Teemu Mäkelä

Natural patterns of energy dispersal

Universal patterns such as power-law dependences, skewed distributions, tree-like structures, networks and spirals are associated with energy dispersal processes using the principle of least action. Also ubiquitous temporal courses such as sigmoid growth, bifurcations and chaos are ascribed to the decrease of free energy in the least time. Moreover, emergence of natural standards such as the common genetic code and chirality consensus of amino acids are understood to follow from the quest to maximize the dispersal of energy. Many mathematical functions that model natural patterns and processes are found as approximations of the evolutionary equation of motion that has been derived from statistical physics of open systems. The evolutionary processes can be described as flows of energy that run from high energy sources to low energy sinks in the least time. However, the equation of evolution cannot be solved in general because the flows of energy and their driving forces are inseparable. Since the energy of the system keeps changing, the paths of evolution cannot be integrated from a given initial state to a final state. Although evolutionary courses of these non-Hamiltonian systems with two or more alternative ways of dissipation cannot be predicted, the flows of energy will search and naturally select paths of least action, known as geodesics, to consume free energy in the least time. The scale-invariant natural patterns follow from this natural law that impinges on processes at all scales of space and time.

Integrating nTMS Data into a Radiology Picture Archiving System

Navigated transcranial magnetic stimulation (nTMS) is employed in eloquent brain area localization prior to intraoperative direct cortical electrical stimulations and neurosurgery. No commercial archiving or file transfer protocol existed for these studies. The aim of our project was to establish a standardized protocol for the transfer of nTMS results and medical assessments to the end users in pursuance of improving data security and facilitating presurgical planning. The existing infrastructure of the hospital’s Radiology Department was used. Hospital information systems and networks were configured to allow communications and archiving of the study results, and in-house software was written for file manipulations and transfers. Graphical user interface with description suggestions and user-defined text legends enabled an easy and straightforward workflow for annotations and archiving of the results. The software and configurations were implemented and have been applied in studies of ten patients. The creation of the study protocol required the involvement of various professionals and interdepartmental cooperation. The introduction of the protocol has ended previously recurrent involvement of staff in the file transfer phase and improved cost-effectiveness.

Ejection fraction in myocardial perfusion imaging assessed with a dynamic phantom: comparison between IQ-SPECT and LEHR

BackgroundDevelopments in single photon emission tomography instrumentation and reconstruction methods present a potential for decreasing acquisition times. One of such recent options for myocardial perfusion imaging (MPI) is IQ-SPECT. This study was motivated by the inconsistency in the reported ejection fraction (EF) and left ventricular (LV) volume results between IQ-SPECT and more conventional low-energy high-resolution (LEHR) collimation protocols. IQ-SPECT and LEHR quantitative results were compared while the equivalent number of iterations (EI) was varied. The end-diastolic (EDV) and end-systolic volumes (ESV) and the derived EF values were investigated.A dynamic heart phantom was used to produce repeatable ESVs, EDVs and EFs. Phantom performance was verified by comparing the set EF values to those measured from a gated multi-slice X-ray computed tomography (CT) scan (EFTrue). The phantom with an EF setting of 45, 55, 65 and 70% was imaged with both IQ-SPECT and LEHR protocols. The data were reconstructed with different EI, and two commonly used clinical myocardium delineation software were used to evaluate the LV volumes.ResultsThe CT verification showed that the phantom EF settings were repeatable and accurate with the EFTrue being within 1% point from the manufacture’s nominal value. Depending on EI both MPI protocols can be made to produce correct EF estimates, but IQ-SPECT protocol produced on average 41 and 42% smaller EDV and ESV when compared to the phantom’s volumes, while LEHR protocol underestimated volumes by 24 and 21%, respectively. The volume results were largely similar between the delineation methods used.ConclusionsThe reconstruction parameters can greatly affect the volume estimates obtained from perfusion studies. IQ-SPECT produces systematically smaller LV volumes than the conventional LEHR MPI protocol. The volume estimates are also software dependent.

An Automatic Image Processing Workflow for Daily Magnetic Resonance Imaging Quality Assurance

The performance of magnetic resonance imaging (MRI) equipment is typically monitored with a quality assurance (QA) program. The QA program includes various tests performed at regular intervals. Users may execute specific tests, e.g., daily, weekly, or monthly. The exact interval of these measurements varies according to the department policies, machine setup and usage, manufacturer’s recommendations, and available resources. In our experience, a single image acquired before the first patient of the day offers a low effort and effective system check. When this daily QA check is repeated with identical imaging parameters and phantom setup, the data can be used to derive various time series of the scanner performance. However, daily QA with manual processing can quickly become laborious in a multi-scanner environment. Fully automated image analysis and results output can positively impact the QA process by decreasing reaction time, improving repeatability, and by offering novel performance evaluation methods. In this study, we have developed a daily MRI QA workflow that can measure multiple scanner performance parameters with minimal manual labor required. The daily QA system is built around a phantom image taken by the radiographers at the beginning of day. The image is acquired with a consistent phantom setup and standardized imaging parameters. Recorded parameters are processed into graphs available to everyone involved in the MRI QA process via a web-based interface. The presented automatic MRI QA system provides an efficient tool for following the short- and long-term stability of MRI scanners.

CT of facial fracture fixation: an experimental study of artefact reducing methods

OBJECTIVES This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material. METHODS Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120- and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metal-induced artefacts. RESULTS The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT. CONCLUSIONS CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.

Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation

Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population.

