Model-Based Iterative Reconstruction in Cone-Beam Computed Tomography: Advanced Models of Imaging Physics and Prior Information

Cone-beam computed tomography (CBCT) represents a rapidly developing imaging modality that provides three-dimensional (3D) volumetric images with sub-millimeter spatial resolution and soft-tissue visibility from a single gantry rotation. CBCT tends to have small footprint, mechanical simplicity, open geometry, and low cost compared to conventional diagnostic CT. Because of these features, CBCT has been used in a variety of specialty diagnostic applications, image-guided radiation therapy (on-board CBCT), and surgical guidance (e.g., C-arm based CBCT). However, the current generation of CBCT systems face major challenges in low-contrast, soft-tissue image quality – for example, in the detection of acute intracranial hemorrhage (ICH), which requires a fairly high level of image uniformity, spatial resolution, and contrast resolution. Moreover, conventional approaches in both diagnostic and image-guided interventions that involve a series of imaging studies fail to leverage the wealth of patient-specific anatomical information available from previous scans. Leveraging the knowledge gained from prior images holds the potential for major gains in image quality and dose reduction. Model-based iterative reconstruction (MBIR) attempts to make more efficient use of the measurement data by incorporating a forward model of physical detection processes. Moreover, MBIR allows incorporation of various forms of prior information into image reconstruction, ranging from image smoothness and sharpness to patient-specific anatomical information. By leveraging such advantages, MBIR has demonstrated improved tradeoffs between image quality and radiation dose in multi-detector CT in the past decade and has recently shown similar promise in CBCT. However, the full potential of MBIR in CBCT is yet to be realized. This dissertation explores the capabilities of MBIR in improving image quality (especially low-contrast, soft-tissue image quality) and reducing radiation dose in CBCT. The presented work encompasses new MBIR methods that: i) modify the noise model in MBIR to compensate for noise amplification from artifact correction; ii) design regularization by explicitly incorporating task-based imaging performance as the objective; iii) mitigate truncation effects in a computationally efficient manner; iv) leverage a wealth of patient-specific anatomical information from a previously acquired image; and v) prospectively estimate the optimal amount of prior image information for accurate admission of specific anatomical changes. Specific clinical challenges are investigated in the detection of acute ICH and surveillance of lung nodules. The results show that MBIR can substantially improve low-contrast, soft-tissue image quality in CBCT and enable dose reduction techniques in sequential imaging studies. The thesis demonstrates that novel MBIR methods hold strong potential to overcome conventional barriers to CBCT image quality and open new clinical applications that would benefit from high-quality 3D imaging

Image-Guided Abdominal Surgery and Therapy Delivery

ABSTRACT Image-Guided Surgery has become the standard of care in intracranial neurosurgery providing more exact resections while minimizing damage to healthy tissue. Moving that process to abdominal organs presents additional challenges in the form of image segmentation, image to physical space registration, organ motion and deformation. In this paper, we present methodologies and results for addressing these challenges in two specific organs: the liver and the kidney

