Search

Many interventional procedures aim at changing soft tissue perfusion or blood flow. One problem at present is that soft tissue perfusion and its changes cannot be assessed in an interventional suite because cone-beam computed tomography is too slow (it takes 4–10 s per volume scan). In order to address the problem, we propose a novel method called IPEN for Intra-operative 4-dimensional soft tissue PErfusion using a standard x-ray system with No gantry rotation. In this simulation study, we provide a proof-of-concept that the core ideas work.

One of the challenges in photon counting detector (PCD)-based computed tomography (CT) is the spectral distortion in the PCD caused by physical effects such as charge sharing and K-escape fluorescence. This chapter summarizes for conventional approaches to compensate for the spectral distortion in PCD-CT and provides in great detail for a recently developed x-ray transmittance modeling-based three-step algorithm as a fast alternative to the maximum likelihood-based estimator. We describe both theoretical and practical aspects of the algorithm and also provide an example of two-material decomposition with practical implementations.

Rationale and Objectives To investigate the stabilities of plaque attenuation and coronary lumen for different plaque types, stenotic degrees, lumen densities, and reconstruction methods using coronary vessel phantoms and the visualization of coronary plaques in clinical patients through coronary computed tomography (CT) angiography. Materials and Methods We performed 320-detector volume scanning of vessel tubes with stenosis and a tube without stenosis using three types of plaque CT numbers. The stenotic degrees were 50% and 75%. Images were reconstructed with filtered back projection (FBP) and two types of iterative reconstructions (AIDR3D and FIRST [forward-projected model-based iterative reconstruction solution]), with stenotic CT number of approximately 40, 80, and 150 HU (Hounsfield unit), respectively. In each case, the tubing of the coronary vessel was filled with diluted contrast material and distilled water to reach the target lumen CT numbers of approximately 350 HU and 450 HU, and 0 HU, respectively. Peak lumen and plaque CT numbers were measured to calculate the lumen–plaque contrast. In addition, we retrospectively evaluated the image quality with regard to coronary arterial lumen and the plaque in 10 clinical patients on a 4-point scale. Results At 50% stenosis, the plaque CT number with contrast enhancement increased for FBP and AIDR3D, and the difference in the plaque CT number with and without contrast enhancement was 15–44 HU for FBP and 10–31 HU for AIDR3D. However, the plaque CT number for FIRST had a smaller variation and the difference with and without contrast enhancement was −12 to 8 HU. The visual evaluation score for the vessel lumen was 2.8 ± 0.6, 3.5 ± 0.5, and 3.7 ± 0.5 for FBP, AIDR3D, and FIRST, respectively. Conclusions The FIRST method controls the increase in plaque density and the lumen–plaque contrast. Consequently, it improves the visualization of coronary plaques in coronary CT angiography.

Molecular-targeted therapy was recommended for the systemic therapy of renal cell cancer (RCC) in the RCC guidelines, but these guidelines do not address the order of administration of the multiple presently available agents. There are several aspects that remain unknown regarding the optimal administration order and combination of molecular-targeted drugs. Until the optimal treatment sequence is determined by clinical trials, treatment individualization is required for each patient based on patient and disease characteristics. We herein investigate 12 cases of RCC patients who received axitinib. Axitinib was used as the first-line drug in 4 cases, second-line in 5 cases, third-line in 1 case and as a fourth-line drug in 2 cases. Partial response (PR) was observed in 4 cases (30%) and stable disease in 4 cases (30%) during axitinib treatment, with an overall response rate of 60%. The duration of PR ranged from 6 to 19 months. Based on our cases, axitinib exhibited reasonable therapeutic efficacy as first- as well as second-line treatment. However, more cases are required to draw firm conclusions.

A novel imaging technique ("X-map") has been developed to identify acute ischemic lesions for stroke patients using non-contrast-enhanced dual-energy computed tomography (NE-DE-CT). Using the 3-material decomposition technique, the original X-map ("X-map 1.0") eliminates fat and bone from the images, suppresses the gray matter (GM)-white matter (WM) tissue contrast, and makes signals of edema induced by severe ischemia easier to detect. The aim of this study was to address the following 2 problems with the X-map 1.0: (1) biases in CT numbers (or artifacts) near the skull of NE-DE-CT images and (2) large intrapatient and interpatient variations in X-map 1.0 values.We improved both an iterative beam-hardening correction (iBHC) method and the X-map algorithm. The new iBHC (iBHC2) modeled x-ray physics more accurately. The new X-map ("X-map 2.0") estimated regional GM values-thus, maximizing the ability to suppress the GM-WM contrast, make edema signals quantitative, and enhance the edema signals that denote an increased water density for each pixel. We performed a retrospective study of 11 patients (3 men, 8 women; mean age, 76.3 years; range, 68-90 years) who presented to the emergency department with symptoms of acute stroke. Images were reconstructed with the old iBHC (iBHC1) and the iBHC2, and biases in CT numbers near the skull were measured. Both X-map 2.0 maps and X-map 1.0 maps were computed from iBHC2 images, both with and without a material decomposition-based edema signal enhancement (ESE) process. X-map values were measured at 5 to 9 locations on GM without infarct per patient; the mean value was calculated for each patient (we call it the patient-mean X-map value) and subtracted from the measured X-map values to generate zero-mean X-map values. The standard deviation of the patient-mean X-map values over multiple patients denotes the interpatient variation; the standard deviation over multiple zero-mean X-map values denotes the intrapatient variation. The Levene F test was performed to assess the difference in the standard deviations with different algorithms. Using 5 patient data who had diffusion weighted imaging (DWI) within 2 hours of NE-DE-CT, mean values at and near ischemic lesions were measured at 7 to 14 locations per patient with X-map images, CT images (low kV and high kV), and DWI images. The Pearson correlation coefficient was calculated between a normalized increase in DWI signals and either X-map or CT.The bias in CT numbers was lower with iBHC2 than with iBHC1 in both high- and low-kV images (2.5 ± 2.0 HU [95% confidence interval (CI), 1.3-3.8 HU] for iBHC2 vs 6.9 ± 2.3 HU [95% CI, 5.4-8.3 HU] for iBHC1 with high-kV images, P0.01; 1.5 ± 3.6 HU [95% CI, -0.8 to 3.7 HU] vs 12.8 ± 3.3 HU [95% CI, 10.7-14.8 HU] with low-kV images, P0.01). The interpatient variation was smaller with X-map 2.0 than with X-map 1.0, both with and without ESE (4.3 [95% CI, 3.0-7.6] for X-map 2.0 vs 19.0 [95% CI, 13.3-22.4] for X-map 1.0, both with ESE, P0.01; 3.0 [95% CI, 2.1-5.3] vs 12.0 [95% CI, 8.4-21.0] without ESE, P0.01). The intrapatient variation was also smaller with X-map 2.0 than with X-map 1.0 (6.2 [95% CI, 5.3-7.3] vs 8.5 [95% CI, 7.3-10.1] with ESE, P = 0.0122; 4.1 [95% CI, 3.6-4.9] vs 6.3 [95% CI, 5.5-7.6] without ESE, P0.01). The best 3 correlation coefficients (R) with DWI signals were -0.733 (95% CI, -0.845 to -0.560, P0.001) for X-map 2.0 with ESE, -0.642 (95% CI, -0.787 to -0.429, P0.001) for high-kV CT, and -0.609 (95% CI, -0.766 to -0.384, P0.001) for X-map 1.0 with ESE.Both of the 2 problems outlined in the objectives have been addressed by improving both iBHC and X-map algorithm. The iBHC2 improved the bias in CT numbers and the visibility of GM-WM contrast throughout the brain space. The combination of iBHC2 and X-map 2.0 with ESE decreased both intrapatient and interpatient variations of edema signals significantly and had a strong correlation with DWI signals in terms of the strength of edema signals.

