Paul E. Kinahan

Radiomics: Images Are More than Pictures, They Are Data

This report describes the process of radiomics, its challenges, and its potential power to facilitate better clinical decision making, particularly in the care of patients with cancer.

Positron Emission Tomography-Computed Tomography Standardized Uptake Values in Clinical Practice and Assessing Response to Therapy

The use of standardized uptake values (SUVs) is now common place in clinical 2-deoxy-2-[(18)F] fluoro-D-glucose (FDG) position emission tomography-computed tomography oncology imaging and has a specific role in assessing patient response to cancer therapy. Ideally, the use of SUVs removes variability introduced by differences in patient size and the amount of injected FDG. However, in practice there are several sources of bias and variance that are introduced in the measurement of FDG uptake in tumors and also in the conversion of the image count data to SUVs. In this article the overall imaging process is reviewed and estimates of the magnitude of errors, where known, are given. Recommendations are provided for best practices in improving SUV accuracy.

Application and Evaluation of a Measured Spatially Variant System Model for PET Image Reconstruction

Accurate system modeling in tomographic image reconstruction has been shown to reduce the spatial variance of resolution and improve quantitative accuracy. System modeling can be improved through analytic calculations, Monte Carlo simulations, and physical measurements. The purpose of this work is to improve clinical fully-3-D reconstruction without substantially increasing computation time. We present a practical method for measuring the detector blurring component of a whole-body positron emission tomography (PET) system to form an approximate system model for use with fully-3-D reconstruction. We employ Monte Carlo simulations to show that a non-collimated point source is acceptable for modeling the radial blurring present in a PET tomograph and we justify the use of a Na22 point source for collecting these measurements. We measure the system response on a whole-body scanner, simplify it to a 2-D function, and incorporate a parameterized version of this response into a modified fully-3-D OSEM algorithm. Empirical testing of the signal versus noise benefits reveal roughly a 15% improvement in spatial resolution and 10% improvement in contrast at matched image noise levels. Convergence analysis demonstrates improved resolution and contrast versus noise properties can be achieved with the proposed method with similar computation time as the conventional approach. Comparison of the measured spatially variant and invariant reconstruction revealed similar performance with conventional image metrics. Edge artifacts, which are a common artifact of resolution-modeled reconstruction methods, were less apparent in the spatially variant method than in the invariant method. With the proposed and other resolution-modeled reconstruction methods, edge artifacts need to be studied in more detail to determine the optimal tradeoff of resolution/contrast enhancement and edge fidelity.

The impact of respiratory motion on tumor quantification and delineation in static PET/CT imaging

Our aim is to investigate the impact of respiratory motion on tumor quantification and delineation in static PET/CT imaging using a population of patient respiratory traces. A total of 1295 respiratory traces acquired during whole body PET/CT imaging were classified into three types according to the qualitative shape of their signal histograms. Each trace was scaled to three diaphragm motion amplitudes (6 mm, 11 mm and 16 mm) to drive a whole body PET/CT computer simulation that was validated with a physical phantom experiment. Three lung lesions and one liver lesion were simulated with diameters of 1 cm and 2 cm. PET data were reconstructed using the OS-EM algorithm with attenuation correction using CT images at the end-expiration phase and respiratory-averaged CT. The errors of the lesion maximum standardized uptake values (SUV(max)) and lesion volumes between motion-free and motion-blurred PET/CT images were measured and analyzed. For respiration with 11 mm diaphragm motion and larger quiescent period fraction, respiratory motion can cause a mean lesion SUV(max) underestimation of 28% and a mean lesion volume overestimation of 130% in PET/CT images with 1 cm lesions. The errors of lesion SUV(max) and volume are larger for patient traces with larger motion amplitudes. Smaller lesions are more sensitive to respiratory motion than larger lesions for the same motion amplitude. Patient respiratory traces with relatively larger quiescent period fraction yield results less subject to respiratory motion than traces with long-term amplitude variability. Mismatched attenuation correction due to respiratory motion can cause SUV(max) overestimation for lesions in the lower lung region close to the liver dome. Using respiratory-averaged CT for attenuation correction yields smaller mismatch errors than those using end-expiration CT. Respiratory motion can have a significant impact on static oncological PET/CT imaging where SUV and/or volume measurements are important. The impact is highly dependent upon motion amplitude, lesion location and size, attenuation map and respiratory pattern. To overcome the motion effect, motion compensation techniques may be necessary in clinical practice to improve the tumor quantification for determining the response to therapy or for radiation treatment planning.

