Spectral photon-counting CT: Image quality evaluation using a metal-containing bovine bone specimen.

PURPOSE: To find the optimal imaging parameters for a photon-counting detector CT (PCD-CT) and to compare it to an energy-integrating detector CT (EID-CT) in terms of image quality and metal artefact severity using a metal-containing bovine knee specimen. METHODS: A bovine knee with a stainless-steel plate and screws was imaged in a whole-body research PCD-CT at 120 kV and 140 kV and in an EID dual-source CT (DSCT) at Sn150 kV and 80/Sn150 kV. PCD-CT virtual monoenergetic 72 and 150 keV images and EID-CT images processed with and without metal artefact reduction algorithms (iMAR) were compared. Four radiologists rated the visualisation of bony structures and metal artefact severity. The Friedman test and Wilcoxon signed-rank test with Bonferroni's correction were used. P-values of ≤ 0.0001 were considered statistically significant. Distributions of HU values of regions of interest (ROIs) in artefact-affected areas were analysed. RESULTS: PCD-CT 140 kV 150 keV images received the highest scores and were significantly better than EID-CT Sn150 kV images. PCD-CT 72 keV images were rated significantly lower than all the others. HU-value variation was larger in the 120 kV and the 72 keV images. The ROI analysis revealed no large difference between scanners regarding artefact severity. CONCLUSION: PCD-CT 140 kV 150 keV images of a metal-containing bovine knee specimen provided the best image quality. They were superior to, or as good as, the best EID-CT images; even without the presumed advantage of tin filter and metal artefact reduction algorithms. PCD-CT is a promising method for reducing metal artefacts.

Photon-counting detector CT and energy-integrating detector CT for trabecular bone microstructure analysis of cubic specimens from human radius.

BACKGROUND: As bone microstructure is known to impact bone strength, the aim of this in vitro study was to evaluate if the emerging photon-counting detector computed tomography (PCD-CT) technique may be used for measurements of trabecular bone structures like thickness, separation, nodes, spacing and bone volume fraction. METHODS: Fourteen cubic sections of human radius were scanned with two multislice CT devices, one PCD-CT and one energy-integrating detector CT (EID-CT), using micro-CT as a reference standard. The protocols for PCD-CT and EID-CT were those recommended for inner- and middle-ear structures, although at higher mAs values: PCD-CT at 450 mAs and EID-CT at 600 (dose equivalent to PCD-CT) and 1000 mAs. Average measurements of the five bone parameters as well as dispersion measurements of thickness, separation and spacing were calculated using a three-dimensional automated region growing (ARG) algorithm. Spearman correlations with micro-CT were computed. RESULTS: Correlations with micro-CT, for PCD-CT and EID-CT, ranged from 0.64 to 0.98 for all parameters except for dispersion of thickness, which did not show a significant correlation (p = 0.078 to 0.892). PCD-CT had seven of the eight parameters with correlations ρ > 0.7 and three ρ > 0.9. The dose-equivalent EID-CT instead had four parameters with correlations ρ > 0.7 and only one ρ > 0.9. CONCLUSIONS: In this in vitro study of radius specimens, strong correlations were found between trabecular bone structure parameters computed from PCD-CT data when compared to micro-CT. This suggests that PCD-CT might be useful for analysing bone microstructure in the peripheral human skeleton.

ACCURACY OF CT NUMBERS OBTAINED BY DIRA AND MONOENERGETIC PLUS ALGORITHMS IN DUAL-ENERGY COMPUTED TOMOGRAPHY.

Dual-energy computed tomography (CT) can be used in radiotherapy treatment planning for the calculation of absorbed dose distributions. The aim of this work is to evaluate whether there is room for improvement in the accuracy of the Monoenergetic Plus algorithm by Siemens Healthineers. A Siemens SOMATOM Force scanner was used to scan a cylindrical polymethyl methacrylate phantom with four rod-inserts made of different materials. Images were reconstructed using ADMIRE and processed with Monoenergetic Plus. The resulting CT numbers were compared with tabulated values and values simulated by the proof-of-a-concept algorithm DIRA developed by the authors. Both the Monoenergetic Plus and DIRA algorithms performed well; the accuracy of attenuation coefficients was better than about ±1% at the energy of 70 keV. Compared with DIRA, the worse performance of Monoenergetic Plus was caused by its (i) two-material decomposition to iodine and water and (ii) imperfect suppression of the beam hardening artifact in ADMIRE.

OPTIMAL SELECTION OF BASE MATERIALS FOR ACCURATE DUAL-ENERGY COMPUTED TOMOGRAPHY: COMPARISON BETWEEN THE ALVAREZ-MACOVSKI METHOD AND DIRA.

