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4D reconstruction for low-dose cardiac gated SPECT

Sun, 10/12/2014 - 1:20pm

PURPOSE: Due to the combination of high-frequency use and relatively high diagnostic radiation dose (>9 mSv for one scan), there is a need to lower the radiation dose used in myocardial perfusion imaging (MPI) studies in cardiac gated single photon emission computed tomography (GSPECT) in order to reduce its population based cancer risk. The aim of this study is to assess quantitatively the potential utility of advanced 4D reconstruction for GSPECT for significantly lowered imaging dose. METHODS: For quantitative evaluation, Monte Carlo simulation with the 4D NURBS-based cardiac-torso (NCAT) phantom is used for GSPECT imaging at half and quarter count levels in the projections emulating lower injected activity (dose) levels. Both 4D and 3D reconstruction methods are applied at these lowered dose levels, and compared with standard clinical spatiotemporal reconstruction (ST121) at full dose using a number of metrics on the reconstructed images: (1) overall reconstruction accuracy of the myocardium, (2) regional bias-variance analysis of the left ventricle (LV) wall, (3) uniformity of the LV wall, (4) accuracy of the time activity curve (TAC) of the LV wall, and (5) detectability of perfusion defects using channelized Hotelling observer. As a preliminary demonstration, two sets of patient data acquired in list-mode are used to illustrate the conservation of both image quality and LV ejection fraction (LVEF) by 4D reconstruction where only a portion of the acquired counts at each projection angle are used to mimic low-dose acquisitions. RESULTS: Compared to ST121 at standard dose, even at quarter dose 4D achieved better performance on overall reconstruction accuracy of the myocardium (28.7% improvement on relative root mean square error: standard vs 4D quarter p-value < 10(-30)), regional bias-variance analysis, and similar performance on accuracy of the TAC of the LV wall and detectability of perfusion defects. A slight degradation in uniformity of the LV wall was observed in 4D at quarter dose due to use of scatter correction which increases reconstruction variance. The reconstructed images from simulated and patient data show that 4D at quarter dose is visually comparable to ST121 at standard dose, if not better. Compared to ST121 and 3D, 4D images exhibit less noise artifacts and better definition of the LV wall. The 4D images are also observed to be more consistent between half dose and quarter dose. 4D also yields more consistent LVEF results at different count levels on the patient data. CONCLUSIONS: With various quantitative metrics 4D reconstruction is demonstrated to achieve better or comparable performance at quarter dose ( approximately 2.25 mSv, 75% dose reduction) compared to conventional clinical reconstruction at standard dose ( approximately 9 mSv). Preliminary results from two patient datasets also show that 4D at an equivalent quarter dose can achieve better performance than clinical and 3D methods at higher dose levels. Such a significant dose reduction (75%) has not been demonstrated quantitatively in previous studies in GSPECT. These promising results warrant further investigations on the lower bound of dose reduction with different reconstruction strategies and more comprehensive clinical studies with greater patient variability.

A quantitative study of motion estimation methods on 4D cardiac gated SPECT reconstruction

Sun, 10/12/2014 - 1:20pm

PURPOSE: Motion-compensated temporal processing can have a major impact on improving the image quality in gated cardiac single photon emission computed tomography (SPECT). In this work, we investigate the effect of different optical flow estimation methods for motion-compensated temporal processing in gated SPECT. In particular, we explore whether better motion estimation can substantially improve reconstructed image quality, and how the estimated motion would compare to the ideal case of known motion in terms of reconstruction. METHODS: We consider the following three methods for obtaining the image motion in 4D reconstruction: (1) the Horn-Schunck optical flow equation (OFE) method, (2) a recently developed periodic OFE method, and (3) known cardiac motion derived from the NURBS-based cardiac-torso (NCAT) phantom. The periodic OFE method is used to exploit the inherent periodic nature in cardiac gated images. In this method, the optical flow in a sequence is modeled by a Fourier harmonic representation, which is then estimated from the image data. We study the impact of temporal processing on 4D reconstructions when the image motion is obtained with the different methods above. For quantitative evaluation, we use simulated imaging with multiple noise realizations from the NCAT phantom, where different patient geometry and lesion sizes are also considered. To quantify the reconstruction results, we use the following measures of reconstruction accuracy and defect detection in the myocardium: (1) overall error level in the myocardium, (2) regional accuracy of the left ventricle (LV) wall, (3) accuracy of regional time activity curves of the LV, and (4) perfusion defect detectability with a channelized Hotelling observer (CHO). In addition, we also examine the effect of noise on the distortion in the reconstructed LV wall shape by detecting its contours. As a preliminary demonstration, these methods are also tested on two sets of clinical acquisitions. RESULTS: For the different quantitative measures considered, the periodic OFE further improved the reconstruction accuracy of the myocardium compared to OFE in 4D reconstruction; its improvement in reconstruction almost matched that of the known motion. Specifically, the overall mean-squared error in the myocardium was reduced by over 20% with periodic OFE; with noise level fixed at 10%, the regional bias on the LV was reduced from 20% (OFE) to 14% (periodic OFE), compared to 11% by the known motion. In addition, the CHO results show that there was also improvement in lesion detectability with the periodic OFE. The regional time activity curves obtained with the periodic OFE were also observed to be more consistent with the reference; in addition, the contours of the reconstructed LV wall with the periodic OFE were demonstrated to show less degree of variations among different noise realizations. Such improvements were also consistent with the results obtained from the clinical acquisitions. CONCLUSIONS: Use of improved optical flow estimation can further improve the accuracy of reconstructed images in 4D. The periodic OFE method not only can achieve improvements over the traditional OFE, but also can almost match that of the known motion in terms of the several quality measures considered.

