A Novel Low-Dose Dual-Energy Imaging Method for a Fast-Rotating Gantry-Type CT Scanner.

CT scan by use of a beam-filter placed between the x-ray source and the patient allows a single-scan low-dose dual-energy imaging with a minimal hardware modification to the existing CT systems. We have earlier demonstrated the feasibility of such imaging method with a multi-slit beam-filter reciprocating along the direction perpendicular to the CT rotation axis in a cone-beam CT system. However, such method would face mechanical challenges when the beam-filter is supposed to cooperate with a fast-rotating gantry in a diagnostic CT system. In this work, we propose a new scanning method and associated image reconstruction algorithm that can overcome these challenges. We propose to slide a beam-filter that has multi-slit structure with its slits being at a slanted angle with the CT gantry rotation axis during a scan. A streaky pattern would show up in the sinogram domain as a result. Using a notch filter in the Fourier domain of the sinogram, we removed the streaks and reconstructed an image by use of the filtered-backprojection algorithm. The remaining image artifacts were suppressed by applying l0 norm based smoothing. Using this image as a prior, we have reconstructed low- and high-energy CT images in the iterative reconstruction framework. An image-based material decomposition then followed. We conducted a simulation study to test its feasibility using the XCAT phantom and also an experimental study using the Catphan phantom, a head phantom, an iodine-solution phantom, and a monkey in anesthesia, and showed its successful performance in image reconstruction and in material decomposition.

Development of liver surface nodularity quantification program and its clinical application in nonalcoholic fatty liver disease.

The liver morphological changes in relation to fibrosis stage in nonalcoholic fatty liver disease (NAFLD) have not yet been clearly understood. This study was to develop a liver surface nodularity (LSN) quantification program and to compare the fibrosis grades in simple steatosis (SS) and nonalcoholic steatohepatitis (NASH). Thirty subjects (7 normal controls [NC], 12 SS and 11 NASH) were studied. LSN quantification procedure was bias correction, boundary detection, segmentation and LSN measurement. LSN scores among three groups and fibrosis grades compared using Kruskal-Wallis H test. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristics (ROC) curve. Mean LSN scores were NC 1.30 ± 0.09, SS 1.54 ± 0.21 and NASH 1.59 ± 0.23 (p = 0.008). Mean LSN scores according to fibrosis grade (F) were F0 1.30 ± 0.09, F1 1.45 ± 0.17 and F2&F3 1.67 ± 0.20 (p = 0.001). The mean LSN score in F2&F3 is significantly higher than that in F1 (p = 0.019). The AUROC curve to distinguish F1 and F2&F3 was 0.788 (95% CI 0.595-0.981, p = 0.019) at a cut-off LSN score greater than 1.48, and its diagnostic accuracy had 0.833 sensitivity and 0.727 specificity. This study developed LSN program and its clinical application demonstrated that the quantitative LSN scores can help to differentially diagnose fibrosis stage in NAFLD.

Development of mobile intraoperative computed tomography imaging system and assessment of its performance in a brain and body phantom study.

BACKGROUND: Intraoperative computed tomography (iCT) system has been developed focusing on combining the advanced imaging techniques for the best imaging modality. However, the use of iCT system in the operating rooms is limited due to the lack of flexible mobility. OBJECTIVE: This study aims to develop a mobile iCT imaging system and assess its imaging performance in a phantom study. METHODS: The mobile iCT system with mecanum omni-directional wheels has three major components namely, a rotating gantry, a slip-ring and a stationary gantry. Performance of mecanum iCT system was evaluated using the indices of signal-to-noise (SNR), contrast-to noise (CNR), and spatial resolution (MTF). Anatomical landmarks on phantom images were assessed using a 5-point scale (5 = definitely seen; 4 = probably seen; 3 = equivocal; 2 = probably not seen; and 1 = definitely not seen). RESULTS: The mecanum iCT system can be conveniently used for a whole-body scan under intraoperative conditions even in narrow operating rooms due to a smaller turning radius. The image quality of the mecanum iCT system was found to be acceptable for clinical applications (with SNR = 162.72, CNR = 134.29 and MTF = 694 µm). The diagnostic scores on the phantom images were 'definitely seen' value. CONCLUSIONS: The proposed mecanum iCT system achieved the improved flexible mobility and has potential to better serve as a useful imaging tool in the clinical intraoperative setting.

