The efficacy of interventional treatments highly relies on an accurate identification of the target lesions and the interventional tools in the guidance images. Whereas X-ray radiography poses low doses to the patient, its weakness is in the superposition of the different image structures in a 2D image. Cone-beam computed tomography (CBCT) might look ideal providing exact 3D information, however this is at the cost of a higher radiation dose, longer imaging time, and more space requirements in the operating room. Introducing some depth information with relatively low dose, and requiring less space, digital tomosynthesis (DTS) is a potential candidate for guiding interventions. However, due to the few number of projections and to the limited angle acquisition, DTS has poor depth resolution. Since high quality patient-specific prior CT scans are usually performed prior to the intervention for diagnosis or to plan the intervention, and given that such images share a fair amount of information with the intraoperative DTS images, we propose in this work a prior-based iterative reconstruction framework to improve the intraoperative DTS image quality. The framework is based on registering the prior CT image to an intermediate low-quality intraoperative DTS image, then iteratively re-reconstructing the intraoperative DTS image using the co-registered prior CT as the starting image. We acquired prior CT and intraoperative CBCT data of a liver phantom and simulated some intraoperative DTS projection images using a spherical ellipse scan geometry. Our results show a great improvement in the DTS image quality with the proposed method and prove the importance of choosing a good starting point for the iterative DTS reconstruction.
We present further progress on the implementation of C-arm CT imaging with the extended line-ellipse-line (LEL) trajectory. This novel data acquisition geometry is designed to enhance image quality in interventional radiology. Previously, we showed that robust extended LEL data acquisition is feasible using a state-of-the-art multi-axis robotic C-arm (ARTIS pheno, Siemens Healthcare GmbH, Germany) and we also showed that accurate reconstruction from real data can be obtained using an iterative algorithm. The extensive computational effort required by such an algorithm is however not suitable for clinical translation. Reconstruction using a filtered- backprojection (FBP) formula would be practical. To use such a formula, there needs to be a technique to handle imperfections in the data acquisition geometry, which result from mechanical vibrations and gravity effects. We recently presented such a technique, but this development was only carried out for a single cycle of the LEL trajectory. In this work, we address the more challenging issue of reconstructing the volume covered by multiple cycles of the trajectory. Specifically, we propose an extension of our single cycle approach to multiple cycles. We successfully demonstrate that our procedure now allows seamless volume reconstruction from real data using a cone-beam performance phantom as well as an anthropomorphic head phantom. Our results bring the extended LEL trajectory closer to clinical deployment for improved image quality in interventional radiology. Further work will focus on increasing the number of views to avoid few view artifacts and on thoroughly demonstrating image quality benefits.
C-arm CT imaging can be improved in terms of axial coverage and cone-beam artifacts using advanced data acquisition geometries such as the extend line-ellipse-line trajectory. Previously, we showed that such a geometry can be robustly implemented on a clinical system. Here, we demonstrate that imperfections in the trajectory realization can be addressed so as to achieve accurate high contrast imaging with a theoretical-exact filtered- backprojection algorithm. The performance of the proposed algorithm is evaluated using the FORBILD head phantom as well as real data of an anthropomorphic head phantom.
Three-dimensional cone-beam (CB) imaging using a multi-axis floor-mounted (or ceiling-mounted) C-arm system has become an important tool in interventional radiology. This success motivates new developments to improve image quality. One direction in which advancement is sought is the data acquisition geometry and related CB artifacts. Currently, data acquisition is performed using the circular short-scan trajectory, which yields limited axial coverage and also provides incomplete data for accurate reconstruction. To improve the image quality, as well as to increase the coverage in the longitudinal direction of the patient, we recently introduced the ellipse- line-ellipse trajectory and showed that this trajectory provides full R-line coverage within the field-of-view, which is a key property for accurate reconstruction from truncated data. An R-line is any segment of line that connects two source positions. Here, we examine how the application of asymmetrical variations to the definition of the ELE trajectory impacts the R-line coverage. This question is significant to understand how much flexibility can be used in the implementation of the ELE trajectory, particularly to adapt the scan to patient anatomy and imaging task of interest. Two types of asymmetrical variations, called axial and angular variations, are investigated.
