David A. P. Dunkerley

Detector, collimator and real-time reconstructor for a new scanning-beam digital x-ray (SBDX) prototype

Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system for low dose cardiac imaging. The use of a narrow scanned x-ray beam in SBDX reduces detected x-ray scatter and improves dose efficiency, however the tight beam collimation also limits the maximum achievable x-ray fluence. To increase the fluence available for imaging, we have constructed a new SBDX prototype with a wider x-ray beam, larger-area detector, and new real-time image reconstructor. Imaging is performed with a scanning source that generates 40,328 narrow overlapping projections from 71 x 71 focal spot positions for every 1/15 s scan period. A high speed 2-mm thick CdTe photon counting detector was constructed with 320x160 elements and 10.6 cm x 5.3 cm area (full readout every 1.28 s), providing an 86% increase in area over the previous SBDX prototype. A matching multihole collimator was fabricated from layers of tungsten, brass, and lead, and a multi-GPU reconstructor was assembled to reconstruct the stream of captured detector images into full field-of-view images in real time. Thirty-two tomosynthetic planes spaced by 5 mm plus a multiplane composite image are produced for each scan frame. Noise equivalent quanta on the new SBDX prototype measured 63%-71% higher than the previous prototype. X-ray scatter fraction was 3.9-7.8% when imaging 23.3-32.6 cm acrylic phantoms, versus 2.3- 4.2% with the previous prototype. Coronary angiographic imaging at 15 frame/s was successfully performed on the new SBDX prototype, with live display of either a multiplane composite or single plane image.

Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

PURPOSE Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. METHODS The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. RESULTS Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. CONCLUSIONS Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on real-time implementation and application-specific analysis.

Single-view geometric calibration for C-arm inverse geometry CT

Abstract. Accurate and artifact-free reconstruction of tomographic images requires precise knowledge of the imaging system geometry. A projection matrix-based calibration method to enable C-arm inverse geometry CT (IGCT) is proposed. The method is evaluated for scanning-beam digital x-ray (SBDX), a C-arm mounted inverse geometry fluoroscopic technology. A helical configuration of fiducials is imaged at each gantry angle in a rotational acquisition. For each gantry angle, digital tomosynthesis is performed at multiple planes and a composite image analogous to a cone-beam projection is generated from the plane stack. The geometry of the C-arm, source array, and detector array is determined at each angle by constructing a parameterized three-dimensional-to-two-dimensional projection matrix that minimizes the sum-of-squared deviations between measured and projected fiducial coordinates. Simulations were used to evaluate calibration performance with translations and rotations of the source and detector. The relative root-mean-square error in a reconstruction of a numerical thorax phantom was 0.4% using the calibration method versus 7.7% without calibration. In phantom studies, reconstruction of SBDX projections using the proposed method eliminated artifacts present in noncalibrated reconstructions. The proposed IGCT calibration method reduces image artifacts when uncertainties exist in system geometry.

A geometric calibration method for inverse geometry computed tomography using P-matrices

Accurate and artifact free reconstruction of tomographic images requires precise knowledge of the imaging system geometry. This work proposes a novel projection matrix (P-matrix) based calibration method to enable C-arm inverse geometry CT (IGCT). The method is evaluated for scanning-beam digital x-ray (SBDX), a C-arm mounted inverse geometry fluoroscopic technology. A helical configuration of fiducials is imaged at each gantry angle in a rotational acquisition. For each gantry angle, digital tomosynthesis is performed at multiple planes and a composite image analogous to a cone-beam projection is generated from the plane stack. The geometry of the C-arm, source array, and detector array is determined at each angle by constructing a parameterized 3D-to-2D projection matrix that minimizes the sum-of-squared deviations between measured and projected fiducial coordinates. Simulations were used to evaluate calibration performance with translations and rotations of the source and detector. In a geometry with 1 mm translation of the central ray relative to the axis-of-rotation and 1 degree yaw of the detector and source arrays, the maximum error in the recovered translational parameters was 0.4 mm and maximum error in the rotation parameter was 0.02 degrees. The relative rootmean- square error in a reconstruction of a numerical thorax phantom was 0.4% using the calibration method, versus 7.7% without calibration. Changes in source-detector-distance were the most challenging to estimate. Reconstruction of experimental SBDX data using the proposed method eliminated double contour artifacts present in a non-calibrated reconstruction. The proposed IGCT geometric calibration method reduces image artifacts when uncertainties exist in system geometry.