Smaller pixels sizes of x-ray photon counting detectors (PCDs) have the two conflicting effects as follows. On one hand, smaller pixel sizes improve the ability to handle high count rates of x-rays (i.e., pulse pileups) because incident rates onto each PCD pixel decreases with decreasing the size. On the other hand, smaller pixel sizes increase chances of crosstalk and double-counting (or n-tuple-counting in general) between neighboring pixels, because, while the same size of electron charge cloud generated by a photon is independent of PCD sizes, the charge cloud size relative to the PCD size increases with decreasing the PCD size. In addition, the following two aspects are practical configurations in actual PCD computed tomography systems: N×N-pixel binning and anti-scatter grids. When n-tuple-counting occurs and those data are binned/added during post-acquisition process, the variance of the data will be larger than its mean. The anti-scatter grids may eliminate or decrease the cross-talk and n-tuple-counting by blocking primary x-rays near pixel boundaries or for the width of one pixel entirely. In this study, we studied the effects of PCD pixel sizes, N×N-pixel binning, and pixel masking on soft tissue contrast visibility using newly developed Photon Counting Toolkit (PcTK version 3.2; https://pctk.jhu.edu).

Aims The aim of this article is to determine the association between left atrial appendage (LAA) regional dysfunction using image-based motion-estimation computed tomography (CT) (iME) and a prior history of stroke or transient ischaemic attack (TIA) in patients with atrial fibrillation (AF). Methods and results In this single-centre retrospective case–control study, among patients referred for AF ablation who underwent pre-ablation cardiac CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA at the time of CT scan and 18 age- and gender-matched controls. All the patients were in sinus rhythm at the time of CT scan. Four-dimensional motion vector field was estimated from the CT images using iME. To assess myocardial deformation, area change ratio ( A ) and area change rate (AR) were calculated over the endocardial surface of the LAA. There was no significant difference in the baseline patient characteristics between the stroke/TIA group and the control group (67.6 ± 8.1 years old, 66.7% male, 16.7% persistent AF). LAA maximum ( A max; 23.8 ± 33.0 vs. 52.9 ± 41.2%, P = 0.02) and pre-atrial contraction area change ratio ( A preA; 13.7 ± 17.7 vs. 30.9 ± 29.2%, P = 0.04) were significantly lower in the stroke/TIA group than in the control group, respectively. The difference in LAA A max and A preA remained significant in multivariate analysis ( P = 0.03 and P = 0.04, respectively). Conclusion LAA regional dysfunction is associated with stroke/TIA in AF patients. Our results offer a basis for a prospective study to determine the role of LAA regional dysfunction by iME in predicting cerebrovascular events such as stroke or TIA.

Purpose To investigate whether a newly-developed single-energy metal artifact reduction (SEMAR) algorithm applied to images acquired on a 320-MDCT volume scanner reduces image artifacts from dental metal. Methods We inserted the lower right teeth covered with a dental metal alloy and crown in a skull phantom and performed single-volume scanning on a second-generation 320-MDCT scanner. A 12-mm diameter spherical lesion was placed either close to or far from the dental metal. The tube voltage and current were 120 kVp and 80 or 155 mA, respectively. Images were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR), with or without SEMAR. We calculated the signal-to-artifact ratios (SAR) to quantify the visibility of the lesion. Two radiologists inspected 96 images (48 with lesion and 48 without) for the presence or absence of the lesion using a 5-point ordinal scale (1 = definitely absent to 5 = definitely present). Results On images reconstructed with FPB and IR with SEMAR, streak artifacts from the dental metal were reduced substantially compared to images without SEMAR. At 155 mA with the lesion near the dental metal, the SARs were better on FBP and IR images (FBP: 1.7 and 0.5 with and without SEMAR, respectively; IR: 1.6 and 0.9 with and without SEMAR, respectively). The observer visual scores improved with SEMAR (FBP: 4.2 and 3.2 with and without SEMAR, respectively; IR: 4.2 and 3.0). Conclusion The SEMAR algorithm reduces dental metal artifacts and improves lesion detectability and image quality in patients with oral cavity lesions.

We report a histologically pure stage 1 seminoma with an elevated human chorionic gonadotropin (hCG). A 38 year-old man was referred for the evaluation of the left testicular swelling. He showed an elevated serum hCG level of 25,265 mIU/ml with normal a fetoprotein and lactate dehydrogenase. Imaging showed heterogeneous tumor without any metastatic lesions. We conducted 4 courses of chemotherapy before detecting hCG nadir. The final pathological report showed pure seminoma with syncytiotrophoblastic cells but no choriocarcinoma components. The patient remains disease free until present time. The case raised several questions regarding diagnosis and treatment strategy for bulky testicular seminoma.

Purpose The interpixel cross-talk of energy-sensitive photon counting x-ray detectors (PCDs) has been studied and an analytical model (version 2.1) has been developed for double-counting between neighboring pixels due to charge sharing and K-shell fluorescence x-ray emission followed by its reabsorption (Taguchi K, et al., Medical Physics 2016;43(12):6386-6404). While the model version 2.1 simulated the spectral degradation well, it had the following problems that has been found to be significant recently: (1) The spectrum is inaccurate with smaller pixel sizes; (2) the charge cloud size must be smaller than the pixel size; (3) the model underestimates the spectrum/counts for 10-40 keV; and (4) the model version 2.1 cannot handlen-tuple-counting withn > 2 (i.e., triple-counting or higher). These problems are inherent to the design of the model version 2.1; therefore, we developed a new model and addressed these problems in this study. Methods We propose a new PCD cross-talk model (version 3.2; Pc TK for "photon counting toolkit") that is based on a completely different design concept from the previous version. It uses a numerical approach and starts with a 2-D model of charge sharing (as opposed to an analytical approach and a 1-D model with version 2.1) and addresses all of the four problems. The model takes the following factors into account: (1) shift-variant electron density of the charge cloud (Gaussian-distributed), (2) detection efficiency, (3) interactions between photons and PCDs via photoelectric effect, and (4) electronic noise. Correlated noisy PCD data can be generated using either a multivariate normal random number generator or a Poisson random number generator. The effect of the two parameters, the effective charge cloud diameter (d0 ) and pixel size (dpix ), was studied and results were compared with Monte Carlo simulations and the previous model version 2.1. Finally, a script for the workflow for CT image quality assessment has been developed, which started with a few material density images, generated material-specific sinogram (line integrals) data, noisy PCD data with spectral distortion using the model version 3.2, and reconstructed PCD- CT images for four energy windows. Results The model version 3.2 addressed all of the four problems listed above. The spectra withdpix = 56-113 μm agreed with that of Medipix3 detector withdpix = 55-110 μm without charge summing mode qualitatively. The counts for 10-40 keV were larger than the previous model (version 2.1) and agreed with MC simulations very well (root-mean-square difference values with model version 3.2 were decreased to 16%-67% of the values with version 2.1). There were many non-zero off-diagonal elements withn-tuple-counting withn > 2 in the normalized covariance matrix of 3 × 3 neighboring pixels. Reconstructed images showed biases and artifacts attributed to the spectral distortion due to the charge sharing and fluorescence x rays. Conclusion We have developed a new PCD model for spatio-energetic cross-talk and correlation between PCD pixels. The workflow demonstrated the utility of the model for general or task-specific image quality assessments for the PCD- CT.Note: The program (Pc TK) and the workflow scripts have been made available to academic researchers. Interested readers should visit the website (pctk.jhu.edu) or contact the corresponding author.

