Static Phantom Research Articles

Phase contrast MRI with minimized background phase errors.

Phase contrast MRI (PC-MRI) is used clinically to measure velocities in the body, but systematic background phase errors caused by magnetic field imperfections corrupt the velocity measurements with offsets that limit clinical utility. This work aims to minimize systematic background phase errors in PC-MRI, thereby maximizing the accuracy of velocity measurements. The MRI scanner's background phase errors from eddy currents and mechanical oscillations were modeled using the gradient impulse response function (GIRF). Gradient waveforms were then numerically optimized using the GIRF to create pulse sequences that minimize the background phase errors. The pulse sequences were tested in a static phantom where the predicted response could be compared directly to the measured background velocity. The optimized acquisitions were then tested in human subjects, where flow rates and background errors were compared to conventional PC-MRI. When using the GIRF-optimized gradient waveforms, the predicted background phase was within 0.6 [95% CI = -3.4, 5.4] mm/s of the measured background phase in a static phantom. Excellent agreement was seen for in vivo blood flow values (flow rate agreement = 0.96), and the background phase was reduced by 78.8 18.7%. This work shows that using a GIRF to model the effects of magnetic field imperfections combined with numerically optimized gradient waveforms enables PC-MRI waveforms to be designed to produce a minimal background phase in the most time-efficient manner. The methodology could be adapted for other MRI sequences where similar magnetic field errors affect measurements.

Technical Note: Swing golden angle - A navigator-interleaved golden angle trajectory with eddy current suppression - Application in free-running cardiac MRI.

Golden angle (GA) radial trajectory is advantageous for dynamic magnetic resonance imaging (MRI). Recently, several advanced algorithms have been developed based on navigator-interleaved GA trajectory to realize free-running cardiac MRI. However, navigator-interleaved GA trajectory suffers from the eddy-current effect, which reduces the image quality. This work aims to integrate the navigator-interleaved GA trajectory with clinical cardiac MRI acquisition, with the minimum eddy-current artifacts. The ultimate goal is to realize a high-quality free-running cardiac imaging technique. In this paper, we propose a new "swing golden angle" (swingGA) radial profile order. SwingGA samples the k-space by rotating back and forth at the generalized golden ratio interval, with smoothly interleaved navigator readouts. The sampling efficiency and angle increment distributions were investigated by numerical simulations. Static phantom imaging experiments were conducted to evaluate the eddy current effect, compared with cartesian, golden angle radial (GA), and tiny golden angle (tGA) trajectories. Furthermore, 12 heart-healthy subjects (aged 21-25years) were recruited for free-running cardiac imaging with different sampling trajectories. Dynamic images were reconstructed by a low-rank subspace-constrained algorithm. The image quality was evaluated by signal-to-noise-ratio and spectrum analysis in the heart region, and compared with traditional clinical cardiac MRI images. SwingGA pattern achieves the highest sampling efficiency (mSE>0.925) and the minimum azimuthal angle increment (mAD<1.05). SwingGA can effectively suppress eddy currents in static phantom images, with the lowest normalized root mean square error (nRMSE) values among radial trajectories. For the in-vivo cardiac images, swingGA enjoys the highest SNR both in the blood pool and myocardium, and contains the minimum level of high-frequency artifacts. The free-running cardiac images have good consistency with traditional clinical cardiac MRI, and the swingGA sampling pattern achieves the best image quality among all sampling patterns. The proposed swingGA sampling pattern can effectively improve the sampling efficiency and reduce the eddy currents for the navigator-interleaved GA sequence. SwingGA is a promising sampling pattern for free-running cardiac MRI.

Feasibility of patient-specific quality assurance (PSQA) for real-time robotic stereotactic body radiotherapy (SBRT) based on tumor motion traces.

