Prediction of Trabecular Bone Anisotropy from Quantitative Computed Tomography using Supervised Learning and a Novel Morphometric Feature Descriptor

Patient-specific biomechanical models including local bone mineral density and anisotropy have gained importance for assessing musculoskeletal disorders. However the trabecular bone anisotropy captured by high-resolution imaging is only available at the peripheral skeleton in clinical practice. In this work, we propose a supervised learning approach to predict trabecular bone anisotropy that builds on a novel set of pose invariant feature descriptors. The statistical relationship between trabecular bone anisotropy and feature descriptors were learned from a database of pairs of high resolution QCT and clinical QCT reconstructions. On a set of leave-one-out experiments, we compared the accuracy of the proposed approach to previous ones, and report a mean prediction error of 6% for the tensor norm, 6% for the degree of anisotropy and 19◦ for the principal tensor direction. These findings show the potential of the proposed approach to predict trabecular bone anisotropy from clinically available QCT images.

Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability

AIMS Transcatheter mitral valve replacement (TMVR) is an emerging technology with the potential to treat patients with severe mitral regurgitation at excessive risk for surgical mitral valve surgery. Multimodal imaging of the mitral valvular complex and surrounding structures will be an important component for patient selection for TMVR. Our aim was to describe and evaluate a systematic multi-slice computed tomography (MSCT) image analysis methodology that provides measurements relevant for transcatheter mitral valve replacement. METHODS AND RESULTS A systematic step-by-step measurement methodology is described for structures of the mitral valvular complex including: the mitral valve annulus, left ventricle, left atrium, papillary muscles and left ventricular outflow tract. To evaluate reproducibility, two observers applied this methodology to a retrospective series of 49 cardiac MSCT scans in patients with heart failure and significant mitral regurgitation. For each of 25 geometrical metrics, we evaluated inter-observer difference and intra-class correlation. The inter-observer difference was below 10% and the intra-class correlation was above 0.81 for measurements of critical importance in the sizing of TMVR devices: the mitral valve annulus diameters, area, perimeter, the inter-trigone distance, and the aorto-mitral angle. CONCLUSIONS MSCT can provide measurements that are important for patient selection and sizing of TMVR devices. These measurements have excellent inter-observer reproducibility in patients with functional mitral regurgitation.

Impact of Hybrid Iterative Reconstruction on Agatston Coronary Artery Calcium Scores in Comparison to Filtered Back Projection in Native Cardiac CT

PURPOSE To investigate whether the effects of hybrid iterative reconstruction (HIR) on coronary artery calcium (CAC) measurements using the Agatston score lead to changes in assignment of patients to cardiovascular risk groups compared to filtered back projection (FBP). MATERIALS AND METHODS 68 patients (mean age 61.5 years; 48 male; 20 female) underwent prospectively ECG-gated, non-enhanced, cardiac 256-MSCT for coronary calcium scoring. Scanning parameters were as follows: Tube voltage, 120 kV; Mean tube current time-product 63.67 mAs (50 - 150 mAs); collimation, 2 × 128 × 0.625 mm. Images were reconstructed with FBP and with HIR at all levels (L1 to L7). Two independent readers measured Agatston scores of all reconstructions and assigned patients to cardiovascular risk groups. Scores of HIR and FBP reconstructions were correlated (Spearman). Interobserver agreement and variability was assessed with ĸ-statistics and Bland-Altmann-Plots. RESULTS Agatston scores of HIR reconstructions were closely correlated with FBP reconstructions (L1, R = 0.9996; L2, R = 0.9995; L3, R = 0.9991; L4, R = 0.986; L5, R = 0.9986; L6, R = 0.9987; and L7, R = 0.9986). In comparison to FBP, HIR led to reduced Agatston scores between 97 % (L1) and 87.4 % (L7) of the FBP values. Using HIR iterations L1 - L3, all patients were assigned to identical risk groups as after FPB reconstruction. In 5.4 % of patients the risk group after HIR with the maximum iteration level was different from the group after FBP reconstruction. CONCLUSION There was an excellent correlation of Agatston scores after HIR and FBP with identical risk group assignment at levels 1 - 3 for all patients. Hence it appears that the application of HIR in routine calcium scoring does not entail any disadvantages. Thus, future studies are needed to demonstrate whether HIR is a reliable method for reducing radiation dose in coronary calcium scoring.

