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Characterization of image quality and image-guidance performance of a preclinical microirradiator.

ABSTRACT: To assess image quality and image-guidance capabilities of a cone-beam CT based small-animal image-guided irradiation unit (micro-IGRT).A micro-IGRT system has been developed in collaboration with the authors' laboratory as a means to study the radiobiological effects of conformal radiation dose distributions in small animals. The system, the X-Rad 225Cx, consists of a 225 kVp x-ray tube and a flat-panel amorphous silicon detector mounted on a rotational C-arm gantry and is capable of both fluoroscopic x-ray and cone-beam CT imaging, as well as image-guided placement of the radiation beams. Image quality (voxel noise, modulation transfer, CT number accuracy, and geometric accuracy characteristics) was assessed using water cylinder and micro-CT test phantoms. Image guidance was tested by analyzing the dose delivered to radiochromic films fixed to BB's through the end-to-end process of imaging, targeting the center of the BB, and irradiation of the film/BB in order to compare the offset between the center of the field and the center of the BB. Image quality and geometric studies were repeated over a 5-7 month period to assess stability.CT numbers reported were found to be linear (R2 0.998) and the noise for images of homogeneous water phantom was 30 HU at imaging doses of approximately 1 cGy (to water). The presampled MTF at 50% and 10% reached 0.64 and 1.35 mm(-1), respectively. Targeting accuracy by means of film irradiations was shown to have a mean displacement error of [deltax, deltay, deltaz] = [-0.12, -0.05, -0.02] mm, with standard deviations of [0.02, 0.20, 0.17] mm. The system has proven to be stable over time, with both the image quality and image-guidance performance being reproducible for the duration of the studies.The micro-IGRT unit provides soft-tissue imaging of small-animal anatomy at acceptable imaging doses (< or =1 cGy). The geometric accuracy and targeting systems permit dose placement with submillimeter accuracy and precision. The system has proven itself to be stable over 2 yr of routine laboratory use (>1800 irradiations) and provides a platform for the exploration of targeted radiation effects in small-animal models.

SUBMITTER: Clarkson R

PROVIDER: S-EPMC3188651 | biostudies-other | 2011 Feb

REPOSITORIES: biostudies-other

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Project description:Percutaneous pelvic screw placement is challenging due to narrow bone corridors surrounded by vulnerable structures and difficult visual interpretation of complex anatomical shapes in 2D x-ray projection images. To address these challenges, a system for planning, guidance, and quality assurance (QA) is presented, providing functionality analogous to surgical navigation, but based on robust 3D-2D image registration techniques using fluoroscopy images already acquired in routine workflow. Two novel aspects of the system are investigated: automatic planning of pelvic screw trajectories and the ability to account for deformation of surgical devices (K-wire deflection). Atlas-based registration is used to calculate a patient-specific plan of screw trajectories in preoperative CT. 3D-2D registration aligns the patient to CT within the projective geometry of intraoperative fluoroscopy. Deformable known-component registration (dKC-Reg) localizes the surgical device, and the combination of plan and device location is used to provide guidance and QA. A leave-one-out analysis evaluated the accuracy of automatic planning, and a cadaver experiment compared the accuracy of dKC-Reg to rigid approaches (e.g. optical tracking). Surgical plans conformed within the bone cortex by 3-4?mm for the narrowest corridor (superior pubic ramus) and??>5?mm for the widest corridor (tear drop). The dKC-Reg algorithm localized the K-wire tip within 1.1?mm and 1.4° and was consistently more accurate than rigid-body tracking (errors up to 9?mm). The system was shown to automatically compute reliable screw trajectories and accurately localize deformed surgical devices (K-wires). Such capability could improve guidance and QA in orthopaedic surgery, where workflow is impeded by manual planning, conventional tool trackers add complexity and cost, rigid tool assumptions are often inaccurate, and qualitative interpretation of complex anatomy from 2D projections is prone to trial-and-error with extended fluoroscopy time.