Comparison study of temporal regularization methods for fully 5D reconstruction of cardiac gated dynamic SPECT

Sun, 10/12/2014 - 1:20pm

Temporal regularization plays a critical role in cardiac gated dynamic SPECT reconstruction, of which the goal is to obtain an image sequence from a single acquisition which simultaneously shows both cardiac motion and tracer distribution change over the course of imaging (termed 5D). In our recent work, we explored two different approaches for temporal regularization of the dynamic activities in gated dynamic reconstruction without the use of fast camera rotation: one is the dynamic EM (dEM) approach which is imposed on the temporal trend of the time activity of each voxel, and the other is a B-spline modeling approach in which the time activity is regulated by a set of B-spline basis functions. In this work, we extend the B-spline approach to fully 5D reconstruction and conduct a thorough quantitative comparison with the dEM approach. In the evaluation of the reconstruction results, we apply a number of quantitative measures on two major aspects of the reconstructed dynamic images: (1) the accuracy of the reconstructed activity distribution in the myocardium and (2) the ability of the reconstructed dynamic activities to differentiate perfusion defects from normal myocardial wall uptake. These measures include the mean square error (MSE), bias-variance analysis, accuracy of time-activity curves (TAC), contrast-to-noise ratio of a defect, composite kinetic map of the left ventricle wall and perfusion defect detectability with channelized Hotelling observer. In experiments, we simulated cardiac gated imaging with the NURBS-based cardiac-torso phantom and Tc99m-Teboroxime as the imaging agent, where acquisition with the equivalent of only three full camera rotations was used during the imaging period. The results show that both dEM and B-spline 5D could achieve similar overall accuracy in the myocardium in terms of MSE. However, compared to dEM 5D, the B-spline approach could achieve a more accurate reconstruction of the voxel TACs; in particular, B-spline 5D could achieve a much smaller bias level in the early uptake stage of the imaging period. Furthermore, it could allow better separation of the perfusion defect from the normal at both the early and the late stages of the imaging period.

Effects of motion, attenuation, and scatter corrections on gated cardiac SPECT reconstruction

Sun, 10/12/2014 - 1:20pm

PURPOSE: In gated cardiac single photon emission computed tomography (SPECT), image reconstruction is often hampered by various degrading factors including depth-dependent spatial blurring, attenuation, scatter, motion blurring, and low data counts. Consequently, there has been significant development in image reconstruction methods for improving the quality of reconstructed images. The goal of this work is to investigate how these degrading factors will impact the reconstructed myocardium when different reconstruction methods are used. METHODS: The authors conduct a comparative study of the effects of these degrading factors on the accuracy of myocardium by several reconstruction algorithms, including (1) a clinical spatiotemporal processing method, (2) maximum likelihood (ML) estimation, (3) 3D maximum a posteriori (MAP) estimation, (4) 3D MAP with posttemporal filtering, and (5) motion-compensated spatiotemporal (4D) reconstruction. To quantify the reconstruction results, the authors use the following measures on different aspects of the myocardium: (1) overall error level in the myocardium, (2) regional accuracy of the left ventricle (LV) wall, (3) uniformity of the LV, (4) accuracy of regional time activity curves by normalized cross-correlation coefficient, and (5) perfusion defect detectability. The authors also assess the effectiveness of degrading corrections in reconstruction by considering an upper bound for each reconstruction method, which represents what would be achieved by each method if the acquired data were free from attenuation and scatter degradations. In the experiments the authors use Monte Carlo simulated cardiac gated SPECT imaging based on the 4D NURBS-based cardiac-torso (NCAT) phantom with different patient geometry and lesion settings, in which the simulated ground truth is known for the purpose of quantitative evaluation. RESULTS: The results demonstrate that use of temporal processing in reconstruction (Methods 1, 4, and 5 above) can greatly improve the reconstructed myocardium in terms of both error level and perfusion defect detection. In low-count gated studies, it can have even greater impact than other degrading factors. Both attenuation and scatter corrections can lead to reduced error levels in the myocardium in all methods; in particular, with 4D the bias can be reduced by as much as four-fold compared to no correction. There is a slight increase in noise level observed with scatter correction. A significant improvement in heart wall appearance is demonstrated in reconstruction results from three sets of clinical acquisitions as correction for degradations is combined with refinement of temporal filtering. CONCLUSIONS: Correction for degrading factors such as resolution, attenuation, scatter, and motion blur can all lead to improved image quality in cardiac gated SPECT reconstruction. However, their effectiveness could also vary with the reconstruction algorithms used. Both attenuation and scatter corrections can effectively reduce the bias level of the reconstructed LV wall, though scatter correction is also observed to increase the variance level. Use of temporal processing in reconstruction can have greater impact on the accuracy of the myocardium than correction of other degrading factors. Overall, use of degrading corrections in 4D reconstruction is shown to be most effective for improving both reconstruction accuracy of the myocardium and detectability of perfusion defects in gated images.