IMPROVED IMAGE QUALITY IN CONE-BEAM COMPUTED TOMOGRAPHY FOR IMAGE-GUIDED INTERVENTIONS

In the past few decades, cone-beam computed tomography (CBCT) emerged as a rapidly developing imaging modality that provides single rotation 3D volumetric reconstruction with sub-millimeter spatial resolution. Compared to the conventional multi-detector CT (MDCT), CBCT exhibited a number of characteristics that are well suited to applications in image-guided interventions, including improved mechanical simplicity, higher portability, and lower cost. Although the current generation of CBCT has shown strong promise for high-resolution and high-contrast imaging (e.g., visualization of bone structures and surgical instrumentation), it is often believed that CBCT yields inferior contrast resolution compared to MDCT and is not suitable for soft-tissue imaging. Aiming at expanding the utility of CBCT in image-guided interventions, this dissertation concerns the development of advanced imaging systems and algorithms to tackle the challenges of soft-tissue contrast resolution. The presented material includes work encompassing: (i) a comprehensive simulation platform to generate realistic CBCT projections (e.g., as training data for deep learning approaches); (ii) a new projection domain statistical noise model to improve the noise-resolution tradeoff in model-based iterative reconstruction (MBIR); (iii) a novel method to avoid CBCT metal artifacts by optimization of the source-detector orbit; (iv) an integrated software pipeline to correct various forms of CBCT artifacts (i.e., lag, glare, scatter, beam hardening, patient motion, and truncation); (v) a new 3D reconstruction method that only reconstructs the difference image from the image prior for use in CBCT neuro-angiography; and (vi) a novel method for 3D image reconstruction (DL-Recon) that combines deep learning (DL)-based image synthesis network with physics-based models based on Bayesian estimation of the statical uncertainty of the neural network. Specific clinical challenges were investigated in monitoring patients in the neurological critical care unit (NCCU) and advancing intraoperative soft-tissue imaging capability in image-guided spinal and intracranial neurosurgery. The results show that the methods proposed in this work substantially improved soft-tissue contrast in CBCT. The thesis demonstrates that advanced imaging approaches based on accurate system models, novel artifact reduction methods, and emerging 3D image reconstruction algorithms can effectively tackle current challenges in soft-tissue contrast resolution and expand the application of CBCT in image-guided interventions

Multi-Surface Simplex Spine Segmentation for Spine Surgery Simulation and Planning

This research proposes to develop a knowledge-based multi-surface simplex deformable model for segmentation of healthy as well as pathological lumbar spine data. It aims to provide a more accurate and robust segmentation scheme for identification of intervertebral disc pathologies to assist with spine surgery planning. A robust technique that combines multi-surface and shape statistics-aware variants of the deformable simplex model is presented. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user-assistance is allowed to disable the prior shape influence during deformation. Results have been validated against user-assisted expert segmentation

Augmented Image-Guidance for Transcatheter Aortic Valve Implantation

The introduction of transcatheter aortic valve implantation (TAVI), an innovative stent-based technique for delivery of a bioprosthetic valve, has resulted in a paradigm shift in treatment options for elderly patients with aortic stenosis. While there have been major advancements in valve design and access routes, TAVI still relies largely on single-plane fluoroscopy for intraoperative navigation and guidance, which provides only gross imaging of anatomical structures. Inadequate imaging leading to suboptimal valve positioning contributes to many of the early complications experienced by TAVI patients, including valve embolism, coronary ostia obstruction, paravalvular leak, heart block, and secondary nephrotoxicity from contrast use. A potential method of providing improved image-guidance for TAVI is to combine the information derived from intra-operative fluoroscopy and TEE with pre-operative CT data. This would allow the 3D anatomy of the aortic root to be visualized along with real-time information about valve and prosthesis motion. The combined information can be visualized as a `merged\u27 image where the different imaging modalities are overlaid upon each other, or as an `augmented\u27 image, where the location of key target features identified on one image are displayed on a different imaging modality. This research develops image registration techniques to bring fluoroscopy, TEE, and CT models into a common coordinate frame with an image processing workflow that is compatible with the TAVI procedure. The techniques are designed to be fast enough to allow for real-time image fusion and visualization during the procedure, with an intra-procedural set-up requiring only a few minutes. TEE to fluoroscopy registration was achieved using a single-perspective TEE probe pose estimation technique. The alignment of CT and TEE images was achieved using custom-designed algorithms to extract aortic root contours from XPlane TEE images, and matching the shape of these contours to a CT-derived surface model. Registration accuracy was assessed on porcine and human images by identifying targets (such as guidewires or coronary ostia) on the different imaging modalities and measuring the correspondence of these targets after registration. The merged images demonstrated good visual alignment of aortic root structures, and quantitative assessment measured an accuracy of less than 1.5mm error for TEE-fluoroscopy registration and less than 6mm error for CT-TEE registration. These results suggest that the image processing techniques presented have potential for development into a clinical tool to guide TAVI. Such a tool could potentially reduce TAVI complications, reducing morbidity and mortality and allowing for a safer procedure