Modeling the respiratory motion of solitary pulmonary nodules and determining the impact of respiratory motion on their detection in SPECT imaging.

The objectives of this investigation were to model the respiratory motion of solitary pulmonary nodules (SPN) and then use this model to determine the impact of respiratory motion on the localization and detection of small SPN in SPECT imaging for four reconstruction strategies. The respiratory motion of SPN was based on that of normal anatomic structures in the lungs determined from breath-held CT images of a volunteer acquired at two different stages of respiration. End-expiration (EE) and time-averaged (Frame Av) non-uniform-B-spline cardiac torso (NCAT) digital-anthropomorphic phantoms were created using this information for respiratory motion within the lungs. SPN were represented as 1 cm diameter spheres which underwent linear motion during respiration between the EE and end-inspiration (EI) time points. The SIMIND Monte Carlo program was used to produce SPECT projection data simulating Tc-99m depreotide (NeoTect) imaging. The projections were reconstructed using 1) no correction (NC), 2) attenuation correction (AC), 3) resolution compensation (RC), and 4) attenuation correction, scatter correction, and resolution compensation (AC_SC_RC). A human-observer localization receiver operating characteristics (LROC) study was then performed to determine the difference in localization and detection accuracy with and without the presence of respiratory motion. The LROC comparison determined that respiratory motion degrades tumor detection for all four reconstruction strategies, thus correction for SPN motion would be expected to improve detection accuracy. The inclusion of RC in reconstruction improved detection accuracy for both EE and Frame Av over NC and AC. Also the magnitude of the impact of motion was least for AC_SC_RC.

LROC Investigation of Three Strategies for Reducing the Impact of Respiratory Motion on the Detection of Solitary Pulmonary Nodules in SPECT.

The objective of this investigation was to determine the effectiveness of three motion reducing strategies in diminishing the degrading impact of respiratory motion on the detection of small solitary pulmonary nodules (SPN) in single photon emission computed tomographic (SPECT) imaging in comparison to a standard clinical acquisition and the ideal case of imaging in the absence of respiratory motion. To do this non-uniform rational B-spline cardiac-torso (NCAT) phantoms based on human-volunteer CT studies were generated spanning the respiratory cycle for a normal background distribution of Tc-99m NeoTect. Similarly, spherical phantoms of 1.0 cm diameter were generated to model small SPN for each of 150 uniquely located sites within the lungs whose respiratory motion was based on the motion of normal structures in the volunteer CT studies. The SIMIND Monte Carlo program was used to produce SPECT projection data from these. Normal and single-lesion containing SPECT projection sets with a clinically realistic Poisson noise level were created for the cases of: 1) the end-expiration (EE) frame with all counts, 2) respiration-averaged motion with all counts, 3) one-fourth of the 32 frames centered around EE (Quarter-Binning), 4) one-half of the 32 frames centered around EE (Half-Binning), and 5) eight temporally binned frames spanning the respiratory cycle. Each of the sets of combined projection data were reconstructed with RBI-EM with system spatial-resolution compensation (RC). Based on the known motion for each of the 150 different lesions, the reconstructed volumes of respiratory bins were shifted so as to superimpose the locations of the SPN onto that in the first bin (Reconstruct and Shift). Five human-observers performed localization receiver operating characteristics (LROC) studies of SPN detection. The observer results were analyzed for statistical significance differences in SPN detection accuracy among the three correction strategies, the standard acquisition, and the ideal case of the absence of respiratory motion. Our human-observer LROC determined that Quarter-Binning and Half-Binning strategies resulted in SPN detection accuracy statistically significantly below (P < 0.05) that of standard clinical acquisition, whereas the Reconstruct and Shift strategy resulted in a detection accuracy not statistically significantly different from that of the ideal case. This investigation demonstrates that tumor detection based on acquisitions associated with less than all the counts which could potentially be employed may result in poorer detection despite limiting the motion of the lesion. The Reconstruct and Shift method results in tumor detection that is equivalent to ideal motion correction.

Impact on reader performance for lesion-detection/ localization tasks of anatomical priors in SPECT reconstruction.

