Computed Tomography Projection Research Articles

Segmentation of artifacts and anatomy in CT metal artifact reduction

Metal objects present in x-ray computed tomography (CT) scans are accompanied by physical phenomena that render CT projections inconsistent with the linear assumption made for analytical reconstruction. The inconsistencies create artifacts in reconstructed images. Metal artifact reduction algorithms replace the inconsistent projection data passing through metals with estimates of the true underlying projection data, but when the data estimates are inaccurate, secondary artifacts are generated. The secondary artifacts may be as unacceptable as the original metal artifacts; therefore, better projection data estimation is critical. This research uses computer vision techniques to create better estimates of the underlying projection data using observations about the appearance and nature of metal artifacts. The authors developed a method of estimating underlying projection data through the use of an intermediate image, called the prior image. This method generates the prior image by segmenting regions of the originally reconstructed image, and discriminating between regions that are likely to be metal artifacts and those that are likely to represent anatomical structures. Regions identified as metal artifact are replaced with a constant soft-tissue value, while structures such as bone or air pockets are preserved. This prior image is reprojected (forward projected), and the reprojections guide the estimation of the underlying projection data using previously published interpolation techniques. The algorithm is tested on head CT test cases containing metal implants and compared against existing methods. Using the new method of prior image generation on test images, metal artifacts were eliminated or reduced and fewer secondary artifacts were present than with previous methods. The results apply even in the case of multiple metal objects, which is a challenging problem. The authors did not observe secondary artifacts that were comparable to or worse than the original metal artifacts, as sometimes occurred with the other methods. The accuracy of the prior was found to be more critical than the particular interpolation method. Metals produce predictable artifacts in CT images of the head. Using the new method, metal artifacts can be discriminated from anatomy, and the discrimination can be used to reduce metal artifacts.

4D digitally reconstructed radiography for verifying a lung tumor position during volumetric modulated arc therapy

We have proposed four dimensional (4D) digitally reconstructed radiography (DRR) for verifying a lung tumor position during volumetric modulated arc therapy (VMAT). An internal target volume (ITV) was defined based on two clinical target volumes (CTVs) delineated on maximum exhalation and maximum inhalation images acquired by 4D planning computed tomography (CT). A planning target volume (PTV) was defined by adding a margin of 5 mm to the ITV on the maximum exhalation 3D CT images. A single-arc VMAT plan was created on the same CT data using Pinnacle SmartArc with a maximum multi-leaf collimator leaf speed of 1 mm/degree, thereby resulting in quasi-conformal field shapes while optimizing each beam intensity for each gantry angle. During VMAT delivery, cone-beam CT (CBCT) projection data were acquired by an on-board kilovoltage X-ray unit and a flat panel 2D detector. Four CBCT image sets with different respiratory phases were reconstructed using in-house software, where respiratory phases were extracted from the projection data. Subsequently a CTV was delineated on each of the 4D CBCT images by an oncologist. Using the resulting 4D CBCT data including the CTV contours, 4D DRRs during the VMAT delivery were calculated as a function of gantry angle. It was confirmed that the contoured CTV was within the radiation field during the four-fraction lung VMAT delivery. The proposed 4D DRR may facilitate the verification of the position of a respiratory moving lung tumor during VMAT delivery on each treatment day.

TH-E-211-07: Development and Evaluation of a Dose Reduction Emulation Method for Computed Tomography

