Michael Brehler

Automatic standard plane adjustment on mobile C-Arm CT images of the calcaneus using atlas-based feature registration

Intraarticular fractures of the calcaneus are routinely treated by open reduction and internal fixation followed by intraoperative imaging to validate the repositioning of bone fragments. C-Arm CT offers surgeons the possibility to directly verify the alignment of the fracture parts in 3D. Although the device provides more mobility, there is no sufficient information about the device-to-patient orientation for standard plane reconstruction. Hence, physicians have to manually align the image planes in a position that intersects with the articular surfaces. This can be a time-consuming step and imprecise adjustments lead to diagnostic errors. We address this issue by introducing novel semi-/automatic methods for adjustment of the standard planes on mobile C-Arm CT images. With the semi-automatic method, physicians can quickly adjust the planes by setting six points based on anatomical landmarks. The automatic method reconstructs the standard planes in two steps, first SURF keypoints (2D and newly introduced pseudo-3D) are generated for each image slice; secondly, these features are registered to an atlas point set and the parameters of the image planes are transformed accordingly. The accuracy of our method was evaluated on 51 mobile C-Arm CT images from clinical routine with manually adjusted standard planes by three physicians of different expertise. The average time of the experts (46s) deviated from the intermediate user (55s) by 9 seconds. By applying 2D SURF key points 88% of the articular surfaces were intersected correctly by the transformed standard planes with a calculation time of 10 seconds. The pseudo-3D features performed even better with 91% and 8 seconds.

High-resolution extremity cone-beam CT with a CMOS detector: evaluation of a clinical prototype in quantitative assessment of bone microarchitecture

Purpose: A prototype high-resolution extremity cone-beam CT (CBCT) system based on a CMOS detector was developed to support quantitative in vivo assessment of bone microarchitecture. We compare the performance of CMOS CBCT to an amorphous silicon (a-Si:H) FPD extremity CBCT in imaging of trabecular bone. Methods: The prototype CMOS-based CBCT involves a DALSA Xineos3030 detector (99 μm pixels) with 400 μm-thick CsI scintillator and a compact 0.3 FS rotating anode x-ray source. We compare the performance of CMOS CBCT to an a- Si:H FPD scanner built on a similar gantry, but using a Varian PaxScan2530 detector with 0.137 mm pixels and a 0.5 FS stationary anode x-ray source. Experimental studies include measurements of Modulation Transfer Function (MTF) for the detectors and in 3D image reconstructions. Image quality in clinical scenarios is evaluated in scans of a cadaver ankle. Metrics of trabecular microarchitecture (BV/TV, Bone Volume/Total Volume, TbSp, Trabecular Spacing, and TbTh, trabecular thickness) are obtained in a human ulna using CMOS CBCT and a-Si:H FPD CBCT and compared to gold standard μCT. Results: The CMOS detector achieves ~40% increase in the f20 value (frequency at which MTF reduces to 0.20) compared to the a-Si:H FPD. In the reconstruction domain, the FWHM of a 127 μm tungsten wire is also improved by ~40%. Reconstructions of a cadaveric ankle reveal enhanced modulation of trabecular structures with the CMOS detector and soft-tissue visibility that is similar to that of the a-Si:H FPD system. Correlations of the metrics of bone microarchitecture with gold-standard μCT are improved with CMOS CBCT: from 0.93 to 0.98 for BV/TV, from 0.49 to 0.74 for TbTh, and from 0.9 to 0.96 for TbSp. Conclusion: Adoption of a CMOS detector in extremity CBCT improved spatial resolution and enhanced performance in metrics of bone microarchitecture compared to a conventional a-Si:H FPD. The results support development of clinical applications of CMOS CBCT in quantitative imaging of bone health.

