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.

Post-mortem tissue sampling using computed tomography guidance

PURPOSE: Currently, in forensic medicine cross-sectional imaging gains recognition and a wide use as a non-invasive examination approach. Today, computed tomography (CT) or magnetic resonance imaging that are available for patients are unable to provide tissue information on the cellular level in a non-invasive manner and also diatom detection, DNA, bacteriological, chemical toxicological and other specific tissue analyses are impossible using radiology. We hypothesised that post-mortem minimally invasive tissue sampling using needle biopsies under CT guidance might significantly enhance the potential of virtual autopsy. The purpose of this study was to test the use of a clinically approved biopsy needle for minimally invasive post-mortem sampling of tissue specimens under CT guidance. MATERIAL AND METHODS: ACN III biopsy core needles 14 gauge x 160 mm with automatic pistol device were used on three bodies dedicated to research from the local anatomical institute. Tissue probes from the brain, heart, lung, liver, spleen, kidney and muscle tissue were obtained under CT fluoroscopy. RESULTS: CT fluoroscopy enabled accurate placement of the needle within the organs and tissues. The needles allowed for sampling of tissue probes with a mean width of 1.7 mm (range 1.2-2 mm) and the maximal length of 20 mm at all locations. The obtained tissue specimens were of sufficient size and adequate quality for histological analysis. CONCLUSION: Our results indicate that, similar to the clinical experience but in many more organs, the tissue specimens obtained using the clinically approved biopsy needle are of a sufficient size and adequate quality for a histological examination. We suggest that post-mortem biopsy using the ACN III needle under CT guidance may become a reliable method for targeted sampling of tissue probes of the body.

Micro-FEM models based on micro-CT reconstructions for the in vitro characterization of the elastic properties of trabecular bone tissue.

This master’s thesis describes the research done at the Medical Technology Laboratory (LTM) of the Rizzoli Orthopedic Institute (IOR, Bologna, Italy), which focused on the characterization of the elastic properties of the trabecular bone tissue, starting from october 2012 to present. The approach uses computed microtomography to characterize the architecture of trabecular bone specimens. With the information obtained from the scanner, specimen-specific models of trabecular bone are generated for the solution with the Finite Element Method (FEM). Along with the FEM modelling, mechanical tests are performed over the same reconstructed bone portions. From the linear-elastic stage of mechanical tests presented by experimental results, it is possible to estimate the mechanical properties of the trabecular bone tissue. After a brief introduction on the biomechanics of the trabecular bone (chapter 1) and on the characterization of the mechanics of its tissue using FEM models (chapter 2), the reliability analysis of an experimental procedure is explained (chapter 3), based on the high-scalable numerical solver ParFE. In chapter 4, the sensitivity analyses on two different parameters for micro-FEM model’s reconstruction are presented. Once the reliability of the modeling strategy has been shown, a recent layout for experimental test, developed in LTM, is presented (chapter 5). Moreover, the results of the application of the new layout are discussed, with a stress on the difficulties connected to it and observed during the tests. Finally, a prototype experimental layout for the measure of deformations in trabecular bone specimens is presented (chapter 6). This procedure is based on the Digital Image Correlation method and is currently under development in LTM.

Analysis of cone-beam ct dose in image-guided radiation therapy for brain and prostate cancer patients via gpu-based Monte Carlo simulations

