Biomedical subjects

Jeffrey H Siewerdsen

Publications and source records attributed to Jeffrey H Siewerdsen.

9 recordsLinked to original sources

PubMed2006

Intraoperative cone-beam CT for guidance of temporal bone surgery.

OBJECTIVES: To describe our preclinical experience with Cone Beam CT (CBCT) in image-guided surgery of the temporal bone. STUDY DESIGN AND SETTINGS: A mobile isocentric C-arm (PowerMobil, Siemens Medical Systems, Erlangen, Germany) modified to include a flat-panel detector (Varian Imaging Products, Palo Alto, CA) and a motorized orbit was developed to acquire multiple projections in rotation about a subject. Initial experiments imaging steel wire in air were used to investigate the system's spatial resolution in 3D image reconstruction. Subsequently temporal bone dissection was performed on five cadaver heads using the modified C-arm as an image guidance system. RESULTS: We obtained a spatial resolution of 0.85 mm. The image acquisition time was 120 seconds and the radiation dose approximately one-tenth of a conventional CT scan. CONCLUSION: CBCT provided submillimeter accuracy at high speed with low radiation dosage to offer utility as an intraoperative imaging system. SIGNIFICANCE: CBCT offers technology that approximates "near-real-time" image guidance. EBM RATING: C-4.

Cadaver↗

PubMed2006

The stability of mechanical calibration for a kV cone beam computed tomography system integrated with linear accelerator.

The geometric accuracy and precision of an image-guided treatment system were assessed. Image guidance is performed using an x-ray volume imaging (XVI) system integrated with a linear accelerator and treatment planning system. Using an amorphous silicon detector and x-ray tube, volumetric computed tomography images are reconstructed from kilovoltage radiographs by filtered backprojection. Image fusion and assessment of geometric targeting are supported by the treatment planning system. To assess the limiting accuracy and precision of image-guided treatment delivery, a rigid spherical target embedded in an opaque phantom was subjected to 21 treatment sessions over a three-month period. For each session, a volumetric data set was acquired and loaded directly into an active treatment planning session. Image fusion was used to ascertain the couch correction required to position the target at the prescribed iso-center. Corrections were validated independently using megavoltage electronic portal imaging to record the target position with respect to symmetric treatment beam apertures. An initial calibration cycle followed by repeated image-guidance sessions demonstrated the XVI system could be used to relocate an unambiguous object to within less than 1 mm of the prescribed location. Treatment could then proceed within the mechanical accuracy and precision of the delivery system. The calibration procedure maintained excellent spatial resolution and delivery precision over the duration of this study, while the linear accelerator was in routine clinical use. Based on these results, the mechanical accuracy and precision of the system are ideal for supporting high-precision localization and treatment of soft-tissue targets.

Calibration↗

PubMed2006

Patient dose from kilovoltage cone beam computed tomography imaging in radiation therapy.

Kilovoltage cone-beam computerized tomography (kV-CBCT) systems integrated into the gantry of linear accelerators can be used to acquire high-resolution volumetric images of the patient in the treatment position. Using on-line software and hardware, patient position can be determined accurately with a high degree of precision and, subsequently, set-up parameters can be adjusted to deliver the intended treatment. While the patient dose due to a single volumetric imaging acquisition is small compared to the therapy dose, repeated and daily image guidance procedures can lead to substantial dose to normal tissue. The dosimetric properties of a clinical CBCT system have been studied on an Elekta linear accelerator (Synergy RP, XVI system) and additional measurements performed on a laboratory system with identical geometry. Dose measurements were performed with an ion chamber and MOSFET detectors at the center, periphery, and surface of 30 and 16-cm-diam cylindrical shaped water phantoms, as a function of x-ray energy and longitudinal field-of-view (FOV) settings of 5,10,15, and 26 cm. The measurements were performed for full 360 degrees CBCT acquisition as well as for half-rotation scans for 120 kVp beams using the 30-cm-diam phantom. The dose at the center and surface of the body phantom were determined to be 1.6 and 2.3 cGy for a typical imaging protocol, using full rotation scan, with a technique setting of 120 kVp and 660 mAs. The results of our measurements have been presented in terms of a dose conversion factor fCBCT, expressed in cGy/R. These factors depend on beam quality and phantom size as well as on scan geometry and can be utilized to estimate dose for any arbitrary mAs setting and reference exposure rate of the x-ray tube at standard distance. The results demonstrate the opportunity to manipulate the scanning parameters to reduce the dose to the patient by employing lower energy (kVp) beams, smaller FOV, or by using half-rotation scan.

