Use of Neurophysiological Monitoring during MRI-Guided Ablation Procedures at 1.5 Tesla: Workflow and Safety Considerations.

PURPOSE: To evaluate the feasibility of intraoperative neurophysiological monitoring (IONM) during MRI-guided ablations and identify strategies to reduce IONM electrode radiofrequency (RF)-heating during MRI. MATERIALS AND METHODS: Ex vivo experiments with a porcine tissue phantom simulating a typical high RF-heating risk IONM setup during an MRI-guided ablation procedure on the shoulder were performed on a 1.5 T scanner. Mutual interference between MRI and IONM was evaluated. To assess RF-heating risks, four pairs of IONM electrodes were inserted into the phantom at regions corresponding to the shoulders, mid-arm, and wrist. MRI of the "shoulder" was performed at three different specific absorption rate (SAR) levels with electrode wires positioned in various geometrical configurations. Different combinations of electrode connections to the IONM system were investigated. Temperatures of each electrode were recorded using fiber-optic sensors. RESULTS: Simultaneous IONM readout and MRI resulted in distortion of the IONM signal, but interleaving MRI and IONM without moving electrodes was feasible. During MRI, temperature elevations greater than 60 °C at the electrode insertion sites were observed. Temperature reductions were achieved by routing electrode wires along the scanner central axis, reducing the wire length within the scanner bore, or lowering the SAR of the imaging sequence. Altering the electrode connection with the IONM system did not result in consistent changes in RF-heating. CONCLUSIONS: With electrodes in the scanner bore, interleaving IONM and MRI is desired to avoid signal interference, and several strategies identified herein can reduce risk of electrode RF-heating during MRI-guided ablation.

Simultaneous photon counting and charge integrating for pulse pile-up correction in paralyzable photon counting detectors.

Objective.In photon counting detectors (PCDs), electric pulses induced by two or more x-ray photons can pile up and result in count losses when their temporal separation is less than the detector dead time. The correction of pulse pile-up-induced count loss is particularly difficult for paralyzable PCDs since a given value of recorded counts can correspond to two different values of true photon interactions. In contrast, charge (energy) integrating detectors work by integrating collected electric charge induced by x-rays over time and do not suffer from pile-up losses. This work introduces an inexpensive readout circuit element to the circuits of PCDs to simultaneously collect time-integrated charge to correct pile-up-induced count losses.Approach.Prototype electronics were constructed to collect time-integrated charges simultaneously with photon counts. A splitter was used to feed the electric signal in parallel to both a digital counter and a charge integrator. After recording PCD counts and integrating collected charge, a lookup table can be generated to map raw counts in the total- and high-energy bins and total charge to estimate pile-up-free true counts. Proof-of-concept imaging experiments were performed with a CdTe-based PCD array to test this method.Main results.The proposed electronics successfully recorded photon counts and time-integrated charge simultaneously, and whereas photon counts exhibited paralyzable pulse pile-up, time-integrated charge using the same electric signal as the counts measurement was linear with x-ray flux. With the proposed correction, paralyzable PCD counts became linear with input flux for both total- and high-energy bins. At high flux levels, uncorrected post-log measurements of PMMA objects severely overestimated radiological path lengths for both energy bins. After the proposed correction, the non-monotonic measurements again became linear with flux and accurately represented the true radiological path lengths. No impact on the spatial resolution was observed after the proposed correction in images of a line-pair test pattern.Significance.Time-integrated charge can be used to correct for pulse pile-up in paralyzable PCDs where analytical solutions may be difficult to use, and integrated charge can be collected simultaneously with counts using inexpensive electronics.

Photon counting-energy integrating hybrid flat panel detector systems for image-guided interventions: an experimental proof-of-concept.