To design a patient specific quality assurance (PSQA) process for the CyberKnife Synchrony system and quantify its dosimetric accuracy using a motion platform driven by patient tumor traces with rotation. The CyberKnife Synchrony system was evaluated using a motion platform (MODUSQA) and a SRS MapCHECK phantom. The platform was programed to move in the superior-inferior (SI) direction based on tumor traces. The detector array housed by the StereoPhan was placed on the platform. Extra rotational angles in pitch (head down, 4.0°±0.15° or 1.2°±0.1°) were added to the moving phantom to examine robot capability of angle correction during delivery. A total of 15 Synchrony patients were performed SBRT PSQA on the moving phantom. All the results were benchmarked by the PSQA results based on static phantom. For smaller pitch angles, the mean gamma passing rates were 99.75%±0.87%, 98.63%±2.05%, and 93.11%±5.52%, for 3%/1mm, 2%/1mm, and 1%/1mm, respectively. Large discrepancy in the passing rates was observed for different pitch angles due to limited angle correction by the robot. For larger pitch angles, the corresponding mean passing rates were dropped to 93.00%±10.91%, 88.05%±14.93%, and 80.38%±17.40%. When comparing with the static phantom, no significant statistic difference was observed for smaller pitch angles (p=0.1 for 3%/1mm), whereas a larger statistic difference was observed for larger pitch angles (p<0.02 for all criteria). All the gamma passing rates were improved, if applying shift and rotation correction. The significance of this work is that it is the first study to benchmark PSQA for the CyberKnife Synchrony system using realistically moving phantoms with rotation. With reasonable delivery time, we found it may be feasible to perform PSQA for Synchrony patients with a realistic breathing pattern.

Free-breathing motion corrected magnetic resonance elastography of the abdomen.

Magnetic resonance elastography (MRE) is a non-invasive method to measure the viscoelastic properties of tissue and has been applied in multiple abdominal organs. However, abdominal MRE suffers from detrimental breathing motion causing misalignment of structures between repeated acquisitions for different MRE dimensions (e.g., motion encoding directions and wave phase offsets). This study investigated motion correction strategies to resolve all breathing motion on sagittal free-breathing MRE acquisitions in a phantom, in healthy volunteers and showed feasibility in patients. First, in silico experiments were performed on a static phantom dataset with simulated motion. Second, eight healthy volunteers underwent two sagittal MRE acquisitions in the pancreas and right kidney. The multi-frequency free-breathing spin-echo echo-planar-imaging (SE-EPI) MRE consisted of four frequencies (30, 40, 50, 60 Hz), eight wave-phase offsets, with 3 mm3 isotropic voxel size. Following data re-sorting in different number of motion states (4 till 12) based on respiratory waveform signal, three intensity-based registration methods (monomodal, multimodal, and phase correlation) and non-rigid local registration were compared. A ranking method was used to determine the best registration method, based on seven signal-to-noise and image quality measures. Repeatability was assessed for no motion correction (Original) and the best performing method (Best) using Bland-Altman analysis. Lastly, the best motion correction method was compared to no motion correction on patient MRE data [pancreatic ductal adenocarcinoma (PDAC, n=5) and metabolic dysfunction-associated steatotic liver disease (MASLD) (n=1)]. In silico experiments showed a deviation of shear wave speed (SWS) with simulated motion to the ground truth, which was (partially) resolved using motion correction. In healthy volunteers ranking resulted in the best motion correction method of monomodal registration using nine motion states, while no motion correction was ranked last. Limits of agreement were (-0.18, 0.14), and (-0.25, 0.18) m/s for Best and Original, respectively. Using motion correction in patients resulted in a significant increase in SWS in the pancreas (Original: 1.39±0.10 and Best: 1.50±0.17 m/s). After motion correction PDAC had a mean SWS of 1.56±0.27 m/s (Original: 1.42±0.25 m/s). The fibrotic liver mean SWS was 2.07±0.20 m/s (Original: 2.12±0.18 m/s). Motion correction in sagittal free-breathing abdominal MRE results in improved data quality, inversion precision, repeatability, and is feasible in patients.