Robust quantitative assessment of trabecular microarchitecture in extremity cone-beam CT using optimized segmentation algorithms

Purpose: In-vivo evaluation of bone microarchitecture remains challenging because of limited resolution of conventional orthopaedic imaging modalities. We investigate the performance of flat-panel detector extremity Cone-Beam CT (CBCT) in quantitative analysis of trabecular bone. To enable accurate morphometry of fine trabecular bone architecture, advanced CBCT pre-processing and segmentation algorithms are developed. Methods: The study involved 35 transilliac bone biopsy samples imaged on extremity CBCT (voxel size 75 μm, imaging dose ~13 mGy) and gold standard μCT (voxel size 7.67 μm). CBCT image segmentation was performed using (i) global Otsu’s thresholding, (ii) Bernsen’s local thresholding, (iii) Bernsen’s local thresholding with additional histogram-based global pre-thresholding, and (iv) the same as (iii) but combined with contrast enhancement using a Laplacian Pyramid. Correlations between extremity CBCT with the different segmentation algorithms and gold standard μCT were investigated for measurements of Bone Volume over Total Volume (BV/TV), Trabecular Thickness (Tb.Th), Trabecular Spacing (Tb.Sp), and Trabecular Number (Tb.N). Results: The combination of local thresholding with global pre-thresholding and Laplacian contrast enhancement outperformed other CBCT segmentation methods. Using this optimal segmentation scheme, strong correlation between extremity CBCT and μCT was achieved, with Pearson coefficients of 0.93 for BV/TV, 0.89 for Tb.Th, 0.91 for Tb.Sp, and 0.88 for Tb.N (all results statistically significant). Compared to a simple global CBCT segmentation using Otsu’s algorithm, the advanced segmentation method achieved ~20% improvement in the correlation coefficient for Tb.Th and ~50% improvement for Tb.Sp. Conclusions: Extremity CBCT combined with advanced image pre-processing and segmentation achieves high correlation with gold standard μCT in measurements of trabecular microstructure. This motivates ongoing development of clinical applications of extremity CBCT in in-vivo evaluation of bone health e.g. in early osteoarthritis and osteoporosis.

High-resolution extremity cone-beam CT with a CMOS detector: Task-based optimization of scintillator thickness

Purpose: CMOS x-ray detectors offer small pixel sizes and low electronic noise that may support the development of novel high-resolution imaging applications of cone-beam CT (CBCT). We investigate the effects of CsI scintillator thickness on the performance of CMOS detectors in high resolution imaging tasks, in particular in quantitative imaging of bone microstructure in extremity CBCT. Methods: A scintillator thickness-dependent cascaded systems model of CMOS x-ray detectors was developed. Detectability in low-, high- and ultra-high resolution imaging tasks (Gaussian with FWHM of ~250 μm, ~80 𝜇m and ~40 μm, respectively) was studied as a function of scintillator thickness using the theoretical model. Experimental studies were performed on a CBCT test bench equipped with DALSA Xineos3030 CMOS detectors (99 μm pixels) with CsI scintillator thicknesses of 400 μm and 700 𝜇m, and a 0.3 FS compact rotating anode x-ray source. The evaluation involved a radiographic resolution gauge (0.6-5.0 lp/mm), a 127 μm tungsten wire for assessment of 3D resolution, a contrast phantom with tissue-mimicking inserts, and an excised fragment of human tibia for visual assessment of fine trabecular detail. Results: Experimental studies show ~35% improvement in the frequency of 50% MTF modulation when using the 400 μm scintillator compared to the standard nominal CsI thickness of 700 μm. Even though the high-frequency DQE of the two detectors is comparable, theoretical studies show a 14% to 28% increase in detectability index (d’2) of high- and ultra- high resolution tasks, respectively, for the detector with 400 μm CsI compared to 700 μm CsI. Experiments confirm the theoretical findings, showing improvements with the adoption of 400 μm panel in the visibility of the radiographic pattern (2x improvement in peak-to-through distance at 4.6 lp/mm) and a 12.5% decrease in the FWHM of the tungsten wire. Reconstructions of the tibial plateau reveal enhanced visibility of trabecular structures with the CMOS detector with 400 μm scinitllator. Conclusion: Applications on CMOS detectors in high resolution CBCT imaging of trabecular bone will benefit from using a thinner scintillator than the current standard in general radiography. The results support the translation of the CMOS sensor with 400 μm scinitllator.