The choice of the material base to which the material decomposition is performed in dual-energy computed tomography may affect the quality of reconstructed images. The aim of this work is to investigate how the commonly used bases (water, bone), (water, iodine) and (photoelectric effect, Compton scattering) affect the reconstructed linear attenuation coefficient in the case of the Alvarez-Macovski method. The performance of this method is also compared with the performance of the Dual-energy Iterative Reconstruction Algorithm (DIRA). In both cases, the study is performed using simulations. The results show that the Alvarez-Macovski method produced artefacts when iodine was present in the phantom together with human tissues since this method can only work with one doublet. It was shown that these artefacts could be avoided with DIRA using the (water, bone) doublet for tissues and the (water, iodine) doublet for the iodine solution.

ON THE POSSIBILITY TO RESOLVE GADOLINIUM- AND CERIUM-BASED CONTRAST AGENTS FROM THEIR CT NUMBERS IN DUAL-ENERGY COMPUTED TOMOGRAPHY.

Cerium oxide nanoparticles with integrated gadolinium have been proved to be useful as contrast agents in magnetic resonance imaging. Of question is their performance in dual-energy computed tomography. The aims of this work are to determine (1) the relation between the computed tomography number and the concentration of the I, Gd or Ce contrast agent and (2) under what conditions it is possible to resolve the type of contrast agent. Hounsfield values of iodoacetic acid, gadolinium acetate and cerium acetate dissolved in water at molar concentrations of 10, 50 and 100 mM were measured in a water phantom using the Siemens SOMATOM Definition Force scanner; gadolinium- and cerium acetate were used as substitutes for the gadolinium-integrated cerium oxide nanoparticles. The relation between the molar concentration of the I, Gd or Ce contrast agent and the Hounsfield value was linear. Concentrations had to be sufficiently high to resolve the contrast agents.

SEMI-AUTOMATED 3D SEGMENTATION OF PELVIC REGION BONES IN CT VOLUMES FOR THE ANNOTATION OF MACHINE LEARNING DATASETS.

Automatic segmentation of bones in computed tomography (CT) images is used for instance in beam hardening correction algorithms where it improves the accuracy of resulting CT numbers. Of special interest are pelvic bones, which-because of their strong attenuation-affect the accuracy of brachytherapy in this region. This work evaluated the performance of the JJ2016 algorithm with the performance of MK2014v2 and JS2018 algorithms; all these algorithms were developed by authors. Visual comparison, and, in the latter case, also Dice similarity coefficients derived from the ground truth were used. It was found that the 3D-based JJ2016 performed better than the 2D-based MK2014v2, mainly because of the more accurate hole filling that benefitted from information in adjacent slices. The neural network-based JS2018 outperformed both traditional algorithms. It was, however, limited to the resolution of 1283 owing to the limited amount of memory in the graphical processing unit (GPU).

Segmentation of bones in medical dual-energy computed tomography volumes using the 3D U-Net.

Deep learning algorithms have improved the speed and quality of segmentation for certain tasks in medical imaging. The aim of this work is to design and evaluate an algorithm capable of segmenting bones in dual-energy CT data sets. A convolutional neural network based on the 3D U-Net architecture was implemented and evaluated using high tube voltage images, mixed images and dual-energy images from 30 patients. The network performed well on all the data sets; the mean Dice coefficient for the test data was larger than 0.963. Of special interest is that it performed better on dual-energy CT volumes compared to mixed images that mimicked images taken at 120 kV. The corresponding increase in the Dice coefficient from 0.965 to 0.966 was small since the enhancements were mainly at the edges of the bones. The method can easily be extended to the segmentation of multi-energy CT data.

Investigation of a synthetic diamond detector response in kilovoltage photon beams.

