Accuracy of Patient-Specific Organ Dose Estimates Obtained Using an Automated Image Segmentation Algorithm

The overall goal of this work is to develop a rapid, accurate, and automated software tool to estimate patient-specific organ doses from computed tomography (CT) scans using simulations to generate dose maps combined with automated segmentation algorithms. This work quantified the accuracy of organ dose estimates obtained by an automated segmentation algorithm. We hypothesized that the autosegmentation algorithm is sufficiently accurate to provide organ dose estimates, since small errors delineating organ boundaries will have minimal effect when computing mean organ dose. A leave-one-out validation study of the automated algorithm was performed with 20 head-neck CT scans expertly segmented into nine regions. Mean organ doses of the automatically and expertly segmented regions were computed from Monte Carlo-generated dose maps and compared. The automated segmentation algorithm estimated the mean organ dose to be within 10% of the expert segmentation for regions other than the spinal canal, with the median error for each organ region below 2%. In the spinal canal region, the median error was -7%, with a maximum absolute error of 28% for the single-atlas approach and 11% for the multiatlas approach. The results demonstrate that the automated segmentation algorithm can provide accurate organ dose estimates despite some segmentation errors

A fast, linear Boltzmann transport equation solver for computed tomography dose calculation (Acuros CTD)

Purpose To improve dose reporting of CT scans, patient‐specific organ doses are highly desired. However, estimating the dose distribution in a fast and accurate manner remains challenging, despite advances in Monte Carlo methods. In this work, we present an alternative method that deterministically solves the linear Boltzmann transport equation (LBTE), which governs the behavior of x‐ray photon transport through an object. Methods Our deterministic solver for CT dose (Acuros CTD) is based on the same approach used to estimate scatter in projection images of a CT scan (Acuros CTS). A deterministic method is used to compute photon fluence within the object, which is then converted to deposited energy by multiplying by known, material‐specific conversion factors. To benchmark Acuros CTD, we used the AAPM Task Group 195 test for CT dose, which models an axial, fan beam scan (10 mm thick beam) and calculates energy deposited in each organ of an anthropomorphic phantom. We also validated our own Monte Carlo implementation of Geant4 to use as a reference to compare Acuros against for other common geometries like an axial, cone beam scan (160 mm thick beam) and a helical scan (40 mm thick beam with table motion for a pitch of 1). Results For the fan beam scan, Acuros CTD accurately estimated organ dose, with a maximum error of 2.7% and RMSE of 1.4% when excluding organs with3provided marginal improvement to the accuracy for the cone beam scan but came at the expense of increased run time. Across the different scan geometries, run time of Acuros CTD ranged from 8 to 23 s. Conclusions In this digital phantom study, a deterministic LBTE solver was capable of fast and accurate organ dose estimates

A Prototype Table-Top Inverse-Geometry Volumetric CT System

A table-top volumetric CT system has been implemented that is able to image a 5-cm-thick volume in one circular scan with no cone-beam artifacts. The prototype inverse-geometry CT (IGCT) scanner consists of a large-area, scanned x-ray source and a detector array that is smaller in the transverse direction. The IGCT geometry provides sufficient volumetric sampling because the source and detector have the same axial, or slice direction, extent. This paper describes the implementation of the table-top IGCT scanner, which is based on the NexRay Scanning-Beam Digital X-ray system (NexRay, Inc., Los Gatos, CA) and an investigation of the system performance. The alignment and flat-field calibration procedures are described, along with a summary of the reconstruction algorithm. The resolution and noise performance of the prototype IGCT system are studied through experiments and further supported by analytical predictions and simulations. To study the presence of cone-beam artifacts, a “Defrise” phantom was scanned on both the prototype IGCT scanner and a micro CT system with a ±5° cone angle for a 4.5-cm volume thickness. Images of inner ear specimens are presented and compared to those from clinical CT systems. Results showed that the prototype IGCT system has a 0.25-mm isotropic resolution and that noise comparable to that from a clinical scanner with equivalent spatial resolution is achievable. The measured MTF and noise values agreed reasonably well with theoretical predictions and computer simulations. The IGCT system was able to faithfully reconstruct the laminated pattern of the Defrise phantom while the micro CT system suffered severe cone-beam artifacts for the same object. The inner ear acquisition verified that the IGCT system can image a complex anatomical object, and the resulting images exhibited more high-resolution details than the clinical CT acquisition. Overall, the successful implementation of the prototype system supports the IGCT concept for single-rotation volumetric scanning free from cone-beam artifacts

Correction for patient table-induced scattered radiation in cone-beam computed tomography (CBCT)1

