Advanced Image Reconstruction Research Articles

Electrical Impedance Tomography, Artificial Intelligence, and Variable Ventilation: Transforming Respiratory Monitoring and Treatment in Critical Care

Background: Electrical Impedance Tomography (EIT), combined with variable ventilation strategies and Artificial Intelligence (AI), is poised to revolutionize critical care by transitioning from reactive to predictive approaches. This integration aims to enhance patient outcomes through personalized interventions and real-time monitoring. Methods: this narrative review explores the principles and applications of EIT, variable ventilation, and AI in critical care. EIT impedance sensing creates dynamic images of internal physiology, aiding the management of conditions like Acute Respiratory Distress Syndrome (ARDS). Variable ventilation mimics natural breathing variability to improve lung function and minimize ventilator-induced lung injury. AI enhances EIT through advanced image reconstruction techniques, neural networks, and digital twin technology, offering more accurate diagnostics and tailored therapeutic interventions. Conclusions: the confluence of EIT, variable ventilation, and AI represents a significant advancement in critical care, enabling a predictive, personalized approach. EIT provides real-time insights into lung function, guiding precise ventilation adjustments and therapeutic interventions. AI integration enhances EIT diagnostic capabilities, facilitating the development of personalized treatment plans. This synergy fosters interdisciplinary collaborations and sets the stage for innovative research, ultimately improving patient outcomes and advancing the future of critical care.

Clinical – anatomical correlation of anti-dystonic effect in pallidal stimulation by advanced image reconstruction

Clinical – anatomical correlation of anti-dystonic effect in pallidal stimulation by advanced image reconstruction

ACR benchmark testing of a novel high-speed ring-gantry linac kV-CBCT system.

A new generation cone-beam computed tomography (CBCT) system with new hardware design and advanced image reconstruction algorithms is available for radiation treatment simulation or adaptive radiotherapy (HyperSight CBCT imaging solution, Varian Medical Systems-a Siemens Healthineers company). This study assesses the CBCT image quality metrics using the criteria routinely used for diagnostic CT scanner accreditation as a first step towards the future use of HyperSight CBCT images for treatment planning and target/organ delineations. Image performance was evaluated using American College of Radiology (ACR) Program accreditation phantom tests for diagnostic computed tomography systems (CTs) and compared HyperSight images with a standard treatment planning diagnostic CT scanner (Siemens SOMATOM Edge) and with existing CBCT systems (Varian TrueBeam version 2.7 and Varian Halcyon version 2.0). Image quality performance for all Varian HyperSight CBCT vendor-provided imaging protocols were assessed using ACR head and body ring CT phantoms, then compared to existing imaging modalities. Image quality analysis metrics included contrast-to-noise (CNR), spatial resolution, Hounsfield number (HU) accuracy, image scaling, and uniformity. All image quality assessments were made following the recommendations and passing criteria provided by the ACR. The Varian HyperSight CBCT imaging system demonstrated excellent image quality, with the majority of vendor-provided imaging protocols capable of passing all ACR CT accreditation standards. Nearly all (8/11) vendor-provided protocols passed ACR criteria using the ACR head phantom, with the Abdomen Large, Pelvis Large, and H&N vendor-provided protocols produced HU uniformity values slightly exceeding passing criteria but remained within the allowable minor deviation levels (5-7 HU maximum differences). Compared to other existing CT and CBCT imaging modalities, both HyperSight Head and Pelvis imaging protocols matched the performance of the SOMATOM CT scanner, and both the HyperSight and SOMATOM CT substantially surpassed the performance of the Halcyon 2.0 and TrueBeam version 2.7 systems. Varian HyperSight CBCT imaging system could pass almost all tests for all vendor-provided protocols using ACR accreditation criteria, with image quality similar to those produced by diagnostic CT scanners and significantly better than existing linac-based CBCT imaging systems.

Compressed SVD-based L + S model to reconstruct undersampled dynamic MRI data using parallel architecture.

