High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer.

BACKGROUND: Two-dimensional (2D) specimen radiography (SR) and tomosynthesis (DBT) for breast cancer yield data that lack high-depth resolution. A volumetric specimen imager (VSI) was developed to provide full-3D and thin-slice cross-sectional visualization at a 360° view angle. The purpose of this prospective trial was to compare VSI, 2D SR, and DBT interpretation of lumpectomy margin status with the final pathologic margin status of breast lumpectomy specimens. METHODS: The study enrolled 200 cases from two institutions. After standard imaging and interpretation was performed, the main lumpectomy specimen was imaged with the VSI device. Image interpretation was performed by three radiologists after surgery based on VSI, 2D SR, and DBT. A receiver operating characteristic (ROC) curve was created for each method. The area under the curve (AUC) was computed to characterize the performance of the imaging method interpreted by each user. RESULTS: From 200 lesions, 1200 margins were interpreted. The AUC values of VSI for the three radiologists were respectively 0.91, 0.90, and 0.94, showing relative improvement over the AUCs of 2D SR by 54%, 13%, and 40% and DBT by 32% and 11%, respectively. The VSI has sensitivity ranging from 91 to 94%, specificity ranging from 81 to 85%, a positive predictive value ranging from 25 to 30%, and a negative predicative value of 99%. CONCLUSIONS: The ROC curves of the VSI were higher than those of the other specimen imaging methods. Full-3D specimen imaging can improve the correlation between the main lumpectomy specimen margin status and surgical pathology. The findings from this study suggest that using the VSI device for intraoperative margin assessment could further reduce the re-excision rates for women with malignant disease.

Variable temporal sampling and tube current modulation for myocardial blood flow estimation from dose-reduced dynamic computed tomography.

Quantification of myocardial blood flow (MBF) can aid in the diagnosis and treatment of coronary artery disease. However, there are no widely accepted clinical methods for estimating MBF. Dynamic cardiac perfusion computed tomography (CT) holds the promise of providing a quick and easy method to measure MBF quantitatively. However, the need for repeated scans can potentially result in a high patient radiation dose, limiting the clinical acceptance of this approach. In our previous work, we explored techniques to reduce the patient dose by either uniformly reducing the tube current or by uniformly reducing the number of temporal frames in the dynamic CT sequence. These dose reduction techniques result in noisy time-attenuation curves (TACs), which can give rise to significant errors in MBF estimation. We seek to investigate whether nonuniformly varying the tube current and/or sampling intervals can yield more accurate MBF estimates for a given dose. Specifically, we try to minimize the dose and obtain the most accurate MBF estimate by addressing the following questions: when in the TAC should the CT data be collected and at what tube current(s)? We hypothesize that increasing the sampling rate and/or tube current during the time frames when the myocardial CT number is most sensitive to the flow rate, while reducing them elsewhere, can achieve better estimation accuracy for the same dose. We perform simulations of contrast agent kinetics and CT acquisitions to evaluate the relative MBF estimation performance of several clinically viable variable acquisition methods. We find that variable temporal and tube current sequences can be performed that impart an effective dose of 5.5 mSv and allow for reductions in MBF estimation root-mean-square error on the order of 20% compared to uniform acquisition sequences with comparable or higher radiation doses.

Evaluation of static and dynamic perfusion cardiac computed tomography for quantitation and classification tasks.

Cardiac computed tomography (CT) acquisitions for perfusion assessment can be performed in a dynamic or static mode. Either method may be used for a variety of clinical tasks, including (1) stratifying patients into categories of ischemia and (2) using a quantitative myocardial blood flow (MBF) estimate to evaluate disease severity. In this simulation study, we compare method performance on these classification and quantification tasks for matched radiation dose levels and for different flow states, patient sizes, and injected contrast levels. Under conditions simulated, the dynamic method has low bias in MBF estimates (0 to [Formula: see text]) compared to linearly interpreted static assessment (0.45 to [Formula: see text]), making it more suitable for quantitative estimation. At matched radiation dose levels, receiver operating characteristic analysis demonstrated that the static method, with its high bias but generally lower variance, had superior performance ([Formula: see text]) in stratifying patients, especially for larger patients and lower contrast doses [area under the curve [Formula: see text] to 96 versus 0.86]. We also demonstrate that static assessment with a correctly tuned exponential relationship between the apparent CT number and MBF has superior quantification performance to static assessment with a linear relationship and to dynamic assessment. However, tuning the exponential relationship to the patient and scan characteristics will likely prove challenging. This study demonstrates that the selection and optimization of static or dynamic acquisition modes should depend on the specific clinical task.

Material identification in x-ray microscopy and micro CT using multi-layer, multi-color scintillation detectors.

