F. Pennazio

Large scale validation of the M5L lung CAD on heterogeneous CT datasets

PURPOSE M5L, a fully automated computer-aided detection (CAD) system for the detection and segmentation of lung nodules in thoracic computed tomography (CT), is presented and validated on several image datasets. METHODS M5L is the combination of two independent subsystems, based on the Channeler Ant Model as a segmentation tool [lung channeler ant model (lungCAM)] and on the voxel-based neural approach. The lungCAM was upgraded with a scan equalization module and a new procedure to recover the nodules connected to other lung structures; its classification module, which makes use of a feed-forward neural network, is based of a small number of features (13), so as to minimize the risk of lacking generalization, which could be possible given the large difference between the size of the training and testing datasets, which contain 94 and 1019 CTs, respectively. The lungCAM (standalone) and M5L (combined) performance was extensively tested on 1043 CT scans from three independent datasets, including a detailed analysis of the full Lung Image Database Consortium/Image Database Resource Initiative database, which is not yet found in literature. RESULTS The lungCAM and M5L performance is consistent across the databases, with a sensitivity of about 70% and 80%, respectively, at eight false positive findings per scan, despite the variable annotation criteria and acquisition and reconstruction conditions. A reduced sensitivity is found for subtle nodules and ground glass opacities (GGO) structures. A comparison with other CAD systems is also presented. CONCLUSIONS The M5L performance on a large and heterogeneous dataset is stable and satisfactory, although the development of a dedicated module for GGOs detection could further improve it, as well as an iterative optimization of the training procedure. The main aim of the present study was accomplished: M5L results do not deteriorate when increasing the dataset size, making it a candidate for supporting radiologists on large scale screenings and clinical programs.

An innovative detection module concept for PET

The design of a Positron Emission Tomography detection module capable of working inside a Magnetic Resonant Imaging system is the main objective of the 4D-MPET project. Combining the two imaging technologies offers better soft tissue contrast and lower radiation doses by providing both functional and morphological information at the same time. The proposed detector will feature a three-dimensional architecture based on two tiles of Silicon Photomultipliers coupled to a single LYSO scintillator on both its faces. Silicon Photomultipliers are magnetic-field compatible photo-detectors with a very small size enabling novel detector geometries that allow the measurement of the Depth of Interaction as well as a high detector packing fraction to maximize system sensitivity. Furthermore they can be fabricated using standard silicon technology, have a large gain in the order of 106 and are very fast thus allowing evaluating the Time of Flight. Among the other features of the proposed detection system, the architecture of the innovative readout electronics will be also described which plays a relevant role for the achievement of the desired performance and is based on custom integrated circuits. Simulation results of the whole system show good performance in terms of time and spatial resolution: a timestamp of 100 ps is the ultimate performance achievable with the use of a double threshold technique along with fast electronics. Time over threshold is exploited to provide the energy information with a bin size of 400 ps. Moreover, a z resolution of 1.4 mm Full Width at Half Maximum can be achieved. The proposed detector can also be exploited in other tracking applications, such as High Energy Physics and Astrophysics.

Full-beam performances of a PET detector with synchrotron therapeutic proton beams

Treatment quality assessment is a crucial feature for both present and next-generation ion therapy facilities. Several approaches are being explored, based on prompt radiation emission or on PET signals by [Formula: see text]-decaying isotopes generated by beam interactions with the body. In-beam PET monitoring at synchrotron-based ion therapy facilities has already been performed, either based on inter-spill data only, to avoid the influence of the prompt radiation, or including both in-spill and inter-spill data. However, the PET images either suffer of poor statistics (inter-spill) or are more influenced by the background induced by prompt radiation (in-spill). Both those problems are expected to worsen for accelerators with improved duty cycle where the inter-spill interval is reduced to shorten the treatment time. With the aim of assessing the detector performance and developing techniques for background reduction, a test of an in-beam PET detector prototype was performed at the CNAO synchrotron-based ion therapy facility in full-beam acquisition modality. Data taken with proton beams impinging on PMMA phantoms showed the system acquisition capability and the resulting activity distribution, separately reconstructed for the in-spill and the inter-spill data. The coincidence time resolution for in-spill and inter-spill data shows a good agreement, with a slight deterioration during the spill. The data selection technique allows the identification and rejection of most of the background originated during the beam delivery. The activity range difference between two different proton beam energies (68 and 72 MeV) was measured and found to be in sub-millimeter agreement with the expected result. However, a slightly longer (2 mm) absolute profile length is obtained for in-spill data when compared to inter-spill data.