Multi-energy in-vivo imaging of multiple contrast agents in a mouse using MPPC-based photon-counting CT

Contrast-enhanced computed tomography (CT) is an indispensable technique in modern diagnostic medicine because it not only allows non-destructive, three-dimensional observation of the inside of the body but also provides images that highlight lesions. Recent developments in photon-counting (PC) CT systems have enabled contrast-enhanced CT scanning and quantitative evaluations, such as material discrimination and concentration estimation of contrast agents, using X-ray energy information. We established a PC-CT system that combines fast scintillators and multipixel photon counters (MPPCs) and demonstrated its performance. In this paper, we report the imaging performance of a PC-CT system using a mixture of contrast agents containing gadolinium and iodine. We performed CT imaging of a static phantom containing a mixture of the two contrast agents. The concentration of each contrast agent from the CT images in multiple energy bands were estimated. We succeeded in obtaining the concentration distributions for each contrast agent and verified the possibility of discriminating between two substances with different atomic numbers. In addition, the same procedures and analytical methods used for the static phantom were applied to the in vivo imaging of a mouse, in which gadolinium- and iodine-containing contrast agents were injected at different time intervals. We also succeeded in discriminating between the two contrast agents in vivo, making it possible to provide new imaging diagnostics such as the determination of necrotic tissues and normal blood vessels. Furthermore, we succeeded in creating three-dimensional concentration maps of gadolinium and iodine in a mouse, demonstrating the great potential of MPPC-based PC-CT for future clinical applications.

Scan-Free and Fully Automatic Tracking of Native Knee Anatomy from Dynamic Stereo-Radiography with Statistical Shape and Intensity Models.

Kinematic tracking of native anatomy from stereo-radiography provides a quantitative basis for evaluating human movement. Conventional tracking procedures require significant manual effort and call for acquisition and annotation of subject-specific volumetric medical images. The current work introduces a framework for fully automatic tracking of native knee anatomy from dynamic stereo-radiography which forgoes reliance on volumetric scans. The method consists of three computational steps. First, captured radiographs are annotated with segmentation maps and anatomic landmarks using a convolutional neural network. Next, a non-convex polynomial optimization problem formulated from annotated landmarks is solved to acquire preliminary anatomy and pose estimates. Finally, a global optimization routine is performed for concurrent refinement of anatomy and pose. An objective function is maximized which quantifies similarities between masked radiographs and digitally reconstructed radiographs produced from statistical shape and intensity models. The proposed framework was evaluated against manually tracked trials comprising dynamic activities, and additional frames capturing a static knee phantom. Experiments revealed anatomic surface errors routinely below 1.0 mm in both evaluation cohorts. Median absolute errors of individual bone pose estimates were below 1.0 or mm for 15 out of 18 degrees of freedom in both evaluation cohorts. Results indicate that accurate pose estimation of native anatomy from stereo-radiography may be performed with significantly reduced manual effort, and without reliance on volumetric scans.

Sparse-view image reconstruction with total-variation minimization applied to sparsely sampled projection data from SiPM-based photon-counting CT

We constructed a sparse-view computed tomography (CT) system that combines a compressed sensing (CS)-based image-reconstruction algorithm and SiPM-based photon-counting (PC) CT. CS-based image-reconstruction algorithms have been extensively studied for X-ray CT image reconstruction using fewer projections because they are expected to reduce CT imaging time and radiation exposure while maintaining CT image quality. In most previous studies, CS-based image-reconstruction algorithms have been applied to data obtained through numerical simulations or conventional dual-energy CT. However, studies on PC-CT have been scarce. Therefore, we applied a CS-based image-reconstruction algorithm to the projection data obtained using our previously established SiPM-based PC-CT system and evaluated its image quality. We prepared static phantoms equivalent to iodine-containing contrast agents and a mouse model injected with iodine-containing contrast agents as subjects. Thereafter, CT scanning was performed. The obtained projection data were downsampled to simulate a sparse-view situation, and a CS-based image-reconstruction algorithm with total-variation minimization was applied. Consequently, sparse-view CT images were successfully reconstructed, and the image quality was maintained even after downsampling the projection data (downsampling ratios of 1/10 and 1/2 for the rod phantom and mouse model, respectively). Thus, the imaging time and exposure dose could be remarkably reduced (by a factor of 10 or 2), indicating that the CS-based image-reconstruction algorithm is effective for PC-CT.

Beat phenomena of oscillating readouts.