Estimation and correction of cardiac respiratory motion in SPECT in the presence of limited-angle effects due to irregular respiration

Sun, 10/12/2014 - 1:20pm

PURPOSE: One issue with amplitude binning list-mode studies in SPECT for respiratory motion correction is that variation in the patient's respiratory pattern will result in binned motion states with little or no counts at various projection angles. The reduced counts result in limited-angle reconstruction artifacts which can impact the accuracy of the necessary motion estimation needed to correct the images. In this work, the authors investigate a method to overcome the effect of limited-angle reconstruction artifacts in SPECT when estimating respiratory motion. METHODS: In the first pass of the reconstruction method, only the projection angles with significant counts in common between the binned respiratory states are used in order to better estimate the motion between them. After motion estimation, the estimates are used to correct for motion within iterative reconstruction using all of the acquired projection data. RESULTS: Using simulated SPECT studies based on the NCAT phantom, the authors demonstrate the problem caused by having data available for only a limited number of angles when estimating motion and the utility of the proposed method in diminishing this error. For NCAT data sets with a clinically appropriate level of Poisson noise, the average registration error for motion with the proposed method was always less with the use of their algorithm, the reduction being statistically significant (p<0.05) in the majority of cases. The authors illustrate the ability of their method to correct the degradations caused by respiratory motion in short-axis slices and polar maps of the NCAT phantom for cases with 1 and 2 cm amplitudes of respiratory motion. In four cardiac-perfusion patients acquired on the same day, the authors demonstrate the large variability of the number of counts in the amplitude-binned projections. Finally, the authors demonstrate a visual improvement in the slices and polar maps of patient studies with the algorithm for respiratory motion correction. CONCLUSIONS: The authors' method shows promise in reducing errors in respiratory motion estimation despite the presence of limited-angle reconstruction effects due to irregularity in respiration. Improvements in image quality were observed in both simulated and clinical studies.

Detectability of perfusion defect in five-dimensional gated-dynamic cardiac SPECT images

Sun, 10/12/2014 - 1:20pm

PURPOSE: In previous work, the authors developed and demonstrated the concept of an image reconstruction procedure aimed to unify gated and dynamic nuclear cardiac imaging, which the authors have termed five-dimensional (5D) SPECT. Gated imaging permits the clinician to evaluate wall motion and, through the use of stress and rest scans, allows perfusion defects to be observed. Dynamic imaging depicts kinetics in the myocardium, which can be used to evaluate perfusion, but traditional dynamic images are motionless and do not depict wall motion. In this article, the authors investigate the degree to which perfusion defects can be detected from the dynamic information conveyed by 5D images, a problem that is particularly challenging in the absence of multiple fast camera rotations. METHODS: The authors first demonstrate the usefulness of dynamic reconstructed images for perfusion detection by using linear discriminant analyses (Fisher linear discriminant analysis and principal component analysis) and a numerical channelized Hotelling observer. The authors then derive three types of discriminant metrics for characterizing the temporal kinetic information in reconstructed dynamic images for differentiating perfusion defects from normal cardiac perfusion, which are the Fisher linear discriminant map, temporal derivative map, and kinetic parametric images. RESULTS: Results are based on the NURBS-based cardiac-torso phantom with simulation of Tc99m-teboroxime as the imaging agent. The derived metric maps and quantitative contrast-to-noise ratio results demonstrate that the reconstructed dynamic images could yield higher detectability of the perfusion defect than conventional gated reconstruction while providing wall motion information simultaneously. CONCLUSIONS: The proposed metrics can be used to produce new types of visualizations, showing wall motion and perfusion information, that may potentially be useful for clinical evaluation. Since 5D imaging permits wall motion and kinetics to be observed simultaneously, it may ultimately obviate the need for separate stress and rest scans.

