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Background: Cone beam computed tomography (CBCT) provides critical anatomical information for adaptive radiotherapy (ART), especially for tumors in the pelvic region that undergo significant deformation. However, CBCT suffers from inaccurate Hounsfield Unit (HU) values and lower soft tissue contrast. These issues affect the accuracy of pelvic treatment plans and implementation of the treatment, hence requiring correction. Purpose: A novel stacked coarse‐to‐fine model combining Denoising Diffusion Probabilistic Model (DDPM) and spatial‐frequency domain convolution modules is proposed to enhance the imaging quality of CBCT images. Methods: The enhancement of low‐quality CBCT images is divided into two stages. In the coarse stage, the improved DDPM with U‐ConvNeXt architecture is used to complete the denoising task of CBCT images. In the fine stage, the deep convolutional network model jointly constructed by fast Fourier and dilated convolution modules is used to further enhance the image quality in local details and global imaging. Finally, the accurate pseudo‐CT (pCT) images consistent with the size of the original data are obtained. Two hundred fifty paired CBCT‐CT images from cervical and rectal cancer, combined with 200 public dataset cases, were used collectively for training, validation, and testing. Results: To evaluate the anatomical consistency between pCT and real CT, we have used the mean(std) of structure similarity index measure (SSIM), peak signal to noise ratio (PSNR), and normalized cross‐correlation (NCC). The numerical results for the above three metrics comparing the pCT synthesized by the proposed model against real CT for cervical cancer cases were 87.14% (2.91%), 34.02 dB (1.35 dB), and 88.01% (1.82%), respectively. For rectal cancer cases, the corresponding results were 86.06% (2.70%), 33.50 dB (1.41 dB), and 87.44% (1.95%). The paired t‐test analysis between the proposed model and the comparative models (ResUnet, CycleGAN, DDPM, and DDIM) for these metrics revealed statistically significant differences (p < 0.05). The visual results also showed that the anatomical structures between the real CT and the pCT synthesized by the proposed model were closer. For the dosimetric verification, mean absolute error of dosimetry (MAEdoes) values for the maximum dose (Dmax), the minimum dose (Dmin), and the mean dose (Dmean) in the planning target volume (PTV) were analyzed, with results presented as mean (lower quartile, upper quartile). The experimental results show that the values of the above three dosimetry indexes (Dmin, Dmax, and Dmean) for the pCT images synthesized by the proposed model were 0.90% (0.48%, 1.29%), 0.82% (0.47%, 1.17%), and 0.57% (0.44%, 0.67%). Compared with 10 cases of the original CBCT image by Mann–Whitney test (p < 0.05), it also proved that pCT can significantly improve the accuracy of HU values for the dose calculation. Conclusion: The pCT synthesized by the proposed model outperforms the comparative models in numerical accuracy and visualization, promising for ART of pelvic cancers. [ABSTRACT FROM AUTHOR]

In the field of knee imaging, the incorporation of MR-based pseudo-CT synthesis holds the potential to mitigate the need for separate CT scans, simplifying workflows, enhancing patient comfort, and reducing radiation exposure. In this work, we present a novel DL framework, grounded in the development of the Cycle-Consistent Generative Adversarial Network (CycleGAN) method, tailored specifically for the synthesis of pseudo-CT images in knee imaging to surmount the limitations of current methods. Upon visually examining the outcomes, it is evident that the synthesized pseudo-CTs show an excellent quality and high robustness. Despite the limited dataset employed, the method is able to capture the particularities of the bone contours in the resulting image. The experimental Mean Absolute Error (MAE), Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), Zero-Normalized Cross Correlation (ZNCC), Mutual Information (MI), Relative Change (RC), and absolute Relative Change (|RC|) report values of 30.4638 ± 7.4770, 28.1168 ± 1.5245, 0.9230 ± 0.0217, 0.9807 ± 0.0071, 0.8548 ± 0.1019, 0.0055 ± 0.0265, and 0.0302 ± 0.0218 (median ± median absolute deviation), respectively. The voxel-by-voxel correlation plot shows an excellent correlation between pseudo-CT and ground-truth CT Hounsfield units (m = 0.9785; adjusted R 2 = 0.9988; ρ = 0.9849; p < 0.001). The Bland–Altman plot shows that the average of the differences is low (( H U C T − H U p s e u d o − C T = 0.7199 ± 35.2490; 95% confidence interval [−68.3681, 69.8079]). This study represents the first reported effort in the field of MR-based knee pseudo-CT synthesis, shedding light to significantly advance the field of knee imaging. [ABSTRACT FROM AUTHOR]

Purpose/objectives: An artificial intelligence-based pseudo-CT from low-field MR images is proposed and clinically evaluated to unlock the full potential of MRI-guided adaptive radiotherapy for pelvic cancer care. Materials and method: In collaboration with TheraPanacea (TheraPanacea, Paris, France) a pseudo-CT AI-model was generated using end-to-end ensembled self- supervised GANs endowed with cycle consistency using data from 350 pairs of weakly aligned data of pelvis planning CTs and TrueFisp-(0.35T)MRIs. The image accuracy of the generated pCT were evaluated using a retrospective cohort involving 20 test cases coming from eight different institutions (US: 2, EU: 5, AS: 1) and different CT vendors. Reconstruction performance was assessed using the organs at risk used for treatment. Concerning the dosimetric evaluation, twenty- nine prostate cancer patients treated on the low field MR-Linac (ViewRay) at Montpellier Cancer Institute were selected. Planning CTs were non-rigidly registered to the MRIs for each patient. Treatment plans were optimized on the planning CT with a clinical TPS fulfilling all clinical criteria and recalculated on the warped CT (wCT) and the pCT. Three different algorithms were used: AAA, Acuros XB and Monte Carlo. Dose distributions were compared using the global gamma passing rates and dose metrics. Results: The observed average scaled (between maximum and minimum HU values of the CT) difference between the pCT and the planning CT was 33.20 with significant discrepancies across organs. Femoral heads were the most reliably reconstructed (4.51 and 4.77) while anal canal and rectum were the less precise ones (63.08 and 53.13). Mean gamma passing rates for 1%1mm, 2%/2mm, and 3%/3mm tolerance criteria and 10% threshold were greater than 96%, 99% and 99%, respectively, regardless the algorithm used. Dose metrics analysis showed a good agreement between the pCT and the wCT. The mean relative difference were within 1% for the target volumes (CTV and PTV) and 2% for the OARs. Conclusion: This study demonstrated the feasibility of generating clinically acceptable an artificial intelligence-based pseudo CT for low field MR in pelvis with consistent image accuracy and dosimetric results. [ABSTRACT FROM AUTHOR]

In the field of knee imaging, the incorporation of MR-based pseudo-CT synthesis holds the potential to mitigate the need for separate CT scans, simplifying workflows, enhancing patient comfort, and reducing radiation exposure. In this work, we present a novel DL framework, grounded in the development of the Cycle-Consistent Generative Adversarial Network (CycleGAN) method, tailored specifically for the synthesis of pseudo-CT images in knee imaging to surmount the limitations of current methods. Upon visually examining the outcomes, it is evident that the synthesized pseudo-CTs show an excellent quality and high robustness. Despite the limited dataset employed, the method is able to capture the particularities of the bone contours in the resulting image. The experimental Mean Absolute Error (MAE), Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), Zero-Normalized Cross Correlation (ZNCC), Mutual Information (MI), Relative Change (RC), and absolute Relative Change (|RC|) report values of 30.4638 ± 7.4770, 28.1168 ± 1.5245, 0.9230 ± 0.0217, 0.9807 ± 0.0071, 0.8548 ± 0.1019, 0.0055 ± 0.0265, and 0.0302 ± 0.0218 (median ± median absolute deviation), respectively. The voxel-by-voxel correlation plot shows an excellent correlation between pseudo-CT and ground-truth CT Hounsfield units (m = 0.9785; adjusted R2 = 0.9988; ρ = 0.9849; p < 0.001). The Bland–Altman plot shows that the average of the differences is low ((HUCT−HUpseudo−CT = 0.7199 ± 35.2490; 95% confidence interval [−68.3681, 69.8079]). This study represents the first reported effort in the field of MR-based knee pseudo-CT synthesis, shedding light to significantly advance the field of knee imaging.