To demonstrate slowly varying, erroneous magnetic field gradients for oscillating readouts due to the mechanically resonant behavior of gradient systems. Projections of a static phantom were acquired using a one-dimensional (1D) EPI sequence with varying EPI frequencies ranging from 1121 to 1580 Hz on clinical 3T systems (30 mT/m, 200 T/m/s). Phase due to static B0 inhomogeneities was eliminated by a complex division of two separate scans with different polarities of the EPI readout. The temporal evolution of phase was evaluated and related to the mechanical resonances of the gradient systems derived from the gradient modulation transfer function. Additionally, the impact of temporally varying mechanical resonance effects on EPI was evaluated using an echo-planar spectroscopic imaging sequence. A beat phenomenon resulting in a slowly varying phase was observed. Its temporal frequency was given by the difference between the EPI frequency and the mechanical resonance frequency of the activated gradient axis. The maximum erroneous, oscillating phase during phase encoding was ±0.5 rad for an EPI frequency of 1281 Hz. Echo-planar spectroscopic imaging images showed the resulting time-dependent stretching/compression of the FOV. Oscillating readouts such as those used in EPI can result in low-frequency, erroneous phase contributions, which are explained by the beat phenomenon. Therefore, EPI phase-correction approaches may need to include beat effects for accurate image reconstruction.

Evaluation of 2D ion chamber arrays for patient specific quality assurance using a static phantom at a 0.35 T MR-Linac

IntroductionPatient specific quality assurance (QA) in MR-Linacs can be performed with MR-compatible ion chamber arrays. However, the presence of a static magnetic field can alter the angular response of such arrays substantially. This works investigates the suitability of two ion chamber arrays, an air-filled and a liquid-filled array, for patient specific QA at a 0.35 T MR-Linac using a static phantom. MethodsIn order to study the angular response, the two arrays were placed in a static, solid phantom and irradiated with 9.96 × 9.96 cm2 fields every 10° beam angle at a 0.35 T MR-Linac. Measurements were compared to the TPS calculated dose in terms of gamma passing rate and relative dose to the central chamber. 20 patient specific quality assurance plans were measured using the liquid-filled array. ResultsThe air-filled array showed asymmetric angular response changes of central chamber dose of up to 18% and down to local 3 mm / 3% gamma rates of 20%, while only minor differences within 3% (excluding parallel irradiation and beams through the couch edges) were found for the liquid-filled ion chamber array without rotating the phantom. Patient plan QA using the liquid-filled array yielded a median local 3 mm / 3% 3D gamma passing rate of 99.8% (range 96.9%–100%) ConclusionA liquid-filled ionization chamber array in combination with a static phantom can be used for efficient patient specific plan QA in a single measurement set-up in a 0.35 T MR-Linac, while the air-filled ion chamber array phantom shows large angular response changes and has its limitations regarding patient specific QA measurements

Survey on fan-beam computed tomography for radiotherapy: Current implementation and future perspectives of motion management and surface guidance devices

Background and purposeThis work reports on the results of a survey performed on the use of computed tomography (CT) imaging for motion management, surface guidance devices, and their quality assurance (QA). Additionally, it details the collected user insights regarding professional needs in CT for radiotherapy. The purpose of the survey is to understand current practice, professional needs and future directions in the field of fan-beam CT in radiation therapy (RT). Materials and methodsAn online institutional survey was conducted between 1-Sep-2022 and 10-Oct-2022 among medical physics experts at Belgian and Dutch radiotherapy institutions, to assess the current status, challenges, and future directions of motion management and surface image-guided radiotherapy. The survey consisted of a maximum of 143 questions, with the exact number depending on participants’ responses. ResultsThe response rate was 66 % (31/47). Respiratory management was reported as standard practice in all but one institution; surface imaging during CT-simulation was reported in ten institutions. QA procedures are applied with varying frequencies and methodologies, primarily with commercial anatomy-like phantoms. Surface guidance users report employing commercial static and dynamic phantoms. Four main subjects are considered clinically important by the respondents: surface guidance, CT protocol optimisation, implementing gated imaging (4DCT, breath-hold), and a tattoo-less workflow. ConclusionsThe survey highlights the scattered pattern of QA procedures for respiratory motion management, indicating the need for well-defined, unambiguous, and practicable guidelines. Surface guidance is considered one of the most important techniques that should be implemented in the clinical radiotherapy simulation workflow.

The Effect of Respiratory Motion in Breast Intensity-modulated Radiation Therapy: 3D-Printed Dynamic Phantom Study.