PURPOSE: An important characteristic of radiation dosimetry detectors is their energy response which consists of absorbed-dose and intrinsic energy responses. The former can be characterized using Monte Carlo (MC) simulations, whereas the latter (i.e., detector signal per absorbed dose to detector) is extracted from experimental data. Such a characterization is especially relevant when detectors are used in nonrelative measurements at a beam quality that differs from the calibration beam quality. Having in mind the possible application of synthetic diamond detectors (microDiamond PTW 60019, Freiburg, Germany) for nonrelative dosimetry of low-energy brachytherapy (BT) beams, we determined their intrinsic and absorbed-dose energy responses in 25-250 kV beams relative to a 60 Co beam, which is usually the reference beam quality for detector calibration in radiotherapy. MATERIAL AND METHODS: Three microDiamond detectors and, for comparison, two silicon diodes (PTW 60017) were calibrated in terms of air-kerma free in air in six x-ray beam qualities (from 25 to 250 kV) and in terms of absorbed dose to water in a 60 Co beam at the national metrology laboratory in Sweden. The PENELOPE/penEasy MC radiation transport code was used to calculate the absorbed-dose energy response of the detectors (modeled based on blueprints) relative to air and water depending on calibration conditions. The MC results were used to extract the relative intrinsic energy response of the detectors from the overall energy response. Measurements using an independent setup with a single ophthalmic BEBIG I25.S16 125 I BT seed (effective photon energy of 28 keV) were used as a qualitative check of the extracted intrinsic energy response correction factors. Additionally, the impact of the thickness of the active volume as well as the presence of extra-cameral components on the absorbed-dose energy response of a microDiamond detector was studied using MC simulations. RESULTS: The relative intrinsic energy response of the microDiamond detectors was higher by a factor of 2 in 25 and 50 kV beams compared to the 60 Co beam. The variation in the relative intrinsic energy response of silicon diodes was within 10% over the investigated photon energy range. The use of relative intrinsic energy response correction factors improved the agreement among the absorbed dose to water values determined using microDiamond detectors and silicon diodes, as well as with the TG-43 formalism-based calculations for the 125 I seed. MC study of microDiamond detector design features provided a possible explanation for inter-detector response variation at low-energy photon beams by differences in the effective thickness of the active volume. CONCLUSIONS: MicroDiamond detectors had a non-negligible variation in the relative intrinsic energy response (factor of 2) which was comparable to that in the absorbed-dose energy response relative to water at low-energy photon beams. Silicon diodes, in contrast, had an absorbed-dose energy dependence on photon energy that varied by a factor of 6, whereas the intrinsic energy dependence on beam quality was within 10%. It is important to decouple these two responses for a full characterization of detector energy response especially when the user and reference beam qualities differ significantly, and MC alone is not enough.

Suitability of microDiamond detectors for the determination of absorbed dose to water around high-dose-rate 192 Ir brachytherapy sources.

PURPOSE: Experimental dosimetry of high-dose-rate (HDR) 192 Ir brachytherapy (BT) sources is complicated due to high dose and dose-rate gradients, and softening of photon energy spectrum with depth. A single crystal synthetic diamond detector microDiamond (PTW 60019, Freiburg, Germany) has a small active volume, high sensitivity, direct readout, and nearly water-equivalent active volume. The purpose of this study was to evaluate the suitability of microDiamond detectors for the determination of absorbed dose to water around HDR 192 Ir BT sources. Three microDiamond detectors were used, allowing for the comparison of their properties. METHODS: In-phantom measurements were performed using microSelectron and VariSource iX HDR 192 Ir BT treatment units. Their treatment planning systems (TPSs), Oncentra (v. 4.3) and BrachyVision (v. 13.6), respectively, were used to create irradiation plans for a cubic PMMA phantom with the microDiamond positioned at one of three source-to-detector distances (SDDs) (1.5, 2.5, and 5.5 cm) at a time. The source was stepped in increments of 0.5 cm over a total length of 6 cm to yield absorbed dose of 2 Gy at the nominal reference-point of the detector. Detectors were calibrated in 60 Co beam in terms of absorbed dose to water, and Monte Carlo (MC) calculated beam quality correction factors were applied to account for absorbed-dose energy dependence. Phantom correction factors were applied to account for differences in dimensions between the measurement phantom and a water phantom used for absorbed dose calculations made with a TPS. The same measurements were made with all three of the detectors. Additionally, dose-rate dependence and stability of the detectors were evaluated in 60 Co beam. RESULTS: The percentage differences between experimentally determined and TPS-calculated absorbed doses to water were from -1.3% to +2.9%. The values agreed to within experimental uncertainties, which were from 1.9% to 4.3% (k = 2) depending on the detector, SDD and treatment delivery unit. No dose-rate or intrinsic energy dependence corrections were applied. All microDiamonds were comparable in terms of preirradiation dose, stability of the readings and energy response, and showed a good agreement. CONCLUSIONS: The results indicate that the microDiamond is potentially suitable for the determination of absorbed dose to water around HDR 192 Ir BT sources and may be used for independent verification of TPS's calculations, as well as for QA measurements of HDR 192 Ir BT treatment delivery units at clinical sites.

A model-based iterative reconstruction algorithm DIRA using patient-specific tissue classification via DECT for improved quantitative CT in dose planning.