Regularized Fully 5D Reconstruction of Cardiac Gated Dynamic SPECT Images

Sun, 10/12/2014 - 1:20pm

In our recent work, we proposed an image reconstruction procedure aimed to unify gated imaging and dynamic imaging in nuclear cardiac imaging. With this procedure the goal is to obtain an image sequence from a single acquisition which shows simultaneously both cardiac motion and tracer distribution change over the course of imaging. In this work, we further develop and demonstrate this procedure for fully 5D (3D space plus time plus gate) reconstruction in gated, dynamic cardiac SPECT imaging, where the challenge is even greater without the use of multiple fast camera rotations. For 5D reconstruction, we develop and compare two iterative algorithms: one is based on the modified block sequential regularized EM (BSREM-II) algorithm, and the other is based on the one-step late (OSL) algorithm. In our experiments, we simulated gated cardiac imaging with the NURBS-based cardiac-torso (NCAT) phantom and Tc99m-Teboroxime as the imaging agent, where acquisition with the equivalent of only three full camera rotations was used during the course of a 12-minute postinjection period. We conducted a thorough evaluation of the reconstruction results using a number of quantitative measures. Our results demonstrate that the 5D reconstruction procedure can yield gated dynamic images which show quantitative information for both perfusion defect detection and cardiac motion.

Quantitative Study of Rigid-Body and Respiratory Motion of Patients Undergoing Stress and Rest Cardiac SPECT Imaging

Sun, 10/12/2014 - 1:20pm

We report patient motion in 110 Tl-201 cardiac perfusion SPECT studies in 66 patients. The imaging consisted of emission followed by sequential transmission imaging during which motion tracking with a visual tracking system (VTS) was performed. We investigated the extent, time, and frequency of respiratory and rigid-body motion in these patients. We also determined whether the motion occurred gradually or in sudden jumps, whether it was sustained, and if it occurred along one or more axes predominantly. We then studied the differences in respiratory and body motion (BM), if any, between stress versus rest imaging groups, male versus female subjects, and exercise versus pharmacological stress groups. We found that 23% of the studies had sustained motion (> 4min.) of between 3-6 mm, and 5% had sustained motion larger than 6 mm during emission imaging. In terms of respiratory motion, 13% showed a downward trend of the respiratory baseline of more than 6 mm during emission imaging. Also, in 9% of the studies, the average position of patients was displaced by more than 3 mm between emission and transmission imaging phases. Both of these motions may lead to misalignment of the attenuation map. In hypothesis testing of grouped studies, it was determined that stress and rest imaging did not show any significant differences in body motion but did in respiratory motion associated with a change in respiration following stress. Exercise-stress studies showed a larger extent of respiratory motion than the pharmacologically induced stress studies. Significant differences in body and respiratory motion of male and female groups were also observed. A visual assessment of the reconstructed slices in the studies with measured motion was made to investigate the impact of the motion. Illustrative example studies are included.

Body Deformation Correction for SPECT Imaging

Sun, 10/12/2014 - 1:20pm

Patient motion degrades the quality of SPECT studies. Body bend and twist are types of patient deformation, which may occur during SPECT imaging, and which has been generally ignored in SPECT motion correction strategies. To correct for these types of motion, we propose a deformation model and its inclusion within an iterative reconstruction algorithm. Two experiments were conducted to investigate the applicability of our model. In the first experiment, the return of the postmotion-compensation locations of markers on the body-surface of a volunteer to approximate their original coordinates is used to examine our method of estimating the parameters of our model and the parameters' use in undoing deformation. The second experiment employed simulated projections of the MCAT phantom formed using an analytical projector which includes attenuation and distance-dependent resolution to investigate applications of our model in reconstruction. We demonstrate in the simulation studies that twist and bend can significantly degrade SPECT image quality visually. Our correction strategy is shown to be able to greatly diminish the degradation seen in the slices, provided the parameters are estimated accurately. We view this work as a first step towards being able to estimate and correct patient deformation based on information obtained from marker tracking data.

Improved Dynamic Cardiac Phantom Based on 4D NURBS and Tagged MRI

Sun, 10/12/2014 - 1:20pm

We previously developed a realistic phantom for the cardiac motion for use in medical imaging research. The phantom was based upon a gated magnetic resonance imaging (MRI) cardiac study and using 4D non-uniform rational b-splines (NURBS). Using the gated MRI study as the basis for the cardiac model had its limitations. From the MRI images, the change in the size and geometry of the heart structures could be obtained, but without markers to track the movement of points on or within the myocardium, no explicit time correspondence could be established for the structures. Also, only the inner and outer surfaces of the myocardium could be modeled. We enhance this phantom of the beating heart using 4D tagged MRI data. We utilize NURBS surfaces to analyze the full 3D motion of the heart from the tagged data. From this analysis, time-dependent 3D NURBS surfaces were created for the right (RV) and left ventricles (LV). Models for the atria were developed separately since the tagged data only covered the ventricles. A 4D NURBS surface was fit to the 3D surfaces of the heart creating time-continuous 4D NURBS models. Multiple 4D surfaces were created for the left ventricle (LV) spanning its entire volume. The multiple surfaces for the LV were spline-interpolated about an additional dimension, thickness, creating a 4D NURBS solid model for the LV with the ability to represent the motion of any point within the volume of the LV myocardium at any time during the cardiac cycle. Our analysis of the tagged data was found to produce accurate models for the RV and LV at each time frame. In a comparison with segmented structures from the tagged dataset, LV and RV surface predictions were found to vary by a maximum of 1.5 mm's and 3.4 mm's respectively. The errors can be attributed to the tag spacing in the data (7.97 mm's). The new cardiac model was incorporated into the 4D NURBS-based Cardiac-Torso (NCAT) phantom widely used in imaging research. With its enhanced abilities, the model will provide a useful tool in the study of cardiac imaging and the effects of cardiac motion in medical images.