Coefficient of variation on Gd-EOB MR imaging: Correlation with the presence of early-stage hepatocellular carcinoma in patients with chronic hepatitis B.

PURPOSE: To study whether the measurement of hepatic fibrosis on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) magnetic resonance (MR) imaging using the coefficient of variation (CV) might be correlated with the presence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). MATERIALS AND METHODS: This study included 104 patients with and without CHB, who were divided into 4 groups: control group, CHB without liver cirrhosis (LC; Group I), CHB with LC (Group II), and CHB with LC and HCC (Group III). MR images were analyzed to measure the inhomogeneity of signal intensities calculated using the CV map of the liver parenchyma. Intergroup comparisons of CV values were performed using ANOVA. The diagnostic performance of the CV map and alpha-fetoprotein (AFP) for diagnosing HCC was evaluated using the receiver operating characteristic (ROC) curve. RESULTS: On the hepatobiliary phase of Gd-EOB-DTPA-enhanced T1-weighted imaging, the mean CV values of the control group and Groups I, II, and III were 3.9 ±â€¯0.99, 3.97 ±â€¯1.09, 5.58 ±â€¯2.05, and 6.80 ±â€¯2.34, respectively (P = 0.000). On ROC analysis of the CV value for predicting HCC, the value of the area under the curve (AUC) on Gd-EOB-DTPA MR imaging was 0.788 (95% CI: 0.697-0.862). The sensitivity and specificity were 84.2% and 63.6%, respectively, at a CV cutoff value >4.75. The value of AUC determined using AFP was 0.766. CONCLUSION: The CV value for hepatic fibrosis on Gd-EOB-DTPA MR imaging may be correlated with the presence of HCC in patients with CHB, and shows comparable diagnostic performance to AFP analysis.

Quantitative Measurement of Hepatic Fibrosis with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Chronic Hepatitis B Infection: A Comparative Study on Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index.

OBJECTIVE: To quantitatively measure hepatic fibrosis on gadoxetic acid-enhanced magnetic resonance (MR) in chronic hepatitis B (CHB) patients and identify the correlations with aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) values. MATERIALS AND METHODS: This study on gadoxetic acid-enhanced 3T MR imaging included 81 patients with CHB infection. To quantitatively measure hepatic fibrosis, MR images were analyzed with an aim to identify inhomogeneous signal intensities calculated from a coefficient of variation (CV) map in the liver parenchyma. We also carried out a comparative analysis between APRI and FIB-4 based on metaregression results. The diagnostic performance of the CV map was evaluated using a receiver-operating characteristic (ROC) curve. RESULTS: In the MR images, the mean CV values in control, groups I, II, and III based on APRI were 4.08 ± 0.92, 4.24 ± 0.80, 5.64 ± 1.11, and 5.73 ± 1.28, respectively (p < 0.001). In CHB patients grouped by FIB-4, the mean CV values of groups A, B, and C were 4.22 ± 0.95, 5.40 ± 1.19, and 5.71 ± 1.17, respectively (p < 0.001). The mean CV values correlated well with APRI (r = 0.392, p < 0.001) and FIB-4 (r = 0.294, p < 0.001). In significant fibrosis group, ROC curve analysis yielded an area under the curve of 0.875 using APRI and 0.831 using FIB-4 in HB, respectively. CONCLUSION: Gadoxetic acid-enhanced MR imaging for calculating a CV map showed moderate correlation with APRI and FIB-4 values and could be employed to quantitatively measure hepatic fibrosis in patients with CHB.

Development of Portable Digital Radiography System with a Device for Monitoring X-ray Source-Detector Angle and Its Application in Chest Imaging.