Radiation treatment planning and delivery strategies for a pregnant brain tumor patient

Abstract The management of a pregnant patient in radiation oncology is an infrequent event requiring careful consideration by both the physician and physicist. The aim of this manuscript was to highlight treatment planning techniques and detail measurements of fetal dose for a pregnant patient recently requiring treatment for a brain cancer. A 27‐year‐old woman was treated during gestational weeks 19–25 for a resected grade 3 astrocytoma to 50.4 Gy in 28 fractions, followed by an additional 9 Gy boost in five fractions. Four potential plans were developed for the patient: a 6 MV 3D‐conformal treatment plan with enhanced dynamic wedges, a 6 MV step‐and‐shoot (SnS) intensity‐modulated radiation therapy (IMRT) plan, an unflattened 6 MV SnS IMRT plan, and an Accuray TomoTherapy HDA helical IMRT treatment plan. All treatment plans used strategies to reduce peripheral dose. Fetal dose was estimated for each treatment plan using available literature references, and measurements were made using thermoluminescent dosimeters (TLDs) and an ionization chamber with an anthropomorphic phantom. TLD measurements from a full‐course radiation delivery ranged from 1.0 to 1.6 cGy for the 3D‐conformal treatment plan, from 1.0 to 1.5 cGy for the 6 MV SnS IMRT plan, from 0.6 to 1.0 cGy for the unflattened 6 MV SnS IMRT plan, and from 1.9 to 2.6 cGy for the TomoTherapy treatment plan. The unflattened 6 MV SnS IMRT treatment plan was selected for treatment for this particular patient, though the fetal doses from all treatment plans were deemed acceptable. The cumulative dose to the patients unshielded fetus is estimated to be 1.0 cGy at most. The planning technique and distance between the treatment target and fetus both contributed to this relatively low fetal dose. Relevant treatment planning strategies and treatment delivery considerations are discussed to aid radiation oncologists and medical physicists in the management of pregnant patients.

Localization of cardiac volume and patient features in inverse geometry x-ray fluoroscopy

The scanning-beam digital x-ray (SBDX) system is an inverse geometry x-ray fluoroscopy technology that performs real-time tomosynthesis at planes perpendicular to the source-detector axis. The live display is a composite image which portrays sharp features (e.g. coronary arteries) extracted from a 16 cm thick reconstruction volume. We present a method for automatically determining the position of the cardiac volume prior to acquisition of a coronary angiogram. In the algorithm, a single non-contrast frame is reconstructed over a 44 cm thickness using shift-and-add digital tomosynthesis. Gradient filtering is applied to each plane to emphasize features such as the cardiomediastinal contour, diaphragm, and lung texture, and then sharpness vs. plane position curves are generated. Three sharpness metrics were investigated: average gradient in the bright field, maximum gradient, and the number of normalized gradients exceeding 0.5. A model correlating the peak sharpness in a non-contrast frame and the midplane of the coronary arteries in a contrast-enhanced frame was established using 37 SBDX angiographic loops (64-136 kg human subjects, 0-30° cranial- caudal). The average gradient in the bright field (primarily lung) and the number of normalized gradients >0.5 each yielded peaks correlated to the coronary midplane. The rms deviation between the predicted and true midplane was 1.57 cm. For a 16 cm reconstruction volume and the 5.5-11.5 cm thick cardiac volumes in this study, midplane estimation errors of 2.25-5.25 cm were tolerable. Tomosynthesis-based localization of cardiac volume is feasible. This technique could be applied prior to coronary angiography, or to assist in isocentering the patient for rotational angiography.

Automated 3D coronary sinus catheter detection using a scanning-beam digital x-ray system

Scanning-beam digital x-ray (SBDX) is an inverse geometry x-ray fluoroscopy system capable of tomosynthesis-based 3D tracking of catheter electrodes concurrent with fluoroscopic display. To facilitate respiratory motion-compensated 3D catheter tracking, an automated coronary sinus (CS) catheter detection algorithm for SBDX was developed. The technique uses the 3D localization capability of SBDX and prior knowledge of the catheter shape. Candidate groups of points representing the CS catheter are obtained from a 3D shape-constrained search. A cost function is then minimized over the groups to select the most probable CS catheter candidate. The algorithm was implemented in MATLAB and tested offline using recorded image sequences of a chest phantom containing a CS catheter, ablation catheter, and fiducial clutter. Fiducial placement was varied to create challenging detection scenarios. Table panning and elevation was used to simulate motion. The CS catheter detection method had 98.1% true positive rate and 100% true negative rate in 2755 frames of imaging. Average processing time was 12.7 ms/frame on a PC with a 3.4 GHz CPU and 8 GB memory. Motion compensation based on 3D CS catheter tracking was demonstrated in a moving chest phantom with a fixed CS catheter and an ablation catheter pulled along a fixed trajectory. The RMS error in the tracked ablation catheter trajectory was 1.41 mm, versus 10.35 mm without motion compensation. A computationally efficient method of automated 3D CS catheter detection has been developed to assist with motion-compensated 3D catheter tracking and registration of 3D cardiac models to tracked catheters.