Purpose This work concerns computed tomography (CT)-based cardiac functional analysis (CFA) with a reduced radiation dose. As CT-CFA requires images over the entire heartbeat, the scans are often performed at 10–20% of the tube current settings that are typically used for coronary CT angiography. A large image noise then degrades the accuracy of motion estimation. Moreover, even if the scan was performed during the sinus rhythm, the cardiac motion observed in CT images may not be cyclic with patients with atrial fibrillation. In this study, we propose to use two CT scan data, one for CT angiography at a quiescent phase at a standard dose and the other for CFA over the entire heart beat at a lower dose. Methods We have made the following four modifications to an image-based cardiac motion estimation method we have previously developed for a full-dose retrospectively-gated coronary CT angiography: (1) A full-dose prospectively-gated coronary CT angiography image acquired at the least motion phase was used as the reference image; (2) a three-dimensional median filter was applied to lower-dose retrospectively-gated cardiac images acquired at 20 phases over one heartbeat in order to reduce image noise; (3) the strength of the temporal regularization term was made adaptive; and (4) a one-dimensional temporal filter was applied to the estimated motion vector field in order to decrease jaggy motion patterns. We call the conventional method iME1 and the proposed method iME2 in this paper. Five observers assessed the accuracy of the estimated motion vector field of iME2 and iME1 using a 4-point scale. The observers repeated the assessment with data presented in a new random order one week after the first assessment session. Results The study confirmed that the proposed iME2 was robust against the mismatch of noise levels, contrast enhancement levels, and shapes of the chambers. There was a statistically significant difference between iME2 and iME1 (accuracy score, 2.08±0.81 versus 2.77±0.98, P

We have developed a digitally synthesized patient which we call “Zach” (Zero millisecond Adjustable Clinical Heart) phantom, which allows for an access to the ground truth and assessment of image-based cardiac functional analysis (CFA) using CT images with clinically realistic settings. The study using Zach phantom revealed a major problem with image-based CFA: "False dyssynchrony." Even though the true motion of wall segments is in synchrony, it may appear to be dyssynchrony with the reconstructed cardiac CT images. It is attributed to how cardiac images are reconstructed and how wall locations are updated over cardiac phases. The presence and the degree of false dyssynchrony may vary from scan-to-scan, which could degrade the accuracy and the repeatability (or precision) of image-based CT-CFA exams.

OBJECTIVES We validated a novel image-based motion estimation computed tomographic (CT) technique (iME) to quantify atrial regional function in swine in vivo. MATERIALS AND METHODS Domestic swine (n = 8) underwent CT scan with intravenous contrast before and after median sternotomy where 15 to 30 glass beads were sutured to the atria to calculate the motion estimation error. Four-dimensional motion vector field was estimated using iME. Area change ratio (%AC) was calculated over the atrial endocardium to assess the surface deformation. RESULTS The error between the measured and the calculated coordinates based on motion vector field was 0.76 ± 0.43 mm. The %AC was regionally heterogeneous. The %AC time course was significantly different between the right and the left atriums (P < 0.001) as well as between the right atrial appendage and the right atrial chamber (P = 0.004). CONCLUSIONS Quantitative assessment of atrial regional function using iME is highly accurate. Image-based motion estimation computed tomographic (CT) technique can quantify subtle regional dysfunction that is not apparent in global functional indices such as ejection fraction.

Energy-sensitive photon counting detectors (PCDs) have recently been developed for medical X-ray computed tomography (CT) imaging and a handful of prototype PCD-CT systems have been built and evaluated. PCDs detect X-rays by using mechanisms that are completely different from the current CT detectors (i.e., energy integrating detectors or EIDs); PCDs count photons and obtain the information of the object tissues (i.e., the effective atomic numbers and mass densities) to be imaged. Therefore, these PCDs have the potential not only for evolution-to improve the current CT images such as providing dose reduction-but also for a revolution-to enable novel applications with a new concept such as molecular CT imaging. The performance of PCDs, however, is not flawless, and thus, it requires integrated efforts to develop PCD-CT for clinical use. In this article, we review the current status and the prediction for the future of PCDs, PCD-CT systems, and potential clinical applications.

To evaluate stent lumen visualization by combining high-resolution cardiac kernel and the iterative reconstruction (iDose) on an anthropomorphic moving heart phantom and in patients at coronary computed tomography (CT) angiography.We used the moving heart phantom and a 64 detector-row CT, retrospectively gated helical scanning, and image reconstruction. The heart rate was set at nonpulsating condition of 0 beats/min, 50 beats/min, and 80 beats/min. The 120-kV images were reconstructed in synchronization with electrocardiogram data using filtered back projection (FBP) or iDose algorithm and standard kernel/filter (CB) or high-resolution kernel/filter (CD). We measured image noise, the kurtosis, and stent lumen diameter in the phantom study. We also assessed the visual inspections by two radiologists.With cardiac motion at 50 and 80 beats/min, the difference of kurtosis improved with CD relative to CB (P.05). iDose algorithm with level 7 provided lowest noise, with no statistically significance in difference of the kurtosis relative to level 4 (P.05). Without cardiac motion at 0 beats/min, the stent lumen diameter measurements with CD kernel were better relative to CB kernel (P.05). In addition, no significant difference was found in stent lumen diameter between iDose level 4 and level 7 (P.05).The use of iDose and a sharp kernel allowed improved stent visualization at a lower radiation dose.

