Variation assessment of deformable registration in stereotactic radiosurgery.

INTRODUCTION: The regular functions of CT-MRI registration include delineation of targets and organs-at-risk (OARs) in radiosurgery planning. The question of whether deformable image registration (DIR) could be applied to stereotactic radiosurgery (SRS) in its place remains a subject of debate. METHODS: This study collected data regarding 16 patients who had undergone single-fraction SRS treatment. All lesions were located close to the brainstem. CT and MRI two image sets were registered by both rigid image registration (RIR) and DIR algorithms. The contours of the OARs were drawn individually on the rigid and deformable CT-MRI image sets by qualified radiation oncologists and dosimetrists. The evaluation metrics included volume overlapping (VO), Dice similarity coefficient (DSC), and dose. The modified demons deformable algorithm (VARIAN SmartAdapt) was used for evaluation in this study. RESULTS: The mean range of VO for OARs was 0.84 ± 0.08, and DSC was 0.82 ± 0.07. The maximum average volume difference was at normal brain (17.18 ± 14.48 cm3) and the second highest was at brainstem (2.26 cm3 ± 1.18). Pearson correlation testing showed that all DIRs' OAR volumes were linearly and significantly correlated with RIRs' volume (0.679-0.992, two tailed, P << 0.001). The 100% dose was prescribed at gross tumor volume (GTV). The average maximum percent dose difference was observed in brainstem (26.54% ± 27.027), and the average mean dose difference has found at same organ (1.6% ± 1.66). CONCLUSION: The change in image-registration method definitely produces dose variance, and is significantly more what depending on the target location. The volume size of OARs, however, was not statistical significantly correlated with dose variance.

Autoradiographic and histopathological studies of boric acid-mediated BNCT in hepatic VX2 tumor-bearing rabbits: Specific boron retention and damage in tumor and tumor vessels.

Hepatoma is a malignant tumor that responds poorly to conventional therapies. Boron neutron capture therapy (BNCT) may provide a better way for hepatoma therapy. In this research, (10)B-enriched boric acid (BA, 99% (10)B) was used as the boron drug. A multifocal hepatic VX2 tumor-bearing rabbit model was used to study the mechanisms of BA-mediated BNCT. Autoradiography demonstrated that BA was selectively targeted to tumors and tumor vessels. Histopathological examination revealed the radiation damage to tumor-bearing liver was concentrated in the tumor regions during BNCT treatment. The selective killing of tumor cells and the destruction of the blood vessels in tumor masses may be responsible for the success of BA-mediated BNCT for liver tumors.

Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan.

Flatfoot (pes planus) is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA-MT5) angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI) registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA-MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot.

Improvements on a patient-specific dose estimation system in nuclear medicine examination.

The purpose of this paper is to develop a patient-specific dose estimation system in nuclear medicine examination. A dose deposition routine to store the deposited energy of the photons during their flights was embedded in the widely used SimSET Monte Carlo code and a user-friendly interface for reading PET and CT images was developed. Dose calculated on ORNL phantom was used to validate the accuracy of this system. The ratios of S value for (99m)Tc, (18)F and (131)I computed by this system to those obtained with OLINDA for various organs were ranged from 0.93 to 1.18, which were comparable to that obtained from MCNPX2.6 code (0.88-1.22). Our system developed provides opportunity for tumor dose estimation which cannot be known from the MIRD. The radiation dose can provide useful information in the amount of radioisotopes to be administered in radioimmunotherapy.

Prediction of nodal metastasis in head and neck cancer using a 3T MRI ADC map.

BACKGROUND AND PURPOSE: The detection of cervical nodal metastases is important for the prognosis and treatment of head and neck tumors. The purpose of this study was to assess the ability of ADC values at 3T to distinguish malignant from benign lymph nodes. MATERIALS AND METHODS: From July 2009 to June 2010, twenty-two patients (21 men and 1 woman; mean age, 49.8±9.5 years; age range, 28-66 years) scheduled for surgical treatment of biopsy-proved head and neck cancer were prospectively and consecutively enrolled in this study. All patients were scanned on a 3T imaging unit (Verio) by using a 12-channel head coil combined with a 4-channel neck coil. Histologic findings were the reference standard for the diagnosis of lymph node metastasis. RESULTS: The ADC values derived from the signal intensity averaged across images obtained with b-values of 0 and 800 s/mm2 were 1.086±0.222×10(-3) mm2/s for benign lymph nodes and 0.705±0.118×10(-3) mm2/s for malignant lymph nodes (P<.0001). When an ADC value of 0.851×10(-3) mm2/s was used as a threshold value for differentiating benign from malignant lymph nodes, the best results were obtained with an accuracy of 91.0%, sensitivity of 91.3%, and specificity of 91.1%. CONCLUSIONS: The ADC value is a sensitive and specific parameter that can help to differentiate malignant from benign lymph nodes.

