Cone-beam Computed Tomography Simulation Research Articles

Vessel-targeted compensation of deformable motion in interventional cone-beam CT

The present standard of care for unresectable liver cancer is transarterial chemoembolization (TACE), which involves using chemotherapeutic particles to selectively embolize the arteries supplying hepatic tumors. Accurate volumetric identification of intricate fine vascularity is crucial for selective embolization. Three-dimensional imaging, particularly cone-beam CT (CBCT), aids in visualization and targeting of small vessels in such highly variable anatomy, but long image acquisition time results in intra-scan patient motion, which distorts vascular structures and tissue boundaries. To improve clarity of vascular anatomy and intra-procedural utility, this work proposes a targeted motion estimation and compensation framework that removes the need for any prior information or external tracking and for user interaction. Motion estimation is performed in two stages: (i) a target identification stage that segments arteries and catheters in the projection domain using a multi-view convolutional neural network to construct a coarse 3D vascular mask; and (ii) a targeted motion estimation stage that iteratively solves for the time-varying motion field via optimization of a vessel-enhancing objective function computed over the target vascular mask. The vessel-enhancing objective is derived through eigenvalues of the local image Hessian to emphasize bright tubular structures. Motion compensation is achieved via spatial transformer operators that apply time-dependent deformations to partial angle reconstructions, allowing efficient minimization via gradient backpropagation. The framework was trained and evaluated in anatomically realistic simulated motion-corrupted CBCTs mimicking TACE of hepatic tumors, at intermediate (3.0 mm) and large (6.0 mm) motion magnitudes. Motion compensation substantially improved median vascular DICE score (from 0.30 to 0.59 for large motion), image SSIM (from 0.77 to 0.93 for large motion), and vessel sharpness (0.189 mm−1 to 0.233 mm−1 for large motion) in simulated cases. Motion compensation also demonstrated increased vessel sharpness (0.188 mm−1 before to 0.205 mm−1 after) and reconstructed vessel length (median increased from 37.37 to 41.00 mm) on a clinical interventional CBCT. The proposed anatomy-aware motion compensation framework presented a promising approach for improving the utility of CBCT for intra-procedural vascular imaging, facilitating selective embolization procedures.

Feasibility of proton dosimetry overriding planning CT with daily CBCT elaborated through generative artificial intelligence tools

Radiotherapy commonly utilizes cone beam computed tomography (CBCT) for patient positioning and treatment monitoring. CBCT is deemed to be secure for patients, making it suitable for the delivery of fractional doses. However, limitations such as a narrow field of view, beam hardening, scattered radiation artifacts, and variability in pixel intensity hinder the direct use of raw CBCT for dose recalculation during treatment. To address this issue, reliable correction techniques are necessary to remove artifacts and remap pixel intensity into Hounsfield Units (HU) values. This study proposes a deep-learning framework for calibrating CBCT images acquired with narrow field of view (FOV) systems and demonstrates its potential use in proton treatment planning updates. Cycle-consistent generative adversarial networks (cGAN) processes raw CBCT to reduce scatter and remap HU. Monte Carlo simulation is used to generate CBCT scans, enabling the possibility to focus solely on the algorithm’s ability to reduce artifacts and cupping effects without considering intra-patient longitudinal variability and producing a fair comparison between planning CT (pCT) and calibrated CBCT dosimetry. To showcase the viability of the approach using real-world data, experiments were also conducted using real CBCT. Tests were performed on a publicly available dataset of 40 patients who received ablative radiation therapy for pancreatic cancer. The simulated CBCT calibration led to a difference in proton dosimetry of less than 2%, compared to the planning CT. The potential toxicity effect on the organs at risk decreased from about 50% (uncalibrated) up the 2% (calibrated). The gamma pass rate at 3%/2 mm produced an improvement of about 37% in replicating the prescribed dose before and after calibration (53.78% vs 90.26%). Real data also confirmed this with slightly inferior performances for the same criteria (65.36% vs 87.20%). These results may confirm that generative artificial intelligence brings the use of narrow FOV CBCT scans incrementally closer to clinical translation in proton therapy planning updates.

Impact of cone-beam computed tomography artifacts on dose calculation accuracy for lung cancer.

