gy (V20), mean heartdose(MHD), and spinal cord dose (SCD). It is shown that the tumor volume and dose coverage are comparable for Plan BH and Plan 50 . On average, PTV GW are 38% less than PTV 50 . Although for most patients PTV 50 encompasses the entire PTV GW , up to 5.48 cm 3 (6%) of PTV GW is outside PTV 50 . Compared to Plan 50 , prescribed percentage is about 2% higher for Plan GW , and the average dose decreases in critical organs are 0.78 Gy for MLD, 1.02% for V20, 0.61 Gy for MHD and 0.59 Gy for maximum SCD. For the cases receiving high lung and heartdose with Plan 50 , the dose reduction is 1.0 Gy for MLD and 1.14 Gy for MHD with Plan GW . Our preliminary results show that a patient-specific ITV, defined as the composite volume of all GTVs within the gating window, may be used to define PTV in image-guided respiratory-gated SBRT. This approach potentially reduces the irradiated volume of normal tissue further without sacrificing target dose coverage and thus may minimize the risk of treatment-related toxicities.

Dosimetric effect of intrafraction tumor motion in phase gated lung stereotactic body radiotherapy

PURPOSEnA major concern for lung intensity modulated radiation therapy delivery is the deviation of actually delivered dose distribution from the planned one due to simultaneous movements of multileaf collimator (MLC) leaves and tumor. For gated lung stereotactic body radiotherapy treatment (SBRT), the situation becomes even more complicated because of SBRTs characteristics such as fewer fractions, smaller target volume, higher dose rate, and extended fractional treatment time. The purpose of this work is to investigate the dosimetric effect of intrafraction tumor motion during gated lung SBRT delivery by reconstructing the delivered dose distribution with real-time tumor motion considered.nnnMETHODSnThe tumor motion data were retrieved from six lung patients. Each of them received three fractions of stereotactic radiotherapy treatments with Cyberknife Synchrony (Accuray, Sunnyvale, CA). Phase gating through an external surrogate was simulated with a gating window of 5 mm. The resulting residual tumor motion curves during gating (beam-on) were retrieved. Planning target volume (PTV) was defined as physician-contoured clinical target volume (CTV) surrounded by an isotropic 5 mm margin. Each patient was prescribed with 60 Gy∕3 fractions. The authors developed an algorithm to reconstruct the delivered dose with tumor motion. The DMLC segments, mainly leaf position and segment weighting factor, were recalculated according to the probability density function of tumor motion curve. The new DMLC sequence file was imported back to treatment planning system to reconstruct the dose distribution.nnnRESULTSnHalf of the patients in the study group experienced PTV D95% deviation up to 26% for fractional dose and 14% for total dose. CTV mean dose dropped by 1% with tumor motion. Although CTV is almost covered by prescribed dose with 5 mm margin, qualitative comparison on the dose distributions reveals that CTV is on the verge of underdose. The discrepancy happens due to tumor excursion outside of the gating window, which, for our study group, is mainly caused by baseline shift, i.e., the change in general trend of the motion curve during extended period of treatment time.nnnCONCLUSIONSnThe dose deviation in PTV and CTV due to target motion is not always negligible in gated SBRT. Although CTVs are covered sufficiently with prescribed dose in most cases, some are on the verge of underdose due to large tumor excursion caused by factors such as baseline shift.