Over the last decade, significant progress has been made in terms of treatment of diseases using minimallyinvasive
procedures. This progress was facilitated through multiple refinements of the imaging capabilities of
C-arm systems in the interventional room, and more sophisticated procedures may become feasible by further
refining the performance of these systems. Our primary focus is to eliminate two strong limitations of the
current circular cone-beam imaging approach: cone-beam artifacts and limited extent of the volume covered in
the direction of the patient bed. To solve this problem, we seek a source trajectory that (i) is complete in terms
of Tuy's condition, (ii) can be periodically-repeated without discontinuities to allow long-object imaging, (iii)
is practical, and (iv) offers full R-line coverage (an R-line is a line that connects any two source positions). A
trajectory that satisfies all of our constraint is the
Arc-Extended-Line-Arc(AELA) trajectory. Unfortunately,
this trajectory does not allow smooth, continuous scanning at reasonable dose. In this work, we propose a new
data acquisition geometry: the Ellipse-Line-Ellipse (ELE) trajectory. This geometry satisfies all of our constraints
along with the attractive feature that smooth, continuous scanning at reasonable dose is enabled.
Diagnosis and treatment of coronary diseases depends on the data acquired during
angiographic investigations. To provide better assistance for angiographic procedures, a segmentation
of the lumen is required. A new algorithm for vessel centerline computation and
lumen segmentation in 2D projection coronary angiograms is presented. Centerlines are extracted
by a graph-based optimization technique, which searches for paths with minimal costs.
The search starts from a source point, which is automatically set by the proposed algorithm. A
new objective function for determining the costs of the graph edges is proposed. It consists of
the response from the medialness filter and is regularized by the centerline potential function.
In the medialness filter a vessel cross-section is represented by a 1D profile parameterized by
center position and radius. The medialness filter at a point optimizes a gradient-based response
over the profile radius. The proposed centerline potential function defines likeliness of each
point of the image to be a centerline. Both the medialness filter and the centerline potential
function are multi-scale. The entire lumen segmentation is achieved by the radii extracted during
the medialness response computation. Application to clinical data shows that the presented
algorithm segments coronary lumen with good accuracy and allows for subsequent assessment
of the quantitative characteristics (i.e. diameter, curvature, etc.) of the vessels.
Diagnosis and treatment of coronary heart disease are performed in the catheter laboratory using an angiographic X-ray
C-arm system. The morphology of the coronary tree and potentially ischemic lesions are determined in 2D projection
views. The hemodynamic impact of the lesion would be valuable information for treatment decision. Using other
modalities for functional imaging is disrupting the clinical workflow since the patient has to be transferred from the
catheter laboratory to another scanner, and back to the catheter laboratory for performing the treatment. In this work a
novel technology is used for simultaneous 3D imaging of first pass perfusion and the morphology of the coronary tree
from a single rotational angiogram. A selective, single shot of contrast agent of less than 20ml directly into the
coronaries is sufficient for a proper contrast resolution. Due to the long acquisition time cardiac motion has to be
considered. A novel reconstruction technique for estimation and compensation of cardiac motion from the acquired
projection data is used. The overlay of the 3D structure of the coronary tree and the perfusion image shows the
correlation of myocardial areas and the associated coronary sections supporting that region. In a case example scar
lesions caused by a former myocardial infarct are investigated. A first pass perfusion defect is found which is validated
by a late enhancement magnetic resonance image. No ischemic defects are found. The non vital regions are still
supported by the coronary vasculature.