PURPOSE: To develop and evaluate-in a proof-of-concept configuration-a novel iterative reconstruction algorithm (DIRA) for quantitative determination of elemental composition of patient tissues for application to brachytherapy with low energy (< 50 keV) photons and proton therapy. METHODS: DIRA was designed as a model-based iterative reconstruction algorithm, which uses filtered backprojection, automatic segmentation and multimaterial tissue decomposition. The evaluation was done for a phantom derived from the voxelized ICRP 110 male phantom. Soft tissues were decomposed to the lipid, protein and water triplet, bones were decomposed to the compact bone and bone marrow doublet. Projections were derived using the Drasim simulation code for an axial scanning configuration resembling a typical DECT (dual-energy CT) scanner with 80 kV and Sn140 kV x-ray spectra. The iterative loop produced mono-energetic images at 50 and 88 keV without beam hardening artifacts. Different noise levels were considered: no noise, a typical noise level in diagnostic imaging and reduced noise level corresponding to tenfold higher doses. An uncertainty analysis of the results was performed using type A and B evaluations. The two approaches were compared. RESULTS: Linear attenuation coefficients averaged over a region were obtained with relative errors less than 0.5% for all evaluated regions. Errors in average mass fractions of the three-material decomposition were less than 0.04 for no noise and reduced noise levels and less than 0.11 for the typical noise level. Mass fractions of individual pixels were strongly affected by noise, which slightly increased after the first iteration but subsequently stabilized. Estimates of uncertainties in mass fractions provided by the type B evaluation differed from the type A estimates by less than 1.5% for most cases. The algorithm was fast, the results converged after 5 iterations. The algorithmic complexity of forward polyenergetic projection calculation was much reduced by using material doublets and triplets. CONCLUSIONS: The simulations indicated that DIRA is capable of determining elemental composition of tissues, which are needed in brachytherapy with low energy (< 50 keV) photons and proton therapy. The algorithm provided quantitative monoenergetic images with beam hardening artifacts removed. Its convergence was fast, image sharpness expressed via the modulation transfer function was maintained, and image noise did not increase with the number of iterations.

Estimating statistical uncertainty of Monte Carlo efficiency-gain in the context of a correlated sampling Monte Carlo code for brachytherapy treatment planning with non-normal dose distribution.

Correlated sampling Monte Carlo methods can shorten computing times in brachytherapy treatment planning. Monte Carlo efficiency is typically estimated via efficiency gain, defined as the reduction in computing time by correlated sampling relative to conventional Monte Carlo methods when equal statistical uncertainties have been achieved. The determination of the efficiency gain uncertainty arising from random effects, however, is not a straightforward task specially when the error distribution is non-normal. The purpose of this study is to evaluate the applicability of the F distribution and standardized uncertainty propagation methods (widely used in metrology to estimate uncertainty of physical measurements) for predicting confidence intervals about efficiency gain estimates derived from single Monte Carlo runs using fixed-collision correlated sampling in a simplified brachytherapy geometry. A bootstrap based algorithm was used to simulate the probability distribution of the efficiency gain estimates and the shortest 95% confidence interval was estimated from this distribution. It was found that the corresponding relative uncertainty was as large as 37% for this particular problem. The uncertainty propagation framework predicted confidence intervals reasonably well; however its main disadvantage was that uncertainties of input quantities had to be calculated in a separate run via a Monte Carlo method. The F distribution noticeably underestimated the confidence interval. These discrepancies were influenced by several photons with large statistical weights which made extremely large contributions to the scored absorbed dose difference. The mechanism of acquiring high statistical weights in the fixed-collision correlated sampling method was explained and a mitigation strategy was proposed.

CTmod-a toolkit for Monte Carlo simulation of projections including scatter in computed tomography.

The CTmod toolkit is a set of C++ class libraries based on the CERN's application development framework ROOT. It uses the Monte Carlo method to simulate energy imparted to a CT-scanner detector array. Photons with a given angle-energy distribution are emitted from the X-ray tube approximated by a point source, transported through a phantom, and their contribution to the energy imparted per unit surface area of each detector element is scored. Alternatively, the scored quantity may be the fluence, energy fluence, plane fluence, plane energy fluence, or kerma to air in the center of each detector element. Phantoms are constructed from homogenous solids or voxel arrays via overlapping. Implemented photon interactions (photoelectric effect, coherent scattering, and incoherent scattering) are restricted to the energy range from 10 to 200keV. Variance reduction techniques include the collision density estimator and survival biasing combined with the Russian roulette. The toolkit has been used to estimate the amount of scatter in cone beam computed tomography and planar radiography.

Effect of scatter on reconstructed image quality in cone beam computed tomography: evaluation of a scatter-reduction optimisation function.

The effect of scatter on reconstructed image quality in cone beam computed tomography was investigated and a function which can be used in scatter-reduction optimisation tasks was tested. Projections were calculated using the Monte Carlo method in an axially symmetric cone beam geometry consisting of a point source, water phantom and a single row of detector elements. Image reconstruction was performed using the filtered backprojection method. Image quality was assessed by the L2-norm-based difference relative to a reference image derived from (1) weighted linear attenuation coefficients and (2) projections by primary photons. It was found that the former function was strongly affected by the beam hardening artefact and did not properly reflect the amount of scatter but the latter function increased with increasing beam width, was higher for the larger phantom and exhibited properties which made it a good candidate for scatter-reduction optimisation tasks using polyenergetic beams.