First results of the INSIDE in-beam PET scanner for the on-line monitoring of particle therapy treatments

Quality assessment of particle therapy treatments by means of PET systems has been carried out since late `90 and it is one of the most promising in-vivo non invasive monitoring techniques employed clinically. It can be performed with a diagnostic PET scanners installed outside the treatment room (off-line monitoring) or inside the treatment room (in-room monitoring). However the most efficient way is by integrating a PET scanner with the treatment delivery system (on-line monitoring) so that the biological wash out and the patient repositioning errors are minimized. In this work we present the performance of the in-beam PET scanner developed within the INSIDE project. The INSIDE PET scanner is made of two planar heads, 10 cm wide (transaxially) and 25 cm long (axially), composed of pixellated LFS crystals coupled to Hamamatsu MPPCs. Custom designed Front-End Electronics (FE) and Data AcQuisition (DAQ) systems allow an on-line reconstruction of PET images from separated in-spill and inter-spill data sets. The INSIDE PET scanner has been recently delivered at the CNAO (Pavia, Italy) hadrontherapy facility and the first experimental measurements have been carried out. Homogeneous PMMA phantoms and PMMA phantoms with small air and bone inserts were irradiated with monoenergetic clinical proton beams. The activity range was evaluated at various benchmark positions within the field of view to assess the homogeneity of response of the PET system. Repeated irradiations of PMMA phantoms with clinical spread out Bragg peak proton beams were performed to evaluate the reproducibility of the PET signal. The results found in this work show that the response of the INSIDE PET scanner is independent of the position within the radiation field. Results also show the capability of the INSIDE PET scanner to distinguish variations of the activity range due to small tissue inhomogeneities. Finally, the reproducibility of the activity range measurement was within 1 mm.

SiPM-based PET module with depth of interaction

Silicon Photomultipliers are used in many new generation PET block detectors. High granularity pixel SiPMs allow a high precision measurement of the photon interaction coordinates along the crystal surface. In order to further improve the resolution it is necessary to measure the photon Depth of Interaction (DOl), so as to reduce the parallax error in the Line of Response reconstruction. An innovative technique for DOl determination is proposed and tested. Measurements are made with a 2 cm × 2 cm × 1 cm LYSO slab with readout on the front and back large sides by means of two 4 × 4 square SiPM pixel matrices of 5 mm pitch. The data acquisition is based on the new BASIC32 chip read out with an FPGA-based system.

Monte Carlo simulation tool for online treatment monitoring in hadrontherapy with in-beam PET: A patient study

Hadrontherapy is a method for treating cancer with very targeted dose distributions and enhanced radiobiological effects. To fully exploit these advantages, in vivo range monitoring systems are required. These devices measure, preferably during the treatment, the secondary radiation generated by the beam-tissue interactions. However, since correlation of the secondary radiation distribution with the dose is not straightforward, Monte Carlo (MC) simulations are very important for treatment quality assessment. The INSIDE project constructed an in-beam PET scanner to detect signals generated by the positron-emitting isotopes resulting from projectile-target fragmentation. In addition, a FLUKA-based simulation tool was developed to predict the corresponding reference PET images using a detailed scanner model. The INSIDE in-beam PET was used to monitor two consecutive proton treatment sessions on a patient at the Italian Center for Oncological Hadrontherapy (CNAO). The reconstructed PET images were updated every 10 s providing a near real-time quality assessment. By half-way through the treatment, the statistics of the measured PET images were already significant enough to be compared with the simulations with average differences in the activity range less than 2.5 mm along the beam direction. Without taking into account any preferential direction, differences within 1 mm were found. In this paper, the INSIDE MC simulation tool is described and the results of the first in vivo agreement evaluation are reported. These results have justified a clinical trial, in which the MC simulation tool will be used on a daily basis to study the compliance tolerances between the measured and simulated PET images.