Purpose: With advancement in computed tomography(CT)reconstruction and dose reduction technologies, e.g., Model‐Based‐Iterative‐Reconstruction (MBIR) and Adaptive‐Statistical‐Iterative‐Reconstruction (ASiR), there is potential for significant dose reduction in clinical practice; therefore, it is immensely desirable to have a benchmarking of dose reduction steps to ensure un‐compromised diagnostic image‐quality at optimally reduced dose levels. Purpose of this work was to develop and evaluate a new projection domain noise insertion tool that can emulate lower dose scans using routine dose scans, and can provide a benchmarking guide for clinicians and physicists to achieve optimal dose levels without multiple scans of the patient. Methods: In order to emulate lower dose CT projections at reduced signal‐to‐noise‐ratio (SNR), a normally distributed random noise (quantum and electronic) was added to the transmission data obtained from initial scan. The estimate of variance was obtained using initial projections with appropriate scaling to represent true x‐ray photon‐flux for desired dose reduction factor. For validation of the method, a GE multi‐slice CT system was used to acquire a set of multi‐dose data for cylindrical and anthropomorphic phantoms. A comparison of emulated vs. acquired scans was made at different dose levels (upto 1/56th) relative to a baseline higher dose. Imagenoise,Modulation Transfer Function(MTF), Noise‐Power‐ Spectrum (NPS), and artifacts were compared between the emulated low dose scans and. the corresponding acquired scans. In addition, few clinical case studies were also used to compare the imaging performance in clinical data. Results: Initial results for the presented noise emulation method showed very good agreement with noise,MTF and NPS from actual acquired scans at significantly reduced dose levels, demonstrating immense potential in dose reduction studies and clinical protocol optimizations. Conclusions: The noise emulation tool has potential to provide a benchmarking guide to explore optimal dose levels without having multiple scans of the patient.

Noise‐resolution tradeoffs in x‐ray CT imaging: A comparison of penalized alternating minimization and filtered backprojection algorithms

In comparison with conventional filtered backprojection (FBP) algorithms for x-ray computed tomography (CT) image reconstruction, statistical algorithms directly incorporate the random nature of the data and do not assume CT data are linear, noiseless functions of the attenuation line integral. Thus, it has been hypothesized that statistical image reconstruction may support a more favorable tradeoff than FBP between image noise and spatial resolution in dose-limited applications. The purpose of this study is to evaluate the noise-resolution tradeoff for the alternating minimization (AM) algorithm regularized using a nonquadratic penalty function. Idealized monoenergetic CT projection data with Poisson noise were simulated for two phantoms with inserts of varying contrast (7%-238%) and distance from the field-of-view (FOV) center (2-6.5 cm). Images were reconstructed for the simulated projection data by the FBP algorithm and two penalty function parameter values of the penalized AM algorithm. Each algorithm was run with a range of smoothing strengths to allow quantification of the noise-resolution tradeoff curve. Image noise is quantified as the standard deviation in the water background around each contrast insert. Modulation transfer functions (MTFs) were calculated from six-parameter model fits to oversampled edge-spread functions defined by the circular contrast-insert edges as a metric of local resolution. The integral of the MTF up to 0.5 1p/mm was adopted as a single-parameter measure of local spatial resolution. The penalized AM algorithm noise-resolution tradeoff curve was always more favorable than that of the FBP algorithm. While resolution and noise are found to vary as a function of distance from the FOV center differently for the two algorithms, the ratio of noises when matching the resolution metric is relatively uniform over the image. The ratio of AM-to-FBP image variances, a predictor of dose-reduction potential, was strongly dependent on the shape of the AM's nonquadratic penalty function and was also strongly influenced by the contrast of the insert for which resolution is quantified. Dose-reduction potential, reported here as the fraction (%) of FBP dose necessary for AM to reconstruct an image with comparable noise and resolution, for one penalty parameter value of the AM algorithm was found to vary from 70% to 50% for low-contrast and high-contrast structures, respectively, and from 70% to 10% for the second AM penalty parameter value. However, the second penalty, AM-700, was found to suffer from poor low-contrast resolution when matching the high-contrast resolution metric with FBP. The results of this simulation study imply that penalized AM has the potential to reconstruct images with similar noise and resolution using a fraction (10%-70%) of the FBP dose. However, this dose-reduction potential depends strongly on the AM penalty parameter and the contrast magnitude of the structures of interest. In addition, the authors' results imply that the advantage of AM can be maximized by optimizing the nonquadratic penalty function to the specific imaging task of interest. Future work will extend the methods used here to quantify noise and resolution in images reconstructed from real CT data.