To implement image-guided adaptive radiotherapy (IGART), many studies investigated dose calculations on cone-beam computed tomography (CBCT). A high HU accuracy is crucial for a high dose calculation accuracy and many imaging sites showed satisfactory results. It has been shown that the dose calculation accuracy for lung cancer lags behind. To examine why the dose calculation accuracy for lung is insufficient, the relative effects of the field-of-view (FOV), breathing motion, and scatter on dose calculation accuracy were studied. A framework was built to simulate CBCT scans for lung cancer patients by forward projecting repeat CT (rCT) scans for two scan geometries: small (SFOV) and medium FOV (MFOV). Breathing motion was modeled by applying a 4D deformation vector field to the mid-position rCT. Scatter was modeled by Monte-Carlo simulations with/without an anti-scatter grid (ASG). Simulated projections were reconstructed using filtered back-projection with/without scatter correction. In case of the SFOV, the CBCT images were patched with the planning CT scan in axial direction. The treatment plan was recalculated on the rCT and simulated CBCT. The mean Hounsfield unit (HU) difference (ΔHUmean ), the structural similarity index measure (SSIM), and γ metrics were calculated for the CBCT datasets of various imaging settings. The differences in HU, SSIM and dose calculation accuracy for CBCTs with and without breathing motion were negligible (mean ΔHUmean =6.4vs. 13.7, mean SSIM=0.941vs. 0.957, mean γ (ref=MFOV)=0.75). The SFOV resulted in a lower HU (mean ΔHUmean =-9.2vs. 13.7) and SSIM (mean SSIM=0.912vs. 0.957), and therefore in dose differences compared to the MFOV (mean γ=1.22). Scatter led to considerable discrepancies in all metrics. Adding only the ASG improved the results more than only applying a scatter correction algorithm. Combining ASG and scatter correction algorithm resulted in an even higher dose calculation accuracy. Scatter and FOV are the main contributors to dose inaccuracies and motion has only a minor effect on dose calculation accuracy. Therefore, utilizing an appropriate scatter correction and FOV is important to achieve sufficient dose calculation accuracy to facilitate IGART for lung.

Simulation and pre-planning omitted radiotherapy (SPORT): a feasibility study for prostate cancer

This study explored the feasibility of on-couch intensity modulated radiotherapy (IMRT) planning for prostate cancer (PCa) on a cone-beam CT (CBCT)-based online adaptive RT platform without an individualized pre-treatment plan and contours. Ten patients with PCa previously treated with image-guided IMRT (60 Gy/20 fractions) were selected. In contrast to the routine online adaptive RT workflow, a novel approach was employed in which the same preplan that was optimized on one reference patient was adapted to generate individual on-couch/initial plans for the other nine test patients using Ethos emulator. Simulation CTs of the test patients were used as simulated online CBCT (sCBCT) for emulation. Quality assessments were conducted on synthetic CTs (sCT). Dosimetric comparisons were performed between on-couch plans, on-couch plans recomputed on the sCBCT and individually optimized plans for test patients. The median value of mean absolute difference between sCT and sCBCT was 74.7 HU (range 69.5–91.5 HU). The average CTV/PTV coverage by prescription dose was 100.0%/94.7%, and normal tissue constraints were met for the nine test patients in on-couch plans on sCT. Recalculating on-couch plans on the sCBCT showed about 0.7% reduction of PTV coverage and a 0.6% increasing of hotspot, and the dose difference of the OARs was negligible (<0.5 Gy). Hence, initial IMRT plans for new patients can be generated by adapting a reference patient’s preplan with online contours, which had similar qualities to the conventional approach of individually optimized plan on the simulation CT. Further study is needed to identify selection criteria for patient anatomy most amenable to this workflow.

A TOPAS Monte Carlo simulated cone beam CT (CBCT) C-arm incorporating automatic exposure control (AEC): Validation with an anthropomorphic phantom

A TOPAS Monte Carlo simulated cone beam CT (CBCT) C-arm incorporating automatic exposure control (AEC): Validation with an anthropomorphic phantom

Deep learning enables time-efficient soft tissue enhancement in CBCT: Proof-of-concept study for dentomaxillofacial applications