Magnetic Resonance Imaging (MRI) is a highly demanded medical imaging system due to high resolution, large volumetric coverage, and ability to capture the dynamic and functional information of body organs e.g. cardiac MRI is employed to assess cardiac structure and evaluate blood flow dynamics through the cardiac valves. Long scan time is the main drawback of MRI, which makes it difficult for the patients to remain still during the scanning process. By collecting fewer measurements, MRI scan time can be shortened, but this undersampling causes aliasing artifacts in the reconstructed images. Advanced image reconstruction algorithms have been used in literature to overcome these undersampling artifacts. These algorithms are computationally expensive and require a long time for reconstruction which makes them infeasible for real-time clinical applications e.g. cardiac MRI. However, exploiting the inherent parallelism in these algorithms can help to reduce their computation time. Low-rank plus sparse (L+S) matrix decomposition model is a technique used in literature to reconstruct the highly undersampled dynamic MRI (dMRI) data at the expense of long reconstruction time. In this paper, Compressed Singular Value Decomposition (cSVD) model is used in L+S decomposition model (instead of conventional SVD) to reduce the reconstruction time. The results provide improved quality of the reconstructed images. Furthermore, it has been observed that cSVD and other parts of the L+S model possess highly parallel operations; therefore, a customized GPU based parallel architecture of the modified L+S model has been presented to further reduce the reconstruction time. Four cardiac MRI datasets (three different cardiac perfusion acquired from different patients and one cardiac cine data), each with different acceleration factors of 2, 6 and 8 are used for experiments in this paper. Experimental results demonstrate that using the proposed parallel architecture for the reconstruction of cardiac perfusion data provides a speed-up factor up to 19.15× (with memory latency) and 70.55× (without memory latency) in comparison to the conventional CPU reconstruction with no compromise on image quality. The proposed method is well-suited for real-time clinical applications, offering a substantial reduction in reconstruction time.

Dedicated Cone-Beam Breast CT: Reproducibility of Volumetric Glandular Fraction with Advanced Image Reconstruction Methods.

Dedicated cone-beam breast computed tomography (CBBCT) is an emerging modality and provides fully three-dimensional (3D) images of the uncompressed breast at an isotropic voxel resolution. In an effort to translate this modality to breast cancer screening, advanced image reconstruction methods are being pursued. Since radiographic breast density is an established risk factor for breast cancer and CBBCT provides volumetric data, this study investigates the reproducibility of the volumetric glandular fraction (VGF), defined as the proportion of fibroglandular tissue volume relative to the total breast volume excluding the skin. Four image reconstruction methods were investigated: the analytical Feldkamp-Davis-Kress (FDK), a compressed sensing-based fast, regularized, iterative statistical technique (FRIST), a fully supervised deep learning approach using a multi-scale residual dense network (MS-RDN), and a self-supervised approach based on Noise-to-Noise (N2N) learning. Projection datasets from 106 women who participated in a prior clinical trial were reconstructed using each of these algorithms at a fixed isotropic voxel size of (0.273 mm3). Each reconstructed breast volume was segmented into skin, adipose, and fibroglandular tissues, and the VGF was computed. The VGF did not differ among the four reconstruction methods (p = 0.167), and none of the three advanced image reconstruction algorithms differed from the standard FDK reconstruction (p > 0.862). Advanced reconstruction algorithms developed for low-dose CBBCT reproduce the VGF to provide quantitative breast density, which can be used for risk estimation.

Angiography and optical coherence tomography derived shear stress: are they equivalent in my opinion?