A quantitative evaluation study of four-dimensional gated cardiac SPECT reconstruction

Sun, 10/12/2014 - 1:20pm

In practice, gated cardiac SPECT images suffer from a number of degrading factors, including distance-dependent blur, attenuation, scatter and increased noise due to gating. Recently, we proposed a motion-compensated approach for four-dimensional (4D) reconstruction for gated cardiac SPECT and demonstrated that use of motion-compensated temporal smoothing could be effective for suppressing the increased noise due to lowered counts in individual gates. In this work, we further develop this motion-compensated 4D approach by also taking into account attenuation and scatter in the reconstruction process, which are two major degrading factors in SPECT data. In our experiments, we conducted a thorough quantitative evaluation of the proposed 4D method using Monte Carlo simulated SPECT imaging based on the 4D NURBS-based cardiac-torso (NCAT) phantom. In particular, we evaluated the accuracy of the reconstructed left ventricular myocardium using a number of quantitative measures including regional bias-variance analyses and wall intensity uniformity. The quantitative results demonstrate that use of motion-compensated 4D reconstruction can improve the accuracy of the reconstructed myocardium, which in turn can improve the detectability of perfusion defects. Moreover, our results reveal that while traditional spatial smoothing could be beneficial, its merit would become diminished with the use of motion-compensated temporal regularization. As a preliminary demonstration, we also tested our 4D approach on patient data. The reconstructed images from both simulated and patient data demonstrated that our 4D method can improve the definition of the LV wall.

Theoretical and Numerical Study of MLEM and OSEM Reconstruction Algorithms for Motion Correction in Emission Tomography

Sun, 10/12/2014 - 1:20pm

Patient body-motion and respiratory-motion impacts the image quality of cardiac SPECT and PET perfusion images. Several algorithms exist in the literature to correct for motion within the iterative maximum-likelihood reconstruction framework. In this work, three algorithms are derived starting with Poisson statistics to correct for patient motion. The first one is a motion compensated MLEM algorithm (MC-MLEM). The next two algorithms called MGEM-1 and MGEM-2 (short for Motion Gated OSEM, 1 and 2) use the motion states as subsets, in two different ways. Experiments were performed with NCAT phantoms (with exactly known motion) as the source and attenuation distributions. Experiments were also performed on an anthropomorphic phantom and a patient study. The SIMIND Monte Carlo simulation software was used to create SPECT projection images of the NCAT phantoms. The projection images were then modified to have Poisson noise levels equivalent to that of clinical acquisition. We investigated application of these algorithms to correction of (1) a large body-motion of 2 cm in Superior-Inferior (SI) and Anterior-Posterior (AP) directions each and (2) respiratory motion of 2 cm in SI and 0.6 cm in AP. We determined the bias with respect to the NCAT phantom activity for noiseless reconstructions as well as the bias-variance for noisy reconstructions. The MGEM-1 advanced along the bias-variance curve faster than the MC-MLEM with iterations. The MGEM-1 also lowered the noiseless bias (with respect to NCAT truth) faster with iterations, compared to the MC-MLEM algorithms, as expected with subset algorithms. For the body motion correction with two motion states, after the 9th iteration the bias was close to that of MC-MLEM at iteration 17, reducing the number of iterations by a factor of 1.89. For the respiratory motion correction with 9 motion states, based on the noiseless bias, the iteration reduction factor was approximately 7. For the MGEM-2, however, bias-plot or the bias-variance-plot saturated with iteration because of successive interpolation error. SPECT data was acquired simulating respiratory motion of 2 cm amplitude with an anthropomorphic phantom. A patient study acquired with body motion in a second rest was also acquired. The motion correction was applied to these acquisitions with the anthropomorphic phantom and the patient study, showing marked improvements of image quality with the estimated motion correction.