The upper limits of the SNR in radiography and CT with polyenergetic x-rays

The aim of the study is to determine the upper limits of the signal-to-noise ratio (SNR) in radiography and computed tomography (CT) with polyenergetic x-ray sources. In x-ray imaging, monoenergetic x-rays provide a higher SNR compared to polyenergetic x-rays. However, the SNR in polyenergetic x-ray imaging can be increased when a photon-counting detector is used and x-rays are optimally weighted according to their energies. For a particular contrast/background combination and at a fixed x-ray entrance skin exposure, the SNR in energy-weighting x-ray imaging depends on tube voltage and can be maximized by selecting the optimal tube voltage. The SNR in energy-weighted x-ray images acquired at this optimal tube voltage is the highest SNR that can be achieved with polyenergetic x-ray sources. The optimal tube voltages and the highest SNR were calculated and compared to the SNR of monoenergetic x-ray imaging. Monoenergetic, energy-weighting polyenergetic and energy-integrating polyenergetic x-ray imagings were simulated at a fixed entrance skin exposure of 20 mR. The tube voltages varied in the range of 30–140 kVp with 10 kV steps. Contrast elements of CaCO3, iodine, adipose and tumor with thicknesses of 280 mg cm−2, 15 mg cm−2, 1 g cm−2 and 1 g cm−2, respectively, inserted in a soft tissue background with 10 cm and 20 cm thicknesses, were used. The energy weighting also improves the contrast-to-noise ratio (CNR) in CT when monoenergetic CT projections are optimally weighted prior to CT reconstruction (projection-based weighting). Alternatively, monoenergetic CT images are reconstructed, optimally weighted and composed to yield a final CT image (image-based weighting). Both projection-based and image-based weighting methods improve the CNR in CT. An analytical approach was used to determine which of these two weighting methods provides the upper limit of the CNR in CT. The energy-weighting method was generalized and expanded as a weighting method applicable in areas other than x-ray and CT. An optimal x-ray tube voltage providing the highest SNR in energy-weighting x-ray imaging was determined for each contrast/background combination. Depending on the imaging task, the highest SNR with energy-weighted polyenergetic x-rays was close to the SNR provided by monoenergetic x-rays. In CT, projection-based weighting provided higher CNR than image-based weighting, thus determining an upper limit of the CNR in CT. The weighting approach can be applied to imaging methods with contrast mechanisms other than x-ray interaction. A unique, task-dependent tube voltage exists in photon-counting x-ray and CT that provides the highest SNR with polyenergetic x-rays. The highest SNR achieved in photon-counting energy-weighted x-ray and CT can approach the SNR of monoenergetic x-ray and CT imaging, depending on the imaging task.

Quantification of Vasa Vasorum Density in Multi-Slice Computed Tomographic Coronary Angiograms

This study is motivated by the possibility of using computed tomography (CT) to detect early coronary atherosclerosis by the increased CT values within the arterial wall resulting from vasa vasorum proliferation. Coronary arteries (n = 5) with early atherosclerotic changes were injected with Microfil and scanned (micro-CT). Noise was added to the CT projection data sets (to represent the radiation exposure of current clinical CT scanners) and then reconstructed to generate 3-dimensional images at different voxel sizes. Higher CT values were detected because of contrast agent in vasa vasorum if voxel size was less than (150 microm)(3). Contrast in the main lumen increased the CT values dramatically at voxels greater than (100 microm)(3), whereas CT values of the same specimen without contrast in the main lumen remained constant. Voxel sizes less than (200 microm)(3) are needed to quantitate arterial wall opacification due to vasa vasorum proliferation.