PurposeThe use of iterative and deep learning reconstruction methods, which would allow effective noise reduction, is limited in cone-beam computed tomography (CBCT). As a consequence, the visibility of soft tissues is limited with CBCT. The study aimed to improve this issue through time-efficient deep learning enhancement (DLE) methods. MethodsTwo DLE networks, UNIT and U-Net, were trained with simulated CBCT data. The performance of the networks was tested with three different test data sets. The quantitative evaluation measured the structural similarity index measure (SSIM) and the peak signal-to-noise ratio (PSNR) of the DLE reconstructions with respect to the ground truth iterative reconstruction method. In the second assessment, a dentomaxillofacial radiologist assessed the resolution of hard tissue structures, visibility of soft tissues, and overall image quality of real patient data using the Likert scale. Finally, the technical image quality was determined using modulation transfer function, noise power spectrum, and noise magnitude analyses. ResultsThe study demonstrated that deep learning CBCT denoising is feasible and time efficient. The DLE methods, trained with simulated CBCT data, generalized well, and DLE provided quantitatively (SSIM/PSNR) and visually similar noise-reduction as conventional IR, but with faster processing time. The DLE methods improved soft tissue visibility compared to the conventional Feldkamp-Davis-Kress (FDK) algorithm through noise reduction. However, in hard tissue quantification tasks, the radiologist preferred the FDK over the DLE methods. ConclusionPost-reconstruction DLE allowed feasible reconstruction times while yielding improvements in soft tissue visibility in each dataset.

Development and validation of a 3D anthropomorphic phantom for dental CBCT imaging research.

Optimization of dental cone beam computed tomography (CBCT) imaging is still in a preliminary stage and should be addressed using task-based methods. Dedicated models containing relevant clinical tasks for image quality studies have yet to be developed. To present a methodology to develop and validate a virtual adult anthropomorphic voxel phantom for use in task-based image quality optimization studies in dental CBCT imaging research, focusing on root fracture (RF) detection tasks in the presence of metal artefacts. The phantom was developed from a CBCT scan with an isotropic voxel size of 0.2mm, from which the main dental structures, mandible and maxilla were segmented. The missing large anatomical structures, including the spine, skull and remaining soft tissues, were segmented from a lower resolution full skull scan. Anatomical abnormalities were absent in the areas of interest. Fine detailed dental structures, that could not be segmented due to the limited resolution and noise in the clinical data, were modelled using a-priori anatomical knowledge. Model resolution of the teeth was therefore increased to 0.05mm. Models of RFs as well as dental restorations to create the artefacts, were developed, and could be inserted in the phantom in any desired configuration. Simulated CBCT images of the models were generated using a newly developed multi-resolution simulation framework that incorporated the geometry, beam quality, noise and spatial resolution characteristics of a real dental CBCT scanner. Ray-tracing and Monte Carlo techniques were used to create the projection images, which were reconstructed using the classical FDK algorithm. Validation of the models was assessed by measurements of different tooth lengths, the pulp volume and the mandible, and comparison with reference values. Additionally, the simulated images were used in a reader study in which two oral radiologists had to score the realism level of the model's normal anatomy, as well as the modelled RFs and restorations. A model of an adult head, as well as models of RFs and different types of dental restorations were created. Anatomical measurements were consistent with ranges reported in literature. For the tooth length measurements, the deviations from the mean reference values were less than 20%. In 77% of all the measurements, the deviations were within 10.1%. The pulp volumes, and mandible measurements were within one standard deviation of the reference values. Regarding the normal anatomy, both readers considered the realism level of the dental structures to be good. Background structures received a lower realism score due to the lack of detailed enough trabecular bone structure, which was expected but not the focus of this study. All modelled RFs were scored at least adequate by at least one of the readers, both in appearance and position. The realism level of the modelled restorations was considered to be good. A methodology was proposed to develop and validate an anthropomorphic voxel phantom for image quality optimization studies in dental CBCT imaging, with a main focus on RF detection tasks. The methodology can be extended further to create more models representative of the clinical population.

A new dental CBCT metal artifact reduction method based on a dual-domain processing framework