Purpose/objectivesAn artificial intelligence-based pseudo-CT from low-field MR images is proposed and clinically evaluated to unlock the full potential of MRI-guided adaptive radiotherapy for pelvic cancer care.Materials and methodIn collaboration with TheraPanacea (TheraPanacea, Paris, France) a pseudo-CT AI-model was generated using end-to-end ensembled self-supervised GANs endowed with cycle consistency using data from 350 pairs of weakly aligned data of pelvis planning CTs and TrueFisp-(0.35T)MRIs. The image accuracy of the generated pCT were evaluated using a retrospective cohort involving 20 test cases coming from eight different institutions (US: 2, EU: 5, AS: 1) and different CT vendors. Reconstruction performance was assessed using the organs at risk used for treatment. Concerning the dosimetric evaluation, twenty-nine prostate cancer patients treated on the low field MR-Linac (ViewRay) at Montpellier Cancer Institute were selected. Planning CTs were non-rigidly registered to the MRIs for each patient. Treatment plans were optimized on the planning CT with a clinical TPS fulfilling all clinical criteria and recalculated on the warped CT (wCT) and the pCT. Three different algorithms were used: AAA, AcurosXB and MonteCarlo. Dose distributions were compared using the global gamma passing rates and dose metrics.ResultsThe observed average scaled (between maximum and minimum HU values of the CT) difference between the pCT and the planning CT was 33.20 with significant discrepancies across organs. Femoral heads were the most reliably reconstructed (4.51 and 4.77) while anal canal and rectum were the less precise ones (63.08 and 53.13). Mean gamma passing rates for 1%1mm, 2%/2mm, and 3%/3mm tolerance criteria and 10% threshold were greater than 96%, 99% and 99%, respectively, regardless the algorithm used. Dose metrics analysis showed a good agreement between the pCT and the wCT. The mean relative difference were within 1% for the target volumes (CTV and PTV) and 2% for the OARs.ConclusionThis study demonstrated the feasibility of generating clinically acceptable an artificial intelligence-based pseudo CT for low field MR in pelvis with consistent image accuracy and dosimetric results.

Despite being thirteen years since the installation of the first PET-MR system, the scanners constitute a very small proportion of the total hybrid PET systems installed. This is in stark contrast to the rapid expansion of the PET-CT scanner, which quickly established its importance in patient diagnosis within a similar timeframe. One of the main hurdles is the development of an accurate, reproducible and easy-to-use method for attenuation correction. Quantitative discrepancies in PET images between the manufacturer-provided MR methods and the more established CT- or transmission-based attenuation correction methods have led the scientific community in a continuous effort to develop a robust and accurate alternative. These can be divided into four broad categories: (i) MR-based, (ii) emission-based, (iii) atlas-based and the (iv) machine learning-based attenuation correction, which is rapidly gaining momentum. The first is based on segmenting the MR images in various tissues and allocating a predefined attenuation coefficient for each tissue. Emission-based attenuation correction methods aim in utilising the PET emission data by simultaneously reconstructing the radioactivity distribution and the attenuation image. Atlas-based attenuation correction methods aim to predict a CT or transmission image given an MR image of a new patient, by using databases containing CT or transmission images from the general population. Finally, in machine learning methods, a model that could predict the required image given the acquired MR or non-attenuation-corrected PET image is developed by exploiting the underlying features of the images. Deep learning methods are the dominant approach in this category. Compared to the more traditional machine learning, which uses structured data for building a model, deep learning makes direct use of the acquired images to identify underlying features. This up-to-date review goes through the literature of attenuation correction approaches in PET-MR after categorising them. The various approaches in each category are described and discussed. After exploring each category separately, a general overview is given of the current status and potential future approaches along with a comparison of the four outlined categories. [ABSTRACT FROM AUTHOR]

Introduction: The five-class Dixon-based PET/MR attenuation correction (AC) model, which adds bone information to the four-class model by registering major bones from a bone atlas, has been shown to be error-prone. In this study, we introduce a novel method of accounting for bone in pelvic PET/MR AC by directly predicting the errors in the PET image space caused by the lack of bone in four-class Dixon-based attenuation correction. Methods: A convolutional neural network was trained to predict the four-class AC error map relative to CT-based attenuation correction. Dixon MR images and the four-class attenuation correction µ-map were used as input to the models. CT and PET/MR examinations for 22 patients ([18F]FDG) were used for training and validation, and 17 patients were used for testing (6 [18F]PSMA-1007 and 11 [68Ga]Ga-PSMA-11). A quantitative analysis of PSMA uptake using voxel- and lesion-based error metrics was used to assess performance. Results: In the voxel-based analysis, the proposed model reduced the median root mean squared percentage error from 12.1% and 8.6% for the four- and fiveclass Dixon-based AC methods, respectively, to 6.2%. The median absolute percentage error in the maximum standardized uptake value (SUVmax) in bone lesions improved from 20.0% and 7.0% for four- and five-class Dixon-based AC methods to 3.8%. Conclusion: The proposed method reduces the voxel-based error and SUVmax errors in bone lesions when compared to the four- and five-class Dixon-based AC models. [ABSTRACT FROM AUTHOR]

Background: Magnetic Resonance Imaging (MRI) applications offer superior soft tissue contrast compared with computed tomography (CT) for accurate radiotherapy planning. Although, MRI images suffer from poor image quality and lack electron density for radiation dose calculation. The present study aims to use the deep learning (DL) approach to 1) enhance the quality of MRI images and 2) generate synthetic CT images using MRI images for more accurate radiotherapy planning. Methods: In this paper, the pix2pix Generative Adversarial Network was utilized to synthesize CT images from noisy MRI images of 20 arbitrarily patients with brain disease. The standard statistical measurements investigated the accuracy comparison of the modeled Hounsfield unit (HU) value from MRI images and referenced CT of each patient. The famous quality metrics that were used to compare synthetic CTs and referenced CTs were the mean absolute error (MAE), the structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR(. Results: The higher quality measurements between the synthetic pseudo-CT and the referenced CT images as PSNR, and SSIM, should correlate to the lower MAE value. For the overall brain among blind test data, the measured peak signal-to-noise ratio, mean absolute error, and structural similarity index values were about 16.5, 28.13, and 93.46, respectively. Conclusion: The proposed method provides an acceptable level of statistical measurements computed on the Pseudo-CT and referenced CT, and it could be concluded that the p-CT can be implemented in radiotherapy treatment planning with acceptable accuracy.