PV-0562: Hadron-therapy monitoring with in-beam PET: measurements and simulations of the INSIDE PET scanner

Hadrontherapy monitoring goal: Provide to clinicians information about the conformity between the dose distribution planned in TPS and the actual one [1-3]. In-beam PET: exploit the beta+ activation induced in the patients body by the hadrontherapy (HT) particle beam to perform treatment monitoring and dose-delivery accuracy assessment. INSIDE collaboration: build an in-beam PET and tracker combined device for on-line HT monitoring [4-5]. METHODS

A four-dimensional photon detector for PET application

We analyzed a photon detector for positron emission tomography with high spatial resolution and depth of interaction capability. The detector is composed of a monolithic LYSO scintillator crystal coupled on top and bottom sides to two custom SiPM arrays. We investigated the ability to reconstruct the DOI of the 511 keV photon comparing the number of triggered SiPMs on the two sides of the module. Acquisitions were performed scanning the lateral surface of the crystal with a collimated 511 keV photon beam at different incident positions. A standard deviation of 1.5 mm in depth of interaction was obtained at the center of the module.

TDC-based readout electronics for real-time acquisition of high resolution PET bio-images

Positron emission tomography (PET) is a clinical and research tool for in vivo metabolic imaging. The demand for better image quality entails continuous research to improve PET instrumentation. In clinical applications, PET image quality benefits from the time of flight (TOF) feature. Indeed, by measuring the photons arrival time on the detectors with a resolution less than 100 ps, the annihilation point can be estimated with centimeter resolution. This leads to better noise level, contrast and clarity of detail in the images either using analytical or iterative reconstruction algorithms. This work discusses a silicon photomultiplier (SiPM)-based magnetic-field compatible TOF-PET module with depth of interaction (DOI) correction. The detector features a 3D architecture with two tiles of SiPMs coupled to a single LYSO scintillator on both its faces. The real-time front-end electronics is based on a current-mode ASIC where a low input impedance, fast current buffer allows achieving the required time resolution. A pipelined time to digital converter (TDC) measures and digitizes the arrival time and the energy of the events with a timestamp of 100 ps and 400 ps, respectively. An FPGA clusters the data and evaluates the DOI, with a simulated z resolution of the PET image of 1.4 mm FWHM.

Evaluation of algorithms for photon depth of interaction estimation for the TRIMAGE PET component

The TRIMAGE consortium aims to develop a multimodal PET/MR/EEG brain scanner dedicated to the early diagnosis of schizophrenia and other mental health disorders. The TRIMAGE PET component features a full ring made of 18 detectors, each one consisting of twelve 8 ×8 Silicon PhotoMultipliers (SiPMs) tiles coupled to two segmented LYSO crystal matrices with staggered layers. The identification of the pixel where a photon interacted is performed on-line at the front-end level, thus allowing the FPGA board to emit fully digital event packets. This allows to increase the effective bandwidth, but imposes restrictions on the complexity of the algorithms to be implemented. In this work, two algorithms, whose implementation is feasible directly on an FPGA, are presented and evaluated. The first algorithm is driven by physical considerations, while the other consists in a two-class linear Support Vector Machine (SVM). The validation of the algorithm performance is carried out by using simulated data generated with the GAMOS Monte Carlo. The obtained results show that the achieved accuracy in layer identification is above 90% for both the proposed approaches. The feasibility of tagging and rejecting events that underwent multiple interactions within the detector is also discussed.