Objective. Cone beam computed tomography (CBCT) has been wildly used in clinical treatment of dental diseases. However, patients often have metallic implants in mouth, which will lead to severe metal artifacts in the reconstructed images. To reduce metal artifacts in dental CBCT images, which have a larger amount of data and a limited field of view compared to computed tomography images, a new dental CBCT metal artifact reduction method based on a projection correction and a convolutional neural network (CNN) based image post-processing model is proposed in this paper. Approach. The proposed method consists of three stages: (1) volume reconstruction and metal segmentation in the image domain, using the forward projection to get the metal masks in the projection domain; (2) linear interpolation in the projection domain and reconstruction to build a linear interpolation (LI) corrected volume; (3) take the LI corrected volume as prior and perform the prior based beam hardening correction in the projection domain, and (4) combine the constructed projection corrected volume and LI-volume slice-by-slice in the image domain by two concatenated U-Net based models (CNN1 and CNN2). Simulated and clinical dental CBCT cases are used to evaluate the proposed method. The normalized root means square difference (NRMSD) and the structural similarity index (SSIM) are used for the quantitative evaluation of the method. Main results. The proposed method outperforms the frequency domain fusion method (FS-MAR) and a state-of-art CNN based method on the simulated dataset and yields the best NRMSD and SSIM of 4.0196 and 0.9924, respectively. Visual results on both simulated and clinical images also illustrate that the proposed method can effectively reduce metal artifacts. Significance. This study demonstrated that the proposed dual-domain processing framework is suitable for metal artifact reduction in dental CBCT images.

Four-Dimensional Cone Beam CT Imaging Using a Single Routine Scan via Deep Learning.

A novel method is proposed to obtain four-dimensional (4D) cone-beam computed tomography (CBCT) images from a routine scan in patients with upper abdominal cancer. The projections are sorted according to the location of the lung diaphragm before being reconstructed to phase-sorted data. A multiscale-discriminator generative adversarial network (MSD-GAN) is proposed to alleviate the severe streaking artifacts in the original images. The MSD-GAN is trained using simulated CBCT datasets from patient planning CT images. The enhanced images are further used to estimate the deformable vector field (DVF) among breathing phases using a deformable image registration method. The estimated DVF is then applied in the motion-compensated ordered-subset simultaneous algebraic reconstruction approach to generate 4D CBCT images. The proposed MSD-GAN is compared with U-Net on the performance of image enhancement. Results show that the proposed method significantly outperforms the total variation regularization-based iterative reconstruction approach and the method using only MSD-GAN to enhance original phase-sorted images in simulation and patient studies on 4D reconstruction quality. The MSD-GAN also shows higher accuracy than the U-Net. The proposed method enables a practical way for 4D-CBCT imaging from a single routine scan in upper abdominal cancer treatment including liver and pancreatic tumors.

Combining physics-based models with deep learning image synthesis and uncertainty in intraoperative cone-beam CT of the brain.

Image-guided neurosurgery requires high localization and registration accuracy to enable effective treatment and avoid complications. However, accurate neuronavigation based on preoperative magnetic resonance (MR) or computed tomography (CT) images is challenged by brain deformation occurring during the surgical intervention. To facilitate intraoperative visualization of brain tissues and deformable registration with preoperative images, a 3D deep learning (DL) reconstruction framework (termed DL-Recon) was proposed for improved intraoperative cone-beam CT (CBCT) image quality. The DL-Recon framework combines physics-based models with deep learning CT synthesis and leverages uncertainty information to promote robustness to unseen features. A 3D generative adversarial network (GAN) with a conditional loss function modulated by aleatoric uncertainty was developed for CBCT-to-CT synthesis. Epistemic uncertainty of the synthesis model was estimated via Monte Carlo (MC) dropout. Using spatially varying weights derived from epistemic uncertainty, the DL-Recon image combines the synthetic CT with an artifact-corrected filtered back-projection (FBP) reconstruction. In regions of high epistemic uncertainty, DL-Recon includes greater contribution from the FBP image. Twenty paired real CT and simulated CBCT images of the head were used for network training and validation, and experiments evaluated the performance of DL-Recon on CBCT images containing simulated and real brain lesions not present in the training data. Performance among learning- and physics-based methods was quantified in terms of structural similarity (SSIM) of the resulting image to diagnostic CT and Dice similarity metric (DSC) in lesion segmentation compared to ground truth. A pilot study was conducted involving seven subjects with CBCT images acquired during neurosurgery to assess the feasibility of DL-Recon in clinical data. CBCT images reconstructed via FBP with physics-based corrections exhibited the usual challenges to soft-tissue contrast resolution due to image non-uniformity, noise, and residual artifacts. GAN synthesis improved image uniformity and soft-tissue visibility but was subject to error in the shape and contrast of simulated lesions that were unseen in training. Incorporation of aleatoric uncertainty in synthesis loss improved estimation of epistemic uncertainty, with variable brain structures and unseen lesions exhibiting higher epistemic uncertainty. The DL-Recon approach mitigated synthesis errors while maintaining improvement in image quality, yielding 15%-22% increase in SSIM (image appearance compared to diagnostic CT) and up to 25% increase in DSC in lesion segmentation compared to FBP. Clear gains in visual image quality were also observed in real brain lesions and in clinical CBCT images. DL-Recon leveraged uncertainty estimation to combine the strengths of DL and physics-based reconstruction and demonstrated substantial improvements in the accuracy and quality of intraoperative CBCT. The improved soft-tissue contrast resolution could facilitate visualization of brain structures and support deformable registration with preoperative images, further extending the utility of intraoperative CBCT in image-guided neurosurgery.