This study evaluated the dosimetric effect of respiratory motion in intensity-modulated radiation therapy (IMRT) for breast cancer using a three-dimensional (3D)-printed dynamic phantom. Computed tomography (CT) data from breast cancer patients were used to create a 3D-printed breast phantom. Various types of treatment plans were generated using CT images acquired at the exhalation phase. Different infill densities in the 3D-printed phantom were tested to validate their effect on simulating the average human breast tissue density. Plans were delivered to the 3D-printed dynamic phantom in the exhalation position and free-breathing motion. Dosimetric verification was performed using Gafchromic EBT3 films. After changing the infill density to obtain Hounsfield Unit values similar to those of human breast tissue, a realistic patient-specific breast phantom was fabricated using a 3D printer at 80% infill density. The gamma passing rates of the dose distribution delivered in the exhalation phase and free-breathing motion were 92% or more. In addition, the dynamic phantom doses with free-breathing motion were directly compared with the static phantom dose in terms of sagittal dose profiles. Gamma passing rates of >93% and 90% were achieved at 3%/3 mm and 3%/2 mm, respectively. Despite a blurred dose distribution, the dose map of the film measurement with respiratory motion could be delivered without significantly increasing the dose heterogeneity of the tumor bed or loss of target coverage. Our findings demonstrate that the impact of respiration on breast IMRT for whole-breast irradiation was not significant, even in the tumor bed.

Model-independent traversable wormholes from baryon acoustic oscillations

In this paper, we investigate the model-independent traversable wormholes from baryon acoustic oscillations. Firstly, we place the statistical constraints on the average dark energy equation of state ωav by only using BAO data. Subsequently, two specific wormhole solutions are obtained, i.e, the cases of the constant redshift function and a special choice for the shape function. For the first case, we analyze the traversabilities of the wormhole configuration, and for the second case, we find that one can construct theoretically a traversable wormhole with infinitesimal amounts of average null energy condition violating phantom fluid. Furthermore, we perform the stability analysis for the first case, and find that the stable equilibrium configurations may increase for increasing values of the throat radius of the wormhole in the cases of a positive and a negative surface energy density. It is worth noting that the obtained wormhole solutions are static and spherically symmetrical metric, and that we assume ωav to be a constant between different redshifts when placing constraints, hence, these wormhole solutions can be interpreted as stable and static phantom wormholes configurations at some certain redshift which lies in the range [0.32, 2.34].

Experimental demonstration of a new near-infrared spectroscopy technique based on optical dual-comb: DC-NIRS

We present a novel near-infrared spectroscopy technique based on Dual-Comb optical interrogation (DC-NIRS) applied to dispersive media. The technique recovers the frequency response of the medium under investigation by sampling its spectral response in amplitude and phase. The DC-NIRS reference and sample signals are generated using electro-optic modulation which offers a cost-effective, integrable solution while providing high adaptability to the interrogated medium. A careful choice of both line spacing and optical span of the frequency comb ensures that the retrieved information enables the reconstruction of the temporal impulse response of the medium, known as the diffuse-time-of-flight (DTOF), to obtain its optical properties with a 70 µs temporal resolution and 32 ps photon propagation delay resolution. Furthermore, the DC-NIRS technique also offers enhanced penetration due to noiseless optical amplification (interferometric detection). The presented technique was demonstrated on a static bio-mimetic phantom of known optical properties reproducing a typical brain’s optical response. The DTOF and optical properties of the phantom were measured, showing the capabilities of this new technique on the estimation of absolute optical properties with a deviation under 3%. Compared to current technologies, our DC-NIRS technique provides enhanced temporal resolution, spatial location capabilities, and penetration depth, with an integrable and configurable cost-effective architecture, paving the way to next-generation, non-invasive and portable systems for functional brain imaging, and brain-computer interfaces, among other. The system is patent pending PCT/ES2022/070176.

