Application of Fractal Dimension for Quantifying Noise Texture in Computed Tomography Images

Purpose Evaluation of noise texture information in CT images is important for assessing image quality. Noise texture is often quantified by the noise power spectrum (NPS), which requires numerous image realizations to estimate. This study evaluated fractal dimension for quantifying noise texture as a scalar metric that can potentially be estimated using one image realization. Methods The American College of Radiology CT accreditation phantom (ACR) was scanned on a clinical scanner (Discovery CT750, GE Healthcare) at 120 kV and 25 and 90 mAs. Images were reconstructed using filtered back projection (FBP/ASIR 0%) with varying reconstruction kernels: Soft, Standard, Detail, Chest, Lung, Bone, and Edge. For each kernel, images were also reconstructed using ASIR 50% and ASIR 100% iterative reconstruction (IR) methods. Fractal dimension was estimated using the differential box‐counting algorithm applied to images of the uniform section of ACR phantom. The two‐dimensional Noise Power Spectrum (NPS) and one‐dimensional‐radially averaged NPS were estimated using established techniques. By changing the radiation dose, the effect of noise magnitude on fractal dimension was evaluated. The Spearman correlation between the fractal dimension and the frequency of the NPS peak was calculated. The number of images required to reliably estimate fractal dimension was determined and compared to the number of images required to estimate the NPS‐peak frequency. The effect of Region of Interest (ROI) size on fractal dimension estimation was evaluated. Feasibility of estimating fractal dimension in an anthropomorphic phantom and clinical image was also investigated, with the resulting fractal dimension compared to that estimated within the uniform section of the ACR phantom. Results Fractal dimension was strongly correlated with the frequency of the peak of the radially averaged NPS curve, having a Spearman rank‐order coefficient of 0.98 (P‐value \u3c 0.01) for ASIR 0%. The mean fractal dimension at ASIR 0% was 2.49 (Soft), 2.51 (Standard), 2.52 (Detail), 2.57 (Chest), 2.61 (Lung), 2.66 (Bone), and 2.7 (Edge). A reduction in fractal dimension was observed with increasing ASIR levels for all investigated reconstruction kernels. Fractal dimension was found to be independent of noise magnitude. Fractal dimension was successfully estimated from four ROIs of size 64 × 64 pixels or one ROI of 128 × 128 pixels. Fractal dimension was found to be sensitive to non‐noise structures in the image, such as ring artifacts and anatomical structure. Fractal dimension estimated within a uniform region of an anthropomorphic phantom and clinical head image matched that estimated within the ACR phantom for filtered back projection reconstruction. Conclusions Fractal dimension correlated with the NPS‐peak frequency and was independent of noise magnitude, suggesting that the scalar metric of fractal dimension can be used to quantify the change in noise texture across reconstruction approaches. Results demonstrated that fractal dimension can be estimated from four, 64 × 64‐pixel ROIs or one 128 × 128 ROI within a head CT image, which may make it amenable for quantifying noise texture within clinical images

Reducing Radiation Dose to the Female Breast during CT Coronary Angiography: A Simulation Study Comparing Breast Shielding, Angular Tube Current Modulation, Reduced kV, and Partial Angle Protocols Using an Unknown-location Signal-detectability Metric

Purpose: The authors compared the performance of five protocols intended to reduce dose to the breast during computed tomography (CT) coronary angiography scans using a model observer unknown-location signal-detectability metric. Methods: The authors simulated CT images of an anthropomorphic female thorax phantom for a 120 kV reference protocol and five “dose reduction” protocols intended to reduce dose to the breast: 120 kV partial angle (posteriorly centered), 120 kV tube-current modulated (TCM), 120 kV with shielded breasts, 80 kV, and 80 kV partial angle (posteriorly centered). Two image quality tasks were investigated: the detection and localization of 4-mm, 3.25 mg/ml and 1-mm, 6.0 mg/ml iodine contrast signals randomly located in the heart region. For each protocol, the authors plotted the signal detectability, as quantified by the area under the exponentially transformed free response characteristic curve estimator (AˆFE), as well as noise and contrast-to-noise ratio (CNR) versus breast and lung dose. In addition, the authors quantified each protocol\u27s dose performance as the percent difference in dose relative to the reference protocol achieved while maintaining equivalentAˆFE. Results: For the 4-mm signal-size task, the 80 kV full scan and 80 kV partial angle protocols decreased dose to the breast (80.5% and 85.3%, respectively) and lung (80.5% and 76.7%, respectively) withAˆFE= 0.96, but also resulted in an approximate three-fold increase in image noise. The 120 kV partial protocol reduced dose to the breast (17.6%) at the expense of increased lung dose (25.3%). The TCM algorithm decreased dose to the breast (6.0%) and lung (10.4%). Breast shielding increased breast dose (67.8%) and lung dose (103.4%). The 80 kV and 80 kV partial protocols demonstrated greater dose reductions for the 4-mm task than for the 1-mm task, and the shielded protocol showed a larger increase in dose for the 4-mm task than for the 1-mm task. In general, the CNR curves indicate a similar relative ranking of protocol performance as the correspondingAˆFEcurves, however, the CNR metric overestimated the performance of the shielded protocol for both tasks, leading to corresponding underestimates in the relative dose increases compared to those obtained when using theAˆFEmetric. Conclusions: The 80 kV and 80 kV partial angle protocols demonstrated the greatest reduction to breast and lung dose, however, the subsequent increase in image noise may be deemed clinically unacceptable. Tube output for these protocols can be adjusted to achieve a more desirable noise level with lesser breast dose savings. Breast shielding increased breast and lung dose when maintaining equivalentAˆFE. The results demonstrated that comparisons of dose performance depend on both the image quality metric and the specific task, and that CNR may not be a reliable metric of signal detectability