This paper provides an overview of the different deep convolutional neural network (DCNNs) architectures that have been investigated in the past years for the generation of synthetic computed tomography (CT) or pseudo-CT from magnetic resonance (MR). The U-net, the Atrous-net and the Residual-net architectures were analyzed, implemented and compared. Each network was implemented using 2D filters and 3D filters with 2D slices and 3D patches respectively as inputs. Two datasets were used for training and evaluation. The first one is composed by pairs of 3D T1-weighted MR and Low-dose CT images from the head of 19 healthy women. The second database contains dual echo Dixon-VIBE MR images and CT images from the pelvis of 13 colorectal and 6 prostate cancer patients. Bone structures in the target anatomy were key in choosing the right deep learning approach. This work provides a deep explanation of the architectures in order to know which DCNN fits better each medical application. According to this study, the 3D U-net architecture would be the best option to generate head pseudo-CTs while the 2D Residual-net provides the most accurate results for the pelvis anatomy. [ABSTRACT FROM AUTHOR]

Purpose: CT is routinely used to detect cranial abnormalities in pediatric patients with head trauma or craniosynostosis. This study aimed to develop a deep learning method to synthesize pseudo‐CT (pCT) images for MR high‐resolution pediatric cranial bone imaging to eliminating ionizing radiation from CT. Methods: 3D golden‐angle stack‐of‐stars MRI were obtained from 44 pediatric participants. Two patch‐based residual UNets were trained using paired MR and CT patches randomly selected from the whole head (NetWH) or in the vicinity of bone, fractures/sutures, or air (NetBA) to synthesize pCT. A third residual UNet was trained to generate a binary brain mask using only MRI. The pCT images from NetWH (pCTNetWH) in the brain area and NetBA (pCTNetBA) in the nonbrain area were combined to generate pCTCom. A manual processing method using inverted MR images was also employed for comparison. Results: pCTCom (68.01 ± 14.83 HU) had significantly smaller mean absolute errors (MAEs) than pCTNetWH (82.58 ± 16.98 HU, P < 0.0001) and pCTNetBA (91.32 ± 17.2 HU, P < 0.0001) in the whole head. Within cranial bone, the MAE of pCTCom (227.92 ± 46.88 HU) was significantly lower than pCTNetWH (287.85 ± 59.46 HU, P < 0.0001) but similar to pCTNetBA (230.20 ± 46.17 HU). Dice similarity coefficient of the segmented bone was significantly higher in pCTCom (0.90 ± 0.02) than in pCTNetWH (0.86 ± 0.04, P < 0.0001), pCTNetBA (0.88 ± 0.03, P < 0.0001), and inverted MR (0.71 ± 0.09, P < 0.0001). Dice similarity coefficient from pCTCom demonstrated significantly reduced age dependence than inverted MRI. Furthermore, pCTCom provided excellent suture and fracture visibility comparable to CT. Conclusion: MR high‐resolution pediatric cranial bone imaging may facilitate the clinical translation of a radiation‐free MR cranial bone imaging method for pediatric patients. [ABSTRACT FROM AUTHOR]

The purpose of this article is to give a summary of the progress of magnetic resonance imaging (MRI) in radiotherapy. MRI is an important imaging modality for treatment planning in radiotherapy. However, the registration step with the simulation scanner can be a source of errors, motivating the implementation of all-MRI simulation methods and new accelerators coupled with on-board MRI. First, practical MRI imaging for radiotherapy is detailed, but also the importance of a coherent imaging workflow incorporating all imaging modalities. Second, future evolutions and research domains such as quantitative imaging biomarkers, MRI-only pseudo computed tomography and radiomics are discussed. Finally, the application of MRI during radiotherapy treatment is reviewed: the use of MR-linear accelerators. MRI is increasingly integrated into radiotherapy. Advances in diagnostic imaging can thus benefit radiotherapy, but specific radiotherapy constraints lead to additional challenges and require close collaboration between radiologists, radiation oncologists, technologists and physicists. The integration of quantitative imaging biomarkers in the radiotherapy process will result in mutual benefit for diagnostic imaging and radiotherapy. MRI-guided radiotherapy has already been used for several years in clinical routine. Abdominopelvic neoplasias (pancreas, liver, prostate) are the preferred locations for treatment because of their favourable contrast in MRI, their movement during irradiation and their proximity to organs at risk of radiation exposure, making the tracking and daily adaptation of the plan essential. MRI has emerged as an increasingly necessary imaging modality for radiotherapy planning. Inclusion of patients in clinical trials evaluating new MRI-guided radiotherapy techniques and associated quantitative imaging biomarkers will be necessary to assess the benefits. [ABSTRACT FROM AUTHOR]

In recent years, research has been showing a great interest in using magnetic resonance imaging (MRI) as the only modality for radiation therapy (RT) for its superior soft-tissue visualisation and non-ionizing proprieties. Furthermore, MRI-only RT would be of great benefit to eliminate image registration errors, reduce cost and workload. In addition, machine-learning algorithms have been taking the lead in many fields. For instance, in MRI-only RT, machine learning is showing a notable performance compared to other methods owed to the flexibility of these methods towards data regardless of model complexity. In this paper, we present an ensemble learning approach with stacked generalisation to simulate a CT scan from multi-modal MR images from which patch-based shape, texture and spatial features were considered. Feature extraction, fusion and reduction were performed to get the most descriptive and informative features. The ensemble learning model was constructed with two levels of learning were the basic level consisted of three base learners namely: artificial neural networks (ANN), random forests (RF) and k-nearest neighbours (kNN) and the second level representing the stacking learner that takes predictions from the base learner and generates the final predictions. Multiple linear regression (MLR) was used for the stacked generalisation. The proposed ensemble learning with stacked generalisation (ES) approach produced an average mean absolute error (MAE) of 87.60 ± 19.70 and an average mean error (ME) of −4.68 ± 16.43 outperforming the RF method, which produced an average MAE of 106.88 ± 33.20 and an average ME of −5.38 ± 20.77. In addition, average Pearson correlation was 0.92 for the proposed approach compared to 0.89 for RF. Evaluation of the proposed approach shows that stacked generalisation can greatly improve prediction accuracy and reduce bias in electron density estimation.