TOF MLEM Adaptation for the Total-Body J-PET With a Realistic Analytical System Response Matrix

We report a study of the original image reconstruction algorithm based on the time-of-flight maximum likelihood expectation maximisation (TOF MLEM), developed for the total-body (TB) Jagiellonian PET (J-PET) scanners. The method is applicable to generic cylindrical or modular multi-layer layouts and is extendable to multi-photon imaging. The system response matrix (SRM) is represented as a set of analytical functions, uniquely defined for each pair of plastic scintillator strips used for the detection. A realistic resolution model (RM) in detector space is derived from fitting the Monte Carlo simulated emissions and detections of annihilation photons on oblique transverse planes. Additional kernels embedded in SRM account for TOF, parallax effect and axial smearing. The algorithm was tested on datasets, simulated in GATE for the NEMA IEC and static XCAT phantoms inside a 24-module 2-layer TB J-PET. Compared to the reference TOF MLEM with none or a shift-invariant RM, an improvement was observed, as evaluated by the analysis of image quality, difference images and ground truth metrics. We also reconstructed the data with additive contributions, pre-filtered geometrically and with non-TOF scatter correction applied. Despite some deterioration, the obtained results still capitalise on the realistic RM with better edge preservation and superior ground truth metrics. The envisioned prospects of the TOF MLEM with analytical SRM include its application in multi-photon imaging and further upgrade to account for the non-collinearity, positron range and other factors.

Evaluation of stereotactic VMAT lung treatment plans for small moving targets

PurposeThe aim of this study is to perform patient quality controls and end-to-end tests for stereotactic VMAT lung treatment plans and to investigate the influence of various parameters on the results. Method18 plans were defined by an experimental design methodology to cover a large variety of stereotactic VMAT lung treatments including different doses per fraction, target diameters, target movements and respiratory parameters. Plans were first controlled using portal dosimetry and a homogeneous static cylindrical phantom. End-to-end tests were then performed in a dynamic respiratory thorax phantom. Measurements were conducted with ionization chamber and films. Calculations were performed with the AcurosXB and AAA algorithms in 6 FFF. ResultsPortal dosimetry gave excellent gamma pass rates (greater than 97.1 %) and dose deviations between measurement and calculations in a homogeneous static phantom were smaller than 2 %. The methodology followed for comparing calculated and measured doses in a moving target was validated in static fields (largest deviation smaller than 2 %). End-to-end tests showed mean deviations of 1.9 %, 3.3 % and 6.6 % for the 3, 2 and 1 cm diameter’s target respectively. Deviations increased for larger movements for the 1 cm lesion. ConclusionEnd-to-end tests revealed that stereotactic VMAT lung treatment plans for moving targets can be delivered within 5 % for 3 and 2 cm diameter targets and amplitudes up to 1.5 cm. The AcurosXB and AAA algorithms however tend to underestimate the dose to the target. Even with satisfactory patient quality controls like portal dosimetry, extra care should be taken for GTV lesions smaller than 2 cm.

Retrospective motion correction through multi-average k-space data elimination (REMAKE) for free-breathing cardiac cine imaging.

To develop a motion-robust reconstruction technique for free-breathing cine imaging with multiple averages. Retrospective motion correction through multiple average k-space data elimination (REMAKE) was developed using iterative removal of k-space segments (from individual k-space samples) that contribute most to motion corruption while combining any remaining segments across multiple signal averages. A variant of REMAKE, termed REMAKE+, was developed to address any losses in SNR due to k-space information removal. With REMAKE+, multiple reconstructions using different initial conditions were performed, co-registered, and averaged. Both techniques were validated against clinical "standard" signal averaging reconstruction in a static phantom (with simulated motion) and 15 patients undergoing free-breathing cine imaging with multiple averages. Quantitative analysis of myocardial sharpness, blood/myocardial SNR, myocardial-blood contrast-to-noise ratio (CNR), as well as subjective assessment of image quality and rate of diagnostic quality images were performed. In phantom, motion artifacts using "standard" (RMS error [RMSE]: 2.2 ± 0.5) were substantially reduced using REMAKE/REMAKE+ (RMSE: 1.5 ± 0.4/1.0 ± 0.4, p < 0.01). In patients, REMAKE/REMAKE+ led to higher myocardial sharpness (0.79 ± 0.09/0.79 ± 0.1 vs. 0.74 ± 0.12 for "standard", p=0.004/0.04), higher image quality (1.8 ± 0.2/1.9 ± 0.2 vs. 1.6 ± 0.4 for "standard", p=0.02/0.008), and a higher rate of diagnostic quality images (99%/100% vs. 94% for "standard"). Blood/myocardial SNR for "standard" (94 ± 30/33 ± 10) was higher vs. REMAKE (80 ± 25/28 ± 8, p=0.002/0.005) and tended to be lower vs. REMAKE+ (105 ± 33/36 ± 12, p=0.02/0.06). Myocardial-blood CNR for "standard" (61 ± 22) was higher vs. REMAKE (53 ± 19, p=0.003) and lower vs. REMAKE+ (69 ± 24, p=0.007). Compared to "standard" signal averaging reconstruction, REMAKE and REMAKE+ provide improved myocardial sharpness, image quality, and rate of diagnostic quality images.