Energy-resolved computed tomography: first experimental results

First experimental results with energy-resolved computed tomography (CT) are reported. The contrast-to-noise ratio (CNR) in CT has been improved with x-ray energy weighting for the first time. Further, x-ray energy weighting improved the CNR in material decomposition CT when applied to CT projections prior to dual-energy subtraction. The existing CT systems use an energy (charge) integrating x-ray detector that provides a signal proportional to the energy of the x-ray photon. Thus, the x-ray photons with lower energies are scored less than those with higher energies. This underestimates contribution of lower energy photons that would provide higher contrast. The highest CNR can be achieved if the x-ray photons are scored by a factor that would increase as the x-ray energy decreases. This could be performed by detecting each x-ray photon separately and measuring its energy. The energy selective CT data could then be saved, and any weighting factor could be applied digitally to a detected x-ray photon. The CT system includes a photon counting detector with linear arrays of pixels made from cadmium zinc telluride (CZT) semiconductor. A cylindrical phantom with 10.2 cm diameter made from tissue-equivalent material was used for CT imaging. The phantom included contrast elements representing calcifications, iodine, adipose and glandular tissue. The x-ray tube voltage was 120 kVp. The energy selective CT data were acquired, and used to generate energy-weighted and material-selective CT images. The energy-weighted and material decomposition CT images were generated using a single CT scan at a fixed x-ray tube voltage. For material decomposition the x-ray spectrum was digitally spilt into low- and high-energy parts and dual-energy subtraction was applied. The x-ray energy weighting resulted in CNR improvement of calcifications and iodine by a factor of 1.40 and 1.63, respectively, as compared to conventional charge integrating CT. The x-ray energy weighting was also applied to low- and high-energy CT projections used for material decomposition. This improved the CNR in images of decomposed calcification and iodine by a factor of 1.57 and 1.46, respectively, as compared to conventional charge integrating CT. Some limitations were observed due to hole trapping in CZT and charge sharing between the detector pixels. First experimental results demonstrate that energy-resolved CT is coming close to its practical applications. Although hole trapping and charge sharing in CZT deteriorates x-ray spectrum and limits CNR improvement with energy weighting and detector count rate, this problem has a feasible solution, which is discussed in this paper and is a matter of ongoing research.

Computed tomography with energy-resolved detection: a feasibility study

The feasibility of computed tomography (CT) with energy-resolved x-ray detection has been investigated. A breast CT design with multi slit multi slice (MSMS) data acquisition was used for this study. The MSMS CT includes linear arrays of photon counting detectors separated by gaps. This CT configuration allows for efficient scatter rejection and 3D data acquisition. The energy-resolved CT images were simulated using a digital breast phantom and the design parameters of the proposed MSMS CT. The phantom had 14 cm diameter and 50/50 adipose/glandular composition, and included carcinoma, adipose, blood, iodine and CaCO3 as contrast elements. The x-ray technique was 90 kVp tube voltage with 660 mR skin exposure. Photon counting, charge (energy) integrating and photon energy weighting CT images were generated. The contrast-to-noise (CNR) improvement with photon energy weighting was quantified. The dual energy subtracted images of CaCO3 and iodine were generated using a single CT scan at a fixed x-ray tube voltage. The x-ray spectrum was electronically split into low- and high-energy parts by a photon counting detector. The CNR of the energy weighting CT images of carcinoma, blood, adipose, iodine, and CaCO3 was higher by a factor of 1.16, 1.20, 1.21, 1.36 and 1.35, respectively, as compared to CT with a conventional charge (energy) integrating detector. Photon energy weighting was applied to CT projections prior to dual energy subtraction and reconstruction. Photon energy weighting improved the CNR in dual energy subtracted CT images of CaCO3 and iodine by a factor of 1.35 and 1.33, respectively. The combination of CNR improvements due to scatter rejection and energy weighting was in the range of 1.71–2 depending on the type of the contrast element. The tilted angle CZT detector was considered as the detector of choice. Experiments were performed to test the effect of the tilting angle on the energy spectrum. Using the CZT detector with 20° tilting angle decreased the tailing of the measured x-ray spectrum as compared to a conventional CZT detector. It was concluded that the energy-resolved MSMS CT with tilted angle CZT detector is potentially feasible and could provide a unique combination of photon counting, energy weighting, scatter rejection and single kVp dual energy subtraction CT imaging.