Recently,deep learning (DL)‐based methods for the generation of synthetic computed tomography (sCT) have received significant research attention as an alternative to classical ones. We present here a systematic review of these methods by grouping them into three categories, according to their clinical applications: (i) to replace computed tomography in magnetic resonance (MR) based treatment planning, (ii) facilitate cone‐beam computed tomography based image‐guided adaptive radiotherapy, and (iii) derive attenuation maps for the correction of positron emission tomography. Appropriate database searching was performed on journal articles published between January 2014 and December 2020. The DL methods' key characteristics were extracted from each eligible study, and a comprehensive comparison among network architectures and metrics was reported. A detailed review of each category was given, highlighting essential contributions, identifying specific challenges, and summarizing the achievements. Lastly, the statistics of all the cited works from various aspects were analyzed, revealing the popularity and future trends and the potential of DL‐based sCT generation. The current status of DL‐based sCT generation was evaluated, assessing the clinical readiness of the presented methods. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the different deep convolutional neural network (DCNNs) architectures that have been investigated in the past years for the generation of synthetic computed tomography (CT) or pseudo-CT from magnetic resonance (MR). The U-net, the Atrous-net and the Residual-net architectures were analyzed, implemented and compared. Each network was implemented using 2D filters and 3D filters with 2D slices and 3D patches respectively as inputs. Two datasets were used for training and evaluation. The first one is composed by pairs of 3D T1-weighted MR and Low-dose CT images from the head of 19 healthy women. The second database contains dual echo Dixon-VIBE MR images and CT images from the pelvis of 13 colorectal and 6 prostate cancer patients. Bone structures in the target anatomy were key in choosing the right deep learning approach. This work provides a deep explanation of the architectures in order to know which DCNN fits better each medical application. According to this study, the 3D U-net architecture would be the best option to generate head pseudo-CTs while the 2D Residual-net provides the most accurate results for the pelvis anatomy.

In recent years, research has been showing a great interest in using magnetic resonance imaging (MRI) as the only modality for radiation therapy (RT) for its superior soft-tissue visualisation and non-ionizing proprieties. Furthermore, MRI-only RT would be of great benefit to eliminate image registration errors, reduce cost and workload. In addition, machine-learning algorithms have been taking the lead in many fields. For instance, in MRI-only RT, machine learning is showing a notable performance compared to other methods owed to the flexibility of these methods towards data regardless of model complexity. In this paper, we present an ensemble learning approach with stacked generalisation to simulate a CT scan from multi-modal MR images from which patch-based shape, texture and spatial features were considered. Feature extraction, fusion and reduction were performed to get the most descriptive and informative features. The ensemble learning model was constructed with two levels of learning were the basic level consisted of three base learners namely: artificial neural networks (ANN), random forests (RF) and k -nearest neighbours (k NN) and the second level representing the stacking learner that takes predictions from the base learner and generates the final predictions. Multiple linear regression (MLR) was used for the stacked generalisation. The proposed ensemble learning with stacked generalisation (ES) approach produced an average mean absolute error (MAE) of 87.60 ± 19.70 and an average mean error (ME) of −4.68 ± 16.43 outperforming the RF method, which produced an average MAE of 106.88 ± 33.20 and an average ME of −5.38 ± 20.77. In addition, average Pearson correlation was 0.92 for the proposed approach compared to 0.89 for RF. Evaluation of the proposed approach shows that stacked generalisation can greatly improve prediction accuracy and reduce bias in electron density estimation. [ABSTRACT FROM AUTHOR]

Featured Application: The Franken-CT approach allows synthesizing pseudo-CT images from using diverse anatomical overlapping MR-CT datasets as a potential application in PET/MR attenuation correction. Typically, pseudo-Computerized Tomography (CT) synthesis schemes proposed in the literature rely on complete atlases acquired with the same field of view (FOV) as the input volume. However, clinical CTs are usually acquired in a reduced FOV to decrease patient ionization. In this work, we present the Franken-CT approach, showing how the use of a non-parametric atlas composed of diverse anatomical overlapping Magnetic Resonance (MR)-CT scans and deep learning methods based on the U-net architecture enable synthesizing extended head and neck pseudo-CTs. Visual inspection of the results shows the high quality of the pseudo-CT and the robustness of the method, which is able to capture the details of the bone contours despite synthesizing the resulting image from knowledge obtained from images acquired with a completely different FOV. The experimental Zero-Normalized Cross-Correlation (ZNCC) reports 0.9367 ± 0.0138 (mean ± SD) and 95% confidence interval (0.9221, 0.9512); the experimental Mean Absolute Error (MAE) reports 73.9149 ± 9.2101 HU and 95% confidence interval (66.3383, 81.4915); the Structural Similarity Index Measure (SSIM) reports 0.9943 ± 0.0009 and 95% confidence interval (0.9935, 0.9951); and the experimental Dice coefficient for bone tissue reports 0.7051 ± 0.1126 and 95% confidence interval (0.6125, 0.7977). The voxel-by-voxel correlation plot shows an excellent correlation between pseudo-CT and ground-truth CT Hounsfield Units (m = 0.87; adjusted R2 = 0.91; p < 0.001). The Bland–Altman plot shows that the average of the differences is low (−38.6471 ± 199.6100; 95% CI (−429.8827, 352.5884)). This work serves as a proof of concept to demonstrate the great potential of deep learning methods for pseudo-CT synthesis and their great potential using real clinical datasets. [ABSTRACT FROM AUTHOR]

Magnetic resonance (MR) images have distinctive advantages in radiation treatment (RT) planning due to their superior, anatomic and functional information compared with computed tomography (CT). For the RT dose calculation, MR images cannot be directly used because of the lack of electron density information. To address this issue, we propose to generate pseudo-CT (pCT) in terms of multiple matching Dixon MR images to support MR-only RT, particularly in the challenging body section of the abdomen. To this end, we design the dedicated multichannel residual conditional generative adversarial network (MCRCGAN). The significance of our efforts is three-fold: 1) The MCRCGAN organically incorporates multiple theories and techniques, such as multichannel residual network (ResNet) and conditional generative adversarial network (cGAN), which facilitate its more authentic pCT generation than many existing methods. 2) The usage of residual modules effectively deepens the network without performance degradation, and the multichannel ResNet helps to simultaneously capture the substance of images, as extensively as possible, which is implicitly contained in the multiple different MR images of the same subject. 3) Due to the designed dedicated network structure, the MCRCGAN is capable of generating satisfactory pCTs under the condition of limited training data as well as prompt prediction response. Experimental studies on ten patients' paired MR-CT images demonstrate the effectiveness of our proposed MCRCGAN model on both the pCT generation quality and the performance stability.

In this study, an anatomic semantic guided neural style transfer (ASGNST) algorithm was developed and pseudo-computed tomography (CT) images synthesized in steps. CT images and ultrasound (US) images of 20 cervical cancer patients to be treated were selected. The foreground (FG) and background (BG) regions of the US images were segmented by the region growth method, and three objective functions for content, style, and contour loss were defined. Based on the two types of regions, a local pseudo-CT image synthesis model based on a convolution neural network was established. Then, global 2D pseudo-CT images were obtained using the weighted average fusing algorithm, and the final pseudo-CT images were obtained through 3D reconstruction. US phantom and data of five additional cervical cancer patients were used for prediction. Furthermore, three image synthesis algorithms-global deformation field (GDF), stepwise local deformation field (SLDF), and neural style transfer (NST)-were selected for comparative verification. The pseudo-CT images synthesized by the four algorithms were compared with the ground-truth CT images obtained during treatment. The structural similarity index between the ground-truth CT and pseudo-CT synthesized by the improved algorithm significantly differed from those synthesized by the other three algorithms (tGDF_bg = 7.175, tSLDF_bg = 4.513, tNST_bg = 3.228, tGDF_fg = 10.518, tSLDF_fg = 5.522, tNST_fg = 2.869, p

