Abstract
.Research into conebeam CT concepts began as soon as the first clinical single-slice CT scanner was conceived. Early implementations of conebeam CT in the 1980s focused on high-contrast applications where concurrent high resolution (), for visualization of small contrast-filled vessels, bones, or teeth, was an imaging requirement that could not be met by the contemporaneous CT scanners. However, the use of nonlinear imagers, e.g., x-ray image intensifiers, limited the clinical utility of the earliest diagnostic conebeam CT systems. The development of consumer-electronics large-area displays provided a technical foundation that was leveraged in the 1990s to first produce large-area digital x-ray detectors for use in radiography and then compact flat panels suitable for high-resolution and high-frame-rate conebeam CT. In this review, we show the concurrent evolution of digital flat panel (DFP) technology and clinical conebeam CT. We give a brief summary of conebeam CT reconstruction, followed by a brief review of the correction approaches for DFP-specific artifacts. The historical development and current status of flat-panel conebeam CT in four clinical areas—breast, fixed C-arm, image-guided radiation therapy, and extremity/head—is presented. Advances in DFP technology over the past two decades have led to improved visualization of high-contrast, high-resolution clinical tasks, and image quality now approaches the soft-tissue contrast resolution that is the standard in clinical CT. Future technical developments in DFPs will enable an even broader range of clinical applications; research in the arena of flat-panel CT shows no signs of slowing down.
Highlights
Introduction to Dedicated Head and Extremitiesflat-panel CTs (FPCTs)Flat-panel-based CBCT for dedicated head and extremities systems was born out of contemporaneous developments in imaging for radiotherapy and interventional imaging (Fig. 28)
While early digital flat panel (DFP) technology did not meet all of the imaging requirements for all clinical applications, the geometric fidelity and high resolution of the detectors allowed for the implementation of flatpanel CT for “semistatic” imaging tasks, such as neurovascular imaging; 3D radiation oncology treatment verification; 3D mammographic CT; and extremity, dental, and ear, nose, and throat (ENT) imaging
In this historical and technical review, we present the development of flat-panel CT with a focus on four clinical applications: breast FPCT, fixed C-arm FPCT, on-board FPCT, and extremity/head FPCT
Summary
The dynamic spatial reconstructor (Mayo Clinic, 1980 to 19901–3) was one of the first clinical attempts to reconstruct a volume of three-dimensional (3D) data from large-area projection x-ray images. While early DFP technology did not meet all of the imaging requirements for all clinical applications (especially readout-rate), the geometric fidelity and high resolution of the detectors allowed for the implementation of flatpanel CT for “semistatic” imaging tasks, such as neurovascular imaging; 3D radiation oncology treatment verification; 3D mammographic CT; and extremity, dental, and ear, nose, and throat (ENT) imaging. In this historical and technical review, we present the development of flat-panel CT with a focus on four clinical applications: breast FPCT, fixed C-arm FPCT, on-board FPCT, and extremity/head FPCT. Especially driven recently by the development of AI-based algorithms for image processing and reconstruction, are opening interesting avenues for further improvements
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