The aim of this in vitro study was to examine the capability of three protocols of dual-energy CT imaging in distinguishing calcium oxalate, calcium phosphate, and uric acid kidney stones.A total of 48 calcium oxalate, calcium phosphate, and uric acid human kidney stone samples were placed in individual containers inside a cylindric water phantom and imaged with a dual-energy CT scanner using the following three scanning protocols of different combinations of tube voltage, with and without a tin filter: 80 and 140 kVp without a tin filter, 100 and 140 kVp with a tin filter, and 80 and 140 kVp with a tin filter. The mean attenuation value (in Hounsfield units) of each stone was recorded in both low- and high-energy CT images in each protocol. The dual-energy ratio of the mean attenuation values of each stone was computed for each protocol.For all three protocols, the uric acid stones were significantly different (p0.001) from the calciferous stones according to their dual-energy ratio values. For differentiating calcium oxalate and calcium phosphate stones, the difference between their dual-energy ratio values was statistically significant, with different degrees of significance (range, p0.001 to p = 0.03) for all three protocols. On the basis of the values of the area under receiver operating characteristic curve (AUC) of calcified stone differentiation, the three protocols were ranked in the following order: the 80- and 140-kVp tin filter protocol (AUC, 0.996), the 100- and 140-kVp tin filter protocol (AUC, 0.918), and the 80- and 140-kVp protocol (AUC, 0.871).The tin filter added to the high-energy tube and the use of a wider dual-energy difference are important for improving the stone differentiation capability of dual-energy CT imaging.

We compare the performance of low tube voltage with the hybrid iterative reconstruction (iDose) with standard and low tube voltage with the filtered backprojection (FBP) using phantoms at computed tomographic coronary angiography. In computed tomographic coronary angiography, application of the combined low tube voltage with iDose resulted in significant image quality improvements compared to the low tube voltage with FBP. Image quality was the same or better despite a reduction in the radiation dose by 76% compared with standard tube voltage with FBP.

C-arm cone-beam computed tomography (CBCT) can be used to visualize tumor-feeding vessels and parenchymal staining during transcatheter arterial chemoembolization (TACE). To capture these two phases, all current commercially available CBCT systems necessitate two separate contrast-enhanced scans. In this feasibility study, we report initial results of novel software that enhanced our current CBCT system to capture these two phases using only one contrast injection. Novelty of this work is the addition of software that enabled the acquisition of two sequential, back-to-back CBCT scans (dual-phase CBCT, DPCBCT) so both tumor feeding vessels and parenchyma are captured using only one contrast injection. To illustrate our initial experience, DPCBCT was used for TACE treatments involving lipiodol, drug-eluting beads, and Yttrium-90 radioembolizing microspheres. For each case, the DPCBCT images were compared to pre-intervention contrast-enhanced MR/CT. DPCBCT is feasible for TACE treatments and the preliminary results show positive correlation with pre-intervention conventional CT and MR. In addition, the degree of embolization can be monitored. DPCBCT is a promising technology that provides comprehensive visualization of tumor-feeding vessels and parenchymal staining using a single injection of contrast. DPCBCT could potentially be used during TACE to verify catheter position and monitor the embolization effect.

The purpose of this study was to use phantom and patient data acquired with 64-MDCT to compare the image quality and characteristics of helical high-resolution CT images obtained with cone-beam reconstruction with those of stepwise high-resolution CT images obtained with fan-beam reconstruction.We reconstructed helical high-resolution CT images with cone-beam technique and stepwise high-resolution CT images with fan-beam technique. In the phantom study, we measured high-contrast spatial resolution and image noise using a phantom. Streak artifact was evaluated by five radiologists using the phantom. In the clinical phase of the study, two radiologists independently evaluated high-resolution helical and stepwise CT images of the lung fields of 30 patients with diffuse lung disease. Using a 3-point ordinal scale, the radiologists assessed the sharpness of peripheral vessels and interlobular fissures, artifacts, and graininess in the lung fields; overall image quality; and the sharpness of the contour of the left ventricle.In high-contrast spatial resolution, the contrast curves in each spatial frequency were similar on the helical and stepwise images. In the clinical study, there was no statistically significant difference between helical and stepwise images with respect to sharpness of the contour of the left ventricle, peripheral vessels, or interlobular fissures (p0.05). With respect to streak artifacts and graininess in the lung fields, helical images received a significantly higher quality grade than did stepwise images (p0.05).Our phantom and clinical evaluation showed that the quality of high-resolution CT images of the lung obtained with helical scanning was comparable with the quality of stepwise scans.

Spectral computed tomography (CT) with photon-counting detectors (PCDs) has the potential to substantially advance diagnostic CT imaging by reducing image noise and dose to the patient, by improving contrast and tissue specificity, and by enabling molecular and functional imaging. However, the current PCD technology is limited by two main factors: imperfect energy measurement (spectral response effects, SR) and count rate non-linearity (pulse pileup effects, PP, due to detector deadtimes) resulting in image artifacts and quantitative inaccuracies for material specification. These limitations can be lifted with image reconstruction algorithms that compensate for both SR and PP. A prerequisite for this approach is an accurate model of the count losses and spectral distortions in the PCD. In earlier work we developed a cascaded SR-PP model and evaluated it using a physical PCD. In this paper we show the robustness of our approach by modifying the cascaded SR-PP model for a faster PCD with smaller pixels and a different pulse shape. We compare paralyzable and non-paralyzable detector models. First, the SR-PP model is evaluated at low and high count rates using two sets of attenuators. Then, the accuracy of the compensation is evaluated by estimating the thicknesses of three basis functions.

Purpose: Photon counting x-ray detectors (PCXDs) are an important emerging technology for spectral imaging and material differentiation with numerous potential applications in diagnostic imaging. We report development of a Si-strip PCXD system originally developed for mammography with potential application to spectral CT of musculoskeletal extremities, including challenges associated with sparse sampling, spectral calibration, and optimization for higher energy x-ray beams. Methods: A bench-top CT system was developed incorporating a Si-strip PCXD, fixed anode x-ray source, and rotational and translational motions to execute complex acquisition trajectories. Trajectories involving rotation and translation combined with iterative reconstruction were investigated, including single and multiple axial scans and longitudinal helical scans. The system was calibrated to provide accurate spectral separation in dual-energy three-material decomposition of soft-tissue, bone, and iodine. Image quality and decomposition accuracy were assessed in experiments using a phantom with pairs of bone and iodine inserts (3, 5, 15 and 20 mm) and an anthropomorphic wrist. Results: The designed trajectories improved the sampling distribution from 56% minimum sampling of voxels to 75%. Use of iterative reconstruction (viz., penalized likelihood with edge preserving regularization) in combination with such trajectories resulted in a very low level of artifacts in images of the wrist. For large bone or iodine inserts (>5 mm diameter), the error in the estimated material concentration was

Multislice helical computed tomography (CT) is a promising noninvasive technique for coronary artery imaging. Various factors can cause inconsistencies in cardiac CT data, which can result in degraded image quality. These inconsistencies may be the result of the patient physiology (e.g., heart rate variations), the nature of the data (e.g., cone-angle), or the reconstruction algorithm itself. An algorithm which provides the best temporal resolution for each slice, for example, often provides suboptimal image quality for the entire volume since the cardiac temporal resolution (TRc) changes from slice to slice. Such variations in TRc can generate strong banding artifacts in multi-planar reconstruction images or three-dimensional images. Discontinuous heart walls and coronary arteries may compromise the accuracy of the diagnosis. A {beta}-blocker is often used to reduce and stabilize patients' heart rate but cannot eliminate the variation. In order to obtain robust and optimal image quality, a software solution that increases the temporal resolution and decreases the effect of heart rate is highly desirable. This paper proposes an ECG-correlated direct cone-beam reconstruction algorithm (TCOT-EGR) with cardiac banding artifact correction (CBC) and disconnected projections redundancy compensation technique (DIRECT). First the theory and analytical model of the cardiac temporal resolution is outlined. Next, themore » performance of the proposed algorithms is evaluated by using computer simulations as well as patient data. It will be shown that the proposed algorithms enhance the robustness of the image quality against inconsistencies by guaranteeing smooth transition of heart cycles used in reconstruction.« less