Background: One of the challenges of PET/MRI combined systems is to derive an attenuation map to correct the PET image. For that, the pseudo-CT image could be used to correct the attenuation. Until now, most existing scientific researches construct this pseudo-CT image using the registration techniques. However, these techniques suffer from the local minima of the non-rigid deformation energy function which leads to unsatisfactory results. Objective: We propose in this paper a new approach for the generation of a pseudo-CT image from an MR image. Materials and Methods: This approach is based on a dense stereo matching concept, for that, we encode each pixel according to a shape related coordinates method, and we apply a local texture descriptor to put into correspondence pixels between MRI patient and MRI atlas images. The proposed approach was tested on a real MRI data, and in order to show the effectiveness of the proposed local descriptor, it has been compared to three other local descriptors: SIFT, SURF and DAISY. Also it was compared to registration method. Results: The calculation of structural similarity (SSIM) index and DICE coefficients, between the pseudo-CT image and the corresponding real CT image show that the proposed stereo matching approach outperforms a registration one. Conclusion: The use of dense matching with atlas promises good results in the creation of pseudo-CT. The proposed approach can be recommended as an alternative to registration techniques.

Purpose: Estimation of accurate attenuation maps for whole-body positron emission tomography (PET) imaging in simultaneous PET-MRI systems is a challenging problem as it affects the quantitative nature of the modality. In this study, we aimed to improve the accuracy of estimated attenuation maps from MRI Dixon contrast images by training an augmented generative adversarial network (GANs) in a supervised manner. We augmented the GANs by perturbing the non-linear deformation field during image registration between MRI and the ground truth CT images. Methods: We acquired the CT and the corresponding PET-MR images for a cohort of 28 prostate cancer patients. Data from 18 patients (2160 slices and later augmented to 270,000 slices) was used for training the GANs and others for validation. We calculated the error in bone and soft tissue regions for the AC μ-maps and the reconstructed PET images. Results: For quantitative analysis, we use the average relative absolute errors and validate the proposed technique on 10 patients. The DL-based MR methods generated the pseudo-CT AC μ-maps with an accuracy of 4.5% more than standard MR-based techniques. Particularly, the proposed method demonstrates improved accuracy in the pelvic regions without affecting the uptake values. The lowest error of the AC μ-map in the pelvic region was 1.9% for μ-mapGAN + aug compared with 6.4% for μ-mapdixon, 5.9% for μ-mapdixon + bone, 2.1% for μ-mapU-Net and 2.0% for μ-mapU-Net + aug. For the reconstructed PET images, the lowest error was 2.2% for PETGAN + aug compared with 10.3% for PETdixon, 8.7% for PETdixon + bone, 2.6% for PETU-Net and 2.4% for PETU-Net + aug.. Conclusion: The proposed technique to augment the training datasets for training of the GAN results in improved accuracy of the estimated μ-map and consequently the PET quantification compared to the state of the art. [ABSTRACT FROM AUTHOR]

Despite the extensive attention attracted by magnetic resonance imaging (MRI) in the radiation therapy, computed tomography was reintroduced by the researchers. During the calculation process of the 3D dose distribution of tissues, there were some arguments about the electron density information obtained from the CT scan. However, the CT-provided bones are accurate for constructing a radiograph. Recently, the advantages boosted by the soft tissue contrast relying on MRI and as well as the advantages boosted by CT imaging have been combined by the using of MRI/CT. Unfortunately, disadvantages still exist in the MRI/CT workflow because the voxel-intensities are unbalanced in the MRI and the CT scan. Here, based on the mapping method of CT and MRI, the potential of pseudo-CT (PCT) instead of CT planning was studied. The estimated PCT only from the corresponding MRI was obtained by using the patch-based random forest regression. The CT voxel target was trained by 3D Gabor feature in the MRI cube and the Local Binary Pattern (LBP). Besides, the regression task was solved by the alternative regression forest. According to the experiment, the method performs better than the current dictionary learning-based (DLB) method or atlas-based (AB) method. [ABSTRACT FROM AUTHOR]

The aim of this study is to construct and evaluate Pseudo-CT images (P-CTs) for electron density calculation to facilitate external radiotherapy treatment planning. Despite numerous benefits, computed tomography (CT) scan does not provide accurate information on soft tissue contrast, which often makes it difficult to precisely differentiate target tissues from the organs at risk and determine the tumor volume. Therefore, MRI imaging can reduce the variability of results when registering with a CT scan. In this research, a fuzzy clustering algorithm was used to segment images into different tissues, also linear regression methods were used to design the regression model based on the feature extraction method and the brightness intensity values. The results of the proposed algorithm for dose-volume histogram (DVH), Isodose curves, and gamma analysis were investigated using the RayPlan treatment planning system, and VeriSoft software. Furthermore, various statistical indices such as Mean Absolute Error (MAE), Mean Error (ME), and Structural Similarity Index (SSIM) were calculated. The MAE of a range of 45–55 was found from the proposed methods. The relative difference error between the PTV region of the CT and the Pseudo-CT was 0.5, and the best gamma rate was 95.4% based on the polar coordinate feature and proposed polynomial regression model. The proposed method could support the generation of P-CT data for different parts of the brain region from a collection of MRI series with an acceptable average error rate by different evaluation criteria. [ABSTRACT FROM AUTHOR]

