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Background Purpose Methods Results Conclusions Transbronchial needle biopsy is crucial for diagnosing lung cancer, yet its efficacy depends on accurately localizing the target lesion and biopsy needle. Digital tomosynthesis (DTS) is considered a promising imaging modality for guiding bronchoscopy procedures due to its low radiation dose and small footprint relative to cone‐beam computed tomography (CBCT). However, the image quality of DTS is still not sufficient for an accurate guidance, mainly due to its limited‐angle acquisition.Preoperative computed tomography (CT) scans are often performed prior to bronchoscopy interventions for diagnosis or to plan the procedure. The CT images are of high quality and are characterized by a high spatial resolution compared to intraoperative DTS images. These patient‐specific prior CT images and the intraoperative DTS images share a fair amount of anatomical information. The main differences only stem from patient positioning and respiratory motion. When these differences are addressed properly, prior CT images augment intraoperative DTS image reconstruction with strong prior knowledge and potentially enhance DTS image quality.We propose in this work a prior‐aided DTS image reconstruction technique leveraging prior CT images to improve DTS image quality. This technique is based on a recently published deformable CT‐to‐DTS image registration algorithm which is customized for bronchoscopy interventions. The main idea is to register a prior CT image to an intermediate DTS image reconstructed using the standard iterative algebraic reconstruction technique (ART), then to re‐reconstruct the DTS image using ART and the registered prior CT image as a first estimation.The proposed prior‐aided reconstruction method was tested on a physical phantom and six patient bronchoscopy datasets. Real DTS data acquired with a pseudo‐linear (PL) scan geometry and simulated DTS data generated according to a spherical ellipse (SE) scan geometry were considered. Results evaluated qualitatively by visual inspection and quantitatively by computing Pearson's correlation (PC) with respect to the reference CBCT images suggest significant improvements in image quality using the prior‐aided DTS reconstruction compared to the standard zero‐initialized ART reconstruction. PC coefficients of the six patient datasets were on average 0.64±0.13$0.64\pm 0.13$ and 0.55±0.13$0.55\pm 0.13$ using a zero‐initialized ART reconstruction with SE data and PL data, respectively, and 0.82±0.09$0.82\pm 0.09$ and 0.72±0.09$0.72\pm 0.09$ using the proposed prior‐aided reconstruction with SE data and PL data, respectively.While the initial estimation in iterative reconstruction algorithms is often overlooked, we proved that initial estimation is of critical importance in DTS image reconstruction and we have demonstrated the profound advantages of integrating prior CT images in intraoperative DTS image reconstruction. CT‐augmented DTS offers a viable alternative to CBCT in guiding bronchoscopy interventions at a fraction of the radiation dose. Further clinical studies are needed to validate improved diagnostic yield. [ABSTRACT FROM AUTHOR]

Purpose: We have developed a clinically viable method for measurement of direct, patient‐specific intravertebral displacements using a novel digital tomosynthesis based digital volume correlation technique. These displacements may be used to calculate vertebral stiffness under loads induced by a patient's body weight; this is particularly significant because, among biomechanical variables, stiffness is the strongest correlate of bone strength. In this proof of concept study, we assessed the feasibility of the method through a preliminary evaluation of the accuracy and precision of the method, identification of a range of physiological load levels for which displacements are measurable, assessment of the relationship of measured displacements with microcomputed tomography based standards, and demonstration of the in vivo application of the technique. Methods: Five cadaveric T11 vertebrae were allocated to three groups in order to study (a) the optimization of digital volume correlation algorithm input parameters, (b) accuracy and precision of the method and the ability to measure displacements at a range of physiological load levels, and (c) the correlation between displacements measured using tomosynthesis based digital volume correlation vs. high resolution microcomputed tomography based digital volume correlation and large scale finite element models. Tomosynthesis images of one patient (Female, 60 yr old) were used to calculate displacement maps, and in turn stiffness, using images acquired in both standing and standing‐with‐weight (8 kg) configurations. Results: We found that displacements were accurate (2.28 µm total error) and measurable at physiological load levels (above 267 N) with a linear response to applied load. Calculated stiffness among three tested vertebral bodies was within an acceptable range relative to reported values for vertebral stiffness (5651‐13260 N/mm). Displacements were in good qualitative and quantitative agreement with both microcomputed tomography based finite element (r2 = 0.762, P < 0.001) and digital volume correlation (r2 = 0.799, P < 0.001) solutions. For one patient tested twice, once standing and once holding weights, results demonstrated excellent qualitative reproducibility of displacement distributions with superior endplate displacements increasing by 22% with added weight. Conclusions: The results of this work collectively suggest the feasibility of the method for in vivo measurement of intravertebral displacements and stiffness in humans. These findings suggest that digital volume correlation using digital tomosynthesis imaging may be useful in understanding the mechanical response of bone to disease and may further enhance our ability to assess fracture risk and treatment efficacy for the spine. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to characterize a new generation stationary digital breast tomosynthesis system with higher tube flux and increased angular span over a first generation system. Methods The linear CNT x-ray source was designed, built, and evaluated to determine its performance parameters. The second generation system was then constructed using the CNT x-ray source and a Hologic gantry. Upon construction, test objects and phantoms were used to characterize system resolution as measured by the modulation transfer function ( MTF), and artifact spread function ( ASF). Results The results indicated that the linear CNT x-ray source was capable of stable operation at a tube potential of 49 kVp, and measured focal spot sizes showed source-to-source consistency with a nominal focal spot size of 1.1 mm. After construction, the second generation (Gen 2) system exhibited entrance surface air kerma rates two times greater the previous s- DBT system. System in-plane resolution as measured by the MTF is 7.7 cycles/mm, compared to 6.7 cycles/mm for the Gen 1 system. As expected, an increase in the z-axis depth resolution was observed, with a decrease in the ASF from 4.30 mm to 2.35 mm moving from the Gen 1 system to the Gen 2 system as result of an increased angular span. Conclusions The results indicate that the Gen 2 stationary digital breast tomosynthesis system, which has a larger angular span, increased entrance surface air kerma, and faster image acquisition time over the Gen 1 s- DBT system, results in higher resolution images. With the detector operating at full resolution, the Gen 2 s- DBT system can achieve an in-plane resolution of 7.7 cycles per mm, which is better than the current commercial DBT systems today, and may potentially result in better patient diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Digital tomosynthesis (DTS) has been shown to be useful for reducing the overlapping of abnormalities with anatomical structures at various depth levels along the posterior-anterior (PA) direction in chest radiography. However, DTS provides crude three-dimensional (3D) images that have poor resolution in the lateral view and can only be displayed with reasonable quality in the PA view. Furthermore, the spillover of high-contrast objects from off-fulcrum planes generates artifacts that may impede the diagnostic use of the DTS images. In this paper, the authors describe and demonstrate the use of a dual-view DTS technique to improve the accuracy of the reconstructed volume image data for more accurate rendition of the anatomy and slice images with improved resolution and reduced artifacts, thus allowing the 3D image data to be viewed in views other than the PA view. Methods: With the dual-view DTS technique, limited angle scans are performed and projection images are acquired in two orthogonal views: PA and lateral. The dual-view projection data are used together to reconstruct 3D images using the maximum likelihood expectation maximization iterative algorithm. In this study, projection images were simulated or experimentally acquired over 360? using the scanning geometry for cone beam computed tomography (CBCT). While all projections were used to reconstruct CBCT images, selected projections were extracted and used to reconstruct single- and dual-view DTS images for comparison with the CBCT images. For realistic demonstration and comparison, a digital chest phantom derived from clinical CT images was used for the simulation study. An anthropomorphic chest