PRIOR: Prior-Regularized Iterative Optimization Reconstruction For 4D CBCT.

4D cone-beam computed tomography (CBCT) is an important imaging modality in image-guided radiation therapy to address the motion-induced artifacts caused by organ movements during the respiratory process. However, due to the extremely sparse projection data for each temporal phase, 4D CBCT reconstructions will suffer from severe streaking artifacts. Therefore, to tackle the streak artifacts and provide high-quality images, we proposed a framework termed Prior-Regularized Iterative Optimization Reconstruction (PRIOR) for 4D CBCT. The PRIOR framework combines the physics-based model and data-driven method simultaneously, with powerful feature extracting capacity, significantly promoting the image quality compared to single model-based or deep learning-based methods. Besides, we designed a specialized deep learning model named PRIOR-Net, which can effectively excavate the static information in the prior image reconstructed from the fully-sampled projections at the encoding stage to improve the reconstruction performance for individual phase-resolved images. Both the simulated and clinical 4D CBCT datasets were performed to evaluate the performance of the PRIOR-Net and the PRIOR framework. Compared with the advanced 4D CBCT reconstruction methods, the proposed methods achieve promising results quantitatively and qualitatively in streak artifact suppression, soft tissue restoration, and tiny detail preservation.

Context-Aware, Reference-Free Local Motion Metric for CBCT Deformable Motion Compensation.

Deformable motion is one of the main challenges to image quality in interventional cone beam CT (CBCT). Autofocus methods have been successfully applied for deformable motion compensation in CBCT, using multi-region joint optimization approaches that leverage the moderately smooth spatial variation motion of the deformable motion field with a local neighborhood. However, conventional autofocus metrics enforce images featuring sharp image-appearance, but do not guarantee the preservation of anatomical structures. Our previous work (DL-VIF) showed that deep convolutional neural networks (CNNs) can reproduce metrics of structural similarity (visual information fidelity - VIF), removing the need for a matched motion-free reference, and providing quantification of motion degradation and structural integrity. Application of DL-VIF within local neighborhoods is challenged by the large variability of local image content across a CBCT volume, and requires global context information for successful evaluation of motion effects. In this work, we propose a novel deep autofocus metric, based on a context-aware, multi-resolution, deep CNN design. In addition to the inclusion of contextual information, the resulting metric generates a voxel-wise distribution of reference-free VIF values. The new metric, denoted CADL-VIF, was trained on simulated CBCT abdomen scans with deformable motion at random locations and with amplitude up to 30 mm. The CADL-VIF achieved good correlation with the ground truth VIF map across all test cases with R2 = 0.843 and slope = 0.941. When integrated into a multi-ROI deformable motion compensation method, CADL-VIF consistently reduced motion artifacts, yielding an average increase in SSIM of 0.129 in regions with severe motion and 0.113 in regions with mild motion. This work demonstrated the capability of CADL-VIF to recognize anatomical structures and penalize unrealistic images, which is a key step in developing reliable autofocus for complex deformable motion compensation in CBCT.

Deep learning-based segmentation in prostate radiation therapy using Monte Carlo simulated cone-beam computed tomography.