Time-resolved 3-D imaging of the heart is a major research topic in the medical imaging community. Recent advances in the interventional cardiac 3-D imaging from rotational angiography (C-arm CT) are now also making 4-D imaging feasible during procedures in the catheter laboratory. State-of-the-art reconstruction algorithms try to estimate the cardiac motion and utilize the motion field to enhance the reconstruction of a stable cardiac phase (diastole). The available data offers a handful of opportunities during interventional procedures, e.g. the ECG-synchronized dynamic roadmapping or the computation and analysis of functional parameters. In this paper we will demonstrate that the motion vector field (MVF) that is output by motion compensated image reconstruction algorithms is in general not directly usable for animation and motion analysis. Dependent on the algorithm different defects are investigated. A primary issue is that the MVF needs to be inverted, i.e. the wrong direction of motion is provided. A second major issue is the non-periodicity of cardiac motion. In algorithms which compute a non-periodic motion field from a single rotation the in depth motion information along viewing direction is missing, since this cannot be measured in the projections. As a result, while the MVF improves reconstruction quality, it is insufficient for motion animation and analysis. We propose an algorithm to solve both problems, i.e. inversion and missing in-depth information in a unified framework. A periodic version of the MVF is approximated. The task is formulated as a linear optimization problem where a parametric smooth motion model based on B-splines is estimated from the MVF. It is shown that the problem can be solved using a sparse QR factorization within a clinical feasible time of less than one minute. In a phantom experiment using the publicly available CAVAREV platform, the average quality of a non-periodic animation could be increased by 39% by applying the proposed periodization and inversion method.
The purpose of this study was to evaluate whether contrast-enhanced C-arm CT (3D rotational angiography) can
distinguish radiofrequency (RF) ablation lesions created in the left ventricle. Ablation lesions were created on the
endocardial surface of the left ventricle of 6 swine using a 7 F RF ablation catheter with a 4 mm electrode. An ECGgated
C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and every 5
min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline and the mean and
standard deviation of the signal intensity of the ablation lesion, normal myocardium, and blood were measured. Eleven
ablation lesions were visualized and the time-attenuation curve of the signal intensity was plotted. A mean signal
intensity increase of 64.8 ±33.6 HU was measured in the late enhancement of seven lesions compared to normal
myocardium. This is the first study to demonstrate RF ablation lesion enhancement patterns similar to those seen for MR
imaging using C-arm CT, an imaging modality that can provide valuable feedback during cardiac interventional
procedures.
Image guidance during cardiac interventional procedures (IP) using cardiac C-arm CT systems is desirable for
many procedures. Applying the concept of retrospective electrocardiogram gating (ECG) to the acquisition of
multiple, ECG-triggered rotational acquisitions using a C-arm system allows the 3D+t reconstruction of the
heart. The process of retrospective gating is a crucial component of 3-D reconstruction. The gold-standard
in gating is still ECG based. However, the ECG signal does not directly reflect the mechanical situation of
the heart. Therefore an alternative gating method, based on the acquired projection data is required. Our
goal is to provide an image-based gating (IBG) method without ECG such that already acquired projection
data from a multi-sweep acquisition can still be used for reconstruction. We formulate the gating problem as a
shortest-path optimization problem. All acquired projection images build a directed graph and the path costs are
defined by projection image similarities that are based on image metrics to measure the heart phase similarity.
The optimization is additionally regularized to prefer solutions where the path segment of consecutive selected
projections acquired along a particular forward or backward C-arm sweep is short. This regularization depends
on an estimated average heart rate that is also estimated using an image-based method. First promising results
using in-vivo data are presented and compared to standard ECG gating. We conclude that the presented IBG
method provides a reliable gating.