Dynamic electronic collimation method for 3-D catheter tracking on a scanning-beam digital x-ray system

Abstract. Scanning-beam digital x-ray (SBDX) is an inverse geometry x-ray fluoroscopy system capable of tomosynthesis-based 3-D catheter tracking. This work proposes a method of dose-reduced 3-D catheter tracking using dynamic electronic collimation (DEC) of the SBDX scanning x-ray tube. This is achieved through the selective deactivation of focal spot positions not needed for the catheter tracking task. The technique was retrospectively evaluated with SBDX detector data recorded during a phantom study. DEC imaging of a catheter tip at isocenter required 340 active focal spots per frame versus 4473 spots in full field-of-view (FOV) mode. The dose-area product (DAP) and peak skin dose (PSD) for DEC versus full FOV scanning were calculated using an SBDX Monte Carlo simulation code. The average DAP was reduced to 7.8% of the full FOV value, consistent with the relative number of active focal spots (7.6%). For image sequences with a moving catheter, PSD was 33.6% to 34.8% of the full FOV value. The root-mean-squared-deviation between DEC-based 3-D tracking coordinates and full FOV 3-D tracking coordinates was less than 0.1 mm. The 3-D distance between the tracked tip and the sheath centerline averaged 0.75 mm. DEC is a feasible method for dose reduction during SBDX 3-D catheter tracking.

Long‐term dosimetric stability of multiple TomoTherapy delivery systems

&NA; The dosimetric stability of six TomoTherapy units was analyzed to investigate changes in performance over time and with system upgrades. Energy and output were tracked using monitor chamber signal, onboard megavoltage computed tomography (MVCT) detector profile, and external ion chamber measurements. The systems (and monitoring periods) include three Hi‐Art (67, 61, and 65 mos.), two TomoHDA (31 and 26 mos.), and one Radixact unit (11 mos.), representing approximately 10 years of clinical use. The four newest systems use the Dose Control Stability (DCS) system and Fixed Target Linear Accelerator (linac) (FTL). The output stability is reported as deviation from reference monitor chamber signal for all systems and/or from an external chamber signal. The energy stability was monitored using relative (center versus off‐axis) MVCT detector signal (beam profile) and/or the ratio of chamber measurements at 2 depths. The clinical TomoHDA data were used to benchmark the Radixact stability, which has the same FTL but runs at a higher dose rate. The output based on monitor chamber data of all systems is very stable. The standard deviation of daily output on the non‐DCS systems was 0.94–1.52%. As expected, the DCS systems had improved standard deviation: 0.004–0.06%. The beam energy was also very stable for all units. The standard deviation in profile flatness was 0.23–0.62% for rotating target systems and 0.04–0.09% for FTL. Ion chamber output and PDD ratios supported these results. The output stability on the Radixact system during extended treatment delivery (20, 30, and 40 min) was comparable to a clinical TomoHDA system. For each system, results are consistent between different measurement tools and techniques, proving not only the dosimetric stability, but also these quality parameters can be confirmed with various metrics. The replacement history over extended time periods of the major dosimetric components of the different delivery systems (target, linac, and magnetron) is also reported.

Method for dose-reduced 3D catheter tracking on a scanning-beam digital x-ray system using dynamic electronic collimation

Scanning-beam digital x-ray (SBDX) is an inverse geometry x-ray fluoroscopy system capable of tomosynthesis-based 3D catheter tracking. This work proposes a method of dose-reduced 3D tracking using dynamic electronic collimation (DEC) of the SBDX scanning x-ray tube. Positions in the 2D focal spot array are selectively activated to create a regionof- interest (ROI) x-ray field around the tracked catheter. The ROI position is updated for each frame based on a motion vector calculated from the two most recent 3D tracking results. The technique was evaluated with SBDX data acquired as a catheter tip inside a chest phantom was pulled along a 3D trajectory. DEC scans were retrospectively generated from the detector images stored for each focal spot position. DEC imaging of a catheter tip in a volume measuring 11.4 cm across at isocenter required 340 active focal spots per frame, versus 4473 spots in full-FOV mode. The dose-area-product (DAP) and peak skin dose (PSD) for DEC versus full field-of-view (FOV) scanning were calculated using an SBDX Monte Carlo simulation code. DAP was reduced to 7.4% to 8.4% of the full-FOV value, consistent with the relative number of active focal spots (7.6%). For image sequences with a moving catheter, PSD was 33.6% to 34.8% of the full-FOV value. The root-mean-squared-deviation between DEC-based 3D tracking coordinates and full-FOV 3D tracking coordinates was less than 0.1 mm. The 3D distance between the tracked tip and the sheath centerline averaged 0.75 mm. Dynamic electronic collimation can reduce dose with minimal change in tracking performance.