Segmenting organs in cone-beam CT (CBCT) images would allow to adapt the radiotherapy based on the organ deformations that may occur between treatment fractions. However, this is a difficult task because of the relative lack of contrast in CBCT images, leading to high inter-observer variability. Deformable image registration (DIR) and deep-learning based automatic segmentation approaches have shown interesting results for this task in the past years. However, they are either sensitive to large organ deformations, or require to train a convolutional neural network (CNN) from a database of delineated CBCT images, which is difficult to do without improvement of image quality. In this work, we propose an alternative approach: to train a CNN (using a deep learning-based segmentation tool called nnU-Net) from a database of artificial CBCT images simulated from planning CT, for which it is easier to obtain the organcontours. Pseudo-CBCT (pCBCT) images were simulated from readily available segmented planning CT images, using the GATE Monte Carlo simulation. CT reference delineations were copied onto the pCBCT, resulting in a database of segmented images used to train the neural network. The studied segmentation contours were: bladder, rectum, and prostate contours. We trained multiple nnU-Net models using different training: (1) segmented real CBCT, (2) pCBCT, (3) segmented real CT and tested on pseudo-CT (pCT) generated from CBCT with cycleGAN, and (4) a combination of (2) and (3). The evaluation was performed on different datasets of segmented CBCT or pCT by comparing predicted segmentations with reference ones thanks to Dice similarity score and Hausdorff distance. A qualitative evaluation was also performed to compare DIR-based and nnU-Net-basedsegmentations. Training with pCBCT was found to lead to comparable results to using real CBCT images. When evaluated on CBCT obtained from the same hospital as the CT images used in the simulation of the pCBCT, the model trained with pCBCT scored mean DSCs of 0.92 ± 0.05, 0.87 ± 0.02, and 0.85 ± 0.04 and mean Hausdorff distance 4.67 ± 3.01, 3.91 ± 0.98, and 5.00 ± 1.32 for the bladder, rectum, and prostate contours respectively, while the model trained with real CBCT scored mean DSCs of 0.91 ± 0.06, 0.83 ± 0.07, and 0.81 ± 0.05 and mean Hausdorff distance 5.62 ± 3.24, 6.43 ± 5.11, and 6.19 ± 1.14 for the bladder, rectum, and prostate contours, respectively. It was also found to outperform models using pCT or a combination of both, except for the prostate contour when tested on a dataset from a different hospital. Moreover, the resulting segmentations demonstrated a clinical acceptability, where 78% of bladder segmentations, 98% of rectum segmentations, and 93% of prostate segmentations required minor or no corrections, and for 76% of the patients, all structures of the patient required minor or nocorrections. We proposed to use simulated CBCT images to train a nnU-Net segmentation model, avoiding the need to gather complex and time-consuming reference delineations on CBCTimages.

A fidelity-embedded learning for metal artifact reduction in dental CBCT.

Dental cone-beam computed tomography (CBCT) has been increasingly used for dental and maxillofacial imaging. However, the presence of metallic inserts, such as implants, crowns, and dental braces, violates the CT model assumption, which leads to severe metal artifacts in the reconstructed CBCT image, resulting in the degradation of diagnostic performance. In this study, we used deep learning to reduce metalartifacts. The metal artifacts, appearing as streaks and shadows, are nonlocal and highly associated with various factors, including the geometry of metallic inserts, energy-dependent attenuation, and energy spectrum of the incident X-ray beam, making it difficult to learn their complicated structures directly. To provide a step-by-step environment in which deep learning can be trained, we propose an iterative learning approach in which the network at each iteration step learns the correction error caused by the previous network, while enforcing the data fidelity in the projection domain. To generate a realistic paired training dataset, metal-free CBCT scans were collected from patients without metallic inserts, and then simulated metal projection data were added to generate the corresponding metal-corrupted projectiondata. The feasibility of the proposed method was investigated in clinical metal-affected CBCT scans, as well as simulated metal-affected CBCT scans. The results show that the proposed method significantly reduces metal artifacts while preserving the morphological structures near metallic objects and outperforms direct image domainlearning. The proposed fidelity-embedded learning can effectively reduce metal artifacts in dental CBCT compared with direct image domainlearning.

Assessment of lower third molar space: A comparative radiographic study.

The aim of this study was to assess lower third molar space using four different radiographic reconstructed Cone Beam Computed Tomography (CBCT) images: orthopantomogram, lateral cephalogram, multiplanar CBCT and a newly introduced three-dimensional (3D) simulation technique. The CBCT scans of 32 individuals (20.97 ± 2.152 years) with a total of 50 lower third molars were collected and analyzed. The ratio between the necessary space and available space for lower third molars was calculated on each radiographic reconstructed image. Repeated-measure analysis of variance followed by multiple comparison tests were used. The mean ratio was significantly smaller with cephalograms (0.611 ± 0.263), followed respectively by orthopantomograms (0.756 ± 0.221), multiplanar CBCT (0.789 ± 0.191) and 3D simulation technique (0.807 ± 0.193) (p < 0.001). The lowest mean difference was recorded between multiplanar CBCT and 3D simulation technique (0.017). Intraclass correlation coefficient was strong (>0.90) for all techniques except cephalograms. The assessment of the lower third molar space differs according to the adopted imaging technique. Three-dimensional simulation technique is a useful novel technology that allows an exploration of the crown in many different dimensions and orientations, giving more predictable results than the conventional methods.