La radioterapia guidata da immagini (IGRT), grazie alle ripetute verifiche della posizione del paziente e della localizzazione del volume bersaglio, si è recentemente affermata come nuovo paradigma nella radioterapia, avendo migliorato radicalmente l’accuratezza nella somministrazione di dose a scopo terapeutico. Una promettente tecnica nel campo dell’IGRT è rappresentata dalla tomografia computerizzata a fascio conico (CBCT). La CBCT a kilovoltaggio, consente di fornire un’accurata mappatura tridimensionale dell’anatomia del paziente, in fase di pianificazione del trattamento e a ogni frazione del medisimo. Tuttavia, la dose da imaging attribuibile alle ripetute scansioni è diventata, negli ultimi anni, oggetto di una crescente preoccupazione nel contesto clinico. Lo scopo di questo lavoro è di valutare quantitativamente la dose addizionale somministrata da CBCT a kilovoltaggio, con riferimento a tre tipici protocolli di scansione per Varian OnBoard Imaging Systems (OBI, Palo Alto, California). A questo scopo sono state condotte simulazioni con codici Monte Carlo per il calcolo della dose, utilizzando il pacchetto gCTD, sviluppato sull’architettura della scheda grafica. L’utilizzo della GPU per sistemi server di calcolo ha permesso di raggiungere alte efficienze computazionali, accelerando le simulazioni Monte Carlo fino a raggiungere tempi di calcolo di ~1 min per un caso tipico. Inizialmente sono state condotte misure sperimentali di dose su un fantoccio d’acqua. I parametri necessari per la modellazione della sorgente di raggi X nel codice gCTD sono stati ottenuti attraverso un processo di validazione del codice al fine di accordare i valori di dose simulati in acqua con le misure nel fantoccio. Lo studio si concentra su cinquanta pazienti sottoposti a cicli di radioterapia a intensità modulata (IMRT). Venticinque pazienti con tumore al cervello sono utilizzati per studiare la dose nel protocollo standard-dose head e venticinque pazienti con tumore alla prostata sono selezionati per studiare la dose nei protocolli pelvis e pelvis spotlight. La dose media a ogni organo è calcolata. La dose media al 2% dei voxels con i valori più alti di dose è inoltre computata per ogni organo, al fine di caratterizzare l’omogeneità spaziale della distribuzione.

Detection of cavitated approximal surfaces using cone beam CT and intraoral receptors

Objectives: The aim of this study was to compare cone beam CT (CBCT) in a small field of view (FOV) with a solid-state sensor and a photostimulable phosphor plate system for detection of cavitated approximal surfaces. Methods: 257 non-filled approximal surfaces from human permanent premolars and molars were recorded by two intraoral digital receptors, a storage phosphor plate (Digora Optime, Soredex) and a solid-state CMOS sensor (Digora Toto, Soredex), and scanned in a cone beam CT unit (3D Accuitomo FPD80, Morita) with a FOV of 4 cm and a voxel size of 0.08 mm. Image sections were carried out in the axial and mesiodistal tooth planes. Six observers recorded surface cavitation in all images. Validation of the true absence or presence of surface cavitation was performed by inspecting the surfaces under strong light with the naked eye. Differences in sensitivity, specificity and agreement were estimated by analysing the binary data in a generalized linear model using an identity link function. Results: A significantly higher sensitivity was obtained by all observers with CBCT (p,0.001), which was not compromised by a lower specificity. Therefore, a significantly higher overall agreement was obtained with CBCT (p,0.001). There were no significant differences between the Digora Optime phosphor plate system and the Digora Toto CMOS sensor for any parameter. Conclusions: CBCT was much more accurate in the detection of surface cavitation in approximal surfaces than intraoral receptors. The differences are interpreted as clinically significant. A CBCT examination performed for other reasons should also be assessed for approximal surface cavities in teeth without restorations. © 2013 The British Institute of Radiology.

Influence of anatomical location on CT numbers in cone beam computed tomography

Objective: To assess the influence of anatomical location on computed tomography (CT) numbers in mid- and full field of view (FOV) cone beam computed tomography (CBCT) scans. Study Design: Polypropylene tubes with varying concentrations of dipotassium hydrogen phosphate (K2HPO4) solutions (50-1200 mg/mL) were imaged within the incisor, premolar, and molar dental sockets of a human skull phantom. CBCT scans were acquired using the NewTom 3G and NewTom 5G units. The CT numbers of the K2HPO 4 phantoms were measured, and the relationship between CT numbers and K2HPO4 concentration was examined. The measured CT numbers of the K2HPO4 phantoms were compared between anatomical sites. Results: At all six anatomical locations, there was a strong linear relationship between CT numbers and K2HPO4 concentration (R 2 > 0.93). However, the absolute CT numbers varied considerably with the anatomical location. Conclusion: The relationship between CT numbers and object density is not uniform through the dental arch on CBCT scans. © 2013 Elsevier Inc.

