Yiannis Kyriakou

Flat-detector computed tomography (FD-CT)

Flat-panel detectors or, synonymously, flat detectors (FDs) have been developed for use in radiography and fluoroscopy with the defined goal to replace standard X-ray film, film-screen combinations and image intensifiers by an advanced sensor system. FD technology in comparison to X-ray film and image intensifiers offers higher dynamic range, dose reduction, fast digital readout and the possibility for dynamic acquisitions of image series, yet keeping to a compact design. It appeared logical to employ FD designs also for computed tomography (CT) imaging. Respective efforts date back a few years only, but FD-CT has meanwhile become widely accepted for interventional and intra-operative imaging using C-arm systems. FD-CT provides a very efficient way of combining two-dimensional (2D) radiographic or fluoroscopic and 3D CT imaging. In addition, FD technology made its way into a number of dedicated CT scanner developments, such as scanners for the maxillo-facial region or for micro-CT applications. This review focuses on technical and performance issues of FD technology and its full range of applications for CT imaging. A comparison with standard clinical CT is of primary interest. It reveals that FD-CT provides higher spatial resolution, but encompasses a number of disadvantages, such as lower dose efficiency, smaller field of view and lower temporal resolution. FD-CT is not aimed at challenging standard clinical CT as regards to the typical diagnostic examinations; but it has already proven unique for a number of dedicated CT applications, offering distinct practical advantages, above all the availability of immediate CT imaging in the interventional suite or the operating room.

Combining deterministic and Monte Carlo calculations for fast estimation of scatter intensities in CT

A side effect of increased volume coverage by using multi-row and flat-panel detectors in computed tomography (CT) is the concurrently growing contribution of scattered radiation to the measured signal. In order to investigate the effect of scatter on x-ray projections used for CT imaging, our study aimed at the development of a simulation tool for fast calculation of primary and scatter intensities. We developed a deterministic method to assess the contribution of single-scatter events to the measured signal. The investigation of multiple scatter by Monte Carlo simulations showed that it results in a smooth signal as compared to single scatter. A hybrid method is proposed in order to optimize the performance of the scatter simulation: a fast and exact analytical calculation of the single-scatter intensity combined with a coarse Monte Carlo (MC) estimate of multiple scatter to reduce overall computational expenses, while assuring an acceptable signal quality. The results of the hybrid simulation of total scatter were in excellent agreement with the corresponding MC only simulations, thereby allowing us to reduce computational time by orders of magnitude. Estimates of two-dimensional scatter distributions for flat-panel CT imaging took about 30-40 s (per projection). The hybrid method provides a realistic simulation of x-ray scatter and offers a basis for scatter correction approaches.

A novel forward projection-based metal artifact reduction method for flat-detector computed tomography

Metallic implants generate streak-like artifacts in flat-detector computed tomography (FD-CT) reconstructed volumetric images. This study presents a novel method for reducing these disturbing artifacts by inserting discarded information into the original rawdata using a three-step correction procedure and working directly with each detector element. Computation times are minimized by completely implementing the correction process on graphics processing units (GPUs). First, the original volume is corrected using a three-dimensional interpolation scheme in the rawdata domain, followed by a second reconstruction. This metal artifact-reduced volume is then segmented into three materials, i.e. air, soft-tissue and bone, using a threshold-based algorithm. Subsequently, a forward projection of the obtained tissue-class model substitutes the missing or corrupted attenuation values directly for each flat detector element that contains attenuation values corresponding to metal parts, followed by a final reconstruction. Experiments using tissue-equivalent phantoms showed a significant reduction of metal artifacts (deviations of CT values after correction compared to measurements without metallic inserts reduced typically to below 20 HU, differences in image noise to below 5 HU) caused by the implants and no significant resolution losses even in areas close to the inserts. To cover a variety of different cases, cadaver measurements and clinical images in the knee, head and spine region were used to investigate the effectiveness and applicability of our method. A comparison to a three-dimensional interpolation correction showed that the new approach outperformed interpolation schemes. Correction times are minimized, and initial and corrected images are made available at almost the same time (12.7 s for the initial reconstruction, 46.2 s for the final corrected image compared to 114.1 s and 355.1 s on central processing units (CPUs)).