Minimum number of basis projections for caries detection with local CT

To investigate the relationship between the number of basis projections for local computed tomography (CT) and the detection of proximal caries and to find a minimum number of projections needed to maintain diagnostic accuracy. We presented observers (n = 12) with stacks of both axial and vertical CT slices of 23 extracted teeth placed in a dry human mandible. The slices were prepared with 14, 20, 33 and 100 basis projections. The observers scored the proximal surfaces for the presence of caries on a 1-5 confidence scale. The performance of the varying number of projections was compared with conventional digital radiographs. The performance of all four CT modalities was significantly better than conventional radiographs (P = 0.005 to P = 0.021) and showed a consistent increase with the number of projections. Diagnostic performance depended significantly on lesion depth (P = 0.00), but not on observer. We conclude that the number of CT projections used can be reduced at least to 20 with the diagnostic performance still markedly better than that of conventional film, provided that the observer can make use of both axial and vertical stacks of CT slices.

Application of transform algorithms to high-resolution image reconstruction in optical diffusion tomography of strongly scattering media

The applicability of transform algorithms generally used in projection-computed tomography is substantiated for the case of medical optical diffusion tomography (ODT). To reconstruct tissue optical inhomogeneities, a new method based on a concept of an average statistical trajectory for transfer of light energy [photon average trajectory (PAT)] is proposed. By this method, the inverse problem of ODT is reduced to a solution of an integral equation with integration along a PAT. Within the internal zone of the object, well away from the boundaries, PATs tend to a straight line, and standard integral algorithms based on the inverse Radon transform may be used to restore diffuse optical images. To demonstrate the capabilities of the PAT method, a numerical experiment on cross sectional reconstruction of cylindrical strongly scattering objects with low-contrast absorbing inhomogeneities is conducted. To solve the time-domain ODT inverse problem, two filtered backprojection algorithms (of Radon and Vainberg) are used. The reconstruction results are compared with those obtained by a well-known software package for temporal optical absorption and scattering tomography, based on multiple solutions of a diffusion equation. It is shown that in important cases of low-contrast absorbing inhomogeneities, the PAT method using the Vainberg algorithm allows reconstruction of tissue optical inhomogeneities with a 20% gain in spatial resolution.

Image reconstruction and the effect on dose calculation for hip prostheses

High atomic number inserts, such as hip prostheses and dental fillings, cause streak artifacts on computed tomography (CT) images when filtered back-projection (FBP) methods are used. These streak artifacts severely degrade our ability to differentiate the tumor volume. Also, incorrect Hounsfield numbers yield incorrect electron density information that may lead to erroneous dose calculations, and, as a result, compromise clinical outcomes. The aim of this research was to evaluate the dosimetric consequences of artifacts during radiotherapy planning of a prostate patient containing a hip prosthesis. The CT numbers corresponding to an iron prosthesis were inserted into the right femoral head of an existing CT image set. This artifact-free image was used as the standard image set. CT projections through the image set formed the sinogram, from which filtered back projection and iterative deblurring methods were used to create reconstructed image sets. These reconstructed image sets contained artifacts. Prostate treatment plans were then calculated using a Monte Carlo system for the standard and reconstructed CT image sets. Close to the prosthesis, the CT numbers between the reconstructed and standard image sets differed substantially. However, because the CT number differences covered only a small area, the dose distributions on the reconstructed and standard image sets were not significantly different. The dose-volume histograms for the prostate, rectum, and bladder were virtually identical. Our results indicate that even though CT image artifacts restrict our ability to differentiate tumors and critical structures, the dose distributions for a prostate plan containing a hip prosthesis, calculated on both artifact-free image sets and image sets containing artifacts, are not significantly different.

In vivo validation of cardiac spiral computed tomography using retrospective gating