Impact of Respiratory Motion on the Skin Dose for Breast Cancer in Tomotherapy: A Study in the In-house Moving Phantom.

Purpose: The dose expansion methods as the skin flash and virtual bolus were used to solve intrafraction movement for breast planning due to breathing motion. We investigated the skin dose in each planning method by using optically stimulated luminescence on an in-house moving phantom for breast cancer treatment in tomotherapy. The impact of respiratory motion on skin dose between static and dynamic phantom's conditions was evaluated. Methods: A phantom was developed with movement controlled by the respirator for generating the respiratory waveforms to simulate respiratory motion. Five optically stimulated luminescence dosimeters were placed on the phantom surface to investigate the skin dose for the TomoDirect and TomoHelical under static and dynamic conditions. Eight treatment plans were generated with and without skin flash or virtual bolus by varying the thickness. The difference in skin dose between the two phantom conditions for each plan was explored. Results: All plans demonstrated a skin dose of more than 87% of the prescription dose under static conditions. However, the skin dose was reduced to 84.1% (TomoDirect) and 78.9% (TomoHelical) for dynamic conditions. The treatment plans without skin flash or virtual bolus showed significant skin dose differences under static and dynamic conditions by 4.83% (TomoDirect) and 9.43% (TomoHelical), whereas the skin flash with two leaves (TomoDirect 2L) or virtual bolus of at least 1.0 cm thickness (VB1.0) application compensated the skin dose in case of intrafraction movements by presenting a skin dose difference of less than 2% between the static and dynamic conditions. Conclusion: The skin dose was reduced under dynamic conditions due to breathing motion. The skin flash method with TomoDirect 2L or virtual bolus application with 1.0 cm thickness was useful for maintaining skin dose following the prescription by compensating for intrafraction movement due to respiratory motion for breast cancer in tomotherapy.

Comparison of protocols with respiratory-gated (4D) motion compensation in PET/CT: open-source package for quantification of phantom image quality

BackgroundPatient’s breathing affects the quality of chest images acquired with positron emission tomography/computed tomography (PET/CT) studies. Movement correction is required to optimize PET quantification in clinical settings. We present a reproducible methodology to compare the impact of different movement compensation protocols on PET image quality. Static phantom images were set as reference values, and recovery coefficients (RCs) were calculated from motion compensated images for the phantoms in respiratory movement. Image quality was evaluated in terms of: (1) volume accuracy (VA) with the NEMA phantom; (2) concentration accuracy (CA) by six refillable inserts within the electron density CIRS phantom; and (3) spatial resolution (R) with the Jaszczak phantom. Three different respiratory patterns were applied to the phantoms. We developed an open-source package to automatically analyze VA, CA and R. We compared 10 different movement compensation protocols available in the Philips Gemini TF-64 PET/CT (4-, 6-, 8- and 10-time bins, 20%-, 30%-, 40%-window width in Inhale and Exhale).ResultsThe homemade package provided RC values for VA, CA and R of 102 PET images in less than 5 min. Results of the comparison of the 10 different protocols demonstrated the feasibility of the proposed method for quantifying the variations observed qualitatively. Overall, prospective protocols showed better motion compensation than retrospective. The best performance was obtained for the protocol Exhale 30% (0.3 s after maximum Exhale position and window width of 30%) with RC_{VA}=1.6pm 1.3, RC_{CA}=0.90pm 0.09 and RC_{R}=0.6 pm 0.4. Among retrospective protocols, 8 Phase protocol showed the best performance.ConclusionWe provided an open-source package able to automatically evaluate the impact of motion compensation methods on PET image quality. A setup based on commonly available experimental phantoms is recommended. Its application for the comparison of 10 time-based approaches showed that Exhale 30% protocol had the best performance. The proposed framework is not specific to the phantoms and protocols presented on this study.