With increasing availability of multimodality imaging systems, high-resolution anatomical images can be used to guide the reconstruction of emission tomography studies. By measuring reader performance on a lesion detection task, this study investigates the improvement in image-quality due to use of prior anatomical knowledge, for example organ or lesion boundaries, during SPECT reconstruction. Simulated (67)Ga -citrate source and attenuation distributions were created from the mathematical cardiac-torso (MCAT) anthropomorphic digital phantom. The SIMIND Monte Carlo software was then used to generate SPECT projection data. The data were reconstructed using the De Pierro maximum a posteriori (MAP) algorithm and the rescaled-block-iterative (RBI) algorithm for comparison. We compared several degrees of prior knowledge about the anatomy: no knowledge about the anatomy; knowledge of organ boundaries; knowledge of organ and lesion boundaries; and knowledge of organ, lesion, and pseudo-lesion (non-emission uptake altering) boundaries. The MAP reconstructions used quadratic smoothing within anatomical regions, but not across any provided region boundaries. The reconstructed images were read by human observers searching for lesions in a localization receiver operating characteristic (LROC) study of the relative detection/localization accuracies of the reconstruction algorithms. Area under the LROC curve was computed for each algorithm as the comparison metric. We also had humans read images reconstructed using different prior strengths to determine the optimal trade-off between data consistency and the anatomical prior. Finally by mixing together images reconstructed with and without the prior, we tested to see if having an anatomical prior only some of the time changes the observer's detection/localization accuracy on lesions where no boundary prior is available. We found that anatomical priors including organ and lesion boundaries improve observer performance on the lesion detection/localization task. Use of just organ boundaries did not provide a statistically significant improvement in performance however. We also found that optimal prior strength depends on the level of anatomical knowledge, with a broad plateau in which observer performance is near optimal. We found no evidence that having anatomical priors use lesion boundaries only when available changes the observer's performance when they are not available. We conclude that use of anatomical priors with organ and lesion boundaries improves reader performance on a lesion-detection/localization task, and that pseudo-lesion boundaries do not hurt reader performance. However, we did not find evidence that a prior using only organ boundaries helps observer performance. Therefore we suggest prior strength should be tuned to the organ-only case, since a prior will likely not be available for all lesions.

An Assessment of a Low-Cost Visual Tracking System (VTS) to Detect and Compensate for Patient Motion during SPECT.

Patient motion is inevitable in SPECT and PET due to the lengthy period of time patients are imaged and patient motion can degrade diagnostic accuracy. The goal of our studies is to perfect a methodology for tracking and correcting patient motion when it occurs. In this paper we report on enhancements to the calibration, camera stability, accuracy of motion tracking, and temporal synchronization of a low-cost visual tracking system (VTS) we are developing. The purpose of the VTS is to track the motion of retro-reflective markers on stretchy bands wrapped about the chest and abdomen of patients. We have improved the accuracy of 3D spatial calibration by using a MATLAB optical camera calibration package with a planar calibration pattern. This allowed us to determine the intrinsic and extrinsic parameters for stereo-imaging with our CCD cameras. Locations in the VTS coordinate system are transformed to the SPECT coordinate system by a VTS/SPECT mapping using a phantom of 7 retro-reflective spheres each filled with a drop of Tc(99m). We switched from pan, tilt and zoom (PTZ) network cameras to fixed network cameras to reduce the amount of camera drift. The improved stability was verified by tracking the positions of fixed retro-reflective markers on a wall. The ability of our VTS to track movement, on average, with sub-millimeter and sub-degree accuracy was established with the 7-sphere phantom for 1 cm vertical and axial steps as well as for an arbitrary rotation and translation. The difference in the time of optical image acquisition as decoded from the image headers relative to synchronization signals sent to the SPECT system was used to establish temporal synchrony between optical and list-mode SPECT acquisition. Two experiments showed better than 100 ms agreement between VTS and SPECT observed motion for three axial translations. We were able to track 3 reflective markers on an anthropomorphic phantom with a precision that allowed us to correct motion such that no loss in visual quality was noted in motion corrected slices relative to motion free slices.