Development of an imaging-planning program for screen/film and computed radiography mammography for breasts with short chest wall to nipple distance.

OBJECTIVE: Imaging breasts with a short chest wall to nipple distance (CWND) using a traditional mammographic X-ray unit is a technical challenge for mammographers. The purpose of this study is the development of an imaging-planning program to assist in determination of imaging parameters of screen/film (SF) and computed radiography (CR) mammography for short CWND breasts. METHODS: A traditional mammographic X-ray unit (Mammomat 3000, Siemens, Munich, Germany) was employed. The imaging-planning program was developed by combining the compressed breast thickness correction, the equivalent polymethylmethacrylate thickness assessment for breasts and the tube loading (mAs) measurement. Both phantom exposures and a total of 597 exposures were used for examining the imaging-planning program. RESULTS: Results of the phantom study show that the tube loading rapidly decreased with the CWND when the automatic exposure control (AEC) detector was not fully covered by the phantom. For patient exposures with the AEC fully covered by breast tissue, the average fractional tube loadings, defined as the ratio of the predicted mAs using the imaging-planning program and mAs of the mammogram, were 1.10 and 1.07 for SF and CR mammograms, respectively. The predicted mAs values were comparable to the mAs values, as determined by the AEC. CONCLUSION: By applying the imaging-planning program in clinical practice, the experiential dependence of the mammographer for determination of the imaging parameters for short CWND breasts is minimised.

A method incorporating 4DCT data for evaluating the dosimetric effects of respiratory motion in single-arc IMAT.

This study introduces a method incorporating 4DCT data to determine the impact of respiratory motion in single-arc intensity-modulated arc therapy (IMAT). Simulation was done by re-warping the static dose distribution of all phases of a 4DCT image set with a 3D deformation map to reference CT images at end-inspiration and end-expiration. To calculate the dose received during respiration under IMAT, the control points were interpolated and re-distributed into separate IMAT plans corresponding to each respiratory phase. This study also investigated the role that plan complexity may play in the dosimetric impact of the respiratory motion in the delivery of IMAT. The dosimetric impact of organ motion was evaluated by analyzing the degradation of D(95,) D(50) and D(05) of the CTV and PTV. From the results shown for the patients in this study who had maximum organ motion displacement approximately 15 mm, the dosimetric impact is rather small. Therefore, our preliminary results suggest that respiratory motion of less than 1.5 cm may be ignored for both moderately and highly modulated IMAT, irrespective of the number of fractions. Specifically, highly modulated plans only increased the degradation of D(95) of the DVH curves for a single fraction by 2% in the CTV and 9% in the PTV compared to the expected value of the multi-fraction plan.

Beam hardening correction for computed tomography images using a postreconstruction method and equivalent tissue concept.

A postreconstruction method for correcting the beam-hardening artifacts in computed tomography (CT) images is proposed. This method does not require x-ray spectrum measurement. The authors assumed that a pixel in a CT image can be decomposed into equivalent tissue percentages, depending on its CT number. A scout view of the step wedges made of these equivalent tissues was performed to obtain a beam-hardening correction curve for each tissue. Projecting through the CT image from various angles generated simulated projection data and the total thickness of each tissue along the ray. The correction term was estimated using the tissue thickness traveled by the ray, and this term was then added to its corresponding projection data. A second reconstruction using the corrected projection data yielded a beam-hardening corrected image. The preliminary results show that this method reduces beam hardening artifacts by 14% for aluminum and increased the object contrast by 18% near the aluminum-water boundary. The variation in CT numbers at different locations were reduced, and the aluminum CT number also was restored.

Thresholding histogram equalization.

The drawbacks of adaptive histogram equalization techniques are the loss of definition on the edges of the object and overenhancement of noise in the images. These drawbacks can be avoided if the noise is excluded in the equalization transformation function computation. A method has been developed to separate the histogram into zones, each with its own equalization transformation. This method can be used to suppress the nonanatomic noise and enhance only certain parts of the object. This method can be combined with other adaptive histogram equalization techniques. Preliminary results indicate that this method can produce images with superior contrast.