phantom was imaged for the experimental study. The resultant dual-view DTS images were visually compared with the single-view DTS images and CBCT images for the presence of image artifacts and accuracy of CT numbers and anatomy and quantitatively compared with root-mean-square-deviation (RMSD) values computed using the digital chest phantom or the CBCT images as the reference in the simulation and experimental study, respectively. High-contrast wires with vertical, oblique, and horizontal orientations in a PA view plane were also imaged to investigate the spatial resolutions and how the wire signals spread in the PA view and lateral view slice images. Results: Both the digital phantom images (simulated) and the anthropomorphic phantom images (experimentally generated) demonstrated that the dual-view DTS technique resulted in improved spatial resolution in the depth (PA) direction, more accurate representation of the anatomy, and significantly reduced artifacts. The RMSD values corroborate well with visual observations with substantially lower RMSD values measured for the dual-view DTS images as compared to those measured for the single-view DTS images. The imaging experiment with the high-contrast wires shows that while the vertical and oblique wires could be resolved in the lateral view in both singleand dual-view DTS images, the horizontal wire could only be resolved in the dual-view DTS images. This indicates that with single-view DTS, the wire signals spread liberally to off-fulcrum planes and generated wire shadow there. Results: Both the digital phantom images (simulated) and the anthropomorphic phantom images (experimentally generated) demonstrated that the dual-view DTS technique resulted in improved spatial resolution in the depth (PA) direction, more accurate representation of the anatomy, and significantly reduced artifacts. The RMSD values corroborate well with visual observations with substantially lower RMSD values measured for the dual-view DTS images as compared to those measured for the single-view DTS images. The imaging experiment with the high-contrast wires shows that while the vertical and oblique wires could be resolved in the lateral view in both singleand dual-view DTS images, the horizontal wire could only be resolved in the dual-view DTS images. This indicates that with single-view DTS, the wire signals spread liberally to off-fulcrum planes and generated wire shadow there. [ABSTRACT FROM AUTHOR]

Purpose: This paper concerns the feasibility of x-ray differential phase contrast (DPC) tomosynthesis imaging using a grating-based DPC benchtop experimental system, which is equipped with a commercial digital flat-panel detector and a medical-grade rotating-anode x-ray tube. An extensive system characterization was performed to quantify its imaging performance. Methods: The major components of the benchtop system include a diagnostic x-ray tube with a 1.0 mm nominal focal spot size, a flat-panel detector with 96 μm pixel pitch, a sample stage that rotates within a limited angular span of ±30°, and a Talbot-Lau interferometer with three x-ray gratings. A total of 21 projection views acquired with 3° increments were used to reconstruct three sets of tomosynthetic image volumes, including the conventional absorption contrast tomosynthesis image volume (AC-tomo) reconstructed using the filtered-backprojection (FBP) algorithm with the ramp kernel, the phase contrast tomosynthesis image volume (PC-tomo) reconstructed using FBP with a Hilbert kernel, and the differential phase contrast tomosynthesis image volume (DPC-tomo) reconstructed using the shift-and-add algorithm. Three inhouse physical phantoms containing tissue-surrogate materials were used to characterize the signal linearity, the signal difference-to-noise ratio (SDNR), the three-dimensional noise power spectrum (3D NPS), and the through-plane artifact spread function (ASF). Results: While DPC-tomo highlights edges and interfaces in the image object, PC-tomo removes the differential nature of the DPC projection data and its pixel values are linearly related to the decrement of the real part of the x-ray refractive index. The SDNR values of polyoxymethylene in water and polystyrene in oil are 1.5 and 1.0, respectively, in AC-tomo, and the values were improved to 3.0 and 2.0, respectively, in PC-tomo. PC-tomo and AC-tomo demonstrate equivalent ASF, but their noise characteristics quantified by the 3D NPS were found to be different due to the difference in the tomosynthesis image reconstruction algorithms. Conclusions: It is feasible to simultaneously generate x-ray differential phase contrast, phase contrast, and absorption contrast tomosynthesis images using a grating-based data acquisition setup. The method shows promise in