MRI quality assurance based on 3D FLAIR brain images

ObjectiveQuality assurance (QA) of magnetic resonance imaging (MRI) often relies on imaging phantoms with suitable structures and uniform regions. However, the connection between phantom measurements and actual clinical image quality is ambiguous. Thus, it is desirable to measure objective image quality directly from clinical images.Materials and methodsIn this work, four measurements suitable for clinical image QA were presented: image resolution, contrast-to-noise ratio, quality index and bias index. The methods were applied to a large cohort of clinical 3D FLAIR volumes over a test period of 9.5 months. The results were compared with phantom QA. Additionally, the effect of patient movement on the presented measures was studied.ResultsA connection between the presented clinical QA methods and scanner performance was observed: the values reacted to MRI equipment breakdowns that occurred during the study period. No apparent correlation with phantom QA results was found. The patient movement was found to have a significant effect on the resolution and contrast-to-noise ratio values.DiscussionQA based on clinical images provides a direct method for following MRI scanner performance. The methods could be used to detect problems, and potentially reduce scanner downtime. Furthermore, with the presented methodologies comparisons could be made between different sequences and imaging settings. In the future, an online QA system could recognize insufficient image quality and suggest an immediate re-scan.

Automated daily quality control analysis for mammography in a multi-unit imaging center

Background The high requirements for mammography image quality necessitate a systematic quality assurance process. Digital imaging allows automation of the image quality analysis, which can potentially improve repeatability and objectivity compared to a visual evaluation made by the users. Purpose To develop an automatic image quality analysis software for daily mammography quality control in a multi-unit imaging center. Material and Methods An automated image quality analysis software using the discrete wavelet transform and multiresolution analysis was developed for the American College of Radiology accreditation phantom. The software was validated by analyzing 60 randomly selected phantom images from six mammography systems and 20 phantom images with different dose levels from one mammography system. The results were compared to a visual analysis made by four reviewers. Additionally, long-term image quality trends of a full-field digital mammography system and a computed radiography mammography system were investigated. Results The automated software produced feature detection levels comparable to visual analysis. The agreement was good in the case of fibers, while the software detected somewhat more microcalcifications and characteristic masses. Long-term follow-up via a quality assurance web portal demonstrated the feasibility of using the software for monitoring the performance of mammography systems in a multi-unit imaging center. Conclusion Automated image quality analysis enables monitoring the performance of digital mammography systems in an efficient, centralized manner.

The Use of Model-based Iterative Reconstruction to Optimize Chest CT Examinations for Diagnosing Lung Metastases in Patients with Sarcoma: A Phantom Study

RATIONALE AND OBJECTIVES This phantom study aimed to evaluate low-dose (LD) chest computed tomography (CT) protocols using model-based iterative reconstruction (MBIR) for diagnosing lung metastases in patients with sarcoma. MATERIALS AND METHODS An adult female anthropomorphic phantom was scanned with a 64-slice CT using four LD protocols and a standard-dose protocol. Absorbed organ doses were measured with 10 metal-oxide-semiconductor field-effect transistor dosimeters. Furthermore, Monte Carlo simulations were performed to estimate organ and effective doses. Image quality in terms of image noise, contrast, and resolution was measured from the CT images reconstructed with conventional filtered back projection, adaptive statistical iterative reconstruction, and MBIR algorithms. All the results were compared to the performance of the standard-dose protocol. RESULTS Mean absorbed organ and effective doses were reduced by approximately 95% with the LD protocol (100-kVp tube voltage and a fixed 10-mA tube current) compared to the standard-dose protocol (120-kVp tube voltage and tube current modulation) while yielding an acceptable image quality for diagnosing round-shaped lung metastases. The effective doses ranged from 0.16 to 2.83 mSv in the studied protocols. The image noise, contrast, and resolution were maintained or improved when comparing the image quality of LD protocols using MBIR to the performance of the standard-dose chest CT protocol using filtered back projection. The small round-shaped lung metastases were delineated at levels comparable to the used protocols. CONCLUSIONS Radiation exposure in patients can be reduced significantly by using LD chest CT protocols and MBIR algorithm while maintaining image quality for detecting round-shaped lung metastases.

Fetal radiation dose in three common CT examinations during pregnancy – Monte Carlo study

PURPOSE To determine fetal doses in different stages of pregnancy in three common computed tomography (CT) examinations: pulmonary CT angiography, abdomino-pelvic and trauma scan with Monte Carlo (MC) simulations. METHODS An adult female anthropomorphic phantom was scanned with a 64-slice CT using pulmonary angiography, abdomino-pelvic and trauma CT scan protocols. Three different sized gelatin boluses placed on the phantoms abdomen simulated different stages of pregnancy. Intrauterine dose was used as a surrogate to a dose absorbed to the fetus. MC simulations were performed to estimate uterine doses. The simulation dose levels were calibrated with volumetric CT dose index (CTDIvol) measurements and MC simulations in a cylindrical CTDI body phantom and compared with ten point doses measured with metal-oxide-semiconductor field-effect-transistor dosimeters. Intrauterine volumes and uterine walls were segmented and the respective dose volume histograms were calculated. RESULTS The mean intrauterine doses in different stages of pregnancy varied from 0.04 to 1.04mGy, from 4.8 to 5.8mGy, and from 9.8 to 12.6mGy in the CT scans for pulmonary angiography, abdomino-pelvic and trauma CT scans, respectively. MC simulations showed good correlation with the MOSFET measurement at the measured locations. CONCLUSIONS The three studied examinations provided highly varying fetal doses increasing from sub-mGy level in pulmonary CT angiography to notably higher levels in abdomino-pelvic and trauma scans where the fetus is in the primary exposure range. Volumetric dose distribution offered by MC simulations in an appropriate anthropomorphic phantom provides a comprehensive dose assessment when applied in adjunct to point-dose measurements.