Depending on the clinical application, it is frequently necessary to tilt the gantry of an x-ray CT system with respect to the patient and couch. For single-slice fan-beam systems, tilting the gantry introduces no errors or artifacts. Most current systems, however, are helical multislice systems with up to 16 slices. The multislice helical reconstruction algorithms used to create CT images must be modified to account for tilting of the gantry. If they are not, the quality of reconstructed images will be poor with the presence of significant artifacts, such as smearing and double-imaging of anatomical structures. Current CT systems employ three primary types of reconstruction algorithms: helical fan-beam approximation, advanced single-slice rebinning, and Feldkamp-based algorithms. This paper presents a generalized helical cone-beam Feldkamp-based algorithm that is valid for both tilted and nontilted orientations of the gantry. Unlike some of the other algorithms, generalization of the Feldkamp algorithm to include gantry tilt is simple and straightforward with no significant increase in computational complexity. The effect of gantry tilt for helical Feldkamp reconstruction is to introduce a lateral shift in the isocenter of the reconstructed slice of interest, which is a function of the tilt, couch speed, and view angle. The lateral shift is easily calculated and incorporated into the helical Feldkamp backprojection algorithm. A tilt-generalized helical Feldkamp algorithm has been developed and incorporated into Aquilion 16-slice CT (Toshiba, Japan) scanners. This paper describes modifications necessary for the tilt generalization and its verification.

In recent years, iterative algorithms have become popular in diagnostic CT imaging to reduce noise or radiation dose to the patient. The non-linear nature of these algorithms leads to non-linearities in the imaging chain. However, the methods to assess the performance of CT imaging systems were developed assuming the linear process of filtered backprojection (FBP). Those methods may not be suitable any longer when applied to non-linear systems. In order to evaluate the imaging performance, a phantom is typically scanned and the image quality is measured using various indices. For reasons of practicality, cost, and durability, those phantoms often consist of simple water containers with uniform cylinder inserts. However, these phantoms do not represent the rich structure and patterns of real tissue accurately. As a result, the measured image quality or detectability performance for lesions may not reflect the performance on clinical images. The discrepancy between estimated and real performance may be even larger for iterative methods which sometimes produce “plastic-like”, patchy images with homogeneous patterns. Consequently, more realistic phantoms should be used to assess the performance of iterative algorithms. We designed and constructed a biological phantom consisting of porcine organs and tissue that models a human abdomen, including liver lesions. We scanned the phantom on a clinical CT scanner and compared basic image quality indices between filtered backprojection and an iterative reconstruction algorithm.

Multislice helical computed tomography (CT) substantially reduces scanning time. However, the temporal resolution of individual images is still insufficient for imaging rapidly moving organs such as the heart and adjacent pulmonary vessels. It may, in some cases, be worse than with current single-slice helical CT. The purpose of this study is to describe a novel image reconstruction algorithm to improve temporal resolution in multislice helical CT, and to evaluate its performance against existing algorithms. The proposed image reconstruction algorithm uses helical interpolation followed by data weighting based on the acquisition time. The temporal resolution, the longitudinal (z-axis) spatial resolution, the image noise, and the in-plane image artifacts created by a moving phantom were compared with those from the basic multislice helical reconstruction (helical filter interpolation, HFI) algorithm and the basic single-slice helical reconstruction algorithm (180 degrees linear interpolation, 180LI) using computer simulations. Computer simulation results were verified with CT examinations of the heart and lung vasculature using a 0.5 second multislice scanner. The temporal resolution of HFI algorithm varies from 0.28 and 0.86 s, depending on helical pitch. The proposed method improves the resolution to a constant value of 0.29 s, independent of pitch, allowing moving objects to be imaged with reduced blurring or motion artifacts. The spatial (z) resolution was slightly worse than with the HFI algorithm; the image noise was worse than with the HFI algorithm but was comparable to axial (step-and-shoot) CT. The proposed method provided sharp images of the moving objects, portraying the anatomy accurately. The proposed algorithm for multislice helical CT allowed us to obtain CT images with high temporal resolution. It may improve the image quality of clinical cardiac, lung, and vascular CT imaging.

Purpose To investigate whether electrocardiogram (ECG)-gated single- and dual-heartbeat computed tomography coronary angiography (CTCA) with automatic exposure control (AEC) yields images with uniform image noise at reduced radiation doses. Materials and methods Using an anthropomorphic chest CT phantom we performed prospectively ECG-gated single- and dual-heartbeat CTCA on a second-generation 320-multidetector CT volume scanner. The exposure phase window was set at 75%, 70–80%, 40–80%, and 0–100% and the heart rate at 60 or 80 or corr80 bpm; images were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR, adaptive iterative dose reduction 3D). We applied AEC and set the image noise level to 20 or 25 HU. For each technique we determined the image noise and the radiation dose to the phantom center. Results With half-scan reconstruction at 60 bpm, a 70–80% phase window- and a 20-HU standard deviation (SD) setting, the imagenoise level and -variation along the z axis manifested similar curves with FBP and IR. With half-scan reconstruction, the radiation dose to the phantom center with 70–80% phase window was 18.89 and 12.34 mGy for FBP and 4.61 and 3.10 mGy for IR at an SD setting SD of 20 and 25 HU, respectively. At 80 bpm with two-segment reconstruction the dose was approximately twice that of 60 bpm at both SD settings. However, increasing radiation dose at corr80 bpm was suppressed to 1.39 times compared to 60 bpm. Conclusion AEC at ECG-gated single- and dual-heartbeat CTCA controls the image noise at different radiation dose.

Cardiac deformation indices such as strain, strain rate, and time to maximal strain are valuable in early detection of heart disease and hold tremendous prognostic value in assessing patients recovering from heart failure. These indices have been previously measured in modalities such as Doppler echocardiography and magnetic resonance imaging. However, cardiac deformation has not been well characterized in X-ray computed tomography (CT), a modality whose balance of high acquisition speed and good temporal and spatial resolution makes it highly desirable in the clinical setting. The current work, an extension of our group’s previously published cardiac motion estimation algorithm, calculates deformation indices such as strain, strain rate, maximum strain, and time to maximal strain from four-dimensional motion vector field data. Along each dimension, calculations are made between every adjacent pair of grid points, thus striving for simplicity while yielding an increase in spatial resolution over approaches that divide the heart into a number of segments. Results are visualized as semi-transparent color maps superimposed on CT image slices in the short-axis view and the two long-axis views. Results agree with the expected behavior of myocardial contraction. Animal studies are underway to better assess the physiologic accuracy of the calculated deformation indices as well as to compare the results with those from other imaging modalities. The present work and its further refinements may yield rich yet easily accessible information for clinicians in early diagnosis and follow-up monitoring.