Simple empirical formula for predicting range variation of central-axis parameters in small electron fields.

The depth of central-axis percent dose Rx (except R100) and practical range, Rp, for small field electron beams can be calculated by the proposed empirical formula: Rx = Rxo x [1 - (1 - r/Rpo)m], where Rxo and Rpo are the broad beam percentage dose depth and practical range respectively; r is the small field cutout side when it is less than the maximum lateral scatter equivalent range, and m is the exponent term relative to the decreasing curvature. Five electron beams from a Varian CL-2100CD linear accelerator were used to verify this formula. The difference between measured and calculated depth dose range is within +/- 1 mm when cutout side reduced to 2 x 2 cm2. This formula offers a simple and time-saving method to quickly determine the useful treatment percentage dose depth of small field electron beams.

Shape-based grey-level image interpolation.

The three-dimensional (3D) object data obtained from a CT scanner usually have unequal sampling frequencies in the x-, y- and z-directions. Generally, the 3D data are first interpolated between slices to obtain isotropic resolution, reconstructed, then operated on using object extraction and display algorithms. The traditional grey-level interpolation introduces a layer of intermediate substance and is not suitable for objects that are very different from the opposite background. The shape-based interpolation method transfers a pixel location to a parameter related to the object shape and the interpolation is performed on that parameter. This process is able to achieve a better interpolation but its application is limited to binary images only. In this paper, we present an improved shape-based interpolation method for grey-level images. The new method uses a polygon to approximate the object shape and performs the interpolation using polygon vertices as references. The binary images representing the shape of the object were first generated via image segmentation on the source images. The target object binary image was then created using regular shape-based interpolation. The polygon enclosing the object for each slice can be generated from the shape of that slice. We determined the relative location in the source slices of each pixel inside the target polygon using the vertices of a polygon as the reference. The target slice grey-level was interpolated from the corresponding source image pixels. The image quality of this interpolation method is better and the mean squared difference is smaller than with traditional grey-level interpolation.

Noise content analysis in clinical digital images.

Most digital modalities in radiology use 12 bits precision to store the digital images. To determine whether all these bits contain useful information, a statistical method called the Moran test was used to measure the noise level in computed tomographic, magnetic resonance, and digital radiographic images. The test was performed on the bit planes of each pixel. After the noise level was estimated, the pixel data were separated into signal bits and noise bits, and image enhancement techniques were applied on the noise-bits-removed images to demonstrate that the removal of noise bits did not affect image quality. Preliminary results showed no noticeable difference between the original images and the noise-bits-removed images.

Evaluation of inherent gray-level dynamic range in a digital image using the runs test and join-count statistics.

The dynamic range of the gray level of a digital image is limited by the noise it contains. Two statistical methods called "runs test" and "join-count statistic" are used to measure the noise level in a digital image. A residual image is formed by subtracting an original image from its smoothed version. Theoretically, the noise level in the residual image should be identical to that in the original image. The noise level is determined by examining each bit plane of the residual image individually starting from the least significant bit up to the bit plane whose statistic does not show a random pattern. Images from three digital modalities: computerized tomography, magnetic resonance, and computed radiography are used to evaluate the gray-level dynamic range. Both methods are easy to implement and fast to perform.

Implementation of a large-scale picture archiving and communication system.

This paper describes the implementation of a large-scale picture archiving and communication system (PACS) in a clinical environment. The system consists of a PACS infrastructure, composed of a PACS controller, a database management system, communication networks, and optical disk archive. It connects to three MR units, four CT scanners, three computed radiography systems, and two laser film digitizers. Seven display stations are on line 24 h/day, 7 days/wk in genitourinary radiology (2K), pediatric radiology in-patient (1K and 2K) and outpatient (2K), neuroradiology (2K), pediatric ICU (1K), coronary care unit (1K), and one laser film printing station. The PACS is integrated with the hospital information system and the radiology information system. The system has been in operation since February 1992. We have integrated this PACS as a clinical component in daily radiology practice. It archives an average of 2.0-gigabyte image data per workday. A 3-mo system performance of various components are tabulated. The deployment of this large-scale PACS signifies a milestone in our PACS research and development effort. Radiologists, fellows, residents, and clinicians use it for case review, conferences, and occasionally for primary diagnosis. With this large-scale PACS in place, it will allow us to investigate the two critical issues raised when PACS research first started 10 yrs ago: system performance and cost effectiveness between a digital-based and a film-based system.