improving the visibility of several low-density materials and therefore merits further investigation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this work is to (1) demonstrate laboratory measurements of phase shift images derived from in-line phase-contrast radiographs using the attenuation-partition based algorithm (APBA) of Yan et al. [Opt. Express 18(15), 16074-16089 (2010)], (2) verify that the APBA reconstructed images obey the linearity principle, and (3) reconstruct tomosynthesis phase shift images from a collection of angularly sampled planar phase shift images. Methods: An unmodified, commercially available cabinet x-ray system (Faxitron LX-60) was used in this experiment. This system contains a tungsten anode x-ray tube with a nominal focal spot size of 10 μm. The digital detector uses CsI/CMOS with a pixel size of 50 × 50 μm. The phantoms used consisted of one acrylic plate, two polystyrene plates, and a habanero pepper. Tomosynthesis images were reconstructed from 51 images acquired over a ±25° arc. All phase shift images were reconstructed using the APBA. Results: Image contrast derived from the planar phase shift image of an acrylic plate of uniform thickness exceeded the contrast of the traditional attenuation image by an approximate factor of two. Comparison of the planar phase shift images from a single, uniform thickness polystyrene plate with two polystyrene plates demonstrated an approximate linearity of the estimated phase shift with plate thickness (-1600 rad vs -2970 rad). Tomographic phase shift images of the habanero pepper exhibited acceptable spatial resolution and contrast comparable to the corresponding attenuation image. Conclusions: This work demonstrated the feasibility of laboratory-based phase shift tomosynthesis and suggests that phase shift imaging could potentially provide a new imaging biomarker. Further investigation will be needed to determine if phase shift contrast will be able to provide new tissue contrast information or improved clinical performance. [ABSTRACT FROM AUTHOR]

Purpose: Four-dimensional cone-beam computed tomography (4D CBCT) has been investigated for motion imaging in the radiotherapy treatment room. The drawbacks of 4D CBCT are long scan times and high imaging doses. The aims of this study were to develop and investigate a slow gantry rotation acquisition protocol for four-dimensional digital tomosynthesis (4D DTS) as a faster, lower dose alternative to 4D CBCT. Methods: This technique was implemented using an On-Board Imager® kV imaging system (Varian Medical Systems, Palo Alto, CA) mounted on the gantry of a linear accelerator. The general procedure for 4D DTS imaging using slow gantry rotation acquisition consists of the following steps: (1) acquire projections over a limited gantry rotation angle in a single motion with constant frame rate and gantry rotation speed; (2) generate a respiratory signal and temporally match projection images with appropriate points from the respiratory signal; (3) use the respiratory signal to assign phases to each of the projection images; (4) sort projection images into phase bins; and (5) reconstruct phase images. Phantom studies were conducted to validate theoretically derived relationships between acquisition and respiratory parameters. Optimization of acquisition parameters was then conducted by simulating lung scans using patient data. Lung tumors with approximate volumes ranging from 0.12 to 1.53 cm3 were studied. Results: A protocol for slow gantry rotation 4D DTS was presented. Equations were derived to express relationships between acquisition parameters (frame rate, phase window, and angular intervals between projections), respiratory cycle durations, and resulting acquisition times and numbers of projections. The phantom studies validated the relationships, and the patient studies resulted in determinations of appropriate acquisition parameters. The phase window must be set according to clinical goals. For 10% phase windows, we found that appropriate frame rates ranging from 2 to 5 frames/s, gantry rotation speeds ranging from 0.44 to 1.03°/s, and aiming for an approximate maximum angular interval of 3.4° between projections in phase bins were appropriate for dose, scan time, and tumor visibility optimization. Adequate tumor visibility was achieved for coronal 4D DTS images of all three lung tumors with acquisition times ranging from 0.45 to 2.12 min. vs 1.84 to 4.24 min for 4D CBCT. 4D DTS imaging doses ranged from 0.12 to 0.72 times the dose of a standard CBCT scan vs 0.48 to 1.44 times the dose of a standard CBCT scan for 4D CBCT. Conclusions: A slow gantry rotation acquisition technique for 4D DTS was developed and investigated. Study results indicated that 4D DTS is a feasible technique for imaging lung tumor motion in the treatment room and requires shorter acquisition times and less imaging dose than 4D CBCT for larger tumors that do not require large scan angles for sagittal views and for situations where only coronal views are needed to meet clinical needs. [ABSTRACT FROM AUTHOR]