This study developed a device measuring the X-ray source-detector angle (SDA) and evaluated the imaging performance for diagnosing chest images. The SDA device consisted of Arduino, an accelerometer and gyro sensor, and a Bluetooth module. The SDA values were compared with the values of a digital angle meter. The performance of the portable digital radiography (PDR) was evaluated using the signal-to-noise (SNR), contrast-to-noise ratio (CNR), spatial resolution, distortion and entrance surface dose (ESD). According to different angle degrees, five anatomical landmarks were assessed using a five-point scale. The mean SNR and CNR were 182.47 and 141.43. The spatial resolution and ESD were 3.17 lp/mm (157 µm) and 0.266 mGy. The angle values of the SDA device were not significantly difference as compared to those of the digital angle meter. In chest imaging, the SNR and CNR values were not significantly different according to the different angle degrees. The visibility scores of the border of the heart, the fifth rib and the scapula showed significant differences according to different angles (p < 0.05), whereas the scores of the clavicle and first rib were not significant. It is noticeable that the increase in the SDA degree was consistent with the increases of the distortion and visibility score. The proposed PDR with a SDA device would be useful for application in the clinical radiography setting according to the standard radiography guidelines.

Reduced radiation dose and improved image quality using a mini mobile digital imaging system in a neonatal intensive care unit.

This study was aimed to assess the radiation dose and image quality of a mini-mobile digital imaging (mini-DI) system for neonatal chest radiography and compared to conventional digital radiography (DR). A total of 64 neonates were examined and anatomical landmarks were assessed. The entrance surface dose of mini DI and conventional DR was 26.64±0.15 µGy and 49.11±1.46 µGy, respectively (p<0.001). The mean SNR values for mini-DI and DR were 233.2±5.1 and 31.6±1.2, and 10% MTF values were 131 and 161µm. A newly developed mini-DI is capable of preserving the diagnostic information with dose reduction in neonates under intensive care.

Performance of mobile digital X-ray fluoroscopy using a novel flat panel detector for intraoperative use.

BACKGROUND: Technologies employing digital X-ray devices are developed for mobile settings. OBJECTIVE: To develop a mobile digital X-ray fluoroscopy (MDF) for intraoperative guidance, using a novel flat panel detector to focus on diagnostics in outpatient clinics, operating and emergency rooms. METHODS: An MDF for small-scale field diagnostics was configured using an X-ray source and a novel flat panel detector. The imager enabled frame rates reaching 30 fps in full resolution fluoroscopy with maximal running time of 5 minutes. Signal-to-noise (SNR), contrast-to-noise (CNR), and spatial resolution were analyzed. Stray radiation, exposure radiation dose, and effective absorption dose were measured for patients. RESULTS: The system was suitable for small-scale field diagnostics. SNR and CNR were 62.4 and 72.0. Performance at 10% of MTF was 9.6 lp/mm (53 µ m) in the no binned mode. Stray radiation at 100 cm and 150 cm from the source was below 0.2 µ Gy and 0.1 µ Gy. Exposure radiation in radiography and fluoroscopy (5 min) was 10.2 µ Gy and 82.6 mGy. The effective doses during 5-min-long fluoroscopy were 0.26 mSv (wrist), 0.28 mSv (elbow), 0.29 mSv (ankle), and 0.31 mSv (knee). CONCLUSIONS: The proposed MDF is suitable for imaging in operating rooms.

Dedicated mobile volumetric cone-beam computed tomography for human brain imaging: A phantom study.