Spectral computed tomography (CT) with photon-counting detectors (PCDs) has the potential to substantially advance diagnostic CT imaging by reducing image noise and dose to the patient, by improving contrast and tissue specificity, and by enabling molecular and functional imaging. The current PCD technology, however, is limited by two main factors: imperfect energy measurement (spectral response effects, SRE) and limited count rate (pulse-pileup effects, PPE, due to detector dead-times). The overall goal of our research is to develop compensation algorithms for these sources of data distortions, to demonstrate that PCDs are suitable for clinical CT, and to identify key clinical applications for spectral CT with PCDs. We have already developed an iterative compensation scheme that includes a forward projection model of the imaging chain and that can compensate for either SRE or PPE distortions separately by maximizing a penalized log-likelihood function. In this paper we describe the evaluation of a combined, cascaded SRE and PPE model for PCDs and compare the models to data acquired with an experimental table-top PCD-CT system. The separation into count-rate independent effects (SRE) and count-rate dependent effects (PPE) allows cascading the forward model. First, the SRE model is evaluated using low count rates. Then the PPE model is cascaded and the combined SRE+PPE model is evaluated. Several different attenuators were used, including K-edge materials and the models and data were compared for various count-rate conditions.

One of the major obstacles toward photon counting detector (PCD)-based clinical x-ray CT systems is the large count rates, because when operated under too intense x-rays, pulse pileup effects (PPEs) due to coincident photons distort the spectrum recorded by PCDs. In this paper we discuss a strategy using a hybrid detector, which consists of PCDs for the central part of the detector [which corresponds to a central small field-of-view (FOV) of the object] and energy integrating detectors (EIDs) for the peripheral part, to achieve the following three goals: 1) to minimize the PPEs; 2) to produce accurate spectral images for the small FOV; and 3) to provide conventional CT images for the entire FOV. The third goal requires a solution to exterior problem, because the central part of EID data is missing. The spectral data obtained by PCDs carry richer information than the intensity data obtained by EIDs; however, performing a simple weighted summation of counts from multi-energy windows of PCD would not produce realistic EID data, as the spectrum recorded by PCD could be skewed by spectral response effects (SREs) and PPEs. We propose a unique approach for the hybrid PCD/EID-CT system in this paper.

A semi-analytical model describing spectral distortions in photon-counting detectors (PCDs) for clinical computed tomography was evaluated using simulated data. The distortions were due to count rate-independent spectral response effects and count rate-dependent pulse-pileup effects and the model predicted both the mean count rates and the spectral shape. The model parameters were calculated using calibration data. The model was evaluated by comparing the predicted x-ray spectra to Monte Carlo simulations of a PCD at various count rates. The data-model agreement expressed as weighted coefficient of variation [Formula: see text] was better than [Formula: see text] for dead time losses up to 28% and [Formula: see text] or smaller for dead time losses up to 69%. The accuracy of the model was also tested for the purpose of material decomposition by estimating material thicknesses from simulated projection data. The estimated attenuator thicknesses generally agreed with the true values within one standard deviation of the statistical uncertainty obtained from multiple noise realizations.

This Special Report presents the consensus of the Summit on Management of Radiation Dose in Computed Tomography (CT) (held in February 2011), which brought together participants from academia, clinical practice, industry, and regulatory and funding agencies to identify the steps required to reduce the effective dose from routine CT examinations to less than 1 mSv. The most promising technologies and methods discussed at the summit include innovations and developments in x-ray sources; detectors; and image reconstruction, noise reduction, and postprocessing algorithms. Access to raw projection data and standard data sets for algorithm validation and optimization is a clear need, as is the need for new, clinically relevant metrics of image quality and diagnostic performance. Current commercially available techniques such as automatic exposure control, optimization of tube potential, beam-shaping filters, and dynamic z-axis collimators are important, and education to successfully implement these methods routinely is critically needed. Other methods that are just becoming widely available, such as iterative reconstruction, noise reduction, and postprocessing algorithms, will also have an important role. Together, these existing techniques can reduce dose by a factor of two to four. Technical advances that show considerable promise for additional dose reduction but are several years or more from commercial availability include compressed sensing, volume of interest and interior tomography techniques, and photon-counting detectors. This report offers a strategic roadmap for the CT user and research and manufacturer communities toward routinely achieving effective doses of less than 1 mSv, which is well below the average annual dose from naturally occurring sources of radiation.

In order to clarify the ultrastructural consequence of the VX2 cancer cell exposed to underwater shock waves. The VX2 cancer implanted to the urinary bladder of rabbit was received the shock waves (1000 shots, 100 MPa, 5/sec.) generated by the piezo-ceramics. Damage to the cancer cell were manifested by the three kind of findings: the one was the cell junction failure which caused the isolated cells; the second was the destruction of organelle which seemed to form the vacuole in cytoplasm; and the last finding was the emergence of moth eaten appearance in the exposed cell. We conclude that underwater shock wave exposure induces lethal injury in VX2 implanted cancer.

Photon counting x-ray detectors (PCXDs) are an emerging technology in x-ray computed tomography (CT) as they have the potential to overcome some of the most significant limitations of current CT with energy integrating detectors. Among these are: insufficient tissue contrast, relatively high radiation dose, tissue non-specificity, and the non-quantitative nature. In contrast, CT with PCXDs has shown promise in producing higher contrast, tissue specific, quantitative images at lower dose. Novel applications for PCXDs include k-edge and functional imaging and material decomposition. A limiting factor, however, is the high photon flux that occurs in clinical applications resulting in signal pulse pile up in the detector. Faster detectors and new strategies for data corrections and image reconstruction algorithms are needed to overcome these limitations. A research tabletop x-ray CT scanner was developed with the following aims: 1) to characterize and calibrate the PCXD; 2) to acquire CT projection data under conditions similar to those of clinical CT; and 3) to reconstruct images using correction schemes specific for PCXDs. The scanner employs a commercial clinical x-ray tube, a PCXD with two energy thresholds, and allows scanning of objects of up to 40 cm in diameter. This paper presents measurements of detector quantities crucial for data corrections and calibration, such as energy response, deadtime, and count rates. Reconstructed CT images are presented and qualitative results from material decomposition are shown.