Project description:A flat-panel detector based mobile isocentric C-arm for cone-beam CT (CBCT) has been developed to allow intraoperative 3D imaging with sub-millimeter spatial resolution and soft-tissue visibility. Image quality and radiation dose were evaluated in spinal surgery, commonly relying on lower-performance image intensifier based mobile C-arms. Scan protocols were developed for task-specific imaging at minimum dose, in-room exposure was evaluated, and integration of the imaging system with a surgical guidance system was demonstrated in preclinical studies of minimally invasive spine surgery.Radiation dose was assessed as a function of kilovolt (peak) (80-120 kVp) and milliampere second using thoracic and lumbar spine dosimetry phantoms. In-room radiation exposure was measured throughout the operating room for various CBCT scan protocols. Image quality was assessed using tissue-equivalent inserts in chest and abdomen phantoms to evaluate bone and soft-tissue contrast-to-noise ratio as a function of dose, and task-specific protocols (i.e., visualization of bone or soft-tissues) were defined. Results were applied in preclinical studies using a cadaveric torso simulating minimally invasive, transpedicular surgery.Task-specific CBCT protocols identified include: thoracic bone visualization (100 kVp; 60 mAs; 1.8 mGy); lumbar bone visualization (100 kVp; 130 mAs; 3.2 mGy); thoracic soft-tissue visualization (100 kVp; 230 mAs; 4.3 mGy); and lumbar soft-tissue visualization (120 kVp; 460 mAs; 10.6 mGy)--each at (0.3 x 0.3 x 0.9 mm3) voxel size. Alternative lower-dose, lower-resolution soft-tissue visualization protocols were identified (100 kVp; 230 mAs; 5.1 mGy) for the lumbar region at (0.3 x 0.3 x 1.5 mm3) voxel size. Half-scan orbit of the C-arm (x-ray tube traversing under the table) was dosimetrically advantageous (prepatient attenuation) with a nonuniform dose distribution (-2 x higher at the entrance side than at isocenter, and -3-4 lower at the exit side). The in-room dose (microsievert) per unit scan dose (milligray) ranged from -21 microSv/mGy on average at tableside to -0.1 microSv/mGy at 2.0 m distance to isocenter. All protocols involve surgical staff stepping behind a shield wall for each CBCT scan, therefore imparting -zero dose to staff. Protocol implementation in preclinical cadaveric studies demonstrate integration of the C-arm with a navigation system for spine surgery guidance-specifically, minimally invasive vertebroplasty in which the system provided accurate guidance and visualization of needle placement and bone cement distribution. Cumulative dose including multiple intraoperative scans was -11.5 mGy for CBCT-guided thoracic vertebroplasty and -23.2 mGy for lumbar vertebroplasty, with dose to staff at tableside reduced to -1 min of fluoroscopy time (-4(0-60 microSv), compared to 5-11 min for the conventional approach.Intraoperative CBCT using a high-performance mobile C-arm prototype demonstrates image quality suitable to guidance of spine surgery, with task-specific protocols providing an important basis for minimizing radiation dose, while maintaining image quality sufficient for surgical guidance. Images demonstrate a significant advance in spatial resolution and soft-tissue visibility, and CBCT guidance offers the potential to reduce fluoroscopy reliance, reducing cumulative dose to patient and staff. Integration with a surgical guidance system demonstrates precise tracking and visualization in up-to-date images (alleviating reliance on preoperative images only), including detection of errors or suboptimal surgical outcomes in the operating room.

Project description:BACKGROUND:44Sc has been increasingly investigated as a potential alternative to 68Ga in the development of tracers for positron emission tomography (PET). The lower mean positron energy of 44Sc (0.63 MeV) compared to 68Ga (0.83 MeV) can result in better spatial image resolutions. However, high-energy γ-rays (1157 keV) are emitted at high rates (99.9%) during 44Sc decay, which can reduce image quality. Therefore, we investigated the impact of these physical properties and performed an unbiased performance evaluation of 44Sc and 68Ga with different imaging phantoms (image quality phantom, Derenzo phantom, and three-rod phantom) on two preclinical PET scanners (Mediso nanoScan PET/MRI, Siemens microPET Focus 120). RESULTS:Despite the presence of high-energy γ-rays in 44Sc decay, a higher image resolution of small structures was observed with 44Sc when compared to 68Ga. Structures as small as 1.3 mm using the Mediso system, and as small as 1.0 mm using the Siemens system, could be visualized and analyzed by calculating full width at half maximum. Full widths at half maxima were similar for both isotopes. For image quality comparison, we calculated recovery coefficients in 1-5 mm rods and spillover ratios in either air, water, or bone-equivalent material (Teflon). Recovery coefficients for 44Sc were significantly higher than those for 68Ga. Despite the lower positron energy, 44Sc-derived spillover ratio (SOR) values were similar or slightly higher to 68Ga-derived SOR values. This may be attributed to the higher background caused by the additional γ-rays. On the Siemens system, an overestimation of scatter correction in the central part of the phantom was observed causing a virtual disappearance of spillover inside the three-rod phantom. CONCLUSION:Based on these findings, 44Sc appears to be a suitable alternative to 68Ga. The superior image resolution makes it an especially strong competitor in preclinical settings. The additional γ-emissions have a small impact on the imaging resolution but cause higher background noises and can effect an overestimation of scatter correction, depending on the PET system and phantom.