Impact of respiratory motion on lung dose during total marrow irradiation.

We evaluated the impact of respiratory motion on the lung dose during linac-based intensity-modulated total marrow irradiation (IMTMI) using two different approaches: (1) measurement of doses within the lungs of an anthropomorphic phantom using thermoluminescent detectors (TLDs) and (2) treatment delivery measurements using ArcCHECK where gamma passing rates (GPRs) and the mean lung doses were calculated and compared with and without motion. In the first approach, respiratory motions were simulated using a programmable motion platform by using typical published peak-to-peak motion amplitudes of 5, 8, and 12mm in the craniocaudal (CC) direction, denoted here as M1, M2, and M3, respectively, with 2mm in both anteroposterior (AP) and lateral (LAT) directions. TLDs were placed in five selected locations in the lungs of a RANDO phantom. Average TLD measurements obtained with motion were normalized to those obtained with static phantom delivery. The mean dose ratios were 1.01 (0.98-1.03), 1.04 (1.01-1.09), and 1.08 (1.04-1.12) for respiratory motions M1, M2, and M3, respectively. To determine the impact of directional respiratory motion, we repeated the experiment with 5-, 8-, and 12-mm motion in the CC direction only. The differences in average TLD doses were less than 1% when compared with the M1, M2, and M3 motions indicating a minimal impact from CC motion on lung dose during IMTMI. In the second experimental approach, we evaluated extreme respiratory motion 15 mm excursion in only the CC direction. We placed an ArcCHECK device on a commercial motion platform and delivered the clinical IMTMI plans of five patients. We compared, with and without motion, the dose volume histograms (DVHs) and mean lung dose calculated with the ArcCHECK-3DVH tool as well as GPR with 3%, 5%, and 10% dose agreements and a 3-mm constant distance to agreement (DTA). GPR differed by 11.1 ± 2.1%, 3.8 ± 1.5%, and 0.1 ± 0.2% with dose agreement criteria of 3%, 5%, and 10%, respectively. This indicates that respiratory motion impacts dose distribution in small and isolated parts of the lungs. More importantly, the impact of respiratory motion on the mean lung dose, a critical indicator for toxicity in IMTMI, was not statistically significant (p > 0.05) based on the Student's t-test. We conclude that most patients treated with IMTMI will have negligible dose uncertainty due to respiratory motion. This is particularly reassuring as lung toxicity is the main concern for future IMTMI dose escalation studies.

System requirements to improve adaptive 4-dimensional computed tomography (4D CT) imaging

Four-Dimensional Computed Tomography (4D CT) is of increasing importance in stereotactic body radiotherapy (SBRT) treatments affected by respiratory motion. However, 4D CT images are commonly impacted by irregular breathing, causing image artifacts that can propagate through to treatment, negatively effecting local control. REspiratory Adaptive CT (REACT) is a real-time gating method demonstrated to reduce motion artifacts by avoiding imaging during irregular respiration. Despite artifact reduction seen through in silico and clinical phantom-based studies, REACT has not been able to remove all artifacts. Here, we explore several hardware and software latencies (gantry rotation time, couch shifts, acquisition delays and phase calculation method) inherently linked to REACT and 4D CT in general and investigate their contribution to artifacts beyond those caused by irregular breathing. Imaging was simulated using the digital extended cardiac-torso (XCAT) phantom for fifty patient-measured respiratory traces. Imaging protocols included conventional cine 4D CT and five REACT scans with systematically varied parameters to test the effect of different latencies on artifacts. Artifacts were quantified by comparing the image normalized cross correlation across couch transition points and determining the volume error compared to a static phantom ground truth both as a total error and individually across pixel rows in the main plane of motion. Artifacts were determined for each lung, the whole heart and lung tumour and were compared back to conventional 4D CT and REACT with standard clinical scanning parameters. The gantry rotation time and acquisition delay were found to have the largest impact on reducing image artifacts and should be the focus of future development. The phase calculation method was also found to influence motion artifacts and should potentially be assessed on a patient-to-patient basis. Finally, the correlation between an increase in artifacts and baseline drift suggests that longer scan times allowing drift to occur may impact image quality.