Objective.Current C-arm x-ray systems equipped with scintillator-based flat panel detectors (FPDs) lack sufficient low-contrast detectability and spectral, high-resolution capabilities much desired for certain interventional procedures. Semiconductor-based direct-conversion photon counting detectors (PCDs) offer these imaging capabilities, although the cost of full field-of-view (FOV) PCD is still too high at the moment. The purpose of this work was to present a hybrid photon counting-energy integrating FPD design as a cost-effective solution to high-quality interventional imaging.Approach.In the proposed hybrid detector design, the central scintillator and thin-film transistor elements in the FPD are replaced with a semiconductor PCD module to upgrade the imaging capabilities of the C-arm system while preserving the full FOV coverage. The central PCD module can be used for high-quality 2D and 3D region-of-interest imaging with improved spatial- and temporal-resolution as well as spectral resolving capability. An experimental proof-of-concept was conducted using a 30 × 2.5 cm2CdTe PCD and a 40 × 30 cm2CsI(Tl)-aSi(H) FPD.Main results.Phantom andin vivoanimal studies show (1) improved visualization of small stent wires in both 2D and 3D images due to the better spatial resolution of the PCD; (2) dual-energy angiography imaging capability by using the spectral PCD; (3) better conspicuity of small peripheral iodinated vessels (contrast-to-noise ratio improvement range: (29%, 151%)); (4) the central PCD outputs can be fused seamlessly with the surrounding scintillator detector outputs to provide full field imaging: A post-processing chain was developed by leveraging the PCD's spectral information to match the image contrast of the PCD images to the surrounding scintillator detector, followed by spatial filtering of the PCD image to match noise texture and spatial resolution.Significance.The hybrid FPD design provides a cost-effective option to upgrade C-arm systems with spectral and ultra-high resolution capabilities without interfering with the clinical need for full FOV imaging.

Benefits of using removable filters in dual-layer flat panel detectors.

Objective.Existing dual-layer flat panel detectors (DL-FPDs) use a thin scintillator layer to preferentially detect low-energy x-rays, followed by a permanent Cu filter to absorb residual low-energy x-rays, and finally, a thicker scintillator layer to preferentially detect high-energy x-rays. The image outputs of the two scintillator layers can be jointly processed for dual-energy (DE) planar and cone-beam CT imaging. In clinical practice, a given FPD is often used for not only DE imaging but also routine single-energy (SE) imaging. With the permanent Cu layer, the total x-ray absorption is unsatisfactory for SE imaging since more than 30% of x-rays can be lost in the Cu layer. The purpose of this work was to demonstrate the benefits of using a removable filter material in DL-FPDs for SE and DE imaging applications.Approach.The proposed detector contains a removable filter between the two scintillator layers. The filter can be either a chamber filled with a liquid high-Zeffmaterial or a removable solid filter. When DE imaging is not clinically indicated, the DL-FPD can switch to a high-efficiency SE imaging mode by retracting the filter from the inter-scintillator space. For commonly available filter materials (iodine, gadolinium, and Cu), their optimal area densities were theoretically calculated for both water-bone decomposition and water-iodine decomposition DE imaging tasks. Preliminary experimental studies were also performed to compare the SE performance of the proposed DL-FPD with the existing DL-FPD with the permanent Cu filter and study the stability of the liquid filter on a rotating gantry.Main results.The optimal filter material was found to be an iodine solution (approximately 375 mg cm-2). With this liquid filter in place, the proposed DL-FPD has equivalent or better DE imaging performance compared with the existing DL-FPD with the Cu filter. When the filter is removed from the inter-scintillator space for SE imaging, the total x-ray absorption efficiency of the proposed DL-FPD ranges from 73% (100 kVp) to 54% (140 kVp), compared with 51% (100 kVp) to 41% (140 kVp) for the existing DL-FPD with a permanent 1 mm Cu filter.Significance.The removable filter provides a boost to the total x-ray absorption efficiency of DL-FPDs for SE imaging without compromising DE imaging. This can facilitate the adoption of DL-FPDs in clinical x-ray imaging systems that usually perform more SE imaging procedures than DE imaging series.

A C-arm photon counting CT prototype with volumetric coverage using multi-sweep step-and-shoot acquisitions.

Objective.Existing clinical C-arm interventional systems use scintillator-based energy-integrating flat panel detectors (FPDs) to generate cone-beam CT (CBCT) images. Despite its volumetric coverage, FPD-CBCT does not provide sufficient low-contrast detectability desired for certain interventional procedures. The purpose of this work was to develop a C-arm photon counting detector (PCD) CT system with a step-and-shoot data acquisition method to further improve the tomographic imaging performance of interventional systems.Approach.As a proof-of-concept, a cadmium telluride-based 51 cm × 0.6 cm PCD was mounted in front of a FPD in an Artis Zee biplane system. A total of 10 C-arm sweeps (5 forward and 5 backward) were prescribed. A motorized patient table prototype was synchronized with the C-arm system such that it translates the object by a designated distance during the sub-second rest time in between gantry sweeps. To evaluate whether this multi-sweep step-and-shoot acquisition strategy can generate high-quality and volumetric PCD-CT images without geometric distortion artifacts, experiments were performed using physical phantoms, a human cadaver head, and anin vivoswine subject. Comparison with FPD-CT was made under matched narrow beam collimation and radiation dose conditions.Main results.Compared with FPD-CT images, PCD-CT images had lower noise and improved visualization of low-contrast lesion models, as well as improved visibility of small iodinated blood vessels. Fine structures were visualized more clearly by the PCD-CT than the highest-available resolution provided by FPD-CBCT and MDCT. No perceivable geometric distortion artifacts were observed in the multi-planar PCD-CT images.Significance.This work is the first demonstration of the feasibility of high-quality and multi-planar (volumetric) PCD-CT imaging with a rotating C-arm gantry.