Assessment of CT numbers in limited and medium field-of-view scans taken using Accuitomo 170 and Veraviewepocs 3De cone-beam computed tomography scanners

To assess the influence of anatomic location on the relationship between computed tomography (CT) number and X-ray attenuation in limited and medium field-of-view (FOV) scans. Materials and Methods Tubes containing solutions with different concentrations of K2HPO4 were placed in the tooth sockets of a human head phantom. Cone-beam computed tomography (CBCT) scans were acquired, and CT numbers of the K2HPO4 solutions were measured. The relationship between CT number and K2HPO4 concentration was examined by linear regression analyses. Then, the variation in CT number according to anatomic location was examined. Results The relationship between K2HPO4 concentration and CT number was strongly linear. The slopes of the linear regressions for the limited FOVs were almost 2-fold lower than those for the medium FOVs. The absolute CT number differed between imaging protocols and anatomic locations. Conclusion There is a strong linear relationship between X-ray attenuation and CT number. The specific imaging protocol and anatomic location of the object strongly influence this relationship.

Dacryocystography using cone beam CT in patients with lacrimal drainage system obstruction.

PURPOSE To assess the usefulness of cone beam CT (CBCT) for dacryocystography (DCG) using either direct syringing or passive application of contrast medium. METHODS Ten consecutive patients with epiphora who had CBCT-DCG in a sitting position were retrospectively analyzed. CBCT-DCGs were performed using 2 techniques: direct syringing with contrast medium or using the passive technique, where patients received 3 drops of contrast medium into the conjunctival sac before CBCT-DCG. Clinical and radiologic diagnoses were compared for both groups. RESULTS The 10 patients (men = 3) had a mean age of 63.2 years. Both techniques proved to be simple procedures with good delineation of the bone, soft tissue, and the contrast medium in the lacrimal system. No side effects were noted. CONCLUSIONS CBCT-DCG is a useful alternative to determine the localization of stenosis in patients with chronic epiphora.

Validação do uso de cone-beam computed tomography de kilovoltagem de um LINAC para a realização de estudos dosimétricos

Mestrado em Radioterapia

Prevalence of apical periodontitis detected in cone beam CT images of a Brazilian subpopulation

Objectives The aim of this study was to determine the prevalence of apical periodontitis (AP) detected in cone beam CT (CBCT) images from a database. Methods CBCT images of 300 Brazilian patients were assessed. AP images were measured in three dimensions. Age, gender, number and location of total teeth in each patient were considered. AP location was considered according to tooth groups. The extent of AP was determined by the largest diameter in any of the three dimensions. Percentages and the X2 test were used for statistical analysis. Results AP was found in 51.4% of the patients and in 3.4% of the teeth. Higher prevalence of AP was found in 60- to 69-year-olds (73.1%) and in mandibular molars (5.9%) (p < 0.05). Inadequate endodontic treatment presented higher prevalence of AP (78.1%). Conclusions AP can be frequently found in CBCT examinations. The presence of AP has a significant association with patients' age, and tooth type and condition. CBCT databases are useful for cross-sectional studies about AP prevalence in a population.

Sviluppo di un metodo di radioterapia adattativa tramite immagini portali e Cone-Beam CT