Regularizing Image Reconstruction for Gradient-Domain Rendering with Feature Patches

We present a novel algorithm to reconstruct high-quality images from sampled pixels and gradients in gradient-domain rendering. Our approach extends screened Poisson reconstruction by adding additional regularization constraints. Our key idea is to exploit local patches in feature images, which contain per-pixels normals, textures, position, etc., to formulate these constraints. We describe a GPU implementation of our approach that runs on the order of seconds on megapixel images. We demonstrate a significant improvement in image quality over screened Poisson reconstruction under the L1 norm. Because we adapt the regularization constraints to the noise level in the input, our algorithm is consistent and converges to the ground truth.

Denoising Your Monte Carlo Renders: Recent Advances in Image Space-Adaptive Sampling and Reconstruction

With the ongoing shift in the computer graphics industry toward Monte Carlo rendering, there is a need for effective, practical noise-reduction techniques that are applicable to a wide range of rendering effects and easily integrated into existing production pipelines. This course surveys recent advances in image-space adaptive sampling and reconstruction algorithms for noise reduction, which have proven very effective at reducing the computational cost of Monte Carlo techniques in practice. These approaches leverage advanced image-filtering techniques with statistical methods for error estimation. They are attractive because they can be integrated easily into conventional Monte Carlo rendering frameworks, they are applicable to most rendering effects, and their computational overhead is modest.

Prospective gated 64 slice computed tomography in assessment of coronary artery disease: A single center experience and relationship of body mass index to outcomes

Coronary artery disease (CAD) is the most common cause of morbidity and mortality in the United States. While Coronary Angiography (CA) is the gold standard test to investigate coronary artery disease, Prospective gated-64 Slice Computed Tomography (Prosp-64CT) is a new non-invasive technology that uses the 64Slice computed tomography (64CT) with electrocardiographic gating to investigate coronary artery disease. The aim of the current study was to investigate the role of Body Mass Index (BMI) as a factor affecting occurrence of CA after a Prosp-64CT, as well as the quality of the Prosp-64CT. Demographic and clinical characteristics of the study population were described. A secondary analysis of data on patients who underwent a Prosp-64CT for evaluation of coronary artery disease was performed. Seventy seven patients who underwent Prosp-64CT for evaluation for coronary artery disease were included. Fifteen patients were excluded because they had missing data regarding BMI, quality of the Prosp-64CT or CA. Thus, a total of 62 patients were included in the final analysis. The mean age was 56.2 years. The mean BMI was 31.3 kg/m 2. Eight (13%) patients underwent a CA within one month of Prosp-64CT. Eight (13%) patients had a poor quality Prosp-64CT. There was significant association of higher BMI as a factor for occurrence of CA post Prosp-64CT (P<0.05). There was a trend, but no statistical significance was observed for the association of being obese and occurrence of CA (P=0.06). BMI, as well as obesity, were not found to be significantly associated with poor quality of Prosp-64CT (P=0.19 and P=0.76, respectively). In conclusion, BMI was significantly associated with occurrence of CA within one month of Prosp-64CT. Thus, in patients with a higher BMI, diagnostic investigation with both tests could be avoided; rather, only a CA could be performed. However, the relationship of BMI to quality of Prosp-64CT needs to be further investigated since the sample size of the current study was small.^

Animation of micro-computed tomography of bioerosion trace Entobia megastoma made by East Australian bioeroding sponge Cliona celata

Endolithic bioerosion is difficult to analyse and to describe, and it usually requires damaging of the sample material. Sponge erosion (Entobia) may be one of the most difficult to evaluate as it is simultaneously macroscopically inhomogeneous and microstructurally intricate. We studied the bioerosion traces of the two Australian sponges Cliona celata Grant, 1826 (sensu Schönberg 2000) and Cliona orientalis Thiele, 1900 with a newly available radiographic technology: high resolution X-ray micro-computed tomography (MCT). MCT allows non-destructive visualisation of live and dead structures in three dimensions and was compared to traditional microscopic methods. MCT and microscopy showed that C. celata bioerosion was more intense in the centre and branched out in the periphery. In contrast, C. orientalis produced a dense, even trace meshwork and caused an overall more intense erosion pattern than C. celata. Extended pioneering filaments were not usually found at the margins of the studied sponge erosion, but branches ended abruptly or tapered to points. Results obtained with MCT were similar in quality to observations from transparent optical spar under the dissecting microscope. Microstructures could not be resolved as well as with e.g. scanning electron microscopy (SEM). Even though sponge scars and sponge chips were easily recognisable on maximum magnification MCT images, they lacked the detail that is available from SEM. Other drawbacks of MCT involve high costs and presently limited access. Even though MCT cannot presently replace traditional techniques such as corrosion casts viewed by SEM, we obtained valuable information. Especially for the possibility to measure endolithic pore volumes, we regard MCT as a very promising tool that will continue to be optimised. A combination of different methods will produce the best results in the study of Entobia.