Humans↗

PubMed2006

Characterization of scattered radiation in kV CBCT images using Monte Carlo simulations.

Kilovoltage (kV) cone beam computed tomography (CBCT) images suffer from a substantial scatter contribution. In this study, Monte Carlo (MC) simulations are used to evaluate the scattered radiation present in projection images. These predicted scatter distributions are also used as a scatter correction technique. Images were acquired using a kV CBCT bench top system. The EGSnrc MC code was used to model the flat panel imager, the phantoms, and the x-ray source. The x-ray source model was validated using first and second half-value layers (HVL) and profile measurements. The HVLs and the profile were found to agree within 3% and 6%, respectively. MC simulated and measured projection images for a cylindrical water phantom and for an anthropomorphic head phantom agreed within 8% and 10%. A modified version of the DOSXYZnrc MC code was used to score phase space files with identified scattered and primary particles behind the phantoms. The cone angle, the source-to-detector distance, the phantom geometry, and the energy were varied to determine their effect on the scattered radiation distribution. A scatter correction technique was developed in which the MC predicted scatter distribution is subtracted from the projections prior to reconstruction. Preliminary testing of the procedure was done with an anthropomorphic head phantom and a contrast phantom. Contrast and profile measurements were obtained for the scatter corrected and noncorrected images. An improvement of 3% for contrast between solid water and a liver insert and 11% between solid water and a Teflon insert were obtained and a significant reduction in cupping and streaking artifacts was observed.

Algorithms↗

PubMed2005

Prostate gland motion assessed with cine-magnetic resonance imaging (cine-MRI).

PURPOSE: To quantify prostate motion during a radiation therapy treatment using cine-magnetic resonance imaging (cine-MRI) for time frames comparable to that expected in an image-guided radiation therapy treatment session (20-30 min). MATERIALS AND METHODS: Six patients undergoing radiation therapy for prostate cancer were imaged on 3 days, over the course of therapy (Weeks 1, 3, and 5). Four hundred images were acquired during the 1-h MRI session in 3 sagittal planes through the prostate at 6-s intervals. Eleven anatomic points of interest (POIs) have been used to characterize prostate/bony pelvis/abdominal wall displacement. Motion traces and standard deviation for each of the 11 POIs have been determined. The probability of displacement over time has also been calculated. RESULTS: Patients were divided into 2 groups according to rectal filling status: full vs. empty rectum. The displacement of POIs (standard deviation) ranged from 0.98 to 1.72 mm for the full-rectum group and from 0.68 to 1.04 mm for the empty-rectum group. The low standard deviations in position (2 mm or less) would suggest that these excursions have a low frequency of occurrence. The most sensitive prostate POI to rectal wall motion was the mid-posterior with a standard deviation of 1.72 mm in the full-rectum group vs. 0.79 mm in the empty-rectum group (p = 0.0001). This POI has a 10% probability of moving more than 3 mm in a time frame of approximately 1 min if the rectum is full vs. approximately 20 min if the rectum is empty. CONCLUSION: Motion of the prostate and seminal vesicles during a time frame similar to a standard treatment session is reduced compared to that reported in interfraction studies. The most significant predictor for intrafraction prostate motion is the status of rectal filling. A prostate displacement of <3 mm (90%) can be expected for the 20 min after the moment of initial imaging for patients with an empty rectum. This is not the case for patients presenting with full rectum. The determination of appropriate intrafraction margins in radiation therapy to accommodate the time-dependent uncertainty in positional targeting is a topic of ongoing investigations for the on-line image guidance model.

Humans↗

PubMed2005

Cone-beam-CT guided radiation therapy: technical implementation.