Empirical beam hardening correction (EBHC) for CT

PURPOSE Due to x-ray beam polychromaticity and scattered radiation, attenuation measurements tend to be underestimated. Cupping and beam hardening artifacts become apparent in the reconstructed CT images. If only one material such as water, for example, is present, these artifacts can be reduced by precorrecting the rawdata. Higher order beam hardening artifacts, as they result when a mixture of materials such as water and bone, or water and bone and iodine is present, require an iterative beam hardening correction where the image is segmented into different materials and those are forward projected to obtain new rawdata. Typically, the forward projection must correctly model the beam polychromaticity and account for all physical effects, including the energy dependence of the assumed materials in the patient, the detector response, and others. We propose a new algorithm that does not require any knowledge about spectra or attenuation coefficients and that does not need to be calibrated. The proposed method corrects beam hardening in single energy CT data. METHODS The onlya priori knowledge entering EBHC is the segmentation of the object into different materials. Materials other than water are segmented from the original image, e.g., by using simple thresholding. Then, a (monochromatic) forward projection of these other materials is performed. The measured rawdata and the forward projected material-specific rawdata are monomially combined (e.g., multiplied or squared) and reconstructed to yield a set of correction volumes. These are then linearly combined and added to the original volume. The combination weights are determined to maximize the flatness of the new and corrected volume. EBHC is evaluated using data acquired with a modern cone-beam dual-source spiral CT scanner (Somatom Definition Flash, Siemens Healthcare, Forchheim, Germany), with a modern dual-source micro-CT scanner (TomoScope Synergy Twin, CT Imaging GmbH, Erlangen, Germany), and with a modern C-arm CT scanner (Axiom Artis dTA, Siemens Healthcare, Forchheim, Germany). A large variety of phantom, small animal, and patient data were used to demonstrate the data and system independence of EBHC. RESULTS Although no physics apart from the initial segmentation procedure enter the correction process, beam hardening artifacts were significantly reduced by EBHC. The image quality for clinical CT, micro-CT, and C-arm CT was highly improved. Only in the case of C-arm CT, where high scatter levels and calibration errors occur, the relative improvement was smaller. CONCLUSIONS The empirical beam hardening correction is an interesting alternative to conventional iterative higher order beam hardening correction algorithms. It does not tend to over- or undercorrect the data. Apart from the segmentation step, EBHC does not require assumptions on the spectra or on the type of material involved. Potentially, it can therefore be applied to any CT image.

Metal Artifact Reduction for Clipping and Coiling in Interventional C-Arm CT

BACKGROUND AND PURPOSE: Metallic implants induce massive artifacts in CT images which deteriorate image quality and often superimpose structures of interest. The purpose of this study was to apply and evaluate a dedicated MAR method for neuroradiologic intracranial clips and detachable platinum coiling events. We here report the first clinical results for MAR in FDCT. MATERIALS AND METHODS: FDCT volume scans of several patients treated with endovascular coiling or intracranial clipping were corrected by using a dedicated FDCT MAR correction algorithm combined with an edge-preserving attenuation-normalization method in the projection space. Corrected and uncorrected images were compared by 2 experienced radiologists and evaluated for several image-quality features. RESULTS: After application of our algorithm, implant delineation and visibility were highly improved. CT values compared with values in metal artifact−unaffected areas showed good agreement (average correction of 1300 HU). Image noise was reduced overall by 27%. Intracranial hemorrhage in the direct surroundings of the implanted coil or clip material was displayed without worrisome metal artifacts, and our algorithm even allowed diagnosis in areas where extensive information losses were seen. The high spatial resolution provided by FDCT imaging was well preserved. CONCLUSIONS: Our MAR method provided metal artifact−reduced images in every studied case. It reduced image noise and corrected CT values to levels comparable with images measured without metallic implants. An overall improvement of brain tissue modeling and implant visibility was achieved. MAR in neuroradiologic FDCT imaging is a promising step forward for better image quality and diagnosis in the presence of metallic implants.