Upper ankle joint space detection on low contrast intraoperative fluoroscopic C-arm projections

Intraoperative mobile C-arm fluoroscopy is widely used for interventional verification in trauma surgery, high flexibility combined with low cost being the main advantages of the method. However, the lack of global device-to- patient orientation is challenging, when comparing the acquired data to other intrapatient datasets. In upper ankle joint fracture reduction accompanied with an unstable syndesmosis, a comparison to the unfractured contralateral site is helpful for verification of the reduction result. To reduce dose and operation time, our approach aims at the comparison of single projections of the unfractured ankle with volumetric images of the reduced fracture. For precise assessment, a pre-alignment of both datasets is a crucial step. We propose a contour extraction pipeline to estimate the joint space location for a prealignment of fluoroscopic C-arm projections containing the upper ankle joint. A quadtree-based hierarchical variance comparison extracts potential feature points and a Hough transform is applied to identify bone shaft lines together with the tibiotalar joint space. By using this information we can define the coarse orientation of the projections independent from the ankle pose during acquisition in order to align those images to the volume of the fractured ankle. The proposed method was evaluated on thirteen cadaveric datasets consisting of 100 projections each with manually adjusted image planes by three trauma surgeons. The results show that the method can be used to detect the joint space orientation. The correlation between angle deviation and anatomical projection direction gives valuable input on the acquisition direction for future clinical experiments.

WE-AB-207A-01: BEST IN PHYSICS (IMAGING): High-Resolution Cone-Beam CT of the Extremities and Cancellous Bone Architecture with a CMOS Detector

PURPOSE Extremity cone-beam CT (CBCT) with an amorphous silicon (aSi) flat-panel detector (FPD) provides low-dose volumetric imaging with high spatial resolution. We investigate the performance of the newer complementary metal-oxide semiconductor (CMOS) detectors to enhance resolution of extremities CBCT to ∼0.1 mm, enabling morphological analysis of trabecular bone. Quantitative in-vivo imaging of bone microarchitecture could present an important advance for osteoporosis and osteoarthritis diagnosis and therapy assessment. METHODS Cascaded systems models of CMOS- and FPD-based extremities CBCT were implemented. Performance was compared for a range of pixel sizes (0.05-0.4 mm), focal spot sizes (0.3-0.6 FS), and x-ray techniques (0.05-0.8 mAs/projection) using detectability of high-, low-, and all-frequency tasks for a nonprewhitening observer. Test-bench implementation of CMOS-based extremity CBCT involved a Teledyne DALSA Xineos3030HR detector with 0.099 mm pixels and a compact rotating anode x-ray source with 0.3 FS (IMD RTM37). Metrics of bone morphology obtained using CMOS-based CBCT were compared in cadaveric specimens to FPD-based system using a Varian PaxScan4030 (0.194 mm pixels). RESULTS Finer pixel size and reduced electronic noise for CMOS (136 e compared to 2000 e for FPD) resulted in ∼1.9× increase in detectability for high-frequency tasks and ∼1.1× increase for all-frequency tasks. Incorporation of the new x-ray source with reduced focal spot size (0.3 FS vs. 0.5 FS used on current extremities CBCT) improved detectability for CMOS-based CBCT by ∼1.7× for high-frequency tasks. Compared to FPD CBCT, the CMOS detector yielded improved agreement with micro-CT in measurements of trabecular thickness (∼1.7× reduction in relative error), bone volume (∼1.5× reduction), and trabecular spacing (∼3.5× reduction). CONCLUSION Imaging performance modelling and experimentation indicate substantial improvements for high-frequency imaging tasks through adoption of the CMOS detector and small FS x-ray source, motivating the use of these components in a new system for quantitative in-vivo imaging of trabecular bone. Financial Support: US NIH grant R01EB018896. Qian Cao is a Howard Hughes Medical Institute International Student Research Fellow. Disclosures: W Zbijewski, J Siewerdsen and A Sisniega receive research funding from Carestream Health.

