State of the art: iterative CT reconstruction techniques

Owing to recent advances in computing power, iterative reconstruction (IR) algorithms have become a clinically viable option in computed tomographic (CT) imaging. Substantial evidence is accumulating about the advantages of IR algorithms over established analytical methods, such as filtered back projection. IR improves image quality through cyclic image processing. Although all available solutions share the common mechanism of artifact reduction and/or potential for radiation dose savings, chiefly due to image noise suppression, the magnitude of these effects depends on the specific IR algorithm. In the first section of this contribution, the technical bases of IR are briefly reviewed and the currently available algorithms released by the major CT manufacturers are described. In the second part, the current status of their clinical implementation is surveyed. Regardless of the applied IR algorithm, the available evidence attests to the substantial potential of IR algorithms for overcoming traditional limitations in CT imaging

Evaluation of Motion Artifact Metrics for Coronary CT Angiography

Purpose This study quantified the performance of coronary artery motion artifact metrics relative to human observer ratings. Motion artifact metrics have been used as part of motion correction and best‐phase selection algorithms for Coronary Computed Tomography Angiography (CCTA). However, the lack of ground truth makes it difficult to validate how well the metrics quantify the level of motion artifact. This study investigated five motion artifact metrics, including two novel metrics, using a dynamic phantom, clinical CCTA images, and an observer study that provided ground‐truth motion artifact scores from a series of pairwise comparisons. Method Five motion artifact metrics were calculated for the coronary artery regions on both phantom and clinical CCTA images: positivity, entropy, normalized circularity, Fold Overlap Ratio (FOR), and Low‐Intensity Region Score (LIRS). CT images were acquired of a dynamic cardiac phantom that simulated cardiac motion and contained six iodine‐filled vessels of varying diameter and with regions of soft plaque and calcifications. Scans were repeated with different gantry start angles. Images were reconstructed at five phases of the motion cycle. Clinical images were acquired from 14 CCTA exams with patient heart rates ranging from 52 to 82 bpm. The vessel and shading artifacts were manually segmented by three readers and combined to create ground‐truth artifact regions. Motion artifact levels were also assessed by readers using a pairwise comparison method to establish a ground‐truth reader score. The Kendall\u27s Tau coefficients were calculated to evaluate the statistical agreement in ranking between the motion artifacts metrics and reader scores. Linear regression between the reader scores and the metrics was also performed. Results On phantom images, the Kendall\u27s Tau coefficients of the five motion artifact metrics were 0.50 (normalized circularity), 0.35 (entropy), 0.82 (positivity), 0.77 (FOR), 0.77(LIRS), where higher Kendall\u27s Tau signifies higher agreement. The FOR, LIRS, and transformed positivity (the fourth root of the positivity) were further evaluated in the study of clinical images. The Kendall\u27s Tau coefficients of the selected metrics were 0.59 (FOR), 0.53 (LIRS), and 0.21 (Transformed positivity). In the study of clinical data, a Motion Artifact Score, defined as the product of FOR and LIRS metrics, further improved agreement with reader scores, with a Kendall\u27s Tau coefficient of 0.65. Conclusion The metrics of FOR, LIRS, and the product of the two metrics provided the highest agreement in motion artifact ranking when compared to the readers, and the highest linear correlation to the reader scores. The validated motion artifact metrics may be useful for developing and evaluating methods to reduce motion in Coronary Computed Tomography Angiography (CCTA) images

Automated Selection of the Optimal Cardiac Phase for Single-Beat Coronary CT Angiography Reconstruction