BACKGROUND: Mobile computed tomography (CT) with a cone-beam source is increasingly used in the clinical field. Mobile cone-beam CT (CBCT) has great merits; however, its clinical utility for brain imaging has been limited due to problems including scan time and image quality. OBJECTIVE: The aim of this study was to develop a dedicated mobile volumetric CBCT for obtaining brain images, and to optimize the imaging protocol using a brain phantom. METHODS: The mobile volumetric CBCT system was evaluated with regards to scan time and image quality, measured as signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR), spatial resolution (10% MTF), and effective dose. Brain images were obtained using a CT phantom. RESULTS: The CT scan took 5.14 s at 360 projection views. SNR and CNR were 5.67 and 14.5 at 120 kV/10 mA. SNR and CNR values showed slight improvement as the x-ray voltage and current increased (p < 0.001). Effective dose and 10% MTF were 0.92 mSv and 360 µ m at 120 kV/10 mA. Various intracranial structures were clearly visible in the brain phantom images. CONCLUSIONS: Using this CBCT under optimal imaging acquisition conditions, it is possible to obtain human brain images with low radiation dose, reproducible image quality, and fast scan time.

Combined Radiofrequency Ablation and Double Anti-Angiogenic Protein Therapy to Increase Coagulation Efficacy: An Experimental Study in a Murine Renal Carcinoma Model.

OBJECTIVE: To evaluate whether suppression of tumor microvasculature by double anti-angiogenic protein (DAAP) treatment could increase the extent of radiofrequency ablation (RFA)-induced coagulation in a murine renal cell carcinoma model. MATERIALS AND METHODS: Renal cell carcinoma cell lines were implanted subcutaneously into 10 nude mice. Four mice received adenoviral DAAP treatment and 6 mice received sterile 0.9% saline solution as DAAP-untreated group. The effect of DAAP was evaluated according to the vascularity by contrast-enhanced ultrasound (CEUS) using microbubbles. Four DAAP-treated mice and 4 DAAP-untreated mice were then treated with RFA, resulting in 3 groups: no-therapy (n = 2), RFA only (n = 4), and RFA combined with DAAP treatment (n = 4). Immediately after RFA, the size of coagulation necrosis and mitochondrial enzyme activity were compared between the groups using analysis of variance (ANOVA) and post hoc test. RESULTS: The contrast enhancement ratio for tumor vascularization on CEUS was significantly lower in the DAAP treated group than in DAAP-untreated group (30.2 ± 9.9% vs. 77.4 ± 17.3%; p = 0.021). After RFA, the mean coagulation diameter was 0 mm for no-therapy group, 6.7 ± 0.7 mm for the RFA only group and 8.5 ± 0.4 mm for the RFA with DAAP group (ANOVA, p < 0.001). The area of viable mitochondria within the tumor was 27.9 ± 3.9% in no-therapy group, 10.3 ± 4.5% in the RFA only group, and 2.1 ± 0.7% in the RFA with DAAP group (ANOVA, p < 0.001). CONCLUSION: Our results suggest the potential value of combining RFA with anti-angiogenic therapy.

Development of a mini-mobile digital radiography system by using wireless smart devices.

The current technologies that trend in digital radiology (DR) are toward systems using portable smart mobile as patient-centered care. We aimed to develop a mini-mobile DR system by using smart devices for wireless connection into medical information systems. We developed a mini-mobile DR system consisting of an X-ray source and a Complementary Metal-Oxide Semiconductor (CMOS) sensor based on a flat panel detector for small-field diagnostics in patients. It is used instead of the systems that are difficult to perform with a fixed traditional device. We also designed a method for embedded systems in the development of portable DR systems. The external interface used the fast and stable IEEE 802.11n wireless protocol, and we adapted the device for connections with Picture Archiving and Communication System (PACS) and smart devices. The smart device could display images on an external monitor other than the monitor in the DR system. The communication modules, main control board, and external interface supporting smart devices were implemented. Further, a smart viewer based on the external interface was developed to display image files on various smart devices. In addition, the advantage of operators is to reduce radiation dose when using remote smart devices. It is integrated with smart devices that can provide X-ray imaging services anywhere. With this technology, it can permit image observation on a smart device from a remote location by connecting to the external interface. We evaluated the response time of the mini-mobile DR system to compare to mobile PACS. The experimental results show that our system outperforms conventional mobile PACS in this regard.