Simultaneous misalignment correction for approximate circular cone-beam computed tomography

Currently, CT scanning is often performed using flat detectors which are mounted on C-arm units or dedicated gantries as in radiation therapy or micro CT. For perspective cone-beam backprojection of the Feldkamp type (FDK) the geometry of an approximately circular scan trajectory has to be available for reconstruction. If the system or the scan geometry is afflicted with geometrical instabilities, referred to as misalignment, a non-perfect approximate circular scan is the case. Reconstructing a misaligned scan without knowledge of the true trajectory results in severe artefacts in the CT images. Unlike current methods which use a pre-scan calibration of the geometry for defined scan protocols and calibration phantoms, we propose a real-time iterative restoration of reconstruction geometry by means of entropy minimization. Entropy minimization is performed combining a simplex algorithm for multi-parameter optimization and iterative graphics card (GPU)-based FDK-reconstructions. Images reconstructed with the misaligned geometry were used as an input for the entropy minimization algorithm. A simplex algorithm changes the geometrical parameters of the source and detector with respect to the reduction of entropy. In order to reduce the size of the high-dimensional space required for minimization, the trajectory was described by only eight fix points. A virtual trajectory is generated for each iteration using a least-mean-squares algorithm to calculate an approximately circular path including these points. Entropy was minimal for the ideal dataset, whereas strong misalignment resulted in a higher entropy value. For the datasets used in this study, the simplex algorithm required 64-200 iterations to achieve an entropy value equivalent to the ideal dataset, depending on the grade of misalignment using random initialization conditions. The use of the GPU reduced the time per iteration as compared to a quad core CPU-based backprojection by a factor of 10 resulting in a total of 15-20 ms per iteration, and thus providing an online geometry restoration after a total computation time of approximately 1-3 s, depending on the number of iterations. The proposed method provides accurate geometry restoration for approximately circular scans and eliminates the need for an elaborate off-line calibration for each scan. If a priori information about the trajectory is used to initialize the simplex algorithm, it is expected that the entropy minimization will converge significantly faster.

Comparison of ring artifact correction methods for flat-detector CT

In flat-detector CT, imperfect or defect detector elements may cause concentric ring artifacts due to their continuous over- or underestimation of attenuation values, which often disturb image quality. Especially due to the demand for high-spatial resolution images and the necessary pixel read-out without arbitrary pixel-binning, ring artifacts become more pronounced and the reduction of these artifacts becomes a necessity. We here present a comparison of two dedicated ring artifact correction methods for flat-detector CT, on the basis of different median and mean filterings of the reconstructed image but each working in different geometric planes. While the first method works in Cartesian coordinates, the second method performs a transformation to polar coordinates. Both post-processing methods efficiently reduce ring artifacts in the reconstructed images and improve image quality. The transformation to polar coordinates turned out to be a necessary step for efficient ring artifact correction, since correction in Cartesian coordinates suffers from newly introduced artifacts as well as insufficient correction of artifacts close to the center of rotation.

Volume-of-interest (VOI) imaging in C-arm flat-detector CT for high image quality at reduced dose

PURPOSE A novel method for flat-detector computed tomography was developed to enable volume-of-interest (VOI) imaging at high resolution, low noise, and reduced dose. For this, a full low-dose overview (OV) scan and a local high-dose scan of a VOI are combined. METHODS The first scan yields an overview of the whole object and enables the selection of an arbitrary VOI. The second scan of that VOI assures high image quality within the interesting volume. The combination of the two consecutive scans is based on a forward projection of the reconstructed OV volume that was registered to the VOI. The artificial projection data of the OV scan are combined with the measured VOI data in the raw data domain. Different projection values are matched by an appropriate transformation and weighting. The reconstruction is performed with a standard Feldkamp-type algorithm. In simulations, the combination of OV scan and VOI scan was investigated on a mathematically described phantom. In measurements, spatial resolution and noise were evaluated with image quality phantoms. Modulation transfer functions and noise values were calculated. Measurements of an anthropomorphic head phantom were used to validate the proposed method for realistic applications, e.g., imaging stents. In Monte Carlo simulations, 3D dose distributions were calculated and dose values were assessed quantitatively. RESULTS By the proposed combination method, an image is generated which covers the whole object and provides the VOI at high image quality. In the OV image, a resolution of 0.7 lp/mm (line pairs per millimeter) and noise of 63.5 HU were determined. Inside the VOI, resolution was increased to 2.4 lp/mm and noise was decreased to 18.7 HU. For the performed measurements, the cumulative dose was significantly reduced in comparison to conventional scans by up to 93%. The dose of a high-quality scan, for example, was reduced from 97 to less than 7 mGy, while keeping image quality constant within the VOI. CONCLUSIONS The proposed VOI application with two scans is an effective way to ensure high image quality within the VOI while simultaneously reducing the cumulative patient dose.