Advances in image reconstruction using either single or multimodality imaging data provide increasingly accurate three-dimensional (3D) patient's arterial models for shear stress evaluation using computational fluid dynamics (CFD). We aim to evaluate the impacts on endothelial shear stress (ESS) derived from a simple image reconstruction using 3D-quantitative coronary angiography (3D-QCA) versus a multimodality reconstruction method using optical coherence tomography (OCT) in patients' vessels treated with bioresorbable scaffolds. Seven vessels at baseline and five-year follow-up of seven patients from a previous CFD investigation were retrospectively selected for a head-to-head comparison of angiography-derived versus OCT-derived ESS. 3D-QCA significantly underestimated the minimum stent area [MSA] (-2.38mm2) and the stent length (-1.46mm) compared to OCT-fusion method reconstructions. After carefully co-registering the region of interest for all cases with a sophisticated statistical method, the difference in MSA measurements as well as the inability of angiography to visualise the strut footprint in the lumen surface have translated to higher angiography-derived ESS than OCT-derived ESS (1.76Pa or 1.52 times for the overlapping segment). The difference in ESS widened with a more restricted region of interest (1.97Pa or 1.63 times within the scaffold segment). Angiography and OCT offer two distinctive methods of ESS calculation. Angiography-derived ESS tends to overestimate the ESS compared to OCT-derived ESS. Further investigations into ESS analysis resolution play a vital role in adopting OCT-derived ESS.

Comparative study of advanced image reconstruction algorithms for complex arbitrary components

Accurate ultrasonic imaging and inspection of specimens with non-planar complex surfaces are often challenging from both transducer coupling and imaging perspectives. Several inspection strategies have been developed to inspect such complex interfaced components such as flat arrays with flexible wedges or water-filled chambers with a flexible membrane. In these methods, firstly surface profiles are estimated and then Fermat’s principle or other algorithms are applied to calculate delay laws. The main drawback of these methods is the longer computation time and therefore real time inspection is limited, also a coupling problem due to the complex geometries. Alternative approaches have been developed to compute the ultrasonic beam paths such as the Fast-Marching Method (FMM), Dijkstra’s algorithms, numerical analysis, bisection and root-finding algorithms for the inspection of complex surface components. These algorithms can be applied in two and three-dimensional domains resulting in high computation time. This work presents an experimental comparison of an iterative beamforming method for arbitrary shaped surface profile imaging against both Full Matrix Capture-Total Focusing Method (FMC-TFM) and CIVA simulation on an aluminium calibration block with Side drilled holes (SDHs) at various depths in the range of 15-80 mm. The performance of the iterative beamforming method is evaluated in terms of sensitivity, Signal to Noise Ratio (SNR) and Array Performance Indicators (API). The method provides a 2 dB improved SNR when compared to FMC-TFM.

Stochastic three-dimensional numerical phantoms to enable computational studies in quantitative optoacoustic computed tomography of breast cancer.

When developing a new quantitative optoacoustic computed tomography (OAT) system for diagnostic imaging of breast cancer, objective assessments of various system designs through human trials are infeasible due to cost and ethical concerns. In prototype stages, however, different system designs can be cost-efficiently assessed via virtual imaging trials (VITs) employing ensembles of digital breast phantoms, i.e., numerical breast phantoms (NBPs), that convey clinically relevant variability in anatomy and optoacoustic tissue properties. The aim is to develop a framework for generating ensembles of realistic three-dimensional (3D) anatomical, functional, optical, and acoustic NBPs and numerical lesion phantoms (NLPs) for use in VITs of OAT applications in the diagnostic imaging of breast cancer. The generation of the anatomical NBPs was accomplished by extending existing NBPs developed by the U.S. Food and Drug Administration. As these were designed for use in mammography applications, substantial modifications were made to improve blood vasculature modeling for use in OAT. The NLPs were modeled to include viable tumor cells only or a combination of viable tumor cells, necrotic core, and peripheral angiogenesis region. Realistic optoacoustic tissue properties were stochastically assigned in the NBPs and NLPs. To advance optoacoustic and optical imaging research, 84 datasets have been released; these consist of anatomical, functional, optical, and acoustic NBPs and the corresponding simulated multi-wavelength optical fluence, initial pressure, and OAT measurements. The generated NBPs were compared with clinical data with respect to the volume of breast blood vessels and spatially averaged effective optical attenuation. The usefulness of the proposed framework was demonstrated through a case study to investigate the impact of acoustic heterogeneity on OAT images of the breast. The proposed framework will enhance the authenticity of virtual OAT studies and can be widely employed for the investigation and development of advanced image reconstruction and machine learning-based methods, as well as the objective evaluation and optimization of the OAT system designs.