In context of head-and-neck radiotherapy, this study aims to compare MR image quality according to diagnostic (DIAG) and radiotherapy (RT) setups; and to optimise an MRI-protocol (including 3D T 1 and T 2 -weighted sequences) for dose-planning (based on pseudo-CT generation). To compare DIAG and RT setups, signal-to-noise-ratio (SNR) and percentage-image-uniformity (PIU) were computed on T 1 images of phantoms and volunteers. Influence of the sample conductivity on SNR was quantified using homemade phantoms. To obtain reliable T 1 and T 2 images for RT-planning, an experimental design was performed on volunteers by using SNR, contrast-to-noise-ratio (CNR) and mean-opinion-score (MOS). Further, pseudo-CTs were generated from 8 patients T 2 images with a state-of-art deep-learning method. These pseudo-CTs were evaluated by mean-absolute-error (MAE) and mean-error (ME). SNR was higher for DIAG-setup compared to RT-setup (SNR-ratio = 1.3). A clear influence of the conductivity on SNR was observed. PIU was higher for DIAG-setup (38.8%) compared to RT-setup (33.5%). Regarding the protocol optimisation, SNR, CNR, and MOS were 20.6, 6.16, and 3.91 for the optimal T 1 sequence. For the optimal T 2 sequence, SNR, CNR and MOS were 25.6, 44.46 and 4.0. In the whole head-and-neck area, the mean MAE and ME of the pseudo-CTs were 82.8 and -3.9 HU. We quantified the image quality decrease induces by using an RT-setup for head-and-neck radiotherapy. To compensate this decrease, an MRI protocol was optimised by using an experimental design. This protocol of 15 minutes provides accurate images which could be used for MRI-dose-planning in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To develop and evaluate a novel method for pseudo‐CT generation from multi‐parametric MR images using multi‐channel multi‐path generative adversarial network (MCMP‐GAN). Methods: Pre‐ and post‐contrast T1‐weighted (T1‐w), T2‐weighted (T2‐w) MRI, and treatment planning CT images of 32 nasopharyngeal carcinoma (NPC) patients were employed to train a pixel‐to‐pixel MCMP‐GAN. The network was developed based on a 5‐level Residual U‐Net (ResU‐Net) with the channel‐based independent feature extraction network to generate pseudo‐CT images from multi‐parametric MR images. The discriminator with five convolutional layers was added to distinguish between the real CT and pseudo‐CT images, improving the nonlinearity and prediction accuracy of the model. Eightfold cross validation was implemented to validate the proposed MCMP‐GAN. The pseudo‐CT images were evaluated against the corresponding planning CT images based on mean absolute error (MAE), peak signal‐to‐noise ratio (PSNR), Dice similarity coefficient (DSC), and Structural similarity index (SSIM). Similar comparisons were also performed against the multi‐channel single‐path GAN (MCSP‐GAN), the single‐channel single‐path GAN (SCSP‐GAN). Results: It took approximately 20 h to train the MCMP‐GAN model on a Quadro P6000, and less than 10 s to generate all pseudo‐CT images for the subjects in the test set. The average head MAE between pseudo‐CT and planning CT was 75.7 ± 14.6 Hounsfield Units (HU) for MCMP‐GAN, significantly (P‐values < 0.05) lower than that for MCSP‐GAN (79.2 ± 13.0 HU) and SCSP‐GAN (85.8 ± 14.3 HU). For bone only, the MCMP‐GAN yielded a smaller mean MAE (194.6 ± 38.9 HU) than MCSP‐GAN (203.7 ± 33.1 HU), SCSP‐GAN (227.0 ± 36.7 HU). The average PSNR of MCMP‐GAN (29.1 ± 1.6) was found to be higher than that of MCSP‐GAN (28.8 ± 1.2) and SCSP‐GAN (28.2 ± 1.3). In terms of metrics for image similarity, MCMP‐GAN achieved the highest SSIM (0.92 ± 0.02) but did not show significantly improved bone DSC results in comparison with MCSP‐GAN. Conclusions: We developed a novel multi‐channel GAN approach for generating pseudo‐CT from multi‐parametric MR images. Our preliminary results in NPC patients showed that the MCMP‐GAN method performed apparently superior to the U‐Net‐GAN and SCSP‐GAN, and slightly better than MCSP‐GAN. [ABSTRACT FROM AUTHOR]

Medical image synthesis represents a critical area of research in clinical decision-making, aiming to overcome the challenges associated with acquiring multiple image modalities for an accurate clinical workflow. This approach proves beneficial in estimating an image of a desired modality from a given source modality among the most common medical imaging contrasts, such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET). However, translating between two image modalities presents difficulties due to the complex and non-linear domain mappings. Deep learning-based generative modelling has exhibited superior performance in synthetic image contrast applications compared to conventional image synthesis methods. This survey comprehensively reviews deep learning-based medical imaging translation from 2018 to 2023 on pseudo-CT, synthetic MR, and synthetic PET. We provide an overview of synthetic contrasts in medical imaging and the most frequently employed deep learning networks for medical image synthesis. Additionally, we conduct a detailed analysis of each synthesis method, focusing on their diverse model designs based on input domains and network architectures. We also analyse novel network architectures, ranging from conventional CNNs to the recent Transformer and Diffusion models. This analysis includes comparing loss functions, available datasets and anatomical regions, and image quality assessments and performance in other downstream tasks. Finally, we discuss the challenges and identify solutions within the literature, suggesting possible future directions. We hope that the insights offered in this survey paper will serve as a valuable roadmap for researchers in the field of medical image synthesis. • A comprehensive review of deep learning-based synthetic MRI, CT, and PET. • We analyse distinct network architectures in medical image synthesis. • We explore datasets, imaging modalities, and loss functions used in network training. • Finally, we assess network performances discussing challenges and future directions. [ABSTRACT FROM AUTHOR]

Purpose: This project investigates the feasibility of implementation of MRI-only prostate planning in a prospective multi-center study.Method and Materials: A two-phase implementation model was utilized where centers performed retrospective analysis of MRI-only plans for five patients followed by prospective MRI-only planning for subsequent patients. Feasibility was assessed if at least 23/25 patients recruited to phase 2 received MRI-only treatment workflow. Whole-pelvic MRI scans (T2 weighted, isotropic 1.6 mm voxel 3D sequence) were converted to pseudo-CT using an established atlas-based method. Dose plans were generated using MRI contoured anatomy with pseudo-CT for dose calculation. A conventional CT scan was acquired subsequent to MRI-only plan approval for quality assurance purposes (QA-CT). 3D Gamma evaluation was performed between pseudo-CT calculated plan dose and recalculation on QA-CT. Criteria was 2%, 2 mm criteria with 20% low dose threshold. Gold fiducial marker positions for image guidance were compared between pseudo-CT and QA-CT scan prior to treatment.Results: All 25 patients recruited to phase 2 were treated using the MRI-only workflow. Isocenter dose differences between pseudo-CT and QA-CT were −0.04 ± 0.93% (mean ± SD). 3D Gamma dose comparison pass-rates were 99.7% ± 0.5% with mean gamma 0.22 ± 0.07. Results were similar for the two centers using two different scanners. All gamma comparisons exceeded the 90% pass-rate tolerance with a minimum gamma pass-rate of 98.0%. In all cases the gold fiducial markers were correctly identified on MRI and the distances of all seeds to centroid were within the tolerance of 1.0 mm of the distances on QA-CT (0.07 ± 0.41 mm), with a root-mean-square difference of 0.42 mm.Conclusion: The results support the hypothesis that an MRI-only prostate workflow can be implemented safely and accurately with appropriate quality assurance methods.

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Purpose: This project investigates the feasibility of implementation of MRI-only prostate planning in a prospective multi-center study. Method and Materials: A two-phase implementation model was utilized where centers performed retrospective analysis of MRI-only plans for five patients followed by prospective MRI-only planning for subsequent patients. Feasibility was assessed if at least 23/25 patients recruited to phase 2 received MRI-only treatment workflow. Whole-pelvic MRI scans (T2 weighted, isotropic 1.6 mm voxel 3D sequence) were converted to pseudo-CT using an established atlas-based method. Dose plans were generated using MRI contoured anatomy with pseudo-CT for dose calculation. A conventional CT scan was acquired subsequent to MRI-only plan approval for quality assurance purposes (QA-CT). 3D Gamma evaluation was performed between pseudo-CT calculated plan dose and recalculation on QA-CT. Criteria was 2%, 2 mm criteria with 20% low dose threshold. Gold fiducial marker positions for image guidance were compared between pseudo-CT and QA-CT scan prior to treatment. Results: All 25 patients recruited to phase 2 were treated using the MRI-only workflow. Isocenter dose differences between pseudo-CT and QA-CT were −0.04 ± 0.93% (mean ± SD). 3D Gamma dose comparison pass-rates were 99.7% ± 0.5% with mean gamma 0.22 ± 0.07. Results were similar for the two centers using two different scanners. All gamma comparisons exceeded the 90% pass-rate tolerance with a minimum gamma pass-rate of 98.0%. In all cases the gold fiducial markers were correctly identified on MRI and the distances of all seeds to centroid were within the tolerance of 1.0 mm of the distances on QA-CT (0.07 ± 0.41 mm), with a root-mean-square difference of 0.42 mm. Conclusion: The results support the hypothesis that an MRI-only prostate workflow can be implemented safely and accurately with appropriate quality assurance methods. [ABSTRACT FROM AUTHOR]