Project description:PurposeIn this paper we compared two different 3D ultrasound (US) modes (3D free-hand mode and 3D wobbler mode) to see which is more suitable to perform the 3D-US/3D-US registration for clinical guidance applications. The typical errors with respect to their impact on the final localization error were evaluated step by step.MethodsMulti-point target and Hand-eye calibration methods were used for 3D US calibration together with a newly designed multi-cone phantom. Pointer based and image based methods were used for 2D US calibration. The calibration target error was computed by using a different multi-cone phantom. An egg-shaped phantom was used as ground truth to compare distortions for both 3D modes along with the measurements of the volume. Finally, we compared 3D ultrasound images acquired by 3D wobbler mode and 3D free-hand mode with respect to their 3D-US/3D-US registration accuracy using both, phantom and patient data. A theoretical step by step error analysis was performed and compared to empirical data.ResultsTarget registration errors based on the calibration with the 3D Multi-point and 2D pointer/image method have been found to be comparable (∼1mm). They both outperformed the 3D Hand-eye method (error >2mm). Volume measurements with the 3D free-hand mode were closest to the ground truth (around 6% error compared to 9% with the 3D wobbler mode). Additional scans on phantoms showed a 3D-US/3D-US registration error below 1 mm for both, the 3D free-hand mode and the 3D wobbler mode, respectively. Results with patient data showed greater error with the 3D free-hand mode (6.50mm - 13.37mm) than with the 3D wobbler mode (2.99 ± 1.54 mm). All the measured errors were found to be in accordance to their theoretical upper bounds.ConclusionWhile both 3D volume methods showed comparable results with respect to 3D-US/3D-US registration for phantom images, for patient data registrations the 3D wobbler mode is superior to the 3D free-hand mode. The effect of all error sources could be estimated by theoretical derivations.

Project description:Hypothesis: The use of freehand stereotactic image-guidance with a target registration error (TRE) of μTRE + 3σTRE < 0.5 mm for navigating surgical instruments during neurotologic surgery is safe and useful. Background: Neurotologic microsurgery requires work at the limits of human visual and tactile capabilities. Anatomy localization comes at the expense of invasiveness caused by exposing structures and using them as orientation landmarks. In the absence of more-precise and less-invasive anatomy localization alternatives, surgery poses considerable risks of iatrogenic injury and sub-optimal treatment. There exists an unmet clinical need for an accurate, precise, and minimally-invasive means for anatomy localization and instrument navigation during neurotologic surgery. Freehand stereotactic image-guidance constitutes a solution to this. While the technology is routinely used in medical fields such as neurosurgery and rhinology, to date, it is not used for neurotologic surgery due to insufficient accuracy of clinically available systems. Materials and Methods: A freehand stereotactic image-guidance system tailored to the needs of neurotologic surgery-most importantly sub-half-millimeter accuracy-was developed. Its TRE was assessed preclinically using a task-specific phantom. A pilot clinical trial targeting N = 20 study participants was conducted (ClinicalTrials.gov ID: NCT03852329) to validate the accuracy and usefulness of the developed system. Clinically, objective assessment of the TRE is impossible because establishing a sufficiently accurate ground-truth is impossible. A method was used to validate accuracy and usefulness based on intersubjectivity assessment of surgeon ratings of corresponding image-pairs from the microscope/endoscope and the image-guidance system. Results: During the preclinical accuracy assessment the TRE was measured as 0.120 ± 0.05 mm (max: 0.27 mm, μTRE + 3σTRE = 0.27 mm, N = 310). Due to the COVID-19 pandemic, the study was terminated early after N = 3 participants. During an endoscopic cholesteatoma removal, a microscopic facial nerve schwannoma removal, and a microscopic revision cochlear implantation, N = 75 accuracy and usefulness ratings were collected from five surgeons each grading 15 image-pairs. On a scale from 1 (worst rating) to 5 (best rating), the median (interquartile range) accuracy and usefulness ratings were assessed as 5 (4-5) and 4 (4-5) respectively. Conclusion: Navigating surgery in the tympanomastoid compartment and potentially in the lateral skull base with sufficiently accurate freehand stereotactic image-guidance (μTRE + 3σTRE < 0.5 mm) is feasible, safe, and useful. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03852329.

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Characterization of image quality and image-guidance performance of a preclinical microirradiator.

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