We demonstrate that a dual-layer, dual-color scintillator construct for microscopic CT, originally proposed to increase sensitivity in synchrotron imaging, can also be used to perform material quantification and classification when coupled with polychromatic illumination. We consider two different approaches to data handling: (1) a data-domain material decomposition whose estimation performance can be characterized by the Cramer-Rao lower bound formalism but which requires careful calibration and (2) an image-domain material classification approach that is more robust to calibration errors. The data-domain analysis indicates that useful levels of SNR (>5) could be achieved in one second or less at typical bending magnet fluxes for relatively large amounts of contrast (several mm path length, such as in a fluid flow experiment) and at typical undulator fluxes for small amount of contrast (tens of microns path length, such as an angiography experiment). The tools introduced could of course be used to study and optimize parameters for a wider range of potential applications. The image domain approach was analyzed in terms of its ability to distinguish different elemental stains by characterizing the angle between the lines traced out in a two-dimensional space of effective attenuation coefficient in the front and back layer images. This approach was implemented at a synchrotron and the results were consistent with simulation predictions.

Simulation Evaluation of Quantitative Myocardial Perfusion Assessment from Cardiac CT.

Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ∼0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ∼1.2 and ∼1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial blood flow estimation. In conclusion, quantitative model-based dynamic cardiac CT perfusion assessment is capable of accurately estimating MBF across a range of cardiac outputs and tissue perfusion states, outperforms comparable static perfusion estimates, and is relatively robust to noise and temporal subsampling.

Comparison of blood flow models and acquisitions for quantitative myocardial perfusion estimation from dynamic CT.

Myocardial blood flow (MBF) can be estimated from dynamic contrast enhanced (DCE) cardiac CT acquisitions, leading to quantitative assessment of regional perfusion. The need for low radiation dose and the lack of consensus on MBF estimation methods motivates this study to refine the selection of acquisition protocols and models for CT-derived MBF. DCE cardiac CT acquisitions were simulated for a range of flow states (MBF = 0.5, 1, 2, 3 ml (min g)(-1), cardiac output = 3, 5, 8 L min(-1)). Patient kinetics were generated by a mathematical model of iodine exchange incorporating numerous physiological features including heterogenenous microvascular flow, permeability and capillary contrast gradients. CT acquisitions were simulated for multiple realizations of realistic x-ray flux levels. CT acquisitions that reduce radiation exposure were implemented by varying both temporal sampling (1, 2, and 3 s sampling intervals) and tube currents (140, 70, and 25 mAs). For all acquisitions, we compared three quantitative MBF estimation methods (two-compartment model, an axially-distributed model, and the adiabatic approximation to the tissue homogeneous model) and a qualitative slope-based method. In total, over 11 000 time attenuation curves were used to evaluate MBF estimation in multiple patient and imaging scenarios. After iodine-based beam hardening correction, the slope method consistently underestimated flow by on average 47.5% and the quantitative models provided estimates with less than 6.5% average bias and increasing variance with increasing dose reductions. The three quantitative models performed equally well, offering estimates with essentially identical root mean squared error (RMSE) for matched acquisitions. MBF estimates using the qualitative slope method were inferior in terms of bias and RMSE compared to the quantitative methods. MBF estimate error was equal at matched dose reductions for all quantitative methods and range of techniques evaluated. This suggests that there is no particular advantage between quantitative estimation methods nor to performing dose reduction via tube current reduction compared to temporal sampling reduction. These data are important for optimizing implementation of cardiac dynamic CT in clinical practice and in prospective CT MBF trials.

Sinogram smoothing techniques for myocardial blood flow estimation from dose-reduced dynamic computed tomography.

Dynamic contrast-enhanced computed tomography (CT) could provide an accurate and widely available technique for myocardial blood flow (MBF) estimation to aid in the diagnosis and treatment of coronary artery disease. However, one of its primary limitations is the radiation dose imparted to the patient. We are exploring techniques to reduce the patient dose by either reducing the tube current or by reducing the number of temporal frames in the dynamic CT sequence. Both of these dose reduction techniques result in noisy data. In order to extract the MBF information from the noisy acquisitions, we have explored several data-domain smoothing techniques. In this work, we investigate two specific smoothing techniques: the sinogram restoration technique in both the spatial and temporal domains and the use of the Karhunen-Loeve (KL) transform to provide temporal smoothing in the sinogram domain. The KL transform smoothing technique has been previously applied to dynamic image sequences in positron emission tomography. We apply a quantitative two-compartment blood flow model to estimate MBF from the time-attenuation curves and determine which smoothing method provides the most accurate MBF estimates in a series of simulations of different dose levels, dynamic contrast-enhanced cardiac CT acquisitions. As measured by root mean square percentage error (% RMSE) in MBF estimates, sinogram smoothing generally provides the best MBF estimates except for the cases of the lowest simulated dose levels (tube current = 25 mAs, 2 or 3 s temporal spacing), where the KL transform method provides the best MBF estimates. The KL transform technique provides improved MBF estimates compared to conventional processing only at very low doses (<7 mSv). Results suggest that the proposed smoothing techniques could provide high fidelity MBF information and allow for substantial radiation dose savings.