Prior image-guided cone-beam computed tomography augmentation from under-sampled projections using a convolutional neural network.

Acquiring sparse-view cone-beam computed tomography (CBCT) is an effective way to reduce the imaging dose. However, images reconstructed by the conventional filtered back-projection method suffer from severe streak artifacts due to the projection under-sampling. Existing deep learning models have demonstrated feasibilities in restoring volumetric structures from the highly under-sampled images. However, because of the inter-patient variabilities, they failed to restore the patient-specific details with the common restoring pattern learned from the group data. Although the patient-specific models have been developed by training models using the intra-patient data and have shown effectiveness in restoring the patient-specific details, the models have to be retrained to be exclusive for each patient. It is highly desirable to develop a generalized model that can utilize the patient-specific information for the under-sampled image augmentation. In this study, we proposed a merging-encoder convolutional neural network (MeCNN) to realize the prior image-guided under-sampled CBCT augmentation. Instead of learning the patient-specific structures, the proposed model learns a generalized pattern of utilizing the patient-specific information in the prior images to facilitate the under-sampled image enhancement. Specifically, the MeCNN consists of a merging-encoder and a decoder. The merging-encoder extracts image features from both the prior CT images and the under-sampled CBCT images, and merges the features at multi-scale levels via deep convolutions. The merged features are then connected to the decoders via shortcuts to yield high-quality CBCT images. The proposed model was tested on both the simulated CBCTs and the clinical CBCTs. The predicted CBCT images were evaluated qualitatively and quantitatively in terms of image quality and tumor localization accuracy. Mann-Whitney U test was conducted for the statistical analysis. P<0.05 was considered statistically significant. The proposed model yields CT-like high-quality CBCT images from only 36 half-fan projections. Compared to other methods, CBCT images augmented by the proposed model have significantly lower intensity errors, significantly higher peak signal-to-noise ratio, and significantly higher structural similarity with respect to the ground truth images. Besides, the proposed method significantly reduced the 3D distance of the CBCT-based tumor localization errors. In addition, the CBCT augmentation is nearly real-time. With the prior-image guidance, the proposed method is effective in reconstructing high-quality CBCT images from the highly under-sampled projections, considerably reducing the imaging dose and improving the clinical utility of the CBCT.

Experimental validation of Fastcat kV and MV cone beam CT (CBCT) simulator.

To experimentally validate the Fastcat cone beam computed tomography (CBCT) simulator against kV and MV CBCT images acquired with a Varian Truebeamlinac. kV and MV CBCT images of a Catphan 504 phantom were acquired using a 100 kVp beam with the on-board imager (OBI) and a 6 MV treatment beam with the electronic portal imaging device (EPID), respectively. The kV Fastcat simulation was performed using detailed models of the x-ray source, bowtie filter, a high resolution voxelized virtual Catphan phantom, anti-scatter grid, and the CsI scintillating detector. Likewise, an MV Fastcat CBCT was simulated with detailed models for the beam energy spectrum, flattening filter, a high-resolution voxelized virtual Catphan phantom, and the gadolinium oxysulfide (GOS) scintillating detector. Experimental and simulated CBCT images of the phantom were compared with respect to HU values, contrast to noise ratio (CNR), and dose linearity. Detector modulation transfer function (MTF) for the two detectors were also experimentally validated. Fastcat's dose calculations were compared to Monte Carlo (MC) dose calculations performed with Topas. For the kV and MV simulations, respectively: Contrast agreed within 14 and 9 HUs and detector MTF agreed within 4.2% and 2.5%. Likewise, CNR had a root mean squared error (RMSE) of 2.6% and 1.4%. Dose agreed within 2.4% and 1.6% of MC values. The kV and MV CBCT images took 71 and 72 s to simulate in Fastcat with 887 and 493 projections, respectively. We present a multienergy experimental validation of a fast and accurate CBCT simulator against a commercial linac. The simulator is open source and all models found in this work can be downloaded from https://github.com/jerichooconnell/fastcat.git.

A feasibility study of time of flight cone beam computed tomography imaging.