Estimation of Cardiac Respiratory-Motion by Semi-Automatic Segmentation and Registration of Non-Contrast-Enhanced 4D-CT Cardiac Datasets

Sun, 10/12/2014 - 1:20pm

The goal of this work is to investigate, for a large set of patients, the motion of the heart with respiration during free-breathing supine medical imaging. For this purpose we analyzed the motion of the heart in 32 non-contrast enhanced respiratory-gated 4D-CT datasets acquired during quiet unconstrained breathing. The respiratory-gated CT images covered the cardiac region and were acquired at each of 10 stages of the respiratory cycle, with the first stage being end-inspiration. We devised a 3-D semi-automated segmentation algorithm that segments the heart in the 4D-CT datasets acquired without contrast enhancement for use in estimating respiratory motion of the heart. Our semi-automated segmentation results were compared against interactive hand segmentations of the coronal slices by a cardiologist and a radiologist. The pairwise difference in segmentation among the algorithm and the physicians was on the average 11% and 10% of the total average segmented volume across the patient, with a couple of patients as outliers above the 95% agreement limit. The mean difference among the two physicians was 8% with an outlier above the 95% agreement limit. The 3-D segmentation was an order of magnitude faster than the Physicians' manual segmentation and represents significant reduction of Physicians' time. The segmented first stages of respiration were used in 12 degree-of-freedom (DOF) affine registration to estimate the motion at each subsequent stage of respiration. The registration results from the 32 patients indicate that the translation in the superior-inferior direction was the largest component motion, with a maximum of 10.7 mm, mean of 6.4 mm, and standard deviation of 2.2 mm. Translation in the anterior-posterior direction was the next largest component of motion, with a maximum of 4.0 mm, mean of 1.7 mm, and standard deviation of 1.0 mm. Rotation about the right-left axis was on average the largest component of rotation observed, with a maximum of 4.6 degrees, mean of 1.6 degrees, and standard deviation of 2.1 degrees. The other rotation and shear parameters were all close to zero on average indicting the motion could be reasonably well approximated by rigid-body motion. However, the product of the three scale factors averaged about 0.97 indicating the possibility of a small decrease in heart volume with expiration. The motion results were similar whether we used the Physician's segmentation or the 3-D algorithm.

Impact on reader performance for lesion-detection/ localization tasks of anatomical priors in SPECT reconstruction

Sun, 10/12/2014 - 1:20pm

With increasing availability of multimodality imaging systems, high-resolution anatomical images can be used to guide the reconstruction of emission tomography studies. By measuring reader performance on a lesion detection task, this study investigates the improvement in image-quality due to use of prior anatomical knowledge, for example organ or lesion boundaries, during SPECT reconstruction. Simulated (67)Ga -citrate source and attenuation distributions were created from the mathematical cardiac-torso (MCAT) anthropomorphic digital phantom. The SIMIND Monte Carlo software was then used to generate SPECT projection data. The data were reconstructed using the De Pierro maximum a posteriori (MAP) algorithm and the rescaled-block-iterative (RBI) algorithm for comparison. We compared several degrees of prior knowledge about the anatomy: no knowledge about the anatomy; knowledge of organ boundaries; knowledge of organ and lesion boundaries; and knowledge of organ, lesion, and pseudo-lesion (non-emission uptake altering) boundaries. The MAP reconstructions used quadratic smoothing within anatomical regions, but not across any provided region boundaries. The reconstructed images were read by human observers searching for lesions in a localization receiver operating characteristic (LROC) study of the relative detection/localization accuracies of the reconstruction algorithms. Area under the LROC curve was computed for each algorithm as the comparison metric. We also had humans read images reconstructed using different prior strengths to determine the optimal trade-off between data consistency and the anatomical prior. Finally by mixing together images reconstructed with and without the prior, we tested to see if having an anatomical prior only some of the time changes the observer's detection/localization accuracy on lesions where no boundary prior is available. We found that anatomical priors including organ and lesion boundaries improve observer performance on the lesion detection/localization task. Use of just organ boundaries did not provide a statistically significant improvement in performance however. We also found that optimal prior strength depends on the level of anatomical knowledge, with a broad plateau in which observer performance is near optimal. We found no evidence that having anatomical priors use lesion boundaries only when available changes the observer's performance when they are not available. We conclude that use of anatomical priors with organ and lesion boundaries improves reader performance on a lesion-detection/localization task, and that pseudo-lesion boundaries do not hurt reader performance. However, we did not find evidence that a prior using only organ boundaries helps observer performance. Therefore we suggest prior strength should be tuned to the organ-only case, since a prior will likely not be available for all lesions.