The purpose of this study is to create a new pseudo-computed tomography (CT) imaging approach under superposed ultrasound (US) deformation fields based on step-by-step local registration. Scanned CT and US 3D image datasets of three patients with postoperative cervical carcinoma were selected, including CT (CTsim) and US images (USsim) acquired during simulated positioning process and cone beam CT (CBCT) and US images for positioning verification (USpv) acquired after treatment for 10 times. Regions of interest such as urinary bladders were segmented out and accepted local registration to obtain different deformation fields. These deformation fields were successively performed according to their order and then applied to localized CT images to obtain pseudo-CT (CTps). After filtering, we obtained the final correct pseudo-CT (CTpsf). The pseudo-CT based on the mask of the whole imaging region of US images (WCTps) were acquired as control. Then, we compared CTpsf, CTps, WCTps, and CBCT in terms of their similarity in anatomical structure and differences in pseudo-CT and CTsim in terms of dosimetry. Structural similarity degree between CTpsf and CBCT was larger compared with that between CTps and WCTps. Target regions and dosages of endangered organs between CTpsf and CTsim were different under the same calculation conditions based on the Monte Carlo algorithm. Compared with the VMAT plan of CTsim, the pass rate of CTpsf in γ analysis under the standards of 2% dosage difference and 2-mm distance difference was 91.8%. The imaging quality of CTpsf was better compared with WCTps and CTps. It exhibited high similarity with CBCT in anatomical structure and had favorable application prospect in adaptive radiotherapy. Graphical abstract The local deformation registration is performed between the ultrasound images based on different regions of interest, and then stepwise applied to localized CT images to obtain pseudo-CT. After filtering, the corrected pseudo CT image is obtained. [ABSTRACT FROM AUTHOR]

Typically, pseudo-Computerized Tomography (CT) synthesis schemes proposed in the literature rely on complete atlases acquired with the same field of view (FOV) as the input volume. However, clinical CTs are usually acquired in a reduced FOV to decrease patient ionization. In this work, we present the Franken-CT approach, showing how the use of a non-parametric atlas composed of diverse anatomical overlapping Magnetic Resonance (MR)-CT scans and deep learning methods based on the U-net architecture enable synthesizing extended head and neck pseudo-CTs. Visual inspection of the results shows the high quality of the pseudo-CT and the robustness of the method, which is able to capture the details of the bone contours despite synthesizing the resulting image from knowledge obtained from images acquired with a completely different FOV. The experimental Zero-Normalized Cross-Correlation (ZNCC) reports 0.9367 ± 0.0138 (mean ± SD) and 95% confidence interval (0.9221, 0.9512); the experimental Mean Absolute Error (MAE) reports 73.9149 ± 9.2101 HU and 95% confidence interval (66.3383, 81.4915); the Structural Similarity Index Measure (SSIM) reports 0.9943 ± 0.0009 and 95% confidence interval (0.9935, 0.9951); and the experimental Dice coefficient for bone tissue reports 0.7051 ± 0.1126 and 95% confidence interval (0.6125, 0.7977). The voxel-by-voxel correlation plot shows an excellent correlation between pseudo-CT and ground-truth CT Hounsfield Units (m = 0.87; adjusted R2 = 0.91; p < 0.001). The Bland–Altman plot shows that the average of the differences is low (−38.6471 ± 199.6100; 95% CI (−429.8827, 352.5884)). This work serves as a proof of concept to demonstrate the great potential of deep learning methods for pseudo-CT synthesis and their great potential using real clinical datasets.

Purpose: To describe a method for converting Zero TE (ZTE) MR images into X‐ray attenuation information in the form of pseudo‐CT images and demonstrate its performance for (1) attenuation correction (AC) in PET/MR and (2) dose planning in MR‐guided radiation therapy planning (RTP). Methods: Proton density‐weighted ZTE images were acquired as input for MR‐based pseudo‐CT conversion, providing (1) efficient capture of short‐lived bone signals, (2) flat soft‐tissue contrast, and (3) fast and robust 3D MR imaging. After bias correction and normalization, the images were segmented into bone, soft‐tissue, and air by means of thresholding and morphological refinements. Fixed Hounsfield replacement values were assigned for air (‐1000 HU) and soft‐tissue (+42 HU), whereas continuous linear mapping was used for bone. Results: The obtained ZTE‐derived pseudo‐CT images accurately resembled the true CT images (i.e., Dice coefficient for bone overlap of 0.73 ± 0.08 and mean absolute error of 123 ± 25 HU evaluated over the whole head, including errors from residual registration mismatches in the neck and mouth regions). The linear bone mapping accounted for bone density variations. Averaged across five patients, ZTE‐based AC demonstrated a PET error of ‐0.04 ± 1.68% relative to CT‐based AC. Similarly, for RTP assessed in eight patients, the absolute dose difference over the target volume was found to be 0.23 ± 0.42%. Conclusion: The described method enables MR to pseudo‐CT image conversion for the head in an accurate, robust, and fast manner without relying on anatomical prior knowledge. Potential applications include PET/MR‐AC, and MR‐guided RTP. [ABSTRACT FROM AUTHOR]

Background: One of the challenges of PET/MRI combined systems is to derive an attenuation map to correct the PET image. For that, the pseudo-CT image could be used to correct the attenuation. Until now, most existing scientific researches construct this pseudo-CT image using the registration techniques. However, these techniques suffer from the local minima of the non-rigid deformation energy function which leads to unsatisfactory results. Objective: We propose in this paper a new approach for the generation of a pseudo-CT image from an MR image. Materials and Methods: This approach is based on a dense stereo matching concept, for that, we encode each pixel according to a shape related coordinates method, and we apply a local texture descriptor to put into correspondence pixels between MRI patient and MRI atlas images. The proposed approach was tested on a real MRI data, and in order to show the effectiveness of the proposed local descriptor, it has been compared to three other local descriptors: SIFT, SURF and DAISY. Also it was compared to registration method. Results: The calculation of structural similarity (SSIM) index and DICE coefficients, between the pseudo-CT image and the corresponding real CT image show that the proposed stereo matching approach outperforms a registration one. Conclusion: The use of dense matching with atlas promises good results in the creation of pseudo-CT. The proposed approach can be recommended as an alternative to registration techniques. [ABSTRACT FROM AUTHOR]