Detektion chirurgischer schrauben in 3D C-bogen daten

Frakturen am Fersenbein werden mit Hilfe offener Reduktion und interner Fixation korrigiert. Eine anatomisch korrekte Rekonstruktion beteiligter Gelenke ist notwendig, um Knorpelschaden und verfruhte Arthrose vorzubeugen. Um intraartikulare Schraubenplatzierungen zu vermeiden wird der mobile 3D C-Bogen eingesetzt. Die detaillierte Analyse der Schraubenlage anhand des erzeugten 3D Bildes ist jedoch auf eine zeitaufwandige Mensch-Computer-Interaktion angewiesen. Etablierte Interaktionsprozeduren basieren auf wiederholtem Positionieren und Rotieren von Schnittebenen, wodurch die intraoperative Kontrolle der Schraubenplatzierung die Dauer der Operation wesentlich verlangert. Um die Interaktion mit 3D C-Bogen Daten zu erleichtern schlagen wir eine automatische Schraubendetektion vor, mit der eine direkte Anwahl relevanter Schnittebenen moglich wird. Unser Ansatz setzt sich aus zwei Schritten zusammen. Im ersten Schritt werden zylindrische Charakteristiken anhand lokaler Gradientstrukturen mit Hilfe von RANSAC ermittelt. Diese Charakteristiken werden dann durch die Anwendung des DBScan Clustering Algorithmus im zweiten Schritt gruppiert. Jedes detektierte Cluster reprasentiert abschliesend eine Schraube. Unsere Evaluation mit 309 Schrauben in 50 Bildern zeigt robuste Ergebnisse. Der Algorithmus detektierte 97.4% der Schrauben korrekt.

Atlasbasierte Feature-Registrierung zur automatischen Einstellung der Standardebenen bei mobilen C-Bogen CT-Daten

Das Standardvorgehen bei der Behandlung von Calcaneusfrakturen ist eine Osteosynthese. Mit Hilfe der intraoperativen Bildgebung wie dem mobilen C-Bogen CT kann der Chirurg das Repositionsergebnis noch im Operationssaal verifizieren und wenn notig korrigieren. Die Mobilitat des C-Bogen CT hat jedoch zur Folge, dass Informationen uber die Orientierung des Patienten zum Gerat verloren gehen. Dadurch kann keine Standard-Ausrichtung der dreidimensionalen Daten an die Anatomie erfolgen. Eine manuelle Einstellung des Volumendatensatzes durch den Chirurgen ist damit unabdingbar. Dies ist ein zeitaufwendiger Schritt und kann bei einer unprazisen Einstellung zu Fehlern bei der Beurteilung der Daten fuhren. In diesem Paper stellen wir zwei automatische Methoden zur Einstellung der Standard-Ebenen auf mobilen C-Bogen CT Daten vor. Die automatischen Methoden rekonstruieren die Standard-Ebenen in zwei Schritten: als Erstes werden SURF-Keypoints (2D und neu eingefuhrte Pseudo-3D-Punkte) fur das Bildvolumen berechnet, in einem zweiten Schritt wird eine Atlas-Punktwolke auf diese Merkmale registriert und die Parameter der Standard-Ebenen transformiert. Die Genauigkeit unserer Methoden wurde an 51 klinischen mobilen C-Bogen CT Bildern mit manuell eingestellten Standard-Ebenen evaluiert. Die Referenzdaten wurden von drei Chirurgen mit unterschiedlichem Erfahrungsstand erstellt. Die durchschnittlich benotigte Zeit der Experten (46 s) unterscheidet sich von der des fortgeschrittenen Benutzers (55 s) um neun Sekunden. Die Berechnungszeit des 2D-Surf Ansatzes betragt 10 Sekunden und liefert bei 88% der Ebenen der Referenzdaten eine korrkte Einstellung. Der Pseudo-3D Ansatz liefert die besten Ergebnisse mit einer Genauigkeit von 91% und einer Berechnungszeit von nur 8 Sekunden.