Technical developments for computed tomography on the CENBG nanobeam line

The use of ion microbeams as probes for computedtomography has proven to be a powerful tool for the three-dimensional characterization of specimens a few tens of micrometers in size. Compared to other types of probes, the main advantage is that quantitative information about mass density and composition can be obtained directly, using specific reconstruction codes. At the Centre d’Etudes Nucléaires de Bordeaux Gradignan (CENBG), this technique was initially developed for applications in cellular biology. However, the observation of the cell ultrastructure requires a sub-micron resolution. The construction of the nanobeamline at the Applications Interdisciplinaires des Faisceaux d’Ions en Region Aquitaine (AIFIRA) irradiation facility has opened new perspectives for such applications. The implementation of computedtomography on the nanobeamline of CENBG has required a careful design of the analysis chamber, especially microscopes for precise sample visualization, and detectors for scanning transmission ion microscopy (STIM) and for particle induced X-ray emission (PIXE). The sample can be precisely positioned in the three directions X, Y, Z and a stepper motor coupled to a goniometer ensures the rotational motion. First images of 3D tomography were obtained on a reference sample containing microspheres of certified diameter, showing the good stability of the beam and the sample stage, and the precision of the motion.

Analysis of the scale effect in different computed tomography systems on the evaluation of bone tissue parameters

Tra le patologie ossee attualmente riconosciute, l’osteoporosi ricopre il ruolo di protagonista data le sua diffusione globale e la multifattorialità delle cause che ne provocano la comparsa. Essa è caratterizzata da una diminuzione quantitativa della massa ossea e da alterazioni qualitative della micro-architettura del tessuto osseo con conseguente aumento della fragilità di quest’ultimo e relativo rischio di frattura. In campo medico-scientifico l’imaging con raggi X, in particolare quello tomografico, da decenni offre un ottimo supporto per la caratterizzazione ossea; nello specifico la microtomografia, definita attualmente come “gold-standard” data la sua elevata risoluzione spaziale, fornisce preziose indicazioni sulla struttura trabecolare e corticale del tessuto. Tuttavia la micro-CT è applicabile solo in-vitro, per cui l’obiettivo di questo lavoro di tesi è quello di verificare se e in che modo una diversa metodica di imaging, quale la cone-beam CT (applicabile invece in-vivo), possa fornire analoghi risultati, pur essendo caratterizzata da risoluzioni spaziali più basse. L’elaborazione delle immagini tomografiche, finalizzata all’analisi dei più importanti parametri morfostrutturali del tessuto osseo, prevede la segmentazione delle stesse con la definizione di una soglia ad hoc. I risultati ottenuti nel corso della tesi, svolta presso il Laboratorio di Tecnologia Medica dell’Istituto Ortopedico Rizzoli di Bologna, mostrano una buona correlazione tra le due metodiche quando si analizzano campioni definiti “ideali”, poiché caratterizzati da piccole porzioni di tessuto osseo di un solo tipo (trabecolare o corticale), incluso in PMMA, e si utilizza una soglia fissa per la segmentazione delle immagini. Diversamente, in casi “reali” (vertebre umane scansionate in aria) la stessa correlazione non è definita e in particolare è da escludere l’utilizzo di una soglia fissa per la segmentazione delle immagini.

Collimation of a D-D Neutron Generator for Clinical Implementation of Neutron Stimulated Emission Computed Tomography: a Monte Carlo Study

This work is an investigation into collimator designs for a deuterium-deuterium (DD) neutron generator for an inexpensive and compact neutron imaging system that can be implemented in a hospital. The envisioned application is for a spectroscopic imaging technique called neutron stimulated emission computed tomography (NSECT).