Purpose: The low dose rate brachytherapy procedure would benefit from an intraoperative postimplant dosimetry verification technique to identify possible suboptimal dose coverage and suggest a potential reimplantation. The main objective of this project is to develop an efficient, operator-free, intraoperative seed detection technique using the imaging modalities available in a low dose rate brachytherapy treatment room. Methods: This intraoperative detection allows a complete dosimetry calculation that can be performed right after an I-125 prostate seed implantation, while the patient is still under anesthesia. To accomplish this, a digital tomosynthesis-based algorithm was developed. This automatic filtered reconstruction of the 3D volume requires seven projections acquired over a total angle of 60° with an isocentric imaging system. Results: A phantom study was performed to validate the technique that was used in a retrospective clinical study involving 23 patients. In the patient study, the automatic tomosynthesis-based reconstruction yielded seed detection rates of 96.7% and 2.6% false positives. The seed localization error obtained with a phantom study is 0.4±0.4 mm. The average time needed for reconstruction is below 1 min. The reconstruction algorithm also provides the seed orientation with an uncertainty of 10°±8°. The seed detection algorithm presented here is reliable and was efficiently used in the clinic. Conclusions: When combined with an appropriate coregistration technique to identify the organs in the seed coordinate system, this algorithm will offer new possibilities for a next generation of clinical brachytherapy systems. [ABSTRACT FROM AUTHOR]

The purpose of this study is to propose four-dimensional digital tomosynthesis (4D-DTS) for on-board analysis of motion information in three dimensions. Images of a dynamic motion phantom were reconstructed using acquisition scan angles ranging from 20° (DTS) to full 360° cone-beam computed tomography (CBCT). Projection images were acquired using an on-board imager mounted on a clinical linear accelerator. Three-dimensional (3D) images of the moving target were reconstructed for various scan angles. 3D respiratory correlated phase images were also reconstructed. For phase-based image reconstructions, the trajectory of a radiopaque marker was tracked in projection space and used to retrospectively assign respiratory phases to projections. The projections were then sorted according phase and used to reconstruct motion correlated images. By using two sets of projections centered about anterior-posterior and lateral axes, this study demonstrates how phase resolved coronal and sagittal DTS images can be used to obtain 3D motion information. Motion artifacts in 4D-DTS phase images are compared with those present in four-dimensional CT (4DCT) images. Due to the nature of data acquisition for the two modalities, superior-inferior motion artifacts are suppressed to a greater extent in 4D-DTS images compared with 4DCT. Theoretical derivations and experimental results are presented to demonstrate how optimal selection of image acquisition parameters including the frequency of projection acquisition and the phase window depend on the respiratory period. Two methods for acquiring projections are discussed. Preliminary results indicate that 4D-DTS can be used to acquire valuable kinetic information of internal anatomy just prior to radiation treatment. [ABSTRACT FROM AUTHOR]

We developed a novel digital tomosynthesis (DTS) reconstruction method using a deformation field map to optimally estimate volumetric information in DTS images. The deformation field map is solved by using prior information, a deformation model, and new projection data. Patients’ previous cone-beam CT (CBCT) or planning CT data are used as the prior information, and the new patient volume to be reconstructed is considered as a deformation of the prior patient volume. The deformation field is solved by minimizing bending energy and maintaining new projection data fidelity using a nonlinear conjugate gradient method. The new patient DTS volume is then obtained by deforming the prior patient CBCT or CT volume according to the solution to the deformation field. This method is novel because it is the first method to combine deformable registration with limited angle image reconstruction. The method was tested in 2D cases using simulated projections of a Shepp–Logan phantom, liver, and