A Deep Learning Framework for Unsupervised Affine and Deformable Image Registration

Image registration, the process of aligning two or more images, is the core technique of many (semi-)automatic medical image analysis tasks. Recent studies have shown that deep learning methods, notably convolutional neural networks (ConvNets), can be used for image registration. Thus far training of ConvNets for registration was supervised using predefined example registrations. However, obtaining example registrations is not trivial. To circumvent the need for predefined examples, and thereby to increase convenience of training ConvNets for image registration, we propose the Deep Learning Image Registration (DLIR) framework for \textit{unsupervised} affine and deformable image registration. In the DLIR framework ConvNets are trained for image registration by exploiting image similarity analogous to conventional intensity-based image registration. After a ConvNet has been trained with the DLIR framework, it can be used to register pairs of unseen images in one shot. We propose flexible ConvNets designs for affine image registration and for deformable image registration. By stacking multiple of these ConvNets into a larger architecture, we are able to perform coarse-to-fine image registration. We show for registration of cardiac cine MRI and registration of chest CT that performance of the DLIR framework is comparable to conventional image registration while being several orders of magnitude faster.Comment: Accepted: Medical Image Analysis - Elsevie

CT Automated Exposure Control Using A Generalized Detectability Index

Purpose Identifying an appropriate tube current setting can be challenging when using iterative reconstruction due to the varying relationship between spatial resolution, contrast, noise, and dose across different algorithms. This study developed and investigated the application of a generalized detectability index (d\u27gen) to determine the noise parameter to input to existing automated exposure control (AEC) systems to provide consistent image quality (IQ) across different reconstruction approaches. Methods This study proposes a task‐based automated exposure control (AEC) method using a generalized detectability index (d\u27gen). The proposed method leverages existing AEC methods that are based on a prescribed noise level. The generalized d\u27gen metric is calculated using lookup tables of task‐based modulation transfer function (MTF) and noise power spectrum (NPS). To generate the lookup tables, the American College of Radiology CT accreditation phantom was scanned on a multidetector CT scanner (Revolution CT, GE Healthcare) at 120 kV and tube current varied manually from 20 to 240 mAs. Images were reconstructed using a reference reconstruction algorithm and four levels of an in‐house iterative reconstruction algorithm with different regularization strengths (IR1–IR4). The task‐based MTF and NPS were estimated from the measured images to create lookup tables of scaling factors that convert between d\u27gen and noise standard deviation. The performance of the proposed d\u27gen‐AEC method in providing a desired IQ level over a range of iterative reconstruction algorithms was evaluated using the American College of Radiology (ACR) phantom with elliptical shell and using a human reader evaluation on anthropomorphic phantom images. Results The study of the ACR phantom with elliptical shell demonstrated reasonable agreement between the d\u27gen predicted by the lookup table and d\u27 measured in the images, with a mean absolute error of 15% across all dose levels and maximum error of 45% at the lowest dose level with the elliptical shell. For the anthropomorphic phantom study, the mean reader scores for images resulting from the d\u27gen‐AEC method were 3.3 (reference image), 3.5 (IR1), 3.6 (IR2), 3.5 (IR3), and 2.2 (IR4). When using the d\u27gen‐AEC method, the observers’ IQ scores for the reference reconstruction were statistical equivalent to the scores for IR1, IR2, and IR3 iterative reconstructions (P \u3e 0.35). The d\u27gen‐AEC method achieved this equivalent IQ at lower dose for the IR scans compared to the reference scans. Conclusions A novel AEC method, based on a generalized detectability index, was investigated. The proposed method can be used with some existing AEC systems to derive the tube current profile for iterative reconstruction algorithms. The results provide preliminary evidence that the proposed d\u27gen‐AEC can produce similar IQ across different iterative reconstruction approaches at different dose levels

γ-H2AX foci as in vivo effect biomarker in children emphasize the importance to minimize x-ray doses in paediatric CT imaging

Objectives: Investigation of DNA damage induced by CT x-rays in paediatric patients versus patient dose in a multicentre setting. Methods: From 51 paediatric patients (median age, 3.8 years) who underwent an abdomen or chest CT examination in one of the five participating radiology departments, blood samples were taken before and shortly after the examination. DNA damage was estimated by scoring gamma-H2AX foci in peripheral blood T lymphocytes. Patient-specific organ and tissue doses were calculated with a validated Monte Carlo program. Individual lifetime attributable risks (LAR) for cancer incidence and mortality were estimated according to the BEIR VII risk models. Results: Despite the low CT doses, a median increase of 0.13 gamma-H2AX foci/cell was observed. Plotting the induced gamma-H2AX foci versus blood dose indicated a low-dose hypersensitivity, supported also by an in vitro dose-response study. Differences in dose levels between radiology centres were reflected in differences in DNA damage. LAR of cancer mortality for the paediatric chest CT and abdomen CT cohort was 0.08 and 0.13% respectively. Conclusion: CT x-rays induce DNA damage in paediatric patients even at low doses and the level of DNA damage is reduced by application of more effective CT dose reduction techniques and paediatric protocols