BACKGROUND AND PURPOSE: X-ray volumetric imaging system (XVI) mounted on a linear accelerator is available for image guidance applications. In preparation for clinical implementation, phantom and patient imaging studies were conducted to determine the irradiation parameters that would trade-off image quality, patient dose and scanning time. PATIENTS AND METHODS: The XVI image quality and imaging dose were benchmarked against those obtained with a helical CT scanner for a head and body phantom. The irradiation parameters were varied including the total imaging dose, number of projections, field of view, reconstruction resolution and use of a scatter rejection grid. We characterized the image quality based on relative contrast, noise, contrast to noise ratio (CNR) and point spread function (PSF). XVI scans of pelvis, head and neck and lung patients were acquired and submitted to a range of observers to identify the favorable reconstruction parameters. RESULTS: Phantom studies have demonstrated that a scatter rejection grid reduces photon scattering and improves the image uniformity. For the body phantom, the helical CT and the wide field XVI technique produce similar image quality, with surface doses of 0.025 and 0.044 Gy respectively. We have demonstrated that the local tomography technique improves the image contrast and the CNR while reducing the skin dose by 40-50% compared to the wide field technique. Clinical scans of head and neck, lung and prostate patients present good soft tissue contrast and excellent bone definition. CONCLUSIONS: With adjustment of irradiation parameters and an imaging surface dose of less than 0.05 Gy, high quality XVI images can be obtained for a phantom simulating the body thickness. XVI is currently feasible for image-guided treatments of head and neck, torso and pelvic areas using soft tissue and bony structures.

Humans↗

PubMed2005

Accurate technique for complete geometric calibration of cone-beam computed tomography systems.

Cone-beam computed tomography systems have been developed to provide in situ imaging for the purpose of guiding radiation therapy. Clinical systems have been constructed using this approach, a clinical linear accelerator (Elekta Synergy RP) and an iso-centric C-arm. Geometric calibration involves the estimation of a set of parameters that describes the geometry of such systems, and is essential for accurate image reconstruction. We have developed a general analytic algorithm and corresponding calibration phantom for estimating these geometric parameters in cone-beam computed tomography (CT) systems. The performance of the calibration algorithm is evaluated and its application is discussed. The algorithm makes use of a calibration phantom to estimate the geometric parameters of the system. The phantom consists of 24 steel ball bearings (BBs) in a known geometry. Twelve BBs are spaced evenly at 30 deg in two plane-parallel circles separated by a given distance along the tube axis. The detector (e.g., a flat panel detector) is assumed to have no spatial distortion. The method estimates geometric parameters including the position of the x-ray source, position, and rotation of the detector, and gantry angle, and can describe complex source-detector trajectories. The accuracy and sensitivity of the calibration algorithm was analyzed. The calibration algorithm estimates geometric parameters in a high level of accuracy such that the quality of CT reconstruction is not degraded by the error of estimation. Sensitivity analysis shows uncertainty of 0.01 degrees (around beam direction) to 0.3 degrees (normal to the beam direction) in rotation, and 0.2 mm (orthogonal to the beam direction) to 4.9 mm (beam direction) in position for the medical linear accelerator geometry. Experimental measurements using a laboratory bench Cone-beam CT system of known geometry demonstrate the sensitivity of the method in detecting small changes in the imaging geometry with an uncertainty of 0.1 mm in transverse and vertical (perpendicular to the beam direction) and 1.0 mm in the longitudinal (beam axis) directions. The calibration algorithm was compared to a previously reported method, which uses one ball bearing at the isocenter of the system, to investigate the impact of more precise calibration on the image quality of cone-beam CT reconstruction. A thin steel wire located inside the calibration phantom was imaged on the conebeam CT lab bench with and without perturbations in source and detector position during the scan. The described calibration method improved the quality of the image and the geometric accuracy of the object reconstructed, improving the full width at half maximum of the wire by 27.5% and increasing contrast of the wire by 52.8%. The proposed method is not limited to the geometric calibration of cone-beam CT systems but can be used for many other systems, which consist of one or more point sources and area detectors such as calibration of megavoltage (MV) treatment system (focal spot movement during the beam delivery, MV source trajectory versus gantry angle, the axis of collimator rotation, and couch motion), cross calibration between Kilovolt imaging and MV treatment system, and cross calibration between multiple imaging systems. Using the complete information of the system geometry, it was demonstrated that high image quality in CT reconstructions is possible even in systems with large geometric nonidealities.