A pilot study on intracerebral hemorrhage imaging based on electrical capacitance tomography

Introduction: Intracerebral hemorrhage (ICH) is a devastating disease with high rates of mortality and disability. The survival rate and postoperative outcome of ICH can be greatly improved through prompt diagnosis and treatment. CT and MRI are now the gold standards for the diagnosis of ICH, but they are not practical for use in pre-hospital emergencies or at the bedside monitoring.Methods: Based on the earlier research of ICH detection with a single parallel plate electrode sensor, we developed a 16-electrode Electrical Capacitance Tomography (ECT) system for two-dimensional tomographic imaging of ICH in this study. A 5-layer spherical numerical model and an ex vivo porcine physical model of ICH were created for ECT simulation imaging and actual imaging, respectively, to assess the feasibility of this ECT for ICH imaging.Results: The bleeding circles were easily seen in the image reconstruction in numerical imaging. In ex vivo imaging, the existence of bleeding was also more clearly shown with the ECT system; however, the position of the bleeding reconstructed in the image was offset by 3 mm from the real site.Discussion: The study analyzes the causes of this discrepancy and discusses the steps that may be taken to rectify it. Overall, the simulation and ex vivo experimental trials validated the potential of ICH imaging with the ECT method; however, further work is required to increase the performance of the ECT and a more advanced imaging reconstruction algorithm is urgently needed for ICH imaging.

Complex Valued Long Short Term Memory Based Architecture for Frequency Domain Photoacoustic Imaging

Frequency domain photoacoustic (FDPA) imaging has great potential in a clinical setting compared to time-domain photoacoustic imaging due to its reduced cost and small form factors. However FDPA system struggles with lower signal to noise ratio, necessitating the need for advanced image reconstruction methods. Most of the image reconstruction approaches in FDPA imaging are based on analytical or model based schemes. Very less emphasis has been placed on developing deep learning based approaches for FDPA imaging. In this work, a image translation network was developed with the ability to directly map from sinogram data (complex-valued) to the initial pressure rise distribution (real-valued) for FD-PA imaging. This architecture was based on a Long Short Term Memory (LSTM) backbone (with adjoined real and imaginary parts of the complex sinogram data as input) followed by a fully connected layer, which is then passed through a convolution and transposed convolution layer pair. The result of the FDPA-LSTM architecture was compared with direct translational networks based on ResNet, UNet and AUTOMAP and found to have an improvement of about 15% in terms of PSNR and 10% in terms of SSIM with <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$150^{\circ }$</tex-math></inline-formula> data acquisition limited-view angle. Further, the FDPA-LSTM was also compared with post-processing UNet architecture on backprojection and Tikhonov regularized reconstruction. A 20% improvement in terms of PSNR with backprojection and post-processing UNet was observed. Further FDPA-LSTM had similar performance as Tikhonov and post-processing UNet (with 75 times acceleration). The developed scheme will indeed be very useful for achieving accelerated and accurate frequency domain photoacoustic imaging.

The 100[formula omitted]PET project: A small-animal PET scanner for ultra-high resolution molecular imaging with monolithic silicon pixel detectors

Recent developments in semiconductor pixel detectors allow a new generation of positron-emission tomography (PET) scanners that, combined with advanced image reconstruction algorithms, will allow for a few hundred microns spatial resolutions. Such novel scanners will pioneer ultra-high resolution molecular imaging, a field that is expected to have an enormous impact in several medical domains, neurology among others.The University of Geneva, the École Polytechnique Fédérale de Lausanne, and the University of Lucerne, have launched the 100μPET project that aims to produce a small-animal PET scanner with ultra-high resolution. The scanner will be composed of 4 ”towers”, each containing a stack of 60 monolithic silicon pixel sensors for the direct measurement of the annihilation photons. The sensors are 270 μm thick, providing unprecedented depth-of-interaction measurement. Monte Carlo simulations were done simulating different scanner conditions, resulting in a spatial resolution down to 0.2 mm FWHM and a sensitivity of 3.2%.