Modeling and incorporation of system response functions in 3-D whole body PET

Appropriate application of spatially variant system models can correct for degraded resolution response and mispositioning errors. This paper explores the detector blurring component of the system model for a whole body positron emission tomography (PET) system and extends this factor into a more general system response function to account for other system effects including the influence of Fourier rebinning (FORE). We model the system response function as a three-dimensional (3-D) function that blurs in the radial and axial dimension and is spatially variant in radial location. This function is derived from Monte Carlo simulations and incorporates inter-crystal scatter, crystal penetration, and the blurring due to the FORE algorithm. The improved system model is applied in a modified ordered subsets expectation maximization (OSEM) algorithm to reconstruct images from rebinned, fully 3-D PET data. The proposed method effectively removes the spatial variance in the resolution response, as shown in simulations of point sources. Furthermore, simulation and measured studies show the proposed method improves quantitative accuracy with a reduction in tumor bias compared to conventional OSEM on the order of 10%-30% depending on tumor size and smoothing parameter

FDG-PET/CT–guided intensity modulated head and neck radiotherapy: A pilot investigation†‡

2‐deoxy‐2[18F]fluoro‐d‐glucose–positron emission tomography (FDG‐PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG‐PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning.

Noise and signal properties in PSF-based fully 3D PET image reconstruction: an experimental evaluation.

The addition of accurate system modeling in PET image reconstruction results in images with distinct noise texture and characteristics. In particular, the incorporation of point spread functions (PSF) into the system model has been shown to visually reduce image noise, but the noise properties have not been thoroughly studied. This work offers a systematic evaluation of noise and signal properties in different combinations of reconstruction methods and parameters. We evaluate two fully 3D PET reconstruction algorithms: (1) OSEM with exact scanner line of response modeled (OSEM+LOR), (2) OSEM with line of response and a measured point spread function incorporated (OSEM+LOR+PSF), in combination with the effects of four post-reconstruction filtering parameters and 1-10 iterations, representing a range of clinically acceptable settings. We used a modified NEMA image quality (IQ) phantom, which was filled with 68Ge and consisted of six hot spheres of different sizes with a target/background ratio of 4:1. The phantom was scanned 50 times in 3D mode on a clinical system to provide independent noise realizations. Data were reconstructed with OSEM+LOR and OSEM+LOR+PSF using different reconstruction parameters, and our implementations of the algorithms match the vendors product algorithms. With access to multiple realizations, background noise characteristics were quantified with four metrics. Image roughness and the standard deviation image measured the pixel-to-pixel variation; background variability and ensemble noise quantified the region-to-region variation. Image roughness is the image noise perceived when viewing an individual image. At matched iterations, the addition of PSF leads to images with less noise defined as image roughness (reduced by 35% for unfiltered data) and as the standard deviation image, while it has no effect on background variability or ensemble noise. In terms of signal to noise performance, PSF-based reconstruction has a 7% improvement in contrast recovery at matched ensemble noise levels and 20% improvement of quantitation SNR in unfiltered data. In addition, the relations between different metrics are studied. A linear correlation is observed between background variability and ensemble noise for all different combinations of reconstruction methods and parameters, suggesting that background variability is a reasonable surrogate for ensemble noise when multiple realizations of scans are not available.

The positron emission mammography/tomography breast imaging and biopsy system (PEM/PET): design, construction and phantom-based measurements