Algorithms↗

PubMed2003

Optical-CT gel-dosimetry I: basic investigations.

Comprehensive verification of the intricate dose distributions associated with advanced radiation treatments is now an immediate and substantial problem. The task is challenging using traditional dosimeters because of restrictions to point measurements (ion chambers, diodes, TLD, etc.) or planar measurements (film). In essence, rapid advances in the technology to deliver radiation treatments have not been paralleled by corresponding advances in the ability to verify these treatments. A potential solution has emerged in the form of water equivalent three dimensional (3D) gel-dosimetry. In this paper we present basic characterization and performance studies of a prototype optical-CT scanning system developed in our laboratory. An analysis of the potential role or scope of gel dosimetry, in relation to other dosimeters, and to verification across the spectrum of therapeutic techniques is also given. The characterization studies enabled the determination of nominal operating conditions for optical-CT scanning. "Finger" phantoms are introduced as a powerful and flexible tool for the investigation of optical-CT performance. The modulation-transfer function (MTF) of the system is determined to be better than 10% out to 1 mm(-1), confirming sub-mm imaging ability. System performance is demonstrated by the acquisition of a 1 x 1 x 1 mm3 dataset through the dose distribution delivered by an x-ray lens that focuses x rays in the energy range 40-80 KeV. This 3D measurement would be extremely difficult to achieve with other dosimetry techniques and highlights some of the strengths of gel dosimetry. Finally, an optical Monte Carlo model is introduced and shown to have potential to model light transport through gel-dosimetry systems, and to provide a tool for the study and optimization of optical-CT gel dosimetry. The model utilizes Mie scattering theory and requires knowledge of the variation of the particle size distribution with dose. The latter was determined here using the technique of dynamic-light-scattering.

Algorithms↗

PubMed2002

Flat-panel cone-beam computed tomography for image-guided radiation therapy.

PURPOSE: Geometric uncertainties in the process of radiation planning and delivery constrain dose escalation and induce normal tissue complications. An imaging system has been developed to generate high-resolution, soft-tissue images of the patient at the time of treatment for the purpose of guiding therapy and reducing such uncertainties. The performance of the imaging system is evaluated and the application to image-guided radiation therapy is discussed. METHODS AND MATERIALS: A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography (CT) has been integrated with a medical linear accelerator. Kilovoltage X-rays are generated by a conventional X-ray tube mounted on a retractable arm at 90 degrees to the treatment source. A 41 x 41 cm(2) flat-panel X-ray detector is mounted opposite the kV tube. The entire imaging system operates under computer control, with a single application providing calibration, image acquisition, processing, and cone-beam CT reconstruction. Cone-beam CT imaging involves acquiring multiple kV radiographs as the gantry rotates through 360 degrees of rotation. A filtered back-projection algorithm is employed to reconstruct the volumetric images. Geometric nonidealities in the rotation of the gantry system are measured and corrected during reconstruction. Qualitative evaluation of imaging performance is performed using an anthropomorphic head phantom and a coronal contrast phantom. The influence of geometric nonidealities is examined. RESULTS: Images of the head phantom were acquired and illustrate the submillimeter spatial resolution that is achieved with the cone-beam approach. High-resolution sagittal and coronal views demonstrate nearly isotropic spatial resolution. Flex corrections on the order of 0.2 cm were required to compensate gravity-induced flex in the support arms of the source and detector, as well as slight axial movements of the entire gantry structure. Images reconstructed without flex correction suffered from loss of detail, misregistration, and streak artifacts. Reconstructions of the contrast phantom demonstrate the soft-tissue imaging capability of the system. A contrast of 47 Hounsfield units was easily detected in a 0.1-cm-thick reconstruction for an imaging exposure of 1.2 R (in-air, in absence of phantom). The comparison with a conventional CT scan of the phantom further demonstrates the spatial resolution advantages of the cone-beam CT approach. CONCLUSIONS: A kV cone-beam CT imaging system based on a large-area, flat-panel detector has been successfully adapted to a medical linear accelerator. The system is capable of producing images of soft tissue with excellent spatial resolution at acceptable imaging doses. Integration of this technology with the medical accelerator will result in an ideal platform for high-precision, image-guided radiation therapy.

Algorithms↗