Il presente lavoro, svolto presso il servizio di Fisica Sanitaria dell’Azienda Ospedaliera Universitaria di Parma, consiste nello sviluppo di un metodo innovativo di radioterapia adattativa. Il metodo è stato applicato a pazienti affetti da varie patologie, trattati con tecnica VMAT, (Volumetric Modulated Arc Therapy), altamente conformata al target. Il metodo sviluppato si compone di due fasi: nella prima fase vengono effettuate due analisi su immagini portali, di ricostruzione della dose all'isocentro e l'analisi gamma 2D. Se almeno una di queste fallisce, si interviene con la seconda fase, che vede l'acquisizione della CBCT del paziente e la taratura in densità elettronica della stessa. Si calcola dunque il piano su CBCT, previa operazione di contouring da parte del medico e, infine, si esegue l'analisi gamma 3D sulle matrici di dose calcolate sulla CT e sulla CBCT del paziente, quantificando gli indici gamma sulle strutture PTV, CTV e OAR di interesse clinico. In base ai risultati, se necessario, si può intervenire sul piano di trattamento. Le analisi gamma 2D e 3D sono state svolte avvalendosi di un software toolkit chiamato GADD-23 (Gamma Analysis on 2D and 3D Dose Distributions) implementato e sviluppato appositamente in ambiente Matlab per questo lavoro di tesi; in particolare, la realizzazione di GADD-23 è stata resa possibile grazie all'interazione con due software di tipo open-source, Elastix e CERR, specifici per l’elaborazione e la registrazione di immagini mediche. I risultati ottenuti mostrano come il metodo sviluppato sia in grado di mettere in luce cambiamenti anatomici che alcuni pazienti hanno subìto, di tipo sistematico, in cui è possibile prendere in considerazione una ripianificazione del trattamento per correggerli, o di tipo casuale, sui quali può essere utile condurre l'attenzione del medico radioterapista, sebbene non sia necessario un replanning.

A virtual source model for kilo-voltage cone beam CT: source characteristics and model validation

The purpose of this investigation was to study the source characteristics of a clinical kilo-voltage cone beam CT unit and to develop and validate a virtual source model that could be used for treatment planning purposes.

A comparison of frontal radiographs obtained from cone beam CT scans and conventional frontal radiographs of human skulls

This study evaluated whether measurements on conventional frontal radiographs are comparable with measurements on cone beam computed tomography (CBCT)-constructed frontal cephalometric radiographs taken from dry human skulls. CBCT scans and conventional frontal cephalometric radiographs were made of 40 dry skulls. With I-Cat Vision((R)) software, a cephalometric radiograph was constructed from the CBCT scan. Standard cephalometric software was used to identify landmarks and calculate ratios and angles. The same operator identified 10 landmarks on both types of cephalometric radiographs on all Images 5 times with a time-interval of 1 week. Intra-observer reliability was acceptable for all measurements. The reproducibility of the measurements on the frontal radiographs obtained from the CBCT scans was higher than those on conventional frontal radiographs. There is a statistically significant and clinically relevant difference between measurements on conventional and constructed frontal radiographs. There is a clinically relevant difference between angular measurements performed on conventional frontal cephalometric radiographs, compared with measurements on frontal cephalometric radiographs constructed from CBCT scans, owing to different positioning of patients in both devices. Positioning of the patient in the CBCT device appears to be an important factor in cases where a 2D projection of the 3D scan is made.

Design and Optimization of Four-dimensional Cone-beam Computed Tomography in Image-guided Radiation Therapy

The influence of respiratory motion on patient anatomy poses a challenge to accurate radiation therapy, especially in lung cancer treatment. Modern radiation therapy planning uses models of tumor respiratory motion to account for target motion in targeting. The tumor motion model can be verified on a per-treatment session basis with four-dimensional cone-beam computed tomography (4D-CBCT), which acquires an image set of the dynamic target throughout the respiratory cycle during the therapy session. 4D-CBCT is undersampled if the scan time is too short. However, short scan time is desirable in clinical practice to reduce patient setup time. This dissertation presents the design and optimization of 4D-CBCT to reduce the impact of undersampling artifacts with short scan times. This work measures the impact of undersampling artifacts on the accuracy of target motion measurement under different sampling conditions and for various object sizes and motions. The results provide a minimum scan time such that the target tracking error is less than a specified tolerance. This work also presents new image reconstruction algorithms for reducing undersampling artifacts in undersampled datasets by taking advantage of the assumption that the relevant motion of interest is contained within a volume-of-interest (VOI). It is shown that the VOI-based reconstruction provides more accurate image intensity than standard reconstruction. The VOI-based reconstruction produced 43% fewer least-squares error inside the VOI and 84% fewer error throughout the image in a study designed to simulate target motion. The VOI-based reconstruction approach can reduce acquisition time and improve image quality in 4D-CBCT.