On the performance of multi-compartment relaxometry for myelin water imaging (MCR-MWI) – test-retest repeatability and inter-protocol reproducibility

In this study, we optimized the variable flip angle (VFA) acquisition scheme using numerical simulations to shorten the acquisition time of multicompartment relaxometry for myelin water imaging (MCR-MWI) to a clinically practical range in the absence of advanced image reconstruction methods. As the primary objective of this study, the test-retest repeatability of myelin water fraction (MWF) measurements of MCR-MWI is evaluated on three gradient echo (GRE) sequence settings using the optimized VFA schemes with different echo times and repetition times, emulating various scanner setups. The cross-protocol reproducibility of MCR-MWI and MCR with diffusion-informed myelin water imaging (MCR-DIMWI) is also examined. As a secondary objective, we explore the bundle-specific profiles of various microstructural parameters from MCR-(DI)MWI and their cross-correlations to determine if these parameters possess supplementary microstructure information beyond myelin concentration.Numerical simulations indicate that MCR-MWI can be performed with a minimum of three flip angles covering a wide range of T1 weightings without adding significant bias. This is supported by the results of an in vivo experiment, allowing whole-brain 1.5 mm isotropic MWF maps to be acquired in 9 min, reducing the total scan time to 40% of the original implementation without significant quality degradation. Good test-retest repeatability is observed for MCR-MWI for all three GRE protocols. While good correlations can also be found in MWF across protocols, systematic differences are observed. Bundle-specific MWF analysis reveals that certain white matter bundles are similar in all participants. We also found that microstructure relaxation parameters have low linear correlations with MWF. MCR-MWI is a reproducible measure of myelin. However, attention should be paid to the protocol related MWF differences when comparing different studies, as the MWF bias up to 0.5% can be observed across the protocols examined in this work.

Group-Based Sparse Representation for Compressed Sensing Image Reconstruction with Joint Regularization

Achieving high-quality reconstructions of images is the focus of research in image compressed sensing. Group sparse representation improves the quality of reconstructed images by exploiting the non-local similarity of images; however, block-matching and dictionary learning in the image group construction process leads to a long reconstruction time and artifacts in the reconstructed images. To solve the above problems, a joint regularized image reconstruction model based on group sparse representation (GSR-JR) is proposed. A group sparse coefficients regularization term ensures the sparsity of the group coefficients and reduces the complexity of the model. The group sparse residual regularization term introduces the prior information of the image to improve the quality of the reconstructed image. The alternating direction multiplier method and iterative thresholding algorithm are applied to solve the optimization problem. Simulation experiments confirm that the optimized GSR-JR model is superior to other advanced image reconstruction models in reconstructed image quality and visual effects. When the sensing rate is 0.1, compared to the group sparse residual constraint with a nonlocal prior (GSRC-NLR) model, the gain of the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) is up to 4.86 dB and 0.1189, respectively.

Can optimized model-based iterative reconstruction improve the contrast of liver lesions in CT?

Computed tomography is a standard imaging procedure for the detection of liver lesions, such as metastases, which can often be small and poorly contrasted, and therefore hard to detect. Advances in image reconstruction have shown promise in reducing image noise and improving low-contrast detectability. To examine a novel, specialized, model-based iterative reconstruction (MBIR) technique for improved low-contrast liver lesion detection. Patient images with reported poorly contrasted focal liver lesions were retrospectively reconstructed with the low-contrast attenuating algorithm (FIRST-LCD) from primary raw data. Liver-to-lesion contrast, signal-to-noise, and contrast-to-noise ratios for background and liver noise for each lesion were compared for all three FIRST-LCD presets with the established hybrid iterative reconstruction method (AIDR-3D). An additional visual conspicuity score was given by two experienced radiologists for each lesion. A total of 82 lesions in 57 examinations were included in the analysis. All three FIRST-LCD algorithms provided statistically significant increases in liver-to-lesion contrast, with FIRSTMILD showing the largest increase (40.47 HU in AIDR-3D; 45.84 HU in FIRSTMILD; P < 0.001). Substantial improvement was shown in contrast-to-noise metrics. Visual analysis of the lesions shows decreased lesion visibility with all FIRST methods in comparison to AIDR-3D, with FIRSTSTR showing the closest results (P < 0.001). Objective image metrics show promise for MBIR methods in improving the detectability of low-contrast liver lesions; however, subjective image quality may be perceived as inferior. Further improvements are necessary to enhance image quality and lesion detection.