Background Cardiac functional assessment represents the basis for diagnostics and cardiac operation planning. Spiral computed tomography (CT) combines the advantages of three-dimensional imaging and high temporal resolution when using gating techniques. However, in vivo validation data of this novel imaging technology are lacking. The purpose of this study was to validate in vivo the new imaging method using retrospective gating and to evaluate the clinical usefulness of the achieved temporal resolution. Methods In domestic pigs (n = 10, weight 35 to 40 kg) a flowmeter was placed surgically on the ascending aorta. Flow velocity integrated over systole served as the gold standard for left ventricular (LV) stroke volume (LVSV-FM). CT signal, projection data, pacemaker signal, and flow velocity were recorded simultaneously at constant heart rate (pacemaker, 90 beats per minute). End-systolic and end-diastolic frames were calculated by retrospective gating. LV volumes were traced, the difference representing CT stroke volume (LVSV-CT). Image data were three-dimensionally reconstructed using ray-tracing. Results Temporal resolution was 170 ms. Correlation of stroke volumes was high ( r = 0.94, mean difference 1.75 mL). Intraobserver (0.49 mL for LVEDV, 0.31 for LVESV) and interobserver variability ( p = 0.21 and p = 0.06, respectively) were low. Postprocessing resulted in four-dimensional beating-heart models useful for operation planning. Conclusions Spiral CT using retrospective gating was validated in vivo. Clinically acceptable temporal resolution and accuracy in determining cardiac stroke volumes were found. As a true volumetric imaging modality the method may now play an important role in computer-assisted diagnostics and surgery.

Adaptive streak artifact reduction in computed tomography resulting from excessive x-ray photon noise.

The quality of a computed tomography (CT) image is often degraded by streaking artifacts resulting from excessive x-ray quantum noise. Often, a patient has to be rescanned at a higher technique or at a larger slice thickness in order to obtain an acceptable image for diagnosis. This results in a higher dose to the patient, a degraded cross plane resolution, or a reduced patient throughput. In this paper, we propose an adaptive filtering approach in Radon space based on the local statistical properties of the CT projections. We first model the noise characteristics of a projection sample undergoing important preprocessing steps. A filter is then designed such that its parameters are dynamically adjusted to adapt to the local noise characteristics. Because of the adaptive nature of the filter, a proper balance between streak artifact suppression and spatial resolution preservation is achieved. Phantom and clinical studies have been conducted to evaluate the robustness of our approach. Results demonstrate that the adaptive filtering approach is effective in reducing or eliminating quantum noise induced artifacts in CT. At the same time, the impact on the spatial resolution is kept at a low level.

Correction of scattering neutron effects on neutron CT

Correction of the scattering neutron effects in neutron computed tomography (CT) has been carried out. By subtracting the component of scattering neutrons in CT projection data, only the corrected direct transmitting component through objects is treated. By using the correction of the scattering component on neutron CT, the relatively low contrast on them by neutron electronic imaging method (TV) has been improved. Quantitative analyses with neutron CT have shown a better linear relationship between the neutron macroscopic cross sections and the CT outputs of metal objects.

CT angiography with spiral CT and maximum intensity projection.

The authors describe a technique for obtaining angiographic images by means of spiral computed tomography (CT), preprocessing of reconstructed three-dimensional sections to suppress bone, and maximum intensity projection. The technique has some limitations, but preliminary results in 48 patients have shown excellent anatomic correlation with conventional angiography in studies of the abdomen, the circle of Willis in the brain, and the extracranial carotid arteries. With continued development and evaluation, CT angiography may prove useful as a screening tool or replacement for conventional angiography in some patients.

Advances in Imaging of Rheumatoid Arthritis

Several new imaging modalities have been found useful in clinical evaluation of patients with rheumatoid arthritis (RA). Magnetic resonance (MR) imaging has proven to be an excellent noninvasive method to evaluate the spine, shoulder, hip, and knees; its use for the evaluation of smaller joints is still being investigated. In patients with RA, MR imaging has been used to evaluate cervical spine instability, rotator cuff tear, osteonecrosis, and osteomyelitis. Patients with RA may have advanced osteoporosis, predisposing to insufficiency fractures. This includes fractures associated with increased activity after hip or knee arthroplasty. Newer methods for measuring the degree of osteoporosis include single photon absorptiometry, dual photon absorptiometry, quantitative computed tomography (CT), and dual-energy projection radiography. It has not yet been determined which of these methods will be most widely used in the future, but quantitative CT and dual-energy projection radiography currently show the most promise. Ultrasonography provides an excellent noninvasive method for the diagnosis of popliteal cysts, and color Doppler sonography can differentiate cyst and popliteal aneurysm. As compared to radiography or conventional CT, high-resolution CT provides an improved method to detect the early changes of RA in the lung parenchyma.