KEYWORDS: Heart, Motion estimation, Signal to noise ratio, 3D image processing, Image registration, Temporal resolution, Electrocardiography, Motion measurement, 3D image reconstruction, Data acquisition
The combination of real-time fluoroscopy and 3D cardiac imaging on the same C-arm system is a promising technique
that might improve therapy planning, guiding, and monitoring in the interventional suite. In principal, to reconstruct a 3D
image of the beating heart at a particular cardiac phase, a complete set of X-ray projection data representing that phase is
required. One approximate approach is the retrospectively ECG-gated FDK reconstruction (RG-FDK). From the acquired
data set of Ns multiple C-arm sweeps, those projection images which are acquired closest in time to the desired cardiac
phase are retrospectively selected. However, this approach uses only 1/
Ns
of the obtained data. Our goal is to utilize data from
other cardiac phases as well. In order to minimize blurring and motion artifacts, cardiac motion has to be compensated for,
which can be achieved using a temporally dependent spatial 3D warping of the filtered-backprojections. In this work we
investigate the computation of the 4D heart motion based on prior reconstructions of several cardiac phases using RG-FDK.
A 4D motion estimation framework is presented using standard fast non-rigid registration. A smooth 4D motion vector
field (MVF) represents the relative deformation compared to a reference cardiac phase. A 4D deformation regridding by
adaptive supersampling allows selecting any reference phase independently of the set of phases used in the RG-FDK for
a motion corrected reconstruction. Initial promising results from in vivo experiments are shown. The subjects individual
4D cardiac MVF could be computed from only three RG-FDK image volumes. In addition, all acquired projection data
were motion corrected and subsequently used for image reconstruction to improve the signal-to-noise ratio compared to
RG-FDK.
X-ray 3D rotational angiography based on C-arm systems has become a versatile and established tomographic imaging modality for high contrast objects in interventional environment. Improvements in data acquisition, e.g. by use of flat panel detectors, will enable C-arm systems to resolve even low-contrast details. However, further progress will be limited by the incompleteness of data acquisition on the conventional short-scan circular source trajectories. Cone artifacts, which result from that incompleteness, significantly degrade image quality by severe smearing and shading. To assure data completeness a combination of a partial circle with one or several line segments is investigated. A new and efficient reconstruction algorithm is deduced from a general inversion formula based on 3D Radon theory. The method is theoretically exact, possesses shift-invariant filtered backprojection (FBP) structure, and solves the long object problem. The algorithm is flexible in dealing with various circle and line configurations. The reconstruction method requires nothing more than the theoretically minimum length of scan trajectory. It consists of a conventional short-scan circle and a line segment approximately twice as long as the height of the region-of-interest. Geometrical deviations from the ideal source trajectory are considered in the implementation in order to handle data of real C-arm systems. Reconstruction results show excellent image quality free of cone artifacts. The proposed scan trajectory and reconstruction algorithm assure excellent image quality and allow low-contrast tomographic imaging with C-arm based cone-beam systems. The method can be implemented without any hardware modifications on systems commercially available today.
In multi-slice spiral computed tomography (CT) there is an obvious trend in adding more and more detector rows. The goals are numerous: volume coverage, isotropic spatial resolution, and speed. Consequently, there will be a variety of scan protocols optimizing clinical applications. Flexibility in table feed requires consideration of data redundancies to ensure efficient detector usage. Until recently this was achieved by approximate reconstruction algorithms only. However, due to the increasing cone angles there is a need of exact treatment of the cone beam geometry. A new, exact and efficient 3-PI algorithm for considering three-fold data redundancies was derived from a general, theoretical framework based on 3D Radon inversion using Grangeat's formula. The 3-PI algorithm possesses a simple and efficient structure as the 1-PI method for non-redundant data previously proposed. Filtering is one-dimensional, performed along lines with variable tilt on the detector.
This talk deals with a thorough evaluation of the performance of the 3-PI algorithm in comparison to the 1-PI method. Image quality of the 3-PI algorithm is superior. The prominent spiral artifacts and other discretization artifacts are significantly reduced due to averaging effects when taking into account redundant data. Certainly signal-to-noise ratio is increased. The computational expense is comparable even to that of approximate algorithms. The 3-PI algorithm proves its practicability for applications in medical imaging. Other exact n-PI methods for n-fold data redundancies (n odd) can be deduced from the general, theoretical framework.