Purpose To characterize the spectral parameters of tissues with high spectral and spatial resolution magnetic resonance images to be used as a foundation for a classification-based synthetic CT algorithm. Methods A phantom was constructed consisting of a section of fresh beef leg with bone embedded in 1% agarose gel. The high spectral and spatial (HiSS) resolution MR imaging sequence used had 1.0 mm in-plane resolution and 11.1 Hz spectral resolution. This sequence was used to image the phantom and one patient. Post-processing was performed off-line with IDL and included Fourier transformation of the time-domain data, labeling of fat and water peaks, and fitting the magnitude spectra with Lorentzian functions. Images of the peak height and peak integral of both the water and fat resonances were generated and analyzed. Several regions-of-interest (ROIs) were identified in phantom: bone marrow, cortical bone, adipose tissue, muscle, agar gel, and air; in the patient, no agar gel was present but an ROI of saline in the bladder was analyzed. All spectra were normalized by the noise within each voxel; thus, all parameters are reported in terms of signal-to-noise (SNR). The distributions of tissue spectral parameters were analyzed and scatterplots generated. Water peak height in cortical bone was compared to air using a nonparametric t-test. Composition of the various ROIs in terms of water, fat, or fat and water was also reported. Results In phantom, the scatterplot of peak height (water versus fat) showed good separation of bone marrow and adipose tissue. Water versus fat integral scatterplot showed better separation of muscle and cortical bone than the peak height scatterplot. In the patient data, the distributions of water and fat peak heights were similar to that in phantom, with more overlap of bone marrow and cortical bone than observed in phantom. The relationship between bone marrow and cortical bone for peak integral was better separated than those of peak heights in the patient data. For both the phantom and patient, there was a significant amount of overlap in spectral parameters of cortical bone versus air. Conclusion These results show promising results for utilizing HiSS imaging in a classification-based synthetic CT algorithm. Cortical bone and air overlap was expected due to the short T2* of bone; reducing early echo times would improve the SNR in bone and image data from these early echoes could help differentiate these tissue types. Further studies need to be done with the goal of better separation of air and bone, and to extend the concept to volumetric imaging before it can be clinically applied. [ABSTRACT FROM AUTHOR]

Purpose: Magnetic resonance imaging (MRI)-only radiotherapy treatment planning requires accurate pseudo-CT (pCT) images for precise dose calculation. The current work introduced an atlas-based method combined with MR intensity information. pCT analyses and Monte Carlo dose calculations for intracranial stereotactic treatments were performed. Methods: Twenty-two patients, representing 35 tumor targets, were scanned using a 3D T1-weighted MRI sequence according to the clinical protocol. The MR atlas image was registered to the MR patient image using a deformable algorithm, and the deformation was then applied to the atlas CT. Two methods were applied. The first method (MRdef) was based on deformations only, while the second (MRint) also used the actual MR intensities. pCT analysis was performed using the mean (absolute) error, as well as an in-house tool based on a gamma index. Dose differences between pCT and true CT were analyzed using dose-volume histogram (DVH) parameters, statistical tests, the gamma index, and probability density functions. An unusual case, where the patient underwent an operation (part of the skull bone was removed), was studied in detail. Results: Soft tissues presented a mean error inferior to 50 HUs, while low-density tissues and bones presented discrepancies up to 600 HUs for hard bone. The MRdef method led to significant dose differences compared with the true CT (p-value < 0.05; Wilcoxon-signed-rank test). The MRint method performed better. The DVH parameter differences compared with CT were between -2.9% and 3.1%, except for two cases where the tumors were located within the sphenoid bone. For these cases, the dose errors were up to 6.6% and 5.4% (D98 and D95). Furthermore, for 85% of the tested patients, the mean dose to the planning target volume agreed within 2% with the calculation using the actual CT. Fictitious bone was generated in the unusual case using atlas-based methods. Conclusions: Generally, the atlas-based method led to acceptable dose distributions. The use of common T1 sequences allows the implementation of this method in clinical routine. However, unusual patient anatomy may produce large dose calculation errors. The detection of large anatomic discrepancies using MR image subtraction can be realized, but an alternative way to produce synthetic CT numbers in these regions is still required. [ABSTRACT FROM AUTHOR]

Purpose: In radiotherapy based only on magnetic resonance imaging (MRI), knowledge about tissue electron densities must be derived from the MRI. This can be achieved by converting the MRI scan to the so-called pseudo-computed tomography (pCT). An obstacle is that the voxel intensities in conventional MRI scans are not uniquely related to electron density. The authors previously demonstrated that a patch-based method could produce accurate pCTs of the brain using conventional T1-weighted MRI scans. The method was driven mainly by local patch similarities and relied on simple affine registrations between an atlas database of the co-registered MRI/CT scan pairs and the MRI scan to be converted. In this study, the authors investigate the applicability of the patch-based approach in the pelvis. This region is challenging for a method based on local similarities due to the greater inter-patient variation. The authors benchmark the method against a baseline pCT strategy where all voxels inside the body contour are assigned a water-equivalent bulk density. Furthermore, the authors implement a parallelized approximate patch search strategy to speed up the pCT generation time to a more clinically relevant level. Methods: The data consisted of CT and T1-weighted MRI scans of 10 prostate patients. pCTs were generated using an approximate patch search algorithm in a leave-one-out fashion and compared with the CT using frequently described metrics such as the voxel-wise mean absolute error (MAEvox) and the deviation in water-equivalent path lengths. Furthermore, the dosimetric accuracy was tested for a volumetric modulated arc therapy plan using dose-volume histogram (DVH) point deviations and γ-index analysis. Results: The patch-based approach had an average MAEvox of 54 HU; median deviations of less than 0.4% in relevant DVH points and a γ-index pass rate of 0.97 using a 1%/1 mm criterion. The patch-based approach showed a significantly better performance than the baseline water pCT in almost all metrics. The approximate patch search strategy was 70x faster than a brute-force search, with an average prediction time of 20.8 min. Conclusions: The authors showed that a patch-based method based on affine registrations and T1-weighted MRI could generate accurate pCTs of the pelvis. The main source of differences between pCT and CT was positional changes of air pockets and body outline. [ABSTRACT FROM AUTHOR]

The interface for a capacitive 2-axis micro-gyroscope is implemented in a 0.35-\mum HVCMOS technology with a total area of 4.3 mm^2. The ASIC comprises the complete analog interface electronics for the gyroscope, while the focus of the design is in maintaining low supply current and in reducing the chip area. The paper reports the design of reference circuits, high-voltage generation, drive-loop and the capacitive open-loop readout circuits. The prototype sensor that is measured is assembled by directly wire-bonding the stacked dies comprising the interface electronics and the sensor element. The noise floors of the two sensors are 0.028^\circ/s/\sqrt\Hz for z-axis and 0.032^\circ/s/\sqrt\Hz for y-axis. The supply current of the chip is 2.2 mA from a 3 V-supply. [ABSTRACT FROM AUTHOR]

The interface for a capacitive 2-axis micro-gyroscope is implemented in a 0.35-μm HVCMOS technology with an active area of 2.5 mm². Compared to a regular continuous-time interface with large on-chip RC time constants, the reduction of the chip area is made possible by the pseudo-continuous-time readout technique, of which a detailed analysis is presented in this paper. The technique allows a dc biasing voltage to be used for the detection and does not require any large RC time constants to be implemented. For the sensor that was implemented the x- and y axis noise floors are 0.015°/s/√Hz and 0.041°/s/√Hz The supply current and voltage for the chip, including the charge pump and the drive and sense interfaces, are 1.8 mA and 2.5-3.6 V, respectively. The supply current of a single sense readout channel is approximately 0.4 mA. [ABSTRACT FROM AUTHOR]