Reducing Metal Artifacts in Computed Tomography Caused by Hip Endoprostheses Using a Physics-Based Approach

Purpose:Metal-induced artifacts may cause severe problems in clinical computed tomography (CT) imaging and may impair diagnosis as well as overall image quality. Many approaches for reducing these artifacts tackle the problem by simply ignoring or interpolating the metal traces in the raw data, which results in a general information loss and additional artifacts in the corrected image. It was the objective of this study to develop an approach aiming at correcting several physical artifact sources. We have also tried to minimize the impact on spatial resolution and attempted to avoid new artifacts resulting from the correction. Materials and Methods:The algorithm works with a first volumetric reconstruction followed by threshold-based metal prostheses segmentation. The segmented metal implants are then forward projected and the resulting sinogram entries are squared and combined, followed by a second reconstruction to yield correction volumes. The resulting volumes are then combined linearly with a combination weight determined to minimize the flatness of the initial image. A directional filtering algorithm following the beam hardening correction applies a nonlinear convolution in the metal traces of the sinogram which reduces existing metal-induced noise artifacts.Phantom measurements on a polyethylene (PE) disc with different inserts and a semi-anthropomorphic hip phantom with optional bone and titanium inserts were used for evaluating the algorithm. Patient datasets containing uni- and bilateral hip endoprostheses verified the applicability and efficiency on realistic clinical cases. Results:Deviations in CT values were reduced to below 3 HU on average. Image noise reduction of up to 70% was achieved (average noise reduction of 37%) with a more homogeneous CT value distribution in soft-tissue areas. A comparison to standard interpolation methods showed superior artifact suppression without producing artifacts caused by interpolation and without the general information loss in the close vicinity to the implants. The impact on spatial resolution was minimized as compared with interpolation algorithms. Conclusions:Metal artifacts caused by hip-endoprostheses were strongly reduced. Soft tissue areas and skeletal structures surrounding the implants were well restored. The correction works by postprocessing CT datasets and it is applicable to any reconstructed image without a priori knowledge.

Digitale Volumentomografie (DVT) und Mehrschicht-Spiral-CT (MSCT): eine objektive Untersuchung von Dosis und Bildqualität

PURPOSE In the last five years digital volume tomographs (DVT) have found their way into the diagnostic imaging of the facial skull. In this study both the image quality and dose of DVT and multislice spiral CT (MSCT) in this field of application were investigated using established physical methods for CT. MATERIALS AND METHODS Measurements on DVT scanners of various manufacturers and on a modern MSCT scanner were performed. The investigation was based on equivalent dose levels for both modalities (CT dose index, CTDI). For this purpose, the dose was measured with an ionization chamber in a cylindrical PMMA phantom. For the evaluation of image quality, the spatial resolution, contrast and noise were investigated with phantoms established for CT. RESULTS MSCT exhibited spatial resolution values of 1.0 to 1.6 lp/mm, while DVT provided resolution between 0.6 and 1.0 lp/mm only. Thus, MSCT offered similar or better resolution at an equivalent dose. For soft tissue resolution, DVT showed significant image artifacts. MSCT yielded higher homogeneity and no significant artifacts, and the contrast steps of the phantom were more verifiable. The different DVT devices, from image intensifiers to modern flat-detector (FD) devices, showed significant differences in favor of the FD devices. CONCLUSION For medium and high contrast applications (teeth/bones), DVT scanners can be an alternative to MSCT at comparable radiation exposure. However, MSCT offers advantages in terms of constantly good and controlled image quality with significantly more flexible scan parameters at a constant or lower dose and should therefore be given preference.