Development of an Integrated C-Arm Interventional Imaging System With a Strip Photon Counting Detector and a Flat Panel Detector.

Modern interventional x-ray systems are often equipped with flat-panel detector-based cone-beam CT (FPD-CBCT) to provide tomographic, volumetric, and high spatial resolution imaging of interventional devices, iodinated vessels, and other objects. The purpose of this work was to bring an interchangeable strip photon-counting detector (PCD) to C-arm systems to supplement (instead of retiring) the existing FPD-CBCT with a high quality, spectral, and affordable PCD-CT imaging option. With minimal modification to the existing C-arm, a 51×0.6 cm2 PCD with a 0.75 mm CdTe layer, two energy thresholds, and 0.1 mm pixels was integrated with a Siemens Artis Zee interventional imaging system. The PCD can be translated in and out of the field-of-view to allow the system to switch between FPD and PCD-CT imaging modes. A dedicated phantom and a new algorithm were developed to calibrate the projection geometry of the narrow-beam PCD-CT system and correct the gantry wobbling-induced geometric distortion artifacts. In addition, a detector response calibration procedure was performed for each PCD pixel using materials with known radiological pathlengths to address concentric artifacts in PCD-CT images. Both phantom and human cadaver experiments were performed at a high gantry rotation speed and clinically relevant radiation dose level to evaluate the spectral and non-spectral imaging performance of the prototype system. Results show that the PCD-CT system has excellent image quality with negligible artifacts after the proposed corrections. Compared with FPD-CBCT images acquired at the same dose level, PCD-CT images demonstrated a 53% reduction in noise variance and additional quantitative imaging capability.

An experimental method to correct low-frequency concentric artifacts in photon counting CT.

Large-area photon counting detectors (PCDs) are usually built by tiling multiple semiconductor panels that often have slightly different spectral responses to input x-rays. As a result of this spectral inconsistency, experimental PCD-CT images of large, human-sized objects may show high-frequency ring artifacts and low-frequency band artifacts. Due to the much larger width of the bands compared with the rings, the concentric artifact problem in PCD-CT images of human-sized objects cannot be adequately addressed by conventional CT ring correction methods. This work presents an experimental method to correct the concentric artifacts in PCD-CT. The method is applicable to not only energy-discriminating PCDs with multiple bins but also PCDs with only a single threshold controller. Its principle is similar to the two-step beam hardening correction method, except that the proposed method uses pixel-specific polynomial functions to address the spectral inconsistency problem across the detector plane. The pixel-specific polynomial coefficients were experimentally calibrated using 15 acrylic sheets and 6 aluminum sheets of known thicknesses. The pixel-specific polynomial functions were used to convert the measured PCD-CT projection data to acrylic- and aluminum-equivalent thicknesses that are energy-independent. The proposed method was experimentally evaluated using a human cadaver head and multiple physical phantoms: two of them contain iodine and one phantom contains dual K-edge contrast materials (gadolinium and iodine). The results show that the proposed method can effectively remove the low-frequency concentric artifacts in PCD-CT images while reducing beam hardening artifacts. In contrast, the conventional CT ring correction algorithm did not adequately address the low-frequency band artifacts. Compared with the direct material decomposition-based correction method, the proposed method not only relaxes the requirement of multi-energy bins but also generates images with lower noise and fewer concentric artifacts.

Anomalous edge response of cadmium telluride-based photon counting detectors jointly caused by high-flux radiation and inter-pixel communication.