The Influence of Photon Attenuation on Tumor-to-Background and Signal-to-Noise Ratios for SPECT Imaging.

Expanding on the work of Nuyts et. al [1], Bai et. al. [2], and Bai and Shao [3], who all studied the effects of attenuation and attenuation correction on tumor-to-background ratios and signal detection, we have derived a general expression for the tumor-to-background ratio (TBR) for SPECT attenuated data that have been reconstructed with a linear, non-iterative reconstruction operator O. A special case of this is when O represents discrete filtered back-projection (FBP). The TBR of the reconstructed, uncorrected attenuated data (TBR(no-AC)) can be written as a weighted sum of the TBR of the FBP-reconstructed unattenuated data (TBR(FBP)) and the TBR of the FBP-reconstructed "difference" projection data (TBR(diff)). We evaluated the expression for TBR(no-AC) for a variety of objects and attenuation conditions. The ideal observer signal-to-noise ratio (SNR(ideal)) was also computed in projection space, in order to obtain an upper bound on signal detectability for a signal-known-exactly/background-known-exactly (SKE/BKE) detection task. The results generally show that SNR(ideal) is lower for tumors located deeper within the attenuating medium and increases for tumors nearer the edge of the object. In addition, larger values for the uniform attenuation coefficient µ lead to lower values for SNR(ideal). The TBR for FBP-reconstructed, uncorrected attenuated data can both under- and over-estimate the true TBR, depending on several properties of the attenuating medium, including the shape of the attenuator, the uniformity of the attenuator, and the degree to which the data are attenuated.

Choosing anatomical-prior strength for MAP SPECT reconstruction to maximize lesion detectability.

With the widespread availability of SPECT/CT systems it has become feasible to incorporate prior knowledge about anatomical boundaries into the SPECT reconstruction process, thus improving observer performance on tasks of clinical interest. We determine the optimal anatomical-prior strength for lesion search by measuring area under the LROC curve using human observers. We conclude that prior strength should be chosen assuming that only organ boundaries are available, even if lesion boundaries will also be known some of the time. We also test whether or not the presence of anatomical priors affects the observer's strategy, and conclude that mixing images with and without priors does not hurt reader performance when priors are not available. Finally, we examine whether using an anatomical prior in SPECT reconstruction helps observer performance when the observer already knows the possible lesion location, and conclude for this task anatomical priors do not provide the same improvement seen in search tasks.

Location-known-exactly human-observer ROC studies of attenuation and other corrections for SPECT lung imaging.

We use receiver operating characteristic (ROC) analysis of a location-known-exactly (LKE) lesion detection task to compare the image quality of SPECT reconstruction with and without various combinations of attenuation correction (AC), scatter correction (SC) and resolution compensation (RC). Hybrid images were generated from Tc-99m labelled NeoTect clinical backgrounds into which Monte Carlo simulated solitary pulmonary nodule (SPN) lung lesions were added, then reconstructed using several strategies. Results from a human-observer study show that attenuation correction degrades SPN detection, while resolution correction improves SPN detection, even when the lesion location is known. This agrees with the results of a previous localization-response operating characteristic (LROC) study using the same images, indicating that location uncertainty is not the sole source of the changes in detection accuracy.

Human-observer LROC study of lesion detection in Ga-67 SPECT images reconstructed using MAP with anatomical priors.

We compare the image quality of SPECT reconstruction with and without an anatomical prior. Area under the localization-response operating characteristic (LROC) curve is our figure of merit. Simulated Ga-67 citrate images, a SPECT lymph-nodule imaging agent, were generated using the MCAT digital phantom. Reconstructed images were read by human observers.Several reconstruction strategies are compared, including rescaled block iterative (RBI) and maximum-a-posteriori (MAP) with various priors. We find that MAP reconstruction using prior knowledge of organ and lesion boundaries significantly improves lesion-detection performance (p < 0.05). Pseudo-lesion boundaries, regions without increased uptake which are incorrectly treated as prior knowledge of lesion boundaries, do not decrease performance.