Recently one of the authors proposed a reconstruction algorithm, which is theoretically exact and has the truly shift-invariant filtering and backprojection structure. Each voxel is reconstructed using the theoretically minimum section of the spiral, which is located between the endpoints of the PI segment of the voxel. Filtering is one-dimensional, performed along lines with variable tilt on the detector, and consists of five terms. We will present evaluation of the performance of the algorithm. We will also discuss and illustrate empirically the contributions of the five filtering terms to the overall image. A thorough evaluation proved the validity of the algorithm. Excellent image results were achieved even for high pitch values. Overall image quality can be regarded as at least equivalent to the less efficient, exact, Radon-based methods. However, the new algorithm significantly increases efficiency. Thus, the method has the potential to be applied in clinical scanners of the future. The empirical analysis leads to a simple, intuitive understanding of the otherwise obscure terms of the algorithm. Identification and skipping of the practically irrelevant fifth term allows significant speed-up of the algorithm due to uniform distance weighting.
In the long object problem it is intended to reconstruct exactly a region-of-interest (ROI) of an object from spiral cone beam data which covers the ROI and its nearest vicinity only. In the first paper in a series of two the theory of the local ROI method is derived using the filtered-backprojection approach. In the present second paper the demanding numerical implementation is described. The straightforward 4-step algorithm is applied. It mainly consists of explicit calculations of the derivatives of partial plane integrals of the object from line segments in the projection images. In the local ROI method grouping of line segments to particular (phi) -planes in 3-D Radon space is important. A rigorous grouping causes artifacts which can be avoided by a fuzzy correspondence of line segments to (phi) -planes. In the ROI the same image quality is achieved for a partial scan as for a full scan. However, the method suffers from high computational requirements. The filtering step can be speeded up by replacing the 4-step algorithm by convolution with spatially variant 1-D Hilbert transforms. An in-depth analysis of the empirical PSF of detector pixels filtered by the 4-step algorithm confirmed the theoretical results. Modifications for practical implementation are outlined which are subject to further investigations.
We present a spiral scan cone beam reconstruction algorithm in which image reconstruction proceeds via backprojection in the object space. In principle the algorithm can reconstruct sectional ROI in a long object. The approach is a generalization of the cone beam backprojection technique developed by Kudo and Saito in two aspects: the resource- demanding normalization step in the Kudo and Saito's algorithm is eliminated through the technique of data combination which we published earlier, and the elimination of the restriction that the detector be big enough to capture the entire image of the ROI. Restricting the projection data to the appropriate angular range required by data combination can be accomplished by a masking process. The mask consists of a top curve and a bottom curve formed by projecting the spiral turn above and the turn below from the current source position. Because of the simplification resulting from the elimination of the normalization step, the most time-consuming operations of the algorithm can be approximated by the efficient step of line-by-line ramp filtering the cone beam image in the direction of the scan path, plus a correction term. The correction term is needed because data combination is not properly matched at the mask boundary when ramp filtering is involved. This correction term to the mask boundary effect can be computed exactly. The results of testing the algorithm on simulated phantoms are presented.
Tomosynthesis provides only incomplete 3D-data of the imaged object. Therefore it is important for reconstruction tasks to take all available information carefully into account. We are focusing on geometrical aspects of the scan process which can be incorporated into reconstruction algorithms by filtered backprojection methods. Our goal is a systematic approach to filter design. A unified theory of tomosynthesis is derived in the context of linear system theory, and a general four-step filter design concept is presented. Since the effects of filtering are understandable in this context, a methodical formulation of filter functions is possible in order to optimize image quality regarding the specific requirements of any application. By variation of filter parameters the slice thickness and the spatial resolution can easily be adjusted. The proposed general concept of filter design is exemplarily discussed for circular scanning but is valid for any specific scan geometry. The inherent limitations of tomosynthesis are pointed out and strategies for reducing the effects of incomplete sampling are developed. Results of a dental application show a striking improvement in image quality.
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