Assessment of noise in a digital image using the join-count statistic and the Moran test.

We assume that the data bits of a pixel in digital images can be divided into signal and noise bits. The signal bits occupy the most significant part of the pixel and the noise bits the least significant part. The signal part of each pixel are correlated while the noise parts are uncorrelated. Two statistical methods, the Moran test and the join-count statistic, are used to examine the noise parts. Images from three digital modalities--computerized tomography, magnetic resonance and computed radiography--are used for the evaluation of the noise bits. A residual image is formed by subtracting the original image from its smoothed version. The noise level in the residual image is then identical to that in the original image. Both statistical tests are then performed on the bit planes of the residual image. The results show that most digital images contain only 8-9 bits of correlated information. Both methods are easy to implement and fast to perform.

Receiver-operating-characteristic study of chest radiographs in children: digital hard-copy film vs 2K x 2K soft-copy images.

Two methods are commonly used to visualize digital radiologic imaging data: (1) hard-copy viewing, in which the digital data are used to modulate the intensity of a laser beam that exposes an analog film and (2) soft-copy viewing, in which the digital data are converted to an analog video signal and presented on a CRT monitor. The film method allows new digital imaging systems to be easily integrated into conventional radiologic management and viewing methods. The second method, soft-copy viewing, allows digital imaging data to be managed and viewed electronically in a picture archiving and communication system (PACS). These PACS systems are hypothesized to have improved operational efficiency and enhanced image-analysis capabilities. The quality of soft-copy images is still not widely accepted. This article reports on the results of a large-scale receiver-operating-characteristic study comparing observers' performance in detecting various pediatric chest abnormalities on soft-copy 2048 x 2048K byte displays with their performance with digital laser-printed film from computed radiography. The disease categories studied were pneumothorax, linear atelectasis, air bronchogram, and interstitial disease. The selected data set included 239 images; 77 contained no proved abnormality and 162 contained one or more of the abnormalities mentioned. Seven pediatric radiologists participated in the study, two as judges and five as observers. Our results show no significant difference between viewing images on digital hard copy and soft copy for the detection of pneumothoraces and air bronchograms. A slight performance edge for soft copy was seen for interstitial disease and linear atelectasis. This result indicates that computed chest radiographs in children viewed in a soft-copy PACS environment should result in diagnoses similar to or slightly more accurate than those obtained in a laser-printed film-based environment.

Comparison of chi-square and join-count methods for evaluating digital image data.

The significance of each bit of the pixel in digital image data from various radiological modalities is tested to determine the contrast resolution. Two statistical methods, join-count statistic and chi-square goodness of fit test, are used to perform the test. Join-count statistic is used to measure the spatial coherence among pixels, while the chi-square test is used to determine if the bit data are randomly distributed. A residual image is formed by subtracting an original image from its smoothed version. The contrast revolution is determined by applying both statistics on each bit plane of the residual image starting from the least significant bit up to the bit plane whose statistic does not show a random pattern. Images from three digital modalities, computerized tomography, magnetic resonance, and computed radiography, are used to evaluate the gray-level dynamic range. Both methods are easy to implement and fast to perform.

Localization of the sympathetic postganglionic neurons innervating cardiac coronary artery with horseradish peroxidase in monkeys.

Localization of the sympathetic postganglionic neurons innervating the cardiac coronary arteries in monkeys was investigated by using retrograde axonal transport of horseradish peroxidase (HRP). HRP was applied to the main trunk of the left and right coronary arteries, and to the terminal branches of the ventral and dorsal descending vessels of the left and right coronary arteries, respectively. The animals were sacrificed 84-96 hours later and perfused via the left ventricle. The paravertebral sympathetic ganglia from the superior cervical, middle cervical and stellate ganglia to the T9 ganglia, and nodose ganglia were removed and processed for HRP identification. After HRP was applied into the main trunk of the right coronary artery, and into the main trunk and the terminal branches of the descending vessels of the left coronary artery, the HRP-labeled sympathetic neurons were localized predominantly in the right superior cervical ganglion, and next in the left superior cervical ganglia. However, labeled cells were found in the stellate ganglia bilaterally. After HRP applications to the terminal branches of the dorsal descending vessels of the right coronary artery, HRP-labeled cells were mainly present in the left superior cervical ganglion and next in the right superior cervical ganglion. Some labeled cells were found in the middle cervical and stellate ganglia. No labeled cell was found in ganglia below the second thoracic ganglia on either side in these four groups.