head-and-neck patient data. The accuracy of the reconstruction was evaluated by comparing both organ volume and pixel value differences between DTS and CBCT images. In the Shepp–Logan phantom study, the reconstructed pixel signal-to-noise ratio (PSNR) for the 60° DTS image reached 34.3 dB. In the liver patient study, the relative error of the liver volume reconstructed using 60° projections was 3.4%. The reconstructed PSNR for the 60° DTS image reached 23.5 dB. In the head-and-neck patient study, the new method using 60° projections was able to reconstruct the 8.1° rotation of the bony structure with 0.0° error. The reconstructed PSNR for the 60° DTS image reached 24.2 dB. In summary, the new reconstruction method can optimally estimate the volumetric information in DTS images using 60° projections. Preliminary validation of the algorithm showed that it is both technically and clinically feasible for image guidance in radiation therapy. [ABSTRACT FROM AUTHOR]

The authors developed a hybrid multiresolution rigid-body registration technique to automatically register reference digital tomosynthesis (DTS) images with on-board DTS images to guide patient positioning in radiation therapy. This hybrid registration technique uses a faster but less accurate static method to achieve an initial registration, followed by a slower but more accurate adaptive method to fine tune the registration. A multiresolution scheme is employed in the registration to further improve the registration accuracy, robustness, and efficiency. Normalized mutual information is selected as the criterion for the similarity measure and the downhill simplex method is used as the search engine. This technique was tested using image data both from an anthropomorphic chest phantom and from eight head-and-neck cancer patients. The effects of the scan angle and the region-of-interest (ROI) size on the registration accuracy and robustness were investigated. The necessity of using the adaptive registration method in the hybrid technique was validated by comparing the results of the static method and the hybrid method. With a 44° scan angle and a large ROI covering the entire DTS volume, the average of the registration capture ranges in single-axis simulations was between -31 and +34 deg for rotations and between -89 and +78 mm for translations in the phantom study, and between -38 and +38 deg for rotations and between -58 and +65 mm for translations in the patient study. Decreasing the DTS scan angle from 44° to 22° mainly degraded the registration accuracy and robustness for the out-of-plane rotations. Decreasing the ROI size from the entire DTS volume to the volume surrounding the spinal cord reduced the capture ranges to between -23 and +18 deg for rotations and between -33 and +43 mm for translations in the phantom study, and between -18 and +25 deg for rotations and between -35 and +39 mm for translations in the patient study. Results also showed that the hybrid registration technique had much larger capture ranges than the static method alone in registering the out-of-plane rotations. [ABSTRACT FROM AUTHOR]

The successful implementation of digital tomosynthesis (DTS) for on-board image guided radiation therapy (IGRT) requires fast DTS image reconstruction. Both target and reference DTS image sets are required to support an image registration application for IGRT. Target images are usually DTS image sets reconstructed from on-board projections, which can be accomplished quickly using the conventional filtered backprojection algorithm. Reference images are DTS image sets reconstructed from digitally reconstructed radiographs (DRRs) previously generated from conventional planning CT data. Generating a set of DRRs from planning CT is relatively slow using the conventional ray-casting algorithm. In order to facilitate DTS reconstruction within a clinically acceptable period of time, we implemented a high performance DRR reconstruction algorithm on a graphics processing unit of commercial PC graphics hardware. The performance of this new algorithm was evaluated and compared with that which is achieved using the conventional software-based ray-casting algorithm. DTS images were reconstructed from DRRs previously generated by both hardware and software algorithms. On average, the DRR reconstruction efficiency using the hardware method is improved by a factor of 67 over the software method. The image quality of the DRRs was comparable to those generated using the software-based ray-casting algorithm. Accelerated DRR reconstruction significantly reduces the overall time required to produce a set of reference DTS images from planning CT and makes this technique clinically practical for target localization for radiation therapy. [ABSTRACT FROM AUTHOR]