This thesis investigates an automated algorithm for selecting the optimal cardiac phase for CCTA reconstruction. Reconstructing a low-motion cardiac phase improves coronary artery visualization in coronary CT angiography (CCTA) exams. Currently, standard end-systole and/or mid-diastole default phases are prescribed or alternatively, quiescent phases are determined by the user. As manual selection may be time-consuming and standard locations may be suboptimal due to patient variability, an automated method is investigated. An automated algorithm was developed to select the optimal phase based on quantitative image quality (IQ) metrics. For each reconstructed slice at each reconstructed phase, an image quality metric was calculated based on measures of circularity and edge strength of through-plane vessels. The image quality metric was aggregated across slices, while a metric of vessel-location consistency was used to ignore slices that did not contain through-plane vessels. A binary metric based on the edge strength of in-plane vessels was calculated to determine if IQ of in-plane vessels was acceptable. The algorithm performance was evaluated using two observer studies. Fourteen single-beat CCTA exams (Revolution CT, GE Healthcare) reconstructed at 2% intervals were evaluated for best systolic (1), diastolic (6), or systolic and diastolic phases (7) by three readers and the algorithm. Inter-reader (RR) and reader-algorithm (RA) agreement was calculated using the mean absolute difference (MAD) and concordance correlation coefficient (CCC). A reader-consensus best phase was determined and compared to the algorithm selected phase. In cases where the algorithm and consensus best phases differed by more than 2%, IQ was scored by three readers using a 5pt Likert scale. There was no significant difference between RR and RA agreement for either MAD or CCC metrics (p\u3e0.2). The algorithm phase was within 2% of the consensus phase in 71% of cases. There was no significant difference (p\u3e0.2) between the IQ of the algorithm phase (4.06±0.73) and the consensus phase (4.11±0.76). The proposed algorithm was statistically equivalent to a reader in selecting an optimal cardiac phase for CCTA exams. When reader and algorithm phases differed by \u3e2%, IQ was statistically equivalent

Assessing and Improving 4D-CT Imaging for Radiotherapy Applications

Lung cancer has both a high incidence and death rate. A contributing factor to these high rates comes from the difficulty of treating lung cancers due to the inherent mobility of the lung tissue and the tumour. 4D-CT imaging has been developed to image lung tumours as they move during respiration. Most 4D-CT imaging methods rely on data from an external respiratory surrogate to sort the images according to respiratory phase. However, it has been shown that respiratory surrogate 4D-CT methods can suffer from imaging artifacts that degrade the image quality of the 4D-CT volumes that are used to plan a patient\u27s radiation therapy. In Chapter 2 of this thesis a method to investigate the correlation between an external respiratory surrogate and the internal anatomy was developed. The studies were performed on ventilated pigs with an induced inconsistent amplitude of breathing. The effect of inconsistent breathing on the correlation between the external marker and the internal anatomy was tested using a linear regression. It was found in 10 of the 12 studies performed that there were significant changes in the slope of the regression line as a result of inconsistent breathing. From this study we conclude that the relationship between an external marker and the internal anatomy is not stable and can be perturbed by inconsistent breathing amplitudes. Chapter 3 describes the development of a image based 4D-CT imaging algorithm based on the concept of normalized cross correlation (NCC) between images. The volumes produced by the image based algorithm were compared to volumes produced using a clinical external marker 4D-CT algorithm. The image based method produced 4D-CT volumes that had a reduced number of imaging artifacts when compared to the external marker produced volumes. It was shown that an image based 4D-CT method could be developed and perform as well or better than external marker methods that are currently in clinical use. In Chapter 4 a method was developed to assess the uncertainties of the locations of anatomical structures in the volumes produced by the image based 4D-CT algorithm developed in Chapter 3. The uncertainties introduced by using NCC to match a pair of images according to respiratory phase were modeled and experimentally determined. Additionally, the assumption that two subvolumes could be matched in respiratory phase using a single pair of 2D overlapping images was experimentally validated. It was shown that when the image based 4D-CT algorithm developed in Chapter 3 was applied to data acquired from a ventilated pig with induced inconsistent breathing the displacement uncertainties were on the order of 1.0 millimeter. The results of this thesis show that there exists the possibility of a miscorrelation between the motion of a respiratory surrogate (marker) and the internal anatomy under inconsistent breathing amplitude. Additionally, it was shown that an image based 4D-CT method that operates without the need of one or more external respiratory surrogate(s) could produce artifact free volumes synchronous with respiratory phase. The spatial uncertainties of the volumes produced by the image based 4D-CT method were quantified and shown to be small (~ 1mm) which is an acceptable accuracy for radiation treatment planning. The elimination of the external respiratory surrogates simplifies the implementation and increases the throughput of the image based 4D-CT method as well