Previous NSECT studies have been performed using a Van-de-Graaff accelerator at the Triangle Universities Nuclear Laboratory (TUNL) in Duke University. This facility has provided invaluable research into the development of NSECT. To transition the current imaging method into a clinically feasible system, there is a need for a high-intensity fast neutron source that can produce collimated beams. The DD neutron generator from Adelphi Technologies Inc. is being explored as a possible candidate to provide the uncollimated neutrons. This DD generator is a compact source that produces 2.5 MeV fast neutrons with intensities of 1012 n/s (4π). The neutron energy is sufficient to excite most isotopes of interest in the body with the exception of carbon and oxygen. However, a special collimator is needed to collimate the 4π neutron emission into a narrow beam. This work describes the development and evaluation of a series of collimator designs to collimate the DD generator for narrow beams suitable for NSECT imaging.

A neutron collimator made of high-density polyethylene (HDPE) and lead was modeled and simulated using the GEANT4 toolkit. The collimator was designed as a 52 x 52 x 52 cm3 HDPE block coupled with 1 cm lead shielding. Non-tapering (cylindrical) and tapering (conical) opening designs were modeled into the collimator to permit passage of neutrons. The shape, size, and geometry of the aperture were varied to assess the effects on the collimated neutron beam. Parameters varied were: inlet diameter (1-5 cm), outlet diameter (1-5 cm), aperture diameter (0.5-1.5 cm), and aperture placement (13-39 cm). For each combination of collimator parameters, the spatial and energy distributions of neutrons and gammas were tracked and analyzed to determine three performance parameters: neutron beam-width, primary neutron flux, and the output quality. To evaluate these parameters, the simulated neutron beams are then regenerated for a NSECT breast scan. Scan involved a realistic breast lesion implanted into an anthropomorphic female phantom.

This work indicates potential for collimating and shielding a DD neutron generator for use in a clinical NSECT system. The proposed collimator designs produced a well-collimated neutron beam that can be used for NSECT breast imaging. The aperture diameter showed a strong correlation to the beam-width, where the collimated neutron beam-width was about 10% larger than the physical aperture diameter. In addition, a collimator opening consisting of a tapering inlet and cylindrical outlet allowed greater neutron throughput when compared to a simple cylindrical opening. The tapering inlet design can allow additional neutron throughput when the neck is placed farther from the source. On the other hand, the tapering designs also decrease output quality (i.e. increase in stray neutrons outside the primary collimated beam). All collimators are cataloged in measures of beam-width, neutron flux, and output quality. For a particular NSECT application, an optimal choice should be based on the collimator specifications listed in this work.

Machine Learning-based Techniques to Address Spectral Distortions in Photon Counting X-ray Computed Tomography

Spectral CT using a photon counting x-ray detector (PCXD) shows great potential for measuring material composition based on energy dependent x-ray attenuation. Spectral CT is especially suited for imaging with K-edge contrast agents to address the otherwise limited contrast in soft tissues. We have developed a micro-CT system based on a PCXD. This system enables full spectrum CT in which the energy thresholds of the PCXD are swept to sample the full energy spectrum for each detector element and projection angle. Measurements provided by the PCXD, however, are distorted due to undesirable physical eects in the detector and are very noisy due to photon starvation. In this work, we proposed two methods based on machine learning to address the spectral distortion issue and to improve the material decomposition. This rst approach is to model distortions using an articial neural network (ANN) and compensate for the distortion in a statistical reconstruction. The second approach is to directly correct for the distortion in the projections. Both technique can be done as a calibration process where the neural network can be trained using 3D printed phantoms data to learn the distortion model or the correction model of the spectral distortion. This replaces the need for synchrotron measurements required in conventional technique to derive the distortion model parametrically which could be costly and time consuming. The results demonstrate experimental feasibility and potential advantages of ANN-based distortion modeling and correction for more accurate K-edge imaging with a PCXD. Given the computational eciency with which the ANN can be applied to projection data, the proposed scheme can be readily integrated into existing CT reconstruction pipelines.