The objective of the study was to demonstrate that, in x-ray computed tomography (CT), more than two types of materials can be effectively separated with the use of an energy resolved photon-counting detector and classification methodology. Specifically, this applies to the case when contrast agents that contain K-absorption edges in the energy range of interest are present in the object. This separation is enabled via the use of recently developed energy resolved photon-counting detectors with multiple thresholds, which allow simultaneous measurements of the x-ray attenuation at multiple energies.To demonstrate this capability, we performed simulations and physical experiments using a six-threshold energy resolved photon-counting detector. We imaged mouse-sized cylindrical phantoms filled with several soft-tissue-like and bone-like materials and with iodine-based and gadolinium-based contrast agents. The linear attenuation coefficients were reconstructed for each material in each energy window and were visualized as scatter plots between pairs of energy windows. For comparison, a dual-kVp CT was also simulated using the same phantom materials. In this case, the linear attenuation coefficients at the lower kVp were plotted against those at the higher kVp.In both the simulations and the physical experiments, the contrast agents were easily separable from other soft-tissue-like and bone-like materials, thanks to the availability of the attenuation coefficient measurements at more than two energies provided by the energy resolved photon-counting detector. In the simulations, the amount of separation was observed to be proportional to the concentration of the contrast agents; however, this was not observed in the physical experiments due to limitations of the real detector system. We used the angle between pairs of attenuation coefficient vectors in either the 5-D space (for non-contrast-agent materials using energy resolved photon-counting acquisition) or a 2-D space (for contrast agents using energy resolved photon-counting acquisition and all materials using dual-kVp acquisition) as a measure of the degree of separation. Compared to dual-kVp techniques, an energy resolved detector provided a larger separation and the ability to separate different target materials using measurements acquired in different energy window pairs with a single x-ray exposure.We concluded that x-ray CT with an energy resolved photon-counting detector with more than two energy windows allows the separation of more than two types of materials, e.g., soft-tissue-like, bone-like, and one or more materials with K-edges in the energy range of interest. Separating material types using energy resolved photon-counting detectors has a number of advantages over dual-kVp CT in terms of the degree of separation and the number of materials that can be separated simultaneously.

Purpose The purpose of our study was to acquire dose profiles at critical organs of lung and breast regions using optically stimulated luminescence (OSL) dosimeters; assess the actual radiation dose delivered at retrospective and prospective computed tomography coronary angiography (CTCA). Materials and methods Using a chest CT phantom we applied a prospectively-gated step-and-shoot- and a retrospectively-gated helical mode on a 64-detector row CT scanner. Retrospective scan mode was used with and without electrocardiogram (ECG) based tube current modulation. OSL dosimeters were used to measure dose profiles. In the both scan modes we acquired dose profiles and determined the mean and maximum dose in left lung and in left breast regions. Results In prospective mode, the mean dose was 21.53 mGy in left lung- and 23.59 mGy in left breast region. With respect to the retrospective mode, the mean dose with tube current modulation was 38.63 mGy for left lung- and 46.02 mGy for left breast region, i.e. 0.56 and 0.55 times lower than the mean dose without modulation. Conclusion The OSL dosimeter is useful for measurement of the actual radiation dose along z-axis at lung and breast regions in the prospective and the retrospective CTCA.

In order to clarify the pathogenesis of hypercalciuria, the response to extrinsic human parathyroid hormone (h-PTH) was studied the 21 patients with calcium containing urinary stone(s) and 5 normal controls (NO). The stone patients were classified into 3 groups from the result of the oral calcium loading test, i.e. Non-hypercalciura (NH, n = 8) and absorptive hypercalciuria (AH, n = 8) and renal hypercalciuria (RH, n = 5). Only in the AH group, urinary excretion of calcium (u-Ca) was strongly correlated to that of sodium (u-Na) in pre-load of h-PTH, and both increments were also correlated in post-load of h-PTH. As of this fact the increase in Na excretion seems to be responsible for a cause of hypercalciuria in the AH group. There was a significant correlation between the value of %TRP in pre-load of h-PTH and the rate of urinary phosphorus (P) increment between pre-load and post-load of h-PTH in the NO and NH groups. However, this relationship was not found in the AH and RH groups. These findings indicate that there is response disorder of P to h-PTH. In addition, serum P was low, plasma 1,25 (OH)2D was high, N-c-AMP was low in the AH group, whereas both serum P and %TRP were low in the RH group in pre-load of h-PTH. These findings are compatible with the primary renal P leak.(ABSTRACT TRUNCATED AT 250 WORDS)

We report on a characterization study of a multi-row direct-conversion x-ray detector used to generate the first photon counting clinical x-ray computed tomography (CT) patent images. In order to provide the photon counting detector with adequate performance for low-dose CT applications, we have designed and fabricated a fast application specific integrated circuit (ASIC) for data readout from the pixellated CdTe detectors that comprise the photon counting detector. The cadmium telluride (CdTe) detector has 512 pixels with a 1 mm pitch and is vertically integrated with the ASIC readout so it can be tiled in two dimensions similar to those that are tiled in an arc found in 32-row multi-slice CT systems. We have measured several important detector parameters including the maximum output count rate, energy resolution, and noise performance. Additionally the relationship between the output and input rate has been found to fit a non-paralyzable detector model with a dead time of 160 nsec. A maximum output rate of 6 × 106 counts per second per pixel has been obtained with a low output x-ray tube for CT operated between 0.01 mA and 6 mA at 140 keV and different source-to-detector distances. All detector noise counts are less that 20 keV which is sufficiently low for clinical CT. The energy resolution measured with the 60 keV photons from a 241Am source is ~12%. In conclusion, our results demonstrate the potential for the application of the CdTe based photon counting detector to clinical CT systems. Our future plans include further performance improvement by incorporating drift structures to each detector pixel.

Perfusion imaging is often used for diagnosis and for assessment of the response to the treatment. If perfusion can be measured during interventional procedures, it could lead to quantitative, more efficient and accurate treatment; however, imaging modalities that allow continuous dynamic scanning are not available in most of procedure rooms. Thus, we developed a method to measure the perfusion-time attenuation curves (TACs)-of regions-of-interest (ROIs) using xray C-arm angiography system with no gantry rotation but with a priori. The previous study revealed a problem of large oscillations in the estimated TACs and the lack of comparison with CT-based approaches. Thus the purposes of this study were (1) to reduce the variance of TDCs; and (2) to compare the performance of the improved PAP with that of the CT-based perfusion method. Our computer simulation study showed that the standard deviation of PAP method was decreased by 10.7-59.0% and that it outperformed (20× or 200× times) higher dose CT methods in terms of the accuracy, variance, and the temporal resolution.

This work aims at discriminating between soft and calcified coronary artery plaques using microCT with a multi-energywindow photon counting X-ray detector (PCXD). We have previously investigated a solid state X-ray detector which has the capability to count individual photons in different energy windows. The data from these energy windows may be treated as multiple simultaneous X-ray acquisitions within non-overlapping energy windows that can provide additional information about tissue differences. In this work, we simulated a photon counting detector with five energy windows. We investigated two approaches for using the energy information provided by this detector. First, we applied energy weighting to the reconstruction from different energy windows to improve the signal-to-noise ratio between calcified and soft plaques. This resulted in a significant improvement in the signal-to-noise ratio. Second, we applied the basis material decomposition method to discriminate coronary artery plaques based on their calcium content. The results were compared with those obtained using dual-kVp material decomposition. We observed significantly improved contrast-tonoise ratios for the PCXD-based approaches.

The results of clinical trial using a TOSHIBA piezolectric extracorporeal lithotripter are presented. The advantages of this machine are the installation of an anti-miss-shot control device (AMCD) to prevent miss-shots to the renal tissue and the improved ultrasound stone localization by an over-head type applicator. AMCD functions so that shock waves are generated only when the stone is in the focal region. Forty patients with urinary tract stone were treated by this machine from October 1989 to March 1990 at the Department of Urology, Tohoku University School of Medicine. Almost all patients could be treated with an analgesic only. The X-ray film obtained three months after ESWL treatment showed that 23 cases (57.5%) were stone-free and 10 cases (25.0%) had stone fragments of less than 4 mm. The successful rate of ESWL using this machine was 82.5%, the result was better than that using other piezolectric machines. No serious complication was observed, except mild hematuria in all cases. Milder postoperative hematuria suggested the decrease of renal tissue injury. It is concluded that the treatment with this machine is safe and seems to be more favorable than the conventional ones.