Tomographic breast imaging techniques can potentially improve detection and diagnosis of cancer in women with radiodense and/or fibrocystic breasts. We have developed a high-resolution positron emission mammography/tomography imaging and biopsy device (called PEM/PET) to detect and guide the biopsy of suspicious breast lesions. PET images are acquired to detect suspicious focal uptake of the radiotracer and guide biopsy of the area. Limited-angle PEM images could then be used to verify the biopsy needle position prior to tissue sampling. The PEM/PET scanner consists of two sets of rotating planar detector heads. Each detector consists of a 4 x 3 array of Hamamatsu H8500 flat panel position sensitive photomultipliers (PSPMTs) coupled to a 96 x 72 array of 2 x 2 x 15 mm(3) LYSO detector elements (pitch = 2.1 mm). Image reconstruction is performed with a three-dimensional, ordered set expectation maximization (OSEM) algorithm parallelized to run on a multi-processor computer system. The reconstructed field of view (FOV) is 15 x 15 x 15 cm(3). Initial phantom-based testing of the device is focusing upon its PET imaging capabilities. Specifically, spatial resolution and detection sensitivity were assessed. The results from these measurements yielded a spatial resolution at the center of the FOV of 2.01 +/- 0.09 mm (radial), 2.04 +/- 0.08 mm (tangential) and 1.84 +/- 0.07 mm (axial). At a radius of 7 cm from the center of the scanner, the results were 2.11 +/- 0.08 mm (radial), 2.16 +/- 0.07 mm (tangential) and 1.87 +/- 0.08 mm (axial). Maximum system detection sensitivity of the scanner is 488.9 kcps microCi(-1) ml(-1) (6.88%). These promising findings indicate that PEM/PET may be an effective system for the detection and diagnosis of breast cancer.

Clinical Imaging Characteristics of the Positron Emission Mammography Camera: PEM Flex Solo II

We evaluated a commercial positron emission mammography (PEM) camera, the PEM Flex Solo II. This system comprises two 6 × 16.4 cm detectors that scan together covering up to a 24 × 16.4 cm field of view (FOV). There are no specific standards for testing this detector configuration. We performed several tests important to breast imaging, and we propose tests that should be included in standardized testing of PEM systems. Methods: We measured spatial resolution, uniformity, counting- rate linearity, recovery coefficients, and quantification accuracy using the systems software. Image linearity and coefficient of variation at the edge of the FOV were also characterized. Anecdotal examples of clinical patient data are presented. Results: The spatial resolution was 2.4 mm in full width at half maximum for image planes parallel to the detector faces. The background variability was approximately 5%, and quantification accuracy and recovery coefficients varied within the FOV. Positioning linearity began at approximately 13 mm from the edge of the detector housing. The coefficient of variation was significantly higher close to the edge of the FOV because of limited sensitivity in these image planes. Conclusion: A reconstructed spatial resolution of 2.4 mm represented a significant improvement over conventional whole-body PET scanners and should reduce the lower threshold on lesion size and tracer uptake for detection in the breast. Limited-angle tomography and a lack of data corrections result in spatially variable quantitative results. PEM acquisition geometry limits sampling statistics at the chest-wall edge of the camera, resulting in high variance in that portion of the image. Example patient images demonstrate that lesions can be detected at the chest-wall edge despite variance artifacts, and fine structure is visualized routinely throughout the FOV in the focal plane. The PEM Flex camera should enable the functional imaging of breast cancer earlier in the disease process than whole-body PET.

Comparison of 3-D reconstruction with 3D-OSEM and with FORE+OSEM for PET

The combination of Fourier rebinning (FORE) and the ordered subsets expectation-maximization (OSEM), a fast statistical algorithm, appears as a promising alternative to the fully three-dimensional (3-D) iterative approach for clinical positron emission tomography (PET) data. Here, the authors evaluated the properties of FORE+OSEM and compared it with fully 3-D OSEM using both simulations and data acquired by commercial scanners. The aim is to determine to what extent the speed advantage of FORE+OSEM is paid for by a possible degradation of image quality in the case of noisy clinical PET data. A forward- and back-projection pair based on a line integral model was used in two-dimensional OSEM and 3-D OSEM (3D-OSEM) instead of a system matrix. Different variants of both approaches have been studied with simulations in terms of contrast-noise tradeoff. Two variants-FORE+OSEM with attenuation weighting (AW) [FORE+OSEM(AW)] and 3D-OSEM with attenuation-normalization weighting (ANSP) and a shifted-Poisson (SP) model [3D-OSEM(ANSP)]-were compared with measured phantom data and patient data. Based on the results from both simulations and measured data, the authors conclude that: 1) both attenuation (-normalization) weighting and the SP model improve the image quality but slow down the convergence and 2) despite its approximate nature, FORE+OSEM does not show apparent image degradation compared with 3D-OSEM for data with a noise level typical of a whole-body FDG scan.