Optical breast atlas as a testbed for image reconstruction in optical mammography

We present two optical breast atlases for optical mammography, aiming to advance the image reconstruction research by providing a common platform to test advanced image reconstruction algorithms. Each atlas consists of five individual breast models. The first atlas provides breast vasculature surface models, which are derived from human breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data using image segmentation. A finite element-based method is used to deform the breast vasculature models from their natural shapes to generate the second atlas, compressed breast models. Breast compression is typically done in X-ray mammography but also necessary for some optical mammography systems. Technical validation is presented to demonstrate how the atlases can be used to study the image reconstruction algorithms. Optical measurements are generated numerically with compressed breast models and a predefined configuration of light sources and photodetectors. The simulated data is fed into three standard image reconstruction algorithms to reconstruct optical images of the vasculature, which can then be compared with the ground truth to evaluate their performance.

Computed tomography recent history and future perspectives.

.Purpose: We provide a review of the key computed tomography (CT) technologies developed since the late 1980s and offer an overview of one of the future technologies under development. The focus of this review is mainly on the hardware and system development. The topics on the historical event linked to the early days of CT development and other innovations that contributed to the CT development, such as advanced image reconstruction techniques, are covered by companion papers in this special issue.Approach: The review is divided into five major sections, each linked to a key innovation in CT: helical spiral data acquisition, multi-slice CT, wide-cone CT, dual-source CT, and spectral CT. Given the limited scope of this review, only one of the future technologies, photon-counting CT, is discussed in detail. Whenever possible, both theory of operation and clinical examples are provided.Results: Theoretical analyses, phantom results, and clinical examples clearly demonstrate the efficacy and clinical relevancy of five historical technology developments and one future technology in CT. These technologies have improved and will continue to improve CT performance in terms of isotropic volume coverage, improved temporal resolution, and material differentiation and characterization capabilities.Conclusions: Over the past 30 years, technological developments of CT have contributed to the success of CT in many clinical applications such as trauma, oncology, cardiac imaging, and stroke. Advanced clinical applications have and will continue to demand more advanced technology development.

Boosting the signal-to-noise of low-field MRI with deep learning image reconstruction

Recent years have seen a resurgence of interest in inexpensive low magnetic field (< 0.3 T) MRI systems mainly due to advances in magnet, coil and gradient set designs. Most of these advances have focused on improving hardware and signal acquisition strategies, and far less on the use of advanced image reconstruction methods to improve attainable image quality at low field. We describe here the use of our end-to-end deep neural network approach (AUTOMAP) to improve the image quality of highly noise-corrupted low-field MRI data. We compare the performance of this approach to two additional state-of-the-art denoising pipelines. We find that AUTOMAP improves image reconstruction of data acquired on two very different low-field MRI systems: human brain data acquired at 6.5 mT, and plant root data acquired at 47 mT, demonstrating SNR gains above Fourier reconstruction by factors of 1.5- to 4.5-fold, and 3-fold, respectively. In these applications, AUTOMAP outperformed two different contemporary image-based denoising algorithms, and suppressed noise-like spike artifacts in the reconstructed images. The impact of domain-specific training corpora on the reconstruction performance is discussed. The AUTOMAP approach to image reconstruction will enable significant image quality improvements at low-field, especially in highly noise-corrupted environments.