In this study, we propose to estimate time-dependent attenuation curves on region-of-interest basis using a priori and projection data acquired without gantry rotation.

In the animal experiments, glomerular filtration rate (GFR) values were estimated from the urinary response to the intravenously administrated iopamidol. By introducing some reasonable assumptions, mass balance equations about the contrast medium were transformed and GFR was defined as the ratio of logarithm of urinary concentration by time. Urinary concentrations were determined by measuring the photodensity on the X-ray film of urine specimens. Obtained values of GFR were well fitted to those obtained by the analysis of the plasma disappearance curve. The advantage of this method is that measurement of urinary volume is not necessary.

C-arm computed tomography is an option on a C-arm angiographic system capable of acquiring projections while rotating the C-arm around the patient and reconstructing cross-sectional images with improved contrast resolution of 5 to 10 Hounsfield units. Typical abdominal C-arm computed tomographic (CCT) images, however, exhibit artifacts with spatially varying and drifting pixel values. Considering liver tumor oncologic procedures, the aim of this study was to evaluate the accuracy of liver iodine concentration (IC) estimated from CCT images under such challenging conditions.The proposed method estimates the IC in a region of interest (ROI) using pixel values of CCT images measured at the ROI and a nonenhanced background. Two approaches to measure the background value were tested: one approach, L-BG, measured a corresponding local background value near each ROI, and the other, G-BG, used one global background value for the entire object. The accuracy of estimations using CCT and computed tomographic scanners was evaluated; an elliptical cylinder water phantom with iodine solution inserts and seven patient data sets with transcatheter arterial chemoembolization were used.With the least "truncation" (the edge of the object being outside the field of view) of 27 mm, the IC was accurately estimated with CCT images (n = 9; root-mean-square error [RMSE], 1.60-1.63 mg/mL; normalized RMSE, 11.8%; r(2) = 0.97; P.001), with the true concentration ranging from 2.32 to 31.82 mg/mL. With truncations of up to 100 mm (n = 88), the estimation by L-BG remained accurate independent of the amount of truncation (RMSE, 1.58 mg/mL; normalized RMSE, 12.5%; r(2) = 0.06; P = .02), whereas the estimation by G-BG reduced the accuracy (RMSE, 4.61 mg/mL; normalized RMSE, 34.3%; r(2) = 0.10; P = .003). Clinical data (n = 37) showed that the estimation from CCT images using the L-BG method agreed well with that from computed tomographic images (RMSE, 2.86 mg/mL; normalized RMSE, 38.7%; r(2) = 0.76; P.001).The liver IC can be accurately estimated with abdominal CCT images.

Last few years has witnessed the development of novel of X-ray imaging modalities, such as spectral CT, phase contrast CT, and X-ray acoustic/fluorescence/luminescence imaging. This symposium will present the recent advances of these emerging X-ray imaging modalities and update the attendees with knowledge in various related topics, including X-ray photon-counting detectors, X-ray physics underlying the emerging applications beyond the traditional X-ray imaging, image reconstruction for the novel modalities, characterization and evaluation of the systems, and their practical implications. In addition, the concept and practical aspects of X-ray activatable targeted nanoparticles for molecular X-ray imaging will be discussed in the context of X-ray fluorescence and luminescence CT. Learning Objectives: 1. Present background knowledge of various emerging X-ray imaging techniques, such as spectral CT, phase contrast CT and X-ray fluorescence/luminescence CT. 2. Discuss the practical need, technical aspects and current status of the emerging X-ray imaging modalities. 3. Describe utility and future impact of the new generation of X-ray imaging applications.

We investigate the effect of heart rate on the quality and artifact generation in coronary artery images obtained using multi-slice computed tomography (MSCT) with the purpose of finding the optimal time resolution for data acquisition. To perform the study, we used the 4D NCAT phantom, a computer model of the normal human anatomy and cardiac and respiratory motions developed in our laboratory. Although capable of being far more realistic, the 4D NCAT cardiac model was originally designed for low-resolution imaging research, and lacked the anatomical detail to be applicable to high-resolution CT. In this work, we updated the cardiac model to include a more detailed anatomy and physiology based on high-resolution clinical gated MSCT data. To demonstrate its utility in high-resolution dynamic CT imaging research, the enhanced 4D NCAT was then used in a pilot simulation study to investigate the effect of heart rate on CT angiography. The 4D NCAT was used to simulate patients with different heart rates (60-120 beats/minute) and with various cardiac plaques of known size and location within the coronary arteries. For each simulated patient, MSCT projection data was generated with data acquisition windows ranging from 100 to 250 ms centered within the quiet phase (mid-diastole) of the heart using an analytical CT projection algorithm. CT images were reconstructed from the projection data, and the contrast of the plaques was then measured to assess the effect of heart rate and to determine the optimal time resolution required for each case. The 4D NCAT phantom with its realistic model for the cardiac motion was found to provide a valuable tool from which to optimize CT cardiac applications. Our results indicate the importance of optimizing the time resolution with regard to heart rate and plaque location for improved CT images at a reduced patient dose.

A detailed four-dimensional model of the coronary artery tree has great potential in a wide variety of applications especially in biomedical imaging. We developed a computer generated three-dimensional model for the coronary arterial tree based on two datasets: (1) gated multi-slice computed tomography (MSCT) angiographic data obtained from a normal human subject and (2) statistical morphometric data obtained from porcine hearts. The main coronary arteries and heart structures were segmented from the MSCT data to define the initial segments of the vasculature and geometrical details of the boundaries. An iterative rule-based computer generation algorithm was then developed to extend the coronary artery tree beyond the initial segmented branches. The algorithm was governed by the following factors: (1) the statistical morphometric measurements of the connectivities, lengths, and diameters of the arterial segments, (2) repelling forces from other segments and boundaries, and (3) optimality principles to minimize the drag force at each bifurcation in the generated tree. Using this algorithm, the segmented coronary artery tree from the MSCT data was optimally extended to create a 3D computational model of the largest six orders of the coronary arterial tree. The new method for generating the 3D model is effective in imposing the constraints of anatomical and physiological characteristics of coronary vasculature. When combined with the 4D NCAT phantom, a computer model for the human anatomy and cardiac and respiratory motions, the new model will provide a unique tool to study cardiovascular characteristics and diseases through direct and medical imaging simulation studies.

Two major problems with the current electrocardiogram-gated cardiac CT imaging technique are a large patient radiation dose and insufficient temporal resolution. Our long-term goal is to develop new time resolved and low dose cardiac CT imaging techniques that consist of image reconstruction algorithms and estimation methods of the time-dependent motion vector field of the heart from the acquired CT data. Toward this goal, we developed a method that estimates the 2D components of the motion vector field from a sequence of cardiac CT images.