This work reports an edge enhancing effect experimentally observed in cadmium telluride (CdTe)-based photon counting detector (PCD) systems operated under the charge summing (CS) mode and irradiated by high-flux x-rays. Experimental measurements of the edge spread functions (ESFs) of a PCD system (100µm pixel size, 88 ns deadtime) were performed at different input flux levels from 4.5 × 105count per second (cps) mm-2to 1.5 × 109cps mm-2for the single pixel mode (SP) and the CS mode. A theoretical model that incorporates the impacts of inter-pixel communications and the arbitration process involved in the CS mode was developed to help explain the physical origin of the observed edge enhancing effect. Compared with the monotonically increasing ESF of the SP mode, the ESF of the CS mode measured at high-flux levels shows a peak at an intermediate location (50µm from the edge). The peak became more pronounced with increasing flux levels. The theoretically calculated ESFs agreed well with experimental results with relative errors less than 5% at all flux levels and tested. These results indicate that the anomalous edge enhancing effect is jointly caused by the pileup effect and the CS circuit that introduces negative correlations between adjacent pixels. When the input flux is high enough to deliver photons to multiple adjacent pixels within the same deadtime period, the CS mode may treat the coincident x-rays as shared charges and thus introduce count losses in addition to the well-known pileup count loss. When a high contrast object partially blocks certain pixels from x-rays, the adjacent unblocked pixels have an increased probability of registering counts as a result of the negative correlation. This leads to a peak on the ESF at a pixel-to-edge distance half of the pixel pitch.

Accuracy of weighted CTDI in estimating average dose delivered to CTDI phantoms: An experimental study.

PURPOSE: The concept of the weighted computed tomography dose index ( CTDI w ) was proposed in 1995 to represent the average CTDI across an axial section of a cylindrical phantom. The purpose of this work was to experimentally re-examine the validity of the underlying assumptions behind CTDI w for modern MDCT systems. METHODS: To enable experimental mapping of CTDI 100 in the axial plane, in-house 16 and 32 cm cylindrical phantoms were fabricated to allow the pencil chamber to reach any arbitrary axial location within the phantoms. The phantoms were scanned on a clinical MDCT with five beam collimation widths, three bowtie filters, and four kV levels. To evaluate the linearity and rotational invariance assumptions implicitly made when the weighting factors of 1/3 and 2/3 in the CTDI w formula were originally derived, CTDI 100 was measured at different radial and angular locations within the phantom for different collimation, bowtie, and kV combinations. The average CTDI ( CTDI avg ) across the axial plane was calculated from the experimental two-dimensional (2D) dose distribution and was compared with the traditional CTDI w . RESULTS: For both phantoms under all scan conditions, the axial dose distributions were found to have significant angular dependence, potentially due to the x-ray attenuation by the patient couch or the head holder. The radial dose profiles were also found to significantly deviate from linearity in many cases due to the presence of the bowtie filter. When only the 12 o'clock peripheral CTDI 100 and the traditional weighting factors were used to calculate CTDI w , the average dose was overestimated in the 16 cm phantom by up to 8.4% at isocenter and up to 35.3% when the phantom was off-centered by 6 cm; in the 32 cm phantom at isocenter, the average dose was overestimated by up to 12.8%. Using an average of the four peripheral CTDI 100 measurements at the 12, 3, 6, and 9 o'clock locations reduced the error of CTDI w to within 1.2% in the 16 cm phantom. For the 32 cm phantom, even by using the average of the peripheral measurements, the traditional CTDI w underestimated the average dose by up to 4.3% due to aggressive drop-off of the CTDI 100 at the phantom periphery. CONCLUSIONS: The linearity and rotational-invariance assumptions behind the traditional CTDI w formalism may not be valid for modern CT systems and thus CTDI w may not accurately represent the average dose or radiation output within a CTDI phantom. Utilizing data from all four peripheral locations always improves accuracy of CTDI w in representing the true average dose. For the large (32 cm) phantom, nonlinear models and more measurement points are needed if a more precise estimation of the average axial dose is required.

Drosophila strain specific response to cisplatin neurotoxicity.

Drosophila melanogaster has recently been developed as a simple, in vivo, genetic model of chemotherapy-induced peripheral neuropathy. Flies treated with the chemotherapy agent cisplatin display both a neurodegenerative phenotype and cell death in rapidly dividing follicles, mimicking the cell specific responses seen in humans. Cisplatin induces climbing deficiencies and loss of fertility in a dose dependent manner. Drosophila sensitivity to cisplatin in both cell types is affected by genetic background. We show that mutation or RNAi-based knockdown of genes known to be associated with CIPN incidence in humans affect sensitivity of flies to CIPN. Drosophila is a promising model with which to study the effect of genetics on sensitivity to CIPN.