Quantitative imaging and automated fuel pin identification for passive gamma emission tomography

Compliance of member States to the Treaty on the Non-Proliferation of Nuclear Weapons is monitored through nuclear safeguards. The Passive Gamma Emission Tomography (PGET) system is a novel instrument developed within the framework of the International Atomic Energy Agency (IAEA) project JNT 1510, which included the European Commission, Finland, Hungary and Sweden. The PGET is used for the verification of spent nuclear fuel stored in water pools. Advanced image reconstruction techniques are crucial for obtaining high-quality cross-sectional images of the spent-fuel bundle to allow inspectors of the IAEA to monitor nuclear material and promptly identify its diversion. In this work, we have developed a software suite to accurately reconstruct the spent-fuel cross sectional image, automatically identify present fuel rods, and estimate their activity. Unique image reconstruction challenges are posed by the measurement of spent fuel, due to its high activity and the self-attenuation. While the former is mitigated by detector physical collimation, we implemented a linear forward model to model the detector responses to the fuel rods inside the PGET, to account for the latter. The image reconstruction is performed by solving a regularized linear inverse problem using the fast-iterative shrinkage-thresholding algorithm. We have also implemented the traditional filtered back projection (FBP) method based on the inverse Radon transform for comparison and applied both methods to reconstruct images of simulated mockup fuel assemblies. Higher image resolution and fewer reconstruction artifacts were obtained with the inverse-problem approach, with the mean-square-error reduced by 50%, and the structural-similarity improved by 200%. We then used a convolutional neural network (CNN) to automatically identify the bundle type and extract the pin locations from the images; the estimated activity levels finally being compared with the ground truth. The proposed computational methods accurately estimated the activity levels of the present pins, with an associated uncertainty of approximately 5%.

A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

C-arm orbits for metal artifact avoidance (MAA) in cone-beam CT

Metal artifacts present a challenge to cone-beam CT (CBCT) image-guided surgery, obscuring visualization of metal instruments and adjacent anatomy—often in the very region of interest pertinent to the imaging/surgical tasks. We present a method to reduce the influence of metal artifacts by prospectively defining an image acquisition protocol—viz., the C-arm source-detector orbit—that mitigates metal-induced biases in the projection data. The metal artifact avoidance (MAA) method is compatible with simple mobile C-arms, does not require exact prior information on the patient or metal implants, and is consistent with 3D filtered backprojection (FBP), more advanced (e.g. polyenergetic) model-based image reconstruction (MBIR), and metal artifact reduction (MAR) post-processing methods. The MAA method consists of: (i) coarse localization of metal objects in the field-of-view (FOV) via two or more low-dose scout projection views and segmentation (e.g. a simple U-Net) in coarse backprojection; (ii) model-based prediction of metal-induced x-ray spectral shift for all source-detector vertices accessible by the imaging system (e.g. gantry rotation and tilt angles); and (iii) identification of a circular or non-circular orbit that reduces the variation in spectral shift. The method was developed, tested, and evaluated in a series of studies presenting increasing levels of complexity and realism, including digital simulations, phantom experiment, and cadaver experiment in the context of image-guided spine surgery (pedicle screw implants). The MAA method accurately predicted tilted circular and non-circular orbits that reduced the magnitude of metal artifacts in CBCT reconstructions. Realistic distributions of metal instrumentation were successfully localized (0.71 median Dice coefficient) from 2–6 low-dose scout views even in complex anatomical scenes. The MAA-predicted tilted circular orbits reduced root-mean-square error (RMSE) in 3D image reconstructions by 46%–70% and ‘blooming’ artifacts (apparent width of the screw shaft) by 20–45%. Non-circular orbits defined by MAA achieved a further ∼46% reduction in RMSE compared to the best (tilted) circular orbit. The MAA method presents a practical means to predict C-arm orbits that minimize spectral bias from metal instrumentation. Resulting orbits—either simple tilted circular orbits or more complex non-circular orbits that can be executed with a motorized multi-axis C-arm—exhibited substantial reduction of metal artifacts in raw CBCT reconstructions by virtue of higher fidelity projection data, which are in turn compatible with subsequent MAR post-processing and/or polyenergetic MBIR to further reduce artifacts.