Photoacoustic image reconstruction in an attenuating medium using singular-value decomposition.

Attenuation effects can be significant in photoacoustic tomography since the generated pressure signals are broadband, and ignoring them may lead to image artifacts and blurring. La Rivière et al. [Opt. Lett. 31(6), pp. 781-783, (2006)] had previously derived a method for modeling the attenuation effect and correcting for it in the image reconstruction. This was done by relating the ideal, unattenuated pressure signals to the attenuated pressure signals via an integral operator. We derive an integral operator relating the attenuated pressure signals to the absorbed optical energy for a planar measurement geometry. The matrix operator relating the two quantities is a function of the temporal frequency, attenuation coefficient and the two-dimensional spatial frequency. We perform singular-value decomposition (SVD) of this integral operator to study the problem further. We find that the smallest singular values correspond to wavelet-like eigenvectors in which most of the energy is concentrated at times corresponding to greater depths in tissue. This allows us to characterize the ill-posedness of recovering the absorbed optical energy distribution at different depths in an attenuating medium. This integral equation can be inverted using standard SVD methods, and the initial pressure distribution can be recovered. We conduct simulations and derive an algorithm for image reconstruction using SVD for a planar measurement geometry. We also study the noise and resolution properties of this image-reconstruction method.

Optimizing wavelength choice for quantitative optoacoustic imaging using the Cramer-Rao lower bound.

Several papers have recently addressed the issue of estimating chromophore concentration in optoacoustic imaging (OAI) using multiple wavelengths. The choice of wavelengths obviously affects the accuracy and precision of the estimates. One might assume that the wavelengths that maximize the extinction coefficients of the chromophores would be the most suitable. However, this may not always be the case since the distribution of light intensity in the medium is also wavelength dependent. In this paper, we explore a method for optimizing the choice of wavelengths based on the Cramer-Rao lower bound (CRLB) on the variance of the chromophore concentration. This lower bound on variance can be evaluated numerically for different wavelengths using the variation of the extinction coefficients and scattering coefficients with wavelength. The wavelengths that give the smallest variance will be considered optimal for multi-wavelength OAI to estimate the chromophore concentrations. The expression for the CRLB has been derived analytically for estimating the concentration of multiple chromophores for several simple phantom models for the case when the optoacoustic signal is proportional to the product of the optical absorption and the illumination function. This approach could be easily extended to other geometries.

Image reconstruction in photoacoustic tomography with variable speed of sound using a higher-order geometrical acoustics approximation.

Previous research correcting for variable speed of sound in photoacoustic tomography (PAT) based on a generalized radon transform (GRT) model assumes first-order geometrical acoustics (GA) approximation. In the GRT model, the pressure is related to the optical absorption, in an acoustically inhomogeneous medium, through integration over nonspherical isochronous surfaces. Previous research based on the GRT model assumes that the path taken by acoustic rays is linear and neglects amplitude perturbations to the measured pressure. We have derived a higher-order GA expression that takes into account the first-order effect in the amplitude of the measured signal and higher-order perturbation to the travel times. The higher-order perturbation to travel time incorporates the effect of ray bending. Incorrect travel times can lead to image distortion and blurring. These corrections are expected to impact image quality and quantitative PAT. We have previously shown that travel-time corrections in 2-D suggest that perceivable differences in the isochronous surfaces can be seen when the second-order travel-time perturbations are taken into account with a 10% speed-of-sound variation. In this work, we develop iterative image reconstruction algorithms that incorporate this higher-order GA approximation assuming that the speed of sound map is known. We evaluate the effect of higher-order GA approximation on image quality and accuracy.

Implementation and comparison of reconstruction algorithms for two-dimensional optoacoustic tomography using a linear array.

Our goal is to compare and contrast various image reconstruction algorithms for optoacoustic tomography (OAT) assuming a finite linear aperture of the kind that arises when using a linear-array transducer. Because such transducers generally have tall, narrow elements, they are essentially insensitive to out-of-plane acoustic waves, and the usually 3-D OAT problem reduces to a 2-D problem. Algorithms developed for the 3-D problem may not perform optimally in 2-D. We have implemented and evaluated a number of previously described OAT algorithms, including an exact (in 3-D) Fourier-based algorithm and a synthetic-aperture-based algorithm. We have also implemented a 2-D algorithm developed by Norton for reflection mode tomography that has not, to the best of our knowledge, been applied to OAT before. Our simulation studies of resolution, contrast, noise properties, and signal detectability measures suggest that Norton's approach-based algorithm has the best contrast, resolution, and signal detectability.