The time of flight (TOF) cone beam computed tomography (CBCT) was recently shown to reduce the X-ray scattering effects by 95% and improve the image CNR by 110% for large volume objects. The advancements in X-ray sources like in compact Free Electron Lasers (FEL) and advancements in detector technology show potential for the TOF method to be feasible in CBCT when imaging large objects. To investigate the feasibility and efficacy of TOF CBCT in imaging smaller objects with different targets such as bones and tumors embedded inside the background. The TOF method used in this work was verified using a 24 cm phantom. Then, the GATE software was used to simulate the CBCT imaging of an 8 cm diameter cylindrical water phantom with two bone targets using a modeled 20 keV quasi-energetic FEL source and various TOF resolutions ranging from 1 to 1000 ps. An inhomogeneous breast phantom of similar size with tumor targets was also imaged using the same system setup. The same results were obtained in the 24 cm phantom, which validated the applied CBCT simulation approach. For the case of 8 cm cylindrical phantom and bone target, a TOF resolution of 10 ps improved the image contrast-to-noise ratio (CNR) by 57% and reduced the scatter-to-primary ratio (SPR) by 8.63. For the case of breast phantom and tumor target, image CNR was enhanced by 12% and SPR was reduced by 1.35 at 5 ps temporal resolution. This study indicates that a TOF resolution below 10 ps is required to observe notable enhancements in the image quality and scatter reduction for small objects around 8 cm in diameter. The strong scattering targets such as bone can result in substantial improvements by using TOF CBCT.

Comparison of convolutional neural network training strategies for cone-beam CT image segmentation

Background and objectiveOver the past decade, convolutional neural networks (CNNs) have revolutionized the field of medical image segmentation. Prompted by the developments in computational resources and the availability of large datasets, a wide variety of different two-dimensional (2D) and three-dimensional (3D) CNN training strategies have been proposed. However, a systematic comparison of the impact of these strategies on the image segmentation performance is still lacking. Therefore, this study aimed to compare eight different CNN training strategies, namely 2D (axial, sagittal and coronal slices), 2.5D (3 and 5 adjacent slices), majority voting, randomly oriented 2D cross-sections and 3D patches. MethodsThese eight strategies were used to train a U-Net and an MS-D network for the segmentation of simulated cone-beam computed tomography (CBCT) images comprising randomly-placed non-overlapping cylinders and experimental CBCT images of anthropomorphic phantom heads. The resulting segmentation performances were quantitatively compared by calculating Dice similarity coefficients. In addition, all segmented and gold standard experimental CBCT images were converted into virtual 3D models and compared using orientation-based surface comparisons. ResultsThe CNN training strategy that generally resulted in the best performances on both simulated and experimental CBCT images was majority voting. When employing 2D training strategies, the segmentation performance can be optimized by training on image slices that are perpendicular to the predominant orientation of the anatomical structure of interest. Such spatial features should be taken into account when choosing or developing novel CNN training strategies for medical image segmentation. ConclusionsThe results of this study will help clinicians and engineers to choose the most-suited CNN training strategy for CBCT image segmentation.

Feasibility of image quality improvement for high-speed CBCT imaging using deep convolutional neural network for image-guided radiotherapy in prostate cancer.

High-speed cone-beam computed tomography (CBCT) scan for image-guided radiotherapy (IGRT) can reduce both the scan time and the exposure dose. However, it causes noise and artifacts in the reconstructed images due to the lower number of acquired projection data. The purpose of this study is to improve the image quality of high-speed CBCT using a deep convolutional neural network (DCNN). CBCT images of 36 prostate cancer patients were selected. The CBCT images acquired at normal scan speed were defined as CBCT100%. Simulated high-speed CBCT images acquired at twofold and fourfold scan speed were created, which were defined as CBCT50% and CBCT25%, respectively. The image quality of the CBCT50% was treated as the requirement for IGRT in this study because previous studies reported that its image is sufficient with respect to IGRT. The DCNN model was trained to learn direct mapping from CBCT25% to the corresponding CBCT100%. The performance of the DCNN model was evaluated using the sixfold cross-validation method. CBCT images generated by DCNN (CBCT25%+DCNN) were evaluated for voxel value accuracy and image quality. The DCNN model can process CBCT25% of a new patient within 0.06s/slice. The CBCT25%+DCNN was comparable to the CBCT50% in terms of both voxel value accuracy and image quality. We developed a DCNN model to remove noise and artifacts from high-speed CBCT. We emphasize that it is possible to reduce exposure to one quarter and to increase the CBCT scan speed by a factor of four.