Status and outlook of coherent-x-ray scatter imaging.

X-ray scattering, including coherent, incoherent, and resonance (fluorescent) phenomena, is of fundamental importance in contemporary science as a tool to probe the structure of matter at an atomic level. This elevated status is in sharp contrast to the role of x-ray scatter in medical and industrial radiography, where it is generally regarded as an unmitigated nuisance to be corrected for or, preferably, eliminated. We introduce a novel x-radiographic technique [x-ray diffraction computed tomography (CT)] based on measurement of coherent scatter. The physical background to coherent scattering is described in a simple, classical way, and its importance in conventional radiography is demonstrated by using Monte Carlo analysis. Some diffraction patterns of plastics and animal tissues are presented to illustrate the relevance of coherent scattering to material characterization and diagnosis in industrial and medical radiology. An experimental first-generation (single-pencil-beam) CT system has been constructed to demonstrate the feasibility of x-ray diffraction CT. Some diffraction CT and coherent scatter projection images of simple objects are presented. Possibilities for improving the ratio of image contrast to noise and increasing the momentum resolution of the technique are illustrated.

High-resolution computed tomography of the middle ear and mastoid. Part II: Tubotympanic disease.

Of more than 200 patients who underwent high-resolution computed tomography (CT) of the middle ear, the vast majority had tubotympanic disease in one of its forms: middle ear effusion, tympanosclerosis, granulation tissue, tympanic membrane retractions, or acquired cholesteatoma. The CT appearance of each of these conditions is discussed and illustrated. Emphasis is placed on the differential diagnosis of tubotympanic disease by determining dependent from nondependent soft-tissue opacity using two CT projections.

COMPOSITION-SELECTIVE MEASUREMENT OF MINERAL CONTENT IN THE AXIAL AND APPENDICULAR SKELETON

Quantitative tissue densitometry using computed tomography (CT) can be made difficult by the polychromaticity of the x-ray beam and the variable chemical composition of tissues. The accuracy of trabecular bone mineral measurement in the spine, radius, femoral neck and proximal tibia using conventional CT scanners at single x-ray energies (80–140kVp) is limited by the contribution of intraosseous fat to the measured attenuation coefficient. Highly accurate measurement of bone mineral content for diagnostic applications at these sites, particularly in elderly and severely osteopenic patients, requires the use of a composition-selective reconstruction method based on CT data obtained with two different x-ray spectra. Two spatially identical x-ray projections obtained at two energies can be decomposed into equivalent lengths of high-Z (aluminum) and low-Z (plastic) calibration materials. A step wedge calibration phantom is used to generate a table of differential x-ray absorptions for various combinations of aluminum and plastic thicknesses. These data are then fit with polynomials to obtain a basis set for transformation of the CT projections at two energies into calculated ray lengths of aluminum and plastic. These respective lengths are then reconstructed using manufacturer-supplied hardware and software and displayed as maps of the aluminum and plastic, or “mineral” and “soft tissue”, distributions in the patient. From these images, mineral content in the various anatomic sites can be determined independently of soft tissue components, with an in vitro accuracy of 3–4% and a precision of 2–3%.

Evaluation of a preprocessing algorithm for truncated CT projections.

A preprocessing algorithm for completing truncated computed tomography (CT) projection data (so that reconstruction methods suitable for complete projection data can be applied) is experimentally investigated. The study is motivated primarily by the problem of patients who are too obese to fit into the fan beam of a rotate-only (third generation) scanner, and secondarily by dose reduction considerations. Four sets of patient data collected by a rotate-only scanner are used, and the reconstructions from the complete and truncated projection data are compared. It is illustrated that the preprocessing algorithm leads to qualitatively good images, since local variations are nearly identical in the reconstruction from the complete and from the truncated data. Quantitatively, the results are less encouraging; the exact values of CT numbers differ in the two reconstructions by a significant (although slowly varying) amount across the two reconstructed images.