Purpose: In image-guided radiotherapy, an artifact typically seen in axial slices of x-ray cone-beam computed tomography (CBCT) reconstructions is a dark region or “black hole” situated below the scan isocenter. The authors trace the cause of the artifact to scattered radiation produced by radiotherapy patient tabletops and show it is linked to the use of the offset-detector acquisition mode to enlarge the imaging field-of-view. The authors present a hybrid scatter kernel superposition (SKS) algorithm to correct for scatter from both the object-of-interest and the tabletop

Leveraging multi-layer imager detector design to improve low-dose performance for megavoltage cone-beam computed tomography

While megavoltage cone-beam computed tomography (CBCT) using an electronic portal imaging device (EPID) provides many advantages over kilovoltage (kV) CBCT, clinical adoption is limited by its high doses. Multi-layer imager (MLI) EPIDs increase DQE(0) while maintaining high resolution. However, even well-designed, high-performance MLIs suffer from increased electronic noise from each readout, degrading low-dose image quality. To improve low-dose performance, shift-and-bin addition (ShiBA) imaging is proposed, leveraging the unique architecture of the MLI. ShiBA combines hardware readout-binning and super-resolution concepts, reducing electronic noise while maintaining native image sampling. The imaging performance of full-resolution (FR); standard, aligned binned (BIN); and ShiBA images in terms of noise power spectrum (NPS), electronic NPS, modulation transfer function (MTF), and the ideal observer signal-to-noise ratio (SNR)-the detectability index (d')-are compared. The FR 4-layer readout of the prototype MLI exhibits an electronic NPS magnitude 6-times higher than a state-of-the-art single layer (SLI) EPID. Although the MLI is built on the same readout platform as the SLI, with each layer exhibiting equivalent electronic noise, the multi-stage readout of the MLI results in electronic noise 50% higher than simple summation. Electronic noise is mitigated in both BIN and ShiBA imaging, reducing its total by ~12 times. ShiBA further reduces the NPS, effectively upsampling the image, resulting in a multiplication by a sinc2 function. Normalized NPS show that neither ShiBA nor BIN otherwise affects image noise. The LSF shows that ShiBA removes the pixilation artifact of BIN images and mitigates the effect of detector shift, but does not quantifiably improve the MTF. ShiBA provides a pre-sampled representation of the images, mitigating phase dependence. Hardware binning strategies lower the quantum noise floor, with 2  ×  2 implementation reducing the dose at which DQE(0) degrades by 10% from 0.01 MU to 0.004 MU, representing 20% improvement in d'

Investigation into the optimal linear time-invariant lag correction for radar artifact removal

Purpose: Detector lag, or residual signal, in amorphous silicon (a-Si) flat-panel (FP) detectors can cause significant shading artifacts in cone-beam computed tomography (CBCT) reconstructions. To date, most correction models have assumed a linear, time-invariant (LTI) model and lag is corrected by deconvolution with an impulse response function (IRF). However, there are many ways to determine the IRF. The purpose of this work is to better understand detector lag in the Varian 4030CB FP and to identify the IRF measurement technique that best removes the CBCT shading artifact. Methods: We investigated the linearity of lag in a Varian 4030CB a-Si FP operating in dynamic gain mode at 15 frames per second by examining the rising step-response function (RSRF) followed by the falling step-response function (FSRF) at ten incident exposures (0.5%–84% of a-Si FP saturation exposure). We implemented a multiexponential (N = 4) LTI model for lag correction and investigated the effects of various techniques for determining the IRF such as RSRF versus FSRF, exposure intensity, length of exposure, and spatial position. The resulting IRFs were applied to (1) the step-response projection data and (2) CBCT acquisitions of a large pelvic phantom and acrylic head phantom. For projection data, 1st and 50th frame lags were measured pre- and postcorrection. For the CBCT reconstructions, four pairs of ROIs were defined and the maximum and mean errors within each pair were calculated for the different exposures and step-response edge techniques. Results: A nonlinearity greater than 50% was observed in the FSRF data. A model calibrated with RSRF data resulted in overcorrection of FSRF data. Conversely, models calibrated with FSRF data applied to RSRF data resulted in undercorrection of the RSRF. Similar effects were seen when LTI models were applied to data collected at different incident exposures. Some spatial variation in lag was observed in the step-response data. For CBCT reconstructions, an average error range of 3–21 HU was observed when using IRFs from different techniques. For our phantoms and FP, the lowest average error occurred for the FSRF-based techniques at exposures of 1.6 or 3.4% a-Si FP saturation, depending on the phantom used. Conclusions: The choice of step-response edge (RSRF versus FSRF) and exposure intensity for IRF calibration could leave large residual lag in the step-response data. For the CBCT reconstructions, IRFs derived from FSRF data at low exposure intensities (1.6 and 3.4%) best removed the CBCT shading artifact. Which IRF to use for lag correction could be selected based on the object size