Influence of intracanal post on apical periodontitis identified by cone-beam computed tomography

The determination of the success of endodontic treatment has been often discussed based on outcome obtained by periapical radiography. The aim of this study was to verify the influence of intracanal post on apical periodontitis detected by cone-beam computed tomography (CBCT). A consecutive sample of 1020 images (periapical radiographs and CBCT scans) taken from 619 patients (245 men; mean age, 50.1 years) between February 2008 and September 2009 were used in this study. Presence and intracanal post length (short, medium and long) were associated with apical periodontitis (AP). Chi-square test was used for statistical analyses. Significance level was set at p<0.01. The kappa value was used to assess examiner variability. From a total of 591 intracanal posts, AP was observed in 15.06%, 18.78% and 7.95% using periapical radiographs, into the different lengths, short, medium and long, respectively (p=0.466). Considering the same posts length it was verified AP in 24.20%, 26.40% and 11.84% observed by CBCT scans, respectively (p=0.154). From a total of 1,020 teeth used in this study, AP was detected in 397 (38.92%) by periapical radiography and in 614 (60.19%) by CBCT scans (p<0.001). The distribution of intracanal posts in different dental groups showed higher prevalence in maxillary anterior teeth (54.79%). Intracanal posts lengths did not influenced AP. AP was detected more frequently when CBCT method was used.

Method for determination of root curvature radius using cone-beam computed tomography images

This article describes and discusses a method to determine root curvature radius by using cone-beam computed tomography (CBCT). The severity of root canal curvature is essential to select instrument and instrumentation technique. The diagnosis and planning of root canal treatment have traditionally been made based on periapical radiography. However, the higher accuracy of CBCT images to identify anatomic and pathologic alterations compared to panoramic and periapical radiographs has been shown to reduce the incidence of false-negative results. In high-resolution images, the measurement of root curvature radius can be obtained by circumcenter. Based on 3 mathematical points determined with the working tools of Planimp® software, it is possible to calculate root curvature radius in both apical and coronal directions. The CBCT-aided method for determination of root curvature radius presented in this article is easy to perform, reproducible and allows a more reliable and predictable endodontic planning, which reflects directly on a more efficacious preparation of curved root canals.

Computed tomography and scintigraphy exams for diagnosis and treatment planning of the condylar osteochondroma: a case report

PURPOSE: To report an uncommon case of osteochondroma affecting the mandibular condyle of a young patient and to illustrate the important contributions of different imaging resources to the diagnosis and treatment planning of this lesion. CASE DESCRIPTION: A 24-year-old female patient with the chief complaint of an increasing facial asymmetry and pain in the left pre-auricular region, revealing a reduced mouth opening, mandibular deviation and posterior cross-bite over a period of 18 months. Panoramic radiography revealed an enlargement of the left condyle, whereas computed tomography (CT) sections and three-dimensional CT showed a well-defined bone growth arising from condylar neck. The scintigraphy exam showed an abnormal osteogenic activity in the left temporomandibular joint. The condyle was surgically removed and after 18 months follow-up the panoramic radiography and CT scans showed no signs of recurrence. CONCLUSION: Although osteochondroma is a benign bone tumor that rarely arises in cranial and maxillofacial region, it should be considered in the differential diagnosis of slow-growing masses of the temporomandibular area and the use of different imaging exams significantly contribute to the correct diagnosis and treatment planning of this pathological condition.

Decision theory applied to image quality control in radiology

Background: The present work aims at the application of the decision theory to radiological image quality control ( QC) in diagnostic routine. The main problem addressed in the framework of decision theory is to accept or reject a film lot of a radiology service. The probability of each decision of a determined set of variables was obtained from the selected films. Methods: Based on a radiology service routine a decision probability function was determined for each considered group of combination characteristics. These characteristics were related to the film quality control. These parameters were also framed in a set of 8 possibilities, resulting in 256 possible decision rules. In order to determine a general utility application function to access the decision risk, we have used a simple unique parameter called r. The payoffs chosen were: diagnostic's result (correct/incorrect), cost (high/low), and patient satisfaction (yes/no) resulting in eight possible combinations. Results: Depending on the value of r, more or less risk will occur related to the decision-making. The utility function was evaluated in order to determine the probability of a decision. The decision was made with patients or administrators' opinions from a radiology service center. Conclusion: The model is a formal quantitative approach to make a decision related to the medical imaging quality, providing an instrument to discriminate what is really necessary to accept or reject a film or a film lot. The method presented herein can help to access the risk level of an incorrect radiological diagnosis decision.