A flexible multicamera visual-tracking system for detecting and correcting motion-induced artifacts in cardiac SPECT slices

Sun, 10/12/2014 - 1:20pm

Patient motion is inevitable in SPECT and PET due to the lengthy period of time patients are imaged. The authors hypothesized that the use of external-tracking devices which provide additional information on patient motion independent of SPECT data could be employed to provide a more robust correction than obtainable from data-driven methods. Therefore, the authors investigated the Vicon MX visual-tracking system (VTS) which utilizes near-infrared (NIR) cameras to stereo-image small retroreflective markers on stretchy bands wrapped about the chest and abdomen of patients during cardiac SPECT. The chest markers are used to provide an estimate of the rigid-body (RB) motion of the heart. The abdomen markers are used to provide a signal used to bin list-mode acquisitions as part of correction of respiratory motion of the heart. The system is flexible in that the layout of the cameras can be designed to facilitate marker viewing. The system also automatically adapts marker tracking to employ all of the cameras visualizing a marker at any instant, with visualization by any two being sufficient for stereo-tracking. Herein the ability of this VTS to track motion with submillimeter and subdegree accuracy is established through studies comparing the motion of Tc-99m containing markers as assessed via stereo-tracking and from SPECT reconstructions. The temporal synchronization between motion-tracking data and timing marks embedded in list-mode SPECT acquisitions is shown to agree within 100 ms. In addition, motion artifacts were considerably reduced in reconstructed SPECT slices of an anthropomorphic phantom by employing within iterative reconstruction the motion-tracking information from markers attached to the phantom. The authors assessed the number and placement of NIR cameras required for robust motion tracking of markers during clinical imaging in 77 SPECT patients. They determined that they were able to track without loss during the entire period of SPECT and transmission imaging at least three of the four markers on the chest and one on the abdomen bands 94% and 92% of the time, respectively. The ability of the VTS to correct motion clinically is illustrated for ten patients who volunteered to undergo repeat-rest imaging with the original-rest SPECT study serving as the standard against which to compare the success of correction. Comparison of short-axis slices shows that VTS-based motion correction provides better agreement with the original-rest-imaging slices than either no correction or the vendor-supplied software for motion correction on, our SPECT system. Comparison of polar maps shows that VTS-based motion-correction results in less numerical difference on average in the segments of the polar maps between the original-rest study and the second-rest study than the other two strategies. The difference was statistically significant for the comparison between VTS-based and clinical vendor-supplied software correction. Taken together, these findings suggest that VTS-based motion correction is superior to either no-motion correction or the vendor-supplied software the authors investigated in clinical practice.

Estimation of Rigid-Body and Respiratory Motion of the Heart From Marker-Tracking Data for SPECT Motion Correction

Sun, 10/12/2014 - 1:20pm

Motion of patients undergoing cardiac SPECT perfusion imaging causes artifacts in the acquired images which may lead to difficulty in interpretation. Our work investigates a technique of obtaining patient motion estimates from retro-reflective markers on stretchy bands wrapped around the chest and abdomen of patients being imaged clinically. Motion signals obtained from the markers consist of at least two components, body motion (BM) and periodic motion (PM) due to respiration. We present a method for separating these components from the motion-tracking data of each marker, and then report a method for combining the BM estimated from chest markers to estimate the 6-degree-of-freedom (6-DOF) rigid-body motion (RBM) of the heart. Motion studies of volunteers and patients are used to evaluate the methods. Illustrative examples of the motion of the heart due to patient body movement and respiration (upward creep) are presented and compared to estimates of the motion of the heart obtained directly from SPECT data. Our motion-tracking method is seen to give reasonable agreement with the motion-estimates from the SPECT data while being considerably less noisy.

An evaluation of iterative reconstruction strategies based on mediastinal lesion detection using hybrid Ga-67 SPECT images

Sun, 10/12/2014 - 1:20pm

Using psychophysical studies, the authors have evaluated the effectiveness of various strategies for compensating for physical degradations in SPECT imaging. The particular application was Ga-67-citrate imaging of mediastinal tumors, which was chosen because Ga-67 is a particularly challenging radionuclide for imaging. The test strategies included compensations for nonuniform attenuation, distance-dependent spatial resolution, and scatter applied in various combinations as part of iterative reconstructions with the rescaled block iterative-expectation maximization (RBI-EM) algorithm. The authors also evaluated filtered backprojection reconstructions. Strategies were compared on the basis of human-observer studies of lesion localization and detection accuracy using the localization receiver operating characteristics (LROC) paradigm. These studies involved hybrid images which were obtained by adding the projections of Monte Carlo-simulated lesions to disease-free clinical projection data. The background variability in these images can provide a more realistic assessment of the relative utility of reconstruction strategies than images from anthropomorphic digital phantoms. The clinical datasets were obtained using a GE-VG dual-detector SPECT system with CT-estimated attenuation maps. After determining a target lesion contrast, they conducted pilot LROC studies to obtain a near-optimal set of reconstruction parameters for each strategy, and then conducted the strategy comparison study. The results indicate improved detection accuracy with RBI-EM as more compensations are applied within the reconstruction. The relative rankings of the test strategies agreed in most cases with those of previous studies that employed simulated projections of digital anthropomorphic phantoms, thus confirming the findings of those studies.

Convolution-Based Forced Detection Monte Carlo Simulation Incorporating Septal Penetration Modeling

Sun, 10/12/2014 - 1:20pm

In SPECT imaging, photon transport effects such as scatter, attenuation and septal penetration can negatively affect the quality of the reconstructed image and the accuracy of quantitation estimation. As such, it is useful to model these effects as carefully as possible during the image reconstruction process. Many of these effects can be included in Monte Carlo (MC) based image reconstruction using convolution-based forced detection (CFD). With CFD Monte Carlo (CFD-MC), often only the geometric response of the collimator is modeled, thereby making the assumption that the collimator materials are thick enough to completely absorb photons. However, in order to retain high collimator sensitivity and high spatial resolution, it is required that the septa be as thin as possible, thus resulting in a significant amount of septal penetration for high energy radionuclides. A method for modeling the effects of both collimator septal penetration and geometric response using ray tracing (RT) techniques has been performed and included into a CFD-MC program. Two look-up tables are pre-calculated based on the specific collimator parameters and radionuclides, and subsequently incorporated into the SIMIND MC program. One table consists of the cumulative septal thickness between any point on the collimator and the center location of the collimator. The other table presents the resultant collimator response for a point source at different distances from the collimator and for various energies. A series of RT simulations have been compared to experimental data for different radionuclides and collimators. Results of the RT technique matches experimental data of collimator response very well, producing correlation coefficients higher than 0.995. Reasonable values of the parameters in the lookup table and computation speed are discussed in order to achieve high accuracy while using minimal storage space for the look-up tables. In order to achieve noise-free projection images from MC, it is seen that the inclusion of the RT implementation for septal penetration increases the speed of the simulation by a factor of about 7,500 compared to the conventional SIMIND MC program.

Principles of Radiation Oncology

Tue, 10/07/2014 - 2:22pm

This chapter in Cancer Concepts: a Guidebook for the Non-Oncologist describes the principles of Radiation Oncology. Radiation Oncology utilizes ionizing radiation to treat cancer (and occasionally a few benign conditions). Radiotherapy or radiation therapy (RT) was initially developed in conjunction with diagnostic radiology, but has evolved into a separate specialty. Currently, more than fifty percent of cancer patients undergo RT at some point during the course of their cancer. Most receive treatment with curative intent (radical therapy); however, patients with incurable disease receive shorter, gentler courses of therapy to relieve cancer-induced symptoms.

The Agency for Healthcare Research and Quality Inpatient Quality Indicator #11 overall mortality rate does not accurately assess mortality risk after abdominal aortic aneurysm repair

Fri, 10/03/2014 - 10:29am

OBJECTIVE: The Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicator (IQI) #11, abdominal aortic aneurysm (AAA) repair mortality rate, is a measure of hospital quality that is publically reported but has not been externally validated. Because the IQI #11 overall mortality rate includes both intact and ruptured aneurysms and open and endovascular repair, we hypothesized that IQI #11 overall mortality rate does not provide accurate assessment of mortality risk after AAA repair and that AAA mortality cannot be accurately assessed by a single quality measure.

METHODS: Using AHRQ IQI software version 4.2, we calculated observed (O) and expected (E) mortality rates for IQI #11 for all hospitals performing more than 10 AAA repairs per year in the Nationwide Inpatient Sample for the years 2007 to 2011. We used Spearman correlation coefficient to compare expected rates as determined by IQI #11 overall mortality rate risk adjustment methodology and observed rates for all AAA repairs in four cohorts stratified by aneurysm stability (ruptured vs intact) and method of repair (open vs endovascular).

RESULTS: Among 187,773 AAA repairs performed at 1268 U.S. hospitals, hospitals' IQI #11 overall expected rates correlated poorly with their observed rates (E: 5.0% ± 4.4% vs O: 6.0% ± 9.8%; r = .49). For ruptured AAAs, IQI #11 overall mortality rate methodology underestimated the mortality risk of open repair (E: 34% ± 7.2% vs O: 40.1% ± 38.2%; r = 0.20) and endovascular repair (E: 24.8% ± 9% vs O: 27.3% ± 37.9%; r = 0.08). For intact AAA repair, IQI #11 overall mortality rate methodology underestimated the mortality risk of open repair (E: 4.3% ± 2.4% vs O: 6.3% ± 16.1%; r = .24) but overestimated the mortality risk of endovascular repair (E: 1.3% ± 0.8% vs O: 1.1% ± 3.7%; r = 0.25). Hospitals' observed mortality rates after intact AAA repair were not correlated with their mortality rates after ruptured AAA repair (r = 0.03).

CONCLUSIONS: IQI #11 overall mortality rate fails to provide accurate assessment of inpatient mortality risk after AAA repair. Thus, it is inappropriate to use IQI #11 overall mortality rate for quality reporting. The accuracy of separate quality measures that assess mortality risk after repair of ruptured and intact AAAs, stratified by the use of open or endovascular repair, should be examined.